Sampling time and indications appropriateness for therapeutically monitored drugs at a teaching university hospital in Oman

Objective: To evaluate prospectively the appropriateness of indications, sampling time and outcome of TDM requests at a teaching university hospital in Oman. Methods: A prospective cross-sectional study was conducted over a four months period; October 2013–January 2014 at the Sultan Qaboos University Hospital (SQUH), an 855 bed university teaching hospital. Appropriateness criteria for indications and sampling time were defined a priori. The evaluated drug’s requests were for carbamazepine, phenytoin, phenobarbital, valproic acid, digoxin, gentamicin, amikacin, vancomycin, tobramycin, theophylline, lithium, and cyclosporine. Results: Of 733 evaluated TDM requisitions, the majority were for antibiotics (75.0%) followed by antiepileptics (10.5%) and cyclosporine (8.9%). Most of the requests had appropriate indication (78.2%), however, only 28.5% had appropriate sampling time. Results were applied by dosage adjustments in 65.8% of requests and some of the inappropriately sampled requests (15.3%) were used as a basis for modifying the dosage regimen. Of all the reported plasma concentrations 42.3%, 41.2%, and 16.5% were within, below and above the reference range, respectively. Conclusion: TDM service is much less than optimal in SQUH. A lot of effort needs to be carried out to improve TDM use in the developing countries as adjusting the doses on results that are based on wrong sampling time might expose patients to toxicity or therapeutic failure.     

我院住院药房2011-2015年药品质量数据分析

目的加强住院药房药品质量管理,促进药品质量不断提高。方法收集我院住院药房2011-2015年HIS系统登记上报的药品质量信息数据,对近5年质量问题药品批次按厂家性质、剂型分布和质量问题类型进行回顾性统计分析。结果我院住院药房近5年药品质量问题共303批次,呈逐年下降趋势;医院制剂、注射剂质量问题较突出;各年度质量问题的类型主要为内、外包装破损及污染,其次为内容物出现异物、色差、结晶、吸潮结块,再次为标签模糊不清、掉签及装置异常;内、外包装破损及污染的质量问题呈逐年下降趋势。结论药品的质量是通过科学的设计得以保障和实现的,通过设置药品质量上报系统、构建医院药房药品质量风险管理体系并创建医疗机构药品质量管理规范,完善和健全药品质量管理制度,可保障药品质量,提升医院药学服务质量与合理用药水平。     

Study on drug related hospital admissions in a tertiary care hospital in South India

Background and objectives

Accidental and intentional poisonings or drug overdoses constitute a significant source of aggregate morbidity, mortality, and health care expenditure. Studies evaluating drug related hospitalization have estimated that approximately 5–10% of all hospital admissions are drug related. The present study was carried out to investigate type, nature and incidence of drug related admissions in our hospital settings.

Method

A hospital based retrospective study was conducted in 575 cases of drug related admissions. The case records of patients admitted in various clinical departments of Amrita Institute of Medical Sciences (AIMS) Hospital during last 8 years (January 2002–December 2009) were collected and analyzed.

Results

During the retrospective study, the total number of drug related cases reported were 575. Out of these, 35.5% cases were induced by central nervous system (CNS) drugs, 19.8% were by cardiovascular system (CVS) drugs, 12.3% were by NSAIDs, 11.3% were by antibiotics and 9.9% were by anticoagulants, 11.3% by other drugs which includes hormones, cytotoxic drugs, hypolipidemics, etc. Four hundred and forty cases were admitted to emergency department. Common drug related problems resulting in hospital visits were due to intentional, accidental and overdose. The incidence of drug related hospital admissions was found to be 0.20%.

Conclusion

The most of the accidental and suicidal cases were reported are by CNS drugs. Psychiatric patients intentionally taking medicines as suicidal attempt and as a part of their illness. As drug related problems are so significant, increased awareness and enhanced collaborative efforts among patients, physicians, pharmacists and caregivers within community and hospital have the potential to minimize the impact of this problem.     

