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OBJECTIVE：To explore the key factors affecting the sustainable development of pharmacy intravenous admixture service（PIVAS），and to provide theoretical basis for the healthy development of PIVAS. METHODS ：Retrieved from PubMed ， CNKI，Wanfang database and VIP ，literatures related to the development of PIVAS. Combining with the actual operation and development of PIVAS in China in recent 20 years，based on actual experience of PIVAS in our hospital in recent 10 years，the key factors affecting the sustainable development of PIVAS were analyzed by retrospective method from five aspects ，i.e. drug management，quality control ，pharmacists’professional quality improvement ，pharmaceutical care extension ，cost and benefit. RESULTS & CONCLUSIONS ：The key elements of PIVAS drug management included drug inventory ，expiration date ，daily inventory，high-warning drug ，drug damage ，slack demand of drug and drug shortage. The key elements of PIVAS quality control included personnel quality control ，environment quality control and quality control of finished infusion. Improving the professional ability and communication service ability of pharmacists were the key factors to improve the professional quality of pharmacists. The establishment and application of medication order review and accurate flushing database based on PIVAS prescription audit system，professional drug consultation and clinical education ，whole pharmaceutical care of cytotoxic drugs and PIVAS adverse drug reaction monitoring were the key elements of pharmaceutical service extension. It can promote the sustainable and healthy development of PIVAS to improve pharmacists ’professional ability and communication ability ，strictly drug management and quality control ，continously extend pharmaceutical care ，improve professional influence and expand social influence and formulate reasonable charging mechanism.
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OBJECTIVE:To improve the automation and information level of Pharmacy intravenous admixture service (PIV-AS),and provide reference for the PIVAS development. METHODS:Related functions of DS8000 intelligent sorting system and its effect of PIVAS were introduced;work environment,workflow,work efficiency,labor intensity and sorting error before and af-ter the system application were compared. RESULTS:The application of intelligent sorting system achieved the automation of multi-ple links including reviewing,sorting,automatically counting,automatically generating hand-over lists of departments,statistical inquiring for related information in finished soft bag infusion sorting. Compared with manual sorting,it only covered less area, working environment was neat and orderly,workflow links was reduced (6 vs. 10),work time was shortened (average time for sorting per bag of infusion 13.53 s vs. 3.11 s),labor intensity was decreased,and work error rate was reduced (0.128‰ vs. 0.013‰);meanwhile,it improved the management for shading drugs,and achieved data analysis of PIVAS and management infor-mation. CONCLUSIONS:The application of DS8000 intelligent sorting system has improved the automation and information of PI-VAS,and promoted the construction and development of PIVAS.
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The apical sodium--dependent bile acid transporter (ASBT) is the main transporter to promote re-absorption of bile acids from the intestinal tract into the enterohepatic circulation. Inhibition of ASBT could increase the excretion of bile acids, thus increasing bile acid synthesis and consequently cholesterol consumption. Therefore, ASBT is an attractive target for developing new cholesterol-lowering drugs. In this report, a series of 1-(2,4-bifluorophenyl)-7-dialkylamino-1,8-naphthyridine-3-carboxamides were designed as inhibitors of ASBT. Most of them demonstrated potency against ASBT transport of bile acids. In particular, compoundwas found to have the best activity, resulting in 80.1% inhibition of ASBT at 10 μmol/L.
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OBJECTIVE:To effectively control the quality of intravenous infusion product of antitumor drugs in PIVAS,and to guarantee the safety of clinical drug use. METHODS:According to the operation flow of intravenous infusion product,the quality control of anti-tumor drugs was conducted in PIVAS of our hospital from three aspects,i.e. before,during and after admixture. The improvement effect was compared before and after the implementation. RESULTS:Pre-admixture management was carried out through special classification management and medical order check management for antitumor drug;intra-admixture management was carried out through the management of admixture environment,solvent selection,admixture method,order for adding drug, dosage;post-admixture management was carried out through standard examination of infusion product and the management of deliv-ery time and condition. 5 months later,the times of communication between PIVAS and clinical departments was decreased from 30 times to 10 times,and the incidence of infusion product was decreased from 0.68% to 0.18%. CONCLUSIONS:Standard man-agement has been conducted for operation procedure of anti-tumor drugs before,during and after admixture. The quality of intrave-nous infusion product of antitumor drugs can be effectively controlled to ensure the safety of clinical drug use.
