Practice Management Software Research Articles

Use of Antibiotics in Companion Animals from 133 German Practices from 2018 to 2023.

Background/Objectives: While antibiotic usage in farm animals has been systematically monitored and reduced in many countries, including Germany, data on companion animals such as dogs and cats remain scarce. To address this gap, a study was conducted in Germany to analyze patterns of antibiotic use in dogs and cats. Methods: Antibiotic usage data were obtained from debevet, a cloud-based veterinary practice management software based in Berlin, Germany. Practices with fewer than 100 patients were excluded, and data from 2018 to 2022 were analyzed. Results: The analysis included 477,310 consultations of 78,381 dogs and 241,532 consultations of 55,729 cats across 133 veterinary practices. Antibiotics were used in 12.9% of dog consultations and 22.5% of cat consultations, with substantial variation across practices. Aminopenicillins, particularly amoxicillin, were the most commonly used antibiotics, while the highest-priority critically important antibiotics (HPCIAs) accounted for 12.4% of treatments. Follow-up treatments led to changes in antibiotic substances in 9.3% of cases, often within the first two days. Indications varied by species, with respiratory issues more frequent in cats and orthopedic problems in dogs. Body weight and breed characteristics influenced the likelihood of antibiotic treatment, with short-nosed breeds showing higher odds. Conclusions: The routine data analysis provided valuable insights into antibiotic use in dogs and cats, enabling tracking trends across species and indications over time. While some specific information was missing, the invoicing data's completeness, the cost-effectiveness of their use, and their unbiased nature make them a robust tool for monitoring and informing legislative changes.

Drapes in Routine Aseptic Procedures for Environmental Sustainability (project DRAPES): a protocol for a multi-centre randomised controlled trial comparing post-operative wound complication rates following routine neutering of dogs and cats using reusable or disposable surgical drapes

BackgroundReusable surgical drapes have a lower lifetime environmental impact than disposable drapes in most cases. There is limited evidence regarding whether drape choice impacts patient outcomes including post-operative wound complications. The aim of this study is to compare wound complication rates following routine neutering surgeries in cats and dogs when reusable drapes are used as compared with disposable drapes.MethodsThe trial will be conducted as a pragmatic, multi-centre, parallel group randomised controlled trial in the UK. Dogs and cats undergoing routine neutering will be randomised to disposable or reusable drapes with all other aspects of care occurring as they usually would at the practice. The required sample size is 2,850, with 4750 animals to be recruited from up to ten practices to allow for a 40% loss to follow-up. Demographic data and details on peri-operative care will be collected at the time of surgery. Post-operative wound complications will be assessed and recorded as usual at each practice using clinical codes. The post-operative wound clinical codes and any antibiotic use within 30 days of surgery will be retrieved from the practice management software. The primary outcome that will be compared between the two groups is the rate of post-operative wound complications within 30 days of surgery which will be analysed by multivariable logistic regression with a binary outcome of wound complication (yes/no). Secondary outcomes are the prevalence of different types of complications and antibiotic use within 30 days of surgery which will be compared between the two groups by chi square analysis.DiscussionOur hypothesis is that there will be no difference in post-operative wound complication rates between disposable and reusable drapes. If the likely rate of post-surgical wound complications with reusable drapes is similar to that with disposable drapes, then veterinary clinical teams can choose the more sustainable option, confident that their patients will not be impacted by this choice.Trial registrationWe have retrospectively registered the protocol on the Open Science Framework on 14 Nov 2023 (Trial registration entry: https://doi.org/10.17605/OSF.IO/72HMA).

