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Klein, Harald. "Reforming Primary Care in Victoria: Will Primary Care Partnerships Do the Job?" Australian Journal of Primary Health 8, no. 1 (2002): 23. http://dx.doi.org/10.1071/py02004.
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Spiralling medical costs and escalating demand for health services are putting primary care reform firmly on the agenda for governments around the world. A more coordinated and prevention-oriented approach must be adopted now to avoid a looming crisis in health care. In Victoria, the Primary Care Partnership (PCP) Strategy aims to improve health outcomes and better manage the demand for services by functionally integrating health and community support services. This paper provides an overview of the key factors that have shaped primary care reform in the State of Victoria; the logic of the PCP Strategy; a summary of the results of the strategy after 18 months; and a critical assessment of the key challenges for the strategy in the future. The paper concludes that the strategy has already led to much stronger collaboration between agencies, more integrated service planning and emerging models for service coordination. For these achievements to translate to improved health outcomes, the systems changes being initiated by PCPs need to be translated into the way services are provided in the community. This cannot be achieved by collaboration between service providers alone. It is now time for all relevant parts of government to support PCP objectives and initiatives in the way they plan and fund services.
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Curtis, Kate, Margaret Fry, Sarah Kourouche, Belinda Kennedy, Julie Considine, Hatem Alkhouri, Mary Lam, et al. "Implementation evaluation of an evidence-based emergency nursing framework (HIRAID): study protocol for a step-wedge randomised control trial." BMJ Open 13, no. 1 (January 2023): e067022. http://dx.doi.org/10.1136/bmjopen-2022-067022.
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IntroductionPoor patient assessment results in undetected clinical deterioration. Yet, there is no standardised assessment framework for >29 000 Australian emergency nurses. To reduce clinical variation and increase safety and quality of initial emergency nursing care, the evidence-based emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) was developed and piloted. This paper presents the rationale and protocol for a multicentre clinical trial of HIRAID.Methods and analysisUsing an effectiveness-implementation hybrid design, the study incorporates a stepped-wedge cluster randomised controlled trial of HIRAID at 31 emergency departments (EDs) in New South Wales, Victoria and Queensland. The primary outcomes are incidence of inpatient deterioration related to ED care, time to analgesia, patient satisfaction and medical satisfaction with nursing clinical handover (effectiveness). Strategies that optimise HIRAID uptake (implementation) and implementation fidelity will be determined to assess if HIRAID was implemented as intended at all sites.Ethics and disseminationEthics has been approved for NSW sites through Greater Western Human Research Ethics Committee (2020/ETH02164), and for Victoria and Queensland sites through Royal Brisbane & Woman’s Hospital Human Research Ethics Committee (2021/QRBW/80026). The final phase of the study will integrate the findings in a toolkit for national rollout. A dissemination, communications (variety of platforms) and upscaling strategy will be designed and actioned with the organisations that influence state and national level health policy and emergency nurse education, including the Australian Commission for Quality and Safety in Health Care. Scaling up of findings could be achieved by embedding HIRAID into national transition to nursing programmes, ‘business as usual’ ED training schedules and university curricula.Trial registration numberACTRN12621001456842.
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Bladin, Chris F., Kathleen L. Bagot, Michelle Vu, Joosup Kim, Stephen Bernard, Karen Smith, Grant Hocking, et al. "Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care." BMJ Open 12, no. 7 (July 2022): e052332. http://dx.doi.org/10.1136/bmjopen-2021-052332.
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ObjectivesTo determine if a digital communication app improves care timelines for patients with suspected acute stroke/ST-elevation myocardial infarction (STEMI).DesignReal-world feasibility study, quasi-experimental design.SettingPrehospital (25 Ambulance Victoria branches) and within-hospital (2 hospitals) in regional Victoria, Australia.ParticipantsParamedics or emergency department (ED) clinicians identified patients with suspected acute stroke (onset <4.5 hours; n=604) or STEMI (n=247).InterventionThe Pulsara communication app provides secure, two-way, real-time communication. Assessment and treatment times were recorded for 12 months (May 2017–April 2018), with timelines compared between ‘Pulsara initiated’ (Pulsara) and ‘not initiated’ (no Pulsara).Primary outcome measureDoor-to-treatment (needle for stroke, balloon for STEMI) Secondary outcome measures: ambulance and hospital processes.ResultsStroke (no Pulsara n=215, Pulsara n=389) and STEMI (no Pulsara n=76, Pulsara n=171) groups were of similar age and sex (stroke: 76 vs 75 years; both groups 50% male; STEMI: 66 vs 63 years; 68% and 72% male). When Pulsara was used, patients were off ambulance stretcher faster for stroke (11(7, 17) vs 19(11, 29); p=0.0001) and STEMI (14(7, 23) vs 19(10, 32); p=0.0014). ED door-to-first medical review was faster (6(2, 14) vs 23(8, 67); p=0.0001) for stroke but only by 1 min for STEMI (3 (0, 7) vs 4 (0, 14); p=0.25). Door-to-CT times were 44 min faster (27(18, 44) vs 71(43, 147); p=0.0001) for stroke, and percutaneous intervention door-to-balloon times improved by 17 min, but non-significant (56 (34, 88) vs 73 (49, 110); p=0.41) for STEMI. There were improvements in the proportions of patients treated within 60 min for stroke (12%–26%, p=0.15) and 90 min for STEMI (50%–78%, p=0.20).ConclusionsIn this Australian-first study, uptake of the digital communication app was strong, patient-centred care timelines improved, although door-to-treatment times remained similar.
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Shafique, Muhammad Asim, Muhammad Amir Nadeem, and Muhammad Afzal. "Relationship of Timings and Outcome of Tracheostomy Among Patients Requiring Prolonged Mechanical Ventilation." Journal of Bahria University Medical and Dental College 10, no. 1 (December 5, 2019): 12–16. http://dx.doi.org/10.51985/jbumdc2019068.
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Objective: To assess the indications of tracheostomy among patients requiring prolonged mechanical ventilation and to observe the relationship of the timings and outcome of tracheostomy with age and gender. Study Design and Setting: It was a descriptive study conducted at intensive care unit (ICU) of Department of Otorhinolaryngology at Bahawal Victoria Hospital from January 2017 to December 2018. Methodology: Secondary data was collected with the help of charts of ICU patients in which elective tracheostomy was done to replace orotracheal intubation for mechanical ventilation. Inclusion and exclusion criteria were designed. Clinical record was reviewed for the assessment of indications of the procedure (medical or surgical) along with age and gender distribution. The timing of tracheostomy in these patients with its outcome in terms of decannulation and weaning were recorded. Proforma was used to enter the findings. Finally results were obtained and assessed on SPSS Version 23. Results: Out of total 551 tracheostomies 42(7.6%) were indicated for the patients of ICU requiring prolonged mechanical ventilation. From the 42 mechanical ventilated patients majority had Guillain-Barre syndrome (GBS) 20(47.6%). Twenty six patients were adults (61.9%) and sixteen were children (38%).Twenty four were male patients (57.1%) and eighteen were females (42.8%). The timing of tracheostomy among majority of the patients (40) was from 7-10 days, with mean of 9th day with good outcome. Only two patients who underwent tracheostomy after two weeks had to face poor outcome (failed decannulation, late weaning) (4.7%). Conclusion: Neuroparalytic lesions were the common indication among the patients requiring prolonged mechanical ventilation with tracheostomy. Tracheostomy if performed earlier in such patients carries good outcome
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Considine, Julie, Anastasia F. Hutchison, Helen Rawson, Alison M. Hutchinson, Tracey Bucknall, Trisha Dunning, Mari Botti, Maxine M. Duke, and Maryann Street. "Comparison of policies for recognising and responding to clinical deterioration across five Victorian health services." Australian Health Review 42, no. 4 (2018): 412. http://dx.doi.org/10.1071/ah16265.
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Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to individual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.
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Oshovskyy, Victor. "The Results of a Prospective Cohort Study of the Effectiveness of the Algorithm for Monitoring Pregnancies in Patients from the Group of High Perinatal Risk to Reduce Perinatal Losses and Improve Neonatal Outcome." Family Medicine, no. 2-3 (July 30, 2021): 86–91. http://dx.doi.org/10.30841/2307-5112.2-3.2021.240773.
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Prenatal prognosis is an important part of obstetric care, which aims to reduce fetal and neonatal losses. A differentiated approach to the management of different risk groups allows you to optimize existing approaches. The objective: сomparison of pregnancy results in the high perinatal risk group using the proposed monitoring algorithms and the traditional method of management in a prospective cohort study. Materials and methods. The prospective cohort study was conducted from 2016 to 2018 on the basis of the medical center LLC «Uniclinica», Medical Genetics Center «Genome», Clinic of Reproductive Genetics «Victoria», Kyiv City Maternity Hospital №2. 580 women were included in the final analysis. Exclusion criteria were: low risk (0–2) according to the adapted antenatal risk scale (Alberta perinatal health program), multiple pregnancy, critical malformations and chromosomal abnormalities of the fetus, lack of complete information about the outcome of pregnancy, lack of results of all intermediate clinical and laboratory surveys. Results. The introduction of a comprehensive differentiated approach has improved the diagnosis of late forms of growth retardation (OR 4,14 [1.42–12.09]; p=0,009), reduced the frequency of urgent cesarean sections (OR 1,61 [1,03–2,49]; p=0,046) and reduced perinatal mortality [1,09–21,3]; р=0,041) due to reduction of antenatal losses (OR 2,2 [1,06–4,378]; р=0,045). There was a significant increase in the frequency of planned cesarean sections (p<0,0001, without affecting the total number of operative deliveries) and statistically insignificant, but tendentiously clear shifts to the increase in the frequency of preterm birth between 34–37 weeks of pregnancy and intensive care unit. The latter observation can be explained by better diagnosis of threatening fetal conditions and an increase in the frequency of active obstetric tactics, which in turn affects the number of premature infants, the involvement of the neonatal service, and thus the intensification of the load on intensive. Conclusions. Adequate enhanced monitoring should combine ultrasound, cardiotocography, actography and laboratory techniques, each of which will have a clearly defined purpose in a combined approach to fetal assessment.
