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Vpliv izboljšanja bolnišničnega okolja na zmanjšanje porabe anksiolitikov in hipnotikov
Prijon, Špela (Avtor), Locatelli, Igor (Mentor) Več o mentorju... Povezava se odpre v novem oknu, Brvar, Miran (Komentor)

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Izvleček
Spanec igra veliko vlogo pri fizičnem in psihičnem zdravju ljudi, še bolj pomemben pa je pri ranljivejši populaciji, kot so pacienti. Zaradi sočasnih obolenj, raznolikosti pacientov in velikega števila nasprotujočih si raziskav je zdravljenje nespečnosti precej zahtevno. Z retrospektivno raziskavo smo ovrednotili uvedbo televizije v bolniške sobe kot sredstva za pomoč pri nespečnosti in znižanje porabe sedativov. Znotraj te raziskave smo spremljali tudi strukturo in odmerek predpisovanja izbranih sedativov glede na obdobje in predpisovalca. Pregledali smo terapevtske liste pacientov Centra za klinično toksikologijo in farmakologijo (CKTF) na Univerzitetnem kliničnem centru Ljubljana. Raziskava je razdeljena na dve enaki obdobji; pred uvedbo TV in po uvedbi TV v sobe. Obdobje pred uvedbo je med 1. 8. 2016 in 31. 1. 2017, obdobje po uvedbi TV pa med 1. 8. 2017 in 31. 1. 2018. Televizija je bila v sobe postavljena v aprilu 2017. V raziskavo smo vključili 612 pacientov, 302 iz obdobja pred uvedbo TV in 312 iz obdobja po uvedbi TV. V obdobju pred uvedbo TV je bilo 181 (60 %) žensk, v obdobju po uvedbi pa 142 (46 %) žensk. V obeh obdobjih je bilo več kot 80 % pacientov starih 65 let ali več: 85 % v obdobju pred uvedbo TV in 86 % v obdobju po uvedbi TV. Podatke smo zbirali v Excel datoteki, v kateri smo jih tudi analizirali. Skupaj so pacienti iz obdobja pred uvedbo preživeli na oddelku 3163 bolnišnično oskrbovanih dni, po uvedbi TV pa 2783 bolnišnično oskrbovanih dni (BOD). Število BOD s sedativom pred uvedbo TV je bilo 829, po uvedbi pa 696. V raziskavo so bili vključeni sedativi, ki jih CKTF predpisuje za namen nespečnosti, benzodiazepini (alprazolam, bromazepam, diazepam, klonazepam, lorazepam, medazepam), zolpidem in kvetiapin. V deležu BOD s sedativom upoštevamo dni, ko so imeli pacienti predpisane sedative zvečer, ne pa nujno tudi čez dan. Delež BOD s sedativi je pred uvedbo TV znašal 23,8 % in po uvedbi TV 23,4 %, razlika ni statistično značilna. Povprečno število enot ekvivalenta 5 mg diazepama na dan sedacije se je statistično značilno (p<0,0001) zvišalo iz 0,80 enote pred uvedbo TV na 0,90 enote po uvedbi TV. Predpisovalec A je število BOD s sedativom ohranil skoraj enako (pred 20,8 %, po 21,6 %, p=0,78), statistično značilno pa je zmanjšal višino odmerka (pred 1,09, po 0,90 ekvivalenta diazepama 5 mg na dan sedacije, p<0,0001). Predpisovalec B je statistično značilno znižal delež BOD s sedativom (pred 26,5 %, po 9,1 %, p=0,011), medtem ko je velikost odmerka ohranil skoraj nespremenjen (pred 0,90, po 0,91 ekvivalenta diazepama 5 mg na dan sedacije, p=0,833). Predpisovalec C je statistično značilno povišal delež BOD s sedativom (pred 26,7 %, po 38,9 %, p=0,00032) ter statistično značilno povišal velikost odmerka (pred 0,78 in po 1,06 ekvivalenta diazepama 5 mg na dan sedacije, p<0,0001). Televizija ni bila edini dejavnik, ki je povzročil spremembe v predpisovanju sedativov. Opazili smo, da ima velik vpliv zdravnik in njegov odnos do sedativov.

