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OBJECTIVE:To explore an effective method to formulate management-related strategies for off-lable use of drugs by the evidence-based medicine. METHODS:The process of guideline formulation included seven procedures,i.g. establishment ofguideliesformulation workgroup;investigation and selection of the status quo on off-label drug use;identification of the clinical problems;retrieval and evaluation and comprehensing of evidence;applification of GRADE in evidence quality grading;formation of the recommendations consensus;peer review and result publication. And eventually guidelines were formed based on the steps. This study took off-label use of rheumatoid immunoprotective subjects as a case to explore. RESULTS & CONCLUSIONS:Based on the evidence evaluation system and above 7 steps,the methods and process of guideline formulation on off-label use of rheuma-toid immunoprotective subjects that integrated administration,law,clinical medicine,pharmacy subjects were made .The process of guideline formulation fully reflects multidisciplinary characteristics of the workgroup,the advanced nature of the process,the comprehensiveness of evidence ,the rigor of evidence quality grading,and the normalization of consensus. It provides reference in methodology for establishing a comprehensive evidence-based evaluation and management system of off-label use of drugs for all clinical specialist disease. Therefore,this scientific research results may promote the standardization and legalization of the off-label use of drugs management in China.
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Objective: To evaluate the intervention effect of clinical pharmacists in hypertension chronic disease management. Methods:All the patients with hypertensive chronic diseases from Ziyang community, Xingan Street, Beilun district were involved in the study. Combined with community doctors, clinical pharmacists provided pharmaceutical care for the patients, such as regular face-to-face medication guide, telephone communication, home follow-up, special lectures on health and so on. The cognitive level, blood pressure control level and medication compliance were statistically analyzed and compared before and after the pharmacy intervention. Results:After the intervention of clinical pharmacists, the level of hypertension cognition and the level of antihypertensive drug under-standingof the patients was improved significantly (P<0. 05 or 0. 01), the level of blood pressure control and medication compliance of the patients were improved significantly (P<0. 01), and unscheduled outpatient rate, emergency rate, hospitalization rate and fre-quency were decreased (P<0. 05 or 0. 01). Conclusion: Pharmacy intervention carried out by clinical pharmacists for the patients with hypertension chronic diseases can provide reasonable medication security and improve the quality of life, and the pharmacy inter-vention mode for the hypertension chronic disease management is worthy of promotion.
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ObjectiveTo observe the difference in analgesia effects of ropivacaine with fentanyl used intraarticularly after the single knee arthroscopy procedure.Methods40 patients performed knee arthroscopy under combined spinal-epidural anaesthesia( CSEA),were randomly divided into 4 groups (n =10),at the end of operation 10mlof different drug at the group F,R,FR and N(fentanyl 10μg,0.5％ ropivacaine,fentanyl 10μg +0.5％ ropivacaine,normal saline)were injected intra-articularly.The antalgic effects of four groups based on standard of VAS were observed at the 2,4,8,12 and 24h after operation.ResultsThe 2h postoperative VAS scores were lower in four groups,the differences in four groups were not significant.The 4,8,12,24h postoperative VAS scores of F,R and FR group were much lower than that of N group ( all P ＜ 0.05 ).Moreover,VAS scores of FR group were much lower than that of F and R group( all P ＜ 0.05 ).No other adverse effects were observed.ConclusionIntra-articular administration of ropivacaine with fentanyl could provide superior postoperative analgesia without side effects.It was an excellent regimen for analgesia after knee arthroscopy.
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Objective To evaluate the effect of perioperative enteral immunotrition(IMPACT) on liver regeneration in cirrhotic rats with hepatectomy. Methods Forty-eight cirrhotic rats were randomly divided into two groups: Group A, perioperative standard enteral nutrition group(n=24), receiving standard enteral nutrient NUTRISON during hepatectomy. Group B, perioperative enteral immunonutrition group(n=24), receiving enteral immunonutrient IMPACT after hepatectomy. According to the different time of taking specimens, each group was separated into four subgroups, each subgroup had six rats. The rats in the two groups received equal daily nutritional supplement intragastrically, which was 690kJ/kg per day. Before the 68% hepatectomy, the rats were fed with enteral nutrient for 8 days, and after operation were fed until the day of taking specimens. On the day before hepatectomy and 1st, 4th and 8th postoperative day(POD), MI (mitotic index) of liver cell and PCNA (proliferating cell nuclear antigen) labeling index of hepatocyte were determined. Results MI increased significantly in both group on 4th and 8th postoperative day(P