Vital sign monitoring using human patient simulators at pharmacy schools in Japan

Objective

To develop, implement, and assess an experience-based education program using human patient simulators to instruct pharmacy students in monitoring vital signs to identify drug treatment effects and adverse events.

Design

Medical emergency care programs using human patient simulators were prepared and facilitated practical clinical training in resuscitation, which required selecting drugs while monitoring changes in blood pressure, pulse, and arterial blood oxygen saturation. Training encompassed the monitoring of routes of drug administration, drawing of simulated blood, vital-sign monitoring based on a pharmaceutical universal training model, vital-sign monitoring devices and simulators, and medical emergency education using biological simulators.

Assessment

Before and after bedside training, students were asked to complete a questionnaire to assess their understanding of vital sign monitoring and emergency care. Students successfully learned how to monitor routes of drug administration, vital signs, and pathological conditions. There was a significant increase in students'' recognition of the importance of vital-sign monitoring.

Conclusion

Experienced-based training using patient simulators successfully prepared pharmacy students to monitor vitals signs and identify drug treatment effects and adverse events.     

Establishment of an educational program concerning adverse drug reaction reporting-system in long-term practical training at a hospital

The model core curriculum for pharmaceutical education specifies the specific behavioral objectives (SBOs) concerning adverse drug reactions, which aims to train pharmacy students to manage adverse drug reactions. Fukuoka University Hospital has developed a problem-based learning (PBL) program concerning adverse drug reactions as long-term practical training to collect adverse event information, identify adverse effects, and acquire management skills. Students' level of satisfaction with the program was high (approximately 90%), and the mean self-evaluation score for the SBOs concerning adverse reaction was 4.4 (5-grade scale), showing a high level of understanding. In addition, students' will of participation to the adverse drug reaction-reporting system was significantly improved after the PBL program, showing the usefulness of this program (p=0.02). However, the results of the PBL program revealed students' insufficient knowledge of adverse reactions and lack of reviewing skills, suggesting the need to improve the education system whereby students can learn adverse drug reactions in clinical settings.     

临床药师对1例喘息性支气管肺炎患儿用药方案分析及药学监护

目的：通过分析1例喘息性支气管肺炎患儿的药物治疗过程,探讨临床药师开展临床药学的主要方法。方法：从一般病史、用药史、疗效观察、不良反应观察、用药教育等方面分析1例喘息性支气管肺炎患儿的用药方案。结果：从病史及用药史采集、观察疗效、观察不良反应、抗感染药物应用、专科药物的应用等方面分析得出该患儿用药方案基本合理,但用药仍有值得改进之处。结论：从疗效、不良反应、专科药物应用等方面分析用药方案,是临床药师开展临床药学监护的基本工作内容;深入研究抗感染用药、专科用药、益生菌等药物的使用是实施儿童支气管肺炎药学监护的亮点。临床药师可以通过分析现状、临床实践、分析解决问题的持续改进这一循环方式推动临床药学发展。     

The role of the suspicious renal pharmacist in identifying unusual adverse drug reactions—why this is not a small problem

Renal patients have a high incidence of adverse drug reactions due to both pharmacokinetic and pharmacodynamic changes and detecting these adverse drug reactions relies heavily on having a high index of suspicion—which seems to be invoked through experience, whether our own or that of our colleagues. Pharmacists must be vigilant about adverse drug reactions and it is vital that pharmacists continue to teach their colleagues about their experiences identifying less common adverse drug reactions and adverse drug reactions with unusual presentations in addition to simply reporting these adverse drug reactions.     

Clinical Pharmacy Education in China

Pharmacy education in China focuses on pharmaceutical sciences, with the bachelor of science (BS) of pharmacy as the entry-level degree. Pharmacy practice curricula in these programs are centered on compounding, dispensing, pharmacy administration, and laboratory experiences, which are the traditional responsibilities for pharmacists. Additional graduate-level training is available at the master of science (MS) and the doctor of philosophy (PhD) levels, most of which concentrate on drug discovery and drug development research. Presently, the emphasis in practice is beginning to shift to clinical pharmacy. With this change, additional degree offerings are being developed to meet the growing demand for clinical pharmacists. There is also interest in developing more clinical skills in practicing pharmacists through additional non-degree training. The Ministry of Education is considering a proposal for an entry-level professional degree of master and/or doctor in clinical pharmacy similar to the doctor of pharmacy (PharmD) degree in the United States.     

