Objective The Health Technology Assessment (HTA) Based Guideline for Drug Added-value Evaluation was formulated in order to set up an objective and scientific drug evaluation indicator system and selection method,standardize drug evaluation and selection operation procedures,and expand the application scenarios of HTA in medical institutions. Methods During the construction of the guideline,preliminary evaluation indicators and detailed rules were formed through sufficient evidence retrieval and evaluation.Then,the dimensions and weight values of evaluation indicators were further determined using Delphi method and Analytical Hierarchy Processes. Results Eventually,a drug evaluation system and a relevant standard operating procedure with four primary indicators and eleven secondary indicators were constructed as the core. Conclusion This guideline is suitable for scenarios where two drugs are compared with each other for specific indications,such as the selection of new drugs in medical institutions,comprehensive clinical evaluation of drugs,rational use of medicine,etc.As such,it helps to improve the scientism,fairness and transparency of the decision-making process while also providing reference for the evaluation of the drugs' added value.
Objective To evaluate the acute toxicity reaction and severity of Zilian cream on percutaneous topical administration in rabbits,and to provide a reference for dose design of repeat dose toxicity study and clinical medication safety. Methods Twenty-four New Zealand rabbits were randomly divided into two normal skin groups and two model groups which back topical skin be injured with sandpaper,namely the normal control group,the normal Zilian cream group,the model control group,and the model Zilian cream group,three female and three male rabbits in each group.The corresponding drugs were percutaneously given three times in 24 h to rabbits with a volume of 50 mg·(cm2)-1 (12.50 g·kg-1 of the total dose,and equivalent to 5 times of proposed clinical dosage in 10% body surface area of human) at (4.0±0.5) h interval.General symptoms,signs,and administrated topical skin irritation of rabbits were observed every day for 14 days.During the different study periods,the body mass was weighed,the temperature was measured,and routine blood test indexes,and serum biochemical and electrolytes indexes were detected in rabbits of groups.After dissecting rabbits at the end of the study,the volume,color,and texture of organs were observed if there were abnormalities. Results The rabbits in each group were generally in good condition,and there was no obvious skin irritation to topical skin in rabbits. The detected results of body mass,temperature,routine blood test indexes,serum biochemical and electrolytes indexes were not abnormal,and pathological changes were not observed in the main organs. Conclusion Zilian cream does not show significantly toxic and irritation reactions in the maximal feasible dose (MFD) in rabbits.
Objective To investigate the effect and its mechanism of microRNA-199a-5p (miR-199a-5p) on the resistance of non-small cell lung cancer (NSCLC) cells to paclitaxel (PTX). Methods The relative expression levels of miR-199a-5p in human NSCLC cell line A549 and drug-resistant NSCLC cell line A549/PTX were detected by qRT-PCR;the resistance of A549 and A549/PTX cells to PTX were detected by CCK-8.The targeting relationship between miR-199a-5p and heat shock factor-1 (HSF-1) was verified by a dual luciferase experiment.Cell proliferation and apoptosis were detected by CCK-8 and TUNEL,respectively;the expression levels of HSF-1,heat shock protein (HSP) 90,HSP60,and P-glycoprotein (P-gp) proteins of cells were detected by Western blotting. Results The resistance of A549/PTX cells to PTX was significantly higher than that of A549 cells (P<0.05),and the IC50 of A549/PTX cells to PTX was higher than that of A549 cells.The expression of miR-199a-5p in the drug-resistant cell line A549/PTX was significantly down-regulated,and HSF-1 mRNA was significantly up-regulated (P<0.05).In the drug-resistant cell line A549/PTX,miR-199a-5p negatively targeted the expression of HSF-1 (P<0.05).Overexpression of miR-199a-5p or inhibition of HSF-1 in A549/PTX cells could reduce PTX IC50 values,promote cell apoptosis,down-regulate HSF-1,HSP90,HSP60,and P-gp protein levels(P<0.05);overexpression of HSF-1 could reverse the effect of up-regulation of miR-199a-5p on A549/PTX cells to a certain extent (P<0.05). Conclusion MiR-199a-5p can attenuate the PTX resistance of NSCLC cells by inhibiting HSF-1.
