急门诊处方抗菌药物使用情况调查

［摘要］目的分析急门诊处方中抗菌药物使用情况,促进临床用药水平的提高。方法随机抽取浙江省慈溪市中医医院2007年急门诊处方,按一定的调查项目进行统计,按使用频率进行排序,对前10位药品在使用剂量的合理性以及与药品说明书中适应证的相符性进行分析。结果急门诊使用频率排名前10位的抗菌药物的DUI值均≤1,属于合理用药。急门诊使用频率在前10位的抗菌药物的适应证总相符率为76.43%,平均相符率为76.48%。结论该院急门诊抗菌药物使用剂量合理,与说明书所述适应证的相符率也比较高,抗菌药物的使用情况基本合理。     

门诊抗高血压药物处方分析

目的了解我院门诊抗高血压药物利用情况,分析门诊抗高血压药物之间相互应用的合理性,为临床合理用药提供参考。方法从我院门诊2009年10～12月份处方中筛选出含有康高血压药物的处方,统计患者性别、年龄、抗高血压药物的用药频度及药物联合应用情况。结果在抽取1536张抗高血压处方中,男796张,女740张,分别占抗高血压药物处方的51.88%及48.12%。其中各年龄段使用抗高血压药情况见表1,DDDs排序前10位的药品统计结果见表2,对药物联用情况统计,以二联用药处方最多,共481张,占35.5%,三联用药处方132张占9.77%,四联用药处方11张占0.81%,联用处方共624张。结论抗高血压药物品种繁多、选择安全有效、经济合理的药物至关重要。     

药品“零差率”销售对某三级医院门诊西药房用药的影响

目的:调查分析实施药品"零差率"销售后,某三级医院门诊西药房用药变化情况,分析新的药物政策的利与弊,为政策进一步推广提供借鉴。方法:选取该院的门诊西药房为调查对象,统计政策实施前(2012年1-6月)与政策实施后(2013年1-6月)的数据,运用Excel软件进行统计,分析"零差率"销售前后药品使用情况的变化。分别从2012年5月和2013年5月的处方中随机抽取200张,共400张处方,点评处方的合理用药问题。结果:实施药品"零差率"销售政策后,各类药品销售金额有所增加。该院门诊西药房使用量居前的10大类药品中,2013年5月的总销售金额比2012年5月增加了702 533.84元(上升22.32%);销售金额排序列前10位的药品有一定变化;门诊月处方量、门诊销售金额均较2012年5月有增长,但平均单张处方金额略有下降;抽查处方的平均每张处方使用药品数减少,使用抗菌药物的处方数增加,处方点评的合理率有所提高。结论:实行药品"零差率"销售政策后,规范了用药,吸引了更多患者到医院就诊,对门诊合理用药有一定促进作用。     

2013-2015年我院门诊注射剂、抗菌药物应用分析

目的了解我院落实抗菌药物合理应用情况,对我院门诊注射剂、抗菌药物的应用情况进行分析。方法计算机检索我院2013-2015年门诊所有处方、注射剂处方、抗菌药物处方,进行统计分析;检索全部门诊药品、急诊科药品销售情况,计算出普通门诊药品销售情况,分别统计普通门诊、急诊注射剂、抗菌药物品种出库情况;对2013-2015年销售金额排序前10位的注射剂和销售金额排序前10位的抗菌药物进行统计分析。结果门、急诊注射剂使用比例符合WHO对发展中国家医疗机构门诊药品合理利用制定的注射剂使用比例标准,门诊患者抗菌药物处方比例<20%,急诊患者抗菌药物处方比例<40%;门诊注射剂、抗菌药物销售金额比例变化趋势与处方比例一致,但注射剂销售金额比例明显高于处方比例;3年注射剂销售金额排序前10位中,辅助用药占比较大;3年抗菌药物销售金额排序前10位中,注射剂占比较大。结论我院门诊注射剂、抗菌药物处方比例较为合理,但注射剂中辅助用药比例偏高且费用欠合理,抗菌药物注射剂日均费用偏高,提示我院合理用药需进一步加强。     

17077张门急诊处方点评及合理用药分析

目的:了解北京大学口腔医院门诊处方用药情况,为对不合理用药进行干预提供参考。方法:对我院2011年6月全部门急诊处方、处方数量前5位科室、医师的处方分别进行处方评价,并分析处方数量前5位药品的使用情况。结果:处方平均用药品种数为1.50种,抗菌药物使用率为12.90%,注射剂使用率为2.08%,基本药物使用率为20.44%,药品通用名使用率为100%,平均每张处方金额为43.02元;处方数量前5位科室分别为口腔颌面外科、中医黏膜科、急诊科、儿童口腔科和综合科;处方数量排序前4位的医师均为中医黏膜科医师,居第5位的为综合科医师;处方数量排序前5位药品为局部麻醉药2种、中成药2种、含漱剂1种。结论:我院各项处方指标基本正常,临床用药基本合理,但基本药物的使用有待提高。     

