目的 分析和总结上海交通大学医学院附属仁济医院南院区门诊药物咨询室药物咨询数据,提高药学服务水平、改进药物咨询服务质量、促进患者合理用药.方法 对门诊药物咨询室2020年1月至12月的5110例专业药学问题咨询的数据进行分类和统计,应用帕累托图对主要因素和次要因素进行分析.结果 5110例专业药学问题咨询者中,女性多于男性,女性3007例,占58.85％;男性2103例,占41.15％.主要为患者及家属咨询4794例,占93.82％;其中中老年患者(40～70岁)咨询较多,为3585例,占70.16％.专业药学问题分为10类数据中,发现用法用量、注意事项、不良反应、特殊装置用药指导、药物相互作用等为主要因素,其累计构成比在0～80％区间;咨询的13类药物中,以心血管系统用药、消化系统用药、呼吸系统用药,神经系统用药、抗感染用药、内分泌系统用药为主要因素,累计构成比在0～80％.结论 针对咨询内容和咨询类别的主要问题、次要问题进行分析,咨询药师可以针对性地对主要问题进行学习培训,提高药学服务水平,促进合理用药.

为确保风湿免疫疾病患者在基层医疗机构续方及随访过程中获得与在三级医院同质化的治疗与管理,我们构建了三级医院和社区医院联动的风湿免疫疾病药物治疗管理模式.通过药物流行病学调查明确患者的需求,并通过真实世界研究优化药物治疗管理,以多学科协作管理模式规范药学服务标准,不仅缓解了社区医院专科药师匮乏的窘境,患者能在社区医院得到所需的药学服务,而且保证了患者在社区医院治疗的安全性、有效性和经济性,实现了不同级别医疗机构间双向的纵向转诊和医疗资源上下级联动的就医新秩序.

目的 研究临床药师参与的三级-社区医院联动的双向转诊模式对系统性红斑狼疮(systemic lupus erythematosus,SLE)患者临床结局的影响.方法 对上海交通大学医学院附属仁济医院的SLE患者进行临床药师参与的三级-社区医院联动的药物治疗模式干预,主要结局指标为基线和12个月时的SLE疾病活动指数(SLEDAI-2K)和欧洲生活质量五维度问卷(EQ5D)分数.结果 在2016年6月—2018年11月,82例SLE患者接受临床药师参与护理干预的治疗模式.在12个月时,与基线相比SLEDAI-2K的改善结果有差异(7.72 vs 2.05,P=0.000);根据EQ5D,患者的生活质量也有显著改善(0.733 vs 0.825,P=0.010).结论 应用临床药师参与的三级-社区医院联动的双向转诊治疗模式能够有效改善临床结局,提高患者的生活质量,是一种有效的辅助临床治疗模式.

[目的]了解系统性红斑狼疮病人对于自身疾病治疗依从性的现状,探讨提高治疗依从性的应对措施.[方法]采用中文版风湿病治疗依从性问卷(CCQR19)对195例系统性红斑狼疮病人进行问卷调查,分析影响相关因素.[结果]接受调查的住院系统性红斑狼疮病人中具有治疗依从性的病人55例,占28.21％,不具有依从性的病人为140例,占71.79％.单因素分析结果显示,病人的治疗依从性在性别、婚姻状况、支付类别方面,差异有统计学意义(P<0.05).对系统性红斑狼疮病人治疗依从性的影响因素进行回归分析结果显示,性别、婚姻状况、支付类别进入回归方程式.[结论]系统性红斑狼疮病人的治疗依从性低,其依从性与性别、婚姻状况、支付类别因素相关,医务人员应针对病人的具体情况,实施有效的干预措施提高疾病治疗依从性.

