根因分析法在病区患者给药错误不良事件及其管理中的应用分析

目的:分析根本原因分析法(Root causes analysis,RCS)在病区患者给药错误不良事件管理中的应用。方法:选取2013年7月—2016年6月间医院住院病区患者给药错误不良事件产生的原因进行分析,比较根本原因分析法应用前后给药错误的发生率。结果:通过分析,根本原因分析法应用前给药错误错误发生率为1.089‰(29/26 632),应用后的发生率为0.153‰(4/26 217),后者优于前者经组间数据比较其差异有统计学意义(P<0.05);对应用前用药错误原因分析上,主要是未落实查对制度、不熟悉药理知识、医嘱处理不规范、患者多和工作量大、交接班不仔细等。结论:采用根本原因分析法对病区给药错误不良事件进行分析与管理,能够使各项给药问题得到及时发现与纠正,提高用药安全,降低病区患者给药错误的发生率,这是保障病区患者给药准确的重要举措。     

基于失效模式与效应分析联合根本原因分析法探索给药错误发生原因

目的 基于失效模式与效应分析联合根本原因分析法探索给药错误发生原因,为制订降低护士给药错误发生率对策提供参考依据。方法 收集深圳市龙岗中心医院2019年1月至2021年12月上报的63例给药错误不良事件报表,整理与分析汇总,依次通过根本原因法中的头脑风暴法、鱼骨图、特性要因评价、真因查验等确定真因,统计各真因的风险优先系数确定主要失效模式,分析给药错误危险因素及不良事件各项特征的分布差异。结果 给药错误主要失效模式是给药核查、身份核查和打印执行单或转抄三大环节,给药核查主要的危险因素是未核查药名（注射剂）、无单给药（口服药）和药名相似;身份核查主要的危险因素是被打扰;打印执行单或转抄主要的危险因素是漏打印。不同事件级别风险优先指数比较,差异有统计学意义（P<0.05）;不同科系、事件类型、当事人身份、当事人职称、当事人学历、当事人工龄、发生时段与班次、药物类型、注射剂、事件发生阶段、危险因素风险优先指数比较,差异无统计学意义（P>0.05）。不同事件类型、药物类型和发生阶段的给药错误危险因素、给药错误事件级别的发生阶段和当事人学历分布和给药错误注射剂的科系分布,差异有统计学...     

肿瘤靶向给药系统的临床应用进展

目的对抗肿瘤靶向给药系统的研究进展作一简介。方法检索近年国内外有关对靶向给药系统在肿瘤治疗中的研究性文献,并进行分析、归纳,综述肿瘤组织靶向、肿瘤细胞靶向、肿瘤血管靶向等给药系统及肿瘤靶向治疗基因给药系统的研究进展,以完善现有肿瘤的靶向治疗。结果靶向药物制剂能使药物选择性地与靶组织在细胞或亚细胞水平上发生反应,使药物能够可控性地分布,并于靶区持续缓慢地释放药物,降低其对正常组织的不良反应。结论靶向制剂对于克服肿瘤治疗中的不良反应,提高疗效具有不可忽视的作用,但它们广泛应用于临床尚需时日。     

肿瘤血管内皮是肿瘤导向给药与免疫疗法的屏障或者靶区

采用化疗，药物靶向制剂及免疫调节剂直接攻击肿瘤细胞治疗实体肿瘤的方法，由于受肿瘤脉管系统的屏障作用，难以取得满意的疗效，在肿瘤血管内皮细胞，基底膜或肿瘤基质中，可能存在一些潜在的肿瘤特异性靶向给药部位，近年来出现了导向这些靶部位的新型给药方法。这些方法通过增加肿瘤血管通透性，可以提高药物在肿瘤中的蓄积；通过抑制肿瘤血管生成并切断肿瘤供血，可以阻止肿瘤生长；通过调节肿瘤内皮细胞粘附分子的表达，可以诱     

不同黏膜给药途径与载体优化的研究进展

黏膜给药因具有便捷无创、直接进入体循环及给药部位多等优点而成为传统侵入性给药方式的主要替代方法之一,为儿童、老年患者和对侵入性给药不耐受的患者提供了可接受的治疗方案。然而由于黏膜本身复杂而强大的生理屏障作用,药物的生物利用度仍处于较低水平。目前,新型药物递送系统多基于对载体的改性及对固有屏障的突破。本文就口腔黏膜、鼻黏膜、阴道黏膜、眼部黏膜、直肠黏膜和膀胱黏膜这6种主要黏膜给药途径的研究进展作一综述。     

