scholarly journals Clinical standards for the assessment, management and rehabilitation of post-TB lung disease

2021 ◽  
Vol 25 (10) ◽  
pp. 797-813
Author(s):  
G. B. Migliori ◽  
F. M. Marx ◽  
N. Ambrosino ◽  
E. Zampogna ◽  
H. S. Schaaf ◽  
...  
Keyword(s):  
Public Health ◽  
Lung Disease ◽  
Pulmonary Rehabilitation ◽  
Improve Patient Care ◽  
Patient Needs ◽  
Clinical Standards ◽  
Tb Treatment ◽  
Local Setting ◽  
Improve Patient

BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.

Analytical Methods for the Determination of Sartans in Pharmaceutical Formulations and Biological Fluids: A Review

2020 ◽  
Vol 16 (3) ◽  
pp. 208-222
Author(s):  
Miglena Smerikarova ◽  
Stanislav Bozhanov ◽  
Vania Maslarska
Keyword(s):  
Biological Fluids ◽  
Pharmaceutical Preparations ◽  
Improve Patient Care ◽  
Pharmaceutical Formulations ◽  
Treatment Of Hypertension ◽  
Therapeutic Doses ◽  
Reliable Methods ◽  
Improve Patient

Background: Sartans are mostly used as a part of combination with additional medicines in the therapy of essencial hypertension. Preferred combinations are ARB and thiazide diuretics (Hydrochlorothiazide (HCT) and Chlorthalidone (CHL)) or ARB and calcium antagonists. The number of sartans mostly prescribed by specialists is only seven - Candesartan (CDS), Eprosartan (EPS), Irbesartan (IBS), Losartan (LOS), Olmesartan (OMS), Telmisartan (TMS) and Valsartan (VLS). Methods: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. According to our knowledge, a review devoted to the analysis of sartans was published in 2014. Results: Spectral methods are widely used in the analysis of bulk drugs and pharmaceutical dosage forms due to their relatively simple procedures, low reagent and sample consumption, speed, precision and accuracy combined with accessibility and comparatively low cost of common apparatus. Many papers for determination of sartans in bulk drugs and pharmaceutical preparations based on liquid chromatographic techniques were published in the available literature. Among these methods, HPLC takes the leading place but UPLC and HPTLC are also present. Conclusion: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. Since 2014, many articles have been published on the sartans analysis and this provoked our interest to summarize the latest applications in the analysis of sartans in pharmaceutical formulations and biological media. Articles published from 2014 to 2018 are covered.

scholarly journals Minimal versus specialist equipment in the delivery of pulmonary rehabilitation: protocol for a non-inferiority randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e047524
Author(s):  
Claire M Nolan ◽  
Jessica A Walsh ◽  
Suhani Patel ◽  
Ruth E Barker ◽  
Oliver Polgar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Disease ◽  
Exercise Capacity ◽  
Chronic Lung Disease ◽  
Pulmonary Rehabilitation ◽  
Randomised Trial ◽  
Global Rating ◽  
Process Data ◽  
Exercise Equipment

IntroductionPulmonary rehabilitation (PR), an exercise and education programme for people with chronic lung disease, aims to improve exercise capacity, breathlessness and quality of life. Most evidence to support PR is from trials that use specialist exercise equipment, for example, treadmills (PR-gym). However, a significant proportion of programmes do not have access to specialist equipment with training completed with minimal exercise equipment (PR-min). There is a paucity of robust literature examining the efficacy of supervised, centre-based PR-min. We aim to determine whether an 8-week supervised, centre-based PR-min programme is non-inferior to a standard 8-week supervised, centre-based PR-gym programme in terms of exercise capacity and health outcomes for patients with chronic lung disease.Methods and analysisParallel, two-group, assessor-blinded and statistician-blinded, non-inferiority randomised trial. 436 participants will be randomised using minimisation at the individual level with a 1:1 allocation to PR-min (intervention) or PR-gym (control). Assessment will take place pre-PR (visit 1), post-PR (visit 2) and 12 months following visit 1 (visit 3). Exercise capacity (incremental shuttle walk test), dyspnoea (Chronic Respiratory Questionnaire (CRQ)-Dyspnoea), health-related quality of life (CRQ), frailty (Short Physical Performance Battery), muscle strength (isometric quadriceps maximum voluntary contraction), patient satisfaction (Global Rating of Change Questionnaire), health economic as well as safety and trial process data will be measured. The primary outcome is change in exercise capacity between visit 1 and visit 2. Two sample t-tests on an intention to treat basis will be used to estimate the difference in mean primary and secondary outcomes between patients randomised to PR-gym and PR-min.Ethics and disseminationLondon-Camden and Kings Cross Research Ethics Committee and Health Research Authority have approved the study (18/LO/0315). Results will be submitted for publication in peer-reviewed journals, presented at international conferences, disseminated through social media, patient and public routes and directly shared with stakeholders.Trial registration numberISRCTN16196765.

