静脉配置药物不合理用药情况分析

目的探讨如何审核静脉配置药物医嘱及如何提高合理用药水平。方法依据药物说明书等资料对临床不合理用药作了分类统计。结果选用不合理载体占40%;不合理多药配伍占22%;重复开药占18%;不合理给药方式占9%;其他不合理用药占11%。结论提高药师审方能力,加强合理用药管理,建立合理用药规范非常必要。     

Factors Associated With Health-Related Quality of Life of Student Pharmacists

Objective. To assess the health-related quality of life (HRQoL) of student pharmacists and explore factors related to HRQoL outcomes of student pharmacists in a doctor of pharmacy (PharmD) program at a public university.Methods. A survey instrument was administered to all student pharmacists in a PharmD program at a public university to evaluate differences and factors related to the HRQoL outcomes of first-year (P1), second-year (P2), third-year (P3), and fourth-year (P4) student pharmacists in the college. The survey instrument included attitudes and academic-related self-perception, a 12-item short form health survey, and personal information components.Results. There were 304 students (68.6%) who completed the survey instrument. The average health state classification measure and mental health component scale (MCS-12) scores were significantly higher for P4 students when compared with the P1through P3 students. There was no difference observed in the physical component scale (PCS-12) scores among each of the 4 class years. Significant negative impact on HRQoL outcomes was observed in students with higher levels of confusion about how they should study (scale lack of regulation) and concern about not being negatively perceived by others (self-defeating ego orientation), while school satisfaction increased HRQoL outcomes (SF-6D, p<0.001; MCS-12, p=0.013). A greater desire to be judged capable (self-enhancing ego-orientation) and career satisfaction were positively associated with the PCS-12 scores (p<0.05).Conclusion. Factors associated with the HRQoL of student pharmacists were confusion regarding how to study, ego orientation, satisfaction with the chosen college of pharmacy, and career satisfaction. First-year through third-year student pharmacists had lower HRQoL as compared with P4 students and the US general population. Support programs may be helpful for students to maintain or improve their mental and overall health.     

Relationship between Tobacco Use and Health-Related Quality of Life (HRQoL) among Clients in Substance Use Disorders Treatment

We examined relationships of smoking status and tobacco-related variables with health-related quality of life (HRQoL), a metric of disease burden, among clients in substance use disorders (SUDs) treatment. Participants (N = 2,068; 46.6% female) completed surveys reporting demographics, smoking status, and past-month days they experienced physical and/or mental health distress. Smokers (n = 1,596; 77.2% of sample) answered questions on tobacco-related variables. Multinomial regression models assessed relationships between tobacco-related variables (smoking status, nicotine dependence, menthol smoking, electronic-cigarette use, health concerns, and cost as reasons affecting reducing/quitting smoking, past and future quit attempts) with HRQol in four categories (good health, physical health distress, mental health distress, or both physical and mental health distress). Current smokers were more likely than former smokers to report frequent physical and mental health distress than good health (OR = 1.97, 95% CI = 1.16, 3.34), as were smokers with higher nicotine dependence (OR = 1.18, 95% CI = 1.03, 1.35). Smokers reporting both frequent physical and mental health distress were more sensitive to cigarettes’ cost (OR = 1.56, 95% CI = 1.06, 2.29), and less likely to use e-cigarettes (OR = 0.59, 95% CI = 0.38, 0.94). Findings of poor HRQoL among nicotine-dependent smokers with additional SUDs strengthen the imperative to provide smoking cessation interventions in addictions treatment.     

Quality of Life,Symptomatology and Healthcare Utilization in HIV/HCV Co-Infected Drug Users in Miami

Abstract

HIV/HCV co-infection is becoming one of the main causes of death in HIV+ persons. We determined quality of life, clinical symptoms and health care utilization in HIV mono-infected and HIV/HCV co-infected chronic drug users. After consenting 218 HIV+ drug users, a physical examination and questionnaires on demographics, quality of life, drugs of abuse, and healthcare utilization were completed. Blood was drawn for HCV status, CD4 cell count, HIV viral load, CBC and chemistry. HIV/HCV co-infected participants had significantly higher risk of having poorer perceived outlook and health, presented significantly more frequent depression and physical symptoms, and used significantly more healthcare services than those infected with HIV only, after adjusting for age, gender, ethnicity, CD4 cell count, and viral load. Diminished quality of life in the HIV/HCV co-infected group was explained by increased frequency of depression, physical symptoms, healthcare utilization, and poor access to HCV treatment in this population.     

