Adverse drug events in hospital: pilot study with trigger tool

OBJECTIVE

To estimate the frequency of and to characterize the adverse drug events at a terciary care hospital.

METHODS

A retrospective review was carried out of 128 medical records from a hospital in Rio de Janeiro in 2007, representing 2,092 patients. The instrument used was a list of triggers, such as antidotes, abnormal laboratory analysis results and sudden suspension of treatment, among others. A simple random sample of patients aged 15 and over was extracted. Oncologic and obstetric patients were excluded as were those hospitalized for less than 48 hours or in the emergency room. Social and demographic characteristics and those of the disease of patients who underwent adverse events were compared with those of patients who did not in order to test for differences between the groups.

RESULTS

Around 70.0% of the medical records assessed showed at least one trigger. Adverse drug events triggers had an overall positive predictive value of 14.4%. The incidence of adverse drug events was 26.6 per 100 patients and 15.6% patients suffered one or more event. The median length of stay for patients suffering an adverse drug event was 35.2 days as against 10.7 days for those who did not (p < 0.01). The pharmacological classes most commonly associated with an adverse drug event were related to the cardiovascular system, nervous system and alimentary tract and metabolism. The most common active substances associated with an adverse drug event were tramadol, dypirone, glibenclamide and furosemide. Over 80.0% of events provoked or contributed to temporary harm to the patient and required intervention and 6.0% may have contributed to the death of the patient. It was estimated that in the hospital, 131 events involving drowsiness or fainting 33 involving falls, and 33 episodes of hemorrhage related to adverse drug effects occur annually.

CONCLUSIONS

Almost one-sixth of in-patients (16,0%) suffered an adverse drug event. The instrument used may prove useful as a technique for monitoring and evaluating patient care results. Psycothropic therapy should be critically appraised given the frequency of associated events, such as excessive sedation, lethargy, and hypotension.     

Access to medicines for acute illness in middle income countries in Central America

OBJECTIVE

To analyze the main predictors of access to medicines for persons who experienced acute health conditions.

METHODS

This was a cross-sectional analytic study, based on data from household surveys. We examined the predictors of: (1) seeking care for acute illness in the formal health care system and (2) obtaining all medicines sought for the acute condition.

RESULTS

The significant predictors of seeking health care for acute illnesses were urban geographic location, head of household with secondary school education or above, age under 15, severity of illness perceived by the respondent, and having health insurance. The most important predictor of obtaining full access to medicines was seeking care in the formal health care system. People who sought care in the formal system were three times more likely to receive all the medicines sought (OR 3.0, 95%CI 2.3;4.0). For those who sought care in the formal health system, the strongest predictors of full access to medicines were seeking care in the private sector, having secondary school education or above, and positive perceptions of quality of health care and medicines in public sector health facilities. For patients who did not seek care in the formal health system, full access to medicines was more likely in Honduras or Nicaragua than in Guatemala. Urban geographic location, higher economic status, and male gender were also significant predictors.

CONCLUSIONS

A substantial part of the population in these three countries sought and obtained medicines outside of the formal health care system, which may compromise quality of care and pose a risk to patients. Determinants of full access to medicines inside and outside the formal health care system differ, and thus may require different strategies to improve access to medicines.      

白花香莲解毒方联合西药治疗重度慢性乙型肝炎疗效观察

目的观察白花香莲解毒方联合西药治疗重度慢性乙型肝炎的临床疗效。方法将符合纳入标准的104例患者随机分为治疗组和对照组,每组52例。对照组给予西医综合治疗方案,治疗组在对照组的基础上加用白花香莲解毒方口服。两组疗程均为4周,观察临床疗效及肝功能（TBIL、ALB、ALT、CHE）、凝血功能（PT、PTA）变化情况。结果治疗组、对照组总有效率分别为90．38％、75．00％,治疗组临床疗效优于对照组（P〈0．05）。两组治疗后TBIL、ALB、ALT、CHE及PT、PTA均明显改善（P〈0．05）;组间治疗后比较,各指标差异均有统计学意义（P〈0．05）。结论白花香莲解毒方联合西药治疗重度慢性乙型肝炎,具有良好的保肝护肝、退黄、改善凝血功能等作用。     

