Design and Performance Evaluation of A Pre-evaluation Tool for Medical Orders of Perioperative Antibiotics / 医药导报

Objective To design a medical order pre-evaluation tool for perioperative prophylactic application of antibiotics,and to improve the efficiency of antibiotics management in hospitals during the perioperative period.Methods Using the open-source software R as the platform,a web application was built with tidy verse and shiny package based on related documents and guidelines.The discharge records of Affiliated Hospital of North Sichuan Medical College from April 1,2021,to December 31,2022,were retrospectively reviewed using the constructed pre-evaluation tool and compared with previous manual evaluation results using McNemar's Chi-squared test.Results This medical order pre-evaluation tool can quickly complete perioperative antibiotics order sampling,batch pre-evaluation,result statistics,visualization,and result output,and flexibly adjust the evaluation rules according to actual needs.The pre-evaluation tool is more efficient,with a review speed of 13.46 ms per medical record.Among the 2 642 discharge medical records of manual review,there was no significant difference between systematic pre-evaluation and manual evaluation results(ratio of prophylactic use:76.85%vs.78.21%)in terms of the type of use(preventive or curative)(P= 0.078).Among the 1 857 discharge records judged to be prophylactic for both manual and systematic reviews,the difference in unreasonable detection rate(39.90%vs.30.32%)was statistically significant(P＜0.001).Among the 63 typical ludicrous medical records confirmed by the review of clinical pharmacists with senior professional titles,60 were judged and limited by the pre-evaluation tool,and the detection rate of typical unreasonable was 95.24%.Conclusions The pre-evaluation tool based on R in this study can improve the efficiency of perioperative antibacterial drug evaluation.The evaluation conclusions and statistical results are reliable and are worthy of further development and application.

Investigation and analysis of the review and comment on inpatient medical orders in Beijing municipal hospitals / 中国药房

OBJECTIVE To investigate the current situation of the review and comment on inpatient medical orders in Beijing municipal hospitals， and to put forward countermeasures and suggestions for further improving related work. METHODS A questionnaire survey was conducted to investigate the current situation of the review and comment on inpatient medical orders in 22 Beijing municipal hospitals. The statistical analysis was conducted for the survey results. RESULTS A total of 22 questionnaires were distributed， with recovery effective rate of 100%. The 22 hospitals carried out inpatient medical order comment， but their proportion varied among hospitals （0.88%-98.54%）； medical order comment mainly focused on antibiotics， proton pump inhibitors， anesthetic drugs/class Ⅰ psychotropic drugs， auxiliary drugs and other categories； 205 pharmacists participated in the comment of inpatient medical orders， most of whom hold intermediate or higher professional titles （89.27%）； 21 hospitals conducted inpatient medical order comment and feedback the results to relevant departments/responsible persons， but the intervention situation was not the same. Eighteen hospitals had carried out the review of inpatient medical orders； reviewed drug category was roughly the same as the category involved in the medical order comment； review content involved the suitability of administration routes， dosage， etc. The review was conducted mainly through the cooperation of audit software and pharmacists. CONCLUSIONS The comment and review of inpatient medical orders in Beijing municipal hospitals carried out in an orderly manner， and preliminary results have been achieved； at the same time， it is necessary to further increase the ability of participating pharmacists， improve audit standards， optimize pre-audit （No.ZYLX201805） software， and promote rational drug use among hospitalized patients through doctor-pharmacist collaboration.

Application of extended reality technology in orthopaedics / 中华创伤骨科杂志

Extended reality (XR) includes a variety of visualisation technologies such as virtual reality, augmented reality, and mixed reality. It refers to a combination of the real and the virtual entities through computers to create a virtual environment where human and computer can interact, characterized by immersion, interactivity, conceptualization, and combination of reality and fiction. Recently, great progress has been made in the application of XR in the fields of medical education, precision medicine, telemedicine, surgical assistance and navigation so that XR has drawn increasing attention. This paper briefly describes the concept of XR and its technological development, expounds its clinical application in orthopedics, surgery in particular, analyzes the existing problems and difficulties, and predicts its future development trend. This review may help readers gain a more comprehensive and in-depth understanding of the history, current status and future development of intelligent orthopaedics based on XR technology.

