我国29个省市155个地区居民对药品说明书的认知情况调查分析

目的:了解我国居民对药品说明书的认知情况,为满足居民药品信息获得与指导需求、提供高质量的药学服务提供依据.方法:在全国范围内,就药品说明书认知情况进行问卷调查,并就调查结果进行统计分析.结果:共发放问卷550份,回收有效问卷525份(525名受访者),有效问卷来源于我国29个省市155个地区.调查结果表明,服用药品时,...     

Hospital pharmacy practice in India

The status of pharmacy practice was evaluated at six hospitals in India. Common drugs were available at private hospitals but the pharmacies at government hospitals had fewer than half of the needed drugs. Selection of the best generic drug appeared difficult because the bioavailability and pharmacokinetic data generally were not available. The hospitals did not have formularies. No unit dose and intravenous admixture services had been implemented. The patient profiles were not maintained. The pharmacists did not appear to provide any professional, educational, or clinical services to patients or physicians. Serum concentrations of drugs were not measured for monitoring therapy. A lack of clinical education and training of pharmacists, lower status and salaries in the hospital pharmacy compared with industry and government, and overall limited resources appear to be the important reasons for the present status of pharmacy practice.     

A study of fifty drug users in Ankara,Turkey

The purpose of the present article is to explore the relationship between socio-demographic characteristics of a sample of drug users in Ankara, Turkey and their stated reasons for using drugs from the perspective of changes taking place in that country. Interviews were carried out with 50 drug users found by means of snowball sampling. The respondents were all male, young (mean?=?21.26 years; SD 4.30), mainly unmarried (64%), their age of starting to use drugs was low (mean?=?18.21 and SD 2.30), but their level of education was not low (mean?=?10.84 years; SD 2.41). Findings indicate that psychological reasons (concern about future, curiosity, and lack of spiritual values) and socio-psychological reasons (peer pressure) were more powerful than economic reasons for starting drug use. The level of education of the addict and the type of drug used (mostly hashish) appear to be the most important demographic variables. These emerging drug users in Ankara are not unlike those in countries currently in the European Union, although hashish is their drug of choice and they appear to start rather later in life.     

Training primary health care workers about drugs: a national survey of UK trainers' perceptions towards training

Reports have consistently shown that non-specialist drug workers (whose working role is not specifically concentrated on dealing with drug-related issues) are reluctant to work with drug users. A number of explanations have been offered to account for this unwillingness including attitudinal factors, occupational constraints and a lack of motivation to learn about drug-related issues. Previously, it has been shown that training affects commitment to working with substance misusers, although failure to attract particular professional groups (e.g. general practitioners) into training courses has also been reported. No previous research has examined the views of trainers about training primary health care and health-related workers. This study of a (non-probability) sample of UK drug trainers (n = 145) assessed training activity for different health care workers, and trainers' differential perceptions of training needs and methods. GPs were the group least likely to become trained about drug issues. Training in attitudes towards drug using individuals was perceived to be more important than either skills or knowledge training for GPs, practice nurses, other nurses and probation officers. Experiential training methods were perceived to be more important than a didactic approach for training all health groups except GPs for whom lecture type instruction was believed to be equally appropriate. Seventy-nine percent of subjects reported providing training across drugs in alcohol or drugs, alcohol and tobacco. Most trainers who stated that certain professions required independent training believed that GPs should be trained separately from other groups.     

仿制药一致性评价的背景、实施及结局

我国是仿制药大国,开展仿制药质量和疗效一致性评价是国际惯例,也是我国经济、技术水平进步的必然结果。仿制药一致性评价适应国家新政,选择合适终点指标进行研究,目的是提高社会认可、实现仿制药与原研药的真正互换。仿制药一致性评价从简单的体外溶出度试验到系统的药学评价再到生物等效性评价,评价方法正在逐步完善,同时明确化学仿制药参比制剂遴选原则以减少仿制过程中的质量差异。仿制药一致性评价不仅能够提升我国制药行业的整体发展水平,促进医药产业升级和结构调整,同时可以节约医疗费用,保证患者用药安全。     

D-galactose as a vector for prodrug design

D-galactose is a simple and natural compound that has mainly been exploited in prodrug strategies. Galactosyl prodrugs can be considered a good approach to reach different goals in clinical drug application, especially when traditional drugs are likely to fail therapeutically owing to reasons such as the lack of site specificity, toxicity, and chemical instability. Indeed, of paramount importance is their ability to increase the selectivity of the parent compound, a phenomenon that helps to reduce the incidence of adverse effects, while preserving intact the pharmacodynamic features of the parent drug. Study results have varied according to the type of linkage between the drug and the hydroxyl group exploited. By working with these parameters, researchers have been able not only to generate selective pharmacological targeting of brain, liver, and cancerous cells, but also to improve cellular permeability as well as the pharmacokinetic profile of parent drugs. This review describes the broad spectrum of possibilities for exploiting D-galactose as a vector for prodrug design and the synthetic strategies that allow its realization.     

