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Strict Adherence (strict + adherence)
Selected AbstractsUnexpected Events during the Intrahospital Transport of Critically Ill PatientsACADEMIC EMERGENCY MEDICINE, Issue 6 2007Jonathan P.N. Papson MBBS Objectives:To examine unexpected events (UEs) that occur during the intrahospital transport of critically ill emergency department patients. Methods:This was a prospective observational study of consecutive intrahospital transports between March 2003 and June 2004. The escorting emergency physician completed the data collection document either during or immediately after the transport. This document detailed equipment-related UEs, patient instability and invasive line-related UEs, whether the UEs required intervention, and whether the UEs were potentially life threatening (serious UEs). Results:Of 339 transports observed, 230 (67.9%; 95% confidence interval [CI] = 62.6% to 72.7%) were associated with 604 UEs. Overall, there was a median of 1.0 UE per transport (range, 0,16). There were 277 (45.9%; 95% CI = 41.8% to 49.9%) UEs related to equipment, 158 (26.2%; 95% CI = 22.7% to 29.9%) related to patient instability, 156 (25.8%; 95% CI = 22.4% to 29.6%) related to equipment lines, and 13 (2.2%, 95% CI = 1.2% to 3.8%) miscellaneous UEs. The most common UEs were oxygen saturation probe failures, lead and line tangles, hypotension, and the wearing off of sedation and/or paralysis. Most UEs (478 [79.1%]; 95% CI = 75.6% to 82.3%) required an intervention. Emergency physicians had a significantly lower UE rate than residents. Thirty serious UEs occurred; 5.0% (95% CI = 3.4% to 7.1%) of UEs and 8.9% (95% CI = 6.2% to 12.5%) of transports were associated with a serious UE. The most common were severe hypotension, decreasing consciousness requiring intubation, and increased intracranial pressure. Conclusions:Unexpected events during the intrahospital transport of critically ill patients from the emergency department are common and can be potentially life threatening. Transporting physician experience is associated with UE rate. Strict adherence to and review of existing transport guidelines is recommended. [source] Effect of intravenous immunoglobulin on cerebellar ataxia and neuropathic pain associated with celiac diseaseEUROPEAN JOURNAL OF NEUROLOGY, Issue 12 2008N. Souayah Background:, Cerebellar syndrome and small fiber neuropathy may complicate celiac disease (CD) and may be resistant to a strict gluten-free diet. Methods:, Case series. Results:, We report three patients with biopsy-proven CD who developed cerebellar ataxia and neuropathic pain despite strict adherence to a gluten-free diet. A small fiber neuropathy was suggested by skin biopsy findings in two patients. All patients' symptoms, including small fiber neuropathy symptoms, responded to treatment with intravenous immunoglobulin (IVIG). Discontinuation of IVIG in two patients resulted in worsened ataxia that reversed after resumption of IVIG. Conclusion:, Intravenous immunoglobulin may be effective in treating cerebellar ataxia and small fiber neuropathy associated with CD, suggesting an immune pathogenesis. Further prospective, controlled studies are necessary to determine the long-term response to IVIG or other immunomodulation therapy. [source] Determination of rank by median absolute deviation (DRMAD): a simple method for determining the number of principal factors responsible for a data matrix,JOURNAL OF CHEMOMETRICS, Issue 1 2009Edmund R. Malinowski Abstract Median absolute deviation (MAD) is a well-established statistical method for determining outliers. This simple statistic can be used to determine the number of principal factors responsible for a data matrix by direct application to the residual standard deviation (RSD) obtained from principal component analysis (PCA). Unlike many other popular methods the proposed method, called determination of rank by MAD (DRMAD), does not involve the use of pseudo degrees of freedom, pseudo F -tests, extensive calibration tables, time-consuming iterations, nor empirical procedures. The method does not require strict adherence to normal distributions of experimental uncertainties. The computations are direct, simple to use and extremely fast, ideally suitable for online data processing. The results obtained using various sets of chemical data previously reported in the chemical literature agree with the early work. Limitations of the method, determined from model data, are discussed. An algorithm, written in MATLAB format, is presented in the Appendix. Copyright © 2008 John Wiley & Sons, Ltd. [source] SARS , a perspective from a school of nursing in Hong KongJOURNAL OF CLINICAL NURSING, Issue 2 2004David R. Thompson PhD Background., Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. Aims and objectives., This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. Conclusions., The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Relevance to clinical practice., Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large. [source] Blunt abdominal trauma in childrenJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1 2000CH Rance Abstract: Blunt abdominal trauma is the commonest cause of intra-abdominal injuries in children. The use of computerized axial tomography and non-operative management of haemoperitoneum are two significant developments in the last two decades in the management of blunt abdominal trauma in children. The concept of non-operative management