Exploratory research in clinical and social pharmacy最新文献_第8页

Multidisciplinary perspective on a pharmacist-led vaccination clinic in a regional cancer care setting: A qualitative study 多学科的观点在药剂师主导的疫苗接种诊所在区域癌症护理设置：一个定性研究

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy

Pub Date : 2025-07-05 DOI: 10.1016/j.rcsop.2025.100633

Kristoffer Johnstone , Joyce Cooper , John Smithson , Beverley Glass

Background

Immunosuppression in patients with cancer increases susceptibility to vaccine-preventable diseases, with suboptimal vaccination rates attributed to complex treatment schedules, timing of vaccination and uncertainty in relation to vaccination effectiveness. While pharmacists are routinely vaccinating patients in the community, high-risk cohorts, such as oncology patients, often lack access to dedicated vaccine services in hospital outpatient settings. Pharmacist-led vaccination clinics offer a promising solution to overcome existing barriers by integrating accessible, trusted healthcare professionals into patients' treatment location, to improve uptake through timely, co-located, and coordinated care. This study aimed to explore the perspectives of healthcare professionals regarding the implementation of a pharmacist-led vaccine clinic in an outpatient oncology unit.

Methods

Semi-structured interviews were conducted with pharmacists, nurses, and doctors from a single site regional referral hospital. Interviews were audio-recorded, transcribed verbatim, deductively and inductively coded and thematically analysed, with emerging themes mapped to the constructs of the Diffusion of Innovation Theory: relative advantage, complexity, compatibility, observability and trialability.

Results

Nineteen interviews were conducted with healthcare professionals, including seven pharmacists, six nurses and six doctors. Factors identified for successful implementation of a pharmacist-led vaccination clinic included patient-centred models, improved convenience and reduced complexity for patients, and compatibility with pharmacists' existing knowledge and role in outpatient units. Barriers were found to be work overload for pharmacists, reduced interaction with general practitioners, and lack of understanding of pharmacists' vaccination training.

Conclusion

Healthcare professionals expressed strong support for a pharmacist-led vaccine clinic in an outpatient oncology unit, recognising the potential to improve vaccination rates. Future research should however focus on assessing patient acceptance of such a service and the impact of such a clinic on vaccination rates.

癌症患者的免疫抑制增加了对疫苗可预防疾病的易感性，由于复杂的治疗计划、疫苗接种时间和疫苗接种有效性的不确定性，疫苗接种率不理想。虽然药剂师在社区定期为患者接种疫苗，但高风险人群，如肿瘤患者，往往无法在医院门诊环境中获得专门的疫苗服务。药剂师领导的疫苗接种诊所提供了一种很有希望的解决方案，通过将可获得的、值得信赖的医疗保健专业人员整合到患者的治疗地点，以通过及时、共同定位和协调的护理提高患者的接受程度，从而克服现有的障碍。本研究旨在探讨医疗保健专业人员对在门诊肿瘤科实施药剂师主导的疫苗诊所的看法。方法采用半结构化访谈法，对来自单一站点地区转诊医院的药师、护士和医生进行访谈。访谈录音，逐字抄录，演绎和归纳编码，主题分析，新主题映射到创新扩散理论的结构：相对优势，复杂性，兼容性，可观察性和可试验性。结果共对19名医护人员进行了访谈，其中药师7名，护士6名，医生6名。确定的成功实施药剂师主导的疫苗接种诊所的因素包括以患者为中心的模式，提高了便利性并降低了患者的复杂性，以及与药剂师在门诊单位的现有知识和作用相兼容。发现障碍是药剂师的工作过载，与全科医生的互动减少，以及缺乏对药剂师疫苗接种培训的了解。结论卫生保健专业人员强烈支持在门诊肿瘤科设立药剂师主导的疫苗诊所，认识到提高疫苗接种率的潜力。然而，未来的研究应侧重于评估患者对这种服务的接受程度以及这种诊所对疫苗接种率的影响。

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引用次数: 0

Assessment of patient perception and administration technique of vaginal tablets at a tertiary care women's hospital 某三级保健妇女医院对阴道片剂的患者认知和给药技术的评估

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy

Pub Date : 2025-07-03 DOI: 10.1016/j.rcsop.2025.100632

Nirmal Raj Marasine , Garima Kunwar , Manisha Chaudhary , Anjana Adhikari , Sabina Sankhi

Background

Vaginal tablets offer an effective and patient-friendly route for both localized and systemic therapies, bypassing hepatic first-pass metabolism and minimizing gastrointestinal side effects. However, in low-resource settings like Nepal, their optimal use is often hindered by patient's perception and administration techniques.

