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??OBJECTIVE To explore standardized pharmaceutical care service mode from establishment of process for pregnancy combined with hypothyroidism or hyperthyroidism. METHODS According to evidence-based medicine, relevant regulations and clinical practice, the pharmaceutical care process was established and tried out based on the clinical pharmacists?? daily work. We used METHODS of pharmaceutical care classification and standard record forms to carry out the systematic, real-time and continuous medical supervision work for patients. RESULTS Pharmaceutical care was performed on forty-two patients with hypothyroidism or hyperthyroidism in accordance with this procedure. Clinical pharmacists participated in the optimization of drug treatment regimens, intervened with irrational use of drugs, and advised on drug adverse reactions. CONCLUSION The practice of pharmaceutical care process is beneficial for clinical pharmacists to carry out pharmaceutical service in depth and ensure the safety of drug use. Standardization can promote this procedure in the industry field, as well as promote the improvement and homogenization of professional skill level and pharmacy service ability of clinical pharmacists in gynecology and obstetrics.     

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??OBJECTIVE To explore the keypoints and METHODS of pharmaceutical care provided by clinical pharmacists in nutritional support for patients with severe burn. METHODS Through summarizing the pharmaceutical care process in nutrition support therapy in large area burn patients,the contents of pharmaceutical care including the requirements for thermal energy and nutrients,choice of drugs,nutrition support pathway,complication prevention,application of other special nutrients and so on were described. RESULTS Through pharmaceutical care,the nutritional support regimen was adjusted,which improved the safety and effectiveness of drug treatment and laid the foundation for related treatments for patients with severe burn. CONCLUSION Nutritional support is one of the important measures in the treatment of severe burn patients. Pharmaceutical care can improve the standardization and effectiveness of nutritional support treatment. At the same time,the value of clinical pharmacists can be reflected through collaborative service with doctors and nurses.     

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??OBJECTIVE To understand the prevalence of chronic diseases and the demands of pharmaceutical care in the ederly, and to explore the content and mode of pharmaceutical care for elderly people.METHODS A questionnaire survey was conducted in 1 262 people over 60 years old, and the data were processed by SPSS.RESULTS Respondents?? prevalence rate of chronic diseases was as high as 95.2%, the top three chronic diseases was hypertension,bone hyperplasia/osteoporosis and coronary heart disease.The respondents?? cognition and evaluation of pharmacists and pharmaceutical care needed to be improved, their pharmaceutical care needs mainly concentrated in the popularization education of medication particularity,the detailed explanation of drug instructions and the coping measures to common adverse drug reactions; lectures,face-to-face communication,pamphlets were more acceptable for the elderly to carry out pharmaceutical care.CONCLUSION The health status of the elderly is not optimistic, and they generally have an urgent need for pharmaceutical care. Pharmacists should improve their ability, to carry out various pharmaceutical care to meet the needs of the elderly.     

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??OBJECTIVE To find out the essentials of clinical pharmacists?? work on making individualized anticoagulation therapy, tailored to patients with deep vein thrombosis and pulmonary tuberculosis, and on its pharmaceutical care. METHODS The clinical pharmacist participated in one case of individualized anticoagulation therapy and provided pharmaceutical care to one patient with deep vein thrombosis and pulmonary tuberculosis. The patient used to take warfarin, but the treatment was ineffective, therefore the clinical pharmacist tried to find out the reason from such aspects as interactions among genetic polymorphism, anticoagulants and anti-TB drugs, then adjusted the therapy for the patient. RESULTS A dosage regimen suitable for the patient was formulated, and medication education was carried out to the patient in terms of medication instructions, such as influencing factors on curative effects of warfarin and monitoring of INR, to improve the patient compliance related to anticoagulation therapy. CONCLUSION Clinical pharmacists should start pharmaceutical service right from making individualized anticoagulation therapy and carrying out pharmaceutical care.     

