scholarly journals Audit of availability and awareness of guidelines for the management of confusion in older patients on general wards

2008 ◽  
Vol 32 (4) ◽  
pp. 143-145
Author(s):  
Ceri G. Evans ◽  
Charles d'Souza ◽  
Paul Reynolds ◽  
Caroline Linton ◽  
Lokesh Nukalapati ◽  
...  
Keyword(s):  
Action Plan ◽  
Minimal Change ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Evidence Based ◽  
Action Plans ◽  
Older Patient ◽  
Significant Difference ◽  
General Wards ◽  
Evidence Based Guidelines

Aims and MethodConfusion in an older patient on a general hospital ward requires prompt and appropriate management. To this end, evidence-based guidelines have been produced and disseminated by Gwent Healthcare NHS Trust. An audit was carried out when it became apparent that junior doctors might not be aware of the guidelines and that their availability on the wards was limited. An action plan was generated and a second audit carried out. Our aim was to establish whether the doctors' knowledge of the guidelines and their availability on wards changed as a result of our action plan and audit.ResultsThe audit consisted of a survey of general wards at the Royal Gwent Hospital and at St Woolos Hospital to assess availability of the guidelines and a questionnaire administered to a sample of junior doctors. The guidelines were available on 17% of wards; 11% of junior doctors were aware of them. Results of the audit informed implementation of an action plan. The second audit showed a limited improvement in availability (increased to 34%) and awareness (increased to 15%) of the guidelines, with no statistically significant difference.Clinical ImplicationsApparently well-thought-out action plans may produce minimal change, but unless the audit cycle is completed this fact cannot be corroborated. In generating action plans, more consideration may need to be given to the factors that influence the spread of change in healthcare systems.

scholarly journals Attitudes of psychiatrists to evidence-based guidelines

2002 ◽  
Vol 26 (11) ◽  
pp. 421-424 ◽  
Author(s):  
Harvey Rees ◽  
Attila Sipos ◽  
Matthew Spence ◽  
Glynn Harrison
Keyword(s):  
Response Rate ◽  
Postal Questionnaire ◽  
Clinical Implications ◽  
Evidence Based ◽  
Previous Survey ◽  
Health Partnership ◽  
Improved Outcomes ◽  
Actual Use ◽  
Evidence Based Guidelines ◽  
Improving Patient Care

Aims and MethodWe aimed to survey clinicians' attitudes on using evidence-based guidelines. A postal questionnaire based on a previous survey of general practitioners was sent to 105 psychiatrists working within Avon and Western Wiltshire Mental Health Partnership NHS Trust.ResultsThere was a 91% response rate. Respondents were generally in favour of clinical guidelines, with scores indicating a positive attitude to guidelines in 13 of the 18 statements. The majority felt that guidelines were effective in improving patient care, could be used flexibly to suit individual patients and did not impinge on their clinical judgement.Clinical ImplicationsPsychiatrists welcomed the increasing use of guidelines. Further research is needed to determine whether this will translate into actual use and improved outcomes for patients.

Referral letters: are we prioritizing consistently?

2005 ◽  
Vol 119 (5) ◽  
pp. 377-380 ◽  
Author(s):  
David D Pothier ◽  
Costa Repanos
Keyword(s):  
General Practice ◽  
Waiting Time ◽  
Fast Track ◽  
Evidence Based ◽  
Rater Reliability ◽  
Significant Difference ◽  
Prospective Assessment ◽  
The Mean ◽  
Evidence Based Guidelines ◽  
Referral Letters

Objectives: To determine the levels of intra- and inter-grade variability of the vetting of general practice (GP) letters as well as the intra-rater reliability of letterprioritization.Design: Prospective assessment of letter vetting and questionnaire survey.Setting: Three otolaryngology secondary referral centres in Bristol and Bath, UK.Participants: Twelve consultants, nine registrars, four staff and associate specialists (SAS) and 16 senior house officers (SHOs) in otolaryngology.Methods: Fifty GP letters (not including ’fast-track’ referrals) addressed to one of the ENT departments were chosen sequentially. These were anonymized, photocopied and included in the questionnaire to all participating staff. Participants were asked to vet the letters as ’urgent’, ’soon’ or ’routine’ according to supplied waiting time criteria. The same letters were sent out again six weeks later.Results: There was no significant difference between grades for the mean number of letters vetted into each category. Intra-grade variability was high; the number of letters vetted urgentvaried from one out of 50 to 15 out of 50 for the consultants.The intra-rater reliability was high.Conclusion: The grade of trainee seems to make little difference with regard to ability to prioritize referrals, but within grades there is little agreement on what constitutes an urgent referral. We suggest further research, looking at the final outcome of patients, needs to be done to try to establish evidence-based guidelines to assist with letter vetting.

