Severe TBI in Military: Medical and Surgical Interventions

Neurotrauma ◽  
2018 ◽  
pp. 13-20
Author(s):  
Geoffrey S. F. Ling ◽  
James M. Ecklund
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Medical Condition ◽  
Healthcare Providers ◽  
Surgical Interventions ◽  
Military Healthcare ◽  
Life Threatening ◽  
Severe Tbi ◽  
To Come

Traumatic brain injury (TBI) is a common casualty of war. In Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan, TBI was described as the “signature injury of these wars.” As in civilian practice, severe TBI is a serious life-threatening medical condition requiring treatment by expert medical providers. Military providers adapt existing civilian clinical practice guidelines (CPG) to manage these patients. Where civilian CPG are nonexistent or inadequate for war theater use, the DoD creates new ones. These CPG are published to enable critique and improvement. Two CPG for TBI to come from the war are the “Guidelines for the Field Management of Combat-Related Head Trauma” and the “VA/DoD Clinical Practice Guidelines for Management of Concussion/Mild TBI.” From these efforts, a new type of TBI, explosive blast TBI, was elucidated. Intracranial vasospasm was identified as a sequelae to this TBI. Treatments used by military healthcare providers include hemicraniectomy and endovascular techniques.

scholarly journals A view into clinical practice guidelines: who uses them, who doesn’t and possibly, why

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Mihaela C. Munteanu ◽  
Julie Choi Jordan
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Healthcare Providers ◽  
Medical Professional ◽  
Physician Attitudes ◽  
Negative Consequences ◽  
Access To Treatment ◽  
Medical Specialties ◽  
And Behavior

Medical professional societies each develop specific clinical practice guidelines (CPGs). Based on the best available evidence, CPGs are intended to control variability and optimize quality of care in clinical practice. Yet, healthcare providers often do not accept or adhere to guidelines, but their reasons are not fully understood. When providers opt to choose not to follow CPGs, unfavorable patient outcomes including unequal access to treatment become negative consequences. In this small qualitative study, we will explore what causes non-adherence to CPGs and what changes have been made to CPGs from when physicians completed their medical residencies to the present. We interviewed physicians from a variety of medical specialties to assess how these changes may influence guideline adherence as well as the consequences of not following them. We found that guidelines may not be followed in cases where patients have comorbidities that are not described in the guidelines or when physicians do not incorporate new evidence and technology advances into their practice. In some specialties, physicians can develop a poor reputation if they do not adhere to the CPGs, and managed care agencies may deny reimbursement for care they provided. To best serve the physician and the patient, we need to find ways to improve CPG adherence. Tactics such as improving the methodology of CPG formation, using information technology, and creating ways to change physician attitudes and behavior are all viable options.

National consensus project for quality palliative care

2015 ◽  
pp. 11-19 ◽  
Author(s):  
Constance M. Dahlin
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Quality Care ◽  
Life Threatening ◽  
National Consensus

The National Consensus Project for Quality Palliative Care’s Clinical Practice Guidelines for Quality Care is a significant resource that offers the nurse a framework for quality care in all settings. The Clinical Practice Guidelines are appropriate to a range of populations from neonates to children to adults and older adults; a range of chronic progressive and serious life-threatening illnesses, injuries, and trauma; and a range of vulnerable and underresourced populations. The Clinical Practice Guidelines are appropriate for any setting because they facilitate partnerships for caring for patients with debilitating and life-limiting illnesses and offer support for the nurse in delivering the care, particularly for long-term patients.

scholarly journals Visualization of Nutrient-Related Clinical Practice Guidelines in Childhood

2021 ◽  
Vol 5 (12) ◽  
pp. 79-92
Author(s):  
George Antonogeorgos ◽  
Eirini Bathrellou ◽  
Matina Kouvari ◽  
Dimitrios Poulimeneas ◽  
Mary Yannakoulia ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Healthcare Providers ◽  
Diabetes Mellitus Type 1 ◽  
Dietary Advice ◽  
Childhood Diseases ◽  
Childhood Nutrition ◽  
Obesity And Diabetes ◽  
Major Interest

Obesity and diabetes rates have been rising to epidemic levels during the last decade, especially among young populations. Recommendations for clinicians and primary healthcare providers concerning the improvement of childhood nutrition and the healthcare of childhood nutrition-related diseases are of major interest. Clinical Practice Guidelines (CPGs) of the most updated evidence-based recommendations are useful tools that help clinicians in their practice. However, a gap has been observed between the suggested CPGs and their implementation in the context of everyday clinical practice. This could be merely attributed to the text format that is usually presented. In this review article, all the CPGs about the best dietary advice regarding energy and macronutrient intake in childhood and the most common chronic nutrition-related childhood diseases, i.e., obesity, dyslipidemia, and diabetes mellitus type 1 and 2, are summarized and visualized in an algorithmic format and practical examples are given. This could help healthcare providers to achieve a higher adoption rate of CPGs in clinical practice, thus, resulting in better management of children’s health and improved clinical outcomes. Keywords: nutrition, guidelines, algorithm, children.

