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OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions for each diagnosis was basically the same as before； the defined daily dose system （DDDs） and proportion of a few antimicrobial drugs changed compared with before according to the anatomical therapeutic chemical classification of drugs， among which DDDs of lincomycin， gentamicin and other drugs declined significantly； DDDs of antimicrobial drugs for each classification was basically the same as before according to AWaRe classification. CONCLUSIONS The management mode of the use of antimicrobial drugs led by anti-infective clinical pharmacists is constructed in the prescription pre-reviewing center of county-level medical communities， which can effectively improve the rational use of antimicrobial drugs in the primary township medical institutions.
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This review summarizes the basic situation and characteristics of nuclear technology utilization and radiation safety supervision in Sichuan Province, analyzed the main problems of radiation safety supervision, put forward the corresponding countermeasures and suggestions, and provided reference for improving the radiation safety supervision ability of the whole province.
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OBJECTIVE:To evaluate the economics of penehyclidine hydrochloride and atropine in the treatment of acute organophosphorus poisoning (AOPP).METHODS:The information of 118 AOPP patients were collected and divided into group A (59 cases) and B (59 cases) according to therapy plan.There were 22 cases of mild poisoning,20 cases of moderate poisoning and 17 cases of severe poisoning in group A.There were 21 mild cases,21 moderate cases and 17 severe cases in group B.Based on routine treatment,group A was given Penehyclidine hydrochloride injection intramuscularly with initial dose of 1 mg (mild),2 mg (moderate) and 4 mg (severe).Group B was given Atropine sulfate injection intravenously,with initial dose of 2 mg (mild),5 mg (moderate) and 10 mg (severe).Both received maintenance treatment according to patients condition and stopped taking medicine after symptoms disappeared.Clinical efficacies,the time of acetylcholinesterase recovery and ADR were observed in 2 groups.The economics of therapy plans for mild,moderate and severe poisoning were evaluated in 2 groups by cost-effectiveness analysis.RESULTS:There was no statistical significance in total response rate of mild poisoning or the time of acetylcholinesterase recovery between 2 groups (P＞0.05).Total effective rates of moderate and severe poisoning in group A were significantly higher than group B,and the time of acetylcholinesterase recovery was significantly shorter than group B,with statistical significance (P＜0.05).There was no statistical significance in the incidence of ADR in mild,moderate and severe poisoning patients (P＞0.05).Cost-effectiveness ratio of penehyclidine hydrochloride was similar to that of atropine in mild poisoning patients;that of penehyclidine hydrochloride were significantly lower than that of atropine in moderate and severe patients.It was inline with the results of sensitivity analysis.CONCLUSIONS:Based on routine treatment,penehyclidine hydrochloride is similar to atropine in therapeutic efficacy of AOPP and the time of acetylcholinesterase recovery.For moderate and severe AOPP patients,penehyclidine hydrochloride is significantly better than atropine in improving therapeutic efficacy and the time of acetylcholinesterase recovery.The safety of 2 drugs are satisfactory;penehyclidine hydrochloride possesses cost-effectiveness advantage.
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Objective To explore the clinical manifestations,diagnosis,misdiagnosis and treatment of primary hyperparathyroidism.Methods The clinical data of 36 patients with primary hyperparathyroidism admitted into the First Affiliated Hospital of Chongqing Medical University from January 2009 to October 2014 were reviewed and analyzed retrospectively.Results The manifestations of primary hyperparathyroidism were various and atypical.Primary hyperparathyroidism was often misdiagnosed as other diseases by 25.0％ (9/36).Among the patients,the ratio of male to female was 1:1,and median age was 58 years old.Of all patients,there were 9 persons with joint pain,digestive system symptoms in 7 cases,cervical mass discovered in 6 cases(3 cases were found when B ultrasonic examination),urinary calculus in 5 cases,fatigue symptoms in 4 cases,osteoporosis and urinary calculus in 2 cases,1 case with fracture,2 cases without any symptoms.Their calcium and parathyroid hormone level were increased by various degree.The accuracy rates of level diagnosis of Color Doppler ultrasound combine with CT or 99Tcm-MIBI were improved obviously,85.2％ and 93.1％ respectively.Twenty-eight patients received surgical treatment and pathology examination confirmed the accurate pathological types after surgery.There were 23 cases of parathyroid adenoma,1 case parathyroid hyperplasia,1 case parathyroid carcinoma,2 cases of parathyroid adenoma with nodular goiter,parathyroid adenoma merged thyroid carcinoma in 1 case.Serum calcium and parathyroid hormone level declined obviously after operation.The other 8 patients received non-surgical treatment,7 cases were alleviated and 1 case died due to irreformable high blood calcium crisis.Conclusion There should be pay attention to recognize primary hyperparathyroidism,check the blood calcium,and about suspected cases should be performed as early as parathyroid tested,neck color Doppler ultrasound.Early surgical treatment can significantly improve the prognosis and quality of life.
