我院静脉用药调配中心自动化建设的应用与实践

目的：建立静脉用药调配中心（PIVAS）智能系统，为PIVAS的信息化、自动化建设提供借鉴。方法：基于医院信息系统（HIS），开发智能审方、智能摆药、扫描核对、智能轨道运送等系统模块, 分析其在实践中的应用情况, 并对应用前后不合格医嘱率、摆药效率、差错件数、人员效率等进行比较，以评价应用效果。结果：该系统运用后, 实现了自动审核医嘱、智能分拣摆药、智能扫描核对、成品输液自动运送；不合理医嘱由原来的0.10％下降为0.06％，摆药贴签用时由每日（4.35±0.48）h 缩短至（3.15±0.31）h；每日调配内差由（4.23±0.82）件降低至（1.52±0.24）件；药品破损由每日（2.78±0.24）件降低至（0.69±0.74）件；成品输液打包分拣差错由每日（6.78±0.45）件降低至（2.36±0.14）件。每日可减少排药人员1名，减少外送人员1名。结论：PIVAS的信息化和自动化建设有助于提升药学服务水平，降本增效，提高医院整体管理水平。     

某三甲医院静脉用药集中调配中心智能化、信息化、均质化建设的实践

目的：探讨静脉用药集中调配中心（PIVAS）流程智能化、信息闭环化、模式均质化的实践效果。方法：收集某院PIVAS在2017年3-6月和2017年7-10月的各项报表数据，对比评估PIVAS信息化改造和智能设备引入前后各运行指标的变化，包括每日排药时间、贴签时间、分拣时间，输液存储量以及各个环节中的人力分配、差错发生率等；基于PIVAS流程整体设计，评价PIVAS工作新模式的价值。结果：在经过智能化、信息化改造后，PIVAS的工作效率显著提高，差错率大幅下降，其中贴签环节每张标签贴签、核对、排筐用时（7.81±1.66）s下降至（5.34±0.64）s，差错率由（1.38±0.40）‰下降至（0.15±0.05）‰；排药环节每张标签用时（5.37±0.97）s下降至（3.38±0.27）s，差错率由（1.91±0.41）‰下降至（0.44±0.18）‰；分拣环节每袋输液分拣用时（4.57±1.30）s下降至（1.49±0.19）s，差错率由（2.87±0.34）‰下降至（0.29±0.11）‰，PIVAS人员工作模式达到均质化要求。结论：该院智能化、信息化、均质化改造后，PIVAS人员工作效率显著提高、差错率大幅下降，在质量管控方面成效卓著。     

基于闭环管理改造的门诊药房系统在某儿童医院的应用

目的以我院门诊药房信息系统升级改造为契机,探索进一步提高医疗质量、保障患者用药安全的新途径,为门诊药房的自动化建设提供参考依据。方法观察基于我院闭环管理改造的信息系统在门诊药房的应用情况,通过比较改造前后相关指标的结果评价其效果。结果门诊系统改造后患者在高峰期取药时间分别由(354. 50±38. 27) s和(280. 13±50. 42) s缩短到(261. 56±48. 80) s和(186. 22±46. 41) s,发药差错率由0. 018 3%降到0. 003 3%,处方合格率由96. 54%提高到97. 05%,患者的满意度由92. 86%升高到96. 65%,以上结果差异均有统计学意义(P <0. 05)。结论改造后的门诊药房系统执行了药品的闭环管理,保证了患者的用药安全,提高了患者的满意度,是未来医院门诊药房信息化建设的发展趋势。     

医院静脉用药调配中心的自动化系统建设与实践

目的：探讨某院静脉用药调配中心（PIVAS）的自动化和信息化水平，为PIVAS的发展提供参考。方法：介绍该院PIVAS自动化系统建设和实践的主要情况，收集该院PIVAS自动化系统启用前、后相关工作环节的用时和差错件数等数据信息，进行比较以评价其应用效果。结果：该院PIVAS的自动化系统由智能贴签系统、智能退药模式、智能配液系统、智能责任追溯系统、智能分拣系统组成。自动化系统使用后，每日贴标签的用时由（1.97±0.19）h缩短至（1.15±0.17）h；每日贴签差错由（6.51±1.24）件降低至（0.53±0.30）件；每日配液用时由（1.73±0.20）h缩短至（1.41±0.62）h；每日分拣成品输液的内部差错由（3.52±1.68）件降低至（0.03±0.16）件。结论：该院PIVAS自动化系统的应用使工作效率提高、差错率降低、减轻了工作人员的劳动强度，在提高PIVAS工作效率和防范差错方面起到了重要作用。     

