PDCA循环管理在我院药品不良反应监测工作中的应用

目的:探讨应用PDCA循环管理在医院药品不良反应(ADR)报告和监测中的效果,提高ADR报告和监测管理质量,促进临床合理用药。方法:采用PDCA循环管理法,制定ADR上报和效果评价标准,并提出持续改进的措施。结果:实施PDCA循环管理后,我院ADR监测数量及质量明显提高,2011-2014年ADR上报例数依次为63、95、136、206例,新的/严重的ADR上报例数依次为2、5、15、30例,临床科室上报例数依次为15、39、87、164例,均显著增加。无效报表例数和ADR病历无记录/记录不详实例数都显著减少。结论:PDCA循环管理可以有效地改进医院ADR监测工作,提高医务人员主动上报的自觉性。     

PDCA循环管理方法在我院药品不良反应监测管理中的应用效果分析

目的:探讨PDCA(计划、实施、检查、处理)循环管理方法在我院药品不良反应(ADR)监测工作中的应用效果。方法:分析我院2012年ADR监测工作中存在的问题,运用PDCA循环法进行干预,评价管理实施1年后的改进效果。结果:实施PDCA循环管理后,通过完善ADR监测的管理制度、将ADR监测纳入临床药师考核体系、建立ADR网络上报平台、加强医务人员的培训、传递ADR信息及加强重点药品品种的ADR监测,2013年我院ADR上报数量增加了18.37%,其中新的和严重的ADR上报比例明显升高(由22.28%增至38.42%);ADR上报来源方面,病区ADR上报率明显增加(由8.16%增至43.84%);抗菌药物和中药制剂导致的ADR占比均明显下降(分别由54.52%、23.03%下降至43.84%、13.30%);ADR临床表现方面,累及皮肤及其附件的比例也显著下降(由53.64%下降至39.41%)。结论:PDCA循环管理法用于我院ADR监测工作的管理成效显著。     

基于PDCA循环的ADR教学及其效果研究

目的:探索基于PDCA循环的药品不良反应(adverse drug reaction,ADR)教学及其在改善ADR报告工作的应用效果。方法:根据ADR报告工作的特点,应用PDCA循环,进行现状分析、提出计划、实施干预并评价效果。在干预措施中,采用以案例为基础和以问题为导向的ADR教学方案。通过对某三甲医院某病区住院患者ADR报表的回顾性调查,对进行干预前后的病区ADR上报情况进行数量统计与质量分析。采用SPSS19.0软件进行数据处理。结果:应用PDCA循环管理期间列入分析评价的有效ADR报表为42份。干预前共上报ADR报表2份(占PDCA循环管理期间报告数量的4.76%),均为医师上报的一般的ADR,优秀报告0份,关联性评价一致率为0。进行干预后共上报ADR报表40份(95.24%),较前增加38份(90.50%),药师/药学生上报例数占同期总上报ADR例数的90.00%,包括严重ADR报告4份,优秀报告率为75.00%,关联性评价一致率62.50%。结论:基于PDCA循环的ADR教学,可提升ADR的报告数量和质量,建立医护药共同支撑的药物警戒体系,为临床安全合理用药奠定基础。     

PDCA循环管理法提高医院药品不良反应报告和监测水平的研究

目的探讨开展医院药品不良反应(ADR)报告和监测的有效方法,提高医院药品不良反应报告和监测工作质量,促进医院用药安全。方法分析本院2016年ADR报告和监测工作中存在的问题,运用PDCA循环管理法进行干预,评价干预1年后的整改效果。结果针对我院ADR上报质量不高的原因,制定了奖惩措施,并将该项工作纳入绩效考核,定期为医护人员进行ADR专项培训及加强与医护人员和患者的沟通等措施。与2016年相比,2017年我院ADR上报数量增加了41.81%,其中严重的ADR数量增加明显;药师上报比例明显增加;抗菌药物导致ADR例数虽然增加,但是占比下降,而生物制品导致ADR例数与占比均明显增加。结论 PDCA循环管理法的干预,明显提高了我院ADR报告和监测水平,有助于降低临床用药风险,保障患者用药安全。     

