scholarly journals Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials

2008 ◽  
Vol 23 (12) ◽  
pp. 2095-2105 ◽  
Author(s):  
Monika Kastner ◽  
Sharon E. Straus
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Disease Management ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Controlled Trials ◽  
Decision Support Tools ◽  
Randomized Controlled ◽  
Support Tools ◽  
Clinical Decision Support Tools

scholarly journals Adverse effects information in clinical guidelines on pharmacological treatment of depression in children and adolescents: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036412
Author(s):  
Tone Westergren ◽  
Sigrid Narum ◽  
Marianne Klemp
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Adverse Effects ◽  
Children And Adolescents ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Decision Support Tools ◽  
Treatment Of Depression ◽  
Support Tools ◽  
Clinical Decision Support Tools

ObjectivesTo analyse to what extent clinical practice guidelines on drug treatment of depression in children and adolescents mention the risk of adverse effects, to characterise the citations in the guidelines and to assess to what extent data from a major study (Treatment for Adolescents With Depression Study, TADS) was used as basis for information about adverse effects.DesignSystematic review of clinical guidelines and clinical decision support tools.Data sourcesPubMed, EMBASE, guideline collections, Health libraries.Eligibility criteriaWe included national guidelines on depression in children and adolescents from European and/or English-speaking countries, published in English, German, French or any Scandinavian language since 2008. We also included well-known, international clinical decision support tools.Data extraction and synthesisGuidelines were examined by all authors to identify and classify information on adverse effects. Citations for statements on adverse effects were extracted and classified by category. The extent of citations about suicidality risk versus other adverse effects was assessed.Results19 guidelines were assessed. All guidelines discussed risk of suicidal behaviour connected with use of antidepressants. Most guidelines mentioned some other psychiatric adverse effects. Several guidelines did not include information on well-known and common somatic adverse effects. Most references concerned risk of suicidality. Adverse effects identified in underlying studies were not always presented. The TADS study was referred to, directly or indirectly, by 18/19 guidelines, but some only referred to TADS with regard to suicidality without citing the study’s findings of somatic adverse effects. No guideline commented on the lack of long-term adverse effects data from TADS.ConclusionsGuidelines for treatment of depression in children and adolescents vary widely regarding information on adverse effects. Many guidelines do not provide information on common somatic adverse effects. There is no consensus as to what extent risks of adverse effects connected with use of antidepressants should be described in guidelines.

scholarly journals 72. Improving Antibiotic Prescribing in Interventional Radiology Using Clinical Decision Support Tools to Assess Penicillin Allergies

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S54-S54
Author(s):  
Vidya Atluri ◽  
Paula Marsland ◽  
Luke M Johnson ◽  
Rupali Jain ◽  
Paul Pottinger ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Prophylactic Antibiotics ◽  
Decision Support Tools ◽  
First Line ◽  
Support Tools ◽  
History Of ◽  
Clinical Decision Support Tools

Abstract Background Patients labeled with penicillin allergies often receive alternative antibiotics, leading to increased cost, higher risk of adverse events, and decreased efficacy of procedural prophylaxis. However, most of those patients can tolerate a cephalosporin. University of Washington Medical Center – Montlake (UWMC-ML) Interventional Radiology (IR) frequently administer a pre-procedure prophylactic cephalosporin. We worked with the clinicians in IR to develop tools to allow them to better assess penicillin allergies, make the most appropriate antibiotic choice, and update the patient’s allergy documentation. Methods We identified all patients who underwent procedures in IR between 2017–2019. Chart review was done to determine the procedures performed, patient demographic information, allergies, allergy documentation, and prophylactic antibiotics received. In May 2020 we implemented new Clinical Decision Support tools, including an online assessment app (https://tinyurl.com/IRPCNAllAssess) and handouts to guide antibiotic decision making to clinicians in IR. Results From 2017 to 2019, 381 patients underwent 958 procedures in IR. Of those, 379 patients underwent 496 procedures for which the recommended first line choice for antibiotic prophylaxis is a cephalosporin. Of patients who received pre-procedure prophylactic antibiotics for those procedures, 15.9% [n=11] of patients with penicillin allergies received the first line antibiotic, compared to 89.9% [n=319] of patients without a reported penicillin allergy. Since implementation, the online app has been used to evaluate 9 patients, of whom 8 had penicillin allergies. All 8 patients safely received the first line antibiotic (3 were delabeled, 4 reported a history of mild reactions, and 1 reported a history of an immediate IgE mediated response to penicillin but safely received cefazolin). Conclusion IR evaluates hundreds of patients who may receive prophylactic antibiotics each year. By providing tools to assess penicillin allergies, we were able to improve both their prescribing and de-label patients which will provide a much broader impact on their care than on just their current procedure. Our free tool can be accessed at the website above, and we will demonstrate in person. Disclosures All Authors: No reported disclosures

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