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1
Sisterman, Kathryn, and Kathryn Sisterman. "Improving Care for Patients Hospitalized with Heart Failure." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626616.
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Background: Heart failure is a clinical syndrome occurring from the heart’s inability to effectively fill and or pump blood, it is the most common reason for admission in elderly patients. Guideline directed medical therapy refers to implementation of all class I agents to reduce patient morbidity and mortality, unless there is an appropriate contraindication. Appropriate beta blocker (BB), angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and aldosterone antagonist (AA) are recommended to be prescribed together prior to discharge for a hospital admission for decompensated heart failure with reduced ejection fraction (HFrEF). Get With The Guidelines – Heart Failure (GWTG- HF) is an online quality improvement project that assists hospitals in providing guideline directed care.
Objective: The purpose of this study was to determine if implementation of the GWTG-HF program, increases provider adherence to guideline directed medical therapy (GDMT) for patients admitted with a primary diagnosis of decompensated HFrEF at Banner University Medical Center Tucson (BUMCT).
Design: This is a quality improvement project with a pre and post test descriptive design.
Setting: BUMCT from 10/04/17 – 11/08/17
Participants: Fifty-five patients discharged with the primary diagnosis of decompensated HFrEF
Measurements: Baseline guideline adherence for a 30-day period was compared to guideline adherence after the initiation of the GWTG-HF program.
Results: The 24 patients pre intervention were compared to 31 patients post intervention. The following results were found when comparing pre and post adherence rates: BB adherence 92% versus 100%, ACEI/ARB adherence 100% versus 94%, AA adherence 67% versus 84%, and guideline directed medical therapy 58% versus 81%. There were no statistically significant differences for the pre and post adherence rates.
Conclusion: Although, there were no statistically significant differences found to support that implementation of the GWTG-HF program, increases providers adherence to GDMT for patients admitted with a primary diagnosis of decompensated HFrEF, the trends were clear. In three out of four class I agents, there was an increase in appropriate provider prescribing per the guidelines.
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Hui, Chi-hoi, and 許志海. "Nurse-led non-invasive mechanical ventilation guideline for acute pulmonary oedema patients in acute medical wards." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B4658190X.
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English, Thomas MacAndrew. "Impact of an electronic medical record on adherence to current diabetes guidelines in a family medical center." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008p/english.pdf.
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Leung, Mei-ling, and 梁美玲. "An evidence based guideline of pre- and post operative oronasopharyngeal care for cardiac patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48335642.
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Background Nosocomial infection is a crucial problem and cause of morbidity and mortality especially in cardiac surgery settings. The risk of acquiring such infection is even higher because cardiac surgery patients require intensive care postoperatively. The phenomenon is evidenced by longer length of hospital stay and increased cost of care. Pneumonia and surgical site infections were ranked among the top three most common hospital acquired infections. The usual practice for mouth care is diluted thymol gargle solution for intubated patients after cardiac surgery in Hong Kong. No local studies examine the effect of oronasopharyngeal care on minimizing such infections. An evidence based guideline in oral and nasopharyngeal nursing care is necessary to implement in hospitals for improving patient surgical outcome.
Objective To develop an evidence based practice guideline for pre- and postoperative oronasopharyngeal care of in-patients undergoing cardiac surgery with implementation planning and discussion on evaluation.
Methods The most recent publications were searched till August 2011. Randomized controlled trials with oropharyngeal and/ or nasopharyngeal care with outcome measures on surgical site infection and/ or nosocomial pneumonia were reviewed. Essential data were extracted with quality assessed methodologically.
Results Six randomized controlled trials comparing oropharyngeal and/ or nasopharyngeal care intervention with usual care were reviewed. The studies mostly included middle-aged male patients undergoing cardiac surgery. The results showed positively of interventions on nosocomial pneumonia and surgical site infection when compared with usual care. In view of quality assessments and statistically significant findings, the proposed change that could improve surgical outcome of patients is to use chlorhexidine gluconate on oronasopharyngeal care in the guideline. It mainly carries out in in-hospital settings both by patients with education from nurses preoperatively, and by nurses postoperatively.
Conclusion Reviewed evidence shown that the oronasopharyngeal care interventions help effectively on minimizing the occurrence of nosocomial pneumonia and surgical site infections for patients undergoing heart surgery. It could be potentially adopted for nurses working in cardiac surgical ward and cardiac intensive care unit.published_or_final_version
Nursing Studies
Master
Master of Nursing
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Onion, Carl William Reginald. "Changes in medical practice following superficial and deep processing of evidence : a controlled experiment in clinical guideline implementation." Thesis, University of Liverpool, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364176.
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Chow, Yung-wai, and 周勇偉. "An evidence-based guideline for online health education program for men who have sex with men (MSM)." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48335319.
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Sex among men has been existed in all society with variety of reasons. They are often stigmatized by other people. As a result, men who have sex with men (MSM) are less willing to expose themselves even if they have health problems.
To increase the awareness of the public and establish trust relationship within health organizations and MSM, Internet is a good platform to promote health concepts and health education.
In recent 10 years, Internet becomes popular. There was an increasing trend that MSM people are using Internet to seek partners. As a result, the sexually transmitted infections (STI) among MSM people had been increasing in recent years. The global population of HIV infection among MSM increased from3.9 million in 2007 to 20.4 million in 2010. It is predicted that the number will further increase to 23.3 million in 2015 (Joint United Nations Programme on HIV and AIDS [UNAIDS], 2011).
In Hong Kong the HIV infection rate among MSM is still increasing around 42.4% of HIV infected cases were MSM (Department of Health, 2010).Therefore, a comprehensive health promotion program is needed to promote safer sex and prevent further spread of STI in Hong Kong.
Internet-based Sex Education Program is a health promotion program that was held in many countries. Those studies used webpage containing sex education materials such as STI knowledge, STI prevention methods, information about risky sexual behavior, knowledge of condom using skills, negotiation skills with partners and information of STI screening. Results showed that internet-based sex education program is successful in most countries.
Three electron bibliographical databases MEDLINE, CINAHL and Cochrane Library were used to search the relevant primary studies. After assessing the quality of the studies, six studies were found fulfilling the criteria of the program. By comparing the transferability and feasibility of the interventions of the six reviewed literatures, a new guideline was set. Stake holders were identified and through communication with the stake holders, a pilot study plan was designed and data collected from the pilot study would be used to modify the online health education program and provide a better nursing care for MSM clients.
Online health education program for MSM contributes a better platform to promote sexual health through internet. The program helps to prevent STI and HIV transmission and it is expected that the guideline of the program can be used by different health care settings such as hospitals or clinics when they are providing health education to MSM clients. A decrease of STI and HIV infection among MSM clients is expected since the program is carried out in public settings and hoping that MSM clients could gain benefit from it.published_or_final_version
Nursing Studies
Master
Master of Nursing
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Meyer, David C. "Evaluation of a Tiered Opioid Prescribing Guideline for Inpatient Colorectal Operations." eScholarship@UMMS, 2020. https://escholarship.umassmed.edu/gsbs_diss/1073.
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Background:
In light of the opioid epidemic, reducing excess prescription quantities while tailoring to patient need is key. We previously created an opioid prescribing guideline using retrospective institutional data to satisfy the majority of patients’ opioid needs following inpatient colorectal surgery.
Objective:
This study sought to prospectively validate an institutional prescribing guideline based on previously-defined opioid consumption patterns following inpatient colorectal operations.
Methods:
We carried out a cohort study comparing opioid prescribing and consumption patterns before (7/18 – 1/19) and after (9/19 – 2/20) adoption of a tiered opioid prescribing guideline for inpatient elective colorectal operations (colectomies, proctectomies, and ostomy reversals) at a single tertiary care medical center. Opioid use was quantified as Equianalgesic 5mg Oxycodone Pills (EOP), and patients were grouped in three tiers based on opioid consumption in the 24-hours prior to discharge: Tier 1 (0 EOP), Tier 2 (0.1-3 EOP), and Tier 3 (>3 EOP). Our guideline recommended maximum prescriptions of 0 EOP for Tier 1, 12 EOP for Tier 2, and 30 EOP for Tier 3.
Results:
The study included 100 patients before and 101 after guideline adoption. Demographic and operative variables were similar before and after guideline adoption. Guideline adherence was 85%. Overall, there was a 41% reduction in mean prescription quantity and 53% reduction in excess pills per prescription with no change in opioid consumption or refill rates.
Conclusion:
Adoption of a tiered opioid prescribing guideline significantly reduced opioid prescription quantity with no change in consumption or refill rates. Standardization of discharge prescriptions based on patient consumption in the 24 hours prior to discharge may be an important step towards minimizing excess prescribing.
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Flippies, Emirenthia Emogin Elouise, and D. J. L. Venter. "The relationship between organisational contextual factors and clinical practice guideline implementation in private critical care units." Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/12583.
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Clinical practice guidelines are one way of ensuring that healthcare is based on the evidence-based practices. In a dynamic unit, like the critical care unit, where sound decision-making and critical thinking are required in the care of critically ill patients, the implementation of such guidelines for care is of utmost importance. Guideline implementation is however not so simplistic, and various studies have proven that there are various barriers linked to guideline implementation. However, most the barriers have proven to be related to individual factors. Therefore, a greater focus has been placed on organisational contextual factors that might have an influence on clinical practice guideline implementation. The research study followed a positivistic, quantitative paradigm, where the hypothesised relationship between the organisational contextual factors and clinical practice guideline implementation were investigated. A structured pre-existing questionnaire, namely the Alberta Context Tool, was used to collect data from 65 registered nurses in private critical care units. Descriptive and inferential statistics were used to analyse the data. The findings revealed that although the organisational contextual factors were prevalent in the private critical care units sampled, some factors like leadership and culture scored higher than the other factors. Positive relations were reported between the organisational contextual factors and clinical practice guideline implementation. The results imply that the alternative hypothesis H1 is supported, and thus proved that there are significant relationships between organisational contextual factors and clinical practice guideline implementation in private critical care units in the East London area.Recommendations were made on how to enhance organisational contextual factors in the implementation of clinical practice guidelines. Ethical principles were maintained throughout the study.
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Carlisle, Heather Lynn. "Implementing a Clinical Practice Guideline on the Use of Capnography in Monitoring for Opioid-Induced Respiratory Depression on Medical-Surgical Units." Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/293641.
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Background: Opioid-induced respiratory depression (OIRD) is a life-threatening complication of opioid analgesia. Failure to recognize and respond to OIRD may result in respiratory arrest, anoxic brain injury, and death. Measuring end-tidal carbon dioxide through the use of capnography has been shown to detect early signs of OIRD. Early detection of OIRD facilitates the timely rescue of patients on medical-surgical units where critical patient events are less likely to be witnessed. Purpose: The goal of this quality improvement project was to enhance patient safety by decreasing the incidence of OIRD. The aim was to design, implement, and evaluate a multifaceted intervention to improve patient monitoring for OIRD on medical-surgical units through the use of capnography. The intervention included an updated nursing protocol, an electronic order trigger, improved access to capnography monitors, and education to nurses about OIRD and the use of capnography. Methods: The project was conducted over twelve months on ten medical-surgical units at a 489-bed academic medical center in Southern Arizona. Outcomes were measured using pre- and post-intervention point prevalence surveys. Indicators included the number of patients being monitored with capnography and the number of cases of OIRD. A survey of medical-surgical RNs was also conducted to gather their perceptions on the ease of use and effectiveness of capnography. Results: Twelve months after introducing the intervention, there was a statistically significant increase in monitoring frequency, with 2.56 times more patients at high risk for OIRD being monitored with capnography than at baseline (p = .006). Of the 167 RNs surveyed during this project, 99% perceived the portable capnography monitors as easy to use and interpret. However, 71% reported systems issues in obtaining the monitoring equipment, and 65% reported problems with patient adherence. Preliminary data suggest that the incidence of OIRD decreased after one year, although not by a statistically significant amount (p = .876). Implications for Practice: The intervention succeeded in increasing the number of high-risk patients being monitored with capnography, though the increased monitoring did not improve patient outcomes. The RN survey highlighted areas in need of further improvement, such as the supply of monitors and patient education.
