我院门诊妊娠患者处方点评及用药合理性分析

摘 要 目的： 分析我院门诊妊娠患者处方用药的基本情况以及存在的问题,以促进妊娠期患者合理用药。方法: 抽取我院门诊2014年临床诊断中涉及妊娠但不包括“正常妊娠监督”的处方,依据美国食品药品监督管理局（FDA）妊娠分级药物使用情况、相关法规及药品说明书等,进行归纳分析及点评。结果: 共抽取处方882张,平均每张处方用药品种数为（1.3±0.1）,平均处方金额为（77.7±0.2）元,其中不合理处方31张（3.5%）。结论:需加强临床医师的相关知识培训和药师的处方审核,进一步促进妊娠患者的合理用药,提高用药安全性。     

2015～2017年上海市松江区15家社区卫生服务中心门诊处方合理用药调研

摘 要 目的：了解2015～2017年上海市松江区15家社区卫生服务中心门诊处方合理用药总体情况及抗菌药物的使用情况,为促进临床合理用药提供理论依据。方法：收集2015年1月～2017年12月上海市松江区15家社区卫生服务中心54 000张门诊处方信息,参照WHO/INRUD处方指标要求及抗菌药物临床应用监测指标,统计并客观评价合理用药问题。结果：15家社区卫生服务中心平均每张处方用药品种数均值为2.08种;静脉注射剂使用百分率为7.0%;基本药物使用百分率98.33%,合格处方百分率为98%;3年平均抗菌药物占药品总收入比例10.3%,复合年均增长率（CAGR）为-8.45%;门诊就诊患者抗菌药物用药频度为110 110,CAGR为-4.92%;门诊就诊患者抗菌药物的使用强度0.56,CAGR为-1.50%;使用抗菌药物处方百分率为12.56%,CAGR为1.23%,抗菌药物监测指标中除使用抗菌药物处方百分率呈正增长外,其余指标均呈负增长。结论：松江15家社区卫生服务中心处方质量及抗菌药物的合理使用水平明显提高,但仍存在一定的提升空间。     

某院癌痛规范化治疗示范病房创建前后镇痛药使用分析及处方点评

摘 要 目的：分析某院创建癌痛规范化治疗示范病房前后镇痛药的使用情况并对其处方进行点评,评价癌痛规范化治疗示范病房创建工作开展的意义。方法：提取2011~2012年及2013~2014年肿瘤科室患者使用镇痛药的相关数据,对镇痛药的用药频度（DDDs）进行比较;分别从门诊抽取2 400张癌痛患者的镇痛药处方并对其进行点评。结果：癌痛规范化治疗示范病房创建后癌痛患者镇痛药的DDDs较创建前增加,其中第一、第三阶梯镇痛药的DDDs分别较创建前增加了31.85%、1.99%;癌痛规范化治疗示范病房创建后不合理处方减少,药品名称的书写合格率分别从86.25%上升为95.17%, 用法用量的书写合格率和药品用法用量的合理率,分别从81.92%、84.93%上升到90.04%和93.28%。结论：创建癌痛规范化治疗示范病房使镇痛药的使用及其处方书写更规范。     

某三甲医院普外科2 408例肠外营养处方分析

摘 要 目的：通过对某院普外科肠外营养（PN）处方合理性进行调查分析,为药师处方审核及临床合理用药提供参考。 方法：对某三甲医院普外科2018年1～12月住院患者的PN处方情况进行回顾性统计分析,依据相关指南对全营养混合液处方进行合理性评价。 结果：本次调查的2 408例PN的处方中96.4%的患者具有PN指征;但仍存在微营养素缺失（14.7%）、氨基酸品种选用不当（3.4%）、热氮比不合理（20.3%）、糖脂比不合理（17.9%）、阳离子浓度不合理（2.3%）、胰岛素用量过大（2.8%）等问题。结论：该院普外科PN处方主要存在热氮比、糖脂比不合理和微营养素缺失等问题,临床药师应积极对PN处方进行审核与干预,确保临床安全合理用药。     

中西医结合医院门诊中药饮片处方点评及分析

摘 要 目的： 通过对中西医结合医院门诊中药饮片处方进行点评与分析,了解医院中药处方和中药临床使用存在的问题,为指导中药房调剂工作和临床合理用药提供参考。方法: 随机抽查我院2014年1～12月1 200张门诊中药饮片处方,对处方中不合理情况进行分析,提出合理应用中药的措施。结果: 中药饮片处方中存在临床诊断填写不全、临床诊断与用药不符、中药名称不规范、处方脚注不明确、用法用量不适宜、配伍禁忌等问题;单张处方药味数大于15个以上的处方占比为65.70%,处方平均剂量大于250g的处方占比为40.25%。结论:加强中药饮片处方的定期点评检查和质量监督,有利于提高处方质量,确保患者用药的安全和经济。     

