Long-term posttreatment functioning among those treated for alcohol use disorders

This article summarizes the proceedings of a symposium that was organized and chaired by Patrick R. Clifford and presented at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California. The aims of the presentation were to focus on the prediction and explanation of longer-term functioning following alcohol use disorders (AUD) treatment. Along these lines, Stephen A. Maisto, PhD, presented data (i.e., Project MATCH outpatient sample) on the relationship between drinking behavior in the first year following AUD outpatient treatment initiation and functioning at 3-year follow-up. Robert L. Stout, PhD, using data from the Extended Case Monitoring Study, analyzed long-term drinking patterns using shorter-term information. James R. McKay, PhD, examined the relationship between treatment services received and problem severities across a 2-year follow-up period. J. Scott Tonigan, PhD, served as the panel discussant.     

2010—2012年防城港市中医医院住院患者抗菌药物应用分析

目的：了解我院住院患者抗菌药物的应用情况及趋势,为临床合理用药及管理提供参考和依据。方法：对2010—2012年我院住院患者抗菌药物的品种、销售金额、使用率、抗菌药物使用强度（AUD）、用药频度（DDDs）、限定日费用（DDC）、全院及各主要科室使用抗菌药物情况进行统计、分析。结果：2010—2012年我院住院患者抗菌药物人均使用品种数、抗菌药物使用率及AUD呈逐年下降趋势;抗菌药物销售金额呈逐年上升趋势,头孢菌素类一直居销售金额排序首位。结论：我院住院患者抗菌药物使用情况趋于合理,临床药师参与临床查房对合理应用抗菌药物起到了积极作用。个别科室仍存在认识误区,仍有不规范使用抗菌药物的现象,有待进一步加强管理和规范。     

我院抗菌药物临床应用专项整治的干预措施及成果分析

目的:介绍我院抗菌药物临床应用专项整治活动采取的干预措施并评价其成效。方法:选取我院2011年5月–2012年10月就诊患者为研究对象,以抗菌药物使用强度、使用率和I类切口围术期抗菌药物应用情况等为观察指标,对比整治前后抗菌药物控制指标的变化。结果:通过实施干预措施,住院患者抗菌药物使用率和使用强度显著降低,分别由2011年5月的67.37%和92 DDD下降至2012年10月的49.16%和41 DDD,I类切口预防用抗菌药物使用率由78.1%下降至29.5%,术后用药时间由3.5 d下降至1.8 d,微生物送检率大于60%,门诊抗菌药物处方比率小于20%。结论:我院抗菌药物临床应用专项整治措施加强了抗菌药物临床应用的管理,提高了抗菌药物合理应用水平,并建立了长效的管理机制。     

State-of-the-art behavioral and pharmacological treatments for alcohol use disorder

Background: Alcohol use disorder (AUD) and its associated consequences remain significant public health concerns. Given that AUD represents a spectrum of severity, treatment options represent a continuum of care, ranging from single-session brief interventions to more intensive, prolonged, and specialized treatment modalities. Objective: This qualitative literature review seeks to describe the best practices for AUD by placing a particular emphasis on identifying those practices which have received the most empirical support. Method: This review summarizes psychological and pharmacological intervention options for AUD treatment, with a focus on the relapse prevention phase of recovery. Psychological and pharmacological treatments are summarized in terms of the empirical evidence favoring each approach and the level of AUD severity for which they are most indicated. Scientific significance: One of the broad assertions from this review is that while AUD is highly prevalent, seeking treatment for AUD is not. There are a myriad of behavioral and pharmacological treatments that have shown compelling evidence of efficacy for the treatment of AUD. In the behavioral treatment literature, cognitive behavioral therapy has received the most consistent support. Opioid antagonism (via naltrexone) has been the most widely studied pharmacotherapy and has produced moderate effect sizes. While none of the treatments reviewed herein represents a so-called silver bullet for AUD, they each have the potential to significantly improve the odds of recovery. Precision medicine, or the identification of best treatment matches for individual patients, looms as an important overarching goal for the field, although specific matches are not yet sufficiently reliable in their empirical evidence to warrant clinical dissemination.     

