The medical complications of drug abuse

There is a vast array of abused drugs, and only a few of the more commonly used substances have been discussed. Patients with drug abuse frequently present with atypical syndromes and diseases. These individuals usually have less social, medical and economic support, making them more susceptible to the diseases that are associated with poverty, such as tuberculosis, and the complications of diseases such as hypertension, congestive heart disease and diabetes that require long-term care. Our strategy in the evaluation of these patients should consider all these aspects of medicine. A meticulous assessment and comprehensive care are necessary to render quality care for these complicated human and toxicological problems.     

Patients' evaluation of outpatient medical care

150 patients attending an outpatient clinic at the University of Oklahoma Hospital over a 5-week period were asked whether the clinic care they were receiving was better than, as good as, or worse than the care they had received from local physicians. The patients were drawn from the general medicine, cardiology, and oncology-hematology units and tended to be elderly and chronically ill. Most of the patients viewed favorably the care they received in the medical outpatient clinics. 65% reported they had experienced pain or discomfort in the week prior to their visit, but there was no association between these factors and degree of satisfaction with clinic care. Patients averaged about 30 minutes with the physician, and 80% felt the doctor adequately explained their medical condition to them. Patients who rated the clinic care as being worse than the care of private practitioners felt that their condition was not adequately explained. When asked to define a "good doctor," patient responses were "interest in the patient," "skilled and thorough," and "explains things to you." Characteristics identified as being most important in a "good clinic" were; good doctors, well-trained staff, and information from doctors. Of all the factors examined, the one associated most directly with patient satisfaction was personal interest on the part of the physician in the patients.     

合理用药管理系统在门诊用药安全中的应用

门诊老年患者安全用药越来越受到社会的关注,医院药学信息化的发展可帮助药师提供更好的药学服务。本文介绍了我院合理用药管理的运行及规则管理,通过回顾性分析发现,合理用药管理系统使用后门诊处方合格率稳步提升,不合理用药拦截次数逐渐减少,医生开具合理处方意识逐渐提升,药师管理水平逐渐提高。合理用药管理系统保障了门诊患者的用药安全,让药师在合理用药方面发挥了更大作用。     

门诊不合理用药分析

目的 调查研究笔者所在医院门诊不合理用药的情况,以提出好的解决方案.方法 选取2007年1月～2009年12月笔者所在医院门诊的3034份门诊处方为研究对象,将其根据年份分为2007年1～12月组(A组)1011份、2008年1～12月组(B组)1011份和2009年1～12月组(C组)1012份,总结分析其不合理用药情况.结果 经研究统计发现,不合理用药情况并不少见,其中随着年份的增加,药物选择不合理、配伍不合理、给药方式不合理、抗生素应用不合理及非抗生素应用不合理情况均有所改善,所占比例逐年下降,经比较,P均＜0.05,均有显著性差异.结论随着用药越来越规范,笔者所在医院门诊不合理用药情况发生率越来越低,但仍需进一步加强.     

Trends in medical use and abuse of opioid analgesics

Context  Pain often is inadequately treated due in part to reluctance about using opioid analgesics and fear that they will be abused. Although international and national expert groups have determined that opioid analgesics are essential for the relief of pain, little information has been available about the health consequences of the abuse of these drugs. Objective  To evaluate the proportion of drug abuse related to opioid analgesics and the trends in medical use and abuse of 5 opioid analgesics used to treat severe pain: fentanyl, hydromorphone, meperidine, morphine, and oxycodone. Design and Setting  Retrospective survey of medical records from 1990 to 1996 stored in the databases of the Drug Abuse Warning Network (source of abuse data) and the Automation of Reports and Consolidated Orders System (source of medical use data). Patients  Nationally representative sample of hospital emergency department admissions resulting from drug abuse. Main Outcome Measures  Medical use in grams and grams per 100,000 population and mentions of drug abuse by number and percentage of the population. Results  From 1990 to 1996, there were increases in medical use of morphine (59%; 2.2 to 3.5 million g), fentanyl (1168%; 3263 to 41,371 g), oxycodone (23%; 1.6 to 2.0 million g), and hydromorphone (19%; 118,455 to 141,325 g), and a decrease in the medical use of meperidine (35%; 5.2 to 3.4 million g). During the same period, the total number of drug abuse mentions per year due to opioid analgesics increased from 32,430 to 34,563 (6.6%), although the proportion of mentions for opioid abuse relative to total drug abuse mentions decreased from 5.1% to 3.8%. Reports of abuse decreased for meperidine (39%; 1335 to 806), oxycodone (29%; 4526 to 3190), fentanyl (59%; 59 to 24), and hydromorphone (15%; 718 to 609), and increased for morphine (3%; 838 to 865). Conclusions  The trend of increasing medical use of opioid analgesics to treat pain does not appear to contribute to increases in the health consequences of opioid analgesic abuse.      

基本药物及合理用药政策对农村用药情况的影响分析

目的 通过对实施基本药物及合理用药政策的农村地区用药状况的分析，发现政策对农村用药情况的影响，以及分析政策实施的影响因素并提出解决对策。方法 抽样调查某县乡镇卫生院门诊处方，并进行多元方差等统计学分析，调查基本药物及合理用药政策对农村用药情况的影响。结果 农村基本药物及合理用药政策实施后，并没有改善农村用药存在的不合理现象。结论：政策执行力度不够、乡村医生长期的用药习惯以及患者的诱导需求等原因影响了基本药物及合理用药政策实施，为了达到改善农村用药情况的效果，建议加强政策实施的约束力、加强乡村医生的业务培训以及农村居民的卫生宣教等，促使基本药物及合理用药政策发挥其应有的效应。     

入户调查结合线索调查在社区药物滥用流行病学调查中的可行性分析

目的 了解入户调查结合线索调查在社区选点药物滥用流行病学研究中的可行性.方法 与湖南省第五次人口普查资料比较,分析样本的代表性;对370例阿片类物质滥用者信息来源线索进行描述性分析.结果 (1)样本资料收集质鼍较高,有效问卷率高达99.7%,具有较好代表性.(2)新发现阿片类物质滥用者130例,实际吸毒人员数量与登记在册吸毒人员之比是1.49:1.(3)阿片类药物滥用者信息来源以单一渠道为主(55.1%),2种或以上渠道者44.9%.(4)调查仅发现33例新型毒品滥用者,且多为多药滥用者(20/33例).结论 入户调查结合线索调查进行社区居民阿片类物质滥用流行病学调查切实可行,但不适于新型毒品.     

儿科门诊抗菌药物使用情况分析

目的:分析贵港市人民医院儿科门诊抗菌药物的使用情况,评估其合理性。方法:抽查抗菌药物治疗儿科患者6 070例,分析抗菌药物使用的种类、频率及联合用药等情况。结果:β-内酰胺类与大环内酯类是儿科门诊主要使用的抗菌药物,使用频率分别占抗菌药物例次的89.81%和7.83%;单用抗菌药物和联合用药分别占抽查患者的77.51%,22.49%。结论:贵港市人民医院儿科门诊抗菌药物的使用基本合理。     

门诊处方合理用药分析

目的 了解本院门诊指标的现状.方法 回顾性调查与分析本院2010年3月至2011年2月的门诊处方6009张(不包括急诊、儿科、皮肤科以及精神类处方).结果 单方品种数为2.18种,处方通用名使用百分比为99.98％,注射剂应用百分比为13.93％,抗生素应用百分比为12.50％,平均单方费用为238.20元.结论 本院各项用药指标比较合理,但单方费用偏高.