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Training Community Pharmacy Staff How to Help Manage Urgent Mental Health Crises 培训社区药房员工如何帮助处理紧急精神健康危机
Pub Date : 2019-09-01 DOI: 10.3390/pharmacy7030133
Nathaniel M. Rickles, A. Wertheimer, Yifan Huang
Nearly 44 million Americans are affected by mental illness every year. Many individuals, however, are not diagnosed and/or do not receive treatment. The present manuscript reviews the incidence of mental illness, the continuum from mental wellness to mental illness, and the role of the pharmacy staff in helping individuals manage different mental health needs. In particular, there is discussion of stigma of mental illness that those with mental health needs experience by those around them including health professionals such as pharmacy staff. One way to resolve such stigma is through training such as Mental Health First Aid (MHFA). The paper reviews key aspects of MHFA, the evidence supporting MHFA, and how MHFA relates specifically to pharmacy practice and services. A conceptual framework for MHFA and its relationship to individual factors, attitudes, behaviors, and outcomes. Lastly, a discussion is presented that briefly compares MHFA to other similar approaches to helping those in mental health crises, the limits of what is known about MHFA, and what future research might explore to better understand the outcomes of pharmacy staff providing mental health education, support, and referral to care.
每年有近4400万美国人受到精神疾病的影响。然而,许多人没有得到诊断和/或没有接受治疗。本文回顾了精神疾病的发病率,从精神健康到精神疾病的连续体,以及药房工作人员在帮助个人管理不同心理健康需求方面的作用。特别是讨论了有精神健康需要的人周围的人,包括药房工作人员等卫生专业人员,对精神疾病的污名化问题。解决这种耻辱的一种方法是通过培训,如精神卫生急救(MHFA)。本文回顾了MHFA的关键方面,支持MHFA的证据,以及MHFA如何与药房实践和服务具体相关。MHFA的概念框架及其与个体因素、态度、行为和结果的关系。最后,本文简要地比较了MHFA与其他类似的方法来帮助那些处于精神健康危机中的人,MHFA所知的局限性,以及未来的研究可以探索什么,以更好地了解药房工作人员提供心理健康教育、支持和转介护理的结果。
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引用次数: 7
Sulfonamide Allergies 磺胺类药过敏
Pub Date : 2019-09-01 DOI: 10.3390/pharmacy7030132
Amber B. Giles, J. Foushee, Evan Lantz, G. Gumina
As one of the earliest developed antimicrobial classes, sulfonamides remain important therapeutic options for the empiric and definitive treatment of various infectious diseases. In the general population, approximately 3–8% of patients are reported to experience a sulfonamide allergy. Sulfonamide allergies can result in various physical manifestations; however, rash is reported as the most frequently observed. In patients with human immunodeficiency virus (HIV), dermatologic reactions to sulfonamide antimicrobial agents occur 10 to 20 times more frequently compared to immunocompetent patients. This article describes the incidence, manifestations, and risk factors associated with sulfonamide allergies. The potential for cross-reactivity of allergies to sulfonamide antimicrobials with nonantimicrobial sulfonamide medications is also reviewed. Data suggest that substitutions at the N1 and N4 positions are the primary determinants of drug allergy instead of the common sulfonamide moiety. For patients with an indication for a sulfonamide antimicrobial with a listed allergy, it is important for healthcare practitioners to adequately assess the allergic reaction to determine appropriate management. Rechallenge and desensitization strategies may be appropriate for patients with delayed maculopapular eruptions, while alternative treatment options may be prudent for more severe reactions. Available data suggests a low risk of cross-allergenicity between sulfonamide antimicrobial and nonantimicrobial agents.
