腰椎间盘髓核摘除术围手术期抗菌药物应用情况调查

目的了解腰椎间盘髓核摘除术围手术期抗菌药物应用情况,为临床合理使用抗菌药物提供依据。方法采用回顾性调查方法,对脊柱外科2008-01～2009—12腰椎间盘髓核摘除术的79份病历进行抗菌药物应用的统计分析。结果79例手术患者围手术期抗菌药物使用率为100％,一联使用占55．69％,二联使用占43．04％,三联使用占1．27％;预防用药共4种,头孢菌素类占47．83％,而且多为二、三代头孢菌素类。结论腰椎间盘髓核摘除术的预防用药存在使用率高、种类选用欠妥及用药时间过长等问题,应针对问题,抓住重点,进一步规范管理,促进抗菌药物合理使用。     

泸州地区8家医院门、急诊处方抗菌药物应用调查与分析

目的:了解泸州地区8家医院门、急诊处方抗菌药物应用现状,促进临床合理用药。方法:采用回顾性分析方法,对泸州地区8家医院(二级医院6家、三级医院2家)2011年3~6月共4800张门急诊处方指标进行评价分析(每家医院每月儿科处方、普通成人处方、急诊处方各50张)。结果:4800张处方中使用抗菌药物的处方有1985张,占处方总数的41.35%;存在头孢菌素类抗菌药物使用比例较大,药物联用偏多,给药途径、用法用量不尽合理等问题。结论:应重视抗菌药物的合理应用,制订相应制度,加强管理,保证患者的用药安全。     

Laboratory detection of marijuana use

Frequent smoking of cannabis (marijuana) has been shown to be associated with a decline in social, mental, and perceptual skills and, during adolescence, with maladaptive emotional development. Urinalysis for the detection of such use can be a useful tool for the physician responsible for treatment and counseling of adolescents who develop habitual use of marijuana. Primary methods for urinalysis detection of cannabis use include the homogeneous enzyme immunoassay (EMIT) and the radioimmunoassay. These and other methods are discussed along with the issues of "false" results (both positive and negative) and the "limits of interpretation" that can be placed on a positive urine result. The pharmacokinetics and metabolism of the active constituents of cannabis are described as well as the interpretation of urinalysis results as they relate to use patterns. Guidelines are presented for the primary care physician for selecting candidates for such testing and for the use of such tests in the treatment or counseling of adolescents for whom marijuana abuse has become a psychological and social problem.     

麻风病院患者用药情况及合理性分析

目的 分析麻风病患者的用药情况及趋势。方法 选取我院麻风病院药房2015年1月～2017年1月用于治疗麻风病患者药物处方单1278份,共涉及826例次患者。分析研究对象并发症相关疾病的诊断情况、抗菌(单一使用和联合用药)和抗炎药物(非甾体抗炎药)使用情况以及不合理用药情况。结果 临床诊断发病较多的为麻风溃疡、上呼吸道感染及神经痛,使用抗菌药物患者共826例次,其中使用单一药物治疗占抗菌药物治疗的79.30%,联合用药占20.70%;使用抗炎镇痛药物较多的为麻风溃疡(55.21%)、关节损伤(32.43%)及麻风眼病(12.36%);共有92例次患者出现用药不合理情况,占总数的11.13%,其中用药剂量不合理情况最多。结论 麻风病院患者的用药主要集中于麻风溃疡、上呼吸道感染和疼痛等疾病,应根据患者病情发展,合理调整药物的剂量,增强用药的合理性,减少不良反应的发生,提高麻风病患者的生活质量。     

抗茵药物应用现状分析及对策

目的分析抗茵药物的应用情况,对用药不合理情况提出对策。方法选取大连市第三人民医院2009年7月-2009年8月600例使用抗茵药物的住院病历作为研究对象。对患者使用抗茵药物后的反映情况进行分析。结果600例患者病历中使用抗菌药物最多的是头孢曲松钠针,其次是头孢替唑钠针,往下依次是阿奇霉素针、头孢他啶针、头孢哌酮／舒巴坦钠、克林霉素针、头孢哌酮钠针和头孢唑啉钠针,最少是去甲万古霉素针。600例患者的处方中诊断与选药符合处方数占97％,诊断与选药不符合处方数占3％,两者有明显的差异性。结论临床对住院患者抗茵药物的应用基本合理,但也有不合理的地方,应加以改进,进一步提高临床用药的合理性。     

