危重症患者用药的监测与护理

目的探讨危重症患者的用药监测,减少用药过程中并发症的发生。方法从危重症患者用药的特点、用药原则和用药监护的要点对危重症患者用药的过程和用药安全进行监控。结果经过有效干预后,患者不合理用药有效降低,均进行了正确用药。结论有效护理干预,可以有效的提高危重症患者的用药安全,值得临床推广。     

我院肾内科超说明书用药情况分析

目的调查并分析本院肾内科的超说明书用药情况,以提高本院合理用药水平及保障患者用药安全。方法回顾性分析本院肾内科2019年1-6月出院患者医嘱中的超说明书用药,总结超说明书用药的原因。结果共纳入患者337人次,用药医嘱3525条。超说明书用药289人次(占85.76%),超说明书用药医嘱605条(占17.16%),超说明书用药例数650次其中超适应证337次,超频次用药156次,超剂量用药91次,超适用人群用药59次,超给药途径用药4次,超禁忌证用药3次;分析后认为其中365次是合理的超说明书用药。37.69%的超说明书用药是医师在不熟悉药品说明书的情况下开具的。结论肾内科超说明书用药现象普遍,本院应制订超说明书用药规范和流程,降低患者用药风险。     

中药颗粒剂不合理用药处方分析

目的分析中药颗粒剂处方用药不合理情况。方法随机抽取2010年1月~2013年12月门诊中药颗粒剂处方12 000张,回顾性分析其用药不合理情况。结果 12 000张中药颗粒剂处方中,150张用药不合理,占总数的1.25%,用药不合理主要表现在用药不当、用药过量、重复用药、配伍不当、合并用药不当以及用药禁忌等。结论加强门诊中药颗粒剂临床用药管理,强化药理知识,减少盲目用药,提高合理用药水平非常重要。     

宁波市姚江社区2010-2011年老年人群安全用药现状调查

目的通过调查老年人群安全用药知识和用药行为现状,给予有针对性的干预指导,保障老年人群的用药安全。方法自制问卷调查表,对宁波市姚江社区276名老年人进行现状调查,内容包括用药状况、用药知识和常见不良用药行为。结果社区老年人群用药品种繁多,大多数缺乏安全用药知识,常见的不良用药行为以用药依从性较差居首。结论社区老年人群用药品种多,并缺乏安全用药知识和存在不正确的用药行为,易影响药物疗效,导致药物不良反应发生,提示社区护理人员应加强老年人群用药知识和用药行为的教育和干预指导。     

西药房不合理用药处方的研究与分析

目的:探讨西药房不合理用药处方情况,为临床合理用药提供参考.方法:将我院西药房用药处方进行回顾性分析,2015年1～12月未加强不合理用药处方分析,作为对照组,2016年1～12月加强不合理用药处方分析并采取改进措施,作为研究组,随机抽取西药房用药处方10000份进行调查,比较两组处方不合理用药情况.结果:研究组不合理用药率为1.00％,显著低于对照组的2.31％(P<0.05);不合理用药处方主要有药物选择、联合用药、药物剂量、用药次数等方面的不合理,有显著差异(P<0.05).结论:西药房不合理用药处方原因以药物选择、联合用药、药物剂量、用药次数等不合理为主,积极做好不合理原因分析,采取有效的干预措施,可减少不合理用药.     

门诊药房不合理用药的原因及改进对策

目的:了解我院门诊药房处方不合理用药情况,探讨不规范合理用药因素,提高临床合理用药水平.并提出相关的改进对策,确保处方用药质量,使医疗行业走向规范化.方法:随机抽取我院2015～2016年门诊处方9000张,将不合理用药情况分析汇总.结果:9000张门诊处方中,不合理用药占3.8％,其中用药选择不合理占16.6％,重复用药占22.5％,选药不当占6.2％,用药剂量不合理占30.4％,联合用药不当占10.9％,用药次数不合理占8％,其他不合理占5.4％.结论:我院门诊药房用药不合理,医院需加强处方用药规范性,加大处方用药审核力度,建立健全用药制度,医师和药剂师需提高职业道德操守,增强用药责任心,保障用药的合理性,使院内门诊用药水平得到提高.     

