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1.
目的:探讨益生菌不同用药时机对妊娠合并糖尿病患者胰岛素抵抗及妊娠结局的影响。方法:选择2019年5月至2021年5月在衡水市妇幼保健院就建档分娩的妊娠合并糖尿病患者,分为对照组、孕早期组、孕中期组和孕晚期组,每组200例。对照组仅采用常规干预措施(未予以益生菌制剂),孕早期组、孕中期组和孕晚期组均予以双歧杆菌三联活菌肠溶胶囊420 mg,每日2次口服,疗程均为12周。比较4组患者分娩时血糖水平、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、血脂水平、产妇及新生儿不良妊娠结局等情况。结果:共纳入783例患者。孕早期组、孕中期组和孕晚期组患者分娩时血糖水平、HbA1c、HOMA-IR和血脂水平均优于对照组,孕中期组和孕晚期组优于孕早期组(P<0.05),而孕中期组和孕晚期组比较差异无统计学意义(P>0.05)。孕早期组、孕中期组和孕晚期组产妇及新生儿妊娠结局不良发生率均小于对照组,孕中期组和孕晚期组产妇及新生儿妊娠结局不良发生率均小于孕早期组,孕中期组早产和产后感染小于孕晚期组(P<0.05)。结论:益生菌不同用药时机对妊娠合并糖尿病患者胰岛素抵抗及妊娠结局存在一定差异,其中孕中期(孕14~16周)开始用药为最佳用药时机。  相似文献   
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目的:构建儿科门急诊药房用药指导岗位胜任力标准。方法:运用问卷调研法收集各大儿科医院中患儿照护人需要的用药指导信息,运用文献分析法查阅国内外规范中要求药师提供的用药指导信息,据此设计专家函询问卷。选取全国三甲儿科医院或医院儿科的20名专家,采用Delphi法进行两轮专家函询。结果:问卷回收率为100%,两轮函询后,专家权威系数为0.83。各级指标变异系数均<0.25,专家意见肯德尔和谐系数为0.416~0.836,均满足P<0.05。建立的儿科门急诊药房用药指导岗位胜任力共分为4个层次的指标,其中一级指标3项、二级指标14项、三级指标20项,3项为儿科特色指标、四级指标7项,均为儿科特色指标。结论:本研究构建的儿科门急诊药房用药指导岗位胜任力标准具有权威性和科学性,"分剂量药品储存""儿童用药方法""喂药的技巧与对策"等指标体现了明确的儿科特色,为儿科门急诊药师的用药指导能力培养提供了方向和依据。  相似文献   
3.
ObjectivesSeveral implementation strategies can reduce potentially inappropriate medication (PIM) prescribing. Although use of PIMs has declined in recent years, it remains prevalent. Various strategies exist to improve the appropriateness of medication use. However, little is known about the processes of these different implementation strategies. This scoping review aims to investigate how the process evaluation of implementation strategies for reducing PIM prescribing in the older population has been studied.MethodsWe searched for process evaluations of implementation strategies for reducing PIM prescribing in PUBMED, SCOPUS and Web of Science published between January 2000 and November 2019 in English. We applied the following inclusion criteria: patients aged ≥65 years, validated PIM criteria, and implementation process evaluated. The review focuses on decision support for health care professionals. We described the findings of the process evaluations, and compared the authors’ concepts of process evaluation of the included publications to those of Proctor et al.( 2010).ResultOf 9131 publications screened, 29 met our inclusion criteria. Different process evaluation conceptualizations were identified. Most process evaluations took place in the initial stages of the process (acceptability, adoption, appropriateness, and feasibility) and sustainability and implementation costs were seldom evaluated. None of the included publications evaluated fidelity.Multifaceted interventions were the most studied implementation strategies. Medication review was more common in acceptability evaluations, multidisciplinary interventions in adoption evaluations, and computerized systems and educational interventions in feasibility evaluations. Process evaluations were studied from the health care professionals’ viewpoint in most of the included publications, but the management viewpoint was missing.DiscussionThe conceptualization of process evaluation in the field of PIM prescribing is indeterminate. There is also a current gap in the knowledge of sustainability and implementation costs. Clarifying the conceptualization of implementation process evaluation is essential in order to effectively translate research knowledge into practice.  相似文献   
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ObjectivesTo investigate the prevalence of frailty in older adults living with dementia and explore the differences in medication use according to frailty status.DesignSystematic review of published literature from inception to August 20, 2020.Setting and ParticipantsAdults age ≥65 years living with dementia in acute-care, community and residential care settings.MethodsA systematic search was performed in Embase, Medline, International Pharmaceutical Abstracts, APA PscyInfo, CINAHL, Scopus, and Web of Science. Two reviewers independently screened records and conducted quality assessment using the Newcastle-Ottawa