Primarily Exploration of Medical Orders Evaluation Mode According to Disease Classification / 中国药房

OBJECTIVE： To investigate the effects of new mode of medical orders evaluation according to disease classification. METHODS： Totally 16 kinds of common diseases were selected from each department of our hospital. Each 10 electronic medical records of each disease were randomly selected from 160 patients in the hospital information system from Jan. 1 to Dec. 31， 2016. The rationality of 10 720 medical orders were evaluated retrospectively during hospitalization. Statistical analysis was made on the relevant indicators such as unsuitable usage and dosage， the proportion of auxiliary drugs and unsuitable indications in medical orders of irrational drug use， and a new mode of prescription comment was established according to the classification of diseases. 9 862 medical orders of same disease types were collected after the implementation （from Apr.-May， 2017） of new mode and intervene to evaluate the irrational rate of them so as to evaluate the effects of new mode. RESULTS： In the samples in 2016， a total of 751 medical orders of irrational drug use were evaluated， the most of them were unsuitable usage and dosage （414 items， 55.12％）， especially in the intracerebral hemorrhage diseases （69 items， 16.67％）； under this kind of disease， most of irrational drug use was excessive dosage of single dosing （31 items， 44.92％）. The top three disease types in the list of the ratio of adjuvant drug cost in total drug cost were surgery for renal tumors （39.43％）， acute cerebral infarction （non-surgery） （37.03％） and intervertebral disc herniation surgery （35.26％）. 70 medical orders of irrational drug use were unsuitable indications （9.32％）. After the application of evaluation mode according to classification of disease types and intervene， the irrational rate of medical orders decreased from 7.00％ （751/10 720） before evaluation to 2.95％ （291/9 862）after evaluation， decreasing by 57.86％. CONCLUSIONS： The application of evaluation mode according to classification of disease types can achieve good results in controlling the irrational rate of medical orders and contribute to rational drug use in clinic.

Influence of key monitoring drugs policy on the change of adjuvant drugs in sample area / 中国药学杂志

OBJECTIVE:To examine the influence of key monitoring drugs policy in Anhui province and Sichuan province on the change of adjuvant drugs for promoting its rational use and providing a basis for policy formulation. METHODS: Based on the key monitoring drug libraries formed in the monitoring catalogs of all the provinces, combining with the key monitoring drug catalogs in Anhui province and Sichuan province, this study selected the characteristics of drug-typicality and data availability through the selection of adjuvant drug selection criteria. Eight drugs of Anhui province and 10 drug of Sichuan province were selected as research objects. The study extracted monthly data from 3 hospitals in Anhui province from November 2014 to September 2017 and quarterly data from 9 hospitals in Chengdu, Sichuan province in the first quarter of 2014 to the first quarter of 2017. Interrupted Time Series (ITS) model was used to analyze the changes of dosage and amount of sample drugs and reference drugs. RESULTS: ①After the implementation of the key monitoring drugs policy in Anhui province in November 2015, the usage trend of adjuvant drugs changed from rising to declining, with a significant decrease in the dosage (β3=-0.035, P0.1) and the amount of money (β3=-0.001, P>0.1). ③After the implementation of the key monitoring drugs policy in the first quarter of 2016 in Sichuan Province, the declining trend of the use of adjuvant drugs was widened with a decrease of the dosage (β3=-0.045, P<0.001) and the amount (β3=-0.037,P<0.001). CONCLUSION: The implementation of key monitoring drugs policy in Anhui province and Sichuan province can effectively control the use of most adjuvant drugs, with a significantly decrease of the dosage and amount.

