针刺联合药物治疗痛风的临床观察

目的针刺联合药物治疗痛风的临床观察。方法采用随机对照的方法,将99例痛风患者随机分为针刺组、药物组、针刺联合药物组。结果3组治疗7d观察,疗效差异亦有统计学意义。针刺组与针刺加药物组（χ^2=15.28,P〈0.01）,药物组与针刺加药物组（χ^2=12.28,P〈0.01）,针刺加药物组明显优于针刺组和药物组。结论针刺联合药物组在治疗痛风的过程中,症状缓解快且不良反应少,效果显著。     

我院门急诊处方抗菌药物应用调查与分析

目的了解医院门急诊处方抗菌药物应用现状,促进临床合理用药。方法随机抽取2009年8月20日的2955张门急诊处方进行分析。结果 2955张处方中使用抗菌药物的处方有1152张,占处方总数的38.98%;存在头孢菌素类抗菌药物使用比例较大,药物联用偏多,给药途径、用法用量不尽合理等问题。结论应重视抗菌药物的合理应用,制订相应制度,加强管理,保证患者的用药安全。     

利用ABC分析法调查医院2008年药品使用状况

目的调查精神专科医院的药品使用情况,为临床合理用药提供参考。方法采用ABC分析法对药品使用的数量和金额进行统计分析。结果药品的种数及药品金额的构成比,A类药品为6.39%和75.38%,B类药品为9.59%和14.48%,C类药品为84.02%和10.14%。结论该院用药结构合理,符合医院用药特点。     

节日性急性胃肠炎（腹泻）5种用药方案的疗效观察

目的总结节日急性胃肠炎（腹泻）5种综合治疗用药方案的疗效。方法随机抽取2009年元旦、春节诊治的207例急性肠胃炎（腹泻）患者,按轻、重症分组应用5种综合治疗用药方案观察疗效。结果剔除3例资料不详者后,5种综合治疗方案用药治疗显效167例（81.86%）,有效37例（18.14%）,总有效率为100%。结论对症治疗节日急性胃肠炎（腹泻）的5种综合治疗用药方案均安全、有效、经济、合理、可控。     

Moving from a culture of blame to a culture of safety in the nursing home setting

TOPIC: A culture of safety. PURPOSE: To explore the current culture of blame and what organizational elements must be impacted to move toward a culture of safety in the nursing home setting. METHODS: A mixed-method approach incorporating a case study and staff member survey results were used to explicate the organizational elements impacting the current nursing home culture. CONCLUSION: Nurse leaders can create an environment in which every member of the team feels a responsibility and an ability to insure that residents are safe by improving communication and participation in decision making.     

Computerized prescribing alerts and group academic detailing to reduce the use of potentially inappropriate medications in older people

OBJECTIVES: To examine the effect of replacing drug-specific computerized prescribing alerts with age-specific alerts on rates of dispensing potentially inappropriate medications in older people and to determine whether group academic detailing enhances the effectiveness of these alerts. DESIGN: Cluster-randomized trial of group academic detailing and interrupted time-series analysis. SETTING: Fifteen clinics of a staff-model health maintenance organization. PARTICIPANTS: Seven practices (113 clinicians, 24,119 patients) were randomly assigned to receive age-specific prescribing alerts plus the academic detailing intervention; eight practices (126 clinicians, 26,805 patients) received alerts alone. Prior implementation of drug-specific alerts established a downward trend in use of target medications that served as the baseline trend for the present study. INTERVENTION: The computerized age-specific alerts occurred at the time of prescribing a targeted potentially inappropriate medication (e.g., tertiary tricyclic amine antidepressants, long-acting benzodiazepines, propoxyphene) and suggested an alternative medication. Clinicians at seven sites were randomized to group academic detailing, an interactive educational program delivering evidence-based information. MEASUREMENTS: Number of target medications dispensed per 10,000 patients per quarter, 2 years before and 1.5 years after the replacement of drug-specific with age-specific alerts. RESULTS: Age-specific alerts resulted in a continuation of the effects of the drug-specific alerts without measurable additional effect (P=.75 for level change), but the age-specific alerts led to fewer false-positive alerts for clinicians. Group academic detailing did not enhance the effect of the alerts. CONCLUSION: Age-specific alerts sustained the effectiveness of drug-specific alerts to reduce potentially inappropriate prescribing in older people and resulted in a considerably decreased burden of the alerts.     

