中药也要凭处方购买？

日前召开的第16届全国医院药剂科主任年会提供的资料表明，目前已知可引起不良反应的中药材有243味。专家建议，应该及时纠正民间认为中药药性平和、无毒副作用的观念，积极推行中药凭处方购买，最大限度地保障患者用药安全。     

我院儿童药物中毒特点与药学服务

[摘要] 目的：研究我院收治的药物中毒患儿的一般规律及特点,为预防儿童药物中毒及抢救药物中毒患儿提供更好的药学服务。方法：对我院2015-2017年收治的儿童药物中毒病例进行统计分析。结果：儿童药物中毒主要与误服、家庭药品保管、基层医务工作者和家长的安全用药知识等有相关,医院部分药品解毒剂配备不足。结论：预防儿童药物中毒重点在于加强家庭常用药的日常管理、提高基层医务工作者及家长的安全用药意识和改进药品包装等方面,同时医院药品解毒剂配备应完善,全社会应对此引起足够的重视。     

有机磷农药中毒临床应用复方解磷疗效观察

有机磷农药中毒在我们基层乡医院经常遇到,传统方法使用的解毒剂是阿托品和解磷定或氯磷定。而我们现在所用的解毒剂是复方解磷,疗效较好,报告探讨如下。     

基于数据仓库的医院决策支持系统的构建

随着商品经济的发展，医院问的竞争也日益加剧，越来越多的医院认识到正确及时的决策是医院生存和发展的关键所在。因此，充分利用现代信息科技技术，自动快速获取有用的决策信息，为医院提供快速、准确的决策支持，已成为大多数成功医院的共识。在医疗信息技术悄速发展的今天，大部分医院已广泛使用医院信息管理系统。由于该系统大部分都是事务处理型的，数据的组织和存储均是围绕事务处理进行的，     

药物利用在药学服务中的体现——在美国霍普金斯医院学习临床药学

通过在美国霍普金斯医院的学习，介绍药物利用在临床药学服务中的重要作用。药物利用是美国临床药师提供药学服务的主要内容之一，医院对临床药师的出现也持积极和配合的态度。     

临床前研究中肝损伤的临床病理指标的选择及意义

目的探讨临床前研究中肝损伤的鉴定以及推测药物可能在患者中造成的肝损伤。方法利用美国兽医临床病理学会的“管理事务委员会”专家建议的方法。结果与结论为临床前药物安全性研究中药物诱导肝损伤的临床病理学指标提供特异性诊断数据。     

军字一号工程在医院经济管理中的效能评价

军字一号工程开发使用给医院管理工作带来质量上的飞跃。这个以病人信息为主线，以人、财、物三线并举为特征的医院管理信息系统，能对医院海量信息进行快捷的传递、存储、控制和处理，满足了多层次、多角度的医疗信息需求，提高了工作效率和工作质量，增强了医院综合效益，推动了医院的发展和建设。笔者根据实践体会，对军字一号工程在医院经济管理中的效能做一简要评价：１强大的费用查询功能，有利于营造公开透明的医疗收费环境费用查询是医院经济管理工作基本内容。军字一号工程所提供的费用查询功能非常强大、全面和传统手工方法相比，…     

电子病历（EMR）签名及存储方式探讨

目的 适应医院信息系统改革需要，改变病历的载体和储存方式，做到无纸化槠存和节约经费和存储空间。方法 对军惠医院信息管理系统各种病历文书传输和电子签名等进行改进和完善，使电子病历具有真实、完整、防伪和不可抵赖性。结果 实现电子病历的硬盘或光盘存贮，明显提高了医疗工作效率，并产生巨大经济效益。结论 实现电子病历的硬盘和光盘存储，辅之以必要的管理手段，可以确立电子病历签名及存储方式的法律地位。     

