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县级药品不良反应监测机构是我国药品不良反应监测体系中的重要环节，作用与特点突出。
我国至今还没有在县一级政府建立专职的药品不良反应监测机构，现行的县级药品不良反应监测机构都是县级药品监督管理机构指派一至二名人员兼职负责辖区内的药品不良反应监测工作。
1县级药品不良反应监测机构的状况1.1人员少、兼职多县级药品监管机构的工作人员是按照国家规定比例配置，除去正副局长、工勤人员、办公室人员等后，剩下的监管人员已经不多，同时抽出一至二名监管人员负责药品不良反应的监测工作；而县级药品监管机构监管本身任务重，管理相对人多达400至500家，基本上是一个或者两个科室除了要承担上级主管部门四至六个处室下达的监管任务，还要承担本部门同级政府下派的其他工作任务，由此形成工作时间主抓药作者简介：朱跃勇（1971-）,男,本科,主管药师,药品监管。
浅谈县级药品不良反应监测与日常监管工作相结合的工作模式朱跃勇1，王艳春2，王淑芳3（1抚顺县食品药品监督管理局，辽宁抚顺113006；2抚顺市药品不良反应监测中心，辽宁抚顺113006；3抚顺市第四医院，辽宁抚顺113123）中图分类号：R954文献标识码：A 文章编号：1672-8629（2009）05-0305-03摘要：县级药品不良反应监测机构是我国药品不良反应监测体系中的重要环节，作用与特点突出。
抚顺县食品药品监督管理局努力探索县级药品不良反应监测的工作模式，即把药品不良反应的监测工作与日常药品监管工作有机结合起来，完善辖区内药品不良反应体系建设，采取“六个结合”与“五查八对”等办法，有效促进了药品不良反应监测工作的健康发展。
关键词：药品不良反应；监测；监管Discussion on the Combination of Adverse Drug Reaction Monitoring and Drug Supervision ZU Yue-yong 1,WANG Yan-chun 2,WANG Shu-fang 31Fushun Food and Drug Administration (Fushun 113006,China)2Fushun Center for ADR Monitoring (Fushun 113006,China)3The Fourth Hospital of Fushun (Fushun 113123,China)Abstract:Adverse drug reaction (ADR)monitoring in county is the terminal of ADR monitoring system,and has important action.Fushun food and drug administration finds a way suitable for ADR monitoring in county.ADR monitoring in county combined with the drug supervision by improving the construction of adverse reactions system with the "6combination"and "5inspection and 8check"approach.Key words:adverse drug reactions(ADR);monitoring;supervision305品监管、业余时间抓药品不良反应监测及上报工作的局面。
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Laryngopharyngeal reflux 2002: a new paradigm of airway disease. (Introduction).AbstractOur purpose in writing this supplement is to provide an overview of laryngopharyngeal reflux (LPRencompassing; some of the material presented is controversial; and we recognize that it does represent the bias of physicians at the Center for Voice Disorders of Wake Forest University. Furthermore, we understand that we raise as many questions as we answer. Still, we hope that this supplement will serve as a useful summary of LPR for clinicians, and that it will stimulate others in the research arena.Background) was recognized in antiquity. In 1618, Fabricius described the gastroesophagealjunction, which he referred to as cardiaterm because symptoms arising from the gastroesophageal junction could mimic those arising fromAds by Google Questions on Lung DiseaseFind Instant Answers to All Your Lung Disease Questions on Bing ™.Ask a Feline Vet Online8 Veterinarians Are Online! Ask a Question, Get an Answer ASAP./Cat/Feline(1) for the first half of the 20th century he and his contemporaries did not understand GER. For(3)In 1968, laryngopharyngeal reflux (LPR)--that is, GERD that affects the larynx and pharynx--was described in relationship to contact ulcers and granulomas of the larynx. (4,5) However, relatively fewreflux of gastric contents into the throat, but rather the result of vagally mediated reflexes.together with small dental rubber bands. Published in 1987, preliminary data from patients with clinical LPR who had undergone ambulatory 24-hour double-probe (simultaneous pharyngealthat acid was present in the pharynx of most of these patients. (21)In 1989, Wiener et al reported the results of double-probe pH monitoring in a series of 32 otolaryngology patients with clinical LPR; 78% of them had pH-documented LPR. (22) Analysis of the pH tracings made it apparent that the pattern of reflux in LPR was different from that usually seen in GERD; the LPR patients had predominantly upright (daytime) reflux. (22) This finding was new and surprising, because most patients with GERD had been previously shown to be predominantly supine (nocturnal) refluxers. (1) In addition, fewer than one-third of the LPR patients had esophagitison that the patterns and mechanisms of LPR might be different from those of classic GERD (figure). But the reason LPR patients were upright refluxers without heartburn or esophagitis was still unknown.Areas of ongoing researchMuch of the subsequent LPR research has been focused on seven areas: (1) associations with other diseases, (2) symptoms and findings, (3) mechanisms, (4) neurophysiologic reflexes, (5) diagnostic tests, (6) treatment outcomes, and (7) cell biology.LPR association data. The goal of this type of research is to show the association between certain medical conditions and the presence