Exploring the Contribution of Pharmacists in Addressing the Opioid Crisis through Naloxone Prescriptions and Pharmacist-Led Interventions

The opioid epidemic in the United States continues to take the lives of many individuals, with overdoses continuing to rise every year. Naloxone is an opioid antagonist that is efficacious in temporarily reversing opioid overdoses. Pharmacists play an important role in the accessibility and education of naloxone in both the community and health system settings. Recent efforts, such as co-dispensing naloxone with opioid prescriptions, naloxone training programs, and approval of naloxone to be over-the-counter, have been implemented in hopes to better control the opioid epidemic. Despite the efforts to make naloxone more accessible, there are still some barriers to overcome such as lack of training, cost, stigma, and patient refusal. This review aims to explore the contributions pharmacists have made thus far and define the barriers that still have to be resolved.

Roles of Community Pharmacists in Screening and Disseminating of Information about Non-Steroidal Anti-Inflammatory Drugs Risks: Implications for Drug Safety Assessment

Background: The increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) both on prescription and over the counter raises a major global health concern because of the risks associated with their use if no proper guidance is given by the health care provider. This study assessed the roles of community pharmacists in screening and disseminating information about the risks associated with NSAID use in Zambia. Methodology: This was a national cross-sectional study in which a structured self-administered questionnaire was administered to 245 registered community pharmacists in Zambia. Stata/BE, version 15.1 (Stata Corporation, College Station, Texas, USA) and multivariate logistic regression model was used to determine factors associated with information dissemination about ADRs of NS-NSAIDs. Results: 231 of the 245 distributed questionnaires were returned giving a response rate of 94.3%. All (100%) participating community pharmacists claimed to have practiced dispensing NSAIDs. However, only 26 (11.0%) and 71 (30.8%) regularly screened for risk factor of selective COX-2 NSAIDS (SC2-NSAIDS) and non-selective NSAIDS (NS-NSAIDs) respectively. Information dissemination on adverse drug reactions (ADRs) of SC2-NSAIDS was regularly provided by only 22 (9.5%) of pharmacists while that of NS-NSAIDs was regularly provided by 49 (21.2%). In the multivariate logistic regression model, being the owner of a pharmacy (AOR: 5.4, CI: 1.84 - 16.4) was significantly associated with information dissemination about ADRs of NS-NSAIDs while an hour increase in the working hours per day (AOR: 0.9, CI: 0.64 - 0.95) was associated with less likelihood of information dissemination. Conclusion: Pharmacists working in community pharmacies in Zambia did not regularly screen and disseminate information about the risks associated with NSAID use. Therefore, pharmacists should be able to screen and monitor patients at risk and be aware of the majority of risk factors while dispensing NSAIDs to minimize the associated complications.

Investigation of Patients’ Mood on Their Distance from the Pharmacist during Medication Instruction

Background: Pharmacists must adjust their distance from patients to facilitate communication during interviews and gain their trust. The distance between the patients and the pharmacists varies depending on many factors, such as gender, posture and the patients’ mood. Only a few of these papers have actually measured and validated distance with patients. In this study, we validated our method of assessing mood and measuring distance before beginning a survey with patients. Methods: We measured comfortable interpersonal distance among men and women using an ecological scenario, in which a pharmacist approaches the subject, and the subject is asked to stop the pharmacist at the distance he/she feel comfortable with. Five pharmacists and 33 subjects participated in the study. The Japanese version of the Brief Mood Questionnaire Checklists (BMC-J) was used to quantify the subject’s mood for the day, and then the distance from the pharmacist that the subjects considered comfortable was measured at the bedside. The relationship between the mood and distance obtained was examined. Results: The comfortable distance of subjects was influenced by gender, posture, and mood. The shortest distance was 94.7 ± 11.1 cm (mean ± SD), for the male subjects versus the female pharmacists in the sitting position. The distance of male subjects shorted when they had positive emotions and lengthened when they were worried. Female subjects maintained a long distance from both male and female pharmacists when they had positive emotions and a short distance when they were worried. Conclusion: Findings show that the distance changes depending on the subjects’ mood at the time of measurement. It was found that the present measurement method can be used to determine the psychological state of the patient and measure the comfort distance at that time, and can be used as a simple method to examine these relationships. Therefore, it is also considered a practical method for the next step, which is a clinical study on patients.

