Prevalence of hepatitis C infection among intravenous drug users in Shanghai

AIM:To characterize the prevalence of hepatitis C virus(HCV)infection among Chinese intravenous drug users(IDUs).METHODS:A total of 432 adult IDUs(95 women and337 men)in Shanghai were included in the study.The third-generation Elecsys Anti-HCV assay(Roche Diagnostics GmbH,Sandhofer Strasse 116,D-68305,Mannheim,Germany)was used to screen for antibodies against HCV.The RIBA strip,a supplemental antiHCV test with high specificity,was performed on all of the samples that tested positive during the initial screening.All of the anti-HCV positive samples were analyzed with a Cobas TaqMan 48 Analyzer(Roche Diagnostics)for direct detection of HCV RNA.All of the HCV RNA-positive samples were sequenced for genotype determination.RESULTS:The preliminary screening identified 262(60.6%)subjects who were seropositive for HCV.Of the 62 females and 200 males seropositive subjects,16(16.7%)and 65(19.3%),respectively,were confirmed by RIBA,yielding an overall HCV seropositive rate of18.8%.Four female(6.5%)and 14 male(7.0%)subjects tested positive for HCV RNA,indicating an active infection rate of 4.2%for the entire study population.The 18 HCV RNA-positive serum samples were genotyped.Seven individuals were genotype 1b,and four were genotype 1a.One individual each was infected with genotypes 2a,2b and 3a.Four subjects were coinfected with multiple strains:two with genotypes 1a and 2a,and two with genotypes 1b and 2a.The active infection rate among HCV-seropositive individuals was22.2%,which was significantly lower than most estimates.CONCLUSION:The prevalence of HCV is relatively low among IDUs in Shanghai,with a spontaneous recovery rate much higher than previous estimates.

Progress in oncolytic viruses modified with nanomaterials for intravenous application

In oncolytic virus(OV)therapy,a critical component of tumor immunotherapy,viruses selectively infect,replicate within,and eventually destroy tumor cells.Simultaneously,this therapy activates immune responses and mobilizes immune cells,thereby eliminating residual or distant cancer cells.However,because of OVs’high immunogenicity and immune clearance during circulation,their clinical applications are currently limited to intratumoral injections,and their use is severely restricted.In recent years,numerous studies have used nanomaterials to modify OVs to decrease virulence and increase safety for intravenous injection.The most commonly used nanomaterials for modifying OVs are liposomes,polymers,and albumin,because of their biosafety,practicability,and effectiveness.The aim of this review is to summarize progress in the use of these nanomaterials in preclinical experiments to modify OVs and to discuss the challenges encountered from basic research to clinical application.

Epidemiology of Hepatitis B,C,D and G Viruses and Cytokine Levels among Intravenous Drug Users

To investigate the features of various hepatitis virus infection in intravenous drug users （IVDU）, we conducted an epidemiological survey of hepatitis viruses including hepatitis B virus （HBV）, hepatitis C virus （HCV）, hepatitis D virus （HDV） and hepatitis G virus （HGV） in IVDU. The correlation of Tn lymphocyte cytokine and hepatitis virus infection was examined. A. study population of 406 IVDU consisted of 383 males and 23 females. HBV-DNA and HCV-RNA were detected by fluorescence quantitative polymerase chain reaction. HBsAg, HBeAg, anti-HBc, anti-HCV, HDV-Ag and anti-HGV were assayed by ELISA. The levels of cytokines of TH1 and TH2 were measured by ELISA. The similar indices taken from 102 healthy persons served as controls. The infection rate of each virus among IVDU was 36.45% for HBV, 69. 7 % for HCV, 2.22 % for HDV, and 1.97 % for HGV, respectively. The co-infection rate of HBV and HCV was detected in 113 of 406 （27. 83 %）. In contrast, among controls, the infection rate was 17.65% for HBV and 0% for the other hepatitis viruses. The levels of PHA-induced cytokines （IFN-γ and IL-4） and the level of serum IL-2 were obviously decreased in IVDU. On the other hand, the level of serum IL-4 was increased. The IFN-γ level was continuously decreased when the IVDU was infected with HBV/HCV. In conclusion, HBV and HCV infection were common in this population of IVDU and they had led to a high incidence of impaired TH 1 cytokine levels.

