门诊不合理处方调查分析

目的通过调查门诊处方不合理用药情况,提高门诊合理用药水平。方法随机抽查山大学附属第一医院2009年1月至3月门诊西药处方9854张,了解我院不合理用药情况,对处方中重复用药、联用增大毒性、联用降低药效、溶媒不合理及选药不合理、用法等情况进行全面调查。结果不合理用药处方386张,占抽查处方总数的3．92％。结论我院门诊用药基本合理,但仍存在一定问题,同时临床医师与药师需共同加强药学知识的学习。     

肿瘤专科医院门诊不合理用药处方分析

目的为更好地开展医院药学服务工作,本院药剂科自2008—07开始每月对门诊处方抽查并进行合理用药分析,每季度汇总进行一次处方点评工作,以提高临床合理用药水平。方法随机抽查本院每月门诊处方300张（2008—07—2009—06）,共计3600张处方,填写专用登记表,分析处方不合理用药情况,统计不合理用药处方比例。结果不合理用药处方254张,占所抽查处方的7．06％。结论本院门诊用药存在一定问题,应引起临床医师、药师重视,同时医院需加强处方点评的力度,进一步提高临床合理用药水平。     

本院2009年度门诊处方回顾性调查分析

目的了解本院2009年度门诊处方的质量,同时分析本院不合理用药的情况,促进临床用药的合理化。方法采用回顾性分析的方法,随机抽查本院2009-01～2009-12门诊处方7 980张,对其中不合理用药处方进行统计分析。结果不合理处方355张,占抽查总处方数的4.45%。其中,不规范处方216张,用药不适宜处方及超常处方139张。用药不适宜处方及超常处方主要表现在选药不当、重复用药、剂量用法不当、滥用药物等。结论本院门诊处方用药基本合理,但在处方规范化管理上要加强力度,以减少不合理用药,保障患者用药安全。     

我院门诊处方不合理用药分析

目的：通过调查门诊处方不合理用药情况，以减少用药差错和纠纷，更安全、合理使用药品，同时推进2007年5月1日起实行的新《处方管理办法》的正确实施。方法：随机抽查本院2007年9月～2008年8月门诊西药处方12000张进行回顾性统计分析。结果：不合理用药处方265张，占抽查处方总数2．2％。结论：我院用药情况基本合理，但临床医师、药师仍需加强专业知识学习。     

门诊处方不合理用药调查分析

目的:调查本院门诊处方不合理用药情况.方法:随机抽查分析2004年7月～12月本院门诊处方5 000张.结果:门诊不合理用药处方约占2%,抗菌药物使用率为30.26%,抗菌药物不合理应用占不合理用药处方的70%.结论:本院门诊用药基本合理,但也存在一些问题,不合理用药主要以抗菌药物为主,临床医生及药师应加强抗菌药物合理应用的再学习.     

10825张门诊处方用药分析

目的分析本院门诊处方用药情况,提高门诊合理用药水平。方法随机抽取本院2011年10月-2012年9月的门诊处方10825张,对不合理用药情况进行全面分析。结果不合理用药处方607张,占抽查总数的5．61％。结论本院门诊处方用药基本合理,但仍存在一些问题,需引起重视,以保证患者用药的安全、有效、合理。     

本院2009年度门诊处方回顾性调查分析

目的 了解本院2009年度门诊处方的质量,同时分析本院不合理用药的情况,促进临床用药的合理化.方法　采用回顾性分析的方法,随机抽查本院2009-01-2009-12门诊处方7980张,对其中不合理用药处方进行统计分析.结果 不合理处方355张,占抽查总处方数的4.45%.其中,不规范处方216张,用药不适宜处方及超常处...     

我院门诊处方用药的合理性评估

目的：了解本院门诊药品使用情况,以促进和提高门诊合理用药水平。方法：随机抽查门诊2010年1—3月期间门诊药房处方共计6 293张,对不合理处方进行登记评估。结果：不合理处方311张,占抽查处方总数的4.94%。结论：本院门诊处方仍存在一些问题,应进一步深入落实《处方管理办法》,提高医生与药师的专业知识水平,加强协作,促进合理用药水平。     

2010年我院门诊处方用药分析

目的：分析本院门诊处方用药情况和存在的问题,为临床合理用药提供参考。方法：随机抽取门诊处方,从用药品种总数、基本药物和药品通用名总数、抗菌药和注射剂的处方张数、处方金额等进行点评;对不规范处方和不合理用药统计分析。结果：本院门诊处方中药品名称全部使用通用名;抽查的12000张处方中,不规范处方736张,不合理用药处方270张。结论：本院门诊用药情况基本合理,但处方书写不规范及不合理用药现象仍存在一些问题,期望能引起临床医师的重视,促进合理用药。     

2007年门诊不合理处方调查分析

目的调查本院门诊处方不合理使用情况。方法随机抽取2007年度门诊处方,根据药品说明书、临床药理学知识及文献资料,对不合理处方进行分析,并加以分类统计。结果共抽查处方12850张,不合理现象表现在给药方案、重复用药、溶媒不当、不合理配伍、选药不合理等方面。结论本院临床用药存在一定程度不合理用药现象,不合理用药亟待改进。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。