藏医安尔建:生命本无价,医者存仁爱

作为世界四大传统医学之一、中国国家级非物质文化遗产，藏医药以其独特的文化魅力和神奇的治疗效果屹立于世界民族医药之林。

医疗纠纷“外包”:上海力推“医安保”探索多方共赢

近日上海市中山医院等七家医院加入“上海地区综合医疗风险安心保障计划”的消息引发热议。较于传统的”医责险”，这种“调赔结合”的创新模式能否真正将医疗纠纷引出医院？近日，上海市七家医疗机构加入上海地区综合医疗风险安心保障计划（以下简称“医安保”）这一新型“医责险”的新闻引发热议。较之传统的“医责险”，这种“调赔结合”的创新模式能否更有效打通医、患、医调委和保险公司链条，探索出医疗纠纷第三方调处机制的新路？

杨百茀论治肺胀撷要

杨百茀教授从医从教五十余年,对肺胀病辨证论治有丰富的经验,既深得家传,又擅用经方,并在临床实践中不断总结提高,形成相对固定的经验方。用于临床,疗效较佳。 杨老认为肺胀病是因内伏痰饮,感寒而发,以咳嗽、喘息、咳痰为主症,或见发热恶寒,甚则身肿、心悸、周身动瞤振颤,不能自主,面色黧黑。此痰邪内闭、肺气胀满之症。

Acupuncture treatment in gastrointestinal diseases: A systematic review

The purpose of this work was to assess the evidence for effectiveness of acupuncture （AC） treatment in gastrointestinal diseases. A systematic review of the Medline-cited literature for clinical trials was performed up to May 2006. Controlled trials assessing acupuncture point stimulation for patients with gastrointestinal diseases were considered for inclusion. The search identified 18 relevant trials meeting the inclusion criteria. Two irritable bowel syndrome （IBS） trials, 1 Crohn＇s disease and 1 colitis ulcerosa trial had a robust random controlled trial （RCT） design. In regard to other gastrointestinal disorders, study quality was poor. In all trials, quality of life （QoL） improved significantly independently from the kind of acupuncture, real or sham. Real AC was significantly superior to sham acupuncture with regard to disease activity scores in the Crohn and Colitis trials. Efficacy of acupuncture related to QoL in IBS may be explained by unspecific effects. This is the same for QoL in inflammatory bowel diseases （IBD）, whereas specific acupuncture effects may be found in clinical scores. Further trials for IBDs and in particular for all other gastrointestinal disorders would be necessary to evaluate the efficacy of acupuncture treatment. However, it must be discussed on what terms patients benefit when this harmless and obviously powerful therapy with regard to QoL is demystified by further placebo controlled trials.

Patient safety culture and handoff evaluation of nurses in small and medium-sized hospitals

Objectives:This study was conducted to investigate the current status of handoffs,perception of patient safety culture,and degrees of handoff evaluation in small and medium-sized hospitals and identified factors that make a difference in handoff evaluation.Methods:This is a descriptive study.425 nurses who work at small and medium-sized hospitals in South Korea were included in our study.They completed a set of self-reporting questionnaires that evaluated demographic data,handoff-related characteristics,perception of patient safety culture,and handoff evaluation.Results:Results showed that the overall score of awareness of a patient safety culture was 3.65±0.45,the level was moderate.The score of handoff evaluation was 5.24±0.85.Most nurses experienced errors in handoff and most nurses had no guidelines and checklist in the ward.Handoff evaluation differed significantly according to the level of education,work patterns,duration of hospital employment,handoff method,degree of satisfaction with the current handoff method,errors occurring at the time of handoff,handoff guidelines,and appropriateness of handoff education time(P<0.05).Conclusion:For handoff improvement,guidelines and standards should be established.It is necessary to develop a structured handoff education system.And formal handoff education should be implemented to spread knowledge uniformly.

