医院门诊处方中痤疮药物治疗的适宜性分析

目的:为提高皮肤科门诊合理用药的水平,根据相关法规、技术规范,对门诊处方中有关痤疮药物治疗的适宜性进行评价.方法:选取我院皮肤科门诊近2年来的处方,对其中临床诊断为痤疮的处方共计192份进行分析.结果:我院皮肤科门诊近两年就诊的痤疮患者占到皮肤病患者的8%,其中以中、重度患者较多,痤疮药物治疗不适宜处方比例为8.85%,存在着一定的不合理用药现象.结论:开展对专病门诊用药适宜性的点评,是医院处方点评工作的延伸,也是将该病种治疗尽快纳入临床治疗路径的必要过程.根据痤疮药物分级治疗的原则,当前急需完善的是合理规范的使用抗菌药物,预防痤疮丙酸杆菌耐药性的发生.     

Utilization of hospital and outpatient care for adverse cutaneous reactions to medications

PURPOSE: To quantify hospitalizations, visits to office based physicians, hospital clinics and emergency departments with primary diagnoses of skin conditions that are often due to drug reaction. METHODS: I analyzed data from the National Hospital Discharge Summary (1997-2001), National Ambulatory Care Survey (1995-2000) and National Hospital Ambulatory Care Survey (1995-2000) to determine the number of hospitalizations and visits with primary diagnoses of skin conditions that are often attributed to drugs. Using statistical methods for surveys, I determined the demographic characteristics of patients with these diagnoses and compared them with patients seeking care for other reasons. RESULTS: In the United States, there are about 5000 hospitalizations each year with a primary diagnosis of erythema multiform, Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis, of which 35% are specifically ascribed to drugs. Annually, there are more than 100,000 outpatient visits for these diagnoses and about two million visits for immediate hypersensitivity reactions that may be due to drugs. Outpatient visits for drug eruptions and drug allergies that include a skin component exceed 500,000 annually. CONCLUSIONS: Skin conditions often attributed to drugs are frequent reasons for hospitalization and physician visits. Optimal care of the individual patients with these conditions requires careful attention to drugs as a possible cause.     

The association between functional health literacy and patient-reported recall of medications at outpatient pharmacies

BackgroundPublished literature on assessing the functional health literacy (FHL) level of patients in pharmacy practice is lacking.ObjectivesTo assess FHL in an outpatient pharmacy setting and the associations between FHL and patient recall of medications.MethodsIn a cross-sectional study of 79 English-speaking adults recruited from 3 outpatient pharmacies, patients were given the Short Test of Functional Health Literacy in Adults and asked to recall their medication names, dosages, frequencies, and indications. Patients’ responses were compared with pharmacy records (medication name, dosage, frequency) and Facts and Comparisons (indication).ResultsOf the 79 patients, 27 had inadequate FHL. Correct medication names were recalled less frequently by patients with inadequate FHL compared with patients with adequate FHL (60% vs 84%, P < .001). Similarly, correct dosages (71% vs 83%, P = .03) and frequencies (62% vs 85%, P < .001) were reported less often by patients with inadequate FHL. There was no significant difference in the frequency of correct indications for medications between the 2 groups.ConclusionsInadequate FHL is associated with poor recall of correct medication name, dosage, and administering frequency. Future research to evaluate the effect of pharmacists on improving patients’ recall of medication name, dosage, and frequency is warranted.     

心脏神经官能症药物加心理暗示治疗效果对比分析

目的通过对比研究了解心脏神经官能症药物加心理暗示治疗的临床效果。方法 (1)对照组予以盐酸氟西汀20mg,1次/d,以及谷维素等药物治疗;(2)研究组药物治疗相同,另加用心理暗示治疗:确诊后告知患者其心脏疾病处于边缘期,如按医嘱服用特效药(药物由护士发放并监督其服下,只告知患者盐酸氟西汀的英文名)治疗,可以完全消除症状并回复到健康状态。结果研究组有效20例,其中治愈13例;对照组有效16例,其中治愈5例。两组有效率比较差异无统计学意义(P0.05);治愈率比较差异有统计学意义(P0.01)。结论只要治疗方法正确得当,心脏神经官能症完全可以在短期内治愈。     

