Practice and reflection on continuing education and training of clinical pharmacists in the neurology department / 中国药房

OBJECTIVE To provide a reference for continuing education and training of clinical pharmacists. METHODS The revision of the syllabus and the improvement of training methods of practical skills training class for clinical pharmacists in the neurology department held by Xuanwu Hospital of Capital Medical University from 2007 to 2022 was sorted to summarize its advantages and characteristics. RESULTS Training programs were developed to benefit clinical pharmacists at different levels， and the training contents were adjusted according to the training programs and the needs of trainees. Teachers with teaching experience were selected to participate in the teaching. Theory teaching was combined with practice teaching in the teaching process， and case teaching and question-based teaching methods were adopted to benefit both senior clinical pharmacists and new clinical pharmacists. In addition， the influence of the training class was expanded through online teaching， so that doctors and pharmacists could communicate and learn together on the platform of the training class. For example， when designing the training program， we replaced one common neurological disease every two years， and carried rollover study on its new progress and new ideas； clinical pharmacist skill course was reduced， drug history writing， information retrieval and test index interpretation were compressed into clinical pharmacy skill course. CONCLUSIONS The continuing education platform is established for clinical pharmacists； new knowledge and concepts that clinical pharmacists of this specialty need to be familiar with are compiled into the teaching syllabus， and the experts who are familiar with the training of clinical pharmacists are selected to explain to the students so that the students could follow the platform to constantly update their knowledge and improve the ability of clinical pharmacists to participate in the clinic work.

Pharmaceutical Care for the Treatment of Hypertension for a Cerebral Hemorrhage Patient / 中国药师

Clinical pharmacists joined the team for treating a cerebral hemorrhage patient with hypertension. Medications were as-sessed by learning guidelines and consulting the related literature reports,and the regimen was adjusted according to the condition of the disease and drug characteristics during the whole process of pharmaceutical care. As a result, the clinical medication became more rea-sonable. The patient's blood pressure was controlled within the target range timely, and the vital signs were sufficiently stable so that the patient could be transferred to a general ward for the further treatment.

Analysis of Related Factors for Valproic Acid-induced Fibrinogenopenia in Epilepsy Patients / 中国药房

OBJECTIVE:To investigate related factors for valproic acid-induced fibrinogenopenia in epilepsy patients. METHODS:A retrospective survey was conducted to collect the epilepsy patients treated with routine dose of valproic acid regularly more than one week in Epilepsy Diagnosis and Treatment Center of Xuanwu Hospital,Capital Medical University during Jan. 1st,2017 to Mar. 1st,2017. The general situation,drug use (dosage of valproic acid,dosage form of valproic acid,drug combination),liver function,blood routine indexes and coagulation indexes,etc. were collected. Univariate and binary Logistic regression analysis were used to analyze the relationship of above factors with fibrinogenopenia. ROC curve was used to screen and predict the cut-off points when sensitivity and specificity of fibrinogenopenia were good. RESULTS:A total of 59 valid cases were collected,including 40 male(67.8％)and 19 female(32.2％);35 patients(59.3％)were under 14 years of age,and 24 patients (40.7％)over 14 years of age,with average age of(17.2±15.7). Of these,24 had fibrinogenopenia(40.7％). Univariate analysis showed that fibrinogenopenia was negatively correlated with age(P=0.042),but was positively correlated with dosage of valproic acid(P=0.003);fibrinogenopenia was not correlated with gender(P=0.679),dosage form of valproic acid(P=0.790)or drug combination (P=0.502). Binary Logistic regression analysis showed that dosage of valproic acid and neutrophil percentage, erythrocyte count and platelet count of patients were related risk factors of fibrinogenopenia;odds ratios of related risk factors were 1.101,0.925,0.132,0.976. ROC curve showed that the area under the ROC curve which was correlated with dosage of valproic acid was 0.766,sensitivity and specificity were 98.5％ and 54.3％;the cut-off dosage was 13.3117 mg/kg. CONCLUSIONS:The greater the dosage of valproic acid and the younger the age,the greater the possibility of the fibrinogenopenia. For patients with long-term use of valproic acid,even if the normal dosage are used,it is necessary to monitor fibrinogen changes regularly,for whom the dosage are greater than 13.3117 mg/kg,the frequency of fibrinogen monitoring should be increased.

