Guideline for the evaluation of prescription appropriateness.

Evaluation of prescriptions is a necessary process of evaluating the appropriateness of clinical drug usage, discovering existing problems, and formulating solutions. There are challenges for professionals within hospital medical departments and for clinicians and pharmacists who have clinical questions relating to inappropriate or abnormal prescriptions as identified by the electronic evaluation system of prescription. Medications are usually used correctly according to the drug instructions or guidelines. At present, there are no relevant domestic or international guidelines, or principles or standards for identifying inappropriate or abnormal prescriptions. To develop the guideline for evaluation of prescriptions appropriateness in clinical practice, the Pharmaceutical Affairs Commission of the Chinese Hospital Association formed the guideline working group consisting of multidisciplinary experts. The guideline working group summarized clinical questions in the evaluation of prescriptions, searched for supporting evidence, and reached a consensus for recommendations. The guideline contains 6 recommendations for evaluating prescription appropriateness, and the general principle of these recommendations is that clinicians should provide drug instructions, guidelines, or moderate evidence supporting the prescription, and the evaluators will then judge the prescription to be either appropriate or irrational. The recommendations resolve common clinical questions, using supporting examples, explanations and a flow chart. The evaluation of prescription appropriateness could be made more systematic and transparent based on this guideline's conclusions.

Regional environmental change and human activity over the past hundred years recorded in the sedimentary record of Lake Qinghai, China.

Environmental change and human activity can be recorded in sediment cores in aquatic systems such as lakes. Information from such records may be useful for environmental governance in the future. Six sediment cores were collected from Lake Qinghai, China and its sublakes during 2012 and 2013. Measurements of sediment grain-size fractions indicate that sedimentation in the north and southwest of Lake Qinghai is dominated by river input, whereas that in Lake Gahai and Lake Erhai is dominated by dunes. The sedimentation rates in Lake Qinghai were calculated to be 0.101-0.159 cm/y, similar to the rates in other lakes on the Qinghai-Tibetan Plateau. Using these data and sedimentation rates from the literature, we compiled the spatial distribution of sedimentation rates. Higher values were obtained in the three main areas of Lake Qinghai: two in river estuaries and one close to sand dunes. Lower values were measured in the center and south of the lake. Measurements of total organic carbon (TOC), total nitrogen (TN), phosphorus concentrations, and TOC/TN ratios in three cores (QH01, QH02, and Z04) revealed four horizons corresponding to times of increased human activity. These anthropogenic events were (1) the development of large areas of cropland in the Lake Qinghai watershed in 1960, (2) the beginning of nationwide fertilizer use and increases in cropland area in the lake watershed after 1970, (3) the implementation of the national program "Grain to Green," and (4) the rapid increase in the tourism industry from 2000. Profiles of Rb, Sr concentrations, the Rb/Sr ratio, and grain-size fraction in core Z04 indicate that the climate has become drier over the past 100 years. Therefore, we suggest that lake sediments such as those in Lake Qinghai are useful media for high-resolution studies of regional environmental change and human activity.

Genetic polymorphisms are associated with variations in warfarin maintenance dose in Han Chinese patients with venous thromboembolism.

AIM: Warfarin is a clinical anticoagulant that requires periodic monitoring because it is associated with adverse outcomes. Personalized medicine, which is based on pharmacogenetics, holds great promise in solving these types of problems. It aims to provide the tools and knowledge to tailor drug therapy to an individual patient, with the potential of increasing safety and efficacy of medications. MATERIALS & METHODS: In the present study we analyzed genotypes of 14 SNPs for seven genes using DNA from 297 Han Chinese venous thromboembolism patients treated with warfarin. RESULTS: Multiple regression analyses revealed that CYP2C9 genotype (p = 0.001), VKORC1 genotype (p < 0.001), age (p < 0.01) and weight (p < 0.001) were all associated with warfarin dose requirements, which can explain 37.4% of the variability of warfarin dose among Han Chinese patients. Meanwhile, in the validation cohort, the predicted warfarin daily dose was calculated using the best model with a 64.5% predicted dose being acceptable (-1 mg/day ≤Δwarfarin dose ≤1 mg/day). CONCLUSION: We developed a pharmacogenetic dose algorithm for warfarin treatment that uses genotypes from two genes (VKORC1 and CYP2C9) and clinical variables to predict therapeutic maintenance doses in Chinese patients with venous thromboembolism. The validity of the dosing algorithm was confirmed in a cohort of venous thromboembolism patients on warfarin therapy.

CYP1A1, smoking and venous thromboembolism.

Since CYP1A1 enzyme is involved in metabolism of tobacco carcinogens, the CYP1A1 gene may be of relevance to smoking-induced differences in the risks of venous thromboembolism (VTE). We conducted a case-control study to investigate genetic polymorphisms in CYP1A1 that might modify the risk of developing VTE. A total of 425 Chinese patients with VTE and 527 VTE-free control individuals, matched by age and gender, were included in this analysis. The MspI and Ile462Val polymorphisms in CYP1A1 gene were analysed using the Amplification Refractory Mutation System (ARMS) method. The Ile462Val AG variant and combined AG and GG variant was significantly associated with VTE, adjusted for age, gender, weight and contraceptives (OR=1.362, 95%CI 1.026, 1.809, p=0.033; OR=1.420, 95% CI 1.081, 1.865, p=0.012, respectively); The AG and GG combined variant was still significantly associated with VTE when adjusting further for smoking (OR=1.344, 95%CI 1.019,1.772, p=0.036) A more than two-fold increase for VTE was associated with the Ile462Val combined variant of AG+GG (OR of 2.805, 95% CI 1.250, 6.293, p=0.012) in the smokers. Genetic variations of CYP1A1 Ile462Val contribute to susceptibility to smoking-induced VTE in the Chinese populations. A two-fold increase in the risk in the smokers in the patients who carry CYP1A1 Ile462Val variant alleles has demonstrated the importance of gene-environment interactions in the development of this disease.