药物从多孔骨架聚合物系统中恒速释放的机理

以组分的连续性方程为基础 ,建立了药物从多孔骨架聚合物系统中释放的数学模型。在模型中引入相对渗透速度来刻画药物释放过程中不同机理的影响。对药物从多孔骨架聚合物系统中non -Fickian扩散现象进行了研究 ,特别对药物溶出机制控制的恒速释药现象进行了解释。     

Doctor shopping before and after a visit to a paediatric emergency department

BACKGROUND:

Use of multiple care providers is known to be associated with poor continuity of care.

OBJECTIVES:

To estimate the prevalence of and identify risk factors for doctor shopping by parents of children with common acute illnesses seen in the emergency department (ED) of a children’s hospital.

SETTING:

ED at the Montreal Children’s Hospital (MCH), Montreal, Quebec.

METHODS:

Doctor shopping was defined as visiting three or more different care sites (the MCH ED, other EDs, outpatient clinics or private offices) for a single illness episode, including all visits occurring within successive 72 h periods up to a maximum of 15 days before and after an ED visit from April 1995 to March 1996. Logistic regression was used to compare characteristics of illness episodes with doctor shopping versus those without.

RESULTS:

Of the total 40,150 visits during the study period, doctor shopping was observed in 18% of the visits. The risk of doctor shopping was positively associated with an initial visit at other EDs (odds ratio [OR] 9.08, 95% CI 7.16 to 11.52), outpatient clinics (OR 4.47, 95% CI 3.71 to 5.37) or private offices (OR 1.71, 95% CI 1.48 to 1.96) versus those who visited the MCH ED first. The risk did not differ according to whether a paediatrician versus a general practitioner saw the child during the initial visit (OR 0.99, 95% CI 0.86 to 1.15). Some diagnoses (the reference category was upper respiratory infection), including urinary tract infection (OR 3.31, 95% CI 2.58 to 4.23) and gastroenteritis (OR 1.59, 95% CI 1.35 to 1.88), were associated with an increased risk of doctor shopping, while asthma was associated with a reduced risk (OR 0.71, 95% CI 0.60 to 0.86).

CONCLUSION:

Doctor shopping is common among parents of children with acute illnesses. Parents of children who were seen in the MCH ED first were less likely to doctor shop, perhaps because the parents were more confident about the advice and treatment received. Further research should investigate the underlying reasons for doctor shopping, eg, services other than an ED were not available and parents’ perceptions of the quality of health services.     

Guidance of children and adolescents with cystic fibrosis

Cystic fibrosis is the most common serious genetic disorder in people of European descent. Treatment of these patients is ongoing throughout life and until now has been aimed at the consequences and is still not curative. Over the past 10–20 years, there has been a dramatic improvement of mortality rates for cystic fibrosis, due in large part to advances in medical care. The average age of survival for young people with cystic fibrosis is pushing well into the 20s with one third living into their 30s. Consequently, education plays a major role in management of patients with cystic fibrosis, and starts directly after being sure of the diagnosis. Growing up, these patients experience a lot of problems, and these are especially marked in the adolescent. A special problem, for many cystic fibrosis patients is becoming an adult. Continuity in care for these patients from the pediatric to the adult department is not always guaranteed. It is concluded that patients with cystic fibrosis should be treated in specialized centers, and such treatment cannot be carried out sufficiently by one person, but has to be embedded in a team of caregivers.     

The effect on medication errors of pharmacists charting medication in an emergency department

Objective To determine the frequency and clinical significance of medication errors when (a) pharmacists elicit medication histories in the Emergency Department after medications have been prescribed by doctors and (b) pharmacists obtain and chart medication histories prior to doctors’ approval. Setting The Queen Elizabeth Hospital, a 350 bed South Australian teaching hospital, serving the local adult community. Method Emergency Department patients at risk of medication misadventure were recruited in two phases with a ‘usual practice’ arm (6 weeks) and a ‘pharmacist medication charting’ arm (5 weeks) reflecting an alternative intervention. In the ‘usual care’ arm, medication histories were compiled by a pharmacy researcher after a doctor had completed the medication chart. The researcher-elicited medication histories were compared with the doctors’ medication charts and unintentional discrepancies were recorded. In the ‘pharmacist medication charting’ arm, the same process was followed except the researcher compiled the patients’ medication histories at triage, prior to patients seeing a doctor. The medication history was then transcribed onto a medication chart for authorisation by a doctor. In addition, whether resolution of unintentional discrepancies for patients in the ‘usual care’ arm had occurred by discharge was determined by examining patients’ medical records. Main outcome measure Frequency of unintentional discrepancies and medication errors. Results The study included 45 and 29 patients in the ‘usual care’ and intervention arms, respectively. In the ‘usual care’ arm, 75.6% of patients had one or more unintentional discrepancies compared with 3.3% in the ‘pharmacist medication charting’ arm. This resulted in an average of 2.35 missed doses per patient in the ‘usual care’ arm and 0.24 in the intervention arm. In addition, an average of 1.04 incorrect doses per patient were administered in the ‘usual care’ arm and none in the ‘pharmacist medication charting’ arm. The differences observed between the arms were statistically significant (P < 0.05) and deemed clinically significant by a multidisciplinary panel. Conclusion This study provides evidence for pharmacists eliciting medication histories to prepare medication charts at the earliest possible opportunity following a patient’s presentation to the Emergency Department     

Association between continuity of care in Swedish primary care and emergency services utilisation: a population-based cross-sectional study

Objective: The primary objective of this study was to determine the association between longitudinal continuity of care (CoC) in Swedish primary care (PC) and emergency services (ES) utilisation.

