scholarly journals 1018 Implementing A Standardised Orthopaedic Admission Pro-Forma to Improve Adherence to The Royal College of Surgeons of England (RCSEng) Best Practice Clerking Guidelines

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Peacock ◽  
D North ◽  
T Brookes
Keyword(s):  
Best Practice ◽  
Clinical Decision Making ◽  
Statistical Significance ◽  
Clinical Decision ◽  
Smoking History ◽  
Exact Test ◽  
Orthopaedic Patients ◽  
The Impact ◽  
Pro Forma

Abstract Introduction Within our Trust, Orthopaedic patients are clerked in on A&E notes via freehand text. Audit, clinical incidents, and root cause analysis revealed suboptimal documentation. Using RCSEng Best Practice Guidelines we designed, implemented, and evaluated the impact of an admission pro-forma on quality of clerking. Method An Orthopaedic clerking pro-forma was designed based on standards set by RCSEng and feedback from Orthopaedic colleagues. First- and second-cycle data collection involving quantitative analysis of clerking against RCSEng domains was conducted before (n = 23) and after (n = 25) intervention. Fisher’s exact test was performed to calculate the statistical significance of our data. A qualitative survey was performed to gain feedback on the pro-forma. Results Observations, allergies, and smoking history were omitted in over half of freehand documentations. Medical/surgical history and management plans were well documented regardless. Intervention resulted in statistically significant increases in 7 out of 12 RCSEng clerking domains, most notably allergies (p < 0.00001). Qualitative feedback was positive; 100% of those surveyed stated that the pro-forma ‘improved quality of clerking‘ and ‘benefited clinical decision making’. Conclusions Our study demonstrated that implementing an Orthopaedic pro-forma improved adherence to RCSEng best practice clerking guidelines compared to freehand documentation and standardised the process improving the level and quality of documentation.

Prediction of benefit from treatment beyond the first line in patients with metastatic breast cancer (MBC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11565-e11565
Author(s):  
Marta Bonotto ◽  
Lorenzo Gerratana ◽  
Alessandro Minisini ◽  
Elena Poletto ◽  
Stefania Russo ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Statistical Significance ◽  
Metastatic Breast ◽  
Progression Free Survival ◽  
Clinical Decision ◽  
Consecutive Series ◽  
First Line ◽  
Her2 Positive ◽  
Free Survival ◽  
The Impact

e11565 Background: Despite the availability of several therapeutic options for MBC, palliative treatments beyond 1st line lack of predictive factors that could help clinical decision making. We aimed to determine which is the impact of benefit at 1stline into the benefit from subsequent therapeutic lines. Methods: We analyzed a consecutive series of 472 MBC patients treated with chemotherapy (CT) and/or endocrine therapy (ET) at the Department of Oncology of Udine, Italy, between 2004 and 2012. We evaluated Progression Free Survival at 1st (PFS1), 2nd (PFS2), 3rd (PFS3) and 4th (PFS4) line of treatment. Three distinct analyses were conducted: the first for the lines of CT, the second for the lines of ET and the third by considering both CT and ET as a line of treatment. A PFS longer than 6 months was defined as “6-month benefit". Results: Median Overall Survival was 34.5 mo (25th – 75th percentile: 14.5 – 58.8), median overall PFS1 and PFS2 was 8.9 mo and 4.3 mo respectively. Median PFS1 and PFS2 in CT lines only was 7 mo and 3.7 mo, respectively. Median PFS1 and PFS2 in ET lines only was 9.4 mo and 4.6 mo respectively. Overall, 289 patients (63.5%) presented 6-month benefit at 1st line, 128 (40.5%) at 2nd, 76 (33.8%) at 3rd and 34 (23.3%) at 4th. Not having a 6-month benefit in overall PFS1 was associated with a lack of benefit both at 2nd line (OR=0.48; p=0.0026) and at any line beyond the 1st (OR=0.39; p< 0.0001). Taking into consideration CT lines only, not having a 6-month benefit in CT PFS1 was associated with a lack of benefit both at 2nd line (OR=0.45; p=0.0072) and at any line beyond the 1st (OR=0.43; p=0.0026). A lack of benefit at the 1st ET line was not associated with further ET outcome neither in 2nd line nor in any line beyond the 1st. Stratification according to immunophenotype highlighted a statistical significance only among HER2 positive tumors (OR=0.2; p=0.0152 in 2nd line and OR=0.14; p=0.0036 beyond 1st line). Conclusions: Our results suggest that the absence of a “6-month benefit” in PFS1 predicts a lack of benefit in subsequent therapy lines, especially in HER2 positive disease. However, a lack of benefit at first line ET appears not to be detrimental to further anti-hormonal lines.

