Clinical Analysis of Common Irrational Gastroenterology Medication Problems in The Gastroenterology Department

Objective: To investigate and analyze the irrational problems of common gastroenterology medications applied to gastroenterology patients during treatment, and to develop and implement countermeasures. Methods: This study included 60 patients admitted to the Department of Gastroenterology from January 2021 to December 2023 who were randomly divided into a control group (conventional drug management) and an observation group (targeted drug treatment), of 30 cases each. After the implementation of different management methods, the occurrence of irrational drug use and the incidence of adverse reactions between both groups were compared and statistically analyzed. Results: The incidence of irrational medication in the observation group (13.33%) was lower than that in the control group (40.00%) (P < 0.05). The occurrence of adverse reactions in the observation group (10.00%) was lower than that of the control group (36.67%) after treatment (P < 0.05). The observation group had a higher level of satisfaction after treatment (90.00%) as compared to the control group (66.67%) (P < 0.05). Conclusion: Implementation of targeted drug treatment for gastroenterology patients reduced the incidence of irrational medication use, reduced adverse reactions, and improved patient satisfaction.

Development of the Irrational Belief Test for Nurses (IBTN): Examination of Reliability and Validity

[Purpose]: The purpose of this study is to develop irrational belief test for nurses, and to examine reliability and validity. [Method]: In study 1, The Irrational belief test for nurses was developed based JIBT-20 (mori et al., 1994) of previous studies. And for the nurse (N = 96, 5 male, 91 female), carried out preliminary investigation, created the provisional version of the Irrational belief test for nurses, and examined factor structure and internal consistency. In study 2, for the nurse (N = 541, 21 male, 520 female) examined validity based on JIBT-20 (Japanese Irrational Belief Test), MBI (Maslach Burnout Inventory), ATQ-R Japanese version (Automatic Thoughts Questionnare-Revised), and for the nurse (N = 91, 3 male, 88 female) examined a test-retest reliability four weeks afterward before long. [Result]: As a result of the explanatory factor analysis by a maximum likelihood estimation and promax rotation, 28-item 7 factors were extracted and was named a “patient belief”, “self-expectation”, “avoidance”, “self-inhibition”, “Ethical blame”, “helplessness”, and “dependence”. Moreover, as a result of conducting confirmation factor analysis, the hypothetical model obtained by explanatory factor analysis fitted (GFI = 0.89, AGFI = 0.86). About the reliability of the measure, a Cronbach’s alpha coefficient is 0.68 - 0.82, and a test-retest reliability is 0.64 and reliability is affirmed. About construct validity was checked correlation with JIBT-20, and about criterion validity was checked the correlation with MBI and ATQ-R Japanese-translation version. [Conclusion]: It is suggested that reliability and validity are verified and the irrational belief test for nurses is a useful measure. The developed test can be used to measure the irrational belief in the context of burnout in nurses.

Bifurcations and chaotic threshold for a nonlinear system with an irrational restoring force

Nonlinear dynamical systems with an irrational restoring force often occur in both science and engineering, and always lead to a barrier for conventional nonlinear techniques. In this paper, we have investigated the global bifurcations and the chaos directly for a nonlinear system with irrational nonlinearity avoiding the conventional Taylor＇s expansion to retain the natural characteristics of the system. A series of transformations are proposed to convert the homoclinic orbits of the unperturbed system to the heteroclinic orbits in the new coordinate, which can be transformed back to the analytical expressions of the homoclinic orbits. Melnikov＇s method is employed to obtain the criteria for chaotic motion, which implies that the existence of homoclinic orbits to chaos arose from the breaking of homoclinic orbits under the perturbation of damping and external forcing. The efficiency of the criteria for chaotic motion obtained in this paper is verified via bifurcation diagrams, Lyapunov exponents, and numerical simulations. It is worthwhile noting that our study is an attempt to make a step toward the solution of the problem proposed by Cao Q J et al. （Cao Q J, Wiercigroch M, Pavlovskaia E E, Thompson J M T and Grebogi C 2008 Phil. Trans. R. Soe. A 366 635）.

Intramolecular vibrational dynamical barrier due to extremely irrational couplings

The intramolecular vibrational dynamics due to extremely irrational couplings is demonstrated by contrast to the resonance couplings, for the three-mode case of H2O as an example. The extremely irrational couplings are shown to impose such strong hindrance to intramolecular vibrational relaxation （IVR） that they act as barriers. They restrict the direct action/energy transfer between the two stretching modes, though they allow the transfer between a stretching and a bending modes. In contrast, the resonance is more mediated by the bending mode and leads to chaotic IVR. It is also shown that there is a region in the dynamical space in which resonance and extremely irrational couplings coexist.

