ABSTRACT
To provide prevention and control strategies of occupational exposure risks to cytotoxic drug in medical institutions， improve the awareness of protection among medical staff，and reduce potential occupational exposure risks，the Guidelines for the Prevention and Control of Occupational Exposure Risk to Cytotoxic Drugs in Medical Institutions is developed. Based on the World Health Organization Guidelines Development Manual，the exposure risk issues of the cytotoxic drug collected from the time that it entered the hospital to the several stages after delivery to hospital，such as transportation，receipt，storage，unpacking，dispensing，use of finished products，and waste disposal. Delphi method is used to construct identification of clinical issues，and evidence-based research method is used to develop relevant evidence. Quality evaluation is conducted by using the recommended GRADE method. The consensus is reached on the recommendation opinions and evidence levels through expert consensus method. By combining engineering controls，administrative controls and personal protective equipment at different levels，a graded control approach is established. A total of 37 clinical issues are identified，resulting in 36 recommendations. This guideline provides reference and supplementation for the formulation of cytotoxic drug prevention and control measures in medical institutions.
ABSTRACT
In order to standardize the review and comment of national key monitoring drug prescriptions （medical orders） by medical institutions at all levels， the Sichuan Academy of Medical Sciences·Sichuan Provincial People’s Hospital took the lead in compiling the Review and Comment Rules of National Key Monitoring Drugs prescriptions （Medical Orders） herein after referred to as the Rules in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as the List） issued by the National Health Commission confirmed in Jan. 13， 2023. According to the laws and drug instructions issued by the national drug regulatory department， clinical guidelines and expert consensus， combined with the actual situation of patients （including age， body weight， liver and kidney function）， the writing group classified the common and unreasonable drug use problems for 30 kinds of drugs included in the List and develop the review and comment details. After two rounds of Delphi method questionnaire research and experts’ online meetings， and reviewed by the steering committee， the final Rules was formed. The Rules aim to provide reference for the evaluation of the rational use of drugs included in the List by medical institutions， so as to realize the standardized management of key monitoring drugs， promote the rational drug use in medical institutions， and ensure the safety of drug use for patients.
ABSTRACT
In order to strengthen the supervision of the use of drugs in hospitals，the Sichuan Academy of Medical Sciences· Sichuan Provincial People’s Hospital took the lead in compiling the Principles for the Rational Use of National Key Monitoring Drugs （the Second Batch） with a number of experts from multiple medical units in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as “the List”） issued by the National Health Commission. According to the method of the WHO Guidelines Development Manual， the writing team used the Delphi method to unify expert opinions by reading and summarizing the domestic and foreign literature evidence of related drugs， and applied the evaluation， formulation and evaluation method of recommendation grading （GRADE） to evaluate the quality of evidence formed， focusing on more than 30 drugs in the List about the evaluation of off-label indications of drugs， key points of rational drug use and key points of pharmaceutical monitoring. It aims to promote the scientific standardization and effective management of clinical medication， further improve the quality of medical services， reduce the risk of adverse drug reactions and drug abuse， promote rational drug use， and improve public health.
ABSTRACT
At present， there is a lack of unified and standardized management for the rational use of national key monitoring drugs. According to the relevant requirements of the state， based on the relevant literature published at home and abroad in recent years and combined with the management practice of many medical institutions across the country on the national key monitoring drugs， in order to make the national key monitoring drugs more reasonable use and standardized management in medical institutions at all levels， the Clinical Pharmacy Branch of the Chinese Medical Association， the Pharmaceutical Epidemiology Special Committee of the Chinese Pharmaceutical Association and the Pharmaceutical Epidemiology Special Committee of the Sichuan Pharmaceutical Association organized experts to fully discuss， and to form this management standard. This standard mainly provides relevant opinions and suggestions on the basic principles of rational use of key monitoring drugs and the regulatory measures for key monitoring drugs， especially on how to strengthen the pharmaceutical management and use management of key monitoring drugs， further promoting the standardized use of key monitoring drugs.