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Langhorne, Peter, Olivia Wu, Helen Rodgers, Ann Ashburn, and Julie Bernhardt. "A Very Early Rehabilitation Trial after stroke (AVERT): a Phase III, multicentre, randomised controlled trial." Health Technology Assessment 21, no. 54 (September 2017): 1–120. http://dx.doi.org/10.3310/hta21540.
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BackgroundMobilising patients early after stroke [early mobilisation (EM)] is thought to contribute to the beneficial effects of stroke unit care but it is poorly defined and lacks direct evidence of benefit.ObjectivesWe assessed the effectiveness of frequent higher dose very early mobilisation (VEM) after stroke.DesignWe conducted a parallel-group, single-blind, prospective randomised controlled trial with blinded end-point assessment using a web-based computer-generated stratified randomisation.SettingThe trial took place in 56 acute stroke units in five countries.ParticipantsWe included adult patients with a first or recurrent stroke who met physiological inclusion criteria.InterventionsPatients received either usual stroke unit care (UC) or UC plus VEM commencing within 24 hours of stroke.Main outcome measuresThe primary outcome was good recovery [modified Rankin scale (mRS) score of 0–2] 3 months after stroke. Secondary outcomes at 3 months were the mRS, time to achieve walking 50 m, serious adverse events, quality of life (QoL) and costs at 12 months. Tertiary outcomes included a dose–response analysis.Data sourcesPatients, outcome assessors and investigators involved in the trial were blinded to treatment allocation.ResultsWe recruited 2104 (UK,n = 610; Australasia,n = 1494) patients: 1054 allocated to VEM and 1050 to UC. Intervention protocol targets were achieved. Compared with UC, VEM patients mobilised 4.8 hours [95% confidence interval (CI) 4.1 to 5.7 hours;p < 0.0001] earlier, with an additional three (95% CI 3.0 to 3.5;p < 0.0001) mobilisation sessions per day. Fewer patients in the VEM group (n = 480, 46%) had a favourable outcome than in the UC group (n = 525, 50%) (adjusted odds ratio 0.73, 95% CI 0.59 to 0.90;p = 0.004). Results were consistent between Australasian and UK settings. There were no statistically significant differences in secondary outcomes at 3 months and QoL at 12 months. Dose–response analysis found a consistent pattern of an improved odds of efficacy and safety outcomes in association with increased daily frequency of out-of-bed sessions but a reduced odds with an increased amount of mobilisation (minutes per day).LimitationsUC clinicians started mobilisation earlier each year altering the context of the trial. Other potential confounding factors included staff patient interaction.ConclusionsPatients in the VEM group were mobilised earlier and with a higher dose of therapy than those in the UC group, which was already early. This VEM protocol was associated with reduced odds of favourable outcome at 3 months cautioning against very early high-dose mobilisation. At 12 months, health-related QoL was similar regardless of group. Shorter, more frequent mobilisation early after stroke may be associated with a more favourable outcome.Future workThese results informed a new trial proposal [A Very Early Rehabilitation Trial – DOSE (AVERT–DOSE)] aiming to determine the optimal frequency and dose of EM.Trial registrationThe trial is registered with the Australian New Zealand Clinical Trials Registry number ACTRN12606000185561, Current Controlled Trials ISRCTN98129255 and ISRCTN98129255.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 54. See the NIHR Journals Library website for further project information. Funding was also received from the National Health and Medical Research Council Australia, Singapore Health, Chest Heart and Stroke Scotland, Northern Ireland Chest Heart and Stroke, and the Stroke Association. In addition, National Health and Medical Research Council fellowship funding was provided to Julie Bernhardt (1058635), who also received fellowship funding from the Australia Research Council (0991086) and the National Heart Foundation (G04M1571). The Florey Institute of Neuroscience and Mental Health, which hosted the trial, acknowledges the support received from the Victorian Government via the Operational Infrastructure Support Scheme.
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Rosenberg, Ted, Patrick Montgomery, Vikki Hay, and Rory Lattimer. "Using frailty and quality of life measures in clinical care of the elderly in Canada to predict death, nursing home transfer and hospitalisation - the frailty and ageing cohort study." BMJ Open 9, no. 11 (November 2019): e032712. http://dx.doi.org/10.1136/bmjopen-2019-032712.
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ObjectiveTo assess the value of using frailty measures in primary care for predicting death, nursing home transfer (NHT) and hospital admission.DesignCohort study.Setting and participantsAll 380 people, mean age 88.4, living in the community and receiving home-based primary geriatric care from one practice in Victoria, Canada.Interventions/measurementsA 60 min baseline assessment which included: Clinical Frailty Scale (CFS), EuroQol EQ-5D-5L (EQ-5D), EuroQol Visual Analogue Scale (EQ-VAS) and Gait Speed (Gaitspeed).OutcomesDeath, NHT and hospital admission.ResultsDuring 18 months of follow-up, there were 39 (10.3%) deaths, 48 (12.6%) NHTs and 93 (24.5%) individuals admitted to hospital. All three outcomes were predicted by: CFS Level 6+7/4+5 (HR death 5.92, 95% CI 3.12 to 11.22, NHT 6.00, 95% CI 3.37 to 10.66 and hospital admission 2.92, 95% CI 1.93 to 4.40); EQ-5D Quintile 1/Quintile 5 (death 6.26, 95% CI 2.11 to 18.62; NHT 3.18, 95% CI 1.29 to 7.82 and hospital admission 2.94, 95% CI 1.47 to 5.87); EQ-VAS Q1/Q5 (death 7.0, 95% CI 2.34 to 20.93; NHT 3.38, 95% CI 1.22 to 9.35 and hospital admission 6.69, 95% CI 3.20 to 13.99) and Gaitspeed (death 5.87, 95% CI 1.78 to 19.34; NHT 8.51, 95% CI 3.18 to 22.79 and hospital admission 11.05, 95% CI 5.45 to 22.40). Medical diagnoses, multiple comorbidities and polypharmacy were weaker predictors of these outcomes. Cox regression analyses showed CFS (adjusted HR 2.88, 95% CI 1.23 to 6.68), EQ-VAS (0.96, 95% CI 0.93 to 0.98), estimated glomerular filtration rate (0.97, 95% CI 0.95 to 1.00) and haemoglobin (0.97, 95% CI 0.94 to 0.99) were independently associated with death. Gaitspeed (0.13, 95% CI 0.03 to 0.57), Geriatric Depression Scale (1.39, 95% CI 1.07 to 1.82) and dementia diagnosis (4.61, 95% CI 1.86 to 11.44) were associated with NHT. Only CFS (1.75, 95% CI 1.21 to 2.51) and EQ-VAS (0.98, 95% CI 0.96 to 0.99) were associated with hospital admission. No other diagnoses, polypharmacy nor multiple comorbidities predicted these outcomes.ConclusionsFor elderly people, standardised simple measures of frailty and health status were stronger predictors of death, NHT and hospital admission than medical diagnoses. Consideration should be given to adding these measures into usual medical care for this age group.
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Considine, Julie, Maryann Street, Mari Botti, Bev O'Connell, Bridie Kent, and Trisha Dunning. "Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care." Australian Health Review 39, no. 4 (2015): 387. http://dx.doi.org/10.1071/ah14106.
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Objective The aim of the present study was to examine the timing and outcomes of patients requiring an unplanned transfer from subacute to acute care. Methods Subacute care in-patients requiring unplanned transfer to an acute care facility within four Victorian health services from 1 January to 31 December 2010 were included in the study. Data were collected using retrospective audit. The primary outcome was transfer within 24 h of subacute care admission. Results In all, 431 patients (median age 81 years) had unplanned transfers; of these, 37.8% had a limitation of medical treatment (LOMT) order. The median subacute care length of stay was 43 h: 29.0% of patients were transferred within 24 h and 83.5% were transferred within 72 h of subacute care admission. Predictors of transfer within 24 h were comorbidity weighting (odds ratio (OR) 1.1, P = 0.02) and LOMT order (OR 2.1, P < 0.01). Hospital admission occurred in 87.2% of patients and 15.4% died in hospital. Predictors of in-hospital mortality were comorbidity weighting (OR 1.2, P < 0.01) and the number of physiological abnormalities in the 24 h preceding transfer (OR 1.3, P < 0.01). Conclusions There is a high rate of unplanned transfers to acute care within 24 h of admission to subacute care. Unplanned transfers are associated with high hospital admission and in-hospital mortality rates. What is known about the topic? Subacute care is becoming a high acuity environment where many patients are at significant risk of clinical deterioration. Systems for recognising and responding to deteriorating patients are well developed in acute care, but still developing in subacute care. What does this paper add? This is the first Australian multisite study of clinical deterioration in patients situated in subacute care facilities. One-third of unplanned transfers occur within 24 h of admission to subacute care. Patients who require unplanned transfer from subacute to acute care have unexpectedly high hospital admission rates and high in-hospital mortality rates. The frequency and completeness of physiological monitoring preceding transfer was low. What are the implications for practitioners? Patients in subacute care require regular physiological assessment and early escalation of care if there are physiological abnormalities. Risk of clinical deterioration should be a factor in the decision to admit patients to subacute care after an acute illness or injury. There is a need to improve systems for recognising and responding to deteriorating patients in subacute care settings.
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Ryland, Georgina L., Lucy C. Fox, Ella Thompson, Graham John Lieschke, David Hughes, Francoise Marie Mechinaud, Anthea Louise Greenway, et al. "Providing Diagnoses in Bone Marrow Failure Syndromes through Multimodal Comprehensive Genomic Evaluation and Multidisciplinary Care: The Melbourne Genomics Health Alliance Bone Marrow Failure Flagship." Blood 132, Supplement 1 (November 29, 2018): 3867. http://dx.doi.org/10.1182/blood-2018-99-114410.
