创伤截瘫患者创伤后成长的自我管理教育和护理干预

目的探究自我管理教育对创伤后截瘫患者创伤后成长的作用。方法遵循促进创伤后成长的途径和体验,医护人员将自我管理教育纳入48例创伤后截瘫患者康复期全过程。结果通过在患者入院后、住院期、出院前、出院后进行自我管理教育,提高了患者疾病相关知识水平,有效改善了自我心理卫生状况和健康相关生活质量,调动了康复积极性和主动性,促进了创伤后成长。结论自我管理教育的护理干预模式能够促进创伤后截瘫患者的创伤后成长。     

COPD患者初级护理保健中自我健康护理教育的作用

目的探究自我健康护理教育在COPD患者初级护理保健中的作用。方法截取我院2012年1月至2012年12月共80例COPD患者,按随机数字表分为观察组及对照组,两组患者均予以COPD常规化治疗及护理,观察组在此基础上额外进行COPD自我健康护理教育,对比两组患者间临床资料差异性。结果观察组COPD知识问卷得分明显高于对照组(P<0.05),SGRQ问卷得分明显低于对照组(P<0.05),观察组对COPD的认识明显高于对照组,生活质量得到明显提高;观察组戒烟成功率明显高于对照组(P<0.05)。结论对COPD患者进行自我健康护理教育,可以增强患者对疾病的认识,改正不良生活习惯,提高患者的生活质量,促进患者早日康复。     

骨肉瘤患者应用异环磷酰胺致心脏毒性的药学监护

目的 通过临床药师对1例骨肉瘤患者异环磷酰胺引起心脏毒性患者药学监护的过程,探讨药师在临床治疗中发挥的作用.方法 针对具体病例,协助医师为患者制定有效的治疗方案,为患者建立药历,关注患者用药期间出现的不良反应,提出合理的药学监护措施及健康教育计划.结果 临床药师为患者实施药学监护,提高药物治疗效果,患者病情平稳.结论 临床药师参与临床药物治疗,可使用药更规范合理.     

Paradigm for the management of patient outcomes

Health-status measurement is discussed, and a paradigm for the management of patient outcomes is described and applied to a patient case. Challenged not only to eradicate disease but to improve health, today's health-care professionals must examine the structure, process, and outcomes of care to ensure that optimal care is provided. Techniques for measuring outcomes have been developed; important indicators are functional status, general well-being, and the patient's assessment of care. An interdisciplinary team of physicians, social scientists, and public policy experts at The Health Institute, New England Medical Center, Boston, Massachusetts, studies ways of monitoring and improving the quality and efficiency of care. The team, which now includes a pharmacist, is working to develop practical systems of care whose outcomes can be tested in patients at the medical center. The paradigm developed for the management of patient outcomes begins with evaluation based on results of history, physical examination, and diagnostic tests. Problems and goals (therapeutic endpoints) are then defined, and the safest, most effective, and least costly treatment is selected. Treatment is monitored for subjective and objective results and adjusted as necessary. The achievement of each endpoint contributes to improvement of the patient's health. Knowledge of health-status measurement will enable pharmacists to increase their contribution to patients' health.     

Consortium recommendations for advancing pharmacists' patient care services and collaborative practice agreements

ObjectiveTo develop consensus recommendations that provide principles and strategies for effectively implementing health care system changes, including an optimized role for pharmacists to engage in team-based, patient-centered care.Data sourcesAn interdisciplinary group of stakeholders representing 12 states and 10 pharmacy practice settings. Consortium participants represented many areas of pharmacy, medicine, and nursing.SummaryThe health care environment in the United States is undergoing unprecedented change, with myriad health care reform initiatives, mounting evidence for the positive contributions of pharmacists, and federal government interest in pharmacist-provided services from the Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, and Surgeon General. Many individuals and groups have asserted that pharmacists are a dramatically underused resource that could help improve outcomes within our health care delivery system, if properly engaged as essential members of the health care team. In January 2012, the American Pharmacists Association Foundation convened a roundtable consortium in Washington, DC, for dialogue on the role of pharmacists in patient care. The consortium participants' seven recommendations for advancing pharmacists' patient care services and collaborative practice agreements included (1) use of consistent terminology; (2) provider control over collaborative practice details; (3) infrastructure that embeds pharmacists' patient care services and collaborative practice agreements into care; (4) use of electronic health records and technology in patient care services; (5) relationships among the health care team that are strong, trusting, and mutually beneficial; (6) incentive alignments based on meaningful process and outcome measures; and (7) redesign of health professionals' practice acts, education curriculums, and operational policies.ConclusionPharmacists deliver many patient care services to sustain and improve health. In an era of health care reform, advancing the level and scope of pharmacy practice holds promise to improve health and reduce costs for care. Published evidence supports the role of pharmacists as essential members of the interdisciplinary health care team and emphasizes that pharmacists are well positioned to perform medication- and wellness-related interventions that improve patient outcomes. The consortium participants' seven recommendations provide methods and infrastructure for empowering collaborative, interdisciplinary care.     

