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Jt hierarchical decision support system for Comm J Qual Patient Saf 2009;35(5):278­ cardiac surgical intensive care patients buy kamagra oral jelly 100mg online gluten causes erectile dysfunction. Jt Comm J community chain pharmacists’ interventions Qual Patient Saf 2009;35(5):271-7 cheap kamagra oral jelly 100mg on-line erectile dysfunction drugs prices. Point- improve and standardize medication of-care technologies: a case for resource reconciliation in a specialty care setting buy kamagra oral jelly 100mg amex impotence at 46. Stud Health literacy program tailored for older adults Technol Inform 2009;143:131-5 cheap 100mg kamagra oral jelly with amex erectile dysfunction statistics canada. A risk analysis method to evaluate the computerized prescriber-order-entry system. A Application, a software screening tool for guideline-based computerised decision drug-drug interactions. An mandatory reporting of drug hypersensitivity automated personalised intervention reactions has been shown to improve the algorithm for remote patient monitoring. Retrospective evaluation of a computerized Survey of information technology in physician order entry adaptation to prevent Intensive Care Units in Ontario, Canada. Feasibility and acceptability of a alerts: limited opportunities for doing it computerised system with automated safely. Comparison of two personal-computer­ Maximizing the adequacy of medication based mobile devices to support treatment in controlled trials and clinical pharmacists’ clinical documentation. Detection and prevention of using a computerised reminder, through prescriptions with excessive doses in order-entry system. Physicians value patient review of their Misperceptions of patients vs providers electronic health record data as a means to regarding medication-related improve accuracy of medication list communication issues. Automated dose checking and intervention Medication administration discrepancies for bariatric patients. Evaluating 2007;916 the implementation and use of a computerized physician order entry system: 84. Clinical decision support to improve antibiotic prescribing for acute respiratory 97. Electronic medical Patient perceptions regarding electronic records for a rural family practice: a case prescriptions: is the geriatric patient ready? Am J Health information technology in critical access Syst Pharm 2007;64(13):1427-31. To clinicians after postprescription what extent do pediatricians accept antimicrobial review based on the Centers computer-based dosing suggestions? For Disease Control and Prevention’s 12 Pediatrics 2007;119(1):e69-e75 Steps to Prevent Antimicrobial Resistance 113. InfectControl Practitioners’ views on computerized drug- Hosp Epidemiol 2007;28(6):641-6. Six sigma methodology can be used to Errors prevented by and associated with bar­ improve adherence for antibiotic code medication administration systems. Jt prophylaxis in patients undergoing Comm J Qual Patient Saf 2007;33(5):293­ noncardiac surgery. Nurses’ perceptions of causes of characteristics associated with the medication errors and barriers to reporting. Software regarding the usefulness of accessing design to facilitate information transfer at personal health information and services hospital discharge. The effects of Computerized Prescribers’ responses to alerts during Provider Order Entry on medication turn­ medication ordering in the long term care around time: a time-to-first dose study at the setting. Automated surveillance for adverse drug Infobuttons at Intermountain Healthcare: events at a community hospital and an utilization and infrastructure. Design factors for success or failure of Proliferation of electronic health records guideline-based decision support systems: among obstetrician-gynecologists. Evaluation of reported medication errors Reduction of broad-spectrum antibiotic use before and after implementation of with computerized decision support in an computerized practitioner order entry. Code Medication Administration in acute and long-term care: an observational study. Workload and availability of impact on patient safety of free-text entry of technology in metropolitan community nursing orders into an electronic medical pharmacies. Medication safety in the ambulatory The development and evaluation of an chemotherapy setting. Hospital improve the safety of the cancer implementation of computerized provider chemotherapy process. Int J Qual Health order entry systems: results from the 2003 Care 2006;18(1):9-16. Technology induced error and usability: him to drink: managing change and the relationship between usability problems increasing utilization of computerized and prescription errors when using a provider order entry. Evaluation of drug interaction