Dispensary Management Research Articles

The role of stress reactions in the genesis of menstrual cycle disorders in recurrent urinary tract infections in minors

BACKGROUND. Extragenital diseases, including recurrent urinary tract infections, have an adverse effect on the reproductive health of children and adolescents. Vaginitis and menstrual cycle disorders, including primary oligomenorrhea, predominate in the structure of gynecological morbidity of minors suffering from recurrent UTIs.THE AIM: to study the role of stress reactions in the genesis of various variants of menstrual cycle disorders in minors suffering from recurrent UTIs to improve the dispensary management of this cohort of patients. PATIENTS AND METHODS. A prospective study was conducted in 98 adolescent girls aged 16 to 18 years. Taking into account the nature of the clinical course of UTI, all the subjects were divided into 3 groups: group 1 (n=41) – patients with UTI; group 2 (n=27) patients with frequent recurrence of UTI (more than 3 times a year (rIMP); group 3 (n=30) – minors, 1, 2 health groups with no IPM episode. A specialized gynecological examination, functional diagnostic tests, ultrasound examination of the placemark and ovaries, determination of cortisol, norepinephrine, adrenaline by enzyme immunoassay were carried out. Statistical analysis was performed using the program "SPSS Statistics 17.0 for Windows".RESULTS. Anovulation was observed in patients with frequent recurrence of UTI. Copious and prolonged menstruation, uterine bleeding and primary oligomenorrhea were observed only in patients with recurrent UTIs. In this cohort, inflammatory gynecological diseases take a chronic course. Polycystic ovarian syndrome (40.7 %) and chronic salpingoophoritis (44.4 %) were often detected in patients with frequently recurrent UTI. In patients suffering from UTI, in contrast to the data of the comparison group, there were significant violations of the nature of adaptive reactions, and changes in antistress reactions and their levels differed depending on the variant of the course of the microbial-inflammatory process. In patients with rare relapses of UTI, antistress reactions of a high level of reactivity prevailed, but there were reactions of calm and increased activation, training that took place at low levels of reactivity.CONCLUSION. Adaptive-compensatory disorders were revealed in almost every patient with recurrent UTI. Considering that stress is especially pathogenic during puberty, when hormonal and psychophysiological restructuring of the body occurs, prevention and complex therapy of microbial-inflammatory diseases of the urinary system in this category of patients should be carried out taking into account the formation of reproductive function and the severity of adaptation reactions.

Mortality patterns and survival rates in HIV-infected patients with immunological ineffectiveness of antiretroviral therapy

Introduction. Due to the lack of criteria for determining the case of immunological non-response to ART, data on the analysis of deaths in this group of patients are heterogeneous. We analyzed the structure of deaths, clinical and laboratory indicators, and also conducted a survival analysis. Materials and methods. We conducted a retrospective study of HIV-infected patients who had a level of CD4+ T-lymphocytes at the beginning of treatment < 350 cl/mcl and further after that. Two groups were formed: the main one-deceased patients – 357 people; control one-surviving patients – 1846 people. Results. Men and older patients significantly prevailed in the main group of patients. Drug-addicted patients were more likely to have a fatal outcome. When comparing the average indicators of CD4+ T-lymphocytes and viral load at the time of the onset of ART, no statistically significant differences were found. When assessing the frequency of deaths in patients with extremely severe immunodeficiency (CD4 < 50 cells/μl.) at the beginning of ART, the chances of death were significantly higher (OR 1.523; 95 % CI 1,236–1,785). The probability of death increased rapidly by the 5-year period (60 months) from the beginning of ART to 26.9 % ± 1.5, and by the 120-month period (10 years) it reached 43.6 ± 6.8 %. The average development period of a fatal case from the moment of the start of treatment was 82 months (95 % CI: 78.87–85.56 months). Discussion. The question is raised about the predictors of adverse clinical outcomes in patients with immunological inefficiency of ART. A prospective study will provide a complete picture of the course of the disease in this group of patients. Conclusion. The high probability of death in patients with immunological non-response to ART in the first 5 years of follow-up from the beginning of ART requires increased attention from specialists in terms of treatment and dispensary management.

