Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience

Objective There have been growing concerns about the impact of drug allergy alerts on patient safety and provider alert fatigue. The authors aimed to explore the common drug allergy alerts over the last 10 years and the reasons why providers tend to override these alerts. Design: Retrospective observational cross-sectional study (2004–2013). Materials and Methods Drug allergy alert data (n = 611,192) were collected from two large academic hospitals in Boston, MA (USA). Results Overall, the authors found an increase in the rate of drug allergy alert overrides, from 83.3% in 2004 to 87.6% in 2013 (P < .001). Alarmingly, alerts for immune mediated and life threatening reactions with definite allergen and prescribed medication matches were overridden 72.8% and 74.1% of the time, respectively. However, providers were less likely to override these alerts compared to possible (cross-sensitivity) or probable (allergen group) matches (P < .001). The most common drug allergy alerts were triggered by allergies to narcotics (48%) and other analgesics (6%), antibiotics (10%), and statins (2%). Only slightly more than one-third of the reactions (34.2%) were potentially immune mediated. Finally, more than half of the overrides reasons pointed to irrelevant alerts (i.e., patient has tolerated the medication before, 50.9%) and providers were significantly more likely to override repeated alerts (89.7%) rather than first time alerts (77.4%, P < .001). Discussion and Conclusions These findings underline the urgent need for more efforts to provide more accurate and relevant drug allergy alerts to help reduce alert override rates and improve alert fatigue

The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting

Background Experts suggest that formulary alerts at the time of medication order entry are the most effective form of clinical decision support to automate formulary management. Objective Our objectives were to quantify the frequency of inappropriate nonformulary medication (NFM) alert overrides in the inpatient setting and provide insight on how the design of formulary alerts could be improved. Methods Alert overrides of the top 11 (n = 206) most-utilized and highest-costing NFMs, from January 1 to December 31, 2012, were randomly selected for appropriateness evaluation. Using an empirically developed appropriateness algorithm, appropriateness of NFM alert overrides was assessed by 2 pharmacists via chart review. Appropriateness agreement of overrides was assessed with a Cohen’s kappa. We also assessed which types of NFMs were most likely to be inappropriately overridden, the override reasons that were disproportionately provided in the inappropriate overrides, and the specific reasons the overrides were considered inappropriate. Results Approximately 17.2% (n = 35.4/206) of NFM alerts were inappropriately overridden. Non-oral NFM alerts were more likely to be inappropriately overridden compared to orals. Alerts overridden with “blank” reasons were more likely to be inappropriate. The failure to first try a formulary alternative was the most common reason for alerts being overridden inappropriately. Conclusion Approximately 1 in 5 NFM alert overrides are overridden inappropriately. Future research should evaluate the impact of mandating a valid override reason and adding a list of formulary alternatives to each NFM alert; we speculate these NFM alert features may decrease the frequency of inappropriate overrides

Effect of event selection on jetlike correlation measurement in d+Au collisions at sNN=200 GeV

AbstractDihadron correlations are analyzed in sNN=200 GeV d+Au collisions classified by forward charged particle multiplicity and zero-degree neutral energy in the Au-beam direction. It is found that the jetlike correlated yield increases with the event multiplicity. After taking into account this dependence, the non-jet contribution on the away side is minimal, leaving little room for a back-to-back ridge in these collisions

Beam-energy Dependence Of Charge Balance Functions From Au + Au Collisions At Energies Available At The Bnl Relativistic Heavy Ion Collider

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Balance functions have been measured in terms of relative pseudorapidity (Δη) for charged particle pairs at the BNL Relativistic Heavy Ion Collider from Au + Au collisions at sNN=7.7GeV to 200 GeV using the STAR detector. These results are compared with balance functions measured at the CERN Large Hadron Collider from Pb + Pb collisions at sNN=2.76TeV by the ALICE Collaboration. The width of the balance function decreases as the collisions become more central and as the beam energy is increased. In contrast, the widths of the balance functions calculated using shuffled events show little dependence on centrality or beam energy and are larger than the observed widths. Balance function widths calculated using events generated by UrQMD are wider than the measured widths in central collisions and show little centrality dependence. The measured widths of the balance functions in central collisions are consistent with the delayed hadronization of a deconfined quark gluon plasma (QGP). The narrowing of the balance function in central collisions at sNN=7.7 GeV implies that a QGP is still being created at this relatively low energy. © 2016 American Physical Society.942CNPq, Conselho Nacional de Desenvolvimento Científico e TecnológicoMinistry of Education and Science of the Russian FederationMOE, Ministry of Education of the People's Republic of ChinaMOST, Ministry of Science and Technology of the People's Republic of ChinaNRF-2012004024, National Research FoundationNSF, National Stroke FoundationConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

