OBJECTIVE: To investigate the situation of rational use of drugs in the outpatient prescriptions in 21 medical institutions in Shanghai Songjiang district.METHODS: The international indicators for rational drug use were employed to evaluate outpatient prescriptions in 21 medical institutions in Shanghai Songjiang district.RESULTS: As for the international indicators for rational drug use in the outpatient prescriptions,an average of 2.5 kinds of drugs were prescribed per prescription in 21 hospitals,42% prescriptions prescribed antibacterials,20% prescribed injections,and 43.97% prescribed basic drugs of zero difference rate.CONCLUSIONS: The drug use in outpatients of 21 medical institutions was rational on the whole;however,the proportions of prescribing antibacterials and injections in some hospitals were still on the high side. Thus the rational drug use level remains to be improved further.

OBJECTIVE:To investigate the application of antibacterials in patients with chronic obstructive pulmonary disease(COPD)in our hospital.METHODS:A retrospective analysis was performed on 77 COPD inpatients with respect to the varieties of antibiotics,DDDs,drug costs,routes of administration,medication duration,combined use of antibiotics,therapeutic outcome,bacterial culture and susceptibility test,adverse drug reactions(ADR)and irrational drug use etc.RESULTS:100% of the patients received antibacterials.Topping the first five places on the DDDs list were levofloxacin,cefuroxime,amoxicillin/clavulanate potassium,ceftazidime and azithromycin.The combined use of two kinds of antibiotics accounted for 77.65% versus 2.35% of three kinds concomitantly.CONCLUSION:The use of antibacterials in COPD patients in our hospital is basically rational;however,the indications of antibacterials for COPD patients should be followed strictly toachieve rational and standard drug use.

Objective:To evaluate the clinical efficacy and safety of Danhong injections in the adjuvant therapy for angina pecto-ris. Methods:According to a random number table,totally 120 cases of patients with angina pectoris were randomly divided into the observation group and the control group. The control group was treated with the conventional therapy,such as oxygen uptake,anti-in-flammation,expectoration and relieving asthma,and the observation group was treated with Danhong injections(30ml added in 250ml glucose infusions,ivd,qd)additionally. The treatment course was 2 weeks. The hemorheology and blood lipid changes before and af-ter the treatment were recorded,the ECG was analyzed and the clinical symptom improvement was evaluated in the two groups. Re-sults:After the treatment,the hemorheological indices of the two groups were significantly reduced(P<0. 01),and the improvement of the observation group was much better than that of the control group(P<0. 01). After the treatment,the TC,TG and LDL were significantly lower and the HDL was notably higher than those before the treatment in the two groups(P<0. 01),and the improvement of the observation group was significantly better than that in the control group(P<0. 01). The total efficiency of ECG and clinical symptom improvement in the observation group was significantly higher than that in the control group(P<0. 05). Conclusion:Dan-hong injections in the treatment of angina pectoris can significantly improve the hemorheology and blood lipid to enhance the clinical ef-ficacy,which are worthy of promoted application.

Objective To observe the method of mechanical ventilation in the chest compressions during cardiopulmonary resuscitation (CPR),and to explore the influence of the flow pattern selection of square-wave and decelerating-wave on airway pressure of patients. Methods A prospective self-pairing study was conducted. Forty patients undergoing CPR admitted to Department of Emergency of Lishui City Central Hospital from January 2011 to February 2013 were enrolled. Using Respironics Eisprit ventilator,the working mode and parameters of ventilator were set reasonably according to previous research,while the chest compressions was performed in a stable state by the same doctor,. Each patient received different flow,waves,including square-wave and decelerating-wave,and the highest peak airway pressure was recorded as a pair of data when the time-pressure and time-flow waveform were frozen. Two pairs of data by different doctors were collected in each patient. Eighty pairs of data from 40 patients were collected for statistical analysis by paired t test. Results The highest peak airway pressure of decelerating-wave was (38.15± 5.99)cmH2O (1 cmH2O=0.098 kPa),which was (5.71±1.98)cmH2O lower than that of square wave 〔(43.86± 6.68)cmH2O〕with significantly statistical difference(t=22.010,P=0.000). 73.75%patients undergoing square wave with peak airway pressure over 40 cmH2O were found,but only 45.00% patients were found in decelerating-wave. Conclusion Because decelerating-wave used in mechanical ventilation during CPR can obviously reduce the peak airway pressure,the occurrence of barotrauma,and the probability of triggering high pressure ventilator alarm,and improve the compliance of ventilator,so decelerating-wave is more reasonable than square-wave.

