医院实施药学服务的影响因素与对策

目的:探讨和分析目前医院在实施药学监护、药学服务中存在的问题,提出相应的对策。方法:选取一家二级甲等医院,总结其临床药学服务、药学监护等相关情况。主要应用演绎及归纳的方法分析开展药学监护与药学服务的困难及其出现的问题。同时提出相应解决对策以提升该院的药学服务质量及监护水平。结果:药学服务开展过程中出现的问题有:药师的团队意识及专业技能低,培训不够系统化,临床药师人才不足;药学服务的工作分配粗糙;药物检测等基础研究条件差,研究水平低;未充分运用信息化与自动化;医院药物制剂技术及条件不足,药学服务未得到普及。针对以上问题的解决措施有:药师的工作应当引起医院的关注,增强其业务技能,改善工作环境;强化医院的基础硬件条件,充分借助现代信息与医疗科技手段;增加临床药师的实验室研究水准;医学制剂学应得到重视。结论:只有大型医院才有条件实施药学服务项目。需要有关权威部门制定相关法律条例,明文规定实施药学服务的详细内容、步骤及执行规范。     

What Triggers the Resolution of Alcohol Problems Without Treatment?*

This study investigated natural recoveries (self-change) from alcohol problems, and overcame several methodological problems that affected the few previous studies of this phenomenon. Three groups of individuals who had resolved an alcohol problem without treatment were interviewed about their drinking history, life events that occurred during the year prior to their resolution, and factors that helped maintain their resolution. As a control for prevalence of life events, a control group of nonresolved, nontreated alcohol abusers were interviewed about events in a randomly selected year. Collaterals were interviewed for all subjects. No life event or constellation of events was differentially associated with the resolutions across the three resolved groups or differentiated the resolved and nonresolved groups. Interviews with resolved subjects were qualitatively analyzed—the majority (57%) of recoveries were characterized as Involving a “cognitive evaluation” or appraisal of the pros and cons of drinking. Spousal support was reported by the greatest number of resolved subjects as having helped them maintain their resolution. Findings from this study may provide direction for developing new treatment strategies and for accelerating self-change among problem drinkers in the community. The study also demonstrates the importance of using a control group, without which very different conclusions might have been drawn.     

Comparison of Screening Instruments for Alcohol Problems Between Black and White Emergency Room Patients from Two Regions of the Country

A number of brief screening instruments to identify alcohol dependence exist, but the validity of these instruments across ethnic groups or regions of the country is not well established. The sensitivity and specificity of a number of standard screening instruments (CAGE, brief MAST, AUDIT, TWEAK, and RAPS), as well as other measures (History of Trauma Scale, breathalyzer reading, self-reported drinking before the event, and consuming five or more drinks at a sitting at least monthly) are compared against ICD-10 and DSM-IV criteria for alcohol dependence between probability samples of Black and White emergency room patients in Santa Clara County, CA (n= 716) and in Jackson, MS (n= 1330). Variability in the sensitivity of screening instruments among current drinkers was found to be greater between samples for both Blacks and Whites, than for Blacks compared with Whites within the same sample. The AUDIT, TWEAK, and RAPS seemed to perform well by gender and injury status for both Blacks and Whites in the two samples, and no significant differences were found in the performance of these instruments across sample sites. To evaluate the influence of regional differences in alcohol dependence on differences found in the performance of screening instruments, using logistic regression with the simultaneous entry of demographic variables (age, gender, ethnicity, injury status, and site) and drinking variables (breathalyzer reading, serf-reported drinking before the event, and drinking five or more drinks at a sitting at least monthly) to predict alcohol dependence in a merged sample of these patients (Jackson vs. Santa Clara) site was not found to be significant Data suggest that, whereas region of the country may not be important in predicting alcohol dependence in emergency room populations, regional differences in the performance of screening instruments for alcohol dependence may exist, even when ethnicity is taken into account Given distinct regional differences in drinking patterns and problems in the U.S., further research on commonly used screening instruments is needed to determine those screeners most efficient for identifying problem drinking.     

Alcohol Dependence and Abuse Diagnoses: Validity in Community Sample Heavy Drinkers

Despite the widespread influence of the alcohol dependence syndrome concept on the major nosological classification systems, little work has been done to test the validity of the alcohol dependence syndrome in community samples. In addition, numerous questions have been asked about the validity of current definitions of alcohol abuse. We examined the cross-sectional validity of DSM-IV alcohol dependence and abuse in 936 household residents randomly selected and screened for elevated drinking. We investigated validity by testing the association of a set of seven "criterion" variables, external to the alcohol diagnostic criteria, with dependence and abuse diagnoses. Results indicated that dependence diagnoses were significantly associated with all criterion variables when compared to those with no diagnosis, even though all subjects had elevated drinking and the cases of alcohol dependence were mild. In contrast, abuse diagnoses did not show a pattern of association with the criterion variables when compared to no diagnosis. When associations were tested comparing dependence cases to those with abuse only, results were mixed. This study is one in a series of investigations in this sample of household residents screened for elevated drinking levels.     

A Longitudinal Examination of the Relationships Among Stress, Coping Strategies, and Problems Associated with Alcohol Use

This study examined the longitudinal relationships among family history of alcoholism (FH+), stress levels, utilization of coping methods, and alcohol-related problems. Data used in this study were obtained from a nonclinical sample of subjects who were originally interviewed when they were 12, 15, or 18 years of age and followed-up twice more at 3-year intervals for a longitudinal sample size of 1270. Although a greater percentage of females in this sample reported a FH+ background as well as higher levels of stress, they tended to utilize positive coping strategies more often and reported fewer numbers of alcohol problems than males. In general, younger subjects who reported high levels of stress experienced more alcohol-related problems regardless of coping method chosen. In older subjects, the effect of stress on problems appeared to be buffered when coupled with the use of support seeking. Subjects whose stress preceded problems exhibited no significant difference from subjects whose problems preceded stress and symptom-free and "stressed-only" subjects were not significantly different from each other in number of problems at time 3, suggesting that a direct effect of stress alone on alcohol-related problems is questionable.     

