Abstract Background: Currently, there is a paucity of data on the reasons for the occurrence of thromboembolic events in patients with atrial fibrillation (AF). This study attempted to unravel the factors contributing to the failure of stroke prevention in AF patients. Subjects and Methods: This single-center, cross-sectional study prospectively enrolled patients with non-valvular AF with a history of thromboembolism from January 2017 to September 2021. Data on clinical characteristics, awareness of AF diagnosis, use of oral anticoagulants (OACs) prior to the first thromboembolic event, and reasons for either non-use or discontinuation of OACs were collected through a questionnaire survey administered to the patients or their family members. The index date was defined as the date of the first thromboembolic event. Results: Based on the patients’ awareness of their AF diagnosis prior to the index date, they were categorized into two groups: Group A ( n = 309), consisting of those who were unaware of their diagnosis, and Group B ( n = 443), consisting of those who were aware. Of the 402 patients in Group B who were at high risk of stroke before the index date, 75.9% (305/402) had never received anticoagulant therapy. The primary reason for this was that patients were not informed about the elevated risk of stroke associated with AF. Another 24.1% (97/402) of them had ever been treated with OACs, but 43.3% (42/97) of them had already discontinued OACs, for which minor bleeding was the most common factor (15/42). Of the 55 patients who continuously received anticoagulation therapy, 33 received the inappropriate treatment of OACs. Conclusions: This study revealed that the major factors contributing to the failure of stroke prevention in patients with AF included unawareness of AF diagnosis, unawareness of stroke risk due to AF, discontinuation of OACs due to minor bleeding, and inappropriate use of OACs. Measures should be taken to increase patient and physician awareness of AF and AF-related stroke risk.

Purpose To study epidemiology, complications, risk factors, clinical course and treatment patterns of diabetes, the Nanjing Diabetes Cohort (NDC) was established using anonymised electronic health records from 650 hospitals and primary care since 2020. This cohort provides valuable data for researchers and policy-makers focused on diabetes management and public health strategies.Participants Diabetes was defined as having inpatient or outpatient encounters with a diagnosis of diabetes International Classification of Diseases-9/10 codes, any use of insulin or oral hypoglycaemic drugs, or one encounter with haemoglobin A1C >4.8 mmol/mol or 6.5%. Patients with diabetes have been continuously enrolled on hospitals and primary care in Nanjing since 2020. Demographic, medications and comorbidities data were extracted from clinical notes, diagnostic codes, labs, prescriptions and vital signs among different types of diabetes.Findings to date The NDC consisted of 1 033 904 patients from 1 January 2020 to 31 December 2022, the majority were male (50.62%) and from the Gulou district (30.79%). The clinical characteristics and medication usage of patients with type 1 diabetes, type 2 diabetes, gestational diabetes and other diabetes were assessed. The prevalences of hypertension, ischemic heart disease, and cerebrovascular disease were 49.72%, 17.85% and 24.90%, respectively.Future plans NDC will annually enrol eligible patients and include socioeconomic data in future updates. The data of NDC are maintained by the Department of Medical Informatics at Nanjing Medical University.

Objective:To assess the concerns about oral anticoagulants (OAC) in patients with nonvalvular atrial fibrillation (NAF) receiving anticoagulant therapy and find the education target in the use of OAC.Methods:It was a cross-sectional study. From December 2018 to October 2019, patients with NAF receiving OAC treatment in Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University were included. The questionnaire survey containing 10 questions was conducted to evaluate each patient's degree of concerns about OAC. A score of 0-10 indicated a level of concern ranging from none to very serious, with 0-3 considered as mild concern, 4-7 considered as moderate concern, and 8-10 considered as serious concern.Results:A total of 115 patients [mean age (65.9±12.5) years and 71 males] were selected in this study. The mean CHA 2DS 2-VASc score was 2.87±1.80. Fifty-six patients (48.7%, 56/115) took warfarin, 36 patients (31.3%, 36/115) took rivaroxaban, and 23 patients (20.0%, 23/115) took dabigatran. There were 89 (77.4%, 89/115) urban residents (urban group) and 26 (22.6%, 26/115) rural residents (rural group) . It had no significant difference in the types of OAC between urban and rural groups ( P=0.828) . Compared to urban patients, rural patients were more concerned about the risk of bleeding (4.1±3.6 vs.6.9±3.0, P=0.003) and the absence of antagonist after OAC overdose (3.6±3.8 vs.5.8±3.7, P=0.039) . There was no significant difference in drug cost between rural and urban population ( P=0.349) . Both of the two groups showed little concern about OAC's interaction with other drugs (66.1%, 76/115) or food (42.6%, 49/115) , while much concern about the potential impairment of liver and kidney functions by OAC (36.5%, 42/115) . Conclusion:Patients with NAF who received OAC treatment had little economic concerns. However, their knowledge of OAC remained lacking. Proper scientific education and optimized out-patient management of OAC should be further strengthened to improve the adherence to OAC.

