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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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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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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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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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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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Nelson, Jessica L., Stephanie P. Chambers, Holly E. Brakke, and Jessica H. Hus. "Decreasing the Frequency of Nursing Assessment for Medically Stable Hospitalized Patients." Clinical Nurse Specialist 37, no. 5 (September 2023): 223–27. http://dx.doi.org/10.1097/nur.0000000000000768.
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Purpose/Objectives During the COVID-19 pandemic, a large Midwest tertiary care medical center had prolonged hospitalizations due to strained staffing and few options for post–acute care recovery. Patients deemed medically ready for discharge were receiving the same care interventions as all other hospitalized medical-surgical patients. The study objective was to appropriately match care assessment frequency for these patients with their individual needs by reducing the frequency of routine nursing assessments. Description of the Project/Program This quality improvement initiative reduced the frequency of nursing assessments, including routine monitoring of vital signs, to once daily for medically stable patients whose discharge was delayed. Outcome During the 4-week pilot, 40 hospitalized patients were enrolled; 960 assessments were eliminated, and nurses were able to reallocate approximately 500 hours to other nursing tasks. No adverse outcomes were observed among patients who received once-daily assessment. Conclusion By decreasing nursing assessment frequency for hospitalized patients with discharge delays, nurses appropriately matched care interventions with the patient's needs.
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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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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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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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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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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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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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Khan, AA, J. Lim, B. Janzen, A. Amiraslany, and S. Almubarak. "P.032 The impact of waiting time on the assessment of the first seizure onset in pediatrics." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, S2 (June 2017): S21. http://dx.doi.org/10.1017/cjn.2017.117.
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Background: Childhood epilepsy has increased in global incidence. Children with epilepsy require immediate healthcare evaluation and monitoring. Waiting times between first seizure onset and pediatric neurology assessment may impact seizure outcome at follow-up. Quality of medical care for children with first seizure onset will be assessed and the impact of pediatric neurology clinic waiting times on seizure outcomes will be determined Methods: This retrospective study, based on chart review, includes patients with first seizure evaluation at the Royal University Hospital in Saskatoon between January 2012 and December 2015. The interim period before first assessment and other factors were studied in relation to seizure outcome on follow-up. Results: 1158 patients were assessed. 378 (32.6%) patients had first seizure clinic assessment. 197 (52%) had epileptic events. 181 (48%) had non-epileptic events. The mean age of patients was 8.8 years. The mean waiting time for assessment by a pediatric neurologist was 4.33 months. The mean duration of follow-up was 20.9 months. At the last seizure assessment, 132 patients were free of seizures and 65 patients had a recurrence of seizures. Conclusions: First seizure assessment is crucial for management of children with epilepsy. Waiting time and other factors may influence seizure outcome, representing opportunities to improve standard medical care.
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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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Sebring, Kelly, Jo Shattuck, Julie Berk, Isabel Boersma, Stefan Sillau, and Benzi M. Kluger. "Assessing the validity of proxy caregiver reporting for potential palliative care outcome measures in Parkinson’s disease." Palliative Medicine 32, no. 9 (July 17, 2018): 1522–28. http://dx.doi.org/10.1177/0269216318785830.
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Background: There is increasing interest in applying palliative care approaches for patients with Parkinson’s disease. Methodological studies are needed to validate palliative care outcome measures for Parkinson’s disease to build this evidence base. As many patients with Parkinson’s disease have cognitive and/or communication issues, proxy outcome measures may improve the inclusivity and relevance of research. Aim: To assess the validity of proxy caregiver reports for several potential palliative care outcome measures. Design: A cross-sectional study of Parkinson’s disease patients and caregivers completed a battery of outcome measures relevant to palliative care including the Memorial Symptom Assessment Scale, Hospital Anxiety and Depression Scale, Prolonged Grief Questionnaire 12, Parkinson Disease Questionnaire 39, Functional Assessment of Chronic Illness Therapy–Spiritual Wellbeing, and Schwab and England. Intraclass correlation coefficients were used to assess agreement. Setting/participants: A total of 50 Parkinson’s disease patient and caregiver dyads recruited at an academic medical center, Veterans Affairs Medical Center, and community support groups. Results: There was moderate to good agreement for Schwab and England, Parkinson Disease Questionnaire 39 total, and majority of Parkinson Disease Questionnaire 39 subscales; moderate to good agreement for the Hospital Anxiety and Depression Scale, Functional Assessment of Chronic Illness Therapy–Spiritual Wellbeing, Prolonged Grief Questionnaire 12, and Memorial Symptom Assessment Scale; and poor to moderate agreement for the Parkinson Disease Questionnaire 39 stigma, social support, and bodily pain subscales. Caregivers tended to attribute higher symptom severity than patients. We did not detect differences in intraclass correlation coefficient based on cognitive status but patients with advanced illness had significantly lower intraclass correlation coefficients for several outcomes. Conclusions: Caution is indicated when considering caregiver proxy reporting for most outcomes assessed, particularly in Parkinson’s disease patients with advanced disease.
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Evans, Todd A., and Kenneth C. Lam. "Clinical Outcomes Assessment in Sport Rehabilitation." Journal of Sport Rehabilitation 20, no. 1 (February 2011): 8–16. http://dx.doi.org/10.1123/jsr.20.1.8.