Gender Differences in Patterns of Alcohol Consumption in Spain

Gender differences in alcohol consumption components, hazardous alcohol consumption, and drinking patterns among Spaniards were analyzed. The study was conducted in the fall of 1992 on 2,500 individuals, aged 14–70 years, who lived in the region of Castile and Leon (Spain). Males drank more frequently (with a high intake of alcohol), were more likely to be hazardous drinkers, and started drinking earlier than females. Both sexes drank beer in a similar way, but not wine and spirits. Males and females gave similar reasons for drinking and showed similar patterns of "family" drinking, although sex differences in other patterns of alcohol consumption were found. The relevance of results was discussed.     

Management of Sleep Problems in Pre-School Children: Effects of a Behavioural Programme on Sleep Routines, Maternal Depression and Perceived Control.

The sleep patterns of 31 children aged between 9 months and 3 1/2 years were studied over a period of 3 months during which time a behavioural programme was initiated and evaluated. Measures of the mothers' mental state and of the relative behavioural control the child was perceived to have were also taken. The childrens' sleep showed rapid improvement following the intervention and similar changes were observed in the other measures.     

POCT的临床应用及存在问题

随着免疫反应和分子生物技术的引进,即时检验（point of care testing,POCT）越来越受到人们的关注和重视。POCT临床应用广泛,主要用于儿科疾病、心血管疾病、感染性疾病、内分泌疾病、免疫性疾病、优生优育等方面的疾病的诊断及检测。但目前POCT还存在组织管理不够健全、质量控制体系不完善,检测成本偏高等问题。急需加强POCT临床应用的组织管理;加强非检验人员的操作培训;建立有效的质控措施;加强仪器功能的选择,做好仪器间的比对和日常实验过程中的室内质控,是POCT质量保证的重要手段。     

A Rasch Model Analysis of Alcohol Consumption and Problems Across Adolescence and Young Adulthood

Background:  Recent investigations using item response modeling have begun to conceptualize alcohol consumption, problems, and dependence as representing points along a single continuum of alcohol involvement. Such a conceptualization may be of particular benefit to measurement of alcohol involvement in adolescents, but investigations to date have been limited to adult samples and may not generalize to adolescents due to age-related developmental differences.
Methods:  This study used Rasch model analyses to examine the properties of indices of alcohol consumption and problems among 6,353 adolescents, aged 12 to 18 years, in Wave 1 of the Add Health survey. A particular focus was on whether the functioning of items changed when these adolescents were re-interviewed in Wave 3 when they were 18 to 24 years of age.
Results:  Rasch model analyses supported the unidimensionality and additive properties of the items in the Wave 1 data. Comparisons of Wave 1 and Wave 3 data indicated differential item functioning in most of the items such that items related to alcohol consumption were more severe during adolescence, whereas items related to alcohol problems were more severe in young adulthood.
Conclusions:  A valid index of alcohol involvement in adolescents can be constructed combining indices of alcohol consumption and alcohol problems. Such an index covers a range of severity and functions similarly across sex and race/ethnicity. A similar index can be constructed in young adulthood. However, the interpretation of scores must be attentive to developmental differences. In particular, for adolescents, indices of alcohol consumption are relatively closer in severity to indices of alcohol problems than they are among young adults. Thus, alcohol problems are more likely among adolescents than young adults given a similar level of drinking.     

Disparities in Alcohol-Related Problems Among White, Black, and Hispanic Americans

Background: This study assesses racial/ethnic disparities in negative social consequences of drinking and alcohol dependence symptoms among white, black, and Hispanic Americans. We examine whether and how disparities relate to heavy alcohol consumption and pattern, and the extent to which social disadvantage (poverty, unfair treatment, and racial/ethnic stigma) accounts for observed disparities. Methods: We analyzed data from the 2005 U.S. National Alcohol Survey, a nationally representative telephone‐based survey of adults ages 18 and older (N = 6,919). Given large racial/ethnic differences in abstinence rates, core analyses were restricted to current drinkers (N = 4,080). Logistic regression was used to assess disparities in alcohol‐related problems at 3 levels of heavy drinking, measured using a composite variable incorporating frequency of heavy episodic drinking, frequency of drunkenness, and maximum amount consumed in a single day. A mediational approach was used to assess the role of social disadvantage. Results: African American and Hispanic drinkers were significantly more likely than white drinkers to report social consequences of drinking and alcohol dependence symptoms. Even after adjusting for differences in heavy drinking and demographic characteristics, disparities in problems remained. The racial/ethnic gap in alcohol problems was greatest among those reporting little or no heavy drinking, and gradually diminished to nonsignificance at the highest level of heavy drinking. Social disadvantage, particularly in the form of racial/ethnic stigma, appeared to contribute to racial/ethnic differences in problems. Conclusions: These findings suggest that to eliminate racial/ethnic disparities in alcohol‐related problems, public health efforts must do more than reduce heavy drinking. Future research should address the possibility of drink size underestimation, identify the particular types of problems that disproportionately affect racial/ethnic minorities, and investigate social and cultural determinants of such problems.