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Better Documentation (good + documentation)
Selected AbstractsPriapism: Pathogenesis, Epidemiology, and ManagementTHE JOURNAL OF SEXUAL MEDICINE, Issue 1pt2 2010Gregory A. Broderick MD ABSTRACT Introduction., Priapism describes a persistent erection arising from dysfunction of mechanisms regulating penile tumescence, rigidity, and flaccidity. A correct diagnosis of priapism is a matter of urgency requiring identification of underlying hemodynamics. Aims., To define the types of priapism, address its pathogenesis and epidemiology, and develop an evidence-based guideline for effective management. Methods., Six experts from four countries developed a consensus document on priapism; this document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. This report focuses on guidelines written over the past decade and reviews the priapism literature from 2003 to 2009. Although the literature is predominantly case series, recent reports have more detailed methodology including duration of priapism, etiology of priapism, and erectile function outcomes. Main Outcome Measures., Consensus recommendations were based on evidence-based literature, best medical practices, and bench research. Results., Basic science supporting current concepts in the pathophysiology of priapism, and clinical research supporting the most effective treatment strategies are summarized in this review. Conclusions., Prompt diagnosis and appropriate management of priapism are necessary to spare patients ineffective interventions and maximize erectile function outcomes. Future research is needed to understand corporal smooth muscle pathology associated with genetic and acquired conditions resulting in ischemic priapism. Better understanding of molecular mechanisms involved in the pathogenesis of stuttering ischemic priapism will offer new avenues for medical intervention. Documenting erectile function outcomes based on duration of ischemic priapism, time to interventions, and types of interventions is needed to establish evidence-based guidance. In contrast, pathogenesis of nonischemic priapism is understood, and largely attributable to trauma. Better documentation of onset of high-flow priapism in relation to time of injury, and response to conservative management vs. angiogroaphic or surgical interventions is needed to establish evidence-based guidance. Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, and Shamloul R. Priapism: Pathogenesis, epidemiology and management. J Sex Med 2010;7:476,500. [source] Software Use in Psychometric ResearchEDUCATIONAL MEASUREMENT: ISSUES AND PRACTICE, Issue 1 2004Gary Skaggs Research on psychometric methods is heavily dependent on software. The quality, availability, and documentation of such software are critical to the advancement of the field. In 2000, an ad hoc committee of NCME recommended that NCME adopt policies that promote greater availability and better documentation of software. This article follows the ad hoc committee's report by examining the use of software in four top-tiered journals in recent years. The results indicated that the most frequently cited programs were those written by the articles' authors. The documentation and availability for these programs are often not clear, particularly for software used for simulations. The use of proprietary software was not widespread in the four journals, but there is still room for concern in the future. This article recommends that NCME form a permanent committee to address software issues. [source] Making better biogeographical predictions of species' distributionsJOURNAL OF APPLIED ECOLOGY, Issue 3 2006ANTOINE GUISAN Summary 1Biogeographical models of species' distributions are essential tools for assessing impacts of changing environmental conditions on natural communities and ecosystems. Practitioners need more reliable predictions to integrate into conservation planning (e.g. reserve design and management). 2Most models still largely ignore or inappropriately take into account important features of species' distributions, such as spatial autocorrelation, dispersal and migration, biotic and environmental interactions. Whether distributions of natural communities or ecosystems are better modelled by assembling individual species' predictions in a bottom-up approach or modelled as collective entities is another important issue. An international workshop was organized to address these issues. 3We discuss more specifically six issues in a methodological framework for generalized regression: (i) links with ecological theory; (ii) optimal use of existing data and artificially generated data; (iii) incorporating spatial context; (iv) integrating ecological and environmental interactions; (v) assessing prediction errors and uncertainties; and (vi) predicting distributions of communities or collective properties of biodiversity. 4Synthesis and applications. Better predictions of the effects of impacts on biological communities and ecosystems can emerge only from more robust species' distribution models and better documentation of the uncertainty associated with these models. An improved understanding of causes of species' distributions, especially at their range limits, as well as of ecological assembly rules and ecosystem functioning, is necessary if further progress is to be made. A better collaborative effort between theoretical and functional ecologists, ecological modellers and statisticians is required to reach these goals. [source] Pre-audit survey of documentation of invasive procedures in paediatric anaesthesiaPEDIATRIC ANESTHESIA, Issue 9 2002A. Patil Introduction Consent of patients for any medical procedure is an essential part of good practice (1). Verbal consent is increasingly sought for invasive anaesthetic procedures and documentation of this is an important feature of risk management. Paediatric consent is a complex issue and although it is common practice to explain things to the child, written consent is generally still sought from the parent (2). Recent guidelines from the Royal College (3) are quite specific about having a ,child centred approach'. They clearly state that ,where special techniques (e.g. epidurals, other regional blocks including caudal, and invasive monitoring or blood transfusion) are used there should generally be written evidence that these have been discussed with the child (when appropriate) and the parents'. Our aim was to discover the current amount of documentation on invasive procedures in our paediatric anaesthetic notes and to subsequently agree on a local standard. Method We looked retrospectively at anaesthetic records of children aged 10, 11 and 12 years undergoing general anaesthesia for elective surgery over a 2-month period. We specifically looked for documentation of who was present at the pre-operative discussion and where an invasive anaesthetic technique was planned. written evidence that it had been discussed. Results 73 anaesthetic records were examined. The case mix was as follows: 37% ENT, 28% Plastic Surgery, 24% General Surgery, 11 % Orthopaedic and Oral Surgery. A Consultant was present for 98% of the anaesthetics and was accompanied by a trainee in half of those cases. In 82% (60 patients) there was no documentation of who was present at the pre-operative discussion. In 2 cases (3%) the child was seen alone, in 8 cases (11 %) both a parent and child were documented to have been involved in the discussion and in 3 cases (4%) only the parents appeared to have been involved. Of the 73 anaesthetic records, 11 did not have invasive procedures planned or performed and the following data is from the remaining 62 anaesthetic records ,,83.5% of invasive procedures were documented pre-operatively ,,12 patients (19%) had more than one procedure. ,,Only 7 notes (11 %) had a record of the procedure being specifically discussed with the child. ,,2 out of the 4 caudal (50%) were done without documentatior, of discussion about the procedure ,,7 out of 48 suppositories (14%) were given without record of verbal consent ,,5 out of 16 (31 %) of the local anaesthetic techniques were performed without documentation of discussion. Discussion This pre-audit survey demonstrates that in 82% of cases there was no record of exactly who was present at the preoperative discussion and that some invasive procedures were carried out without any record of a discussion having taken place. We feel that this level of documentation is insufficient. We looked at the age range 10,12 years as this might be regarded as approximately the age at which agreement should be sought for relatively simple procedures such as those chosen in this survey. This is not to imply that children below this age should not be involved in a plan of management or that all children of this age will be fully competent to participate in decisions. We deliberately chose to look at elective surgery, as there should be better documentation in these cases. One reason for such poor results may be that most anaesthetists do not realise the importance of documentation. Our current chart provides no means of prompting the anaesthetist to record who was present at pre-operative discussions. There is also a lack of a clear standard as to an age when invasive procedures should generally be discussed. We feel that this is probably a common problem and hope this surveys increases awareness on this important topic. Conclusions The results of this survey are to be brought to the attention of the local department. Having identified the problem we hope to agree on a local standard and audit against these standards. [source] | ||||||||||