Professori Erik Tawaststjerna 14/1 1966

Kirje 14.1.1966

Computerized advice on drug dosage to improve prescribing practice.

BACKGROUND: Maintaining therapeutic concentrations of drugs with a narrow therapeutic window is a complex task. Several computer systems have been designed to help doctors determine optimum drug dosage. Significant improvements in health care could be achieved if computer advice improved health outcomes and could be implemented in routine practice in a cost effective fashion. This is an updated version of an earlier Cochrane systematic review, by Walton et al, published in 2001. OBJECTIVES: To assess whether computerised advice on drug dosage has beneficial effects on the process or outcome of health care. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialized register (June 1996 to December 2006), MEDLINE (1966 to December 2006), EMBASE (1980 to December 2006), hand searched the journal Therapeutic Drug Monitoring (1979 to March 2007) and the Journal of the American Medical Informatics Association (1996 to March 2007) as well as reference lists from primary articles. SELECTION CRITERIA: Randomized controlled trials, controlled trials, controlled before and after studies and interrupted time series analyses of computerized advice on drug dosage were included. The participants were health professionals responsible for patient care. The outcomes were: any objectively measured change in the behaviour of the health care provider (such as changes in the dose of drug used); any change in the health of patients resulting from computerized advice (such as adverse reactions to drugs). DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Twenty-six comparisons (23 articles) were included (as compared to fifteen comparisons in the original review) including a wide range of drugs in inpatient and outpatient settings. Interventions usually targeted doctors although some studies attempted to influence prescriptions by pharmacists and nurses. Although all studies used reliable outcome measures, their quality was generally low. Computerized advice for drug dosage gave significant benefits by:1.increasing the initial dose (standardised mean difference 1.12, 95% CI 0.33 to 1.92)2.increasing serum concentrations (standradised mean difference 1.12, 95% CI 0.43 to 1.82)3.reducing the time to therapeutic stabilisation (standardised mean difference -0.55, 95%CI -1.03 to -0.08)4.reducing the risk of toxic drug level (rate ratio 0.45, 95% CI 0.30 to 0.70)5.reducing the length of hospital stay (standardised mean difference -0.35, 95% CI -0.52 to -0.17). AUTHORS' CONCLUSIONS: This review suggests that computerized advice for drug dosage has some benefits: it increased the initial dose of drug, increased serum drug concentrations and led to a more rapid therapeutic control. It also reduced the risk of toxic drug levels and the length of time spent in the hospital. However, it had no effect on adverse reactions. In addition, there was no evidence to suggest that some decision support technical features (such as its integration into a computer physician order entry system) or aspects of organization of care (such as the setting) could optimise the effect of computerised advice.

Pääministeri Rafael Paasio 10/11 1966

Kirje

Vuorineuvos Niilo Saarivirta 22/4 1966

Kirje

Records of Myodopsylla wolffsohni wolffsohni (Rothschild, 1903) (Siphonaptera, Ischnopsyllidae) on Myotis nigricans Schinz, 1821 (Chiroptera, Vespertilionidae), from the State of Paraná, Southern Brazil

The flea, Myodopsylla wolffsohni wolffsohni (Rothschild, 1903), had been recorded for the first time in the State of Paraná in 1940, on the bat, Myotis levis (I. Geoffroy, 1824). Previously, this species of flea had only been recorded on Myotis nigricans, in the Amazonian region. This is the second record of M. w. wolffsohni on M. nigricans in Brazil, and the first in the State of Paraná. Although this flea has been found on undetermined Chiroptera in the State of Santa Catarina, the present record represents the meridional limit of geographic distribution for the infestation on M. nigricans.

Ulkoministeri Ahti Karjalainen 27/11 1966

Kirje

Nova espécie de Anatrichobius Wenzel, 1966 (Diptera, Streblidae) do Brasil meridional

New species of Anatrichobius Wenzel, 1966 (Diptera, Streblidae) from Southern Brazil. Anatrichobius passosi sp. nov. collected on the vespertilionid bat Myotis nigricans, from southern Brazil is described. Habitus, gonopod and hipoproct are illustrated and a key for the species of Anatrichobius is given.

Valtiopäivät 1979 (avajaispuhe)

Puhe

Talman Rafael Paasio 19.5.1966

Kirje

Valtiopäivät 1966 (avajaispuhe)

Puhe

New records of Simuliidae (Diptera, Nematocera) in the State of São Paulo, Brazil

Adult and immature Simuliidae were studied in 31 streams of 8 regions of the State of São Paulo. Among the 25 species collected, seven are new records for the State of São Paulo, and one of them, Simulium shewellianum Coscarón, 1985 for Brazil as well.