临床药师开展临床药学服务实践

临床药学服务是医院药学生存发展的关键因素和核心竞争力,随着中国医疗制度改革的深入开展,临床药学研究是社会进步和发展的需要,也是保证病人用药安全、有效、合理、经济及减少医疗资源浪费的重要举措。本文结合国内外临床药师开展情况,阐述临床药学服务的重要性和必要性,以及临床药学的工作内容和药师在参与静脉药物配置中心(PIVAS)工作的作用。     

在临床工作中创造和谐医疗环境

医疗工作中,医患关系紧张,医疗就医环境不和谐,不利于临床医疗的正常开展。创建和谐的医疗就医环境,不断改进医疗服务工作方法,改善服务态度,提高服务质量,是更好地开展临床医疗工作,正确处理好医患关系重要基础。     

如何更好地开展临床科研、教学、医疗工作

对于高等医科类院校的教师来说,临床科研、教学和临床医疗工作都是其工作的内容,而更好的开展临床科研、教学、医疗工作是医疗工作者奋斗终生的目标。临床科研是临床医疗工作的生命,有科研才有临床医疗工作的发展和进步;教学是临床科研和医疗工作的延续和传承,教学搞好了才能培养新生代的力量继续钻研科研,培养大量合格的医疗工作者来为人民中国医药指南2008年9月第6卷第18期服务,并且在医疗工作中有所创新;临床医疗工作是切实服务于社会服务于人民的实践,只有将科研成果应用到临床中,为患者解除痛苦,工作才有意义。为此,读者常常在工作中思考如何能更好地干好各项工作,为我的事业注入新的活力,以下是我的一些不成熟的想法。1临床科研临床科研的进展状况,常常是一个医院技术水平、学术水平高低的重要标志,也在相当程度上反映出医疗水平的高低。因此,认真研究新技术,创造新理论,开辟新领域,向临床医学的深度和广度进军,是各医院的重要任务。但是,各级医院的物质条件、技术力量条件不同,其开展科研的起点和最终目标也必须结合自身的特点,不应盲目地求高求远,否则只能浪费资源而又得不到有社会价值的科研成果。如基层医院首先要加强科研领导,把科研工作纳入医院管理的议...     

临床药师在临床路径中的作用

临床路径近年来在许多国家得以应用。实践证明,临床路径在提高服务质量、规范医疗服务行为和控制医疗费用上涨等方面具有重要作用,同时也为临床工作者、政府部门、医疗费用偿付单位提供了医疗服务的规范,成为日常医疗和管理决策的得力工具。临床药师在临床路径中发挥积极的作用,参与给药方案的制订、药学监护、药物应用评价、药物咨询等等,为医师和患者提供了重要的、安全的药学服务。     

临床药师在临床工作体会

临床药学是一门以患者为对象,研究合理用药、提高医疗质量、促进患者健康的学科。我国《医疗机构药事管理暂行规定》明确药师参与临床医疗工作的合法性,同时也明确了责任。作为一名普通药师,在接受了临床药师培训后,我进入临床与医生一起,以临床药师的身份工作了近两年时间。在这一年的工作中,除了最初感受到临床药师在工作时需要建立起适当的工作方法,比如与临床的沟通技巧、加强临床技能学习等,对临床药师在临床工作的开展工作的难点、寻找工作切入点以及未来可能的发展有深刻的体会。     

临床药师深入临床的学习体会

临床药学是医院药学的一个重要组成部分,临床药师的工作意义在于通过药师直接参与治疗过程,成为临床医疗团队中的一员,参与治疗方案的设计,保证患者合理用药,提高医疗质量、减少医疗事故的发生。但由于主观和客观条件的限制,我国临床药学工作进展较为缓慢,而且地区与地区、医院与医院之间的发展也颇不平衡。为加快临床药师工作的发展、推进临床药师制的建立、探索出符合中国国情的临床药学工作模式,卫生部决定在全国42所医院进行临床药师制的试点工作,我院有幸成为甘肃省内唯一一所试点医院,现将工作的心得体会总结如下。     

