2011～2013年我院门诊调脂类药物使用情况分析

目的为探索药物应用的流行趋势,现对我院门诊2011～2013年调脂类药物的使用情况进行了调查、统计、分析,以期为临床合理用药提供参考。方法运用Excel软件对调脂类药物的所有相关数据进行处理。按药品通用名以限定日剂量DDD为标准计算药品的用药频度（DDDs）和日均费用（DDC）,并采用销售金额排序及用药频度（DDDs）排序的分析方法,对我院2011～2013年调脂类药物的使用进行统计和分析。结果门诊调脂类药物的使用量呈逐年上升趋势,2012年和2013年门诊调脂类药物的出库金额比2011年分别增长了46．15％和134．86％。2011～2013年各年度调脂药中DDDs排序列前3位的均为HMG—CoA还原酶抑制剂（他汀类）,其中阿托伐他汀连续三年都位居榜首,瑞舒伐他汀在2013年的用药频度大幅提升。阿昔莫司克服了烟酸类的不良反应,DDDs排序也比较靠前。结论HMG—CoA还原酶抑制剂（他汀类）占据首位,苯氧芳酸类药物（贝特类）使用情况比较稳定,烟酸衍生物及其类似物的使用频度呈逐年下降趋势。我院调脂药物的使用整体上比较合理。     

我院儿科门诊处方用药点评

目的:剖析儿科门诊用药现状,促进儿科合理用药.方法:随机抽取我院2011年1-3月儿科门诊处方1147张,对儿科的疾病构成比、处方用药分布及抗菌药使用情况进行了归纳统计.结果:我院儿科门诊患者以上、下呼吸道感染为主,抗菌药物使用率为58.15％,注射剂使用率为55.27％,口服中成药占口服药处方数的76.22％,抗菌药物的使用途径以静脉注射为主,所用抗菌药物均为单联.结论:我院儿科门诊用药能中西药并重,尚存在抗菌药物使用率高及给药途径选择不恰当等现象,需注意合理用药.     

门诊处方不合理用药分析

目的:分析我院门诊处方不合理用药现状,提高临床医师用药水平.方法:随机抽取医院2010年7月-2011年2月门诊处方10000张,按要求进行逐步点评和统计分析.结果:在10000张处方中不台理用药处方为168张,处方合格率为98.32%,不合理用药主要表现在不适当的联合用药、药物配伍不合理、药物选择不合理及用法用量不舍理几个方面.结论:我院门诊处方用药基本合理,但应加强处方合理用药审核,以提高临床医师合理用药水平,保障患者的用药安全.     

皮肤病医院2021年-2023年门诊处方合理用药分析

目的 分析皮肤病防治所2021-2023年门诊处方合理用药情况。方法 选取宜兴市皮肤病防治所 2021年1月-2023年12月门诊12 000张处方,统计皮肤病门诊药物处方合理率、处方药物的使用种类、处方 金额、抗菌药使用比例,并分析处方开具不合理的类别。结果 2021-2023年皮肤病门诊药物处方开具合理 率依次为58.14%、82.64%、95.77%,处方合理率逐步提高;2023年门诊处方每张处方平均使用种类、每 张处方平均费用及抗菌药物比例优于2021年及2022年（P ＜0.05）;2021-2023年处方开具不合理类别以 疗程时间过长为主,2023年门诊各种不合理处方数量均低于2021年及2022年（P ＜0.05）。结论 皮肤 病门诊药物处方存在用药不适宜的情况,需强化临床中对药物的应用管理,增加医师在药物处方开具的 合理及科学性。     

关于基层医生抗菌药物回顾性调查分析

目的 根据基层医生处方中抗菌药物的用药情况,进行回顾性调查分析,为基层医生临床用药过程中的安全性、有效性、经济性、适当性提供参考依据.方法 对基层医院的门诊处方500张采用回顾性调查分析方法,结合临床药理学知识及医院合理用药的规定,对基层医院医生用药的合理性进行分析.结果 使用针剂的处方有399例,占79.8% 使用抗菌药物的处方有415例,占83.0%.结论 回顾性调查分析显示,基层医院滥用抗菌药物的现象普遍存在,基层广大医务工作者应引起高度重视.     

