什么是“七月效应”？它真的会致命吗？【福布斯中文网】

男丁格尔

7月份去医院，千万别找新手医生。1. 致命的药物组合：两种或多种药物，会互相放大各自的药效或副作用。
2. 混淆了名称相似的两种药物。
3. 将药物与酒精混合。
4. 因为没有分清药物的品牌名和通用名，重复开了两倍的剂量。
5. 将处方药与非处方药或者替代性补充药剂（alternative supplements）混合使用。
6. 使用的药物在患者的年龄阶段不安全。
最后这一条，前不久刚被揭示可能酿成可怕的后果。就在两周前，《美国老年病协会会刊》（the American Geriatrics Society）刊登的一份研究指出，一些普通药品，例如抗抑郁药（antidepressants）和抗组胺药（antihistamines）的混合使用，对老年人会产生令人担忧的高致死率。超过一半65岁以上的老人会使用至少一种上述混合药物，通常称为抗胆碱能类药物(anticholinergics)。这种药物会对大脑中一种称为“乙酰胆碱”的神经传导素产生影响，可能造成晕眩、困倦、意识混乱和记忆丧失等症状。
根据研究，大剂量摄入此类药物，或者同时摄入多种此类药物的老人中，有20%的人在两年中死亡，这是需要警觉的高死亡率。很多老年病学专家早就认为如无绝对的必要，不应该给65岁以上的老年人开抗胆碱能类药。他们已经呼吁了好几年。但仍然有医生在给老人开这类药，好像没有注意到——或者故意不理睬他们的警告。
现在，让我们回到“七月效应”：对于它，我们可以做些什么？巴克和菲利普建议人们做一些后续的研究，确认他们的研究结果，并且分析新的电子处方系统是否对“七月效应”产生影响。他们还建议重新审视新医生的管理方式，加强住院实习期间的医疗安全教育。不过，除了等待医院自己改进，我建议我们要采取更加积极主动的方式。
最后，让我们期待巴克和菲利普的号召能够得到回应，并且期待随着本月数据加入统计，“七月效应”能够逐渐减退。 【福布斯中文网】本文网址：http://www.forbeschina.com/tech/review/201107/0011029_2.shtml

Every July, a little-noticed phenomena occurs in hospitals around the country. Immediately upon graduation, newly minted doctors arrive, diplomas in hand, ready to take up their resident duties. Except maybe they’re not. Because according to some pretty convincing research out of UC San Diego, the July influx brings with it a 10 percent surge in fatal medication errors.

Dubbed the “July Effect” by researchers David Phillips and Gwendolyn Barker of UC San Diego, the spike in deaths by medication error has occurred every July for the past 7 years.

Barker and Phillips studied data obtained from the death certificates of people who died in hospital settings between 1979 and 2006, culling those for which medication error was listed as the primary cause of death. They then correlated those data with records of the number of hospital beds in each county that are affiliated with medical residency training programs. The study was published a year ago, but since then Barker and Phillips have continued to compile data.

Two striking facts stand out from their review:

1.The spike occurs every July — and only in July
.
2.It’s recorded only in counties with teaching hospitals.
As you can imagine, the research caused a furor, and letters and articles in numerous medical publications followed, analyzing Phillips and Barker’s conclusions, and supporting them. In an editorial in Physician, for example, Glenn Laffel MD notes that although the study didn’t address how or why the fatal medication errors occurred, likely reasons include:

•overprescribing
•incorrect dosing
•failure to recognize drug interactions
•failure to notice early warning signs of drug allergies and side effects
There’s more to the story, though. Overall, our nationwide statistics on medication errors are frightening to begin with. Every year an average of 1.5 million people are sickened or severely injured by medication mistakes, and 100,000 die. The subject of medication errors is a subject I’ve researched and written on frequently over the years, and indeed the reasons Laffel suggests are some of the most common — and most deadly — occurrences. Others include:

•Deadly drug combinations; taking two more drugs that magnify each others’ intended effects or side effects
•Confusing two medications with similar-sounding names
•Mixing alcohol with medications
•Double dosing by taking a brand-name medication and the equivalent generic at the same time
•Mixing prescription drugs with over-the-counter medications or alternative supplements
•Taking medications that aren’t safe for your age
This last is turning out to be a particularly scary phenomenon. Just two weeks ago, a study published in the Journal of the American Geriatrics Society revealed that deadly combinations of common medications such as antidepressants and antihistamines are killing the elderly at alarming rates. Half of all those over 65 are taking at least one of the drugs, known as anticholinergics. The drugs affect a neurotransmitter in the brain called acetylcholine and can cause dizziness, drowsiness, confusion, and memory loss.

According to the researchers, 20 percent of those taking either high dosages or several of the drugs at once died in a two-year period, an alarmingly high fatality rate. Many geriatricians believe anticholinergics shouldn’t be prescribed to those over 65 unless absolutely necessary and have warned so for several years. Yet prescribing doctors appear to be ignorant of — or actively ignoring — the warning.

Meanwhile, back to the “July effect”: what can be done about it? Barker and Phillips recommended doing follow-up studies to confirm their data, and also to see if new e-prescribing systems are having an impact on the July effect. They also recommended a review of how new physicians are supervised and stronger resident training programs in medication safety. But rather than relying on hospitals to clean up their act, I suggest taking a more proactive approach and following my advice on how to protect yourself from medication errors.

And let’s hope Barker and Phillips’ calls to action were answered and that when the data from this month are in, the “July effect” will be on the wane.