沈绍功教授治疗不孕症临床用药规律研究

目的探讨沈绍功教授治疗不孕症的临床用药规律。方法对沈教授治疗的女性不孕症患者的电子病历进行整理,依据沈教授在病历中记载的病名诊断与中医证候诊断,对相应处方及用药频次进行分类统计,对用药情况进行分析。结果共搜集不孕症病例321例,经随访确认其中137例患者成功受孕,成功受孕率为42.7%。沈教授在病历中记载的病名诊断为月经失调、乳腺增生症、子宫肌瘤、痛经及多囊卵巢综合征,共计5类。在病历中记载的中医证候诊断为肾阴阳失调、气血不和(包括气血不足、气滞、气虚血瘀)、肝气郁滞、痰瘀阻滞、湿热下注,共计5类。沈教授治疗不孕症处方中药物使用频次>40次的中药共30味,使用频次较高的前6位为蛇床子、淫羊藿、黄柏、知母、灵芝、丹参。按病名分类分别统计了治疗每种疾病使用频次较高的前10味中药。按中医证候分类分别统计了治疗每种中医证候使用频次较高的前6味中药。结论沈教授治疗不孕症用药特点是在6味基本药物组合的基础上,结合辨病辨证进行加减,注重辨病与辨证相结合。     

国医大师刘柏龄治疗脊髓型颈椎病用药规律探析＊

目的 挖掘、分析国医大师刘柏龄治疗脊髓型颈椎病的用药特点及组方规律。方法 收集120份符合纳入标准的刘柏龄教授治疗脊髓型颈椎病的验案，利用Epidata 3.0软件建立方药数据库，使用IBM SPSS Modeler 18.2软件中基于关联规则的Apriori算法，对处方中的中药及其分类的使用频次、中药之间的应用关系进行分析。结果 纳入处方共涉及中药104味，其中使用频次较高的中药依次为黄芪、当归、附子、丹参、赤芍等，用药以补虚药、活血化瘀药、祛风湿药、平肝息风药为主，辅以解表、温里、化湿等药。在关联规则集中，在支持度20%和置信度90%的情况下分析得到二阶、三阶和四阶关联规则，核心药物群包括黄芪、当归、赤芍、附子、红花、桃仁、鸡血藤、地龙、川芎等。结论 刘柏龄治疗脊髓型颈椎病用药具有补虚祛邪并重的鲜明特点，主要采取益气温里助阳、活血化瘀通络、补肾强骨、祛除风湿之邪的治疗原则。     

Number of drugs most frequently found to be independent risk factors for serious adverse reactions: a systematic literature review

In order to reduce the numbers of medication errors (MEs) that cause adverse reactions (ARs) many authors have tried to identify patient-related risk factors. However, the evidence remains controversial. The aim was to review systematically the evidence on the relationship between patient-related risk factors and the risk of serious ARs. A systematic search in Pubmed, Embase, Cochrane Systematic Reviews, Psychinfo and SweMed+ was performed. Included full text articles were hand searched for further references. Peer reviewed papers including adults from primary and secondary healthcare were included if they clearly defined seriousness of the ARs and described correlations to risk factors by statistical analysis. A total of 28 studies were identified including 85 212 patients with 3385 serious ARs, resulting in an overall frequency of serious ARs in 4% of patients. Age, gender and number of drugs were by far the most frequently investigated risk factors. The total number of drugs was the most consistent correlated risk factor found in both univariate and multivariate analyses. The number of drugs is the most frequently documented independent patient-related risk factor for serious ARs in both the general adult population as well as in the elderly. The existing evidence is however conflicting due to heterogeneity of populations and study methods. The knowledge of patient-related risk factors for experiencing ARs could be used for electronic risk stratification of patients and thereby allocation of healthcare resources to high risk patients.     

Characteristics of inappropriate multiple medication use in older urological outpatients

ObjectivesTo investigate polypharmacy and potentially inappropriate medications (PIMs) in elderly patients visiting the urology department for lower urinary tract symptoms (LUTS).MethodsWe retrospectively analyzed digital medical records of individuals over the age of 65 who visited the urology department for LUTS. This cross-sectional study was conducted in 10 hospitals located in South Korea, between September 2017 and December 2017. All prescribed medications were analyzed using electronic medical records. The updated 2015 Beers criteria were used to identify and assess the appropriateness of the prescribed drugs in elderly patients.ResultsWe analyzed a total of 2143 patients aged over 65 years from 10 institutions. The mean age was 74.2 ± 6.26 years (65–97), 1634 (76.2%) were men. Patients took a mean of 6.48 ± 2.46 medications (range 0–18), and polypharmacy was found in 1762 patients (82.2%). The number of patients who received PIMs at least once was 1579 (73.7%). The average number of PIMs used per patient was 1.31 ± 1.25 (0–7). PIM use ratio was 18.9 ± 0.15% (0–67%). The number of chronic diseases, and concurrent medication and polypharmacy were predictive factors associated with PIM use.ConclusionOur multi-institutional results show that a substantial proportion of elderly patients took PIMs when visiting the urology department. Factors associated with PIMs were the number of chronic diseases and polypharmacy. Medication use in elderly patients, especially in urology, should be monitored carefully.     

Diabetes treatment and hypoglycaemic episodes in elderly patients at nursing homes in Uppsala County

Aim: The aim of this study was to examine the situation for elderly patients with diabetes living in nursing homes with regard to diabetes treatment, clinical variables, and vascular complications associated with diabetes. A second aim was to evaluate if the patients were at risk of hypoglycaemia.

Methods: This was a cross-sectional study including diabetes patients from all 30 nursing homes in Uppsala County, Sweden. Current antidiabetic medications, HbA_1c, hypoglycaemic events, and diabetes complications were registered from the medical records. The patients were stratified into a general group and divided into three groups according to HbA_1c (<52, 52–73, and >73?mmol/mol).

Results: Of 1,350 individuals, 218 patients were identified with diabetes mellitus. The diabetes duration was 11.2?±?9.4 years and their serum HbA_1c concentration 56.0?±?1.2?mmol/mol. Hypoglycaemic events were reported in 24% of the diabetic individuals, and 43.1% of them had HbA_1c <52?mmol/mol (mean value 44.0?±?1.1?mmol/mol). Of these, 36% were taking antidiabetic drugs. Another 35.8% of the patients had HbA_1c values between 52–73?mmol/mol (mean value 60.0?±?1.1?mmol/mol), and 82% of these patients were taking antidiabetic drugs. Almost 80% of the diabetic patients had either micro- or macrovascular complications, with diabetes duration as an association for both micro- or macrovascular complications and hypoglycaemic events.

Conclusions: A reduction of the use of antidiabetic drugs with follow-up of HbA_1c level should be considered, especially for multimorbid elderly patients with low HbA_1c and hypoglycaemia.