老年多重用药患者处方精简效果的回顾性研究

目的:通过对北京某三级医院老年住院患者实施处方精简,为处方精简临床效果提供参考.方法:采用回顾性分析的方法,以2019年7-12月在该院老年内科住院的患者为研究对象.临床药师在日常工作中对老年患者进行医嘱审核、用药咨询,对不合理用药情况进行处方精简.根据是否接受处方精简药学服务,将患者分为精简组和对照组.评价患者住院期...     

居家药学服务在多重用药老年患者中效果的系统评价与Meta分析

目的:评价居家药学服务在多重用药老年患者中的效果.方法:采用Cochrane系统评价方法,以"多重用药"、"药师主导"和"老年患者"为检索词,检索Cochrane Library、PubMed、Web of Science数据库,对符合纳入标准的随机对照试验进行质量评价并提取有效信息进行Meta分析.结果:共纳入10项...     

老年患者用药分析

目的 了解老年患音的用药情况。方法 采用回顾性调查方法，查阅山东省千佛山医院2005年门诊处方，随机抽取11月中10d的处方共计12167张，对其中年龄≥60岁的处方进行统计分析．结果 老年患者处方数占总处方数的比例为36．2％；男性占59．3％，女性占40．7％：合并用药平均种数为2．6种；不合理用药处方占1．97％；用药类别排序前3位的是心血管药、降血糖药、抗菌药物，结论 该院老年患者就诊率高，其中以高血压、糖尿病就诊率为最；应注意老年患者处方用药的合理性。     

我院门诊老年患者用药分析

目的:分析2013年上半年笔者单位开具的门诊药房处方,探究老年患者的用药情况.方法:择取2013年1～6月我院门诊处方共3000张,将其与老年患者在临床上的用药情况结合进行分析.结果:结合处方开具情况与老年患者用药情况可知,老年患者在心脑血管药物、消化系统药物以及抗生素药物的使用上有较大的消耗量,联合用药不适宜的、用法用量不适宜的是普遍现象.结论:在临床用药上,老年患者存在不合理用药的问题,鉴于不同药物之间有着配伍禁忌,开具处方时需要格外注意药物搭配合理性.     

我院门诊老年患者公费用药的处方分析

目的：调查我院老年干部职工门诊保健治疗用药情况。方法：统计2006年1-6月份60岁以上的老年患者1 767人次,门诊2 700张处方的药物联用、高频用药、不合理用药及降压药的药物利用情况。结果：联合用药超过5种药物的用药人数占所查总人数的27.5%;使用频率最高的药品为作用于循环系统的药物和维生素类药物;降压药的使用基本符合低成本的药物治疗方案。结论：所统计患者药物应用情况基本符合我院老年门诊患者的用药特点,但也反映出了所存在着的不合理用药。为保证我院老干部的健康保健,需要我院医师和药师的共同努力。     

高龄老年患者潜在不适当用药处方精简干预效果的系统评价

目的系统评价处方精简对高龄老年患者潜在不适当用药(PIM)的干预效果。方法计算机检索PubMed、EMBase、The Cochrane Library(2019年5期)、CBM、中国知网(CNKI)、重庆维普(VIP)和万方数据库(Wanfang Data),检索自建库至2019年5月。搜集高龄老年患者PIM进行处方精简的随机对照试验,由2位研究人员独立进行文献筛选、数据提取和质量评价后,采用RevMan 5.3版软件进行Meta分析。结果共纳入12个随机对照试验,包括4 056例患者。Meta分析结果显示:与不进行处方精简比较,高龄老年患者进行处方精简后,并不能显著降低患者病死率[RR=1.09,95%CI(0.94,1.27),P=0.27],入院率[RR=0.89,95%CI(0.59,1.35),P=0.59]、PIM再次发生率[RR=0.57,95%CI(0.26,1.27),P=0.17],且差异无统计学意义(P>0.05);有效降低患者跌倒发生率[RR=0.82,95%CI(0.72,0.95),P=0.007],差异有统计学意义(P<0.05)。结论对高龄...     

对15000张老年患者处方中不合理用药的分析

目的 :了解当前老年患者的合理用药情况。方法 :对我院2000年1月～2001年12月15000余张老年住院患者处方中的不合理用药情况进行统计、分析。结果 :处方中存在诸多不合理用药现象。结论 :必须遵循一定的原则 ,才能保证老年患者安全、有效用药     

