正确掌握老年病人的合理用药

老年人随着年龄的不断增长，各器官功能的逐渐减退，对药物的吸收、分布、代谢、排泄及其作用与青年人相比都有很大差异，又由于体弱多病，用药种类较多，药物的不良反应也随之增加。老年病人用药必须严格遵照药物的体内过程及药物代谢动力学理论，结合患者的生理、病理条件，合理使用药物，以取得最佳的疗效。正确掌握合理有效的用药，要结合老年人年高、体弱、多病的特点，选择最佳剂量、时间，合理的配伍和用药方法。既要考虑药物有效性、合理性和安全性，又要权衡药物疗效、配伍禁忌。临床医师必需要以对病人健康极端负责的精神，精通业务，通晓药理及有关知识，慎重、准确地使用药物，尽量避免药物不良反应的产生。确保老年病人的用药安全和疗效。     

老年患者用药指导

我国是世界上实际老年人最多的国家，人口老龄化问题越来越突出。老年人因病住院逐渐上升，老年人护理及住院安全问题已成为今后护理工作中面临的主要问题之一。随着年龄的增长，老年人生理机能发生退行性变化，引发机体总体功能障碍。思维混乱、记忆力减弱、行动迟缓、感觉迟钝、视力下     

老年人的合理用药

老年人不仅患病率高，而且往往同时患有多种疾病，应用各类药物时，药物的吸收、分布、代谢和排泄可直接影响着组织特别是靶器官中药物的浓度及有效药物浓度维持的时间，从而影响药物的疗效和药物不良反应的发生。因此，在制定老年人的用药方案时，应考虑其药代动力学的特点，因人施药，以其达到最佳的疗效和最少的不良反应。     

老年病人发生药物不良反应影响因素及护理对策

[目的]了解老年病人发生药物不良反应（ADR）的影响因素。[方法]对635例老年病人进行了ADR相关因素问卷调查。[结果]635例老年病人中发生ADR者413例，发生率为65．04％。服药品种、服药数量越多，ADR发生率越高；遵医行为越差。药理知识缺乏者，ADR发生率越高。[结论]重视对老年病人的用药指导、提高老年病人的遵医行为可减少ADR发生率。     

老年人合理用药

老年人由于身体主要器官功能逐渐衰退 ,对药物的吸收、代谢、排泄与中青年人有很大不同。此外 ,老年人又往往同时患有几种疾病 ,治疗用药种类较多 ,因而药物不良反应较中青年人明显增多。一旦发生药物不良反应 ,由于肝、肾、心、肺、脑等主要器官代偿功能显著减退以及其他因素 ,老年人往往出现病情发展迅速 ,造成严重后果。因此 ,老年人合理用药已成为现代老年医学中的一个重要组成部分。1老年人药代动力学特点1.1药物吸收　以下 5种因素影响老年人口服药物的吸收 :1.1.1胃酸减少　老年人因胃黏膜萎缩而致胃酸的分泌减少。胃酸减少直接影响…     

正确指导病人合理应用药物

随着改革开放纵深发展，市场经济的今天各地药品大超市不断涌现，加上公费医疗制度改革普遍实行医保。因此，许多患者都纷纷往药品超市自主购药然而存在用药不合理的现象。因此，医院里的医生及药剂工作者要加强宣传，患者最好在医院购药，在医生指导下用药，即使要在药超市购药也要正确指导合理应用，使用时应该注意如下问题。     

儿科用药特点与儿科合理用药

由于小儿尤其是新生儿的生理特点、患儿用药的依从性、市场对儿科专用药物剂型的开发程度不够、不适当的广告宣传等方面的原因,造成目前儿科用药复杂化的局面,出现了一些不合理用药,如经验性或臆断性用药太多,适应证过宽或失控,药物品种选择失当,用药方法不当等.目前在临床中,儿科用药安全性的缺乏越来越引起人们的关注.     

如何指导老年人临床合理用药

随着国民经济稳步增长，人民物质生活不断提高，老年人群体数量不断增加。如何提高老年人生存质量和健康水平。正确指导临床合理用药，最大限度地提高药物治疗效果，最大限度地降低药物不良反应，达到预期治疗目的已成为医药工作者的工作目标和研究对象。在此，我谈自己的一些认识。     

老年病人发生药物不良反应影响因素及护理对策

目的了解老年病人发生药物不良反应(ADR)的影响因素。方法对635例老年病人进行了ADR相关因素问卷调查。结果635例老年病人中发生ADR者413例,发生率为65.04%。服药品种、服药数量越多,ADR发生率越高;遵医行为越差,药理知识缺乏者,ADR发生率越高。结论重视对老年病人的用药指导、提高老年病人的遵医行为可减少ADR发生率。     

