A programme of individualized and self-administration of medicines in a hospice

Hospice care is changing. Statistics show that people are surviving longer with cancer and many more are choosing to be cared for in the community. The hospice is no longer an institution solely for the care of people in the terminal phase of their illness but is involved in the palliation of symptoms, so allowing patients to return home to independent living. It was with this in mind that we recognized the need for the introduction of a programme of individualized and self-administration of medication at the hospice where we work. Although self-administration of medication was our first aim, the individuality of care brought about by its introduction, the adaptations required to include all palliative care patients and the resulting enhancement of holistic patient care, has become the main thrust of the project. This article will explore the term 'self-administration of medication'; the evidence of its use in other areas of health care; the rationale for change within the hospice movement; consequences to practice; and the staged implementation of a programme of individualized and self-administration of medication.     

An evaluation of nurse-led team care within a rehabilitation ward for elderly people

• ? This small exploratory study evaluated the effects of introducing a system of nurse-led team care on a ward providing intensive nursing and rehabilitation to elderly people.
• ? A quasi-experimental design compared three variables between the study ward and two similar wards within the unit. These were:

• — quality of care,
• — job satisfaction,
• — length of patient stay. Quantitative data were complemented by semi-structured interviews with team members and by observation of team meetings.

• ? Quality of care scores showed an improvement on the study ward, but no difference on the main comparison ward. There were no differences between nurse job satisfaction between the study and comparison wards or in length of patient stay throughout the period of evaluation.
• ? Observation of team meetings suggested that communication was more structured and focused on the study ward and that patient goals were more clearly specified. Interviews suggested three main factors in successful implementation of the change to nurse-led team care:

• — commitment of the team,
• — open communication about difficulties,
• — the support of managers and medical staff. The main effects noted were:

• — partnership with patients,
• — equality between team members,
• — improved decision making and quality of care.

• ? Further studies of nurse-led team care are required, and the stress and anxiety for staff consequent on developing the nurse's role in this way should be considered.

     

证据与基本药物:药物目录的筛选、评价和持续

1　前言在许多医院和卫生经济系统 ,药典和基本药物目录屡见不鲜。虽然其使用和有效性缺乏高质量的研究去论证 ,但这体现了资源的有效管理。反映出证据的宁缺毋滥。药典 (我将从这里开始使用这个术语 )的价值基于 :确保一套适用于所有人的基本药物 ;确保病人可随时获取所需要药物 ;确保高质量地治疗常见病。此外 ,药典便于药剂师购买药物和管理库存 ,鼓励地方生产和批发销售 ,而且能够直接培训低年资医生并指导他们处方。药典的编订很费时 ,需要一丝不苟 ,并且容易过时。药典过时后对任何人都毫无裨益 ,只能废弃。我将在本文讨论其中的一些…     

特需病房护理管理新模式的应用及效果评价

[目的]提高特需病房的护理质量和满意度.[方法]回顾性分析过去两年特需病房病人的身份、疾病种类及提出的意见,以及不同身份、不同病种病人的满意度,概括总结出我科护理工作中存在的主要问题和缺陷,并针对这些问题进行有针对性的应对:改变病房的分配模式;对全科护士进行为期半年的专科进修与培训;对不同疾病的病人安排相应的护士实施护理;对重点病人进行重点照顾.[结果]在实施新的护理管理模式后,病人对我科护理工作的满意度显著上升.[结论]基于我科资料回顾分析结果设计而成的护理管理模式的应用,对提高特需病房的护理质量和病人满意度是行之有效的.     

Collaboratively planning for medicines administration competency: a survey evaluation

hemingway s., baxter h., smith g., burgess-dawson r. & dewhirst k. (2011) Journal of Nursing Management  19, 366–376
Collaboratively planning for medicines administration competency: a survey evaluation Aims This survey evaluated the experiences of mental health nurses who had undergone assessment of their competence in the administration of medicines using established assessment frameworks. Background Medicines management activities have at times been widely criticized. Joint collaborations between Higher Education Authorities and the National Health Service in education and training can start to address some of these criticisms. Method A questionnaire using 22 closed and open response questions was distributed to 827 practising mental health nurses and 44 graduate mental health nurses. Results A total of 70 registered and 41 graduate mental health nurses who had completed the assessment of administration competency frameworks responded to the survey. Response rates were 24 and 96%, respectively. The assessment frameworks were received positively. Environmental factors were perceived as the main barrier to medicines safety; however, this was not reflected in how this aspect of the competency framework was perceived. Implications for nursing management The administration of medicines is an area of mental health and all fields of nursing practice that needs attention. The use of competency frameworks as outlined in the ‘Medicine with Respect Project’ is one strategy to achieve the improvement in this essential clinical skill.     