Analysis of Antibiotic Drug Use in Elderly Patients with Cerebral Infarction Complicated with Pulmonary Infection Consulted by Clinical Pharmacist / 中国药师

Objective: To investigate the rational use of antibiotics in the elderly patients with cerebral infarction complicated with pulmonary infection.Methods: A retrospective investigation was used to analyze the drug resistance of 86 cases of elderly patients with cerebral infarction complicated with pulmonary infection.The data were collected from the consultation records of clinical pharmacists in Xuanwu hospital from February 2013 to November 2015.Results: The pathogenic bacteria mainly distributed to Acinetobacter baumannii and Pseudomonas aeruginosa, and the drug resistance rate was 48.89%.After the consultation, the rate of combination therapy increased from 20.23% to 61.63%.After using sensitive antibiotics, such as cefperazone-sulbactam,piperacillin-sulbactar and amikacin, the infectious indices recovered significantly (P＜0.05).The case proportion with BUN/SrCr＞20 in 27 cases complicated with impaired renal function was 62.9%, and although the patients didn''t use antibiotics with reduced doses, the indices of infection and renal function improved in a certain degree (P＜0.05).The case proportion with ALB and PAB decreasing was 53.49%, and after the consultation, all the infectious indices decreased and protein levels increased (P＜0.05).Conclusion: More attention should be paid to the elderly patients with cerebral infarction complicated with pulmonary infection, and sensitive antibiotics with single or combination drug therapy should be used according to the distribution of resistant bacteria.For the renal failure patients, the kind of renal failure should be clear, and then the appropriate dosage of antibiotics should be adjusted.For the patients with malnutrition, adequate protein intake contributes to the recovery of infection.The clinical symptoms and laboratory indices should be integrated to effectively develop rational treatment for the elderly patients with cerebral infarction complicated with pulmonary infection.

Pharmaceutical Care for One Patient with Adult Purulent Meningitis Performed by Clinical Pharmacists / 中国药师

Objective:To explore the methods and ideas for developing pharmaceutical care in clinical practice. Methods: The pharmaceutical care performed by clinical pharmacists and the therapeutic scheme assisted by clinical pharmacists for one patient with adult purulent meningitis were analyzed retrospectively. Results and Conclusion:Through selection of anti-infective agents, treatment of adverse drug reactions and assessment of patients’ economic capacity,clinical pharmacists help provide reasonable medication to im-prove therapeutic efficacy, safety and economy.

Chinese and Western Medicine Pharmaceutical Care for One Myelitis Patient Infected by Brucellosis / 中国药师

Objective:To discuss the methods and effects of clinical pharmacists in the Chinese and western medicine pharmaceu-tical care for one myelitis patient infected by brucellosis. Methods:Taking one myelitis patient infected by brucellosis as the example, clinical pharmacists provided Chinese and western medicine pharmaceutical care through making individualized drug regimen, perform-ing drug education and so on. Results:Clinical pharmacists participated in the therapeutic process actively, and performed Chinese and western medicine pharmaceutical care. As a result, the body temperature, look,tongue coating and excrement of the patient were obvi-ously improved. Conclusion:Performing Chinese and western medicine pharmaceutical care in clinics is very important for safety and effectiveness of drugs and improvement of drug use level.

Practice and Analysis of Clinical Pharmacist Participating in the Consultation for 39 Cases of Acinetobacter baumannii Infection / 中国药房

OBJECTIVE:To investigate the methods and breakthrough point of clinical pharmacist participating in the consulta-tion for Acinetobacter baumannii infection cases,in order to improve the level of clinical rational drug use. METHODS:The con-sultation records of 39 A. baumannii infection cases in neurology department of our hospital during 2013-2014 were analyzed retro-spectively. The patients’general condition,site of infection,bacterial culture and drug sensitivity test were analyzed statistically as well as drug regimen before and after consultation,disease condition,lab indexes and nutritional status. RESULTS:A. baumannii were found in sputum culture of all patients,among which there were 11 cases of multiple resistant bacteria(28.2%),13 cases of pan resistant bacteria (33.3%),8 cases of drug resistant A. baumannii (20.5%) and 7 cases of non-multiple resistant bacteria (17.9%). The most widely used drug was minocycline (average dose of 0.2 g/d),followed by cefoperazone-sulbactam (average dose of 9 g/d),ceftazidime (average dose of 6 g/d), etimicin (average dose of 0.27 g/d),amikacin (average dose of 0.4 g/d). The antibacterial daily doses were higher than before. 3 patients were recommended to use fosfomycin. Before consultation,2 pa-tients didn’t received antibiotics (5.1%),and there were 13 cases of single drug (33.4%),22 cases of two-drug combination (56.4%)and 2 cases of three-drug combination(5.1%). After consultation,none of patients didn’t received antibiotics(0),and there were 7 cases of single drug (17.9%),26 cases of two-drug combination (66.7%) and 6 cases of three-drug combination (15.4%). After the consultation,body temperature,symptom and infection indexes of patients got better. Clinical pharmacists ad-justed nutrition program of 12 patients (30.8%) and expecterant program of 9 patients (23.1%). Compared with before consulta-tion,oubumin level of 11 patients (28.2%) and prealbumin level of 20 patients (51.3%) were all increased. CONCLUSIONS:Clinical pharmacist should formulate reasonable therapeutic regimen and reduce irrational drug use according to infection and physi-cal condition. They should provide anti-infective regimen,at the same time,pay attention to the adjustment of expectorant regimen and nutrition support program.