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Objective To determine the optimum dose of dexmedetomidine administered locally through evaluating the effects of different doses of dexmedetomidine on the median effective concentration (EC50) of ropivacaine for brachial plexus block.Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 19-50 yr, weighing 50-80 kg, scheduled for elective ulna and radius fracture open reduction and internal fixation, requiring ultrasound-guided axillary brachial plexus block, were randomly assigned into 4 groups using a random number table: control group (group C) and dexmedetomidine 0.4, 0.6 and 0.8 μg/kg groups (D1 , D2 and D3 groups).Axillary brachial plexus block was performed only with ropivacaine in group C.In D1-3 groups, axillary brachial plexus block was performed with the mixture of ropivacaine and dexmedetomidine 0.4, 0.6 and 0.8 μg/kg, respectively.The effective block was defined as complete loss of pain sensation in the areas innervated by the brachial plexus.The volume of local anesthetics was 40 ml.The concentration of ropivacaine was determined by up-and-down technique.The initial concentration was 0.4％ and the ratio between the two successive concentrations was 1.0.If the block was effective, the next patient received a lower dose of ropivacaine;or conversely if ineffective, a higher dose was given in the next patient.At least 7 independent crossover pairs were observed in each group.The EC50 of ropivacaine was the mean of the concentration of ropivacaine of each crossover pair.The occurrence of brachial plexus block-related adverse events, adverse cardiovascular events and over-sedation was recorded.Results In C, D1, D2 and D3 groups, 20, 22, 24 and 19 patientswere enrolled, respectively.Compared with group C, the EC50 of ropivacaine was significantly decreased in D2 and D3 groups, and no significant change in the EC50 of ropivacaine was found in group D1.No patients developed adverse events in group D1.The incidence of bradycardia was 17％, but it was transient in group D2.In group D3, the incidence of bradycardia and hypotension was 58％ and 32％, respectively, and they required special treatment, and the incidence of over-sedation was 10％.Conclusion The optimum dose of dexmedetomidine is 0.6 μg/kg when mixed with ropivacaine for brachial plexus block.
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Objective To investigate the effects of different doses of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane required to inhibit the body movement evoked by skin incision.Methods ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 21-27 kg/m2,undegoing elective lower abdominal surgery under general anesthesia,were randomly divided into 4 groups:control group (group C) and different doses of dexmedetomidine groups (groups D1,D2 and D3 ).Dexmedetomidine 0.2,0.4 and 0.6 μg/kg in 15 ml of normal saline was infused over 30 min before induction of anesthesia in groups D1,D2 and D3 respectively.While 15 ml of normal saline was given instead in group C.Anesthesia was induced with inhalation of 8％ sevoflurane.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with inhalation of sevoflurane.The initial end-tidal concentration of sevoflurane was set at 3.0％,3.0％,2.5％,2.0％ in groups C,D1,D2 and D3 respectively.The ratio between the two successive concentrations was 0.9.Skin incision was made after 15 min of equilibratiton.At least 7 independent crossover pairs were observed in each group.The MAC of sevoflurane was the mean of the end-tidal concentration of sevoflurane of each crossover pair,and 95 ％ confidence interval (CI) was calculated.Results In groups C,D1,D2 and D3,18,20,20 and 22 patients were enrolled respectively.The MAC (95 ％ CI) of sevoflurane was 2.5 ％ (2.3 ％-2.8 ％ ),1.5 ％ ( 1.3 ％-1.7％),1.3％ (1.0％-1.6％) and 1.1％ (0.7％-1.5％) in groupsC,D1,D2 and D3 respectively.The MAC of sevoflurane was significantly lower in groups D1,D2,D3 than in group C,and in groups D2 and D3 than in group D1 ( P ＜ 0.05).There was no significant difference in the MAC of sevoflurane between groups D2 and D3 ( P ＞0.05).Conclusion Dexmedetomidine 0.2,0.4,0.6 μg/kg can significantly decrease the MAC of sevoflurane required to inhibit the body movement evoked by skin incision in a dose-dependent manner.
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OBJECTIVE: To provide references for clinical rational and safe use of immunosuppressant agents. METHODS: The data regarding the consumption quantity and consumption sum of the immunosuppressant agents were retrieved from "China medical economy information network" ( "menet" ), which were analyzed and compared with the pertinent literature both at home and abroad. RESULTS & CONCLUSIONS: From 2004 to 2006, dominating the first 3 places in respect of consumption quantity and consumption sum were mycophenolate mofetil, ciclosporin, and tarcolimus. And tacrolimus is expected to become the choice drug for organ transplantation.