was introduced in late 1979 and wherever possible remains the optimum treatment. Computerized tomography scan for paediatric abdominal trauma was first described in 1980 and remains the investigation of choice. There is no substitute, however, for a good history, astute physical examination, and strict adherence to the principles of primary and secondary survey, prompt resuscitation, vigilant monitoring and repeated evaluation. [source] Against the grain: An overview of celiac diseaseJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 5 2008FNP-C Clinical Instructor, Suzanne Martin RN Abstract Purpose: To review the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of celiac disease (CD). Data sources: Review of literature using Pub Med and Access Medicine. The following search terms were used: celiac disease, malabsorption syndromes, diarrhea, and gluten-free diet (GFD). There was no limitation placed on publication year. Only articles written in English were included. Conclusions: CD is a chronic systemic autoimmune disorder triggered in genetically susceptible individuals by the ingestion of gluten proteins (wheat, barley, and rye). CD often presents atypically, and diagnosis delays are common. Currently, the only effective treatment for CD is strict adherence to a GFD. This is a difficult diet to comprehend and follow. Adherence to a GFD requires ongoing education and support from a multidisciplinary healthcare team, support groups, family, and friends. Implications for practice: Once considered a rare disease of childhood, CD is now recognized as a common disorder that can occur at any age. Clinicians need to be cognizant of risk factors, clinical manifestations, conditions, and complications associated with CD in order to make a timely diagnosis, ameliorate symptoms, and minimize disease complications. [source] Many asthma patients experience persistent symptoms despite appropriate clinical and guideline-based treatment with inhaled corticosteroidsJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2007Joan Mogil MSN, NP-C (Nurse Practitioner) Abstract Purpose: To review possible reasons for persistence of asthma symptoms despite appropriate use of clinical and guideline-based treatments, including the use of inhaled corticosteroids. Data sources: Review of the worldwide scientific literature on factors related to persistent symptoms in patients with asthma. Conclusions: Patients with asthma may not respond as expected to therapy because of factors that include poor adherence, improper inhaler technique, persistent exposure to symptom triggers, and limitations of current standard therapy, including steroid insensitivity or the steroid plateau effect. Persistent symptoms may also be associated with IgE-mediated airway inflammation, as current standard asthma therapies do not directly address the IgE-mediated component of the inflammatory cascade. Asthma is a complex disease and its treatment requires the full cooperation and participation of the patient. Implications for practice: Healthcare professionals can play a key role by educating patients and their family members about the nature of asthma and rationale for treatment, supporting the importance of strict adherence to prevention measures and the prescribed treatment regimen. [source] Systematic review: adherence to a gluten-free diet in adult patients with coeliac diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009N. J. HALL Summary Background, Coeliac disease is increasingly diagnosed in adult patients who present with atypical symptoms or who are asymptomatic and detected by case screening. Its treatment, a gluten-free diet, can have a considerable impact on daily living. Understanding the factors associated with non-adherence is important in terms of supporting patients with their condition. Aim, To investigate factors associated with adherence to a gluten-free diet in adults with coeliac disease. Methods, A literature search of multiple electronic databases using a pre-determined search string for literature between 1980 and November 2007 identified a possible 611 hits. After checking for relevance, 38 studies were included in this review. Results, Rates for strict adherence range from 42% to 91% depending on definition and method of assessment and are the lowest among ethnic minorities and those diagnosed in childhood. Adherence is most strongly associated with cognitive, emotional and socio-cultural influences, membership of an advocacy group and regular dietetic follow-up. Screen and symptom-detected coeliac patients do not differ in their adherence to a gluten-free diet. Conclusions, The existing evidence for factors associated with non-adherence to a gluten-free diet is of variable quality. Further and more rigorous research is needed to characterize those individuals most likely to be non-adherent to assist them better with their treatment. [source] Lack of de novo hepatitis C virus infections and absence of nosocomial transmissions of GB virus C in a large cohort of German haemodialysis patientsJOURNAL OF VIRAL HEPATITIS, Issue 4 2009R. S. Ross Summary., To determine the prevalence and incidence of hepatitis C virus (HCV) infections among haemodialysis patients, a large prospective multicentre trial was conducted in the German Federal State of North Rhine-Westphalia. Sera obtained from the recruited patients in two separate sampling rounds run 1 year apart were analysed for both anti-HCV antibodies and HCV RNA. HCV RNA positive