Medication Action Plan Research Articles

Design and development of the clinical pharmacy key performance indicators dashboard for equity of service provision at regional and rural hospitals in North Queensland, Australia

AbstractBackgroundProvision of a Medication Action Plan (MAP) on admission and a Discharge Medication Record (DMR) are associated with reduced medication‐related harm.AimTo report factors associated with the provision of MAPs and DMRs in rural and regional hospitals in Queensland, Australia.MethodA literature search, environmental scan and department consultations were conducted to develop Clinical Pharmacy Key Performance Indicators (cpKPIs) and design a cpKPI dashboard. Two of the five KPIs included in the dashboard, relating to medication action plans on admission and medication records on discharge, were reported for all the hospitals and were included in the study. A retrospective, period‐prevalence study was conducted to evaluate the coverage and equity of clinical pharmacy service provision for patients admitted for longer than 24 h. The proportions of patients who received MAPs and DMRs were stratified by age, gender, Indigeneity and hospital type. Statistical analysis used chi‐squared tests and logistic regression in R. This project was exempt due to the local policy requirements that constitute research by the Far North Queensland Human Research Ethics Committee (Reference no: EX/2023/QCH/94383‐1684QA). The justification for this exemption is as follows: the project was determined to be negligible risk research and involved the use of existing collection of data or records that contain only non‐identifiable data about human beings.ResultsIn total, 13 818 patients (37.9% of admissions) received a MAP and 11 631 patients (32.7% of discharges) received a DMR. The proportion of MAPs and DMRs was significantly higher in rural hospitals than in regional hospitals (MAP 50.6% vs 34.6%, DMR 33.1% vs 31.3%) and for male patients than female patients (MAP 42.2% vs 33.7%, DMR 36.4% vs 29.2%). When stratified by age, First Nations patients received a higher proportion of MAPs and DMRs in each age group, except for age 85 years and over. The proportion of First Nations patients aged 50 years and over who received MAP was lower compared to that for non‐Indigenous patients aged 65 years and over (56.3% vs 59.8%), whilst the proportion for DMRs was similar (50.4% vs 49.3%).ConclusionThe study defined the clinical pharmacy key performance indicators for measuring equity of clinical pharmacy service provision in Australia. When adjusted for a difference in life expectancy, the proportion of MAPs for First Nations patients was lower compared to the proportion of MAPs for non‐Indigenous patients. Further improvements are required to achieve equity of service provision for First Nations patients and female patients.

Role of a Pharmacist in Postdischarge Care for Patients With Kidney Disease: A Scoping Review.

The objective was to explore and describe the role of pharmacists in providing postdischarge care to patients with kidney disease. PubMed, Embase (Elsevier), CINAHL (Ebscohost), Web of Science Core Collection, and Scopus were searched on January 30, 2023. Publication date limits were not included. Search terms were identified based on 3 concepts: kidney disease, pharmacy services, and patient discharge. Experimental, quasi-experimental, observational, and qualitative studies, or study protocols, describing the pharmacist's role in providing postdischarge care for patients with kidney disease, excluding kidney transplant recipients, were eligible. Six unique interventions were described in 10 studies meeting inclusion criteria. Four interventions targeted patients with acute kidney injury (AKI) during hospitalization and 2 evaluated patients with pre-existing chronic kidney disease. Pharmacists were a multidisciplinary care team (MDCT) member in 5 interventions and were the sole provider in 1. Roles commonly identified include medication review, medication reconciliation, medication action plan formation, kidney function assessment, drug dose adjustments, and disease education. Some studies showed improvements in diagnostic coding, laboratory monitoring, medication therapy problem (MTP) resolution, and patient education; prevention of hospital readmission was inconsistent. Limitations include lack of standardized reporting of kidney disease, transitions of care processes, and differences in outcomes evaluated. This review identifies potential roles of a pharmacist as part of a postdischarge MDCT for patients with varying degrees of kidney disease. The pharmacist's role in providing postdischarge care to patients with kidney disease is inconsistent. Multidisciplinary care teams including a pharmacist provided consistent identification and resolution of MTPs, improved patient education, and increased self-awareness of diagnosis.

A script-enabled interactive checklist document for efficient management of electronic devices in a busy multimodality radiotherapy clinic.

