| The clinical pharmacy service of traditional Chinese medicine is part of clinical pharmacy and its core is the safety,effectiveness and rationality of traditional Chinese medicine treatment.Although the clinical pharmacy of traditional Chinese medicine has been proposed for more than 30 years,but it has not formed a perfect disciplinary system.The development level and working mode of different medical institutions are different,which leads to the slow development of clinical pharmacy service model for traditional Chinese medicine.In April 2017,Beijing implemented the Implementation Plan for the Separate Reform of Pharmaceuticals,in which the traditional Chinese medicine clinical pharmacy service faces opportunities and challenges.This study explores and summarizes the main content that clinical pharmacists should have at present in the practice of hospital-based clinical pharmacy.In the clinical practice of the Rheumatology Department of Traditional Chinese Medicine of China-Japan Friendship Hospital,more patients with ankylosing spondylitis were found and the improvement of symptoms after treatment was satisfactory.Ankylosing spondylitis is a chronic inflammatory autoimmune disease with an incidence of approximately 0.3%in our country.The onset of ankylosing spondylitis is more occult.The course of the disease is characterized by persistent,recurrent seizures and high morbidity.It severely affects the quality of life of the patient.At the same time,it causes the patient to suffer a great psychological burden and causes loss of labor ability,At the same time,it brings heavy financial burden to families and society.the etiology and pathogenesis of the disease are not clear.Some long-term western medicine treatment can slowly relieve clinical symptoms and control the development of the disease to some extent.However,there are many kinds of adverse reactions and it is easy to reduce the dependence of patients.The higher the price of drugs for biological agents,the more economical burden patients may have.Traditional Chinese medicine has accumulated a great deal of experience in the long-term treatment of ankylosing spondylitis.The literature suggests that the combined use of Chinese and Western medicines can reduce adverse reactions and have a great advantage in the treatment.However,there is no unified understanding of the dialectical classification of ankylosing spondylitis treated by traditional Chinese medicine,and the evidence-based evidence for the efficacy and safety of the combined use of Chinese and Western medicines is less evidence-based.Part 1 Exploration of Clinical Pharmacy Service of Traditional Chinese Medicine Based on Hospital PracticeObject:According to the regulations and policies of clinical pharmacy services,through the clinical pharmacy practice and related literature research of the hospital,the main contents of the clinical pharmacy service mode of traditional Chinese medicine were initially proposed,which provided reference for standardizing the clinical pharmacyservice mode of traditional Chinese medicine and promoting the cultivation of traditional Chinese medicine clinical pharmacists.Method:To visit the website of national medical institutions to collect regulatory p-olicies and evaluation criteria for clinical pharmaceutical service;Through eight months of pharmaceutical practice and a questionnaire for 12 clinical pharmacists of TCM from different hospital was carried out in China-Japan friendship hospital("our hospital");Search CNKI,WF and VIP database,compare the clinical pharmacy service model in our hospital with Chinese medicine hospital and comprehensive hospital,and summ-arize the main contents of TCM clinical pharmacy service.Consult:China has relevant laws and regulations to support clinical pharmacy service,but the pharmacist law has not been established.Based on the regulation policy,literature data and questionnaire,the clinical pharmacy services of our hospital are at a higher level.Summarize the main content of traditional Chinese medicine clinical pharmacy services can be divided into medicine skills(identification,processing,medicament,dispensing,decoction)and pharmaceutical care(rational drug use,evidence-based medicine,information consultation,TDM,laboratory studies).Conclusion:A preliminary clinical pharmacy service content of traditional Chinese medicines as a fundamental,perfecting laws and regulations policy foundation,learning from each other to regulate the hospital clinical pharmacy service mode,providing the reference for TCM clinical pharmacists.Part 2 Clinical application and related Meta analysis of traditional Chinese medicine for ankylosing spondylitisObject:?In the real world,a retrospective analysis of the use of herbal medicine and TCM syndromes in the patients with ankylosing spondylitis in the Department of Rheumatology of the China-Japan Friendship Hospital,it provides reference for the treatment of the disease;?It is evaluate the effect and safty of total glucosides of paeony combined with sulfasalazine(SSZ)in