中药注射剂不良反应危险因素分析及药学干预

目的：尝试应用条件 logistic 回归多因素分析方法,识别和分析我医院中药注射剂（ Traditional Chinese Medical Injection,TCMI）不良反应（Adverse Drug Reaction,ADR）的主要危险因素,有针对性进行药学干预,从而降低我院中药注射剂 ADR 的发生率。方法选取126例使用中药注射剂的患者,发生 ADR 者和未发生 ADR 者各63例,采用1∶1病例－对照研究的方法,应用条件logistic回归多因素分析模型综合分析和识别出中药注射剂ADR的主要危险因素。根据分析出的主要危险因素进行药学干预,分析药学干预的临床效果。结果条件logistic回归多因素分析结果表明,在控制潜在混杂因素的影响后,配液后放置时长≥15min （ OR ＝9．475, P ＝0．004）、联合用药（OR＝20．574,P＝0．001）是中药注射剂产生 ADR 的主要危险因素;经药学干预的干预组的 ADR 发生率明显低于对照组（χ2＝7．179,P＝0．007）。结论配液后放置时长≥15min、联合用药为中药注射剂发生ADR的主要危险因素。针对性地对主要危险因素进行药学干预,能明显降低中药注射剂ADR的发生率。     

苯丙胺类兴奋剂所致精神障碍者临床特征及危险因素分析

目的：探讨苯丙胺类兴奋剂（amphetamine—type stimulant，ATS）所致精神障碍患者的临床特征及危险因素。方法：采用横断面研究，收集一T355例ATS滥用／依赖者的临床资料，其中符合ATS所致精神障碍者181例。结果：ATS滥用／依赖者以男性、低学历、无业及单身者居多。与无精神障碍的患者相比，有精神障碍组首次吸毒年龄较低、ATS依赖者和多药滥用者比例较高、吸毒剂量较高和过去1月中吸毒天数较多（P〈0．01）。多因素分析结果显示，存在ATS依赖的OR值为5．813（95％CI=3．655—10．231，P〈0．01），多药滥用的OR值为2．262（95％CI=1．309—3．727，P〈0．01）。结论：精神障碍患者的药物滥用程度较无精神障碍的患者更为严重。因此，在临床诊治中应重点预防药物滥用程度严重者的精神障碍的发生，尤其是依赖者及多药滥用者，以减少药物滥用所带来的损害。     

195例过敏性休克文献分析

目的分析引起过敏性休克的相关因素。方法收集《药物不良反应杂志》报道的有关过敏性休克病例资料，并进行整理、汇总、分析。结果可导致过敏性休克的药物中，抗微生物药物品种数居首位（占33．85％），中成药次之（占21．54％）；致过敏性休克死亡的药物品种数也是抗微生物药物居首位（占62．50％）；给药途径以静脉用药发生率最高，占73．85％；发生时间以速发型过敏性休克多见，占74．36％；过敏性休克的发生与性别、年龄无关。结论临床用药前应详细询问过敏史，把握用药指征，选择合适的给药途径，备齐抢救设备，仔细观察用药后反应，以确保用药安全。     

117例门诊患者退药情况分析

目的 了解门诊退药情况，为合理用药及减少浪费提供依据。方法 按退药原因、所退药品品种、申请退药科室等方面统计、分析我院各科门诊2003年1～12月117份退药报告表。结果 病人用药后发生不良反应占36．75％，其中左氧氟沙星片占5．98％；医生用药不当(有禁忌)占11．97％。结论 病人用药后发生不良反应是所有退药原因中最主要的因素。     