PDCA循环在提高药品不良反应上报数量中的运用

目的了解本院药品不良反应(ADR)上报不积极的原因,利用PDCA循环管理法提高ADR上报数量,达到每年100例的上报要求。方法成立ADR品管圈,设计ADR上报不积极的原因问卷调查,分析原因并制定计划持续改进。结果 2014年1-8月ADR上报数每月均达到10例以上。结论应用PDCA循环提高ADR上报的持续改进工作是有效的。     

我院药品不良反应监测工作的持续质量改进

目的了解我院ADR监测工作现状,结合实际进一步完善我院的ADR监测上报工作,持续质量改进。方法根据ADR监测中心判断标准对我院2009年收集的116份ADR报告进行来源、分布、报告质量的回顾性统计分析,确定目标,制定相关环节的改进方案,评估实施结果。结果经过持续质量改进,2010年、2011年我院ADR监测上报工作在数量、质量上有持续性显著提升。结论实施有效的持续质量改进措施能明显提升我院ADR监测、上报工作的数量和质量。     

鱼骨分析联合 PDCA 循环在病区药品质量管理中的应用

目的：利用鱼骨分析联合PDCA循环管理法,加强病区药品质量管理,保证药品质量,保障患者用药安全。方法利用鱼骨分析法分析影响病区药品质量的因素,对其影响因素利用PDCA 循环的方法进行整改、落实及持续改进。结果病区药品质量管理引入管理工具后,护士人员对药品质量管理知晓率由及病区药品质量管理效果有显著改善。结论在药品质量管理中引入鱼骨分析、PDCA 循环等管理工具,病区药品质量管理有很大提高,值得推广。     

PDCA循环管理在医院药品不良反应监测工作中的应用

目的：探讨医疗单位药品不良反应（ADR）报告监测管理办法,提高ADR报告和监测管理质量,促进医院安全、合理用药。方法：运用PDCA循环医疗质量管理办法,分析贵州省肿瘤医院2011-2015年ADR监测情况,提出持续改进措施,促进我院安全、合理用药。结果：我院5年上报ADR数量为1363例,其中运用PDCA管理方法前（2011年）有效例数仅为47例,实施PDCA循环管理后2012-2015年ADR有效例数分别为171、286、417、442例,报告总例数逐年升高;2011-2015年严重的ADR报告例数分别为0（占0.00%）、58（占33.92%）、142（占49.65%）、118（占28.30%）、172（占38.91%）例;有效报表的比例从2011年的82.46%上升到2015年100.00%;对比实施管理前我院ADR报告的品种和数量明显增多,以抗肿瘤及其辅助用药为主,占57.45%;2011-2015年抗肿瘤药物引发的严重ADR累及系统以红细胞异常为主,占68.67%。结论：运用PDCA循环和质量管理工具,坚持计划、实施、检查、处理循序渐进,能有效提高ADR监测管理水平,最大程度地减低风险、保证患者用药安全。     

某院PDCA循环管理在病区药品质量持续改进中的应用及其成效分析

目的:分析PDCA循环管理在医院病区药品质量持续改进中的应用及其效果.方法:选取2019年1月-6月间28个病区药品管理资料为PDCA实施前组,另选取2019年7月-12月间28个病区采用PDCA循环管理后资料为PDCA实施后组;比较管理前后28个病区全方位药品质量检查结果,分析其药品管理(高危药品、大输液、冷藏药品、抢救药品和麻醉药品)及药品质量存在缺陷的发生情况,以及对药学服务的满意率,评价其方法的可行性.结果:28个病区的各大类药品出现管理缺陷问题,经PDCA循环管理后出现缺陷频率明显低于实施前组(P＜0.05),病区对药学服务的总满意率明显高于PDCA实施前组(96.43％ vs 78.57％,P＜0.05).结论:PDCA循环管理用于病区药品质量持续改进中,有效促使质控指标及相关管理制度进一步细化,以达到质量持续改进,实现病区药品的规范化、科学化管理.     

PDCA循环在我院药品不良反应监测中的效果研究

目的 探讨运用PDCA循环在促进我院药品不良反应（ADR）报告和监测中的效果,提高我院ADR报告和监测工作的规范化及标准化,促进临床用药安全。方法 通过分析我院2017-2020年的ADR报告数量和类型,评价自2019年运用PDCA循环进行干预后监测效果的变化。结果 运用 PDCA 循环进行干预后,我院药品不良反应上报数量、新/严数量及病程记录率均有所提高。结论 PDCA 循环的干预,明显提高我院 ADR 监测水平。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.