医务人员临床合理用药认知水平现况调研

目的：了解医务人员对药物不良反应、处方管理、国家药物基本政策和抗生素合理使用等基本政策和知识的认知情况。方法：对107名不同年资的医师、护师和药师进行了问卷调查。结果：调研问卷总体正确率低于50％，对政策法规了解率相对于其他几项稍高，不良反应知识的认知率最低。结论：医务人员虽然已经普遍认识到合理用药的重要性，但对合理用药相关政策和知识仍然缺乏了解，掌握合理用药知识的水平差异较大；应加强对医务人员进行药物合理应用知识的宣传与培训。     

对我院医务人员抗菌药物合理应用知识水平的调查与分析

目的:评价我院医务人员的抗菌药物合理应用知识水平,有针对性地提出干预措施。方法:根据抗菌药物合理应用基本原则及基本知识设计问卷,对我院医务人员进行无记名、现场问卷调查。结果:医务人员对抗菌药物合理应用知识水平的差异较大,药师的得分明显高于医师和护士,内科医师得分略高于外科医师,中级职称医务人员得分较高,其次分别为高级职称和初级职称人员。结论:有必要加强对医务人员抗菌药物应用知识的培训、监管。     

对泉州市县级以上医务人员合理使用抗菌药物知识的调查

目的了解医务人员对合理使用抗菌药物知识的掌握程度，找出存在问题，帮助医务人员提高合理使用抗菌药物意识，保障病人用药安全。方法采用问卷调查法．以抗菌药物概念、合理用药原则、联合用药指征、滥用药物危害、降低耐药途径为主要内容，抽样调查县级以上医院1370名医务人员合理使用抗菌药物知识认知程度。结果医务人员对合理使用抗菌药物知识认知程度低，而对这方面知识需求较强烈。结论必须加强培训、加大宣传合理使用抗菌药物知识的力度，并促进理论与实践相结合。     

不同类别医务人员对中成药合理应用的认知现状调查与分析

目的:了解不同类别医务人员对中成药合理应用的认知现状,分析存在的问题,为进一步研究合理应用中成药对策提供依据。方法:通过专家采访与指导,制定调查问卷,以北京地区为主并面向全国医务人员进行中成药合理应用的认知现状调查,对调查结果进行统计分析。结果:共有791名医务人员参与本调查,包括中医师、中药师、西医师、西药师和护师。不同类别及工作年限的医务人员对中成药的用药认知存在差异,中药师的用药认知明显优于中医师、西医师、西药师和护师,差异均有统计学意义(P<0.001)。不同工作年限的医务人员在用药认知得分方面的差异有统计学意义(P<0.001),工作年限<5年的医务人员对中成药的用药认知相对较差。对中成药所含西药成分的认知方面,47.79%的医务人员(378名)认知度高,45.64%的医务人员(361名)认知度中等,6.57%的医务人员(52名)认知度低;药师的认知度明显优于医师和护师,差异均有统计学意义(P<0.001)。对中成药用药禁忌的认知方面,23.51%的医务人员(186名)认知度高,50.70%的医务人员(401名)认知度中等,25.79%的医务人员(204名)认知度低;中药师的认知度明显优于其他四类医务人员,差异均有统计学意义(P<0.05)。对辨证用药的认知方面,有40.08%的医务人员(317名)认知度高,44.37%的医务人员(351名)认知度中等,15.55%的医务人员(123名)认知度低;中医类医务人员的认知度明显优于非中医类医务人员,差异有统计学意义(P<0.001)。结论:不同类别的医务人员对中成药合理应用的认知存在差异,且低工作年限的医务人员认知较差。有必要根据工作年限和不同岗位类别对医务人员进行有针对性的中成药用药知识培训,发挥中药临床药师的专业优势,加强对临床中成药使用的指导作用。     