software to Implementing a commercial rule base as a identify alerts for transplant medications. Dose range control of medication use with an integrated checking in a computer order entry system. Systems failure in using laboratory values related to two hospitals-using Reason’s model to predict problem-prone drugs. Anaesthesiologists’ views on the need for Evaluating provider adherence in a trial of a point-of-care information system in the guideline-based decision support system for operating room: a survey of the European hypertension. A computerized clinical decision support Treating asthma by the guidelines: system as a means of implementing developing a medication management depression guidelines. Using bar-code of a safer approach to intravenous drug point-of-care technology for patient safety. Effect on amphotericin B lipid complex approach to assist in the prescribing of new use of a clinical decision support system for therapeutic agents: case study of activated computerized prescriber order entry. Reasons for Using a computerized drug prescription physician non-adherence to electronic drug screening system to trace drug interactions alerts. Stud Health Technol Inform Clinicians’ perceptions of clinical decision 2004;107(Pt:2):2-6. Stud Health Technol Inform Lessons from the implementation of a near 2004;107(Pt:2):2-7. A Impact of an electronic antibiotic advice and chemotherapy incident reporting and approval system on antibiotic prescribing in improvement system. Characteristics and override rates of order Pathophysiol Haemost Thromb 2003;33(5­ checks in a practitioner order entry system. Implementation of an automated Automated quality checks on repeat guideline monitor for secondary prevention prescribing. Physicians’ decisions to override Effectiveness of the electronic medical computerized drug alerts in primary care. Controlled multicenter study on the effect of Computerized monitoring of valproate and computer assistance in intensive insulin physician responsiveness to laboratory therapy of type 1 diabetics. Implementation of an electronic Physician Order Entry impact on drug turn­ medical record system in a pediatric around times. Evaluations pop-up menu linked to a computerized drug of the prescription order entry system for prescribing system. Prescribing pattern’s outpatient clinics by physicians in the 80 feedback via a simple and quick method. J Am Med Implementation of rules based computerised Inform Assoc 2001;8(5):499-509. Moving towards an electronic patient computerized price comparison module record: a survey to assess the needs of reduce prescribing costs in general practice? A computer alert system to prevent record system in Kaiser Permanente’s injury from adverse drug events: Northwest Region. Bar elderly through an online drug utilization code documentation of pharmacotherapy review intervention: a system linking the services in intensive care units.

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Magellan encourages providers to be familiar with this information and consult the referenced research articles 100 mg kamagra oral jelly mastercard erectile dysfunction types. Prevalence rates are higher in white and Native American persons than in black generic kamagra oral jelly 100 mg with visa erectile dysfunction treatment herbs, Asian and Hispanic individuals (Newman et al generic kamagra oral jelly 100mg online erectile dysfunction doctors in ct. The worry and anxiety are out of proportion to the actual likelihood or impact of the anticipated events cheap kamagra oral jelly 100mg free shipping erectile dysfunction pills with no side effects, its focus often ©2008-2014 Magellan Health, Inc. Having difficulty in controlling the worry, the individual’s worrisome thoughts may interfere with attention to tasks at hand. They may occur without precipitants, and are more pervasive, distressing, and pronounced with longer duration. Clinical presentations often include somatic illness, pain, fatigue, depression and problems with sleeping. Worry may focus on finances, marriage, children, personal or family health, job performance or security. The extent of anxiety is in excess of what might be considered reasonable given the reality of the situation. Anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important area of function. Items are selected for each patient from a large bank of test items based on prior item responses (Gibbons et al. Community epidemiological data for the range of 1-12 months showed that lifetime prevalence changed from 6. The co-morbidity rate with major depression is about 59% and 56% with other anxiety disorders (Hales et al. Also, cumulatively, 72% of lifetime anxiety cases had a history of depression, but 48% of lifetime depression cases had anxiety. This study