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Electronic Prescription

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121. Patterns of Antibiotic Prescription in Children: Tirana, Albania Region (PubMed)

use of broad-spectrum antibiotics for common respiratory tract infection in children less than 6 years old. We would recommend the creation of an electronic database of patient's record in order to monitor the quality of prescription and education of the healthcare professionals and patient of risks related to antibiotic resistance. (...) Patterns of Antibiotic Prescription in Children: Tirana, Albania Region Antibiotics (abx) constitute the most prescribed therapeutic agent in the world. There is little data regarding antibiotic consumption by young children in Albania.This study aims to evaluate antibiotic prescription in children in quantitative and qualitative terms, and therefore, propose recommendations to improve overall clinical outcomes.A retrospective, cross-sectional drug utilisation study was conducted based

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2018 Open access Macedonian journal of medical sciences

122. Effect of Electronic Health Record-Based Medication Support and Nurse-Led Medication Therapy Management on Hypertension and Medication Self-management: A Randomized Clinical Trial

Effect of Electronic Health Record-Based Medication Support and Nurse-Led Medication Therapy Management on Hypertension and Medication Self-management: A Randomized Clinical Trial Complex medication regimens pose self-management challenges, particularly among populations with low levels of health literacy.To test medication management tools delivered through a commercial electronic health record (EHR) with and without a nurse-led education intervention.This 3-group cluster randomized clinical (...) trial was performed in community health centers in Chicago, Illinois. Participants included 794 patients with hypertension who self-reported using 3 or more medications concurrently (for any purpose). Data were collected from April 30, 2012, through February 29, 2016, and analyzed by intention to treat.Clinics were randomly assigned to to groups: electronic health record-based medication management tools (medication review sheets at visit check-in, lay medication information sheets printed after

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2018 EvidenceUpdates

123. NHMRC CEO Statement: Electronic cigarettes (e-cigarettes)

NHMRC CEO Statement: Electronic cigarettes (e-cigarettes) CEO Statement: Electronic cigarettes | NHMRC NHMRC Tagline NHMRC Tagline Publication date Publication date Content type Filtered by: All Publications News Page Search Quick links Toggle navigation Main navigation Funding One researcher has the potential to improve millions of lives. We provide funding for research through our grant system, with a transparent peer-review process to determine how funding is allocated. May 07 2018 May 07 (...) researchers and help them protect intellectual property. Jun 14 2018 Jul 25 2018 About us At NHMRC we are excited by the huge potential benefits of the research we fund and by the opportunities we have to ensure Australians have access to evidence-based, authoritative health advice. We create pathways to a healthier future through our research funding, our health guidelines and the ethical standards we set and uphold. Jul 25 2018 Jul 25 2018 CEO Statement: Electronic cigarettes CEO Statement: Electronic

2015 National Health and Medical Research Council

124. Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette Users: Implications for Cardiovascular Risk (PubMed)

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

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2017 JAMA cardiology

125. Applying STOPP Guidelines in Primary Care Through Electronic Medical Record Decision Support: Randomized Control Trial Highlighting the Importance of Data Quality (PubMed)

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

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2017 JMIR medical informatics Controlled trial quality: uncertain

126. Electronic Health Records (EHRs)

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 (...) . Key challenges identified by health practitioners who have implemented EHRs b. Proposed Solutions 10. EHRs: More Research? Background • In 1991, the Institute of Medicine released a landmark report recommending that electronic health records (EHRs) be implemented in health systems within 10 years 1 ; • Almost 20 years later, only a small proportion of health providers have implemented EHRs. 2 3 • A meta-analysis of diffusion rates of EHRs in the U.S. shows that uptake has slowed in recent years

2014 OHRI Knowledge to Action

127. Validating laboratory defined chronic kidney disease in the electronic health record for patients in primary care. (PubMed)

Validating laboratory defined chronic kidney disease in the electronic health record for patients in primary care. Electronic health record (EHR) data is increasingly used to identify patients with chronic kidney disease (CKD). EHR queries used to capture CKD status, identify comorbid conditions, measure awareness by providers, and track adherence to guideline-concordant processes of care have not been validated.We extracted EHR data for primary-care patients with two eGFRcreat 15-59 mL/min (...) and the EHR diagnoses on the presence of comorbidities was good (κ > 0.70, p < 0.05), except for congestive heart failure, (κ = 0.45, p < 0.05). Reviewers felt the providers were aware of CKD in 23 of 34 (68%) of the confirmed CKD cases. A CKD diagnosis was associated with higher odds of guideline-driven care including CKD-specific laboratory tests and prescriptions for statins. After adjustment, CKD diagnosis documentation was not significantly associated with ACE/ARB prescription.Identifying CKD status

