Impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive medications

BACKGROUND: Non-compliance with immunosuppressive medications may result in allograft rejection and is regarded as an important impediment to post-transplant care. This randomized, controlled trial evaluates the impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive agents. METHODS: Patients who received a renal transplant at the Medical College of Georgia from February 1997 through January 1999 were randomized in the intervention or control group provided they met study criteria. In addition to routine clinic services at each clinic visit, patients in the intervention group received clinical pharmacy services, which included medication histories and review of patients' medications with an emphasis on optimizing medication therapy to achieve desired outcomes and minimizing adverse medication events. The clinical pharmacist also provided recommendations to the nephrologists with the goal of achieving desired outcomes. To promote medication compliance by using compliance enhancement strategies, the clinical pharmacist counseled patients concerning their medication therapy and instructed them how to properly take their medications. Patients in the control group received the same routine clinic services as the intervention group except that they did not have any clinical pharmacist interaction. Compliance rate (CR) was calculated and patient's compliance status was determined from the CR. The CR, the fraction of patients remaining compliant for each month, and the mean time patients were compliant were compared between groups. Whether there was a difference in the frequency of patients achieving 'target' immunosuppressive levels in the control and study groups was evaluated. RESULTS: The mean CR for patients who had clinical pharmacist intervention (n=12) was statistically higher than the control group's (n=12) mean CR (p<0.001). During the 12-month post-transplant study period, patients in the intervention group had a longer duration of compliance than patients in the control group (p<0.05). Additionally, patients who had clinical pharmacy services had a greater achievement of 'target' levels than patients who did not receive these services (p<0.05). CONCLUSIONS: Patients who received clinical pharmacy services with traditional patient care services had better compliance with immunosuppressants than patients who only received traditional patient care services. Results of this study suggest a multidisciplinary team that includes a clinical pharmacist as part of the care for post-transplant patients is beneficial for enhancing medication compliance.     

护士门诊对提高糖尿病患者知识性健康素养的作用

目的提高糖尿病患者的健康素养水平,促进其进行自我管理,减缓疾病进程。方法开设护士门诊,对121例糖尿病患者进行系统管理,建立健康档案,制订具体就诊及病情监测计划,开具护理处方,实施糖尿病护理诊治。比较管理前后患者知识性健康素养的变化。结果管理后患者糖尿病相关知识性健康素养正确持有率显著高于管理前(P0.05,P0.01)。结论开设护士门诊对提高糖尿病患者的知识性健康素养,促进糖尿病患者病情控制有着积极意义。     

Impact of a novel education curriculum on surgical training within an academic training program

BACKGROUND: The training of the 21st century surgeon has become increasingly complex with the Accreditation Council for Graduate Medical Education (ACGME) core competency requirements and work-hour restrictions. Herein we report the two-year results of a novel problem-based learning education module at a large academic surgery program. METHODS: All data were prospectively collected from 2004 to 2006 on all categorical residents in the department of surgery (n = 42). Analysis was performed to identify any correlation between class attendance and American Board of Surgery In-Service Training Exam (ABSITE) score performance (percentile change). All data were reported as a mean with a standard error of the mean. Categorical variables were analyzed using a paired Student's t-test. A bivariate correlation was calculated using Spearman's rho correlation. RESULTS: When comparing the 2004 scores (pre-program) to 2006 scores, there was significant score improvement (P 相似文献   

Evaluation of a screening and prevention programme for diabetic foot complications

Foot complications in diabetes can be decreased by preventive measures. The authors evaluated the current diabetic foot screening and prevention programme of the diabetes outpatient clinic of their university hospital, by assessing the presence of risk factors for the development of foot disorders and the preventive measures taken. Fifty (50) diabetic patients not known to have foot complications were selected at random. Risk factors and preventive measures were inventarised with the Coleman risk-categorization system and the Preventive Measures Scale, respectively. Sixty per cent (60%) of the patients were at risk of developing diabetic foot complications. The preventive measures were low in these patients. Patient knowledge was insufficient and behaviour even worse. Basal preventive shoe adaptations were absent in most patients at risk. No relation between risk category and the preventative status was found. Cross-sectional examination at a university outpatient clinic showed serious risk profiles for foot complications, which were not balanced by the application of generally accepted preventive measures. At the outpatient clinic, screening should be optimised.     

