加强用药咨询服务提高患者用药依从性

用药依从性是指病人是否按医师所嘱用药。要治愈患者疾病,不仅取决于医师正确用药,还取决于病人是否配合、严格执行医嘱用药。病人用药依从是药物治疗有效性的基础,用药依从性的效果直接影响患者的健康结局。1用药不依从的原因及危害产生用药不依从的原因有多方面:①对病人缺乏用药指导,药师在发药时未能详细解释和指导病人如何正确用药。有的药师将调配好的多种药物放在一个塑料袋中发给病人,不说一句指导、提醒的话,至使一些病人用错药物,甚至将栓剂当内服药使用。②用药方案复杂是用药不依从的直接原因。有的疾病需要多种药物治疗,病人往…     

病人的依从性与老年化的关系

病人的依从性是治疗有效性的基础,老年化会引起病人的不依从。本探讨了因老年化引起不依从的因素,认为老年人的心理因素、社会因素、感觉与运动功能下降以及认知功能障碍等是引起老年病人不依从的主要原因。     

对患者用药依从性的调查

目的：通过对患者用药依从性的调查,分析目前病人对医嘱的依从程度。方法：对患者及家属进行问卷调查,以收回的完整问卷为有效问卷,进行统计分析。结果：共回收263份有效问卷。其中55份（20．9％）为不依从,中青年患者不依从比例高于儿童及老年患者,而性别对用药依从性影响不明显。结论：通过分析患者不依从的原因和对其中问题的解决方法,为医务工作者更好的为患者服务提供参考。     

86例慢性阻塞性肺疾病病人吸氧状况调查分析

目的了解慢性阻塞性肺疾病(COPD)病人吸氧依从状况,以及不依从的原因,以便制定相应的护理措施,以提高护理质量。方法采用观察法和面对面访谈法对86例COPD病人的吸氧情况进行调查。结果 28例(33%)能按规范吸氧;58例(67%)不能进行规范吸氧,主要表现为拒绝吸氧、随意吸氧、自行调节流量。结论 COPD病人存在许多不规范吸氧现象,护理人员应根据病人的性别、文化程度、住院时间、住院次数、吸氧时间等进行相应的护理干预。     

门诊药师在提高病人用药依从性方面的作用

病人依从性（patient compliance）是指病人遵守医师确定的治疗方案及服从医护人员对健康其他方面指导的执行程度,不遵守医嘱的称之为不依从性（noncompliance）。已证明病人对药物疗法的不依从可增加发病率、就诊率、住院率及死亡率。目前依从性问题不仅仅是病人的问题,医务人员也应考虑自身态度、言行在病人的遵医行为中的作用,重视对病人主动性的调动。而药师在门诊发药时对病人实施细致、清楚的用药指导,是提高病人用药依从性的关键。     

对胃病患者的药学服务

正确的用药方法是治疗疾病的前提。病人对医嘱的依从程度直接影响到临床疗效,临床过程中常见自行停药,不规律用药和用量不足等问题,胃病患者不按规定用药的比率很高,所以告知患者使用方法和注意事项是非常重要的。     

提高精神病人用药依从性的体会

提高精神病人用药依从性的体会盛国荣（江苏省南通市通济医院２２６００５）产生精神病人用药不依从的原因很多，临床医药工作者应针对原因，研究改进工作，以提高病人的依从性。药剂人员是负责药品调配的专业人员，也是病人眼药前最后接触的专业人员。因此在将不依从性减...     

皮肤科病人用药依从性改变及护理对策

近年来,由于病人某些方面的原因,致使用药依从性改变,造成药物疗效降低或产生不良后果的现象屡见不鲜.据文献[1]报道,30%的病人在短期抗菌治疗中不遵循医嘱,而且在非卧床病人中,有92%的病人用药是不依从的.皮肤科病人多为非卧床病人,而且不少病人需用抗菌药物治疗.经调查发现,皮肤科病人用药依从性改变的比例呈上升趋势,值得重视.     

