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The new Chinese medicine handbook : an innovative guide to integrating Eastern wisdom with Western practice for modern healing
\"The New Chinese Medicine Handbook is an essential guide to achieving total health in body, mind,and spirit. Explore the powerful benefits of Chinese medicine--particularly acupuncture, massage,nutrition, meditation and herbs--along with other Eastern healing arts. This practical guide totraditional Chinese medicine can help you take control of your healing process and maintain orrestore wholeness and harmony in all aspects of your life.Dr. Misha Ruth Cohen, an internationallyمa??recognized practitioner, lecturer, leader and mentorin the field of Chinese medicine, offers comprehensive healing plans for a wide range of ailmentsincluding digestive problems, stress, anxiety, depression, cancer support, liver health, gynecological problems, PMS, fertilitymenopause, and more.This comprehensive guidebook combines Chinese dietary guidelines with Western medicine, plus various other Eastern and Western healing therapies including:Basics of Chinese medicine Acupuncture and moxibustionQi Gong: Chinese exercise and meditationDietary practicesChinese herbal therapyThe New Chinese Medicine Handbook keeps esoteric information to \"need to know\" basics andshows you how to use Chinese medicine for different conditions from pain to infertility to various illnesseslike cancer and diabetes. Take the first steps to natural healing remedies and a longer, healthier life\"-- Provided by publisher.
Book
Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study
AimTo evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.MethodsA parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were randomised to the intervention which comprised wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders. Control wards were blinded to the intervention. Structured direct observations of medication administration processes were conducted. The primary outcome was non-medication-related interruptions during individual medication dose administrations. The secondary outcomes were total interruption and multitasking rates. A survey of nurses' experiences was administered.ResultsOver 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications. At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed. Intervention wards experienced a significant reduction in non-medication-related interruptions from 50/100 administrations (95% CI 45 to 55) to 34/100 (95% CI 30 to 38). Controlling for clustering, ward type and medication route showed a significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards. A total of 88 nurses (38.8%) completed the poststudy survey. Intervention ward nurses reported that vests were time consuming, cumbersome and hot. Only 48% indicated that they would support the intervention becoming hospital policy.DiscussionNurses experienced a high rate of interruptions. Few were related to the medication task, demonstrating considerable scope to reduce unnecessary interruptions. While the intervention was associated with a statistically significant decline in non-medication-related interruptions, the magnitude of this reduction and its likely impact on error rates should be considered, relative to the effectiveness of alternate interventions, associated costs, likely acceptability and long-term sustainability of such interventions.
Journal Article
Remedios caseros : sencillos consejos para prevenir y mejorar malestares o enfermedades
\"Margarita Chávez Martínez, reconocida nutrióloga y defensora de la medicina natural desde hace más de 30 años, recupera en este libro los mejores remedios de la sabiduría tradicional para mejorar y sanar diversos malestares y enfermedades...[Es] la guía más confiable para desintoxicar el sistema y reiniciar el organismo a través de las herramientas que la madre naturaleza ha puesto a nuestro servicio...\"--Page 4 of cover.
Book
Analysis of a medication discrepancy management platform in reducing medication discrepancy and influencing factors among elderly patients with polypharmacy
Objective
This study aimed to investigate the impact of a medication discrepancy management platform on reducing medication discrepancies among elderly patients with polypharmacy and to analyze influencing factors.
Methods
A total of 110 elderly polypharmacy patients were divided into a control group and an observation group using a random number method, each with 55 participants. The control group received routine management, while the observation group utilized a medication discrepancy management platform. Medication knowledge and adherence before and after intervention were compared between the two groups. Reasons and types of medication discrepancies were statistically analyzed. Patients were divided into a non-discrepancy group and a discrepancy group, with multivariate logistic regression used to analyze factors influencing medication discrepancies among elderly patients with polypharmacy.
Results
Utilizing a medication discrepancy management platform significantly improved medication knowledge and adherence among elderly patients (
P
< 0.05). A total of 34 patients (30.91%) experienced at least one medication discrepancy within one-week post-discharge, primarily involving decreased frequency, missed doses, reduction in medication types, and medication substitution. Multivariate logistic regression analysis showed that the use of the medication discrepancy management platform, caregiver involvement, and prescribed discharge medications (7–8 types or ≥ 9 types) were independent factors influencing medication discrepancies in elderly patients (
P
< 0.05).