No improvement in AUDIT-C screening and brief intervention rates among wait-list controls following support of Aboriginal Community Controlled Health Services: evidence from a cluster randomised trial

BackgroundWhile Aboriginal and Torres Strait Islander Australians are less likely to drink any alcohol than other Australians, those who drink are more likely to experience adverse alcohol-related health consequences. In a previous study, providing Aboriginal Community Controlled Health Services (ACCHSs) with training and support increased the odds of clients receiving AUDIT-C alcohol screening. A follow-up study found that these results were maintained for at least two years, but there was large variability in the effectiveness of the intervention between services. In this study, we use services that previously received support as a comparison group to test whether training and support can improve alcohol screening and brief intervention rates among wait-list control ACCHSs.MethodsDesign: Cluster randomised trial using routinely collected health data. Setting: Australia. Cases: Twenty-two ACCHSs that see at least 1000 clients a year and use Communicare as their practice management software. Intervention and comparator: After initiating support, we compare changes in screening and brief intervention between wait-list control services and services that had previously received support. Measurement: Records of AUDIT-C screening and brief intervention activity in routinely collected data.ResultsDuring the reference period we observed 357,257 instances where one of 74,568 clients attended services at least once during a two-monthly data extraction period. Following the start of support, the odds of screening (OR = 0.94 [95% CI 0.67, 1.32], p = 0.74, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$B{F}_{10}$$\\end{document}\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\approx$$\\end{document} 0.002) and brief intervention (OR = 1.43 [95% CI 0.69, 2.95], p = 0.34, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$B{F}_{10}$$\\end{document}\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\approx$$\\end{document} 0.002) did not improve for the wait-list control group, relative to comparison services.ConclusionsWe did not replicate the finding that support and training improves AUDIT-C screening rates with wait-list control data. The benefits of support are likely context dependent. Coincidental policy changes may have sensitised services to the effects of support in the earlier phase of the study. Then the COVID-19 pandemic may have made services less open to change in this latest phase. Future efforts could include practice software prompts to alcohol screening and brief intervention, which are less reliant on individual staff time or resources.Trial registrationRetrospectively registered on 2018-11-21: ACTRN12618001892202.

Measuring and describing perceived quality on physiotherapy practice management software

IntroductionDespite the growing trend in the use of digital technologies in physiotherapy, the overall adoption and satisfaction of both, practice management software (PMS) and electronic health records in physiotherapy clinics has been low and slow over time. Satisfaction of expectations or perceived quality (PQ) is an abstract construct based on the discrepancy between expectations and perceptions, to measure the satisfaction of physiotherapists on PMS. This study aims to develop and validate an instrument to measure PQ on PMS, and to describe the PQ of the currently available physiotherapy PMS. MethodsInstrument development study with validity and reliability testing. The development of this questionnaire was conducted in 3 phases: identification of attributes to be explored; development of the item pairs and pretesting; pilot study for item reduction, and psychometric testing. The questionnaire was distributed to chartered physiotherapists. A total of 144 participants completed the questionnaire. ResultsA series of analyses were conducted to assess item reduction, factor structure of the questionnaire and metric properties of multi-item scales. From the initial 43 attributes, the final version of the Quality Questionnaire on Physiotherapy Practice Management Software consisted of 24 items of PQ on PMS, structured in 3 areas (clinical care, administrative activities, and accounting), which included 11, 9, and 4 items grouped into 4, 3, and 2 scales respectively. The questionnaire proved to be reliable and valid. In multitrait scaling analysis, all scores had strong item-scale correlations, excellent item scaling success, and good internal consistency (Cronbach alpha coefficients of >0.7). ConclusionsOur study provides a valuable PQ questionnaire on PMS attributes for clinical care, administrative activities, and accounting. The attributes related to clinical care and control stock supplies showed a worse PQ. This suggests that those functions related to clinical care should be improved to facilitate greater satisfaction with physiotherapy PMS.

Attributes Required by Physiotherapists to Increase Adoption and Implementation of Practice Management Software: A Qualitative Study Using Focus Groups

(1) Background: The aim of this study was to identify the practice management software (PMS) attributes required by physiotherapists to improve software design and development in order to increase the adoption and implementation of software and minimize the impact on the workflow of the clinic. (2) Methods: In total, 27 graduated physiotherapists with clinical and management expertise and experience in management software for physiotherapy services participated in six focus groups. Research staff members recorded, transcribed, and analyzed the focus groups, using a thematic analysis to code and classify the comments. (3) Results: A total of 43 categories of coded statements divided into 12 subthemes and five broad themes were identified and compiled in two core areas of content: clinical care and administrative tasks. In order to improve the adoption and implementation of physiotherapy PMS, this research provides experiential knowledge on the inefficiencies perceived by physiotherapists regarding current software programs and the specific attributes to assist practice management and facilitate workflows. The focus group analyses led us to map the multifaceted framework for physiotherapy PMS. (4) Conclusion: These findings provide valuable information as to what aspects are meaningful for the future design and development of physiotherapy PMS, thus providing guidance to both software developers and to end-users when benchmarking software solutions.

