PDCA循环在药房麻精药品管理中的应用效果观察

目的探讨在药房麻醉和精神药品管理中采取PDCA循环的临床效果。方法药剂科的药品质量管理小组于2017年1～12月期间检查该院药房麻醉药品和精神药品的使用情况,2017年1～6月为PDCA管理前时间段,2017年7～12月开展PDCA循环管理,观察PDCA循环管理前后的医患纠纷发生情况、患者满意度情况及麻精药品检出问题情况。结果药房麻精药品检查中存在的问题在PDCA循环管理后明显减少,与PDCA管理前比较有统计学差异(P 0.05);PDCA管理实施后,患者满意度明显提高,关于麻醉、精药品使用中引起的医患纠纷明显减少,与管理前比较,有统计学差异(P 0.05); PDCA管理实施后,各项风险发生情况均明显减少。结论在药房麻精药品的管理中开展PDCA循环模式,能有效提高麻精药品的管理质量,效果显著,减少医疗纠纷,提高患者满意度,具有临床推广价值。     

PDCA循环模式在药房管理质量改善中的应用价值探讨

目的:探讨PDCA循环模式在药房管理质量改善中的应用效果。方法:随机将2016年6月~2018年6月门诊药房采取常规管理模式的设为A组,采用PDCA循环模式管理的设为B组,选取45名药剂师,1000种药物,观察比较实施不同管理模式的药房管理质量。结果:B组药房管理质量评分明显高于A组,药品库存、缺药情况与药物批号管理失误状况均显著优于A组,差异有统计学意义(P<0.05)。结论:在药房管理中采用PDCA循环模式进行管理,能有效提升药房管理质量,降低药品应用期间发生差错的风险性,适合在临床上应用。     

基于药品集团采购模式下的药库零库存管理对医院药品供应与药房管理的影响

目的:探究基于药品集团采购(GPO)模式下的药库零库存管理对医院药品供应与药房药品管理的影响,为医院合理的药品采购和药学管理提供参考.方法:抽取2019年10月-2020年3月间医院药品采购、入库数据(实施后),另抽取2019年4月-2019年9月间药品采购、入库数据(实施前);比较与分析其不同时间段、不同采购平台的药品配送率、配送时效性和配送准确性,以及实施前后药品销售额的变化情况.结果:与实施前比较,实施后药品配送率、配送准确率和药品销售额更低,而平均配送时间更长;同一采购平台平均配送时间从短到长依次为某市药品集团采购平台(简称“市采购平台”)、某省第三方药品电子交易平台(简称“电子交易平台”)和全药网平台(简称“药网平台”);药网平台配送准确率除11月份外,均低于市采购平台.结论:不同采购平台关键配送指标的差异,极易造成医院药品供应和药房药品管理的影响;针对不同采购平台的药品采购,药房应合理规划应对措施(扩充货柜存量、增加药房药品储备量、提高采购临界值、缩短采购频率和加大采购量等),以提高药房药品管理水平,确保医院药品的日常供应.     

基于药品集团采购模式下的药库零库存管理对医院药品供应与药房管理的影响

目的:探究基于药品集团采购(GPO)模式下的药库零库存管理对医院药品供应与药房药品管理的影响,为医院合理的药品采购和药学管理提供参考.方法:抽取2019年10月-2020年3月间医院药品采购、入库数据(实施后),另抽取2019年4月-2019年9月间药品采购、入库数据(实施前);比较与分析其不同时间段、不同采购平台的药品配送率、配送时效性和配送准确性,以及实施前后药品销售额的变化情况.结果:与实施前比较,实施后药品配送率、配送准确率和药品销售额更低,而平均配送时间更长;同一采购平台平均配送时间从短到长依次为某市药品集团采购平台(简称“市采购平台”)、某省第三方药品电子交易平台(简称“电子交易平台”)和全药网平台(简称“药网平台”);药网平台配送准确率除11月份外,均低于市采购平台.结论:不同采购平台关键配送指标的差异,极易造成医院药品供应和药房药品管理的影响;针对不同采购平台的药品采购,药房应合理规划应对措施(扩充货柜存量、增加药房药品储备量、提高采购临界值、缩短采购频率和加大采购量等),以提高药房药品管理水平,确保医院药品的日常供应.     

