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By comparing the proportion of hospital pharmaceutical functions and work contents of different levels of pharmaceutical professionals at home and abroad, the authors divided pharmaceutical care in medical institutions into basic pharmaceutical care based on drug management and advanced pharmaceutical care based on drug treatment. Different pharmaceutical service levels created different pharmaceutical service values. Pharmaceutical classification service can stimulate the work potential of pharmaceutical professionals at all levels, improve the service level of pharmacists, and provide basis for the better distribution of medical costs in China.
RESUMO
OBJECTIVE： To provide reference for the revision of China National Formulary for Children and make a sample for Chinese medical institutions to formulate their own formulary. METHODS： The suggestions on formulary revision and the formulation of formulary in medical institutions were put forward through comparing the selection principle， catalogues， chapters， drug items， formulary quantity and coincident drugs of World Health Organization （WHO） Model Formulary for Children （2010 edition） （WMFc）， British National Formulary （Children edition） （2016-2017 edition） （BNFc）， Chinese National Formulary （Children edition） （2013 edition） （CNFc）. RESULTS & CONCLUSIONS： The selection principle of WMFc was safe， effective and economical； that of BNFc was accurate and up-to-date， that of CNFc was safe， effective， economical and appropriate. The catalogues of three formularies included introduction， outline and separated section， but the contents or descriptions were different. For example， in separated section， WMFc was divided into 27 chapters， BNFc was divided into 16 chapters and CNFc was divided into 20 chapters. The chapters and catalogues of WMFc were classified according to ATC； those of BNFc were classified according to organ system and disease arrangement； those of CNFc were classified according to disease treatment system. 15 chapters of three formularies were the same， such as drug for nervous system diseases， drug for endocrine system and drug for respiratory system. The unique chapter of CNFc was “drugs for stomatological diseases”. The drug items of three formularies included drug name， indications， usage and dosage， contraindication， ADR， matters need attention， preparation and specifications， etc. Compared with CNFc， unique chapters of WMFc included ATC numbering， drug interaction， liver injury， etc.； those of BNFc included pharmacological action， interaction， allergy， etc. WMFc contained 271 drugs， CNFc 847 drugs and BNFc 955 drugs. Among them， there were 166 overlaps between WMFc and CNFc， 359 between BNFc and CNFc， 174 between WMFc and BNFc. There were 141 same drugs in the three formularies. When revising or formulating formulary， our country should not copy them mechanically， but should revise formulary according to our national conditions. It is necessary to refer to selection principles of WMFc and BNFc， update our children’s formulary in certain or real time， standardize drug access criteria of formulary， rationally increase the variety of drug and call on the relevant departments of the state to improve the standards for the formulation of drug instructions for children.
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To compare the effectiveness and safety of spinal versus general anesthesia for arthroplasty with respect to deep vein thrombosis(DVT),pulmonary embolism (PE) and epidural hematoma.Randomized controlled trials involving spinal and general anesthesia for arthroplasty were searched.Quality assessment were analyzed according to the Cochrane Collaboration's rule.A total of 12 trials involving 1023 participants met the inclusion criteria,Meta-analyses showed that spinal anesthesia may reduce the incidence of DVT or PE after arthroplagty without anticoagulant.There is no difference in the incidence of DVT and PE when anticoagulant is used.Whether anticoagulant was used or not,no epidural hematoma was observed after using the two anesthesia methods.
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Objective To estimate the relationship between the parameters used to estimate the depth of anesthesiaMethods Fifty-two ASA I - II patients undergoing choleeystectomy or exploration of eommon bile duet without jaundice were emdled in the study. Premedieation consisted of midazolam 5 mg and atropine 0.5 mg im.30 min before operation. Anesthesia was induced with fentanyl 4 ug.kg-1 , droperidol 0.08 mg.kg-1 , propofol 2 mg. kg-1 and vecuronium 0.1 mg.kg-1 , and maintained with enflurane and continuous infusion of propofol and intermittent intravenous boluses of vecuronium. The patients were intubated and mechanically ventilated. B1S,HRV and BP were continuously monitored and recorded before induction (T1 ) , 1 min(T2 ) , 3 min(T3 ) after intubation, 1 min before skin incision (T4) , 3 min after skin incision (T5), 1 h after induction (T6), 1 min before extubation (T7) and when the patient was conscious (T8). Blood samples were taken at the same intervals for detenninaton of blood propofol and cortisol level (n = 18) by using radioimmunoasscey and HPL, BIS was maintained at 30 ~ 60 during anesthesia by adjustment of propofol infusion rate. Results There was negative correlation between plasma propofol concentration and BIS/MAP; there was positive correlation between HR and MAP. Plasma cortisol level was positively correlated with BIS, MAP and HR and negatively correlated with plasma propofol concentration. Conclusion The LF and HF can reflect the changes in cardiac sympathetic-vagal tension but cannot reflect the depth of anesthesia. Stress response can be controlled by plasma propofol concentration and estimated by BIS,MAP and HR monitoring.