小儿定喘口服液联合甲泼尼龙治疗重症支气管哮喘的临床研究

目的探讨小儿定喘口服液联合甲泼尼龙治疗重症支气管哮喘的临床疗效。方法选取2015年2月—2016年2月在西电集团医院呼吸内科接受治疗的小儿重症支气管哮喘患者86例,随机分成对照组和治疗组,每组各43例。对照组患儿静脉滴注注射用甲泼尼龙琥珀酸钠,1 mg/kg加入到5%葡萄糖溶液250 m L中,1次/d。治疗组在对照组的基础上口服小儿定喘口服液,3~6岁患儿10 m L/次,7~10岁患儿15 m L/次,10岁以上患儿20 m L/次,均为3次/d。所有患儿均连续治疗2周。比较两组临床疗效、肺功能变化、动脉血气指标、临床症状和体征消失时间以及肿瘤坏死因子α(TNF-α)、白介素-8(IL-8)和免疫球蛋白E(Ig E)表达水平。结果治疗后,对照组和治疗组总有效率分别为81.40%和95.35%,两组比较差异有统计学意义(P0.05)。治疗后,两组一秒用力呼气容积(FEV1)、最大呼气流量(PEF)、用力肺活量(FVC)和FEV1/FVC均较同组治疗前显著升高,同组比较差异具有统计学意义(P0.05);且治疗组这些观察指标显著高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组氧分压(p O2)和血氧饱和度(Sp O2)升高,二氧化碳分压(p CO2)较治疗前下降,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组患儿喘憋消失时间和肺部哮鸣音消失时间短于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患儿TNF-α、IL-8和Ig E表达水平均下降,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标水平低于对照组,两组比较差异具有统计学意义(P0.05)。结论小儿定喘口服液联合甲泼尼龙治疗重症支气管哮喘的疗效显著,可有效改善患儿肺功能及降低血清炎性因子水平,具有一定的临床推广应用价值。     

固肾定喘丸联合盐酸氨溴索治疗老年慢性阻塞性肺疾病急性加重期的临床研究

目的探讨固肾定喘丸联合盐酸氨溴索治疗老年慢性阻塞性肺疾病急性加重期的临床疗效。方法选取2015年6月—2016年6月在葛洲坝集团中心医院进行治疗的老年慢性阻塞性肺疾病急性加重期患者82例,根据治疗方案的差别分为对照组(41例)和治疗组(41例)。对照组患者静脉滴注盐酸氨溴索注射液,30 mg加入5%葡萄糖溶液200 m L,2次/d。治疗组在对照组的基础上口服固肾定喘丸,2 g/次,3次/d。两组均连续治疗14 d。观察两组的临床疗效,同时比较两组第1秒时间肺活量(FEV1)、用力肺活量(FVC)、FEV1/FVC、肿瘤坏死因子α(TNF-α)、白细胞介素8(IL-8)、肺表面活性蛋白D(SP-D)、Clara细胞分泌蛋白(CC16)、降钙素原(PCT)、p H值、血氧分压(p O2)以及动脉血二氧化碳分压(pCO_2)。结果治疗后,对照组总有效率为80.49%,显著低于治疗组的95.12%,两组总有效率比较差异有统计学意义(P0.05)。治疗后,两组患者p H值、p O2均明显升高,而pCO_2明显降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组这些指标改善情况明显优于对照组,两组比较差异均具有统计学意义(P0.05)。治疗后,两组FEV1、FVC和FEV1/FVC均明显升高(P0.05);且治疗组这些观察指标的升高程度明显优于对照组(P0.05)。治疗后,两组患者血清SP-D、CC16、PCT、IL-8、TNF-α水平均显著降低(P0.05);且与对照组相比,治疗组上述指标降低更明显(P0.05)。结论固肾定喘丸联合盐酸氨溴索治疗老年慢性阻塞性肺疾病急性加重期效果显著,可明显改善患者肺功能,并降低机体炎性反应,具有一定的临床推广应用价值。     