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Grauer, Dennis W. "Pharmaceutical guideline compliance and its impact on costs and effectiveness : case studies of orders based on Vancomycin use and intravenous to oral switch antimicrobial guidelines at The Ohio State University Medical Center /." The Ohio State University, 2000. http://rave.ohiolink.edu/etdc/view?acc_num=osu1488203552777345.
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Razavi, Amir Reza. "Applications of Knowledge Discovery in Quality Registries - Predicting Recurrence of Breast Cancer and Analyzing Non-compliance with a Clinical Guideline." Doctoral thesis, Linköping : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-10142.
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Dahlgren, Hedda. "Adherence to guidelines after sexual assaultat Örebro University Hospital and Karlskoga Hospital." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-61584.
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Lundberg, Jessica, and Fia Karppinen. "Prehospital undersökning och behandling av patienter med central bröstsmärta." Thesis, Umeå universitet, Institutionen för omvårdnad, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-181622.
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Abtract Background Myocardial infarction is a critical and potentially deadly condition which requires immediate treatment in hospital. Ambulance personnel shall follow prehospital guidelines of care when examinating and treating patients with chest pain and the ambulance is equipped with ECG-monitoring for early identification of infarction in order for rapidly transport to hospital. Previous studies indicate deficiency in compliance to prehospital guidelines and patients with chest pain don´t always receive an ECG in prehospital care. A report from region Västerbotten have shown that 66,3% of patients with chest pain receive ECG in ambulance care. Aim To examine compliance to prehospital guidelines in care of patients with chest pain. Methods A retrospective medical record review (N=204). Inclusion criteria The journals that was reviewed are patients who in 2019 were cared by ambulance staff and taken to hospital as priority one with chest pain. Result The mean age of patients in this study was 70,3 year (SD+/-14,1) and the majority where men (59,3%). Most of the patients presenting with prior heart or vascular disease (67,2%). A total of 42,4% experienced secondary features such as nausea, sweating or dizziness and in 32,4% of the journals these symptoms where not documented. In ambulance 80,9% did receive ECG and 35,8% got ASA, with no significant differences between gender and time of day. Most of the patients (73,5%) required pain relief one or several times during ambulance transport and 21,6% of the patients experienced pain but didn't receive treatment. Conclusion This study indicates that not all patients with chest pain get treated by the prehospital guidelines. Not every patient received an ECG and few patients received ASA. Lack of documentation regarding patients exhibited symptoms and reasons for not treating pain were found in the journals. In summary these deficiencies can negatively affect patient safety, cause medical hazards and increase health care costs.Keywords: Prehospital care, prehospital guideline of care, chest pain, myocardial infarction, ECG
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Pettersson, Billie. "Lipid‐modifying and glucose-lowering therapies in clinical practice : The impact of guidelines and changing reimbursement schemes." Doctoral thesis, Linköpings universitet, Utvärdering och hälsoekonomi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-75545.
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cardiovascular disease, which is still a major cause of death that creates large burdens to society in terms of costs and morbidity. Dyslipidemia and type 2 diabetes mellitus are the main risk factors for cardiovascular disease, and national and international guidelines recommend lipid-modifying and glucose-lowering treatments for prevention. In 2010, about 836,000 (9% of the population) and 372,000 patients respectively were treated with these therapies in Sweden. Various pharmaceutical policies aimed at improving the efficiency of drug use have been introduced over the years. Health technology assessment (HTA) was introduced in Sweden in 2002 as a foundation for informing pricing and reimbursement decisions by the Dental and Pharmaceutical Benefits Agency (TLV). Following HTA reviews, new reimbursement schemes for lipid-modifying and glucose-lowering therapies were introduced in 2009 and 2010 respectively. To assess the impact of the changing reimbursement schemes on the use and costs of these therapies, we analyzed data from the Swedish drug registry, using a quasi-experimental design and interrupted time series analyses. Our results showed that the new reimbursement scheme for lipid-modifying treatment had a major effect on use; following the implementation of this scheme, there was a substantial increase in both discontinuation and switching to higher doses. Conversely, the new reimbursement scheme for glucose-lowering therapies had overall only a minor effect on use. Larger savings in the lipid market were anticipated but not fully realized, while even the minor anticipated changes in costs in the glucose-lowering market were not realized due to increased costs for insulins. We found that changes in reimbursement schemes might lead to unintended effects, which should be considered before implementation. Softer demand-side policies, such as recommendations and guidelines, might be a better option under some circumstances. Clinical and national guidelines are other policies aimed at improving quality of care and drug use. We assessed the impact of guidelines on the quality of lipid-modifying therapies, defined as proportions of patients attaining goal/normal levels according to guidelines for lipid management. A longitudinal retrospective observational study was carried out, covering time periods before and after initiation of lipid-modifying treatment. The findings show that about 40% of the patients attained the recommended low-density lipoprotein cholesterol goals following treatment, but only 18% attained goals/normal levels in all lipid parameters. Improvement in triglycerides was moderate, and low levels of high-density lipoprotein cholesterol persisted, showing only modest improvement following therapy. Treatment patterns were found to have a better degree of adherence to guidelines regarding low-density lipoprotein cholesterol as compared to other lipid parameters. The overall objective of treatment of type 2 diabetes mellitus is to improve glycemic control without negatively affecting quality of life. Hypoglycemia is a common side effect of intensive blood glucose control, mostly seen in patients treated with insulins. Earlier studies have suggested that hypoglycemia has a negative impact on quality of life, even in patients treated with oral glucose-lowering therapies. We carried out a cross-sectional retrospective study to assess the impact of self-reported experience of hypoglycemia on quality of life in Swedish adult patients with type 2 diabetes mellitus treated with a combination of metformin and sulfonylureas. The results showed that about 40% of the patients achieved the goal of glycemic control. About 19% reported experience of moderate or more severe hypoglycemia, and these patients were found to have lower quality of life than those patients reporting no or mild hypoglycemia, as measured by EQ-5D, a generic quality of life instrument. This could be important to consider in clinical practice.
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Osakwe, Chijioke Pius. "Perceptions of Private Medical Practitioners towards the Nigerian National Tuberculosis Treatment Guidelines." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4939.
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Tuberculosis (TB) is a major public health problem in many parts of the world. Nigeria is one of the 30 countries in the world that has the highest burden of TB. Private medical practitioners in Nigeria play an important role in health care delivery. Motivating them to adhere to TB treatment guidelines in managing persons suspected of having TB or diagnosed with the disease is one of the strategies employed by the National Tuberculosis Program to Reduce the Burden of TB. Few studies were identified which used qualitative study approaches to study the perceptions of these practitioners towards the TB treatment guidelines. The overarching question asked the study participants centered on eliciting their perceptions towards the guidelines. Guided by the theory of planned behavior, this qualitative narrative study explored the perceptions of private medical practitioners in Anambra State, Nigeria towards the Nigerian National TB Treatment Guidelines. To elicit these perceptions, in-depth interviews were conducted on 11 purposefully selected practitioners. Data analysis comprised coding of data obtained and extracting themes from them. The QSR Nvivo 11 helped to manage data. The main finding of the study was that the practitioners perceived the treatment guidelines to be adequate to meet most of their needs in the diagnosis and treatment of TB patients. Other key findings were that provision of financial incentives and regular training will motivate collaboration with the TB program and adherence to the guidelines. Positive social change may occur by insight being gained into how private medical practitioners view the treatment guidelines and how this knowledge will lead to improved management of TB patients. This may in turn result in the reduction in the morbidity and mortality associated with TB in Nigeria.
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Bradbrook, Kirsty. "Deliberative artificial intelligence in the development, refinement and use of medical guidelines." Thesis, University of Brighton, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.438522.
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Hagman, Anna, and Sander Riedberg. "Guidelines for smartphone usage in telemedical photography." Thesis, KTH, Skolan för teknik och hälsa (STH), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-150492.
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The wide usage of smartphones makes them an interesting and potential medical device. Given that smartphone cameras have a sufficiently high quality - some of the medical photography done at health care facilities could be done telemedically and by non-medically educated per- sons. Therefore a research of the quality of the photos taken with smartphone cameras has been done. This thesis presents guidelines regarding how inexperienced persons could take high qualitative medical photos with a smartphone. This thesis includes a review of current guidelines within medical photography. A compari- son between two popular smartphones and a professional medical camera has been done - where possibilities and limitations in smartphone cameras have been identified. In order to evaluate the sharpness and the color temperature representation in the photos taken with smartphones, an experiment with realistic lighting and easy accessible color-calibration cards has been done. The execution and the achieved result have formed the basis of the proposed guidelines. The result shows that smartphone cameras are of high quality and thereby could be used as a complement to advanced medical camera equipment. With the help of the proposed guidelines inexperienced persons could acquire sufficiently good medical photos, in order to be used as diagnostic material. This thesis provides a foundation for further research and implementation within the area, with the purpose of becoming an important part of the efficiency improvement within the telemedical health care.
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Aziz, Ayesha. "A service oriented architecture to implement clinical guidelines for evidence-based medical practice." Thesis, University of Sussex, 2015. http://sro.sussex.ac.uk/id/eprint/53223/.
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Health information technology (HIT) has been identified as the fundamental driver to streamline the healthcare delivery processes to improve care quality and reduce operational costs. Of the many facets of HIT is Clinical Decision Support (CDS) which provides the physician with patient-specific inferences, intelligently filtered and organized, at appropriate times. This research has been conducted to develop an agile solution to Clinical Decision Support at the point of care in a healthcare setting as a potential solution to the challenges of interoperability and the complexity of possible solutions. The capabilities of Business Process Management (BPM) and Workflow Management systems are leveraged to support a Service Oriented Architecture development approach for ensuring evidence based medical practice. The aim of this study is to present an architecture solution that is based on SOA principles and embeds clinical guidelines within a healthcare setting. Since the solution is designed to implement real life healthcare scenarios, it essentially supports evidence-based clinical guidelines that are liable to change over a period of time. The thesis is divided into four parts. The first part consists of an Introduction to the study and a background to existing approaches for development and integration of Clinical Decision Support Systems. The second part focuses on the development of a Clinical Decision Support Framework based on Service Oriented Architecture. The CDS Framework is composed of standards based open source technologies including JBoss SwitchYard (enterprise service bus), rule-based CDS enabled by JBoss Drools, process modelling using Business Process Modelling and Notation. To ensure interoperability among various components, healthcare standards by HL7 and OMG are implemented. The third part provides implementation of this CDS Framework in healthcare scenarios. Two scenarios are concerned with the medical practice for diagnosis and early intervention (Chronic Obstructive Pulmonary Disease and Lung Cancer), one case study for Genetic data enablement of CDS systems (New born screening for Cystic Fibrosis) and the last case study is about using BPM techniques for managing healthcare organizational perspectives including human interaction with automated clinical workflows. The last part concludes the research with contributions in design and architecture of CDS systems. This thesis has primarily adopted the Design Science Research Methodology for Information Systems. Additionally, Business Process Management Life Cycle, Agile Business Rules Development methodology and Pattern-Based Cycle for E-Workflow Design for individual case studies are used. Using evidence-based clinical guidelines published by UK's National Institute of Health and Care Excellence, the integration of latest research in clinical practice has been employed in the automated workflows. The case studies implemented using the CDS Framework are evaluated against implementation requirements, conformance to SOA principles and response time using load testing strategy. For a healthcare organization to achieve its strategic goals in administrative and clinical practice, this research has provided a standards based integration solution in the field of clinical decision support. A SOA based CDS can serve as a potential solution to complexities in IT interventions as the core data and business logic functions are loosely coupled from the presentation. Additionally, the results of this this research can serve as an exemplar for other industrial domains requiring rapid response to evolving business processes.
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Jansen, Friso Johannes. "The shifting sands of evidence : a socio-legal enquiry into the development of medical guidelines." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:efd9b784-3df7-400e-bb0a-8f898578bc91.