Study on the blood-borne virus co-infection and T lymphocyte subset among intravenous drug users

AIM: To investigate the features of various blood- borne virus infections and co-infection in intravenous drug users (IDUs), and to examine the correlation of T lymphocyte subsets with virus co-infection. METHODS: Four hundred and six IDUs without any clinical manifestation of hepatitis and 102 healthy persons were enrolled in this study. HBV-DNA and HCV-RNA were detected by fluorescence quantitative PCR. HBsAg, HBeAg, anti-HBc, anti-HCV, HDV-Ag, anti-HGV, anti-HIV, and HCMV-IgM were assayed by enzyme-linked immunosorbent assay (ELISA) and immunochromatographic tests. The levels of Th1 and Th2 cytokines were measured by ELISA and radioactive immune assay (RIA). The T lymphocyte subpopulation was detected by using fluorescence immunoassay. The similar indices taken from the healthy persons served as controls. RESULTS: The viral infection rate among IDUs was 36.45% for HBV, 69.7% for HCV, 47.3% for HIV, 2.22% for HDV, 1.97% for HGV, and 3.45% for HCMV. The co- infection rate of blood-borne virus was detected in 255 of 406 (62.81%) IDUs. More than 80% (161/192) of subjects infected with HIV were co-infected with the other viruses, such as HBV, HCV. In contrast, among the controls, the infection rate was 17.65% for HBV and 0% for the other viruses. Our investigation showed that there was a profound decrease in the proportion of CD4/CD8 and the percentage of CD3 and CD4, but not in the percentage of CD8. The levels of PHA-induced cytokines (IFN-γ and IL-4) and serum IL-2 were obviously decreased in IDUs. On the other hand, the level ofserum IL-4 was increased. The level of IFN-γ and the percentage of CD4 were continuously decreased when the IDUs were infected with HIV or HIV co-infection. IDUs with HIV and HBV co-infection was 15.1% (29/192). Of those 29 IDU with HIV and HBV co-infection, 51.72% (15/29) and 37.93% (11/29) were HBV-DNA-positive and HBeAg-positive, respectively. But, among IDUs without HIV infection, only 1.68% (2/119) of cases were HBV- DNA-positive. CONCLUSION: HCV, HBV and HIV infections are common in this population of IDU, leading to a high incidence of impaired Th1 cytokine levels and CD4 lymphocyte. IDUs with HIV and HBV/HCV co-infection have lower expression of Th1 cytokine with enhancement of the Th2 response. HIV may be causing HBV replication by decreasing Th1 function.

Optimization of the intravenous infusion workflow in the isolation ward for patients with coronavirus disease 2019

Objective:This study aimed to evaluate the effect of optimization of the intravenous infusion workflow in isolation wards for patients with coronavirus disease 2019.Methods:The infusion management group optimized the intravenous infusion workflow based on Hamer's Process Reengineering Theory and applied it to the treatment of patients with coronavirus disease 2019.The work efficiency,patients'satisfaction and economic indicators before and after optimization were compared.Results:After the infusion workflow was optimized,average times for preparation drugs and intravenous admixture,and patients'waiting time decreased from 4.84 min,4.03 min,and 34.33 min to 3.50 min,2.60 min,and 30.87 min,respectively,patients'satisfaction increased from 66.7%to 93.3%,and the cost of personal protective equipment(PPE)decreased from 46.67 sets and 186.6 CNY per day to 36.17 sets and 144.6 CNY,with statistical significance.Conclusion:The optimization of the intravenous infusion workflow can effectively decrease the cost of PPE while improving the efficiency of infusion and patients'satisfaction.

