Promoción de la adherencia al tratamiento antihipertensivo a través de un servicio de atención farmacéutica apoyado en telefonía móvil / Promoting of Adherence to Antihypertensive Treatment through a Pharmaceutical Care Service Supported by Mobile Phones / Promoção da adesão ao tratamento anti-hipertensivo através de um serviço de assistência farmacêutica apoiado por telefonia móvel

ntroducción: la hipertensión arterial continúa siendo un desafío para la salud pública del Paraguay. La falta de adherencia a los tratamientos es un problema desde los puntos de vista médico, económico y psicosocial. Objetivo: promover la adherencia al tratamiento farmacológico antihipertensivo en pacientes con hiperten-sión que asisten a servicio de salud público, mediante un servicio de atención farmacéutica apoyado en el uso de telefonía móvil. Materiales y métodos: estudio cuasiexperimental en pacientes mayores de 18 años de ambos sexos con hipertensión arterial, en quienes se aplicaron intervenciones farmacéuticas apoyadas con el uso de telefonía móvil (llamada, mensajería sms y WhatsApp) y en quienes se evaluó la adherencia al tratamiento mediante el cuestionario de Morisky-Green, junto con preguntas complementarias para cono-cer las causas de no adherencia. Resultados: participaron 60 pacientes. Al inicio, el 68.3 % (n = 41) mostró adherencia al tratamiento según el cuestionario de Morisky-Green, y el 31.7 % (n = 19) no cumplió con la indicación. Después de las intervenciones se ha encontrado una mayor adherencia al tratamiento, al llegar al 96.7 % los cumplidores (p < 0.001). Entre las causas de no adherencia a la farmacoterapia están el olvido (28.3 %; n = 17), la falta de disponibilidad del medicamento en el hospital (20 %; n = 12) y el costo (10 %; n = 6). Conclusión: la utilización de telefonía móvil como apoyo a la atención farmacéutica podría constituirse en una herramienta para la promoción de la adherencia en pacientes con hipertensión arterial.

Introduction: Arterial hypertension remains a public health challenge in Paraguay; lack of adherence to treatment poses medical, economic, and psychosocial concerns. Information and communication tech-nologies (ICT) are valuable tools in monitoring patients and improving adherence to drug treatment. Objective: Promote adherence to antihypertensive drug treatment among hypertensive patients who attend a public health service by implementing a pharmaceutical care service supported by mobile phones. Materials and methods: A quasi-experimental study was conducted in male and female patients aged 18 years and older with arterial hypertension, in which pharmaceutical interventions supported by mobile telephony (calls, SMS messaging, and WhatsApp) were applied and adherence to treatment was assessed using the Morisky-Green questionnaire with complementary questions to identify the reasons for non-adherence. The research protocol was approved by a Research Ethics Committee of the FCQ-UNA (714/2021). Results: A total of 60 patients participated. Initially, 68.3% (n=41) showed adhe-rence to treatment according to the Morisky-Green questionnaire, while 31.7% (n=19) did not adhere to the indication. After the interventions, an increase in adherence to treatment was observed, with a compliance of 96.7% (p<0.001). Reasons non-adherence to pharmacotherapy included forgetfulness 28.3% (n=17), unavailability of drugs at the hospital 20% (n=12) and cost 10% (n=6).Conclusion: The use of mobile phones to support pharmaceutical care has the potential to serve as a tool for promoting adherence in patients with arterial hypertension

Introdução: A hipertensão arterial continua a ser um desafio para a saúde pública no Paraguai; a falta de adesão aos tratamentos é um problema do ponto de vista médico, econômico e psicossocial. Objetivo:Promover a adesão ao tratamento farmacológico anti-hipertensivo nos doentes com hipertensão que frequentam os serviços públicos de saúde, através de um serviço de assistência farmacêutica apoiado na utilização de telefonia móvel. Materiais e métodos: Estudo quase experimental realizado em pacientes maiores de 18 anos de ambos os sexos com hipertensão arterial; em que foram aplicadas intervenções farmacêuticas apoiadas no uso da telefonia móvel (chamada, mensagem sms e WhatsApp) e a adesão ao tratamento foi avaliada por meio do questionário Morisky-Green, juntamente com perguntas comple-mentares para determinar as causas da não adesão. Resultados. 60 pacientes participaram. No início, 68,3% (n = 41) apresentaram adesão ao tratamento conforme questionário de Morisky-Green e 31,7% (n = 19) não cumpriram a indicação. Após as intervenções constatou-se maior adesão ao tratamento, com adesão chegando a 96,7% (p < 0,001), as causas da não adesão à farmacoterapia foram esquecimento em 28,3% dos casos (n = 17), falta de disponibilidade de medicamentos no hospital 20% (n = 12) e custo 10% (n = 6). Conclusão: a utilização de telefonia móvel para apoio à assistência farmacêutica poderá tornar-se uma ferramenta para promover a adesão ao tratamento em pacientes com hipertensão.