Antipsychotic medications and the elderly: effects on cognition and implications for use

Despite being frequently prescribed in the elderly, antipsychotic medications are commonly associated with adverse effects in this population, including sedative, orthostatic and extrapyramidal adverse effects. Growing evidence suggests that antipsychotics can also cause deleterious cognitive effects in some elderly patients. Preclinical and growing clinical evidence indicates that inhibitory effects on dopaminergic, cholinergic and histaminergic neurochemical systems may account for antipsychotic-associated cognitive impairment in the elderly. A review of published reports of the cognitive effects of antipsychotics in the elderly suggests that newer antipsychotic medications may possess a more favourable cognitive profile than that of traditional agents in this population. The cognitive effect that a specific antipsychotic will have in the elderly, however, is likely better predicted by considering the pharmacodynamic action of an individual agent in combination with the pathophysiology of the condition being treated. Agents with relatively weak dopamine inhibiting effects (e.g. clozapine and quetiapine), for example, would theoretically have a cognitive profile superior to that of agents with higher degrees of dopaminergic inhibition (all traditional agents, risperidone, olanzapine and ziprasidone) when used for conditions associated with diminished dopamine function (e.g. idiopathic Parkinson's disease). Drugs with weak anticholinergic effects (high-potency traditional agents, risperidone, quetiapine and ziprasidone) would theoretically be less likely to cause cognitive impairment than agents with high degrees of cholinergic receptor blocking actions (clozapine and olanzapine) when treating patients with impaired cholinergic function (e.g. Alzheimer's disease). Cholinergic agonist effects of clozapine and olanzapine may, however, mitigate potential adverse cognitive effects associated with the cholinergic blocking actions of these agents. Large, rigorous trials comparing the cognitive effects of antipsychotics with diverse pharmacodynamic actions are lacking in the elderly and are needed.     

Cost implications for the use of inhaled anti-inflammatory medications in the treatment of asthma

OBJECTIVE: To compare the expected costs of treating patients with asthma with versus without inhaled anti-inflammatory medications, adjusting for other factors that also influence medical care expenditures. DESIGN: Nonlinear exponential regression analyses were used to estimate relationships between medical care expenditures and treatment with inhaled corticosteroids, sodium cromoglycate (cromolyn) or nedocromil. The regressions adjusted for differences in patients' demographics, location, plan type and severity of illness. SETTING: Large, self-insured, corporate-sponsored medical plans represented in MarketScan database. PATIENTS AND PARTICIPANTS: 7466 continuously enrolled patients with asthma. INTERVENTIONS: Treatment with inhaled corticosteroids, sodium cromoglycate or nedocromil. MAIN OUTCOME MEASURES: (i) Total inpatient, outpatient and pharmaceutical expenditures; and (ii) asthma-related expenditures in the 1996 calendar year. RESULTS: If all patients had been treated with inhaled anti-inflammatory drugs, total expenditures would be expected to be about $US944.82 per patient lower, on average, than would be the case if no patients received these drugs. Asthma-related expenditures would be about $US498.74 per patient higher, on average, if all patients were treated with these drugs. CONCLUSIONS: Using inhaled anti-inflammatory agents would be associated with higher asthma-related expenditures but lower total expenditures. Treatment with inhaled anti-inflammatory drugs may represent an investment in better care that pays off with better health and lower total medical care expenditures.     

Priapism associated with typical and atypical antipsychotic medications

Priapism is a urologic emergency, and a urologic consultation should be obtained as early as possible. Its etiologies are numerous and diverse. Patients who use antipsychotic drugs should be informed about the complications of priapism, especially those patients with a history of prolonged erections associated with other alpha-adrenergic blocking agents or a history of sickle cell disease. If antipsychotic medication is considered to be needed in the treatment of patients with a history of priapism, physicians should select a drug with a low peripheral alpha-adrenergic blocking property. Physicians should be aware of this rare but potentially serious complication of antipsychotic drugs. Early intervention and appropriate treatment are essential to prevent permanent impotence and other serious complications.