家庭药师参与家庭医师团队对社区老年性高血压患者药物治疗管理的干预

目的 观察家庭药师参与家庭医师团队对社区老年性高血压患者药物治疗管理(MTM)的干预成效。方法 选择2018年8月—2019年8月在某社区健康服务中心(简称社康)就诊的规范化管理且签约的原发性老年性高血压患者,于2019年9月—2021年2月进行药物治疗管理干预,共纳入100例患者,实际完成研究98例。患者同时服用3种及以上高血压药物,或合并其他多病种联合用药。采取调查问卷分析患者需要的药学服务内容及服务方式,通过药物治疗管理干预,观察比较干预前后服药依从性、血压控制情况及高血压药物费用成本。结果 干预后服药依从性为89.80%,高于干预前的54.08%;血压控制情况干预前为68.37%,干预后第1个月为70.41%,干预后第3个月为87.76%,干预后第6个月为94.90%;高血压药物费用成本自费患者干预后6个月下降了52.61%,医保患者干预后6个月下降了79.12%。结论 通过家庭药师参与家庭医师团队中对社区老年性高血压患者MTM的干预,可有效提高药物治疗效果、用药依从性及血压达标率;降低医疗成本,减少不良反应,提高患者的生活质量,同时也提高了慢性病患者对家庭医师团队的满意度,对...     

社区居民家庭用药安全现状调查与分析

目的 通过对上海市杨浦区居民安全用药知识调查,了解公众用药安全现状以及对药物安全的认知程度和关心的用药问题,为药师深入开展居家药学服务,保障广大居民用药安全提供思路和建议。方法 以社区居民为调查对象,采用自拟问卷进行调查。其中,患者用药依从性评估使用MMAS-8量表。结果 共发放问卷213份,回收213份,其中有效问卷201份。在受调居民中,用药依从性差者占52.74%。居民最关心的用药问题是药品不良反应（占50.75%）,其次是治疗效果（占26.87%）。居民对过期药品的正确回收存在误区,少数（占23.21%）居民将其作为有害垃圾进行处理,大部分居民未做分类直接扔进了垃圾桶。结论 社区居民在安全合理用药方面仍然存在较多问题,如用药依从性差、药品不良反应处理不当和过期药品处理不当等,药师需要重视和开拓居家药学服务,加强公众安全合理用药指导和教育,保障社区居民家庭用药安全。     

重庆市家庭过期药品居民处置行为调查及回收建议

目的:为构建重庆市家庭过期药品专业回收处理体系提供参考。方法:对重庆市6城区1 683户居民进行问卷调查,内容包括是否储备和定期清理家中的药品、发现过期药品后如何处置、不同处置行为背后的原因、对过期药品回收的建议,采用Epidata 3.1软件进行数据录入与统计分析,并由此提出相应措施和建议。结果:共回收有效问卷1 579份,有效回收率达93.82%。1 322户(83.72%)居民有储备药品的习惯;1 213户(91.75%)居民对过期药品处理方式随意;109户受访者已经参与了过期药品回收,进行追问调查显示,75户(68.81%)居民对目前所接触的过期药品回收方式并不满意,90户(82.57%)居民建议增加回收点,101户(92.66%)居民建议回收点就近设置,93户(85.33%)居民接受上门回收过期药品,97户(88.99%)居民希望能对过期药品有偿回收;1 062户将过期药品随垃圾处理的受访者参与回收的意愿较强,对不同回收方式的接受度都很好。结论:居民多有储药习惯,但缺乏主动清理储备药品的意识,居民处理家庭过期药品方式随意,缺乏过期药品相关专业知识和环保意识,已参与回收的居民对现有回收方式满意度不高,缺乏积极性和主动性,居民支持过期药品专业回收,但实际行为受多种因素影响。建议国家尽快完善过期药品回收和专业处理的相关法律法规,构建政府主导、企业参与、多方联动的家庭过期药品专业回收处理体系。     

