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Can an evidence-based guideline reminder card improve asthma management in the emergency department?

https://arctichealth.org/en/permalink/ahliterature143857
Source
Respir Med. 2010 Sep;104(9):1263-70
Publication Type
Article
Date
Sep-2010
Author
Teresa To
Chengning Wang
Sharon D Dell
Bonnie Fleming-Carroll
Patricia Parkin
Dennis Scolnik
Wendy J Ungar
Author Affiliation
The Hospital for Sick Children, Toronto, Ontario, Canada. teresa.to@sickkids.ca
Source
Respir Med. 2010 Sep;104(9):1263-70
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - therapy
Child
Child, Preschool
Emergency Service, Hospital
Evidence-Based Medicine - statistics & numerical data
Female
Guideline Adherence - statistics & numerical data
Humans
Male
Ontario
Practice Guidelines as Topic
Prospective Studies
Reminder Systems - standards
Retrospective Studies
Abstract
Asthma is the most common chronic disease in children. Previous studies described significant variations in acute asthma management in children. This study was conducted to examine whether asthma management in the pediatric emergency department (ED) was improved through the use of an evidence-based acute asthma care guideline reminder card.
The Pediatric Acute Asthma Management Guideline (PAMG) was introduced to the ED of a pediatric tertiary care hospital in Ontario, Canada. Medical charts of 278 retrospective ED visits (January-December 2002) and 154 prospective visits (July 2003-June 2004) were reviewed to assess changes in acute asthma management such as medication treatment, asthma education, and discharge planning. Logistic and linear regressions were used to determine the effect of PAMG on asthma management in the ED. The propensity score method was used to adjust for confounding.
During the implementation of PAMG, patients who visited the ED were more likely to receive oral corticosteroids (Adjusted Odds Ratio [AOR] = 2.26, 95% CI: 1.63-3.14, p
PubMed ID
20434896 View in PubMed
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Contribution of chest and paranasal sinus radiographs to the management of acute asthma.

https://arctichealth.org/en/permalink/ahliterature15946
Source
Int Arch Allergy Immunol. 1994 Sep;105(1):96-100
Publication Type
Article
Date
Sep-1994
Author
O V Rossi
S. Lähde
J. Laitinen
E. Huhti
Author Affiliation
Department of Internal Medicine, University of Oulu, Finland.
Source
Int Arch Allergy Immunol. 1994 Sep;105(1):96-100
Date
Sep-1994
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Asthma - drug therapy - therapy
Female
Humans
Male
Middle Aged
Paranasal Sinuses - radiography
Radiography, Thoracic
Sinusitis - drug therapy
Abstract
In order to evaluate the clinical utility of chest and paranasal sinus radiographs on admission in cases of acute asthma, the radiographs of adult patients admitted to our hospital for acute asthma over a period of 1 year were studied. The findings were specified afterwards by a senior diagnostic radiologist and their impact on the management of asthma was evaluated by reviewing the medical records of the patients retrospectively. Abnormalities were detected in 50% of the chest radiographs (55 of 110) and these resulted in management changes in 5% of cases (6 of 100). Abnormalities in any paranasal sinuses were detected in 85% of the sinus radiographs (93 of 100), and maxillary sinus abnormalities in 63% (70 of 100). 29% of the sinus abnormalities (32 of 110) resulted in an immediate alteration in treatment. Hence abnormalities were more common in the paranasal sinus radiographs than in the chest radiographs (p
PubMed ID
8086834 View in PubMed
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[Effectiveness of several methods of treatment of bronchial asthma in children according to catamnestic data]

https://arctichealth.org/en/permalink/ahliterature16335
Source
Pediatr Akus Ginekol. 1969 Jul-Aug;4:10-1
Publication Type
Article

Guidelines for the emergency management of asthma in adults. CAEP/CTS Asthma Advisory Committee. Canadian Association of Emergency Physicians and the Canadian Thoracic Society.

