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Electronic Prescription

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261. Prescriber and institutional barriers and facilitators of clozapine use: A systematic review. (Abstract)

Prescriber and institutional barriers and facilitators of clozapine use: A systematic review. As clozapine is under-prescribed in persons with treatment-resistant schizophrenia (TRS), it is necessary to better identify the determinants of health inequalities in access to clozapine use.To identify mental health professionals' characteristics or attitudes and institutional characteristics facilitating or limiting clozapine prescribing.We systematically searched multiple electronic databases (...) are lack of personal prescribing experience and concern with pharmacological characteristics of clozapine (blood monitoring and adverse effects). Lack of knowledge about the effectiveness of clozapine does not appear as a major determinant of under-prescription. Institutional-related characteristics favoring clozapine prescribing are prescribers' adherence to evidence-based medicine principles and learning by modelling from experienced clozapine prescribers.Effective strategies to increase access

2018 Schizophrenia Research

262. Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project. Full Text available with Trip Pro

Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project. Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the implementation (...) of a health system-wide, guideline-driven policy on opioid prescribing in primary care. This manuscript describes the protocol for this QI project.A health system with 28 primary care clinics caring for approximately 294,000 primary care patients developed and implemented a guideline-driven policy on long-term opioid therapy in adults with opioid-treated chronic non-cancer pain (estimated N = 3980). The policy provided multiple recommendations, including the universal use of treatment agreements, urine

2018 BMC health services research

263. Reducing the default dispense quantity for new opioid analgesic prescriptions: study protocol for a cluster randomised controlled trial. Full Text available with Trip Pro

Reducing the default dispense quantity for new opioid analgesic prescriptions: study protocol for a cluster randomised controlled trial. As opioid analgesic consumption has grown, so have opioid use disorder and opioid-related overdoses. Reducing the quantity of opioid analgesics prescribed for acute non-cancer pain can potentially reduce risks to the individual receiving the prescription and to others who might unintentionally or intentionally consume any leftover tablets. Reducing the default (...) dispense quantity for new opioid analgesic prescriptions in the electronic health record (EHR) is a promising intervention to reduce prescribing.This study is a prospective cluster randomised controlled trial with two parallel arms. Primary care sites (n=32) and emergency departments (n=4) will be randomised in matched pairs to either a modification of the EHR so that new opioid analgesic prescriptions default to a dispense quantity of 10 tablets (intervention) or to no EHR change (control

2018 BMJ open Controlled trial quality: uncertain

264. Physician Time Burden Associated with Querying Prescription Drug Monitoring Programs. Full Text available with Trip Pro

Physician Time Burden Associated with Querying Prescription Drug Monitoring Programs. Prescription drug monitoring programs (PDMPs) enable prescribers to review patient prescription histories, and their use is mandatory in many states. We estimated the cost of physicians retrieving PDMP patient reports compared with a model where a delegate (i.e., administrative staff) retrieves reports.We performed a cost analysis with a one-year time horizon, from the perspective of physicians' employers. We (...) obtained specialty-specific estimates of controlled substance prescribing frequency from the National Ambulatory Medical Care Survey, 2012-2014. We defined three PDMP usage cases based on the frequency of queries: comprehensive (before every Schedule II-IV controlled substance prescription), selective (before new Schedule II-IV prescriptions and every six months for continuing medications), and minimal (before new Schedule II or III prescriptions and annually for continuing medications).The delegate

2018 Pain Medicine

265. Education of Providers on Prescribing Best Practices

Outcome Measures : Median morphine milligram equivalents (MME) per opioid prescription [ Time Frame: 8 months ] By extracting prescribing data for opioids from the electronic health records Percentage of orders for balanced intravenous (IV) fluid solutions (i.e. not normal saline) [ Time Frame: 8 months ] By extracting prescribing data for intravenous fluids from the electronic health records Secondary Outcome Measures : Chloride levels in patients receiving intravenous fluid orders from a provider (...) health records Percent of opioid prescriptions (discharge) that also had a scheduled (not PRN) non-opioid (APAP, NSAIDs, GABA, muscle relaxant, etc.) [ Time Frame: 8 months ] By extracting medication data from the electronic health records Number of Rapid Response Team calls (RRT s) indexed to the number of patients cared for per prescriber (evaluated by level of engagement of the learner with QuizTime) [ Time Frame: 8 months ] By extracting RRT calls from the electronic health records Eligibility

