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Electronic Prescription

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4261. Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: evidence from a meta analysis

very old patients (older than 74 years) were excluded. The mean age of the participants ranged from 50 to 67 years. Outcomes assessed in the review Studies that reported adherence rates, which were measured using the same method for both treatment groups, were eligible for inclusion. The studies could use any method to assess adherence. The included studies measured adherence using at least one of the following: pill count, patient interview, electronic compliance monitor, prescription refill data

2002 DARE.

4262. Screening for lipid disorders: diet and exercise therapy

. Such interventions had a very modest, if any, effect on lowering serum cholesterol. Moreover they may be associated with harms specific to children. Exercise interventions considered as a whole did not appear to have a large impact on lipid levels. However, some studies employing rigorous activity prescriptions and producing weight loss showed changes in lipid profiles that may be clinically meaningful. It was noted that these programmes have been difficult to implement widely. Authors' conclusions Diet (...) the search was restricted to English publications found on two electronic databases. The validity of the trials was assessed using published methods, which were implemented well. However, there was no description of the quality of evidence from different study designs, i.e. meta-analyses, RCTs and observational studies. Evidence from the better quality trials was not highlighted. Details of the primary data were given and appropriate information was tabulated. The narrative synthesis, which was split

2001 DARE.

4263. Antiretroviral drug resistance testing in patients with HIV-1 infection: a meta-analysis study

antovirogram assay or the use of in-house assays. In some studies expert advice was used to maximise resistance test benefit, because results on genotype testing may not immediately lead to the most adequate drug prescription and they may need correct interpretation. The intervention in the control group included standard of care (SOC). Reference standard test against which the new test was compared The review did not include any diagnostic accuracy studies that compared the performance of the index test (...) % in patients treated based on SOC (OR 1.1, 95% CI: 0.8, 1.6, P=0.32; heterogeneity, P=0.15). Authors' conclusions The results supported the use of a genotype test in patients experiencing virological failure during ART. Expert interpretation of the test increased the probability of virological response. CRD commentary The review appears to address an appropriate question and the inclusion and exclusion criteria were reported. The literature search was fairly limited in that only one electronic database

2002 DARE.

4264. Q9. How can different models of organisation or bed utilisation improve the care of patients dying in hospital?

and benefits of different palliative care models including nursing skill mix, models of service delivery and models of organisations or bed utilisation. Searching Electronic databases (years not given): MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Index of Scientific and Technical Proceedings, SIGLE, NHS Project Research System, Cancerlit, Health Planning and Administration, DHSS Data. Literature published since 1980, in English, French, German, Italian or Swedish was included. Selected papers (...) prescribing, 'change in insight', appropriate placement, survival, total number of inpatient days, proportion receiving anti- cancer treatment, patient satisfaction, prescription of antiemetics, laxatives and regulan. How were decisions on the relevance of primary studies made? The project researcher allocated all titles and abstracts to a research question number, 'irrelevant' or excluded. All those labelled irrelevant or excluded were double checked by another member of the research team. All those

1997 DARE.

4265. Clinical and economic outcomes of pharmacist recommendations in a Veterans Affairs medical center

summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology This study considered pharmacist recommendations to alter medication. A recommendation was defined as a suggestion made to a care provider that involved the application of the pharmacist's knowledge to a specific patient or prescription. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study (...) The cost data were taken retrospectively from the same patient sample that provided the effectiveness evidence. Study sample The authors reported that to obtain a statistical power of 80% at the 95% significance level, they required a minimum of 100 recommendations for each of the three settings (inpatient, outpatient and nursing home). The cases were selected consecutively from the electronic system used to document recommendations. Overall, 600 recommendations were included in the study

