RESUMO
Introduction: Drug-related problems (DRPs) are not only detrimental to patients' physical health and quality of life but also lead to a serious waste of health care resources. The condition of DRPs might be more severe for patients in primary health care institutions. Objective: This systematic review aims to comprehensively review the characteristics of DRPs for patients in primary health care institutions, which might help find effective strategies to identify, prevent, and intervene with DRPs in the future. Methods: We searched three English databases (Embase, The Cochrane Library, and PubMed) and four Chinese databases (CNKI, CBM, VIP, and Wanfang). Two of the researchers independently conducted literature screening, quality evaluation, and data extraction. Qualitative and quantitative methods were combined to analyze the data. Results: From the 3,368 articles screened, 27 met the inclusion criteria and were included in this review. The median (inter-quartile range, IQR) of the incidences of DRPs was 70.04% (59%), and the median (IQR) of the average number of DRPs per patient was 3.4 (2.8). The most common type of DRPs was "treatment safety." The causes of DRPs were mainly in the prescribing section, including "drug selection" and "dose selection", while patients' poor adherence in the use section was also an important cause of DRPs. Risk factors such as the number of medicines, age, and disease condition were positively associated with the occurrence of DRPs. In addition, the medians (IQR) of the rate of accepted interventions, implemented interventions, and solved DRPs were 78.8% (22.3%), 64.15% (16.85%), and 76.99% (26.09%), respectively. Conclusion: This systematic review showed that the condition of DRPs in primary health care institutions was serious. In pharmaceutical practice, the patients with risk factors of DRPs should be monitored more closely. Pharmacists could play important roles in the identification and intervention of DRPs, and more effective intervention strategies need to be established in the future.
RESUMO
OBJECTIVE: To study the effects of enteral administration of carbachol on organ dysfunction induced by partial ischemia/reperfusion injury to the intestine. METHODS: Seventy-five white rabbits were randomized into four groups: ischemia/reperfusion (I/R), carbachol+ I/R and sham operation. The superior mesenteric artery (SMA) was partially blocked with self-designed blocker, producing 50% decrease in SMA blood flow, lasting for 4 hours. One hour after SMA occlusion, carbachol was injected into gut in carbachol+I/R group. Sham group was treated as same as I/R group except without SMA occlusion. The levels of alanine aminotransferase (ALT), creatinine (Cr), MB isoenzyme of creatine kinase (CK-MB) and tumor-necrosis factor-alpha (TNF-alpha) were measured by automatic analyzer and with radio-immunology method before SMA occlusion, and at 2, 4, 6, 8, 24, 48 and 72 hours after occlusion. The pathological changes of the intestinal tissue were observed with hematoxylin and eosin stained sections. RESULTS: In I/R groups, the levels of TNF-alpha, Cr, ALT, CK-MB in plasma were increased dramatically after partial ischemia/reperfusion injury to the gut. Severe pathological changes were observed in the hearts, livers, and kidneys. While in carbachol treatment groups, the levels of TNF-alpha, Cr, ALT, CK-MB in plasma were decreased dramatically after enteral administration of carbachol during ischemia stage. The pathological injuries were alleviated in the heart, liver, and kidney. CONCLUSION: Enteral administration of carbachol may alleviate after the systemic inflammatory response and pathological changes in various organs, thus provide a protective effect on gut and remote organs partial ischemia/reperfusion of the intestine.
