我院病房药房医嘱干预情况分析

目的：探讨住院患者用药医嘱干预内容,对不合理情况进行分析。方法：利用住院医嘱点评程序,对我院心血管病房和神经外科十病房近一个月的用药医嘱进行逐条查找,分析存在的问题并进行汇总讨论。结果：病房药房医嘱主要存在用量错误、药物相互作用、出院带药处方自然项不全、重复用药、频次错误、溶媒选用不当、没有明确的指标等问题。结论：药师应加强药学知识特别是药物相互作用的学习,重视临床实践,为临床提供优质的药学服务。     

北京、上海、天津、广州、杭州、成都六城市部分医院门诊中特殊使用级抗菌药的处方金额趋势分析

目的：分析并比较北京、上海、天津、广州、杭州、成都六城市部分医院特殊使用级抗菌药处方金额和趋势情况。方法：对这六个城市部分医院特殊使用级抗菌药的药品名称、规格、处方张数、取药数量、取药金额进行统计,并对金额进行分析。结果：各城市特殊使用级抗菌药使用情况数据见正文。结论：经过整治,特殊使用级抗菌药处方金额明显下降。     

邯郸地区40家社区卫生院抗菌药物使用情况分析

目的：研究邯郸地区40家社区卫生院2013年抗菌药物使用情况,促进合理用药。方法：统计邯郸地区40家社区卫生院2013年的抗菌药物出库数据并进行分析。统计内容包括药品名称、用药金额、使用时间和使用数量,利用抗菌药物的用药频度观察各种抗菌药物的应用现状。结果：邯郸地区40家社区医院2013年抗菌药物使用量前3位的是阿莫西林克拉维酸钾、头孢哌酮舒巴坦和头孢曲松,用药数量以头孢菌素类(46.47%)和青霉素类(42.09%)为主,抗菌药物在四个季度的应用数量上没有明显波动。结论：2013年邯郸地区社区卫生院的抗菌药物应用总体上符合用药标准,但是对社区卫生院抗菌药物合理应用的宣传和管理仍需加强。     

离子色谱直接提取法测定天花粉中二氧化硫的含量

目的：建立离子色谱直接提取法测定天花粉中二氧化硫（SO2）含量的实验方法。方法采用氢氧化钾溶液（25 mmol/L）直接提取,色谱柱为AS11-HC色谱柱（4 mm×250 mm,9.0μm）;柱温20℃;淋洗液：氢氧化钾溶液（20 mmol/L）;淋洗液流速1.00 mL/min;电导检测法,电导池温度20℃通过分离度实验、精密度实验、重复性实验检测并计算分离度、亚硫酸根峰面积和天花粉中SO2含量及亚硫酸根峰面积与进样量的关系。结果亚硫酸根色谱峰与其他相邻色谱峰间有较好的分离度,峰面积变化不大,亚硫酸根平均含量为每克天花粉含SO20.1977 mg、RSD为0.6%。亚硫酸根标准溶液进样量在1.16～29.1μg（即当进样体积为100μL时,被测定溶液浓度为11.6～291.2μg/mL）与亚硫酸根色谱峰的峰面积有良好的线性关系,平均回收率为99.2%,最低定量限以被测定溶液计算为0.00138μg/mL。结论离子色谱法操作简便、准确、快速,适用于天花粉中SO2的定量检测。     

Prevalence of marijuana use at college entry and risk factors for initiation during freshman year

Background

Marijuana is currently the most commonly used drug on college campuses. Marijuana use among college students is increasing, and many students begin using marijuana during college. The goal of this study was to investigate predictors of lifetime marijuana use at college entry and initiation during freshman year.

Methods

We used responses from the first two semesters of a longitudinal study of 3146 students from 11 colleges in North Carolina and Virginia. Random-effects logistic regression models were constructed to identify factors that predict lifetime marijuana use at college entry and initiation during freshman year.

Results

Nearly 30% of students reported ever having used marijuana at college entry. Among students who had never used marijuana prior to college, 8.5% initiated use during freshman year. In multivariable logistic regression models, having at least $100 per month in spending money; attending church rarely or never; current use of cigarettes, alcohol, and hookah tobacco; lifetime use of other illicit drugs; and a higher propensity toward sensation seeking were associated with a higher likelihood of having used marijuana at least once at college entry. Hispanic ethnicity, living on campus, and current use of cigarettes and alcohol were associated with a higher likelihood of initiating marijuana use during freshman year.

Conclusion

These results have implications for targeting substance abuse prevention programs on college campuses.     

