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Electronic Prescription

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4301. Time to achieving therapeutic international normalized ratio increases hospital length of stay after heart valve replacement surgery. (Abstract)

underwent MCVR over a consecutive 42-month period were included. Clinical data were obtained from the Society of Thoracic Surgeons Adult Cardiac Surgery database and electronic medical records. Therapeutic INR was defined as per standard guidelines. Warfarin dose was prescribed using an inpatient pharmacy-managed algorithm and computer-based dosing tool. International normalized ratio trajectory, procedural needs, and drug interactions were included in warfarin dose determination.There were 708 patients

2017 American Heart Journal

4302. Urine Culture Follow-up and Antimicrobial Stewardship in a Pediatric Urgent Care Network. Full Text available with Trip Pro

antibiotic exposure in children.A multidisciplinary task force developed and implemented a protocol for routine nurse and clinician follow-up of urine culture results, discontinuation of unnecessary antibiotics, and documentation in the electronic medical record. Monthly antibiotic discontinuation rates were tracked in empirically treated patients with negative urine culture results from July 2013 through December 2015. Statistical process control methods were used to track improvement over time (...) . Fourteen-day return visits for UTIs were monitored as a balancing measure.During the study period, 910 patients received empiric antibiotic therapy for UTIs but had a negative urine culture result. The antibiotic discontinuation rate increased from 4% to 84%, avoiding 3429 (40%) of 8648 antibiotic days prescribed. Among patients with discontinued antibiotics, none was diagnosed with a UTI within 14 days of the initial urgent care encounter.Implementation of a standard protocol for urine culture follow

2017 Pediatrics

4303. Understanding the implementation and adoption of a technological intervention to improve medication safety in primary care: a realist evaluation. Full Text available with Trip Pro

Understanding the implementation and adoption of a technological intervention to improve medication safety in primary care: a realist evaluation. Monitoring for potentially hazardous prescribing is increasingly important to improve medication safety. Healthcare information technology can be used to achieve this aim, for example by providing access to prescribing data through surveillance of patients' electronic health records. The aim of our study was to examine the implementation and adoption (...) of an electronic medicines optimisation system that was intended to facilitate clinical audit in primary care by identifying patients at risk of an adverse drug event. We adopted a sociotechnical approach that focuses on how complex social, organisational and institutional factors may impact upon the use of technology within work settings.We undertook a qualitative realist evaluation of the use of an electronic medicines optimisation system in one Clinical Commissioning Group in England. Five semi-structured

2017 BMC health services research

4304. Minor Injury Crashes: Prevalence of Driver-Related Risk Factors and Outcome. (Abstract)

interviews were conducted 6 months after the crash.We approached 123 injured drivers; baseline interviews were completed in 69 and follow-up interviews in 45. Prior to the index crash, 1.4% of drivers drank alcohol, 1.4% used illicit drugs, and 7.2% used sedating prescription medications. Nine drivers (13%) were distracted. In this sample, 5.8% met criteria for being aggressive drivers, 7.2% were risky drivers, and 11.6% drove while experiencing negative emotions. At 6-month follow-up, many drivers were (...) still having health problems, 53.3% were not fully recovered, 46.7% had not returned to usual activities, and 28.9% were off work. Of the 42 participants who resumed driving, 16.7% had a near miss and 4.8% had another crash. Nine (21.4%) reported drinking and driving, and 9.5% reported driving after cannabis use. Cell phone use (16.7%) and use of other electronics while driving (23.8%) were also common.Driver-related risk factors are common in drivers involved in minor injury crashes, and drivers

2017 Journal of Emergency Medicine

4305. Clarithromycin

offspring neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes (...) prescribing guidelines. If a macrolide is indicated, erythromycin is the preferred choice during pregnancy because there is more documented experience of its use than for other macrolides. Exposure to a macrolide antibiotic at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians

2014 UK Teratology Information Service

4306. Azithromycin

neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes, but that antibiotic (...) treatment should not be withheld at any stage in pregnancy if a pregnant woman is showing signs of infection. A single study has identified an association between asthma and in utero exposure to macrolides, but found the same for other antibiotic classes studied and did not take into account other reasons for asthma being more common in these children. Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing

2014 UK Teratology Information Service

4307. Cyanoacrylates

such as the manufacture of plastics, electronics and scientific instruments. Exposure may therefore occur in both domestic and occupational settings including factories and during manicuring, dentistry and surgery. No published reports have been found on the possible adverse effects of cyanoacrylate on human reproductive function or following exposure in human pregnancy or lactation. An evidence-based assessment of the risk to the fetus following either acute or chronic exposure during pregnancy is thus not possible (...) reporting form. Please encourage all women to complete an . Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced

2014 UK Teratology Information Service

4308. Macrolides

neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes, but that antibiotic (...) treatment should not be withheld at any stage in pregnancy if a pregnant woman is showing signs of infection. A single study has identified an association between asthma and in utero exposure to macrolides, but found the same for other antibiotic classes studied and did not take into account other reasons for asthma being more common in these children. Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing

2014 UK Teratology Information Service

4309. Ionising Radiation

kinetic energy or sufficient charge to displace atomic electrons resulting in molecular ionisation. Key factors which influence the degree of ionising radiation exposure and the subsequent biological effects include the duration of exposure, the distance from the source, the degree of shielding and the type of radiation emitted. Adverse fetal effects following ionising radiation exposure during gestational development can include dose-related deterministic effects which arise as a result of damage (...) of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs

