Obstacles to the Implementation of Antiemetic Guidelines

2009 ◽  
Vol 7 (5) ◽  
pp. 601-605 ◽  
Author(s):  
Steven M. Grunberg
Keyword(s):  
Physician Behavior ◽  
Clinical Care ◽  
Guideline Implementation ◽  
Scientific Basis ◽  
Physician Education ◽  
Standards Of Care ◽  
Minimal Impact ◽  
Antiemetic Guidelines ◽  
The Relationship

Although guidelines help physicians deliver high quality clinical care, they will have minimal impact unless familiarity and adherence are achieved. Although nausea and vomiting are highly feared toxicities of chemotherapy that markedly decrease patient quality of life, modifications in physician behavior and improvements in standards of care, particularly in terms of preventing delayed emesis, have been slow. Variations in format, goals, physician education, and institutional education may all affect guideline implementation and state-of-the-art care. The relationship between these factors and the scientific basis of antiemetic guidelines must be considered to achieve optimal results and compliance.

scholarly journals Variation in clinical care associated with weekend admission and discharge in psychiatric in-patient units: retrospective case-note review

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Ryan Williams ◽  
Lorna Farquharson ◽  
Ellen Rhodes ◽  
Mary Dang ◽  
Natasha Lindsay ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Psychiatric Hospital ◽  
Depressive Disorders ◽  
Clinical Care ◽  
Case Note ◽  
Weekend Effect ◽  
Standards Of Care ◽  
Retrospective Case ◽  
Case Note Review

Background Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends. Aims To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’. Method Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses. Results In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97). Conclusions There is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.

scholarly journals Life’s quality of immigrant workers in Ho Chi Minh City

2020 ◽  
Vol 4 (3) ◽  
pp. First
Author(s):  
Nguyen Hong Nga ◽  
Nguyen Thi Thu Trang
Keyword(s):  
Quality Of Life ◽  
Migrant Workers ◽  
Structural Equation ◽  
Scientific Basis ◽  
Equation Model ◽  
Immigrant Workers ◽  
Ho Chi Minh City ◽  
The Relationship ◽  
Analyze Data

Migration is an indispensable trend in Ho Chi Minh City (HCMC), and immigrant workers have become an important resource contributing to economic growth. This study aims to clarify the quality of life of immigrant workers and offer a scientific basis for policies that promote the positive contributions of immigrant workers. A linear structural equation model is used to analyze data of 394 observations, including 253 migrant workers and 141 local workers. Quality of life is first assessed by whether immigrant workers can meet or satisfy a variety of their needs. Then the relationship between the needs and outcomes such as income, education, and effort-to-stay is analyzed using a mediator named assimilation. Finally, a comparison between groups such as migrant and local workers, migrants living in HCMC under and over ten years is conducted. The results indicated that employment, settlement, and social support have a direct impact on their assimilation and the strongest indirect impact on effort-to-stay, income, and education. Besides, effort-to-stay and income have a mutual impact. The results also proved that there are differences between migrant workers and local workers but no difference between under 10-year migrants and over 10-year migrants.

scholarly journals A critical appraisal of guidelines for electronic communication between patients and clinicians: the need to modernize current recommendations

2017 ◽  
Vol 25 (4) ◽  
pp. 413-418 ◽  
Author(s):  
Joy L Lee ◽  
Marianne S Matthias ◽  
Nir Menachemi ◽  
Richard M Frankel ◽  
Michael Weiner
Keyword(s):  
Electronic Communication ◽  
Clinical Care ◽  
Negative Consequences ◽  
Ovid Medline ◽  
Primary Focus ◽  
Future Work ◽  
The Relationship ◽  
Published Research ◽  
Current Guidelines

Abstract Background Patient-provider electronic communication has proliferated in recent years, yet there is a dearth of published research either leading to, or including, recommendations that improve clinical care and prevent unintended negative consequences. We critically appraise published guidelines and suggest an agenda for future work in this area. Objective To understand how existing guidelines align with current practice, evidence, and technology. Methods We performed a narrative review of provider-targeted guidelines for electronic communication between patients and providers, searching Ovid MEDLINE, Embase, and PubMed databases using relevant terms. We limited the search to articles published in English, and manually searched the citations of relevant articles. For each article, we identified and evaluated the suggested practices. Results Across 11 identified guidelines, the primary focus was on technical and administrative concerns, rather than on relational communication. Some of the security practices recommended by the guidelines are no longer needed because of shifts in technology. It is unclear the extent to which the recommendations that are still relevant are being followed. Moreover, there is no guideline-cited evidence of the effectiveness of the practices that have been proposed. Conclusion Our analysis revealed major weaknesses in current guidelines for electronic communication between patients and providers: the guidelines appear to be based on minimal evidence and offer little guidance on how best to use electronic tools to communicate effectively. Further work is needed to systematically evaluate and identify effective practices, create a framework to evaluate quality of communication, and assess the relationship between electronic communication and quality of care.

