Journal of evaluation in clinical practice
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Randomized Controlled Trial
Electronic prescribing in an ambulatory care setting: a cluster randomized trial.
Medication-prescribing errors with adverse drug events impose substantial harms on patients and health systems. Medication errors resulting in preventable adverse drug events most commonly occur at the ordering stage. Electronic prescribing may prevent such errors but its impact has not been rigorously evaluated. ⋯ Implementation of the electronic prescribing system had no impact on total prescription error, and increased the callback rate. In spite of intensive user support, few prescriptions in intervention weeks were made using the electronic system. Given the costs, training requirements, workflow redesigns and regulatory hurdles, additional evaluations of outpatient prescribing on clinically important outcomes are needed.
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To analyse pharmacists' interventions in a setting where a computerized physician order entry system (CPOE) is in use and a pharmacist works on the ward. ⋯ When a clinical pharmacist is present on a ward in which a CPOE is in use, the pharmacists' interventions are well accepted by physicians. Specific predictors of the acceptance by physicians emerge, but further research as to the impact of CPOE on pharmacist-physician communication is needed.
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At present, most patients presenting directly to emergency departments (EDs) do not meet the recommended door-to-balloon goal of less than 90 minutes for ST-elevation myocardial infarction (STEMI) patients. Until the year 2005, the goal of less than 90 minutes door-to-balloon time has been rarely achieved in our hospital (i.e. 17% of all cases). ⋯ Taken together, all these organizational changes have allowed to reduce the total ischemic time from 465 minutes in year 2005 to 232 minutes in year 2009, thereby demonstrating the effectiveness of our intervention.
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Comparative Study
Electronic medical record system at an opioid agonist treatment programme: study design, pre-implementation results and post-implementation trends.
Electronic medical record (EMR) systems are commonly included in health care reform discussions. However, their embrace by the health care community has been slow. ⋯ The preliminary findings in the domain of quality are very promising. Should the findings in the other domains prove to be positive, then the impetus to implement EMR in similar health care facilities will be advanced.
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Comparative Study
The identification of risk factors for critically ill patients with acute fever and formulation of activation criteria to alert outpatient clinic doctors.
Acute fever is the most common early clinical symptom of many critical illnesses with a high mortality rate. It is necessary to identify patients with severe acute fever early and accurately. The aim of this study is to identify risk factors for critically ill outpatients with acute fever and formulate activation criteria of adult fever state score (AFSS) to alert outpatient clinic doctors. ⋯ The AFSS has high diagnostic accuracy and reliability for the early identification of patients with severe acute fever.