Reviewing an #archetype

I’ve been meaning to write this for a while, but you know how things go.

While at HIMSS12 in Las Vegas last month I was asked to do a little review work. That’s not all that uncommon. People ask me to do things on occasion; review a blog post, review an app, give my opinion on something and so on. But this was completely different as Dr. Heather Leslie (@omowizzrd), Director of Clinical Modeling for Ocean Informatics and Editor for the openEHR Clinical Knowledge Manager asked me to review an archetype. A what? Yeah, that was my response when Heather and I first spoke about the topic nearly two years ago.

According to good ol’ Merriam-Webster an archetype is “the original pattern or model of which all things of the same type are representations or copies: also : a perfect example“. Simple enough, but still too vague for my brain so I went in search of a better explanation which I found at Heather’s blog – Archetypical.
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ADR death statistics for the US, 1999-2006 [article]

Here’s an interesting article from the February 2012 issue of The Annals of Pharmacotherpy [Adverse Drug Reaction Deaths Reported in United States Vital Statistics, 1999-2006].1 The most commonly involved drug classes are no big surprise, but it was interesting to note that the incidence of ADR death changed with age, race, and urbanization. I suppose the increase in death rate for ADR with increased age and rural living isn’t that big of a surprise, but the differences among sex and race was unexpected. 

ABSTRACT


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Background: Adverse drug reactions (ADRs) are an important source of morbidity and mortality during medical care.
Objective: To examine the trends in mortality related to ADRs reported through the US vital statistics system since January 1999.
Methods: Demographic characteristics of people reported as dying as a result of ADRs from 1999 to 2006 were evaluated. The National Mortality Statistics database was queried for International Classification of Diseases, Tenth Revision, codes Y40-Y59, which are specific for deaths due to adverse effects of drugs in therapeutic use. The data were subgrouped based on demographic factors to identify important trends. Crude rates were calculated based on incidents per 100,000 population. Odds ratios and 95% confidence intervals for subgroups were calculated by logistical regression.
Results: During the 8-year study period 2,313,902,748 person years were evaluated and 2341 ADR-related deaths were identified. Annual rates ranged from 0.08/100,000 to 0.12/100,000, and rates increased significantly over time at a rate of 0.0058 per year. ADR deaths were significantly more likely in persons older than 55 years. The risk was greatest in those aged 75 years or older (OR 6.96, 95% CI 6.30 to 7.69). ADR deaths were higher among men than women. Rates varied by race and ethnicity and were highest among blacks (OR 1.38, 95% CI 1.23 to 1.54). Geographically, rates varied widely between states. Based on urbanization, rates were highest in extremely rural (non-core) areas (OR 2.05, 95% CI 1.76 to 2.38). The most common drug classes associated with death were anticoagulants, opioids, and immunosuppressants.
CONCLUSIONS: ADR death rates have a clear association with age, race, and urbanization subgroups. Older individuals, males, blacks, and individuals residing in extremely rural areas experienced higher ADR death rates; these findings warrant further study to develop prevention strategies.

  1. Ann Pharmacother February 2012 vol. 46 no. 2 169-175

EMRs as a tool for patient safety.

A short jaunt over to the EMR and HIPPA weblog led me to an interesting article in Time written by Scott Haig, MD. While Dr. Haig touches on a couple of positive features of electronic medical records (EMRs), he like many physicians, focuses on the negatives. He concludes that “Doctors and patients live in a world of painful, pressing questions. The great physicians I’ve known seek answers through personal commitment to each patient and judgment born of practical experience — neither of which I have found in a machine.” I think he is missing the point of an EMR.
Continue reading EMRs as a tool for patient safety.