ABSTRACT
Objective@#To construct symptom-formula-herb heterogeneous graphs structured Treatise on Febrile Diseases (Shang Han Lun,《伤寒论》) dataset and explore an optimal learning method represented with node attributes based on graph convolutional network (GCN).@*Methods@#Clauses that contain symptoms, formulas, and herbs were abstracted from Treatise on Febrile Diseases to construct symptom-formula-herb heterogeneous graphs, which were used to propose a node representation learning method based on GCN − the Traditional Chinese Medicine Graph Convolution Network (TCM-GCN). The symptom-formula, symptom-herb, and formula-herb heterogeneous graphs were processed with the TCM-GCN to realize high-order propagating message passing and neighbor aggregation to obtain new node representation attributes, and thus acquiring the nodes’ sum-aggregations of symptoms, formulas, and herbs to lay a foundation for the downstream tasks of the prediction models.@*Results@#Comparisons among the node representations with multi-hot encoding, non-fusion encoding, and fusion encoding showed that the Precision@10, Recall@10, and F1-score@10 of the fusion encoding were 9.77%, 6.65%, and 8.30%, respectively, higher than those of the non-fusion encoding in the prediction studies of the model.@*Conclusion@#Node representations by fusion encoding achieved comparatively ideal results, indicating the TCM-GCN is effective in realizing node-level representations of heterogeneous graph structured Treatise on Febrile Diseases dataset and is able to elevate the performance of the downstream tasks of the diagnosis model.
ABSTRACT
Objective@#To establish the knowledge graph of “disease-syndrome-symptom-method-formula” in Treatise on Febrile Diseases (Shang Han Lun,《伤寒论》) for reducing the fuzziness and uncertainty of data, and for laying a foundation for later knowledge reasoning and its application.@*Methods@#Under the guidance of experts in the classical formula of traditional Chinese medicine (TCM), the method of “top-down as the main, bottom-up as the auxiliary” was adopted to carry out knowledge extraction, knowledge fusion, and knowledge storage from the five aspects of the disease, syndrome, symptom, method, and formula for the original text of Treatise on Febrile Diseases, and so the knowledge graph of Treatise on Febrile Diseases was constructed. On this basis, the knowledge structure query and the knowledge relevance query were realized in a visual manner. @*Results@#The knowledge graph of “disease-syndrome-symptom-method-formula” in the Treatise on Febrile Diseases was constructed, containing 6 469 entities and 10 911 relational triples, on which the query of entities and their relationships can be carried out and the query result can be visualized. @*Conclusion@#The knowledge graph of Treatise on Febrile Diseases systematically realizes its digitization of the knowledge system, and improves the completeness and accuracy of the knowledge representation, and the connection between “disease-syndrome-symptom-treatment-formula”, which is conducive to the sharing and reuse of knowledge can be obtained in a clear and efficient way.
ABSTRACT
Objective:To investigate the correlation between body composition and cardiovascular disease (CVD) in patients with chronic kidney disease (CKD).Methods:CKD patients who were hospitalized in the Department of Nephrology of Chongqing General Hospital from January 2017 to December 2019 and had complete clinical biochemical data were divided into CKD patients with CVD and CKD patients without CVD according to their medical history and corresponding auxiliary examinations. Clinical data were collected and anthropometric measurements were conducted. Skeletal muscle index (SMI), appendage lean mass/height 2, total body fat (TBF), visceral adipose tissue (VAT), bone mineral capacity, bone mineral density and et al, were measured by dual-energy X-ray absorptiometry. T test, U test and Chi-square test were used for statistical analysis. Logistic regression was used to analyze the relationship between body composition and CVD. Results:A total of 604 CKD patients were included in this study, including 560 patients (92.7%) with CKD stage 3, 44 patients (7.3%) with CKD stage 4, and 180 CKD patients with CVD (29.8%), 424 CKD patients without CVD (70.2%). Compared with CKD patients without CVD, the proportion of men, the proportion of hypertension, the proportion of diabetes, age, duration of CKD, systolic blood pressure, blood uric acid, waist to hip ratio and waist circumference were higher (all P<0.05), while low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, and estimated glomerular filtration rate (eGFR) were lower in CKD patients with CVD (all P<0.05). In terms of body composition, SMI ( t=-11.964, P<0.001) and body mass index ( t=-4.462, P<0.001) in CKD patients with CVD were significantly lower than those in CKD patients without CVD, but VAT ( t=3.089, P=0.002) and TBF ( t=5.177, P<0.001) in CKD patients with CVD were significantly higher. After adjusting for confounders such as age, CKD duration, hypertension history, diabetes history, LDL-C, body mass index, eGFR, TBF, etc. by multivariate logistic regression analysis, the risk of CKD patients suffering from CVD increased significantly with the decrease of SMI [with SMI high tertile (36.37%-50.80%) as reference, SMI middle tertile (28.23%-36.31%): OR=1.49, 95% CI 1.24-1.71, P=0.003; SMI low tertile (15.28%-28.19%): OR=2.17, 95% CI 1.79-2.62, P<0.001], and VAT was not found to be associated with the risk of CVD in CKD patients ( P>0.05). Conclusion:Reduction of SMI is independently associated with CVD in CKD patients.
