scholarly journals Implementation of the best practice guidelines on geriatric trauma care: a Canadian perspective

2019 ◽  
Vol 49 (2) ◽  
pp. 227-232
Author(s):  
Melanie Bérubé ◽  
Theresa Pasquotti ◽  
Barbara Klassen ◽  
Angie Brisson ◽  
Nancy Tze ◽  
...  
Keyword(s):  
Practice Guidelines ◽  
Older Patients ◽  
Best Practice ◽  
Decision Makers ◽  
Geriatric Trauma ◽  
Trauma Management ◽  
Care Providers ◽  
Trauma Centres ◽  
Best Practice Guidelines ◽  
Level I

Abstract Background traumatic injuries are increasingly affecting older patients who are prone to more complications and poorer recovery compared to younger patients. Practices of trauma health care providers therefore need to be adapted to meet the needs of geriatric trauma patients. Objective to assess the implementation of the American College of Surgeons best practice guidelines on geriatric trauma management across level I to III Canadian trauma centres. Methods 69 decision-makers working in Canadian trauma centres were approached to complete a web-based practice survey. Percentages and means were calculated to describe the level of best practice guideline implementation. Results 50 decision-makers completed the survey for a response rate of 72%. Specialised geriatric trauma resources were utilised in 37% of centres. Implementation of mechanisms to evaluate common geriatric issues (e.g. frailty, malnutrition and delirium) varied from 28 to 78% and protocols for the optimisation of geriatric care (e.g. Beers criteria to adjust medication, anticoagulant reversal and early mobilisation) from 8 to 56%. Guideline recommendations were more often implemented in level I and level II trauma centres. The adjustment of trauma team activation criteria to the geriatric population and transition of care protocols were more frequently used by level III centres. Conclusion despite the growing number of older patients admitted in Canadian trauma centres annually, the implementation of best practice guidelines on geriatric trauma management is still limited. Prospective multicentre studies are required to develop and evaluate interdisciplinary knowledge translation initiatives that will promote the uptake of guidelines by trauma centres.

scholarly journals 289 Detection of Falls in Older Patients by Medical Professionals on Admission to Hospital: An Audit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Emily Buckley ◽  
Mazen Alalawi
Keyword(s):  
Practice Guidelines ◽  
Older Patients ◽  
Best Practice ◽  
Acute Hospital ◽  
Medical Professionals ◽  
Medical Patients ◽  
Screening Questionnaire ◽  
Best Practice Guidelines ◽  
Audit Data ◽  
History Of

Abstract Background A history of a previous fall is one of the best predictors of future falls, increasing its risk 3-fold. The Health Service Executive (HSE) best practice guidelines recommend that all patients aged over 65 years in contact with healthcare professionals should be asked routinely whether they have fallen in the past year and asked about the fall-frequency, context and characteristics. The aim of this audit was to increase falls recognition by medical professionals following the implementation of a falls screening questionnaire into the admission proforma of an acute hospital. Methods This was a clinical audit. Data was collected on 29 consecutive patients aged > 65 who were admitted via the emergency department of an acute hospital over a 6 day period. Data on falls was collected using the medical admissions hospital proforma during the first 72 hours. Following the initial audit, a new proforma containing a falls screening questionnaire (as per best practice guidelines) was introduced and an information session provided on its use. A re-audit of 17 admitted medical patients was then completed over the next 72 hours. Results The initial audit highlighted poor assessment of falls with only 3 (25%) patients being screened at admission. 1 (33%) had a fall; described as mechanical. Following introduction of a falls screening questionnaire into the admission proforma, a re-audit showed a significant increase, with 58% of admissions now being screened. Of these, 40% had fallen in the last year: 75% of falls were mechanical and 25% due to other causes. Conclusion This audit shows that falls in this patient population was largely unrecognised by medical professionals. Following implementation of a screening questionnaire, significant improvements were made. This audit concludes that implementation of a falls screening questionnaire into the medical admissions proforma is an effective method in identifying falls in older patients admitted to hospital.