scholarly journals Insulin Bolus Calculator in a Pediatric Hospital

2017 ◽  
Vol 08 (02) ◽  
pp. 529-540 ◽  
Author(s):  
Mohammad Ateya ◽  
Ranjit Aiyagari ◽  
Colleen Moran ◽  
Kanakadurga Singer
Keyword(s):  
User Satisfaction ◽  
Bolus Dose ◽  
Improve Patient Care ◽  
Severe Hypoglycemia ◽  
Pediatric Hospital ◽  
User Perceptions ◽  
Hospital Safety ◽  
Survey Responses ◽  
Improve Patient

Summary Background: Insulin dosing in hospitalized pediatric patients is challenging and requires dosing to be matched with the specific clinical and nutritional circumstances. We implemented a customized subcutaneous insulin bolus dose calculator tool integrated with the electronic health record to improve patient care. Here we describe this tool, its utilization and safety, and assess user satisfaction and perceptions of the tool. Methods: Blood glucose results for all patients who received insulin with and without the calculator tool were compared to assess safety. To assess user perceptions and satisfaction, a survey was sent to all identified users who interacted with the tool during the period from May 2015 to the end of November 2015. Survey responses were summarized, mean user satisfaction calculated, and correlation of Likert scale items with overall satisfaction assessed. Results: Hypoglycemia rates (2.2% and 2.9%, p = 0.17) and severe hypoglycemia rates (0.04% and 0.1%, p = 0.21) were similar for the groups that received insulin with and without the calculator tool. Overall satisfaction for all survey respondents was high (4.05, SD = 0.83). Physicians indicated a slightly higher satisfaction than nurses (4.33 versus 3.94, p = 0.04). User agreement with improvement of quality of care showed the highest correlation with overall satisfaction (r = 0.80, 95% CI 0.7 –0.87). Conclusion: Implementation of an insulin calculator tool streamlined ordering and administration of insulin in a pediatric academic institution while maintaining patient safety. Users indicated high overall satisfaction with the tool. Citation: Ateya MB, Aiyagari R, Moran C, Singer K. .:Insulin bolus calculator in a pediatric hospital: Safety and user perceptions. Appl Clin Inform 2017; 8: 529–540 https://doi.org/10.4338/ACI-2016-11-RA-0187

Combined Regenerative Approach for a Complex Lower Extremity Wound: A Case Report

2021 ◽  
Vol 33 (5) ◽  
pp. E34-E38
Author(s):  
Pedro Piccinini ◽  
Mariana de Sousa Rebelato ◽  
Marwan Masri ◽  
Carlos Uebel ◽  
Rubem Stümpfle ◽  
...  
Keyword(s):  
Negative Pressure Wound Therapy ◽  
Improve Patient Care ◽  
Acellular Dermal Matrix ◽  
Dermal Matrix ◽  
Plantar Ulcer ◽  
Regenerative Approach ◽  
Lower Extremity Wound ◽  
Acellular Dermal ◽  
Improve Patient

More than 400 million patients worldwide are affected by diabetes; over their lifetime, at least 25% will develop foot ulcers that often result in high rates of nonhealing wounds and amputation. The authors present the case of a 43-year-old female patient with multiple comorbidities who presented with a large (8 cm x 4 cm), noninfected, hindfoot plantar ulcer that extended down to the bone and calcaneus. Over 2 weeks, the patient was successfully treated using a combination of an acellular dermal matrix, nanofat grafting, and negative pressure wound therapy, lessening the effects of the ulcer on the patient’s quality of life and achieving limb salvage. Utilizing the regenerative procedures described herein may improve patient care and decrease costs.