肿瘤医院门诊患者退药情况分析

目的分析该院门诊患者退药情况,针对存在的问题提出改进措施,为临床合理用药提供参考。方法选择502例门诊患者的退药清单,按退药原因、退药类型、退药金额进行统计分析。结果退药原因前3位为药品的不良反应（56.57%）、病情变化（13.15%）、患者拒绝治疗或检查（9.96%）;退药类型分布前3位为抗肿瘤药36种（22.09%）,抗肿瘤辅助治疗药36种（22.09%）,抗生素类药22种（14.11%）。退药金额前3位为抗肿瘤药424479.48元,抗肿瘤辅助药166864.62元,抗生素56039.02元。结论应加强医、药、患之间的沟通,努力提高服务意识;加强退药管理,规范退药程序;加强药品不良反应监测工作;加强业务学习、及时总结,是减少退药的有效措施。     

Nonformulary drug requests at an academic hospital in Germany – the role of general practitioners' long-term medication

Objective: To determine the influence of general practitioners' outpatient medication on nonformulary drug requests in university hospitals. Methods: During a period of 1 year every nonformulary drug request at the Göttingen University Hospital was analysed (reason for request, drug class). A second analysis examined whether the introduction of a new order form that allowed the prescribing physician to mark a box to declare that this request is due to general practitioner's outpatient therapy influenced the rate of requests. Results: During 12 months a total of 6,281 nonformulary drugs were ordered from the pharmacy, 1,077 (17.1%) of them because of outpatient medication. The percentage of requests according to general practitioners' outpatient medication was about 11% in both the medical and the surgical departments. The rate was rather high in the departments of psychiatry and orthopaedic surgery (39% and 60%, respectively). With the introduction of the new order form, there was a significant increase in the general practice based rate of nonformulary requests on the general surgical wards (from 10.8% to 19.9%). Only a minority of requests (14%) represented drugs of unproven efficacy. Conclusion: Since nonformulary requests attributable to previous outpatient medication accounts for less than 20% and since only a minor portion of them lack scientific proof of efficacy we suggest that hospital doctors and clinical pharmacologists should avoid a drug policy, which is too restrictive, and support maintenance of chronic medication initiated by general practitioners. Especially in the department of psychiatry, nonformulary requests seem to be justified by patient needs.     

鲍曼不动杆菌的院内感染分布及耐药性分析

目的了解鲍曼不动杆菌的院内感染分布特征及耐药趋势,为临床治疗提供参考。方法统计2008年1月-2008年12月临床送检标本中鲍曼不动杆菌检出及耐药情况并分析。结果共检出185株鲍曼不动杆菌,其中138株来自痰标本占74.6%。具重耐药,对头孢菌素类耐药率超过50%,对氨基糖甙类超过70%,对亚胺培南、左氧氟沙星尚有较高的敏感率（分别为71.4%和66.7%）。结论鲍曼不动杆菌耐药性监测可为临床合理用药提供依据。     

某教学医院2014—2018年5年间血培养病原菌分布及耐药性变迁

目的 探讨我院2014—2018年5年间血培养病原菌的分布及耐药性变迁,为临床血流感染的诊治提供依据。方法 使用VITEK2 Compact 细菌鉴定系统和VITEK MS质谱仪器进行细菌鉴定,抗菌药物敏感性试验采用VITEK 2 Compact和K-B法进行检测,采用WHONET 5.6软件进行药敏结果的统计分析。结果 5年间血培养共检出病原菌11398株,其中革兰阴性菌占54.7%,革兰阳性菌占38.6%,真菌占6.7%,前5位分离菌分别是：大肠埃希菌(2517株,22.1%)﹑凝固酶阴性葡萄球菌(1951株,17.1%)﹑肺炎克雷伯菌(1572株,13.8%)﹑金黄色葡萄球菌(698株,6.1%)和屎肠球菌(570株,5.0%)。5年间大肠埃希菌对亚胺培南的耐药率由1.1%上升至5.0%;肺炎克雷伯菌对亚胺培南的耐药率由15.7%上升至56.1%;鲍曼不动杆菌对亚胺培南的耐药率平均高达88.1%;铜绿假单胞菌对亚胺培南的耐药率平均为20.8%,对哌拉西林/三唑巴坦﹑环丙沙星和阿米卡星的耐药率均在10%以下;2014—2018年血培养中耐甲氧西林金黄色葡萄球菌的检出率分别为42.6%﹑50.0%﹑40.4%﹑47.5%和35.1%,平均检出率为42.6%。结论     