Association between cancer fatalism and optimistic attitudes in colorectal cancer patients and the moderating effects / 国际外科学杂志

Objective:To investigate the association between cancer fatalism and optimistic attitudes among colorectal cancer patients, and how the above linkage is moderated by the involvement of patients′ opinions, the family members′ opinions and the physicians′ opinions in treatment decision-making.Methods:A cross-sectional survey was conducted on 64 patients diagnosed with colorectal cancer and awaiting radical colorectal cancer surgery in the Department of General Surgery of Beijing Friendship Hospital Affiliated to Capital Medical University, from January 2021 to December 2021. There were 38 males and 26 females, aged (61.2±13.0) years from 30 to 84 years. Cancer fatalism, optimism attitudes, and the involvement of patients′ opinions, the family members′ opinions and the physicians′ opinions in treatment decision-making were assessed. The patients′ cancer fatalism beliefs were measured by the " Chance" subscale of the Form C of the Multidimensional Health Locus of Control (MHLC-C), optimism attitudes were assessed by the Chinese version of the revised Life Orientation Test (CLOT-R), and the influence of patients′, family members′, and physicians′ opinions in the medical decision-making process was measured by a self-designed single factor scale. Measurement data of normal distribution were expressed as mean±standard deviation ( ± s). Measurement data of skewed distribution were expressed as M( Q1, Q3). Spearman correlation analysis and Chi-square test was used to examine the association between the main outcome variable (patients′ optimistic attitudes) and demographic and clinical characteristics. Interaction was examined by hierarchical linear regression analysis combined with simple slope tests. Results:Cancer fatalism was negatively associated with patients′ optimistic attitudes ( r=-0.35, P<0.01). Optimistic attitude of patients was significantly and negatively correlated with the influence of family members′ opinions on medical decision-making ( r=-0.25, P<0.05). There were significant positive correlations between the influence of patients′ and family members′ opinions ( r=0.50, P<0.01), family members′ and physicians′ opinions ( r=0.67, P<0.01), and physicians′ and patients′ opinions ( r=0.38, P<0.01) in medical decision making. Hierarchical linear regression analysis showed a negative association between cancer fatalism and optimism ( β=-0.32, P=0.01). This association was further moderated by the involvement of family members′ opinions ( β=-0.56, P<0.01) and the involvement of physicians′ opinions ( β=-0.36, P=0.04) in medical decision-making. Simple slope tests revealed that the negative impact of fatalistic attitudes on patients′ optimism attitudes may be potentiated when family members′ opinions have high influence on medical decision-making, while the negative impact may be buffered to some extent when physicians′ opinions have high influence on medical decision-making. Conclusions:Cancer fatalism had a negative effect on patients′ optimism. The high influence of physicians in treatment decision-making buffered the negative effect of cancer fatalism on optimism; the high influence of family members in treatment decision-making potentiated the negative effect of cancer fatalism on optimism. In the process of doctor-patient communication and shared decision-making, for patients with strong fatalistic attitudes, consideration should be given to appropriately increasing direct informational communication between physicians and patients and reducing excessive family intervention in medical decision-making, so as to enhance patients′ autonomy for treatment, promote optimism, and reduce the negative effects of cancer fatalism.

Analysis of 197 cases of pentoxifylline injection and exploring supervision mode of rational drug use in hospitals / 中国临床药理学与治疗学

AIM: To analyze and evaluate the use of pentoxifylline injection in a hospital, and explore effective supervision mode, so as to provide some reference for clinical rational drug use. METHODS: A total of 197 inpatients with pentoxifylline injection who were discharged from October 2021 to June 2022 were randomly selected from HIS system. Referring to drug-label and collecting evidence-based medical evidence to judge the rationality of use of pentoxifylline injection in the hospital. RESULTS: Among the 197 medical records extracted, 140 medical records were unreasonable, accounting for 71.07% of the total medical records. Among them, 111 cases (79.29%) were no indication for use, 13 cases (9.29%) were off-label, 2 cases (1.43%) were inappropriate for indications, 13 cases (9.29%) were inappropriate for usage and dosage, and 1 case (0.71%) was inappropriate for solvent. CONCLUSION: The irrational use of pentoxifylline injection in this hospital is serious. It is necessary to standardize its clinical application through the intervention of smart pharmacy management mode, improving system, strengthening medication education and other ways.

