新医改形势下医院药学发展的思考

为适应新医改形势的发展需求,通过研究新医改政策和《医疗机构药事管理规定》,改变医院药师观念,转变药学服务模式,全面开展临床药学,推动医院药学工作模式由"以药品为中心"的供应型保障型向"以患者为中心"的药学技术服务型转变,促使医院药学工作者实现角色转变,让药学服务成为医疗体系的重要组成部分。     

医疗体制改革下的医院药学发展思路

<正>医院药学服务是医院医疗服务的重要组成部分,在保证患者用药安全,提高医疗质量方面具有不可替代的作用。传统的医院药学涉及药品储存供应、调剂、制剂检验,处方审核,药房药品配发以及药事管理等任务。随着医疗体制改革的试点与逐渐深入推行,对医院药学发展提出了新的要求。1工作模式转变1.1由被动向主动转变《医疗机构药事管理规定》中指出"医院药学管理,以临床药学为核心,促进临床科学、合理用药的药学服务"。新改革形势     

基层医院药学服务现状与对策

目的探索二级医院药学服务管理模式,为基层医院药学工作者开展药学服务提供参考。方法针对我院药学服务工作目前现状,结合当前医院药学发展的方向进行终结分析。结果药学服务作为医院医疗质量管理的重要组成部分,必须顺应当前医疗制度改革的发展,实现功能转变,突出"以患者为中心"的药学服务模式[1],通过药品和药学技术手段向患者提供更为周到的药学服务。结论药学服务是医院药学的发展方向工作核心。     

对我国临床药学发展的思考

临床药学起源于美国,随着医药卫生行业与国际接轨,医疗单位开展临床药师工作,是保证患者用药安全、合理、有效、经济,改善和提升医院医疗服务质量,增强竞争力的有力措施和迫切需要。随着我国医疗改革的不断深入,医药学服务模式已逐步由单纯的保障供给型向技术服务型转变。本文通过对国内外临床药学发展现状进行分析,以探讨我国临床药学服务工作中存在的问题并提出推动我国临床药学发展的建议。     

对我院药事管理工作的探讨

随着社会的进步和时代的发展,患者更注重医院的医疗质量和治疗效果,医院药学逐步由传统的药品供应保障型向临床药学技术服务型转变[1],临床药学服务理念也由以药品为中心逐步向以患者为中心转变.药事工作在临床药学中的作用日趋重要,建立以合理用药为中心的药学服务体系是医院药学工作中的重要环节.     

浅析医院药事管理

在新形势的医疗体制改革下,医院药事管理如何适应新医改的发展变化,将医院药学工作由传统的供应服务模式向技术服务模式转变,面临着一些新的课题,对此,我们要有新理念、新思路、新举措,才能求得新的发展.为跟上改革的步伐,我院认真学习研究相关的法律法规,积极开拓创新,充分发挥药事管理委员会职能,提高医院药剂科管理水平,促进药品的合理使用,提高患者满意度.     

医改形势下基层医院药事管理的发展

针对基层医院现有药事管理的问题,总结提出医改形势下药事管理的新举措。医改形势下转变药品供应模式为以患者为中心的药学技术服务模式,重点促进医院药学发展,提高药学服务的技术含量,加强人才培养等措施有利于药事管理的健康发展。     

新“医改”形势下我院医院药学实践的创新与发展

目的:为持续提升医院临床合理用药水平提供参考。方法:就新"医改"形势下我院医院药学实践中管理和服务的特色和创新进行探讨。结果与结论:临床药学特色和创新包括药事考核工作、临床药师培训和工作、用药咨询和患者床前教育、药物临床研究几个方面;药品管理特色和创新包括药品风险管理、实库存管理、零库存管理几个方面;科室管理特色和创新包括绩效管理、质控管理2个方面。在新"医改"形势下,医院药学实践应不断创新和发展,转变管理理念,转换服务模式,为患者、为临床医护人员提供一流的专业药学服务。     

中国加入WTO药学事业发展的思考

药学是医疗体系的重要支柱之一 ,随着医疗保障制度的不断完善 ,人们保健意识的增强 ,药学建设日趋完善。未来药学服务范围越来越宽。入世后面临着巨大的竞争和压力。现就医院药学发展提出自己的几点思考。1　医院药学面临的机遇和挑战随着医改的进行 ,要求彻底改变“以药养医”局面。为药品管理规范化、现代化 ,不断发展 ,提供了契机。发达国家 ,医院药学、医疗、护理医疗工作中缺一不可。我国医院药学的现状与国外相比差距很大 ,除了传统的观念外 ,药学教育的模式制约了医院药学的发展。由于用药的复杂性 ,药物引起的社会问题日趋增多。全社会文化程度的提高、医学知识的普及、患者自我保护意识增强 ,药师面临着全方位药学服务问题。2　医院应拓展药学服务范围医药科学发展迅速 ,促使社会对药学服务的需求提高 ;新药层出不穷 ,用药越来越复杂 ;医师和患者更加需要药师提供药学新信息 ,以保证药物应用合理、经济、安全、有效。实行处方药与非处方药分类管理制度后 ,指导消费者合理用药 ,已成为药师的首要任务。拓展服务理念 ,满足不同层次的医疗需要 ,努力与国际接轨 ,医院药学才能充分发挥作用。3　培养临床药师随着医疗事业的发展 ,药师工作不再局限于...     

当今医院药师的职责

随着医疗保险事业不断发展和完善,医疗体制改革必将全面推行。当今医院药学工作正从传统的“以药品为中心”向“以病人为中心”转变,从“药物提供型”服务向“药学监护型”服务转变,临床药学已成为医院药学的重点。因此,当今医院药学的发展赋予医院药师新的工作职责。     

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.

---

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.     

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.     

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.