医院药学服务风险性探讨

目的探讨医院药学服务安全性和风险性,为保证药学服务安全性把风险性下降最低提供参考。方法本人从多年工作经验体会分析探讨医院药学服务过程风险所在原因以及防范措施。结果医院药学服务风险主要存在：药品保管贮存,处方调配,说明书信息获得不足,退药处理,临床药师参与度。从发现问题中找到解决方法是防止医院药学风险,保证药学服务质量的重点。     

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??OBJECTIVE To assess the cost-effectiveness of clinical pharmaceutical care in the H. pylori(HP) eradication in outpatients with peptic ulcer.METHODS Ninty-six Outpatients with HP positive peptic ulcer from July 2015 to June 2016 were prospectively collected, and randomly divide into control group and intervention group. Patients in the control group were given the traditional outpatient service. The intervention group patients were given with pharmaceutical education and follow-up by clinical pharmacist. The score of compliance with medication, HP eradication rate and the improvement of gastrointestinal symptom were selected as outcome indicator. Time cost of intervention and fee of clinical pharmacist training were estimated and recorded as the cost of clinical pharmacy intervention. RESULTS ??Improvement of the score of compliance with medication of intervention group patients was significantly higher than the control group (1.71 vs. 0.44, P<0.01). Forty-four patients of the intervention group, while 36 patients in the control group reported less gastrointestinal symptoms (91.67% vs. 75.00%, P=0.028). The HP eradication rate of the intervention group was significantly higher than the control group (91.67% vs. 72.92%, P=0.016). ??For the hospital, the cost of pharmacy service of control group was 292.31 yuan, and 821.61 yuan of the intervention group. ??The cost-effectiveness ratio of the score of compliance with medication of control group was 664.34, while the intervention group was 480.47, which was superior to the control group. It was cost-effective. However, the cost-effectiveness ratio of HP eradication rate and the improvement of gastrointestinal symptom of the intervention group were both higher than the control group. CONCLUSION Clinical pharmaceutical care increase the cost of the hosipital. However, clinical pharmaceutical care can result in cost-effective improvement of the medication compliance.     

关于加强医院药房管理及提高服务质量的探讨

目的：改善医院药房管理,促使其更好地为患者提供合理用药,提高服务质量.方法：根据工作实践对医院药房管理及提高服务质量提出改革方案,对加强对药品的管理,开展药学服务工作,培养高素质的药学服务专业人员.结论：对医院药房实行规范化、科学化和现代化管理,能健全医院药房管理制度,提高人员素质及服务质量.     

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??OBJECTIVE To analyze the adjustment of therapeutic regimen and pharmaceutical care for a patient with AIDS accompanied by a variety of opportunistic infection, and to explore the work pattern of pharmacists in the clinical practice. METHODS According to the patient??s condition and clinical guidelines to disease, reasonable suggestions for rational drug use were put forward, and adverse drug reactions were also monitored by the pharmacists during the treatment. RESULTS With adjustment of therapeutic regimen and pharmaceutical care, clinical pharmacists optimized the treatment program and solved clinical programs. CONCLUSION Through participating clinical practice, pharmacists improve the safety and effectives.     

持续性药学服务在妇科肿瘤化疗患者中的应用实践

目的 建立妇科肿瘤化疗持续性药学服务路径并分析应用效果。方法 通过文献检索和北京妇产医院(以下简称我院)现状调研,建立妇科肿瘤化疗持续性药学服务路径,并以我院妇科肿瘤科2020年5月至2021年4月收入的173例化疗患者为研究对象进行效果观察,分为干预组和对照组。干预组按路径实施至少3个化疗疗程的持续性的药学服务,对照组实施常规用药指导及护理宣教。在第3程化疗当日采用问卷调查的方式比较两组患者对用药知识了解程度,采用床旁问诊和病历查询的方式获取患者药物不良反应(ADR)和用药错误(ME)发生情况并及时干预,用专用表格记录。结果 最终纳入干预组和对照组患者分别为66、72名,两组患者基线特征比较差异无统计学意义(P＞0.05);干预组患者对药物了解程度较对照组明显改善,总分[(14.121±1.398)∶(12.292±2.441)],F=25.734,P＜0.001,差异有统计学意义。干预组患者给药与监测环节中ME较对照组明显减少,[9.1%(6/66)比40.3%(29/72)],χ²=17.693,P＜0.001,差异有统计学意义。ME级别大多为B级和C级,但也有3例E级ME,需及时干预以避免对患者造成进一步危害。结论 妇科肿瘤化疗持续性药学服务路径的建立及应用有助于提高妇科肿瘤化疗患者对用药知识的了解程度,及时发现并干预ADR,预防ME。     

对脑卒中患者实施临床路径康复护理的影响

临床路径（clinicalpathwaysCNP）的概念最早起源于20世纪70年代早期,临床护理路径是一种先进有效的护理管理模式,指医院里的一组人员共同针对某一病种的监测、治疗、康复和护理所制定的一个有严格工作顺序的,有准确时间要求的照顾计划,以减少康复的延迟及资源的浪费,使服务对象获得最佳的医疗护理服务质量.