Co-occurrence of alcohol and cigarette use among adolescents

Concurrent use of alcohol and cigarettes among adolescents is a serious public health issue. Trends in concurrent use of alcohol and cigarettes were determined using data from three comparable large statewide samples of 7-12th-grade students in New York State, from surveys conducted in 1983, 1990, and 1994. The prevalence of use of alcohol and cigarettes decreased from 1983 (23%) to 1990 (19%), and increased by 1994 (22%). Logistic regression analysis showed that these trends are highly significant, and that the probability of use of alcohol and cigarettes is higher for females than males, increases with age, and is lower for most ethnic minorities than for Whites. In the 1990s, Blacks, Hispanics, and Asians increased in their probability of concurrent use more than did Whites. Users of both alcohol and cigarettes are at increased risk of personal and social problems, as well as increased risk of delinquency. Drinking and smoking show synergistic effects on illicit drug use and drug problems.     

Patterns of antibiotic use and expenditures during 7 years at a university hospital

Before 1982, annual retrospective drug-use audits clearly established the pattern of increased antibiotic use and expenditures at the University of Minnesota Hospital. At that point, a concurrent trend analysis system was developed to track this use by individual drug and therapeutic class, to identify trends in use for qualitative evaluation, and to provide an assessment of any intervention intended to alter use. Monthly use of all injectable antibiotics and antifungal agents, and selected oral antifungals has been tracked since 1982 as both defined daily doses and dollars. Use patterns in 1981 served as baseline. The defined daily dose index, which captures changes associated with intensity of antibiotic use per patient, increased 62% from baseline through 1988. This increase, however, resulted in a disproportionate 228% rise from baseline in antibiotic expenditures to nearly $3 million/year for 1988. The defined daily dose index peaked in 1985, declined in 1986, and remained stable for 1987 and 1988. Qualitative drug-use review programs were associated with this positive change. These results demonstrate the utility of concurrent trend analysis as a resource-management tool and as a measure of effectiveness for collaborative physician-pharmacist programs to foster safe, appropriate, and economical use of antiinfective agents.     

Developing and implementing guidelines to promote appropriate use of fluconazole therapy in an AIDS clinic

A retrospective and concurrent drug use evaluation for fluconazole in an outpatient AIDS clinic is described. Eighty-eight patient charts were reviewed in the evaluation during an 8-week period, and 72 patients were studied in the concurrent evaluation for a period of 5 weeks. A set of preestablished fluconazole usage and dosing guidelines was developed by the clinical pharmacist and the chairman of the antimicrobial subcommittee/chief of infectious disease and approved by the pharmacy and therapeutics committee. Patients who did not meet these guidelines were those being treated for oropharyngeal and esophageal candidiasis. The use of fluconazole was not indicated in 43 of 54 (80%) patients in retrospective evaluation and 31 of 39 (79.5%) patients before clinical pharmacist intervention in concurrent study. If guidelines had been followed during the retrospective evaluation, cost savings would have been $295 per day, which adds up to $16,520 for 8 weeks. In the actual evaluation, the cost savings with pharmacist intervention for 5 weeks was $5,460, which can be extrapolated to annual cost savings of $65,520.     

Warfarin: a quality assurance model for concurrent drug monitoring

Until recently, the mechanism to gain the attention of hospital decision makers on the potential implication of pharmacists' involvement in the drug use review process was missing. However, integrating clinical pharmacy services with quality assurance activities appears to provide a mechanism to reduce patient risk and cost while maintaining the quality of patient care services provided. The department of pharmacy at The Mercy Hospital of Pittsburgh, through the hospital-wide quality assurance committee (QAC) and pharmacy evaluation committee (PEC), has developed concurrent drug the reviews. The concurrent warfarin review conducted by the department of pharmacy is described in detail to illustrate the process that is followed in the development and implementation of a concurrent drug use review. The concurrent review of warfarin was initiated and, in general, criteria were met and few variations occurred. Interventions by staff pharmacists were effective in further improving compliance with certain criteria. Although it was not proven that the incidence of hemorrhage was actually decreased, the QAC felt that such an approach would serve to decrease the likelihood of hemorrhage as warfarin therapy is initiated in the hospital. Similar drug use reviews have been developed for aminoglycosides, third-generation cephalosporins, piperacillin, cefoxitin, cefazolin, vancomycin, phenytoin, and the digoxin-quinidine interaction. The objective of these reviews is also to reduce patient risk and costs associated with drug use. Therefore, in today's hospital environment, a mechanism to improve the visibility of the pharmacist's involvement in the health care process is to integrate clinical pharmacy services with quality assurance activities.     

