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Electronic Prescription

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161. Correlates of Nonmedical Prescription Opioid Use Among U.S. Adolescents. (Abstract)

opioid use. Nonmedical prescription opioid use was 1.5 times more likely among electronic vapor users (AOR=1.58, 95% CI=1.34, 1.86), 2 times more likely among cigarette (AOR=2.49, 95% CI=2.16, 2.88) and marijuana users (AOR=2.45, 95% CI=2.05, 2.93), and almost 3 times as likely among alcohol users (AOR=2.98, 95% CI=2.18, 4.07).Study findings suggest a need for more interventions for nonmedical prescription opioid use among adolescents in the U.S. Information on nonmedical prescription opioid use (...) Correlates of Nonmedical Prescription Opioid Use Among U.S. Adolescents. The purpose of this study is to assess risk factors, including other substance use, for nonmedical prescription opioid use among U.S. adolescents.A secondary data analysis of the 2017 Youth Risk Behavior Survey was conducted (n=10,175) in 2018. The outcome was nonmedical prescription opioid use. Predictor variables included other substance use, mood, sleep, academic performance, and demographic characteristics. Survey

2019 American journal of preventive medicine

162. COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines? Full Text available with Trip Pro

COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines? In a primary care setting, our aim was to investigate characteristics of patients classified as having chronic obstructive pulmonary disease (COPD) and currently being prescribed inhaled corticosteroids (ICSs). The electronic patient record system in each participating general practice was searched for patients coded as COPD (ICPC, Second Edition code R95) and treated (...) with ICS (ACT code R03AK and R03BA, that is, ICS in combination with a long-acting β2-agonist) or ICS as monotherapy. Data, if available, on demographics, smoking habits, spirometry, COPD medication, symptom score, blood eosinophils, co-morbidity and exacerbation history were retrieved from the medical records for all identified cases. Of all patients registered in the 138 participating general practices, 12.560 (3%) were coded as COPD, of whom 32% were prescribed ICS. The final study sample comprised

2019 Chronic respiratory disease

163. Targeted Intervention to Increase Awareness of Opioid Overprescribing Significantly Reduces Narcotic Prescribing Within an Academic Orthopaedic Practice. (Abstract)

Targeted Intervention to Increase Awareness of Opioid Overprescribing Significantly Reduces Narcotic Prescribing Within an Academic Orthopaedic Practice. To evaluate the impact of a targeted intervention focused on increasing awareness of opioid overprescribing within an academic orthopaedic practice.Retrospective prescribing data was collected through an electronic chart review. A single time point, a departmental grand rounds titled "Opioid Use, Misuse, & Abuse in Orthopaedics," was conducted (...) on February 8, 2017. Opioid prescribing data was analyzed for the year preceding and year immediately following this targeted intervention. Narcotics were standardized using milligram morphine equivalents (MME) for comparison, and patients were categorized as opioid naive or non-naive based on whether an opioid prescription was written within 90 days prior to surgery. A segmented time series regression model was utilized to determine statistical significance of the educational intervention.Academic

2019 Journal of Surgical Education

164. Development of Machine Learning Algorithms for Prediction of Sustained Postoperative Opioid Prescriptions After Total Hip Arthroplasty. (Abstract)

Development of Machine Learning Algorithms for Prediction of Sustained Postoperative Opioid Prescriptions After Total Hip Arthroplasty. Postoperative recovery after total hip arthroplasty (THA) can lead to the development of prolonged opioid use but there are few tools for predicting this adverse outcome. The purpose of this study is to develop machine learning algorithms for preoperative prediction of prolonged opioid prescriptions after THA.A retrospective review of electronic health records (...) was conducted at 2 academic medical centers and 3 community hospitals to identify adult patients who underwent THA for osteoarthritis between January 1, 2000 and August 1, 2018. Prolonged postoperative opioid prescriptions were defined as continuous opioid prescriptions after surgery to at least 90 days after surgery. Five machine learning algorithms were developed to predict this outcome and were assessed by discrimination, calibration, and decision curve analysis.Overall, 5507 patients underwent THA

