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Electronic Prescription

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201. Clinical features in primary care electronic records before diagnosis of ankylosing spondylitis: a nested case-control study. Full Text available with Trip Pro

Clinical features in primary care electronic records before diagnosis of ankylosing spondylitis: a nested case-control study. Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records over time prior to a diagnosis of AS.Nested case-control study using anonymised primary care electronic health records from Scotland. Cases were 74 adults (...) with a first diagnosis of AS between 2000 and 2010. Controls were matched for age, sex and GP practice: (a) 296 randomly selected adults (b) 169 adults whose records contained codes indicating spinal conditions or symptoms. We extracted clinical features (symptoms, AS-related disorders, prescriptions and diagnostic tests). Conditional logistic regression was used to examine the association between clinical features (both individually and in combinations) and diagnosis of AS. We examined the associations

2020 BMC Family Practice

202. Lifetime risk assessment in cholesterol management among hypertensive patients: observational cross-sectional study based on electronic health record data. Full Text available with Trip Pro

Lifetime risk assessment in cholesterol management among hypertensive patients: observational cross-sectional study based on electronic health record data. In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive (...) patients to find the most potential age and sex subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control.In this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting.More

2020 BMC Family Practice

203. Effectiveness and safety of electroacupuncture and its cotreatment with electronic moxibustion in the treatment of patients with moderate benign prostatic hyperplasia using alpha blocker: Study protocol for an assessor-blinded, randomized controlled clini Full Text available with Trip Pro

Effectiveness and safety of electroacupuncture and its cotreatment with electronic moxibustion in the treatment of patients with moderate benign prostatic hyperplasia using alpha blocker: Study protocol for an assessor-blinded, randomized controlled clini Benign prostatic hyperplasia (BPH) is a medical condition that affects the quality of life by causing lower urinary tract symptoms (LUTS) in 40% to 70% of men aged ≥60 years. Medication treatment is primarily recommended for patients with BPH (...) if their symptom score based on the International Prostate Symptom score (IPSS) is above the moderate level. However, electroacupuncture (EA) and electronic moxibustion (EM), one of the most recent complementary and alternative treatments, are suggested as adjuvant treatments in the improvement of LUTS caused by BPH with respect to the limitations of medication treatments, such as side effects or no improvement in LUTS despite treatment. Therefore, this study aimed to evaluate the effectiveness and safety

2020 Medicine

204. Medical student experiences with accessing and entering patient information in electronic health records during the obstetrics-gynecology clerkship. (Abstract)

Medical student experiences with accessing and entering patient information in electronic health records during the obstetrics-gynecology clerkship. Medical school graduates should be able to enter information from patient encounters and to write orders and prescriptions in the electronic health record. Studies have shown that, although students often can access electronic health records, some students may receive inadequate preparation for these skills. Greater understanding of student (...) exposure to electronic health records during their obstetrics and gynecology clerkships can help to determine the extent to which students receive the educational experiences that may best prepare them for their future training and practice.The purpose of this study was to examine medical student reporting of electronic health record use during the obstetrics and gynecology clerkship.A Step 2 Clinical Knowledge End-of-Examination Survey about electronic health record use was administered to medical

2020 American Journal of Obstetrics and Gynecology

205. Incidence, risk factors, and health service burden of sequelae of campylobacter and non-typhoidal salmonella infections in England, 2000-2015: A retrospective cohort study using linked electronic health records. Full Text available with Trip Pro

Incidence, risk factors, and health service burden of sequelae of campylobacter and non-typhoidal salmonella infections in England, 2000-2015: A retrospective cohort study using linked electronic health records. Reactive arthritis, irritable bowel syndrome (IBS), Guillain-Barré syndrome, ulcerative colitis, and Crohn's disease may be sequelae of Campylobacter or non-typhoidal Salmonella (NTS) infections. Proton pump inhibitors (PPI) and antibiotics may increase the risk of gastrointestinal (...) infections (GII); however, their impact on sequelae onset is unclear. We investigated the incidence of sequelae, their association with antibiotics and PPI prescription, and assessed the economic impact on the NHS.Data from the Clinical Practice Research Datalink for patients consulting their GP for Campylobacter or NTS infection, during 2000-2015, were linked to hospital, mortality, and Index of Multiple Deprivation data. We estimated the incidence of sequelae and deaths in the 12 months following GII