samples were also genotyped by direct sequencing of an HCV core fragment. In the first and second rounds, 150 (5.2%) of 2909 and 114 (5.4%) of 2100 patients were anti-HCV positive, respectively, and 4% of individuals were viraemic. Evaluation of potential risk factors in a case,control study indicated that the factors ,foreign country of birth', ,blood transfusions given before 1991' and ,duration of treatment on haemodialysis' were associated with the risk of HCV infection. Among the 2100 patients of whom ,paired' serum samples from both rounds were available for testing, not a single ,de novo' HCV infection could be recorded. The fact that in a subset of about 20% of these patients no nosocomial GB virus C (GBV-C) transmission occurred during the observational period suggests that the lack of HCV seroconversions was not only attributable to the isolation of HCV-infected patients but also to the strict adherence to so-called universal hygienic precautions for infection control maintained in the participating dialysis centres. [source] The ethics of reusing archived tissue for researchNEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 5 2000R. Ashcroft Pathologists have been establishing archives of human organs and tissue for research use for many years now. Controversy has arisen recently over these collections, particularly with regard to the right of patients or relatives to consent to removal and retention of tissue, genetic research using stored tissue samples, and commercial exploitation of tissue collections and genetic material. This paper discusses the ethics of reusing existing archives of tissue. New archives are established under much more stringent conditions than in the past. What rules should apply to existing archives? Guidelines to regulate such use are useful, but face serious difficulties in balancing the variety of public and private interests relating to tissue banking. Consent cannot be obtained retrospectively, but public trust can be established by open acknowledgement of the evolution of ethical standards and strict adherence to current best practice. Guidelines and standards vary from country to country, but ethical principles should not. The implications of this view for pathologists worldwide are discussed. [source] Dietary advice, dietary adherence and the acquisition of tolerance in egg-allergic children: a 5-yr follow-upPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 3 2009Clare Wendy Allen IgE-mediated egg allergy is a common childhood food allergy affecting about 1,2% of 2-yr-old children. Egg avoidance is the mainstay of treatment for egg allergy; however, it is unclear what type of dietary advice parents of children with egg allergy receive and to what extent this dietary advice is adhered to. This study aimed to assess: (i) the type and source of dietary advice parents receive in a tertiary hospital setting, (ii) how closely parents adhere to advice given, (iii) what patient characteristics influenced adherence to diet and (iv) whether strict adherence to dietary advice was an identifiable factor in whether children outgrew their egg allergy. In 2006, a questionnaire was sent to 261 parents of children seen in a tertiary paediatric allergy clinic in 2003 and diagnosed with egg allergy which included 84 children who had undergone an in-hospital open oral egg challenge during this time period (2003,2006). Questions included demographic data, details of egg allergy, dietary avoidance and attainment of unrestricted egg ingestion. Of 199 questionnaires confirmed received, 167 were returned (84%). The mean age of the cohort was 6.6 yr with an average of 5.5 yr of follow-up since the first reaction. Sixty-eight percent of subjects reported avoidance of all food containing egg all the time. Forty-seven percent of the children had been accidentally exposed to egg. The severity of the initial reaction did not appear to influence adherence to an advised diet. Of the 84 children who underwent in-hospital open egg challenges, 57 children were able to ingest egg without clinical reaction and were classified as having outgrown their egg allergy. These children did not differ from those who were challenge positive to egg in terms of either the dietary advice they received or the degree to which they had undertaken strict avoidance of egg. In addition, children who had outgrown their egg allergy did not differ from those who remained egg-allergic on in-hospital challenge in terms of either the frequency of accidental ingestion or the severity of initial reaction. Strict avoidance of egg and accidental ingestion of egg did not appear to influence the acquisition of tolerance. [source] Constitutionalism and Presidential Prerogative: Jeffersonian and Hamiltonian PerspectivesAMERICAN JOURNAL OF POLITICAL SCIENCE, Issue 3 2004Clement Fatovic Scholars, the courts, and the public have been ambivalent about prerogative, the power of presidents to take extraordinary actions without explicit legal authorization in emergencies, because it seems to defy core principles of liberal constitutionalism. This article examines the relation between prerogative and liberal constitutionalism by comparing the approaches of two Founders with different conceptions of executive power, Jefferson and Hamilton. Although they both endorsed a Lockean conception of prerogative that makes it possible to secure vital substantive ends that might be imperiled by strict adherence to ordinary legal forms in an emergency, they