Dataset Information

Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention.

ABSTRACT: Background: Mannitol has been used in the past for the prevention of cisplatin-induced nephrotoxicity. Studies on its efficacy have conflicting results. An educational newsletter was designed for local oncologists on the conflicting data of mannitol use in preventing cisplatin-induced nephrotoxicity. Purpose: The purpose of this study was to determine whether a pharmacist-created newsletter intervention led to changes in the mannitol prescribing practices of local oncologists. Methods: A newsletter describing the paucity of evidence to support mannitol use to prevent cisplatin-induced nephrotoxicity was distributed via e-mail to local oncologists in October 2010. Mannitol prescribing rates were retrospectively evaluated before and after newsletter distribution. The Mann-Whitney U test was used to compare nonparametric continuous data. The chi-square test was used for nominal data. Descriptive statistics were performed for baseline demographics, and odds ratios were calculated for possible risk factors for acute kidney injury (AKI). The primary endpoint was a change in mean mannitol dose before and after the newsletter intervention. The secondary endpoint was the difference in the rate of AKI before and after the intervention. Data were collected for 67 patients with various malignancies. Results: There was a difference in the average mannitol dose before and after newsletter intervention (P = .02). The rates of AKI before and after newsletter were similar. Conclusion: A pharmacist-led newsletter intervention was associated with significantly decreased rates of mannitol usage after intervention.

SUBMITTER: Corbin M

PROVIDER: S-EPMC5551635 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention.

Corbin Morgan M Bossaer John B JB

Hospital pharmacy 20170501 5

Background: Mannitol has been used in the past for the prevention of cisplatin-induced nephrotoxicity. Studies on its efficacy have conflicting results. An educational newsletter was designed for local oncologists on the conflicting data of mannitol use in preventing cisplatin-induced nephrotoxicity. Purpose: The purpose of this study was to determine whether a pharmacist-created newsletter intervention led to changes in the mannitol prescribing practices of local oncologists. M ...[more]

PMID: 28804151

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Project description:ImportanceOverprescribing of opioids has generated and sustains the opioid overdose epidemic. Health systems have a responsibility to lead the effort to reduce overprescribing.ObjectiveTo measure the effects of multilevel interventions on opioid prescribing within a health system.Design, setting, and participantsQuality improvement study comparing a 6-month preintervention baseline with a 16-month postintervention period ending in April 2018. Inpatient and outpatient clinical activity within a regional health system including an acute care hospital, same-day surgery, and outpatient clinics. Opioid prescribing activity by hundreds of clinicians involving over a million clinical encounters was measured using a health system's electronic medical record.InterventionsMultiple parallel interventions in different domains, including prescriber education and accountability, enhanced oversight via measurement of individual prescribers, tools to right-size postoperative discharge prescriptions, reduction of default amounts on standard opioid prescription orders, and professionally written patient and public education about opioid risks and alternatives.Main outcomes and measuresMorphine milligram equivalents (MME) per encounter per month, MME per opioid prescription, and rate of opioid prescriptions (opioid prescriptions per encounter per month).ResultsMore than 44?000 clinical encounters per month were recorded. All baseline trends were not significantly different from 0. Total health system MME per encounter decreased 1.0 MME per encounter per month. At the end of the postintervention observation period, the monthly MME per encounter was 58% lower than the average of the 6-month baseline, the MME per opioid prescription per month was 34% less than the average of the baseline, and the opioid prescription rate was 38% lower than the average of the baseline.Conclusions and relevanceOpioid overprescribing was reduced with multifocal interventions targeting patient and public demand, creating prescriber awareness and accountability, and creating tools for clinical leadership accountability. The interventions described are adoptable by most organized health systems. Reducing total opioid supply within communities should be given high priority by those with a mission to protect and improve public health.

Project description:BACKGROUND:Anticipatory guidance for parents is commonly used to improve parenting skills. The objective of this pre/post-intervention controlled study was to evaluate the effectiveness of a periodic newsletter with advice on childcare and development in improving parenting self-efficacy. METHODS:This was a non-randomized pre/post-intervention controlled study. All the parents of children born between September 2014 and December 2015 resident in the S. Ilario d'Enza municipality (Italy) received eight Baby Newsletters. Parents resident in other municipalities of the same Health District were the control. Parents with linguistic barriers or with preterm or hospitalized children were excluded. Improvement in parenting self-efficacy was measured through the TOPSE (Tool to Measure Parenting Self-Efficacy) questionnaire during the first week (t0) after delivery and at 5 (t1) and 12?months (t2) of life at two vaccination appointments. A score ranging from 0 to 60 was computed for each of the eight domains investigated by the TOPSE. Variations of each TOPSE score between delivery and 12?months in the two groups were compared, adjusting for parity, education, age of parents, and child's sex, and stratifying by parity and education. RESULTS /FINDINGS:One hundred thirty-six families accepted to participate in the study. Scores at 12?months were higher than 1 week after delivery in both groups for all TOPSE domains. The improvement was slightly stronger in the Newsletter group for almost all the skills except learning and knowledge [difference in the mean of variation: -0.48 (95% CI: -?3.17; 2.21)]; the difference was significant only for play and enjoyment [2.18 (95% CI: 0.12; 4.25)]. The increase in scores in almost all domains was more pronounced for parents with high education level at first child. CONCLUSIONS:The intervention was effective in improving parents' ability to play. However, it risks worsening existing differences between parents with high and with low education levels. TRIAL REGISTRATION:Clinical trial registration: NCT03268408 .