北京市22家医院老年失眠患者用药分析

目的:了解老年失眠患者的用药情况,更好的完成医疗保健工作,促进老年患者合理用药。方法:利用自行编制的统计软件,并用Excel 2010做后续的数据处理,分别对老年失眠患者的比例、老年失眠症患者用药总体情况和排名前5位的药品使用情况进行了统计分析。结果:诊断为失眠症的老年患者处方数27 945,占老年患者处方比例的13.29%,在老年人诊断疾病中排名第6位。BZRAs的使用量最大,处方占比58.49%。BZDs处方占比38.64%,non-BZDs处方占比19.85%。DDDs排名前5位的药品分别是艾司唑仑、佐匹克隆、唑吡坦、劳拉西泮和氯硝西泮,其中,PDD超过指南中成人推荐剂量的有佐匹克隆(8.07 mg vs 7.5 mg),唑吡坦(10.06 mg vs 10 mg)和氯硝西泮(5.51 mg vs 2~4 mg)。结论:老年患者失眠比例高但是就诊比例偏低。BZRAs是处方医师在治疗老年失眠患者时的首选用药,但是BZDs比non-BZDs使用率高与指南推荐不符。镇静催眠药物的使用剂量偏高。药师应积极关注老年失眠患者的用药情况,用药过程中需密切观察药物的不良反应,对患者进行相关的用药教育和生活方式指导,促进老年患者合理用药。     

门诊老年患者用药情况分析

目的:了解老年患者的用药特点。方法:对我院2000~2006年门诊老年患者的用药品种、患病状况、用药史及药品不良反应等进行回顾性分析。结果:心血管系统药不良反应发生率最高,神经系统药及皮肤系统药次之;8种及以上药物联用占11.74%,并随年龄的增长、疾病的增多而增多。结论:应重视老年患者安全、合理、有效用药。     

116例老年住院患者的用药分析和评价

目的对老年患者的病例资料分析,分析是否存在超说明书用药和潜在的不适当用药问题,为临床选择用药提供参考。方法回顾性收集我院老年内科116份65岁以上患者病例资料,借助药品说明书分析存在的超说明书用药问题,并以2012修订版Beers标准为参考,调查潜在的不适当用药。结果 116份病历中,超说明书用药64例,不符合Beers标准的潜在不适当用药56例。结论临床存在超说明书用药和潜在的不适当用药,临床药师应加强对医嘱的审核和用药合理性的评估。     

A narrative review of the safety concerns of deprescribing in older adults and strategies to mitigate potential harms

Introduction: As with prescribing or continuing medications, deprescribing brings with it the potential for harm as well as benefit. Uncertainty and avoidance of harm has been reported as a barrier to deprescribing in practice and may contribute to continuation of inappropriate medications.

Areas covered: This narrative review covers four main safety concerns/potential harms of deprescribing in older adults: adverse drug withdrawal events, return of medical condition(s), reversal of drug-drug interactions and damage to the doctor-patient relationship. These are discussed in relation to medications in general, with some examples of medication classes used to illustrate the potential safety concerns. The majority of these harms can be minimized or even prevented by using a patient-centered, structured deprescribing process with planning, tapering and close monitoring during, and after medication withdrawal.

Expert opinion: More research is needed into the safety concerns of deprescribing, however, avenues exist during drug development and post-marketing surveillance to gain knowledge on this topic. Questions remain about when it is suitable to discontinue certain medications/medication classes and there is uncertainty about the harms and benefits of both medication continuation and discontinuation in complex older adults.     

中枢神经系统疾病及其药物与蛋白质组学研究进展

阐述中枢神经系统疾病及其药物蛋白质组学研究的最新进展。蛋白质组学是后基因组时代的一门重要学科 ,是从整体水平对蛋白质进行综合分析 ,目前已广泛应用于临床和生物医学各个领域。蛋白质组学研究有助于阐明CNS疾病发生、发展、转归的网络机制 ,寻找疾病特异性蛋白质 ,针对疾病靶点定向合成药物 ,构建分子药理模型 ,高通量地筛选和评价药物的效应及毒副作用。可以预见 ,蛋白质组学将为CNS疾病的诊断、监测和药物研制起到不可估量的作用     

A systems approach to identifying the challenges of implementing deprescribing in older adults across different health-care settings and countries: a narrative review

ABSTRACT

Introduction: There is increasing recognition of the need for deprescribing of inappropriate medications in older adults. However, efforts to encourage implementation of deprescribing in clinical practice have resulted in mixed results across settings and countries.

Area covered: Searches were conducted in PubMed, Embase, and Google Scholar in June 2019. Reference lists, citation checking, and personal reference libraries were also utilized. Studies capturing the main challenges of, and opportunities for, implementing deprescribing into clinical practice across selected health-care settings internationally, and international deprescribing-orientated policies were included and summarized in this narrative review.

Expert opinion: Deprescribing intervention studies are inherently heterogeneous because of the complexity of interventions employed and often do not reflect the real-world. Further research investigating enhanced implementation of deprescribing into clinical practice and across health-care settings is required. Process evaluations in deprescribing intervention studies are needed to determine the contextual factors that are important to the translation of the interventions in the real-world. Deprescribing interventions may need to be individually tailored to target the unique barriers and opportunities to deprescribing in different clinical settings. Introduction of national policies to encourage deprescribing may be beneficial, but need to be evaluated to determine if there are any unintended consequences.     

