以药物重整为基础的肿瘤患者围手术期药学监护模式

目的 建立以药物重整为基础的围手术期药学监护服务模式,为促进肿瘤患者围手术期安全、合理用药提供参考。方法 调取本院2017年3月1日至3月31日全部肿瘤患者的择期手术病历2057例,统计患者基础疾病用药和既往化疗用药情况,通过查阅药品说明书、指南、文献,整理所涉及药物的围手术期药物重整核查要点,建立择期手术的肿瘤患者围手术期药学监护流程。结果 在2057例择期手术肿瘤患者中,术前因基础疾病长期使用的药物共13类,接受的抗肿瘤治疗药物7类。根据药品说明书、指南及文献,明确以上药物在围手术期的药物重整核查要点。参照药物重整基本步骤与核查要点,建立以药物重整为基础的围手术期药学监护流程,即获取完整用药史、整理治疗药物清单、分析和分享治疗药物清单、围手术期药学监护和出院药物重整。结论 以药物重整为基础的药学监护模式,能为围手术期肿瘤患者提供标准化的监护流程,提高药学监护质量,保障肿瘤患者围手术期安全、促进合理用药。     

药学问诊在药物重整服务中的作用

目的:探讨药学问诊在药物重整服务中的作用。方法:临床药师通过药学问诊,对患者进行药物重整服务,并分析评价临床药学实践中的问诊案例及取得的效果。结果与结论:药学问诊可侧重于患者既往用药史、不良反应史、过敏史、伴发疾病的药物治疗、自备药品的使用情况等方面。通过药学问诊,可详细了解患者病情、药物治疗情况、用药依从性、不良反应发生史,结合现有的药物治疗方案,分析其治疗效果不佳的原因,判断发生药物相互作用和不良反应的风险,为协助医师调整治疗方案提供依据,最大程度地保证患者用药安全,在药物重整工作中发挥作用。     

基于工作实践探讨药物重整的分级服务

目的 通过对慢病患者中开展的药物重整工作进行分析,探讨药物重整目标人群和分级服务。方法 2021年3月-2021年9月药师收集入住河南省国际医疗中心一病区诊断为高血压、糖尿病、冠心病患者的药物清单,开展药物重整工作并进行资料汇总分析。结果 共收集了252例患者的院外最可能收集的用药清单,共发现108个非故意用药差异（干预率42.85%）,对发现药物问题的患者进行Logistic因素分析发现老年、冠心病患者适宜开展药物重整,Ⅰ型干预中药物遗漏（40.00%）和用法用量差异（36.00%）比例较大,Ⅱ型干预主要集中在用法用量调整（31.00%）和依从性问题（21.00%）方面;Ⅰ型干预接受度为90.00%,Ⅱ型干预接受度为79.31%。结论 在老年及冠心病患者中适宜开展药物重整工作,建议通过信息化辅助和分级药学服务推动药物重整的广泛开展。     

临床药师对1例药物性肝损伤患者的闭环式药学服务实践初探

目的 通过梳理与总结临床药师对1例药物性肝损伤(DILI)患者开展的药学服务过程,探讨基于闭环式药学服务模式实践方法与成效.方法 临床药师对1例DILI患者进行闭环式药学服务,包括治疗前开展药物重整,协助评价肝损可疑药物;治疗时参与用药方案制定、实时审核处方、评价药物疗效、处理不良反应、提供药事咨询、住院患者用药教育;...     

临床药师开展药物重整的药学服务实践

目的:为临床药师开展药物重整的药学实践提供参考。方法:探讨临床药师在实践工作中如何通过掌握用药史,及引入诺氏评估量表进行不良反应分析为切入点实现药物重整的药学服务实践。结果和结论:临床药师在药物重整工作中扮演着重要的角色。在临床实践中,临床药师获取精确的用药清单,加强专业知识地学习,借助一些适当的工具,才能实现药物重整。     

慢病药学门诊的规范化工作模式探索及实例分析

目的 探索慢病药学门诊的工作模式。方法 通过介绍慢病药学门诊服务模式及1例高血压伴失眠患者就诊实例,阐述慢病药学门诊各就诊步骤的服务要点。结果 通过对患者进行药物重整,用药教育及生活方式指导等药物治疗管理,患者改善了症状,提高了对疾病的认识及用药依从性。结论 慢病药学门诊规范工作模式具有一定可行性。     

临床药师在肾内科开展药学服务的实例与体会

目的总结临床药师在肾内科开展药学服务的工作经验。方法通过案例介绍笔者在肾内科开展药学服务的内容和体会。结果临床药师通过开展药物重整、医嘱审核、给药方案设计、药学监护、患者用药教育等工作,能够使临床药物治疗更加安全、有效、适宜。结论肾内科应建立专业标准的药学服务模式,促进临床合理用药。     

药物重整药学服务模式在糖尿病患者中的应用

目的：探讨药物重整药学服务对糖尿病患者住院期间的用药合理性、依从性及多重用药的作用。方法：通过对六盘水市人民医院内分泌科糖尿病合并其他疾病的患者实施用药重整服务,收集并整理了82例糖尿病患者当前正在应用及入院后或转科后24 h内所有药物的医嘱。结果：82例患者中有64例(78%)存在不合理用药情况,对该类患者进行治疗药物干预。共收集了514条药物医嘱,其中198条药物医嘱错误,医嘱干预条例率达38.5%。结论：药物重整服务对于糖尿病患者住院期间的用药依从性有较好的改善,提高了患者就医满意度,减少了药物不良反应的发生,保障患者用药安全,极大避免了重复用药,降低患者药品费用,减轻患者的经济负担。     

医疗机构药师服务模式与效果评估的研究进展

医疗机构的药学工作逐渐从药品供应保障转变为以患者为中心的药学服务模式。我国的药学服务发展迅速,越来越多的药学服务模式已经建立起来。药师作为医疗机构药学服务工作的主要实施者,为门急诊或住院患者提供用药教育、药学监护、药物重整和治疗药物监测等服务,在调整给药方案、优化治疗效果、预防用药差错、减少不良反应发生率和节约医疗费用等多个方面发挥着重要作用,同时在人才培养和科学研究方面做出了重要贡献。本文综述了在以患者为中心的新型背景下,医疗机构药学服务的主要工作模式和药学服务效果评估,为开展药学服务和评估药师价值提供参考。     

住院糖尿病患者精准化药学服务模式的构建与实施

目的:探讨精准医疗形势下,如何构建临床药师对住院糖尿病患者药学服务的模式。方法:结合药物治疗管理理念,构建本院精细化药学服务模式用于临床实践,通过个体化多个用药案例体以现药学服务的效果。结果:对本院住院糖尿病患者精细化药学服务,针对不同患者进行个体化用药服务,提高了药物治疗效果,达到了精准用药。结论:目前药师对糖尿病药学服务的流程已初步形成,标准化的工作模式有利于药学服务的规范性和可操作性。     

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.     

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.     

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.     

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.     

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.