The effect of eradication therapy on the quality of life of patients with chronic erosive gastritis induced with Helicobacter pylori

The aim of the study was to evaluate the effect of eradication therapy on the quality of life of patients with chronic erosive gastritis induced with Helicobacter pylori. The quality of life was assessed according to the GIQLI questionnaire before treatment during incomplete remission, remission, and during the year. It was found that the exacerbation of the disease significantly changes the level of quality of life of patients, and the complex treatment, eradication of Helicobacter pylori, which stopped the exacerbation of the disease, gradually increases and brings this indicator closer to the control group. The gastrointestinal quality of life index can be used as an additional criterion for diagnosing the stages of chronic erosive gastritis, for evaluating the effectiveness of therapy, determining the timing of treatment, rehabilitation and prevention in the dispensary management of patients at the therapeutic site.

Reproductive health issues of adolescent girls suffering from recurrent urinary tract infections

Currently, adolescent girls with recurrent urinary tract infection have a high frequency of reproductive disorders. In order to study the state of reproductive health of adolescent girls with urinary tract infections, depending on the frequency of relapses, 70 adolescent girls aged 16–18 years were examined, of which 1 group (n=23) — with rare relapses of UTI (relapses up to 3 times a year); 2 group (n=27) with frequent relapses of UTI (more than 3 times a year). The control group (n=30) consisted of adolescent girls of the same age of 1.2 health groups. We studied the features of sexual development, the concentration of gonadotropin and steroid hormones. In patients of group 2, a high frequency of hypoprogesteronemia, hyperandrogenism, and anovulatory cycles was revealed, which contributes to the development of a number of gynecological diseases. An interdisciplinary approach to the dispensary management of these patients is necessary, which prevents the development of reproductive disorders.

Features of comorbid symptoms in vulvovaginitis in girls with urinary tract infections

Background . Urinary tract infections are the most common nephrological diseases in girls. Currently, there is a need to develop comprehensive interdisciplinary approaches to the examination of patients with vulvovaginitis against the background of pre-school urinary tract infection. The aim: to study the characteristics of comorbid symptoms of vulvovaginitis in girls of pre-school age suffering from urinary tract infections. PATIENTS AND METHODS. A prospective controlled study was conducted in 107 girls aged 3-6 years, including: group 1 (n=45) - patients with vulvovaginitis against a background of recurrent urinary tract infection; group 2 (n=32) - patients with an isolated form of vulvovaginitis; group 3(n=30) - girls of 1, 2 health groups. A specialized gynecological examination was performed. Statistical processing was performed using the application program "SPSS Statistics 17.0 for Windows". Results. Revealed that patients with concomitant vulvovaginitis compared to patients with isolated vulvovaginitis, often marked by painful urination, discomfort in the genital area, serous (35.7 %) and mucopurulent (55,6 %) vaginal discharge, petechial rash, anatomical (prolapse of the urethra, close proximity of the meatus to the entrance of the vagina) and inflammatory changes (edema, hyperemia) in the region of the urethra, high frequency fringed structure of the hymen (p=0,12). Diffuse hyperemia in the vulva area was more often observed in patients with isolated vulvovaginitis. Conclusions. Patients with vulvovaginitis and recurrent recurrent urinary tract infection have a burdened social and biological history. In dispensary management, an interdisciplinary approach is required, taking into account the identified medical and social risk factors.