2020 Journal of Infection

206. Feasibility of an Electronic Health Tool to Promote Physical Activity in Primary Care: Pilot Cluster Randomized Controlled Trial. Full Text available with Trip Pro

Feasibility of an Electronic Health Tool to Promote Physical Activity in Primary Care: Pilot Cluster Randomized Controlled Trial. Physical inactivity is associated with increased health risks. Primary care providers (PCPs) are well positioned to support increased physical activity (PA) levels through screening and provision of PA prescriptions. However, PCP counseling on PA is not common.This study aimed to assess the feasibility of implementing an electronic health (eHealth) tool to support PA (...) to automatically produce tailored resources and a PA prescription in the electronic medical record of participants in the intervention arm. Participants assigned to the control arm received usual care from their PCP. Feasibility was assessed by the proportion of completed surveys and patient-reported acceptability and fidelity measures. The primary effectiveness outcome was patient-reported PA at 4 months post-PHR, measured as metabolic equivalent of task (MET) minutes per week. Secondary outcomes assessed

2020 Journal of medical Internet research

207. Should Neuraminidase Inhibitors Be Prescribed To Patients With Influenza?

Should Neuraminidase Inhibitors Be Prescribed To Patients With Influenza? Systematic Review Snapshot TAKE-HOME MESSAGE Patientswhoreceivedneuraminidaseinhibitorsforacutein?uenzawithin48hours of symptom onset began to have symptom resolution approximately 1 day sooner compared with those who received placebo. Should Neuraminidase Inhibitors Be Prescribed for Patients With In?uenza? EBEM Commentators Deepa M. Patel, MD Stephen R. Pitts, MD, MPH Department of Emergency Medicine Emory University (...) ) *Oseltamivir 138.7 hours (5.8 days) vs placebo 160 hours (6.7 days). Table 2. Effect of oseltamivir on hospitalization events compared with placebo. Odds Ratio 95% Con?dence Interval Number of Studies (No. of Patients) Hospitalization events 0.95 0.57–1.61 7 (4,696) METHODS DATA SOURCES A list of clinical trials was compiled with the following: previous reviews, electronic databases (CENTRAL, MEDLINE, EMBASE, DatabaseofAbstractsofReviewsof Effects, NHS Economic Evaluation Database), Food and Drug

2013 Annals of Emergency Medicine Systematic Review Snapshots

208. Development of a Web-Based Clinical Decision Support System for Drug Prescription: Non-Interventional Naturalistic Description of the Antipsychotic Prescription Patterns in 4345 Outpatients and Future Applications. Full Text available with Trip Pro

Development of a Web-Based Clinical Decision Support System for Drug Prescription: Non-Interventional Naturalistic Description of the Antipsychotic Prescription Patterns in 4345 Outpatients and Future Applications. The emergence of electronic prescribing devices with clinical decision support systems (CDSS) is able to significantly improve management pharmacological treatments. We developed a web application available on smartphones in order to help clinicians monitor prescription and further (...) propose CDSS.A web application (www.MEmind.net) was developed to assess patients and collect data regarding gender, age, diagnosis and treatment. We analyzed antipsychotic prescriptions in 4345 patients attended in five Psychiatric Community Mental Health Centers from June 2014 to October 2014. The web-application reported average daily dose prescribed for antipsychotics, prescribed daily dose (PDD), and the PDD to defined daily dose (DDD) ratio.The MEmind web-application reported that antipsychotics

