新型冠状病毒肺炎疫情下治疗药物监测实验室感染防控策略

2019年12月以来,武汉暴发新型冠状病毒肺炎疫情。随着疫情蔓延,全国范围内确诊病例和疑似病例均呈上升趋势。华中科技大学同济医学院附属协和医院医、护、药、技人员奋战在抗击疫情的一线,治疗药物监测(TDM)药师每天处理大量血样标本,人员职业暴露保护及实验室生物安全管理显得非常重要。该文总结该院TDM药师在新型冠状病毒肺炎疫情下的感染防控策略和经验,以期为同行提供参考和帮助。     

新型冠状病毒肺炎疫情防控期间需了解的口罩知识

口罩作为重要的防护品,在新型冠状病毒肺炎(COVID-19)疫情期间消耗极大。为了避免口罩的不合理使用,减少疾病传播,本文介绍了口罩的分类及评价其质量和性能的重要技术指标,包括过滤效率与通气阻力、佩戴的密合度和舒适度、气流阻力、合成血液穿透性、微生物指标等。     

关注新型冠状病毒肺炎疫情防控阻击战中的患者用药安全CSCD

新型冠状病毒肺炎(COVID⁃19)疫情正面临着最危急的状况,截至2021年1月11日,全球确诊病例已近9000万,死亡病例近200万。我国本土疫情呈零星散发和局部聚集性疫情交织叠加态势,防疫战疫形势严峻复杂。在这种形势下,患者的用药安全面临诸多问题,如COVID⁃19治疗的超说明书用药和同情用药中的安全问题、COVID⁃19治疗药物与其他疾病治疗药物并用中的安全问题、COVID⁃19治疗药物不良反应监测、公众自购药物预防和治疗COVID⁃19的安全问题以及疫情期间其他疾病患者用药的安全问题等。因此,需要对患者的用药安全问题给予更多关注,科学抗疫,用更小的代价去赢取COVID⁃19疫情防控阻击战的更大胜利。     

抗菌药物在新型冠状病毒肺炎治疗中合理应用的思考

新型冠状病毒肺炎(COVID-19)的患者中一些病例合并细菌和/或真菌感染,但实际中,使用抗菌药物的比例较高。我国《新型冠状病毒肺炎诊疗方案》中指出:"避免盲目或不恰当使用抗菌药物,尤其是联合使用广谱抗菌药物"。本文根据以往在严重急性呼吸综合征、中东呼吸综合征治疗中的经验和目前发表的COVID-19相关文献中细菌和真菌感染以及抗菌药物应用的情况,提出在COVID-19治疗中抗菌药物的应用应遵循以下原则:(1)对尚未确诊的患者在病因不明且不能排除细菌感染时,可短期经验性使用抗菌药物;(2)对已经确诊的COVID-19患者,在没有细菌感染证据的情况下应避免预防性使用抗菌药物;(3)有医院内感染证据的COVID-19患者应根据病原学检查,选择适当的抗菌药物。     

认识新型冠状病毒肺炎，关注疫情防控药物研发

2019新型冠状病毒(2019-nCoV)于2019年在武汉被发现。由于疫情事关人民群众生命安全和身体健康,事关经济社会发展大局,此次疫情得到世界卫生组织高度重视。党中央和国务院将防控疫情发展当做当前头等大事。本文从对冠状病毒与新型冠状病毒发生发展的认识、新型冠状病毒的特性、疫苗预防、治疗药物应用和治疗药物研发等进行综述评价。聚焦新型冠状病毒及疫情的发展、落实预防为主方针和加强重大疫情管理, 作者基于有关认识提出有关强化我国公共卫生体系建设、守正创新和加强科学开发和应用的基础研究等方面的建议。     

新型冠状病毒肺炎疫情期间肿瘤患者用药不良反应的居家药学服务

目的为新型冠状病毒肺炎疫情期间肿瘤患者的安全有效用药提供参考。方法对肿瘤患者居家用药可能产生的不良反应及防治进行总结分析。结果与结论肿瘤患者常用药品易出现消化道反应、骨髓抑制、皮肤反应、脏器损伤等不良反应,应做好相应预防措施的宣传教育,以保障肿瘤患者在疫情期间用药的安全有效性。     