Medical and social risk factors for recurrent vulvovaginitis in girls with urinarysystem infections

BACKGROUND. The leading role in the development of vulvovaginitis in girls of pre-school age belongs to the extragenital diseases, including recurrent urinary tract infections. The study of medical and social factors that affect the development of reproductive health disorders is of urgent importance. THE AIM: to study the medical and social risk factors for recurrent vul­vovaginitis in preschool girls suffering from urinary tract infections. PATIENTS AND METHODS. A prospective controlled study was conducted in 107 girls aged 3-6 years, including group 1 (n=45) - patients with vulvovaginitis against the background of recurrent uncomplicated urinary tract infection; group 2 (n=32) - patientswith an isolated form of vulvovaginitis; group 3(n=30) - girls of health groups 1 and 2. The main parameters of social and biological anamnesis are analyzed. Statistical analysis was performed using the program "SPSS Statistics V. 17.0" ("SPSS Inc. IBM Company", USA). RESULTS. Patients with a combined form of vulvovaginitis, in comparison with patients with isolated vulvovaginitis, more often lived in rural areas, were from large families, belonged to the group of preschool children who do not attend preschool educational institutions, in their families, the monetary income was lower than the subsistence minimum (p<0.001). The lowest level of hygiene was observed in pa­tientswith isolated forms of vulvovaginitis. In patientswith combined forms of vulvovaginitis, in comparison with patientswith isolated vulvovaginitis, gestational complications were significantly higher: 22.2% had gestational pyelonephritis, 13.6% had a premature birth, and 22.2% had a cesarean section (p <0.05). CONCLUSION. Patients with vulvovaginitis and recurrent UTI have a burdened social and biological history. In dispensary management, an interdisciplinary approach is required, taking into account the identified medical and social risk factors.

How to manage the practice dispensary

Dispensary management is made of different elements: the stock (what you stock, the amount you stock, rotation of old and new); the personnel within the dispensary; and the protocols that they are required to adhere to. Some of these elements you will be in control of and some will be set out by the practice. Monitoring of stock usage helps to set overall quantities of what is kept in. Monitoring of any dispensing errors can help identify how to improve protocols, placement of items on shelves and look at the type and quantity of items that are held in stock.

Hawke's Bay pharmacists' activities during a campylobacter contamination of public water supply in Havelock North during 2016.

INTRODUCTION In August 2016 contamination of the local water supply resulted in a significant gastroenteritis outbreak in Hawke's Bay. The significance of the initial test result was recognised early, partly as a result of information provided by a Havelock North pharmacist to health authorities about an unusual number of requests for anti-diarrhoeal medication. AIM To describe the breadth of activities undertaken by pharmacists working in Hawke's Bay in August 2016, following Campylobacter jejuni contamination of the public water supply in Havelock North, New Zealand. METHODS All pharmacists and hospital pharmacy management staff working in Hawke's Bay in 2017 were eligible to complete the qualitative online questionnaire. Additionally, information was requested from stakeholders with known relevant experiences. Free-text responses were thematically analysed using a general inductive approach. RESULTS Thirteen pharmacists and two ancillary staff from community pharmacy, hospital pharmacy, general practice, management, emergency response and dispensary management responded to the survey. Analysis of responses revealed three overarching themes and six sub-themes. The first was public wellbeing, with sub-themes of community information, local emergency response and pharmacy operational management. The second was pharmaceutical distribution, with a sub-theme of stock management. The third theme was clinical medicine management, with sub-themes of acute symptom management and medicine management. DISCUSSION The pharmacy profession appears to have played an important role in public wellbeing, pharmaceutical distribution and medicine therapy management during the outbreak. It is likely that through their actions, responding pharmacists reduced demand on other primary care services and prevented hospitalisations. Further research directions include exploring the effectiveness of community pharmacists in public health surveillance and the use of endorsed public health information to ensure consistent delivery of health messages.

User-centered design and usability testing of RxMAGIC: a prescription management and general inventory control system for free clinic dispensaries

