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Electronic Prescription

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181. Practice Variation in Anticoagulation Prescription and Outcomes after Device-Detected Atrial Fibrillation: Insights from the Veterans Health Administration. Full Text available with Trip Pro

a retrospective cohort study using data from the Veterans Health Administration linked to remote monitoring data that included day-level AF burden. We included patients with cardiac implantable electronic devices and remote monitoring from 2011 to 2014, CHA2DS2-VASc score ≥2, and no prior stroke or OAC receipt in the preceding 2 years. We determined the proportion of patients prescribed OAC within 90 days after new device-detected AF across a range of AF thresholds (≥6 minutes to >24 hours) and examined site (...) variation in OAC prescription. We used multivariable Cox proportional hazards regressions to determine the association of OAC prescription with stroke by device-detected AF burden.Among 10 212 patients with cardiac implantable electronic devices, 4570 (45%), 3969 (39%), 3263 (32%), and 2469 (24%) had device-detected AF >6 minutes, >1 hour, >6 hours, and >24 hours, respectively. For device-detected AF >1 hour, 1712 patients met inclusion criteria (72±10 years; 1.5% female; CHA2DS2-VASc score 4.0±1.4; HAS

2019 Circulation

182. Intervention to reduce benzodiazepine prescriptions in primary care, study protocol of a hybrid type 1 cluster randomised controlled trial: the BENZORED study. Full Text available with Trip Pro

prescription and BZD deprescribing, monthly feedback about their BZD prescribing practices and access to a support web page. Outcome measures for each GP are the defined daily dosage per 1000 inhabitants per day and the proportion of long-term BZD users at 12 months. Data will be collected from the electronic prescription database of the public health system, and will be subjected to intention-to-treat analysis. Implementation will be evaluated by mixed methods following the five domains (...) Intervention to reduce benzodiazepine prescriptions in primary care, study protocol of a hybrid type 1 cluster randomised controlled trial: the BENZORED study. Benzodiazepines (BZDs) are mainly used to treat anxiety and sleep disorders, and are often prescribed for long durations, even though prescription guidelines recommend short-term use due to the risk of dependence, cognitive impairment, and falls and fractures. Education of general practitioners (GPs) regarding the prescription of BZDs

2019 BMJ open Controlled trial quality: uncertain

183. Long-term outcomes of an educational intervention to reduce antibiotic prescribing for childhood upper respiratory tract infections in rural China: Follow-up of a cluster-randomised controlled trial. Full Text available with Trip Pro

from the one county (14 facilities and 1:1 cluster randomisation ratio) that had electronic records available 12 months after the trial ended, at the 18-month follow-up period. Our primary outcome was the antibiotic prescription rate (APR)-the percentage of outpatient prescriptions containing any antibiotic(s) for children aged 2 to 14 years who had a primary diagnosis of a URTI and had no other illness requiring antibiotics. We also conducted 15 in-depth interviews to understand how interventions (...) and focused prescription review meetings, whereas lack of supervision and monitoring may be associated with relapse. Key limitations were not including all clusters from the trial and not collecting returned visits or sepsis cases.Our intervention was associated with sustained and substantial reductions in antibiotic prescribing at the end of the intervention period and 12 months later. Our intervention may be adapted to similar resource-poor settings.ISRCTN registry ISRCTN14340536.

2019 PLoS medicine Controlled trial quality: predicted high

184. Avoiding chemotherapy prescribing errors: Analysis and innovative strategies. (Abstract)

Avoiding chemotherapy prescribing errors: Analysis and innovative strategies. At Freiburg University Medical Center, chemotherapy prescriptions are processed via a computerized physician order entry (CPOE) tool and clinically checked by a designated chemotherapy surveillance team. Any error detected is reported instantly, corrected, and prospectively recorded. The objective of the current study was to gain insight into the causes, potential consequences, and future preventability (...) of chemotherapy prescribing errors.A detailed analysis of 18,823 consecutive antineoplastic orders placed in 2013 through 2014 was performed. In cooperation with information technology (IT) specialists, the intercepted errors were analyzed for effective future prevention using IT measures. Potential error consequences were determined by case discussions between pharmacists and physicians.Within 24 months, a total of 406 chemotherapy prescribing errors were intercepted that affected 375 (2%) of the total