Effects of intensive pharmaceutical intervention led by clinical pharmacists on the risk of ischemic stroke in hypertensive patients / 中国药房

OBJECTIVE To explore the effects of intensive pharmaceutical intervention led by clinical pharmacists on hypertension patients with medium and high risk of ischemic stroke. METHODS The hypertension outpatients with medium and high risk of ischemic stroke， who were assessed by the modified Framingham stroke scale in Zhengzhou People’s Hospital from Oct. 2019 to Apr. 2020， were randomly divided into control group and intervention group， with 200 cases in each group. Patients in the control group received conventional treatment without pharmaceutical intervention； on the basis of conventional treatment， patients in the intervention group received 12-month intensive pharmaceutical intervention （grading management of compliance+ regular follow-up， involving medication education and guidance， blood glucose， blood pressure， blood lipid management and healthy life guidance） provided by clinical pharmacists. The blood glucose indexes， blood lipid indexes， blood pressure compliance rate， medication compliance， 10-year stroke risk and stroke incidence were compared between two groups at baseline and 12 months after enrollment. RESULTS After 12 months of enrollment， the level of low-density lipoprotein cholesterol （LDL-C） in intervention group was significantly lower than that in the same group at baseline， and the levels of fasting blood glucose， glycosylated hemoglobin， total cholesterol and LDL-C in intervention group were significantly lower than those in control group at the same time points （P＜0.05 or P＜0.01）. The compliance rate of blood pressure and medication compliance in intervention group were significantly higher or better than those in control group （P＜0.01）. There were 12 and 15 patients in control group and intervention group turned into low-risk ones respectively， and the proportion of high-risk patients in intervention group was significantly lower than that in control group（P＜0.01）， while the proportion of medium-risk patients was significantly higher than that in control group（P＜0.05）； the incidence of stroke in intervention group was significantly lower than that in control group （1.0% vs. 4.5%， P＜0.05）. CONCLUSIONS The pharmaceutical intensive intervention led by clinical pharmacists can reduce blood glucose and blood lipid levels of hypertensive outpatients， improve their blood pressure compliance rate and medication compliance， and help reduce the risk of stroke.

Immune debt and its impact in children during severe acute respiratory syndrome coronavirus 2 epidemic / 中华实用儿科临床杂志

Non-pharmaceutical interventions (NPIs) implemented during the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) epidemic have been proven to be effective in blocking the spread of the epidemic.While reducing SARS-CoV-2 transmission, NPIs also reduce children exposure to other pathogens, leading to a decline in the incidence of many viral and bacterial infections.The reduction in contact with viruses and bacteria and the delay or interruption of routine immunization during SARS-CoV-2 epidemic have resulted in insufficient immune stimulation of pathogens on the population, leading to an increase in susceptible populations and a decline in herd immunity, forming the immune debt during SARS-CoV-2 epidemic.After reducing or lifting NPIs, the incidence of some viral or bacterial infectious diseases was significantly higher than pre-epidemic.In this review, the definition, source, impact and strategies of immune debt during epidemic period were expounded, inorder to improve clinicians′ attention and understanding of immune debt and optimize the prevention of children′s infectious diseases.

Study on the feasibility of pharmaceutical intervention to improve medication appropriateness in elderly inpatients / 中国药房

