中药配伍减毒增效的现代研究及思考

中药配伍是中医药临床应用的精华之一,合理配伍是保障中药临床用药有效性和安全性的重要措施。配伍后减毒增效机制的研究是诠释中药配伍合理性的关键内容。中药配伍机制研究正处于从体外到体内、成分到靶标、单一技术到多学科融合研究技术的转变历程,因此提出以“体外成分、体内过程、直接靶标”研究为基础,“中药配伍药理机制研究”为目的,从不同角度和不同层面探索中药配伍后作用机制的研究策略。     

Euthanasia, Physician Assisted Suicide and Other Methods of Helping Along Death

This paper introduces a series of papers dealing with the topic of euthanasia as an introduction to a variety of attitudes by health-care professionals and philosophers interested in this issue. The lead in paper--and really the lead in idea--stresses the fact that what we are discussing concerns only a minority of people lucky enough to live in conditions of acceptable sanitation and who have access to medical care. The topic of euthanasia and PAS really has three questions: (1) is killing another ever ethically acceptable; (2) is the participation of health professionals ethically different and (3) is it wiser to permit and set criteria (being fully aware of some dangers that lurk in such a move) or to forbid (knowing that it will occur clandestinely and uncontrolled). This paper takes no definite stand although it is very troubled by useless suffering (not only pain) by many who would wish their life and with it their suffering ended.     

门诊抗菌药物使用情况分析

目的了解门诊病人使用抗菌药物的基本情况，为合理用药提供依据。方法查询资源管理平台的ORACLE数据库，分类统计2006年4月门诊西药房抗菌药物处方。结果抗菌药物的处方占总处方的32．8％。抗菌药物消耗金额占药品消耗金额的13．6％，均比去年同期有所降低。DDDs排序表明，氟喹诺酮类药物连续两年位居第一位。其次为头孢菌素类、大环内酯类以及青霉素类，注射、口服抗菌药物处方数分别占抗菌药物处方数的49．3％、36．6％。结论门诊对抗菌药物的使用比去年同期有所改善，但注射用抗菌药物使用率有所增高，选择趋向于高效、广谱、新型抗菌药物，应予以重视。     

围手术期使用依替米星和奈替米星注射剂的合理性评价

目的:在大范围内观察依替米星和奈替米星注射剂围手术期的使用情况,特进行两药围手术期应用的合理性、安全性和经济学评价.方法:回顾性定量调查,对患者一般情况、用药情况、用药费用、手术切口、用药合理性及药物不良反应(adverse drug re-action,ADR)情况等做综合分析.结果:依替米星与奈替米星的ADR发生率＜2%;不合理用药主要表现在Ⅰ类切口无适应证使用抗生素,Ⅲ类切口使用时间过长,联合用药多及配伍不合理;围手术期预防用药同等疗效下净成本比较,依替米星略高于奈替米星.结论:依替米星和奈替米星临床安全性较好,但不适宜作为围手术期的首选药.     

我院住院部抗菌药物应用的调查分析

目的 :了解我院住院部抗菌药物的应用情况 ,评价各科抗菌药物应用的合理性。方法 :抽查 2 0 0 2年 1 2月～ 2 0 0 3年 5月出院病历资料 ,统计住院患者抗菌药物的应用情况 ,并按抗菌药物的应用率、费用比、DDD指数、联合用药等因素进行分析、评价。结果 :患者抗菌药物的平均应用率 83 6 5 % ;用药以单独用药为主 ,Ⅰ联用药占 6 3 6 4 % ,Ⅲ联以上联合用药率 8 6 8% ;药费 /住院费 (% )和抗菌药费 /总药费 (% )分别为 2 5 95 %和 37 0 1 % ;约 70 %药物利用指数 (DUl)值 <1 ,基本合理 ;用药前的相关标本送检率仅占 1 2 75 % ,比较低 ;选用抗生素以经验用药为主 ,按药敏结果用药者仅 2 85 % ,针对性不强 ;围手术期用药时机不当 ,预防性用药时间过长。结论 :我院住院患者的抗菌药物应用率较高 ;用药前的相关标本送检率太低 ,抗菌药的选择针对性不强 ;大多数品种的利用指数 (DDl)基本合理 ;围手术期用药时机不当 ,预防性用药时间过长 ,应引起重视     

Towards compassionate care through aesthetic rationality

The Francis Report, which was based on the investigation of complaints regarding standards of care in the Staffordshire NHS Trust in the UK, was published in 2013. The Report revealed that while the Trust appeared to be compliant with the standards set by official regulating bodies, the quality of care provided to patients was often appalling. While the Report constituted a ‘critical moment’ in health care, its findings resonated with widespread concern in the UK and elsewhere that health care is sometimes characterised by a lack of compassion. The Francis Report partially attributed this lack of compassion to a task‐based culture which tended to prioritise the meeting of targets over the quality of care provided to patients. Older patients, in particular, were identified as being vulnerable to neglect. This qualitative study of hospice volunteers responds to concerns regarding the quality of organisational forms of care by considering how motivations to care may be sustained and enhanced within organisational contexts. Charitable and third sector organisations, such as the hospice in this study, have been identified as potentially relevant to other health and social care contexts precisely because they emphasise values such as altruism and goodwill. Our sociological approach suggests that altruism or compassion can be encouraged within contexts that emphasise a sociability of care. We argue that a sociability of care may be encouraged in organisational contexts if dominant understandings of rationality are extended through the incorporation of aesthetic rationality, a feminist perspective taken from Roslyn Bologh. This, however, would require a degree of authentic emotional engagement on the part of formal caregivers, which is more typically associated with relationships in the private sphere.     

Antipodean forensics: a comment on ANZFSS’s response to PCAST

Recently, one of the world’s leading scientific and technical advisory groups, the U.S. President’s Council of Advisors on Science and Technology (or PCAST), published an assessment of the research supporting several forensic science procedures in regular use. PCAST was particularly interested in pattern recognition or comparison procedures, specifically: simple and mixed DNA profiles; bite marks; latent fingerprints; firearms; footwear; and hair analysis. In its report and recommendations PCAST emphasised the primacy of validation. In response, the Council of the Australian and New Zealand Forensic Science Society produced a short statement suggesting that the PCAST report has limited application to forensic science in Australia and New Zealand. This short commentary offers an alternative perspective.     

2018年某院辅助用药重点监控品种使用情况分析

目的 对西安医学院附属宝鸡医院排名前10位的辅助用药重点监控品种的使用情况进行分析，为加强辅助用药的监管和促进临床合理用药提供参考。方法 通过医院信息系统将2018年重点监控药品的科室分布、销售金额、用药频度（DDDs）、日均费用（DDC）和药品排序比（B/A）进行统计分析，并对其使用合理性进行医嘱点评分析。结果 重点监控品种使用科室大多与其科室疾病谱相符。销售金额排序前3位依次为小牛血清去蛋白注射液、丹参川芎嗪注射液和醒脑静注射液；按DDDs排序前3位依次为丹参川芎嗪注射液、小牛血清去蛋白注射液、腺苷钴胺注射液；按DDC排序前3位依次为醒脑静注射液、小牛血清去蛋白注射液、转化糖电解质注射液；鹿瓜多肽注射液、注射用硫辛酸、舒血宁注射液和注射用血栓通的B/A接近1。不合理应用集中表现在适应症不适宜、给药剂量不规范，构成比分别为59.41%、16.01%。结论 西安医学院附属宝鸡医院重点监控药品管理工作初见成效，但仍需采取积极有效的监管措施进一步促进重点监控药品的合理使用。