抗菌药物临床应用指导原则(指南)在合理用药中的价值.ppt

* The optimal method has not been determined. Publication in medical journals, especially general medical journals, has, to date, been the most commonly used strategy, but is regarded as a poor means of disseminating guidelines with a low likelihood of implementation.23 Direct mailing to relevant practitioners is seen as a more effective measure, but is still of limited efficacy, levels of awareness rarely increasing to 40%.7,24 The impact of this intervention can be enhanced by making the guidelines visually attractive and/or by staging their delivery in manageable ‘chunks’ of information.25,26 In general, however, the ability of passive methods such as written communications to achieve even a temporary change in behaviour is questionable. Grimshaw Russell23 claimed that the more overtly educational the dissemination strategy the greater the likelihood that guidelines will be adopted and the more lasting their impact, provided that dissemination is linked to an effective implementation strategy. 加拿大感染性疾病学会和胸科学会CIDS和CTS1993, 2000 Candian Guidelines for the Initial Management of CAP 美国胸科学会ATS 1993, 2001 Guidelines for management of Adults with CAP 美国感染性疾病学会IDSA 1998, 2000 Practice Guidelines for the Management of CAP in Adults 美国American Health Consultants: ASCAP Panel 2002 CAP Year 2002 Antibiotic Selection and Management update 英国胸科学会BTS 1993, 2001（A）, 2002（C） Guidelines for Management of CAP in Adults Guidelines for Management of CAP in Childhood * Dr.HU Bijie * 病原体 检出率％ 排位 80～82(132686) 90～96(101821) 80～82 90～96 枸橼酸菌 1 1 12 9 肠杆菌 6 4 6 7 大肠杆菌 13 5 2 4 肺炎杆菌 8 5 4 4 其他克雷伯 2 1 10 9 奇异变形杆菌 2 1 11 9 其他变形杆菌 0 0 14 13 粘质沙雷菌 3 1 8 9 其他沙雷菌 1 0 13 13 肠杆菌科合计 36 18 绿脓杆菌 6 3 7 8 金葡菌 13 16 1 2 CoNS 11 31 3 1 肠球菌 7 9 5 3 念珠菌 3 5 9 4 其他 24 18 * Dr.HU Bijie * * Dr.HU Bijie * 早期 中期 晚期 1 3 5 10 15 20 链球菌 流感杆菌 金葡菌 MRSA 肠杆菌 肺克，大肠 绿脓杆菌 不动杆菌 嗜麦芽窄食单胞菌 入院天数 编写 发布 实施 评估 * Dr.HU Bijie * * Dr.HU Bijie * The consensus-based g