我院门诊不合格处方分析与建议

目的:了解我院门诊处方书写质量及合理用药基本情况,提高临床合理用药水平。方法:以《处方管理办法》、《抗菌药物临床应用指导原则》、《医院处方点评管理规范(试行)》为依据,随机抽取我院2010年3-8月门诊处方共1800张,对处方基本指标进行分析,并对书写规范情况、用药适宜性及超常处方进行评价(其中1项不合格即判定为不合格处方),同时提出建议。结果与结论:我院平均每张处方用药品种数2.1种,抗菌药物使用百分率为18.7%;不合格处方471张,其中书写不规范处方415张,表现为临床诊断、药品的剂量书写不规范等;用药不适宜处方49张,表现为遴选药品不适宜、重复给药等;超常处方7张,表现为开具2种以上药理作用相同的药物、无适应证用药等。可见我院处方合格率较低,抗菌药物过度应用现象普遍。建议通过加强医师处方规范书写意识、加强药师与医师之间的沟通、建立处方质量管理制度来提高门诊处方质量。     

我院门诊处方点评与分析

目的了解我院门诊处方的书写质量和用药情况,以提高门诊合理用药水平。方法回顾性随机抽取我院2013年3月-2014年2月门诊处方共计3600张(300张/月),参照《医院处方点评管理规范(试行)》进行处方点评。结果抗菌药物处方659张,抗菌药物使用率18.31%,不合格处方251张,占抽样处方的6.97%。结论我院存在少数处方书写不规范,用药不合理情况。通过门诊处方点评,可及时发现问题,合理干预,进而提高处方质量,保障医疗安全。     

我院儿科门诊处方点评与分析

目的了解我院儿科门诊处方药物的应用情况,促进处方用药的合理性与规范性。方法对我院2010年的3000张门诊普通处方和药师日常处方审核工作中所记录的疑义处方进行点评、统计和分析。结果我院处方基本控制较好,不合格处方129张,占4.3%,其中处方书写不规范的121张,用药不适宜的8张,分别占全部抽查处方比率为4%、0.27%。结论通过处方点评,提高了临床医师合理用药水平,特别是提高抗菌药物的合理应用水平,为提高医院医疗质量提供了基础。     

2010—2012年西安医学院附属宝鸡医院门诊中成药处方点评

目的:提高门诊药房的中成药处方质量,促进中成药的合理使用。方法:随机抽取西安医学院附属宝鸡医院(以下简称"我院")2010-2012年门诊中成药处方4 965张,参考2010年《医院处方点评管理规范(试行)》和《处方管理办法》对处方进行点评。结果:共抽查的4 965张处方中,合格处方4 725张,不合格处方240张,处方合格率为95.17%。不合格处方主要表现为用药与诊断不符,重复用药,剂型、剂量及用法不合理,书写不规范等。结论:我院处方书写欠规范,合理用药水平有待加强。     

13200张门急诊处方点评分析

目的了解我院门急诊处方书写质量及合理用药情况。方法采用回顾性调查方法,依据《医院处方点评管理规范(试行)》,对我院2010年抽查的13200张门急诊处方进行分析。结果抗菌药物使用率等多项处方基本指标超标,处方不合格率为7.6%,不规范处方占不合格处方的75.6%;用药不适宜处方及超常处方占不合格处方的24.4%。结论我院门急诊处方书写质量及合理用药水平有待进一步提高。     

我院门诊2015年7～12月抗菌药物处方点评与分析

目的:了解我院门诊处方的书写质量和用药情况,提高门诊合理用药水平,促进抗菌药物合理使用.方法:从我院2015年7～12月抗菌药物处方中随机抽查12000张,参照《医院处方点评管理规范(试行)》进行处方点评.结果:其中抗菌药物处方2063张,抗菌药物使用率为18.54％,不合理处方2007张,占抽样处方的16.73％,抗菌药物不合理使用主要表现为二联及以上.结论:通过对门诊有关抗菌药物的使用处方点评,可以对不合理的处方进行定量分析,从而做到及时发现问题,早期进行合理干预,使处方的质量得以改善,规范合理用药,保障医疗行为安全.     

门急诊处方点评分析

目的规范处方管理,提高处方质量,促进合理用药。方法按科室分层等比抽取每月每个星期一处方100人次,按照《处方管理办法》、《抗菌药物临床应用指导原则》、《医院处方点评管理规范（试行）》点评标准的有关规定,对所查处方进行点评,填写《处方评价表》,计算门诊处方用药指标。结果 2011年9月至2012年9月共抽查门诊处方5696张,合格处方5321张,合格率为93.42%,平均每张处方用药品种数为1.82种,抗菌药物使用率为18.98%,注射剂使用率为14.57%,基本药物占处方用药的44.14%,药品通用名占处方用药的100%,平均每张处方金额为79.94元。结论处方书写基本合格,但仍存在用药不合理、书写不规范的情况,应加大对《处方管理办法》的贯彻执行力度和门诊处方检查力度,使处方书写进一步规范化,提高临床合理用药。     

我院门诊处方点评及结果分析

目的:通过对门诊处方用药情况分析,促进临床合理用药,保证医疗安全。方法:按照《处方管理办法》、《医院处方点评管理规范(试行)》、《医院抗生素分级管理目录》中的要求,抽查我院2014年和2015年门诊处方共7200张,对不规范处方、用药不适宜处方和基本指标情况进行归类,分析不合理处方存在问题。结果:平均每张处方用药品种数1.89,抗菌药物使用率为24.54%,注射剂使用率为47.54%,平均每张处方金额为82.90元,不合理处方为315张,处方合格率为95.63%。结论:在不断加强对处方质量书写和用药合理的监督中,门诊处方质量及合理用药情况有改善,但还存在一些问题仍需进一步加强管理。     

某院2014年一季度门诊处方点评与结果分析

目的对我院2014年第一季度门诊处方进行点评,了解门诊用药情况,提高处方质量,促进临床合理用药。方法随机抽取2013年12月26日至2014年3月25日我院门诊处方6000张,进行统计分析并点评。结果共抽查处方6000张,其中合格处方5704张,合格率为95.10%;不合格处方296张,占抽查处方的4.90%。不合格处方中不规范处方243张,占不合格处方的82.09%;用药不适宜处方41张,占不合格处方的13.85%;超常处方12张,占不合格处方的4.05%。平均用药品种2.87种,基本药物使用比例60.23%,药品通用名使用率100%,抗菌药物使用处方1085张,占全部抽查处方比例18.08%,注射剂使用处方数1274张,占全部处方比例21.23%。结论门诊一季度处方质量还应进一步提高,应加强《处方管理办法》《抗菌药物临床应用指导原则》的相关培训学习,提高医师药师专业水平,加强处方质量管理,以保证临床用药安全、经济、有效。     

我院2010年第2季度处方中抗菌药物应用调查分析

目的调查并分析我院处方中抗菌药物应用情况,进一步促进合理用药。方法随机抽查我院2010年第2季度门诊和住院处方各850张,对其进行统计分析。结果 850张门诊处方中抗菌药物处方320张(37.65%);合格处方753张(88.59%),不合格97张(11.41%)。850张住院处方中抗菌药物处方450张(52.94%);合格处方720张(84.71%),不合格130张(15.29%)。结论我院抗菌药物的使用基本合理,但尚需进一步规范和管理。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.