The Effect of Medication Reconciliation via a Patient Portal on Medication Discrepancies: A Randomized Noninferiority Study

BackgroundMedication reconciliation has become standard care to prevent medication transfer errors. However, this process is time-consuming but could be more efficient when patients are engaged in medication reconciliation via a patient portal.ObjectivesTo explore whether medication reconciliation by the patient via a patient portal is noninferior to medication reconciliation by a pharmacy technician.Design (including intervention)Open randomized controlled noninferiority trial. Patients were randomized between medication reconciliation via a patient portal (intervention) or medication reconciliation by a pharmacy technician at the preoperative screening (usual care).Setting and ParticipantsPatients scheduled for elective surgery using at least 1 chronic medication were included.MeasuresThe primary endpoint was the number of medication discrepancies compared to the electronic nationwide medication record system (NMRS). For the secondary endpoint, time investment of the pharmacy technician for the medication reconciliation interview and patient satisfaction were studied. Noninferiority was analyzed with an independent t test, and the margin was set at 20%.ResultsA total of 499 patients were included. The patient portal group contained 241 patients; the usual care group contained 258 patients. The number of medication discrepancies was 2.6 ± 2.5 in the patient portal group and 2.8 ± 2.7 in the usual care group. This was not statistically different and within the predefined noninferiority margin. Patients were satisfied with the use of the patient portal tool. Also, the use of the portal can save on average 6.8 minutes per patient compared with usual care.Conclusions and ImplicationsMedication reconciliation using a patient portal is noninferior to medication reconciliation by a pharmacy technician with respect to medication discrepancies, and saves time in the medication reconciliation process. Future studies should focus on identifying patient characteristics for successful implementation of patient portal medication reconciliation.     

Regulatory review time and pharmaceutical research and development

In the United States, all newly developed drugs undergo a lengthy review process conducted by the US Food and Drug Administration (FDA). These regulatory delays have direct immediate costs for drug manufacturers and patients waiting for treatment. Under certain market conditions, regulatory delays may also affect future research and development (R&D) strategies of pharmaceutical companies. To estimate the magnitude of this effect, we match data on drugs in the development pipeline in 2006 to data that we collect on FDA review times for all drugs approved between 1999 and 2005. Employing a rich and novel set of controls that affect drug R&D decisions and, potentially, regulatory review lags, we find that on average, three additional months of delay result in one fewer drug in development in that drug category. Our results suggest that the length of the regulatory delay matters for pharmaceutical firms' R&D decisions and that the firms are likely unable to pass on these costs onto consumers.     

Ischemic toe after surgery for lesser toe deformities: An algorithm

Ischemia after correction of lesser toe deformities is usually due to temporary vasospasm and can rarely cause gangrene. The published literature on dealing with the issue and been reviewed and used to suggest an algorithm for a logical step by step approach to a pale or white toe when encountered in the postoperative period.     

Digital health technologies for osteopaths and allied healthcare service providers: A scoping review

BackgroundDigital health technologies are poised to revolutionise the healthcare industry by improving accessibility to services and patient outcomes. The novel coronavirus disease-19 (COVID-19) pandemic has presented unprecedented challenges for the delivery of allied healthcare and has catalysed rapid adoption of telehealth. As such, allied healthcare consumers and providers stand to benefit from the capabilities of the digital health movement, ultimately justifying a scoping review of current and emerging technologies.ObjectiveTo provide decision makers with up-to-date information on the allied health applications of new and emerging digital health technologies; their evidence of efficacy, scope of use, and limitations.MethodsA scoping review of the literature was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. To synthesise original research, MEDLINE, CINAHL, and EMBASE databases were searched from 2010 to June 2020 and reference lists were examined for randomised control trials analysing the efficacy of these technologies in allied health applications.ResultsA total of 14 articles were included with a focus on common musculoskeletal conditions managed by allied health service providers. Studies were selected for data extraction after abstract and full-text screening by three independent reviewers. The results of this review indicate that telehealth technology effectively monitors and progresses patient care, while mobile health applications provide remote support and enable data collection.ConclusionEmerging trends suggest that digital technologies serve as promising adjuncts to allied healthcare. Further research is warranted regarding the safety and efficacy of digital health technologies in this context.     

新型数字显示式颈总动脉压迫器

本文介绍了新近研制的数显便携式颈总劝脉压迫器的工作原理、电路设计和调试结果，该仪器增强了患侧动脉切术前施行压迫锻炼改善脑侧支循环的效果并为临床实时监测提供客观数据指标。     

自适应算法与小波变换在心电信号滤波中的应用

心电信号是一种基本的人体生理信号,具有重要的临床诊断价值。然而,体表检测人体心电信号中常带有工频干扰、基线漂移、肌电干扰等各种噪声,给临床对心血管疾病的诊断带来了障碍。为了消除心电信号检测过程中带有的上述三种噪声,采用LM S自适应算法及小波变换理论,有针对性的设计了自适应滤波器、小波变换滤波器和自适应信号分离器等三种数字滤波器来滤除相应干扰。结果表明,对心电信号中存在的这三种噪声具有很好的滤波效果。     

数字X射线成像中的摄像机技术比较

数字化已成为现代医学成像的主流，摄像机则是数字Ｘ射线成像设备中的核心技术，本文就上前在数字Ｘ射线成像系统中使用的两种摄像机技术－－摄像管及ＣＣＤ摄像机进行了讨论和比较，结果在未来主分辩力成像研究中ＣＣＤ优于摄像管。     

颅底富血供肿瘤术前超选择性颈外动脉插管栓塞9例报告

目的：探讨超选择性颈外动脉插管栓塞术在颅底富血供肿瘤手术治疗中的作用。方法：对９例颅底富血供肿瘤患者术前先作双侧颈内、颈外及椎动脉造影后再行栓塞治疗。结果：９例栓塞后,肿瘤供血网显影消失,术中出血量明显减少,术后病理检查,镜下均见瘤体微血管及血窦内充满大量明胶海绵。结论：超选择性颈外动脉插管造影,在明确肿瘤血供类型后辅以术前栓塞治疗,既可缩小瘤体又能减少术中出血,是肿瘤围手术期处理的重要手段之一。     

21纪我国医药行业的创新与发展

在分析我国医药行业发展现状及存在问题的基础上,研究了加入WTO后医药行业所面临的机遇与挑战,以及当前医药企业技术创新存在的不足,提出了21世纪我国医药行业创新与发展的对策和建议。     

正交试验法优选心脑安胶囊提取工艺

用正交试验法对心脑安胶囊的制备工艺进行了探讨。用正丁醇浸出物含量为指标,考察了加水量、浸泡时间、煎煮时间、煎煮次数４种因素对其提取效果的影响。结果表明,加水量的多少是影响切药材煎煮效果的主要因素,为了保证有效成分的煎出,心脑安胶囊拟采用１３倍量水,浸泡１２ｈ,煎煮２次,每次１．５ｈ为宜。