Markus G. Pruszydlo

Bio: Markus G. Pruszydlo is an academic researcher from Heidelberg University. The author has contributed to research in topics: Formulary & Decision support system. The author has an hindex of 8, co-authored 10 publications receiving 429 citations.

Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms

Abstract: We assessed the prevalence of difficulties in swallowing solid oral dosage forms in a general practice population. Reasons, nature, and characteristics of tablets and capsules causing such difficulties were investigated as well as general practitioners’ (GP) awareness of these difficulties. A questionnaire survey was conducted in 11 general practices and consecutive patients taking at least one solid oral dosage form for ≥4 weeks were invited to respond to a questionnaire at the practices and one at home. Physicians completed a short questionnaire for each included patient. Of all participants (N = 1,051), 37.4 % reported having had difficulties in swallowing tablets and capsules. The majority (70.4 %) of these patients was not identified by their GP. The occurrence of swallowing difficulties was related to gender (f>m), age (young>old), dysphagia [adjusted odds ratio (adOR): 7.9; p < 0.0001] and mental illness (adOR: 1.8; p < 0.05). By asking “Do you choke while eating or drinking?”, affected patients could be identified with a sensitivity of 62.6 % and a specificity of 78.1 %. Because of these difficulties, 58.8 % of the affected patients had already modified their drugs in a way that may alter safety and efficacy and 9.4 % indicated to be non-adherent. One in 11 primary care patients had frequent difficulties in swallowing tablets and capsules while GPs grossly underestimated these problems. Therefore, physicians should rule out swallowing difficulties regularly to avoid non-adherence and inappropriate drug modifications. Special attention should be paid to specific patient groups (e.g. women and patients with dysphagia, dysphagia indicators, or mental illness).

Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system.

Abstract: Objective We investigated the effect of written drug information for senior clinicians on the incidence of drug–drug interactions (DDIs) and DDI-related adverse events in intensive care patients.

Patient-specific electronic decision support reduces prescription of excessive doses

Abstract: Objectives Prescription of excessive doses is the most common prescription error, provoking dose-dependent adverse drug reactions. Clinical decision support systems (CDSS) can prevent prescription errors especially when mainly clinically relevant warnings are issued. We have built and evaluated a CDSS providing upper dose limits personalised to individual patient characteristics thus guaranteeing for specific warnings. Methods For 170 compounds, detailed information on upper dose limits (according to the drug label) was compiled. A comprehensive software-algorithm extracted relevant patient information from the electronic chart (eg, age, renal function, comedication). The CDSS was integrated into the local prescribing platform for outpatients and patients at discharge, providing immediate dosage feedback. Its impact was evaluated in a 90-day intervention study (phase 1: baseline; phase 2: intervention). Outcome measures were frequency of excessive doses before and after intervention considering potential induction of new medication errors. Moreover, predictors for alert adherence were analysed. Results In phase 1, 552 of 12 197 (4.5%) prescriptions exceeded upper dose limits. In phase 2, initially 559 warnings were triggered (4.8%, p=0.37). Physicians were responsive to one in four warnings mostly adjusting dosages. Thus, the final prescription rate of excessive doses was reduced to 3.6%, with 20% less excessive doses compared with baseline (p<0.001). No new manifest prescription errors were induced. Physicians' alert adherence correlated with patients' age, prescribed drug class, and reason for the alert. Conclusion During the 90-day study, implementation of a highly specific algorithm-based CDSS substantially improved prescribing quality with a high acceptance rate compared with previous studies.

An overview of clinical decision support systems: benefits, risks, and strategies for success.

Abstract: Computerized clinical decision support systems, or CDSS, represent a paradigm shift in healthcare today. CDSS are used to augment clinicians in their complex decision-making processes. Since their first use in the 1980s, CDSS have seen a rapid evolution. They are now commonly administered through electronic medical records and other computerized clinical workflows, which has been facilitated by increasing global adoption of electronic medical records with advanced capabilities. Despite these advances, there remain unknowns regarding the effect CDSS have on the providers who use them, patient outcomes, and costs. There have been numerous published examples in the past decade(s) of CDSS success stories, but notable setbacks have also shown us that CDSS are not without risks. In this paper, we provide a state-of-the-art overview on the use of clinical decision support systems in medicine, including the different types, current use cases with proven efficacy, common pitfalls, and potential harms. We conclude with evidence-based recommendations for minimizing risk in CDSS design, implementation, evaluation, and maintenance.

