Efficacy and safety of a pharmacist-managed inpatient anticoagulation service for warfarin initiation and titration

What is known and Objective: Anticoagulation consultations provided by a pharmacist‐staffed inpatient service, similar to the experience reported in outpatient anticoagulation clinics, can potentially improve anticoagulation control and outcomes. At Tan Tock Seng Hospital, a 1200‐bed acute care teaching hospital in Singapore, pharmacist‐managed anticoagulation clinics have been in place since 1997. Pharmacist‐managed services were extended to inpatient consultations in anticoagulation management from April 2006. Our objective was to assess the effect of implementing a pharmacist‐managed inpatient anticoagulation service. Methods: This was a single‐centre cohort study. Baseline data from 1 January 2006 to 31 March 2006 were collected and compared with post‐implementation data from 1 April 2006 to 31 March 2007. Patients newly started on warfarin for deep vein thrombosis, pulmonary embolism or atrial fibrillation in general medicine and surgery departments were included. The three endpoints were as follows: (i) percentage of international normalized ratios (INRs) achieving therapeutic range within 5 days, (ii) INRs more than 4 during titration and (iii) subtherapeutic INRs on discharge. Results and Discussion: A total of 26 patients in the control period were compared with 144 patients who had received dosing consultations by a pharmacist during the initiation of warfarin. The provision of pharmacist consult resulted in 88% compared to 38% (P < 0·001) of INR values achieving therapeutic range within 5 days. There was a reduction in INR values of more than 4 during titration from 27% to 2% (P < 0·001), and subtherapeutic INR values on discharge without low molecular weight heparin from 15% to 0% (P < 0·001). The mean time to therapeutic INR was reduced from 6·5 to 3·9 days (P < 0·001) and mean length of stay after initiation of warfarin from 11 to 7·7 days (P = 0·004). What is new and Conclusion: Inpatient anticoagulation care and outcomes were significantly improved by a pharmacist‐managed anticoagulation service. The time to therapeutic INR was achieved appropriately and efficiently without compromising patient’s safety.     

Anxiety and depression levels of inpatients in the city centre of Kirşehir in Turkey

Ünsal A, Ünaldi C, Baytemir Ç. International Journal of Nursing Practice 2011; 17 : 411–418 Anxiety and depression levels of inpatients in the city centre of Kir?ehir in Turkey The aim of this study was to determine the anxiety and depression levels of inpatients. A cross‐sectional study was conducted in K?r?ehir in the middle part of Turkey with a sample of 433 inpatients. As the data‐gathering tools, a questionnaire form and Hospital Anxiety and Depression Scale (HADS) were used. Statistical analyses were performed using Kruskal–Wallis Variance analysis and Mann–Whitney U‐test. The mean HADS‐depression scores of patients were compared according to the clinics they were in, and the difference was found to be significant for HADS‐depression (P < 0.01) scores. The mean HADS‐anxiety score of participants was 9.07, and the mean HADS‐depression scores was 8.88. Among the participants in this study, 44.3% had an anxiety disorder (HADS‐anxiety score of ≥ 10) whereas the 73.7% showed depression (HADS‐depression score of ≥ 7). Results indicate that support, counselling, and routine screening for anxiety and depression should be provided to inpatients.     

脑卒中患者出院时生活质量及相关因素分析

目的 调查脑卒中患者出院时生活质量,并分析其相关因素.方法 利用横断面研究设计,采用自设问卷和脑卒中生活质量影响量表3.0版对94例来自4所三级甲等医院住院脑卒中患者一般情况和入院及出院时的生活质量进行测评.结果 出院脑卒中患者生活质量影响量表6个领域的总分为(502.79±90.05)分;相关分析显示,年龄、住院时间...     

行为训练对矫正流浪精神病患者不良行为的效果观察

目的:探讨行为训练对矫正流浪精神病患者不良行为的效果。方法:将50例流浪救助精神病患者随机分为研究组和对照组,均使用抗精神病药物治疗,研究组同时进行为期4个月的行为训练。采用护士用住院病人观察量表(NOSIE)和住院病人康复疗效评定量表(IPROS)进行疗效评定。结果:行为训练前后,两组NOSIE、IPROS评分比较有显著性差异(P<0.05、P<0.01)。结论:行为训练能够有效矫正流浪救助精神病患者的不良行为,改善社会功能,促进患者早日回归社会。     

