浅谈护士长的管理技巧

护理管理是学习和运用现代化的管理方法和管理知识，对护理工作进行以质量控制为中心的科学管理。因此，护理管理主要是通过护理部主任、科护士长和病区及门诊护士长对护理人员的管理。科护士长和病区及门诊护士长作为医院中的基层领导者，起着承上启下的关键作用。她们接触广泛，工作复杂，在工作中担任各种角色。护士长要搞好管理工作，就要具有强烈的事业心、责任感和较强的业务水平，协调好人际关系，保证各部门密切配合，互相取长补短，以提高护理质量。更重要的是要学会科学的工作方法和掌握好领导艺术，只有这样，才能使愿望和效果统一，动机和目的一致，收到事半功倍的效果，成为一个合格的护士长。     

儿童预防接种晕厥的分析与预防

儿童免疫预防接种，是有计划的使儿童获得特异性免疫，降低人群易感性，控制相应传染病的主要方法之一，关系到下一代的健康成长。我国原来的国家计划免疫是五苗防七病，即卡介苗、脊灰疫苗，百白破，白喉破伤风麻疹和乙肝疫苗。主要防治结核病，脊髓灰质炎，百日咳，白喉破伤风麻疹和乙型肝炎。现在计划免疫规划扩大化，新增加了乙脑和甲肝疫苗，预防乙型脑炎和甲型肝炎。但是在预防接种工作中经常会遇到一些儿童发生预防接种异常反应如晕厥等情况。近几年，我们曾经对16例儿童预防接种晕厥病例进行了处理，观察和分析，现将粗浅的体会分析总结报告如下：     

医院药品编码的研究

21世纪是一个网络科技飞速发展的世纪，随着各行各业计算机的普及，逐渐实现了网络的资源共享和信息交流。当前我院管理信息系统的开发，尤其是药剂科各部门计算机的应用，在节省了大量的人力、物力、财力资源的同时，也收到了良好的社会效益和经济效益。但由于药品品种众多，给药品管理和流通造成混乱，药学管理和信息系统软件功能开发困难，而科学的药品编码是实现药品信息化管理的核心和基础。结合我院实际需要，建立以下药品编码原则，方便药品管理、统计和分析。     

中西医结合临床研究的思路

长期以来，临床研究主要停留在临床观察和一般病例医学报告上，师徒心传口授和个人经验的积累对临床医学的产生和发展虽发挥了积极的作用，但毕竟有其片面性和盲目性。随着科学方法学与科学技术的飞速发展，临床医学的研究思路与方法也跨人了一个崭新的阶段。临床流行病学及循证医学等科学方法学的形成和广泛运用，大大促进了临床医学的发展，提高了中西医结合临床研究的质量和水平。中西医结合是中西医两种医学的取长补短，互相渗透。一般说来，辨证论治是中医学的特点，它体现了中医的整体恒动观，重视人体内在的抗病能力，强调具体情况具体分析。西医以辨病为主，重视局部的器质和功能变化，运用现代科学技术和手段，在诊断和治疗方面也有许多特长。     

中药的合理应用

药物是治疗疾病的重要手段之一，直接关系到患者和公众的生命健康以及生活质量。但药物对人体的效应具有双重性，治疗作用和不良反应。因此，中药的合理应用具有至关重要的作用。每一个中药工作者，都应以安全，有效，简便，经济为基本原则，熟练掌握中药知识和相关技能，使社会和患者都获得最佳效益。     

常用几种盐制中药炮制方法的改进

食盐性味咸寒，有清热凉血，软坚散结，润燥，通便的作用。因此，盐灸法多用于补肾固精，治疝和利尿泻相火的药物。而盐灸的目的是引药下行和增加滋阴降火的作用。它的操作方法不外分为两种，即先拌盐水后炒和先炒药后加盐水。但在实际操作中，我们仍旧采用的是传统的炮制方法，致使炒制时间和温度难以控制，外观不能一致，质量更是难以掌握。     

脑出血患者的健康教育

脑出血又称脑溢血，是指脑实质内的、非创伤性出血，主要发生于高血压和脑动脉硬化的患者，发病急，进展快，是临床上常见病，死亡率和致残率高。死亡率和致残率与患者是否及时就诊，知识缺乏与生活护理不当有直接关系。通过健康教育，可减少疾病复发次数，降低病死率和致残率，达到提高生活质量，使患者早日康复的目的。     

心血管危险因素控制目标的健康号码

过去的100年，世界范围的疾病谱发生了明显的变化，心血管病取代传染病，从一种相对无关紧要的疾病，转变为主要的疾病和死亡原因。20世纪初，心血管病仅占死亡的10％，到了21世纪初，心血管病在发达国家和发展中国家分别占了总死亡率的50％和25％。随着中国人民生活水平的提高，寿命的延长，社会城市化和生活方式变化，体力活动减少，     