205例阑尾炎手术患者围手术期抗菌药物应用分析

目的了解阑尾炎手术患者围手术期抗菌药物的应用情况。方法回顾性调查我院2007年205例阑尾炎手术患者围手术期抗菌药物的应用情况。结果阑尾炎手术患者抗菌药物应用率达100％,其中预防性用药占74．6％,其余均为治疗性用药。抗菌药物应用率列前5位的分别为甲硝唑（占32．1％）、替硝唑（占7．3％）、头孢哌酮／舒巴坦钠（占5．4％）、头孢匹胺（占5．4％）和加替沙星（占4．7％）。联合用药中以二联应用比例最大。结论我院阑尾炎手术患者围手术期应用抗菌药物仍存在预防性用药时间偏长、部分应用抗菌药物起点偏高、联用方式不恰当等,亟待干预。     

达比加群酯药物利用评价标准的建立与回顾性分析

目的:建立达比加群酯药物利用评价标准(drug use evaluation, DUE),为临床合理应用达比加群酯提供参考。方法:以达比加群酯药品说明书为基础,参考相关指南和文献,通过专家咨询法制订达比加群酯药物利用评价标准,并采用回顾性研究方法,对湖北省某大型三甲医院2021年1-6月使用达比加群酯的住院患者用药进行合理性评价,具体包括适应证、用法用量、联合用药、禁忌证、不良反应监测及药物转换等。结果:共纳入501份病例,完全符合评价标准的合理率为91.42%,不合理应用常见于适应证不适宜(2.2%)和用法用量不适宜(2.0%),同时存在30.3%的联合用药的高风险。结论:建立的达比加群酯的DUE具有较强的科学性、实用性和可行性,该院达比加群酯临床应用中尚存在一些问题,应进一步加强干预,促进临床合理用药。     

The effect of an antimicrobial formulary change on hospital resistance patterns.

A university hospital formulary change that was designed to reduce the use of the third-generation cephalosporins ceftazidime and cefotaxime and replace them with the so-called "fourth-generation" cephalosporin cefepime was evaluated. A retrospective review of antibiotic use and antimicrobial resistance during two 6-month periods before and after the formulary change was performed. All hospital patients with vancomycin-resistant Enterococcus (VRE), ceftazidime-resistant Klebsiella pneumoniae (CRKP), methicillin-resistant Staphylococcus aureus (MRSA), piperacillin-resistant Pseudomonas aeruginosa (PRPA), and ceftazidime-resistant P. aeruginosa (CRPA) infections were included in the study Ceftazidime use decreased from 9600 g to 99 g, and cefotaxime use decreased from 6314 g to 732 g, which represented a combined decrease of 89%. Use of cefepime increased from 0 g to 5396 g. Infections from CRKP decreased from 13% to 3%, PRPA infections decreased from 22% to 14%, and CRPA infections decreased from 25% to 15% (p<0.05 for all). Infections from MRSA dropped insignificantly, and VRE infections increased significantly. Substituting cefepime for ceftazidime and cefotaxime while reducing the overall use of cephalosporins appears to decrease rates of CRKP, PRPA, and CRPA.     

