Electronic Prescribing by Medical Students: Descriptive Data and Inferred Clinical Impact.

We analysed data from the electronic medication chart at tertiary healthcare facilities during Nov 2020-Nov 2023 following a reconfiguration of prescribing permissions allowing medical student inpatient prescribing. A total of 262 students prescribed for 2205 patients. The 17,769 prescriptions were spread throughout the 7-day week and were mainly created in the evening (1600-2100) and within 4 hours of patient entry into hospital. The supervising doctors approved 11,434 (64%) prescriptions, which are inferred to have saved 203 hours of doctor time. Allowing medical students to prescribe facilitates clinical workflow. The impact on student education and prescribing errors requires further work.

Compulsory Indications in Hospital Prescribing Software Tested with Antibacterial Prescriptions.

The aim was to assess how making the indication field compulsory in our electronic prescribing system influenced free text documentation and to visualise prescriber behaviour. The indication field was made compulsory for seven antibacterial medicines. Text recorded in the indication field was manually classified as 'indication present', 'other text', 'rubbish text', or 'blank'. The proportion of prescriptions with an indication was compared for four weeks before and after the intervention. Indication provision increased from 10.6% to 72.4% (p<0.01) post-intervention. 'Other text' increased from 7.6% to 25.1% (p<0.01), and 'rubbish text' from 0.0% to 0.6% (p<0.01). Introducing the compulsory indication field increased indication documentation substantially with only a small increase in 'rubbish text'. An interactive report was developed using a live data extract to illustrate indication provision for all medicines prescribed at our tertiary hospital. The interactive report was validated and locally published to support audit and quality improvement projects.

Evaluation of pleural fluid cytology for the diagnosis of malignant pleural effusion: a retrospective cohort study.

BACKGROUND: Cytological examination of pleural fluid has good specificity, but imperfect sensitivity for the diagnosis of malignant pleural effusion (MPE). Published estimates of sensitivity vary and predictors of false negative cytology are not well established. AIMS: To estimate pleural fluid cytology sensitivity and identify risk factors for false negative cytology. METHODS: We conducted a retrospective cohort study of patients who had cytology testing of pleural fluid at Christchurch Hospital, New Zealand, from July 2017 to October 2019. Data on clinical and pleural fluid characteristics were collected. MPE was defined by positive pleural fluid cytology, tissue histology or multidisciplinary meeting consensus. We estimated sensitivity of the first pleural cytology assessment. We performed multivariate logistic regression to ascertain patient groups at greatest risk of false negative results. RESULTS: Initial pleural fluid cytology was diagnostic in 117 of 156 patients, providing a sensitivity (95% confidence interval (CI)) of 75.0% (67.4-81.6%). The sensitivity was 79.0% (66.8-88.3%) for lung cancer, 91.3% (72.0-98.9%) for breast cancer and 33.3% (95% CI 11.8-61.6%) for mesothelioma. Cloudy appearance of pleural fluid (odds ratio (OR) 0.12; 95% CI 0.03-0.54) and yellow/gold pleural fluid (OR 0.24; 95% CI 0.06-0.96) reduced the odds of false negative pleural cytology. Pleural thickening on computed tomography scan (OR 3.3; 95% CI 1.2-9.4) was a risk factor for false negative cytology. CONCLUSION: Sensitivity of pleural fluid cytology was greatest in primary lung and breast cancer, and lowest in mesothelioma. Clinicians should be alert to false negative results when suspecting mesothelioma or if pleural thickening is present.