Biogenic Amine Neurotransmitter Response to Morphine in the Anterior Cingulate Cortex Predicts Propensity for Acquiring Self-Administration and the Intensity of the Withdrawal Syndrome

Individual differences in behavioral characteristics or initial responses to abused drugs had been recently demonstrated to have predictive value in the propensity of later abuse. The research described here was initiated to determine the initial response of rats to administration of morphine if the physiological response has predictive value for the propensity of the animals to later self-administration. The initial response of extracellular fluid levels of the biogenic monoamine neurotransmitters in the anterior cingulate cortex (aCC) was assessed in drug rats with in vivo microdialysis following administration of morphine. Rats that did not acquire morphine self-administration (NSA) had higher baseline levels of aCC extracellular fluid levels of dopamine (DA) and 3,4-dihydroxyphenylacetic acid (DOPAC) than animals that developed stable morphine self-administration (SA). However, the response independent administration of morphine resulted in a dramatic increase in (DA) in aCC in the SA group, while the morphine injection in the NSA rats increased extracellular fluid levels of noradrenaline (NA). It is possible that these differences might be related to the development of physical dependence. Therefore, the development of physical dependence was observed in these animals. There was no relationship between the propensity to self-administration morphine and the development of physical dependence. Rats that showed the highest withdrawal scores had lower extracellular fluid levels of serotonin (5-HT) compared to rats showing low withdrawal scores. Thus, monoamine neuronal innervations of the aCC respond to an initial dose of morphine that is predictive of the later propensity to self-administration and the resistance and predisposition to the formation of opiate dependence, but there is no relationship between these two indices in individual animals. These data add to a growing body of evidence for the involvement of neuronal systems in the aCC in the actions of opiates.

Intracranial Abscess Post Intravenous Misuse of Transdermal Fentanyl in an Immunocompetent Patient

Infections, including intracranial abscesses, are a well-known and potentially serious complication of intravenous drug abuse. There have been increasing reports of intravenous misuse of transdermal Fentanyl, with severe sequelae. Intracranial abscesses in intravenous drug users tend to involve uncommon pathogens, and may present with atypical symptoms, which can lead to delayed diagnosis and inadequate treatment. We present the case of a 28-year-old female, with a history of intravenous misuse of transdermal Fentanyl, who was found to have intracranial abscesses with Fusobacterium nucleatum and Nocardia species, causing significant vasogenic oedema and mass effect.

精细管理在静脉药物集中调配中心药品调配管理中的应用效果分析

目的:探讨精细管理在医院静脉药物集中调配中心(简称静配中心)药品调配管理中的应用效果。方法:贵州航天医院静配中心于2019年1月开始实施精细管理,以此时间分为管理前与管理后。管理前实施常规管理,管理后实施精细管理。比较管理前后不良事件和出门差错发生情况、病房医护人员对静配中心管理情况的满意度。结果:管理后,不良事件及出门差错发生率低于管理前,差异有统计学意义(P<0.001)。管理后,病房医护人员对静配中心管理情况的总满意度高于管理前,差异有统计学意义(P<0.001)。结论:精细管理能够降低静配中心工作差错率,提高病房医护人员对静配中心管理情况的满意度。

静脉用药调配中心护理管理中应用目视管理模式的干预效果

目的:探讨静脉用药调配中心(PIVAS)护理管理中应用目视管理模式的干预效果。方法:选取2022年1—6月滨州医学院附属医院PIVAS应用常规管理模式的工作人员12名作为常规管理组,选取2022年7—12月滨州医学院附属医院PIVAS应用目视管理方案的工作人员12名作为目视管理组。比较两组病区医护人员满意度及不良事件发生率。结果:目视管理组服务态度、接受处方及退药及时准确性、药物分批次合理性、药物配置准确性、药物配送及时准确性评分均高于常规管理组,差异有统计学意义(P<0.001);目视管理组不良事件发生率低于常规管理组,差异有统计学意义(P<0.001)。结论:PIVAS护理管理期间,以目视管理模式为干预对策,不仅能够提高病区医护人员的满意度,还可降低不良事件发生率。

