Detection and prevention of medication misadventures in general practice.

BACKGROUND: Adverse drug events are leading categories of iatrogenic patient injury. Development of preventive strategies for general practice setting depends on effective detection of events. OBJECTIVE: The aim of the study is to compare the strengths and weaknesses of voluntary reporting, chart review and patient survey in measuring medication misadventures in general practice and to analyze the events by severity and preventability, drug groups and patients' and doctors' characteristics, for the formulation of preventive strategies. METHOD: In the 2-month study period, we applied voluntary report, chart review and patient survey to collect data related to medication misadventures and compared their detection rate. RESULTS: The chart review demonstrated the highest yield for detecting overall medication misadventures (2.03% medication orders), followed by patient survey (1.46% medication orders) and voluntary reporting (0.52% medication orders). Chart review and patient survey were better than voluntary reporting in uncovering preventable adverse drug events. However, voluntary reporting was pivotal in capturing sentinel events. Beta-blocker, diuretic, angiotensin-converting enzyme inhibitor, aspirin and non-steroidal anti-inflammatory drugs had caused 82.0% of all adverse drug events. These events were more common with advanced age of patients, greater number of consultation problems and prescribed drug items. Additional resources implicated were minimal. CONCLUSION: We suggested a complementary approach using chart review and voluntary reporting in measuring and monitoring medication misadventures in general practice. Close monitoring of the events was necessary for older patients, multiple medical problems and poly-pharmacy and for patients using beta-blocker, diuretic, angiotensin-converting enzyme inhibitor, aspirin or non-steroidal anti-inflammatory drugs on a long-term basis.     

苦楝化学成份的研究

从苦楝(Melia azedarach L.)果中分得苦楝新醇(Ⅰ),苦楝醇(Ⅱ)、苦楝酮(Ⅲ)、苦楝二醇(Ⅳ)、香草醛(Ⅴ)和香草酸(Ⅵ)。根据波谱(IR,MS,¹HNMR,¹³CNMR)分析和理化常数测定,确定了它们的结构。其中苦楝新醇(Ⅰ)为新化合物,对菜青小虫有一定的拒食活性。     

多波长系数法的研究与应用

在多组分光度分析的方法中,最小二乘法、Kalman滤波、因子分析等虽已能成功的消除组分间的相互干扰,不经分离直接定量,但均需有微机配套进行矩阵运算。而双波长、三波长法,虽然简单,但对于吸收光谱重叠严重的混合组分,则难以选出满足要求的波长;     

壳聚糖的纳米化及其生物学效应

目的:综合分析壳聚糖纳米微粒的制备方法、研究进展及其生物学效应资料来源:应用计算机检索PUBMED 1998-01/2006-12有关壳聚糖纳米化方面的文献,检索词“Chitosan;nanoparticles”,同时计算机检索超星数字图书库2000-01/2006-12期间的相关文献,检索词为“壳聚糖”。资料选择:对资料进行初审,并查看每篇文献后的引文。选择针对性强的文章。同一领域的选择近期或权威杂志的文章。资料提炼:共收集到259篇相关文献,其中34篇符合纳入标准,排除25篇。符合纳入标准的34篇文献中,26篇涉及壳聚糖纳米粒的制备,8篇涉及纳米化后产生的生物学效应。资料综合:壳聚糖作为一类带正电的多糖,其性质不活泼,不与体液和体内组织产生免疫反应,并具有很好的生物相容性和生物可降解性。目前壳聚糖纳米化主要采用离子交联法、沉淀法、共价交联法、乳化溶剂扩散挥发法、自组装法等方法。纳米化后具有增加药物的吸收作用、增加药物的靶向性和降低药物副作用、增强药物的缓释作用及提高药物稳定性的生物学效应。结论:壳聚糖纳米粒的研究已成为当前生物医学领域的热点。纳米化后的壳聚糖在缓控释给药系统中具有广阔的应用前途,但其溶解性能有待于进一步提高。     

