Psychotropic medication in chronic spinal disorders.

BACKGROUND CONTEXT: Optimal treatment of nonmalignant chronic spinal disorders (CSDs) may require the use of one or more nonopioid psychotropic medications. Vast research literature has documented high rates of psychiatric disorders in patients with CSDs. Psychotropic medications are one type of effective treatment for these disorders. Many medications of this type are also used as adjuvants to primary analgesic medications. PURPOSE: Physicians treating CSDs may have little training and experience in prescribing psychotropic medications. Further, they may possess limited information about the efficacy of these types of medications in treating psychiatric disorders comorbid with CSDs or as adjunctive analgesics. Because of the wide variety (antidepressants, anxiolytics, sleep-promoting agents, anticonvulsants, neuroleptics, muscle relaxants) and numerous indications for psychiatric medications, a concise review of the use of psychotropic medications with CSD patients is offered for the spine specialist. STUDY DESIGN: A systematic review of the contemporary English literature on psychotropic medications in the CSD population. METHODS: A computerized search of MEDLINE was performed on all English literature published from 1982 to August 2002. RESULTS: Psychotropic medications have been found to be very efficacious in the large subgroup of patients with CSDs with psychiatric comorbidity, particularly patients with the common constellation of depression, anxiety, excessive somatic complaints, insomnia and irritability. Although the type of medication indicated depends on the particular psychiatric syndrome(s), antidepressants have been found to be extremely useful with the constellation described above. There is less evidence to support the use of nonopioid psychotropic medications in the treatment of nociceptive pain, although clinical experience indicates that some individuals demonstrate a marked analgesic response. Research support for the efficacy of particular psychotropic medications in treating neuropathic pain is stronger, although more controlled research is clearly needed. CONCLUSIONS: Psychotropic medications are extremely useful in the treatment of psychiatric disorders comorbid with CSDs and modestly useful as analgesic adjuvants, particularly with pain of neuropathic etiology. Familiarity with these medications will aid the primary treating physician in optimizing outcomes in this difficult group of patients.     

慢性前列腺炎/慢性骨盆疼痛综合征药物治疗进展

慢性前列腺炎(chronic prostatitis.CP)是泌尿外科门诊中最常见的一种疾病,流行病学调查显示:CP在男性人群发病率高达2.5%～16.0%,慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)是CP中最常见也是疗效最差的类型,其发病机制目前不是很清楚.治疗没有规范和标准.本文就近年来国内外有关CWCPPS药物治疗方面的新进展作一综述,并探讨目前治疗所面临的主要问题及可能原因.     

联合用药吸入治疗慢性阻塞性肺疾病的用药监护

COPD是临床呼吸系统疾病中较为常见的多发病。该病的发病率较高,患者较多,而且其临床死亡率也是比较高的,因而给患者及家属均带来了严重的心理及经济上的压力。选取我院近年收治的1例COPD急性发作期患者作为研究对象。结合病例具体病情及COPD指南,开展治疗及用药监护工作,经治疗15d后基本痊愈。药师通过实际参与临床诊治,结合患者具体病情,通过开展用药监护,能够有效提升COPD急性期用药有效性及安全性。     

Sleep disturbance in patients taking opioid medication for chronic back pain

Poor sleep is an increasingly recognised problem with chronic pain and further increases the effect on daily function. To identify the relationship between chronic pain, opioid analgesia and sleep quality, this study investigated activity and sleep patterns in patients taking opioid and non‐opioid analgesia for chronic back pain. Thirty‐one participants (10 healthy controls, 21 patients with chronic pain: 6 on non‐opioid medication; 15 on opioid medication) were assessed using actigraphy, polysomnography and questionnaires. Patients with chronic pain subjectively reported significant sleep and wake disturbances as shown by decreased overall sleep quality (Pittsburgh Sleep Quality Index, p < 0.001), increased symptoms of insomnia (Insomnia Severity Index, p < 0.001) and increased fatigue (Fatigue Severity Scale, p = 0.002). They also spent increased time in bed (p = 0.016), took longer to get to sleep (p = 0.005) and had high interindividual variability in other measures of activity but no overall irregular rest‐activity pattern. Patients on high doses of opioids (> 100 mg morphine‐equivalent/day) demonstrated distinctly abnormal brain activity during sleep suggesting that polysomnography is necessary to detect sleep disturbance in this population in the absence of irregular rest‐activity behaviour. Night‐time sleep disturbance is common in individuals suffering from chronic pain and may be further exacerbated by opioid treatment. Considerations must be made regarding the appropriate use of combined actigraphy and miniaturised polysomnography for future population‐based studies.     