Objective

This study aimed to assess patient perception and administration technique of vaginal tablets at a tertiary women's hospital in Nepal.

Methods

A hospital-based cross-sectional study was conducted from February to July 2024 among 117 women of reproductive age visiting a tertiary care women's hospital in Kathmandu. Data were collected through face-to-face interviews using a validated 8-item perception questionnaire and an 8-item administration technique checklist. Bivariate analysis using Pearson's chi-square test and binary logistic regression were performed to identify factors associated with patients' perceptions and administration techniques.

Results

More than half (56.4 %) of the patient's demonstrated adequate administration techniques (scores ≥6), yet a striking 76.1 % exhibited suboptimal perceptions towards vaginal tablet use. Factors such as being unmarried, having lower educational attainment (illiterate or school level education), being unemployed or a housemaker, residing in rural areas, and lacking prior experience were significantly associated with poorer perceptions. Notably, younger age, prior use and counseling by pharmacists were positively linked to better administration techniques.

Conclusion

Despite adequate administration practices among most women, suboptimal perceptions persist, influenced by demographic and experiential factors. Tailored, provider-led educational interventions focusing on counseling and user-friendly instructions are essential to enhance patient understanding, comfort, and adherence, thereby improving therapeutic outcomes and empowering women in their reproductive health decisions.

阴道片为局部和全身治疗提供了一种有效且患者友好的途径，绕过肝脏第一过代谢并最大限度地减少胃肠道副作用。然而，在尼泊尔等资源匮乏的环境中，它们的最佳使用往往受到患者感知和管理技术的阻碍。目的了解尼泊尔某三级妇女医院患者对阴道片的认知和给药技术。方法对2024年2月至7月在加德满都一家三级保健妇女医院就诊的117名育龄妇女进行了以医院为基础的横断面研究。数据通过面对面访谈收集，使用一份经过验证的8项感知问卷和一份8项管理技术清单。采用皮尔逊卡方检验和二元逻辑回归进行双变量分析，以确定与患者感知和给药技术相关的因素。结果超过一半（56.4%）的患者表现出适当的给药技术（得分≥6），但令人震惊的是，76.1%的患者表现出对阴道片剂使用的不理想看法。未婚、受教育程度较低（文盲或中等教育程度）、失业或家庭主妇、居住在农村地区以及缺乏先前的经验等因素与较差的看法显著相关。值得注意的是，更年轻的年龄，以前的使用和咨询药剂师正相关的更好的管理技术。结论：尽管在大多数妇女中有充分的管理实践，但受人口统计学和经验因素的影响，次优认知仍然存在。量身定制的、由提供者主导的教育干预措施，侧重于咨询和用户友好的指导，对于增强患者的理解、舒适和依从性至关重要，从而改善治疗结果，增强妇女作出生殖健康决定的权能。

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引用次数: 0

Not so great expectations: The role of price and name information in the nocebo effect 不太大的期望：价格和名称信息在反安慰剂效应中的作用

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy

Pub Date : 2025-06-28 DOI: 10.1016/j.rcsop.2025.100630

Kiarne Humphreys , Michelle Lin , Kirsten Barnes , Yasmin Hasan , Ashwin Vignaraja , Kritika Sarna , Andrew L. Geers , Kate Faasse

Background

The perception of taking a generic medication can result in reduced efficacy and increased side effects, despite equivalence to brand name medications under double blind conditions. It may be that cues typically associated with generics, including lower price and more complex name, exacerbate negative expectations and cause nocebo effects.

Methods

Healthy participants (N = 196) were randomised to receive sham-oxytocin nasal spray associated with either a generic (complex name, low price; n = 66) or brand (simple name, high price; n = 68) cue, or to no treatment control (n = 62). Participants were informed that oxytocin could enhance trust and cooperation, but might cause side effects of headache, nausea, vomiting, rapid heartbeat, feeling faint or light-headed, and skin itching or rash. Treatment-related side effects were assessed at baseline, and after 3 days of sham-oxytocin use.

