2012-2014我院门诊中成药处方合理性分析

目的：调查门诊中成药处方的合理性,以减少药物不良反应,保障患者用药安全。方法对医院2012-2014年门诊中成药处方3600张进行抽样点评、分析的结果进行分类统计。结果不合理处方375张,占点评中成药处方总量的10.42%,其中不规范处方177张,占不合理处方的47.2%,不合理原因包括：处方书写不规范、医师签名不规范,超天数用药等。用药不适宜处方174张,占不合理处方的46.4%,不合理原因包括：重复用药、药品用法用量不适宜、联合用药不适宜等。超常处方24张,占不合理处方的6.4%。不合理原因主要是无适应证用药。结论加强不合理处方干预,可有效提高医师、药师合理用药水平,保证患者用药安全有效,减少医疗纠纷。     

2019年门诊处方不合理用药点评分析

目的分析2019年1-12月门诊处方用药合理性,对不合理用药进行分析,进一步促进合理用药。方法2019年1-12月甘肃省金昌市第一人民医院药剂科每月抽取4个工作日(不同星期)所有门诊处方(不含中药处方)11045张,对处方不合理情况进行点评分析。结果11045张门诊处方中,不合格处方834张(7.55%),其中不规范处方303张占36.33%,用药不适宜处方376张占45.08%,超常处方155张占18.59%。不合格处方占比全年呈总体下降趋势,与上半年相比,下半年不合格处方率明显降低。不合格处方的主要问题为临床诊断未写或书写不全、开具超规定用量处方、适应证不适宜、用法用量不适宜、无适应证用药。结论门诊处方用药不合理情况严重,通过点评分析和及时干预不合理用药情况,可降低不合理用药发生率。     

某院2018年—2019年355张门诊处方用药不合理用药的原因分析及其干预对策的效果评价

目的:分析医院门诊处方不合理用药的原因,评价其干预对策的效果.方法:收集医院2018年1月—12月(干预前)和2019年1月—12月(干预后)门诊药房调配处方199 788张,其中2018年为97 405张,2019年度为102 383张;比较与分析干预前后不合理用药处方的构成比、处方用药不合理原因类型的构成比以及患者对药学服务的满意度.结果:干预前门诊处方用药不合理原因以用法用量不合理、超说明书用药、溶媒选择不适宜等为主;经干预后门诊不合理用药处方构成比低于干预前(P＜0.05),用法用量、超说明书用药构成比明显低于干预前(P＜0.05),而患者对药学服务的满意度评分值均高于干预前(P＜0.05).结论:医院门诊处方用药不合理主要表现为用法用量不合理、超说明书用药、溶媒选择不适宜和重复用药等,这可能与医师疏忽、药师专业能力欠缺或医师与药师缺乏有效沟通有关,实施针对性干预对策有效减少了不合理用药处方的再现,确保了患者用的合理性和安全性.     

某院2020年门诊患者处方用药的合理性与其不合理原因的Pareto图分析及其干预措施

目的：统计医院门诊西药房处方,分析处方用药与其不合理原因与类型,为门诊患者合理用药提供参考。方法：抽取2020年个旧市人民医院门诊西药房用药处方191 603张（平均月处方15 967张）,按《医疗机构临床合理用药检查考核细则》中相关要求,采用Pareto图确定不合理用药的主要因素和次要因素,分析处方用药的合理性与不合理处方的原因,并对其提出干预对策。结果：191 603张门诊总处方中,药师干预的不合理处方3 825张占2.00%,处方平均合理率为98.00%;不合理处方类型中不规范处方、用药不适宜处方和超说明书处方分别占不合理处方的6.69%、92.89%、0.42%,其中用药不适宜处方中,用法用量不适宜和适应证不适宜的处方占不合理处方的47.87%、31.53%,分别居前2位。结论：不合理处方用药的主要因素为用法用量不适宜、适应证不适宜,次要因素为处方前记缺失,医院行政部门应加强对处方医师的规范化培训,及时分析不合理处方用药原因及其对策。     

2018年辽宁省肿瘤医院门诊中成药不合理处方分析

目的 分析辽宁省肿瘤医院2018年门诊中成药处方的合理用药情况,为临床安全合理用药提供依据。方法 收集2018年辽宁省肿瘤医院门诊中成药处方共9 744张,每个月随机抽取100张,共抽取1 200张处方,采用回顾性分析方法对所抽取的处方用药合理性进行点评分析。结果 在1 200张处方中,合理处方1 144张,不合理处方56张,处方合格率为95.3%。不合理处方中不规范处方13张,占不合理处方20.00%;超常处方12张,占不合理处方18.47%;不适宜处方共40张,占不合理处方61.53%。其中用法用量不适宜处方最多,共25张,占38.46%。结论 辽宁省肿瘤医院门诊处方采用前置审核和后置点评相结合的工作模式,中成药处方总体基本合理,但仍存在不合理用药的情况。药师应不断提高处方审核及点评能力,规范临床医生用药,保证患者用药安全。     

关于中成药处方点评实施要点的探讨

目的 探讨中成药处方点评实施要点及干预措施。方法 选择2020年1月～2020年12月医院门诊中成药处方1 200张作为对象,分析不同处方科室来源,统计中成药处方中成药物不合理使用情况、科室分布、药物类型及患者年龄段等,并完成数据的分类,针对可能的原因采取相应的措施进行干预。结果 本研究调查某院12个月中成药处方,每个月抽取处方数100张,合计处方1 200张。通过对抽取的中成药处方进行点评,结果表明：不合理处方数为155份,不合格率为12.92%。不合格中成药处方类型相对较多,排在前三位的分别为：适应证不适应、用法用量不适宜和重复用药,分别占：29.68%、25.81%和20.00%;本研究罗列了处方适应证不适宜主要集中在普外科、肿瘤科、消化科,主要是未考虑患者症状及疾病类型用药;而药物用法用量不适宜主要是未考虑成人与儿童用药等特殊情况;医院不同科室出现频次相对较高的重复用药类型包括：盆腔炎、咽炎、冠心病等,患者均以中成药处方重复用药为主。结论 中成药处方中不合理处方发生率较高,且主要以药物的适应证不适宜、用法用量不适宜和重复用药为主,应根据上述可能的因素,从医师、药师及医院管理系统...     