社区老年慢性病患者用药困惑的质性研究

目的了解社区老年慢性病患者用药过程中存在的困惑。方法应用质性研究方法,对32例社区老年慢性病患者进行深度访谈,采用Colaizzi现象学研究法分析资料。结果提炼出4个困扰社区老年慢性病患者用药的问题:如何寻找可靠的用药信息、如何做到遵医嘱服药、担心服药过量、如何合理服用非处方药。结论社区老年慢性病患者用药过程中存在一些困惑,医护人员需要根据其存在的问题提供帮助和支持,以保证其用药安全。     

游泳运动与药物综合治疗对慢性非细菌性前列腺炎大鼠TNF-α、IL-1β和IL-6水平的影响

目的:观察游泳运动与药物综合治疗对慢性非细菌性前列腺炎(CAP)大鼠前列腺组织中TNF-α、IL-1β和IL-6水平的影响。方法:成年雄性健康SD大鼠40只,随机分为正常对照组、CAP模型对照组、药物治疗组、运动治疗组及运动与药物综合治疗组,每组8只。注射消痔灵制备CAP大鼠模型,造模期7 d后药物治疗组和综合治疗组每天给予前列舒通胶囊水溶液(0.016 g/ml)灌胃治疗(剂量为20 ml/kg);运动治疗组和综合治疗组每天于固定时间进行1次游泳运动,第1天35 min/次,每天递增5 min,直至50 min/次,每周6 d,持续4周;正常对照组、CAP模型对照组及运动治疗组给予无菌生理盐水灌胃(剂量同上)。于治疗过程中的第14、28天分别处死各组大鼠4只,并提取前列腺,观察组织病理学改变,制作组织匀浆;采用ELISA法检测组织匀浆内TNF-α、IL-1β、IL-6的水平。结果:第14天时,正常对照组、CAP模型对照组、药物治疗组、运动治疗组及综合治疗组大鼠前列腺组织匀浆内TNF-α水平依次为(20.36±1.82)、(183.08±8.07)、(118.49±8.06)、(169.63±10.64)、(107.82±7.81)pg/ml,IL-1β依次为(14.64±1.91)、(57.55±3.53)、(42.64±4.64)、(50.45±5.71)、(40.35±6.93)pg/ml,IL-6依次为(70.58±2.09)、(256.15±13.95)、(200.74±9.33)、(245.23±6.49)、(187.04±10.85)ng/L,后面4组的TNF-α、IL-1β和IL-6水平均明显高于正常对照组(P0.05);第28天时,综合治疗组的TNF-α、IL-1β、IL-6水平依次为(29.30±3.78)pg/ml、(16.91±1.24)pg/ml、(88.65±6.74)ng/L,药物治疗组依次为(39.67±3.19)pg/ml、(26.27±3.49)pg/ml、(110.26±6.33)ng/L,综合治疗组的TNF-α、IL-1β、IL-6水平显著低于药物治疗组(P0.05),并逐渐接近正常对照组[依次为(19.34±1.76)pg/ml、(13.68±1.06)pg/ml、(71.34±2.50)ng/L]水平。在治疗过程的14~28 d,正常对照组大鼠的前列腺病理学检查未见明显变化;模型对照组大鼠前列腺组织表现为明显的慢性炎症的病理变化;各治疗组大鼠前列腺慢性炎症改变均有不同程度缓解,其中综合治疗组的慢性炎症明显减轻。结论:游泳运动能够降低CAP大鼠炎症程度,与药物并用综合治疗可有效降低CAP大鼠TNF-α、IL-1β和IL-6水平,并改善组织学损伤。     

居家老年慢性病共病患者药物自我管理干预方案的实施

目的 评价居家老年慢性病共病患者药物自我管理方案的实施效果。方法 基于自我决定理论和信息-动机-行为理论模型构建居家老年慢性病共病患者药物自我管理干预方案。随机选取郑州市2个社区卫生服务中心的80例老年慢性病共病患者,使用抽签法将A社区卫生服务中心分为对照组,B社区卫生服务中心为干预组,两组各40例。对照组实施有关药物知识的健康教育,每周1次,连续8周,干预组在对照组基础上实施药物自我管理干预,每周1次,连续8周。干预后采用药物自我管理量表、基本心理需要满足量表、合理服药自我效量表、服药依从性量表进行评价。结果 干预后,干预组药物自我管理、基本心理需要满足、合理服药自我效能和服药依从性得分显著高于对照组（均P<0.05）。结论 对居家老年慢性病共病患者实施药物自我管理干预方案,可提高患者药物自我管理水平,激发患者合理服药自我效能,提升患者服药依从性。     