某教学医院2014—2018年5年间血培养病原菌分布及耐药性变迁

目的 探讨我院2014—2018年5年间血培养病原菌的分布及耐药性变迁,为临床血流感染的诊治提供依据。方法 使用VITEK2 Compact 细菌鉴定系统和VITEK MS质谱仪器进行细菌鉴定,抗菌药物敏感性试验采用VITEK 2 Compact和K-B法进行检测,采用WHONET 5.6软件进行药敏结果的统计分析。结果 5年间血培养共检出病原菌11398株,其中革兰阴性菌占54.7%,革兰阳性菌占38.6%,真菌占6.7%,前5位分离菌分别是：大肠埃希菌(2517株,22.1%)﹑凝固酶阴性葡萄球菌(1951株,17.1%)﹑肺炎克雷伯菌(1572株,13.8%)﹑金黄色葡萄球菌(698株,6.1%)和屎肠球菌(570株,5.0%)。5年间大肠埃希菌对亚胺培南的耐药率由1.1%上升至5.0%;肺炎克雷伯菌对亚胺培南的耐药率由15.7%上升至56.1%;鲍曼不动杆菌对亚胺培南的耐药率平均高达88.1%;铜绿假单胞菌对亚胺培南的耐药率平均为20.8%,对哌拉西林/三唑巴坦﹑环丙沙星和阿米卡星的耐药率均在10%以下;2014—2018年血培养中耐甲氧西林金黄色葡萄球菌的检出率分别为42.6%﹑50.0%﹑40.4%﹑47.5%和35.1%,平均检出率为42.6%。结论 我院血培养病原菌以革兰阴性菌为主,细菌耐药性呈总体上升的趋势,碳青霉烯类耐药肺炎克雷伯菌的检出率显著升高,给临床用药带来极大挑战。     

医院空气中细菌分类及耐药性分析

目的了解我院空气中细菌种类及耐药情况，为医院感染控制提供参考。方法对2004年1-12月我院感染监测各类环境中培养出的450株菌用细菌生化微量鉴定编码方法进行鉴定。药敏试验用纸片扩散法。结果表皮葡萄球菌是空气中最主要的细菌。占51．1％（230／450）；其次是微球菌。占22．2％（100／450）；再次是真菌占11．1％（50／450）。本组细菌对常用抗菌药物青霉素和氨苄西林耐药率高达72．0％和76．9％。对新一代头孢菌素类、喹诺酮类药物的耐药率也在40％以上。结论定期对医院空气进行细菌监测及耐药性分析，对预防医院感染和合理使用抗生素意义重大。     

2011～2013年某院住院药房麻醉药品使用情况分析

目的分析该院住院药房2011～2013年麻醉药品的使用情况,为临床合理用药提供依据。方法利用医院HIS系统,对2011～2013年期间住院药房麻醉药品的使用品种、数量、销售金额和用药频度等进行统计、分析,评价临床应用是否合理。结果该院住院药房常用的麻醉药品有12个品规,麻醉药品销售金额呈逐年增加,其中排名靠前的依次为：舒芬太尼注射液、羟考酮控释片、芬太尼透皮贴剂等,除舒芬太尼注射液和芬太尼透皮贴剂、吗啡缓释片外,所有药物利用指数（DUI）均≤1。结论该院住院药房麻醉药品的使用基本合理,但对于癌症慢性疼痛患者,应进一步更新用药观念,最大限度的减轻患者的痛苦。     

Computerized surveillance of adverse drug reactions in hospital: Implementation

Objective: To implement and measure the effects of automatic computerized laboratory signals (ALS) as a detection support tool of adverse drug reactions (ADRs) in hospital. Methods: This was a prospective observational study of a total of 192 patients (199 sequential medical admissions) during a 2-month period in a 34-bed medical ward at the Hadassah University Hospital, Jerusalem, Israel. The study involved the routine (daily) distribution to staff physicians of lists of automatic signals generated from computerized laboratory data as potential indicators of ADRs. Patient charts were reviewed by the clinical pharmacology team for ADRs and to see whether these were recognized by the staff physicians. Results: Seventy-one ADRs were detected in 64 of the 199 (32%) admissions. Twenty-seven per cent of the ADRs were serious, 9% of the admissions were due to ADRs. Two hundred and ninety-five ALS were generated involving 69% of the admissions. Sixty-one per cent of the ADRs were identified by ALS. ALS were present in 58% of the ADR negative admissions. Eighty-five per cent of the ADRs were recognized as such and 19% of the ALS-positive ADRs were not recognized by the staff physicians. Conclusions: The routine implementation of ALS doubled the number of ADRs recognized by the physicians while patients were hospitalized in the medical ward. The use of the system appeared valid, simple and potentially cost-effective. Received: 17 June 1998 / Accepted in revised form: 1 October 1998     