军队基层卫生机构临床无适应证用药分析

所谓的无适应证用药简而言之就是用药指征不明或无用药指征。无适应证用药在军队基层卫生机构临床用药中较为常见,特别是抗菌药物的不合理使用。为了减少军队基层卫生机构无适应证用药的盲目性,做到安全、有效用药,提高用药合理性,必须要引起高度重视。现对无适应证用药分析如下。     

加强基本用药管理,促进合理用药

目的 阐述基本用药在临床治疗中的作用,及促进合理用药的意义.方法 统计医院用药总数与基本用药目录数相比较.结果 用药总数远超基本用药目录数,主要表现在不同规格不同剂型,甚至不同厂家,出现用药结构不合理现象,给药学服务增加了难度,不利于减少差错,降低费用,提高效益,合理用药.结论 保障基本用药,根据专科需要适度增加新特药品,扩大OTC、医保用药是促进合理用药的关键.     

我院血液肿瘤病房超说明书用药调查分析

目的：调查我院血液肿瘤病房住院患儿超说明书用药情况,促进儿童合理用药。方法：采用系统抽样方法从我院血液肿瘤病房2012年4月至2013年3月的住院病历中抽取97份病历,包含3 548条医嘱,对其中的超说明书用药情况进行统计分析。结果：3 548条医嘱中超说明书用药医嘱1 509条（42.5%）,依次为无儿童用法用量用药1 260条,溶媒不适宜用药139条,超适应证用药136条,超给药频率用药94条,超剂量用药61条,超疗程用药18条,超给药途径用药14条,超年龄用药12条,部分医嘱存在多种超说明书用药情况;用药对象主要集中在幼儿期和学龄期,青春期患儿医嘱中超说明书用药医嘱比例最高（47.1%）,其次为幼儿期（45.5%）;水、电解质及酸碱平衡调节用药医嘱及超说明书用药医嘱最多,抗组胺用药医嘱中超说明书用药医嘱比例最高（78.3%）,其次为心血管系统用药、消化系统用药、糖皮质激素等。结论：超说明书用药现象在儿童血液肿瘤病房普遍存在,具有一定的医疗安全隐患,为兼顾临床需求与用药安全,应加强监管力度,并要求与患儿签署超说明书用药知情同意书。     

内分泌科患者实施用药教育后依从性调查

目的:调查分析内分泌科患者实施用药教育后的用药依从性,探讨用药教育对患者用药依从性的影响。方法:对内分泌科接受用药教育的100例住院患者进行用药依从性问卷调查,并选取100例未接受用药教育的住院患者作为对照。同时统计分析用药依从性的影响因素。结果:接受用药教育的患者,用药依从性明显高于对照组患者(P<0.01)。患者用药依从性受患者疾病特征、药物治疗特征、患者对医务人员信任度等多种因素的影响。结论:内分泌科住院患者用药依从性影响因素众多,实施用药教育能提高患者用药依从性,促进合理用药。     

Event-Specific Cannabis Use and Cannabis Use Motives

Background: Specific events such as Mardi Gras (MG) and St. Patrick's Day (SPD) have been identified as high-risk events for cannabis use. Further, some campuses may have traditions that are associated with more event-specific cannabis use. Objectives: Campus A has specific traditions regarding MG whereas Campus B has specific traditions regarding SPD and these campuses are differentially related to event-specific cannabis use (Buckner, Henslee, &; Jeffries, 2015 Buckner, J. D., Henslee, A. M., &; Jeffries, E. R. (2015). Event-specific cannabis use and use-related impairment: the relationship to campus traditions. Journal of Studies on Alcohol And Drugs, 76, 190–194. dx.doi.org/10.15288/jsad.2015.76.190[Crossref] , [Google Scholar]). Yet, little work has identified individual difference variables related to high-risk cannabis use events. Methods: Current cannabis using undergraduates (N = 154) at two campuses completed an online survey of event-specific cannabis use motives, cannabis use, and cannabis-related problems. Results: Campus A endorsed more MG-specific social and enhancement motives than Campus B. Campus A reported more socially, enhancement, coping, conformity, and expansion motivated cannabis use on MG than on SPD, whereas Campus B reported more socially and enhancement motivated cannabis use on SPD than on MG. Campus A was indirectly related to more MG-specific cannabis use through MG-specific social and enhancement motives. Conclusions/Importance: Event-specific cannabis motives are differentially related to specific high-risk cannabis use events and may be important therapeutic targets.     

