国外药师参与慢病管理的能力要求及培训体系

药师在药物治疗中发挥着重要作用。药师参与慢病患者的治疗管理，能够保障合理用药，改善患者预后。该文结合美国、澳大利亚、土耳其和日本等国情况，介绍药师参与慢病管理的能力要求及培训体系，为我国药师参与慢病管理提供参考。     

临床药师在COPD稳定期管理中的作用

我国慢性病患者数量庞大,反复住院治疗占用大量医疗资源。如何对慢病进行有效的管理,减少患者急性发作住院的次数成为临床药师需要探索的方向。本文就临床药师参与呼吸系统慢性阻塞性肺疾病（COPD）慢病管理的切入点进行分析探讨,为临床药师对COPD稳定期的管理提供工作思路。     

临床药师慢病管理工作模式的探讨

目的:探讨临床药师慢病管理的工作模式。方法:以临床药师为主导的临床医生、护士共同参与的药物治疗团队对96例心内科患者进行慢病管理工作。慢病管理的工作包括住院期间的慢病管理及出院后的随访。入出院时分别对患者进行了用药知识评估,4组评价指标分别为适应证、用法用量、不良反应、注意事项。结果:对比入院时,患者出院时对用药知识的了解明显改善,4组指标P=0.000。疾病越多、年龄越大对药物的了解程度越差,应调整用药教育方式。慢病管理工作可提高药师对医生医嘱的干预比例(比同期重点患者增加90.48%)。结论:临床药师参与慢病管理的模式可明显提高慢病管理效果。     

执业药师在疾病管理中的作用

疾病管理可提高医疗的服务质量,减少不必要的医疗费用,执业药师在疾病管理尤其是慢病管理中可发挥重要作用。本文介绍了执业药师在疾病管理中的作用,并提出执业药师在慢病管理中的策略。     

内分泌临床药师细化MDTCare模式优化糖尿病患者管理的实践

目的：探索并逐步优化临床药师开展慢病管理的工作模式,以全面提升临床药师参与慢病管理的水平。方法：临床药师在内分泌专科以糖尿病常见病种为例,细化多学科团队照护（MDTCare）模式,通过收集患者数据、优化治疗、监护追踪、长期随访4个阶段对内分泌科住院糖尿病患者实行流程化管理。结果：进入临床药师MDTCare工作模式的糖尿病患者,血糖、血压、血脂指标较入院时明显改善,至第4阶段,达标率分别提高13%,8%和4%,体现了良好的治疗效应。结论：内分泌科临床药师细化MDTCare工作模式可优化糖尿病患者的管理,并为探索慢病管理工作模式提供可操作性的借鉴。     

临床惯性在慢性病管理中的影响及药师克服临床惯性的方法

目的：本文综述了临床惯性的定义和影响因素，根据实际情况提出了药师克服临床惯性的诸多建议，为临床药师参与慢病管理提供指导和参考。方法：我院门诊药师应用“药物治疗管理”服务模式， 对2019年6-8月接收的200名高血压病患者，分析探讨临床惯性的影响及药师克服的方法。结果：在初诊的200名患者中血压达标率为60%，存在临床惯性现象的患者共60人，由于药师的干预，复诊患者减少了 40人，血压达标率上升到90%。结论：临床惯性在慢病管理中普遍存在，药师参与慢病管理可以有效地克服临床惯性。     

临床药师参与高血压慢病管理的效果评价

目的:评价临床药师对高血压慢病管理患者开展药学干预的效果。方法:选取北仑区新矸街道紫荆社区的所有高血压慢病管理患者为研究对象,由临床药师定期和社区医生一起对慢性病患者进行面对面用药指导、电话交流沟通、上门随访、专题健康讲座等方法,为慢病管理患者提供用药指导,实施药学干预,将干预前后患者对自身疾病的认知水平、血压控制水平、用药依从性等进行统计并比较。结果:临床药师干预后患者对高血压和抗高血压用药的认识水平有明显提高(P<0.05或P<0.01),患者血压控制水平及用药依从性明显改善(P<0.01),非预约就诊率、急诊率、住院率及住院次数明显下降(P<0.05或0.01)。结论:临床药师开展高血压慢病管理患者的药学干预,可以为患者提供科学合理的用药保障,提高患者的生活质量,值得推广。     

临床药师在县域医共体慢病管理团队中的价值探讨

目的 在"医共体"建设及分级诊疗模式的背景下，借鉴"家庭医生"签约模式，探索由药师参与的医、药、护慢病管理团队，并分析药师在基层患者慢病精细化管理中的作用。方法 通过临床药师参与医共体慢病患者用药管理的模式分析其中的价值。结果 临床药师的干预是慢病患者合理诊疗中必不可少的环节。结论 为保证医共体慢病管理团队的持续发展，相关配套设施的完善势在必行。     