用循证医学指导临床合理用药

当前 ,在临床上如何合理用药的问题一直是专业人士和公众关注的热点。一方面由于经济因素的掺杂使这个原本属于业务技术方面的问题更加复杂 ;另一方面 ,随着医药学科的快速发展 ,临床用药的可选择性范围不断扩大 ,也更加复杂 ,临床医生面对大量的药物信息 ,往往难以对用药方案及时做出正确选择和判断 ,以至于药物滥用或错用等情况屡见不鲜。那么 ,在当前医药快速发展条件下 ,临床用药是否有章可循呢 ?答案是肯定的。这种解决临床合理用药中存在的技术性问题的最佳指导性原则就是循证医学[1 3] 。1　临床用药当“用证”循证医学 ,系指在医学…     

Patient Safety: A Curriculum for Teaching Patient Safety in Emergency Medicine

The last decade has witnessed a growing awareness of medical error and the inadequacies of our health care delivery systems. The Harvard Practice Study and subsequent Institute of Medicine Reports brought national attention to long-overlooked problems with health care quality and patient safety. The Committee on Quality of Health Care in America challenged professional societies to develop curriculums on patient safety and adopt patient safety teaching into their training and certification requirements. The Patient Safety Task Force of the Society for Academic Emergency Medicine (SAEM) was charged with that mission. The curriculum presented here offers an approach to teaching patient safety in emergency medicine.     

乙肝患者家庭护理指导

阐述连对乙肝患者的家庭护理方法。提出了对乙肝患者出院前进行康复护理教育,出院后进行通联指导和巡访指导等措施。实践证明,良好的家庭护理可控制乙肝患者的病情发展和降低复发率,是达到预期康复目标的重要保证。     

Patient Disclosure about Herb and Supplement Use among Adults in the US

Analyses of 2002 National Health Interview supplement on complementary and alternative medicine (NHI%AM) indicate that approximately 38 million adults in the US (18.9% of the population) used natural herbs or supplements in the preceding 12 months, but only one-third told their physician about this use. The objectives of this study are: (i) to determine subpopulation rates of patient–physician communication about herbal product and natural supplement use and (ii) to identify the relative influence of patient factors and interaction factors associated with patient-physician communication about herb and supplement use. Logistic secondary analysis was done by using the complementary and alternative medicine supplement of the 2002 National Health Interview Survey. Subjects were a random stratified sample of US adults who used herbs in the past 12 months (n = 5196) and self-reported rates of disclosure to physicians about herb and supplement use. Results show that disclosure rates were significantly lower for males, younger adults, racial and ethnic minorities and less intensive users of medical care. Across subpopulations, disclosure was the exception rather than the norm. Given the potential risks of delayed or inappropriate treatment and adverse drug reactions and interactions, physicians should be aware of herb and supplement use and counsel patients on the potential risks and benefits of these treatments.     

An Educator''s Guide to Teaching Emergency Medicine to Medical Students

There is a need for every medical school graduate to handle emergencies as they arise in the daily practice of medicine. Emergency medicine (EM) educators are in a unique position to provide students with basic life support skills, guidance in assessing the undifferentiated patient, and exposure to the specialty of EM during all years of medical school. Emergency physicians can become involved in a variety of education experiences that can supplement the preclinical curriculum and provide access to our specialty at an early stage. A well-designed course in the senior year allows students to develop critical thinking and patient management skills that are necessary for any medical career path. It can ensure that all medical students are exposed to the skills essential for evaluating and stabilizing the acutely ill patient. To implement this type of course, learning objectives and evaluation methods must be set when the curriculum is developed. An effective course combines didactic and clinical components that draw on the strengths of the teaching institution and faculty of the department. A structured clerkship orientation session and system for feedback to students are essential in nurturing the development of student learners. This article provides an approach to assist the medical student clerkship director in planning and implementing EM education experiences for students at all levels of training, with an emphasis on the senior-year rotation.     

A Systematic Review of Patient Tracking Systems for Use in the Pediatric Emergency Department

Background

Patient safety is of great importance in the pediatric emergency department (PED). The combination of acutely and critically ill patients and high patient volumes creates a need for systems to support physicians in making accurate and timely diagnoses. Electronic patient tracking systems can potentially improve PED safety by reducing overcrowding and enhancing security.

Objectives

To enhance our understanding of current electronic tracking technologies, how they are implemented in a clinical setting, and resulting effect on patient care outcomes including patient safety.

Methods

Nine databases were searched. Two independent reviewers identified articles that contained reference to patient tracking technologies in pediatrics or emergency medicine. Quantitative studies were assessed independently for methodological strength by two reviewers using an external assessment tool.

