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.

Restoration and Rational Use of Degraded Saline Reed Wetlands:A Case Study in Western Songnen Plain, China

The protection, restoration and sustainable use are key issues of all the wetlands worldwide. Ecological, agronomic, and engineering techniques have been integrated in the development of a structurally sound, ecologically beneficial engineering restoration method for restoring and utilizing a degraded saline wetland in the western Songnen Plain of China. Hydrological restoration was performed by developing a system of biannual irrigation and drainage using civil engineering measures to bring wetlands into contact with river water and improve the irrigation and drainage system in the wetlands. Agronomic measures such as plowing the reed fields, reed rhizome transplantation, and fertilization were used to restore the reed vegetation. Biological measures, including the release of crab and fish fry and natural proliferation, were used to restore the aquatic communities. The results of the restoration were clear and positive. By the year 2009, the reed yield had increased by 20.9 times. Remarkable ecological benefits occurred simultaneously. Vegetation primary-production capacity increased, local climate regulation and water purification enhanced, and biodiversity increased. This demonstration of engineering techniques illustrates the basic route for the restoration of degraded wetlands, that the biodiversity should be reconstructed by the comprehensive application of engineering, biological, and agronomic measures based on habitat restoration under the guidance of process-oriented strategies. The complex ecological system including reeds, fish and crabs is based on the biological principles of coexistence and material recycling and provides a reasonable ecological engineering model suitable for the sustainable utilization of degraded saline reed wetlands.

Vegetation Improvement and Rational Use of Winter Pastures of ＂CeyranchoI-Acinohur＂ Arrays

This article describes the development of human potential interaction between society and nature. The environment, sustainable use of natural resources, prevention of adverse effects of human activities on the environment, and disturbances of dynamical ecological balance of the existing natural systems have received increased attention. The heed is introduced both on the state scale and in broad circles of science and society in The Azerbaijan Republic.

Evaluation of Rational Use of Antiretrovirals before the Dolutegravir Transition in Kinshasa, Democratic Republic of Congo

Background: The ultimate goal of AntiRetroViral Treatments (ART) is to achieve complete immune restoration and lasting viral suppression in the infected patient. In order to ensure the efficacy, safety and accessibility of antiretroviral drugs (ARVs), it is recommended that they should be prescribed according to national guidelines;which are evolving with the various recommendations of the World Health Organization (WHO) and the arrival of newer, more effective and safer molecules. Objective: The objective of this study was to assess the rational use of Antiretrovirals in patients treated in Kinshasa before the use of Dolutegravir within the national program in order to assess the correct use of these molecules. Methods: This work is a descriptive cross-sectional study to assess the rational use of first-line ARVs among People Living with HIV (PLHIV) in different Centers of Treatment (ATCs) in Kinshasa before the introduction of Dolutegravir. The records of patients on ARVs were randomly and rationally selected in 12 different ATCs for HIV in Kinshasa according to three centers per district in the period from June to September 2018. Information on use and consumption of ARVs, compliance with guidelines, change of therapeutic combination as well as their reasons were consulted for the present study. Results: 507 files of PLHIV were collected in the various ATCs. 274 (54.1%) were from female patients. The most represented age group was 26 to 35 years with 192 patients (37.9%). The mean duration of first-line treatment for all patients included was 16.30 ± 5.85 months. The most widely used combination of ARVs overall was TDF + 3TC + EFV at 45.4%. 305 (60.2%) PLHIV kept the same first-line treatment molecule throughout the treatment period with an average treatment duration of 12.9 ± 2.77 months. The most common combination found in this population was TDF + 3TC + EFV (69.2%). 202 (39.8%) PLHIV changed treatment molecule yet respecting the first-line combinations. The average duration of treatment for those who changed molecules was 21.43 ± 7.25 months. Before the change, 112 (55.5%) of these patients were using the ZDV + 3TC + EFV combination. After switching, 105 (52%) of the patients used the TDF + 3TC + NVP combination. The first reason for changing molecules was its unavailability (53.3%) in the ATCs. Conclusion: Although some banned molecules are still available in some treatment centers, the guidelines on first-line treatments are respected in different centers in Kinshasa.

Cases analysis of rational use of medicine (31) Nongonococcal urethritis(NGU)

1.Patient's conditionsA 29-year-old man,was infected with nongonococcal urethritis(NGU).He complained that he had dysuria and discomfort in the urethra and mucopurulent discharge,which appeared one week after intercourse.

Evaluation of rational use of antimicrobial agents in a Brazilian intensive care unit

The present study sought to assess the rational use of antimicrobial agents in a Brazilian intensive care unit (ICU) and its association with antimicrobial resistance in elderly patients admitted to the unit. Results: Choice of empiric and sensitivity-guided therapy was inadequate in > 80% and 59% of cases respectively. Inadequate antimicrobial therapy, whether empiric or sensitivity-guided, was positively correlated with bacterial resistance (r = 0.316;p = 0.001). Sensitivity testing revealed a 46.5% resistance rate to eight out of the ten most commonly used antibiotics. Multiple drug-resistant organisms were found in 40.8% of patients. A significant increase was observed in the number of multidrug-resistant samples between 2006/2007 and 2008 (r = 0.41, p = 0.006), (r = 0.598, p = 0.001), (r = 0.688, p = 0.00). Conclusion: We found a high rate of antibiotic misuse in the study sample. Inadequate therapy was correlated with resistance to antimicrobial agents.