Results

Nocebo effects were observed across sham-treated participants relative to control (p = .015; d = 0.28). Association with a generic relative to branded cue significantly enhanced nocebo effects (p = .042; d = 0.36). Negative expectations mediated the observed nocebo and branding effects.

Conclusions

Cues associated with generic medications can exacerbate nocebo effects and these findings may explain clinical observations of increased side effects from generic medications. Results have important implications for medical care, and interventions to mitigate nocebo effects from generic medications are needed.

在双盲条件下，服用非专利药物可能导致疗效降低和副作用增加，尽管与品牌药物相同。这可能是通常与仿制药相关的线索，包括更低的价格和更复杂的名称，加剧了负面预期并导致反安慰剂效应。方法健康受试者（N = 196）随机接受假催产素鼻喷雾剂，该喷雾剂的名称复杂，价格低廉；N = 66)或品牌(名称简单，价格高；N = 68)提示，或无治疗对照（N = 62）。参与者被告知催产素可以增强信任和合作，但可能会导致头痛、恶心、呕吐、心跳加快、头晕目眩、皮肤瘙痒或皮疹等副作用。在基线和使用假催产素3天后评估治疗相关副作用。结果与对照组相比，假药治疗的受试者存在反安慰剂效应(p = 0.015；d = 0.28)。与品牌线索相关的非专利亲属显著增强了反安慰剂效应(p = 0.042；d = 0.36)。负面预期介导观察到的反安慰剂和品牌效应。结论与非专利药物相关的并发症可加重反安慰剂效应，这些发现可以解释非专利药物副作用增加的临床观察结果。研究结果对医疗保健具有重要意义，需要采取干预措施减轻仿制药的反安慰剂效应。

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引用次数: 0

Self-reported treatment burden: A comparison between vitamin K and non-vitamin K oral anticoagulants 自我报告的治疗负担：维生素K和非维生素K口服抗凝剂的比较

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy

Pub Date : 2025-06-25 DOI: 10.1016/j.rcsop.2025.100628

Miroslav Mihajlovic , Nevena Zec , Jelena Simic , Aleksandar Mihajlovic , Milan Marinkovic , Nebojsa Mujovic , Tatjana Potpara

Introduction

Treatment burden (TBN) refers to the impact of patients' healthcare-related workload on their functioning and well-being. A high TBN has been associated with lower adherence to treatment and increased risk of major adverse events, and patients considered a TBN score of ≥59 points as unacceptably high. In the present analysis, we explored differences in TBN, the prevalence of unacceptably high TBN score and discern the contributory factors associated with TBN among patients receiving vitamin K oral anticoagulants (VKA) or non-vitamin K oral anticoagulants (NOAC).

Methods

In a single-centre cross-sectional study from April to June 2019, consecutive patients receiving medical care at the Cardiology Clinic of University hospital were invited to fulfil the TBN Questionnaire encompassing 17 questions assessing TBN.

Results

Of 514 study patients, 320 (62.3 %) were taking oral anticoagulant therapy (OAC) and were included in the present analysis. Of those, 206 patients (64.4 %) were prescribed a VKA. The mean TBN score was significantly higher in VKA versus NOAC patients (48.8 ± 26.5 vs. 41.8 ± 19.7, P = 0.014). Patients taking VKA reported a TBN of ≥59 points significantly more often than those taking NOAC (30.1 % vs 18.4 %, P = 0.024). The VKA patients reported significantly higher TBN score values for questions related to self-monitoring, including INR monitoring (3.85 ± 3.32 vs. 1.62 ± 1.38, P < 0.001) and diet restrictions (3.98 ± 3.43 vs. 2.48 ± 2.49, P < 0.001) compared with NOAC patients.

Conclusion

In the present study, VKA patients reported significantly higher TBN and more frequently unacceptably high TBN compared to NOAC, primarily due to numerous VKA-food interactions and the need for regular INR monitoring. Our findings suggest that the prescription of NOAC could reduce the TBN, which could translate to improved patient outcomes.

