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OBJECTIVE To improve the a pplicability of the prescription pre-review system to traditional Chinese medicine （TCM），and improve the quality of prescription review and rational drug use. METHODS The inappropriate pre-review rules of TCM prescription in prescription automatic screening system of our hospital were summarizd ，review rules were revised and the review process was standardized purposefully. The data of prescription review of Chinese patent medicine and TCM decoction pieces were collected from outpatient and emergency department of our hospital in the second quarter of 2020 （before the optimization of review rules ）and the fourth quarter of 2021（after the optimization of review rules ）. The reasonable rate of prescription and effective rate of intervention before and after the optimization of review rules were compared，and unreasonable problems were counted. RESULTS In our hospital ，the pre-review system had poor applicability in reviewing TCM prescriptions. There were some problems ，such as inconsistent or nonstandard names of TCM decoction pieces ，unreasonable dosage range settings，mechanical review of repeated drug use ，excessively strict review of “eighteen incompatible medicaments ”and“nineteen medicaments of mutual restraint ”and lack of safety warnings for special populations. In view of the above problems ，our hospital standardized the name of TCM decoction pieces ，and optimized the review rules such as dose range of TCM decoction pieces ， usage and dosage of Chinese patent medicine ，repeated medication ，drug interaction ，drug taboos for special people ，etc. After the revision of the rules ，the qualification rate of Chinese patent medicine prescriptions increased from 97.38％ to 98.17％（P＞0.05）， and the rate of effective intervention increased from 42.86％ to 79.71％（P＜0.05）；the qualification rate of TCM decoction pieces prescriptions increased from 47.98％ to 79.29％（P＜0.05），and the rate of effective intervention increased from 11.17％ to 29.13％（P＜0.05）. The number of unreasonable problems such as excessive daily dosage of TCM ，excessive dosage range ，drug interaction and drug contraindications for special groups decreased significantly in our hospital （P＜0.05）. There was no statistical significance in the number of unreasonable problems of repeated medication between 2 groups （P＞0.05），but there was a downward trend. T he total number of unreasonable problems had also decreased significantly （P＜0.05）. CONCLUSIONS The optimization measures of review rules in our hospital canimprove the applicability of the review system for TCM prescriptions，and improve the quality of prescription review and the level of rational drug use. However ，review rules of indications and the effectiveness of prescription intervention still needs to be further improved.
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OBJECTIVE：To provide r eference for optimizing the review rules of PASS system and improving rational drug use in our hospital. METHODS ：The prescription review of Calcineurin inhibitor （CNI）was taken as an example. The pharmacists of our hospital collected the inappropriate rules in PASS system in their daily work ，and modified and improved them. Three thousands outpatient prescriptions and inpatient orders containing CNI in the fourth quarter of 2019（before the rule modification ） and the fourth quarter of 2020（after the rule modification ）were randomly selected for our hospital. The warnings ，false positives and false negatives of PASS system review were compared before and after rule modification. RESULTS ：There were some problems in the PASS system of our hospital ，such as too strict judgement on off-label use ，lax review rules ，false positive in the audit of contraindications ，failure to grade warnings according to the severity of drug interactions ，inaccurate judgment of patients ’ liver and kidney function ，lengthy problem description ，incomplete or wrong information in the system database ，lack of effects information of food and traditional Chinese medicine on CNI ，etc. In view of these inappropriate rules ，the pharmacy department of our hospital improved the quality of PASS system review rules through formulating the standardized management process of off-label use ， reasonably enabling the interception function of PASS system ， modifying the false-positive rules of drug contraindications，warning drug interaction by grade ，reviewing in combination with laboratory test reports ，and real-time maintenance of system database information and adding patient education content. The number of warning had decreased from 182 to 105，and the proportion of false-negative and false-positive review results from 25.03％ to 0.43％ after a year of optimization. CONCLUSIONS：The optimization of CNI review rules can enhance the applicability of the PASS system ，facilitate the advance of the prescription pre-review ，and promote clinical rational drug use.
