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Electronic Prescription

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4481. Development and validation of a clinical prediction rule for angiotensin-converting enzyme inhibitor-induced cough. (Full text)

Development and validation of a clinical prediction rule for angiotensin-converting enzyme inhibitor-induced cough. Angiotensin-converting enzyme inhibitors are effective for many cardiovascular diseases and are widely prescribed, but cough sometimes necessitates their withdrawal.To develop and validate a model that predicts, by using information available at first prescription, whether a patient will develop cough within 6 months.Retrospective cohort study with derivation and validation (...) sets.Outpatient clinics affiliated with an urban tertiary care hospital.Clinical data were collected from electronic charts. The derivation set included 1125 patients and the validation set included 567 patients.None.Angiotensin-converting enzyme inhibitor-induced cough assessed by predetermined criteria.In the total cohort, 12% of patients developed angiotensin-converting enzyme inhibitor-induced cough. Independent multivariate predictors of cough were older age, female gender, non-African American

2004 Journal of General Internal Medicine

4482. Physician practice revenues and use of information technology in patient care. (PubMed)

Survey. Physician practice revenues, measured as the percentage of total revenues, is defined along 2 dimensions: type (capitation, noncapitated managed care, or fee-for-service) and source (Medicare, Medicaid, or private/other). Analyses were adjusted for physician and practice characteristics and geographic location.The proportion of physicians using IT for 5 functions of patient care: treatment guidelines, formularies, patient notes or lists, electronic prescriptions, and data exchange with other

2007 Medical Care

4483. The denominator in general practice, a new approach from the Intego database. (Full text)

. Therefore a brief overview will be given from known approaches, then the new approach will be illustrated on a database named Intego, with data from 43 general practices in Belgium.The Intego database contains information about patient contacts, diagnoses, laboratory results and drug prescriptions, extracted from the participants' structured electronic medical record system. The number of patients who contacted the practice in a year can be calculated from the Intego data. On the other hand

2005 Family Practice

4484. The 'number needed to sample' in primary care research. Comparison of two primary care sampling frames for chronic back pain. (Full text)

and epidemiological research in primary care--a convenience sample and a general population sample--comparing the response and follow-up rates, the demographic and clinical characteristics of each sample, and calculating the 'number needed to sample' (NNS) for a hypothetical randomized controlled trial.In 1996, we selected two random samples of adults from 29 general practices in Grampian, for an epidemiological study of chronic pain. One sample of 4175 was identified by an electronic questionnaire that listed (...) patients receiving regular analgesic prescriptions--the 'repeat prescription sample'. The other sample of 5036 was identified from all patients on practice lists--the 'general population sample'. Questionnaires, including demographic, pain and general health measures, were sent to all. A similar follow-up questionnaire was sent in 2000 to all those agreeing to participate in further research. We identified a potential group of subjects for a hypothetical trial in primary care based on a recently

2005 Family Practice

4485. Utilisation of health care by women who have suffered abuse: a descriptive study on medical records in family practice. (Full text)

and managing partner abuse a retrospective study was performed. Anonymised data from the electronic medical records of women who have suffered abuse were collected over the period January 2001-July 2004. These data were compared to those from the average female population of the Second Dutch National Survey in General Practice 2001 (DNSGP-2).Family practices in Rotterdam and surrounding areas in 2004.The numbers of consultations and prescriptions for pain medication, tranquillisers and antidepressants (...) doubled consultation frequency, chronic pain and an excessively high number of prescriptions for pain medication are characteristics of healthcare utilisation of women have been abused in this study. These findings contribute to the development of the concept of the 'symptomatic' female patient.