目的:考察按病种分类进行用药医嘱点评新模式的应用效果.方法:从我院各科室中共选择16个常见病种,每个病种分别随机抽取2016年1月1日-12月31日医院信息系统中的各10份、总计160例患者的电子病历,对各患者住院期间的10720条用药医嘱从合理性方面进行回顾性点评,对不合理用药医嘱中用法用量不适宜、辅助用药占比、适应证不适宜等相关指标进行统计和分析,建立按病种分类进行用药医嘱点评的新模式;收集点评新模式实施及进行相关干预后(2017年4-5月)相同病种的9862条用药医嘱,点评其不合理率,评价新模式的应用效果.结果:在2016年的样本中,共点评出751条不合理用药医嘱,以用法用量不适宜情况最多(414条,55.12％),其中尤以在脑出血病种中最多(69条,16.67％),此病种下以单次给药用量过大最多(31条,44.92％);辅助用药占病种药品总费用比排序前3位的病种依次为肾肿瘤手术(39.43％)、急性脑梗死(非手术)(37.03％)和椎间盘突出手术(35.26％);适应证不适宜用药有70条(9.32％).应用按病种分类的点评模式及进行相关干预后,医嘱不合理率由点评前的7.00％(751/10720)下降至点评后的2.95％(291/9862),降幅为57.86％.结论:应用按病种分类的点评模式管理用药医嘱不合理率取得了一定的成效,该模式有助于促进临床合理用药.

目的:评价片剂包装核对支援装置在住院药房的应用效果.方法:通过对比装置使用前后各3个月的数据,包括药包核对时间、分包调剂准确率、员工满意度等,考察片剂包装核对支援装置的应用价值.结果:片剂包装核对支援装置使用后,药包核对时间由原来的平均15 s/包提速至1.2 s/包,分包调剂差错率大幅下降,员工满意度显著提高.结论:片剂包装核对支援装置的使用,可缩短药师核对时间,保障分包调剂工作的准确率,改善员工满意度,值得推广应用.

Although a variety of drug delivery strategies have been designed for enhancing the treatment of Triple negative breast cancer (TNBC), combating with TNBCs is still dramatically challenged by the selection of appropriate therapeutic targets and insufficient tumor accumulation or inner penetration of chemotherapeutics. To address these issues, the classical EGFR-inhibitor, erlotinib (EB), was selected as the model drug here and PLA-based nano-platform (NP-EB) was prepared for tumor site drug delivery. Given the significant role of Notch-EGFR interplay in raising severe resistance to EGFR inhibition of EB, gamma secretase inhibitor (GSI)-DAPT was further entrapped into the core of nanoparticles to inhibit the activation of Notch signaling (NP-EB/DART). For achieving the goal of tumor targeting drug delivery, we developed a new peptide CF and decorating it on the surface of EB/DART-dual loaded nanoparticles (CF-NP-EB/DART). Such CF peptide was designed by conjugating two separated peptide CREKA, tumor-homing peptide, and F3, cell penetrating peptide, to together via a pH-sensitive hydrazone bond. By this way, the tumor unspecific property of F3 was sealed and significantly reduced the site effects. However, after the nanoparticles reach the tumor site, the pH-sensitive linkage can be broken down by the unique acidic environment of tumor, and subsequently discovered the F3 peptide to penetrate into tumor cells.

Background For the large number of systemic lupus erythematosus (SLE) patients in China, it is critical to carry out effective disease management to improve the treatment effect and reduce disease burden. A pharmacist-led multidisciplinary care model has not been reported in Chinese SLE patients before. Objective To assess the effect of patient-centered, pharmacist-led, multidisciplinary care on clinical outcomes and satisfaction with health care in Chinese SLE patients. Setting: The South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Method Participants were 143 systemic lupus erythematosus patients randomly assigned to either the intervention group (multidisciplinary care: physician, pharmacist and nurse) or the control group (usual care only). Main outcome measures The primary outcome was scores on the systemic lupus erythematosus disease activity index-2000, the satisfaction with information about medicines scale, and the EuroQol five-dimension questionnaire, assessed at baseline and 12 months. Results Between October 1, 2017 and October 1, 2018, 42 participants were included in the intervention group and 40 in the control group. At 12 months, results for the systemic lupus erythematosus disease activity index-2000 differed significantly between the intervention group and the control group (0 vs. 2, P = 0.027). Patient satisfaction with health care was also significantly greater in the intervention group than in the control group (92.9 vs. 0%, P = 0.000). According to the EuroQol five-dimension questionnaire, health quality was also improved (0.94 vs. 0.85, P = 0.006). Conclusion Our multidisciplinary care team significantly improved clinical outcomes and satisfaction with drug information in Chinese systemic lupus erythematosus patients.