ABSTRACT
OBJECTIVE：To investigate the situ ation and characteristics of ADR reports in the elderly patients （≥65 years old ） of Sichuan province ，and to provide reference for guaranteeing the safety of drug use. METHODS ：ADR reporting data of elderly patients collected by spontaneous reporting system of Sichuan ADR monitoring center from 2013 to 2019 were collected ，and then analyzed in respects of report types ，reproting institution ，relationship，patienst’age，gender，nationality，drug type ，organ/system invovled. RESULTS & CONCLUSIONS ：In the past seven years ，175 431 cases spontaneous ADR were collected by Sichuan ADR monitoring center ，and the annual proportion of “general”ADR reports decreased from 78.93％ in 2013 to 60.50％ year by year ； the annual proportion of “new general ”and“serious”ADRs increased year by year ，among which that of “new general ”ADR increased more obviously. The main reporting institutions were medical institutions ，accounting for 92.79％-98.87％ of the total annual reports. The enthusiasm of enterprises and individuals to report ADR needed to be improved ；8 031 cases（4.58％）were “positive”relationship，21 283 cases（12.13％）were“likely”，146 117 cases（83.29％）were“possible”. Except that the gender of 272 cases were not reported ，there were 88 176 male cases and 86 983 female cases ；most of them were 65-74 years old （104 962 cases，59.83％）. The reports covered 19 nationalities，among which the re were 166 752 cases（98.72％）of Han nationality. The distribution of ADR related drug categories in elderly patients of Yi ， Tibetan and Qiang nationalities was significantly different from that of Han nationality （P＜0.01）. The top three drug categories in the total frequency were anti-infective drugs （31.10％），traditional Chinese medicine com （18.27％），and central nervous system drugs （9.99％）. The injection route was the most likely to cause ADR （72.12％）. ADR mainly involved s kin and its appendants （21.47％）， gastrointestinal system （19.61％）and central and peripheral nervous system （18.55％）. Aminophylline injection was the only dr ug in the top 10 drugs leading to “new general ”ADR for consecutive 7 years. Cefotaxime sodium for injection ，Ceftriaxone sodium for injection ，Cefoperazone sodium and sulbactam sodium for injection were the top 10 drugs causing “severe”ADR in consecutive 7 years，which should be paid more attention in clinic.
