静脉用药调配中心干预不合理医嘱的效益分析

目的对静脉用药调配中心(pharmacy intravenous admixture services,PIVAS)干预临床不合理用药产生的经济效益、社会效益、人力资源效益进行分析,促进临床合理、安全、经济用药。方法采用回顾性分析方法,调取2018年10月1-31日山东大学齐鲁医院PIVAS接收的全部静脉用药医嘱及对不合理用药医嘱的干预结果,分析PIVAS干预不合理用药医嘱产生的药品资源、人力资源节约情况。结果2018年10月1-31日PIVAS药师共审核用药医嘱412782组,其中不合理医嘱1967组,占0.417%,包括不规范、不适宜及超常医嘱等类型。通过PIVAS药师干预不合理用药医嘱,及时纠正医师用药医嘱错误,节约了药品资源及护理工时。结论PIVAS进行用药医嘱审核对于保障患者临床合理用药具有积极意义,有利于节约医疗资源。     

Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture

ObjectivesTo evaluate a machine learning model designed to predict mortality for Medicare beneficiaries aged >65 years treated for hip fracture in Inpatient Rehabilitation Facilities (IRFs).DesignRetrospective design/cohort analysis of Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility–Patient Assessment Instrument data.Setting and ParticipantsA total of 17,140 persons admitted to Medicare-certified IRFs in 2015 following hospitalization for hip fracture.MeasuresPatient characteristics include sociodemographic (age, gender, race, and social support) and clinical factors (functional status at admission, chronic conditions) and IRF length of stay. Outcomes were 30-day and 1-year all-cause mortality. We trained and evaluated 2 classification models, logistic regression and a multilayer perceptron (MLP), to predict the probability of 30-day and 1-year mortality and evaluated the calibration, discrimination, and precision of the models.ResultsFor 30-day mortality, MLP performed well [acc = 0.74, area under the receiver operating characteristic curve (AUROC) = 0.76, avg prec = 0.10, slope = 1.14] as did logistic regression (acc = 0.78, AUROC = 0.76, avg prec = 0.09, slope = 1.20). For 1-year mortality, the performances were similar for both MLP (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.96) and logistic regression (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.95).Conclusion and ImplicationsA scoring system based on logistic regression may be more feasible to run in current electronic medical records. But MLP models may reduce cognitive burden and increase ability to calibrate to local data, yielding clinical specificity in mortality prediction so that palliative care resources may be allocated more effectively.     

基于住院病案首页数据的全国部分医院心血管临床专科评估探索

目的运用“基于住院病案首页数据的心血管临床专科评估框架”,对全国部分医院的心血管临床专科进行评估。方法梳理112所医院心血管专科重点疾病和重点手术操作的编码情况,计算评估框架中的各个指标,根据医院纳入标准,运用基于数据的多指标综合评价方法,对医院进行打分排序。结果112所医院2010—2012年心血管疾病患者出院人次、重点疾病和重点手术/操作缺失数量均呈偏态分布。按照综合评价医院的纳入标准共56所医院纳入排序,前十位是YN05、SD04、BJ14、SH02、ZJ01、HN01、SX09、YN08、SD01、SX08。重点疾病和重点手术操作均完整的医院共12所,其排序是:BJ14、SH02、HN02、BJ01、TJ01、SH05、SC01、NA03、GD02、SH08、YN03、HL01。本研究综合评价的56所医院中,有30所在国家公布的名单之内,26所不在国家公布的名单之内。结论运用“基于住院病案首页数据的心血管临床专科评估框架”进行心血管临床专科评估是科学、可行的,为专科评估方法提供了新的思路,为专科对口支援建设提供了数据支持。     