Develop an efficient, interactive, and instructive checklist document for the management of implanted electronic medical devices in a multimodality radiotherapy clinic. The built-in scripting and interactivity of a popular commercial word processor was used to develop an interactive document that changes the information presented to the user based on drop-down selections. The interactivity and scripting were compatible with the radiation oncology information system (ROIS) which allows the document to be accessible by all team members and serve as a permanent record in a patient's electronic chart. The final interactive document, which was clinically deployed after beta testing with a group consisting of nurses and medical physicists, presents information and action plans to the user based on multiple departmental medical device decision trees that are specific to the combination of device, treatment modality, rhythm-pacing dependence for cardiac devices, and distance from the device to the treatment volume. A script-enabled interactive document was developed for a busy multimodality clinic, condensing multiple comprehensive departmental guidelines spanning multiple device types and treatment modalities into a single interactive checklist accessible within the ROIS. Given the wide accessibility of the commercial word processor, this approach could be adopted by other clinics to streamline their own respective workflows.

Techniques for the Analysis of Covid-19 Virus: State-of-the-Art and Future Prospects

SARS-CoV-2 was first reported in 2019 in China, which then inadvertently spread rapidly across the globe and by 2020 WHO has confirmed Covid-19 as a pandemic. Infections have been transmitted through airborne mechanisms leading to an exponential spread which called out for a strategic medical action plan to curtail the spread. Though WHO has established definite guidelines for containing the spread, such as isolation, social distancing, mandatory masks, sanitization, quarantines, international travel bans, and lockdowns. Early diagnosis and a large number of screenings were given a crucial role in the medical action plan, as they helped in delivering the medical aid and protecting the uninfected population. Various diagnostic methods have sprung up to detect Covid-19 with varying modes of sample collection, time of sampling, duration of test results, and accuracy. These diagnostics tests have been majorly based on a molecular and serological assays which are readily available, mass-produced, easy to handle, offer high accuracy, and shorter duration for results. This review article consolidates the functionality and efficacy of different diagnostic methods describing details of their functioning mechanisms, limitations, and accuracy of the test results. The role of artificial intelligence and deep learning algorithms have also been mentioned for future integrations to make the diagnostic tools efficient, reproducible, and robust. Auxiliary methods like Point care devices, biosensors, and lateral flow devices have also been used for quick diagnosis, which is however only qualitative in nature. Each technique is unique and has its limitations, but in testing times like a pandemic every technological development can be a game-changer when put to the right use.

Improving the Outpatient Pain Management Plan for Patients with Sickle Cell Disease with Electronic Medical Record-Based Pain Action Plans