Periodic, Irrational and Transcendental Numbers in the Factorial Series

The main aim of the article is to investigate the irrational and transcendental properties of certain real numbers by means of the factorial series and the factorial number system. The difference between the factorial series and the factorial system is that the factorial series does not set an upper bound at a given place after the radix point, while in the factorial system (i – 1) is the maximal possible value for ri after the radix point. I give an extended definition of periodic numbers, and show the relationship between periodic and irrational numbers. I prove the transcendence of e by means of the factorial series and the factorial number system.

Analysis on Irrational Decision Making of Tobacco Family Farmers from the Perspective of Optimal Scale of Efficiency

The larger the difference between the willingness scale of tobacco family farmers and the optimal scale of efficiency,the greater the degree of irrationality,and the higher the decision making risk.With the aid of DEA model,this study calculated the optimal scale of efficiency of Guiyang tobacco family farms.Using the ratio of willingness scale and efficiency optimal scale,it measured the degree of irrationality of family farmers.In addition,with the help of multiple linear regression model,it explained the irrational decision making mechanism of family farmers.Finally,it made a portrait of farmers who tend to make irrational decisions,to find specific farmers and guide them in their production and operation,reduce the risk of planting scale decision making and stabilize the sustainable development of the tobacco industry.

Irrational Narration in The Black Cat

Edgar Allan Poe,a writer of American Romantic period,is a forerunner in the use of irrational narration,especially in his dark tales,opening up a new approach for literature.Whether from narration perspective,plot or theme,The Black Cat,one of his masterpiece,is the typical manifestation of this narration.

On the Irrational Narration in The Black Cat

Edgar Allan Poe is one of the representative writers in American Dark Romanticism.Different from his contemporaries,the majority of Poe's short stories are characterized by irrational narration.Whether from narration technique or elements,The Black Cat is the best elucidation of such narration.Thus,this thesis is devoted to a condensed study of irrational narration in The Black Cat,holding views that Poe's contribution in promoting the development of American literature and continuing the American dream is profound and significant.

非理性偏好下动力电池再制造供应链最优决策与协调研究

考虑动力电池剩余容量不确定特征,构建由电池供应商和汽车制造商组成的再制造供应链,分别探讨决策双方完全理性、单向非理性偏好和双向非理性偏好等5种决策情形下的均衡解。研究发现:动力电池再制造容量起始点对回收量具有正向作用。在双向非理性偏好情形下,供应商的利他(公平)偏好程度增加导致制造商和系统总利润提高(降低),而自身利润总是降低;制造商的非理性偏好对供应链成员及系统利润的影响与供应商的非理性偏好程度有关。在单向非理性情形下,供应链成员的利他(公平)偏好程度增加导致自身利润下降(上升)而对方利润上升(下降)。两部定价契约和收益共享契约能够实现双向非理性偏好情形下再制造供应链的协调。

我院静脉配置中心抗肿瘤药不合理用药分析

目的分析我院静脉用药调配中心抗肿瘤药不合理用药情况,为临床抗肿瘤静脉用药提供参考,促进临床合理用药,保障肿瘤患者用药安全。方法我院2022年度住院静脉用药调配中心抗肿瘤用药医嘱10098份,依据药品说明书、相关文献等相关资料对87份不合理医嘱进行统计分析。结果我院2022年度住院静脉用药调配中心医嘱10098份,其中有不合理用药医嘱87份,每个科室均存在不合理用药情况,妇科的不合理医嘱数最多,其占比23.08%;静脉用药调配中心抗肿瘤药不合理用药情况主要包括溶媒错误(40.23%)、药物剂量不合理(29.89%)、给药顺序不合理(18.39%)、给药时间不合理(11.49%)。结论应加强我院的静脉用药调配中心抗肿瘤药不合理用药情况和抗肿瘤药溶媒管理,加强医师对抗肿瘤药物性质的认知,合理规范选择药物,同时药剂师应严格审核医嘱,以最大幅度减少不合理用药情况。

公司股利迎合行为:研究述评与展望

股利政策是上市公司财务决策的重要内容,基于行为金融学视角分析公司股利迎合行为具有重要的理论意义和实践意义。从内涵、动机、表现和经济后果等方面系统梳理并评述了公司股利迎合行为的现有研究成果,并提炼了需要进一步着重研究的问题。首先,结合投资者非理性股利偏好,厘清和归纳了投资者非理性行为的内涵和衡量方法。其次,从动机、影响因素、回购场景等方面总结了公司的现金股利迎合行为,并结合股票拆分、高送转等多种方式归纳了公司的股票股利迎合行为。再次,从市场反应、信息质量、未来业绩、公司风险等角度阐释了公司股利迎合行为的经济后果。最后,从投资者非理性股利情绪指标的构建、现金股利迎合中的委托代理问题、股票股利迎合行为的差异性以及互联网环境下公司股利迎合的经济后果等多个方面指出了关于公司股利迎合行为的未来研究方向,为后续的理论研究和监管政策的优化完善提供了指引和启示。

