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.

Training of clinical pharmacists in psychiatric pharmacy services during the prevention and treatment of COVID-19

A series of pharmacy services of clinical pharmacists at the Wuhan Mental Health Center during the prevention and treatment of Coronavirus disease 2019(COVID-19),such as participation in the formulation of COVID-19 prevention and treatment plans suitable for psychiatric departments,popular science of pharmacy,medical order review,real-time intervention,and medication education are summarized here.Due to the sudden public health incident,the service model of psychiatric clinical pharmacists should be addressed,as clinical pharmacists are an important part of the diagnosis and treatment of psychiatric diseases.Among the majors currently available in the clinical pharmacy training base curriculum,no psychiatry major has been set up in China yet;therefore,in this paper,we provide guidance in psychiatry pharmacy for those who wish to integrate clinical teams.

The Impact of a Clinical Pharmacist in the Emergency Department of an Academic Hospital in the Kingdom of Saudi Arabia

Introduction： The department of emergency medicine （DEM） has a high-risk environment due to its unique and complex workflow. Many high-risk medications are ordered and administered at patients’ bedsides without being checked by a pharmacist first, which may lead to an increase in the incidence of patient medication errors （MEs）. Objective： The current study evaluated the needs of the clinical pharmacy service in the DEM at King Saud University Medical City （KSUMC）, Riyadh, Saudi Arabia. Methods： A cross-sectional retrospective study was conducted between Jan 2016 to Dec 2017 and the documentation of clinical pharmacist interventions was extracted from Esihi database. Results： A total of 2,255 interventions for 862 patients were documented. The recommended interventions were as follows： 645 （dose adjustments）, 108 （therapeutic substitutions）, and 354 interventions （initiating drug therapy）. Adverse drug reactions （ADRs） were reported in 16 patients, and drug interactions were managed in 26 patients. The DEM responded to 713 information inquires and 290 pharmacokinetic consultations. Drug discontinuations included 39 incidents （where unjustified drug prescription occurred）, 37 （where contraindications were involved）, and 19 （where duplicate therapy was involved）. The most common interventions were related to the following drugs： antibiotics （34%）, anticoagulants （15%）, and anticonvulsants （10%）. The acceptance rates for the EM clinical pharmacist recommendations increased from 93.9% in 2016 to 99% in 2017. The most common outcome for interventions was to optimize the therapeutic effects of the drugs that were administered （73%）. Reconciliation was done in 796 patients. Conclusions： The clinical pharmacy service plays a critical role in the management of patients in the emergency department （ED）.

Perception of Physicians to the Role of Clinical Pharmacists in United Arab Emirates (UAE)

The present study aims to investigate the perceptions and experience of physicians regarding the clinical role of the pharmacists. This is an observational study that was conducted during the period of September 2013 through March 2014. A self-administered questionnaire was designed to be distributed by personal interview to the physicians. The questionnaire population consisted of randomly selected physicians practicing in UAE. The questionnaire was piloted by 10 physicians for face and understandability. Demographic data, frequencies and cross tabulation between different variables were calculated. The Chi-square test was used to determine the significance of association between categorical variables (gender, length of medical practice, and specialty) and the perception of physicians. A total of 285 filled questionnaires were returned representing 285 physicians, with a male dominance (65.3%). The average age of the physician screened was 32.4 (SD = 10.38) years with a minimum one year experience and up to 24 years. General practitioners consumed the widest sector (21.8%) followed by cardiologists (15.8%), then internal medicine (10.1%). In the current study, two thirds of the physicians believed that pharmacists could act as a reliable source of general drug information and play an important role in discovering clinical related problems. It was found that the physicians who had fewer years in practice (less than 10 years) and recently graduated had more acceptances to the clinical role of the pharmacist and believed that there should be a clinical pharmacy services in their hospitals (p-value < 0.05). No other statistically significant differences were found from analyzing the data. In conclusion, results suggest that physicians in UAE appear comfortable with pharmacists providing the broad range of services but appear somewhat less comfortable with pharmacists’ provision of direct patient care.

