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https://www.readbyqxmd.com/read/28240996/impact-of-the-opioid-safety-initiative-on-opioid-related-prescribing-in-veterans
#1
Lewei A Lin, Amy S B Bohnert, Robert D Kerns, Michael A Clay, Dara Ganoczy, Mark A Ilgen
The Veterans Health Administration (VHA) designed the Opioid Safety Initiative (OSI) to help decrease opioid prescribing practices associated with adverse outcomes. Key components included disseminating a dashboard tool that aggregates electronic medical record data to audit real-time opioid-related prescribing and identifying a clinical leader at each facility to implement the tool and promote safer prescribing. This study examines changes associated with OSI implementation in October 2013 among all adult VHA patients who filled outpatient opioid prescriptions...
January 4, 2017: Pain
https://www.readbyqxmd.com/read/28240771/inappropriate-medication-in-non-hospitalized-patients-with-renal-insufficiency-a-systematic-review
#2
Michael Dörks, Katharina Allers, Guido Schmiemann, Stefan Herget-Rosenthal, Falk Hoffmann
OBJECTIVES: Renal insufficiency is common among older patients and, accordingly, renally excreted drugs may require an adjustment in dosage for them. Rates of non-adherence to renal dosing guidelines range from 19% to 70% across all settings, with the highest rate occurring in outpatient care. However, there is a paucity of research in this field. The main objective of this systematic review is to assess how often drugs are inappropriately prescribed in non-hospitalized patients with renal insufficiency...
February 27, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28239317/analysis-of-the-clinical-indications-for-opiate-use-in-inflammatory-bowel-disease
#3
Youran Gao, Sundas Khan, Meredith Akerman, Keith Sultan
BACKGROUND/AIMS: Opiate use for inflammatory bowel disease (IBD), particularly high-dose (HD) use, is associated with increased mortality. It's assumed that opiate use is directly related to IBD-related complaints, although this hasn't been well defined. Our goal was to determine the indications for opiate use as a first step in developing strategies to prevent or decrease opiate use. METHODS: A retrospective cohort was formed of adults who were diagnosed with IBD and for whom outpatient evaluations from 2009 to 2014 were documented...
January 2017: Intestinal Research
https://www.readbyqxmd.com/read/28237430/evaluation-of-impact-of-an-external-breast-shield-flexishield-in-electronic-brachytherapy-for-breast-iort-a-phantom-study
#4
Yongbok Kim, Jason Wei-Yeong Huynh, Victor J Gonzalez
PURPOSE: To investigate Axxent (iCAD, Inc., San Jose, CA) electronic brachytherapy balloon deformation and its dosimetric impact because of an external flexible shield (FlexiShield [FS]; iCAD, Inc.). METHODS AND MATERIALS: Prostheses breast tissue phantom overlaid three spherical balloon applicators to simulate three clinical scenarios depending on minimum skin-to-balloon surface spacing (SS): balloon with SS of 2 cm, 1 cm, and balloon with 1 cm SS and touching the chest wall...
February 23, 2017: Brachytherapy
https://www.readbyqxmd.com/read/28236849/should-metformin-be-included-in-fertility-treatment-of-pcos-patients
#5
Jigal Haas, Yaakov Bentov
Metformin, a drug developed for the treatment of patients with type II diabetes, has become commonly prescribed medication for PCOS patients. Initially, metformin was prescribed for patients with impaired glucose tolerance at the pre conception period, however more recently its use was expanded to many of the PCOS patients and for the whole duration of pregnancy. Several studies examining the effects of Metformin during pregnancy reported a lower pregnancy loss, reduced gestational diabetes and no increased risk for birth defects, however, several more recent studies also raised concerns about its safe use...
March 2017: Medical Hypotheses
https://www.readbyqxmd.com/read/28230449/real-world-glycemic-control-from-glp-1ra-therapy-with-and-without-concurrent-insulin-in-patients-with-type-2-diabetes
#6
Mukul Singhal, Sudhir Unni, Marisa Schauerhamer, Hiep Nguyen, Jeff Hurd, Carrie McAdam-Marx
BACKGROUND: Glucagon-like peptide 1 receptor agonists (GLP-1RAs) are recommended as add-on therapy in patients with uncontrolled type 2 diabetes (T2D), with no specific guidance as to timing versus insulin. Furthermore, real-world data assessing GLP-1RA outcomes with or without concurrent insulin therapy are lacking. OBJECTIVE: To identify glycemic response with GLP-1RAs by insulin use in patients with T2D at 1-year follow-up to inform decisions regarding GLP-1RA use with or without insulin...
