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.

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 of serum 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 Thl 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 Thl function.

An Investigation of Oxidative DNA Damage in Pharmacy Technicians Exposed to Antineoplastic Drugs in Two Chinese Hospitals Using The Urinary 8-OHdG Assay

Objective To investigate oxidative DNA damage in pharmacy technicians preparing antineoplastic drugs at the PIVAS （Pharmacy Intravenous Admixture Service） in two Chinese hospitals. Methods Urinary 8-OHdG served as a biomarker. 5-Fluorouracil （5-FU） concentrations in air, masks and gloves were determined. The spill exposure of each PIVAS technician to antineoplastic drugs was investigated. Eighty subjects were divided into exposed group t, II, and control group I, II. Results 5-FU concentration ratios for gloves and masks in exposed group I were significantly higher than those in exposed group II （P〈0.05 or P〈0.01）. The average urinary 8-OHdG concentrations in exposed group I, control group I, exposed group II, and control group II were 24.69＋0.93, 20.68＋1.07, 20.57＋0.55, and 12.96_＋0.73 ng/mg Cr, respectively. Urinary 8-OHdG concentration in exposed group I was significantly higher than that in control group I or that in exposed group 11 （P〈0.02）. There was a significant correlation between urinary 8-OHdG concentrations and spill frequencies per technician （P〈0.01）. Conclusion There was detectable oxidative DNA damage in PIVAS technicians exposed to antineoplastic drugs. This oxidative DNA damage may be associated with their spill exposure experience and contamination of their personal protective equipment.

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.

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.

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.

PIVAS临床试验用静脉输液类药品调配管理专家共识

目的进一步规范医疗机构临床试验用静脉输液类药品在静脉用药调配中心(PIVAS)的调配管理标准,为医疗机构提供高质量药学服务提供参考。方法上海市药学会医院药学专委会PIVAS学组发起,上海中医药大学附属龙华医院、上海市老年医学中心共同牵头,组织多个医疗机构的PIVAS专家成立编写组,就临床试验用静脉输液类药品在PIVAS调配管理中的基本要求、调配过程等重点内容进行研讨,由牵头单位专家对意见进行整理、归纳、分析、反馈、修订,最终召开定稿会形成《PIVAS临床试验用静脉输液类药品调配管理专家共识》。结果与结论本共识主要内容包括PIVAS临床试验用静脉输液类药品的信息化管理、操作流程、经费管理以及文档管理等要点。本共识建立了规范的PIVAS临床试验用静脉输液类药品调配管理模式,通过规范临床试验药品管理操作流程,准确记录、保存药品相关信息,使PIVAS接收临床试验药品的管理能达到规范化、精细化的结果。

2024版《输液治疗实践标准》中管制药物转移的解读

输液治疗中的管制药物转移对医疗、法律和社会均具有潜在威胁,管制药物转移的管理面临着挑战。对2024版美国静脉输液护士学会《输液治疗实践标准》中首次提出的关于药物转移的预防、识别和处理等内容进行解读,旨在为我国医护人员的临床实践和相关决策制订提供参考,以减少输液治疗中的药物转移,保护患者和临床安全。

品管圈活动在静脉用药调配中心静脉药物污染管控中的应用效果

目的探讨品管圈(QCC)活动在静脉用药调配中心(PIVAS)静脉药物污染管控中的应用效果。方法收集2023年3月1日至4月30日未实施QCC活动时PIVAS收到的10000份静脉用药处方(依据静脉用药调配流程进行药剂调配)和2023年5月1日至6月30日实施QCC活动后PIVAS收到的10000份静脉用药处方(对静脉用药调配实施QCC活动管理)为研究对象。分析活动的有形成果及无形成果。结果QCC活动后静脉用药污染率由1.09%下降至0.22%,其中微粒污染率由0.78%下降至0.12%,微生物污染率由0.31%下降至0.10%。目标达成率为124.29%,污染总进步率为79.82%,微粒污染进步率为84.62%,微生物污染进步率为67.74%。QCC活动后,圈员各项能力均明显提高。结论QCC活动能通过深入发掘分析静脉用药污染发生真因并制定干预策略来有效降低静脉用药配制污染率,提升用药安全。

麦肯锡7S模式在静配中心降低新生儿肠外营养液调配差错的效果应用

目的分析麦肯锡7S模式在降低该院静脉药物调配中心(PIVAS)新生儿全胃肠外营养(TPN)调配差错方面的效果。方法收集2023年1-12月新生儿TPN配置差错数据,按照麦肯锡7S模式流程优化前后将其分为对照组和试验组,比较2组新生儿TPN调配差错的情况。结果流程优化后,试验组的差错率从2.206‰(66/29921)降至0.646‰(18/27861),低于对照组,差异有统计学意义(P<0.05)。结论麦肯锡7S模式能够降低PIVAS新生儿TPN的调配差错,完善并优化配置流程,提高患儿用药质量。