单克隆抗体靶向抗肿瘤药的临床评价

伴随生态环境、遗传基因、生活和精神因素的改变，肿瘤已经成为威胁中国人健康和生命的“头号杀手”。其发病率和病死率逐年攀升，成为人类所必须应对的一项严峻挑战，同时也为新药的研发和问世带来了契机。鉴于抗肿瘤药作用的非特异性和非专一性，其在带来化疗效果和临床获益的同时，也给人体带来各种器官损伤和药品不良反应。因此，必须提高用药的安全意识，把防范风险的意识前移，从药品临床应用的各个方面进行反思，防微杜渐，以追求药物治疗的最大获益。     

心血管危险因素控制目标的健康号码

过去的100年，世界范围的疾病谱发生了明显的变化，心血管病取代传染病，从一种相对无关紧要的疾病，转变为主要的疾病和死亡原因。20世纪初，心血管病仅占死亡的10％，到了21世纪初，心血管病在发达国家和发展中国家分别占了总死亡率的50％和25％。随着中国人民生活水平的提高，寿命的延长，社会城市化和生活方式变化，体力活动减少，高脂肪饮食增多和体重增加，心脑血管疾病的顺位逐渐前移。据中国国家卫生部统计信息中心发布的2006年中国卫生事业发展情况统计公报显示，     

Darifenacin: in the treatment of overactive bladder

Darifenacin is a selective muscarinic M3-receptor antagonist that has been evaluated in clinical trials in patients with overactive bladder syndrome (OAB) using a controlled-release formulation. In multicentre, randomised, double-blind trials in patients with OAB, darifenacin 7.5 or 15 mg once daily for 12 weeks significantly reduced the frequency of urinary incontinence, frequency of micturition and frequency and severity of urgency versus placebo. A significant difference from placebo was apparent 2 weeks after starting treatment. At a dosage of 30 mg once daily, darifenacin significantly prolonged warning time compared with placebo. Darifenacin 15 mg once daily for 2 weeks was as effective as oxybutynin 5 mg three times daily at reducing the frequency of urinary incontinence and frequency and severity of urgency in patients with OAB. Darifenacin was generally well tolerated in clinical trials. The most common adverse events were dry mouth and constipation. CNS tolerability appeared to be similar to that of placebo. Darifenacin had no adverse effect on cognitive function in healthy elderly volunteers.     

Long-term darifenacin treatment for overactive bladder in patients aged 65 years and older: analysis of results from a 2-year,open-label extension study

ABSTRACT

Objectives: This analysis evaluated the long-term safety, tolerability and efficacy of darifenacin, a muscarinic M₃ selective receptor antagonist, in the treatment of overactive bladder (OAB) in patients ≥ 65 years of age.

Methods: Patients who completed one of two 12-week, placebo-controlled, double-blind, feeder studies received once-daily (o.d.) treatment with darifenacin 7.5?mg for the first 2 weeks of the 2-year, open-label extension study. The dose could be subsequently adjusted (7.5 or 15?mg o.d.) according to need. Safety and tolerability were assessed, and efficacy variables/endpoints were evaluated from patient diary data.

Results: 214 patients (65–89 years) entered and 137 (64.0%) completed the 2-year extension study, amounting to 308 patient-years’ drug exposure. Darifenacin was well tolerated with no new safety concerns. The most common adverse events (AEs) were dry mouth and constipation, which infrequently resulted in discontinuation (2.3% and 4.2%, respectively). Darifenacin produced significant improvements in OAB symptoms that were maintained over the 2-year period (median reduction from feeder-study baseline to 2 years: –11.0 [–83.7%] for incontinence episodes/week and –1.2 [–12.4%] for micturitions/day, both p < 0.05), with 44.4% patients achieving ≥ 90% reduction in incontinence episodes at 2 years.

Conclusions: Darifenacin demonstrated good tolerability and safety in older patients with OAB. The improvement in OAB symptoms was sustained throughout the 2-year extension, resulting in high treatment persistence rates. Results were comparable with those in the overall OAB population from this study, indicating that darifenacin treatment is effective and well tolerated irrespective of age.     

