目的 报道临床药师参与抗结核药物致结核性胸膜炎待诊患者多形红斑型药疹的临床药学实践的经验。 方法 1例结核性胸膜炎待诊患者在2011年11月3日出现皮疹后，临床药师根据患者的用药情况及病情变化，提供咨询意见，与临床医师共同制定不良反应的临床处理措施。 结果 推断为链霉素所致的多形红斑型药疹，积极处理后患者病情好转。 结论 临床药师参与药学监护，有利于处理药物不良反应。
In October 2022, thirteen government departments including the National Health Commission jointly issued the National Action Plan to Combat Antimicrobial Resistance (2022-2025) to proactively address challenges of antimicrobial resistance. In support of the implementation of the National Action Plan in healthcare institutions, the authors put forward following suggestions for prevention and control measures: strengthen construction of supporting systems and disciplines, enhance prevention and control of hospital-acquired infections caused by drug-resistant bacteria, promote precision diagnosis and treatment through diagnostic stewardship, advance rational drug use by performing prescription review, carry out universal and targeted training, establish clinical decision support systems using information technology, improve monitoring and evaluation systems, and enhance multi-source data fusion and application.
【摘要】 目的 探讨抗菌药物诱导尖端扭转型室速（torsade de pointes，TDP）的规律及特点，为临床合理用药提供参考。 方法 检索中国期刊全文数据库、维普、万方、中国生物医学文献数据库建库至2011年7月有关抗菌药物致TDP的病例报道，共16例，并进行分析。 结果 16例患者中男3例，女13例；年龄17～88岁，平均54岁。6例患者存在心脏疾病；诱导TDP的抗菌药物包括常用的莫西沙星、司帕沙星、头孢拉定、头孢哌酮、磷霉素、克林霉素、两性霉素B、氟康唑、伊曲康唑以及不常用的红霉素、酮康唑；TDP发生时间为用药后（5.1±6.6） d，多数患者先出现心悸、心电图提示QTc间期延长，进而出现TDP。 结论 临床医师、药师应重视抗菌药物诱导TDP的不良反应。【Abstract】 Objective To investigate the regularity and characteristics of antimicrobial agents-induced torsade de pointes(TDP),and to provide reference for rational use of drugs. Methods A total of 16 reported cases of antimicrobial agents-induced TDP were analyzed. Results The 16 cases including 3 males and 13 females at the age of 17-88 years with the mean age of 54. Six patients suffered from heart disease. The antimicrobial agents included moxifloxacin, sparfloxacin, cefradine, cefoperazone, fosfomycin, clindamycin, amphoterincin B, fluconazole, and itraconazole; which were used frequently, as well as some less frequently-used ones liked erythromycin, ketoconazole. The mean time from medication to onset of TDP was (5.1±6.6) days. Patients usually presented with palpitations at first following by prolonged QTc intervals, and then TDP appeared. Conclusion Clinical physicians and pharmacists should pay attention to antimicrobial agents-induced TDP.
ObjectiveTo research on the advances of stress ulcer drug prophylaxis. MethodsGuidelines for stress ulcer prophylaxis in and out of China were searched and analyzed. Risk factors for stress ulcer, recommended prevention drugs and safety of medicines were summarized. ResultsThe risk factors for stress ulcer included mechanical ventilation, coagulopathy, severe sepsis, multiple organ failure, shock, severe head injury, burns, major trauma, older than 65 and drug use. The recommended prevention drugs included proton pump inhibitors, H2-receptor antagonist and misoprostol, which played a role in the reduction of bleeding in intensive care units. However, recommended drugs had little function in the reduction of bleeding in general patients outside the intensive care units, which was even not recommended or supported in the clinical literature. Related adverse effects of these drugs also needed careful consideration. ConclusionExistence of risk factors for stress ulcer does not necessarily indicate the use of preventive drugs. Drug prophylaxis is used only for critically ill patients. This view summarized by the author provides a reference for physicians and pharmacists.
