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Electronic Prescription

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221. Patterns of Antibiotic Prescription in Children: Tirana, Albania Region Full Text available with Trip Pro

Patterns of Antibiotic Prescription in Children: Tirana, Albania Region Antibiotics (abx) constitute the most prescribed therapeutic agent in the world. There is little data regarding antibiotic consumption by young children in Albania.This study aims to evaluate antibiotic prescription in children in quantitative and qualitative terms, and therefore, propose recommendations to improve overall clinical outcomes.A retrospective, cross-sectional drug utilisation study was conducted based (...) on unreimbursed prescriptions collected in 25 pharmacies, randomly selected within the district of Tirana, during the period beginning December 2015 to January 2016. They contain at least one antibacterial therapeutic agent prescribed for children 0-15 years old, for systemic use. The data were analysed using SPSS 20.A group of 904 prescriptions meet inclusion criteria, 54.1% patient were female, and 45.9% were male. The most exposed age group were 2-6 years old. The most common diagnosis was respiratory

2018 Open access Macedonian journal of medical sciences

222. Derivation and validation of a multivariable model to predict when primary care physicians prescribe antidepressants for indications other than depression Full Text available with Trip Pro

depression. Thus, the aim of this study was to derive a model to predict when primary care physicians prescribe antidepressants for indications other than depression and to identify important determinants of this prescribing practice.Prediction study using antidepressant prescriptions from January 2003-December 2012 in an indication-based electronic prescribing system in Quebec, Canada. Patients were linked to demographic files, medical billings data, and hospital discharge summary data to create over (...) Derivation and validation of a multivariable model to predict when primary care physicians prescribe antidepressants for indications other than depression Physicians commonly prescribe antidepressants for indications other than depression that are not evidence-based and need further evaluation. However, lack of routinely documented treatment indications for medications in administrative and medical databases creates a major barrier to evaluating antidepressant use for indications besides

2018 Clinical epidemiology

223. Physical Activity on Prescription with Counsellor Support: A 4-Year Registry-Based Study in Routine Health Care in Sweden Full Text available with Trip Pro

population as well as between PAP recipients who used and did not use counsellor support. We also investigated professional belonging and health care setting of health care professionals who prescribed PAP. Methods: All patients’ ≥18 years who received PAP during 2009–2012 in primary and secondary care in the County Council of Kronoberg were included (n = 4879). Data were retrieved from electronic medical records. Main outcome measures were patient and professional characteristics. Results (...) Physical Activity on Prescription with Counsellor Support: A 4-Year Registry-Based Study in Routine Health Care in Sweden Background: Public health gains from physical activity on prescription (PAP) depend on uptake in routine care. We performed an evaluation of the implementation, in a Swedish county council, of counsellors who give personalized support to PAP recipients aimed at facilitating PAP delivery. The aim was to compare characteristics between PAP recipients and the health care

2018 Healthcare

224. Predicting the need for a reduced drug dose, at first prescription Full Text available with Trip Pro

Predicting the need for a reduced drug dose, at first prescription Prescribing the right drug with the right dose is a central tenet of precision medicine. We examined the use of patients' prior Electronic Health Records to predict a reduction in drug dosage. We focus on drugs that interact with the P450 enzyme family, because their dosage is known to be sensitive and variable. We extracted diagnostic codes, conditions reported in clinical notes, and laboratory orders from Stanford's clinical (...) data warehouse to construct cohorts of patients that either did or did not need a dose change. After feature selection, we trained models to predict the patients who will (or will not) require a dose change after being prescribed one of 34 drugs across 23 drug classes. Overall, we can predict (AUC ≥ 0.70-0.95) a dose reduction for 23 drugs and 22 drug classes. Several of these drugs are associated with clinical guidelines that recommend dose reduction exclusively in the case of adverse reaction

2018 Scientific reports

225. Primary care cohort study in the sequence of diagnosing chronic respiratory diseases and prescribing inhaled corticosteroids Full Text available with Trip Pro