Objective To learn and evaluate the present prescriptions from outpatient departments of 21 public hospitals in Songjiang district,and to promote rational drug use.Methods A total of 75,600 outpatient prescriptions from 21 public hospitals in Songjing district were collected monthly from January 2008 to October 2010 and analyzed statistically using indexes for prescription evaluation.Results of the 75,600 prescriptions,the types of drugs in each prescription averaged 2.35,the ratio of antibiotics use and injection agents use were 35.77％ and 17.40％,respectively.The percentage of essential drugs without added profit accounted for 41.91％ of the total drug use,and the average drug cost per prescription was RMB 85.99.Comparison of indexes for prescription evaluation showed that the ratio of antibiotics use and injection agents use as well as the average cost per prescription in secondary hospitals were significantly higher that those in community health centers (P＜0.01),while the percentage of essential drugs without added profit and the average number of drugs in each prescription were statistically smaller than those in community health centers (P＜0.01).Conclusion Drug use in outpatient departments of 21 public hospitals was rational in general,especially noteworthy is the significant improvement made at community health centers in recent three years.

Large amount of data including chemical composition and size information of individual particles would be generated in the measurement of aerosol particles using atmospheric aerosol time-of-flight mass spectrometry ( ATOFMS ) . Our home-made ATOFMS was used to measure the indoor individual aerosol particles in real-time for 24 h, and the obtained mass spectrometric data were clustering analysis by self-organizing map ( SOM ) because of its ability of vector quantization and data dimensionality reduction. 20 classification results were got which includedCalcium-Containing,Salt+Secondary particles,Secondary particles,Organic Amines,K+-Rich Organics andSoil particles, etc. Compared with previous mass spectrometric methods, SOM is a natural visualization tool, more classification results can be obtained. This classification information would be useful to assess the response and toxicity of atmospheric aerosol particles and identify the origin of atmospheric aerosol particles.

Objective To study the clinical application of laparoscope combined with gastroscope surgery in patients with gastric stromal tumor. Methods The clinical data of 50 patients with gastric stromal tumor were retrospectively analyzed. Among them 20 cases were treated with traditional laparotomy (laparotomy group), and 30 cases were treated with laparoscope combined with gastroscope surgery (combination group). The intraoperative bleeding, operation time, postoperative recovery time, postoperative hospitalization time and complications were compared between 2 groups. Results One case in combination group received open surgery (3.33%, 1/30), mainly because of obesity, and tumor rupture occurred in 1 case during operation. All specimens of the 2 groups had no tumor residue. There were no statistical differences in tumor diameter and operation time between 2 groups (P>0.05); the intraoperative bleeding, postoperative recovery time and postoperative hospitalization time in combination group were significantly lower than those in laparotomy group:(26.33 ± 14.21) ml vs. (42.57 ± 15.67) ml, (37.96 ± 8.80) h vs. (60.14 ± 13.41) h and (6.42 ± 2.80) d vs. (12.04 ± 4.69) d, and there were statistical differences (P<0.05). The 2 groups had no death, stomach bleeding, anastomotic stenosis and anastomotic leakage. The laparotomy group had postoperative incision fat liquefaction in 3 cases and incision infection in 2 cases, and the combination group had pulmonary infection in 1 case. All were cured after symptomatic treatment. Conclusions Laparoscope combined with gastroscope surgery in the treatment of gastric stromal tumors has a short operation time, less blood loss, faster postoperative gastrointestinal function recovery, shorter hospitalization time, and no major complications. It is a more ideal and minimally invasive surgery.

