拜唐苹联合其他口服降糖药治疗2型糖尿病的有效性和安全性临床研究——多中心、非随机、开放性、自身对照研究

目的 评价已用其他口服降精药物治疗血糖不能达标的2型糖尿病患者,联合拜唐苹后的有效性和安全性.方法 全国17个中心的493例糖尿病患者参加了本次多中心、非随机、开放性、自身对照的临床研究,在患者已用其他口服降糖药物基础上加用拜唐苹治疗后观察12周,主要的疗效参数是空腹血糖(FBG)和餐后2 h血糖(PBG)水平的变化及糖化血红蛋白(Hb)A1c水平的变化.结果 联合拜唐苹治疗后总体FBG下降1.3 mmol/L,早餐PBG下降3.3 mmol/L,午餐PBG下降3.2mmol/L,晚餐PBG下降3.44 mmol/L,HbA1c降低了0.90%,P均＜0.001.拜唐苹联合非胰岛素促泌剂组、磺脲类组和格列奈类组的FBG分别下降1.24 mmol/L、1.30 mmol/L和1.13 mmol/L;早餐PBG分别下降3.36 mmol/L、3.35 mmol/L和2.25 mmol/L;午餐PBG分别下降3.57 mmol/L、3.61 mmol/L和3.15 mmol/L,晚餐PBG分别下降3.65 mmol/L、3.48 mmol/L和3.09 mmol/L;HbA1c分别降低了0.99%、1.06%和1.01%;P均＜0.001.联合拜唐苹治疗后无严重低血糖反应,体重无增加,消化道不良反应发生率为3.60%,多为腹胀和(或)排气,但可耐受.结论 当2型糖尿病患者使用一种或多种口服降糖药治疗血糖不能达标时,联用拜唐苹可使血糖控制获得明显改善,达标率显著提高,且有良好的安全性和耐受性.     

斋堂社区老年人潜在不适当用药及其相关因素

目的使用不同潜在不适当用药(PIM)标准调查乡镇社区门诊PIM现状,分析PIM与医师处方、患者自身疾病及认知功能障碍等因素的关系,帮助提高乡镇门诊老年人合理用药水平。方法采取横断面研究,纳入北京市门头沟区斋堂社区卫生服务中心门诊长期就诊老年患者264例,收集患者年龄、共病情况[疾病数量、查尔森共病指数(CCI)]、口服药、认知功能状态等资料。分别以中国老年人潜在不适当用药判断标准2017版(标准1)、美国Beers标准2019版(标准2)、联合使用中国老年人潜在不适当用药判断标准和美国Beers标准(标准3)确定PIM。将患者分为PIM组和非PIM组,调查不同标准PIM检出率,对比2组患者年龄、共病情况、认知功能状态等差异。应用SPSS 23.0软件包进行统计分析,分别应用χ2检验、独立样本t检验、非参数检验、Pearson相关分析、Spearman相关分析等对数据进行统计分析。结果共入选患者264例,年龄(71.7±5.9)岁。标准1、标准2、标准3 PIM检出率逐渐增高,分别为28.4%、39.0%、50.8%。以标准3确定的PIM分组与男性(OR=1.941,95%CI 1.110~3.394,P=0.020)、CCI(OR=1.470,95%CI 1.115~1.939,P=0.006)、口服药种类(OR=1.241,95%CI 1.056~1.459,P=0.009)、认知功能障碍(OR=3.686,95%CI 1.448~9.382,P=0.006)等相关,而与年龄无相关性。结论乡镇门诊老年人PIM高发,联合使用中国和美国PIM标准可以提高PIM检出率,PIM与口服药种类、自身疾病严重程度和认知功能障碍相关。医师应联合使用中外PIM标准加强对存在共病、认知功能障碍老人的合理用药筛查,减少乡镇门诊老年人潜在不适当用药。     

Inappropriate Medication Use as a Risk Factor for Self-Reported Adverse Drug Effects in Older Adults

OBJECTIVES: To determine the association between inappropriate medication use and self‐reported adverse drug effects (ADEs). DESIGN: Prospective cohort study with three annual mailed surveys. SETTING: Population‐based sample of Iowa Medicare beneficiaries. PARTICIPANTS: Cohort members (n=626) with established mobility disability and complete pharmacy dispensing records, continuous Medicare eligibility, and survey data. MEASUREMENTS: The number of unique drug ingredients dispensed and inappropriate use were assessed for the year before the ADE survey. Inappropriate medication use was defined according to published criteria: contraindicated drugs for elderly people, drug–disease interactions (constructed from linked Medicare claims), drug–drug interactions, and therapeutic duplications. An ADE was defined from the following question: “In the past 12 months, have you experienced an unwanted effect or side effect of a medication?” RESULTS: Of respondents to the ADE survey, 22.0% reported having experienced an ADE in the past year, and 322 (51.4%) received at least one potential inappropriate medication. Factors associated univariately with ADE self‐report were number of medications, number of mobility limitations, any inappropriate medication use, and each of the individual domain appropriateness indicators, as well as number of different domains of inappropriate use. The adjusted odds ratio for developing an ADE was 2.14 (95% confidence interval=1.26–3.65) for those with inappropriate use versus no inappropriate use. CONCLUSION: Efforts to reduce ADEs by reducing medication inappropriateness should be encouraged as a complement to efforts focused on reducing the number of medications prescribed.     