某院静脉用药调配中心抗肿瘤药物不合理医嘱评价结果分析

目的探讨某院静脉用药调配中心抗肿瘤药物不合理医嘱的原因,根据不合理的原因制定个性化的对策,规范患者合理、安全用药。方法收集某院2023年静脉用药调配中心抗肿瘤药物不合理医嘱的记录共258条,统计这些不合理医嘱的药物种类、科室分布,以及记录不合理医嘱的原因,并采取针对性的措施,减少不合理医嘱。结果统计分析显示,某院2023年静脉用药调配中心抗肿瘤药物不合理医嘱共258张,其中放疗科、肿瘤科、胸外科的不合理医嘱比率占前三位,分别为32.17%、21.71%、20.16%;不合理类型中溶媒选择不合理的占比最高,为43.41%,其次分别为溶媒用量、浓度不合理,用药剂量不合理,用药顺序不合理,配伍不当,其他,占比分别为29.07%、15.50%、5.04%、4.26%、2.71%。112张抗肿瘤药物溶媒选择不合理医嘱中,注射用依托泊苷溶媒选择不合理最多,占比为33.04%。75张抗肿瘤药物溶媒用量、浓度不合理医嘱中,注射用吉西他滨溶媒用量、浓度不合理最多,占比为24.00%。40张抗肿瘤药物用药剂量不合理医嘱中,复方苦参注射液超量使用最多,占比为40.00%。结论评价静脉用药调配中心抗肿瘤药物不合理医嘱发生具体原因,加强合理用药管理,采取针对性的措施,可保障抗肿瘤药物合理应用。

医院静脉用药调配中心抗肿瘤药物配置的精益管理

目的研究分析精益管理在医院静脉用药调配中心(Pharmacy Intravenous Admixture Services,PIVAS)抗肿瘤药物配置中的应用效果。方法选取2022年1月—2023年12月滨州市中心医院PIVAS的22名抗肿瘤药物配置工作人员作为研究对象,按照时间的不同,设为对照组(实施常规管理,2022年1—12月)和观察组(实施精益管理,2023年1—12月)。对比分析两组的管理效果。结果观察组的审方、配置、排药时间均短于对照组,差异有统计学意义(P均<0.05)。观察组药物配置环节差错发生率比对照组低,差异有统计学意义(P均<0.05)。观察组的总满意度高于对照组,差异有统计学意义(P<0.05)。结论在PIVAS抗肿瘤药物配置中,采取精益管理能够获取良好效益,可有效提升药物配置质量,同时能够有效减少差错事件发生,为临床抗肿瘤药物的合理用药提供了保障。

品管圈管理在静脉用药调配中心的应用效果

目的:观察品管圈管理在静脉用药调配中心(PIVAS)的应用效果。方法:选取2020年1—12月该院PIVAS的46名护士作为对照组,实施常规管理;另选取2021年1—12月该院PIVAS的46名护士作为观察组,实施品管圈管理。比较两组配药安全知识知晓率、药物配制差错率和药物配送时间延长率。结果:观察组药物配置流程、药物配伍禁忌、药物剂量换算、用药前正确评估患者、药物输注流程、输注时观察要点等配药安全知识知晓率均高于对照组,差异有统计学意义(P<0.05);观察组药物配置差错率为0.48%(12/2500),低于对照组的2.32%(58/2500),差异有统计学意义(P<0.05);观察组药物配送延长率为0.36%(9/2500),低于对照组的2.48%(62/2500),差异有统计学意义(P<0.05)。结论:品管圈管理应用于PIVAS可提高配药安全知识知晓率,以及降低药物配制差错率和药物配送时间延长率的效果优于常规管理效果。

医疗机构静脉用药评价与遴选专家共识

近年来国家卫生健康委员会将提高住院患者静脉输液规范使用率作为医疗质量安全改进目标之一,而医疗机构配备合理的静脉用药是规范使用静脉输液的前提,因此建立适宜的静脉用药评价与遴选体系势在必行。中国药学会静脉用药调配管理专业委员会在前期工作基础上,组织专家讨论“静脉用药评价与遴选量化记录表”的维度设置、分值分配及评分细则,编写《医疗机构静脉用药评价与遴选专家共识》,旨在为医疗机构静脉用药遴选、临床用药方案决策提供参考,提升合理用药水平,保障患者接受安全、有效、经济、适宜的药物治疗。

