临床药师下临床的探索与实践

药师参与临床治疗是今后医院药学发展的趋势,我国医院药学工作正在由药品供应、以药品为中心的服务模式向以患者为中心方向转变,作为药学工作者应顺应新形势的要求,不断完善、发展自己。我国在20世纪80年代初开始开展临床药学工作,同时开始呼吁药师与临床结合。     

医院开展临床药学应注重临床药师的培养

临床药师是开展临床药学的主体,临床药师培养是现代医院药学发展的关键环节。2002年我国卫生部和国家中医药管理局联合颁布的《医疗机构药事管理暂行规定》中明确指出医院药学工作要以服务患者为中心,以临床药学为基础,以合理用药为核心,参与临床疾病的诊断治疗,提供药学技术服务。2005年又颁布《医院管理评价指南》,进一步明确要求开展临床药学工作,建立临床药师制度。临床药学没有固定模式可循,下病区参与查房,提供药学服务工作,应该在实践中摸索,在尝试中积累经验。1临床药师的现状与其应有的地位不相符我国临床药师高等教育匮乏,而且缺…     

临床药师的职责，使命与努力方向

临床药学是医院药学新的发展方向。医院覆盖面广,诊治病人多,迫切需要开展临床药学工作,为患者提供“安全、有效、经济、适当”的临床药学服务,因此临床药师这一职业应运而生。通过临床实践,笔者充分认识到在医院开展临床药学工作的必要性和重要性,并了解了医院开展临床药学面临的困难和临床药师的职责、使命与努力方向。     

药师深入临床的意义及临床药师的培养

始于20世纪60年代的临床药学是医院药学的发展方向，美国药学家于1988年提出并于1993年在国际药学会议上确定了医院药师的职责，即“药师必须履行药学服务的义务与职责，药师工作的发展方向是直接为病人提供更好的服务，技术含量应越来越高”。我国2002年颁布的《医疗机构药事管理暂行规定》也明确指出：“医疗机构的药学部门要建立以病人为中心的药学管理工作模式，开展以合理用药为核心的临床药学工作，参与临床疾病的诊断和治疗，提供药学技术服务，提高医疗质量”。     

国内外药师临床介入方式的探讨

目的探讨现时国内外医院药师的临床介入方式,明确临床药师的职责及地位。方法通过国内外临床药学工作的实例,阐述药师介入临床的方式,说明药师的介入干预所带来的临床效果。结果合理用药水平在药师的介入下均有所提高,临床治疗工作得到正面的效果。结论开展临床药学工作及推广药学服务是国际医疗界的发展趋势,国家应积极完善相关的制度,并重点培养临床药学专业人才。     

国内外药师临床介入方式的探讨

目的探讨现时国内外医院药师的临床介入方式,明确临床药师的职责及地位。方法通过国内外临床药学工作的实例,阐述药师介入临床的方式,说明药师的介入干预所带来的临床效果。结果合理用药水平在药师的介入下均有所提高,临床治疗工作得到正面的效果。结论开展临床药学工作及推广药学服务是国际医疗界的发展趋势,国家应积极完善相关的制度,并重点培养临床药学专业人才。     

加速临床药师教育培养发展我国临床药学事业

目的探讨我国临床药师的培养，大力改革继续药学教育，加速发展我国临床药学事业。方法建议改革高等药学教育和继续药学教育，分期分批开展临床药师培训，尽快培养临床药学人才。结果临床药师深入临床全方位地开展以病人为中心，以临床治疗为目的的药学服务，使临床用药更趋安全有效经济合理，从而减少药物不良反应的发生，进一步提高临床效治疗果。结论临床药学工作发展前景广阔喜人，需要得到各级领导的支持和临床的配合与信任。     

临床药师如何开展临床药学工作

临床药师要开展临床药学工作,须从前期准备、临床实践和出院患者用药教育三方面开展工作。临床药师可以从对患者进行用药教育、对护士配药及执行做指导和与医生一起为患者制定用药方案三方面入手开展临床药学工作。临床药师从力所能及的工作内容入手,可获得临床医疗团队的认可,大大提升临床药师的工作热情与信心。     

药师下临床开展临床药学工作实践

临床药学的工作核心是合理用药,药师的使命是提供药学服务(pharmaceutical care),美国医院药师协会对药学服务的定义为:以患者为中心的全方位服务,以推进社会用药的合理性,提高人们的健康水平,降低卫生资源的消耗为目的[1].我国正在大力发展临床药学,医院药师也正朝着提供药学服务的目标努力.     