Darifenacin: a novel M3 muscarinic selective receptor antagonist for the treatment of overactive bladder

Darifenacin is a novel M3 muscarinic selective receptor antagonist for once-daily treatment of overactive bladder (OAB), a highly prevalent, chronic and debilitating disease defined by urinary urgency with or without urge incontinence, usually with increased frequency of micturition and nocturia. In vitro, darifenacin is a potent and specific muscarinic receptor antagonist with 相似文献   

Darifenacin: a novel M3 muscarinic selective receptor antagonist for the treatment of overactive bladder

Darifenacin is a novel M₃ muscarinic selective receptor antagonist for once-daily treatment of overactive bladder (OAB), a highly prevalent, chronic and debilitating disease defined by urinary urgency with or without urge incontinence, usually with increased frequency of micturition and nocturia. In vitro, darifenacin is a potent and specific muscarinic receptor antagonist with ≤ 59-fold higher selectivity for muscarinic M₃ receptors relative to other muscarinic receptor subtypes. This profile may, therefore, confer clinical efficacy in the treatment of OAB, with a lower propensity for adverse effects and safety issues related to blockade of other muscarinic receptor subtypes. Indeed, consistent with its low relative affinity for M₁ and M₂ receptors, no effects on cognitive function and heart-rate variability, respectively, have been observed with darifenacin. Subsequent large-scale clinical trials have confirmed that darifenacin (at doses of 7.5 and 15 mg/day) results in central nervous system and cardiac adverse events comparable to placebo, and provides early and meaningful improvement across a range of OAB symptoms including incontinence episodes, urgency and urinary frequency. On the basis of such findings, darifenacin would appear to meet the current need for an effective OAB pharmacotherapy that is efficacious, well-tolerated and, more importantly, minimises the risk of safety-related adverse effects.     

Darifenacin: a muscarinic M3-selective receptor antagonist for the treatment of overactive bladder

Darifenacin is a novel, muscarinic M(3)-selective receptor antagonist with up to 59-fold selectivity for M(3) receptors compared with other muscarinic receptor subtypes and a low relative affinity for M(1) and M(2) receptors. This profile may explain its clinical efficacy in overactive bladder (OAB), the observed absence of adverse effects on cognitive function and reduced cardiovascular risks. Large-scale clinical trials have confirmed that darifenacin 7.5 and 15 mg/day provide rapid and meaningful improvement across a range of OAB symptoms, but with CNS and cardiac adverse event rates comparable to placebo. On this basis, darifenacin seems to meet the standard for an effective OAB pharmacotherapy that is well-tolerated and, more importantly, minimises the risk of safety-related adverse effects.     

Blood-brain barrier permeation and efflux exclusion of anticholinergics used in the treatment of overactive bladder

Overactive bladder (OAB) is a common condition, particularly in the elderly. Anticholinergic agents are the mainstay of pharmacological treatment of OAB; however, many anticholinergics can cross the blood-brain barrier (BBB) and may cause central nervous system (CNS) effects, including cognitive deficits, which can be especially detrimental in older patients. Many anticholinergics have the potential to cause adverse CNS effects due to muscarinic (M(1)) receptor binding in the brain. Of note, permeability of the BBB increases with age and can also be affected by trauma, stress, and some diseases and medications. Passive crossing of a molecule across the BBB into the brain is dependent upon its physicochemical properties. Molecular characteristics that hinder passive BBB penetration include a large molecular size, positive or negative ionic charge at physiological pH, and a hydrophilic structure. Active transport across the BBB is dependent upon protein-mediated transporter systems, such as that of permeability-glycoprotein (P-gp), which occurs only for P-gp substrates, such as trospium chloride, darifenacin and fesoterodine. Reliance on active transport can be problematic since genetic polymorphisms of P-gp exist, and many commonly used drugs and even some foods are P-gp inhibitors or are substrates themselves and, due to competition, can reduce the amount of the drug that is actively transported out of the CNS. Therefore, for drugs that are preferred not to cross into the CNS, such as potent anticholinergics intended for the bladder, it is optimal to have minimal passive crossing of the BBB, although it may also be beneficial for the drug to be a substrate for an active efflux transport system. Anticholinergics demonstrate different propensities to cross the BBB. Darifenacin, fesoterodine and trospium chloride are substrates for P-gp and, therefore, are actively transported away from the brain. In addition, trospium chloride has not been detected in cerebrospinal fluid assays and does not appear to have significant CNS penetration. This article reviews the properties of anticholinergics that affect BBB penetration and active transport out of the CNS, discusses issues of increased BBB permeability in patients with OAB, and examines the clinical implications of BBB penetration on adverse events associated with anticholinergics.     