同伴教育对稳定期COPD患者长期家庭氧疗依从性的影响

目的探讨同伴教育对稳定期慢性阻塞性肺疾病(COPD)患者长期家庭氧疗依从性的影响。方法将87例COPD患者按纳入顺序编号,采用随机数字表法分为对照组43例与观察组44例。对照组采用COPD氧疗知识的常规健康教育,观察组在此基础上接受同伴教育1年,包括同伴教育者的选择、成立同伴教育者培训小组及同伴教育活动的实施等。连续6个月后评价患者长期家庭氧疗依从性、生活质量评分(SGRQ),统计2年内急性发病再住院率。结果观察组长期家庭氧疗依从性显著高于对照组,肺功能及血气指标显著好于对照组,2年内再住院率显著低于对照组(均P0.05)。结论同伴教育能有效提高COPD患者长期家庭氧疗的依从性,改善肺功能,减少COPD急性发作,从而改善患者生活质量。     

同伴教育对稳定期COPD患者长期家庭氧疗依从性的影响

目的探讨同伴教育对稳定期慢性阻塞性肺疾病（COPD）患者长期家庭氧疗依从性的影响。方法将87例COPD患者按纳入顺序编号,采用随机数字表法分为对照组43例与观察组44例。对照组采用COPD氧疗知识的常规健康教育,观察组在此基础上接受同伴教育1年,包括同伴教育者的选择、成立同伴教育者培训小组及同伴教育活动的实施等。连续6个月后评价患者长期家庭氧疗依从性、生活质量评分（SGRQ）,统计2年内急性发病再住院率。结果观察组长期家庭氧疗依从性显著高于对照组,肺功能及血气指标显著好于对照组,2年内再住院率显著低于对照组（均P〈0.05）。结论同伴教育能有效提高COPD患者长期家庭氧疗的依从性,改善肺功能,减少COPD急性发作,从而改善患者生活质量。     

Results of a single center vascular screening and education program

BACKGROUND: Vascular screening events have become a popular way to increase vascular awareness. Most screenings programs involve multiple locations on a single date and do not explore the local impact of screening. We evaluated the economic and community impact of the Dare to C.A.R.E. (DTC) program, a large, single center, continuous vascular screening and education program in Annapolis, Maryland. METHODS: Between July 2000 and July 2006, DTC was offered free to the public for those over 60 or over 50 with risk factors of hypertension, diabetes, smoking, or elevated cholesterol. DTC consisted of a 2-hour educational lecture, completing a risk factor questionnaire, and testing blood pressure, carotid duplex, abdominal aortic aneurysm (AAA) ultrasound, and pedal pulse/ankle-brachial index (ABI). Mild disease (MD) was defined as 1% to 39% carotid stenosis or an ABI between .7 and .95; intermediate disease (ID) as carotid stenosis >or=40%, AAA >or=3 cm, or an ABI or=60%, AAA >or=5 cm, or an ABI 相似文献   

强化考核式健康教育对肾移植患者遵医行为的影响

目的探讨强化考核式健康教育对加强肾移植患者遵医行为的影响。方法将160例肾移植患者按入院时间分为对照组(76例)和观察组(84例)。对照组采用常规健康教育,如集中教育、召开座谈会、家访及个别指导、热线电话咨询;观察组在对照组教育的基础上增加术后及出院前2次强化考核,针对考核结果调整健康教育内容。结果观察组患者术后6个月未按量服药、忘记记录尿量等10项不良事件发生率显著低于对照组(均P<0.05)。结论强化考核式健康教育可促进肾移植患者的遵医行为,减少不良事件的发生。     

Effect of a preventive foot care program on lower extremity complications in diabetic patients with end-stage renal disease

