Diabetes is a leading cause of mortality,morbidity and disability around the globe.In the past two decades,diabetes care has grown more complex as patients have received multi-component care.Recent studies have illumi...Diabetes is a leading cause of mortality,morbidity and disability around the globe.In the past two decades,diabetes care has grown more complex as patients have received multi-component care.Recent studies have illumined the complexity of drug therapy in patients with diabetes.A high level of drug utilization in diabetes patients has serious implications for quality of care,in terms of coordination of care,drug safety and access to care.Practitioners,researchers,payers and policy makers should be aware of these implications and incorporate the complexity of diabetes care into practice guidelines,benefit design and policy formulation to improve the quality of care.展开更多
This review is intended to help clinicians design drug regimens for special populations of critically ill patients with extremes of body size, habitus and composition that make drug choice or dosing particularly chall...This review is intended to help clinicians design drug regimens for special populations of critically ill patients with extremes of body size, habitus and composition that make drug choice or dosing particularly challenging due to the lack of high-level evidence on which to make wellinformed clinical decisions. The data sources included a literature search of MEDLINE and EMBASE with reviews of reference lists of retrieved articles. Abstracts of original research investigations and review papers were reviewed for their relevance to drug choice or dosing in the following special critically ill populations: patients with more severeforms of bodyweight or height, patients with amputations or missing limbs, pregnant patients, and patients undergoing extracorporeal membrane oxygenation or plasma exchange. Relevant papers were retrieved and evaluated, and their associated reference lists were reviewed for citations that may have been missed through the electronic search strategy. Relevant original research investigations and review papers that could be used to formulate general principles for drug choice or dosing in special populations of critically ill patients were extracted. Randomized studies with clinically relevant endpoints were not available for performing quantitative analyses. Critically ill patients with changes in body size, habitus and composition require special consideration when designing medication regimens, but there is a paucity of literature on which to make drug-specific, high-level evidencebased recommendations. Based on the evidence that is available, general recommendations are provided for drug choice or dosing in special critically ill populations.展开更多
Health and Development Foundation has worked collaboratively with the Government of the Russian Federation to develop and implement a model program of retention and continuity of care for opioid dependence and HIV inf...Health and Development Foundation has worked collaboratively with the Government of the Russian Federation to develop and implement a model program of retention and continuity of care for opioid dependence and HIV infection. The model utilizes the Narcology Detoxification Service, State AIDS Centers, Non Government Organization (NGO) managed narcology treatment and rehabilitation centers, NGO outreach programs and the community. The model program was developed and implemented as a pilot demonstration project to provide essential health services to injection drug users and retain them in care. The interventions developed and implemented comprised HIV Testing and Counseling, HIV/AIDS Narcology Post-Graduate Curriculum, Peer Support Groups (Buffer groups), Narcological Follow-up Phone Monitoring, Women’s Narcological Services and Short Messaging Services for Injection Drug Users. These services and interventions promoted the integration and utilization of HIV/AIDS health services and narcological services to form an evidence-based health service delivery model providing essential services to people who inject drugs and people living with HIV/AIDS in the Russian Federation.展开更多
Correct drug labelling is central for ensuring proper drug dispensing and thus for patient safety. Labelling errors may result in adverse health outcomes. The objective of this study was, therefore, to assess the effe...Correct drug labelling is central for ensuring proper drug dispensing and thus for patient safety. Labelling errors may result in adverse health outcomes. The objective of this study was, therefore, to assess the effect of labelling on the quality of drug dispensing and patient knowledge about dispensed drugs in Jimma University model and specialized hospital outpatient Pharmacies. Individual packages with prescribed drugs were examined using pretested questionnaire and observational check lists during the dispensing process. Patients’ knowledge about drugs dispensed to them was assessed at the exit interview using a pretested questionnaire. Out of 743 prescribed drugs, 682 (91.8%) were dispensed to 426 patients. The average labelling score (range from 0 to 6) of dispensed drugs in Model and Outpatient pharmacy was 2.00 (95% CI 1.97 to 2.04) and 1.73 (95% CI 1.6 to 1.8) respectively, with overall average labelling score of 1.90 (95% CI 1.84 to 1.91). The average patient knowledge score (range from 0 t0 5) was 3.45 (95% CI 3.31 to 3.59) and 3.5 (95% CI 3.35 to 3.64) for model and outpatient pharmacy, respectively, while the overall average knowledge score was 3.46 (95% CI 3.37 to 3.57). Major labelling problems were absence of patient’s name and dose followed by frequency of administration, duration of treatment, and the reason for prescription. Literacy status of patients had a significant effect on their knowledge (p 0.05). We recommend that corrective measures targeting both, labelling and patients’ knowledge should be implemented to improve the patients’ safety and drug therapy adherence.展开更多
1例硬化失代偿期患者持续高热,经验性抗感染治疗效果不佳,临床药师参与制订个体化抗结核+抗感染方案:异烟肼0.3 g qd+利福平0.45 g qd+乙胺丁醇0.75 g qd+左氧氟沙星0.6 g qd,抗结核治疗一周后患者体温恢复正常;治疗两周后,患者胸腔积...1例硬化失代偿期患者持续高热,经验性抗感染治疗效果不佳,临床药师参与制订个体化抗结核+抗感染方案:异烟肼0.3 g qd+利福平0.45 g qd+乙胺丁醇0.75 g qd+左氧氟沙星0.6 g qd,抗结核治疗一周后患者体温恢复正常;治疗两周后,患者胸腔积液较前明显减少,但复查总胆红素升高(61μmol·L^(-1)),考虑患者出现了抗结核药物性肝损伤。临床药师评估病情与肝功能情况,决定继续抗结核治疗,并加用腺苷蛋氨酸保肝治疗,一周后复查胆红素较前未再升高;两周后肝功能显著好转,顺利出院。肝硬化患者的抗结核治疗方案制订需结合患者的病情和抗结核药物的特点进行个体化选择,以寻求获益与风险的平衡。展开更多
文摘Diabetes is a leading cause of mortality,morbidity and disability around the globe.In the past two decades,diabetes care has grown more complex as patients have received multi-component care.Recent studies have illumined the complexity of drug therapy in patients with diabetes.A high level of drug utilization in diabetes patients has serious implications for quality of care,in terms of coordination of care,drug safety and access to care.Practitioners,researchers,payers and policy makers should be aware of these implications and incorporate the complexity of diabetes care into practice guidelines,benefit design and policy formulation to improve the quality of care.
