Three-month follow-up effects of a medication management program on nurses’ knowledge

This quasi-experimental study examined the effects of a medication management program on nurses knowledge of medication management, three months after program completion. Fifty-seven nurses took a multiple-choice test both immediately after the program and three months later. Changes in test performance were assessed using McNemar's test and generalized estimating equations for binary outcomes. Test results were generally consistent from immediately post-program to three months later, though four items differed significantly. From immediately post-program to three months later, fewer nurses correctly answered the items: documenting no medication administration (98.2 vs 86.6, p = 0.04); documenting opioid administration (56.1 vs 33.3, p = 0.01); and observation after opioid administration (35.1 vs 19.3, p = 0.08. Significantly more nurses correctly answered the item concerning the pharmacology of medication administered with food (64.9 vs 77.2, p = 0.09). We recommend both continuous medication management training and focusing on the correspondence between theory-based knowledge and clinical practice routines.     

MEBO治疗慢性难愈性皮肤溃疡的临床疗效观察

目的观察湿润烧伤膏(Moist Exposed Burn Ointment,MEBO)治疗慢性难愈性皮肤溃疡的临床疗效。方法对2010年1月-2014年12月收治的344例慢性难愈性皮肤溃疡患者创面采用"药刀结合"的方法治疗,药即MEBO,刀即外科清创术、植皮术等。患者初诊时尽量清除创面坏死组织,不能耐受一次性清创者行蚕食疗法;清创后创面均匀涂抹MEBO并外敷MEBO药纱包扎治疗,存在潜腔的创面用MEBO药纱填塞引流,待肉芽组织填满创面后行肉芽创面游离植皮术。观察患者创面愈合时间及愈合情况。结果344例患者中除38例患者好转后自动出院,3例患者死于基础疾病外,其余303例患者创面均完全愈合,愈合率达88.1%,创面平均愈合时间为80.4 d±15.8 d。其中,193例患者经MEBO换药治疗后创面自行愈合(56.1%);48例合并趾骨坏死的糖尿病足患者进行了坏死组织剜除术(14.0%);34例骨外露创面进行了钻孔术(9.9%);54例患者进行了肉芽创面植皮术(包括接受趾骨剜除术及骨钻孔术后的创面)。89例烧伤残余创面愈合较快,最短为7 d,最长为29 d,平均愈合时间为18.8 d±4.9 d。结论MEBO可有效控制创面感染,促进坏死组织液化脱落及肉芽组织生长,缩短创面愈合时间,减轻患者疼痛,适时配合"刀法"还可进一步加速坏死组织脱落,促进肉芽组织生长,及时封闭创面,减少瘢痕增生,是治疗慢性难愈性皮肤溃疡的理想方法。     

Improving Medication Adherence in Patients with Hypertension: A Randomized Trial

Background and Purpose

In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention.

Methods

Patients (n = 532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review, and tailored adherence counseling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at 1-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months included persistence to medications, blood pressure, hospital admission, and a combined clinical endpoint of cardiovascular death, stroke, or acute myocardial infarction.

Results

At 12 months, 20.3% of the patients in the intervention group (n = 231) were nonadherent (MPR <0.80), compared with 30.2% in the control group (n = 285) (risk difference −9.8; 95% confidence interval [CI], −17.3, −2.4) and median MPR (interquartile range) was 0.93 (0.82-0.99) and 0.91 (0.76-0.98), respectively, P = .02. The combined clinical endpoint was reached by 1.3% in the intervention group and 3.1% in the control group (relative risk 0.41; 95% CI, 0.11-1.50). No significant differences were found for persistence, blood pressure, or hospital admission.

Conclusions

A multifaceted pharmacist intervention in a hospital setting led to a sustained improvement in medication adherence for patients with hypertension. The intervention had no significant impact on blood pressure and secondary clinical outcomes.     

刘尚义教授运用紫菀、款冬花、百部治疗肺系疾病经验举隅

中医所言肺系疾病,属于现代医学呼吸系统疾病范畴.临床常见呼吸系统疾病包括上呼吸道感染、支气管扩张、慢性阻塞性肺疾病、肺炎等,属中医“感冒”、“肺胀”、“咳嗽”范畴.本文对我省名老中医刘尚义教授配伍运用紫菀、款冬花、百部治疗肺系疾病的经验进行了介绍.     

Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia

PURPOSE: We assessed the performance of 3 validated prognostic rules in predicting 30-day mortality in community-acquired pneumonia: the 20 variable Pneumonia Severity Index and the easier to calculate CURB (confusion, urea nitrogen, respiratory rate, blood pressure) and CURB-65 severity scores. SUBJECTS AND METHODS: We prospectively followed 3181 patients with community-acquired pneumonia from 32 hospital emergency departments (January-December 2001) and assessed mortality 30 days after initial presentation. Patients were stratified into Pneumonia Severity Index risk classes (I-V) and CURB (0-4) and CURB-65 (0-5) risk strata. We compared the discriminatory power (area under the receiver operating characteristic curve) of these rules to predict mortality and their accuracy based on sensitivity, specificity, predictive values, and likelihood ratios. RESULTS: The Pneumonia Severity Index (risk classes I-III) classified a greater proportion of patients as low risk (68% [2152/3181]) than either a CURB score <1 (51% [1635/3181]) or a CURB-65 score <2 (61% [1952/3181]). Low-risk patients identified based on the Pneumonia Severity Index had a slightly lower mortality (1.4% [31/2152]) than patients classified as low-risk based on the CURB (1.7% [28/1635]) or the CURB-65 (1.7% [33/1952]). The area under the receiver operating characteristic curve was higher for the Pneumonia Severity Index (0.81) than for either the CURB (0.73) or CURB-65 (0.76) scores (P <0.001, for each pairwise comparison). At comparable cut-points, the Pneumonia Severity Index had a higher sensitivity and a somewhat higher negative predictive value for mortality than either CURB score. CONCLUSIONS: The more complex Pneumonia Severity Index has a higher discriminatory power for short-term mortality, defines a greater proportion of patients at low risk, and is slightly more accurate in identifying patients at low risk than either CURB score.     

炎症性肠病患者治疗依从性影响因素调查与分析

目的:调查炎症性肠病(IBD)患者的治疗依从性现状,分析其影响因素。方法:采用问卷调查法对82例IBD患者发放自行设计的治疗依从性问卷,对其一般资料及影响因素进行调查。结果:IBD患者服药依从性和生活方式依从性相对较高,而定期复查和适当锻炼的依从性较差。患者是否参加自我管理项目的教育和患者的文化程度是其治疗依从性的主要影响因素(P0.05)。结论:应加强对IBD患者的健康教育,尤其应加强对文化程度较低患者治疗依从性相关知识的宣教。     

数据挖掘分析王晖治疗肺癌用药规律

<正>王晖主任中医师是第三批全国老中医药专家学术经验继承工作指导老师,享受国务院特殊津贴,拥有宁波市首个国家中医药管理局全国名老中医专家传承工作室,临床经验丰富,对肺癌的治疗有独到见解。笔者通过收集、整理王老师治疗的肺癌病例,采用数据挖掘的方法,分析处方中药物的使用频次、关联规则,摸索处方规律及用药经验,提炼经验为临床诊治打下前期基础。1资料与方法1.1研究对象及诊断标准按原发性支气管肺癌诊     

Low literacy is associated with uncontrolled blood pressure in primary care patients with hypertension and heart disease

Objectives

To evaluate the association between low literacy and uncontrolled blood pressure (BP) and their associations with medication adherence.

Methods

Cross-sectional study of 423 urban, primary care patients with hypertension and coronary disease. The relationship between low literacy (Rapid Estimate of Adult Literacy in Medicine ≤ 44) and uncontrolled BP (≥140/90 mmHg, ≥130/80 mmHg for patients with diabetes) was evaluated by crude and adjusted logistic regression. Relationships with self-reported adherence and refill adherence were explored using adjusted linear and logistic regression.

Results

Overall, 192 (45%) subjects had low literacy and 227 (52.9%) had uncontrolled BP. Adjusting for age, gender, race, employment, education, mental status, and self-reported adherence, low literacy was associated with uncontrolled BP (OR 1.75, 95% CI 1.06–2.87). Lower self-reported adherence was associated with uncontrolled BP; the relationship between refill adherence and uncontrolled BP was not statistically significant.

Conclusion

Low literacy is independently associated with uncontrolled BP.

Practice implications

Awareness of the relationships among patient literacy, BP control, and medication adherence may guide healthcare providers as they communicate with patients.