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神经精神药理学治疗药物监测共识指南:2017版

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实用药物与临床 2022年第1期25卷 1-20页

作者： C.Hiemke N.Bergemann H.W.Clement A.Conca J.Deckert K.Domschke G.Eckermann K.Egberts M.Gerlach C.Greiner G.Gründer E.Haen U.Havemann-Reinecke G.Hefner R.Helmer G.Janssen E.Jaquenoud G.Laux T.Messer R.M ssner M.J.Müller M.Paulzen B.Pfuhlmann P.Riederer a.saria B.Schoppek G.Schoretsanitis M.Schwarz M.Silva Gracia B.Stegmann W.Steimer J.C.Stingl M.Uhr S.Ulrich S.Unterecker R.Waschgler G.Zernig G.Zurek P.Baumann 李文标(主译) 果伟(译) 贺静(译) 鲍爽(译) 路钊(译) 牛梦溪(译) 阮灿军(译) 臧彦楠(译) 王勇(译) 张玲(译) 刘辰庚(译) 李洁(译) 汤宜朗(审校) 王传跃(审校) 王刚(审校) Department of Psychiatry and Psychotherapy University Medical Center of MainzMainzGermany Institute of Clinical Chemistry and Laboratory Medicine University Medical Center of MainzMainzGermany Kitzberg Hospitals Center for Psychosomatic Medicine and PsychotherapyBad MergentheimGermany Department of Child and Adolescent Psychiatry University of FreiburgFreiburgGermany Servizio Psichiatrico del Comprensorio Sanitario di Bolzano BolzanoItaly Department of Psychiatry Psychotherapy and PsychosomaticsUniversity Hospital of WürzburgGermany Department of Psychiatry and Psychotherapy Medical Center-University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany Psychiatric Hospital KaufbeurenGermany Department of Child and Adolescent Psychiatry Psychosomatics and PsychotherapyCenter of Mental HealthUniversity Hospital of WürzburgGermany Federal Institute for Drugs and Medical Devices(BfArM) BonnGermany Department of Psychiatry Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenand JARA–Translational Brain MedicineAachenGermany Clinical Pharmacology Department of Psychiatry and Psychotherapy and Department of Pharmacology and ToxicologyUniversity of RegensburgRegensburgGermany Department of Psychiatry and Psychosomatics University of G ttingenG ttingenGermany Psychiatric Hospital Vitos KlinikEichbergEltvilleGermany Center of Epilepsy BielefeldGermany Medical Laboratory Stein Limbach GroupM nchengladbachGermany Psychiatric Hospital K nigsfeldenBruggAargauSwitzerland Institute of Psychological Medicine Haag in OberbayernGermany Danuviuskliniken Psychiatric HospitalPfaffenhofenGermany Department of Psychiatry and Psychotherapy University of TübingenTübingenGermany Psychiatric Hospitals Oberberggruppe BerlinGermany Psychiatric Hospital Weisser Hirsch DresdenGermany Experimental Psychiatry Unit Department of Psychiatry1Medical University of InnsbruckInnsbruckAustria kbo-Isar-Amper Klinikum München-Ost Psychiatric HospitalMunich-HaarGermany Department of

治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童... 详细信息

治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童、孕妇、老年患者、智障患者、药物滥用者、涉法精神病患者、已知或怀疑药代动力学异常的患者以及合并躯体疾病影响药代动力学的患者。常规剂量下治疗无效,用药依从性难以判断,药物耐受性不佳,以及可能存在药代动力学方面的药物-药物相互作用等情况都是治疗药物监测的典型指征。然而,只有将TDM充分整合到临床治疗过程中,才能发挥其优化药物治疗的潜在优势。为了向临床医生和实验室提供有效的TDM信息,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了第一版《精神科治疗药物监测指南》。2011年进行了更新之后,现在再次更新。遵循新版指南,可能会改善神经精神药物治疗的效果,加快很多患者的康复,并降低医疗费用。

