Design of Pharmaceutical Care Process for Retail Pharmacies Based on Pareto Analysis

Objective To study the problems of pharmaceutical care in retail pharmacies and provide reference for the standardized development of pharmaceutical care in China.Methods Based on the literature of CNKI database,Pareto analysis was used to study the present situation of pharmaceutical care in retail pharmacies.Then the following problems in pharmaceutical care were found such as low personnel professional quality,inadequate attention,imperfect laws and regulations,and lack of standard service process.As to the first three problems,there were more research references.But there was less literature on the standard care process.Results and Conclusion Focusing on the customer demand,taking drug sales process as the basic framework of pharmaceutical care standardized process,and combining with the collaboration,the service process including prescription drugs review and OTC drugs purchase consultation is established.This process elaborates the division of staff services as well as the service standards in pre-sale,on-sale,and after-sale stages.Besides,it also puts forward some advice for the previous three problems,which will ensure the smooth implementation of pharmaceutical care in drugstores.

The Process of Compliance with Self-Care among Patients with Hypertension: A Grounded Theory Study

Introduction: Controlling hypertension across world continues to be challenging. Managing hypertension is not only concerned with lowering blood pressure by using antihypertensive medications;it also aims to minimize its consequences through adopting self-care practices. Compliance with self-care practices among patients with hypertension is considered a multidimensional phenomenon. The phenomenon of hypertension has been studied quantitatively, however;little qualitative studies were conducted to understand the compliance with self-care among patients with hypertension. Aim: To understand the process that patients with hypertension go through to comply with self-care practices. Methods: This study used a qualitative design that followed constructivist grounded theory approach;purposive sampling was used to recruit participants from cardiac clinics;semi structured, in-depth and face-to-face interview was used as a major method for data collection. Findings: Four participants with hypertension participated in this study;the phenomena of self-care was identified as the central phenomena;the start of the disease was identified as a casual condition;beliefs toward hypertension disease, beliefs toward self-care practices, knowledge and awareness regarding hypertension disease and self-care practices were identified as strategies;experiencing self-care practices was identified as consequence and being patients with hypertension in a social context. Conclusions: The process of compliance with self-care has a path of actions and interactions. The process started from the moment of diagnosis where the patients start to think about self-care. The absence of health care context leads to varying level of compliance with self-care among patients with hypertension. This indicated the need for more effective patient and health care provider relationship, education and awareness campaign.

基于CARES工具课题达成型品管圈构建晚期肿瘤患者安宁疗护全流程照护模式

目的基于CARES工具的课题达成型品管圈构建晚期肿瘤患者安宁疗护全流程照护模式。方法以新疆医科大学附属肿瘤医院安宁疗护团队为主导的品管圈小组确定了“基于CARES工具构建晚期肿瘤患者安宁疗护全流程照护模式”的活动主题,按照课题达成型品管圈操作步骤,在现况调查基础上从人员、制度、流程等方面对晚期肿瘤患者安宁疗护全流程照护模式进行构建。结果活动实施后,初步构建了晚期肿瘤患者安宁疗护全流程照护模式,晚期癌症患者疼痛控制有效率由90.54%提升至98.52%,呼吸困难改善率由60.53%提升至87.10%,谵妄状态改善率由21%提升至55.66%,晚期癌症患者照护者中重度负担水平由72%降至46.15%,ACP的普及率由10%提升至25.74%。圈员在专业知识、积极性、品管手法和团队凝聚力的能力均有所提高。结论基于CARES工具应用课题达成型品管圈构建晚期肿瘤患者安宁疗护全流程照护模式为患者及其照护者提供了有效的支持,同时促进了安宁疗护工作推广和进步。