文摘This review is intended to help clinicians design drug regimens for special populations of critically ill patients with extremes of body size, habitus and composition that make drug choice or dosing particularly challenging due to the lack of high-level evidence on which to make wellinformed clinical decisions. The data sources included a literature search of MEDLINE and EMBASE with reviews of reference lists of retrieved articles. Abstracts of original research investigations and review papers were reviewed for their relevance to drug choice or dosing in the following special critically ill populations: patients with more severeforms of bodyweight or height, patients with amputations or missing limbs, pregnant patients, and patients undergoing extracorporeal membrane oxygenation or plasma exchange. Relevant papers were retrieved and evaluated, and their associated reference lists were reviewed for citations that may have been missed through the electronic search strategy. Relevant original research investigations and review papers that could be used to formulate general principles for drug choice or dosing in special populations of critically ill patients were extracted. Randomized studies with clinically relevant endpoints were not available for performing quantitative analyses. Critically ill patients with changes in body size, habitus and composition require special consideration when designing medication regimens, but there is a paucity of literature on which to make drug-specific, high-level evidencebased recommendations. Based on the evidence that is available, general recommendations are provided for drug choice or dosing in special critically ill populations.
文摘Health and Development Foundation has worked collaboratively with the Government of the Russian Federation to develop and implement a model program of retention and continuity of care for opioid dependence and HIV infection. The model utilizes the Narcology Detoxification Service, State AIDS Centers, Non Government Organization (NGO) managed narcology treatment and rehabilitation centers, NGO outreach programs and the community. The model program was developed and implemented as a pilot demonstration project to provide essential health services to injection drug users and retain them in care. The interventions developed and implemented comprised HIV Testing and Counseling, HIV/AIDS Narcology Post-Graduate Curriculum, Peer Support Groups (Buffer groups), Narcological Follow-up Phone Monitoring, Women’s Narcological Services and Short Messaging Services for Injection Drug Users. These services and interventions promoted the integration and utilization of HIV/AIDS health services and narcological services to form an evidence-based health service delivery model providing essential services to people who inject drugs and people living with HIV/AIDS in the Russian Federation.
文摘Correct drug labelling is central for ensuring proper drug dispensing and thus for patient safety. Labelling errors may result in adverse health outcomes. The objective of this study was, therefore, to assess the effect of labelling on the quality of drug dispensing and patient knowledge about dispensed drugs in Jimma University model and specialized hospital outpatient Pharmacies. Individual packages with prescribed drugs were examined using pretested questionnaire and observational check lists during the dispensing process. Patients’ knowledge about drugs dispensed to them was assessed at the exit interview using a pretested questionnaire. Out of 743 prescribed drugs, 682 (91.8%) were dispensed to 426 patients. The average labelling score (range from 0 to 6) of dispensed drugs in Model and Outpatient pharmacy was 2.00 (95% CI 1.97 to 2.04) and 1.73 (95% CI 1.6 to 1.8) respectively, with overall average labelling score of 1.90 (95% CI 1.84 to 1.91). The average patient knowledge score (range from 0 t0 5) was 3.45 (95% CI 3.31 to 3.59) and 3.5 (95% CI 3.35 to 3.64) for model and outpatient pharmacy, respectively, while the overall average knowledge score was 3.46 (95% CI 3.37 to 3.57). Major labelling problems were absence of patient’s name and dose followed by frequency of administration, duration of treatment, and the reason for prescription. Literacy status of patients had a significant effect on their knowledge (p 0.05). We recommend that corrective measures targeting both, labelling and patients’ knowledge should be implemented to improve the patients’ safety and drug therapy adherence.
文摘1例硬化失代偿期患者持续高热,经验性抗感染治疗效果不佳,临床药师参与制订个体化抗结核+抗感染方案:异烟肼0.3 g qd+利福平0.45 g qd+乙胺丁醇0.75 g qd+左氧氟沙星0.6 g qd,抗结核治疗一周后患者体温恢复正常;治疗两周后,患者胸腔积液较前明显减少,但复查总胆红素升高(61μmol·L^(-1)),考虑患者出现了抗结核药物性肝损伤。临床药师评估病情与肝功能情况,决定继续抗结核治疗,并加用腺苷蛋氨酸保肝治疗,一周后复查胆红素较前未再升高;两周后肝功能显著好转,顺利出院。肝硬化患者的抗结核治疗方案制订需结合患者的病情和抗结核药物的特点进行个体化选择,以寻求获益与风险的平衡。