对哮喘病人的药学服务

正确的用药方法是治疗疾病的前提,病人对医嘱的依从程度直接影响到临床疗效,临床过程中常见自行停药、不规律用药和用量不足等问题。国内外调查结果显示,哮喘患者不按规定用药的比率是很高的,所以告知患者使用方法     

麻风患者联合化疗依从性及其影响因素的调查

为了了解病人服药过程中的不依从现象及其影响因素，以便更好发挥联合化疗在麻风防治中的作用，对江苏省扬州市及东台市的３７０例麻风联合化疗病人进行了调查，结果表明，２４．９％的病人依从性不良，多菌型与少菌型ＭＤＴ方案治疗者间无显著性差异，患者的治疗方式对依从没有明显的影响，而对ＭＤＴ的认识及ＭＤＴ知识的了解状况明显影响了病人的服药依从性。由此可见，在实施ＭＤＴ的同时必要及时向病人提供有关ＭＤＴ知识的健康     

Monoclonal antibodies to treat graft-versus-host disease

To date, Graft-versus-host disease (GVHD) represents one of the most important complications of allogeneic hematopoietic stem cell transplantation (HSCT). GVHD is one of the major determinants of transplant-related mortality and it also may be an additional cause that affects patients late outcome. Despite of the development of new and advanced Human Leukocyte Antigens (HLA) matching techniques, this complication occurs in approximately 50-80% of patients who underwent allogeneic hematopoietic stem cell transplantation, and it is responsible for one-third of deaths after transplantation. Moreover, GVHD occurrence, if moderate, may strongly contribute to the eradication of residual malignant cells which survived after myeloablative conditioning regimen, allowing the patients to have a reduced risk of relapse so that the presence of this complication may have a determinant role for the allogeneic transplantation outcome through the so-called graft-versus-tumor (GVT) effect.     

Severe hypercalcemia due to teriparatide

Osteoporosis that is by far the most common metabolic bone disease, has been defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Anabolic therapy with teriparatide, recombinant human parathyroid hormone (PTH 1-34), stimulates bone formation and resorption and improves trabecular and cortical microarchitecture. Teriparatide is indicated for the treatment of men and postmenopausal women with osteoporosis who are at high risk for fracture, including those who have failed or are intolerant of previous osteoporosis therapy. In conclusion, although teriparatide seems quite effective in the treatment of osteoporosis, it may cause life-threatening hypercalcemia. Therefore, patients should be closely monitored if symptoms of hypercalcemia are present during teriparatide treatment. Sustained hypercalcemia due to teriparatide treatment can not be seen in literature so we wanted to emphasize that severe hypercalcemia may develop due to teriperatide.     

民间验方金蟾膏治疗骨髓炎的疗效观察

目的对骨髓炎患者经民间验方金蟾膏治疗的结果进行分析归纳。让人们认识一种治疗骨髓炎更好的方法。方法采用经金蟾膏治疗的245例骨髓炎患者的治疗效果。结果245例患者，233例痊愈，占95％，12例好转，总有效率100％。结论金蟾膏确实是一种治疗骨髓炎的好药，值得推广。     

群体药动学应用于个体化给药的研究进展

群体药动学运用经典的药动学原理结合统计学方法,以稀疏数据预测患者血药浓度,可达到监测药物体内过程和指导临床个性化给药的目的。查阅近年来的相关文献,结合实例综述群体药动学应用于治疗窗窄的药物、个体差异大的药物、联合用药、特殊人群用药等方面的最新进展,为其深入研究和指导临床用药提供参考。     

An e-mail system for obtaining approval to use a restricted agent.

Because of concerns over cost, proper patient selection, and prescribing patterns, pharmacy and therapeutics committees must be very selective about which new medications can be added to formularies and used in health systems. However, in the final analysis, many problems with important new agents are easily solved when clinicians select the right patients and prescribe these agents properly. Physician specialists in appropriate fields often already know about important new medications from clinical trials, professional meetings, and published articles. In such cases, these specialists can help with the needed diffusion of information to other physicians so that a broad range of prescribers in a health system become familiar with the new agent, its advantages, what types of patients need the drug, and what problems may be encountered.     

慢性病毒性肝炎伴糖代谢紊乱患者药学监护的分析

摘要 慢性病毒性肝炎尤其伴肝硬化时,常出现糖代谢紊乱,病情十分复杂,治疗中需要解决的药学问题有很多。本文以降糖药物、保肝药物及抗菌药物使用监护为切入点,结合我院临床药师参与药学监护的3例典型病例,提出慢性病毒性肝炎伴糖代谢紊乱药学监护要点为：降血糖药物应避免使用损害肝功能的口服降糖药物,尽量选用胰岛素;保肝药物应避免使用可能升高血糖的甘草酸制剂等药物;抗菌药物使用时应避免使用对肝功能有损害及对血糖有影响的抗菌药物。实施这些药学监护,对慢性病毒性肝炎伴糖代谢紊乱患者血糖控制、肝功能恢复等均有重要临床意义。     

