scholarly journals Role of clinical pharmacists in epilepsy management at a general hospital in Vietnam: a before-and-after study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Hong Tham Pham ◽  
Minh-Hoang Tran ◽  
Ngoc Quy Nguyen ◽  
Van Tan Vo ◽  
Manh Hung Tran
Keyword(s):  
General Hospital ◽  
Good Control ◽  
World Health ◽  
Secondary Outcome ◽  
Healthcare Team ◽  
Clinical Pharmacists ◽  
Drug Concentrations ◽  
Number Of Patients ◽  
Before And After ◽  
Before And After Study

Abstract Background Clinical pharmacists have an important role in inter-professional healthcare collaboration for epilepsy management. However, the pharmacy practices of managing epilepsy are still limited in Vietnam, deterring pharmacists from routine adjustments of antiepileptic drugs, which could decrease the patients’ quality of life. This study aimed to assess the effectiveness of pharmacist interventions in epilepsy treatment at a Vietnamese general hospital. Methods A before-and-after study was conducted from January 2016 to December 2018. All patients with a diagnosis of epilepsy and being treated at the investigated hospital were recruited and screened for eligibility and exclusion criteria. The primary outcome was the proportion of patients in good control of their epilepsy (with two seizures or less in a year). The secondary outcome was the number of patients maintaining optimized concentrations within the therapeutic range of carbamazepine (4–12 mg/L), phenytoin (10–20 mg/L), or valproic acid (50–100 mg/L). Collected data were analyzed using two proportions Z-test or Chi-square test. Results A total of 141 participants were enrolled in the study. While most patients were given lower prescribed daily doses than the recommendations from the World Health Organization, over 56% of the participants still experienced adverse drug effects. More than half of the patients received at least one pharmacists’ intervention, which increased by 25.0% the effectiveness of the therapy (p < 0.001) and by 14.6% the number of patients with optimized drug concentrations (p = 0.018). Conclusion Epilepsy management requires a multiple-stepped and comprehensive approach, with a focus on the health and safety of the patients. As part of the healthcare team, pharmacists need to engage at every stage to monitor the patient’s response and determine the most effective treatment with the fewest adverse drug reactions. Trial registration ClinicalTrials.gov, NCT04967326. Registered July 19, 2021—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04967326

Abstract W P207: STOP STROKE©-A Novel Medical Application to Improve Coordination of Stroke Care: A Brief Report on Door to Thrombolysis Times After Initiating the Application

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Robert Dickson ◽  
Adrian Nedelcut
Keyword(s):  
Emergency Department ◽  
Rapid Assessment ◽  
Stroke Care ◽  
Medical Application ◽  
Secondary Outcome ◽  
Level Ii ◽  
Number Of Patients ◽  
Before And After ◽  
Patient Arrival ◽  
The Mean

Hypothesis: We hypothesized that introduction of a care coordination application to our emergency stroke care would improve time to thrombolysis in acute ischemic stroke (AIS). Introduction: The objective of our study was to evaluate the effect of the STOP STROKE© medical application on patient arrival to thrombolytic times for patients arriving at our emergency department with AIS. STOP STROKE© is a novel medical application developed by physicians to improve the coordination and communication tasks essential to rapid assessment and care of patients suffering from AIS. Methods: We conducted a retrospective review of the Good Shepherd Health System stroke dashboard between February 2012 and February 2014 (13 months prior to STOP STROKE© and 12 months after). The stroke dashboard is a quality improvement database for acute stroke activations in patients arriving to our level II emergency department with annual volumes of 90,000. We analyzed all data from CMS reportable cases receiving TPA for AIS during the study period. The primary outcome was mean Door-to- Needle (DTN) times before and after initiating STOP STROKE©. Secondary outcome was the effect on the DTN <60 min benchmark. Results: During the study period we had 533 stroke activations (200 pre-application and 333 post-application), representing an 80% increase in activations after the app. A total of 85 patients received TPA therapy for AIS (41 pre-application and 44 post-application). Of these, 17 cases were excluded that did not meet CMS criteria for reporting. We observed the mean D2N times post STOP STROKE© decreased 21 min (77 - 56min), a 28% improvement (p=0.001). Further, the patients meeting D2N < 60 min improved from 32% (11/34) to 82% (28/34) after the app. Conclusions: In this cohort of patients with AIS, STOP STROKE© improved mean D2N times and number of patients treated within 60 min of arrival. Further we saw an increase in total stroke activations. We conclude our results demonstrate the app’s effect of increasing awareness of suspected AIS and improved coordination of care, evidenced by the magnitude of its effect on treatment times.

scholarly journals The type and screen method of blood requisition in General Hospital Zrenjanin

2013 ◽  
Vol 66 (1-2) ◽  
pp. 58-63
Author(s):  
Ivana Tesic ◽  
Dusan Velisavljev ◽  
Dobrivoje Martinov
Keyword(s):  
General Hospital ◽  
Blood Products ◽  
High Quality ◽  
Screen Method ◽  
Whole Process ◽  
Exact Data ◽  
Number Of Patients ◽  
Before And After ◽  
Transfusion Ratio ◽  
Surgical Operations

