Practice of Perioperative Rational Use of Antibacterial Drugs Based on Drug Pathway

[Objectives]To establish a new management model for rational use of perioperative antibacterial drugs in surgical departments.[Methods]Based on evidence-based medicine,the department s drug pathway was formulated,and the new mode of rational drug use control was established by using fine pharmaceutical technology intervention,and the intervention effect was evaluated by the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs.[Results]After adopting drug pathway in departments,the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs decreased significantly,and the effect of rational drug use control was remarkable.[Conclusions]The drug pathway provides a new management and control mode for the rational use of perioperative antibacterial drugs in surgical departments of hospitals.Thus,it is worthy of popularization and application.

Present situation of rational drug use in plateau area

Plateau is characterized by low oxygen,low pressure,strong radiation,cold and dryness,among which low oxygen is the main factor that affects the normal life activities of human body.Altitude hypoxia leads to significant changes in the metabolic characteristics of drugs in vivo,which in turn affects the efficacy and adverse actions of drugs.This paper summarizes the present situation of rational drug use in plateau area and pinpoints the existing problems.Meanwhile,we posit the strategies and measures for realizing rational and precise pharmacotherapy of plateau residents.First,we need to acquire a panoramic view of differential and relative pharmacokinetics and pharmacodynamics in between plateau area and plain area by carrying out comparative studies on drug metabolisms and on comprehensive drug efficacies and mechanisms.Second,we must apply the findings from basic research to clinical practice and formulate guidelines and recommendations of drug use for plateau habitants.Finally,we should eventually achieve precise and individualized drug use for plateau habitants based on their characteristic etiology and pathogenesis.

The Level of Knowledge, Behaviors, and Attitudes on Rational Use of Drugs of Patients Who Applied to the Family Health Center in Istanbul, Türkiye: A Cross-Sectional Study

Background: This study, it was aimed to determine the level of knowledge, attitudes, and behaviors of patients who applied to a family health center about the rational use of drugs. Irrational use of drugs is a major problem worldwide. WHO reports that half of the patients do not use their drugs correctly. Methods: This cross-sectional study was conducted between 1 October 2017 and 30 November 2018 at Istanbul Fatih Family Health Center No 7. The sample size was determined as 301 people selected by systematic sampling method from patients aged 18 and older. Results: The mean age of the participants was 53.8% ± 16.8%, 59.8% were female, 62.5% were married, and 52.5% were primary school graduates. 63.9% of the participants knew the names of the drugs they used, and 79.9% of them knew the indication for use. 89% of individuals check the expiry date of the drugs before using them, and 83.1% read the drug prospectus. 84% of the participants support the prohibition of using over-the-counter drugs. Conclusion: The level of knowledge of the participants about the rational use of drugs is above the societal average. However, some issues need more awareness. The high level of rational use of drugs awareness of physicians and pharmacists will also strengthen the rational use of drugs and indirectly increase the awareness of the public.

Analysis on the Problems of Rational Drug Use Carrying Out by Hospital Pharmacists in China

Pharmacists are the implementers of clinical drug management, and they play an irreplaceable role in promoting the improvement of rational drug use. However, the current role of pharmacists in the supervision and protection of rational drug use has not been fully exerted. This article is aimed to investigate the current situation of pharmacists’ work of rational drug use from the perspectives of pharmacists, physicians, and patients. It is found that the professional value of pharmacists in the rational drug use has not been valued by medical institutions, physicians, and patients. Pharmacists face problems such as workload, working conditions, and doctor-patient cooperation in the rational drug use. Suggestions are made for further exerting the professional value of pharmacists in promoting the level of rational drug use. Relevant managers should pay full attention to the professional value of pharmacists, and provide corresponding system and facility guarantees for pharmacists to carry out rational drug use.

The Guiding Role of Pharmaceutical Care in the Rational Drug Use of Bronchial Asthma

Objective:To investigate the guiding role of pharmaceutical care in the treatment of bronchial asthma.Methods:Eighty patients with bronchial disease admitted to our hospital from November 2008 to December 1818 were enrolled in this research.The computer program was used to generate random numbers.The method was divided into two groups:control group and observation group,40 cases respectively.40 patients in the control group were treated with normal medication according to the doctor’s advice;40 patients in the observation group were enrolled in the pharmacological care on the basis of the control group,and the rational drug use was compared between the two groups.Results:The incidence of adverse reactions in the observation group and the control group were 5.00%and 17.50%,respectively,and the difference was statistically significant(P<0.05);the incidence of medication error events in the observation group was 7.50%,which was significantly lower than that of the control group,which was 25.00%,and the difference was statistically significant(P<0.05).The medication errors mainly include improper administration,incorrect dosage,and unscientific administration.Conclusion:The guiding role of pharmaceutical care in bronchial asthma rational drug use can reduce medication error events and ensure rational drug use,which is worthy of popularization in clinical practice.