某三甲医院门诊不合理用药处方Pareto图分析

目的分析某三甲医院门诊处方,确定不合理用药情况及类型,为进一步提高合理用药水平提供参考。方法以该院2018年6月至2019年5月门诊处方为对象,采用人工点评方式对处方的合理性进行评价,并通过Pareto图分析造成门诊处方不合理用药的主要、次要及一般因素。结果2018年6月至2019年5月期间,随机提取该院门诊处方共计23658张,不合理用药处方1022张,占4.32%。不合理用药的主要因素为适应证不适宜、临床诊断书写不全;次要因素为用法用量不适宜;一般因素为医师未按规定开具抗菌药物、临床诊断不规范、联合用药不适宜、药品剂型或给药途径不适宜、遴选药品不适宜、重复给药、超禁忌用药。结论通过Pareto图对门诊不合理用药处方进行分析,有利于确定该院门诊不合理用药处方存在问题的主要因素和次要因素,从而有针对性地实施药学干预,提高临床用药的合理性。     

某院28080张门急诊处方用药点评与不合理处方的原因分析及其对策

目的:分析医院门急诊不合理处方用药原因与对策,为合理用药提供参考.方法:抽取医院2020年1月-9月门急诊处方28080张,依据药品说明书和相关法规等要求,点评与分析其用药的合理性,对不合理处方的原因提出管理对策.结果:28080张处方中,不合理处方1333张,处方不合理率为4.75％;在不合理处方中,其不合理原因1406例次;其含抗菌药物处方261张(占19.58％),含中成药处方379张(占28.43％),处方平均药品数为(2.83±1.97)种;不合理处方TOP 5的科室为普通内科(18.90％)、皮肤科(9.83％)、眼科(8.10％)、耳鼻咽喉科(7.88％)和妇科(5.48％);不合理处方主要类型有:处方未写明"临床诊断"或临床诊断书写不全的413例次(占29.37％);用法、用量不适宜的206例次(占14.65％);适应证不适宜的192例次(占13.66％);联合用药不适宜的151例次(占10.74％);用法、用量含糊不清的114例次(占8.11％);医师未按照《抗菌药物临床应用指导原则》中管理规定,开具抗菌药物处方的88例次(占6.26％).结论:医院处方质量总体较好,不合理的突出问题有待改进,应定期开展处方用药合理性点评,以确保患者用药的安全性和有效性.     

某院28080张门急诊处方用药点评与不合理处方的原因分析及其对策

目的:分析医院门急诊不合理处方用药原因与对策,为合理用药提供参考.方法:抽取医院2020年1月-9月门急诊处方28080张,依据药品说明书和相关法规等要求,点评与分析其用药的合理性,对不合理处方的原因提出管理对策.结果:28080张处方中,不合理处方1333张,处方不合理率为4.75％;在不合理处方中,其不合理原因1406例次;其含抗菌药物处方261张(占19.58％),含中成药处方379张(占28.43％),处方平均药品数为(2.83±1.97)种;不合理处方TOP 5的科室为普通内科(18.90％)、皮肤科(9.83％)、眼科(8.10％)、耳鼻咽喉科(7.88％)和妇科(5.48％);不合理处方主要类型有:处方未写明"临床诊断"或临床诊断书写不全的413例次(占29.37％);用法、用量不适宜的206例次(占14.65％);适应证不适宜的192例次(占13.66％);联合用药不适宜的151例次(占10.74％);用法、用量含糊不清的114例次(占8.11％);医师未按照《抗菌药物临床应用指导原则》中管理规定,开具抗菌药物处方的88例次(占6.26％).结论:医院处方质量总体较好,不合理的突出问题有待改进,应定期开展处方用药合理性点评,以确保患者用药的安全性和有效性.     

某医院2012年门急诊处方点评与不合理处方分析

目的 了解医院的临床用药情况,更好地开展处方点评工作,提高处方质量,促进临床合理用药,保障医疗安全.方法 对某医院2012年的1 800张门急诊处方进行了统计点评,并分析其中的不合理处方.结果 急诊的每张处方使用药品种数、注射剂的使用率、抗菌药物使用率、国家基本药物使用率高于门诊,门诊平均单张处方金额、合理处方百分率高于急诊,门急诊药品通用名使用率均为100％.经过处方点评,共排查出不合理处方172张,占门急诊处方数的9.56％ (172/1 800),其中门诊103张,急诊69张.不合理处方中存在的主要问题分别是:诊断与用药不符,处方超量,药品用法、用量不适宜,临床诊断不规范,适应证不适宜,抗生素使用不合理.结论 该院2012年门急诊处方基本合理,但尚存在不合理处方.医院应加强用药知识宣讲,提高门急诊处方的质量,切实贯彻处方点评制度,避免不合理用药.     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.