标准护理流程在数字化截骨导板辅助下颌角截骨术患者中的应用

目的:探讨标准护理流程在数字化截骨导板辅助下颌角截骨术患者中的应用效果。方法:选取2020年1月-2023年6月笔者医院收治的数字化截骨导板辅助下颌角截骨术的158例下颌角肥大就医者,按照不同护理干预模式进行分组。将2020年1月-2021年9月收治的79例就医者纳入对照组,行常规护理;2021年10月-2023年6月收治的79例就医者纳入研究组,按照标准护理流程实施干预。比较两组术前准备完整率、并发症情况、焦虑评分及护理满意度。结果:研究组术前准备完整率为98.73%,显著高于对照组的72.15%(P<0.05);研究组并发症发生率为3.80%,低于对照组的13.92%(P<0.05);研究组干预后焦虑自评量表(Self-rating anxiety scale,SAS)评分低于对照组(P<0.05);研究组护理满意度为97.47%,明显高于对照组的82.28%(P<0.05)。结论:在数字化截骨导板辅助下颌角截骨术患者中实施标准护理流程,可提高术前准备完整率,降低并发症发生风险,在改善患者焦虑的同时提高了满意度,值得临床推广。

BIM技术在公共医疗建设项目施工阶段的应用分析

BIM技术在公共医疗建设项目施工阶段表现出显著优势。本文以兰州新区疾病预防控制中心建设项目为例,探讨BIM技术在方案深化、管线综合排布、参数化建模和施工工序模拟等方面的应用。BIM技术提高了设计精度和施工可视化,优化了资源利用,减少了施工错误和变更,并通过工序模拟确保工程顺利进行。项目顺利施工验证了BIM技术的可行性和优势,展示了其在提高管理水平和施工效率方面的潜力,对未来类似项目的推进具有重要意义。

Pharmaceutical Care:An Additional and Personalized Service in Health Care

The Pharmaceutical Care(PC)service is a growing sector.The continuous development of the role of the professional pharmacist in the sector of health services within the pharmacy leads to having an active role in the primary care.The PC service has been in operation for years in other western countries such as Spain,the United Kingdom and the United States.Several studies have been carried out,which confirm the benefits of the service in reducing morbidity,hospital admissions and the cost of the health care system.This article sets out the concept of PC and the financial benefit to health expenditure.It also analyzes the Drug Therapy Problem(DTP)and the Patient Care Process.To conclude,a patient case is presented to understand the practical implementation of the theory of the PC and to show how the professional pharmacist reports the pharmacotherapeutic case.

医护一体化护理流程在急性脑梗死静脉溶栓治疗中的应用效果

目的 分析医护一体化护理流程在急性脑梗死(ACI)静脉溶栓治疗中的应用效果。方法 选取2022年1月至12月我院收治的96例ACI静脉溶栓治疗患者为研究对象,以随机数字表法将其分为对照组(48例,常规护理)和研究组(48例,医护一体化护理流程)。比较两组的干预效果。结果 研究组的入院至静脉溶栓治疗时间短于对照组,溶栓治疗总有效率高于对照组(P<0.05)。溶栓治疗后24 h、出院时,研究组的广泛性焦虑障碍量表(GAD-7)、病人健康问卷(PHQ-9)评分均低于对照组(P<0.05)。出院前,研究组的美国国立卫生研究院脑卒中量表(NIHSS)评分低于对照组,Fugl-Meyer运动功能量表(FMA)、巴氏指数(BI)评分高于对照组(P<0.05)。结论 医护一体化护理流程在ACI静脉溶栓治疗中的应用效果显著,能缩短入院至静脉溶栓治疗时间,改善患者心理状态及功能结局。

全程精细化护理模式在自闭症谱系障碍患儿中的应用

目的探讨全程精细化护理对自闭症谱系障碍(ASD)患儿的临床效果。方法选取某医院130例ASD患儿,其中65例行常规护理作为对照组,另外65例予以常规护理和全程精细化护理管理作为观察组,均持续6个月。比较两组孤独症儿童行为量表(ABC)、孤独症治疗评估量表(ATEC)、自闭症儿童心理教育评估量表(第3版)(PEP-3)和儿童自闭症评定量表(CARS)评分。结果与干预前相比,干预后两组ASD患儿ABC、ATEC和CARS评分均下降,且对照组高于观察组(P均<0.05);两种ASD患儿PEP-3评分均升高,且对照组低于观察组(P均<0.05)。结论通过全程精细化护理干预ASD患儿,有助于改善患儿语言障碍、社交障碍和刻板的兴趣取向等ASD核心症状,值得临床推广使用。