2019 Cancer

185. Continued Statin Prescriptions After Adverse Reactions and Patient Outcomes: A Cohort Study. (Abstract)

, 19 989 (70.7%) continued receiving statin prescriptions after the adverse reaction. Four years after the presumed adverse event, the cumulative incidence of the composite primary outcome was 12.2% for patients with continued statin prescriptions, compared with 13.9% for those without them (difference, 1.7% [95% CI, 0.8% to 2.7%]; P < 0.001). In a secondary analysis of 7604 patients for whom a different statin was prescribed after the adverse reaction, 2014 (26.5%) had a documented adverse (...) Continued Statin Prescriptions After Adverse Reactions and Patient Outcomes: A Cohort Study. Many patients discontinue statin treatment, often after having a possible adverse reaction. The risks and benefits of continued statin therapy after an adverse reaction are not known.To examine the relationship between continuation of statin therapy (any prescription within 12 months after an adverse reaction) and clinical outcomes.Retrospective cohort study.Primary care practices affiliated with 2

2017 Annals of Internal Medicine

186. Effects of Behavioral Interventions on Inappropriate Antibiotic Prescribing in Primary Care 12 Months After Stopping Interventions Full Text available with Trip Pro

, N.I.H., Extramural Research Support, Non-U.S. Gov't United States JAMA 7501160 0098-7484 0 Anti-Bacterial Agents AIM IM Anti-Bacterial Agents therapeutic use Electronic Health Records Follow-Up Studies Humans Inappropriate Prescribing prevention & control statistics & numerical data Logistic Models Peer Group Practice Patterns, Physicians' Primary Health Care Respiratory Tract Infections drug therapy 2017 10 20 6 0 2017 10 20 6 0 2017 10 27 6 0 ppublish 29049577 2656800 10.1001/jama.2017.11152 (...) Effects of Behavioral Interventions on Inappropriate Antibiotic Prescribing in Primary Care 12 Months After Stopping Interventions 29049577 2017 10 25 2018 11 13 1538-3598 318 14 2017 10 10 JAMA JAMA Effects of Behavioral Interventions on Inappropriate Antibiotic Prescribing in Primary Care 12 Months After Stopping Interventions. 1391-1392 10.1001/jama.2017.11152 Linder Jeffrey A JA Northwestern University Feinberg School of Medicine, Chicago, Illinois. Meeker Daniella D University of Southern

2017 JAMA Controlled trial quality: uncertain

187. Preoperative Exposure to Benzodiazepines or Sedative/hypnotics Increases the Risk of Greater Filled Opioid Prescriptions After Surgery. (Abstract)

of opioids, benzodiazepines, and sedative/hypnotics filled 6 months before and after the procedure. Patients were grouped into exposed or naïve cohorts depending on whether a prescription was filled 6 months before surgery. Smoking history (current or previous smoking was considered positive) and a history of mood and pain disorders (as noted in the medical history), were collected from the outpatient and the operating room electronic medical record.After controlling for age, gender, and other (...) Preoperative Exposure to Benzodiazepines or Sedative/hypnotics Increases the Risk of Greater Filled Opioid Prescriptions After Surgery. The effect of the preoperative exposure to controlled substances such as benzodiazepines and sedative/hypnotics on prolonged opioid consumption after hand surgery is not known.(1) Is preoperative exposure to benzodiazepines and sedative/hypnotics associated with greater numbers of filled postoperative opioid prescriptions after hand surgery? (2) Is a positive

2019 Clinical Orthopaedics and Related Research

188. Examining the effect of prescription sequence on developing adverse drug reactions: The case of renal failure in diabetic patients. (Abstract)