“应酬综合征”拉动利胆药市场

春节过后的这一段时间，到医院门诊治疗胆类疾病的患者明显增加。这是因为节日前后人们的各种应酬增多，导致胃出血、胰腺炎、胆囊炎、痛风等“节日应酬综合征”开始凸显。笔者从医院门诊了解到，因为吃得太好、喝得太多，导致胃出血、急性胰腺炎、胆囊炎、痛风四大疾病患者就诊“扎堆”。为此，专家建议，在年终应酬时，切忌暴饮暴食，饮食应清淡为佳。     

浅谈医院信息系统的日常维护及网络安全问题

医院信息系统(HIS)是专门存储、维护和应用医院信息的数据库管理系统.是处理医院的各种信息和支持医院管理流程.为管理层决策提供依据的应用系统,对医院信息系统的日常维护和网络安全管理是非常重要的.     

Trends in antidote utilization at a tertiary care hospital in Saudi Arabia: A 6-year retrospective study

Antidote stocking has been described in several studies from many countries to be problematic and constantly insufficient. During our institution's previous experience with a medication event that resulted from lack of antidote stocking, we initiated a review of all our antidotes and realized the lack of data on utilization in the literature that would help us in planning for our stocks. Therefore, we conducted this retrospective review of antidotes utilized at a large tertiary care hospital over a period of 6 years. The paper describes the types of antidotes and toxins involved, together with important patient characteristics and antidote utilization data that can be useful to other healthcare institutions in planning for their antidote stocks.     

Which cyanide antidote?

Cyanide has several antidotes, with differing mechanisms of action and diverse toxicological, clinical, and risk–benefit profiles. The international medical community lacks consensus about the antidote or antidotes with the best risk–benefit ratio. Critical assessment of cyanide antidotes is needed to aid in therapeutic and administrative decisions that will improve care for victims of cyanide poisoning (particularly poisoning from enclosed-space fire-smoke inhalation), and enhance readiness for cyanide toxic terrorism and other mass-casualty incidents. This paper reviews preclinical and clinical data on available cyanide antidotes and considers the profiles of these antidotes relative to properties of a hypothetical ideal cyanide antidote. Each of the antidotes shows evidence of efficacy in animal studies and clinical experience. The data available to date do not suggest obvious differences in efficacy among antidotes, with the exception of a slower onset of action of sodium thiosulfate (administered alone) than of the other antidotes. The potential for serious toxicity limits or prevents the use of the Cyanide Antidote Kit, dicobalt edetate, and 4-dimethylaminophenol in prehospital empiric treatment of suspected cyanide poisoning. Hydroxocobalamin differs from these antidotes in that it has not been associated with clinically significant toxicity in antidotal doses. Hydroxocobalamin is an antidote that seems to have many of the characteristics of the ideal cyanide antidote: rapid onset of action, neutralizes cyanide without interfering with cellular oxygen use, tolerability and safety profiles conducive to prehospital use, safe for use with smoke-inhalation victims, not harmful when administered to non-poisoned patients, easy to administer.     

Antidote Availability in Saudi Arabia Hospitals in the Riyadh Province

Inadequate antidote stocking is a global problem in hospitals. Insufficient supplies and delays in the administration of antidotes could lead to death and additional potentially negative clinical consequences. Our objective was to determine the availability of antidotes in hospitals listed on the Saudi Ministry of Health website in the Riyadh Province and to evaluate the leading poison in Saudi Arabia. A cross‐sectional study was conducted using questionnaires. The questionnaires were distributed to pharmacist directors and emergency room‐treating physicians in 17 public hospitals throughout the Riyadh Province. None (0/17) of the pharmacies contained the 24 recommended essential antidotes by the expert consensus guidelines for stocking of antidotes in hospitals. Polyvalent scorpion antivenom, atropine sulphate, calcium gluconate, flumazenil and naloxone hydrochloride were stocked in 94.12% (16/17) of hospitals. 66.67% of patients presented with osmolality, and 55.56% of referral patients with opiates, barbiturates, acetaminophen and salicylate. Our findings have important implications for healthcare institutions and pharmaceutical practices. National practice guidelines are needed to assist pharmacists in selecting appropriate antidotes based on the local pattern of poisoning incidents. Therefore, further study in the Kingdom of Saudi Arabia needs to be completed to fully evaluate the availability of antidotes throughout the country.     