Objective To study the current status and difficulties of the construction of pharmacist-managed clinic,and to discuss its role in promoting of the quality of hospital care. Methods From the perspective of pharmacy discipline,the current situation and difficulties of pharmacist-managed clinic development in multiple dimensions were analyzed,and the role of pharmacist-managed clinic development in promoting the improvement of hospital medical quality was highlighted by combining the practice of pharmacist-managed clinic in Sichuan Provincial People's Hospital. Results Our innovative work in pharmacist-managed clinic,the Major Medical Insurance Audit Clinic,plays an important role in medical insurance cost control and health management.In addition,the role of pharmacist-managed clinics in promoting the quality of hospital care is mainly reflected in clinical outcomes,humanistic outcomes,economic outcomes,research and innovation,teaching,and other aspects. Conclusion In the future,efforts should be made to overcome and solve the difficulties in the construction of pharmacist-managed clinics,further practice and explore the role of pharmaceutical clinics in improving the quality of hospital care,and promote the construction of pharmaceutical disciplines and the common development of hospitals.
Objective To provide new ideas for the construction and development of hospital pharmacies. Methods Under the new medical reform policy background,the department of pharmacy of the 2nd Affiliated Hospital of Wenzhou Medical University was taken as an example.From the perspectives of "management,service,practice and innovation",the development strategy of pharmaceutical discipline with "patient as the center" was proposed.The paper analyzed the promotion effect of the innovative reform of hospital pharmacy on the hospital in three aspects,including drug management guarantee,clinical guidances and technological innovation. Results Based on the hospital's actual needs,our department took the patient as the center and the clinic as the core to promote the development of clinical multidisciplinary and enhance the value of pharmaceutical professional services.The operation of an informationized pharmaceutical quality control system effectively improved the quality of pharmaceutical care and rationalized clinical medication.The proportion of the income from adjunctive drugs,the total cost,and the proportion of drugs decreased gradually.Under the innovative construction and reform of the pharmaceutical discipline,the department is expected to build a comprehensive medical technology department integrating drug supply and deployment,preparation production and testing,clinical pharmacy practice,and scientific research and teaching. Conclusion The department of pharmacy of the 2nd Affiliated Hospital of Wenzhou Medical University has explored a new mode for the common development of "Medicine,Teaching and Research",which provides an effective guarantee for promoting the high-quality and sustainable development of public hospitals.
Under the current educational connection state between the pharmaceutical colleges and on-the-job education for hospital pharmacists,we compared the competency standards of pharmacists at home and abroad,and analyzed the training mode of pharmaceutical talents draws upon the relevant implementation experience of international peers based on post competency,such as clinical medicine,nursing,etc.A multi-stage accurate talents training program was developed on the basis of the existing training system of new pharmacists and several pilot training programs of hospital pharmacists during the entire career at present,which is according to the developing needs of hospital pharmaceutical services,as well as the clinical pharmacy disciplines under new situations and circumstances.In view of the personalized career development needs of pharmacists with different education background,follow the talent growth law of “from novice to expert”,we carry out a “tailored” complete period training program for hospital pharmacists based on post competency.In order to conduct a novel forward-looking hospital pharmacists training program and the corresponding evaluation system,thus to meet the needs of social development needs,and effectively improve the service efficiency of hospital pharmacists under “The Framework of Healthy China”,simultaneously assist the hospital develop with high quality.
Objective To explore the effectiveness of the medical order audit system optimization and the construction of a custom rule base. Methods After the medical order audit system was induced,the results of manual comments and software comments on medical orders were compared to evaluate the system's function.Then,the software functions were optimized,the rules were modified,the online application process of off-label drug use and the routine rules maintenance operation procedure was established,and the dynamic custom rule base of our hospital was formed. Results After the optimization of software functions,rules maintenance was more logical,and it was easier for pharmacists to query and modify rules.The number of rules was decreased significantly from about 309 000 to 28 000.After the establishment of the custom rule base,the medical order audit entered the stable period,compared with the initial stage,the proportion of unreasonable medical orders in system prereview was increased from 16.16% to 17.92% (P<0.01),the proportion of rigid blocking orders increased from 0.33% to 2.34% (P<0.01),avoiding serious medication errors,the rate of doctors' self-returned modification was increased from 45.29% to 60.83% (P<0.01),the proportion of successful intervention by pharmacists was greater than 60%.Compared with the stage before adopting medical order pre-audit system,the qualified rate of the medical orders increased from 88.03% to 92.50% (P<0.01),and further increased to 95.60%(P<0.01) after the completion of the custom-defined rule base. Conclusion With the help of a prescription audit system,the establishment of a hospital custom rule base can significantly improve the accuracy of prescription audits,reduce the workload of pharmacists,improve the qualified rate of prescriptions,and ensure the safe and rational drug use of inpatients.
