Matoses-Chirivella Carmen, Navarro-Ruíz Andrés, Lumbreras Blanca
Department of Pharmacy Services, University Hospital of Elche, Camino de la Almazara 11, 03203, Elche, Spain.
Department of Public Health, History of Science and Gynecology, Miguel Hernández University, Alicante, Spain.
J Orthop Traumatol. 2018 Aug 27;19(1):4. doi: 10.1186/s10195-018-0490-2.
Increased longevity and the prevalence of associated pathologies is leading to more hospital admissions involving chronic patients with multiple pathological problems. In orthopedic surgical patients, it is very important to individually evaluate the risk/benefit of maintaining or suppressing chronic medications. For certain medications, there are consensus recommendations, but for others, the available information may be limited or controversial.
To develop and validate a new guide for the continuity of care in perioperative medication management in older orthopedic surgical patients.
An expert pharmacist developed the guide by systematically reviewing each medication category according to the Anatomical Therapeutic Chemical (ATC) classification system. The Pharmacy and Therapeutics Committee at the Hospital General Universitario de Elche reviewed the guide. After a training course on the guide for pharmacists, the guide was validated by studying the interobserver variability between pharmacists as well as between each pharmacist and the expert pharmacist. Cohen's kappa index (κ) was applied to determine interrater reliability.
The guide includes 51 therapeutic groups. Each ATC pharmacological subgroup is structured according to the benefits and risks of continuing therapy. When we compared each pharmacist's recommendations with those of the expert pharmacist, the kappa value was found to be 0.8 [95% CI (0.7, 0.9)], indicating almost perfect concordance (overall percentage agreement 89.3%).
We developed a guide for the continuity of care in perioperative medication management to improve the rationalization of medicines in the perioperative environment. After the pharmacists had been trained, the guide was validated by demonstrating a high level of concordance among the pharmacists' recommendations. Formal training seems to be essential to ensure consistency in medical decisions.
IV (Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653 ).
寿命延长以及相关病理状况患病率的增加，导致涉及患有多种病理问题的慢性病患者的住院人数增多。在骨科手术患者中，单独评估维持或停用慢性药物的风险/益处非常重要。对于某些药物，有共识性建议，但对于其他药物，可用信息可能有限或存在争议。
制定并验证一份针对老年骨科手术患者围手术期药物管理中持续治疗的新指南。
一名专家药剂师根据解剖治疗化学（ATC）分类系统对每种药物类别进行系统回顾，制定了该指南。埃尔切大学综合医院的药学与治疗学委员会对该指南进行了审核。在为药剂师举办了关于该指南的培训课程后，通过研究药剂师之间以及每位药剂师与专家药剂师之间的观察者间变异性对该指南进行了验证。应用科恩kappa指数（κ）来确定评分者间的可靠性。
该指南包括51个治疗组。每个ATC药理学亚组根据继续治疗的益处和风险进行构建。当我们将每位药剂师的建议与专家药剂师的建议进行比较时，发现kappa值为0.8 [95%可信区间（0.7, 0.9）]，表明几乎完全一致（总体百分比一致性为89.3%）。
我们制定了一份围手术期药物管理中持续治疗的指南，以改善围手术期环境中药物的合理使用。在对药剂师进行培训后，通过证明药剂师建议之间的高度一致性对该指南进行了验证。正式培训似乎对于确保医疗决策的一致性至关重要。
IV（牛津循证医学中心。http://www.cebm.net/index.aspx?o=5653 ）