Conclusion
Using a medication discrepancy management platform can effectively reduce medication discrepancies in elderly patients with polypharmacy and improve elderly patients’ adherence to medication. Expanding the platform’s use can enhance discharge guidance quality and ensure medication safety.
Journal Article
Impact of medication reconciliation and review and counselling, on adverse drug events and healthcare resource use
Background Adverse drug events from preventable medication errors can result in patient morbidity and mortality, and in cost to the healthcare system. Medication reconciliation can improve communication and reduce medication errors at transitions in care. Objective Evaluate the impact of medication reconciliation and counselling intervention delivered by a pharmacist for medical patients on clinical outcomes 30 days after discharge. Setting Sultan Qaboos University Hospital, Muscat, Oman. Methods A randomized controlled study comparing standard care with an intervention delivered by a pharmacist and comprising medication reconciliation on admission and discharge, a medication review, a bedside medication counselling, and a take-home medication list. Medication discrepancies during hospitalization were identified and reconciled. Clinical outcomes were evaluated by reviewing electronic health records and telephone interviews. Main outcome measures Rates of preventable adverse drug events as primary outcome and healthcare resource utilization as secondary outcome at 30 days post discharge. Results A total of 587 patients were recruited (56 ± 17 years, 57% female); 286 randomized to intervention; 301 in the standard care group. In intervention arm, 74 (26%) patients had at least one discrepancy on admission and 100 (35%) on discharge. Rates of preventable adverse drug events were significantly lower in intervention arm compared to standard care arm (9.1 vs. 16%, p = 0.009). No significant difference was found in healthcare resource use. Conclusion The implementation of an intervention comprising medication reconciliation and counselling by a pharmacist has significantly reduced the rate of preventable ADEs 30 days post discharge, compared to the standard care. The effect of the intervention on healthcare resource use was insignificant. Pharmacists should be included in decentralized, patient-centred roles. The findings should be interpreted in the context of the study’s limitations.
Journal Article
Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits
Purpose
To examine the impact of systematic medication reconciliations upon hospital admission and of a medication review while in hospital on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients.
Methods
This was a prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Intervention patients received the complete Lund Integrated Medicines Management model (medication reconciliation upon admission and discharge, and medication review and monitoring) provided by a multi-professional team, including a clinical pharmacist. Control patients received standard care and medication reconciliation upon discharge. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within 3 months of discharge (using World Health Organisation causality criteria).
Results
There was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population {51% [95% confidence interval (CI) 43–58%] vs. 39% (95% CI 30–48%);
p
= 0.0446} and the per-protocol population [60% (95% CI 51–67%) vs. 44% (95% CI 34–52%);
p
= 0.0106)]. There were six revisits to hospital in the intervention group which were judged as ‘possibly, probably or certainly drug-related’, compared with 12 in the control group (
p
= 0.0469).
Conclusions
In this study, medication reconciliation and review provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits among elderly patients.
Journal Article
Medication Errors: An Overview for Clinicians
Medication error is an important cause of patient morbidity and mortality, yet it can be a confusing and underappreciated concept. This article provides a review for practicing physicians that focuses on medication error (1) terminology and definitions, (2) incidence, (3) risk factors, (4) avoidance strategies, and (5) disclosure and legal consequences. A medication error is any error that occurs at any point in the medication use process. It has been estimated by the Institute of Medicine that medication errors cause 1 of 131 outpatient and 1 of 854 inpatient deaths. Medication factors (eg, similar sounding names, low therapeutic index), patient factors (eg, poor renal or hepatic function, impaired cognition, polypharmacy), and health care professional factors (eg, use of abbreviations in prescriptions and other communications, cognitive biases) can precipitate medication errors. Consequences faced by physicians after medication errors can include loss of patient trust, civil actions, criminal charges, and medical board discipline. Methods to prevent medication errors from occurring (eg, use of information technology, better drug labeling, and medication reconciliation) have been used with varying success. When an error is discovered, patients expect disclosure that is timely, given in person, and accompanied with an apology and communication of efforts to prevent future errors. Learning more about medication errors may enhance health care professionals' ability to provide safe care to their patients.
