Characteristics of pharmaceutical opinions written in a Quebec community pharmacy.

OBJECTIVE: To describe the characteristics of pharmaceutical opinions written in a community pharmacy and to estimate the possible effects of these opinions on patient drug profiles. DESIGN: Retrospective survey. SETTING: The community pharmacy where these opinions were written is located in a rural area of the province of Quebec. Only health-related items are sold and no merchandise is displayed in this pharmacy. PARTICIPANTS: Ten pharmacists worked at this pharmacy during the period of the study. INTERVENTION: Pharmacists were paid when they sent advice to a patient or a physician about the patient's drug profile or about the therapeutic value of a prescribed treatment. This survey included recommendations made from 1978 to 1983. A sample of 600 opinions was drawn at random from a total of 1992 opinions that had been written at the site of the study. MAIN OUTCOME MEASURE: The impact of each opinion was assessed by analyzing patient drug profiles for three months after the opinion was written to determine if the recipient had followed the pharmacist's recommendation. RESULTS: Pharmacists, on their own initiative, sent 97.9 percent of the opinions. Only 1.7 percent of the opinions were requested by patients and 0.4 percent by physicians. Most opinions were addressed to patients (86.7 percent) rather than to physicians (13.3 percent). Almost four of five recommendations sent to patients were about compliance (45.1 percent) or were suggestions for improving the therapeutic effect of a medication or replacing a drug with nondrug treatment (33.4 percent). The three most common recommendations sent to prescribers were to replace one drug with another (25 percent), to change the dose or dosing schedule of a drug (16.3 percent), and to discontinue drug treatment (16.3 percent). Chemical stability, underuse or overuse of a medication, and adverse effects were the most frequent causes of recommendations sent to patients. Adverse effects, interactions, and the underuse of a medication were the most frequent reasons for recommendations sent to physicians. The proportion of recommendations that were implemented was 77.7 percent for patients and 58.1 percent for physicians. CONCLUSIONS: The pharmaceutical opinion seemed to be a good means of communicating with patients and prescribers on a wide variety of problems encountered in a community pharmacy. It allowed pharmacists to be paid for their expertise even if a drug was not dispensed. Also, the pharmaceutical opinion could compensate for the loss of income when the pharmacist recommended replacing a prescribed medicine with nondrug treatment.     

技能训练对社区精神分裂症患者社会功能的影响

目的探讨社会技能训练程式对社区精神分裂症患者的社会功能的影响。方法将100例康复期精神分裂症患者纳入我院社区开放管理体系,随机分为观察组和对照组各50例,对照组进行常规的随访,观察组按照社会技能训练程式进行为期15周的训练。并于训练前后以及半年后随访时用简明精神病评定量表(BPRS)、Morningside康复状态量表(MRSS)和社会功能缺陷筛选量表(SDSS)评定所有患者精神症状和社会功能。结果实际完成94例,训练组48例,对照组46例,两组患者入组前BPRS、MRSS和SDSS评分差异无统计学意义(P<0.05),训练15周后,两组间BPRS(P<0.05)、MRSS和SDSS评分差异有统计学意义(P<0.01),训练结束半年后随访时,两组间BPRS、MRSS和SDSS评分差异进一步扩大。结论社会技能训练程式可以显著改善社区精神分裂症患者的精神症状,并使其尽可能地掌握健康生活知识,提高社交能力,改善社会功能。     

社区血脂异常病人非药物干预效果分析

[目的]探讨社区血脂异常病人非药物干预的方法及效果.[方法]应用健康教育、饮食和运动个性化量化指导,对112例血脂病人进行为期3个月的强化干预.[结果]干预后,病人血脂异常防治的知识水平、饮食评价、有效运动量及血清总胆固醇(TC)、三酰甘油(TG)和低密度脂蛋白(LDL-C)与干预前比较,差异有统计学意义.[结论]健康教育、饮食及运动量化干预,可有效提高干预对象对非药物干预的依从性,提升血脂异常病人自我管理能力,有效降低病人血脂水平.     

