This review found that 4 benchmark institutions have done most of the published research on the effects of the electronic health record on medical care. The research shows that electronic health re...

Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care

Timothy H. Dellit, Robert C. Owens, John E. McGowan, Jr., Dale N. Gerding, Robert A. Weinstein, John P. Burke, W. Charles Huskins, David L. Paterson, Neil O. Fishman, Christopher F. Carpenter, P. J. Brennan, Marianne Billeter, and Thomas M. Hooton Harborview Medical Center and the University of Washington, Seattle; Maine Medical Center, Portland; Emory University, Atlanta, Georgia; Hines Veterans Affairs Hospital and Loyola University Stritch School of Medicine, Hines, and Stroger (Cook County) Hospital and Rush University Medical Center, Chicago, Illinois; University of Utah, Salt Lake City; Mayo Clinic College of Medicine, Rochester, Minnesota; University of Pittsburgh Medical Center, Pittsburgh, and University of Pennsylvania, Philadelphia, Pennsylvania; William Beaumont Hospital, Royal Oak, Michigan; Ochsner Health System, New Orleans, Louisiana; and University of Miami, Miami, Florida

/pdf/infectious-diseases-society-of-america-and-the-society-for-34gfecer7v.pdf

Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship

Methodological Review: The Technology Acceptance Model: Its past and its future in health care

Can Electronic Medical Record Systems Transform Health Care

To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually—by improving health care efficiency and safety—and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits. However, this is unlikely to be realized without related changes to the health care system.

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Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs

ContextHospital computerized physician order entry (CPOE) systems are widely
regarded as the technical solution to medication ordering errors, the largest
identified source of preventable hospital medical error. Published studies
report that CPOE reduces medication errors up to 81%. Few researchers, however,
have focused on the existence or types of medication errors facilitated by
CPOE.ObjectiveTo identify and quantify the role of CPOE in facilitating prescription
error risks.Design, Setting, and ParticipantsWe performed a qualitative and quantitative study of house staff interaction
with a CPOE system at a tertiary-care teaching hospital (2002-2004). We surveyed
house staff (N = 261; 88% of CPOE users); conducted 5 focus groups
and 32 intensive one-on-one interviews with house staff, information technology
leaders, pharmacy leaders, attending physicians, and nurses; shadowed house
staff and nurses; and observed them using CPOE. Participants included house
staff, nurses, and hospital leaders.Main Outcome MeasureExamples of medication errors caused or exacerbated by the CPOE system.ResultsWe found that a widely used CPOE system facilitated 22 types of medication
error risks. Examples include fragmented CPOE displays that prevent a coherent
view of patients’ medications, pharmacy inventory displays mistaken
for dosage guidelines, ignored antibiotic renewal notices placed on paper
charts rather than in the CPOE system, separation of functions that facilitate
double dosing and incompatible orders, and inflexible ordering formats generating
wrong orders. Three quarters of the house staff reported observing each of
these error risks, indicating that they occur weekly or more often. Use of
multiple qualitative and survey methods identified and quantified error risks
not previously considered, offering many opportunities for error reduction.ConclusionsIn this study, we found that a leading CPOE system often facilitated
medication error risks, with many reported to occur frequently. As CPOE systems
are implemented, clinicians and hospitals must attend to errors that these
systems cause in addition to errors that they prevent.

https://jamanetwork.com/journals/jama/articlepdf/200498/JOC42133.pdf

Role of computerized physician order entry systems in facilitating medication errors.

Combination of atomoxetine with the novel antimuscarinic aroxybutynin improves mild to moderate OSA.


 
 
 Extended-release, once-nightly sodium oxybate (ON-SXB; FT218) is under FDA review for the treatment of adults with narcolepsy. RESTORE, an ongoing, open-label extension/switch study (NCT04451668), evaluates long-term ON-SXB safety and tolerability. This interim analysis assessed dosing titration, tolerability, and study continuation.
 
 
 
 RESTORE enrolls adults with narcolepsy in 1 of 3 groups: those with prior REST-ON participation but no current oxybate use (Group A), those who switched from twice-nightly oxybates (Group B), and oxybate-naïve patients (Group C). No patients rolled directly from REST-ON to RESTORE. Initial dose for Groups A/C was 4.5 g/night. Group B switched to ON-SXB from stable doses of twice-nightly oxybate to the nearest equivalent single dose. Investigators could increase or decrease dose by 1.5-g increments weekly as needed. Descriptive statistics were used to analyze dose titration and discontinuations.
 