临床药学小组推广临床药学服务的方法和效果

临床药学服务是随着中国医疗制度改革深入后对医院药学提出的新的要求,也是保证其稳步发展的关键因素,是保证病患用药安全、有效、合理的重要举措。本文通过介绍我院临床药学小组的工作内容,总结其推广药学服务的方法,以及开展活动以来取得的效果,为临床药学在医院药学服务方面工作的展开提供思路。     

临床路径及临床药师在临床路径中的作用

临床路径是近年来发展起来的新型医疗管理模式,对降低日益增长的医疗费用、提高医疗质量、合理运用医疗资源来说,在全世界许多国家的医院都取得了显著成效。随着临床路径在国内越来越多的医院中应用,临床药师肩负着用药方案制订、监测、用药指导与教育等责任,在临床路径的实施中发挥着更加重要的作用。     

临床医护人员的营养学知识继续教育

营养对疾病的发生、发展和转归有着重大影响,营养支持是临床医疗工作不可或缺的重要环节,临床医护人员掌握一定的营养知识对于提高医疗水平、促进患者康复具有重要意义。然而,我国目前普遍存在临床医务人员对临床营养工作的重要性认识不足和掌握营养知识不够的问题,直接影响到临床医护质量。继续教育是对在职专业技术人员进行知识更新、补充、拓展和能力提高的一种高层次的追加教育,继续医学教育已成为医护人员获取新知识、提高工作能力的重要途径之一。本文拟就在临床医护人员中开展营养学知识继续教育的相关问题作一探讨。     

临床护理带教现状调查

临床实习是护理教学中的最后阶段,是理论和实际相结合的重要途径,是很重要的教学环节,也是积累社会经验走向独立工作的第一步。本文通过调查西藏自治区人民医院、西藏自治区第二人民医院和拉萨市人民医院的护理临床带教的现状,认为随着医疗制度的改革和临床医疗技术的进步,临床护理需要对患者提供高质量的整体护理,因此改善临床带教工作现状具有重要意义。     

临床思维对临床药师开展临床实践的指导作用

目的探讨临床药师以临床思维方式来指导临床实践工作的作用。方法临床药师在临床思维指导下以病史采集和用药教育、治疗方案分析、药学监护、不良反应分析等多方面为突破口开展了一系列临床实践工作。结果临床药师赢得了参与多例患者治疗的机会,并辅助临床医生使药物的选择更优化,使用更合理,提高了患者的用药依从性和安全用药意识。结论临床思维对临床药师更好地参与临床实践工作具有重要指导作用。     

LGC: clinical about clinical measurement

LGC is the UK's designated National Measurement Institute for chemical and bioanalytical measurement, and through this role improves the quality and international acceptance of measurements performed within the UK. This research spotlight, highlighting measurement 'across the scale', from elemental analysis and small molecules, through to proteins, DNA and RNA and on to whole cells and tissues, demonstrates how LGC is supporting the clinical sector by ensuring sound measurement practice that underpins clinical efficacy, quality assurance and patient safety.     

Managing clinical pharmacists and clinical pharmacy services

One of the ironies in the use of power in today's management setting is that the manager of workers at a high level of readiness is actually giving more power to subordinates as a leadership strategy. Indeed, the empowered manager may achieve goals by shifting responsibility from the manager to the employee, providing a vision for subordinates, providing resources when possible, and providing the freedom to accomplish organizational goals. The challenge for the manager is to determine employee level of readiness and to assess that readiness for different assignments and varying responsibilities. Given the proper situation, the manager may paradoxically gain power (influence over others) by giving others a high degree of responsibility for their actions.     

Norfloxacin: clinical pharmacology and clinical use

Norfloxacin, a nalidixic acid analog, is the first of the fluorinated quinolinecarboxylic acids to be marketed in the United States. It demonstrates potent antibacterial activity against aerobic, gram-negative bacteria including the Enterobacteriaceae, gentamicin-resistant Pseudomonas aeruginosa, and penicillin-resistant Neisseria gonorrhoeae. Norfloxacin exhibits good activity against methicillin-resistant and -sensitive Staphylococcus aureus, but less activity against most other aerobic, gram-positive organisms. Anaerobic bacteria are resistant to the drug. Resistance to norfloxacin is not plasmid mediated, but is secondary to bacterial mutation, and occurs less frequently than nalidixic acid resistance. Its pharmacokinetic properties after a 400-mg oral dose consist of a peak serum concentration of 1.3-1.58 micrograms/ml, an elimination half-life of 3-7 hours, and good penetration into kidney and prostatic tissues. Renal excretion is the major route of elimination. Norfloxacin is highly effective in the treatment of uncomplicated and complicated urinary tract infections, and gonococcal urethritis. Adverse effects are generally well tolerated and usually do not require discontinuation of therapy.     