Background: Patients with sickle cell disease (SCD) experience recurrent vaso-occlusive crises (VOC) as a primary manifestation of their illness. The American Society of Hematology (ASH) best practice guidelines recommend that individuals with SCD have individualized care plans to effectively begin pain management at home prior to presenting to the emergency room. A needs assessment of the comprehensive sickle cell program at Rady Children's Hospital San Diego (RCHSD) identified the need for a standardized approach for the provision of Pain Action Plans (PAP). In 2022, an outpatient PAP Quality Improvement (QI) project was initiated at RCHSD with the global aim to improve outpatient pain management and quality of life for patients with SCD. SMART Aim: Within 6 months (January-June 2023), to increase the proportion of patients with SCD receiving a PAP during a comprehensive clinic visit from 0 to 50%. Methods: The QI project was conducted by an interprofessional team with clinical, QI, and information technology expertise. An initial approach utilizing the Med Action Plan function in EPIC had technical challenges and was not implemented. We identified an existing Epic Asthma Action Plan which could be adapted to a SCD PAP. Meetings with clinical informaticists, pulmonology (consultants), and hematology teams informed the QI tools (process mapping, key driver and Ishikawa diagrams) that we used to design our PDSA cycles. The PAPs were modeled after the existing Asthma Action Plan, with green, yellow, and red zones to indicate different levels of pain management. Patients were given laminated Youth Acute Pain Functional Ability Questionnaire (YAPFAQ) and a comfort measures sheet to complete prior to their visit with the provider to inform the PAP which included pain medication details and supportive care measures for each zone. PAPs were created within the clinic note at comprehensive clinic visits and then provided to the family as a printed letter in person and via MyChart (if activated). Our outcome measure was the percentage of patients who were provided a PAP at their SCD comprehensive clinic visit. Process measures included the percentage of patients who had documentation in the PAP of the YAPFAQ and comfort measures, percentage of patients who had a PAP routed to patient via MyChart, percentage of patients who confirmed receipt of their PAP, percentage of patients who had used their PAP by parental report after one week, and percentage of patients who had used their PAP after 3 months per Epic documentation. Balancing measures were the perceived burden of patient care/documentation for the PAP to be evaluated with pre and post surveys among providers. Results: Interventions were evaluated using PDSA cycles. PDSA Cycle 1 (January-March 2023) included development of the SCD PAP by adapting the existing Asthma Action Plan to a SCD PAP. This included the creation of medication templates, integrating comfort measures and pain triggers, creating EPIC smart phrases to document the YAPFAQ. We educated providers on the SCD PAP and documentation process and worked with the interdisciplinary team including case managers, nurses, child life specialists, and psychologist to incorporate YAPFAQ and comfort measures into the comprehensive clinic visit. PDSA Cycle 2 (April-June 2023) included additional education, training, and targeted e-mail reminders to hematology attendings. From May 2023 to July 2023, 94% percent (13/14) of patients seen at a comprehensive clinic visit received a PAP. One patient had the PAP created but did not receive the printed letter due to time constraints for family. Feedback from families indicated that they felt the PAP was a valuable tool to have at home during VOC, however none had yet utilized it in the week since they were seen in clinic. Early provider feedback has indicated that this functionality is easy to use and efficient during the comprehensive clinic visit. Conclusion: The adaptation of the Asthma Action Plan to the SCD PAP allowed for successful implementation of PAPs for our patients with SCD. Subsequent PDSA cycles will focus on optimizing implementation in the clinic and utilization for pain events. We will evaluate the clinical impact of the PAPs on pain management outcomes.

Evaluating the use of role-play simulations in teaching management of medical emergencies in the dental clinic

BackgroundPractical hands-on training is necessary for clinical competence in managing medical emergencies in the dental setting. Therefore, the King Abdulaziz University Faculty of Dentistry developed a role-play simulation-based clinical module for training clinical years (Years 4, 5, and 6) dental students in medical emergency management between 2016 and 2020. This study aimed to assess the knowledge and skills of years 4, 5, and 6 dental students before and after the completion of the role-play simulation-based medical emergency training module.MethodsA mandatory four-hour annual training module was designed consisting of a 45-minute lecture on the medical emergency basic action plan and overview, four hands-on stations, and six role-play simulation-based medical emergency stations. A 16-item multiple choice test was used to assess the knowledge of the students before and after the training module every academic year. An objective structured clinical exam (OSCE) on a medical emergency scenario was administered to the students graduating each year. The difference between the pre- and post-module test scores and the one-time OSCE pass/fail rate were analyzed statistically using appropriate tests.ResultsA total of 846 students participated in the study between 2017 and 2020: 275 once, 483 twice, 87 thrice, and one participated four times; in total, 1,506 assessments were conducted. Overall, the pre-test and post-test mean scores were 9.4 ± 3.0 and 13.5 ± 1.6, respectively. All students showed significant improvements in the post-test scores compared to the pre-test scores. Year 4 students showed the highest improvement, followed by Year 5 and Year 6. There was a statistically significant association between the pass/fail rate of the OSCE station and the number of times the module was taken.ConclusionsThe significant improvement in the scores of clinical year students in this study supports an annual mandate for all dental students to undergo simulation-based competency training in their clinical years. Teaching institutions are recommended to utilize simulation and hands-on instruction to teach medical emergency management.

