scholarly journals Impact of Clinical Decision Support on Time to Order Resolution for Patients with Documented Allergies

Pharmacy ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 80 ◽  
Author(s):  
Tenielle Watkins ◽  
Sandra Aguero ◽  
Michael Jaecks
Keyword(s):  
Median Time ◽  
Medical Information ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Clinical Decision ◽  
Second Shift ◽  
The Difference ◽  
Verification Process ◽  
The Impact ◽  
Third Shift

Failure to appropriately document patient medical information, such as allergies, is an important cause of medication errors. Lack of allergy details in the electronic medical record (EMR) may prolong the pharmacist order verification process. A retrospective chart review was conducted in October 2017, to evaluate the impact of incomplete allergy details on time to antibiotic order resolution at the Einstein Medical Center Philadelphia. Details were present on 71% of orders. The difference in median time to order resolution, for orders with versus without details, was –21 min (95% CI (confidence interval), –39 to –2.9; p = 0.02). The difference in median time to order resolution for orders, based on pharmacist work shift was, –21 min for the first shift (95% CI, –41.2 to –0.8; p = 0.04), –50 min for the second shift (95% CI, –109.8 to 9.8; p = 0.10), and +3 min for the third shift (95% CI, –36.1 to 30.1; p = 0.85). Orders with an allergy intervention by a pharmacist were 2.75 times more likely (adjusted odds ratio = 2.75; 95% CI, 0.98 to 7.7; p = 0.06) to have a therapy change than orders without allergy interventions. Based on the results, when information about antibiotic allergies lacks details, it takes more time for pharmacists to resolve alerted orders.

The Impact of Face-to-Face Pharmacist Transitional Care Management Visits on Medication-Related Problems

2020 ◽  
Vol 36 (3) ◽  
pp. 95-101
Author(s):  
Bianca Mayzel ◽  
Sandra Axtell ◽  
Carolyn Richardson ◽  
Nicholas Link
Keyword(s):  
Readmission Rate ◽  
Medication Reconciliation ◽  
Transitional Care ◽  
Retrospective Chart Review ◽  
Optimization Methods ◽  
Related Factor ◽  
Prospective Group ◽  
The Difference ◽  
Internal Medicine Clinic ◽  
The Impact

Background: Studies are needed to evaluate medication-related problems (MRPs) to assess the effect of a pharmacist on managing medications postdischarge. Objective: To assess the ability of pharmacist-led medication review and reconciliation to reduce the number of MRPs found in transitional care medicine (TCM) visits, leading to medication optimization. Methods: This study involved a retrospective chart review of standard TCM procedure at a family/internal medicine clinic and a prospective, team-based TCM visit in the same clinic. Inclusion criteria included patients discharged from any hospital within our institution and seen in the clinic. The primary outcome was the difference in the proportion of MRPs found between the prospective and retrospective groups. Secondary outcomes included the number and specific type of MRPs found, classified by the Pharmaceutical Care Network Europe tool, and further subdivided by patient aware or unaware of MRP, only in the prospective group, as well as 30-day readmission rate. Results: Patients in the prospective group (n = 50) had an average age of 67.9 years versus 65.5 years in the retrospective group (n = 50). Four times as many patients in the prospective group were found to have MRPs than the retrospective group. The most common MRP was due to a patient-related factor, meaning the cause is related to a patient’s behavior. Patients were unaware of the MRP in a majority of these cases. Thirty-day readmission rate did not differ between the groups. Conclusion: Team-based TCM visits that included a pharmacist-led medication reconciliation uncovered more MRPs than patients who did not have a pharmacist perform a medication reconciliation.

scholarly journals Is the Climb Worth the View? The Savings/Alert Ratio for Reducing Vitamin D Testing

2020 ◽  
Vol 11 (01) ◽  
pp. 160-165
Author(s):  
Chase D. Hendrickson ◽  
Michael F. McLemore ◽  
Kathryn M. Dahir ◽  
Shari Just ◽  
Zahra Shajani-Yi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Medical Center ◽  
Intervention Group ◽  
Clinical Decision ◽  
Control Group ◽  
Hydroxyvitamin D ◽  
Patient Demographics ◽  
25 Hydroxyvitamin D ◽  
A Charge ◽  
The Impact