challenged the prevailing notion of a predominant pattern in which generalized anxiety usually develops into depression by showing that depression develops into generalized anxiety almost as often (Moffitt, Harrington, et al. Co-morbid Physical Conditions – Anxiety disorders have been shown to be independently associated with several physical conditions. Results from a large study, The German Health Survey, revealed that after adjusting for socio-demographic factors and other common mental disorders, the presence of an anxiety disorder was significantly associated with thyroid disease, respiratory disease, gastrointestinal disease, arthritis, migraine headaches and allergic conditions. Co-morbidity was also shown to be significantly associated with poor quality of life and disability (Sareen, Jacobi, et al. Suicide Ideation and Suicide Attempt – Two studies demonstrated that as a group of disorders, anxiety disorders were highly prevalent among those with suicidal behavior in large community samples. One study showed that anxiety disorders were independent risk factors for suicidal behavior, even after adjusting for co-morbidity with common mental disorders. Also, the presence of an anxiety disorder in combination with a mood disorder was associated with increased likelihood of suicidal behavior, compared with those with mood disorder alone (Hawgood et al. Another study of adolescents and young adults aged 16-18, 19-21 and 21-25 years ©2008-2014 Magellan Health, Inc. Also, the rates of suicidal behavior increased in proportion to the number of anxiety disorders present (Boden, 2006). Physicians should identify alleviating and aggravating factors as well as signs of relapse for each patient. In addition, information on local self-help and support groups, self-help reading material describing evidence-based treatment strategies, and other resources such as websites, may be helpful. To support informed decision-making, patients should be informed about effectiveness, common side effects of medications, probable duration of treatment, any costs they might incur, and what to expect when treatment is discontinued (Canadian Psychiatric Association Guideline, 2006). Along with educating the patient, the individual’s symptoms and functioning should be actively monitored. Care managers called patients at regular intervals and provided them with psycho- education; assessed preferences for guideline-based care, monitored treatment responses, and informed physicians of their patients’ care preferences and progress via an electronic ©2008-2014 Magellan Health, Inc. Also, these findings noted that most studies used psychologists as providers and recommended that more studies are needed with other professional groups as well as other modes of administration, e. They concluded that the almost identical outcomes across transdiagnostic and diagnosis-specific groups provides preliminary evidence supporting the efficacy of ©2008-2014 Magellan Health, Inc. Homework assignments were included and at the end of each week the patient responded by providing information about their progress and related problems. The therapist replied to the e-mail with feedback and answers to any patient questions. In this study, the therapist e-mails to patients were analyzed and therapist behaviors were coded as follows: deadline flexibility, task reinforcement, alliance bolstering, task prompting, psychoeducation, self-disclosure, self-efficacy shaping, and empathetic utterance. Investigators indicated that distinct therapist behaviour exists in online therapy. Lenience regarding deadlines was negatively associated with treatment outcome, and task reinforcement correlated with module completion and positive outcomes. Investigators suggested further studies with a larger sample size are needed along with studies addressing the impact of e- mail support given in addition to traditional face-to-face therapy (Paxling et al. These effects however, were lost for psychotherapeutic interventions when other active conditions were employed as comparators, i. Results showed that patients in both groups exhibited distinct improvements on all primary and secondary measures where symptoms of anxiety, depression, excessive worrying, negative metacognitive appraisal of worrying and thought suppression were reduced. These treatment effects were stable at six month and one year follow-up (Hoyer et al. Participants randomized to information-only received written information on anxiety disorders and a list of referral options. Follow-up data (6-months after treatment completion) indicated no significant differences in the reductions in anxiety sensitivity and insomnia between the two conditions, suggesting that a longer intervention or more intense follow-up may be needed. They also suggested