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Electronic Prescription

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221. 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

222. 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

223. 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

224. 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

225. Safety and tolerability of prescription omega-3 fatty acids: A systematic review and meta-analysis of randomized controlled trials. Full Text available with Trip Pro

Safety and tolerability of prescription omega-3 fatty acids: A systematic review and meta-analysis of randomized controlled trials. Omega-3 fatty acids [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] are widely recommended for health promotion. Over the last decade, prescription omega-3 fatty acid products (RxOME3FAs) have been approved for medical indications. Nonetheless, there is no comprehensive analysis of safety and tolerability of RxOME3FAs so far.A systematic review (...) of randomized controlled trials (RCTs) was carried out based on searches in six electronic databases. The studies involving marketed RxOME3FA products were included, and adverse-effect data were extracted for meta-analysis. Subgroup analysis and meta-regression were conducted to explore the sources of potential heterogeneity.Among the 21 included RCTs (total 24,460 participants; 12,750 from RxOME3FA treatment cohort and 11,710 from control cohort), there was no definite evidence of any RxOME3FA-emerging

2018 Prostaglandins, leukotrienes, and essential fatty acids

226. 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

227. 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

228. 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

229. 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

230. Are ADHD medications under or over prescribed worldwide?: Protocol for a systematic review and meta-analysis: Erratum. Full Text available with Trip Pro

Are ADHD medications under or over prescribed worldwide?: Protocol for a systematic review and meta-analysis: Erratum. Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, characterized by age inappropriate and impairing levels of inattention and/or hyperactivity/impulsivity. Pharmacotherapy is an important part of the ADHD multimodal treatment. The extent to which ADHD is pharmacologically over or under treated worldwide is controversial. We aimed (...) to estimate the pooled worldwide rate of ADHD pharmacological treatment in individuals with and without the disorder.We will include published or unpublished studies reporting the rates of ADHD pharmacological treatment in participants with and without ADHD of any age group. Population-based, cohort, or follow-up studies, as well as data from insurance health system and third-party reimbursements will be eligible. Searches will be performed in a large number of electronic databases, including Medline

2018 Medicine

231. 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

232. 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

233. 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

234. Behavioral Economics Interventions to Improve Outpatient Antibiotic Prescribing for Acute Respiratory Infections: a Cost-Effectiveness Analysis. Full Text available with Trip Pro

Behavioral Economics Interventions to Improve Outpatient Antibiotic Prescribing for Acute Respiratory Infections: a Cost-Effectiveness Analysis. Behavioral economics interventions have been shown to effectively reduce the rates of inappropriate antibiotic prescriptions for acute respiratory infections (ARIs).To determine the cost-effectiveness of three behavioral economic interventions designed to reduce inappropriate antibiotic prescriptions for ARIs.Thirty-year Markov model from the US (...) societal perspective with inputs derived from the literature and CDC surveillance data.Forty-five-year-old adults with signs and symptoms of ARI presenting to a healthcare provider.(1) Provider education on guidelines for the appropriate treatment of ARIs; (2) Suggested Alternatives, which utilizes computerized clinical decision support to suggest non-antibiotic treatment choices in lieu of antibiotics; (3) Accountable Justification, which mandates free-text justification into the patient's electronic

2018 Journal of General Internal Medicine

235. Opioid Prescribing: Where Should Academic Emergency Departments Focus Their Efforts? Full Text available with Trip Pro

, observational, study was performed at an academic ED with an annual census of 61,289 visits. We extracted all 6962 opioid prescriptions attributed to the ED during calendar year 2015 from the electronic health record. Error prescriptions were excluded from the analysis. Overall prescribing by opioid class was performed. Prescriptions written by EM trainees were categorized by postgraduate year and compared with other prescribers. Prescribing patterns for recurrent visits were also analyzed.Of the 6962 (...) Opioid Prescribing: Where Should Academic Emergency Departments Focus Their Efforts? Opioid prescriptions from the emergency department (ED) are being heavily scrutinized. This has resulted in prescribing guidelines and laws.We analyzed the "current state" of opioid prescribing practices by emergency medicine (EM) trainees to gain understanding where operational, educational, or supervisory efforts should be directed to comply with current guidelines and future legislation.Our retrospective

2018 Journal of Emergency Medicine

236. Real-world evidence analysis of palbociclib prescribing patterns for patients with advanced/metastatic breast cancer treated in community oncology practice in the USA one year post approval. Full Text available with Trip Pro

