Good Patient Care (good + patient_care)

Distribution by Scientific Domains

Selected Abstracts

Metrics in the Science of Surge

Jonathan A. Handler MD
Metrics are the driver to positive change toward better patient care. However, the research into the metrics of the science of surge is incomplete, research funding is inadequate, and we lack a criterion standard metric for identifying and quantifying surge capacity. Therefore, a consensus working group was formed through a "viral invitation" process. With a combination of online discussion through a group e-mail list and in-person discussion at a breakout session of the Academic Emergency Medicine 2006 Consensus Conference, "The Science of Surge," seven consensus statements were generated. These statements emphasize the importance of funded research in the area of surge capacity metrics; the utility of an emergency medicine research registry; the need to make the data available to clinicians, administrators, public health officials, and internal and external systems; the importance of real-time data, data standards, and electronic transmission; seamless integration of data capture into the care process; the value of having data available from a single point of access through which data mining, forecasting, and modeling can be performed; and the basic necessity of a criterion standard metric for quantifying surge capacity. Further consensus work is needed to select a criterion standard metric for quantifying surge capacity. These consensus statements cover the future research needs, the infrastructure needs, and the data that are needed for a state-of-the-art approach to surge and surge capacity. [source]

The impact of pressure ulcer risk assessment on patient outcomes among hospitalised patients

Mohammad Saleh
Aims and objectives., To determine whether use of a risk assessment scale reduces nosocomial pressure ulcers. Background., There is contradictory evidence concerning the validity of risk assessment scales. The interaction of education, clinical judgement and use of risk assessment scales has not been fully explored. It is not known which of these is most important, nor whether combining them results in better patient care. Design., Pretest,posttest comparison. Methods., A risk assessment scale namely the Braden was implemented in a group of wards after appropriate education and training of staff in addition to mandatory wound care study days. Another group of staff received the same education programme but did not implement the risk assessment scale and a third group carried on with mandatory study days only. Results., Nosocomial Pressure Ulcer was reduced in all three groups, but the group that implemented the risk assessment scale showed no significant additional improvement. Allowing for age, gender, medical speciality, level of risk and other factors did not explain this lack of improvement. Clinical judgement seemed to be used by nurses to identify patients at high risk to implement appropriate risk reduction strategies such as use of pressure relieving beds. Clinical judgement was not significantly different from the risk assessment scale score in terms of risk evaluation. Conclusions., It is questioned whether the routine use of a risk assessment scale is useful in reducing nosocomial pressure ulcer. It is suggested clinical judgement is as effective as a risk assessment scale in terms of assessing risk (though neither show good sensitivity and specificity) and determining appropriate care. Relevance to clinical practice., Clinical judgement may be as effective as employing a risk assessment scale to assess the risk of pressure ulcers. If this were true it would be simpler and release nursing time for other tasks. [source]

The role of research, evidence and education in optometry: a perspective,

Anthony J Adams OD PhD FAAO
Eye and health care are and always will be both art and science. The science of discovery, its translation to clinical care and the education that necessarily follows for practitioners is witnessing remarkable change and increasing impact on patient care. An independent and vibrant profession commits to discovery as a basis of better patient care; optometry is no exception. Some recent discoveries in our field are breathtaking and the increasing awareness in health care, including in optometry, of the advantages of accepting the challenge of translating these discoveries to patient care is becoming more evident. Health-care practice is increasingly evidence-based on careful science. The implications of evidence-based health care are surprisingly broad, with impact on clinical care guidelines, reimbursement, future scope of practice responsibilities and education both within our schools of optometry and for our practitioner. [source]

Management of systemic lupus erythematosus in the coming decade: potentials and challenges

Hiok Hee CHNG
Abstract The management of systemic lupus erythematosus (SLE) has improved in the past 50 years, but there is still a 3,5-fold increased mortality compared to the general population, with major organ failure due to active disease, infection and cardiovascular disease as the major challenges for the coming decade. Research advances at cellular, molecular and genetic levels enhance our understanding of the immunopathogenic mechanisms of SLE, leading to the development of drugs targeting specific sites of immune dysregulation , with therapies directed at cytokines, B- and T-cells, and their interactions showing promise. Advances are expected in the field of haematopoietic stem cell transplant (HSCT) as a therapeutic option for a subset of patients. Furthermore, some non-traditional immunomodulating therapies like statins, leflunomide and tacrolimus may prove useful as alternative or adjunct treatment in some patients. A better understanding of how current immunosuppressants act at the cellular and molecular level should guide the re-evaluation of the indications, doses and duration of therapy in clinical trials using these agents, many of which have not been subjected to proper double-blinded placebo-controlled studies. Research on triggers of SLE onset and flare of activity continues to yield information helpful in prevention. The evidence on the impact of psychosocial and economic factors on the outcome of SLE is overwhelming and the rheumatology community should enlist the assistance of other healthcare professionals, patient advocates and local health authorities to address these issues pertinent to good patient care and outcome. [source]

