scholarly journals Polypharmacy and excessive dosing: Psychiatrists' perceptions of antipsychotic drug prescription

2005 ◽  
Vol 187 (3) ◽  
pp. 243-247 ◽  
Author(s):  
Hiroto Ito ◽  
Asuka Koyama ◽  
Teruhiko Higuchi
Keyword(s):  
Regression Analysis ◽  
Antipsychotic Drugs ◽  
Drug Prescription ◽  
Patient Characteristics ◽  
Educational Interventions ◽  
Evidence Based ◽  
Factors Associated ◽  
Psychiatric Units ◽  
Prescribing Practice ◽  
Evidence Based Guidelines

BackgroundDespite extensive research and recommendations regarding the optimal prescription of antipsychotic drugs, polypharmacy and excessive dosing still prevail.AimsTo identify the factors associated with the polypharmacy and excessive dosing phenomena.MethodWe studied 139 patients with schizophrenia, in 19 acute psychiatric units in Japanese hospitals, who were due to be discharged between October and December 2003. We examined patient characteristics, nurses' requests, and psychiatrists' characteristics and perceptions of prescribing practice and algorithms.ResultsPolypharmacy and excessive dosing were observed in 96 cases. Logistic regression analysis revealed that the use of multiple medications and excessive dosing were influenced by the psychiatrist's scepticism towards the use of algorithms, nurses' requests for more drugs and the patient's clinical condition.ConclusionsEducational interventions are necessary for psychiatrists and nurses to follow evidence-based guidelines or algorithms.

scholarly journals Overnight in-hospital observation following tonsillectomy: retrospective study of post-operative intervention

2017 ◽  
Vol 132 (1) ◽  
pp. 46-52 ◽  
Author(s):  
S Morris ◽  
E Hassin ◽  
M Borschmann
Keyword(s):  
Patient Characteristics ◽  
University Hospital ◽  
Evidence Based ◽  
Airway Compromise ◽  
Day Case ◽  
Day Case Surgery ◽  
Case Surgery ◽  
American Society ◽  
Evidence Based Guidelines ◽  
Critical Intervention

AbstractObjective:The safety of day-case tonsillectomy is widely documented in the literature; however, there are no evidence-based guidelines recommending patient characteristics that are incompatible with day-case tonsillectomy. This study aimed to identify which patients should be considered unsafe for day-case tonsillectomy based on the likelihood of needing critical intervention.Method:Retrospective review of 2863 tonsillectomy procedures performed at University Hospital Geelong from 1998 to 2014.Results:Of the patients, 7.81 per cent suffered a post-tonsillectomy complication and 4.15 per cent required intervention. The most serious complications, haemorrhage requiring a return to the operating theatre and airway compromise, occurred in 0.56 per cent and 0.11 per cent of patients respectively. The following patient characteristics were significantly associated with poorer outcomes: age of two years or less (p < 0.01), tonsillectomy indicated for neoplasm (p < 0.01) and quinsy (p < 0.05).Conclusion:The authors believe that all elective tonsillectomy patients should be considered for day-case surgery, with the following criteria necessitating overnight observation: age of two years or less; an indication for tonsillectomy of neoplasm or quinsy; and an American Society of Anesthesia score of more than 2.

scholarly journals Assessment of Knowledge and Compliance to Evidence-Based Guidelines for VAP Prevention among ICU Nurses in Tanzania

2020 ◽  
Author(s):  
Vicent Bankanie ◽  
Anne Outwater ◽  
Li Wang ◽  
Li Yinglan
Keyword(s):  
Nursing Education ◽  
Knowledge Score ◽  
Educational Interventions ◽  
Cross Sectional Study ◽  
Local Context ◽  
Evidence Based ◽  
Cross Sectional ◽  
Effective Measure ◽  
The Mean ◽  
Evidence Based Guidelines

Abstract Background: Implementation of evidence-based guidelines (EBGs) related to VAP is an effective measure for the prevention of ventilator-associated pneumonia (VAP). While low knowledge regarding the EBGs related to VAP prevention among ICU nurses is still a major concern among nurses in ICUs globally, the situation in Tanzania is scarcely known. This study aimed to assess the ICU nurses’ knowledge, compliance, and barriers toward evidence-based guidelines for the prevention of VAP in Tanzania.Methods: A cross-sectional study, involving ICU nurses of major hospitals in Tanzania, was conducted. A structured questionnaire was administered among 116 ICU. Data analysis included descriptive statistics and independent t-test.Results: The mean knowledge score was 38.6% which is lower than the lowest ever reported knowledge score for EBGs for VAP prevention. Nurses with a degree or higher level of nursing education performed significantly better than the nurses with a diploma or lower level of nursing education(p=0.004). The mean self-reported adherence score for EBGs for the prevention of VAP was 60.8%. The main barriers to the implementation of EBGs for VAP prevention were lack of skills (96.6%), lack of adequate staff (95.5%), and lack of knowledge (79.3%).Conclusion: Considering the severity and impact of VAP, and the higher risks of HAIs in resource-limited countries like Tanzania, the lower level of knowledge and compliance implies the need for on-going educational interventions and evaluation of the implementation of the EBGs for VAP prevention by considering the local context.

