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101.
Differences in generalist and specialist physicians’ knowledge and use of angiotensin-converting enzyme inhibitors for congestive heart failure 总被引:3,自引:5,他引:3 下载免费PDF全文
Marshall H. Chin MD MPH Peter D. Friedmann MD MPH Christine K. Cassel MD Roberto M. Lang MD 《Journal of general internal medicine》1997,12(9):523-530
Objective To quantify the extent and determinants of underutilization of angiotensin-converting enzyme (ACE) inhibitors for patients
with congestive heart failure, especially with respect to physician specialty and clinical indication.
Design Survey of a national systematic sample of physicians.
Participants Five hundred family practitioners, 500 general internists, and 500 cardiologists.
Measurements and main results Physicians’ choice of medications were determined for four hypothetical patients with left ventricular systolic dysfunction:
(1) new-onset, symptomatic; (2) asymptomatic; (3) chronic heart failure, on digitalis and diuretic; and (4) asymptomatic,
post-myocardial infarction. For each patient, randomized controlled trials have demonstrated that ACE inhibitors decrease
mortality or the progression of symptoms. Among the 727 eligible physicians returning surveys (adjusted response rate 58%),
approximately 90% used ACE inhibitors for patients with chronic heart failure who were already taking digitalis and a diuretic.
However, family practitioners and general internists chose ACE inhibitors less frequently (p≤.01) than cardiologists for the other indications. Respective rates of ACE inhibitor use for each simulated patient were
new-onset, symptomatic (family practitioners 72%, general internists 76%, cardiologists 86%); asymptomatic (family practitioners
68%, general internists 78%, cardiologists 93%); and asymptomatic, post-myocardial infarction (family practitioners 58%, general
internists 70%, cardiologists 94%). Compared with generalists, cardiologists were more likely (p≤.05) to increase ACE inhibitors to a target dosage (45% vs 26%) and to tolerate systolic blood pressures of 90 mm Hg or less
(43% vs 15%).
Conclusions Compared with cardiologists, family practitioners and general internists probably underutilize ACE inhibitors, particularly
among patients with decreased ejection fraction who are either asymptomatic or post-myocardial infarction. Educational efforts
should focus on these indications and emphasize the dosages demonstrated to lower mortality and morbidity in the trials.
Presented in part at the annual meeting of the Society of General Internal Medicine, Washington, DC, May 3, 1996, and American
College of Cardiology, Anaheim, Calif., March 18, 1997.
Funded by a grant-in-aid from the American Heart Association of Metropolitan Chicago. Dr. Chin is supported by National Institutes
of Health/National Institute on Aging Geriatric Academic Program Award 5-K12-AG-00488. 相似文献
102.
本文报道了1例老年慢性阻塞性肺疾病急性加重伴肾功能不全患者进行临床药师药学监护。此患者入院给予注射用哌拉西林舒巴坦等药物治疗。由于指南中未提及肾功能减退患者哌拉西林舒巴坦的剂量调整方法,临床药师考虑哌拉西林舒巴坦与哌拉西林他唑巴坦的半衰期、排泄时间和排泄比率相似,因此用药方案采用哌拉西林他唑巴坦的剂量调整方法;患者入院第3天复查血常规提示白细胞、血小板计数低于正常值范围,临床药师考虑为哌拉西林舒巴坦的不良反应,停药后白细胞、血小板计数升至正常值范围;另外,临床药师根据患者用药情况,对支气管舒张剂的注意事项、氟康唑胶囊与其他药物的相互作用、双歧杆菌四联活菌片与美罗培南应用时间等方面进行药学监护,后患者病情好转出院。临床药师针对慢性阻塞性肺疾病的正规治疗方案对患者进行用药教育及出院注意事项的指导。 相似文献
103.
临床药师参与高血压慢病管理的效果评价 总被引:1,自引:0,他引:1
目的:评价临床药师对高血压慢病管理患者开展药学干预的效果。方法:选取北仑区新矸街道紫荆社区的所有高血压慢病管理患者为研究对象,由临床药师定期和社区医生一起对慢性病患者进行面对面用药指导、电话交流沟通、上门随访、专题健康讲座等方法,为慢病管理患者提供用药指导,实施药学干预,将干预前后患者对自身疾病的认知水平、血压控制水平、用药依从性等进行统计并比较。结果:临床药师干预后患者对高血压和抗高血压用药的认识水平有明显提高(P<0.05或P<0.01),患者血压控制水平及用药依从性明显改善(P<0.01),非预约就诊率、急诊率、住院率及住院次数明显下降(P<0.05或0.01)。结论:临床药师开展高血压慢病管理患者的药学干预,可以为患者提供科学合理的用药保障,提高患者的生活质量,值得推广。 相似文献
104.
目的:分析临床药师参与狼疮性肾炎并发社区获得性肺炎患者抗感染用药监护。方法:对1例狼疮性肾炎并发社区获得性肺炎(重症)患者进行全程药学监护,协助医师制定抗感染药物治疗方案,并随病情变化作修正或调整。结果:莫西沙星和哌拉西林钠/他唑巴坦钠的联合用药,使患者的肺部感染得到及时有效控制,避免了潜在狼疮性肾炎复发或加重的危险。结论:特殊人群抗菌药物的选择,不仅要考虑抗菌谱、抗菌活性,还应结合患者的个体特征和药动学特性来做综合选择,可提高患者用药的安全性和有效性。 相似文献
105.