Determinants of poor glycaemic control and proteinuria in patients with type 2 diabetes: a retrospective analysis of general practice records in Ireland

BackgroundAnalysis of general practice records can address the information gap on the epidemiology of type 2 diabetes (T2DM) in Ireland, informing practice and the development of interventions in primary care. The aim of this study was to identify patients with poor glycaemic control, risk factors for complications and evidence of end organ damage in a large multi-practice study and to profile their characteristics.MethodsPatients with T2DM were identified using disease coding in Health One practice management software in 41 general practices. Patients’ demographics and clinical data were extracted. Rates of poor glycaemic control (glycated haemoglobin > 58 mmol/mol) and albumin creatinine ratio > 3 mg/mmol were calculated. A multilevel logistic regression analysis using both patient and practice variables was conducted.ResultsData was collected from 3188 patients of whom 29% (95% CI 28 to 31%) had poor glycaemic control, which was associated with younger age, higher BMI and higher total cholesterol. Only 42% of patients (n = 1332) had albumin creatinine ratio measured with 42% (95% CI 40 to 45%) of these having values > 3 mg/mmol. Older age groups, men, those with hypertension, eGFR < 60 ml/min/1.73m2 and poor glycaemic control were most associated with higher values of albumin creatinine ratio.ConclusionsAnalysing this large multi-practice dataset gives important information on the prevalence and characteristics of diabetic patients who are most at risk of poor outcomes. It highlights that recording of some data could be improved.

Development and validity of the expectations of physiotherapists questionnaire on practice management software.

Despite the growing trend in the use of digital technologies in physiotherapy, the overall adoption of both, practice management software (PMS) and electronic health records in physiotherapy clinics has been low and slow over time. In order to learn what factors determine the adoption of these technologies by physiotherapists, there is a need to examine the expectations of physiotherapists (EPs) on specific software attributes. The main aims of this study were to develop a questionnaire to measure and describe the EPs towards PMS. The knowledge of these EPs will be useful to guide PMS design in order to improve physiotherapists' satisfaction. Instrument development study with validity and reliability testing. The development of this questionnaire was conducted in three phases: identification of attributes to be explored, development of the items, pilot study, and psychometric testing. The questionnaire was distributed to chartered physiotherapists. A total of 272 participants completed the questionnaire. A series of analysis were conducted to assess item reduction, factor structure of the questionnaire and metric properties of multi-item scales. From the initial 43 attributes, the final version of the questionnaire consisted of 26 items on EPs, grouped in nine scales and two areas (clinical care and administrative activities). As a result, all scores had strong item-scale correlations, excellent item scaling success, and good internal consistency (Cronbach alpha coefficients of >.7). Our study also showed that current EPs were high towards most of the items, only two scales concentrated most of the attributes with the least expectations (monitoring quality of care and digital health interventions). Our study included physiotherapists with and without experience with PMS, and it showed that both groups had a similar pattern of expectations. Our study provides a valuable questionnaire of EP on PMS attributes for clinical care and administrative activities and shows a detailed development process.

RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice

BackgroundMany people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies.MethodsDesign3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1. Setting: primary care general practices in southeast Queensland, Australia. Population: adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+. Intervention: RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs. Outcome measures: the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks. Secondary outcomes: at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs. Sample size: 653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity).DiscussionThe RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients.Trial registrationANZCTR, ACTRN12622001379707p. Registered on 27 October 2022.

Antibiotic usage in 14 equine practices over a 10-year period (2012-2021).