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Evidence-based practice is an established guiding principle in most medical and health care disciplines. Central to establishing evidence-based practice is the assessment of clinical outcomes. Clinical outcomes represent a form of evidence on which to base medical decisions, as well as providing the mechanism for assessing the effectiveness of evidence-based interventions. However, clinical outcomes are not routinely assessed in sport rehabilitation. If sport rehabilitation clinicians fail to incorporate clinical outcomes assessment and, as a result, evidence into daily practice, they may be missing an opportunity to improve patient care and putting their professional reputation at risk within the medical community. The purposes of the article are to highlight the emergence of clinical outcomes assessment in the medical community and the current health care system, illustrate the role of clinical outcomes assessment as it pertains to providing the best patient care, and identify challenges that could potentially impede the implementation of outcomes assessment in sport rehabilitation.
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Swing, Susan R., Stephen G. Clyman, Eric S. Holmboe, and Reed G. Williams. "Advancing Resident Assessment in Graduate Medical Education." Journal of Graduate Medical Education 1, no. 2 (December 1, 2009): 278–86. http://dx.doi.org/10.4300/jgme-d-09-00010.1.
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Abstract Background The Outcome Project requires high-quality assessment approaches to provide reliable and valid judgments of the attainment of competencies deemed important for physician practice. Intervention The Accreditation Council for Graduate Medical Education (ACGME) convened the Advisory Committee on Educational Outcome Assessment in 2007–2008 to identify high-quality assessment methods. The assessments selected by this body would form a core set that could be used by all programs in a specialty to assess resident performance and enable initial steps toward establishing national specialty databases of program performance. The committee identified a small set of methods for provisional use and further evaluation. It also developed frameworks and processes to support the ongoing evaluation of methods and the longer-term enhancement of assessment in graduate medical education. Outcome The committee constructed a set of standards, a methodology for applying the standards, and grading rules for their review of assessment method quality. It developed a simple report card for displaying grades on each standard and an overall grade for each method reviewed. It also described an assessment system of factors that influence assessment quality. The committee proposed a coordinated, national-level infrastructure to support enhancements to assessment, including method development and assessor training. It recommended the establishment of a new assessment review group to continue its work of evaluating assessment methods. The committee delivered a report summarizing its activities and 5 related recommendations for implementation to the ACGME Board in September 2008.
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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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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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Hassan, Layla, Shauna A. M. Cortenraad, Charlotte B. M. Rosenberg, Merel L. Kimman, Michel Haanen, Wim G. van Gemert, and Ruben Gerardus Johannes Visschers. "Protocol for the development of a core outcome set for the optimisation of treatment and follow-up of patients with an anorectal malformation (ARM): The ARM and OUtcome Review (ARMOUR)-project." BMJ Paediatrics Open 7, no. 1 (March 2023): e001691. http://dx.doi.org/10.1136/bmjpo-2022-001691.
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BackgroundPrimary treatment of an anorectal malformation (ARM) is surgical restoration of the anatomy. These children can experience many problems later in life; therefore, a long-term follow-up by an experienced team is needed. The aim of the ARM and OUtcome Review (ARMOUR-study) is to identify the lifetime outcomes that are important from a medical and patients’ perspective and develop a core outcome set (COS) that can be implemented in a care pathway to support individual ARM management decisions.MethodsFirst, a systematic review will identify clinical and patient-reported outcomes described in studies conducted in patients with an ARM. Second, qualitative interviews with patients of different age categories and their caregivers will be held to ensure that the COS will include outcomes that are relevant from the patient’s perspective. Finally, the outcomes will be taken forward to a Delphi consensus exercise. Using multiple web-based Delphi rounds, key stakeholders (medical experts, clinical researchers and patients) will prioritise outcomes. During a face-to-face consensus meeting, the final COS will be determined. These outcomes can be evaluated in a life-long care pathway for patients with ARM.DiscussionThe development of a COS for ARMs aims to reduce heterogeneity in outcome reporting between (clinical) studies, enhancing the availability of comparable data, which will facilitate evidence-based patient care. Assessment of the outcomes in the COS during individual care pathways for ARM can support shared decisions regarding management. The ARMOUR-project has ethical approval and is registered with the Core Outcome Measures in Effectiveness Trials (COMET) initiative.Level of evidenceTreatment study level II.
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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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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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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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Selby, Debbie, Sally Bean, Elie Isenberg-Grzeda, Blair Henry D. Bioethics, and Amy Nolen. "Medical Assistance in Dying (MAiD): A Descriptive Study From a Canadian Tertiary Care Hospital." American Journal of Hospice and Palliative Medicine® 37, no. 1 (June 30, 2019): 58–64. http://dx.doi.org/10.1177/1049909119859844.
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Background: In June 2016, the Government of Canada passed Bill C-14 decriminalizing medically assisted death. Increasing numbers of Canadians are accessing medical assistance in dying (MAiD) each year, but there is limited information about this population. Objective: To describe the characteristic outcomes of MAiD requests in a cohort of patients at an academic tertiary care center in Toronto, Ontario, Canada. Methods: A retrospective chart review of patients making a formal request for a MAiD eligibility assessment from July 16 to September 18. Data extracted included demographics, diagnosis, psychosocial characteristics, information relating to the MAiD request, and clinical outcome. Results: We received 107 formal requests for MAiD assessment. Ninety-seven patients were found eligible, of whom 80 received MAiD. Cancer was the primary diagnosis for 78% and median age was 74 years. The majority of patients (64%) cited “functional decline or inability to participate in meaningful activities” as the main factor motivating their request for MAiD. Half of patients who received MAiD (46%) described their request as consistent with a long-standing, philosophical view predating their illness. The 10-day reflection period was reduced for 39% of provisions due to impending loss of capacity. Our cohort was very similar demographically to those described both nationally and internationally. Conclusion: Patients seeking MAiD at our institution were similar to those described in other jurisdictions where assisted dying is legal and represent a group for whom autonomy and independence is critical. We noted a very high rate of risk of loss of capacity, suggesting a need for both earlier assessments and regular monitoring.