医院2011年门诊药房退药情况

目的分析门诊药房退药情况,探讨处理方法和预防措施。方法对中国中医科学院西苑医院2011年1—12月门诊退药处方进行分析。结果1178张退药处方中,因不良反应退药226张,占19．2％;医师开错处方221张,占18．8％;挂号收费错误183张,占15．5％;药师干预165张,占14．0％;患者自身原因127张,占10．8％;患者住院或死亡95张,占8．1％;药房缺药77张,占6．5％;特殊人群禁忌63张,占5．4％;检查项目取消21张,占1．8％。退药品种中,抗生素类药物发生退药比例最大,共287张,占24．4％,其次是中药注射剂265张,占22．5％;心脑血管系统用药182张,占15．4％;呼吸系统用药103张,占8．7％;骨科用药102张,占8．7％;内分泌系统用药84张,占7．1％;消化系统用药76张,占6．4％;解热镇痛抗炎药43张,占3．6％;妇科用药19张,占1．6％;检查用药10张,占0．8％;其他7张,占0．6％。结论门诊退药原因主要为药品的不良反应,退药品种主要为抗生素类药物和中药注射剂。应重视药品不良反应,加强医患沟通,更好地开展药学服务,降低门诊退药率,确保用药安全。     

抗感染药不良反应临床分析

目的为了解临床抗感染药不良反应情况,指导临床合理用药,本文对2010年1月至2012年12月共450份不良反应报告进行统计分析。方法对450份不良反应报告进行统计,分析发生不良反应的性别、年龄特征、药品种类、给药途径、累及器官系统等。结果男性患者约占54．0％,女性患者占46．O％,0-18岁占20．2％,19～59岁占65．8％,60～82岁占14．0％。头孢菌素类、氟喹诺酮类和大环内酯类抗感染类用药是不良反应发生率最高的三类用药,发生比例分别占38．4％、22．4％和22．0％;静脉滴注发生不良反应的比例最高,占90．7％,其次是口服给药和肌内注射。累及皮肤及附件的不良反应发生比例最高,占64．4％,其次是消化系统、神经系统等。结论抗感染药的滥用易带来危险隐患和医疗纠纷,临床应合理应用抗感染药物,提高用药安全性。     

大肠癌发病危险因素研究（附98例报告）

目的：调查大肠癌发病的危险因素,为疾病防治提供理论参考。方法采用回顾性分析方法对2011年2月至2013年2月在我院接受诊治和体检的患者864例作为研究对象,其中大肠癌患者98例,未患大肠癌患者766例,采用单因素分析和多因素Logistic回归分析法对大肠癌相关因素进行分析。结果经过单因素分析及多因素非条件：Logistic回归分析,在调整性别、年龄等混杂因素后,亲属患肿瘤（OR＝1724,95％ CI＝1．104～3．618）、喜食熏腊腌渍食品（OR＝1．121,95％ CI＝1．103～3．002）、慢性阑尾炎（史）（OR＝1．107,95％ CI＝1．002～2．006）和糖尿病史（OR＝1．678,95％ C I＝1．113～3．967）为大肠癌发生的主要危险因素。结论亲属患肿瘤、喜食熏腊腌渍食品、慢性阑尾炎（史）和糖尿病史为大肠癌发生的主要危险因素,对此类人群应加强体检,同时改变生活方式。     

药物性肝损害82例临床分析

目的分析药物性肝损害发生、发展的相关因素，临床表现及预后。方法对82例药物性肝炎病例进行回顾性分析。结果引起肝损害的前4位药物依次为中药（30．5％）、抗结核药（15．8％）、精神科用药（12．2％）、化疗药（12．2％），重度肝损害占29．3％，发生肝损害的时间多在用药后3个月内，主要表现为乏力、纳差、黄疸、恶心，治愈好转率为93．9％。结论药物性肝损害的发生、发展与用药种类、剂量、联合用药、个体因素等密切相关，临床医师及药师应加强合理用药，尽量避免药物性肝损害的发生。     