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Objective To analyze the clinical and CT characteristics of pancreatic metastasis to improve the correct diagnosis rate.Methods The clinical and CT data of 14 patients with pancreatic metastasis were reviewed retrospectively.Results Among the 14 patients,the primary malignancy was lung cancer in 6 cases,renal carcinoma in 3 cases,colon carcinoma in 2 cases,laryngeal cancer in 1 case,gastric cancer in 1 case and ovarian carcinoma in 1 case.Pancreatic metastases from renal carcinomas often developed a long period after initial nephrectomy and survived for a relatively long time.Abdominal CT plain scan and enhanced scan was performed in all cases.Four cases were of solitary type,9 cases were of multiple types and 1 was of diffuse type.Totally 28 lesions were found,which were usually located in the neck and body of the pancreas,the diameter of 28 pancreatic lesions was ranging from 0.5 cm to 11 cm,with a mean diameter of 2.3 cm.On CT plain scan,there were 19 hypodense lesions,7 slightly hyperdense lesions and 2 isodense lesions,5 necrotic lesions.On enhanced CT,the lesions showed moderate enhancement in 7 cases,circular enhancement in 6 cases,moderate and circular enhancement in 6 lesions,obvious enhancement in 8 lesions and no enhancement in 1 lesion.All patients had extra-pancreatic metastases,and 2 cases had peripheral vascular invasion.Conclusions Pancreatic metastases are rare,often accompanied with multiple lesions and extra-pancreatic metastases.The CT features of pancreatic metastases from renal carcinomas are slightly hyperdense and obvious enhancement; in other metastases,there are hypodense,morderate and/or circular enhancement lesions.Accurate diagnosis can be achieved by knowledge of patients' medical history.
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Purpose: To study the clinical application of intensity modulation radiation therapy (IMRT) in patients with prostate cancer. Methods: From May 2000 to June 2001, 14 patients with prostate carcinoma were treated . 12 patients underwent orchiectomy before IMRT. All patients were treated by IMRT with PEACOCK-MIMiC system ( CORVUS 3. 0 NOMOS CORPORATION) and VARIAN 6MV-photons. The prescription dose-time- fraction was 2.5 to 3. 0 Gy per fraction, 5 times per week , the total was 25 to 30 fractions, the total IMRT dose was 72 to 77 Gy, 5 to 6 weeks. Results: 3 months after IMRT , PR: 10(71.4%), NC: 4 cases and 6 month after IMRT CR: 6,PR: 8 cases. The overall response( CR + PR) rate were 100% . No Grade Ⅲ ,Ⅳ gastrointestinal ( GI) and genitourinary ( GU) toxicity occurred in any of the patients. Conclusions: IMRT is an effective approach for patients with prostate carcinoma. The dose of 72 to 77 Gy was safe.
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From March 1980 to December 1987, 650 patients with non-small cell lung cancers were treated by radiotherapy alone, chemotherapy alone, operation alone, Chinese medicine therapy alone, radiotherapy combined with chemotherapy, operation with radiotherapy operation with chemotherapy. The survival rates of the patients who received operation were obviously higher than radiotherapy alone, chemotherapy alone and Chinese medicine therapy alone groups. No relationship was found between the survival rates and pathological classification, but there was a close relationship between the survival rates and stages.