充血性心力衰竭患者的药物利用评估

目的:建立适合中国医院的充血性心力衰竭(CHF)药物利用评估(DUE)程序;评价某大学附属医院CHF患者用药的合理性。方法:采用回顾法执行DUE程序,使用CHFDUE数据收集表格,从2002-03-01至2002-06-15,对在某大学附属医院接受治疗的30名CHF患者的用药进行了评价。结果:经治疗后27名(90%)患者的临床症状得到了改善。结论:根据调查结果,作者认为该科的医疗水平同当前先进的CHF治疗指南相接近,但还有不足之处,对此,作者提出了一些建议。     

Impact of a pharmacist/physician cooperative target drug monitoring program on prophylactic antibiotic prescribing in obstetrics and gynecology

The pharmacist's role in promoting rational, cost-effective use of drugs has been described in the literature. In a target drug monitoring program (TDMP), a single agent or group of agents becomes targeted for review. Antibiotics have been the primary focus of TDMP because of their therapeutic impact and cost considerations. The objectives of this project were to assess the prophylactic antibiotic prescribing habits of OB/GYN physicians and to evaluate the impact of a pharmacist/physician cooperative TDMP on prophylactic antibiotic prescribing and cost. The study was conducted in three phases: 1) a retrospective chart review of 150 patients, 2) an in-service education session, and 3) a concurrent chart review of 107 patients. Patient selection, timing of preoperative dose, and use of single dose prophylaxis were according to criteria in greater than 90% of patients both before and after the in-service training. Compliance with recommended regimens increased from 45 to 73% after the in-service training. A cost savings was not realized because the physicians wished to use a regimen with anti-anaerobic coverage (i.e., cefotetan) rather than a less expensive agent. However, the cost of selection of resistant organisms must be considered when discouraging the use of multiple broad spectrum agents. Active involvement of the medical staff in a pharmacy-based TDMP produces a cooperative atmosphere in which to educate clinicians and promote rational prescribing habits.     

163例阑尾炎手术患者围手术期抗菌药物应用分析

目的:了解阑尾炎手术患者围手术期抗菌药物的应用情况。方法:回顾性调查我院2006年163例阑尾炎手术患者围手术期抗菌药物的应用情况。结果:阑尾炎手术患者抗菌药物应用率达100%,其中预防性用药占78.5%,其余均为治疗性用药。抗菌药物应用率列前5位的分别为甲硝唑(占32.5%)、替硝唑(占7.3%)、头孢哌酮/舒巴坦钠(占5.4%)、头孢匹胺(占5.4%)和加替沙星(占4.9%)。联合用药中以二联应用比例最大。结论:我院阑尾炎手术患者围手术期应用抗菌药物仍存在预防性用药时间偏长、部分应用抗菌药物起点偏高、联用方式不恰当等,亟待干预。     

DUE模式在抗菌药物专项整治工作中的应用与实证研究

目的：探讨药物利用评估（ DUE）模式在抗菌药物专项整治实践中的应用。方法：按照DUE的基本步骤,采用回顾性方法收集资料,对某实践单位进行万古霉素的DUE实践并根据评价结果改善临床用药模式。结果：该院万古霉素使用的合理性得到提高,DUE评价使用理由和关键病程指征方面的指标大多有明显改善,尤其在适应证和用药指征方面的合格率由79.5%提高到95.0%;抗菌药物分级管理方面的合格率由63.3%提高到92.7%;给药频率合格率由72.5%提高到96.0%。结论：DUE作为一种较新的临床药学工作模式和医疗质量持续改进方案,在实践单位的运行获得良好的效果,促进了万古霉素的合理使用。     

Multidisciplinary medication review: evaluation of a pharmaceutical care model for nursing homes