Inter-rater reliability of case-note audit: a systematic review

2007 ◽  
Vol 12 (3) ◽  
pp. 173-180 ◽  
Author(s):  
Richard Lilford ◽  
Alex Edwards ◽  
Alan Girling ◽  
Timothy Hofer ◽  
Gian Luca Di Tanna ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Care ◽  
Quality Care ◽  
Correlation Coefficients ◽  
Poor Quality ◽  
Case Note ◽  
Rater Reliability ◽  
The Relationship ◽  
Retrospective Examination

Objective: The quality of clinical care is often assessed by retrospective examination of case-notes (charts, medical records). Our objective was to determine the inter-rater reliability of case-note audit. Methods: We conducted a systematic review of the inter-rater reliability of case-note audit. Analysis was restricted to 26 papers reporting comparisons of two or three raters making independent judgements about the quality of care. Results: Sixty-six separate comparisons were possible, since some papers reported more than one measurement of reliability. Mean kappa values ranged from 0.32 to 0.70. These may be inflated due to publication bias. Measured reliabilities were found to be higher for case-note reviews based on explicit, as opposed to implicit, criteria and for reviews that focused on outcome (including adverse effects) rather than process errors. We found an association between kappa and the prevalence of errors (poor quality care), suggesting alternatives such as tetrachoric and polychoric correlation coefficients be considered to assess inter-rater reliability. Conclusions: Comparative studies should take into account the relationship between kappa and the prevalence of the events being measured.

scholarly journals Clinical governance in the asylum

2002 ◽  
Vol 26 (11) ◽  
pp. 430-432
Author(s):  
Paul Wolfson ◽  
Carol Paton ◽  
Peter Jarrett
Keyword(s):  
Clinical Care ◽  
Clinical Governance ◽  
Standards Of Care ◽  
Quality Of Services ◽  
Department Of Health

Clinical governance was introduced in 1998: ‘a framework through which NHS organisations are accountable for constantly improving the quality of services and safeguarding standards of care by creating an environment in which excellence in clinical care can flourish’. (Department of Health, 1997)

scholarly journals Dynamic Changes in Endophytic Microorganisms and Metabolites During Natural Drying of Licorice

2021 ◽  
Vol 12 ◽  
Author(s):  
Ting Li ◽  
Guangxi Ren ◽  
Dan Jiang ◽  
Chunsheng Liu
Keyword(s):  
Scientific Basis ◽  
Shannon Index ◽  
Drying Method ◽  
Drying Process ◽  
Dynamic Changes ◽  
Endophytic Microorganisms ◽  
Relationship Of ◽  
The Relationship ◽  
Natural Drying

The method of drying licorice is an important factor affecting the quality of the final product. To determine the best processing method of licorice postharvest, we investigated the interaction of increasing aridity between the endophytic microorganisms and the accumulation of metabolites. Samples from the roots of licorice growing along an aridity gradient during the natural drying process were collected, and the metabolic components, the content of the main active substances and the dynamic changes of the endophytic microbial community were assessed. The glycyrrhizic acid and liquiritin contents decreased slightly or remained flat during natural drying, whereas those of liquiritigenin and isoliquiritigenin increased slightly. Moreover, the Shannon index of endophytic microbial diversity of licorice was the highest in the fresh period and showed a downward trend during the drying process. When the licorice were fresh, Cladosporiaceae and Burkholderiaceae were the dominant family present, but after drying, Nectriaceae and Enterobacteriaceae were the dominant families. A similar trend was also found in which the differential metabolites of licorice were reduced during natural drying. Furthermore, correlation analysis between dominant families and differential metabolites showed that there was a correlation between the two. Therefore, fresh processing is an effective drying method to ensure the quality of licorice. This study revealed the relationship of endophytic microbiota and changes in the licorice metabolites during different stages of drying, which provided a scientific basis for the drying method of licorice.