Availability of antidotes in hospital pharmacies in Greece

We determined the availability of poisoning antidotes in the pharmacies of state hospitals in Greece and in Health Centers of the island of Crete. A questionnaire survey was sent to all pharmacy directors of hospitals with emergency departments, asking them to report anonymously the amount currently in stock of each of 12 common antidotes. Questionnaires were sent to 100 pharmacy directors and 68 (68%) of them replied. Only 2 (3%) of the 68 hospitals stocked all 12 antidotes. The percentage of sufficient stocking for individual antidotes ranged from 6% (for digoxin immune fab) to 91% (for methylene blue). Recent circulation of government guidelines for antidote stocking and hospital type had no significant effect on antidote stocking. In a multiple regression analysis, hospital type (prefectural, regional, university hospital) and smaller hospital size were not predictors of the number of antidotes sufficiently stocked. Storing of key poisoning antidotes is inadequate in regional as well as in prefectural hospitals in Greece. Antidotes, including those which should be used without delay to be effective, are often not available, even for the commoner poisons in Greece such as pesticides.     

Inadequate stocking of antidotes in Taiwan: is it a serious problem?

OBJECTIVE: Insufficient hospital stock of a variety of poisoning antidotes is a worldwide problem. In an attempt to establish an antidote storage and distribution system for the response of the various poisoning accidents, we conducted a nationwide survey to characterize the current availability of selected antidotes and their anticipated need in Taiwan. MATERIALS AND METHODS: A questionnaire was mailed to 834 hospitals to gather information on the availability, anticipated need, and preferred purchase policy of 20 selected antidotes. A survey on the availability of cyanide antidote in 523 cyanide-handling facilities and their neighboring hospitals was also conducted. RESULTS: Hospitals of different size and service levels had a statistically significant difference in response rates. Except for pyridoxine, the availability and anticipated need for antidotes also varied significantly among different hospital groups. We found that physostigmine, cyanide antidote kit, BAL, EDTA, methylene blue, Vipera Russell formosensis antivenin, and botulism antitoxin were not available in most (>90%) hospitals. Interestingly, these antidotes are also among the most needed antidotes. Most hospitals preferred a government-ordered purchase of antidotes. In the survey of cyanide-processing facilities, a response rate of 24.1% was obtained and only 9.3% of these 107 facilities that both replied to the questionnaire and continued handling cyanide products had stocked cyanide antidote. It is noteworthy that cyanide antidote was also frequently lacking in the neighboring hospitals. CONCLUSIONS: The appropriate storage of antidotes in hospitals or workplaces in rural areas is instrumental in the timely treatment of certain poisonings, while nationwide unavailability is the critical problem. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions.     

Toxicology cart for stocking sufficient supplies of poisoning antidotes.

Within a three-month period, the University of New Mexico Health Sciences Center (UNMHSC) encountered three toxicological emergencies in which antidotes were either unavailable or inadequately stocked. Patient A was a patient with ethylene glycol intoxication. The emergency department (ED) physician ordered a 10% ethanol infusion. The pharmacy staff was unable to locate the commercially available solution and had to compound the infusion, resulting in a delay in administration of the antidote. Patient B was a patient at an outside hospital with organophosphate exposure whose transfer to our ED was requested by the other hospital. The pharmacy staff was unable to locate the pralidoxime needed to treat this patient; therefore; the patient was not transferred. It was later discovered that the pralidoxime had been stored in a location inconsistent with the storage policy for this medication. Patient C was a patient with severe rattlesnake envenomation. The pharmacy staff could locate only half of the antivenin needed to treat this patient. In each of these three cases, it was necessary to compound the required medication or to obtain it from other local facilities. These cases underscore the need for pharmacies to stock adequate amounts of poisoning antidotes in one immediately accessible location. A similar problem with understocking of poisoning antidotes exists throughout the United States.     