运用PDCA循环法管理药房的效果分析

目的探讨运用PDCA循环法管理药房的效果。方法依据采用的管理方法,药房不同分为对照组和观察组。对照组采用传统方法管理,观察组运用PDCA循环法管理。结果观察组有效使用药品、不合格药品报损及去向明确率情况优于对照组,差异具有显著性（P〈0.05）,有统计学意义。结论运用PDCA循环法管理药房,能促使医院药房的管理工作向科学管理发展,提高临床用药的质量,减少药物造成的医疗问题。     

PDCA循环法提高药房管理质量分析

目的：评价实施PDCA循环法管理对提高门诊药房的管理质量及门诊药房药事人员工作效率的作用。方法根据管理方法不同将药房管理分为观察组和对照组。观察组实行PDCA循环法管理,重点对药房管理的服务质量药品出入库流程、工作效率三个关键点进行观察。对照组为传统药房管理。结果观察组人均处理处方数量72±14张、有效使用率99．32％、去向明确率分别为98．97％;对照组的人均处理处方数量56±11张、有效使用率95．96％、去向明确率分别为93．02％;两组比较差异有统计学意义（ P＜0．05）,观察组显著高于对照组。观察组每月病人投诉3．0±1．3次、调剂差错率0．82％、不合格报损率0．26％、平均候药时间23．6±6．5 min;对照组每月病人投诉7．2±2．5次、调剂差错率2．18％,不合格报损率1．14％、平均候药时间31．2±7．1 min;两组比较差异有统计学意义（ P＜0．05）,观察组均显著低于对照组。统计分析表明观察组药房服务质量、人力资源效率增加,药品出入库管理更为规范。结论门诊药房实施PDCA循环法能提高门诊药房管理质量及门诊药事人员工作效率。     

PDCA循环对规范药房退药管理的应用效果分析

目的:分析讨论PDCA循环对规范药房退药管理的应用效果.方法:选择2013年1月1日～12月31日,实行常规管理模式,我院登记退药为312例,作为本次试验的对照组,2014年6月1日～2015年6月30日,接受PDCA循环管理后,我院登记退药为192例,作为本次试验的观察组,比较两组退药情况及对药房工作效率的影响.结果:实行PDCA循环法以来,退药情况明显减少,与退药相关的主要因素得到有效改善.其中,对照组退药中以患者已有该药品或拒绝用药所占比例较高,为47.12％,观察组为36.98％;通过退药发现的药品质量和不良反应得到有效跟踪.结论:在药房退药管理中引入PDCA循环理念,可降低退药发生率,同时提高药房工作效率,促进医患关系和谐发展.     

PDCA循环法在减少门诊药房患者退药中的效果分析

目的探讨PDCA循环法在减少门诊药房患者退药中的效果。方法选取2017年1～7月我院门诊药房在未实施PDCA循环之前作为对照组,2017年8～12月实施PDCA管理之后作为研究组,在此期间分别抽取各组的4000张处方进行比较分析。对照组采用常规的药房药品管理,研究组采用PDCA循环法对门诊药房进行管理。比较两组的退药情况,退药率以及两组药房管理质量的评分。结果研究组门诊药房的退药情况明显少于对照组(P 0.05);研究组退药率明显低于对照组(P 0.05);研究组药房管理质量的各项评分明显高于对照组(P 0.05)。结论在门诊药房的管理中采用PDCA循环法,能够明显降低退药的出现情况,提升门诊药房的管理水平,利于在临床中推广。     

新医改背景下基于VMI模式建立的医院药房管理新模式探讨

目的:研究医院运用"供应商管理库存"(VMI)模式建立的药房管理新模式。方法:从华山医院北院VMI模式的实施、效果及存在的问题等方面描述医院与两家供应商合作后在医院药房管理方面建立的新模式。医院主要负责对药房人员、设备的管理使用,负责药品的资金流,负责用药目录的选择优化,专注于核心专业人才的培养,提升药品质量管理、药事管理、药学服务和合理用药的水平;而两家供应商主要负责药品的物流,分担供应链的物流成本,负责医院药房服务人员及所需软件系统和硬件(如自动发药机)的配置;药品的信息流则由医院与供应商共同组建。结果:新模式建立后,医院药学人员及相关设备和药品库存成本缩减(每月减少医院流动资金近1 000万元),药品配送效率提高;自动化药房的建立使门诊药房药品调配差错率降低(由0.39‰下降至0.12‰),药房窗口患者流量异常预警系统的建立使患者取药时间缩短、药房服务水平提高、患者满意度提高(由84.91%升高至93.62%)。结论:基于VMI模式建立的医院药房管理新模式为新医改下公立医院的改革和创新院企合作方式提供了参考。     