2019 Journal of Arthroplasty

165. Opioid-prescribing Habits of Practitioner and Educator Members of the American Association of Endodontists: Report of a National Survey. (Abstract)

in the United States. The 20-question survey addressed provider demographics, types and frequency of medications prescribed, and clinical scenarios that compelled prescription-writing habits. The anonymous survey was electronically mailed. There was a preference to prescribe nonsteroidal anti-inflammatory drugs and/or acetaminophen followed by hydrocodone to manage endodontic pain. The majority of respondents limited an opioid prescription to ≤4 days. Different demographics played a role in the response (...) Opioid-prescribing Habits of Practitioner and Educator Members of the American Association of Endodontists: Report of a National Survey. Dentists and physicians alike often prescribe opioids for dental pain management. The purpose of this study was to identify the common practices among United States endodontists for prescribing opioids to their patients. A descriptive, cross-sectional survey was developed to query 1000 American Association of Endodontists members from all 7 districts

2019 Journal of Endodontics

166. A new OPIATE (Optimizing Positive Ibuprofen and Acetaminophen Treatment Expectations) model: A brief comment on "Concurrent and lagged associations of prescription opioid use with pain and negative affect in the daily lives of chronic pain patients" (Carp (Abstract)

A new OPIATE (Optimizing Positive Ibuprofen and Acetaminophen Treatment Expectations) model: A brief comment on "Concurrent and lagged associations of prescription opioid use with pain and negative affect in the daily lives of chronic pain patients" (Carp This commentary expands upon the clinical implications arising from the Carpenter et al. (2019) negative reinforcement model of opioid use. A new model called OPIATE-which stands for Optimizing Positive Ibuprofen and Acetaminophen Treatment (...) and acetaminophen. These strategies are (a) altering defaults in electronic medical record systems; (b) highlighting appropriate descriptive social norms to patients; (c) improving the quality of interactions during discharges between patients and their physicians, nurses, and pharmacists; and (d) priming patients to have positive expectations regarding ibuprofen and acetaminophen involving careful selection of language to describe these medications.Instead of creating alternative pharmaceuticals, efforts

2019 Journal of Consulting and Clinical Psychology

167. Has a Prescription-limiting Law in Rhode Island Helped to Reduce Opioid Use After Total Joint Arthroplasty? Full Text available with Trip Pro

Has a Prescription-limiting Law in Rhode Island Helped to Reduce Opioid Use After Total Joint Arthroplasty? In the United States, since 2016, at least 28 of 50 state legislatures have passed laws regarding mandatory prescribing limits for opioid medications. One of the earliest state laws (which was passed in Rhode Island in 2016) restricted the maximum morphine milligram equivalents provided in the first postoperative prescription for patients defined as opioid-naïve to 30 morphine milligram (...) equivalents per day, 150 total morphine milligram equivalents, or 20 total doses. While such regulations are increasingly common in the United States, their effects on opioid use after total joint arthroplasty are unclear.(1) Are legislative limitations to opioid prescriptions in Rhode Island associated with decreased opioid use in the immediate (first outpatient prescription postoperatively), 30-day, and 90-day periods after THA and TKA? (2) Is this law associated with similar changes in postoperative

2019 Clinical Orthopaedics and Related Research

168. Racial and Ethnic Disparities in Opioid Prescribing for Long Bone Fractures at Discharge From the Emergency Department: A Cross-sectional Analysis of 22 Centers From a Health Care Delivery System in Northern California. (Abstract)

Racial and Ethnic Disparities in Opioid Prescribing for Long Bone Fractures at Discharge From the Emergency Department: A Cross-sectional Analysis of 22 Centers From a Health Care Delivery System in Northern California. We examine racial and ethnic differences in opioid prescribing and dosing for long bone fractures at emergency department (ED) discharge.We conducted an electronic health records-based cross-sectional study of adults with long bone fractures who presented to the ED across 22 (...) sites from a health care delivery system (2016 to 2017). We examined differences in opioid prescribing at ED discharge and, among patients with a prescription, differences in opioid dosing (measured as morphine milligram equivalents) by race/ethnicity, using regression modeling with statistical adjustment for patient, fracture, and prescriber characteristics.A total of 11,576 patients with long bone fractures were included in the study; 64.4% were non-Hispanic white; 16.4%, 7.3%, 5.8%, and 5.1