2016 PLoS ONE

209. Pharmacist-to-prescriber intervention to close therapeutic gaps for statin use in patients with diabetes: A randomized controlled trial. (Abstract)

a statin medication.This new measure has been implemented within the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) dashboard.In this randomized controlled study, eligible patients identified in EQuIPP are those who received medications from a large chain community pharmacy in North Carolina, are 40-75 years, had ≥2 prescription fills of a diabetes medication, and were not receiving statin therapy.The control group received no intervention. Primary care prescribers (...) of patients in the intervention group were contacted by phone and fax to obtain a prescription for an appropriate statin.The primary outcome was the proportion of patients in each group who were dispensed a statin, calculated using Fisher exact test. Sub-analyses were performed to control for patient age, sex, and insurance type.The number of statins prescribed was statistically significant between intervention group (n = 221) versus control group (n = 199) with 46 statins versus 17 statins, respectively

2018 Journal of the American Pharmacists Association : JAPhA Controlled trial quality: uncertain

210. Improving the Affordability of Prescription Medications for People with Chronic Respiratory Disease. An Official American Thoracic Society Policy Statement. Full Text available with Trip Pro

Improving the Affordability of Prescription Medications for People with Chronic Respiratory Disease. An Official American Thoracic Society Policy Statement. Mounting evidence indicates that out-of-pocket costs for prescription medications, particularly among low- and middle-income patients with chronic diseases, are imposing financial burden, reducing medication adherence, and worsening health outcomes. This problem is exacerbated by a paucity of generic alternatives for prevalent lung diseases (...) , such as asthma and chronic obstructive pulmonary disease, as well as high-cost medicines for rare diseases, such as cystic fibrosis. Affordability and access challenges are especially salient in the United States, as citizens of many other countries pay lower prices for and have greater access to prescription medications.The American Thoracic Society convened a multidisciplinary committee comprising experts in health policy pharmacoeconomics, behavioral sciences, and clinical care, along with individuals

2018 American Journal of Respiratory and Critical Care Medicine

211. Re: 'Determinants of in-hospital antibiotic prescription behaviour' by Lambregts et al. (Abstract)

Re: 'Determinants of in-hospital antibiotic prescription behaviour' by Lambregts et al. 30594653 2019 02 04 1469-0691 2018 Dec 28 Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases Clin. Microbiol. Infect. Cognitive biases in the decision-making process of antibiotic prescribing. S1198-743X(18)30798-5 10.1016/j.cmi.2018.12.010 Peiffer-Smadja N N Hopital Bichat Claude Bernard, Infectious Diseases Department (...) , Paris, France; INSERM, Infection Antimicrobials Modelling Evolution, Paris, France. Electronic address: nathan.psmadja@gmail.com. Lescure F X FX Hopital Bichat Claude Bernard, Infectious Diseases Department, Paris, France; INSERM, Infection Antimicrobials Modelling Evolution, Paris, France. Maatoug R R Hopital Universitaire Pitie Salpetriere, Department of Psychiatry, Paris, France. Rohaut B B Institut du Cerveau et de la Moelle epiniere, PICNIC Lab, Paris, France; Columbia University Department

2018 Clinical Microbiology and Infection

212. Application of Economics & Social Psychology to Improve Opioid Prescribing Safety (AESOPS): R21 Pilot Phase

and an abundance of evidence of harm. The objective of the R21 pilot phase of the Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS) is to develop and test novel behavioral nudges to encourage adherence to pain and CDC guidelines for opioid prescribing for persons with noncancer pain. Interventions will leverage the electronic health record (EHR): Accountable Justification alerts triggered by discordant prescriptions that populate the note with provider's rationale (...) Psychology to Improve Opioid Prescribing Safety (AESOPS): R21 Pilot Phase Estimated Study Start Date : February 2019 Estimated Primary Completion Date : June 2019 Estimated Study Completion Date : August 2019 Arms and Interventions Go to Arm Intervention/treatment Experimental: Clinical Decision Support/Audit & Feedback Clinical decision support nudges (Accountable Justification and Active Choice (SmartSet)) within the electronic health record and Audit and Feedback on performance. Participating