基于全过程管理的静脉用药调配中心智慧型管理平台的构建与应用

目的:建立与医院信息系统(HIS) 和静脉用药调配中心(PIVAS) 系统无缝对接、集监控与管理为一体的智慧型管理平 台,实现PIVAS 日常管理的全程信息化与高效化。方法:介绍我院自主研发的智慧型管理平台的结构和功能,并对其应用前后 员工的平均配置速度、药品破损率、差错率等进行比较以评价其应用效果。结果:该系统应用后PIVAS 人员的平均配置速度由 (1. 06±0. 09)袋/ 分提高到(1. 46±0. 10)袋/ 分(P<0. 05);系统运行前后3 个月的药品总破损率由0. 04%下降至0. 02%,由人为 因素造成的破损量下降(P<0. 01);运行前后PIVAS 的差错率由0. 03%降低至0. 01%(P<0. 01);患者满意率从86. 50%提升至 93. 50%(P<0. 05)。结论:该管理平台可以协助管理者运用现代化信息技术对PIVAS 药品、人员、工作量、差错、报表等日常管 理项目实现全程信息化与智能化监控,提高了管理效率,提升了PIVAS 的精细化与科学化管理水平。     

静脉用药调配中心自动分拣系统应用效果评价

目的：评价静脉用药调配中心(PIVAS)应用自动分拣系统的效果,为提高PIVAS成品输液的分拣效率提供参考。方法：介绍自动分拣系统设备组成及工作流程;比较该系统使用前、后日均分拣工作量、分拣时间、分拣劳动强度、分拣差错及临床科室满意度等指标的变化,评价其对PIVAS工作环境及成品输液分拣工作的影响。结果：自动分拣系统使用后,人工分拣比率降低为3.29%,平均每袋成品输液所需分拣时间缩短5.97 s(61.80%),人均每日步行数下降45.08%,总差错率下降87.93%,临床各科室对PIVAS的满意度提升了10.92%。结论：自动分拣系统使用后,PIVAS工作环境更舒适,流程更优化,提升了效率、降低了差错,可将药师从繁琐的分拣工作中解放出来;同时该系统的智能化应用推进了PIVAS工作的自动化和信息化,促进了PIVAS自动化信息建设。     

妇幼专科医院静脉用药调配中心质量持续改进实践与成效

目的:探索妇幼专科医院静脉用药调配中心(PIVAS)的有效管理方法。方法:通过成立PIVAS质量管理小组、开展品管圈活动以提高药品账物相符率、运用六西格玛方法改进流程缺陷、优化医院信息系统功能等方法对我院PIVAS工作进行质量持续改进,并评价改进活动开展后1年内的成效。结果:与第一季度相比,第四季度药品账物相符率提高了3.03%(由96.97%升至100%),药品损耗率降低0.097%(由0.19%降至0.093%),缺陷医嘱发生率下降0.5%(由1 811/67 840降至1 635/75 243),改进2项缺陷流程,内差发生率降低0.25%(由217件降为51件),病区满意度提高5分(由89分升至94分),每份输液平均调配时间缩短10 s(由104 s缩至94 s);无形成果评价指标各项圈能力均为正向。结论:在PIVAS实施各环节质量管理的持续改进,成效明显。     

门诊处方差错管理方法的改进

目的 观察门诊处方差错管理方法改进后的效果.方法 （1）通过分析2010年门诊处方差错原因,改进工作流程.一是完善信息化功能：安装了合理用药监控系统和处方预览界面;二是延伸查对内容：在执行“四查十对”的同时,增加核对门诊病历和鼓励患者参与核对;三是打包收费项目,简化医生开单流程;四是加强监督检查.观察改进管理方法前后门诊处方差错发生情况.（2）采用自行设计的调查问卷分别对2010年和201 1年的320例和326例门诊患者进行了满意度调查,并进行对比分析.结果 （1）管理方法改进后,门诊处方差错发生率由4.2％降至1.8％,差异有极显著性（x2=40.07,P＜0.01）.（2）患者满意度由83.8％％升高达97.2％,因处方差错引起的纠纷降为0,差异均有统计学意义（x2=34.36,P＜0.01; x2=6.31,P＜0.05）.结论 改进后的管理方法明显规范了药品使用,降低处方差错发生率,降低医疗风险和医疗纠纷的发生,提高了门诊医疗质量,提高了患者对医院的信任度和满意度.     

基于SBAR沟通模式的PIVAS药师临床实践

目的： 探讨标准化沟通模式（SBAR）在静脉用药调配中心（PIVAS）药师临床实践中的应用效果。方法： 选取2019年2月-2019年6月放疗科患者330例为对照组,PIVAS药师采用传统沟通模式;选取2019年8月-2019年12月苏州大学附属第一医院放疗科患者321例为观察组,PIVAS药师采用SBAR沟通模式。对比两组模式下抗肿瘤药物临床监护结果、医生用药咨询数、药师用药干预采纳数、患者满意度。结果： 应用SBAR沟通模式进行临床实践后,抗肿瘤药物临床监护中紫杉醇脂质体预处理时机达标率由46.73%提高到76.55%,奈达铂水化达标率由48.67%提高到97.25%,联合化疗给药顺序总体达标率由71.53%提高至96.78%,稳定性总体达标率由81.91%提高至99.12%,滴注时间总体达标率由72.69%提高至88.26%;医生用药咨询数由（25±3）例/月提高至（53±4）例/月、药师用药干预采纳数由（23±5）例/月提高至（67±9）例/月;与患者沟通时,用药教育完整性由66.67%提升至93.15%、用药咨询回答准确性由53.33%提升至86.60%、不良事件记录及时性由60.00%提升至93.46%（均P<0.05）。结论： 基于SBAR沟通模式,提升了PIVAS药师在临床实践中与护士、医生、患者沟通过程的专业性及满意度,在医、药、护多学科协作的建设中体现出一定价值。     

