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Electronic Prescription

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141. Prescription of Antibiotics to Treat Gonorrhoea in General Practice in Flanders 2009–2013: A Registry-Based Retrospective Cohort Study (PubMed)

followed.A retrospective cohort study (2009-2013) of antibiotic prescriptions for gonorrhoea cases registered in the Flemish Intego general practice database was carried out. The database is based on electronic health record routine registration by over 90 GPs using the software programme Medidoc.Ninety-one gonorrhoea cases with ten chlamydia and one genital trichomonas coinfections in 90 patients were registered between 2009 and 2013. The proportion of cases with ceftriaxone and/or spectinomycin (...) Prescription of Antibiotics to Treat Gonorrhoea in General Practice in Flanders 2009–2013: A Registry-Based Retrospective Cohort Study General practitioners (GPs) as a group have been identified as playing an important role in gonorrhoea management in Flanders. Belgian guidelines recommended ceftriaxone or alternatively spectinomycin from 2008 onwards and azithromycin combination therapy since 2012.This study investigates to which extent contemporary gonorrhoea treatment guidelines were

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2017 Journal of sexually transmitted diseases

142. Elaboration and Validation of the Medication Prescription Safety Checklist (PubMed)

Elaboration and Validation of the Medication Prescription Safety Checklist to elaborate and validate a checklist to identify compliance with the recommendations for the structure of medication prescriptions, based on the Protocol of the Ministry of Health and the Brazilian Health Surveillance Agency.methodological research, conducted through the validation and reliability analysis process, using a sample of 27 electronic prescriptions.the analyses confirmed the content validity and reliability (...) of the tool. The content validity, obtained by expert assessment, was considered satisfactory as it covered items that represent the compliance with the recommendations regarding the structure of the medication prescriptions. The reliability, assessed through interrater agreement, was excellent (ICC=1.00) and showed perfect agreement (K=1.00).the Medication Prescription Safety Checklist showed to be a valid and reliable tool for the group studied. We hope that this study can contribute to the prevention

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2017 Revista latino-americana de enfermagem

143. Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department (PubMed)

Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department Objective: The aim of this study was to compare the 30-day emergency department (ED) return rate between patients given a Take Home Medication pack (THM) versus a standard paper prescription (SPP) prior to discharge. Methods: This was an observational, prospective cohort study in an urban, university-affiliated, level I trauma center. Patients were identified through daily (...) pharmacy reports. Consecutive adult patients discharged from the ED with either a THM or equivalent SPP were included. For each patient, baseline characteristics including age, gender, primary care provider (PCP), primary language, ethnicity, marital status, and insurance status were recorded from the electronic medical record (EMR). Review of the EMR was used to determine whether patients returned to the ED within 30 days and whether the return visit was for all-causes or for the same complaint

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2017 Hospital pharmacy

144. Health-Compromising Practices of Undergraduate College Students: Examining Racial/Ethnic and Gender Differences in Characteristics of Prescription Stimulant Misuse (PubMed)

Health-Compromising Practices of Undergraduate College Students: Examining Racial/Ethnic and Gender Differences in Characteristics of Prescription Stimulant Misuse 28088745 2018 04 04 2018 11 13 1873-6327 68 2017 05 Addictive behaviors Addict Behav Health-compromising practices of undergraduate college students: Examining racial/ethnic and gender differences in characteristics of prescription stimulant misuse. 59-65 S0306-4603(17)30016-3 10.1016/j.addbeh.2017.01.016 Cruz Sheena S Health Science (...) Department, California State University, 1250 Bellflower Blvd., Long Beach, CA 90840, United States. Electronic address: Sheena.Cruz@student.csulb.edu. Sumstine Stephanie S Health Science Department, California State University, 1250 Bellflower Blvd., Long Beach, CA 90840, United States. Electronic address: Stephanie.Sumstine@student.csulb.edu. Mendez Jocelyne J Health Science Department, California State University, 1250 Bellflower Blvd., Long Beach, CA 90840, United States. Electronic address

