The current quantitative methods of bilirubin have disadvantages such as high cost and low sensitivity. Due to the negative correlation between the level of serum bilirubin and the risk of cardiovascular diseases, a fluorescent ratiometric film sensor was developed aiming at bilirubin detection at low level concentration. Blue-emitting and red-emitting gold nanoclusters were assembled into the same film using layer-by-layer self-assembly technology. Detection of bilirubin was achieved based on the intensity ratio of the two nanoclusters. Bilirubin exposure causes fluorescent quenching of the film. The fluorescence intensity ratio of the two cluster probes had quantitative relationship versus bilirubin concentration. Based on this film sensor, a portable fluorescence detection system was designed for the ratiometric sensing of bilirubin. The hardware of the system was mainly composed of main control chip STM32F407, TSL237 and TSL238T optical frequency sensor. A light-avoiding dark room and detection light path were designed through three-dimensional printing to reduce the interference from ambient light and improve detection accuracy. Experimental results showed that the proposed detection system had strong anti-interference, good stability and accuracy. The linear coefficient of bilirubin detected by this system was 0.987. The system presented good results in reproducible experiments and possessed a good linear relationship with the data obtained by standard spectrofluorometer. The portable system is expected to detect serum bilirubin at low levels.
Objective To analyze the rationality of emergency medication in the West China Hospital after Lushan earthquake based on the actual drug use of earthquake victims. Methods We applied DDDs and DUI as evaluation index, input data using Excel software, and analyzed if the emergency medication was required for the injury/illness and the rationality of emergency medication. Results Earthquake victims mainly had trauma and wound infection and they were given antibiotics as main treatment one week after the earthquake. Drugs for the respiratory system and digestive system were mainly used in patients who mainly manifested as non-traumatic diseases and internal diseases four weeks after the earthquake. Among 49 kinds of drugs which could be calculated for the value of DUI, injection accounted for a larger proportion than non-injection (59.18% vs. 40.82%). The results showed that, the medication (DUI=1) only accounted for 12.24%; the medication (DUIlt;1, Mean=0.65) accounted for 38.78%, which implied insufficient drug use; the medication (DUIgt;1, Mean=1.77) accounted for 46.94%, which implied drug overuse. Conclusion Medication for every system is basically timely and rational when treating symptoms and causes in the West China Hospital within one month after Lushan earthquake. However, the rationality of emergency medications using DUI=1 under normal conditions still needs to be further verified.
ObjectivesTo evaluate the current situation and rationality of electronic prescription in retail pharmacies in Chengdu, so as to provide references for further improving the sales of prescription drugs in retail drugstores and the level of rational drug use.MethodsA set of evaluation index system was constructed, and a prescription review group was set up. Eventually, 7 200 sample electronic prescriptions were collected for retrospective analysis and evaluation.ResultsPrescriptions from private medical institutions constituted the majority (3 543, 49.21%), and the majority of patients were junior and middle-aged, primarily respiratory diseases (38.24%) and circulatory diseases (17.11%), etc. The average quantity of drugs was 1.60 per prescription, percentage of antimicrobial use was 65.25%, percentage of essential medicines used was 34.92%, and reasonable rate of prescription was 95.21%.ConclusionsElectronic prescription services mode for retail pharmacy follows with the trend of “Internet + drug circulation” and complies with the rules of reasonable medical guidance and medication. However, optimizations are required, such as the lack of high-quality medical resources and the urgent need to optimize structure of prescription, and it is still essential to strengthen the management of antibacterial drugs and national essential medicines.
Objective To investigate drug usage and costs of chronic obstructive pulmonary disease (COPD) inpatients in Karamay Central Hospital in 2014 and to provide evidence and reference for evidence-based pharmacy study on COPD. Methods The information of drug use and expenditure of COPD inpatients were collected from the hospital information system (HIS). We analyzed the data including frequency, proportion and cumulative proportion by Excel 2007 software. Results A total of 194 inpatients with COPD/AECOPD were included in Karamay Central Hospital in 2014, the average age was 74.28±7.81 years old. Fifty-three drugs were used for COPD treatment; the total frequency were 1 798 times and per capita cost was 7 419.78 yuan. The top three used drugs were budesonide suspension, montelukast tablets and methylprednisolone injection. In total expenditure, the cost of piperacillin-tazobactam, imipenem/cilastatin and moxifloxacin injection ranked top three. Conclusion The top 3 used drugs are budesonide suspension, montelukast tablets and methylprednisolone injection for COPD inpatients in Karamay Central Hospital in 2014, while the top 3 total expenditure drugs are piperacillin-tazobactam, imipenem/cilastatin and moxifloxacin injection.