ABSTRACT
OBJECTIVE： To investigation occupational exposure and exposure outcome of antineoplastic in medical staff ，to provide support for their safety in Sichuan Province. METHODS：The respondents included doctors ，nurses，technicians and pharmacists from 11 related departments including tumor department ，hematology department ，PIVAS and pharmacy department in 4 third-level class A hospitals mainly in Sichuan Provincial People ’s Hospital and 6 second-level and below hospitals. Self-designed questionnaires were adopted to investigate general information of medical staff ，cognitive status to occupational exposure hazards ， occupational exposure and exposure outcome and protective behaviors and make suggestions of the investigation. RESULTS：A total of 350 questionnaires were sent out and 304 were recovered ，with effective recovery rate of 86.86％. Among 304 investigated pharmacentical staff ，involving 253 female（83.22％），51 male（16.78％），the most of persons aged 20-29 years old （43.42％）. The most of persons （66.78％）had a bachelor degree. The largest number of occupation was nurses （55.26％）；the pharmacy department had the largest number （21.71％）；working hours were mainly 8 h/day（84.21％）；working years were the most less than 5 years（39.47％）. 121 persons（39.80％）were aware of the potential hazards of occupational exposure to antineoplastic drugs，and 131 persons（43.09％）only knew a little about the Δ 项目基金：国家临床重点专科建设项目；四川省科研院所基本科 exposure hazards ；in PIVAS ，15 persons （71.43％） were 研业务项目（No.2018YSKY0017） ＊药师，硕士研究生。研究方向：临床药学。E-mail：370951417@ aware of the potential hazards of occupational exposure to qq.com antineoplastic drugs ，accounting the highest proportion among # 通信作者：主任药师，硕士生导师。研究方向：国家药物政策、药 all departments ； the proportion of technicians and other 事管理、医院药学。电话：028-87393436。E-mail：289302309@qq.com medical staff who did not know the occupational exposure 中国药房 2020年第31卷第8期 China Pharmacy 2020Vol. 31 No. 8 ·1009· hazard was the highest ，being 60％；the longer the total working time ，the higher the cognition degree of occupational exposure hazards （P＝0.035 8）. The most exposed antineoplastic drug was cyclophosphamide 165 persons（54.28％） and pemetrexed disodium 57 persons（18.75％）was the least. The total time of occupational exposure of medical staff in different departments was mainly short-term exposure ，among which the number of exposed persons in hematology department was the most （85.71％）. 67 persons（22.04％）reported that they had physical discomfort after excluding the influence of other physical diseases ，mainly the increase of alopecia （73.13％）；the propertion of medical staff who had physical discomfort in hematology department was the most（50.00％）；the number of nurses who had physical discomfort （31.55％）was the most. 155 persons（50.99％）could not understand the antineoplastic drug protection measures ，41 persons （13.49％） had received relevant training ，108 persons （35.53％）understood the occupational protection of antineoplastic drugs. The highest level of awareness of protective measures was found among the medical staff in PIVAS ，and only 14.29％ of the staff did not understand the protective measures. In term of occupation，the proportion of nurses who had received relevant training was the highest （19.05％）. CONCLUSIONS ：Medical staffs have a low level of knowledge about occupational exposure hazards and self-protection measures of antineoplastic drugs. The government should strengthen the construction of occupational protection regulations and standards for medical staff ；hospitals should strengthen internal management and attach great importance to the management of occupational protection in hospitals ； medical staff should increase awareness ，skills and reduce the risk of occupational exposure.
ABSTRACT
OBJECTIVE： To investigate the characteristics and regularity of gestational （including perinatal period） adverse drug reactions （ADR） in Sichuan province， and to provide evidence for ensuring the safety and effectiveness of drug use in clinic. METHODS： Gestational ADR reported to Sichuan provincial ADR monitoring center from Nov. 2016 to Nov. 2017 were statistically analyzed in respects of report source， personnel distribution， general information of patients， route of administration， drug types and main drugs， involved system/organ， grading and outcome， etc. RESULTS： A total of 1 309 gestational ADR cases （1 340 case time） were collected， in which 1 305 were from medical institutions， 3 from enterprises and 1 from manufacturer. There were 986 physicians， 188 nurses， 133 pharmacists and 2 commissioners for drug safety. 859 cases （65.62％） were 21-30 years old， accounting for the largest proportion. 867 case time were caused by intravenous administration （64.70％）. ADR-inducing drug types mainly included reproductive system drugs （491 case time， 36.64％）， antimicrobial drugs （479 case time， 35.75％） and blood system drugs （110 case time， 8.21％）. Main of them were Carboprost tromethamine injection （187 case time， 13.96％）， Cefazolin sodium for injection （122 case time， 9.10％） and Oxytocin injection （105 case time， 7.84％）. ADR mainly involved skin and its appendants （517 case time， 33.95％）， gastrointestinal system （387 case time， 25.41％）， whole body （175 case time， 11.49％）. In 1 309 gestational ADR， 1 251 cases （95.57％） were general ADR； 58 cases （4.43％） were severe ADR， including 14 life-threatening cases， 7 extended hospital stay and 37 others； 592 （45.22％） patients improved， 716 （54.70％） recovered and 1 （0.08％） did not improve. CONCLUSIONS： In clinical practice， it is necessary to strengthen the monitoring of drug use in patients during gestational， especially monitor ADR of uterine contraction drugs and antimicrobial drugs during gestational， use drug cautiously and promote clinical medication safety in gestational patients.