Monitoring antibiotic usage is an important part of tackling antimicrobial resistance. The use of computerised records for monitoring has been previously described in the equine sector but there is currently no consensus on metrics used to report usage. To document antibiotic use in equine practices in the United Kingdom over a 10-year period using commercially available practice management software. Retrospective survey. A custom antibiotic usage report was created using Eclipse® practice management software. Participating practices were given instructions on how to generate the usage report. Annual reports were requested for a 10-year period (2012-2021 inclusive). Each report provided sales of each class of antibiotic in total mg and in mg/kg, based on the number of equids treated (for any transaction) and their average weight. The defined daily dose for animals (DDDvet) and the DDD/1000 (used in people) were also calculated to correct for variation in dosage rates between antibiotics. Fourteen practices submitted data for an annual maximum of 107 977 horses. Overall, median annual antibiotic usage was 54.25 mg/kg (range 45.34-60.27 mg/kg), 1.52 defined daily doses/animal/year (range 1.39-1.70) and 4.17 defined daily dose/1000 animals (range 3.82-4.66). Overall median highest priority critically important antimicrobial usage was 0.67 mg/kg (range 0.56-1.71), 0.12 defined daily doses/animal/year (range 0.10-0.14) and 0.33 defined daily dose/1000 animals (range 0.29-0.39). The software relied on the accurate identification of antibiotic preparations. The calculation of DDDvet was complicated by the varying dose rates of antimicrobials used in equine practice. A reliable technique to measure antibiotic usage is presented. Defined daily dosage calculations may be more helpful in equine practice due to the preponderance of potentiated sulphonamides usage. These data and methods may provide the basis for future clinical audits aiming to enhance antimicrobial stewardship.

Making a SmartStart for peanut introduction to support food allergy prevention guidelines for infants.

Food allergy affects up to 10% of Australian infants. It was hypothesized that if parents follow the Australasian Society of Clinical Immunology and Allergy guidelines, Australian food allergy rates may stabilize or decline. This project aimed to determine whether SmartStartAllergy influenced parental introduction of peanut by age 12 months, including in high-risk infants. SmartStartAllergy integrates with general practice management software to send text messages to parents via participating general practices. The intervention group participants were sent text messages when their child was aged 6, 9, and 12 months; the control group participants were parents of 12-month-old infants. When their child was aged 12 months, all participants completed a questionnaire regarding eczema and family history of atopy. Infants with severe eczema and/or a family history of atopy were considered high-risk. Between 21 September 2018 and 26 April 2022, a total of 29,092 parents were enrolled in SmartStartAllergy as intervention (n= 18,090) and control (n= 11,002) group members The intervention group was more likely to introduce peanut by 12 months (crude odds ratio= 5.18; P< .0001; 95% CI= 4.35-6.16). After adjustment for the infants' level of risk and family history of atopy and food allergy, the intervention group was more likely to introduce peanut by 12 months of age (adjusted odds ratio= 5.34; P< .01; 95% CI= 4.48-6.37). SmartStartAllergy appears to be an effective tool for encouraging parental introduction of peanut. The ability to provide parents with credible allergy prevention information, along with the capacity to collect simple responses via text along with additional information via an online questionnaire, make this a useful public health tool.

Incidence and prevalence of alopecia areata in the Australian primary care setting: A retrospective analysis of electronic health record data.

Alopecia areata (AA) is a common immune-mediated non-scarring hair loss, with a worldwide incidence between 0.57% and 3.8%. The incidence and prevalence of AA in the Australian general population have not been previously reported. To describe the incidence and prevalence of AA in Australia using primary care data. A secondary objective was to identify common demographic characteristics, comorbidities and treatment patterns among Australians living with AA. We analysed electronic health record data captured from a national clinical practice management software over a 10-year index period between 2011 and 2020 calendar years, inclusive. The incidence of new-onset AA and the prevalence of active records with AA were estimated. Differences in incidence by sociodemographic groups, and patterns of treatment were also evaluated. There were 976 incident AA records. The incidence of new-onset AA in the total study cohort was 0.278 per 1000 person-years (95% CI 0.26-0.295). By age, the incidence was highest in the 19- to 34-year-old age bracket (0.503 per 1000 person-years: 95% CI 0.453-0.554). AA incidence was lower among females than males (IRR 0.763, p < 0.001, 95% CI 0.673-0.865). Among active records, 520 were prevalent AA records. AA point prevalence at 31/12/2020 was 0.13% (1.26 per 1000 persons; 95% CI 1.15-1.37). This is the first study to describe the epidemiology (incidence and point prevalence) and management of AA in the Australian primary health-care population through large-scale database analysis. Incidence and prevalence findings were consistent with earlier estimates from other regions.