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Abstract Background and Aims The detection of sequence variants and copy number changes can improve diagnosis, inform prognosis and guide treatment in patients with bone marrow failure syndromes (BMFS). We aimed to establish and prospectively assess the impact of comprehensive genomic evaluation on diagnostic categorisation and clinical outcomes in patients with genomically uncharacterised BMFS. Methods Eligible patients were recruited from four participating institutions across Victoria, Australia. Inclusion criteria were (i) age >3 months (ii) clinicopathological diagnosis or suspicion of either acquired aplastic anaemia (AA), inherited BMFS, hypoplastic myelodysplastic syndrome (hMDS) or a BMFS with marrow hypoplasia/aplasia not able to be definitively categorised. Patients initially underwent 90-gene targeted sequencing (Peter MacCallum Cancer Centre PanHaem and Myeloid Amplicon next generation sequencing [NGS] panels) for rapid turnaround of accredited results for clinical decision-making. In addition, whole exome sequencing (WES), whole genome copy number analysis, NGS T-cell receptor β (TRB) repertoire assessment and longitudinal monitoring of selected mutations by digital droplet PCR (ddPCR) were performed. All patients received pre-test counselling and assessment. Genomic results were reviewed in centralised multidisciplinary case conferences including the treating clinician, molecular haematopathologists, medical scientists, clinical geneticists and genetic counsellors. Results 100 patients were enrolled. Median age was 25 years (range 3 months - 80 years); 39% were under 18 years. Detection of sequence variants or copy number abnormalities led to or confirmed a diagnosis of either an inherited or acquired BMFS in 36 patients. In 17 patients a diagnosis of an inherited BMFS was positively made by detection of pathogenic sequence variants or copy number changes in FANCA(1 patient [pt]), FANCM(1 pt), FANCI(1 pt), RAD51C(1 pt), HAX1(1 pt), SBDS(1 pt), DNAJC21(1 pt), RPS19(5 pts), RPL35A(1 pt), TERT(1 pt), TINF2(1 pt) and SAMD9L(1 pt). In five patients the clinical BMFS was considered undifferentiated without a clear candidate gene suspected on phenotypic features prior to genomic evaluation. Importantly, an established diagnosis of AA was altered to an inherited BMFS by genomic characterisation in two patients (SAMD9L, FANCA). In 19 patients pathogenic sequence variants or copy number changes were detected either leading to or confirming a diagnosis of an acquired BMFS (paroxysmal nocturnal haemoglobinuria, hMDS or AA). Pathogenic sequence variants were detected in TET2(n=5), RUNX1(n=4), ASXL1(n=3), PIGA(n=3), DNMT3A(n=3),CBL(n=2), and BCOR/IDH2/SF3B1/SRSF2/TP53/U2AF1(n=1 each). Sequencing-detected copy number abnormalities included loss of chromosome 7 (n=6), losses on chromosome 5q (n=2) and copy number loss of ETV6(n=2). Longitudinal monitoring of an acquired truncating RUNX1 mutation by ddPCR resulted in one patient undergoing allogeneic bone marrow transplant for a progressively rising allelic burden. There was a trend towards more restricted TRB diversity in patients with genomically-defined acquired BMFS versus inherited BMFS (normalised Shannon index ≤0.85, 36.4% vs 0%, p=0.09). Conclusion We have established and evaluated a model of comprehensive multimodal genomic characterisation and multidisciplinary care for 100 patients with BMFS. Our results demonstrate a significant contribution to diagnostic categorisation and patient care in this area of clinical need. Disclosures Lieschke: CSL Behring Australia: Consultancy. Tam:Janssen: Honoraria, Research Funding; Gilead: Honoraria; AbbVie: Honoraria, Research Funding; Pharmacyclics: Honoraria, Travel funding; Pharmacyclics: Honoraria; Beigene: Honoraria, Other: Travel funding; Roche: Honoraria; Beigene: Honoraria, Other: Travel funding; Gilead: Honoraria; Roche: Honoraria; AbbVie: Honoraria, Research Funding.
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Bauer, Seth R., and Sandra L. Kane-Gill. "Outcome Assessment of Critical Care Pharmacist Services." Hospital Pharmacy 51, no. 7 (July 2016): 507–13. http://dx.doi.org/10.1310/hpj5107-507.
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Camacho, Luiz Antonio Bastos, and Haya Rahel Rubin. "Reliability of medical audit in quality assessment of medical care." Cadernos de Saúde Pública 12, suppl 2 (1996): S85—S93. http://dx.doi.org/10.1590/s0102-311x1996000600009.
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Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcome of care ranged from low to moderate (0.2 to 0.6), depending on the review item and the principal diagnoses and procedures the patients underwent. Results from several studies seem to converge on this point. Comparisons among different settings should be made with caution, given the sensitivity of agreement measurements to prevalence rates. Reliability of review methods in their current stage could be improved by combining the assessment of two or more reviewers, and by emphasizing outcome-oriented events.
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McBryde, Emma S., Judy Brett, Philip L. Russo, Leon J. Worth, Ann L. Bull, and Michael J. Richards. "Validation of Statewide Surveillance System Data on Central Line–Associated Bloodstream Infection in Intensive Care Units in Australia." Infection Control & Hospital Epidemiology 30, no. 11 (November 2009): 1045–49. http://dx.doi.org/10.1086/606168.
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Objective.To measure the interobserver agreement, sensitivity, specificity, positive predictive value, and negative predictive value of data submitted to a statewide surveillance system for identifying central line-associated bloodstream infection (BSI).Design.Retrospective review of hospital medical records comparing reported data with gold standard according to definitions of central line–associated BSI.Setting.Six Victorian public hospitals with more than 100 beds.Methods.Reporting of surveillance outcomes was undertaken by infection control practitioners at the hospital sites. Retrospective evaluation of the surveillance process was carried out by independent infection control practitioners from the Victorian Hospital Acquired Infection Surveillance System (VICNISS). A sample of records of patients reported to have a central line-associated BSI were assessed to determine whether they met the definition of central line–associated BSI. A sample of records of patients with bacteremia in the intensive care unit during the assessment period who were not reported as having central line–associated BSI were also assessed to see whether they met the definition of central line-associated BSI.Results.Records of 108 patients were reviewed; the agreement between surveillance reports and the VICNISS assessment was 67.6% (κ = 0.31). Of the 46 reported central line–associated BSIs, 27 were confirmed to be central line–associated BSIs, for a positive predictive value of 59% (95% confidence interval [CI], 43%–73%). Of the 62 cases of bacteremia reviewed that were not reported as central line–associated BSIs, 45 were not associated with a central line, for a negative predictive value of 73% (95% CI, 60%–83%). Estimated sensitivity was 35%, and specificity was 87%. The positive likelihood ratio was 3.0, and the negative likelihood ratio was 0.72.Discussion.The agreement between the reporting of central line–associated BSI and the gold standard application of definitions was unacceptably low. False-negative results were problematic; more than half of central line–associated BSIs may be missed in Victorian public hospitals.
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Granger, Carl V., and Carol M. Brownscheidle. "Outcome Measurement in Medical Rehabilitation." International Journal of Technology Assessment in Health Care 11, no. 2 (1995): 262–68. http://dx.doi.org/10.1017/s0266462300006875.
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AbstarctThe Uniform Data System for Medical Rehabilitation (UDSmr) provides a method for uniform assessment of the severity of patient disability and the outcomes of medical rehabilitative care. The effectiveness and efficiency of medical rehabilitation services may be analyzed using the Functional Independence Measure (FIM), the functional assessment component of the UDS, and other data. Program evaluation models based on the UDSMR and the FIM are useful for measuring resource cost of disability.
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Spiridonov, V. A., L. G. Aleksandrova, V. A. Kalyanov, and R. R. Latfullina. "Medical legal assessment of medical care for tick-borne encephalitis with lethal outcome." Kazan medical journal 99, no. 4 (August 8, 2018): 678–84. http://dx.doi.org/10.17816/kmj2018-678.
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Aim. Study of regulatory and legal base according to the criminal case file submitted for expert and medico-legal assessment of a case of failure of health care in tick-borne viral encephalitis in an endemic zone.
Methods. During the research, the expert and legal analysis was performed to establish the cause-and-effect relationship between health workers’ actions and lethal outcome of tick-borne viral encephalitis on the basis of standard and legal acts of the Russian Federation. Special authors’ attention was paid to the assessment of influence of quality of preventive measures organization concerning this viral infection.
Results. Features and possible defects were studied and revealed not only at a stage of diagnosis and treatment of patients with tick-borne encephalitis, but also when taking preventive measures, taking into account the operating standard and legal base. Based on the research results the algorithm of actions during an expert legal assessment of efficiency of health care in similar cases was offered.
Conclusion. The correct expert assessment of the revealed defects of health care is possible if overcoming all complexity of interpretation of epidemiological, clinical, laboratory and morphological data.
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Gray, James E., Marie C. McCormick, Douglas K. Richardson, and Steven Ringer. "Normal Birth Weight Intensive Care Unit Survivors: Outcome Assessment." Pediatrics 97, no. 6 (June 1, 1996): 832–38. http://dx.doi.org/10.1542/peds.97.6.832.