治疗负担（TBN）是指患者的医疗相关工作量对其功能和福祉的影响。高TBN与较低的治疗依从性和主要不良事件风险增加相关，患者认为TBN评分≥59分是不可接受的高。在本分析中，我们探讨了在服用维生素K口服抗凝剂（VKA）或非维生素K口服抗凝剂（NOAC）的患者中TBN的差异，TBN评分过高的患病率，并辨别与TBN相关的因素。方法采用单中心横断面研究方法，于2019年4月至6月邀请连续在大学医院心脏病科门诊就诊的患者填写TBN问卷，问卷包含17个问题，评估TBN。结果514例患者中，320例（62.3%）接受口服抗凝治疗（OAC），纳入本分析。其中，206例患者（64.4%）使用了VKA。VKA患者TBN平均评分明显高于NOAC患者（48.8±26.5比41.8±19.7,P = 0.014）。VKA组患者TBN≥59分的发生率明显高于NOAC组（30.1% vs 18.4%, P = 0.024）。VKA患者在自我监测相关问题（包括INR监测）的TBN评分值显著高于对照组(3.85±3.32 vs. 1.62±1.38,P <；0.001)和饮食限制(3.98±3.43比2.48±2.49,P <；0.001)，与NOAC患者相比。在本研究中，与NOAC相比，VKA患者报告的TBN明显更高，而且更频繁地出现不可接受的高TBN，这主要是由于VKA-食物之间的大量相互作用以及需要定期监测INR。我们的研究结果表明，NOAC处方可以减少TBN，这可以转化为改善患者的预后。

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引用次数: 0

A qualitative exploration of community pharmacist views on providing a mental health and well-being intervention for long-term condition patients 社区药师对长期疾病患者提供心理健康和幸福干预意见的定性探讨

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy

Pub Date : 2025-06-25 DOI: 10.1016/j.rcsop.2025.100629

Patrick Cabasag , Kebede Beyene , Frederick Sundram , Amy Hai Yan Chan , Holly Wilson , Jeff Harrison

Background

Subthreshold depression and anxiety are common, affecting up to 24 % of people over their lifetime and are often associated with long-term conditions. Community pharmacists, who often have an established relationship with people who have long-term conditions, are well placed to identify and address subthreshold depression and anxiety and reduce the risk of progression to clinical mental health disorders.

Methods

Semi-structured individual qualitative interviews were conducted with community pharmacists to explore their perspectives on a pharmacy service for long-term condition patients with subthreshold depression and anxiety. Interviews were audio recorded, transcribed in intelligent verbatim and analysed using a General Inductive Approach.

Results

Eleven purposively selected community pharmacists from diverse backgrounds were interviewed. Four main themes were identified, each with several subthemes. These related to existing support mechanisms for delivering long-term condition and mental health services in community pharmacies, pharmacists' perceptions and attitudes toward service delivery, barriers and facilitators to service implementation, and the design and implementation of a service.

Conclusions

This is the first study to explore community pharmacists' perspectives on a pharmacy intervention for long-term condition patients with subthreshold depression and anxiety. Overall, community pharmacists expressed positive attitudes toward delivering an intervention for people with long-term conditions and subthreshold depression and anxiety. Future work would involve taking a co-design approach to developing and evaluating such an intervention.

阈下抑郁和焦虑很常见，影响了24%的人的一生，并且通常与长期疾病有关。社区药剂师往往与患有长期疾病的人建立了牢固的关系，他们能够很好地识别和处理阈下抑郁和焦虑，并降低发展为临床精神健康障碍的风险。方法对社区药师进行半结构化的个人定性访谈，探讨他们对长期阈下抑郁和焦虑患者的药学服务的看法。访谈录音，以智能逐字转录，并使用一般归纳方法进行分析。结果有针对性地选取不同背景的社区药师进行访谈。确定了四个主要主题，每个主题又有若干次主题。这些问题涉及社区药房提供长期疾病和精神卫生服务的现有支持机制、药剂师对提供服务的看法和态度、服务实施的障碍和促进因素，以及服务的设计和实施。结论本研究首次探讨了社区药师对长期阈下抑郁和焦虑患者的药物干预。总的来说，社区药剂师对长期患有阈下抑郁和焦虑的人表达了积极的态度。未来的工作将涉及采取共同设计的方法来开发和评估这种干预措施。

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引用次数: 0

Building primary care providers' confidence in deprescribing opioids and benzodiazepines in older adults 建立初级保健提供者对老年人处方阿片类药物和苯二氮卓类药物的信心

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy

Pub Date : 2025-06-24 DOI: 10.1016/j.rcsop.2025.100627

Stefanie P. Ferreri , Lori T. Armistead , Ben Urick , Tamera D. Hughes , Anne-Therese Hunt , J. Marvin McBride , Joshua Niznik , Ellen Roberts , Kimberly A. Sanders , Jan Busby-Whitehead

Background

Opioids and benzodiazepines (BZDs) are among the most prescribed medications that contribute to falls in older adults; however, little guidance exists on their safe prescribing and deprescribing. Although some resources are available to assist providers with opioid and BZD deprescribing, many report lack of confidence as a barrier. The objective of this study was to assess PCPs' confidence in their ability to deprescribe opioids and BZDs before and after an intervention.

