Nghien
CLFU- Ky thuat
Cac chi so danh gia hoat dong ^
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cua Hoi dong thuoc va dieu trj
Vu Thj Thu Huong', Nguyen Thanh Binh', Nguyen Trung Nghia Trtrimg dgi hgc Duac Hd Ndi. 'Benh vien E
Dat van de
Su dung thudc thifeu hieu qua va b i t hop ly ndi chung va trong khu vuc benh vien noi rieng da va dang la v i n dd b i t cap ctia nhi^u qudc gia, day la mpt trong cac nguyen nhan chinh lam tang chi phi cho nguai benh, giam chit luang cham soc strc khoe va uy tin ctia cac ca sd kham chCia benh'^', De gop phin ngan chan cac tinh trang tren, nguyen t i c lua chpn thudc trong xay dung danh muc thudc d\ku tri da duac dat ra, nguyen t i c nay vdn da duac b i t d i u ttr the ky thtr 18 tai My''^'. Den nhtrng nam 30 cua the ky truac, da co nhung su tiin bp mang tinh toan cau trong viec thuc hien nguyen tac nay, tren ca sd do viec thanh lap mpt hpi ddng lam nhiem vu xay dung danh muc thudc tai cac ca sd dieu tri da duoc hinh thanh, no duac biet d i n duai ten H O T & O T ' ^ ' .
Nhieu nghien etru cho thay hoat dpng ctia H O T & O T CO tac dpng tich cue den dich vu cham soc y te. Cac loi ich ma HOT&OT mang lai duac t h i hien qua cac hoat dpng cu the; lua chon cac thudc hieu qua, an toan, chit lugng va gia hap ly cho danh muc thuoc; nang cao chit luang cham soc benh nhan va hieu qua dieu tri; tang cu'ang hieu biet ctia nhan vien y te va benh nhan; giam cac phan u'ng cd hai ctia thudc va cac sai sot trong dieu tri va tang cuang quan ly hoat dpng mua sam va bao quan thuoc, quan ly va kiem soat chi phi mua thudc t i t han'^l
NhCrng tac dong va anh hudng ctia HOT&OT khdng chi trong benh vien va cdn ca trong cpng ddng. Tuy nhien do lu'dng hieu qua va lai ich ctia cac hoat dpng nay la mpt van de khd khan va phtrc tap. Theo khuyen cao ctia WHO, de danh gia dupc cac hoat dong ctia HOT&OT c i n thiit phai xay dung bp chi s6 n h i m lam ro ro vai trd ctia hpi dong nay trong hoat dpng cung trng thudc tai benh vien. Vi vay r i t nhiiu qudc gia, khi thanh lap HOT&OT, mpt viec khdng the thieu la xay dung cac chf sd de danh gia hoat dpng va vai trd ctia hpi ddng nay.
Tai Viet Nam, theo b^o cao cua Bp Y t i hau h i t cac benh vien hoat dpng bing ngan sach nha nudc d i u da cd HOT&OT hoat dpng han 10 nam qua'''. Tuy nhien, chting ta van chua xay dung cac chi sd d i danh gia vai trd hoat dpng ctia hpi dong nay. Vi vay, viec tong quan cac chi sd danh gia hoat dpng ctia HOT&OT cua mpt sd qudc la viec rit c i n thiit, tren ca sd dd lam ca sd de tirng budc xay dung mpt bp chi sd danh gia hoat dpng HOT&OT phti hp'p vdi thuc tien Viet Nam,
Cac chi so danh gia hoat dong cua HDT&DT
Tai h i u h i t cac qudc gia, viec xay dung bp chi sd danh gia hoat dpng ctia HOT&OT duac dua tren muc dich, muc tieu va cac chien luac nhim nang cao hieu qua hoat dpng ctia HOT&OT. Chi s6 danh gia qua trinh hoat dpng duac xay dung dua tren cac chien luac ctia HOT&OT. Chi sd danh gia cac tac dpng ctia HOT&OT duac xay dung dua tren cac muc tieu cua HOT&OT va chi s6 danh gia hieu qua hoat dpng ctia HOT&OT duac xay dung dua tren muc dich cua H O T & O T ' ^ ' .