2019 Annals of Emergency Medicine

169. Low-Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System. Full Text available with Trip Pro

currently prescribed any PPI using the electronic health record (EHR) medication list (current defined as September 1, 2018). A geriatrician, a gastroenterologist, a QI expert, and two primary care physicians (PCPs) created multidisciplinary PPI appropriateness criteria based on evidenced-based guidelines. Supervised by a gastroenterologist and PCP, two internal medicine residents conducted manual chart reviews in a random sample of 399 patients prescribed PPIs. We considered prescriptions potentially (...) prevalence.Among 69 352 older adults, 8729 (12.6%) were prescribed a PPI. In the sample of 399 patients prescribed PPIs, 63.9% were female; their mean age was 76.2 years, and they were seen by 169 PCPs. Of the 399 prescriptions, 143 (35.8%; 95% CI = 31.3%-40.7%) were potentially low value-of which 82% began appropriately (eg, GERD) but then continued long term without a guideline-based indication. Among 169 PCPs, 32 (18.9%) contributed to 59.2% of potentially low-value prescriptions.One in eight older adults

2019 Journal of the American Geriatrics Society

170. Pain management and prescribing practices in otolaryngology residency programs. Full Text available with Trip Pro

Pain management and prescribing practices in otolaryngology residency programs. To understand the knowledge, competency and influencing factors regarding postoperative opioid prescribing practices among Otolaryngology Residents. To understand the educational background and resources regarding pain management and opioid prescribing among Otolaryngology Residency Programs.An anonymous electronic survey was distributed to Otolaryngology residents in the greater New York City area. Subjects (...) reported their preferred pain management prescription for eight common otolaryngology surgeries. Questions addressed opioid and non-opioid prescribing influences, use/knowledge of pain management resources, and prior opioid prescribing education (OPE). An anonymous survey was distributed to US Otolaryngology Program Directors addressing resident prescribing influences and OPE in residency training programs.Thirty-Five residents and fifteen PDs participated. Resident opioid prescribing was widely

2019 American Journal of Otolaryngology

171. Zolpidem in comatose patients: Prescriptions on clinical practice and time for a new randomized clinical trial. (Abstract)

Zolpidem in comatose patients: Prescriptions on clinical practice and time for a new randomized clinical trial. 30682515 2019 01 25 1878-8769 2019 Jan 22 World neurosurgery World Neurosurg Zolpidem in comatose patients: Prescriptions on clinical practice and time for a new randomized clinical trial. S1878-8750(19)30146-9 10.1016/j.wneu.2019.01.049 Welling Leonardo C LC Neurological Surgery Department. State University of Ponta Grossa. Brazil. Welling Mariana S MS Neurology Department. State (...) University of Ponta Grossa. Brazil. Figueiredo Eberval G EG Neurological Surgery Department. University of Sao Paulo. Brazil. Electronic address: ebgadelha@yahoo.com. eng Journal Article 2019 01 22 United States World Neurosurg 101528275 1878-8750 2019 1 26 6 0 2019 1 27 6 0 2019 1 27 6 0 aheadofprint 30682515 S1878-8750(19)30146-9 10.1016/j.wneu.2019.01.049

2019 World neurosurgery Controlled trial quality: uncertain

172. Practice Variation in Anticoagulation Prescription and Outcomes after Device-Detected Atrial Fibrillation: Insights from the Veterans Health Administration. Full Text available with Trip Pro

a retrospective cohort study using data from the Veterans Health Administration linked to remote monitoring data that included day-level AF burden. We included patients with cardiac implantable electronic devices and remote monitoring from 2011 to 2014, CHA2DS2-VASc score ≥2, and no prior stroke or OAC receipt in the preceding 2 years. We determined the proportion of patients prescribed OAC within 90 days after new device-detected AF across a range of AF thresholds (≥6 minutes to >24 hours) and examined site (...) variation in OAC prescription. We used multivariable Cox proportional hazards regressions to determine the association of OAC prescription with stroke by device-detected AF burden.Among 10 212 patients with cardiac implantable electronic devices, 4570 (45%), 3969 (39%), 3263 (32%), and 2469 (24%) had device-detected AF >6 minutes, >1 hour, >6 hours, and >24 hours, respectively. For device-detected AF >1 hour, 1712 patients met inclusion criteria (72±10 years; 1.5% female; CHA2DS2-VASc score 4.0±1.4; HAS