scholarly journals Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

2003 ◽  
Vol 27 (07) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Quality Score ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Quality Of Prescribing ◽  
Evidence Based Guidelines

Aims and Method To compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis. Results Five-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P &lt; 0.01) and in older patients (P &lt; 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P &lt; 0.001). Clinical Implications Prescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

scholarly journals Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

2003 ◽  
Vol 27 (7) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Quality Score ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Quality Of Prescribing ◽  
Evidence Based Guidelines

Aims and MethodTo compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis.ResultsFive-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001).Clinical ImplicationsPrescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

scholarly journals Using English National Cancer Registration and Linked Health Datasets to Assess Variation in Diagnostic Pathway Length for Colorectal and Lung Cancer Patients by Stage and Route to Diagnosis

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 75s-75s
Author(s):  
C. Pearson ◽  
J. Fraser ◽  
J. Shelton
Keyword(s):  
Lung Cancer ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Patient Characteristics ◽  
Cancer Site ◽  
Lung Cancer Patients ◽  
Factors Associated ◽  
Diagnostic Pathway ◽  
Pathway Length ◽  
Diagnostic Pathways

Background: Understanding factors that contribute to longer diagnostic pathways is important to improve efficiency of these pathways and can provide evidence for the implementation of the forthcoming 28-day Faster Diagnostic Standard (FDS) in England. This analysis uses linked national cancer registrations and other health datasets to define diagnostic pathway length and examine variation by route to diagnosis (RtD), stage and patient characteristics for colorectal and lung cancer patients. Aim: To achieve a more in-depth understanding of the diagnostic pathway for colorectal and lung cancer patients and identify particular factors associated with longer diagnostic pathways. Methods: English cancer registrations (2014 & 2015) diagnosed with colorectal and lung cancers (C18-20, C33-34) were linked to the hospital episode statistics, diagnostic imaging dataset, cancer waiting times and RtD data. Patients with multiple diagnoses or unknown RtD were excluded. To construct the pathway length, a start date was derived by defining the earliest relevant event (referral into/appointment in secondary care or diagnostic procedure) from available datasets in the 6 months prediagnosis. The pathway length was determined for each cancer site separately, by stage, RtD and patient characteristic. Regression analysis produced odds ratios (OR) of having a longer diagnostic pathway while controlling for other factors, including age, sex, comorbidities and deprivation. The longer pathway was defined as longer than the median days per cancer site. Results: Of 64,320 colorectal and 71,526 lung patients included, 99.5% and 99.8% respectively had at least one relevant first event recorded. The median pathway length (days) was 26 (IQR 11-56) for colorectal and 35 for lung (15-83). Pathway length decreased significantly with later stage (stage 1-4 - colorectal: 35 to 20, lung: 75 to 25) with significant variation also by presentation route and comorbidity score. Regression analysis showed that, after adjustment for other factors (including stage), patients on a GP referral route had an increased odds of a long pathway compared with the two week wait route (an urgent GP referral with a suspicion of cancer) (colorectal aOR: 4.5, lung aOR: 2.5). Patients diagnosed via emergency presentation route, which are predominantly late stage, had the shortest pathway length and reduced ORs of having a longer diagnostic pathway (colorectal aOR: 0.2, lung aOR: 0.4). Certain patient characteristics are also associated with longer diagnostic pathway length. Conclusion: There is substantial variation in diagnostic pathway length by stage and route for both sites and in many cases these pathways exceeded 28-days (colorectal: 45.3%, lung: 56.4%). Vague symptoms, comorbidities and other patient characteristics may make cancer more difficult to diagnose. Factors associated with longer waits could support the creation of targeted initiatives to reduce the diagnostic pathway length.

scholarly journals Route to heart failure diagnosis in English primary care: a retrospective cohort study of variation