of LPR by clinical and reflux-testing criteria. (1,23-49)Defining the symptoms and findings of LPR. Many studies have sought to define the clinicalparameters of LPR. (1,50,51)LPR mechanisms. (52-54) Why is LPR different from GERD? Why do LPR patients have upright reflux and not esophagitis or heartburn? How are the mechanisms of LPR different from those of GERD?begun to examine the neurophysiologic mechanisms and pathophysiologyNew diagnostic tests for LPR. Although double-probe pH testing is an excellent diagnostic test, it has its limitations. Since 1997, our laboratory has been working to develop sensitive immunoassays forinexpensive tests for LPR. Other new diagnostic methods (e.g., impedance measurement) are also on the horizon. (60-62)Treatment outcomes. Outcomes data have become increasingly important in clinical medicine. Outcomes studies have been and still are being conducted in LPR. (51)Cell biology. Investigations of the impact of reflux on a cellular level are being conducted. In 1998, an international collaborative research network of basic scientists and clinicians was established.than is esophageal epithelium and that peptic injury can occur at a pH level of 5.0 or more. (63,64)LPR is not GERDDespite discoveries that have yielded a better understanding of LPR and how it differs from GERD, much is still not known. LPR remains controversial, partly because the gastroenterology model of reflux disease (i.e., GERD) does not seem to apply to patients with LPR. The term laryngopharyngeal reflux itself was coined because otolaryngologists wanted a new diagnostic term to designate reflux in otolaryngology patients. The clinical dichotomy of reflux patients who are seen by gastroenterologists and those who are seen by otolaryngologists warrants the use of two different diagnostic designations. Several other terms have been used for LPR in the medical literature (table).The prevalence of GERD and of LPR is unknown, but each has been estimated. Reportedly, 10% of the American population has heartburn on a daily basis, and as many as one-third has it less often. (1) In 1988, we estimated that approximately 10% of patients with laryngeal and voice disorders had LPR.(65) In 2000, a prospective study of 113 patients with laryngeal and voice disorders found that 57 (50%) had pH-documented reflux. (46)A study to determine the prevalence of LPR symptoms and findings in a community-based cohort found that they were common in "normals." (66) The mean age of the 100 volunteers was 60 years, and none of them had a history of reflux disease or took any antireflux medication. However, 35% of these subjects reported one or more LPR symptoms, and 64% had one or more LPR findings on examination.A host of controversies remainsLPR is ubiquitous. If one combines all the clinical and normative data, it would be easy to conclude that at least one-third of the American population older than 40 years has LPR. Although this is speculation, if one combines the potential size of the LPR and GERD populations, as many as 100 million Americans might have reflux. In truth, the epidemiology of LPR and GERD remains to be studied.But who really has LPR? In fact, what is LPR? Is it simply a combination of certain symptoms and findings? How is the diagnosis made? Indeed, there has been controversy about how to diagnosecompare the symptoms of individual patients during the course of treatment. (50) We have also instituted a standardized method of grading the laryngeal findings of LPR, which we call the reflux(51) This tool has proved to be very useful in the diagnosis and treatment of LPR. The RSI and the RFS are both validated outcomes instruments. Based on data obtained from normals, an RSI of more than 10 and an RFS of more than 5 are abnormal. (66)Why is LPR controversial? Not only are the symptoms and findings of LPR not clearcut, more important is the fact that there is no ideal diagnostic test battery for evaluating LPR. Traditional diagnostic criteria for GERD simply do not apply to LPR. Why is a pH value of less than 4.0 defined as a significant reflux event? Do patients with LPR require esophageal screening for esophagitis and other complications? Why do LPR patients require relatively high-dose (twice-daily) treatment withSymptoms. There is no universal agreement on the symptoms of LPR. When is postnasal dripCould the presence of too much mucus in the nose and throat be