https://arctichealth.org/en/permalink/ahliterature211642
Source
CMAJ. 1996 Jul 1;155(1):25-37
Publication Type
Article
Date
Jul-1-1996
Author
R C Beveridge
A F Grunfeld
R V Hodder
P R Verbeek
Author Affiliation
Region 2 Hospital Corporation, Saint John, NB.
Source
CMAJ. 1996 Jul 1;155(1):25-37
Date
Jul-1-1996
Language
English
Publication Type
Article
Keywords
Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - therapy
Canada
Emergency Medicine
Humans
Patient Discharge
Respiratory Function Tests
Abstract
To develop a set of comprehensive, standardized evidence-based guidelines for the assessment and treatment of acute asthma in adults in the emergency setting.
The use of medications was evaluated by class, dose, route, onset of action and optimal mode of delivery. The use of objective measurements and clinical features to assess response to therapy were evaluated in relation to the decision to admit or discharge the patient or arrange for follow-up care.
Control of symptoms and disease reflected in hospital admission rates, frequency of treatment failures following discharge, resolution of symptoms and improvement of spirometric test results.
Previous guidelines, articles retrieved through a search of MEDLINE, emergency medical abstracts and information from members of the expert panel were reviewed by members of the Canadian Association of Emergency Physicians (CAEP) and the Canadian Thoracic Society. Where evidence was not available, consensus was reached by the expert panel. The resulting guidelines were reviewed by members of the parent organizations.
The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination were used.
As many as 80% of the approximate 400 deaths from asthma each year in Canada are felt to be preventable. The use of guidelines, aggressive emergency management and consistent use of available options at discharge are expected to decrease the rates of unnecessary hospital admissions and return visits to emergency departments because of treatment failures. Substantial decreases in costs are expected from the use of less expensive drugs, or drug delivery systems, fewer hospital admissions and earlier return to full activity after discharge.
Beta2-agonists are the first-line therapy for the management of acute asthma in the emergency department (grade A recommendation). Bronchodilators should be administered by the inhaled route and titrated using objective and clinical measures of airflow limitation (grade A). Metered-dose inhalers are preferred to wet nebulizers, and a chamber (spacer device) is recommended for severe asthma (grade A). Anticholinergic therapy should be added to beta 2 agonist therapy in severe and life-threatening cases and may be considered in cases of mild to moderate asthma (grade A). Aminophylline is not recommended for use in the first 4 hours of therapy (grade A). Ketamine and succinylcholine are recommended for rapid sequence intubation in life-threatening cases (grade B). Adrenaline (administered subcutaneously or intravenously), salbutamol (administered intravenously) and anesthetics (inhaled) are recommended as alternatives to conventional therapy in unresponsive life-threatening cases (grade B). Severity of airflow limitation should be determined according to the forced expiratory volume at 1 second or the peak expiratory flow rate, or both, before and after treatment and at discharge (grade A). Consideration for discharge should be based on both spirometric test results and assessment of clinical risk factors for relapse (grade A). All patients should be considered candidates for systemic corticosteroid therapy at discharge (grade A). Those requiring corticosteroid therapy should be given 30 to 60 mg of prednisone orally (or equivalent) per day for 7 to 14 days; no tapering is required (grade A). Inhaled corticosteroids are an integral component of therapy and should be prescribed for all patients receiving oral corticosteroid therapy at discharge (grade A). Patients should be given a discharge treatment plan and clear instructions for follow-up care (grade C).
The guidelines share the same principles of those from the British Thoracic Society and the National Institutes of Health. Two specific validation initiatives have been undertaken: (a) several Canadian centres have been involved in the collection of comprehensive administrative data to assess compliance and outcome measures and (b) a survey of Canadian emergency physicians conducted to gather baseline informaton of treatment patterns, was conducted before development of the guidelines and will be repeated to re-evaluate emergency management of asthma.
Notes
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PubMed ID
8673983 View in PubMed
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Qualitative study of the use of traditional healing by asthmatic Navajo families.

