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OBJECTIVE：To investigate the effects of pharmaceutical management intervention on the use of TCM injection in primary medical institutions. METHODS ：Twenty grass-roots health centers in Yichun city ，Jiangxi province were randomly selected. Relying on Department of Pharmacy and Health Services of the Municipal Health Committee and the Quality Control Center for Pharmacy Affairs of the City ，Yichun People ’s Hospital took the lead in establishing the prescription evaluation criteria for TCM injection ，training pharmaceutical service skills ，conducting special reviews on prescriptions/medical orders ，improving control measures ，obtaining relevant data of drug use in primary health centers by issuing questionnaires on the use of TCM injection and randomly selecting prescriptions/medical orders for comments. The relevant data without drug administration （before intervention）from Jan. to Jun. 2018 were taken as the non-intervention group ，and the relevant data with drug administration （after intervention）from Jan. to Jun. 2019 were taken as the intervention group. The use of TCM medicine injection ，DDDs，DDC and sequencing ratio were compared before and after intervention. At the same time ，the prescriptions/medical orders of TCM injections before（1 222 copies）and after （1005 copies）intervention were randomly selected for comment and the reasonable situations of the prescriptions/medical orders were compared before and after the intervention. RESULTS ：After intervention ，total amount ， consumption sum and DDDs of top 10 TCM injections in the list of amount were significantly decreased. The reasonable rate of prescriptions and medical orders was 48.04％ before intervention ， but increased to 70.65％ after intervention. Besides ， unreasonable situations before and after intervention all manifested as inappropriate indications. After the intervention ，the unreasonable rates of Xuesaitong powder for injection （lyophilized），Xueshuantong injection ，Xingnaojing injection （two specifications），Shengmai injection ，Xueshuantong for injection （lyophilized）and Qingkailing injection were significantly lower than before intevention （P＜0.05）. CONCLUSIONS ：Pharmaceutical administration intervention can reduce the total amount and the consumption sun of TCM injection in primary medical institutions ，and promote rational drug use in the clinic.
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Drug combination is a common clinical phenomenon. However, the scientific implementation of drug combination is li-mited by the weak rational evaluation that reflects its clinical characteristics. In order to break through the limitations of existing evaluation tools, examining drug-to-drug and drug-to-target action characteristics is proposed from the physical, chemical and biological perspectives, combining clinical multicenter case resources, domestic and international drug interaction public facilities with the aim of discovering the common rules of drug combination. Machine learning technology is employed to build a system for evaluating and predicting the rationality of clinical drug combinations based on "drug characteristics-repository information-artificial intelligence" strategy, which will be debugged and validated in multi-center clinical practice, with a view to providing new ideas and technical references for the safety and efficacy of clinical drug use.
Subject(s)
Artificial Intelligence , Drug Combinations , Machine Learning , TechnologyABSTRACT
OBJECTIVE： To evaluate the influential factors for drug-induced liver injury （DILI） caused by routine lung cancer chemotherapy plan and the rationality of hepatoprotective drugs. METHODS： The information of lung cancer patients receiving routine chemotherapy in our hospital from Feb. 1st， 2018 to Jan. 31st， 2019 were selected. The occurrence of DILI induced by different routine chemotherapy plans， the correlation of each influential factor with DILI and the rationality of hepatoprotective drugs were analyzed retrospectively. RESULTS： A total of 325 patients were involved in this study， among which 126 patients （38.77％） suffered from DILI， involving 109 first-level cases （33.54％） and 17 second-level cases （5.23％）. Routine chemotherapy plan included etoposide+cisplatin， gemcitabine+cisplatin， docetaxel+platinum， pemetrexed disodium+platinum. The clinical classification of DILI included hepatocyte injury type 44 cases （14.52％）， cholestasis type 38 cases （12.54％） and mixed type 37 cases （12.21％）. Totally 174 patients （53.54％） received hepatoprotective drugs during chemo-therapy， among whom 49 patients （28.16％） suffered from first-level DILI and 6 patients （3.45％） second-level DILI， with total incidence of 31.61％. Among patients without hepatoprotective drugs， 60 patients （39.74％） suffered from first-level DILI， and 11 patients （7.28％） suffered from second-level DILI， with total incidence of 47.02％. The incidence of DILI in patients without hepatoprotective drugs was significantly higher than those with hepatoprotective drugs （P＜0.05）. Among patients with hepatoprotective drugs， 23 patients （13.22％） used hepatoprotective drugs unreasonably， including 5 patients （2.87％） received 3 kinds or more hepatoprotective drugs； 3 patients （1.72％） received drugs with same mechanism repeatedly； 11 patients （6.32％） received 3 kinds or more drugs and drug with same mechanism repeatedly； 4 patients （2.30％） used drugs contrary to contraindication. Influential factor correlation analysis showed that there was a positive correlation between DILI and the dosage of chemotherapeutic drugs， treatment course and KPS before chemotherapy （P＜0.05）. CONCLUSIONS： KPS before chemotherapy， dosage of chemotherapeutic agents and treatment course are the main factors of DILI. There is still unreasonable use of drugs such as repeated use， unreasonable drug combination， violation of drug contraindications. The use of hepatoprotective drugs during chemotherapy can reduce the risk of DILI occurrence. Clinicians should be more aware of the methods and indications of hepatoprotective drugs in order to improve the effectiveness and safety of drug use.