Comparison of Anticancer Drug Preparation Techniques between Chemotherapy Specialist Pharmacists and Non-Chemotherapy Pharmacists Using Eye-Tracking Techniques

Anticancer drug preparation by pharmacists is a critical task directly related to medical incidents. This study examined the factors influencing medical errors in chemotherapy, that is, errors by specialist pharmacists (CPh) and pharmacists in other departments (NCPh), by measuring their gaze during the preparation of anticancer drugs. The eye-tracking results showed that the gazing time of NCPh was significantly longer than that of CPh for items such as “preparation of a closed-system device” and “preparation of the syringe” and all preparation times (P < 0.05). The NCPh were not assigned to prepare drugs on a regular basis, indicating their lack of familiarity with the process. There was no significant difference in gaze ratio between CPh and NCPh. This outcome was suggested to be a result of the use of an anticancer drug preparation support system. The results for the pupil diameter variation rate showed that NCPh were significantly more mydriatic in the “mixing injections” category than CPh. However, CPh tended to be more mydriatic in the “checking” category. CPh exhibited a smooth workflow and focused on the important items to be checked. This study showed that the differences in procedure flow and concentration points may lead to errors. Furthermore, the results are of interest from the perspective of medical incident prevention. They will be useful in identifying potential human factors, such as where the pharmacist focuses their attention by measuring eye movements.

A Survey on Pharmacists’ Job Burnout and Satisfaction during the COVID-19 Era

Background: The COVID-19 outbreak negatively impacted pharmacists who provided basic medical services by inducing anxiety and depression, thus, leading to medical errors. Objective: This study aimed to investigate the job burnout and satisfaction levels among hospital pharmacists during the period when China downgraded COVID-19 from a Category A disease to a Category B disease. Method: We selected pharmacists from several medical institutions in Yunnan Province as the subjects by using the general information questionnaire survey, the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the Work Environment Scale-10 (WES-10). Results: After analyzing 461 questionnaires, the results showed that the age and marital status of the pharmacists displayed significant effects on their emotional exhaustion and sense of achievement, with younger pharmacists getting higher and lower scores for their tests on emotional exhaustion and sense of achievement, respectively (p Conclusion: Hence, it was concluded that the job burnout of pharmacists was at a low level during the period when China downgraded COVID-19 as a Category B disease from Category A.

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.

多因素线性回归模型分析门诊药房自动发药机对药师工作效率的影响

目的分析使用自动发药机对药师工作效率的影响。方法选择北京积水潭医院新街口院区和回龙观院区门诊药房(两种工作场景:配备自动发药机、完全传统手工调配模式)。以患者取药等候时间为因变量,分别以日门诊药房窗口药师数、当日该院区门诊药房处方量、患者当日就诊科室数、实际取药数量4项指标作为自变量,建立多因素线性回归模型,比较不同模型下患者取药等候时间的影响因素。以患者取药等候时间为因变量,以日门诊药房窗口药师数、是否配备自动发药机、当日该院区门诊药房处方量、患者当日就诊科室数、实际取药数量5项指标作为自变量,建立多因素线性回归模型,分析门诊药房工作药师数、是否采用自动发药机等对患者取药等候时间的影响。结果使用自动发药机院区每增加1名药师,患者取药等候时间缩短9.63 s,未使用自动发药机院区每增加1名药师,患者取药等候时间缩短5.41 s。将自动发药机作为影响因素纳入模型后,5项自变量均对患者取药等候时间有影响(P<0.05)。其中采用自动发药机的院区相比另一院区的取药等候时间节省20.08 s;院区日处方量每增1张,患者取药等候时间增加0.07 s;每增加1名门诊上班药师,患者取药等候时间减少5.69 s;患者当日每多就诊1个科室,取药等候时间增加72.72 s;患者取药数方面,取2~10盒/支相比取1盒/支、取超过10盒/支相比取1盒/支,患者取药等候时间分别减少15.72、9.25 s。结论自动发药机有助于提升门诊药房的工作效率,改善就医体验。