Examining the effect of prescription sequence on developing adverse drug reactions: The case of renal failure in diabetic patients. While the effect of medications in development of Adverse Drug Reactions (ADRs) have been widely studied in the past, the literature lacks sufficient coverage in investigating whether the sequence in which [ADR-prone] drugs are prescribed (and administered) can increase the chances of ADR development. The present study investigates this potential effect by applying (...) emergent sequential pattern mining techniques to electronic health records.Using longitudinal medication and diagnosis records from more than 377,000 diabetic patients, in this study, we assessed the possible effect of prescription sequences in developing acute renal failure as a prevalent ADR among this group of patients. Relying on emergent sequential pattern mining, two statistical case-control approaches were designed and employed for this purpose.The results taken from the two employed approaches

2019 International journal of medical informatics

189. Assessment of Topical Corticosteroid Prescribing, Counseling, and Communication Among Dermatologists and Pharmacists. (Abstract)

-question survey recalling experiences with TC prescribing from the past year along with self-reported demographic information.Dermatologists' and pharmacists' self-reported counseling of patients regarding TC application, duration of use, and adverse effects; frequency of communication of changes to TC prescriptions and instructions; and demographic data were tabulated and compared.Of the 117 dermatologists, 52 (44.4%) completed and returned the survey; of the 2954 pharmacists, 111 (3.8%) returned (...) Assessment of Topical Corticosteroid Prescribing, Counseling, and Communication Among Dermatologists and Pharmacists. Topical corticosteroids (TCs) are common treatments for many dermatologic conditions. Anecdotal experience and literature suggest that dermatologists and pharmacists differ in their beliefs about TCs and approach to TC counseling, creating the opportunity for patient confusion.To examine interprofessional practice gaps between dermatologists and pharmacists with regard to how

2019 JAMA dermatology (Chicago, Ill.)

190. Predictors and variability of antibiotic prescribing amongst family physicians. (Abstract)

physicians in Ontario, Canada using a repository of electronic medical records. Using multilevel logistic regression models fitted with random intercepts for physicians, we evaluated the association of patient-, physician- and clinic-level characteristics with antibiotic prescribing rates.We included 3 956 921 physician-patient encounters, 322 129 unique patients and 313 physicians from 41 family medicine clinics. Physicians prescribed a median of 54 (interdecile range 28-95) antibiotics per 1000 (...) Predictors and variability of antibiotic prescribing amongst family physicians. Rising rates of antimicrobial resistance are driven by overuse of antibiotics. Characterizing physician antibiotic prescribing variability can inform interventions to optimize antibiotic use.To describe predictors of overall antibiotic prescribing as well as the inter-physician variability in antibiotic prescribing amongst family physicians.We conducted a 5 year cohort study of antibiotic prescribing rates by family

2019 Journal of Antimicrobial Chemotherapy

191. Antibiotic prescribing for common infections in UK general practice: variability and drivers. Full Text available with Trip Pro

Antibiotic prescribing for common infections in UK general practice: variability and drivers. To examine variations across general practices and factors associated with antibiotic prescribing for common infections in UK primary care to identify potential targets for improvement and optimization of prescribing.Oral antibiotic prescribing for common infections was analysed using anonymized UK primary care electronic health records between 2000 and 2015 using the Clinical Practice Research (...) in their propensity to prescribe antibiotics and this variance increased over time. Change points in prescribing did not reflect updates to national guidelines. Prescribing levels within practices were not consistent for different infectious conditions. A history of antibiotic use significantly increased the risk of receiving a subsequent antibiotic (by 22%-48% for patients with three or more antibiotic prescriptions in the past 12 months), as did higher BMI, history of smoking and flu vaccinations. Other drivers

2019 Journal of Antimicrobial Chemotherapy

192. Improving the Safety of Teratogen Prescribing Practices in a Pediatric Rheumatology Clinic. (Abstract)

clinic.Eligible participants included female patients age 10 and older prescribed teratogenic medications in a single-center tertiary care pediatric rheumatology clinic. Seven plan-do-study-act cycles were completed to test the following interventions: visible project reminders, physician and nurse education, progress updates, previsit planning, and development of an electronic health record education template. Chart reviews were performed, and control charts were created for each aim to analyze improvement (...) Improving the Safety of Teratogen Prescribing Practices in a Pediatric Rheumatology Clinic. Although teratogenic medications are commonly used to treat rheumatic disease, no standard model currently exists for educating adolescent patients about teratogenic risk or performing routine pregnancy screening. We performed a quality improvement project to increase education and pregnancy screening in girls and women of childbearing age prescribed teratogenic medications in our pediatric rheumatology