Designing solutions for securing patient privacy--meeting the demands of health care in the 21st century.

OBJECTIVES: To define the issues surrounding patient privacy, examine the political context in which debate is taking place, and present a novel technology model for addressing privacy, confidentiality, and security in 21st century health care. SUMMARY: The discussion of privacy addresses one of the basic issues in health care today--the tension between the needs of the individual patient for privacy and confidentiality and the needs of society to effectively manage health care practices and control health care costs. Patient concerns for privacy, confidentiality, and security are legitimate, and can usually be reduced to issues that potentially affect an individual's employment, ability to get and maintain health coverage, and have control over his or her records and care. These concerns, combined with several precipitating events, are forcing the issue of privacy into the political arena, where new health policy decisions will be made. The debate must be framed within a principle-centered approach that focuses on boundaries, security, consumer control, accountability, and public responsibility. A global, distributed electronic health record management model that provides location-independent, secured, authenticated access to relevant patient care records by qualified health care professionals on a need-to-know basis provides solutions. Information asset considerations should be designed to equitably represent the ownership needs of corporate entities, society, and the individual. CONCLUSION: A secure electronic health record structure that systematically ensures a high level of accountability combined with thoughtful dialogue among key stakeholders in the public policy development process can offer the privacy outcomes we seek.     

Mandatory medication content in the curricula of six health care personnel types with patient contact in Denmark

Medication use is a complex process involving different types of health care personnel. This study investigated and compared mandatory medication content in the curricula of six types of health care personnel with patient contact. Using content analysis, three independent raters analysed the mandatory medication content for physicians, pharmacists, pharmaconomists, nurses, health care assistants and support workers in the Capital Region of Denmark. Three dimensions were analysed as follows: communication with patients about medication, medication use or pharmacology and medication formulation and production. ECTS credits were totalled for courses analysed to have high or medium content, and inter‐rater reliability was tested with Fleiss’ kappa. The total mandatory medication content for pharmacists was 197.0 ECTS, physicians 136.0 ECTS, pharmaconomists 123.3 ECTS, nurses 52.0 ECTS, health care assistants 17.8 ECTS and support workers 0.0 ECTS. Communication with patients about medication was included to the greatest extent in the educations of pharmaconomists (112.0 ECTS), pharmacists (37.5 ECTS) and physicians (25.0 ECTS). Knowledge about medication use and pharmacology was taught primarily to pharmacists (146.5 ECTS), physicians (123.6 ECTS) and pharmaconomists (89.8 ECTS) and to a lesser extent nurses (52.0 ECTS), health care assistants (17.8 ECTS) and support workers (0.0 ECTS). Medication formulation and production were taught only to pharmacists (93.0 ECTS) and pharmaconomists (25.1 ECTS). Mapping the basic competencies about medication taught to each of the six health care personnel types can lead to a better understanding of how they can complement each other in patient care. The study points to weaknesses in medication curriculum content for health care personnel with the most patient contact.     

Reality check: the patient perspective

No discussion of the topic of oncology chemotherapy quality improvement is complete without the patient as the focus of health care provider efforts. To explore the patients' perspective in their wellness quest, we present an interview with a patient who was diagnosed with lymphoma and received autologous stem cell and allogenic bone marrow transplants. As health care providers, let us never forget that advances in the science of medicine will ultimately be judged by their lasting effects, either positive or negative, on real people.     

