{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:04:15Z","timestamp":1764785055952,"version":"3.40.5"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T00:00:00Z","timestamp":1675987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2023,4]]},"abstract":"Abstract<\/jats:title>Introduction\/Aims<\/jats:title>High\u2010risk medication exposure is a modifiable risk factor for myasthenic exacerbation and crisis. We evaluated whether real\u2010time electronic clinical decision support (CDS) was effective in reducing the rate of prescribing potentially high\u2010risk medications to avoid or use with caution in patients with myasthenia gravis.<\/jats:p><\/jats:sec>Methods<\/jats:title>An expert panel reviewed the available drug\u2010disease pairings and associated severity levels to activate the alerts for CDS. All unique alerts activated in both inpatient and outpatient contexts were analyzed over a two\u2010year period. Clinical context, alert severity, medication class, and alert action were collected. The primary outcome was alert override rate. Secondary outcomes included the percentage of unique medication exposures avoided and predictors of alert override.<\/jats:p><\/jats:sec>Results<\/jats:title>During the analysis period, 2817 unique alerts fired, representing 830 distinct patient\u2010medication exposures for 577 unique patients. The overall alert override rate was 85% (80.3% for inpatient alerts and 95.8% for outpatient alerts). Of unique medication\u2010patient exposures, 19% were avoided because of the alert. Assigned alert severity of \u201ccontraindicated\u201d were less likely to be overridden (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.32\u20130.56), as well as alerts activated during evening staffing (OR 0.69, 95% CI 0.55\u20130.87).<\/jats:p><\/jats:sec>Discussion<\/jats:title>Implementation of a myasthenia gravis drug\u2010disease interaction alert reduced overall patient exposure to potentially harmful medications by approximately 19%. Future optimization includes enhanced provider and pharmacist education. Further refinement of alert logic criteria to optimize medication risk reduction and reduce alert fatigue is warranted to support clinicians in prescribing and reduce electronic health record time burden.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mus.27790","type":"journal-article","created":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T04:55:29Z","timestamp":1674536129000},"page":"284-290","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Implementation of a myasthenia gravis drug\u2010disease<\/scp> interaction clinical decision support tool reduces prescribing of h<\/b>igh\u2010risk<\/scp> medications"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7696-1540","authenticated-orcid":false,"given":"Megan E.","family":"Barra","sequence":"first","affiliation":[{"name":"Department of Pharmacy Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Webb","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russel J.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marjorie","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Neurology Newton Wellesley Hospital Newton Lower Falls Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Hallisey","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Szumita","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0843-2935","authenticated-orcid":false,"given":"Amanda C.","family":"Guidon","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,10]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10071537"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.14503\/THIJ\u201014\u20104584"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410170222"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/0028\u20103886.53270"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.26689"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1197\/jamia.M2170"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000011124"},{"volume-title":"Drugs to Avoid or Use with Caution in MG","year":"2019","author":"Myasthenia Gravis Foundation of America","key":"e_1_2_11_9_1"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocz020"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12911\u2010017\u20100430\u20108"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2020.00707"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096\u2010021\u201001308\u20100"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl\u20102011\u2010000185"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.JAA.0000465221.04234.ca"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_578_19"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phr.2004.04.005"}],"container-title":["Muscle & Nerve"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.27790","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mus.27790","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.27790","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T03:07:13Z","timestamp":1692673633000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/mus.27790"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,10]]},"references-count":16,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1002\/mus.27790"],"URL":"https:\/\/doi.org\/10.1002\/mus.27790","archive":["Portico"],"relation":{},"ISSN":["0148-639X","1097-4598"],"issn-type":[{"type":"print","value":"0148-639X"},{"type":"electronic","value":"1097-4598"}],"subject":[],"published":{"date-parts":[[2023,2,10]]},"assertion":[{"value":"2022-06-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}