摘 要 目的: 概述美国的药学服务实践流程变迁,为我国开展药学服务工作提供借鉴。方法: 查阅文献,对美国医院药学相关学会组织提出的药学服务实践流程进行总结、分析。结果与结论:美国药学从业者联合委员会提出的以患者为中心的药学服务完整总结了其实践流程,包括采集-评估-计划-实施-随访等步骤,强调与团队的沟通、合作、资源共享,适合任何工作环境对患者提供的药学服务。 相似文献
106.
107.
Holtz TH Marum LH Mkandala C Chizani N Roberts JM Macheso A Parise ME Kachur SP 《Tropical medicine & international health : TM & IH》2002,7(3):220-230
OBJECTIVE: To evaluate the use of insecticide-treated bednets and the effectiveness of social marketing for their distribution. METHODS: Systematic cluster sample survey of 1080 households in 36 census enumeration areas across Blantyre district, Malawi, in February 2000. RESULTS: A total of 672 households had one or more children under 5. Bednet ownership was low (20.5% of households) overall, and significantly lower in rural areas than urban areas (6.4 vs. 29.8%, P=0.001). Only 3.3% of rural children under 5 had slept under a net the previous night, compared with 24.0% of urban children (P < 0.001). When asked why they did not own a net, nearly all (94.9%) caretakers in households without nets stated they had no money to buy them. In multivariate statistical models that controlled for the influence of house structure, urban vs. rural location, gender of the head of household, and the primary caretaker's education, rural children under 5 in households without nets experienced a statistically significant higher prevalence of malaria parasitaemia [RR (risk ratio) 4.9, 95% CI (confidence interval) 2.3-10.5] than children in households with at least one bednet. This was also true for urban children under 5 (RR 2.1, 95% CI 1.0-4.2, P=0.04). CONCLUSION: Social marketing approaches to promoting insecticide-treated nets in Blantyre District may have produced measurable health benefits for children in those households in which residents bought and used the products. Market-based approaches may take years to achieve high levels of coverage and may exaggerate inequities between urban and rural populations. 相似文献
108.
靳爱红 《中华医学图书情报杂志》2015,24(5):23-27
微博已经成为图书馆重要的营销工具,营销评价是微博营销管理不可缺少的环节。图书馆微博营销评价可以从微博的可信度、微博的影响力、微博的沟通性和内容的表达力等四个方面建立指标体系,在评价中,对收集到的数据要作科学的分析与处理,评价方法应更加综合性,要采取措施使评价工作得到可持续发展。 相似文献
109.
Katherine Smith Carmen Washington Jennifer Brown Alison Vadnais Laura Kroart Jacqueline Ferguson Joanna Cohen 《JMIR Public Health and Surveillance》2015,1(2)
Background
Tobacco remains the world’s leading preventable cause of death, with the majority of tobacco-caused deaths occurring in low- and middle-income countries. The first global health treaty, the Framework Convention on Tobacco Control (FCTC), outlines a set of policy initiatives that have been demonstrated as effective in reducing tobacco use. Article 11 of the FCTC focuses on using the tobacco package to communicate tobacco-caused harms; it also seeks to restrict the delivery of misleading information about the product on the pack.Objective
The objective of this study was to establish a surveillance system for tobacco packs in the 14 low- and middle-income countries with the greatest number of smokers. The Tobacco Pack Surveillance System (TPackSS) monitors whether required health warnings on tobacco packages are being implemented as intended, and identifies pack designs and appeals that might violate or detract from the communication of harm-related information and undermine the impact of a country’s tobacco packaging laws. The protocol outlined is intended to be applicable or adaptable for surveillance efforts in other countries.Methods
Tobacco packs were collected in 14 countries during 2013. The intention was, to the extent possible, to construct a census of “unique” pack presentations available for purchase in each country. The TPackSS team partnered with in-country field staff to implement a standardized protocol for acquiring packs from 36 diverse neighborhoods across three cities in each country. At the time of purchase, data on price and place of acquisition of each pack was recorded. The field staff, according to a standardized protocol, then photographed packs before they were shipped to the United States for coding and archiving.Results
Each pack was coded for compliance with the country-specific health warning label laws, as well as for key design features of the pack and appeals of the branding elements. The coding protocols were developed based upon prior research, expert opinion, and communication theories. Each pack was coded by two independent coders, with consistency of personnel across the project. We routinely measured intercoder reliability, and only retained variables for which a good level of reliability was achieved. Variables where reliability was too low were not included in final analyses, and any inconsistencies in coding were resolved on a daily basis.Conclusions
Across the 14 countries, the TPackSS team collected 3307 tobacco packs. We have established a publicly accessible, Internet archive of these packs that is intended for use by the tobacco control policy advocacy and research community. 相似文献110.