慢性阻塞性肺疾病患者的综合护理干预

目的：探讨慢性阻塞性肺疾病（COPD）患者的护理干预效果。方法：将126例COPD患者随机分为对照组和观察组各63例,对照组仅给予一般护理措施,观察组在对照组的基础上给予综合护理干预措施。结果：观察组并发症发生率、住院天数明显低于对照组（P〈0.05）,观察组患者对护理工作的满意度、健康知识掌握情况明显高于对照组（P〈0.05）。结论：COPD在保证护理质量前提下实施综合护理干预可以降低并发症的发生,减少住院天数,提高患者的满意度。     

A pharmacoeconomic evaluation of clozapine in one patient

Sandoz Canada Inc. began distributing clozapine in Canada under the Clozaril Support and Assistance Network (CSAN) in 1990. The costs associated with the required compliance to the CSAN program has prompted much debate regarding the ethical and clinical considerations in selecting patients to receive clozapine therapy. We undertook a one year cost-comparison analysis of clozapine therapy by assessing total mental health care costs for a patient with an extensive hospitalization history who was prescribed clozapine. Average yearly hospitalization costs were $17,413. The average yearly cost associated with clozapine therapy for this patient, with no hospital admissions was $8,411. The total health care cost for the year following initiation of clozapine was $17,828, compared to a cost of $68,423 in the year prior to clozapine, or $27,754 in an estimated average year. This case is representative of costs savings that can be achieved by using clozapine and breaking the institution-dependency of many schizophrenic patients.     

Clinical pharmacy interventions: an optimum way to accomplish positive patient care outcome

In this age of demand for optimum quality of care and shortened length of patient stay in the hospital, the opportunities for clinical pharmacy interventions are enormous. Pharmacists, with their unique background in clinical therapeutics, can make a significant difference in patient outcome. As in our case, initially there may be some skepticism among some of the physicians about the intent of pharmacy interventions. However, pharmacists' continual striving for improvement of quality of care can persuade skeptical physicians to consider pharmacists as their allies in achieving optimum quality of care. At our institution, our consistent approach has resulted in support from our physicians. Continuous feedback from managers to staff pharmacists (our monthly performance review feedback program) also helps to continue consistency of the program. The recent focus of the Joint Commission on optimum quality of care has also created an arena of tremendous opportunities for pharmacists to work with the physicians and other health care professionals to accomplish excellence in quality of care.     

Rational use of psychoactive drugs in the geriatric patient

It is impossible in an article such as this to present every aspect of psychopharmacology for the geriatric patient. Pharmacists occupy a unique position in the health care system that enables them to monitor and provide input into the pharmacotherapy of the elderly. The reader is encouraged to maintain competency in this important area of practice. Only by diligent attention to the problems experienced by the geriatric patient can we produce a framework of knowledge upon which to make rational therapeutic decisions.     

Importance of direct patient care in advanced pharmacy practice experiences

The Accreditation Council for Pharmacy Education issued revised standards (Standards 2007) for professional programs leading to the Doctor of Pharmacy degree in July 2007. The new standards require colleges and schools of pharmacy to provide pharmacy practice experiences that include direct interaction with diverse patient populations. These experiences are to take place in multiple practice environments (e.g., community, ambulatory care, acute care medicine, specialized practice areas) and must include face-to-face interactions between students and patients, and students and health care providers. In 2009, the American College of Clinical Pharmacy (ACCP) identified concerns among their members that training for some students during the fourth year of pharmacy curriculums are essentially observational experiences rather than encounters where students actively participate in direct patient care activities. These ACCP members also stated that there is a need to identify effective mechanisms for preceptors to balance patient care responsibilities with students' educational needs in order to fully prepare graduates for contemporary, patient-centered practice. The 2010 ACCP Educational Affairs Committee was charged to provide recommendations to more effectively foster the integration of pharmacy students into direct patient care activities during advanced pharmacy practice experiences (APPEs). In this commentary, the benefits to key stakeholders (pharmacy students, APPE preceptors, clerkship sites, health care institutions, academic pharmacy programs) of this approach are reviewed. Recommendations for implementation of direct patient care experiences are also provided, together with discussion of the practical issues associated with delivery of effective APPE. Examples of ambulatory care and acute care APPE models that successfully integrate pharmacy students into the delivery of direct patient care are described. Enabling students to engage in high-quality patient care experiences and to assume responsibility for drug therapy outcomes is achievable in a variety of practice settings. In our opinion, such an approach is mandatory if contemporary pharmacy education is to be successful in producing a skilled workforce capable of affecting drug therapy outcomes.     

