ABSTRACT
Objective To explore the fluctuation characteristics of long-term doctor's order workload in pharmacy intravenous admixture services (PIVAS) and build a daily workload fluctuation prediction model and provide reference for the adjustment of PIVAS work mode. Methods Daily workload data of long-term doctor’s orders from PIVAS in the East Campus of Zhongshan Hospital affiliated to Fudan University from July 2020 to June 2021 were selected , and the time series analysis method was used to analyze the workload fluctuation characteristics and a prediction model was established. The accuracy of the model was verified by fitting parameters and prediction results. Results The fluctuation of PIVAS long-term doctor's daily workload data had the characteristics of periodicity, short-term slow rise and irregular variation. The Winters multiplier model was used to fit the series with R2 = 0.777, the significance value of Ljung-Box statistic value (P value) was 0.060, and the mean absolute error percentage between the fitted and actual values was 4.45%, indicating that the model fitting accuracy was high. The average relative deviation between the predicted and actual results was 3.81%, indicating that the model prediction was effective. Conclusion The model constructed in this study could be used for the analysis and prediction of long-term doctor's orders workload of PIVAS. However, because the workload of doctor's orders has fluctuations such as periodicity and irregular changes, it is necessary to adjust the working model according to the fluctuation characteristics of the workload and the prediction results to ensure the efficient operation of PIVAS.
ABSTRACT
Objective:To investigate the current situation and needs of pharmaceutical training for general practice faculty.Methods:A self-designed questionnaire survey was conducted in April 2019. The participants were general practice faculty attending the national training course in Zhongshan Hospital and selected by convenience sampling method.Results:A total of 219 general practice teachers participated in the survey, 51.14% (112/219) of the participants thought that the current pharmaceutical knowledge did not meet the needs of pharmaceutical services in daily work, and 67.58% (148/219) attended pharmacy related training every year, and the frequency was mainly 1—2 times per year (56.62%, 124/219). The main reasons for attending the training were working needs (68.24%, 101/148) and willingness (55.41%, 82/148); 63.51% (94/148) of the participants thought that the training was moderate or less effective, mainly because of the weak strength of trainers (40.54%, 60/148), insufficient attention paid by trainers (37.16%, 55/148) and lack of depth (37.16%, 55/148). The survey showed that 76.26% (167/219) of general practice teachers had pharmaceutical training needs; and gender, working years and working experience in secondary and/or tertiary hospitals were influencing factors for pharmaceutical training needs. And female faculty, those working less than 10 years and with working experience in secondary hospitals had higher demand for pharmaceutical training. The expected pharmaceutical training focused primarily on the selection and optimization of medication schemes (72.60%, 159/219), interaction/incompatibility between medicines (62.10%, 136/219) and pharmaceutical care in medical treatment (57.08%, 125/219). The expected training methods were mainly interactive case analysis and discussion (69.41%, 152/219) through the internet or APP (such as WeChat) (54.34%, 119/219); the expected training frequency was no more than once in two months (36.07%, 79/219), better in working time (48.86%, 107/219) and each session was 30—45 minutes (38.36%, 84/219).Conclusion:General practice faculty has a high demand for pharmaceutical training. Targeted, individualized and systematic pharmaceutical training courses should be developed according to the pharmaceutical training needs of participants.
