我院开展临床药学工作的实践与体会

临床药学是一门以患者为研究中心，提供安全、有效、合理的药物治疗为目的药学学科。它是医院药学的重要组成部分，是一门药学与医学、社会学、法学、经济学、心理学、教育学、管理学等学科相互交叉、渗透、内容丰富多彩的综合药学学科。这门学科的发展将有力的推动合理用药。因此。它正日益受到重视，结合我院实际情况笔者将开展临床药学工作的体会介绍如下。     

浅论临床药学的风险控制

临床药学是一门综合性应用型药学分支学科，内容广泛，技术服务性强，它体现了学科渗透、交叉的趋势。随着临床药学的发展，临床药师参与药物治疗的深人，公众医疗保健意识的提高，临床药师要承担药物治疗的责任，医疗风险随之而来。为了提高防范意识，在一定程度上减少医疗风险，笔者就临床药学与医疗风险及其防范作一探讨。     

药学信息检索

药学是一门专业性很强的学科,它与化学化工、生物学、医学、物理学、材料学、社会学等其它学科相互交融。在学科发展进步速度上药学可与生物医学一起,随着科学技术的进步,信息技术的融入不断产生突破性的发展变化,人类研究领域的开阔、学科知识的深度,对药学的不断认知,推动了药学学科的发展,结果改变了人类健康、生活质量。     

开展护理药学，促进临床药学的工作

临床药师在参与临床工作的过程中逐渐发现只同临床医师进行交流探讨是远远不够的,护理人员（护师、护士）在临床药学中发挥着不可忽视的作用。一门新的学科——护理药学正在悄然兴起,并逐渐成熟。护理药学是为了维护人类生命健康,围绕护理过程中的或与护理患者密切相关的药物应用领域开展研究和服务的一门药学分支学科。     

临床药学的回顾与展望

始于20世纪60年代的临床药学是医院药学的发展方向^[1]。临床药学（clinical pharmacy）是药学与医学结合的产物，内涵丰富，涉及面广，综合性强，是一门以合理用药为己任的学科，“在患者身边开展药学工作”成为“临床药学”最简单的字面理解^[2]。作为药学专业的一门新兴学科，临床药学从形成到曲折发展，经历不平凡的历程^[3]，我国临床药学取得长足的进步，但开展的情况极不平衡^[4]。本资料试图探讨我国临床药学的过去、现在与未来，以便我们能理清30年来国内临床药学工作的脉络，明晰亟待解决的问题，客观公正地评价现状，更加理性地思考未来。     

基层医院如何开展临床药学工作

改革开放以来，我国的医药卫生事业得到了快速发展。医院药学作为临床医疗的组成部分，其工作内容和工作重点，也将随之进行调整和更新：医院药学的学科体系在发展过程中不断完善，已经成为药学专业中一门新兴的综合应用型的分支学科。     

临床药学发展趋向微探

现代药学以临床药学和药学监护为核心，已经实现了医院药学的两个转变：一方面是从保障供应型向技术服务型转变；另一方面是从围绕医生提高安全用药到对患者药物治疗全过程直接负责的工作模式的转变。临床药学是药师联系临床，探讨药物应用规律，促进临床用药合理化的一门新兴综合性交叉学科，其研究对象是个体化的临床患者，任务是保证患者用药安全、有效、经济。临床药学发展在我国已有20多年，但该学科发展不平衡。笔者经过多年的教学实践和学习调查，认真研究普通医院开展临床药学的模式，对临床药学发展趋向进行了初步的探索。     

医院药学前瞻

随着卫生事业改革的深化,人们对卫生保健要求水准的提高,医院药学正逐步由供应保障、质量检验以及普通常用制剂的配制向多功能、多学科交叉的技术服务型转变,并且已经发展成为一门综合性、应用性药学学科.目前世界上的结构药物已达5万多种,用药复杂程度越来越高,用药引起越来越多的社会问题[1].医院药学向何处去,医院药房药学技术人员面临着改变工作模式,适应发展的问题.     

国外医院临床药学实践模式探讨

1临床药学 1.1临床药学学科概况临床药学也叫医院药学,临床药学是一门研究医院药品供应、药学技术、药事管理及临床用药的科学。临床药学与临床医学紧密联系,以药剂学为中心,应用药学技术，开展药事管理，服务临床医师和广大患者。     

浅谈医院药学工作模式进展

我国医院药学是近年来在医院调剂、制剂、检验、供应等传统工作的基础上，随着医院科学，药学科学等学科的发展而发展起来的一门古老而新兴的学科。是医药理工以及社会学相结合的新型医药学模式的重要组成部分。目前医院药学是以供应、教学、科研、质控、管理及临床药学等更加丰富的新内容的充实，更直接地参与临床合理用药。更明确有为患者为临床服务。卫生事业的发展是一系列工程，医院药学发展是客观的需要，是提高防病治病的重要保证。下面仅就一些粗浅认识从医院药学工作模式内容谈谈。     

