Computer Implementation of the Hierarchical-Modular Approach to Treatment Protocols

1982 ◽  
Vol 21 (03) ◽  
pp. 117-126 ◽  
Author(s):  
S. Michelson ◽  
M. Ben-Bassat ◽  
A. Macneil ◽  
M. H. Weil
Keyword(s):  
Critical Care ◽  
Knowledge Base ◽  
Life Support ◽  
Treatment Protocol ◽  
Modular Approach ◽  
Computer Implementation ◽  
Treatment Protocols ◽  
Treatment Information ◽  
Simple Language ◽  
Medical Disciplines

A computer implementation of the hierarchical modular approach to treatment protocols [1] is presented. By this approach the clinical treatment is defined in terms of a hierarchical structure composed of several substructures each varying with the complexity of treatment-related action that is required.The treatment protocol software consists of two major components. The first elicits treatment protocols from experts and stores them in the system’s knowledge base. The second component accesses those elements of the knowledge base relevant to the disorders and specific features (medical findings) of the patient, and drives the display of treatment information tailored specifically to the particular patient. The system interacts with the user in a friendly and very simple language. Displays are formatted in a structured manner and contain as much or as little detail as necessary. This system may find application in various areas, including generation of nursing and life support protocols as well as treatment protocols for critical care and other medical disciplines.

Treatment Algorithms in Critical Care: Do They Improve Outcomes?

2010 ◽  
Vol 23 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Stephen W. Nissen ◽  
Keith M. Olsen
Keyword(s):  
Critical Care ◽  
Treatment Guidelines ◽  
Medical Center ◽  
Treatment Guideline ◽  
Treatment Protocol ◽  
Clinical Trial Data ◽  
Critically Ill Patient ◽  
Successful Implementation ◽  
Treatment Protocols ◽  
Order Form

Patients admitted to the intensive care unit (ICU) often have significant underlying morbidities that require complex treatment plans. Because of these complexities, numerous guidelines have been developed to facilitate the management of the critically ill patient. Some of these guidelines include sepsis, community-acquired and ventilator-associated pneumonia, sedation, and glycemic control. Once guidelines are written, a treatment protocol must be developed and implemented within the critical care unit. Our medical center has implemented multiple treatment protocols, often with preprinted order sets with various degrees of success. In 2003, we implemented and later evaluated a sedation order form and protocol. Patients whose sedation was initiated with a standardized order form had more frequent sedation score assessment, less time between sedation vacations, reduced ICU length of ICU stay, and a trend in reduction of ventilator days. However, only 37% of eligible patients were treated using the order form and the protocol, despite the potentially beneficial effects. Some recommendations within guidelines are based on sound clinical evidence supported by randomized controlled trials, although others are based on expert opinion only. The most often-cited reason for protocol noncompliance is disagreement with the published clinical trial data. This paper examines both infectious and noninfectious treatment guidelines and the supportive evidence that they improved patient outcomes. In addition, strategies for successful implementation of a treatment guideline are discussed for clinicians to follow in order to maximize clinical outcomes.

scholarly journals Favorable Outcome of Severe Poisoning by Snake Green Mamba (Dendroaspis viridis) Clinical Case

2019 ◽  
Vol 15 (2) ◽  
pp. 21-26
Author(s):  
A. R. Nasibullina ◽  
A. N. Lodyagin ◽  
V. A. Vdovin ◽  
N. E. Filippova ◽  
B. V. Batotsyrenov ◽  
...  
Keyword(s):  
Critical Care ◽  
Clinical Case ◽  
Life Support ◽  
Treatment Protocol ◽  
Acute Poisoning ◽  
Favorable Outcome ◽  
Channel Blockers ◽  
Antioxidant Mechanism ◽  
Comprehensive Therapy ◽  
Toxic Myopathy

