临床药师干预重点监控药品合理应用的效果分析

目的 通过临床药师干预重点监控药品的合理应用,促进临床合理用药。方法 通过临床药学管理系统(PASS PharmAssist)调取南通市第一人民医院2019年10月至2020年6月重点监控药品的使用数据并筛选在此期间使用重点监控药品的出院患者,对干预前(2019年第四季度)与干预后(2020年第一季度、第二季度)重点监控药品金额、重点监控药品金额占药品总金额的比例以及不合理使用率进行分析。结果 临床药师干预后重点监控药品金额较干预前下降33.23%,重点监控药品金额占药品总金额比例下降34.77%,不合理使用率49.7%下降至30.7%。结论 临床药师干预效果良好,提高重点监控药品的用药合理性,同时减轻患者经济负担。     

临床药师在降低药占比中的药学实践及效果评价

目的以辅助用药专项点评为切入点,探讨临床药师在降低药占比中的有效药学服务模式。方法回顾性分析我院2015年1-12月(干预前)和2016年1-12月(干预后)辅助用药应用情况、药占比及住院患者人均药费,评价干预效果。结果我院不合理使用辅助用药有效改善,辅助用药收入占药品收入的比例由26.29%降至23.21%;医院药占比由36.23%降至33.96%;患者住院人均药费由0.36万元下降至0.33万元。结论临床药师在降低药占比中发挥了重要作用,促进了临床合理用药。     

临床药师参与合理用药管控的药学服务模式及效果分析

摘 要 目的：临床药师参与合理用药管控的药学服务模式的建立。方法: 医院建立合理用药考核及监管体制,制定《医师合理用药记分制管理考核标准》;通过信息化手段对重点监控药品的适应证进行管控,建立质控体系实时动态监测;临床药师针对不合理用药问题进行综合干预。结果:2017年上半年药占比、抗菌药物使用强度、重点监控药品费用、人均药费均呈下降趋势;各项指标均达标;且2017年上半年临床药师会诊数量明显增加。结论:临床药师在合理用药管控模式中发挥了重要作用,有助于合理用药各项指标的达标,促进临床合理用药。     

2003年我国临床药学发展状况回顾——以患者为中心的医药服务是当代医院药师的首要任务

1科学地规范医疗机构药事管理,加强行业自律,塑 造医院药师新形象 2002年1月由卫生部与国家中医药管理局联合制定并发布的<医疗机构药事管理暂行规定>,旨在贯彻<药品管理法>,科学地规范医疗机构药事管理工作,保证用药安全、有效和经济;同时也明确了医院药学部门必须从传统的药品供应模式向以病人为中心的药学技术服务模式转变.该规定要求药学部门建立以病人为中心的药学管理模式,开展以合理用药为核心的临床药学工作,逐步建立临床药师制;临床药学专业技术人员应参与临床药物治疗方案设计,对重点患者实施治疗药物监测,指导合理用药;收集药物安全性和疗效等信息,建立药学信息系统,提供用药咨询服务.该规定的发布,使临床药学工作的开展有法可依,有章可循,使临床药学工作在2003年得到稳步有序的发展.     

药品管理规范化 药事服务人性化

在实施药品规范化管理过程中,加强制度建设健全质量管理体系。明确药师职责提高药事服务水平。抗菌药物规范管理临床药师指导合理用药,持续改进药品全程使用的规范化管理,提高药品的安全合理使用,通过参与治疗方案设计、调整,指导合理用药,个体化给药,建立"以患者为中心"的规范化管理、人性化服务药学管理模式,     

药品管理规范化 药事服务人性化

在实施药品规范化管理过程中,加强制度建设健全质量管理体系。明确药师职责提高药事服务水平。抗菌药物规范管理临床药师指导合理用药,持续改进药品全程使用的规范化管理,提高药品的安全合理使用,通过参与治疗方案设计、调整,指导合理用药,个体化给药,建立"以患者为中心"的规范化管理、人性化服务药学管理模式。     

