邢台市第三医院门急诊抗菌药物合理应用分析

目的:调查我院门急诊处方抗菌药物的使用情况,促进抗菌药物的合理应用。方法:随机抽取我院2010年9月—2011年9月门急诊处方6 606张,从中筛选出含抗菌药物处方,分析抗菌药物的种类及品种,并对其使用合理性进行审查。结果:抗菌药物处方共1 595张,抗菌药物使用率为24.14%(1 595/6 606),涉及10类29个品种,大环内酯类抗菌药物使用率最高,占32.93%(566/1 719)。抗菌药物处方中单一用药使用率为92.85%(1 484/1 595),口服抗菌药物处方占所有抗菌药物处方的69.66%(1 111/1 595),儿科抗菌药物使用率最高。抗菌药物不合理处方共151张,占所有抗菌药物处方的9.47%(151/1 595)。结论:我院门急诊抗菌药物使用基本合理,但仍存在一些不足之处,有待进一步改善。     

2010年我院门急诊抗菌药物应用分析

目的:了解我院门急诊抗菌药物应用情况,为临床合理用药提供参考。方法:随机抽取2010年1—12月门急诊处方40 729张,对抗菌药物的应用情况进行调查分析。结果:我院门急诊使用抗菌药物处方为9 347张,抗菌药物使用率达22.95%,抗菌药物用药频率排序前3位的分别是氟喹诺酮类、氨基糖苷类和头孢菌素类。不合理用药原因包括给药方案问题、重复用药、药物选用不合理等问题。结论:抗菌药物使用基本合理,但仍需进一步加强监督和管理。     

2013年上半年门急诊电子处方的点评分析

目的通过分析我院2013年1月至6月门急诊电子处方,了解本院门急诊患者处方用药的基本情况,促进合理用药。方法 2013年1月至6月每月抽取一天的门急诊处方,随机抽取其中的100张,按照用药品种数、注射剂使用率、抗菌药物使用率、基本药物使用率、平均用药金额等项目进行评价。结果抽取的600张处方中,平均用药品种数为2.93种,注射剂使用率为25.91%,抗菌药物使用率为24.5%,基本药物使用率为22.09%,平均用药金额为225.54元,处方合格率为95.33%。结论我院门急诊处方用药各项指标与国际和国家标准尚有一点差距,还需要加强和规范临床合理用药的工作。     

急性上呼吸道感染患者抗菌药物应用分析

目的 分析急性上呼吸道感染患者抗菌药物的合理性应用.方法 对本院2010年6月520例上呼吸道感染患者的门急诊处方进行回顾性分析.结果 520张处方中,应用抗菌药物406例,使用率为78.1%,多为单一用药与静脉注射给药.上呼吸道感染抗菌药物使用率头孢菌素居首位,其次为大环内酯类和青霉素类.用药导致的不良反应稍多.结论 我院医师在治疗急性上呼吸道感染时,医院应加强对临床医师抗菌药物知识的培训与再教育,提高抗菌药物的临床合理应用水平.     

我院肿瘤患者门/急诊处方用药与处方书写情况调查分析

目的:了解我院肿瘤患者用药情况,促进临床合理用药。方法:对我院2009年门急诊肿瘤患者12000份处方的用药品种数、抗菌药物使用率、注射剂使用率、处方金额、处方书写情况等进行统计分析。结果:肿瘤患者门急诊用药品种相对单一,抗菌药物使用率低,注射剂使用率、处方金额均较大;在10.6%的不合格处方中书写不规范是主要原因,其中以用法用量和药品规格书写不规范最明显。结论:我院肿瘤患者用药情况基本合理,但处方书写仍存在不规范现象,需进一步改善和提高。     