作为最早开发的抗菌药物之一,磺胺类药物仍然是各种传染病经验性和决定性治疗的重要治疗选择。在一般人群中,约有3-8%的患者报告有磺胺过敏。磺胺过敏可导致各种身体表现;然而,据报道,皮疹是最常见的。在人类免疫缺陷病毒(HIV)患者中,磺胺类抗菌药物的皮肤反应比免疫正常的患者频繁10至20倍。本文描述了与磺胺过敏相关的发病率、表现和危险因素。对磺胺类抗菌剂过敏与非抗菌磺胺类药物交叉反应的可能性也进行了综述。数据表明,N1和N4位置的取代是药物过敏的主要决定因素,而不是常见的磺胺部分。对于患者磺酰胺抗菌剂的适应症与列出的过敏,这是重要的医疗从业人员充分评估过敏反应,以确定适当的管理。再挑战和脱敏策略可能适用于延迟性黄斑丘疹患者,而对于更严重的反应,替代治疗方案可能是谨慎的。现有数据表明,磺胺类抗菌剂和非抗菌剂之间的交叉致敏性风险较低。
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引用次数: 34
The Use of Primary Care Electronic Health Records for Research: Lipid Medications and Mortality in Elderly Patients 使用初级保健电子健康记录研究:老年患者的脂类药物和死亡率
Pub Date : 2019-09-01 DOI: 10.3390/pharmacy7030134
A. Hodgkins, J. Mullan, D. Mayne, Andrew D Bonney
General practice electronic health record (EHR) data have significant potential for clinical research. This study demonstrates the feasibility of utilising longitudinal EHR data analysis to address clinically relevant outcomes and uses the relationship between lipid medication prescription and all-cause mortality in the elderly as an exemplar for the validity of this methodology. EHR data were analysed to describe the association of lipid medication use, non-use or cessation with all-cause mortality in patients aged ≥75 years. Survival analysis with Cox regression was used to calculate hazard ratios, which were adjusted for confounders. There was no significant difference in all-cause mortality among patients according to their use, non-use, or cessation of lipid medications. The outcomes of this study correlate well with the results of other research works. This single-practice study demonstrates the feasibility and potential of analysing EHR data to address important clinical issues such as the relationship between all-cause mortality and lipid medication prescription in the elderly.
全科电子健康记录(EHR)数据在临床研究中具有重要的潜力。本研究证明了利用纵向电子病历数据分析解决临床相关结果的可行性,并使用老年人脂质药物处方与全因死亡率之间的关系作为该方法有效性的范例。对EHR数据进行分析,以描述≥75岁患者使用、不使用或停止使用脂质药物与全因死亡率的关系。采用Cox回归的生存分析计算风险比,并对混杂因素进行调整。在使用、不使用或停止使用脂质药物的患者中,全因死亡率没有显著差异。这项研究的结果与其他研究工作的结果密切相关。这项单一实践研究证明了分析电子病历数据解决重要临床问题的可行性和潜力,如老年人全因死亡率与脂类药物处方之间的关系。
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引用次数: 0
Impact of a Pharmacy-Led Transition of Care Service on Post-Discharge Medication Adherence 以药房为主导的护理服务过渡对出院后药物依从性的影响
Pub Date : 2019-08-31 DOI: 10.3390/pharmacy7030128
A. Stroud, G. Adunlin, Jessica W Skelley
This study assesses the effectiveness of a pharmacy-led transition of care (TOC) service on increasing patients’ understanding of, and reported adherence to, medication post hospital discharge. A cross-sectional survey was administered to patients who were discharged from the hospital with at least one medication received via bedside delivery from the TOC service. Adherence was assessed by asking the patient if they had taken their discharge medications as instructed by the prescriber. Satisfaction with the discharge medication counseling service was assessed through a five-point Likert scale. Descriptive statistics were conducted for all questionnaire items and qualitative data was examined using content analysis. The majority of patients (73%) were counseled on their medication(s) before leaving the hospital. Among those who received counseling, 76 patients had a better understanding of their medication(s). Ninety-five percent of the patients reported adherence, and all six of the patients reporting non-adherence claimed they were not counseled on their medications prior to discharge. Many patients had questions regarding their medication during the follow-up phone call, substantiating the need for further follow-up with patients once they have left the hospital environment. The implementation of medication bedside delivery and counseling services, followed by outpatient adherence monitoring via a transitional care management service, can result in higher levels of reported medication adherence.