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2019 BMC Nephrology

128. Prognosis of undiagnosed chest pain: linked electronic health record cohort study. (PubMed)

Prognosis of undiagnosed chest pain: linked electronic health record cohort study. Objective To ascertain long term cardiovascular outcomes in patients whose chest pain remained undiagnosed six months after first presentation.Design Cohort study.Setting UK electronic health record database (CALIBER) linking primary care, secondary care, coronary registry, and death registry information.Participants 172 180 adults aged ≥18 from 223 general practices presenting with a first episode of recorded (...) chest pain, classified from medical records as diagnosed (non-coronary condition or angina) or undiagnosed (cause unattributed) at first consultation between 2002 and 2009 and with no previous record of cardiovascular disease.Main outcome measures Fatal or non-fatal cardiovascular events over 5.5 years' follow-up. Adjustments were made for age, sex, deprivation, body mass index, smoking status, year of index presentation, and previous records of diabetes or hypertension or previous prescriptions

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2017 BMJ

129. Ascertainment of Aspirin Exposure Using Structured and Unstructured Large-scale Electronic Health Record Data. (PubMed)

Ascertainment of Aspirin Exposure Using Structured and Unstructured Large-scale Electronic Health Record Data. Aspirin impacts risk for important outcomes such as cancer, cardiovascular disease, and gastrointestinal bleeding. However, ascertaining exposure to medications available both by prescription and over-the-counter such as aspirin for research and quality improvement purposes is a challenge.Develop and validate a strategy for ascertaining aspirin exposure, utilizing a combination (...) of structured and unstructured data.This is a retrospective cohort study.In total, 1,869,439 Veterans who underwent usual care colonoscopy 1999-2014 within the Department of Veterans Affairs.Aspirin exposure and dose were obtained from an ascertainment strategy combining query of structured medication records available in electronic health record databases and unstructured data extracted from free-text progress notes. Prevalence of any aspirin exposure and dose-specific exposure were estimated. Positive

2019 Medical Care

130. Comparing prescribing and dispensing databases to study antibiotic use: a validation study of the Electronic Medical Record Administrative data Linked Database (EMRALD). (PubMed)

Comparing prescribing and dispensing databases to study antibiotic use: a validation study of the Electronic Medical Record Administrative data Linked Database (EMRALD). Monitoring and studying community antibiotic use is a critical component in combating rising antimicrobial resistance.To validate an electronic medical record dataset containing antibiotic prescriptions and to quantify some important differences between prescribing and dispensing databases.We evaluated antibiotics prescribed (...) the highest prescribing physicians.We demonstrated EMRALD is well suited for studying antibiotic prescribing by EMRALD physicians. However, due to the frequency with which patients receive antibiotic prescriptions from their non-primary care physicians, we caution against the use of non-population-based prescribing databases to infer antibiotic use rates or trends over time.© Her Majesty the Queen in Right of Canada, as represented by the Minister of Public Health Agency of Canada, 2019.

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2019 Journal of Antimicrobial Chemotherapy

131. Long-term outcomes of urinary tract infection (UTI) in Childhood (LUCI): protocol for an electronic record-linked cohort study. (PubMed)

Long-term outcomes of urinary tract infection (UTI) in Childhood (LUCI): protocol for an electronic record-linked cohort study. Current guidelines advise the prompt diagnosis and treatment of urinary tract infection (UTI) in children to improve both short and longer term outcomes. However, the risk of long-term complications following childhood UTI is unclear.UTI is relatively common but difficult to diagnose in children as symptoms are non-specific. Diagnosis requires a urine sample (...) ) Databank (an 'e-cohort'). Urine sampling in this data set reflects normal practice 'routine sampling'. Outcomes (including renal scarring, hypertension, end-stage renal failure, hospital admissions, GP consultations, antibiotic prescriptions) for children with at least one UTI confirmed with microbiological culture (mcUTI) or no mcUTI before the age of 5 will be compared.The second will combine data from two prospective observational studies ('DUTY' and 'EURICA') employing systematic urine sampling

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2019 BMJ open

132. Identifying musculoskeletal conditions in electronic medical records: a prevalence and validation study using the Deliver Primary Healthcare Information (DELPHI) database. (PubMed)