门急诊抗菌药物处方分析

目的:了解门急诊抗菌药物的使用情况,配合抗菌药物整治活动,促进抗菌药物的合理使用。方法:以随机抽样法抽取2010—2011年门急诊处方,运用描述统计学的方法,对抽取的处方进行统计分析,并结合《处方管理办法》、《医院处方点评管理规范》、药物说明书、相关文献等资料对其进行点评。结果:抽取的总处方数为51 728张,其中2010年处方24 318张,2011年处方27 410张。使用抗菌药物的处方为17 121张,抗菌药物使用率为33.10%,其中2010年抗菌药物处方8 864张,抗菌药物使用率为36.45%,2011年抗菌药物处方8 257张,抗菌药物使用率为30.12%;头孢菌素类抗菌药物使用率最高,大环内酯类次之。单一用药处方12 538张,二联用药处方3 117张,三联用药处方1 466张。有关抗菌药物的不合理处方有1 595张,占抗菌药物处方的9.32%。抗菌药物使用不合理主要表现为用法与用量不合理、遴选药品不合理、联合用药不合理等。结论:门急诊抗菌药物临床应用基本合理,但仍存在一些不合理的地方,需要继续加强管理,使抗菌药物临床应用水平进一步提高。     

2012年厦门莲花医院门急诊抗菌药物应用合理性分析

目的：了解我院门急诊抗菌药物使用情况,并评价其使用合理性,为临床合理使用抗菌药物提供参考。方法：根据卫生部办公厅发出的《2011年全国抗菌药物临床应用专项整治活动方案》,每个月组织对25%具有抗菌药物处方权的医师所开具的处方中抗菌药物使用情况进行分析,并评价抗菌药物使用的合理性。每名医师抽查的处方不少于50张,不足50张的按实际开具处方数。结果：2012年共抽查门诊处方31 729张,其中抗菌药物处方6 870张,抗菌药物使用率为21.65%;使用抗菌药物不合理处方406张,占5.91%。急诊处方9 402张,其中抗菌药物处方2 483张,抗菌药物使用率为26.41%;使用抗菌药物不合理处方443张,占17.84%。结论：我院门急诊抗菌药物使用基本合理,但仍存在不合理用药情况,应进一步加强抗菌药物的管理,提高抗菌药物合理用药水平。     

2012年我院儿科门急诊处方分析

目的：调查分析我院儿科门急诊用药情况和处方中存在的问题,以提高处方质量及合理用药水平。方法：从我院2012年门急诊处方中随机抽取每月两天的处方,分析基本用药和抗菌药物使用情况。结果：共抽取处方11 288张,平均每张处方药品品种数为2.81种,不合格处方率为6.18%,抗菌药物使用比例为30.86%,平均每张处方金额为73.45元。结论：该院儿科门急诊处方用药基本合理,但抗菌药物使用率较高,需加强抗菌药物合理使用管理。     

某院2011年抗菌药物专项整治成效分析

目的分析我院2011年抗菌药物临床应用专项整治活动(简称"专项活动")的成效。方法采用回顾性分析对专项整治活动前后我院门急诊抗菌药物处方比例、住院患者抗菌药物使用率、住院患者抗菌药物使用强度、Ⅰ类切口手术预防使用抗菌药物比例进行统计、分析。结果专项整治活动使我院门急诊抗菌药物处方比例、住院患者抗菌药物使用率分别下降3.1%和5.9%,住院患者抗菌药物使用强度下降到38.68%,Ⅰ类切口手术患者预防使用抗菌药物比例下降至36.43%。结论我院抗菌药物的临床使用基本达到专项整治的要求,专项整治活动对提高医疗质量和安全有促进作用。     

综合干预管理对海盐县医疗机构合理使用抗菌药物的促进作用

目的:对县乡两级医疗机构门急诊使用抗菌药物进行综合干预,促进合理使用。方法:依照《抗菌药物临床应用指导原则》等法规,在各医疗机构实施综合干预措施。调研干预前1个时段、干预后2个时段各医疗机构抗菌药物使用、管理情况,进行对照研究。结果:综合干预管理后,各医疗机构完善了抗菌药物使用管理制度;3个时段门急诊处方抗菌药物不合理例次率,县级医院为14.13%、10.69%、7.25%,乡镇卫生院为23.65%、16.17%、14.38%,差异均有显著统计学意义(P<0.01)。结论:通过对县乡两级医疗机构抗菌药物使用管理的综合干预,降低了门急诊抗菌药物使用率,提高了合理使用率。     

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.     

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.