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Janusmed Renal Function is a clinical decision support system (CDSS) that provides evidence-based dosage recommendations for adult patients with renal impairment. Dosage recommendations are presented for each drug/active substance in relation to four stages of chronic kidney disease (CKD). In addition, substances that are nephrotoxic are labelled with a warning. The web version is available with free access for all caregivers in Sweden, and there is also a version available for integration in electronic health record (EHR) systems. A questionnaire distributed among users who already use a health record integrated version of the CDSS showed that physicians have good support from the system and perceive it as useful.

Two studies have examined safety regarding drug treatment of pediatric inpatients (including both children in pediatric clinics and in adult clinics) within the Sahlgrenska University Hospital, Gothenburg. 20% of pediatric inpatients are treated outside of pediatric clinics. The highest risks are seen during prescription followed by administration and preparation of drugs (greatest risk: wrong dose). The staff perceives risks related to drug prescription, the IT system for medication management and the work environment. Improved support systems for drug prescription and administration, coordination of procedures and development of IT systems adapted to the specific needs associated with drug treatment of children as well as improved working environment is needed.

In a recent Swedish register study, a limited number of specific drugs explained a large part of clinically relevant, potential drug-drug interactions (DDI), as defined and detected by the DDI database SFINX. Regarding interactions that should be avoided according to the definition in the database (class D), 15 drug combinations accounted for as much as 80 % of the prevalence in the Swedish population. Ten specific drugs were involved in 94 % of all detected class D interactions. About half of the clinically relevant interactions detected during the four-month study period were associated with an increased risk of adverse drug reactions, whereas the other half has a potential to cause therapeutic failure. An increased awareness among prescribers of these interacting drugs could contribute to safer and more effective drug use.

New drugs and new discoveries--such as those concerning the use of individual genetic profiles to help customize dosages--have refined drug treatment. Drug companies' marketing efforts as well as patients' views and wishes influence physicians in their choice of treatment. Drug-drug interactions continue to be a common cause of admissions to hospitals. Instantaneous access to a patient's complete drug list and to reliable medical information in a computer-based drug-prescribing system will help ensure patient safety. It will also contribute to evidence-based choice of pharmacological principle, drug, method of administration and dosage and to better agreement between patient and doctor.

Prescribers today encounter increasing demands for up-to-date knowledge of medical advances and drug therapies, and for a straightforward dialogue with patients. Cost-effective drug treatment calls for fast and intuitive access to information about drugs, treatment strategies and patient data. There are several computer-based drug-prescribing systems in Sweden. Information independent of the drug industry is wanting, as are uniform national standards for medical content and functionality. Decision-support systems must facilitate decisions about therapy, drug distribution and intake, as well as quality work, i.e. support the entire process which defines an effective drug therapy. A very important feature is access to a patient's drug list showing all current drugs. This joint initiative by county councils aims at drawing up a national Swedish specification of requirements for a suitable decision-support system and at creating a national entity responsible for distributing unbiased information from a unique database to a range of computerized medical records systems.

Everyday clinical work raises many questions regarding diagnosis, prognosis and treatment. Traditional sources such as text books do not give all the answers, especially not in situations when decisions are needed without further delay. By learning the fundamentals of evidence-based medicine we may stand a better chance of founding our decisions on the best available evidence in order to provide better patient care. A focused question need to be posed, followed by a cost-effective literature search. This clinical question comprises of four parts: Who is the patient? Which is the intervention? What is the comparison? What outcome is relevant to the patient and what are the adverse effects?