- Unintended Consequences—Inappropriate Use of Metrics

2018 ◽  
pp. 162-165
Keyword(s):  
Unintended Consequences ◽  
Inappropriate Use

scholarly journals 968. Effect of Outpatient Antibiotic Ordering Restrictions on Antibiotic Prescribing Patterns at a State-wide VA Healthcare System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S32-S32
Author(s):  
Rohini Dave ◽  
Jacqueline Bork
Keyword(s):  
Healthcare System ◽  
Respiratory Infections ◽  
Outpatient Setting ◽  
Unintended Consequences ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Inappropriate Use ◽  
Amoxicillin Clavulanate ◽  
Rural Clinics ◽  
The Impact

Abstract Background Approximately 30% of antibiotics prescribed in the outpatient setting are inappropriate, mostly due to unnecessary prescriptions (Rx) for upper respiratory infections. Ordering restrictions is one approach to curtail inappropriate use. However, this approach may cause unintended consequences, such as increases in Rx of higher level antibiotics. This study evaluated the downstream effect of an azithromycin (AZM) ordering restriction. Methods This was a pre–post evaluation of the impact of an AZM removal (October 2017) on prescribing patterns of common outpatient antibiotics at the VA Maryland Healthcare System. AZM restriction was placed >10 years ago for concerns of emerging AZM resistance and overuse. During the study period, fluoroquinolone (FQ) use was scrutinized due to increasing toxicity risk. The proportion of several outpatient antibiotic Rx were compared between October 2017 and September 2018 (FY17) and October 2018 and September 30, 2018 (FY18) using χ 2 and logistic regression. FQ and AZM Rx were also stratified by location of prescribing clinic (urban vs. rural) and duration (≤14 days vs. >14 days). Results There were 15,972 and 14,451 prescriptions in FY17 and FY18, respectively. AZM Rx increased from 1,247 (7%) Rx in FY17 to 1,734 (11%) in FY18 (P < 0.0001) with an OR of 1.8 (95% CI 1.65–1.94). There was a greater effect on shorter than longer duration (OR 1.9 vs. 1.3, P < 0.0001), but no significant effect difference for urban and rural clinics (OR 1.8 vs. 1.9, P = 0.6). Conversely, FQ Rx decreased from 2,414 (15%) in FY17 to 1,731 (11%) in FY18 (P < 0.0001) with an OR of 0.7 (95% CI 0.66–0.76). There was a greater effect on shorter than longer duration (0.6 vs. 1.2, P < 0.0001) and also a greater effect on urban than rural clinics (OR 0.6 vs. 0.97, P < 0.0001). Doxycycline, amoxicillin–clavulanate and trimethoprim–sulfamethoxazole did not change significantly. Conclusion Removal of AZM restriction led to a significant decrease in FQ Rx, with greater effect in shorter duration and urban clinics, and an increase in AZM Rx, with greater effect in shorter duration, but no difference in clinic setting. Disparity of rural prescribers needs further exploration, as do other interventions outside of restrictive ordering, which needs periodic evaluation of risk and benefit if implemented. Disclosures All Authors: No reported Disclosures.

Strategic colorblindness: The paradox of unintended consequences

2007 ◽  
Author(s):  
Evan P. Apfelbaum ◽  
Samuel R. Sommers ◽  
Michael I. Norton
Keyword(s):  
Unintended Consequences

Health Informatics: Handle with Caution

1997 ◽  
Vol 36 (02) ◽  
pp. 79-81
Author(s):  
V. Leroy ◽  
S. Maurice-Tison ◽  
B. Le Blanc ◽  
R. Salamon
Keyword(s):  
Health Care ◽  
Data Management ◽  
Medical Informatics ◽  
Health Care Professionals ◽  
Data Security ◽  
Health Informatics ◽  
The Other ◽  
Inappropriate Use

Abstract:The increased use of computers is a response to the considerable growth in information in all fields of activities. Related to this, in the field of medicine a new component appeared about 40 years ago: Medical Informatics. Its goals are to assist health care professionals in the choice of data to manage and in the choice of applications of such data. These possibilities for data management must be well understood and, related to this, two major dangers must be emphasized. One concerns data security, and the other concerns the processing of these data. This paper discusses these items and warns of the inappropriate use of medical informatics.