我院142例药品不良反应报告分析

目的：为促进临床合理用药和进一步评价药品安全风险提供参考。方法：收集我院2008年1月1日--2011年12月31日的ADR报告142份,分别从ADR报告来源、患者性别及年龄分布、ADR关联性评价、ADR涉及药品种类、给药途径、ADR累及器官或系统及主要临床表现、ADR分级及转归等方面进行统计、分析。结果：142份ADR报告中,涉及药品以抗感染药居多（占30．99％）;静脉给药方式是导致ADR的主要给药途径（占71．83％）;ADR最常见的临床表现为皮肤及其附件损害（占42．25％）。结论：临床应充分评估用药安全风险,提高合理用药水平,减少或避免ADR的重复发生。     

我院门诊西药房742例退药情况分析及对策

目的对我院门诊西药房退药情况进行统计分析,并提出相应对策,以减少退药,促进临床合理用药。方法收集我院2013年6月-2013年12月门诊西药房退药处方,按退药科室、退药原因及退药品种进行统计分析。结果在f1诊西药房调配的1107360张处方中有742张退药处方,退药率为0．67‰。退药科室位居前3位分别是呼吸科、急诊科、消化内科,分别占全部退药的14．82％、9．84％、9．84％;引起退药的主要原因是患者用药后发生不良反应,占全部退药的47．17％;其次是患者拒绝用药以及医师错开医嘱,分别占全部退药的26．95％和10．38％;退药类别以抗菌药物居多,占全部退药的44．20％,其次为中药类和诊断用药,分别占全部退药的13．21％和10．65％。结论建议规范退药程序,并加强医师、药师及患者之间的沟通,以减少退药,保障患者的用药安全。     

Psychotropic medication use and accidents, injuries and cognitive failures

BACKGROUND: Psychotropic medication has the potential to impair psychomotor and cognitive function, and several medications have well documented links to increased accident and injury susceptibility. Those developed more recently have many fewer side effects. However, there is little work examining any association between psychotropic medication use and safety within the context of other demographic, health and lifestyle factors. AIMS: To examine and compare any associations between psychotropic medication use (including benzodiazepines, tricyclics and SSRIs) and accidents, injuries and cognitive failures in a community sample. METHODS: A postal questionnaire survey was conducted among people selected at random from the electoral registers of Cardiff and Merthyr Tydfil. RESULTS: Psychotropic medication use was associated with accidents, injuries and cognitive failures, particularly among those who already had higher levels of other risk factors and/or continuing mental health problems. CONCLUSIONS: The well established associations between accidents and injuries and older psychotropic medications were replicated. SSRIs, however, were relatively safer. The study also highlighted the need to consider any effect of psychotropic medication within the context of both mental health status and other factors.     

Alcohol, personality traits, and high risk driving: a comparison of young, drinking driver groups.

Four types of drinking driver groups were compared with each other and also with two nondrinking driver groups on sensation seeking, social responsibility, and hostility. Groups were also compared on traffic violations, accidents, alcohol consumption, frequency of driving after drinking, frequency of driving impaired, and perception of driving risk taking after drinking. Drivers under the influence apprehended in conjunction with an accident or moving violation had significantly greater alcohol consumption, frequency of driving after drinking, frequency of driving impaired, traffic violations, accidents, and self rating of risk taking after drinking in comparison with other groups.     

Drugs, alcohol and driving.

Driving a car is a complex psychomotor and perceptual task which is subject to impairment by many factors. Several workers have studied the potential effects of drugs and alchol in crash production by epidemiological and laboratory studies. Both types of studies have yielded useful data but their limitations must be borne in mind when applying the results in pratice. Alcohol is obviously the most common single cause of traffic accidents. A progessively increased risk with increasing blood alcohol levels is well documented; fatigue and/or drugs increase this risk. Drugs are related much more infrequently to traffic accidents although on the basis of statistics, there is a potential risk with drug use. However, drugs alone are not as important as alcohol. The most significant drugs as regards driving risk are obviously certain antianxiety agents, hypnotics, stimulants, hallucinogens, marihuana, lithium and narcotic analgesics, as well as ganglionic blocking agents, insulin and sulphonylurea derivates. Patients should not drive after taking these drug until they are objectively fully alert and capable. Anticholinergics, antihistamines, antidepressants, antipsychotics, phenybutazone, indomethacin, alpha-methyldopa, and beta-blockers may in some cases cause central side effects (e.g. drowsiness) strong enough to affect driving performance. After starting therapy with these drugs, or after a significant change in dose, driving should be avoided until it is known that unwanted effects do not occur. Psychotropic drugs may enhance the deleterious effect of alcohol, and with most hypnotics there is still an effect the next morning. Some drugs (e.g. anticonvulsants or antiparkinsonian drugs) may make driving safer, but the disease (epilepsy, Parkinsonism, cardiovascular diseases, psychic disorders, etc.) ofter precludes driving. Clinicians should warn their patients about an impairment of driving skills if this is likely to occur due to the drug or the illness concerned.     