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Rationale/Objective. Although the short-and long-term outcome of low birth weight neonatal intensive care unit (NICU) survivors has been extensively studied, much less information is available for normal birth weight (NBW) infants (greater than or equal to 2500 g) who require NICU care. Methods. To address this issue, we retrospectively examined the neonatal hospitalizations and 6-month health status of 521 consecutive NBW admissions to a single NICU. Information on the neonatal hospitalization was obtained from a review of medical records. Postdischarge health status was collected by using telephone survey techniques. Results. NBW infants comprised 88.1% of births in this hospital and 35.4% of NICU admissions during the study period. The in-hospital mortality rate for this group was 2%. The median length of stay was 7.7 days (range 1 to 110 days) with median hospital charges of $5222 (range $565 to $317,820). Only 59% of infants required active intensive care therapy; the remainder received only intensive monitoring. The need for intensive therapy on admission day along with the presence of prematurity and congenital anomalies were significant predictors of hospital charges (R2 = 0.31, P < .01). After initial discharge, 10.1% of these infants required rehospitalization in the first 6 to 8 months of life. The rate of readmission among infants with congenital anomalies was over 30%. In addition to its association with neonatal resource consumption, the presence of congenital anomalies along with low 5-minute Apgar scores was associated with higher postdischarge resource use, as measured by frequency of physician visits, need for special medical items, and rate of rehospitalization (P < .05). Conclusions. NBW infants represent a significant percentage of NICU admissions, but for many of these patients NICU admission could be avoided if alternative care settings that provided intensive monitoring were available. In addition, these infants also incur higher rates of postdischarge use of medical care.
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Ravi, K., TM Maithili, David Mathew Thomas, and Sphoorti P. Pai. "Bacteriological profile and outcome of Ventilator associated pneumonia in Intensive care unit of a tertiary care centre." Asian Journal of Medical Sciences 8, no. 5 (August 31, 2017): 75–79. http://dx.doi.org/10.3126/ajms.v8i5.17630.
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Background: Ventilator associated pneumonia (VAP) complicates the course of 8-28% of patients receiving mechanical ventilation. Appropriate antimicrobial treatment significantly improves the outcome. Hence rapid identification of infected patients and accurate selection of antimicrobials are important clinical goals.Aims and Objectives: The present study was conducted with an aim to know the outcome of VAP and to identify pathogens, compare the bacteriological profile, duration of mechanical ventilation and length of hospitalization.Materials and Methods: Sixty patients who developed VAP during our study period of 2 years were included after meeting inclusion and exclusion criteria. Study was conducted in Victoria hospital and Bowring & Lady Curzon hospitals attached to Bangalore Medical College and Research institute.Results: Majority of patients were in the age group of 21-40 years. The occurrence of late VAP was 70 %. Klebsiella was the most common organism isolated in our study. Mortality was 13.3%. Average duration of intubation was 13.1±6.6days. Duration of hospital stay was 16.2±7.1 days.Conclusion: Our study concluded that occurrence of late VAP was more common than early VAP. Targeted strategies aimed at preventing VAP should be implemented to improve patient outcome and length of hospitalisation. Above all utmost importance must be given to prevent VAP. Asian Journal of Medical Sciences Vol.8(5) 2017 75-79
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Farris, Karen B., and Duane M. Kirking. "Assessing the Quality of Pharmaceutical Care II. Application of Concepts of Quality Assessment from Medical Care." Annals of Pharmacotherapy 27, no. 2 (February 1993): 215–23. http://dx.doi.org/10.1177/106002809302700218.
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Objective To present a framework that facilitates quality assessment of pharmaceutical care (PC) so that the profession and the public may identify pharmacists in ambulatory settings who provide quality care in all aspects of their practices. Data Sources A MEDLINE search augmented by a review of International Pharmacy Abstracts was used to identify pertinent quality assessment and pharmacy practice literature; indexing terms included quality assurance, healthcare, pharmacists, community pharmacy services, ambulatory, pharmacy, and process and outcome assessment. Study Selection All identified quality assessments of community pharmacy practice were considered. Studies that documented the effectiveness of specific pharmacist activities and patient satisfaction were also included. Data Extraction The literature was independently reviewed by the primary author. Data Synthesis The structure–process–outcome paradigm is presented as a framework for quality assessment of PC. Structure should be assessed at periodic intervals because it identifies the potential for the provision of quality care. Process, the care that pharmacists provide, must be documented and linked to outcomes before either structure or process can be used to make inferences about the quality of PC. Technical and interpersonal processes should be examined. Outcomes require an interdisciplinary approach that not only considers other medical care inputs but also recognizes the psychologic, economic, and social factors that affect health status and quality of life. Process and outcome must both be assessed to distinguish the contribution of pharmacists from that of other healthcare providers. Examples of criteria are provided and a model to integrate PC within the healthcare system is discussed. Conclusions It is pharmacists’ duty to ensure that patients receive an acceptable level of PC. The structure-process-outcome paradigm provides a framework to identify and link pharmacists’ processes with patients’ outcomes.
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Suljic, Enra, Admir Mehicevic, and Aida Gavranovic. "Stroke Emergency Medical Care: Initial Assessment, Risk Factors, Triage and Hospitalization Outcome." Materia Socio Medica 25, no. 2 (2013): 83. http://dx.doi.org/10.5455/msm.2013.25.83-87.
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Bontsevich, Roman, Yulia Kirienko, Viktoriya Bogatova, Elena Milutina, Vladimir Kovalenko, Aleksandra A. Melnichenko, Galina Batishcheva, Natalia Goncharova, and Andrey Agapov. "Assessment of senior medical care majors’ knowledge in antimicrobial chemotherapy." Research Results in Pharmacology 4, no. 4 (December 18, 2018): 107–13. http://dx.doi.org/10.3897/rrpharmacology.4.31960.
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Introduction: The resistance of microorganisms to antimicrobials has been gradually increasing since 2011 and is now recognized by the World Health Organization as a global biological threat. Causes of antimicrobial resistance must be actively addressed. Healthcare workers’ awareness of rational antimicrobial prescribing practices is of great importance. The increasing relevance of this issue is considered within this study, which started in 2014. Materials and methods: The article represents the results of anonymous prospective surveys within the framework of the KANT multi-centered research project aimed at assessing students’ knowledge of rational antimicrobial prescribing practices also known as “antimicrobial stewardship”. The survey involved 309 Medical Care majors in their fifth- and sixth- years in two Russian regional centers: Belgorod and Voronezh. The answers to four main questions of the survey were analyzed in this work. Results and discussion: According to the survey, 51.5% of the respondents properly identified a pharmacological group of an antimicrobial; 79.3% of the students would change an antibiotic if the desired therapeutic outcome was not achieved within two or three days of treatment; 29.8% of the students believed that an antimicrobial substitution was required even when a positive therapeutic outcome was achieved; and nobody could correctly identify all the proposed pharmacologically irrational combinations of antimicrobials. Conclusions: The survey showed that senior medical students have insufficient knowledge in antimicrobial stewardship. Appropriate use of antibiotics and antimicrobial prescribing practices need to be considered more thoroughly in Pharmacology, Clinical Pharmacology and Medical Care curricula. Likewise, educational activities on antimicrobial stewardship and best prescribing practices are of great importance for students as they will help with improving the knowledge of future doctors.
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Ponsford, Jennie, John Olver, Michael Ponsford, and Michael Schönberger. "Two-Year Outcome Following Traumatic Brain Injury and Rehabilitation: A Comparison of Patients From Metropolitan Melbourne and Those Residing in Regional Victoria." Brain Impairment 11, no. 3 (December 1, 2010): 253–61. http://dx.doi.org/10.1375/brim.11.3.253.
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AbstractBackground and Objective:Victoria's trauma management system provides acute care and rehabilitation following traumatic brain injury (TBI), with care of more complex injuries generally provided in specialist centres in metropolitan Melbourne. Little is known about how the outcomes of TBI survivors living in metropolitan Melbourne compare to those who reside in regional Victoria once they return to their community, where support services may be less available. The aim of the present study was to compare, in TBI individuals who have been treated at an inner-city rehabilitation centre in Melbourne, the long-term outcomes of those who live in metropolitan Melbourne (termed ‘Metro’) with those who reside in regional Victoria, termed ‘Regional.’Design and participants:Comparative study with quantitative outcome measures. A total of 959 patients, of whom 645 were designated ‘metro’ and 314 ‘regional’, were followed-up routinely at 2 years post-injury.Outcome measures:Structured Outcome Questionnaire, Glasgow Outcome Scale — Extended, Sickness Impact Profile, Craig Handicap Assessment and Reporting Technique, Hospital Anxiety and Depression Scale, Alcohol Use Disorders Identification Test and Drug Abuse Screening Test.Results:Few differences in outcomes were found between groups. However, after controlling for group differences in age and injury severity, some non-significant trends were suggestive of better outcomes in terms of less social isolation and anxiety and fewer dysexecutive behaviours in regional dwellers.Conclusions:These findings suggest that outcomes in patients from regional areas are at least as good as those from metropolitan Melbourne.
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Hoare, Connie D., Dickran A. Malatjalian, Bernard W. Badley, Joseph J. Sidorov, and C. Noel Williams. "Acute Fatty Liver of Pregnancy: A Review of Maternal Morbidity in 13 Patients Seen Over 12 Years in Nova Scotia." Canadian Journal of Gastroenterology 8, no. 2 (1994): 81–87. http://dx.doi.org/10.1155/1994/357397.
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OBJECTIVE: To review the maternal and fetal survival in all cases of acute fatty liver of pregnancy seen by the Division of Gastroenterology at Grace Maternity Hospital and the Victoria General Hospital from 1979-91.DESIGN: A retrospective review of the clinical data obtained from the medical charts of 13 patients with a liver biopsy-based histopathological diagnosis of acute fatty liver of pregnancy.SETTING: Grace Maternity Hospital, a tertiary care centre serving d1e Atlantic provinces. Twelve patients were subsequently transferred to Victoria General Hospital for postpartum management in the setting of the medical intensive care unit.MAIN OUTCOME MEASURES: Classically, acute fatty liver of pregnancy is complicated by over 70% maternal and fetal mortality rate. Recent reports have indicated significantly improved maternal and fetal survival because of more awareness, improved management and the identification of milder forms of the disease.RESULTS: In this study of 13 cases of acute fatty liver of pregnancy, maternal survival was 100% and fetal survival was 93%.CONCLUSION: The excellent maternal and fetal survival in this series is attributed co awareness, close collaboration between obstetricians and gastroenterologists, prompt diagnosis and delivery and the management of postpartum patients in an intensive care unit setting.
