某院处方、医嘱点评模式的实践与用药分析

通过对我院门诊处方及病区医嘱的点评,提升医院药学服务能力,提高临床合理用药水平。根据《医院处方点评管理规范》、《抗菌药物临床应用管理办法》的相关要求,根据我院实际情况,建立组织机构,制定工作流程,规范标准和实施细则,对处方、医嘱进行点评,并将考核结果纳入医师绩效考核。促进了我院合理用药,降低了药费比例。     

“第十八届全国儿科药学学术会议”征文通知

经中国药学会批准,由中国药学会医院药学专业委员会主办、中国药学会医院药学专业委员会儿科药学专业组和湖南省儿童医院联合承办的“第十八届全国儿科药学学术会议”,定于2007年6月初在湖南省长沙市召开。本届会议的主题是“关爱儿童健康,科学、合理、规范儿科临床用药”,目的是加强国内各儿童(科)医院和妇幼(婴)保健院药学工作者的联系和交流,促进儿科药学科学研究,提高儿科药学水平;加强儿科药学服务,促进儿科临床合理规范用药,提高药物治疗效果;加强儿科临床安全用药,促进药物不良反应监察工作,避免和减少药物不良事件的发生。敬请各省…     

慢性肾脏病患者医嘱点评难点和模式探讨

目的:探讨医院慢性肾脏病患者医嘱点评的难点、模式和评价的具体标准,促进《医院处方点评管理规范(试行)》的贯彻实施.方法:在分析慢性肾脏病点评疾病和用药特点及其难点的基础上,对《医院处方点评管理规范(试行)》关于慢性肾脏病用药不适宜处方及超常处方的界定标准、处方专项点评模式进行探索.结果:建立慢性肾脏病医嘱专项点评的模式和慢性肾脏病不适宜处方及超常处方的界定标准.为规范化慢性肾脏病医嘱点评提供了参考.结论:医院慢性肾脏病医嘱合理性评价具体标准及专项点评模式需不断完善统一,以进一步提高慢性肾脏病合理用药水平.     

信息技术在医院药学服务中的应用与实践

目的：介绍信息技术在我院医院药学中的应用,以促进医院药学发展、提高药学服务水平。方法：介绍我院药房建立的处方评价与药物利用研究系统、药学信息智能提示系统、网络及手机版药品词典、短信用药依从性管理系统等在临床的应用情况和实施效果。结果与结论：我院运用信息技术实现了药师全样本处方点评、为医师提供医嘱前及医嘱中干预措施、为患者提供咨询服务等,逐步在医疗质量管理、药品监管、处方质控等方面确立了医院药学服务在整个医疗服务体系中的地位,促进了医院药学的发展。     

美国临床药师如何复核医嘱——在美国霍普金斯医院学习临床药学

霍普金斯医院（Johns Hopkins Hospital）是美国霍普金斯大学的附属教学医院，连续十几年都保持了美国最佳医院排名榜上顶级的排名，2005年最佳医院排名第一。其药房包括儿科药房、成人肿瘤药房、成人外科药房、中心药房及普通成人药房。作于2005年4～6月在该院的儿科药房进行了为期2个月的临床药学学习，在学习中体会到真正体现药师提供临床药学专业服务主要有四个方面的内容；即复核医嘱（doetogsorder），监测药物的治疗过程，药物利用和病人用药教育。本就该院的临床药师如何复核医嘱作一介绍。     

湖北省黄石市中心医院2012年儿科用药分析

目的为儿科临床合理用药提供参考和建议。方法收集2012年1~12月湖北省黄石市中心医院儿科门诊处方,依照《医院处方点评管理规范（试行）》的要求进行点评,通过药物使用频率,分析常用抗感染药物、激素类药物、维生素类药物的合理应用情况。结果儿科抗感染药物、激素类药物的使用频率较高,维生素类注射液有超剂量使用现象,中药注射液的使用率有所降低。结论需降低抗感染和激素类药物的使用率,通过对不合理医嘱的及时干预,提高合理用药水平。     

临床药师参与口服补钾药物医嘱合理应用干预经验探讨

目的 规范医院口服补钾药物医嘱,促进医院口服补钾药物的合理使用.方法 随机抽取某院2020年1～6月以及2021年1～6月住院口服补钾药物的低钾患者各300例,对这些患者口服补钾药物医嘱进行点评分析比较.结果 临床药师参与口服补钾药物医嘱合理应用干预后,某院住院口服补钾药物医嘱不合理情况较前明显好转.结论 临床医师应提...     

儿童医院门诊药房药学服务的实践与思考

目的探讨如何充分发挥门诊药房在儿童医院药学服务中的作用。方法从儿童医院门诊药房的药学服务现状和医院药学的发展方向,探讨其作用。结果通过倡导＂感动服务＂,提高药学服务水平和质量来增强门诊药房在儿科药学服务中的作用。结论门诊药师应转变观念,从＂单纯交代医嘱的被动服务＂转变为＂保障用药安全、有效、合理的主动服务＂,循序渐进地提高门诊药房的儿科药学服务工作。     

基于循证药学医嘱点评对长春西汀注射液合理应用的影响

目的促进长春西汀注射液的合理应用。方法抽取某院2018年1月至6月专项点评前(A组)及2018年10月至2019年3月专项点评后(B组)使用长春西汀注射液的各240例出院患者的病历资料,采用循证药学思维对长春西汀注射液用药医嘱进行点评,比较点评前后用药不合理情况、用药疗程、药品费用及药品不良反应(ADR)的发生率。结果与A组比较,B组超适应证用药、单次用量不当、溶剂选择错误、用药疗程不适宜、配伍禁忌、药品费用及ADR发生率均明显降低(P<0.05)。结论开展基于循证药学医嘱点评,可有效规范长春西汀注射液的合理使用,保证临床用药的安全、有效、经济。     

对某院2011年1～6月份病区用药医嘱点评的结果分析

目的分析我院住院病历医嘱点评,规范病区医嘱单的书写,提高合理用药水平。方法根据我院药剂科临床药学室的数据,对病区医嘱点评的结果进行统计、分析。结果通过对住院病历医嘱的点评,病区医嘱单书写合格率、合理用药率明显提高,抗菌药物不规范使用率偏高。结论对住院病历医嘱进行点评,对提高医嘱书写合格率、促进临床合理用药有一定意义。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.