聚合物胶束作为肿瘤靶向给药载体的研究

聚合物胶束是近年来出现的一种新型胶态药物载体,具有很多优良的性能,如体内外稳定性高、良好的生物相容性、难溶性药物的增溶作用等.它可以作为靶向肿瘤的给药载体,通过多种机制,如环境响应的聚合物胶束、特异性配基耦合的聚合物胶束、免疫聚合物胶束、通透性增强与滞留(EPR)效应、肿瘤的血管系统等途径来实现药物靶向给药.现主要讨论肿瘤给药的靶向策略和聚合物胶束作为靶向肿瘤给药载体的研究进展.     

微针经皮给药系统应用于皮肤肿瘤治疗的研究进展

经皮给药系统（TDDS）作为一种经表皮给药途径递药,近年来受到广泛关注。然而,皮肤的主要屏障角质层极大地限制了大部分药物的药效。微针（MNs）可穿透角质层,为药物经皮渗透创造瞬时微通道,从而递送药物至真皮层或皮下。同时MNs给药微创、操作简单、无痛且药物可控释放,因此在皮肤局部或全身给药具有广阔的应用前景。综述MNs的制备、分类及其应用于皮肤肿瘤治疗的最新研究进展,探讨MNs在生物医药研究领域的发展前景,为MNs经皮给药系统应用于临床提供参考。     

干扰素α治疗骨髓增殖性肿瘤的给药间隔临床研究

目的探讨不同给药间隔对干扰素α治疗骨髓增殖性肿瘤临床疗效的影响,寻找临床应用的推荐方案。方法骨髓增殖性肿瘤应用干扰素α治疗的98例患者随机分组为普通制剂每日应用组、隔日应用组、长效制剂每周应用组,监测用药过程中血常规相关细胞计数、bcr/abl-p210融合基因或jak2-v617f点突变定量检测,同时观察用药初期发热、头痛、乏力等不良反应的发生频率和程度。结果对三组患者相关血细胞计数、相关基因定量百分数、临床缓解分级3类指标进行SPSS11.0多参数样本χ2检验,三组无显著差别。用药初期不良反应在连续应用、隔日应用两组中无明显差别,长效制剂组较其他两组在发生频率和程度显著低下。结论干扰素α连续应用与隔日应用无疗效差别,推荐使用普通制剂隔日应用方案。     

RGD肽在肿瘤靶向纳米给药系统中的应用

RGD肽是一类含有精氨酸一甘氨酸一天冬氨酸(Arg-Gly-Asp)的短肽,作为肿瘤细胞或者新生血管特异表达的整合素和其配体相互作用的识别位点,可介导肿瘤的靶向治疗.抗肿瘤药物及其递送系统经过RGD肽修饰.可增加药物的肿瘤主动靶向特性,达到更有效、精确和安全的治疗.本文主要综述了RGD肽在脂质体、聚合物胶束、基因载体等...     

运用失效模式及效应分析改善临床给药流程的探讨

Objective To improve clinical dosing process and reduce the ri8k of clinical dosing.Mothods We used the basic step of Failure Mode and Effect Analysis and establish process improvement working group.Then list out clinical dosing process,point out parts and reasons,which probably lead to errors in branch process.Di~uss and study the Priority problem and draw out improvementscheme.Design new clinical dosing process.Results The result showed significant differences between two processes in risk value(P＜0.01). Clinical dosing error descended from 4 cases to 2 cases.Conclusion Clinical dosing process with failure mode and effect analysis can find out potential errors,predictability and priority problem solution,providing clinical working process with scientific methods and keeping safety in dosing.     

运用失效模式及效应分析改善临床给药流程的探讨

Objective To improve clinical dosing process and reduce the ri8k of clinical dosing.Mothods We used the basic step of Failure Mode and Effect Analysis and establish process improvement working group.Then list out clinical dosing process,point out parts and reasons,which probably lead to errors in branch process.Di~uss and study the Priority problem and draw out improvementscheme.Design new clinical dosing process.Results The result showed significant differences between two processes in risk value(P＜0.01). Clinical dosing error descended from 4 cases to 2 cases.Conclusion Clinical dosing process with failure mode and effect analysis can find out potential errors,predictability and priority problem solution,providing clinical working process with scientific methods and keeping safety in dosing.     

