Clinical Care/Management Strategies

2002 ◽  
Vol 8 (4) ◽  
pp. S81-S98 ◽  
2018 ◽  
Vol 42 (5) ◽  
pp. 563 ◽  
Author(s):  
Elizabeth Sturgiss ◽  
Kees van Boven

International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic? Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add? We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not be able to partake in these kinds of comparison studies. What are the implications for practitioners? Australian primary care researchers and clinicians will be at a disadvantage in any international collaboration if they are unable to accurately describe current general practice management. The Netherlands has developed an impressive dataset that requires within-consultation data collection. These datasets allow for person-centred, symptom-specific, longitudinal understanding of general practice management. The possibilities for the quasi-experimental questions that can be answered with such a dataset are limitless. It is only with the ability to answer clinically driven questions that are relevant to primary care that the clinical care of patients can be measured, developed and improved.


2018 ◽  
pp. 286-296
Author(s):  
Michael E. Reznik ◽  
Amy K. Wagner

Rehabilitation is a process that should begin in the neurointensive care unit. Once a rough prognosis has been made within the context of goals of care discussions, and a decision has been made to proceed with measures geared toward recovery, the focus of clinical care should begin to shift toward the transition to rehabilitation in order to maximize functional gains. In the acute care setting, this necessitates the collaboration of a multidisciplinary team, including physical medicine and rehabilitation, physical and occupational therapy, speech and language pathology, neuropsychology, social work, and nursing. Among the most challenging issues facing intensivists and the rehabilitation team in the critical care setting is the management of the various rehabilitation-related medical complications associated with acquired brain injury, including decreased level of arousal, agitation, sleep disturbances, depression, dysautonomia, bowel and bladder dysfunction, and spasticity. This chapter highlights current management strategies for dealing with these issues.


2018 ◽  
Vol 12 ◽  
pp. 117955491875488 ◽  
Author(s):  
Thomas J FitzGerald ◽  
Maryann Bishop-Jodoin

With continued progress and success in clinical care, the management of patients with Hodgkin lymphoma (HL) has undergone continuous revision to improve patient care outcomes and limit acute and late treatment effects on normal tissue imposed by therapy. Hodgkin lymphoma is a disease that affects children, adolescents, and adults. Clinical management strategies are influenced by the patient’s age at diagnosis, tumor burden, response to induction therapy, and potential expectation of treatment impact on normal tissue. The approach to patient management varies in many parts of the world and is influenced by treatment availability, physician training, and medical culture. Differences in approach are important to understand for accurately comparing and contrasting outcome studies. In this article, we will identify current areas of common ground and points of separation in patient care management for HL. Opportunities for clinical trial strategies will be defined for future clinical trials.


2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 218-218
Author(s):  
Carrie Tompkins Stricker ◽  
Beth Faiman ◽  
Diana Harris ◽  
Nicole Rozario

218 Background: Rapidly emerging therapeutics for multiple myeloma (MM) have diverse and sometimes life-threatening toxicities, underscoring the need for proactive screening, assessment, and management to mitigate symptoms and adverse events [AEs] (i.e., “supportive care (SC) practices”). Little is known about the real-world systematic use of such strategies in routine MM clinical care. A 3 center pilot study aims to describe documented adherence to evidence-based SC practices, and then intervene with a novel ePRO and supportive care planning system (CPS) technology designed to improve adherence. Methods: 90 patients and 90 controls with MM from 3 sites are being evaluated in this pilot study. A scorecard to measure provider use of evidence-based SC practices, at the patient level, was developed by an interdisciplinary team, using an iterative process of literature review and a modified Delphi technique to gain metric consensus. The scorecard is applied to medical records of intervention subjects and controls over an 8-12 week period. Results: Scorecards have been completed to date for 20 historical controls & 7 intervention subjects; remaining to be complete by meeting. For controls, screening for specific symptoms was fairly consistent, but documentation of detailed assessments (e.g., severity, functional impact) and management strategies was poor. For intervention subjects to date, screening almost always was documented, and both detailed assessment and intervention was better than for controls in most cases. See table. Conclusions: For controls, providers regularly documented symptom/AE screening, yet detailed assessments and evidence of interventions were inconsistently documented. Barriers may include the limited availability of effective interventions for symptoms such as CIPN & fatigue, as well as time barriers to effective symptom assessment and management, and its documentation. Almost all metrics were better in intervention subjects to date. Although documentation may not reflect actual practice, improvement in detailed assessment and management strategies is likely needed, and a novel CPS technology may improve this state of affairs; evaluation ongoing. [Table: see text]


