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Objective To optimize the treatment plan for dermatitis medicamentosa in a patient with abnormal liver function associated with infection.Methods The culprit medication for drug eruption was identified by reviewing the patient′s liver and kidney function, routine blood count, therapeutic drugs, allergic history, by analyzing the characteristics of the compounding medication, combined with literature search on drug eruption diagnosis and treatments.Following the antihistamines and glucocorticoid use guidelines, the treatment plan was optimized by selecting appropriate antihistamines and glucocorticoids based on their metabolism and excretion pathway.Results The rash was poorly controlled after clinical pharmacist′s initial recommendation to use chlorpheniramine (intramuscular injection) and cetirizine (oral).The clinical pharmacist further suggested dexamethasone intravenous drip.The patient recovered well with the combination therapy of antihistamines and glucocorticoid.Conclusion When drug eruption occurred, clinical pharmacists should evaluate patient′s disease and medications comprehensively, provide timely and accurate pharmaceutical care to patients.
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Objective To improve the rational use of angiotensin-converting enzyme inhibitors (ACEI).Methods Clinical pharmacists reviewed ACEI use for the patients admitted into coronary heart disease care unit (CCU) during May 2012 to May 2013 to analyze the rational use of ACEI according to the expert consensus standards, guidelines and drug instructions of ACEI without any interventions.Clinical pharmacists intervened the irrational use of ACEI based on the same standard from June 2013 to May 2015.Results By comparing the data before and after intervention, it was found that the percentage of ACEI use increased from 80.1％ to 98.9％.The percentage of initial ACEI overdose was dropped from 21.4％ to 0.9％, and the percentage of under dose was decreased from 4.7％ to 0.5％, which was statistically significant.Conclusion Clinical pharmacists can play a leading role in promoting the rational use of ACEI.
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Objective The aim of the study is to evaluate clinical efficacy and safety of azatreonam or ceftazidime on treatment of lower respiratory tract infection .Methods Four English databases (MEDLINE、EMBASE、Pubmed、Cochrane li‐brary) and three Chinese databases (CNKI、VIP、WANFANG) were searched .Meta‐analysis was performed using Review Manager 5 .2 .Results The Meta‐analysis revealed azatreonam was superior to ceftazidime in total efficiency (RR=1 .15 ,95%CI is 1 .09‐1 .21) .No significant differences are seen between azatreonam and ceftazidime (RR=1 .03 ,95% CI is 0 .98‐1 .09) on the bacterial eradication rates or the incidence of adverse reactions (RR=0 .66 ,95% CI is 0 .39‐1 .12) .Conclusion Azatreonam is more effective than ceftazidime on the treatment of lower respiratory tract infection in the clinical practice .
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Objective:To explore the role of clinical pharmacists in the diagnosis and treatment of drug-induced diseases. Meth-ods:Clinical pharmacists analyzed the abnormal changes in the patients and looked for drug factors during the ward round with physi-cians. Results:Clinical pharmacists found drug-induced diseases and irrational drug use, and proposed the solutions accepted by phy-sicians. Conclusion:Clinical pharmacists should actively participate in the diagnosis and treatment of drug-induced diseases.
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Objective:To analyze the intervention effect of a successfully created platform“intelligent interactive software for drug monitoring warning” on the decrease of medication errors and adverse drug events,and the increase of the drug treatment level. Meth-ods:The intensive care unit ( ICU) of our hospital was selected as the experiment group, and the ICU of the other two hospitals was used as the contrast group. During the first 18 months, both groups were without intervention. During the latter 18 months, the plat-form was used in the experiment group, and the clinical pharmacists employed alerts of the system in the practice of interaction with doctors to correct the medication errors. No intervention was performed in the contrast group. In addition, all adverse drug events in both groups were surveyed. Results:During the first period, 50 preventable adverse drug events were discovered with the incidence of 6. 8% in the experimental group. During the second period, the correct rate of the alerts was 97. 7%. Through the effective interven-tion,the alerts and their percentage in the prescriptions were from the maximum of 68 and 1. 1% to the minimum of 6 and 0. 1%. To-tally 17 preventable adverse drug events were found with the incidence of 2. 4% after the intervention. The decline was significant, 848 991 yuan of hospitalization expenses was saved, and 294 days of the length of stay were shortened. There was no change in the contrast group, and there was no change in unpreventable adverse drug events in the two groups before and after the intervention. Conclusion:The intelligent interactive software for drug monitoring warning can examine many sorts of medication errors,and decline the inci-dence rate of preventable adverse drug events in ICU. However, it needs to continuously improve the intelligence. Clinical pharmacists need to master the relevant conditions of patients to detect the irrational drug use based on the clinical practice for each patient.
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Objective:To understand the use of antibiotics in our hospital to provide clinical drug reference. Method:The hospital outpatient and emergency prescriptions in 2007 were randomly selected and according to clinical pharmacology knowledge and literature material,sorting of the antibiotics use frequency and category was carried out,and the statistics and rationality about the antibiotics prescriptions were classified and analyzed.Result:According to the use frequency(DDDs),the top 3 kinds were ornidazole,levofloxacuin and azithromycin.Cephalosorins,quinolones and macrolides were most frequently used in clinic.In the total 10,800 prescriptions audited,3842 antibiotic prescriptions and 409 irrational prescriptions were used respectively in the drug solvent which presented problems in the dosage regimen,pharmacological effects and rational drug use.Conclusion:The use of antibiotics in the hospital was basically reasonable,but there were still some problems and the need to further improve the prescription audit would be helpful for the rational use of antibiotics.
