肾移植术后妇女妊娠期的药物治疗

肾移植后的女性生育能力通常会恢复,但肾移植术后的妊娠期妇女出现妊娠并发症的风险增加,而有些肾移植术后用药可能会受妊娠影响需要调整剂量,甚至某些肾移植术后用药可能会影响胎儿,增加胎儿早产、致畸等不良结局的风险。本文针对肾移植术后妊娠期妇女免疫抑制剂的选择以及妊娠并发症药物治疗的合理应用进行综述,以期对该类人群的临床用药提供参考。     

纳洛酮治疗老年多发脑梗死性痴呆的疗效观察

目的 研究多发脑梗死性痴呆患者使用纳洛酮治疗的临床效果.方法 临床纳入86例本院2013年8月至2014年8月期间收治的多发脑梗死性痴呆患者,按随机数字表法分为两组,各43例.其中43例患者使用常规治疗作为对照组,另43例患者在常规治疗基础上使用纳洛酮进行治疗作为观察组.观察两组患者脑缺血及生活质量情况等.结果 治疗前,观察组Hachinski评分、ADL评分以及HDS-R评分与对照组比较差异无统计学意义,P＞0.05;治疗后观察组Hachinski评分、ADL评分以及HDS-R评分明显优于对照组,P＜0.05.结论 多发脑梗死性痴呆患者采用纳洛酮进行治疗效果显著,明显改善脑缺血情况,提高患者生活质量,值得临床应用及推广.     

Survival analysis and prognosis for dementia patients

How long a dementia patient is cared for in the home before admission to a nursing home depends on the state of the patient and the state of the caregiver. Using 5-year follow-up data, the times until entry to nursing home and until death are modeled using a Cox survival model in which patient and caregiver variables at entry to study as well as changes in these variables over the following 12 months are the regression variables. Treatment variables quantify the effects of a caregiver training program. Statistical methods used in fitting the Cox survival model and consequent predictions of survival rates are discussed.     

高血压患者的药物重整服务与药学监护

目的探讨药师参与药物重整服务的工作模式及其在防范用药差错中的作用与实践。方法对我院心内科收治的400例高血压患者实施药物重整服务,建立药师参与药物重整服务的工作模式,分析此期间发现的常见问题及其在防范用药差错中的作用与实践。结果初步建立了药师参与药物重整服务的工作模式。药物重整服务可减少重复用药、漏服药物、药物选择不适宜、用法用量不适宜、给药时间不适宜、停药时间不适宜、药物相互作用等现象。结论药物重整服务在减少用药差错中具有重要作用,为药师参与临床治疗提供了一个新的突破口。     

出院患者床旁用药教育模式的研究与实践

目的:通过对冠状动脉粥样硬化性心脏病患者开展用药教育实践,探讨如何优化临床药师在出院患者教育过程中的流程和工作模式。方法:临床药师对2016年6―8月在首都医科大学附属北京安贞医院心内科住院的冠状动脉粥样硬化性心脏病患者使用传统用药教育模板制作用药教育材料并进行用药教育;2016年9―12月期间出院的心内科冠心病患者采用新模式制作用药教育材料并进行用药教育。结果:2016年6―8月共对12名患者进行出院带药教育,2016年9―12月共对58名冠心病患者进行出院教育。结论:应用Excel标准化患者教育清单程序可大幅度提高临床药师工作效率,从而提高药物治疗的安全性和有效性,并提高患者对药师服务的满意度。也为建立标准化的出院带药流程提供参考。     

Medication review: whose job it is?

Pharmacists are able to identify pharmaceutical care issues (PCIs) and resolve them better than normal care GPs, if trained, supported and given similar time, are also able to identify and resolve PCIs Nurses trained in identifying medication‐related problems are able to identify some PCIs Given limited availability of pharmacist time, training of GPs and nurses in reviewing medication should be considered A proportion of patients prefer to have GP reviews, therefore GP training in this area would be of benefit     

Antipsychotic drugs and cerebrovascular events in elderly patients with dementia: a systematic review

Recently, Canadian, US and European health regulatory agencies issued warnings about an increased risk of stroke and death in elderly patients with dementia receiving atypical antipsychotics. Assessing both randomised and non-randomised evidence, this systematic review found conflicting findings, particularly for risperidone. More research is needed to better inform clinical practice.     

Short dementia questionnaire for assessing the severity of cognitive impairment in patients with dementia

This paper describes the Short Dementia Questionnaire (SDQ), a psychometric test that provides an initial assessment of the severity of cognitive impairment in patients with dementia. This test requires minimal effort on the part of the assessor and places little strain on the patient. For several years now, a preliminary form of the test has been used for large-scale screening of dementia patients in nursing homes within clinical drug trials. This test is short, inexpensive and largely standardized in regard to implementation, even without the usual intensive training. This paper focuses in particular on the structure and implementation of the test. The item and scale parameters relevant for the evaluation of its field of application are presented, and finally, the results of an initial validation study are reported. These results show that the test procedure is a good predictor of severity scores in frequently used, more extensive tests for grading the severity of dementia. (c) 2001 Prous Science. All rights reserved.     