2019 Pediatrics

193. Long-term assessment of NSAID prescriptions and potential nephrotoxicity risk in adult kidney transplant recipients. Full Text available with Trip Pro

retrospectively followed in the VA system from 2001-10 that assessed for risk of AKI with NSAID prescriptions. NSAID prescriptions, patient characteristics and eGFRs were abstracted from the VA comprehensive electronic health record. NSAID exposure was assessed by duration, dosage and type. AKI events were defined by ≥50% decrease in eGFR. Risk was estimated using longitudinal multivariable generalized logistic regression model.5,100 patients were included with a total of 29,980 years of follow up; 671 NSAID (...) Long-term assessment of NSAID prescriptions and potential nephrotoxicity risk in adult kidney transplant recipients. NSAID use is recommended to be avoided in kidney transplantation (KTX), with a paucity of studies assessing their safety within this population. This study aims to use a large cohort of Veterans Affairs (VA) KTX recipients to assess the risk of acute kidney injury (AKI) with NSAID use.This is a ten-year longitudinal cohort study of adult kidney transplant recipients

2019 Transplantation

194. Changes in prescribing for bipolar disorder between 2009 and 2016: national-level data linkage study in Scotland. Full Text available with Trip Pro

patterns in bipolar disorder in Scotland between 2009 and 2016.By linking prescribing data to the electronic Scottish Morbidity Records, we identified a cohort of 23 135 patients with bipolar disorder who were prescribed psychotropic medication between 2009 and 2016. We examined trends in proportions of patients prescribed each of six drug categories. Random effects logistic models examined change in prescribing over years of interest.The most common form of treatment was antidepressant monotherapy (...) Changes in prescribing for bipolar disorder between 2009 and 2016: national-level data linkage study in Scotland. People with bipolar disorder typically require long-term pharmacological treatment to prevent episodes of depression or mania. However, evidence-based guidelines are often not followed by prescribers and, in some countries, prescribing of lithium is in decline. Polypharmacy is also common in bipolar disorder.AimsTo employ a data linkage approach to describe and evaluate prescribing

2019 British Journal of Psychiatry

195. Adherence to antibiotic guidelines and reported penicillin allergy: pooled cohort data on prescribing and allergy documentation from two English National Health Service (NHS) trusts. Full Text available with Trip Pro

Adherence to antibiotic guidelines and reported penicillin allergy: pooled cohort data on prescribing and allergy documentation from two English National Health Service (NHS) trusts. To investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context.Data were collected at two English hospital NHS trusts over two (...) time-periods: June 2016 and February 2017.Cohort study. Trust 1 data were sourced from prospective point prevalence surveys. Trust 2 data were extracted retrospectively from an electronic report.Inpatients treated for urinary tract infection (UTI), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and skin and soft tissue infection (SSTI). Data on allergy were collected, and antibiotic selection assessed for adherence to trust guidelines with differences between groups presented

2019 BMJ open

196. Opioid Prescribing and Use in Ambulatory Otolaryngology. (Abstract)

of opioids consumed postoperatively, patient-reported pain control, and methods of opioid disposal. We compared patient-reported opioid consumption to opioids prescribed based on data in the electronic data warehouse.There was wide variation in prescribing between providers both in the quantity and type of opioids prescribed. Patients used significantly less opioids than they were prescribed (10 vs. 30 tablets, P < 0.001) for both opioid-exposed and opioid-naïve patients. More than 75% of patients had (...) Opioid Prescribing and Use in Ambulatory Otolaryngology. The objective of this study was to evaluate surgeon-prescribing patterns and opioid use for patients undergoing common otolaryngology surgeries. We hypothesized that there was little consistency across surgeons in prescribing patterns and that surgeons prescribed significantly more opioids than consumed by patients.E-mail-based surveys were sent to all postoperative patients across a 23-hospital system. The survey assessed quantity

