电子病案对病案管理职能转变的作用探究

目前信息技术在医院各个领域都获得了不断的应用,而医院和地方各级卫生行政管理部门对信息化管理工作提出的要求也越来越高。同时,在医疗保险体制下,对患者信息的相关需求也日益强烈,使得传统的医疗信息管理架构无法适应这些新的高需求。而在医院管理工作中,体现其信息技术的重要部门就是病案管理,为适应当下各种需求,电子病案管理模式应运而生。而电子病案的运用在很大程度上改变了医院病案管理的职能。电子病案作为日后医院信息化建设工作的最终目标,病案管理者应该适应电子病案管理工作环境,改变原有的服务理念。另外,提升自身专业素质与技术水平,并遵循电子病案管理工作流程。最后,医院应该履行电子病案管理职能,做好现代化电子病案管理工作。     

Identification with drug use among young adults who are at risk of transitioning to more serious use

Understanding the drug use trajectories for at risk young adults can help reduce harms associated with serious drug use. This longitudinal study tracked young people to assess whether implicit and explicit identification with substance use predicts changes in use over time and whether patterns of use impacts identification with drugs. Two hundred and twenty-eight participants were initially recruited from homeless shelters, youth centers, drug health services, and parks where young people who use drugs are known to frequent. Over a 20-month period, 78 of these original participants were successfully recontacted and surveyed again. The survey assessed implicit and explicit identification with drug use, along with known risk factors, to determine if identification predicts changes in drug use over time as assessed by frequency, recency, and multiple drug use. Results revealed that implicit and explicit identification with drug use were stronger among participants who used more frequently, more recently, and used multiple drugs, although this finding only emerged cross-sectionally and not longitudinally. Overall, these results suggest that patterns of drug use are associated with the identity of the individual and that identification with drug use is a marker of drug-using behavior, but identification with drug use does not appear to be predictive of future behavior nor an outcome of prior drug use.     

Decision support considerations in the development and implementation of an electronic medical record

The requirement for decision support capability has been a major force in the evolution of the electronic medical record (EMR). The EMR should deliver contextual information so that financial and clinical decision makers can efficiently, and with patient-centered understanding, deliver appropriate care. An organization's pursuit of the EMR is based in its need to overcome problems managing information and its analysis and to create a picture of the patient in terms of outcomes. This discussion is designed for use as a guide to how pharmacy management can support or lead an enterprise's EMR and decision support evolution.     

Assessment of time to follow-up visits in newly-treated hypertensive patients using an electronic medical record database

Abstract

Objective:

Use of electronic medical record (EMR) data for evaluating healthcare processes and outcomes is relatively new. Using EMR data, this study evaluated the time from antihypertensive initiation to the first follow-up office visit controlling for adverse events (AEs) and other factors that could influence follow-up timing. Findings were compared to treatment guidelines which recommend monthly follow-up in treatment naive patients until blood pressure (BP) levels are controlled.     

Development and validation of an algorithm to identify drug-induced anaphylaxis in the Beijing Pharmacovigilance Database

International Journal of Clinical Pharmacy - Background Pharmacovigilance databases are utilized to identify serious adverse drug events (ADEs). In China, very few studies have evaluated the...     

5-year evaluation of electronic medical record flag alerts for patients warranting secondary prevention of coronary heart disease