Advice alone vs. structured detoxification programmes for medication overuse headache: a prospective, randomized, open-label trial in transformed migraine patients with low medical needs

The aim of this study was to compare the effectiveness of strong advice to withdraw the overused medication with the effectiveness of two structured pharmacological detoxification strategies in a cohort of patients diagnosed with probable migraine overuse headache (MOH) plus migraine and presenting low medical needs. One hundred and twenty patients participated in the study. Exclusion criteria included: previous detoxification treatments, coexistent medical or psychiatric illnesses and overuse of agents containing opioids, benzodiazepines and barbiturates. Group A received only intensive advice to withdraw the overused medication. Group B underwent a standard out-patient detoxification programme (advice+prednisone+preventive treatment). Group C underwent a standard in-patient withdrawal programme (as in group B + fluid replacement and antiemetics). Withdrawal therapy was considered successful if, after 2 months, the patient had reverted to an episodic pattern of headache and to an intake of symptomatic medication on fewer than 10 days/month. We were able to detoxify 75.4% of the whole cohort, 77.5% of patients in group A, 71.7% of patients in group B and 76.9% of those in group C (P>0.05). In patients with migraine plus MOH and low medical needs, effective drug withdrawal may be obtained through the imparting of advice alone.     

Chronic frequent headache in the general population: prevalence and associated factors

We studied the prevalence and short-term natural course of chronic frequent headache (CFH) in the general population and identified risk factors. In the Netherlands everyone is registered at a single general practice. We sent questionnaires to all persons (n = 21 440) aged 25-55 years, registered at 16 general practices. We compared the characteristics of 177 participants with CFH (>14 headache days/month for >3 months) with 141 participants with infrequent headache (1-4 days/month) and 526 without headache (<1 day/month). The prevalence of CFH was 3.7% [95% confidence interval (CI) 3.4, 4.0]. In 5 months, 12% showed a clinically relevant decrease to <7 days/month. In both headache groups 70% were women vs. 41% in the group without headache. Compared with the group with infrequent headache, the CFH group had more subjects with low educational level [35% vs. 11%; odds ratio (OR) 4.3, 95% CI 2.3, 7.8], medication overuse (62% vs. 3%; OR 38.4, 95% CI 13.8, 106.9), sleeping problems (44% vs. 8%; OR 8.1, 95% CI 3.6, 18.1), a history of head/neck trauma (36% vs. 14%; OR 4.0, 95% CI 2.2, 7.1), high scores on the General Health Questionnaire (62% vs. 34%; OR 2.7, 95% CI 1.3, 3.6) and more smokers (45% vs. 19%; OR 3.1, 95% CI 1.9, 5.3). We conclude that headache frequency fluctuates. CFH is common and associated with overuse of analgesics, psychopathology, smoking, sleeping problems, a history of head/neck trauma and low educational level. Female sex is a risk factor for headache, not for chronification of headache.     

Patient self-medication--a change in hospital practice

Aims and objectives. The purpose of this study was to evaluate the effectiveness of a self‐medication programme (SMP) for inpatients of the Nursing Convalescent Unit, a 26‐bed unit with medical and surgical patients. Background. Self‐medication is an important part of self‐management of chronic illness. Self‐medication is a way of allowing patients to give themselves their medications in hospital after receiving education instead of the usual practice of medications administered by a Registered Nurse (RN). Design. The pilot study was undertaken over a six‐month period to examine the relationship between a programme of self‐medication and patient knowledge and adherence to medication regimens, number of medication errors, efficiency in relation to the number of nursing hours associated with the SMP, patient and nursing satisfaction. Methods. A total of 220 patients participated in the study. The SMP included three levels of patient self‐administration of medications: level one, medications administered by a RN; level two, self‐medication directly supervised by a RN and level three, self‐medication indirectly supervised by a RN. Outcome measures included staff and patient satisfaction, number of medication errors, time taken by nurses to undertake activities related to the SMP and the number of patients who achieved levels two and three. Results. Study findings showed that 45% of patients remained on level one, 26% achieved level two and 29% achieved level three. There were no patient initiated medication errors during the study period. Efficiencies were identified in staff workload associated with patient discharge procedures. Overall, nurses perceived that the SMP increased their knowledge of medications and contributed to effective patient education. Conclusions. In selected patients, the SMP was an effective aid for improving adherence to medication regimens. Relevance to clinical practice. Collaboration between nurses, medical staff, pharmacists, patients and carers is integral to the success of in hospital SMP.