本院静脉药物配置中心的建设和实践体会

目的通过静脉药物配置中心（Pharmacy Intravenous Admixture Service,PIVAS）的运行情况,探讨静脉药物配置中心的具体建设和实践,借此提升医院的管理水平,保障患者用药安全。方法通过福建省肿瘤医院静脉药物配置中心一年来的建设及实践,分析开展PIVAS的利弊。结果PIVAS实施一年来,为患者提供高品质的输液产品,配置15万袋大输液,无1例输液反应发生,同时减少了药品浪费,加强配药护士的职业防护,促进临床药学的发展。结论建设好静脉药物配置中心,是现代医院药学服务的重要内容。     

Local ancestry at APOE modifies Alzheimer's disease risk in Caribbean Hispanics

IntroductionAlthough the relationship between APOE and Alzheimer's disease (AD) is well established in populations of European descent, the effects of APOE and ancestry on AD risk in diverse populations is not well understood.MethodsLogistic mixed model regression and survival analyses were performed in a sample of 3067 Caribbean Hispanics and 3028 individuals of European descent to assess the effects of APOE genotype, local ancestry, and genome-wide ancestry on AD risk and age at onset.ResultsAmong the Caribbean Hispanics, individuals with African-derived ancestry at APOE had 39% lower odds of AD than individuals with European-derived APOE, after adjusting for APOE genotype, age, and genome-wide ancestry. While APOE E2 and E4 effects on AD risk and age at onset were significant in the Caribbean Hispanics, they were substantially attenuated compared with those in European ancestry individuals.DiscussionThese results suggest that additional genetic variation in the APOE region influences AD risk beyond APOE E2/E3/E4.     

Polymorphisms of Alcohol Metabolizing Enzymes in Indigenous Mexican Population: Unusual High Frequency of CYP2E1*c2 Allele

Background: Alcohol abuse represents the major identified etiological factor of cirrhosis in México. ADH1B, ALDH2, and CYP2E1 have been considered candidate genes in alcohol‐related diseases. Controversial results probably due to ethnic differences, among other factors, have been reported. Mexican Mestizos (MES) derive from the combination of indigenous, Spaniard, and African genes. Huichols (HUI) constitute an indigenous group from western Mexico with no racial admixture. We determined ADH1B*2, ALDH2*2, and CYP2E1*c2 allele frequencies in healthy HUI and MES from western Mexico. Lipid and hepatic profile were also carried out. Methods: One hundred and one HUI and 331 MES subjects were studied. Genotype and allele frequency were assessed through polymerase chain reaction–restriction fragment length polymorphism after DNA isolation from peripheral leukocytes. Commercial kits for lipid and hepatic determinations were used. Results: Polymorphic allele distribution in HUI was: 0%ADH1B*2, 0.5%ALDH2*2, 51.5%CYP2E1*c2; in MES: 3.4%ADH1B*2, 0%ALDH2*2, 16.1%CYP2E1*c2. Frequency of ADH1B*2 was statistically (p < 0.001) lower in HUI than MES. CYP2E1*c2 polymorphic allele was significantly higher (p < 0.0001) in HUI than MES. Hepatic profile was normal in both groups. HUI showed a better lipid profile than MES independently of genotype. Conclusions: Huichols exhibited the highest CYP2E1*c2 allele frequency of the world documented up to this date; meanwhile, ADH1B*2 and ALDH2*2 were practically absent. This feature could be useful in the understanding of Mexican population gene composition, alcohol metabolism, and alcoholic liver disease development. However, further association studies are necessary. The heterogeneity of Mexican population was evidenced by the significantly different distribution of CYP2E1*c2 allele observed among different regions of the country. Lipid and hepatic values were not associated to genotype. This report constitutes the first study dealing with gene polymorphisms of alcohol metabolizing enzymes conducted in HUI.     

在静脉药物配制中心实施弹性排班的实践与体会

目的针对静脉药物配制中心工作性质以及工作流程的特殊性,对排班方法进行改革。方法根据不同时间段输液量的不同,在固定排班的基础上,实行按需工作制,合理利用和分配人力资源。结果有效解决了护士以往无法实行的公休假,保证了静脉药物配制中心的高效运转,满足了临床治疗的需要。结论科学、合理排班能最大限度地调动和利用人力资源。     

In vitro deposition properties of nebulized formoterol fumarate: effect of nebulization time,airflow, volume of fill and nebulizer type

ABSTRACT

Objective: The aim of this study was to investigate in vitro the delivery of a new long-acting β₂-agonist (LABA) drug formoterol fumarate inhalation solution (20?µg/2?mL) nebulized with and without ipratropium bromide (0.5?mg/2.5?mL) at different administration times (2.5–22.5?min), airflows (5–28.3?L/min), nebulizer fill volumes (2–6?mL), and nebulizer brands (Pari LC+, Ventstream and DeVilbiss).