关键词：抗凝药物妊娠期静脉血栓栓塞疾病抗抑郁药抗癫痫药抗帕金森病药抗精神病药血药浓度共识指南药物分析基因型分析神经药物遗传药理学药代动力学表型分析血浆药物浓度精神药物参考范围血清药物浓度治疗药物监测治疗窗

神经精神药理学治疗药物监测共识指南:2017版

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实用药物与临床 2022年第2期25卷 97-118页

作者： C.Hiemke N.Bergemann H.W.Clement A.Conca J.Deckert K.Domschke G.Eckermann K.Egberts M.Gerlach C.Greiner G.Gründer E.Haen U.Havemann-Reinecke G.Hefner R.Helmer G.Janssen E.Jaquenoud G.Laux T.Messer R.M ssner M.JMüller M.Paulzen B.Pfuhlmann P.Riederer a.saria B.Schoppek G.Schoretsanitis M.Schwarz M.Silva Gracia B.Stegmann W.Steimer J.C.Stingl M.Uhr S.Ulrich S.Unterecker R.Waschgler G.Zernig G.Zurek P.Baumann 李文标(译) 果伟(译) 贺静(译) 鲍爽(译) 路钊(译) 牛梦溪(译) 阮灿军(译) 臧彦楠(译) 王勇(译) 张玲(译) 刘辰庚(译) 李洁(译) 汤宜朗(译) 王传跃(译) 王刚(译) Department of Psychiatry and Psychotherapy University Medical Center of MainzMainzGermany Institute of Clinical Chemistry and Laboratory Medicine University Medical Center of MainzMainzGermany Kitzberg Hospitals Center for Psychosomatic Medicine and PsychotherapyBad MergentheimGermany Department of Child and Adolescent Psychiatry University of FreiburgFreiburgGermany Servizio Psichiatrico del Comprensorio Sanitario di Bolzano BolzanoItaly Department of Psychiatry Psychotherapy and PsychosomaticsUniversity Hospital of WürzburgGermany Department of Psychiatry and Psychotherapy Medical Center-University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany Psychiatric Hospital KaufbeurenGermany Department of Child and Adolescent Psychiatry Psychosomatics and PsychotherapyCenter of Mental HealthUniversity Hospital of WürzburgGermany Federal Institute for Drugs and Medical Devices(BfArM) BonnGermany Department of Psychiatry Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenand JARA–Translational Brain MedicineAachenGermany Clinical Pharmacology Department of Psychiatry and Psychotherapy and Department of Pharmacology and ToxicologyUniversity of RegensburgRegensburgGermany Department of Psychiatry and Psychosomatics University of G ttingenG ttingenGermany Psychiatric Hospital Vitos KlinikEichbergEltvilleGermany Center of Epilepsy BielefeldGermany Medical Laboratory Stein Limbach GroupM nchengladbachGermany Psychiatric Hospital K nigsfeldenBruggAargauSwitzerland Institute of Psychological Medicine Haag in OberbayernGermany Danuviuskliniken Psychiatric HospitalPfaffenhofenGermany Department of Psychiatry and Psychotherapy University of TübingenTübingenGermany Psychiatric Hospitals Oberberggruppe BerlinGermany Psychiatric Hospital Weisser Hirsch DresdenGermany Experimental Psychiatry Unit Department of Psychiatry1Medical University of InnsbruckInnsbruckAustria kbo-Isar-Amper Klinikum München-Ost Psychiatric HospitalMunich-HaarGermany Department of

2.2剂量相关参考浓度范围对于TDM结果的解释,除了治疗参考浓度范围外还有另一个浓度范围,即所谓的剂量相关参考浓度范围。治疗参考浓度范围的应用是药效动力学问题,而剂量相关参考浓度范围的运用是药代动力学问题。后者比较的是测得的... 详细信息