用药咨询是药师应用药学知识和临床技能,对咨询者提供药物治疗和合理用药的药学服务.用药咨询标准的制订基于国家相关法规、规范性文件,结合医院评审标准要求、行业专家意见、依据科学性、通用性、指导性和可操作性原则.用药咨询标准规定用药咨询的基本要求,规范用药咨询服务过程及质量管理与评价改进的全过程,是医疗机构药学专业技术人员用药咨询服务的依据.该文通过阐述用药咨询标准的制订过程,并解析该标准的重点内容,有助于药师在用药咨询实践中,遵守并执行用药咨询标准的各项要求.

目的 改善医疗机构处方前置审核系统对中药处方的审核适用性,提高中药处方审核质量和合理用药水平.方法 总结我院合理用药监测系统在中药处方前置审核中存在的审核规则不适宜问题,并针对性地修订审核规则、规范审方流程.抽取2020年第2季度(审核规则优化前)和2021年第4季度(审核规则优化后)我院门急诊的全部中成药和中药饮片处方的审核数据,比较审核规则优化前后的处方合理率和干预有效率并统计不合理问题.结果 我院审方系统对中药处方的审核适用性较差,存在审方系统与医院信息系统中的中药饮片名称不统一或不规范、剂量范围设置不合理、重复用药的审核逻辑过于机械化、"十八反""十九畏"审核过于严格、特殊人群用药安全警示缺乏的问题.针对上述问题,我院规范了中药饮片名称,优化了中药饮片的剂量范围、中成药用法用量、重复用药、药物相互作用、特殊人群用药禁忌等审核规则.审核规则优化后,我院中成药处方合理率从97.38％上升至98.17％(P>0.05),干预有效率从42.86％提高至79.71％(P<0.05);中药饮片处方合理率从47.98％上升至79.29％(P<0.05),干预有效率从11.17％提高至29.13％(P<0.05).我院平均每月中药超多日用量、超剂量范围、药物相互作用、特殊人群药物禁忌不合理问题数均显著下降(P<0.05);重复用药不合理问题数组间比较差异虽无统计学意义(P>0.05),但有下降趋势.不合理问题总数也大幅减少(P<0.05).结论 我院的审核规则优化措施能改善审方系统对中药处方的审核适用性,提高处方审核质量和合理用药水平.但用药适应证的相关审核规则和中药处方干预有效率有待进一步完善和提高.

目的:探讨使用非维生素K拮抗剂的口服抗凝药物(NOAC)代替肝素类药物在围手术/操作期患者进行桥接抗凝的可行性.方法:本研究为前瞻性观察研究,2018年8月至2021年5月入选长期使用华法林抗凝的非瓣膜性房颤患者,观察患者在围手术/操作期使用NOAC桥接抗凝后,围手术/操作期以及术后30天内栓塞事件与出血事件的发生率.结果:共入选患者21例,其中4例行肠镜检查,3例行胃镜检查,8例行拔牙操作,3例行眼科相关操作,3例行皮肤科相关操作.患者的平均年龄(70.8±8.5)岁,女性有9例,平均CHA2DS2-VASc评分(3.0±1.0)分,平均HAS-BLED评分(1.4±0.7)分.21例术后30天均未出现出血事件与栓塞事件.结论:对于非瓣膜性房颤患者,采取NOAC在围手术/操作期进行桥接抗凝,具有一定的可行性.

Background: Anticoagulation clinic (AC) is aimed at improving anticoagulation control and outcomes in patients with atrial fibrillation (AF). There is little published data on the benefits of providing an AC in China even if Asians have a higher risk of hemorrhage and stroke when taking warfarin. This study attempts to assess the impact of the AC on warfarin management in the Chinese population. Subjects and Methods: This prospective observational study was conducted in the First Affiliated Hospital of Nanjing Medical University and consecutively enrolled 42 AF patients from the joint physician-and pharmacist-managed AC from March 2017 to April 2018. The study protocol was approved by the Institutional Review Board of the First Affiliated Hospital of Nanjing Medical University. Patients already on warfarin for at least 6 months before coming to the AC and unwilling to receive AF ablation or switch to non-Vitamin K antagonist oral anticoagulants were included. The anticoagulant activity of warfarin was monitored using the international normalized ratio (INR). The primary outcome of this study was INR control, which was defined by the time-in-therapeutic range (TTR). The TTR before and after visiting the AC was compared. Results: The mean age of the enrolled 42 patients was 68.3 ± 10.6 years and 25 (59.5%) were women. The mean CHA2DS2-VASc score and the mean HAS-BLED score were 3.43 ± 1.29 and 1.86 ± 0.80, respectively, in 28 (66.7%) patients with nonvalvular AF. The median follow-up time after visiting the AC was 298.5 days (interquartile range: 151.8–441.8 days). The TTR (% days) before and after visiting the AC was 44.1% ± 27.5% and 69.7% ± 23.3% (P < 0.001), respectively. Meanwhile, 6 (14.3%) and 25 (59.5%) patients had TTR (% days) >65% before and after visiting the AC (P = 0.001), respectively. Conclusions: TTR values were higher in AF patients taking warfarin after the AC. More patients reached satisfactory warfarin control after visiting the AC.