五年住院病人医院感染率分析

目的 :了解五年中医院感染的动态变化情况 ,为控制医院感染提供依据。方法 :科室自报和专职人员补漏相结合 ,发现医院感染病例 ,调查所有住院病人。结果 :1994年 7月～ 1998年 10月 ,某医院住院病人共计 5 9413例 ,发生医院感染 362 2例次 ,总医院感染率 6 10 % ,1994～ 1998年感染率分别为 8 0 5 %、7 98%、6 16%、4 97%、4 5 1% ,呈持续下降。部位例次感染率以上呼吸道最高 ( 2 67% ) ,手术伤口 ( 1 15 % )次之 ,下呼吸道感染率( 1 0 8% )居第三位 ,但不同年份的不同部位感染率的位次略有变化 ,外科、儿科、内科感染率分别为 9 0 3%、8 0 6%和 6 70 % ,居前三位。但不同年份不同科室所居位次变化较大。结论 :医院感染率的持续下降 ,原因是多方面的 ,但监测工作对感染率的降低所起的作用 ,是不容忽视的。在医院感染控制时应以上一年的监测结果为依据 ,把感染率最高的科室作为重点 ,查找其感染率高的原因 ,并采取相应控制措施 ,降低其医院感染率。这样交替进行 ,最终将能达到降低全院感染率之目的     

住院患者尊严现状及影响因素分析

目的 了解住院患者尊严期望现状,为针对性干预提供参考.方法 采用普通话版住院患者尊严量表对442例住院患者进行问卷调查.结果 住院患者尊严期望值为48.00(40.00,53.00)分,尊严满意度为71.00(61.00,75.00)分;回归分析结果显示,性别、家庭人均月收入、住院科室是住院患者尊严期望值影响因素(均P＜0.05);近年住院经历、经济负担、文化程度是住院患者尊严满意度影响因素(均P＜0.05).结论 住院患者尊严期望值处于中度水平,满意度较高.临床护士应根据不同尊严期望值和尊严满意度患者提供个性化和针对性干预,满足其尊严期望和尊严满意度.     

Examining community pharmacists’ intention to provide pharmacist-driven vaccination services: A structural equation modelling

BackgroundThe evidence of pharmacists' current involvement in vaccination services in low- and middle-income countries (LMICs) is uncertain. This study would be a first step to develop vaccination services by investigating community pharmacists’ intention to be involved in PDV services not just during COVID-19 pandemic but also during standard service provision in Turkey which can be taken as an example across LMICs.ObjectiveConsidering the efforts to empower community pharmacists in service provision, the goal of the present study was to develop a structural equation model to explain the “Pharmacist-Driven Vaccination Service Intention Model (PDV-SIM)” by using the theory of planned behavior (TPB).MethodsBased on the constructs of TPB, a measurement tool was developed. Sub-factors of PDV service intention was determined by conducting exploratory factor analysis (EFA). In the second step, confirmatory factor analysis (CFA) was conducted to prove the theoretical structure of the tool. Finally, a model explaining the relationship between observed variables, latent constructs from TPB was developed by SEM analysis.ResultsIn the proposed PDV-SIM, patient related attitude toward PDV services, attitude toward negative consequences of PDV services, and subjective norm about PDV services had an impact on the behavioral intention of community pharmacists. Nevertheless, professional development attitude toward PDV services and perceived behavioral control were not evaluated as determinants of the behavioral intention.ConclusionResults of this study revealed that TPB is appropriate for modelling PDV service intention of community pharmacists. This model can be utilized as a guide to potential pharmacy regulatory bodies and policy makers in their efforts to enable community pharmacists as vaccinators across LMICs.     

基层医院如何开展临床药学工作

临床药学是现代药学的重要组成部分,临床药学工作在各级医院开展极不平衡,特别是基层医院开展较差。本文论述了在基层医院应从人才的选择入手开展临床药学工作。     

住院病人焦虑的原因及护理对策

目的：分析住院病人焦虑的原因,有效地减轻住院病人的焦虑程度。方法：使用焦虑自评量表（SAS）及问卷对347例住院病人进行焦虑原因的调查分析。结果：问卷20题中有13项肯定组与否定组的SAS评分存在显著差异或非常显著差异;不同年龄、不同文化程度、不同住院时间、治疗费用不同支出方式的住院病人SAS评分也存在显著差异。结论：明确住院病人焦虑原因,可有针对性地对其做好心理护理。