Strategies for Pharmacists in the Implementation of Diabetes Mellitus Management Programs

Pharmacists are in an ideal position to assess, monitor and treat adherence-related problems that can adversely affect patients’ health outcomes. To accomplish these goals, pharmacists must accept the responsibilities and challenges of a primary care provider. They also must assume an interdisciplinary role in collaborative drug therapy management. Strategies to monitor and improve adherence are key components of pharmaceutical care plans, especially for patients with chronic diseases, such as hypertension, diabetes mellitus and atherosclerotic heart disease.This article gives an overview of guidelines, recommendations, current practices and related issues in the management of patients with diabetes mellitus. It also reviews the behavioral and social factors that influence adherence to therapeutic and lifestyle regimens, and highlights special needs in selected high-risk populations. Finally, best practice strategies that could serve as appropriate models for pharmaceutical care services are discussed.The overall goal is to enhance pharmacists’ professional abilities to coordinate pharmaceutical care services targeted for major modifiable behavioral and biological risk factors. Pharmacists can overcome their apprehension about undertaking a primary care role in diabetes management through adequate preparation (including training and certification). The primary care functions that have been evaluated to date in the care of patients with diabetes mellitus by pharmacists show successful patient outcomes in terms of cost, quality of life and reduction of complications.     

New Approaches to Management of Bleeding Disorders

In many patients, topical hemostatics, antifibrinolytics, and coagulation factor stimulators can eliminate or markedly reduce the need for blood product transfusions—with their attendant hazards and costs. Desmopressin has the added advantage of minimal side effects and a broad range of applications in both hemostatically normal and impaired patients.     

特困人口医疗救助有关管理问题探讨

世界银行贷款“综合性妇幼卫生保健项目”在改善贫困地区妇幼卫生服务提供能力的同时，积极地推动和开展了旨在提高贫困家庭孕产妇和５岁以下儿童公平享受基本妇幼卫生保健服务的“医疗救助计划”。文章对该计划在试点中有关扶贫对象的确定和费用控制两方面的管理问题以及如何进一步加强管理，提高效率和效果进行了初步的分析和探讨。     

New Opportunities for the Management and Therapy of Hepatitis C in Correctional Settings

Hepatitis C in prison populations is now a major public health problem, and large numbers of correctional facilities have no comprehensive management program, often because of formidable projected costs and tightening budget constraints. The North Dakota Department of Corrections and Rehabilitation has operated a management and therapy program since 2002 using consensus interferon and ribavirin with 45% cost savings. The program has provided excellent sustained viral responses: 54.2% for genotype 1 hepatitis C, 75% for genotypes 2 and 3, and 63.6% overall.DETECTION AND MANAGEMENT of hepatitis C in the US prison population is a major public health problem, as evidenced by the estimate that more than one third¹ of the approximately 5 400 000 people in the United States with active hepatitis C enter correctional facilities yearly.² In North Dakota (population 642 000), the true incidence and prevalence of hepatitis C is not known; however, 25% of all positive antibody tests for hepatitis C reported yearly by the North Dakota Department of Health originate from the North Dakota Department of Corrections and Rehabilitation (ND DOCR).In spite of guidelines published by the Federal Bureau of Prisons in 2005,³ state correctional facilities have only begun to formulate comprehensive management policies,^4,5 a task now complicated by shrinking correctional budgets. Prisons offer an ideal setting for the treatment of hepatitis C^6,7 because maximum compliance, which is necessary for achieving a sustained viral response, can be assured. Limited information is available on the outcome of correctional screening and treatment programs,⁴ most of which now use pegylated interferon and weight-based ribavirin. There is limited published data on the use of consensus interferon combined with ribavirin despite its lower cost and theoretical advantages. Studies exist that suggest the usefulness of this product in noncorrectional settings,^8–10 but, to our knowledge, ours is the first report of consensus interferon combined with weight-based ribavirin for the treatment of hepatitis C in a US prison system.Type 1 α-interferons (IFNs) are mostly made up of proteins containing 166 amino acids with 14 subtypes, all of which have antiproliferative and antiviral activities. Analysis of the subtypes has revealed a high degree of conservation for amino acids in certain positions. Minor amino acid changes result in major changes in binding affinity to cellular receptors; receptor affinity is directly correlated with biologic potency. A synthetic type 1 α-IFN has been manufactured with the most common amino acids at each position for the 14 subtypes, resulting in a protein having the highest binding affinity of all α-IFN molecules. The biopotency of this “consensus interferon,”¹¹ which is also known as IFN alfacon-1, is 10-fold higher than that of all the natural variants.¹² Its use in the treatment of hepatitis C has been limited by failure of attempts to prolong the half-life in vivo.The 2 commercial interferons, PegIFNα-2a and PegIFNα-2b, now commonly used for hepatitis C therapy differ by only 1 amino acid. The significant difference is the configuration and weight of the polyethylene glycol polymers attached (by a process called pegylation) to the active interferon, which prolong the half-life. The pegylation process results in a 60% to 90% loss in the biologic activity of IFN, evidenced by comparison of the dosing of the pegylated products (150–180 μg weekly) with the dosing of the nonpegylated products (15 μg 3 times a week).     

