我院门诊应用抗菌药物处方分析

为了解我院门诊抗茵药使用状况,随机抽取全院2006年10月门诊处方1000份,统计并综合分析了使用抗茵药物的比率、抗茵药物种类及联合用药情况等项目.结果显示,门诊抗茵药的使用比率为20.90%,联合用抗茵药的比率为7.26%;合理用药处方占84.7%,但在某些方面还存在不合理现象.宜制定相应措施,提高用药合理性.     

外科过度预防性用药的思考

1　存在的问题过度医疗现象在我国普遍存在 ,外科过度的预防性用药特别突出。据报道 ,某医院分析了 596例抗菌药物使用的患者 ,预防性用药 352例 ,占59 .1 % ,治疗用药 2 4 4例 ,占 40 .9% [1 ] 。另一家教学医院调查的 1 652份病历中 ,使用抗生素的 1 394份 ,占 84.4 % ,其中治疗性用药 51 4例 ,占 36.9% ,预防性用药 880例 ,占 63 .1 % [2 ] 。医院预防性抗菌药物使用率过高 ,而且集中在手术科室。有的医院外科手术病例预防使用抗菌药的比例是 77.2 % [1 ] 。普外、胸外、妇科Ⅱ类术后预防用药均在 7～ 1 0天。某科一位骨外科患者抗菌药物…     

抗菌药物的重大转折

近年来,细菌耐药性增加,耐药感染日趋势,严重目前基本上所有已经批准的抗菌药均存在不同程度的耐药性。因而针对耐药菌设计抗菌药物进行抗菌药物的重要转折迫在遐睫。在抗菌新药开发中可能的途径有;绕过目前的药物耐药机制;寻找细菌内抗菌作用的新靶子;探索抗菌五感染免疫调节的联合品。     

临床指征优先谨慎使用抗菌药物

抗菌药物是临床广泛应用的一类药物。根据卫生部全国医院感染监测网监测结果,我国临床抗菌药物使用率较高。抗菌药物压力是细菌产生耐药性最重要的原因。对于临床谨慎使用抗菌药物来说,知晓和掌握使用指征是非常重要的,在任何情况任何时候,指征是优先考虑的。抗茵药物使用指征包括治疗性用药指征和预防性用药指征,尤其是预防用药方面。本文讨论抗菌药物应用指征,包括感染诊断与治疗性用药的关系、手术前预防性使用抗菌药物预防手术部位、内科患者预防性使用抗菌药物指征与药物选择等。     

门诊抗高血压用药分析

通过对天津市某医院的高血压患者发病和用药情况进行调查,了解此医院血压用药特点及其合理性和局限性。结果显示,用药频度的前三类分别是钙离子拮抗剂（CCB）、血管紧张素Ⅱ受体拮抗剂（ARB）、血管紧张素转换酶抑制剂（AcEI）;用药频度的前三个药分别是硝苯地平控释片、厄贝沙坦、贝那普利;使用一种降压药物的处方占49．25％,...     

抗菌药物合理应用的宏观和微观问题

抗菌药物不合理应用现象长期得不到纠正,细菌耐药稳步攀升,正引起医学界、社会和政府的高度关注。本文就宏观上的抗菌药物使用政策与微观上的临床用药两方面存在的问题进行探讨。介绍了国际上关于抗菌药物政策的研究以及抗菌药物合理使用的新观点（尽早开始经验性治疗、“降阶梯”治疗策略、运用抗菌药物PK／PD原理指导临床用药、短程治疗）。主张调整宏观抗生素策略,去除该政策单纯、片面限制使用和应用药敏实验结果指导临床用药绝对化的做法。吸纳国际上的新成果,强化监管力度,更多采用教育和技术手段。     

抗菌药物合理应用的宏观和微观问题

抗菌药物不合理应用现象长期得不到纠正,细菌耐药稳步攀升,正引起医学界、社会和政府的高度关注.本文就宏观上的抗菌药物使用政策与微观上的临床用药两方面存在的问题进行探讨.介绍了国际上关于抗菌药物政策的研究以及抗菌药物合理使用的新观点(尽早开始经验性治疗、"降阶梯"治疗策略、运用抗菌药物PK/PD原理指导临床用药、短程治疗).主张调整宏观抗生素策略,去除该政策单纯、片面限制使用和应用药敏实验结果指导临床用药绝对化的做法,吸纳国际上的新成果,强化监管力度,更多采用教育和技术手段.     

