Outcome Analysis of a Pharmacist-Managed Anticoagulation Service

The primary objective of this study was to determine if a pharmacist-managed anticoagulation monitoring service (AMS) improved the outcomes of patients receiving warfarin in a family practice setting and was cost effective in treating and preventing thromboembolic disorders. A retrospective chart review was performed on all patients at the University of Florida's Family Practice Residency Program who received warfarin pharmacotherapy between October 1, 1988, and December 15, 1993. The outcomes of patients followed by AMS were compared with those of a control group consisting of patients receiving warfarin but followed only by their physician. Outcomes were evaluated based on the number of thromboembolic and hemorrhagic events, as well as unplanned clinic visits, emergency room visits, and hospital admissions. Cost of hospital admissions, emergency room visits, and participation in the AMS were analyzed. During 28 person-years of treatment, control subjects sustained 12 thromboembolic events (2 pulmonary embolisms, 1 cerebrovascular accident, and 9 deep venous thromboses) and 2 minor and 5 major hemorrhagic events. The study group reported two minor hemorrhagic events during a total of 60 person-years. The control group was 20 times more likely than the study group to experience any event (rate ratio 20, 95% CI 5–87). In addition, hospitalization and emergency room charges indicated an actual cost of $119,074.95 for the control group's events. The cost to this group for 28 person-years of participation in the AMS would have been $5040.00. A potential cost avoidance of $4072.68 per person-year of follow-up may have been possible if these patients had been followed by the AMS. A pharmacist-managed AMS in a family practice setting can result in improved outcomes for patients receiving warfarin and is cost effective.     

抗凝门诊模式的建立和展望

目的:探索抗凝门诊模式的建立和优化。方法:结合阜外医院特点构建抗凝门诊运行模式,汇总分析中国医学科学院阜外心血管病医院建立抗凝门诊的就诊量、抗凝达标率、过度抗凝率。结果:从2014年12月初至2015年7月底,阜外医院抗凝门诊月就诊量逐月递增,总就诊量为1 259人次,总体INR达标率为57.8%,INR>3比率为6.6%。结论:抗凝门诊模式的建立缓解了临床医师负担,为抗凝药物管理开辟了一条更加方便、安全的道路。     

Anti-inflammatory activity of some Saudi Arabian medicinal plants

Five plants which have been used for the treatment of rheumatism, arthritis and gout in the traditional medicine of Saudi Arabia, were evaluated for their anti-inflammatory properties. Of these the ethanolic extract of Capparis decidua and the aqueous extract of Capparis spinosa were found to possess significant anti-inflammatory activity against carrageenan induced oedema in rats. These two plants were also tested for their antipyretic and analgesic activity. C. decidua was found to possess significant antipyretic effect. Both of them are devoid of analgesic activity.     

Comparison of Two Methods for INR Determination in a Pharmacist-Based Oral Anticoagulation Clinic

Warfarin is a commonly used oral anticoagulant that is usually initiated after the definitive diagnosis of a certain thromboembolic disorder or disease. Warfarin therapy will usually be prescribed for 6–12 weeks or more, and some patients may continue therapy throughout life, depending on the type of thromboembolic disorder. Major problems associated with warfarin therapy include adverse effects such as bleeding complications and drug-drug or drug-food interactions. In addition, thromboembolic complications may occur due to subtherapeutic dosages of warfarin. The laboratory reference standards for monitoring warfarin therapy are the prothrombin time (PT) and the International Normalized Ratio (INR). While both the PT or INR will reflect the clinical response in the patient, results reported as INR values have been shown to be more accurate than those reported as PT values. Thirty-two patients were enrolled in this study. Our objectives were to compare INR values measured by both the Coumatrak and conventional laboratory method, and to demonstrate the effects of pharmacist intervention on managing patients receiving warfarin therapy. Results from our study reveal that INR monitoring by Coumatrak is similar to the conventional laboratory method. In addition, our study indicates that patients receiving warfarin therapy can be monitored and managed effectively by pharmacists.     

Impact of Point-of-Care Implementation in Pharmacist-Run Anticoagulation Clinics Within a Community-Owned Health System: A Two-Year Retrospective Analysis

Background:

Point-of-care (POC) testing devices allow laboratory monitoring to be performed in various settings and accessed immediately.

Objective:

To evaluate the outcomes of monitoring anticoagulation patients in pharmacistmanaged, multicenter clinics utilizing i-STAT POC machines.

