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Model informed precision dosing for warfarin is to provide individualized dosing by integrating information related to patient characteristics, disease status and pharmacokinetics /pharmacodynamics of warfarin, through mathematical modeling and simulation techniques based on the quantitative pharmacology. Compared with empirical dosing, it can improve the safety, effectiveness, economy, and adherence of pharmacotherapy of warfarin. This consensus report describes the commonly used modeling and simulation techniques for warfarin, their application in developing and adjusting dosing regimens, medication adherence and economy. Moreover, this consensus also elaborates the detailed procedures for the implementation in the warfarin pharmacy service pathway to facilitate the development and application of model informed precision dosing for warfarin.
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Under the policy background of zero addition of drugs and consumables in public hospitals, with clinical practice as the guide and information platform as the means, the hospital constructed an intelligent management system for hospitals′ drugs and consumables through the Internet of things. The hospital adopted the intelligent medicine cabinet extended ward management, consumables " one material, one code" two-level warehouse management mode, reengineering the material supply process.Finally, it can realize the whole process traceability of information, unify the flow of goods and data, save human resources, improve the efficiency of operation and management, and achieve the purpose of ensuring safety, reducing costs and increasing benefits.
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Objective To explore the interaction between warfarin and antiepileptic drugs such as carbamazepine and oxcarbazepine.Methods A 78-year-old woman suffered from warfarin resistance after initial warfarin dosing for several days.Based on her medication review,clinical pharmacist found that the warfarin resistance resulted from co-administered carbamazepine.Her warfarin dosage was increased,and the international normalized ratio (INR) increased to the target range.Another woman had been taking warfarin therapy for long time with a stable maintenance dose.She consulted clinical pharmacist for the influence of co-administered oxcarbazepine on warfarin.The patient was advised to maintain the dose and monitor her INR more closely.Her INR did not fluctuate.Results Carbamazepine induced warfarin metabolism.As a result,the patient needed increased dosage of warfarin to maintain the INR in the therapeutic target range.Oxcarbazepine does not induce liver enzymes,and therefore the INR did not fluctuate.Conclusion Carbamazepine may reduce the efficacy of warfarin.Oxcarbazepine offers a clinical advantage over carbamazepine,especially when co-administration of warfarin is required.
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OBJECTIVE:To improve the drug storehouse management model,and provide reference for hospital management reform. METHODS:Management operation of external drug storehouse management model in our hospital in 3 months was intro-duced from aspects of number of personnel,delivery timeliness as well as accuracy rate of entering and going-out storage,etc. Ef-fective and feasible solutions for developing external drug storehouse management and guaranteeing clinical drug supply were sum-marized. RESULTS:Through ensuring drug category,management level of external drug storehouse,job responsibility of related staff in hospital and pharmaceutical business companies,information platform and distribution management,external drug store-house work in our hospital was basically completed. Compared with before,it had effectively reduced the investment of human and material resources,management staff was decreased from 4 persons to 3 persons;and purchased drugs could be completely deliv-ered within the specified time. CONCLUSIONS:Under the circumstances of hospital management facing constant reform,the man-agement model of external drug storehouse can be considered to reduce management cost of hospital and expand the scale of company.
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OBJECTIVE:To change the drug management mode in wards,promote drug use for patients timely and rationally. METHODS:Automated dispensing cabinet(ADC)was used to manage the drugs in some wards in our hospital,and introduce its use practice from aspects of drug management mode,pharmacists'management to ADC,related measures when using ADC manag-ing ward drugs,effect evaluation after using ADC(using species of base drugs,average time of dispensing temporary medical or-ders,drug returning times in 5 wards before and after using ADC as indexes),etc. RESULTS:Drug management method was es-tablished in ADC by screening drugs into the cabinet and developing process of taking drugs out. And pharmacists had achieved drug management in wards by establishing drug lists,conducting replenishment and inventory management,developing emergency plan,enhancing supervision and inspection,etc. Compared with before using ADC,average species of base drugs in the 5 wards increased from 65.8 to 157.2;average time of dispensing temporary medical orders dropped from 24.5 min to 5.8 min;and average drug returning times in 3 months decreased from about 200 times to about 20 times(P<0.05 or P<0.01). CONCLUSIONS:Us-ing ADC in wards for drug management has not only improved use convenience of drugs in wards,working efficiency of nurses as well as pharmaceutical care quality of pharmacists,but also has changed drug management mode and promoted rational drug use of patients.
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Objective To summarize the clinical application of parenteral nutrition (PN) in Fuwai Hospital. Methods The clinical applications of PN in 132 critically ill patients undergoing cardiac surgery in our hospital were retrospectively investigated and analyzed. Results The application of PN in Fuwai hospital was basically appropriate and standardized. Energy supply in PN formulation was reasonably low, but still met the energy needs of patients in the fasting period. The nutritional composition and energy/nitrogen ratio in the formulation were basically rational. However, problems including the lack of double energy in partial formulation, low proportion of glucose-supplied energy due to low glucose-lipid ratio, and insufficient supply of insulin still existed. One (0.76%)patient was discharged according to his own decision; 22 ( 16.67% ) patients died, which were not directly associated with PN; and the other 109 (82.58%) patients were cured and discharged. Conclusion Application of PN for critically ill patients undergoing cardiac surgery must strictly follow the operation indications and rationally select nutritional components and proportions to ensure its safety and effectiveness.
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Objective:To discuss the regularity of adverse drug reactions induced by statin.Method:82 cases from published articles were retrieved from 1998 to 2008.According to the given standard,the data were statistically analyzed. Result:77 articles carried 82 case reports concerning statins inducing ADRs in the period of 10 years.52 cases were caused by simvastatin.ADRs of statins could involve multiple organs and systems,mainly myopathys.Severe reaction could result in renal failure and even death.Conclusion:A rational use of statins should be strengthened in the clinical practice and strict monitoring in order to prevent and reduce the occurrence of serious adverse drug reactions.
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OBJECTIVE: To establish bacterial endotoxin test for cardioplegic solution (compound jiagaimei solution).METHODS: Semi-quantitative analysis stated in volume Ⅱ of Chinese Pharmacopoiea (2005 edition) was used to detect 3 batches of compound jiagaimei solution with tachypleus amebocyte lysate (TAL).RESULTS: The interference factors of bacterial endotoxin test could be overcome through 6-fold dilution of cardioplegic solution.The content of bacterial endotoxin in 3 batches of samples were 0.36,0.36 and 0.255 EU?mL-1,respectively.They were all lower than the limitation of bacteria endotoxin of 1.5 EU?mL-1.CONCLUSION: It is feasible to detect bacterial endotoxin of compound jiagaimei solution using semi-quantitative analysis.
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Objective:To analyze infection-related factors for Coronary artery bypass grafting(CABG).Method: The cases undergoing operations with CABG from January to June in 2006 were 614.The records of the two sets of statistical indicators were kept and the data were analyzed to find the infection-related factors.Result:There were three factors related to infection:the measure of anaesthesia,the time of hospitalization before surgical operations and the duration of prophylac- tic antibiotics treatment.Diabetes mellitus was not a risk factor in our study.Conclusion:In view of patients'health condi- tion,prophylactic antibiotics can be used to prevent infection in surgical operations.Shortening the time of hospitalization before surgical operations and adopting off-pump coronary artery bypass grafting can decrease the infection.CABG is as safe for diabetic patients as for non-diabetic patients.