目的 调查上海市系统性红斑狼疮(systemic lupus erythematosus,SLE)患者的治疗依从性与经济负担的现状,分析影响患者用药和治疗依从性的相关因素.方法 研究纳入于上海交通大学附属仁济医院南院风湿免疫科门诊就诊的SLE患者,进行问卷调查.内容包括患者个人情况、治疗依从性以及经济负担情况,采用风湿病治疗依从性问卷(CQR)和基于访谈的自我报告调查综合评价患者治疗依从性,最后用逐步回归模型进行相关性分析.结果 2017年1-2月,121例就诊于门诊的SLE患者中依从患者为59例(48.7％),直接医疗支出为每年33 899元;多因素回归分析显示SLE的治疗依从性主要与用药提醒工具、可选择性药物、工作强度有关.结论 上海市SLE患者的治疗依从性差,经济负担重.亟需采取有效干预措施提高SLE患者治疗依从性(如有效的提醒工具),改善健康状态,以及减轻经济负担.

1临床资料 患儿,女,3岁9个月,体质量16 kg,因“咳嗽,发热”于2017年10月24日9:26来我院门诊治疗.体检:T 39.3℃,P 108次/min,R24次/min;无恶心呕吐,无腹痛,无皮疹瘙痒,精神可,双肺呼吸音粗,心率齐,心音有力,未及杂音,腹软.血常规:白细胞(WBC)计数13.35×109 ·L-1,中性粒细胞百分比74.0％,淋巴细胞百分比19.7％,单核细胞百分比6.1％,嗜酸性粒细胞百分比0.1％,嗜碱性粒细胞胞百分比0.1％,红细胞(RBC)计数5.22 ×1012·L-1,血红蛋白142 g·L-1,血小板(Plt)计数261×109·L-1,C反应蛋白＜2.5mg·L-1.患儿既往无药物过敏史和不良反应史,但对猫毛皮屑和狗毛皮屑,以及食物中的牛奶和鸡蛋白过敏.入院诊断:急性支气管炎.

OBJECTIVE:To explore the medication rules of TCM complex formulas for anti-experimental liver injury. METH-ODS:Using"experimental liver injury""TCM complex preparations""protection effect"as themes,related literatures about medi-cation rules of TCM complex formulas for anti-experimental liver injury in CJFT,Wanfang database and VIP database were re-trieved,and general information,distribution,use frequency and co-occurrence frequency of single herbal medicine were descrip-tively analyzed. K-means clustering model and Apriori in SPSS Modeler were adopted for cluster analysis(clustering side and im-portance)and correlation analysis in medicines with top 10 use frequency. RESULTS:498 related literatures were retrieved,and 70 valid literatures were involved totally,including 51 TCM complex formulas and 111 Chinese herbal medicines. It was mainly drug for clearing heat,restoring vital energy and blood circulation. Drugs for clearing heat were most widely used(34 varieties),drugs for restoring vital energy showed the highest use frequency,with 63 times(25.82%);Prunella vulgaris had the highest frequency in single herbal medicines(accounting for 25.49%);and P. vulgaris-Salvia miltiorrhiza had the highest co-occurrence frequency in drug pairs. 5 clustering sides were obtained in clustering analysis,which were P. vulgaris-S. miltiorrhiza-Angelica sinensis- Glycyr-rhiza uralensis,Astragalus membranaceus-A. sinensis-Hedyotis diffusa,Artemisia scoparia-Curcuma wenyujin-Plygonum cuspida-tum,P. vulgaris-S. miltiorrhiza-A. scoparia,Schisandra chinensis-G. uralensis. Importance prediction showed,S. chinensis was the most important and P. cuspidatum was the least important. 13 drug pair rules were obtained from correlation analysis,and both sup-port and confidence degrees were low. CONCLUSIONS:The TCM complex formulas for anti-experimental liver injury are mainly based on drugs for clearing heat and restoring vital energy,while the compatibility is varied,and correlation degree is relatively low.

