限制性液体复苏治疗创伤性失血性休克的临床观察

目的:探讨限制性液体复苏治疗创伤性失血性休克的疗效及对炎症因子的影响。方法:选择2008年3月至2011年3月60例创伤性失血性休克患者,随机分为对照组和观察组,每组30例。对照组采用充分液体复苏治疗,观察组应用限制性液体复苏治疗,观察两组患者的术前输液量、红细胞压积、凝血酶原时间、死亡率以及C-反应蛋白、IL-6浓度变化。结果:观察组术前输液量、凝血酶原时间、死亡率、C-反应蛋白、IL-6浓度分别是(1768.79±236.54)ml、(12.14±4.13)s、6.67%、(102.43±33.57)ng/L、(213.49±64.82)ng/L,明显低于对照组的(2876.59±287.34)ml、(17.13±3.94)s、16.67%、(124.67±37.84)ng/L、(275.61±72.35)ng/L,P<0.05。观察组术前红细胞压积是(31.45±3.25)%,显著高于对照组的(24.37±3.69)%,P<0.05。结论:限制性液体复苏治疗创伤性失血性休克临床疗效较好,减轻机体炎症反应,有利于患者康复。     

纸塑包装延长高压灭菌包的临床应用

目的:纸塑包装延长高压灭菌包的临床应用。方法:双层棉包布常规包装高压灭菌按要求存放7d,霉季5d,而纸塑包装可保存6个月。结果:纸塑包装大大延长无菌包的无菌时间。包装安全经济,可靠,并可预防院内感染。     

Merit and Evaluation Models for Managers in the National Health System： An Empirical Study

The national health system （NHS） complexity increase requires a review of the managerial human resources evaluation and recruiting methods, considering that nowadays doctors need to improve not just their clinical capabilities, but also managerial competences. At this end it is important to develop performances control models and to identify appropriate results indicators, with the aim of introducing an effective doctors selection system for managerial roles. The paper considers the Italian situation and tests the current evaluation and selection methods, by analysing the literature and the existing legislation and by interviewing experts. Moreover, in order to reach an innovative model, complex organizations have been taken into account as benchmarks. Three different categories of experts have been interviewed and texted： national health care organizations managers, companies managers, and business consultants. The 137 interviewed experts have been asked about four main questions concerning the evaluation for hiring managers as chief medical director, department director, and head of complex units. The conducted research suggests four different options in order to evaluate and to select heads of complex unit for the most strategic roles. By consequence, the analysis shows that required characteristics must be managerial attitudes as well as clinical capabilities.     

Converging scientific fields and new technological paradigms as main drivers of the division of scientific labour in drug discovery process: the effects on strategic management of the R&D corporate change

The thesis of this study is that the convergence of genetics, genomics and proteomics spurs new technological paradigms in medicine, which are generating a R&D corporate change: division of scientific labour of the drug discovery process by strategic alliances among firms in order to reinforce the integrative capabilities in different biomedical research fields and collective and cumulative learning between in-house R&D and external sources of innovation. This study shows, by key a case study of pharmaceutical companies, as scientific and technological paradigms in medicine are main drivers of industrial and R&D corporate change to enhance and accelerate the discovery process of ground-breaking drugs for more and more personalised healthcare.     

Understanding Responsible Leadership: Role Identity and Motivational Drivers

This article contributes to the emerging discussion on responsible leadership by providing an analysis of the inner theatre of a responsible leader. I use a narrative approach for analyzing the biography of Anita Roddick as a widely acknowledged prototype of a responsible leader. With clinical and normative lenses I explore the relationship between responsible leadership behavior and the underlying motivational systems. I begin the article with an introduction outlining the current state of responsible leadership research and explaining the kind of magnifying glasses used to examine the case. I continue with a brief summary of Anita Roddick’s development from childhood to adulthood, which provides the biographical background for exploring her motivational systems as a leader. Against this backdrop, I analyze the relationship between motivational drivers and a responsible leadership identity as revealed by Roddick in different behavioral leadership roles. I conclude the article by providing a number of lessons learned for responsible leadership and the development of future global leaders. Dr. Nicola M. Pless is a former Vice President of leadership development at a large financial services institution. Currently she is Reader in Responsible Leadership at the University of St. Gallen and Research Director of the HSG-INSEAD Initiative on Responsible Leadership. She holds a Ph.D. in organizational theory and social issues from the University of St. Gallen and a diploma in clinical organizational psychology from INSEAD where she is a Visiting Senior Research Fellow. She is editor of “Responsible Leadership”, published by Routledge in 2006.     

