RESUMO
【Objective】 To study the distribution and haplotype polymorphism of HLA-A, -B, -C, -DRB1, -DQB1 alleles in Anhui Han population. 【Methods】 The HLA-A, -B, -C, -DRB1 and -DQB1 genotyping of 3 169 random unrelated stem cell donors was performed by PCR-SBT. The allele frequency, haplotype frequency and linkage imbalance parameters were calculated by counting method, maximum expectation algorithm and PyPop software. 【Results】 A total of 411 HLA alleles were detected in the population, of which 67, 143, 65, 75 and 64 alleles were detected for HLA-A, -B, -C, -DRB1 and -DQB1, respectively. The alleles with frequency >0.1 were HLA-A*11∶01, A*11∶01, A*24∶02, A*02∶01, C*01∶02, C*07∶02, C*06∶02, DRB1*09∶01, DRB1*15∶01, DRB1*07∶01, DQB1* 03∶01, DQB1* 03∶03, and DQB1*02∶01. 1426 HLA-A~HLA-B, 1 772 HLA-B~HLA-DRB1, 798 HLA-B~HLA-C, and 446 HLA-DRB1~HLA-DQB1 haplotypes were detected. The haplotypes showed linkage imbalance, and 19 of them showed strong linkage imbalance (RLD>0.80). 【Conclusion】 The frequency and haplotype distribution of HLA-A, -B, -C, -DRB1 and -DQB1 alleles in Anhui Han population were obtained. The distribution of those alleles and haplotypes have their own characteristics.
RESUMO
OBJECTIVE：To explore the key factors affecting the sustainable development of pharmacy intravenous admixture service（PIVAS），and to provide theoretical basis for the healthy development of PIVAS. METHODS ：Retrieved from PubMed ， CNKI，Wanfang database and VIP ，literatures related to the development of PIVAS. Combining with the actual operation and development of PIVAS in China in recent 20 years，based on actual experience of PIVAS in our hospital in recent 10 years，the key factors affecting the sustainable development of PIVAS were analyzed by retrospective method from five aspects ，i.e. drug management，quality control ，pharmacists’professional quality improvement ，pharmaceutical care extension ，cost and benefit. RESULTS & CONCLUSIONS ：The key elements of PIVAS drug management included drug inventory ，expiration date ，daily inventory，high-warning drug ，drug damage ，slack demand of drug and drug shortage. The key elements of PIVAS quality control included personnel quality control ，environment quality control and quality control of finished infusion. Improving the professional ability and communication service ability of pharmacists were the key factors to improve the professional quality of pharmacists. The establishment and application of medication order review and accurate flushing database based on PIVAS prescription audit system，professional drug consultation and clinical education ，whole pharmaceutical care of cytotoxic drugs and PIVAS adverse drug reaction monitoring were the key elements of pharmaceutical service extension. It can promote the sustainable and healthy development of PIVAS to improve pharmacists ’professional ability and communication ability ，strictly drug management and quality control ，continously extend pharmaceutical care ，improve professional influence and expand social influence and formulate reasonable charging mechanism.
RESUMO
Objective To investigate the fine management in the role of infection control management and the effect evaluation in pharmacy intravenous admixture services. Methods From July 2013 to June 2016, infection control management were reviewed retrospectively in pharmacy intravenous admixture services:routine management (from July 2013 to December 2014) and fine management (from January 2015 to June 2016). The settlement of air bacteria formation rate, hand hygiene compliance and accuracy of drug-care workers, and worker′s hand colonization monitoring data before and after the fine management were compared. Results After the implementation of fine management, the settlement of air bacteria formation rate was reduced from 10.42%(120.0/1152) to 4.45%(51.3/1152); there was significant differences (t=3.417, P<0.01).The hand hygiene compliance of drug-care workers increased from 81.50%(1172/1438) to 95.56%(1314/1375), the difference was statistically significant (χ2=1.353, P<0.01);the accuracy rate increased from 86.09%(1109/1172) to 95.13%(1250/1314), the difference was statistically significant (χ2=60.975, P<0.01); workers′ hands colonies number after fine management decreased than before, and there was significant differences (χ2=41.163, P<0.01). Conclusions The fine management has a higher application value in the infection control management of pharmacy intravenous admixture services, which can reduce the settlement of air bacteria formation rate, workers′ hands colonies number, improve hand hygiene compliance and accuracy of drug-care workers, further standardize the worker′s behavior, provide a more secure configuration environment, and guarantee the quality of drug configuration.
