Abstract Background Research on potentially inappropriate medications (PIM) and medication-related problems (MRP) among the Chinese population with chronic diseases and polypharmacy is insufficient. Objectives This study aimed to investigate the prevalence of PIM and MRP among older Chinese hospitalized patients with chronic diseases and polypharmacy and analyze the associated factors. Methods A retrospective cross-sectional study was conducted in five tertiary hospitals in Beijing. Patients aged ≥ 65 years with at least one chronic disease and taking at least five or more medications were included. Data were extracted from the hospitals’ electronic medical record systems. PIM was evaluated according to the 2015 Beers criteria and the 2014 Screening Tool of Older Persons’ Prescriptions (STOPP) criteria. MRPs were assessed and classified according to the Helper-Strand classification system. The prevalence of PIM and MRP and related factors were analyzed. Results A total of 852 cases were included. The prevalence of PIM was 85.3% and 59.7% based on the Beers criteria and the STOPP criteria. A total of 456 MRPs occurred in 247 patients. The most prevalent MRP categories were dosages that were too low and unnecessary medication therapies. Hyperpolypharmacy (taking ≥ 10 drugs) (odds ratio OR 3.736, 95% confidence interval CI 1.541–9.058, P = 0.004) and suffering from coronary heart disease (OR 2.620, 95%CI 1.090–6.297, P = 0.031) were the influencing factors of inappropriate prescribing (the presence of either PIM or MRP in a patient). Conclusion PIM and MRP were prevalent in older patients with chronic disease and polypharmacy in Chinese hospitals. More interventions are urgently needed to reduce PIM use and improve the quality of drug therapies.

目的 分析心理干预对输卵管碘油造影患者术后负性情绪、健康认知和干预满意度的影响.方法 前瞻性选取2020年8月 ～2022年2月于首都医科大学附属北京朝阳医院妇产科门诊或住院收治的需要进行输卵管碘油造影的135例患者,按照患者的就诊时间交替分入两组,心理干预组(68例)和常规干预组(67例).常规干预组患者在造影术前、术中、术后行常规干预措施;心理干预组患者在造影术前、术中、术后行常规干预措施的同时进行心理干预.应用焦虑自评量表(SAS)和汉密尔顿焦虑量表(HAMD)在输卵管碘油造影术前、后对两组患者的负性情绪(抑郁、焦虑)评估;在输卵管碘油造影术后对两组患者的健康认知和干预满意度进行评价.结果 干预前,心理干预组和常规干预组患者的负性情绪SAS评分和HAMD24量表得分比较,差异无统计学意义(P>0.05).干预后,心理干预组患者负性情绪SAS评分和HAMD24量表得分较干预前明显下降,差异有统计学意义(P<0.05);常规干预组患者的负性情绪SAS评分和HAMD24量表得分较干预前下降不明显,差异无统计学意义(P>0.05);心理干预组的负性情绪SAS评分和HAMD24量表得分明显小于常规干预组,差异有统计学意义(P<0.05).常规干预组患者的健康认知量表得分(75.4±6.9)分,心理干预组健康认知量表得分(91.7±3.6)分,差异有统计学意义(P<0.05).常规干预组患者的干预满意度得分(81.62±3.58)分,明显低于心理干预组(93.61±2.57)分,差异有统计学意义(P<0.01).结论 对输卵管碘油造影患者进行心理干预有助于其科学认识疾病、积极看待疾病,使心情放松、缓解其负面心理情绪,提升患者的干预满意度.

患者女性,34岁,主因"发现左侧外阴包块7个月余,疼痛伴进行性加重2个月余"入院.患者于7个多月前(当时处于孕期)无明显诱因发现左侧外阴包块,外院考虑诊断:前庭大腺囊肿.患者于4个月前行剖宫产手术,近2个月自觉外阴包块增大,疼痛进行性加重.体格检查:左侧外阴扪及一硬质包块,边界欠清楚,局部皮温不高,未见明显红肿、溃疡.

Objective:To investigate the effect of ICU nurses-led procedural sedation and analgesia (PSA) regimen in critically ill patients after liver transplantation.Methods:Using the convenient sampling method, a total of 140 critically ill patients after liver transplantation who were admitted to the surgical ICU of Beijing Chaoyang Hospital from January to December 2019 were selected as the research objects. According to the random number table method, the patients were divided into the experimental group and the control group, with 70 cases in each group. The control group was given routine analgesia and sedation, while the experimental group was given a self-designed PSA program on the basis of the control group. The dosage of analgesic and sedative drugs, incidence of complications, length of mechanical ventilation and length of ICU stay in 2 groups were recorded and compared.Results:The per capita dose of analgesic and sedative drugs in the experimental group was lower than that in the control group, and the difference was statistically significant ( P<0.01) . The duration of mechanical ventilation, the duration of ICU stay and the incidence of delirium in the experimental group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The use of PSA in critically ill patients after liver transplantation can reduce the dosage of sedative and analgesic drugs, shorten the duration of mechanical ventilation and ICU stay and reduce the incidence of delirium.

