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Multifaceted Strategy (multifaceted + strategy)

Distribution by Scientific Domains

Medical Sciences	80%

Selected Abstracts

Plantar pressures in diabetic patients with foot ulcers which have remained healed

DIABETIC MEDICINE, Issue 11 2009
T. M. Owings
Abstract Aims, The recurrence of foot ulcers is a significant problem in people with diabetic neuropathy. The purpose of this study was to measure in-shoe plantar pressures and other characteristics in a group of neuropathic patients with diabetes who had prior foot ulcers which had remained healed. Methods, This was an epidemiological cohort study of patients from diabetes clinics of two Swedish hospitals. From a database of 2625 eligible patients, 190 surviving patients with prior plantar ulcers of the forefoot (hallux or metatarsal heads) caused by repetitive stress were identified and 49 patients agreed to participate. Barefoot and in-shoe plantar pressures were measured during walking. Data on foot deformity, activity profiles and self-reported behaviour were also collected. Results, Mean barefoot plantar peak pressure at the prior ulcer site (556 kPa) was lower than in other published series, although the range was large (107,1192 kPa). Mean in-shoe peak pressure at this location averaged 207 kPa when measured with an insole sensor. Barefoot peak pressure only predicted ,35% of the variance of in-shoe peak pressure, indicating variation in the efficacy of the individual footwear prescriptions (primarily extra-depth shoes with custom insoles). Conclusions, We propose that the mean value for in-shoe pressures reported in these patients be used as a target in footwear prescription for patients with prior ulcers. Although plantar pressure is only one factor in a multifaceted strategy to prevent ulcer recurrence, the quantitative focus on pressure reduction in footwear is likely to have beneficial effects. [source]

A Multifaceted Intervention to Implement Guidelines Improved Treatment of Nursing Home,Acquired Pneumonia in a State Veterans Home

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2006
Evelyn Hutt MD
OBJECTIVES: To assess the feasibility of a multifaceted strategy to translate evidence-based guidelines for treating nursing home,acquired pneumonia (NHAP) into practice using a small intervention trial. DESIGN: Pre-posttest with untreated control group. SETTING: Two Colorado State Veterans Homes (SVHs) during two influenza seasons. PARTICIPANTS: Eighty-six residents with two or more signs of lower respiratory tract infection. INTERVENTION: Multifaceted, including a formative phase to modify the intervention, institutional-level change emphasizing immunization, and availability of appropriate antibiotics; interactive educational sessions for nurses; and academic detailing. MEASUREMENTS: Subjects' SVH medical records were reviewed for guideline compliance retrospectively for the influenza season before the intervention and prospectively during the intervention. Bivariate comparisons-of-care processes between the intervention and control facility before and after the intervention were made using the Fischer exact test. RESULTS: At the intervention facility, compliance with five of the guidelines improved: influenza vaccination, timely physician response to illness onset, x-ray for patients not being hospitalized, use of appropriate antibiotics, and timely antibiotic initiation for unstable patients. Chest x-ray and appropriate and timely antibiotics were significantly better at the intervention than at the control facility during the intervention year but not during the control year. CONCLUSION: Multifaceted, evidence-based, NHAP guideline implementation improved care processes in a SVH. Guideline implementation should be studied in a national sample of nursing homes to determine whether it improves quality of life and functional outcomes of this debilitating illness for long-term care residents. [source]

Influencing Fisheries Management: Multitasking for Maximum Effectiveness

ANNALS OF ANTHROPOLOGICAL PRACTICE, Issue 1 2007
John R. Maiolo
From the very first drafts of what later became the Magnuson-Stevens Fishery Conservation and Management Act, and the subsequent creation of regional and state counterparts, social science was supposed to play more than a perfunctory role in the nation's fishery management process. But our involvement as social scientists has not been a cakewalk and, although growing, our influence often has been limited at best. This article discusses how we can impact the process by using different styles of involvement and different research methods. Different styles of involvement include teaching, with an emphasis on recruitment of students and colleagues into the effort, along with multidisciplinary team research. This article illustrates how we must be willing to gather information on an opportunistic basis rather than be wedded to any one type of data gathering and analytic strategy as we move from one project to another. We social scientists can be most effective if we are willing to be persistent, flexible but focused, and able to employ a variety of complementary tactics. Along with this we need to find ways to participate in the management process from the inside. We must also establish our work in the fisheries management process as legitimate within our own respective professions. Finally, this article suggests that such a multifaceted strategy can be effective in other areas of policy concern. [source]

A randomised controlled trial of a tailored multifaceted strategy to promote implementation of a clinical guideline on induced abortion care

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2004
R. Foy
Objective To evaluate the effectiveness and efficiency of a tailored multifaceted strategy, delivered by a national clinical effectiveness programme, to implement a guideline on induced abortion. Design Cluster randomised controlled trial. Setting and participants All 26 hospital gynaecology units in Scotland providing induced abortion care. Intervention Following the identification of barriers to guideline implementation, intervention units received a package comprising audit and feedback, unit educational meetings, dissemination of structured case records and promotion of a patient information booklet. Control units received printed guideline summaries alone. Main outcome measures Compliance with five key guideline recommendations (primary outcomes) and compliance with other recommendations, patient satisfaction and costs of the implementation strategy (secondary outcomes). Results No effect was observed for any key recommendation: appointment with a gynaecologist within five days of referral (odds ratio 0.89; 95% confidence interval 0.50 to 1.58); ascertainment of cervical cytology history (0.93; 0.36 to 2.40); antibiotic prophylaxis or screening for lower genital tract infection (1.70; 0.71 to 5.99); use of misoprostol as an alternative to gemeprost (1.00; 0.27 to 1.77); and offer of contraceptive supplies at discharge (1.11; 0.48 to 2.53). Median pre-intervention compliance was near optimal for antibiotic prophylaxis and misoprostol use. No intervention benefit was observed for any secondary outcome. The intervention costs an average of £2607 per gynaecology unit. Conclusions The tailored multifaceted strategy was ineffective. This was possibly attributable to high pre-intervention compliance and the limited impact of the strategy on factors outside the perceived control of clinical staff. [source]