BackgroundLower extremity complications are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD) and diabetes mellitus. Patient education programs may decrease the risk of diabetic foot complications.MethodsA preventive program was instituted, consisting of regular assessments by a foot care nurse with expertise in foot care and wound management and patient education about foot care practices and footwear selection. Medical records were reviewed and patients were examined. A comparison was made with data about patients from a previous study done from this institution prior to development of the foot care program.ResultsDiabetic subjects more frequently had weakness of the left tibialis anterior, left tibialis posterior, and left peroneal muscles than non-diabetic subjects. A smaller percentage of diabetic subjects had sensory neuropathy compared with the previous study from 5 years earlier, but a greater percentage of diabetic subjects had absent pedal pulses in the current study. The frequency of inadequate or poor quality footwear was less in the current study compared with the previous study.ConclusionsThe current data suggest that a foot care program consisting of nursing assessments and patient education may be associated with a decrease in frequency of neuropathy and improved footwear adequacy in diabetic patients with ESRD.     

结构化治疗与教育课程对血液透析患者慢性牙周炎的作用

目的开发血液透析患者慢性牙周炎结构化治疗与教育课程(STEP),探讨其对患者牙周健康状态、口腔保健自我效能、牙科畏惧和焦虑、以及全身炎症水平的作用。 方法选取2020年9月至2021年3月北京市某三甲医院的96例确诊为慢性牙周炎的老年血液透析(HD)患者,随机分为对照组和干预组。对于患者的口腔宣教,对照组(48例)使用传统方法,干预组(48例)则使用STEP方法。7个月后分析患者的菌斑指数(PLI)、龈沟出血指数(SBI)、牙周袋探诊深度(PD)、口腔保健自我效能量表(SESS)、牙科焦虑量表(DAS)、牙科畏惧量表(DFS)评分,以及超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和转化生长因子β(TGF-β)的变化。 结果与对照组比较,干预组患者的PLI、SBI、PD、SESS、DAS、DFS评分均改善(P<0.05),且hs-CRP、TNF-α水平显著降低(P<0.001),而IL-6、TGF-β指标改善不具有统计学意义。 结论STEP方法显著改善了血液透析合并慢性牙周炎患者的口腔健康状况、自我保健意识、焦虑和畏惧情绪、以及全身炎症水平。     

实施自我管理教育项目对住院2型糖尿病患者的影响

目的探讨实施自我管理教育项目对2型糖尿病患者健康信念、自我管理行为及糖化血红蛋白的影响。方法将100例住院2型糖尿病患者随机分为对照组与观察组各50例。对照组给予常规健康教育,观察组在此基础上由科室医生、教育护士、营养师、心理咨询师等8名成员组成自我管理教育项目组,对患者进行自我管理教育。两组均随访3个月,分别在干预前、干预后第3个月评估患者的健康信念、自我管理行为和糖化血红蛋白水平。结果观察组干预后健康信念得分显著高于对照组（P〈0．01）;自我管理行为显著优于对照组（P〈0．05）;糖化血红蛋白降低程度较对照组更为显著（P〈0．01）。结论对住院2型糖尿病患者实施自我管理教育项目,能提高其健康信念水平、改善自我管理行为、降低糖化血红蛋白。     

专项教育对糖尿病患者注射胰岛素效果的影响

目的提高糖尿病患者胰岛素皮下注射正确率及相关知识掌握度。方法将540例糖尿病患者按均等原则分为观察组320例和对照组220例,观察组行胰岛素用药专项健康教育即成立专项教育小组、设置糖尿病教育示教室、讲解与注射操作示范结合、建立胰岛素用药档案;对照组由责任护士进行常规健康教育。患者出院访视6个月后评价效果。结果观察组胰岛素知识掌握率显著高于对照组,胰岛素注射不良事件发生率显著低于对照组(P0.05,P0.01)。结论专项教育有利于提高教育效果,可作为糖尿病教育的补充形式。     

Prognostic importance of clinic and home blood pressure recordings in patients with chronic kidney disease