Sodium thiosulfate for acute cyanide poisoning: study in a rat model

Unlike practices in the United States where it is associated with other antidotes, sodium thiosulfate is not used for emergency therapy for cyanide poisoning in France. The purpose of this study was to develop a rat model using intraperitoneal injections of sodium thiosulfate at a dose of 225 mg/kg to test its therapeutic efficacy for acute cyanide poisoning. Efficacy was assessed directly by quantifying arterial blood cyanide and indirectly using markers of hypoxia: serum lactate and arteriolization of venous blood gases. Cyanide poisoning induced intense biological anomalies which were persistent (serum lactate) or transient (blood gases). Sodium thiosulfate was found to be an effective antidote in the rat enabling rapid normalization of hypoxia markers and clearing of cyanide from arterial blood.     

Clinical Toxicology, Poisoning and Treatment

W41Treatmentoforganophosphatepoison ing:atropine,pralidoximeandbeyond AndrewDAWSON(SouthAsianClinicalToxicologyResearchCollabora tion,UniversityofPeradeniya,SriLanka)Self poisoningwithpesticidesisamajorproblem acrosstheAsiaPacificregion.Despitethisthereislit tlecoordinatedeffortbeingappliedtoimprovethemed icalresponsetothisproblem.Goodclinicalandsup portivecareisthecornerstoneofmanagementofthe poisonedpatientandinsomesituationswillsuffice evenintheabsenceofaspecificantidote.Onlyone an…     

An update of antidote availability in veterinary medicine.

Lack of commercially available antidotes for animals is an issue of significant concern to the American Board of Veterinary Toxicology. A few antidotes are available for food animals through extra-label use, regulatory discretion and compounding. However, regulatory restrictions arising from human food, safety concerns have limited the availability of food animal antidotes. Use of some antidotes in food animals requires establishment of an investigational new animal drug application. Antidotes are generally more available for non-food animals from several sources: approved animal drugs, extra-label use of approved animal and human drugs, regulatory discretion and compounding. Present alternatives are discussed as well as the need for legislation to increase antidote availability. Human food safety will always be an issue for food animal antidotes. Future availability of non-food animal and food animal antidotes will depend on several mechanisms and may include the establishment of veterinary antidote depots. Stakeholders are encouraged to participate in identifying and implementing these mechanisms.     

Anticoagulation Bridge Therapy in Patients with Atrial Fibrillation: Recent Updates Providing a Rebalance of Risk and Benefit

In 2011 we reviewed clinical updates and controversies surrounding anticoagulation bridge therapy in patients with atrial fibrillation (AF). Since then, options for oral anticoagulation have expanded with the addition of four direct oral anticoagulant (DOAC) agents available in the United States. Nonetheless, vitamin K antagonist (VKA) therapy continues to be the treatment of choice for patients who are poor candidates for a DOAC and for whom bridge therapy remains a therapeutic dilemma. This literature review identifies evidence and guideline and consensus statements from the last 5 years to provide updated recommendations and insight into bridge therapy for patients using a VKA for AF. Since our last review, at least four major international guidelines have been updated plus a new consensus document addressing bridge therapy was released. Prospective trials and one randomized controlled trial have provided guidance for perioperative bridge therapy. The clinical trial data showed that bridging with heparin is associated with a significant bleeding risk compared with not bridging; furthermore, data suggested that actual perioperative thromboembolic risk may be lower than previously estimated. Notably, patients at high risk for stroke have not been adequately represented. These findings highlight the importance of assessing thrombosis and bleeding risk before making bridging decisions. Thrombosis and bleeding risk tools have emerged to facilitate this assessment and have been incorporated into guideline recommendations. Results from ongoing trials are expected to provide more guidance on safe and effective perioperative management approaches for patients at high risk for stroke.