Implementing and evaluating Social Behaviour and Network Therapy in drug treatment practice in the UK: a feasibility study

This paper reports on the implementation and preliminary evaluation of Social Behaviour and Network Therapy (SBNT) within drug treatment services. SBNT was initially developed and evaluated as part of a trial for alcohol treatment in the UK (UKATT). For the study reported in this paper SBNT was adapted for application with drug users. Therapists (N=20) from community drug services in Birmingham, UK, were trained to deliver the intervention. Training methods were supported by a treatment manual and included a two-day workshop followed by video supervision and monitoring. Following training therapists were asked to implement the treatment within the services in which they worked. Twelve of the therapists that were trained delivered SBNT to 24 clients within the study period of 8 months. Baseline and 3-month follow-up measures were administered using both quantitative and qualitative methods. This paper reports the quantitative results including drug use, levels of dependence, drug users' social network variables and family environment. Results suggest that it was feasible to train a number of therapists to deliver SBNT, and preliminary outcome results are encouraging. Further evaluation is needed in order to continue developing this promising social intervention.     

Dependence to morphine in differentially housed rats

Although the effects of differential housing, particularly isolation, on the action of several classes of pharmacological agents have been studied, little attention has been given to this factor in regard to narcotics. The present study involves the effects of long-term social isolation on dependence to morphine produced by pellet implants in rats. When abstinence was precipitated with naloxone, isolated rats demonstrated less jumping and less diarrhea than grouped rats. No differences were found in other signs. In addition, the differences were seen both in isolates developing muricidal behavior and those not developing this behavioral pattern.Supported in part by G. L. Pfeiffer Foundation, N.Y., NATO Research Grant No. 719, USPHS Grants DA 00049 and DA 00376.Visiting Scientist from the Department of Pharmacology, Temple University School of Medicine, Philadelphia, Pa., U.S.A.     

老年期躁狂症临床特征的探讨

回顾性分析和归纳总结29例老年期躁狂症患者临床特征及治疗情况。结果表明：老年性躁狂症的发病诱因、临床症状、疾病转归以及治疗情况均有别于一般躁狂症,社会心理因素对疾病的发生、发展和预后都有重要影响。     

社会与管理药学学科研究生培养的几点思考

社会与管理药学是一门新兴的边缘交叉学科,目前国内本学科研究生培养工作正在如火如荼的展开。本研究将国内与国外学科研究生培养情况进行比较,发现国外社会药学教育更偏向于药学实践的教育,人文社会科学教育的比例较大,更强调人在药学服务中的主观能动性。由此,笔者提出采取科学定位人才培养目标,完善课程体系,加大教材建设的力度,加强师资队伍建设,引入不同的教学法等一系列措施来保证构建科学合理的学科教学体系,为研究生培养提供思路。     

DRUG AND ALCOHOL OFFENDERS COERCED INTO TREATMENT: A REVIEW OF MODALITIES AND SUGGESTIONS FOR RESEARCH ON SOCIAL MODEL PROGRAMS

Outcome studies on drug and alcohol offenders coerced into treatment by the criminal justice system were reviewed. Positive outcomes were found for therapeutic community, methadone maintenance, and unspecified residential and outpatient programs. No outcome studies were found for court-mandated clients coerced into social model recovery programs. When developing studies, researchers should consider how clients perceive legal mandates and whether they are receiving pressures to enter treatment from other sources, such as family members, employers, friends or the welfare system. Use of the Social Model Philosophy Scale (SMPS) is suggested to correlate program characteristics and processes with outcome.     

“In their perception we are addicts”: Social vulnerabilities and sources of support for men released from drug treatment centers in Vietnam

BackgroundAmid the global transition to treat opioid addiction as an illness, many people who inject drugs (PWID) face heterogeneous legal environments that include both punitive and harm reduction measures. In Vietnam, many PWID, who have a high burden of HIV, are sent to drug treatment centers, or “06 centers”, for compulsory detoxification, vocational training, and labor for up to four years. This study investigates the challenges and facilitators of reentry into community and family life among men who are released from “06 centers” and provides insights and recommendations for developing policies and interventions that address special needs of this vulnerable population.MethodsIn-depth interviews were conducted in 2011 by trained interviewers among a sample of 43 male PWID released within the past 2 years from “06 centers” in Hanoi, Vietnam to investigate the above issues and to recommend potential interventions. Participants were recruited from outpatient HIV clinics that serve PWID (n = 22) and through peer referral from self-help groups for PWID (n = 21). Interviews were audiotaped, transcribed, translated, entered into Atlas.TI qualitative data analysis software and analyzed for key themes.ResultsThe interviews revealed persistent drug-related stigmatization, frequently paired with HIV-related stigmatization and discrimination, which hindered employment, increased participants’ social isolation and exacerbated their struggles with addiction. Families were participants’ primary source of financial, employment, and emotional support, but addiction-related family tensions also had negative psychological effects. Participants identified methadone maintenance treatment as an effective means of overcoming addiction, yet few could fully benefit from this treatment due to its limited availability.ConclusionOur study suggests that PWID released from “06 centers” would greatly benefit from the scale-up of community-based harm reduction measures that include addiction and HIV treatment, coupled with employment-support and family centered mental health services.     