PDCA循环管理方式用于改善门诊药房处方质量分析

目的分析门诊药房中开展PDCA循环管理方式对处方质量的改善情况。方法选取2019年1-6月未实施PDCA循环管理前的门诊药方处方质量作为对照组,2019年7月对门诊药房开始实施PDCA循环管理,2019年7-12月实施PDCA循环管理后的门诊药方处方质量作为研究组,比较门诊药房实施PDCA循环管理前后处方质量缺陷存在的问题及数量、处方合格率。结果研究组实施PDCA循环管理后,在药品批号管理失效、缺药、发药错误、药品失效等发生率均低于对照组(P<0.01),研究组门诊药房处方合格率为98.0%,高于对照组的82.4%(χ²=68.827,P=0.000)。结论将PDCA循环管理方式应用在门诊药房管理中,可有效降低发药风险,减少药品调配差错,有效提高处理质量,确保患者的用药安全、生命健康。     

Design of anti-bacterial drug and anti-mycobacterial drug for drug delivery system

Liposome-encapsulated drugs often exhibit reduced toxicity and have also been shown to enhance retention of drugs in the tissues. Thus, encapsulation of drugs in liposomes has often resulted in an improved overall therapeutic efficacy. The results of efficacy of liposome-encapsulated ciplofloxacin or azithromycin for therapy of intracellular M. avium infection show enhanced cellular delivery of liposome-encapsulated antibiotics and suggest that efficiency of intracellular targeting is sufficient to mediate enhanced antimycobacterial effects. The antitubercular drugs encapsulated in lung specific stealth liposomes have enhanced efficacies against tuberculosis infection in mice. These results from stealth liposome study indicate that antitubercular drugs encapsulated in liposome may provide therapeutic advantages over the existing chemotherapeutic regimen for tuberculosis. Liposomes with encapsulated amikacin are able to protect collagen almost completely from adherence of bacterial cells of all strains examined and prevent from invading of bacteria.     

新药研发中的me-too, me-better, me-new

文中根据作者对我国新药研发的认识和理解,提出了新药研发过程中me-too,me-better和me-new类新药的概念,并对新药研发过程中的这3类创新活动之间的关系、新药研发的创新程度与经济效益的关系,以及目前我国新药研发的途径选择做了简要的论述。     

Increased drug sensitivity in the drug discrimination procedure afforded by drug versus drug training

Rats were trained to discriminate norfenfluramine (NF) 1.4 mg/kg from its vehicle or amphetamine (AMPH) 0.8 mg/kg or pentobarbital (PB) 6.0 mg/kg in order to determine the role that drug combination training plays in the rate of learning and sensitivity to lower drug doses. The results suggest that drug versus drug training can increase the rate of drug discrimination learning for some drugs that are learned slowly when trained in a drug versus vehicle training procedure, whereas drug versus drug training does not increase the rate of learning for other drugs that are learned rapidly. Drug versus drug training does, however, appear to increase the level of stimulus control of the training drug for all drugs examined in this study.     

Compliance spectrum as a drug fingerprint of drug intake and drug disposition

Since drug related variability arises from different origins, particularly driven by the behaviour or physiology of the patient, the problems of drug intake and drug disposition are separately presented in general. To overcome the potential drawbacks of this artificial split, we propose in this paper a combined illustrative approach, named compliance spectrum, such that these two subprocesses can be equitably studied and visualized. We construct the compliance spectrum based on the Bayesian decision method we previously developed for the inverse problem of patient compliance within the framework of Population-PK. This spectrum provides an intuitive and interactive way to evaluate the relationship between drug intake and drug disposition along with their consequences on PK profile. As well, it opens a new direction for model quality diagnostic.     

Impact of drug usage review on drug utilisation

Drug use review (DUR) programmes have been a component of efforts to improve prescribing practices in both the institutional and ambulatory care settings in various areas of the world. DUR provides the mechanism for developing standards, assessing current therapy, and implementing a specific intervention followed by reassessment of drug utilisation. A number of interventions aimed at improving drug prescribing practices have been included as components of the DUR process. At this time, face-to-face interaction with the prescriber has been shown to be the most effective intervention. However, DUR interventions have rarely been subjected to quality pharmacoeconomic evaluation. There is a need for future research to evaluate the effects of DUR programmes on overall healthcare outcomes.     