Chi sd danh gia qua trinh nham cung cap thdng tin dinh tinh ve cac hoat dpng hoac ca sd ha ting c i n thiit de dat duac cac muc tieu ctia mot HOT&OT. Chi sd nay duac thiit k i bdi mot loat cac cau tra Idi hoan thien de phan anh qui md va pham vi cua cac hoat dpng hoac ca sd ha t i n g cd dugc xay dung va thuc thi. Cac chi s6 nay khdng danh gia viec thuc hien chtrc nang hoac hieu qua cua cac hoat dpng hpac cau true ctia cac H O T & O T ' ^ ' .
Chi s i danh gia cac tac dpng ctia HOT&OT cung c i p cac thcng tin mang tinh djnh lugng v i cac heat dpng va ca c i u to chtrc ctia HOT&OT, cd the danh gia va dinh lugng cac thay doi theo thdi gian va cac tiin bp trong cac ITnh vuc cu the.
Cac chi s6 nay nhim do ludng v i tinh an toan, hieu i]ua, chi phi - hieu qua, kha nang cung trng va chit lugng str dung thudc trong benh vien'^'.
TAP CHI DUOC HOC - 6/2011 (SO 422 NAM 51)
N g h i e n CLFU - Ky t h u a t
Chi s i danh gia hieu qua ctia HOT&OT la do ludng mirc dp cai thien ve chat lugng dieu tri va hieu qua kinh t i ctia benh vien, nhit la cac v i n de cd lien quan den str dung thucc'^'.
Nhim nang cao hieu qua boat dpng ctia HOT&OT thi viec tu danh gia, xem xet hoat ddng la rit c i n thiit. To chtrc Y T i The gidi da xay dung bo chi s i d i danh gia tac dpng va anh hudng ctia HOT&OT. Bing each nay, HOT&OT cd the xac dmh xem cac muc tieu, muc dich cd dat dugc hay khong va t r e n c a sd dd d i xuit nhu'ng bien phap hd trg ttr benh vien'^l
Muc dich ctia HOT&OT la n h i m dam bao cho nguai benh dugc hudng che dp cham soc tot nhat vai chi phi phu hgp thdng qua viec xac dinh xem loai thuic nao c i n phai cung trng, gia ca ra sao va su dung nhu t h i nao'®'.
Oe dat dugc muc dich tren, HOT&OT c i n dat nhtrng muc tieu'®':
- Xay dung va thuc hien mpt he thdng danh muc thuic cd hieu qua ca v i diiu tn cung nhu gia thanh.
- 0am bao chi str dung cac thuic thoa man cac tieu chi ve hieu qua diiu tri, dp an toan, hieu qua - chi phi va chat lugng.
- Oam bao an toan thuic thong qua cong
tac theo ddi, danh gia va tren ca sd dd ngan ngti'a cac phan trng cd hai va sai sdt trong diiu tn.
- Xay dung va thuc hien nhung can thiep nhim nang cao thuc hanh str dung thudc cua cac thay thuic ke dan, dugc sy c i p phat va nguai benh.
Cac chiin lugc ctia HOT&OT tai Australia bao gim'^';
- HOT&OT nang dpng, uy tin, b i n vtrng.
*- Dam bao luon cd s i n , dti thuic va thuic dam bao chat lugng trong toan benh vien.
- Oam bao tinh dting dan va khach quan trong qua trinh dua ra quyet dinh.
- Quan ly cac nguin luc cd hieu qua
- Cai thien chit lugng d i i u tri thong qua cac tieu chuan ctia viec kham chua benh va cac can thiep v i hanh vi va dao tao.
Chi s i danh gia hoat dpng ctia HOT&OT giup giam sat va danh gia tien trinh trong viec thuc thi cac chinh sach ctia HOT&OT mpt each khach quan, ddng thai cting c i cac chiin lugc ca ban nham nang cao hieu qua hoat dong cua hpi ddng'^'.
WHO da xay dung bp chi so danh gia hoat dpng ctia HOT&OT bao gdm mudi chi s i danh gia qua trinh hoat dpng, ba chi so danh gia anh hudng va mpt chi s i danh gia hieu qua hoat dpng ctia HOT&OT.
Bang 1: Bg chi s6 danh gia hoat dgng cua HDT&DT ciia WHO' fsi Chi so qua trinh
Chi so anh huong
HOT&OT CO van ban quy dinh ro muc dich, muc tieu, nhiem vu va chuc nang cua tung thanh vien khong?