ABSTRACT
OBJECTIVE： To investigate the situation and reasons of drug shortage in some medical institutions from Sichuan province. METHODS： A questionnaire survey was conducted among 78 medical institutions in Sichuan province by stratified random sampling. The situation of drug shortage were collected from Jan. 2015 to Jun. 2017， mainly including the basic information of medical institutions， drug shortage situation， specific drug shortage information and the reasons for drug shortage. Descriptive analysis of the information collected by the questionnaire was carried out， and Logistic regression analysis of the data by SPSS 20.0 software was adopted to find out the key factors affecting drug shortage. RESULTS & CONCLUSIONS： Totally 78 medical institutions include 13 third-level hospitals， 22 second-level hospitals and 43 primary medical institutions （10 community health service centers， 33 township health centers）. A total of 78 questionnaires were sent out， and the recovery rate and effective rate both were 100％. Among them， 68 medical institutions reported 206 shortage drugs totally， involving 240 specifications. The prices of more than 88.34％ of the shortage drug were less than 50 yuan. Main types of shortage drugs included anti-infective drugs， central nervous system drugs and cardiovascular system drugs， and most of them were purchased directly through internet. The proportion of temporary shortage （shortage time＜3 months） and long-term shortage （shortage time＞12 months） was relatively high （more than 68％ in total）. Drug supply and medical institutions’own factors were two main causes of drug shortage. Logistic regression analysis showed that main factors affecting the time of drug shortage were hospital drug purchase process， location of medical institution and drug purchase price. The main factors affecting the specifications of drug shortage in medical institutions were the process of drug purchase， the limitation of hospital purchase catalogue， primary or non-primary medical institution， comprehensive or specialized hospitals. It is suggested that medical institutions in this region can reduce the drug shortage caused by their own reasons by building a platform for drug information management， optimizing drug purchase catalogues and plans， strengthening the management of pharmacy inventory and establishing a regulatory system for distribution enterprises.
ABSTRACT
OBJECTIVE： To investigate the reasons for drug shortage in medical institutions of Sichuan province and put forward relevant countermeasures， and to provide reference for establishing supply security mechanism of drug shortage. METHODS： Questionnaire survey was conducted to investigate drug shortage in 78 medical institutions of the province during Jan. 2015-Jun. 2017. Traceability investigation was conducted from manufacturers and distribution enterprises involved in drug shortage. Questionnaire survey and field investigation were combined to analyze the reasons for drug shortage in Sichuan province and put forward countermeasures. RESULTS： Totally 78 questionnaires were sent out to medical institutions with recovery rate and effective rate of 100％. A total of 206 drugs were reported by 78 medical institutions， involving 240 specifications for shortage in total. Totally 140 questionnaires and 68 questionnaires were distributed to the manufacturers and distribution enterprises involved in drug shortage， and the recovery rate and effective rate were all 100％. Combined with the field survey， survey results of shortage drugs of 212 specifications were obtained. From the perspective of manufacturers， the most important factors causing drug shortage were the increase of production cost （66.51％） and circulation cost（26.88％）. From the perspective of distribution enterprises，the main factors causing drug shortage were insufficient supply of drugs（75.47％），inventory management（16.51％） and price inversion（11.32％）. CONCLUSIONS： Main reasons of drug shortage from manufacturers and distribution enterprises include the increase of production cost and circulation cost， drug price inversion， inventory management and bidding procurement. It is suggested that measures should be taken to improve the bidding and pricing system of drugs， mobilize the enthusiasm of enterprises； improve the early warning mechanism of drug shortage on the enterprises， strengthen information communication； establish the mechanism of drug shortage reserve， organize the emergency production of drug for shortage； strengthen the management of drug shortage supply chain， purify the unhealthy atmosphere in the market； improve the emergency disposal methods of drug shortage， and improve the supply guarantee ability of drug shortage. Departments cooperate to reduce the emergence of drug shortage and ensure the continuous access to safe and effective drugs in clinic.