围手术期预防应用抗菌药物调查分析

目的分析围手术期抗菌药物使用基本情况及存在问题。方法对全国118所三级综合性医院围手术期预防用药情况进行调研。随机抽取2006年9月11—17日和12月11—17日手术病历各15份,共计3557份,对围手术期预防应用抗菌药物的合理性进行分析评价。结果（1）围手术期预防性抗菌药物的使用率为98％;（2）用药种类：按频次高低排序前3位是三代头孢、二代头孢、喹诺酮类;三代头孢占用药者的50．4％,一代头孢只占16．0％;（3）每例平均用药天数：Ⅰ类切口为7．4d,Ⅱ类切口为7．6d,Ⅲ类切口为10．5d;（4）用药时机：手术开始前2h内用药者只占30．4％,手术结束后才用药者占52．2％;（5）16．7％病例无用药适应证;（6）在抗菌药物的用法、用量、药物更换以及联合用药的指征掌握、药物配伍等方面,也存在诸多不合理现象。结论118所医院围手术期抗菌药物使用率过高,疗程过长,在药物选择、用药时机、联合用药方面不合理、不规范的情况比较普遍,改进的空间较大。     

儿科门诊留观抗菌药物使用分析

目的:通过对我院儿科门诊留观抗菌药物使用情况,分析我院临床抗菌药物的使用情况.方法:抽取我院6月-8月儿科门诊留观处方7781张,采用儿童限定日剂量(CDDD)和儿童药物利用指数(CDUI)来分析抗生素的使用情况.结果:抗菌药物使用调查表中显示,10种抗菌药物中4种CDUI=1,6种抗菌药物CDUI= 1.1.使用比较合理.结论:我院儿科门诊留观使用抗菌药物的用量较为合理,同时建议医生按体表面积计算用量能进一步提高用量的准确度.     

铜绿假单胞菌耐药性分析及耐药基因检测

目的观察杭州市第一人民医院临床分离的铜绿假单胞菌的耐药性变迁及相关耐药基因。方法采用WHONET软件对2003-2007年临床分离的1489株铜绿假单胞菌的药物敏感性试验结果进行统计分析;用琼脂稀释法测定11种抗菌药物对36株多药耐药铜绿假单胞菌的最低抑菌浓度（MIC）;用PCR法检测β-内酰胺酶、氨基糖苷类修饰酶等编码基因,并对PCR扩增产物进行测序分析。结果铜绿假单胞菌对氨曲南、亚胺培南、头孢他啶、头孢吡肟、哌拉西林、哌拉西林／他唑巴坦、头孢哌酮／舒巴坦、环丙沙星、左氧氟沙星、庆大霉素和阿米卡星的耐药率由2003年的13．4％、10．6％、8．7％、7．9％、12．7％、12．7％、6．7％、15．8％、20．5％、24．7％和10．9％分别增至2007年的35．3％、40．9％、18．4％、32．4％、32．9％、32．0％、21．9％、37．8％、38．6％、39．4％和34．8％;11种抗菌药物对多药耐药铜绿似单胞菌的MIC90均≥128μg/mL。36株多药耐药铜绿假单胞菌中,β-内酰胺酶编码基因阳性占58．3％（21／36）,氨基糖苷类修饰酶基因阳性占88．9％（32／36）,oprD2基因缺失率为80．6％（29／36）。结论铜绿假单胞菌对常用抗菌药物的耐药率呈增高趋势,多药耐药情况严重,临床上应给予高度重视。多药耐药铜绿假单胞菌携带多种β-内酰胺酶编码基因及氨基糖苷类修饰酶基因,oprD2基因的缺失率高。     

2010年某院皮肤科门诊用药统计分析

目的了解笔者所在医院皮肤科门诊用药情况，为今后医院临床用药的科学管理提供参考。方法对笔者所在医院皮肤科门诊2010年药品的使用数量、金额进行统计分析。结果皮肤科用药占用药总金额的31．4％，抗真菌药占用药总金额的15．3％。结论笔者所在医院皮肤科门诊用药以皮肤科用药、抗真菌药为主，与综合性医院有别，反映出鲜明的皮肤科特征。     