Primary care cohort study in the sequence of diagnosing chronic respiratory diseases and prescribing inhaled corticosteroids To prevent unnecessary use of inhaled corticosteroids (ICS), ICS treatment should only be started when the diagnostic process of asthma and COPD is completed. Little is known about the chronological order between these diagnoses and the start of ICS. We performed a retrospective cohort study, based on electronic medical records of 178 Dutch general practices, to explore (...) the temporal relations between starting continuous use of ICS and receiving a diagnosis of asthma and/or COPD. The database included information of patients who were registered with a diagnosis of asthma and/or COPD in one of the practices during January 1, 2012 and December 31, 2013. Two or more successive prescriptions of ICS within 6 months were considered as continuous ICS treatment. The chronological order of events based on available dates were analysed using descriptive analyses. For 8507 patients

2018 NPJ primary care respiratory medicine

226. Building interpretable models for polypharmacy prediction in older chronic patients based on drug prescription records Full Text available with Trip Pro

from drug prescription records for newly diagnosed chronic patients. We evaluate the models' performance with a strong focus on interpretability of the results.A centrally collected nationwide dataset of prescription records was used to perform electronic phenotyping of patients for the following two chronic conditions: type 2 diabetes mellitus (T2D) and cardiovascular disease (CVD). In addition, a hospital discharge dataset was linked to the prescription records. A regularized regression model (...) Building interpretable models for polypharmacy prediction in older chronic patients based on drug prescription records Multimorbidity presents an increasingly common problem in older population, and is tightly related to polypharmacy, i.e., concurrent use of multiple medications by one individual. Detecting polypharmacy from drug prescription records is not only related to multimorbidity, but can also point at incorrect use of medicines. In this work, we build models for predicting polypharmacy

2018 PeerJ

227. Prescribing Empiric Antibiotics for Febrile Neutropenia: Compliance with Institutional Febrile Neutropenia Guidelines Full Text available with Trip Pro

Prescribing Empiric Antibiotics for Febrile Neutropenia: Compliance with Institutional Febrile Neutropenia Guidelines Background: Febrile neutropenia (FN) is an oncologic emergency which should be treated immediately with empiric antibiotics. Different institutions observe different antibiograms and use different FN management guidelines. Our center implemented FN management guidelines for adult cancer patients in 2009. Hence, we decided to assess compliance with FN management guidelines (...) and to describe the pattern of bacterial infections. Method: We conducted a cross-sectional study on all adult cancer patients admitted with FN. Data were collected from electronic medical records between January and December 2014. Results: One hundred FN episodes met the study inclusion criteria. The mean age of the patients was 41 ± 17 years; 52% (52 patients) were women. The most common diagnosis was lymphoma (33%). In terms of compliance to institutional FN guidelines, 55% of patients received guideline

2018 Pharmacy: Journal of Pharmacy Education and Practice

228. Factors associated with physicians’ prescriptions for rheumatoid arthritis drugs not filled by patients Full Text available with Trip Pro

Factors associated with physicians’ prescriptions for rheumatoid arthritis drugs not filled by patients This study estimated the extent and predictors of primary nonadherence (i.e., prescriptions made by physicians but not initiated by patients) to methotrexate and to biologics or tofacitinib in rheumatoid arthritis (RA) patients who were newly prescribed these medications.Using administrative claims linked with electronic health records (EHRs) from multiple healthcare provider organizations (...) in the USA, RA patients who received a new prescription for methotrexate or biologics/tofacitinib were identified from EHRs. Claims data were used to ascertain filling or administration status. A logistic regression model for predicting primary nonadherence was developed and tested in training and test samples. Predictors were selected based on clinical judgment and LASSO logistic regression.A total of 36.8% of patients newly prescribed methotrexate failed to initiate methotrexate within 2 months; 40.6