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Medical guidelines on the same medical condition differ between England and the Netherlands. These guidelines are referred to as evidence-based because they are supposedly based on a systematic searching for and appraisal of medical studies to drive recommendations for appropriate care for specific clinical circumstances. This comparative study interrogates what causes these differences and similarities between guidelines and tries to uncover the mechanisms behind the development of medical practice guidelines. Four case studies, on lower back pain and on type 2 diabetes in both countries, are used to provide a detailed empirical account of the development of medical guidelines. Interviews with guideline developers are combined with a detailed analysis of available guideline documents. The overarching finding of this thesis is that medical evidence plays a more limited and nuanced role in guideline construction than might be expected and that guidelines are manifestations of professional (self-) regulation. Importantly, the research also finds that institutions shape guidelines in a multitude of ways. This study has endeavoured to add to a more nuanced understanding of evidence within the literature: conceptualising evidence as part of a process of a social and institutional construction. This construction is used within a collaborative and communicative process aimed at creating 'objective facts'. Contrary to existing scholarship, this thesis argues that evidence merely informs the understanding of members of guideline groups while a range of economic, cultural, institutional, and political factors, that together form cognitive frames, provide the driving force behind the development of guidelines. Institutional factors have shown to be essential elements in guideline development, influencing all aspects of development through institutional cultures of practice. This study concludes that calling guidelines evidence-based is an important rhetorical instrument, which helps to conceal and legitimize some of the normative choices that are inherent in guideline making.
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Benjamin, Jennifer Claudette. "Incorporating ADA Best Practice Guidelines in Electronic Medical Records to Improve Glycemic Management in Hospitals." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/318.
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Aggressive management of diabetes using American Diabetes Association (ADA) best practice guidelines in hospitalized patients reduces morbidity and mortality. Inpatient electronic medical records systems improve care in chronic diseases by identifying care needs and improving the data available for decision making and disease management. The purpose of this quality improvement project was to evaluate the impact of ADA best practice guidelines of glycemic management once they have been entered into the electronic medical record (EMR) of hospitalized diabetics. Kotter's organizational change process guided the project. The project question investigated whether nurses' use of ADA Best Practice Guidelines incorporated into the EMR improves glycemic management in hospitalized patients. A quality improvement project pretest-posttest design evaluated the intervention to assess whether the program goals were met. A convenience sample of 8 nurses practicing in a subacute health care facility participated in the program with data obtained from a convenience sampling of diabetic patients admitted to the facility (n = 50). A1C, diabetes types, and hypo/hyperglycemic treatment event data were compared 30 days pre- and post-intervention. Outcome data calculated using descriptive statistics revealed improved documentation for A1C results (4% to 96%), the different types of diabetes (from 100% documented as Type 1 to 28 % documented as Type2), and increased corrective measures for abnormal glycemic events (increased 16% to 44%). EMR alerts and reminders provided timely information to health care practitioners, resulting in better management for the diabetic patient, thus affecting social change of diabetes care.
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Stien, Beate. "Det är patienten som behandlas inte symtomet : Distriktssköterskans erfarenheter av det preventiva arbetet med patienter som har hypertoni." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-16767.
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Ett blodtryck som överstiger 140/85 mmHg diagnostiseras som hypertoni, och upptäcks ofta av läkare och distriktssköterskor i primärvården. Forskare menar att hypertoni går att förebygga med prevention, och att förebyggande åtgärder är ekonomiskt försvarbart då många drabbade är i arbetsför ålder. Prevention av hypertoni innefattar förändring av patientens levnadsvanor och kan implementeras av distriktssköterskan. En kvalitativ studie genomfördes av författaren under hösten 2011. Sex stycken distriktssköterskor från fyra olika vårdcentraler intervjuades om sina erfarenheter av prevention för patienter med hypertoni. Resultatet visade att informanternas uppfattning var att mycket av deras preventiva arbete bestod av information om levnadsvanor till patienten och klinisk mätning av blodtrycket. Information till patienter med hypertoni genomfördes med hjälp av en hälsoenkät som berörde fem områden, motion, stress, tobak, alkohol och mat. Informanternas kompetens och erfarenhet gjorde att de kunde identifiera vilka riskfaktorer som fanns hos patienterna och utvärdera vilka levnadsvanor som patienten behövde ändra/förbättra. Rökstopp hos patienterna ansågs som en prioriterad förändring. Svårigheter i det preventiva arbetet var främst upplevelsen av tidspress under arbetet. Det var mycket som skulle utföras under de 15 minuter informanterna hade till förfogande vid patientbesöket. Resurser som underlättade i deras arbete var kollegor med specialområden och andra yrkeskategorier. Samarbete med andra kollegor och andra yrkeskategorier var ett stöd som gjorde att informanten upplevde en trygghet i patientarbetet. Implementering av rutiner och riktlinjer på vårdcentralerna skiljde sig åt, men samtliga informanter beskrev att de använde sig av riktlinjerna för behandling av hypertoni.Program: Specialistsjuksköterskeutbildning med inriktning mot distriktssköterska
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Hansson, Amina. "PROLACTINOMA : Treatment and outcome of patients in a Swedish county." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-93342.
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Introduction: Dopamine agonists (DA) constitute primary treatment for prolactinomas.Recent international guidelines on prolactinoma management recommend use of cabergolineover other DAs and suggest attempting withdrawal after two years given certain criteria. Thelocal data on adherence to guidelines are scarce. Aim: This study aimed to compare local clinical practice to regional and internationalguidelines for prolactinomas and investigate management and outcome of patients with thisdiagnosis in a clinical setting in Örebro county. Methods: Medical records of patients with prolactinoma visiting the unit of endocrinology atÖrebro University Hospital between 2015-2019 were reviewed. Data on initial investigations,monitoring, treatment, and outcome were collected. Results: 91 patients with a median follow-up time of 69 months, were included. All patientshad initial investigations according to regional guidelines. 98.9% were ever treated with DA,and overall use of bromocriptine was higher than that of cabergoline. DA-withdrawal wasattempted in 40% of patients after a median treatment time of 6 years and was often successful.9.9% of patients had pituitary surgery. At last follow-up 37.4% of the patients were cured while20.9% had hypopituitarism. Treatment outcome differed significantly with adenoma size;microadenomas dominated among patients cured and macroadenomas among patients withremaining hypopituitarism (p<0.001). Conclusions:Local diagnostic prolactinoma care is in line with regional guidelines and patients are monitoredregularly. However, it is feasible that local practice concerning the choice of dopamine agonistand routines for its withdrawal could be revised and adjusted to international guidelines.
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Murphy, Rebecca Cowell. "Advocating for advance directives guidelines for health care professionals /." Thesis, Montana State University, 2009. http://etd.lib.montana.edu/etd/2009/murphy/MurphyR0509.pdf.
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An advance directive, such as a Living Will or Durable Power of Attorney for Health Care, allows a person to give their instructions about future medical care if he or she is unable to participate in decisions due to serious illness or incapacity. Despite the fact the Patient Self Determination Act requires health care facilities to provide patients with information about advance directives on admission, and the public and health care professionals support the use of advance directives, few people actually complete these documents. This project was developed in support of a local community hospital's commitment to promote the creation and use of advance directives. Part one of the project involved working with the hospital's Advance Directive Committee to update and revise the Advance Directive Policy and Procedure to meet Joint Commission Standards. Part two of the project was the creation of an Advance Directive Education Module for health care professionals designed to be used as part of the employees' annual education review. The new policy created a solid framework for health care professionals to follow when working with patients and their health care goals. The computer-based Advance Directive Education Module reviewed general information about advance directives, informed health care professionals of the new Advance Directive Policy and Procedure, and gave facility-specific actions to take when working with patients and their advance directives.
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Mxoli, Ncedisa Avuya Mercia. "Guidelines for secure cloud-based personal health records." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/14134.
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Traditionally, health records have been stored in paper folders at the physician’s consulting rooms – or at the patient’s home. Some people stored the health records of their family members, so as to keep a running history of all the medical procedures they went through, and what medications they were given by different physicians at different stages of their lives. Technology has introduced better and safer ways of storing these records, namely, through the use of Personal Health Records (PHRs). With time, different types of PHRs have emerged, i.e. local, remote server-based, and hybrid PHRs. Web-based PHRs fall under the remote server-based PHRs; and recently, a new market in storing PHRs has emerged. Cloud computing has become a trend in storing PHRs in a more accessible and efficient manner. Despite its many benefits, cloud computing has many privacy and security concerns. As a result, the adoption rate of cloud services is not yet very high. A qualitative and exploratory research design approach was followed in this study, in order to reach the objective of proposing guidelines that could assist PHR providers in selecting a secure Cloud Service Provider (CSP) to store their customers’ health data. The research methods that were used include a literature review, systematic literature review, qualitative content analysis, reasoning, argumentation and elite interviews. A systematic literature review and qualitative content analysis were conducted to examine those risks in the cloud environment that could have a negative impact on the secure storing of PHRs. PHRs must satisfy certain dimensions, in order for them to be meaningful for use. While these were highlighted in the research, it also emerged that certain risks affect the PHR dimensions directly, thus threatening the meaningfulness and usability of cloud-based PHRs. The literature review revealed that specific control measures can be adopted to mitigate the identified risks. These control measures form part of the material used in this study to identify the guidelines for secure cloud-based PHRs. The guidelines were formulated through the use of reasoning and argumentation. After the guidelines were formulated, elite interviews were conducted, in order to validate and finalize the main research output: i.e. guidelines. The results of this study may alert PHR providers to the risks that exist in the cloud environment; so that they can make informed decisions when choosing a CSP for storing their customers’ health data.
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SOUZA, RAPHAELA GASPARINI FRANCOIS DIEHL DE. "METHOD PROPOSAL TO TRANSFORM MEDICAL GUIDELINES TO A CONCEPTUAL PROCESS MODEL: A CASE STUDY FOR SEPSIS." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2016. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=29839@1.
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PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIROCOORDENAÇÃO DE APERFEIÇOAMENTO DO PESSOAL DE ENSINO SUPERIOR
CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO
PROGRAMA DE SUPORTE À PÓS-GRADUAÇÃO DE INSTS. DE ENSINO
Uma das principais questões dos profissionais de saúde é como aprimorar a qualidade do tratamento oferecido aos pacientes. Problemas relacionados à qualidade e altos custos nos serviços de saúde são observados não somente no Brasil, mas também em países desenvolvidos. A grande variação no processo de tratamento de uma determinada doença pode gerar erros médicos, uso excessivo de recursos e sofrimento desnecessário aos pacientes. Por esse motivo, atualmente muitas instituições ao redor do mundo desenvolvem diretrizes clínicas baseadas em evidências, com recomendações para o tratamento de diversas doenças. A utilização de diretrizes clínicas pode reduzir a variabilidade no processo de tratamento e trazer benefícios como redução da mortalidade e redução de custos. No entanto, existe uma grande dificuldade para implementação destas diretrizes. Normalmente escritas por médicos, estes documentos são de difícil leitura para não-médicos, que tem um papel importante em sua implementação, como desenvolvedores de sistema e administradores. Esta dissertação propõe um método para transformar diretrizes clínicas em um modelo de processo conceitual que possa ser implementado num software. O método proposto facilita a leitura e entendimento das recomendações presentes nestas diretrizes. A transformação das recomendações em informações de processo facilita a implantação das diretrizes em qualquer departamento hospitalar. Além disto, o método permite a comparação de recomendações propostas em diferentes publicações de diretrizes clínicas. O método proposto foi aplicado no processo de diagnóstico e tratamento da Sepse. A Sepse é uma condição grave que acomete milhões de pessoas por ano no mundo, com altos índices de mortalidade. A rapidez na identificação dos sintomas e início do tratamento adequado aumenta significativamente a probabilidade de sobrevivência. A intenção do método proposto nesta dissertação é aumentar a utilização de diretrizes clinicas de Sepse em hospitais. O modelo de processo conceitual apresentado no método será utilizado no desenvolvimento de uma solução tecnológica real para suportar o processo de identificação e tratamento da Sepse em hospitais. Este modelo foi construído com base na revisão da literatura de Sepse e no estudo de caso realizado em um hospital de grande porte no Brasil. O modelo desenvolvido foi validado por médicos durante o estudo de caso e por uma equipe de especialistas em desenvolvimento de sistemas hospitalares.
