医务人员临床合理用药认知水平现况调研

目的：了解医务人员对药物不良反应、处方管理、国家药物基本政策和抗生素合理使用等基本政策和知识的认知情况。方法：对107名不同年资的医师、护师和药师进行了问卷调查。结果：调研问卷总体正确率低于50％，对政策法规了解率相对于其他几项稍高，不良反应知识的认知率最低。结论：医务人员虽然已经普遍认识到合理用药的重要性，但对合理用药相关政策和知识仍然缺乏了解，掌握合理用药知识的水平差异较大；应加强对医务人员进行药物合理应用知识的宣传与培训。     

对我院医务人员抗菌药物合理应用知识水平的调查与分析

目的:评价我院医务人员的抗菌药物合理应用知识水平,有针对性地提出干预措施。方法:根据抗菌药物合理应用基本原则及基本知识设计问卷,对我院医务人员进行无记名、现场问卷调查。结果:医务人员对抗菌药物合理应用知识水平的差异较大,药师的得分明显高于医师和护士,内科医师得分略高于外科医师,中级职称医务人员得分较高,其次分别为高级职称和初级职称人员。结论:有必要加强对医务人员抗菌药物应用知识的培训、监管。     

对泉州市县级以上医务人员合理使用抗菌药物知识的调查

目的了解医务人员对合理使用抗菌药物知识的掌握程度，找出存在问题，帮助医务人员提高合理使用抗菌药物意识，保障病人用药安全。方法采用问卷调查法．以抗菌药物概念、合理用药原则、联合用药指征、滥用药物危害、降低耐药途径为主要内容，抽样调查县级以上医院1370名医务人员合理使用抗菌药物知识认知程度。结果医务人员对合理使用抗菌药物知识认知程度低，而对这方面知识需求较强烈。结论必须加强培训、加大宣传合理使用抗菌药物知识的力度，并促进理论与实践相结合。     

湖北省三级医疗机构医务人员抗菌药物合理应用考核效果调查与评估

目的：对湖北省医疗机构抗菌药物临床应用与管理培训班进行效果调查与评估,以促进抗菌药物的合理使用。方法：设计调查问卷,从抗菌药物的基本概念、用药原则、作用机制、药物特点等角度进行考核,用SPSS13.0软件统计数据,分析医务人员的抗菌药物知识水平。结果：医务人员对单选题和多选题设计的知识点整体掌握较好,问答题中各得分点的正确回答人数比例在7.88%-99.01%间,差异很大;对抗菌药物管理要求认知状况较好,但对于抗菌药物概念及其与抗生素的区别缺少关注。结论：学员合理使用抗菌药物的知识水平总体较高,明确抗菌药物的管理要求;对抗菌药物与抗生素的区分需要进一步明晰。     

临床药师干预临床不合理用药的效果评价

目的:评价临床药师干预临床不合理用药的效果。方法:选取本院2016年实施临床药师干预前后住院医嘱中使用抗菌药物的病历各200例,采用回顾性分析法,回顾分析在临床药师干预下的住院医嘱中抗菌药物合理使用效果。结果:实施临床药师干预后,本院住院患者抗菌药物用药排序以及用药频率有了显著改善;在干预后的抗菌药物使用中,主要使用差异体现在单独用药、二联用药、三联用药等方面;经过临床药师干预,临床用药不合理的现象有了明显改善,差异存在统计学意义(P<0.05)。结论:临床药师干预抗菌药物不合理使用,可降低抗菌药物的使用率和联合用药的比例,可促进我院抗菌药物的合理使用,提高合理用药水平。     

