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Specific Clinical Problems (specific + clinical_problem)
Selected AbstractsMonitoring the care of lung cancer patients: linking audit and care pathwaysJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2001E. Kaltenthaler BSc Abstract Clinical audit plays an important role in monitoring the provision of care for patients whatever their condition. Care pathways define the steps and expected course of events in the care of patients with a specific clinical problem over a set time scale. This paper describes a study undertaken in a multisite cancer unit to develop a tool for monitoring the progress of lung cancer patients through a care pathway and auditing key standards within the pathway. Important issues associated with the development of this tool are highlighted. The process of developing this tool involved the following steps: a review of the literature dealing with the management of lung cancer patients; interviews with key personnel in primary, secondary, tertiary and palliative care; development of a paper-based series of forms representing key steps in the patient's care pathway; 3-month trial of the paper-based tool; analysis of completion rates and interviews with form users to evaluate effectiveness; and recommendations for creating an electronic record using the experience and lessons learned from the paper version. The paper forms developed through this multistage process were found to be acceptable to users and have the potential to provide accurate information at key points for audit throughout the patient's time within the health-care system for their lung cancer condition. The flexibility of this methodology allows it to be adapted readily to a variety of clinical situations and conditions. [source] assessment: Checking the checklist: a content analysis of expert- and evidence-based case-specific checklist itemsMEDICAL EDUCATION, Issue 9 2010Agatha M Hettinga Medical Education 2010: 44: 874,883 Objectives, Research on objective structured clinical examinations (OSCEs) is extensive. However, relatively little has been written on the development of case-specific checklists on history taking and physical examination. Background information on the development of these checklists is a key element of the assessment of their content validity. Usually, expert panels are involved in the development of checklists. The objective of this study is to compare expert-based items on OSCE checklists with evidence-based items identified in the literature. Methods, Evidence-based items covering both history taking and physical examination for specific clinical problems and diseases were identified in the literature. Items on nine expert-based checklists for OSCE examination stations were evaluated by comparing them with items identified in the literature. The data were grouped into three categories: (i) expert-based items; (ii) evidence-based items, and (iii) evidence-based items with a specific measure of their relevance. Results, Out of 227 expert-based items, 58 (26%) were not found in the literature. Of 388 evidence-based items found in the literature, 219 (56%) were not included in the expert-based checklists. Of these 219 items, 82 (37%) had a specific measure of importance, such as an odds ratio for a diagnosis, making that diagnosis more or less probable. Conclusions, Expert-based, case-specific checklist items developed for OSCE stations do not coincide with evidence-based items identified in the literature. Further research is needed to ascertain what this inconsistency means for test validity. [source] Antibiotic use in five children's hospitals during 2002,2006: the impact of antibiotic guidelines issued by the Chinese Ministry of Health,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 3 2008Wenshuang Zhang Abstract Purpose To investigate the pattern of antibiotic use in five Chinese children's hospitals from 2002 to 2006. To see if the Guidelines to encourage rational use of antibiotics issued by the Ministry of Health in October 2004 have any impact on the use. Methods The Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) methodology was used. Aggregate data on antibiotic use (ATC code-J01) were expressed in numbers of DDD/100 bed-days for inpatients. Results Total 56 different substances of systemic antibiotics were used. The overall consumption of antibiotic drugs was 68.2, 58.4, 65.8, 65.6 and 49.9 DDD/100 bed-days for the years 2002,2006, respectively. The top antibiotics used were third-generation cephalosporins. There was considerable variation in both type and amount of antibiotics used in the five hospitals. In 2002, some hospitals had twice the antibiotic use compared to others. While the overall antibiotic use in 2005 was largely unchanged compared with previous years, by 2006 antibiotic use had decreased by 22.6% and the variation in use between hospitals was also reduced. Conclusions The ATC/DDD methodology proved useful for studying overall antibiotic usage in children's hospitals. The decline in antibiotic usage found in 2006 (and the reduced variation between hospitals) may be attributed to the impact of the Ministry of Health guidelines which took some time to be promulgated to individual staff members. Further research will focus on compliance of antibiotic use in these five hospitals with particular guideline recommendations for specific clinical problems such as bacterial resistance and surgical antibiotic prophylaxis. Copyright © 2007 John Wiley & Sons, Ltd. [source] The urticaria spectrum: recognition of clinical patterns can help managementCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 3 2004C. E. H. Grattan Summary Urticaria has diverse clinical presentations and causes. The implication of classifying urticaria primarily by clinical presentation rather than aetiology is that management can be focused on specific clinical problems without extensive investigations. Management pathways may involve nonpharmacological measures and drug interventions, which can be grouped into first-, second- and third-line therapies. Stronger, but potentially more risky, second- and third-line approaches may be justified for patients who do not respond to first-line therapy with antihistamines even though it may not be possible to define a specific aetiology, such as autoimmune urticaria, with confidence. [source] Fighting infections due to multidrug-resistant Gram-positive pathogensCLINICAL MICROBIOLOGY AND INFECTION, Issue 3 2009G. Cornaglia Guest Editor Growing bacterial resistance in Gram-positive pathogens means that what were once effective and inexpensive treatments for infections caused by these bacteria are now being seriously questioned, including penicillin and macrolides for use against pneumococcal infections and,in hospitals,oxacillin for use against staphylococcal infections. As a whole, multidrug-resistant (MDR) Gram-positive pathogens are rapidly becoming an urgent and sometimes unmanageable clinical problem. Nevertheless, and despite decades of research into the effects of antibiotics, the actual risk posed to human health by antibiotic resistance has been poorly defined; the lack of reliable data concerning the outcomes resulting from antimicrobial resistance stems, in part, from problems with study designs and the methods used in resistence determination. Surprisingly little is known, too, about the actual effectiveness of the many types of intervention aimed at controlling antibiotic resistance. New antibiotics active against MDR Gram-positive pathogens have been recently introduced into clinical practice, and the antibiotic pipeline contains additional compounds at an advanced stage of development, including new glycopeptides, new anti-methicillin-resistant Staphylococcus aureus (MRSA) ,-lactams, and new diaminopyrimidines. Many novel antimicrobial agents are likely to be niche products, endowed with narrow antibacterial spectra and/or targeted at specific clinical problems. Therefore, an important educational goal will be to change the current, long-lasting attitudes of both physicians and customers towards broad-spectrum and multipurpose compounds. Scientific societies, such as the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), must play a leading role in this process. [source] | ||||||||||