2019 ◽  
Vol 69 (687) ◽  
pp. e697-e705 ◽  
Author(s):  
Dani Kim ◽  
Benedict Hayhoe ◽  
Paul Aylin ◽  
Azeem Majeed ◽  
Martin R Cowie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Patient Characteristics ◽  
Deprivation Level ◽  
Factors Associated ◽  
Evidence Based Guidelines ◽  
Heart Failure Diagnosis

BackgroundDespite the existence of evidence-based guidelines supporting the identification of heart failure (HF) in primary care, the proportion of patients diagnosed in this setting remains low. Understanding variation in patients’ routes to diagnosis will better inform HF management.AimTo identify the factors associated with variation in patients’ routes to HF diagnosis in primary care.Design and settingA retrospective cohort study of 13 897 patients diagnosed with HF between 1 January 2010 and 31 March 2013 in English primary care.MethodThis study used primary care electronic health records to identify routes to HF diagnosis, defined using the National Institute for Health and Care Excellence (NICE) guidelines, and adherence to the NICE-recommended guidelines. Multilevel logistic regression was used to investigate factors associated with the recommended route to HF diagnosis, and funnel plots were used to visualise variation between practices.ResultsFew patients (7%, n = 976) followed the recommended route to HF diagnosis. Adherence to guidelines was significantly associated with younger age (P = 0.001), lower deprivation level (P = 0.007), HF diagnosis source (P<0.001), not having chronic pulmonary disease (P<0.001), receiving further consultation for symptom(s) suggestive of HF (P<0.001), and presenting with breathlessness (P<0.001). Route to diagnosis also varied significantly between GP practices (P<0.001).ConclusionThe significant association of certain patient characteristics with route to HF diagnosis and the variation between GP practices raises concerns about equitable HF management. Further studies should investigate reasons for this variation to improve the diagnosis of HF in primary care. However, these must consider the complexities of a patient group often affected by frailty and multiple comorbidities.

scholarly journals Factors Associated with Pressure to Eat as a Feeding Practice among Mothers with Infants

2020 ◽  
Vol 26 (2) ◽  
pp. 277-285
Author(s):  
Jin Suk Ra ◽  
Yeon-Hee Jeong ◽  
Soon Ok Kim
Keyword(s):  
Body Mass Index ◽  
Regression Analysis ◽  
Explanatory Power ◽  
Educational Interventions ◽  
Educational Programs ◽  
Feeding Practice ◽  
Correct Evaluation ◽  
Cross Sectional ◽  
Factors Associated ◽  
Cross Sectional Design

Purpose: This study aimed to identify factors-both infant-related and maternal-associated with pressure to eat as a feeding practice among mothers with infants. Methods: This study used a cross-sectional design and included 163 mothers of infants aged 2~12 months. Of the 180 self-reported questionnaires that were distributed, 163 (91%) were included in the data analysis. Multiple regression analysis was used to identify the factors associated with pressure to eat as a feeding practice among the mothers.Results: Infant’s temperament (β=-.17, <i>p</i>=.035), mother’s body mass index (β=-.16, <i>p</i>=.048), and concern about the infant being underweight (β=.30, <i>p</i>=.001) were associated with pressure to eat as a feeding practice among mothers. The explanatory power of these variables in the predictive model was 19.2%. Conclusion: Educational programs should be developed for improving mother’s awareness of cues from infants with difficult temperament. In addition, educational interventions regarding the correct evaluation of infant’s weight are needed to relieve mother’s concern about their infant’s being underweight. These interventions might be helpful to reduce the prevalence of pressure to eat as a feeding practice among mothers with infants.

scholarly journals Achieving evidence-based prescribing practice in an adult community mental health service

2006 ◽  
Vol 30 (2) ◽  
pp. 51-55 ◽  
Author(s):  
Maria Moran ◽  
Bangaru Raju ◽  
Jean Saunders ◽  
David Meagher
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Community Mental Health ◽  
Health Service ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Evidence Based Guidelines ◽  
The Impact

Aims and MethodPrescribing in everyday practice frequently deviates from evidence-based guidelines. Previous work compared practice in a community mental health service with evidence-based guidelines and identified factors related to suboptimal prescribing. This study reports the impact of a multifaceted intervention on prescribing practice. A Prescribing Practice Quality (PPQ) score was generated from six key aspects of prescribing at initial assessment and again 1 year later after an intervention to reduce suboptimal prescribing practices.ResultsA total of 264 patients were attending the service at both the initial and follow-up phase and were thus exposed to the prescribing intervention. In this population, PPQ scores were significantly lower at follow-up (0.96v.0.67,P<0.001). Improved prescribing practice was predicted by receipt of adjunctive supportive inputs, such as anxiety management (P=0.003).Similarly, mean PPQ scores substantially decreased when the total patient population was considered at each time point (0.75 in 2001 and 0.52 in 2002). These results suggest a reduction in both the initiation and continuation of suboptimal practices.Clinical ImplicationsPrescribing in real-world settings can be improved by interventions that target multiple aspects of service activity. The provision of supportive inputs is a key factor in improving practice.

