临床思维对临床药师开展临床实践的指导作用

目的探讨临床药师以临床思维方式来指导临床实践工作的作用。方法临床药师在临床思维指导下以病史采集和用药教育、治疗方案分析、药学监护、不良反应分析等多方面为突破口开展了一系列临床实践工作。结果临床药师赢得了参与多例患者治疗的机会,并辅助临床医生使药物的选择更优化,使用更合理,提高了患者的用药依从性和安全用药意识。结论临床思维对临床药师更好地参与临床实践工作具有重要指导作用。     

LGC: clinical about clinical measurement

LGC is the UK's designated National Measurement Institute for chemical and bioanalytical measurement, and through this role improves the quality and international acceptance of measurements performed within the UK. This research spotlight, highlighting measurement 'across the scale', from elemental analysis and small molecules, through to proteins, DNA and RNA and on to whole cells and tissues, demonstrates how LGC is supporting the clinical sector by ensuring sound measurement practice that underpins clinical efficacy, quality assurance and patient safety.     

Managing clinical pharmacists and clinical pharmacy services

One of the ironies in the use of power in today's management setting is that the manager of workers at a high level of readiness is actually giving more power to subordinates as a leadership strategy. Indeed, the empowered manager may achieve goals by shifting responsibility from the manager to the employee, providing a vision for subordinates, providing resources when possible, and providing the freedom to accomplish organizational goals. The challenge for the manager is to determine employee level of readiness and to assess that readiness for different assignments and varying responsibilities. Given the proper situation, the manager may paradoxically gain power (influence over others) by giving others a high degree of responsibility for their actions.     

Norfloxacin: clinical pharmacology and clinical use

Norfloxacin, a nalidixic acid analog, is the first of the fluorinated quinolinecarboxylic acids to be marketed in the United States. It demonstrates potent antibacterial activity against aerobic, gram-negative bacteria including the Enterobacteriaceae, gentamicin-resistant Pseudomonas aeruginosa, and penicillin-resistant Neisseria gonorrhoeae. Norfloxacin exhibits good activity against methicillin-resistant and -sensitive Staphylococcus aureus, but less activity against most other aerobic, gram-positive organisms. Anaerobic bacteria are resistant to the drug. Resistance to norfloxacin is not plasmid mediated, but is secondary to bacterial mutation, and occurs less frequently than nalidixic acid resistance. Its pharmacokinetic properties after a 400-mg oral dose consist of a peak serum concentration of 1.3-1.58 micrograms/ml, an elimination half-life of 3-7 hours, and good penetration into kidney and prostatic tissues. Renal excretion is the major route of elimination. Norfloxacin is highly effective in the treatment of uncomplicated and complicated urinary tract infections, and gonococcal urethritis. Adverse effects are generally well tolerated and usually do not require discontinuation of therapy.     

小儿支原体肺炎的临床治疗分析及临床体会

目的探讨小儿支原体肺炎的临床发病特点及治疗措施。方法选取商丘市第一人民医院2012年10月至2013年5月收治的164例小儿支原体肺炎患儿,根据用药的不同分为观察组（86例）和对照组（78例）。观察组应用阿奇霉素治疗,对照组应用红霉素治疗,观察两组的疗效及症状、体征改善情况。结果观察组患儿总有效率为96．51％,明显高于对照组的83．33％,两组比较差异有统计学意义（P〈0．05）;观察组患儿症状、体征改善时间,肺部哕音消失时间及平均治疗时间较对照组明显缩短,差异有统计学意义（P〈0．05）。结论小儿支原体肺炎肺外表现多样,阿奇霉素序贯疗法是安全且有效的,能较好地改善病情,提高治愈率。     