March 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28228380/off-label-indications-for-antidepressants-in-primary-care-descriptive-study-of-prescriptions-from-an-indication-based-electronic-prescribing-system
#7
Jenna Wong, Aude Motulsky, Michal Abrahamowicz, Tewodros Eguale, David L Buckeridge, Robyn Tamblyn
Objective To examine off-label indications for antidepressants in primary care and determine the level of scientific support for off-label prescribing.Design Descriptive study of antidepressant prescriptions written by primary care physicians using an indication based electronic prescribing system.Setting Primary care practices in and around two major urban centres in Quebec, Canada.Participants Patients aged 18 years or older who visited a study physician between 1 January 2003 and 30 September 2015 and were prescribed an antidepressant through the electronic prescribing system...
February 21, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28224108/implementation-of-enteral-feeding-protocol-in-an-intensive-care-unit-before-and-after-study
#8
Martin Padar, Gerli Uusvel, Liis Starkopf, Joel Starkopf, Annika Reintam Blaser
AIM: To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients. METHODS: An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit (ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012 (the Before group) and 2014-2015 (the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection Control Service...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28220511/review-article-pharmacotherapy-for-alcohol-dependence-the-why-the-what-and-the-wherefore
#9
REVIEW
E T Goh, M Y Morgan
BACKGROUND: The development of alcohol dependence is associated with significant morbidity and mortality. For the majority of affected people the most appropriate goal, in terms of drinking behaviour, is abstinence from alcohol. Psychosocial intervention is the mainstay of the treatment but adjuvant pharmacotherapy is also available and its use recommended. AIM: To provide an updated analysis of current and potential pharmacotherapeutic options for the management of alcohol dependence...
February 20, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28219437/the-effect-of-a-test-ordering-software-intervention-on-the-prescription-of-unnecessary-laboratory-tests-a-randomized-controlled-trial
#10
Carlos Manuel Silva Martins, Andreia Sofia da Costa Teixeira, Luís Filipe Ribeiro de Azevedo, Luísa Maria Barbosa Sá, Paulo Alexandre Azevedo Pereira Santos, Maria Luciana Gomes Domingues do Couto, Altamiro Manuel Rodrigues da Costa Pereira, Alberto Augusto Oliveira Pinto Hespanhol, Cristina Maria Nogueira da Costa Santos
BACKGROUND: The way software for electronic health records and laboratory tests ordering systems are designed may influence physicians' prescription. A randomised controlled trial was performed to measure the impact of a diagnostic and laboratory tests ordering system software modification. METHODS: Participants were family physicians working and prescribing diagnostic and laboratory tests. The intervention group had a modified software with a basic shortcut menu changes, where some tests were withdrawn or added, and with the implementation of an evidence-based decision support based on United States Preventive Services Task Force (USPSTF) recommendations...
February 20, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28216955/patterns-of-prescription-drugs-use-among-pregnant-women-at-sultan-qaboos-university-hospital-and-sultan-qaboos-university-hospital-family-and-community-medicine-clinic-oman
#11
J Z Al-Hamimi, K A Al Balushi
OBJECTIVE: This study evaluates the patterns of prescription drugs use among women attending antenatal clinic at Sultan Qaboos University Hospital (SQUH) and SQUH Family and Community Medicine clinic (FAMCO), Oman. METHODS: The study was a descriptive retrospective cross-sectional study on pregnant women who attended the antenatal clinic at SQUH and FAMCO from February to April 2014 and received a prescription containing at least one drug. Patients' information was extracted from SQUH electronic records...
October 2016: Journal of Pharmacy & Bioallied Sciences
https://www.readbyqxmd.com/read/28211183/a-comparison-of-the-self-reported-dry-eye-practices-of-new-zealand-optometrists-and-ophthalmologists
#12
Ally L Xue, Laura E Downie, Susan E Ormonde, Jennifer P Craig
PURPOSE: The aim of this cross-sectional survey was to evaluate the self-reported clinical practices of New Zealand optometrists and ophthalmologists with respect to the diagnosis and management of dry eye disease. It also sought to compare these behaviours with the current research evidence base. METHODS: An anonymous survey was distributed electronically to New Zealand eye care clinicians (optometrists n = 614, ophthalmologists n = 113) to determine practitioner interest in dry eye disease, practice experience, practice modality, preferred diagnostic and management strategies, and information used to guide patient care...
March 2017: Ophthalmic & Physiological Optics: the Journal of the British College of Ophthalmic Opticians (Optometrists)
https://www.readbyqxmd.com/read/28208876/prescribing-pattern-of-antifungal-medications-at-a-tertiary-care-hospital-in-oman
#13
Khalid A Al Balushi, Mohammed A Alzaabi, Fatma Alghafri
INTRODUCTION: Inappropriate use of antifungal agents is implicated in the global burden of antifungal resistance, adverse outcomes like persistent infections, unnecessary exposure and increased cost. Data collection from time to time is to be done in order to have a check on the resistance/sensitivity pattern of the commonly prescribed antifungal drugs. AIM: To describe the pattern of antifungal drug prescription and administration to patients attending a university hospital in Oman...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28207996/the-use-of-a-contextual-modal-and-psychological-classification-of-medication-errors-in-the-emergency-department-a-retrospective-descriptive-study
#14
C J Cabilan, J A Hughes, C Shannon
BACKGROUND: The causes of medication errors are unique in every clinical setting; hence error minimisation strategies are not always effective. For this reason, it is fundamental to understand the causes specific to the emergency department so that targeted strategies can be implemented. OBJECTIVES: To describe the contextual, modal, and psychological classification of medication errors in the emergency department to know the factors associated with the reported medication errors...