临床药师在慢性病管理中的作用与探讨

<正>在医学上,"慢性病"主要指以高血压病、心脑血管疾病、糖尿病、恶性肿瘤、慢性阻塞性肺疾病、老年性痴呆、认知功能障碍、精神异常和精神病等为代表的一组疾病,通常以前四种为主,它们共同具有病程长、病因复杂、健康损害和社会危害严重等特点,影响劳动能力和生活质量,且医疗费用昂贵,增加社会和家庭的经济负担[1]。本文对我国临床药师参与慢病管理的形式与现状进行总结分析,探讨适合我国临床药师参与慢病管理的模式。     

药师在慢病患者自我监护中的角色和作用

慢病占全球死亡率原因的60%,严重危害人类健康，慢病患者通常需要终身治疗。有效的自我监护有助于改善慢病患者治疗结局、减少并发症的发生并节约治疗成本。在美国、日本、澳大利亚、英国等发达国家，药师通过用药指导、教育、监护、随访、转诊等方式参与慢病患者自我监护，促进其改善生活方式，合理使用药物，提高用药依从性，控制慢病危险因素。该文以糖尿病、心血管疾病、肿瘤、慢性呼吸系统疾病、精神疾病和心理健康为例，综述国外药师参与慢病患者自我监护的现状，以期为我国药师的工作提供参考。     

ω-3多不饱和脂肪酸治疗非酒精性脂肪性肝病的研究进展

非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)是由多种危险因素,如营养过剩、胰岛素抵抗(insulin resistance,IR)及相关代谢紊乱等诱导的慢性肝损伤,是代谢综合征在肝脏的病理表现。其病程的进展表现为非酒精性单纯性脂肪肝(nonalcoholic simple fatty liver,NAFL)、非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)、脂肪性肝纤维化和脂肪性肝硬化。NAFLD患病率逐年升高,已成为我国最常见的慢性肝病之一。NAFLD的治疗主要为增加运动、健康饮食等基础治疗,药物治疗尚未达成共识。ω-3多不饱和脂肪酸(ω-3 polyunsattrated fatty acids,ω-3PUFAs)具有调节血脂的功能。NAFLD患者ω-3PUFAs水平较低,增加饮食中的ω-3PUFAs可以延缓病情进展,改善肝脏脂代谢的失衡和肝细胞的炎性损伤。本文主要就ω-3PUFAs对NAFLD治疗的研究进展作一综述。     

评估肾小球功能的内源性标志物

全球慢性肾脏病患者数量逐年增长，使用快捷、有效的方法评估肾小球滤过率，对判断病情、评估疗效及延缓病情进展速度具有重要意义。本文就目前常用的肾小球内源性标志物进行阐述。     

上海地区α-干扰素治疗慢性乙型肝炎的药物经济学分析

通过比较α-干扰素治疗慢性乙型肝炎的费用和收益,从经济方面分析在我国这种治疗的意义.结果表明这种治疗不仅可拯救生命、延长病人的存活时间,而且可大大改善病人的生活质量.在经济方面,用α-干扰素治疗慢性乙型肝炎的成本效益比值(干扰素的治疗费用/因治疗而节省的费用)为1.22,即每投入1元可节省医疗费用1.22元;若同时计算因病休损失的社会费用,成本效益比值为3.02,平均每年为社会减少大量的由肝病导致的经济损失.提示在上海地区用α-干扰素治疗慢性乙型肝炎病人具有重要的医学和经济意义.     

中国社会药房慢病药学服务水平评价指标体系的构建

我国社会药房近年来逐渐开展针对慢性病患者的药学服务,目前还没有相关的服务标准和质量评价体系。目的 制定一套针对我国社会药房慢病药学服务水平的评价体系。方法 首先通过文献研究法,基于结构-过程-结果理论模型制定了一套候选指标。随后采用两轮德尔菲调查法对候选库指标收集了15名药学专家的意见,专家来自社会药房、政府机构、高校和行业协会。结果 最终制定了一套适合中国社会药房慢病药学服务质量评价体系,包括18个结构指标、16个过程指标和14个结果指标。结论 本研究构建的社会药房药学服务评价指标体系有望促进我国社会药房慢病药学服务质量的提升。     

Fibrocytes: emerging effector cells in chronic inflammation

Fibrocytes are unique cells possessing the proinflammatory properties of macrophages and the tissue remodeling properties of fibroblasts. Because these cells display a strong association with many human diseases characterized by chronic and dysregulated inflammatory responses the study of fibrocytes is important and timely. This review presents recent data regarding fibrocyte origin, identification, differentiation, and appearance in diseased tissue. The available data regarding the association of fibrocytes with several forms of chronic tissue inflammation seen in the setting of lung disease, autoimmunity, liver disease, and normal aging will be presented. This review concludes by putting these data in perspective and by suggesting future areas of investigation. It is hoped that this information will lead to additional investigations in this burgeoning field and improve our understanding of the novel role fibrocytes may play in human disease.     