One of the main issues for health professionals is how to improve the quality of care offered to patients. Problems related to healthcare quality and high costs are observed not only in Brazil but also in developed countries. The wide variation in a particular disease treatment process can lead to medical errors, overuse of resources and unnecessary patient suffering. Therefore, nowadays many institutions around the world are developing clinical evidence-based guidelines with recommendations for the treatment of several diseases. However, there is a great difficulty to implement these guidelines. Usually written by doctors, these documents are difficult to read by non-physicians, who play an important role in its implementation, such as system developers and administrators. This master thesis proposes a method to transform clinical guidelines in a conceptual process model that can be implemented in a software. The method facilitates the reading and understanding of these guidelines recommendations. The transformation of guidelines recommendations in process information facilitates its implementation in any hospital department. The proposed method was applied for the Sepsis diagnosis and treatment process. The conceptual process model designed in this Master Thesis will be used in the development of a Clinical Pathway technological solution for Sepsis treatment. Sepsis is a serious medical condition that affects millions of people worldwide each year, with high mortality rates. The early recognition of its symptoms and proper treatment significantly increases the survival probability. The intent behind the proposed method in this thesis is to increase the use of clinical guidelines for Sepsis in hospitals.
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Godlonton, Michael D. "Evaluating prevention strategies used by general practitioners in Grahamstown in terms of recommended guidelines." Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97241.
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Background: Increasing attention has been paid to preventative health over the past few decades. However because of constraints on consultation time and medical funds general practitioners (GPs) are often unsure which measures are appropriate and when to carry them out. They need to be well informed about the cost-effectiveness and evidence regarding each preventative measure to help their patients make informed choices about what needs to be done. Due to the large number of recommended screening measures general practitioners are often unsure which to prioritise and also forget to carry out all recommended measures. Recommendations for screening in South Africa and research into preventive strategies used by general practitioners are lacking. This research attempts to find out whether the prevention strategies used by general practitioners in private practice in Grahamstown follow recommended guidelines.
Methods: To obtain a broad understanding of prevention strategies used by general practitioners in Grahamstown, the following tracer conditions were selected for the study: screening for smoking, breast cancer, cervical cancer, colorectal cancer, hyperlipidaemia, prostate cancer and human immunodeficiency virus (HIV) infection. Research on routine annual health checks was included as these are used by many GPs to screen for tracer conditions. The research was done in 2 parts: 1. Review of the literature to obtain evidence on the recommended prevention strategy for each of the selected tracer conditions and 2. Interviews with GPs to evaluate the prevention strategy they used for each tracer condition. The literature was reviewed for evidence on the following parameters for each tracer condition: burden of the disease prevented; cost-effectiveness of the screening measures; sensitivity and specificity of screening tests; whether the screening measure for and treatment of the tracer condition is acceptable to patients; appropriate duration between repeated screening tests and whether there is effective treatment for the tracer condition. Eleven general practitioners were interviewed on the prevention strategies they use for each of the selected tracer conditions. Transcriptions of the interviews were analysed qualitatively and qualitatively. The prevention strategies used by the general practitioners was then compared to recommended guidelines.
Results: Evidence from the literature regarding the burden of and optimal prevention strategy for each tracer condition is reported. Using this evidence an appropriate prevention strategy for each tracer condition is outlined. The prevention strategies used by the GPs for each tracer condition and the routine annual health check is reported from the analysis of the interviews. The results show a wide range of differing strategies used by the GPs, often not following recommendations from research.
Discussion: The prevention strategies used by general practitioners for each tracer condition is compared with the recommendations from the literature. Important differences between what are recommended and what general practitioners are doing is discussed. Some general practitioners are practicing largely curative medicine and are not adequately screening their patients. Others are over screening with too many unnecessary tests being done annually as a routine. The interviews reveal that generally GPs do not discuss the potential harms and limitations of screening tests with their patients; do not keep check lists for each patient and do not use registers or recall systems to ensure all screening is done.
Conclusion: General practitioners need to ensure their prevention strategies follow recommended guidelines. To do so they can use the routine annual health check or opportunistic case finding and prevention. They need to ensure that routine health checks are targeted to the individual patients’ health risks and avoid doing unnecessary tests. Check lists can help to ensure all screening is done on every patient. While registers and recall systems improve screening rates they are not always possible in busy general practices. Recommended prevention strategies for each of the tracer conditions are made.
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Yeung, Mei-yan, and 楊美恩. "Evidence-based guidelines on ventilator-associated pneumonia prevention for mechanically ventilated patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44626885.
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Kativu, Kevin. "Guidelines for the effective use of telemedicine in public healthcare in resource constrained settings." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1020061.
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On September 8 2000, world leaders gathered at the United Nations summit and resolved to help citizens in the world's poorest countries to achieve a better life by the year 2015. This resolve was outlined in the Millennium Development Goals that were subsequently published with goals 4, 5 and 6 specific to healthcare. The integration of ICT‘s in the remote delivery of services has opened new avenues from which centralised, scarce resources can be accessed remotely for the benefit of the general population. Telemedicine has made great strides in the developed world with remote populations benefiting from the improved access to healthcare. In the Eastern Cape Province of South Africa, the sub-field of teleradiology has shown promise for enabling the wider delivery of specialist services. However, in resource constrained settings such as developing countries, telemedicine has had limited success and as a result, the equitable access to healthcare for remote populations remains inconceivable. This is exacerbated by the migration of healthcare professionals both domestically and internationally. The public sector has suffered the most with acute staff shortages in the public healthcare institutions, more so in rural and remote areas. This study identifies the prevailing challenges posing as barriers to the effective use of telemedicine services in the Public health sector in resource constrained settings and provides recommendations and guidelines aimed at facilitating the adoption and effective use of telemedicine. Challenges are identified from literature and from the first person accounts of specific role-players who are directly involved with telemedicine in their respective institutions. Participants are drawn from institutions offering telemedicine services within the Eastern Cape Province of South Africa. Challenges identified from literature are collated with those identified from the participant interviews to provide a concise list of factors that is used as input to the recommendation and guideline development process. The results thus far point to an enthusiastic environment coupled with a semi-capable infrastructure but however hampered by staff shortages and a general lack of support structures and propulsion mechanisms to adequately encourage the wider use of telemedicine. The proposed guidelines aim to address the challenges at the different role-player levels.
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Masieri, C. M. "L'ACCERTAMENTO DELLA RESPONSABILITÀ CIVILE DEL MEDICO TRAMITE L'UTILIZZO DELLE LINEE-GUIDA E DEGLI ALTRI DOCUMENTI SCIENTIFICI." Doctoral thesis, Università degli Studi di Milano, 2017. http://hdl.handle.net/2434/490018.
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Il presente lavoro è volto ad analizzare un particolare aspetto della disciplina della responsabilità civile del medico: si tratta dell’utilizzo di documenti medico-scientifici, variamente denominati practice parameters, practice patterns, written policies, protocols, standards, e riassumibili nella locuzione clinical practice guidelines o linee-guida per la pratica clinica, che viene fatto dai rule makers, siano essi legislatori o giudici, per individuare il criterio di giudizio della condotta tenuta dal medico.
Nel primo capitolo, dopo aver brevemente accennato alle necessarie nozioni di epistemologia della medicina, al contenuto delle guidelines e alla metodologia con cui esse vengono prodotte, si dà conto di alcune interazioni tra scienza e diritto verificatesi – con riferimento ai documenti medico-scientifici in esame – nell’ordinamento dell’Unione Europea, del Consiglio d’Europa e poi in quello italiano.
Lo studio della responsabilità medica, nonché quello dell’utilizzo delle guidelines, induce poi ad attingere alle risorse della comparazione giuridica. In particolare, si è imposta la scelta dell’ordinamento degli Stati Uniti d’America, in quanto proprio dalla dottrina americana è stata formulata per la prima volta alla fine degli anni ’80 l’ipotesi di utilizzare le linee-guida nei processi per medical malpractice. Nel secondo capitolo si offre perciò una ricostruzione dettagliata del sistema delle fonti e del ruolo delle giurisdizioni statali e federali nella produzione e applicazione del diritto americano, con particolare attenzione alla responsabilità civile del medico. Inoltre, per quanto attiene alla struttura della medical malpractice, si rileva che il criterio di giudizio prevalentemente utilizzato è quello della medical custom, che è ritenuta un fatto, il quale deve essere pertanto oggetto di prova dinnanzi alla giuria.
Da ciò discende che nei processi relativi alla responsabilità civile del medico assumono particolare rilievo le conoscenze tecniche in materia di medical custom, però negli Stati Uniti una consulenza tecnica d’ufficio non viene praticamente mai disposta dal giudice: poiché l’onere della prova del breach of duty grava sull’attore, si osserva che l’expert witness di parte in materia di negligenza del medico diviene un requisito astrattamente necessario di procedibilità della domanda del paziente.
È dunque in un’ottica essenzialmente probatoria, e cioè nell’interazione e – a volte – nella contrapposizione con quanto affermato dalla expert testimony, che la giurisprudenza e la dottrina americane concepiscono l’uso processuale delle linee-guida per la pratica clinica. Si prosegue perciò con l’analisi delle regole della Law of Evidence, con particolare attenzione al vaglio sulla expert witness testimony imposto dal c.d. Daubert test, e alle disposizioni in materia di ammissibilità dei documenti nel trial.
Nel terzo capitolo, si dimostra che l’uso delle linee-guida nei processi americani per medical malpractice è un fatto assai più frequente di quello che la dottrina americana ritiene, e che le regole appena descritte in materia di Evidence costituiscono tuttora i riferimenti normativi più significativi per il giudizio di ammissibilità e rilevanza di tali documenti, più che i pochi statutes speciali in materia di linee-guida e responsabilità medica, che sembrano essere invece il modello a cui ha fatto riferimento il legislatore italiano per l’adozione del decreto Balduzzi.
Nel quarto capitolo si ritorna al diritto italiano, e si ricostruisce la parabola che ha portato, nel nostro ordinamento, la responsabilità civile dall’illecito aquiliano alla responsabilità per inadempimento dell’obbligazione da contatto sociale. Si mettono inoltre in rilievo le distorsioni operate dalla giurisprudenza, che ha voluto caratterizzare la disciplina di questa responsabilità in senso oggettivo assoluto.
Nel quinto capitolo, si rileva che in questo humus – assai diverso da quello della Law of Torts – viene trapiantata dall’art. 3, co. 1 d.l. 13 settembre 2012, n. 158 conv. con modif. in l. 8 novembre 2012, n. 189 l’idea di escludere la responsabilità del medico in caso di rispetto delle linee-guida, che trae ispirazione da alcuni statutes americani, i quali però – come si è detto – non rappresentano “il” modello più autorevole e diffuso in materia negli Stati Uniti.
Viene poi effettuato un inquadramento delle guidelines assai differente rispetto a quanto accade oltreoceano: infatti, se l’obbligazione del medico ha ad oggetto una prestazione a regola d’arte, sinonimo di perizia, tali documenti si devono collocare a livello del criterio di qualificazione giuridica della condotta, non a quello dell’accertamento del fatto, e dunque non sono affatto prove, a differenza di quanto ritengono generalmente i giuristi americani. Si sostiene, in seguito, che in forza del principio iura novit curia e dell’esplicito richiamo di cui all’art. 3, co. 1 decreto Balduzzi, il giudice è tenuto a conoscere e a fare uso delle linee-guida per la pratica clinica nell’accertamento della responsabilità civile del medico, nella misura in cui esse siano applicabili al caso di specie e scientificamente valide.
Proprio per quanto attiene al vaglio giudiziale di tali documenti, e specialmente a quello relativo alla loro validità scientifica, si propone poi all’interprete italiano di cogliere i frutti dell’esperienza americana, guardando con particolare attenzione al Daubert test. Ma nella circolazione del modello che qui si propone, si è coscienti che l’originale subisce alcune importanti modificazioni, di cui si dà conto.