Results

Of 2292 initial articles, 22 were deemed relevant. Seventeen were qualitative, and the remaining five quantitative articles were assessed as being methodologically weak. Existing patient tracking systems in the ED included: infant monitoring/abduction prevention; barcode identification; radiofrequency identification (RFID)- or infrared (IR)-based patient tracking. Twenty articles supported the use of tracking technology to enhance patient safety or improve efficiency. One article failed to support the use of IR patient sensors due to study design flaws.

Conclusions

Support exists for the use of barcode-, IR-, and RFID-based patient tracking systems to improve ED patient safety and efficiency. A lack of methodologically strong studies indicates a need for further evidence-based support for the implementation of patient tracking technology in a clinical or research setting.     

Nurses' Attitudes to the Use of Alternative Medicine in Cancer Patients

This study reports results from a questionnaire study on nurses' attitudes to and experiences with alternative medicine, especially related to cancer patients' use of alternative medicine. Sixty nurses from a department of oncology and haematology participated in the study. The response rate was 62%. The nurses primarily perceived the use of alternative medicine as an individual choice which the nurses wanted to support. Sixty-three percent of the nurses indicated that alternative medicine could be useful in the treatment of cancer patients, 32% would sometimes suggest alternative medicine to the patients, and 20% used alternative medicine in their nursing. One-third of the nurses had experienced conflict in connection with alternative medicine and their patients, mostly when established treatment was delayed or refused in favour of alternative medicine. Fifty-three percent of the nurses had tried alternative medicine themselves. This study reveals that nurses are in an ambiguous and complex situation: they are simultaneously professionals in the established health care system, caregivers supporting the patients, and individuals using alternative medicine.     

The Eight Cs: A Guide to Success in an International Emergency Medicine Educational Collaboration

The Tuscan Emergency Medicine Initiative (TEMI) is a comprehensive emergency medicine (EM) training program designed to build an EM training infrastructure in Tuscany, Italy. The program has successfully trained a team of instructors using a train-the-trainers model, certified 350 physicians who are already practicing in emergency departments (EDs), and established a master's program as a bridge to specialty training at the region's three universities. Using lessons learned from this program, the authors identify eight factors (The Eight Cs) that can serve as a guide to implementing a collaborative EM program in other environments: collaboration , context, culture , credibility , consulting , consistency , critique , and conclusion . Each of these topics is described in detail and may be useful to other international interventions.     

Patient adherence to treatment: three decades of research. A comprehensive review

Low compliance to prescribed medical interventions is an ever present and complex problem, especially for patients with a chronic illness. With increasing numbers of medications shown to do more good than harm when taken as prescibed, low compliance is a major problem in health care. Relevant studies were retrieved through comprehensive searches of different database systems to enable a thorough assessment of the major issues in compliance to prescribed medical interventions. The term compliance is the main term used in this review because the majority of papers reviewed used this term. Three decades have passed since the first workshop on compliance research. It is timely to pause and to reflect on the accumulated knowledge. The enormous amount of quantitative research undertaken is of variable methodological quality, with no gold standard for the measurement of compliance and it is often not clear which type of non-compliance is being studied. Many authors do not even feel the need to define adherence. Often absent in the research on compliance is the patient, although the concordance model points at the importance of the patient's agreement and harmony in the doctor-patient relationship. The backbone of the concordance model is the patient as a decision maker and a cornerstone is professional empathy. Recently, some qualitative research has identified important issues such as the quality of the doctor-patient relationship and patient health beliefs in this context. Because non-compliance remains a major health problem, more high quality studies are needed to assess these aspects and systematic reviews/meta-analyses are required to study the effects of compliance in enhancing the effects of interventions.     

The Use of Health Care Policy to Facilitate Evidence-based Knowledge Translation in Emergency Medicine

Health care policy can facilitate emergency medicine knowledge translation (KT). Because of this, the 2007 Academic Emergency Medicine Consensus Conference on KT identified a specific theme regarding issues of health care policy and KT. Six months before the Consensus Conference, international experts in the area were invited to communicate on health care policies regarding all areas of KT via e-mail and "Google groups." From this communication, and using available evidence, specific recommendations and research questions were developed. At the Consensus Conference, additional comments were incorporated. This report summarizes the results of this collaborative effort and provides a set of recommendations and accompanying research questions to guide development, implementation, and evaluation of health care policies intended to promote KT in emergency medicine. The recommendations are to 1a) involve appropriate stakeholders in the health care policy process; 1b) collaborate with policy makers when health care policy focus areas are being developed; 2) use previously validated clinical practice guideline development tools; 3) address implementation issues during the development of health care policies; 4) monitor outcomes with performance measures appropriate to different practice environments; and 5) plan periodic reviews to uncover new clinical evidence, new methods to improve KT, and new technologies. To advance the further development of these recommendations, a research agenda is proposed.