Risk assessment in clinical pharmacy

Medication error forms a major proportion of the errors in the medical system. Despite many studies of adverse drug events, there are no systematic ways of ensuring safety, or of assessing how safe a pharmaceutical system is. Risk assessment is required in hazardous industries such as nuclear power or oil and gas. Risk assessments involve identifying the defences and assessing their effectiveness and are relatively uncommon in clinical pharmacy , as opposed to reactive approaches involving incident analyses. Risk factors, that degrade barriers, can be identified and their effect measured. A risk assessment structure for pharmacy processes is proposed that can also be used to support incident investigation and analysis processes and provide a standard for audit.     

Trace Metals' abnormalities in hemodialysis patients: relationship with medications

A multicenter collaborative study was performed to investigate the prevalence of abnormal blood contents of 6 trace metals, copper (Cu), zinc (Zn), aluminum (Al), lead (Pb), cadmium (Cd), and mercury (Hg), in hemodialysis (HD) patients and to analyze their relationship with the medications, such as CaCO3, Ca acetate, Al containing phosphate-binding agents, 1,25-dihydroxy vitD3, 1-hydroxy vitD3, and erythropoietin (EPO), as well as hematocrit level, by chi-square statistics. From 6 medical centers in Taiwan, we included 456 patients in maintenance HD for more than 4 months for this study, and they had continued the previously mentioned medications for at least 3 months. Blood samples were collected before initiating HD, and atomic absorption spectrophotometry was used to measure plasma levels of Cu, Zn, and Al as well as whole blood levels of Pb, Cd, and Hg. Three hundred seventy-five (78%) of the HD patients had low plasma Zn levels, that is, <800 microg/L, and the mean (+/-SD) concentration was 705.8 (+/-128.23) microg/L in all subjects. One hundred forty-one (31%) of the HD patients had high plasma Al, that is, >50 microg/L, and the mean (+/-SD) was 44.30 (+/-28.28) microg/L in all subjects. Three hundred thirty-three (73%) of the dialysis patients had high Cd levels, that is, >2.5 microg/L, and the mean (+/-SD) was 3.32 (+/-1.49) microg/L in all subjects. The majority of HD patients had normal blood levels of Cu, PB, and Hg. Only 21 (4. 6%), 5 (1.1%), and 3 (0.06%) patients had elevated blood levels of Cu, Pb, and Hg, respectively. Their mean (+/-SD) blood concentration of Cu, Pb, and Hg were 1,049.78 (+/-233.25) microg/L, 7.45 (+/-3.95) microg/dL, and 3.17 (+/-25.56) microg/L, respectively. Three patients had elevated plasma Hg concentrations, that is, 546, 12.6, and 24.0 microg/L, respectively. In the 152 normal healthy age and sex matched control group, the blood levels of Al, Cd, and Pb were all significantly lower than the HD patients. However, the levels of Cu and Zn were higher in the control group. The Hg level was not significantly different in both groups. There was no statistical difference between patients with normal and abnormal blood levels of trace metals in various medications except Al containing phosphate binder. The Al containing phosphate binder users had significantly higher plasma Al levels (54.71 +/- 26.70 versus 41.15 +/- 28.03 microg/L, p < 0.001) and hematocrit levels (29.61 +/- 4.61 versus 27. 81 +/- 3.91, p < 0.0005). There was no statistical correlation between erythropoietin (EPO) dose and hematocrit level in these patients. In conclusion, the blood level of trace metals of these HD patients except Al was not related to their medications. However, caution must be exercised in interpreting this result as dose and duration of medication; efficiency of HD and water treatment may play an important role. Otherwise, environmental factors, diet, and the aging process may contribute to the trace metal burden in uremia. Thus, Zn and Cu are abundant in seafood, and Cd is abundant in contaminated plants such as rice.     

Observations on the curative effect of acupuncture on cardiac vegetative neuropathy of diabetes

将36例糖尿病Ⅱ型患者分为西药组和针刺组,分别予降糖药物和针刺治疗.治疗前患者血糖、HbA1,各项心脏植物神经功能试验均异常.治疗1个月西药组血糖及HbA1显著下降,而其余各项指标均无显著变化.针刺组血糖HbA1无显著变化,但乏氏指数、立卧位心率差、30/15R-R期间比值、异常项目数均显著改善.说明针刺可以改善心脏植物神经功能.     

