Validation Of Prescriptions Research Articles

Validation of medical prescriptions’ suitability on patients with heart disease

Validation of medical prescriptions’ suitability on patients with heart disease

Accuracy of wrist-worn wearable devices for determining exercise intensity.

ObjectiveAs an indicator of exercise intensity, heart rate can be measured in a timely manner using wrist-worn devices. No study has attempted to estimate a target exercise intensity using wearable devices. The objective of the study was to evaluate the validity of prescribing exercise intensity using wrist-worn devices.MethodsThirty healthy subjects completed a maximal cardiopulmonary exercise test. Their heart rates were recorded using an electrocardiogram and two devices—Apple Watch Series 6 and Garmin Forerunner 945. Exercise intensity with the target heart rate was defined as resting heart rate + (maximal heart rate − resting heart rate) *n% (n%: 40–60% for moderate-intensity exercise and 60–89% for vigorous-intensity exercise). Heart rate was analyzed at the lower and upper limits of each exercise intensity (HR40, HR60, and HR89). The mean absolute percentage error and concordance correlation coefficient were calculated, and Bland–Altman plots and scatterplots were constructed.ResultsBoth devices showed a low mean absolute error (1.16–1.48 bpm for Apple and 1.35–2.25 for Garmin) and mean absolute percentage error (<1% for Apple and 1.16–1.39% for Garmin) in all intensities. A substantial correlation with electrocardiogram-measured heart rate was observed for moderate to vigorous intensity with concordance correlation coefficient > 0.95 for both devices, except that Garmin showed moderate correlation at the upper limit of vigorous activity with concordance correlation coefficient = 0.936. Moreover, Bland–Altman plots and scatterplots demonstrated a strong correlation without systematic error when the values obtained via the two devices were compared with electrocardiogram measurements.ConclusionsOur findings indicate the high validity of exercise prescriptions based on the heart rate measured by the two devices. Additional research should explore other populations to confirm these findings.

General practitioners’ management of depression symptoms in Somali refugee and Norwegian patients: a film vignette experiment

ObjectivesRefugees in comparison with non-refugee patients may face higher unmet mental healthcare needs. The mechanisms underlying these disparities are still poorly understood. The general practitioner (GP) plays a vital role...

Digital v Human Pharmacist: Can technology be used in the clinical validation of Rheumatology prescriptions?

Introduction: Currently pharmacists clinically validate prescriptions written by hospital clinicians for the supply of medicines to patients in their own homes via the Homecare Medicines Services. This ensures all prescriptions leaving the hospital are accurate, safe, follow the treatment pathway, meet appropriate funding criteria and the disease state is monitored appropriately. The organisation has invested in their Pharmacy Homecare Management team to maximise the use of the Homecare Medicines Services, in order to increase hospital capacity, reduce medicines expenditure and embed robust financial governance. This means clinical pharmacists are required to check more homecare prescriptions, taking them away from patient facing work on wards.Aim: To explore whether technology can be used to undertake Homecare prescription validation to the same standard as clinical pharmacists within rheumatology.Method: The prescription validation process was mapped out with clinical pharmacists and a technology partner (human+) employed to build a ‘BoT’ to mimic the pharmacist and act as a digital member of the workforce. Rheumatology was chosen because it makes up 44% of homecare, prescribing follows a defined treatment pathway with a limited number of drugs and there is a specialist rheumatology pharmacist. The specific prescription template and the advanced clinical system (Cellma®) are receptive to automation. Robotic Process Automation (RPA) was employed to automate the pharmacist accessing and checking the clinical legacy systems and shared drives. An RPA architect worked on-site to build the ‘BoT’ using Blue Prism platform. Results. Five pharmacists recorded the time taken to validate rheumatology prescriptions over one month. The average time per prescription was 112 seconds, not including travel time to the homecare team. The BoT validated batches of prescriptions at different intervals throughout the day. The average process time of the BoT was 24 seconds/prescription. Different average processing times were seen throughout the day as internal IT systems run at different speeds dependent on the number of users accessing them.BoT effectiveness was also measured by the number of ‘exception’ prescriptions which were unable to be validated. The BoT only adheres to the process it is taught and anything outside of these ‘rules’ (e.g. incorrectly spelt diagnosis) is marked as an exception.Overall 15.4% of the 881 prescriptions processed by the BoT were rejected. The vast majority were attributed to errors in information inputted by clinicians. Conclusion: The BoT or digital workforce member validates prescriptions approximately five times faster than the human pharmacist. This is a small scale study in rheumatology but it may have relevance for other clinical pharmacy disciplines and redesigning the wider workforce. By using automated software to undertake high importance, low variance work, we can free up highly skilled humans to be on the front line in patient facing roles.