本研究评估了药房主导的护理过渡(TOC)服务在提高患者对出院后药物治疗的理解和依从性方面的有效性。一项横断面调查对出院的患者进行了管理,这些患者至少通过床边递送从TOC服务获得了一种药物。通过询问患者是否按照处方者的指示服用了出院药物来评估依从性。出院药物咨询服务满意度采用李克特五点量表进行评估。对所有问卷项目进行描述性统计,对定性数据进行内容分析。大多数患者(73%)在出院前接受了药物咨询。在接受咨询的患者中,76名患者对他们的药物有了更好的理解。95%的患者报告了依从性,所有6名报告不依从性的患者声称他们在出院前没有接受过药物咨询。许多患者在随访电话中对他们的药物有疑问,证实了一旦患者离开医院环境后需要进一步随访。实施药物床边交付和咨询服务,然后通过过渡护理管理服务进行门诊依从性监测,可以提高报告的药物依从性水平。
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引用次数: 3
The Experiences of People Living with Peripheral Neuropathy in Kuwait—A Process Map of the Patient Journey 科威特周围神经病变患者的经历——病人旅程的过程图
Pub Date : 2019-08-30 DOI: 10.3390/pharmacy7030127
Maryam Alkandari, K. Ryan, A. Hollywood
Peripheral neuropathy is a neurological disease characterised by pain, numbness, tingling, swelling or muscle weakness due to nerve damage, caused by multiple factors such as trauma, infections and metabolic diseases such as diabetes. In Kuwait 54% of the diabetic population, has peripheral neuropathy. In this exploratory, qualitative study conducted in Kuwait, 25 subjects with peripheral neuropathy took part in one-on-one, semi-structured interviews lasting 45–60 min. Interviews were transcribed, translated into English and coded using NVivo 12. Four individual patient journeys were mapped out in detail, then compared and condensed into a single process map. The remaining 21 interviews were then reviewed to ensure the final map represented all patient journeys. Participants reported similar healthcare pathways for their peripheral neuropathy and faced various difficulties including lack of psychological support, administrative issues (long waiting referral periods, loss of medical documents, shortage of specialists and lack of centralized electronic medical records) and inadequate medical care (shortage of new treatments and deficient follow-ups). Mapping the patient journey in Kuwait showed similar pharmacological treatment to UK guidelines, except that some medicines were unavailable. The map also indicated the need for an integrated referral approach, the use of technology for electronic medical recording and report transmission, alongside education on self-management, coping mechanisms and treatment options for people living with peripheral neuropathy.
周围神经病变是一种神经系统疾病,其特征是神经损伤引起的疼痛、麻木、刺痛、肿胀或肌肉无力,由创伤、感染和糖尿病等代谢性疾病等多种因素引起。在科威特,54%的糖尿病患者有周围神经病变。在科威特进行的这项探索性质的研究中,25名周围神经病变患者参加了一对一的半结构化访谈,持续45-60分钟。访谈被转录、翻译成英语并使用NVivo 12进行编码。四个病人的旅程被详细地绘制出来,然后比较并浓缩成一个单一的过程图。然后对其余21个访谈进行审查,以确保最终的地图代表所有患者的旅程。参与者报告了其周围神经病变的类似保健途径,并面临各种困难,包括缺乏心理支持、行政问题(转诊等待时间长、医疗文件丢失、缺乏专家和缺乏集中的电子医疗记录)和医疗护理不足(缺乏新的治疗方法和缺乏随访)。绘制科威特病人旅程的地图显示,除了一些药物无法获得外,药物治疗与英国指南相似。该地图还表明,需要采取综合转诊办法,使用电子医疗记录和报告传输技术,同时对周围神经病变患者进行自我管理、应对机制和治疗选择方面的教育。
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引用次数: 14
Aminoglycoside Allergic Reactions 氨基糖苷过敏反应
Pub Date : 2019-08-29 DOI: 10.3390/pharmacy7030124
L. Childs‐Kean, Kristy M Shaeer, Sheeba Varghese Gupta, Jonathan C. Cho
Aminoglycosides are antimicrobial agents that are primarily used for infections caused by Gram-negative pathogens. The purpose of this article is to review the allergic reactions reported in the published literature to aminoglycoside antibiotics. A thorough PubMed search was conducted and excluded non-allergic adverse reactions to aminoglycosides. Allergic reactions to aminoglycosides occur infrequently, but can include cutaneous reactions as well as systemic reactions, including anaphylaxis. Of the evaluated aminoglycosides, gentamicin had the most reported allergic reactions, including the most reports of anaphylaxis, followed by tobramycin, and then amikacin. Most reports of allergic reactions occurred in patients who had a prior exposure to some dosage form of an aminoglycoside. Cross-reactivity among aminoglycosides is common and occurs due to the similarities in their chemical structures. Desensitization protocols to tobramycin have been described in the literature.