The Impact of Clinical Pharmacist Interventions on Drug and Antibiotic Prescribing in a Teaching Hospital in Cairo

Background: The present study was undertaken to investigate the patterns of drug and antibiotics prescribing in a teaching hospital in Cairo, Egypt. Aim: to determine the impact of interventions on such trends in an attempt to rationalize drug use. Method: 1200 prescriptions and patients' records covering the months of January to December, 2011. Prescribing patterns were analyzed using WHO guidelines with regard to prescribing, patient care and health facility indicators. The same parame-ters were again assessed after distributing antibiotic guidelines and holding workshops activities directed towards rational drug use. Results: The number of hospital visits resulting in a prescription was significantly reduced from 94% to 86% (P-value <0.05) and in both cases none of the en-counters contained a generic drug. The average number of drugs per encounter was 2.7 and did not decrease significantly after intervention. A significant reduction was achieved in the number of prescriptions with antibiotics whereas reduction in encounters with injectable drugs was not statis-tically significant. Penicillins was the most commonly prescribed class of antibiotics and amoxicillin was the most frequently prescribed antibiotic. A significant reduction was observed in both en-counters with penicillin and the total of those with antibiotics. Analysis of prescriptions with anti-biotics revealed that penicillins, cephalosporins and erythromycin comprised 94% and 97% of all antibiotics prescribed before and after interventions respectively. Conclusion: The present results clearly indicated that interventions including distribution of antibiotic guidelines and running workshops and seminars on rational drug use to prescribers can lead to significant improvement in prescribing behavior.

Effectiveness of Clinical Pharmacist Directed-Diabetes Management

Objective: The main aim of the study is predominately utilizing clinical pharmacist in the provision of continuing diabetic education programs to emphasize and re-emphasize the importance of risk factors, prevention, adherence to medication and behavioral changes to prevent recurrences of the disease, their progression, and ultimately minimize hospitalization. Specific goals are to improve clinical outcomes for patients with diabetes—to maintain optimal plasma glucose concentrations Fasting, Postprandial Plasma Glucose, and Glycated Hemoglobin. Study design: A prospective interventional study in the Outpatient General Medicine Department, for a period of six months from October 2018 to March 2019. Results: HbA1c levels were reduced from baseline by &minus;1.107 ± 0.8634, Fasting Plasma Glucose levels and Postprandial blood glucose levels were reduced from baseline by &minus;24.2218 ± 5.70352 and &minus;30.1891 ± 1.40592 respectively. Conclusion: A trained clinical pharmacist by providing diabetes education and care can significantly reduce hyperglycemia, thereby improving the quality of life in diabetes patients and ultimately reducing health care costs associated with these morbidities.

Analysis of the status of clinical pharmacist pilot training in Chinese hospitals

A total of 626 questionnaires were collected and analyzed to study the current status of Clinical Pharmacist Pilot Training（CPPT）in Chinese hospitals.The training satisfaction of the training hospitals,trainees,and the trainee providing hospitals are all very high,among which the satisfaction of the training hospital is the highest.According to the results of the questionnaire, the most important training mode in the training hospitals＇ opinion is different from that in the trainees＇ opinion.Trainees prefer more initiative,practical,and participatory training and hope to learn from the wards round process,while the training hospitals are more inclined to group discussion and teaching.It＇s necessary to increase the number of eligible training hospitals, to implement one on one mentoring strategy in hospital pharmacist training,and to increase active learning in the training program. The result of this research would help to build more effective and efficient pharmacist training programs in Chinese hospitals.

Analysis for the vancomycin plasma concentration data in infants by clinical pharmacists

In the present study, clinical pharmacists monitored the blood concentration of vancomycin in children in the Infant Ward from 2013 to 2014, and the drug dose was adjusted according to its plasma concentration. Moreover, we analyzed the plasma concentration of vancomycin in infants in the hospital from 2013 to 2014. Simultaneously, we also discussed the necessity of regular therapeutic drug monitoring of vancomycin in infants, and the important role of clinical pharmacists was further explored. The results showed that it was necessary to routinely monitor the therapeutic drug in infants. Clinical pharmacists performed medication monitoring, which improved the effectiveness of vancomycin and prevented its adverse effects. In addition, it is a new treatment model for the participation of clinical pharmacists in the clinical treatment.