我院静脉药物配置中心不合理处方及药师干预分析

目的:为静脉药物的安全、合理使用提供参考。方法:对我院静脉药物配置中心2009-2013年拦截的不合理处方进行统计分析。结果:2009-2013年不合理处方5 802组,占总配置处方数量的0.12%;按原因排名前3位依次为溶剂用量不当、药品超量和溶剂选择不当;按药品类别统计依次为抗菌药物、抗肿瘤药、普通药品与肠外营养液。在药师的干预下,静脉药物不合理处方发生率从2009年的0.169 4%下降至2013年的0.082 8%;下降幅度最大的为用法错误,其后依次为药品超量、频次错误、医嘱开立错误、溶剂用量不当、配伍禁忌以及溶剂选择不当。结论:药师进行用药干预可有效降低不合理处方,显著提高静脉药物的合理用药水平。     

北京市和平里医院门诊抗菌药物应用分析

目的:了解我院门诊抗菌药物应用现状,为合理使用抗菌药物提供依据。方法:随机抽取我院2010年1—12月每月1天的门诊处方,共计13 162张,统计处方的用药品种、销售金额等,并统计抗菌药物处方中抗菌药物种类、名称、每日剂量、用药天数、给药途径、联合用药情况及抗菌药物分类使用情况等。以世界卫生组织(WHO)建议的限定日剂量(DDD)及药物利用指数(DUI)作为判断是否合理用药的标准。结果:抗菌药物使用率为27.98%,其销售金额占药品总销售金额的12.5%,单一抗菌药物使用率为87.48%,处方平均金额为233.87元。口服抗菌药物DUI排序前10位中有7种药品的DUI>1,注射用抗菌药物DUI排序前10位中有2种药品的DUI>1,其中6种口服药、1种注射用药是由于临床用药日剂量基本符合我国药品说明书规定日剂量但高于WHO的DDD所致。结论:我院门诊抗菌药物处方各项指标基本符合要求,除个别药品外,抗菌药物的应用基本符合我国药品说明书要求。     

杭州地区公立医院实行药品“零差率”前后处方金额和数量的对比分析

目的:分析药品"零差率"政策对公立医院处方金额和数量的影响,为药品政策的评估和持续改进提供参考。方法:采用回顾性分析方法,分别统计杭州地区7家省级医院和5家市县级公立医院实行药品"零差率"前后处方金额和处方数的变化以及对不同类别药品、不同科室和常见慢性病诊断的处方数和处方金额的影响。结果:实行药品"零差率"后,12家医院药品处方总金额增长率为16.51%,其中省级医院(18.20%)高于市县级医院(7.58%)。市县级医院的门诊处方总金额、处方总张数和平均处方金额均比"零差率"前增加,省级医院门诊处方总金额和平均处方金额均有所增加,而处方张数有所下降。抗恶性肿瘤药物的门诊处方金额占比由实行前的7.00%上升至9.10%,神经系统用药的住院处方金额占比由9.40%上升至11.20%,抗感染药物无论是门诊还是住院处方金额占比均下降10%以上。门诊处方总金额排名前10位科室中除肾内科和普通内科出现下降外,其他科室均有不同程度增加,平均处方金额增加幅度最大的是泌尿外科(16.89%),而下降幅度最大的是肾内科(-4.31%)。实行"零差率"后,诊断为高血压、糖尿病和高脂血症的平均处方金额和平均处方药品种数均有所上升。结论:药品"零差率"政策对省级和市县级医院用药带来的变化存在一定差异,对门诊和住院医师用药行为的影响也有所不同。     

我院门诊抗菌药物处方使用调查及分析

目的了解、分析该院门诊抗菌药物的使用情况,评价用药合理性,为临床合理用药提供参考。方法随机抽取该院2011年门诊处方8400张,依据相关制度、药物说明书及相关文献,计算抗菌药物的使用比例,统计用药频度(DDDs)排名前10位的抗菌药物及不合理用药情况等,从而对门诊抗菌药物的使用情况进行分析。结果 8400张门诊处方中使用抗菌药物的处方共计3024张,抗菌药物使用率为36.0%;含头孢菌素类药物处方共计1966张,占抗菌药物处方的65.0%;采用静脉途径给药的处方共计2273张,占抗菌药物处方的75.2%;不合理应用抗菌药物处方共计330张,占抗菌药物处方的10.9%,不合理用药主要表现在无指征用药、用药方法不当、超越权限用药、溶媒不适宜、重复用药、联合用药不规范。结论该院门诊抗菌药物的使用基本合理,但仍存在某些问题,需要进一步加强抗菌药物合理应用的管理。     

