Self-Administration of Medication in Hospital: A Literature Review.

The idea of patients self-administering their medication in hospital is not new; it was first cited in literature in 1959. Up to date, there is a growing body of literature that recognizes the importance of this approach. In this current state of the literature, self-administration of medication in hospital is positioned in the context of the definition of health as proposed by Huber et al. and Orem's self-care deficit theory: first identify the concept of medication self-administration, as well as the prevalence, existing procedures, tools, and proven effects of interventions; then the findings should point the way forward for research, practice, and policy.

[Status for self-medication based on bibliometric study in China].

OBJECTIVE: To figure out problems through analyzing the status for self-medication in China and to provide references for further research.
 Methods: Papers related to self-medication were collected from Chinese journal net database, Wanfang database, VIP database and China biomedical literature database (CBMDisc). A literature metrology analysis was carried out by NoteExpress 2.0 and Excel.
 Results: A total of 161 papers were included in this study, while 33 papers belong to Hubei and Jiangsu Province, accounting for 20.50% of the total amount of the papers. 22 papers were from journals as follows: China Pharmacy, Medicine and Society and Chinese Journal of Pharmacoepidemiology, accounting for 13.67% of the total papers. 118 papers belong to research and experience discuss, accounting for 73.29% of all. The cooperation degree was 2.37, and 28 papers were funded. Domestic research reflected the current status of self-medication in our country. Although self-medication brought convenience for residents and reduce the burden on health system, it also brought a series of safety problems.
 Conclusion: Self-medication gradually catches the attention of the researchers. Some researchers have paid attention to self medication, but the evidence is at a low level. Researchers should strengthen cooperation with interagency and carry out experimental study to promote further development for self-medication.

Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time?

BACKGROUND: Problems with the use of inhalers by patients were noted shortly after the launch of the metered-dose inhaler (MDI) and persist today. We aimed to assess the most common errors in inhaler use over the past 40 years in patients treated with MDIs or dry powder inhalers (DPIs). METHODS: A systematic search for articles reporting direct observation of inhaler technique by trained personnel covered the period from 1975 to 2014. Outcomes were the nature and frequencies of the three most common errors; the percentage of patients demonstrating correct, acceptable, or poor technique; and variations in these outcomes over these 40 years and when partitioned into years 1 to 20 and years 21 to 40. Analyses were conducted in accordance with recommendations from Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Strengthening the Reporting of Observational Studies in Epidemiology. RESULTS: Data were extracted from 144 articles reporting on a total number of 54,354 subjects performing 59,584 observed tests of technique. The most frequent MDI errors were in coordination (45%; 95% CI, 41%-49%), speed and/or depth of inspiration (44%; 40%-47%), and no postinhalation breath-hold (46%; 42%-49%). Frequent DPI errors were incorrect preparation in 29% (26%-33%), no full expiration before inhalation in 46% (42%-50%), and no postinhalation breath-hold in 37% (33%-40%). The overall prevalence of correct technique was 31% (28%-35%); of acceptable, 41% (36%-47%); and of poor, 31% (27%-36%). There were no significant differences between the first and second 20-year periods of scrutiny. CONCLUSIONS: Incorrect inhaler technique is unacceptably frequent and has not improved over the past 40 years, pointing to an urgent need for new approaches to education and drug delivery.

Towards an empowerment approach in tuberculosis treatment in Cape Town, South Africa: a qualitative analysis of programmatic change.