scholarly journals Protocol for the validation of four search strategies for retrieval of Clinical Practice Guidelines in MEDLINE, Embase and PubMed

2018 ◽  
Author(s):  
Carole A Lunny ◽  
Doug M Salzwedel ◽  
Tracy Liu ◽  
Cynthia Ramasubbu ◽  
Savannah Gerrish ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Healthcare Providers ◽  
Policy Formulation ◽  
Bibliographic Databases ◽  
Test Set ◽  
University Of Texas ◽  
Ovid Medline ◽  
Search Filters

Background Guidelines are systematically developed recommendations to assist practitioner and patient decisions about treatments for clinical conditions. Researchers, healthcare professionals and policy makers need to be able to retrieve clinical practice guidelines (CPGs) efficiently and quickly from the literature. Despite the widespread use of CPGs in practice and policy formulation, no filter for retrieval of guidelines has been validated to date. The use of a validated search filter for CPGs would make their retrieval from major bibliographic databases more efficient. Objectives We aim to fill this gap by validating search filters for use in the systematic retrieval of CPGs and measure their performance according to sensitivity and precision. Methods We found four search filters for retrieval of CPGs (two CADTH, PubMed and University of Texas filters) which we will validate in three databases (MEDLINE, Embase and PubMed). We will derive a test set of CPGs from a search of the TRIP and Epistemonikos databases. The citations retrieved will be randomly sorted and screened sequentially by two reviewers until at least 100 CPGs are included. We will include CPGs that provide at least two explicit recommendations for the treatment of any clinical condition, and that are produced by a group or organization (i.e., not authored by one person) . We will translate the filters into Ovid MEDLINE, Embase, and PubMed syntax as appropriate. Then, we will run the strategies and assess whether the filters retrieved the citations in our test set. We will calculate and compare the sensitivity and precision of the four filters in each database. The limitations of the CADTH, PubMed and University of Texas search filters for each database will be assessed by examining the keywords in the titles and abstracts of the citations not found by the search filters. Discussion Decision makers, healthcare providers and researcher will be able to choose the most precise and sensitive search strategy among the four available, which will enable them to more efficiently identify relevant clinical practice guidelines.

scholarly journals Critical appraisal of clinical practice guidelines for the management of COVID-19: protocol for a systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Thanansayan Dhivagaran ◽  
Umaima Abbas ◽  
Fahad Butt ◽  
Luckshann Arunasalam ◽  
Oswin Chang
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Healthcare Providers ◽  
World Health ◽  
High Quality ◽  
Agree Ii ◽  
Agree Ii Instrument

Abstract Background In December 2019, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 was identified as the cause of an acute respiratory disease, coronavirus disease 2019 (COVID-19). Given the lack of validated treatments, there is an urgent need for a high-quality management of COVID-19. Clinical practice guidelines (CPGs) are one tool that healthcare providers may use to enhance patient care. As such, it is necessary that they have access to high-quality evidence-based CPGs upon which they may base decisions regarding the management and use of therapeutic interventions (TI) for COVID-19. The purpose of the proposed study is to assess the quality of CPGs that make management or TI recommendations for COVID-19 using the AGREE II instrument. Methods The proposed systematic review will identify CPGs for TI use and/or the management of COVID-19. The MEDLINE, EMBASE, CINAHL, and Web of Science databases, as well as the Guidelines International Network, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, and the World Health Organization websites, will be searched from December 2019 onwards. The primary outcome of this study is the assessed quality of the CPGs. The quality of eligible CPGs will be assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Descriptive statistics will be used to quantify the quality of the CPGs. The secondary outcomes of this study are the types of management and/or TI recommendations made. Inconsistent and duplicate TI and/or management recommendations made between CPGs will be compared across guidelines. To summarize and explain the findings related to the included CPGs, a narrative synthesis will also be provided. Discussion The results of this study will be of utmost importance to enhancing clinical decision-making among healthcare providers caring for patients with COVID-19. Moreover, the results of this study will be relevant to guideline developers in the creation of CPGs or improvement of existing ones, researchers who want to identify gaps in knowledge, and policy-makers looking to encourage and endorse the adoption of CPGs into clinical practice. The results of this review will be published in a peer-reviewed journal and presented at conferences. Systematic review registration International Prospective Register for Systematic Reviews (PROSPERO)—CRD42020219944