肿瘤静脉化疗安全用药规范的构建

目的 :构建一套由多学科团队参与、涵盖化疗用药全环节的肿瘤静脉化疗安全用药规范,为化疗药物规范化使用提供参考。方法 :以物理-事理-人理系统方法论为指导,采用文献研究法形成规范初稿,通过专家会议对初稿进行讨论和修订后形成咨询稿,应用德尔菲专家咨询形成终稿。结果 :共对18名专家进行了3轮专家咨询,问卷回收率均为100%,专家权威系数分别为0.895、0.890、0.885,总条目的肯德尔协调系数为0.147~0.166(均P<0.001),三级条目的可操作性肯德尔协调系数为0.168~0.207(均P<0.001)。肿瘤静脉化疗安全用药规范包括4个一级条目(人员、环境、流程、监测与随访)、14个二级条目、47个三级条目,以及36个条目说明。结论:本研究构建的肿瘤静脉化疗安全用药规范纳入了“医-药-护”多学科专业规范要求,包含人员资质、用药环境、用药流程、监测与随访等全流程,有利于静脉化疗实践的多学科沟通合作,促进化疗用药过程的规范化和同质化,保障患者化疗用药安全。

静脉用药自动调配药学管理中国专家共识(2023)

静脉用药自动调配装置是一种智能化设备,旨在模仿人工配药过程,通过相应程序及机械结构实现静脉输液药品的配置。该装置的应用加速了智慧化医院建设,提高了静脉用药配置的效率和准确性,同时减少了医务人员的职业伤害风险。然而,与此装置的广泛应用趋势相比,相关的管理共识更新滞后,缺乏统一标准,且其操作的正确性和配置药物的安全性尚未得到充分验证,可能存在潜在的临床风险。为规范静脉用药自动调配装置的管理和使用,中国医疗保健国际交流促进会临床药学分会在国家癌症中心的指导下联合全国多学科专家,基于现有药品临床使用领域的循证证据、药事管理相关法规和药学服务实践,采用德尔菲法和专家会议法制定了《静脉用药自动调配药学管理中国专家共识(2023)》。该共识拓展并延伸了静脉用药自动调配药学管理的内涵,构建了全方位的药学管理体系,为药师进行静脉用药自动调配药学管理提供了科学依据。

精益管理在静脉用药集中调配中心药物配置中的应用

目的 分析在静脉用药集中调配中心配置环节中应用精益管理的效果。方法 抽取2022年1月—2023年1月期间我院静脉用药集中调配中心收到的医嘱3000组,2022年1月—2022年6月(未实施精益管理)期间的1500组医嘱为对照组,2022年7月—2023年1月(实施精益管理)期间的1500组医嘱为观察组。对比两组的细胞毒性药物调配过程中各个环节差错发生率、药物配置时间、药物残余液体量、病区医护工作人员对调配中心配置环节的满意度。结果 观察组细胞毒性药物调配过程中各个环节差错发生率均比对照组低(均P <0.05);观察组药物配置时间用时比对照组短、药物残余液体量比对照组少(均P <0.05);病区医护工作人员对观察组的满意度更高(P <0.05)。结论 在静脉用药集中调配中心配置环节中实施精益管理可降低配置环节差错率、提高配置工作效率、减少浪费、提高病区医护工作人员对配置环节工作的满意度。

基于DRG支付的药事管理干预对基层医院静脉输液合理使用的影响

目的促进医院合理使用静脉输液。方法基于疾病诊断相关分组(DRG)支付进行药事管理干预,干预时间为2021年10月至12月,干预手段包括加强宣传教育培训,梳理静脉输液药品品种与疾病谱,制订病种相应临床路径,增加输液处方专项点评内容,将不合理处方开具情况纳入绩效考核,开展信息系统管控。通过医院信息系统与合理用药软件提取医院门/急诊与住院部2021年1月至9月(药事管理干预前)与2022年1月至9月(药事管理干预后)的病例资料,分析干预前后全部处方及含抗菌药物、含中药注射剂、含激素类药物(或辅助药品)处方中静脉输液相关指标及住院病例DRG相关药事指标。结果静脉输液相关指标,与干预前比较,干预后的门/急诊患者总体及不同类型药物静脉输液率(以人次、处方数计)均显著降低(P<0.01),住院患者除抗菌药物外的静脉输液率(以人次计)均显著降低(P<0.01);门/急诊与住院患者药品使用金额均不同幅度降低;门/急诊患者处方退回修改率显著升高(3.54%比2.41%,P<0.01);患者对静脉输液服务的总满意度显著升高(94.20%比73.20%,P<0.01)。DRG相关指标,与干预前比较,干预后的住院患者DRG总权重、病例组合指数(CMI)及基本药物使用金额占比均升高,费用消耗指数、时间消耗指数和患者次均费用均降低,且患者死亡率及静脉输液药品结构比、辅助药品结构比、次均药费、次均辅助药费均降低。结论该药事管理模式显著降低了静脉输液率,并提高了医院合理用药水平,减少了患者的就医费用,并提高了患者满意度,继而整体提升了该院的医疗服务能力。