Abstract Background Despite guideline recommendations, vitamin D testing has increased substantially. Clinical decision support (CDS) presents an opportunity to reduce inappropriate laboratory testing. Objectives and Methods To reduce inappropriate testing of vitamin D at the Vanderbilt University Medical Center, a CDS assigned providers to receive or not receive an electronic alert each time a 25-hydroxyvitamin D assay was ordered for an adult patient unless the order was associated with a diagnosis in the patient's chart for which vitamin D testing is recommended. The CDS ran for 80 days, collecting data on number of tests, provider information, and basic patient demographics. Results During the 80 days, providers placed 12,368 orders for 25-hydroxyvitamin D. The intervention group ordered a vitamin D assay and received the alert for potentially inappropriate testing 2,181 times and completed the 25-hydroxyvitamin D order in 89.9% of encounters, while the control group ordered a vitamin D assay (without receiving an alert) 2,032 times and completed the order in 98.1% of encounters, for an absolute reduction of testing of 8% (p < 0.001). Conclusion This CDS reduced vitamin D ordering by utilizing a soft-stop approach. At a charge of $179.00 per test and a cost to the laboratory of $4.20 per test, each display of the alert led to an average reduction of $14.70 in charges and of $0.34 in spending by the laboratory (the savings/alert ratio). By describing the effectiveness of an electronic alert in terms of the savings/alert ratio, the impact of this intervention can be better appreciated and compared with other interventions.

scholarly journals Evaluation of a Multidisciplinary Pain, Agitation, and Delirium Guideline in Mechanically Ventilated Critically Ill Adults

2018 ◽  
Vol 54 (2) ◽  
pp. 119-124
Author(s):  
Melissa Heim ◽  
Ryan Draheim ◽  
Anna Krupp ◽  
Paula Breihan ◽  
Ann O’Rourke ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Medical Center ◽  
Guideline Implementation ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Hospital Length Of Stay ◽  
Mechanically Ventilated ◽  
The Impact ◽  
Daily Sedation Interruption

Background: A multidisciplinary team updated an institution-specific pain, agitation, and delirium (PAD) guideline based on the recommendations from the Society of Critical Care Medicine (SCCM) PAD guidelines. This institution-specific guideline emphasized protocolized sedation with increased as needed boluses, and nonbenzodiazepine infusions, daily sedation interruption, and pairing of spontaneous awakening (SAT) and breathing trials (SBT). Objective: The purpose of this study was to evaluate the impact of implementation of a PAD guideline on clinical outcomes and medication utilization in an academic medical center intensive care unit (ICU). It was hypothesized that implementation of an updated guideline would improve clinical outcomes and decrease usage of benzodiazepine infusions. Methods: Pre-post retrospective chart review of 2417 (1147 pre, 1270 post) critically ill, mechanically ventilated adults in a medical/surgical ICU over a 2-year period (1 year pre and post guideline implementation). Results: After guideline implementation, average ventilation days was reduced (3.98 vs 3.43 days, P = .0021), as well as ICU and hospital length of stay (LOS) (4.79 vs 4.34 days, P = .048 and 13.96 vs 12.97 days, P = .045, respectively). Hospital mortality (19 vs 19%, P = .96) and acute physiology and chronic health evaluation (APACHE) IV scores (77.28 vs 78.75, P = .27) were similar. After guideline implementation, the percentage of patients receiving midazolam infusions decreased (422/1147 [37%] vs 363/1270 patients [29%], P = .0001). The percentage of patients receiving continuous infusion propofol (679/1147 [59%] vs 896/1270 [70%], P = .0001) and dexmedetomidine (78/1147 [7%] vs 147/1270 [12%], P = .0001) increased. Conclusions: Implementing a multidisciplinary PAD guideline utilizing protocolized sedation and daily sedation interruption decreased ventilation days and ICU and hospital LOS while decreasing midazolam drip usage.