临床药师在消化科开展药学服务模式的探讨及实例分析

目的总结临床药师在消化科开展药学服务的经验,探讨临床药师参与临床药物治疗实践、促进合理用药模式。方法临床药师深入临床,在消化科开展面向医护人员和患者的药学服务,并对部分典型的药学服务实例进行展示和分析。结果临床药师充分发挥自身药学专长,在促进合理用药、抗菌药物监控、药品不良反应监测、患者用药教育等方面发挥了良好的作用。结论临床药师提供了多种形式的药学服务,对安全、有效、经济用药起到积极的作用,但还需不断提高自身的专业水平,保证知识体系与时俱进。     

我院住院药房如何开展合理用药工作

根据2002年1月21日,国家卫生部和国家中医药管理局颁布《医疗机构药事管理暂行规定》明确提出“药学部门要建立以患者为中心的药学保健工作模式,开展以合理用药为核心临床药学工作,参与临床诊断、治疗、提供药学技术服务,提高医疗质量”及“逐步建立临床药师制”。上述规定指出了我国医院药学的发展方向。所以医院药房的药师要切实转变观念（药师应以参与临床用药、正确选药和促进合理用药为患者提供服务）,门诊药房的临床药师负责处方不合理用药分析和用药咨询,住院药房的临床药师负责口服单剂量配发药品时不合理用药分析。     

某院重点监控药品的药事管理实践

目的：探索对重点监控药品合理使用的有效药事管理措施。方法：建立重点监控药品的药事管理措施,通过对比监管前后某院医疗指标以及重点监控药品目录的变化情况,对管理效果进行参考性评价。结果：对比监管前后数据,发现收治人数增加了53.0%;但药占比从34.4%下降至24.5%;人均药费从8 492.5元降至6 078.3元;而平均住院天数、诊断疾病种类数、治愈率均无显著性差异。对比全院重点监控药品目录前20位药品,亦明显可见非针对性治疗用药明显减少,针对疾病的治疗用药明显增加,而且监管后非针对性治疗用药的使用不合理率也大幅度下降。结论：某院通过建立重点监控药品的药事管理措施,对重点监控药品实施的药事管理效果初具成效,在一定程度上规范了医疗机构药物使用管理,减轻了患者医药费用负担,保障医疗质量和医疗安全。     

对慢性心力衰竭伴糖尿病肾病患者的药学监护

目的对慢性心力衰竭伴糖尿病肾病患者实施药学监护,探讨心内科临床药师在合理用药中的作用。方法临床药师通过参与慢性心力衰竭伴糖尿病肾病患者的临床诊治,提供药学监护及药学服务,总结对于此类患者的药物选择、注意事项、不良反应处理等方面的个体化给药方案的设计及个体化药学监护。结果通过对患者的个体化药学服务,提高患者临床药物治疗学的水平及用药的依从性,避免或减少了药品不良反应的发生。结论临床药师通过病例分析,可以发现临床药物治疗中的药学监护要点,提出合理化给药建议,提高临床合理用药水平。     

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.     

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。     

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。     

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.     

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.     

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.     

舒乐洗剂治疗外阴阴道念珠菌病的体内外实验研究

目的：观察舒乐洗剂治疗外阴阴道念珠菌病（VVC）的效果。方法建立体外白念珠菌生物膜模型,采用 XTT 法检测生物膜抑制率;建立 VVC 小鼠模型,采用阴道涂片检查和病理组织检测法,比较给药前后炎症状况的变化。结果舒乐洗剂对体外白念珠菌生物膜的形成有明显抑制作用,并成一定的剂量依赖性;能够抑制体外白念珠菌菌落形成,其中原液稀释一倍的效果最为显著;能够明显减少小鼠体内白念珠菌菌落形成,并能够减少炎性细胞向阴道黏膜的浸润。结论舒乐洗剂具有体外抗生物膜形成的作用,并能降低体内小鼠白念珠菌的感染状况,减轻VVC 小鼠阴道黏膜炎症,从而达到治疗 VVC 的作用。