Drug discrimination procedures: Differential characteristics of the drug A vs drug B and the drug A vs drug B vs no drug cases

Two groups of pigeons with a history of two choice operant drug discrimination tasks (3.0 mg/kg morphine versus 5.6 mg/kg cocaine, and 3.0 mg/kg morphine versus 3.0 mg/kg cocaine, respectively; Swedberg and Järbe 1985) were subjected to three choice tasks in which responses on a third manipulandum were reinforced in the no drug condition. Training drugs generalization gradients in both groups were similar to those normally obtained in two choice drug versus no drug tasks. The salience differences between the training stimuli within the groups observed in the previous two choice task did not differentially affect the three choice discrimination gradients. Tests with novel drugs after the introduction of the no drug condition yielded increased responding to the no drug condition with the exception of the dopamine agonist apomorphine. Results are discussed in terms of a discrimination learning model specifying principles of relative discriminative stimulus control in various discrimination cases.Portions of these data were presented at the International Union of Pharmacology, IUPHAR, 9th International Congress of Pharmacology Satellite Meeting: European Study Group for Internal Stimulus Control by Electrical Stimulation, Drugs and Other Means, ESISC, London, July 29–August 3, 1984 (Swedberg and Järbe 1984). An earlier version of this work appears in the doctoral thesis by the first author (Swedberg 1985).     

抗心律失常药物不良反应分析

目的：探讨抗心律失常药物所致不良反应(ADR)的发生情况,为临床安全、合理用药提供参考。方法130例抗心律失常药物所致不良反应报告,对患者的年龄、性别、基础疾病、用药途径、用药剂量、不良反应史、所用药物、不良反应的临床表现等进行统计分析。结果上报的抗心律失常药物所致不良反应发生在21~97岁;不良反应主要包括致心律失常作用及其他系统损害。结论医疗机构应重视抗心律失常药物引起的不良反应,加强抗心律失常药物的合理应用。     

Evaluation of drug–drug interactions with fesoterodine

Purpose  To assess drug–drug interactions of fesoterodine with cytochrome P450 (CYP) 3A4 inhibitor (ketoconazole), inducer (rifampicin), and substrates (ethinylestradiol and levonorgestrel). Methods  Effects of ketoconazole 200 mg twice daily and rifampicin 600 mg twice daily on fesoterodine 8 mg once daily were investigated in CYP2D6 extensive metabolizers (EMs) and poor metabolizers (PMs) based on 5-hydroxymethyl tolterodine (5-HMT) pharmacokinetics (principal active fesoterodine metabolite and CYP3A4 substrate). Effects of fesoterodine 8 mg versus placebo once daily on ethinylestradiol and levonorgestrel were investigated based on oral contraceptive pharmacokinetics and on pharmacodynamic effects on progesterone, luteinizing hormone, follicle-stimulating hormone, and estradiol plasma levels. Results  Compared with fesoterodine alone, coadministration of fesoterodine with ketoconazole resulted in increases in mean 5-HMT maximum concentration in plasma (C_max; from 3.0 to 6.0 ng/mL in EMs and from 6.4 to 13.4 ng/mL in PMs) and mean area under the plasma concentration time curve (AUC; from 38.2 to 88.3 ng h/mL in EMs and 88.3 to 217.2 ng h/mL in PMs). Coadministration of festerodine with rifampicin resulted in decreases in mean 5-HMT C_max (from 5.2 to 1.5 ng/mL in EMs and from 6.8 to 1.9 ng/mL in PMs) and mean AUC (from 62.4 to 14.4 ng h/mL in EMs and from 87.8 to 19.6 ng h/mL in PMs). Fesoterodine did not affect oral contraceptive pharmacokinetics or pharmacodynamics or the suppression of ovulation. Conclusions  Fesoterodine dosage should not exceed 4 mg once daily when taken concomitantly with potent CYP3A4 inhibitors. Coadministration of CYP3A4 inducers with fesoterodine may produce subtherapeutic 5-HMT exposures. No dose adjustment is necessary for concomitant use of fesoterodine with oral contraceptives. Funding for this study was provided by Schwarz Biosciences GmbH, and Pfizer Inc.