This clinical case of acute poisoning due to bite of snake Dendroaspis viridis seems interesting to share because of its rare incidence inRussiaand management peculiarities: the critical care was conducted without specific antidote therapy due to absence of the antidote.The prevailing clinical presentation included signs of toxic myopathy combined with paresis of skeletal and breathing muscles that led to development of acute respiratory failure and metabolic disorders. The processes described were induced by the action of snake poison dendrotoxins featuring the activities of potassium channel blockers and acetyl cholinesterase inhibitors.The proper critical care included conduct of syndrome therapy aimed at maintaining life support systems adequately to condition (replacement of the breathing and circulation functions), antibiotic therapy and desensitizing treatment and metabolic care by administration of drugs characterized by antihypoxant/antioxidant mechanism of action.The comprehensive therapy applied has resulted in a favorable outcome of acute poisoning by snake green mamba without development of possible complications even when the specific antidote drug has not been included into the treatment protocol.

Fact file 1: Critical care and emergency medicine

2017 ◽  
Author(s):  
Daisy Fancourt
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Sports Medicine ◽  
Orthopaedic Surgery ◽  
Extreme Environment ◽  
Disaster Medicine ◽  
Medical Attention ◽  
Life Threatening ◽  
Medical Disciplines ◽  
The Brain

Emergency medicine involves the care of patients who require immediate medical attention. The specialty encompasses a broad range of medical disciplines, including anaesthesia, cardiology (a field related to the heart), neurology (a field related to the brain), plastic surgery, orthopaedic surgery (surgery relating to the bones or muscles), and cardiothoracic surgery (surgery relating to the heart, chest, or lungs). There are also a number of subspecialties including extreme environment medicine, disaster medicine and sports medicine. Related to emergency medicine is the specialty of critical care medicine, which is concerned with the care of patients with life-threatening conditions often treated in intensive care settings....

Expanding the Knowledge Base in Diet, Nutrition and Critical Care: Electronic and Published Resources

2015 ◽  
pp. 1193-1199
Author(s):  
Fawaz Alzaid ◽  
Rajkumar Rajendram ◽  
Vinood B. Patel ◽  
Victor R. Preedy
Keyword(s):  
Critical Care ◽  
Knowledge Base

scholarly journals External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era

2020 ◽  
Author(s):  
Haewon Jung ◽  
Mijin Lee ◽  
Jae Wan Cho ◽  
Sang Hun Lee ◽  
Suk Hee Lee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Disease Transmission ◽  
Life Support ◽  
External Validation ◽  
Advanced Life Support ◽  
Survival Outcomes ◽  
Shock Delivery ◽  
Treatment Protocols ◽  
Multicenter Observational Study ◽  
Hospital Cardiac Arrest

Abstract Background: Futile resuscitation for out-of-hospital cardiac arrest (OHCA) patients in the coronavirus disease (COVID)-19 era can lead to risk of disease transmission and unnecessary transport. Various existing basic or advanced life support (BLS or ALS, respectively) rules for the termination of resuscitation (TOR) have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era.Methods: This was a multicenter observational study using the WinCOVID-19 Daegu registry data collected during February 18–March 31, 2020. The subjects were patients who showed cardiac arrest of presumed cardiac etiology. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity, specificity, false positive value (FPV), and positive predictive value (PPV) of each TOR rule were evaluated. Results: In total, 170 of the 184 OHCA patients were eligible and evaluated. TOR was recommended for 122 patients based on the international basic life support termination of resuscitation (BLS-TOR) rule, which showed 85% specificity, 74% sensitivity, 0.8% FPV, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPV (upper limit of 95% confidence interval <5%), specificity (100%), and PPV (>99%) criteria, only the KoCARC TOR rule I, which included a combination of three factors including not being witnessed by emergency medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock delivery or return of spontaneous circulation, was found to be superior to all other TOR rules. Conclusion: Among the previous nine BLS and ALS TOR rules, KoCARC TOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide.