氨基糖苷类抗菌剂主要用于革兰氏阴性病原体引起的感染。本文的目的是回顾已发表的氨基糖苷类抗生素的过敏反应报道。进行了全面的PubMed检索,并排除了氨基糖苷的非过敏性不良反应。对氨基糖苷的过敏反应很少发生,但可包括皮肤反应以及全身反应,包括过敏反应。在评估的氨基糖苷类药物中,庆大霉素有最多的过敏反应报告,包括最多的过敏反应报告,其次是妥布霉素,然后是阿米卡星。大多数过敏反应报告发生在先前暴露于某种剂量形式的氨基糖苷的患者中。氨基糖苷之间的交叉反应是常见的,这是由于它们的化学结构相似而发生的。对妥布霉素的脱敏方案已在文献中描述。
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引用次数: 14
Pharmacists’ Utilization of Information Sources Related to Community and Population Needs in the Upper Midwest and Associations with Continuing Professional Education 中西部上游地区药剂师对社区和人口需求相关信息源的利用及其与继续专业教育的关联
Pub Date : 2019-08-29 DOI: 10.3390/pharmacy7030125
P. Henkel, Marketa Marvanova
Background: To investigate information sources utilized in pharmacists’ assessment of population-based health needs and/or community changes; and the association between information sources utilized and reported completion of continuing professional education topics. Methods: In 2017; licensed pharmacists (n = 1124) in North Dakota; South Dakota; Minnesota; Iowa; and Nebraska completed a questionnaire on continuing professional education and information sources on population-based health needs and community changes. Data were entered; cleaned and imported into Stata 11.1. Census Bureau county-level population density data were used to classify local area characteristics. Descriptive statistics and multivariate logistic regression analyses were performed. Results: Most sources of primary; county-level data on population-based health needs or community changes were minimally utilized. Pharmacists in more rural areas were statistically more likely to use local health professionals; local non-health professionals; and/or the state health department compared to pharmacists in less rural areas. Pharmacists reporting higher use of population-based information sources were more likely to have completed continuing education in the past 12 months for all 21 surveyed topics; 13 significantly so. Conclusions: There is a reliance of pharmacists on information from local health and non-health professionals for information on population-based health needs and/or community changes. Utilization of health departments and other primary information sources was associated with increased rates of completion of an array of continuing professional education topics. Expanding utilization of evidence-driven information sources would improve pharmacists’ ability to better identify and respond to population-based health needs and/or community changes through programs and services offered; and tailor continuing professional education to population-based health needs.
背景:调查药师评估基于人群的健康需求和/或社区变化的信息来源;以及信息来源利用和报告完成继续专业教育主题之间的关系。方法:2017年;北达科他州持牌药剂师(n = 1124);南达科塔;明尼苏达州的;爱荷华州;内布拉斯加州完成了一份关于继续专业教育和基于人口的健康需求和社区变化的信息来源的调查问卷。输入数据;清理并导入到Stata 11.1。使用人口普查局县级人口密度数据对当地区域特征进行分类。进行描述性统计和多元逻辑回归分析。结果:主要来源;关于基于人口的保健需求或社区变化的县级数据很少得到利用。统计数据显示,更多农村地区的药剂师更有可能使用当地的卫生专业人员;本地非保健专业人员;和/或州卫生部门与农村地区的药剂师相比。报告使用基于人群的信息源较高的药剂师更有可能在过去12个月内完成所有21个调查主题的继续教育;显著地……结论:药剂师依赖当地卫生和非卫生专业人员的信息来获取基于人群的卫生需求和/或社区变化的信息。利用卫生部门和其他主要信息来源与提高一系列继续专业教育主题的完成率有关。扩大循证信息来源的利用将提高药剂师通过提供的项目和服务更好地识别和应对基于人群的健康需求和/或社区变化的能力;并使继续专业教育适应以人口为基础的健康需要。
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引用次数: 1
Polypharmacy Definitions for Multimorbid Older Adults Need Stronger Foundations to Guide Research, Clinical Practice and Public Health 多种疾病老年人的多种用药定义需要更坚实的基础来指导研究、临床实践和公共卫生
Pub Date : 2019-08-29 DOI: 10.3390/pharmacy7030126
C. Sirois, N. Domingues, M. Laroche, A. Zongo, C. Lunghi, L. Guénette, E. Kröger, V. Émond
There are numerous definitions of polypharmacy to describe the use of many medications among older adults, but there is a need to clarify if they are purposive and meaningful. By means of a systematic review, we identified definitions of polypharmacy used in multimorbid older adults (≥65 years). We evaluated if the definitions align among the domains of research, clinical practice, and public health and appraised whether concepts of polypharmacy are based on strong foundations. More than 46 definitions of polypharmacy were retrieved from 348 publications (research: n = 243; clinical practice: n = 88; public health: n = 17). Several thresholds based on the number of medications were mentioned. The majority of the publications (n = 202, 58%) used a minimal threshold of five medications. Heterogeneous qualitative definitions were identified, mostly stating that polypharmacy is “more drugs than needed”. There was no significant divergence between domains as to the type of definitions used, although qualitative definitions were more common in clinical practice. Nearly half (n = 156, 47%) of the publications provided no justification for the polypharmacy definition used. The wide variety of definitions for polypharmacy precludes comparisons, appropriate identification and management of polypharmacy in multimorbid older adults. Standardized definitions would allow more coherent judgments regarding the individual and collective stakes of polypharmacy.