Alcohol Use Policies That Restrict Alcohol Use

The present commentary reacts to ideas including viewing alcohol use as being an important device of proper socialization, which may contrast with duties to regulate alcohol misuse. I argue that formal policies to restrict alcohol use are often based on attempting to reduce misuse of alcohol as an intoxicant, and often times support informal policies. In general, evidence-based alcohol misuse-oriented policies do not intend to greatly restrict nonharmful levels of alcohol use.     

Train-of-Four: To Use or Not to Use

A pattern of nerve stimulation called train-of-four (TOF) is frequently used to monitor therapy with nondepolarizing neuromuscular blocking agents in patients treated in intensive care units. Based on our experience with TOF monitoring in several critically ill patients, we believe its application as an indicator of neuromuscular blockade may be problematic in this setting.     

Cohort Alcohol Use in France and the Transition from Use to Alcohol Use Disorder and Remission

ABSTRACT

The study aimed to examine the age of onset of stages of alcohol use in the general population, and to estimate the association of cohort use with the probability of transitioning from alcohol use to alcohol use disorder (AUD) and remission. French data (N = 2,894) from the European Study of the Epidemiology of Mental Disorders Survey and collected in 2000 were used. Data on lifetime history of alcohol use and DSM-IV alcohol use disorders, and remission were collected. Nearly every adult has consumed alcohol at least once in their lifetime (92.8%), and among users, 88.3% developed regular use, 6.0% met criteria for abuse and 1.7% for dependence. One-third of the population (32.8%) had used alcohol by the age of 15. Over 85% of cases of regular use were established prior to age 25, as were 61.1% of abuse and 39.4% of dependence cases. The proportion of people in an individual’s age and sex cohort who had already used alcohol by a given age was positively and significantly associated with increased odds of transitioning to each stage examined. The findings highlight sensitive periods of life where persons are at greater risk for transitioning to a higher level of alcohol use, and underscore the importance of cohort use in transition risk.     

探讨合理用药之对策

目地:探讨如何进一步提高合理用药的水平。方法:参考有关文献和资料,结合工作实际,进行汇总,分析并加以阐述。结果:合理用药可以提高治疗水平,减少不良反应和药源性疾病的发生。结论:合理用药意义重大,呼吁医务人员要自觉规范用药行为。     

The Use of the Case-Crossover Design in Studying Illicit Drug Use

The case-crossover design was developed to study time-varying exposures that cause transient excess risk of acute health events. It is a variant of case-control and subject-as-own-control research designs, involving use of information about exposure history of each case to estimate the transient effect. This kind of self-control design can help to reduce sampling bias otherwise introduced in the selection of controls, as well as confounding bias that might be derived from enduring individual characteristics, especially personality traits and other long-standing inherited or acquired vulnerabilities. When the subject is used as his or her own control, these personal vulnerabilities are matched. In this paper we discuss strengths and weaknesses of the case-crossover design and suggest applications of the case-crossover design in epidemiologic studies on suspected hazards of illicit drug use, and in studies of drug use and co-occurring psychiatric disturbances. We conclude that the case-crossover design can play a useful role, but it discloses a need to secure fine-grained measurements in epidemiologic research on psychiatric comorbidity. As explained in the paper, we also believe the case-crossover method may be of use to criminologists who study the drugs-crime nexus, to services researchers and clinicians who seek to understand treatment entry and compliance behavior, and to etiologists interested in polydrug use. [Translations are provided in the International Abstracts Section of this issue.]     

Drug Use Among Teenagers: Patterns of Present and Anticipated Use

All the students in four elective classes in one high school re-ponded to a questionnaire concerning drug use, selected attitudes, and selected behaviors. There were few differences between drug users and nonusers in terms of the attitudes and behaviors measured. However, there were striking differences between the high school sample and youth who frequented a free clinic. The “hang-loose” ethic was much more apparent at the clinic. Implications are briefly discussed.     

Diachronic Substance Use Assessment and the Emergence of Substance Use Disorders

SUMMARY

Substance use is a complex phenomenon that changes during the natural history of consumption. Relevant parameters encompass age of initiation, type and amount of drug consumed per episode, and problems resulting from substance consumption. Comprehensive developmental assessment of substance involvement is thus a prerequisite for conducting rigorous research designed to advance understanding of the progression of substance use behavior to a substance use disorder (SUD). At the Center for Education and Drug Abuse Research, a protocol has been developed for detailed temporal assessment of substance involvement. This article describes the evaluation procedures. The diachronic assessment protocol described herein has yielded several important findings pertaining to substance use behavior and SUD.