BACKGROUND: Tuberculosis rates in the world remain high, especially in low- and middle-income countries. International tuberculosis (TB) policy generally recommends the use of directly observed therapy (DOT) to ensure treatment adherence. OBJECTIVE: This article examines a change in TB treatment support that occurred in 2005 in South Africa, from DOT to the enhanced TB adherence programme (ETA). DESIGN: Seven key individuals representing academics, policy makers and service providers involved in the development of the ETA programme or knowledgeable about the issue were purposively sampled and interviewed, and participant observation was conducted at ETA programme steering group meetings. Qualitative content analysis was used to analyse the data, drawing on the Kingdon model of agenda setting. This model suggests that three independent streams - problem, policy and politics - come together at a certain point, often facilitated by policy entrepreneurs, to provide an opportunity for an issue to enter the policy agenda. RESULTS: The results suggest the empowerment-oriented programme emerged through the presence of policy entrepreneurs with access to resources. Policy entrepreneurs were influenced by a number of simultaneously occurring challenges including problems within the existing programme; a perceived mismatch between patient needs and the existing TB treatment model; and the TB-HIV co-epidemic. Policy entrepreneurs saw the ART approach as a possible solution to these challenges. CONCLUSIONS: The Kingdon model contributed to describing the process of policy change. Research evidence seemed to influence this change diffusely, through the interaction of policy entrepreneurs and academics.

Factores estimuladores de colonias. Consejos para la autoadministración / Self-administration of colony stimulating factors (CSF'S): basic advice

Como profesionales de enfermería conocemos la importancia de impartir una buena educación sanitaria para conseguir la máxima autonomía en nuestros pacientes. Como enfermeras de una Unidad de Hospital de día médico, en el que tratamos pacientes oncológicos y oncohematológicos que necesitan tratamiento con factores de estimulación de colonias, hemos creído oportuno la elaboración de un díptico informativo sobre la autoadministración de los mismos. Es cierto que los pacientes, gracias a los diferentes medios de comunicación, reciben mucha información pero, desgraciadamente, puede llegar de manera distorsionada, poco comprensible y -en ocasiones- de forma no del todo lícita. Nuestro objetivo es reforzar la autoadministración de este medicamento o, en su defecto, la aplicación por el cuidador principal o familiar. Tras varias pruebas, hemos optado por un díptico más visual que escrito porque creemos que una imagen vale más que mil palabras(AU)

As nurses we all know the importance of good health education to achieve the highest level of autonomy in our patients. In the Medical Day Unit of Palamós Hospital we treat cancer patients who need CSF's (Colony Stimulating Factors) medication. We thought it would be appropriate, therefore, to draw up an information leaflet on self-administration of CSF's. These kind of patients receive a lot of information through the different media but, unfortunately, it can get distorted, unclear, and often, not at all lawful. Our goal is that the patient or, in his absence, the main career can improve the self-administration of the drug. After several tests we have opted for a visual leaflet instead of a written one because we believe that «a picture is worth a thousand words»(AU)

Cooperativa de pediatras. Una alternativa para garantizar la atención pediátrica en áreas de difícil cobertura / A cooperative of pediatricians. A model for providing universar pediatric primary care in underserved areas

Fundamento. Dado el déficit de pediatras, existen dificultades para la cobertura pediátrica en diferentes zonas, obligando a buscar nuevas alternativas. Objetivo. Presentamos los resultados de dos años de funcionamiento de un modelo innovador de autogestión, basado en una cooperativa de profesionales ligada a un hospital docente de referencia. Métodos. En octubre de 2009 se realizó un convenio entre la Fundació Sant Hospital de la Seu d’Urgell (FSH), el Institut Català de la Salut, el Hospital Sant Joan de Déu de Barcelona y el Departament de Salut, para prestar asistencia pediátrica (primaria y hospitalaria) en la comarca del Alt Urgell. Los pediatras se constituyeron en una sociedad cooperativa catalana limitada professional, Pediatria dels Pirineus, asumiendo las decisiones asistenciales, organizativas, económicas y legales. Resultados. Se ha conseguido cubrir el 100% de la asistencia pediátrica, dotar de una excelente accesibilidad en el ambulatorio (100% de éxito para visitas pediátricas <48 horas y 0,46-0,66 días de demora para cita previa), incrementar notablemente los estándares de calidad asistencial y disminuir en un 30% las visitas pediátricas en el Servicio de Urgencias de la FSH (del 66% en horarios de obertura del ambulatorio). Se ha objetivado una disminución del 33% de las derivaciones a otros centros y del 41% de los traslados interhospitalarios. A nivel docente se han consolidado las sesiones en el territorio y mejorado la asistencia de los profesionales a los cursos formativos (media de 6,5 cursos/profesional año 2010 y 5,6 año 2011). Conclusiones. Este modelo permite una mejor cobertura pediátrica, con visión territorial, continuidad en la atención, integración en el sistema de salud y sostenibilidad(AU)