抗菌药物合理使用动态监测系统的应用

目的:对医院抗菌药物的使用实施动态监测,促进临床合理用药。方法:利用抗菌药物合理应用动态监测系统并结合临床药学的实际工作特点,实现对医院临床抗菌药物合理使用的动态监测及实时干预。结果:本系统从医院药学的实际工作需要出发,较好地实现了对全院临床抗菌药物使用的动态监控。结论:本法高效、科学和实用性强,能提高医院合理用药,更好地为患者服务。     

Colchicine in acute gout. Reassessment of risks and benefits

Colchicine is an effective and relatively specific treatment for acute gout and has a long, venerable history. Serious toxic reactions to colchicine could be prevented if guidelines for its use were followed strictly, but because of its relatively infrequent use and conflicting recommendations, considerable toxic effects might occur and still be undetected by passive surveillance. A review of a teaching hospital's four years' experience showed two deaths (2% incidence) due to inappropriate use. Colchicine has the smallest benefit-to-toxicity ratio of drugs that are effective for acute gout. This article gives specific recommendations for the use of colchicine in different clinical settings.     

注射用阿莫西林克拉维酸钾与注射用溴己新配伍禁忌1例报道

注射用阿莫西林克拉维酸钾为白色或类白色粉末,主要成分为阿莫西林钠和克拉维酸钾,两者成分所占比例为5∶1,为广谱青霉素类抗生素,主要用于治疗呼吸道感染。注射用盐酸溴己新是从鸭咀花碱得到的半合成品,具有减少和断裂痰液中粘多糖纤维的作用,使痰液粘度降低,痰液变薄,易于咳出。其次是其能抑制粘液腺和杯状细胞中的唾液酸（酸性粘多糖成分之一）含量减少,痰液粘度下降,有利于痰咳出。本药的祛痰作用与其促进呼吸道粘膜的纤毛运动及祛痰作用有关。该药主要用于呼吸道感染有粘痰不易咳出的患者。本品与抗生素联用,疗效更好,但在实际应用过程中静脉滴注阿莫西林克拉维酸钾与盐酸溴己新时,输液管道内会出现乳白色混浊。现对发生过程报道如下。     

抗菌药物不合理应用的现状分析与讨论

目的 针对当前抗菌药物不合理应用及滥用的现状，探讨如何合理应用抗菌药物。方法 根椐抗菌药物联合用药的原则对所抽查298张门诊、住院患者处方的临床资料进行分析比较。结果 处方中存在着许多不合理应用抗菌药物的现象，抗生素口服与注射分别占处方中药物的48．7％和49．3％，其中半数以上处方的抗生素超过2种或2种以上。结论 对抗菌药物不合理应用及滥用的现状应引起重视，建议加强学习，提高诊疗技术水平，以达到合理应用抗菌药物的目的。     

回顾性分析总结胎儿超声检查的操作技巧及注意事项

目的探讨巧妙运用胎儿超声检查的操作技巧在产前诊断中的意义。方法选取该院2009年—2011年2024名孕13～26周进行超声产检的孕妇,总结在检查过程中是否灵活运用操作技巧及一些注意事项,比如:用标准化的方法测量、超声入射线角度选取、注意胎儿解剖结构的完整性及标准平面、应适当保存图像等。结果 428名孕妇(21.2%)初次检查时图像采集存在一些问题:图像不完整,有些畸形易发部位无法清楚显示或难以显示。掌握超声检查操作技巧后,420名孕妇再次接受检查,共检出畸形胎儿42例,占产前超声检查的胎儿畸形数的10.0%。结论巧妙地运用胎儿超声检查技巧、注意相关事项可以准确地对胎儿形态结构畸形进行筛查,为产科提供可靠的信息以指导临床。     

