Trends and patterns of national antimicrobial consumption in Japan from 2004 to 2016

Frequent use of broad-spectrum antimicrobial classes has been reported in Japan; however, little is known about the long-term trend of national antimicrobial consumption, and that of individual agents. This study analyzed the national sales data of systemic antimicrobials from 2004 to 2016, derived from the IMS Japan Pharmaceutical Market database, to assess the consumption patterns of antimicrobial classes and agents in Japan. The number of defined daily doses per 1000 inhabitants per day (DID) was calculated for each antimicrobial agent. During the last 13 years, total antimicrobial consumption fluctuated by only 5% around the average of 14.41 DID. In 2016, the most used class was macrolides (32%), followed by cephalosporins (28%) and fluoroquinolones (19%). Oral agents comprised a large proportion (93%) of antimicrobial consumption. The most used agent, clarithromycin, accounted for 25% of all oral compounds used in 2016. The consumption of oral agents with high bioavailability, such as fluoroquinolones, amoxicillin, and sulfamethoxazole/trimethoprim increased, whereas that of cephalosporins decreased. In 2016, ceftriaxone was the most consumed parenteral agent, followed by cefazolin. The consumption of parenteral agents increased after 2009 when high-dose regimens of piperacillin/tazobactam, meropenem, and ampicillin/sulbactam were approved by the health insurance system. National antimicrobial consumption has been stable over the last 13 years. Moreover, shifts in the use of agents with high bioavailability and those approved for high-dose regimens were observed. However, the increased use of broad-spectrum agents is worrisome. A multifaceted approach is required to reduce overall antimicrobial consumption.     

PDCA循环结合微信平台在PICC导管门诊护理中的应用效果研究

目的探讨PDCA(Plan、Do、Check、Action)循环结合微信平台在经外周静脉穿刺中心静脉置管术(peripher ally inserted central catheter,PICC)导管门诊护理中的应用效果。方法将2016年1月~2018年1月在我院门诊行PICC导管维护的90例患者纳入本研究。按照随机数字表法均分为常规健康教育组、微信组、PDCA+微信组各30例。在干预前和干预后1周评估3组患者的PICC相关知识水平,干预后1个月评估3组患者的导管维护依从性和自我护理能力。结果 PDCA+微信组对提高患者PICC相关知识掌握度的作用明显高于常规健康教育组和单纯微信组(P0.05);PDCA+微信组在提高患者导管维护依从性、自我护理能力评分明显高于常规健康教育组(P0.05);PDCA+微信组和单纯微信组患者导管维护依从性、自我护理能力评分对比,差异无统计学意义(P0.05)。结论 PDCA循环结合微信平台能够改善患者PICC相关知识知晓情况,提高患者管维护依从性、自我护理能力评分,有较高的应用价值。     

Impact of shared decision making on asthma quality of life and asthma control among children

Objective: Few studies have examined the effectiveness of shared decision making (SDM) in clinical practice. This study evaluated the impact of SDM on quality of life and symptom control in children with asthma. Methods: We conducted a prospective 3-year study in six community-based practices serving a low-income patient population. Practices received training on SDM using an evidence-based toolkit. Patients aged 2–17 with a diagnosis of asthma were identified from scheduling and billing data. At approximate 6-month intervals, patients completed a survey consisting of the Mini Pediatric Asthma Quality of Life Questionnaire (range 1–7) and the control domain of the Pediatric Asthma Therapy Assessment Questionnaire (range 0–7). We used propensity scores to match 46 children receiving SDM to 46 children receiving usual care with decision support. Included children had completed a baseline survey and at least one follow-up survey. Random coefficient models incorporated repeated measures to assess the effect of SDM on asthma quality of life and asthma control. Results: The sample was primarily of non-White patients (94.6%) with Medicaid insurance (92.4%). Receipt of SDM using an evidence-based toolkit was associated with higher asthma quality of life [mean difference 0.9; 95% confidence interval (CI) 0.4–1.4] and fewer asthma control problems (mean difference ?0.9; 95% CI ?1.6–?0.2) compared to usual care with decision support. Conclusions: Implementation of SDM within clinical practices using a standardized toolkit is associated with improved asthma quality of life and asthma control for low-income children with asthma when compared to usual care with decision support.     