Postdischarge Video Visits for Adherence to Hospital Discharge Recommendations: A Randomized Clinical Trial

ObjectiveTo determine whether a postdischarge video visit with patients, conducted by hospital medicine advanced practice providers, improves adherence to hospital discharge recommendations. Patients and MethodsWe conducted a single-institution 2-site randomized clinical trial with 1:1 assignment to intervention vs control, with enrollment from August 10, 2020, to June 23, 2022. Hospital medicine patients discharged home or to an assisted living facility were randomized to a video visit 2-5 days postdischarge in addition to usual care (intervention) vs usual care (control). During the video visit, advanced practice providers reviewed discharge recommendations. Both intervention and control groups received telephone follow-up 3-6 days postdischarge to ascertain the primary outcome of adherence to all discharge recommendations for new and chronic medication management, self-management and action plan, and home support. ResultsAmong 1190 participants (594 intervention; 596 control), the primary outcome was ascertained in 768 participants (314 intervention; 454 control). In intervention vs control, there was no difference in the proportion of participants with the primary outcome (76.7% vs 72.5%; P=.19) or in the individual domains of the primary outcome: new and chronic medication management (94.1% vs 92.8%; P=.50), self-management and action plan (76.5% vs 71.5%; P=.18), and home support (94.1% vs 94.3%; P=.94). Women receiving intervention vs control had higher adherence to recommendations (odds ratio, 1.77; 95% CI, 1.08-2.91). ConclusionIn hospital medicine patients, a postdischarge video visit did not improve adherence to discharge recommendations. Potential gender differences in adherence require further investigation.Clinicaltrials.gov number, NCT04547803.

Medical Disputes on the Concept of Inspanningsverbintenis vs Resultaatsverbintenis: A Critical Review

The relationship between patients and doctors in health services is a therapeutic contract-based relationship. The therapeutic contract begins with an (unwritten) agreement where both parties are assumed to be accommodated when the agreement is reached. Agreement that can be reached include agreeing to medical action or rejecting a medical action plan. Doctors as health workers who work in the health care sector are involved in a working relationship with the hospital as a place to carry out their profession. A doctor working in a hospital also has an administrative relationship that affects rights and obligations between the two parties and responsibilities to third parties. In the relationship between patients and the hospital, patients are the recipient of health services and the hospital is the provider of such services. Hospitals are obliged to provide health services in accordance with health care standards. Doctors, patients and hospitals are in a relationship based on trust, under an assumption that doctors can cure patients' illnesses and will do the best for patients. However, this mindset has changed along with the times, science, and technology that affect the human mind. Their social-moral-oriented relationship has turned into a material-oriented one because doctors face various demands to improve their professionalism. The change in orientation above is one of the causes of medical conflicts and disputes. Conflicts arise between doctors as health service provider and patients as health service receivers. Conflicts can turn into disputes if the party who feels aggrieved has expressed dissatisfaction with the party considered to be the cause. Medical disputes have risen sharply along with the disruption of services amid the turbulence of the COVID-19 pandemic throughout 2020 and 2021. The high rate of disputes also begs question of quality control of health services. This qualitative research-based article attempted to describe and analyze the phenomenon of medical disputes at the Dr. Iskak General Hospital of Tulungagung using the conception of inspanningsverbintenis vs resultaatsverbintenis. The findings show that, in the provision of health services, there may arise four violation categories, namely: ethical violations, disciplinary violations, administrative violations, and legal (both civil and criminal) violations.

Web-Based Electronic Health Record Program: A Twelve-Month Evaluation on Pharmacist’s Intervention in Medicare Part D Annual Comprehensive Medication Review

Objective:The objective of this study was to evaluate the impact of pharmacist’s intervention on annual comprehensive medication review (Annual CMR) for Medicare Part D beneficiaries. Background: To develop a new approach to assess Medicare Part D Annual CMR using a technological tool. Methods: One hundred sixty-three (163) eligible Medicare Part D beneficiaries were enrolled. By using an Electronic Health Record (EHR) Program, the pharmacist was able to assess laboratory, pharmacy, diagnosis, and patient information. A post-medication review summary was provided to the medical providers and patients which included a medication action plan. At the end of 3 months, 6 months and 12 months after the medication review, data were collected, assessed and compared. Results: The study showed that pharmacist’s interventions were recommended to seventy-four (74) enrollees which comprised of 45% of the total enrollees. It showed that at 3-month, 6-month, and 12-month intervals after the medication review, the recommended interventions acknowledged and implemented by the medical providers were 20%, 51% and 64% respectively, which showed a significant difference over a 12-month period (P-value <.05). Different types of pharmacist’s interventions that were recommended may include to initiate, to adjust and to discontinue medication. The most common disease states that required interventions were psychiatric disorder, cardiovascular disease, pulmonary disease, gastrointestinal disease, diabetes, dyslipidemia and pain. Conclusion: The finding of this study revealed that such a web-based EHR system was a very meaningful and effective tool in assisting pharmacists to assess the proper and safe use of medication in elderly patients.