全覆盖处方点评对门、急诊抗菌药物合理应用的影响

目的观察对门、急诊所有抗菌药物处方进行全覆盖大样本量的点评对医院抗菌药物合理用药影响。方法对门、急诊所有抗菌药物处方进行点评,本文通过实践前后对照的方法,将点评模式优化前(2022年)、优化后(2023年)的点评结果即不合格率进行比较和统计学处理,计数资料采用χ2检验。结果对比优化前,门急诊抗菌药物处方不合格率进一步降低。2023年与2022年相比明显降低,差异有统计学意义(P<0.05)。结论通过全覆盖处方点评、人工点评结合软件点评、学术交流和行政干预并行等措施可显著降低抗菌药物处方不合格率,持续改进不合理用药现象。

某医院2019~2021年特殊使用级抗菌药物应用分析

目的为减缓超级细菌的产生速度,更经济合理地用药,笔者拟对某医院2019~2021年特殊使用级抗菌药物应用情况进行分析,为临床实践的改进提供参考信息。方法利用电子病历系统调阅2019~2021年该院应用特殊使用级抗菌药物的情况,用WPS Office的WPS表格制表。内容包括2019~2021年特殊使用级抗菌药物的用药频度(DDDs)、限定日费用(DDC)、药品销售金额排序(B)/DDDs排序(A)、病原学检出情况。结果该院2019~2021年注射用比阿培南、注射用美罗培南的DDDs始终处于前两位;注射用伏立康唑、注射用替加环素的DDC较高,该院应用的特殊使用级抗菌药物的B/A大都趋近于1,药物总体经济效益与社会效益较为一致;该院革兰氏阴性菌检出率大于革兰氏阳性菌,且每年革兰氏阳性菌检出最高的均为金黄色葡萄球菌。结论该院特殊使用级抗菌药物应用基本合理,但仍存在部分问题,需加大特殊使用级抗菌药物管理力度,加强相关医务人员培训,更合理用药的同时减轻患者的医疗经济负担。

医院药事管理的优化改革在临床药学服务中的应用效果

目的:分析医院药事管理的优化改革在临床药学服务中的应用效果。方法:选取2022年9月—2023年2月滕州市第一人民医院收治的100例患者为常规组,选取2023年3—8月收治的100例患者为管理组。选取2022年9月—2023年8月滕州市第一人民医院药师20名。常规组进行常规药事管理,管理组进行药事管理优化改革。比较药师实施前后的药学服务质量,两组不合理用药率、不良反应发生率、满意度。结果:实施后应变能力、沟通能力、主动性、协作能力评分高于实施前,差异有统计学意义(P<0.001);管理组不合理用药率低于常规组,差异有统计学意义(P=0.011);管理组不良反应发生率低于常规组,差异有统计学意义(P=0.023);管理组满意度高于常规组,差异有统计学意义(P=0.014)。结论:医院药事管理的优化改革可以提高药师的药学服务质量,降低不合理用药率,保证临床用药安全,提高患者满意度。

某三甲医院出院带药不合理处方分析

目的了解合肥市第二人民医院出院带药不合理处方,分析原因并研究改进措施。方法对医院2022年3月~2023年2月期间出院带药进行处方点评,并从临床、药学、信息系统3个角度进行总结分析不合理医嘱产生的原因。结果28387张出院带药处方中,不合理处方551张,不合理率为1.94%,其中不规范处方190张,占0.67%;用药不适宜处方361张,占1.27%。结论药学专业人员和临床医生应及时更新专业知识并加强沟通和协作,以实现合理用药;持续改进电子处方系统可以减少系统操作错误风险并提高出院带药处方的合理性。

某院全肠外营养不合理处方的帕累托图分析

目的应用帕累托图分析年龄<60岁和年龄≥60岁的患者(老年患者)全肠外营养(total parenteral nutrition,TPN)不合理处方的情况及原因,为保障患者营养支持的安全性提供参考。方法选取福建医科大学附属泉州第一医院2023年1月至12月住院患者病历,每月随机抽取30份的TPN处方,应用帕累托图针对不合理处方的主、次要和一般因素进行分析。结果年龄<60岁的患者和老年患者TPN不合理处方类型几乎一致。但造成年龄<60岁的患者TPN不合理处方的主要因素为超适应症、热氮比不合理、糖脂比不合理,次要因素为谷氨酰胺用量不适宜;而造成老年患者TPN不合理处方的主要因素为热氮比不合理、谷氨酰胺用量不适宜、糖脂比不合理,次要因素为超适应症;一般因素均为脂溶性维生素用量不适宜和添加物不稳定。结论应用帕累托图分析年龄<60岁的患者和老年患者TPN不合理处方情况,可及时发现主次要因素,有利于临床药师针对性地进行相应的干预及营养基础知识的培训,以保障临床营养治疗的安全性和有效性。