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Wagner, Rafaela, Thalita Cecília Lima, Marielen Ribeiro Tavares da Silva, Anna Clara Pereira Rabha, Marinei Campos Ricieri, Mariana Millan Fachi, Rogério Carballo Afonso, and Fábio Araújo Motta. "Assessment of Pediatric Telemedicine Using Remote Physical Examinations With a Mobile Medical Device." JAMA Network Open 6, no. 2 (February 2, 2023): e2252570. http://dx.doi.org/10.1001/jamanetworkopen.2022.52570.
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ImportanceThe number of innovations in health care based on the use of platforms, digital devices, apps, and artificial intelligence has grown exponentially in recent years. When used correctly, these technologies allow inequities in access to health care to be addressed by optimizing care and reducing social and geographic barriers. However, most of the technological health care solutions proposed have not undergone rigorous clinical studies.ObjectiveTo assess the concordance between measurements from a remote physical examination using a mobile medical device and measurements from a conventional in-person physical examination.Design, Setting, and ParticipantsThis nonrandomized controlled trial was conducted from January 1 to December 31, 2020. The clinical parameters compared were heart rate; body temperature; heart, lung, and abdominal auscultation; otoscopy; throat and oral examination; and skin examination. A total of 690 patients with clinical stability and various symptoms who were seen in the emergency department of 2 Brazilian pediatric hospitals were eligible to enter this study.Main Outcomes and MeasuresThe primary outcome was concordance between measurements from a telemedicine physical examination using a mobile medical device and measurements from a conventional in-person physical examination. The secondary outcome was the specificity and sensitivity of the digital device, considering the conventional in-person consultation as the gold standard.ResultsAmong 690 patients, the median (IQR) age at study entry was 5 (1-9) years; 348 (50.4%) were female, and 331 (48.0%) presented with a chronic disease. Regarding the primary outcome, the concordance values were 90% or greater for skin examination (94% for rash, 100% for hemorrhagic suffusion, and 95% for signs of secondary infection), characteristics of the mucosa (98% for hydration and 97% for coloring), and heart (95% for murmur, 97% for rhythms, and 98% for sounds), lung (91% for adventitious sounds, 97% for vesicular sounds, and 90% for fever), and abdominal (92% for abdominal sounds) auscultations. Concordance values were lower for otoscopy (72% for the ear canal and 86% for the tympanic membrane), throat and oral examination (72%), and rhinoscopy (79% for mucosa and 81% for secretion). The specificity was greater than 70% (ranging from 74.5% for the ear canal to 99.7% for hemorrhagic suffusion) for all variables. The sensitivity was greater than 52% for skin examination (58.0% for rash and 54.8% for signs of secondary infection), throat and oral examination (52.7%), and otoscopy (66.1% for the ear canal and 64.4% for the tympanic membrane).Conclusions and RelevanceIn this study, measurements from remote physical examination with a mobile medical device had satisfactory concordance with measurements from in-person physical examination for otoscopy, throat and oral examination, skin examination, and heart and lung auscultation, with limitations regarding heart and lung auscultation in infants and abdominal auscultation in children of all ages. Measurements from remote physical examination via a mobile medical device were comparable with those from in-person physical examination in children older than 2 years. These findings suggest that telemedicine may be an alternative to in-person examination in certain contexts and may help to optimize access to health care services and reduce social and geographic barriers.Trial RegistrationBrazilian Registry of Clinical Trials Identifier: RBR-346ymn
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Daulay, Elvita Rahmi. "Unusual Case of Low-Velocity Large Object Penetrating the Frontal Bone with Favorable Outcome: A Case Report in Pediatric Patient." Open Access Macedonian Journal of Medical Sciences 9, no. C (October 24, 2021): 273–76. http://dx.doi.org/10.3889/oamjms.2021.6805.
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BACKGROUND: Penetrating head injury is one of the deadliest forms of head trauma; the outcome is usually low, and patients who survive long enough require complex medical treatment. Immediate imaging assessment with appropriate management can improve patient recovery. CASE REPORT: We reported a case of head penetration trauma on a 12-year-old child with embedded cylindrical iron that enters the skull without any signs of neurological deficit. CONCLUSIONS: This case shows that aggressive diagnostic imaging and emergency care followed by proper immediate head surgery management and postoperative intensive care to monitor and intervene in possible surgical and medical complications could significantly improve patient outcomes.
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Pu, Dai, Thomas Murry, May C. M. Wong, Edwin M. L. Yiu, and Karen M. K. Chan. "Indicators of Dysphagia in Aged Care Facilities." Journal of Speech, Language, and Hearing Research 60, no. 9 (September 18, 2017): 2416–26. http://dx.doi.org/10.1044/2017_jslhr-s-17-0028.
