84例抗凝药物致不良反应的帕累托图分析

目的： 分析抗凝药物不良反应（ADR）发生的规律、特点,探讨ADR发生与变化的可能原因及影响因素,为临床应用提供参考。方法： 对上海交通大学附属第一人民医院2012年1月-2018年12月上报至国家药品不良反应监测系统的84例抗凝药物所致ADR进行帕累托图分析。结果： 84例抗凝药物ADR报告中,男性比例较高为46例（54.76%）;60岁以上人群ADR发生例次较多,有62例（73.81%）;新的ADR报告4例（4.76%）,严重的ADR报告19例（22.62%）;发生ADR的抗凝药物共4个种类,其中低分子肝素类药物最多（41.84%）,其次为维生素K拮抗剂类（27.55%）;以血液系统损害最为常见（74.23%）;以药师上报为主。结论： 抗凝药物引发ADR与多种因素有关,临床用药时应全方位监控,以减少ADR的发生,确保用药安全。     

基于限定日剂量和帕累托图法分析某院2016年重点监控药品的使用情况

目的:了解重点监控药品管控成效,为进一步控制重点监控药品使用量提供参考。方法:参照2016年《四川省卫生和计划生育委员会关于建立医疗机构重点监控药品管理制度的通知》[1]所规定的重点监控药品制定某院重点监控药品目录,在对监控前后重点监控药品的销售金额进行回顾性分析的基础上,引入限定日剂量(DDD)的概念,采用DDD方法分析监控前后重点监控药品使用情况,并通过帕累托图分析法对实施重点监控后所监控药品进行分析,提示其中的主要影响品种。结果:经过对重点监控药品的专项整治,该院重点监控药品销量及DDDs下降有显著性,说明该院对重点监控药品的专项整治有效。实施监控后,重点监控药品销售金额的帕累托图分析显示在36个品规中14个品规构成主要因素。该院重点监控药品经整治后,主要影响重点监控药品销售金额的药品为兰索拉唑注射剂(17.84%),泮托拉唑注射制剂(16.49%),脑苷肌肽注射液(5.84%)。结论:临床药师对整治前后重点监控药品进行回顾性分析,重点监控药品使用情况改善有显著性,但具体分析后仍有不合理使用现象存在,应进一步优化管理。     

基于博弈论的我国分级诊疗制度分析与政策建议

目的研究我国建立分级诊疗制度的困境以及相关解决政策建议。方法利用博弈论和帕累托改进理论分析促进分级诊疗制度的实施方法。结果分级诊疗的难点在于未能实现帕累托改进,即患者和政府可以在分级诊疗制度中节约成本,但医生并未得到相应的激励,因此,缺乏下沉积极性。结论若能够让政府和患者节省的一部分费用补贴给大医院医生,则这些医生就会下沉到基层医疗机构,即可以实现帕累托改进,建立分级诊疗就医秩序。     

应用帕累托图分析门诊药房差错原因

目的：分析门诊药房差错原因,优化服务流程,提高服务质量。方法：利用Excel软件进行差错处理,应用帕累托图分析差错的主要原因。结果：药剂人员、医师、药品包装是造成药房差错的主要原因;药品名称、药位相似、药品不同剂型为次要因素;其余为一般因素。结论：根据造成差错现象的主要原因,应进一步的完善药房管理制度、端正药师的工作态度、提升药师的专业素质等。     

向量评估遗传算法优化聚乳酸载药微球工艺

目的:研究向量评估遗传算法(VEGA)优化聚乳酸载药微球的制备工艺,寻求同时使药物包封率最大及产物平均粒径最小的两目标最佳工艺体系。方法:对均匀设计试验制备聚乳酸载药微球的药物包封率和平均粒径两目标采用VEGA进行优化,影响因素有内水相体积(x1)、二氯甲烷(DCM)的质量浓度(x2)、聚乙烯醇(PVA)的质量浓度(x3)、搅拌速度(x4)及氯化钠的质量分数(x5),通过搜索最优制备工艺,比较VEGA搜索载药微球最优处方结果;利用Matlab 2009a外挂SGALAB工具箱Beta 5008完成遗传算法寻优,利用SPSS 17.0软件进行统计分析;并对其处方优化效果进行评价。结果:VEGA进行两目标优化后,最佳工艺中影响因素有x2、x4、x5,分别为86.68 mg/ml、1 499.48 r/min、0.04%,x1和x3因素影响不显著;目标值药物包封率最大达到95.99%,平均粒径最小达到20.80μm。结论:VEGA搜索的Pareto非劣解是合理的,确定的最优提取工艺的效果较好,均高于均匀设计中的试验方案。     