Project description:ObjectiveTo review the literature on educational interventions to improve prescribing and identify educational methods that improve prescribing competency in both medical and non-medical prescribers.DesignA systematic review was conducted. The databases Medline, International Pharmaceutical Abstracts (IPA), EMBASE and CINAHL were searched for articles in English published between January 1990 and July 2013.SettingPrimary and secondary care.ParticipantsMedical and non-medical prescribers.InterventionEducation-based interventions to aid improvement in prescribing competency.Primary outcomeImprovements in prescribing competency (knows how) or performance (shows how) as defined by Miller's competency model. This was primarily demonstrated through prescribing examinations, changes in prescribing habits or adherence to guidelines.ResultsA total of 47 studies met the inclusion criteria and were included in the systematic review. Studies were categorised by their method of assessment, with 20 studies assessing prescribing competence and 27 assessing prescribing performance. A wide variety of educational interventions were employed, with different outcome measures and methods of assessments. In particular, six studies demonstrated that specific prescribing training using the WHO Guide to Good Prescribing increased prescribing competency in a wide variety of settings. Continuing medical education in the form of academic detailing and personalised prescriber feedback also yielded positive results. Only four studies evaluated educational interventions targeted at non-medical prescribers, highlighting that further research is needed in this area.ConclusionsA broad range of educational interventions have been conducted to improve prescribing competency. The WHO Guide to Good Prescribing has the largest body of evidence to support its use and is a promising model for the design of targeted prescribing courses. There is a need for further development and evaluation of educational methods for non-medical prescribers.

Project description:Electronic prescribing (e-prescribing) has the potential to improve the safety and efficiency of medication use, but uptake of e-prescribing in community-based settings has been limited to date. In April 2004, 2 large insurers in Massachusetts began a program to fund e-prescribing systems for targeted clinicians and practices. We studied the adoption and uptake of e-prescribing by the targeted prescribers.We obtained data on all e-prescriptions written from April 2004 to March 2005. We tabulated the number of clinicians using the e-prescribing system and the number of prescriptions written. We also obtained claims data from the 2 insurance companies and calculated the proportion of each clinician's prescriptions that were written electronically. We developed multivariable models to estimate the impact of different clinician characteristics on the proportional rate of e-prescribing.During the first 12 months of the e-prescribing program, 1,217 prescribers began using the e-prescribing system. In the final month of the study, over 55,000 e-prescriptions were written for patients covered by the 2 included insurance plans. The proportion of total reimbursed claims per clinician written electronically increased slowly during the study period and was still below 30% by the end of the study period. This number increased to 42% when we restricted the sample to medications normally used for acute indications. Multivariable models showed that younger clinicians, pediatricians, and prescribers in larger practices exhibited higher uptake rates as a proportion of total prescriptions.Clinician use of e-prescribing increased steadily in the first 12 months of an initiative sponsoring e-prescribing systems. Uptake of e-prescribing was only partial, with younger clinicians and pediatricians more likely to use the system. Research to understand why prescribers vary in their use of e-prescribing and to develop techniques to encourage more wide-spread adoption will be an important priority for future studies.

Project description:BackgroundFew studies regarding Knowledge, Attitude and Practice (KAP) towards medicines among school teachers have been carried out in Nepal. Obtaining baseline KAP is important to note deficiencies and plan appropriate interventions. School teachers have to know about medicines as they can be an important source of information about rational and safe use of medicines. The department of Clinical Pharmacology, KIST Medical College, Lalitpur, conducted a study regarding KAP of school teachers about medicines before and after an educational intervention from April 2011 to December 2011.MethodsThe study was done in selected schools of Lalitpur district. Teachers were selected on a voluntary basis after obtaining written informed consent. Gender, ethnic or caste group, native place, age, educational qualifications, subject taught were noted. An educational intervention using a combination of methods like presentations, brainstorming sessions, interactive discussions using posters and distribution of information leaflets about the use of medicines was conducted. The KAP and overall scores among subgroups according to gender, age, level of education, subject, ethnicity, type of school (primary vs. secondary and government vs. private school) were studied. KAP and overall scores before and after the intervention was compared using Wilcoxon signed ranks test as the scores were not normally distributed.ResultsA total of 393 teachers participated before and after the intervention. The median (interquartile range) knowledge, attitude and practice scores before the intervention were 63 (10), 23 (5) and 270 (48) respectively while the overall score was 356. The median knowledge, attitude and practice scores after the intervention were 71 (10), 28 (5) and 270 (48) respectively while the overall score increased to 369. Maximum possible score of knowledge, attitude and practice were 100, 40 and 320 respectively. Scores improved significantly for knowledge (p<0.001), attitude (p<0.001) and total scores (p<0.001) but not for practice (p=0.528).ConclusionThe intervention was effective in improving knowledge and attitude of the teachers. More studies among school teachers about their knowledge, attitude and practice about medicines are required in Nepal.

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Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention.

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Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention.

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