Ann Pharmacother:急诊科抗菌药物管理干预对改善患者结局是否有意义?

2017-09-16 石岩 环球医学

2017年9月,发表在《Ann Pharmacother》的一项由加拿大科学家进行的系统评价,考察了急诊科实施抗菌药物管理干预能否改善患者结局。



2017年9月,发表在《Ann Pharmacother》的一项由加拿大科学家进行的系统评价,考察了急诊科实施抗菌药物管理干预能否改善患者结局。

背景和目的:为了改善抗菌药物使用,已经推荐在急诊科(ED)发展和实施抗菌药物管理项目。本评价的首要目的为描述急诊科中抗菌药物管理(AMS)的特征,识别可改善患者结局或治疗过程和/或降低抗菌药物使用的干预措施。

方法:本研究为系统评价。检索了Medline、Embase、治疗及相关健康文献累积索引、Scopus和Web of Science数据库,截止日期为2016年11月。评估急诊中AMS干预措施的随机对照试验、非随机对照试验、对照和非对照前后研究、中断时间序列分析、重复测量研究都纳入到本评价中。排除英语以外语言的研究。

结果:总共43项研究符合入组标准。患者或医生教育和指南或临床路径实施为最常报道的干预措施。很少有研究报道了评估和反馈,没有研究评估预先授权。干预措施的影响显示了不同的结果。在识别具体获益的时候,AMS干预措施的获益主要包括医疗护理的改善或抗菌药使用的减少;然而,多数研究的偏倚风险未知或较高。

结论:急诊科中AMS干预措施可改善患者治疗。然而,干预措施的最佳组合未知。需要更严格设计的评估AMS项目核心元素的研究,包括前瞻性评估和反馈。

原始出处:

Losier M, et al. A Systematic Review of Antimicrobial Stewardship Interventions in the Emergency Department. Ann Pharmacother. 2017 Sep;51(9):774-790. doi: 10.1177/1060028017709820. Epub 2017 May 24.

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1787322, encodeId=69331e87322cb, content=<a href='/topic/show?id=fa03141591e' target=_blank style='color:#2F92EE;'>#Pharm#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14159, encryptionId=fa03141591e, topicName=Pharm)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Wed Apr 04 19:17:00 CST 2018, time=2018-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1996047, encodeId=d327199604e52, content=<a href='/topic/show?id=ed881120ec8' target=_blank style='color:#2F92EE;'>#MAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11207, encryptionId=ed881120ec8, topicName=MAC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, 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  6. [GetPortalCommentsPageByObjectIdResponse(id=1787322, encodeId=69331e87322cb, content=<a href='/topic/show?id=fa03141591e' target=_blank style='color:#2F92EE;'>#Pharm#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14159, encryptionId=fa03141591e, topicName=Pharm)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Wed Apr 04 19:17:00 CST 2018, time=2018-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1996047, encodeId=d327199604e52, content=<a href='/topic/show?id=ed881120ec8' target=_blank style='color:#2F92EE;'>#MAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11207, encryptionId=ed881120ec8, topicName=MAC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, 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  7. 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  8. 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  9. 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    2017-09-17 lhlxtx
  10. 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澳洲网16日刊文称,调查显示,澳洲逾三分之一的急诊医生都曾遭遇过欺凌,其中6.2%的受访者表示遭受过性骚扰。

CCLM:急诊部门实际动机在检测中是重要的

研究人员为了调查在这种压力下工作的医生的行为,针对急诊科(ED)的学员和工作人员设计了一份问卷。此问卷涉及到要求检测的必要性,排序时间,测试成本和可用性以及当天的时间等主题。研究人员假设排序行为将主要由医疗需求导向,并旨在确定有影响的实际动机。

J Am Heart Assoc:急诊血管成形术后AKI 造影剂是罪魁祸首?

与接受择期干预的患者相比,接受急诊经皮冠状动脉介入治疗(pPCI)的患者被认为具有造影剂(CM)诱导的急性肾损伤(CI-AKI)的较高风险,但pPCI后肾功能的恶化也可能是由于多种其他因素导致。2017年6月,发表在《J Am Heart Assoc.》的一项研究调查了造影剂暴露和pPCI后AKI发生率之间的因果关系。请看本期多学科讨论组临床药师各抒己见为您梳理本文看点—— 背景:pPCI后急性

Crit Care Med:美国修订版脓毒症急诊就诊现状

急诊是脓毒症初始诊断和治疗的重要场所。近期,一项发表在杂志Crit Care Med上的研究评估了美国急诊中脓毒症的流行病学的现状。此项研究分析了2009 - 2011年美国国立医院急诊的相关数据。受试人群为急诊成人(年龄≥18岁)败血症患者。研究者们将严重感染定义为急诊部门诊断的严重感染或温度大于38°C或低于36°C的患者,并将三个急诊部门的脓毒症进行分类:1)原急诊部门脓毒症严重感染加急诊部