ATC/DDD体系指标用于质子泵抑制剂使用管理效果评价

目的为质子泵抑制剂(PPI)的临床规范使用提供参考。方法采用ATC/DDD体系的分类法查询并计算各PPI的限定日剂量(DDD)值,回顾性分析医院2015年至2017年使用PPI的品种、消耗数量、科室分布、用药频度(DDDs)、使用强度(AUD)及使用率等相关指标。结果医院PPI的DDDs、AUD及使用率,各科室PPI的DDDs、AUD及使用率排名相对稳定;住院患者PPI的DDDs呈上升趋势,PPI销售金额排前10名的科室波动不大,PPI使用率总体略有下降,但仍较高。结论以ATC/DDD评价系统为基础制订各临床科室PPI使用指标具有可行性,可为医疗机构规范PPI的临床应用提供参考。     

WFSBP* and IAWMH** Guidelines for the treatment of alcohol use disorders in pregnant women

Objectives: These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women’s Mental Health.

Methods: We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication.

Results and Discussion: There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.     

某二甲医院肠杆菌科细菌分布与耐药性分析

目的分析某医院肠杆菌科细菌的临床分布及耐药现状,为临床提供耐药预警和用药依据。方法收集2014年1月~2016年12月临床分离的肠杆菌科细菌,使用WHONET 5.6分析其临床分布与耐药率,使用SPSS 17.0分析耐药率与抗菌药物使用强度的Pearson相关性。结果共分离肠杆菌科细菌3 193株,占分离菌的68.93%。分离率排前4位的肠杆菌是大肠埃希菌、肺炎克雷伯菌、产气肠杆菌和聚团肠杆菌。检出率前3位的科室是呼吸科、消化科和神经外科。产超广谱β内酰胺酶在大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌和奇异变形杆菌中检出,在呼吸科、消化科和重症医学科检出率最高;产碳青霉烯酶在聚团肠杆菌等7种菌株中检出,主要分布在重症医学科和神经外科。大肠埃希菌耐药情况较肺炎克雷伯菌严重;最新数据显示,大肠埃希菌对氨苄西林、头孢唑林、头孢哌酮和头孢噻肟的耐药率均>75%,肺炎克雷伯菌对氨苄西林和头孢噻肟的耐药率>75%。常用抗菌药物使用强度与大肠埃希菌和肺炎克雷伯菌耐药率有较复杂的相关性。结论肠杆菌科细菌在该院检出率高、耐药率不断变迁,大肠埃希菌与肺炎克雷伯菌耐药率与抗菌药物使用强度有相关性。医院应加强耐药数据监测,规范抗菌药物使用,延缓耐药进程,提高抗感染疗效。     

我院近4年抗菌药使用与大肠埃希菌的耐药情况分析

目的调查2011~2014年我院抗菌药物使用情况和大肠埃希菌的耐药情况,分析两者之间的关系,为临床合理用药提供依据。方法对我院2011~2014年病区检出的820株大肠埃希菌及药敏试验结果和各年度抗菌药物的使用情况分别进行统计,对大肠埃希菌的耐药率和抗菌药物的使用强度采用SPSS 18.0软件进行相关性分析。结果虽然大肠埃希菌的耐药率仍处于较高水平,但4年来从53.20%降为41.03%,降幅达12.17%,大肠埃希菌的耐药率与抗生素的使用呈现一定的相关性。结论大肠埃希菌耐药率与抗菌药物的使用率及AUD存在相关性,临床应规范抗菌药物的使用,以减少细菌耐药性的发生。     

呼吸内科抗菌药物使用强度及药物经济学分析

目的：了解我院呼吸内科抗菌药物的使用强度情况,并进行药物经济学分析评估,为合理应用抗菌药物提供参考依据。方法回顾性分析我院2012－06～2014－06间呼吸内科328例患者的临床资料与记录,统计我院呼吸内科抗菌药物的用药频度（ DDDs）、抗菌药物使用强度（ AUD）,采用线性回归分析抗菌药物的使用强度与细菌的耐药性的关系,运用药物经济学方法进行抗菌药物限定日费用（DDDc）与药物利用指数（DUI）评价。结果我院呼吸内科抗菌药物的使用强度平均为108．6 DDD／100人／d;排名前10位抗菌药物的DDDs与耐药率的相关系数r＝0．657,P＜0．05;头孢类抗菌药物日费用较高,DUI＜1;左氧氟沙星、阿莫西林、哌拉西林／舒巴坦等抗菌药物日费用较低,DUI＞1。结论我院呼吸内科抗菌药物的使用强度过高,应严格按照《抗菌药物临床应用指导原则》科学、有计划地分批、分期替换合理应用,以降低细菌耐药性;在此基础上,选用廉价、有效的抗菌药物,以缓解患者就医经济负担。