that more follow-up sessions should be integrated into telephone treatment (Brenes et al. According to investigators, these findings remained stable at the 12-month follow-up. Investigators also proposed the conceptualization of worry in psychodynamic psychotherapy as “a mechanism of defense that protects the subject from fantasies or feelings that are even more threatening than the contents of his or her worries” (Salzer et al. Second-line treatment options include buspirone (for augmentation), benzodiazepines, i. In addition, these guidelines cited strong evidence and recommended the benzodiazepines, alprazolam and diazepam, for treatment- resistant cases with no history of addiction and as adjuncts for immediate relief of anxiety during the initiation of other agents and for use in episodes of acute exacerbation. Moreover, all of these drugs precipitate response (50% improvement in symptom severity) in approximately two-thirds of patients and remission (a reduction in symptom severity clinical measurement scores to the normal range) in approximately one-half of the responders, or one-third of total patients (Collins et al. There was also some evidence for the efficacy of certain benzodiazepines, buspirone, imipramine, hydroxyzine and trifluoperazine (Baldwin, 2005). It addresses the needs of patients who may achieve a good response, partial response, non-response or loss of previous response (Davidson et al. This includes a careful evaluation for suicidality, insomnia, substance abuse, non-compliance, childbearing potential, elderly patient problems and cultural issues. A partial response should occur by the initial evaluation point after 4-6 weeks with adequate dosing. Current state of knowledge permits the prescriber to increase dose, augment, switch or wait longer when there has been a partial response. A switching strategy should be considered where adequate drug trial has not elicited at least a 25% symptom improvement from baseline using a valid clinical measurement scale. Recommended drugs are as follows:  Co-morbid depression – adequate dose of an antidepressant or augmentation with bupropion, buspirone, atypical antipsychotic, or the nutritional supplement, chromium picolinate. Other unwanted effects of benzodiazepines may include sedation, memory disruption and psychomotor impairment, with an associated increased risk of traffic accidents. Other safety concerns with the use of benzodiazepines in the elderly population have been noted due to the high incidence of falls, hip fracture, withdrawal difficulties and increased risk of cognitive impairment (Davidson et al. Researchers found that healthcare costs increased in patients following benzodiazepine treatment and noted that approximately half of the increase in costs was associated with known sequelae of long-term treatment with benzodiazepines, e. Results showed that both lorazepam and paroxetine treatments were effective in reducing anxiety-related psychiatric symptoms.

The impact of computerized physician medication order entry in hospitalized patients--a systematic review kamagra oral jelly 100mg generic erectile dysfunction treatment michigan. Enhancing a Wearable help button to support the Medication Adherence of older adults quality kamagra oral jelly 100mg impotence workup. Portable physician profiling system: Application designed to measure changes in prescribing order 100mg kamagra oral jelly with mastercard erectile dysfunction injections youtube. Impact of smart infusion technology on administration of anticoagulants (unfractionated Heparin kamagra oral jelly 100mg with visa herbal erectile dysfunction pills nz, Argatroban, Lepirudin, and Bivalirudin). Use of structured paediatric-prescribing screens to reduce the risk of medication errors in the care of children. Impact of a computerized physician order entry driven algorithm on the prescribing and utilization of psychiatric drugs. Guidelines for the use of ondansetron in the prevention and treatment of post-operative nausea and vomiting. Development and implementation of guidelines for the monitoring of serum vancomycin concentrations. A new method for active surveillance of adverse events from diphtheria/tetanus/pertussis and measles/mumps/rubella vaccines. Mail-order prescriptions requiring clarification contact with the prescriber: prevalence, reasons, and implications. Just-in-time evidence-based e-mail “reminders” in home health care: impact on patient outcomes. Prescribing safety features of general practice computer systems: Evaluation using simulated test cases. Evaluation of a pharmacy bar-code controlled drug management system in a community hospital. Strategies for detecting adverse drug events among older persons in the ambulatory setting. Intravenous medication safety system averts high-risk