The Widened Pipe Model of plant hydraulic evolution

Shaping global water and carbon cycles, plants lift water from roots to leaves through xylem conduits. The importance of xylem water conduction makes it crucial to understand how natural selection deploys conduit diameters within and across plants. Wider conduits transport more water but are likely more vulnerable to conduction-blocking gas embolisms and cost more for a plant to build, a tension necessarily shaping xylem conduit diameters along plant stems. We build on this expectation to present the Widened Pipe Model (WPM) of plant hydraulic evolution, testing it against a global dataset. The WPM predicts that xylem conduits should be narrowest at the stem tips, widening quickly before plateauing toward the stem base. This universal profile emerges from Pareto modeling of a trade-off between just two competing vectors of natural selection: one favoring rapid widening of conduits tip to base, minimizing hydraulic resistance, and another favoring slow widening of conduits, minimizing carbon cost and embolism risk. Our data spanning terrestrial plant orders, life forms, habitats, and sizes conform closely to WPM predictions. The WPM highlights carbon economy as a powerful vector of natural selection shaping plant function. It further implies that factors that cause resistance in plant conductive systems, such as conduit pit membrane resistance, should scale in exact harmony with tip-to-base conduit widening. Furthermore, the WPM implies that alterations in the environments of individual plants should lead to changes in plant height, for example, shedding terminal branches and resprouting at lower height under drier climates, thus achieving narrower and potentially more embolism-resistant conduits.

Water transport through plants is a key driver of the carbon and other biogeochemical cycles (1–3) and is a crucial link in plant adaptation to climate and vegetation response to climate change (4–9). The water conducting cells of plants, xylem conduits, widen with distance from the stem tip, and, therefore, taller plants have wider conduits (6, 10–12). Xylem conduits are of two main types: tracheids, found in most gymnosperms, and vessels, found in most flowering plants. Tracheids have intact cell membranes, so water must flow from cell to cell through these membranes. Vessels are made up of cells aligned vertically end to end, with the cell membranes dissolved between successive members, forming a tube. Whatever their differences in structure, wider conduits are beneficial because they conduct more water. Tip-to-base widening is expected to help maintain conductance per unit leaf area constant as an individual plant grows taller, counterbalancing the resistance that would otherwise accrue with increasing conductive path length the individual grows (2, 13). Wider conduits, however, are more vulnerable to embolisms caused by cold and likely drought (8, 14–18) and cost more in terms of carbon for a plant (ref. 1; cf. ref. 19). Embolisms in the xylem even affect transport of photosynthates in the phloem (8, 20). This means that as trees grow taller, conductance, embolism vulnerability, and carbon costs must interrelate in a delicate evolutionary balance.Because of the importance of this balance in plant hydraulic evolution and in forest reactions to climate change (3, 6, 21–23), an important goal of plant biology is to construct models that predict how and why plants deploy conduit diameters throughout their bodies (1, 2, 17, 24–26). Some models predict that conduits should be of uniform diameter (27, 28), while others predict that they should widen tip to base (1, 2, 13, 24, 29, 30). But even current models include untested assumptions and large numbers of parameters, making it difficult to identify the biological causes of the predictions they make. For example, some invoke Da Vinci’s rule, the largely untested assumption that the summed wood area of the twigs is the same as that at the base (24, 26). Other models depict plant conduits as branching as they do in mammalian circulatory systems, but whether this happens along the entire stem in plants is unclear (30–33). There is an expectation that conduit diameter D should widen with distance from the stem tip L following a power-law (D ∝ L^b), but there is no agreement on the value of b, the conduit widening exponent (1, 2). Furthermore, even though within-individual tip-to-base conduit widening has been confirmed in a handful of species (34–36), and the scaling of conduit diameter with plant size across species is consistent with it (6, 10–12, 34), the expectation that conduits should widen similarly within stems across terrestrial vascular plant lineages and habits has yet to be empirically confirmed. Here we present the Widened Pipe Model (WPM), which correctly predicts the form of tip-to-base conduit widening across the span of plant size, life form, and habitat across the terrestrial plant phylogeny.     