OBJECTIVE To evaluate the effects of pharmaceutical interventio n led by clinical pharmacists on medication appropriateness of elderly inpatients. METHODS A non-randomized concurrent controlled trial was carried out. Elderly patients admitted to two treatment groups in the geriatric department of Yancheng First People ’s Hospital since June 2021 were selected as the research objects. According to the inclusion and exclusion criteria ，the first 40 patients were selected from each of the two treatment groups （according to the order of admission time ）and set as the control group or the intervention group. The control group received routine treatment and nursing services ，and the intervention group additionally received pharmaceutical intervention led by clinical pharmacists on the basis control group. Clinical pharmacists found potential inappropriate medication （PIM）and put forward suggestions on optimization of medication regimen. American Geriatrics Society 2019 Updated AGS Beers Criteria ® for PIM Use in Older Adults （hereinafter referred to as “Beers criteria ”）and the Criteria of PIMs for Older Adults in China 2017 Edition （hereinafter referred to as “Chinese criteria ”）were used as reference tools for drug use review. The medication appropriateness index （MAI）total scores （main evaluation indicator ），the number of PIMs ，the number of drugs used ，the length of hospital stay ，the number of drug-related adverse events during hospital stay ，the number of drug regimen optimization suggestions by pharmacists ， and implementation rate of E-mail：zhihuadou@163.com optimization suggestions adopted by clinicians were compared between 2 groups at admission and at discharge. RESULTS At admission ，there were no statistically differences in MAI total scores，the number of PIMs based on Beers criteria ，the number of PIMs based on Chinese criteria or the number of drugs used between 2 groups（P＞0.05）. At discharge ，there were no statistically differences in the number of PIMs based on Chinese criteria and the length of hospital stay between 2 groups（P＞0.05），but the MAI total scores ，the number of PIMs based on Beers criteria and the number of drugs used in the intervention group were lower than those in the control group （P＜0.05）. In the intervention group，the proportion of drugs recorded as “inappropriate medication ”at admission （34.5％）was significantly higher than that at discharge（19.5％）（P＜0.05）. The difference between the number of drugs discharged from hospital and the number of drugs admitted to hospital in the control group [ 3（1-4.8)] was significantly higher than that in the intervention group [ 1（0-2.8)]（P＝ 0.012）. Compared with admission ，the proportion of drugs recorded as “inappropriate medication ”in the intervention group at discharge was significantly decreased on the basis of “effectiveness”dimension and “course”dimension （P＜0.05）. During hospitalization，clinical pharmacists put forward 70 optimization suggestions of drug regimen for the intervention group ，among which 39 suggestions were adopted and implemented by clinicians ，with an implementation rate of 55.7％. CONCLUSIONS The pharmaceutical intervention led by clinical pharmacists can improve overall appropriateness of drug use in the elderly inpatients using MAI as main evaluation indicator.

Analysis of potential drug interactions in medical clinic sector in a Hospital of João Pessoa - PB

Abstract The objective of this study was to evaluate drug interactions based on medical records of patients hospitalized in University Hospital Lauro Wanderley (UHLW) in João Pessoa-PB, Brazil. This was a quantitative, descriptive study with a cross-sectional design. This research was conducted in the medical clinic of the above hospital by analyzing pharmaceutical intervention in medical records. The investigated samples consisted of all medical profiles with drug interaction information of patients hospitalized from June 2016 to June 2017. Most of these drug interactions were determined and classified by Micromedex® Solutions database. This research was approved by the Ethics Committee in Institutional Human Research, protocol number 2.460.206. In total, 331 drug interactions were found in 131 medical profiles. Dipyrone, enoxaparin, sertraline, ondansetron, quetiapine, tramadol, bromopride, amitriptyline, and simvastatin were medications that showed highest interactions. According to Anatomical Therapy Classification (ATC), drugs that act on the central nervous system result in more interactions. The most prevalent interaction was between dipyrone and enoxaparin. Some limitations of this study are the lack of notifications and data on drug interactions.

Economic impact of pharmaceutical interventions in a medium complexity Brazilian university hospital

Abstract Clinical pharmacists have been increasing their participation mainly through actions aimed at patient care, with international studies demonstrating favorable cost-benefit ratio from pharmacists interventions. However, there are few studies carried out in Brazil about the subject. This study aims to assess the economic impact of pharmaceutical interventions (PIs) in a hospital setting performed in October 2018. Each performed PI was registered and associated with the direct cost of drugs for economic impact analysis. A total of 185 PIs were evaluated, comprising 106 patients. The most intervened drugs were antibiotics, presenting the greatest economic impact, R$2,370. The total economic impact was R$2,578, mainly in the Pediatric Intensive Care Unit that represented R$1,701. Regarding the economic impact by PI as the "Suspension of drug without indication" saved R$1,360 while the "Inclusion of required drugs" cost R$807. It was estimated that the savings would be R$30,936 and, if PIs were performed at day zero, the savings would be R$79,728 per year. An average of 1.75 PI per patient was performed with an economic impact of R$14 per PI. Our results showed that clinical pharmacist's role in the evaluation of pharmacotherapy is important for patients' health and represents a positive economic impact.