Hurricane Ida Emergency Medicine Resident Disaster Response.

This report describes the medical response, action plan, and after-action summary adopted by the Louisiana State University (LSU) New Orleans - Emergency Medicine (EM) Residency Program in response to Hurricane Ida which occurred in New Orleans, Louisiana (USA) late August through early September 2021. New Orleans has an estimated 385,000 people within the 350 square miles surrounding the metropolitan area, with greater than one million residents in all of Louisiana. In the two-week time span during and following the event, residents, nurses, attendings, ancillary staff, and Emergency Medical Services (EMS) managed a substantial intensification in daily EM activities due to a substantial lack of resources (ie, food, electricity, water, housing, medications, oxygen, and primary care). This report outlines the redistribution of emergency department (ED) residents within the primary clinical site, University Medical Center New Orleans (UMCNO); describes the daily communication flow from the chief residents and program director; describes the daily EM response; describes the pre- and post-action plans based on those efforts during hurricane operations; and summarizes the obtained information.

Real-World Impact of a Pharmacogenomics-Enriched Comprehensive Medication Management Program.

The availability of clinical decision support systems (CDSS) and other methods for personalizing medicine now allows evaluation of their real-world impact on healthcare delivery. For example, addressing issues associated with polypharmacy in older patients using pharmacogenomics (PGx) and comprehensive medication management (CMM) is thought to hold great promise for meaningful improvements across the goals of the Quadruple Aim. However, few studies testing these tools at scale, using relevant system-wide metrics, and under real-world conditions, have been published to date. Here, we document a reduction of ~$7000 per patient in direct medical charges (a total of $37 million over 5288 enrollees compared to 22,357 non-enrolled) in Medicare Advantage patients (≥65 years) receiving benefits through a state retirement system over the first 32 months of a voluntary PGx-enriched CMM program. We also observe a positive shift in healthcare resource utilization (HRU) away from acute care services and toward more sustainable and cost-effective primary care options. Together with improvements in medication risk assessment, patient/provider communication via pharmacist-mediated medication action plans (MAP), and the sustained positive trends in HRU, we suggest these results validate the use of a CDSS to unify PGx and CMM to optimize care for this and similar patient populations.

Impact of community paramedicine program on APPE student skillsets

Background and purposeThis article describes the clinical and educational impact resulting from interprofessional (IP) collaboration between fourth-year advanced pharmacy practice experience (APPE) pharmacy students and community paramedics within a community paramedicine (CP) program. Educational activity and settingThe Manatee County, Florida CP program partnered with Lake Erie College of Osteopathic Medicine School of Pharmacy faculty to reduce 911 calls, emergency room visits, and hospital readmissions for underserved populations. The CP-pharmacist partnership optimized medication therapy, chronic disease management, and access to care through scheduled in-home visits with an IP team. With guidance from the pharmacist, APPE student responsibilities included comprehensive medication review, medication action plan development, communication with providers, and patient counseling to resolve medication issues. FindingsSurvey data demonstrated this approach to APPEs increased student confidence in optimizing care plans (100%), assessing vitals (76%), identifying medical emergencies (84%), and communicating with patients (96%). Student incorporation into a CP program augmented the pharmacist's ability to successfully correct medication use errors and improve nonadherence through patient counseling. Medication interventions were successful in 693 of 799 scenarios, for a success rate of 86.7%. SummaryResults from this analysis reinforced prior research indicating pharmacy students can be successfully incorporated into a CP program, with resulting improvement in student clinical skills, communication strategies, and successful medication intervention outcomes.