2007 British Journal of General Practice

4486. Development and verification of a "virtual" cohort using the National VA Health Information System. (PubMed)

Development and verification of a "virtual" cohort using the National VA Health Information System. The VA's integrated electronic medical record makes it possible to create a "virtual" cohort of veterans with and without HIV infection to monitor trends in utilization, toxicity, and outcomes.We sought to develop a virtual cohort of HIV-infected veterans by adapting an existing algorithm, verifying this algorithm against independent clinical data, and finally identifying demographically-similar (...) HIV-uninfected comparators.Subjects were identified from VA administrative data in fiscal years 1998-2003 using a modified existing algorithm, then linked with Immunology Case Registry (ICR, the VA's HIV registry) and Pharmacy Benefits Management (centralized database of outpatient prescriptions) to verify accuracy of identification. The algorithm was modified to maximize positive predictive value (PPV) against ICR. Finally, 2 HIV-uninfected comparators were matched to each HIV-infected

2006 Medical Care

4487. Antibiotics for anthrax: patient requests and physician prescribing practices during the 2001 New York City attacks. (Full text)

Antibiotics for anthrax: patient requests and physician prescribing practices during the 2001 New York City attacks. Little is known about patient encounters with primary care physicians and prescribing practices during the 2001 US anthrax attacks.We retrospectively reviewed the electronic medical record of outpatient telephone and clinic visits at a large primary care practice in New York City from September 11 to December 31, 2001, to identify physician- and patient-related factors that were (...) an important and heretofore underdocumented role in responding to the 2001 anthrax attacks. Prescription of prophylactic antibiotics for anthrax was uncommon and appears to have been selective among concerned patients. These results highlight the importance of including primary care physicians in community-wide bioterrorism response planning.

2004 Archives of Internal Medicine

4488. Physician alerts to increase antidepressant adherence: fax or fiction? (Full text)

Physician alerts to increase antidepressant adherence: fax or fiction? Many managed care organizations use feedback based on electronically maintained claims data to alert physicians to potential treatment problems, including patient medication nonadherence. However, the efficacy of such interventions for improving adherence among patients treated for depression is unknown.We examined an antidepressant compliance program consisting of faxed alerts to physicians beginning May 2003 using (...) interrupted time series analysis to evaluate its impact on rates of antidepressant adherence between May 2002 and May 2004 among members of the managed care plan of Harvard Pilgrim Health Care, which is a health plan operating in 3 states in New England, with corporate headquarters in Wellesley, Mass. The program alerted prescribing physicians to patients with gaps of more than 10 days in refilling antidepressant prescriptions during the first 180 days of treatment. Our outcome measures were rates

2006 Archives of Internal Medicine

4489. Effect of a clinical pharmacy service on lipid control in patients with peripheral arterial disease. (Full text)

to the outpatient management of lipids in patients with PAD. The purpose of this study was to determine the effect of this service on lipid screening and control in patients with PAD.We analyzed the records of patients treated at a large, group-model, not-for-profit regional managed care system serving approximately 405,000 members. An electronic medical record provided full examination, laboratory, and pharmacy data for all patients. Pharmacy data were analyzed to determine prescriptions for lipid-lowering

2006 Journal of Vascular Surgery

4490. Rational Prescribing in Primary Care (RaPP-trial). A randomised trial of a tailored intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs in general practice [ISRCTN48751230]. (Full text)

eligible patients seen in the participating practices during one year after the intervention. A multifaceted intervention has been tailored to address identified barriers to change. Key components are an educational outreach visit with audit and feedback, and computerised reminders. Pharmacists will conduct the visits. During the outreach visit the main recommendations will be presented and software will be installed that links to the electronic medical record systems used in the participating (...) practices. The software will perform an audit that will be fed back during the visit, present pop-up reminders for patients with high blood pressure or cholesterol, and provide a cardiovascular risk calculator and patient education material. The main outcomes are the proportions of 1) first time prescriptions for hypertension where thiazides are not prescribed, 2) patients not assessed for cardiovascular risk before prescribing antihypertensive or cholesterol-lowering drugs, and 3) patients treated

2003 BMC health services research Controlled trial quality: uncertain

4491. Failure of computerized treatment suggestions to improve health outcomes of outpatients with uncomplicated hypertension: results of a randomized controlled trial. (PubMed)

Failure of computerized treatment suggestions to improve health outcomes of outpatients with uncomplicated hypertension: results of a randomized controlled trial. To assess the effects of evidence-based treatment suggestions for hypertension made to physicians and pharmacists using a comprehensive electronic medical record system.Randomized controlled trial with a 2 x 2 factorial design of physician and pharmacist interventions, which resulted in four groups of patients: physician intervention (...) only, pharmacist intervention only, intervention by physician and pharmacist, and intervention by neither physician nor pharmacist (control).Academic primary care internal medicine practice.Seven hundred twelve patients with uncomplicated hypertension.Suggestions were displayed to physicians on computer workstations used to write outpatient orders and to pharmacists when filling prescriptions. The primary end point was generic health-related quality of life. Secondary end points were symptom