灾害性突发事件急救对医疗设备器材综合管理的探讨

灾害性突发事件中病员的救治不同于常规的医疗救治．有其自身的特点。通过对2002年9月14日发生在南京汤山镇“毒鼠强”中毒抢救过程中设备器材所发挥的作用,系统阐述了灾害性突发事件性质和救治方案的确定．抢救过程中应急预案制订．对设备器材管理的要求及医疗设备管理技术人员的素质要求。它的探讨对医疗设备器材在灾害性突发事件中的作用有了更明确的定义。     

PDCA循环改进在急救仪器管理中的应用

目的：研究分析在急救仪器管理中运用PDCA循环管理方式的效果。方法：本院自2019年5月开始对科室内30台急救仪器实施PDCA循环改进,将实施前30台急救仪器设备管理效果和实施后30台急救仪器设备管理效果进行对比,将实施前后仪器设备完好率、仪器放置规范率、使用记录完整率、仪器准备时间、环境整理时间和仪器维护保养时间使用统计学软件进行处理和分析。结果：比较发现,改进后的仪器设备完好率、仪器放置规范率和使用记录完整率高于改进前,差异有统计学意义（P<0.05）;改进后仪器准备时间及环境准备时间小于改进前,差异有统计学意义（P<0.05）;改进前后仪器维护保养时间没有统计学意义（P>0.05）。结论：在急救仪器管理中运用PDCA循环的模式,能够有效提高仪器的使用规范,保证仪器设备的完整性,在对患者进行急救的时候能够快速进行使用,提高了急救工作的效率。     

Opportunities for the transfer of astronomical technology to medicine

There are many examples of technology transfer from astronomy to medicine, for example algorithms for reconstructing X-ray CT images were first developed for processing radio astronomy images. In more recent times, X-ray detectors developed for the Hubble Space Telescope have been used in a fine-needle breast biopsy system. Software originally developed to mosaic planetary images has been incorporated into a system for detecting breast cancer. Australia has expertise in the development of instrumentation for producing radio images from an array of radio telescopes and in multi-object fibre systems for capturing the spectra of hundreds of stellar objects simultaneously. Two possible applications of these Australian technologies are suggested that may merit further exploration. A meeting between interested parties is suggested to discuss future directions and funding.     

Child Neglect in the Family Context: Challenges and Opportunities for Management in Pediatric Settings

Pediatric populations who have experienced deficient parental care are at significant risk for various psychological and health problems. Practitioners' abilities to institute effective assessments and interventions for these children and their families are limited by the difficulties of defining child neglect, lack of reliable and valid assessment methods, and limited empirical data concerning intervention, especially prevention. Research and practice for neglected children and their families would be enhanced by developing methods to identify and describe deficient care using clear guidelines and normative standards, conceptual models to guide assessment and intervention, new models of intervention involving partnerships between hospital and community-based agencies. and advocacy for services and research.     

Child Neglect in the Family Context: Challenges and Opportunities for Management in Pediatric Settings

Pediatric populations who have experienced deficient parental care are at significant risk for various psychological and health problems. Practitioners' abilities to institute effective assessments and interventions for these children and their families are limited by the difficulties of defining child neglect, lack of reliable and valid assessment methods, and limited empirical data concerning intervention, especially prevention. Research and practice for neglected children and their families would be enhanced by developing methods to identify and describe deficient care using clear guidelines and normative standards, conceptual models to guide assessment and intervention, new models of intervention involving partnerships between hospital and community-based agencies. and advocacy for services and research.     

Opportunities for Improving Post-Hospital Home Medication Management Among Older Adults

SUMMARY

Effective post-hospital home medication management among older adults is a convoluted, error-prone process. Older adults, whose complex medication regimens are often changed at hospital discharge, are susceptible to medication-related problems (e.g., Adverse Drug Events or ADEs) as they resume responsibility for managing their medications at home. Human error theory frames the discussion of multi-faceted, interacting factors including care system functions, like discharge medication teaching that contribute to post-hospital ADEs. The taxonomy and causes of post-hospital ADEs and related risk factors are reviewed, as we describe in high-risk older adults a population that may benefit from targeted interventions. Potential solutions and future research possibilities highlight the importance of interdisciplinary teams, involvement of clinical pharmacists, use of transitional care models, and improved use of informational technologies.     

The Management of Esophageal Motility Disorders

Until now, management has remained heavily dependent on physical measures to stretch smooth muscle by dilation or surgical myotomy. Pharmacologic treatment has played a secondary but significant role—one that may well be enhanced by renewed interest in the anticholinergics and the utilization of the calcium channel blockers. New treatment strategies are evolving.