Healthcare Risk Management and Patient Safety in Turkish Hospital

Patient safety is an important component of risk management in hospitals. The aim of the study is to measure physician and nurse awareness about four selected patient safety indicators by authors and events reported about these relevant indicators in the hospital. The study uses standardized four patientsafety indicators like ＂needle sticks, cut wounds, dressing allergy, infections indicators＂. Cross section study was conducted through three month period in 2011-2012 based on voluntary response to the questionnaire that intend to measure knowledge about four health indicators. Studypopulations consisted of accessible sample of 146 different specialty physicians and 108 nurses present on duty during survey period. The association between the patient safety indicators and events reported about indicators in questionswere analyzed. Meanpatient safety knowledge questionnaire scores of health staff （nurse and physician） for needle sticks, cut wounds, dressing allergy, infections indicators were 47.13（11.8）, 39.04（14.5）, 38.02（10.5）, 39.72（9.7）, respectively. Significant statistical differences were also found between the frequency of events reported according to department and patient safety indicators （F = 8.34; p 〈 0.05） Measuring patient safety culture via safety indicators is essential in improving patient safety. This matter is perfectly influence the financial management of the hospital.

Clinical Efficacy and Therapeutic Mechanisms of Traditional Chinese Medicine for Neuroprotection and Neurogenesis in Stroke Treatment

Stroke is the leading cause of human disability with limited effective drugs availability. The disruption of multiple signaling pathways in stroke makes developing new drugs be difficult. Traditional Chinese medicine(TCM) has its unique advantage in targeting multiple signaling pathways with multiple components. Many TCM formulas have the potential for neuroprotection and neurogenesis, but well-designed clinical trials are insufficient and underlying mechanisms unclear. Herein, we introduce the commonly used TCM formulas for stroke treatment and selectively introduce two classic formulas, An Gong Niu Huang(AGNH) pill and Bu Yang Huan Wu Decoction(BYHWD) for neuroprotection and neurogenesis, respectively. Current scientific evidence and clinical trials indicate AGNH pill could be an effective neuroprotective formula as adjunct therapy with relative safety. On the other hand, as a representative TCM formula for post stroke disability, BYHWD could improve the neurological outcome with its neuroprotective and neurogenic effects. The underlying mechanisms could be attributed to the modulation of multiple molecular targets with its multiple components. In conclusion, TCM formulas could be potential adjunct therapies for stroke treatment. The clinical efficacies and molecular mechanisms of promoting neuroprotection and neurogenesis remain to be further studies.

AUTHENTICATED SYMMETRIC-KEY ESTABLISHMENT FOR MEDICAL BODY SENSOR NETWORKS

This study concerns security issues of the emerging Wireless Body Sensor Network (WBSN) formed by biomedical sensors worn on or implanted in the human body for mobile healthcare appli-cations. A novel authenticated symmetric-key establishment scheme is proposed for WBSN,which fully exploits the physiological features obtained by network entities via the body channel available in WBSN but not other wireless networks. The self-defined Intrinsic Shared Secret (ISS) is used to replace the pre-deployment of secrets among network entities,which thus eliminates centralized services or au-thorities essential in existing protocols,and resolves the key transport problem in the pure symmet-ric-key cryptosystem for WBSN as well. The security properties of the proposed scheme are demon-strated in terms of its attack complexity and the types of attacks it can resist. Besides,the scheme can be implemented under a light-weight way in WBSN systems. Due to the importance of the ISS concept,the analysis on using false acceptance/false rejection method to evaluate the performance of ISS for its usage in the scheme is also demonstrated.

＂Don＇t Break Your Caregiver＂ Campaign 2011 by Tehy--The Union of Health and Social Care Professionals

According to several researches and survey findings, violence and the threat of violence are increasingly present at workplaces in the field of healthcare. In 2011, the Finnish Union of Health and Social Care Professionals--Tehy implemented a poster campaign targeted at the users of healthcare services, as well as healthcare staff. Representatives of local trade unions, as well as safety representatives, reported that the campaign was relevant. Most employers had a favorable attitude toward distributing campaign posters at the workplace. Raising this issue, which increases the mental burden of work and risks occupational safety at the workplace, helps to achieve improvements. Following the poster campaign, Tehy conducted an electronic survey in early 2012 about the impacts of the campaign among representatives of local trade unions （N= 279） and safety representatives （N = 278）. The campaign resulted in some working environment improvements, as well as an increase in reporting situations involving violence. On a more worrying note, the provision of workplace-level training on managing violent situations did not increase.

Accuracy and Electromagnetic Safety Evaluation of a Portable Electromagnetic Localization System for Micro Invasive Medical Devices in Vivo

Aiming at localizing the telemetric capsule for detecting gastrointestinal physiological parameters in vivo accurately,a portable alternating current(AC)electromagnetic localization system is designed.To verify the feasibility of the method,the model and construction of the localization system are detailed.And static and dynamic accuracy of the localization system are tested by experiments.Next,we compare the simulating results of the electromagnetic radiation aroused by the localization system with the electromagnetic safety standards of human(ICNIRP guidelines and IEEE standard C95.1-1991).Finally,in terms of the results of the static and dynamic experiments,conclusions are drawn that the accuracy of portable positioning system is high(less than 10 mm)enough to satisfy the localization need of the micro invasive medical devices in vivo,and there is no harm of electromagnetic radiation to human.