2004 Pharmacotherapy Controlled trial quality: uncertain

4492. Effects of continuous versus bolus infusion of enteral nutrition in critical patients. (PubMed)

consecutive candidates for enteral feeding were divided into 2 groups (n = 14 each) that were matched for diagnosis and APACHE II score. A commercial immune-stimulating polymeric diet was administered via nasogastric tube by electronic pump in the proportion of 25 kcal/kg/day, either as a 1-hour bolus every 3 hours (Group I), or continuously for 24 hours (Group II), over a 3-day period. Anthropometrics, biochemical measurements, recording of administered drugs and other therapies, thorax X-ray (...) in this regard, without statistical differences, probably because of meticulous technique, careful monitoring, strict patient matching, and conservative amounts of diet employed in both situations. Further studies with additional populations, diagnostic groups, and dietetic prescriptions should be performed in order to elucidate the differences between these commonly used feeding modalities.

2003 Revista do Hospital das Clínicas Controlled trial quality: uncertain

4493. Prescribing a website. (PubMed)

Prescribing a website. To assess the value of directing the attention of patients to sources of medical information on the internet.Prospective qualitative study in an orthopaedic outpatient clinic.253 patients agreed to complete electronic questionnaires before and after reviewing information relevant to their conditions on the internet. Patients were allocated randomly into two groups; one group was given indications of general sites and the other recommended specific non-commercial sites (...) represented the best source of patient education.Increasing numbers of patients are familiar with the internet. Most of our patients felt that the internet was, on balance, helpful in providing information. The main difficulties with the internet are the sheer volume of information, the potential for misleading and the danger of misunderstanding. We feel that there is a real place for the specific prescription of an internet site by a clinician who has personally reviewed it to a patient thought

2005 Scottish medical journal Controlled trial quality: uncertain

4494. Reducing warfarin medication interactions: an interrupted time series evaluation. (Full text)

organization with an electronic medical record, we evaluated the effectiveness of electronic medical record alerts and group academic detailing to reduce the coprescribing of warfarin and interacting medications. Participants were 239 primary care providers at 15 primary care clinics and 9910 patients taking warfarin. All 15 clinics received electronic medical record alerts for the coprescription of warfarin and 5 interacting medications: acetaminophen, nonsteroidal anti-inflammatory medications (...) , fluconazole, metronidazole, and sulfamethoxazole. Seven clinics were randomly assigned to receive group academic detailing. The primary outcome, the interacting prescription rate (ie, the number of coprescriptions of warfarin-interacting medications per 10 000 warfarin users per month), was analyzed with segmented regression models, controlling for preintervention trends.At baseline, nearly a third of patients had an interacting prescription. Coinciding with the alerts, there was an immediate

2006 Archives of internal medicine Controlled trial quality: uncertain

4495. A pharmacy-based coaching program to improve adherence to antidepressant treatment among primary care patients. (Full text)

A pharmacy-based coaching program to improve adherence to antidepressant treatment among primary care patients. The effects on adherence and depressive symptoms of a community pharmacy-based coaching program, including a take-home videotape, were evaluated in a randomized controlled trial in the Netherlands. A total of 147 depressed primary care patients who had a new antidepressant prescription were included in the study. Adherence was measured with an electronic pill container and was also

2005 Psychiatric services (Washington, D.C.) Controlled trial quality: uncertain

4496. Can computer-generated evidence-based care suggestions enhance evidence-based management of asthma and chronic obstructive pulmonary disease? A randomized, controlled trial. (Full text)

of 246 physicians (25 percent faculty general internists, 75 percent internal medicine residents) and 20 outpatient pharmacists. We enrolled 706 of their primary care patients with asthma or chronic obstructive pulmonary disease. Care suggestions concerning drugs and monitoring were delivered to a random half of the physicians and pharmacists when writing orders or filling prescriptions using computer workstations. A 2 x 2 factorial randomization of practice sessions and pharmacists resulted in four (...) groups of patients: physician intervention, pharmacist intervention, both interventions, and controls. DATA EXTRACTION/COLLECTION METHODS: Adherence to the guidelines and clinical activity was assessed using patients' electronic medical records. Health-related quality of life, medication adherence, and satisfaction with care were assessed using telephone questionnaires.During their year in the study, patients made an average of five scheduled primary care visits. There were no differences between