ABSTRACT
OBJECTIVE:To promote effective supervision of key monitoring drugs by provincial pharmaceutical quality control center,and to improve rational drug use. METHODS:The effects of No.2 district of Sichuan province pharmaceutical quality con-trol center on 3 categories of key monitoring drugs guidance and supervision,through urging medical institution in the area to estab-lish key monitoring drugs supervision system,formulating prescription review guideline for 3 categories of key monitoring drugs [TCM injection,adjunctive drug,proton pump inhibitors (PPIs)],developing baseline data survey,inspecting the application of key monitoring drug in medical instaurations on the spot and other measures,were introduced. Through collecting the reports of re-gional quality control center to the provincial quality control center,supervision system of medical institutions were analyzed statisti-cally. Key monitoring drugs of medical institutions in the area were analyzed statistically in respects of rational utilization ratio,uti-lization quantity,utilization amount,etc.,so as to evaluate supervision effects. RESULTS:Up to Apr. 2016,92.26%medical insti-tutions had been aware of the relevant requirements of the documents;84.25% had established the hospital supervision system. 3 categories of key monitoring drugs prescription(orders)comment guideline had been developed in Mar. 2016. 18 third-grade class-A general medical institutions were randomly selected;among 3 categories,irrational utilization ratio of TCM injection decreased by 12.35%(35.41% vs. 47.76%);that of adjunctive drugs decreased by 9.64%(20.95% vs. 30.59%);that of PPIs decreased by 7.44%(40.49% vs. 47.93%) in May 2016,compare to Jan. 2016. Average consumption sum of them decreased by 12.07%, 13.30%,9.49%,respectively in Apr. 2016,compared to Jan. 2016. 55.02% medical institutions had started to collect the baseline data. CONCLUSIONS:The provincial pharmaceutical quality control center has played an important role on establishing a supervi-sion system,it can promote the effective supervision by guiding and supervising the medical institutions evaluating the supervision of medical institutions and pointing out the problems.
ABSTRACT
Objective To understand the current application status of global trigger tool ( GTT) in China and abroad, and to provide reference for application and improvement of GTT in medical institutes in China. Methods The databases of Pubmed and CNKI were searched, and the relevant literatures were reviewed and collected, and the application of GTT for measuring adverse events ( AE ) were analyzed and evaluated. Results Fifty-eight valid articles from 15 countries were included.The studies involve several aspects of GTT applications. Articles about GTT used for measuring the incidence of AE accounted for 62.07%, the researches on the object category of AE accounted for 36.21%, those evaluating the effectiveness of GTT as an AE measurement tool accounted for 27.59%, those about improvement and exploration of GTT application performance accounted for 23. 41%, and those about comparison between GTT and other AE detection methods accounted for 15. 52%. In 18.97% of the studies, the number of reviewers and criteria were accordant with the GTT White Paper, but 32.76% of the studies did not clearly describe the reviewers and criteria. The most common method for reporting the AE rate was the proportion of patients with AE.The research object includes 11 categories:common hospital patients, children, patients in intensive care unit ( ICU) , etc.; AE ratio of common hospital patients was 3. 4% to 43. 3%, the preventable proportion was between 32. 2% and 72.4%.The most common types of AE were drug related adverse events, infection/hospital acquired infections, surgery-related complications, abnormal blood potassium, pressure ulcer and so on. Evaluation performed in the United States, Republic ofKorea, Spain, China and other countries and regions' showed GTT had higher efficiency and other advantages as compared with the other AE detection methods including voluntary reporting system, HMPS, QPSIQ DLCR.The exploration of GTT performance improvement involves many factors influencing the detection effectiveness such as different reviewers, review experience, sampling method, sample size, trigger etc. Conclusion GTT has been applied to AE detection of hospital patients in various countries, and it has shown some advantages. GTT is an effective tool for AE measuring, which could be widely used in AE monitoring of hospitalized patients in medical institutions of China.