Effect of Early Adjuvant Chemotherapy on Survival of Advanced Gastric Cancer Patients: a Propensity Score-matched Analysis

PURPOSE: Generally, adjuvant chemotherapy (AC) should be initiated as soon as possible after surgery to eradicate microscopic cancer cells. In this study, we investigated the effect of early AC on the survival of stage II/III gastric cancer patients. MATERIALS AND METHODS: Four hundred sixty patients who received AC (S-1 or XELOX) for pathologic stage II/III gastric cancer at Seoul National University Bundang Hospital between January 2008 and December 2014 were included. Patients were divided into 2 groups: early AC administration (within 4 weeks) and late AC administration (more than 4 weeks). Patients in the early AC group (n=174) were matched 1:1 with patients in the late AC group (n=174) by propensity scoring to adjust for clinical differences. Three-year relapse-free survival (RFS) was evaluated according to the timing of AC. RESULTS: Three-year RFS was 98.1% in stage IIA (n=109), 85.0% in stage IIB (n=83), 87.4% in stage IIIA (n=96), 83.5% in stage IIIB (n=91), and 62.5% in stage IIIC (n=81). After propensity score matching, RFS was similar between early and late AC groups (hazard ratio [HR],1.04; 95% confidence interval [CI], 0.62–1.74; P=0.889). Pathologic stage and histological type were independent prognostic factors of RFS (HR, 2.05; 95% CI, 1.06–3.96; P=0.033 and HR, 2.61; 95% CI, 1.42–4.80; P=0.002, respectively). CONCLUSIONS: Early initiation of AC within 4 weeks does not affect survival rates in stage II/III gastric cancer.

Retrospective Analysis of the Impact of the Adjuvant Huoxuehuayu Drugs on Upper Gastrointestinal Haemorrhage in Patients with Acute Coronary Syndrome / 中国药学杂志

OBJECTIVE: To analyze the usage of the adjuvant huoxuehuayu drugs in patients with acute coronary syndrome(ACS), observe the impact of the drugs on upper gastrointestinal haemorrhage(UGH), and provide a reference for the clinical rational use of the adjuvant huoxuehuayu drugs. METHODS: The ACS patients were enrolled in our hospital during May to July 2016. And the patients were divided into four groups according to whether using the adjuvant huoxuehuayu drugs: not use, used one kind, used two kinds, used ≥three kinds of huoxuehuayu drugs. Then we collected medical history, therapeutic measures and other baseline data, gathered the data of the usage of the adjuvant huoxuehuayu drugs, evaluated CRUSADE bleeding risk and analyzed frequency of occurrence of UGH. RESULTS: Overall 503 ACS patients were enrolled, there was no significant differences among the four groups when the medical history, essential medicines and intervene frequency were compared respectively. On the other hand, the incidence rate of UGH increased significantly with CRUSADE bleeding risk rank increasing incrementally.For very low and low bleeding risk ACS patients, there were no significant differences in UGH incidence rate among the four groups; For moderate and high bleeding risk ACS patients, UGH incidence rate increased significantly in ACS patients using more than one kind of huoxuehuayu drugs compared with other two groups(P<0.05). For very high bleeding risk ACS patients, UGH incidence rate increased significantly in ACS patients using 2 and ≥3 kinds of huoxuehuayu drugs compared with patients using one kind drug, P=0.009, 0.025 respectively. CONCLUSION: For moderate and high bleeding risk ACS patients, UGH incidence rate increase significantly in ACS patients using ≥2 kinds of huoxuehuayu drugs. A significant increase in the incidence rate of UGH with CRUSADE bleeding risk rank increasing, the use of huoxuehuayu drugs shoud be controled strictly, especially for very high bleeding risk ACS patients.

Investigation and Analysis of the Application of Key Monitoring Varieties among Adjuvant Drugs in Medical Institutions of Yunnan Province / 中国药房

