加强临床药理学实践教学为培养临床药师服务

临床药学正在逐渐取代传统医院药学模式，而成为现代临床医疗实践全新模式中不可或缺的部分。培养合格的临床药师是做好临床药学工作、提高综合医疗水平的前提。临床药理学课程是临床药师的必修之课。为了充分体现临床药师的专业职能，即为提高临床医疗水平服务，笔者在教学中从提高临床药师的服务技能和服务意识出发，加强了实践教学环节。紧密结合临床，在临床药师协助下建立药历，搜集药物不良反应和药物相互作用的实例并制作成CAI课件，制订了实践教学大纲并编写了讲义，从内容和形式上完善了实践教学。     

临床药师参与社区获得性肺炎药物治疗的实践与体会

目前医院药学正在由“供给型”向“服务型”转变，因此开展临床药学工作、以病人为中心做好合理用药工作已成为医院药学首要任务，卫生部为了培养临床药师，先后确定了50个单位作为临床药师培训基地，为全国培养了多名临床药师，必将使全国临床药学工作掀起一个高潮，为了有效促进临床药师下临床工作的开展，我刊特开辟了《临床药师在临床专题》栏目。由于临床药师如何下临床、怎样进行工作、遇到问题如何去解决均无现成的答案，本期发表的几篇文章可供临床药师参考，起到抛砖引玉作用，希望各地临床药师能将自己心得体会、经验教训与大家分享，本栏目文稿的表现形式不限，欢迎广大临床药师踊跃投稿。     

临床药师参与临床药学实践的意义

目的临床药学实践是每一位临床药师都应该参与的必要学习项目，临床药学工作应面向患者，一名优秀的临床药师，其应有全面的知识结构且具备独立的临床药学工作能力，能够合理的协助医生为患者用药，在最大限度上，合理安排患者用药，使患者早日康复，同时，在临床诊疗过程中，建立健全医药结合制度，逐步让广大患者意识到临床药师的地位。本文首先阐述了临床药师进行药学实践前的知识准备，并阐述了进行临床药学实践过程的意义。     

临床护士技能考核侧重点的探讨

临床护理技能考核是评价一个合格护士的一项重要标准。多年来，临床护士技能考核一直沿用教学护生技能考核评分标准，评分标准细致人微，护士发挥自由创新空间很小，扼杀了护士的创新意识，影响了临床护理技能的革新与提高。本院通过探讨临床护士技能考核标准，根据实际工作需要，从以下几方面制定临床护士考核标准，受到临床护士欢迎，总结如下。     

目标管理原理在护理临床实习教学管理中的研究

目的提高临床实习教学管理水平。方法在护理临床实习教学管理中，应用目标管理原理制定新的临床实习管理组织和考核要求，以满足需求的变化，不断完善临床护理教学。结果目标管理原理教学法有助于提高医院临床实习教学的管理。结论目标管理原理教学法有助于加强对护理临床实习教学环节的管理，规范了护理临床教学，提高了老师的综合素质，保证了教学质量。     

临床护士用药中的安全管理

随着临床用药的不断增加，药品的标识、包装与命名都非常相近，在实际护理工作中经常会出现用药上的失误，为了保证护理安全，杜绝此类事件的发生，护理部与临床药剂科主任联系为全院护理人员讲解临床用药安全，并建立了药品安全管理制度，从而保证了临床用药安全，最大限度地减少护理差错，提高了医院的护理质量。     

循证护理在消化道出血急救中的应用效果

消化道出血在临床上是一种十分常见的疾病，由于此病较为严重，如果患者得不到较好的护理，那么在很大程度上会有生命危险，严重影响了患者的健康和生活，而如何进行有效的临床护理显得尤为重要。近些年来，随着社会经济的不断发展以及医学护理模式的不断变革，人们不仅在追求着物质上的生活，也在追求着一种精神层次的满足，因此人们对临床的服务质量提出了更高的要求，即要求在医院内要享受到人性化的护理服务。而循证护理满足了临床护理的需要，在现代护理中发挥了十分重要的作用。为了进一步研究其临床效果，我院选取了120例消化道出血患者的临床资料，回顾性分析临床护理措施，报道如下。     

现阶段临床药学工作的实践与思考

自我国开展临床药学工作20多年来，药师的职责发生了重大变化，由以往的关注药物转为直接面向病人，药师的地位也变得更加重要。深圳市人民医院药学部于20世纪90年代初成立了临床药学研究室，现有专职临床药师8名，负责为病人和医护人员提供药学服务，指导临床合理用药。与国内其他许多医院一样，本院的临床药学工作也刚刚起步，尚未完全发展到以病人为中心的药学服务阶段。作者总结了自己近年来在临床药学工作中的经验，并对其发展提出了一些思考。     

中国临床药学出路何在？——一名药理生的临床手记

临床药学在中国举步维艰，而作为药理生，初下临床或许会遭遇到很多阻碍，但如果没有临床经验，药学的进步就只能是闭门造车。那么，究竟药理生下临床对不对，怎样下？一直是从事临床药学人员的困惑，本期我们摘编了一名药理生的临床手记。同时选编了一些网络意见，欢迎读者就这个问题继续展开讨论。如有高见，请发至邮箱：nlyq@165．com。     

客观结构化临床考试在临床药师教育培训中的探索与实践

目的 探索临床药师培训中客观结构化临床考试（OSCE）的模式。方法 查阅国内外OSCE相关文献，结合医院基地临床药师培训实际情况，建立OSCE模式，对培训学员进行OSCE，以提升学员临床药学服务能力。结果 建立了针对临床药师培训学员的OSCE培训体系和OSCE题库，并成功运用OSCE模式完成通科学员考核，发现了现有常规带教和考核在临床药学服务能力提升方面的局限性。结论 建立基于OSCE的临床药师学员培训的新模式，可以有效提升临床药师培训满意度，值得进一步推广。     

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.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

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.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

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.