Neuroleptic malignant syndrome during low dosed neuroleptic medication in first-episode psychosis: a case report

 Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal side-effect of antipsychotic drug therapy, especially of dopamine receptor antagonists. As a dose relationship has been postulated, low dose neuroleptization would be expected to help to avoid this side-effect. In contrast, we report on a 21-year-old female following low dose fluphenazine treatment with 2.5 mg/day. The patient recovered from NMS after 3 days of dantrolene administration. Eventually, remission from psychotic symptoms was achieved with clozapine. At 8-month follow-up, psychopathology remained stable and there were no more signs of NMS. Received: 8 July 1998 / Final version: 6 November 1998     

医院用药经济分析的基本方法

本文简要介绍了医院药品经济分析的基本方法，包括购药分析、处方分析、质量控制和相关文献。     

美沙酮戒毒安全剂量的研究

目的：制定美沙酮戒毒的安全剂量范围。方法：检测男性（女性）戒毒人员体重指数（BMI）,计算出戒毒者服用美沙酮的剂量,按吸食毒品的类别和剂量换算美沙酮用量,检测2位死亡者生化指标和尿美沙酮含量,分析死亡原因。结果：两例死亡病例尿美沙酮含量为300ng／ml即0．3mg／L。肝脏是美沙酮代谢的主要场所,从尿中和大便中排出未经变化的药量小于血药量的10％左右。美沙酮的治疗血浓度为0．48—0．86mg／L,中毒血药浓度为2．0mg／L,致死血浓度〉4．0mg／L。故可推算出两例病例血中美沙酮含量在3mg／L左右,已达中毒剂量。结论：美沙酮替代疗法给药剂量应个体化,防止诱发死亡。     

心脏病专科医院麻醉药品使用分析与安全管理对策

目的 了解我院麻醉药品使用情况,进一步加强麻醉药品安全管理,使用好麻醉药品.方法 统计我院2002年至2006年麻醉药品药库出库数据并进行分析,采用有效管理对策进行麻醉药品管理.结果 通过加强临床使用与规范化管理,最大程度的提高患者用药安全,降低管理漏洞,严防流入非法渠道.结论 麻醉药品管理必须规范化、法制化,良好的管理模式是实现管好用好麻醉药品的重要手段.     

重庆地区市民用药习惯调查分析

  目的  了解河南省居民安全用药情况,为维护居民健康提供基础研究,提升居民用药安全水平。  方法  2016年7 — 9月,采用简单随机抽样法抽取河南省郑州、新乡、焦作等15个市的2 146名居民为研究对象,使用自行设计的调查问卷进行调查,利用SPSS 22.0软件对数据进行统计分析。  结果  居民安全用药意识不高,仅有748人（34.86 %）经常关注药物说明书,关注度大致随着文化程度的增加逐渐增高,差异有统计学意义（χ² = 71.065 1,P < 0.05）。当服用药物后出现不良反应时,有85.00 %的人表示会选择立即停药咨询医生。自行购药比例较高,有88.77 %的人有过自行购药的经历,其中 ≥ 60岁居民经常自行购药的比例最高（35.42 %）,差异有统计学意义（χ² = 62.693 3 ,P < 0.05）。不良用药习惯最常见的是不按时服药,其次为稍有好转就停药、自行增减药量、自行调快输液速度等。  结论  居民安全用药意识有待提高,正确了解用药知识,合理安全使用药品,对市民促进身体健康水平、事业发展和生活质量都有着十分重要的意义。     

Mental Health Issues and Psychotropic Medication: Current Applications for Children and Adolescents in Residential Treatment

ABSTRACT

Severe mental and emotional conditions are much more prominent in juvenile resident treatment facilities than they are within the general adolescent population. These conditions are often painful to the juveniles and create management difficulties for the facility. Several mental illnesses are particularly severe and troublesome when not properly treated. Many of these require medication in order to be treated properly. This article identifies and describes those conditions, identifies many of the medications commonly used to treat them, and discusses both the effects and common side-effects of the medications. The paper does not offer medical advice and cannot be used as a guide to effective treatment. Rather, it is intended to improve the understanding of non-medical practitioners in the mental health field.     

某院47名护士长高危药物外渗相关态度技能认知调查分析

目的了解护士长对高危药物外渗态度技能知识掌握情况,为加强高危药物的风险管理提供依据,促进护理持续质量改进.方法采用自制高危药物外渗相关态度技能知识调查问卷对暨南大学附属第一医院47名护士长进行调查评定,调查内容包括高危药物外渗相关态度、技能和知识3个维度,采用SPSS 16.0统计软件进行系统描述分析.结果关于高危药物外渗态度、技能、知识的平均正确率分别为99%、75%、23%;加权后总体平均正确率为70%.不同年龄、学历、职称、工作年限的护士长问卷总体平均正确率差异均无统计学意义(P>0.05).结论护士长在高危药物外渗态度方面掌握较好,在技能和知识方面存在欠缺.作为风险管理者和质量控制者,护士长应同时重视处理高危药物外渗技能和知识方面的提高.     

Demystifying Analytical Approaches for Urine Drug Testing to Evaluate Medication Adherence in Chronic Pain Management

ABSTRACT

This comprehensive review of analytical methods used for urine drug testing for the support of pain management describes the methods, their strengths and limitations, and types of analyses used in clinical laboratories today. Specific applications to analysis of opioid levels are addressed. Qualitative versus quantitative testing, immunoassays, chromatographic methods, and spectrometry are discussed. The importance of proper urine sample collection and processing is addressed. Analytical explanations for unexpected results are described. This article describes the scientific basis for urine drug testing providing information which will allow clinicians to differentiate between valid and questionable claims for urine drug testing to monitor medication adherence among chronic pain patients.     

Cost-effectiveness analysis of a hospital electronic medication management system

Objective To conduct a cost–effectiveness analysis of a hospital electronic medication management system (eMMS).Methods We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs.Results The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05; a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63–66 (US$56–59) per admission (A$97 740–$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially.Conclusion The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost–effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors.     

张灿玾临证方药运用经验

国医大师张灿玾教授,从医70余载,始终坚持多科应诊、博采众长的医风,重视理论与实践结合、继承与发展并重,临证经验丰富,在方药运用方面造诣颇深,主要体现在以下四个方面:一是临证思路精妙,辨证精准,遣药组方注重通权达变,勇于突破创新,并主张辨证宜多面化,有是证用是药;二是制方严谨,谨遵君臣佐使的组方原则,配伍合理,尤其强调药性平衡,临证处方善用对药,相辅相成,或相反相成;三是善用古方,师而不泥,化裁灵活,无论单方化裁,多方合用,还是群队组合,重在章法有度,使对古方的认识及应用得到进一步的扩展和深化;四是临证选用土单方、经验方,用药简便廉验,注重方药的经济实用。