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Purpose The current cross-sectional study aimed to investigate risk factors for dysphagia in elderly individuals in aged care facilities. Method A total of 878 individuals from 42 aged care facilities were recruited for this study. The dependent outcome was speech therapist-determined swallowing function. Independent factors were Eating Assessment Tool score, oral motor assessment score, Mini-Mental State Examination, medical history, and various functional status ratings. Binomial logistic regression was used to identify independent variables associated with dysphagia in this cohort. Results Two statistical models were constructed. Model 1 used variables from case files without the need for hands-on assessment, and Model 2 used variables that could be obtained from hands-on assessment. Variables positively associated with dysphagia identified in Model 1 were male gender, total dependence for activities of daily living, need for feeding assistance, mobility, requiring assistance walking or using a wheelchair, and history of pneumonia. Variables positively associated with dysphagia identified in Model 2 were Mini-Mental State Examination score, edentulousness, and oral motor assessments score. Conclusions Cognitive function, dentition, and oral motor function are significant indicators associated with the presence of swallowing in the elderly. When assessing the frail elderly, case file information can help clinicians identify frail elderly individuals who may be suffering from dysphagia.
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Alshevsky, A. A., A. S. Kataev, and A. S. Suvorov. "FORENSIC MEDICAL ASSESSMENT OF CAUSE-AND-EFFECT RELATIONSHIPS DURING EXAMINATION IN CASES WHERE A DOCTOR HAS CAUSED DEATH OF A PATIENT WITH A NATURAL OUTCOME OF THE EXISTING PATHOLOGY." Bulletin of the Medical Institute of Continuing Education 3, no. 4 (December 15, 2023): 99–102. http://dx.doi.org/10.36107/2782-1714_2023-3-4-99-102.
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Some forensic medical experts believe that during the examination in criminal proceedings in cases where a doctor has caused harm to a patient’s health, in the case of a natural outcome of the existing pathology, it should be limited to resolving the issue of the presence of a defect in the provision of medical care and the causal relationship with the outcome of treatment. In their opinion, it is the prerogative of the investigation to evaluate the doctor's actions, in the event of the patient's death from the existing pathology. Background. Since this point of view significantly affects the expert practice, it is necessary to determine the content of the expert's assistance in establishing the objective side of the crime. Purpose. To discuss the boundaries of the forensic medical expert’s competence when conducting examinations in criminal proceedings in cases of a doctor causing harm to a patient’s health in the event of a natural outcome of pathology during the provision of medical care Materials and methods. Regulatory documents and arguments of opponents were analyzed. Results. Essentially, assessing the performance of professional duties from the perspective of a forensic medical expert and a lawyer are two different content approaches to assessing one event, which are necessary for criminal proceedings. At the same time, the material nature of the crime provided for by the above-mentioned article of the Criminal Code of the Russian Federation requires, first of all, the establishment of the cause-and-effect relationships between the therapeutic and diagnostic measures not taken and the resulting outcome of the pathology, and only then, the assessment of the violations of social relations by a particular person providing the medical service. Conclusions. In the course of the forensic medical examination of cases initiated in the event of a doctor being accused of causing death to a patient due to improper performance of professional duties with a natural outcome of the existing pathology, the assessment of the medical care provided from the point of view of the existence of a medical care defect is inappropriate.
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Goldstein, Laura H., Emily J. Robinson, Izabela Pilecka, Iain Perdue, Iris Mosweu, Julie Read, Harriet Jordan, et al. "Cognitive–behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT." Health Technology Assessment 25, no. 43 (June 2021): 1–144. http://dx.doi.org/10.3310/hta25430.
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Background Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic interventions; however, the evidence for this is limited. Objectives To evaluate the clinical effectiveness and cost-effectiveness of dissociative seizure-specific cognitive–behavioural therapy for adults with dissociative seizures. Design This was a pragmatic, multicentre, parallel-arm, mixed-methods randomised controlled trial. Setting This took place in 27 UK-based neurology/epilepsy services, 17 liaison psychiatry/neuropsychiatry services and 18 cognitive–behavioural therapy services. Participants Adults with dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous year and meeting other eligibility criteria were recruited to a screening phase from neurology/epilepsy services between October 2014 and February 2017. After psychiatric assessment around 3 months later, eligible and interested participants were randomised between January 2015 and May 2017. Interventions Standardised medical care consisted of input from neurologists and psychiatrists who were given guidance regarding diagnosis delivery and management; they provided patients with information booklets. The intervention consisted of 12 dissociative seizure-specific cognitive–behavioural therapy 1-hour sessions (plus one booster session) that were delivered by trained therapists, in addition to standardised medical care. Main outcome measures The primary outcome was monthly seizure frequency at 12 months post randomisation. The secondary outcomes were aspects of seizure occurrence, quality of life, mood, anxiety, distress, symptoms, psychosocial functioning, clinical global change, satisfaction with treatment, quality-adjusted life-years, costs and cost-effectiveness. Results In total, 698 patients were screened and 368 were randomised (standardised medical care alone, n = 182; and cognitive–behavioural therapy plus standardised medical care, n = 186). Primary outcome data were obtained for 85% of participants. An intention-to-treat analysis with multivariate imputation by chained equations revealed no significant between-group difference in dissociative seizure frequency at 12 months [standardised medical care: median of seven dissociative seizures (interquartile range 1–35 dissociative seizures); cognitive–behavioural therapy and standardised medical care: median of four dissociative seizures (interquartile range 0–20 