STUDY OBJECTIVES: To assess the effect of flag alerts that were placed in electronic medical records on patients' adherence with National Cholesterol Education Program (NCEP) guidelines for secondary prevention of coronary heart disease. A secondary objective was to identify the proportion of patients who were prescribed lipid-lowering agents and assess the barriers of patients who did not reach low-density lipoprotein cholesterol (LDL) goals 5.6 years after the intervention. DESIGN: Retrospective analysis of a prospective medical record intervention. SETTING: University-based primary care clinic. PATIENTS: Eighty-nine adult patients with atherosclerotic vascular disease. INTERVENTION: For each patient identified as needing secondary prevention for coronary heart disease according to NCEP guidelines, flags were inserted into the patient's electronic medical record. MEASUREMENTS AND MAIN RESULTS: Baseline patient data were collected. After 5.6 years, we performed a retrospective analysis. At that time, 72 patients were evaluated; 17 were lost to follow-up. Fifty-four percent of patients (39 of 72 patients) had reached their LDL goal compared with 25% (16 of 64 patients for whom complete lipid panels had been obtained) at baseline (p=0.001). The proportion of patients prescribed lipid-lowering agents rose from 16% at baseline to 75% at follow-up (p=0.0001). However, 33 patients (46%) were above their LDL goal levels at follow-up. Reasons for failure to reach LDL goal were as follows: drug dosage not titrated (10 patients [30%]), adverse drug reaction (four patients [12%]), planned to adjust therapy in the future (three patients [9%]), high drug cost (two patients [6%]), drug contraindicated (two patients [6%]), and non-compliance (one patient [3%]). In 11 patients (33%), the reason for failure was not addressed in the progress notes. Thus, inadequate drug dosage titration (dosage not titrated, planned to adjust therapy, and reason not addressed [assume no action]) occurred in more than 70% of these patients. CONCLUSIONS: These findings emphasize the need for regular evaluation of patients' lipid panels followed by appropriate therapy titration to reach LDL goals. Further study of factors influencing cholesterol management and methods to improve adherence is needed.     

Polytobacco use and risk perceptions among young adults: The potential role of habituation to risk

IntroductionPolytobacco use and experimentation is common among young adults. Additional research is needed to determine how these patterns of use impact perceptions of tobacco-related harm and risk. The current study examined whether a relationship exists between an increased number of tobacco products used and decreases in perceptions of harmfulness and health risk.MethodParticipants (N = 792) completed a survey assessing current/lifetime tobacco use, perceived absolute harmfulness of tobacco/nicotine products and perceived health risk of smoking. For some analyses, participants were grouped by polytobacco use status.ResultsAmong participants who ever tried a tobacco product, a greater number of products tried was associated with lower perceptions of harm (all p < .05). For e-cigarettes and hookah, nonusers rated tobacco products as more harmful compared to single product, dual, and poly users (all p < .05). Number of products tried predicted perceived harmfulness above and beyond demographic characteristics and polytobacco use status across all products. Similarly, number of products tried predicted perceived health risk above and beyond demographic characteristics and polytobacco use status for both lung cancer and heart disease risk.DiscussionTrying a greater number of tobacco products is associated with lower perceived harmfulness of tobacco products. Prospective studies are needed to determine if experimentation with more tobacco products leads to reductions in perceived risk of tobacco use and subsequent sustained use of tobacco.     

Selecting an equation to estimate glomerular filtration rate for use in renal dosage adjustment of drugs in electronic patient record systems

STUDY OBJECTIVE: To identify a variant of the Cockcroft-Gault equation whose estimate would agree with the Modification of Diet in Renal Disease (MDRD) estimate of glomerular filtration rate (GFR) since the MDRD equation may not be programmable in some electronic patient record systems. DESIGN: Prospective case series. SETTING: A 625-bed, adults-only, private, tertiary care teaching hospital. PATIENTS: Two hundred eight consecutive hospitalized patients with MDRD-estimated GFRs less than 90 ml/minute/1.73 m 2 . Seventeen patients were black (includes native African immigrants). INTERVENTION: Chemistry assays were performed, and patients' records were reviewed for age, ethnic background, height, and actual weight. Ideal weight, corrected weight, body mass index, body surface area (BSA), and GFR by the original MDRD equation were calculated for each patient. MEASUREMENTS AND MAIN RESULTS: Cockcroft-Gault estimates of renal clearance were calculated by using actual weight, ideal weight, and corrected weight both with and without correction for BSA. These estimates, as well as an estimate of GFR by the abbreviated MDRD equation, were compared with the original MDRD estimate. The results obtained with the abbreviated MDRD equation and with the Cockcroft-Gault equation that used corrected weight and BSA adjustment had the best agreement; both were within +/- 30% of the original MDRD equation in 80% of the 208 patients' results. All other Cockcroft-Gault variants tested were less accurate. CONCLUSION: Electronic patient record databases may not contain a nominal variable database field for black or non-black status, which is required by the MDRD equations. The Cockcroft-Gault equation that used corrected weight and BSA adjustment performed about as well as the abbreviated MDRD equation and can be programmed into electronic patient records. Given the small number of black patients included in this study, further study in this patient population is recommended before applying this Cockcroft-Gault variant to this subgroup.     