药物治疗对冠状动脉粥样硬化性心脏病伴焦虑抑郁患者预后及生活质量的影响

目的观察抗焦虑抑郁药物治疗对冠状动脉粥样硬化心脏病（简称冠心病）伴有焦虑抑郁情绪患者的预后及生活质量的影响。方法选择2011年1月至2012年12月确诊为冠心病患者,采用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）量化评分。筛选出伴有焦虑抑郁情绪的患者171例,随机分为抗焦虑抑郁药物氟哌噻吨美利曲辛治疗组86例,常规治疗对照组85例,分别统计两组12个月内的再入院率和平均住院日,并采用焦虑抑郁评分和西雅图心绞痛量表（SAQ）对生活质量进行评估。结果治疗组再入院率为12．79％、平均住院天数为（15．2±2．31）d,对照组再入院率为69．23％、平均住院天数为（23．5±3．78）d,两组比较有显著性差异（P〈0．01）。治疗组SAQ评分及HAMD及HAMA量化评分较对照组有显著改善（P〈0．01）。结论抗焦虑抑郁治疗能够显著改善冠心病伴有焦虑抑郁情绪患者的预后,明显提高生活质量。     

A 12-Month Evaluation of Health-Related Quality of Life Outcomes of Methadone Maintenance Program in a Rural Malaysian Sample

This paper focuses on the evaluation of addiction program effectiveness which involves changes in health-related quality of life (HRQoL) profile. This study was conducted from 2007 until 2010 at a rural methadone maintenance treatment center in Malaysia to assess HRQoL outcomes before and after treatment. Fifty-seven respondents completed the WHOQOL-BREF at baseline, 6 months, and 12 months postintervention. Data were analyzed using nonparametric techniques (SPSS 15). Significant and positive HRQoL impacts were demonstrated. Future studies with larger sample are encouraged. This study was supported by the Ministry of Health Malaysia.     

医院抗肿瘤静脉用药的合理配置与使用

目的：提高抗肿瘤静脉用药的安全性和有效性,降低不良反应的发生率。方法：收集静脉用药集中配置中心（PIVAS）各工作环节相关资料和我院近5年抗肿瘤静脉用药的不合理用药医嘱、医护沟通记录等,依据《静脉用药集中调配质量管理规范》、药品说明书、相关文献及药学工具书等,从合理配置、合理使用及不良反应防治等方面进行分析与要点探讨。结果与结论：为保证抗肿瘤静脉用药的安全、有效,应从溶媒、剂量、给药方式、给药顺序、给药时间、辅助用药等方面全面监控。我院开展PIVAS集中配置后,抗肿瘤化疗药、辅助用药及中药注射剂使用行为逐步得以完善、规范。     

Quality of life in children with adverse drug reactions: a narrative and systematic review

Aims

Adverse drug reactions are a common problem affecting adults and children. The economic impact of the adverse drug reactions has been widely evaluated; however, studies of the impact on the quality of life of children with adverse drug reactions are scarce. The aim was to evaluate studies assessing the health-related quality of life of children with adverse drug reactions.

Methods

We conducted a systematic review that included the following electronic databases: MEDLINE, EMBASE and the Cochrane Library (including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Cochrane Controlled Trials Register and the Health Technology Assessment Databases).

Results

Nine studies were included. Four of the studies were conducted in children with epilepsy; the rest of them involved children with chronic viral hepatitis, Crohn’s disease, paediatric cancer and multiple adverse drug reactions compared with healthy children. Based on their findings, authors of all studies concluded that adverse drug reactions had a negative impact on the quality of life of children. No meta-analysis was conducted given the heterogeneous nature of the studies.

Conclusions

To date, there is no specific instrument that measures quality of life of children with adverse drug reactions, and the information available is poor and variable. In general, adverse drug reactions have a negative impact on the quality of life of affected children. For those interested in this area, more work needs to be done to improve tools that help to evaluate efficiently the health-related quality of life of children with adverse drug reactions and chronic diseases.     

药品急需建立使用期限管理制度

本文针对我国没有规定有效期药品已经形成长期销售和使用的客观事实，提出药品急需建立使用期限管理制度，并对其必要性、可行性和基本构想进行了论述。     

The Relationships Between Alcohol/Drug Use and Quality of Life Among Adolescents: An International,Cross-Sectional Study

Although a major public health and social concern globally, limited data exist on substance use and their effects among adolescents living in low- and middle-income countries. This study evaluated the relationships between alcohol/drug use and quality of life (QOL) among adolescents in general populations from India, Indonesia, Nigeria, Serbia, Turkey, Bulgaria, and Croatia. The sample included 2,393 adolescents. The Pediatric Quality of Life Inventory (PedsQL) was used for QOL assessments, the Strengths and Difficulties Questionnaire (SDQ) was used for mental health problems, and the CRAFFT self-report questionnaire was administered for eliciting alcohol/drug use. Alcohol/drug use was significantly associated with lower levels of QOL. In particular, substance use among older male adolescents, adolescents with overt psychopathology, or adolescents in lower socioeconomic status was associated with greater reductions in levels of QOL.     