Treatment Considerations for Adolescents Who Exhibit Cognitive/Communication Problems: A Neuroscience Perspective

2020 ◽  
Vol 5 (6) ◽  
pp. 1767-1775
Author(s):  
Martha S. Burns
Keyword(s):  
Social Communication ◽  
Transition Period ◽  
Clinical Intervention ◽  
Review Article ◽  
Sensitive Period ◽  
Clinical Implications ◽  
Evidence Based ◽  
Communication Problems ◽  
Treatment Considerations ◽  
Behavioral Growth

Purpose Adolescence is a period of substantial neurophysiological and behavioral growth, representing a second sensitive period of brain development. It is a psychological and social transition period between childhood and adulthood with many beneficial changes occurring, especially with respect to potential responsiveness to clinical intervention. However, adolescent behavioral complexities introduce clinical challenges as well. The purpose of this review article is to review the current neuroimaging research on neurophysiological changes observed during adolescence and the cognitive and social behavioral counterparts, with specific attention to the clinical implications. The review article will then summarize currently available intervention tools that can be utilized by speech-language pathologists working with this population. It will conclude with available evidence-based social-communication approaches that may be applicable as well as available evidence-based supplemental technological cognitive interventions that may be useful in working with adolescents who exhibit language and communication issues. Conclusion As a transition period between childhood and adulthood, adolescence represents a second sensitive period during which there is opportunity for clinically derived beneficial cognitive and communication growth.

An evaluation of a shoulder rehabilitation class in a UK hospital following evidence-based modifications

2021 ◽  
pp. 1-8
Author(s):  
Emily Kell ◽  
John A. Hammond ◽  
Sophie Andrews ◽  
Christina Germeni ◽  
Helen Hingston ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Shoulder Pain ◽  
Management Strategies ◽  
Cost Effective ◽  
Rehabilitation Programme ◽  
Patient Specific ◽  
Satisfaction Survey ◽  
Evidence Based ◽  
Patient Satisfaction Survey ◽  
Significant Difference

OBJECTIVES: Shoulder pain is a common musculoskeletal disorder, which carries a high cost to healthcare systems. Exercise is a common conservative management strategy for a range of shoulder conditions and can reduce shoulder pain and improve function. Exercise classes that integrate education and self-management strategies have been shown to be cost-effective, offer psycho-social benefits and promote self-efficacy. This study aimed to examine the effectiveness of an 8-week educational and exercise-based shoulder rehabilitation programme following the introduction of evidence-based modifications. METHODS: A retrospective evaluation of a shoulder rehabilitation programme at X Trust was conducted, comparing existing anonymised Shoulder Pain and Disability Index (SPADI) and Patient-Specific Functional Scale (PSFS) scores from two cohorts of class participants from 2017-18 and 2018-19 that were previously collected by the physiotherapy team. Data from the two cohorts were analysed separately, and in comparison, to assess class efficacy. Descriptive data were also analysed from a patient satisfaction survey from the 2018-19 cohort. RESULTS: A total of 47 patients completed the 8-week shoulder rehabilitation programme during the period of data collection (2018-2019). The 2018-19 cohort showed significant improvements in SPADI (p 0.001) and PSFS scores (p 0.001). No significant difference was found between the improvements seen in the 2017-18 cohort and the 2018-19 cohort. 96% of the 31 respondents who completed the patient satisfaction survey felt the class helped to achieve their goals. CONCLUSION: A group-based shoulder rehabilitation class, which included loaded exercises and patient education, led to improvements in pain, disability and function for patients with rotator cuff related shoulder pain (RCRSP) in this outpatient setting, but anticipated additional benefits based on evidence were not observed.

scholarly journals Heat Perception and Coping Strategies: A Structured Interview-Based Study of Elderly People in Cologne, Germany

2021 ◽  
Vol 18 (14) ◽  
pp. 7495
Author(s):  
Juliane Kemen ◽  
Silvia Schäffer-Gemein ◽  
Johanna Grünewald ◽  
Thomas Kistemann
Keyword(s):  
Health Status ◽  
Coping Strategies ◽  
Elderly People ◽  
Heat Waves ◽  
Action Plan ◽  
Heat Strain ◽  
Action Plans ◽  
Health Action ◽  
Heat Perception ◽  
And Coping

The transdisciplinary project “Heat-Health Action Plan for Elderly People in Cologne” addresses the most heat-vulnerable risk group, people over 65 years of age. A quantitative study aimed to better understand heat perception and coping strategies of elderly people during heat waves to inform heat-health action plans. We conducted a representative quantitative survey via structured interviews with 258 randomly chosen people over 65 years old, living in their own homes in four areas of Cologne, Germany. These areas varied, both in terms of social status and heat strain. Data regarding demographics, health status, coping strategies, and heat perception were collected in personal interviews from August to October 2019. The majority of the participants perceived heat strain as moderate to very challenging. Women, people with a lower monthly income, and those with a lower health status found the heat more challenging. We found that participants adapted to heat with a number of body-related, home-protective, and activity-related coping strategies. The number of coping strategies was associated with perceived personal heat strain. There is a definite underuse of water-related heat adaption strategies among the elderly. This is of increasing relevance, as rising heat impact will lead to more heat-related geriatric morbidity. Our results are seminal to inform elderly-specific, socio-adapted local heat-health action plans.

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