Identifying musculoskeletal conditions in electronic medical records: a prevalence and validation study using the Deliver Primary Healthcare Information (DELPHI) database. Musculoskeletal (MSK) conditions are a common presentation in primary care. This study sought to determine the prevalence of MSK conditions in primary care in Ontario and to validate the extent to which health administrative date billing codes accurately represent MSK diagnoses.De-identified electronic medical records (EMR (...) prevalence of MSK was 52.3% and varied by age (4.5% 0-17 years, 20.1% 18-44, 42.7% 45-64, and 32.7% 65+). Patients at MSK encounters had a higher number of: investigations (17.9% compared to 9.1%, p < .0001); referrals (17.6% compared to 14.3%, p < .0001); and prescriptions for opioids (17.2% compared to 5.3%, p < .0001).This study determined the prevalence of musculoskeletal conditions in primary care in Ontario using a reference standard definition. The study highlighted the value of using primary care

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2019 BMC Musculoskeletal Disorders

133. Effect of New York State Electronic Prescribing Mandate on Opioid Prescribing Patterns. (PubMed)

Effect of New York State Electronic Prescribing Mandate on Opioid Prescribing Patterns. Drug overdose was the leading cause of injury and death in 2013, with drug misuse and abuse causing approximately 2.5 million emergency department (ED) visits in 2011. The Electronic Prescriptions for Controlled Substances (EPCS) program was created with the goal of decreasing rates of prescription opioid addiction, abuse, diversion, and death by making it more difficult to "doctor-shop" and alter (...) prescriptions.In this study, we describe the opioid-prescribing patterns of emergency physicians after the introduction of the New York State EPCS mandate.We conducted a retrospective, single-center, descriptive study with a pre-/post-test design. The pre-implementation period used for comparison was April 1-July 31, 2015 and the post-implementation period was April 1-July 31, 2016. All ED discharge prescriptions for opioid medications prior to and after the initiation of New York State EPCS were

2019 Journal of Emergency Medicine

134. 'Warning: allergic to penicillin': association between penicillin allergy status in 2.3 million NHS general practice electronic health records, antibiotic prescribing and health outcomes. (PubMed)

'Warning: allergic to penicillin': association between penicillin allergy status in 2.3 million NHS general practice electronic health records, antibiotic prescribing and health outcomes. The prevalence of reported penicillin allergy (PenA) and the impact these records have on health outcomes in the UK general population are unknown. Without such data, justifying and planning enhanced allergy services is challenging.To determine: (i) prevalence of PenA records; (ii) patient characteristics (...) associated with PenA records; and (iii) impact of PenA records on antibiotic prescribing/health outcomes in primary care.We carried out cross-sectional/retrospective cohort studies using patient-level data from electronic health records. Cohort study: exact matching across confounders identified as affecting PenA records. Setting: English NHS general practices between 1 April 2013 and 31 March 2014. Participants: 2.3 million adult patients. Outcome measures: prevalence of PenA, antibiotic prescribing

2019 Journal of Antimicrobial Chemotherapy

135. Opportunities to reduce antibiotic prescribing for patients with COPD in primary care: a cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD). (PubMed)

Opportunities to reduce antibiotic prescribing for patients with COPD in primary care: a cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD). In primary care there is uncertainty about which patients with acute exacerbations of COPD (AECOPD) benefit from antibiotics.To identify which types of COPD patients get the most antibiotics in primary care to support targeted antibiotic stewardship.Observational study of COPD patients using a large English (...) primary care database with 12 month follow-up. We estimated the incidence of and risk factors for antibiotic prescribing relative to the number of AECOPD during follow-up, considering COPD severity, smoking, obesity and comorbidity.From 157 practices, 19594 patients were diagnosed with COPD, representing 2.6% of patients and 11.5% of all prescribed antibiotics. Eight hundred and thirty-three (4.5%) patients with severe COPD and frequent AECOPD were prescribed six to nine prescriptions per year

2019 Journal of Antimicrobial Chemotherapy

136. A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results. (PubMed)

A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results. Smokers usually abstain from tobacco while hospitalized but relapse after discharge. Inpatient interventions may encourage sustained quitting. We previously demonstrated that a decision support tool embedded in an electronic health record (EHR) improved physicians' treatment of hospitalized smokers. This report describes the effect on quit rates of this decision (...) support tool and order set for hospitalized smokers.In a single hospital system, 254 physicians were randomized 1:1 to receive a decision support tool and order set, embedded in the EHR. When an adult patient was admitted to a medical service, an electronic alert appeared if current smoking was recorded in the EHR. For physicians receiving the intervention, the alert linked to an order set for tobacco treatment medications and electronic referral to the state tobacco quitline. Additionally, "Tobacco