Impact of weight and creatinine measurements in carboplatin dosing.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e13027-e13027 ◽  
Author(s):  
Feriel Boumedien ◽  
Youri Arsenault ◽  
Nathalie LeTarte
Keyword(s):  
Body Weight ◽  
Serum Creatinine ◽  
Actual Body ◽  
Retrospective Chart Review ◽  
Actual Body Weight ◽  
Calculated Dose ◽  
The Difference ◽  
The Impact ◽  
Carboplatin Dose ◽  
Creatinine Measurement

e13027 Background: Controversy surrounding weight in Carboplatin dosing is still current. Also, new methods of measuring serum creatinine have raised more questions regarding the precision of Carboplatin dose calculations. The two objectives of this study were to evaluate the impact of alternative weight indicators (actual and adjusted body weight) in the Cockcroft–Gault equation and the use of different creatinine measurements (standard and IDMS) in order to accurately predict Carboplatin dose. Methods: We performed a retrospective chart review on all patients who received at least one dose of Carboplatin between March 7th and May 8th 2010. The patients were divided into two groups according to their body mass index (BMI): 20 < BMI < 27 and BMI ≥ 27. The differential creatinine clearance and Carboplatin dose were assessed in each group using the actual body weight and the adjusted body weight with IDMS creatinine. Moreover, for patients who had their creatinine measurement at the CHUM hospital, we calculate the difference in Carboplatin dose by using the standard creatinine (SC) measurement and IDMS creatinine with the same weight. Results: A total of 95 patients, representing 119 Carboplatin doses, were included in the analysis. 82% were women and median age was 63. The average BMI was 26,6. The Carboplatin expected AUC was 5 for 89% of patients and Carboplatin was associated to Paclitaxel in 78% of patients. In patients with a 20<BMI< 27 (44%), the average difference between the calculated dose using their actual body weight and adjusted body weight was +6.03% (95% CI, 5.2 to 6.9%). For patients with a BMI ≥ 27 (43%), the mean dose difference was +20.6% (95% CI, 18.8 to 22.5%). The use of SC or IDMS creatinine led to a discrepancy in doses of 5.2% (95% CI, 4.7 to 5.7%) for patients with BMI <27 (35 patients) and 5.5% (95% CI, 4.9 to 6.2%) for those with BMI ≥ 27 (23 patients). Conclusions: Based on these findings, we decide in our clinic, to use the actual body weight for patients with a BMI between 20 and 27, and the adjusted body weight for those with a BMI ≥ 27. We also chose not to modify our doses based on the type of the serum creatinine measurement.

Factors Affecting Dilation Interval in Patients With Granulomatosis With Polyangiitis-Associated Subglottic and Glottic Stenosis

2021 ◽  
pp. 019459982110042
Author(s):  
Lena W. Chen ◽  
Ioan Lina ◽  
Kevin Motz ◽  
Alexandra J. Berges ◽  
Rafael Ospino ◽  
...  
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Interquartile Range ◽  
Surgical Interventions ◽  
Factors Affecting ◽  
Academic Medical ◽  
Preliminary Study ◽  
The Impact

Objective Subglottic stenosis (SGS) is a known complication of granulomatosis with polyangiitis (GPA). We investigated the impact of medical and surgical interventions on the surgical dilation interval and characterized patients with glottic involvement. Study Design A retrospective chart review of patients with GPA-associated SGS was performed from 2010 to 2019. Setting Tertiary academic medical center. Methods The impact of medical and surgical interventions on dilation interval was assessed. The prevalence of glottic involvement was assessed, and clinical characteristics and outcomes were compared with patients without glottic involvement. Results A total of 39 patients with GPA-associated SGS were analyzed. Dilation intervals in patients receiving leflunomide (n = 4; median, 484 days; 95% CI, 405-1099) were greater than in those not receiving leflunomide (median, 155 days; 95% CI, 48-305; P = .033). The surgical technique used did not affect dilation interval. Patients with glottic involvement (n = 13) had a greater incidence of dysphonia (13/13 vs 15/26 [58%], P = .007) and a shorter dilation interval with involvement (median, 91 days; interquartile range, 70-277) versus without involvement (median, 377 days; interquartile range, 175-1148; hazard ratio, 3.38; 95% CI, 2.26-5.05; P < .001). Of 13 patients, 8 (62%) did not have glottic involvement on first presentation. Conclusion Although GPA is classically thought to affect the subglottis, it also involves the glottis in a subset of patients. These patients have greater complaints of dysphonia and require more frequent surgery. Systemic therapy may increase dilation intervals. In this preliminary study, patients taking leflunomide demonstrated an improvement, highlighting the need for further study of immunosuppression regimens in the treatment of GPA-associated SGS.