Teachers’Practice in Improving the Training Quality of Neurology Clinical Pharmacists / 中国药师

Objective:To improve the training quality of neurology clinical pharmacist. Methods:The experience during the training of neurology clinical pharmacists in recent ten years was summarized. Results:The students were taught in groups according to their majors and promoted in stages according to the teaching plans. Besides,various teaching methods were carried out timely. After tutored by the methods mentioned above,the students could quickly raise their working ability to play good roles of clinical pharmacist and work independently with more confidence. Conclusion:The training quality of neurology clinical pharmacists has been effectively improved by teaching in groups,promoting in stages and providing various teaching methods timely.

Analysis of the Result of Clinical Pharmacists' Investigation of Medical Advice / 中国药师

Objective:To explore the methods and the role of clinical pharmacists in the medical advice audit. Methods: The questionnaire was designed to analyze the results of the medical advice investigated by the clinical pharmacists from November 2011 to October 2012. Results:Totally 3 232 patients were in the use of antimicrobial drugs in a investigation of 14 675 patients in 178 724 medical advices, accounting for 22. 0% of the total number of the investigation;the use of antimicrobial agents in patients with medical advices of antimicrobial were 5 387, accounting for 3. 0% of the total number of the investigation;597 errors were detected and inter-vened, accounting for 0. 33% of the total number of the investigation;the main errors were dose errors, usage errors and repeated med-ication errors. Indication error and interaction error were more in the critically ill patients monitored by the clinical pharmacists than that in the general ward patients. Conclusion:Clinical pharmacists and ward pharmacists to participate medical advice review, partic-ularly to concern about the patients with medical advices of antimicrobial drugs, and to intervene reasonably in the dose errors, usage errors and repeated medication errors can improve the overall quality of the hospital pharmacist team, make sustainable development of rational use of drugs and reduce the risk of medication.

Study on management mode of antiepileptic drugs following epilepsy surgery / 中华神经科杂志

Objective To investigate antiepileptic drug application and the influential factors in patients after epilepsy surgery.Methods During the period from 2002 through 2005,170 patients with intractable epilepsy who received epilepsy surgery in Xuanwu hospital were studied.They were divided into 3 groups according to the stages of operation.Patients in group A received epilepsy surgery during 2002 to October 2003,those in group B received initial phannacentieal care after epilepsy surgery during November 2003 to October 2004,and those in group C received integrated pharmaceutical care after epilepsy surgery during November 2004 to October 2005.The clinical outcomes,factors affecting antiepileptic drugs,safety and compliance with antiepileptic medication were analyzed.Results Patient's clinical outcomes(group B was 71%and group C was 81%),safety and compliance with antiepileptic medication in group B and group C are better than those in group A(46%)with a significance difference(X2=7.08,15.50,P<0.05).Conclusions The integrated pharmaceutical care rendered from the cooperation of neurosurgeon,neurologist and clinical pharmaceutist is a new and effective management mode for postsurgical epilepsy patients.

Experience of Teaching Clinical Pharmacists in the Department of Neurology / 中国药房

OBJECTIVE: To discuss the method of training clinical pharmacists.METHODS: The experience of training clinical pharmacists was introduced.RESULTS: We can train clinical pharmacists to learn basic theories through finding problems from the clinical practice.Clinical pharmacists' level of basic knowledge could be improved by adhering to clinical practice.The basic skills of clinical pharmacists in communicating with patients can be learned by applying the methods such as examining,companying,encouraging and complementing.CONCLUSION: Basic theories,basic knowledge and basic skills should be emphasized in the training of clinical pharmacists.