Infine, si definiscono i limiti entro i quali la Cassazione può sindacare l’utilizzo delle linee-guida da parte dei giudici di merito.PHD DISSERTATION - ABSTRACT - THE ASCERTAINMENT OF MEDICAL MALPRACTICE THROUGH CLINICAL PRACTICE GUIDELINES AND OTHER SCIENTIFIC DOCUMENTS. This PhD dissertation aims to analyze a specific aspect of Medical Malpractice Law: the use of scientific documents – known as practice parameters, practice patterns, written policies, protocols, standards or clinical practice guidelines – by rule makers (legislators and Courts) in order to identify the standard of care for health care practitioners. In the first chapter, after a short introduction on fundamental notions of medical epistemology, guidelines’ content and their production, some interactions between Science and Law are described, picking the European Union Law, Council of Europe Law and finally Italian Law. Research on guidelines and Medical Malpractice calls for taking the advantage of Comparative Legal Studies. In particular, the legal system of the United States of America has been chosen. This because American scholars have first proposed in the ‘80s to use guidelines in Medical Malpractice trials. The second chapter offers thus a detailed picture of the sources of the law, including the role of state and federal Courts in making American Law. Focusing then on Medical Malpractice, it has to be said that the majority of the States adopted medical custom as the standard of care, which is a matter of fact, to be proven in front of the jury. According to this, in Medical Malpractice trials expert witness testimony about medical custom became very relevant, but no Court in the U.S. appoints experts. This, and the fact that the plaintiff retains the burden of proof of the breach of duty, makes partisan expert testimony mandatory for the claim of the patient to be heard by the jury. Therefore, Courts and scholars in the United States put guidelines in the Evidence Law frame, looking at how they interact – or sometimes clash – with expert testimonies. So, the chapter ends with an analysis of the Law of Evidence, with a focus on the so called “Daubert test” on expert witnesses, and one on the admissibility of documents. The third chapter demonstrates that the use of clinical practice guidelines in Medical Malpractice trials is way more frequent than American scholars think. Furthermore, it shows that the above-mentioned rules of Evidence are still the most relevant source of the law governing admissibility and relevance of these documents. Evidence Law indeed is far more relevant than the small number of state and federal statutes on Medical Malpractice that mention guidelines as a judicial tool for assessing liability. But these statutes seem to have inspired the Italian legislator seems adopting the so called “decreto Balduzzi” (see art. 3, comma 1 d.l. n. 158 of 2012 – l. n. 189 of 2012). The fourth chapter goes back to the Italian legal system, describing the path that brought Medical Malpractice from Tort Law to Contract Law through the so called “contatto sociale” doctrine. Furthermore, the case law caused some distortions of the rules that are now similar to strict liability. The fifth chapter describes a legal transplant from American Tort Law to the very different Italian legal environment: the idea of giving a defense to doctors who complied with clinical practice guidelines. Anyhow, some American state statutes, not the prevailing traditional Evidence Law pattern, have influenced the Italian legislator. Moreover, the conceptual framing of clinical practice guidelines under Italian Law is very different from the original. In Italy, Medical Malpractice is a branch of Contract Law, according to which the clinician is bound to perform treatments with the due technical expertise (“perizia”). Scientific documents can help Courts to define doctor’s behavior as coping with technical expertise, which is a matter of law. Guidelines cannot prove any fact. Therefore, they are not related to Evidence Law. The core of this PhD dissertation is that Italian Courts have to take judicial notice of clinical practice guidelines in Medical Malpractice trials. This comes out of the “iura novit curia” principle (“The Court must know the law” principle) and art. 3, co. 1 of decreto Balduzzi, which explicitly talks about clinical practice guidelines and iatrogenic injuries. The above-mentioned scientific documents have also to pass muster under a test of applicability to the case and scientific validity. This dissertation suggests taking the advantage of the American experience, in particular of the so called “Daubert doctrine”. However, even this would be a legal transplant, in which the original model would be surely modified, as this work shows. Finally, the fifth chapter describes how Cassazione Court could reverse lower Courts’ decisions that apply clinical practice guidelines in Medical Malpractice cases.
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Önder, Stefan. "Adrenal incidentaloma : – A retrospective study of cardiovascular mortality and morbidity in patients with hypercortisolemia defined by the European Society of Endocrinology guidelines." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-77252.
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Introduction: Diagnosed adrenal incidentalomas (AI) are increasing and dexamethasonesuppression test (DST) is gold standard for detection of excess cortisol production. Patients canbe categorized into three groups based on the DST level; non-functional adrenal adenomas(NFAA), possible autonomous cortisol secretion (PACS) and autonomous cortisol secretion(ACS), the latter two associated with increased risk of cardiovascular morbidity and mortality. Aim: The aim of this study was to compare cardiovascular morbidity and mortality in patientswith adrenal incidentalomas with and without hypercortisolemia defined by the EuropeanSociety of Endocrinology (2016) guidelines. Method: Retrospectively 160 consecutive patient charts between 2008 and 2015 were reviewedand 59 included. They were further categorized in NFAA (n = 37) or PACS (n = 22). Patientswith signs and symptoms of hormonal overproduction or AI found during malignancyinvestigations were excluded. Due to strict adherence to inclusion and exclusion criteria, onlyone case of ACS was found and excluded due to ethical reason. Results: Increased prevalence of type 2 diabetes in PACS group at baseline. No difference incardiovascular disease or mortality between the groups could be seen after mean follow up of7 years. Three (8%) patients in the NFAA group deceased, all of malignancy. In the PACSgroup, five (23%) deceased. Cause of death was cerebral infarction (n = 2), malignancy (n =1)and other causes (n =2). Conclusion: No significant difference of cardiovascular morbidity and mortality could be seenbetween NFAA and PACS during follow up. A prospective multicentre study is needed toidentify the long-term outcomes.
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Ballou-Nelson, Pamela. "A Synthesized Model of Compliance Based on Physician and Patient Reported Barriers to Hypertension Guidelines." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/977.
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Hypertension affects as many as 50-70 million Americans; early and consistent compliance to hypertension guidelines is important to prevent heart attack and stroke, both leading causes of death in the United States. Despite the advances in medicine and health-care technology, the effectiveness with which hypertension is managed at the individual and community level is less than optimal. The research questions in this study addressed the lack of physician compliance to hypertension guidelines and why patients fail to follow guidelines. Improving hypertension management depends on bridging the gap between physician awareness of evidence-based guidelines and patient compliance. Grounded theory was used to understand and integrate the perspectives of a purposeful selection of nine physicians and seven patients regarding barriers to hypertension guidelines compliance. Theoretical perspectives used to frame this research were self-efficacy and the health-belief model for the patient and awareness to adherence and the dissemination model for the physician. Data analysis strategies included open/axial and in-vivo coding to assign and refine themes and discover key concepts. Themes for both physician and patient participants related to methods of compliance, the physician/patient relationship, awareness of theoretical models by both groups, and issues related to patient non-compliance. Eight key recommendations were developed, including: evidence and theory must coexist to increase compliance, health insurance practices must be reformed, and collaboration and communication between physicians and patients must improve. Implications for positive social change included reduced health care costs and improved outcomes for hypertensive patients.
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Lasker, Judith N., Myron Aldrink, Ramaswami Balasubramaniam, Paul Caldron, Bruce Compton, Jessica Evert, Lawrence C. Loh, Shailendra Prasad, and Shira Siegel. "Guidelines for responsible short-term global health activities: developing common principles." BIOMED CENTRAL LTD, 2018. http://hdl.handle.net/10150/627194.
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Background: Growing concerns about the value and effectiveness of short-term volunteer trips intending to improve health in underserved Global South communities has driven the development of guidelines by multiple organizations and individuals. These are intended to mitigate potential harms and maximize benefits associated with such efforts. Method: This paper analyzes 27 guidelines derived from a scoping review of the literature available in early 2017, describing their authorship, intended audiences, the aspects of short term medical missions (STMMs) they address, and their attention to guideline implementation. It further considers how these guidelines relate to the desires of host communities, as seen in studies of host country staff who work with volunteers. Results: Existing guidelines are almost entirely written by and addressed to educators and practitioners in the Global North. There is broad consensus on key principles for responsible, effective, and ethical programs-need for host partners, proper preparation and supervision of visitors, needs assessment and evaluation, sustainability, and adherence to pertinent legal and ethical standards. Host country staff studies suggest agreement with the main elements of this guideline consensus, but they add the importance of mutual learning and respect for hosts. Conclusions: Guidelines must be informed by research and policy directives from host countries that is now mostly absent. Also, a comprehensive strategy to support adherence to best practice guidelines is needed, given limited regulation and enforcement capacity in host country contexts and strong incentives for involved stakeholders to undertake or host STMMs that do not respect key principles.
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Massuthe, Peter. "Operating guidelines for services /." [Amsterdam] : SIKS, 2009. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=017682193&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Lundberg, Camilla, and Karin Winge. "Prehospital bedömning : En forskningsöversikt." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-18828.
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Patienter utsätts för onödiga transporter och efterföljande väntetid på akutmottagningen, vilket i sin tur leder till ett onödigt vårdlidande. Det är inte längre en självklar åtgärd för ambulanssjukvården att transportera alla patienter till akutmottagningen för fortsatt vård. Detta innebär att kravet har ökat på ambulanssjukvården och den prehospitala bedömningen. Mot bakgrund av dessa förutsättningar som idag gäller för ambulanssjukvård, är frågan om forskningen kan vägleda till hur den prehospitala bedömningen ska kunna underlättas.Syftet med studien är att beskriva prehospital bedömning i ambulanssjukvård och genom en forskningsöversikt har kvalitativ och kvantitativ forskning analyserats.I resultatet framkommer det att prehospital bedömning består av två huvudinnehåll, dels en vårdvetenskaplig där den prehospitala bedömningen ses som en kontinuerlig process och dels en medicinsk där den prehospitala bedömningen inriktas på att utifrån fastställda kriterier ringa in patientens vårdbehov. I den vårdvetenskapliga forskningen framkommer att vårdrelationen är en central del i den prehospitala bedömningen liksom att vinna patientens förtroende. I den medicinska forskningen framkommer att prehospital bedömning och triagering med hjälp av protokoll kan vara ett sätt att minska patientens vårdlidande. Protokoll kan ge en vägledning till alternativa vårdnivåer men måste kombineras med ett vårdvetenskapligt patientperspektiv och ett öppet förhållningssätt för att möta patienters individuella nyanser. Genom att möjliggöra patientstyrning till alternativa vårdnivåer, kan akutmottagningar avlastas och leda till att fler patienter kan vårdas hemma, dock i ringa omfattning.Program: Fristående kurs
Uppsatsnivå: C
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Van, Niekerk Anida. "Implementation of intravenous to oral antibiotic switch therapy guidelines in the general medical wards of a tertiary level hospital." Thesis, Nelson Mandela Metropolitan University, 2010. http://hdl.handle.net/10948/1325.