运用失效模式及效应分析改善临床给药流程的探讨

目的对临床给药流程进行改造,以减少用药流程的风险。方法运用失效模式及效应分析的基本步骤,成立流程改进工作小组,列出临床给药的流程,指出子流程下可能导致差错的环节及原因。提出优先解决的问题及流程整改方案,设计新型的临床给药流程。结果新旧给药流程优先风险数值比较差异有显著性（P〈0．01）;改造后用药相关缺陷从4例下降至2例。结论将失效模式及效应分析对临床护理给药流程进行分析,能前瞻性地发现工作流程中潜在的缺陷,使管理者发现流程中应该优先解决的问题,为护理工作流程改造提供科学的方法,确保病人用药安全。     

运用失效模式及效应分析改善临床给药流程的探讨

Objective To improve clinical dosing process and reduce the ri8k of clinical dosing.Mothods We used the basic step of Failure Mode and Effect Analysis and establish process improvement working group.Then list out clinical dosing process,point out parts and reasons,which probably lead to errors in branch process.Di~uss and study the Priority problem and draw out improvementscheme.Design new clinical dosing process.Results The result showed significant differences between two processes in risk value(P＜0.01). Clinical dosing error descended from 4 cases to 2 cases.Conclusion Clinical dosing process with failure mode and effect analysis can find out potential errors,predictability and priority problem solution,providing clinical working process with scientific methods and keeping safety in dosing.     

Single daily dose and simplified dosing regimens as a method to improve antibiotic therapy

Pharmacists can be an important member of the patient care team by assisting with the development of dosing regimens. By optimizing the pharmacokinetic properties of the antimicrobial agents, regimens can be developed that are simple to manage. Newer approaches to simplifying dosing regimens include once-daily aminoglycoside therapy, continuous infusion beta-lactams, and utilizing agents with long half-lives such as ceftriaxone and azithromycin. These efforts could result in improved compliance and in some instances decrease costs and toxicities associated with antibiotic therapy.     

A pharmacokinetic dosing method for oral theophylline in pediatric patients

Requirements for regular-release oral theophylline were determined in 34 pediatric patients aged 0.25-14.8 years using orally derived pharmacokinetic data and the first-order absorption equation. Large ranges were found in the half-life (2.3-21.3 h) and calculated apparent volume of distribution (Vd) (0.300-1.54 L/kg). Mean serum theophylline concentration was more closely correlated with actual mean concentration (r = 0.61, p less than 0.0002) when calculated with the individual patients' Vd values than with the standard Vd of 0.5 L/kg (r = 0.31, NS), and predictions obtained with the individuals' Vd values were more precise (p less than 0.05) and less biased than those obtained with the standard Vd. The precision of prediction based on individual Vd values was quantitatively similar (root mean squared error = 3.38 mg/L) to reported predictions based on pharmacokinetic values derived from an initial intravenous course of aminophylline therapy. We conclude that theophylline dosage requirements can be accurately estimated from orally derived pharmacokinetic data and that the method described may be useful for patients in whom intravenous therapy is not required or contraindicated.     

A minimax approach to the single-point method of drug dosing

The single-point dose prediction method is based on the observation that for drugs obeying single compartment elimination kinetics there is a nearly constant reciprocal relation between the plasma level at a fixed time following a single loading dose and the dose that is required to maintain the desired steady state plasma level of the drug. This paper describes an improved method for choosing a plasma sampling time and a proportionality constant. It applies to either drugs administered intravenously or to drugs whose rates of absorption from the site of administration are very rapid compared to their rates of elimination from the body. The sampling time and proportionality constant chosen are those that minimize the maximum relative deviation of the maintenance dose estimated by the single-point method from the dose that would be estimated if the individual's true elimination rate constant were known. The paper also supplies a method to determine the maximum error that may be introduced into the estimation of the maintenance dose by using the single-point method.This investigation was supported in part by NIH National Research Service Award GM 09279-02 (M.M.B.), NIH grant R01 AM 25744-07, and NATO Collaborative Research Grant 85/0207 (E.M.L.). M.M.B. is a Daland Scholar of the American Philosophical Society.     

电刀应用与甲状腺手术的改良

目的探讨如何对甲状腺手术的方法进行改进，以减少手术并发症，满足医患对甲状腺手术质量不断提高的要求。方法利用电刀切割、止血的功能对甲状腺肿块进行“揭盖子”、“去根”、“灭死腔”三步曲的改良方式进行手术。结果改良手术方式具有损伤小，美容效果好，功能恢复快，出血少，神经损伤少，并发症少等优点，优于传统手术方法。结论改良手术方式在良性甲状腺肿块的手术治疗中值得推广应用。