Perioperative Use of Drugs in Epileptic Patients:Analysis of 117 Cases / 中国药房

OBJECTIVE:To probe into the perioperative use of drugs in epileptic patients.METHODS:By a retrospective analysis,the general condition,and drug use before,during and after operation of 117 epileptic inpatients in our hospital in 2006 was analyzed statistically.RESULTS:71(60.7%)epileptic patients before operation versus 83(70.9%)after operation received blood routine test and biochemical test.105(89.7%)received anti-epileptic drugs alone versus 12(10.3%)received combined drugs.The mean administration duration was 6.5 d for antibiotics versus 4.3 d for hormones.CONCLUSION:Great importance should be attached to the perioperative drug use in epileptic patients to standardize the use of antibiotics and hormones and follow the rational drug use principle so as to keep seizure under control and improve the quality of life for epileptic patients.

Clinician's Involvement in the Training of Clinical Pharmacists in Neurology Intensive Care Unit / 中国药房

OBJECTIVE:To discuss the training method for clinical pharmacists working in Neurology Intensive Care Unit. METHODS: The characteristics of the specialty of neurology were analyzed and out experiences in training clinical pharmacists were summarized. RESULTS: With a good and systematic learning method, clinical pharmacists can adapt to clinical work and become one of the members in the treatment corps as soon as possible. CONCLUSION: With a specialty characteristic, clinicians' participating in the training of clinical pharmacists is of great important for the quick transformation of pharmacists' working model.

Investigation and Evaluation of Clinical Safety of Clindamycin Injection / 中国药房

OBJECTIVE: To utilize the clindamycin injection safely.METHODS: 167 cases of hospitalized patients, who underwent clindamycin injection during the period between March 22, 2004 and April 27, 2004 were followed up and analyzed through the self-made questionnaires. RESULTS: 98 cases were for preventing infections; 76 cases were for treating infections; in 107(47+60) cases clindamycin injection was used in combination with other anti-infective drugs to prevent and treat infections; the average dosage was 0.6g～1.2g,bid,and the average length of time was (17?15)d;the incidence of ADR was 6.6%(11/167), and the main clinical manifestations were sickness, vomiting, diarrhea, numbness of mouth and lip, fever, and mycoinfection. CONCLUSION: Only by strict control of signs for drug use and ways of administration can the clinical safety be improved.

Retrospective Analysis of154Cases ADR of Nervous System Medicine / 中国药房

OBJECTIVE:To study the damage of drugs to the nervous system.METHODS:154cases of adverse reactions of nervous system drugs collected from1999to2003in our hospital were analyzed statistically.RESUTLS:ADR of nervous system accounted for14.27%of all the ADR cases in our hospital;there were18kinds of drugs involved in ADR,which in?cluded the anti-infection drugs,Chinese drugs preparation,cardiovascular system drugs,nervous system drugs,antipyretic analgesic etc.CONCLUSION:It is of great clinical significance to keep alert,to identify and avoid the adverse effects of drugs on nervous system.

Analysis of the Safety of Puerarin Injection Used in 135 Patients / 中国药房

OBJECTIVE:To understand the safety of Puerarin injection in clinical use.METHODS:The adverse drug re?actions(ADRs)and administration of Puerarin injection at Xuanwu Hospital from Oct.2002to Feb.2003were investigat?ed.RESULTS:According to the dosage in drug intruction,the Puerarin injection was diluted in0.9%sodium chloride of5%glucose solution and infused alone with a infusion rate of40～60drops/min,which would be safe and induce less ADRs,and use in overdose markedly increased the incidence of ADRs.CONCLUSION:Use of this preparation should strictly be in accordance with the specification.

Analysis of the Results of Blood Concentrations of Anti-epileptic Drugs in 733 Epilepsy Patients / 中国药房

OBJECTIVE:To guide the rational use of anti-epileptic drugs(AEDs)in clinical practice.METHODS:In a retrospective review,there were733patients in Xuanwu hospital who suffered from poor curative effect or intoxication of AEDs from March2000to March2001.The results of blood concentration of anti-epileptic drugs(AEDs Css)were ana?lyzed.RESULTS:The Css of37.6%of the patients were within the normal Css range,and6.4%were higher and55.9%were lower than the normal.In combined use of AEDs and other drugs,79.1%of the patients had higher or lower Css than nor?mal.In addition,chemosynthetic components were detected in90%of the patients who took Chinese medicine.Among them,86%of the patients had abnormal Css.CONCLUSION:Css monitoring should be done when AEDs were administrated.It is advisable to use only one or two kinds of AEDs,and to pay attention of the chemosynthetic components in Chinese medicine.