Jezik:Slovenski jezik
Ključne besede:nespečnost, univerzitetni klinični center, starostniki, uporaba televizije v bolniških sobah
Vrsta gradiva:Magistrsko delo/naloga (mb22)
Organizacija:FFA - Fakulteta za farmacijo
Leto izida:2019
Število ogledov:35
Število prenosov:9
Metapodatki:XML RDF-CHPDL DC-XML DC-RDF
 
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Sekundarni jezik

Jezik:Angleški jezik
Naslov:The influence of hospital environment improvements on lower hypnotic and anxiolytic drug usage
Izvleček:
Sleep is a big part of people's physical and psychological health. It is even more important when it comes to the more at risk population, such as patients. Multiple diseases, patient variability and a vast amount of contradicting research make the treatment of insomnia complicated and complex. We conducted a retrospective study, researching the impact television – as a sleeping aid – has on the patients with a TV in their rooms. We were also measuring the impact of the TV implementation in terms of lowering the sedative prescribing. Within this study we also looked at the prescribing structure and the prescribed dose of sedatives in correlation with the prescriber and pre/post TV period. We analysed the patient documentation of the Center for clinical toxicology and pharmacology (CKTF), University Clinical Center Ljubljana. The period before the implementation of TVs spanned between August 1st 2016 and January 31st 2017. The period after the implementation of TVs spanned between August 1st 2017 and January 31st 2018. Television was introduced into patients' rooms in April 2017. The study included 612 patients, 302 in the period before the addition of TVs and 312 from the period after. In the period before there were 181 (61%) women and in the period after the implementation of TVs 142 (46%). Both periods – before and after – include more than 80% of patients age 65 years or older. In the period before – 85%, in the period after – 86%. The data was kept and analysed in an Excel file. In total, the patients in the group before the TVs were added, stayed in the hospital 3163 days, and after the TVs were added the patients total stay was 2783 days. Days with the prescribed sedative totaled 829 before the TVs and 696 days after the TVs. The study includes sedatives mainly prescribed at the CKTF for battling insomnia, benzodiazepines (alprazolam, bromazepam, diazepam, klonazepam, lorazepam, medazepam, midazolam), quetiapine and zolpidem. The percentage of days with a sedative take into account the days which have a sedative prescribed in the evening and not necessarily during the day. Before the implementation of TVs, the patients were prescribed a sedative 23,8% of the days at the hospital, and in the period after 23,4%, the difference is not statistically significant. The average number of units of diazepam 5mg equivalent per day of sedation changed from 0,80 units before the TV to 0,90 units after the TV was introduced and the change is statistically significant (p<0,0001). Prescriber A kept the percentage of days with a sedative at a similar level (before 20,8% after 19,6%, p=0,78), however he lowered the average prescribed dose of sedatives (before 1,09, after 0,90 units of the 5mg diazepam equivalent per day of sedation), which is a statistically significant change ( p<0,0001). Prescriber B lowered the percentage of days with a sedative statistically significantly (before 26,5%, after 9,1%, p=0,011) while keeping the dose almost unchanged (before 0,90 after 0,91 units of the 5mg diazepam equivalent per day of sedation, p=0,833). Prescriber C increased the percentage of days with a sedative (before 26,7%, after 38,9%, p=0,00032), which is statistically significant and increased the average unit of the diazepam equivalent per day prescribed from 0,78 to 1,06 units, which is also statistically significant (p<0,0001). Television is not the sole factor influencing the changes in sedative prescription. We noticed that doctors and their attitude to sedatives had a big influence on the outcome.

Ključne besede:insomnia, university clinical center, elderly, implementation of television in patient rooms

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