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Kaplow, M., S. Charest, N. Mayo, and S. Benaroya. "Managing Patient Length of Stay Better Using an Appropriateness Tool." Healthcare Management Forum 11, no. 2 (July 1998): 13–16. http://dx.doi.org/10.1016/s0840-4704(10)60640-0.
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A multidisciplinary group from two medical floors at the Royal Victoria Hospital chose the Managed Care Appropriateness Program (MCAP) to evaluate the appropriateness of the days of stay for their patients. Of 100 charts of consecutive patients examined by the nurse reviewer (comprising 1,095 patient days), 33 percent of the days were deemed inappropriate. The reasons for each of these inappropriate days were documented, and strategies were implemented to address the issues. The major outcome of the study was a change in the culture of the health professionals to a more positive approach to defining and carrying out efficient patient care.
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Nakajima, Nobuhisa. "Palliative Care Outcome Scale Assessment for Cancer Patients Eligible for Palliative Care: Perspectives on the Relationship between Patient-Reported Outcome and Objective Assessments." Current Oncology 29, no. 10 (September 28, 2022): 7140–47. http://dx.doi.org/10.3390/curroncol29100561.
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(1) Background: The importance of patient-reported outcome (PRO), i.e., prioritizing patient voice, has increased in cancer treatment, as well as palliative and supportive settings. The Integrated Palliative Care Outcome Scale (IPOS), a hybrid evaluation consisting of “patient evaluation” (PRO) and “peer evaluation” by medical professionals, was developed as a successor version of the Support Team Assessment Schedule (STAS) in 2013 and has been utilized worldwide. The Japanese version of the IPOS (IPOS-J) was developed and released in 2019. The purpose of this study was to explore the applicability of the IPOS-J to clinical practice in the future. (2) Methods: We conducted the following two studies with terminally ill cancer patients: (i) Can an evaluation with the IPOS-J performed by medical professionals (peer evaluation) replace the STAS-J evaluation? (ii) Can the quality of palliative care improve by combining the IPOS-J patient evaluation with the peer evaluation? (3) Results: The overall intervention rate and urgent intervention rate for the STAS-J and IPOS-J was 34.4 vs. 34.1% (p = 0.91) and 10.4 vs. 9.9% (p = 0.78), respectively. The patients selected “intervention required” but the medical professionals selected “no intervention required” in 47 cases. The medical team performed appropriate intervention after re-assessment. As a result, more than 70% of the patients were “intervention-free” after 1 week of intervention. (4) Conclusions: The IPOS-J peer evaluation was as useful as the STAS-J evaluation. A hybrid type of evaluation, combining patient evaluation (PRO) and peer evaluation, may help us to understand patient needs and improve the quality of palliative care.
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Pilcher, David V., Graeme Duke, Melissa Rosenow, Nicholas Coatsworth, Genevieve O’Neill, Tracey A. Tobias, Steven McGloughlin, et al. "Assessment of a novel marker of ICU strain, the ICU Activity Index, during the COVID-19 pandemic in Victoria, Australia." Critical Care and Resuscitation 23, no. 3 (September 6, 2021): 300–307. http://dx.doi.org/10.51893/2021.3.oa7.
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OBJECTIVES: To validate a real-time Intensive Care Unit (ICU) Activity Index as a marker of ICU strain from daily data available from the Critical Health Resource Information System (CHRIS), and to investigate the association between this Index and the need to transfer critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic in Victoria, Australia. DESIGN: Retrospective observational cohort study. SETTING: All 45 hospitals with an ICU in Victoria, Australia. PARTICIPANTS: Patients in all Victorian ICUs and all critically ill patients transferred between Victorian hospitals from 27 June to 6 September 2020. MAIN OUTCOME MEASURE: Acute interhospital transfer of one or more critically ill patients per day from one site to an ICU in another hospital. RESULTS: 150 patients were transported over 61 days from 29 hospitals (64%). ICU Activity Index scores were higher on days when critical care transfers occurred (median, 1.0 [IQR, 0.4–1.7] v 0.6 [IQR, 0.3–1.2]; P < 0.001). Transfers were more common on days of higher ICU occupancy, higher numbers of ventilated or COVID-19 patients, and when more critical care staff were unavailable. The highest ICU Activity Index scores were observed at hospitals in north-western Melbourne, where the COVID-19 disease burden was greatest. After adjusting for confounding factors, including occupancy and lack of available ICU staff, a rising ICU Activity Index score was associated with an increased risk of a critical care transfer (odds ratio, 4.10; 95% CI, 2.34–7.18; P < 0.001). CONCLUSIONS: The ICU Activity Index appeared to be a valid marker of ICU strain during the COVID-19 pandemic. It may be useful as a real-time clinical indicator of ICU activity and predict the need for redistribution of critical ill patients.
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Hatton, Jessica, Rachel Chandra, David Lucius, and Elizabeth Ciuchta. "Patient Satisfaction of Pharmacist-Provided Care via Clinical Video Teleconferencing." Journal of Pharmacy Practice 31, no. 5 (July 13, 2017): 429–33. http://dx.doi.org/10.1177/0897190017715561.
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Purpose: Patient satisfaction with the use of telehealth in disease state management provided by pharmacists has not been fully studied. We hypothesized that patient satisfaction with pharmacist-provided consultations via clinical video teleconferencing (CVT) would not differ from face-to-face delivery. Methods: Patients were recruited from 2 primary care provider sites from September 2015 to May 2016. Patients completed a survey to evaluate their satisfaction and quality of provider–patient communication with the method in which consultation with a pharmacist was provided. The survey was a 10-item, patient self-reported questionnaire. The primary outcome evaluated patients’ scores on assessment of the provider’s use of patient-centered communication. The secondary outcome evaluated patients’ scores on assessment of the provider’s clinical competence and skills and interpersonal skills. Results: There were a total of 57 surveys collected. For both the primary outcome and secondary outcome, over 80% of collected responses for each question in both clinics were scored a 5 that indicates patients were very satisfied with the provider’s use of patient-centered communication and clinical competence and skills. For both the primary and secondary outcomes, there were no statistically significant differences in patients’ scores that assessed provider’s use of patient-centered communication nor the provider’s clinical competence and skill. Conclusion: The results of this study indicate patients are satisfied with pharmacists’ use of patient-centered communication and clinical competence and skills via both CVT and face-to-face consultations supporting our research hypothesis that patient satisfaction with care provided via CVT did not differ from face-to-face provided care.
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Tetzlaff, John E., and David C. Warltier. "Assessment of Competency in Anesthesiology." Anesthesiology 106, no. 4 (April 1, 2007): 812–25. http://dx.doi.org/10.1097/01.anes.0000264778.02286.4d.
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Assessment of competency in traditional graduate medical education has been based on observation of clinical care and classroom teaching. In anesthesiology, this has been relatively easy because of the high volume of care provided by residents under the direct observation of faculty in the operating room. With the movement to create accountability for graduate medical education, there is pressure to move toward assessment of competency. The Outcome Project of the Accreditation Council for Graduate Medical Education has mandated that residency programs teach six core competencies, create reliable tools to assess learning of the competencies, and use the data for program improvement. General approaches to assessment and how these approaches fit into the context of anesthesiology are highly relevant for academic physicians.
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Saral, Swati, and Pawan Ghanghoria. "Assessment of developmental outcome of neonatal seizures at NICU of tertiary care centre hospital." International Journal of Contemporary Pediatrics 4, no. 1 (December 21, 2016): 100. http://dx.doi.org/10.18203/2349-3291.ijcp20164586.
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Background: Seizures are relatively common among first month of life. New-born with neonatal seizures are at risk of developmental delay. The objective of this study was to assess the developmental outcome of neonatal seizures and to study the factors associated with delayed developmental outcome in neonatal seizures.Methods: A prospective observational Study was conducted in 71 term and preterm neonates with documented seizure admitted in Medical college hospital, Jabalpur. A predesigned pretested questionnaire was used. The face to face interview technique was used for collection of data by mother, followed by clinical examination of newborn and investigations were done. DDST II was used for developmental assessment of neonates. Results: Neonates with delayed developmental outcome are 42.62%. Delayed developmental outcome is significantly associated with male sex, low birth weight, prematurity and multiple frequencies of seizures.Conclusions: The delayed developmental outcome was high among neonatal seizures.
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Zunaira Javed, Syed Usman Masood, and Javed Laal. "Outcome of acute bacterial meningitis among children in Tertiary care hospital." Professional Medical Journal 29, no. 02 (January 31, 2022): 167–71. http://dx.doi.org/10.29309/tpmj/2022.29.02.6533.
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Objective: To determine the frequency of Hemophilus Influenzae type b, streptococcus pneumonia and Niesseria Meningitidis and outcome in culture proven meningitis in children 6 months to 24 months of age admitted in children ward. Study Design: Cross Sectional Analytical study. Setting: Pediatric Medical Unit of Bahawal Victoria Hospital, Bahawalpur. Period: January 2019 to December 2019. Material & Methods: A total of 220 children of either sex with culture proven meningitis, aged 6 months to 24 months, were included in the study. Demographic characteristics, duration of fever, history of seizures, weight of child, vaccination status and bacteria isolated from Cerebrospinal Spinal Fluid (CSF) and outcome were analyzed. Confidentiality of data was maintained and it was assured that no harm to the participants will be done. The outcome in the form of mortality was noted during the first 10 days of hospital stay. There was no conflict of interest among the authors and study was self-funded. Results: Amongst a total of 220 children, 123 (55.9%) were male. There were 130 (59.1%) children who were less than or equal to 1 year of age. There were 154 (70.0%) children who were having a weight of 7 to 10 kg. Vaccination status showed that, 111 (50.5%) were fully vaccinated, 59 (26.8%) partially vaccinated and 50 (22.7%) not vaccinated. Duration of fever revealed that, 141 (64.1%) had fever for more than 5 days. There were 139 (63.2%) children who had a history of seizures. Streptococcus pneumonia was the commonest bacteria found in 110 (50%) children followed by Neisseria meningitides 53 (24.1%), H. Influenza 37 (16.8%). Overall mortality was noted in 34 (15.5%) children. Conclusion: In children with bacterial meningitis, mortality was high and most common bacteria were found to be S.pneumoniae followed by H.influenzae.