dissociative seizures); incidence rate ratio 0.78, 95% confidence interval 0.56 to 1.09; p = 0.144]. Of the 16 secondary outcomes analysed, nine were significantly better in the arm receiving cognitive–behavioural therapy at a p-value < 0.05, including the following at a p-value ≤ 0.001: the longest dissociative seizure-free period in months 7–12 inclusive post randomisation (incidence rate ratio 1.64, 95% confidence interval 1.22 to 2.20; p = 0.001); better psychosocial functioning (Work and Social Adjustment Scale, standardised treatment effect –0.39, 95% confidence interval –0.61 to –0.18; p < 0.001); greater self-rated and clinician-rated clinical improvement (self-rated: standardised treatment effect 0.39, 95% confidence interval 0.16 to 0.62; p = 0.001; clinician rated: standardised treatment effect 0.37, 95% confidence interval 0.17 to 0.57; p < 0.001); and satisfaction with treatment (standardised treatment effect 0.50, 95% confidence interval 0.27 to 0.73; p < 0.001). Rates of adverse events were similar across arms. Cognitive–behavioural therapy plus standardised medical care produced 0.0152 more quality-adjusted life-years (95% confidence interval –0.0106 to 0.0392 quality-adjusted life-years) than standardised medical care alone. The incremental cost-effectiveness ratio (cost per quality-adjusted life-year) for cognitive–behavioural therapy plus standardised medical care versus standardised medical care alone based on the EuroQol-5 Dimensions, five-level version, and imputed data was £120,658. In sensitivity analyses, incremental cost-effectiveness ratios ranged between £85,724 and £206,067. Qualitative and quantitative process evaluations highlighted useful study components, the importance of clinical experience in treating patients with dissociative seizures and potential benefits of our multidisciplinary care pathway. Limitations Unlike outcome assessors, participants and clinicians were not blinded to the interventions. Conclusions There was no significant additional benefit of dissociative seizure-specific cognitive–behavioural therapy in reducing dissociative seizure frequency, and cost-effectiveness over standardised medical care was low. However, this large, adequately powered, multicentre randomised controlled trial highlights benefits of adjunctive dissociative seizure-specific cognitive–behavioural therapy for several clinical outcomes, with no evidence of greater harm from dissociative seizure-specific cognitive–behavioural therapy. Future work Examination of moderators and mediators of outcome. Trial registration Current Controlled Trials ISRCTN05681227 and ClinicalTrials.gov NCT02325544. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 43. See the NIHR Journals Library website for further project information.
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Rainey, Petrie M. "Outcomes Assessment for Point-of-Care Testing." Clinical Chemistry 44, no. 8 (August 1, 1998): 1595–96. http://dx.doi.org/10.1093/clinchem/44.8.1595.
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Kelly, Sean G., Kunling Wu, Katherine Tassiopoulos, Kristine M. Erlandson, Susan L. Koletar, and Frank J. Palella. "Frailty Is an Independent Risk Factor for Mortality, Cardiovascular Disease, Bone Disease, and Diabetes Among Aging Adults With Human Immunodeficiency Virus." Clinical Infectious Diseases 69, no. 8 (December 24, 2018): 1370–76. http://dx.doi.org/10.1093/cid/ciy1101.
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Abstract Background We characterized associations between frailty and incident cardiovascular disease (CVD), diabetes mellitus (DM), bone disease, and mortality within a cohort of aging persons with human immunodeficiency virus (PWH). Methods Participants underwent frailty evaluations using the Fried frailty assessment (baseline and annually). Frailty was defined as having ≥3 frailty criteria. Clinical outcomes of mortality, CVD events, DM, and bone disease events were recorded throughout the study period (baseline to most recent study or clinic visit, or date of clinical outcome, whichever came first). Poisson regression models were used to evaluate associations between baseline frailty, change in frailty score over 48 weeks, and each clinical outcome. Results Among 821 men and 195 women (median age 51 years), 62 (6%) were frail at baseline. Frailty scores increased by ≥1 component among 194 participants (19%) from baseline to 48 weeks. Baseline frailty was associated with an increased risk of incident CVD and DM, with a trend toward a significant association with bone events. Among frailty components, slow gait speed was associated with incident DM and borderline associated with incident CVD. An increase in frailty from baseline to week 48 was associated with mortality but not with the other clinical outcomes. Conclusions Baseline frailty was associated with multiple adverse health outcomes (incident CVD, DM, and bone disease), while increase in frailty score was associated with mortality among PWH engaged in care. Incorporation of frailty assessments into the care of PWH may assist in improvement of functional status and risk stratification for age-related chronic diseases.
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Rolf, M. Jane. "Pain Assessment: An Overview." Journal of Pharmacy Practice 16, no. 4 (August 2003): 225–30. http://dx.doi.org/10.1177/0897190003258508.
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Pain assessment is an integral part of providing quality patient care. Treatment of pain is driven by the findings of the pain assessment. Pain assessment provides health care professionals with the information necessary to effectively mange a patient's course of treatment and plan of care. To assess and manage pain with the best possible outcomes, the health care provider must depend on the patient's subjective description in addition to objective tools. Barriers, related to the patient's religion or cultural beliefs, and/or lack of knowledge on the part of the health care providers often impede proper assessment and treatment of patients' pain.
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Joseph, Stephen, and Frank Keating. "The role of locus of control in mental health nursing and other healthcare interventions in the UK." British Journal of Mental Health Nursing 12, no. 2 (May 2, 2023): 1–7. http://dx.doi.org/10.12968/bjmh.2023.0002.
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This article explores the role of service users' locus of control in determining the motivation, engagement and outcome in healthcare settings. The article also advocates for incorporating the concept of locus of control in the assessment, planning, implementation and evaluation of health care in the UK, particularly within sectors that cover mental health and wellbeing. It also highlights intervention tools that mental health nurses and other healthcare professionals would find useful for positive patient outcomes.