Predicting potential liver toxicity from phase 2 data: a case study with ximelagatran

Ximelagatran was denied marketing approval in the USA and was withdrawn from those markets in which it had been approved, because of concerns over potential liver toxicity. A retrospective analysis of phase 2 data relating to liver toxicity is performed using the methods of extreme value modelling. The analysis reveals that the phase 2 data were predictive of the phase 3 results and, had the methods been available at the time, such analysis would have provided valuable information relating to the decision to proceed with further development of the compound. Copyright © 2014 John Wiley & Sons, Ltd.     

帕累托图及鱼骨图分析法在管理中成药合理用药中的应用

目的分析帕累托图及鱼骨图分析法在管理中成药合理用药中的作用。方法搜集2018年1-12月本院中成药专项点评不合理处方743份,采用帕累托图及鱼骨图进行分析,确定不合理用药的主要类型,找出根本原因,制定整改措施。结果整改前(2018年1-6月)中成药不合理用药处方为537张,整改后(2018年7-12月)为206张。帕累托图分析显示,不合理用药主要类型为:用法用量不适宜(25.33%)、适应证不适宜(15.26%)、禁忌证用药(14.71%)、联合用药不适宜(13.78%)、重复用药(10.43%)。整改后,处方不合格率由2.29%降至0.84%,差异有统计学意义(P<0.01)。结论利用帕累托图及鱼骨图分析法准确分析中成药不合理用药情况,有针对性地采取整改措施,可有效促进中成药合理用药。     

柏拉图分析法在阿尔茨海默病患者照顾者负性感受评价中的应用

目的：用柏拉图分析法对阿尔茨海默病（ AD）患者照顾者负性感受进行评价,对AD患者照顾者负性感受的主要问题及需求进行干预,使AD患者照顾者得到心理和情感支持,减轻负性感受。方法对46例AD患者照顾者进行回访调查,采用柏拉图分析法进行统计分析,找出照顾者需求及问题的要因,并采取针对性护理干预措施,6个月后再次调查,对比干预前后效果。结果干预前A（负担沉重感）、B（与社会分离）、C（体力上的疲倦）三项累积比为49．82％,D（家庭关系紧张）、E（缺乏社会支持）两项所占比重为28．57％（25％～75％）,F（知识的缺乏）、G（对患者感到厌恶）两项所占比重为21．61％（＜25％）。干预6个月后再次调查,A项被选例次从46次下降至30次,B项被选例次从45次下降至29次,C项被选例次从45次下降至25次,三项共计被选例次从136次降至84次。结论通过应用柏拉图分析法对AD患者照顾者负性感受进行统计分析,可发现其中的主要问题,同时也为缓解AD患者照顾者的心理压力、提高其生活质量、满足其身心需求提供了可靠依据。     

ED-NM-MO三联法对丹参三七配比的多目标优化研究

[目的]采用ED-NM-MO三联法对经基线等比增减设计的丹参、三七不同配比的药效学数据进行非线性拟合和多目标优化。[方法]对经基线等比增减设计的丹参、三七不同配比的药效学数据,以心肌缺血程度Σ-ST、心肌缺血程度(缺血区左室)等7个分别反映心肌缺血、心脏状态和血流动力学的指标作为待优化的药效目标,进行非线性拟合和多目标优化。[结果]分别得到针对7个药效指标和6个药效指标(不包含血清中心肌钙蛋白)的Pareto最优配比。[结论]ED-NM-MO三联法是一种适合复方特点的优化方法,可以应用于由多饮片多组分多成分复方药物的剂量配比优化。