Impact of pharmacist-led heart failure tool kits on patient-reported self-care behaviors in a primary care–based accountable care organization

ObjectiveThe goal of this project is to evaluate the impact of a pharmacist-led heart failure (HF) intervention, using an educational toolkit, on patient-reported self-care maintenance, management, and confidence at 30 days. SettingThree Accountable Care Organization (ACO) primary care provider offices in South Florida from January to March 2018. Practice descriptionEach primary care clinic was staffed with at least 1 physician, nurse practitioners, a clinical pharmacy faculty member, pharmacy residents and students, and ancillary staff. Pharmacists spent approximately 2 days per week in clinic. Practice innovationAt the time of this project, no formalized management program for HF patients existed within the clinics. An educational toolkit was designed, reviewed, and approved by the team of pharmacists and ACO providers before use within the clinics, and included educational material outlining common causes of HF exacerbation, symptoms of HF, symptom management strategies, medication action plan, self-management instructions, medication adherence tips, and a weight-management log sheet. EvaluationA prospective, pretest and posttest observational project was conducted at the 3 clinical sites for eligible patients. The Self-Care for Heart Failure Index (SCHFI, v.6.2) tool was used to evaluate self-care practices and adequacy of maintenance, management, and confidence at baseline as compared with 30 days. ResultsTwelve participants completed the initial interview and 30-day follow-up. SCHFI scores for self-maintenance (63–68, P = 0.04) and self-management (38–58, P = 0.01) significantly improved from baseline, whereas self-confidence scores showed an increase, but was not statistically significant (80–82, P = 0.58). All self-care behaviors saw a nonstatistically significant improvement in percentage of patients achieving adequacy. ConclusionPharmacists and educational toolkits in the ACO primary care setting may improve self-maintenance, self-management, and self-confidence behaviors in patients with HF.

Findings from a National Survey of Medicare Beneficiary Perspectives on the Medicare Part D Medication Therapy Management Standardized Format.

The Medication Therapy Management (MTM) Program Standardized Format (SF) is a written summary of a comprehensive medication review (CMR) that must be provided to Medicare Part D beneficiaries. Concerns have been raised regarding the number of pages of the SF, mailing costs, the static nature of the document, and the lack of integration into beneficiaries' electronic health records. To date, limited research exists on beneficiaries' perceptions of the SF. To evaluate the perspectives of beneficiaries regarding the utility of the SF to inform potential modifications for optimal use. An online survey, designed based on the standard approach to measuring patient satisfaction with health service attributes and previous qualitative research, was distributed through Medicare Part D plans to beneficiaries who had received a CMR in the past year. Survey distribution began July 1, 2018, and data collection ended on October 31, 2018. Descriptive statistics are reported for demographic information; health status; perceived value and helpfulness of the SF and its 3 components (cover letter, medication action plan [MAP], personal medication list [PML]); updates to the SF; alternate formatting; and integration of the SF into health records. A total of 9,975 surveys were sent electronically by 4 Medicare Part D plans to beneficiaries who had received a CMR in the past year. Of the 434 unduplicated survey respondents (response rate of 4.3%), 58.5% were aged 65 to 84 years; 60% identified themselves as white; and 49.1% had at least a college education. The most commonly reported comorbidities were diabetes (50.5%) and high cholesterol (43.1%), with 10.7% of respondents rating their health as "very good" or "excellent" and 27.4% choosing "poor" or "fair." Beneficiaries rated how well the SF helped improve different aspects of their medication management (e.g., solving medication-related problems, keeping track of medications, correctly using medications, and understanding why medications are being taken), with 40.8%-44.9% choosing "very good" to "excellent" for each aspect. Helpful sections included "What we talked about" and "What I need to do"for the MAP, and medication name, strength, dosage form, and "How and why I use the medication" for the PML. Less helpful were the fill-in sections of the MAP, with 48.6% reporting that they did not write in any information. In contrast, 44.7% of the participants noted that they updated their PML. A wallet card version of the PML, if available, would be used by 54.6% of participants. About one third of Medicare beneficiaries shared the SF with their doctor, and 26% of the participants gave copies of their medication summary to their relatives. Fewer than half of the respondents perceived the SF as very good or excellent in helping them to manage their medications. This national survey provides Medicare beneficiary-focused evidence that more work is needed to improve the usability and portability of the SF. This can be achieved by allowing flexibility in the design of the SF, while including essential elements. This study was funded by the Academy of Managed Care Pharmacy (AMCP), which provided a grant to the University of Maryland School of Pharmacy to conduct this study. Carden and Kumbera are AMCP employees. Brandt reports a grant from IMPAQ and consulting fees from Rand, outside of this study. Pellegrin is a member of the AMCP MTM Advisory Board. The other authors have nothing to disclose.

Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas.