COVID-19 associated reduction in elective spay-neuter surgeries for dogs and cats.

The rise in subsidized spay-neuter access helped drive the euthanasia of shelter pets in the US from an estimated 13. 5 million in 1973 to 1.5 million in 2019. When the arrival of the COVID-19 pandemic triggered lockdowns beginning in March 2020, many veterinary providers suspended nonessential services such as routine spay-neuter surgeries. The purpose of this study was to determine the impact of the COVID-19 pandemic on the volume of spay-neuter procedures performed by spay-neuter clinics. A retrospective study of patient data from 212 spay-neuter clinics using Clinic HQ practice management software was conducted from January 2019 through December 2021. The clinics collectively performed 1,217,240 surgeries in the pre-COVID baseline year of 2019. A sharp decline in surgeries began in March 2020 (−22%) and reached a nadir in April 2020 (−80%). Surgeries began to increase in May 2020 (−39%), before plateauing in July 2020 (−6%) and remaining slightly below the 2019 baseline in most months through the end of 2021. Compared to 2019, total surgeries decreased 13% to 1,059,388 in 2020 and decreased 3% to 1,184,274 in 2021. In 2020, when clinic disruptions were highest, the impact of the surgery cutbacks varied by geographic region, species, age, and source of animals. Compared with 2019, in 2020 surgeries decreased 17% in the Midwest region, 15% in the Northeast and West, and 11% in the South. Surgeries were reduced 19% in dogs and 10% in cats. When grouped by age, surgeries were reduced by 18% in geriatrics, 14% in adults, and 11% in juveniles. Reductions were similar for females (−14%) and males (−12%) and similar for unowned/organization-owned animals (−14%) and privately owned animals (−12%). In total, 190,818 fewer surgeries were performed by the 212 studied clinics in the 24 months from January 2020 through December 2021 than would be expected had 2019 levels been maintained. If a similar pattern was experienced by other spay/neuter providers in the US, it would suggest there is a deficit of more than 2.7 million spay/neuter surgeries that animal welfare organizations have yet to address.

Time to engage sheep farmers with Medicine Hub

Since its quiet launch in October 2021, Medicine Hub has been populated with farming accounts predominantly via practice management software programmes and bulk data holders, with a skew towards dairy. However, now is the perfect time to address this by engaging with sheep farmer clients; Animal Health and Welfare Pathway visits represent an ideal opportunity to open discussions. Meanwhile, capitalising on trading advantages which may come about as a result of antibiotic use recording could be especially relevant for sheep producers. Although the sector is typically a low user of antibiotics, this remains important information to gather for the national picture.

How accurately does the Australian Immunisation Register identify children overdue for vaccine doses? A national cross-sectional study