Análise de intervenções farmacêuticas utilizando um instrumento de acompanhamento farmacêutico em uma Unidade de Terapia Intensiva Pediátrica / Analysis of pharmaceutical interventions using a pharmaceutical monitoring instrument in a Pediatric Intensive Care Unit

Introdução: A pediatria apresenta um cenário bastante específico devido ao uso de medicamentos off-label e carência de estudos científicos direcionados à utilização de medicamentos por essa população. Assim, o farmacêutico clínico pode contribuir na identificação e prevenção de problemas relacionados a medicamentos.Métodos: Estudo de coorte retrospectivo realizado em uma unidade de terapia intensiva pediátrica de um hospital universitário do Rio Grande do Sul. Foram analisadas as intervenções farmacêuticas realizadas entre março de 2016 a julho de 2018 por farmacêuticos clínicos. Tais intervenções foram reclassificadas conforme os critérios de um instrumento de acompanhamento farmacêutico (bundle) utilizado na rotina. Foi realizada análise estatística descritiva das variáveis estudadas.Resultados: Das 582 intervenções farmacêuticas analisadas, as categorias mais prevalentes foram dose (n = 97; 16,7%), necessidade (n = 92; 15,8%) e forma farmacêutica (n = 56; 9,6%). Após reclassificação das intervenções farmacêuticas utilizando o bundle, os critérios mais prevalentes foram: critério 1 (revisão da farmacoterapia; n = 285; 49%), critério 4 (analgesia; n = 78; 13,4%) e critério 10 (antimicrobianos; n = 65; 11,2%). As classes de medicamentos mais frequentes foram os do sistema nervoso (n = 213; 36,6%) e os anti-infecciosos gerais para uso sistêmico (n = 115; 19,8%). A taxa de adesão das intervenções farmacêuticas pela equipe médica foi de 85,1%.Conclusão: A classificação das intervenções farmacêuticas utilizando o bundle pode contribuir no aperfeiçoamento do instrumento tornando-o mais viável para uso na unidade de terapia intensiva pediátrica e direcionar o trabalho do farmacêutico clínico nas situações que geram mais problemas relacionados a medicamentos.

Introduction: Pharmaceutical interventions in the pediatric setting are highly peculiar due to the use of off-label drugs associated with the lack of scientific studies on the use of drug therapies in this population. Thus, clinical pharmacists may help identify and prevent drug-related problems.Methods: We conducted a retrospective cohort study in the pediatric intensive care unit of a teaching hospital in Rio Grande do Sul, Brazil. Pharmaceutical interventions conducted between March 2016 and July 2018 were analyzed by clinical pharmacists. These interventions were reclassified according to the criteria of a routine pharmaceutical monitoring instrument (care bundle). We conducted a descriptive statistical analysis of study variables.Results: Of 582 pharmaceutical interventions analyzed, the most prevalent categories were dose adjustment (n = 97; 16.7%), need for drug therapy (n = 92; 15.8%), and dosage forms (n = 56; 9.6%). After reclassification of pharmaceutical interventions, the most prevalent criteria were criterion 1 (review of drug therapy; n = 285; 49%), criterion 4 (analgesia; n = 78; 13.4%), and criterion 10 (antimicrobials; n = 65; 11.2%). The most common drug classes were nervous system agents (n = 213; 36.6%) and anti-infectives for systemic use (n = 115; 19.8%). The rate of adherence to pharmaceutical interventions by the medical team was 85.1%.Conclusions: The classification of pharmaceutical interventions according to the pharmaceutical care bundle may help improve the instrument, allowing its use in the pediatric intensive care unit and guiding clinical pharmacists in situations causing drug-related problems.

Perfil Farmacoterapêutico em pacientes internados em um Centro de Terapia Intensiva Adulto de um Hospital Universitário / Pharmacotherapeutic Profile in Inpatients at an Adult Intensive Care Center of a University Hospital

RESUMO Este trabalho é um estudo observacional descritivo retrospectivo, com análise de dados quantitativos de abril a julho de 2019 no Hospital Universitário de Canoas. Foram avaliados 419 prescrições e dados de pacientes quanto a sexo, idade, patologias prévias, vias de administração e medicamentos mais prescritos no CTI. Para análise, foi elaborado um Instrumento de Coleta de Dados, no qual foram transferidos para uma planilha do software Microsoft Excel para análise de frequência. Os resultados encontrados foram que a maioria dos pacientes era do sexo masculino (59%), com idade entre 40 e 69 anos (47%). As patologias mais frequentes foram Hipertensão Arterial (31%), Diabetes Mellitus (18%) e outras como infecções bacterianas, fraturas ou cirurgia cardíaca (46%). A via de administração mais utilizada foi a parenteral (63%). Os medicamentos mais prescritos foram analgésicos / antipiréticos (n = 175), analgésicos narcóticos (n = 126) e antieméticos (n = 126). A caracterização do perfil farmacoterapêutico permitiu definir estratégias de avaliação da prescrição e propor o serviço de farmácia clínica para contribuir com o conhecimento de outros profissionais relacionados aos medicamentos.