Introduction. The basic principle of patient?s chemotherapy is that its performance is rational, safe and of high quality. In order to rationalize the whole process, the Transfusiology Committee has decided to introduce the Type and Screen method (typifying of blood types and screening of antibodies) in pre-transfusion testing in General Hospital ?Djordje Joanovic? in Zrenjanin. The method represents the strategy of clear defining and standardizing of the blood requirement process during various elective surgical operations. Material and Methods. In order to record chemotherapy efficiency, the following parameters are used: crossmatch/ transfusion ratio, transfusion probability and transfusion index. These parameters give us exact data that enable us to understand whether adequate blood requisition is made. The aforementioned parameters are followed both before and after the introduction of the Type and Screen method. Results. Since the Type and Screen method was introduced, the percentage of the reserved blood has been used more efficiently, i.e. the number of patients taken off the reservations list has been reduced, which can be seen from the correction of transfusion probability from 44.96 to 61.28 and transfusion index from 0.36 to 0.60. Crossmatch/transfusion ratio has changed from 2.33 to 1.81 after the Type and Screen method was introduced, which implies that deplasmatised erythrocytes reservation has been rationalized. Conclusion. By following the above parameters, data have been obtained which point to the rationalization in blood reservations, resulting in greater number of blood units available. The ?Type and Screen? list has become a standard in our hospital when it comes to blood products requisition.

Ten-fold increase in genetic testing in pancreatic and metastatic prostate cancer with implementation of point of care (POC) testing.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1506-1506 ◽  
Author(s):  
Heather Symecko ◽  
Rebecca Mueller ◽  
Kelsey Spielman ◽  
Melissa Batson ◽  
Stacy Pundock ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Genetic Counseling ◽  
Genetic Testing ◽  
Family Members ◽  
Fold Increase ◽  
Number Of Patients ◽  
Before And After ◽  
Post Test ◽  
The Impact ◽  
Before And After Study

1506 Background: Germline genetic testing (GT) for cancer susceptibility is recommended for pancreatic and advanced prostate cancer patients, due to potential implications for targeted therapies and risk assessment of family members. Traditional cancer GT programs may create barriers for certain patient populations. To more effectively integrate testing into standard oncology care POC GT was introduced in early 2018 in a joint protocol with Memorial Sloan Kettering Cancer Center. Here we report pre and post POC referral and testing numbers at the University of Pennsylvania. Methods: Patients with metastatic prostate or pancreatic cancer were ascertained through their GU/GI oncologist onto an IRB approved protocol and shown an educational video about GT by research staff who obtained informed consent and facilitated biospecimen collection. Genetic counselors returned results and provided post-test counseling by phone. To evaluate the impact of this model on the uptake of GT services, the number of patients who were referred to and proceeded with GT was compared before and after study initiation. Results: In 2017, 77 patients were referred to genetics of which 45 underwent genetic counseling and testing. Twenty-nine (38%) did not complete genetic counseling or testing, and 3 later underwent testing through the POC study. Since the study launched in 2018, 407 patients were referred and underwent testing through the study. This represents a ten-fold increase in patients who underwent GT. Conclusions: Comparing uptake of GT services before and after study initiation suggests that a POC model with abbreviated pre-test education and post-test genetic counseling by phone is a possible solution to barriers of traditional genetic counseling, increasing physician referrals and uptake of testing by patients. This approach allows for more timely access to genetic information that may impact treatment strategies and medical management of family members. Clinical trial information: pending. [Table: see text]

Impact of clinical pharmacists in the emergency department of an Australian public hospital: A before and after study

2015 ◽  
Vol 27 (3) ◽  
pp. 232-238 ◽  
Author(s):  
John S Proper ◽  
Annie Wong ◽  
Alice E Plath ◽  
Kirsty A Grant ◽  
Derek W Just ◽  
...  
Keyword(s):  
Emergency Department ◽  
Public Hospital ◽  
Clinical Pharmacists ◽  
Before And After ◽  
Before And After Study

scholarly journals Changes in the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region of Canada

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255992
Author(s):  
Ellen Stephenson ◽  
Debra A. Butt ◽  
Jessica Gronsbell ◽  
Catherine Ji ◽  
Braden O’Neill ◽  
...  
Keyword(s):  
Primary Care ◽  
Preventive Care ◽  
Research Network ◽  
Secondary Outcome ◽  
Primary Care Visit ◽  
Virtual Care ◽  
Number Of Patients ◽  
Before And After ◽  
Practice Based Research ◽  
Virtual Visits