scholarly journals Scar Resurfacing

2020 ◽  
pp. 311-316
Author(s):  
Fiona M. Wood
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Healing Process ◽  
Clinical Decision ◽  
Skin Surface ◽  
History Of ◽  
Secondary Healing ◽  
The Impact ◽  
Selection Of

AbstractScar resurfacing is focused on the improvement in the quality of a scar by disruption of the skin surface and reducing the bulk of the scar by control of the secondary healing process. The prerequisite is knowledge of the wound healing and scarring process such that the intervention can be designed to reduce the risk of increasing the scarring.The clinical examination and assessment of the scar will guide the selection of the technique addressing the specific aspects of the scar, such as the pigment restoration and volume reduction, with the aim of blending the scar with the surrounding uninjured skin.Understanding the natural history of the scar, the impact it has on the patient, and the techniques available for improvement provides the clinical decision-making matrix to drive an improved scar outcome. Resurfacing is one opportunity for scar modulation which needs to be taken into context relative to the range of conservative and surgical therapeutic opportunities explored within the chapters of the book.

Critical Thinking in Facilitating the Development of Cultural Competence in Speech Pathology: A Training Module Based on a Review of Resources on Arab Americans

2018 ◽  
Vol 3 (14) ◽  
pp. 5-18 ◽  
Author(s):  
Reem Khamis-Dakwar ◽  
Anthony DiLollo
Keyword(s):  
Critical Thinking ◽  
Clinical Decision Making ◽  
Linguistic Diversity ◽  
Diversity Training ◽  
Clinical Decision ◽  
Arab Americans ◽  
Speech Pathology ◽  
Essential Knowledge ◽  
The Impact

The importance of critical thinking in training preservice and postservice speech-language pathologists (SLPs) is increasingly acknowledged in the collected works of communication sciences and disorders. Incorporation of critical thinking enhances the quality of clinical decision making, is important for interprofessional practice, and is an essential knowledge in educational services for SLPs at all levels (Finn, Brundage, & DiLollo, 2016). In this article, we propose the need to infuse critical thinking within cultural and linguistic diversity training and recommend the use of literature and instructional activities focused on guiding SLPs in working with Arab Americans to serve this mission. On the basis of existing resources in communication sciences and disorders literature on Arab Americans, we created a study module to target the 3 components of critical thinking: interpretation, evaluation, and metacognition. The first part of the module (Units 1 and 2) is designed to introduce students to critical thinking and facilitate their use of critical thinking in evaluating information presented within speech pathology resources on working with diverse population. The second part, Unit 3, assists learners in reflecting on the impact of their own preconceptions. The last part, Unit 4, facilitates students' understanding of best practices in servicing individuals from diverse populations.

The Role of Digital Clinical Decision Support Tool in Improving Quality of Intrapartum and Postpartum Care: Experiences From Two States of India.

2020 ◽  
Author(s):  
Gulnoza Usmanova ◽  
Kamlesh Lalchandani ◽  
Ashish Srivast ◽  
Chandra Joshi ◽  
Deepak Bhatt ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision Making ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Decision ◽  
Interrupted Time Series Analysis ◽  
Clinical Practices ◽  
The Impact

Abstract Background: Computerized clinical decision support (CDSS) –digital information systems designed to improve clinical decision making by providers – are a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes. Methods: We have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August –October 2017 (baseline) and the data collected between December 2019 – March 2020 was analysed (latest). Results: The completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded to significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased. Conclusions: Our study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.

scholarly journals Does The Reformed Cancer Drug Fund Generate Evidence On Effectiveness? A Cross-sectional Analysis On Publicly Accessible Documentation

2020 ◽  
Author(s):  
Helen Macdonald ◽  
Ben Goldacre
Keyword(s):  
Decision Making ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Routine Data ◽  
Clinical Decision ◽  
New Drugs ◽  
Cancer Drug ◽  
Cross Sectional ◽  
Off Label