Purpose The purpose of this study was to determine treatment adherence and disease burden, analyze detailed medication problems experienced by patients, and identify factors associated with adherence in patients with rheumatic diseases in China. Patients and methods Patients with confirmed diagnoses of ankylosing spondylitis (AS), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) were recruited, regardless of demographics, disease severity, and treatment characteristics. Adherence was assessed using the Compliance Questionnaire for Rheumatology and interview-based self-reports. A backwards-stepwise multivariate regression analysis was used to identify factors associated with adherence. Results We collected data on 252 patients who had a rheumatic disease and visited our outpatient clinic in January or February of 2017. There were 121 patients with SLE, 70 with RA, and 61 with AS. The overall adherence rate was 41.7%, with 48.7% for SLE patients, 38.6% for RA patients, and 31.1% for AS patients. The overall EuroQol (EQ)-index was 0.761; AS patients had the best EQ-index (0.792), followed by those with SLE (0.780) and RA (0.700). SLE patients also had greater annual direct costs (US$5,103.58) than RA or AS patients. Conclusion Overall, 41.7% of our rheumatic disease patients were adherent to treatment, lower than in many other parts of the world. This indicates that it is important to identify methods that improve adherence in this population. It is particularly important to improve the health status and reduce the disease burden of patients with SLE, the most common of the three rheumatic diseases we analyzed. Our results suggest that reminder tools may improve adherence. Further prospective research is needed to confirm whether reminder tools and other measures can improve patient compliance.

Objective:The clinical pharmacist's work mode was investigated.Clinical pharmacist participated in the drug treatment of patients with clopidogrel resistance.Methods:Clinical pharmacists participating in the treatment of one clopidogrel resistant patient with non-mutated in CYP2C19.The result of thromboela-stogram was not consistent with the result of the clopidogrel gene polymorphism test.As the TEG shown,the inhibition rate of clopidogrel was 25.2％,MADP was 57 mm.The clopidogrel gene polymorphism test showed that CYP2C19 * 2 GG,CYP2C19 * 3 GG,CYP2C19 * 17 GG,ABCB1 3435 TT,and PON1 576 AA.Combined with the actual situation of patients,and comprehensive analysis of the patient's condition,to achieve accurate drug therapy,clinical pharmacists developed an individualized medication program,and adjusted the anti-platelet therapy program.What's more,taking the economic situation of the patient into account,clinical pharmacists replaced clopidogrel for ticagrelor.Results:The patient was followed up for 1 year.The cardiovascular events or adverse events such as gastrointestinal bleeding were not reported in the period.Conclusion:Clinical pharmacists participated in the development of individualized treatment programs for patients with clopidogrel resistance,such as adjusting anti-platelet therapy for patients,providing directions of drugs,and so on.It ensured the safe,effective,reasonable and precise clinical use of drugs.

Objective To study the effects of compound zhenma capsules on SOD,MDA,NOS and peripheral T-cell subgroup and its mechanism in the ovariectomized rats.Methods Sixty SD female rats,6-month old were randomized into an experiment group(zhenma capsules group)and a control group,30 cases in each one.The ovaries were removed in the two groups.The changes in serum SOD,MDA and NOS and peripheral T-cell subgroups(CD3+,CD4+,CD8+ and CD4+/CD8+)were observed before and after intervention.Results In 4 weeks of experiment,the body weight in the experiment group was lower than that in the control group,indicating the significant difference(P<0.05).In 4 weeks,the levels of NOS and MDA were increased apparently and the results in the experiment group were lower than those in the control group,indicating the significant differences(P<0.05).In 4 weeks,SOD level was increased in the experiment group and that in the control group was reduced,indicating the significant difference in comparison of the two groups(P<0.05).The results of CD3+,CD4+,CD8+ and CD4+/CD8+ were reduced in either group 4 weeks later,indicating the significant differences as compared with those before experiment.The results in the experiment group were higher apparently than those in the control group,indicating the significant differences(P<0.05).Conclusion Compound zhenma capsules reduce oxidative stress molecules,improve immune cell function and act on anti-aging in ovariectomized rats.

目的 为临床合理使用舒肝祛脂胶囊提供参考.方法 采用回顾性分析方法,提取医院信息系统中2013年12月-2015年12月临床应用舒肝祛脂胶囊的相关数据,进行分类统计和分析.包括患者基本情况、临床诊断与辅助检查、用法用量、联合用药、用药监测等.结果 应用舒肝祛脂胶囊的患者男性明显多于女性,主要用药人群的年龄45～60岁.用药前进行过辅助检查以明确诊断的比例较低,仅10.5％患者进行血脂检查,19.9％的患者进行肝脏B超检查.9.43％处方用法用量未达到药品说明书的推荐剂量,两药联用的治疗方案占49.33％,但大部分患者没有开展用药效果的监测.结论 舒肝祛脂胶囊的临床应用存在部分不合理的情况,应明确临床诊断,规范用法用量,合理选择联合用药,定期评估用药效果,以保障患者用药的安全有效.

