基于Beers标准(2019版)评价河北省多种慢性病共存老年心力衰竭住院患者的潜在不适当用药

目的 基于Beers标准(2019版)对河北地区多种慢性病共存老年心力衰竭(简称心衰)住院患者的潜在不适当用药(PIM)进行调查,并结合各疾病专科诊疗指南进行深入分析,探讨其相关危险因素,为促进多种慢性病共存老年人群临床合理用药提供参考。方法 2022年1月随机从河北省4家医疗机构信息系统中各抽取50例老年心衰住院患者的电子病历资料。根据纳入与排除标准,最终纳入135例符合标准的患者。基于Beers标准(2019版)对老年心衰住院患者的PIM情况进行评估,结合疾病诊疗指南深入用药分析评价,给出用药建议。采用多因素Logistic回归分析老年心衰住院患者发生PIM的影响因素。结果 不同年龄、罹患疾病种类的老年心衰住院患者PIM发生率比较,差异均无统计学意义(P>0.05);不同性别、用药种类、肾小球滤过率(GFR)的老年心衰住院患者PIM发生率比较,差异均有统计学意义(P<0.05)。按PIM发生频率高低排序前3位依次为利尿剂、螺内酯、苯二氮类镇静催眠药物。38例患者存在53例次PIM,排名前3的药物分别为苯二氮类镇静催眠药物、地高辛和抗精神病药物。24例患者存在26例次PI...     

北京市社区老年人潜在不适当用药的调查分析

目的 调查北京市社区老年人潜在不适当用药(potentially inappropriate medication,PIM)现状.方法 采用自我报告方式,收集北京市社区215名老年人用药信息,根据2019版美国老年人PIM标准(Beers criteria for PIM use in older adults,Beers标准)和中国老年人潜在不适当用药判断标准(中国PIM标准)评价并做描述性分析.结果 根据2019版Beers标准发现66人(30.7%)存在84例次PIM,其中中枢神经系统药物(36例次)、血液系统药物(14例次)、内分泌系统药物(11例次)导致的PIM最多;采用中国PIM标准发现53人(24.7%)存在73例次PIM,前三位分别为:中枢神经系统药物(31例次),血液系统药物(17例次),解热、镇痛、抗炎与抗风湿药(17例次).结论 社区老年人PIM发生率较高,特别是中枢神经系统和血液系统用药需要引起关注.Beers标准和中国PIM标准可相互补充,且需不断更新完善.     

老年人潜在不适当用药Beers标准2019修订版解读

Beers标准是一个用于避免老年人潜在不适当用药的实用工具。该标准于1991年由老年医学专家Beers首次公布,自2011年开始由美国老年医学会(American geriatrics society,AGS)管理,每3年更新一次,最近AGS更新发布了2019版。Beers标准的主要目的在于指导医务工作者为老年患者选择适当药物,确保老年人用药安全。     

基于Beers标准和STOPP/START标准评价老年消化道疾病的潜在不适当用药

目的了解老年患者消化道疾病的潜在不恰当用药,为老年患者消化道疾病的临床用药提供借鉴。方法提取在老年医学科住院的285例患者病历,依据Beers标准和STOPP/START标准,对消化道疾病存在的潜在不恰当用药情况进行筛查。结果依据Beers标准,285例患者病历中有61例(21%)存在潜在不适当用药,共计85项。按照STOPP标准,285例患者病历中23例(8%)筛查出潜在不适当用药,共计39项;按照START标准,筛查出16例(6%)患者病历存在处方遗漏情况,共计16项; 50例(18%)患者存在Beers标准和STOPP/START标准未包括的潜在不适当用药(PIMs);影响老年消化道疾病患者发生PIMs的因素包括:年龄、疾病种类、住院时间、用药种类、日常生活能力量表评分(ADL)。结论老年患者消化道疾病存在潜在不恰当用药,易导致PIMs的影响因素较多,使用Beers标准和STOPP/START标准对老年消化道疾病患者的用药进行评估,能有效降低PIMs发生,提高老年消化道疾病诊疗的医疗质量。     

老年住院患者潜在不恰当用药的影响因素分析

目的研究老年住院患者潜在不恰当用药发生率及影响因素。方法随机抽取符合纳入标准的陕西省人民医院住院患者699例,使用2015版Beers标准评价病例,采用频率统计方法、χ2检验中的独立性检验及多因素Logistic回归分析进行统计描述及推断。结果 (1)老年住院患者潜在不恰当用药发生率为79.5%。(2)联合用药数量多、医保报销比例高的老年住院患者更容易发生潜在不恰当用药,内科病房相对外科病房的老年住院患者更容易发生潜在不恰当用药。结论老年住院患者潜在不恰当用药发生率高,联合用药数量、医保类型、出院科室为其影响因素。     