2005 Health services research Controlled trial quality: uncertain

4497. Point-of-Service reminders for prescribing cardiovascular medications. (PubMed)

identified from electronic data in a managed care organization and randomly assigned into 2 groups. Physicians seeing outpatients in the intervention group were faxed a sheet with pertinent patient data, including a recommendation to prescribe the indicated medication. In the control group, the data sheet did not include the recommendation. Dispensed prescriptions were compared between groups.More than 4000 visits were observed for each medication type. Angiotensin-converting enzyme inhibitors (...) Point-of-Service reminders for prescribing cardiovascular medications. To provide physicians with evidence-based recommendations for care at the point of service, using an automated system, and to evaluate its effectiveness in promoting prescriptions to prevent cardiovascular events.Randomized controlled trial.Patients at risk for cardiovascular events who might benefit from angiotensin-converting enzyme inhibitors or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) were

2005 The American journal of managed care Controlled trial quality: uncertain

4498. A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97. (Full text)

A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97. To appraise findings from studies examining the impact of computers on primary care consultations.Systematic review of world literature from 1980 to 1997.5475 references were identified from electronic databases (Medline, Science Citation Index, Social Sciences Citation Index, Index of Scientific and Technical Proceedings, Embase, OCLC FirstSearch Proceedings (...) for preventive tasks and disease management improved process rates, although some returned to pre-intervention levels when reminders were stopped. Use of computers for issuing prescriptions increased prescribing of generic drugs, and use of computers for test ordering led to cost savings and fewer unnecessary tests. There were no negative effects on those patient outcomes evaluated. Doctors and patients were generally positive about use of computers, but issues of concern included their impact on privacy

2001 BMJ

4499. Weight management: a comparison of existing dietary approaches in a work-site setting. (Full text)

. For the 12 week structured weight maintenance phase, individualized energy prescriptions were re-calculated for the ED group as 1.4 (activity factor) x basal metabolic rate. Healthy eating advice was reviewed with subjects in the GLC group. All subjects were contacted by electronic mail at 2 week intervals and anthropometric and dietary information requested.No difference was evident between diet groups in mean weight loss at 12 weeks (4.3 (s.d. 3.4) kg ED group vs 5.0 (s.d. 3.5) kg GLC group, P=0.34 (...) than the 6279 kJ (1500 kcal) GLC approach. However the ED approach might be considered preferable as compliance was better with this less demanding prescription. In terms of weight loss the elimination of red meat from the diet is unnecessary. The weight maintenance intervention was designed as a low-input approach, however weight regain was significant and weight maintenance strategies require further development.

2002 International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity Controlled trial quality: uncertain

4500. Radiation Therapy and Chemotherapy Before and After Surgery in Treating Patients With Esophageal Cancer

Procedure: conventional surgery The type of resection (lvor-Lewis, Transhiatal, etc.) was left to the discretion of the operating surgeon. One lymph node dissection was required. Radiation: radiation therapy The total dose to the prescription point was 4500 cGy given in 25 fractions. The patient was treated with one fraction per day with all fields treated per day. 180 cGy was delivered to the isocenter. If the dose to the supraclavicular fossa (SCF) was less than 4500 cGy, a localized photon (...) or electron boost was allowed in order to increase the SCF dose to 4500 cGy, specified at 3 cm depth from the anterior skin surface. Experimental: Paclitaxel / Cisplatin / Radiation therapy (Arm B) Days 1 - 35 : Concurrent radiation therapy (RT) and Paclitaxel/Cisplatin Chemotherapy. Radiotherapy 45 Gy administered at 1.8 Gy per day, 5 days a week for 5 weeks. Paclitaxel 50 mg/m² (1 hr) days 1, 8, 15, 22, 29. Cisplatin 30 mg/m² days 1, 8, 15, 22, 29. Chemotherapy should begin within 24 hours of start

2002 Clinical Trials

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