Methods

We modified a validated deprescribing self-efficacy survey to assess primary care provider (PCP) confidence in deprescribing opioids and BZDs in older adults before and after a consultant pharmacist educational intervention. The survey consisted of 35 questions divided into three sections: deprescribing opioids (10 questions), deprescribing BZDs (10 questions), and deprescribing under potentially impeding circumstances [UPIC] (15 questions). The survey was sent to 88 PCPs using a modified Dillman method. We evaluated providers' confidence on a 100-point scale pre- and post-intervention, comparing the difference-in- differences (DID) in scores between the intervention and control groups.

Results

A total of 41 PCPs (46.6 %) completed the survey both pre-and post-intervention. The intervention group (n = 21) showed an improvement in their knowledge and self-efficacy skills by an average of 19.7 out of 100 points, while the control group (n = 20) improved by an average of 5.2 points. The DID in self-efficacy improvement between the two groups was +14.5 points (p = 0.003) overall. For each of the opioid-, BZD-, and UPIC-specific scores, the intervention group had a statistically significant DID compared to the control group (+15.8, p = 0.004; +14.2, p = 0.017; +13.9, p = 0.016, respectively).

Conclusion

This consultant pharmacist educational intervention improved PCPs' confidence in deprescribing opioids and BZDs in older adults.

阿片类药物和苯二氮卓类药物（BZDs）是导致老年人跌倒的最常用药物之一；然而，关于它们的安全处方和解除处方的指导很少。虽然有一些资源可以帮助阿片类药物和BZD处方的提供者，但许多人报告缺乏信心是一个障碍。本研究的目的是评估pcp在干预前后解除阿片类药物和BZDs处方能力的信心。方法我们修改了一项经过验证的处方自我效能感调查，以评估初级保健提供者（PCP）在咨询药师教育干预前后对老年人阿片类药物和bzd处方的信心。调查包括35个问题，分为三个部分：处方阿片类药物（10个问题），处方bzd（10个问题），以及在潜在阻碍情况下处方[UPIC]（15个问题）。使用改进的Dillman方法将调查结果发送给88个pcp。我们在干预前和干预后以100分制评估了提供者的信心，比较了干预组和对照组之间的得分差异（DID）。结果干预前和干预后共有41名pcp（46.6%）完成了调查。干预组（n = 21）在知识和自我效能技能方面平均提高了19.7分（满分100分），而对照组（n = 20）平均提高了5.2分。两组患者自我效能改善DID总分为+14.5分（p = 0.003）。对于阿片类药物、BZD和upic特异性评分，干预组的DID与对照组相比具有统计学意义(+15.8,p = 0.004；+14.2, p = 0.017；+13.9, p = 0.016)。结论咨询药师教育干预提高了pcp对老年人阿片类药物处方和BZDs的信心。

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引用次数: 0

The role of U.S. pharmacists in deprescribing: Recommendations based on a systematic literature review of qualitative studies 美国药剂师在处方中的作用：基于定性研究的系统文献综述的建议

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy

Pub Date : 2025-06-24 DOI: 10.1016/j.rcsop.2025.100625

Alina Cernasev , Devin Scott , Becka Eckert , Hilary Jasmin , David R. Axon

Purpose

Deprescribing is increasingly investigated through a qualitative lens, yet no evidence synthesis of the extant qualitative deprescribing literature exists. This study aimed to identify and synthesize relevant qualitative data about the role of the pharmacist or pharmacy profession in deprescribing in the United States.

Methods

A systematic literature review was conducted in July 2024 in MEDLINE (PubMed), Scopus (Elsevier), and Embase (Elsevier). The primary search concepts included terms around pill burden, cessation and de-prescription, as well as a search string to narrow results to qualitative reports. From 4410 unique records after deduplication, 46 abstracts were included for full text review.