16 CASES OF SCALENUS SYNDROME TREATED BY MASSAGE AND ACUPOINT-INJECTION

Scalenus syndrome is a kind of thoracicoutlet syndrome. I treated 16 such cases withmassage in combination with acupointinjection from 1989-1996. The results weresatisfactory and introduced as follows.

Second-order problem solving:Nurses'perspectives on learning from.near misses

Objectives:Near misses happen more frequently than actual errors,and highlight system vulnerabilities without causing any harm,thus provide a safe space for organizational learning.Second-order problem solving behavior offers a new perspective to better understand how nurses promote learning from near misses to improve organizational outcomes.This study aimed to explore frontline nurses’perspectives on using second-order problem solving behavior in learning from near misses to improve patient safety.Methods:A qualitative exploratory study design was employed.This study was conducted in three tertiary hospitals in east China from June to November 2015.Purposive sampling was used to recruit 19 frontline nurses.Semi-structured interviews and a qualitative directed content analysis was undertaken using Crossan’s 4I Framework of Organizational Learning as a coding framework.Results:Second-order problem solving behavior,based on the 4I Framework of Organizational Learning,was referred to as being a leader in exposing near misses,pushing forward the cause analysis within limited capacity,balancing the active and passive role during improvement project,and promoting the continuous improvement with passion while feeling low-powered.Conclusions:4I Framework of Organizational Learning can be an underlying guide to enrich frontline nurses’role in promoting organizations to learn from near misses.In this study,nurses displayed their pivotal role in organizational learning from near misses by using second-order problem solving.However,additional knowledge,skills,and support are needed to maximize the application of second-order problem solving behavior when near misses are recognized.

THE CLINICAL ANALYSIS OF HYPNOTICS AND SEDATIVES USED IN OUTPATIENT CLINICS IN GENERAL HOSPITAL

Aim. To statistic the usage of hypnotics and sedatives in outpatient and emergency clinics prescriptions in one day. Method. Check all prescriptions on April 29, 1987 and November 13, 1995 in order to know the quantity, kind and distribution of hypnotics and sedatives in different outpatient departments. Result. There were 1 319 prescriptions on April 29, 1987. Among them, hypnotics and sedatives were 122(9. 24%); in comparing with 2 065 prescriptions on November 13, 1995, hypnotics and sedatives were 141 (6. 82%). Benzodiazepine used more than 80% in all prescriptions. Conclusion. The possibility of long-term low-dosage using benzodiazepine is present. It must strengthen the control and education to avoid the drug-abuse.

How PDCA cycle implementation improved surgical time-out compliance rate

Objective： To explore the effect of PDCA-cycle in improving time-out compliance rate and improvement in quality and safety management of surgery. Methods： We improved time-out compliance rate by using PDCA-cycle （a quality improvement tools）. Data were collected before and after the implementation of PDCA-cycle. The results were analyzed. Results： After implementation of PDCA-cycle, over all time-out compliance rate was increased from 80% to 99.8% （P=0.000）. The compliance rate of identifying patient, performing site marking before surgery, verification of correct-site and correct procedure were increased from 85.1%, 79.2%, 89.7% and 89.1% to 99.8%, 99.9%, 100% and 100% （P〈0.05） respectively. Conclusion： Our study validated the PDCA-cycle methodology improves time-out compliance rate, and it is one of the most effective quality improvement tools for hospital management.

Enhancing Hospital Management of High-risk Medications by Computer PDCA-Cycle

Objective： To imensify management on high-alert Medications, ensure clinical medication safety. Methods： Statistical analysis was applied between before and after the implementation of PDCA-cycle in the management of high-alert Medications. Results： After PDCA- cycle, the rate of management of high-alert Medications increased from 59.5% to 94.6% （P〈0.01）, Conclusion： Our study suggested that the PDCA-cycle play an important role in the management of high-alert Medications, and then can increase the level of safety on management and utilization of medicine.

Exploratory research on drug safety in China

The article defines the concept of drug safety,summarizes the problems and causes in the area of drug safety in China, and proposes relevant measures to solve the problems.

