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Electronic Prescription

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4381. Differences between integrated and stand-alone E-prescribing systems have implications for future use. Full Text available with Trip Pro

Differences between integrated and stand-alone E-prescribing systems have implications for future use. Understanding the benefits of electronic prescribing systems has important implications for quality and efficiency in medical care. We surveyed physicians about their use of e-prescribing in outpatient practices. We found that physicians who use e-prescribing systems integrated into an electronic health record have different characteristics, usage patterns, perceived benefits, and levels (...) of satisfaction than physicians who use stand-alone systems. For example, although only 56 percent of the physicians we surveyed said that they checked a patient's drug history most or all of the time when writing a prescription, those with integrated systems were significantly more likely to report doing so than their counterparts with stand-alone systems. Our findings have implications for the American Recovery and Reinvestment Act's requirements for e-prescribing and the future use of this technology

2010 Health affairs

4382. Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline

), with consideration of the values that expert review- ers attributed to various outcomes and parents’ preferences. In total, we evaluated 71 studies that included 8050 chil- dren. We presented and discussed draft recommendations at an in-person meeting. We revised the recommendations to reflect the comments of panel members, and the revised ver- sions were disseminated electronically to the group for addi- tional comments. We held a conference call for further dis- cussion and confirmation of the recommendations (...) for or against the use of parent-led distraction or parent coaching during vaccina- tion of children as a way to reduce pain at the time of injec- tion, clinicians may offer this intervention to parents to reduce pain-related distress (grade B recommendation, based on level I evidence). Clinical considerations Education of parents (written, electronic or in person) is required before the use of parent-led distraction and parental behaviours that promote the child’s ability to cope. Parents are usually

2011 CPG Infobase

4383. Canadian clinical practice guidelines for acute and chronic rhinosinusitis

days spent bedridden and more visits to family physicians, alternative healthcare providers, and mental health experts. These findings underscore the significant impact of this disease on patient quality of life, as well as costs of care to patients and society. In Canada, 2.89 million prescriptions were dispensed for acute rhinosinusitis (ARS) or CRS in 2006, with approximately 2/3 for ARS and 1/3 for CRS [ ]. Despite well-established differences between these 2 diseases in pathophysiology (...) , bacteriology, and standard specialist treatment strategies, an assessment of therapies prescribed in Canada for CRS has shown that medications prescribed for CRS exactly paralleled those prescribed for ARS [ ]. The incidence of bacterial rhinosinusitis is difficult to obtain precisely given that not all patients will seek medical help. In the United States in 2007, ARS affected 26 million individuals and was responsible for 12.9 million office visits [ ]. Although no specific Canadian data is available

2011 CPG Infobase

4384. Diagnosis and management of colorectal cancer

be required to justify the actions that they have taken. Prior to prescribing, the licensing status of a medication should be checked in the current version of the British National Formulary (BNF). 4 The summary of product characteristics (SPC) should also be consulted in the electronic medicines compendium (www.medicines.org.uk). 1.4.2 ADDITIONAL ADVICE TO NHSSCOTLAND FROM HEALTHCARE IMPROVEMENT SCOTLAND AND THE SCOTTISH MEDICINES CONSORTIUM Healthcare Improvement Scotland processes multiple technology (...) derived from it should be fully documented in the patient’s case notes at the time the relevant decision is taken. 1.4.1 PRESCRIBING OF LICENSED MEDICINES OUTWITH THEIR MARKETING AUTHORISATION Recommendations within this guideline are based on the best clinical evidence. Some recommendations may be for medicines prescribed outwith the marketing authorisation (product licence). This is known as ‘off label’ use. It is not unusual for medicines to be prescribed outwith their product licence and this can

2011 SIGN

4385. Impact of statin related media coverage on use of statins: interrupted time series analysis with UK primary care data. Full Text available with Trip Pro

Impact of statin related media coverage on use of statins: interrupted time series analysis with UK primary care data.  To quantify how a period of intense media coverage of controversy over the risk:benefit balance of statins affected their use. Interrupted time series analysis of prospectively collected electronic data from primary care. Clinical Practice Research Datalink (CPRD) in the United Kingdom. Patients newly eligible for or currently taking statins for primary and secondary (...) ) and 1.04 (0.92 to 1.18; P=0.54), respectively), though there was a decrease in the overall proportion of patients with a recorded risk score. Patients already taking statins were more likely to stop taking them for both primary and secondary prevention after the high media coverage period (1.11 (1.05 to 1.18; P<0.001) and 1.12 (1.04 to 1.21; P=0.003), respectively). Stratified analyses showed that older patients and those with a longer continuous prescription were more likely to stop taking statins