某院神经外科2 596条含氯化钾注射液医嘱的专项点评

摘 要 目的：探讨制订某院神经外科氯化钾注射液合理使用管理规范。方法: 采用回顾性调查方法,对2016年1～6月神经外科含氯化钾注射液医嘱进行专项处方点评。结果: 在含氯化钾注射液的2 596条医嘱中,不合理用药率为17.87%,其中不合理配伍用药占总不合理医嘱92.67%,存在严重的用药风险。结论:该院对神经外科使用氯化钾注射液的管理存在一定的缺陷,为避免临床用药风险,有必要建立该院氯化钾注射液合理使用管理规范,进一步规范和促进临床常用静脉高危药品管理。     

2015年某院癌痛患者麻醉性镇痛药使用合理性分析

摘 要 目的：分析某院癌痛患者麻醉性镇痛药的使用情况、存在问题,促进癌痛临床合理用药。方法: 调取某院2015年所有住院癌痛患者含麻醉性镇痛药的处方,对麻醉性镇痛药使用的合理性进行点评分析。结果: 7 789张处方中不合理处方134张,处方不合格率为1.7%,处方问题主要表现在给药频次错误、医师签字与签章不符、修改未签章、用法错误等。结论:某院住院癌痛麻醉性镇痛药使用基本合理,为确保处方合格率应加强药事管理,药师监管,及时与医师沟通。     

医院门诊处方不合理用药分析及干预效果评价

目的：通过分析甘肃省定西市人民医院处方点评中发现的不合理用药现象并进行干预,评价其效果,为临床合理用药提供参考。方法：采用回顾性方法,对我院2015年7-12月门诊处方随机抽样,对不合理用药进行分类、汇总、统计,制定并实施干预措施,考察干预后（2016年1-6月）的用药情况,评价干预效果。结果：2015年7-12月门诊处方不合理用药率为20.67%,干预后下降为10.19%。结论：为了倡导合理用药、规范医师处方,通过定期点评、剖析不合理用药的原因,并进行有效干预,提高了医生合理用药水平,达到安全、有效、经济、适当的用药目的。     

4 367例儿科住院不合理用药医嘱帕累托图分析

摘 要 目的：了解某院住院患者电子医嘱的不合理用药情况,促进临床合理用药。方法: 收集2015年1月~2017年6月某院住院患者不合理用药电子医嘱4 367例,对其类型、涉及的药物种类、具体品种进行统计,并采用帕累托图进行分析。结果: 该院住院患者不合理用药医嘱的主要类型为给药剂量不当（1 601例,36.67%）、给药途径或方式不当（545例,12.48%）、药物浓度不当（481例,11.01%）、输液速度不当（470例,10.76%）和溶媒选择不当或无（387例,8.86%）。不合理用药医嘱涉及的主要药物种类为抗菌药物（981例,22.46%）、电解质、维生素及营养药（663例,15.18%）、呼吸系统用药（532例,12.18%）、消化系统用药（446例,10.21%）、中成药（419例,9.59%）和血液系统用药（335例,7.67%）。结论: 针对该院住院患者不合理用药的主要原因,应加强对临床医师安全合理用药知识培训、建立持续改进措施、保证临床用药安全。     

某三甲医院中医科门诊处方类型及开药量分析

摘 要 目的：了解某三甲医院中医科门诊处方类型及开药量现状,为促进合理用药提供依据。方法: 通过医院信息系统调取2015年7~9月中医科门诊处方信息,以开药量为主要评估指标,对饮片类和非饮片类处方用药进行分类整理与分析。结果: 收集饮片类药品条目203 831条（占总药品条目比例77.0%）,其中开药量不超过4周量的条目数占95.1%;非饮片类药品条目61 037条（占总药品条目比例23.0%）,其中不超过4周量的条目数占98.4%。饮片和非饮片类药品中开药量大于4周量的条目不足5%,主要为外埠慢性疾病患者,其中部分西药开药量较大值得关注。结论:该院中医科门诊开药总体规范,但部分药品的临床使用仍存在安全隐患。     

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.     

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.     

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.     

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.