Pharmacokinetic considerations in clinical toxicology: clinical applications

Pharmacokinetic and pharmacodynamic principles should be regarded in the assessment and proper management of patients exposed to a poison. Clinicians must apply these principles to make rational clinical decisions regarding the significance of the poisoning (risk assessment) and to formulate an appropriate management plan. However, pharmacokinetic processes and parameters may be changed in the patient with acute poisoning. This may result from saturation of the capacity of a number of physiological processes due to the high dose, or the toxic effects of the poison may change these processes directly. For example, absorption kinetics may be altered because of increased gastrointestinal transit time (e.g. cholinergic receptor antagonists) or saturable absorption (e.g. methotrexate). Saturation of protein binding may increase the volume of distribution and thereby increase the elimination half-life (e.g. salicylates). Alteration of the acid-base balance (poison-induced or iatrogenic) may also increase or decrease the distribution of a poison. Saturation of metabolism at high doses can prolong toxicity (e.g. phenytoin) or lead to other routes of metabolism that lead to increased toxicity (e.g. paracetamol [acetaminophen]). Excretion may be reduced by saturation of active transporters or decreased renal blood flow.A better understanding of pharmacokinetic principles should improve the clinical care of patients. It should lead to more accurate interpretation of blood concentrations or biomarkers (e.g. ECG intervals or acetylcholinesterase activity) and how these relate to the time course for that poison, and better prediction of prognosis. This in turn, indicates the appropriate duration of observation and the requirement for some specific treatments. Many specific poisoning treatments aim to favourably alter the pharmacokinetics of the poison. These include activated charcoal, whole bowel irrigation, extracorporeal elimination, chelating agents, antitoxins and urinary alkalinisation. The evidence supporting them, their indications and limitations can only be understood using pharmacokinetic principles. These principles also underpin the appropriate choice within the flexible dosage regimen for many antidotes. In particular, naloxone, flumazenil, methylene blue, atropine and pralidoxime all use variable doses and have an elimination half-life that is much shorter than many (but not all) of the poisons treated by these agents. A firm grounding in pharmacokinetics/toxicokinetics should be regarded as a core competency for all professionals involved in clinical care or undertaking research in clinical toxicology.     

开展药物临床试验以促进临床科研工作的发展

开展药物临床试验不仅在完善临床专业学科建设,规范临床诊疗等方面有巨大推动作用,对提升临床科研能力也具有一定促进作用。本文将从科研队伍人才培养,医学伦理学意识、科研作风培养,科技信息获取、科研思维启发,科研质量管理意识强化,多学科协作建立及团队合作意识提升等方面进行分析,并结合本院相关临床专业在开展药物临床试验前后科研立项、专业重点实验室建设等情况,探讨开展药物临床试验对临床科研的促进作用。     

临床试验的重要角色:临床研究协调员

临床研究协调员（CRC）在国外作为临床试验中的一员和一项专门的职业已有30多年历史。CRC主要由护理、药剂等生物医学专业背景的人员担任。CRC的工作范围涉及到临床试验的各个方面，包括试验的准备，与伦理委员会和中办者的联络，协助试验实施的各项工作，如获取知情同意，与患者及其家属的教育、联络、咨询与商谈，数据收集与CRF转录，以及临床检查、不良事件、试验药物、文件资料等管理，应对监查、稽查与视察。CRC对确保临床试验的伦理合理性、科学性及试验数据的可信度方面起重要保证作用。     

抗凝专业临床药师工作模式及临床实践

目的:探索临床药师实施抗凝工作的切入点。方法:借鉴国内外先进管理模式,结合北京大学第一医院具体情况,在如下方面开展了相关工作:1院内抗凝患者的教育管理;2药物基因组学方法指导下进行的药物剂量建议;3医护药师联合的随访门诊;为药师参与的抗凝一体化门诊的建立提供工作模式参考。结果:已经初步取得临床的认可,目前完成抗凝相关患者教育和药物基因组学指导下的药物剂量建议会诊120余例。为进一步建立抗凝的全程化药学服务提供了参考资料。结论:抗凝专业临床药师的介入可以为全面抗凝临床药学服务提供新的模式。     

药物临床试验与GCP(三)

9.试验药品的管理 试验用的药品包括试验药和对照药均应该由申办单位提供,进行适当的包装.如果药品用于双盲对照试验或双盲双模拟对照试验,应每人一个小包装,标记明晰,编号醒目,并注明"临床试验用药"字样.试验药和对照药的外观、气味、包装、标签和其他特征均应一致.     