新型冠状病毒肺炎疫情期间医院门诊药房防控管理实践

目的加强医院门诊药房应对新型冠状病毒肺炎(COVID-19)疫情的防控管理措施。方法根据医院相关规定和要求,在保障患者和药师安全的基础上,结合门诊药房疫情防控实践,梳理具体处置措施。结果在疫情防控期间,医院门诊药房通过成立督导小组,向员工普及COVID-19相关知识,窗口运行精细化管理,开展互联网+药品配送服务等措施,至今已服务20万余人次,无员工感染及疑似感染新型冠状病毒。结论医院门诊药房在COVID-19疫情期间的防控管理措施,可提升患者和员工疫情期间的安全,保障门诊药房的正常运转。     

新型冠状病毒肺炎疫情期间公立医院应急管理探讨

探讨新型冠状病毒肺炎疫情期间安徽省某三级甲等公立医院应急管理的实践经验,结合疫情动态发展形势,从医院应急管理体制建设和应急管理实践的流程改造、就诊确诊、诊疗规范、互联网服务、物资后勤保障方面的工作措施来分析我国公立医院疫情防控的应急管理策略,为我国公立医院面对突发公共卫生事件和重大传染病疫情时的应急管理工作提供借鉴。     

方舱医院新型冠状病毒感染患者应激相关障碍的药物治疗刍议

新型冠状病毒肺炎疫情暴发后,数万名患者被隔离治疗,轻/中症患者被隔离在方舱医院集中治疗,有些患者可能会出现应激相关障碍。对出现焦虑、抑郁、胸闷、心跳加快等症状,病程不足3 d,且无法进行心理干预的患者,可以经验性给予苯二氮[艹卓]类(BZD)药物治疗;当患者应激反应症状持续3 d没有明显改善时,建议启动治疗。治疗方法包括支持疗法、心理危机干预和药物治疗。药物治疗以对症治疗应激引起的焦虑、抑郁为主,其中抗抑郁药起主要治疗作用,BZD药物起辅助治疗作用。     

Pharmacological treatments available for the management of underactive bladder in neurological conditions

Introduction: Underactive bladder (UAB) is a common cause of lower urinary tract dysfunction which has an increasing incidence with aging. It is characterized as an incompetent detrusor contraction with reduced strength and/or duration to completely empty the bladder. UAB is observed in both men and women. The exact definition, classification, and pathophysiological mechanism responsible for UAB is still debatable, however neurologic, myogenic, and iatrogenic causes are explained. The symptom complex related to UAB includes hesitancy, diminished sensation of bladder filling, a slow urinary stream, increased post-void residue, and etc.

Areas covered: We reviewed the current understanding of UAB with special focus on pharmacological treatments and potential pharmacotherapy options particularly in neurological conditions. Also, the definition, etiology, symptoms, diagnosis and management of UAB were discussed in this review.

Expert commentary: The underlying mechanism of UAB is not clear yet. Therefore; the lack of efficient pharmacotherapies is evident in such patients. Prior to any decision for pharmacological or surgical interventions, the underlying causes of UAB and detrusor impairment in each patient should be distinguished. Future researches need to address the exact dynamics of detrusor contraction and the muscular and neurological contributors to UAB.     

Recommendations for the management of migraine in paediatric patients

Migraine is a common and disabling condition in children and adolescents. The complexity of migraine on a pathogenetic and clinical level results from the interaction between biological, psychological and environmental factors. Appropriate management requires an individually tailored strategy giving due consideration to both pharmacological and non-pharmacological measures. Ibuprofen (7.5 – 10.0 mg/kg) and acetaminophen (15 mg/kg) are safe and effective, and should be considered for symptomatic treatment. Sumatriptan nasal spray (5 and 20 mg) is also likely to be effective, but at the moment, should be considered for the treatment of adolescents only. With reference to prophylactic drug treatment, the available data suggest that flunarizine (5 mg/day) is likely to be effective and pizotifen and clonidine are likely to be ineffective. The efficacy data regarding propranolol, nimodipine and trazodone are conflicting. Insufficient evidence is available on cyproheptadine, amitriptyline, divalproex sodium, topiramate, levetiracetam, gabapentin or zonisamide. The management of migraine in children needs an individualised therapeutic approach, directed to the whole person of the child, taking into account the developmental perspective and the high rate of psychiatric comorbidities. It is the authors’ opinion that for the prophylaxis of migraine, interventions such as identification and avoidance of trigger factors, regulation of lifestyle, relaxation, biofeedback, cognitive behavioural treatment and psychological or psychotherapeutic interventions (e.g., psychodynamics) could be much more effective than pharmacotherapy.     