HOT&OT CO duo'c ho tra ve tai chinh de hoat dong khong?
Ty 1$ cac thanh vien tham du tren 50% cac cuoc hop HOT&OT?
Co bao nhieu cugc hgp HOT&OT da dugc to chuc trong nam trugc?
HOT&OT CO van ban quy dinh viec be sung hay loai bg thuoc ra khgi danh muc thuoc benh vien khong?
HOT&OT CO xay dung, ban hanh va to chuc thuc hien cac hugng dan dieu trj chuan khgng?
HOT&OT eg tg chuc cac hgat dgng tap huan ve su dung thugc khgng?
Co bag nhieu nghien cuu can thiep nham nang cag thuc hanh SLP dung thuoc da dugc thuc hien?
Cc bao nhieu dieu tra su- dung thugc da dugc tiSn hanh?
HOT&OT eg xay dung chinh sach de kiem soat van de trinh dugc vien va quang cao thucc tai benh vien khong?
Lua chon thuoc
Cc bao nhieu thuoc trong danh muc thucc benh vien?
Ty le cac thucc ke don nam trgng danh muc thugc benh vien?
Cc bao nhieu thu6c khang sinh trcng danh muc thucc benh vien?
Chat lug'ng ke don
Ty le benh nhan dugc dieu tri phii hgp vo'i huong din di§u tri chuan?
Ty le cac thuoc da dieu tri phu hop vgi cac tieu chi danh gia trcng dieu tra SLP dung thu6c?
An tcan trong dung thugc:
Ty le tti' vgng va benh tat trgng mgt nam gay ra do phan trng cc hai cua thu6c va sai sot trcng dieu tri?
TAP CHi DUOC HOC-6/2011 (SO 422 NAM 51)
N g h i e n CLFU - Ky t h u a t
Chi sg hieu qua Hieu qua ve tai chinh
Chi chi cho cac heat dgng ctia HOT&OT sc vgi cac sc tiSn tiet kiem dugc thcng qua cai thien viec SLP dung thucc va giam lang phi.
8 6 chi s i danh gia hoat ddng HOT&OT ctia Australia d u g c Hiep hpi d u g c tai Australia nghien etru xay dung, d u a tren cac quy djnh, cac nghien etru da d u g c t i i n hanh va t u v i n ctia cac chuyen gia v i thudc trong benh vien. Nghien etru xay dung 35 chi s i gia dinh, trong do 4 chi s i danh gia
hieu qua, 7 chi so danh gia anh h u d n g va 24 chi s i danh gia qua trinh. Sau khi bp chi s i tren d u g c tien hanh nghien cti'u tren 16 benh vien. bp chi so chinh thtpc d u g c xay d u n g g i m 1 chi s i danh gia hieu qua, 6 chi s i danh gia anh h u d n g va 17 chi so danh gia qua trinh.
Bang 2: Bg chi s6 danh gia hoat dgng cua HDT&DT tai Australia'' Chi so danh gia
qua trinh hgat dgng ctia HOT&OT
Cac chi so danh gia anh huong cua HOT&OT
Chi so danh gia hieu qua ctia HOT&OT
HOT&OT quy dinh ro ve eg cau to chuc, tham quyen va trach nhiem khcng?
Cac muc dich, muc tieu, cac dieu khoan va ke hcach chien lugc cua HOT&OT cc dugc quy dinh bang van ban khcng khgng?
HOT&OT CO cac quy dinh ve:
a. Tham quyen quyet dinh viec cung ti'ng va SLP' dung thucc tai benh vien khgng?
b. Qua trinh thuc hien va danh gia cac chinh sach ve thucc.
c. Cach thtpc ra quyet dinh ctia HOT&OT
d. Chinh sach va quy trinh ke khai v§ lgi ich cua cac thanh vien trong hgi dgng?
e. Quy dinh ve cac cugc hgp dinh ky?
HOT&OT CO dugc phan be ngugn luc ho trg khcng?
HOT&OT cc cac thanh vien dai dien cac khca lam sang, khga dugc, dieu dugng va cac nha quan ly de cung nhau ra quyet dinh khong?
Co van ban quy dinh v§ viec dua ra quyet dinh cua cac thanh vien trgng HOT&OT khgng?
Cac quyet djnh ctia cugc hgp HOT&OT cc dugc ghi thanh bien ban va chuyen tgi cac thanh vien khcng?