开展药物临床试验以促进临床科研工作的发展

开展药物临床试验不仅在完善临床专业学科建设,规范临床诊疗等方面有巨大推动作用,对提升临床科研能力也具有一定促进作用。本文将从科研队伍人才培养,医学伦理学意识、科研作风培养,科技信息获取、科研思维启发,科研质量管理意识强化,多学科协作建立及团队合作意识提升等方面进行分析,并结合本院相关临床专业在开展药物临床试验前后科研立项、专业重点实验室建设等情况,探讨开展药物临床试验对临床科研的促进作用。     

小儿支原体肺炎的临床治疗分析及临床体会

目的探讨小儿支原体肺炎的临床发病特点及治疗措施。方法选取商丘市第一人民医院2012年10月至2013年5月收治的164例小儿支原体肺炎患儿,根据用药的不同分为观察组（86例）和对照组（78例）。观察组应用阿奇霉素治疗,对照组应用红霉素治疗,观察两组的疗效及症状、体征改善情况。结果观察组患儿总有效率为96．51％,明显高于对照组的83．33％,两组比较差异有统计学意义（P〈0．05）;观察组患儿症状、体征改善时间,肺部哕音消失时间及平均治疗时间较对照组明显缩短,差异有统计学意义（P〈0．05）。结论小儿支原体肺炎肺外表现多样,阿奇霉素序贯疗法是安全且有效的,能较好地改善病情,提高治愈率。     

Pharmacokinetic considerations in clinical toxicology: clinical applications

Pharmacokinetic and pharmacodynamic principles should be regarded in the assessment and proper management of patients exposed to a poison. Clinicians must apply these principles to make rational clinical decisions regarding the significance of the poisoning (risk assessment) and to formulate an appropriate management plan. However, pharmacokinetic processes and parameters may be changed in the patient with acute poisoning. This may result from saturation of the capacity of a number of physiological processes due to the high dose, or the toxic effects of the poison may change these processes directly. For example, absorption kinetics may be altered because of increased gastrointestinal transit time (e.g. cholinergic receptor antagonists) or saturable absorption (e.g. methotrexate). Saturation of protein binding may increase the volume of distribution and thereby increase the elimination half-life (e.g. salicylates). Alteration of the acid-base balance (poison-induced or iatrogenic) may also increase or decrease the distribution of a poison. Saturation of metabolism at high doses can prolong toxicity (e.g. phenytoin) or lead to other routes of metabolism that lead to increased toxicity (e.g. paracetamol [acetaminophen]). Excretion may be reduced by saturation of active transporters or decreased renal blood flow.A better understanding of pharmacokinetic principles should improve the clinical care of patients. It should lead to more accurate interpretation of blood concentrations or biomarkers (e.g. ECG intervals or acetylcholinesterase activity) and how these relate to the time course for that poison, and better prediction of prognosis. This in turn, indicates the appropriate duration of observation and the requirement for some specific treatments. Many specific poisoning treatments aim to favourably alter the pharmacokinetics of the poison. These include activated charcoal, whole bowel irrigation, extracorporeal elimination, chelating agents, antitoxins and urinary alkalinisation. The evidence supporting them, their indications and limitations can only be understood using pharmacokinetic principles. These principles also underpin the appropriate choice within the flexible dosage regimen for many antidotes. In particular, naloxone, flumazenil, methylene blue, atropine and pralidoxime all use variable doses and have an elimination half-life that is much shorter than many (but not all) of the poisons treated by these agents. A firm grounding in pharmacokinetics/toxicokinetics should be regarded as a core competency for all professionals involved in clinical care or undertaking research in clinical toxicology.