2019 Circulation

173. Intervention to reduce benzodiazepine prescriptions in primary care, study protocol of a hybrid type 1 cluster randomised controlled trial: the BENZORED study. Full Text available with Trip Pro

prescription and BZD deprescribing, monthly feedback about their BZD prescribing practices and access to a support web page. Outcome measures for each GP are the defined daily dosage per 1000 inhabitants per day and the proportion of long-term BZD users at 12 months. Data will be collected from the electronic prescription database of the public health system, and will be subjected to intention-to-treat analysis. Implementation will be evaluated by mixed methods following the five domains (...) Intervention to reduce benzodiazepine prescriptions in primary care, study protocol of a hybrid type 1 cluster randomised controlled trial: the BENZORED study. Benzodiazepines (BZDs) are mainly used to treat anxiety and sleep disorders, and are often prescribed for long durations, even though prescription guidelines recommend short-term use due to the risk of dependence, cognitive impairment, and falls and fractures. Education of general practitioners (GPs) regarding the prescription of BZDs

2019 BMJ open Controlled trial quality: uncertain

174. Long-term outcomes of an educational intervention to reduce antibiotic prescribing for childhood upper respiratory tract infections in rural China: Follow-up of a cluster-randomised controlled trial. Full Text available with Trip Pro

from the one county (14 facilities and 1:1 cluster randomisation ratio) that had electronic records available 12 months after the trial ended, at the 18-month follow-up period. Our primary outcome was the antibiotic prescription rate (APR)-the percentage of outpatient prescriptions containing any antibiotic(s) for children aged 2 to 14 years who had a primary diagnosis of a URTI and had no other illness requiring antibiotics. We also conducted 15 in-depth interviews to understand how interventions (...) and focused prescription review meetings, whereas lack of supervision and monitoring may be associated with relapse. Key limitations were not including all clusters from the trial and not collecting returned visits or sepsis cases.Our intervention was associated with sustained and substantial reductions in antibiotic prescribing at the end of the intervention period and 12 months later. Our intervention may be adapted to similar resource-poor settings.ISRCTN registry ISRCTN14340536.

2019 PLoS medicine Controlled trial quality: predicted high

175. How do primary healthcare workers in low-income and middle-income countries obtain information during consultations to aid safe prescribing? A systematic review protocol. Full Text available with Trip Pro

prescribing and impact on patient safety. The aim of this review is to systematically review the evidence on how primary healthcare workers obtain information during consultations to prescribe safely and appropriately.We will identify relevant articles by searching electronic databases: Medline (Ovid), EMBASE (Ovid), Cochrane Central Register of Controlled Trials, CABI Global Health (Ovid), WHO global health library, POPLINE, Africa-Wide Information (Ebsco), Library, Information Science & Technology (...) How do primary healthcare workers in low-income and middle-income countries obtain information during consultations to aid safe prescribing? A systematic review protocol. There is a wide variety in prescribing by primary healthcare workers in low-income and middle-income countries. While there is much information available, both online and offline, there is variation in quality and relevance to different settings. Acting on incorrect or out-of-date information can lead to inappropriate

2019 BMJ open

176. Avoiding chemotherapy prescribing errors: Analysis and innovative strategies. (Abstract)

Avoiding chemotherapy prescribing errors: Analysis and innovative strategies. At Freiburg University Medical Center, chemotherapy prescriptions are processed via a computerized physician order entry (CPOE) tool and clinically checked by a designated chemotherapy surveillance team. Any error detected is reported instantly, corrected, and prospectively recorded. The objective of the current study was to gain insight into the causes, potential consequences, and future preventability (...) of chemotherapy prescribing errors.A detailed analysis of 18,823 consecutive antineoplastic orders placed in 2013 through 2014 was performed. In cooperation with information technology (IT) specialists, the intercepted errors were analyzed for effective future prevention using IT measures. Potential error consequences were determined by case discussions between pharmacists and physicians.Within 24 months, a total of 406 chemotherapy prescribing errors were intercepted that affected 375 (2%) of the total