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Bergman, David A. "Thriving in the 21st Century: Outcome Assessment, Practice Parameters, and Accountability." Pediatrics 96, no. 4 (October 1, 1995): 831–35. http://dx.doi.org/10.1542/peds.96.4.831.
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The past two decades have brought about major health care changes that have been driven by an ever-increasing cost of health care, practice variability, and medical malpractice litigation. These changes pose a challenge to pediatricians to contain costs, to reduce inappropriate use of health care services, and to demonstrate improved health care outcomes. To meet this challenge, a new "clinical tool kit" is required, one that will allow the pediatrician to analyze current practices and to document effective interventions. Two of the major tools in this kit are practice guidelines and outcomes assessment instruments. Practice guidelines are optimal care specifications that provide an analytic framework for defining high-quality care and measuring health care outcomes. Ideally, these guidelines should be developed from scientific evidence. In practice, however, scientific evidence to support the majority of recommendations made in guidelines is insufficient. Consequently, these recommendations are instead developed by expert consensus. Measurement of health outcomes includes clinical outcomes, patient satisfaction, cost and use, and quality of life. Health care organizations have become very sophisticated in measuring cost and use, but considerably less work has been done in the patient-centered areas of satisfaction and quality of life. This is particularly true for children, because measures are dependent on the viewpoint chosen (parent, child, or teacher), the age of the child, and the adjustment for severity of illness. Analyzing practice patterns and improving health outcomes will not be easy tasks to accomplish. For the pediatrician to use these tools in an efficient and effective manner, a new research agenda and new skills will be required.
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Dhondt, E. L., F. Van utterbeek, C. Ullrich, and M. Debacker. "(A145) Simulation for the Assessment and Optimization of Medical Disaster Management." Prehospital and Disaster Medicine 26, S1 (May 2011): s41—s42. http://dx.doi.org/10.1017/s1049023x11001464.
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BackgroundThe ultimate goal of medical disaster management must be to predictably orchestrate transition from “standard of care” to “sufficiency of care” using evidence-based methods. However, neither descriptive reports of disaster responses nor epidemiological studies investigating disaster risk factors have been able to provide validated outcome measures as to what constitutes a “good” disaster response. Moreover, it either has been considered impossible, ethically inappropriate, or both, to identify experimental and control groups essential for hypothesis testing for the conduct of scientific randomized controlled clinical trials.ObjectiveThe aim of this study was to identify a number of performance and outcome indicators and define optimal disaster response and management decision-making for various disaster scenarios using simulation optimization.Methods and ResultsA system model of medical disaster management was designed, and victim models and performance and outcome indicators were developed. Various mass-casualty and large-scale disaster scenarios were developed, including: (1) a hospital emergency incident/disaster; (2) a CBRNE incident; (3) an airplane crash and airport disaster; (4) a mass gathering; and (5) a military battlefield mass casualty. Using “Discrete Event Driven Simulation”, multiple replications were made for different decision-making modalities, different resource allocations, and different disaster response procedures. Statistical analysis and optimization techniques were applied to achieve the best available setting of parameters of the simulation model. In such a way, the “Medical Disaster Management Simulator” runs the “missing experimental studies” in a simplified artificial simulated disaster environment.ConclusionsSimulation optimization is an adequate tool for judging and evaluating the effectiveness and adequacy of health and relief services provided during disaster medical response. Evidence-based recommendations and codes of best practice were formulated for optimal medical disaster and military battlefield management in different large-scale event scenarios as well as for teaching, training, and research in medical disaster management.
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Hall, J. R. "Critical-care medicine and the acute-care laboratory." Clinical Chemistry 36, no. 8 (August 1, 1990): 1552–56. http://dx.doi.org/10.1093/clinchem/36.8.1552.
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Abstract Critical-care medicine today is practiced by anesthesiologists, internists, pediatricians, and surgeons. Outcome from today's management of critically ill patients is very good, yet associated costs are very high. Over one-half of the hospital costs of critically ill patients emanates from the intensive-care unit (ICU), although the ICU stay accounts for less than 20% of their time in the hospital. Outside of the operating room, the ICU is the most expensive location for patient care in the hospital, and laboratory tests are the most expensive single item. Plans for cost containment should incorporate the following: more effective data management, education of practitioners about appropriateness and costs of tests, conversion from laboratory measurements to appropriate in vivo and ex vivo measurements, and real-time utilization assessment. To provide high-quality, cost-effective critical care in the future, laboratorians and clinicians must work together today to meet the challenges of technology, data management, and staff education.
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Hoodless, Mary, and Frank Evans. "The Multipurpose Service Program: The Best Health Service Option for Rural Australia." Australian Journal of Primary Health 7, no. 1 (2001): 90. http://dx.doi.org/10.1071/py01015.
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Small relatively isolated rural communities in Australia have been provided with the opportunity to address the difficulties surrounding the provision of health services. The Multi Purpose Services (MPS) program was initiated in 1991 when it was identified that small rural communities have been disadvantaged by separated Commonwealth and state funding arrangements and the criteria for these arrangements where services were often unable to be sustained separately. The MPS program provided the opportunity for sustainability through flexibility and pooling of resources. The application of a primary health care framework would enable more community consultation and participation in reorientating rural health services. Upper Murray Health and Community Services (UMH&CS), a small rural health service in North East Victoria, embraced the concept and undertook a rigorous Evidence Based Needs Assessment to reorientate its health service. The needs assessment combined a sociodemographic, epidemiological and community consultative approach. Evidence of best practice was identified and the recommendations were used for ongoing service development. UMH&CS represents a highly integrated health service and as such a number of strategies are used to enable the continuum of care. These include point of contact advocacy, continuum and coordination of care and the use of a standardised multidisciplinary assessment and outcome based care plan. This paper expands on these processes and the opportunities the MPS has provided to address the health needs of small rural communities.
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Perez, David J., Sheila Williams, and Jenny Morris. "Is longitudinal functional assessment of cancer therapy-general a useful outcome measure for palliative cancer care?" Clinical Therapeutics 25 (January 2003): D24—D25. http://dx.doi.org/10.1016/s0149-2918(03)80260-6.
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Renzaho, Andre. "Re-visioning cultural competence in community health services in Victoria." Australian Health Review 32, no. 2 (2008): 223. http://dx.doi.org/10.1071/ah080223.
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There are few studies exploring the need to develop and manage culturally competent health services for refugees and migrants from diverse backgrounds. Using data from 50 interviews with service providers from 26 agencies, and focus group discussion with nine different ethnic groups, this paper examines how the Victorian state government funding and service agreements negatively impact on the quest to achieve cultural competence. The study found that service providers have adopted ?one approach fits all? models of service delivery. The pressure and competition for resources to address culturally and linguistically diverse communities? needs allows little opportunity for partnership and collaboration between providers, leading to insufficient sharing of information and duplication of services, poor referrals, incomplete assessment of needs, poor compliance with medical treatment, underutilisation of available services and poor continuity of care. This paper outlines a model for cultural consultation and developing needs-led rather than serviceled programs.
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Bloom, Bernard S. "Does It Work? The Outcomes of Medical Interventions." International Journal of Technology Assessment in Health Care 6, no. 2 (January 1990): 326–32. http://dx.doi.org/10.1017/s0266462300000854.
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The focus of this article is on contemporary roots of medical care quality measurement, while it also examines some of the most important historical precedents. Specifically, it singles out Dr. Ernest Avery Codman and his early 20th-century work emphasizing the assessment of outcome as the paramount indicator of medical care quality. The standard that he set for himself and others is the one that late 20th-century researchers must uphold, and to which we must answer.
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Spiridonov, V. A., L. G. Alexandrova, A. A. Anisimov, R. R. Latfullina, and E. V. Kulakova. "Clinical case of special legal liability which is the result of a doctor when combination of specialties." Kazan medical journal 102, no. 4 (August 8, 2021): 557–62. http://dx.doi.org/10.17816/kmj2021-557.
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We analyzed a forensic case related to an unfavorable outcome of medical care by a pediatrician. One of the reasons for the unfavorable outcome of medical care was the combination of pediatric and pediatric neurology specialties by the doctor, which, according to experts, contributed to an incorrect assessment of the severity of the childs condition and incorrect assessment of general cerebral symptoms and neurological disorders, without proper differentiation. As a result, the diagnostic was not fully provided, and more serious diseases at the time were not excluded. We determined the objective and subjective aspects of liability for combination several specialties. A medical-legal and forensic assessment of a specific unfavorable outcome of medical practice is given. It is concluded that any combination of different specialties by a doctor not only requires additional professional duties but, at the same time, creates additional legal risks in term of criminal law, which should be taken into account by each specialist who has assumed additional obligations.
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Peschel, Richard E., and Enid Peschel. "Consumerism for Neurobiological Disorders: An Assessment." International Journal of Technology Assessment in Health Care 12, no. 4 (1996): 644–56. http://dx.doi.org/10.1017/s0266462300010941.