2018 Clinical Trials

266. Draft Opioid-Prescribing Guidelines for Uncomplicated Normal Spontaneous Vaginal Birth. (Abstract)

Draft Opioid-Prescribing Guidelines for Uncomplicated Normal Spontaneous Vaginal Birth. Women who experience an uncomplicated vaginal delivery have acute intrapartum pain and variable pain in the immediate postpartum period. Although the Centers for Disease Control and Prevention (CDC) has urged clinicians to improve opioid-prescribing behavior, there are no published clinical practice guidelines for prescribing opioids during labor and delivery and at discharge for patients with uncomplicated (...) statistics were generated to document the characteristics of the patients receiving opioids as well as the characteristics of hospitals administering opioids during inpatient labor and delivery and on discharge. Patient-level variables included age group, marital status, race, ethnicity, payer type, and length of stay. Hospital-level variables included bed size, geographic region, teaching status, and urbanicity status. These data were then presented in an electronic Delphi survey to 14 participants

2018 Obstetrics and Gynecology

267. Trends in statin prescription prevalence, initiation, and dosing: Hong Kong, 2004-2015. Full Text available with Trip Pro

included if they received a lipid test at a single center (n = 58,672). Using the territory-wide electronic health record, prescribed daily statin dose, nondaily dose frequency, and statin dose intensity were determined for statin prescriptions from 2004 to 2015. Statin prescription prevalence and initiation rates were estimated using the appropriate at-risk population in the hospital catchment area as the denominator. Prescribed daily doses were stratified by primary or secondary cardiovascular (...) Trends in statin prescription prevalence, initiation, and dosing: Hong Kong, 2004-2015. Clinical practice guidelines recommend specific statin doses for the primary and secondary prevention of cardiovascular disease. Little is known about how statin utilization and dosing have evolved over time in Hong Kong. The aim of this study was to describe trends in statin prevalence, initiation, and dosing from 2004 to 2015.Patients receiving public health services, who were prescribed a statin, were

2018 Atherosclerosis

268. Interventions to Optimise Prescribing in Older People with Dementia: A Systematic Review. (Abstract)

Interventions to Optimise Prescribing in Older People with Dementia: A Systematic Review. Older adults living with dementia may have a higher risk of medication toxicity than those without dementia. Optimising prescribing in this group of people is a critically important yet challenging process.Our aim was to systematically review the evidence for the effectiveness of interventions for optimising prescribing in older people with dementia.This systematic review searched the Pubmed, Embase (...) , CINAHL, PsycINFO and Cochrane Library electronic databases for studies that evaluated relevant interventions. Experimental, quasi-experimental and observational studies published in English prior to August 2018 were included. Data were synthesised at a narrative level.The 18 studies accepted for review included seven randomised, two nonrandomised controlled, five quasi-experimental and four observational studies. Half the studies were conducted in nursing homes and the other half in hospital

2018 Drugs & Aging

269. Patient Safety and Pro Re Nata Prescription and Administration: A Systematic Review Full Text available with Trip Pro

Patient Safety and Pro Re Nata Prescription and Administration: A Systematic Review PRN is the acronym for 'pro re nata,' written against prescriptions whose administration should be based on patients' needs, rather than at set times. The aim of this systematic review was to explore safety issues and adverse events arising from PRN prescription and administration. Electronic databases including Scopus, PubMed [including Medline], Embase, Cinahl, Web of Science and ProQuest were systematically (...) searched to retrieve articles published from 2005 to 2017.we included all randomized controlled trials (RCTs) and studies with comparison groups, comparing PRN prescription and administration with scheduled administration, where safety issues and adverse events were reported. The authors independently assessed titles, abstracts and full-texts of retrieved studies based on inclusion criteria and risk of bias. Results were summarised narratively. The search identified 7699 articles. Title, abstract

2018 Pharmacy: Journal of Pharmacy Education and Practice

270. Antibiotic prescribing for acute lower respiratory tract infections (LRTI) - guideline adherence in the German primary care setting: An analysis of routine data. Full Text available with Trip Pro

Antibiotic prescribing for acute lower respiratory tract infections (LRTI) - guideline adherence in the German primary care setting: An analysis of routine data. Antibiotic overprescribing in primary care has major impacts on the development of antibiotic resistance. The objective of this study is to provide insight in antibiotics prescriptions for patients suffering from cough, acute bronchitis or community acquired pneumonia in primary care.Data from 2009 to 2013 of electronic health records (...) of 12,880 patients in Germany were obtained from a research database. The prescription of antibiotics for acute lower respiratory tract infections was compared to the national S3 guideline cough from the German Society of General Practitioners and Family Medicine.Antibiotics were prescribed in 41% of consultations. General practitioners' decision of whether or not to prescribe an antibiotic was congruent with the guideline in 52% of consultations and the antibiotic choice congruence was 51