目的:调查住院老年慢病患者多重用药情况并评估多重用药的影响因素和后果.方法:在中国14个省27家三级医院开展多重用药现状横断面调查.从医院电子病历系统中收集数据,计算患者的查尔森合并症指数并且评估患者是否使用了潜在不适当用药.对各省数据进行地区差异分析.采用Logistic回归模型分析多重用药的影响因素.结果:纳入研究的1 249例患者中91.6％存在多重用药情况,50.4％的患者用药超过10种.查尔森合并症指数越高[OR=1.33,95％CI(1.07,1.64),P=0.009],出院诊断数越多[OR=1.09,95％CI(1.01,1.19),P=0.035],越易发生多重用药.高血压[OR=2.13,95％CI(1.37,3.30),P＜0.001]和冠心病[OR=1.77,95％CI(1.04,3.00),P=0.035]患者多重用药发生率较高.合并三种及以上慢病的患者多重用药风险更高(P＜0.001).多重用药增加了潜在不适当用药(P＜0.001)、药物不良反应发生(P=0.024)的可能性,延长了住院时间(P＜0.001)并且增加了医疗费用(P＜0.001).华北地区和华南地区多重用药及潜在不适当用药的发生率均较高而西北地区最低(P＜0.001).结论:中国住院老年慢病患者普遍存在多重用药现象,亟需采取强有力的干预措施来减少多重用药,改善患者用药问题.

目的 探讨北京市老年住院慢性疾病(简称慢病)患者多重用药的发生情况及其影响因素.方法 抽取北京市5家三级甲等医院4个科室(神经内科、老年科、心内科、内分泌科)中年龄不小于65岁,至少患高血压、高脂血症、冠状动脉粥样硬化性心脏病(简称冠心病)、脑梗死、2型糖尿病中的1种,并于2017年3月、6月、9月、12月首周出院患者的临床基本信息.统计住院期间使用5种及以上药物患者的临床基本信息,计算多重用药发生率,并分析其影响因素.结果 共纳入912例患者,其中男455例,女457例;中位年龄74岁;中位用药品种数为9种.多重用药发生率为93.42％.单因素分析结果表明,年龄、出院诊断疾病数、查尔森合并症指数(CCI)评分、高血压、2型糖尿病、冠心病、高脂血症是多重用药的影响因素;多因素Logistic回归分析结果表明,出院诊断疾病数、2型糖尿病、冠心病是多重用药的独立影响因素.结论 多病共存、患有2型糖尿病或冠心病的老年慢病住院患者更易发生多重用药,临床应重点关注相关人群,减少过度治疗,提高用药的合理性.

Objective:To explore the key points of ultrasound diagnosis of adnexal torsion (AT) in patients with ovarian hyperstimulation (OHSS).Methods:A retrospective analysis was carried out on the clinical medical records and ultrasonic features of 15 patients diagnosed with OHSS with AT at Chongqing Maternal and Child Health Hospital from January 2016 to April 2020. Their outcomes were followed, and the causes of misdiagnosis were analyzed. The difference between the affected ovary and contralateral ovary was compared by two-sample paired Wilcoxon test.Results:Among the 15 patients included, 12 were treated by surgery (1 case was misdiagnosed), and 3 underwent follow-up observation. Eleven of the patients treated by surgery were diagnosed with AT, with torsion angle ranging from 180° to 1080°. All of them had unilateral onset, including 7 cases (63.6%) on the right side and 4 (36.4%) on the left side. There were 2 cases (18.2%) with ovarian torsion alone, and 9 cases (81.8%) with fallopian tube, ligament, and ovarian torsion. The symptoms of 3 patients improved or disappeared after clinical follow-up observation. One case was misdiagnosed as intrauterine complicated with extrauterine pregnancy. In the patients diagnosed with AT, ultrasonography showed significant enlargement of the ovary on the affected side [8.5 (7.5, 10.3) cm vs 5.8 (4.3, 7.3) cm], the difference was statistically significant (Z=-2.58, P=0.010 ). The torsion pedicle structure showed the "vortex sign", decreased or disappeared blood flow signals, and pelvic effusion compared with the opposite side. The "vortex sign" of the torsion pedicle structure can be a direct and specific sign of AT in OHSS patients.Conclusion:Ultrasound can be used to diagnose OHSS with AT and preliminarily judge the ovarian activity. During scanning, clinical history and ultrasonic characteristics should be combined to avoid misdiagnosis, so as to give timely clinical treatment for patients.