微信应用于肺结核患者健康管理服务的可行性研究

目的 调查、分析贵州省肺结核患者健康管理服务现状，探讨微信对肺结核患者实施健康干预的可行性。方法 收集2017—2019年贵州省肺结核患者健康管理资料，分析患者管理及服药现状。随机抽取10个县区2019年治疗管理肺结核患者共50例进行电话复核，调查患者管理及服药情况。选取盘州市人民医院作为研究现场，纳入研究对象40例，随机分为干预组和对照组各20例，干预组实施微信督导管理，对照组实施常规督导管理，比较两组患者肺结核知识知晓及按时复查情况。采用率、中位数进行统计描述，采用卡方检验进行率的比较，采用秩和检验进行测试得分比较。结果 2017—2019年贵州省肺结核患者规则服药率呈上升趋势（x2=87.453，P<0.01）。电话复核肺结核患者管理率及规则服药率低于相应系统上报（x2管理=238.767，P<0.01；x2规则服药=18.731，P<0.01）。干预组复查时测试得分高于对照组（U=4.000，P<0.01），两组患者复查时测试得分均高于首次测试（Z干预组=3.992，P干预组<0.01；Z对照组=3.640，P对照组<0.01）。干预组患者按时复查率高于对照组（Fisher精确概率法，P=0.003）。 结论 贵州省肺结核患者健康管理工作仍存不足。微信督导管理肺结核患者可有效提高其肺结核知识的知晓程度及按时复查率，可进一步推广使用。     

微信平台在轻中度特应性皮炎延续性护理中的应用

目的探讨微信平台在门诊轻中度特应性皮炎(AD)延续性护理中的应用效果。方法将100例2018年1月至2019年10月来自铜陵市阳光社区卫生服务中心和铜陵市疾病预防控制中心皮肤科门诊的AD患儿随机分成观察组和对照组,每组各50例。观察组在首诊后分别以建立微信群和电话随访等方式进行延续性护理,对照组采用常规护理,均持续6个月。在首诊及随访6个月时,应用AD评分指数(SCORAD)、儿童皮肤病生活质量指数问卷(CDLQI)、皮炎家庭影响调查表(DFI)对患儿和家长分别进行评分或调查。结果在首诊时,两组SCORAD、CDLQI、DFI评分比较,差异无统计学意义(P0.05);随访6个月,观察组SCORAD、CDLQI、DFI评分分别为(10.38±2.10)分、(7.68±1.40)分、(5.08±1.12)分,对照组为(12.84±2.86)分、(9.46±2.05)分、(6.00±1.36)分,观察组均低于对照组,差异有统计学意义(P0.05)。结论应用微信平台对门诊AD患儿进行延续性护理,更有利于控制病情,提高患儿及家庭生活质量,增加幸福感。     

Simulation-Based Learning in Nurse Practitioner Programs: A Scoping Review

This scoping review aims to identify what is known about simulation-based learning as an instructional tool in nurse practitioner programs. The authors used the 6-step framework by Arksey and O’Malley to conduct the review. Twelve studies fit the inclusion criteria, and 3 themes were identified, including changes in students’ confidence, improved clinical skills, and improved student knowledge. The use of simulation appears to be beneficial for developing clinical skills, cementing knowledge, and helping nurse practitioner students feel more confident in their practice. Randomized controlled trials and longitudinal studies are required to confirm the preliminary results found in this scoping review.     

中医医院微信公众号服务平台功能分类研究

阐述基于卡片分类法对中医医院微信公众号服务平台功能进行分类的方法与过程,分析中医医院微信服务号功能分类相关问题并提出建议,为中医医院微信公众号服务平台信息结构设计提供思路。     

The national landscape of culminating experiences in master’s programs in health and biomedical informatics

Health and biomedical informatics graduate-level degree programs have proliferated across the United States in the last 10 years. To help inform programs on practices in teaching and learning, a survey of master’s programs in health and biomedical informatics in the United States was conducted to determine the national landscape of culminating experiences including capstone projects, research theses, internships, and practicums. Almost all respondents reported that their programs required a culminating experience (97%). A paper (not a formal thesis), an oral presentation, a formal course, and an internship were required by ≥50% programs. The most commonly reported purposes for the culminating experience were to help students extend and apply the learning and as a bridge to the workplace. The biggest challenges were students’ maturity, difficulty in synthesizing information into a coherent paper, and ability to generate research ideas. The results provide students and program leaders with a summary of pedagogical methods across programs.