Participation of clinical pharmacist specialized in oncology in the treatment of a patient with advanced esophageal carcinoma complicated with hypertension: one case report

Clinical pharmacists specialized in oncology contributed to the safe and effective chemotherapy treatment for advanced esophageal carcinoma patients complicated with hypertension by participating in medication practice. Optimal therapeutic regimen was proposed, and pharmaceutical care and health education were provided based on the condition of each patient. By providing pharmaceutical care for cancer patients with their pharmacy knowledge, clinical pharmacists specialized in oncology can not only reduce the potential risks of chemotherapy, but also take into account of other accompanying diseases, thus improving the comprehensive treatment of patients. Furthermore, it deepened the understanding of the role of clinical pharmacy practice by patients and other medical workers. Involvement of clinical pharmacist in therapeutic practice could improve the outcome of pharmacotherapy.

Impact of clinical pharmacist intervention on rational use of surgical antibiotic prophylaxis in thyroid surgery

In the present study, we aimed to evaluate the intervention effect of prophylactic antibiotic use in thyroid surgery in a large hospital. From 2004 to 2012, 70 patients who underwent thyroid surgery were randomly selected each year. The quality of surgical antibiotic prophylaxis （SAP） was assessed each year in terms of antibiotic ratio, choice, duration, timing, combination, route of administration and so on. The result showed that the SAP ratio was 100% from 2004 to 2010. With our intervention, this SAP ratio was decreased to 45.7% in 2011, and it reached 2.9% in 2012. The AUD was consistently greater than 38 before 2010, while it rapidly declined to 1 in 2012. The number of DDDs per 100 operations was decreased from 431 to 3 after the intervention. The average cost of antibiotic drugs per patient was RMB 350.65 in 2010, whereas it was decreased to RMB 18.51 in 2012. The average duration of hospitalization showed no difference during the intervention. This study indicated that implementation of a multi-disciplinary protocol and clinical pharmacist interventions could improve the rational use of SAP.

Peking University Health Science Center Model of Clinica Pharmacy Education and Clinical Pharmacist Services

In the 1950s, clinical pharmacy emerged in the United States and gradually developed into an indispensable component of the clinical services system, The American College of Clinical Pharmacy defines clinical pharmacy as a pharmaceutical field that focuses on the science and practice of rational drug use.

Advances on anticancer new drugs in China and the USA in 2020:from ongoing trial to drug approval

Objectives:To describe and compare the research and development(R&D)pipeline of cancer new drugs and newly approved drugs in China and the USA in 2020,thus to provide decision-making evidence for related stakeholders.Methods:Clinical trials and tested cancer new drugs information in China and the USA were respectively ac-quired from Information Disclosure Platform for Drug Clinical Studies and Trialtrove database.Drug approval was tracked from the official release.Subgroup comparison in terms of initiated trials and drugs were conducted between the two countries.Results:In 2020,577 trials on 335 cancer new drugs were registered in China,accounting for 22.6%of all clinical drug trials,while in the USA,916 trials on 678 cancer new drug trials were captured,accounting for 19.9%of the total.Relatively,a lower proportion of earlier phase(76.9%vs 87.4%),global(17.7%vs 39.0%),and top 20 pharmaceutics contribution(15.8%vs 43.2%)were found for cancer drug trials initiated in China.The fight against solid tumor took top billing in both countries,and the different distribution of cancer indications associated with cancer spectrum was also observed.Compared with the USA,more targeted agents(87.5%vs 77.0%,P<0.001)and less immune agents(30.7%vs 41.6%,P<0.001)were tested in China.In addition,16 and 18 anticancer new drugs were approved in China and the USA,with 6(37.5%)and 17(94.4%)drugs being firstly approved worldwide,respectively.Among them,32 drugs were granted by at least one expedited program,and 31 drugs were approved based on evidence from surrogate endpoints.A total of 17 cancer types were covered,and only one drug was targeted on digestive cancers,including gastric,liver,and esophageal cancers.Conclusions:R&D of anticancer new drugs is substantial,and great progress has been made in both China and the USA in 2020.The difference and gap between China and the USA highlight that more efforts should be paid to anticancer drug R&D on innovative agents and cancers unique to Chinese populations,as well as to facilitate global synchronous R&D in China.