Recommendations for the management of migraine in paediatric patients

Migraine is a common and disabling condition in children and adolescents. The complexity of migraine on a pathogenetic and clinical level results from the interaction between biological, psychological and environmental factors. Appropriate management requires an individually tailored strategy giving due consideration to both pharmacological and non-pharmacological measures. Ibuprofen (7.5-10.0 mg/kg) and acetaminophen (15 mg/kg) are safe and effective, and should be considered for symptomatic treatment. Sumatriptan nasal spray (5 and 20 mg) is also likely to be effective, but at the moment, should be considered for the treatment of adolescents only. With reference to prophylactic drug treatment, the available data suggest that flunarizine (5 mg/day) is likely to be effective and pizotifen and clonidine are likely to be ineffective. The efficacy data regarding propranolol, nimodipine and trazodone are conflicting. Insufficient evidence is available on cyproheptadine, amitriptyline, divalproex sodium, topiramate, levetiracetam, gabapentin or zonisamide. The management of migraine in children needs an individualised therapeutic approach, directed to the whole person of the child, taking into account the developmental perspective and the high rate of psychiatric comorbidities. It is the authors' opinion that for the prophylaxis of migraine, interventions such as identification and avoidance of trigger factors, regulation of lifestyle, relaxation, biofeedback, cognitive behavioural treatment and psychological or psychotherapeutic interventions (e.g., psychodynamics) could be much more effective than pharmacotherapy.     

新型冠状病毒肺炎疫情下医院实习生网络教学体验探讨

目的 探讨新型冠状病毒肺炎(COVID-19)疫情下网络教学对医院实习生学习的影响.方法 通过问卷调查的形式,分析并总结2019年5月至2020年3月于四川大学华西医院实习的雅安职业技术学院、四川护理职业技术学院学生对上网课的条件及网络教学的满意度、网络教学对实习学员的情绪影响及上网课的条件等,讨论线上教学对实习生教育...     

Pharmacokinetic evaluation of novel oral fluorouracil antitumor drug S-1 in Chinese cancer patients

Aim:

S-1 is an oral anticancer fluoropyrimidine formulation consisting of tegafur, 5-chloro-2,4-dihydroxypyridine and potassium oxonate. The aim of this study was to evaluate the pharmacokinetics and bioequivalence of a newly developed generic formulation of S-1 in Chinese cancer patients in comparison with the branded reference formulation of S-1.

Methods:

A single-dose, randomized-sequence, open-label, two-way self-crossover study was conducted in 30 Chinese cancer patients. The subjects alternatively received the two formulations (40 mg/m², po) with a 7-d interval. Plasma concentrations of FT, CDHP, Oxo, and 5-Fu were determined using LC-MS/MS. Pharmacokinetic parameters, including C_max, T_max, t_1/2, AUC_0–t, and AUC_0–∞ were determined using non-compartmental models with DAS2.0 software. Bioequivalence of the two formulations were to be evaluated according to 90% CIs for the log-transformed ratios of AUC and C_max of S-1. Adverse events were evaluated through monitoring the symptom, physical and laboratory examinations, ECGs and subject interviews.

Results:

The mean values of C_max, AUC_0–t, and AUC_0–∞ of FT, 5-Fu, CDHP, and Oxo for the two formulations had no significant differences. The 90% CIs for natural log-transformed ratios of C_max, AUC_0–t, and AUC_0–∞ were within the predetermined bioequivalence acceptance limits. A total of 11 mild adverse events, including fatigue, nausea and vomiting, anorexia, diarrhea and myelosuppression, were observed, and no serious and special adverse events were found.

Conclusion:

The newly developed generic formulation and reference formulation of S-1 have similar pharmacokinetics with one dose (40 mg/m²) in Chinese cancer patients. Both the formulations of S-1 are well tolerated.     