P115. Validation of endocrine therapy prescriptions with primary care prescriptions data for women newly-diagnosed with invasive breast cancer in England: Application to the NABCOP cohort

P115. Validation of endocrine therapy prescriptions with primary care prescriptions data for women newly-diagnosed with invasive breast cancer in England: Application to the NABCOP cohort

Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes.

To assess the impact of antimicrobial stewardship programs (ASPs) in adult medical-surgical intensive care units (MS-ICUs) in Latin America. Quasi-experimental prospective with continuous time series. The study included 77 MS-ICUs in 9 Latin American countries. Adult patients admitted to an MS-ICU for at least 24 hours were included in the study. This multicenter study was conducted over 12 months. To evaluate the ASPs, representatives from all MS-ICUs performed a self-assessment survey (0-100 scale) at the beginning and end of the study. The impact of each ASP was evaluated monthly using the following measures: antimicrobial consumption, appropriateness of antimicrobial treatments, crude mortality, and multidrug-resistant microorganisms in healthcare-associated infections (MDRO-HAIs). Using final stewardship program quality self-assessment scores, MS-ICUs were stratified and compared among 3 groups: ≤25th percentile, >25th to <75th percentile, and ≥75th percentile. In total, 77 MS-ICU from 9 Latin American countries completed the study. Twenty MS-ICUs reached at least the 75th percentile at the end of the study in comparison with the same number who remain within the 25th percentile (score, 76.1 ± 7.5 vs 28.0 ± 7.3; P < .0001). Several indicators performed better in the MS-ICUs in the 75th versus 25th percentiles: antimicrobial consumption (143.4 vs 159.4 DDD per 100 patient days; P < .0001), adherence to clinical guidelines (92.5% vs 59.3%; P < .0001), validation of prescription by pharmacist (72.0% vs 58.0%; P < .0001), crude mortality (15.9% vs 17.7%; P < .0001), and MDRO-HAIs (9.45 vs 10.96 cases per 1,000 patient days; P = .004). MS-ICUs with more comprehensive ASPs showed significant improvement in antimicrobial utilization.

Impact of a Carbapenem Stewardship Programme on the Incidence of Carbapenem-Resistant Gram-Negative Bacilli: An Interrupted Time-Series Analysis