中西药结合宫颈旁注射治疗急慢性盆腔炎121例临床观察

目的总结中西药结合宫颈旁注射治疗急慢性盆腔炎的疗效及优点。方法对确诊为急慢性盆腔炎的69例患者行宫颈旁注射治疗,随访统计其疗效及复发率。结果 121例中,治愈116例,显效5例,治愈率95.9%,有效率100%。1年复发率为0,5年复发率14.88%。结论宫颈旁注射是治疗急慢性盆腔炎较好的方法,可明显降低复发率。     

Triple-drug, fixed-dose combinations for the treatment of hypertension: focus on olmesartan/amlodipine/hydrochlorothiazide combination

Hypertension is a major risk factor for cardiovascular, renal and stroke complications. Its incidence continues to rise worldwide, and it is projected that by the year 2025, 1 billion people will be hypertensive. Despite the enormity of the high blood pressure burden, its control to < 140/90 mmHg for uncomplicated hypertensives and < 130/80 mmHg for patients with diabetes mellitus, chronic kidney disease or coronary artery disease remains poor and currently stands at approximately 50%. Reasons for this poor control include physician inertia and poor patient compliance and adherence due mostly to complicated drug regimens. Since hypertension is a multifactorial condition, its control will require the administration of multiple drugs with complimentary mechanisms of action. Several studies have shown that the patient's compliance and adherence to treatment is inversely related with the number of drugs administered. It is, therefore, important to combine different drugs with complimentary mechanisms of action into a single pill. Recent studies have shown that triple-drug combinations are very effective, safe and well tolerated by the patients. Three different triple-drug, fixed-dose combinations have recently been approved by the FDA for the treatment of hypertension, including, olmesartan medoxomil/amlodipine besylate/hydrochlorothiazide. These studies with collateral literature will be discussed in this concise review.     

Therapeutic vaccines

The science and medical usage of vaccination are undergoing revolutionary changes both in terms of disease scope and enabling technologies. The traditional usage of vaccines to prevent infectious disease is still growing, but the faster growth rate is in vaccine R&D for cancer and chronic disease indications. The latter category of vaccines has been designated as 'Therapeutic Vaccines'. However, this is loose usage of terminology, and the new generation of vaccines will be used for treatment of both infectious and non-infectious diseases, in addition to the more traditional preventative usage of vaccines for the latter.Moreover, the emerging platform technologies, which encompass peptide-conjugate, nucleic acid and virus vector based vaccines, are shared by the broad range of disease applications. Hence the terms infectious disease vaccines (IDVs) and non-infectious disease vaccines (NIDVs), may be more suitable than 'therapeutic' and 'prophylactic'. Cancer vaccines are currently the dominant category of NIDVs and encouraging results are emerging from clinical trials, with the first product registrations expected by the year 2000. The lead products utilise the tumour 'marker' strategy for immunisation, but antihormone and antigrowth factor vaccines are also under development. Expansion into chronic disease treatment has already occurred, including rheumatoid arthritis, multiple sclerosis and hypertension/heart failure targets. The true potential of these novel vaccines will be established by clinical trial results over the next few years.     

Regulation of immune-related diseases by multiple factors of chromatin,exosomes, microparticles,vaccines, oxidative stress,dormancy, protein quality control,inflammation and microenvironment: a meeting report of 2017 International Workshop of the Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine on Tumor Immunology

Immune cells play key roles in cancer and chronic inflammatory disease. A better understanding of the mechanisms and risks will help develop novel target therapies. At the 2017 International Workshop of the Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine on Tumor Immunology held in Beijing, China, on May 12, 2017, a number of speakers reported new findings and ongoing studies on immune-related diseases such as cancer, fibrotic disease, diabetes, and others. A considerably insightful overview was provided on cancer immunity, tumor microenvironments, and new immunotherapy for cancer. In addition, chronic inflammatory diseases were discussed. These findings may offer new insights into targeted immunotherapy.     

Pharmacologic Treatment of Hypertension in Patients With Chronic Kidney Disease

Hypertension remains an important cause of morbidity and mortality in patients with chronic kidney disease. It both contributes to and is a consequence of chronic renal dysfunction. There is a high prevalence of hypertension in chronic kidney disease, and rates of control remain sub-optimal. Numerous studies have highlighted the benefit of treating hypertension in reducing the overall mortality as well as progression of renal disease in this population. Non-pharmacologic treatment strategies remain the primary intervention in all patients but are insufficient on their own to control hypertension in most cases. Pharmacologic treatment recommendations, however, vary depending on the specific etiology of disease as well as patient characteristics. Though most classes of anti-hypertensive drugs can be used to lower blood pressure in chronic kidney disease, therapy needs to be selected based on the presence of specific co-morbidities as well as the etiology of the kidney disease. Most patients will require multi-drug therapy for achieving target blood pressure goals. This review discusses the pharmacologic options in management of hypertension in various forms of chronic kidney disease.