Interprofessional education: the interface of nursing and social work

Engle Angela Chan
Aims., To examine the influence of interdisciplinary seminars on undergraduate nursing and social work students' perceptions of their learning. Background., Collaboration is considered to be important for health professionals in working towards good patient care, and interdisciplinary education is seen as one way of addressing this need for greater collaboration and team work. Today's health professionals are dealing with an increasing number of older and chronically ill patients. The biopsychosocial dimensions inherent in such chronic illnesses bring about a closer working relationship between the nursing and social work professions to foster good patient care. No local research in Hong Kong, however, has looked specifically at how these two professions can develop their collaborative skills and qualities through interdisciplinary education. Design., Mixed methods design. Method., Data from questionnaires, videotape recordings of the sessions and follow-up phone interviews were used for quantitative and qualitative analyses. Results., The findings revealed three themes: an increased awareness of each other's professional values and personal judgement, a recognition of each other's disciplinary knowledge emphases and more, and an appreciation for, and learning about each other's roles for future collaboration. Conclusions., Whilst, it is usual to identify health professionals as non-judgemental, it is also important to recognise the existence of their personal and professional values and beliefs that shape their decision-making. Equally beneficial for students is their reported understanding of the other discipline's emphasis on the physical or social aspects of care, and the interrelationships and complementary values that lead to students' appreciation of each other's roles and the possibility for their future collaboration in the holistic care of patients. Relevance to clinical practice., The sharing of each other's knowledge and their appreciation of the corresponding roles enhanced students' decision-making capacity and the extension of the holistic approach beyond one profession, which is essential for good patient care. [source]

Relatives in end-of-life care , part 1: a systematic review of the literature the five last years, January 1999,February 2004

Birgitta Andershed PhD
Aim., To review systematically research conducted during the past five years focusing on the relatives' situation and needs in end-of-life care. Background and aim., That relatives make a large contribution in the care of the dying is well-known. In this situation, relatives often have to solve many new practical problems in the care as well as dealing with the sorrow of both themselves and the dying person. In recent years, palliative care has been developed in many countries and many new studies have been carried out. Methods., A systematic search of the literature was performed in the CINAHL and Medline databases. Of the 94 papers analysed, there were 59 qualitative and 35 quantitative studies with differing designs. The studies were carried out in 11 countries and were published in 34 different journals. Results., The results were categorized in two main themes with several subthemes: (1) being a close relative , the situation: (i) exposed position , new responsibility, (ii) balance between burden and capacity and (iii) positive values; (2) being a close relative , needs: (i) good patient care, (ii) being present, (iii) knowing and communicating and (iv) support from and trusting relationship with the professional. The relative's feelings of security and trust in the professional were found to be of great importance. Conclusion., More than twice as many studies had a descriptive/explorative design, which is of importance in the assessment of evidence. However, different studies complement one another and in summary, it can be said that analytic evidence is unequivocal: good patient care, communication, information and the attitude of the professional are of decisive importance regarding relatives' situation. These results are also in accord with earlier review studies. Relevance to clinical practice., Staff members have a great deal of responsibility for assuring that the patient feels as good as possible, facilitating relatives' involvement based on the family's wishes and limiting the stress and difficulties experienced by the family. The results showed that the relative's satisfaction could depend on the attitude of the professional as well as on good communication, good listening and good information. This can also be viewed as a prerequisite for the professional to get to know the family and to provide ,care in the light'. [source]

Development of a clinical chart audit programme

Y Zissiadis
Summary Radiation oncology charts containing medical information and treatment details are the major methods of communication between the various personnel involved in delivering radiation therapy to the patient. It is paramount to good patient care for this communication to be clear, precise and accurate in detail. A regular chart audit should be a part of the quality assurance programme of every radiation oncology department. The primary aim of this study was to develop and assess an objective and quantitative programme for reviewing radiation oncology charts, thereby improving the quality of communication and hence patient management. A secondary aim was to compare the charts of radically treated patients with those treated palliatively. A pilot study using a new chart review tool, developed at the Perth Radiation Oncology Centre, was carried out over an 8-month period. A sample of charts, representing 25% of our treatment group, were assessed using the tool on a monthly basis. A total of 156 charts were reviewed during this time period. Fifty-six per cent were radical treatments and 44% were palliative. The overall mean chart scores significantly improved over the time of this study (P < 0.001). The individual radiation oncologists' scores were also seen to improve during the study period. The alpha coefficients for intra-rater and inter-rater reliability were 0.99 and 0.88, respectively. The chart review programme was found to be an easy-to-use and a reliable tool by both medical and non-medical reviewers. It appeared to have a positive influence on the standard of radiation oncology charts in our department. [source]

The accuracy of medical history information in referral letters

AF DeAngelis
Abstract Background: Accurate medical history information is essential for good patient care and should be notified in the letter of referral. The aim of this study was to investigate the subjective opinion that the medical information in a large number of referrals is either inaccurate or non-existent. Methods: Medical histories from 54 patients with positive medical history findings upon taking the medical history at the initial consultation appointment were compared to the medical information supplied in the referral letter. Results: Overall, medical information was only 58.8% complete with dental referrals being 55.2% complete and medical referrals 62.4%. The majority of referral letters (70.4%) missed at least one relevant finding and only 29.6% of referrals were 100% complete. Conclusions: The results of this study suggest that the standard of referral letters needs to be improved as the received referrals were generally incomplete and contained inaccurate information. This highlights the need for each and every practitioner to take their own detailed medical history and not rely on the information supplied in the referral. [source]