Relationships Between Nurses and Physicians Matter

2015 ◽  
Vol 20 (3) ◽  
Author(s):  
Sandra Siedlecki ◽  
Eric Hixson
Keyword(s):  
Physician Behavior ◽  
Relevant Literature ◽  
Clinical Settings ◽  
Practice Environment ◽  
Experienced Nurses ◽  
Nurses And Physicians ◽  
The Impact ◽  
The Relationship ◽  
Better Than

Both safety and quality of care patients receive depend upon the quality of the practice environment where care is provided. In this article, the authors review relevant literature, and describe their study that identified how nurses and physicians define respectful behavior; examined perceptions of the relationship between nurses and physicians in clinical settings in which they practice together; and analyzed the impact of nurse-physician relationships on nursing care decisions. Perceptions of nurse-physician relationships were assessed using the Professional Practice Environment Assessment Scale and perceptions of respectful behavior and the effect of physician behavior on nursing practice were assessed with single, forced-choice items. The authors report finding that physicians rated relationships significantly better than did nurses. Additionally, they note that 55% of nurses said that a physician’s behavior impacted nursing decisions, and that younger, less experienced nurses were more likely to report being affected by negative physician behaviors than older nurses or nurses with more experience. They discuss how nurses’ and physicians’ different perceptions of the same environment is not surprising, but is instructive, and conclude that acknowledging differences in values, incentives, and perceptions can provide insights that focus improvement initiatives.

Clinical practice guidelines and risk management: a medicolegal perspective

Clinical Risk ◽  
2007 ◽  
Vol 13 (5) ◽  
pp. 169-172 ◽  
Author(s):  
Jo Samanta ◽  
Ash Samanta
Keyword(s):  
Risk Management ◽  
Clinical Practice ◽  
Clinical Guidelines ◽  
Clinical Care ◽  
Evidence Base ◽  
Medical Evidence ◽  
High Quality ◽  
Treatment Processes ◽  
The Relationship

Clinical guidelines are systematically developed statements created to assist clinicians in making decisions about the treatment and management of specific conditions. They are linked to the medical evidence base and aim to reduce unnecessary variations in treatment processes, thereby maintaining consistently high quality clinical care. Healthcare risk management is concerned with preventing harm to patients and this goal can be facilitated by clinical guidelines which enhance the quality of care. This paper explores the relationship between clinical guidelines and risk management from a medicolegal perspective.

scholarly journals Current Practices and Potential Nanotechnology Perspectives for Pain Related to Cystic Fibrosis

2019 ◽  
Vol 8 (7) ◽  
pp. 1023
Author(s):  
Laura M. Trandafir ◽  
Magdalena M. Leon ◽  
Otilia Frasinariu ◽  
Ginel Baciu ◽  
Gianina Dodi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Pain Assessment ◽  
Clinical Care ◽  
System Disease ◽  
Pain Symptoms ◽  
The Impact ◽  
The Relationship ◽  
Critical Overview

Pain is a complex, multidimensional process that negatively affects physical and mental functioning, clinical outcomes, quality of life, and productivity for cystic fibrosis (CF) patients. CF is an inherited multi-system disease that requires a complete approach in order to evaluate, monitor and treat patients. The landscape in CF care has changed significantly, with currently more adult patients than children worldwide. Despite the great advances in supportive care and in our understanding regarding its pathophysiology, there are still numerous aspects of CF pain that are not fully explained. This review aims to provide a critical overview of CF pain research that focuses on pain assessment, prevalence, characteristics, clinical association and the impact of pain in children and adults, along with innovative nanotechnology perspectives for CF management. Specifically, the paper evaluates the pain symptoms associated with CF and examines the relationship between pain symptoms and disease severity. The particularities of gastrointestinal, abdominal, musculoskeletal, pulmonary and chest pain, as well as pain associated with medical procedures are investigated in patients with CF. Disease-related pain is common for patients with CF, suggesting that pain assessment should be a routine part of their clinical care. A summary of the use of nanotechnology in CF and CF-related pain is also given. Further research is clearly needed to better understand the sources of pain and how to improve patients’ quality of life.

Malleable Standards of Care Required by Jurors When Assessing Auditor Negligence

2016 ◽  
Vol 92 (1) ◽  
pp. 165-181 ◽  
Author(s):  
Eldar M. Maksymov ◽  
Mark W. Nelson
Keyword(s):  
Sample Size ◽  
Audit Quality ◽  
Data Availability ◽  
Standards Of Care ◽  
The Relationship ◽  
Insight Into

ABSTRACT We report the results of four experiments investigating the relationship between (1) the quality of an audit, (2) jurors' assessments of the standard of prudent care (SOC) against which audit quality is compared, and (3) jurors' negligence verdicts. Experiment 1 operationalizes audit quality by varying the sample size used in audit testing, and provides evidence that jurors anchor their assessment of SOC on audit quality, producing a “competitive mediation” in which audit quality reduces the potential for a negligence verdict directly, but increases that potential indirectly by increasing SOC. Experiment 2 generalizes this finding to a setting that operationalizes audit quality by varying the size of adjustment the auditor required. Experiments 3 and 4 extend these results to a setting in which SOC is elicited after jurors make negligence verdicts. Overall, these experiments provide insight into the role of SOC in constraining and justifying negligence verdicts. Data Availability: Contact the authors.

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