Objective The objective of this study was to assess implementation of a pharmaceutical care model for the multidisciplinary care of elderly patients in nursing homes. Setting Prospective study, medication review, from January 2007 to December 2009 in ten nursing homes affiliated to the Pharmacie interjurassienne (PIJ), Switzerland. Method Medication use data were collected and reviewed by a pharmacist, focusing on drug indication, dosing, side effects, renal/hepatic elimination and interactions. Drug-related problems (DRPs) were discussed face-to-face with the responsible physician and a nurse. The pharmaceutical care issues were formulated and medication interventions proposed during this meeting. DRPs and interventions were documented using the Pharmaceutical Care Network Europe scheme version 5.00 (PCNE V5.00). The economic impact of the service was estimated through a retrospective evaluation of annual drug costs. A satisfaction evaluation was conducted among practitioners and nurses. Main outcome measures DRPs, interventions, treatment changes implemented. Results Drug therapy of 329 patients was reviewed. The number of medicines per patient ranged from 2 to 27 (mean 12.8). A total of 1,225 DRPs were detected and discussed with the physician and the nurse. Medication review led to 343 medical evaluations secondary to drug-drug interactions and 803 treatment adaptations: 373 drugs were stopped, 197 dosages changed, 95 instructions for use amended, 86 drug choices were altered, 35 drug formulations changed and 17 new drugs started. According to the Anatomical Classification System, the main classes involved in interventions were related to Alimentary tract and metabolism (n = 285), Nervous system (n = 189) and Cardiovascular system (n = 115). Since the outset of the PIJ, the annual drug costs decreased in nursing homes with medication review including a pharmacist, whereas it was stable in the other nursing homes. The satisfaction evaluation showed a very positive appreciation by practitioners and nurses. Conclusion The study showed an efficient pharmaceutical care model, well accepted by physicians and nurses. It also indicated that for elderly patients, continuous drug review contributed to improved drug therapy, reduced unnecessary polypharmacy and reduced pharmaceutical costs.     

Cost-effectiveness comparison of cefepime and ceftazidime using decision analysis

A retrospective cost-effectiveness analysis, from the institutional perspective, was performed on the 1637 clinically evaluable patients who participated in randomised studies of cefepime versus ceftazidime. The clinical success rate was 88% for patients in both the cefepime and ceftazidime groups. Adverse events occurred in 16.5% of cefepime and 19.0% of ceftazidime patients (p greater than 0.05). In most cases cefepime was administered every 12 hours while ceftazidime was administered every 8 hours. The amount of drug administered per patient (mean+/-SEM) was 17.6+/-0.4g of cefepime and 29.1+/-0.8g of ceftazidime (p less than 0.01). The median number of days of antibiotic treatment was 8 for each group. Decision and sensitivity analyses of drug price and hospital bed cost demonstrated that cefepime was consistently more cost effective than ceftazidime. The probability of clinical success varied between 60 and 97% and revealed that ceftazidime would have to be 31% more effective than cefepime to change the economic decision. If the acquisition prices per gram of drug are similar, cefepime will be cost effective compared with ceftazidime.     

DUE Software Highlights Therapeutic Issues: Drug use evaluation systems concurrently review prescribing criteria and patient medication history to identify potential drug therapy problems.

Drug use evaluation (DUE) or drug use review (DUR) for the ambulatory care setting is creating many opportunities to improve the pharmaceutical care provided by pharmacists. This study documents one year of peer-review interventions based on a retrospective drug utilization review software system (Qualisure, Q-A, Inc.) that screens patient profiles for a high likelihood of drug therapy problems. Letters are written to physicians and pharmacists providing care to these patients. The software identifles frequent opportunities for selecting therapeutic class alternatives to prescribed agents. Antibiotics, antihistamines, nonsteroidal anti-inflammatory drugs, and antidepressants were the classes for which therapeutic class alternatives were most often recommended.     

颅脑损伤患者抗生素使用现状调查及分析

目的了解颅脑损伤患者抗菌药物的临床应用现状及存在问题。方法随机抽取我院近3年916份出院病历进行回顾性调查,以药物利用指数(DUI)进行用药评价。结果抗生素总使用率89.85%,预防用药使用率78.1%,治疗用药使用率100%。治疗用药中联合用药的比例为77.16%,抗生素使用频率最高的为头孢菌素类(79.13%),前5位为:头孢呋辛钠、头孢曲松钠、头孢哌酮钠、头孢他啶、头孢噻肟钠。有药敏试验的仅占14.84%;DUI等于或近于1的品种占40%。结论我院颅脑损伤患者抗菌药物使用率高,且存在较多不合理现象。     

Are drunk-driving offenders referred for screening accurately reporting their drug use?