205例血管性痴呆患者精神科用药概况

目的:了解血管性痴呆患者使用精神科药物的情况.方法:将住院血管性痴呆患者205例,统计所有精神科药物名称、剂量、用法.并按照年份分四组分析.结果:①各类精神科药物总使用率为100％,抗精神病药物的使用率为92.68％,其中前三位的是利培酮(34.15％)、奋乃静(31.71％)、喹硫平(20.48％)；新型抗精神病药物的使用率呈现上升趋势.抗焦虑药的使用率为40.98％,其中劳拉西泮(18.54％)、阿普唑仑(15.61％)、艾司唑仑(10.24％)占主导地位.②各种精神科用药的使用剂量明显低于其日常使用剂量.③合并用药的概率较高,达63.41％.结论:各类精神科药物是血管性痴呆患者伴发精神行为症状的重要治疗方式.     

活血注射液组方药效学研究

目的:通过药效学研究,探讨丹芪偏瘫胶囊中黄芪和赤芍用于治疗缺血性脑血管病急性期的最优配伍比例。方法:选择黄芪和赤芍四种不同的配伍比例,以颈动脉血栓形成时间为检测指标,筛选出一个有效样品。再选用健康Wistar大鼠,制备高粘滞血症大鼠模型作为模型对照组,分别给药2.5、5、10 mL/kg作为低、中、高剂量组,观察黄芪-赤芍浓缩液不同剂量组对高粘滞血症大鼠血液黏度和血浆纤维蛋白原含量的影响。结果:通过黄芪和赤芍不同配伍比例组合研究发现,延长大鼠颈动脉血栓形成时间效果最佳的黄芪和赤芍配伍比例为1:3。以此比例制成的浓缩液不同剂量对大鼠血液黏度的影响中发现,中、高剂量组可明显降低各切变速率下的全血黏度;低、中、高剂量组均明显降低红细胞压积至(48.1±4.3)%、(47.5±3.4)%、(42.2±2.4)%,并随剂量增加,作用增强。高剂量组可明显降低血浆纤维蛋白原含量至(1.3±0.3)g/L。结论:黄芪和赤芍剂量配伍比例为1:3,给药剂量为10 mL/kg时具有明显的活血作用。     

One-year experience of Men's Outpatient Health Care Unit without specifying the category of disease

The Men's Outpatient Health Care Unit was established in April 2006 in Kyoto City Hospital. In this outpatient unit, medical services are provided to males of all ages and with any category of complaints. For patients' privacy, the unit is situated on a different floor from the other outpatient ward, and all-male staff handles from reservation to examination. Furthermore, each patient is given 30 minutes to provide enough time for counseling and examination. To our knowledge, this system was established for the first time in Japan. During the first one year, a total of 106 new patients visited this ward with a large variety of chief complaints : sexual dysfunction, urinary disorder, consultation for aging male, consultation for size and shape of the penis, and so forth. Over 25% of patients disinclined against visiting the conventional urological ward. Furthermore, over 25% of patients revealed that they were hesitant to see female staffs including clerks and nurses. Although more facilities in Japan are recently providing gender-specific medical services, most of them are directed to the female gender. Our experience of this health care system suggested that male-specific gender medicine should become more widespread and cover various categories of diseases.     

2013年我院门诊处方点评与不合理处方分析

目的：为提高门诊处方合格率,保障用药安全,减少不合理用药,维护就医患者身心健康,对2013年我院门诊处方的合理性进行评价。方法回顾性的对我院2013年门诊全样本共212263张处方根据本院《处方点评规范实施细则》进行统计、分析和评价。结果处方合格率为97.7％,不合理处方中书写不规范和用药不适宜为主要原因,分别占到了不合理处方的45.23％和51.92％。其中,用法用量不适宜占到了整个不合理处方的35.93％。结论我院处方的开具中还存在着一些问题,需针对存在的问题采取有效的措施,加强处方点评的力度,加强与医生的沟通和反馈以及对医生合理用药相关知识的培训,以期提高处方合格率,规范合理用药行为。     

Use of Veterans Administration outpatient facilities by older, rural veterans

A mail survey was conducted in rural northeastern Missouri to study the factors affecting use of Veterans Administration (VA) outpatient medical services by older veterans. During the year preceding the survey, 39.6% of the 169 responding veterans had used VA outpatient facilities. Travel time, long waiting time at the clinic, and travel expense were the most common perceived barriers to use. However, these factors were generally poor predictors of use. The reported percentage of each perceived geographic or administrative barrier to use was consistently greater for previous users than for nonusers of these facilities. Multiple regression analysis revealed private medical insurance coverage to be the only significant predictor of use. Veterans with private medical insurance were more likely to receive ambulatory medical care from local providers than from the VA. The potential impact of removing perceived barriers to use in this population remains unclear.     

