Professional Guidelines (professional + guideline)

Distribution by Scientific Domains

Selected Abstracts

Frequency and nature of drug,drug interactions in a Dutch university hospital

Jeannette E. F. Zwart-van Rijkom
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT , Drug,drug interactions (DDIs) may lead to often preventable adverse drug events and health damage. , In Dutch community pharmacies approximately 6% of all prescriptions generate a DDI alert. , Hospitalized patients may be especially at risk, as they are more severely ill and multiple medications may be prescribed simultaneously; however, only limited data are available on the frequency and nature of DDIs during hospitalization. WHAT THIS STUDY ADDS , In a Dutch university hospital 10% of all prescriptions generated a DDI alert; overall 25% of patients encountered at least one potential DDI. , Besides the risk of decreased effectiveness (25% of the DDIs), the most frequently occurring potential clinical consequence of the DDIs was an increased risk of side-effects, such as an increased bleeding risk (22% of DDIs), hypotension (15%) and nephrotoxicity (13%). , Almost half of the DDIs could be managed by monitoring laboratory values. AIM Drug,drug interactions (DDIs) may lead to often preventable adverse drug events and health damage. Especially within hospitals, this might be an important factor, as patients are severely ill and multiple medications may be prescribed simultaneously. The objective of this study was to measure the frequency and nature of DDI alerts in a Dutch university hospital. METHODS All patients hospitalized in the University Medical Centre Utrecht in 2006 who were prescribed at least one medication were included. The frequency of DDIs was calculated as: (i) the percentage of patients experiencing at least one DDI, and (ii) the percentage of prescriptions generating a DDI alert. Based on the national professional guideline, DDIs were classified into categories of potential clinical outcome, management advice, clinical relevance (A,F) and available evidence (0,4). RESULTS Of the 21 277 admissions included, 5909 (27.8%) encountered at least one DDI. Overall, the prescribing physician received a DDI alert in 9.6% of all prescriptions. The most frequently occurring potential clinical consequence of the DDIs was an increased risk of side-effects such as increased bleeding risk (22.0%), hypotension (14.9%), nephrotoxicity (12.6%) and electrolyte disturbances (10.5%). Almost half (48.6%) of the DDIs could be managed by monitoring laboratory values. CONCLUSIONS Computerized DDI alerts may be a useful tool to prevent adverse drug events within hospitals, but they may also result in ,alert fatigue'. The specificity of alerts could significantly improve by the use of more sophisticated clinical decision support systems taking into account, for example, laboratory values. [source]

Insulin therapy in Europe

Werner A. Scherbaum
Abstract The prevalence of type 1 diabetes is rising in all European countries, particularly in Scandinavia and the UK. Insulin therapy in Europe is strongly influenced by the results of the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS), both of which showed the importance of tight metabolic control in patients with diabetes. The importance of tight glycemic control is also emphasized in the Saint Vincent Declaration, which established 5-year goals for antidiabetic therapy in Europe. Insulin therapy in Europe has been significantly improved over the past 10,years, owing to a number of developments. These include increased use of intensive insulin therapy in patients with type 1 diabetes; the development of new insulin analogs, including insulin glargine for injection therapy and short-acting agents that are particularly suitable for use in pumpsand the establishment of comprehensive and standardized treatment goals and guidelines. Nevertheless, important obstacles must still be overcome to optimize therapy for patients with diabetes and reduce the long-term complications of this disease. These obstacles include low public awareness of diabetes and its symptoms, training of physicians as well as patients that is often insufficient to ensure adherence to professional guidelines for diabetes care, and limitations in communication among professional care providers. Copyright 2002 John Wiley & Sons, Ltd. [source]

Maintaining gender sensitivity in the family practice: facilitators and barriers

Halime Celik MSc LLB
Abstract Objective, This study aims to identify the facilitators and barriers perceived by General Practitioners (GPs) to maintain a gender perspective in family practice. Methods, Nine semi-structured interviews were conducted among nine pairs of GPs. The data were analysed by means of deductive content analysis using theory-based methods to generate facilitators and barriers to gender sensitivity. Results, Gender sensitivity in family practice can be influenced by several factors which ultimately determine the extent to which a gender sensitive approach is satisfactorily practiced by GPs in the doctor,patient relationship. Gender awareness, repetition and reminders, motivation triggers and professional guidelines were found to facilitate gender sensitivity. On the other hand, lacking skills and routines, scepticism, heavy workload and the timing of implementation were found to be barriers to gender sensitivity. Conclusion, While the potential effect of each factor affecting gender sensitivity in family practice has been elucidated, the effects of the interplay between these factors still need to be determined. [source]

Legal Implications of Fetal Heart Assessment

Laura Mahlmeister RN
The standard of care requires perinatal nurses to perform fetal heart (FH) assessment competently and safely. Failure to adhere to established guidelines and standards for FH assessment may result in negative outcomes for the fetus or newborn and contributes to claims of nursing negligence. The perinatal nurse must be fully cognizant of professional guidelines and standards for FH assessment and comply with agency policies and procedures when conducting assessment of the fetal heart. Guidelines for FH assessment during the antepartum and intrapartum period are discussed within the context of restructured health care settings and today's medicolegal climate. [source]