BackgroundThe chance of surviving an out-of-hospital cardiac arrest (OHCA) seems to be increased if the cardiac arrests occurs in relation to exercise. Hypothetically, an exercise-related OHCA at a sports arena would have an even better prognosis, because of an increased likelihood of bystander cardiopulmonary resuscitation (CPR) and higher availability of automated external defibrillators (AEDs). The purpose of the study was to compare survival rates between exercise-related OHCA at sports arenas versus outside of sports arenas.MethodsData from all treated exercise-related OHCA outside home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 in 10 counties of Sweden was analyzed (population 6 million). The registry has in those counties a coverage of almost 100% of all OHCAs.Results3714 cases of OHCA outside of home were found. Amongst them, 268(7%) were exercise-related and 164 (61.2%) of those occurred at sports arenas. The 30-day survival rate was higher for exercise-related OHCA at sports arenas compared to outside (55.7% vs 30.0%, p<0.0001). OHCA-victims at sports arenas were younger (mean age±SD 57.6±16.3 years compared to 60.9±17.0 years, p = 0.05), less likely female (4.3% vs 12.2%, p = 0.02) and had a higher frequency of shockable rhythm (73.0% vs 54.3%, p = 0.004). OHCAs at arenas were more often witnessed (83.9% vs 68.9%, p = 0.007), received bystander CPR to a higher extent (90.0% vs 56.8%, p<0.0001) and the AED-use before EMS-arrival was also higher in this group (29.8% vs 11.1%, p = 0.009).ConclusionThe prognosis is markedly better for exercise-related OHCA occurring at sports arenas compared to outside. Victims of exercise-related OHCA at sports arenas are more likely to receive bystander CPR and to be connected to a public AED. These findings support an increased use of public AEDs and implementation of Medical Action Plans (MAP), to possibly increase survival of exercise-related OHCA even further.

Development and Pilot Testing of a Computerized Asthma Kiosk to Initiate Chronic Asthma Care in a Pediatric Emergency Department.

Emergency department (ED) visits are an opportunity to initiate chronic asthma care. Ideally, this care should be implemented in a fashion that limits utilization of scarce ED resources. We developed, iteratively refined, and pilot tested the feasibility of a computerized asthma kiosk to (1) capture asthma information, (2) deliver asthma education, and (3) facilitate guideline-based chronic asthma management. The following are the 4 phases of this study: (1) developing the content and structure of a computerized asthma kiosk, (2) iterative refinement through heuristic testing by human-computer interface experts, (3) usability testing with ED providers (n = 4) and caregivers of children with asthma (n = 4), and (4) pilot testing the kiosk with caregivers (n = 31) and providers in the ED (n = 18). Outcome measures for the pilot-testing phase were the proportion of ED providers who prescribed long-term controller medication (LTCM) and asthma action plans (AsAPs) and the proportion of children who took LTCMs and attended primary care providers follow-up. After kiosk development and refinement, pilot implementation resulted in LTCMs prescribing and AsAP provision for 19 (61%) of 31 and 17 (55%) of 31 patients, respectively. Before kiosk use, the proportion of the 18 ED providers who reported prescribing LTCM was 1 (5%) of 18, and providing AsAPs was 0 (0%) of 18. Eighteen (58%) of the 31 caregivers reported that their children used LTCMs after kiosk use and 13 (42%) of 31 reported following up with the primary care provider within 1 month of the ED visits. A rigorously developed asthma kiosk showed promise for initiating chronic asthma care in the ED.

Kedudukan Informed Consent Dalam Hubungan Dokter Dan Pasien

Informed Consent can be defined as a statement of the patient or legitimately representing him in the form of an agreement on a medical action plan submitted by a doctor after receiving sufficient information to be able to make an agreement or rejection. The signing of the written informed consent form is only an affirmation of what was previously agreed. The purpose of the complete explanation is so that the patient determines his decision according to the patient's choice (informed decision). The type of research in this paper is normative legal research. The nature of this research is descriptive analytical, which is a study that describes, examines, explains and analyzes a legal regulation related to the informed consentration position in the relationship between doctors and patients. The results of this study are that before carrying out a medical action the patient has the right to obtain information on medical actions to be carried out to him as stipulated in the Minister of Health Regulation (Permenkes) No. 290 of 2008 concerning Medical Action Approval, if viewed in terms of form, the informed consent consists of Imflied consent (considered given) and expressed consent (stated), the presence of informed consent is very important in the relationship between doctors and patients where informed consent is the basis or foundation to take medical action against patients .