Objective:To explore the effect of general clinical training on core competence, ICU knowledge and skills of ICU nurses.Methods:Using the convenient sampling method, a total of 32 nurses from various specialties who worked in ICU of Beijing Chaoyang Hospital from February to March 2020 were selected for ICU general clinical practice training. The core competencies of ICU nurses were evaluated by the ICU nurse professional core competencies questionnaire before and 1 month after the training, including the ability to master and apply ICU setting and management, the ability to master and apply critically ill patient care, the ability to master and apply specialized technical skills, and the ability to educate and train. ICU theoretical knowledge and operation skills were assessed by using self-made theoretical knowledge examination papers and operation assessment standards. Paired t test and paired χ 2 test were used for statistical analysis. Results:After the general clinical training, the proportion of 32 nurses who scored good in 16 items in the evaluation of core competence was higher than before (χ 2= 4.571-6.583) . Among the four dimensions of core competence, the score of master and apply ICU setting and management was higher than that before training ( t=-2.442) . The difference was statistically significant ( P<0.05) . After training, theoretical knowledge score of nurses ( t=-9.500) and operational skills score ( t=-2.590) were improved, and the differences were all statistically significant ( P<0.05) . Conclusions:The general clinical training can improve ICU nurses' ability to master and apply ICU setting and management and their knowledge and skills of general intensive care, so as to provide a certain basis for the reserve of general ICU nursing team for future public health emergencies.

目的 探讨多学科康复小组及分级运动对重症监护病房(ICU)机械通气患者术后康复的影响.方法 前瞻性选取2020年6月 ～2021年5月首都医科大学附属北京朝阳医院收治的174例患者,按随机数表法分为观察组与对照组,各87例.对照组患者给予常规治疗,在病情稳定后进行常规康复训练;观察组患者在对照组基础上组建多学科康复小组并对患者采取分级运动方式进行康复训练.结果 观察组机械通气时间、ICU住院时间、总住院时间显著少于对照组,差异有统计学意义(P<0.05);两组干预后MRC评分、FIM评分、MBI评分显著高于干预前,且观察组显著高于对照组,差异有统计学意义(P<0.05);两组干预后CD4+、CD4+/CD8+显著高于干预前,CD8+显著低于干预前,且观察组干预后CD4+、CD4+/CD8+显著高于对照组,CD8+显著低于对照组,差异有统计学意义(P<0.05);观察组ICU获得性肌无力发生率及总发生率显著低于对照组,差异有统计学意义(P<0.05).结论 多学科康复小组及分级运动可降低ICU机械通气患者发生获得性肌无力的风险.

目的 通过应用药学门诊服务模式,探究多重用药老年慢病患者药物相关问题现状.方法 选取2021年2月1日-6月30日于我院药学门诊接受药学服务的老年患者,收集信息,评估药物治疗问题,提供干预后记录,并于首次就诊30 d后进行随访.结果 共纳入48名老年患者,发现276个药物相关问题;提供202条干预措施,其中175条得到接受并实施,最终解决了118个药物相关问题.干预后患者的用药依从性、生活质量均得到显著提高,高血压患者的收缩压也有所降低.结论 门诊老年患者普遍存在药物相关问题,药学服务有利于改善该人群的药物治疗和疾病控制.