心理护理程序对神经症患者失眠症状的影响

目的:探讨心理护理程序对神经症患者失眠症状的影响.方法:将46例伴失眠症状的神经症患者随机分为观察组24例和对照组22例,两组均实施常规治疗护理,观察组在此基础上采用心理护理程序进行护理.治疗前后分别对两组进行睡眠质量评价,并进行比较.结果:观察组平均住院时间短于对照组,两组比较有极显著性差异(P<0.01);两组入院3周PSQI评分与入院1周比较均有极显著性差异(P<0.01),入院3周时两组PSQI评分比较有显著性差异(P<0.05).结论:实施临床心理护理程序对减轻焦虑、调整睡眠、改善患者生活质量有积极意义.     

From oncology pharmacy to pharmaceutical care: new contributions to multidisciplinary cancer care

In recent years a paradigm shift towards a patient-focused rather than a disease-focused approach occurred in many health care systems. The pharmacy profession experienced an accordant development. The traditional drug-oriented services expanded towards patient-oriented services. In oncology, pharmacists established central services for compounding of cytotoxic drugs and offered therapeutic drug monitoring for critical substances. Pharmaceutical care concepts are now being introduced to optimize individual drug therapy. Pharmaceutical care aims at improving safety and therapeutic outcomes and consequently, the patients quality of life. These objectives imply a close relationship to supportive care. To achieve this, a multidisciplinary approach seems to be beneficial.Presented as an invited lecture at the 15th International Symposium Supportive Care in Cancer, Berlin, Germany, June 18–21, 2003     

脂代谢异常对腹膜透析超滤衰竭的影响

目的探讨血脂异常对腹膜透析患者超滤衰竭的影响.方法随机选取124例规律腹膜透析12个月以上的患者,测定患者的白蛋白(ALb)、血红蛋白(Hb)、总胆固醇(T-Ch)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、尿素氮(BUN)、肌酐(Cr)、血糖(Glu)水平,计算残肾功能,记录透析龄,根据患者血脂结果分为血脂异常组和血脂正常组,比较2组腹膜透析超滤衰竭的发生率,并以超滤衰竭与否分组,比较2组的血脂水平、肾功能、Glu、ALB、Hb的差异;结果血脂异常组腹膜透析超滤衰竭的发生率明显高于血脂正常组(P=0.008);超滤衰竭组的透析龄长于超滤正常组(t=7.93,P=0.000);超滤衰竭组的收缩压和舒张压明显高于超滤正常组(t收缩压=7.360,P收缩压=0.000,t舒张压=4.51,P舒张压=0.000);超滤衰竭组的T-Ch、TG水平明显高于超滤衰竭正常组(tT-Ch=3.450,PT-Ch=0.001;tTG=6.760,PTG=0.000),而HDL-C水平明显低于超滤正常组(t=-7.53,P=0.000);血脂异常组低转运水平发生率明显高于血脂正常组(P=0.021);多因素分析显示透析龄长、低水平的HDL为腹膜透析超滤衰竭发生的独立危险因素(P透析龄长=0.034、P低水平的HDL=0.048)结论①腹膜透析患者血脂异常是超滤衰竭发生的原因之一,血脂异常患者腹膜透析超滤衰竭的发生与高TG、T-Ch水平、低HDL-C水平有关;②血脂异常患者腹膜透析超滤衰竭可能是通过降低腹膜转运能力而发生的;③透析龄长、低水平的HDL为腹膜透析超滤衰竭发生的独立危险因素。     

护理程序和Haddon模式在社区儿童意外伤害护理中的运用

儿童意外伤害已经被国际学术外确认为21世纪重要的健康问题。减少意外伤害的发生，减轻伤害的影响是社区护理工作者的重要工作内容。但是影响儿童意外伤害发生、发展和结局的因素是多方面、不确定的。如何才能在社区对儿童意外伤害做到全面、有效的护理，真正达到减少发生、减轻影响的日的．这是社区护理工作的难题。护理程序指导和规范护理工作，Haddon模式则概括意外伤害护理的各个方面，两者结合能达到提高护理质量的目的。     

