The Red Legs RATED tool to improve diagnosis of lower limb cellulitis in the emergency department

2021 ◽  
Vol 30 (12) ◽  
pp. S22-S29
Author(s):  
Gillian O'Brien ◽  
Patricia White
Keyword(s):  
Emergency Department ◽  
Lower Limb ◽  
Treatment Guidelines ◽  
Positive Impact ◽  
Data Gathering ◽  
Pilot Project ◽  
Accurate Diagnosis ◽  
Evidence Based ◽  
Significant Burden ◽  
User Friendly

Background: Lower limb cellulitis poses a significant burden for the Irish healthcare system. Accurate diagnosis is difficult, with a lack of validated evidence-based tools and treatment guidelines, and difficulties distinguishing cellulitis from its imitators. It has been suggested that around 30% of suspected lower limb cellulitis is misdiagnosed. An audit of 132 patients between May 2017 and May 2018 identified a pattern of misdiagnosis in approximately 34% of this cohort. Objective: The aim of this pilot project was to develop a streamlined service for those presenting to the emergency department with red legs/suspected cellulitis, through introduction of the ‘Red Leg RATED’ tool for clinicians. Method: The tool was developed and introduced to emergency department clinicians. Individuals (n=24) presenting with suspected cellulitis over 4 weeks in 2018 were invited to participate in data gathering. Finally, clinician questionnaire feedback regarding the tool was evaluated. Results: Fourteen participants consented, 6 female and 8 male with mean age of 65 years. The tool identified 50% (n=7) as having cellulitis, of those 57% (n=4) required admission, 43% (n=3) were discharged. The remainder who did not have cellulitis (n=7) were discharged. Before introduction of the tool, all would typically have been admitted to hospital for further assessment and management of suspected lower limb cellulitis. Overall, 72% (n=10) of patients who initially presented with suspected cellulitis were discharged, suggesting positive impact of the tool. Clinician feedback suggested all were satisfied with the tool and contents. Conclusion: The Red Leg RATED tool is user friendly and impacts positively on diagnosis treatment and discharge. Further evaluation is warranted.

scholarly journals Use of Lugol’s Solution in the Management of Complex Graves’ Disease-a Small Case Series

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A972-A972
Author(s):  
Rufaro Asefa ◽  
Allison Shane Martin
Keyword(s):  
Emergency Department ◽  
Adverse Effects ◽  
Total Thyroidectomy ◽  
Treatment Guidelines ◽  
Case Series ◽  
Graves Disease ◽  
Evidence Based ◽  
Once Daily ◽  
Evidence Based Treatment ◽  
Severe Anxiety

Abstract Background: There are currently no clear guidelines for the peri-operative use of Lugol’s solution (LS) as an alternative to conventional anti-thyroid drug (ATD) therapy in patients with complex Graves’ thyrotoxicosis. Clinical Cases: Case 1 is a 44- year-old woman who presented with symptoms of hyperthyroidism and a moderately enlarged goiter due to Graves disease. She was treated initially with Methimazole 45 mg, once daily which was reduced to 30 mg once daily after a week. She subsequently presented to the emergency department with severe anxiety, sore throat, and a high fever. A blood panel showed evidence of profound agranulocytosis due to Methimazole. Methimazole was stopped and she was treated with a 10-day course of LS followed by a semi-elective total thyroidectomy. Case 2 is a 54-year-old old woman who presented with thyrotoxicosis due to Graves’ disease. She was started on Propylthiouracil (PTU) to which she developed hepatotoxicity and the decision was made to stop PTU. Methimazole was substituted to which she developed a severe desquamating rash hence it had to be stopped immediately. She was given a 10 day course of LS followed by semi-elective total thyroidectomy. Conclusion: In both cases, hyperthyroidism was successfully treated with Lugol’s solution and their surgeries were uneventful with full recovery. Although beneficial, Lugol’s Solution may result in adverse effects such as severe hypothyroidism, escape hyperthyroidism and death. These cases highlight the need for evidence based treatment guidelines for the use of Lugol’s solution in complex hyperthyroid cases.

