Accepted Guidelines (accepted + guideline)

Distribution by Scientific Domains

Selected Abstracts

Substitute consent for nursing home residents prescribed psychotropic medication

Nicola Rendina
Abstract Background Prescribing psychotropic medications for persons with dementia who lack capacity to give informed consent requires proxy consent under NSW Guardianship legislation. Objective To survey current practice in complying with legislation and regulations in prescribing psychotropic medications for nursing home residents. Method In three Sydney nursing homes, the files of 77 residents identified as having dementia, being on a psychotropic medication and not having capacity to give informed consent, were audited. Results In only 6.5% of cases were all regulations adhered to; a further 6.5% attempted and partially completed substitute consent requirements. The problem and the nature of the treatment were documented in 70.1% of cases. In 16.9% of files the only documentation of the prescribed medication was in the medication chart. Doses of medications prescribed were within accepted guidelines. Conclusion Current regulations and legislation are not being observed. Recommendations are made as to how to make them more practicable. Copyright 2008 John Wiley & Sons, Ltd. [source]

Paediatric dentistry experience of the first cohort of students to graduate from Dublin Dental School and Hospital under the new curriculum

Summary. Aim., To assess undergraduate clinical experience in Paediatric Dentistry in students graduating under a new curriculum. Methods., An audit using logbooks completed by 34 students for all patients for whom they had provided treatment in the university paediatric dentistry clinic. Results., A total of 177 child patients had received treatment from the students, age range 2,8 years. Students had performed an average of 13 restorative techniques. Sixty-eight percent had provided stainless steel crowns and 71% at least one pulpotomy for a primary tooth. All students had provided fissure sealants. Eighteen had carried out extractions and 8 had provided treatment for fractured incisors on this clinic. Conclusions., The cohort of students included had a wide range of experience of paediatric dentistry which compared favourably with accepted guidelines. A relative lack of experience of dental extractions currently remains a problem. [source]

A systematic review of informal caregivers' needs in providing home-based end-of-life care to people with cancer

Penny E Bee
Aims., This paper presents the results of a systematic review examining the practical information needs of informal caregivers providing home-based palliative and end-of-life care to people with advanced cancer. Background., Modern hospice care has led to increases in home-based palliative care services, with informal caregivers assuming responsibility for the majority of care. In response, health policy emphasises the provision of palliative care services in which both the patient and carer receive adequate support throughout illness and death. While the emotional needs of carers have been extensively researched, their practical needs with respect to the provision of physical care are yet to receive systematic attention. Design., Systematic review. Methods., Eligible articles were identified via electronic searches of research and evidence-based databases, hand-searching of academic journals and searches of non-academic grey literature websites. Quality of research was assessed via accepted guidelines for reviewing non-randomised, observational and qualitative literature. Data were synthesised by comparing and contrasting the findings to identify prominent themes. Results., Research consistently highlights this lack of practical support, often related to inadequate information exchange. These deficits typically manifest in relatives adopting a ,trial and error' approach to palliative care. Informal carers request a greater quantity of practically-focussed information, improvements in quality and increased methods of dissemination. Conclusion., Synthesis of the literature suggests that home-based palliative care services have been insufficiently focussed on assisting informal caregivers acquire practical nursing skills. Relevance to clinical practice., Enhanced access to professional advice represents a potentially effective method of increasing carers' confidence in their ability to undertake practical aspects of home-based care. Evidence suggests that nurses and other health providers may better assist home-based carers by providing the information and skills-training necessary to facilitate this. This may necessitate the involvement of carers in the design and testing of new educational interventions. [source]

Why do doctors attend traditional CME events if they don't change what they do in their surgeries?

Evaluation of doctors' reasons for attending a traditional CME programme
Objective ,This study aimed to discover what the family doctors who attended an annual refresher course wished to obtain from participating in the event and what their response was to evidence that doctor behaviour is not changed by such programmes. Design ,The study used the qualitative method of in-depth interviews. Setting ,Ottawa, Ontario, Canada and the surrounding area. Participants The informants for the study were a sample of 6 family doctors who attended the 50th Annual Refresher Course for Family Physicians, held in April 2001 in Ottawa, Ontario, Canada. Method ,In-depth interviews with the participants were conducted before and after they attended the annual refresher course. The doctors had pre-registered for the 3-day course. They were purposely selected to obtain diversity of gender, year of graduation from medical school and practice location. Results ,The doctors interviewed had 3 main reasons for attending the refresher course: to obtain information or to be updated; to be reassured that their practice behaviour was within accepted guidelines, and to hear from and interact with the specialists who gave presentations. All the participants in the study were able to name changes they had made as the result of attending a similar type of programme in the past and were sceptical of findings that practice behaviour did not change as a result of traditional continuing medical education (CME). Conclusions ,Despite current support for interactive and practice-linked educational activities, the doctors in this study valued the input of the experts who lectured at the course. These doctors were not prepared to accept the currently held precept that their behaviour did not change as a result of attendance at traditional CME programmes. [source]

Difficult airway equipment in English emergency departments

ANAESTHESIA, Issue 5 2000
T. Morton
The need for tracheal intubation in the emergency department is often unpredictable and precipitous in nature. When compared with the operating room, a higher incidence of difficult intubation is observed. There are currently no accepted guidelines with respect to the stocking of difficult airway equipment in the emergency department. We have conducted a telephone survey to determine the availability of equipment for the management of the difficult airway in English emergency departments. Overall, the majority of units held a curved laryngoscope blade (100%), gum elastic bougie (99%) and surgical airway device (98%). Of alternative devices for ventilation, a laryngeal mask airway was kept by 65% of departments, a needle cricothyroidostomy kit by 63% and an oesophageal-tracheal twin-lumen airway (Combitube) by 18%. Of alternative devices for intubation, fewer than 10% held a retrograde intubating kit, intubating laryngeal mask, bronchoscope or lighted stylet. Seventy-four per cent of departments held an end-tidal carbon dioxide detector. [source]