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2017 Addictive behaviors

145. Adverse and Hypersensitivity Reactions to Prescription Nonsteroidal Anti-Inflammatory Agents in a Large Healthcare System (PubMed)

Adverse and Hypersensitivity Reactions to Prescription Nonsteroidal Anti-Inflammatory Agents in a Large Healthcare System Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently used medications in the United States. NSAID use can be limited by adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs).We aimed to use electronic health record data to determine the incidence and predictors of HSRs to prescription NSAIDs.We performed a retrospective cohort (...) study of all adult outpatients in a large health care system prescribed diclofenac, indomethacin, nabumetone, or piroxicam between January 1, 2004, and September 30, 2012. The primary outcome was an ADR or HSR attributed to the prescribed NSAID within 1 year of prescription, determined from a longitudinal allergy database. We used natural language processing to classify known ADRs as either HSRs or side effects. Multivariable logistic regression models were used to identify independent risk factors

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2017 The journal of allergy and clinical immunology. In practice

146. Safe Opioid Prescription: A SMART on FHIR Approach to Clinical Decision Support (PubMed)

Safe Opioid Prescription: A SMART on FHIR Approach to Clinical Decision Support Background Prescription opioid pain medication overuse, misuse and abuse have been a significant contributing factor in the opioid epidemic. The rising death rates from opioid overdose have caused healthcare practitioners and researchers to work on optimizing pain therapy and limiting the prescriptions for pain medications. The state of New York has implemented a prescription drug monitoring program(PDMP), amended (...) public health law to limit the prescription of opioids for acute pain and utilized the resources of the state and county health departments to help in curbing this epidemic. The recent publication of guidelines for prescription opioids from CDC [1] and ASIPP (American Society of Interventional pain practitioners) have independently reviewed literature and found good evidence of limiting opioid prescription for acute and chronic non cancer pain. [2] Method Over the last decade, advanced technology has

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2017 Online journal of public health informatics

147. Antipsychotic prescription to identify delirium: results from two cohorts (PubMed)

Antipsychotic prescription to identify delirium: results from two cohorts Detection of delirium in hospitalized patients remains challenging. The objective was to determine if the prescription of antipsychotic medications was associated with delirium.Two patient cohorts were utilized from a tertiary Veterans Affairs hospital: a palliative care retrospective cohort and a prospective medical cohort. Patients prescribed outpatient antipsychotics were excluded. Retrospectively, delirium (...) was identified using a validated medical record-review instrument. Prospectively, a clinical expert assessed patients for delirium daily using a standardized interview. Acute antipsychotic medication administration was recorded from the electronic medical record.In the retrospective cohort (n=217), delirium was found in 31% (n=67) and antipsychotic use in 18% (n=40) of patients. Acute antipsychotic use indicated delirium with 54% sensitivity and 97% specificity. In the prospective cohort (n=100), delirium

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2017 Clinical pharmacology : advances and applications

148. Collaborative Care from the Emergency Department for Injured Patients with Prescription Drug Misuse: An Open Feasibility Study (PubMed)

Collaborative Care from the Emergency Department for Injured Patients with Prescription Drug Misuse: An Open Feasibility Study Collaborative Care is a comprehensive longitudinal care management strategy. The purpose of this pilot effectiveness-implementation hybrid study was to determine the feasibility of a Collaborative Care intervention initiated from the Emergency Department and proceeding longitudinally for six months for injured patients with prescription drug misuse (PDM). Adult patients (...) presenting to an urban ED with an injury were screened for eligibility from 2/2015-8/2015. Eligible participants with a positive screen for PDM were enrolled in the 'ED-LINC' intervention which included the following elements: 1) active care coordination and linkage, 2) medication safety and utilization of opioid guidelines 3) longitudinal care management and 4) utilization of Electronic Medical Record (EMR) innovations such as the statewide Emergency Department Information Exchange (EDIE) and statewide

