国冢级继续医学教育项目“临床思维和临床决策”学习班报名通知（项目编号：2009-15-01-002）

临床思维和临床决策是临床工作者（医师、药师、护师、营养师、心理师、康复师和检验师）的逻辑思维能力和临床处置能力。临床思维是临床决策的前提,而临床决策则是临床思维的结果;临床思维和临床决策都以临床信息和医药知识作为基础。临床思维和临床决策是否得当,决定了临床信息的收集是否全面,分析是否得当,疾病诊断是否正确,病情判断是否适当,治疗方案是否合理,治疗监护是否充分。一句话,正确的临床思维和临床决策让病人承受必要的痛苦、承担必须的风险、     

临床药师在呼吸科病区的药学实践

随着临床药师制度的建立、健全,国家对临床药学工作的重视和投入,医院药学已经全面进入以病人为中心的药学服务阶段。临床药师在临床的作用和地位,随着临床药学工作的深入和其自身能力的提高,越来越得到医生和病人的认可。面向临床,如何找到工作的切入点,如何有效地开展临床药学实践,是每一位临床药师关注的重点。作者根据自己在呼吸科多年的临床药学工作实践,探讨临床药师的作用和临床药学工作的思路。     

临床药师参与临床用药的体会

目的通过临床会诊谈临床药师与临床用药的体会。方法通过对左氧氟沙星注射液在临床出现的严重不良反应,要告知医生和患者可能存在的潜在风险,避免严重的不良反应发生。结果临床药的回诊意见和建意临床医师采纳。结论临床药师参与临床用药势在必行,需要得到临床的配合和信任。     

探讨现阶段我国临床药师的职责和未来

目的 探讨现阶段我国临床药师在临床合理用药过程中的职责所在,以及临床药师队伍的建设和培养,促进临床用药的规范化和合理化.方法 根据相关政策和资料,从目前我国临床药师在临床用药中所起的作用及遇到的问题为出发点,探讨并提出相关的建议和措施.结果 我国临床药师在临床用药中的作用还有待发展,但已初有成效,临床药师队伍的培养还需进一步摸索.结论 临床药师的培养以及相关制度的完善是一个重大课题,是临床规范化用药的基石.     

新药临床试验中药物临床价值的考虑

新药上市的目的是为满足临床需求、实现临床价值.疗效是药物临床价值和临床意义的核心体现.因此,在新药研发临床试验的设计与疗效评价中,要充分重视临床价值评估.本文从药物临床试验目的和临床定位的确定、临床试验比较类型选择及相关界值的确定、临床疗效指标的选择和使用等多方面进行了分析和讨论,强调在新药临床试验中,需要重视药物临床...     

浅谈临床药师开展临床药学服务的途径和方法

目的探讨临床药师开展临床药学服务的途径和方法。方法查阅大量相关文献,对其进行研究整理,并结合我院临床药师开展工作的具体情况,总结出临床药师开展临床药学服务的基本途径和方法。结果临床药师可以通过参与医师查房与会诊、制定个体化给药方案、提供药学咨询服务、临床使用药物的不良反应监测、处理临床中的药品不良反应事件、撰写药历等途径和方法为临床提供药学服务。结论临床药师可为临床提供多种形式的药学服务,临床药师参与临床治疗工作,可减少药物不良反应的发生,促进合理用药。     

真实世界数据和证据在我国临床决策中的应用现状

传统上,循证医学理念下的临床决策通常以随机对照试验作为最佳临床证据。快速发展的真实世界数据和真实世界证据领域结合了真实临床环境的复杂性,为临床医生提供了补充性证据,并丰富了证据类别,以辅助临床医生做出更好的循证临床决策。本研究旨在梳理我国用于循证临床决策的真实世界数据和证据的范围和适用性,并总结潜在障碍和可行建议,以期进一步推进高质量真实世界数据和证据在循证临床决策中的可接受性。     

浅议临床药学在医院药学发展中的作用

目的积极开展临床药学工作,提高医院药学服务水平和医院整体水平。方法针对目前常州地区临床药学的现状和不足之处,通过加强和规范临床药师培养、药师下临床、加强临床药师继续教育等手段。结果明确和规范临床药学研究室的工作。结论临床药学工作是医院药学发展的关键。     

我国临床药学建设与发展趋势(上篇)

目的:调整我国临床药学的发展方向,加速临床药师制和临床药师培训基地建设.方法:采用回顾和思考的方式,总结我国临床药学和临床药师制体系建设的现状、经验、不足与发展趋势.结果与结论:肯定临床药学和医院药学取得的成绩,明确临床药学学科和临床药师制体系建设的必要性,要坚持正确发展方向,药师应树立走出药房,面向临床,坚持以病人为中心、以合理用药为核心,服务患者的理念,转变观念与职责,走人才和科技发展的道路.     