我院静脉用药集中调配中心自动化智能建设与实践

目的:探讨我院静脉用药集中调配中心(PIVAS)的自动化智能建设及效果。方法:介绍我院PIVAS自动化智能建设的主要情况,收集我院PIVAS自动化智能建设前(2016年7-9月)、后(2016年10-12月)相关工作环节的用时和差错率,评价建设效果。结果:我院在PIVAS的摆药、贴签、分拣以及配送环节进行了自动化智能建设,并进行了相关的制度和流程建设。自动化智能建设后,每张医嘱摆药用时由建设前的(6.78±0.87)s缩短至(2.65±0.71)s,贴签用时由(3.24±0.71)s缩短至(1.41±0.55)s,分拣每袋输液成品用时由(13.37±2.84)s缩短至(5.33±1.72)s,配送相同数量的输液用时由(35.64±4.33)min缩短至(18.12±3.57)min(P<0.05);摆药差错率由(2.35±0.59)‰降至(0.26±0.21)‰,贴签差错率由(1.51±0.45)‰降至(0.22±0.10)‰,分错病区差错率由(3.47±1.02)‰降至(0.17±0.10)‰,配送差错率由(1.33±0.55)‰降至(0.13±0.11)‰(P<0.05)。结论:我院PIVAS自动化智能建设后工作效率提高、差错率降低,降低了潜在的用药风险,提升了PIVAS管理水平。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Nachweis einiger Heilmittel in der Kniegelenksynovialflüssigkeit

Zusammenfassung Mittels Gaschromatographie und Dünschichtchromatographie wiesen die Autoren 11 Substanzen nach, welche durch Injektion oder nach Verabreichung per os in die Kniegelenksynovialflüssigkeit eindrangen. In ihrer Aufstellung konnten sie eine direkte Beziehung zwischen Struktur sowie chemischphysikalischen Eigenschaften der Substanz und ihrer Fähigkeit, aus dem Blut in die Kniegelenksynovialflüssigkeit einzudringen, nicht nachweisen, außer der Tatsache, daß Substanzen mit starker Affinität zu Eiweißstoffen erst in höheren Dosen nachweisbar waren.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Biochemical and molecular characterisation of cubozoan protein toxins

Class Cubozoa includes several species of box jellyfish that are harmful to humans. The venoms of box jellyfish are stored and discharged by nematocysts and contain a variety of bioactive proteins that are cytolytic, cytotoxic, inflammatory or lethal. Although cubozoan venoms generally share similar biological activities, the diverse range and severity of effects caused by different species indicate that their venoms vary in protein composition, activity and potency. To date, few individual venom proteins have been thoroughly characterised, however, accumulating evidence suggests that cubozoan jellyfish produce at least one group of homologous bioactive proteins that are labile, basic, haemolytic and similar in molecular mass (42-46 kDa). The novel box jellyfish toxins are also potentially lethal and the cause of cutaneous pain, inflammation and necrosis, similar to that observed in envenomed humans. Secondary structure analysis and remote protein homology predictions suggest that the box jellyfish toxins may act as α-pore-forming toxins. However, more research is required to elucidate their structures and investigate their mechanism(s) of action. The biological, biochemical and molecular characteristics of cubozoan venoms and their bioactive protein components are reviewed, with particular focus on cubozoan cytolysins and the newly emerging family of box jellyfish toxins.     

Dose tolerability of chronically inhaled voriconazole solution in rodents

Invasive pulmonary aspergillosis (IPA) is a fungal disease of the lung associated with high mortality rates in immunosuppressed patients despite treatment. Targeted drug delivery of aqueous voriconazole solutions has been shown in previous studies to produce high tissue and plasma drug concentrations as well as improved survival in a murine model of IPA. In the present study, rats were exposed to 20 min nebulizations of normal saline (control group) or aerosolized aqueous solutions of voriconazole at 15.625 mg (low dose group) or 31.25 mg (high dose group). Peak voriconazole concentrations in rat lung tissue and plasma after 3 days of twice daily dosing in the high dose group were 0.85 ± 0.63 μg/g wet lung weight and 0.58 ± 0.30 μg/mL, with low dose group lung and plasma concentrations of 0.38 ± 0.01 μg/g wet lung weight and 0.09 ± 0.06 μg/mL, respectively. Trough plasma concentrations were low but demonstrated some drug accumulation over 21 days of inhaled voriconazole administered twice daily. Following multiple inhaled doses, statistically significant but clinically irrelevant abnormalities in laboratory values were observed. Histopathology also revealed an increase in the number of alveolar macrophages but without inflammation or ulceration of the airway, interstitial changes, or edema. Inhaled voriconazole was well tolerated in a rat model of drug inhalation.