HOT&OT cc ban hanh ban yeu cau be xung thugc vac danh muc?
HOT&OT giam sat, xem xet va phe chuan quy trinh chuan cua cac yeu cau SLP dung cac thucc khcng nam trgng danh muc trong mgt sg tinh hugng nhat dinh khdng?
Danh muc thucc cc dugc xem xet hang nam khcng?
HOT&OT cc xay dung va thuc thi chinh sach danh gia va nhan thucc khuyen mai ttp cac ccng ty dugc p h i m khong?
HOT&OT co xay dung cac chinh sach he trg nhSm giup do cac benh nhan khong co BHYT duy tri phac do dieu tri cua hg khong?
HOT&OT cc xay dung chinh sach n h i m danh gia cac thuoc chua cc dang ky chi djnh va cac thucc thay the khcng?
HOT&OT CO hd trg hay phe c h u i n bat ky heat dgng nag sau khgng?
a. Cung cap cac tai lieu dao tag chg cac bac sy;
b. Cung c i p cac thcng tin khach quan cho bac sy, c. Thcng ke va phan hdi du lieu thcng tin chg bac sy;
Oag tag hgac tg chtpc hgi thag phuong phap di4u trj?
Ty le cac thanh vien tham d u tren 50% cac cugc hgp HOT&OT
Ty le mgt sg nhom thucc: giam dau, gay me, khang sinh Cephalgspgrin.
Ty le Bac sy va d\hu duong nhan dugc hudng dan SLP dung thudc t u HOT&OT.
Ty le p h i n tram cac heat chat mdi dugc bd sung vac DMTBV dugc danh gia qua; bing chung y hgc ve su an tcan va hieu qua cua thucc, phan tich ve chi phi, danh gia iam sang c i n thilt?
Ty le phan tram cac chinh sach vg SLP dung thudc da thcng qua?
Ty trgng cac thuoc khcng cc trgng danh muc sc vdi tgng gia trj ti§n thugc?
Ty le Bac sy va dieu du&ng SLP dung cac hudng d i n SLP dung thudc t u HOT&OT.
Ty le cai thien ctia viec tuan thti hudng dan SLP dung thucc chg mgt tinh trang benh nhat
djnh trudc va sau can thiep? ' Tinh trang benh tat ctia benh vien dugc cai thien dc phdng tranh dugc cac phan ipng cd
hai ctia thucc va cac sai sdt trong dieu trj.
TAP CHi DUOC HOC - 6/2011 (SO 422 NA.M 51)
Nghien CLFU - Ky t h u a t
Nham danh gia hieu qua hoat dpng va xay dung bp chi so danh gia hieu qua hoat dpng ctia HOT&OT, Thai Lan da tiin hanh khao sat hoat
dpng ctia HOT&OT thdng qua y kiin ctia 452 chti tich va thu ky hpi d i n g ctia mot s i benh vien [6]
Bang 3: Mgt s6 chi s6 danh gia hoat dgng cua HDT&DT cua Thai Lan 161 Mdt sd chi sd dugc
cac chu tich HOT&OT dd nghj;
Mgt sd chi so dugc de nghj bdi cac thu ky HOT&OT
1. HOT&OT CO chju trach nhiem xem xet va phan bd ngan sach mua thudc khcng?
2. HOT&OT cd van ban quy dinh cac tieu chi be sung va Igai bd thudc khdi danh muc thudc benh vien khdng?
3. HOT&OT cc xay dung cac hudng din didu trj chuan che mgt sg benh thdng thudng;
nhiem trung dudng hd hip, tieu chay, tidu dudng, cac huydt ap, du phdng khang sinh...khdng?
4. HOT&OT cd thee ddi cip phat thuoc tai khga Dugc de dam bac cac thudc dugc cip theg dung y lenh khdng?
5. HOT&OT cd tidn hanh dieu tra ve su hai Icng ctia nhan vien benh vien khdng?
1 .Co van ban quy dinh rd ve muc dich, muc tieu, ca cau va chtPC nang cua HOT&OT khcng?