Clinical decision support systems

Abstract: Clinical decision support (CDS) systems link patient data with an electronic knowledge base in order to improve decision-making and computerised physician order entry (CPOE) is a requirement to set up electronic CDS. The medical informatics literature suggests categorising CDS tools into medication dosing support, order facilitators, point-of-care alerts and reminders, relevant information display, expert systems and workflow support. To date, CDS has particularly been recognised for improving processes. CDS successfully fostered prevention of deep-vein thrombosis, improved adherence to guidelines, increased the use of vaccinations, and decreased the rate of serious medication errors. However, CDS may introduce errors, and therefore the term "e-iatrogenesis" has been proposed to address unintended consequences. At least two studies reported severe treatment delays due to CPOE and CDS. In addition, the phenomenon of "alert fatigue" - arising from a high number of CDS alerts of low clinical significance - may facilitate overriding of potentially critical notifications. The implementation of CDS needs to be carefully planned, CDS interventions should be thoroughly examined in pilot wards only, and then stepwise introduced. A crucial feature of CPOE in combination with CDS is speed, since time consumption has been found to be a major factor determining failure. In the near future, the specificity of alerts will be improved, notifications will be prioritised and offer detailed advice, customisation of CDS will play an increasing role, and finally, CDS is heading for patient-centred decision support. The most important research question remains whether CDS is able to improve patient outcomes beyond processes.

Emergence of 3D Printed Dosage Forms: Opportunities and Challenges

Abstract: The recent introduction of the first FDA approved 3D-printed drug has fuelled interest in 3D printing technology, which is set to revolutionize healthcare. Since its initial use, this rapid prototyping (RP) technology has evolved to such an extent that it is currently being used in a wide range of applications including in tissue engineering, dentistry, construction, automotive and aerospace. However, in the pharmaceutical industry this technology is still in its infancy and its potential yet to be fully explored. This paper presents various 3D printing technologies such as stereolithographic, powder based, selective laser sintering, fused deposition modelling and semi-solid extrusion 3D printing. It also provides a comprehensive review of previous attempts at using 3D printing technologies on the manufacturing dosage forms with a particular focus on oral tablets. Their advantages particularly with adaptability in the pharmaceutical field have been highlighted, which enables the preparation of dosage forms with complex designs and geometries, multiple actives and tailored release profiles. An insight into the technical challenges facing the different 3D printing technologies such as the formulation and processing parameters is provided. Light is also shed on the different regulatory challenges that need to be overcome for 3D printing to fulfil its real potential in the pharmaceutical industry.

Electronic health records and clinical decision support systems: impact on national ambulatory care quality.

Abstract: American physicians often fail to provide outpatient care that is recommended by clinical guidelines,1,2 and many stakeholders identify health information technology (HIT) as a potential solution to low quality care.3 Since 1991, the Institute of Medicine has repeatedly called for increasing electronic health record (EHR) use to improve healthcare quality.3,4 Clinical practices implementing outpatient EHRs self-report improved clinical decisions and resulted in easier communication with other providers and patients, faster and more accurate access to medical records, and avoidance of medication errors. While US physicians have been slow to adopt outpatient EHRs,5,6 their use is likely to accelerate because of the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Reinvestment and Recovery Act (ARRA) of 2009. 7,8 Nonetheless, evidence linking increased national use of outpatient EHRs to improved care quality is lacking. While past studies within specific institutions have demonstrated better quality from EHR implementation,9,10 using 2004 national data Linder et al. found no quality difference between ambulatory care provided with and without EHRs.11 Several recent studies also fail to observe an association between EHR use and improved care quality.12,13 This lack of association between EHRs and national outpatient care quality may reflect early patterns of EHR use in past studies and the heterogeneous functionality of EHRs studied. One EHR function of key relevance to quality is clinical decision support (CDS), a feature that that alerts, reminds, or directs health care providers according to clinical guidelines. Past evaluations present conflicting results regarding CDS’s effects on quality, although most previous studies have had small sample sizes and have focused on specific diseases in a limited number of institutions.12, 14–20 Broader evaluations of CDS effects on quality across several institutions and diseases have had variable results.13 Using nationally representative, federally-collected 2005–07 data, we reexamined the impact of EHRs on outpatient care in the United States. We hypothesized that CDS functionality is associated with higher-quality outpatient care compared to EHR use without CDS.