Regular dialysis treatment in Germany: the role of non-profit organisations

Germany's healthcare system is almost entirely premium-funded through compulsory insurance. Doctors practicing in an outpatient setting are obliged to be members of the "Kassenarztliche Vereinigung" (KV), a kind of union for physicians that has to guarantee adequate medical care for all insured patients. Health money is transferred from health insurances to KV and then distributed to individual doctors. In 1998, 47,000 patients were treated in Germany by dialysis, 40% in privately-owned units, 22% in hospital units and 40% by non-profit facilities. Of these, 35% have diabetes mellitus, 50% of the patients new to dialysis. A total of 92% are treated in HD units, 1.5% at home, and 6.7% by PD. Not-for-profit organisations were founded in 1969 to overcome the shortage of dialysis facilities. These organisations provide all the non-medical components of dialysis therapy such as machines, disposables, buildings, employment, and management of staff. Nephrologists who are employed by or work with not-for-profit organisations are free to choose the best medical therapy, with no economic bias. Assessment of dialysis quality is not yet official in Germany and it is not clear whether there are different provider associated outcomes.     

The burden of illness of osteoporosis in Canadian men

There is a dearth of information about the burden of osteoporosis in Canadian men. To fill this gap, we conducted a burden of illness study aimed at estimating the economic burden attributable to osteoporosis in Canadian men aged 50 years and older. Five national data sources were used to estimate health care resource utilization and costs (in 2010 Canadian dollars) associated with osteoporosis in men. Any information gap was supplemented by using data from provincial and community sources. Direct medical costs included costs associated with hospitalizations, same day surgeries, emergency room visits, rehabilitation, chronic care, long-term care, home care, physician visits, and prescribed medications. The value of lost productivity from patients and informal caregivers was also determined to provide a societal perspective. Sensitivity analyses were conducted to evaluate the impact of key assumptions on the results. In fiscal year 2007/2008, the total economic burden of treating and rehabilitating male osteoporotic fractures was estimated at $570 million per year, where direct medical costs accounted for 86%. Acute care utilization was responsible for 70% of all direct costs. About 51% of all hospitalizations were for hip fractures and hip fractures alone accounted for 54% of the acute care spending. If a proportion of Canadian men were assumed to live in long-term care facilities due to osteoporosis, the overall annual cost of osteoporosis would increase from $570 million to $910 million. Male osteoporosis has a substantial economic burden on the Canadian society.     

Use of discharge abstract databases to differentiate among pediatric hospitals based on operative procedures: surgery in infants and young children in the state of Iowa

INTRODUCTION: A pediatric hospital may aim to show governmental agencies, charitable organizations, and philanthropic individuals how its clinical services differ from those of nonpediatric surgical facilities and of other pediatric hospitals. Yet, it is unknown how to use existing databases to quantify where infants and young children undergo surgery, and to use that information to differentiate among facilities. METHODS: Discharge abstracts were used to study inpatient and outpatient operative procedures performed between January and June 2001 in children 0-2 yr old at hospitals or hospital-affiliated outpatient surgery centers in Iowa. RESULTS: Of the 93 facilities performing at least one procedure, the 90 performing 15 or fewer different types of procedures provided surgical care for 80% of procedures. Among procedures performed at these 90 facilities, less than 0.15% were physiologically complex (more than seven American Society of Anesthesiologists' basic units). In contrast, at the larger and smaller pediatric hospitals, the percentages were 26% and 7%, respectively. These pediatric hospitals performed 181 and 73 different types of procedures, respectively; 64% of the physiologically complex procedures performed statewide were performed at the larger pediatric hospital. The smaller pediatric hospital was no more similar to the larger pediatric hospital in its relative volumes of each type of procedure than it was to the other 91 facilities. CONCLUSIONS: Statewide discharge abstract data can be used by a hospital to quantify how its surgical practice differs from that of other hospitals (e.g., to show that it provides a more diverse, comprehensive, and physiologically complex selection of procedures in younger patients).