Prosopo-Thoracopagus Conjoined Twins and Other Cephalopagus-Thoracopagus Intermediates: Case Report and Review of the Literature

Prosopo-thoracopagus twins are united from the face down to the umbilicus, none with union in the brain but all with visceral anomalies intermediate between those of cephalopagus and thoracopagus. In a review of over 1200 cases of conjoined twins reported during the past 100 years, there were 14 that illustrate the continuum between cephalopagus and thoracopagus, including three that were united only from the cervical region to the umbilicus. Classic cephalopagus twins are joined from the top of the head to the umbilicus, sharing a single foregut as well as two relatively normal hearts, the “posterior” one often diminished. Typical thoracopagus, however, are conjoined only from the upper thorax to the umbilicus, each twin with a normal foregut but both sharing a single complex multiventricular heart. The intermediate cases shared either a single very abnormal heart or two hearts united by double aortic arches, and all except one had a single foregut. It is these cases intermediate between cephalopagus and thoracopagus which are the subject of this report. Received September 11, 1996; accepted December 16, 1996     

针刺治疗稳定性心绞痛30例体会

目的:比较针刺与药物治疗稳定性心绞痛的疗效差异。方法:随机选取稳定性心绞痛患者,分为针刺组30例、药物组2 2例,分别比较治疗后两组症状、心电图及硝酸甘油停减情况。结果:症状疗效方面:针刺组有效率为90 .0 0 %,药物组有效率为81 .82 %,两组比较有显著性差异(P <0 .0 5 )。心电图改善情况两组未见明显差异。硝酸甘油停减情况:针刺组停药率为2 3.3%,药物组停药率为1 8.2 %,两组比较无明显差异。结论:针刺具有明显改善稳定性心绞痛症状的功效。     

抗菌药使用中药物治疗错误的研究

目的：研究抗茵药使用中药物治疗错误（ME）的发生情况，探讨其防范重点。方法：药师深入中心ICU病房，通过调查病历、直接观察的方式发现抗茵药ME。结果：10个月研究期间共发现ME301次，其中可预防药物不良事件（ADE）19次（3．3％），潜在ADE94次（16．2％）。有潜在危害ME（可预防的ADE＋潜在ADE）中有生命威胁6次（5．3％），严重88次（77．9％），明显19次（16．8％）。结论：抗茵药使用中ME经常发生，其中约1／3有潜在危害且往往带来严重后果，应该采取措施防范ME、特别是有潜在危害ME的发生。     

2004年武汉地区医院用药状况分析

目的：了解2004年度武汉地区的用药状况.方法：根据HPDIS提供的资料,回顾性统计分析购药金额、用药频度、每日费用及年平均增长率.结果：本年度购药金额与去年相比增幅明显,购药金额列前20名药品用药频度呈上升趋势,日费用有所下降.结论：武汉地区医院用药呈现稳定、健康增长,药品市场具有良好发展空间.     

卡前列甲酯栓与米索前列醇终止早孕的临床比较

目的:比较小剂量卡前列甲酯栓(卡孕栓,PG05)配伍米非司酮与米索前列醇(米索)配伍米非司酮终止早孕的疗效。方法:确诊为宫内早孕并要求终止妊娠的妇女200例,随机分为PG05组及米索组,于口服米非司酮150 mg后36 h,阴道放置PG05 0.5 mg或口服米索600μg,比较两组的疗效及副反应。结果:两组完全流产率,不全流产率及失败率无统计学差异,PG05组的药流副反应轻于米索组,但排胎时间较长。阴道出血时间及出血量两组间无统计学差异。结论:0.5 mg PG05配伍米非司酮是一种有效的终止早孕方案,在不降低完全流产率的前提下,降低药流副作用,减少痛苦,增加病人的依从性。     

一个快速的多维数据包分类算法

通过引入位图映射以及元组空间的概念,提出了一个数据包分类算法,该算法可以满足高性能网络对骨干路由器的要求,能够以线速完成对输入数据包的分类处理。算法在时间及空间复杂度上性能较好,并具有很好的扩展性。