Inappropriate benzodiazepine use in older adults and the risk of fracture

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Benzodiazepine use increases the risk of fracture in the elderly.
• It is controversial which conditions of use are most risky, e.g. use of short- or long-acting benzodiazepines, dose and duration of use.
• The well-known Beers criteria include statements about inappropriate benzodiazepine use in elderly and the risk of fracture, but their clinical value has never been tested in an outcome study.

WHAT THIS STUDY ADDS

• Inappropriate benzodiazepine use according to the Beers criteria is not associated with an increased risk of fracture.
• Daily dose and duration of use is associated with higher risk of fracture, not the type of benzodiazepine prescribed as the Beers criteria state.

AIMS

The Beers criteria for prescribing in elderly are well known and used for many drug utilization studies. We investigated the clinical value of the Beers criteria for benzodiazepine use, notably the association between inappropriate use and risk of fracture.

METHODS

We performed a nested case–control study within the Rotterdam Study, a population-based cohort study in 7983 elderly. The proportion of ‘inappropriate’ benzodiazepine use according to the Beers criteria was compared between fracture patients and controls. ‘Inappropriate’ use for elderly implies use of some long-acting benzodiazepines and some intermediate/short-acting ones exceeding a suggested maximum daily dose. Also, alternative criteria were applied to compare the risk of fracture. Cases were defined as persons with incident fracture between 1991 and 2002 who were current benzodiazepine users on the fracture date. Controls were matched on fracture date and were also current benzodiazepine users.

RESULTS

The risk of fracture in ‘inappropriate’ benzodiazepine users according to the Beers criteria was not significantly different from ‘appropriate’ users [odds ratio (OR) 1.07, 95% confidence interval (CI) 0.72, 1.60]. However, a significantly higher risk of fracture was found in ‘high dose’ users and a longer duration of use (14–90 days), irrespective of the type of benzodiazepine (OR 3.45, 95% CI 1.38, 8.59).

CONCLUSIONS

These findings suggest that inappropriate benzodiazepine use according to the Beers criteria is not associated with increased risk of fracture. Daily dose and longer duration of use (>14 days) is associated with higher risk of fracture, irrespective of the type of benzodiazepine prescribed.     

Pharmacist perceptions of competency: Identifying priority areas for a competency program development at an academic medical center

Background

Competency-based education models can serve as valuable resources for providing quality continuing education and professional development in healthcare. However, competency development programs can be stifled by scarce stakeholder involvement and insufficient recognition of resource challenges. Engaging pharmacists in program development can inform program design and prioritization of needs.

改良版柏林问卷用于鼾症门诊筛查阻塞性睡眠呼吸暂停低通气综合征高风险患者的评价

目的评估改良版柏林问卷（MBQ）在鼾症门诊筛查阻塞性睡眠呼吸暂停低通气综合征（OSAHS）高风险患者的作用。方法共312例鼾症门诊患者参与本研究,所有患者均填写MBQ,其中符合本研究入选标准的199例受试者在睡眠中心接受多导睡眠监测（PSG）。根据MBQ分数将受试者分为高危组和低危组,根据PSG监测结果将受试者分为非OSAHS组及轻、中、重度OSAHS组。分析由MBQ评分得出的危险度与呼吸暂停低通气指数（AHI）的关系,并行相关性分析。以PSG结果 AHI≥5为金标准,计算MBQ的敏感度、特异度、阳性预测值和阴性预测值等。结果根据MBQ结果,把患者分为OSAHS高风险组162例（81.4%）和低危组37例（18.6%）,MBQ筛查OSAHS的敏感度为90.1%,特异度为46.8%。结论 MBQ在中国鼾症人群中具有较高的敏感性,可用于对门诊鼾症患者是否存在高风险OSAHS的初步筛查。