临床药师在普外科的药学服务简

临床药师在临床工作中的作用和地位,随着临床药学工作的深入和临床药师自身能力的提高,越来越得到医师和病人的认可[1].如何有效地开展临床药学服务,是每一位临床药师关注的重点.现就广州市花都区人民医院临床药师参与普外科药学服务的内容和取得的成效总结如下.     

Relationship between leadership styles of hospital pharmacists and perceptions of work-unit effectiveness

Relationships between hospital pharmacists' perceptions of their own and their immediate supervisors' leadership styles and their perceptions of the effectiveness of their work units were examined. Pharmacists practicing in 12 large Chicago-area hospitals were asked to complete a four-part questionnaire that consisted of demographic questions, the LEADSelf instrument, the LEADOther instrument, and a measure of perceived work unit effectiveness. Respondents' primary, secondary, and combination leadership styles and their degree of style adaptability were determined and compared with the primary, secondary, and combination leadership styles and style adaptability of their immediate supervisors and with their perceptions of the effectiveness of their work units. Pharmacists involved in providing clinical or drug information services and pharmacists responsible for purchasing activities perceived their work units to be most and least effective, respectively. Most respondents perceived their primary leadership style to be high task-high relationship, but only 32% perceived their immediate supervisors to exhibit this style. Pharmacists who perceived their immediate supervisors to have high relationship leadership styles (based on primary and combination style classifications) had significantly more favorable perceptions of the effectiveness of their work units than did pharmacists who perceived their supervisors to exhibit low relationship styles. Respondents' perceptions of their supervisors' style adaptability were positively and significantly correlated with their perceptions of work-unit effectiveness. Respondents who thought their supervisors' leadership styles were more adaptable than their own had the most favorable perceptions of work-unit effectiveness.(ABSTRACT TRUNCATED AT 250 WORDS)     

A pilot study of what African American maternal caregivers and their adolescent daughters talk about when asked to discuss tobacco together

Parents play a critical role in shaping their children’s substance use behaviors, yet few studies have examined the messages that caregivers give their adolescents about tobacco. In this study, we identify tobacco-related messages discussed by African American maternal caregivers and their adolescent daughters. Twenty-five African American maternal caregivers and their adolescent daughters participated in a video-taped discussion about tobacco. Discussions were transcribed and coded thematically. Seven themes emerged, which were grouped into tobacco-messages and communication strategies. Messages included health risks, non-health-related reasons to stop smoking, reasons people smoke, and tobacco products and marijuana. Strategies caregivers used to communicate their tobacco-related messages included sharing personal or their families’ experience with smoking, using humor, and role-playing. Finally, embedded within all of the themes, participants expressed their disapproval of tobacco use, whether it was directed at their own use, their adolescents’ use, a family members’ use, or peers’ use. African American maternal caregivers and their daughters openly talk about a variety of tobacco-related topics, and caregivers are open to sharing their own and their families’ experience with substance use. Findings also suggest that having caregivers and their adolescents participate in discussions tasks could be potentially beneficial in facilitating discussions and could identify areas in which caregivers could use help in discussing sensitive topics.     

Issues of Fatherhood and Recovery for VA Substance Abuse Patients

Abstract

Drug-addicted fathers bring to treatment many uncertainties about their relevance to their children. Whether they are in contact with their children or not, they often believe their children are better off without contact with them. In working with these fathers, the authors have observed these men raising a number of issues concerning the father role. These include having no concept of what a father should be, confusing the roles of manhood and fatherhood, feeling inadequate as a provider, and not knowing how to reconnect with children they have not seen, particularly daughters. The fathers also have to learn to deal with their own guilt concerning their abandonment of their children. Suggestions for interventions with the fathers are given and include offering a workshop for fathers where they are shown visual images of positive fathering and can discuss their own parenting experiences.     

Job satisfaction of HMO pharmacy personnel.

This study identifies and examines the job satisfaction of pharmacy personnel in a large integrated prepaid group practice HMO. A large share of pharmacy personnel were satisfied with almost all aspects of their jobs. There were few differences between pharmacists and support personnel in satisfaction with specific aspects of their jobs. Among pharmacists, the challenge of their work, their management, and their physical working environment were the most significant factors in their overall job satisfaction while among support personnel the control of their work was the only significant factor. It seems that working in a large HMO can be satisfying for pharmacy personnel.     