2.2剂量相关参考浓度范围对于TDM结果的解释,除了治疗参考浓度范围外还有另一个浓度范围,即所谓的剂量相关参考浓度范围。治疗参考浓度范围的应用是药效动力学问题,而剂量相关参考浓度范围的运用是药代动力学问题。后者比较的是测得的药物浓度与理论预期药物浓度范围。参照药代动力学研究,优先考虑没有合并用药或药物基因组异常的患者群(“正常”患者),在日维持剂量(Daily maintenance dose,D m)、给药间隔(Dosing interval,d i)、总清除率(Total clearance,CL)和生物利用度(Bioavailability,F)已知情况下,某种药物在某个“正常”患者体内的预期平均稳态浓度(Average steady-state concentration,C av)可通过下面的公式计算。

关键词：治疗药物监测药效动力学给药间隔维持剂量生物利用度药物浓度药代动力学合并用药

传统乐器的录音方法分析——以乍得非洲鼓为例

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传统乐器的录音方法分析——以乍得非洲鼓为例

作者： saria Dilla Olivier（李乐迪）上海音乐学院

学位级别：硕士

本论文旨在分析与传统乍得乐器——非洲鼓在传统录音技术与现代录音技术中所面临的困难,并提出改善方法。笔者通过对群众进行问卷调查的方式,梳理了从古至今,录音技术在乍得的发展历程。笔者分析了在乍得录制这种乐器的过程中常遇到的问... 详细信息

本论文旨在分析与传统乍得乐器——非洲鼓在传统录音技术与现代录音技术中所面临的困难,并提出改善方法。笔者通过对群众进行问卷调查的方式,梳理了从古至今,录音技术在乍得的发展历程。笔者分析了在乍得录制这种乐器的过程中常遇到的问题,包括:嘈杂的录音环境、缺乏受过专门培训的录音技术人员和工程师等等问题,并提出了系统性的解决方案。本文列出了一份乍得传统乐器清单,希望以此唤起大众对乍得传统音乐的保护意识,并借此机会向大家展示录音是最好的保护传统乍得音乐的方法之一。本文对乍得传统乐器的录音方法和不同类型非洲鼓的不同录制方法都有所探讨,并提供实际的音乐会录音演示,包括笔者在音乐厅、歌剧院和交响乐厅进行的实习经验。最后,笔者使用互联网的方式对乍得国内外人群进行了问卷调查,以了解他们对传统乍得音乐的看法。笔者通过大量的录音实践,以确定不同类型的麦克风和不同的安装方法,以便得到不同的听觉效果,最终对传统乍得乐器的录音方案给出了建议,希望能使得乍得的传统音乐与乐器重现荣光。

关键词：乍得传统乐器录音技术非洲鼓录音

Diagnostic Analysis of Mechanical Conditions of Small-Scale Incinerators in the Healthcare Facilities in Tanzania

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Journal of Environmental Protection 2022年第11期13卷 895-912页

作者： Samwel Manyele Mahir Said Honest Anicetus Adolf Kiyunge Josephat saria Michael Habtu Grace Saguti Department of Chemical and Mining Engineering University of Dar es Salaam Dar es Salaam Tanzania Ministry of Health Community Development Gender Elderly and Children Dodoma Tanzania Department of Environmental Studies The Open University of Tanzania Dar es Salaam Tanzania World Health Organization Dar es Salaam Country Office Dar es salaam Tanzania

This paper provides analytical diagnosis of mechanical conditions of medical waste incinerators used for healthcare waste (HCW) treatment in Tanzania. The main features assessed were types of incinerators, features of incinerators and incinerator house. The assessment was conducted in three levels of health care facilities (HCFs), that is, Regional, district hospitals and health centers, existed in 26 regions of Tanzania. Questionnaires, interview and checklists were used as tools for data collection. It was observed that High-Tech incinerators are mainly used in regional hospitals, while district hospital and health center use both High-Tech and De-Montfort incinerators. About 60% of the incinerators have defective doors. More than 55% of incinerators are corroded in regional and district hospitals. The chimney, top plates and grate which are good condition are 55.6% and 60% in regional hospitals and health centers, respectively. The situation is below 50% in district hospitals. The leakage of the roof and loose structures were observed in district hospitals and health center to be more than 50% of the incinerator houses. On other hand, the performance of burners and incinerator housing cleanliness are generally good. It was concluded that the incinerators in the HCFs are in bad conditions, necessitating maintenance.