disagreed over the constitutionality of prerogative. Whereas Hamilton located the authority for prerogative within the implied powers of the Constitution, Jefferson expected presidents to admit wrongdoing and seek post-hoc approval from the public, a difference with important implications for both democracy and constitutional practice that can be traced back to ambiguities in Locke's theory of prerogative. [source] Virulence genes, serobiotypes and antibiotic resistance profile of Escherichia coli strains isolated from aquaculture and other sourcesAQUACULTURE RESEARCH, Issue 7 2010Surendraraj Alagarsamy Abstract In order to determine the prevalence of pathogenic Escherichia coli, a total number of 155 E. coli isolates from aquaculture, clinical and veterinary sources were screened for seven pathogenic virulence markers and a house-keeping gene by a polymerase chain reaction. The targeted virulence genes included eaeA of enteropathogenic E. coli, elt and est of enterotoxigenic E. coli (ETEC), ipaH of enteroinvasive E. coli, pCVD432 of enteroaggregative E. coli, stx, hlyA and eaeA of shigatoxigenic E. coli (STEC) and Enterohaemorrhagic E. coli. All the isolates were positive for phoA, the house-keeping gene for E. coli. Among the 155 isolates, seven numbers (4.5%) harboured the virulence markers belonging to the pathogenic group ETEC and STEC. The virulent genes detected in these groups were elt, est, hlyA and stx. The sources of these virulence genes were fish (hlyA), shrimp (elt), feeder canal water (hlyA and elt) of aquaculture origin and from diarrhoea affected cow (hlyA, est and stx). The isolates with pathogenic traits belonged to the serogroups O6 or O29 and the remaining could not be typed. They showed resistance to two to four antibiotics out of the 12 antibiotics tested. Biotyping revealed that three isolates belonged to a single biotype (7333) and the remaining isolates were of diverse types. In conclusion, a molecular tool such as PCR proves as more effective tool for detection of this pathogen than the conventional methods. Detection of these emerging pathogens in aquaculture samples warrants for strict adherence to hygienic handling at retail outlets and proper cooking by the consumer before consumption. [source] Review of the first 1502 cases of ECG-ST waveform analysis during labour in a teaching hospitalBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2007V Doria Objective, To assess the impact of introduction of the STAN monitoring system. Study design, Prospective observational study. Setting, Tertiary referral labour ward, St George's Hospital, London. Population, High-risk term pregnancies. Methods, We report all consecutive cases of intrapartum monitoring using the STAN S 21 fetal heart monitor. Cases with adverse neonatal outcome were evaluated in relation to the ST waveform analysis and cardiotocography (CTG). Main outcome measures, Cord artery metabolic acidosis, neonatal encephalopathy (NNE) and reasons behind cases with poor outcome. Results, Between 2002 and 2005, there were 1502 women monitored by STAN. Based on combined STAN analysis in the 1502 women, action was indicated in 358 women (23.8%), while in 1108 women (73.8%) no action was indicated. Traces were not interpretable in 36 women (2.4%). Of the 836 cases (55.7%) where cord blood gases were available, there were 23 cases (2.8%) of metabolic acidosis and 16 of these (70%) were identified by STAN. Overall, there were 14 cases of NNE monitored by STAN. Retrospective analysis of these highlights human errors, such as poor CTG interpretation, delay in taking appropriate action and not following the guidelines. Conclusions, Our experience suggests the need for more intense training on interpretation of CTG and strict adherence to guidelines. [source] Management of fever without source in young children presenting to an emergency roomACTA PAEDIATRICA, Issue 11 2006Martial M. Massin Abstract Background: The management of fever without source in young children is controversial. Aim: To analyse the management approach in our paediatric emergency room, and to correlate it to existing practice guidelines. Methods: We indexed 2176 consecutive patients, aged 1 to 36 mo, seen in our emergency department because of fever,,,38.5°C. Patients with chronic illness, recent antibiotic use, focal bacterial infection or typical viral illness were excluded, and the management approach of the remaining 376 patients was analysed. Results: The most common final diagnosis was acute febrile illness (n=228), whereas bacterial and viral infections were demonstrated in 120 and 28 patients, respectively. Most of the time, our residents correctly ordered complete blood count, chest radiograph and urinalysis in children for whom those investigations are recommended. A blood culture was rarely obtained, even in patients under empirical antibiotherapy. Residents often ordered chest radiograph and urinalysis in low-risk patients, and conflicted with guidelines when considering the prescription of empirical antibiotherapy. Their management allowed the early diagnosis and treatment of two pneumococcal bacteraemias, one meningococcal bacteraemia, seven urinary tract infections and 11 pneumonias, which would have been initially missed by strict adherence to the guidelines. Conclusion: Significant differences exist in the management of the young febrile child between our practice patterns and guidelines, without influence on patient outcome. [source] | |||||||||||||||||||