2018 Arthritis research & therapy

229. Evaluation of Physician Prescribing Patterns For Antibiotics in the Treatment of Nonnecrotizing Skin and Soft Tissue Infections Full Text available with Trip Pro

Evaluation of Physician Prescribing Patterns For Antibiotics in the Treatment of Nonnecrotizing Skin and Soft Tissue Infections Skin and soft tissue infections (SSTIs) cause about 15 million cases of infection that result in more than 869,000 annual hospitalizations in the United States. Cellulitis accounted for 63% of all patients hospitalized with SSTIs between 2009 and 2011. The primary objective of this study was to evaluate physician adherence rates to evidence-based practice guidelines (...) . Secondary objectives included evaluating antibiotic selection preferences and duration of therapy. The goal of the project was to generate data to inform the development of a hospital-based protocol for nonnecrotizing SSTI treatment.This study was a single-center, retrospective, electronic chart review of patients admitted to the hospital for nonnecrotizing SSTI. We reviewed charts of patients who were admitted with a diagnosis of cellulitis and abscess infection from August 2014 to August 2015

2018 Pharmacy and Therapeutics

230. Antibiotic prescription for the prevention and treatment of postoperative complications after routine dental implant placement. A cross-sectional study performed in Spain Full Text available with Trip Pro

Antibiotic prescription for the prevention and treatment of postoperative complications after routine dental implant placement. A cross-sectional study performed in Spain As there are no established guidelines for antibiotic prescription after dental implant placement a study was made to determine the current prescribing habits of several groups of practitioners regarding antibiotics to prevent and/or treat postoperative complications - early failures and infections - in relation to routine (...) dental implant placement.An electronic survey was sent to postgraduate students and professionals with experience in routine dental implant placement who practice in Spain. The questions asked were related to whether antibiotics were routinely prescribed either pre- or postoperatively to prevent and/or treat postoperative complications during routine dental implant placement, and, if so, what antibiotics, dosage, frequency, and duration were used. Descriptive and bivariate analyses of the data were

2018 Journal of clinical and experimental dentistry

231. Infectious disease burden and antibiotic prescribing in primary care in Israel Full Text available with Trip Pro

at the individual patient level were extracted for 2015 from Clalit Health Services' electronic medical records and linked to determine the condition for which the antimicrobial was prescribed.There were 6.6 million visits due to infections, representing 22% of all primary care visits. The most common events were upper respiratory tract infections (38%) and pharyngitis (10%). Highest prescription rates were for urinary tract infections (80%), otitis media (64%), pharyngitis (71%), sinusitis (63%), and lower (...) Infectious disease burden and antibiotic prescribing in primary care in Israel Antibiotics are frequently prescribed at many of the visits to primary care clinics, often for conditions for which they provide no benefit, including viral respiratory tract infections.The aim was to evaluate primary care visits due to infectious diseases, and to estimate antibiotic prescribing and antibiotic dispensing by pharmacies.Diagnosis of infectious disease, antibiotic prescribing and dispensing data

2018 Annals of Clinical Microbiology and Antimicrobials

232. A Prescription for Note Bloat: An Effective Progress Note Template. Full Text available with Trip Pro

A Prescription for Note Bloat: An Effective Progress Note Template. United States hospitals have widely adopted electronic health records (EHRs). Despite the potential for EHRs to increase efficiency, there is concern that documentation quality has suffered.To examine the impact of an educational session bundled with a progress note template on note quality, length, and timeliness.A multicenter, nonrandomized prospective trial.Four academic hospitals across the United States.Intern physicians

2018 Journal of Hospital Medicine

233. What is in your wallet? A cluster randomized trial of the effects of showing comparative patient out-of-pocket costs on primary care prescribing for uncomplicated hypertension. Full Text available with Trip Pro