patients with Ankylosing Spondylitis(AS);?It is to evaluate the clinical efficacy and safety of Buyang Huanwu Decoction Combined with chemical drugs in patients with Ankylosing Spondylitis(AS),and to provide reference for clinical treatment.Method:? I used the HIS system and electronic medical record system in our hospital to collect relevant clinical data of Chinese ankylosing spondylitis From March 2017 to September 2017.The database of drug use was established.Data mining method was carried out on the medication rule of AS in our hospital by frequency analysis.? By literature analysis based on evidence-based medicine,randomized controlled trials about the effect of TGP combined with SSZ on patients were collected by searching PubMed,China National Knowledge Infrastructure(CNKI),China Wan Fang Database,Chinese VIP database(VIP).The quality of included studies was assessed according to the criteria recommended Cochrane Collaboration,Meta-analysis was performed using RevMan5.3 software.Retrieved from PubMed,CNKI,Wanfang Database and VIP,randomized controlled trials(RCT)and clinical controlled trial(CCT)about Buyang Huanwu Decoction combined with chemical medicines(test group)versus chemical medicines alone(control group)in the treatment of AS were collected.The quality of included studies was assessed according to the criteria recommended Cochrane Collaboration,Meta-analysis was performed using RevMan5.3 software.Consult:In the real world,there are 10 common TCM Syndromes of ankylosing spondylitis,including kidney deficiency and cold dampness syndrome,kidney deficiency and cold syndrome,kidney deficiency and damp heat syndrome,blood stasis syndrome,kidney deficiency cold coagulation syndrome,phlegm stasis syndrome and so on.It is concluded that the highest frequency of treatment of ankylosing spondylitis is the traditional Chinese medicine,which has the highest frequency of use of traditional Chinese medicine.Nine randomized controlled trials involving 579 patients were included.Meta-analysis showed that significant differeces exsisted between treat group of glucosides of paeony combined with sulfasalazine and the control group of sulfasalazine alone[OR=3.90,95%CI(2.24,6.80),P<0.01];The morning stiffness duration[MD=-5.05,95%CI(-6.96,-3.14),P<0.01],Joit pain index[MD=-1.28,95%CI(-2.13,-0.43),P<0.01],expansion[MD=0.26,95%CI(0.07,0.46),P<0.01]and ESR[MD=-2.68,95%CI(-8.45,3.08),P=0.36],the group of paeoniforin combined with sulfasalazine was better than the group of sulfa-salazine alone.No statistically difference was found in reducing erythrocyte sedimentation rate,Adverse reaction index diarrhea,leucopenia.Meta-analysis reported the incidence rate of impaired liver function[MD=0.23,95%CI(0.10,0.50),P<0.01]after treated was lower in the treat group than the control group.Totally 8 RCTs were included,involving 601 patients.Meta-analysis showed that significant differences existed between treat group of Buyang Huanwu Decoction combined with chemical drugs and the control group of chemical drugs alone[OR=1.28,95%CI(1.17,1.41),P<0.00001]The main clinical efficacy indicators were Bath Ankylosing Spondylitis Functional Index(BASFI).There was a significant difference between the experimental group and the control group[OR=-1.33,95%CI(-2.08,-0.58),P=0.0005].Bath disease activity index(BASDAI)of ankylosing spondylitis[OR=-1.07.95%CI(-1.79,0.34),P=0.004;Signs Schober[OR=0.97.95%CI(0.30,1.63),P=0.005];The morning stiffness duration[OR=-3.37,95%CI(-4.57,-2.17,P<0.00001],the improvement test group was significantly better than the control group.No statistically difference was found in reducing erythrocyte sedimentation rate and C-reactive protein.Compared with the control group,the incidence of adverse reactions was significantly lower than that in the control group.There were significant differences in the two groups[OR=0.52,95%CI(0.38,0.73),P<0.0001].Conclusion:?The use of traditional Chinese medicine in the treatment of ankylosing spondylitis can be used regularly to investigate the reality of Chinese medicine combined with western medicine in the treatment of ankylosing spondylitis,and provide a scientific and reasonable reference for the prevention and treatment of ankylosing spondylitis by traditional Chinese medicine.? The effect and safety of TGP combined with SSZ was better than treated with SSZ alone,Adverse reactions to abnormal liver function were significantly reduced.? Buyang Huanwu decoction combined with chemical medicines shows better efficacy than chemical medicines alone,It can obviously improve the clinical symptoms,and the incidence of adverse reactions is obviously reduced.The efficacy and safety of the combination of traditional Chinese medicine and Western medicine in the treatment of ankylosing spondylitis were verified by modern evidence-based methods.However,a multi center,large sample,rigorous design and high quality clinical randomized trial were needed to collect and study the more reliable evidence. |
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