临床药师的临床思维培养

临床药学的发展促使了临床药师的产生,其参与到各个临床治疗以及实践中。但他们常局限于以药物为中心的思考模式中,往往造成与医师沟通困难。针对目前临床药师的临床思维模式现状,本文就临床药师的工作与职责以及临床思维概念进行了分析总结,并针对相应问题总结临床药师的临床思维培养措施以及临床实践要点培养,以充实药师的知识层面,积累经验,同时还要注意做好相关的药物治疗要点,使其以正确的临床思维方式深入临床,从而提高医疗质量。同时指导临床药师在临床实践中运用知识,并将理论与实践相结合,积累经验,充实知识层面,提升其临床思维及临床实践能力。     

临床药师深入临床的学习体会

临床药学是医院药学的一个重要组成部分,临床药师的工作意义在于通过药师直接参与治疗过程,成为临床医疗团队中的一员,参与治疗方案的设计,保证患者合理用药,提高医疗质量、减少医疗事故的发生。但由于主观和客观条件的限制,我国临床药学工作进展较为缓慢,而且地区与地区、医院与医院之间的发展也颇不平衡。为加快临床药师工作的发展、推进临床药师制的建立、探索出符合中国国情的临床药学工作模式,卫生部决定在全国42所医院进行临床药师制的试点工作,我院有幸成为甘肃省内唯一一所试点医院,现将工作的心得体会总结如下。     

临床路径及临床药师在临床路径中的作用

临床路径是近年来发展起来的新型医疗管理模式,对降低日益增长的医疗费用、提高医疗质量、合理运用医疗资源来说,在全世界许多国家的医院都取得了显著成效。随着临床路径在国内越来越多的医院中应用,临床药师肩负着用药方案制订、监测、用药指导与教育等责任,在临床路径的实施中发挥着更加重要的作用。     

探讨临床药师参与临床工作的临床药学思维

目的:探讨临床药师建立临床药学思维的重要性。方法:结合临床药师在临床工作的特点,通过临床药师参与临床实践工作,对临床药学思维进行分析总结。结果:临床药师通过临床药学思维,能在临床上发现、识别并预防潜在的用药问题,可以与医师有效合作,使病人得到更加有效的治疗。结论:临床药师的临床药学思维能力的提高,对于临床药师能更好地开展药学服务,保障药物在临床使用过程中的安全及有效性具有重要意义。     

临床药师融入临床的切入点

目的：探讨，临床药师融入临床的方法和切入点。方法：总结本院临床药师通过与医生、护士、患者加强沟通交流而融入临床的方法，并以查房实例说明。结果：良好的专业性沟通交流可较好地融入临床。结论：临床药师既要有过硬的专业知识也要有良好的沟通交流能力，方能融入临床，为临床服务。     

临床药师在临床工作体会

临床药学是一门以患者为对象,研究合理用药、提高医疗质量、促进患者健康的学科。我国《医疗机构药事管理暂行规定》明确药师参与临床医疗工作的合法性,同时也明确了责任。作为一名普通药师,在接受了临床药师培训后,我进入临床与医生一起,以临床药师的身份工作了近两年时间。在这一年的工作中,除了最初感受到临床药师在工作时需要建立起适当的工作方法,比如与临床的沟通技巧、加强临床技能学习等,对临床药师在临床工作的开展工作的难点、寻找工作切入点以及未来可能的发展有深刻的体会。     

临床药学与临床药理学临床药剂学的联系与区别

1　三者之间的异同1.1　概念之差异　临床药学:是一门运用现代药学知识,结合临床,研究药物在病人体内的作用及代谢等方面的规律,使药物发挥最大的疗效,更好地保证病人的安全,有效,合理地进行药物治疗的综合性学科[1]。另一解释是以病人为对象研究药物及其剂型与病体相互作用和应用规律的综合性学科,旨在用客观科学指标来研究具体病人的合理用药。其核心问题是最大限度地发挥药物的临床疗效,确保病人的用药安全与合理[2]。还有一更简洁的解释是一门以病人为对象,研究安全,有效,合理用药的科学[3]。从以上三个解释中体会到,临床药学的特点主要…     

附子临床配伍及临床应用

附子具有回阳救逆,温肾助阳,散寒止痛等作用.临床通过配伍,用于胃痛、梅尼埃病、冻疮、心律失常、心力衰竭、休克、慢性支气管炎、支气管哮喘等的治疗.     

