外科藥學(xué)：FIP的全球視角-國際藥學(xué)聯(lián)合會(huì)（FIP）主席Paul Sinclair AM在第三屆外科藥學(xué)大會(huì)的講話
Surgical pharmacy: A global perspective from FIP
外科藥學(xué)：FIP的全球視角
Hello, I’m Paul Sinclair, president of the International Pharmaceutical Federation — FIP. I’d like to thank the FIP China Envoy Chen Zheng-Yu and the China (GuangDong) Pharmaceutical Association for inviting me to give a global perspective on the topic of surgical pharmacy, the diverse roles of pharmacists and the importance of our profession.
大家好，我是Paul Sinclair，國際藥學(xué)聯(lián)合會(huì)（FIP）主席。感謝FIP中國特使陳征宇先生和中國（廣東省）藥學(xué)會(huì)邀請我就外科藥學(xué)的主題、藥師的不同角色，以及我們這個(gè)職業(yè)的重要性發(fā)表全球視角的演講。
FIP is the global body for pharmacy, pharmaceutical sciences and pharmaceutical education. Through 153 national organisations, allied organisations (including academic institutional members) and individual members, we represent over four million pharmacists, pharmaceutical scientists and pharmaceutical educators around the world. Our vision is a world where everyone benefits from access to safe, effective, quality and affordable medicines and health technologies, as well as from pharmaceutical care services provided by pharmacists, in collaboration with other healthcare professionals. Our mission is to support global health by enabling the advancement of pharmaceutical practice, sciences and education.
FIP是藥學(xué)、藥物科學(xué)和藥學(xué)教育的全球性機(jī)構(gòu)。通過153個(gè)國家組織、聯(lián)盟組織（包括學(xué)術(shù)機(jī)構(gòu)成員）和個(gè)人會(huì)員，我們代表了世界各地400多萬藥師、制藥科學(xué)家和藥學(xué)教育工作者。我們的愿景是建立一個(gè)人人都能獲得安全、有效、優(yōu)質(zhì)和可負(fù)擔(dān)的藥品和衛(wèi)生技術(shù)，以及藥師與其他醫(yī)務(wù)人員合作提供的藥學(xué)服務(wù)的世界。我們的使命是通過促進(jìn)藥學(xué)實(shí)踐、科學(xué)和教育的進(jìn)步來支持全球健康。
FIP believes that many health outcomes, including surgical outcomes, can be enhanced through pharmacist interventions.
FIP認(rèn)為，許多治療結(jié)局，包括外科治療結(jié)局，可以通過藥師的干預(yù)得到改善。
? Pharmacists play a crucial role in post-operative care, focusing on antibacterial treatment prophylaxis.
? 藥師在術(shù)后監(jiān)護(hù)中起著至關(guān)重要的作用，重點(diǎn)是預(yù)防感染。
? Audit data reveals non-compliance with guidelines regarding the duration of parenteral treatment and the prolonged duration of prophylactic therapy.
? 處方審核數(shù)據(jù)顯示，不遵守指南規(guī)定的腸外治療用藥時(shí)間以及延長預(yù)防治療時(shí)間的情況較為常見。
? Highlighting the need for a switch from parenteral to oral use in a timely manner to prevent prolonged therapy durations.
? 強(qiáng)調(diào)需要及時(shí)從腸外轉(zhuǎn)向口服，以防止治療時(shí)間的延長。
? In surgery and obstetrics/gynaecology settings, medical teams have recognised the value of having pharmacists oversee medication protocols as a step toward enhanced antimicrobial stewardship.
? 在外科和產(chǎn)科/婦科，醫(yī)療團(tuán)隊(duì)已經(jīng)認(rèn)識(shí)到藥師監(jiān)管用藥方案的作用，這是加強(qiáng)抗菌藥物管理的重要一步。
Pharmacists can make a particular contribution in cardiology.
藥師可以在心臟病治療方面做出特殊的貢獻(xiàn)。
? As cardiology moves from conventional surgery to more interventional approaches using robotics and medical devices, pharmacists' roles have evolved.
? 隨著心臟病治療從傳統(tǒng)的外科手術(shù)轉(zhuǎn)向更具介入性的方法，如使用機(jī)器人技術(shù)和醫(yī)療器械，藥師的角色也發(fā)生了變化。
? Pharmacists ensure personalised and optimised medication therapy post-intervention, especially in acute settings, to avoid hypotensive crises.