Background: Evidence on the impact of antimicrobial stewardship programmes (ASPs) on carbapenem resistance is needed. We aimed to study the efficacy and safety of a bundle of educational and restrictive measures to optimise carbapenem use and its impact on carbapenem-resistant Gram-negative bacilli (CR-GNB) in a hospital with a carbapenem-resistant KPC-3 producing Klebsiella pneumoniae endemic. Methods: A quasi-experimental study with an interrupted time-series analysis was designed and conducted in a tertiary-care hospital before and after the implementation of an ASP aimed at hospitalised adult patients with Gram-negative infections treated with carbapenems (meropenem or imipenem). The core activity of the ASP consisted of a prescription validation interview held between the prescribers and an infectious disease specialist from the ASP team to reinforce the appropriate antibiotic indication. A standardised prescription form for carbapenem was also developed. We assessed carbapenem consumption, incidence of CR-GNB, crude death rate of sentinel events per 1000 occupied bed days (OBDs), hand-hygiene compliance, and complexity of the hospital activity. Findings: The study was conducted from January 2013 to February 2016. The intervention started in February 2014. Throughout the intervention period, 1359 educational interviews were conducted between the prescribers and the consultants. An intense reduction in carbapenem consumption occurred after starting the intervention, and was sustained two years later (relative effect -83·51%; 95% CI -87·23 to -79·79). The incidence density of CR-GNB decreased by -0·915 cases per 1000 OBDs (95% CI -1·743 to -0·087). This effect was especially marked in CR K. pneumoniae and CR Escherichia coli, reversing the pre-intervention upward trend and leading to a relative reduction of -91·15% (95% CI -105·53 to -76·76) and -89·93% (95% CI -107·03 to -72·83), respectively, two years after starting the programme. Mortality of sentinel events and hand-hygiene compliance trends did not change. Interpretation: This ASP to optimise carbapenem use based on prescription validation interviews can contribute to decreasing the incidence of CR-GNB, in particular Enterobacteriaceae, without increasing death rates. Funding: Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, European Regional Development Fund, and Sub-Directorate General for Research Assessment and Promotion, Spain. Declaration of Interests: LMM has been a consultant for MSD and Shionogi, has served as speaker for MSD, Astra- Zeneca, Astellas, Becton Dickinson and bioMerieux, and has received research support from Shionogi, Janssen-Cilag and Pfizer. AC has received honoraria for the development of educational presentations for Pfizer JMC has received travel grants and honoraria as a speaker from Novartis, Astellas Pharma, Pfizer, MSD, Janssen Pharmaceuticals, and AstraZeneca, outside the submitted work. GP and JMC report grants from Instituto de Salud Carlos III, Spanish Government, co-financed by the European Development Regional Fund “A way to achieve Europe”, during the conduct of the study. All other authors declare no competing interests. Ethics Approval Statement: The study was approved by the HURS Ethics Committee (approval number 4731), which renounced obtaining written informed consent as all collected data were anonymised.

Automated Tele-Health Monitoring System for Animal Health using Image Processing

For effective livestock management identification and control of parasites and bacteria is a challenging factor. Parasites, worms and bacteria has a huge hazard to the health of animals, which can harm the gastrointestinal tract, and result in decreased propagative routine, diminished development rates, less yield in terms of meat, fiber and milk, even leads to death of the animals, which in turn causing health problems for human society also. A proper knowledge of animal parasites by identification of them and application of the proper antibiotic or vaccine in appropriate dosage will improve the quality of the livestock and its byproducts leading to the more profits to the farmer. The livestock farms are located at the remote places and the communication between the veterinary doctor to the farmer is poor, took long time and expensive. This can be overcome by utilization of the digital technology and automation of the process which can be handled by a layman at the field to provide electronic information for both e-prescription for intermediate treatment and the information to the expert at the remote location for proper diagnosis and validation of the electronic prescription. Digital image processing of the microscopic pictures with high resolution cameras from the samples of the animals will provide a platform for automation of the process. The detection of the parasites and its stages can be done by denoising the images, segmentation of the parasites, templating the images for isolation of parasites and bacteria by comparing them with preloaded data of different types of parasites and their different stages leads to the identification of parasites, bacteria and giving the electronic prescription within a short period then the diagnosed report can be sent to the expert for validation.In the present paper the authors have proposed a smart system for tele-monitoring and mobile health management system.

Using MyDispense to simulate validation of controlled substance prescriptions in a pharmacy law course

Background and purposeMyDispense is an innovative, web-based program which simulates a community pharmacy. Use of this software may assist students' comprehension of validating controlled substance prescriptions by determining if prescriptions contain errors or omissions. Educational activity and settingFourteen MyDispense practice exercises were created and implemented into a required second-year pharmacy law course. Completion of the MyDispense exercises and performance on the pharmacy law midterm exam were recorded. A questionnaire was administered to students to receive feedback on the exercises. FindingsThere were complete data on all 94 student pharmacists enrolled in the didactic course. Thirty-five students (37%) completed all MyDispense exercises, 15 students (16%) completed some of the exercises, and 44 (47%) did not complete any of the exercises. Linear regression results indicate that students who completed more MyDispense exercises were significantly more likely to score higher on the midterm than those who completed fewer exercises (β = 0.28, p = 0.02). Students reported moderate to high exercise value and a willingness to use the software in preparation for future pharmacy law examinations. SummaryMyDispense provided a platform for students to apply controlled substance laws to the prescription validation process in the community pharmacy setting. Completion of practice exercises in MyDispense was shown to positively impact student performance on a pharmacy law midterm. Students valued the innovative simulation tool and were willing to access the tool again to prepare for future examinations.