Translation of pharmacokinetics to clinical medicine

The translation of pharmacokinetics to clinical medicine involves answering the following question: “When the pharmacodynamic or chemotherapeutic activity of a drug is known, how must its dosage regimen be adapted to its pharmacokinetic characteristics so that the desired therapeutic effect may be achieved and maintained?” This presentation discusses examples of pharmacokinetic analyses which influence the practice or principles of practical therapeutics. Physicians have intuitively appreciated the basic importance of pharmacodynamics because they are primarily interested in the action of a drug on the patient. However, in pharmacokinetics we consider the fact that there is not only a unidirectional action but also a mutual interaction between drug and organism. The action of the organism on the drug may be summarized in terms of the pharmacokinetic parameters: absorption, distribution, metabolism, and excretion. These parameters are examined with respect to drug accumulation, relation of pharmacokinetic data to therapeutic effects, saturation phenomena, the effect of kidney disease, the variation of pharmacokinetic parameters in individual patients due to age, pH of body fluids, and the states of wakefulness.     

Infection of intravascular prostheses: how to treat other than surgery

Long-term antimicrobial therapy may be effective in some patients with intravascular prosthesis infection. However, this approach does not represent an alternative to surgery when this is feasible, but is merely the best opportunity for patients too ill to tolerate a re-intervention. Prosthetic valve endocarditis may be treated with antibiotic therapy alone in selected patients who are haemodynamically stable with non-staphylococcal infections and no para-valvular complications. In contrast, infections of pacemaker leads or other implantable cardiac devices require complete hardware removal, as infection recurrence always occurs, even after a seemingly effective initial treatment. Attempts to treat conservatively infections of abdominal aortic grafts can be successful in a few cases, provided the patient is stable, the pathogen has been identified, and antibiotic susceptibility has been demonstrated. Treatment requires at least 4-6 weeks and may be followed by a sequential oral regimen once the acute phase of the infection has subsided. The correct duration of this treatment is often unknown and relapses are common after treatment withdrawal. The availability of novel antibacterial and antifungal agents - showing fast microbicidal activity that includes biofilm micro-organisms - such as daptomycin and caspofungin, or having a wide antimicrobial spectrum, such as tigecycline, may increase the probability of long-standing suppression or even eradication of the infection in these particular subsets of inoperable patients. However, so far, very little experience is available on the efficacy and tolerability of these drugs in intravascular prosthesis infections. Controlled studies are lacking and difficult to plan. Well-designed prospective studies may help to establish guidelines and reach a multidisciplinary consensus on the optimal therapeutic approach, and are therefore awaited.     

Immune monitoring to predict the development of infections after immunosuppression for solid organ transplantation and autoimmune diseases

Infections are relevant complications that cause morbidity in solid organ transplantation and autoimmune diseases. Infection represents a leading single cause of death in these patients. Identification of patients at risk for development of infections and specific intervention to decrease infection risk might lead to better outcomes, though one needs first to evaluate the presence of risk factors for infection. Underlying disease itself, activity of the disease, presence of co-morbidities, transplantation procedures along with immunosuppressive and immunomodulatory therapies may be associated with an increased risk of infections. Among host factors, there are no reliable immunological markers to predict infections. Immune monitoring (assessment of immunocompetence) to estimate the risk of infection has so far not been performed routinely, with the only exception of neutrophil counts, tuberculin skin testing and serological evaluation of donor and recipients of transplants for anti-cytomegalovirus IgG antibodies. However, alterations of specific and non specific humoral and cellular immunity may be associated with a higher risk of infection among immunosuppressed patients. We review studies that have been designed to assess immune monitoring for prediction of infections in patients with selected solid organ transplantations and systemic autoimmune diseases.     

多种中枢性药物合用致帕金森综合征及其恶化的临床分析

目的本研究主要就患者在使用各类中枢性药物进行治疗后出现帕金森综合征的相关情况展开分析讨论。方法对我院所收治的24例帕金森综合征患者的临床用药情况进行回顾性分析。结果采用中枢性药物来进行治疗时,多种药物联用可能导致患者出现帕金森综合征,通过停药或采取相应的措施可以使患者的病情得以缓解。结论通过对相关资料以及患者的临床表现进行分析发现,多种中枢性药物联用、使用5-羟色胺再摄取抑制剂(SSRI)后出现不良反应等情况与患者出现帕金森综合征及其恶化之间存在密切联系。