Objective:To establish a drug-related problems (DRPs) classification system for outpatients and home patients and provide healthcare staff with tools for standardized recording of DRPs.Methods:DRPs classification systems-related literature were collected by searching foreign databases. The selected DRPs classification systems were compared and analyzed, and the initial DRPs classification system was formed by integrating the characteristics of pharmaceutical care for outpatients and home patients in China. The expert consultation form of DRPs classification system was made, expert consultation was performed for 2 rounds using Delphi method, and the final DRPs classification system was formed through modification and adjustment according to expert opinions.Results:A total of 25 DRPs classification systems were obtained, of which 16 were selected and then integrated to form the initial version of the DRPs classification system. The primary structure of the initial DRPs classification system consisted of 5 parts: problem state, problem type, problem cause, problem intervention, and intervention result. Each part had different number of items, among which there were different number of secondary structure items in problem cause, problem intervention, and intervention result. In the first round of consultation, 32 experts were invited and 30 consultation forms were collected, with a recovery rate of 94%. In the second round of consultation, 30 experts were invited and 30 consultation forms were collected, with a recovery rate of 100%. After 2 rounds of consultation, the acceptance rates of experts for the question state, problem type, problem cause, question intervention, and intervention result in the primary structure were 100%, 90%, 83%, 83%, and 97%, respectively. For the evaluation of 5 categories of drug treatment (indications, effectiveness, safety, economy, and compliance) in DRPs classification system, except for that the expert authority coefficient of economics was 0.79, the expert authority coefficient of the other 4 categories of issues was all >0.8. In the first and second round of consultation, the coordination coefficient of expert opinions was 0.386 ( χ2=995.258, P<0.001) and 0.364 ( χ2=971.232, P<0.001), respectively. After modifying with expert opinions, a final version of DRPs classification system was formed, which included 38 primary structure items in 5 categories and 90 secondary structure items in 3 categories. Conclusion:A DRPs classification system for outpatients and home patients suitable for China′s national conditions has been initially established, which can be used as a standardized recording tool for DRP.

A typical output of a metabolomic experiment is a peak table corresponding to the intensity of measured signals. Peak table processing, an essential procedure in metabolomics, is characterized by its study dependency and combinatorial diversity. While various methods and tools have been developed to facilitate metabolomic data processing, it is challenging to determine which processing workflow will give good performance for a specific metabolomic study. NOREVA, an out-of-the-box protocol, was therefore developed to meet this challenge. First, the peak table is subjected to many processing workflows that consist of three to five defined calculations in combinatorially determined sequences. Second, the results of each workflow are judged against objective performance criteria. Third, various benchmarks are analyzed to highlight the uniqueness of this newly developed protocol in (1) evaluating the processing performance based on multiple criteria, (2) optimizing data processing by scanning thousands of workflows, and (3) allowing data processing for time-course and multiclass metabolomics. This protocol is implemented in an R package for convenient accessibility and to protect users’ data privacy. Preliminary experience in R language would facilitate the usage of this protocol, and the execution time may vary from several minutes to a couple of hours depending on the size of the analyzed data.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. Unfortunately, most of HCC patients were diagnosed at the intermediate or advanced stage, losing the chance to receive the surgical intervention. Locoregional interventional treatment is one of the major therapeutic options for inoperable HCC treatment and prolongs the survival of the patients. Evaluation of the efficacy of the treatment is the important to determine the further therapy strategies. Currently, the evaluation of patients’ response is mainly based on CT and MR anatomic morphological images, but characteristics of tumor biology changes can be observed earlier than the morphological changes. In the recent years, with the development of diffusion weighted imaging (DWI), its value in clinical application has been continuously explored, and it has been increasingly used for quantitative evaluation the diffusion of water molecular and microcirculation perfusion of blood flow in tumor tissue, with some progress in evaluating the tumor response. This paper mainly reviewed the recent research findings of DWI on locoregional interventional treatment for HCC, thereby providing guidance on clinical practice.

Abstract [Objective]To systematically summarize and evaluate the relevant guidelines and their quality of sedation and analgesia for adult ICU patients and extract the content，so as to provide medical staff with a convenient reference for clinical practice.[Methods]The search strategy was developed，and the evidence⁃based databases and evidence⁃based websites were searched，domestic and foreign clinical guidelines for sedation and analgesia for adult patients in ICU were collected and evaluated the quality according to the internationally recognized guidelines（Appraisal of Guidelines for Research and Evaluation Ⅱ，AGREE Ⅱ） Quality evaluation，and extracted and summarized the content of nursing practice.[Results]A total of 8 Chinese guides，5 English guides，and 1 Japanese guide were included.According to AGREE Ⅱ quality level evaluation results there were 2 A⁃level guidelines，and 6 B⁃level guidelines；comprehensive analysis of the content of the 8 guidelines included a total of 3 thematic dimensions： concept and knowledge training，evaluation and prevention/intervention.[Conclusion]The overall quality of the included guidelines is high，and the Chinese guidelines are highly targeted，but the number is smaller.