Assessing compliance with practice treatment guidelines by treatment centers and the reasons for noncompliance

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17506-e17506 ◽  
Author(s):  
J. J. Biagi ◽  
R. Wong ◽  
J. Brierley ◽  
R. Rahal ◽  
J. Ross
Keyword(s):  
Practice Guidelines ◽  
Cancer Care ◽  
Treatment Guidelines ◽  
Treatment Guideline ◽  
Pilot Project ◽  
Patient Choice ◽  
Stage Iii ◽  
Evidence Based ◽  
Treatment Practice ◽  
The Government

e17506 Background: Cancer Care Ontario (CCO) is the chief advisor on cancer care to the government of Ontario, a province with a population of more than 12 million. One of the many roles of CCO is to develop evidence based consensus-derived treatment practice guidelines for all major cancer types, through its Program in Evidence-based Care (PEBC). To determine province-wide compliance with these guidelines, a pilot project assessed the proportion of patients with stage III colon cancer (CC) treated in concordance with the corresponding treatment guideline. Initial results are made available to the regional cancer centers (RCC) in the province and to the public through web based Cancer Systems Quality Index (CSQI, http://www.cancercare.on.ca/qualityindex2007/ ). Methods: The guideline (http://www.cancercare.on.ca/pdf/pebc2–29s.pdf) states that patients with resected stage 3 CC will have adjuvant fluoropyrimidine-based chemotherapy within eight weeks of resection. Patients at each of 11 RCC who presented in 2007/2008 with stage III CC and the proportion treated according to the guidelines were identified. Individual charts of those patients who were not treated according to guideline were reviewed to determine the reason. Results: Across eight RCC with complete chart results to date 376 patients with stage 3 CC were identified, 244 (65%, range 47% to 72%) treated in concordance with the guideline, including 13% treated with capecitabine and 6% on clinical trials. The reasons for non-concordance of the 132 remaining cases were: age and co morbid conditions 48 (13%), patient choice 36 (10%), referred for treatment outside the RCC system 16 (4%), stage incorrect and other 32 (9%). Conclusions: Adjuvant chemotherapy treatment of stage III CC at the RCC across the Province of Ontario was concordant with the guideline in the majority of patients, and appropriate clinical reasons for non-compliance were identified. Data from all 11 RCC will be presented along with concordance within the eight-week time frame stated in the guideline . Refinement in province-wide data collection and interpretation will allow results from this pilot to be expanded to other PEBC practice guidelines for dissemination through the CSQI. No significant financial relationships to disclose.

scholarly journals A clinical librarian pilot project in psychiatry

2010 ◽  
Vol 34 (2) ◽  
pp. 65-68 ◽  
Author(s):  
Helene Gorring ◽  
Erin Turner ◽  
Ed Day ◽  
Christopher A. Vassilas ◽  
Mark Aynsley
Keyword(s):  
Mental Health ◽  
Positive Impact ◽  
Continuing Professional Development ◽  
Pilot Project ◽  
Evidence Based ◽  
Mental Health Setting ◽  
Team Meetings ◽  
Acute Hospitals ◽  
Professional Development Needs ◽  
Clinical Questions

Aims and methodA 4-month pilot was conducted to assess whether the clinical librarian model, which has been successfully used within acute hospitals, would work in a mental health setting. A librarian attended weekly clinical team meetings in two community mental health teams to help generate clinical questions. A summary of the evidence on each topic was then presented the following week. An evaluation of the pilot was carried out using a questionnaire survey, focus groups and interviews.ResultsResults suggest that the project had produced a positive impact within the teams and begun the process of embedding evidence-based information within clinical practice.Clinical implicationsWith some adaptations, the clinical librarian model can be an effective method of implementing evidence-based practice and addressing continuing professional development needs within mental health clinical teams.

scholarly journals Uncovering Burdens, Examining Needs, and Shedding Assumptions of Evidence-Based Social Support Programs for Mothers: A Descriptive Qualitative Study in a Remote Community

2021 ◽  
Vol 8 ◽  
pp. 233339362110357
Author(s):  
Johanna R. Jahnke ◽  
Julee Waldrop ◽  
Alasia Ledford ◽  
Beatriz Martinez
Keyword(s):  
Social Support ◽  
Young Children ◽  
Healthcare Workers ◽  
Qualitative Interviews ◽  
Well Being ◽  
Evidence Based ◽  
Community Stakeholders ◽  
Significant Burden ◽  
Many Sources ◽  
Evidence Based Programs