心肌灌注断层显像定量分析用参考数据的建立

目的在心肌灌注断层显像定量分析软件的使用过程中,逐步建立和完善参考数据。方法推导使软件能够进行机器学习的公式,并编程实现该功能。结果软件可随时根据新的正常人数据自动刷新现有参考数据,逐步提高参考数据的可信度;并能恢复原参考数据,消除误操作的影响。结论可在使用过程中逐步提高定量分析软件诊断的可靠性。     

Confidentiality and the ethics of medical ethics

In this paper we consider the use of cases in medical ethics research and teaching. To date, there has been little discussion about the consent or confidentiality requirements that ought to govern the use of cases in these areas. This is in marked contrast to the requirements for consent to publish cases in clinical journals, or to use personal information in research. There are a number of reasons why it might be difficult to obtain consent to use cases in ethics. Many cases concern people who are incompetent, and thus unable to give consent. Often the material is of a sensitive nature, it is not clear who should give consent, or the ethicist has no access to those involved. We argue that the use of cases in ethics research and teaching can be justified by appeal to the public interest argument, and suggest a number of areas for discussion and clarification.     

门诊及急诊5072张处方抗菌药物使用情况统计分析

目的通过分析门诊、急诊处方使用抗菌药物的情况,以规范抗菌药物应用,提高临床应用抗菌药物水平。方法随机抽取我院2008-01—2008-04月份门诊、急诊处方5072份,进行了抗菌药物统计分析。结果抗菌药物使用率为48．28％,联用占抗菌药物处方数的46．27％,其中不合理联用占28．30％。结论在门诊、急诊中抗菌药物有待强化合理应用。严格按照卫生部、国家中医药管理局、总后卫生部联合颁布的《抗菌药物临床应用指导原则》来规范和约束抗菌药物使用,促进我院门诊、急诊合理应用抗菌药物水平的提高。     

药物利用研究在中药注射剂临床应用合理性和安全性评价中的应用

随着中药注射剂上市后再评价的深入,围绕着中药注射剂安全性、有效性、经济性的评价,开展了大量的探讨。作为中药注射剂安全和有效使用的基础,合理用药也是中药注射剂上市后再评价研究不可忽视的重要研究内容。采用药物利用研究的相关方法对中药注射剂在医疗机构中的使用进行评价,不仅能够进一步的指导临床用药,提供合理用药信息,还可以促进医院的药事管理,同时药物利用研究具有的经济学评价属性使得其可以为医政部门制定药品政策提供决策依据。通过对中药注射剂的药物利用研究,提示基于PDD计量指标的药物利用研究可作为中药注射剂药物利用评价的借鉴方法,基于DUR的药物流行病学和药物经济学能够为中药注射剂临床使用合理性与安全性再评价提供可借鉴的思路和方法。     

抗菌药物应用情况与分析

目的了解我院住院病例抗菌药物应用现状,促进抗菌药物的合理应用。方法随机抽样调查我院2006年1月—9月出院患者病历2691份,对抗菌药物的应用现状进行回顾性的分析。结果抗菌药物平均使用率为72.9%,联用率为45.4%,用药目的主要是预防性用药,占61.9%,给药方式主要是静脉给药。结论制定抗菌药物的用药原则,加强培训,定期监控,进一步加强抗菌药物合理应用管理。     

Smoking, drinking and use of illicit drugs among adolescents in Ontario: prevalence, patterns of use and sociodemographic correlates.

Data from a cross-sectional survey of the health of Ontario children carried out in 1983 were used to provide estimates of the prevalence, patterns and sociodemographic correlates of the use of tobacco, alcohol and illicit drugs (substance use) among adolescents aged 12 to 16 years. Ninety-one percent of selected households participated. The prevalence rates of all categories of substance use, except use of inhalants, increased with increasing age. Among children aged 14 to 16 years the rates for girls were higher than those for boys for all categories of substance use except use of other, nondefined drugs. The prevalence rates of substance use tended to be higher in small urban areas except for use of marijuana (more prevalent in large urban areas) and use of inhalants (more prevalent in rural areas). The strongest evidence of clustering of substance use within families was found for smoking. Children who used less prevalent drugs (e.g., "hard" drugs) also tended to use the more prevalent ones (e.g., marijuana, tobacco and alcohol). Associations between substance use and low socioeconomic status suggested a positive relation with smoking and a negative relation with use of alcohol. The findings highlight the need for preventive programs aimed at specific subgroups in the adolescent population.     