University hospital-based drug information service in a developing country

In 1994, a clinically oriented drug information unit was established at the Tribhuvan University Teaching hospital in Nepal, with a view to providing objective and independent information through a question–answer service and bulletin production. During the first 2 years of its service, the unit received a total of 674 encounters, with an average of 28 inquiries a month (range 13–42): about three-quarters (74.5%) of all the inquiries were from prescribing doctors, including 38.0% from specialist clinicians; about a quarter (24.6%) were related to patient problems. Most (86.8%) of the responses were provided within 24 h of the inquiry. Frequently encountered queries related to: pharmacotherapy of a disease or drug indication(s), adverse drug reactions, drug doses, availability, drug use in pregnancy, ingredient(s) of a proprietary product, precautions for use and drug interactions. Details of the inquiries received and the responses provided by the unit are documented in a standard question–answer form. The unit also carries out proactive dissemination of information through the publication and free distribution of a bimonthly bulletin which includes brief referenced reviews on drug- and therapeutics-related topics. Nepal- or the local situation-related write-ups are now being increasingly included in the bulletin. A users' survey carried out at the end of 1-year service indicated that the question–answer and bulletin production activities of the unit were well-perceived by its target audiences, i.e. the prescribing doctors and post-graduate medical students. Although Medline on CD-ROM and original journal articles available in the hospital library were consulted for answering a few of the questions, the vast majority of them could be adequately handled by consulting a limited number of well-known drug information books. Our experience indicates that in developing countries such as Nepal, where funds are often severely limited, a small-scale drug information centre, serving a local area, can be usefully initiated by a few motivated staff with a modest collection of about a dozen key reference books. Received: 5 December 1996 / Accepted in revised form: 9 May 1997     

定点医院药学部门应对新型冠状病毒肺炎疫情的策略与效果分析探讨

在全面抗击新型冠状病毒肺炎疫情工作中,承担救治任务的医院是抗击疫情主要阵地,而药品是感染者救治的物资基础之一,药学服务是感染者救治的重要技术支持。因此,医院从人员管理、药品供应、药品管理、调剂环境管理以及用药安全等方面着手,制定一系列措施,建立起应对疫情的医院药学服务与药品保障模式,有效保障疫情诊治和防控工作的有序开展。     

Hospital discharges and 30-day case fatality for drug poisoning: a Danish population-based study from 1979 to 2002 with special emphasis on paracetamol

Objective To examine the number of hospital discharges and 30-day case fatalities due to drug poisoning based on data from a Danish County Hospital Discharge Registry from 1979 to 2002.Methods All patients with a hospital discharge diagnosis of drug poisoning were identified and separated into groups taking: (1) opioid analgesics; (2) non-opioid analgesics; (3) anxiolytics; (4) antidepressants; (5) antipsychotics; or (6) non-specified. Paracetamol and salicylate were analysed separately. From 1994 to 2001, the total amount of drugs sold in the county was identified from a national drug database.Results A total of 13,432 patients with a median age 41.5 years at discharge of whom 59% were females accounted for 20,249 discharges for drug poisoning. The overall number of discharges remained essentially stable around 170 discharges per 100,000 inhabitants per year. From the mid-1990s, paracetamol became the most frequently used drug in poisoning with the largest increase in female teenagers. Thirty-day case fatality in poisoning with opioids was 3.6% compared with around 1% in other drug categories. For most drug categories, a sale of around 80,000 defined daily doses was associated with one hospital discharge due to drug poisoning.Conclusion The overall number of hospital discharges remained stable and seems primarily related to amount of drugs available. With almost 10 years delay, the easier access to paracetamol was followed by an increase in hospitalisation due to poisoning with paracetamol. However, although the majority of hospitalisations were found in the younger age group, the highest mortality was seen among the elderly.     