2018 Clinical Trials

213. User-centered design and usability testing of RxMAGIC: a prescription management and general inventory control system for free clinic dispensaries. Full Text available with Trip Pro

was a requirement for deployment. We utilized health data standards to communicate with the existing order entry system; an outgoing electronic prescribing framework was leveraged to send prescription data to RxMAGIC. The results of the usability study were positive, with all tested features receiving a mean score of four or five (i.e. somewhat easy or easy, respectively) on a five-point Likert scale assessing ease of completion, thus demonstrating the system's simplicity and high learnability. RxMAGIC (...) User-centered design and usability testing of RxMAGIC: a prescription management and general inventory control system for free clinic dispensaries. To address challenges related to medication management in underserved settings, we developed a system for Prescription Management And General Inventory Control, or RxMAGIC, in collaboration with the Birmingham Free Clinic in Pittsburgh, Pennsylvania. RxMAGIC is an interoperable, web-based medication management system designed to standardize

2018 BMC health services research

214. Variability in Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty. (Abstract)

Variability in Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty. To evaluate variation in antibiotic prescribing between pediatric and nonpediatric providers for common upper respiratory illnesses.Patient encounters for children aged <18 years from a regional health care system were identified. Electronic medical records from 2011 to 2016 were extracted for diagnoses of upper respiratory infection, pharyngitis, acute otitis media, and sinusitis. Encounters (...) with competing medical diagnoses, recent hospitalization, and antibiotic prescriptions within 30 days were excluded. Adherence to antibiotic guidelines was assessed by provider training (pediatric, nonpediatric physicians, and advance practice providers). Additional factors assessed were calendar year, and patient's age, sex, insurance status, and number of sick visits in the prior year.Across 6 years, 141 361 visits were examined: 43 914 for upper respiratory infection, 43 701 for pharyngitis, 43 925

2018 Journal of Pediatrics

215. Too much of a bad thing: Discharge opioid prescriptions in pediatric appendectomy patients. (Abstract)

found in the electronic medical record (EMR) or through a statewide prescription monitoring database. All dosing data were converted to oral morphine equivalents (OMEs). Analysis of variance and logistic regression were used.During the study, 590 patients underwent appendectomy, of which 371 (62.9%) were diagnosed as having simple acute appendicitis. The majority of patients were prescribed an opioid analgesic (62.5%). Demographics were similar between those who received opioids and those who did (...) not. The OME prescribed per day (range 0.2 to 3.4 mg/kg/day) was highly variable as was duration of prescription (1 to 30 days). Odds of emergency department visit were 3.3 times higher (95% CI 1.3-8.2) in those who received opioids.Postdischarge prescription practices for pediatric appendectomy are highly variable. Two-thirds of patients who received narcotics had a higher rate of complications. Greater scrutiny is required to optimize opioid stewardship.Retrospective comparative study.Level III.Copyright

2018 Journal of Pediatric Surgery

216. Does shared decision-making reduce antibiotic prescribing in primary care? Full Text available with Trip Pro

Does shared decision-making reduce antibiotic prescribing in primary care? Increasing antibiotic resistance is recognized as a major threat to global health and is related to antibiotic prescription rates in primary care. Shared decision-making (SDM), the process in which patients and doctors participate together in making decisions, is argued to possibly promote more appropriate use of antibiotics and reduce prescribing. However, it is unknown whether in practice fewer antibiotics (...) are prescribed where more SDM takes place.To investigate whether more SDM is related to less antibiotic prescribing and whether this relationship differs between subgroups of patients (male/female and age groups).A questionnaire survey was conducted among 2670 members of the Dutch Health Care Consumer Panel to measure SDM (response rate 45%). Average practice-level SDM scores were calculated for 15 general practices. Data from routine electronic health records of 8192 adult patients of these general