Can the use of low-dose dopamine for treatment of acute renal failure be justified?

The use of dopamine for the prevention and treatment of acute renal failure is widespread. Its use is based on physiology suggesting selective renal vasodilation when it is infused at low dose. This article reviews the available data on the clinical use of dopamine. When used to prevent acute renal failure in high-risk treatments there is no evidence of benefit of dopamine but, given the low incidence of significant renal failure, the studies are underpowered. In treatment of acute renal failure, the quality of the data is poor. Only in one small randomised trial of moderate acute renal failure in patients with malaria was a clinically significant benefit of dopamine shown. The rest of the data, in the form of case series, showed either no benefit of dopamine or small benefits of little clinical significance. Again, these studies are of insufficient power for conclusions to be drawn as to the overall benefits and risks. We conclude that benefits of dopamine use cannot be ruled out by currently available data but its use cannot be advised until trials examining clincally important endpoints in large numbers of patients have been performed.     

大连医科大学SCI论文榜数据库的建设

针对国内高校网站SCI论文榜现状,介绍了大连医科大学SCI论文榜的建设内容、特点,指出高校图书馆建库要从用户角度考虑,充分利用网络技术,在保证数据质量的前提下对数据进行二次加工,为用户提供尽可能多的内容和链接,方便用户浏览详细信息和利用相关资源。由于SCI论文榜数据质量要求较高,还要在技术和人力上做好充分准备,馆员需具备耐心、细致的特质。     

'Eve' and 'Ecstasy'. A report of five deaths associated with the use of MDEA and MDMA

3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy"), a synthetic analogue of 3,4-methylenedioxyamphetamine, has been the center of recent debate over its potential for abuse vs its use as a psychotherapeutic agent. Following its emergency classification in Schedule 1 by the Drug Enforcement Administration in 1985, 3,4-methylenedioxyethamphetamine (MDEA, "Eve") has appeared as MDMA's legal replacement. MDMA is thought to be safe by recreational users and by psychotherapists who support its use. The details of five deaths associated with the use of MDMA and MDEA are reported. In three patients, MDMA or MDEA may have contributed to death by the induction of arrhythmias in individuals with underlying natural disease. In another patient, use of MDMA preceded an episode of bizarre and risky behavior that resulted in accidental death. In another patient, MDMA was thought to be the immediate cause of death. Death as a consequence of the use of these drugs appears to be rare, but it does occur; this outcome may be more common in individuals with underlying cardiac disease.     

Constraining the use of antibiotics: applying Scanlon's contractualism

Decisions to use antibiotics require that patient interests are balanced against the public good, that is, control of antibiotic resistance. Patients carry the risks of suboptimal antibiotic treatment and many physicians are reluctant to impose even small avoidable risks on patients. At the same time, antibiotics are overused and antibiotic-resistant microbes are contributing an increasing burden of adverse patient outcomes. It is the criteria that we can use to reject the use of antibiotics that is the focus of this paper. Scanlon's contractualism explains why antibiotics should not be used to gain small benefits, even when the direct costs of antibiotics are low. We know that some individuals now (and probably more in the future will) carry a burden of irretrievable harm as a consequence of treatment- (antibiotic-) resistant infection. If we accept that the dominant justification for use of antibiotics is to prevent irretrievable harm to an individual or contact, then the use of antibiotics for self-limiting conditions, or for the treatment of individuals with conditions for which antibiotics do not substantially impact on outcomes (eg, in the latter stages of terminal illness), or for access based on preference or willingness to pay (internet or over-the-counter access), or the use of antibiotics as animal growth promoters can be rejected. Scanlon's approach also suggests that, with few new antibiotics in the pipeline and an increasing burden of disease attributable to resistant microbes, control of the spread of antibiotic-resistant microbes should be given increasing priority.