The Frequency and Cost of Redundant Biochemistry Test in Tertiary Teaching Hospital

@#Introduction: Laboratory tests account for 66% of clinical decision making and reducing inappropriate test utilisation is a step towards optimising patients’ care and hospital cost savings. This study aims to identify the rate and cost of redundant test requests in our centre. Methods: A cross-sectional study comprising laboratory results of 14 analytes in renal function test (RFT) and liver function test (LFT) were made. Data involved blood results from adult patients admitted to Hospital Universiti Sains Malaysia from January to December 2018. The redundant test is defined as test results consecutively normal twice and requested within 26 hours for analytes in RFT and 50 hours for analytes in LFT. Cost contributions were estimated by multiplying cost-per-test with total redundant requests. The test redundancy in different wards and disease groups were also evaluated. Results: Equal distribution of RFT and LFT requests were observed in both genders (50% respectively), with the most requests seen in the 60 – 79 years age group. More than 20% redundancy rate was observed for seven analytes (ALT, total bilirubin, sodium, urea, potassium, AST, Chloride), and overall redundancy was 19.7%, equals to Malaysian Ringgit (MYR) 669,105.00. Oncology wards and genitourinary diseases contribute to the highest redundancy rate. Conclusion: This study estimated MYR 600 thousands of saving if test redundancy were to be eliminated. The finding is hoped to serve as a platform for future intervention and policymaking. Future planning to optimise the current laboratory request system and collaboration among physicians and laboratory professionals can minimise test inappropriateness.

Literature Analysis for Clinical Application and Existing Problems of 2 Medical Order Auditing Modes / 中国药房

OBJECTIVE：To summari ze clinical application and existing problems of artificial auditing and information-based medical order auditing modes so as to provide reference for improving rational medication. METHODS ：Collecting data by literature search ，using “Prescription auditing ”“Medical order auditing ”“Prescription pre-auditing ”“Medication error ” “Medication-related problems ”“Medication safety ”“Alert fatigue ”“Medication review ”“Decision support medication review ” “Real-time medication review ”“Real-time prescription surveillance ”“Clinical alarms decision support systems ”“Clinical pharmacy information systems ”“Medication errors ”“Medication related problem ”as keywords ，the related literatures from Jan. 2000 to Nov. 2019 were retrieved from CNKI ，Wanfang database ，PubMed，Embase，Web of Science and other databases. The clinical application and existing problems of 2 medical order auditing modes were analyzed and summarized. RESULTS & CONCLUSIONS：The artificial auditing mode can reduce medication-related problems （such as poor drug treatment effect ， untreated symptoms or indications ，potential adverse drug events ，unnecessary drug treatment ，etc.），improve life quality of patients，but can not decrease the mortality and the length of hospitalization stay ；there are some problems ，such as many pharmacists needed for medical order auditing ，insufficient auditing time ，different auditing standards ，auditing time lagging. The information-based medical order auditing mode can reduce medication-related problems ，save auditing time ，reduce the incidence of medication errors ，reduce unreasonable medical orders ，and improve audit efficiency. Compared with the artificial auditing mode ，it has certain advantages ，but there are problems such as alarm fatigue. At present ，the domestic medical order auditing mode is dominated by artificial audit mode ；the information-based medical order auditing mode is still in the initial stage ，and the most attention is paid to its influence on the qualified rate of prescription ，while the research on the incidence of adverse events and other clinical effects is less. Later ，the 2 midical order can be D181100000218002）； improve to provide a reference for medical order auditing of 2019 hospital pharmacy personnel.