民办医学高校教学基地建设的影响因素浅析

民办医学高校教学基地建设是制约学校发展过程中存在的诸多难题之一,而这一难题在很大程度上关系到教育功能的实现。探析其影响因素,对民办医学院校破解发展难题具有现实意义。     

定额结算下保险医疗费用支付制度安排

医疗保险机构与医院实行定额结算后,医院可通过分科定额结算办法将价格风险下移给科室,促使科室主动控费。而这种制度下,科室将通过牺牲患者利益实现自身效用;若医院按按实结算办法与科室结算医疗费用,则可在一定程度上解决上述问题。本文将针对按实结算办法建立数学模型,确定科室进行合理医疗的费用区间,并通过此模型说明按实结算下,科室通过均衡医患博弈,可在同时保证医院与患者双方利益的基础上有效地控制医疗费用。     

PBL教学法在内科护理学实习课中的应用

为探索临床护理带教方法,提高护理专业学生自我学习和解决问题的能力,依据以问题为基础的学习(Problem-Based Learning,PBL)教学理论,对在我科实习的16名护理本科实习生进行PBL临床带教,另16名学生进行传统带教,发现进行PBL教学后学生的综合素质-获取新知识的主动性,分析问题、解决问题的能力得到明显提高。     

Evaluating drug cost per responder and number needed to treat associated with lixisenatide on top of glargine when compared to rapid-acting insulin intensification regimens on top of glargine,in patients with type 2 diabetes in the UK,Italy, and Spain

Objectives: This study investigated the cost per responder and number needed to treat (NNT) in type 2 diabetes mellitus (T2DM) patients for lixisenatide compared to insulin intensification regimens using composite endpoints in the UK, Italy, and Spain.

Methods: Efficacy and safety outcomes were obtained from GetGoal Duo-2, a 26-week phase 3 trial comparing lixisenatide vs insulin glulisine (IG) once daily (QD) and three times daily (TID). Response at week 26 was extrapolated to 52 weeks, assuming a maintained treatment effect, based on long-term evidence in other T2DM populations. Responders were defined using composite end-points, based on an HbA1c threshold and/or no weight gain and/or no hypoglycemia. The HbA1c threshold was varied in sensitivity analyses. Annual treatment costs were estimated in euros (1 GBP?=?1.26 EUR), including drug acquisition and resource use costs. Cost per responder was computed by dividing annual treatment costs per patient by the proportion of responders.

Results: Lixisenatide was associated with the lowest cost per responder for all composite end-points that included a weight-related component. For the main composite end-point of HbA1c ≤7.5% AND no weight gain AND no symptomatic hypoglycemia, cost per responder results were: UK: 6,867€, 8,746€, and 12,410€; Italy: 7,057€, 9,160€, and 12,844€; Spain: 8,370€, 11,365€, and 17,038€, for lixisenatide, IG QD, and TID, respectively. The NNT analysis showed that, for every 6.85 and 5.86 patients treated with lixisenatide, there was approximately one additional responder compared to IG QD and TID, respectively.

Limitations: A limitation of the clinical inputs is the lack of 52-week trial data from GetGoal Duo-2, which led to the assumption of a maintained treatment effect from week 26 to 52.

Conclusions: This analysis suggests lixisenatide is an efficient economic resource allocation in the UK, Italy, and Spain.     

The 21st Century Cures Act: pharmacoeconomic boon or bane?

Barriers to entry in healthcare markets constitute one of the overriding concerns of health economists. The recent enactment of the 21st Century Cures Act in the United States reduces statutory entry barriers to the discovery, development, testing, and licensing of drugs and medical devices. Drug and device makers also see the burdensome and time-consuming requirements of the Food and Drug Administration?s approval process as key barriers to lowering the costs of their products, considering it takes a decade of research amounting to $1 billion just to bring a single drug to the market. Along with novel opportunities for medical product innovation and faster treatment of diseases, the expedited approval process carries with it contentious challenges involving the safety, efficacy and value of drugs and devices. The ensuing trade-offs and unintended consequences of such a regulatory game-changer bring to the fore one of the most enduring debates between medicine and economics: Whether – or to what extent – cost and efficiency factors affect clinical inquiry into possible solutions to human illnesses. The practical and theoretical contributions of pharmacoeconomics should enlighten contemporary and future issues and discussions surrounding the implementation of this landmark legislation. After all, despite its undeniably good intent and far-reaching significance, no law can ever be perfect.