在老年患者中,STOPP和START标准与胃肠道出血之间的时间依赖关系,使用例行收集的初级保健数据
Anouk Veldhuis1, Danielle Sent1, Rik J B Loijmans2
1Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
PloS one
|December 7, 2023
概括
不遵守STOPP/START标准会显著增加老年人胃肠道出血的风险. 遵守这些处方指南对于预防出血等不良事件至关重要.
科学领域:
- 老年人药物疗法药物疗法
- 患者安全 患者安全
- 临床药房 临床药房 临床药房
背景情况:
- 老年人处方查工具 (STOPP) 和提醒正确治疗的查工具 (START) 标准对于优化老年患者药物使用至关重要.
- 很少有研究评估了这些标准对药物不良事件,特别是胃肠道出血的预防性影响.
研究的目的:
- 确定65岁及以上患者不遵守STOPP/START标准与胃肠道出血之间的关联.
- 调查暴露于潜在有害的START药物和胃肠道出血之间的联系.
主要方法:
- 一项回顾性队列研究利用了荷兰49名全科医生的电子健康记录 (2007-2014).
- 胃肠道出血是通过ICPC代码和文本检查来识别的. 选择了三个与胃肠道出血相关的STOPP和六个START标准.
- 考克斯比例危险回归与时间依赖的共变量评估了不坚持和胃肠道出血之间的关联.
主要成果:
- 该研究包括26,576名参与者,确定了19,070例潜在的不适当药物 (PIM) 或潜在的处方遗漏 (PPO).
- 不遵守STOPP/START的综合结果显示,胃肠道出血的危险比为5.45 (95% CI 3.62-8.21).
- 在单独分析时,两个单独的STOPP/START标准表明与胃肠道出血有显著的关联.
结论:
- 不遵守STOPP/START标准显著与老年人胃肠道出血风险增加有关.
- 坚持特定的STOPP/START标准对于预防胃肠道出血至关重要.
- 决策支持系统可以帮助提高对这些处方指南的遵守.
更多相关视频
相关概念视频
Assessment of the Gastrointestinal System I: Subjective Data
200
Assessing the gastrointestinal (GI) system is a complex process that begins with collecting subjective data. This data, collected through patient interviews, provides crucial insights into the patient's health history, perception patterns, and lifestyle habits, all contributing significantly to GI health.
Health History
The initial step in assessing the GI system is obtaining a comprehensive health history. This includes inquiring about the patient's history or presence of problems...
Health History
The initial step in assessing the GI system is obtaining a comprehensive health history. This includes inquiring about the patient's history or presence of problems...
200
Endoscopic Procedures I: Esophagogastroduodenoscopy
122
An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
During an EGD, the endoscope can be used to:
During an EGD, the endoscope can be used to:
122
Lower GI Series: Barium Enema
289
A Barium Enema, or a lower GI series, is a specialized radiographic examination designed to visualize the lower gastrointestinal tract, specifically the colon and rectum. This procedure is instrumental in diagnosing various conditions such as colorectal cancer, polyps, diverticulosis, and inflammatory bowel disease.
Procedure Details
The examination begins by inserting a lubricated rectal tube into the patient's rectum to administer a radiopaque barium solution. The barium flow is carefully...
Procedure Details
The examination begins by inserting a lubricated rectal tube into the patient's rectum to administer a radiopaque barium solution. The barium flow is carefully...
289
Gastritis III: Clinical Manifestations and Management
272
The clinical manifestations of gastritis can vary depending on the cause and type of gastritis, but some common symptoms may include the following.
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
272
Esophageal Varices-II: Clinical Features and Management
71
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
71
Disorders of Hemostasis
922
Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
922