? 藥師確保干預(yù)后的個(gè)體化藥物治療，特別是在嚴(yán)重情況下，避免低血壓危象。
? In chronic treatment plans, the focus is on achieving manageable blood pressure targets, tailoring heart failure treatment based on patient outcomes (rather than strictly following guidelines), and adjusting to high-intensity statin therapy as needed based on lipid profile monitoring.
? 在長期治療計(jì)劃中，重點(diǎn)是實(shí)現(xiàn)可控制的血壓目標(biāo)，根據(jù)患者情況（而不是嚴(yán)格遵循指南）調(diào)整心衰的治療，并根據(jù)血脂監(jiān)測結(jié)果調(diào)整高強(qiáng)度他汀類藥物治療。
The evolving role of pharmacists includes leading antimicrobial stewardship programmes to combat resistance and improve patient outcomes.
藥師作用不斷發(fā)展，包括主導(dǎo)抗微生物藥的管理，以對抗耐藥性和改善患者預(yù)后。
? Innovative strategies for antimicrobial stewardship have been developed, including real-time monitoring and decision support systems that guide optimal antibiotic selection and duration.
? 最新的抗微生物藥管理策略已被制定，包括指導(dǎo)抗菌素的選擇和治療期間的實(shí)時(shí)監(jiān)測和決策支持系統(tǒng)。
? Collaboration with surgical teams to implement evidence-based protocols for antibiotic prophylaxis, reducing unnecessary antibiotic use while ensuring effective infection prevention.
? 與外科團(tuán)隊(duì)合作，實(shí)施循證的抗生素預(yù)防方案，減少不必要的抗生素使用，同時(shí)確保有效預(yù)防感染。
Technology is playing an important part in enhancing surgical pharmacy practice.
相關(guān)技術(shù)在提高外科藥學(xué)實(shí)踐水平方面發(fā)揮著重要作用。
? The integration of technology, such as robotic dispensing systems and electronic health records (EHRs), enhances the efficiency and accuracy of pharmacists' work in surgical settings.
? 技術(shù)的集成，如機(jī)器人配藥系統(tǒng)和電子健康記錄（EHRs），提高了外科藥師工作的效率和準(zhǔn)確性。
? Pharmacists utilise advanced software for medication therapy management in surgical patients, allowing for personalised medication plans based on patient-specific data and surgery type.
? 藥師利用先進(jìn)的軟件對手術(shù)患者進(jìn)行藥物治療管理，基于患者特定數(shù)據(jù)和手術(shù)類型實(shí)施個(gè)體化的用藥方案。
? Wearable devices for post-surgical patients enable remote monitoring of vital signs and medication adherence, empowering pharmacists to proactively adjust treatments in response to real-time data.
? 術(shù)后患者的可穿戴設(shè)備可遠(yuǎn)程監(jiān)測患者生命體征和用藥依從性，使藥師能夠根據(jù)實(shí)時(shí)數(shù)據(jù)主動(dòng)調(diào)整治療方案。
The future envisions pharmacists as integral members of the multidisciplinary surgical care team, involved from pre-operative assessment to post-operative care and rehabilitation.
藥師將成為多學(xué)科外科治療團(tuán)隊(duì)不可或缺的一員，參與從術(shù)前評估到術(shù)后監(jiān)護(hù)和康復(fù)。
Focus on patient education and empowerment, ensuring patients understand their medication regimens, potential side effects, and the importance of adherence for optimal recovery.
關(guān)注對患者的教育和授權(quán)，確保他們了解藥物治療方案、潛在的副作用，以及用藥依從性對康復(fù)的重要性。
Research and innovation in surgical pharmacy practice continue to push the boundaries, with pharmacists leading and participating in clinical trials to develop and evaluate new pharmacological interventions in surgical care.
外科藥學(xué)實(shí)踐的研究和創(chuàng)新不斷取得突破，藥師主導(dǎo)和參與臨床試驗(yàn)，以開發(fā)和評估外科治療中新的藥物干預(yù)措施。
FIP has a number of resources to support surgical and clinical pharmacy practice.
FIP有許多資源來支持外科和臨床藥學(xué)實(shí)踐。
I‘d like to share with all of you some examples of how far clinical pharmacy has come.
我想和你們分享一些例子，說明臨床藥學(xué)的發(fā)展?fàn)顩r。
? In 1990, Hepler and Strand shared their concept of pharmaceutical care. This can be defined as ‘the responsible provision of drug therapy (by pharmacists) for the purpose of achieving definite outcomes that improve a patient’s quality of life’. Within this, Strand and Hepler included all aspects of disease and symptom prevention and treatment, together with identifying and either preventing or resolving potential and actual drug-related problems.