Patient-targeted interventions for opioid deprescribing: An overview of systematic reviews

Background

Deprescribing (reduction or cessation) of prescribed opioids can be challenging for both patients and healthcare professionals.

Objective

To synthesize and evaluate evidence from systematic reviews examining the effectiveness and outcomes of patient-targeted opioid deprescribing interventions for all types of pain.

Methods

Systematic searches were conducted in five databases with results screened against predetermined inclusion/exclusion criteria. Primary outcomes were (i) reduction in opioid dose, reported as change in oral Morphine Equivalent Daily Dose (oMEDD) and (ii) success of opioid deprescribing, reported as the proportion of the sample for which opioid use declined. Secondary outcomes included pain severity, physical function, quality of life and adverse events. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Findings

Twelve reviews were eligible for inclusion. Interventions were heterogeneous in nature and included pharmacological (n = 4), physical (n = 3), procedural (n = 3), psychological or behavioural (n = 3) and mixed (n = 5) interventions. Multidisciplinary care programmes appeared to be the most effective intervention for opioid deprescribing; however, the certainty of evidence was low, with significant variability in opioid reduction across interventions.

Conclusions

Evidence is too uncertain to draw firm conclusions about specific populations who may derive the greatest benefit from opioid deprescribing, warranting further investigation.     

Valproate in the treatment of PTSD: systematic review and meta analysis

ABSTRACT

Objective: Anticonvulsants are used in clinical practice for the treatment of PTSD. However, a systematic investigation of their effects in the treatment of PTSD is currently lacking from the literature. Our aim is to review and appraise the evidence for the use of the anticonvulsant valproate for the treatment of PTSD.

Methods: We performed a systematic review and meta-analysis of the literature where valproate was used for the treatment of PTSD. Studies of treatment of PTSD with valproate were located using a search protocol which was applied to the electronic databases CINAHL, EMBASE, MEDLINE and PSYCHINFO. A search of the National PTSD Centre Pilots Database and of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) were also conducted.

Findings: We only found one single-blinded study, four open-label studies and three case reports. These data do not allow for robust conclusions because of the design of the studies which are of limited patient number and open to bias. However, the studies reported that valproate was generally effective for the treatment of symptoms of PTSD by reducing hyperarousal, improving irritability and anger outbursts and improving mood.

Conclusions: The limited evidence base suggests that valproate can be effective as a monotherapy for the treatment of both PTSD and mood symptoms. A double blind controlled study should be the next step to robustly study the efficacy of valproate on the treatment of PTSD.     

阿托伐他汀仿制药与原研药的有效性和安全性系统评价

目的 系统评价阿托伐他汀仿制药与原研药的有效性和安全性,为临床用药选择提供最新的循证参考.方法 计算机检索PubMed、Cochrane Library、Embase、中国知网、维普网、万方数据库,收集阿托伐他汀仿制药与原研药的干预性研究和观察性研究,检索时限均为数据库建库起至2021年4月.对符合纳入标准的研究进行资...     

Discontinued drugs in 2006: central and peripheral nervous system drugs

This perspective describes compounds that target the central and peripheral nervous system, whose development was discontinued in 2006 and which were being developed for the treatment of a range of neurological disorders, including chronic pain, Alzheimer's disease, Parkinson's disease, multiple sclerosis, epilepsy and anxiety. These discontinued candidates are described by disease area, based on information available from the Pharmaprojects database.     

比阿培南与美罗培南治疗细菌性感染疗效和安全性的系统评价

目的 系统评价比阿培南对比美罗培南治疗细菌性感染的有效性和安全性。方法 计算机检索Ovid EMBase、Pubmed、Cochrane Library、CNKI、CBM、VIP和WanFang Data，对纳入研究进行筛选，提取数据和评价偏倚风险后，采用Rev Man 5.3软件进行Meta分析。 结果 共纳入11个RCTs，包括1873例患者。Meta分析结果显示：在临床总有效率[OR=1.55, 95%CI(1.13, 2.13), P=0.007]，细菌清除率[OR=1.65, 95%CI(1.15, 2.38), P=0.007]和总体不良反应发生率[OR=0.67, 95%CI(0.48, 0.92), P=0.01]方面，比阿培南优于美罗培南，差异均具有统计学意义；但两组临床痊愈率[OR=1.24, 95%CI(1.00, 1.52), P=0.05]和不良事件发生率[OR=0.58, 95%CI(0.29, 1.16), P=0.13]无明显差异。漏斗图提示无明显发表偏倚。 结论 基于现有临床证据，与美罗培南相比，比阿培南能有效治疗细菌性感染，降低总体不良反应的发生，安全性更好。