Study design: A cross-sectional analysis of longitudinal population data. Setting. PC centres, out-of-hours PC facilities and emergency departments (EDs) in Blekinge County in southern Sweden. Subjects: People of all ages who lived in Blekinge County and who had made two or more visits per year to a general practitioner (GP) during office hours from 1 January 2012 to 31 December 2014.

Main outcome measure: ES utilisation.

Results: Eight-thousand one-hundred and eighty-five people were included in the study. CoC was quantified using three different indices—Usual Provider of Care index (UPC), Continuity of Care index (CoCI), and Sequential Continuity index (SECON). The CoC that the PC centres could offer their enrolled patients varied significantly between the different centres, ranging from 0.23–0.57 for UPC, 0.12–0.43 for CoCI, and 0.25–0.52 for SECON. Association between the three CoC indices and ES utilisation was computed as an incidence rate ratio which ranged between 0.50 and 0.59.

Conclusion: Longitudinal CoC was shown to have a negative association with ES utilisation. The association was significant and of a magnitude that implies clinical relevance. Computed incidence rate ratios suggest that patients with the lowest CoC had twice as many ES visits compared to patients with the highest CoC.     

Supportive care program,Pain Service,Memorial Sloan-Kettering Cancer Center

Advanced cancer patients being cared for at home, with severe pain and multiple symptoms, strain the resources of individual community practitioners and family members. Supportive care programs, such as that developed by the Pain Service at Memorial Sloan-Kettering Cancer Center (New York), with good communication and liaison work between hospital and community, add a much needed dimension to pain and symptom control for these patients and their families, as well as ongoing support to community physicians and nurses.     

基于连续性记录与评估工具对养老机构老年人生命质量及影响因素的分析

目的 基于美国连续性记录与评估工具分析养老机构老年人的生命质量及影响因素。方法 5名培训合格的评估员使用连续性记录与评估工具和欧洲五维健康量表,对北京市顺义区某养老机构的239例≥60岁的老年人进行评估。采用中国的量表效用值积分体系计算生命质量效用值,采用多元逐步线性回归模型分析养老机构老年人生命质量健康自评的影响因素。结果 养老机构老年人的生命质量效用值为（0.65±0.25）分,生命质量健康自评为（67.16±19.18）分。认知功能、吞咽功能、工具性日常生活活动能力和排泄功能是养老机构老年人生命质量健康自评的主要影响因素（P<0.05）。结论 养老机构老年人的生命质量总体水平相对较低。建议养老机构重点关注认知功能下降、吞咽功能障碍、工具性日常生活活动能力减退、排泄功能受损的老年人,并及时为老年人提供针对性的功能维持和改善服务,进一步完善养老机构的专业服务供给能力,从而提高养老机构老年人的生命质量。     

探讨外斜视手术后患者发生继发性内斜视的原因以及治疗方法

目的通过临床对外斜视手术后患者的临床观察分析,患者发生连续性内斜视的原因,并找出临床对患者的治疗方法。方法本文研究资料选取我院2008年1月至2010年1月所收治的外斜视手术患者95进行回顾性分析,观察患者术后发生连续性内斜视的原因,临床给予外斜视手术后发生连续性内斜视患者内斜矫正术,观察患者的治疗情况。结果外斜视手术患者术后发生连续性内斜视中外斜视患者的类型有:间歇性外斜视、集合不足型外斜视以及伴有垂直斜视类型,外斜视手术后发生连续性内斜视患者经过二次手术后,有34例患者眼位恢复正位,术后能够达到恢复双眼单视功能的有48例。结论通过临床对外斜视手术发生连续性内斜视患者的调查结果可以得知,患者的外斜视手术类型以及临床选择的手术方法会直接影响到患者的术后产生连续性内斜视情况。在对外斜视术后发生连续性内斜视患者的临床治疗中不应该立刻进行手术,应该选择对患者观察半年后再实行手术。     

农村卫生服务网络中连续性服务存在的问题与对策

本文分析了农村三级卫生服务网络之间的协调性与连续性的意义及其存在的卫生服务提供缺乏系统性、机构间缺乏有效的衔接与合作的机制、缺乏保障卫生服务连续性的政策支持等问题,从重构和完善卫生服务提供系统、强化机构间衔接与合作机制、发挥新型农村合作医疗制度对促进连续性卫生服务的导向作用及完善和保障卫生服务连续性政策的可持续发展等方面提出建议。     

Drop-out and continuity of care for patients suffering from schizophrenia and schizophrenia-like psychosis evaluated by means of routine registration

For most patients suffering from schizophrenia or other chronic psychoses, uninterrupted contact with psychiatric services for a long period is necessary. By means of routine registrations in Copenhagen County, the use of services in 1995 for patients suffering from schizophrenia or other ICD-10 F2 diagnoses ( n = 1356) was analysed. Substantial interregional differences were found in admission to more than one psychiatric department, admission to more than one similar ward, interruption in treatment and loss of contact with the patient. More than 25% had contact with at least four treatment modalities during 1995, and the proportion of patients who experienced interruption in treatment at least once during the year varied between 19% and 37%. It is concluded that routine registration of psychiatric services is a suitable means for quality assurance and ought to be used regularly in analyses like the one presented here. In concert with the literature, it is concluded that the interregional differences indicate that compliance with treatment can be improved by better organization of the psychiatric treatment.