? 1990年，Hepler和Strand分享了他們的藥學(xué)監(jiān)護(hù)概念，定義為“負(fù)責(zé)任地提供藥物治療（由藥師），以達(dá)到改善患者生活質(zhì)量的明確結(jié)局”。該工作涵蓋了疾病和癥狀的預(yù)防和治療的各個(gè)方面，以及識(shí)別和預(yù)防或解決潛在和存在的用藥相關(guān)問題。
? Since 2006 the pharmacy degree course in Japan has required 6 years of university education, of which six months is spent in hospital and community placements. These changes were, in part, instituted to open the way to closer pharmacist involvement in medicines selection and use. So far, hospital pharmacy practice in Japan has generally been slower to develop clinical care services compared to community services.
? 自2006年以來，日本的藥學(xué)學(xué)位課程要求6年的大學(xué)教育，其中6個(gè)月在醫(yī)院和社區(qū)實(shí)習(xí)。在某種程度上，這些改變是為了使藥師更密切地參與藥物的選擇和使用。迄今為止，與社區(qū)服務(wù)相比，日本醫(yī)院藥房的臨床監(jiān)護(hù)服務(wù)發(fā)展普遍較慢。
? In Sweden, Australia and France, interventions such as the establishment of antibiotic use surveillance systems, linked to changes in prescribing and dispensing incentives and controls, have already been introduced to help ensure more optimal drug use.
? 在瑞典、澳大利亞和法國，已經(jīng)引入了諸如建立抗菌素使用監(jiān)測系統(tǒng)等干預(yù)措施，并與處方和配藥激勵(lì)和控制措施關(guān)聯(lián)，以確保藥物的合理使用。
? In secondary care, the UK Department of Health provided short-term funding in 2003 to establish antimicrobial pharmacists. Their role was to collaborate across teams and networks to integrate antimicrobial stewardship into hospital infection control practice.
? 在二級醫(yī)療方面，英國衛(wèi)生部于2003年提供了短期資金設(shè)立抗微生物藥師。他們的作用是跨團(tuán)隊(duì)、跨部門合作，將抗菌藥管理納入醫(yī)院感染控制工作。
? UK hospital pharmacists have been instrumental in reducing prescribing of high-risk broad-spectrum medicines (notably cephalosporins and fluoroquinolones) associated with Clostridium difficile infection and coinciding with a reduction in C. difficile infections and stabilisation in resistance to these antimicrobial agents.
? 英國的醫(yī)院藥師在減少治療艱難梭菌感染的高風(fēng)險(xiǎn)廣譜藥物（特別是頭孢菌素和氟喹諾酮類藥物）的處方上發(fā)揮了重要作用，同時(shí)也減少了艱難梭菌感染，并穩(wěn)定了艱難梭菌對這些抗菌藥的耐藥性。
? In the UK, a smartphone application for antimicrobial guidelines (MicroGuide) was developed by pharmacists and medical microbiologists and has been licensed to over 45 hospitals. The app content can be edited by clients according to local resistance patterns and clinician preferences. In February 2015, MicroGuide was awarded the NHS Innovation Challenge Prize in the Infection Control category. Another smartphone application “IAPP” was found to have a positive effect on antimicrobial prescribing in hospitals in both medicine and surgery.
? 在英國，藥師和醫(yī)學(xué)微生物學(xué)家開發(fā)了一款指導(dǎo)抗菌的智能手機(jī)應(yīng)用程序（MicroGuide），并已在超過45家醫(yī)院獲得許可?？蛻艨梢愿鶕?jù)當(dāng)?shù)氐哪退幠Ｊ胶团R床醫(yī)生的偏好編輯應(yīng)用程序內(nèi)容。2015年2月，MicroGuide獲得了感染控制類NHS創(chuàng)新挑戰(zhàn)獎(jiǎng)。另一款智能手機(jī)應(yīng)用“IAPP”對醫(yī)院的內(nèi)科和外科抗菌藥物處方產(chǎn)生了積極影響。
? The American Society of Health-System Pharmacists published the 2019 update from the Pharmacy Accountability Measures Working Group regarding quality measures that health-system pharmacists can implement to ensure patient safety. This update included measures such as INR monitoring for patients taking warfarin, undergoing venous thromboembolism prophylaxis in the intensive care unit, taking medicines for glycaemic control or using opioids.