ObjectiveTo evaluate the rationality of antibiotics use by analyzing the prescription reviewing results.MethodsThe review data of antibiotic prescriptions in Beijing Hospital was randomly selected from 2016 to 2019, from which unreasonable prescriptions and the antimicrobial agents were analyzed, and the use of antibiotics and unreasonable prescriptions annually were compared.ResultsThe evaluation of rational use of antibiotics involved 79 701 outpatient prescriptions from 2016 to 2019. There were 10 drugs in the top five irrational rates of outpatient antibiotics, primarily cephalosporin and quinolones, accounting for 50% and 30%, respectively. The primarily unreasonable problems were over prescription (common in gastroenterology and dermatology), unsuitable indications (common in otolaryngology), inappropriate usage and dosage (common in urology, dermatology and gastroenterology), and failure to write clinical diagnosis or incomplete clinical diagnosis (common in obstetrics and gynecology and general surgery). During the four years, the proportion of antibiotics prescriptions and the irrational rate decreased annually.ConclusionsThe use of antibiotics in outpatient department of Beijing Hospital has achieved initial results, however, there are still some problems. We should further strengthen the management of antibiotics usage, strengthen training and learning, and increase medical cooperation to promote rational drug use in clinic.
Objective To analyze drug use for 23 sick and wounded hospitalized in the departments of gynaecology, obstetrics and paediatrics in the West China Second University Hospital, during one month after Lushan earthquake, so as to provide references for the drug use for the sick and wounded women and children. Methods Medication information was retrospectively investigated in the departments of gynaecology, obstetrics and paediatrics in the West China Second University Hospital during one month after Lushan earthquake. We extracted data including hospitalization duration, medication prescriptions, types and costs of essential medicines, types and costs of antibiotic medicines using the HIS system. Discharge diagnosis was standardized and classified according to ICD-10. Indicators of rational drug use included defined daily dose (DDD), defined daily dose statistic (DDDs), drug utilization index (DUI), children defined daily dose (cDDD), children drug utilization index (cDUI), proportion of essential medicines, proportion of antibiotic medicines, mismatch of medicine and diagnosis, repeated drug use, improper combination of drug, incorrect usage and dosage, and frequently drug change. Medication information was evaluated and discussed by the prescription working group. Discrepency was resolved by consulting with the panel. Results A total of 23 sick and wounded women and children were assessed during one month after Lushan Earthquake. There were 13 sick and wounded children in the department of pediatrics (mainly manifested as bronchial pneumonia) and 10 sick and wounded women in the department of gynaecology and obstetrics (mainly involved in cesarean delivery). Proportions of essential medicines were 13/13 in the department of pediatrics and 9/10 in the department of gynaecology and obstetrics. Proportions of antibiotic medicines were 10/13 in the department of pediatrics and 8/10 in the department of gynaecology and obstetrics. Irrational drug use was mainly caused by improper use of antibiotics. Conclusion The drug use for 23 hospitalized sick and wounded is rational in the departments of gynaecology, obstetrics and paediatrics in the West China Second University Hospital during one month after Lushan earthquake. Evaluation methods of rational drug use in high-risk population are urgently needed. Using cDDD and cDUI is an active exploration for the evaluation of pediatric drug use, which needs more practice to test and improve.
ObjectiveTo analyze the clinical distribution and changes of antimicrobial resistance profiles of Staphylococcus aureus (SA), as well as to provide the basis for the prevention and treatment of infection. MethodsThe clinical data and the antimicrobial resistance profiles of SA were collected from Jan, 2008 to Dec, 2014 in West China Hospital of Sichuan University. The WHONET 5.5 software was used to analyze the resistance data. ResultsA total of 5 698 SA isolates were included within 7 years. Of all strains, 2 721 (47.8%) were isolated from secretion, 1 638 (28.75%) were from respiratory tract specimens, 451 (7.9%) were from pus, and 362 (6.4%) were from blood. 811 (49.5%) SA isolates from respiratory tract specimens were Methicillin-resistant Staphylococcus aureus (MRSA), which was higher than those from secretion, pus and blood. 1052 (18.5%) SA strains were isolated from the dermatological department, 604 (10.6%) were from the orthopedics department, 472 (8.3%) were from the intensive care unit (ICU), 471 (8.3%) were from the department of burn, and the detection rate of MRSA from ICU (341, 72.2%) was the highest. During last 7 years, the total separation rate of SA was 8.2%, among them 1 858 (32.6%) MRSA were isolated, and the detection rate was 32.6%. The resistant rate of SA to erythromycin, clindamycin, tetracycline, gentamicin, rifampin, ciprofloxacin, levofloxacin and moxifloxacin had a statistically significant decrease from 2008 to 2014, while the resistant rate of SA to trimethoprim/sulfamethoxazole had increased. No vancomycin, linezolid, teicoplanin or tigecycline resistant strain was detected. The resistance rates of MRSA to common antibiotics such as penicillin G, erythromycin, clindamycin, tetracycline, gentamicin, rifampin and fluoroquinolones were higher than those of MSSA, while the resistance rate of MRSA to trimethoprim/sulfamethoxazole was lower than MSSA. ConclusionCompared with the monitoring data in China, the drug resistance of SA in West China Hospital is well controlled. However, experience-directed antibiotic treatment of MRSA infection is still limited. MRSA infection remains a serious problem in critically ill patients. The rational use of antibiotics and application of effective infection control measures are important to decrease the MRSA infection.