Empirical Verification of Swanson’s Caring Processes Found in Nursing Actions: Systematic Review

Caring has long been recognized as central to nursing and is increasingly posited as a core concept although developing a theoretical description of caring which is adequate in the 21st. century continues to be a difficult task for nursing scholars. Consequently, verifying existing theoretical structures of caring remains an ongoing challenge. The aim of this article is to provide empirical verification of the caring processes of “knowing,” “being with,” “doing for,” “enabling” and “maintaining belief” from Swanson’s Middle Range Caring Theory based on the categorization of nursing actions from a systematic literature review on care. Methods: A systematic literature review was conducted in the fields of nursing sciences, medicine and psychology. Purposeful sampling was carried out covering a period from 2003-2013. The final sample included 25 articles. Results: Major themes of nursing actions included “knowing” which consisted of centering, nurturing, informed understanding, assessment skills, communication and respect for individual differences. “Being with” was characterized by intimate relationship, connecting, presencing, emotional adaptability awareness of self/other and decentering. “Doing for” included competence, knowledge, professional/technical skills, helping actions, anticipatory, multidisciplinary and preserving dignity. “Enabling” was characterized by self care, commitment, complexity of care, appropriate communication, information/education, sharing power, enabling choice and ongoing validation. Finally, “maintaining belief” was characterized by spiritual being, humanistic view, harmonious balance, hope, love, and compassion, meaning, and religious and spiritual orientation. Conclusion: Empirical verification was shown for the caring processes described in Swanson’s Caring Theory grounded in concrete nursing actions.

定时循序体位转换护理联合抚触护理对新生儿肺炎呼吸频率及康复进程的影响

目的分析定时循序体位转换护理联合抚触护理对新生儿肺炎呼吸频率(RR)及康复进程的影响。方法选取晋江市医院在2023年6月至2024年6月收治的180例新生儿肺炎患儿,采用随机数字表法将其分为两组,各90例;对照组给予常规护理,观察组给予定时循序体位转换护理联合抚触护理。分析两组患儿临床相关数据。结果观察组干预后RR水平、血氧饱和度(SpO_(2))水平、临床症状消失时间、患儿家属护理满意度均优于对照组(P<0.05)。结论定时循序体位转换护理联合抚触护理在新生儿肺炎的护理中具有重要的临床应用价值,可以有效改善患儿的呼吸状况,加快康复进程,并提高家属的满意度。

CICARE沟通流程如何运用于老年患者护理服务

相比而言,到医院就诊的老年患者,比年轻患者更需要周到的护理。评价护士护理老年患者质量的应是直观的服务标准。其中,就护士与老年患者沟通而言,运用CICARE沟通流程是一个不错的工具。因此,该研究重在探讨CICARE沟通流程如何应用于老年患者护理,这种方法简明扼要又彰显"以人为本"的内涵。

Automatic quality improvement reports in the intensive care unit: One step closer toward meaningful use

