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131.
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133.
Derivation and Validation of a Clostridium difficile Infection Recurrence Prediction Rule in a National Cohort of Veterans 
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下载免费PDF全文 134.
目的:探讨台湾医院门诊应用电子处方警示系统的效果。方法:采集1998-2009年的医保数据库,纳入各年均有数据库数据的259家医院进行分析。根据台湾医院应用门诊电子处方警示系统的发展,12年分为4个阶段:1998—2000年(T1)、2001-2003年(T2)、2004—2006年(T3)、2007—2009年(T4)。重复用药率是计算每个时间段医院门诊重复用药处方数占全部处方数的比例。应用广义估计方程(Generalized Estimating Equation,GEE)分析4个阶段的重复用药率改变。结果 :T1总体门诊重复用药率11.7%,T2减少到10.4%,但T2-T4维持在10. 5%上下。GEE分析发现重复用药率如期呈现下降,但降幅逐渐减小(T2:b=-2.44; T3:b-3.20;T4:b=-3.30;P0.001)。结论:医院门诊重复用药率随电子处方警示系统应用趋势呈现递减后维持平稳,表示系统虽然有效,但仍有需要持续改善之处。 相似文献
135.
Aisha F. Badr Sawsan Kurdi Samah Alshehri Claire McManus Jeannie Lee 《Saudi Pharmaceutical Journal》2018,26(8):1204-1207
Background
Hospitalization can contribute to insomnia in many patients and is usually treated symptomatically. However, sedative/hypnotic misuse is associated with complications in this population, especially in the elderly. Such complications include dizziness, falls and over-sedation. Due to the implicit dangers, widespread use of these drugs for insomnia, particularly in older patients, has been discouraged by many hospitals. The aim of this study was to review and evaluate prescribing patterns and to optimize the use of the sedative/hypnotic agents through daily pharmacy interventions at a community hospital.Methods
This was a biphasic before and after study. Data on sedative/hypnotic use was collected retrospectively for a 2-month period and a sample of 100 patients was randomly selected for analysis. A 2-month prospective phase followed, in which daily orders were reviewed by one pharmacy resident and recommendations made to discontinue any unnecessary, newly prescribed sedative/hypnotic orders when appropriate. Finally, results of both phases were compared for any differences in patient demographics, being prescribed more than one sedative/hypnotic, and complications documented.Results
During the prospective phase, pharmacist interventions led to the discontinuation of 25% of a total of 97 sedative/hypnotic orders in 97 patients. The number of patients receiving more than one sedative/hypnotic agents in the intervention group was significantly lower than the retrospective control group (15 Vs. 34, P?=?0.0026). The incidence of complications was not significantly different between the control and intervention groups for the following: over-sedation, falls and delirium (p?=?0.835, p?=?0.185, p?=?0.697, respectively).Conclusion
This study suggests that the use of sedative/hypnotics in the inpatient units (excluding the critical care unit), is somewhat prevalent, and many patients may be on more than one sedative/hypnotic, which could potentially cause cumulative harm. During the intervention phase, 25% of the total in-hospital orders for sedative/hypnotics were discontinued following recommendations made by a pharmacist, and significantly lower number of patients receiving duplicate sedative/hypnotics was noted. Further efforts should be implemented to avoid unnecessary sedative/hypnotic initiation in hospitalized patients, and to ensure monitoring by pharmacists is optimized. 相似文献136.
Background
Medication management is commonly performed by informal caregivers, yet they are often unprepared and ill-equipped to manage complex medication regimens for their older adult care recipients. In order to develop interventions that will enhance the caregiver's ability to safely and confidently manage medications, it is critical to first understand caregiver challenges and unmet needs related to medication management.Objectives
To explore how informal caregivers manage medications for their older adult care recipients by identifying the activities involved in medication management and the tools or strategies used to facilitate these activities.Methods
Four focus groups with caregivers of older adults were conducted with 5–9 caregivers per group. Participants were asked to describe the medication management activities performed and the tools or strategies used to facilitate these activities. Focus groups were recorded, transcribed verbatim, and analyzed for themes using an inductive approach.Results
Caregivers were commonly involved in 2 types of activities: direct activities requiring physical handling of medications such as obtaining medications, preparing pill boxes, and assisting with medication administration; and indirect activities that were more complex and required more of a cognitive effort by the caregiver, such as organizing and tracking medications, gathering information, and making treatment decisions. They utilized a variety of tools and strategies to support these medication management activities; however, these approaches often needed to be modified or personalized to meet the specific needs of their caregiving situation.Conclusions
Informal caregivers play a vital role in ensuring safe and appropriate medication use by older adults. Medication management is complex and involves many activities that are supported through the use of a variety of tools and strategies that have been adapted and individualized to each specific caregiving scenario. Caregivers should be an important component of interventions that aim to improve medication use among older adults. 相似文献137.
