Integrating pharmacists into Aboriginal Community Controlled Health Services (IPAC project): Protocol for an interventional,non-randomised study to improve chronic disease outcomes

BackgroundAboriginal and Torres Strait Islander peoples experience a higher burden of chronic disease yet have poorer access to needed medicines than other Australians. Adverse health outcomes from these illnesses can be minimised with improved prescribing quality. This project aims to improve quality of care outcomes for Aboriginal and Torres Strait Islander adult patients with chronic disease by integrating a pharmacist within primary health care teams in Aboriginal Community Controlled Health Services (ACCHSs).MethodologyThis non-randomised, prospective, pre and post quasi-experimental study, will be pragmatic, community-based and participatory, comparing outcomes and costs using paired patient data. Pharmacists will be integrated at 22 sites for approximately 15 months to conduct patient-related and practice-related activities through 10 core roles: providing medication management reviews, assessing adherence and medication appropriateness, providing medicines information and education and training, collaborating with healthcare teams, delivering preventive care, liaising with stakeholders, providing trnsitional care, and undertaking a drug utilisation review. With patients’ consent, de-identified client-level data will be extracted from clinical information systems and pharmacists will record deidentified activity in an electronic logbook. Primary expected outcomes include improvements in biometric indices (glycated haemoglobin, systolic and diastolic blood pressure, lipids, cardiovascular risk, albumin-creatinine ratio) from baseline to end of study. Expected secondary outcomes include improvements in estimated glomerular filtration rate, prescribing indices (appropriateness, overuse and underuse), medication adherence, self-assessed health, and health service utilisation indices. A qualitative assessment of stakeholder and patient perceptions and a cost-effectiveness analysis will be undertaken.DiscussionNumerous inquiries have recommended evaluating the impact of pharmacists integrated within primary health care settings. This study is the first to explore this impact on the health of Aboriginal and Torres Strait Islander peoples who are medically underserved. Evaluation of innovative integrated workforce models is necessary to address the challenges of delivering quality care together with this population.     

裸花紫珠颗粒联合替硝唑、头孢呋辛钠治疗慢性盆腔炎患者的疗效评价

目的分析裸花紫珠颗粒联合替硝唑氯化钠注射液、头孢呋辛钠抗菌药物治疗慢性盆腔炎(CPID)患者的临床效果。方法选取2017年1月~2018年12月某院CPID患者126例,随机分为研究组(n=63)与对照组(n=63),对照组予以替硝唑氯化钠注射液、头孢呋辛钠治疗,研究组在对照组基础上加用裸花紫珠颗粒。对比两组疗效、临床症状改善时间(发热、白带异常、下腹痛)及治疗前后血清炎性因子水平[白细胞介素-1β(IL-1β)、单核细胞趋化蛋白-1(MCP-1)]变化。结果研究组总有效率92.06%(58/63)较对照组79.37%(50/63)高(P<0.05);研究组发热、白带异常、下腹痛改善时间较对照组短(P<0.05);治疗后,研究组血清IL-1β、MCP-1水平较对照组低(P<0.05)。结论裸花紫珠颗粒联合替硝唑氯化钠注射液、头孢呋辛钠抗菌药物治疗CPID患者效果显著,可减轻炎症反应,改善患者临床症状。     

荨麻疹汤联合枸地氯雷他定片治疗慢性荨麻疹临床疗效观察

目的观察荨麻疹汤联合枸地氯雷他定片治疗慢性荨麻疹的方法以及临床疗效。方法 120例慢性荨麻疹患者,随机分成治疗组和对照组,每组60例。对照组给予枸地氯雷他定片口服治疗,治疗组在对照组基础上加用自制荨麻疹汤治疗。比较两组临床疗效、不良反应发生情况。结果治疗组治疗总有效率93.3%明显高于对照组的76.7%,差异具有统计学意义(P<0.05)。治疗组发生轻度嗜睡、口干6例(10.0%),对照组发生轻度嗜睡、口干4例(6.7%),比较差异无统计学意义(P>0.05),且均不影响后续治疗,停药后症状缓解。结论荨麻疹汤联合枸地氯雷他定片治疗慢性荨麻疹临床疗效好,值得推广应用。     