Scale.ResultsSixteen articles met the inclusion criteria, with 7 studies conducted in acute care setting and 9 studies in community-dwelling adults. Five studies recruited people with dementia exclusively, and 11 studies were conducted in older populations that included individuals with dementia diagnosis. Among studies conducted in acute care setting, the prevalence of frailty ranged from 50.8% to 91.8% compared with studies in community-dwelling setting, which reported a prevalence of 24.3% to 98.9%. With respect to medication exposure, 3 studies documented medication use according to frailty status but not dementia status. Higher medications use, measured as total number of medications was reported in frail [7.0 ± 4.0 (SD) ?12.0 ± 9.0 (SD)] compared with nonfrail participants [6.1 ± 3.1(SD) ?10.4 ± 3.8 (SD)].Conclusions and ImplicationsCurrent data suggests a wide range of frailty prevalence in individuals with dementia. Future studies should systematically document frailty in adults living with dementia and its impact on medication use.  相似文献   
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目的 探讨专科护理门诊个案管理对永久性起搏器植入患者复诊及服药依从的影响。方法 将首次植入永久起搏器患者134例采用随机数字表法分为对照组和干预组各67例。对照组给予微信或电话方式进行常规随访,干预组实施专科护理门诊个案管理,即通过线上及专科护理门诊方式对患者进行随访与个性化健康教育。比较两组出院后1、3、6个月的复诊率、服药依从性。结果 出院后1、3、6个月干预组复诊率、服药依从性显著高于对照组(P<0.05,P<0.01)。结论 对永久性起搏器植入患者实施专科护理门诊个案管理,促进患者出院后专业化护理的延续和全程管理,可以显著提高其术后复诊率、服药依从性。  相似文献   
9.
Relational continuity of care (COC) is becoming an important concept related to improving healthcare quality, reducing medical costs and increasing patient satisfaction with primary care. While community pharmacy (CP) has a considerable role in primary care, there are few reports dedicated to the role of relational COC in CP. This study reviewed the existing evidence of relational COC in CP and its effect on patients. PubMed, Embase, CINAHL, Cochrane Library CENTRAL and Google Scholar were used to search for relevant studies from the date of database inception through to January 2021, which were appraised according to eligibility criteria. There were no limitations on the primary outcome or language. Case reports and studies without control groups were excluded. The Newcastle–Ottawa quality assessment scale was used to assess the quality of the studies. Database searches identified 13 records. Relational COC measures in the included studies were grouped in three kinds; pharmacy-visiting pattern, Continuity of Care Index and loyalty. The assessed outcomes were medication adherence behaviour (e.g., the proportion of days covered, medication possession ratio), adverse drug reactions, potentially inappropriate drug prescribing and clinical outcomes. The odds of patients adhering to their medication regimen were about 1.1~2.5 times higher among those who consistently visited a single pharmacy compared to patients visiting multiple pharmacies. Additionally, the care provision with a high level of relational continuity could lower inappropriate drug use by 21~32 per cent and the use of other costly services by 12~29 per cent. This study suggests that a high degree of relational COC in CP could improve safe use of medications among patients. Future research is needed to employ more rigorous methods to reduce heterogeneity and to measure effects on clinical outcomes.  相似文献   
10.
  • Children with cancer receive many medications outside the hospital administered by their caregivers.
  • The study by Walsh et al. shows the number and types of medication errors in these patients. The study includes data from three different centers.
  • Importantly, the study shows the types of errors that cause harm. The authors describe how the harmful errors can be prevented.
  • We suggest ways these results can be used to identify which patients and families will benefit from additional attention. Providing more help at clinic and in the home may help prevent harmful medication errors in children with cancer.
  相似文献   
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