广西柳州市酒后驾驶致严重道路交通事故的现况分析

目的 了解柳州市机动车驾驶员酒后驾驶行为在严重道路交通事故中的比例,为制定预防和控制酒后驾驶行为的政策和干预措施提供依据.方法 2007年1月1日至2007年6月30日,共发生严重道路交通事故100起,连续对所有导致至少有一人严重受伤或死亡的道路交通事故的机动车驾驶员(包括摩托车驾驶员)进行问卷调查和血液酒精含量测试.结果 酒后驾驶事故48起,事故主要发生在晚上21时至凌晨2时,共30起;以30～39岁为高发年龄,占46％;驾龄越长,酒后驾驶事故发生比例越高;非职业驾驶员发生酒后驾驶事故的比例高于职业驾驶员;摩托车驾驶员发生酒后驾驶事故的比例高于轿车驾驶员和客车驾驶员.结论 酒后驾驶是导致柳州市严重道路交通事故的最主要原因之一,必须采取广泛而有效的干预措施来降低酒后驾驶的发生率.     

‘What is not written does not exist’: the importance of proper documentation of medication use history

Medications are perceived as health risk factors, because they might cause damage if used improperly. In this context, an adequate assessment of medication use history should be encouraged, especially in transitions of care to avoid unintended medication discrepancies (UMDs). In a case-controlled study, we investigated potential risk factors for UMDs at hospital admission and found that 150 (42%) of the 358 patients evaluated had one or more UMDs. We were surprised to find that there was no record of a patient and/or relative interview on previous use of medication in 117 medical charts of adult patients (44.8%). Similarly, in the medical charts of 52 (53.6%) paediatric patients, there was no record of parents and/or relatives interviews about prior use of medications. One hundred thirty-seven medical charts of adult patients (52.4%) and seventy-two medical charts of paediatric patients (74.2%) had no record about medication allergies and intolerances. In other words, there was a lack of basic documentation regarding the patient’s medication use history. As patients move between settings in care, there is insufficient tracking of verbal and written information related to medication changes, which results in a progressive and cumulative loss of information, as evidenced by problems associated with clinical transfers and medication orders. Proper documentation of medication information during transfer is a key step in the procedure; hence, it should be rightly performed. It remains unclear whether interviews, and other investigations about medication use history have been performed but have not been recorded as health-care data. Therefore, it is crucial to the improvement of medication use safety that documentation of all drug-related information—even if not directly related to the actual event—become routine practice in health-care organizations, since ‘what is not written does not exist’.     