Grass Roots and Revitalization

Abstract

The study was a cross-sectional survey using a convenience sample of 425 Asian American respondents to examine their perceptions of substance use problems in the Asian American community and help-seeking preferences. The authors examined respondents' perceptions of the severity of substance use problems in the Asian American community, perceived etiology of substance use problems, beliefs about treatment, perceived help-seeking preferences and helpful services. Respondents showed a relatively low prevalence of drinking and drug use: 20.9% for drinking and 3.3% for drug use. As a group, respondents did not perceive substance use as a serious problem in the community except for the Vietnamese American respondents. In addition, respondents showed a positive attitude toward treatment, although such an attitudinal change was not yet accompanied by a change in their behavioral preferences. Findings also suggested a tendency for Asian American respondents to utilize personal resources rather than professional help or formal treatment programs in response to substance use problems. There was an apparent lack of interest among respondents to use support groups such as Alcoholics Anonymous or Narcotics Anonymous. Implications for developing culturally relevant interventions for prevention and treatment as well as future research are discussed.     

Lead optimization in 12 months? True confessions of a chemistry team

In 1998 GlaxoWellcome embarked upon a new enzyme-inhibitor programme. This programme featured an aggressive timeframe of seven years, from the start of medicinal chemistry through to drug launch. This period, dominated as it was by the constraints of the clinical programme, translated into a lead-optimization phase of no more than 12 months. In this article, we describe our attempts to meet this target, examining not only what we did and what worked, but also what didn't work and, most importantly, what we learnt as a result. At a time of considerable upheaval and challenge to the traditional model of drug discovery, we hope our experiences might stimulate interest, empathy and further discussion.     

Historical overview of generic medication policy

OBJECTIVE: To provide a historical perspective on controversies surrounding the use of generic drugs. DATA SOURCES: Articles were indexed initially using terms such as generic medications, generic drugs, multisource medications, and multisource drugs. These terms were used to search indexing services such as MEDLINE, International Pharmaceutical Abstracts, CINAHL (a database of nursing and allied health literature), Science Citation Index, Psychological Abstracts, and Wilson Indexes to Journal Articles. STUDY SELECTION: Performed by the authors, with preference given to events from 1951 to the present. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: The history of generic drug use is a history of conflict from a variety of perspectives. The primary conflict is economic, in which manufacturers of brandname pharmaceuticals aggressively seek to protect their patents from a variety of groups (e.g., the federal government, managed care organizations, consumer groups) that want access to less expensive medications. Another conflict is professional, especially for the members of the pharmacy profession who view drug product selection as an important opportunity for pharmacists to use their professional judgment. The most confusing conflict is the scientific discussion of bioequivalence and product quality. The brand manufacturers suggest that not all products are bioequivalent and of the same quality. This position has been opposed by the pharmacy profession, generic drug manufacturers, health care institutions, and the Food and Drug Administration. CONCLUSION: Generic drug use has increased dramatically during the past 50 years and is an accepted part of health care. However, the economic consequences of generic drug use are sufficiently high for this activity to continue as a source of controversy in the future.     

我院住院患者退药原因的排列图法分析

目的对我院住院患者退药现象进行调查,分析住院患者退药的主要原因,提出相应解决对策,减少退药情况的发生,保证临床用药安全。方法利用我院计算机管理系统和Excel软件进行退药数据处理,利用排列图法找出我院住院患者退药的主要原因。结果造成住院患者退药现象的前3项原因为患者拒用,患者出院、转科,医师更换医嘱;医嘱开错、录入错误,患者死亡这2项为次要原因;药房缺药,检查、手术停做,药物过敏,药品存在质量问题等为一般原因。结论针对造成退药现象的主要原因,应加强本院医师、药师专业技能培训,建立处方点评机制,完善医院信息化系统,完善药品信息,提高科室之间的协调能力,规范退药程序,把影响退药现象的主要原因及次要原因限制在可控范围内。     