Comparison of Open-Source Electronic Health Record Systems Based on Functional and User Performance Criteria / 대한의료정보학회지

OBJECTIVES: Open-source Electronic Health Record (EHR) systems have gained importance. The main aim of our research is to guide organizational choice by comparing the features, functionality, and user-facing system performance of the five most popular open-source EHR systems. METHODS: We performed qualitative content analysis with a directed approach on recently published literature (2012–2017) to develop an integrated set of criteria to compare the EHR systems. The functional criteria are an integration of the literature, meaningful use criteria, and the Institute of Medicine's functional requirements of EHR, whereas the user-facing system performance is based on the time required to perform basic tasks within the EHR system. RESULTS: Based on the Alexa web ranking and Google Trends, the five most popular EHR systems at the time of our study were OSHERA VistA, GNU Health, the Open Medical Record System (OpenMRS), Open Electronic Medical Record (OpenEMR), and OpenEHR. We also found the trends in popularity of the EHR systems and the locations where they were more popular than others. OpenEMR met all the 32 functional criteria, OSHERA VistA met 28, OpenMRS met 12 fully and 11 partially, OpenEHR-based EHR met 10 fully and 3 partially, and GNU Health met the least with only 10 criteria fully and 2 partially. CONCLUSIONS: Based on our functional criteria, OpenEMR is the most promising EHR system, closely followed by VistA. With regards to user-facing system performance, OpenMRS has superior performance in comparison to OpenEMR.

Optimization and Practice of Prescription Audit Platform of PIVAS in Our Hospital / 中国药房

OBJECTIVE： To optimize prescription audit platform of PIVAS in our hospital， and to provide reference for rational drug use in pediatric department. METHODS： The records of irrational drug use and prescription comment record of physicians were collected and sorted out. Retrieved from drug instruction， China’s National Prescription Collection： Chemicals and Biological Products Volume （Children’s Edition） （2013） and other data， PIVAS prescription audit guideline of our hospital was filed. Based on it， PIVAS prescription audit platform was optimized. The efficiency and accuracy of prescription audit were evaluated using average daily medical order audit time， the number of audit pharmacists， average daily number of telephone communication with clinicians， average daily number of irrational medical orders， the detection rate of irrational medical order as indexes. RESULTS： The revised PIVAS prescription audit guideline is simple and easy to consult. After optimizing and implementing PIVAS prescription  auditor platform， average daily medical order audit time， the number of audit pharmacists， average daily number of telephone communication with clinicians， average daily number of irrational medical orders decreased by 33.33 ％， 50.00 ％， 57.89 ％， and 57.14 ％， respectively； the detection rate of irrational medical orders decreased from 1.38％ to 0.54％， with statistical significance （P＜0.05）， which indicated the efficiency and accuracy of prescription audit were improved significantly. CONCLUSIONS： The optimized PIVAS prescription audit platform can significantly improve the standardization of medical order audit and the level of rational drug use， and contribute to rational drug use in pediatric department.

Design and Application of Medical Order Evaluation Software of Proton Pump Inhibitors in the Inpatients from a Third Grade Class A Hospital / 中国药房

OBJECTIVE： To design Proton pump inhibitor （PPI） medical order evaluation software， and to promote rational drug use in clinic. METHODS： According to the use of PPI （PPI injection as an example） of inpatients in a Third Grade Class A hospital （hereinafter referred to as "sample hospital"）， the evaluation process of medical order evaluation software was designed. On this basis， medical order evaluation software for inpatients was developed in collaboration with computer engineers. Taking the detection rate of irrational drug use and the time consuming per capita as indicators， the effects of software evaluation and manual evaluation were compared. Dispensing medical orders of PPI injection in PIVAS of sample hospital was evaluated with the software pre-evaluation in Feb. 2018. Irrational use of PPI injection （including irrational medication for treatment， prevention and non-indication） in the inpatients was evaluated retrospectively during Jan. 2015-Dec. 2017. RESULTS： The software of PPI audit includes four modules：users and tasks （timing audit）， system settings， confirmation of audit results （check the results audited by the software automatically） and reports exporting. Compared with manual evaluation， there was no significant difference in detection rate of irrational drug use in software audit （69.50％ vs. 77.00％， P＞0.05）； the time consuming per capita was shortened significantly （9.25 min vs. 1.50 min， P＜0.05）. In the application of pre-evaluation， 27 （2.23％） were irrational for treatment， 318 （26.24％） were irrational for prevention and 602 （49.67％） for non-indications. In the application of retrospective review， 4 884 （2.68％） were irrational medication for treatment， 50 399 （27.67％） irrational medication for prevention and 85 106 （46.72％） medication without indications. CONCLUSIONS： The application of PPI medical order evaluation software shortens the time of pharmacist's evaluation， improves the efficiency of evaluation， and promotes the rational use of PPI in clinic.