Intelligent pharmacy is an important part of constructing “Internet+” hospitals.In medical institutions with a high level of intelligence,intelligent pharmacy technology has penetrated into drug procurement,storage,dispensing,infusion preparation,subcontracting and transportation,prescription review,pharmacovigilance,and pharmacy services.The combination of information technology and automation equipment can improve the efficiency of hospital pharmacy,the level of rational clinical medication,the quality of hospital pharmacy services,the patient's sense of experience,and ensure the safety and effectiveness of the patient medication.
Objective Optimize the intelligent pharmacy to improve the efficiency of outpatient pharmacy and the quality of pharmaceutical service. Methods To optimize the indicators in the construction of an intelligent pharmacy through adjusting pharmacy layout,drug distribution,and amounts,introducing the intelligent and secondary drug storeroom and changing the transfer rate between the automatic dispensing machine,optimizing the drug dispensing list,and making emergency plans. Results After optimizing the intelligent pharmacy system,the time of drug placement decreased from (9.14±0.73) h per week to (7.64±0.95) h per week (P=0.045 9).The waiting time of patients also decreased,with a significant increase in the proportion of patients waiting less than 3 min (35.4% vs.44.3%,P<0.01);The lack of drug of the automatic dispensing machine system decreased obviously (0.272% vs.0.068%,P<0.01).The number of drugs stuck in the process of the intelligent secondary library decreased from 42 in the first four weeks to 16 in the fourth week. Conclusion The optimization of intelligent pharmacy has reduced the workload of pharmacists,improved work efficiency in the outpatient pharmacy,reduced the waiting time of patients,and improved the quality of pharmaceutical service.
The construction of clinical pharmacy disciplines in county-level hospitals has been facing many confusions.There is a big gap between the level of discipline development and that of tertiary hospitals.The development of clinical pharmacist teams is limited.This article takes the construction of clinical pharmacy discipline in a county-level hospital as an example.Discuss the difficulties and coping strategies in the construction and development of clinical pharmacy disciplines,so as to provide reference for the construction of clinical pharmacy disciplines in county-level hospitals.Develop and expand the clinical pharmacy discipline of county-level hospitals in the process of building a "high-quality and efficient integrated medical and health service system with Chinese characteristics" to better serve grass-roots patients.
Objective To investigate the effect of timing of tumor necrosis factor (TNF)-α antagonist use on the efficacy of combined treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Methods Using real-world research methods,the clinical data of SJS/TEN patients treated with TNF-α antagonist in Tongji hospital (Tongji hospital case group,five patients) and in domestic and foreign literature reports (literature case group,35 patients) were collected. There was no significant difference in the clinical characteristics between our hospital case group and the literature case group. The patients were divided into two groups according to the application timing of TNF-α antagonist:the TNF-α antagonist group after other systemic therapy failed (group A,28 patients),and the TNF-α antagonist directly combined with other systemic therapy groups (group B,12 patients).The effects of the timing of TNF-α antagonist use on the efficacy of SJS/TEN combination therapy were retrospectively analyzed. Results Our hospital cases group responded well after combined treatment with TNF-α antagonists,and their condition improved within three days. The period before TNF-α antagonist use and the period before the lesions improved in group B were shorter than in group A (P<0.05). Conclusion Based on traditional systemic treatment of SJS/TEN,early combined use of TNF-α antagonists can help shorten the time of lesions to improve and ameliorate the disease rapidly.