药学门诊对儿童疱疹性咽峡炎用药干预分析

目的总结药学门诊参与儿童疱疹性咽峡炎用药管理的经验。方法选取2020年1月—2022年12月共832例就诊于我院药学门诊及儿科门诊的疱疹性咽峡炎病例,就诊于药学门诊的病例为干预组,就诊于儿科门诊的病例为对照组,干预组按照循证医学原则进行用药建议与指导,对照组不进行干预,所有患儿随访病情直至痊愈。结果832例患儿全部康复,无重症住院病例。干预组与对照组在发热、疼痛、疱疹愈合等时长及血液检查结果均差异无统计学意义(均P>0.05),干预组与对照组在药物使用方面差异有统计学意义(P<0.001),干预组不良反应数量(5例)及治疗费用[(44.30±5.23)元]均显著低于对照组[23例,(178.20±71.40)元](P<0.001)。结论疱疹性咽峡炎属于自限性病毒感染,应按照循证的原则予以对症支持,过度用药并未给儿童带来显著获益,反而增加不良反应风险,增加治疗费用。

临床药师对1例骨肉瘤患者进行围化疗期药学监护

目的探讨抗肿瘤药物专业临床药师参与肿瘤患者治疗的药学实践。方法通过对1例骨肉瘤患者进行围化疗期药学监护,阐述临床药师在肿瘤患者治疗中的作用。结果临床药师参与了肿瘤患者的全程治疗,医师和护理人员采纳临床药师的建议,患者顺利完成了第1周期化疗。结论围化疗期药学监护注重监护的时间和内容,可对患者进行有针对性和计划性的药学监护,是临床药师参与肿瘤患者治疗的重要切入点,有助于临床药师将自身专业知识转变成专业能力,从而更好地开展药学服务工作。

执业药师培训案例库的构建及在研究生教学中的应用

目的 研究案例教学法在研究生教学中的应用。方法 通过真实性、科学性、趣味性、有效性等原则,构建执业药师培训课程案例库,并在研究生教学过程中实践两个学期,通过学生评价,学生成绩等指标评价教学改革效果。结果 案例教学法通过典型案例的学习和讨论,启发学习者分析问题,解决问题,能够有效提升教学效果,提升学习者学习兴趣,促进理论知识与实践工作的结合,帮助学生掌握知识点,提高综合素养。结论 案例教学法提升了教学效果,培养了具有较强实践能力的药学人才,具有很好的推广价值。

基于内容分析法的临床药师岗位胜任力指标构建

目的 对国内外临床药师胜任力评价指标进行内容分析,为临床药师岗位胜任力构建提供参考。方法 检索国内外临床药师岗位胜任力相关文献,采用内容分析法对符合标准的文献进行分析。结果 最终纳入22篇文献及14篇胜任力评估框架及模型,提取个人素质、知识、个人能力、药学服务、教研5个一级类目、15个二级类目及61个三级类目。结论 初步构建了临床药师岗位胜任力指标体系,为临床药师开展实践工作提供参考。

心病科中药临床药师培训模式探索

目的规范心病科中药临床药师的培训模式。方法从理论学习、临床实践及考核方案3个方面分析1年制全国中药临床药师(简称1年制)和半年制上海市心病科中药临床药师(简称半年制)的规范化培训模式,并总结经验。结果培训后,所有培训学员考核全部达标,且完成了规定作业,可胜任心病科的临床药学工作,部分学员在培训期间还发表了相关论文。结论心病科中药临床药师培养应以患者为中心,并开展中西医结合的药学服务。建议借助信息化技术,重视门诊跟师抄方,加强各培训基地间的学术交流,进一步规范中药临床药师的培训方案。

利用临床药师工作站解读药敏试验结果的工作模式探讨

目的 探讨利用临床药师工作站解读药敏试验结果工作模式的意义。方法 介绍利用临床药师工作站解读药敏试验的工作流程、工作开展情况。结果 我院将常规药敏试验解读工作形成标准化系统板块嵌入临床药师工作站中,医生站以及检验科LIS系统与其智能化链接,使得报告的查收、发送以及接收均在线上完成,减少了中间环节,医生可在查收药敏试验结果的同时,更清晰地查看临床药师的用药建议。结论 利用临床药师工作站解读药敏试验结果的工作模式充分利用了信息化优势,提高了临床药师的临床参与度。该工作模式可量化,且覆盖科室范围较广,获得了临床的认可。