N-乙酰半胱氨酸对脑死亡状态巴马小型猪肾脏结构、功能与核转录因子κB表达的影响

目的：观察核转录因子κB活性抑制剂N-乙酰半胱氨酸对脑死亡状态下巴马小型猪肾脏结构、功能与核转录因子κB mRNA其蛋白表达的影响，以期提高脑死亡供肾的肾移植效果。方法：实验于2003—08／2004—12在河南省实验动物中心及河南省病理学重点实验室完成。①实验分组及方法：将15只巴马小型猪按随机数字表法分为3组（n=5），即脑死亡组、N-乙酰半胱氨酸组及对照组。脑死亡组和N-乙酰半胱氨酸组均应用改进的缓慢间断颅内加压法建立脑死亡模型，脑死亡组不行药物干预；N-乙酰半胱氨酸组分别于初次确认脑死亡后1h，12h给予N-乙酰半胱氨酸。对照组动物麻醉后仅行开颅与开关腹手术。②实验评估：分别于首次判定脑死亡后3，6，12，18和24h检测动物血清中尿素氮、肌酐、白细胞介素1β、白细胞介素6、肿瘤坏死因子α水平。于脑死亡后3，6，12及24h开腹取相同部位肾组织，苏木精-伊红染色后观察肾组织结构变化，应用免疫组化染色观察核转录因子κB蛋白的表达水平，应用反转录-聚合酶链反应法检测核转录因子κB mRNA动态变化。结果：15只猪均进入结果分析。①自首次判定脑死亡后12h开始，脑死亡组和N-乙酰半胱氨酸组尿素氮和肌酐水平逐渐升高（P〈0．05），相同时间点比较N-乙酰半胱氨酸组显著低于脑死亡组（P〈0．05）。②自首次判定脑死亡3h开始，脑死亡组及N-乙酰半胱氨酸组白细胞介素1β、白细胞介素6、肿瘤坏死因子α逐渐升高（P〈0．05），相同时间点比较N-乙酰半胱氨酸组显著低于脑死亡组（P〈0．05）。③自脑死亡后3h开始，脑死亡组及N-乙酰半胱氨酸组肾组织NF-κB mRNA其蛋白表达水平逐渐升高（P〈0．05），相同时间点比较N-乙酰半胱氨酸组显著低于脑死亡组（P〈0．05）。④N-乙酰半胱氨酸组和脑死亡组动物脑死亡后12h可见肾脏结构变化，N-乙酰半胱氨酸组变化程度明显轻于脑死亡组。结论：N-乙酰半胱氨酸可能通过抑制核转录因子κB mRNA其蛋白的表达，减少炎症介质的释放，从而保护脑死亡状态下肾脏的功能及结构，提高脑死亡供肾肾移植效果。     

Sit-and-reach test can predict mobility of patients recovering from acute stroke

OBJECTIVES: To establish the test-retest reliability of the sit-and-reach test (SRT) and to determine the capacity of the SRT to predict mobility of patients recovering from acute stroke. DESIGN: Study 1 consisted of repeating the SRT to examine its reliability over trials (same day) and sessions (alternate days). Study 2 consisted of measuring performance in the SRT 7 to 10 days poststroke and measuring mobility at discharge for prospective analysis. SETTING: Medical and rehabilitation wards in hospital in Hong Kong. PARTICIPANTS: Thirty-six subjects with acute stroke (study 1, n=10; study 2, n=26). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Between 7 and 10 days of stroke onset, distance reached on the SRT was measured. Mobility at discharge was assessed using the transfer and locomotion scale of the FIM instrument (FIM mobility) and a timed walk test. RESULTS: The intertrial and intersession reliability of the SRT were rated good, with intraclass correlation coefficients of .98 and .79, respectively. Distance reached on the SRT correlated with the FIM mobility score on discharge (r=.572, P=.002) and the distance achieved on the timed walk test (r=.524, P=.006). Distance reached on the SRT accounted for 32.7% and 27.5% of the variance in the FIM mobility score at discharge and the distance achieved on the timed walk test, respectively. CONCLUSIONS: Performance in the SRT is reliable and can significantly predict the mobility of patients with acute stroke at discharge.