2014 UK Teratology Information Service

4310. Erythromycin

neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes, but that antibiotic (...) treatment should not be withheld at any stage in pregnancy if a pregnant woman is showing signs of infection. A single study has identified an association between asthma and in utero exposure to macrolides, but found the same for other antibiotic classes studied and did not take into account other reasons for asthma being more common in these children. Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing

2014 UK Teratology Information Service

4312. The commodification of health care is destroying the doctor-patient relationship

and could prescribe whatever drug or test they felt necessary based on years of experience. While there was a strong doctor-patient relationship in those bygone days, it was not necessarily an equal partnership. Patriarchal doctors expected their advice to be followed and patients generally complied because they trusted their doctors. Patients today have lower expectations of their doctors, having never experienced a strong bond forged through generations of caregiving. Unless they need a prescription (...) . Limits must be set on astronomical copays and deductibles that drive patients away from their doctors. Eliminating the time-consuming and expensive middlemen of bureaucracy would not only help reduce costs but also would give back precious doctor-patient time — time that could be used for health caring. In theory, technology should free up time and allow doctors to spend more with their patients. Electronic medical records have fallen far short of this ideal, though, increasing provider frustration

2019 KevinMD blog

4313. Patient Dignity (Formerly:Patient Modesty): Volume 97

I have received for years during routine office visits, then again I'm at the disposable age [and male]. Everything else in my recent routine health care involves lab panels that AI is superior at analyzing and prescribing. The patient's medical history [EHR/EMR] is automatically retained and available to everyone not limited by HIPAA [joke]. Most prescriptions will be available when the patient leaves the booth from a system similar to technology used in warehouses for over 20 years, again (...) is going to stop all the meds and take his chances. He never wanted this procedure and does not want the prescription drug consequences their decision causes. The actions of the medical community and their godlike decrees have major and life altering consequences to its victims but they do not care and will continue to give themselves more power and control over their patient victims. This is the greatest power of modern medicine. The manner in which treatment is delivered has only worsened during

2019 Bioethics Discussion Blog

4315. Patient Dignity (Formerly:Patient Modesty):Volume 101

married gay people as people worthy of being on this planet although priests molesting children seems to okay as the Catholic church gives them shelter & protection forever. Why I mention this is bc the 1st ER hospital my husband went to put in MRs that were transferred electronically to the Catholic hospital where he was sent that he was a gay man w/ a husband, me his actual female wife. So for hours this Catholic hospital thought he was gay. He didn't know what they thought as he was too drugged

2019 Bioethics Discussion Blog

4316. Should we change how we treat mild asthma?

Should we change how we treat mild asthma? The AFP Community Blog: Should we change how we treat mild asthma? | Monday, September 23, 2019 - Jennifer Middleton, MD, MPH Inhaled corticosteroids are a mainstay for treating asthma; typically, they are prescribed on a scheduled basis, though . Two new studies may offer an alternative to scheduled inhaled corticosteroid dosing for patients with mild asthma. As described in the " ," these two randomized controlled trials compared the twice daily (...) years and older into three groups: twice daily placebo with an as needed terbutaline (a SABA) inhaler, twice daily placebo with as needed budesonide-formoterol, and twice daily budesonide with as needed terbutaline. Participants recorded daily peak expiratory flows, asthma symptoms, and nighttime awakenings using an electronic diary, and an electronic inhaler monitor recorded use of their as-needed inhaler. The researchers' primary outcome was "electronically recorded weeks of well-controlled asthma

2019 The AFP Community Blog

4317. Patient Dignity (Formerly:Patient Modesty):Volume 99

he did not get consent or the nurse is not going to say that she chose this patient to sexually abuse. The electronic systems make their coverup too easy. They literally just have to pick & click. This just reconfirms in our minds that it is not safe to seek hospital care where there is a chance they can use drugs to control & manipulate. Bc once they use drugs all the things you have done to maintain dignity & respect no longer matter to them. No, I do not think that any commencement speeches

2019 Bioethics Discussion Blog

4318. Patient Dignity (Formerly: Patient Modesty): Volume 94

-physician relationship (as opposed to the archaic, paternalistic term of the doctor-patient relationship). I am not sure exactly which volume I have brought this up in, but I argue that this is a more correct term as the patient is the primary member of importance in the relationship and thus put first. The term physician is also a more accurate term describing a person that is licensed to diagnose, treat, and prescribe. Three articles focus on the importance of shared decision making in individual (...) electronic devices should be carried by personnel carrying out patient care. 8. There are more but these come to mind first. Please feel free to add. JR At , said... PT Because people want those that care for their health and even their lives to consider them as human beings. They can't accept that patients are just objects to be processed at the convenience of the bureaucracy. Consider how people treat their family and friends when they are sick. These people can't imagine that anyone, with rare

2019 Bioethics Discussion Blog

4320. Patient Dignity (Formerly:Patient Modesty):Volume 102

Banterings, “I have made healthcare as irrelevant as possible in my life.” No physicals, no old sucker poisons, no cancer screenings. Fluoroquinolones thoughtlessly prescribed to me have caused rapid cataract genesis, something they are “famous” for. I am using a natural substance to try and dissolve the cataracts, and seem to be making progress after 6 months. Having fired the ba%^stard that was my optometrist, I now have to find a new one and will report if eyesight is better, which will indicate some

2019 Bioethics Discussion Blog

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