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1、英国药学监护实践模式与方法 ( Pharmaceutical Care Practice in UK) 杨赴云 ,关于“Pharmaceutical Care” 的翻译 “Pharmaceutical service” 药学服务 “Clinical Pharmacy ”临床药学 “Clinical Pharmacy service”临床药学服务 “Pharmaceutical care” 药学监护,“Care” 和 “Service”,Care LONGMAN DICTIONARY OF TEMPERARY ENGLISH Worry; anxiety; sorrow; grief; Char
2、ge; keeping; protection; responsibility; Serious attention; Carefulness in avoiding harm, damage Service LONGMAN DICTIONARY OF TEMPERARY ENGLISH Work or duty done for someone An act or job done in favor of someone,CARE 大英汉词典 烦恼，忧虑，操心 注意，当心，小心，谨慎 关切，关心，关怀，爱护 看护，照管，照顾，管理，监护 负责照管的事，负责，责任 SERVICE 大英汉词典
3、帮佣，业务，事务：尤指公共事务 业务机构，行政部门 劳役，服务性工作 礼拜，宗教仪式,ICU “Intensive Care Unit” “重症监护病房” CCU “Cardiac Care Unit” “心脏病监护病房”,药学服务 Pharmaceutical Service,范围广泛，所有与药学有关的服务。如，卫生行政药事管理部门，企业的制药技术服务，医院的药学服务等。 医院药学部门所提供的系统的服务，包括药品的配制和分发，提供与药物和疾病有关的信息，所有病人用药剂量的监测，审查医生处方并录入数据库等。（The Department of Pharmacy provides systems
4、-based services including drug and disease state information, drug preparation and distribution, and dosage monitoring services for all patients. ）,临床药学 Clinical Pharmacy,临床药学是由药学专业人员实施的，帮助临床最大效益的使用药物，并且将药物的毒性降到最小的学科。（Clinical pharmacy is a discipline concerned with the application of pharmaceutical
5、 expertise to help maximise drug efficacy and minimise drug toxicity in individual patients.）,临床药学服务 Clinical pharmacy service,选择用药 药代动力学评价给药剂量和方法 对病人用药的咨询和教育 其他优化药物治疗的方法。,药学监护 Pharmaceutical care,1990年Robert Cipolle，Linda Strand将药学监护定义为“以病人为中心的实践，实践者负责病人与用药有关的需求并为之负责” （Pharmaceutical care is a pati
6、ent-centred practice in which the practitioner assumes responsibility for a patients drug-related needs and is held accountable for this commitment.）,药学监护实践是一次实践针对一个病人。由三部分组成：评估病人的需求，制定监护计划，跟踪评价。 （It is built up one patient at a time. It has three components: assessment of the patients needs; develo
7、pment of a care plan; and follow up evaluation.）,Pharmaceutical services,Clinical pharmacy services,Pharmaceutical care,A Typical Day of a Clinical Pharmacist in UK,英国临床药师的一天,Morning 8:30 12:00 (Coffee break 10:00 10:30),See the blackboard Those admission Those discharge,For those who discharge toda
8、y Prescribing their discharge drugs Contact with their local pharmacist Approach to the patient,For those who were admitted Medical history Drug history The knowledge of the patient Potential drug related problems Care plan,Ward round Doctors, nurse and pharmacist Discussing about the drug related n
9、eeds,Review the other patients who has potential problems Signs and symptoms of the patients Laboratory tests Documented,Afternoon 13:00 16:30,Ward meetings Nurse meetings Pharmacists meetings Dispensing Library,For the individual patient the Minnesota Model the British Model the Canadian Model the
10、Australia Model,The Minnesota Model Holistic Approach,药学监护计划 （Pharmaceutical Care Plan),病人情况 合并症 疾病史及用药史,协同治疗药物 曾有过的不良反应 疾病及用药,病人条件 选择合适的药,59岁女病人DA,因前胸剧烈疼痛,疼痛放射性的传播到左臂,急救中心到家中急救并送到SGH 医院急诊. 病人主诉: 胸部剧烈疼痛,呈放射性传到左 臂,恶心. 急救医生给diamorphin后 疼痛缓解.aspirin 300mg,Case,入院检查: BP 137/81 mmHg pulse 62 bpm respirat
11、ory rates 16 temperature 36 SaO2 97% on air Her JVP, HS were normal her chest was clear.,病史,.,Mrs DA 过去没有疾病记载,用药史,Mrs DA 住院前没有用过药物,ECG 显示 ST 段升高, 诊断 急性下壁心肌梗塞,诊断,病人社会关系,与丈夫一起住 吸烟 每天25 支 喝酒 每周20 units.,Unit 8g or 10 ml of pure alcohol Half a pint of ordinary strength lager/beer/cider(3.5-4% A.B.V.) =
12、1 unit A 25ml pub measure of a spirit (40%A.B.V) =1 unit A small glass of wine(8-9%) =1 unit 1pint = 568ml 1unit=284ml beer,Day 1(09/01/04),streptokinase 1.5 mu iv 链激酶 metoclopramide 10mg iv 甲氧氯普胺 metoprolol 25mg 美托洛尔 Enoxaparin 40mg, 依诺肝素 aspirin 75mg, 阿司匹林 simvastatin 40mg 辛伐他丁 ramipril 2.5mg 雷米普利
13、 Paracetamol 1g 扑热息痛,稍后复查, ECG 显示病人恢复良好 ,病人生命体征很好 BP 113/81 mmHg pulse 73bpm RR 17,Day 2(10/01/04) Mrs DA 今天没有胸痛 心律为正常窦律 感觉非常疲劳, 起床时头晕 血压BP 73-97/34-69mmHg Metoprolol 25mg bd change to atenolol 25mg bd BP123/69mmHg,Day 4(12/01/04) 无胸痛症状, 生命体征稳定 活动良好,可以在病房内走动 停用enoxaparin,Day 5(13/01/04) BP 83-113/47
14、-65 Nicotine 帖剂 空腹血糖 10.7 mmol/l. 建议营养学家重新调整饮食 Ramipril 剂量由2.5mg增加到 5mg BD 今天可以出院,病人实验室数据,出院带药: Aspirin 75mg od Atenolol 25mg bd Ramipril 5mg bd Simvastatin 40mg od GTN spray 2puffs prn Nicotine Patch 15mg for 2 hours,急性心肌梗塞 Acute Myocardial Infarction,Epidemiology The WHO estimated that in 2002, 12
15、.6 percent of deaths worldwide were from ischemic heart disease. Ischemic heart disease is the leading cause of death in developed countries, but third to AIDS and lower respiratory infections in developing countries.,Risk factors Risk factors for atherosclerosis are generally risk factors for myocardial infarction: Older age Male gender Cigarette smoking Hypercholesterolemia Diabetes Hypertension Obesity,Diagnostic criteria WHO criteria have classically been used to diagnose MI; a patient is diagnosed w