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Mehendale, Advait, Vidya Nagar, Rahul Radhakrishnan, Divya Kantak, Tahir Akhtar, and Arpita Priyadarshini. "Study of obstetric patients admitted to medical intensive care unit in a tertiary care teaching hospital." Journal of Clinical and Scientific Research 12, no. 3 (2023): 174–79. http://dx.doi.org/10.4103/jcsr.jcsr_179_22.
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Abstract Background: Obstetric critical care is of utmost importance and interventions in intensive care unit (ICU) can improve the maternal outcome. The efficient scoring systems for such critically ill patients are the need of the hour. Methods: We prospectively studied the characteristics and outcome of 75 critically ill obstetrics patients admitted to the ICU of our tertiary care teaching hospital. Results: Their mean age was 27.2 ± 5.0 years. Hypertensive diseases of pregnancy (n = 51; 68%) were the most common reasons for ICU admission; hypothyroidism (13.3%) was the most common comorbid condition. The mean ICU stay and mean hospital stay were 4.6 ± 2.5 days and 8.2 ± 4.1 days, respectively. Compared to survivors, patients who died had a significantly higher sequential organ failure assessment (SOFA) score (6.5 ± 0.8 vs. 2.5 ± 1.1; P < 0.0001) and acute physiology and chronic health evaluation II (APACHE II) score, respectively. The predicted mortality by APACHE II score was 11.3 ± 6.4 and the observed mortality rate was 21.3% (P < 0.0001). Conclusions: Hypertensive disorders of pregnancy were the most common indication for ICU admission. The SOFA, APACHE II and length of hospital stay were the most important predictors of maternal mortality.
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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.
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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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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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*Raman, Sainath, Georgia *Brown, *Equal first authors, Debbie Long, Ben Gelbart, Carmel Delzoppo, Johnny Millar, Simon Erickson, Marino Festa, and Luregn J. Schlapbach. "Priorities for paediatric critical care research: a modified Delphi study by the Australian and New Zealand Intensive Care Society Paediatric Study Group." Critical Care and Resuscitation 23, no. 2 (June 7, 2021): 194–201. http://dx.doi.org/10.51893/2021.2.oa6.
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OBJECTIVE: Most interventions in paediatric critical care lack high grade evidence. We aimed to identify the key research priorities and key clinical outcome measures pertinent to research in paediatric intensive care patients. DESIGN: Modified three-stage Delphi study combining staged online surveys, followed by a face-to-face discussion and final voting. SETTING: Paediatric intensive care units in Australia and New Zealand. PARTICIPANTS: Medical and nursing staff working in intensive care. MAIN OUTCOME MEASUREMENTS: Self-reported priorities for research. RESULTS: 193 respondents provided a total of 267 research questions and 234 outcomes. In Stage 3, the top 56 research questions and 50 outcomes were discussed face to face, which allowed the identification of the top 20 research questions with the Hanlon prioritisation score and the top 20 outcomes. Topics centred on the use of intravenous fluids (restrictive v liberal fluids, use of fluid resuscitation bolus, early inotrope use, type of intravenous fluid, and assessment of fluid responsiveness), and patient- and family-centred outcomes (health-related quality of life, liberation) emerged as priorities. While mortality, length of stay, and organ support/organ dysfunction were considered important and the most feasible outcomes, long term quality of life and neurodevelopmental measures were rated highly in terms of their importance. CONCLUSIONS: Using a modified Delphi method, this study provides guidance towards prioritisation of research topics in paediatric critical care in Australia and New Zealand, and identifies study outcomes of key relevance to clinicians and experts in the field.
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Mukhametshin, Rustam F., O. P. Kovtun, N. S. Davydova, and A. A. Kurganski. "TRIPS scale as a predictor of outcomes in newborns requiring medical evacuation: оbservational cohort retrospective study." Annals of Critical Care, no. 2 (April 28, 2023): 130–39. http://dx.doi.org/10.21320/1818-474x-2023-2-130-139.
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INTRODUCTION: Assessment of the patient’s condition and prediction of outcomes is critically important during pre-transport stabilization and remains the most complex challenges of the activities of transport teams. A significant variety of scales and different requirements for their application indicates that there is no consensus on the choice of a specific scale and predictive tool. OBJECTIVE: To study hospital outcomes in transported newborns, depending on the assessment on the TRIPS scale (Transport Risk Index of Physiological Stability for Newborn Infants). MATERIALS AND METHODS: The оbservational, cohort, retrospective study included data from 604 trips of the transport team to newborns consulted by resuscitation and consultative center from August 1, 2017 to December 31, 2018. The total sample was divided into groups depending on the assessment of the score, followed by a comparison of characteristics and outcomes in these groups. RESULTS: There is a significant difference in birth weight and gestational age between TRIPS groups. An increase in the TRIPS score in transported newborns is associated with an increased risk of death with a maximum relative risk of 21.4 (3.35–136.72) (between 6 and 1 groups). For other outcomes, there are significant differences between groups with minimum and maximum TRIPS scores. CONCLUSIONS: The TRIPS scale allows to stratify newborns requiring inter-hospital transportation by the risk of developing a fatal outcome and complications at the upcoming hospital stage.
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Kotsaba, Yuliia, and Liliia Babinets. "Nursing Assessment of Health Status in the Elderly People Care." Family medicine. European practices, no. 4 (December 29, 2023): 42–49. http://dx.doi.org/10.30841/2786-720x.4.2023.297027.