ϒ production in p–Pb collisions at √sNN=8.16 TeV

ϒ production in p–Pb interactions is studied at the centre-of-mass energy per nucleon–nucleon collision √sNN = 8.16 TeV with the ALICE detector at the CERN LHC. The measurement is performed reconstructing bottomonium resonances via their dimuon decay channel, in the centre-of-mass rapidity intervals 2.03 < ycms < 3.53 and −4.46 < ycms < −2.96, down to zero transverse momentum. In this work, results on the ϒ(1S) production cross section as a function of rapidity and transverse momentum are presented. The corresponding nuclear modification factor shows a suppression of the ϒ(1S) yields with respect to pp collisions, both at forward and backward rapidity. This suppression is stronger in the low transverse momentum region and shows no significant dependence on the centrality of the interactions. Furthermore, the ϒ(2S) nuclear modification factor is evaluated, suggesting a suppression similar to that of the ϒ(1S). A first measurement of the ϒ(3S) has also been performed. Finally, results are compared with previous ALICE measurements in p–Pb collisions at √sNN = 5.02 TeV and with theoretical calculations.publishedVersio

(Anti-)deuteron production in pp collisions at 1as=13TeV

The study of (anti-)deuteron production in pp collisions has proven to be a powerful tool to investigate the formation mechanism of loosely bound states in high-energy hadronic collisions. In this paper the production of (anti-)deuterons is studied as a function of the charged particle multiplicity in inelastic pp collisions at s=13 TeV using the ALICE experiment. Thanks to the large number of accumulated minimum bias events, it has been possible to measure (anti-)deuteron production in pp collisions up to the same charged particle multiplicity (d Nch/ d \u3b7 3c 26) as measured in p\u2013Pb collisions at similar centre-of-mass energies. Within the uncertainties, the deuteron yield in pp collisions resembles the one in p\u2013Pb interactions, suggesting a common formation mechanism behind the production of light nuclei in hadronic interactions. In this context the measurements are compared with the expectations of coalescence and statistical hadronisation models (SHM)

Multiplicity dependence of inclusive J/psi production at midrapidity in pp collisions at root s=13 TeV

Measurements of the inclusive J/psi yield as a function of charged-particle pseudorapidity density dN(ch)/d eta in pp collisions at root s = 13 TeV with ALICE at the LHC are reported. The J/psi meson yield is measured at midrapidity (vertical bar y vertical bar <0.9) in the dielectron channel, for events selected based on the charged-particle multiplicity at midrapidity (vertical bar eta vertical bar <1) and at forward rapidity (-3.7 <eta <-1.7 and 2.8 <eta <5.1); both observables are normalized to their corresponding averages in minimum bias events. The increase of the normalized J/psi yield with normalized dN(ch)/d eta is significantly stronger than linear and dependent on the transverse momentum. The data are compared to theoretical predictions, which describe the observed trends well, albeit not always quantitatively. (C) 2020 European Organization for Nuclear Research. Published by Elsevier B.V.Peer reviewe

Dielectron Azimuthal Anisotropy At Mid-rapidity In Au+au Collisions At Snn =200 Gev

We report on the first measurement of the azimuthal anisotropy (v2) of dielectrons (e+e- pairs) at mid-rapidity from sNN=200 GeV Au+Au collisions with the STAR detector at the Relativistic Heavy Ion Collider (RHIC), presented as a function of transverse momentum (pT) for different invariant-mass regions. In the mass region Mee<1.1 GeV/c2 the dielectron v2 measurements are found to be consistent with expectations from π0,η,ω, and φ decay contributions. In the mass region 1.1<Mee<2.9GeV/c2, the measured dielectron v2 is consistent, within experimental uncertainties, with that from the cc¯ contributions.906Adams, J., (2005) Nucl. Phys. A, 757, p. 102. , NUPABL 0375-9474Arsene, I., (2005) Nucl. Phys. A, 757, p. 1. , NUPABL 0375-9474Adcox, K., (2005) Nucl. Phys. A, 757, p. 184. , NUPABL 0375-9474Back, B.B., (2005) Nucl. Phys. A, 757, p. 28. , NUPABL 0375-9474Rapp, R., Wambach, J., (2002) Adv. Nucl. Phys., 25, p. 1. , 0065-2970David, G., Rapp, R., Xu, Z., (2008) Phys. 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J/ψ Production At Low Pt In Au+au And Cu+cu Collisions At Snn =200 Gev With The Star Detector

The J/ψ pT spectrum and nuclear modification factor (RAA) are reported for pT<5GeV/c and |y|<1 from 0% to 60% central Au+Au and Cu+Cu collisions at sNN=200GeV at STAR. A significant suppression of pT-integrated J/ψ production is observed in central Au+Au events. The Cu+Cu data are consistent with no suppression, although the precision is limited by the available statistics. RAA in Au+Au collisions exhibits a strong suppression at low transverse momentum and gradually increases with pT. The data are compared to high-pT STAR results and previously published BNL Relativistic Heavy Ion Collider results. 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