The Expanding Roles of Hospital Pharmacists in Clinical Drug Trials in China

Objective To aim at summarizing the role of hospital pharmacists in clinical drug trials in China against the background that hospital pharmacists have already involved in team-based patient care.Methods The roles and responsibilities of Chinese hospital pharmacists were listed and categorized.Results and Conclusion There has been an upsurge in clinical drug trials in China.Hospital pharmacists play increasingly important roles in all aspects of clinical trials,such as stakeholder liaisons,protocol developers,ethics committee members,research team members,study drug managers,and subject intervention agents.Hospital pharmacists are an integral part of a clinical drug trial multidisciplinary team.Their value is reflected in several pharmacist-led or pharmacist-participating clinical trials as well as the trial project management position within hospitals.Pharmacists should be the designers,researchers,managers and supervisors of clinical drug trials.We expect that all clinical trial projects will include hospital pharmacists in their research teams soon.

临床药学专业抗感染PBL案例库的建设与探索

抗菌药物合理使用已成为临床药学实践教学的重要内容之一。传统的教学方式存在局限性,往往不能有效提升学生在实际临床工作中抗菌药物合理使用的能力。为解决这一问题,笔者研究了以以问题为基础的教学法(problem-based learning,PBL)为基础的案例库建设在抗菌药物合理使用教学中的应用;探讨了PBL案例库在抗菌药物合理使用教学中的重要意义和实用性。它不仅能激发学生的主动学习兴趣,还有助于培养其跨学科团队合作和临床决策能力。文章还明确了PBL案例库编写的基本原则、方法以及案例的结构和内容,以确保建设案例库的可行性。本研究在临床药学专业硕士研究生教育中的实践证明,该方法适用于现代教学模式,有望显著提高抗菌药物合理使用教学的质量和效果,具有重要的教学和临床实践意义。

视频和节点提醒用于结肠镜检查肠道准备患者药学服务效果分析

目的探讨临床药师利用视频和节点提醒的药学服务对结肠镜检查肠道准备质量、不良反应发生情况、健康教育指导满意度的影响。方法选取医院消化内科2021年1月至12月接受结肠镜检查的住院患者216例,按肠道准备指导方式分为干预组和对照组,各108例。对照组患者给予肠道准备方案及复方聚乙二醇电解质散,以及传统纸质肠道准备指导单进行健康教育指导;干预组患者在对照组基础上由临床药师利用视频和节点提醒进行肠道准备健康教育。比较两组患者肠道准备质量的合格率和不良反应发生率,并同时调查患者对临床药师健康教育指导的满意度。结果干预组肠道准备质量合格率为87.96%,显著高于对照组的67.59%(P<0.05);干预组患者波士顿肠道准备评分量表(BBPS)评分显著高于对照组(P<0.05);干预组患者呕吐、腹胀不良反应发生率分别为5.56%和7.41%,均显著低于对照组的12.96%和13.89%(P<0.05)。干预组患者对临床药师健康教育指导的满意率为90.82%。结论临床药师利用视频和节点提醒的药学服务可显著提高结肠镜检查患者的肠道准备质量,减少呕吐、腹胀等不良反应,且患者满意度高。