Stimulating improved patient care: the Joint Commission's Agent for change

Agenda for Change development and testing work now underway will lead to implementation over the next several years of improved accreditation tools: standards focused on key governance, managerial, clinical, and support activities essential to achieving good outcomes; a national database of performance indicators that helps the Joint Commission and accredited organizations monitor and improve patient care and outcomes; survey methods that better assess the organization's engagement in continuous improvement of key processes; and accreditation reports and decisions that are more informative, more balanced, and more helpful in stimulating organizational change. Creating these tools will promote more effective collaboration between the Joint Commission and health care providers in service of the mutual goal of enhancing patient care quality. Successful implementation of quality improvement ideas and methods by all health care professionals is the major challenge for the 1990s.     

心脏瓣膜置换术后患者的出院健康教育

目的探讨心脏瓣膜置换术后患者的出院健康教育的效果。方法通过对21例患者出院后进行个体针对性的实施健康知识教育,使患者掌握自我护理保健的意识,提高生存质量,重点健康教育是生活护理、心理护理、抗凝药物的正确使用方法及副作用的观察。结果21例患者掌握了自我护理能力、抗凝药物的正确使用方法及副作用的观察方法、及时就诊,未发生死亡病例。结论出院健康教育是患者恢复健康的指南,通过对患者进行针对性出院健康教育,提高患者自我保健和自我护理能力,预防术后远期并发症发生,保证康复质量意义重大。     

社区护理干预对糖尿病患者遵医依从性的影响评价

目的 探讨社区护理干预对糖尿病患者遵医依从性的影响.方法 对社区268例糖尿病患者实施为期6个月的社区护理干预,评价干预前后患者遵医依从性的变化.结果 干预后,患者的遵医依从性、生活习惯改善率、健康知识认知率均明显高于干预前,差异有统计学意义（P＜0.05）.结论 有效的社区护理干预可改善糖尿病患者的遵医依从性、不良生活习惯,提高治疗和护理效果.     

人文护理在骨结核患者中的应用

目的探讨人文护理在骨结核患者中的应用。方法分析本院收治的骨结核患者76例,按照护理方法不同分为对照组36例,给予常规护理;治疗组40例,给予人文护理。人文护理内容包括健康教育、心理护理、入院指导、药物护理、疼痛护理、预防并发症护理等。比较两组患者的遵医行为。结果治疗组与对照组的遵医率分别为90.0%（36/40）、75.0%（27/36）,两组间比较,差异有统计学意义（P〈0.05）。结论人文护理应用在骨结核患者中可以提高患者的遵医行为,值得临床推广应用。     

Using the patient activation measure during a pharmacist-led rural patient home visit pilot project

BackgroundMany pharmacists use motivational interviewing as a tool to inspire patients to engage in managing their health. Assessing patient engagement and willingness to actively participate in chronic disease management is a necessary component in improving activation and health outcomes. The patient activation measure (PAM) is a validated assessment tool used to give providers insight into a patient’s level of confidence, knowledge, and skills in self-managing their health. In 2017, 2 pharmacists conducted patient home visits using care coordinators to identify patients who would benefit from pharmacist intervention. The PAM-13 was integrated into the pharmacist-led home visits to collect information on patient activation and engagement in addressing their own health problems.ObjectivesTo describe the implementation of the PAM-13 in pharmacist-led patient home visits and to analyze the collected patient PAM-13 scores and levels to determine whether change occurred after meeting with a pharmacist.MethodsThe PAM was used as part of a pilot program involving pharmacist-led patient home visits to assess drug-related problems within a cohort of high-risk rural patients with uncontrolled chronic conditions.ResultsDuring this 6-month study, PAM-13 scores decreased in 3 patients, increased in 9 patients, and did not change in 2 patients whereas PAM-13 levels decreased in 2 patients, increased in 7 patients, and did not change for 5 patients.ConclusionPAM-13 was used as part of a pilot program involving pharmacist-led patient home visits with a cohort of high-risk rural patients with uncontrolled hypertension and diabetes. PAM-13 is a useful tool that could help pharmacists provide targeted motivational interviewing and medication management by assessing and improving patient activation and engagement.