ABSTRACT
OBJECTIVE：To study clinical situation and influential factors for prognosis of drug-i nduced acute kidney injury （DIAKI）in Chinese population ，and to provide reference for early detection ，early intervention and prognosis improvement of DIAKI. METHODS ：Retrieved from PubMed ，Embase，Cochrane Library ，CNKI，Wanfang database and VIP ，clinical studies related to DIAKI were collected during the inception to Apr. 16th，2020. After the data extraction and quality evaluation of included studies，the results were analyzed descriptively ，and Meta-analysis was carried out by Rev Man 5.3 software. RESULTS ：A total of 29 studies were included ，including 1 870 patients. The results showed that DIAKI accounted for 32.2％（877/2 721）of the patients developed AKI in the same period. Antibacterial drugs were the main cause of DIAKI ，accounting for 47.5％（773/1 629）. The top five drugs by case number were classified as aminoglycoside antibiotics ，diuretics or dehydrating agents ，cephalosporin antibiotics，non-steroidal anti-inflammatory drugs and traditional Chinese medicine. The pathological type of DIAKI was mainly acute interstitial nephritis ，accounting for 51.9％（70/135）. The mortality of DIAKI patients was 14.4％（240/1 677）. A total of 70.4％（1 176/1 670）of patients had renal recovery. Compared with conservative treatment ，the mortality of patients receiving dialysis treatment was significantly lower [OR ＝0.30，95％CI（0.10，0.91），P＝0.003]. Compared with patients without anemia ， patients with anemia had a significantly delayed renal recovery [OR ＝0.25，95％CI（0.09，0.65），P＝0.004]. Lower levels of retinol binding protein was significantly related to rapid renal recovery [MD ＝－15.84，95％CI（－22.34，－9.34），P＜0.01]. CONCLUSIONS：Clinicians need to continuously strengthen antibiotic management and use drugs that induce AKI with caution. For patients with DIAKI ，receiving dialysis treatment as soon as possible may help reduce mortality. Timely correction of the basic anemia status of patients with DIAKI will help patients withrapid renal recovery ，and lower retinol binding protein levels may be a potential biomarker for predicting patients ’rapidrenal recovery.
ABSTRACT
Objective@#To investigate the influence of different discontinuation time of aspirin and clopidogrel before off-pump coronary artery bypass grafting (OPCABG) on postoperative bleeding and blood products transfusion requirement.@*Methods@#Three hundred and fifty-three coronary artery disease patients who underwent OPCABG from January 2017 to January 2018 at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University were retrospectively analysed. There were 268 males and 85 females, aged (66.0±9.1)years. All patients were divided into three groups: (1) guideline-recommended group: patients who discontinued clopidogrel for >5 days without discontinuing aspirin before surgery; (2) without discontinuing group: patients who discontinued clopidogrel for ≤5 days without discontinuing aspirin before surgery; (3) discontinuing group: patients who discontinued clopidogrel for >5 days with discontinuing aspirin before surgery. Postoperative bleeding recorded as chest tube drainage (CTD) volume and blood products transfusion requirement and perioperative complications were recorded. CTD volumes within 12 hours after surgery between groups were compared by Mann-Whitney U tests, CTD volumes after 12 hours postoperatively were compared by repeated measures analysis of variance and blood products transfusion and complications incidence were compared by χ2 test or Fisher′s precise test.@*Results@#The 12 hours CTD volumes of guideline-recommended group, without discontinuing group, discontinuing group after surgery were 280(153) ml (M(QR)), 291(229) ml, 225(161) ml, respectively. There were no significant differences in postoperative 12 hours CTD volumes (P=0.865), red blood cells transfusion incidence (χ2=2.626, P=0.149) and fresh frozen plasma (FFP) transfusion incidence (χ2=1.258, P=0.324) between guideline-recommended group and without discontinuing group. However, the 12 hours CTD volumes were significantly higher in guideline-recommended group patients compared with disconutinuing group patients (U=5 247, P=0.002). No significant differences were observed in red blood cells (χ2=0.182, P=0.757) and FFP (χ2=0.083, P=0.839) transfusion rate between these two groups. Repeated measures analysis of variance indicated that when patients began to take antiplatelet drugs (aspirin and clopidogrel) after 12 hours postoperatively, the change of CTD volumes beyond 12 hours after surgery didn′t differ either between guideline-recommended group and without discontinuing group (F=0.019, P=0.941) or between guideline-recommended group and discontinuing group (F=2.447,P=0.113). Besides, the incidence of perioperative arrhythmia was significantly higher in guideline-recommended group patients compared with without discontinuing group patients (4.8% vs. 0, χ2=5.073, P=0.038).@*Conclusions@#OPCABG patients who discontinued aspirin before surgery had lower postoperative 12 hours CTD volumes but similar blood products transfusion rate and CTD volumes beyond 12 hours postoperatively compared with patients adhering to the current guideline-recommended protocol. And for patients who discontinued clopidogrel for ≤5 days, postoperative CTD volumes and blood products transfusion requirement were similar but the incidence of perioperative arrhythmia was significantly lower compared with guideline-treated patients.