艰难梭菌感染：ICU中如何处理

艰难梭菌相关性腹泻（CDAD）是重症患者非常重要的院内感染性疾病之一,常与广谱抗菌药物的广泛应用有关,其中肠道菌群失调是重要的因素之一。虽然艰难梭菌感染（CDI）仅占抗菌药物相关性腹泻中的10％～20％,但是目前CDAD的发生率呈明显升高趋势,且根据研究显示,重症患者CDAD的30天病死率已达36．7％。CDAD的临床...     

急性重症胰腺炎的抗生素治疗策略

继发性感染是导致急性重症胰腺炎(severe acute pancreatitis,SAP)高病死率最重要的因素。继发感染的微生物多为革兰阴性菌。选用抗菌药物需兼顾病原菌敏感性及抗菌药物穿透血胰屏障能力,合理选择用药方式;对于CT证实有胰腺坏死的急性重症胰腺炎,可预防性使用抗生素;氟康唑可作为经验性抗真菌治疗的首选药物。     

山东省某县供需双方药品使用情况研究

通过调查山东省某县三级医疗机构门诊处方的药品使用情况和调查地农民的药品知识、态度和用药行为,对药品供需双方的不合理用药实际情况进行了研究.结果显示,供需双方均存在不合理用药的情况.针对研究结果提出了加强对医生用药行为的监管、宣传不合理用药的危害性等建议.     

酮咯酸氨丁三醇复合丙泊酚-瑞芬太尼麻醉用于门诊宫腔镜检术的效果观察

观察和评价酮咯酸氨丁三醇复合丙泊酚一瑞芬太尼麻醉用于门诊宫腔镜检术的临床效果。选取无痛门诊宫腔镜检术患者60例,依据随机数字表法将患者随机分为瑞芬太尼组（R组）和酮咯酸氨丁三醇组（K组）。统计患者麻醉满意度、围术期心血管用药情况和术毕2h内不良反应发生情况。结果与K组相比,R组手术开始时（T1）、手术开始10min（T2）循环和呼吸抑制较明显（P〈0．05）,麻醉起效时间相对较长（P〈0．05）,术毕镇静效果较差（P〈0．01）,麻醉满意度较低（P〈0．01）,同时心血管用药次数增多（P〈0．05）。两组患者术后均未发生严重不良反应,但K组患者术后镇痛效果明显好于R组（P〈0．05）。酮咯酸氨丁三醇复合丙泊酚一瑞芬太尼麻醉应用于门诊无痛宫腔镜检术能够使患者呼吸循环更加平稳,提高麻醉满意度,减少围术期心血管用药次数和有效缓解术后疼痛的发生。     

Effect of incentives on retention in an outpatient treatment for cocaine addicts

The high drop-out rate in treatment programs is one of the most important problems in the area of drug addictions. This study evaluated the effect of the use of incentives on retention in an outpatient program for cocaine addicts. The effect of individual variables on program drop-out was also analysed. Participants were 66 subjects who were randomly assigned to one of three treatment groups: standard treatment, treatment with incentives I, and treatment with incentives II. The patients of these two groups received incentives contingent on cocaine abstinence with two different magnitudes. Retention rate at six months was 35% in the standard treatment, 78.6% in the treatment with incentives I, and 53.3% in the treatment with incentives II. The global prognostic capacity of the individual variables (sociodemographic, history and consumption pattern, psychopathological variables, and EuropASI scores) was 85.7%, with the psychopathological variables being more closely related to retention. These results suggest that the use of incentives may be an effective strategy to improve retention in outpatient treatments for cocaine addiction.     