目的:分析丙戊酸相关不良反应发生的特点,为安全应用该类药物、有效开展药学监护提供参考.方法:调取2004年至2017年北京市药品不良反应监测中心接收的丙戊酸相关不良反应报告数据,提取患者性别、年龄等人口学信息,丙戊酸剂型、剂量、血药浓度等药品信息,以及不良反应累及系统、出现时间及预后转归等情况,进行统计分析.结果:614例丙戊酸相关不良反应累及系统前三位分别是皮肤和皮下组织(29.5％)、血液淋巴系统(22.1％)、神经和精神系统(17.1％);多数患者不良反应转归为痊愈(30.6％)或好转(48.5％),少部分患者未好转(8.0％),有2例死亡(0).3％).在71例已知血药浓度的报告中,16例(22.5％)未达到有效血药浓度范围,34例(47.9％)在有效血药浓度范围内,21例(29.6％)超过有效血药浓度范围.结论:皮肤和皮下组织、血液淋巴系统和神经精神系统是丙戊酸相关不良反应常累及的系统,同一患者可同时出现多种或累及多个系统的不良反应;多数患者出现丙戊酸相关不良反应后给予停药、减量或对症处理等措施可以逆转;血药浓度值对于预测丙戊酸用药的安全性仅作参考.

目的:建立我院临床药师初诊药学查房的工作模式并实践,以期为全国药师规范化药学查房模式的建立提供有益借鉴.方法:通过分享初诊药学查房中的临床案例,介绍我院初诊药学查房的工作流程及内容.结果 与结论:我院临床药师初诊药学查房主要包括临床药师自我介绍、在医师主导下对患者的病情进行诊察、临床药师主导对患者既往用药进行信息采集和整理评估(包括既往用药品种、使用方法、疗效与安全性评估)、协助医师制订初始治疗方案、开展初次用药及饮食教育、加强与护士的沟通与合作.初诊药学查房的开展促进了临床合理用药,提高了患者的住院满意度,提升了临床药师的专业素养.

目的 探讨孟鲁司特钠致神经精神系统不良反应的临床特点、发生机制及防治措施,为临床合理用药提供依据.方法 收集孟鲁司特钠自上市以来国内外发表的关于其引起神经精神系统不良反应的文献,按照患者性别、年龄、神经精神系统疾病史、用药情况、不良反应发生的时间、临床表现及处理方法等进行统计分析.结果 共有21篇文献纳入统计,涉及29例患者,18岁以下儿童所占比例最高.神经精神系统不良反应表现最多的为不同程度的睡眠异常,占65. 52%,包括不易入睡、噩梦、梦游和失眠等.有神经精神系统疾病史的患者,不良反应主要表现为病情复发或加重.停药或减量后不良反应症状可缓解.结论 孟鲁司特钠导致的神经精神系统不良反应需引起医务人员重视,尤其是应用于儿童患者和既往有神经精神系统疾病史的患者时.建议临床在应用孟鲁司特钠时,严格按照说明书的适应证及推荐剂量给药,并密切监测患者是否出现神经精神系统的异常症状.

目的 探讨意识模糊评估量表在预防重症监护综合征的应用.方法 选择2016年5月1日-2018年9月30日某院重症监护室患者68例,根据随机数表法分为试验组和对照组各34例,对所有患者使用意识模糊评估量表进行评分,对患者谵妄症进行评估,对照组给予常规护理,观察组根据意识模糊评估量表结果给予心理疏导与精神护理,观察两组谵妄患者谵妄持续时间、住院时间、医疗费用,对干预前后TISS、APACHEⅡ、ICDSC评分进行比较,并比较干预后两组生活质量评分、满意度和依从性.结果 试验组发生谵妄12例,发生率35.29％,对照组发生谵妄20例,发生率58.82％,两组差异有统计学意义(P=0.041).干预前,两组谵妄评分无明显差异(P＞0.05),干预后试验组谵妄评分降低程度较对照组明显(P=O.ooo).试验组谵妄持续时间(0.46±0.21,)、住院时间(9.37±1.31)明显少于对照组(1.14±0.33,13.87±2.52),差异有统计学意义(P=0.000).试验组患者生活质量各项评分均优于对照组,差异有统计学意义(P＜0.05).结论 意识模糊评估量表可对重症监护室患者进行有效评估,提高谵妄发现率,可早期筛查谵妄症患者并实施预见性护理干预措施,保障患者安全,提高患者生命质量和满意度,值得临床进一步研究.

目的 探讨高压氧治疗期间肺部感染的影响因素,降低肺部感染率.方法 回顾性分析2019年1月1日-2019年10月31日于某院行高压氧治疗的80例患者病案资料,应用logistic回归分析评估相关危险因素与高压氧治疗期间肺部感染的关系.结果 气管造口、意识障碍、非单独加压治疗共3个因素经单因素分析,差异具有统计学意义(P<0.05).经Logistic多因素回归分析结果显示,气管造口、意识障碍、非单独加压治疗是高压氧治疗期间肺部感染的独立危险因素.结论 围绕气管造口、意识障碍、非单独加压治疗等因素制定科学合理的干预点可降低肺部感染的发生率.