2019 Cancer

177. Continued Statin Prescriptions After Adverse Reactions and Patient Outcomes: A Cohort Study. (Abstract)

, 19 989 (70.7%) continued receiving statin prescriptions after the adverse reaction. Four years after the presumed adverse event, the cumulative incidence of the composite primary outcome was 12.2% for patients with continued statin prescriptions, compared with 13.9% for those without them (difference, 1.7% [95% CI, 0.8% to 2.7%]; P < 0.001). In a secondary analysis of 7604 patients for whom a different statin was prescribed after the adverse reaction, 2014 (26.5%) had a documented adverse (...) Continued Statin Prescriptions After Adverse Reactions and Patient Outcomes: A Cohort Study. Many patients discontinue statin treatment, often after having a possible adverse reaction. The risks and benefits of continued statin therapy after an adverse reaction are not known.To examine the relationship between continuation of statin therapy (any prescription within 12 months after an adverse reaction) and clinical outcomes.Retrospective cohort study.Primary care practices affiliated with 2

2017 Annals of Internal Medicine

178. Effects of Behavioral Interventions on Inappropriate Antibiotic Prescribing in Primary Care 12 Months After Stopping Interventions Full Text available with Trip Pro

, N.I.H., Extramural Research Support, Non-U.S. Gov't United States JAMA 7501160 0098-7484 0 Anti-Bacterial Agents AIM IM Anti-Bacterial Agents therapeutic use Electronic Health Records Follow-Up Studies Humans Inappropriate Prescribing prevention & control statistics & numerical data Logistic Models Peer Group Practice Patterns, Physicians' Primary Health Care Respiratory Tract Infections drug therapy 2017 10 20 6 0 2017 10 20 6 0 2017 10 27 6 0 ppublish 29049577 2656800 10.1001/jama.2017.11152 (...) Effects of Behavioral Interventions on Inappropriate Antibiotic Prescribing in Primary Care 12 Months After Stopping Interventions 29049577 2017 10 25 2018 11 13 1538-3598 318 14 2017 10 10 JAMA JAMA Effects of Behavioral Interventions on Inappropriate Antibiotic Prescribing in Primary Care 12 Months After Stopping Interventions. 1391-1392 10.1001/jama.2017.11152 Linder Jeffrey A JA Northwestern University Feinberg School of Medicine, Chicago, Illinois. Meeker Daniella D University of Southern

2017 JAMA Controlled trial quality: uncertain

179. Preoperative Exposure to Benzodiazepines or Sedative/hypnotics Increases the Risk of Greater Filled Opioid Prescriptions After Surgery. (Abstract)

of opioids, benzodiazepines, and sedative/hypnotics filled 6 months before and after the procedure. Patients were grouped into exposed or naïve cohorts depending on whether a prescription was filled 6 months before surgery. Smoking history (current or previous smoking was considered positive) and a history of mood and pain disorders (as noted in the medical history), were collected from the outpatient and the operating room electronic medical record.After controlling for age, gender, and other (...) Preoperative Exposure to Benzodiazepines or Sedative/hypnotics Increases the Risk of Greater Filled Opioid Prescriptions After Surgery. The effect of the preoperative exposure to controlled substances such as benzodiazepines and sedative/hypnotics on prolonged opioid consumption after hand surgery is not known.(1) Is preoperative exposure to benzodiazepines and sedative/hypnotics associated with greater numbers of filled postoperative opioid prescriptions after hand surgery? (2) Is a positive

2019 Clinical Orthopaedics and Related Research

180. Examining the effect of prescription sequence on developing adverse drug reactions: The case of renal failure in diabetic patients. (Abstract)

Examining the effect of prescription sequence on developing adverse drug reactions: The case of renal failure in diabetic patients. While the effect of medications in development of Adverse Drug Reactions (ADRs) have been widely studied in the past, the literature lacks sufficient coverage in investigating whether the sequence in which [ADR-prone] drugs are prescribed (and administered) can increase the chances of ADR development. The present study investigates this potential effect by applying (...) emergent sequential pattern mining techniques to electronic health records.Using longitudinal medication and diagnosis records from more than 377,000 diabetic patients, in this study, we assessed the possible effect of prescription sequences in developing acute renal failure as a prevalent ADR among this group of patients. Relying on emergent sequential pattern mining, two statistical case-control approaches were designed and employed for this purpose.The results taken from the two employed approaches

2019 International journal of medical informatics

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