PDCA管理法在降低我院住院药房退药率中的应用

目的:分析临床医院住院药房应用PDCA管理退药率降低情况。方法:医院于2016年开始在住院药房实施PDCA管理,以2015年1月~2015年12月期间医院住院药房退药数据为对照组,以2016年1月~2016年12月期间住院药房退药数据为观察组,观察PDCA管理实施前后医院住院药房退药情况差异。结果:对照组正常用药506871次、退药30754次,退药率为5.72%;观察组正常用药561043次,退药7386,退药率为1.23%。两组比较观察组退药率低于对照组,P<0.05。结论:通过PDCA管理能使临床相关人员,工作质量提高、团队合作意识及责任意识增强,促住院药房退药流程科学化、合理化,从而有效减少药房退药发生,管理效果良好。     

PDCA循环法在医院门诊药房中的应用效果

目的 探究PDCA循环法在医院门诊药房管理中的应用效果.方法 选取常规管理阶段发放的580 450件药品(对照组)和PDCA循环法管理阶段发放的581 357件药品(观察组)作为研究对象.观察两组在PDCA循环法实施前后医院门诊药房药品使用情况(有效使用率、不合格报损率、去向明确率和复核差错率).结果 观察组有效使用率和去向明确率均显著高于对照组(P<0.05);观察组不合格报损率和复核差错率均显著低于对照组(P<0.05).结论 PDCA 循环法应用于医院门诊药房管理,使门诊药房工作质量更规范化、标准化、专业化,提高了药房工作效率和临床用药质量,减少了医疗差错,效果显著,值得临床应用推广.     

PDCA管理法在降低我院住院药房退药率中的应用

目的 研究并分析将PDCA管理法应用于住院药房管理中对药房退药率的影响及作用.方法 从2016年7月开始,在我院住院药房管理中实施PDCA管理法,将实施前后的住院药房退药率进行对比.结果 相较于实施前,实施后的住院药房退药率显著降低,P<0.05.结论     

PDCA循环对规范药房退药管理的应用效果分析

目的:分析讨论PDCA循环对规范药房退药管理的应用效果.方法:选择2013年1月1日～12月31日,实行常规管理模式,我院登记退药为312例,作为本次试验的对照组,2014年6月1日～2015年6月30日,接受PDCA循环管理后,我院登记退药为192例,作为本次试验的观察组,比较两组退药情况及对药房工作效率的影响.结果:实行PDCA循环法以来,退药情况明显减少,与退药相关的主要因素得到有效改善.其中,对照组退药中以患者已有该药品或拒绝用药所占比例较高,为47.12％,观察组为36.98％;通过退药发现的药品质量和不良反应得到有效跟踪.结论:在药房退药管理中引入PDCA循环理念,可降低退药发生率,同时提高药房工作效率,促进医患关系和谐发展.     

PDCA循环管理方式用于改善门诊药房处方质量分析

目的分析门诊药房中开展PDCA循环管理方式对处方质量的改善情况。方法选取2019年1-6月未实施PDCA循环管理前的门诊药方处方质量作为对照组,2019年7月对门诊药房开始实施PDCA循环管理,2019年7-12月实施PDCA循环管理后的门诊药方处方质量作为研究组,比较门诊药房实施PDCA循环管理前后处方质量缺陷存在的问题及数量、处方合格率。结果研究组实施PDCA循环管理后,在药品批号管理失效、缺药、发药错误、药品失效等发生率均低于对照组(P<0.01),研究组门诊药房处方合格率为98.0%,高于对照组的82.4%(χ²=68.827,P=0.000)。结论将PDCA循环管理方式应用在门诊药房管理中,可有效降低发药风险,减少药品调配差错,有效提高处理质量,确保患者的用药安全、生命健康。     

PDCA管理法在降低我院住院药房退药率中的应用

目的降低我院住院药房退药率。方法按照PDCA管理法实施各项活动,应用查检表把握现状,亲和图分析退药率高的原因,采用鱼骨图探讨对策的拟定与实施,应用雷达图评价无形成果。结果住院药房退药率高的主要原因有医生未及时修改医嘱与患者用药依从性差等,针对以上原因,采取了将退药率纳入医院综合目标管理考核、建议医生查房后及时修改医嘱、提高患者用药依从性、加强护士核对药品、降低药房断药率等措施。取得的有形成果:我院住院药房退药率由9.57%降至0.92%,形成了退药标准化流程和制度;无形成果:PDCA小组成员在积极性、解决问题能力、自信心等方面有较大幅度的提高。结论 PDCA管理模式的应用对降低我院住院药房退药率是可行的。     

PDCA循环法对门诊药房药师服务态度的影响

目的 观察PDCA循环法对门诊药房药师服务态度的影响。方法 选取2019年11月1日—12月31日(实施PDCA循环法前,对照组)和2020年7月1日—8月31日(实施PDCA循环法6个月后,研究组)于广东省江门市中心医院门诊药房完成取药的患者各400例(预配窗口、直发窗口各200例),比较2组患者对门诊药房药师服务态度的满意度。结果 研究组患者总满意度为87.00%,高于对照组的72.00%(χ²=27.612,P <0.001)。结论 PDCA循环法管理可有效提高患者对门诊药房药师服务态度,增加患者就医体验感,值得进一步推广应用。     

我院门诊药房退药情况及原因分析

目的：分析我院门诊退药情况,为减少门诊退药,提高处方质量,保证用药安全提供依据。方法：对我院门诊药房2008年3月～8月的患者退药情况进行分析。结果：门诊药房退药原因主要为药物不良反应;退药品种以抗菌药物为主;急诊科发生退药情况较频繁。结论：为降低门诊药房退药率,需建立退药制度,提高医疗服务质量,在门诊药房开展药学服务,制定奖惩制度以规范医务工作者的行为等。     

运用PDCA循环法管理药房的效果分析

目的探讨运用PDCA循环法管理药房的效果。方法依据采用的管理方法,药房不同分为对照组和观察组。对照组采用传统方法管理,观察组运用PDCA循环法管理。结果观察组有效使用药品、不合格药品报损及去向明确率情况优于对照组,差异具有显著性（P〈0.05）,有统计学意义。结论运用PDCA循环法管理药房,能促使医院药房的管理工作向科学管理发展,提高临床用药的质量,减少药物造成的医疗问题。     

我院门诊药房退药情况分析

目的探索减少退药事件的措施,为提高门诊药房管理水平提供参考。方法通过对我院2008年1月-2008年12月门诊药房退药原因分类统计分析。结果全年共调配处方72 856张、其中退药处方179张、退药率占0.25%。结论规范退药程序,加强退药管理,减少医院退药情况的发生、保证药品质量,达到安全有效用药,提高患者满意度。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.