Recent developments in the management of overactive bladder: focus on the efficacy and tolerability of once daily solifenacin succinate 5 mg

BACKGROUND: Overactive bladder (OAB) is a highly prevalent symptom complex that may be extremely distressing to the patient, and can be associated with co-morbidities and reduced quality of life (QoL). One of the major pathophysiological causes of OAB is overactivity of the detrusor muscle, mediated via muscarinic receptors in the bladder. Urgency is the defining symptom of OAB, yet a significant proportion of patients also suffer from incontinence, which is the most distressing symptom to the patient. As such, restoration of continence should be a primary treatment goal. However, effective treatments should also impact on the other key symptoms of OAB, such as micturition frequency and urgency. Non-pharmacologic interventions to treat OAB can be effective but require patients to be highly motivated. In terms of pharmacologic therapy, treatment with an antimuscarinic agent is the mainstay of current therapy. Solifenacin succinate is a once-daily oral antimuscarinic for the treatment of OAB. The recommended dose is 5mg once daily and can be increased to 10 mg once daily if 5 mg is well tolerated. OBJECTIVES: This paper reviews clinical experience with solifenacin 5 mg in patients with OAB as this is the recommended dose according to FDA product labeling. FINDINGS:In Phase 3 studies, based on data captured in 3-day micturition diaries, greater than half of patients who were incontinent at baseline no longer reported experiencing incontinence episodes after 12 weeks of double-blind treatment with solifenacin 5 mg. Furthermore, compared with placebo, solifenacin treatment resulted in statistically significant reductions in incontinence episodes, micturition frequency and urgency episodes, with significant increases in volume voided (based on an analysis of key symptom outcomes in two pooled Phase 3 studies presented here). The most common treatment-related adverse events were expected anticholinergic side effects (dry mouth, constipation, and blurred vision), and these were generally mild to moderate. Discontinuation rates due to adverse events in the treatment and placebo groups were comparable. CONCLUSION: Solifenacin 5 mg was found to be efficacious and had an acceptable tolerability profile in patients with OAB in these trials and this treatment may provide QoL benefits to patients.     

Evidence for the efficacy and safety of tolterodine in the treatment of overactive bladder

Overactive bladder (OAB) is a chronic and prevalent condition, the symptoms of which (urinary frequency and urgency, with or without urge incontinence) can exert a profound negative effect on a person's daily life activities. Tolterodine (Detrol in North America and Detrusitol in the rest of the world, Pharmacia), a competitive muscarinic antagonist, is the first agent of this class to be specifically developed for the treatment of OAB. This agent displays in vivo functional selectivity for the bladder over other tissues that contain muscarinic receptors (e.g., salivary glands, eye), which translates into good efficacy and tolerability in patients with OAB (including the elderly). Comparative, randomised, double-blind studies show that tolterodine (administered as immediate-release [IR] tablets 2 mg b.i.d.) is as effective as oxybutynin (5 mg t.i.d.) in improving all of the troublesome symptoms of OAB but with a significantly lower incidence and severity of dry mouth. The advent of a new extended-release (ER) capsule formulation of tolterodine (4 mg) for convenient once-daily treatment builds upon these findings, with significantly improved efficacy for reducing urge incontinence episodes and a lower frequency of dry mouth relative to the existing IR tablet (2 mg b.i.d.). Tolterodine can therefore be considered a valuable, well-tolerated treatment option for patients with OAB, providing improvements in symptoms that are both clinically meaningful to patients and sustained during long-term treatment.     

Evidence for the efficacy and safety of tolterodine in the treatment of overactive bladder

Overactive bladder (OAB) is a chronic and prevalent condition, the symptoms of which (urinary frequency and urgency, with or without urge incontinence) can exert a profound negative effect on a person’s daily life activities. Tolterodine (Detrol^® in North America and Detrusitol^® in the rest of the world, Pharmacia), a competitive muscarinic antagonist, is the first agent of this class to be specifically developed for the treatment of OAB. This agent displays in vivo functional selectivity for the bladder over other tissues that contain muscarinic receptors (e.g., salivary glands, eye), which translates into good efficacy and tolerability in patients with OAB (including the elderly). Comparative, randomised, double-blind studies show that tolterodine (administered as immediate-release [IR] tablets 2 mg b.i.d.) is as effective as oxybutynin (5 mg t.i.d.) in improving all of the troublesome symptoms of OAB but with a significantly lower incidence and severity of dry mouth. The advent of a new extended-release (ER) capsule formulation of tolterodine (4 mg) for convenient once-daily treatment builds upon these findings, with significantly improved efficacy for reducing urge incontinence episodes and a lower frequency of dry mouth relative to the existing IR tablet (2 mg b.i.d.). Tolterodine can therefore be considered a valuable, well-tolerated treatment option for patients with OAB, providing improvements in symptoms that are both clinically meaningful to patients and sustained during long-term treatment.     

β-3肾上腺素受体激动剂治疗膀胱过度活动症的研究进展

膀胱过度活动症(overactive bladder,OAB)是一种以尿急症状为特征的症候群,常伴有尿频和夜尿症状,可伴或不伴有急迫性尿失禁。β3肾上腺素能受体激动剂作为治疗OAB的一种新药,不但效果确切,而且安全,耐受性较好,具有广阔的应用前景。本文从作用机制、不良反应、安全性和有效性方面就β3肾上腺素受体激动剂治疗膀胱过度活动症的研究进行综述。