新冠肺炎疫情期间泌尿外科老年患者医院感染情况分析

摘要 目的 了解新冠肺炎疫情期间某医院泌尿外科老年住院患者的医院感染情况。方法 回顾性调查2019年1月—2020年12月在某医院泌尿外科住院治疗的老年患者的医院感染情况。以2019年1—12月的1 123例老年患者为疫情前组，2020年1—12月的982例老年患者为疫情组，对2组患者的医院感染发生部位及季节情况进行比较。结果 疫情前组泌尿外科老年住院患者的医院感染发生率显著高于疫情组(P<0.05)，疫情期间呼吸系统医院感染发生率降低(P<0.05)。2019年不同季度的医院感染发生率无统计学差异(P>0.05)，2020年不同季度的医院感染发生率有统计学差异(P<0.05)。结论 新冠疫情期间，泌尿外科老年住院患者呼吸系统的医院感染率显著降低，2020年第一季度泌尿外科医院感染的发生率显著低于其他季度。     

衰弱表型和衰弱筛查量表在老年住院患者中的应用比较

目的 比较衰弱表型和衰弱筛查量表(FRAIL量表)对老年住院患者衰弱风险的筛查能力,为临床选择合适的衰弱筛查工具提供参考.方法 采用便利抽样法,选取2019年11月—2020年7月在宁夏回族自治区某三级甲等医院住院的462例老年住院患者为研究对象,采用衰弱表型、衰弱筛查量表和衰弱指数进行衰弱评价.以衰弱指数为诊断标准,...     

品管圈在降低老年冠状动脉旁路移植术患者中重度营养不良发生率中的应用

目的 探讨品管圈在降低老年冠状动脉旁路移植术(CABG)患者中重度营养不良发生率中的应用效果.方法 选取宁夏某三级甲等医院心脏大血管外科2019年12月—2020年9月收治的96例老年CABG患者为研究对象,2019年12月—2020年4月品管圈开展前的47例患者为对照组,2020年5—9月品管圈开展后的49例患者为观...     

老年骨折患者害怕跌倒现状及影响因素分析

目的 调查老年骨折患者害怕跌倒现状及影响因素,为临床护理干预提供理论依据.方法 选取2017年7月—2019年5月河北省某三级甲等医院骨科病房老年骨折术后患者172例进行问卷调查,包括患者一般资料、修正版跌倒效能量表(MFES)、简版老年抑郁量表(GDS-15)和Morse老年人跌倒风险评估量表(MFS).结果 老年骨...     

我院门诊抗菌药物处方点评结果与分析

目的：分析我院门诊抗菌药物处方合理性及抗菌药物处方点评对我院门诊抗菌药物处方合理性的影响，持续性改进我院门诊抗菌药物的规范使用。方法：收集我院门诊药房收到的2019.01-2020.01所有含抗菌药物的处方及门诊药房点评小组对抗菌药物处方点评的结果，汇总出门诊不同科室抗菌药物消耗量并进行排名；对所选处方进行按月份的汇总分析，得出我院门诊每月抗菌药物处方的数量、不合格抗菌药物处方的数量、抗菌药物处方不合格率、抗菌药物处方不合格类型及数量。结果：经汇总分析得出我院门诊抗菌药物消耗量前十的科室有消化科、呼吸科、口腔科、皮肤科、耳鼻喉科、全科医学科、泌尿外科、内镜中心、肾脏病科、妇科；我院2019.01-2020.01期间抗菌药物处方数为18982张，占总处方数的5.14%，抗菌药物处方的不合格率为8.12%，其中占比对大的不合格类型为处方的规范性（93.02%），其次为用药的适宜性（6.98%），超常处方为0。讨论：我院药剂科持续改进抗菌药物处方的管理，实践证明，加强抗菌药物处方的管理可以降低抗菌药物处方不合格率，提高各科室抗菌药物的临床应用水平，降低不良反应的发生，减少耐药细菌的产生等。     

Trends in outpatient emergency department visits during the COVID-19 pandemic at a large,urban, academic hospital system