Results

After full text review, 11 records were deemed suitable for inclusion in this review. Three used interviews, five used focus groups, and three used both. Three studies used the theory of planned behavior, two studies used the capability, opportunity, and motivation behavior model, one used the chronic care model, one used the interprofessional shared decision-making model, one used grounded theory, and three did not use a framework. Studies were conducted in New York (n = 3), Arizona, Maine, and Tennessee (n = 3), California (n = 1), Iowa (n = 1), Massachusetts (n = 1), North Carolina (n = 1), and Rhode Island (n = 1). Key themes identified across the studies included enablers, obstacles, process of deprescribing, and deprescribing in pharmacy education.

Conclusions

Deprescribing is a complex process that involves the entire healthcare team, including pharmacists who have unique expertise to support the team through education and information about medication and disease states.

目的越来越多地通过定性视角来研究处方，但没有证据综合现有的定性处方文献。本研究旨在识别和综合美国药剂师或药学专业在处方中的作用的相关定性数据。方法于2024年7月在MEDLINE （PubMed）、Scopus （Elsevier）和Embase （Elsevier）进行系统文献综述。主要的搜索概念包括围绕药片负担、戒烟和去处方的术语，以及将搜索结果缩小到定性报告的搜索字符串。从4410条重复数据删除后的唯一记录中，选取46篇摘要进行全文审查。结果经全文审阅后，11条记录被认为适合纳入本综述。三个使用访谈，五个使用焦点小组，三个两者都使用。3项研究使用计划行为理论，2项研究使用能力、机会和动机行为模型，1项研究使用慢性护理模型，1项研究使用跨专业共同决策模型，1项研究使用扎根理论，3项研究未使用框架。研究在纽约州（n = 3）、亚利桑那州、缅因州和田纳西州（n = 3）、加利福尼亚州（n = 1）、爱荷华州（n = 1）、马萨诸塞州（n = 1）、北卡罗来纳州（n = 1）和罗德岛州（n = 1）进行。研究中确定的关键主题包括促进因素、障碍、处方解除过程和药学教育中的处方解除。结论开处方是一个复杂的过程，涉及整个医疗团队，包括药剂师，他们有独特的专业知识，通过教育和药物和疾病状态的信息来支持团队。

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引用次数: 0

Shortening emergency department length of stay: Fast track, short-stay unit and acute medical unit 缩短急诊科住院时间：快速通道、短期住院单位和急症医疗单位

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy

Pub Date : 2025-06-19 DOI: 10.1016/j.rcsop.2025.100626

Bei Huang

Emergency department (ED) length of stay (EDLOS) refers to the waiting time experienced by patients at various stages of the ED. It serves as an indicator of ED overcrowding. Prolonged EDLOS can lead to delays in assessment and care, negatively impacting patient satisfaction, and is associated with a poor prognosis. ED overcrowding may result in higher rates of medical errors, adverse events, and mortality. The crude mortality rate for patients with EDLOS <6 h was significantly lower than for those with EDLOS of 12–24 h and > 24 h. Multiple factors influence EDLOS before admission, including limited medical resources and a high volume of non-emergency cases. Hospitals should develop personalized strategies to reduce EDLOS by analyzing patient volumes and resource demands. In this narrative review, measures involving alternatives to ward admission from the ED such as an emergency fast track (FT), an emergency short-stay ward (ESSW)/emergency short-stay unit (ESSU), and an acute medical unit (AMU)/acute medical admissions unit (AMAU), are summarized, aiming to serve as a reference for shortening EDLOS, improving emergency care efficiency, and optimizing service quality.

急诊科（ED）住院时间（EDLOS）是指患者在急诊科不同阶段的等待时间。它是急诊科过度拥挤的一个指标。延长的EDLOS可导致评估和护理的延迟，对患者满意度产生负面影响，并与预后不良有关。急诊科过度拥挤可能导致更高的医疗差错、不良事件和死亡率。EDLOS 6 h患者的粗死亡率显著低于EDLOS 12 ~ 24 h和EDLOS 12 ~ 24 h患者。24 h.入院前影响EDLOS的因素多种多样，包括医疗资源有限、非急诊病例量大等。医院应该通过分析患者数量和资源需求来制定个性化策略，以减少EDLOS。本文总结了急诊快速通道（FT）、急诊短期住院病房(ESSW)/急诊短期住院单元（ESSU）、急症医疗单元(AMU)/急症医疗住院单元（AMAU）等替代急症住院的措施，旨在为缩短急症住院时间、提高急诊护理效率和优化服务质量提供参考。