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The overuse of antibiotics and consequent resistance is a common problem in medical practice worldwide. Switch therapy is a technique that can be applied to streamline antibiotic therapy reducing unnecessary prolonged Intravenous (IV) antibiotic therapy. Antibiotic switch therapy has several other benefits such as: decreasing length of hospital stay; decreasing the incidence of adverse events associated with the administration of IV antibiotics; decreasing direct and indirect hospitalisation costs while improving patients’ comfort and mobility; and decreasing the risk of acquiring nosocomial infections. Certain elements are required to make the implementation of any guideline, including a switch therapy guideline, a success and probably one of the most important is the support from a motivated multidisciplinary team. The role of such a team, in the South African context, would be filled by the Pharmacy and Therapeutics Committee (PTC). In addition, to make a guideline successful it should be continuously implemented. This responsibility traditionally falls to a pharmacist. In the United Kingdom (UK) and the United States of America (USA) pharmacists are used to promote the appropriate use of antibiotics in hospitals as this has shown to have several economic advantages. The objectives of the study were: to determine, by means of a survey, whether guidelines for IV to oral switch were employed in South African regional, tertiary and national government hospitals; to design and implement an IV to oral antibiotic switch therapy (IVOST) guideline for a local public sector tertiary level hospital; to evaluate the effectiveness of guideline implementation; and to capture, via a questionnaire, the perceptions of prescribers regarding antibiotic prescribing, including switch therapy. The Survey of Current IV Switch Therapy Practice Questionnaire was distributed to Responsible Pharmacists at regional, provincial tertiary and national central government hospitals to determine whether IVOST guidelines were employed in South African government hospitals. Following the survey, an IVOST Guideline was designed by the researcher in consultation with the Department of Medicine and the Department of Pharmacy. The IVOST Guideline was implemented following approval by the PTC at a local tertiary level government hospital. A presentation was held for prescribers, guideline documents were distributed, posters were placed in the medical wards and the ward pharmacist/researcher integrated the guideline into daily practice by placing “reminder stickers” in patient medical folders. A pre-implementation audit and two post-implementation audits, each consisting of 150 patient medical records, were conducted and compared to determine the effect of IVOST guideline implementation on prescribing patterns and to determine whether any changes could be sustained. The Prescriber Antibiotic Survey was then conducted to capture the perceptions of prescribers regarding antibiotic therapy, including switch therapy.
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Kabbur, Nikhil. "Design and Manufacturing Guidelines for Additive Manufacturing of High Porosity Cellular Structures." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504878916930908.
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Regulapati, Sushmitha. "Natural language processing framework to assist in the evaluation of adherence to clinical guidelines." Morgantown, W. Va. : [West Virginia University Libraries], 2007. https://eidr.wvu.edu/etd/documentdata.eTD?documentid=5340.
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Thesis (M.S.)--West Virginia University, 2007.Title from document title page. Document formatted into pages; contains vii, 36 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 33-36).
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Molander, Tobias, and Kin Tran. "Kvalitetsgranskning av svenska ambulanssjukvårdens behandlingsriktlinjer rörande patienter med svår sepsis och septisk chock." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-16687.
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Svår sepsis och septisk chock är sjukdomstillstånd som kan orsaka ett stort lidande för patienten genom att de är förknippade med hög mortalitet och morbiditet. Tidig identifiering och adekvat antibiotikabehandling är avgörande för prognosen. Detta ställer höga krav på ambulanssjukvårdens kvalitet. Ambulanssjukvården har behandlingsriktlinjer som ska utgöra beslutsunderlag och kvalitetssäkring för den givna vården. De potentiella vinsterna med en behandlingsriktlinje blir dock aldrig bättre än kvaliteten på behandlingsriktlinjen i sig. Studiens syfte var att granska och värdera kvaliteten på den svenska ambulanssjukvårdens behandlingsriktlinjer rörande patienter med misstänkt svår sepsis och septisk chock. En kvantitativ metod nyttjades och en totalundersökning av behandlingsriktlinjer i svensk ambulanssjukvård genomfördes, där respektive ambulansorganisation i Sveriges tjugoen landsting kontaktades. Svarsfrekvensen var 76%. Utav dessa kunde nio inkluderades i studien (N = 9). De erhållna prehospitala behandlingsriktlinjerna granskades därefter med hjälp av AGREE II-instrumentet. Resultatet belyser dels att flera organisationer helt saknar behandlingsriktlinjer rörande patienter med misstänkt svår sepsis och septisk chock (33% av alla tjugoen kontaktade landsting. 44% av de sexton som svarade) samt att de övriga behandlingsriktlinjerna har metodologiska brister i rapporteringen kring hur behandlingsriktlinjerna togs fram. Detta utgör ett hinder för att behandlingsriktlinjerna ska kunna utgöra den kvalitetssäkring de är avsedda att vara. Bristerna kan härledas till ambulanssjukvårdens organisation och skulle eventuellt kunna avhjälpas genom centralt utvecklade nationella behandlingsriktlinjer finansierade av vårdgivaren.Program: Specialistsjuksköterskeutbildning med inriktning mot ambulanssjukvård
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Mpasa, Ferestas. "Strategies for the implementation of clinical practice guidelines in the intensive care : a systematic review." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1020046.
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Implementation strategies for the use of clinical practice guidelines are an integral component in bridging the gap between the best research evidence and clinical practice. However, despite some remarkable investments in health research regarding clinical practice guidelines implementation strategies, it is not yet known which of these are the most effective for intensive care units. The purpose of this research study was to systematically identify and /or search, appraise, extract and synthesize the best available evidence for clinical practice guidelines implementation strategies in intensive care units, in order to develop a draft guideline for clinical practice guidelines implementation strategies in the intensive care units. A systematic review design was used to systematically identify and /or search, appraise, extract and synthesize the best available evidence from the eligible included Level 2 studies (randomized controlled trials and quasi-experimental studies). Level 2 studies were applicable because they present robust evidence in the research results regarding effectiveness of clinical practice guideline implementation strategies. Furthermore, although other systematic reviews conducted in this area before, they included studies of In addition, no systematic review was identified that reviewed Level 2 studies and developed a guideline for clinical practice guideline implementation strategies in the intensive care units. Hence, including only Level 2 studies was distinctive to this research study. Databases searched included: CINAHL with full text, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials Issue 8 of 12, August 2013, and MEDLINE via PUBMED. Hand search in bound journals was also done. The search strategy identified 315 potentially relevant studies. After the process of critical appraisal, thirteen Level 2 studies were identified as relevant for the review. Of the 13 relevant studies, 10 were randomized controlled trials and three were quasi experimental studies. After the critical appraisal ten RCTs were included in the systematic review. Three studies (quasi-experimental) were excluded on the basis of methodological quality after the critical appraisal and agreement by the two independent reviewers. The Joanna Briggs Institute Critical Appraisal MASTARI Instrument for Randomized Controlled trials/ Experimental studies, and The Joanna Briggs Institute data extraction tools were used to critically appraise, and extract data from the ten included randomized controlled trials. The two reviewers who performed the critical appraisal were qualified critical care professional nurses and experts in research methodology. These reviewers conducted the critical appraisal independently to ensure the objectivity of the process. Appropriate ethical considerations were maintained throughout the process of the research study. The results indicated that 80 percent of the included studies were conducted in adult intensive care units while 20 percent were conducted in the neonatal intensive care units. Furthermore, 60 percent of the studies were conducted in the United States of America, 10 percent in France, a further 10 percent in Taiwan, another 10 percent in England and yet another 10 percfent was conducted in Australia and Newzealand. The included studies utilized more than one (multifaceted) implementation strategies to implement clinical practice guidelines in the intensive care units. The first most utilized were: printed educational materials; Information/ educational sessions/meetings; audit and feedback and champion/local opinion leaders; seconded by educational outreach visits; and computer or internet usage. Third most used were active/passive reminders; systems support; academic detailing/ one-on-one sessions teleconferences/videoconferences and workshops/in services. Fourth most used were ollaboration/interdisciplinary teams; slide shows, teleconferences/videoconferences and discussions. Fifth most used were practical training; monitoring visits and grand rounds. However all the strategies were of equal importance. Conclusively, the included studies utilized multifaceted implementation strategies. However, no study indicated the use of a guideline for the implementation strategies in the process of clinical practice guidelines implementation. The systematic review developed a draft guideline for clinical practice guideline implementation strategies in the intensive care units. The guideline will enhance effective implementation of clinical practice guidelines in such a complex environment.
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Buhajeeh, Eman A. A. "Diabetes in Kuwait - current patients' experiences of their medical treatment(s) with emphasis on renal complications as compared with worldwide guidelines." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14182.
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Introduction: The studies reported in this thesis investigated a number of patient orientated aspects of its current diagnosis, management and treatment in Kuwait. A comprehensive literature survey is presented with a detailed critical analysis of the very limited number of published material relevant to type 2 diabetes in Kuwait is also provided. A concise list of aims and objectives is also provided. Methodology: The methodology used to derive knowledge of the present situation from the patient perspective, was a series of relevant questions, devised based on the internationally used diabetes Michigan questionnaire. Face to face interviews were used throughout for both patients and medical staff. Suitable data analysis was performed. Results: A pilot study consulted 10 Kuwaiti and 10 non-Kuwaiti patients, and after analysis of their data it was found to be reliable, appropriate and capable of being analysed and so was extended to a larger study of 109 diabetic patients. These 109 diabetic patients were studied in thirteen clinics distributed throughout Kuwait. Two groups of patients were studied – Kuwaiti nationals and non-Kuwaitis both of whom were treated at these clinics during their residency in Kuwait. 38 questions were asked including demographics, medical treatment, monitoring of their disease, physiological consequences and dietary aspects. The major findings were that patients considered two major areas could be improved to enhance the treatment of their disease. The first was to improve the degree of empathy shown to them by the medical/nursing staff and secondly to provide simple practical advice on exercise, dietary considerations and renal aspects of their disease. More comprehensive findings are presented in the thesis but many of these were minor compared with these two major aspects. Also presented are interviews with the medical staff in Kuwait who treat diabetic patients and the problems they face when treating their disease. The opinions and views of selected ophthalmologists and renal specialists are also presented. Medical views were also sought in the UK- Ascot Rehabilitation above their experiences treating diabetic patients from Kuwait. Another aspect of the study was to interview Kuwaiti nationals who had been sent to a clinic in Ascot, UK for the treatment of the serious consequences of their conditions. Many of these were had type 2 diabetes and their views and perspectives of their treatment in Kuwait were gathered as being representative of the long term treatment of this condition. Discussions and Conclusions: The thesis discusses in some detail all the results which were obtained and concludes with a series of recommendations which could be taken to improve the treatment of type 2 diabetes in Kuwait.
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Court, Alex J. "They're NICE and neat, but are they useful? : a grounded theory of clinical psychologists' beliefs about, and use of, NICE guidelines." Thesis, Canterbury Christ Church University, 2014. http://create.canterbury.ac.uk/12832/.
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There is a growing research interest into investigating why NICE (National Institute for Health and Care Excellence) guidelines are not consistently followed in UK mental health services. The current study utilised grounded theory methodology to investigate clinical psychologists’ use of NICE guidelines. Eleven clinical psychologists working in routine practice in the NHS were interviewed. A theoretical framework was produced conceptualising the participants’ beliefs, decision making processes and clinical practices. The overall emerging theme was “considering NICE guidelines to have benefits but to be fraught with dangers”. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, as a result of pressure, and also the rewards that follow from being seen to comply with NICE guidelines, they tended to practice in ways that prevent these skills from being recognised. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. This is the first theoretical framework that attempts to explain why NICE guidelines are not consistently utilised in UK mental health services. Attention is drawn to the proposed benefits and limitations of guidelines and how these are managed. This study highlights the importance of clinical psychologists articulating and advertising their specialist skills. The findings are integrated with existing theory and research, and clinical and research implications are presented.
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Candido, Patricia Tavares da Silva. "O internato médico após as Diretrizes Curriculares Nacionais de 2014: um estudo em escolas médicas do estado do Rio de Janeiro." Universidade Federal de São Paulo, 2017. http://repositorio.unifesp.br/11600/45815.