? 美國衛(wèi)生系統(tǒng)藥師學(xué)會(huì)發(fā)布了2019年更新的藥房問責(zé)措施工作組關(guān)于衛(wèi)生系統(tǒng)藥師為確?；颊甙踩蓪?shí)施的質(zhì)量措施。這一更新包括對服用華法林、在重癥監(jiān)護(hù)病房接受靜脈血栓栓塞預(yù)防、服用血糖控制藥物或使用阿片類藥物的患者進(jìn)行INR監(jiān)測等措施。
? In Canada, hospital pharmacists are often medication experts in therapeutic areas such as internal medicine, obstetrics, oncology and infectious disease management. Pharmacists interpret laboratory values, are involved with antimicrobial stewardship, and act as mentors, collaborators and scholars. Pharmacists are also often involved into interprofessional committees such as drugs and therapeutics, medication safety and different quality improvement initiatives.
? 在加拿大，醫(yī)院藥師通常是內(nèi)科、產(chǎn)科、腫瘤學(xué)和傳染病管理等治療領(lǐng)域的用藥專家。藥師解讀檢驗(yàn)數(shù)據(jù)，參與抗菌藥管理，并成為團(tuán)隊(duì)中的導(dǎo)師、合作者和學(xué)者。藥師也經(jīng)常參加跨專業(yè)的委員會(huì)，如藥物和治療學(xué)委員會(huì)、用藥安全委員會(huì)以及各種質(zhì)量改進(jìn)委員會(huì)。
Pharmacists’ clinical role has grown, and the specialty of surgical pharmacy is a great example of further development. At the end of 2015, the GuangDong Pharmaceutical Association (GDPA) in China proposed the concept of a “surgical pharmacist”. In September 2018, the GDPA worked on creating surgical pharmacist positions in hospitals and defined their responsibilities as taking care of the whole process of medication management during the perioperative period and beyond. This involves focusing on perioperative medication, such as anti-infection, anti-thrombosis and analgesia medicines, as well as on clinical nutrition, blood glucose, blood pressure, liquids management, the treatment of postoperative nausea and vomiting, the use of glucocorticoids, controlled drugs management, medication reconciliation and deprescribing. A further responsibility is the management of drugs prone to be used irrationally, such as proton pump inhibitors, and medication beyond the perioperative period but related to the procedures, such as immunosuppressant use for transplantation patients, and antithrombotic drug use after stent implantation. Pre-, mid-, and post-operative medication therapy management services for perioperative patients are at the crux of the surgical pharmacy specialty. FIP was pleased to hear that most surgeons were delighted to delegate medicines management authority to pharmacists, and that many large hospitals in GuangDong province now have established surgical pharmacist positions. The establishment of the specialty of surgical pharmacy was an important step for the GDPA to promote the extension of pharmacy services in China, and we thank our colleagues for sharing this significant achievement. FIP is very happy to support the sharing of this great development.
藥師的臨床作用日益增強(qiáng)，外科藥學(xué)學(xué)科的出現(xiàn)是藥師作用進(jìn)一步發(fā)展的一個(gè)很好的例子。2015年底，中國廣東省藥學(xué)會(huì)提出了“外科藥師”的概念。2018年9月，廣東省藥學(xué)會(huì)開展了在醫(yī)院設(shè)立外科藥師崗位的工作，并將其職責(zé)定義為負(fù)責(zé)圍手術(shù)期及以后的全流程用藥管理。這包括關(guān)注圍手術(shù)期藥物治療，如抗感染、抗血栓和鎮(zhèn)痛用藥，以及臨床營養(yǎng)、血糖、血壓、液體管理、術(shù)后惡心和嘔吐的治療、糖皮質(zhì)激素的使用、受控藥物的管理、藥物重整和處方精簡。進(jìn)一步的職責(zé)是管理容易不合理使用的藥物，如質(zhì)子泵抑制劑，以及超出圍手術(shù)期但與手術(shù)相關(guān)的藥物，如移植患者使用免疫抑制劑，以及支架植入術(shù)后使用抗血栓藥物。圍手術(shù)期患者術(shù)前、術(shù)中、術(shù)后的藥物治療管理服務(wù)是外科藥學(xué)學(xué)科的核心。FIP很高興地得知，大多數(shù)外科醫(yī)生都愿意將用藥管理權(quán)限賦予藥師，廣東省的許多大醫(yī)院現(xiàn)在都設(shè)立了外科藥師崗位。外科藥學(xué)學(xué)科的建立是廣東省藥學(xué)會(huì)推動(dòng)藥學(xué)服務(wù)在中國延伸的重要一步，我們感謝我們的同事分享這一重大成就。FIP非常樂意支持分享這一偉大的發(fā)展。
Forward with pharmacy, forward with FIP.
藥學(xué)不斷發(fā)展，FIP不斷向前！
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