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引用次数: 0

Stevens-Johnson syndrome triggered by phenytoin in a patient with type 2 diabetes and seizures 史蒂文斯-约翰逊综合征由苯妥英引起的2型糖尿病和癫痫患者

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy

Pub Date : 2025-06-13 DOI: 10.1016/j.rcsop.2025.100624

Mohammed Misbah Ul Haq, Mohammed Ansar, Aieman Siddiqua, Mohd Mudaseer

This case report describes a unique and severe instance of Stevens-Johnson syndrome (SJS) triggered by a combination of phenytoin, levetiracetam, glimepiride, and metformin in a patient with type 2 diabetes. SJS is a serious condition that affects the skin and mucous membranes and is often induced by various medications. The report underscores the critical importance of promptly identifying and managing SJS, as well as the need for careful monitoring of patients on multiple drugs, especially those with prior drug allergies. It also adds valuable insights to the existing literature on drug-induced SJS, emphasizing the role of a multidisciplinary approach in improving patient care and outcomes.

本病例报告描述了一例独特且严重的史蒂文斯-约翰逊综合征（SJS），由苯妥英、左乙拉西坦、格列美脲和二甲双胍联合引起的2型糖尿病患者。SJS是一种影响皮肤和粘膜的严重疾病，通常由各种药物引起。该报告强调了及时识别和管理SJS的重要性，以及对使用多种药物的患者进行仔细监测的必要性，特别是那些先前有药物过敏的患者。它还为现有的药物性SJS文献增加了有价值的见解，强调了多学科方法在改善患者护理和预后方面的作用。

引用次数: 0

Using simulated patient methodology to assess sick day guidance in community pharmacy: The case of an elderly patient with diabetes 用模拟病人方法评估社区药房的病假指导：以一位老年糖尿病患者为例

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy

Pub Date : 2025-06-11 DOI: 10.1016/j.rcsop.2025.100623

Tristan Coppes , Hetty Prins , Kees A. van Amerongen , Teun van Gelder , Ellen S. Koster , Marcel L. Bouvy

Background

Certain high-risk medication, such as diuretics, should be temporarily adjusted during sick days (diarrhoea, vomiting or fever) to reduce the risk of adverse drug events. Guidelines refer to this as ‘sick day guidance’. Prior research has shown limited awareness among pharmacy staff of these recommendations.

Objective

This study assessed how community pharmacies in the Netherlands address a simulated self-care inquiry related to diarrhoea from a 71-year-old patient with diabetes.

Methods

Three trained simulated informal caregivers visited community pharmacies unannounced to seek an antidiarrheal product for a 71-year-old family member with diabetes and high-risk medication. Data were collected through a data collection form with audio recording.

Results

A total of 64 pharmacies were visited. Current comorbidities and medications were identified in 59 % (38/64) of the pharmacies. Sixteen out of 64 pharmacies (25 %) provided sick day guidance either through temporary medication adjustment or GP referral. In more than 80 % of the pharmacies, a pharmaceutical product was dispensed, most often loperamide. The pharmacies that did not identify current comorbidities and medications (n = 26), did not provide sick day guidance nor referred to the GP.

Conclusions

Sick day guidance was applied in one in four cases. Identifying current comorbidities and medications is essential for providing sick day guidance.

背景：某些高风险药物，如利尿剂，应在病假期间（腹泻、呕吐或发烧）临时调整，以减少药物不良事件的风险。指导方针将此称为“病假指导”。先前的研究表明，药房工作人员对这些建议的认识有限。目的：本研究评估荷兰社区药房如何处理与71岁糖尿病患者腹泻有关的模拟自我保健询问。方法三名训练有素的模拟非正式护理人员未经通知前往社区药房，为一位患有糖尿病和高危药物的71岁家庭成员寻求止泻产品。数据通过带有录音的数据收集表收集。结果共走访药店64家。59%（38/64）的药房发现了目前的合并症和药物治疗。64家药房中有16家（25%）通过临时用药调整或全科医生转诊提供病假指导。在80%以上的药店中，配发了一种药品，最常见的是洛哌丁胺。没有确定当前合并症和药物的药房（n = 26），没有提供病假指导，也没有转介给全科医生。结论1 / 4的病例采用病日指导。确定当前的合并症和药物对于提供病假指导至关重要。

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