湖北省三级医疗机构医务人员抗菌药物合理应用考核效果调查与评估

目的：对湖北省医疗机构抗菌药物临床应用与管理培训班进行效果调查与评估,以促进抗菌药物的合理使用。方法：设计调查问卷,从抗菌药物的基本概念、用药原则、作用机制、药物特点等角度进行考核,用SPSS13.0软件统计数据,分析医务人员的抗菌药物知识水平。结果：医务人员对单选题和多选题设计的知识点整体掌握较好,问答题中各得分点的正确回答人数比例在7.88%-99.01%间,差异很大;对抗菌药物管理要求认知状况较好,但对于抗菌药物概念及其与抗生素的区别缺少关注。结论：学员合理使用抗菌药物的知识水平总体较高,明确抗菌药物的管理要求;对抗菌药物与抗生素的区分需要进一步明晰。     

临床药师干预临床不合理用药的效果评价

目的:评价临床药师干预临床不合理用药的效果。方法:选取本院2016年实施临床药师干预前后住院医嘱中使用抗菌药物的病历各200例,采用回顾性分析法,回顾分析在临床药师干预下的住院医嘱中抗菌药物合理使用效果。结果:实施临床药师干预后,本院住院患者抗菌药物用药排序以及用药频率有了显著改善;在干预后的抗菌药物使用中,主要使用差异体现在单独用药、二联用药、三联用药等方面;经过临床药师干预,临床用药不合理的现象有了明显改善,差异存在统计学意义(P<0.05)。结论:临床药师干预抗菌药物不合理使用,可降低抗菌药物的使用率和联合用药的比例,可促进我院抗菌药物的合理使用,提高合理用药水平。     

药品不良反应及安全用药知识在某三甲医院三类医务人员中认知度研究

目的：研究了解医师、护师、药师三类医务人员对药品不良反应（ADR）以及安全用药相关知识的认知情况,为ADR及临床安全用药监测的深入开展提供参考。方法：利用网上药学问卷调查平台对皖南地区某大型三级甲等医院45个临床科室的医务人员（医师、护师、药师）的ADR以及安全用药相关知识进行网上调查,数据由平台自动导出Excel表格,使用SPSS19．0软件进行统计分析。结果：通过调查平台,获取有效调查问卷575份,医务人员对ADR和安全用药知识的平均知晓率为83．0％,对ADR上报流程平均知晓率为83．4％。三类医务人员（医生、护师、药师）对于“什么是ADR”、“用药错误的含义”等基本概念的知晓程度较高,回答无明显差异（P〉0．05）。对于“药品不良反应／不良反应事件（ADR／ADE）”、“用药错误”的判断,回答存在显著差异（P〈0．001）,医师、护师的知晓程度低于药师。对于“用药后出现ADR的应对措施”、“ADR必须填写的项目”等问题,三类医务人员（医生、护师、药师）问题差异无统计学意义（P〉0．05）,但对于“ADR上报期限”等的回答有显著差异（P〈0．001）,药师的知晓率高于医师、护师。结论：综合分析该院三类医务人员对ADR和安全用药基本知识掌握总体较好,但对于ADR与ADE、用药错误等概念之间差别存在混淆。应以多种形式对医务人员的ADR和安全用药相关知识进行培训、教育,提高医务人员对ADR／ADE、用药错误等的判断能力,加强ADR监测水平和上报意识,提升合理用药水平,保障患者用药安全。     

基层医院医师对抗菌药物分级使用的认知现状

目的了解基层医院医师对抗菌药物分级使用的认知现状,寻找抗菌药物不合理使用的因素,以便采取有效措施,促进临床合理用药。方法采用自行设计的问卷调查表,对79名医师进行问卷调查。结果 79名医师对抗菌药物分级使用相关知识知晓率最低的是抗菌药物的特殊使用原则51.90%,抗菌药物疗效与产地的关系50.63%,不合理使用抗菌药物后果48.37%。结论基层医院医师对抗菌药物分级使用的相关知识认知较低,有必要加强医务人员抗菌药物合理应用知识的培训和监督,进一步提高我院医务人员抗菌药物合理应用的水平。     