Medication use review process and information systems utilized for oncology chemotherapy quality improvement

Fatal chemotherapy overdoses at prestigious institutions have prompted extensive reviews of policies and procedures in medical centers throughout the country. Improving medication use systems for chemotherapy requires a comprehensive multidisciplinary approach. A process to develop a medical center policy on chemotherapy based on the medication use model adopted by the Joint Commission on Accreditation of Healthcare Organizations will be discussed. This will include the prescribing, preparing, dispensing, administering, and monitoring process as well as quality improvement systems. Pharmacy information systems enhancements that safeguard patients are also discussed including maximum dose checks and specific dosing algorithms for bone marrow transplant patients.     

Medication review of community-dwelling seniors using intensified home-care service

Investigations on medication burden, falling, and inappropriate dosing in renal impairment have been obtained in patients living in nursing homes. Data from home-dwelling patients in intensified ambulatory care, especially from Germany are scant. Material and method: We evaluated patients daily visited by an ambulatory care service (Cohort 1, n = 102, median age 80 y) or had care given by relatives only (cohort 2, n = 101, median age 76 y) at baseline (V1), 6 (V2) and 12 months (V3). Results: At V1 patients in Cohort 1 had 5 (median, range 3 - 15) and at V3 6 (3 - 17) medications. No differences could be observed between cohorts regarding number and pattern of medications. At V1, 30/102 patients of Cohort 1 had creatinine measured within the last 6 months, 13/30 patients had an eGFR < 50 ml/min. 6/34 medications which need dose-adjustment were unadjusted. Low surveillance of renal function and unadjusted dosing were also observed at other visits and also in Cohort 2. Within 1 year, 29/75 mobile patients in cohort 1 had a fall, 18/29 patients had a benzodiazepine prescribed regularly, whereas a benzodiazepine was prescribed in 6/46 patients which did not fall (chi2 p = 0.004). In Cohort 2, the number of falling patients was lower (19/84 mobile patients, p = 0.028). 11/19 patients had a benzodiazepine prescribed, in contrast to 5/65 patients which did not fall (chi2 p = 0.001). Conclusions: It needs to be elucidated whether a care service can contribute to medication safety in patients e.g. by reviewing medication charts and organizing for controls of ancillary laboratory values.     

发作性睡病的药物治疗

发作性睡病(narcolepsy)以难以控制的嗜睡、发作性猝倒、睡瘫、入睡幻觉及夜间睡眠紊乱为主要临床特点。发作性睡病(narcolepsy) 以难以控制的嗜睡、发作性猝倒、睡瘫、入睡幻觉及夜间睡眠紊乱为主要临床特点。临床电生理检     

糖尿病合并类鼻疽败血症用药分析

目的探讨临床药师在糖尿病合并类鼻疽败血症患者治疗中发挥的作用,促进临床合理用药。方法临床药师参与1例糖尿病合并类鼻疽败血症患者抗菌治疗方案选择、血糖管理等,提出用药建议,并实施全程药学监护。结果临床药师对此例糖尿病合并类鼻疽败血症患者的抗菌及降血糖治疗进行相应的药学监护。结论临床药师通过特殊病例学习协助医师制订了合理化的治疗方案,提高了临床治疗的效果。     

Risperidone for control of agitation in dementia patients.

Currently available research on the use of risperidone to manage agitation in patients with dementia is discussed. Dementia affects up to 70% of nursing-home patients, and more than 90% of them exhibit aggressive or agitated behavior or severe depression. Agitation includes combativeness, hyperactivity, disinhibition, wandering, and restlessness. Environmental interventions are preferred for mild symptoms; medications are the treatment of choice for severe manifestations. Traditional neuroleptics have been the mainstay of treatment for agitated behavior in persons with dementia, but these agents have limited efficacy and are associated with high rates of adverse effects, including worsening of already poor cognitive functioning. Although the literature on the use of risperidone in elderly patients with dementia consists largely of uncontrolled trials, case reports, and chart reviews, it appears that this agent is effective for managing agitation in this population and does so with a low frequency of extrapyramidal symptoms (EPS). Risperidone may also be useful for treating acute agitation in patients with a high risk of EPS and for long-term treatment of "sundowning" (agitation and confusion starting in the late afternoon and worsening at night). A low initial dosage that is gradually adjusted upward is recommended. Risperidone appears effective in controlling agitation in patients with dementia and has a relatively benign adverse-effect profile, but more clinical trials are needed to elucidate its role for this indication.