Illicit drugs, medications and traffic accidents

The European Union (EU) has 25 member-states and 455 million inhabitants. Statistics on traffic accidents in the EU show that more than 45,000 people are killed annually, including 5200 in France. At the same time, nearly two million persons in the EU require medical treatment for traffic-accident-related injuries, including 109,000 in France. In addition, traffic accidents are the major cause of death of those individuals aged 15 to 24 years. One third of the EU inhabitants will be hospitalized during their life due to a traffic accident with a cost over 160 billion euro (2-3% of the Gross Domestic Product). An important contributing factor to crashes is the use of alcohol and/or illicit drugs or medication when driving, as they exert negative effects on cognition and psychomotor functions. For illicit drugs, abuse of cannabis with or without alcohol is a major concern for the EU. In fact, three million Europeans use cannabis daily and 80% of them drive after use. A number of French studies since 1999 have underlined the high prevalence of cannabis found in the blood of injured or killed drivers. From medical or judicial observations, it is clear that cannabis use increases the risk of traffic accidents. Many groups outside Europe have also shown the association between drug abuse and crashes. The number of casualties related to certain medicines, especially benzodiazepines remains at a high level, particularly in the elderly. In many countries the prevalence of medicinal drugs associated with car accidents is higher than with cannabis. Annex III of the European Union Council Directive of July the 29th 1991 in fact states that a driving license should not be issued to or renewed for applicants or drivers who are dependent on psychotropic substances or use them regularly. Recently, France has categorized the medicinal drugs available in the country by using three pictograms: level one yellow, "be careful"; level two orange, "be very careful"; level three red, "don't drive". It is an important campaign that increases awareness among the public and the medical professionals about the potential dangerous effects of medicinal drugs when driving. The EU objective of reducing the number of fatalities to 25,000 by 2010 will require strengthening measures against the use of alcohol, illicit and medicinal drugs by not well-informed drivers. It is not only a really great challenge, but also a significant investment towards improving public health in France as well as in Europe.     

Risk management of free radicals involved in air travel syndromes by antioxidants

Frequent air travelers and airplane pilots may develop various types of illnesses. The environmental risk factors associated with air travel syndromes (ATS) or air travel–related adverse health outcomes raised concerns and need to be assessed in the context of risk management and public health. Accordingly, the aim of the present review was to determine ATS, risk factors, and mechanisms underlying ATS using scientific data and information obtained from Medline, Toxline, and regulatory agencies. Additional information was also extracted from websites of organizations, such as the International Air Transport Association (IATA), International Association for Medical Assistance to Travelers (IAMAT), and International Civil Aviation Organization (ICAO). Air travelers are known to be exposed to environmental risk factors, including circadian rhythm disruption, poor cabin air quality, mental stress, high altitude conditions, hormonal dysregulation, physical inactivity, fatigue, biological infections, and alcoholic beverage consumption. Consequences of ATS attributed to air travel include sleep disturbances (e.g., insomnia), mental/physical stress, gastrointestinal disorders, respiratory diseases, circulatory-related dysfunction, such as cardiac arrest and thrombosis and, at worst, mechanical and terrorism-related airplane crashes. Thus safety measures in the cabin before or after takeoff are undertaken to prevent illnesses or accidents related to flight. In addition, airport quarantine systems are strongly recommended to prepare for any ultimate adverse circumstances. Routine monitoring of environmental risk factors also needs to be considered. Frequently, the mechanisms underlying these adverse manifestations involve free radical generation. Therefore, antioxidant supplementation may help to reduce or prevent adverse outcomes by mitigating health risk factors associated with free radical generation.     

Driving after alcohol consumption: A qualitative analysis among Chinese male drunk drivers

In China, alcohol-related impaired driving has been perceived as a crucial contributor to traffic accidents. However, the topic of driving after alcohol consumption is still understudied in the country. To fill this void, the aim of this study was to find out male drivers’ unique experiences of drunk driving in China. A qualitative analysis was adopted based on semi-structured interviews with 38 Chinese male drunk drivers who were serving community corrections. The findings of this study revealed that, being regular alcohol consumers, Chinese male drunk drivers had very little knowledge of the impairment caused by alcohol intake on driving. They mostly underestimated alcohol's negative influence on their driving ability and were overconfident that they would have a safe drive and would not be involved in any traffic accidents after consuming alcohol. In addition, most participants of this study reported that there was very little possibility that they would be arrested after fully assessing the situation and implementing strategies to avoid detection by traffic police. All these reasons affected these men's decision to drive drunk. Several criminological theories are applied to explain the findings and implications are finally recommended to reduce the possibility of drunk driving among Chinese men.