Many studies have demonstrated a significant burden of maternal stress and depression for women living on the Galápagos Islands. Here, we aim to uncover burdens and needs of women with young children on San Cristóbal Island and then explore options for implementing evidence-based programs of social support to meet these needs. We conducted 17 semi-structured qualitative interviews with mothers of young children, healthcare workers, and community stakeholders. We then used Summary Oral Reflective Analysis (SORA), an interactive methodology, for qualitative analysis. Despite initial reports of a low-stress environment, women described many sources of stress and concerns for their own and their children’s health and well-being. We uncovered three broad areas of need for mothers of young children: (1) the need for information and services, (2) the need for trust, and (3) the need for space. In response to these concerns, mothers, healthcare workers, and community leaders overwhelmingly agreed that a social support program would be beneficial for the health of mothers and young children. Still, they expressed concern over the feasibility of such a program. To address these feasibility concerns, we propose that a web-based education and social support intervention led by nurses would best meet mothers’ needs. Women could learn about child health and development, develop strong, trusting friendships with other mothers, and have their own space to speak freely among experts and peers.

The 6C model for accurately capturing the patient’s medical history

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Taro Shimizu
Keyword(s):  
Artificial Intelligence ◽  
Differential Diagnosis ◽  
Patient Safety ◽  
Information Processing ◽  
Safety Concern ◽  
Data Gathering ◽  
Diagnostic Errors ◽  
Accurate Diagnosis ◽  
History Taking ◽  
Novel Approach

Abstract Diagnostic errors are an internationally recognized patient safety concern, and leading causes are faulty data gathering and faulty information processing. Obtaining a full and accurate history from the patient is the foundation for timely and accurate diagnosis. A key concept underlying ideal history acquisition is “history clarification,” meaning that the history is clarified to be depicted as clearly as a video, with the chronology being accurately reproduced. A novel approach is presented to improve history-taking, involving six dimensions: Courtesy, Control, Compassion, Curiosity, Clear mind, and Concentration, the ‘6 C’s’. We report a case that illustrates how the 6C approach can improve diagnosis, especially in relation to artificial intelligence tools that assist with differential diagnosis.

scholarly journals “What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anh Ly ◽  
Roger Zemek ◽  
Bruce Wright ◽  
Jennifer Zwicker ◽  
Kathryn Schneider ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Clinical Pathways ◽  
Theoretical Domains Framework ◽  
Local Context ◽  
Emergency Department Physician ◽  
Evidence Based ◽  
Care Providers ◽  
Structured Interviews ◽  
Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

“Play with me”: Student perspectives on collaborative chamber music instruction

2021 ◽  
pp. 1321103X2097480
Author(s):  
Katie Zhukov ◽  
Jon Helge Sætre
Keyword(s):  
Higher Education ◽  
Chamber Music ◽  
Positive Impact ◽  
Pilot Project ◽  
Music Instruction ◽  
Student Focus ◽  
Music Community ◽  
Viable Approach ◽  
Education Performance ◽  
The Impact

This article reports on a pilot project conducted in Australia and Norway evaluating new approaches to collaborative chamber music instruction in higher education settings. Following suggestions from the literature on collaborative and group learning in music, chamber music tuition was chosen as a suitable context to examine the possibility of teaching-through-playing and the impact of such an approach on students’ collaborative learning and their induction into the professional music community. Two groups of staff and students in each institution volunteered to participate in the project and implemented their own rehearsal schedule. Student focus group interviews were conducted after the final performance of rehearsed repertoire, and transcripts were analyzed by two researchers independently for the emerging themes and refined through iterative discussions. Key findings include students being inspired by working with experienced staff in a professional setting, learning the skills of ensemble playing such as effective rehearsal techniques, understanding of stylistic conventions, specific technical, musical and co-ordination skills, greater experimentation, positive impact of group discussions, and a more collaborative atmosphere. Students found it challenging to alter power roles, as the ingrained attitudes of teacher-led approaches prevailed. This project has shown that teaching-through-playing chamber music is a viable approach for developing students’ musical and social skills by providing them with authentic professional experiences. We propose an alternative model of higher education performance teaching that is more collaborative and participatory.

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