借助电子药历 提高临床合理用药质量

目的对临床药师所制作的电子药历进行分析,探讨电子药历对临床药师工作的辅助作用。方法采用Excel软件对2008年10月～2009年12月期间临床药师所制作的电子药历,其中临床干预所涉及药物、临床医师结合患者情况对于临床药师的临床干预的采纳情况进行分析汇总。结果临床药师应用电子药历管理系统制作电子药历133份。其中针对药物治疗优化,药品不良反应/事件,特殊人群用药,药物相互作用,药物不合理配伍的药历分别有30份、25份、19份、8份、2份以及教学药历49份。对于临床药师在对患者提供的药学监护过程中所提出的干预建议,临床医师采纳68条,表示关注18条,未采纳19条,采纳率为64.76%（68/105）。结论临床药师通过建立电子药历,对提高临床合理用药水平起到了很好地促进作用,并得到了临床医师的认可,但是临床药师在药物相互作用,药物不合理配伍等方面需加大关注力度。     

针刺联合药物治疗痛风的临床观察

目的针刺联合药物治疗痛风的临床观察。方法采用随机对照的方法,将99例痛风患者随机分为针刺组、药物组、针刺联合药物组。结果3组治疗7d观察,疗效差异亦有统计学意义。针刺组与针刺加药物组（χ^2=15.28,P〈0.01）,药物组与针刺加药物组（χ^2=12.28,P〈0.01）,针刺加药物组明显优于针刺组和药物组。结论针刺联合药物组在治疗痛风的过程中,症状缓解快且不良反应少,效果显著。     

我院门急诊处方抗菌药物应用调查与分析

目的了解医院门急诊处方抗菌药物应用现状,促进临床合理用药。方法随机抽取2009年8月20日的2955张门急诊处方进行分析。结果 2955张处方中使用抗菌药物的处方有1152张,占处方总数的38.98%;存在头孢菌素类抗菌药物使用比例较大,药物联用偏多,给药途径、用法用量不尽合理等问题。结论应重视抗菌药物的合理应用,制订相应制度,加强管理,保证患者的用药安全。     

节日性急性胃肠炎（腹泻）5种用药方案的疗效观察

目的总结节日急性胃肠炎（腹泻）5种综合治疗用药方案的疗效。方法随机抽取2009年元旦、春节诊治的207例急性肠胃炎（腹泻）患者,按轻、重症分组应用5种综合治疗用药方案观察疗效。结果剔除3例资料不详者后,5种综合治疗方案用药治疗显效167例（81.86%）,有效37例（18.14%）,总有效率为100%。结论对症治疗节日急性胃肠炎（腹泻）的5种综合治疗用药方案均安全、有效、经济、合理、可控。     

Moving from a culture of blame to a culture of safety in the nursing home setting

TOPIC: A culture of safety. PURPOSE: To explore the current culture of blame and what organizational elements must be impacted to move toward a culture of safety in the nursing home setting. METHODS: A mixed-method approach incorporating a case study and staff member survey results were used to explicate the organizational elements impacting the current nursing home culture. CONCLUSION: Nurse leaders can create an environment in which every member of the team feels a responsibility and an ability to insure that residents are safe by improving communication and participation in decision making.     

Computerized prescribing alerts and group academic detailing to reduce the use of potentially inappropriate medications in older people

OBJECTIVES: To examine the effect of replacing drug-specific computerized prescribing alerts with age-specific alerts on rates of dispensing potentially inappropriate medications in older people and to determine whether group academic detailing enhances the effectiveness of these alerts. DESIGN: Cluster-randomized trial of group academic detailing and interrupted time-series analysis. SETTING: Fifteen clinics of a staff-model health maintenance organization. PARTICIPANTS: Seven practices (113 clinicians, 24,119 patients) were randomly assigned to receive age-specific prescribing alerts plus the academic detailing intervention; eight practices (126 clinicians, 26,805 patients) received alerts alone. Prior implementation of drug-specific alerts established a downward trend in use of target medications that served as the baseline trend for the present study. INTERVENTION: The computerized age-specific alerts occurred at the time of prescribing a targeted potentially inappropriate medication (e.g., tertiary tricyclic amine antidepressants, long-acting benzodiazepines, propoxyphene) and suggested an alternative medication. Clinicians at seven sites were randomized to group academic detailing, an interactive educational program delivering evidence-based information. MEASUREMENTS: Number of target medications dispensed per 10,000 patients per quarter, 2 years before and 1.5 years after the replacement of drug-specific with age-specific alerts. RESULTS: Age-specific alerts resulted in a continuation of the effects of the drug-specific alerts without measurable additional effect (P=.75 for level change), but the age-specific alerts led to fewer false-positive alerts for clinicians. Group academic detailing did not enhance the effect of the alerts. CONCLUSION: Age-specific alerts sustained the effectiveness of drug-specific alerts to reduce potentially inappropriate prescribing in older people and resulted in a considerably decreased burden of the alerts.