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AbstractConsumerism is a growing phenomenon in U.S. health care, yet its exercise is still inhibited by powerful forces within the medical community. Despite the neuroscientific framework that stresses the commonalities between mental and physical illness, consumerism is even more problematic and difficult in mental health care than in other areas of health care. People with severe mental illness and their advocates must contend with limited public understanding of neurobiological disorders, poor definitions of effective treatment, and a paucity of outcome data, especially from prospective randomized and long-term studies. The only clear way for consumerism to grow in mental health care is for its advocates to align themselves with the neuroscientific revolution and to demand that effective and equitable treatment programs be created based on the documented evidence of the physical nature of neurobiological disorders.
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Persson, Erika, Christina Haines, and Mia Lang. "Parent assessment of medical student skills in ambulatory pediatrics." Canadian Medical Education Journal 4, no. 2 (September 30, 2013): e18-e27. http://dx.doi.org/10.36834/cmej.36608.
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Background: Partnership with parents is a vital part of pediatric medical education, yet few studies have examined parent attitudes towards learners in pediatric settings. Methods: Questionnaires were used to determine parent and student assessment of professional and clinical skills (primary outcome) and parent attitudes towards 3rd year medical students (secondary outcome) at the University of Alberta. Chi Square, Kendall’s Tau and Kappa coefficients were calculated to compare parent and student responses in 8 areas: communication, respect, knowledge, listening, history taking, physical examination, supervision, and overall satisfaction. Results: Overall satisfaction with medical student involvement by parents was high: 56.7% of all parents ranked the encounter as ‘excellent’. Areas of lesser satisfaction included physician supervision of students. Compared to the parent assessment, students tended to underrate many of their skills, including communication, history taking and physical exam. There was no relationship between parent demographics and their attitude to rating any of the students’ skills. Conclusions: Parents were satisfied with medical student involvement in the care of their children. Areas identified for improvement included increased supervision of students in both history taking and physical examination. This is one of the largest studies examining parent attitudes towards pediatric students. The results may enhance undergraduate curriculum development and teaching in pediatric ambulatory clinics and strengthen the ongoing partnership between the community and teaching clinics.
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Bibi, Safia, Khanda Gul, Fozia Mohammad Bukhsh, and Palwasha Gul. "Assessment Of Perinatal Outcome Of Breech Presentation At A Tertiary Care Hospital, Quetta." Journal of Bahria University Medical and Dental College 09, no. 03 (September 4, 2019): 218–21. http://dx.doi.org/10.51985/jbumdc2018098.
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Objective: To review the mode of delivery and perinatal outcome in breech presentation in a tertiary care hospital. Study Design and Setting: Retrospective Analytical Study. Department of Obstetrics and Gynecology Unit-4, Bolan Medical Complex Hospital, Quetta, from 1st January 2012 to 31st December, 2016. Methodology: This retrospective analytical study included review of clinical records of all patients who delivered either vaginally or via caesarean section with breech presentation. Results: During the study period, 806 patients presented with breech (2.4%). Vaginal breech delivery was carried out in 71.8% patients and caesarean section was done in 28.2% patients. In vaginal breech group 30.7% patients were primigravida and 69.3% patients were multigravida. In caesarean section group 50.3% patients were primigravida and 49.7% were multigravida. Most common birth weight was between 2.5-3.5 kg in both group. Most common indication for cesarean section was breech with previous one LSCS. Conclusion: Like all vaginal births, vaginal breech delivery is not only beneficial in the chance of having a vaginal birth in future but also prevents from the complications of caesarean delivery.
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Jaison, Riya, Suja Abraham, Mary Sruthy Johny, Vasant Pk, and Lakshmi R. "ASSESSMENT OF TREATMENT OUTCOME IN TUBERCULOSIS PATIENTS APPROACHING A TERTIARY CARE TEACHING HOSPITAL." Asian Journal of Pharmaceutical and Clinical Research 11, no. 5 (May 1, 2018): 419. http://dx.doi.org/10.22159/ajpcr.2018.v11i5.25012.
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Objectives: The main objectives of the study were to determine the treatment outcome of tuberculosis (TB) patients in a tertiary care hospital, factors associated with the success of treatment, the adverse drug reactions (ADRs) associated with anti-tubercular drugs, and the causality and severity evaluation of ADRs.Methods: It was a prospective study conducted for 10 months to evaluate the treatment outcome in TB patients in a tertiary care teaching hospital in Kerala, India. A total of 101 patients were studied as per the inclusion and exclusion criteria. Treatment outcome analyzed according to the WHO guidelines, causality and severity assessment was done by Naranjo and HARTWID-SIEGEL scale, respectively. A standardized data collection form was prepared, and necessary data were collected from patient’s medical records.Results: A total of 101 patients mostly in the age group of 30–50 years were male population dominates pulmonary TB (PTB) was seen in 57 (56.43%) extra PTB in 44 (43.57%) in which pleural effusion TB was common (34.09%) other types were lymph node TB (15.74%), spine TB, TB meningitis (9.09% each), bone TB (6.481%) treatment outcome found to be success in 85 (84%) 10 (10%)treatment completed 1 (1%) died 4 were defaulters, 1 not evaluated, 82 developed ADR. On causality assessment it was possible and severity of moderate level.Conclusion: By proper management and monitoring TB can be completely cured, and most of them have a favorable outcome with current treatment, and ADR can be managed by providing proper awareness of treatment modalities/disease.
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Cole, Martin G., François J. Primeau, and L. Michel Élie. "Delirium: Prevention, Treatment, and Outcome Studies." Journal of Geriatric Psychiatry and Neurology 11, no. 3 (October 1998): 126–37. http://dx.doi.org/10.1177/089198879801100303.
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The purpose of this paper was to contribute to a new conceptual understanding of delirium by reviewing evidence related to its prevention, treatment, and outcome. The review process involved a systematic search of the literature on each topic, assessment of the validity of the studies retrieved, and examination of their results. The literature search identified 10 studies on prevention, 13 studies on treatment, and 15 studies on outcome. Most studies had methodological limitations. Abroad spectrum of interventions appeared to be modestly effective in preventing delirium in young and old surgical patients but not elderly medical patients; systematic detection and intervention programs and special nursing care appeared to add large benefits to traditional medical care in young and old surgical patients and modest benefits in elderly medical patients; haloperidol, chlorpromazine, and mianserin appeared to be useful in controlling the symptoms of delirium in both surgical and medical patients; and good levels of premorbid function seemed to be related to better outcomes. Although the above findings do not contribute to a new conceptual understanding of delirium, they do suggest directions for further research on the treatment of delirium.
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Gupta, Divya, Premlata Mital, Bhanwar Singh Meena, Devendra Benwal, Saumya, Sunita Singhal, and Richa Ainani. "Comparative assessment of fetomaternal outcome in twin pregnancy with singleton pregnancy at tertiary care centre." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 6 (May 25, 2017): 2395. http://dx.doi.org/10.18203/2320-1770.ijrcog20172319.
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Background: Multiple pregnancy remains one of the highest risk situations for the mother, foetus and neonate despite recent advances in obstetrics, perinatal and neonatal care. Twin pregnancies have increased rates of obstetric and perinatal complications compared to singletons Objective of present study was comparative assessment of fetomaternal outcome in twin pregnancy with singleton pregnancy in Obstetrics and Gynaecology Department of S.M.S. Medical College, Jaipur.Methods: This was a hospital based, prospective observational study done in the Department of Obstetrics and Gynaecology. S.M.S. Medical College, Jaipur from April 2015 to March 2016. 150 women with twin pregnancy and 150 women with singleton pregnancies at gestation age of 28 weeks and above coming for delivery and consented for the study were included in the study. Women with chronic medical disorder or chronic hypertension were excluded from the study. Maternal and neonatal outcome recorded and analysed.Results: Occurrence of twin in our study was 2.82%. Risk of preterm labour was about nine times higher in twin pregnancies than the singleton (OR: 2.74, 95% CI; 1.4494-5.1884, P value 0.001). The risk of premature rupture of membrane was increased by 2.74 times in twin pregnancies (OR:2.74; 95% CI: 1.4494-5.1884, p value .001). There was 3-time increased risk of malpresentation (OR 3.14; CI:1.7184-5.7480, p value .00002) and 2.28 times increase in hypertensive disorder (OR 2.28; 95% CI: 1.0727-4.8823, p value .03) in twin pregnancies. The risk of asphyxia and septicaemia was 2.5 times more in twins.Conclusions: Twin pregnancy is a high-risk pregnancy with more complications in mother and foetus and is a great challenge for obstetrician. So, it should be managed carefully at tertiary care centre to reduce the maternal and perinatal mortality and morbidity.
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Dutch, Martin J., and Kristy B. Austin. "Hospital in the Field: Prehospital Management of GHB Intoxication by Medical Assistance Teams." Prehospital and Disaster Medicine 27, no. 5 (July 19, 2012): 463–67. http://dx.doi.org/10.1017/s1049023x12000994.
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AbstractIntroductionRecreational use of gamma-hydroxybutyrate (GHB) is increasingly common at mass-gathering dance events in Australia. Overdose often occurs in clusters, and places a significant burden on the surrounding health care infrastructure.ObjectiveTo describe the clinical presentation, required interventions and disposition of patrons with GHB intoxication at dance events, when managed by dedicated medical assistance teams.MethodsRetrospective analysis of all patrons attending St. John Ambulance medical assistance teams at dance events in the state of Victoria (Australia), from January 2010 through May 2011.Main outcome measuresClinical presentation, medical interventions and discharge destination.ResultsSixty-one patients with GHB intoxication attended medical teams during the study period. The median age was 22 years, and 64% were male. Altered conscious state was present in 89% of attendances, and a GCS <9 in 44%. Hypotension, bradycardia and hypothermia were commonly encountered. Endotracheal intubation was required in three percent of patrons. Median length of stay onsite was 90 minutes. Ambulance transport to hospital was avoided in 65% of presentations.ConclusionsThe deployment of medical teams at dance events and music festivals successfully managed the majority of GHB intoxications onsite and avoided acute care ambulance transfer and emergency department attendance.DutchMJ,AustinKB.Hospital in the field: prehospital management of GHB intoxication by medical assistance teams.Prehosp Disaster Med.2012;27(4):1-5.