OBJECTIVE:To observe the efficacy and safety of amiodarone combined with valsartan in the treatment of paroxys-mal atrial fibrillation in elderly patients. METHODS:130 elderly patients with paroxysmal atrial fibrillation were randomly divided into observation and control group. Control group was orally given Amiodarone tablet 0.6 g in the first week,3 times a day,0.4 g in the second week,twice a day,0.2 g in the third week,twice a day;observation group was additionally given valsartan capsule 0.4 g in the first 1-3 day(s),once a day,the dose was increased to 0.8 g if patients showed no hypotension,once a day,and then decreased to 0.4 g if the pressure was lower than 100/60 mm Hg,once a day. The treatment course for both groups was 12 weeks. Clinical efficacy,and left atrium(LA),left ventricular end-diastolic volume(LVEDV),left ventricular systolic volume(LVESV), left ventricular ejection fraction (LVEF),heart rate,cardiothoracic ratio,systolic blood pressure,diastolic blood pressure before and after treatment,and incidence of adverse reactions in 2 groups were observed. RESULTS:Total effective rate in observation group was significantly higher than control group,the difference was statistically significant(P<0.05). After treatment,LA, LVEDV and LVESV,heart rate,cardiothoracic ratio,systolic blood pressure,diastolic blood pressure in 2 groups were significant-ly lower than before,and observation group was lower than control group,LVEF was significantly higher than before,and observa-tion group was higher than control group,the differences were statistically significant(P<0.05). There was no significant differ-ence in the incidence of adverse reactions(P>0.05). CONCLUSIONS:The efficacy of amiodarone combined with valsartan is more obvious than only amiodarone in the treatment of paroxysmal atrial fibrillation in elderly patients,with similar safety.

OBJECTIVE:To provide reference for implementation of national essential drug system in primany helth care institations.METHODS:The information of application of essential drug in 21 medical institutions were collected and analyzed statistically in respect of category of drugs,amount of drugs,consumption sum,medical incomes,incomes from drugs,ratio of drugs,total number of persons and bed day in hospital,etc.Category of drugs,classification of drug and spectrum of disease were compared with those of National Essential Drugs List.RESULTS:There were 295 kinds of essential drug which include 16 kinds of dosage forms and 25 kinds of spectrum of disease.Category of essential drugs used in community medical institutions accounted for 37% of total category of drugs and that in secondary medical institutions accounted for 33%.Consumption sum of essential drug in community medical institutions accounted for 18% in total consumption sum and that in secondary medical institutions accounted for 12%.Ratio of drugs in community medical institutions were 62% and that in secondary medical institutions were 43%.CONCLUSION:Category of drugs and spectrum of disease are in line with that in National Essential Drugs List but should be adjusted according to spectrum of disease and ratio of performance and price.Proportion of essential drug should be increased and monitoring for drug use should be enhanced to reduce ratio of drugs.

OBJECTIVE:To compare the pharmacoeconomic efficacies of 5 drug therapeutic regimens for children pneumonia.METHODS:Using retrospective study and cost-effectiveness analysis to compare the pharmacoeconomic efficacies among the following 5 regimens in treating children pneumonia:amoxicillin sodium/clavulanate potassium(Group A),cefotaxime sodium(Group B),cefoperazone sodium/sulbactam sodium(Group C),cefuroxime sodium(Group D),and azithromycin(Group E).RESULTS:The effective rates of the 5 groups(A,B,C,D and E) were 80.43%,76.09%,65.12%,77.27%,and 91.30%,respectively,and the cost-effectiveness ratios were 1 595.06,1 225.38,1 669.69,1 284.83,and 697.84,respectively.CONCLU-SION:The regimen of azithromycin(group E) is the optimal one among the 5 groups for children pnemonia.