Objective To investigate different priming dose of cisatracurium effect on the onset time.Methods In the First Affiliated Hospital of Nanjing Medical University from November 2014 to April 2015,eighty adult patients (male 41 cases,female 39 cases age from 18 to 60.) scheduled for selective surgery,were randomly divided into four groups,20 in each.Control group (group C) priming with 3 ml saline,group C1 priming with cisatracurium 15 μg/kg,group C2 priming with cisatra curium 30 μg/kg and group C3 priming with cisatracurium 50 μg/kg,1 minutes after the priming injection,each group respectively received the left over intubation dose of cisatracurium 0.15,0.135,0.12,0.10 mg/kg,followed by anesthesia induction of midazolam 0.05 mg/kg,fentanyl 5.0 μg/kg,etomidate 0.3 mg/kg.Neuromuscular block was monitored using train of four stimulation mode.The time when T4/T1=0 after the left over intubation dose of cisatracurium injection and adverse reaction were recorded.Results The onset time in group C3 (114.2±14.1) s was significantly less than that in group C2 (136.3±428.1) s,group C1 (164.6±26.9) s and group C (165.9±10.8) s (P＜0.01).No adverse reaction of dyspnea,urticaria,arrhythmia occurred after priming injection of cisatracurium in all the four groups.Conclusion Priming dose of 50 μg/mg cisatracurium can significantly shorten the onset time compared to the priming dose of 15 μg/mg and 30 μg/mg.

Objective To assess the implementation of Healthcare Improvement Initiative ( the Initiative)by 136 tertiary hospitals nationwide in 2017, and provide reference for improving relevant policies. Methods Hospital questionnaires 1 and 2 were designed, and data were collected by self-report and expert scoring.Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H(K), and Spearman rank correlation were used for statistical analysis.Results The median score of the first 11 dimensions of these hospitals was 91.89% , and that of the first 12 dimensions of 30 women and children hospitals was 90.54%.The total score rate of the top 11 hospitals in the eastern region was higher than that of both the central region and western region(P<0.001).The total score rate of the first 12 dimensions of women and children′s hospitals in the eastern region was higher than that in the central and western regions(P=0.032).The total score rate of the first 11 dimensions of the national level hospitals was higher than that of the local hospitals ( P =0.004).The correlation coefficient between the total number of patients and the total score of the first 11 dimensions and the first 12 dimensions was 0.578 and 0.413, respectively.Conclusions Implementation of the Initiative is satisfactory in general. There are however still rooms of improvement for hospitals in the central and western regions, and local level hospitals as well. General hospitals are better than TCm and specialist hospitals.The larger the scale, the better the performance in service improvement.