ABSTRACT This work is a retrospective descriptive observational study, with an analysis of quantitative data from April to July 2019 at the University Hospital of Canoas. 419 prescriptions and patient data were evaluated regarding sex, age, previous pathologies, routes of administration, and most prescribed drugs in the ICU. For analysis, a Data Collection Instrument was elaborated, in which they were transferred to a Microsoft Excel software spreadsheet for frequency analysis. The results found were that most of the patients were male (59%), aged 40 to 69 years (47%). The most frequent pathologies were Arterial Hypertension (31%), Diabetes Mellitus (18%), and others such as bacterial infections, fractures, or cardiac surgery (46%). The most widely used route of administration was the parenteral route (63%). The most prescribed drugs were analgesics/antipyretics (n = 175), narcotic analgesics (n = 126) and antiemetics (n = 126). Characterizing the pharmacotherapeutic profile allowed to determine prescription evaluation strategies and propose the clinical pharmacy service to contribute to the knowledge of other professionals related to medicines.

The pharmaceutical care bundle: development and evaluation of an instrument for inpatient monitoring

Introduction: Care bundles help healthcare professionals provide the best care possible in a structured and reliable way. The purpose of this study was to develop and apply an instrument for inpatient follow-up by clinical pharmacists, and evaluate its results. Methods: The care bundle was based on previously validated instruments. Population consisted of patients monitored by clinical pharmacists at a general hospital. The study was conducted in two phases: the first involved the development and implementation of the bundle, and the evaluation of pharmaceutical interventions; the second involved analyzing data from patients treated with the bundle over one year. Results: The bundle included fourteen pharmaceutical follow-up criteria used in different patterns by each area of care. In the first phase of the study, 3263 patients were monitored and 536 pharmaceutical interventions were performed, with an 85.3% compliance rate. In the second phase of the study, follow-up data was collected from 21,214 patients. The bundle criteria were used in a similar way in clinical, surgical and cancer patients. Pharmacotherapy review was the most prevalent intervention in all cases (60.1%). Hospital discharge planning and medication reconciliation were performed with a similar frequency in clinical, surgical, pediatric and general patients. Conclusions: The development and validation of a bundle aimed at guiding the clinical activities of pharmacists helped standardize procedures and interventions. Pharmacotherapy review was the bundle criterion with the highest rate of application and interventions due to the hospital's complexity and the need to consider individual patient needs and follow institutional policies. (AU)

Atuação da Farmácia Clínica e Hospitalar no Gerenciamento do Uso de Antimicrobianos em Hospital Público do DF / Performance of the Clinical and Hospital Pharmacy in the Management of Antimicrobial Use in Public Hospital of DF

Objetivo: Definir fluxos de trabalho multidisciplinares para padronização do serviço. Definição do elenco de medicamentos a ser monitorado e estudar resultados preliminares. Métodos: Criação de grupo de trabalho e tabulação dos dados em planilhas Excel ® com as principais intervenções executadas em fevereiro/2019. Resultados: Observou-se que 35% dos tratamentos foram mantidos conforme prescrição inicial. 18% tiveram a duração de tratamento reduzida e 9% não foram autorizados pela CCIH devido a inconformidades. Também foi feita a correção de dose para função renal em 8% das prescrições. Calculou-se o valor do tratamento/dia para cada antimicrobiano. As intervenções descritas representam uma economia direta de R$ 1905,08 reais. Não foram contabilizadas as despesas com materiais médico-hospitalares, transporte/logística e recursos humanos. O percentual de intervenções da farmácia clinica ocorre principalmente na etapa de prescrição devido ao rastreio pela dose individualizada. Também foram realizadas intervenções nas etapas de preparo, diluição e estabilidade. Reações adversas foram detectadas, notificadas e monitoradas devido a necessidade de manejo clínico. Conclusões: Este trabalho demonstra a economia financeira gerada pela atuação da equipe multidisciplinar e também reforça a necessidade de ampliação dos serviços farmacêuticos clínicos e logísticos, já que o trabalho no controle de dispensação individualizado associado a intervenções clínicas são mais eficazes. A complexidade do processo exige monitorização interdisciplinar em todas as etapas do tratamento visando a segurança do paciente.