基于Beers标准(2019版)评价河北省多种慢性病共存老年心力衰竭住院患者的潜在不适当用药

目的基于Beers标准(2019版)对河北地区多种慢性病共存老年心力衰竭(简称心衰)住院患者的潜在不适当用药(PIM)进行调查,并结合各疾病专科诊疗指南进行深入分析,探讨其相关危险因素,为促进多种慢性病共存老年人群临床合理用药提供参考。方法2022年1月随机从河北省4家医疗机构信息系统中各抽取50例老年心衰住院患者的电子病历资料。根据纳入与排除标准,最终纳入135例符合标准的患者。基于Beers标准(2019版)对老年心衰住院患者的PIM情况进行评估,结合疾病诊疗指南深入用药分析评价,给出用药建议。采用多因素Logistic回归分析老年心衰住院患者发生PIM的影响因素。结果不同年龄、罹患疾病种类的老年心衰住院患者PIM发生率比较,差异均无统计学意义(P>0.05);不同性别、用药种类、肾小球滤过率(GFR)的老年心衰住院患者PIM发生率比较,差异均有统计学意义(P<0.05)。按PIM发生频率高低排序前3位依次为利尿剂、螺内酯、苯二氮[艹卓]类镇静催眠药物。38例患者存在53例次PIM,排名前3的药物分别为苯二氮[艹卓]类镇静催眠药物、地高辛和抗精神病药物。24例患者存在26例次PIM,其中慢性肾脏病4期或以上阶段患者使用非甾体抗炎药物、心衰患者使用非甾体抗炎药物、晕厥患者使用胆碱酯酶抑制剂的情况较多。86例患者存在117例次高风险用药,其中老年住院患者使用利尿剂情况最多;其次为≥75岁的患者使用新型口服抗凝药物利伐沙班及达比加群。21例患者存在22例次药物相互作用,其中老年住院患者联合使用肾素-血管紧张素系统抑制剂和保钾利尿剂情况最多,共出现12例次。22例肾功能不全患者存在25例次PIM情况,其中肌酐清除率<30 mL/min的老年住院患者使用螺内酯的情况最多,共出现14例次。多因素Logistic回归分析结果显示,回归方程的拟合度为83.2%,其中女性、用药种类≥20种、GFR<45 mL/(min·1.73 m^(2))是发生PIM的危险因素(P<0.05)。结论河北地区多种慢性病共存老年心衰住院患者的PIM发生率较高,女性、用药种类≥20种、GFR<45 mL/(min·1.73 m^(2))是发生PIM的危险因素,合理用药水平有待提高。

某院门急诊处方前置审核系统不合理医嘱拦截情况分析

目的 促进临床安全、合理用药。方法 收集首都医科大学附属北京积水潭医院2022年11月至2023年10月的门急诊处方前置审核系统审核的西药医嘱,分析不合理医嘱发生情况。结果 共收集医嘱3 230 289条,其中不合理医嘱68 730条(2.13%),不合理医嘱的主要类型为适应证不适宜(49 162条,71.53%),次要类型为重复用药(9 629条,14.01%),其余均为一般类型(包括用法用量不适宜、配伍禁忌/不良药物相互作用、遴选药品不适宜、药品剂型/给药途径不适宜、多重因素不适宜等)。适应证不适宜医嘱较多的原因包括部分医师对医院新增药品的适应证欠熟悉,系统判断受到假阳性干扰等;重复用药医嘱较多的原因包括某些复方制剂药品有效成分、功能主治相对复杂,部分医师尚不完全熟悉,以及序贯治疗方案引起的假阳性情况等。结论 处方前置审核系统的应用可有效避免用药错误的产生,减少不合理药费支出。针对系统判定结果中存在的假阳性、假阴性情况,需不断更新完善系统数据库,药师也应不断提升自身的专业知识,同时与医师紧密配合,不断提升医嘱审核的质量,促进临床合理用药。

绘本阅读活动助推儿童非理性因素培养的思考

文章梳理非理性因素研究概况,解读其概念和内涵,分析儿童非理性因素的表征及绘本阅读活动对儿童非理性因素培养的促进作用,进而提出培养儿童非理性因素的路径,即推广分级阅读,根据儿童年龄阶段提供服务;提供主题多样的服务活动,满足儿童不同非理性因素培育需求;注重活动的适配性、系统性,促进儿童高层次非理性因素发展;加强跨界协作,加大儿童非理性因素培养保障力度。