Computerised Protocol-Driven Prescribing

An electronic prescription processing option for electronic medical records can assist medical practitioners in the rapid selection, decision-making, processing and recording of individual prescriptions during encounters with patients in the consultation room or for repeat prescriptions. The applied thesaurus of prescriptions - the prescription formulary - is based on voluntary acceptance of local or regional selections of a limited range of prescriptions. They reflect the choices for the practitioners associated with encounters that are coded according to internationally accepted classifications. After the decision, the prescriptions are automatically checked on relevant interactions and accepted incompatibilities prior to authorisation and further transmission to the dispensing pharmacy. Supportive information, warnings and instructions are concomitantly and instantly available. The local digital prescription formularies that will likely differ regionally or nationally in the details of certain choices are synthesised from professional experiences, available objective and subjective information and documented evidence, and from consensus among collaborating practitioners. The process of achieving consensus in peer groups or professional forums may become supported by multiattribute matrix selection methods. The prescription processing program attempts to pursue an optimum selection of 3 or, when necessary, more prescriptions that generally meet the selection criteria for effective, safe and efficient treatment of the presented reason for the encounter at accepted costs. The first experiences appear to meet these objectives.Pharmacoeconomics, Prescribing, Medical-information, Electronic-information-services

Highly pathogenic avian influenza causes mass mortality in Sandwich Tern Thalasseus sandvicensis breeding colonies across north-western Europe

In 2022, highly pathogenic avian influenza (HPAI) A(H5N1) virus clade 2.3.4.4b became enzootic and caused mass mortality in Sandwich TernThalasseus sandvicensis and other seabird species across north-western Europe. We present data on the characteristics of the spread of the virus between and within breeding colonies and the number of dead adult Sandwich Terns recorded at breeding sites throughout north-western Europe. Within two months of the first reported mortalities, 20,531 adult Sandwich Terns were found dead, which is >17% of the total north-western European breeding population. This is probably an under-representation of total mortality, as many carcasses are likely to have gone unnoticed and unreported. Within affected colonies, almost all chicks died. After the peak of the outbreak, in a colony established by late breeders, 25.7% of tested adults showed immunity to HPAI subtype H5. Removal of carcasses was associated with lower levels of mortality at affected colonies. More research on the sources and modes of transmission, incubation times, effective containment, and immunity is urgently needed to combat this major threat for colonial seabirds