2016 BMJ

4386. Predicting 2-Year Risk of Developing Pneumonia in Older Adults without Dementia Full Text available with Trip Pro

cohort, n = 2,250; validation cohort, n = 1,125.Potential pneumonia risk factors were identified from questionnaire data and interviewer assessments of functional status, medical history, smoking and alcohol use, cognitive function, personal care, and problem solving. Risk factors were also identified based on physical measures such as grip strength and gait speed and administrative database information on comorbid illnesses, laboratory tests, and prescriptions dispensed. Incident community-acquired (...) is commonly available in electronic medical records (EMRs), had equal or better performance (c-index = 0.69 in the validation cohort) than scores including more-detailed data such as functional status.Data commonly available in EMRs can stratify older adults into groups with varying subsequent 2-year pneumonia risk.© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

2016 EvidenceUpdates

4387. Administration of Antibiotics to Children Before Age 2 Years Increases Risk for Childhood Obesity Full Text available with Trip Pro

Administration of Antibiotics to Children Before Age 2 Years Increases Risk for Childhood Obesity Childhood obesity is increasing and is associated with adult obesity. Antibiotics have been used to promote weight gain in livestock for several decades. Antibiotics are commonly prescribed for children, but it is not clear how exposure to antibiotics early in life affects risk for obesity. We performed a population-based cohort study to assess the association between antibiotic exposure before age (...) 2 years and obesity at age 4 years.We performed a retrospective cohort study of 21,714 children in The Health Improvement Network-a population-representative dataset of >10 million individuals derived from electronic medical records from 1995 through 2013 in the United Kingdom. Eligible subjects were registered within 3 months of birth with complete follow-up and height and weight were recorded within 12 months of their 4th birthday. Antibiotic exposure was assessed before age 2 years

2016 EvidenceUpdates

4388. Pioglitazone use and risk of bladder cancer in patients with type 2 diabetes: retrospective cohort study using datasets from four European countries. Full Text available with Trip Pro

Pioglitazone use and risk of bladder cancer in patients with type 2 diabetes: retrospective cohort study using datasets from four European countries.  To evaluate the association between pioglitazone use and bladder cancer risk in patients with type 2 diabetes. Retrospective cohort study using propensity score matched cohorts. Healthcare databases from Finland, the Netherlands, Sweden, and the United Kingdom. Data comprised country specific datasets of linked records on prescriptions, hospitals (...) ); >40 000 mg cumulative dose, 0.65 (0.33 to 1.26) in the nearest match cohort). This study shows no evidence of an association between ever use of pioglitzone and risk of bladder cancer compared with never use, which is consistent with results from other recent studies that also included a long follow-up period. Registered to the European Union electronic register of post-authorisation studies (EU PAS register no EUPAS3626).Published by the BMJ Publishing Group Limited. For permission to use (where

2016 BMJ

4389. Occupational Therapy for Adults Undergoing Total Hip Replacement

rights reserved, including translation. No part of this publication may be reproduced, stored in a retrieval system or transmitted, by any form or means, electronic, mechanical, photocopying, recording, scanning or otherwise without the prior permission in writing of the College of Occupational Therapists, unless otherwise agreed or indicated. Copying is not permitted except for personal and internal use, to the extent permitted by national copyright law, or under the terms of a licence issued (...) agreed. The home situation is discussed from the perspective that the service user is expert in this domain and their speci?c needs and choices. The service user can inform the occupational therapist about speci?c heights of their furniture (chair, bed and toilet) so that equipment may be prescribed to compensate for lack of function, or to enable activities to be continued while observing hip precautions that restrict certain movements (should this be required by team protocols). The general layout

2012 Publication 1554

4390. Pruritus (PDQ®): Health Professional Version

of pruritus. History of malignant disease. Current malignant disease and treatment. Nonmalignant systemic diseases. Use of medications (analgesics, antibiotics, and other prescription and nonprescription drugs, including illicit drugs). Nutritional and fluid level status. Social history (hobbies, occupation, sexual history, and travel). Current skin care practices. Patient’s emotional state. A physical examination will provide data from an assessment of the following: All skin surfaces for signs (...) with atopic dermatitis, may be helpful. A half-cup of plain unscented sodium hypochlorite (bleach) is added to half a tub of tap water for soaking at the beginning of the bath period. If sponge bathing is required, this is equivalent to approximately 5 mL of bleach to 1 gal of water. Prescription products Topical steroids can reduce itching, but they reduce blood flow to the skin, resulting in thinning of the skin and increased susceptibility to injury.[ ][ ] Topical steroids should therefore be reserved