药品不良反应及安全用药知识在某三甲医院三类医务人员中认知度研究

目的：研究了解医师、护师、药师三类医务人员对药品不良反应（ADR）以及安全用药相关知识的认知情况,为ADR及临床安全用药监测的深入开展提供参考。方法：利用网上药学问卷调查平台对皖南地区某大型三级甲等医院45个临床科室的医务人员（医师、护师、药师）的ADR以及安全用药相关知识进行网上调查,数据由平台自动导出Excel表格,使用SPSS19．0软件进行统计分析。结果：通过调查平台,获取有效调查问卷575份,医务人员对ADR和安全用药知识的平均知晓率为83．0％,对ADR上报流程平均知晓率为83．4％。三类医务人员（医生、护师、药师）对于“什么是ADR”、“用药错误的含义”等基本概念的知晓程度较高,回答无明显差异（P〉0．05）。对于“药品不良反应／不良反应事件（ADR／ADE）”、“用药错误”的判断,回答存在显著差异（P〈0．001）,医师、护师的知晓程度低于药师。对于“用药后出现ADR的应对措施”、“ADR必须填写的项目”等问题,三类医务人员（医生、护师、药师）问题差异无统计学意义（P〉0．05）,但对于“ADR上报期限”等的回答有显著差异（P〈0．001）,药师的知晓率高于医师、护师。结论：综合分析该院三类医务人员对ADR和安全用药基本知识掌握总体较好,但对于ADR与ADE、用药错误等概念之间差别存在混淆。应以多种形式对医务人员的ADR和安全用药相关知识进行培训、教育,提高医务人员对ADR／ADE、用药错误等的判断能力,加强ADR监测水平和上报意识,提升合理用药水平,保障患者用药安全。     

基层医院医师对抗菌药物分级使用的认知现状

目的了解基层医院医师对抗菌药物分级使用的认知现状,寻找抗菌药物不合理使用的因素,以便采取有效措施,促进临床合理用药。方法采用自行设计的问卷调查表,对79名医师进行问卷调查。结果 79名医师对抗菌药物分级使用相关知识知晓率最低的是抗菌药物的特殊使用原则51.90%,抗菌药物疗效与产地的关系50.63%,不合理使用抗菌药物后果48.37%。结论基层医院医师对抗菌药物分级使用的相关知识认知较低,有必要加强医务人员抗菌药物合理应用知识的培训和监督,进一步提高我院医务人员抗菌药物合理应用的水平。     

临床药师参与产科抗感染药物应用会诊的实践与体会

目的:为临床药师参与产科抗感染药物应用会诊提供参考。方法:对临床药师参与产科抗感染治疗的4例典型案例进行分析。结果:临床药师在临床疾病治疗进程中,对协助医师合理用药发挥了一定作用,提出的会诊意见和建议得到了临床认可。临床药师应掌握抗菌药物特点,合理选择抗菌药物;不能仅参考药敏结果,还需结合临床症状综合判断,切勿滥用抗菌药物;充分考虑孕期妇女生理特点,作出合理判断。结论:临床药师参与临床会诊,对提高临床诊疗水平及保障患者用药安全、有效、经济、合理具有极大的帮助和促进作用。     

海口市儿童家长抗菌药物知识认知度调查

目的:了解海口市儿童家长对抗菌药物知识的认知度,为儿科合理使用抗菌药物提供参考。方法:向海口市大型综合医院、妇幼保健院儿科门诊和儿科住院患儿家长发放调查问卷,针对儿童家长抗菌药物用药安全意识和抗菌药物知识进行调查研究。结果:共发放问卷5300份,回收5083份,其中有效问卷5000份,有效率为98.37%。调查结果显示,患儿家长抗菌药物用药安全意识和抗菌药物知识与文化程度和居住地有关,文化程度越高和居住在大中城市的家长,抗菌药物用药安全意识越高和掌握抗菌药物知识程度越高,差异有统计学意义(P<0.05)。结论:建议相关部门加强普及大众的抗菌药物知识,药师应发挥积极的作用,通过提供用药咨询和指导等方式,增强患儿家长安全用药意识,促进合理使用抗菌药物,降低抗菌药物不良应发生的风险。     

门诊处方抗菌药物使用调查分析

目的:了解门诊抗菌药物的使用情况,指导临床合理用药。方法:对2010年10月～2010年12月,门诊患者379张抗菌药物处方使用抗菌药物的使用率、国家基本药物目录药品使用率及药品通用名使用率、联合用药等情况进行回顾性调查。结果:门诊处方合格率为87.4%,不合格率为12.6%。结论:门诊处方抗菌药物使用中存在应用不合理的现象,应健全合理使用抗菌药物的管理组织和制度,加强对医务人员合理使用抗菌药物的知识培训,有效开展药学服务指导,以促进抗菌药物的合理使用,提高治疗水平。     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

---

Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.