Know the score: management of patients with a new diagnosis of acute pulmonary embolism

2020 ◽  
Vol 81 (11) ◽  
pp. 1-4
Author(s):  
D'Marieanne Koomson ◽  
Neil Smith ◽  
Simon McPherson ◽  
Vivek Srivastava
Keyword(s):  
Patient Outcome ◽  
Pulmonary Embolism ◽  
Quality Of Care ◽  
Patient Care ◽  
Acute Pulmonary Embolism ◽  
Improve Patient Care ◽  
Confidential Enquiry ◽  
New Diagnosis ◽  
Improve Patient

The National Confidential Enquiry into Patient Outcome and Death review into the quality of care provided to UK patients with a new diagnosis of acute pulmonary embolism highlights both clinical and organisational changes that should be made to improve patient care and outcomes.

scholarly journals Improving the quality of healthcare data through information design

2017 ◽  
Vol 23 (1) ◽  
pp. 104-122 ◽  
Author(s):  
Guillermina Noël ◽  
Janet Joy ◽  
Carmen Dyck
Keyword(s):  
Patient Care ◽  
Healthcare Providers ◽  
Improve Patient Care ◽  
Quality Of Healthcare ◽  
Healthcare Data ◽  
Advantages And Disadvantages ◽  
Quality Of Patient Care ◽  
Improve Patient ◽  
Insight Into

Improving the quality of patient care, generally referred to as Quality Improvement (QI), is a constant mission of healthcare. Although QI initiatives take many forms, these typically involve collecting data to measure whether changes to procedures have been made as planned, and whether those changes have achieved the expected outcomes. In principle, such data are used to measure the success of a QI initiative and make further changes if needed. In practice, however, many QI data reports provide only limited insight into changes that could improve patient care. Redesigning standard approaches to QI data can help close the gap between current norms and the potential of QI data to improve patient care. This paper describes our study of QI data needs among healthcare providers and managers at Vancouver Coastal Health, a regional health system in Canada. We present an overview of challenges faced by healthcare providers around QI data collection and visualization, and illustrate the advantages and disadvantages of different visualizations. At present, user– centred and evidence–based design is practically unknown in healthcare QI, and thus offers an important new contribution.

scholarly journals It's a Non-Dialysis Day… Do You Know How Your Patient Is Doing? A Case for Research into Interdialytic Activity

2015 ◽  
Vol 39 (1-3) ◽  
pp. 74-83 ◽  
Author(s):  
Melissa Mendoza ◽  
Maggie Han ◽  
Anna Meyring-Wösten ◽  
Kenneth Wilund ◽  
Peter Kotanko
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Standard Method ◽  
Healthcare Workers ◽  
Improve Patient Care ◽  
Know How ◽  
Tracking Devices ◽  
The Relationship ◽  
Improve Patient

Hemodialysis (HD) patients are less active than their healthy counterparts; this is associated with higher mortality. Healthcare workers observe their patients only during HD, which accounts for about 7% of the week. Knowing more about what occurs in between sessions, particularly with respect to physical activity, may improve patient care and prognosis. Yet without a standard method to measure interdialytic activity, it is difficult to compare the effect of interventions. However, it is unclear how interdialytic activity can be accurately measured. Since activity associated with quality of life is multi-dimensional, objective and subjective tools should be used in conjunction. While commercially available tracking devices can be seamlessly incorporated into everyday life and can increase awareness of user's activity, their validation is needed in the HD population. Fertile topics for research should include the relationship between objective and subjective measures in HD patients, and the investigation of physical activity in non-ambulatory HD patients.

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