全自动智能静脉用药调配机器人ML300在静脉用药调配中心的开发与应用

目的:探讨全自动智能静脉用药调配机器人ML300在静脉用药调配中心中的开发与应用。方法:抽取2024-06-01/30天津医科大学肿瘤医院静脉用药调配中心含有注射用奥美拉唑钠、维生素C注射液、异甘草酸镁3种药物的配置医嘱处方各100份,按处方配置方法分为对照组(n=100)、实验组(n=100),对照组应用人工模拟临床工作模式配置上述3种药物,操作由若干人员完成;实验组应用全自动智能智能静脉用药调配机器人ML300配置上述3种药物,操作由一人完成。对比两组配置上述3种药物的配药效率、药物残留量、不溶性微粒合格率、微生物检出率。结果与结论:实验组3种药物配药效率与不溶性微粒合格率均高于对照组(P<0.001),3种药物残留量与微生物检出率均低于对照组(P<0.001)。以注射用奥美拉唑钠、维生素C注射液、异甘草酸镁3种药物为例,全自动智能静脉用药调配机器人ML300可提高静脉用药调配中心工作人员的配药效率、优化配药质量。

基于NanoDet和YOLOv5融合的静脉药物复核检测系统研发

静脉药物在我国应用范围大、使用人数多,是临床上常用的治疗手段之一,但是静脉药物的配置过程中,存在着数量多、种类杂等诸多影响配药准确性和质量的因素,所以准确的药物复核系统是解决此问题的优秀方法,为此医疗行业提出“四查十对”等方法来提高配药准确度和质量,但是医护人员工作繁重、任务量大,难以完全正确的配置静脉药物。得益于目标检测模型的发展,静脉药物复核取得了较大的进步,基于不同目标检测模型的复核系统在不同的工作情况下会有不同的表现。基于不同的灯光模式,检测NanoDet和YOLOv5对药名和药瓶类型识别的准确度,以此为基础,为进一步研发静脉药物复核检测系统打下基础。

药师24 h全医嘱审核在静脉用药调配中心的应用效果

目的观察药师24 h全医嘱审核在静脉用药调配中心的应用效果。方法选取2023年1—12月在泗洪医院住院接受静脉用药患者70例,按照治疗时间先后顺序将其分为对照组(2023年1—5月)和观察组(2023年6—12月)各35例。对照组接受常规管理,观察组接受药师24 h全医嘱审核管理。比较两组不合理用药状况及静脉调配中心调配效率、工作质量评价情况。结果观察组不合理用药情况总发生率低于对照组,静脉调配中心日人均审核数量低于对照组,医嘱审核后流程耗时、医嘱同步时间、批次优化耗时短于对照组,静脉调配中心工作质量各项评分高于对照组,差异均有统计学意义(P<0.05)。结论药师24 h全医嘱审核方式可以提升静脉用药调配中心工作质量,提升调配效率,减少不合理用药问题。

精益管理改进优质护理工作应用在静配中心管理中的效果分析

目的分析精益管理改进优质护理工作应用在静脉用药调配中心管理中的效果。方法选取2022年1—12月中国贵航集团三〇二医院3756张药物配置处方,将2022年1—6月实施传统常态化管理的1894张药物配置处方作为对照组,2022年7—12月实施精益管理改进优质护理工作的1862张药物配置处方作为观察组。两组为同一组调配人员,共17名。比较两组差错事件发生情况、调配人员调配技能及工作效率、临床科室对调配人员满意度。结果观察组差错事件总发生率低于对照组,调配人员调配理论评分和调配实践评分均高于对照组,贴标签时间、排药时间、配药时间均短于对照组,临床科室对观察组调配人员总满意度高于对照组,差异有统计学意义(P<0.05)。结论精益管理改进优质护理工作能够降低静脉用药调配中心差错事件总发生率,提高调配人员调配技能及工作效率,提升临床科室对其满意度。

An iterative Approach to Deriving Drug Infusions

A simple iterative process can be used to generate intravenous drug infusion profiles. It overcomes limitations in deriving compartmental pharmacokinetic models and has application to evaluation of new drugs and to clinical practice.

Isolated tricuspid valve infective endocarditis in young drug abusers

Isolated tricuspid valve infective endocarditis (TVIE) is a rare clinical condition. Thus, there is no common consensus for the treatment options for TVIE. Vege-tectomy and valvulectomy, valve repair, and valve replacement, which are controversial in regard to hemodynamic consequences in right-sided low-pressure system and long-term prognosis. We present 2 young intravenous drug users with TVIE and our surgical strategy.

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。

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。

某三甲医院PIVAS绩效管理信息化平台构建与应用

目的探讨构建静脉用药调配中心(PIVAS)绩效管理信息化平台,用于日常PIVAS绩效二次分配管理,从而精细化管理PIVAS工作人员。方法在PIVAS协调软件上增加绩效管理综合模块,根据每个月冲配技术员配置分数、核对药师核对分数、审方药师审方总分数、奖惩分数,计算出相应岗位人员每月最后综合分数,再计算出人员绩效工资。结果PIVAS依据绩效管理信息化平台实施绩效管理后,医嘱审核速率、调配速率、核对速率、考勤合格率均显著提高,差错率显著降低(P<0.05)。结论借助信息化平台统计PIVAS相关工作量、差错数、质控分数等有助于公平公正评价各个环节工作人员绩效分数。