Objective To comparatively analyze the rationality of emergency medication after Wenchuan earthquake with that after Lushan earthquake in West China Hospital of Sichuan University, based on the use of medicine of the victim’s disease spectrum. Method By using Excel, defined daily dose system (DDDs) and drug utilization index (DUI) were used as the evaluation indexes to analyze the rationality of emergency medication in West China Hospital of Sichuan University within one month after Wenchuan earthquake and Lushan earthquake. Results Within one month after Wenchuan and Lushan earthquake, there were 1 839 and 488 victims treated in the hospital, respectively. Within one month after the two earthquakes, the variation tendency of DDDs of drugs and number of victims was consistent, and the consistency was better in Lushan earthquake than that in Wenchuan earthquake. Among the 60 drugs which DDDs were ranked top five in their pharmacological class (top ten for antimicrobials) in Wenchuan earthquake, the majority of them were injections (injections vs. non-injections: 70.0% vs. 30.0%); the results showed that the medication (DUI=1) only accounted for 10.0%, the medication (DUI<1) accounted for 28.3%, which implied that the use of drugs was insufficient, the medication (DUI>1) accounted for 61.7%, which implied that drugs were overused; the average of DUI was 1.61. And in Lushan earthquake, injections also accounted for a larger proportion than non-injections (63.3%vs. 36.7%); the results showed that the medication (DUI=1) accounted for 15.0%, the medication (DUI<1) accounted for 38.3%, the medication (DUI>1) accounted for 46.7%; the average of DUI was 1.30. Conclusions Base on the DUI, we draw the conclusion that the rationality of emergency drug use and the timeliness of emergency drug supply were better in Lushan earthquake than those in Wenchuan earthquake. But the rationality of using the DUI, which is an evaluation index for normal conditions, to evaluate the emergency conditions still needs to be further verified.
ObjectiveTo probe into the writing quality and rational use of drugs for Emergency Department prescriptions in West China Hospital of Sichuan University. MethodsFrom January 2012 to December 2013, the prescriptions for emergencies were selected randomly. According to prescription management method and standard management of hospital prescription comment requirement, the quality of prescription was analyzed. ResultsFrom 2012 to 2013, the qualified prescription rate increased from 91.45% to 96.70%. The average number of drugs on each prescription was 1 or 2; the utilization rate of antibacterials was below 20.00%; the utilization rate of essential drugs increased from 60.68% to 66.15%; the utilization rate of generic drug name approached 100.00%. However, the utilization rate of injections increased from 82.92% to 85.67%. ConclusionBy prescription reviews, we have listed the problems, and intervened irrational prescription to improve the rate of qualified prescriptions. The high rate of injection utilization is a warning for us to take more effective, more specific and stricter intervention measures.
The purpose of this paper is to discuss the evaluation standard of rationality of medical examination from different perspectives, so as to provide theoretical evidence for medical department to establish the evaluation standard of the rationality of medical examination. By researching the relevant literature in the field of rational medical examination and combing the existing research results, this paper discusses the evaluation criteria of the rationality of medical examination from four dimensions: technology, ethics, law, and health economy. The following four suggestions are proposed for the current status of medical examination: construct clinical pathway management to avoid excessive medical examination; establish the internal supervision and evaluation mechanism to improve the professional quality of medical staff; improve medical examination-related policies, laws, and regulations, carry out specialized legislation; apply diagnosis-related group payment method, control the cost of medical examination.