Indications for Platelet Transfusions: How Educational Interventions Can Improve Compliance with National Guidelines

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4331-4331
Author(s):  
Elena Katz ◽  
Malgorzata Klek ◽  
Robert E Graham ◽  
Randy L. Levine
Keyword(s):  
Educational Intervention ◽  
Platelet Transfusion ◽  
Educational Interventions ◽  
Quantitative Relation ◽  
Clinical Indication ◽  
Evidence Based ◽  
Post Intervention ◽  
Transfusion Guidelines ◽  
Evidence Based Guidelines ◽  
Platelet Transfusions

Abstract Abstract 4331 Intro: Evidence-based guidelines are developed and promoted to help physicians implement best practice care. The American Society of Hematology (ASH) platelet transfusion guidelines changed in 2007 to a prophylactic transfusion threshold of 10, 000/μL from the previous 20,000/μL. We conducted a retrospective analysis at a metropolitan teaching hospital to assess how well physicians are complying with the new professional guidelines as well as the older, less stringent criteria to administer platelet transfusions. We then assessed the effect of an educational intervention on transfusion practices. Methods: All patients receiving platelet transfusions over a five-month period from Jan-Feb, and April-June 2010, admitted to the medical, critical care and cardiac services were reviewed. The medical record clinical indication was then evaluated against the ASH 2007 “Evidence-Based Platelet Transfusion Guidelines” (Slichter SJ. Hematology 2007): bleeding and platelets ≤50, 000/μL, pre-invasive procedure and platelets ≤50, 000/μL, prophylactic transfusion for platelets ≤10, 000/μL and WHO bleeding grade ≥ 2. We also assessed how the patients’ clinical indication met the previous prophylactic threshold for platelet transfusion of ≤20, 000/μL laid forth by the landmark study by Gaydos LA. et. al. (The quantitative relation between platelet count and hemorrhage in patients with acute leukemia. N Engl J Med 1962). Following initial data collection, we implemented an educational intervention by giving a lecture, reviewing all indications for platelet transfusions, and distributing a pocket card to the house-staff on the medical wards in August, 2010. We subsequently gathered post-intervention data following the methods described above for four consecutive months from Sept-December, 2011. Results: Eighty-six patients on the selected units received a total of 241 platelet transfusions. Fifty nine percent of the time the patient's clinical indication failed to meet the currently accepted 2007 ASH guidelines and 37% of cases failed to meet even the older guideline. Eighty-one patients received a total of 237 platelet transfusions post-intervention. Forty-seven percent of the time the patient's clinical indication failed to meet the currently accepted 2007 ASH guidelines and 19% of cases failed to meet the older guideline. Conclusions: Based on the significant difference observed between the pre- and post-educational intervention groups, our initial study shows that updating physicians on current evidence-based guidelines for platelet transfusions is a simple and effective means to improve transfusion practices. Periodic educational interventions may prove to even further enhance physician compliance with up-to-date guidelines and we plan to implement additional educational interventions throughout the upcoming academic year. Disclosures: No relevant conflicts of interest to declare.

Psychological Guidelines in Cardiac Rehabilitation and Prevention

2011 ◽  
pp. 710-724
Author(s):  
Marinella Sommaruga
Keyword(s):  
Health Outcomes ◽  
Cardiac Rehabilitation ◽  
Effective Treatment ◽  
Working Group ◽  
Process Development ◽  
Patient Characteristics ◽  
Evidence Based ◽  
Clinical Expertise ◽  
The World ◽  
Evidence Based Guidelines

A large number of evidence-based guidelines are drawn up all over the world to improve standards of healthcare and to reduce inequalities in access to effective treatment. Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. Despite widespread circulation and publicity of these guidelines, often they are not implemented effectively. Consequently, there is a substantial difference between evidence and practice, with best health outcomes not being achieved. The aim of this chapter is to describe and discuss the methodological process, development, and implementation of the Italian Guidelines for psychology activities in Cardiac Rehabilitation and Prevention, published in 2003 by the Working Group of Psychology of the Italian Society of Cardiac Rehabilitation and updated in the 2005 National Cardiac Rehabilitation guidelines issued by the Italian Programme for Guidelines.

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