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Previous issue date: 2017Introdução: Instituídas em 2014, as Diretrizes Curriculares Nacionais (DCNs) do Curso de Graduação em Medicina contêm várias recomendações, especialmente para o Internato Médico. Apesar do reconhecimento da necessidade de mudanças na educação médica, no que se refere à capacitação profissional para atender as demandas da comunidade, a instituição dessas DCNs foi considerada, por muitos, pouco democrática. O seu processo de implantação pelas Escolas Médicas ainda é pouco estudado. Objetivos: Analisar o Internato Médico em Escolas Médicas do Estado do Rio de Janeiro, após a instituição das Diretrizes Curriculares Nacionais para o Curso de Graduação em Medicina de 2014, sob a ótica dos Coordenadores/Diretores de Curso e Coordenadores do Internato. Metodologia: Nessa investigação, foram utilizadas abordagens qualitativas e quantitativas, com a participação dos Coordenadores/Diretores de Curso e Coordenadores de Internato. Em março de 2016, o Estado do Rio de Janeiro possuía 19 cursos de medicina em 15 Escolas Médicas. Destes, nove cursos participaram da pesquisa. A população de estudo foi representada por 13 participantes, nove Coordenadores de Curso e quatro Coordenadores de Internato. Foi aplicado um instrumento de pesquisa composto por questões fechadas, abertas e uma escala atitudinal. Para a análise dos dados, a escala foi avaliada por análise estatística e as respostas das questões abertas foram submetidas à análise de conteúdo, na modalidade análise temática. Resultados e Discussão: Na visão dos Coordenadores participantes da pesquisa, todas as Escolas Médicas estão em processo de adequação às determinações das DCNs de 2014. A maioria está de acordo com a inclusão obrigatória, no Internato, das áreas de Urgência e Emergência, Atenção Básica e Saúde Mental. Muitas são as dificuldades encontradas no processo de implantação e/ou reestruturação dessas atividades no Internato: a escassez de cenários; precariedade dos cenários existentes na Emergência do Sistema Único de Saúde; falta de docentes/preceptores e o prazo estabelecido para a implantação das Diretrizes. Entretanto, os coordenadores têm planejado/utilizado algumas estratégias como a diversificação dos cenários de prática, a criação de estágios eletivos, o estabelecimento de convênios e parcerias, o desenvolvimento de atividades integradas com outras áreas do Internato e a utilização de laboratórios de simulação realística. Considerações finais: As Escolas Médicas vivem um momento de transformação curricular, impulsionado pelas DCNs. Esse momento deve ser encarado como uma oportunidade para revisitar o Internato Médico e, possivelmente, encontrar estratégias para o aprimoramento da formação médica nesse espaço privilegiado da graduação. Acredita-se que a divulgação dos resultados dessa pesquisa possa auxiliar as Escolas Médicas no processo de apropriação e implantação das determinações das DCNs de 2014.
Introduction: Instituted in 2014, the National Curricular Guidelines (NCG) of the Undergraduate Medical Course contains several recommendations, especially for the Medical Internship. Despite the recognition of the need for changes in medical education, in terms of professional training to meet the demands of the community, instituting these NCG was considered by many to be less democratic and its implementation process by the Medical Schools is still little studied. Objectives: to analyze the Medical Internship in Medical Schools of the State of Rio de Janeiro, after instituting the National Curricular Guidelines for the Medical’s Undergraduate Course of 2014, according to the Coordinators / Course Directors and Internship Coordinators. Methodology: In this research, qualitative and quantitative approaches were used, with the participation of Coordinators / Course Directors and Internship Coordinators. In March 2016, the State of Rio de Janeiro had 19 medical courses in 15 Medical Schools. Of these, nine courses participated in the research. The study population was represented by 13 participants and of these 09 Course Coordinators and 04 Internship Coordinators. We applied a research instrument composed of closed-ended and open-ended questions and an attitudinal scale. For data analysis, the scale was evaluated by statistical analysis and the answers of the open-ended questions were submitted to content analysis, in the thematic analysis modality. Results and discussion: In the view of the Coordinators participating in the research, all Medical Schools are in the process of adapting to the NGC’s determinations of 2014. The majority are in agreement with the mandatory inclusion of Urgency and Emergency, Primary Care and Mental Health in the Internship areas. There are many difficulties that we encountered in the process of implantation and / or restructuring of these activities in Internship: the scarcity of scenarios; precariousness of the existing scenarios in the Emergency of the Unified Health System; lack of teachers / preceptors; and the deadline established for the implementation of the Guidelines. However, the coordinators have planned / used some strategies such as the diversification of practice scenarios, the creation of elective internships, the establishment of agreements and partnerships, development of integrated activities with other Internships areas and the use of realistic simulation laboratories. Final considerations: The Medical Schools live a moment of curricular transformation, encouraged by the NCG. We must see this moment as an opportunity to revisit the Medical Internship and, possibly, to find strategies for the improvement of medical training in this privileged space of the undergraduate. We believe that the dissemination of this research’s results can help the Medical Schools in the process of appropriation and implementation of NCG’s determinations of 2014.
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Roman, Angelmar Constantino. "Informatização do registro clínico essencial para a atenção primária à saúde: um instrumento de apoio às equipes da estratégia saúde da família." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5144/tde-28082009-095729/.
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INTRODUÇÃO: A atenção primária à saúde (APS), porta de entrada dos sistemas de saúde organizados, é o nível de atenção de maior contato com as populações e onde as pessoas são atendidas como sujeitos sociais e emocionais com projetos existenciais, sofrimentos e riscos para a saúde e não apenas como portadores de doenças classificáveis. Esse é o modelo da integralidade, opção adotada pelo Sistema Único de Saúde (SUS) brasileiro, desde sua criação oficial em 1990, para reorientação da assistência, em busca da consolidação dos seus princípios. Compatível com esses princípios estruturadores, a Medicina de Família e Comunidade (MFC) é a especialidade que atua na APS. Mas, os níveis de atenção secundária e terciária, que embasam seus conceitos no modelo explicativo biomédico, é que determinam discurso e prática da educação médica e delineiam a forma de registrar os eventos clínicos e de codificar os agravos. Essa forma de registrar e codificar revela-se insuficiente para abarcar o universo complexo de achados no cotidiano do atendimento à maioria das pessoas que acorrem à APS. Assim, este trabalho descreve um software de registro essencial, compatível com os princípios do SUS, com os atributos da APS e com as características estruturadoras da MFC, para os apontamentos do encontro terapêutico que ocorre na atenção primária à saúde. Propõe a integração do método Weed, de história clínica orientada ao problema, com a automatização das indicações de diretrizes clínicas, trazendo como exemplo o manejo e monitoramento dos principais fatores de risco cardiovascular. Mostra como a utilização de um protótipo funcional desse software impactou a quantidade e os custos de procedimentos (exames laboratoriais, consultas com especialistas, procedimentos hospitalares) realizados durante um ano de observação. MÉTODOS: Em um ambulatório de APS, foram observados dois grupos de pacientes com idade maior que 20 anos, atendidos durante o ano de 2003. O grupo intervenção foi atendido por uma equipe de saúde cujo médico de família e comunidade utilizou o software do registro clínico essencial. O grupo controle constou dos pacientes atendidos pelas equipes de saúde cujos médicos de família e comunidade não utilizaram o software. Ao final de um ano de observação, foram comparadas as diferenças entre os dois grupos, quanto ao perfil de indicação e utilização de recursos fora do ambulatório em foco. RESULTADOS: O número de pacientes sob observação foi de 4.193 (616 (15%) no grupo intervenção; 3.577 (85%) no grupo controle). Desses, 3280 realizaram 80.665 procedimentos. A média do número desses eventos foi de 29,28 e 22,00 eventos para cada paciente, nos grupos intervenção e controle, respectivamente (p <0,001). Da mesma forma, o custo médio por paciente/ano caiu de R$1.130,34 para R$611,51 (p < 0,001), e, a média do custo por procedimento, de R$25,96 para R$19,85 (p < 0,001), para os grupos controle e intervenção, respectivamente. CONCLUSÕES: A utilização de um registro clínico essencial que seja capaz de abrigar e dar suporte ao ritual terapêutico que de fato ocorre na APS, integrado a guidelines que automatizem manejo e monitoramento de fatores de risco cardiovascular, reduz significativamente o número e os custos com procedimentos realizados por pacientes atendidos na APS.INTRODUCTION: Primary healthcare is the major portal of entry into organized health systems. In this setting attention to given not only to analysis of health risks characterized by classified diseases but also to social and emotional factors. The Brazilian public healthcare system (Sistema Único de Saúde - SUS) has utilized this integrated model since its inception in 1990. Family and community medicine is the specialty of Primary Care and is compatible with these principles. However, clinical education, often based on a dominance of clinical secondary and tertiary care with a strong bias towards experimental biomedicine has a strong influence over the manner in which clinical events are registered and coded. These factors can create limitations to data registry and is often inadequate to encompass the complex environment which is encountered in the day to day experience of the majority of patients encountered in Primary Care. The present work is based on the integration of the method of Weed of problem oriented medical record taking with an automation of clinical records and cardiovascular risk factor monitoring and management. We describe the results of the use of a software program for improving the essential clinical patient record during patient visits , including guided cardiovascular risk management surveillance. The software program is compatible with the principles of SUS, the Primary Care setting and the philosophy of Family Medicine. METHODS: In 2003, in an Primary Health Care ambulatory setting outpatients, 20 years or older, were either treated by care using the automated patient record including the riskfactor surveillance software (Intervention group, n= 616) or were treated following the standard practice protocols of their family physicians (Control Group, n=3577). At the end of the year patient outcomes and overall patient care costs were compared between the two groups. RESULTS: The average of the number of events (auxiliary tests, specialized referrals, and hospital admissions) decreased from 29.28 events per patient/year in the control group to 22.00 events per patient/year (p < 0,001) in the intervention group. Similarly the cost per patient/year decreased from R$1,130.34 to R$611.51 (p < 0.001), and the average cost per procedure decreased from R$25.96 to R$19.85 (p < 0.001) for the control and intervention groups, respectively. CONCLUSIONS: Our results demonstrated that the use of an primary care automated clinical patient record, including a software program to automate cardiovascular risk factors guidelines, can decrease the number and cost of complementary exams, referrals to specialists, and hospital procedures arising from primary care consultations.
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Neeser, Rudolph. "A Comparison of Statistical and Geometric Reconstruction Techniques: Guidelines for Correcting Fossil Hominin Crania." Thesis, University of Cape Town, 2007. http://pubs.cs.uct.ac.za/archive/00000413/.
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The study of human evolution centres, to a large extent, around the study of fossil morphology, including the comparison and interpretation of these remains within the context of what is known about morphological variation within living species. However, many fossils suffer from environmentally caused damage (taphonomic distortion) which hinders any such interpretation: fossil material may be broken and fragmented while the weight and motion of overlaying sediments can cause their plastic distortion. To date, a number of studies have focused on the reconstruction of such taphonomically damaged specimens. These studies have used myriad approaches to reconstruction, including thin plate spline methods, mirroring, and regression-based approaches. The efficacy of these techniques remains to be demonstrated, and it is not clear how different parameters (e.g., sample sizes, landmark density, etc.) might effect their accuracy.
In order to partly address this issue, this thesis examines three techniques used in the virtual reconstruction of fossil remains by statistical or geometrical means: mean substitution, thin plate spline warping (TPS), and multiple linear regression. These methods are compared by reconstructing the same sample of individuals using each technique. Samples drawn from Homo sapiens, Pan troglodytes, Gorilla gorilla, and various hominin fossils are reconstructed by iteratively removing then estimating the landmarks. The testing determines the methods' behaviour in relation to the extant of landmark loss (i.e., amount of damage), reference sample sizes (this being the data used to guide the reconstructions), and the species of the population from which the reference samples are drawn (which may be different to the species of the damaged fossil).
Given a large enough reference sample, the regression-based method is shown to produce the most accurate reconstructions. Various parameters effect this: when using small reference samples drawn from a population of the same species as the damaged specimen, thin plate splines is the better method, but only as long as there is little damage. As the damage becomes severe (missing 30% of the landmarks, or more), mean substitution should be used instead: thin plate splines are shown to have a rapid error growth in relation to the amount of damage. When the species of the damaged specimen is unknown, or it is the only known individual of its species, the smallest reconstruction errors are obtained with a regression-based approach using a large reference sample drawn from a living species. Testing shows that reference sample size (combined with the use of multiple linear regression) is more important than morphological similarity between the reference individuals and the damaged specimen.
The main contribution of this work are recommendations to the researcher on which of the three methods to use, based on the amount of damage, number of reference individuals, and species of the reference individuals.
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Finley, Leslie K., Alice M. Crawford, and Benjamin J. Roberts. "Career planning in the Medical Service Corps: assessing the validity of current guidelines through a comparative analysis of duty tours and training schools." Thesis, Monterey, California: Naval Postgraduate School, 1993. http://hdl.handle.net/10945/24125.