Prehospital sepsis care in Ireland: an audit

2020 ◽  
Vol 12 (7) ◽  
pp. 269-276
Author(s):  
Nicola Mulrooney ◽  
Patrick McCluskey ◽  
Martin O'Reilly ◽  
Niamh Collins
Keyword(s):  
Severe Sepsis ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Early Recognition ◽  
Prehospital Care ◽  
Young Patients ◽  
Life Threatening Illness ◽  
Chief Complaints ◽  
Life Threatening

Background: Sepsis is a life-threatening illness that requires early recognition and treatment. In Ireland, mortality, while improving, remains at 17% for adults and in a range of 2–4% in children aged under16 years. Prompt, accurate recognition of severe sepsis in the prehospital period could improve outcomes in patients with severe sepsis. Aim: This study aimed to audit the prehospital care of patients with sepsis against national Irish sepsis clinical practice guidelines and identify areas for improvement. Methods: A retrospective analysis of all Dublin Fire Brigade patient care reports over a 1-week period was carried out and patients with potential sepsis and potential severe sepsis were identified. Care was assessed against the national prehospital clinical practice guidelines. Call-taking and dispatch information were cross-checked. Findings: The incidence of potential sepsis was 3.7%. It is a condition of extremes of age; 8.5% of patients were aged less than 1 year and 58% were aged above 65 years. While 48% of calls were categorised as high priority, about one-third (32%) were put in a low-priority category, and 37% of the latter were potential cases of severe sepsis. The most common chief complaints at the call-taking stage were ‘breathing problems’ and ‘sick person’. Conclusion: Potential sepsis is not infrequent and call-taking information may not capture the potential or severity of sepsis. Education must emphasise the risk in old and young patients. To ensure patients receive timely advanced interventions, call-taking and dispatch systems should ensure that practitioners with the skills to identify and manage sepsis are dispatched to these patients.

scholarly journals Ensuring Consistent European-Wide Urological Care by the Use of Evidence-Based Clinical Practice Guidelines: Can We Do Better

2017 ◽  
Vol 2 (Suppl. 1) ◽  
pp. 1-7
Author(s):  
Emma Jane Smith ◽  
Steven MacLennan ◽  
Anders Bjartell ◽  
Alberto Briganti ◽  
Thomas Knoll ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
Scientific Evidence ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Evidence Based ◽  
Robust Methods ◽  
Practice Recommendations

The European Association of Urology (EAU) annually updates 21 clinical practice guidelines in which summaries of the evidence base and best practice recommendations are made. The methodology applied to achieve this and integrate stakeholder opinion is continuously improving. However, there is evidence to suggest wide variation in clinical practice indicating that many patients receive suboptimal and heterogeneous care. Studies from certain countries suggest that 2 out of 5 patients do not receive care according to the current scientific evidence, and in 1 out of 4 cases the care provided is potentially harmful. Clearly, the harmonisation of care in alignment with evidence-based best practice recommendations is something to strive for. Development of robust methods to disseminate and implement guideline recommendations and measure their impact is an objective the EAU is committed to improving. An important strategy for achieving harmonisation in urological care across Europe is to ensure the availability of high-quality clinical practice guidelines and to actively promote their implementation by clinicians and healthcare providers.

scholarly journals Antiphospholipid syndrome: state of the art on clinical practice guidelines

RMD Open ◽  
2018 ◽  
Vol 4 (Suppl 1) ◽  
pp. e000785 ◽  
Author(s):  
Marteen Limper ◽  
Carlo Alberto Scirè ◽  
Rosaria Talarico ◽  
Zahir Amoura ◽  
Tadej Avcin ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Antiphospholipid Syndrome ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Antiphospholipid Antibodies ◽  
Arterial Thrombosis ◽  
State Of The Art ◽  
Healthcare Providers ◽  
Unmet Need ◽  
Important Data

Antiphospholipid syndrome (APS) is a rare disease characterised by venous and/or arterial thrombosis, pregnancy complications and the presence of specific autoantibodies called antiphospholipid antibodies. This review aims to identify existing clinical practice guidelines (CPG) as part of the ERN ReCONNET project, aimed at evaluating existing CPGs or recommendations in rare and complex diseases. Seventeen papers providing important data were identified; however, the literature search highlighted the scarceness of reliable clinical data to develop CPGs. With no formal clinical guidelines in place, diagnosis and treatment of APS is largely based on consensus and expert opinion. Patients’ unmet need refers to the understanding of the disease and its clinical picture and implications, the need of education for patients, family members and healthcare providers, as well as to the development of monitoring pathways involving multiple healthcare providers.

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