The potential value on medication safety of a clinical decision support system in intensive care patients with renal insufficiency

Abstract

These abstracts have been accepted for publication by the Dutch Society of Clinical Pharmacology and BiopharmacyNihon Kohden® and Cambridge Electronic Design (CED®) hardware and Spike2® software at 1 : 35 post drug administration. Results were statistically evaluated using GLM in SPSS® 11.5. Results:Results are presented in table 1. Saccadic peak velocity was increased after MDMA (p = 0.000). Co-administration showed significant increase in peak saccadic velocity compared to placebo (p = 0.004), although significantly less then the increase as observed after MDMA alone (p = 0.003). Smooth pursuit was significantly impaired after ethanol compared to placebo (p = 0.000) and MDMA (p = 0.000), co-adminstration also impaired score compared to placebo (p = 0.000) and MDMA (p = 0.000).Conclusions: MDMA induced arousal as measured by the saccadic peak velocity when administered alone and, to a lesser degree, in combination with ethanol. Co-administration of MDMA with ethanol however could not ameliorate the deterioration of psychomotor accuracy by ethanol as measured by smooth pursuit eye movements. These findings suggest that although MDMA might ameliorate ethanol induced sedation it does not ameliorate impaired psychomotor skills. This might give a false sense of improved performance while intoxicated and thus increases risks of for example road accidents. Introduction: A considerable percentage of young people expose themselves to 3,4-methylenedioxy-methamphetamine (MDMA or 'ecstasy'). Alcohol is relatively commonly used in combination with MDMA (Barrett et al., 2005). As a percentage of MDMA users admit to driving under influence (Riley et al., 2001), the assessment of the effects of co-administration of these substances on psychomotor performance is warranted. Hypothesis:We hypothesized that the co-administration of MDMA and ethanol would ameliorate the impairment induced by ethanol alone. Methods:We performed a double-blind, randomized, placebocontrolled study in 16 healthy volunteers (9 male, 7 female) in the age of 18-29 years. MDMA 100 mg was given orally and blood alcohol concentration (BAC) was maintained at 0.6‰ by a three hour 10% alcohol infusion regime (adjustment of infusion rate according to regular sampled breath alcohol concentration). Saccadic and smooth pursuit eye movements, a validated measure of ethanol induced sedation (van Steveninck et al., 1999), were recorded using Objectives: This study firstly aimed to identify the percentage of nursing home patients who were prescribed more than nine drugs (polypharmacy) and compared prescribing patterns of this patient group to patients who were prescribed fewer drugs. Secondly, teams of hospital pharmacists and nursing home physicians aimed to identify the drug related problems of the polypharmacy patients and the extent to which it was feasible to optimise their medication profiles.Methods: Characteristics of the polypharmacy population were illustrated by retrospective point measurements in five Dutch nursing homes (total of 742 beds) over the years ...

Future of Electronic Health Records: Implications for Decision Support

“…Australian researchers designed a knowledge‐based system to assist pharmacists with medication reviews. Compared with an expert, the system found significantly more potential medication‐related problems in intensive‐care patients 25…”

Success Factors and Barriers for Implementation of Advanced Clinical Decision Support Systems

“…An example is the clinical rule for renal function Helmons et al developed. (Helmons et al, 2009) This clinical rule checks when a patient has a decreased renal function and dose adjustments of the medication are necessary. Compared to chart review, this clinical rule decreases time needed for checking and intervention by 80%.…”

“…Our research shows that with every developed clinical rule, remarkable differences between guidelines and practice were found, even though guidelines are well known. (Wessels-Basten et al, 2007;Helmons et al, 2009) Prospective research must demonstrate the effect of these clinical rules in practice.…”

“…This three-step strategy (retrospective technical, retrospective therapeutic and prospective validation step), following a Plan-do-check-act-cycle in combination with an expert team, has led to high success rates. (Wessels-Basten et al, 2007;Helmons et al, 2009) We found that a well considered strategy, that creates rules with a high positive predictive value (PPV) is essential for accurate content and reliable messages. Application of this strategy has led to clinical rules with a reliability (PPV) of at least 94%, which indicates that more than 94% of the alerts are technically correct and clinically relevant as indicated by the expert team and end-users.…”