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Fønss Rasmussen, Lisa, Louise Bang Grode, Jeppe Lange, Ishay Barat, and Merete Gregersen. "Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review." BMJ Open 11, no. 1 (January 2021): e040057. http://dx.doi.org/10.1136/bmjopen-2020-040057.
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ObjectivesTo identify and synthesise available evidence on the impact of transitional care interventions with both predischarge and postdischarge elements on readmission rates in older medical patients.DesignA systematic review.MethodInclusion criteria were: medical patients ≥65 years or mean age in study population of ≥75 years; interventions were transitional care interventions between hospital and home with both predischarge and postdischarge components; outcome was hospital readmissions. Studies were excluded if they: included other patient groups than medical patients, included patients with only one diagnosis or patients with only psychiatric disorders. PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from January 2008 to August 2019. Study selection at title level was undertaken by one author; the remaining selection process, data extraction and methodological quality assessment were undertaken by two authors independently. A narrative synthesis was performed, and effect sizes were estimated.ResultWe identified 1951 records and included 11 studies: five randomised trials, four non-randomised controlled trials and two pre–post cohort studies. The 11 studies represent 15 different interventions and 29 outcome results measuring readmission rates within 7–182 days after discharge. Twenty-two of the 29 outcome results showed a drop in readmission rates in the intervention groups compared with the control groups. The most significant impact was seen when interventions were of high intensity, lasted at least 1 month and targeted patients at risk. The methodological quality of the included studies was generally poor.ConclusionTransitional care interventions reduce readmission rates among older medical patients although the impact varies at different times of outcome assessment. High-quality studies examining the impact of interventions are needed, preferably complimented by a process evaluation to refine and improve future interventions.PROSPERO registration numberCRD42019121795.
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Fønss Rasmussen, Lisa, Louise Bang Grode, Jeppe Lange, Ishay Barat, and Merete Gregersen. "Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review." BMJ Open 11, no. 1 (January 2021): e040057. http://dx.doi.org/10.1136/bmjopen-2020-040057.
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ObjectivesTo identify and synthesise available evidence on the impact of transitional care interventions with both predischarge and postdischarge elements on readmission rates in older medical patients.DesignA systematic review.MethodInclusion criteria were: medical patients ≥65 years or mean age in study population of ≥75 years; interventions were transitional care interventions between hospital and home with both predischarge and postdischarge components; outcome was hospital readmissions. Studies were excluded if they: included other patient groups than medical patients, included patients with only one diagnosis or patients with only psychiatric disorders. PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from January 2008 to August 2019. Study selection at title level was undertaken by one author; the remaining selection process, data extraction and methodological quality assessment were undertaken by two authors independently. A narrative synthesis was performed, and effect sizes were estimated.ResultWe identified 1951 records and included 11 studies: five randomised trials, four non-randomised controlled trials and two pre–post cohort studies. The 11 studies represent 15 different interventions and 29 outcome results measuring readmission rates within 7–182 days after discharge. Twenty-two of the 29 outcome results showed a drop in readmission rates in the intervention groups compared with the control groups. The most significant impact was seen when interventions were of high intensity, lasted at least 1 month and targeted patients at risk. The methodological quality of the included studies was generally poor.ConclusionTransitional care interventions reduce readmission rates among older medical patients although the impact varies at different times of outcome assessment. High-quality studies examining the impact of interventions are needed, preferably complimented by a process evaluation to refine and improve future interventions.PROSPERO registration numberCRD42019121795.
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Gunzburg, R., M. Szpalski, and J. Van Goethem. "Initial Assessment of Whiplash Patients." Pain Research and Management 8, no. 1 (2003): 24–27. http://dx.doi.org/10.1155/2003/650251.
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The article looks at how for severe trauma, the outcome of treatment depends on the initial medical care. This has now also been accepted for whiplash associated disorders, underlining the importance of a proper initial assessment. Once major injury has been excluded and the diagnosis of whiplash associated disorder has been established, the initial treatment of whiplash in the emergency room can be started. The four key points to remember are described, including reassuring the patient about evolution, no soft collar, nonsteroidal anti-inflammatory drugs and early mobilisation.
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Ruscin>, J. Mark, and Todd P. Semla. "Assessment of Medication Management Skills in Older Outpatients." Annals of Pharmacotherapy 30, no. 10 (October 1996): 1083–88. http://dx.doi.org/10.1177/106002809603001003.
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OBJECTIVE: To identify risk factors for poor medication management skills in community-dwelling older adults by using a performance-based medication management assessment instrument. DESIGN: A cross-sectional investigation. SETTING: A university outpatient geriatric assessment clinic. PARTICIPANTS: Fifty-nine community-dwelling older adults aged 62–102 years. MEASUREMENTS: Patients were assessed on their ability to perform medication management tasks, including reading prescription labels, interpreting medication instructions, opening safety-capped vials, removing tablets from vials, and differentiating tablet colors. The Mini-Mental State Examination (MMSE) was administered and the Katz index of activities of daily living was obtained during the same clinic visit. RESULTS: Cognitive impairment (MMSE <24) and physical dependency (Katz ≥1) were both found to be risk factors for the inability to perform individual tasks and independent risk factors for poor overall outcome on the medication management assessment, odds ratios (95% confidence interval) 9.39 (7.82 to 10.96) and 7.24 (5.60 to 8.88), respectively. Age, gender, education, or number of prescription medications were not associated with the ability to perform individual tasks or to overall outcome on the medication management assessment. CONCLUSIONS: Cognitive deficits and physical dependency appear to be strong predictors for the inability to perform tasks associated with medication management. Assessment of medication management skills in older adults living in the community may help identify specific problems, aid in planning patient care, and promote independence.
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SUCIU, Nicoleta, Lorena Elena MELIȚ, and Cristina Oana MĂRGINEAN. "Teaching communication in medical students – a cornerstone for patient’s outcome." Romanian Journal of Medical Practice 16, no. 2 (June 30, 2021): 143–47. http://dx.doi.org/10.37897/rjmp.2021.2.6.
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Communication is definitely one of the most important contributing factor for an ideal doctor-patient relationship. The major importance of communication is to build a proper relationship with the patients, in which the empathy and respect play an essential role and can be taught and improved with proper training. This process is defined as cross-culture communication and it has to be taught during medical school. Patient-centered communication is a concept closely related to cross-culture communication and it might be defined by the physician’s ability to tailor communication to each patient’s need and level of understanding in order to provide patient-centered care. Training of clinical communication skills in medical students is an incontestable emergency for the patient’s outcome. Medical education formerly focused on training students for solving only the medical problems by providing the treatment for their organic problems. Medical schools recently included in undergraduate curricula clinical communication courses in order to improve student’s and future physician’s the ability to obtain relevant information from their patients, to build strong doctorpatient relationships and provide patient-centered care. Various models were elaborated for teaching and assessing clinical communication skills, which were found to improve multiple aspects of physician-patient communication among which counseling, interviewing techniques and prescription. Medical schools should properly address to clinical communication skills by including training courses in each year of education focused on the specific of the learned medical fields. It is crucial for implementing proper assessment methods in order to prevent and diminish as much as possible the factors that might negatively impact the development of doctor-patient relationship. Proper medical training in terms of clinical communication skills should be initiated during medical school in all students that deal with patients, but also after the graduation, periodically in all health care providers for assuring an ideal outcome for their patients.
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MacPherson, Douglas W., Fausto Mariani, Jacqueline Weekers, and Brian D. Gushulak. "Field Epidemiology Assessment for a Medical Evacuation Programme Related to the Crisis in Kosovo, 1999." Prehospital and Disaster Medicine 15, no. 3 (September 2000): 19–24. http://dx.doi.org/10.1017/s1049023x00025140.
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AbstractIn complex human emergency (CHE)-aid situations, the international community responds to provide assistance to reduce morbidity and mortality related to environmental and civil disruptions. The political and social situation in Kosovo, in combination with the military activity from 23 March to 09 June, 1999, created a crisis associated with mass movement of the population of Kosovo into neighbouring provinces and nations. This forced migration of people seeking protection increased demands for -water, food, shelter, and health care in the refugee areas. The United Nations High Commission for Refugees (UNHCR) estimated that 771,900 ethnic Albanians, and 30,700 Serbians, Croatians, and Montenegrins had been displaced from Kosovo during this time period, and that 439,500 of these people had arrived in Albania. Given the limited health-care resources in Albania to respond to the increasing demands for health care, a field epidemiological study was conducted by the International Organization for Migration (IOM) to assess the need for a medical evacuation program from Albania related to the crisis in Kosovo. Outcome measurements in this assessment were: 1) health-care capacity and health-care utilization rates in Albania before the crisis and by the refugees during the crisis; 2) the frequency of war-related injuries; 3) the frequency of medical evacuation; 4) nature of medical conditions of the patients being evacuated; and 5) destination for medical evacuation (internal or international) during the crisis. The results of the field assessment, which gathered health outcome data during the first eight weeks of the conflict (23 March 1999 to 25 May 1999), indicated that there was a need for a specifically designed medical evacuation programme in Albania. The study demonstrated that the implementation of a medical evacuation programme must be integrated with the national health care objectives. It also was found that the magnitude of an evacuation programme could be reduced markedly by strategic support of existing medical programmes in Albania (haemodialysis, trauma and orthopaedics, blood banking). Implementation of this strategy could permit containment of the majority of cases within Albania or to regional, health-care facilities. The results of such targeted support for specific services could result in a national programme for internal medical evacuation, with limited dependence upon the international movement of patients.