台灣醫學/Formosan Journal of Medicine
臺灣醫學會,正常發行
選擇卷期
- 期刊
開方失誤(Prescribing error)乃醫藥失誤(medication error)產生的重要環節之一，此種失誤常經由專業執業藥師偵測並加以適當處理而及時防止。本研究探討醫學中心藥劑部門透過建置開方失誤網路通報作業系統，使得藥師於部內網頁得以即時逐筆線上登錄住院處方問題的成效，除就問題別做敘述性統計外，並進一步依據問題類型、開方科部、及藥劑部門各住院調劑單位所通報失誤量做分析，期以對醫學中心住院醫療服務之開方失誤問題加以瞭解。在九十二年七月至九十三年六月的一年研究期間，所通報之開方失誤量達33,426筆，佔總開方筆數1.98%，通報比例最多之處方問題依類型別、開方科部別、調劑單位別，分別以鍵入錯誤(70.4%)、內科部(43.3%)、總院東址住院藥局(87.0%)等項次或單位居冠，後兩者亦大致反應了其業務量及編制。整體而言，醫師對藥師所提處方建議之平均接受率達93.5%，如就各處方問題別細部探討，發現以「未在電腦取消應停藥醫囑」之18,783筆(56.2%)為最常見，且此項問題之建議接受率達99.8%，顯示醫院營運效益之提昇仍有極大空間；而接受率最不理想的項目為「出院藥與非碳寫複本不符」(26.3%)，改善方式應可朝加強醫藥溝通、舉辦專業人員教育宣導、及調整機構開方政策等方向進行。
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本研究旨在探討醫師服務量在極低出生體重新生兒的照護上，是否與其照護結果存有相關性。研究進行是以全民健保資料庫2000年出生體重介於500-1499公克的1185位極低出生體重新生兒為研究對象，針對照護醫師及醫療機構特性等資料進行分析。本研究在控制新生兒特性、醫療機構特性及疾病嚴重度後顯示，醫師服務量與其所照護新生兒的存活率呈顯著正相關，其存活勝算比為1.39。因此，建議在實務管理上，應局部採行集中化照護、建立實證醫院／醫師轉介條件、參酌高服務量醫師之照護模式發展臨床照護指引、以及新生兒專科醫師訓練應集中於服務量大的醫院進行。
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The aim of this study was to measure quality of life outcomes following immunotherapeutic treatment of allergic rthinitis. A cross-sectional study design with three groups was conducted. Twenty nine patients with allergic rhinitis (group AR) and twenty six patients with allergic rhinitis who had undergone immunotherapy (group ARIT) were evaluated with the generic outcome measure (validated Chinese version of the Medical Outcome Study Short-form 36 item Health Survey, SF-36) and disease-specific outcome measure (Allergic Rhinitis Quality of Life Instrument, ARQOL). Thirty people without allergic rhinitis (group Normal) also completed the ARQOL. The SF-36 and ARQOL survey scores were compared with normative data and each other. Group AR reported significant impacts (all p＜0.05) in six out of eight SF-36 domains, the two insignificant domains being physical functioning and bodily pain. The only statistically significant difference in the eight SF-36 domains between the group ARIT and Taiwan norms was the general health domain (p＜0.05). In the three ARQOL dimensions, the Pearson correlations of test-retest reliability were all greater than 0.9. Group Normal was found to have higher total and ARQOL subscale scores (p＜0.05) than the other two groups, and group ARIT was also found to have significantly higher total and ARQOL subscale scores (p＜0.05) than group AR, with the exception of medical resource utilization. There was no correlation between the SF-36 and ARQOL in group AR, but in group ARIT, the correlation between the six SF-36 domains and symptoms and activity restrictions in the three ARQOL dimensions were moderate to strong. In general, allergic rhinitis has great impact on generic QOL but generic QOL approaches the same level after immunotherapy. Although immunotherapy improves disease-specific QOL of allergic rhinitis patients, there still exist differences between patients with immunotherapy and normal persons. The high test-retest reliability of the ARQOL suggests that it is a stable instrument. Using the two different instrument is an objective method for assessing quality of life in patients with allergic rhinitis.
- 期刊
For patients on nothing-per-os (NPO) status, tube feeding through nasogastrointestinal (NG) tube or gastrostomy tube can supply the adequate nutritional requirements. This study investigated the nutritional status, the incidence of feeding-related complications, as well as their effects on the nutritional intake in the inpatients undergoing tube feeding. This study recruited 1385 patients from NTUH through April to August in 2001, the assessment items of nutritional intake included total energy and protein. The nutritional status assessed by body weight and albumin level. The gastrointestinal complication items included diarrhea, malabsorption, constipation, nausea, vomiting, and abdominal distension, etc. The results showed that 45.1% of patients had their energy intake less then 90% of daily requirements. The serum albumin condition was positively correlated to the energy intake (r=0.2514, p＜0.0001) and protein intake (r=0.2213, p＜0.0001). The patients with low concentrations of serum albumin ＜3.5mg/dl had a less energy and protein intake than those of patients with high concentrations of serum albumin ≧3.5mg/dl [OR (Odd Ratio)=2.48 (energy), p＜0.05; OR=2.57 (protein), p＜0.05]. The incidence of gastrointestinal complication was reversely correlated with energy intake and protein intake [r=-0.254 (energy), p＜0.0001; r=-0.2365 (protein), p＜0.0001]. Those patients with gastrointestinal complications had a more severe energy insufficiency and protein insufficiency compared with those without gastrointestinal complications [OR=5.69 (energy), OR=4.05 (protein), p＜0.05]. Among them diarrhea was the most common complications, they had worse energy and protein intake as compared with those without diarrhea [OR=2.83 (energy), p＜0.05 OR=2.17 (protein), p＜0.05]. Furthermore, patients with low serum albumin ＜3.5mg/dl suffered from more serious diarrhea as compared with those having higher serum albumin (OR=3.68, p＜0.05). Conclusion: About one half of patients undergoing tube feeding had inadequate energy and protein intake in the first week. These situations were related to the hypoalbuminemia and gastrointestinal complications.
- 期刊
Nimesulid是屬於非類固醇類抗發炎藥物，具有解熱、止痛及抗發炎的作用，1985年於義大利上市，在歐洲廣泛的被使用，但並未在美國、英國、加拿大核准上市，國內於民國89年核准上市，此藥的安全性目前是備受質疑，其曾引起嚴重肝損傷的致死案例。本案例為五十七歲女性，因為退化性關節炎而使用Nimesulide治療，於服藥後一個半月發現肝功能指數異常，立即停藥一個半月後病患肝功能指數恢復正常，依據Naranjo scale評估則極可能(Probable)是Nimosulide引起的急性肝損傷。國內並未有報導有關此藥引起的急性肝損傷，希望籍此病例報告盼能提醒使用Nimesulide時應注意病患肝功能的變化。