ABSTRACT
Objective To design individualized anti-infective therapy for a critically ill patient .Methods Based on patho-physiological conditions and therapeutic drug levels ,clinical pharmacists assisted physicians to optimize individual anti-infective medication regimens for a patient with acute generalized exanthematous pustulosis secondary to blood stream infection and pul-monary infection .Results The patient responded poorly to initial treatment .After the medication regimen adjustments byclini-cal pharmacists according to the individual situation and therapeutic drug monitoring results ,patient′s condition was improved and the infection was under control .Conclusion The key to successful treatment is to ensure the dosage administered to the critically ill patients reach the target value of pharmacokinetics and pharmacodynamics .
ABSTRACT
OBJECTIVE:To provide reference for reducing the occurrence of chemotherapy-induced constipation and optimizing constipation therapy.METHODS:Medical records of malignant lung tumor inpatients meeting inclusion criteria were collected from respiration department of our hospital,and then investigated and analyzed statistically in respects of patient's gender,age,constipation history,tumor types and phases,physical status score,living habit change,chemotherapy plan (including adjuvant drug),constipation occurrence,prevention and treatment,etc.The related factors of chemotherapy-induced constipation were investigated.RESULTS:A total of 135 patients were enrolled in the investigation.Of 135 patients,66 patients had constipation with incidence of 48.89％,among which 96.97％ were grade 1 and grade 2 constipation.The onset of constipation were independent from age,gender and living habit change (P＞0.05).The patients with history of constipation,advanced tumor stage,the period of treatment≥ 3 days,the use of palonosetron and combined with aprepitant had higher prevalence of constipation (P＜0.05).The clinical symptoms were improved spontaneously in 21.21％ patients,33.33％ after diet adjustment and 45.45％ by drug treatment as suppositories glycerol,lactulose;24.24％ patients used lactulose to prevent constipation at rehospitalization.CONCLUSIONS:Chemotherapy-induced constipation was commonly occurred and related to serval factors and had not got enough attention yet.The clinical pharmacists should assist the physicians to make individual chemotherapy regimen as well as the prevention of adverse drug reactions.
ABSTRACT
Objective To compare the contents and features of licensed pharmacist qualification examination papers between those in abroad and domestic in order to provide the informations for the reforming the examination in our country.Method The characteristics of licensed pharmacist qualification examination among USA、UK、Australia and China were analysed and compared with classified statistic by using excel software.Results The scene questions are the main type in the three examination papers(＞50％).There were fewer questions examining the memory ability of examinees in abroad examinations,than that of ours.There were one question just had objects of pharmaceutical care (0.18％) in our examination.In the inspection of pharmaceutical knowledge application ability for the practice test(＞60％),covering all aspects of pharmaceutical care; And Chinese licensed pharmacists exam basic no object and pharmaceutical care link information feedback(＞60％),and the others are theoretical knowledge(＞20％).And in the three abroad examinations other common questions were about clinical drug therapy (＞90％),while they were the knowledge of pharmaceutical analysis and pharmaceutics in domestic examination papers (41.97％).Conclusion Licensed pharmacist qualification examination in our country ignored the ability of employing pharmaceutical knowledge and developing pharmaceutical care.The reformation of the licensed pharmacist qualification examination in our country is extremely urgent.