Practice of informed consent audit system for clinical transfusion in a large tertiary hospital / 中国输血杂志

【Objective】 To pilot an informed consent audit system for clinical transfusion in a large tertiary hospital, so as to provide evidence and recommendations to improve the consent system. 【Methods】 A report table containing key items of transfusion informed consent such as transfusion risk, transfusion benefit and alternative treatment was developed in compliance with the national guidelines and regulations, and issued to a total of 206 patients with records on red blood cell transfusion from April 1 to June 30, 2019 in a tertiary hospital. 【Results】 The audit results showed that 98.06% (202/206) of transfusion informed consents were signed by patients, but only 65.05% (134/206) were signed by doctors. 31.07% did not record the reasons for transfusion, and 46.6% did not record the transfusion plan. 99.31% of the doctors participated in the audit claimed that the patients were informed of the risk of blood transfusion, but only 79.8% (158/198) patients recalled that the doctors mentioned the risk. Although 80.5% (116/198) of the patients were informed of alternative treatment, only 28.79% (57/198) recalled being told about alternative treatment. Allogeneic blood transfusion was the most frequently choice for patients recommended by doctors, accounting for 98.61% (142/144). However, only 48.99% (97/198) of patients could recall allogeneic blood transfusion. 80.5% of the patients recalled being informed of alternative treatment plans, and only 28.79% of the patients recalled being offered alternative treatment plans. Only 43.43% of the patients considered themselves as the main participants in decision-making of blood transfusion. In terms of training, 82.64% (119/144) doctors described having attended training programs. 【Conclusion】 The written consents for blood transfusion in our hospital were not well recorded. Patients received less information of blood transfusion informed by the doctors and did not fully participant in the decision-making of blood transfusion. There is a gap between the practice and the current national guidelines and regulations. The audit results indicated that it is necessary to further strengthen the professional knowledge of clinicians and communication skills between the doctors and patients. This audit results in this study will provide recommendations for further transfusion informed consent audit and continuous improvement of clinical transfusion informed consent practice in China in the future.

The Novel Pathogenic Mutation c.849dupT in BRCA2 Contributes to the Nonsense-Mediated mRNA Decay of BRCA2 in Familial Breast Cancer / 한국유방암학회지

In this study, we used next-generation sequencing methods to screen 300 individuals for BRCA1 and BRCA2. A novel mutation (c.849dupT) in BRCA2 was identified in a female patient and her unaffected brothers. This mutation leads to the truncation of BRCA2 functional domains. Moreover, BRCA2 mRNA expression levels in mutation carriers are significantly reduced compared to noncarriers. Immunofluorescence and western blot assays showed that this mutation resulted in reduced BRCA2 protein expression. Thus, we identified a novel mutation that damaged the function and expression of BRCA2 in a family with breast cancer history. The pedigree analysis suggested that this mutation is strongly associated with familial breast cancer. Genetic counsellors suggest that mutation carriers in this family undergo routine screening for breast cancer, as well as other malignancies, such as prostate and ovarian cancer. The effects of this BRCA2 mutation on drug resistance should be taken into consideration during treatment.

Nosocomial Pulmonary Infection in Elderly Patients with Long-term Mechanical Ventilation / 中华医院感染学杂志

OBJECTIVE To investigate nosocomial pulmonary infection in elderly patients receiving long-term(at least 30 day) mechanical ventilation. METHODS Retrospective survey was carried out in the aged patients with long-term mechanical ventilation,who admitted from Jan 2002 to Jun 2005.The risk factors of common pneumonia were studied by means of Logistic regression analysis. RESULTS In 69 cases with long-term mechanical ventilation,53 patients were caught common pneumonia(76.81%).Pulmonary tuberculosis and plural tuberculosis were(7(10.14%)) and(1(1.14%)),respectively.Nontuberculous mycobacterial infection was identified in 3 cases(4.35%).There were 8 cases suffered from Pneumocystis carinii pneumonia(11.59%).The length of mechanical ventilation and aspiration seemed to be the important risk factors for the development of common bacterial pneumonia. CONCLUSIONS The most significant preventive measures of common pneumonia include short mechanical ventilation and prevention of aspiration of gastric contents.Mycobacterium tuberculosis,nontuberculous mycobacteria and P.carinii induced pneumonia also should be considered in the elderly with(long-term) mechanical ventilation.

Protective effects of anisodamine on ventilator-induced lung injury in rats / 解放军医学杂志

Objective To study the protective effects of anisodamine (ADM) on ventilator-induced lung injury (VILI) in rats. Methods After anesthesia was induced and tracheostomy was performed, 36 healthy male Sprague-Dawley rats were randomly assigned into three groups: control group (group A, VT=8ml/kg); injury group (group B), in which the animals received mechanical ventilation with large tidal volume (VT=40ml/kg); and ADM protective group (group C), in which the animals received the same amount of tidal volume and same respiratory rate with mechanical ventilation as in group B, but were pre-treated with ADM (15mg/kg?iV) at 24h, 12h, 0h time points before ventilation. Arterial blood gases were measured every one hour, and neutrophils in bronchoalveolor lavage fluid (BALF) were counted. Wet to dry (W/D) weight ratio of left lung was determined, and the content of TNF-? and IL-1? in BALF and blood, malondialdehyde (MDA), superoxide dismutase (SOD) levels in the pulmonary tissue and blood were measured respectively. The histopathological changes in pulmonary tissues in the three groups were compared. Results The oxygenation index (PaO2/FiO2) of the animals in group B was significantly lower than that in group A and C, and the BALF neutrophil count was remarkably increased in group B. W/D value of group B was significantly higher than that of group A and C. The levels of TNF-?, IL-1? in BALF were remarkably increased in group B , but decreased in group C . MDA levels in pulmonary tissue and blood in group C were lower than that of group B, but SOD level in group C was significantly higher than that of group B. Histopathologic findings demonstrated there were more neutrophil infiltration and destructive change in the alveolar wall in group B than in other groups. Conclusion ADM appears to have obvious protective effects on VILI through anti-inflammation and antioxidation.

The control technique and clinical application of the intelligentized respirator / 医疗卫生装备

This paper introduces the principle and control technique of the intelligentized respirator and the applications of the modes of SmartCare and AutoFlow. The possible malfunctions of the intelligentized respirator during mechanical ventilation and their countermeasures are analyzed. The influence of the malfunction alert grade on the patient during mechanical ventilation is also discussed. It's the trend to develop the intelligentized respirator. The staff has to be educated and trained to make full use of the intelligentized respirator.

Study on formation of biofilm in bronchi of old patients during application of mechanic air / 医疗卫生装备

Objective To investigate the status of biological membrane(biofilm) formation in the bronchi of old patients treated with mechanical air,and clarify its correlations and risk factors.Methods The retaining time in 25 bronchi from 22 cases of old patients and the results of bacterial culture were analyzed.Results Bacteria culture-positive samples are 22 cases isolated from 25 endotrached tube,accounting for 88%.Negative samples are 3 cases,accounting for 12%.Conclusion The density of bacteria is corresponding to the time of tubing in the bronchi.With the extension of tubing time,the quantity of bacteria is greatly increased.