探讨临床药师参与临床工作的临床药学思维

目的:探讨临床药师建立临床药学思维的重要性。方法:结合临床药师在临床工作的特点,通过临床药师参与临床实践工作,对临床药学思维进行分析总结。结果:临床药师通过临床药学思维,能在临床上发现、识别并预防潜在的用药问题,可以与医师有效合作,使病人得到更加有效的治疗。结论:临床药师的临床药学思维能力的提高,对于临床药师能更好地开展药学服务,保障药物在临床使用过程中的安全及有效性具有重要意义。     

上海市社区卫生服务中心医务人员伦理学知识调查及建议

目的:调查上海社区卫生服务中心医务人员的伦理学知识认知情况.方法:采取分层抽样方式,于2016年6—8月对上海市245家社区卫生服务中心的7552名医务人员进行问卷调查.结果:医务人员对伦理学知识非常了解、基本了解、了解很少和完全不了解的人数分别为536人(7.1%)、5411人(71.7%)、1536人(20.3%)和69人(0.9%).不同岗位、职称、学历的医务人员之间存在着明显的伦理学知识认知差距.结论:上海社区卫生服务中心医务人员的伦理学知识了解程度仍有待提高,需加强伦理学知识的学习和应用.     

Nifedipine in the treatment of hypertension in the elderly

The effect of nifedipine monotherapy, retard tablets, 20 mg bid, was evaluated in 23 hypertensive patients, mean age, 79 +/- 2 years. Twenty-one patients completed an eight-week study. Blood pressure (BP) decreased to 160/90 mm Hg in 15 patients; in four additional patients diastolic BP dropped by 15% to 28%. In a subset of five patients with isolated systolic hypertension, a significant reduction in systolic BP was noted. Side effects were relatively mild and only two patients discontinued the study. The results suggest that nifedipine monotherapy offers an alternative, logic, therapeutic approach to hypertension in the elderly.     

Studies on the receptors involved in the action of the various agents in the phenylbenzoquinone analgesic assay in mice

1. Tolerance to the activity of several narcotic analgesics (morphine, levorphanol, and methadone) and several narcotic-antagonist analgesics (pentazocine, cyclazocine, and nalorphine) was studied in the mouse phenylbenzoquinone stretching test. Virtually complete tolerance was induced by chronic treatment with each of the narcotic agents, while no apparent tolerance was induced by the narcotic antagonists.2. In morphine-tolerant mice there was a high degree of cross-tolerance to the effects of not only the other narcotic drugs but also to those of the narcotic antagonists, acetylsalicylic acid, and physostigmine.3. The effects of morphine and pentazocine were antagonized by naloxone but not by atropine, while the effects of physostigmine were antagonized by atropine but not by naloxone. Neither atropine nor naloxone antagonized the effect of acetylsalicylic acid.4. The results of the tolerance study suggest that there is a fundamental difference in the consequences of receptor interaction for the narcotic and the narcotic-antagonist analgesics. Morphine-tolerant mice exhibit cross-tolerance non-specifically. The selectivity of naloxone and atropine differentiates the narcotic and narcotic-analgesics from the other two agents used in this analgesic test.     

Interactions among the cannabinoids in the antagonism of the abdominal constriction response in the mouse

The ability of ⁹-tetrahydrocannabinol (THC), cannabinol (CBN), cannabidiol (CBD), 11-OH THC and 8,11-diOH THC to antagonise the abdominal constriction response in the mouse induced by formic acid, phenylquinone, 5-hydroxytryptamine, prostaglandin E₁ (PGE₁) and bradykinin was tested. THC was an effective antagonist against all nociceptive agents with an ED₅₀ in all cases between 1.0 and 2.6 mg/kg. CBN, while also effective against all nociceptive agents, was less potent than THC, with an ED₅₀ range between 46.2 and 112.5 mg/kg. CBD in doses as high as 200 mg/kg was without effect. Using PGE₁ as the nociceptive agent, 11-OH THC was equipotent to THC while 8,11-diOH THC was inactive. Naloxone, while able to antagonise the antinociceptive effect of morphine against formic acid-induced writhing, did not reverse the antinociceptive effects of THC. There were no pharmacological interactions between THC, CBD and CBN.     