家庭支持对肝硬变失代偿患者生活质量影响的调查

目的:探讨家庭支持对肝硬变失代偿患者生活质量(QOL)的影响.方法:以SF-36量表对132例肝硬变失代偿患者进行问卷调查,比较低、中、高3组家庭支持水平患者的生活质量水平.结果:获得不同家庭支持水平的患者在生理职能、总体健康、生命活力、社会功能、情感职能、精神健康6个维度比较,差异显著 (P<0.05),而在生理功能、身体健康2个维度方面无明显差异(P>0.05).结论:家庭支持对肝硬变失代偿患者生活质量有正向影响,家庭支持程度越高,患者的生活质量越高.     

我院2007～2009年静脉用抗肿瘤药应用分析

目的:评价我院静脉用抗肿瘤药的应用情况,为临床用药和药物经济学研究提供参考。方法:采用金额排序法和用药频度(DDDs)分析法对我院2007～2009年静脉用抗肿瘤药的应用情况进行统计、分析。结果:近3年来我院静脉用抗肿瘤药用量及销售金额呈快速上升趋势,其DDDs与整体销售金额排序差异较大,如多西他赛注射液等。植物来源静脉用抗肿瘤药所占比例较大,占销售金额排序前10位中的50%。结论:我院静脉用抗肿瘤药品种基本保持稳定,在临床应用中发展迅速,并向价格更合理、疗效更确切、不良反应更小的趋势发展。     

静脉配置中心的不合理用药处方调查分析

目的了解静脉药物配置中心用药医嘱的合理性。方法随机抽取瑞金医院2009年7月1日至9月30日静脉药物配置中心静脉用药处方26091份,依据药物说明书及有关资料,进行合理性的调查与分析。结果随机抽查的26091份静脉用药处方中,共有2622份不合理,占10.04%。不合理性主要包括:配伍禁忌占1.20%;不合理载体溶媒占0.62%;不合理给药剂量占6.89%;不合理给药途径占1.14%;录入失误占0.19%。结论药师应充分发挥专业技能,加强与临床紧密结合,进一步建立合理用药规范,增加用药安全性。     

我院静脉药物配置中心常见不合理用药分析

目的：统计并分析我院静脉药物配置中心常见的不合理用药,为临床合理用药提供参考。方法：对我院2007年8月-2008年3月静脉药物配置中心审方中遇到的不合理用药医嘱进行统计分析。结果：共审查出不合理用药医嘱604例（占0．36％）,主要是给药方法、配伍禁忌、药物剂量、浓度以及溶媒选择等方面的问题。结论：药师通过静脉药物配置中心及时发现并纠正临床用药不合理现象,有效减少了临床因用药不合理引起的不良事件,充分体现了药师的价值。     

实施严格质量考核对合理用药的促进作用

目的分析成都军区总医院推行质量考核后的合理用药情况。方法以月为单位,审核2009年11月至2010年12月所有门诊处方以及部分住院患者用药医嘱。结果随着门诊处方量的增长,处方合格率有了稳步地提高,到2010年12月,处方合格率已由2009年11月的84.1%逐步提高并稳定在了95.7%左右。住院患者用药医嘱不合理用药现象也有了大大改善。结论实施质量考核能在很大程度上提高门诊处方质量及临床用药医嘱的合理性。但要从根本上促进临床合理用药,重点还在于国家政策的完善、医务工作者职业素质的不断提高和医德医风的建设。     

我院静脉用药调配中心不合理用药分析

目的：对我院静脉用药调配中心（PIVAS）审方干预的处方进行统计分析,评估药师在审方中的作用,促进临床安全合理用药。方法：采用回顾性调查方法,抽取2012年1—8月我院PIVAS的审方记录,对不合理用药处方进行统计、分析。结果：大多数处方用药合理,其中不合理用药处方有508张,主要表现为配伍不合理、给药方法不合理、药物配伍禁忌等。结论：PIVAS药师审方可有效地减少不合理用药处方,预防与减少因不合理用药而引发的不良事件,为促进合理用药发挥应有的作用。     

Physicians' Assessment of Drug Use and Other HIV Risk Behavior: Reports by Female Drug Users