2019 Laryngoscope

197. NHMRC CEO Statement: Electronic cigarettes (e-cigarettes)

NHMRC CEO Statement: Electronic cigarettes (e-cigarettes) CEO Statement: Electronic cigarettes | NHMRC NHMRC Tagline NHMRC Tagline Publication date Publication date Content type Filtered by: All Publications News Page Search Quick links Toggle navigation Main navigation Funding One researcher has the potential to improve millions of lives. We provide funding for research through our grant system, with a transparent peer-review process to determine how funding is allocated. May 07 2018 May 07 (...) researchers and help them protect intellectual property. Jun 14 2018 Jul 25 2018 About us At NHMRC we are excited by the huge potential benefits of the research we fund and by the opportunities we have to ensure Australians have access to evidence-based, authoritative health advice. We create pathways to a healthier future through our research funding, our health guidelines and the ethical standards we set and uphold. Jul 25 2018 Jul 25 2018 CEO Statement: Electronic cigarettes CEO Statement: Electronic

2015 National Health and Medical Research Council

198. Electronic Health Record-based Interventions for Reducing Inappropriate Imaging in the Clinical Setting

Electronic Health Record-based Interventions for Reducing Inappropriate Imaging in the Clinical Setting Electronic Health Record-based Interventions for Reducing Inappropriate Imaging in the Clinical Setting: A Systematic Review of the Evidence January 2015 Prepared for: Department of Veterans Affairs Veterans Health Administration Quality Enhancement Research Initiative Health Services Research & Development Service Washington, DC 20420 Prepared by: Evidence-based Synthesis Program (ESP (...) , coordinates dissemination activities, and develops collaborations with VA leadership to identify new ESP topics of importance to Veterans and the VA healthcare system. Comments on this evidence report are welcome and can be sent to Nicole Floyd, ESP Coordinating Center Program Manager, at Nicole.Floyd@va.gov. Recommended citation: Goldzweig C L, Orshansky G, Paige N M, Ewing B A, Miake-Lye I M, Beroes J M, Shekelle P G. Electronic Health Record-Based Interventions for Reducing Inappropriate Imaging

2015 Veterans Affairs Evidence-based Synthesis Program Reports

199. Electron streams in air during magnetic-resonance image-guided radiation therapy. Full Text available with Trip Pro

phantom, was irradiated with field sizes of 6.3 cm × 6.3 cm (FS6.3) and 12.6 cm × 12.6 cm (FS12.6) at gantry angles of 0°, 30°, and 330°, and phantom-angles of 10°, 20°, and 30°. For each beam delivery, the isocenter was located at the center of mass of the phantom and 3 Gy was delivered to the isocenter (prescription dose = 3 Gy). The doses given by the air-electron-streams were measured using the EBT3 films on the panels placed orthogonal to the direction of the magnetic field at distances of 10 (...) Electron streams in air during magnetic-resonance image-guided radiation therapy. To investigate the undesired irradiations outside of the treatment field by electron streams in air (air-electron-stream) during magnetic-resonance image-guided radiation therapy (MR-IGRT). A custom-made support phantom adjusting angles between the beam central axis (CAX) and the phantom surface (termed phantom-angles), were used. Using the ViewRay system, a rectangular parallelepiped phantom placed on the support

2019 PLoS ONE

200. Effect of Electronic Health Record-Based Medication Support and Nurse-Led Medication Therapy Management on Hypertension and Medication Self-management: A Randomized Clinical Trial Full Text available with Trip Pro

Effect of Electronic Health Record-Based Medication Support and Nurse-Led Medication Therapy Management on Hypertension and Medication Self-management: A Randomized Clinical Trial Complex medication regimens pose self-management challenges, particularly among populations with low levels of health literacy.To test medication management tools delivered through a commercial electronic health record (EHR) with and without a nurse-led education intervention.This 3-group cluster randomized clinical (...) trial was performed in community health centers in Chicago, Illinois. Participants included 794 patients with hypertension who self-reported using 3 or more medications concurrently (for any purpose). Data were collected from April 30, 2012, through February 29, 2016, and analyzed by intention to treat.Clinics were randomly assigned to to groups: electronic health record-based medication management tools (medication review sheets at visit check-in, lay medication information sheets printed after

2018 EvidenceUpdates

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