AbstractIntroductionThe Cancer Drugs Fund (CDF) was reformed in 2016 with an ambition to generate new evidence on effectiveness, and to review existing drugs in the fund. We set out to evaluate: whether drugs transitioning from the old CDF were re-reviewed as planned; whether new drugs have a “data collection arrangement” (DCA) as planned; and whether evidence generated under the DCA using routine data from the “Systemic Anti-Cancer Treatment” (SACT) database was of high quality.MethodsWe accessed documents from NHS England, Public Health England and NICE at August 2018. We calculated the proportion of old CDF drugs re-reviewed, and of new drugs and indications with a DCA. We described key features of the DCAs. For all SACT studies we set out to obtain a protocol in order to analyse the quality of the planned methods.Results47 old drugs and indications transitioned to the new CDF. For 14 there was no evidence of a re-review; 9 of these remain under CDF at August 2019 (all off-label uses). 33 had marketing authorisations: 22 of these had a review completed by September 2017 as planned (67%). 20 new drugs and indications entered the CDF by August 2018: 19 had a DCA; one (off-label) had no DCA or equivalent. All DCAs identify uncertainty about overall survival; all express an intent to conduct observational analysis using SACT data; SACT data was central to decision-making for 6 (32%). We were able to find 0 protocols of the 19 planned SACT studies (0). Following Freedom of Information requests we were told these protocols are prepared after the data are collected, and posted with the reappraisal: however we could not locate any protocol for either of the two published re-appraisals. We were therefore unable to assess the quality of the methods in any of the proposed SACT studies.ConclusionsThe revised CDF has not been implemented as planned. Reporting of observational analyses in SACT data fall substantially short of best practice, and the full methods used cannot be established. There is very little information in the public domain around evaluation of off-label uses. Lastly, SACT data itself does not appear to be able to support clinical decision-making in the manner suggested by the CDF policy documents. NHS England should review the conduct of the fund, but also the planning, as unrealistic commitments may have been made.

scholarly journals Measuring the Impact of Diagnostic Decision Support on the Quality of Clinical Decision Making: Development of a Reliable and Valid Composite Score

2003 ◽  
Vol 10 (6) ◽  
pp. 563-572 ◽  
Author(s):  
Padmanabhan Ramnarayan ◽  
Ritika R. Kapoor ◽  
Michael Coren ◽  
Vasantha Nanduri ◽  
Amanda L. Tomlinson ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Composite Score ◽  
Diagnostic Decision ◽  
The Impact

Nursing Information Systems

2015 ◽  
pp. 959-977
Author(s):  
Ana Paula Macedo ◽  
Fernando Petronilho ◽  
João Cainé
Keyword(s):  
Decision Making ◽  
Information Systems ◽  
Nursing Practice ◽  
Clinical Decision Making ◽  
Health Information Systems ◽  
Clinical Decision ◽  
Central Resource ◽  
The Impact ◽  
And Training

We have witnessed a change in the Health Information Systems (HIS) in what concerns structure, contents, and support for optimization of the resources, the best efficiency in cost control, and a better management of the quality of services rendered to the citizens. From the standpoint of reformulating the HIS, we can see an evolution in the production of information centered almost exclusively in the need of a documental proof on the care rendered by nurses to the citizens to produce information that can constitute a central resource for their clinical decision making. The authors describe the evolution of the Nursing Information Systems (NIS), reflect upon the impact of reformulation and implementation of the NIS in Portugal in the development of the nursing practice, and reflect upon the impact of the NIS reformulation in the quality of care as well as in education and training in the nursing area.

scholarly journals Health-related quality of life of partners of adults with haemophilia

2015 ◽  
Vol 2 (1) ◽  
pp. 20-26
Author(s):  
Sylvia von Mackensen ◽  
Karin Lindvall ◽  
Sölve Elmståhl ◽  
Erik Berntorp
Keyword(s):  
Quality Of Life ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Related Quality ◽  
Sf 36 ◽  
Related Quality ◽  
Burden Scale ◽  
Health Related ◽  
The Impact

Abstract Assessment of health-related quality of life (HRQoL) in haemophilia is important in order to provide information for clinical decision-making and to verify the impact of haemophilia on patients and their partners. A crosssectional single-centre study was performed to assess the health-related quality of life (HRQoL) and burden of the disease on partners of adult patients with haemophilia. Self-reported outcomes were completed by partners and patients (SF-36, VAS of Interference); partners also completed the Caregivers’ Burden Scale. A total of 108 of 150 eligible partners of adults with haemophilia (72%) participated. Mean age for partners was 44.7 years (range 20-79) and for patients 47.1 years (range 20-81). The majority of couples were married (65.7%). Couples reported being together a mean of 19.8 years and had, on average, 1.7 children. Partners of haemophilia patients across all severities reported lower HRQoL in the ‘emotional role’ domain of SF-36 (P=<0.041), with highest impairments observed among partners of moderately affected patients. Partners reported significantly less interference with daily life compared to patients (P<0.001). In general, partners reported low burden of haemophilia in the Caregivers’ Burden Scale; ‘emotional involvement’ was the greatest burden in the mild and moderate group; while in the severe group ‘general strain’ was the greatest burden. Partners of severe haemophilia patients on prophylaxis reported, in general, good HRQoL and low burden of the disease. Partners of moderate patients reported decreased HRQoL and higher burden. Our findings may be of importance for the care of the ageing person with haemophilia (PWH).

scholarly journals Descriptive Usability Study of CirrODS: Clinical Decision and Workflow Support Tool for Management of Patients With Cirrhosis (Preprint)