Background. The shortage of pediatricians makes universal pediatric coverage of some areas difficult to achieve; new approaches are needed. Objective. We present the results of two years of operation of an innovative model of self-management, based on a cooperative of health care professionals linked to a tertiary academic center. Method. An agreement was signed in October 2009 between the Sant Hospital Foundation of La Seu d’Urgell (SHF), the Catalan Institute of Health, the Sant Joan de Deu Hospital in Barcelona, and the Department of Health, to provide primary and hospital pediatric care in the Alt Urgell county. As part of this agreement, pediatricians were organized around the professional cooperative society Pyrenees Pediatrics, assuming the patient care, organizational, legal, and financial responsibilities. Results. Pyrenees Pediatrics provides coverage to 100% of children in the region, with excellent access to primary clinics. There has been a 100% success rate for pediatric visits in < 48 hours, and 0.46-0.66 days delay for appointments, a remarkable improvement in the quality of care standards, and a decrease from 60% to 30% in the pediatric visits to the Emergency Department at SHF during primary clinic hours. There has been a decrease of referrals to centers outside the region and hospital transfers of 33% and 41%, respectively. Finally, there has been a significant improvement in attendance to continuing medical education courses (average of 6.5 and 5.6 courses/professional in 2010 and 2011, respectively). Conclusions. This model allows for the provision of a better pediatric coverage, with a regional vision, continuity in care, integration within the health care system, and sustainability(AU)

Potencial adictivo del éxtasis: una visión desde los modelos animales / The addictive potential of ecstasy: an overview of animal models

La 3,4-metilendioximetanfetamina (MDMA) es el principio activo del "éxtasis", un psicoestimulante de gran popularidad entre los adolescentes y los adultos jóvenes. La actividad farmacológica del éxtasis está mediada por la serotonina (5-HT) y la dopamina (DA), esta última fuertemente implicada en la modulación de los efectos reforzantes de las drogas de abuso. Aunque escasos, los estudios realizados en consumidores de éxtasis indican que un porcentaje de ellos cumplirían los criterios de dependencia a esta sustancia. La presente revisión analiza los resultados más relevantes obtenidos hasta el momento sobre los efectos reforzantes de la MDMA, principalmente aquellos obtenidos a partir de modelos animales como la autoadministración intravenosa (AAI) y el condicionamiento de la preferencia de lugar (CPL), así como también los hallazgos derivados a partir del uso de estos paradigmas como modelos de recaída. La MDMA presenta efectos reforzantes y es capaz de reinstaurar una conducta una vez esta se ha extinguido (modelo de recaída), por lo cual podemos concluir que esta droga presenta potencial adictivo y además es capaz de inducir modificaciones en el sistema de refuerzo cerebral que alteran la respuesta ante otras drogas de abuso (AU)

3,4-methylenedioxymetamphetamine (MDMA) is the active compound of the recreational drug "ecstasy", a popular psychostimulant among adolescent and young adults. The pharmacological action of ecstasy is mediated by serotonin (5-HT) and dopamine (DA), the latter of which is strongly implicated in the modulation of the reinforcing effects of drugs of abuse. The few studies performed in human users of ecstasy indicate that a percentage of these subjects fulfill the criteria of dependence to this drug. The present review analyzes the most relevant results published until now regarding the reinforcing effects of MDMA, giving special attention to those obtained with animal models employing intravenous self-administration or conditioned place preference, and those using these paradigms as models of relapse. MDMA produces reinforcing effects and is capable of reinstating an extinguished behavior (relapse model); thus, we can conclude that this drug possesses addictive potential and, in addition, is capable of inducing modifications in the brain reward system that alter the response to other drugs of abuse (AU)

Self-monitoring of blood glucose in diabetes mellitus: arguments for an individualized approach.