某教学医院肛肠疾病术后感染的病原菌特征及其耐药性分析

目的 了解肛肠疾病术后感染的病原菌分布和耐药性特征，为术后细菌性感染的诊断与治疗提供预防措施。方法 收集2016-2018年肛肠科手术患者的临床资料，分析肛肠疾病术后感染的病原菌分布特征和耐药性；应用SPSS 18.0软件进行数据分析。结果 在2714例肛肠疾病手术患者中，186例发生术后感染(6.85%)，其中痔疮92例、肛周脓肿57例、肛裂18例、肛瘘15例、肛乳头肥大3例和直肠息肉1例。从切口部位组织或分泌物中分离194株病原菌，其中革兰阴性菌121株(62.37%)，革兰阳性菌68株(35.05%)和真菌5株(2.58%)。不同肛肠疾病术后感染的病原菌种类和分离率存在较大差异。大肠埃希菌等革兰阴性菌对阿米卡星敏感，对头孢吡肟和氨苄西林/舒巴坦较敏感，对左氧氟沙星耐药率较低，对第一、二代头孢类菌素和第二代喹诺酮类抗菌药物均存在较高耐药性，但未发现亚胺培南耐药株。耐3种以上抗菌药物的革兰阴性菌47株，占革兰阴性菌38.8%。表皮葡萄球菌和金黄色葡萄球菌对利福平敏感；粪肠球菌对利福平和利奈唑胺较敏感；表皮葡萄球菌等革兰阳性菌对氨基糖苷类、喹诺酮类和青霉素类抗菌药物均有较高的耐药性，但未发现万古霉素耐药株以及利奈唑胺耐药的表皮葡萄球菌和金黄色葡萄球菌。耐3种以上抗菌药物的革兰阳性菌22株，占革兰阳性菌32.4%。 结论 肛肠疾病术后感染的病原菌主要为革兰阴性菌，临床应根据病原菌分布特征和耐药性分析，采取积极有效的针对性干预措施，降低肛肠疾病术后感染率和耐药菌的产生。     

2007～2009年我院麻醉药品使用分析

目的评价我院麻醉药品的应用现状及趋势,为麻醉药品的科学管理和合理应用提供参考。方法对我院2007年1月至2009年11月麻醉药品的年用量、各科使用量进行统计、分析。结果哌替啶注射液作用居首位,硫酸吗啡控释片用量呈逐年上升趋势,芬太尼用于术中镇痛,用量稳定。结论麻醉性镇痛药在癌症止痛治疗中存在不合理用药情况。     

Switzerland, HIV and the power of pragmatism: lessons for drug policy development

Switzerland in the 1980s was an epicentre of HIV as open drug injection became part of the urban scene, especially in Zurich. Cracks appeared in Switzerland's long commitment to policing as the main drug-control strategy as law enforcement was unable to contain the health and social consequences of the rapid spread of drug injection. In the early stages of the epidemic, the pioneering health care providers who brought technically illegal harm reduction services into the open drug scene in Zurich helped open the exploration at the federal level of more balanced drug policy. Carefully evaluated pilot experiences in low-threshold methadone, needle exchange, and eventually heroin-assisted therapy yielded evidence of significant HIV prevention and crime reduction that was convincing not only to policy-makers but also to a skeptical Swiss public. Whilst not all countries have Switzerland's resource base, the Swiss experience still holds many useful lessons for establishing evidence-based policy on illicit drugs.     

本院麻醉药品应用情况分析

目的调查分析本院麻醉药品使用情况，进一步规范本院麻醉药品的管理和应用。方法统计2007年全院麻醉药品消耗量，并用DDDs分析其情况；以本院2007年麻醉药品管理专用帐册为调查对象，按使用用途分别统计麻醉药品的处方使用率。结果麻醉药品用量前三位是盐酸枸橼酸芬太尼注射液、盐酸吗啡注射液、盐酸哌替啶注射液。结论麻醉药品使用基本合理，但还应该进一步加强用药管理，使麻醉药品的使用更趋于安全、合理、有效。     

阴沟肠杆菌感染的临床分布与耐药性分析

目的了解阴沟肠杆菌的临床分布状况及耐药性,为临床治疗阴沟肠杆菌的感染提供参考。方法用WHONET5.4统计软件回顾性分析阴沟肠杆菌的分布及抗菌药物耐药性状况。结果 2006年1月至2009年6月共分离出233株阴沟肠杆菌,菌株来源主要为痰液、尿液、伤口分泌物,分别占24.9%、19.3%、14.2%;阴沟肠杆菌对碳青酶烯类、阿米卡星、头孢吡肟、头孢唑肟、哌拉西林/他唑巴坦的敏感性较高。结论阴沟肠杆菌主要引起呼吸道、尿道和创伤感染;对三代头孢菌素耐药严重,呈多药耐药性,亚胺培南、四代头孢菌素仍为治疗阴沟肠杆菌严重感染的首选用药。