Method: Formoterol fumarate with and without ipratropium bromide was aerosolized at different administration times, airflows, nebulizer fill volumes, and nebulizer brands. The drug deposited on the throat, filter and stage plates was collected and analyzed by HPLC to determine the aerodynamic profiles of the nebulized drugs under each variable.

Results: In addition to altering the aerosol characteristics, increasing the nebulizer fill volume including the addition of ipratropium bromide produced a significant (p?<?0.05) increase in the drug output. As expected, sputtering time was significantly longer at low airflows, and vice versa at higher airflows but with a significant loss of drug delivered presumably due to greater solvent evaporation at higher airflows. Airflows between 10 and 28.3?L/min and a nebulization time of approximately 10?min appear sufficient for producing aerosols within the respirable range (1–5?µm MMAD) with the nebulizer/compressor combination used. While the drug output varied significantly (p?<?0.05) among the three brands of nebulizers tested, the LC+ nebulizer appears to produce aerosols (2.7?±?0.1?µm MMAD) capable of penetrating more deeply into the lung than the other nebulizers evaluated under the current test conditions. This study did not attempt to evaluate different nebulizer/compressor combinations. Also, the cascade impaction data may not necessarily reflect aerosol deposition in the airways in vivo, which may be different depending on the health status of the patient.

Conclusion: The results demonstrated that administration of nebulized formoterol fumarate require proper selection of a delivery system/method for safe and effective therapy of the medication with and without ipratropium bromide.     

全医嘱下静脉用药调配中心临时医嘱运行模式介绍

目的：探讨全医嘱模式下静配中心临时医嘱运行模式,满足临床用药需求。方法从医嘱接收、审核、分配输液批次、核对、配置、交接各环节分析临时医嘱运行过程中的影响因素。结果与结论 PIVAS配置长期医嘱,同时也能承接临时医嘱的配置,完善的临时医嘱运行模式是保证其正常动作的基础。     

我院静脉用药调配常见问题及差错分析

目的 分析临床静脉输液调配过程中易出现的问题,减少药品不良反应发生,提高临床输液的安全性.方法 解读药品说明书,查阅相关资料,对医院2010年6月至2011年3月静脉用药调配中心的长期医嘱进行适宜性审核,并对其中不合理静脉输液配置情况进行统计、分析.结果 发现不合理用药医嘱815组,占调配总数的0.26%,主要包括药物配伍禁忌、配伍不当、溶剂选择不当、药物配置浓度过大、给药剂量不当、给药途径不当以及医嘱录入错误等.结论 静脉输液调配应严格执行各项操作规范,严格遵照药品说明书及相关要求,充分发挥药师的审方作用,确保患者用药安全合理.     

静脉药物配置中心药学服务模式探讨

目的:探讨符合静脉药物配置中心(PIVAS)发展要求的药学有服务工作模式,以更好地发挥药师作用。方法:借助PIVAS工作,创新实践,为医师、护士提供专业化服务,为患者疾病治疗提供有可靠保障的药学服务模式。结果:PIVAS开展多层次、多方位的药学服务,在提高了输液质量的同时,有效避免了护士操作错误、医师处方差错,为药师参与临床治疗、推广合理用药提供了平台。结论:多层次、多方位的药学服务模式有利于PIVAS拓展药学服务内涵。     

我院静脉用药调配中心药师工作实践及体会

目的完善医院药师在静脉用药调配中心的相关工作内容,保证输液调配质量,确保临床用药安全。方法对医院静脉药物调配中心出现问题进行定性分析,总结药师在静脉药物调配中心工作的作用及意义。结果医院静脉用药调配中心药师发现的问题包括医生医嘱不舍理、护士排药及调配差错。结论药师进行医嘱审核、排药复核及调配复核,并对护理人员进行调配指导,层层把关保证调配质量,为临床提供高质量的静脉用药,保证患者用药安全。     

Impact of population admixture on the distribution of immune response co-stimulatory genes polymorphisms in a Brazilian population

Co-stimulatory molecules are essential in the orchestration of immune response and polymorphisms in their genes are associated with various diseases. However, in the case of variable allele frequencies among continental populations, this variation can lead to biases in genetic studies conducted in admixed populations such as those from Brazil. The aim of this study was to evaluate the influence of genomic ancestry on distributions of co-stimulatory genes polymorphisms in an admixed Brazilian population. A total of 273 individuals from the north of Brazil participated in this study. Nine single nucleotide polymorphisms in 7 genes (CD28, CTLA4, ICOS, CD86, CD40, CD40L and BLYS) were determined by polymerase chain reaction-restriction fragment length polymorphism. We also investigated 48 insertion/deletion ancestry markers to characterize individual African, European and Amerindian ancestry proportions in the samples. The analysis showed that the main contribution was European (43.9%) but also a significant contribution of African (31.6%) and Amerindian (24.5%) ancestry. ICOS, CD40L and CD86 polymorphisms were associated with genomic ancestry. However there were no significant differences in the proportions of ancestry for the other SNPs and haplotypes studied. Our findings reinforce the need to apply AIMs in genetic association studies involving these polymorphisms in the Brazilian population.