OBJECTIVE:To investigate the application of key monitoring varieties among adjuvant drugs in medical institu tions of Yunnan province,and to provide reference for the formulation of related policy and the promotion of clinical rational drug use.METHODS:The related data of key monitoring varieties in medical institutions of Yunnan province during Jan.1st-Mar.31st,2015 were investigated and analyzed statistically.RESULTS:The data with highest effective rate were reported by tertiary hospi tals,being 93.94％.Among top 10 drugs in the list of consumption sum,the number of key monitoring varieties was the highest in tertiary hospitals,being (5.50 ± 2.12) varieties averagely.The consumption sum of key monitoring varieties in tertiary hospitals took up the highest proportion in total consumption sum of hospitalization drug,being(31.94 ± 16.99)％ averagely;being(26.13 ± 11.93)％ and (22.14 ± 16.39)％ in second level hospitals and first level hospitals.Among top 10 drugs in the list of consumption sum,the consumption sum of key monitoring varieties in second level hospitals took up the highest proportion in total consumption sum of hospitalization key monitoring varieties,being (50.34 ± 26.87) ％ in average,up to 98.53 ％;being (39.13 ± 22.55) ％ and (27.38 ± 27.75)％ in tertiary hospitals and first level hospital.Among top 5 key monitoring types in the list of hospitalization con sumption sum,safflower yellow pigment and omeprazole were involved in hospitals at various levels.CONCLUSIONS:Adjuvant drug use are widespread in medical institutions of Yunnan province.Key monitoring varieties are given priority to TCM injection and proton pump inhibitors.It is necessary to take effective measures,formulate and implement the corresponding supervision sys tem so as to promote rational clinical drug use.

Analysis of Clinical Features of Alprostadil Lipid-micro Injection from 159 Hospitals of China / 中国药房

OBJECTIVE:To provide evidence for rational use and clinical monitoring of Alprostadil lipid-micro injection (Li-po-PGE1). METHODS:Adult inpatients receiving Lipo-PGE1 from hospital information system(HIS)of 159 hospitals were select-ed as research subject. Based on frequency statistics,population,clinical diagnosis,and average daily dose of Lipo-PGE1 were all studied. RESULTS:A total of 71687 adult inpatients were included,and the male was more than female,mostly aged 61-75. The hospitalization duration was 8-14 d(45.01%),most of patients were recovered(68.20%). Lipo-PGE1 was wildly used in the clin-ic,and was used for 871 kinds of clinical diseases in total;top 3 diseases were cerebral infarction(9.06%),non-insulin dependent diabetes mellitus (8.65%) and chronic ischemic heart disease (8.08%). The average daily dose of different diseases and different hospitals were significantly different,mostly≤12.5μg. CONCLUSIONS:As adjuvant drug,medical institutions and related super-vision departments should formulate reasonable monitoring index and strengthen medication guidance and evaluation of Lipo-PGE1.

The application status of adjuvant drugs in our country and the management countermeasures study / 中国药学杂志

OBJECTIVE: To know the current application status of the adjuvant drugs in our country, and preliminary explore the management measures of adjuvant drugs. METHODS: Through searching, reading, and summarizing the relevant content and literature, the application status of adjuvant drugs in China and the global demand for rationalization of drug use were reviewed. A few questionnaires that associated with adjuvant drugs were designed by Delphi method to investigate the medicine experts nationwide and to explore the management countermeasures of adjuvant drugs. RESULTS: The survey showed that 98% of medical institutions existing adjuvant drugs use of unreasonable/no specification. The medicine experts believe that there are unreasonable usages such as traditional Chinese medicine injections, cancer drugs except for chemotherapy drugs, etc. The unified management of adjuvant drugs application should determined by the state. CONCLUSION: The excessive use of adjuvant drugs ubiquitous in our country. Key monitoring varieties directory of adjuvant drugs and the limit to the drugs' use indicators to evaluate the rationality of drug use should be set. And there can be a special review team to review the use of adjuvant at regular intervals in order to standardize the clinical application of adjuvant drugs.

