The feasibility of substance misuse screening in referrals from Accident and Emergency to an inner-city fracture clinic: results from a pilot study

Objectives To assess the prevalence of problem drinking, excessive alcohol consumption and illicit drug use among patients referred to a fracture clinic from Accident and Emergency (A&E). Design Prospective self-completion questionnaire study. Setting An inner-city outpatient fracture clinic in South London. Subjects New referrals from an A&E department ( n = 73). Outcome measurements The AUDIT questionnaire was used to assess problem drinking, while the subjects' report of weekly alcohol consumption was used to identify excessive alcohol consumption. Illicit drug use was measured with the substance misuse section of the Maudsley Addiction Profile (MAP). Results Forty-one per cent of the sample scored over 8 (a positive AUDIT result), indicating problem drinking. This was significantly associated with male gender and with not being married. Twenty-three per cent of the sample consumed above recommended weekly limits of alcohol consumption. The only illicit drug that was used by any of the subjects over the month preceding interview was cannabis: 19% of the patients had used cannabis at least weekly over the month preceding interview. Cannabis use was associated with a positive AUDIT result and with belonging to a white non-UK ethnic group. Conclusions The rates of problem drinking resemble those found in the small number of previous fracture clinic studies and in A&E and orthopaedic in-patient population studies. A high incidence of cannabis use was also found in this patient group and this is the first study of drug use among fracture clinic attendees in the UK. Fracture clinics present an under-utilized opportunity to screen, engage and deliver brief interventions for the treatment of drug and alcohol problems.     

Problems with the performance of the SF-36 among people with type 2 diabetes in general practice

Objective: To validate the short form-36 (SF-36) among people with type 2 diabetes in general practice, and to make comparisons with the Audit of Diabetis Dependent Quality of Life (ADDQoL). Design: Postal survey with one reminder. Setting: Four general practices. Patients: One hundred and eighty-four eligible patients (30–70 years) with type 2 diabetes on 14 general practitioner lists. Measures: SF-36 response rates, distribution of dimension scores and internal consistency. Median scores in relation to sociodemography and self-reported health. Comparisons with ADDQoL scores. Results: One hundred and thirty-one patients responded (71%). Distributions of SF-36 dimension scores were mostly skewed. Internal consistency and construct validity were acceptable, with predictable sociodemographic trends. People with illness related to or unrelated to diabetes scored significantly lower on most dimensions. SF-36 dimension scores correlated best with relevant diabetes-specific ADDQoL scores amongst respondents reporting no comorbidity. Conclusions: Although valid and reliable, SF-36 scores are strongly affected by non-diabetic comorbidity in type 2 diabetes, supporting the complementary use of a diabetes-specific measure, providing information about the impact of diabetes specifically. This revised version was published online in June 2006 with corrections to the Cover Date.     

药师儿科处方审核能力培训的探索

《医疗机构处方审核规范》对药师审核处方能力提出了很高的要求，药师应对处方的合法性、规范性、适宜性等项目进行审核。本院设计的针对药师儿科处方审核能力培训课程分为四个模块：法规和规章制度；各年龄段儿童生理特点及处方适宜性审核；儿科各专科通用的药物处方适宜性审核；儿童常见专科用药处方适宜性审核。该培训体系具有同质化和标准化特点，理论课和案例教学相结合，可操作性强，值得在药师儿科处方审核培训中推广。     

抗菌药物临床应用专项内审

通过对某院抗菌药物临床应用的专项内审,发现抗菌药物临床应用主要存在以下问题:多种抗菌药物使用率较高;抗生药物应用不合理情况;手术科室病原学检查率低;用药频次不正确;未经病原学送检,选择高级别的抗菌药物;不按说明书要求给药;用药疗程过长;手术病人预防用药时间过长等问题。针对这些问题医院采取积极措施,完善制度,加强教育培训,召开专题听证会讨论应用抗菌药物的合理性。     

Prospective audit of the effectiveness of hydrocortisone premedication on drug delivery reactions following amphotericin B lipid complex

ABSTRACT

Objective: Amphotericin B lipid complex (ABLC), a lipid-based formulation of amphotericin B, is an effective treatment for fungal infections, but is associated with mild to moderate drug delivery reactions (DDRs), such as fever, rigors and chills, in some patients. Although clinical studies have indicated that premedication with hydrocortisone may reduce the incidence of DDRs, there are currently limited confirmatory data from clinical practice. The aim of the audit was to assess prospectively a hydrocortisone premedication strategy with ABLC to reduce the rate of DDRs.