对药物临床试验老年受试者依从性管理的建议

药物临床试验是评估新药安全性、有效性,推动医学进步,提供创新治疗方法不可或缺的关键步骤;在中国老龄化人口增加的趋势下,提升临床试验老年受试者的依从性至关重要。为确保研究结果更具代表性和适用性,建议采取以下措施：首先,制定个性化支持计划和多元化的依从性监测方法;其次,根据老年人的生活方式和需求,调整试验设计以提升参与的舒适度和便捷性;此外,建立社会支持系统以提供更广泛的支持;最后,通过加强研究团队的培训,提高对老年患者的关怀水平,激发其积极性和合作度。这些举措有助于减小药物临床试验的选择性和信息偏倚,为改善医疗护理和推动医学科学的发展提供可靠的研究基础。通过科学、伦理和规范的试验设计和实施,可以更好地评估药物的效果,为患者提供更好的医疗选择。     

新冠肺炎流行期间学龄前儿童家庭结构与健康素养关联分析

目的:了解新冠肺炎流行期间扬州市学龄前儿童家庭健康观念、行为素养的影响因素,分析不同家庭结构与健康素养间的关系.方法:共招募扬州市49390名学龄前儿童作为研究对象,采用在线问卷调查收集信息,分析学龄前儿童家庭结构与健康素养间的关系.结果:不同特征调查对象间家庭健康观念、行为素养比较差异有统计学意义(P<0.05).逻...     

新型冠状病毒肺炎医学观察期中医治疗方案的不良反应分析

目的 分析《新型冠状病毒肺炎诊疗方案（试行第七版）》中推荐的新型冠状病毒医学观察期中医治疗方案不良反应（ADR）的特点和规律，为临床合理用药提供指导。方法 检索中国知网（CNKI）、万方数据库、PubMed数据库中有关9种中药方剂导致的ADR病例，对涉及的文献资料进行性别、年龄、发生时间、累及系统/器官、治疗转归、关联性评价等资料的提取与统计分析。结果 按纳入与排除标准，共纳入61篇文献，提取病例70例，涉及到5种中药方剂。男女比例未有明显偏向，年龄跨度大，发生时间大多发生在1 d以内，累及系统/器官广泛，以皮肤及其附件最多，治疗药物以抗组胺药和激素药为主，其他药物多为对症治疗，转归时间以1 h内最多，占47%。结论 医学观察期的中医治疗方案ADR发生人群分布广泛，未见明显特征，应用时应加强监测，以减少ADR的发生。     

Pharmacological management of cancer pain in the elderly

Existing studies indicate a high prevalence rate and poor management of cancer pain in the elderly. Pain is often considered an expected concomitant of aging, and older patients are considered more sensitive to opioids. Despite the well known pharmacokinetic changes in the elderly, the complex network of factors involved in the opioid response make the evaluation of a single element, such as age, more difficult.Notwithstanding such difficulties, appropriate analgesic treatment is able to control cancer pain in the elderly in most cases. Skills necessary to optimise pain control in older cancer patients include the ability to objectively assess functional age (not necessarily related to chronological age since the rate of decline is variable), understand the impact of coexisting conditions, carefully manage the numbers and types of drugs taken at the same time and adequately communicate with patients and relatives.The most common treatment of cancer pain consists of the use of regularly given oral analgesics. The elderly are at increased risk of developing toxicity from NSAIDs, and the overall safety of these drugs in frail elderly patients should be considered. When older patients have clear contraindications to NSAIDs, manifest signs of toxicity from these agents, or find that pain is no longer controlled with this class of drugs, opioids should be started. A variety of opioids are available, and they differ widely with respect to analgesic potency and adverse effects among the elderly.Although the aged population requires lower doses of opioids, only careful titration based on individual response can ensure the appropriate response to clinical demand. Elderly patients are potentially more likely to be affected by opioid toxicity because of the physiological changes associated with aging. Nevertheless, appropriate dosage and administration may limit these risks. Cancer patients with pain who do not respond to increasing doses of opioids because they develop adverse effects before achieving acceptable analgesia may be switched to alternative opioids. Despite the favourable effects reported with opioid switching, monitoring is crucial, particularly in the elderly or patients who are switched from high doses of opioids. Adjuvant analgesics, including antidepressants, antiepileptics, corticosteroids and bisphosphonates may help in the treatment of certain types of chronic pain.With an appropriate and careful approach, it should be possible to reduce or eliminate unrelieved cancer pain in most elderly patients and, consequently, to enhance their quality of life. Older patients with cancer should be continuously assessed for cancer pain, both before and after analgesic treatment.