Analysis of the Utilization of Adjuvant Drugs in 11 Tertiary Hospitals of Xi’an Area during 2013-2015 / 中国药房

OBJECTIVE:To provide reference for promoting rational drug use and formulating medication policy by health ad-ministrative department. METHODS:The utilization of top 20 adjuvant drugs in the list of consumption sum in 11 tertiary hospitals from Xi’an area during 2013-2015 was analyzed statistically in respects of total consumption sum and constituent ratio,the con-sumption sum of single type,DDDs,DDC,ADR,etc. RESULTS:The total consumption sum and the proportion of adjuvant drugs in 11 tertiary hospitals from Xi’an area increased year by year from 2013 to 2015,accounting for 8.43%,10.25% and 12.20%,respectively. 13 kinds of adjuvant drugs were included in top 20 in the list of total consumption sum from more than 3 hospitals. Deproteinised calf blood serum injection,Alprostadil injection and Danhong injection took up the first 4 places in the list of consumption sum,and Salvianolate for injection took up the first 3 place during 2014-2015. Alprostadil injection,Xueshuantong injection and Spleen peptide oral lyophilized powder took up the first 3 places in the list of DDDs. Spleen polypeptides injection, Yiqi fumai for injection and Cattle encephalon glycoside and ignotin injection took up the first 3 places in the list of DDC,and their DDC were 885.24,372.34 and 349.37 yuan. The incidence of adjuvant drugs-induced ADR increased year by year,increasing from 9.13% of 2013 to 13.49% of 2015. CONCLUSIONS:At present,adjuvant drugs become the important part of clinical drug use in Xi’an area. The consumption sum and amount is increasing rapidly. Great importance should be attached to the rational use and safety of adjuvant drugs so as to control the unreasonable increase of drug expenses.

Finding the 'Ideal' Regimen for Fentanyl-Based Intravenous Patient-Controlled Analgesia: How to Give and What to Mix?

PURPOSE: This analysis was done to investigate the optimal regimen for fentanyl-based intravenous patient-controlled analgesia (IV-PCA) by finding a safe and effective background infusion rate and assessing the effect of adding adjuvant drugs to the PCA regimen. MATERIALS AND METHODS: Background infusion rate of fentanyl, type of adjuvant analgesic and/or antiemetic that was added to the IV-PCA, and patients that required rescue analgesics and/or antiemetics were retrospectively reviewed in 1827 patients who underwent laparoscopic abdominal surgery at a single tertiary hospital. RESULTS: Upon multivariate analysis, lower background infusion rates, younger age, and IV-PCA without adjuvant analgesics were identified as independent risk factors of rescue analgesic administration. Higher background infusion rates, female gender, and IV-PCA without additional 5HT3 receptor blockers were identified as risk factors of rescue antiemetics administration. A background infusion rate of 0.38 microg/kg/hr [area under the curve (AUC) 0.638] or lower required rescue analgesics in general, whereas, addition of adjuvant analgesics decreased the rate to 0.37 microg/kg/hr (AUC 0.712) or lower. A background infusion rate of 0.36 microg/kg/hr (AUC 0.638) or higher was found to require rescue antiemetics in general, whereas, mixing antiemetics with IV-PCA increased the rate to 0.37 microg/kg/hr (AUC 0.651) or higher. CONCLUSION: Background infusion rates of fentanyl between 0.12 and 0.67 microg/kg/hr may safely be used without any serious side effects for IV-PCA. In order to approach the most reasonable background infusion rate for effective analgesia without increasing postoperative nausea and vomiting, adding an adjuvant analgesic and an antiemetic should always be considered.

Effects of n-Butanol Extract of Xanthoceras Sorbifolia Bunge on Rat Model with Adjuvant Arthritis and its Mechanism / 中药新药与临床药理

Objective:To study the effects of n-Butanol Extract (BEX)of Xanthoceras Sorbifolia Bunge on rat model with adjuvant arthritis(AA) in rats and its mechanism .Methods: Rat model of adjuvant arthritis(AA) was induced by FCA. Hind paw swelling was observed to evaluate the effect of BEX and phagocytic function of monocyte-macrophage system, antibody level and delayed hypersensitivity were examined to explore its mechanism. Results: BEX can inhibit the primary and secondary hind paw edema and improve the general symptoms (P