目的:借鉴美国的临床药师培养模式,完善我国药学专业型人才培养方法,培养出能指导临床合理用药的临床药师。方法:以美国南加州大学药学院(USC school of pharmacy)的Pharm D教育为例,简单介绍美国如何培养Pharm D的临床实践能力,并与我国现行的临床药师培养模式进行对比。结果:我国药学院课程设置不够合理,本科毕业生缺乏临床思维,无法胜任临床药师一职。结论:从课程、学制、毕业后教育等方面入手,改良传统药学教育模式,培养具备丰富临床实践经验的药学人才。
The emergence and rapid spread of multidrug-resistant gram-positive bacteria has become a vital and serious medical problem. A literature search was conducted in Pub Med, EMBASE, and Elsevier databases to identify relevant publications. To calculate the risk ratios（RRs） with 95% confidential intervals（CIs）, a fixed- or random-effects model was applied based on the heterogeneity across studies. Five studies containing seven RCTs were included in this meta-analysis. Regarding c SSTIs, HAP, SAB, there was no statistically significant difference in the rate of clinical cure between telavancin and vancomycin or standard therapy in intention-to-treat population（ITT）（RR 1.01, 95% CI 0.97–1.05, P = 0.72; FEM） and clinically evaluable population（CE）（RR 1.01, 95% CI 0.98–1.04, P = 0.41; FEM）. However, telavancin was more effective than vancomycin or standard therapy in MRSA eradication rate（RR 1.08, 95% CI 1.02–1.14, P = 0.009; FEM）. Regarding the safety profile, no statistically significant differences were found in all-cause mortality（9.0% vs. 8.4%; RR 1.07, 95% CI 0.88–1.31, P = 0.49; FEM） and overall adverse events（77.0% vs. 72.3%; RR 1.08, 95% CI 0.98–1.20, P = 0.12; FEM） between telavancin and vancomycin or standard therapy. Pooled data from c SSTIs, HAP and SAB studies on telavancin indicated higher rates of adverse-event related withdrawals（7.7% vs. 5.4%; RR 1.43, 95% CI 1.12–1.83, P = 0.05; FEM） and creatinine elevation（10.0% vs. 5.1%; RR 1.95, 95% CI 1.53–2.48, P0.00001; FEM） than vancomycin or standard therapy. Telavancin and vancomycin or standard therapy are equally effective for the treatment of c SSTIs, HAP and SAB, and telavancin might be an option for the treatment of difficult-to-treat serious infections caused by MRSA. However, telavancin is associated a higher incidence of creatinine elevation and adverse-event related withdrawals.