北京市丰台区社区家庭医生式服务实践分析

<正>社区家庭医生式服务在北京地区广泛开展,方庄社区卫生服务中心门诊目前已经签约7 200户家庭。以团队的形式为居民提供全方位的服务。方庄社区卫生服务中心采取的服务模式为将工作人员按照居委会的分部组成15个家庭医生式服务团队,每个团队有3名全科医生、2名全科护士、1名康复医生和1名健康教育人员、1名心理咨询师组成,每个团队平均负责600户左右的居民。每个团队需要对签约家庭的健康状况进行调查,建立个人档案及家庭健康档案,对于慢性病患者定期进行     

对283户家庭小药箱的调查与分析

目的了解社区家庭药品储存、使用情况,探索药师参与社区药学服务的途径和方法。方法采用非概率随机抽样方法,选取283户家庭进行调查,并对调查结果进行统计、分析。结果54.5%的家庭在药品储存方面存在问题;超过85%的家庭认为药师应走进社区,为居民提供药学服务。结论社区家庭小药箱的管理关系到居民健康,需要药学专业人员参与,药师应走进社区,为居民提供药学服务。     

门诊患者药品有效利用调查

目的：调查门诊患者药品利用率以及影响因素。方法：通过访谈形式进行问卷调查，了解门诊患者药品利用情况，应用统计学方法对调查结果和影响因素进行分析。结果：被调查者中有29％的患者药品利用率低于50％；82％家庭有过期药品，其中治疗急性病药品占64％。急性病药品利用率低于慢性病药品利用率。公费医疗患者药品平均利用率低于自费患者。结论：门诊患者药品利用率不高；药品过期浪费现象较为严重。影响因素主要是医保制度存在缺陷、医师开大处方、药品大包装、药师与患者沟通及患者缺乏依从性差等。     

1例外伤合并浆细胞性乳腺炎患者的抗感染治疗体会

目的：为临床药师参与治疗浆细胞性乳腺炎提供参考依据。方法：临床药师参与治疗1例外伤合并浆细胞性乳腺炎患者,为医师提供药物治疗信息、分析用药情况、监护患者用药过程。结果：临床药师参与治疗临床疑难病例获肯定,治疗过程中无明显药品不良反应发生。结论：临床药师协助医师团队治疗疑难病例有助于合理用药及保障患者用药安全。     

北京市方庄社区家庭医生式服务的实践总结及探索分析

<正>家庭医生式服务是社区卫生服务建设的重要组成部分,为更好开展家庭医生式服务,方庄社区卫生服务中心将工作人员成立了15个家庭医生服务团队,开展团队式服务模式,每个团队由全科医生3名、社区护士2名、健康教育人员1名、康复医生1名和心理咨询师1名组成,负责大约600户居民的健康管理。团队服务内容主要为对签约家庭居民建立个人和家庭健康档案,发现家庭存在的健康问题,对居民开展健康教育,对常见疾病进行健     

临床药师对一例妊娠期1型糖尿病患者的药物治疗方案分析

2011年国家卫生部和中医药管理局联合颁布的《医疗机构药事管理规定》指出,我国要逐步建立临床药师制,医疗机构应建立由临床医师、临床药师和护士组成的治疗团队,开展合理用药工作.作者作为一名内分泌科临床药师,参与临床药物治疗,通过药学服务提高患者用药的安全性、合理性和用药依从性.现将作者参与的一例妊娠期1型糖尿病患者用胰岛素治疗的情况报道如下,以供同行参考.关键词：糖尿病;妊娠;胰岛素;临床药师分类号：R977.15 文献标识码：B文章编号：1671-2838（2013）05-0349,356,376-03     

临床药师参与临床药物治疗工作体会

目的：探讨临床药师的工作定位。方法通过对临床药师参与临床药物治疗工作中的典型案例,分析医师接受临床药师建议的关键点。结果（1）心态方面：临床药师是医护患之间的桥梁,是治疗团队中的一员,在治疗中要发挥专业知识,保证患者用药安全、有效,协助医师合理用药;（2）技术方面：要想成为一名合格的临床药师,必须不断加强自身的业务学习,提高素质,以满足临床需要,还要有良好的交流沟通能力,以协助医师、护士提高医疗水平,帮助患者提高其用药依从性。只有这样才能为医护患提供高效、优质的药学服务。结论临床药师只有心态放正、业务扎实,才能得到临床的认可,促进合理用药。     

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.     

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.     

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.