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2019 Implementation Science : IS Controlled trial quality: uncertain

137. Safety and efficacy of C-reactive protein-guided antibiotic use to treat acute respiratory infections in Tanzanian children: a planned subgroup analysis of a randomized, controlled non-inferiority trial evaluating a novel electronic clinical decision algo (PubMed)

Safety and efficacy of C-reactive protein-guided antibiotic use to treat acute respiratory infections in Tanzanian children: a planned subgroup analysis of a randomized, controlled non-inferiority trial evaluating a novel electronic clinical decision algo Antibiotic overuse in pediatric primary care in resource-limited settings is driven by respiratory infections. The safety and efficacy of using C-reactive protein (CRP) to decide on antibiotic prescription among febrile children at risk (...) in the intervention versus 40.4% (345/854) in the control arm received antibiotics at D0 (RR 0.06, 0.040.09). There were fewer secondary hospitalizations and deaths in the CRP arm: 0.5% (4/865) versus 1.5% (13/854, RR 0.30, 0.100.93).CRP testing using a high cut-off, combined with two respiratory signs into an electronic decision algorithm was able to improve clinical outcome in children with respiratory infections while substantially reducing antibiotic prescription.

2019 Clinical Infectious Diseases Controlled trial quality: predicted high

138. A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results. (PubMed)

A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results. Smokers usually abstain from tobacco while hospitalized but relapse after discharge. Inpatient interventions may encourage sustained quitting. We previously demonstrated that a decision support tool embedded in an electronic health record (EHR) improved physicians' treatment of hospitalized smokers. This report describes the effect on quit rates of this decision (...) support tool and order set for hospitalized smokers.In a single hospital system, 254 physicians were randomized 1:1 to receive a decision support tool and order set, embedded in the EHR. When an adult patient was admitted to a medical service, an electronic alert appeared if current smoking was recorded in the EHR. For physicians receiving the intervention, the alert linked to an order set for tobacco treatment medications and electronic referral to the state tobacco quitline. Additionally, "Tobacco

2019 Implementation Science Controlled trial quality: uncertain

139. A novel electronic algorithm using host biomarker point-of-care tests for the management of febrile illnesses in Tanzanian children (e-POCT): A randomized, controlled non-inferiority trial (PubMed)

A novel electronic algorithm using host biomarker point-of-care tests for the management of febrile illnesses in Tanzanian children (e-POCT): A randomized, controlled non-inferiority trial The management of childhood infections remains inadequate in resource-limited countries, resulting in high mortality and irrational use of antimicrobials. Current disease management tools, such as the Integrated Management of Childhood Illness (IMCI) algorithm, rely solely on clinical signs and have not made (...) use of available point-of-care tests (POCTs) that can help to identify children with severe infections and children in need of antibiotic treatment. e-POCT is a novel electronic algorithm based on current evidence; it guides clinicians through the entire consultation and recommends treatment based on a few clinical signs and POCT results, some performed in all patients (malaria rapid diagnostic test, hemoglobin, oximeter) and others in selected subgroups only (C-reactive protein, procalcitonin

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2017 EvidenceUpdates Controlled trial quality: predicted high

140. Adverse drug reactions caused by drug-drug interactions in cardiovascular disease patients: introduction of a simple prediction tool using electronic screening database items. (PubMed)

Adverse drug reactions caused by drug-drug interactions in cardiovascular disease patients: introduction of a simple prediction tool using electronic screening database items. Objective: Cardiovascular disease (CVD) drugs have been frequently implicated in adverse drug reaction (ADR)-related hospitalizations. Drug-drug interactions (DDIs) are common preventable cause of ADRs, but the impact of DDIs in the CVD population has not been investigated. Hence, the primary aim of the study (...) .). Results: DDIs contributed to hospital admission with a total prevalence of 9.69%. DDI-related ADRs affected mainly cardiac function (heart rate or rhythm, 41.07%); bleeding and effect on blood pressure were equally distributed (17.86%). Non-cardiovascular ADRs were found in 23.21% of DDIs. After admission, 73% of the identified DDIs led to changes in prescription. Prediction ability of calculated DDI adverse event probability scores was rated as good (AUC = 0.80, p < .001). Conclusions: CVD patients

2019 Current medical research and opinion

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