关键词： Small-Scale Incinerators Healthcare Waste Mechanical Conditions Waste Generation Rate Operation and Maintenance Environmental Cleanliness

Readiness of Healthcare Facilities to Implement Onsite Healthcare Waste Management Protocols and Incineration Guidelines in Tanzania

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Journal of Environmental Protection 2022年第11期13卷 913-940页

作者： Samwel Manyele Honest Anicetus Michael Habtu Khalid Massa Mahir Said Josephat saria Grace Saguti Zabloni Yoti Department of Chemical and Mining Engineering University of Dar es Salaam Dar es Salaam Tanzania Ministry of Health Dodoma Tanzania World Health Organization Dar es Salaam Country Office Dar es salaam Tanzania Department of Physical and Environmental Sciences The Open University of Tanzania Dar es Salaam Tanzania

The aim of this study was to assess Readiness of Healthcare facilities to Implement onsite Healthcare Waste Management Protocols and Incineration Guidelines in Tanzania. To address this, a national assessment was conducted country wide to assess readiness of Healthcare Facilities (HCFs) to undertake various Healthcare Waste Management (HCWM) initiatives with particular focus to adherence to HCWM protocols and incineration guidelines. The assessment of healthcare waste management was conducted in facilities in the 26 regions of Tanzania mainland for one month. A standardized checklist and tools were used to assess and monitor various aspects related to healthcare waste management using open source software for data collection (ODK). Data were analyzed using SPSS computer software. It was observed that 46.2%, 33.3% and 25% of the health centres, district hospitals and regional hospitals did not have appointed supervisors, which makes it difficult for the HCFs to perform better in managing healthcare waste in their respective facilities. It was further revealed that healthcare facilities have made remarkable improvement in the overall healthcare waste management with evidence of ongoing common activity on purchasing injection safety boxes (69.2%) and purchasing of waste bins (53.8%) at all levels. On average, about 70% of the HCFs have plans and budget though inadequate to support HCWM activities. In a conclusion Healthcare Facilities must designate a better system to compressively address healthcare waste management issues. Again the findings provide evidence for those engaged in improving HCF conditions to develop evidence-based policies and efficient programs, enhance service delivery systems, and make better use of available resources.

关键词： Healthcare Waste Incinerators Waste Segregation Waste Collection Color Coding Ash Pits

In-hospital outcomes of transapical versus surgical aortic valve replacement: from the U.S. national inpatient sample

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Journal of Geriatric Cardiology 2021年第9期18卷 702-710页

作者： Ashraf Abugroun Osama Hallak Ahmed Taha Alejandro Sanchez-Nadales saria Awadalla Hussein Daoud Efehi Igbinomwanhia Lloyd W Klein Department of Internal Medicine Medical College of Wisconsin(MCW)WIUSA Division of Cardiology Ketter-ing Medical CenterOHUSA Department of Internal Medicine School of MedicineIndiana UniversityIndianapolisIndianaUSA Department of Cardiovascular Disease Cleveland Clinic FloridaFLUSA Division of Epidemiology&Biostatistics University of Illinois-ChicagoILUSA Division of Cardiology Creighton UniversityNEUSA Department of Cardiology Case Western Reserve University(MetroHealth)OHUSA University of California San Francisco(UCSF)San FranciscoCAUSA