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has critically affected healthcare delivery in the United States. Little is known on its impact on the utilization of emergency department (ED) services, particularly for conditions that might be medically urgent. The objective of this study was to explore trends in the number of outpatient (treat and release) ED visits during the COVID-19 pandemic.MethodsWe conducted a cross-sectional, retrospective study of outpatient emergency department visits from January 1, 2019 to August 31, 2020 using data from a large, urban, academic hospital system in Utah. Using weekly counts and trend analyses, we explored changes in overall ED visits, by patients' area of residence, by medical urgency, and by specific medical conditions.ResultsWhile outpatient ED visits were higher (+6.0%) in the first trimester of 2020 relative to the same period in 2019, the overall volume between January and August of 2020 was lower (−8.1%) than in 2019. The largest decrease occurred in April 2020 (−30.4%), followed by the May to August period (−12.8%). The largest declines were observed for visits by out-of-state residents, visits classified as non-emergent, primary care treatable or preventable, and for patients diagnosed with hypertension, diabetes, headaches and migraines, mood and personality disorders, fluid and electrolyte disorders, and abdominal pain. Outpatient ED visits for emergent conditions, such as palpitations and tachycardia, open wounds, syncope and collapse remained relatively unchanged, while lower respiratory disease-related visits were 67.5% higher in 2020 relative to 2019, particularly from March to April 2020. However, almost all types of outpatient ED visits bounced back after May 2020.ConclusionsOverall outpatient ED visits declined from mid-March to August 2020, particularly for non-medically urgent conditions which can be treated in other more appropriate care settings. Our findings also have implications for insurers, policymakers, and other stakeholders seeking to assist patients in choosing more appropriate setting for their care during and after the pandemic.     

Potentially inappropriate medication prescribing in outpatient practices: Prevalence and patient characteristics based on electronic health records

Background: Some older adults receive potentially inappropriate medications (PIMs), increasing their risk for adverse events. A literature search did not find any US multicenter studies that measured the prevalence of PIMs in outpatient practices based on data from electronic health records (EHRs), using both the Beers and Zhan criteria.Objectives: The aims of the present study were to compare the prevalence of PIMs using standard drug terminologies at 2 disparate institutions using EHRs and to identify characteristics of elderly patients who have a PIM on their active-medication lists.Methods: This cross-sectional study of outpatients' active-medication lists from April 1, 2006, was conducted using data from 2 outpatient primary care settings: Intermountain Healthcare, Salt Lake City, Utah (center 1), and the Cleveland Clinic, Cleveland, Ohio (center 2). Data were included from patients who were aged ≥65 years at the time of the last office visit and had ≥2 documented clinic visits within the previous 2 years. The primary end point was prevalence of PIMs, measured according to the 2002 Beers criteria or the 2001 Zhan criteria.Results: Data from 61,251 patients were included (36,663 women, 24,588 men; center 1: 37,247 patients; center 2: 24,004). A total of 8693 (23.3%) and 5528 (23.0%) patients at centers 1 and 2, respectively, were documented as receiving a PIM as per the Beers criteria; this difference was not statistically significant. Per the Zhan criteria (P < 0.001), these values were 6036 (16.2%) and 4160 (17.3%). Eight of the most common PIMs were the same at both institutions, with propoxyphene and fluoxetine (once daily) being the most prescribed. Female sex, polypharmacy (≥6 medications), and multiple primary care visits were significantly associated with PIM prescribing.Conclusions: In this analysis of data from elderly patients at 2 outpatient centers, a small set of 8 medications accounted for the majority of PIMs at both centers, irrespective of geographic and demographic variations. Female sex, polypharmacy, and number of primary care visits were significantly associated with PIM prescribing. In this analysis of data from elderly patients at 2 outpatient centers, a small set of 8 medications accounted for the majority of PIMs at both centers, irrespective of geographic and demographic variations.     

心理自助教育对护士心理健康的研究

目的探讨我院10年间急诊疾病谱的变迁特点。方法回顾性调查我院2003年1月-2012年12月99702例急诊患者资料,将数据输入计算机,以Excel软件对结果进行计算,列出我院前5位急诊疾病,分析我院急诊疾病谱的变迁特点。结果近10年我院急诊疾病谱仍以非创伤性疾病为主,然而,与前5年间相比,后5年间神经系统和外伤性急诊疾病明显增多。全年就诊时间分布变化则以第四季度增多为特点：我院急诊患者日就诊时间呈非线性特征。结论我院急诊疾病谱已发生变迁,提示在疾病高峰来临之前应做好应对准备。     