临床药学与临床药学学科建设

目的:探讨临床药学学科建设问题。方法:回顾临床药学发展历程,复习有关国家法律法规和文献,对临床药学学科的定义、形成条件、发展背景、内外环境、教育体系、建设方法等进行讨论。结论:临床药学学科建设能促进医院医疗质量提高,同时推动临床药学发展。     

临床药师指导临床用药探讨

临床药师指导临床用药的要点是在全面掌握病情、患者和药物的基础上明确药物治疗的目的;选择用药时机、制定具体药物治疗方案：包括药物选择、剂型和给药途径、剂量与给药间隔和疗程,分析药物治疗疗效不佳的原因,并对药物疗效、不良反应实施监测。     

原发胃癌恶性表型与患者自发淋巴细胞微核形成的关系

目的 探讨淋巴细胞微核形成与胃癌恶性度的关系.方法 术前取外周血采用体内微核实验方法检测130例胃癌患者(胃癌组)、13例良性胃肠病变(良性病变组)及59例正常人(对照组)淋巴细胞微核率(MNF).结果 胃癌组淋巴细胞MNF为(1.93±0.93)‰,明显高于良性病变组的(0.62士0.49)‰和对照组的(0.51±0.45)‰(P＜0.01);MNF随着胃癌组分化度降低及淋巴结转移率的增加而逐渐上升(P＜0.01).结论 淋巴细胞微核形成与胃癌恶性度密切相关,为胃癌患者的术前恶性度的判断和高危人群筛查提供了一个有用的生物学标志物.     

Absence of respiratory effects with ivabradine in patients with asthma

AIM

β-Blockers are commonly prescribed for stable angina and are recommended as initial therapy. However, β-blockers are contraindicated in patients with obstructive airway disease because of a risk of bronchoconstriction. Ivabradine is a specific heart rate-lowering agent that acts via I_f pacemaker channels in the sinoatrial node with no β-adrenoreceptor activity. Ivabradine has been recently approved for the treatment of stable angina. This study assessed the effects of repeated administration of ivabradine on lung function in patients with asthma.

METHODS

In this double-blind, placebo-controlled, crossover study, 20 subjects with asthma received either oral ivabradine 10 mg b.i.d. or placebo for 4.5 days. Forced expiratory volume in 1 s (FEV₁) and peak expiratory flow rate (PEFR) were designated as the main outcome variable. Diary cards were used to monitor asthma symptoms on a five-point scale, rescue medication usage, and adverse events.

RESULTS

There were no significant differences in mean variation of FEV₁ (ivabradine P = 0.664; placebo P = 0.652) or PEFR (ivabradine P = 0.153; placebo P = 0.356) from baseline following administration of ivabradine. There was also no significant difference in maximum percent variation in FEV₁ or PEF between treatment groups (P = 0.994; FEV₁ and P = 0.704; PEF). On a similar note, there was no significant difference in asthma symptoms or rescue medication usage reported between the two groups. Adverse events were generally mild-to-moderate in intensity and no cardiovascular or serious adverse events were recorded.

CONCLUSIONS

This study confirms that ivabradine does not affect respiratory function or symptoms in patients with asthma and therefore represents a valuable therapeutic alternative to β-blockers for treating patients with stable angina and asthma.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Ivabradine is a new heart rate-lowering agent that acts specifically on the sinoatrial node via the I_f pacemaker channels.
• Ivabradine has demonstrated similar efficacy to β-blockers.
• As β-blockers are contraindicated in patients with obstructive airway disease, this study was conducted to assess the safety of ivabradine in patients with asthma.

WHAT THIS STUDY ADDS

• This study demonstrates that ivabradine has no effect on the pulmonary functions in patients with asthma and can be safely used a heart rate-lowering agent in patients with angina and coexistent airflow obstruction.

