肿瘤外科临床药师参与结直肠外科患者的药学监护实践

目的探讨肿瘤外科临床药师药学监护重点。方法总结归纳肿瘤外科临床药师在结直肠病区中的临床药学实践,以1例典型的结直肠癌肝转移综合治疗患者多学科(MDT)诊疗模式为例,阐述肿瘤外科药师在MDT团队工作的切入点及围术期药学监护重点。结果结合肿瘤MDT的治疗模式,初步摸索出肿瘤外科临床药师的常规工作药学监护关键点。临床药师针对拟进行肿瘤外科治疗患者药物治疗相关问题提出意见和建议,优化术前抗肿瘤药物用药史与手术的间隔时间、围术期的营养支持治疗的制定、肿瘤患者深静脉血栓的预防、出院后患者用药教育等。结论作为MDT团队成员之一,肿瘤外科药师参与并实施药学监护后,有利于保障患者用药安全、有效,改善患者预后,发挥药学专业优势,体现药学服务的价值。     

临床药师开展药物治疗管理的实践经验与成本-效益分析

目的：应用药物治疗管理（MTM）的标准化流程为患者提供药学服务,通过成本-效益分析评价MTM是否具有经济学效益。方法：应用MTM模式对患者进行药学服务,记录患者一般情况,疾病、用药情况及药品费用,对患者的用药及生活方式问题,分析并提出行动计划,随访。成本-效益研究以MTM服务为成本,药品治疗费用的减少为效益,计算服务前后的成本-效益比。结果：临床药师对80例患者进行了MTM服务,最终完成59例,患者男女比例为39:20,平均年龄(62.39±15.75)岁,使用药物446种,人均(7.88±0.53)种,发现患者用药问题与生活问题255例并进行干预,干预成功率73.33%。服务前后用药成本分别作为两组进行统计分析,发现干预后用药费用明显低于干预前（P＜0.05）,成本-效益比值B/C=4.25＞1。结论：临床药师开展药物治疗管理（MTM）服务可以提高患者依从性,改善用药问题与生活方式,且为患者提供积极的经济学影响。     

以药物治疗管理为核心的药学门诊的构建与应用

目的：介绍某院药物治疗管理（MTM）药学门诊的工作流程与成果,分析优点与不足,为其他药学门诊的建立提供参考。方法：介绍该院MTM药学门诊的建立过程、开设目的、服务人群、服务模式、团队构建、管理模式和学术交流方面的经验。统计门诊开设以来的就诊、复诊人次。统计分析前300例患者的一般情况、疾病情况、用药情况、药物治疗相关问题、药学服务内容和咨询问题种类。结果：该院MTM门诊共接诊425人次。37.4%的患者同时患有3种及以上慢性疾病,44%的患者用药数量为6~10种。药师共发现237名患者存在478个药物治疗相关问题,平均每人2.02个问题。有135名患者主动咨询了问题。结论：临床药师通过建立MTM药学门诊,参与患者慢病药物治疗管理,创新药学服务模式,促进药师角色转型。     

药物治疗管理研究进展

药物治疗管理（medication therapy management,MTM）是药学实践中形成的一种服务模式。MTM能有效地帮助患者正确认识及配合药物治疗,增强用药依从性,减少不良反应事件和不合理用药等相关问题,帮助患者获得最佳的治疗受益。本文通过介绍MTM的核心要素、运行模式、国内外实践及发展的研究情况,结合当前我国医疗体制改革的形势,探索如何进一步建立和完善MTM,为积极推进药学服务整体水平提升和服务质量提高给予一定的参考。     

社区药师门诊对老年慢病患者药物治疗管理（MTM）的服务实践

摘 要 目的：探讨在社区开设药学门诊,为老年慢病患者提供药物治疗管理（MTM）服务的工作模式的作用和实践。方法: 临床药师对2017年3～12月372例患者实施MTM服务,分析该类人群患者不合理用药的特点,通过实例介绍临床药师进行MTM服务的作用与实践。结果: 372例患者中合并2种及以上疾病的患者占58.9%,同时服用5种药物以上的患者占78%,其中不合理用药突出问题中重复用药比例高达43.7%。结论: 社区药师门诊开展MTM服务,临床药师为老年患者多重用药管理提供了保障,提高了患者用药安全性和合理性,也为临床药师工作模式转型、建立药物治疗管理体系提供参考。     