Objective To observe the effect of chitosan antibacterial gel on promoting wound healing in patients with chronic cervicitis after cervical microwave operation. Methods A total of 149 patients with chronic cervicitis who received cervical microwave operation were randomly divided into a treatment group (78 cases) and a control group (71 cases).The cervical wounds were coated with chitosan antibacterial gel in the treatment group in postoperative,1,and 4 weeks respectively.No special medication was given in the control group after the operation.The patients in both groups were followed up in postoperative,in 1,4,8,and 12 weeks after the operation.The edema,scab formation,scab removal,healing,vaginal bleeding,and secretion characteristics of the cervical wound were observed,and the adverse reactions and laboratory indexes were recorded. Results Compared with the control group,the average time of wound healing in the treatment group was shortened by 1.83 weeks (P<0.01).The incidence of vaginal bleeding in 4 weeks after the operation in the treatment group was 56.41%,which was significantly lower than that in the control group (77.46%,P<0.01).Meanwhile,in 1 and 4 weeks after the operation,the amount of bleeding was less (P<0.01) and the duration of bleeding was shorter (P<0.01) in the treatment group than those in the control group.The incidence of inflammatory secretion in 1,4,and 8 weeks after the operation in the treatment group was 89.74%,26.92%,and 2.56% respectively,significantly lower than that in the control group (100.00%,56.34%,19.72%,all P<0.01).The incidence of cervical mucosal edema in 1 and 4 weeks after the operation in the treatment group was 15.38% and 6.41% respectively,significantly lower than that in the control group (73.24%,32.39%,all P<0.01).The incidence of scab formation of cervical mucosa in 4 weeks after the operation in the treatment group was 42.31% and that of scab removal in 8 weeks was 51.28%,which were significantly higher than those in the control group (22.54% and 13.33%,all P<0.05).No obvious adverse events related to medication and abnormal changes in laboratory indexes related to medication were found during treatment. Conclusion Chitosan antibacterial gel can promote wound healing and reduce postoperative complications in patients with chronic cervicitis after microwave operation.
Chondroitin sulfate is a glycosaminoglycan produced with animal tissues or microbial cell fermentation,and has been mainly used in clinical treatment and prevention of osteoarthritis,cardiovascular and cerebrovascular diseases,and ophthalmic diseases. In recent years,studies have shown that chondroitin sulfate and its derivatives show a variety of potential biological activities,such as anti-inflammatory,antitumor,anticoagulant,antithrombotic and so on,play a vital role in various physiological and pathological processes,and have the potential to be developed as a new drug in the future. In this paper,the pharmacological activities and clinical studies of chondroitin sulfate and its derivatives were reviewed in order to provide a reference for subsequent studies.
Adult hemophagocytic lymphohistiocytosis (HLH) is a systemic hyperinflammatory cytokinemia associated with an abnormal immune response,primarily secondary to infections,malignancies,and autoimmune diseases.Granulocyte colony-stimulating factor (G-CSF) is commonly used in the treatment of HLH-associated granulocytopenia for its role in stimulating the maturation and mobilization of bone marrow neutrophils.This article reviews the literature related to the treatment of G-CSF in adult HLH and emphasizes that the use of G-CSF in dult HLH needs to be carefully selected according to the pathogenic mechanisms of the primary etiology.
Oxytocin (OT) is a peptide hormone secreted by the posterior pituitary gland and synthesized through the paraventricular nucleus and supraoptic nucleus of the hypothalamus.For a long time,it has been known that OT has the function of promoting the contraction of the smooth muscle of the uterus and the contraction of the myoepithelium of the mammary gland (lactation).In addition to the above two classical functions,the physiological effect of OT binding to oxytocin receptors in the brain has attracted wide attention in central nervous system diseases.This paper reviews and summarizes the research progress of OT in central nervous system diseases,and discusses the possible mechanism of OT,in order to provide a theoretical basis for the clinical application of OT and the development of new drugs.