AIM: To examine the feasibility and validity of electronic generation of quality metrics in the intensive care unit(ICU).METHODS: This minimal risk observational study was performed at an academic tertiary hospital. The Critical Care Independent Multidisciplinary Program at Mayo Clinic identified and defined 11 key quality metrics. These metrics were automatically calculated using ICU Data Mart, a near-real time copy of all ICU electronic medical record(EMR) data. The automatic report was compared with data from a comprehensive EMR review by a trained investigator. Data was collected for 93 randomly selected patients admitted to the ICU during April 2012(10% of admitted adult population). This study was approved by the Mayo Clinic Institution Review Board.RESULTS: All types of variables needed for metric calculations were found to be available for manual and electronic abstraction, except information for availability of free beds for patient-specific time-frames. There was 100% agreement between electronic and manual data abstraction for ICU admission source, admission service, and discharge disposition. The agreement between electronic and manual data abstraction of the time of ICU admission and discharge were 99% and 89%. The time of hospital admission and discharge were similar for both the electronically and manually abstracted datasets. The specificity of the electronically-generated report was 93% and 94% for invasive and non-invasive ventilation use in the ICU. One false-positive result for each type of ventilation was present. The specificity for ICU and in-hospital mortality was 100%. Sensitivity was 100% for all metrics.CONCLUSION: Our study demonstrates excellent accuracy of electronically-generated key ICU quality metrics. This validates the feasibility of automatic metric generation.

Assessment of quality of postnatal care services offered to mothers in Dedza district, Malawi

This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descriptive cross sectional and utilized quantitative data collection and analysis method to determine structural, process and outcome components of postnatal care in two facilities that offer emergency obstetric and neonatal care and five that offer basic emergency obstetric and neonatal care. All 60 midwives who were providing postnatal care during the time of study in the district were interviewed using a structured questionnaire. In addition, the midwives actual practice was observed and compared to a standard checklist on postnatal care practice which was developed by the Malawi Ministry of Health. Data were analyzed using SPSS version 16.0. Results show that structure for providing postnatal counseling services was inappropriate and inadequate. Furthermore, the contents of postnatal services were below reproductive health standards because the clients were neither monitored nor examined physically on discharge. On average, all the seven facilities scored 48% on postnatal services rendered which is far below the recommended 80% according to the Reproductive Health Standards. There is a need to provide basic infrastructure in all the basic emergency obstetric and neonatal care facilities. In addition, refresher training courses for midwives in maternal and neonatal health with emphasis on postnatal care are recommended. There is also a need to restructure the maternal and neonatal health departments in the facilities so that the postnatal care units become stand-alone priority sites to improve the quality of the postnatal care services rendered.

Nursing Process in a Patient with Crohn’s Disease: Case Report

Background: Inflammatory Bowel Disease is a term that covers intestinal diseases, including ulcerative colitis and Crohn’s disease. Due to the condition of chronic and complex disease, the disease requires specialized nursing care and management in the context of a multi-disciplinary approach. As a guarantee of quality nursing care, it is essential to carry out the nursing process. Considering the commitment to assist the patient with Crohn’s disease, the nurse, through the nursing consultation, is able to diagnose the patient’s needs, proceed to the prescription of care and later evaluate the interventions, having the opportunity to develop work aimed at improving the quality of life of these patients. Objective: To describe the nursing process in a patient with Crohn’s disease. Methods: Exploratory case report study, carried out at the outpatient clinic for inflammatory bowel diseases of a public hospital in the countryside of the state of São Paulo, from June 2019 to October 2019. Data collection was performed through anamnesis, physical examination and analysis of medical records. Results: Female patient, 34 years old, diagnosed with Crohn’s disease. With the completion of the nursing process, it was possible to identify five nursing diagnoses and the elaboration of interventions and outcomes. The nursing evaluation was continuous and the patient adhered to the proposed interventions. Final considerations: The systematization and organization of the work of the nursing team proved to be essential for quality care, with efficiency and effectiveness, guaranteeing the patient comfort, general well-being and good rehabilitation.