Pharmacology of carbon nanotubes: Toxicokinetics,excretion and tissue accumulation

Carbon nanotubes (CNT) are increasingly being investigated for their use in biomedical applications and nanomedicine. An emergent need for the understanding of their in vivo biodistribution and pharmacokinetics is therefore needed to establish the essential properties and criteria for their further development as targeted CNT delivery systems to specific tissues for diagnostics and therapeutic purposes. Until their biodistribution and toxicoketic profiles are fully understood, their translation into the clinic will be hindered. This review will highlight the important factors affecting the biodistribution and pharmacokinetic profile of CNT and address their toxicokinetics following systemic, pulmonary and dermal exposure.     

艰难梭状杆菌重组肠毒素A和B与对应天然肠毒素蛋白的功能活性比较

目的：肠毒素A（TcdA）和肠毒素B（TcdB）是艰难芽孢梭状杆菌主要的毒力因子，我们对已经获得的纯化的重组蛋白TcdA和TcdB与对应的天然肠毒素蛋白的活性和功能进行了比较。方法通过光学显微镜观察重组肠毒素和对应的天然肠毒素对肠上皮细胞的细胞病变作用、蛋白印迹实验观察对Rac1蛋白的糖基化作用，以及激光共聚焦显微镜观察肠毒素对肠上皮细胞骨架的破坏作用。结果纯化得到重组蛋白肠毒素TcdA和rTcdB其分子量与天然的TcdA和TcdB蛋白大小接近，生物活性与天然的TcdB蛋白相似，TcdA和极微量TcdB具有使肠上皮细胞病变、Rac1蛋白的糖基、细胞骨架塌陷。结论艰难梭状芽孢杆菌肠毒素A和B重组蛋白具有良好的对应天然肠毒素相似的生物学功能活性。     

患者及其家属对临床药师与药学服务认知和需求情况调查研究

目的：了解患者及其家属对临床药师与药学服务的认知和需求情况,为临床药师职业健康发展和药学服务工作深入开展提供参考。方法：以问卷调查形式,采用分类随机抽样法对在上海市30家三级医院就医的患者及家属进行实地问卷调查,并对调查结果进行统计分析。结果：患者及其家属对临床药师与药学服务认知不足,47.98%的患者和家属不知道临床药师;56.56%的患者和家属不知道临床药师与药房药师的区别;91.92%的患者和家属在遇到用药问题时,希望得到药师的专业帮助;90.41%的患者及其家属在住院时希望临床药师前来关心用药情况,提供药学监护;超过90%的患者及其家属欢迎、支持临床药师下临床,开展药学服务,并认为这样有助于疾病的治疗。结论：应通过加强宣传、推进临床药师制建设等措施提高患者及其家属对临床药师与药学服务的认知,并通过提高临床药师的药学服务质量和水平来满足公众不断增长的健康服务需求。     

Saving face? survey respondents who claim their last week's drinking was atypical

Thirty-one per cent of survey respondents asked about their last week's drinking claimed it was atypical. They are shown, by examining their levels on two blood tests (mean cell volume and gamma-glutamyl transpeptidase) and by a comparison of their consumption on a recent social occasion with that of their companions, to be reporting a trivial difference between their last week and their typical week and appear to be attempting to deny heavy habitual consumption.     

Eph家族蛋白研究进展

Eph家族蛋白包括Eph受体和Ephrin配体,是蛋白酪氨酸激酶家族中的最大成员。由于其具有独特的受体-配体复合物的结构特点及其受体与配体间特有的相互作用模式,所以它们极有可能成为疾病治疗的药物靶标,故该蛋白家族的相关领域研究日益受到重视。该文首先从Eph家族蛋白的分类、表达特点、结构和受体-配体相互作用特点以及其在神经系统中的功能等几个方面简要综述了其相关领域的最新研究进展,进而从结构、作用模式、功能几方面对Eph家族蛋白在神经系统疾患防治中的潜在价值和未来的研究方向进行了探讨和展望。     

Raman spectroscopy analysis and mapping the biodistribution of inhaled carbon nanotubes in the lungs and blood of mice

Because of their small size, robust structure and unique characteristics, carbon nanotubes (CNTs) are increasingly being used in a variety of biomedical applications, materials and products. As their use increases, so does the probability of their unintended release and human exposure. Therefore, it is important to establish their potential biodistribution and biopersistence to better understand the potential effects of their exposure to humans. This study examines the distribution of CNTs in CD‐1 mice after exposure by inhalation of single‐walled carbon nanotubes (SWCNTs) and investigates the possibility that inhaled nanoparticles could enter the circulatory system via the lungs. Raman spectroscopy was employed for the detection of CNTs in lung tissue and blood based on their unique spectroscopic signatures. These studies have important implications concerning the potential effects of exposure to SWCNTs and their use as potential transport vehicles in nanomedicine. Copyright © 2012 John Wiley & Sons, Ltd.