护理程序和Haddon模式在社区儿童意外伤害护理中的运用

儿童意外伤害已经被国际学术界确认为21世纪重要的健康问题.减少意外伤害的发生,减轻伤害的影响是社区护理工作者的重要工作内容.但是影响儿童意外伤害发生、发展和结局的因素是多方面、不确定的.如何才能在社区对儿童意外伤害做到全面、有效的护理,真正达到减少发生、减轻影响的目的,这是社区护理工作的难题.护理程序指导和规范护理工作,Haddon模式则概括意外伤害护理的各个方面,两者结合能达到提高护理质量的目的.现将护理程序和Haddon模式运用于社区儿童意外伤害护理中,应用情况如下.……     

Impact of a two-arm educational program for improving diabetes care in primary care centres

Improvement of the quality of diabetes care is essential for reducing diabetes complications. Nevertheless, compliance with diabetes clinical practice recommendations is inadequate in primary care. The aim of this study was to assess the impact of diabetes education, when directed simultaneously to both diabetes care providers and patients, on the frequency of performance of relevant laboratory tests and improvement of metabolic control. A three-step educational program was applied at 45 community clinics of a health-managed organisation comprising 175 health care providers and 16,275 diabetic patients. At the end of a 2-year period, the proportion of diabetic patients with HbA1c tested at least once a year rose from 60 to 85%. The percentage of patients with HbA1c <7% rose from 38 to 50%, whereas the percentage with HbA1c >8.5% decreased from 27 to 19%. The number of patients visiting an eye clinic at least once yearly rose from 55 to 65% and of those undergoing microalbumin testing from 27 to 37%. There was a 20% increase in the number of patients with low-density lipoprotein cholesterol measurements. Our study demonstrates the efficacy of diabetes education when directed simultaneously to health care providers and diabetic patients. The improvement in quality of care induced by such intervention can translate into better metabolic control and, ultimately, the prevention of diabetes complications.     

Pharmaceutical care in community pharmacy: practice and research in the Netherlands

OBJECTIVE: To describe the pharmaceutical care activities and research in community pharmacy in the Netherlands. FINDINGS: Pharmaceutical care is well advanced in Dutch pharmacy practice. This is largely due to the fact that clinical pharmacy was already an integrated part of community pharmacy practice by the end of the 1980s. Activities of the International Pharmaceutical Federation (FIP), some wholesale companies, and influential individuals in the Netherlands stimulated universities and the Royal Society for the Advancement of Pharmacy to advance the implementation of pharmaceutical care. DISCUSSION: Not all pharmacies in the Netherlands provide pharmaceutical care at the same level, although medication surveillance (concurrent and prospective medication analysis) is part of everyday practice. Implementation of quality assurance systems in community pharmacy practice could be helpful in assuring high levels of care. Similar to those in other countries, Dutch pharmacists are torn between the wish to provide pharmaceutical care and economic considerations, although the financial status of most pharmacies is still (very) healthy. New entrants into the market, such as supermarket and pharmacy chains, seem to put little emphasis on care provision. CONCLUSIONS: Pharmaceutical care has been implemented in many Dutch community pharmacies, but not everywhere to the same extent. Due to excellent automated medication surveillance; structured, high-quality medication counseling; and the fact that patients usually visit the same pharmacy, Dutch patients are well protected against many drug-related problems.     

血脂异常社区健康教育的研究进展

介绍了血脂异常的研究进展,包括血脂异常流行病学、血脂异常与心血管病的相关研究、防治目标及治疗方法;对血脂异常社区健康教育的研究进展及血脂异常社区健康教育的展望与不足进行综述.     

心理护理程序在神经症病人心理护理中的应用研究

[目的]探讨心理护理程序在神经症病人心理护理中的效果,完善神经症病人的心理护理模式.[方法]将85例神经症病人随机分为干预组(44例)和对照组(41例),对照组采用普通的心理护理模式,干预组根据护理评估,采用程序化的心理护理模式,对两组病人焦虑评分、护理的满意度、疾病知识、心理要求评分进行比较.[结果]干预组焦虑水平、护理的满意度、疾病知识均显著优于对照组.[结论]神经症病人经心理护理程序护理能有效提高心理护理的效果.