Methods:

This study was a retrospective, multicenter chart review of 150 patients before and after implementation of the POC intervention for anticoagulation monitoring. Data collected included international normalized ratio (INR) results, indication for warfarin, minor and major bleeds, thromboembolic events, emergency room (ER) visits, and hospitalizations before and after i-STAT POC implementation.

Results:

The time in therapeutic INR range (TTR) was significantly higher after i-STAT POC implementation than before implementation (60.4% ± 21.2% and 52.5% ± 21.5%, respectively; P = .0001). There were no reports of major bleeding during the study period. Twenty-three minor bleeds were reported after i-STAT POC implementation compared to 19 events before implementation (P < .0001). One thromboembolic event was reported after i-STAT POC implementation. There was a significant difference in the number of hospitalizations before i-STAT POC implementation as opposed to after implementation (2 and 0, respectively; P < .0001). There was also a significant increase in ER visits after i-STAT POC implementation (P < .0001).

Conclusion:

The results of the study indicate improvement in TTR in pharmacist-managed anticoagulation clinics by 7.8%. Although the use of the i-STAT POC machine detected an increase in minor bleeds, thromboembolic events, and ER visits, there was a decrease in hospitalization. The outcomes of this multicenter study indicate that implementation on this scale provides improvement in regard to safety and cost.     

护理健康教育在发热门诊中的实施与效果评价

目的探究在发热门诊中应用护理健康教育的具体措施以及临床效果。方法选自2012年1月至12月发热门诊收治的患者共100例,对其临床治疗以回顾性的方法进行分析,对比患者接受护理健康教育之后对于发热的相关知识以及护理行为掌握程度。结果患者接受护理健康教育后对于发热的相关知识以及护理行为相对于护理健康教育之前有明显优越性,二者对比具有统计学意义P<0.05。结论在发热门诊中开展护理健康教育工作能够让患者更好的掌握发热知识,具有重要的临床意义。     

抗凝门诊临床药师管理的抗凝效果评价

目的:评价抗凝门诊临床药师管理的抗凝效果。方法:回顾性分析2019年8月-2020年1月南京鼓楼医院(以下简称"我院")抗凝门诊就诊的481例患者的病历资料,记录其基本信息(性别、年龄、患者分级)、使用的抗凝药物、抗凝原因、抗凝相关检查结果[凝血酶原时间、国际标准化比值(INR)等]、华法林剂量、新型口服抗凝药物(NOACs)使用情况及不良反应发生情况等。结果:481例患者于我院抗凝门诊就诊共1 587例次。患者分级分别为一级401例次、二级547例次、三级639例次。470例患者服用华法林,11例服用NOACs(包括6例利伐沙班、5例达比加群酯)。瓣膜置换术为抗凝的主要原因(65.28%),其次为心房颤动(14.97%)、瓣环修复术(12.47%)。凝血酶原时间检测方法以即时检测设备检测为主(83.44%)。三级患者华法林日平均剂量为(3.03±1.28)mg。使用华法林患者的平均INR为1.99±0.56,INR在目标范围内的时间百分比(TTR)为72.79%,其中一级患者平均INR为2.12±0.84、TTR为44.33%,二级患者平均INR为1.95±0.52、TTR为72.3...     

Perceptions regarding antimicrobial use and resistance among adult hospital patients in Saudi Arabian Ministry of Health (MOH) hospitals

BackgroundEducation, a key strategy within antimicrobial stewardship programmes (ASPs), has been mainly directed towards healthcare professionals and prescribers more than hospitalised patients.AimTo examine patients’ knowledge and perceptions of antibiotic use and resistance, while evaluating the institutional role of patient education on antibiotic use in two Saudi Arabian hospitals, one with an implemented ASP and one without an ASP.MethodA cross-sectional self-administered survey was developed and piloted. A total of 400 surveys were distributed, 200 within the hospital with an ASP and another 200 within the hospital without an ASP. Data were coded and analysed. Ethical approval was obtained before the start of the study.Findings176 patients responded to the survey with 150 surveys completed and analysed. 78% of patients agreed that they should only take an antibiotic when prescribed by the doctor, however they still tended to keep left over antibiotics for future use. 84% of patients were unaware ‘antibiotic resistance’, with 48% believing that antibiotics help them get better quicker when they had a ‘cold’. Information on antibiotic use and resistance were provided to patients in the hospital with an ASP in contrast to the hospital without an ASP.ConclusionOverall there are poor perceptions regarding antibiotic use and resistance among hospital patients in Saudi Arabia. Patients in the hospital with ASP demonstrated greater knowledge during their hospitalisation. ASPs should not only focus on educating healthcare professionals but should involve the patients and seize the opportunity to educate them while hospitalised.     

