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.

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.

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.

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.

Investigation and Analysis of Rational Drug Use of Residents in Changshou District of Chongqing, China

The objective of this study was to acquire the information about residents of Changshou District’s knowledge levels and their behaviors of drug use so that implementation strategies of rational drug use can be formulated accordingly to promote and spread health education of rational drug use.Online and offline surveys were randomly conducted about rational drug use conditions of residents in Changshou District by questionnaires.Online questionnaires were sent to residents of Changshou District by Wenjuanxing,a professional platform used for surveys.Offline questionnaires were mainly distributed to residents of communities in Changshou District.All the online and offline statistics were analyzed and counted.309 questionnaires were distributed(176 online questionnaires and 133 paper questionnaires),and the effective recovery rate was 75.4%.According to investigation and survey,conditions of resident’s rational drug use were optimistic.Only 8.15%of residents who participated in the survey(or research subjects)took paracetamol tablets and Vitamin C Yinqiao tablets(also known as VC Honeysuckle Pills)at the same time when they had a cold or fever.Among 8.15%of residents,5.15%frequently took paracetamol,caffeine,and aspirin powder(also known as headache powder),80.26%checked expiration date of drugs before taking medicine,and>50%knew that drinking after taking medicines such as cephalosporin is prohibited.Common irrational problems caused by drug use were as follows:40%of research subjects took dietary supplements as drugs and 28%of them failed to know the correct usage and dosage of drugs.Proportion of drugs that were taken with irrational usage and dosage was antibiotics(64%),antibacterial(52%),drugs for patients with diabetes mellitus(36%),drugs for patients with hyperlipidemia,hypertension,and hyperglycemia(32%),vitamins(24%),drugs for the treatment of common cold and cough(20%),and others.Publicity of rational drug use should not be restricted to specific population,and knowledge of safe drug use is supposed to be actively popularized.Contents of rational drug use are as follows:Guide the public to correctly understand the functions of vitamins and dietary supplements strengthen publicity of rational use of drugs such as antibiotics,antibacterial drugs,drugs for chronic diseases,cold,and cough.Focus should be given on usage and dosage of drugs,use of antibacterial drugs,and repeated and excessive use of drugs caused by joint use of drugs with same ingredients of OTC drugs for the treatment of common cold and cough.

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.

Experience of clinical pharmaceutical care carried out in pediatric respiratory department

Objective To discuss the role of clinical pharmacists in providing pharmaceutical care in pediatric respiratory department.Methods Supply pharmaceutical information,participate in clinical rounds,provide the rationalization proposal,help doctors to formulate correctly dose regimen,enhance medication efficiency;establish medicine record for the patient,record the drugs which were used,provide pharmaceutical care for the patient such as disease propaganda,medicine-use education,medicine consultation and so on.Results Promote rational administration,enhance the security of medical practice,the clinical pharmacists' work obtains the doctors' approval;improve the medication compliance,reduce patients' economy and spiritual burden,and obtain the patients' trust.Conclusions The pharmaceutical care carried out in pediatric respiratory department can help reduce the incidence of medication errors,cut down the medication cost,shorten the time of patients to be hospitalized,raise the medication efficiency,and promote the doctor-patient relationship harmoniously.In a word the clinical pharmacists are indispensable.

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.

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.

七类81323条多药配伍“混滴”医嘱回顾性分析

目的为多药(含两种及两种以上主药)配伍“混滴”医嘱审核提供参考依据,确保临床用药安全性。方法医院HIS系统提取静脉用药调配中心审核的81323条多药配伍“混滴”医嘱,按用药目的进行分类;查阅文献资料进行联用合理性和配伍稳定性分析。结果多药配伍“混滴”医嘱共7类,含10%氯化钾、10%氯化钠、胰岛素、维生素C等共28种主药,其中硫酸镁与罂粟碱,维生素B 6与维生素C,胰岛素与两性霉素B,复方甘草酸苷与谷胱甘肽两两间存在配伍禁忌;间苯三酚、复方甘草酸单铵S、阿昔洛韦、前列地尔等药物配伍稳定性资料较少,应避免与其他药物组合联用;电解质与水溶性维生素配伍存在争议,应按说明书要求配伍使用。结论多药配伍“混滴”不能简单看作是药物两两相加,配伍联用除参考文献资料外,还需结合实际操作中的配伍结果进行综合分析,确保临床用药安全性。

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。

Mining Typical Treatment Duration Patterns for Rational Drug Use from Electronic Medical Records

Rational drug use requires that patients receive medications for an adequate period of time.The adequate duration time of medications not only improve the therapeutic effect of medicines,but also reduce the side effects and adverse reactions of medicines.This paper proposes a data-driven method to mine typical treatment duration patterns for rational drug use from electronic medical records (EMRs).Firstly,a quintuple is defined to describe drug use duration statistics (DUDS) for each drug and treatment record is further represented with DUDS vector (DUDSV).Next a similarity measure method is adopted to compute the similarity between treatment records.Meanwhile,a clustering algorithm is used to cluster all patient treatment records to extract typical treatment duration patterns including typical drug sets,effective drug use day sets,and the DUDSs of each typical drug.Then the extracted typical treatment duration patterns are evaluated and annotated based on patients' demographic information,disease severity scores,treatment outcome and diagnostic information.Finally,a real-world EMR dataset is performed to indicate that the approach we proposed can effectively mine typical treatment duration patterns from EMRs and recommend the appropriate treatment regimens for patients based on their admission information.