Objective:To analyze the causes and predispositions of gastrointestinal (GI) major bleeding after taking oral anticoagulants (OAC) in patients with atrial fibrillation (AF) .Methods:AF patients with GI major bleeding after taking OAC in the AF anticoagulation clinic in First Aftiliated Hospital of Nanjing Medical University from March 2017 to June 2019 were enrolled in the study and the related information was collected. In this study, major bleeding was defined according to the International Association of Thrombosis and Hemostasis (ISTH) criteria, as clinically overt bleeding accompanied by a decrease in the hemoglobin level of at least 2 g/dL or transfusion of at least 2 units of packed red cells, occurring at a critical site, or resulting in death.Results:Among 410 AF patients who were admitted to our AF anticoagulation clinic, 11 suffered from GI bleeding during OAC. The mean age of the 11 patients was (70.4±5.9) years. The mean CHA 2DS 2-VASc score was 2.8±2.1, and the mean HAS-BLED score was 1.5±0.9. Seven patients (63.6%) took warfarin, 3 patients (27.3%) took dabigatran 110 mg bid, and 1 patient (9.1%) took rivaroxban 10 mg qd. Of the patients taking warfarin, 5 patients (83.3%) had an INR of >3.0 on the day GI major bleeding occurred. One patient (9.1%) concomitantly used non-steroidal anti-inflammatory drugs (NSAIDs) before bleeding, and one patient (9.1%) concomitantly used antiplatelet drugs. Nine patients went through gastrointestinal endoscopy after bleeding. The endoscopic investigation revealed that there were 3 cases of malignant tumor (33.3%) , 2 cases of benign ulcer (22.2%) , 1 case of small intestinal polyps (11.1%) , and 1 case of Dieulafoy disease (11.1%) . Conclusion:OAC may increase the risk of GI bleeding in AF patients, but to optimize the management of OAC, such as increasing times for INR in the target range in patients on warfarin and avoiding the predispositions of bleeding, can reduce the risk. Moreover, there is a high possibility of finding underlying GI diseases, especially malignant tumors after bleeding. Therefore, the importance and necessity of GI endoscopy after bleeding must be emphasized.

1例75岁女性患者,急诊行主动脉夹层术、更换生物瓣膜,术后开启常规华法林抗凝治疗,术后第9天,患者诉双足疼痛,脚趾颜色发紫,并向脚底蔓延,足背动脉搏动可及,至第11天,症状继续加重,考虑华法林引起的紫趾综合征,遂停用华法林,换用依诺肝素钠,直至患者出院,患者疼痛较前好转,左脚脚趾颜色暗紫色未见明显好转,右脚脚趾紫色较前有明显好转.

Objective: To compare the analgesia effect and the adverse reactions of furbiprofen axetil in different dosages combined with fentanyl after scoliosis surgery. Methods: A total of 121 patients undergo-ing scoliosis surgery were selected randomly from March, 2014 to July 2014 in our hospital. They were di-vided into Group A and Group B based on different dosage of furbiprofen axetil. All patients after removal of the trachea intubation received patient-controlled intravenous analgesia (recipe: fentanyl 10μg·kg-1 and ondansetron 4 or 8 mg were mixed and added to 100 mL NS). Results: There was no significant differ-ences of analgesia effects between Group A and Group B, and the adverse events of the two groups were similar; But the rescue medicine consumption in Group B was less than Group A. Conclusion: Combined with fentanyl, the analgesia effects of the two groups seem to be nearly equivalent, it may be wise to con-sider furbiprofen axetil 50 mg Bid as a safe and effective way for pain management in patient undergoing scoliosis surgery.

目的:评价临床药师干预前后,氟比洛芬酯注射液用药不合理现象的改善情况.方法:调取2014年1月我院住院部氟比洛芬酯注射液用量及使用情况详细数据进行点评,干预后采用相同方式调取2014年7月氟比洛芬酯注射液用药数据进行分析对比.结果:临床药师干预后,盐酸氟比洛芬酯注射液用量有所下降(20.6％),各个科室用药剂量有所下调、疗程缩短,该药物的使用费用下降,疼痛评估情况也有所改善,部分外科科室已经建立了根据患者疼痛评估结果调整药物使用的意识.结论:通过临床药师干预,我院氟比洛芬酯注射液用药不合理现象有所改善,但仍存在一些问题,需要持续改进.

Oxycodone is a central nervous system opioid analgesics reformed from thebaine. In recent years, with the development of the formulation of oxycodone, it has been an effective treatment for acute pain and chronic pain. In addition, oxycodone plus opioid receptor antagonist has been developed to improve analgesia in clinical. This article reviews the basic pharmacological properties of oxycodone and its clinical treatment development.