Several studies report that a substantial percentage of offenders arrested for impaired driving test positive for drugs of abuse besides alcohol. Current guidelines recommend screening offenders for both alcohol and other drug use, yet little is known about the accuracy of self-reports of drug use in this population. We compared drug abuse and dependence DSM-III-R diagnoses from an initial, court-ordered screening evaluation of 583 female and 495 male convicted drunk-driving offenders with diagnoses obtained via a voluntary, non-coerced interview 5 years later. At initial screening, fewer than 6% of offenders were diagnosed with drug abuse or dependence. Among offenders who did not receive an initial drug diagnosis, 28% subsequently reported having experienced drug use problems consistent with a retrospective diagnosis of drug abuse or dependence by the age at which they were screened. Half of those with a retrospective diagnosis of drug dependence reported their initial screening responses were "very accurate". We conclude that, although many drunk-driving offenders undergoing screening have diagnosable drug problems, a high proportion under-report their drug use. We suggest that certain modifications to screening procedures, such as urine drug screening, reducing barriers to treatment, and training counselors in motivational interviewing techniques, may increase accurate identification of drug use problems in this population.     

Retrospective review of amphotericin B use in a tertiary-care medical center

A retrospective review of amphotericin B use in a tertiary-care medical center was conducted, and use patterns were evaluated. The pharmacy department audited the medical records of all patients who received amphotericin B during 1983. Of 179 patients who received amphotericin B, the medical records of 140 patients were suitable for review. Amphotericin B use increased almost tenfold over a six-year period. Medical services used approximately two thirds of the total drug, while surgery used one fourth. Amphotericin B was used systemically in 98 patients and as a bladder irrigant in 42 patients. In a third of cases, the drug was used when a fungal infection was not documented. Daily dosages of less than 25 mg and total dosages of 500 mg were commonly administered. Amphotericin B was frequently administered with other antimicrobial agents in patients with serious underlying diseases; therefore, evaluation of its efficacy in all patients was difficult. Clinical nephrotoxicity was detected during treatment in approximately 15% of patients. Amphotericin B is no longer used exclusively for classical deep-seated mycoses; frequently, the drug is used as empiric treatment for candida and aspergillus infections. Amphotericin B use has risen because of the difficulty in diagnosing deep-seated mycoses and because of the frequent isolation of yeasts from seriously ill patients. Prospective studies are needed to guide clinicians in determining indications for amphotericin B use and the proper dosage and length of treatment for the drug.     

Recreational drug use concurrent with abuse or dependence on other psychoactive substances

In an effort to identify instances of the non-problematic use of a drug concurrent with the problematic use of one or more other drugs, we used structured interviews to obtain comprehensive drug use histories from 48 clients admitted to an intensive outpatient program. We classified clients on the basis of whether they demonstrated evidence of concurrent problematic and non-problematic drug use (Index and Probable Index cases) or only problematic drug use patterns (Non-Index cases). Both Index and Non-Index drug use patterns were about equally common in our sample. Both Index and Probable Index cases used a variety of drugs in a non-problematic manner and were generally congruent in their self-labelling of their drug use relative to their DSM-IV status for each drug used. We discuss several limitations of the study, including our reliance on retrospective, self-report data; potential problems with generalization to other populations; and possible changes in drug use patterns over time.     

住院肿瘤患者免疫调节药物处方点评应用实践

目的：建立科学化、标准化的肿瘤患者免疫调节药物处方点评模式,提高住院肿瘤患者免疫调节药物临床合理用药水平。方法：回顾性调查分析我院2012-2013年658份肿瘤患者住院医嘱,对其免疫调节药物的使用情况进行评价,归纳免疫调节药物评价指标和评价标准,建立免疫调节药物点评模式。结果：抽取的658份医嘱中,合格医嘱为495份,适应证及用法、用量适宜,合格率为75.2%;不合格医嘱为163份,多数为无适应证和超剂量使用,另有少部分为给药途径及稀释溶媒不适宜,不合格率为24.8%。结论：通过对住院肿瘤患者应用免疫调节药物的处方点评和分析,初步构建肿瘤辅助药物的评价体系。通过此体系的临床实践,使我院处方的不合格率明显降低。