SUMMARY

With epidemiological trends indicating that Acquired Immune Deficiency Syndrome (AIDS) is the third leading cause of death among women ages 25 to 44 in the United States, it is becoming increasingly important to deal with the issue of Human Immunodeficiency Virus (HIV) prevention for women. Recommendations for primary and secondary prevention strategies tailored to the needs of women have been formulated. Such calls have included the recommendation that prevention efforts be intensified in medical settings regularly frequented by women. One setting identified is that of gynecological and obstetric services where HIV risk assessment, testing, and counseling would be an excellent means of reaching a maximum number of women of child-bearing age. Despite calls by the American College of Obstetricians and Gynecologists for OB/ GYN service providers to engage in HIV prevention, research has shown that physicians remain reluctant to address the issue with patients. This study explored the likelihood of physicians and other health service providers to engage in HIV prevention through risk behavior assessment, HIV testing, and HIV counseling by requesting information from female drug abusers not currently in substance abuse treatment. Sixty percent of the drug abusing women in this study did not receive HIV information from their health care provider, 70% did not receive HIV counseling, 68% were not offered HIV testing, and 66% were not asked to provide a drug history. Of those participants who had not been asked to provide a drug history, almost half indicated that they would have been willing to provide truthful answers had they been asked. These findings indicate that a prime opportunity for HIV prevention is being missed by women's health care providers. Neglecting to ask female patients about their drug use history and to explore their risk for HIV infection can have dire consequences for these women. Early intervention is less likely if the topic is not broached by service providers, increasing the likelihood of infection and the spread of the disease.     

结合药物发放信息化的药物临床试验质量控制模式的建立及应用

目的：评价静脉注射人免疫球蛋白（IVIG）儿科超适应证用药情况,为临床合理使用IVIG提供参考。方法：回顾性分析某三级甲等妇幼保健院2018年11月至2019年4月135例住院患儿使用IVIG的情况,依据药品说明书和相关临床治疗指南,评价其超适应证用药情况。结果：135例使用IVIG的住院患儿中,以28 d~3岁患儿居多,其中超适应证用药占75.56%,主要用于感染性疾病的治疗和预防,超适应证用药中有循证医学证据支持的为16.67%。结论：儿科超适应证使用IVIG的情况普遍存在,应加强IVIG使用的监管力度,促进IVIG的合理使用。     

某院静脉滴注药品说明书滴速限制项标注情况分析

目的为药品生产厂家制订静脉滴注药品说明书及临床输液有效管理提供依据,保证患者用药安全。方法筛选某院可用于静脉滴注的注射剂药品说明书609份,对药品成分分类、药物作用系统、滴速限制项的描述方式及滴速要求等项目进行分别统计。结果 609份药品说明书中有264份(43. 35%)标注了滴速要求,其中中药类标注率为56. 10%,西药类标注率为42. 43%;消化系统用药、呼吸系统用药、抗感染药、心血管系统用药、神经系统用药的标注率相对较高;标注内容有5种描述方式;分别总结了不同滴速要求的药品种类。结论静脉输液时合理调整滴速对用药的安全性和有效性非常重要,通过医、药、护、患共同参与,加强药品说明书的管理和学习,加上药品生产厂家对静脉滴注药品说明书的不断完善,有利于提高用药安全。     

Pulmonary hypertension in patients with a history of intravenous drug use

Objective: Pulmonary hypertension may be a consequence of intrinsic elevation in pulmonary vasculature resistance or complicate numerous other conditions affecting the cardiac and respiratory systems. In this review we sought to explore the relationship between pulmonary hypertension and intravenous drug use.

Methods: A narrative review was conducted using PubMed MeSH search with further papers identified using a standard PubMed search with relevant key terms and various synonyms.

Results: HIV infection may be associated with pulmonary hypertension due to indirect consequences of viral infection, venous thromboembolism or its therapies. Anti-retroviral infection may also influence plasma concentrations of commonly used treatments for pulmonary hypertension. Intravenous drug use is acknowledged as an important portal for the acquisition of hepatitis virus C infection, with portopulmonary hypertension a potential complication associated with poor prognosis. Interferon based therapy, used in treatment of chronic hepatitis C infection, may also play a causal role in the development of pulmonary hypertension. More recently, sofosbuvir has been linked to development or exacerbation of pulmonary arterial hypertension. Certain drugs of abuse may cause pulmonary hypertension due to properties that result in direct injury to the pulmonary vasculature. The potential for embolic phenomena, complicating venous thromboembolism, recurrent embolization of particulate matter or because of right-sided endocarditis, resulting in pulmonary hypertension is an important contributing factor in the pathophysiology in this unique cohort.

Conclusions: Eliciting a history of intravenous drug use is important and may be associated with a number of less common etiologies, each with specific diagnostic and therapeutic implications.