OBJECTIVE To compare the outcomes of transapical transcatheter aortic valve replacement(TA-TAVR)and surgical aortic valve replacement(SAVR)using a large US population *** The *** Inpatient Sample was queried for all patients who underwent TA-TAVR or SAVR during the *** primary outcome was all-cause in-hospital *** outcomes were in-hospital stroke,pericardiocentesis,pacemaker insertion,mechanical ventilation,vascular complications,major bleeding,acute kidney injury,length of stay,and cost of *** were modeled using multi-variable logistic regression for binary outcomes and generalized linear models for continuous *** A total of 1560 TA-TAVR and 44,280 SAVR patients were *** who underwent TA-TAVR were older and *** to SAVR,TA-TAVR correlated with a higher mortality(4.5%vs.2.7%,effect size(SMD)=0.1)and higher periprocedural *** multivariable analysis,both TA-TAVR and SAVR had a similar adjusted risk for in-hospital ***-TAVR correlated with lower odds of bleeding with(adjusted OR(aOR)=0.26;95%CI:0.18-0.38;P<0.001),and a shorter length of stay(adjusted mean ratio(aMR)=0.77;95%CI:0.69-0.84;P<0.001),but higher cost(aMR=1.18;95%CI:1.10-1.28;P<0.001).No significant differences in other study *** subgroup analysis,TA-TAVR in patients with chronic lung disease had higher odds for mortality(aOR=3.11;95%CI:1.37-7.08;P=0.007).CONCLUSION The risk-adjusted analysis showed that TA-TAVR has no advantage over SAVR except for patients with chronic lung disease where TA-TAVR has higher mortality.

关键词： logistic In-hospital outcomes of transapical versus surgical aortic valve replacement from the U.S national inpatient sample

Performance of Healthcare Facilities of Different Levels towards Safe Healthcare Waste Management as Linked to Infection Prevention and Control Standards in Tanzania

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Journal of Environmental Protection 2022年第10期13卷 732-749页

作者： Honest Anicetus Samwel Manyele Josephat saria Michael Habtu Grace Elizabeth Saguti Zabulon Yoti Adolf Kiyunge Leonard Subi Ministry of Health Community Development Gender Elderly and Children Dodoma Tanzania Department of Chemical and Mining Eng. University of Dar es Salaam Dar es Salaam Tanzania Department of Environmental Studies The Open University of Tanzania Dar es Salaam Tanzania World Health Organization (WHO) Dar es Salaam Tanzania

The aim of this study was to ascertain performance of Healthcare Facilities on safe healthcare waste management practices. To achieve this, a national assessment was conducted country wide to assess performance of various healthcare practices related to waste materials management, WASH, and Hygiene practices as linked to infection prevention and control. The assessment of healthcare waste management in the facilities was conducted in all the 26 regions of Tanzania Mainland for one month. A standardized checklist and tools were used to assess and monitor various aspects related to healthcare waste management using open source software for data collection (ODK). Data were analyzed using SPSS computer software. It was observed that most of permanent staff (88%) in the Healthcare facilities had knowledge on hand hygiene, but the gap was observed to the waste handlers (12%) who were not equipped with the hand hygiene knowledge. About 89% of the hand washing stations were available at mortuary units, followed by 75% at main entrance and the lowest was 3% at waste zone areas of the healthcare facilities. Hand washing materials like soap were mainly found at theaters (64%) followed by mortuary (60%) and last at waste zones. It was concluded that handling of HCW is not properly practiced to the expectations, necessitating strengthens of supervision. The findings provide evidence for those engaged in improving HCF conditions to develop evidence-based policies and efficient programs, enhance service delivery systems, and make better use of available resources.