ABSTRACT
OBJECTIVE:To explore effective pharmaceutical administration measures for the rational adjunctive drugs. METH-ODS:The effective pharmaceutical administration of adjunctive drugs in medical institutions of Sichuan province was introduced, including establishing key monitoring management system of adjunctive drugs (establishing and implementing prescription review system,rational drug use training,strict supervision and examination) and playing promotion effect of provincial pharmaceutical quality management control center on medical institutions,etc. The effects of pharmaceutical administration in 18 third-grade class-A medical institutions were evaluated through statistically analyzing rational utilization ratio,drug ratio,consumption sum of ad-junctive drugs. RESULTS:Up to May 2016,key monitoring management system of hospital adjunctive drugs had been established and improved in medical institutions over Sichuan province. The rational utilization ratio of adjunctive drugs in 18 medical institu-tions increased from 69.41% in Jan. 2016 to 79.05% in May 2016;drug ratio decreased from 29.22% to 27.93%. The monthly consumption sum of adjunctive drugs decreased from 22 970 000 yuan in Apr. 2015 to 17 380 000 yuan in Apr. 2016(decreasing by 20.49%). CONCLUSIONS:Medical institutions of Sichuan province conduct effective pharmaceutical administration of adjunc-tive drugs through establishing the key monitoring management system for medical institutions and playing the role of the provincial pharmaceutical quality management control center for the supervision.
ABSTRACT
Objective To understand the current application status of global trigger tool ( GTT) in China and abroad, and to provide reference for application and improvement of GTT in medical institutes in China. Methods The databases of Pubmed and CNKI were searched, and the relevant literatures were reviewed and collected, and the application of GTT for measuring adverse events ( AE ) were analyzed and evaluated. Results Fifty-eight valid articles from 15 countries were included.The studies involve several aspects of GTT applications. Articles about GTT used for measuring the incidence of AE accounted for 62.07%, the researches on the object category of AE accounted for 36.21%, those evaluating the effectiveness of GTT as an AE measurement tool accounted for 27.59%, those about improvement and exploration of GTT application performance accounted for 23. 41%, and those about comparison between GTT and other AE detection methods accounted for 15. 52%. In 18.97% of the studies, the number of reviewers and criteria were accordant with the GTT White Paper, but 32.76% of the studies did not clearly describe the reviewers and criteria. The most common method for reporting the AE rate was the proportion of patients with AE.The research object includes 11 categories:common hospital patients, children, patients in intensive care unit ( ICU) , etc.; AE ratio of common hospital patients was 3. 4% to 43. 3%, the preventable proportion was between 32. 2% and 72.4%.The most common types of AE were drug related adverse events, infection/hospital acquired infections, surgery-related complications, abnormal blood potassium, pressure ulcer and so on. Evaluation performed in the United States, Republic ofKorea, Spain, China and other countries and regions' showed GTT had higher efficiency and other advantages as compared with the other AE detection methods including voluntary reporting system, HMPS, QPSIQ DLCR.The exploration of GTT performance improvement involves many factors influencing the detection effectiveness such as different reviewers, review experience, sampling method, sample size, trigger etc. Conclusion GTT has been applied to AE detection of hospital patients in various countries, and it has shown some advantages. GTT is an effective tool for AE measuring, which could be widely used in AE monitoring of hospitalized patients in medical institutions of China.