住院精神疾病患者治疗药物时点调查

目的：调查、分析住院精神疾病患者药物的应用情况,为临床合理用药提供参考依据。方法：采用一日法对闵行区精神卫生中心住院患者的精神药物处方情况进行调查。结果：1）本院住院患者相对集中于40～69岁的中老年患者;2）精神疾病联合用药现象比较普遍;3）抗精神病药物使用排列居前五位的依次为：氯氮平、利培酮、阿立哌唑、氯丙嗪、奥氮平,新型抗精神病药物已更多地应用于临床,且以单一用药的治疗方案为主;4）苯二氮类在合并用药中的使用频率较大,阿普唑仑的用量位居所有精神药物首位;5）精神药物类的平均使用剂量均在安全范围之内。结论：本院精神药物类使用总体情况合理。对于联合用药和苯二氮类的选择上应更多地兼顾药物相互作用、不良反应的影响和患者的经济支付能力,力求实现安全、有效、经济的用药目的。     

A retrospective evaluation of the impact of total smoking cessation on psychiatric inpatients taking clozapine

Cormac I, Brown A, Creasey S, Ferriter M, Huckstep B. A retrospective evaluation of the impact of total smoking cessation on psychiatric inpatients taking clozapine. Objective: To investigate the effect of a complete smoking ban on a group of psychiatric inpatients maintained on the antipsychotic medication clozapine. Method: Retrospective data on clozapine dose and plasma levels were collected from a three month period before and a six month period after the introduction of the smoking ban. Results: Before the ban only 4.2% of patients who smoked had a plasma clozapine level ≥1000 μg/l but after the ban this increased to 41.7% of the sample within the six month period following the ban despite dose reductions. Conclusion: Abrupt cessation of smoking is associated with a potentially serious risk of toxicity in patients taking clozapine. Plasma clozapine levels must be monitored closely and adjustments made in dosage, if necessary, for at least six months after cessation.     

Which factors predict the persistence of DSM-IV depression, anxiety, and somatoform disorders in the medically ill three months post hospital discharge?

Objective

This study sought to assess the persistence of DSM-IV depression, anxiety, and somatoform disorders in a sample of 206 medical patients 3 months after hospital discharge and to examine which baseline factors predicted the persistence of disorder.

Methods

Patients were interviewed using the Monash Interview for Liaison Psychiatry (a structured psychiatric interview for the medically ill) during admission and again at 3 months post discharge. Scales completed during admission elicited sociodemographic data, psychiatric history, mental and physical functioning, illness behavior, coping modes, and number of close relationships. Best-subset logistic regression was employed to find the best combination of these potential predictors of the persistence of psychiatric disorder.

Results

Persistence of anxiety disorders [n=43; 50.6%; 95% CI=39.5-61.6], depression (n=55; 44.4%; 95% CI=35.4-53.5), and somatoform disorders (n=35; 42.2%; 95% CI=31.3-53.0) was moderately high, with no statistically significant difference in the rate of persistence of the three groups of disorder. Family psychiatric history, education, and poorer physical and mental functioning during hospitalization predicted persistence of depression. Poorer mental functioning, less denial, and greater number of close relationships predicted persistence of anxiety disorders. Higher levels of education, use of acceptance-resignation as a coping mechanism, and greater hypochondriasis predicted persistence of somatoform disorders.

Conclusion

The belief that psychiatric disorders in hospitalized medically ill patients spontaneously remit after discharge is false. A substantial proportion persist for at least 3 months. Early detection and treatment is possible and warranted. Features of the illness (poorer physical and mental health) and personal and social factors identifiable at hospital admission identify patients at risk for persistence.     

“农疗”对慢性精神分裂症住院患者的康复效果

目的探讨＂农疗＂对慢性精神分裂症住院患者的康复效果。方法将68例住院精神分裂症患者随机分成研究组和对照组各34例,两组均接受常规康复治疗,在此基础上研究组联合＂农疗＂。采用阳性和阴性症状量表（PANSS）、Morn ing-side康复状态量表（MRSS）、一般健康问卷（GHQ-28）分别在治疗前及治疗第12月末进行评估。结果治疗12月末时,研究组患者的PANSS总分、MRSS总分及GHQ总分均下降;研究组、对照组PANSS总分减分值分别为（6.59±1.80）、（2.66±1.06）,研究组减分值优于对照组（t=-11.052,P〈0.01）;研究组GHQ总分（10.03±1.87）低于对照组（17.37±1.48）,有统计学差异。结论 ＂农疗＂有助于改善慢性精神分裂症住院患者的精神症状,促进康复。