Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center

Vosler PE et al. Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center. Otolaryngology – Head and Neck Surgery 2016; 155: 879–885 Die meisten Fälle von Nasenbluten lassen sich leicht in den Griff bekommen – schwere Blutungen aus der Arteria sphenopalatina (SPA) oder unter Antikoagulation können aber eine Herausforderung darstellen. US-amerikanische HNO-Ärzte haben jetzt einen klinischen Behandlungspfad zum Management der schweren Epistaxis entwickelt, den sie in einem Tertiär-Krankenhaus evaluierten.

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Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals

Nutrients ◽

10.3390/nu13082635 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2635

Author(s):

Koen Huysentruyt ◽

Kim Brunet-Wood ◽

Robert Bandsma ◽

Leah Gramlich ◽

Bonnie Fleming-Carroll ◽

...

Keyword(s):

Health Care Professionals ◽

Care Pathway ◽

Clinical Care ◽

Tertiary Care ◽

Nationwide Survey ◽

Nutritional Screening ◽

Pediatric Hospitals ◽

Adoption And Implementation ◽

Clinical Care Pathway

Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or “a work in progress”, according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.

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The impact of clinically significant discrepancies from primary pathological review of transurethral bladder resection specimens upon repeat review at a tertiary care center.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.4552 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 4552-4552

Author(s):

Lamont J. Barlow ◽

Edan Shapiro ◽

Jennifer Ahn ◽

Mitchell C. Benson ◽

James M. McKiernan

Keyword(s):

Clinical Care ◽

Care Center ◽

Tertiary Care ◽

Tumor Stage ◽

Tertiary Care Center ◽

Urologic Oncology ◽

Internal Review ◽

Clinically Significant ◽

Muscle Invasion ◽

The Impact

4552 Background: Internal review of outside pathology slides is a common practice among urologic oncologists at tertiary care facilities, and discrepancies have a potential to directly affect the choice of treatment. While repeat prostate biopsy review has been extensively studied, there is little data available on the impact of repeat reviews of bladder biopsies. The purpose of the current study is to perform a standardized comparison of original and internal pathology reviews of identical bladder specimens to characterize the impact of repeat review on treatment decisions. Methods: Using the Columbia Urologic Oncology Database, a retrospective analysis of 91 consecutive patients who underwent bladder resections at outside institutions from 2008-2012 with secondary referral to a single urologist and internal review at our institution was conducted. Characteristics of both original pathology reports and internal reviews were collected and compared by blinded reviewers. A discrepancy in one of the following characteristics was considered treatment-altering: presence of muscularis in specimen or tumor involvement in muscularis. Additional clinically-significant discrepancies including presence of secondary histology, carcinoma in situ, lymphovascular invasion, micropapillary features, tumor stage, and overall accumulative discrepancy rate were also analyzed. Results: Median time from original procedure to internal review was 34 days (range: 9-368). 56/91 (62%) patients had at least one of the predefined clinically-significant discrepancies. 27/91 (30%) patients had at least one treatment-altering discrepancy, including 25 with discrepant muscle in specimen and 11 with discrepant muscle invasion. Regarding tumor stage, 8 patients were upstaged, 71 were unchanged, and 12 were downstaged on internal review. Conclusions: Repeat pathologic review of primary bladder specimens at a tertiary care center has the potential to alter clinical care for the majority of patients. Further studies are needed to determine if these discrepancies and the decisions they influence have a significant impact on patient outcomes.

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