Improving Adherence to Therapy and Clinical Outcomes While Containing Costs: Opportunities From the Greater Use of Generic Medications: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians

2015 ◽  
Vol 164 (1) ◽  
pp. 41 ◽  
Author(s):  
Niteesh K. Choudhry ◽  
Thomas D. Denberg ◽  
Amir Qaseem ◽  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Guidelines ◽  
Best Practice ◽  
Generic Medications ◽  
Adherence To Therapy

scholarly journals Assessing fitness to drive after stroke

2018 ◽  
Vol 46 (2) ◽  
pp. 106-129
Author(s):  
Aisling Helen Stack ◽  
Orla Duggan ◽  
Tadhg Stapleton
Keyword(s):  
Occupational Therapy ◽  
Clinical Guidelines ◽  
Best Practice ◽  
Online Survey ◽  
Occupational Therapists ◽  
Fitness To Drive ◽  
Therapy Evaluation ◽  
Content Type ◽  
Evaluation Practices ◽  
Education Training

Purpose The assessment of fitness to drive after stroke is an emerging area of occupational therapy practice in Ireland. Despite this, little is known about occupational therapists’ evaluation practices, and there are no internationally agreed clinical guidelines to inform best practice. The purpose of this paper is to investigate occupational therapy evaluation practices for fitness to drive after stroke in Ireland. Design/methodology/approach This is a cross-sectional study design targeting occupational therapists working with people after stroke using an online survey. Summary and descriptive statistics were used to analyse the returned surveys. Findings In total, 47 occupational therapists participated. Off-road driving assessment was completed by 68 per cent of respondents. Functional assessment and non-driving-specific assessments were most widely used and perceived to be the most useful in informing the off-road assessment. A total of 89 per cent referred clients for on-road assessments; however, some referred without first completing an off-road assessment. The therapists who completed formal post graduate education/training in driving assessment reported greater confidence and competence in their skills and ability to assess fitness to drive. A vast majority of participants agreed that clinical guidelines regarding best practice in this area would be beneficial. Research limitations/implications A majority of occupational therapists are assessing fitness to drive after stroke in Ireland with non-driving-specific assessments and functional observations; however, there are many gaps and wide variations between services. Education/training in evaluating fitness to drive after stroke is recommended. The development of clinical guidelines to inform practice would facilitate a consistent approach nationally. Originality/value This is the first study completed in Ireland to investigate occupational therapy evaluation practices for fitness to drive after stroke.

Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians

2015 ◽  
Vol 163 (9) ◽  
pp. 701 ◽  
Author(s):  
Ali S. Raja ◽  
Jeffrey O. Greenberg ◽  
Amir Qaseem ◽  
Thomas D. Denberg ◽  
Nick Fitterman ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Guidelines ◽  
Best Practice ◽  
Acute Pulmonary Embolism

Consensus Development Methods: A Review of Best Practice in Creating Clinical Guidelines

1999 ◽  
Vol 4 (4) ◽  
pp. 236-248 ◽  
Author(s):  
Nick Black ◽  
Maggie Murphy ◽  
Donna Lamping ◽  
Martin McKee ◽  
Colin Sanderson ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
Best Practice ◽  
Consensus Development ◽  
Development Methods

scholarly journals P.064 Delays in the emergency department for stroke patients, medical complications and predictors of outcomes: the McGill experience

2016 ◽  
Vol 43 (S2) ◽  
pp. S36-S36
Author(s):  
C Legault ◽  
B Chen ◽  
L Vieira ◽  
B Lo (Montreal) ◽  
L Wadup ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Outcomes ◽  
Stroke Unit ◽  
Best Practice ◽  
Brain Oedema ◽  
Medical Complications ◽  
Significant Delay ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Increased Risk

Background: The Canadian Stroke Best Practice recommends admission of patients to a specialised stroke unit within three hours. We aimed at assessing delays in our emergency department (ED) and correlating these with medical complications and clinical outcomes. Methods: Predictors and outcomes This is a retrospective review of patients (n=353) admitted with ischemic strokes (January 2011-March 2014). We assessed the length of stay in ED, medical complications in ED and in the stroke unit, functional status (modified Rankin Scale) at discharge and survival. Results: The median delay in ED was 13.8 hours. The rate of medical complications in the ED was 14% (most common being delirium), compared to the stroke unit with 46.7% (most common being pneumonia). Worse functional outcome was correlated with diagnosis of pneumonia (standardised β coefficient=0.2, p=0.001) and presence of brain oedema in the stroke unit (standardised β coefficient=0.2, p<0.01). Increased risk of death was correlated with brain oedema (OR=649.2, 95%CI=19-2184, p<0.01) and sepsis in the stroke unit (OR=26.8, 95%CI=2.1-339, p<0.01). Conclusions: We found a significant delay in the admission of our patients from the ED to the stroke unit, which is not in keeping with the present guidelines. Medical complications were correlated with worse outcomes. Future analyses will correlate ED delays with clinical outcomes.