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。

我院处方点评模式构建与实践

目的 构建一套合理高效的处方点评模式,用以提高处方质量,促进合理用药.方法 通过建立和完善处方点评组织机构、处方点评制度、处方点评标准和方法,并进行反馈和干预,建立有效的处方点评模式.运用该模式对浙江大学金华医院（以下简称“我院”）2011～2012年门诊处方进行点评,统计处方合格率,并与模式建立前的2010年门诊处方进行比较.同时统计我院2010年（模式完善前）及2011、2012年（模式完善后）药品比例、抗生素使用比例,并进行比较.结果 处方合格率由模式完善前的58.41％上升到完善后的91.30％.全院药品收入占比从2010年的54.76％下降到2012年的43.29％.抗菌药物金额占比从2010年的23.54％下降到2012年的7.80％.结论 该模式在提高门诊处方合格率、降低药品比例和抗菌药物比例等方面取得了明显的成效,对规范处方行为、提高处方质量、提高医院合理用药水平等方面具有重要意义.

老年人新型冠状病毒感染小分子抗病毒药物治疗建议

新型冠状病毒感染已流行三年之久,虽然病毒的不断变异使得其致病力减弱,但伴有基础病的老年患者仍是新冠病毒重症感染的高危人群。随着对新冠病毒分子结构和致病机制的不断认识,抗新冠病毒药物相继上市,这些药物可以有效降低老年患者的重症率及死亡率。该文就目前我国附条件批准上市的5种小分子抗病毒药物的作用机制、临床用药、药物相互作用、不良反应等多方面进行阐述,为老年人抗新冠病毒治疗的临床合理用药提供参考建议。

PASS系统监测医嘱合理用药水平探讨

目的应用PASS软件对医生合理用药水平进行分析评价。方法对我院2011年2月至3月医嘱经PASS系统监测、分析、统计,结合临床实际操作得出结论。结果本次调查共监测出问题医嘱8 436条,占总医嘱数的46.21%。其中黑灯警示217条,占问题医嘱的1.19%;红灯警示4 947条,占问题医嘱的27.10%;橙色灯警示3 272条,占问题医嘱的17.92%。结论 PASS系统用于医嘱用药监测,能够为临床提供一些警示信息,有助于提高合理用药水平,但需专业人员及时更新维护有关药品信息,以保证PASS系统运行的有效性。

不合理用药医嘱的调查分析

目的调查医嘱中存在的不合理用药问题,指导临床合理用药。方法抽查我院2010年6-10月内科病区37科室,根据《中国药典》、《新编药物学》、药品说明书、公开发表的文献,对不合理医嘱数目统计分析。结果发现不合理医嘱数161条,涉及69种药品。主要为:溶媒选择不当;药物浓度、剂量过大;药物相互作用;给药途径;用药频次错误等。结论认真执行医嘱审核制度,定期通报监测结果,提高合理用药水平。

我院结肠癌抗肿瘤治疗药物合理应用点评分析

目的促进本院结肠癌抗肿瘤治疗药物合理使用。方法制定结肠癌抗肿瘤药物的点评细则,设计结肠癌抗肿瘤药物合理应用点评工作表。回顾性点评本院2016年1月-12月的200份结肠癌接受化疗患者的病例医嘱。结果结肠癌抗肿瘤药物不合理医嘱占比22%,主要问题是化疗药物的用法用量不适宜。结论开展医嘱点评可以促进合理用药,后期临床药师将通过化疗药物血药浓度监测和宣教的形式对部分典型问题进行干预。

静脉用药调配中心不合理医嘱分析及干预

目的:通过对本院静脉用药调配中心(pharmacy intravenous admixture services,PIVAS)不合理用药医嘱进行分析和干预,为临床合理用药提供参考。方法:采用自主开发的医嘱审核软件及人工审核相结合的方式,以2018年10月-2019年3月本院静脉用药调配中心长期用药医嘱作为研究对象,对不合理用药医嘱进行统计分析和干预。结果:选取2018年10月-2019年3月本院PIVAS长期用药医嘱数473530组,其中不合理医嘱数732组,占所有审核医嘱的0.15%。不合理医嘱主要类型包括:给药浓度不当、溶媒种类选择不当、给药剂量不当、给药频次不当、重复用药等。2019年第一季度不合理医嘱总数比2018年第四季度下降,差异有统计学意义(χ^2=5.885,P=0.015)。结论:该院PIVAS通过进一步加强对不合理用药医嘱分析和干预,提高了该院静脉用药的安全性和合理性。

利用PASS监测住院患者医嘱用药

目的利用合理用药监测系统（PASS）监控我院医嘱用药,以提高临床合理用药水平。方法利用PASS对我院2010年1~3月期间住院医嘱进行审查,并通过Excel进行分类统计分析。结果共监测到不合理用药医嘱67 565条,其中,药物相互作用警示医嘱38 386条,剂量审查警示医嘱21 207条,国内注射液体外配伍警示医嘱3 736条,儿童警告3 649条,给药途径警示医嘱587条。结论利用PASS监控医嘱有利于减少药物不良事件,防止用药差错,但PASS本身尚存在一定局限性,有待进一步完善。