1例未足月胎膜早破青霉素过敏患者抗菌药物应用的药学监护

1例29岁有青霉素过敏史的妊娠女性,因“停经31+周,阴道流液5 h”入院。患者诊断为胎膜早破,有预防性应用抗菌药物指征。临床药师了解患者过敏史后,考虑发生青霉素速发型过敏反应风险较低,建议试行青霉素皮试或使用头孢呋辛。患者拒绝青霉素皮试,头孢呋辛皮试阳性。调整为万古霉素(1 g,每8 h 1次,静脉滴注)联合阿奇霉素(首次500 mg口服,第2天250 mg 1次·d^(-1),口服,疗程4 d),行B族链球菌(GBS)筛查及宫腔细菌培养。GBS筛查阴性,建议停用万古霉素。宫腔细菌培养报大肠埃希菌,结合患者症状体征、检验指标考虑污染可能性大,继续使用阿奇霉素。患者羊水较少,予引产后分娩,母儿情况可。阿奇霉素使用5d后停用,患者出院。产后2周随访母儿情况良好。

临床药师参与肾移植妊娠患者药物治疗管理实践

目的提升肾移植术后妊娠患者个体化药物治疗管理水平,提高用药安全,减少母亲、胎儿不良事件发生。方法从免疫抑制剂的调整,降压药物的优化、叶酸的补充、抗凝药物的选择及监护、高尿酸的监护、哺乳等方面制订个体化用药方案,提供用药教育。结果孕早期:HCG阳性明确妊娠,调整免疫抑制剂为他克莫司胶囊(5 mg,2次/d),口服硝苯地平控释片(30 mg,1次/d)降压,补充叶酸片(5 mg QD)、地屈孕酮片(10 mg,1次/12 h)。孕中期:给予达肝素钠注射液(5000 U/d)抗凝治疗。同时继续口服他克莫司(5 mg,2次/d)维持免疫治疗,硝苯地平控释片(30 mg,1次/d)降压。围生期:给予地塞米松肌注(6 mg,1次/12 h)促胎肺成熟治疗降低早产新生儿肺部并发症,产后注射用头孢他啶(2 g,2次/d)、甲硝唑氯化钠注射液(100 ml,1次/d),5 d预防感染,益母草注射液肌注(1 ml,2次/d)促进子宫收缩,同时继续服用他克莫司维持免疫治疗,硝苯地平降压。结论医-药-护三位一体为肾移植患者提供全程化管理,提高治疗效果,同时药师通过参与治疗实践全过程,可有效提升临床辨证思维及循证思维,为提高药学服务水平奠定基础。

客观结构化临床考核在抗感染专业临床药师培训出科考核中的应用

采用客观结构化临床考核(OSCE)模式,模拟不同场景,制定评分标准,综合考核学员临床用药实践技能。该模式构建了一套较为完善的抗感染药师出科培训考核方案,实现了考核的标准化、规范化、同质化,可以综合考量学员解决问题的能力和临床沟通技巧。

精神分裂症发生代谢综合征的影响因素及药师主导团队管理的干预效果

目的:探讨精神分裂症发生代谢综合征(MS)的影响因素及药师主导团队管理的干预效果。方法:选取2022年4至9月于南通市第四人民医院就诊的精神分裂症伴发MS患者80例(MS组),本院同期就诊的精神分裂症无MS患者80例(非MS组)。采用Logistic回归分析精神分裂症发生MS的影响因素。按随机数排秩法将MS组患者分为对照组与干预组,各40例。除常规治疗外,对照组采取常规管理,干预组在对照组基础上给予药师主导团队管理干预,均干预6个月。比较两组干预前后代谢指标(BMI、腰围、空腹血糖、高密度脂蛋白、甘油三酯),精神状况[阴性/阳性量表和一般精神病理量表]及生存质量[世界卫生组织生存质量测量表(WHOQOL-BREF)]的差异。结果:Logistic回归分析结果显示,年龄大,吸烟,IL-6水平高,PAI-1基因4G/4G+4G/5G基因型及高CRP血症是精神分裂症发生MS的危险因素,有适度运动习惯为保护因素(P<0.05)。研究组干预前后BMI、腰围、空腹血糖、甘油三酯、一般精神病理量表、心理功能、躯体健康得分差值均高于对照组(P<0.05)。结论:药师主导团队管理可有效改善精神分裂症伴发MS患者的代谢指标,缓解临床症状,提高生存质量。

