市中心教学医院中儿科急诊医生预防性用药的处方习惯
2010/12/17
摘要
简介：哮喘症状呈现阵发性，哮喘急性恶化患者常常在急诊（ED）就诊，此时，医生并不总是给患者开具哮喘的预防性治疗方案。对哮喘急性恶化患者，启动并调整哮喘控制用药，有助于改善哮喘控制水平，降低急诊就诊频率，对于经常急诊就诊的家庭尤其如此。然而，尚未进行相关研究进行证实。
方法：对随机选取的363名受试者（占2007年儿科急诊接待的哮喘患儿的10%）进行研究，患者年龄2～18岁，来自于美国纽约布朗克斯区一所市中心教学医院。对预防方案调整的频率及季节对该方案的影响进行量化。
结果：在363名儿童中，42.4%的患者前期未接受过哮喘控制治疗。在这些患者中，9.7%的患者采用新的控制治疗，夏季使用的百分比显著增加。前期采用过哮喘控制治疗的患者中，2.87%的患者采用新的控制治疗，0.95%增加其控制治疗的剂量。然而，在过去2年内其预防治疗方案调整4次以上的患者中有14.3%患者的预防方案未进行调整。在所有363名患儿中，78.5%的患者短期口服皮质激素后急诊出院，但皮质激素治疗并不是预防方案的组成部分。仅4名患者有医生出具的哮喘严重程度分类。
结论：在市中心医院急诊中，仅有0.9～2%的患儿存在哮喘治疗方案的调整，而78.5%的患者开始使用全身激素治疗。哮喘严重程度评价仅见于极少数患儿。由于哮喘预防方案的调整需要对哮喘严重程度进行适当的诊断，因此，有必要将哮喘严重程度分类作为急诊常规评价的一部分，有助于医生对持续性哮喘患者采用控制性治疗。
（刘国梁 审校）
J Asthma. 2010 Sep 27. [Epub ahead of print]
Prescription habits for preventative medications among pediatric emergency department physicians at an inner-city teaching hospital.
Lovinsky S, Rastogi D.
Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
Abstract
Introduction. As asthma presentation is episodic, patients with acute exacerbations often present in the emergency department (ED) where preventative regimen may not always be addressed. Addressing initiation and modification of controller medications in the setting of an acute exacerbation may facilitate improved asthma control and decrease the frequency of ED visits, particularly so for families who receive most of their asthma management in the ED. However, this aspect has not yet been explored. Methods. We reviewed a random sample of 363 charts, 10% of the total number of asthmatic children, aged 2–18, seen from January to December 2007 in the pediatric ED of an urban teaching hospital located in Bronx, NY, USA. We quantified the frequency of modification of the preventative regimen and the influence of seasons on this practice. Results. Of these 363 children, 42.4% of patients were not previously on a controller medication. Of these, 9.7% were started on a new controller medication, with a significantly higher percent occurring in the summer months. Of those that were previously on a controller medication, 2.87% were started on a new controller medication and 0.95% had their controller medication dose increased. However, the regimen was not adjusted in 14.3% that had been seen four or more times in the preceding 2 years. Of the total 363 children, 78.5% were discharged from the ED on a short course of oral steroids, and this was not part of their preventative regimen. Only four charts had physician-documented asthma severity classification. Conclusions. We found that the preventative regimen was modified in only 0.9– 2% of all asthmatic children seen in an urban ED whereas 78.5% were started on systemic steroids. Asthma severity was evaluated in a very small number of patients. Because modification of preventative regimen requires appropriate asthma severity classification, the inclusion of asthma severity classification as part of routine ED evaluation may encourage physicians to address controller medications in persistent asthmatics.
J Asthma. 2010 Sep 27. [Epub ahead of print]
简介：哮喘症状呈现阵发性，哮喘急性恶化患者常常在急诊（ED）就诊，此时，医生并不总是给患者开具哮喘的预防性治疗方案。对哮喘急性恶化患者，启动并调整哮喘控制用药，有助于改善哮喘控制水平，降低急诊就诊频率，对于经常急诊就诊的家庭尤其如此。然而，尚未进行相关研究进行证实。
方法：对随机选取的363名受试者（占2007年儿科急诊接待的哮喘患儿的10%）进行研究，患者年龄2～18岁，来自于美国纽约布朗克斯区一所市中心教学医院。对预防方案调整的频率及季节对该方案的影响进行量化。
结果：在363名儿童中，42.4%的患者前期未接受过哮喘控制治疗。在这些患者中，9.7%的患者采用新的控制治疗，夏季使用的百分比显著增加。前期采用过哮喘控制治疗的患者中，2.87%的患者采用新的控制治疗，0.95%增加其控制治疗的剂量。然而，在过去2年内其预防治疗方案调整4次以上的患者中有14.3%患者的预防方案未进行调整。在所有363名患儿中，78.5%的患者短期口服皮质激素后急诊出院，但皮质激素治疗并不是预防方案的组成部分。仅4名患者有医生出具的哮喘严重程度分类。
结论：在市中心医院急诊中，仅有0.9～2%的患儿存在哮喘治疗方案的调整，而78.5%的患者开始使用全身激素治疗。哮喘严重程度评价仅见于极少数患儿。由于哮喘预防方案的调整需要对哮喘严重程度进行适当的诊断，因此，有必要将哮喘严重程度分类作为急诊常规评价的一部分，有助于医生对持续性哮喘患者采用控制性治疗。
（刘国梁 审校）
J Asthma. 2010 Sep 27. [Epub ahead of print]
Prescription habits for preventative medications among pediatric emergency department physicians at an inner-city teaching hospital.
Lovinsky S, Rastogi D.
Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
Abstract
Introduction. As asthma presentation is episodic, patients with acute exacerbations often present in the emergency department (ED) where preventative regimen may not always be addressed. Addressing initiation and modification of controller medications in the setting of an acute exacerbation may facilitate improved asthma control and decrease the frequency of ED visits, particularly so for families who receive most of their asthma management in the ED. However, this aspect has not yet been explored. Methods. We reviewed a random sample of 363 charts, 10% of the total number of asthmatic children, aged 2–18, seen from January to December 2007 in the pediatric ED of an urban teaching hospital located in Bronx, NY, USA. We quantified the frequency of modification of the preventative regimen and the influence of seasons on this practice. Results. Of these 363 children, 42.4% of patients were not previously on a controller medication. Of these, 9.7% were started on a new controller medication, with a significantly higher percent occurring in the summer months. Of those that were previously on a controller medication, 2.87% were started on a new controller medication and 0.95% had their controller medication dose increased. However, the regimen was not adjusted in 14.3% that had been seen four or more times in the preceding 2 years. Of the total 363 children, 78.5% were discharged from the ED on a short course of oral steroids, and this was not part of their preventative regimen. Only four charts had physician-documented asthma severity classification. Conclusions. We found that the preventative regimen was modified in only 0.9– 2% of all asthmatic children seen in an urban ED whereas 78.5% were started on systemic steroids. Asthma severity was evaluated in a very small number of patients. Because modification of preventative regimen requires appropriate asthma severity classification, the inclusion of asthma severity classification as part of routine ED evaluation may encourage physicians to address controller medications in persistent asthmatics.
J Asthma. 2010 Sep 27. [Epub ahead of print]
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MONICA研究的亚组分析：增加孟鲁司特治疗哮喘的12个月开放标签研究
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自我引导的运动能改善部分控制成人哮喘患者的健康感知