scholarly journals An analysis of blood pressure measurement in a primary care hospital in Swaziland

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Ganizani Mlawanda ◽  
Michael Pather ◽  
Srini Govender
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Good Clinical Practice ◽  
Clinical Decision ◽  
Care Hospital ◽  
Correct Treatment ◽  
Primary Care Hospital ◽  
The Mean ◽  
The Difference ◽  
The Impact

Background: Measurement of blood pressure (BP) is done poorly because of both human and machine errors.Aim: To assess the difference between BP recorded in a pragmatic way and that recorded using standard guidelines; to assess differences between wrist- and mercury sphygmomanometerbased readings; and to assess the impact on clinical decision-making.Setting: Royal Swaziland Sugar Corporation Mhlume hospital, Swaziland.Method: After obtaining consent, BP was measured in a pragmatic way by a nurse practitioner who made treatment decisions. Thereafter, patients had their BP re-assessed using standard guidelines by mercury (gold standard) and wrist sphygmomanometer.Results: The prevalence of hypertension was 25%. The mean systolic BP was 143 mmHg (pragmatic) and 133 mmHg (standard) using a mercury sphygmomanometer; and 140 mmHg for standard BP assessed using wrist device. The mean diastolic BP was 90 mmHg, 87 mmHg and 91 mmHg for pragmatic, standard mercury and wrist, respectively. Bland Altman analyses showed that pragmatic and standard BP measurements were different and could not be interchanged clinically.Treatment decisions between those based on pragmatic BP and standard BP agreed in 83.3% of cases, whilst 16.7% of participants had their treatment outcomes misclassified. A total of 19.5% of patients were started erroneously on anti-hypertensive therapy based on pragmatic BP.Conclusion: Clinicians need to revert to basic good clinical practice and measure BP more accurately in order to avoid unnecessary additional costs and morbidity associated within correct treatment resulting from disease misclassification. Contrary to existing research,wrist devices need to be used with caution.

scholarly journals 1063. Impact of Rapid Organism Identification and a Standardized Algorithm on Antimicrobial Therapy in Patients With Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S318-S318
Author(s):  
Christina Koutsari ◽  
Krista Gens ◽  
Jessica Holt
Keyword(s):  
Antibiotic Therapy ◽  
Multiplex Pcr ◽  
Median Time ◽  
Antimicrobial Therapy ◽  
Retrospective Chart Review ◽  
Clinical Decision ◽  
Antimicrobial Resistance Genes ◽  
Polymerase Chain ◽  
Organism Identification ◽  
Algorithm Implementation