The accuracy of data recorded in the Australian Immunisation Register (AIR) is important for assessment of population-level vaccine coverage but has not been assessed nationally since 2001. We undertook a cross-sectional study in five states in 2017 using standard criteria to validate AIR records classified as three months overdue for any vaccine at 12, 24 and 48 months. Of 2,000 records selected for audit, 905 were assessable, of which 124 (14%) were misclassified as overdue (errors). Among 563 general practice (GP) records, 91 (16.1%) were errors. Compared with Victoria (1/99; 1%), errors were significantly higher in Western Australia (11/106; 10.4%), Queensland (13/104; 12.5%), South Australia (23/110; 20.9%) and New South Wales (43/144; 29.9%); p &lt; 0.01 for all. Among 165 council and community health centre providers, the overall error rate (17; 10.3%) was non-significantly lower than for GP providers, with an odds ratio (OR) of 0.6 and a 95% confidence interval (95% CI) of 0.3–1.1, and did not differ between states. Records were transmitted to the AIR by paper-based methods in 13 cases, with significantly higher error rates (7/13; 54%) than for practice management software (77/630; 12.2%); OR 9.8 (95% CI 2.8–36.4) or the AIR secure site (23/87; 26.4%); OR 2.6 (95% CI 1.4–4.5). Accuracy is increasingly important, with mandatory reporting to the AIR for all National Immunisation Program vaccines from July 2021, and best achieved by uniform use of practice management software.

Analysis of urgent follow up visits and complications after intravitreal injections: a retrospective cohort study

BackgroundIntravitreal injections (IVIs), a common treatment in ophthalmology, result in acute complications and urgent follow-up visits causing significant burden to both patient and physician. We evaluated the incidence of acute complications following IVIs which occurred within seven days of injection.MethodsA retrospective cohort study conducted at a private retinal practice, in Cleveland, Ohio. Using the practice management software database, we examined 73,286 injections of patients with unscheduled or urgent visits within 7 days of an injection from August 1st,2018 to August 1st,2020. Data collected included: age, gender, eye, medication injected, diagnosis, reason for urgent follow-up, time between injection and urgent follow-up, and type of anesthesia administered. Data was analyzed using SPSS v.28 (SPSS Inc., Chicago IL).ResultsStudy included 73,286 injections, with 441 injections (n = 441) resulting in urgent follow-up visits (0.60%). Mean patient age was 72.1 (± 30.4) years, with 187 male (42.4%) and 254 female (57.6%) patients. IVI medications included: aflibercept (60.3%), ranibizumab (22.4%), bevacizumab (13.4%), dexamethasone intravitreal implant (2%), triamcinolone acetonide (1.6%) brolucizumab (1.59%), fluocinolone acetonide intravitreal implant 0.19 mg (0.2%), and fluocinolone acetonide intravitreal implant 0.18 mg (0.03%) (Table 1). Medications associated with urgent visits included: aflibercept (42.9%), bevacizumab (37.4%), ranibizumab (7.9%), dexamethasone intravitreal implant (6.8%), brolucizumab (2.7%), and triamcinolone acetonide (2.3%) (Table 2). Days between injection and urgent follow-up was on average 3.96 ± 2.14 days. Urgent follow-ups included blurred vision in 164 patients (37.2% of urgent visits), flashes, floaters or posterior vitreous detachment (PVD) in 55 (12.5%), pain in 42 (9.5%), 43 (9.8%) corneal abrasions, 33 (7.5%) subconjunctival hemorrhages, corneal dryness or foreign body sensation in 30 (6.6%), endophthalmitis in 20 (4.5%), 18 (4.1%)vitreous hemorrhages, iritis or uveitis in 11 (2.5%), miscellaneous complications in 9 (2.0%), 7 (1.6%) elevated intraocular pressures, choroidal neovascular membrane in 4 (0.9%), 4 (0.9%) retinal detachments or tears, and 2 (0.45%) traumatic cataracts (Table 3).ConclusionIVIs resulted in 0.60% urgent/unscheduled follow-up visits within 7 days of injection. Most common causes were blurred vision and symptoms of PVD.

An Automatic Data Mapping for Interoperability of OpenEMR Medical Practice Management Software Using the Fast Healthcare Interoperability Resources

An Automatic Data Mapping for Interoperability of OpenEMR Medical Practice Management Software Using the Fast Healthcare Interoperability Resources

Implementation of SNOMED CT for UK Dental Practice Management Software - Statement from the Dental Software Suppliers Association.

Implementation of SNOMED CT for UK Dental Practice Management Software - Statement from the Dental Software Suppliers Association.