2016 PDQ - NCI's Comprehensive Cancer Database

4391. Cannabis use and treatment resistance in first episode psychosis: a natural language processing study. Full Text available with Trip Pro

Cannabis use and treatment resistance in first episode psychosis: a natural language processing study. Cannabis is frequently used among individuals with first episode psychosis and is associated with poor clinical outcomes. However, little is known about the effect of cannabis use on the response to antipsychotic medications and how use could affect outcomes. Using natural language processing on clinical data from a large electronic case register, we sought to investigate whether resistance (...) to antipsychotic treatment mediated poor clinical outcomes associated with cannabis use.Data were obtained from 2026 people with first episode psychosis in south London, UK. Cannabis use documented in free text clinical records was identified with natural language processing. Data for age, sex, ethnicity, marital status, psychotic disorder diagnosis, subsequent hospital admission, and number of unique antipsychotic medications prescribed were obtained using the Clinical Record Interactive Search instrument

2015 Lancet

4392. Controlled Substance Agreement

medications fall under a different contract (e.g. s prescribed by a psychiatrist) Document all stipulations (examples) All controlled substances in the contract must be prescribed by a single provider (with whom the patient is contracting with) All controlled substances in the contract must be dispensed by a single pharmacy Medication refills Must be done during a scheduled appointment (not by phone or after hours to an on-call provider) Lost prescriptions will not be replaced Prescription should include (...) date of earliest next refill Emergency treatment plan should be made clear to the patient (including an acute exacerbation of ) Compliance ing may be ordered Controlled substance monitoring programs may be accessed Broken Controlled Substance Contract criteria of or s Drug diversion (e.g. selling or sharing controlled substances) Drug seeking controlled substances from multiple providers Consequences of a broken Controlled Substance Contract Contracting provider will no longer prescribe controlled

2018 FP Notebook

4393. Financial Toxicity and Cancer Treatment (PDQ®): Health Professional Version

prescription formularies (i.e., copays that escalate depending on whether the drug is generic or branded, and by price) may be particularly troublesome for patients with cancer who are prescribed expensive oral chemotherapeutics. The proportion of health care plans with multitiered (>3) prescription formularies, in which expensive oral specialty drugs are associated with the highest cost sharing, increased from 3% in 2004 to nearly 88% in 2017.[ ] These trends in treatment cost and changes in insurance (...) the prescription last longer, 11% stated they took less medication than prescribed to make the prescription last longer, and 22% indicated that they did not fill a prescription because of cost.[ ] Among the patients reporting chemotherapy nonadherence, 1% skipped chemotherapy doses to make the prescription last longer, 1.67% took less chemotherapy to make the prescription last longer, and 3.33% did not fill a chemotherapy prescription because of cost. Furthermore, this study found that an increased likelihood

2016 PDQ - NCI's Comprehensive Cancer Database

4394. Financial Toxicity and Cancer Treatment (PDQ®): Health Professional Version

prescription formularies (i.e., copays that escalate depending on whether the drug is generic or branded, and by price) may be particularly troublesome for patients with cancer who are prescribed expensive oral chemotherapeutics. The proportion of health care plans with multitiered (>3) prescription formularies, in which expensive oral specialty drugs are associated with the highest cost sharing, increased from 3% in 2004 to nearly 88% in 2017.[ ] These trends in treatment cost and changes in insurance (...) the prescription last longer, 11% stated they took less medication than prescribed to make the prescription last longer, and 22% indicated that they did not fill a prescription because of cost.[ ] Among the patients reporting chemotherapy nonadherence, 1% skipped chemotherapy doses to make the prescription last longer, 1.67% took less chemotherapy to make the prescription last longer, and 3.33% did not fill a chemotherapy prescription because of cost. Furthermore, this study found that an increased likelihood

2016 PDQ - NCI's Comprehensive Cancer Database

4395. EANM Dosimetry Committee Series on Standard Operational Procedures for Pre-Therapeutic Dosimetry II. Dosimetry prior to Radioiodine Therapy of Benign Thyroid Diseases