Abstract Background Bloodstream infection is associated with 12% to 32% mortality. The FilmArray® BCID panel is a multiplex polymerase chain reaction assay (PCR) that can rapidly identify the most common bacterial pathogens in the blood and three antimicrobial resistance genes. In April 2015, Abbott Northwestern Hospital (ANW) implemented the multiplex PCR panel and a pharmacist-driven process to assist with antibiotic tailoring. In August 2017, a standardized algorithm was approved providing first-line and second-line antimicrobial options for each microbial pathogen included in the multiplex PCR panel. The objective of this study was to compare the time from the multiplex PCR panel result to final appropriate antibiotic therapy (as defined by the standardized algorithm or when clinical decision was indicated) between pre- and post-algorithm implementation in hospitalized patients with bacteremia. Methods Retrospective chart review was performed in 93 randomly selected adult patients with ≥1 positive blood culture in November 2016–February 2017 (pre-algorithm) vs. 93 patients in November 2017–February 2018 (post-algorithm) at ANW. Results The two groups did not differ significantly in terms of age (average ~60 years), sex (45% female), intensive care unit admission on day 1 of bacteremia (~41%), infectious diseases (ID) consult within 72 hours of bacteremia (average 72%), bacteremia source, or etiologic bacteria. The median time to final appropriate antibiotic therapy in response to the multiplex PCR result was 19 hours (interquartile range, IQR 4–38 hours) pre-algorithm and 18 hours (IQR 4–31 hours) post-algorithm (P = 0.34). Conclusion The median time from the multiplex PCR result to final appropriate antibiotic therapy was ~19 hours pre- and post-algorithm. Previous studies showed a median of 21 hours to first appropriate de-escalation. Therefore, ANW performs very well in de-escalating antimicrobial therapy promptly. However, most of the rapidity in antibiotic change was driven by ID providers, who treated &gt;70% of patients. Opportunities for improvement exist for non-ID providers in tailoring antimicrobial therapy and for pharmacists in engaging and providing recommendations in a timely manner. Disclosures All authors: No reported disclosures.

S244 – Intraoperative ABR after Myringotomy and Tube Placement

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P157-P157
Author(s):  
Nanette Sturgill ◽  
Joshua G Yorgason ◽  
Albert H Park
Keyword(s):  
Middle Ear ◽  
Chart Review ◽  
Medical Center ◽  
Hearing Threshold ◽  
Retrospective Chart Review ◽  
Tube Placement ◽  
Threshold Levels ◽  
Time Of Surgery ◽  
The Difference

Objectives Understand the utility of intraoperative ABR testing after myringotomy and tube placement. Methods We performed a retrospective chart review of 27 patients (mean age 23 months) who underwent intraoperative ABR (ioABR) after myringotomy and tube placement at Primary Childrens Medical Center from 2004 to 2007. Paired t-tests were perfomed to analyze the difference in threshold levels from the ioABR to follow up behavioral audiometry at 1kHz and 4kHz frequencies, accounting for the presence or absence of fluid at the time of surgery. Results 15 patients (29 ears) showed a mean improvement of 10 dB at the 1 kHz frequency (p=0.007), and 16 patients (31 ears) improved by 5 dB at 4kHz (p=0.83). An improvement of at least 15 dB was seen in 45% of patients (13/29 ears) at 1 kHz and in 26% (8/31 ears) at 4 kHz; 5 patients improved by as much as 35–50 dB. Of the patients whose thresholds improved by at least 15 dB, 77% at 1 kHz and 83% at 4 kHz showed evidence of fluid at the time of the ioABR Conclusions Patients who undergo ioABR testing show a significant improvement of dB level on follow-up behavioral audiometry. Many patients whose hearing threshold improved by at least 15 dB had fluid at the time of myringotomy. Therefore, the presence of middle ear pathology may lead to an overestimation of ioABR thresholds. Consequently, ioABR results should be interpreted with caution in isolation, and subsequent audiometric testing should always be performed to validate prior results.

scholarly journals Implementation of Two-Step Clostridioides difficile Testing Algorithm and Management of Possible Carriers

2020 ◽  
Vol 41 (S1) ◽  
pp. s269-s270
Author(s):  
J. Daniel Markley ◽  
Daniel Tassone ◽  
Melanie Christian ◽  
Leroy Vaughan ◽  
Michael P. Stevens ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Previous History ◽  
Retrospective Chart Review ◽  
Healthcare Facility ◽  
Nucleic Acid Amplification ◽  
Considerable Proportion ◽  
Testing Algorithm ◽  
The Impact