2. HOT&OT cd quyen lua chon thudc xay dung danh muc thudc benh vien khdng?
3. HOT&OT cd giam sat ty le cac thudc SLP dung ngoai danh muc thudc benh vien khcng?
4. HOT&OT cd theo ddi cap phat thudc tai khoa Dugc de dam bac cac thuoc dugc cip theo dung y lenh khdng?
5. HOT&OT cd xay dung cac quy dinh de lam hai Idng benh nhan ve dich vu dieu tri tai benh vien khdng?
Cac chi so dinh lugng ve hoat dpng ctia HOT&OT tai Thai Lan la so lugng cac buoi hpp ctia HOT&OT va s i lugng thuoc trong danh muc thuic benh vien [6], Bp chi s i danh gia hoat dpng HOT&OT tai Thai Lan dugc de nghj theo doi bdi Cue giam sat va danh gia c h i t lugng hoae To chtrc nang cao chit lugng benh vien.
Tai Lao, HOT&OT da dugc thanh lap tCr nam 1999. Hieu qua hoat dpng ctia HOT&OT tai day cung da ed bao eao, tuy nhien khong ro rang.
Chinh vi t h i , nhim xae dinh cae y i u td anh hudng d i n hoat dpng ctia HOT&OT va xae djnh eac y i u t i gitipcai thien hoat dpng cua hpi ding thdng qua dao tao cac thanh vien HOT&OT, mpt nghien etru can thiep str dung bp chi s i v i c i u true va qua trinh boat dpng da dugc tiin hanh tren 9 benh vien. K i t qua cho thiy sau can thiep, cae ehl sd v i hoat dpng ctia HOT&OT, thdng tin thuic, theo doi phan trng cd hai etia thudc, so buoi hpp hpi ding va xay dung eac huang dan diiu tri chuan dugc eai thien. Tuy nhien, nghien etru cung chi ra mpt s i cac y i u td tac dpng lam han c h i hoat dpng cua HOT&OT;
hop khong thudng xuyen, cae thanh vien qua nhieu viee, giam d i e benh vien it quan tam d i n HOT&OT, cac thanh vien HOT&OT thiiu kien thti'c, giam d i e benh vien khcng tham gia
H O T & O T ' ^ ' .
Cung tuang tu tai Mondova, tu theo doi, danh gia hoat dpng thdng qua bp ehl s i la mpt chien lugc nham on djnh cdng viee va tang cudng str dung thuic an toan hgp ly'^',
Bp ehi so la mpt edng cu hCfu ieh va c i n thiit ehp HOT&OT tu giam sat va tu dieu chinh cac heat dpng ctia minh cho dting muc dich, muc tieu va cac chiin lugc da dat ra. Cdng eg nay edn gitip eae nha quan ly dua ra eac quyet dinh khach quan va thich hgp'®'.
Tai Australia, sau khi bp ccng cu dugc ap dung thtp, da cd mpt so thay doi d mot vai HOT&OT; tiin hanh dieu tra tinh hinh str dung thuic, bo sung dai dien etia ngudi tieu dung lam thanh vien cua HOT&OT va xay dung eac ke hoaeh, chiin lugc hoat dpng cu the'"'.
Ket luan
HOT&OT da dugc thanh lap ttr nhCrng t h i ky XX va d i n nay da cd mat tren han bay muai quic gia tren tren t h i gidi''"'. WHO coi HOT&OT la mpt trong nhtrng cdng cu nhim nang cao viec str dung thuoc an toan va hgp ly. Chinh vi t h i viec do ludng chit lugng va hieu qua ctia hoat dpng nay rat quan trpng. Theo khuyin cao cua WHO, h i u hit eac quic gia d i u thiit lap bp ehl s i nhim danh gia heat dpng etia HOT&OT, ching han nhu Australia da cc mpt bp ehl s i hoan chinh, duge ban hanh va la thude do hieu qua hoat dpng cua HOT&OT tren toan d i t nudc.
TAP CHi DUOC H O C - 6 / 2 0 1 1 (SO 422 NAM 51)
N g h i e n CLFU - K y t h u a t
HOT&OT etia cac benh vien eua Viet Nam da d u g e thanh lap va di vac hoat dpng tai h i u h i t eae benh vien h a n 10 nam qua, n h u n g chting ta la chua cd mpt bp cong eu hCru hieu n h i m danh gia hieu qua hoat dpng ctia hoi d i n g nay de ttr dd ed eac d i i u ehinh va h i t r g e i n t h i i t V i n d i e i n phai dat ra la c i n phai nhanh chong xay d u n g bp chi s i n h i m danh gia vai trd eua HOT&OT trong hoat dpng cung trng t h u i c benh vien tren c a s d dd ra s o a t dieu chlnh hoat dpng etia HOT&OT chp phu hgp vdi thuc t i n h i m eai thien c h i t l u g n g d i i u tri hien nay tai cac benh vien.