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The article presents the peculiarities of the organization of nursing care for the elderly people. The cornerstone of gerontological nursing care is a complex assessment of patients’ health. It is known that the medical care needs of the elderly people are composite, caused by a combination of age-related changes, chronic diseases, heredity and lifestyle. When assessing and providing assistance to older people, the healthcare team includes doctors from various medical disciplines, medical nurses, social workers, confessors, pharmacists, rehabilitation specialists, etc. Each team member contributes, and the nurse can often draw on the knowledge of others to improve the assessment process. She must provide nursing care in a timely and compassionate manner. Medical nurses provide care for older adults, so it is vital for them to note any signs of change in mental and general status based on the patient’s baseline. After all, the physical and social environment can support or suppress the abilities of an older person. Improving medical nurses’ skills in comprehensive geriatric assessment is fundamental for the effective management of older people. Drawing up and implementing a rational individual patient care plan can improve health outcomes and increase the confidence of nursing staff. The important components of a comprehensive geriatric assessment are the functional and physical assessments of the condition of the main human organs and systems (cardiovascular, respiratory, nervous, sensory organs, skin, genitourinary system and others). A comprehensive assessment consists of objective and subjective elements, and how assessment data is interpreted is important.
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Blank, Sebastiaan P., and Ruth M. Blank. "Echocardiography Does not Reduce Mortality in Sepsis: A Re-Evaluation Using the Medical Information Mart for Intensive Care IV Dataset*." Critical Care Medicine 52, no. 2 (October 20, 2023): 248–57. http://dx.doi.org/10.1097/ccm.0000000000006069.
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OBJECTIVES: Echocardiography is commonly used for hemodynamic assessment in sepsis, but data regarding its association with outcome are conflicting. The aim of this study was to evaluate the association between echocardiography and outcomes in patients with septic shock using the Medical Information Mart for Intensive Care IV database. DESIGN: Retrospective cohort study comparing patients who did or did not undergo transthoracic echocardiography within the first 5 days of admission for the primary outcome of 28-day mortality. SETTING: Admissions to the Beth Israel Deaconess Medical Center intensive care from 2008 to 2019. PATIENTS: Adults 16 years old or older with septic shock requiring vasopressor support within 48 hours of admission. Readmissions and patients admitted to the coronary care unit or cardiovascular intensive care were excluded, as well as patients with ST-elevation myocardial infarction or cardiac arrest. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Echocardiography was performed in 1,515 (27%) of 5,697 eligible admissions. The primary outcome was analyzed using a marginal structural model and rolling entry matching to adjust for baseline and time-varying confounders. Patients who underwent echocardiography showed no significant difference in 28-day mortality (adjusted hazard ratio 1.09; 95% CI, 0.95–1.25; p = 0.24). This was consistent across multiple sensitivity analyses. Secondary outcomes were changes in management instituted within 4 hours of imaging. Treatment changes occurred in 493 patients (33%) compared with 431 matched controls (29%), with the most common intervention being the administration of a fluid bolus. CONCLUSIONS: Echocardiography in sepsis was not associated with a reduction in 28-day mortality based on observational data. These findings do not negate the utility of echo in cases of diagnostic uncertainty or inadequate response to initial treatment.
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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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Jacobs, Jeffrey P. "Introduction – Databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease." Cardiology in the Young 18, S2 (December 2008): 1–37. http://dx.doi.org/10.1017/s104795110800334x.
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AbstractThe Multi-Societal Database Committee for Pediatric and Congenital Heart Disease was established in 2005 with the goal of providing the infrastructure, spanning geographical and subspecialty boundaries, for collaboration between health care professionals interested in the analysis of outcomes of treatments provided to patients with congenital cardiac disease, with the ultimate aim of improvement in the quality of care provided to these patients. The purpose of these collaborative efforts is to promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient’s economic means, with an emphasis on excellence in teaching, research and community service. This manuscript provides the Introduction to the 2008 Supplement to Cardiology in the Young titled: “Databases and The Assessment of Complications associated with the Treatment of Patients with Congenital Cardiac Disease”. This Supplement was prepared by The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease.The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease offers the following definition of the term “Complication”: “A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.”The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease offers the following definition of the term “Adverse Event”: “An adverse event is a complication that is associated with a healthcare intervention and is associated with suboptimal outcome. Adverse events represent a subset of complications. Not all medical errors result in an adverse event; the administration of an incorrect dose of a medication is a medical error, but it does not always result in an adverse event. Similarly, not all adverse events are the result of medical error. A child may develop pneumonia after an atrial septal defect repair despite intra- and peri-operative management that is free of error. Complications of the underlying disease state, which are not related to a medical intervention, are not adverse events. For example, a patient who presents for medical care with metastatic lung cancer has already developed a complication (Metastatic spread) of the primary lung cancer without any healthcare intervention. Furthermore, complications not associated with suboptimal outcome or harm are not adverse events and are known as no harm events. The patient who receives an incorrect dose of a medication without harm has experienced a no harm event, but not an adverse event.”Based on the above definitions, it is apparent that The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease has taken an inclusive approach to defining the universe of complications. Complications may or may not be associated with healthcare intervention and may or may not be associated with suboptimal outcome. Meanwhile, adverse events must be associated with healthcare intervention and must be associated with suboptimal outcome.