Objective: Define multidisciplinary protocols for service standardization. Definition of the list of drugs to be monitored and study preliminary results. Methods: Creation of a working group and tabulation of the data in Excel® with the main interventions executed in February / 2019. Results: It was observed that 35% of the treatments were maintained according to the initial prescription. 18% had a reduced treatment duration and 9% were not authorized by CCIH due to nonconformities. Dose correction for renal function was also performed in 8% of prescriptions. The interventions described represent a direct savings of R $ 1905.08. The expenses with medical-hospital materials, transport / logistics and human resources were not accounted for. The percentage of clinical pharmacy interventions occurs mainly at the prescription stage due to individualized dose screening. Conclusions: This work demonstrates the financial economy generated by the multidisciplinary team and also confirm the need for expansion of clinical and logistic pharmaceutical services.

Use of the American Experiences for Reference on the Intervention of Pharmacists to Prescribing Behavior in China / 中国药学杂志

OBJECTIVE: To strengthen pharmacist intervention in prescribing behavior of doctors, so as to further standardize prescribing behavior.METHODS: Through the review of the advantages and disadvantages of the relevant laws, education training and assessment system for prescription intervention in the USA, a deep analysis was made in combination with the Chinese system and the characteristics of the medical staff.RESULTS: A new clinical pathway was introduced to standardize the intervention of doctors′ prescriptions, so as to improve the level of diagnosis and treatment and the environment for medical treatment in China.CONCLUSION: Improving pharmacists′ professional accomplishment and introducing Internet model and intelligent medical technology can improve the linkage among clinical, community medical institutions and social pharmacies, and also enhance the feasibility and reliability of Internet prescription drug purchase intervention. Promote the closed-loop connection and continuous upgrading of the pharmaceutical industry chain, gradually realize the standardization model of diagnosis and treatment, and then promote the results of the overall medical level.

Effects of Clinical Pharmacists' Intervention on Rational Drug Use Index of Neurosurgery Department / 中国药师

Objective: To explore the effect of clinical pharmacists participating in the clinical pharmacy work in neurosurgery de-partment and the influence on the rational drug use index. Methods: A retrospective analysis on the monthly drug proportion, antibac-terial drug utilization rate and intensity, and the other indicators before and after the intervention performed by clinical pharmacists in neurosurgery department was carried out, and the consumption sum, DDDs and medical records were statistically analyzed in April and June 2017. Results: After the intervention, the proportion of medicine, hospital days per capita, use rate and intensity of antimicrobial drugs, and the other rational drug use indices were significantly improved in neurosurgery department, and the differences in the indi-ces before and after the intervention were significant (P<0. 01). Conclusion: Consultation practice of clinical pharmacists in neuro-surgery department can effectively assist and guide the clinical treatment and improve the level of rational drug use.

Formulation and Intervention Effect Analysis of Evaluation Criteria for Alanyl-glutamine Rational Use in Our Hospital / 中国药房

OBJECTIVE:To explore the effect of clinical pharmacist intervention on the rational use of Alanyl-glutamine injection.METHODS:Referring to package inserts of Alanyl-glutamine injection,Clinical Pharmacy Consensus of Parenteral Nutrition,ASPEN Nutrition Therapy Guidelines for Critically Ill Patients,related domestic and foreign literatures,evaluation criteria for Alanyl-glutamine injection rational use was formulated.After collecting Alanyl-glutamine injection cases (497 cases) in the second quarter of 2015 and those cases (385 cases) in the second quarter of 2016,rational use of Alanyl-glutamine injection were analyzed comparatively before and after intervention.RESULTS:The utilization rate and irrational rate of Alanyl-glutamine injection were 4.6％ and 52.9％ before intervention as well as 2.9％ and 10.9％ after intervention,with statistical significance (P＜0.05).There was statistical significance in hyper-indication,excessive concentration of drug liquid,excessive supply of amino acid,irrational compatibility and solvent selection,long treatment course before and after intervention (P＜0.05).CONCLUSIONS:Clinical pharmacists reduce irrational rate of drug use and guarantee safe and effective drug use through formulating evaluation criteria for Alanyl-glutamine injection rational use and providing pharmaceutical intervention on rational use of Alanyl-glutamine injection.