2002 NHS Economic Evaluation Database.

4266. Consequences of intermittent treatment for hypertension: the case for medication compliance and persistence

been prescribed hypertensive medication. Outcomes assessed in the review Compliance with medication and the consequences of poor compliance (with regards to short term and long term outcomes of hypertension). Specific compliance assessment, included in the review, was microelectronic monitoring that documented the number of days on which one dose was taken, and the number of days on which the dose was taken within the prescribed interval of 24 hours (+/- 6 to 12 hours) (8 studies); prescription (...) dosing should be coupled with selection of a drug with long duration of action to overcome problems of missed doses. Widespread adoption of simple compliance enhancement methods could lead to decreased morbidity and mortality from cardiovascular disease and stroke. CRD commentary The author presents a clearly stated objective. However, the literature search that was used was very limited and the only electronic database used was MEDLINE. This may have resulted in some important information being

1998 DARE.

4267. Implementing preventive services: to what extent can we change provider performance in ambulatory care. A review of the screening, immunization, and counseling literature

included over 50 categories and phrases (e.g. preventive health services, prompting, cuing, reminders, flowsheet, prescription pads). Further details are available from the authors. Additional articles were identified by searching the reference lists of retrieved articles and contacting authors. Only English language articles were included in the review. Study selection Study designs of evaluations included in the review Randomised and non-randomised controlled studies based in the USA reporting (...) findings also point to the need for multiple interventions. CRD commentary This is a clearly presented review based on a well-defined question. An adequate search of the literature was performed using a wide range of electronic databases and authors were contacted to locate further studies. However, only English language studies were included and so relevant data may have been omitted. A minimum of two reviewers selected studies for inclusion and extracted the study data, however the validity

1998 DARE.

4268. Modeling the cost and outcomes of pharmacist-prescribed emergency contraception

abortion, ectopic pregnancy and birth). The cost data were obtained from electronic and published sources from 1995 to 1999 and were adjusted to a 1998 price year. Discounting was, appropriately, not applied as the timeframe was only 9 months. The average costs were reported. Statistical analysis of costs Point estimates and a range of values were presented. No statistical analysis of the costs was reported. Indirect Costs The indirect costs were not included. Currency US dollars ($). Sensitivity (...) . Journal of the American Medical Women's Association 1998;53(5 Suppl 2):230-2. Indexing Status Subject indexing assigned by NLM MeSH Ambulatory Care Facilities /economics /utilization; Clinical Protocols /standards; Contraceptives, Postcoital /economics; Cost Savings; Decision Support Techniques; Drug Costs /statistics & Drug Prescriptions /economics; Female; Health Services Research; Humans; Models, Econometric; Monte Carlo Method; Outcome Assessment (Health Care); Pharmacies /economics /utilization

2001 NHS Economic Evaluation Database.

4269. Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care

been seeing patients as a first point of contact for at least two years. A method of coded block randomisation was developed which meant that neither the receptionist nor the patient could determine the group to which a patient was allocated at the time of booking. Analysis of effectiveness The principle used in the analysis of effectiveness appears to have been treatment completers only. The health outcome measures were consultation process (length of consultation, examinations, prescriptions (...) , referrals), patient satisfaction, health status, and return clinic visits over two weeks. An electronic time stamp was used to record the time of each consultation. Patients completed health status measures (SF-36 scale) before the initial consultation and by post two weeks later. After the consultation, patients completed the medical interview satisfaction scale or its paediatric version, and the patient enablement instrument. The comparability of the study groups was not explicitly discussed

2000 NHS Economic Evaluation Database.

4270. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes

treated, total milligrams administered and total doses administered. The costs were adjusted to 1988 prices, by using the prescription drug component of the Consumer Price Index. The data was derived from longitudinal electronic medical records of the hospital. Currency US dollars ($). Sensitivity analysis Not sensitivity analysis was carried out. Estimated benefits used in the economic analysis 39.3% of patients received antibiotics over the 7 year study period. The proportion of patients who