多种用药有许多定义来描述老年人使用多种药物,但有必要澄清它们是否有目的和有意义。通过系统回顾,我们确定了多病老年人(≥65岁)使用多种药物的定义。我们评估了这些定义在研究、临床实践和公共卫生领域之间是否一致,并评估了多药概念是否基于坚实的基础。从348篇出版物中检索到46个以上的多药定义(研究:n = 243;临床:88例;公共卫生:n = 17)。提到了基于药物数量的几个阈值。大多数出版物(n = 202, 58%)使用了5种药物的最低阈值。确定了不同的定性定义,主要是指出多药是“比需要更多的药物”。尽管定性定义在临床实践中更为常见,但在使用定义类型的领域之间没有显着差异。近一半(n = 156,47 %)的出版物没有为所使用的多药定义提供理由。多种多样的多重用药定义妨碍了多种疾病老年人多重用药的比较、适当识别和管理。标准化的定义将允许对多种药物的个人和集体利益作出更连贯的判断。
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引用次数: 43
Design and Implementation of an Integrated Competency-Focused Pharmacy Programme: A Case Report 一个以能力为中心的综合药学计划的设计和实施:一个案例报告
Pub Date : 2019-08-27 DOI: 10.3390/pharmacy7030121
T. Ryan, T. Grimes, M. Henman, Eimear Ní Sheachnasaigh, M. O'Dwyer, Cicely Roche, S. Ryder, A. Sasse, John J Walsh, D. D'Arcy
This paper describes the design and implementation of elements of an integrated competency-focused pharmacy programme in the School of Pharmacy and Pharmaceutical Sciences (SoPPS), Trinity College Dublin (TCD), Ireland. Following a national review of pharmacy education and training in Ireland in 2010, and subsequent publication of legislation in 2014, the School has implemented a five-year integrated programme of pharmacy education and training, leading to the award of a Master’s degree in Pharmacy (M. Pharm.). Curricular integration has been achieved by underpinning the new programme with a national competency framework for pharmacists and through the utilisation of curricular integration themes. Programme integration also encompasses embedded experiential learning placements in Years 2, 4 and 5 of the five-year programme. The new five-year integrated pharmacy programme, which commenced in 2015, replaced the 4 + 1 model of education and training where a four-year Bachelor’s degree was followed by a one-year internship, which was a distinct and separate element of the students’ training.
本文描述了在药学和制药科学学院(SoPPS),都柏林三一学院(TCD),爱尔兰的综合能力为重点的药学计划的设计和实施要素。继2010年爱尔兰药学教育和培训的国家审查之后,随后在2014年颁布了立法,学院实施了一项为期五年的药学教育和培训综合计划,授予药学硕士学位(M. Pharm.)。课程整合已通过支持新的方案与药剂师的国家能力框架,并通过利用课程整合主题实现。课程整合还包括在五年制课程的第2、4和5年级进行嵌入式体验式学习。新的五年制综合药学课程于2015年开始,取代了4 + 1的教育和培训模式,即四年制学士学位之后是一年的实习,这是学生培训的一个独特而独立的元素。
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引用次数: 14
Penicillin Allergy Skin Testing in the Inpatient Setting 住院病人青霉素过敏皮肤试验
Pub Date : 2019-08-27 DOI: 10.3390/pharmacy7030120
J. Justo, Wesley D. Kufel, L. Avery, P. Bookstaver
The consequences of a documented penicillin allergy in the medical record are especially troublesome in acutely ill, hospitalized patients. A penicillin allergy label may lead to alternative or second line therapies resulting in adverse drug events, negative clinical outcomes and increased costs. Reconciling penicillin allergies is a necessity to facilitate early, optimal therapy and is a shared responsibility among the healthcare team. Penicillin skin testing (PST) has been utilized successfully in hospitalized patients to de-label erroneous penicillin allergies and optimize antibiotic therapy. This targeted review aims to discuss the practical development and implementation of PST in the inpatient setting. This includes a needs assessment checklist with common considerations allowing for customization to one’s institution based on available personnel, time, and technological resources.
医学记录中记载的青霉素过敏的后果对急性住院病人尤其麻烦。青霉素过敏标签可能导致替代或二线治疗,导致药物不良事件、负面临床结果和成本增加。协调青霉素过敏是促进早期最佳治疗的必要条件,也是医疗团队的共同责任。青霉素皮肤试验(PST)已成功地用于住院患者去标签错误的青霉素过敏和优化抗生素治疗。这篇有针对性的综述旨在讨论PST在住院患者环境中的实际发展和实施。这包括一个需求评估清单,其中包含了基于可用的人员、时间和技术资源,允许对机构进行定制的共同考虑。
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引用次数: 9
期刊
Pharmacy: Journal of Pharmacy Education and Practice
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