小儿推拿合中药宣肺定喘汤治疗毛细支气管炎临床研究

目的：观察应用小儿推拿合中药宣肺定喘汤治疗毛细支气管炎的临床疗效,大力推广有效的绿色治疗。方法：观察69例采用小儿推拿合中药宣肺定喘汤的门诊治疗效果。结果：有效率达97.04%。结论：此疗法疗效显著。     

固体脂质纳米粒的研究进展

目的综述固体脂质纳米粒的最新研究进展。方法以国内外大量有代表性的论文为依据,将固体脂质纳米粒的制备方法、特性分析、药物载入、药物释放及应用情况进行了概括,指出了发展前景和尚待解决的问题。结果固体脂质纳米粒的多种制备方法各有优、缺点,调整制备参数可调整药物的包封率和释药曲线。结论固体脂质纳米粒可供多途径给药,是极有发展前景的新型给药系统。     

药物制剂研究概况及展望

目的：促进药物制剂理论的不断提高与完善,方法：探讨药物制剂的研究方法,前景及方向性。结果：药物传递系统制剂有许多优点,且有广阔的发展前景。结论：在不久的将来,会有许多新的制剂不断出现,现代药物制剂的发展必定具有广阔的前景。     

基于网络药理学方法预测定喘汤治疗慢性阻塞性肺疾病的作用机制及验证研究

目的：分析定喘汤治疗慢性阻塞性肺疾病(COPD)的分子机制,并通过细胞实验验证定喘汤的药理学作用。方法：在中药系统药理学数据库与分析平台(TCMSP)数据库中,对定喘汤9味中药进行有效成分筛选,利用UniPort数据库得到中药活性成分相关靶点。随后在五大疾病数据库中以COPD作为关键词进行检索,收集疾病对应的靶点基因。对有效成分-交集靶点网络进行拓扑分析,根据中药有效成分与交集靶点之间连接情况筛选定喘汤治疗COPD关键成分。最后通过基因本体(GO)富集分析和京都基因和基因组百科全书(KEGG)富集分析确定定喘汤治疗机制并进行分子对接,从整体生物网络角度阐述定喘汤治疗COPD的免疫炎症机制,并通过细胞实验加以验证。结果：本实验筛选得到定喘汤274个活性成分,与疾病交集靶点262个。KEGG富集分析表明核心靶点作用于白细胞介素-17(IL-17)信号通路、NOD样受体信号通路及趋化因子信号通路等多种免疫和炎症反应相关的信号通路,分子对接显示核心化合物与靶点具有良好的对接活性。细胞实验表明,定喘汤能通过磷脂酰肌醇3激酶/蛋白激酶B(PI3K/AKT)信号通路,抑制人Ⅱ型肺泡上皮细胞炎症反应,...     

2018年上半年威海市妇幼保健院住院患者含丹参注射制剂使用情况分析

目的:分析威海市妇幼保健院住院患者含丹参注射制剂的临床用药情况,并探讨其合理性,为威海市妇幼保健院规范中药注射剂使用提供数据支撑。方法:对威海市妇幼保健院住院患者2018年上半年含丹参注射制剂的用药金额及各科室使用情况进行统计分析;并随机抽取311例病例,对含丹参注射剂型药品使用的合理性进行处方点评分析。结果:2018年上半年威海市妇幼保健院含丹参注射制剂中用药金额最高的为注射用丹参多酚酸盐;使用病例数最多的为心内科;不合理使用的情况,主要表现为超功能主治、溶媒及溶媒用量选择不适宜、药品用量不适宜等。结论:含丹参注射制剂在威海市妇幼保健院的使用较为稳定,但使用的合理性有待于进一步规范。