The property and flavors of Traditional Chinese Medicine (TCM) include four qi and five flavors(The four qi are cold,hot,warm and cool;The five flavors are sour,bitter,sweet,spicy and salty),which are one of the important indicators of the performance of TCM. Identifying and determining the property and flavor of TCM is an important step to correctly guide the practice of TCM and a long-term,comprehensive,and continuously improved process.Traditionally,four qi and five flavors of TCM are identified mainly through tasting,classification according to manifestation,drug efficacy,and other methods.Combined with modern drug research methods and technologies,nowadays,TCM practitioners make innovations based on traditional methods,which summarized the medicinal properties of four qi and five flavors from different aspects and offer a new perspective for revealing the nature of the medicinal properties of TCM.This article intends to summarize the origin and development of TCM property and flavor theory and the research methods and ideas of its identification to provide new means and methods for inheriting and developing the four qi and five flavors theory of TCM and offer references for promoting the modernization of TCM.
Objective To investigate the distribution of chlorogenic acid,isochlorogenic acid A,isochlorogenic acid B,isochlorogenic acid C and luteolin in different parts of the plant in Picris hieracioides L. Methods The contents of chlorogenic acid,isochlorogenic acid A,isochlorogenic acid B,isochlorogenic acid C,and luteolin are determined by an HPLC multi-wavelength switching method,and the detection wavelengths were set at 327 nm and 350 nm.The mobile phase consisted of acetonitrile and 0.1% phosphoric acid in water used at a flow rate of 0.8 mL·min-1 in a gradient elution method. Results The contents of the five active components were significant difference in different parts.The total content of five active components in the inflorescence is the highest,and the roots and stems were the lowest.The contents of the five active components are different in different parts from batch to batch,but the overall variation trend was the same. Conclusion Significant differences exist in the contents of the active components in different growing parts,which could also be reflected in the pharmacological effects.
Objective To establish an HPLC method for determining related substances in fluvastatin sodium extended-release tablets and provide a basis for the specification of fluvastatin sodium extended-release tablets. Methods The analyte was gradient eluted on a C18 column (ZORBAX Eclipse Plus C18 Rapid Resolution,75 mm×4.6 mm,3.5 μm) with mobile phase A (pH 7.2 buffer and methanol-acetonitrile mixture (the volume ratio is 90:10)) and mobile phase B (pH 7.2 buffer and methanol-acetonitrile mixture (the volume ratio is 10:90).The flow rate was 2.0 mL·min-1.The column temperature was set at 35 ℃.The detective wavelengths were 305 nm and 365 nm,and the injection volume was 25 μL. Results The impurity peaks were completely separated from the principal component peak.The detection limits for impurities A,B,C,D,E,F,and G were 0.069 5,0.032 5,0.059 3,0.074 0,0.050 3,0.048 6,and 0.026 3 μg·mL-1,respectively.The quantitation limits for impurities A,B,C,D,E,F,and G were 0.231 8,0.108 3,0.197 8,0.246 6,0.167 6,0.162 1 and 0.087 6 μg·mL-1 respectively.There was a good linear relationship between the concentration and peak area within the concentration range of the study,and the linearity concentration ranges of impurities A,B,C,D,E,F,and G were 0.231 8-6.0,0.108 3-1.2,0.197 8-1.2,0.246 6-3.0,0.167 6-1.2,0.162 1-3.0,0.0876-1.2 μg·mL-1 respectively.The recovery was 89.8%-103.5%.The sample solution was stable in 54 h at 5 ℃. Conclusion The method is simple,accurate,and reliable for determining related substances in fluvastatin sodium extended-release tablets.
Objective To evaluate the accuracy sensitivity,specificity and economy of nucleotide pyrophosphatase linked moiety X-type motif 15( NUDT15) gene polymorphism detection in predicting thiopurine-induced leukopenia(TIL),and to provide evidence-based basis for clinical decision-making. Methods The databases were systematic searched,including PubMed,Cochrane Library,China National Knowledge Infrastructure(CNKI)、 Wanfang Data,VIP Database for Chinese Technical Periodicals (VIP),as well as the official websites of health technology assessment (HTA) institutions. HTA reports,systematic reviews or meta-analyses,and pharmacoeconomic studies on genetic polymorphism testing for TIL were included,and the quality of the evidence was assessed. The accuracy,sensitivity and specificity are quantitatively described,and the economic evaluation results are qualitatively described. Results A total of 9 literatures were included,of which 7 were meta-analysis literatures and 2 were economics literatures. In East Asia,South Asia and the America,the mutation rate of rs116855232 was high,and the mutation rate of this locus in the included studies was 11.07%-40.52%. Compared with the control group,the risk of leukopenia in the rs116855232 mutant group (TT/TC) was significantly higher than that in the non-mutated group. Two studies reported the sensitivity and specificity of the NUDT15 gene polymorphism assay for predicting TIL,yielding an approximate sensitivity of 0.432,0.413,and specificity of 0.917,0.89,respectively. In terms of economy,NUDT15 combined with TPMT has a cost-effectiveness advantage over screening TPMT alone. Conclusion Based on the available evidence,rs116855232 is a clinically relevant predictor of TIL with higher accuracy,sensitivity and specificity than TPMT. Combined screening for NUDT15 and TPMT-deficient alleles is economical compared to screening for TPMT alone.