Parton distributions with theory uncertainties: general formalism and first phenomenological studies

We formulate a general approach to the inclusion of theoretical uncertainties, specifically those related to the missing higher order uncertainty (MHOU), in the determination of parton distribution functions (PDFs). We demonstrate how, under quite generic assumptions, theory uncertainties can be included as an extra contribution to the covariance matrix when determining PDFs from data. We then review, clarify, and systematize the use of renormalization and factorization scale variations as a means to estimate MHOUs consistently in deep inelastic and hadronic processes. We define a set of prescriptions for constructing a theory covariance matrix using scale variations, which can be used in global fits of data from a wide range of different processes, based on choosing a set of independent scale variations suitably correlated within and across processes. We set up an algebraic framework for the choice and validation of an optimal prescription by comparing the estimate of MHOU encoded in the next-to-leading order (NLO) theory covariance matrix to the observed shifts between NLO and NNLO predictions. We perform a NLO PDF determination which includes the MHOU, assess the impact of the inclusion of MHOUs on the PDF central values and uncertainties, and validate the results by comparison to the known shift between NLO and NNLO PDFs. We finally study the impact of the inclusion of MHOUs in a global PDF determination on LHC cross-sections, and provide guidelines for their use in precision phenomenology. In addition, we also compare the results based on the theory covariance matrix formalism to those obtained by performing PDF determinations based on different scale choices.

E-Interconsultations between a hospital pharmacy service and primary care pharmacy units in Spain

PurposeTo analyse the profile of consultations made using an electronic platform system (e-Interconsultation) of communication between the hospital pharmacy service and primary care pharmacy units.MethodDescriptive and retrospective analysis of the...

Validation of drug prescription records for senior patients in Alberta's Tomorrow Project: Assessing agreement between two population-level administrative pharmaceutical databases in Alberta, Canada.

To assess agreement between the Pharmaceutical Information Network (PIN), a newly implemented medication data repository in Alberta, Canada, and the Alberta Blue Cross (ABC) database, a long established database with medication records of all senior patients in Alberta. PIN data (2008-2015) were cross-validated with ABC medication records for senior participants (older than 65 years old) in Alberta's Tomorrow Project (ATP), a longitudinal cohort study in Alberta. The completeness and accuracy of PIN were respectively calculated as the percentage of ABC records coexisting (concordant) in PIN and the percentage of concordant records having mutually agreeable information on drug quantity. Generalized linear models were used to examine potential association of PIN completeness and accuracy with sociodemographic factors. A total of 1 218 191 drug prescription records from 13 143 ATP participants were captured by PIN and ABC in 2008-2015, among which 91.6% were from PIN, 82.5% from ABC, and 74.2% coexisted in PIN and ABC. The overall completeness of PIN in capturing ABC medication records was 89.9%, with small variations (less than ±5%) across types of drugs. The completeness of PIN was improved on average by 1.3% annually over time (P < .001). PIN had 100% accuracy as defined by drug quantity data agreeable with ABC records. No significant associations were observed with age, sex, ethnicity, rural/urban areas, and socioeconomic status of the participants. Cross-validated with the ABC dataset, our study showed that irrespective of drug type, PIN has a fairly good completeness (approximately 90%) and accuracy (100%) in capturing the ABC claimed medications for senior patients in Alberta.

Implementation of a pharmaceutical care program for patients with hepatitis C treated with new direct-action antivirals.