February 16, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28202365/optimising-the-use-of-medicines-to-reduce-acute-kidney-injury-in-children-and-babies
#15
REVIEW
L Oni, D B Hawcutt, M A Turner, M W Beresford, S McWilliam, C Barton, B K Park, P Murray, B Wilm, I Copple, R Floyd, M Peak, A Sharma, D J Antoine
The majority of medications in children are administered in an unlicensed or off-label manner. Paediatricians are obliged to prescribe using the limited evidence available. The 2007 EU regulation on the use of paediatric drugs means pharmaceutical companies are now obliged to (and receive incentives for) contributing to paediatric drug data and carrying out paediatric clinical trials. This is important, as the efficacy and adverse effect profiles of medicines vary across childhood. Additionally, there are significant age-related changes in the pharmacodynamic and pharmacokinetic activity of many drugs...
February 12, 2017: Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28202233/practice-makes-perfect-a-systematic-review-of-the-expertise-development-of-pharmacist-and-nurse-independent-prescribers-in-the-united-kingdom
#16
REVIEW
Aseel S Abuzour, Penny J Lewis, Mary P Tully
BACKGROUND: Prescribing is a complex and error-prone task that demands expertise. McLellan et al.'s theory of expertise development model ("the model"), developed to assess medical literature on prescribing by medical students, proposes that in order to develop, individuals should deliberately engage their knowledge, skills and attitudes within a social context. Its applicability to independent prescribers (IP) is unknown. AIM: A systematic review was conducted to explore whether the model is applicable to non-medical independent prescribing and to assess the factors underpinning expertise development reported in the literature...
February 7, 2017: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/28197420/the-challenges-of-electronic-health-records-and-diabetes-electronic-prescribing-implications-for-safety-net-care-for-diverse-populations
#17
REVIEW
Neda Ratanawongsa, Lenny L S Chan, Michelle M Fouts, Elizabeth J Murphy
Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations...
2017: Journal of Diabetes Research
https://www.readbyqxmd.com/read/28196459/care-provision-and-prescribing-practices-of-physicians-treating-children-and-adolescents-with-adhd
#18
Ayush Patel, Rohan Medhekar, Melissa Ochoa-Perez, Rajender R Aparasu, Wenyaw Chan, Jeffrey T Sherer, Joy Alonzo, Hua Chen
OBJECTIVE: Care provision and prescribing practices of physicians treating children with attention-deficit hyperactivity disorder (ADHD) were compared. METHODS: A retrospective cohort study was conducted with the 1995-2010 General Electric Centricity Electronic Medical Record database. The sample included children (≤18 years) with newly diagnosed ADHD (ICD-9-CM code 314.XX) who received a prescription for a stimulant or atomoxetine. Identification of comorbid psychiatric disorders, duration from initial ADHD diagnosis to treatment, prescription of other psychotropic medications, and follow-up care during the ten months after the ADHD treatment initiation were compared across provider type (primary care physicians [PCPs], child psychiatrists, and physicians with an unknown specialty)...
February 15, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28194729/design-and-implementation-of-decision-support-for-tobacco-dependence-treatment-in-an-inpatient-electronic-medical-record-a-randomized-trial
#19
Steven L Bernstein, June Rosner, Michelle DeWitt, Jeanette Tetrault, Allen L Hsiao, James Dziura, Scott Sussman, Patrick O'Connor, Benjamin Toll
: Tobacco dependence treatment for hospitalized smokers results in long-term cessation if treatment continues at least 30 days post-discharge. Health information technology may facilitate ongoing tobacco dependence treatment after hospital discharge. To describe the use and impact of a new decision support tool and order set for inpatient physicians, addressing tobacco dependence treatment for hospitalized smokers, embedded in an electronic health record (EHR). In a cluster-randomized trial, 254 physicians were randomized (1:1) to either receive or not receive the decision support tool and order set, which were embedded in the Epic (Madison, WI) EHR used at 2 hospitals in a single city...
February 13, 2017: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/28193619/improving-specialist-drug-prescribing-in-primary-care-using-task-and-error-analysis-an-observational-study
#20
Narinder Chana, Talya Porat, Cate Whittlesea, Brendan Delaney
BACKGROUND: Electronic prescribing has benefited from computerised clinical decision support systems (CDSSs); however, no published studies have evaluated the potential for a CDSS to support GPs in prescribing specialist drugs. AIM: To identify potential weaknesses and errors in the existing process of prescribing specialist drugs that could be addressed in the development of a CDSS. DESIGN AND SETTING: Semi-structured interviews with key informants followed by an observational study involving GPs in the UK...
March 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
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