Olayinka O. Shiyanbola Elizabeth Unni Yen-Ming Huang Cameron Lanier 《Research in social & administrative pharmacy》2018,14(9):824-830
Background
Beliefs in medications and illness perceptions is associated with medication adherence among individuals with diabetes and several adherence interventions focus on patients' beliefs in medicines and illnesses. Though health literacy is important in medication adherence, the relationship between health literacy and medication adherence remains inconclusive; thus raising the question as to whether health literacy has an amplifying or reducing effect on the relationship between beliefs and adherence.Objective
The study examined (1) the association between health literacy, beliefs in medicines, illness perceptions, and medication adherence in individuals with type 2 diabetes and (2) the moderating effects of health literacy (including numeracy and document literacy) on the relationship between illness perceptions, beliefs in medicines, and medication adherence.Methods
Adults ≥20 years taking oral diabetes medicines at two family medicine clinics, completed a cross-sectional survey. Participants were assessed on beliefs in medicines, illness perceptions, health literacy, self-efficacy, and medication adherence. Multiple linear regressions examined the effect of health literacy, beliefs and self-efficacy, and the moderator effect of health literacy in the relationship between beliefs and adherence.Results
Of the 174 participants, more than half were women (57.5%) and white (67.8%). There was a significant positive association between self-efficacy and adherence (β?=?0.486, p?<?.001), and a negative association between threatening illness perceptions and adherence (β?=??0.292, p?<?.001). Health literacy had a significant moderator effect on the relationship between adherence and concerns beliefs (β?=??0.156, p?=?.014) and threatening illness perceptions (β?=?0.196, p?=?.002). The concern beliefs - adherence association was only significant at marginal and adequate literacy levels. When health literacy was separated into numeracy and document literacy, only numeracy moderated the illness perceptions - adherence relationship (β?=?0.149, p?=?.038).Conclusions
Health literacy, especially numeracy, needs to be initially addressed before diabetes adherence interventions that address individual concerns about medicines and threatening illness perceptions can work. 相似文献138.
M. Cordina K. Hämeen-Anttila J. Lauri S. Tabone H. Enlund 《Research in social & administrative pharmacy》2018,14(9):817-823
Background
Health and medication literacy may be important factors in the outcomes of medical treatment. Similarly, shared decision making or lack of it may influence patient's behavior and adherence to medications.Objectives
To describe health and medication literacy as well as factors associated with poor medication literacy in two different populations and secondly, to describe desire to participate in decisions concerning medications; and to assess the role of poor medication literacy in decision making.Methods
A general population based survey in Finland (n?=?8003) and in Malta (n?=?2000). Health and medication literacy and the desire to participate in decision making was each measured with three statements based on the literature. Medication literacy was operationalized as understanding the instructions on package insert and ability to follow instructions on pharmacy label.Results
Fifteen percent of the Finnish respondents and 16% of Maltese reported always or often having problems understanding package inserts, i.e., poor medication literacy. Males (p?=?0.004) and respondents in the age group 65–79 years (p?<?0.001) were more prone to report such poor medication literacy. Respondents in Finland (59%) and Malta (65%) reported wanting to discuss different treatment options with the doctor. The respective percentages (42% Finland, 57% Malta) were lower for discussing about the choice of medicine and for deciding about the medicine (36% and 43%, respectively). The desire to participate in deciding about the medicines was higher among females (p?<?0.001) and Maltese respondents (p?<?0.001). Also those with poor medication literacy more often (p?<?0.001) expressed a desire to participate in deciding in the choice of medicine.Conclusions
Medication literacy was rather low, while desire to participate in pharmacotherapy decision making was high, especially in Malta. Overall, women tended to be more willing to participate in decision making. The desire to participate in decisions was higher among persons with low medication literacy. 相似文献139.
140.
[目的] 探讨郭勇教授治疗肝癌的处方用药规律,传承名中医治疗肝癌的指导思想并推广应用。[方法] 收集郭师治疗肝癌的处方,基于信息管理系统软件建立数据库,统计药物使用频次,并对药物的药性、药味、归经等进行描述性分析。[结果] 药性频率最高的是寒(34.46%),其次是温(29.94%)、平(27.12%),累计频率达91.52%;药味频率最高的是甘(37.09%),其次是苦(23.64%)、辛(17.45%),累计频率达78.18%;药物归经频率最高的是肝(19.61%)、其次是脾(15.50%)、肺(15.25%)、胃(14.29%),累计频率达64.65%。采用关联法则、复杂网络分析、聚类分析等数据挖掘方法,确定处方中各种药物的使用频次和药物之间的关联规则,前6位中药依次为:白芍、郁金、预知子、猫爪草、猫人参、太子参。从核心处方总结出,郭师治疗肝癌多用猫人参、猫爪草、郁金、预知子、白芍等药物。[结论] 郭师治疗肝癌,重视辨病与辨证相结合,应用灵活,配伍严谨。数据挖掘应用对于挖掘名老中医临床经验具有重要的价值。 相似文献