     

Improvement in quality of life with omalizumab in patients with severe allergic asthma

ABSTRACT

Background: Patients with severe persistent asthma experience daily symptoms and frequent serious exacerbations that contribute to a significant impairment of health-related quality of life (QoL).

Methods: A pooled analysis was completed of six controlled clinical trials that evaluated the effect of add-on omalizumab on asthma-related QoL in patients with severe persistent allergic (IgE-mediated) asthma. Asthma-related QoL was assessed at baseline and treatment endpoint using the well-validated Juniper Asthma Quality of Life Questionnaire (AQLQ). Change from baseline in AQLQ total score was compared between treatments using analysis of covariance methods. The percentage of patients who achieved a clinically meaningful (≥ 0.5-point) improvement in AQLQ total score was compared using the Mantel–Haenszel Chi-square test.

Results: The pooled patient population comprised 2548 patients (omalizumab, n = 1342; control, n = 1206), of whom 96% had severe persistent asthma according to the GINA 2002 classification. Omalizumab produced significantly greater improvements in AQLQ total score vs the control group (mean increases of 1.01 and 0.61 points, respectively; p < 0.001). In addition, significantly more omalizumab-treated patients achieved a clinically meaningful improvement in AQLQ total score than patients in the control group (66.3% vs 52.4%; p < 0.001).

Conclusions: Add-on therapy with omalizumab improves QoL to a significant and clinically meaningful level in patients with severe persistent allergic asthma.     

重症胰腺炎血小板计数的动态变化与预后的关系

目的探讨血小板计数变化对重症急性胰腺炎(SAP)并发腹膜后出血、多脏器功能衰竭及死亡率的的影响。方法将该院2009年10月～2011年8月收治的73例SAP患者,按血小板计数的动态变化,分成血小板降低组(100×109.L-1)和血小板正常组(≥100×109.L-1)。分析两组血小板计数动态变化对胰腺炎并发腹膜后出血、多脏器功能衰竭及死亡率的影响。结果血小板计数降低组47例,占64.4%;血小板计数正常组26例,占35.6%。两组在并发腹膜后出血、多脏器功能衰竭发生率及死亡率上均有统计学意义(P0.05)。结论血小板计数动态变化对提示重症胰腺炎的预后有一定的临床指导意义。     

拉氧头孢联合罗红霉素治疗支气管扩张症继发肺部感染疗效观察

目的观察拉氧头孢联合罗红霉素治疗支气管扩张症继发肺部感染的疗效和不良反应。方法选取38例支气管扩张症继发肺部感染的患者,对比拉氧头孢联合罗红霉素治疗前后的临床情况、炎症指标、肺通气功能参数、细菌学评价,分析其疗效和观察不良反应。结果在全部38例病人中,痊愈18例,显效8例,进步6例,无效6例,总有效率84.2%（32/38）,细菌清除率为82.4%,没有发现严重不良反应。结论拉氧头孢联合罗红霉素可以作为支气管扩张症继发肺部感染的治疗方案之一。     

Disposcope无线传输气管插管内视镜在困难气管插管中的应用

目的 观察Disposcope内视镜在困难气道气管插管的应用效果.方法 困难气管插管成人患者40例随机均分为Disposcope内视镜(A)组和McCoy喉镜(B)组.记录麻醉诱导前(T0)、诱导后(T1)、插管后即刻(T2)、插管后1 min(T3)的平均动脉压(MAP)、心率(HR)及气管插管时间、次数和并发症.结果 与T1时比较,两组T2、T3时的MAP明显增高(P＜0.05);A组T2时的MAP和HR明显低于B组(P＜0.05).A组插管时间较B组明显缩短[(43.9±14.5)s vs.(90,4±26.6)s](P＜0.01)、一次插管成功率明显高于B组(85.0％ vs.60.0％) (P＜0.05).结论 与McCoy喉镜比较,Disposcope内视镜用于困难气道气管插管一次插管成功率高、插管时间短、应激反应轻.