Objective To rapidly evaluate the effectiveness,safety,and economy of sacubitril-valsartan in the treatment of heart failure (HF),to provide evidence for medication selection and access decisions. Methods PubMed,Cochrane Library,China National Knowledge Infrastructure(CNKI)、VIP Database for Chinese Technical Periodicals(VIP),and Wanfang Data published from inception to May 2021 were systematically retrieved in order to collect literature,including systematic review/Meta-analysis,HTA reports,and pharmacoeconomic studies of sacubitril-valsartan and control drugs in the treatment of HF,including heart failure with reduced ejection fraction(HFrEF),heart failure with preserved ejection fraction(HFpEF),and heart failure with mid-range ejection fraction(HFmEF).Two reviewers independently screened literatures,extracted data,and evaluated the quality of studies,and then compared the research results comprehensively according to the inclusion and exclusion criteria.The effectiveness,safety and economic results were qualitatively described. Results A total of 25 works of literature were included,including one HTA report,13 systematic reviews/meta-analyses,and 11 pharmacoeconomic studies.In terms of effectiveness,compared with ACEI/ARB,sacubitril-valsartan significantly reduced the rehospitalization rate and New York Heart Association(NYHA)grade,improving the life quality of patients with HF.Sacubitril-valsartan significantly reduced the risk of cardiovascular death,all-cause mortality,and N-terminal pro-BNP(NT-proBNP)in patients with HFrEF,and improved the echocardiographic parameters (LVEF,LVESV).In terms of safety,compared with ACEI/ARB,sacubitril-valsartan significantly increased the risk of hypotension while reducing the cessation rate by adverse reactions in patients with HF.In terms of economy,the long medication of sacubitril-valsartan had a cost-effectiveness advantage for patients with HFrEF. Conclusion Sacubitril-valsartan has good efficacy,safety,and economy in treating patients with HFrEF,but its therapeutic value in those with HFpEF and HFmEF needs further investigation.
Objective To evaluate the safety,effectiveness,and economy of levosimendan in the treatment of heart failure. Methods PubMed,The Cochrane Library,Embase,China National Knowledge Infrastructrue(CNKI),Wanfang databases,VIP Databases for Chinese Technicals Periodicals(VIP),and the official website of health technology assessment (HTA) were systematically searched.According to the inclusion and exclusion criteria,the researchers screened the literature,extracted data,and conducted a quality evaluation and qualitative synthesis of the literature. Results A total of 28 pieces of literatures were included,including 18 systematic reviews/Meta-analysis and 10 pharmacoeconomic studies.Levosimendan treatment can improve the clinical effective rate,reduce the rehospitalization rate,and improve the cardiac function and hemodynamic indexes of patients.At the same time,it can increase eGFR and reduce Scr.However,there has been no consistent conclusion in reducing patient mortality.The common adverse reactions of levosimendan included headache,hypotension,ventricular tachycardia,and atrial fibrillation,but there was no significant difference compared with the control group.Foreign studies have shown that the treatment scheme of levosimendan has a cost advantage,while domestic studies have shown that levosimendan has a cost-effectiveness advantage. Conclusions Levosimendan treatment can improve the effective clinical rate,reduce the rehospitalization rate,and improve the related indexes of cardiac function,hemodynamics,and renal function.However,no consistent conclusion has been reached in reducing the mortality of patients.Levosimendan has good safety and cost-effectiveness advantages.