BackgroundTo address challenges related to medication management in underserved settings, we developed a system for Prescription Management And General Inventory Control, or RxMAGIC, in collaboration with the Birmingham Free Clinic in Pittsburgh, Pennsylvania. RxMAGIC is an interoperable, web-based medication management system designed to standardize and streamline the dispensing practice and improve inventory control in a free clinic setting. This manuscript describes the processes used to design, develop, and deploy RxMAGIC.MethodsWe transformed data from previously performed mixed-methods needs assessment studies into functional user requirements using agile development methods. Requirements took the form of user stories that were prioritized to drive implementation of RxMAGIC as a web-application. A functional prototype was developed and tested to understand its perceived usefulness before developing a production system. Prior to deployment, we evaluated the usability of RxMAGIC with six users to diagnose potential interaction challenges that may be avoided through redesign. The results from this study were similarly prioritized and informed the final features of the production system.ResultsWe developed 45 user stories that acted as functional requirements to incrementally build RxMAGIC. Integrating with the electronic health record at the clinic was a requirement for deployment. We utilized health data standards to communicate with the existing order entry system; an outgoing electronic prescribing framework was leveraged to send prescription data to RxMAGIC. The results of the usability study were positive, with all tested features receiving a mean score of four or five (i.e. somewhat easy or easy, respectively) on a five-point Likert scale assessing ease of completion, thus demonstrating the system’s simplicity and high learnability. RxMAGIC was deployed at the clinic in October 2016 over a two-week period.ConclusionsWe built RxMAGIC, an open-source, pharmacist-facing dispensary management information system that augments the pharmacist’s ability to efficiently deliver medication services in a free clinic setting. RxMAGIC provides electronic dispensing and automated inventory management and alerting capabilities. We deployed RxMAGIC at the Birmingham Free Clinic and measured its usability with potential users. In future work, we plan to continue to measure the impact of RxMAGIC on pharmacist efficiency and satisfaction.

The nurse’s role in the effectiveness of dispensary management of young infants. A nurse and her assistance to an infant, family and doctor with correction of the functional intestinal colic during the first months of life

The article presents the main variants of functional gastrointestinal disorders in young infants - posseting, evacuation disorder, intestinal infantile colic, clinical features, modern view on the causes and methods for correction of these conditions (step-bystep methods to alleviate the pain syndrome). It also describes the manipulation methods that help with these conditions (inserting a flatus tube, cleansing enema in infants), as well as the basic principles for counselling and education of parents.

六西格玛质量管理方法在药房管理中的应用价值

六西格玛质量管理方法在药房管理中的应用价值

Dispensary management of patients with venous thromboembolic complications

This article represents the results of dispensary managent of patients with venous thromboembolic complications. All the patients were admitted to the dispensary after discharge from vascular surgery department. Deep venous thrombosis group included 101 patients who underwent conservative treatment, 90 patients who received both conservative treatment and implantation of permanent vena cava filter «Corona», and 74 patients who underwent resection of a main deep vein. 28% patients had anamnestic pulmonary thromboembolism (PTE). Only 3.9% patients who underwent conservative threatment without surgical prophylaxis of PTE had recurrent thromboembolism of pulmonary artery during the period of dispensary management. Comparative analysis revealed a 2-times higher incidence of deep venous thrombosis in contralateral extremity after surgical methods of prophylaxis. According to the research results, dynamic observation of patients as well as timely control and correction of therapy allowed to significantly improve the efficacy of treatment and reduce the number of complications. Efficient programs of treatment and rehabilitation developed individually for each patient with venous thromboembolic complications allow for the effective treatment of thrombosis, impediment of the recurrence, and improvement of patient’s quality of life.

Medical examination of children with chronic pneumonia in rural areas

The literature pays enough attention to the issues of dispensary management of children with chronic pneumonia in urban conditions. However, we have not found any work on the study of medical examination of patients with chronic pneumonia in rural areas. It should be noted that chronic pneumonia in children in rural areas is a common disease (on our material 2.19%). The conditions of rural areas contribute their own characteristics to the stage-by-stage treatment of such children.

The future of dispensary and domiciliary management of tuberculosis

The future of dispensary and domiciliary management of tuberculosis

Hospital and Dispensary Management

Hospital and Dispensary Management

Hospital and Dispensary Management

Hospital and Dispensary Management

Hospital and Dispensary Management

Hospital and Dispensary Management

Hospital and Dispensary Management

Hospital and Dispensary Management

Hospital and Dispensary Management

Hospital and Dispensary Management

Hospital and Dispensary Management

Hospital and Dispensary Management