M00201-BW型医用配药抽吸泵用于静脉用药调配效果分析

目的 探讨M00201-BW型医用配药抽吸泵用于静脉用药调配的效果。方法 选取医院静脉用药调配中心(PIVAS)常用的8种常用化学治疗药物各300支(瓶),分为研究组和对照组。两组各调配5组药品,每组调配240支(瓶)。研究组使用M00201-BW型医用配药抽吸泵辅助传统人工调配,对照组使用传统人工调配,比较两组的调配时间、药品残留量、胶塞脱落数量及调配差错、针刺伤发生情况。结果 研究组单支(瓶)平均调配时间为9.10 s,短于对照组的12.29 s;研究组的调配差错发生率为0.42%,低于对照组的0.92%;研究组胶塞脱落5个,少于对照组的12个;两组药品残留量均在可控限度标准内,且研究组均显著少于对照组(P <0.05)。结论 M00201-BW型医用配药抽吸泵用于静脉用药调配的效果良好,可节约调配时间,减少药品残留量且符合限度控制标准,提高工作效率和成品输液质量,降低PIVAS调配药师的职业风险。

360例小儿静脉用抗肿瘤药物医嘱的合理性分析

目的分析360例小儿静脉用抗肿瘤药物医嘱的合理性,优化临床合理用药提供参考。方法应用智能辅助决策系统检索我院2022年6月至2023年5月住院静脉药物配制中心所有的抗肿瘤药物医嘱,包括系统审核通过与拦截医嘱,共22905例,采用随机函数抽样方法抽取360例医嘱进行分析。统计医嘱涉及患儿性别、年龄、医嘱对应科室、疾病类型、化疗药物、用法等信息,通过查询说明书、临床指南等相关文献,分析医嘱的合理性。结果本研究共纳入360例小儿静脉用抗肿瘤药物医嘱,患儿性别以男性多见,共216例(60.00%),年龄分布以3~6岁最多,共128例(35.56%);医嘱来源科室主要为血液科,共213例(59.17%);医嘱诊断疾病共44种,其中以急性淋巴细胞白血病最多,共81例(22.50%);医嘱涉及抗肿瘤药物共22种,以甲氨蝶呤最多,共52例(14.44%);存在拦截医嘱4例(1.11%),包括溶媒不适宜2例(50.00%),剂量不适宜1例(25.00%),使用时间不适宜1例(25.00%)。结论我院小儿静脉用抗肿瘤药物医嘱存在系统拦截不适宜情况,应加强相关医护专业培训,减少不适宜医嘱发生率,促进临床合理用药。

我院静脉配置中心抗肿瘤药不合理用药分析

目的分析我院静脉用药调配中心抗肿瘤药不合理用药情况,为临床抗肿瘤静脉用药提供参考,促进临床合理用药,保障肿瘤患者用药安全。方法我院2022年度住院静脉用药调配中心抗肿瘤用药医嘱10098份,依据药品说明书、相关文献等相关资料对87份不合理医嘱进行统计分析。结果我院2022年度住院静脉用药调配中心医嘱10098份,其中有不合理用药医嘱87份,每个科室均存在不合理用药情况,妇科的不合理医嘱数最多,其占比23.08%;静脉用药调配中心抗肿瘤药不合理用药情况主要包括溶媒错误(40.23%)、药物剂量不合理(29.89%)、给药顺序不合理(18.39%)、给药时间不合理(11.49%)。结论应加强我院的静脉用药调配中心抗肿瘤药不合理用药情况和抗肿瘤药溶媒管理,加强医师对抗肿瘤药物性质的认知,合理规范选择药物,同时药剂师应严格审核医嘱,以最大幅度减少不合理用药情况。