Legislative Issues Impacting On The Practice Of The South African Nurse Practitioner

Nelouise Geyer
Purpose To present an overview of the impact of the nurse practitioner (NP) on the South African health care arena and describe the legislative framework for NP practice. Data Sources Statutes and laws of the government of South Africa; published professional guidelines; authors' experiences. Conclusions The key challenges for NPs in South Africa lie in lobbying for enabling legislation, obtaining access to education and training opportunities, and managing risks within the rapidly changing environment. Implications for Practice Some aspects of the NP's accountability and responsibilities have as yet not been adequately addressed in the current legislative framework and will certainly increase the risk for malpractice. South African NPs will have to establish partnerships with important role players, not only in South Africa, but also internationally, to ensure that an enabling environment for quality health services is created. [source]

Atropine for prevention of cardiac dysrhythmias in patients with hepatocellular carcinoma undergoing percutaneous ethanol instillation: a randomized, placebo-controlled, double-blind trial

Ferlitsch Arnulf
Abstract Introduction: Percutaneous ethanol injection (PEI) is an established method in the treatment of hepatocellular carcinoma (HCC). During this procedure, severe cardiac bradyarrhythmias can occur. A preemptive injection of atropine is recommended by professional guidelines to prevent these dysrhythmias. Methods: Patients scheduled for PEI were randomized 1:1 to receive 0.5 mg atropinehydrochloride or placebo in a double-blind randomized placebo-controlled trial. Patients were electrocardiogram monitored, which were then analysed by an experienced rhythmologist blinded to the treatment arm. Results: Patients in 40 consecutive PEI sessions were included. During PEI, a significant reduction in the mean heart rate (>15%) was seen in 15% of patients in the placebo group (median, ,37%; range, 15,41%) and in 25% of patients receiving atropine (median, ,20%; range, 16,64%). There was no significant difference between both groups. During PEI, two patients (10%) in the placebo group developed a sinuatrial block (SAB). Four patients in the atropine group (20%) developed arrhythmias: three patients SAB, one of them with escape rhythm and one AV-bundle block. Blood ethanol levels post-PEI, amount of instilled ethanol, tumour size and location were not different between patients with or without dysrhythmias. Conclusion: In this randomized-controlled trial, a preprocedure atropine injection did not prevent the occurrence of bradyarrhythmias. Prophylactic use of atropine might not be effective and therefore cannot be recommended as a routine procedure. NCT00575523. [source]

Whistleblowing procedures at work: what are the implications for human resource practitioners?

David Lewis
This paper explains why it is desirable for employers to have whistleblowing codes, and draws upon professional guidelines and empirical research to suggest the possible contents of whistleblowing policies and procedures. The paper discusses who and what should be covered and examines the issues of confidentiality and anonymity, reprisals and malicious allegations. It also highlights the need to provide advice and assistance to those who have concerns about wrongdoing at work. The author outlines the possible stages in a whistleblowing procedure, indicates how a concern should be raised and handled, and suggests how a procedure might be communicated and monitored. The paper concludes by emphasising that whistleblowing procedures provide an important safeguard against problems being overlooked and may be vital if legal pitfalls are to be avoided. [source]

Qualitative Data Collection and Analysis Methods: The INSTINCT Trial

William J. Meurer MD
Patient care practices often lag behind current scientific evidence and professional guidelines. The failure of such knowledge translation (KT) efforts may reflect inadequate assessment and management of specific barriers confronting both physicians and patients at the point of treatment level. Effective KT in this setting may benefit from the use of qualitative methods to identify and overcome these barriers. Qualitative methodology allows in-depth exploration of the barriers involved in adopting practice change and has been infrequently used in emergency medicine research. The authors describe the methodology for qualitative analysis within the INcreasing Stroke Treatment through INteractive behavioral Change Tactics (INSTINCT) trial. This includes processes for valid data collection and reliable analysis of the textual data from focus group and interview transcripts. INSTINCT is a 24-hospital, randomized, controlled study that is designed to evaluate a system-based barrier assessment and interactive educational intervention to increase appropriate tissue plasminogen activator (tPA) use in ischemic stroke. Intervention hospitals undergo baseline barrier assessment using both qualitative as well as quantitative (survey) techniques. Investigators obtain data on local barriers to tPA use, as well as information on local attitudes, knowledge, and beliefs regarding acute stroke treatment. Targeted groups at each site include emergency physicians, emergency nurses, neurologists, radiologists, and hospital administrators. Transcript analysis using NVivo7 with a predefined barrier taxonomy is described. This will provide both qualitative insight on thrombolytic use and importance of specific barrier types for each site. The qualitative findings subsequently direct the form of professional education efforts and system interventions at treatment sites. [source]