medication errors and provides actionable data. Narrowing the gap in hypertension: effectiveness of a complex antihypertensive program in the elderly. A computerized intervention to improve timing of outpatient follow-up: a multicenter randomized trial in patients treated with warfarin. Pharmacokinetics of computer-controlled alfentanil administration in children undergoing cardiac surgery. Evaluation of computerized decision support for oral anticoagulation management based in primary care. Review of computerized decision support systems for oral anticoagulation management. Oral anticoagulation management in primary care with the use of computerized decision support and near-patient testing: a randomized, controlled trial. Glycemic control and insulin safety: the impact of computerized intravenous insulin dosing. Process evaluation of a cluster randomized trial of tailored interventions to implement guidelines in primary care--why is it so hard to change practice? Pharmacy informatics task force update: Advancing medication- related clinical decision support. Smart infusion systems - How the addition of wireless capability improves smart pump management and utilization. Asthma patients are willing to use mobile and web technologies to support self-management. Pharmacy management based on standardization of processes and their decentralized implementation by clinical area pharmacists. Quality of drug treatment process through medication errors in a tertiary hospital. Current requirements and emerging trends for labelling as a tool for communicating pharmacovigilance findings. Quality insurance of prescribing, dispensing and managing drugs in hospital pharmacy. Medical devices; general hospital and personal use devices; classification of remote medication management system. Smart mote-based medical system for monitoring and handling medication among persons with dementia. Medication administration: the implementation process of bar-coding for medication administration to enhance medication safety. Medication administration: The implementation process of bar-coding for medication administration to enhance medication safety. Unit-of-use bar coding: Balancing the challenge of technological change with improved patient safety. The use of electronic prescribing as part of a system to provide medicines management in secondary care. Evaluating the safety and efficacy of Glucommander, a computer-based insulin infusion method, in management of diabetic ketoacidosis in children, and comparing its clinical performance with manually titrated insulin infusion. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Clinician attitudes towards prescribing and implications for interventions in a multi-specialty group practice. Economic effectiveness of two different automated anesthesia medication dispensing devices at two different facilities. Transport nurse safety practices, perceptions, and experiences: the Air and Surface Transport Nurses Association survey. Improving physician communication through an automated, integrated sign-out system. Dispensing errors in community pharmacy: Frequency, clinical significance and potential impact of authentication at the point of dispensing. Methodological variability in detecting prescribing errors and consequences for the evaluation of interventions. Concordance between medication histories and outpatient electronic prescription claims in patients hospitalized with heart failure. Observational assessment of clinical outcomes associated with the use of chemistry laboratory values in the Theratrac 2 system. Anaesthesia record system on handheld computers--pilot experience and uses for quality control and clinical guidelines. Early experiences with e-Health services (1999-2002): Promise, reality, and implications. Supply of injectable drugs for individual patients using the prescription entry system. Challenge for preventing medication errors-learn from errors: What is the most effective label display to prevent medication error for injectable drug? Computer assisted satellite pharmacy consultative service in a primary care clinic. Would artificial neural networks implemented in clinical wards help nephrologists in predicting epoetin responsiveness? Developing high-specificity anti-hypertensive alerts by therapeutic state analysis of electronic prescribing records. Evaluation of accuracy of drug interaction alerts triggered by two electronic medical record systems in primary healthcare. Computerized physician order entry of medications and clinical decision support can improve problem list documentation compliance. Introduction of computer assisted control of oral anticoagulation in general practice. Healthcare informatics : the business magazine for information and communication systems 2009;26(9):30-3.