Real-world evidence analysis of palbociclib prescribing patterns for patients with advanced/metastatic breast cancer treated in community oncology practice in the USA one year post approval. Rapidly evolving understanding of cancer biology has presented novel opportunities to translate that understanding into clinically relevant therapy. Palbociclib, a novel, first-in-class cyclin-dependent kinase (CDK) 4/6 inhibitor was approved in the USA in February 2015 for the treatment of advanced (...) /metastatic breast cancer. We examined real-world evidence in the first year post approval to understand the clinical and demographic characteristics of patients treated with palbociclib in community oncology practices and the dosing, treatment, and complete blood count (CBC) monitoring patterns.This was a retrospective observational study of structured data from a US electronic medical record (EMR) database. Female patients receiving palbociclib after 31 January 2015 were followed through 31 March 2016

2018 Breast cancer research : BCR

237. Protocol: mixed-methods study to evaluate implementation, enforcement, and outcomes of U.S. state laws intended to curb high-risk opioid prescribing. Full Text available with Trip Pro

Program (PDMP) enrollment laws, which require prescribers to enroll in their state's PDMP, an electronic database of patients' controlled substance prescriptions, (2) mandatory PDMP query laws, which require prescribers to query the PDMP prior to prescribing an opioid, (3) opioid prescribing cap laws, which limit the dose and/or duration of opioid prescriptions, and (4) pill mill laws, which strictly regulate pain clinics to prevent nonmedical opioid prescribing. Some pain experts have expressed (...) Protocol: mixed-methods study to evaluate implementation, enforcement, and outcomes of U.S. state laws intended to curb high-risk opioid prescribing. The U.S. opioid epidemic has been driven by the high volume of opioids prescribed by healthcare providers. U.S. states have recently enacted four types of laws designed to curb high-risk prescribing practices, such as high-dose and long-term opioid prescribing, associated with opioid-related mortality: (1) mandatory Prescription Drug Monitoring

2018 Implementation Science

238. Understanding the gender gap in antibiotic prescribing: a cross-sectional analysis of English primary care. Full Text available with Trip Pro

Understanding the gender gap in antibiotic prescribing: a cross-sectional analysis of English primary care. To explore the causes of the gender gap in antibiotic prescribing, and to determine whether women are more likely than men to receive an antibiotic prescription per consultation.Cross-sectional analysis of routinely collected electronic medical records from The Health Improvement Network (THIN).English primary care.Patients who consulted general practices registered with THIN between 2013 (...) and 2015.Total antibiotic prescribing was measured in children (<19 years), adults (19-64 years) and the elderly (65+ years). For 12 common conditions, the number of adult consultations was measured, and the relative risk (RR) of being prescribed antibiotics when consulting as female or with comorbidity was estimated.Among 4.57 million antibiotic prescriptions observed in the data, female patients received 67% more prescriptions than male patients, and 43% more when excluding antibiotics used to treat

2018 BMJ open

239. Systemic fluoroquinolone prescriptions for hospitalized children in Belgium, results of a multicenter retrospective drug utilization study. Full Text available with Trip Pro

electronic medical files, the study included all children who received a systemic FQ prescription in two Belgian university children's hospitals between 2010 and 2013. Two authors reviewed prescribed daily doses. Univariate and multivariate logistic regression models were used to analyze risk factors for inadequately dosing. Results262 FQ prescriptions for individual patients were included for analysis. 16.8% of these prescriptions were for labeled indications, and 35.1% were guided by bacteriological (...) Systemic fluoroquinolone prescriptions for hospitalized children in Belgium, results of a multicenter retrospective drug utilization study. Fluoroquinolones (FQ) are increasingly prescribed for children, despite being labeled for only a limited number of labeled pediatric indications. In this multicenter retrospective drug utilization study, we analyzed indications for systemic FQ prescriptions in hospitalized children and the appropriateness of the prescribed dose.Using data obtained from

2018 BMC Infectious Diseases

240. Inpatient falls in older adults: a cohort study of antihypertensive prescribing pre- and post-fall. Full Text available with Trip Pro

-fall adjustments of antihypertensive medications are routinely made in a large National Health Service (NHS) Trust.Inpatient records over an eight-month period were captured from an electronic prescribing system to identify older adults (≥80 years old) with normal/low blood pressures (< 140 mmHg systolic) who had a documented inpatient fall as these patients were considered to be at high risk of further falls. Prescribed antihypertensive medication on admission was then compared with the post-fall (...) . In addition, 11 new antihypertensives were prescribed at this time. At discharge, half of the patients (n = 73) remained on the same number of antihypertensive medication as on admission, 51 patients (35%) were on fewer antihypertensives and 22 (15%) were on more. Additionally, no changes were made to individual antihypertensives in 49% of prescriptions; 34% were stopped or reduced in dose but 38 new agents were started by the time of discharge. Angiotensin converting enzyme inhibitors and angiotensin II

2018 BMC Geriatrics

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