关键词： Healthcare Waste Air Pollutants Toxic Gases Incineration Bottom Ash Fly Ash Healthcare Facilities

Improper Disposal of Waste Water and Masks during COVID-19, and the Associated Increased Cycle of Infection to Human Health in Developing Countries: A Case Study of Tanzania

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Journal of Environmental Protection 2022年第11期13卷 842-855页

作者： Honest Anicetus Samwel Manyele Josephat saria Michael Habtu Grace Saguti Zabulon Yoti Yohana Lawi Innocent Messo Mathias Machugu Ministry of Health Community Development Gender Elderly and Children Dodoma Tanzania Department of Chemical and Mining Engineering University of Dar es Salaam Dar es Salaam Tanzania Department of Environmental Studies The Open University of Tanzania Dar es Salaam Tanzania World Health Organization (WHO) Tanzania Dar es Salaam Tanzania Muhimbili University of Health and Allied Sciences Dar es salaam Tanzania

Since COVID-19 was declared by the World Health Organization (WHO), wearing of protective equipment, hand washing using soap and frequent use of antiseptic solution are being applied globally to reduce the transmission rate. This study was intended to investigate handling of after wash waste water and masks among Tanzanian residents on the COVID-19 pandemic after it has been, declared by the World Health Organization (WHO) that, wearing of protective equipment, hand washing using soap and frequent use of antiseptic solution should be applied globally to reduce the transmission rate. The assessment of health care waste management in the facilities was conducted in all the 26 regions of Tanzania Mainland. A standardized checklist and tools were used to assess and monitor various aspects related to healthcare waste using open source software for collection (ODK). Data were analyzed using SPSS computer software. It has been indicated that before disposing the used mask, the best protocol is to spray 0.5% (5000 ppm) of chlorine disinfectant on the surface. In this study, about 46% consider used mask as normal municipal waste and 3% do not care they throw away the face masks in the street. Only 18% and 5% of reported to disposal as infectious and highly hazardous waste respectively. It is well documented that due to potential infectious disease like SARS-CoV-2, wastewater should be treated either on-site or conveyed off-site and treated in well-designed method or technology to kill the micro-organisms. The analysis revealed that majority of respondents (74.7%, 73.8%, 48.1% and 65% for healthcare center, district hospitals, regional hospitals and consultant hospitals respectively);dispose the waste in the open space. Continuous awareness creation programs about the negative impact of contaminated face masks and waste water on the health of individuals and introducing laws that can prohibit improper disposal are among the solutions that could help reduce the problem.

关键词： COVID-19 Waste Water Environmental Pollution Hand Washing Masks

Performance of Experimental Bio-Digestion for Pathological and Biodegradable Waste Management at Mwananyamala Regional Referral Hospital Tanzania

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Journal of Environmental Protection 2020年第10期11卷 838-847页

作者： Anicetus Honest Josephat saria Ministry of Health Community Development Gender Elderly and Children Dodoma Tanzania Department of Environmental Studies The Open University of Tanzania Dar es Salaam Tanzania

The aim of the experimental trial was to evaluate the performance of the designed placenta and other pathological waste digester system on the effectiveness of digesting the placenta and its energy recovery (bio-gas) process in Mwananyamala Referral Hospital in Dar es Salaam. A 32 m3 digester is constructed in Mwananyamala Referral Hospital, one inlet of which is to attach to the toilet of maternity ward, where the placentas are flushed directly into the digester, while food waste is fed through another inlet. The slurry of the digester is sent to a sewer/septic tank to avoid further handling. Most fraction of the waste fed into the digester is food waste. In general with the amount of 25.6 ± 4.5 kg/day of placenta and 83.1 ± 14.7 kg/day of food waste, 2.5 m3/d gas was produced. The pH throughout the study period (that is of 18 weeks) was found to be consistent within the range of 6.3 to 8.0, while the pressure ranged from 5 kPa - 33 kPa. Average temperature within the digester was found to be 30.3°C. With all the favorable condition, gas production was consistent and hence the system has been successful in management of the pathological waste along with the production of gas as an alternative source of energy for the hospital.

关键词： Bio-Digester Biogas Placenta Hydraulic Retention Time