江苏省靖江市人民医院抗感染药物应用分析

目的 分析江苏省靖江市人民医院抗感染药品使用情况,为临床合理使用抗感染药物提供参考.方法 随机抽取该院门诊药房及病区药房2005年1～12月份每月处方共24000张,对抗感染药物消耗金额进行统计分析.结果 抗感染药物销售金额占药品销售金额的31.4%;抗感染药物按数量统计青霉素排在第一位;按金额统计左氧氟沙星排在第一位.24000张处方中使用抗感染药物处方8563张(35.68%).结论 该院抗感染药物的使用基本合理,但仍存在需要进一步改进提高的地方.     

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.

     

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.     

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.     

2-(Acetoxyphenyl)-(Z)-styryl sulfides as cyclooxygenase inhibitors

2-(Acetoxyphenyl)-(Z)-styryl sulfides are described as selective cyclooxygenase-2 (COX-2) inhibitors, useful for treating inflammation and COX-2-mediated disorders including neoplasia. 2-(Acetoxyphenyl)-(Z)-styryl sulfide is claimed to be the most potent COX inhibitor in the series with a COX-2 selectivity ratio of 33. This compound is also claimed to be superior to celecoxib (Celebrex^®, Pfizer) in inhibiting cell growth of colorectal carcinoma cells. In this evaluation, the COX inhibitory activity of this compound is compared to that previously disclosed for diarylheterocycles and 2-(acetoxyphenyl)alkyl sulfides. The validity of the DLD-1 cell line in the growth inhibition studies is questioned based on recent literature reports indicating the lack of COX-2 expression in this cell line.     

Sleep-disordered breathing with chronic opioid use

Chronic opioid use for pain relief or as substitution therapy for illicit drug abuse is prevalent in our societies. In the US, retail distribution of methadone and oxycodone has increased by 824 and 660%, respectively, between 1997 and 2003. μ-Opioids depress respiration and deaths related to illicit and non illicit chronic opioid use are not uncommon. Since 2001 there has been an emerging literature that suggests that chronic opioid use is related to central sleep apnoea of both periodic and non-periodic breathing types, and occurs in ～ 30% of these subjects. The clinical significance of these sleep-related abnormalities are unknown. This review addresses the present knowledge of control of ventilation mechanisms during wakefulness and sleep, the effects of opioids on ventilatory control mechanisms, the sleep-disordered breathing found with chronic opioid use and a discussion regarding the future research directions in this area.     

Drug targets for cognitive enhancement in neuropsychiatric disorders

The investigation of novel drug targets for treating cognitive impairments associated with neurological and psychiatric disorders remains a primary focus of study in central nervous system (CNS) research. Many promising new therapies are progressing through preclinical and clinical development, and offer the potential of improved treatment options for neurodegenerative diseases such as Alzheimer's disease (AD) as well as other disorders that have not been particularly well treated to date like the cognitive impairments associated with schizophrenia (CIAS). Among targets under investigation, cholinergic receptors have received much attention with several nicotinic agonists (α7 and α4β2) actively in clinical trials for the treatment of AD, CIAS and attention deficit hyperactivity disorder (ADHD). Both glutamatergic and serotonergic (5-HT) agonists and antagonists have profound effects on neurotransmission and improve cognitive function in preclinical experiments with animals; some of these compounds are now in proof-of-concept studies in humans. Several histamine H3 receptor antagonists are in clinical development not only for cognitive enhancement, but also for the treatment of narcolepsy and cognitive deficits due to sleep deprivation because of their expression in brain sleep centers. Compounds that dampen inhibitory tone (e.g., GABA_A α5 inverse agonists) or elevate excitatory tone (e.g., glycine transporter inhibitors) offer novel approaches for treating diseases such as schizophrenia, AD and Down syndrome. In addition to cell surface receptors, intracellular drug targets such as the phosphodiesterases (PDEs) are known to impact signaling pathways that affect long-term memory formation and working memory. Overall, there is a genuine need to treat cognitive deficits associated with many neuropsychiatric conditions as well as an increasingly aging population.