药物治疗管理引入欧洲药学监护网络系统对癌痛患者的应用效果研究

目的 探讨临床药师在药物治疗管理(Medication Therapy Management, MTM)中引入欧洲药学监护网络(Pharmaceutical Care Network Europe, PCNE)对癌痛患者镇痛疗效和用药依从性的影响。方法 选取癌痛患者96例,随机分为试验组和对照组。对照组进行传统癌痛治疗,试验组传统癌痛治疗联合疼痛临床药师提供MTM服务及药学干预。结果 试验组在住院期间共发现31个药物相关问题,药师提出的干预64.52%被接受,干预意见有65%被完全执行;试验组的疼痛评分及爆发痛发生率明显低于对照组,依从性明显高于对照组。结论 临床药师运用MTM服务可有效缓解患者疼痛,提高用药依从性。     

药物治疗管理服务对门诊慢病患者干预效果评价

目的:探讨药物治疗管理(MTM)服务对门诊老年慢病患者的干预效果。方法:选取上海市浦东新区公立医院2018年1月至2019年6月药学门诊收治的160名患有高血压或/和糖尿病老年慢病患者,随机分为干预组和对照组。对照组接受普通药物咨询,干预组至少在药学门诊实施1次完整MTM服务,随访时间不少于6个月。利用经济、临床和人文产出(ECHO)模型及药物治疗相关问题(DRPs)的改善评价药师MTM服务前后的效果。结果:入组6个月后,干预组在改善经济结果、临床结局、人文评价、解决药物相关问题(DRPS)方面与对照组有显著性差异。结论:MTM可以通过识别和干预药物治疗相关问题、及时发现和解决药物不良反应,改善患者依从性,从而提高药物治疗效果和安全性。MTM能以较低的成本提高患者的临床疗效和生活质量,患者对MTM服务的效果满意,在高血压/糖尿病等疾病治疗中有较好的作用,可推广应用,使更多患者受益。     

创新药学服务模式探究——门诊药物治疗管理实践

临床药师开设高血压病药物治疗管理(MTM)药学门诊,为门诊高血压病患者服务。药师引进MTM的药学服务模式,结合中国国情,建立了高血压病标准化MTM管理流程,并利用ECHO模型对于药学服务效果进行全面的评价。本文通过部分工作成效的展示和具体的案例分析,证明药师采用MTM工作模式,可以有效解决高血压患者药物相关问题,最终达到与患者共同管理疾病的目的。MTM门诊工作的拓展,可帮助药师进行高血压MTM的临床实践,为我国的药学服务实践提供策略。     

中医院住院糖尿病患者药物治疗管理模式的建立

通过临床药师在中医院住院糖尿病患者中开展药物治疗管理(medication theray management,MTM)服务,探讨中医院住院患者对MTM的需求,以及临床药师为患者提供MTM服务的模式、关注点和风险点。临床药师通过建立标准化的工作流程、工作表格、药物监护标准化内容,为70例患者提供了MTM。本研究显示,中医院住院糖尿病患者通过中、西药联合治疗糖尿病,有其独有的用药特点,建立适用于中医院的药物治疗管理模式尤为重要,以推进中医院住院患者安全合理用药,并可提高临床药师在医药护治疗团队中的专业价值。     

药物治疗管理结合药物基因检测在1例服用华法林致急性上消化道出血的老年患者个体化药学服务中的应用

目的:探讨药师如何通过药物治疗管理(Medication therapy management,MTM)结合药物基因检测为患者提供个体化药学服务,以促进临床合理用药。方法:以1例服用华法林钠片导致急性上消化道出血的老年共病患者(该患者有2型糖尿病、高血压史,入院2个月前行冠状动脉旁路移植术,半个月前患泌尿系统感染)为例,回顾性分析患者住院前后药物治疗过程,结合CYP2C9*3、VKORC1-1639基因分型检测,评估华法林钠片个体化给药剂量,针对急性上消化道出血及患者所有用药进行MTM,制订个体化药物治疗方案。结果:华法林CYP2C9*3、VKORC1-1639的基因分型测定提示患者为超慢代谢型,推荐华法林给药剂量应为0.86～1.86 mg/d,结合急性上消化道出血情况进行MTM分析,患者使用华法林钠片3.0 mg/d、用药依从性差、疾病状态及共病多药联合可能是导致急性上消化道出血的主要原因,患者停用华法林及对症治疗后临床消化道出血好转,抗凝药物更换为利伐沙班片10 mg/d。通过对患者所有用药进行MTM,药物重整结果显示,停用盐酸地尔硫片、阿莫西林克拉维酸钾分散片、复合维生素片,将降糖药物格列美脲片更换格列喹酮片,冠状动脉旁路移植术后用药酒石酸美托洛尔片更换为比索洛尔片,质子泵抑制剂艾司奥美拉唑肠溶片更换为泮托拉唑钠肠溶胶囊。结论:MTM结合药物基因检测的药学服务模式可指导临床安全合理用药,实现个体化药学服务,提高患者依从性,预防药品不良反应相关问题。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.