2017 PLoS ONE

271. Use of electronic health records to support smoking cessation. Full Text available with Trip Pro

Use of electronic health records to support smoking cessation. Health information systems such as electronic health records (EHR), computerized decision support systems, and electronic prescribing are potentially valuable components to improve the quality and efficiency of clinical interventions for tobacco use.To assess the effectiveness of electronic health record-facilitated interventions on smoking cessation support actions by clinicians, clinics, and healthcare delivery systems

2014 Cochrane

272. Setup in a clinical workflow and impact on radiotherapy routine of an in vivo dosimetry procedure with an electronic portal imaging device. Full Text available with Trip Pro

Setup in a clinical workflow and impact on radiotherapy routine of an in vivo dosimetry procedure with an electronic portal imaging device. High conformal techniques such as intensity-modulated radiation therapy and volumetric-modulated arc therapy are widely used in overloaded radiotherapy departments. In vivo dosimetric screening is essential in this environment to avoid important dosimetric errors. This work examines the feasibility of introducing in vivo dosimetry (IVD) checks (...) in a radiotherapy routine. The causes of dosimetric disagreements between delivered and planned treatments were identified and corrected during the course of treatment. The efficiency of the corrections performed and the added workload needed for the entire procedure were evaluated. The IVD procedure was based on an electronic portal imaging device. A total of 3682 IVD tests were performed for 147 patients who underwent head and neck, abdomen, pelvis, breast, and thorax radiotherapy treatments. Two types

2018 PLoS ONE

273. Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette Users: Implications for Cardiovascular Risk Full Text available with Trip Pro

Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette Users: Implications for Cardiovascular Risk Electronic cigarettes (e-cigarettes) have gained unprecedented popularity, but virtually nothing is known about their cardiovascular risks.To test the hypothesis that an imbalance of cardiac autonomic tone and increased systemic oxidative stress and inflammation are detectable in otherwise healthy humans who habitually use e-cigarettes.Cross-sectional case (...) -control study of habitual e-cigarette users and nonuser control individuals from 2015 to 2016 at the University of California, Los Angeles. Otherwise healthy habitual e-cigarette users between the ages of 21 and 45 years meeting study criteria, including no current tobacco cigarette smoking and no known health problems or prescription medications, were eligible for enrollment. Healthy volunteers meeting these inclusion criteria who were not e-cigarette users were eligible to be enrolled as control

2017 JAMA cardiology

274. Applying STOPP Guidelines in Primary Care Through Electronic Medical Record Decision Support: Randomized Control Trial Highlighting the Importance of Data Quality Full Text available with Trip Pro

Applying STOPP Guidelines in Primary Care Through Electronic Medical Record Decision Support: Randomized Control Trial Highlighting the Importance of Data Quality Potentially Inappropriate Prescriptions (PIPs) are a common cause of morbidity, particularly in the elderly.We sought to understand how the Screening Tool of Older People's Prescriptions (STOPP) prescribing criteria, implemented in a routinely used primary care Electronic Medical Record (EMR), could impact PIP rates in community (non (...) and by the decision support such as problem and medication lists. Users also highlighted areas for better integration of STOPP guidelines with prescribing workflows. Many of the STOPP criteria can be implemented in EMRs using simple logic. However, data quality in EMRs continues to be a challenge and was a limiting step in the effectiveness of the decision support in this study. This is important as decision makers continue to fund implementation and adoption of EMRs with the expectation of the use of advanced

2017 JMIR medical informatics Controlled trial quality: uncertain

275. Merging Electronic Health Record Data and Genomics for Cardiovascular Research Full Text available with Trip Pro

with the challenge of knowing which gene variants are actionable for guiding prescribing, even gene variants that may have been identified as incidental to the primary purpose of the genetic testing. The Clinical Pharmacogenetics Implementation Consortium has prioritized genes and drugs that are actionable, maintains an updated list of these genes and drugs, and has developed a number of clinical guidelines for using pharmacogenetic test results to guide prescribing, including the prescription of several (...) available in the EHR) and in the posttest state (a high-risk genetic test result is already in the EHR). In the future, interoperability of EHRs could allow genetic test results to be available at all relevant points of care, including dispensing pharmacies and outpatient clinics ( ). Figure. Current and future approaches to filling prescriptions. Genetic test results obtained from electronic health records (EHRs) could guide diagnosis and suggest drug dosages. Preemptive testing has the advantage