Hepatotoxicity evaluation of traditional Chinese medicines using a computational molecular model

Background: Liver injury caused by traditional Chinese medicines (TCMs) is reported from many countries around the world. TCM hepatotoxicity has attracted worldwide concerns.

Objective: This study aims to develop a more applicable and optimal tool to evaluate TCM hepatotoxicity.

Methods: A quantitative structure-activity relationship (QSAR) analysis was performed based on published data and U.S. Food and Drug Administration’s Liver Toxicity Knowledge Base (LTKB).

Results: Eleven herbal ingredients with proven liver toxicity in the literature were added into the dataset besides chemicals from LTKB. The finally generated QSAR model yielded a sensitivity of 83.8%, a specificity of 70.1%, and an accuracy of 80.2%. Among the externally tested 20 ingredients from TCMs, 14 hepatotoxic ingredients were all accurately identified by the QSAR model derived from the dataset containing natural hepatotoxins.

Conclusions: Adding natural hepatotoxins into the dataset makes the QSAR model more applicable for TCM hepatotoxicity assessment, which provides a right direction in the methodology study for TCM safety evaluation. The generated QSAR model has the practical value to prioritize the hepatotoxicity risk of TCM compounds. Furthermore, an open-access international specialized database on TCM hepatotoxicity should be quickly established.     

产超广谱β内酰胺酶产酸克雷伯菌的医院感染流行分析

目的：研究同一时期、同一病房、不同病人临床分离的8株多重耐药产酸克雷伯菌的同源特性。方法：对8株产酸克雷伯菌进行药物敏感性试验、超广谱β内酰胺酶（ESBLs)表型测定，等电聚焦电泳、脉冲场凝胶电泳，聚合酶链反应（PCR）及PCR产物测序等分子生物学分析。结果：8株产酸克雷伯菌为产CTX－M－3型ESBLs的亲缘关系密切的同源菌。结论：8株产酸克雷伯菌在同一病房引起过小规模暴发流行，系同源菌。     

Pain and rheumatology: An overview of the problem

Actually pain is a very important health problem, affecting the majority of people, leading to a significant worsening of patients quality of life and being responsible for a large amount of both medical resources’ expenses and indirect costs. Between the different causes of pain, rheumatic conditions are predominant; in fact diseases such as osteoarthritis (OA), rheumatoid arthritis (RA), fibromyalgia (FM) and extra-articular rheumatisms (EARs) are not only frequently observed, but are also invariably associated with pain occurrence. According to the wide range of rheumatic diseases described, pain expression is complex and not univocal, being influenced not only by the underlying disease, but also by other factors. Generally, 3 rhythms of pain presentation are described in rheumatic conditions: the “inflammatory” rhythm, characteristic of chronic arthritis, the “mechanic” one, characteristic of degenerative joint’s diseases such as OA, and the “fibromyalgic” one, described in patients affected by FM; however also a true “neuropathic” pain may be present in these patients. This classification may be useful in the initial screening of the diseases potentially underlying to a painful syndrome, and in the follow-up of patients once established the diagnosis. With this paper we describe the different aspect and the burden of pain in different rheumatic diseases.     

The evaluation of a framework for measuring the non-technical ward round skills of final year nursing students: An observational study

BackgroundThe importance of non-technical skills (NTS) to patient outcomes is increasingly being recognised, however, there is limited research into how such skills can be taught and evaluated in student nurses in relation toward rounds.ObjectivesThis pilot study describes an evaluation of a NTS framework that could potentially be used to measure ward round skills of student nurses.Design and MethodsThe study used an observational design. Potential key NTS were identified from existing literature and NTS taxonomies. The proposed framework was then used to evaluate whether the identified NTS were evident in a series of ward round simulations that final year general nursing students undertook as part of their training. Finally, the views of a small group of qualified nurse educators, qualified nurses and general nursing students were sought about whether the identified NTS were important and relevant to practice.ResultsThe proposed NTS framework included seven categories: Communication, Decision Making, Situational Awareness, Teamwork and Task Management, Student Initiative and Responsiveness to Patient. All were rated as important and relevant to practice.ConclusionThe pilot study suggests that the proposed NTS framework could be used as a means of evaluating student nurse competencies in respect of many non-technical skills required for a successful ward round. Further work is required to establish the validity of the framework in educational settings and to determine the extent to which it is of use in a non-simulated ward round setting.     

Consumer satisfaction on a psychiatric ward

A survey of consumer satisfaction was carried out on one ward of the psychiatric unit of a district general hospital. Data were collected by questionnaire, the content of the questionnaire being guided by a number of semi-structured interviews. The information collected suggested many ways in which the patients' time in hospital could be made more comfortable and relaxed. Areas attracting particular concern were the food, noise, the provision of information and boredom. The various methods which can be used to elicit consumer views are described, and we have discussed the value and possible obstacles to users having more influence in the planning and running of mental health services.