Neurotensin causes a greater increase in the metabolism of dopamine in the accumbens than in the striatum in vivo

Differential pulse voltammetry with carbon fibre electrodes was used to study the effect of central administration of neurotensin on the extracellular level of 3,4-dihydroxyphenylacetic acid (DOPAC) in the nucleus accumbens and the striatum in anaesthetised rats. Intracerebroventricular injection of neurotensin (10 micrograms) increased the peak height for DOPAC 20 min after administration in the nucleus accumbens but only after 40 min in the striatum. The maximum increase was similar in both regions, with 30% and 27% above the pre-injection basal level, respectively. Neurotensin (1 micrograms) however increased the extracellular level of DOPAC in the nucleus accumbens alone. Neurotensin (0.1, 1.0 and 3.0 micrograms/0.5 microliter), injected into the ventral tegmental area, induced a potent and long-lasting elevation of the peak height for DOPAC in the nucleus accumbens, while the same doses in the substantia nigra produced effects on the metabolism of dopamine in the striatum of smaller amplitude and shorter duration. The maximum effect of each dose was about 2.5 times greater in the mesolimbic, compared to the nigrostriatal system. Amphetamine (2 mg/kg, s.c.) decreased the extracellular level of DOPAC with a similar magnitude, both in the nucleus accumbens (52%) and the striatum (47%). Intracerebroventricular administration of neurotensin (1 micrograms), 5 min after amphetamine, did not alter the effect of amphetamine on the extracellular level of DOPAC either in the nucleus accumbens or the striatum. However, neurotensin (10 micrograms) partially reversed the effect of amphetamine in the nucleus accumbens and had a similar but smaller and delayed effect in the striatum. The results from the present study, together with previous neurobehavioural studies, suggest that neurotensin has a relatively selective action on the mesolimbic dopaminergic system in the rat.     

Role of the liver in the disposition of intravenous nitroglycerin in the rat

Previous studies have indicated that the liver is the main site of nitroglycerin (NTG) elimination when the drug is systematically infused. To examine this hypothesis, we measured the apparent systemic clearance (Cls) of nitroglycerin in anesthesized rats receiving a constant intravenous infusion at a dose of 100 micrograms per kg per min. Animals were divided into shunt and sham groups; the former had undergone a portal vein ligation 10 days prior to the study, while the latter was subjected to a sham operation. On the study day, half of the animals of each group also received probenecid at 200 mg/kg, i.v., a drug previously reported to inhibit organic nitrate ester reductase (ONER) activity in rat liver. Arterial NTG samples were obtained at 41, 43 and 45 min of infusion in all four experimental groups; Cls was 439 +/- 32 ml per kg per min (mean +/- S.E.) in sham, 460 +/- 44 in sham and probenecid, 477 +/- 39 in shunt, and 461 +/- 34 in shunt and probenecid animals. During NTG infusion, hepatic blood flow (measured with a constant infusion of indocyanine green) was decreased markedly in shunted rats as was liver/body weight, indicating hepatic atrophy. The specific activity of hepatic ONER was similar in all four groups. In spite of marked differences in hepatic blood flow and hepatic mass, the Cls was similar in all four groups. The liver does not appear to be a major site for the elimination of systemic nitroglycerin as hitherto assumed.     

女性医务人员健康状况的研究

目的探讨女性医务人员健康状况的特点。方法对2877例医院工作人员健康查体资料进行统计学分析。结果①女性医务人员中,41.0%的人员患有不同类型的疾病,略高于男性患病率（36.8%）,二者差异有统计学意义（P=0.029）;②女性医务人员高脂血症为31.9%（212/665）,低于男性（65.9%,274/416）;③脂肪肝患病率女性（32.6%,181/556）,亦低于男性（45.9%,151/329）;④女性相关疾病中,乳腺疾病和子宫肌瘤的患病率分别为4.8%和3.4%;而宫颈糜烂为20.2%;⑤女性医务人员高血糖为11.0%（77/702）,高血压为4.6%（56/1229）。结论女性医务人员中妇科与乳腺疾病是健康体检的重点,代谢性疾病也应加以关注。     

人文关怀在手术室护理中的应用

目的探讨在手术室护理中人文关怀的作用。方法将2012年5月至2012年11月200例手术患者随机分为两组,对照组100例,采取术前、术中常规护理,观察组100例,在对照组的基础上给予患者人文关怀,对比两组护理满意度及疗效。结果对照组各项指标满意度低于实验组(P<0.05),与对照组比较,实验组的住院时间明显缩短,痛苦小,并发症发生率低,P<0.05,差异均有统计学意义。结论 "以人为本"的人文关怀理念应用于手术室中,可充分提高护理质量及患者的满意度。