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Appropriate Recommendations (appropriate + recommendation)
Selected AbstractsAdherence to Pressure Ulcer Prevention Guidelines: Implications for Nursing Home QualityJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2003Debra Saliba MD OBJECTIVES: This study aims to assess overall nursing home (NH) implementation of pressure ulcer (PU) prevention guidelines and variation in implementation rates among a geographically diverse sample of NHs. DESIGN: Review of NH medical records. SETTING: A geographically diverse sample of 35 Veterans Health Administration NHs. PARTICIPANTS: A nested random sample of 834 residents free of PU on admission. MEASUREMENTS: Adherence to explicit quality review criteria based on the Agency for Healthcare Research and Quality Practice Guidelines for PU prevention was measured. Medical record review was used to determine overall and facility-specific adherence rates for 15 PU guideline recommendations and for a subset of six key recommendations judged as most critical. RESULTS: Six thousand two hundred eighty-three instances were identified in which one of the 15 guideline recommendations was applicable to a study patient based on a specific indication or resident characteristic in the medical record. NH clinicians adhered to the appropriate recommendation in 41% of these instances. For the six key recommendations, clinicians adhered in 50% of instances. NHs varied significantly in adherence to indicated guideline recommendations, ranging from 29% to 51% overall adherence across all 15 recommendations (P < .001) and from 24% to 75% across the six key recommendations (P < .001). Adherence rates for specific indications also varied, ranging from 94% (skin inspection) to 1% (education of residents or families). Standardized assessment of PU risk was identified as one of the most important and measurable recommendations. Clinicians performed this assessment in only 61% of patients for whom it was indicated. CONCLUSIONS: NHs' overall adherence to PU prevention guidelines is relatively low and is characterized by large variations between homes in adherence to many recommendations. The low level of adherence and high level of variation to many best-care practices for PU prevention indicate a continued need for quality improvement, particularly for some guidelines. [source] Variables affecting the clarity of psychological reportsJOURNAL OF CLINICAL PSYCHOLOGY, Issue 1 2006Virginia Smith Harvey Effective psychological reports are consumer-focused: They address the concerns of the referring persons, present data appropriately, communicate clearly and concisely, and include useful and appropriate recommendations. Although the importance of clear communication has been stressed repeatedly, psychologists often write reports that are very difficult for nonpsychologists to read. In this article, the author explores four reasons behind this dichotomy: (a) model reports available to psychologists in training are written at a level that is very difficult to understand; (b) psychological terms are not commonly defined; (c) the amount of time it takes to write easily understood reports is substantial; and (d) psychologists are confused about how to address multiple audiences. Methods to address each issue are discussed. © 2005 Wiley Periodicals, Inc. J Clin Psychol. [source] Perineal-Vaginal Injuries in Children: Accident or Abuse?JOURNAL OF FORENSIC SCIENCES, Issue 4 2010Claudia Liuzzi M.D. Abstract:, A large number of conditions have been mistaken for abuse. Differentiating accidental injuries from inflicted injuries is important in the management of injured children. In this work, the authors describe two cases of accidental perineal-vaginal injury in children. In case 1, a 4-year-old girl suffered a vaginal tear caused by violent stretching during play; in case 2, a 3-year-old girl had minor lacerations of labia minora and majora. The intervention of a multi-specialist team including a forensic pathologist and forensic psychiatrist was the key factor in being able to exclude abuse by third parties in the described cases.. This leads to the appropriate recommendations to be adopted in the forensic medicine setting. [source] Stability of the Infant Car Seat Challenge and Risk Factors for Oxygen Desaturation EventsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2007Michele DeGrazia Objectives:, To explore the stability of the one-point Infant Car Seat Challenge and risk factors that may be associated with oxygen desaturation events. Design, Setting, and Participants:, This descriptive, nonexperimental, observational study examined the responses of 49 premature infants during two 90-minute Infant Car Seat Challenges at a tertiary health care institution. Main Outcome Measures:, Three Infant Car Seat Challenge outcomes were explored: (a) pass/fail rates following two Infant Car Seat Challenge observation periods, (b) oxygen saturation and desaturation patterns during two Infant Car Seat Challenges, and (c) the association between oxygen desaturation events and infants' chronological, gestational, and corrected gestational ages. Results:, The findings indicated that 86% of premature infants had stable results, 8% passed Infant Car Seat Challenge 1 but not Infant Car Seat Challenge 2, and 6% failed Infant Car Seat Challenge 1 and passed Infant Car Seat Challenge 2. In addition, the odds for oxygen desaturation events increased for infants born at less than or equal to 34 weeks gestation and hospitalized longer than 7 days. Conclusions:, The Infant Car Seat Challenge success rate for identifying infants at risk for oxygen desaturation events was equal to or better than that of other screening tests for newborn medical conditions. The findings of this study will assist neonatal health care providers in making appropriate recommendations for infants' safe travel at discharge. JOGNN, 36, 300-307; 2007. DOI: 10.1111/J.1552-6909.2007.00161.x [source] Missed opportunities for a diagnosis of acute otitis media in Aboriginal childrenJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2003KB Gibney Objective: Severe otitis media and its sequelae are common in rural and remote Aboriginal children. Identification of acute otitis media (AOM) is likely to reduce the number of children who go on to develop chronic suppurative otitis media and associated complications. The aim of this study was to compare the diagnoses made by researchers with that documented in the medical records of children admitted to the paediatric isolation ward of the Royal Darwin Hospital, Darwin, Northern Territory. Methods: Children aged <8 years admitted to Royal Darwin Hospital were eligible for assessment by pneumatic otoscopy, video-otoscopy and tympanometry. A diagnosis was made for each child according to the state of their worst ear. Comparisons were made between the researcher diagnoses of ear disease and those documented in the hospital notes by medical staff. Results: Thirty-one children were enrolled during 32 admissions. Most were aged <2 years, Aboriginal, and resided in remote communities. Sixty-one video-otoscopic assessments were attempted and sufficiently good images to allow diagnosis were obtained in 105 of 122 ears. Acute otitis media was diagnosed by the research team in 20 of 32 child admissions. Of 29 children who had ear examinations documented by hospital staff, only seven had a diagnosis of AOM recorded. Overall, the research team were almost three times more likely to make this diagnosis (relative risk 2.9, 95% confidence interval 1.6, 5.2). This difference was unlikely to have occurred by chance (P = 0.0002, McNemar's Chi-squared test). Conclusions: In this small study, young Aboriginal children with clear bulging of their tympanic membrane were not diagnosed with AOM by medical staff. Further training in diagnosis, including cleaning of the ear canal, may lead to more accurate assessment and appropriate recommendations for ongoing management. [source] | ||||||||||