Journal Article
Impact of collaborative pharmaceutical care on older inpatients’ medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study)
Background
Improving medication safety implies patient-centred multidisciplinary cooperation. During the hospital stay for an acute care episode, the patient needs a comprehensive management to guarantee the best possible outcome.
Methods
The study was designed as a non-blinded, multicentre stepped-wedge cluster randomised clinical trial, taking place in six French University Hospitals.
Each cluster began with the control period in which standard care did not include pharmaceutical intervention. Every 14-day period, one hospital unit was electronically randomised to switch to the intervention period until all cluster groups received the intervention, which consisted of collaborative pharmaceutical care (CPC) associating medication reconciliation at hospital admission, pharmaceutical analysis of the medication order, medication review and collaborative meeting.
The primary outcome was assessing the intervention through the rate of patients with at least one medication error (ME) on the admission medication order (such as omission, wrong dose or wrong route of administration), comparing the two periods.
Results
CPC decreased the rate of patients with at least one ME from 88.9% (n = 243) to 29.2% (n = 267) (
p
< 0.0001). A total of 1817 MEs were discovered, of which 1121 (61.7%) were in the control period and 696 (38.3%) in the intervention period before resolution by the CPC. After resolving 567 of them, 129 medication errors still remained after CPC. So, a median of 3 MEs [IQR = 1;6] per patient were detected in the control period vs 0 [IQR = 0;1] after CPC in the intervention period (
p
< 0.0001). Patients were 21-times more likely to avoid a ME with CPC (OR: 20.8 [8.3;52.2],
p
< 0.0001). The rate of patients with a 2–3 critical ME level decreased from 70.8% to 12.0% in the control vs intervention periods respectively (OR: 18.4 [7.7;43.9],
p
< 0.0001).
Conclusions
CPC can prevent the occurrence of MEs and thus can improve inpatients’ medication management and safety. Pharmacists play a key role in combating medication-related harm in healthcare settings.
Trial registration
This study is registered on ClinicalTrials.gov with the reference number NCT02598115 (2015–11–04).
Journal Article
Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors
ABSTRACT
Background
Little research has examined the incidence, clinical relevance, and predictors of medication reconciliation errors at hospital admission and discharge.
Objective
To identify patient- and medication-related factors that contribute to pre-admission medication list (PAML) errors and admission order errors, and to test whether such errors persist in the discharge medication list.
Design, Participants
We conducted a cross-sectional analysis of 423 adults with acute coronary syndromes or acute decompensated heart failure admitted to two academic hospitals who received pharmacist-assisted medication reconciliation during the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL–CVD) Study.
Main Measures
Pharmacists assessed the number of total and clinically relevant errors in the PAML and admission and discharge medication orders. We used negative binomial regression and report incidence rate ratios (IRR) of predictors of reconciliation errors.
Key Results
On admission, 174 of 413 patients (42%) had ≥1 PAML error, and 73 (18%) had ≥1 clinically relevant PAML error. At discharge, 158 of 405 patients (39%) had ≥1 discharge medication error, and 126 (31%) had ≥1 clinically relevant discharge medication error. Clinically relevant PAML errors were associated with older age (IRR = 1.46; 95% CI, 1.00– 2.12) and number of pre-admission medications (IRR = 1.17; 95% CI, 1.10–1.25), and were less likely when a recent medication list was present in the electronic medical record (EMR) (IRR = 0.54; 95% CI, 0.30–0.96). Clinically relevant admission order errors were also associated with older age and number of pre-admission medications. Clinically relevant discharge medication errors were more likely for every PAML error (IRR = 1.31; 95% CI, 1.19–1.45) and number of medications changed prior to discharge (IRR = 1.06; 95% CI, 1.01–1.11).
Conclusions
Medication reconciliation errors are common at hospital admission and discharge. Errors in preadmission medication histories are associated with older age and number of medications and lead to more discharge reconciliation errors. A recent medication list in the EMR is protective against medication reconciliation errors.
Journal Article