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2017 Journal of substance abuse treatment

149. Opioid Prescription Trends Among Patients With Cancer Referred to Outpatient Palliative Care Over a 6-Year Period (PubMed)

in the type and dose of opioid prescriptions among patients who are referred by oncologists to an outpatient palliative care clinic.We reviewed the electronic health records of 750 patients who were seen as new consultations at MD Anderson Cancer Center's outpatient palliative care clinic between January 1 and April 30 each year from 2010 through 2015. Data collected included demographics, cancer type and stage, symptom assessment, performance status, opioid type, and opioid dose defined as the morphine (...) Opioid Prescription Trends Among Patients With Cancer Referred to Outpatient Palliative Care Over a 6-Year Period In the United States, opioid regulations have become increasingly stringent in recent years. Increased regulatory scrutiny, in part, is related to heightened awareness through literature and a recent media blitz on the opioid prescription epidemic. These regulations have the potential to impact prescription trends by health care providers. Our objective was to evaluate changes

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2017 Journal of Oncology Practice

150. Adherence with epinephrine autoinjector prescriptions in primary care (PubMed)

Adherence with epinephrine autoinjector prescriptions in primary care The aim of this study was to estimate primary adherence for epinephrine autoinjector (EA) prescriptions in primary care practices in Manitoba, Canada.A retrospective analysis of electronic medical record and administrative data was performed to determine primary adherence, defined as dispensation of a new EA prescription within 90 days of the date the prescription was written. Multivariable logistic regression models were (...) used to test predictors of filling an EA prescription.Of 1212 EA prescriptions written between 2012 and 2014, only 69.9% (N = 847) were filled. An increased number of prescriptions for non-EA mediations was associated with an increased odds ratio of not filling an EA prescription.This is the first study in Canada to examine adherence for EA prescriptions. The non-adherence rate identified is higher than rates previously reported in the literature, and indicates that many EA prescriptions for adults

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2017 Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology

151. Bariatric surgery: shedding the monetary weight of prescription costs in the managed care arena. (PubMed)

Bariatric surgery: shedding the monetary weight of prescription costs in the managed care arena. Prescription costs for treatment of comorbidities associated with morbid obesity is a considerable annual health-care expenditure. This study addressed the effect of Roux-en-Y gastric bypass (RYGBP) on diabetic and anti-hypertensive pharmaceutical utilization and cost savings at our institution.Retrospective data from the electronic database of 51 consecutive patients, who underwent RYGBP from March (...) 2001 to May 2002 were studied. Patients had BMI >40 associated with obesity-related diabetes and hypertension. Prescription medications utilized by this cohort were reviewed preoperatively and at 3- and 9-month intervals postoperatively. Significance was analyzed by paired t-test.Prevalence of diabetes and hypertension was 55.7% (29/53) and 44.3% (24/53) respectively, and 34% (18/53) patients had both co-morbidities. Preoperatively, patients were on an average of 2.44 +/- 1.86 medications at a cost

2017 Obesity Surgery

152. Increasing access to emergency contraception through online prescription requests. (PubMed)

Increasing access to emergency contraception through online prescription requests. To describe a pilot program, Plan B Online Prescription Access, to provide easy access to prescriptions for emergency contraception via the Internet.We measured electronic prescriptions for Plan B (Duramed Pharmaceuticals, Cincinnati, Ohio) by month over time. Pharmacists faxed patient-generated prescriptions back to the Department of Public Health for confirmation.Despite no marketing, within the first 18 months (...) of the program, 152 electronic prescriptions for Plan B were requested by 128 female San Francisco residents. Seventy-eight prescriptions were filled (51%) by pharmacists.If correctly marketed, online prescriptions for Plan B have the potential to be an effective means of increasing emergency contraception access in both urban and rural settings across the United States. Further user-acceptability studies are warranted.

2017 Journal of Reproductive Medicine

153. 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

154. 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

155. 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

156. 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

157. 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

158. 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

159. 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

160. 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

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