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OBJECTIVE To explore the pharmaceutical care model for elderly patients with drug-related problems （DRPs） based on the comprehensive medication management review （CMMR）， and to observe the effect of pharmaceutical care under the model. METHODS The pharmaceutical care new model for elderly patients was established by concerning CMMR guidelines in Australia. In other words， clinical pharmacists receive medical care through referral by health practitioners and active consultation by patients or their caregivers. Visits were made by a combination of face-to-face and telephone interviews. Follow-up was carried out in the form of outpatient follow-up， telephone follow-up， appointment， and home guidance to know about the treatment of DRPs by healthcare practitioners or patients.Under this model， the occurrence status and classification of DRPs in elderly patients were studied through cross-sectional investigation. The effect of pharmaceutical care was evaluated from the aspects of hospitalization rate， adverse drug reaction （ADR） incidence，medication compliance， the number of medications， blood lipid level， etc.， through self-before-after comparison. RESULTS In this study， a patient-centered， evaluation-intervention-reevaluation closed-loop pharmaceutical care model was formed. Among 317 study subjects， the average number of DRPs was 1.03 （0-7） cases. Compared before and after the intervention， the number of drug types increased from 2.00（0.00，3.00） to 2.00（1.00，3.00）， but the level of low-density lipoprotein cholesterin in patients decreased from 3.48 （2.58， 4.29） mmol/L to 3.11 （2.29，3.81） mmol/L （P＜0.05）. There was no statistical significance in hospitalization rate， ADR incidence within or medication compliance. CONCLUSIONS CMMR-based pharmaceutical care model can effectively identify and manage the patients’ DRPs and reduce the level of blood lipid.
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With the increasing aging of our population， the incidence of drug-related problems among elderly patients in the community is gradually increasing. Drug-related problems can lead to an increased incidence of adverse health outcomes such as falls and frailty in elderly patients in the community. Medication review is one of the effective means of addressing drug-related problems. The medication review models in Europe and the United States have been developed for decades to address drug-related problems； medication review model in the United Kingdom focuses on the management of drug therapy for elderly patients in aged care facilities， while the medication review models in the United States and Australia have a broader scope（covering all elderly patients in the community）， and the frequency of medication reviews in the United States and Australia are clearer and more standardized. Compared with the above countries， China’s medication review model has a late start. Our country can learn from the advanced experience of the United Kingdom， the United States， Australia and other countries， actively explore and build a drug review model suitable for China’s national conditions， so as to improve the health level of elderly patients in the community and save social public medical resources.
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Multiple medications can increase the risk of adverse drug reactions and adverse events in the elderly.Simplification of multiple medications is a systematic process of weighing the benefits and harms of drug use under the supervision of medical personnel, combining the patient's medical condition, current clinical status and personal preferences and tapering or stopping certain drugs while ensuring efficacy.Simplification of multiple prescription drugs can reduce falls, shorten the lengths of hospitalization, and reduce emergency visits for patients.This article gives a brief overview of simplification of multiple prescription drugs for the elderly and introduces the current available tools to do so.
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Objective To observe the short-term efficacy and adverse reactions of dicycloplatin in the treatment of malignant tumors. Methods A retrospective analysis was performed in our hospital from January 2017 to August 2018 using dicycloplatin to treat patients with malignant tumors. The efficacy and adverse reactions were evaluated after at least 2 cycles of chemotherapy. Results Among the 20 patients with an average of 4 cycles of chemotherapy, 1 had complete remission (CR), 4 had partial remission (PR), 7 had stable diseases (SD), 8 had progression (PD). The total efficacy was 25%. The control rate was 60%. The KPS scores for quality of life was higher than that before treatment (P<0.05). The main adverse effects during chemotherapy were bone marrow suppression, gastro-intestinal reactions. The incidence of leukopenia, thrombocytopenia, reduced hemoglobin, nausea vomiting and liver damage was 45%, 35%, 50%, 20%, and 5%, respectively. Conclusion Dicycloplatin-based chemotherapy has a good curative effect on malignant tumors, and the adverse reactions are mild and tolerable, which deserves further clinical observation and application.
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OBJECTIVE To study the degree and regular of Aspergillus flavus air contamination in hospital.METHODS Some ambient air of different environment in our hospital was taken 5 times in one day of four seasons one year by using centrifugal air sampler,and then cultivated(using eumycete cultural methods),counted and analyzed.RESULTS A.flavus strain was collected in all sampling points in four seasons.The concentration of Aspergillus flavus in six standort was diverse from each other,and the highest was the out-patient clinic with 1238.9 CFU/m3.The concentration of Aspergillus flavus in each division of Medical Department was significant difference during four seasons(P0.05).The difference between internal medicine and external enviroment was significant between the first and the third season(P=0.022,P=0.039),but that of the second and the fouth season was not significant(P=0.022,P=0.624).CONCLUSIONS The contamination of Aspergillus flavus in hospital was severe.So it′s necessary to prevent the Aspergillus flavus infection and enhance the environmental control of susceptible population.