, and their patients with uncomplicated hypertension who were using the MOXXI integrated electronic health record for drug and health problem management. Physicians were randomized to an out-of-pocket expenditure module that provided alerts for comparative out-of-payment costs, thiazide diuretics as recommended first-line therapy, and tools to monitor blood pressure targets and medication compliance, or alternatively the basic MOXXI system. System software and prescription claims were used to analyze the impact (...) What is in your wallet? A cluster randomized trial of the effects of showing comparative patient out-of-pocket costs on primary care prescribing for uncomplicated hypertension. Drug expenditures are responsible for an increasing proportion of health costs, accounting for $1.1 trillion in annual expenditure worldwide. As hundreds of billions of dollars are being spent each year on overtreatment with prescribed medications that are either unnecessary or are in excess of lowest cost-effective

2018 Implementation Science Controlled trial quality: uncertain

234. Prescribing Patterns of Proprotein Convertase Subtilisin-Kexin Type 9 Inhibitors in Eligible Patients With Clinical Atherosclerotic Cardiovascular Disease or Heterozygous Familial Hypercholesterolemia. Full Text available with Trip Pro

to determine differences between eligible patients who were prescribed and those who were not prescribed a PCSK9 inhibitor. Patients from an electronic medical record database were included in the analysis, and their demographic, clinical, and treatment characteristics were evaluated. Of 368,624 PCSK9 inhibitor-eligible patients, 1,752 (<0.5%) received a PCSK9 inhibitor prescription. Patients who received a PCSK9 inhibitor were more frequently associated with a higher cardiovascular disease risk category (...) Prescribing Patterns of Proprotein Convertase Subtilisin-Kexin Type 9 Inhibitors in Eligible Patients With Clinical Atherosclerotic Cardiovascular Disease or Heterozygous Familial Hypercholesterolemia. Two proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are approved for patients with atherosclerotic cardiovascular disease or heterozygous familial hypercholesterolemia who require additional low-density lipoprotein cholesterol (LDL-C) lowering. This retrospective study sought

2018 American Journal of Cardiology

235. Time to Filling of New Prescriptions for Chronic Disease Medications Among a Cohort of Elderly Patients in the USA. Full Text available with Trip Pro

Time to Filling of New Prescriptions for Chronic Disease Medications Among a Cohort of Elderly Patients in the USA. Data on primary nonadherence remains sparse, due to a lack of data resources that combine information on medication prescribing and dispensing. In addition, previous work on primary nonadherence has used follow-up periods ranging from 30 days up to 18 months, making results difficult to compare.To evaluate the prevalence and predictors of primary nonadherence by measuring time (...) until filling in a cohort of elderly patients.Retrospective cohort study of new prescription episodes.Data comes from a linked database of electronic health records and claims for patients aged ≥ 65 years enrolled in Medicare Parts A, B, and D during 2007-2014. We identified patients receiving a new prescription for a chronic disease medication with continuous Medicare enrollment for 180 days prior to the index prescription order and no fills or orders for the medication during this period.Time

2018 Journal of General Internal Medicine

236. Changing use of antidiabetic drugs in the UK: trends in prescribing 2000-2017. Full Text available with Trip Pro

study.UK electronic primary care health records from the Clinical Practice Research Datalink.Adults initiating treatment with a drug for T2DM between January 2000 and July 2017.The primary outcomes were the proportion of each class of T2DM drug prescribed for initiation and first-stage intensification in each year. We also examined drug prescribing by kidney function and country within the UK.Of 280 241 people initiating treatment with T2DM drugs from 2000 to 2017, 73% (204 238/280 241) initiated (...) intensification (87%, 534/615) but by 2017 this fell to 30% (355/1183) as the use of newer drug classes increased. In 2017, new prescriptions for dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium/glucose cotransporter-2 inhibitors (SGLT2i) accounted for 42% (502/1183) and 22% (256/1183) of intensification drugs, respectively. Uptake of new classes differs by country with DPP4is and SGLT2is prescribed more in Northern Ireland and Wales than England or Scotland.Our findings show markedly changing prescribing