Pharmaceutical policy regarding generic drugs in Belgium

Pressure to control pharmaceutical expenditure and price competition among pharmaceutical companies are fuelling the development of generic drug markets in EU countries. However, in Belgium, the market for generic drugs is underdeveloped compared with other countries. To promote the use of generic drugs, the government introduced a reference pricing (RP) scheme in 2001. The aim of this paper is to discuss Belgian pharmaceutical policy regarding generic drugs and to analyse how the Belgian drug market has evolved following initiation of the RP scheme.The market share held by generic drugs increased following implementation of the RP scheme. Focusing on volume, average market share (by semester) for generic drugs amounted to 2.05% of the total pharmaceutical market from January 1998 to June 2001, compared with 6.11% from July 2001 to December 2003. As new generic drugs are introduced, their market share tends to increase in the first couple of months, after which it levels off. Faced with increasing generic competition, some manufacturers have launched new variants of their original drug, thereby effectively extending the period of patent protection. Strategies consisting of price reductions in return for the abolition of prescribing conditions and the launch of new dosages or formulations appear to have been successful in maintaining the market share of original drugs. Nevertheless, the introduction of the RP scheme was associated with savings amounting to 1.8% of pharmaceutical expenditure by the third-party payer in 2001 and 2.1% in 2002.The findings of this paper indicate that the RP scheme has stimulated the Belgian generic drug market. However, existing policy has largely failed to take into account the role that physicians and pharmacists can play in stimulating generic drug use. Therefore, further development of the Belgian generic drug market seems to hinge on the creation of appropriate incentives for physicians to prescribe, and for pharmacists to dispense, generic drugs. With respect to incentives to advance generic drug use, EU countries have experimented with various forms of budget constraints for physicians, generic substitution by pharmacists and RP schemes, although more evidence is needed of their impact on consumption and prices of generic drugs, pharmaceutical expenditure and health outcomes.     

Transplant pharmacists' opinions on generic product selection of critical-dose drugs.

Factors considered important by transplant pharmacists in decisions about generic product selection and in defining critical-dose drugs, as well as transplant pharmacists' attitudes about bioequivalence testing, were studied. Surveys, completed by telephone and fax in 1997, were used to assess pharmacists' role at solid-organ transplant centers, factors the pharmacists considered important for generic product selection, and pharmacists' attitudes about the FDA guidelines on bioequivalence testing. Surveys were completed by 59 pharmacists. The factors considered important by pharmacists for inclusion of generic products on the formulary were safety (97% of respondents), clinical consequences (97%), efficacy (92%), and bioequivalence (92%). Nearly all the pharmacists (95%) expressed a belief that generic products of some critical-dose drugs should not be dispensed. Only 12% of the respondents said they thought that the FDA guidelines on bioequivalence testing were appropriate for critical-dose drugs, and 92% thought that bioequivalence testing for this category of drugs should be conducted in actual patients. Efficacy, safety, the presence of a narrow therapeutic index, bioequivalence, and clinical consequences were identified by transplant pharmacists as important factors in decisions about generic product selection; current FDA guidelines for establishing bioequivalence were viewed as possibly not appropriate for critical-dose drugs.     

Sale of Tobacco Products in Pharmacies: Results and Implications of an Empirical Study

ObjectiveTo provide national-level data concerning the percentage of pharmacies selling tobacco products, examine relationships between selling practices and pharmacy characteristic variables, and explore perceptions of conflicts between tobacco-selling activity and professional and personal values and the potential effects of such conflicts.Design, Setting, ParticipantsData were collected from a geographically stratified systematic random sample of 899 pharmacies. Multiple mailings were sent to the attention of the pharmacy manager. A random sample of nonrespondents was also contacted by telephone, urging participation.Main Outcome MeasuresWhether the pharmacy currently sold cigarettes and/or smokeless tobacco products, and if so, whether these practices differed from what respondents' personal or professional values tell them to do. Scales designed to measure job satisfaction, job-induced tension, and propensity to leave were also included.ResultsSlightly more than half (50.5%) of the pharmacies sold cigarettes and 35.4% sold smokeless tobacco products. Independents were less likely than chain pharmacies to sell tobacco products. For those respondents working in pharmacies where tobacco products were sold, 47.6% responded that this practice differs from what their personal values tell them to do and 63.9% replied that this practice differs from what their professional values tell them to do. Even when controlling for pharmacy type, respondents working in pharmacies that sold tobacco products had significantly lower levels of global job satisfaction, higher levels of job-induced tension, and a higher propensity to leave than did respondents working in pharmacies that did not.ConclusionDecision makers in pharmacies where tobacco products are still sold should take a serious look at the justification for the continued availability of tobacco products in an environment that has a goal of promoting health.     

Assessing the safety of drugs in pregnancy: the role of prospective cohort studies.

Since, for obvious reasons, systematic testing of the teratogenic properties of drugs in humans is not possible in the premarketing phase, the epidemiological approaches to postmarketing risk evaluation are of major importance. Cohort studies, with their prospective exposure assessment, their ability to study even exposure to drugs not commonly used in pregnancy, and their ability to monitor both adverse and beneficial fetal outcomes, seem to be the most promising study type from a methodological viewpoint. Although there are numerous cohort studies on the harmful effects of drug use in pregnant women, only a few have been able to demonstrate a risk in terms of an increase in the prevalence of malformations. Most studies with significant findings were those investigating the risk potential of one group of drugs, the anticonvulsants. The lack of cohort studies showing a risk for drug use in pregnancy, however, is not necessarily indicative of some methodological deficiency. Rather, it may suggest that, for the majority of drugs, their use in pregnancy is not associated with an increased risk of congenital malformations.