RESUMO
Objective To investigate the fine management in the role of infection control management and the effect evaluation in pharmacy intravenous admixture services. Methods From July 2013 to June 2016, infection control management were reviewed retrospectively in pharmacy intravenous admixture services:routine management (from July 2013 to December 2014) and fine management (from January 2015 to June 2016). The settlement of air bacteria formation rate, hand hygiene compliance and accuracy of drug-care workers, and worker′s hand colonization monitoring data before and after the fine management were compared. Results After the implementation of fine management, the settlement of air bacteria formation rate was reduced from 10.42%(120.0/1152) to 4.45%(51.3/1152); there was significant differences (t=3.417, P<0.01).The hand hygiene compliance of drug-care workers increased from 81.50%(1172/1438) to 95.56%(1314/1375), the difference was statistically significant (χ2=1.353, P<0.01);the accuracy rate increased from 86.09%(1109/1172) to 95.13%(1250/1314), the difference was statistically significant (χ2=60.975, P<0.01); workers′ hands colonies number after fine management decreased than before, and there was significant differences (χ2=41.163, P<0.01). Conclusions The fine management has a higher application value in the infection control management of pharmacy intravenous admixture services, which can reduce the settlement of air bacteria formation rate, workers′ hands colonies number, improve hand hygiene compliance and accuracy of drug-care workers, further standardize the worker′s behavior, provide a more secure configuration environment, and guarantee the quality of drug configuration.
RESUMO
Objective To determine the optimum dose of dexmedetomidine administered locally through evaluating the effects of different doses of dexmedetomidine on the median effective concentration (EC50) of ropivacaine for brachial plexus block.Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 19-50 yr, weighing 50-80 kg, scheduled for elective ulna and radius fracture open reduction and internal fixation, requiring ultrasound-guided axillary brachial plexus block, were randomly assigned into 4 groups using a random number table: control group (group C) and dexmedetomidine 0.4, 0.6 and 0.8 μg/kg groups (D1 , D2 and D3 groups).Axillary brachial plexus block was performed only with ropivacaine in group C.In D1-3 groups, axillary brachial plexus block was performed with the mixture of ropivacaine and dexmedetomidine 0.4, 0.6 and 0.8 μg/kg, respectively.The effective block was defined as complete loss of pain sensation in the areas innervated by the brachial plexus.The volume of local anesthetics was 40 ml.The concentration of ropivacaine was determined by up-and-down technique.The initial concentration was 0.4％ and the ratio between the two successive concentrations was 1.0.If the block was effective, the next patient received a lower dose of ropivacaine;or conversely if ineffective, a higher dose was given in the next patient.At least 7 independent crossover pairs were observed in each group.The EC50 of ropivacaine was the mean of the concentration of ropivacaine of each crossover pair.The occurrence of brachial plexus block-related adverse events, adverse cardiovascular events and over-sedation was recorded.Results In C, D1, D2 and D3 groups, 20, 22, 24 and 19 patientswere enrolled, respectively.Compared with group C, the EC50 of ropivacaine was significantly decreased in D2 and D3 groups, and no significant change in the EC50 of ropivacaine was found in group D1.No patients developed adverse events in group D1.The incidence of bradycardia was 17％, but it was transient in group D2.In group D3, the incidence of bradycardia and hypotension was 58％ and 32％, respectively, and they required special treatment, and the incidence of over-sedation was 10％.Conclusion The optimum dose of dexmedetomidine is 0.6 μg/kg when mixed with ropivacaine for brachial plexus block.