Stroke Care in an Australian Rural Private Health Care Setting

Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certified stroke care units in the private health care setting are also unheard of. The superiority of these units is thought to be due to better adherence to processes of care (early utility of CT scan, allied health input within 24 hours, neurological observations, DVT prophylaxis and appropriate use of antiplatelet and anticoagulant use). We audited care of 100 patients who presented to the St. John of God Hospital (rural private hospital) over a period of 3 years. This included baseline demographics, adherence of processes of care, utility of appropriate investigations, and outcome measures such as discharge destination, level of function at discharge and complication rates. These data were compared with the national stroke report (AuSCR) and adherence to processes of care was compared with the SCOPE study (the first study to establish the benefit of POC). When compared with data from the AuSCR national report 2012, we found a higher mortality rate, an increased rate of disability on discharge, and a mixed adherence to processes of care. We also found a significant proportion of patients (40%) who were eligible to receive thrombolysis but did not. Overall we found that there were significant strengths to be drawn upon in the rural private healthcare setting and a more organised approach could improve outcomes.

食用醋粉的制备工艺、营养成分及保健作用研究进展

综述了食用醋粉的制备工艺、营养成分和保健作用,并对其未来发展进行了展望,以期为食用醋粉的综合利用提供参考。

“临床营养”团体标准在提高神经重症患者肠内营养治疗全流程管理达标率中的应用

目的提高神经重症患者肠内营养治疗全流程管理达标率。方法对照中国医院协会中国《医院质量安全管理》“第2-29部分患者服务临床营养”团体标准中肠内营养标准条款,对神经创伤重症科住院患者肠内营养治疗全流程管理达标情况进行调查,通过现状调查、原因解析,制订针对性方策,从组建肠内营养治疗全流程管理“医-护-营-康”多学科团队、构建基于“知-信-行”理论的肠内营养治疗培训闭环管理模式、建立以肠内营养治疗数据精准分析为基础的质量改进体系3方面予以改进。结果科室肠内营养治疗全流程管理达标率由改善前33.9%上升至改善后62.5%。结论开展“临床营养”团体标准实践可有效提高神经重症患者肠内营养治疗全流程管理达标率,规范肠内营养治疗操作流程,减少并发症,保障患者安全。

婴幼儿头皮医用粘胶相关性皮肤损伤防护方案的构建与应用

目的降低视频脑电图监测婴幼儿头皮医用粘胶相关性皮肤损伤。方法采用历史对照设计,将2018年1月至2019年12月入住癫痫监测单元行头皮视频脑电图监测的患儿856例纳入对照组,实施常规皮肤护理;将2021年1月至2022年12月入住癫痫监测单元行头皮视频脑电图监测的患儿851例纳入观察组,构建和实施医用粘胶相关性皮肤损伤防护方案。比较两组头皮医用粘胶相关性皮肤损伤发生率。结果观察组头皮医用粘胶相关性皮肤损伤发生率显著低于对照组(P<0.05)。结论婴幼儿头皮医用粘胶相关性皮肤损伤防护方案的应用,可有效降低婴幼儿头皮医用粘胶相关性皮肤损伤发生率。

The BP-M* Methodology for Process Analysis in the Health Sector

In this paper we present the main phases of the BP-M* methodology and its application to a care pathway for patients in the Oncology Division of a large hospital, to evaluate pros and cons of different drug administration modalities and the impact of these modalities to the organizational process. BP-M* has been developed for the manufacturing sector but the relevance of business modeling, analysis and reorganization is not restricted to a specific sector. The aim of this work is to show its application to a real life study of a complex process in the health sector.

How can collective leadership influence the implementation of change in health care?

Aim: This study focuses on how a collective leadership style could influence the implementation of change in health care.Methods: Kotter's 8-step process and leadership can guide the implementation of change. Collective leadership can highlight all levels of staff engagement, establish an organizational culture of learning and trust, and create continuous improvement. At the same time, it can formulate a well-designed plan;develop efficient strategies; communicate and empower the staff; assess the performance; and integrate the improvement.Results: Collective leadership can establish vision and trust, highlight all levels of staff engagement,establish an organizational culture of learning and trust, create continuous improvement, communicate and empower the staff and integrate the improvement.Conclusions: Collective leadership can be a powerful way to overcome the barrier and create an effective environment of adaptation of changes by analyzing Kotter's eight stage process.