2019 ◽  
Author(s):  
Jennifer Hornung Garvin ◽  
Julie Ducom ◽  
Michael Matheny ◽  
Anne Miller ◽  
Dax Westerman ◽  
...  
Keyword(s):  
Decision Making ◽  
Quantitative Methods ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
User Centered Design ◽  
Support Tool ◽  
Clinical Scenarios ◽  
The Impact

BACKGROUND There are gaps in delivering evidence-based care for patients with chronic liver disease and cirrhosis. OBJECTIVE Our objective was to use interactive user-centered design methods to develop the Cirrhosis Order Set and Clinical Decision Support (CirrODS) tool in order to improve clinical decision-making and workflow. METHODS Two work groups were convened with clinicians, user experience designers, human factors and health services researchers, and information technologists to create user interface designs. CirrODS prototypes underwent several rounds of formative design. Physicians (n=20) at three hospitals were provided with clinical scenarios of patients with cirrhosis, and the admission orders made with and without the CirrODS tool were compared. The physicians rated their experience using CirrODS and provided comments, which we coded into categories and themes. We assessed the safety, usability, and quality of CirrODS using qualitative and quantitative methods. RESULTS We created an interactive CirrODS prototype that displays an alert when existing electronic data indicate a patient is at risk for cirrhosis. The tool consists of two primary frames, presenting relevant patient data and allowing recommended evidence-based tests and treatments to be ordered and categorized. Physicians viewed the tool positively and suggested that it would be most useful at the time of admission. When using the tool, the clinicians placed fewer orders than they placed when not using the tool, but more of the orders placed were considered to be high priority when the tool was used than when it was not used. The physicians’ ratings of CirrODS indicated above average usability. CONCLUSIONS We developed a novel Web-based combined clinical decision-making and workflow support tool to alert and assist clinicians caring for patients with cirrhosis. Further studies are underway to assess the impact on quality of care for patients with cirrhosis in actual practice.

scholarly journals 1413. Effect of Automated Identification of Antimicrobial Stewardship Opportunities for Urinary Tract Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S791-S792
Author(s):  
Connor Deri ◽  
Rebekah Wrenn ◽  
Rebekah W Moehring ◽  
Justin Spivey ◽  
Michael E Yarrington
Keyword(s):  
Median Time ◽  
Antimicrobial Stewardship ◽  
Best Practice ◽  
Asymptomatic Bacteriuria ◽  
Clinical Decision ◽  
Automated Identification ◽  
Exact Test ◽  
Increased Risk ◽  
Tract Infections ◽  
The Impact

Abstract Background The treatment of asymptomatic bacteriuria (ASB) does not improve clinical outcomes in most patients and may be associated with an increased risk of adverse events such as Clostridioides difficile infection. A best practice alert (BPA) was created to identify patients with possible ASB for antimicrobial stewardship (AS) review. We aimed to determine whether automated identification of ASB improved the timing of stewardship intervention. Methods An electronic health record BPA message to inpatient AS pharmacists was activated on 01/19/2021. The BPA identified inpatients with a new antibiotic order with an associated genitourinary indication and a preceding urinalysis with 0 to 5 WBC/hpf. BPAs were reviewed by an AS pharmacist during weekdays and normal business hours. We retrospectively evaluated the impact of the BPA on time from order to stewardship intervention between a cohort of pre-BPA (01/2020 to 12/2020) and post-BPA (01/20/2021 to 04/10/2021) patients. Included patients met the BPA criteria and had an AS intervention within 7 days of the antibiotic order. We specified interventions that were UTI-related. The median time from antibiotic order entry to any AS intervention was compared pre- to post-BPA using the Mann Whitney U test. Rates of UTI-related interventions were compared with Fisher’s Exact test. Results 327 antibiotic orders met BPA criteria and were analyzed: 245 and 82 in the pre- and post-BPA group, respectively. Groups had similar baseline characteristics (Table 1). A total of 33 (27 UTI-related) pre-BPA group and 24 (17 UTI-related) post-BPA group interventions were documented by the AS team. The median time to any intervention was 28 hours (IQR 18-64.5) in the pre-BPA group compared to 13.5 hours (IQR 3.5-28.75) in the post-BPA group (p = 0.03, Figure). The pre-BPA group had a lower rate of UTI-related interventions compared to the post-BPA group (11.0% vs 20.7%, p = .04). Conclusion Automated identification of antibiotics targeting UTI with urinalysis showing absence of pyuria reduced the time to stewardship intervention and increased rate of UTI-specific interventions. The use of clinical decision support may aid in efficiency of AS review and syndrome-targeted AS impact. Disclosures Rebekah W. Moehring, MD, MPH, UpToDate, Inc. (Other Financial or Material Support, Author Royalties)

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