https://arctichealth.org/en/permalink/ahliterature3813
Source
Am Indian Alsk Native Ment Health Res. 2003;11(1):1-18
Publication Type
Article
Date
2003
Author
Van Sickle, D.
Morgan, F.
Wright, A.L.
Author Affiliation
Arizona Respiratory Center and Department of Pediatrics, University of Arizona, College of Medicine, Tucson 85724, USA.
Source
Am Indian Alsk Native Ment Health Res. 2003;11(1):1-18
Date
2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Asthma - drug therapy - therapy
Child
Child, Preschool
Cost of Illness
Female
Humans
Indians, North American
Male
Medicine, Traditional
Middle Aged
New Mexico
Philosophy, Medical
Qualitative Research
Research Support, U.S. Gov't, P.H.S.
Spiritual Therapies
Abstract
Despite increasing prevalence of asthma among American Indians and/or Alaska Natives, little is known about their use of traditional healing in its management. A convenience sample of 24 Navajo families with asthmatic members (n=35) was interviewed between June 1997 and September 1998. While 46% of families had previously used traditional healing, only 29% sought traditional healing for asthma. Use of traditional healing was unrelated to use of biomedical therapies, hospitalizations, or emergency services. Practical factors and questions about the nature and origins of asthma were the primary considerations determining use of traditional medicine. Little conflict between traditional healing and biomedical treatment was reported. The use of traditional healing for asthma is influenced by beliefs about the disease and factors specific to the individual, including their local social, economic, and cultural context.
PubMed ID
12955629 View in PubMed
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Towards excellence in asthma management (TEAM): a populational disease-management model.

https://arctichealth.org/en/permalink/ahliterature189506
Source
J Asthma. 2002 Jun;39(4):341-50
Publication Type
Article
Date
Jun-2002
Author
Louis-Philippe Boulet
Robert L Thivierge
André Amesse
Fatima Nunes
Suzanne Francoeur
Jean-Paul Collet
Author Affiliation
Institut de Cardiologie et de Pneumologie de l'Université Laval, Hôpital Laval, Quebec City, Quebec, Canada.
Source
J Asthma. 2002 Jun;39(4):341-50
Date
Jun-2002
Language
English
Publication Type
Article
Keywords
Asthma - drug therapy - therapy
Benchmarking
Canada
Cohort Studies
Disease Management
Guideline Adherence
Humans
Practice Guidelines as Topic
Quebec
Total Quality Management - methods
Abstract
Asthma management is not always optimal, and deficiencies such as inadequate treatment and insufficient patient education are often reported. Towards Excellence in Asthma Management (TEAM) is a four-phase disease management program of the Quebec Asthma Education Network (QAEN), to be carried out over a 5-year period. The program aims to achieve a continuous improvement of asthma management by caregivers and patients. The first phase, completed in January 2000, consisted of determining the actual level of asthma-associated morbidity and mortality in various Quebec regions. The second phase, which began in September 1999, included three parts: 1. Definition of the burden of asthma, taking into account the socioeconomic consequences of the disease and the quality of life of the patients, 2. Comparison of current medical practices with the Canadian Asthma Consensus Guidelines for adult and pediatric populations, 3. Evaluation of the level of compliance with medical treatment and with the environmental changes recommended to asthmatic patients. This phase is carried out via a cohort study of physicians, mainly general practitioners and pediatricians, generating a patient cohort study, in addition to substudies evaluating specific aspects of asthma care. Once the care gap is identified, it will be possible to define, apply, and evaluate a series of interventions for physicians, other health professionals, and patients. The interventions will be particularly targeted at regions where asthma incidence and morbidity are higher. We hope that this model of disease management will progressively reduce the burden associated with asthma, and potentially other chronic diseases, and will result in the more effective use of health services.
PubMed ID
12095185 View in PubMed
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6 records – page 1 of 1.