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Drug allergy in lung disease
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Amitava Ganguli, Munir Pirmohamed
A drug allergy is an immunologically mediated reaction that exhibits specificity and recurrence on re-exposure to the offending drug.4 In most cases the diagnosis of drug allergy is clinically based since we do not have readily available sensitive and specific laboratory tests that can pinpoint whether the immune system (or what part of it) is involved.5 Furthermore, the clinical diagnosis that a drug is responsible may be difficult because there may be different clinical manifestations with the same drug in different patients, or many different drugs can cause the same manifestation. These manifestations can mimic disease that is not drug-induced, which clearly needs to be excluded through specific investigations. The problem of making a clinical diagnosis becomes particularly difficult when patients are on multiple drugs, which is becoming common-place.6 Some simple rules need to be followed and these are covered later in the chapter. However, this also emphasizes that there is a need to understand the mechanisms of these allergic reactions so that laboratory tests to ascribe causality more precisely to individual therapeutic agents can be developed.
Increasing Recognition of Wrong-Patient Errors through Improved Interface Design of a Computerized Provider Order Entry System
Published in International Journal of Human–Computer Interaction, 2018
Meirav Taieb-Maimon, Catherine Plaisant, A. Zachary Hettinger, Ben Shneiderman
In determining the interface manipulation that should be used in CPOE systems to minimize wrong-patient errors, the pros and cons of each method should be considered. Highlighted selection focuses attention on patient identifiers and does not require physical interaction, but if the user is distracted at that precise moment it can be missed. By comparison, a mandatory single-click confirmation of patient identity in a verification screen with a forced delay requires pointing and clicking, which is time consuming, and was criticized as being intrusive and frustrating for physicians (Wears 2015). However, it ensures that the verification screen is not missed due to distractions or interruptions. Nevertheless, it is well documented (Shah et al., 2006; Van Der Sijs, Aarts, Vulto, & Berg, 2006; Weissman et al., 2009) that providers override between 49% and 96% of the alerts presented to them in the course of entering orders in the EMR and that alarm fatigue in general is a significant concern. In one study, physicians overrode 91.2% of drug allergy and 89.4% of high-severity drug interaction alerts; physician reviewers judged that 36.5% of the alerts were inappropriate (Weingart et al., 2003). Another recent study concluded that more awareness regarding the risks to patient safety from having too many alerts is required, for designers of clinical decision support tools and electronic safeguards for drug order entry (Carspecken, Sharek, Longhurst, & Pageler, 2013). A literature review found little evidence from experimental studies about the most important design factors of computerized alerts and prompts for prescribing. The authors found no empirical studies that evaluated the effectiveness of different approaches to the design and display of alerts and prompts (Schedlbauer et al., 2009).