Background A pharmaceutical care program is necessary to improve the management of direct-acting antivirals in hepatitis C. Objective Describe health outcomes obtained with the implementation of a pharmaceutical care program in Hepatitis C patients treated with direct-acting antivirals. Setting This study was performed in a pharmacy department of a university hospital. Methods Retrospective study between 1st-April 2015 and 28st-February 2016. Hospital pharmacists implemented interventional measures for validation of antivirals prescriptions, detection of drug-interaction, adverse drug events, education and patient´s adherence to antiviral regimen. Main outcome measure Health and quality outcomes of the implementation of the pharmaceutical care program. Results A total 128 patients were enrolled. The overall sustained virologic response at week 12 post-treatment rate was 96.1% (95% CI 92.7-99.5). Adverse drug events occurred in 90.6% of the patients, and the majority were grade 1-2. Pharmacists made 334 pharmaceutical interventions. 35.5% of these interventions were aimed to resolve negative results of drugs. 80.9% of the negative results of drugs improved or were eliminated with the application of the measures proposed by the pharmacists (p ≤ 0.001). Pharmacists carried out 175 preventive interventions to avoid negative results of drugs. 97.3% of these interventions were accepted and managed to prevent the appearance of negative results of drugs (p = 0.453). Conclusion The implementation of a pharmaceutical care program in patients with hepatitis C treated with direct-acting antivirals has improved the safety in the use of these drugs.

Pharmacist utilization of prescription opioid misuse interventions: Acceptability among pharmacists and patients.

This study evaluates pharmacist and patient acceptance of pharmacy-based opioid interventions, and identifies interventions both groups find acceptable. Using two surveys simultaneously administered to Ohio Pharmacists and patients in treatment for substance use disorders, this study compares pharmacist and patient acceptance of five (5) pharmacy-based opioid misuse interventions through the use of Cohen's Kappa using the Altman Benchmark Scale. Through this analysis, we found that both pharmacists and patients view the use of patient counseling and Prescription Drug Monitoring Program-based validation of prescriptions as acceptable prescription misuse interventions. While patients expressed interest in Naloxone-based interventions, many pharmacists were opposed to Naloxone-based interventions. Both pharmacists and patients appear to be far more comfortable with the use of counseling and Prescription Drug Monitoring Program-based validation of prescriptions compared to interventions that involve referral to treatment resources or distribution of Naloxone.

Pharmaceutical Preparations for Intradermal Drug Tests

AbstractOur department of pharmacy takes over all the medical skin tests prescribed by the allergy department. The production takes place in specific premises, with qualified and calibrated equipment, by a qualified and regularly assessed staff—in compliance with the French preparation guidelines. The whole activity is under the responsibility of a pharmacist—handlings are performed by hospital pharmacy technicians. Each new intradermal skin test demand leads to a feasibility analysis—irritating nature, dilution solvent, concentration—this information is gathered in a thesaurus. The manufacturing steps are the following: prescription validation, production sheet and label printing, preparation of the needed equipment, batch numbers and expiration date checking, handling under a vertical laminar flow hood and control after production. The preparation activity increases continuously and the thesaurus currently contents 302 rows with following information: drug, dilution and reconstitution solvent, pure solution concentration and maximum concentration to test with intradermal tests. Work would prospect in costs reduction and resources optimization. Thanks to the allergists’ confidence, the partnership between the two departments can go on. This guarantees the quality of the preparations tested on patients but also the skin tests reproducibility.

Is the Agency Assumption Valid for Public Corporations?

Friedman (1970) stated that CEOs of public corporations are the agents of shareholders, which we refer to as the ‘agency assumption.’ Jensen and Meckling (1976) modeled Friedman’s agency assumption, popularizing it among academics. However, in the mid-1970s, the academic consensus was that the agency assumption had little predictive validity in that CEOs did not generally maximize profits for shareholders (Fama &amp; Miller 1972; Jensen &amp; Walkling 2010). Post-1990s the prescriptive validity of the agency assumption improved with the widespread adoption of executive stock option pay. The purpose of this paper is to determine whether the agency assumption is descriptively and prescriptively valid.