1996 NHS Economic Evaluation Database.

4271. Cost-effectiveness of vaccination versus treatment of influenza in healthy adolescents and adults

population The study population comprised healthy adults aged between 15 and 65 years. Setting The setting was primary care. The economic study was carried out in the USA. Dates to which data relate The effectiveness and resource use data were gathered from studies published between 1986 and 2000. The cost data were taken from published and electronic sources relating to 1993 to 2000, and were adjusted to 1997 prices. Source of effectiveness data The estimates for the final outcomes were derived from (...) health-related quality of life. Direct costs The direct costs to the health service were included. These were for hospitalisation, Guillain-Barre syndrome, visit to a clinician for ILI, influenza vaccine and administration (including patient time as a component), prescriptions and over-the-counter medication, and transport. The cost of the patient's time to be vaccinated was incorporated in the total cost of vaccination. The caregivers' time was valued from 1998 national census data, labour

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2001 NHS Economic Evaluation Database.

4272. Interventions to improve antihypertensive drug adherence: a quantitative review of trials

-report, an electronic medication event monitoring system (MEMS), and pharmacy records of prescription refills. The adherence rate was defined as the proportion of prescribed doses taken. The most frequently used definition was that of Sackett et al. (see Other Publications of Related Interest), which defined adherence as greater than 80% pill consumption. Adherence was typically measured at the end of the study (e.g. the last study month), but in several cases adherence was reported for the entire (...) (or quasi-randomised) controlled trials published in peer-reviewed literature were considered. The study designs included were randomised controlled trials (RCTs), quasi-randomised trials in which assignment was by an arbitrary method or by minimisation, and crossover designs. Studies in which fewer than 10 participants were randomised were excluded. The length of follow-up ranged from 2 to 29 months. Specific interventions included in the review The interventions included the use of electronic vial

2000 DARE.

4273. Antimicrobial treatment in acute maxillary sinusitis: a meta-analysis

were subsequently resolved by the two authors reviewing the paper together. Only data within the publications were considered and authors were not contacted for additional information. The following information was extracted from the publications: type and properties of the antibiotic, outcome details, study setting (primary care/secondary care), prescription of local decongestants (no/yes), treatment dose (prescribed daily dose/antibiotic divided by daily dose (DDD) as defined by the WHO) (1 (...) significant OR, studies with similar background characteristics were clustered in order to increase the power of the analyses. The following background characteristics were considered as potential confounders: setting, prescription of local decongestants, treatment, dose, duration of treatment, basis for the diagnosis, geographical area and year of publication. Clinical significance was defined using an arbitrary cut off point of p>1.50 or p<0.67. Clustering of the studies was considered to be justified

1997 DARE.

4274. Strategies for diagnosing and treating suspected acute bacterial sinusitis: a cost-effectiveness analysis

assumptions: there was no recurrence of resolved symptoms; the risk of developing side effects from the antibiotics remained constant; side effects lasted 2 days and required a change in prescription, but no further reactions occurred and the cure rate was unaltered; antibiotic treatment of patients who did not have ABS did not alter their symptoms; only untreated patients with ABS experienced severe disease complications (brain abscess, meningitis, facial or orbital cellulitis). Outcomes assessed (...) . Weekend days were valued at the same rate to reflect non-work productivity losses and other, unspecified, indirect costs. Productivity losses were calculated from data on the usual weekly earnings for wage and salary earners, obtained electronically from the Bureau of Labor Statistics. The number of days of work lost for each severity of sinusitis was derived using the model. A median value of $115 per day was used. Only productivity losses of patients, not their caregivers, were included. Discounting