The Sendai Framework for Disaster Risk Reduction: Renewing the Global Commitment to People’s Resilience, Health,and Well-being

The Sendai Framework for Disaster Risk Reduction 2015–2030(SFDRR) is the first global policy framework of the United Nations’ post-2015 agenda. It represents a step in the direction of global policy coherence with explicit reference to health, development, and climate change. To develop SFDRR, the United Nations Office for Disaster Risk Reduction(UNISDR) organized and facilitated several global, regional, national, and intergovernmental negotiations and technical meetings in the period preceding the World Conference on Disaster Risk Reduction(WCDRR) 2015 where SFDRR was adopted. UNISDR also worked with representatives of governments, UN agencies, and scientists to develop targets and indicators for SFDRR and proposed them to member states for negotiation and adoption as measures of progress and achievement in protecting lives and livelihoods. The multiple efforts of the health community in the policy development process, including campaigning for safe schools and hospitals, helped to put people’s mental and physicalhealth, resilience, and well-being higher up the disaster risk reduction(DRR) agenda compared with the Hyogo Framework for Action 2005–2015. This article reviews the historical and contemporary policy development process that led to the SFDRR with particular reference to the development of the health theme.

Nanomedicine enables autophagy-enhanced cancer-cell ferroptosis

Ferroptosis and autophagy, playing significant roles in tumor treatment, are two typical forms of the programmed cell death. However, the rational combination of ferroptosis and autophagy for synergistic tumor therapy is still highly challenging. Herein, we report on an intriguing nanomedicine strategy for achieving autophagy-enhanced ferroptosis on efficiently combating cancer, which was based on the construction of trehalose-loaded mSiO_(2)@MnO_(x)-mPEG(Tre MMM) nanoparticles with satisfactory biocompatibility. The nanoparticles are endowed with high glutathione(GSH) consumption efficiency, thereby inducing cancer-cell ferroptosis via inactivating glutathione peroxidases 4(GPX4). Subsequently, the Tre MMM degradation due to the GSH depletion and p H sensitivity contributed to the trehalose release for inducing autophagy, promoting/enhancing ferroptosis by NCOA4-mediated degradation of ferritin.A substantial in vitro and in vivo antitumor effect was achieved by such an intriguing autophagyenhanced ferroptosis. Therefore, the rational combination of GSH-consumption-induced ferroptosis and trehalose-induced autophagy by nanomedicine design provides an alternative but effective strategy for tumor treatment.

Establishment of safety evidence for Xingxue~ Shuxuening injection

OBJECTIVE: To systematically investigate the safety of Xingxue~ Shuxuening injection(SXN) in preand post-marketing, and to ensure clinical drug safety.METHODS: Strict quality control in raw herb selection and production processes was adopted and pharmacology research on SXN was performed by the drug manufacturing company, Heilongjiang ZBD Pharmaceutical Co., Ltd. We systematically reviewed the safety literature of Xingxue~ SXN. Adverse drug reaction(ADR) data of the drug, extracted from Spontaneous Reporting System(SRS), and clinical characters based on 20 hospital information systems(HIS) in China, were analyzed. Large-scale prospective safety monitoring and Risk Minimization Action Plans(Risk MAPs) of Xingxue~SXN were carried out.RESULTS: The quality of SXN was stable and controllable when it was produced. Drug toxicology studies found no effect on rabbits with hemolytic or condensed, local stimulation and muscle stimulation, and no allergic reactions in guinea pigs. The ADRs of Xingxue~ SXN were dizziness, phlebitis,and vomiting based on SRS data. The injection did not conform to instructions in clinical practice when we analyzed HIS database, and patient’s abnormal blood urea nitrogen levels may be related to the drug, when analyzed using the propensity score method. A nested case-control study was designed and performed to analyze the influencing factors of suspected allergic reactions to SXN. The study showed that patients with an allergy history were more prone to allergic reactions(P<0.001),and some medicine combinations could cause allergic reactions.CONCLUSION: These studies have established a body of evidence on Xingxue~ SXN safety, and provide a good model for Chinese medicine injection for clinical safety. The Xingxue~ SXN production process and toxicology research indicate the safety of the injection. However, the use of the injection is not consistent with instructed clinical practice.Xingxue~ SXN causes ADRs perhaps from inappropriate usage or its pharmacological action. This injection needs better Risk MAPs to ensure its clinical safety.