Violent offending severity among injecting drug users: Examining risk factors and issues around classification

Objective

There is a paucity of research as to how injecting drug users (IDU) might be differentiated in the severity of their violent offending. This paper reported on the risks associated with severity, as well as issues around severity classification and the impact on observed relationships with known major risk factors.

Method

A cross-sectional survey administered to 300 IDU, who had injected drugs weekly or more in the past 12 months. A structured questionnaire addresses potential substance use and early-life risk factors for violent offending.

Results

Four severity groups were identified: non-violent (24%), low (34%), moderate (22%) and high (20%) level offenders. Higher severity groups had more prevalent and more severe histories of childhood maltreatment, child psychopathology and dysfunctional trait personalities, as well as more severe substance use problems than low-level and non-violent IDU. Regression analyses found that only two of 15 risk factors remained uniformly associated with violent offending across the four classification schemes tested: (1) having committed violence under the influence and (2) having more impulsive trait personalities.

Conclusions

Disaggregating IDU into distinct subgroups showed that the extent and severity of predispositional and substance use risk exposure corresponded to the severity of violent offending. There is a need to establish a systematic method for classifying severity given that there were clinically meaningful differences between groups which require further exploration and replication, and because there was extensive variation in the risks associated with severity across schemes.     

药物不良反应及预防措施

从药物自身药理作用、药物用法用量、药物制剂工艺和生产质量、用药机体因素（生理因素、病理因素、个体差异）等方面,对药物产生不良反应的原因进行了分析,为临床用药过程中最大限度地减少药物不良反应提出了预防措施。     

我国医疗机构药品集中采购工作回顾性研究

通过文献研究等方法,系统回顾我国医疗机构药品从分散采购到集中采购经历的萌芽阶段、初创阶段、调整阶段和深化阶段,梳理分析不同发展阶段的工作特点、取得的成效、存在的问题.针对当前药品采购面临的问题和挑战,提出改革和完善公立医院药品集中采购办法,坚持以省为单位集中采购的方向,坚持“四个有利于”的基本准则,全面破除“以药补医”机制,同步推进医保、流通、价格改革联动,加强综合服务和监管.     

Modulation of trichloroethylene in vitro metabolism by different drugs in human

Toxicological interactions with drugs have the potential to modulate the toxicity of trichloroethylene (TCE). Our objective is to identify metabolic interactions between TCE and 14 widely used drugs in human suspended hepatocytes and characterize the strongest using microsomal assays. Changes in concentrations of TCE and its metabolites were measured by headspace GC–MS. Results with hepatocytes show that amoxicillin, cimetidine, ibuprofen, mefenamic acid and ranitidine caused no significant interactions. Naproxen and salicylic acid showed to increase both TCE metabolites levels, whereas acetaminophen, carbamazepine and erythromycin rather decreased them. Finally, diclofenac, gliclazide, sulphasalazine and valproic acid had an impact on the levels of only one metabolite. Among the 14 tested drugs, 5 presented the most potent interactions and were selected for confirmation with microsomes, namely naproxen, salicylic acid, acetaminophen, carbamazepine and valproic acid. Characterization in human microsomes confirmed interaction with naproxen by competitively inhibiting trichloroethanol (TCOH) glucuronidation (K_i = 2.329 mM). Inhibition of TCOH formation was also confirmed for carbamazepine (partial non-competitive with K_i = 70 μM). Interactions with human microsomes were not observed with salicylic acid and acetaminophen, similar to prior results in rat material. For valproic acid, interactions with microsomes were observed in rat but not in human. Inhibition patterns were shown to be similar in human and rat hepatocytes, but some differences in mechanisms were noted in microsomal material between species. Next research efforts will focus on determining the adequacy between in vitro observations and the in vivo situation.     

我院开展临床试验用药品集中管理的实践体会

目的:构建临床试验用药品集中管理模式,加强试验用药品的规范化管理。方法:分别从标准操作规程的内容及相关管理措施、工作体会等方面介绍我院建立的以机构专用药库为平台的临床试验用药品集中管理模式。结果与结论:我院建立了试验用药品的接收、保管、发放及回收的标准操作规程,并通过改进试验用药品信息化管理功能模块、药库配备温湿度监控系统、对试验用药品有效期实行色标管理等举措,实现了试验用药品机构内流转各环节的全程规范化管理及药物管理员、研究者、质控人员等的信息共享,保证了药物临床试验的质量。该模式具有药物管理员可随时掌控项目研究进展等优点,但不适用于所有的临床试验流程。