The focus of this survey was the various sides of the work performed by the doctor at a child health center. One third of the children were referred to various specialists. In the case of five children in the physicians at the health center may have overlooked pathological disorder. This applied especially to the vision test at the age of four years. In twelve cases the parents failed to follow up special controls for their children. This again applied particularly to the follow-up of impaired vision. A thorough and correct vision test at the age of four years is recommended, as well as good follow-up routines for children at risk.
A prospective follow-up of a random sample of patients with insulin-dependent diabetes mellitus revealed a marked decompensation of carbohydrate metabolism in 98% of the examinees, a high incidence of diabetic ketoacidosis, a long duration of temporary invalidity, and poor adherence of patients to medical recommendations. Assessment of primary health care rendered to patients with type I diabetes at district outpatient clinics of Moscow demonstrated its poor efficacy and a necessity to improve the level of specialized diabetologic care.
Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy.
To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery.
A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants.
Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified.
The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services.
The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy.
Notes
Cites: Hepatology. 2007 Sep;46(3):922-3817879356
Cites: Circulation. 2007 Oct 9;116(15):1736-5417446442
Cites: Can J Gastroenterol. 2007 Nov;21 Suppl D:5D-24D18026582
Many aged Norwegians live in sparsely populated areas where access to geriatric assessment is limited. In 1990 a non-acute, ambulatory service was started in the Nordmøre region. This article gives a description of the project. From 1990 to 1992 19 visits were made to six municipalities by a physician and a nurse from the out-patient clinic for the elderly at the local hospital. 59 patients were referred by general practitioners--mental impairment, general loss of function and assessment of possible rehabilitation being the most common causes for referral. Ten out of 11 GPs, all of whom had referred patients, and the leading district nurses in the municipalities expressed their satisfaction with the project through a postal questionnaire.
Centre for Research Expertise in Improved Disability Outcomes, University Health Network, and Institute for Work & Health, University of Toronto, Toronto, Ontario, Canada. cammendo@uhnresearch.ca
To measure the adherence to 3 radiography guidelines for low back pain in chiropractic teaching clinics.
Evidence-based guidelines for low back pain suggest that plain radiography should be restricted to patients with suspected serious disease. Among primary healthcare providers who can request radiographs, chiropractors are thought to have utilization rates that exceed what is recommended by practice guidelines. It is uncertain whether this gap between evidence and practice begins in undergraduate training.
We screened 1241 consecutive patients with a new episode of low back pain who presented to any of the 6 out-patient teaching clinics of the Canadian Memorial Chiropractic College between January 2004 and September 2004. We collected information about red flags and radiography recommendations from patients and chiropractic trainees using self-administered questionnaires. Radiography recommendations were compared with criteria used in 3 radiography guidelines. Adherence was measured as the proportion of patients without red flags who were not recommended for radiography.
Of the 503 eligible patients, 448 (89.1%) agreed to participate in the study. Radiography was recommended for 12.3% of patients. According to the selected radiography guidelines, the proportion of patients with red flags ranged from 45.3% to 70.5%. The proportion of patients without red flags who were not recommended for radiography ranged from 89.4% (95% confidence interval, 85.5%-93.2%) to 94.7% (95% confidence interval, 90.9%-98.5%) for the selected guidelines.
The results suggest a strong adherence to radiography guidelines for patients with a new episode of low back pain who presented to chiropractic teaching clinics. Although a high proportion of patients had red flags, radiography utilization was lower than rates reported in previous studies suggesting that adherence to guidelines may help prevent unnecessary radiography.