Evaluation of the Effectiveness of Community Pharmacy Services on Rational Medication Use in Elderly Patients with Hypertension and Diabetes

Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hypertension and diabetes were selected and randomly divided into a control group(routine medication guidance)and an observation group(community pharmacy services),with 40 subjects each.The medication effect scores,blood pressure,blood sugar levels,and quality of life scores before and after intervention were compared between the two groups.Results:Comparison of pharmaceutical knowledge,medication compliance,and safe medication behavior scores showed that the observation group had higher scores as compared to the control group(P<0.05);blood pressure(systolic blood pressure,diastolic blood pressure,heart rate)and blood sugar(fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin)index levels were compared,and the observation group’s index levels were lower than those of the control group(P<0.05);the scores of physical health,mental health,social relationships,and environment in the observation group were higher than those in the control group(P<0.05).Conclusion:Community pharmacy services improved the rational medication effect of elderly patients with hypertension and diabetes,and improved their blood pressure,blood sugar control levels,and quality of life.

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.

Impact of pharmaceutical intervention on the rational use of antibiotics in primary hospital

Evidence based pharmaceutical interventions focusing on the characteristics of antibiotics use in primary hospitals were investigated to optimize the use of antibiotics. Four pharmaceutical interventions were set up in this study： 1） different levels of antibiotic management system were developed; 2） usage of antibiotics was reported in a monthly journal for the entire hospital; 3） early antibiotics warning system was started; 4） communication between pharmacists and physicians was strengthened. Use of antibiotics in 2007 （before intervention） and 2008 （after intervention） in department of respiratory medicine was analyzed. Significant differences （P〈0.01） in antibiotics use before and after intervention were observed. Use of antibiotics was changed from focusing on one category of drugs to a rotation of a wide range of agents. Evidence based, sound pharmaceutical interventions were effective means to ensure the rational use of antibiotics.

The impacts of national essential medicine policies on the rational use of medicines in China: A cross-sectional study in primary health care institution

Irrational use of medicines is a major problem worldwide, and it is believed there would be positive correlation between the National Essential Medicines Policies(NEMPs) and the level of rational use of medicines(RUMs). Though there is some early evidence on the NEMPs’ effects on RUMs in China, the evidence is scarce, and conclusions vary. In the present study, we aimed to evaluate the impacts of the NEMPs of China on the RUMs in the primary health care institutions(PHCs). A cross-sectional survey was conducted in 2010. A total of 201 PHCs from six provinces of China were selected, and 39 181 prescriptions were extracted from January to June, 2010. Six indicators were used and tested by independent-samples T test. We found that the average number of drugs per prescription in PHCs with NEMP implementation(the treatment group) was significantly higher than that of the group without NEMP implementation(the control group)(3.37 vs. 2.83, P<0.01). There was no significant difference in the average cost per prescription(81.43 vs. 75.02). The percentage of prescriptions, including an antibiotic(53.40% vs. 36.48%, P<0.01) or an injection(40.54% vs. 27.94%, P<0.01), was higher in the treatment group, and the percentage of drugs prescribed by general name was significantly lower(83.71% vs. 93.11%, P<0.01). For the percentage of drugs prescribed from essential medicines list, the treatment group exhibited the higher ratio(76.12% vs. 53.45%, P<0.01). From this study, the NEMPs were not likely to have a positive impact on RUMs. China still needed efforts to improve the selection, the absence of physicians’ active involvement, and the patients’ habits of irrational medication use.

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。

Rainwater Harvesting in Multifamily Social Interest Housing

This study evaluated the reduction of water consumption in a SIH （social interest housing） complex from the simulation of implanting a rainwater harvesting system. The methodology consisted of characterization of the case study, survey data of water consumption and data of precipitation in the area, on-site visits to define the average consumption and monthly water distribution, and sizing of a rainwater harvesting tank following the Netuno Program. It was obtained 22.500 L as the ideal volume for the tank, supplying the demand for drinkingwater in 32%, although the reduction in the drinking water bills would be minor, since the object of the case study is considered SIH, and residents pay a fixed fee for consuming up to 10 m3 per month. Therefore, it becomes necessary to analyze this situation from a sustainable and environmental perspective, and the benefits are no longer only economic, but rather they take on a more comprehensive social dimension.

The Concept of Information Support for Bi-oresource and Ecosystem Research in the North-West Pacific: Theory and Practical Implementation

The first part of the article provides an overview of the theoretical evidence, the main provisions, and the implementation strategy of information support for bioresource and ecosystem research in the north-west Pacific, which has been conducted over the past 20 years in the Russian Far East Research Institute TINRO-Center. In short, the concept consists of a combination of the following four assertions: 1) For the steady and sustainable development of the Russian Far East, the entire Russian Federation and the Asia-Pacific Region in general, environmental, food, economic, and other security is required, which cannot be achieved without the rational use of bioresources based on the ecosystem approach to the management of aquatic bioresources. 2) For the inventory, appraisal, monitoring, forecasting of the state of and management the natural water resources when applying this approach, statistically relevant quantitative information is required on the greatest possible number of constituents of marine biocenosis of the north-western Pacific for the longest possible period of time, which is only available at the TINRO-Center. 3) This valuable data should be organized into databases, based on which geo-information and other electronic information systems are prepared, and based on these map atlases and reference books on natural water resources, using automated workplaces created especially for this. 4) The resulting unique information support will be of great value not only for practical purposes, but also for science, both applied and fundamental. Next comes a summary of the many years of work on the practical implementation of this concept and the key achievements in this field obtained by the TINRO-Center by the end of 2015 are reviewed. At the end, some plans for the near future are outlined.

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。