为提高门诊药房的药学服务效率和质量，促进医院药房管理现代化，采用开放式药房及全自动配药系统，改变药房传统服务模式，使得药房窗口服务行为更规范、高效、安全，服务水平更加专业化。医院药房自动配药及开放式窗口服务，能有效改进服务模式，提高审方能力，促进合理用药，提高服务质量和效率。

目的：分析喜炎平注射液处方，探讨临床用药的合理性。方法抽取上海交通大学医学院附属仁济医院2014年度喜炎平的处方600张，并从比例分布情况、适应证、用法用量及滴速、稀释溶媒及联合用药、不良反应等方面分析其临床用药合理性。结果喜炎平在该院儿科与急诊所占比例最大；共用于9种疾病；使用5%葡萄糖注射液稀释337例，药物配伍使用常见；上报不良反应报告8例。结论该院喜炎平注射液使用情况基本合理。

目的:研究复方珍麻胶囊对去卵巢大鼠更年期症状、内分泌激素及炎性因子的影响.方法:选取3月龄SD雌性大鼠150只,随机分为5组:实验组(予复方珍麻胶囊高、中、低3个浓度组),空白对照组(给予与大剂量组等体积的生理盐水),阳性对照组(予地西沣0.01 mg/g),每组30只.观察干预前后大鼠失眠症状,检测干预前后血清性激素((LH、FSH、E2)和炎性因子(IL-16、CRP、TNF-α)水平.结果:干预后高剂量组和阳性对照组入睡个数和睡眠时间比较,差异无统计学意义(P＞0.05),高剂量组和低、中剂量组比较,差异有统计学意义(P＜0.05),低、中剂量组比较,差异无统计学意义(P＞0.05).干预后各组血清FSH、LH水平明显升高,而E2水平明显降低,差异均有统计学意义(P＜0.05);而高剂量组血清FSH、LH、E2水平与中、低剂量组比较,差异均有统计学意义(P＜0.05).干预后各组血清IL-16、CRP及TNF-α水平明显升高,差异均有统计学意义(P＜0.05).高剂量组血清IL-16、CRP、TNF-α上升水平较中、低剂量组上升的水平要低,差异均有统计学意义(P＜0.05).结论:复方麻疹胶囊能够改善去卵巢大鼠的失眠症状,增加体内雌激素水平的同时,降低机体的炎性反应分子水平.

目的:评价小儿支气管肺炎4种抗菌药物治疗方案的安全性、有效性、经济性及合理性.方法:运用回顾性调查法,分析303例小儿支气管肺炎住院病例,对4组抗菌药物联用方案(乳糖酸阿奇霉素+头孢呋辛钠、乳糖酸阿奇霉素+头孢美唑钠、乳糖酸阿奇霉素+头孢哌酮钠/舒巴坦钠、乳糖酸阿奇霉素+盐酸头孢替安)进行安全性评价、疗效比较、药物经济学分析及合理用药评估.结果:各治疗方案组间的安全性和疗效无显著差异(P＞0.05),乳糖酸阿奇霉素+头孢呋辛钠方案的人均抗菌药物费用(429.43±143.18)元(P＜0.05),人均住院总费用(2 445.57±6 44.80)元(P＜0.05),抗菌药物使用强度为77.16(P＜0.05),均较其他治疗组低.结论:4组抗菌药物治疗方案安全性、有效性基本相同,乳糖酸阿奇霉素+头孢呋辛钠方案的医疗成本最低,抗菌药物消耗量和使用强度最低,经济性与合理性具明显优势.

目前,许多大型公立医院开拓新建规模相当的分院区,如何加强多院区之间的有效联动、降低运营成本、提升服务能力已成为多院区医院所迫切需要解决的共性问题.上海交通大学医学院附属仁济医院在5个相对独立院区的背景下,率先将社会资本嵌入整合,通过与医院信息系统互联整合,构建多院区药品供应链管理模式,为建立以公益性为核心的运行机制提供新思路.从设计思路、实施方案以及应用成果3个方面对药品供应链管理体系的构建进行了阐述.