Measuring Outcomes in a Health Service Addiction Clinic

The aim of the study was to identify a method for the routine monitoring of outcomes in a busy city centre health service addiction clinic. The setting for the study was a health service addiction clinic serving a population of seven hundred and fifty thousand people. Study participants were two hundred and thirty consecutive attenders for treatment of alcohol and heroin dependence and misuse. A brief interview to obtain demographic and use data and a short battery of self completion questionnaires measuring dependence, psychological health and social satisfaction were administered at three data collection points. Different methods of follow-up were explored. The instruments used were capable of measuring change in levels of consumption, degrees of dependence, psychological health and social satisfaction over a three month period in over sixty-five per cent of the original sample while over eighty per cent of the original sample were accounted for. It was concluded that routine monitoring of outcomes of a busy National Health Service can provide meaningful clinical data for an acceptable sample of patients within a realistic resource limit.     

运用PCNE分类系统处理抗凝门诊中的药物相关问题

探讨欧洲药学监护联盟(PCNE)分类系统在抗凝门诊药物相关问题(DRPs)中的作用。采用PCNE分类系统9.0版对抗凝门诊每一个病例进行药学监护,分析其中的DRPs,并且对存在的DRPs进行系统而标准的分析、归类及干预,实现连贯的药学监护模式。PCNE可提高临床药师在抗凝门诊药学监护中的效率,实现药学监护模式的精准化与标准化。     

Steady state pharmacokinetics of propranolol in Saudi Arabian patients and comparison with data for different populations

The steady state pharmacokinetics of propranolol was examined in 48 Saudi Arabian patients chronically treated with oral doses [mean (SEM) = 85.8 (5) mg] of this drug. The mean (SEM) of the steady state concentration (Css) per mg/kg daily dose was 21.8 (3.1) ng.ml-1/mg.kg-1. A 6-fold variability in Css was observed between patients treated with 40 mg every 8 hours and 14-fold between patients treated with 40 mg twice daily. The frequency distribution of the apparent oral clearance (TCLor) of propranolol was bimodal with 88% of the patients showing TCLor of 18 to 372 l.hr-1 while the remainder had TCLor of 471 to 749 l.hr-1. The mean (SEM) of the TCLor per kg body weight for all 48 patients was 3.16 (0.38) l.hr-1.kg-1. Both Css and TCLor obtained for Saudi Arabian patients are not significantly different from those reported for subjects from Western populations. While Css increased proportionally (P less than .001) with dosing, a near-significant (P less than .06), inverse, linear relationship was found between age and TCLor. No significant effect of sex, body weight, or disease state (i.e., heart diseases, hypertension, depression, migraine) on Css or TCLor was detected.     

心脏瓣膜置换术后抗凝治疗的健康宣教

目的研究对机械瓣膜置换术后患者进行健康宣教的目的、内容、方法。方法对施行心脏瓣膜置换术的71例患者进行健康宣教,着重进行抗凝指导。结果71例患者术后均用华法林终身抗凝,因服用华法林并发出血2例,均为消化道出血。结论心脏瓣膜置换术后要加强健康宣教,着重加强抗凝治疗的必要性、方法及出院后复查凝血酶原时间等。     

优质护理服务在健康管理中心的应用

目的探讨分析优质护理服务在健康管理中心的应用效果。方法对健康管理中心实施优质的护理服务,再对来我院受检的体检人员做调查问卷,对实施优质护理服务前后满意度做对比,得出优质护理服务在健康管理中心的应用的价值。结果在健康中心实施优质护理服务后,取得了可观的效果,如受检人群对中心环境设施与安全的满意度为90%、导检人员工作态度的满意度为95%、护理工作人员服务态度与质量的满意度为96%、各功能科室检查与候诊时间89%、检后服务的满意度为96%等都与实施优质护理服务前相比具有明显的统计学差异(P<0.05)。结论健康中心实施并推广优质化的护理服务后,不仅提高了中心的护理服务质量,还提升了受检人员满意度,增加了医院的经济效益和社会效益。所以健康管理中心应该提倡与推广优质护理服务。