Blood pressure (BP) measured only in the clinic substantially misclassifies hypertension in patients with chronic kidney disease (CKD). The role of out-of-clinic recordings of BP in predicting end-stage renal disease (ESRD) and death in patients with CKD is unknown. A prospective cohort study was conducted in 217 Veterans with CKD. BP was measured at home and in the clinic by 'routine' and standardized methods. Patients were followed over a median of 3.5 years to assess the end points of total mortality, ESRD or the composite outcome of ESRD or death. Home BP was 147.0+/-21.4/78.3+/-11.6 mmHg and clinic BPs were 155.2+/-25.6/84.7+/-14.2 mmHg by standardized method and 144.5+/-24.2/75.4+/-14.7 mmHg by the 'routine' method. The composite renal end point occurred in 75 patients (34.5%), death in 52 patients (24.0%), and ESRD in 36/178 patients (20.2%). One standard deviation (s.d.) increase in systolic BP increased the risk of renal end point by 1.27 (95% confidence interval (CI) 1.01-1.60) for routine clinic measurement, by 1.69 (95% CI 1.32-2.17) for standardized clinic measurement and by 1.84 (95% CI 1.46-2.32) for home BP recording. One s.d. increase in home systolic BP increased the risk of ESRD by 1.74 (95% CI 1.04-2.93) when adjusted for standardized clinic systolic BP, proteinuria, estimated glomerular filtration rate, and other risk factors. In patients with CKD, BPs obtained at home are a stronger predictor of ESRD or death compared to BPs obtained in the clinic. Systolic home BP is an independent predictor for ESRD.     

Association between visit-to-visit clinic blood pressure variability and home blood pressure variability in patients with chronic kidney disease

Abstract

Although both clinic blood pressure (BP) variability and home BP variability are associated with the risk of cardiovascular disease, the relationship between both BP variabilities remain unclear. We evaluated the association between visit-to-visit variability of clinic BP (VVV) and day-by-day home BP variability (HBPV) in patients with chronic kidney disease (CKD). We recruited 143 CKD patients in whom we performed HBP measurements every morning and evening over seven consecutive days. We obtained clinic BP data during 9.6?±?1.0 consecutive visits within 24 months. The associations between the variables of VVV and HPBV were examined. The CV values of clinic systolic BP (CSBP) was significantly correlated with the mean values of morning systolic BP (MSBP) and those of evening systolic BP (ESBP) (r?=?0.23, 0.20; p?=?0.007, 0.02, respectively). The CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP (r?=?0.19, 0.31; p?=?0.02, <0.001, respectively). On the multivariate regression analysis, the CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP [standardized regression coefficient (β)?=?0.19, 0.34; p?=?0.03, <0.001, respectively]. In conclusion, VVV showed a weak but significant association with HBPV, especially the CV values of ESBP in CKD patients. Further studies are necessary to clarify whether these different BPV elements will be alternative marker of BPV.     

HtoH连续护理对老年慢性心力衰竭患者用药依从性和再入院率的影响

目的探讨HtoH(医院到家庭)连续护理对老年慢性心力衰竭患者用药依从性和再入院率的影响。方法对64例老年慢性心力衰竭患者实施由医院、社区医护人员协作的HtoH连续护理6个月。观察患者的用药依从性和再入院率。结果实施后患者的用药依从性显著提高(均P0.01);患者出院6个月内再入院率显著低于上一年度同类患者(P0.05)。结论 HtoH连续护理可提高老年慢性心力衰竭患者的用药依从性,降低再入院率。     

HtoH连续护理对老年慢性心力衰竭患者用药依从性和再入院率的影响

目的探讨HtoH（医院到家庭）连续护理对老年慢性心力衰竭患者用药依从性和再入院率的影响。方法对64例老年慢性心力衰竭患者实施由医院、社区医护人员协作的HtoH连续护理6个月。观察患者的用药依从性和再入院率。结果实施后患者的用药依从性显著提高（均P〈0.01）;患者出院6个月内再入院率显著低于上一年度同类患者（P〈0.05）。结论 HtoH连续护理可提高老年慢性心力衰竭患者的用药依从性,降低再入院率。