临床药师参与产科抗感染药物应用会诊的实践与体会

目的:为临床药师参与产科抗感染药物应用会诊提供参考。方法:对临床药师参与产科抗感染治疗的4例典型案例进行分析。结果:临床药师在临床疾病治疗进程中,对协助医师合理用药发挥了一定作用,提出的会诊意见和建议得到了临床认可。临床药师应掌握抗菌药物特点,合理选择抗菌药物;不能仅参考药敏结果,还需结合临床症状综合判断,切勿滥用抗菌药物;充分考虑孕期妇女生理特点,作出合理判断。结论:临床药师参与临床会诊,对提高临床诊疗水平及保障患者用药安全、有效、经济、合理具有极大的帮助和促进作用。     

海口市儿童家长抗菌药物知识认知度调查

目的:了解海口市儿童家长对抗菌药物知识的认知度,为儿科合理使用抗菌药物提供参考。方法:向海口市大型综合医院、妇幼保健院儿科门诊和儿科住院患儿家长发放调查问卷,针对儿童家长抗菌药物用药安全意识和抗菌药物知识进行调查研究。结果:共发放问卷5300份,回收5083份,其中有效问卷5000份,有效率为98.37%。调查结果显示,患儿家长抗菌药物用药安全意识和抗菌药物知识与文化程度和居住地有关,文化程度越高和居住在大中城市的家长,抗菌药物用药安全意识越高和掌握抗菌药物知识程度越高,差异有统计学意义(P<0.05)。结论:建议相关部门加强普及大众的抗菌药物知识,药师应发挥积极的作用,通过提供用药咨询和指导等方式,增强患儿家长安全用药意识,促进合理使用抗菌药物,降低抗菌药物不良应发生的风险。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Biochemical and molecular characterisation of cubozoan protein toxins

Class Cubozoa includes several species of box jellyfish that are harmful to humans. The venoms of box jellyfish are stored and discharged by nematocysts and contain a variety of bioactive proteins that are cytolytic, cytotoxic, inflammatory or lethal. Although cubozoan venoms generally share similar biological activities, the diverse range and severity of effects caused by different species indicate that their venoms vary in protein composition, activity and potency. To date, few individual venom proteins have been thoroughly characterised, however, accumulating evidence suggests that cubozoan jellyfish produce at least one group of homologous bioactive proteins that are labile, basic, haemolytic and similar in molecular mass (42-46 kDa). The novel box jellyfish toxins are also potentially lethal and the cause of cutaneous pain, inflammation and necrosis, similar to that observed in envenomed humans. Secondary structure analysis and remote protein homology predictions suggest that the box jellyfish toxins may act as α-pore-forming toxins. However, more research is required to elucidate their structures and investigate their mechanism(s) of action. The biological, biochemical and molecular characteristics of cubozoan venoms and their bioactive protein components are reviewed, with particular focus on cubozoan cytolysins and the newly emerging family of box jellyfish toxins.     

Dose tolerability of chronically inhaled voriconazole solution in rodents

Invasive pulmonary aspergillosis (IPA) is a fungal disease of the lung associated with high mortality rates in immunosuppressed patients despite treatment. Targeted drug delivery of aqueous voriconazole solutions has been shown in previous studies to produce high tissue and plasma drug concentrations as well as improved survival in a murine model of IPA. In the present study, rats were exposed to 20 min nebulizations of normal saline (control group) or aerosolized aqueous solutions of voriconazole at 15.625 mg (low dose group) or 31.25 mg (high dose group). Peak voriconazole concentrations in rat lung tissue and plasma after 3 days of twice daily dosing in the high dose group were 0.85 ± 0.63 μg/g wet lung weight and 0.58 ± 0.30 μg/mL, with low dose group lung and plasma concentrations of 0.38 ± 0.01 μg/g wet lung weight and 0.09 ± 0.06 μg/mL, respectively. Trough plasma concentrations were low but demonstrated some drug accumulation over 21 days of inhaled voriconazole administered twice daily. Following multiple inhaled doses, statistically significant but clinically irrelevant abnormalities in laboratory values were observed. Histopathology also revealed an increase in the number of alveolar macrophages but without inflammation or ulceration of the airway, interstitial changes, or edema. Inhaled voriconazole was well tolerated in a rat model of drug inhalation.