口服药物服药时辰学的探讨

药物口服是临床常用的给药途径。口服药的服用时间有餐前、餐时、餐后、睡前等几种类型。药物的服药时间是根据每种药物的药效学、药动学的不同及药物与食物的关系等多种因素决定的。根据人体生物节律与时展药理学的关系,参考说明书和药学参考书,总结了门诊常用口服药的服用时间,并指出了各种服药时间的优缺点。     

Addiction treatment providers’ perceptions of publicly-funded treatment services in the Western Cape,South Africa

This study explored addiction treatment implementation effectiveness of publicly-funded services in the Western Cape, South Africa, as perceived by service providers. Informants were six service providers from state-subsidised and public outpatient treatment services for substance use disorders (SUDs) (social workers = 4, registered counsellor = 1, psychologist = 1). Data were collected using semi-structured interviews and analysed by means of thematic analysis. The three themes that emerged from the analysis pertained to addiction treatment providers’ perceptions of the effectiveness of treatment services, lack of aftercare services, and service access and participation. Findings highlight sites for interventions to enhance the provision of publicly-funded evidence-based treatment services for SUDs in South Africa; enabling recipients to yield the well-established benefits of treatment.     

Psychiatric Patients’ Evaluation of the Efficacy of Obeah vs. Western Medicine in Treating Their Mental Illness

This study sought to determine any potential benefits in psychiatric patients’ use of traditional medicine in their treatment. Participants were 51 Jamaican patients who self-reported on concurrent use of western and alternative medicine. They completed the Jamaican Healthcare Perception Questionnaire. Data were analysed using the chi-square test of differences between proportions. Findings indicated that 58.8% of patients incorporated traditional medicine in their treatment. These were less likely to agree with the diagnosis given by the formal practitioner and that his treatment was effective or to rate the quality of service of the formal practitioner as being satisfactory. Patients believed alternative medicine should be incorporated into the healthcare system.     

细菌耐药性及其防控中的理性思考

细菌对抗菌药物产生耐药性是自然界的普遍规律。抗菌药物的应用和研发与细菌耐药机制的发展互为因果且相互促进,细菌对抗菌药物的耐药性已对感染性疾病的治疗构成严重威胁。理性认识细菌耐药性产生的机制,并在其防控中进行理性思考是提高感染性疾病治愈率的根本所在。     

A comparative study of family therapy in the treatment of opiate users in a London drug clinic

This study presents the results of a randomized treatment trial of family therapy and two control treatments for 119 outpatient opiate users. All treatments were combined with a methadone reduction programme. The control treatments were: (1) a 'standard' treatment (supportive psychotherapy) and (2) a 'low contact' intervention. Treatment outcome was evaluated six and twelve months after the initial assessment. Both the family therapy and minimal intervention groups had a significantly higher number of drug–free days at six and twelve months, compared to the standard treatment, despite receiving fewer treatment sessions. Across all treatments there was evidence for a gender difference in response to therapy in users who were in a couple relationship. In couples where both partners were using drugs women did significantly better than men. Men living with a non–drug–abusing partner fared better than men living with a drug–using partner. Across the treatment groups diminution in drug use was accompanied by improvements in psychosocial functioning. Unemployment, sharing needles and injecting drugs were predictive of poor outcome.     

Multiple-family group treatment of outpatients with schizophrenia: impact on service utilization

The impact of multiple-family group treatment (MFGT) on outpatient and inpatient mental health service utilization of 97 persons with schizophrenia was investigated. Participants were randomly assigned to standard care (n = 44) or standard care plus MFGT (n = 53). Service use for a year prior to randomization, the 2-year study period, and a 1-year follow-up were examined. Relative to standard care participants, the MFGT group had reduced community hospitalization during year 1 of the intervention and reduced state hospitalization at follow-up. During the intervention period, MFGT participants demonstrated a significant increase in outpatient utilization as a direct consequence of the intervention. However, when service use was summed across 3 years post-randomization, no group differences were observed. Results suggest that implementation of MFGT in a community mental health setting reduces inpatient service at specific time periods, without significantly increasing outpatient service utilization. These findings add to other outcomes from this study that demonstrate decreased psychiatric symptoms and caregiver distress.