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OBJECTIVE： To provide scientific evidence for establishing perfect rationality evaluation indicator system of antibiotics. METHODS： On the basis of literature research， Delphi method was used to conduct several rounds of consultations on 30 experts in related fields with E-mail and questionnaire field investigation. After several rounds of consultations， rationality evaluation index system for antibiotics was determined. The effective recovery rate of expert consultation questionnaire was used to express the positive coefficient of experts； the authoritative coefficient was used to express the authoritative degree of experts； the index importance assignment and the full score ratio were used to reflect the concentration degree of experts’ opinions； the coefficient of variation and the coefficient of coordination were used to express the coordination degree of experts’ opinions. RESULTS & CONCLUSIONS： After two rounds of consultations， response rates of the questionnaire in two rounds of surveys were 100％ and 96.67％， indicating experts were highly motivated. The authoritative coefficients were 0.91 and 0.88， indicating experts had a high degree of authority. Finally， an evaluation index system for rationality of antibiotics was established， which included four first-level indicators （indications， drug selection， medication process， management indicators） and 35 second-level indicators. Among them， the mean value of importance scoring of first-level indicators ranged from 4.28 to 5.00， the full score ratio from 0.93 to 1.00， the coefficient of variation from 0.00 to 0.15 and the coefficient of coordination was 0.446 （P＜0.001）. While， the mean value of importance scoring of second-level indicators ranged from 3.83 to 4.79； the full score ratio from 0.67 to 1.00； variation coefficient from 0.10 to 0.26 and the coefficient of coordination was 0.115 （P＜0.001）， which indicating the system was reliable.
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OBJECTIVE:To understand the rationality of proton pump inhibitors (PPI) in our hospital during perioperative period,in order to provide reference for rational use of drugs in clinical practice. METHODS:Through randomly collecting discharge cases of surgical system of May and Dec. in 2015 from Hospital Information System,the use of PPI during perioperative period was investigated retrospectively,and the rationality of drug use was evaluated. RESULTS:Among 522 cases,418 cases were given PPI for preventing stress ulcer during perioperative period,with utilization rate of 80.1%. Among them,the top three were neurosurgery,orthopedics and general surgery (100%,92.6% and 92.3% respectively). Pantoprazole and lansoprazole (72.5%,14.8%,respectively) were the top two categories of the use of PPI. The irrational utilization rate of PPI was 70.8%during perioperative period. In the top three,the number of drugs was exceeded,the drug was not used,course of treatment was too long (73.7%,64.1% and 62.4% respectively). CONCLUSIONS:The utilization rate of PPI prevention is higher in the department in our hospital during perioperative period,and there is unreasonable situation in some preventive drugs,and the measures need to be implemented and strengthened.
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OBJECTIVE:To provide reference for improving the rationality of perioperative prophylactic application of antibiotics in typeⅠincision operation of neurosurgery. METHODS:Medical records of 794 patients with typeⅠincision operation of neurosurgery were collected from our hospital during Jan.-Dec. 2016 in order to retrospectively investigate the perioperative prophylactic application of antibiotics and evaluate the rationality of drug use. RESULTS:Among all the 794 cases,433 used antibiotics for prophylaxis (single type was used in all cases),with utilization rate of 54.53％. Cefazolin(51.73％)and cefuroxime(21.48％)were the most frequently used antibiotics. The prophylactic application rate of 30 min-1 h before surgery was 85.45％ in 433 patients. Patients with prophylactic medication course≤24 h accounted for 68.36％. The main irrational drug use manifestations were long medication time(31.64％)and improper antibiotics selection(26.10％);other manifestations included improper medication timing(14.55％),etc. CONCLUSIONS:Unreasonable perioperative prophylactic application of antibiotics in typeⅠincision operation of neurosurgery exists in our hospital,such as improper drug selection,improper medication timing,long medication course. It is necessary to further strengthen the comprehensive interventions,so as to promote the rational use of antibiotics.
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OBJECTIVE:To provide reference for further improving the rationality of perioperative prophylactic use of antibiotics in laparoscopy surgery. METHODS:Electronic medical records and medical orders of 5 288 inpatients underwent laparoscopy surgery were collected from our hospital during Jan. 1st-Dec. 31st,2016 by using related information system software. The perioperative prophylactic use of antibiotics was investigated retrospectively. Rationality of medical orders was evaluated. RESULTS:Among 5 288 patients underwent laparoscopy surgery,1 890 patients used antibiotics for infection prevention during perioperative period. The rate of prophylactic use of antibiotics was 35.7%. The rate of prophylactic use of antibiotics in stomach,duodenum and small intestine operation was the highest(69.4%);the rate of prophylactic use of antibiotics in hepatobiliary and pancreatic surgery also reached 68.0%;prophylactic use of antibiotics was not found in the surgery of abdominal external hemia. The majority of 1 890 patients who had used antibiotics prophylactically during perioperative period used antibiotics alone(83.4%). Top 3 drugs in the list of use frequency were cefuroxime sodium(63.9%),metronidazole(13.5%)and cefotaxime sodium(11.85). There were irrational medical orders in 151 cases(8.0%)of perioperative prophylactic use of antibiotics;among prescriptions of irrational drug use,the majority was unsuitable drug selection(50.3%),followed by unsuitable drug selection among nonstandard medical orders. CONCLUSIONS:The overall situation of perioperative prophylactic use of antibiotics is basically satisfactory in laparoscopic surgery of our hospital. The rate of prophylactic use of antibiotics is relatively high in type Ⅰ incision surgery,and irrational drug use is found in some medical orders of prophylactic drug use. It is necessary to formulate regulations for prophylactic use of antibiotics in accordance with the actual situation of the hospital,strengthen medical order evaluation for perioperative prophylactic use of antibiotics in laparoscopy surgery,relevant rational drug use education.