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BACKGROUND: Hematogenesis of a body mainly depends on the proliferation of hematopoietic progenitor cell (HPC). Hematopoietic functional impairment will occur when hematopoietic cells are injured by radioactive ray or chemical drug. The proliferation of HPC is the key link of promoting hematogenesis.OBJECTIVE: To study the effects of nine monomers extracted from Spatholobus suberectus Dunn (SSD) on proliferation of HPC in marrow-depressed mice. DESIGN: Randomized controlled trial.SETTING: Department of Pharmacy, General Hospital of Chinese PLA.MATERIALS: This experiment was conducted in the Department of Clinical Pharmacology, General Hospital of Chinese PLA from November 2002 to February 2003. Totally 348 healthy Kunming mice, weighing 22-25g, clean grade, of irrespective gender, were selected in this study (certification: SCXK-2001-001). The animal experiment was approved by the local ethics committee. SSD was provided by Dispensary of Traditional Chinese Medicine, General Hospital of Chinese PLA; monomers (gallocatechin, formononetin, catechin, pyromucic acid, syringic acid, Demethylvestitol, 1,3,5-benzenetriol, ononin, and epicatechin) were extracted from SSD acetoacetate; TGL-16 centrifuger was made in Shanghai 6th Medical Equipment Factory; CO2 incubator was made in SANYO Company, Japan; MK inverted microscope was provided by OLYMPUS Company, Japan.METHODS: Experimental grouping: Mice were randomly divided into 29 groups, including normal group; control group; gallocatechin high-, medium-, low-dose groups; formononetin high-, medium-, low-dose groups; catechin high-, medium-, low-dose groups; pyromucic acid high-, medium-, low-dose groups; syringic acid high-, medium-, low-dose groups; Demethylvestitol high-, medium-, low-dose groups; 1,3,5-benzenetriol high-, medium-, low-dose groups; ononin high-, medium-, low-dose groups; epicatechin high-, medium-, low-dose groups with 12 mice in each group. Experimental intervention: All the mice except the mice in normal group had been given total body sublethal dose of irradiation by 60Co γ-ray (215.3 rontgen/min, 4 Gy dose rate, irradiation time of 107.5 seconds). Normal saline was injected intraperitoneally into 8 mice in normal group and control group at the third day after inadiation. Stored solution 2,0.4,0.08g/L of each monomer was intraperitoneally injected into the mice in each monomer high-, medium-, low-dose groups, respectively, at the third day after irradiation. Experimental evaluation: Thirty minutes after administration, blood of 8 mice in normal, control group and 12 mice in other groups was collected and normal, control and each dose monomer-containing serums were obtained after centrifugation for 15 minutes, filtering through 0.45μm filter membrane. Then 4 mice in normal and control group were killed to study the effects of nine monomers on proliferation of HPC in marrow-depressed mice by counting erythrocyte colony-forming unit (CFU-E), burst-forming uniterythroid (BFU-E), granulocyte-macrophage colony-forming unit (CFU-GM), and megakaryocyte colony-forming unit (CFU-Meg).MAIN OUTCOME MEASURES: CFU-GM, CFU-E, BFU-E, and CFU-Meg in each group. RESULTS: Totally 348 mice were included in the final analysis. CFU-E: The quantity of CFU-E in high-dose of catechin, gallocatechin, syningic acid, and epicatechin groups was significantly higher than that in the control group (P<0.05-0.01) while the quantity of CFU-E in medium-and low-dose of catechin and medium-dose of gallocatechin was also significantly higher than that in the control group (P<0.05). CFU-GM: Except pyromucic acid and ononin groups, the amount of CFU-GM in other groups was significantly higher than that in the control group (P<0.01). BFU-E: Compared with control group, the amount of BFU-E remarkably increased under the effect of each dose of catechin, gallocatechin, syringic acid and high-, medium-dose of epicatechin (P<0.05). CFU-Meg: The amount of CFU-Meg in high-, low-dose syringic acid groups, low-dose gallocatechin groups and each dose group of catechin and epicatechin was significantly higher than that in the control group (P<0.05). Amount of all colonies in the control group was significantly lower than that in the normal group (P<0.01). CONCLUSION: Nine monomers extracted from SSD can promote the proliferation of HPC in bone marrow depressed mice. In particular, the activity of catechin to stimulate proliferation is the strongest.
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Aim To study effects of nine compounds extracted from Spatholobus suberectus Dunn (SSD) on proliferation of hematopoietic progenitor cell (HPC) in marrow-depressed mice. Methods Serum pharmacology experiment was used to observe the influence of nine compounds on growth of CFU-E、BFU-E、CFU-GM、CFU-Meg in marrow-depressed mice. Results Compared with the control, all compounds except pyromucic acid and ononin could significantly stimulate the growth of CFU-GM (P