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Ekdahl, Anne Wissendorff, Anna Axmon, Magnus Sandberg, and Katarina Steen Carlsson. "Is care based on comprehensive geriatric assessment with mobile teams better than usual care? A study protocol of a randomised controlled trial (The GerMoT study)." BMJ Open 8, no. 10 (October 2018): e023969. http://dx.doi.org/10.1136/bmjopen-2018-023969.
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IntroductionComprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process used to determine the medical, psychological and functional capabilities of frail older people. The primary aim of our current study is to confirm whether CGA-based outpatient care is superior than usual care in terms of health-related outcomes, resource use and costs.Methods and analysisThe Geriatric Mobile Team trial is designed as a single-centre randomised, controlled, assessor-blinded (at baseline) trial. All participants will be identified via local healthcare registries with the following inclusion criteria: age ≥75 years, ≥3 different diagnoses and ≥3 visits to the emergency care unit (with or without admittance to hospital) during the past 18 months. Nursing home residency will be an exclusion criterion. Baseline assessments will be done before the 1:1 randomisation. Participants in the intervention group will, after an initial CGA, have access to care given by a geriatric team in addition to usual care. The control group receives usual care only. The primary outcome is the total number of inpatient days during the follow-up period. Assessments of the outcomes: mortality, quality of life, health care use, physical functional level, frailty, dependence and cognition will be performed 12 and 24 months after inclusion. Both descriptive and analytical statistics will be used, in order to compare groups and for analyses of outcomes over time including changes therein. The primary outcome will be analysed using analysis of variance, including in-transformed values if needed to achieve normal distribution of the residuals.Ethics and disseminationEthical approval has been obtained and the results will be disseminated in national and international journals and to health care leaders and stakeholders. Protocol amendments will be published in ClinicalTrials.gov as amendments to the initial registrationNCT02923843. In case of success, the study will promote the implementation of CGA in outpatient care settings and thereby contribute to an improved care of older people with multimorbidity through dissemination of the results through scientific articles, information to politicians and to the public.Trial registration numberNCT02923843; Pre-results.
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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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Hedley-Whyte, John. "Frederick Mosteller (1916–2006): Mentoring, A Memoir." International Journal of Technology Assessment in Health Care 23, no. 1 (January 2007): 152–54. http://dx.doi.org/10.1017/s0266462307051707.
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Frederick Mosteller was born in Clarksburg, West Virginia, at the time of the birth of medical technology assessment (10). During a long academic career at Harvard, he, probably more than any other person, contributed to techniques of assessment of therapy and outcome (6;14;29). Much of his seminal writing was published in theInternational Journal of Technology Assessment in Health Care(1;3;8;12;16;17;19;21–23).
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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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Beckett, Daniel J., CF Gordon, R. Paterson, S. Chalkley, DC MacLeod, and Derek Bell. "Assessment of clinical risk in the out of hours hospital prior to the introduction of Hospital at Night." Acute Medicine Journal 8, no. 1 (January 1, 2009): 33–38. http://dx.doi.org/10.52964/amja.0229.
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Overnight medical cover in hospital is less than during daylight hours. We aimed to quantify the numbers of patients deteriorating overnight and their clinical outcome. Data was collected in real time on use of the Standardised Early Warning Score (SEWS), ‘time to doctor’, seniority of medical review and clinical outcome. 136 incidents of clinical concern were noted on the general wards with a median response time of 5 minutes for SEWS>4 and 10 minutes if SEWS<4. 159 incidents were recorded in critical care. There was significant inter-speciality variation in median response times and seniority of responding staff, particularly within critical care, which recorded the slowest times across the hospital. This will be reassessed following the establishment of Hospital at Night.
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Devernay, Marie, Emmanuel Ecosse, Joël Coste, and Jean-Claude Carel. "Determinants of Medical Care for Young Women with Turner Syndrome." Journal of Clinical Endocrinology & Metabolism 94, no. 9 (September 1, 2009): 3408–13. http://dx.doi.org/10.1210/jc.2009-0495.
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Context: Turner syndrome is associated with reduced life expectancy. Lifelong follow-up is strongly recommended, but follow-up during the transition between pediatric and adult care has been little evaluated. Objective: Our objective was to evaluate the medical follow-up of a population-based cohort of young adult patients. Design, Setting, and Patients: A questionnaire study was conducted with a national cohort of 568 women, aged 22.6 ± 2.6 yr (range, 18.3–31.2), a mean of 6 yr after stopping GH treatment (StaTur cohort). Main Outcome Measures: We assessed the proportion of patients with adequate follow-up at seven medical assessments over 4 yr and its determinants. Results: Most participants were followed by gynecologists or general practitioners. Medical assessments were performed in 16% (audiometry) to 68% (lipid level determinations) of participants, with little consistency in individual patients. Only 20 of 568 patients (3.5%) underwent all assessments in the 4-yr period. Multivariate analysis identified the type of physician as the only factor consistently associated with follow-up, which was more adequate with endocrinologists than with other physicians. Other variables associated with at least one adequate follow-up assessment were paternal socioeconomic class, education level, number of Turner syndrome disease components, size of the medical center following the patient in childhood, and physical health dimensions of Short Form 36 questionnaire. Conclusions: By contrast with the intensive medical follow-up in childhood, follow-up was grossly inadequate during the transition phase. During this phase, patients should be sent to physicians specializing in Turner syndrome and particular attention should be paid to patients with lower levels of education and from families of low socioeconomic status. This study finds adherence to recommended follow-up for young adult women with Turner syndrome is incomplete even when there is good access to care.