- ommendations of the medical guideline [1] should be followed. For example, 300–400 Gy absorbed dose should be used to ablate autonomous nodules, and in patients with Graves’disease,thethyroidabsorbeddoseshouldbe150Gy if aiming at euthyroidism or 200–300 Gy for ablation. ThisSOPprovidesrecommendationsonhowtotailorthe therapeutic activity such that the absorbed dose to the thy- roid or diseased parts of the thyroid yields the prescribed value.Itisapplicableifalowactivityof 131 Iisadministered (...) of a tracer activity is described in the guideline; how- ever, general use of the method as well as administration of fixed activities or activity dosing linearly to the target mass and to the targeted absorbed dose is not recommended. A derivationoftheformulasrecommendedfordeterminingthe therapeutic activity as well as a worked example of a pretherapeutic dosimetry can be found in the Electronic supplementary material. The EANM Dosimetry Committee guidance document on good practice of clinical dosimetry

2013 European Association of Nuclear Medicine

4396. Pancreatic Cancer Treatment (PDQ®): Health Professional Version

therapy (n = 133). A total dose of 54 Gy in 30 daily fractions was prescribed with concurrent capecitabine at a dose of 800 mg/m 2 twice daily on days of radiation therapy.[ ][ ] The primary endpoint was OS. After interim analysis, the study was stopped early because of futility. With a median follow-up of 36.7 months, the median OS from the date of the first randomization was not significantly different between chemotherapy at 16.5 months (95% CI, 14.5–18.5 months) and chemoradiation therapy at 15.2

2016 PDQ - NCI's Comprehensive Cancer Database

4398. Cancer Genetics Risk Assessment and Counseling (PDQ®): Health Professional Version

Appropriate BRCA1/2 Mutation Testing: The Role of Family History Documentation and Genetic Counseling in a Multidisciplinary Clinic. Ann Surg Oncol 23 (Suppl 5): 634-641, 2016. [ ] Walker AP: The practice of genetic counseling. In: Baker DL, Schuette JL, Uhlmann WR, eds.: A Guide to Genetic Counseling. New York, NY: Wiley-Liss, 1998, pp 1-26. Bartels DM, LeRoy BS, Caplan AL, eds.: Prescribing Our Future: Ethical Challenges in Genetic Counseling. New York, NY: Aldine De Gruyter, 1993. Kenen RH: Genetic

2016 PDQ - NCI's Comprehensive Cancer Database

4399. Non-Small Cell Lung Cancer Treatment (PDQ®): Health Professional Version

: History. Physical examination. Routine laboratory evaluations. Chest x-ray. Chest CT scan with infusion of contrast material. Biopsy. Before a patient begins lung cancer treatment, an experienced lung cancer pathologist must review the pathologic material. This is critical because SCLC, which responds well to chemotherapy and is generally not treated surgically, can be confused on microscopic examination with NSCLC.[ ] Immunohistochemistry and electron microscopy are invaluable techniques (...) -grade non-small cell carcinoma. It has a very poor prognosis similar to that of small cell lung cancer (SCLC). Atypical carcinoid is recognized as an intermediate-grade neuroendocrine tumor with a prognosis that falls between typical carcinoid and high-grade SCLC and LCNEC. Neuroendocrine differentiation can be demonstrated by immunohistochemistry or electron microscopy in 10% to 20% of common NSCLCs that do not have any neuroendocrine morphology. These tumors are not formally recognized within

2016 PDQ - NCI's Comprehensive Cancer Database

4400. Cigarette Smoking: Health Risks and How to Quit (PDQ®): Health Professional Version

is unknown; however, it is presumed that this action is mediated by noradrenergic or dopaminergic mechanisms. Table 6. Bupropion Hydrochloride Brand Dose Side Effects Warning/Precaution Rx Zyban 150 mg/d × 3 d then increase to 300 mg/d × 7–12 wk Insomnia, dry mouth, dizziness, rhinitis Do not take with Wellbutrin or Wellbutrin SR Higher incidence of seizures in patients treated for bulimia, anorexia Do not prescribe >300 mg/d for patients being treated for bulimia d = day; Rx = prescription; wk = week (...) , uncontrolled hypertension, esophagitis, peptic ulcer disease, insulin-treated diabetes, or asthma, pregnant or breast-feeding women, and adolescent smokers).[ ] Table 1. Nicotine Patches Brand Dose Side Effects Comments Rx Habitrol 7–21 mg/d Erythema Use for 6–12 wk OTC Nicoderm CQ 7–21 mg/d Pruritus Use for 6–12 wk OTC Nicotrol 5–15 mg/d Burning at site Use for 14–20 wk Rx ProStep 11–22 mg/d Local irritation Use for 6–12 wk d = day; OTC = over the counter; Rx = prescription; wk = week. Current guidelines

2016 PDQ - NCI's Comprehensive Cancer Database

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