A prospective observational study of medication errors in a pediatric emergency department

We present a prospective, observational study evaluating the incidence of medication errors (ME) in a university hospital pediatric emergency department and describe their characteristics and determinants. A systematic analysis of the handwritten prescriptions was conducted by a clinician and pharmacist. Of 11,573 consecutively studied prescriptions in children under 15 years of age, the ME incidence was 0.9% (n=102). The incidence of errors found was statistically significantly higher in children older than 5 years (OR=2.05; P=0.026). There was no significant difference regarding the time of admission (P=0.544), the day of the week (P=0.940), or the affluence of people in attendance at the emergency department. The errors observed were all prescription errors. Most errors were related to analgesic (51%) and antibiotic (30%) treatments. No serious errors were reported. ConclusionWe found a low incidence of medication errors in this study. The validation of prescriptions by a senior multidisciplinary staff could contribute to limited medication errors. Measures should be continued to further reduce the incidence of drug errors by calling the attention of prescribers to the most common situations at risk of ME.

Мінливість критеріальності дослідження давності смерті у ранньому періоді

Мінливість критеріальності дослідження давності смерті у ранньому періоді

Validity of electronic hospital discharge prescription records as a source of medication data for pharmacoepidemiological research.

The advent of hospital electronic medical records (EMRs) with electronic prescribing provides considerable opportunity for pharmacoepidemiological research. However, validity of EMR prescribing data for research purposes is not well established. Validity concerns the percentage of cases in which medications and characteristics (name, type, formulation, dose) are true when verified with an independent data source. This study evaluated the validity of EMR discharge prescription data within the Eastern Health hospital network in Melbourne, Australia. A random sample of patients were selected who had a diagnosis of atrial fibrillation (AF) and were prescribed at least five medications. Prescription records from 2012 to 2015 were compared with pharmacy dispensing and hospital medical records (reference standards). Medication name, dose, directions and route of administration were compared. Discrepancies between data sources were categorized as omissions, additions, discrepancies in dose, medication form or route of administration or discrepancies in reordering. Sensitivities and 95% confidence intervals (CIs) for intended medication exposure were estimated for therapeutic classes. A total of 5724 prescription orders for 479 patients for whom reference standards were available were included. There were 163 discrepancies (2.8%) between prescription records and reference standards. Additions were the most common data discrepancy (n = 65; ~1.1% of total prescriptions evaluated), followed by discrepancies in reordering (n = 34; 0.59%). Sensitivities for intended patient exposure to a medication for each therapeutic class at the first level of the Anatomical Therapeutic Chemical (ATC) classification system were between 97% and 100%. The genitourinary system and sex hormone level of the ATC system demonstrated the lowest sensitivity, (97.3%; 95% CI 92.0%-100%) and the cardiovascular system level demonstrated the highest sensitivity (99.9%; 95% CI 99.7%-100%). EMR discharge prescription records for patients with AF are a valid information source for conducting pharmacoepidemiological research within Eastern Health in Melbourne, Australia. Further studies in different regions, countries and patient cohorts are required to establish validity of hospital EMR prescription records for pharmacoepidemiological research.

Validation of the electronic prescription as a method for measuring treatment adherence in hypertension

ObjectiveTo validate electronic prescriptions (e-prescriptions) as a method for measuring treatment adherence in patients with hypertension. MethodsThis prospective study initially included 120 patients treated for hypertension in primary care centers. Adherence was measured using the gold standard, the medication event monitoring system (MEMS), versus the index test, the e-prescription program, at baseline and at 6, 12, 18 and 24 months. We calculated the adherence rate using the MEMS and the medication possession ratio (MPR) for the e-prescriptions. We considered patients adherent if they had an adherence rate of 80% to 100%. To validate the e-prescription, we obtained measures of diagnostic accuracy, the Kappa concordance index, and the area under the ROC curve (AUC). ResultsWe included 102 patients. Overall adherence was 77.4% by MEMS (95%CI: 66.8-88) and 80.4% (95%CI: 70.3-90.5) by MPR. At 24 months, sensitivity was 87% and specificity, 93.7%. The AUC was 0.903 (95%CI: 0.817-0.989). ConclusionMeasures of treatment adherence were not significantly different between e-prescription and gold standard at most visits, and the e-prescription showed good discriminatory diagnostic capacity. Practice implicationsIf patients are included in an e-prescription program for at least 2 years, e-prescription is an inexpensive method to measure adherence in hypertension.