Objective To analyze the clinical characteristics of blood concentration of vancomycin at the conventional dosage in patients with hematological diseases and explore the related factors which affect the exposure level of vancomycin in patients with hematological diseases. Methods A retrospective analysis was performed on 85 patients with hematological diseases treated with vancomycin (1.0 g,ivgtt,q12h) and monitored blood concentration of vancomycin from January 2018 to August 2021 in our hospital.These patients were divided into two groups according to the blood concentration of vancomycin achievement and the related influencing factors explored by single-factor analysis and logistic multivariate regression analysis. Results The mean blood concentration of vancomycin was (8.35±3.89)mg·L-1,and the compliance rate was only 27.1% (23/85) in 85 patients.The results of single factor analysis showed the levels of blood creatinine and absolute neutrophil count (ANC) were significantly higher in the achievement group than those in the non-achievement group[(61.47±19.68)μmol·L-1 vs. (53.30±14.66) μmol·L-1,P=0.041;0.65×109·L-1 vs. 0.02×109·L-1,P=0.032],but the endogenous creatinine clearance rate and the rate of augmented renal clearance were lower significant [(125.17±38.56) mL·min-1 vs. (162.06±44.25) mL·min-1,P=0.001;34.8%(8/23)vs. 72.6%(45/62),P=0.001].Multiple linear regression analysis showed that only ANC had a significant effect (P=0.010).Further analysis found that low vancomycin exposure was related to the ANC reduction,but not the degree of ANC reduction. Conclusion Neutropenia may be one of the main reasons for the low blood concentration of vancomycin in patients with hematological diseases.The influence of this factor should be considered when developing the initial dosing regimen for such patients.
Objective To mine and evaluate the safety warning signals of gender differences in opioids, and to provide references for clinic implementation of individualized drug use. Methods Reporting odd ratio (ROR) data mining algorithm was used to investigate signals of gender differences for morphine and fentanyl from the FDA adverse event reporting system from January 1, 2004 to September 30, 2020. Results The female and male reports of morphine included in the analysis were 7968 and 7570, respectively. And the female and male reports of fentanyl were 37 505 and 26 866, respectively. ROR mining showed that men were more likely to develop drug dependence, withdrawal syndrome, respiratory depression, drug overdose and abuse, while women are more likely to develop syndromes such as drug intolerance, nausea, vomiting, depression, rash, pruritus, and joint pain. Conclusion There are gender differences in the signals of adverse events of opioids, which should be fully utilized in clinical practice to explore the possibility of opportunistic treatment.
Objective To understand the satisfaction and influencing factors of inpatients with the service of clinical pharmacists and to provide a reference for improving and evaluating the service level and quality of clinical pharmacists. Methods A total of 267 inpatients were investigated in 10 comprehensive grade III hospitals in 9 cities (prefectures) of Guizhou province.Through the questionnaire survey method, factor analysis, and multiple linear regression analysis, the weights and total satisfaction scores of all levels of inpatients’ satisfaction with clinical pharmacist services were calculated. And the main factors affecting inpatients’ satisfaction with clinical pharmacists’ services were explored. Results In the clinical pharmacist service satisfaction scale, the highest weight coefficient of the first-class index was the service skills of clinical pharmacists (0.538), and the lowest was the service efficiency of clinical pharmacists (0.194). The highest weight coefficient of secondary indicators was the medication reply and help of clinical pharmacists (0.132), and the lowest was the mental outlook of clinical pharmacists (0.042). The comprehensive evaluation score of inpatients' satisfaction with the service of clinical pharmacists was 3.934 (out of 5).Multiple linear regression analysis showed that the service skills of clinical pharmacists were the most important factor affecting patients' satisfaction with clinical pharmacists (P<0.05). At present, the clinical pharmacy services carried out by clinical pharmacists in the grade Ⅲ hospitals of Guizhou province can meet the needs of patients, but there is still room for improvement to achieve overall relative satisfaction. Conclusion The service skills of clinical pharmacists are the primary core competitiveness of clinical pharmacy services.Improving the enthusiasm of clinical pharmacists is an inevitable link in developing clinical pharmacy services.Improving the professional quality of clinical pharmacists is the key to enhancing the soft power of clinical pharmacy services.