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OBJECTIVE:To reduce the incidence of the preventable adverse drug events by using information technology. METHODS:The intelligent prescription screening system was developed and the hospital information system-based link between "contraindications" and diagnosis of patients,their laboratory results and creatinine clearances were realized. RESULTS:Of the total 5 546 prescriptions selected randomly within one day,46 laboratory results-related,28 diagnosis-related and 32 creatinine clearance-related contraindications were detected by the system. CONCLUSION:This link mode is practical in that those prescriptions that violating the contraindications can be found out by the system; however,the clinical effect of the intelligent prescription screening system remains to be proved.
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OBJECTIVE:To introduce the function and operation of "Intelligentized prescription-monitoring system on the dosage and medication frequency of antibiotics" in order to reduce adverse drug events and increase therapeutic efficacy. METHODS: The monitoring system was evaluated and analyzed from aspects of the tools used for the research and development,software and hardware platforms,functional modules,characteristics,technical difficulties,and effectiveness of the monitoring system. Meanwhile,599 prescriptions sampled randomly were examined online. RESULTS: For the total 599 prescriptions,50 warnings appeared in the system,and which had been confirmed to be correct by experts. CONCLUSIONS: The discrepancy between the dosage and (or) medication frequency and the drug package inserts can be detected with the use of monitoring system,which thus meets our expected goal.
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Objective:To study the relations between the length and costs of hospitalization and the severe ad- verse drug events which took place in the gastroenterologic and pulmonary wards.Method:Pharmacists surveyed ADEs in- cluding their existence and preventability in the wards,and found out the quantity of excessive length and extra costs of hos- pitalization.Result:There were totally 20 identified severe ADEs in which 11 were preventable in the pulmonary wards during 8 months and in the gastroenterologic wards during 5 months.The mean attribute length of stay was 17.8 days and mean attribute extra cost of hospitalization was 16,869 yuan for each ADE.The mean attribute length of stay was 19.3 days and mean attribute extra cost of hospitalization was 12,578 yuan for each preventable ADE.Conclusion:The attribute length of stay and extra costs of hospitalization were substantial.Since many severe ADEs were preventable,the effective measure must be taken to decrease their incidence.
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Objective:To study the correlation between in vitro chemosensitivity of Fluorouraci(5-Fu) + Mitomycia (MMC) and its clinical response and prognosis in human colorectal cancers. Method:The chemosensitivity of 5-Fu + MMC was tested in 169 Dukes B and C colorectal cancers with the MTT method,and the progression-free internal and prognosis in 4 years following the surgery were observed. Result:Based on the in vitro chemosensitivity of 5-Fu + MMC, 100 patients were divided into an antagonistic group(28 patients) in which their relapse rates were 57. 1% and a synergistic-additive group(72 patients) in which their relapse rates were 22.2% (P
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OBJECTIVE:To evaluate clinical efficacy and toxicities of oxaliplatin or irinotecan combined with 5-FU/LV for advanced colorectal cancer. METHODS:RCTs were retrieved from PubMed database and CHKD and Metaanalysis was carried out using Review Manager version 4.2.2 software. RESULTS:Six studies were enrolled. The oxaliplatin group was superior to irinotecan group in the overall response rate(RR=0.82,95%CI ranged from 0.74 to 0.91). The incidence rate of neutropenia in irinote-can group was lower than in oxaliplatin group(RR=0.79,95%CI ranged from 0.69 to 0.90)while the incidence of nausea/vomiting and diarrhea in irinotecan group was higher than in oxaliplatin group(RR=1.85,95%CI ranged from 1.42 to 2.40;RR=1.75, 95%CI ranged from 1.41 to 2.17). CONCLUSION:The scheme oxaliplatin combined with 5-FU/LV in the treatment of advanced colorectal cancer is superior to the scheme irinotecan combined with 5-FU/LV.
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OBJECTIVE: To promote rational use of non-antimicrobials based on Intelligent Monitoring System for Dosage and Frequency of Drugs.METHODS: Base on the information system of hospital,dosage and frequency of drugs were collected from Intelligent Monitoring System for Dosage and Frequency of Drugs and connected with patients’ ages,weights,body surface areas and renal functions.1 315 hospitalized prescriptions of non-antimicrobials were randomly collected from our hospital one day.RESULTS: There were 200 warnings of overdosage each time and moderate frequency,91 warnings of overdosage each time and inadequate frequency,43 warnings of moderate dosage each time and inadequate frequency,41 warnings of moderate dosage each time and excessive frequency,15 warnings of inadequate dosage each time and moderate or inadequate frequency for drugs that needn’t be adjusted according to age and renal functions.There were 11 warnings of overdosage and excessive frequency for drugs that should be adjusted according to patients’ age and renal function.CONCLUSION: This kind of connection is practical,when prescriptions of non-antimicrobials which violate the rules of dose and (or) frequency are identified by system.But the significance of Intelligent Monitoring System for Dosage and Frequency of Drugs should be proved by practice.