Objective To investigate the method and effect of continuous improvement of adverse drug reaction (ADR) monitoring in a major public hospital’s cooperating branch hospital. Methods PDCA cycle management was used to continuously improve the quality of ADR monitoring. ADR report network platform was established in the fourth quarter of 2014; ADR report specification training for the medical personnel was held in the first quarter of 2015; a examine mechanism was built in the second quarter of 2015. The quality and quantity of ADR monitoring before and after the PDCA cycle management were analyzed. Results ADR report timeliness conform to the requirements increased from 45.5% (from the first to third quarter of 2014) to 98.1% (from the fourth quarter of 2014 to the second quarter of 2015); accurate ADR types checking, normal name writting, and complete process description increased from 68.6%, 65.7%, 8.6% (from January 2014 to Frequency 2015) to 92.9%, 96.4%, 85.7% (from March to June 2015); the quantity of ADR report was obviously improved. Conclusion Learning from public hospital’s experience and considering its own condition in ADR monitoring, cooperating branch hospital utilizes PDCA cycle management which could continuously improve the ADR monitoring.
ObjectivesTo evaluate the current situation and rationality of electronic prescription in retail pharmacies in Chengdu, so as to provide references for further improving the sales of prescription drugs in retail drugstores and the level of rational drug use.MethodsA set of evaluation index system was constructed, and a prescription review group was set up. Eventually, 7 200 sample electronic prescriptions were collected for retrospective analysis and evaluation.ResultsPrescriptions from private medical institutions constituted the majority (3 543, 49.21%), and the majority of patients were junior and middle-aged, primarily respiratory diseases (38.24%) and circulatory diseases (17.11%), etc. The average quantity of drugs was 1.60 per prescription, percentage of antimicrobial use was 65.25%, percentage of essential medicines used was 34.92%, and reasonable rate of prescription was 95.21%.ConclusionsElectronic prescription services mode for retail pharmacy follows with the trend of “Internet + drug circulation” and complies with the rules of reasonable medical guidance and medication. However, optimizations are required, such as the lack of high-quality medical resources and the urgent need to optimize structure of prescription, and it is still essential to strengthen the management of antibacterial drugs and national essential medicines.
Objective To provide baseline date for further research by retrospectively investigating the disease constitution of over-60-year old patients in the West China Hospital of Sichuan University in 2011. Methods The information of over-60-year old outpatients was extracted from HIS and their diagnoses were classified by ICD-10. The data of single disease among top 3 categories of diseases were rearranged and analyzed by Excel software. Results The total of over-60-year old outpatients was 895 123 person-time in 2011, accounting for 19.65%, including 716 826 person-time in specialist outpatient clinics. The specialist diagnoses of 683 491 person-time could be classified by ICD-10, accounting for 95.35% of specialist outpatients. The top 12 diseases were neoplasm, circulatory, digestive, factors influencing health status and contacting with health services, respiratory, musculoskeletal system and connective tissues, nervous, eyes, symptoms/signs and abnormal clinical and laboratory findings, non-classified, mental and behavioral disorders, endocrine, and genitourinary system diseases, and the cumulative constituent ratio was 92.96%. The main pathogenic sites of neoplasm were bronchus and lung (21.98%), esophagus (8.66%), stomach (8.10%), rectum (7.37%), prostate (5.86%), and liver and intrahepatic bile ducts (5.55%), with a cumulative constituent ratio of 57.72%. The main disease burden in circulatory system was hypertension (39.50%), chronic ischaemic heart disease (11.17%), and cerebral infarction (9.70%), and the cumulative constituent ratio was 60.38%. While the main disease burden in digestive system was gastritis and duodenitis (24.98%), other diseases of digestive system (9.26%), and other diseases of liver (8.90%), and the cumulative constituent ratio was 43.13%. There were more female than male among the over-60-year old outpatients (50.67% vs. 49.33%), and male was higher than female only in the incidence of neoplasm, respiratory, factors influencing health status and contacting with health services, and genitourinary system diseases. The disease constitution ratio of 60-69 years old patients was 58.21%. The top 3 neoplasm were the malignant tumors in digestive (38.20%), respiratory and intrathoracic organs (24.70%), and lymphoid, haematopoietic and related tissue (11.97%), with a cumulative constituent ratio of 74.87%. Conclusion The top 3 disease burden of over-60-year old outpatients in West China Hospital were neoplasm, circulatory and digestive diseases, which reflects the trend and law of treatment demands of old patients. It needs to deeply analyze the frequency and flow pattern of patients, and to provide evidence for preventing and treating geriatric diseases.