《临床药物治疗学》教学中开展临床见习的实践与体会

临床用药的安全、有效、经济是衡量医疗工作质量的重要指标,临床药师在临床药物治疗中发挥着越来越重要的作用。进一步开展临床药学工作是深化医疗体制改革,完善基本医疗服务体系,提高医疗服务质量的重要举措。近年来,     

高脂血症性急性胰腺炎的临床特征分析

目的：分析高脂血症性急性胰腺炎的临床特征。方法选取2009年2月～2014年3月在我院进行治疗的急性胰腺炎患者84例,分为高脂血症性急性胰腺炎组（25例）和胆源性急性胰腺炎合并高脂血症组（59例）,对高脂血症性急性胰腺炎组和胆源性急性胰腺炎合并高脂血症组患者的临床一般特征、临床实验室相关指标和临床并发症进行比较分析。结果高脂血症性急性胰腺炎组的男性比例低于胆源性急性胰腺炎合并高脂血症组,而年龄、Ranson评分、SAP人数、APACHE-Ⅱ评分及CT评分均显著低于胆源性急性胰腺炎合并高脂血症组（P＜0.05）;胆源性急性胰腺炎合并高脂血症的血尿淀粉酶、甘油三酯、总胆固醇、谷丙转氨酶、谷草转氨酶、总胆红素和直接胆红素均显著高于单纯性高脂血症性急性胰腺炎,血钙低于单纯性高脂血症性急性胰腺炎（P＜0.05）。胆源性急性胰腺炎合并高脂血症组的胰腺假性囊肿的发生率、胸腔积液的发生率、肺部感染发生率、住院天数、复发率和死亡率均显著高于高脂血症性急性胰腺炎组。结论高脂血症作为急性胰腺炎中较为常见的病因,需要与其他类型的急性胰腺炎进行鉴别,临床诊治应更具针对性。     

Economic aspects of clinical decision making: evaluating clinical programs

The importance of program evaluation is discussed, and issues to consider when designing and conducting program evaluations in the restructuring health-care environment are identified. Program evaluation is carried out for the purpose of supporting specific decisions for individual organizations. Unlike scientific research, program evaluation accepts time as a constraint, and its audience is composed of managers. Considering the likelihood of being fixed-dollar contractors or employees in an era of managed care, professionals must try to understand the cost objectives of management; similarly, managers must understand the patient-care objectives of professionals. Program evaluation can help provide the necessary documentation of a program's impact on the outcome of health care, which influences the total cost of care. Successful program evaluation requires careful planning, and issues related to six steps in the planning process are described: defining the objective of the evaluation, choosing and defining the program to be evaluated, choosing indicator variables, designing the evaluation, presenting the results, and planning follow-through. While program evaluation is too often understood in negative terms, particularly as something done because of external pressure, it is as much a part of management as is directing day-to-day operations or developing a long-range plan.     

临床服务中心在临床服务中的作用

目的探讨临床服务中心在临床服务中的作用。方法选择2012年10月-2013年10月来本院住院的患者1240例作为研究组,由临床服务中心提供服务,同时选择2012年10月-2013年10月来本院住院的患者1240例作为对照组,临床服务中心未提供服务,比较两组的送检时间、预约检查时间、8 h以外取药及取血时间、患者满意度。结果研究组的送检时间、预约检查时间明显短于对照组,差异有统计学意义（P〈0.01）;研究组8 h以外取药时间为（0.6±0.3）h、8 h以外取血时间为（0.7±0.5）h,明显短于对照组,两组对比差异有统计学意义（P〈0.01）。研究组的患者满意度明显高于对照组,差异有统计学意义（P〈0.01）。结论在临床服务中实施临床服务中心管理工作,能有效提高工作效率及患者满意度,具有较高的临床应用价值。     

Glycopeptides in clinical development: pharmacological profile and clinical perspectives

Vancomycin and teicoplanin are the two glycopeptides currently used in the clinics for the treatment of multiresistant infections by Gram-positive organisms. The development of resistance in enterococci and staphylococci has stimulated the search for new derivatives with improved activity, particularly against strains resistant to conventional derivatives. Three of these, obtained by hemi-synthesis starting from natural compounds, are now in clinical development (oritavancin and telavancin, as derivatives of vancomycin; and dalbavancin, as a derivative of teicoplanin). The presence of a lipophilic tail on these molecules results in them having a prolonged half-life. It also modifies their mode of action, conferring to them a concentration-dependent bactericidal activity. Their spectrum of activity includes methicillin-susceptible or methicillin-resistant staphylococci, penicillin-resistant pneumococci and enterococci (including vancomycin-resistant strains for oritavancin and telavancin). Ongoing clinical studies are evaluating the efficacy and safety of these molecules for the treatment of complicated skin and soft tissue infections and bactereamia, in a once-daily (oritavancin, telavancin) or once-weekly (dalbavancin) scheme of administration. Despite these remarkable properties, the use of these potent molecules should be restricted to severe infections by multiresistant organisms to limit the risk of selection of resistance.