Using telemedicine technology for pharmaceutical services to ambulatory care patients purchase kamagra oral jelly 100 mg visa erectile dysfunction drugs on nhs. Drug effectiveness reporting and monitoring systems: Discussion and prototype development purchase 100 mg kamagra oral jelly free shipping erectile dysfunction quality of life. Computerized decision support in drug prescribing I: Better survey of patients’ medications yields better quality of care buy kamagra oral jelly 100 mg on-line erectile dysfunction treatment options uk. Designing a medication-administration system for the smallest patients was a huge challenge buy kamagra oral jelly 100mg without a prescription erectile dysfunction doctor edmonton. Focusing on food and fitness: State strategies for healthy communities and economic development. A systematic review of the performance characteristics of clinical event monitor signals used to detect adverse drug events in the hospital setting. Depression affects adherence measurement but not the effectiveness of an adherence intervention in heart failure patients. Impact of barcode medication administration on medication safety: Importance of adherence and ongoing monitoring to sustain improvements. A proposed model for an internet-based computerised anticoagulant monitoring system. Unintended consequences of information technologies in health care: An interactive sociotechnical analysis. Impact of an electronic medication administration record and bar code scanning system on the accuracy of medication administration in hospitalized patients. Decision support systems and communication in medicine at the University of Limburg. Computerized physician order entry: Veterans Affairs Health Care System experience. An intravenous medication safety system: preventing high-risk medication errors at the point of care. Development of a patient medication instruction provision system which reflects the doctor’s prescribing intentions. Electronic prescription for controlled substances - New prescribing option to benefit prescriber, pharmacist and patient. Using health information technology to improve drug monitoring: a systematic review. Using intranet-based order sets to standardize clinical care and prepare for computerized physician order entry. Clinical reminders attached to echocardiography reports of patients with reduced left ventricular ejection fraction increase use of beta- blockers: A randomized trial. Development and implementation of the medication module of a hospital ward information system using a pen- based computer. Implementation of an interactive computer- assisted infection monitoring program at the bedside. Using a clinical decision support system to determine the quality of antimicrobial dosing in intensive care patients with renal insufficiency. Potassium and phosphorus repletion in hospitalized patients: implications for clinical practice and the potential use of healthcare information technology to improve prescribing and patient safety. Effect of computerisation on Australian general practice: does it improve the quality of care? Information system issues facing clinical laboratories serving complex integrated delivery systems. Utilizing a point of care documentation system for increased medication administration accuracy. Evaluation of pharmaceutical interventions due to drug-related problems in hospitalized patients. Influence of simple computerized feedback on prescription charges in an ambulatory care: A randomized clinical trial. The effect of computerized feedback coupled with a newsletter upon outpatient prescribing charges: A randomized controlled trial. Online--an Internet-based decision tool for adjuvant chemotherapy in early breast cancer. A prospective randomised trial comparing individualised pharmacokinetic dosage prediction for aminoglycosides with prediction based on estimated cratinine clearance in critically ill patients. Implementing technology to improve medication safety in healthcare facilities: a literature review. Estimation of the supporting functions for prescription making in an order entry system. Contribution to medical risk management of computerized prescription order entry systems - Improvement of master maintenance system using a commercially available order entry program. Electronic prescribing influence on calcium supplementation: a randomized controlled trial. Implementation and evaluation of a comprehensive system to deliver pediatric continuous infusion medications with standardized concentrations. Electronic medical record use by office-based physicians and their practices: United States, 2006. Electronic medical record use by office-based physicians and their practices: United States, 2006. Computerized physician order entry in a pediatric teaching institution: Design process, implementation and benefits. Simple computer program for guiding management of cardiovascular risk factors and prescribing. Patient request for pharmacist counseling and satisfaction: Automated prescription delivery system versus regular pick-up counter. A prospective controlled trial of computerized decision support for lipid management in primary care. Countrywide computer alerts to community physicians improve potassium testing in patients receiving diuretics. Practical consideration for implementation of new technology within a large health-system market. Health technology assessment review: Computerized glucose regulation in the intensive care unit--how to create artificial control. Implementation of an electronic medication administration record system for Point-of-Care Scanning: using bar coding and automated medication distribution technologies. Wireless, hand held device used by physicians to prescribe medication in an outpatient setting. Potential use of bar codes to implement automated dispensing quality assurance programs. Key role of software in implementing computerbased information systems for the hospital pharmacy. Influence of decision aids on patient preferences for anticoagulant therapy: A randomized trial. A comprehensive appropriateness of prescribing questionnaire was validated by nominal consensus group. A review of medical error reporting system design considerations and a proposed cross-level systems research framework. Operating room controlled drug accountability incorporating pharmacy witnessed waste and electronic documentation.

Q. Rozhov. Antioch New England Graduate School.

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