Depression Anxiety Stress Scale-10: A Brief Measure for Routine Psychotherapy Outcome and Progress Assessment

AbstractRoutine outcome measurement and progress monitoring is well established to enhance quality assurance in clinical psychology service delivery but is not widely used in routine care. A major barrier to more widespread implementation is the lack of public domain, brief, psychometrically sound outcome measures that easily integrate into clinical information systems. The current study assessed a brief 10-item version of the widely used Depression Anxiety Stress (DASS)-42 scale, which we called the Depression Anxiety Stress-10 (DASS-10) scale. In two clinical samples of adults (n= 1036, 445 men, 591 women; andn= 1084, 493 men, 591 women), the DASS-10 had a replicable two-level factor structure, which at the lower level had two factors assessing stress-anxiety and depression, which each loaded onto a superordinate psychological distress scale. The items in the distress score discriminated between a clinical sample (n= 376) and a community sample (n= 379) and were sensitive to clinical change. The measure has the potential to make routine outcome measurement and progress monitoring more cost-effective to implement than existing measures, particularly when integrated with practice management software to make administration, scoring, and use easy.

Evaluation of Antimicrobial Usage in Dogs and Cats at a Veterinary Teaching Hospital in Germany in 2017 and 2018.

In contrast to food-producing animals, where the documentation of the usage of antimicrobials is regulated by law, antimicrobial usage (AMU) in dogs and cats is only sparsely monitored. We collected data generated by an electronic practice management software (EPMS) between January 1, 2017 and December 31, 2018 to investigate AMU. All information was obtained from clinical routine data from the Department of Small Animal Medicine and Surgery (DSAM), University of Veterinary Medicine Hannover (TiHo). In 2017, 78,076 drug administrations were documented for 5,471 dogs and cats, of which 14,020 (17.96%) were antimicrobial drugs (AMs) specifically documented in 2,910 (51.31%) dogs and cats. In 2018, 104,481 drug administrations were documented for 5,939 dogs and cats. Of these drug administrations, 18,170 (17.39%) AM administrations were documented for 3,176 (53.48%) dogs and cats. Despite the increasing documentation of AM administrations, differences between 2017 and 2018 were not statistically significant [odds ratio (OR), 1.01; 95% confidence interval (CI), 0.98–1.03]. Prescription diversity (PD) in 2017 for dogs was 0.92 and for cats 0.89. In 2018, PD for dogs was 0.93 and for cats 0.88. As well as the documented number of AM administrations, the documented amount of active ingredients administered in 2018 (total: 17.06 kg; dogs: 16.11 kg, cats: 0.96 kg) increased compared with 2017 (total: 15.60 kg; dogs: 14.80 kg, cats: 0.80 kg). In 2017 and 2018, the most commonly administered antimicrobial groups were penicillins, nitroimidazoles, and quinolones for dogs and cats, respectively. While the in-house point-of-care administration accounts for the largest share of the documented amount of AMs administered, the highest number of documented AM administrations was assigned to inpatient care in 2017 and 2018, respectively. However, AM administration in outpatient care remained the lowest in both years. Since no statistically significant difference in AM administrations was observed between 2017 and 2018 and the most commonly used AMs at the DSAM were ranked, data can be used as a baseline to evaluate how changes in in-house guidelines and future legal requirements affect the prescribing culture. Data generated within the DSAM should be evaluated annually.

Assessing the Feasibility of Retrospective and Prospective Clinical Audit in Farm Animal Veterinary Practice.

As a quality improvement tool, clinical audit has been extensively described in the medical literature. There is scant literature on the use of clinical audit in the farm animal veterinary setting. This study describes the process and feasibility of prospective and retrospective data collection for farm animal clinical audit performed at three different farm animal practices in the United Kingdom. Retrospective clinical audit was difficult in all three practices due to barriers in establishing diagnosis and patient identity from clinical records. Prospective data collection proved feasible but depended on adequate case accrual and practitioner engagement. The decision to conduct clinical audit retrospectively or prospectively will depend on the topic to audit, the availability of data and the wishes of the team members involved. Further work is required looking at the use of clinical coding and alternatives to using practice management software to improve retrospective data availability for clinical audit.