Effects of Pharmaceutical Intervention after Discharge on Medication Compliance and the Prognosis of Coronary Artery Disease Patients after PCI in Primary Hospital / 中国药房

OBJECTIVE:To investigate the effects of pharmaceutical intervention after discharge on medication compliance and prognosis of patients with coronary artery disease after percutaneous coronary intervention(PCI) in primary hospital.METHODS:One hundred and eighty patients with coronary artery disease selected from our hospital after PCI during Jan.2012 to May 2015 were divided into test group and control group according to whether the patients received pharmaceutical intervention after discharge,with 90 cases in each group.Control group received conventional pharmaceutical care and discharge education.Test group additionally received pharmaceutical intervention (pharmaceutical service files,telephone follow-up,patient education,etc.) after discharge.Medication compliance and occurrence of cardiovascular events were compared between 2 groups in 1 year after discharge.RESULTS:Within 1 year after discharge,the proportion of patients showing good compliance in test group was higher than control group,the proportion of patients showing partial and non compliance in test group were lower than control group;the inci dence of heart failure and repeated revascularization,hospitalization mortality and total mortality of test group were significantly lower than control group,with statistical significance (P＜0.05).CONCLUSIONS:Pharmaceutical intervention after discharge can improve the medication compliance of coronary artery disease patients after PCI in primary hospital,reduce the occurrence of cardiovascular events and improve the clinical prognosis.

Adjustment and Analysis of Analgesic Regimen for One Ovarian Cancer Patient with Brain Metastases / 中国药师

Objective:To provide reference for the treatment of mixed pathological pain by analyzing the analgesic regimen for one ovarian cancer patient with brain metastases. Methods: The clinical pharmacists could conduct comprehensive and dynamic pain as-sessment,and supply the best evidence by consulting the related literatures and guidelines to assist the clinicians to formulate individu-alized administration regimen. Results: After comprehensive considering the clinical diseases, the characteristics and degree of the pain,the psychological status and the other factors,the analgesic regimen was finally adjusted to be a strong opioid combined with a tri-cyclic antidepressant,an anticonvulsant and a corticosteroid. Consequently, the patient obtained effective analgesic treatment without adverse reactions. Conclusion:The pain caused by ovarian cancer with brain metastasis is often severe and difficult to be treated. In clinics,comprehensive and dynamic pain assessment,standard titration of opioids and rational use of adjuvant drugs based on consider-ing patients' conditions are critical for controlling the pain as soon as possible and improving the quality of life of patients.

Effect of pharmaceutical intervention on rational use of alanyl-glutamine / 中国基层医药

Objective To explore the effect of clinical pharmacist intervention on the rational use of alanyl-glutamine injection.Methods Refer to the second quarter of 2015 and the second quarter of 2016 in the General Hospital of Shanxi Datong Coal Group using alanyl-glutamine injection discharge instructions for special comment, compared and analyzed the changes in the use of the drug before and after the intervention.Results Before intervention, the usage rate and the irrational rate of alanyl-glutamine injection were 4.6% and 52.9%,those were 2.9% and 10.9% after intervention.The differences were statistically significant(χ2 =49.209,169.200,all P<0.05).There were significant differences before and after intervention compared in the choice of drug suitability,the high concentration of the medicine liquid,the excessive supply of amino acid and the incompatibility of the compatibility (χ2 =38.882, 31.348,26.242,4.286,all P<0.05 ).Conclusion The pharmacy intervention is feasible and effective for the rational use of alanyl-glutamine injection,and it can reduce irrational using rate.

Pharmaceutical Care on Anti-infection Therapy of Patients with Augmented Renal Clearance / 医药导报

Objective To investigate the role of clinical pharmacist in anti-infection therapy for patients with augmented renal clearance (ARC).Methods A case with multi-site severe infection after traffic accident was treated with anti-infection therapy.According to the characteristics of infection and pharmacokinetics,clinical pharmacist discussed the intervention by clinical pharmacist in terms of formulating anti-infection program and adjustment of individual dose.Results After consultation and evaluation by clinical pharmacist,the patient was diagnosed as ARC.According to pharmacokinetics characteristics reported by literature,vancomycin was adjusted to 1 g (once per 8 h).Based on detection result of pathogenic bacteria,meropenem was replaced by cefoperazone/sulbactam,and the dose was increased to 3 g (once per 6 h).And then,vancomycin concentration was detected again,and it reached ＞ 10 μg· mL-1;pathogenic bacteria culture result was negative.This patient obtained good therapeutic effect.Conclusion Clinical pharmacist could assist physician on anti-infection treatment and dose adjustment of ARC patient,and improve ARC patient's therapeutic effect.