Approval of courses in new skills

The Committee on Emerging Surgical Technologies has previously published "Guidelines for Evaluation of Credentials of Individuals for the Purpose of Awarding Surgical Privileges in New Technologies." In that statement, which was approved by the American College of Surgeons' Board of Regents and published in 1994, the completion of a defined educational program in the technology, including didactic and practical elements, was recommended. The following statement, which was approved by the Board of Regents in October 1997, defines standards for courses in new technology that are designed to prepare the practicing surgeon to apply the technology to the care of patients.     

老年慢性病共病患者合理服药自我效能的潜在剖面分析

目的 探究老年慢性病共病患者合理服药自我效能的潜在分型,以及与药物自我管理行为的关系,为精准干预提供依据。 方法 选取河南省3所三级甲等医院住院治疗的371例老年慢性病共病患者为调查对象。研究工具包括一般资料调查表、慢性病老年人药物自我管理行为量表和合理服药自我效能量表。对老年患者合理服药自我效能进行潜在剖面分析,采用logistic回归分析合理服药自我效能各潜在类别的影响因素。 结果 老年慢性病共病患者合理服药自我效能可分为低抗挫组（50.13%）、低掌控组（28.03%）和高抗挫-高掌控组（21.84%）;药物自我管理行为得分越低,个体被归为低抗挫组和低掌控组的风险越大（均P＜0.05）。 结论 老年慢性病共病患者合理服药自我效能具有3个潜在类别,与药物自我管理行为相互影响;医护人员应针对患者服药自我效能特征,实施精准干预,增强患者合理服药自我效能和药物自我管理能力。     

老年慢性病共病患者合理服药自我效能的潜在剖面分析

目的 探究老年慢性病共病患者合理服药自我效能的潜在分型,以及与药物自我管理行为的关系,为精准干预提供依据。方法 选取河南省3所三级甲等医院住院治疗的371例老年慢性病共病患者为调查对象。研究工具包括一般资料调查表、慢性病老年人药物自我管理行为量表和合理服药自我效能量表。对老年患者合理服药自我效能进行潜在剖面分析,采用logistic回归分析合理服药自我效能各潜在类别的影响因素。结果 老年慢性病共病患者合理服药自我效能可分为低抗挫组（50.13%）、低掌控组（28.03%）和高抗挫-高掌控组（21.84%）;药物自我管理行为得分越低,个体被归为低抗挫组和低掌控组的风险越大（均P＜0.05）。结论 老年慢性病共病患者合理服药自我效能具有3个潜在类别,与药物自我管理行为相互影响;医护人员应针对患者服药自我效能特征,实施精准干预,增强患者合理服药自我效能和药物自我管理能力。     

关于厂商认证注射医师的思考

近年来,一些注射产品的厂家开始进行认证医师制度,列出了一些可以注射该产品的医师。这一制度在厂家自身的宣传和炒作中发挥了一定作用,但是的确给整个行业带来一定的影响。本文概述了这一制度的不足之处,期望广大医师和厂家分别给予重视。     

Summary of the US FDA Approval of Belatacept

Elements of the Food and Drug Administration (FDA) review of the clinical data that supported the approval of the Biologics License Application (BLA) for belatacept for prophylaxis of organ rejection in adult patients receiving a kidney transplant are summarized. The article is not intended as a comprehensive summary of the entire belatacept data submission. Rather, the discussion is meant to illustrate aspects of the FDA's process for evaluating efficacy and safety, using belatacept as an example.     

老年慢性病患者医院-家庭过渡期安全用药管理的研究进展

总结慢性病患者在医院-家庭过渡期常见用药问题、评价工具、安全用药现状、保障措施等内容,提出医疗卫生体系应重视老年慢病患者医院-家庭过渡期用药安全,加强多学科团队合作,优化安全用药管理流程,实施药物审核及优化,调动患者药物自我管理的积极性,建立医疗共享平台,以实现老年慢性病患者医院-家庭过渡期安全用药。