2018 BMJ open

237. The impact of risk minimization measures on compliance and prescribing practices of flupirtine in Germany. (Abstract)

The impact of risk minimization measures on compliance and prescribing practices of flupirtine in Germany. In response to safety concerns, risk minimization measures (RMM) for flupirtine were implemented in Europe in 2013 to reduce hepatotoxicity risk. This study aims to characterize compliance and prescribing practices of flupirtine before and after RMM implementation.A retrospective pre-post design cohort study was conducted in the outpatient setting using a longitudinal electronic medical (...) period, included restriction of flupirtine prescribing to patients with acute pain when other analgesics are contraindicated, and avoiding use in patients with either pre-existing liver disease or concomitant drugs known to have a potential hepatotoxic effect. Weekly liver function tests had a low degree of compliance.These findings demonstrate that, while physicians restricted flupirtine prescriptions to short-term use in the target population of acute pain, not all drug labeling elements were

2018 Current medical research and opinion

238. A retrospective study of opioid prescribing patterns at hospital discharge in surgical patients with obstructive sleep apnea. Full Text available with Trip Pro

prescribed to OSA or non-OSA patients (8% difference in total OME; 95% CI, -6% to 25%; P = 0.26).This study shows that surgical patients at risk for OSA or confirmed OSA are prescribed opioids at similar rates and doses upon discharge despite guidelines that recommend minimizing opioid use in OSA patients. These findings indicate a need to implement different strategies to reduce the prescription of opioids to patients with OSA. (...) A retrospective study of opioid prescribing patterns at hospital discharge in surgical patients with obstructive sleep apnea. Obstructive sleep apnea (OSA) is a risk factor for complications with postoperative opioid use, and in those patients with known or suspected OSA, minimization of postoperative opioids is recommended. We hypothesize that despite these recommendations, surgical patients with known or suspected OSA are prescribed postoperative opioids at hospital discharge at similar doses

2018 Canadian Journal Of Anaesthesia

239. Improving antibiotic prescribing skills in medical students: the effect of e-learning after 6 months. Full Text available with Trip Pro

Improving antibiotic prescribing skills in medical students: the effect of e-learning after 6 months. Antimicrobial prescribing behaviour is first established during medical study, but teachers often cite lack of time as an important problem in the implementation of antimicrobial stewardship in the medical curriculum. The use of electronic learning (e-learning) is a potentially time-efficient solution, but its effectiveness in changing long-term prescribing behaviour in medical students (...) is as yet unknown.We performed a prospective controlled intervention study of the long-term effects of a short interactive e-learning course among fourth year medical students in a Dutch university. The e-learning was temporarily implemented as a non-compulsory course during a 6 week period. Six months later, all students underwent an infectious disease-based objective structured clinical examination (OSCE) aimed at simulating postgraduate prescribing. If they passed, each student did the OSCE only once

2018 Journal of Antimicrobial Chemotherapy Controlled trial quality: uncertain

240. Prevalence of the potentially inappropriate Kampo medications to be used with caution among elderly patients taking any prescribed Kampo medications at a single centre in Japan: a retrospective cross-sectional study. Full Text available with Trip Pro

Prevalence of the potentially inappropriate Kampo medications to be used with caution among elderly patients taking any prescribed Kampo medications at a single centre in Japan: a retrospective cross-sectional study. Few studies have investigated the prevalence and characteristics of potentially inappropriate Kampo medication use among elderly ambulatory patients taking any prescribed Kampo medications.A retrospective cross-sectional study was conducted using electronic medical records. All (...) patients aged 65 years or older who continued visiting internal medicine physicians and were prescribed any Kampo medications from January 2015 to March 2015 were included. The primary outcome was the proportion of patients taking any potentially inappropriate Kampo medications that should be used with caution (hereafter referred to as UWC Kampo medications). The medication appropriateness was evaluated based on the 2015 Japan Geriatrics Society guidelines.Eighty eligible patients were identified

2018 BMC Complementary and Alternative Medicine

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