中美老年专科临床药师培训项目比较分析

目的 比较中美两国老年专科临床药师培训项目的基本情况,为我国老年专科临床药师培训项目的进一步优化提供参考。方法 查询美国卫生系统药师协会(ASHP)和中国医院协会官方网站,检索并收集中美两国老年专科临床药师培训项目的培训大纲、机构类型/规模、招生人数、培训内容、申请条件、考核标准等资料和数据,采用Excel软件进行统计分析。结果与结论 截至2024年1月12日,美国ASHP共开展毕业后第2年老年专科临床药师培训项目24个,可招收25人,并提供相应薪酬;培训基地涉及医院、药学院,规模不一;申请人需获得药学博士学位、完成毕业后第1年培训。ASHP就基础患者照护、高级患者照护、领导力和管理能力、知识的教育教学传播能力四大必备技能设计了详细的培训目标,各培训基地可结合自身特点,适当增设学术技能、长期照护技能等可选技能,制订学员轮转计划,并在培训过程的多个时间节点进行考核、评估。我国共开展老年专科临床药师培训项目5个,可招收15人,不提供薪酬;培训基地均为三级甲等医院,规模较大;申请人需要获得本科及以上学位,并根据所学专业和学位的不同,对其有不同的工作年限要求。中国医院协会药事专业委员会设置了详细的培训大纲,就理论知识、实践技能、科研思维等提出了具体的培训目标,在入组时、规定内容培训完成时和结业时由培训基地组织考核、评估。参考美国的项目开展经验,建议带教老师针对不同层次的学员开展差异化的知识和技能培训,灵活安排轮转科室,要求学员尽可能独立开展工作并深入参与临床教学、科研工作,安排多次、多种形式的考核、考察,及时调整学习方案,全面提升学员能力。

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。

57家医疗机构儿科临床药师发展情况调研

目的:了解我国儿科临床药师发展现状,为儿科临床药师的管理、培养和发展提供参考。方法:采用问卷调查法,以福棠儿童医学发展研究中心临床药师组的儿科临床药师为调研对象,了解儿科临床药师的学历分布、专业背景、就业环境、工作内容和学术期望。结果:来自我国27个地区的57家医疗机构的225位儿科临床药师参与了调研。所调研儿科临床药师多来自三级医疗机构(99.55%),年龄分布以30~39岁为主(73.33%),职称主要为主管药师(64.44%),专业背景以药学(34.67%)、临床药学(30.22%)和药理学(16.00%)为主。药学查房、处方点评与处方分析、不良反应收集等工作均有开展。药学查房以与医生共同查房为主,每周总时长10h以内的占48.44%。56.00%的临床药师每月监护1~10例患儿,53.78%的临床药师每月可开展1~5次普通药学会诊,35.56%的临床药师每月参与1~5次多学科会诊,52.44%的临床药师每月回答1~10例药学咨询。结论:儿科临床药师团队构成合理,工作内容已覆盖临床药师要求的各个方面,但与临床融合程度还需继续加强。

CBL教学法在通科专业住培胃肠外科中的应用效果

文章探索了案例教学法(case-based learning,CBL)在通科专业临床药师规范化培训学员中的应用效果。CBL教学法是以临床实际案例为基础的教学方法,通过直接引用在院治疗的患者为案例,让学员将药学理论与临床实践充分结合。文章以1例急性化脓性阑尾炎患者为例,总结近年来所在医院通科专业临床药师规范化培训的经验,并统计结业考核成绩,进行教学效果评定和学员满意度调查。CBL教学法可以运用于通科专业临床药师在胃肠外科临床实践,通科专业学员均顺利结业,考核合格并获得培训证书,且结业考核成绩均达标,教学效果优良,总体培训满意度较高。带教老师通过典型案例引导学员,参与从患者入院到出院整个治疗过程,让学员快速掌握外科临床药师的工作要点及模式,为通科专业临床药师学员在今后的外科临床药学实践中提供参考。

1例多发性骨髓瘤患者发生晕厥的病例分析与干预

本文报道1例多发性骨髓瘤患者在药物治疗后发生晕厥的病例。临床药师通过查阅相关文献,对晕厥原因进行详细分析,并对晕厥与所用药物的关联性进行了评价。结果表明,患者的晕厥可能与使用来那度胺和硼替佐米有关。调整治疗方案为伊沙佐米联合地塞米松后,患者未再出现晕厥。临床药师参与该病例的诊治,体现了临床药师在肿瘤多学科诊疗团队中药物方案制定、不良反应防控方面具有积极作用。