scholarly journals Challenges in Steroid and Anticoagulant Therapy in Severe COVID-19 Pneumonia: A Prospective Study

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1214
Author(s):  
Alaa Thabet Hassan ◽  
Alaa E. Abd Elmoniem ◽  
Marwa Mahmoud Abdelrady ◽  
Mona Embarek Mohamed ◽  
Mohamed A. Mokhtar ◽  
...  
Keyword(s):  
Treatment Protocol ◽  
Severe Pneumonia ◽  
High Risk Group ◽  
University Hospital ◽  
Treatment Protocols ◽  
Neutrophil Lymphocyte Ratio ◽  
Treatment Type ◽  
Acute Kidney Disease ◽  
Significant Difference ◽  
Group B

Background: As COVID-19 has neither a standard treatment protocol nor guidelines, there are many treatment protocols for anti-inflammatory corticosteroids and anti-coagulations for severe COVID-19 pneumonia patients. This study aimed to assess the most suitable modality in this high-risk group. Methods: A prospective, experimental study design was adopted that included 123 severe COVID-19 pneumonia patients admitted at Assiut University Hospital. Patients were divided into three groups according to a combined corticosteroid and anticoagulants therapy protocol. Group A included 32 patients, group B included 45 patients, and group C included 46 patients. Assessment of cases was conducted according to the treatment type and duration, weaning duration from oxygen therapy, length of hospital and ICU stay, and complications during treatment. Three months follow-up after discharge was performed. Results: the three patient groups showed significant differences regarding the 3-month outcome, whereas Group C showed the highest cure rate, lowest lung fibrosis, and lowest mortality rate over the other two groups. The in-hospital outcome, the development of pulmonary embolism, bleeding, hematoma, acute kidney disease, and myocardial infarction showed a significant difference between groups (p values < 0.05). Mortality predictors among severe COVID-19 patients by multivariable Cox hazard regression included treatment modality, history of comorbid diseases, increased C reactive protein, high neutrophil-lymphocyte ratio, and shorter ICU and hospital stay. Conclusion: the use of combined methylprednisolone and therapeutic Enoxaparin, according to a flexible protocol for COVID-19 patients with severe pneumonia, had two benefits; the prevention of disease complications and improved clinical outcome.

Surgical Intervention for Enneking Stage-III Vertebral Hemangiomas and Literature Review

2021 ◽  
pp. 10
Author(s):  
Monerah Annaim
Keyword(s):  
Surgical Intervention ◽  
Treatment Protocol ◽  
Stage Iii ◽  
Spinal Tumors ◽  
Preoperative Embolization ◽  
Comprehensive Treatment ◽  
Treatment Protocols ◽  
Enneking Stage ◽  
Vertebral Hemangiomas

Introduction: Vertebral hemangiomas are benign, slow-growing tumors. They represent 2–3% of spinal tumors and are incidentally found. Various treatment protocols have been described for Enneking stage-III vertebral hemangiomas. However, it is still controversial and a comprehensive treatment protocol is still lacking. Methodology: A retrospective clinical review was conducted on patients diagnosed with Enneking stage-III vertebral hemangiomas at two centers in Riyadh, Saudi Arabia between 2010 and 2020. Result: A total of 11 patients with Enneking stage-III vertebral hemangiomas were included. The mean follow-up period was 47.5 ± 24.1 (9–120 months) months. All patients were symptomatic; the most common presentations were neurological deficit and/or myelopathy (n = 7). Ten patients underwent surgical intervention. Six patients had preoperative embolization, with a mean blood loss of 880.00 ± 334.46 ml. One patient refused surgery and underwent vertebroplasty and repeated sclerotherapy. All patients regained full neurological recovery during follow-up. No recurrence was reported. Conclusion: Intralesional spondylectomy showed good results in treating Enneking Stage-III vertebral hemangiomas. However, larger studies comparing treatment methods are needed to reach a gold standard approach.