兰索拉唑治疗慢性胃溃疡的效果及用药不良反应评价

目的评价兰索拉唑治疗慢性胃溃疡的效果及用药不良反应。方法100例慢性胃溃疡患者,通过随机数字编号分为对照组与研究组,每组50例。对照组给予奥美拉唑肠溶片治疗,研究组采用兰索拉唑肠溶胶囊治疗,比较两组生活质量评分、治疗效果、不良反应(腹泻、头痛)发生情况。结果治疗后,研究组生活质量评分(80.32±2.33)分高于对照组的(73.31±3.21)分,差异具有统计学意义(P<0.05)。研究组治疗总有效率96.00%高于对照组的84.00%,差异具有统计学意义(P<0.05)。研究组不良反应发生率4.00%低于对照组的16.00%,差异具有统计学意义(P<0.05)。结论兰索拉唑治疗慢性胃溃疡的临床效果显著,可以有效降低患者的用药后不良反应发生率,能够改善患者的生活质量水平。     

左氧氟沙星联合甲硝唑对慢性盆腔炎患者的炎症因子水平及安全性的影响

目的探讨左氧氟沙星与甲硝唑联用对慢性盆腔炎患者的安全性、疗效及炎症因子水平的影响。方法 100例慢性盆腔炎患者,按治疗方法的不同分为对照组和观察组,每组50例。对照组患者给予左氧氟沙星胶囊治疗,观察组患者在对照组基础上加用甲硝唑片治疗。比较两组患者治疗前后各炎症因子[全血白细胞计数(WBC)、中性粒细胞绝对值(NEUT#)、中性粒细胞百分比(NEUT%)、降钙素原(PCT)、C反应蛋白(CRP)]水平的变化情况、临床效果以及治疗期间不良反应发生情况。结果治疗后,观察组WBC、NEUT#、NEUT%、PCT、CRP分别为(6.35±0.90)×10^9/L、(5.60±1.20)×10^9/L、(58.00±2.10)%、(0.11±0.02)ng/L、(5.46±1.32)mg/L,对照组分别为(7.50±1.20)×10^9/L、(6.20±1.30)×10^9/L、(60.00±3.60)%、(0.18±0.12)ng/L、(6.32±1.26)mg/L;两组WBC、NEUT#、NEUT%、PCT、CRP均较治疗前降低,且观察组降低幅度大于对照组,差异均有统计学意义(P<0.05)。观察组不良反应发生率8.0%与对照组的6.0%比较,差异无统计学意义(P>0.05)。观察组治疗总有效率96.0%高于对照组的84.0%,差异有统计学意义(P<0.05)。结论左氧氟沙星联合甲硝唑治疗慢性盆腔炎的疗效较为确切,明显改善了机体炎症因子水平,且安全性较高。     

Addressing Sexuality Among People Living With Chronic Disease and Disability: A Systematic Mixed Methods Review of Knowledge,Attitudes, and Practices of Health Care Professionals

ObjectiveTo systematically review health care professionals’ practices and attitudes toward addressing sexuality with people who are living with chronic disease and disability.Data SourcesScopus, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, and MEDLINE were searched to August 2020 for English language publications. Reference lists of relevant publications were also searched.Study SelectionEligible studies reported on knowledge, attitudes, and behaviors of health care professionals about addressing sexuality in the context of chronic disease and disability. The search yielded 2492 records; 187 full texts were assessed for eligibility and 114 documents were included (103 unique studies). Study quality was rated using the Mixed Methods Appraisal Tool.Data ExtractionCharacteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or by a third author.Data SynthesisA sequential, exploratory mixed studies approach was used for synthesis. Pooled analysis showed that 14.2% (95% CI, 10.6-18.9 [I²=94.8%, P<.001]) of health professionals report routinely asking questions or providing information about sexuality. Professionals reported limited confidence, competence, and/or comfort when initiating conversations about sexuality or responding to patient questions. Sexual rehabilitation typically focused on the effect of disease, disability, and medication on sexual function. Broader dimensions of sexuality were rarely addressed.ConclusionDespite recognizing the value of sexuality to health and well-being, most health professionals regardless of clinical context fail to routinely include assessment of sexuality in their practice. Professionals have limited knowledge and confidence when addressing sexuality and experience significant discomfort when raising this topic with people living with chronic disease and disability. Multicomponent implementation programs are needed to improve health professionals’ knowledge, competence, and comfort when addressing sexuality for people living with chronic disease and disability.     