the result of direct irritation from LPR or the result of vagally mediated responses to throat irritation? What happens to patients with sinus symptoms and LPR when the LPR is effectively controlled?Clinical findings. There is no clear consensus about the findings and clinical manifestations of LPR. Although an extremely high incidence of LPR has been reported in patients with subglottic stenosis,ulcers heal uneventfully? Is it not the inflammation of LPR that likely continues the nonhealing process?)Diagnostic testing. Controversy surrounds diagnostic testing for LPR, including pH monitoring. Howundergo pH monitoring? How is it interpreted? (At our center, we believe that full esophageal manometry of the pharynx and esophageal sphincter is essential in p atients with LPR to ensure accurate pH data. (68) Furthermore, we feel that the proximal probe must be located in the pharynx. We perform ambulatory 24-hour double-probe simultaneous [esophageal and pharyngeal] pH monitoring, with probe placement based on manometric measurement. (69)Interpretation of findings. Interpretation of pharyngeal reflux events is controversial. Should we use a pH level of less than 4.0 as the pH threshold for determining reflux in the pharynx? Is laryngeal epithelium more sensitive to acid and peptic injury than is esophageal epithelium? Significant peptic injury to laryngeal epithelium has been reported in patients whose pH level was 5.0. (64) Would it be appropriate to use a pH level of less than 5.0 as the threshold for determining/measuring pharyngeal reflux? How many reflux events in the pharynx should be considered normal? Does a single positive pharyngeal reflux event not prove the existence of LPR?Treatment. It is interesting that many experienced clinicians have long rec ognized that treatment of LPR must be more intense and prolonged than is treatment for GERD. Indeed, the recently published position statement by the American Academy of Otolaryngology--Head and Neck Surgery on LPR was in part commissioned to provide a patient advocacy position--that is, to support the use of twice-daily proton-pump inhibitor medications in LPR, often for extended periods. (67)Considerations for future researchI personally believe that LPR research will someday present us with a new par adigm of airway disease. Reflux will be shown to dominate the internal environment and thus influence nearly all airway diseases (but obviously not all airway diseases in all patients). Tasker et al recently used aFuture research might show that reflux (of activated pepsin) is an inflammatory catalyst for many airway diseases, including cancers of the larynx, lung, esophagus, and pharynx.Table.Synonyms for 'laryngopharyngeal reflux'Atypical refluxExtraesophagela refluxGastropharyngeal refluxLaryngeal refluxPharyngoesophageal refluxReflux laryngitisSupraesophageal refluxReferences(1.) Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): A clinical investigation of 225 patients using ambulatory 25-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991;101 (Suppl 53):1-78.(4.) Cherry J, Margulies SI. Contact ulcer of the larynx. Laryngoscope 1968;78:1937-40.(5.) Delahunty JE, Cherry J. Experimentally produced vocal cord granulomas. Laryngoscope 1968;78:1941-7.Laryngol Otol 1972;86:335-42.(7.) Chodosh PL. Gastro-esophago-pharyngeal reflux. 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Ann Otol Rhinol Laryngol 1984:93:430-7.(16.) Feder RJ, Michell MJ. Hyperfunctional, hyperacidic, and intubation granulomas. ArchOtolaryngol 1984;110:582-4.(18.) Little FB, Koufman JA, Kohut RI, Marshall RB. Effect of gastric acid on the pathogenesis of subglottic stenosis. Ann Otol Rhinol Laryngol 1985;94:516-9.(19.) Menon AP, Schefft GL, Thach BT. Apnea associated with regurgitation(20.) Olson NR. The problem of gastroesophageal reflux. Otolaryngol Clin North Am 1986;19:119-33.(21.) Wiener GJ, Koufman JA, Wu WC, et al. The pharyngo-esophageal dual ambulatory pH probe for evaluation of atypical manifestations of gastroesophageal reflux (GER) [abstract]. Gastroenterology 1987;92:1694.(22.) Wiener GJ, Koufman JA, Wu WC, et al. Chronic hoarseness secondary to gastroesophageal reflux disease: Documentation with 24-h ambulatory pH monitoring. Am J Gastroenterol 1989;84:1503-8.(23.) Svensson G, Schalen L, Fex S. Pathogenesis of idiopathic contact granuloma of the larynx. 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