BACKGROUND: The utility of glucose self-monitoring in different types and stages of diabetes is controversial, as there is only sparse relevant evidence from randomized controlled clinical trials. In this analysis, the authors aim to develop individualized recommendations based on clinical needs and the available literature. METHODS: The PubMed database was searched for articles that appeared up to 30 September 2008 containing the terms "measurement," "control","monitoring," and "hypoglycemia"; the retrieved articles were supplemented by other articles that were cited in them. A directed search was also made for the recommendations of the German, European, American, and international diabetological societies. Conclusions were then drawn about the useful modalities and extent of glucose self-monitoring on the basis of the clinical features of the major types of diabetes and the main treatment strategies for them. RESULTS: With the exception of intensified treatment strategies (which rely on blood-sugar regulation with insulin), only a few evidence-based recommendations can be derived from randomized clinical trials and meta-analyses. Nonetheless, a strategy for self-monitoring according to the patient's individual needs can be derived from the characteristics of therapeutic regimens: depending on the type of diabetes from which the patient suffers, the predicted number of glucometer strips required for self-monitoring will vary from almost none to roughly 400 per month. CONCLUSIONS: The decision to use glucose self-monitoring, as well as the type and extent of self-monitoring that will be used, should be based on the individual patient's type of diabetes, treatment regimen, and clinical characteristics. Like any other type of therapeutic intervention, self-monitoring should have a well-documented, rational justification.

At what age do children start taking daily asthma medicines on their own?

OBJECTIVE: Use of daily controller medications is a critical task in management of persistent asthma. Study aims were to examine (1) the association between child age and extent of daily controller-medication responsibility in a sample aged 4 to 19 years, (2) parent, child, and disease predictors of child daily controller-medication responsibility and overall daily controller-medication adherence, and (3) the association between child daily controller-medication responsibility and overall daily controller-medication adherence. METHODS: We conducted a cross-sectional telephone survey of 351 parents of children who were prescribed daily controller medication. Children's mean age was 10.4 years; 61.5% were male, and 88.1% were white. Parents provided all data, including an estimate of the percentage of child and parent daily controller-medication responsibility. Daily controller-medication adherence was measured as parents' report of percentage of daily doses taken per doses prescribed in a typical week. We used multivariate linear regression to determine associations between parent race/ethnicity, education, income, number of dependents, child age, gender, years since diagnosis, parent perception of symptom severity and control, and dependent variables (child daily controller-medication responsibility and daily controller-medication adherence). We also examined associations between child daily controller-medication responsibility and daily controller-medication adherence. RESULTS: Child daily controller-medication responsibility increased with age. By age 7, children had assumed, on average, almost 20% of daily controller-medication responsibility; by age 11, approximately 50%; by age 15, 75%; and by age 19, 100%. In multivariate models, child age and male gender remained significantly associated with child daily controller-medication responsibility, and child's age and parents' race/ethnicity remained significantly associated with daily controller-medication adherence. CONCLUSIONS: Clinicians may need to screen for child daily controller-medication management and include even young children when educating families on the use of asthma medications and other key asthma-management tasks.

Overview of the changing paradigm in cancer treatment: oral chemotherapy.

PURPOSE: Several new oral chemotherapeutic agents have recently been introduced. Many possess novel mechanisms of action and specific targets that result in different adverse effect profiles from those associated with traditional chemotherapies and hormonal therapies. The potential advantages and challenges associated with oral chemotherapy are discussed. SUMMARY: Use of the oral route is convenient and allows administration to take place at home or in non-traditional settings. However, nausea, difficulty swallowing, patient nonadherence, interactions with drugs and food, other pharmacokinetic factors, and the high cost of treatment can present problems in using these agents by the oral route. Awareness by clinicians of the potential problems with oral chemotherapy can help to avoid or minimize problems that might affect patient outcomes. CONCLUSION: While bioavailability studies are often an integral part of developing oral agents, their comparisons with parenteral forms are less well documented. However, studies comparing intravenous 5-fluorouracil (5-FU) with oral 5-FU prodrugs have demonstrated that efficacy, safety, and quality of life are not compromised by the use of oral therapy. Finally, these studies, as well as others, reveal patients prefer the oral route of administration.