Addressing social and cultural disparities in tobacco use

Disparities in smoking as a function of ethnicity exist, but part of that disparity appears to be mediated by education level. Smoking prevalence differences by ethnicity disappear or decrease substantially when controlling for education level. Nonetheless, ethnicity remains an important consideration when striving to understand the mechanisms associated with smoking, as well as in the development of smoking prevention and treatment programs. In this paper, the complex interrelationships among ethnicity, social class, and smoking are discussed in brief, and a framework for developing a systematic means of addressing social disparities in tobacco use is described.     

Alcohol outcome expectancies and drinking to cope with social situations

Repeated use of alcohol as a coping strategy to reduce anxiety or discomfort increases one's risk of developing alcohol dependence. Previous studies have found alcohol outcome expectancies (AOE) strongly predict drinking behavior, in general, and also are related to drinking to cope. The purpose of the current study was to examine AOE that may be related to drinking to cope with discomfort in social situations. It was hypothesized that positive AOE, especially related to assertion and tension reduction, would be most associated with drinking to cope with social situations. Fifty-six community volunteers from a larger study on attentional bias and drinking to cope were divided into high (n=36) and low (n=20) drinking to cope groups following completion of a questionnaire battery. Findings indicated AOE were well able to classify drinking to cope status, with 91% of cases correctly classified. As hypothesized, assertion and tension reduction AOE uniquely contributed to the discriminant function in classifying drinking to cope groups. These findings have implications for the prevention and treatment of alcohol use disorders and suggest that AOE should be further investigated as potential moderators of the relationship between social anxiety and alcohol use disorders.     

Desire and the consumption of danger: Electronic gaming machines and the commodification of interiority

This article brings together disparate elements of commercialized mass gambling, briefly describing the consumption of local gambling using electronic gaming machines (EGMs) in the Australian state of Victoria, particularly its capital, Melbourne. It also reports on the fieldwork research involving conversations with 62 self-identified EGM ‘problem gamblers’. The article brings the empirical material produced by analysis of data and discussions into conversation with the social theory of Cornelius Castoriadis and others in order to explain some aspects of the rapidly developing social institution of commercialised mass gambling. The article seeks to ‘dig into’ the heart of the gambling transaction, as an act of dangerous consumption, in order to pursue understanding of the significance that this holds for the social individual, and for understanding of the role of desire in the commodification of the interiority of the subject, which, it is argued, lies at the core of dangerous consumptions.     

Sober living houses for alcohol and drug dependence: 18-Month outcomes

Objective

A major challenge facing many individuals attempting to abstain from substances is finding a stable living environment that supports sustained recovery. Sober living houses (SLHs) are alcohol- and drug-free living environments that support abstinence by emphasizing involvement in 12-step groups and social support for recovery. Among a number of advantages, they are financially self-sustaining and residents can stay as long as they wish. Although SLHs can be used as housing referrals after inpatient treatment, while clients attend outpatient treatment, after incarceration, or as an alternative to treatment, they have been understudied and underutilized.

Method

To describe outcomes of SLH residents, we interviewed 245 individuals within 1week of entering SLHs and at 6-, 12-, and 18-month follow-up. Eighty-nine percent completed at least one follow-up interview. Outcomes included the Addiction Severity Index (ASI), Brief Symptom Inventory (BSI), and measures of alcohol and drug use. Covariates included demographic characteristics, 12-step involvement, and substance use in the social network.

Results

Regardless of referral source, improvements were noted on ASI scales (alcohol, drug, and employment), psychiatric severity on the BSI, arrests, and alcohol and drug use. Substance use in the social network predicted nearly all outcome measures. Involvement in 12-step groups predicted fewer arrests and lower alcohol and drug use.

Conclusion

Residents of SLHs made improvements in a variety of areas. Additional studies should use randomized designs to establish causal effects of SLHs. Results support the importance of key components of the recovery model used by SLHs: (a) involvement in 12-step groups and (b) developing social support systems with fewer alcohol and drug users.