The role of drug utilization evaluation in medical sciences

Background:Drug utilization evaluation(DUE)is defined by the World Health Organization(WHO)and focuses on the medical,social,and economic consequences of pharmaceutical marketing,distribution,prescribing,and usage in society.The WHO recommends a physician to every 1000 people.According to the recent data from the Health Ministry in 2019,in which 1.16 million doctors are of active population with just 80%,or 0.9 million,practicing.As a result,a ratio of 0.68 doctors for every 1000 people,which is much below as per the WHO reports.This article describes history,types,WHO guidelines,need and purpose of DUE.Objective:The main aim of this paper is to provide information about the rational use of medication in outpa­tient and inpatient department with special emphasis of DUEs.It also provides awareness directly to healthcare professionals,researchers,academicians,pharmacist and nurses to reduce the irrationality of medicines.Methods:The method used to compile this review information gathered from websites,Google scholar,PubMed,Research gate,and studies published on DUE from July 20 to Oct 22 were included as source of information.Results:We studied more than 35 published study on DUE,that reveals most of the physicians prescribed branded drugs not generic drugs,but WHO prescribing indicator allows to prescribe generic drugs in the hospital pharmacy to maintain better inventory control.It may also help to prevent pharmacist misunderstanding during dispensing.Conclusion:The use of generic prescription names avoids the possibility of medication product duplication and lowers patient costs.It is important to remember that incorrect medication prescriptions have impact on both patients and their family members.WHO indicators identify irrational prescribing behaviours to make therapy more rational and cost-effective.

药品集中带量采购对抗菌药物使用的影响分析:以阿莫西林为例

目的分析抗菌药物集中带量采购(以下简称“集采”)后使用变化,为完善我国带量采购政策和促进合理用药提供参考。方法采用描述性统计分析和间断时间序列分析方法,将第二批和第三批药品集采政策落地时间设为政策干预点,分析2019年1月—2021年12月全国医药企业阿莫西林销售量和销售金额在集采前后的变化情况。结果阿莫西林胶囊剂和颗粒剂在集采后销售量大幅上升,非中选的胶囊剂和颗粒剂销售量也有所上升,但涨幅低于市场整体增长率。非集采剂型中的阿莫西林片剂和混悬剂销售量和销售金额均出现降低,口服剂型中选能有效降低同为口服剂型的其他非集采品规销售量,阿莫西林注射剂销售量和销售金额在集采后短期内明显增长,通过模型预测阿莫西林注射剂长期的销售量和销售金额呈下降趋势。结论药品带量采购能够实现药价降低且达成以量换价的目标,中选药品使用量显著增长,但需要关注同通用名下非集采剂型的使用量情况,减少不同剂型间替代使用的情况;应该进一步扩大抗菌药物集采范围,将更多临床具体替代关系的药物纳入采购范畴,加强对临床抗菌药物的使用监测,保障临床抗菌药物合理使用。

Clinical pharmacists’ involvement in carbapenem antibiotics management at Wenzhou Integrated Hospital

BACKGROUND Carbapenem antibiotics are a pivotal solution for severe infections,particularly in hospital settings.The emergence of carbapenem-resistant bacteria owing to the irrational and extensive use of carbapenems underscores the need for meticulous management and rational use.Clinical pharmacists,with their specialized training and extensive knowledge,play a substantial role in ensuring the judicious use of carbapenem.This study aimed to elucidate the patterns of carbapenem use and shed light on the integral role played by clinical pharmacists in managing and promoting the rational use of carbapenem antibiotics at Wenzhou Integrated Traditional Chinese and Western Medicine Hospital.AIM To analyze carbapenem use patterns in our hospital and role of clinical pharmacists in managing and promoting their rational use.METHODS We performed a retrospective analysis of carbapenem use at our hospital between January 2019 and December 2021.Several key indicators,including the drug utilization index,defined daily doses(DDDs),proportion of antimicrobial drug costs to total hospitalization expenses,antibiotic utilization density,and utilization rates in different clinical departments were comprehensively analyzed.RESULTS Between 2019 and 2021,there was a consistent decline in the consumption and sales of imipenem-cilastatin sodium,meropenem(0.3 g),and meropenem(0.5 g).Conversely,the DDDs of imipenem-cilastatin sodium for injection increased in 2020 and 2021 vs 2019,with a B/A value of 0.67,indicating a relatively higher drug cost.The DDDs of meropenem for injection(0.3 g)exhibited an overall upward trend,indicating an increasing clinical preference.However,the B/A values for 2020 and 2021 were both>1,suggesting a relatively lower drug cost.The DDDs of meropenem for injection(0.5 g)demonstrated a progressive increase annually and consistently ranked first,indicating a high clinical preference with a B/A value of 1,signifying good alignment between economic and social benefits.CONCLUSION Carbapenem use in our hospital was generally reasonable with a downward trend in consumption and sales over time.Clinical pharmacists play a pivotal role in promoting appropriate use of carbapenems.