药物基因组学与合理用药

药物基因组学是人类开始功能基因组学研究后出现的一门新兴的交叉学科,药物基因组学应用于临床药学是一个必然的趋势。临床药师作为药理学研究与临床实践间的信息中介,恰好成为从事药物基因组学研究的基本力量。将药物基因组学应用于临床药学是合理用药深入发展乃至实现个体化用药的必经之路.对于深入解释药物治疗的个体差异、减少药物不良反应、提高药物疗效等有重大意义。     

1例小细胞肺癌患者化疗的药学监护

目的：探讨临床药师对化疗患者进行药学监护的方法,促进合理用药。方法：针对1例小细胞肺癌化疗患者,临床药师分析化疗方案,提供药学监护。结果：该患者的化疗方案为伊立替康联合顺铂,药品不良反应的发生率较高,临床药师及时地制订和调整化疗方案,合理地应用药物预防方案,避免了更严重不良反应的发生;对化疗过程中出现的骨髓抑制、严重腹泻、肠梗阻等问题,结合患者病情,依据相关治疗指南及临床药学知识,与临床医师共同讨论和实施升高白细胞、止泻及胃肠减压等用药方案,根据疗效及时调整用药,使肿瘤患者顺利完成化疗周期。结论：临床药师应深入临床,参与患者治疗全过程,密切配合医师监测患者各项临床指标,协助制定治疗方案,并对患者进行用药指导,以促进临床安全、有效用药。     

探析静脉滴注用药的合理使用与用药监护

目的分析静脉不合理给药,为临床合理、安全应用静脉药物提供参考。方法从药物的浓度、药媒选择、药物配伍、静脉给药的速度、给药间隔等方面进行分析。结果静脉滴注用药存在不合理的情况,通过药师干预可减少失误和不良反应发生。结论加强静脉给药中的用药监护,有利于促进临床合理用药。     

我院住院患者退药情况调查及分析

目的：分析我院住院药房退药现状及原因,为制定相应措施提供依据。方法：对我院2009年7月1日～2010年3月31日住院药房不同病区退药申请单按季度进行分类统计。结果：我院不同病区的退药情况差异较大;退药量较多的科室为外科,肿瘤科和ICU;外科退药原因大多是病情变化;其他退药原因较多的依次为病情好转不需继续使用,患者拒用,转科,药物不良反应,死亡等。结论：我院各病区均有退药现象,个别科室退药量较多,应建立健全规章制度和规范服务条件。     

An ADR surveillance program: increasing quality, number of incidence reports

An Adverse Drug Reaction Surveillance Program (ADRSP) was implemented by the pharmacy department of the University of Maryland Medical System to address the institution's underreporting of adverse drug reactions. The program aims were to increase the number and quality of significant adverse drug reaction (ADR) reports by facilitating and standardizing the reporting process, to more actively involve the pharmacy staff, and to create a comprehensive database, thus enabling the intervention of future untoward events. During the program's first 2 years, the number of ADR reports more than doubled, primarily due to increased pharmacists' participation. The ADRSP has facilitated the reporting process, enhanced the submission of ADR reports to the FDA, and helped prevent ADRs.     

条形码技术在我院药库管理中的全程运用

目的：探索医院药库管理的新模式．用先进的计算机技术替代手工操作,提高药库药品管理水平。方法：利用药品供应商配货后现存的条形码与药品的对应关系．实现药品的条形码验收．将药品对应的条形码信息．与药库货位上的自编条形码进行关联．实现药品上架、存放货位的管理．电子票据导入式入库替代手工输入入库;药品出库按照药库自编条形码货位的顺序打印出库单,提高发药效率．实现药品管理金额帐和实物帐双管理模式,确保实时帐物相符。结果和结论：条形码技术提高医院药库管理水平。     

我院开展临床药学工作的体会

目的介绍我院临床药学工作的开展情况。方法从临床药师参与临床查房,开展处方点评,ADR监测和报告,用药咨询,学术活动,专业培训等方面阐述我院临床药学工作的内容。结果与结论我院临床药学工作目标明确,对临床合理用药起到了一定的促进作用。     