Methods: Over an 18-month period, all cancer patients treated with ABLC at The Royal Shrewsbury Hospital were audited prospectively. Each patient received 100?mg of intravenous hydrocortisone 15–30 minutes prior to each ABLC infusion. The primary outcome was to determine the DDR rate per cycle of ABLC.

Results: A total of 275 cycles of ABLC (mean dosage 930.6?mg) were administered during the course of the study period, and 16.0% were associated with DDRs. The majority of reactions occurred following the first infusion of a cycle (15.3%; subsequent infusions: 2.9%). The most common DDRs were rigor (15.3%) and fever (12.7%). There was no significant difference in the DDR rate (17.2 vs. 15.5%) or types of reactions between ABLC-naïve and previously treated patients. The dosage of ABLC administered had no effect on the DDR rate. Female gender, being neutropenic and younger age were found to be predictive of having a DDR.

Conclusions: The audit demonstrates that premedication with hydrocortisone results in a low incidence of DDRs following ABLC. The main limitation of this study is the lack of a randomised control group.     

THE WEST MIDLANDS “SEVERE HYPERTENSIVE ILLNESS IN PREGNANCY” (SHIP) AUDIT

Objective. To study the management of a series of women presenting with acute-onset hypertension in the 21 maternity units in the West Midlands region, in order to measure the standard of care and the outcomes of these patients and their babies.

Design. Multicenter audit.

Setting. Twenty-one Maternity Units in the West Midlands region with 85,658 births during the audit period.

Methods. Prospective data collection by named coordinators (multidisciplinary) in each unit using customized proformas. The proformas were then forwarded to the Research Coordinator for input onto a database and observational analyses.

Results. The total number of cases was 516. Eighty-one percent were diagnosed as having severe preeclampsia, 14% HELLP syndrome, and 5% eclampsia. Seven percent were admitted to the intensive therapy unit. Seventy percent of births were preterm, 62% of babies were low birth weight (< 2.5 kg), 57% of babies were admitted to the neonatal unit, and the perinatal mortality rate was 5%.

The commonest antihypertensive agents were hydralazine and nifedipine. In terms of compliance with audit standards, 61% had both oxygen saturation and noninvasive blood pressure monitoring, 47% had good fluid balance documentation, and 79% had no fluid mismanagement. Seventy-four percent were seen by a consultant obstetrician, 62% were seen by a member of an “expert team,” 83% adhered to local guidelines, and 71% of eclamptics received magnesium sulfate (MgSO₄).

Conclusion. Our study shows that severe hypertensive illness of pregnancy remains an important cause of maternal mortality and perinatal mortality. This audit highlights areas in which standards of care can be improved.     

A survey of postoperative pain management in fourteen hospitals in the UK

The effectiveness of acute pain services in 14 hospitals in one English region was audited. We collected data on analgesia used, its efficacy and patient satisfaction for 522 patients after four commonly performed procedures: abdominal hysterectomy, total knee replacement, mastectomy and major abdominal surgery.Pain scores were measured on a verbal numeric rating scale in the recovery room and both pain scores and patient satisfaction were assessed at 24 h and 7 days postoperatively.Pain was managed well in recovery rooms but less well on the wards. Epidural analgesia gave significantly better pain scores than other therapies. Better pain relief was obtained if opioids were combined with NSAIDs than when given alone. There were marked differences between hospitals in the delivery of postoperative analgesia. Pain scores in most hospitals left room for improvement, particularly following abdominal hysterectomy, but patient satisfaction was good. The better efficacy of multimodal analgesia was confirmed. Evidence from this data for the effectiveness of multidisciplinary acute pain services was equivocal.