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Objective To investigate the value of A2DS2 score in predicting stroke-associated pneumonia (SAP) in patients with anterior and posterior circulation ischemic stroke. Methods The clinical data of patients with acute ischemic stroke admitted to the Department of Neurology, Heze Municipal Hospital from June 2011 to March 2016 were analyzed retrospectively. The independent risk factors for SAP were determined by binary multivariate logistic regression analysis. The value of A2DS2 score in predicting SAP in patients with anterior and posterior circulation ischemic stroke was evaluated by the receiver operator characteristic (ROC) curve. Results A total of 530 patients with acute ischemic stroke were enrolled, 90 of them (16. 98％) had SAP. There was no significant difference in SAP incidence between the patients with anterior circulation stroke (n = 430) and posterior circulation stroke (n = 100)(17. 2％ vs. 16. 0％; χ2 = 0. 084, P = 0. 772). Binary multivariate logistic regression analysis showed that the A2DS2 score was an independent risk factor for SAP in patients with ischemic stroke (odds ratio [OR] 1. 644, 95％ confidence interval [CI] 1. 097-2. 426), anterior circulation stroke (OR 1. 593, 95％ CI 1. 086- 2. 387), and posterior circulation stroke (OR 1. 463, 95％ CI 1. 064-2. 174). The ROC curve showed that the area under the curve of the A2DS2 score predicting SAP in patients with ischemic stroke, anterior circulation and posterior circulation stroke were 0. 826 (95％ CI 0. 792-0. 869), 0. 821 (95％ CI 0. 783-0. 858), and 0. 832 (95％ CI 0. 781-0. 923), respectively. The best cut-off value was 5. There was no significant difference in the area under SAP curve of the A2DS2 score for predicting SAP between patients with acute anterior circulation and posterior circulation ischemic stroke (Z = 0. 259, P = 0. 394). Conclusion A2DS2 score could predict SAP in patients with anterior circulation and posterior circulation stroke without difference, both of the cut-off value was 5.
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Objective To investigate the pharmacokinetics ( PK ) and pharmacodynamics ( PD ) processes of rabeprazole in inhibiting gastric acid secretion with the combined PK-PD model. Methods A total of 10 healthy volunteers were given a intravenous infusion of 20 mg rabeprazole over a 30-min period. The concentration of rabeprazole in the plasma at different time points was detected by HPLC,and the PK parameters were calculated by DAS 2. 0 software. At the same time the intragastric pH was monitored over 24 hours to fit the PD parameters with indirect inhibition model. Results The main PK parameters,t1/2,Cmax,and AUC were(60. 5±17. 3)min,(1 299. 1±201. 0)ng·mL-1,and(106. 4±26. 0)mg·min·L-1, respectively.The corresponding PD parameters,Kin,Ke,IC50 and Imax were(8.200±3.362)h-1,(1.080±0.378)h-1,(0.286± 0. 129)mg·L-1 and(6. 93± 2. 15)pH,respectively. Conclusion The PK of rabeprazole in healthy volunteers conforms to one compartment model,and the PD fits the indirect response inhibition model. The equation can effectively establish the relationship between the blood drug concentration and the effect.
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Objective To establish the quality standard for Ulter Zhuhuang gel.Methods Indirubin,cholic acid and borneol were identified by TLC.The content of indirubin and cholic acid was determined by HPLC.Result The TLC sports developed was fairly clear.The HPLC method showed that the average recovery of indirubin and cholic acid was 100.3% with RSD=2.1% and 98.9% with RSD=1.8% respectively.Conclusion The method is convenient and accurate.It can be used for the quality control of Ulter Zhuhuang gel.
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Object To investigate the effects of ultra-fine powder technique and granularity of pellets on dissolution rate in vitro. Methods The dissolution rate of ultra-fine ERMIAO PILL with different granule diameters in vitro was measured and compared with the index of berberine by UV spectro-photometry. Results The dissolution parameters T 50 and T d of four kinds of ultra-fine ERMIAO PILL are 61.60, 19.48, 17.84, 8.97 min and 102.3, 33.29, 26.98, 14.77 min, respectively. Those of general powder ERMIAO PILL with granule diameter of 2.4 mm are 89.61 and 155.68 min. Conclusion The dissolution rate of ultra-fine powder is quicker than that of general powder, and the rate increases with the granularity of PILL decreasing.
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Objective To establish a method for the determination of eugenol in Xiao’er Fuxie Waifu Gel.Methods RP-HPLC method was developed with Lichrospher-C18 analysis column,using methyl alcohol-water(65:35) as mobile phase.The detection wavelength was 280 nm and flow rate was 1.0 mL/min.Results The linear range of eugenol was from 0.108 to 1.724 ?g(r= 0.999 9).The average recovery was 99.1 %and RSD was 1.4 %.Conclusion The method is convenient and accurate.It can be used for the quality control of Xiao’er Fuxie Waifu Gel.
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AIM:To investigate the effect of ?-cyclodextrin inclusion on transdermal absorption of volatile oil in lilac-cassiabark Gel. METHODS: The release test of two kinds of lilac-cassiabark Gel(gel A without ?-cyclodextrin inclusion and gel B with ?-cyclodextrin inclusion) was assayed with Franz diffusion cell with the help of the cumulative amount of eugenol in unit area in vitro. RESULTS: The percutaneous absorption process of eugenol in two kinds of gels were conformed to zero-order releasing model,and the transdermal rates were 16.212?4.128 and 11.344?1.929 ?g/(cm~2?h) respectively.Compared with gel A,the transdermal rate of eugenol was slower in gel B(P
