In morbid obesity conservative therapy often fails to reduce overweight permanently. As a consequence, several bariatric surgical procedures have been developed to achieve permanent excess weight loss. Among these, the laparoscopic restrictive procedures seem to be the least invasive. The aim of this prospective study was to assess and analyze the effects, complications, and outcomes after the implantation of the Swedish adjustable gastric band (SAGB) in long-term follow-up.
All consecutive patients with implantation of a SAGB between August 1996 and August 2002 were prospectively investigated. The placement of the SAGB was done by laparoscopy in all cases. Success was rated by the reduction of body mass index (BMI) excess weight loss (EWL), and reduction of comorbidities. "Nonresponders" to SAGB were defined as
To determine the validity of using healthcare worker (HCW) recall of patient interactions and medical record review for contact tracing in a critical care setting.
Trained observers recorded the interactions of nurses, respiratory therapists, and service assistants with study patients in a medical-surgical intensive care unit. These observers' records were used as the reference standard to test the criterion validity of using HCW recall data or medical record review data to identify exposure characteristics. We assessed the effects of previous quarantine of the HCW (because of possible exposure) and the availability of patients' medical records for use as memory aids on the accuracy of HCW recall.
A 10-bed medical-surgical intensive care unit at Mount Sinai Hospital in Toronto, Ontario.
Thirty-six HCWs observed caring for 16 patients, for a total of 55 healthcare worker shifts.
Recall accuracy was better among HCWs who were provided with patient medical records as memory aids (P
The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014.
This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings.
The discussions provided health professionals with insight into their own and their colleagues' practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working.
Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups.
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Cites: J Health Serv Res Policy. 2016 Apr;21(2):91-100 PMID 26811374
Cites: Med Care. 2009 Mar;47(3):356-63 PMID 19194332
To describe clinical course of children hospitalized for a first episode of acute unilateral infectious adenitis and to identify factors predictive of surgical lymph node drainage.
We reviewed medical records of children from 0 to 17 years of age discharged from a tertiary care pediatric center with a diagnosis of adenitis between 1 April 1996 and 31 March 2001. Patients were included if they had acute ( 5 cm in size and 92.6% were cervical. Thirteen of 252 blood cultures were positive (5.2%), of which one showed Streptococcus pneumoniae and 12 contaminants. Mean length of stay was 4.2 days (2.2 SD). Surgical node drainage was performed in 60 (21.1%) patients. Factors significantly associated with increased risk of surgical drainage were age 48 h (adjusted OR: 2.9; 95% CI: 1.2-7.2). There were no major complications. Follow-up was documented in 183 patients, of whom 92.3% achieved complete healing.
Children hospitalized for a first episode of acute unilateral infectious adenitis generally do well. Younger patients and those with longer duration of node involvement before admission have an increased risk of surgical node drainage.
To assess the quality of care of acute myocardial infarction (AMI) in a rural health region.
Clinical audit employing multiple explicit criteria of care elements for emergency department and in-hospital AMI management. The audit was conducted using retrospective chart review.
Twelve acute care health centres and hospitals in the East Central Health Region, a rural health region in Alberta, where medical and surgical services are provided almost entirely by family physicians.
Hospital inpatients with a confirmed discharge diagnosis of AMI (ICD-9-CM codes 410.xx) during the period April 1, 2001, to March 31, 2002, were included (177 confirmed cases).
Quality of AMI care was assessed using guidelines from the American College of Cardiology and the American Heart Association and the Canadian Cardiovascular Outcomes Research Team and Canadian Cardiovascular Society. Quality of care indicators at three stages of patient care were assessed: at initial recognition and AMI management in the emergency department, during in-hospital AMI management, and at preparation for discharge from hospital.
In the emergency department, the quality of care was high for most procedural and therapeutic audit elements, with the exception of rapid electrocardiography, urinalysis, and provision of nitroglycerin and morphine. Average door-to-needle time for thrombolysis was 102.5 minutes. The quality of in-hospital care was high for most elements, but low for nitroglycerin and angiotensin-converting enzyme (ACE) inhibitors, daily electrocardiography, and counseling regarding smoking cessation and diet. Few patients received counseling for lifestyle changes at hospital discharge. Male and younger patients were treated more aggressively than female and older patients. Sites that used care protocols achieved better results in initial AMI management than sites that did not. Stress testing was not readily available in the rural region studied.
Quality of care for patients with AMI in this rural health region was high for most guideline elements. Standing orders, protocols, and checklists could improve care. Training and resource issues will need to be addressed to improve access to stress testing for rural patients. Clinical audit should be at the core of a system for local monitoring of quality of care.
Cites: Am J Med. 2000 Jun 1;108(8):642-910856412
Cites: J Am Coll Cardiol. 1999 Sep;34(3):890-91110483976
Although Canadian best practice recommendations regarding assessment and management of poststroke depression (PSD) have been established, the degree to which these evidence-based guidelines have been translated into practice is not known. The objectives of the present study are to compare current and recommended best practice and examine possible reasons for identified care gaps.
Practice audit by chart review was performed to identify recorded screening, assessment, and treatment for PSD in patients discharged from a specialized inpatient rehabilitation program over a 6-month period. A questionnaire was administered to all clinical staff addressing current screening practices as well as opinions regarding the importance and feasibility of identification and treatment of PSD.
Of 123 patients, 40 (32.5%) had been prescribed antidepressants at discharge. However, evidence of screening was found for 4.9% of patients; another 9.8% were referred for psychological consult. Treatment was associated with previous antidepressant use or history of depression, but not screening or assessment. Of the survey respondents, 56.2% were not aware of best practice recommendations. However, most felt screening and assessment to be important and treatment was regarded as both simple and effective.
Despite potential benefit associated with identification and treatment of PSD and the availability of evidence-based best practice recommendations, PSD may remain unrecognized and undertreated. Given the juxtaposition of perceived importance with the lack of documented best practice, education regarding standardized screening and the development of consistent clinical protocols including roles and responsibilities in the identification, diagnosis, and treatment of PSD are underway.
Patient safety research has focused almost exclusively on hospitals, with few studies investigating the safety of other healthcare sectors, including home care. Before measuring patient safety in home care, this study first sought to translate hospital-focused patient safety definitions and concepts to home care. A context-appropriate approach to measuring adverse events (AEs) in home care was developed using chart reviews prompted by a mixed screening process. These methods were then applied to measure the incidence, type, severity, cause, preventability and ameliorability of AEs among Winnipeg Home Care clients.
Age-related use of fibrinolytic therapy in acute myocardial infarction was studied for patients admitted to the intensive care unit in four hospitals comprising 10% of the national hospital bed capacity in Norway. Altogether, 446 patients were included. All had validated acute myocardial infarction or acute ischaemic coronary heart disease treated with fibrinolytic medication. The fibrinolytic treatment rate decreased linearly from 74% among patients younger than 50 years to 15% among those older than 80 (p