Effects of Clinical Pharmacists Participating in the Implementation of Femoral Neck Fracture Clinical Pat-hway under DRGs-PPS / 中国药房

OBJECTIVE:To investigate the effects of clinical pharmacists participating in the implementation of clinical path-way under the condition of disease diagnosis related groups-prospective payment system(DRGs-PPS),and to provide reference for promoting rational drug use in the clinic. METHODS:Patients with femoral neck fracture in the clinical pathway were collected from our hospital as research objects. The patient collected during Jan.-Dec. 2015 were included in control group(52 patients includ-ed,41 patients completed)and those collected during Jan.-Dec. 2016 were included in observation group(58 patients included,46 patients completed). Clinical pharmacists participated in the implementation of clinical pathway in observation group,and provided technological intervention and administrative intervention. No intervention was performed in control group. Hospitalization time, hospitalization cost,drug cost and ADR were observed in 2 groups. The rationality of antibiotics for prophylactic use,analgesic drugs,adjuvant drugs,anti-osteoporosis drugs and anticoagulant were compared between 2 groups. RESULTS:After clinical pharma-cists participating in the implementation of clinical pathway in observation group,there was no statistical significance in hospitalization time or the incidence of ADR between 2 groups(P>0.05); hospitalization cost and drug cost of observation group were significantly lower than those of control group,with statistical significance(P<0.05). Medication time and cost of antibiotics for prophylactic use,cost of analgesic drugs,medication time of adjuvant drugs in observation group were significantly shorter/lower than control group;type of anti-osteoporosis drugs was significantly more than control group,with statistical significance(P<0.05). CONCLUSIONS:Under DRGs-PPS,the participation of linical pharmacists participating in the implementation of femoral neck fracture clinical pathway can play an important role in regulating the clinical rational use of 5 kinds of drugs and ensuring the safety,effectiveness and econom-ics of drug use.

Special Review on Rational Drug Use in Children with Common Cold / 医药导报

Objective To understand drug use in children with common cold through comments on prescription and drug analysis,and to provide theoretical basis for standardizing medical treatment and promoting rational drug use.Methods A retrospective survey method was applied.Prescriptions of common cold in the department of pediatrics from Oct.to Dec.2015 were reviewed,and Excel 2013 was used for statistical analysis.Rationality of drug use was evaluated based onhospital prescription review management specification (try out),instructions and consensus of related experts at home and abroad.Results The utilization rate of antibacterial drugs was 93.4％in children with common cold of our hospital,utilization rate of antiviral drugs was 59.7％,utilization rate of compound cold medicine was 96.4％,and the rate of combined utilization of more than two kinds of compound medicine was 65.7％.Excessive medicine for common cold existed and abuse of cold medicine,antimicrobial and antiviral drug,irational drug combination in this hospital.Conclusion Clinical doctors lack cognition to common cold and cold medicines.Hospital pharmacy department should take effective pharmaceutical interventions to improve the level of rational drug use.

Analysis of the Effect of Pharmaceutical Intervention on Rational Use of TCM Injection / 中国药房

OBJECTIVE:To provide reference for the rational use of TCM injections. METHODS:487 medical records using TCM injection in our hospital from Jul. to Dec. 2014 were selected as control group,another 500 from Jan. to Jun. 2015 were inter-vention group. Utilization,rationality and adverse reactions of TCM injection between 2 groups were compared. RESULTS:Accord-ing to the intervention by clinical pharmacists,the sales amount and utilization rate of top 10 TCM injection in our hospital were lower significantly. The irrational utilization rate of 5 types (totally 26 varieties) in intervention group decreased (21.60% vs. 43.33%),incidences of adverse reactions reduced(3.00% vs. 7.39%),compared with control group,the differences were statisti-cally significant (P<0.05). Treatment cost per capita [(217.17 ± 22.64) yuan vs. (480.77 ± 21.35) yuan] and hospitalization time [(6.50 ± 1.99)d vs. (10.02 ± 3.25)d] in intervention group were significantly lower or shorter than control group,the differences were statistically significant (P<0.05). CONCLUSIONS:Implementing pharmaceutical interventions can strengthen the sense of clinicians’rational use of TCM injection,raise the level of rational use of drugs and reduce adverse reactions and medical errors.