ABSTRACT
Objective To discuss the clinical influence and advantages of applying the local flap of finger tip lateral skin to repair the fingertip defective injuries.Methods From August,2013 to December,2015,used the way of local the flap of finger tip lateral skin to repair the first-fourth fingertip defects for 32 cases and 32 fingers,among which there were 20 males and 12 females;finger categories:11 thumbs,9 index fingers,8 middle fingers and 4 ring fingers.The defective area of fingertips was 0.5 cm×0.8 cm-1.0 cm×1.5 cm,all with bone exposure,23 cases had defects at the end part of phalanx,32 cases had different extent of nail bed defects.Reasons for the injuries:13 cases of grind injuries,11 cases of punch pressing injuries,8 cases of sharp tool cutting injuries.The time from injury to the treatment was 0.5-3.0 h,all of them had no associated injuries.Results Thirty-two cases of finger flaps all survived,with the follow-up for 3-24 months and average follow-up of 6 months,the flaps were slightly bloated after 3 months comparing with the normal skin,there was no contracture in the flap area and pedicle scars,two-point discrimination was 4-5mm,the farinterphalangeal joint flexion was normal.Conclusion The local flap of fingertip lateral skin can repair the defects of fingertip with less scar,not bloated flap,satisfying appearance,operation is simple,and good function,so it's the ideal way to repair the defects of fingertip.
ABSTRACT
Objective To investigate the clinicopathological and immunophenotype features of hemangiosarcoma.Methods The clinical,pathologic features of 5 cases of hemangiosarcoma,admitted in our hospital during 2006-2014,were retrospectively analyzed.Results Tumors were located in the spleen (n =3),liver(n =1),scalp(n =1),tumor metastasis to the lung or marrow was found in 4 cases.Preoperative misdiagnosis as lymphoma,cavernous haemangiomas or parasite cyst was suggested by ultrasonography or CT,and final diagnosis was established by typical pathological pictures.CD34,CD31,FⅧ and Vim were positive in tumor cells while CK,EMA were negative.The survival time of the patients receiving resection only was 2 days,4 months and 13 months.The survival time of the patients receiving operation plus chemotherapy was 6 months or 48 months.Conclusions Hemangiosarcoma is a rare and aggressive malignant tumor of soft tissue which has poor prognosis.The additional survival benefits provided by chemotherapy remains unproven.
ABSTRACT
Objective: To investigate the impact of thyroid hormone on atrial ifbrillation (AF) prevalence in patients with chronic heart failure (CHF). Methods: A total of 322 non-valvular heart disease CHF patients treated in our hospital from 2011-0-01 to 2012-10-01 were retrospectively studied. Based on previous history and the ECG at admission, the patients were divided into 2 groups: AF group,n=187 and Sinus rhythm group,n=135. The proifle of serum levels of free thyroxine (FT4), free triiodothyronine (FT3), hyroid stimulating hormone (TSH) and LDL-C were examined within 24 hours of admission; 12 lead ECG and echocardiography were conducted to analyze the related factor for AF occurrence. Results: Compared with Sinus rhythm group, AF group had increased FT4 level as 14.52 (12.74, 15.85) pmol/L vs 13.11 (11.68, 14.85) pmol/L,P Conclusion: High serum level of FT4 may increase the risk AF occurrence in CHF patients.
ABSTRACT
Objective To study the protective effect of the thin Recipe of Buyanghuanwu on cerebral ischemic injury of rats. Methods Block model in cerebral artery was established through using the suture method of middle cerebral artery. The rats were randomly divided into sham-operation group, model group, Buyanghuanwu group and thin recipe of Buyanghuanyin high, medium and low-dose groups. Buyanghuanwu group and thin recipe of Buyanghuanyin groups were given gavage with relevant medicine, and sham-operation group and model group were given gavage with the same amount of sterile distilled water for continuous 7 days. Matlab software programming was used to analyze data and observe the changes in neurological function, body weight, the area of cerebral infarction and wet/dry weight ratio of brain of the rats. Results Rats with cerebral ischemia suffered large area of infarction, brain edema and neurological dysfunction. The thin recipe of Buyanghuanwu of medium and low dose groups could effectively improve the indexes of model rats compared with the model group, the difference with statistical significance (P<0.05). Conclusion The thin recipe of Buyanghuanwu has protective effect on cerebral ischemia, and the medium dose is the optimal dose.