Summary
A health care organization's DTC has numerous responsibilities that, when pedormed successfully, will have a positive impact on health care. The overall value of the DTC is not easily measured.
The following process and outcome indicators will help identify when a DTC is effective and making an impact. WHO has developed the DTC indicators includes ten process Indicators, three impact indicators and an outcome indicator Set of indicators ofAstralia Includes an outcome Indicator, six impact indicators and seventeen process indicators. Thailand has surveyed the activities of DTC through the opinions of 452 chairmen and secretary board of a number of hospitals and guantitative indicators for the DTC in Thailand is the number of meetings of DTC and the number of drugs in the hospital drug list Laos and Moldova have also studied to develop set of DTC Indicators.
In Vietnam. DTC has been established over ten years but not build the indicators.
Tai lieu tham khao
1. Luong Nggc Khue, Bao cao tong quan tinh hinh quan ly va SLP dung thudc trong cac co s d kham chua benh. Cue quan ly kham chOa benh Vi0t Nam
2. Cclleen Brggks, Lynn Weekes. Indicators for Drug and Therapeutics Cemmittees, (2001)
3. Cebotarenco N, Veltman K, Tchebetarencg S, Shetinina S, Drug and Therapeutics Committees In Moldova, Secend International Conference on imprgving Use of Medicine (2004),
4. Lynn M Weekes, Cglleen Brooks, Richard 0 Day, Indicators fcr Drug and Therepeutlcs Committees, Br J Clin Pharmaccl. (1998) April; 45(4);
393,398.
5. Management Sciences for Health and World Health Organization. Dmg and Therapeutics Committee Training Course. (2007).
6. Sripairgj A., Liamputtgng P., Harvey KLa Trebe University, Australia, Pharmacy and Therapeutics Committees in Thai Hospitals under Health Reform, Secgnd International Conference on imprgving Use gf Medicine (2004)
7. Summers K., Szeinbach S. Formularies; The rcle gf Pharmacy and Therapeutics (P&T) Cemmittees. Clin Ther (1993); 15(2); 4 3 3 - 4 1 .
8. Vang C, Temsgn G, Kounnavong S, Southammavong T, Phanyanguvgng A, Johanssgn R, Erikssgn B, Wahlstrgm R, Imprgving the perfermance of Drug and Therapeutics Committees in hospitals-a quasi-experimental study in Lags, Eur J Clin Pharmacol (2006) Jan;62(1);57-63. Epub 2005 Dec 22
9. WHO, Drug and Therapeutics Committee Practical, (2004)
10. WHO, Using Indicators to measurecountry pharmaceutical situations. Fact Bcgk gn WHO Level I and Level II monitoring indicators (2006).
N g h i e n C L F U . . . (Tidp theo trang 1 5)
3. Trung tam DI&ADR Qudc gia. Bag cao khag sat danh gia nang luc qudc gia ve Thdng tin thudc va Canh giac dugc, (2009).
4. American Hospital Formulary Service, AHFS Drug Infonvatlon, (2008).
5. Clauson KA, Rglen HH, Marsh WA, Clinical decision support tcgls; perfgrmance of persenal digital assistant versus online drug infgrmatign databases, Phanvacotherapy. (2007), 27; 1651-1658.
6. Ender SJ, Ender JM, Hglstad SG, Drug infgrmatign software fcr Palm Operating System Personal Digital Assistants; Breadth, clinical
dependability and ease cf use. Pharmacotherapy, (2002), 22; 1036-1040.
7. Gait KA, Rule AM, Houghton B et al. Personal digital assistant - based drug infermation sources;
potential to improve medication safety, Joumal of the Medical Library Association, (2005), 93; 229-36.
8. Malcne DC, Kier KL, Stanovich JE, Drug infgrmatign; A guide for pharmacist 3'^ edition, McGraw Hill's Access Pharmacy, (2009).
9. The Royal Pharmaceutical Society gf Great Britain, Martindale; The ccmplete drug references 35'^ The Phanvaceutical Press, (2007)
TAP CHi DU'OC HOC - 6/2011 (SO 422 NAM 51)