Medication Therapy Management after Hospitalization in CKD: A Randomized Clinical Trial.

CKD is characterized by remarkably high hospitalization and readmission rates. Our study aim was to test a medication therapy management intervention to reduce subsequent acute care utilization. The CKD Medication Intervention Trial was a single-blind (investigators), randomized clinical trial conducted at Providence Health Care in Spokane, Washington. Patients with CKD stages 3-5 not treated by dialysis who were hospitalized for acute illness were recruited. The intervention was designed to improve posthospitalization care by medication therapy management. A pharmacist delivered the intervention as a single home visit within 7 days of discharge. The intervention included these fundamental elements: comprehensive medication review, medication action plan, and a personal medication list. The primary outcome was a composite of acute care utilization (hospital readmissions and emergency department and urgent care visits) for 90 days after hospitalization. Baseline characteristics of participants (n=141) included the following: age, 69±11 (mean±SD) years old; women, 48% (67 of 141); diabetes, 56% (79 of 141); hypertension, 83% (117 of 141); eGFR, 41±14 ml/min per 1.73 m2 (serum creatinine-based Chronic Kidney Disease Epidemiology Collaboration equation); and urine albumin-to-creatinine ratio median, 43 mg/g (interquartile range, 8-528) creatinine. The most common primary diagnoses for hospitalization were the following: cardiovascular events, 36% (51 of 141); infections, 18% (26 of 141); and kidney diseases, 12% (17 of 141). The primary outcome occurred in 32 of 72 (44%) of the medication intervention group and 28 of 69 (41%) of those in usual care (log rank P=0.72). For only hospital readmission, the rate was 19 of 72 (26%) in the medication intervention group and 18 of 69 (26%) in the usual care group (log rank P=0.95). There was no between-group difference in achievement of guideline-based goals for use of renin-angiotensin system inhibition or for BP, hemoglobin, phosphorus, or parathyroid hormone. Acute care utilization after hospitalization was not reduced by a pharmacist-led medication therapy management intervention at the transition from hospital to home.

Cardiopulmonary resuscitation and use of the automatic external defibrillator in sport

Cardiac arrest during sport practice is a low-incidence event, however, as it is commonly seen witnessed to have a high survival rate compared to general non-hospital cardiac arrest. The objective of this review is to analyze the special characteristics, give recommendations for the installation of automatic external defibrillators and the elaboration of an adequate medical action plan for each sports center.

Use of pharmacy technicians in elements of medication therapy management delivery: A systematic review.

Documented barriers to Medication Therapy Management (MTM) delivery, such as limited time and inefficient workflow may be overcome by utilizing support staff for administrative services. However, it is unknown how pharmacy technicians have been historically utilized to assist pharmacists in MTM-delivery. To characterize literature describing pharmacy technicians' participation in actions commonly undertaken in the provision of MTM services. In August 2016, a PubMed (MEDLINE) and Journal of Pharmacy Technology search was conducted using the term "pharmacy technician" with services outlined within the MTM Core Elements Version 2.0, and with terms related to administrative actions in the provision of MTM. References were searched using identified studies. Eligible articles described pharmacy technicians' performance and/or assistance in at least one MTM Core Element or related administrative action to the provision of MTM. Data was independently extracted by two researchers; any variation in extraction was reconciled via with discussion until consensus reached. A standardized data extraction template was used. Forty-four manuscripts were included. Manuscripts were most likely to describe pharmacy technicians' assistance with medication reconciliation (70%), documentation (41%) and medication therapy review (30%). Actions least likely to be described included personal medication record development (5%), physical assessment (5%), follow-up (2%), and medication action plan development (0%). Most articles were written in the United States (73%), or Europe (16%), while the remaining articles were Canadian (11%); no articles were found originating from Asia, Africa, Australia or the Middle East. Pharmacy technicians are utilized most often to support MTM through assistance in medication reconciliation. Standardized training for pharmacy technicians that delineates administrative support from pharmacists' role of clinical decision making could help pharmacists obtain greater efficiency in MTM delivery.