Adverse outcomes associated with inappropriate drug use in nursing homes

BACKGROUND: Little empirical evidence exists regarding the influence and outcomes of inappropriate medication use among elderly nursing home residents. OBJECTIVE: To identify the prevalence of inappropriate medication use among elderly patients in Georgia nursing homes using the Beers criteria and identify the relationship between inappropriate drug use and the likelihood of an adverse health outcome. METHODS: A cohort design was used to review 1117 patient medical records in 15 Georgia nursing homes with a high risk of polypharmacy. Prevalence of inappropriate medication use among elderly patients, as defined by the Beers criteria, was estimated. The adverse health outcomes of hospitalizations, emergency department visits, or deaths were identified from Medicaid claims data. RESULTS: A total of 519 (46.5%) patients received at least one inappropriate medication and 143 (12.8%) patients experienced at least one adverse health outcome. Logistic regression revealed that the total number of medications taken (OR 1.139, 95% CI 1.105 to 1.173) significantly increased the likelihood of receiving an inappropriate drug, while having a diagnosis of "dementia" (OR 0.748, 95% CI 0.565 to 0.991) decreased the likelihood. Inappropriate medication use increased the likelihood of experiencing at least one adverse health outcome more than twofold (OR 2.34, 95% CI 1.61 to 3.40). Propoxyphene use alone was significantly associated with the occurrence of an adverse health outcome (OR 2.39, 95% CI 1.54 to 3.71). CONCLUSIONS: Inappropriate drug use was common in our study cohort. Inappropriate use of medication in the elderly, particularly propoxyphene, is associated with a higher risk of adverse health outcomes.     

Potentially inappropriate medication use in elderly Japanese patients

Background: Modified Beers criteria for elderly Japanese patients were developed in 2008 by consensus among 9 experts to reflect regional clinical practice and available medications in Japan. Since then, many physicians and pharmacists have expressed interest in obtaining more information about the criteria and alternative drug choices.Objective: This study examined the incidence, health care utilization, and costs associated with potentially inappropriate medications (PIMs) in elderly patients based on the modified Beers criteria.Methods: A retrospective, observational cohort study was conducted using health insurance claims data in Japan. The study population included elderly patients aged ≥65 years who had at least 2 pharmacy claims in separate months over a 1-year period (April 2006 through March 2007). Use of the PIMs was identified using the modified criteria, and 1-year incidence rates were calculated for the total study population and for subgroups stratified by age and sex. A logistic regression model was used to examine demographic and clinical characteristics associated with PIMs. Health care utilization rates and costs were also analyzed and compared between patients with and without PIMs using generalized linear models. All models included dummy variables indicating age category, female sex, hospitalization, polypharmacy, index month, and number of Elixhauser comorbidities to adjust for potential confounders.Results: Among 6628 elderly patients, 71.2% (4721/6628) were female and 62.9% (4167/6628) were aged 65 to 74 years; 43.6% (2889/6628) were prescribed at least one PIM. The most commonly used PIMs were histamine-2 blockers (20.5% [1356/6628]), benzodiazepines (11.4% [756/6628]), and anticholinergics and antihistamines (7.9% [526/6628]). No significant differences in incidence rates were observed based on age or sex. Inpatient service use, polypharmacy, and comorbidities of peptic ulcer, depression, and cardiac arrhythmias were significant predictors of PIM use while controlling for other factors. PIM users had significantly higher hospitalization risk (1.68-fold), more outpatient visit days (1.18-fold), and higher medical costs (33% increase) than did nonusers.Conclusions: In a group of elderly Japanese patients, 43.6% used at least one PIM over a 1-year period in this study. PIM use was associated with greater health care utilization rates and costs.     

护士分时段现场预约与走动式管理在门诊质控管理中的应用

目的探讨在门诊质控管理中采用护士分时段现场预约与走动式管理的效果。方法选择2020年3—4月在医院门诊就诊的患者89例作为对照组,实施常规门诊质控管理;同时选择2020年5—9月在医院门诊就诊的患者84例作为观察组,实施护士分时段现场预约与走动式管理;对比两组诊疗服务效果、就诊质量、护理管理质量及患者的满意度。结果观察组挂号时间、候诊时间、诊疗完成时间均短于对照组(P<0.05);观察组服务情况、就诊环境及诊疗体验均优于对照组(P<0.05);观察组分诊护理、药物管理、导诊服务、宣教水平、院感控制及行为规范均优于对照组(P<0.05);观察组患者对护理质量的满意度高于对照组(P<0.05)。结论在门诊质控管理中应用护士分时段现场预约与走动式管理效果显著,有效提高门诊的护理质量,缩短就诊、挂号时间,保证就诊顺利。