Purpose We aimed to determine the degree to which reasons for primary care visits changed during the COVID-19 pandemic. Methods We used data from the University of Toronto Practice Based Research Network (UTOPIAN) to compare the most common reasons for primary care visits before and after the onset of the COVID-19 pandemic, focusing on the number of visits and the number of patients seen for each of the 25 most common diagnostic codes. The proportion of visits involving virtual care was assessed as a secondary outcome. Results UTOPIAN family physicians (N = 379) conducted 702,093 visits, involving 264,942 patients between March 14 and December 31, 2019 (pre-pandemic period), and 667,612 visits, involving 218,335 patients between March 14 and December 31, 2020 (pandemic period). Anxiety was the most common reason for visit, accounting for 9.2% of the total visit volume during the pandemic compared to 6.5% the year before. Diabetes and hypertension remained among the top 5 reasons for visit during the pandemic, but there were 23.7% and 26.2% fewer visits and 19.5% and 28.8% fewer individual patients accessing care for diabetes and hypertension, respectively. Preventive care visits were substantially reduced, with 89.0% fewer periodic health exams and 16.2% fewer well-baby visits. During the pandemic, virtual care became the dominant care format (77.5% virtual visits). Visits for anxiety and depression were the most common reasons for a virtual visit (90.6% virtual visits). Conclusion The decrease in primary care visit volumes during the COVID-19 pandemic varied based on the reason for the visit, with increases in visits for anxiety and decreases for preventive care and visits for chronic diseases. Implications of increased demands for mental health services and gaps in preventive care and chronic disease management may require focused efforts in primary care.

scholarly journals EFEKTIVITAS RELAKSASI PROGRESIF TERHADAP PENURUNAN INTENSITAS NYERI PADA PASIEN POST SECTIO CAESAREA DI RSU SEMBIRING TAHUN 2020

2020 ◽  
Vol 2 (2) ◽  
pp. 178-185
Author(s):  
Peny Ariani ◽  
Mastary .
Keyword(s):  
Pain Intensity ◽  
General Hospital ◽  
Sampling Technique ◽  
Progressive Relaxation ◽  
World Health ◽  
Sectio Caesarea ◽  
Control Group ◽  
P Value ◽  
Control Group Design ◽  
Number Of Patients

World Health Organization (WHO) for almost 30 years the rate of births with caesarea section became 10% to 15% of the delivery process exist in developing countries. In Indonesia, the results of basic health research in 2013 showed births with a caesarean section of 15.3% of the sample of 20,591 surveyed from 33 provinces. Based on statistical data that researchers obtained from the Medical Record Room of the Sembiring General Hospital, the number of patients with sectio caesarea from January to September in 2019 totaled 1,600 patients. Nursing problems that often arise in post sectio caesarea cases are painful sensory and emotional experiences that arise due to actual tissue damage. The nurse's independent action to control the pain felt by the patient is to do pain management with non-pharmacological techniques, namely progressive relaxation. The purpose of this study was to determine the effectiveness of progressive relaxation on decreasing pain intensity in post sectio caesarea patients. This study used a quasi-experimental design method with a non equivalent control group design. The sampling technique was 32 respondents, 16 intervention groups and 16 control groups. This study used a T-Test. The results of this study indicate the P-value (0.839) > α (0.05). The conclusion of this study is that there is no effectiveness of progressive relaxation on the decrease in pain intensity in post sectio caesarea patients in the hybrid room of Sembiring General Hospital. For further researchers to be able to have the same research the same but with different variables in order to get more varied and better results.

Only problem gamblers spend less money when loot boxes are removed from a game: A before and after study of Heroes of the Storm

2019 ◽  
Author(s):  
David Zendle
Keyword(s):  
Video Games ◽  
Problem Gambling ◽  
Video Game ◽  
Real World ◽  
Complex Pattern ◽  
Problem Gamblers ◽  
Before And After ◽  
Gambling Severity ◽  
Reliable Correlation ◽  
Before And After Study

Loot boxes are items in video games that may be paid for with real-world money, but which contain randomised contents. There is a reliable correlation between loot box spending and problem gambling severity: The more money gamers spend on loot boxes, the more severe their problem gambling tends to be. However, it is unclear whether this link represents a case in which loot box spending causes problem gambling; a case in which the gambling-like nature of loot boxes cause problem gamblers to spend more money; or whether it simply represents a case in which there is a general dysregulation in in-game spending amongst problem gamblers, nonspecific to loot boxes.The multiplayer video game Heroes of the Storm recently removed loot boxes. In order to better understand links between loot boxes and problem gambling, we conducted an analysis of players of Heroes of the Storm (n=112) both before and after the removal of loot boxes.There were a complex pattern of results. In general, when loot boxes were removed from Heroes of the Storm, problem gamblers appeared to spend significantly less money in-game in contrast to other groups. These results suggest that the presence of loot boxes in a game may lead to problem gamblers spending more money in-game. It therefore seems possible that links between loot box spending and problem gambling are not due to a general dysregulation in in-game spending amongst problem gamblers, but rather are to do with specific features of loot boxes themselves.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

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