Drug use in Estonia in 1994-1995: a follow-up from 1989 and comparison with two Nordic countries.

OBJECTIVE: To determine the patterns of drug use in Estonia for the years 1989 and 1994 1995, i.e. for the years before and after the pharmaceutical services in the country changed from a state monopoly to a competitive market. METHODS: The wholesale data from Estonia and the defined daily doses methodology were used. For comparison, national statistics on medicines from Finland and Sweden for the years 1994-1995 are shown. RESULTS: The general sales of drugs in Estonia decreased almost twofold in all major pharmacological groups from 1989 to 1994 and subsequently increased by 10%-30% in 1995. Substantial differences in patterns of drug use between Estonia and the two Nordic countries were observed. The amount of prescription-only medicines used in Estonia was approximately 25% of that used in Finland and Sweden. The amount of over-the-counter drugs used was 61% of that used in Finland and 58% of that used in Sweden. In the drug use patterns in Estonia, some common trends can be noted: (1) persistent traditions, such as the low use of diuretics, beta-blockers, antithrombotics and inhalant anti-asthmatic drugs; (2) changes in prescription preferences--central anti-adrenergic drugs, pyrazolones, aminoglycosides and barbiturates are being replaced by calcium channel blockers and angiotensin-converting-enzyme inhibitors, propionic acid derivatives, cephalosporins and benzodiazepines, respectively; (3) rapidly increasing use of drugs not prescribed in the 1980s, such as hormonal contraceptives, opioids and antiulcer drugs, which strongly improves the quality of pharmacotherapy in Estonia. CONCLUSION: The general trends in Estonia and the two Nordic countries are similar--the use of newer and more effective drugs is increasing and that of older ones decreasing. The changes are more rapid in Estonia than in Finland and Sweden, but, because of a short observation period, the use of newer drugs not yet prevailing. The international differences in drug utilization observed in this study may possibly be related mainly to the prescription preferences (e.g. therapeutic traditions) and less dependent on the respective health care systems (e.g. reimbursement schemes) and economic state of the country.

Patterns of increasing beta-agonist use and the risk of fatal or near-fatal asthma.

The association between the use of inhaled beta-agonists by metered-dose inhaler and the risk of fatal or near-fatal asthma has been demonstrated. It shows that asthmatics who use one canister of beta-agonist per month more than the number used by other similar asthmatics have twice the risk of fatal or near-fatal asthma. The present investigation assesses the magnitude of this excess risk when an asthmatic increases his/her own monthly use of inhaled beta-agonists over time. From a previous nested case-control study of 129 deaths and near-deaths from asthma (cases) and 655 controls from a cohort of 12,301 asthmatics, the subset using at least 12 inhalers during the 12 month study period was identified (97 cases and 258 controls). A profile score, ranging 0-11, was formed to quantify the patterns of beta-agonist use over time for each subject, covering the entire spectrum extending from decreasing to increasing use. The relative risk was 15.2 (95% confidence interval (CI) 2.4-96.2) per unit increase of the profile score in subjects with a pattern of increasing beta-agonist use (profile score of 6.5 or more), but this relative risk was only 1.5 (95% CI 0.8-2.6) per unit when the profile score was less than 6.5 (non-increasing use). This relative risk was independent of the risk associated with the total quantity of beta-agonist use in the 12 month period, which remained around 1.6 (95% CI 1.3-2.0) per inhaler per month.(ABSTRACT TRUNCATED AT 250 WORDS)