我院临床药师培训基地教学效果及影响因素研究

目的探讨我院临床药师培训基地学员教学效果及相关影响因素,为改进培训工作提供参考。方法选择2016年3月至2022年10月于我院接受规范化培训学员作为研究对象,通过问卷调查形式评价学员满意度,并对成绩进行统计学差异分析及Logistic回归分析检验影响学员考核成绩的影响因素。结果55名学员对培训基地教学总满意度评分为4.52,满意率达90.05%。统计学差异分析显示,理论成绩良好组与非良好组的学员职称、培训专业、第一学历、工作年限、药学及临床带教老师工作年限间有统计学差异(均P<0.05);Logistic回归分析显示,中级及以上职称、专科培训、本科及以上学历、工作年限、临床及药学带教老师工作年限长对于提高学员的理论成绩均为有利因素(OR=3.778、3.75、3.273、1.351、1.736、1.59,均P<0.05)。结论我院临床药师培训基地教学实施效果良好,培训学员职称、学历、培训专业、工作年限及临床与药学带教老师的工作年限是理论成绩的影响因素。

2型糖尿病住院患者药物治疗管理模式的效果评价

目的:对2型糖尿病(T2DM)住院患者药物治疗管理模式进行效果评估,探索适合我国的药学服务模式。方法:研究对象为2022年10月1日-2023年9月30日北京同仁医院内分泌科入院的T2DM患者,将符合纳入标准的患者分为临床药师管理组和常规管理组。临床药师管理组,在常规开展医嘱审核、出院教育、用药咨询等工作外,还会深度参与患者个体化方案制定,给予详细的用药指导和健康教育等,出院后定期随访。比较两组患者出院3个月时的血糖、血压、血脂控制情况等。结果:纳入临床药师管理组221例,其中女性98例,男性123例,中位年龄59(43.5,67.0)岁;常规管理组217例,女性74例,男性143例,中位年龄55(42.0,56.0)岁。临床药师管理组患者宜优选使用的二甲双胍、GLP-1Ra、SGLT2i、他汀类药物应用率均显著高于常规管理组(P<0.05);进一步的亚组分析结果显示,临床药师管理组的动脉粥样硬化心血管疾病(ASCVD)患者、糖尿病肾病(DKD)患者中宜优选药物的应用率较常规管理组明显升高(P<0.05);出院后,临床药师管理组患者糖化血红蛋白(HbA1c)、血压、低密度脂蛋白胆固醇(LDL-c)的达标率较常规管理组均明显提高(P<0.05);但在住院药品费用方面、不良反应方面无明显差异(P>0.05)。结论:临床药师对T2DM住院患者开展药物治疗管理模式的药学服务,有利于优化药物治疗方案,提高临床治疗效果。

1例生痰二氧化碳嗜纤维菌脑膜炎合并肾功能亢进患儿的抗感染治疗实践

目的:探讨临床药师在儿童细菌性脑膜炎抗感染治疗中的作用。方法:临床药师通过参与1例由生痰二氧化碳嗜纤维菌引起的儿童细菌性脑膜炎患者的多次药学会诊,与医师通力合作,对患儿治疗效果欠佳的原因进行分析,结合患儿存在肾功能亢进这一特殊生理病理特点及抗菌药物药动学/药效学(PK/PD)理论,优化抗感染治疗方案并实施药学监护。结果:临床药师提出的治疗方案被医师采纳,患儿临床症状改善、脑脊液恢复正常并顺利出院。结论:临床药师对临床上罕见致病菌引起的特殊部位感染,应充分发挥药学专业特长,进一步提高抗感染药物的临床疗效。