, Positive CBT: Individual and Group Treatment Protocols for Positive Cognitive Behavioral Therapy

2021 ◽  
Author(s):  
Fredrike Bannink ◽  
Nicole Geschwind
Keyword(s):  
Group Treatment ◽  
Behavioral Therapy ◽  
Treatment Protocol ◽  
Cognitive Behavioral ◽  
Individual Treatment ◽  
Treatment Protocols ◽  
Self Compassion ◽  
The Individual ◽  
And Behavior ◽  
Solution Focused

Positive CBT integrates positive psychology and solution-focused brief therapy within a cognitive-behavioral framework. It focuses not on reducing what is wrong, but on building what's right. This fourth wave CBT, developed by Fredrike Bannink, is now being applied worldwide for various psychological disorders. An introductory chapter explores the three approaches incorporated in positive CBT. Next, the book presents research into the individual treatment protocol for use with clients with major depressive disorder by Nicole Geschwind and colleagues at Maastricht University. The last chapters describe two 8-session treatment protocols for positive CBT, one for use with individuals and one for use with groups. The treatment protocols provide therapists with a step-by-step guide on how to apply positive CBT with individual clients and in group therapy. This approach goes beyond symptom reduction and instead focuses on the client’s preferred future, on finding exceptions to problems and identifying competencies. Topics such as self-compassion, optimism, gratitude, and behavior maintenance are explored. In addition to the protocols, two workbooks for clients are available online for download by therapists.

VP169 Grouping Treat-to-Target Studies In Systematic Reviews

2017 ◽  
Vol 33 (S1) ◽  
pp. 227-228
Author(s):  
Marrissa Martyn-St James ◽  
Emma Hock ◽  
Ruth Wong ◽  
Matt Stevenson ◽  
Allan Wailoo
Keyword(s):  
Blood Pressure ◽  
Usual Care ◽  
Systematic Reviews ◽  
Treatment Protocol ◽  
Treat To Target ◽  
Blood Pressure Target ◽  
Treatment Protocols ◽  
Blood Pressure Targets ◽  
Antidiabetic Treatment ◽  
Study Designs

INTRODUCTION:A Health Technology Assessment (HTA) systematic review was undertaken in rheumatoid arthritis (RA) of treat-to-target (TTT) studies (n = 16) in which studies were grouped according to: TTT versus usual care, trials comparing different targets, or trials comparing different treatment protocols. To our knowledge, this was the first RA TTT review where studies were grouped in this way. We wanted to compare if our approach had been adopted in reviews of hypertension, hyperlipidemia or diabetes.METHODS:We searched MEDLINE for systematic reviews (SRs) of TTT studies in hypertension, hyperlipidaemia or diabetes.RESULTS:Eleven SRs were included; eight were in diabetes, and four were in hypertension, while none were in hyperlipidaemia. The diabetes SRs evaluated different insulin regimens (n = 3), non-insulin medications (n = 1), any antidiabetic treatment (n = 2), metformin monotherapy versus combination therapy (n = 1), and tight versus conventional glucose control (n = 1). The metformin review grouped studies by outcome whereas all other diabetes SRs grouped studies by treatment. Two hypertension SRs evaluated the effects of any treatment on two blood pressure targets, whereas one evaluated two different treatment regimen effects on the same blood pressure target. No SR in hypertension or diabetes included a mix of TTT versus usual care, and/or same treatment protocol different targets, and/or different treatment protocols same target study designs.CONCLUSIONS:In RA TTT does not refer to a single concept but a range of different approaches to the treatment of patients and the evidence reflects this. Whilst our approach to grouping RA TTT studies in a review was novel, this made it complex for us to synthesize evidence and draw general conclusions. We did not identify any TTT reviews in hypertension or diabetes including a mix of the TTT approaches we identified in RA. At present, a comparison of the strengths and limitations of our TTT review study grouping with reviews of hypertension, hyperlipidemia or diabetes cannot be made.

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