Risk factors for 28-day mortality in patients with sepsis-related myocardial injury in intensive care units

ObjectiveThis study aimed to identify the risk factors for death in patients with sepsis-related myocardial injury.MethodsA retrospective study was conducted in 158 patients with sepsis-related myocardial injury in a mixed medical intensive care unit from January 2009 to March 2020. The patients were divided into those who survived and those who died on the basis of whether they survived after 28 days. Demographic and clinical parameters were collected. Multivariate logistic regression was performed.ResultsSixty-nine (43.7%) patients died within 28 days after admission to the intensive care unit. Multivariate logistic regression analysis showed that the oxygenation index (odds ratio [OR]: 0.979, 95% confidence interval [CI]: 0.970–0.989), acute kidney injury (OR: 4.787, 95% CI: 1.674–13.693), norepinephrine dose (OR: 1.706, 95% CI: 1.375–2.117), and abdominopelvic cavity infection (OR: 0.257, 95% CI: 0.076–0.866) were significantly associated with mortality within 28 days after admission in patients with sepsis-related myocardial injury.ConclusionsPatients with sepsis-related myocardial injury have a high mortality rate. A high oxygenation index, occurrence of acute kidney injury, high norepinephrine dose, and occurrence of abdominopelvic cavity infection are independent risk factors for 28-day mortality in patients with sepsis-related myocardial injury.     

2014－2018年内蒙古自治区杭锦后旗居民死亡趋势及主要慢性病早死概率分析

  目的  分析内蒙古自治区（内蒙古）巴彦淖尔市杭锦后旗居民死亡原因和变化趋势,以及四类主要慢性病的早死概率及变化趋势,为疾病预防和控制措施提供科学依据。  方法  收集2014 — 2018年杭锦后旗居民死因资料,根据国际疾病分类（ICD-10）对根本死因进行分类和编码,通过Excel 2010及SPSS 24.0软件计算粗死亡率、标化死亡率、死因构成比和早死概率等指标;趋势分析采用趋势χ2分析,率的比较采用χ2检验。  结果  2014 — 2018年杭锦后旗居民粗死亡率为558.31/10万,标化死亡率为554.52/10万,男性、女性和全人群粗死亡率及标化死亡率均呈上升趋势;男性粗死亡率和标化死亡率均高于女性。 前5位死因依次为心脏病（203.30/10万）、恶性肿瘤（122.26/10万）、脑血管疾病（96.97/10万）、损伤和中毒（34.02/10万）和呼吸系统疾病（13.22/10万）,共占总死亡的84.14%。 各年龄组死亡率均呈上升趋势,45～64岁年龄组死亡率上升趋势有统计学意义（趋势χ2=9.29,P< 0.05）;死亡主要集中于≥45岁年龄组,占比92.65%。 四类主要慢性病早死概率总体呈上升趋势（趋势χ2=13.30,P<0.001）;男性主要慢性病早死概率均高于女性（P< 0.05）。 砷中毒病区主要死因标化死亡率高于全旗总人群（P< 0.001）,死因顺位前4位与全旗人群相同。  结论  2014 — 2018年杭锦后旗居民死亡呈上升趋势,心脑血管疾病与恶性肿瘤已成为该地区居民死亡的主要原因。 应通过加强慢性病的三级预防等工作,降低慢性病的早死概率,提高居民的健康寿命和生存质量。