2018 Journal of Antimicrobial Chemotherapy

217. Use of a Behavioral Economic Intervention to Reduce Antibiotic Prescription for Upper Respiratory Infections

antibiotics for URIs. Using a quasi-experiment (pre-post) design, antibiotic prescriptions for URI at LAC+USC Urgent Care Center (intervention site) vs. Olive View-UCLA Urgent Care Center (control site) will used to test the effects of behavioral "nudge" on antibiotic prescribing. Condition or disease Intervention/treatment Phase Antibiotics Upper Respiratory Infections Safety-Net Hospitals Behavioral Economics Choosing Wisely Behavioral: Nudge using Behavioral Economic Interventions Behavioral: Standard (...) to avoid prescribing low-value antibiotics for uncomplicated URIs, which will be displayed in the clinic. In contrast, the control site (Urgent Care Center at Olive View-Medical Center) will receive Centers for Disease Control prescription pads for non-antibiotic treatments (e.g., decongestants) that offer patients alternatives to antibiotics, in a broader health system effort to reduce antibiotic prescribing. Patient with URIs (e.g., acute bronchitis, bronchitis NOS, excluding guideline-based red

2018 Clinical Trials

218. Patient and physician predictors of hyperlipidemia screening and statin prescription. (Abstract)

Health System.Data on patients, screening orders, and prescriptions were obtained from the electronic health record. Multivariate logistic regression models were fit to binary outcomes of lipid screening and statin prescription.Among 97,189 eligible patients, 79.9% had an order for hyperlipidemia screening. In adjusted models, significant patient predictors of greater odds of having screening ordered included a history of diabetes (odds ratio [OR], 1.19; 95% CI, 1.10-1.29; P <.001) or hypertension (...) Patient and physician predictors of hyperlipidemia screening and statin prescription. Appropriate lipid management has been demonstrated to reduce cardiovascular events, but rates of hyperlipidemia screening and statin therapy are suboptimal. We aimed to evaluate patient and physician predictors of guideline-concordant hyperlipidemia screening and statin prescription.Retrospective study of patients with primary care provider (PCP) visits from 2014 to 2016 at the University of Pennsylvania

2018 American Journal Of Managed Care

219. Assessment of discharge treatment prescribed to women admitted to hospital for hyperemesis gravidarum. Full Text available with Trip Pro

prescribed in English hospitals.A retrospective pregnancy cohort was constructed using anonymised electronic records in the Nottingham University Hospitals Trust system for all women who delivered between January 2010 and February 2015. For women admitted to hospital for HG, medications prescribed on discharge were described and variation by maternal characteristics was assessed. Compliance with local and national HG treatment guidelines was evaluated.Of 33 567 pregnancies (among 30 439 women (...) Assessment of discharge treatment prescribed to women admitted to hospital for hyperemesis gravidarum. Prescribing drug treatment for the management of hyperemesis gravidarum (HG), the most severe form of nausea and vomiting in pregnancy, remains controversial. Since most manufacturers do not recommend prescribing antiemetics during pregnancy, little is known regarding which treatments are most prevalent among pregnant patients. Here, we report for the first time, evidence of actual treatments

2018 International journal of clinical practice

220. Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review Full Text available with Trip Pro

. With the increasing uptake of electronic medical records (EMRs) across hospitals, clinics and residential aged care facilities (RACFs), integrated with computerized physician order entry (CPOE) and e-prescribing, opportunities exist for incorporating clinical decision support systems (CDSS) into EMR at the point of care. This narrative review assessed the process and outcomes of using EMR-enabled CDSS to reduce the prescribing of PIMs. We searched PubMed for relevant articles published up to January 2018 (...) Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review Prescribing of potentially inappropriate medications (PIMs) that pose more risk than benefit in older patients is a common occurrence across all healthcare settings. Reducing such prescribing has been challenging despite multiple interventions, including educational campaigns, audits and feedback, geriatrician assessment and formulary restrictions

2018 Therapeutic advances in drug safety

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