Aviation and the Microbiome

2020 ◽  
Vol 91 (8) ◽  
pp. 651-661
Author(s):  
Joshua T. Davis ◽  
Hilary A. Uyhelji
Keyword(s):  
Psychological Health ◽  
Aviation Safety ◽  
Autism Spectrum ◽  
Unintended Consequences ◽  
Microbial Colonization ◽  
Future Research ◽  
Aerospace Medicine ◽  
Medical Certification ◽  
Physical Disorders ◽  
The Impact

INTRODUCTION: Although the impact of microorganisms on their hosts has been investigated for decades, recent technological advances have permitted high-throughput studies of the collective microbial genomes colonizing a host or habitat, also known as the microbiome. This literature review presents an overview of microbiome research, with an emphasis on topics that have the potential for future applications to aviation safety. In humans, research is beginning to suggest relationships of the microbiome with physical disorders, including type 1 and type 2 diabetes mellitus, cardiovascular disease, and respiratory disease. The microbiome also has been associated with psychological health, including depression, anxiety, and the social complications that arise in autism spectrum disorders. Pharmaceuticals can alter microbiome diversity, and may lead to unintended consequences both short and long-term. As research strengthens understanding of the connections between the microbiota and human health, several potential applications for aerospace medicine and aviation safety emerge. For example, information derived from tests of the microbiota has potential future relevance for medical certification of pilots, accident investigation, and evaluation of fitness for duty in aerospace operations. Moreover, air travel may impact the microbiome of passengers and crew, including potential impacts on the spread of disease nationally and internationally. Construction, maintenance, and cleaning regimens that consider the potential for microbial colonization in airports and cabin environments may promote the health of travelers. Altogether, the mounting knowledge of microbiome effects on health presents several opportunities for future research into how and whether microbiome-based insights could be used to improve aviation safety.Davis JT, Uyhelji HA. Aviation and the microbiome. Aerosp Med Hum Perform. 2020; 91(8):651–661.

A Donor Influenced by Local Dynamics

2016 ◽  
Vol 2 (1) ◽  
pp. 51-69 ◽  
Author(s):  
Setsuko Matsuzawa
Keyword(s):  
Poverty Alleviation ◽  
Rural Poverty ◽  
Unintended Consequences ◽  
Local Dynamics ◽  
Grant Program ◽  
Local Actors ◽  
Research Interviews ◽  
National Model ◽  
Management Project ◽  
Development Discourses

This article explores the relations between a foreign aid donor and local actors in the context of the dissemination of development discourses and practices in an authoritarian context. It addresses the question “To what extent may the local dynamics alter the original goals of a donor and lead to unintended consequences?” Based on archival research, interviews, and secondary literature, this case study examines the Yunnan Uplands Management Project (YUM) in 1990–95, the Ford Foundation's first grant program on rural poverty alleviation in China. While the Foundation did not attain its main goal of making YUM a national model for poverty alleviation, the local actors were able to use YUM to develop individual capacities and to build roles for themselves as development actors in the form of associations and nongovernmental organizations, resulting in further support from the Foundation. The study contributes to our understanding of donor-local actor dynamics by highlighting the gaps between the original goals of a donor and the perspectives and motivations of local actors. The study suggests that local dynamics may influence the goals of donors and the ways they seek to disseminate development discourses and practices to local actors, despite the common conception of donors as hegemonic or culturally imperialistic.

Reducing Unintended Consequences of Agricultural Phosphorus

2019 ◽  
Vol 103 (1) ◽  
pp. 33-35 ◽  
Author(s):  
Don Flaten ◽  
Andrew Sharpley ◽  
Helen Jarvie ◽  
Peter Kleinman
Keyword(s):  
Sustainable Management ◽  
Unintended Consequences ◽  
Valuable Resource

This article reflects upon the challenges we face in agricultural P management and provides a discussion about opportunities to promote more comprehensive and sustainable management of this valuable resource.

Sign in / Sign up

Export Citation Format

Share Document