儿科临床药师参与1例病毒性脑炎并发细菌真菌感染药物治疗案例分析

目的:探讨临床药师在儿科药物治疗中的作用。方法:描述患儿病程发展和药物治疗及转归情况,分析病毒性脑炎的初始治疗方案、呼吸机相关肺炎的抗感染治疗及持续静脉给药的药学监护要点。结果:通过临床药师在患儿癫痫持续状态、细菌真菌感染治疗过程中提供的合理用药建议,有利于有效评估和处置治疗过程中出现的药品不良反应。结论:儿科临床药师参与医疗团队,协助医师确定、调整药物治疗方案,可及时处理药品不良反应,有利于提升药物治疗效果。     

一例膀胱肿瘤术后脑梗死伴发热患者治疗的药学监护

目的 探讨对膀胱肿瘤术后脑梗死伴发热患者治疗的药学监护方法,促进合理用药.方法 临床药师协助医师为患者制定个体化治疗方案,关注患者用药期间所出现的不良反应,提供合理的药学服务.结果 临床药师与医师共同制定药物治疗方案,对患者进行药学监护,提高了患者治疗效果,减少了药物的不良反应.结论 药师参与临床药物治疗实践,有利于提高临床药物治疗水平.     

临床药师对1例医院获得性肺炎患者治疗的药学监护

目的：通过分析1例医院获得性肺炎患者的药物治疗过程,探讨临床药师在专科医院开展临床药学的方法。方法：对1例医院获得性肺炎患者的一般病史、用药史、疗效观察、不良反应、用药教育等方面进行详细分析,讨论专科医院治疗医院获得性肺炎的合理方案。结果：,临床药师从患者病史及用药采集、观察疗效、观察不良反应、抗感染药物应用、专科药物应用等方面分析,该患者的用药方案较为合理,并将有待改善之处及时告知医护人员。结论：分析疗效、不良反应、专科用药是临床药师开展临床药学监护的基本工作内容;深入研究抗感染用药、专科用药等药物使用是对老年患者医院获得性肺炎实施药学监护的关键。临床药师通过分析现状、,临床实践、分析并解决问题的持续改进这一循环方式,可促进临床药学发展。     

丙戊酸钠血药浓度与抗癫痫疗效及不良反应关系研究

目的：研究丙戊酸钠血药浓度与其抗癫痫疗效及不良反应的关系,为临床合理应用抗癫痫药丙戊酸钠提供参考,同时也为制订个体化给药方案提供依据。方法：采用回顾性分析方法,查阅我院2010—-2012年服用丙戊酸钠的癫痫患者的病历,收集整理资料,对丙戊酸钠血药浓度、抗癫痫疗效和各个系统出现的不良反应进行统计和分析。结果：研究共收集114例患者监测结果,丙戊酸钠血药浓度在正常范围内的（50—100μg/ml）有72例,其中显效和有效的有50例（占69．44％）,疗效不足或疗效差与无效的有22例（占30．56％）;丙戊酸钠血药浓度〈50μg／ml的有35例,其中显效和有效的有21例（占60．00％）,疗效不足或疗效差与无效的有14例（占40．00％）;丙戊酸钠血药浓度〉100μg／ml的有7例。服用丙戊酸钠,出现肝功能异常者4例、肾功能异常者2例、血液系统异常者4例、消化系统不良反应者3例、神经系统不良反应者5例及皮肤不良反应者3例。结论：丙戊酸钠血药浓度在有效浓度范围内有较好的疗效,但存在个体差异。丙戊酸钠在有效浓度范围内,出现了血液系统、消化系统等不良反应,因此在临床上使用时应监测其血药浓度和不良反应。     

我院中药房门诊1120例患者药物咨询工作统计与分析

目的：了解患者用药情况,更好地开展中药临床药学工作,促进合理用药。方法：对2008年8月~2009年8月我院中药房1 120例咨询记录进行回顾性分析。结果：用药咨询中,药物的相互作用、用法用量及不良反应等问题分别占药物咨询的37.59%、30.27%、9.38%;所咨询疾病的种类以循环系统最多,占23.21%,其他系统所占比例均匀。结论：开展合理用药咨询,对于保证药物疗效、保障用药安全、促进合理用药是十分必要的,对药物的作用及相互作用的解释是临床药师工作重心,多药联合应用更需关注;同时也对药师提出了更高要求。     

时辰药理学及其在中医药中的应用

时辰药理学表明药物的代谢动力学、药效和不良反应具有节律性,临床上根据时辰药理学进行择时给药,可以减小剂量同时达到减毒增效的用药目的。中医时辰治疗是依据人体阴阳消长等节律性变化进行治疗,也是中医学整体观念,辨证施治,因人因时因地制宜的重要体现,具有重要的临床意义。