Psychological Assumptions Underlying Credibility Assessments in Finnish Asylum Determinations

2021 ◽  
Author(s):  
Jenny Skrifvars ◽  
Veronica Sui ◽  
Jan Antfolk ◽  
Tanja van Veldhuizen ◽  
Julia Korkman
Keyword(s):  
Decision Making ◽  
Intercultural Communication ◽  
Practice Guidelines ◽  
Best Practice ◽  
Training Programs ◽  
Real Life ◽  
Decision Makers ◽  
Psychological Science ◽  
Best Practice Guidelines ◽  
Immigration Service

Current best-practice guidelines for credibility assessments in asylum procedures have been criticized for their susceptibility to subjectivity and bias. The current study investigated assumptions underlying credibility assessments in Finnish first-instance asylum procedures and how these assumptions fit with widely accepted psychological science. Following previous research, we categorized assumptions in 56 real-life asylum cases from the Finnish Immigration Service. We found that asylum officials held assumptions about how truthful applicants present their claims, the plausibility of individuals’ behavior in their home countries, and applicants’ knowledge about asylum procedures. The assumptions were only partially in line with psychological science on memory, trauma, intercultural communication, and decision-making. To improve decision-making, training programs for asylum officials should include relevant findings from psychological science. To increase the transparency and combat bias, the written determination letters should also include explicit information about the decision-makers reasoning processes.

scholarly journals Best Practice Guidelines and Recommendations for Health Care Providers

2021 ◽  
Author(s):  
◽  
Bernadette Portillo
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Practice Guidelines ◽  
Best Practice ◽  
International Association ◽  
International Crime ◽  
Care Providers ◽  
Victim Identification ◽  
Best Practice Guidelines ◽  
Guidelines And Recommendations

Human trafficking (HT) is a federal and international crime and is regarded as one of the most pressing human rights issues. Adult and minor victims are trafficked by force (rape, beatings, confinement), fraud, and coercion resulting in profound physical and psychological injuries (Chisolm-Straker et al., 2019, p. 72; Department of Homeland Security, 2020; Vera Institute of Justice, 2014, p. 6). Most clinicians fail to recognize HT victims (Egyud et al., 2017; Leslie, 2018; Mason, 2018; McDow & Dols, 2020; Mostajabian et al., 2019; Patient Safety Monitor Journal, 2017; Stevens & Dinkle, 2020). This policy brief’s purpose is to provide health care providers with a validated HT screening tool and best practice guidelines and recommendations to aid in victim identification. The strategies outlined are those published by the Vera Institute of Justice’s HT Victim Identification Tool and are endorsed by the Emergency Nurses Association and the International Association of Forensic Nurses (Chisolm-Straker et al., 2019; Egyud et al., 2017; Leslie, 2018; McDow & Dols, 2020; Mostajabian et al., 2019; Peck, 2020; Stevens & Dinkle, 2020, p. e1; Vera Institute of Justice, 2014). These proposals will increase the likelihood that patients experiencing sexual and labor exploitation will be identified (Chisolm-Straker et al., 2019; Egyud et al., 2017; Leslie, 2018; McDow & Dols, 2020; Mostajabian et al., 2019; Peck, 2020; Stevens & Dinkle, 2020, p. e1; Vera Institute of Justice, 2014)

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

scholarly journals Introducing New Guidelines on Geoheritage Conservation in Protected and Conserved Areas

Geoheritage ◽  
2021 ◽  
Vol 13 (2) ◽  
Author(s):  
Roger Crofts ◽  
Dan Tormey ◽  
John E. Gordon
Keyword(s):  
Practice Guidelines ◽  
Best Practice ◽  
Communication To The Public ◽  
The Public ◽  
Best Practice Guidelines ◽  
The World ◽  
New Guidelines ◽  
The Many ◽  
Ethical Basis ◽  
Improve Practice

AbstractThis paper introduces newly published guidelines on geoheritage conservation in protected and conserved areas within the “IUCN WCPA Best Practice Guidelines” series. It explains the need for the guidelines and outlines the ethical basis of geoheritage values and geoconservation principles as the fundamental framework within which to advance geoheritage conservation. Best practice in establishing and managing protected and conserved areas for geoconservation is described with examples from around the world. Particular emphasis is given to the methodology and practice for dealing with the many threats to geoheritage, highlighting in particular how to improve practice for areas with caves and karst, glacial and periglacial, and volcanic features and processes, and for palaeontology and mineral sites. Guidance to improve education and communication to the public through modern and conventional means is also highlighted as a key stage in delivering effective geoconservation. A request is made to geoconservation experts to continue to share best practice examples of developing methodologies and best practice in management to guide non-experts in their work. Finally, a number of suggestions are made on how geoconservation can be further promoted.

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