2001 NHS Economic Evaluation Database.

4275. Breast imaging - a guide for practice

. A summary of key points is provided at the end of each chapter. INTRODUCTION AND BACKGROUND TO THE GUIDE Aim and scope The overall aim of Breast imaging: a guide for practice is to optimise the early and accurate diagnosis of breast abnormalities. A secondary aim is to maximise both the woman’s and the clinician’s satisfaction with the breast imaging experience. This guide is not intended to be prescriptive or to serve as a training manual, but rather to offer a guide to practice. While acknowledging (...) of Breast imaging: a guide for practice is to optimise the early and accurate diagnosis of breast abnormalities. A secondary aim is to maximise both the woman’s and the clinician’s satisfaction with the breast imaging experience. This guide is not intended to be prescriptive or to serve as a training manual, but rather to offer a guide to practice. While acknowledging that access to imaging services may be limited in some regions, the recommendations for practice are applicable to both rural/remote

2001 Cancer Australia

4276. Clinical practice guidelines for the management of advanced breast cancer

to provide information to assist decision-making and are based on the evidence available at time of publication. They are not meant to be prescriptive.1 Clinical practice guidelines for the management of advanced breast cancer I N T R O D U C T I O N In 1996, the NHMRC National Breast Cancer Centre established a multidisciplinary working group to develop clinical practice guidelines for the management of advanced breast cancer. The working group comprised representatives from breast surgery, radiology (...) 3 and 8– 11 contain information which is also applicable to locally advanced breast cancer and local recurrence. The process employed to develop the guidelines is described in Appendix B, including the purpose and scope of the guidelines and its intended audience. These guidelines are not rigid procedural paths. They are inclusive, not prescriptive. They aim to provide information on which decisions can be made rather than dictating what those decisions should be. The guidelines use a four-point

2000 Cancer Australia

4277. Clinical practice guidelines for the management of early breast cancer

of breast cancer should consult the relevant texts. These guidelines are neither rigid procedural paths, nor prescriptive. They aim to provide information on which decisions can be made, rather than dictate what decisions should be. 2 Clinical practice recommendations are boxed as ‘Guidelines’ throughout the text and are summarised at the beginning under ‘Summary of Guidelines’. These are all evidence-based and the level of evidence is clearly denoted. There are also boxed ‘Key points’ to draw

2001 Cancer Australia

4278. Effectiveness reviews in health promotion

health promotion interventions … 40 Chapter 5 Searching for studies to include in effectiveness reviews 5.1 Why is systematic searching important? ….. 40 5.2 Searching electronic databases ….. 42 5.3 Methods 5.3.1 Developing a search strategy for each database … 46 5.3.2 Testing the search strategies for their sensitivity and specificity 48 5.3.3 Identifying the best combination of databases to use …. 49 5.4 Results 5.4.1 Search strategies … 49 5.4.2 Sensitivity and specificity of the search (...) >magazine= type journals should raise awareness and signpost full reports. ? Summaries of reviews, however short, should include the Abottom line@ and its implications for planning of services and gaps in knowledge. ? Full reports (paper or electronic versions) should be available to purchasers and providers. These reports should include: C a clear description of the review methods, why these methods have been chosen and the implications they have for the evidence used to draw conclusions about

1999 EPPI Centre

4279. Promoting Continence Using Prompted Voiding

, including in electronic form, for educational or non-commercial purposes, without requiring the consent or permission of the Registered Nurses’ Association of Ontario, provided that an appropriate credit or citation appears in the copied work as follows: Registered Nurses’ Association of Ontario (2005). Promoting Continence Using Prompted Voiding. (Revised). Toronto, Canada: Registered Nurses’ Association of Ontario. Promoting Continence Using Prompted Voiding 67 How to Use this Document This nursing

2002 Registered Nurses' Association of Ontario

4280. Risk Assessment and Prevention of Pressure Ulcers

copying appears, the balance of this document may be produced, reproduced and published, in any form, including in electronic form, for educational or non-commercial purposes, without requiring the consent or permission of the Registered Nurses’ Association of Ontario, provided that an appropriate credit or citation appears in the copied work as follows: Registered Nurses’ Association of Ontario (2005). Risk assessment and prevention of pressure ulcers. (Revised). Toronto, Canada: Registered Nurses

2002 Registered Nurses' Association of Ontario

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