国家组织药品集中采购和使用试点对临床用药管理与使用的影响

目的调查国家组织药品集中采购和使用试点(以下简称“‘4+7’试点”)的影响,提出政策建议,为进一步推行国家组织药品集中采购提供参考。方法用焦点组访谈法,对北京、上海、广州、西安和沈阳5个试点城市的64位医疗保险管理者、卫生行政管理者、医院管理者和医师代表进行访谈。用问卷调查法,就政策影响对5个试点城市的509位医师和498位患者进行分层抽样调查。结果医师对“4+7”试点的认可程度高,认为药品的临床效果达标,不良反应处于常态水平。患者给予中标药品正向反馈,对中标药品的接受度较高,试点降低了患者的医疗费用,患者满意度较高。试点也存在医院为达成政策实施目标而限制医师的处方权、医师工作量加大但激励不足等问题。结论药品集中采购的积极影响明显,但要实现控制药品总费用、保障药品供应和“三医联动”的目标,还应平行推进相关配套改革措施,如加快医疗保险支付改革,依托药品临床综合评价以真实世界数据推动药品的遴选和合理使用,调整医药费用结构,促进公立医院绩效及薪酬制度改革,推进行业监管和医疗卫生服务精细化管理等。

不合理静脉用药医嘱分析与药学干预研究

目的通过对不合理静脉用药医嘱的分析及药学干预,促进临床合理用药。方法选取2019年7月―2019年12月我院静配中心调剂的消化内科、神经内科和胃肠外科等病区的静脉用药医嘱进行逐一分析并统计分类。结果药师共计审核医嘱216043条,发现不合理医嘱603条。不合理用药的类型主要为溶媒选择、药物浓度、给药途径、配伍禁忌及其他,同时分别举例加以阐述。结论针对静脉用药不合理使用问题采取有效干预措施,药师借助合理用药软件进行医嘱审核,以保障患者用药安全。

Analysis of the adverse reactions of atezolizumab: A real-world study based on FAERS database

Objective In this study,we aimed to determine the incidence of adverse drug reactions(ADRs)of atezolizumab,identify ADR signals that are significantly related to atezolizumab,and provide a reference for the rational use of atezolizumab in the clinic through the statistical analysis of its adverse drug events(ADEs)reported in the American Food and Drug Administration(FDA)Adverse Event Reporting System(FAERS)database.Methods In total,4796 cases of atezolizumab ADEs reported in the American FAERS database from 2017 to 2019 were retrospectively analyzed.Results The top three ADEs were febrile neutropenia(3.7%),anemia(2.9%),and acute renal failure(2.3%).In addition,the incidence rates of some ADEs were significantly different according to sex and age.The systematic organ classification of atezolizumab ADEs involved 32 systems,among which the top three were blood and lymphatic system disorders(585 cases,12.2%),gastrointestinal disorders(433 cases,9.0%),and infections and infestations(401 cases,8.4%).The reporting odds ratio(ROR)method was used to detect the ADR signals of atezolizumab.The ROR(95%confidence interval)of the top ADE,febrile neutropenia,was 39.236(33.757–45.604).In addition,we found 121 cases of complications associated with immune-related ADEs.Conclusion The ADRs of atezolizumab reported in the FAERS database were consistent with those mentioned in the instructions for atezolizumab use,suggesting that atezolizumab has an acceptable and controllable drug effect.

Comparative Evaluation of Antitumor Chinese Patent Medicine Injections Based on Evidence-Based Medicine and Markov Model

Objective: The objective of this study was to explore the safety, efficacy, economy, and other aspects of frequently-used antitumor Chinese patent medicine injections through a comprehensive evaluation of evidence-based medical research to provide scientific information and decision-making basis for drug selection, rational drug use, public awareness of safe drug use, and medical insurance. Materials and Methods: The names of five frequently used antitumor Chinese patent medicine injections were used as search terms, including the compound Sophora flavescens injection, Kangai injection, Aidi injection, Kanglaite injection, and Brucea javanica oil emulsion injection. Relevant evidence-based medical research was extracted from the databases. A descriptive evaluation was conducted, and the Markov model was used for the cost-benefit analysis. Finally, the above injections are ranked by comprehensive scores using the multi-criteria decision analysis and Delphi method. Results: The five injections had their own advantages in enhancing the effectiveness of anti-tumor treatments, improving the quality of life for cancer patients, and reducing the incidence of adverse reactions. From the perspective of economy and other attributes, compound S. flavescens was superior to B. javanica oil, Aidi, Kangai, and Kanglaite. After a comprehensive evaluation of the above five injections, the compound S. flavescens injection received the highest score. Conclusions: Compound S. flavescens, Kangai, Aidi, B. javanica oil, and Kanglaite have their own advantages in effectiveness and no significant difference in safety. Compound S. flavescens injection has the highest comprehensive score. Clinical attention should be paid to monitoring the initial stage of medication and special groups.