2016 American Heart Association

276. Ontario stroke evaluation report 2012: prescribing system solutions to improve stroke outcomes

been made for the HTA database. Citation Hall R, Khan F, O'Callaghan C, Kapral MK, Hodwitz K, Fang J, Bayley M. Ontario stroke evaluation report 2012: prescribing system solutions to improve stroke outcomes . Toronto: Institute for Clinical Evaluative Sciences (ICES). 2012 Final publication URL Additional data URL Indexing Status Subject indexing assigned by CRD MeSH Drug Prescriptions; Electronic Prescribing; Ontarios; Stroke; Treatment Outcome Language Published English Country of organisation (...) Ontario stroke evaluation report 2012: prescribing system solutions to improve stroke outcomes Ontario stroke evaluation report 2012: prescribing system solutions to improve stroke outcomes Ontario stroke evaluation report 2012: prescribing system solutions to improve stroke outcomes Hall R, Khan F, O'Callaghan C, Kapral MK, Hodwitz K, Fang J, Bayley M Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has

2012 Health Technology Assessment (HTA) Database.

277. Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients: a before and after study. Full Text available with Trip Pro

Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients: a before and after study. Considerable investments are being made in commercial electronic prescribing systems (e-prescribing) in many countries. Few studies have measured or evaluated their effectiveness at reducing prescribing error rates, and interactions between system design and errors are not well understood, despite increasing concerns regarding new errors associated with system (...) use. This study evaluated the effectiveness of two commercial e-prescribing systems in reducing prescribing error rates and their propensities for introducing new types of error.We conducted a before and after study involving medication chart audit of 3,291 admissions (1,923 at baseline and 1,368 post e-prescribing system) at two Australian teaching hospitals. In Hospital A, the Cerner Millennium e-prescribing system was implemented on one ward, and three wards, which did not receive the e

2012 PLoS medicine

278. Can an electronic prescribing system detect doctors who are more likely to make a serious prescribing error? Full Text available with Trip Pro

Can an electronic prescribing system detect doctors who are more likely to make a serious prescribing error? 22637768 2012 08 06 2018 11 13 1758-1095 105 5 2012 May Journal of the Royal Society of Medicine J R Soc Med Can an electronic prescribing system detect doctors who are more likely to make a serious prescribing error? 191 10.1258/jrsm.2012.120054 Kalantari Elnaz E Fayaz-Bakhsh Ahmad A eng Letter England J R Soc Med 7802879 0141-0768 IM Drug Prescriptions standards statistics & numerical (...) data Electronic Prescribing statistics & numerical data Humans Medication Errors prevention & control Practice Patterns, Physicians' Safety Management Total Quality Management 2012 5 29 6 0 2012 5 29 6 0 2012 8 7 6 0 ppublish 22637768 105/5/191-b 10.1258/jrsm.2012.120054 PMC3360530 JAMA. 2001 Dec 12;286(22):2839-44 11735759 JAMA. 1998 Apr 1;279(13):1024-9 9533503 JAMA. 2005 Mar 9;293(10):1197-203 15755942 Pediatrics. 2005 Dec;116(6):1506-12 16322178

2012 Journal of the Royal Society of Medicine

279. Electronic Health Records (EHRs)

Electronic Health Records for Continuity of Care. Methods Inf Med 2007; 46 Suppl 1: 34-46. 47 Cusack C. Electronic Health Records and Electronic Prescribing: Promise and Pitfalls. Obstet Gynecol Clin N Am 2008; 35: 63–79. 48 Baron RJ, Fabens EL, Schiffman M, Wolf E. Electronic Health Records: Just Around the Comer? Or Over the Cliff? Ann Int Med 2005; 143(3): 222-226. 49 Gagnon MP, Légaré F, Labrecque M, Frémont P, Pluye P, Gagnon J, Car J, Pagliari C, Desmartis M, Turcot L, Gravel K. Interventions (...) Electronic Health Records (EHRs) Evidence Summary: Electronic Health Records (EHRs) To the Chief Information Officer of the Champlain LHIN Prepared by the CIHR-funded Knowledge to Action research group: Sara Khangura, Jeremy Grimshaw, David Moher This report covers a broad collection of recent literature and evidence around the electronic health record (EHR). Evidence summarized from systematic reviews is highlighted in blue boxes, like this one. Systematic review evidence is generally favoured

2014 OHRI Knowledge to Action

280. Electronic Algorithms Based on Host Biomarkers Point of Care Tests to Decide on Admission and Antibiotic Prescription in Tanzanian Febrile Children

Electronic Algorithms Based on Host Biomarkers Point of Care Tests to Decide on Admission and Antibiotic Prescription in Tanzanian Febrile Children Electronic Algorithms Based on Host Biomarkers to Manage Febrile Children - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved (...) clinical assessment and POCTs results (oxygen saturation and a combination of specific biomarkers of inflammation) as a triage tool to decide on admitting febrile children; the second objective is to assess the usefulness and safety of new electronic decision trees that integrate simple clinical assessment and POCT results (a combination of specific biomarkers of inflammation) as decision-making tool to prescribe antibiotics to non-severe febrile children. The development of such a tool will decrease

2014 Clinical Trials

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