1997 ◽  
Vol 10 (3) ◽  
pp. 93-98 ◽  
Author(s):  
Liduïn E.M. Souren ◽  
Emile H. Franssen ◽  
Barry Reisberg

As a result of the neuropathologic process of Alzheimer's disease (AD), significant changes occur in neuromotor function (e.g., paratonia and compulsive grasping). These changes become manifest in the moderately severe stage of AD, when patients begin to require ongoing assistance with activities of daily life (ADL), and they are prominent in the severe stage of AD, when patients are continuously dependent on a caregiver. Patients in these stages often display behavioral disturbances during care activities. These disturbing behaviors result not only from cognitive impairment, but also from a patient's physical inability to cooperate with the caregiver. When care management strategies take into account the characteristic physical restrictions resulting from the neuromotor changes that accompany advanced AD, the caregiving process may be significantly facilitated.


2020 ◽  
Author(s):  
Ana Paula Beck da Silva Etges ◽  
Luciane N Cruz ◽  
Rosane Schlatter ◽  
Jeruza Neyeloff ◽  
Ricardo B Carodso ◽  
...  

Abstract Background: Adopting value-based health care management strategies requires monitoring the real costs and care delivered to patients. This study aimed to evaluate the cost-saving opportunities of interventional coronary procedures (ICPs) by assessing patients’ processes of care and costs in five public academic hospitals.Methods: Data from 90 patients submitted to elective ICP were evaluated in five hospitals in Brazil. Time-driven activity-based costing (TDABC) was used to assess real-world costs and the time spent over the care pathway. Descriptive cost analyses were followed by a labour cost-saving estimate potentially achieved by the redesign of the ICP pathway, considering the benchmark of the patient care cycle identified in the sample of hospitals studied.Results: The mean cost per patient of interventional angioplasty was $1,677 (SD $881). The length of the procedure phase per patient was similar among the hospitals, while the post- procedure phase presented the highest variation in length. However, it was possible to demonstrate that the highest direct cost saving opportunities are concentrated in the procedure phase in which labour and non-labour resources are more consumed. Physician involvement redesign can account for a 51% decrease in procedure cost.Conclusion: This study demonstrated how the level of detailing on cost information provided by the TDABC can contribute to driving health care management to value by identifying cost-saving opportunities in health service delivery.


2020 ◽  
Vol 1 (supplement) ◽  
pp. 6
Author(s):  
Uzma Azeem Awan ◽  
Rida Fatima Saeed ◽  
Muhammad Zeeshan Bhatti ◽  
Muhammad Naeem ◽  
Nosheen Akhtar

The coronavirus 2019 (COVID-19) outbreak has rapidly spread worldwide, which poses great challenges to the healthcare system around the world. This pandemic has shown that globally medical community has no care- models to deal with the effects imposed on patients with chronic illnesses. Appropriate and timely diagnosis and treatment of this highly vulnerable immunocompromised population is mandatory. Prominent challenges faced during the current outbreak include resource allocation, management of patients suffering from and follow-up-phases, patient fear and protection of healthcare workers. During Pandemic, the major management strategies for cancer patients comprise education about personal protective measures, symptoms of COVID- 19, emotional support, clear communication about infection control measures and clinical care. To decrease the risk of exposure, active individualized cancer intervention is required with reduce outpatient visits and maximum telemedicine. Currently, international guidelines to manage cancer patients in any infectious pandemic are not available. The development of a complete contingency plan with guidelines for the safety and patients care will pose beneficial effects by minimizing the risks of morbidity and mortality.


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