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Hernandez, John B. "Evaluating a multi-hospital quality improvement strategy to implement clinical guidelines for radiographic contrast agents." Santa Monica, CA : Rand, 1998. http://catalog.hathitrust.org/api/volumes/oclc/42204634.html.
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Johansson, Axel. "Patient Empowerment and Accessibilityin e-Health Services : Accessibility Evaluation of a Mobile WebSite for Medical Records Online." Thesis, Uppsala universitet, Avdelningen för visuell information och interaktion, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-262241.
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This thesis evaluates a DEMO version of the mobile web site for medical recordsonline, m.minavardkontakter.se, from a web accessibility point of view. The evaluationis an expert evaluation based on the ISO standard for web accessibility, Web ContentAccessibility Guidelines (WCAG) 2.0 that is complemented with an evaluation basedon fictitious characters, so called personas. The personas were used to representthree groups of people with different kinds of disabilities; perceptual impairment(aniridia), physical impairment (rheumatism) and cognitive impairment (aphasia). Bycombining and comparing these two methods of evaluation, the thesis also evaluatesthe methods themselves. It was seen from both evaluations that the mobile web sitedoes not entirely fulfill the requirements (success criteria) for web accessibility.WCAG 2.0 found more problems in accessibility than did the personas. However, thepersonas found some problems that were overseen by WCAG 2.0, especially whenthe mobile web site was explored using voice synthesis. The results from the twoevaluations were combined in a set of recommendations for improvement, ranked inorder of importance according to the author. The results conclude that WCAG 2.0 isa good tool for evaluating web accessibility but it is recommended to continue to usethe personas in the future development of the mobile web site.
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Gordon, Leigh. "Medical consequences in endurance sports - Two Oceans Marathon longitudinal study : an evaluation of participation guidelines in runners presenting with symptoms of acute illness before competition." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13109.
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Includes bibliographical references.Background: One of the most common clinical decisions a Sports and Exercise Medicine (SEM) physician is required to make is whether an athlete presenting with symptoms or signs of an acute illness can participate in exercise training or competition. Currently, a clinical tool, known as the ‘neck check’ is used to determine eligibility to participate in exercise training or competition athletes with acute illness. This original clinical tool, first described about 20 years ago, was based mainly on an abbreviated medical history and findings of a clinical examination were excluded. Symptoms of illness ‘above-the-neck’ e.g.sneezing, rhinorrhoea or sinus congestion constitute a ‘passed’ “neck check”, whereas ‘below-the-neck’ symptoms e.g.cough and/or systemic symptoms such as fever and myalgia, constitute a ‘failed’ “neck check”. However, in the current literature, there remain very few data regarding 1) the adherence of athletes to advice given following a ‘neck check’, and 2) whether the exercise performance (e.g.the ability to finish a race) or the development of medical complications during exercise is different in athletes who “passed” or “failed” the ‘neck check’. Objective The main objectives of this dissertation are: 1) to review the available evidence with respect to medical assessment and participation risk in endurance runners presenting with symptoms of acute illness before a road race; 2) to document the range of acute illnesses in runners presenting in the 3 days before a race; 3) to determine adherence to advice given by medical staff to these runners, and 4) to determine the effects of the outcomes of the medical assessment on running performance particularly, the ability to finish the race and the medical complications experienced during the race. These data are important to improve the medical care of runners (and other athletes) presenting with acute illness before training and competition. Methods: Phase 1: Review of the literature All literature relating to the epidemiology of acute illness in athletes, risk factors for illness, and participation risk, potential medical complications and effects on performance of exercising whilst ill were sourced using established electronic databases (PubMed, Medline, Google Scholar). In addition, literature related to the background of the ‘neck check’, as well as the evolution of the current RTP guidelines in athletes with acute illness were sourced. Phase 2: Research study In a prospective cohort study, 242 runners who presented to a pre-race registration medical facility with medical concerns were assessed by SEM physicians by means of medical history and physical examination (if indicated) using a specific Pre-Race acute Illness Medical Assessment (PRIMA group). 172 of these runners had evidence suggesting acute infective illness (PRIMA-I group) and 70 runners had non-infective complaints (PRIMA-N/I group). The epidemiology (prevalence rate = % runners) of runners with symptoms, signs and specific clinical diagnoses of acute illnesses were documented in the PRIMA-I group. Following clinical evaluation, all the runners in the PRIMA-I group were then advised regarding clearance to run the race, monitoring symptoms, or not running the race, using the ‘neck check’ as a guideline. Runners in the PRIMA cohort were then tracked during and immediately after the race, and the following parameters were compared to those in a control group of runners not presenting to the medical facility at registration (CON=53 734): 1) incidence of not starting of the race (per 1000 runners) (DNS rate), 2) incidence of not finishing the race in those who started (per 1000 runners) (DNF rate), and 3) incidence of medical complications during the race in those who started (per 1000 runners) (MC rate). Results Phase 1: Review The main finding of the review is the relative paucity in clinical data with respect to participation in athletes with acute illness. Upper respiratory tract symptoms are very common in athletes, and the risk factors are discussed. Furthermore, there are different aetiologies underlying athletes’ URT symptoms (other than infection). The documented risks of exercising when systemically ill include sudden cardiac death and reduced pulmonary function, splenic rupture in patients with infectious mononucleosis, and dehydration and electrolyte disturbances when exercising with acute gastro-intestinal illness. There is little evidence in the literature regarding the effects of illness on performance; these include reduced performance, non-participation and the potential effects of WARI (wheezing after respiratory tract infection). Evidence supporting the two aspects of the neck check is reviewed: the presumed safety of exercising with localised URT symptoms, and the perceived risk of exercising with lower respiratory tract or systemic symptoms. Clinical data are severely lacking, and the available data are based on self-reported symptomatology. There are no published data regarding the use of the ‘neck check’ as a participation guideline. Phase 2: In the PRIMA-I cohort of 172 runners, the most common symptoms were sinus congestion (40.1%), cough (38.2%), sore throat (37.8%) and runny nose (25.6%). More than half the cohort (57.5%) had a diagnosis of localised URTI. However, URTI with generalised symptoms was the single most common diagnosis (22.7%). In the PRIMA-I group, 41.3% of the runners failed the ‘neck check’. Compared with the CON group, there was no significant difference in the DNS rate in the PRIMA-I group. However, in those runners who were advised not to run, the DNS rate was 565 per 1000 runners, and this was significantly higher than that of the CON group (192 per 1000 runners) (p<0.0001). PRIMA-I race starters had a higher DNF rate (31 per 1000 runners), and runners with any medical concerns (PRIMA group) had a significantly higher DNF rate (37 per 1000 runners) compared to the CON group of runners who started the race (15 per 1000 runners) (p= 0.0329). There were no documented medical complications in the PRIMA-I group who started the race, while the MC rate of the CON group was 6.7 per 1000 runners. In runners in the PRIMA-I group who had been advised not to run, 43.5% were non-adherent, and started the race despite this advice. Conclusion: Our study indicates that localised upper respiratory tract infection is responsible for the majority of acute illness in a pre-race cohort of runners. Furthermore, the data provide some evidence that it is safe for runners with acute illness to exercise if they pass the ‘neck check’. However, presenting to a pre-race registration medical facility, failing the ‘neck check’ and receiving advice against participation appear to increase the risk of not finishing a race. There is also concern about the high rate of non-adherence to advice given by the SEM physician. Finally, a pre-race registration medical assessment for runners with acute illness may reduce the risk of developing short-term medical complications during the race.
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Karlsson, Sara, and Lina Kristensson. "Attityder och följsamhet vid handhygien hos sjukvårdspersonal." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-25500.
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Syftet med denna litteraturstudie var att sammanställa vetenskaplig kunskap om hälso- och sjukvårdspersonals attityder gentemot handhygien. Resultatet baseras på 10 st vetenskapliga artiklar. Resultatet visar att sjukvårdspersonal har en positiv attityd till handhygien vid patientkontakt eller vid exposition av kroppsvätska. Däremot finns en negativ attityd vid användandet av handskar, tro att handhygien orsakar hudirritation och när handhygiensmedel ej finns lättillgängligt. Personalens attityder påverkas av vilken kunskap de har och deras arbetsledares åsikter gällande handhygien. Slutsatsen är att personalen behöver ökad kunskap inom detta ämne för att därmed påverka deras attityder och hur de utför handhygien. Ytterligare forskning kring sjukvårdspersonals attityder gentemot handhygien behövs och då mer inriktad på enskilda yrkeskategorier för att kunskapsutbildningar ska kunna anpassas till specifika behov.The aim of this study was to compile scientific knowledge of health personnel’s attitudes towards hand hygiene. The result is based on 10 scientific articles. The result shows that health personnel have a positive attitude toward hand hygiene when contact with patients or exposure of body fluids. On the other hand, negative attitude are shown when using gloves, believes that hand hygiene causes skin irritation or when hand disinfection is not easily accessible. Personnel’s knowledge and their superior’s opinions about hand hygiene have an effect on the personnel’s attitude. The summary is that more knowledge among the personnel is needed to change their attitudes and behaviour of hand hygiene. More research about health personnel’s attitudes towards hand hygiene are even needed in a more specific way where different professions attitudes are investigated, so that education can adjust to their particular needs.
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Hermansson, Anna, and Strandell Charlotta Jonsson. "Faktorer som påverkar hälso- och sjukvårdspersonals följsamhet till riktlinjer vid MRSA på sjukhus : En litteraturöversikt." Thesis, Högskolan i Skövde, Institutionen för hälsa och lärande, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-13563.
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Bakgrund: Smittspridning av Meticillinresistenta Staphylococcus Aureus har under de senaste åren ökat vilket ställer högre krav på hälso- och sjukvårdspersonals följsamhet av riktlinjer beträffande vårdhygien. Studier visar att följsamhet till riktlinjer är låg vilket orsakar patientlidande och högre kostnader för hälso- och sjukvården. Syfte: Att belysa faktorer som påverkar hälso- och sjukvårdspersonals följsamhet av riktlinjer vid MRSA på sjukhus. Metod: Litteraturöversikt som baseras på kvalitativa (n=3), kvantitativa (n=7) samt mixad metod (n=3) av vetenskapliga artiklar. Resultat: Ur analysen av datamaterialet framträdde fyra kategorier; kunskap, arbetsmiljö, organisation och negativt förhållningssätt, med nio underkategorier. Slutsats: Kunskap gällande smittspridning av MRSA hos hälso- och sjukvårdspersonal ökar följsamheten av riktlinjer vid vårdhygienrutiner varför det är av betydelse att utbildning, god kommunikation och information erbjuds kontinuerligt. En bättre kunskapsnivå inom detta område ger trygghet i professionen och torde därför även förbättra personalens förhållningssätt till patienter, anhöriga och medarbetare. Hälso- och sjukvården står inför en stor utmaning då underbemanning och överbeläggningar är vanligt förekommande vilket även medför att placering av hygienutrustning brister. Organisationen har ett betydande ansvar för att skapa struktur och förutsättningar till att förbättra faktorer som hindrar personal att arbeta optimalt mot följsamhet av de riktlinjer som finns angivna beträffande smittspridning av MRSA.Background: Transmission of Meticillinresistenta Staphylococcus Aureus has increased in recent years, which places greater demands on health professionals’ adherence to guidelines for infection control. Several studies shows that adherence to guidelines is low which is causing the patient suffering and higher costs for healthcare service. Aim: To illuminate factors that influence health professionals’ adherence to guidelines on MRSA in hospital care. Method: This literature review is based on qualitative (n=3) quantitative (n=7) and mixed method (n=3) scientific articles. Findings: Four categories emerged; knowledge, work environment, organization and negative approach, with nine subcategories. Conclusion: To increase adherence to guidelines regarding MRSA, education, communication and information is required continuously. Increased knowledge would improve health professionals’ approach to patients, relatives and employees, which in turns create confidence in their profession. This might also create opportunities to reduce the staffs concerns of being infected or spreading the infection to family members. Healthcare service is facing a great challenge where understaffing, overcrowding and placement of equipment deficiencies. The organization has a significant responsibility to create structure and conditions for an active and committed leadership to improve factors that may affect the spread of MRSA.