Background: Updated IDSA-SHEA guidelines recommend different diagnostic approaches to C. difficile depending on whether There are pre-agreed institutional criteria for patient stool submission. If stool submission criteria are in place, nucleic acid amplification testing (NAAT) alone may be used. If not, a multistep algorithm is suggested, incorporating various combinations of toxin enzyme immunoassay (EIA), glutamate dehydrogenase (GDH), and NAAT, with discordant results adjudicated by NAAT. At our institution, we developed a multistep algorithm leading with NAAT with reflex to EIA for toxin testing if NAAT is positive. This algorithm resulted in a significant proportion of patients with discordant results (NAAT positive and toxin EIA negative) that some experts have categorized as possible carriers or C. difficile colonized. In this study, we describe the impact of a multistep algorithm on hospital-onset, community-onset, and healthcare-facility–associated C. difficile infection (HO-CDI, CO-CDI, and HFA-CDI, respectively) rates and the management of possible carriers. Methods: The study setting was a 399-bed, tertiary-care VA Medical Center in Richmond, Virginia. A retrospective chart review was conducted. The multistep C. difficile testing algorithm was implemented June 4, 2019 (Fig. 1). C. difficile testing results and possible carriers were reviewed for the 5 months before and 4 months after implementation (January 2019 to September 2019). Results: In total, 587 NAATs were performed in the inpatient and outpatient setting (mean, 58.7 per month). Overall, 123 NAATs (21%) were positive: 59 in the preintervention period and 63 in the postintervention period. In the postintervention period, 23 positive NAATs (26%) had a positive toxin EIA. Based on LabID events, the mean rate of HO+CO+HCFA CDI cases per 10,000 bed days of care (BDOC) decreased significantly from 9.49 in the preintervention period to 1.15 in the postintervention period (P = .019) (Fig. 2). Also, 9 of the possible carriers (22%) were treated for CDI based on high clinical suspicion, and 6 of the possible carriers (14%) had a previous history of CDI. Of these, 5 (83%) were treated for CDI. In addition, 1 patient (2%) converted from possible carrier to positive toxin EIA within 14 days. The infectious diseases team was consulted for 11 possible carriers (27%). Conclusions: Implementation of a 2-step C difficile algorithm leading with NAAT was associated with a lower rate of HO+CO+HCFA CDI per 10,000 BDOC. A considerable proportion (22%) of possible carriers were treated for CDI but did not count as LabID events. Only 2% of the possible carriers in our study converted to a positive toxin EIA.Funding: NoneDisclosures: None

scholarly journals Role of Interleukin 5 Inhibition in the Treatment of Eosinophilic Otitis Media

OTO Open ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 2473974X2199144
Author(s):  
Nathaniel K. Breslin ◽  
N. Hadley Heindel ◽  
Rex S. Haberman
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Disease Status ◽  
University Of Florida ◽  
Interleukin 5 ◽  
Multicenter Clinical Trials ◽  
The Impact

Objective Eosinophilic otitis media (EOM) is a rare form of middle ear disease characterized by a viscous effusion rich in eosinophils, a resistance to conventional treatments, and an association with bronchial asthma. The relationship between asthma and EOM suggests similarities in pathogenesis and treatment possibilities. Recent biologic therapies, specifically those that target interleukin 5 (IL-5), have demonstrated efficacy in controlling eosinophil-driven asthma, yet their impact on the treatment of pathologically similar diseases remains unmeasured. This study identifies patients who have EOM, reviews their otologic clinical course, and investigates the impact of anti-IL-5 drugs on chronic ear disease. Study Design Retrospective chart review. Setting University of Florida Health, an academic medical center. Methods A review of 120 patients treated with benralizumab or mepolizumab was performed. Imaging evidence of otomastoiditis was used to identify 9 patients with possible EOM. Two patients were treated with benralizumab, and the remaining 7 received mepolizumab injections. Results After starting treatment, 5 patients had complete resolution of middle ear effusions (3 with mepolizumab and 2 with benralizumab); 1 had stable middle ear effusion; and 1 patient’s disease status could not be determined due to a lack of follow-up. The remaining 2 patients did not have effusions at the time when anti-IL-5 therapy was initiated, and they have not relapsed since starting treatment. Conclusion EOM is a rare disease that otolaryngologists should include in their differential diagnosis, especially in refractory cases. Anti-IL-5 agents show efficacy in treating EOM, and prospective multicenter clinical trials are needed to further characterize the effect of anti-IL-5 therapies.

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