Moral reasoning perspectives of community pharmacists in situations of drug shortages

BackgroundDrug shortages affect health systems worldwide. Research in community pharmacy has focused on the nature, extent and impact of these shortages on patients and pharmacists. However, pharmacists’ moral reasoning in situations of drug shortages has not been addressed.ObjectiveTo explore the moral reasoning perspectives of Dutch community pharmacists in situations of drug shortages.MethodAn electronic survey was developed around three drug shortage scenarios with a varying impact on patient outcomes: a Contraceptive, a Parkinson's and an Osteoporosis scenario. Pharmacists rated the likelihood of nine handling options and rated and ranked 13 considerations that may have played a role therein. The considerations represented three moral reasoning perspectives (MRPs): a business orientation (BO), a rules and regulations (RR), and a professional ethics (PE) MRP. Principle component analysis (PCA) was used to investigate construct validity of the MRPs. MRP rating and MRP ranking scores measured the relative importance of the different MRPs of pharmacists in the three shortages.ResultsResults from 267 Pharmacists were obtained. They reported mostly similar handling in the three shortages, except for the likelihood to make agreements with prescribers or other pharmacists and regarding the decision to import a product. The PCA analysis confirmed the three MRPs that accounted for 29% of variance in the data. Both the MRP rating and especially the MRP ranking scores indicated that PE-MRP considerations were most influential on pharmacists' intended handling of the shortages. In the Contraceptive and the Osteoporosis scenarios, the relative importance of a BO-MRP was higher than in the Parkinson's scenario.ConclusionPharmacists predominantly reason with a PE-MRP when handling drug shortages. However, this perspective can be compromised when the drug shortage is perceived to have a lower impact on patient outcomes and when alternative drugs or therapy are expensive.     

从气机升降探讨胃癌的病机治则

胃癌是因外邪侵袭、情志内伤、饮食失调等,致气机升降失调,气血津液运化失常,气滞、血瘀、痰浊及癌毒内生,日久积聚于胃脘而成。脾胃为气机升降之枢纽,脾不升清,胃不降浊,则精微不能濡养,浊液不能排出,影响体内正常气机升降。肝主疏泄,调节全身气机的条达,肝之疏泄功能失常,气机升降失调,则影响气血运行。气机升降关系在胃癌形成中起关键作用,气机升降失调,气血津液不能正常输布运行,则气凝血滞,痰浊内停,甚则癌毒内生,发为癌瘤。故在临床治疗中注重恢复脾胃的升降功能,辛开苦降,调畅气机,恢复脾胃的正常升降功能,为胃癌的治疗提供临床指导。     

生理学教学核心理念变革的探讨

医学教育改革更多的是热衷于授课形式和方法的改革，而忽视了真正能够渗透到教学各方面的教学理念的改革。结合对生理学教学目标的反思和“岗位胜任力”培养的需求，将生理学教学的核心理念总结为四个方面：“三观”要正，帮助学生树立平衡观、辩证观和整体观；“三基”要牢，培养学生掌握基本的知识架构体系、基本的知识获取能力、基本的操作技能；重视学以致用和强化人文素养。上述核心理念在教学实践中得到学生的广泛认可，临床医学专业学生对核心理念的评价明显高于护理专业。下一步教学改革的方向是在教学理念的指导下如何细化授课内容，以适应专业设置越来越细化的现状。     

反流性食管炎中医学研究进展

反流性食管炎(RE)是由于胃或十二指肠的内容物反流入食管,而引起食管组织黏膜炎症、糜烂和纤维化等病变。属于胃食管反流病(GERD)的范畴,临床上以反酸、烧心、灼热、疼痛、嗳气等为主要表现,常见的并发症为食管狭窄、出血、Barrett食管及食管腺癌等。中医学中没有反流性食管炎的病名,但根据其临床表现,可以归属于“吞酸”、“吐酸”、“嘈杂”、“胃脘痛”等范围。中医对反流性食管炎的认识逐渐完善,治疗上以“和法”为主,并取得了良好的疗效。但因在中医病名、辨证和治疗上缺乏统一标准,有待临床进一步研究。本文通过查阅相关文献,概括出反流性食管炎的中医病因病机、辨证分型、治则治法及常用方药,探讨反流性食管炎的中医学研究进展。     

卢尚岭对高血压的病机认识与临证经验总结

总结卢尚岭教授对髙血压病机的理论认识及临证经验。髙血压发病之本在气机失调,气机失调先责肝脾二脏。由此引起诸多病机变化,如,情志所伤,肝气郁结,诸郁遂生;饮食失节,损伤脾胃,导致中焦壅滞,气机不利,日久必然损伤血脉,危害脏腑。据此,卢老强调肝脾气机失调、升降之机失常、脏腑功能紊乱存在于髙血压全过程,进而提出调治髙血压以斡旋气机,调整脏腑功能,藉以恢复阴平阳秘之常态为主导。认为临证应首辨气机失调及病变脏腑,治以调气为先,兼顾化痰、活血、疏肝清火、平肝潜阳、滋补肝肾、滋阴和阳、扶阳镇水等,同时强调外治,善用足浴。     

Characterization of the interaction forces in a drug carrier complex of doxorubicin with a drug‐binding peptide

Polypeptide‐based materials are used as building blocks for drug delivery systems aimed at toxicity decrease in chemotherapeutics. A molecular‐level approach is adopted for investigating the non‐covalent interactions between doxorubicin and a recently synthesized drug‐binging peptide as a key part of a system for delivery to neoplastic cells. Molecular dynamics simulations in aqueous solution at room and body temperature are applied to investigate the structure and the binding modes within the drug–peptide complex. The tryptophans are outlined as the main chemotherapeutic adsorption sites, and the importance of their placement in the peptide sequence is highlighted. The drug–peptide binging energy is evaluated by density functional theory calculations. Principal component analysis reveals comparable importance of several types of interaction for the binding strength. π‐Stacking is dominant, but other factors are also significant: intercalation, peptide backbone stacking, electrostatics, dispersion, and solvation. Intra‐ and intermolecular H‐bonding also stabilizes the complexes. The influence of solvent molecules on the binding energy is mild. The obtained data characterize the drug‐to‐peptide attachment as a mainly attractive collective process with interactions spanning a broad range of values. These results explain with atomistic detail the experimentally registered doxorubicin‐binging ability of the peptide and outline the complex as a prospective carrying unit that can be employed in design of drug delivery systems.     

中药对照制剂研制指导原则和技术要求

中药对照制剂是中药标准物质发展的新形式。为指导该标准物质的建立,规范其研究及在国家药品标准中的应用,提出本指导原则。规定了中药对照制剂的定义,介绍其研制指导原则和技术要求,分析其在中药质量控制中的应用,并提出发展思路。对照制剂在中药质量控制中有广泛的应用前景,探索并推行以中药对照制剂为对照的质量评价体系具有实际意义。     

人工牛黄薄层指纹图谱多元图像分析及化学计量学研究

建立了人工牛黄薄层指纹图谱,对其图像进行数字化和化学计量学研究。首先采用以环己烷-乙酸乙酯-乙酸-甲醇(2∶7∶1∶2)为展开剂,10%硫酸乙醇溶液为显色剂,105℃加热至斑点清晰,并在366 nm下采集数码图像。然后将该图像转换成为灰度图像,得到指纹图谱的灰度曲线图多元数据,并采用主成分分析法对多元数据进行分析。结果表明薄层指纹图谱可表征不同生产企业生产的人工牛黄,并且分析得到图谱上表征来源的特征区域。该方法简便,快速,适合用于不同来源的人工牛黄质量差异的评价。