 
 
 At an interim data cutoff date of November 14, 2021, 99 participants were enrolled and had received ≥1 dose of ON-SXB (not currently taking oxybate, n=24; switch, n=75). For Groups A/C, 5 (21%) participants continued the 4.5-g dose, 8 (33%) increased to 6 g, 8 (33%) increased to 7.5 g, and 3 (13%) increased to 9 g by this data cutoff. Most Group B participants received initial ON-SXB doses of either 9 g (n=27) or 7.5 g (n=24). For Group B participants with >1 visit, 41 maintained their initial dose, 20 increased the dose, and 8 increased the dose but then later decreased it. All but 2 Group B participants with initial 9-g doses of ON-SXB maintained this dose. Twenty participants (20%) discontinued study treatment since the first patient enrolled in July 2020; the primary reason was withdrawal of consent (n=3; 3%). Two (2%) discontinued due to adverse reactions: vivid dreams/anxiety/lightheadedness and lack of efficacy (7.5 g); and difficulty breathing (6 g). Two discontinued due to taste/texture (2%); the remainder for miscellaneous reasons (eg, withdrew consent, could not adhere to schedule, left the country, caring for sick parent/child, wanted to get pregnant, using cannabis).
 
 
 
 These interim data indicate that the majority of participants in all groups titrated to therapeutic and tolerable doses of ON-SXB.
 
 
 
 Avadel Pharmaceuticals


/pdf/0411-once-nightly-sodium-oxybate-dose-titration-and-2xavai0e.pdf

0411 Once-Nightly Sodium Oxybate Dose Titration and Tolerability: Interim Data From RESTORE


 
 
 Obstructive sleep apnea (OSA) is a common disorder with often poorly tolerated treatment . While there is currently no approved pharmacotherapy for OSA, the combination of noradrenergic and antimuscarinic drugs, counteracting sleep-related upper airway muscle hypotonia, has recently shown encouraging results. AD109 is a combination of the norepinephrine reuptake inhibitor atomoxetine and the antimuscarinic aroxybutynin, the R-enantiomer of oxybutynin which recently showed efficacy over 1-night treatment in mild OSA patients. Safety and efficacy data over longer periods and in more severe OSA patients are needed.
 
 
 
 Mariposa was a 25-center, randomized, controlled, parallel arms clinical trial designed to evaluate efficacy, safety, and tolerability vs placebo of 2 doses of AD109 (75/2.5mg and 75/5mg) and atomoxetine 75mg alone administered for 4 weeks in OSA patients with an apnea-hypopnea index (AHI4, 4% desaturation definition for hypopneas) between 10 and 45. The primary outcome was the change in AHI4, AD109 vs. placebo. Patient reported outcome questionnaires (PROMIS) were studied as exploratory outcomes.
 
 
 
 211 patients (41% female) with median (IQR) age 55 (48-60) years and BMI 32.2 (28.0-35.2) kg/m2 were randomized. AHI4 was reduced from 20.5 (12.3-27.2) to 10.8 (5.6-18.5) in the AD109 75/2.5mg dose arm and from 19.4 (13.7-26.4) to 9.5 (6.1-19.3) in the 75/5mg arm (both p< 0.0001 vs placebo). AHI4 was reduced from 19.0 (11.8-28.8) to 11.8 (5.5-21.5) with atomoxetine alone (p< 0.01 vs placebo) and from 20.1 (11.9-25.9) to 16.3 (11.1-28.9) on placebo. Overall, 44% had a reduction from baseline greater than 50% when treated with AD109. On AD109 75/2.5 dose, there was an improvement of PROMIS fatigue scores (p< 0.05 vs placebo and atomoxetine alone). Despite improving AHI4, atomoxetine alone reduced by 20+ minutes total sleep time vs placebo and AD109 (p< 0.05). There were no severe adverse events on AD109 with the most common side effects being dry mouth, insomnia, and nausea.
 
 
 
 AD109 objectively and subjectively improved OSA severity in a group of patients with a wide range of AHI4 over 4 weeks of treatment. Results from the Mariposa trial are central for the design of phase 3 trials of AD109 in OSA.
 
 
 
 This study was supported by Apnimed.


/pdf/0538-mariposa-oral-therapy-ad109-improves-objective-patient-1g9e9qu0.pdf

0538 Mariposa: Oral Therapy AD109 Improves Objective & Patient Reported Outcomes In OSA. Randomized, Placebo Controlled Clinical Trial

The Oral Agent AD109 Improves Objective and Subjective Outcomes in Obstructive Sleep Apnea Patients. Results From the Mariposa Study, a Randomized, Controlled Clinical Trial

Brian Abaluck

Papers

Role of computerized physician order entry systems in facilitating medication errors.

Combination of atomoxetine with the novel antimuscarinic aroxybutynin improves mild to moderate OSA.

0411 Once-Nightly Sodium Oxybate Dose Titration and Tolerability: Interim Data From RESTORE

0538 Mariposa: Oral Therapy AD109 Improves Objective & Patient Reported Outcomes In OSA. Randomized, Placebo Controlled Clinical Trial

The Oral Agent AD109 Improves Objective and Subjective Outcomes in Obstructive Sleep Apnea Patients. Results From the Mariposa Study, a Randomized, Controlled Clinical Trial