scholarly journals Embedding EBVM into Practice

2017 ◽  
Vol 2 (1) ◽  
Author(s):  
Bradley Viner
Keyword(s):  
Open Access ◽  
Patient Care ◽  
Practice Guidelines ◽  
Clinical Guidelines ◽  
Best Practice ◽  
Clinical Performance ◽  
Clinical Audit ◽  
Clinical Effectiveness ◽  
Pros And Cons ◽  
Audit Cycle

<p>Embracing EBVM as a concept is an important first step, but is of little value unless it is translated into an improvement in patient care. This session will discuss how EBVM can be incorporated into clinical guidelines at a practice level, using a team-based approach to maximise concordance. The pros and cons of using practice guidelines as a means of improving clinical effectiveness will be discussed, followed by an illustration of how the clinical audit cycle can be used as a tool to ensure that Best Practice as a established by practice guidelines is applied to produce an improvement in clinical performance.</p><p> <a href="/index.php/ve/article/view/95/128"><img src="/public/site/images/bridget/Bradley_twitte_image.PNG" alt="" /></a></p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" />

scholarly journals Aphasia Rehabilitation Service Delivery in a Stroke Rehabilitation Unit in Australia: A Clinical Audit of Speech Pathology Practices

2016 ◽  
Author(s):  
Laleh Rej ◽  
Sebastian Doeltgen ◽  
Amy Rodriguez ◽  
Willem van Steenbrugge
Keyword(s):  
Service Delivery ◽  
Clinical Guidelines ◽  
Stroke Rehabilitation ◽  
Best Practice ◽  
Clinical Audit ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Speech Pathology ◽  
Rehabilitation Unit ◽  
Retrospective Audit

Purpose: To investigate service delivery of aphasia rehabilitation in a metropolitan rehabilitation hospital by speech pathologists and assess adherence to both the National Stroke Foundation (NSF) Clinical Guidelines and the Australasian Rehabilitation Outcomes Centre (AROC) database of benchmarks. Method: A retrospective audit of 34 discharged patients was conducted within a dedicated stroke rehabilitation unit from March 2012 to July 2013 in Australia. Discharge reports, Functional Independence Measure (FIM) scores and clinical time statistics derived from the organization’s electronic database were studied and compared with NSF’s Clinical Guidelines for best practice recommendations and AROC benchmarks. Results: Patients with aphasia were admitted to inpatient rehabilitation at an average of 21 days post stroke, 2 days beyond the AROC benchmark for inpatient rehabilitation. The mean length of stay of patients with aphasia was 60 days, significantly longer than the average AROC benchmark of 32.8 days. Patients received an average of 4.25 hours of speech pathology therapy per week, more than twice the minimum amount of therapy time recommended by the NSF Guidelines. Conclusion: The current clinical audit is the first known speech pathology audit investigating adherence to stroke and aphasia rehabilitation guidelines set forth by the NSF clinical guidelines and AROC benchmarks in Australia. By comparing current care with advocated best practice, strengths were identified in service delivery, as well as priority areas for quality improvement.

Clinical Guidelines for the Treatment of Anxiety in Eating Disorders

2017 ◽  
pp. 21-39
Author(s):  
Stephanie Knatz Peck ◽  
Stuart B. Murray ◽  
Walter H. Kaye
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Anxiety Disorders ◽  
Personality Traits ◽  
Dual Diagnosis ◽  
Clinical Guidelines ◽  
Best Practice ◽  
Negative Impact ◽  
Anxiety Symptoms ◽  
Integrative Treatment

Approximately two-thirds of individuals diagnosed with eating disorders have had one or more concurrent anxiety disorders in their lifetime. Anxiety symptoms most often predate the onset of an eating disorder and are associated with worse outcomes, implicating anxiety as a possible vulnerability factor in the onset and maintenance of an eating disorder. Individuals with eating disorders also tend to possess personality traits associated with anxiety. This significant comorbidity is likely a result of a shared underlying temperament profile that may predispose individuals to both an eating disorder and certain anxiety disorders. Given the negative impact of anxiety on recovery, eating disorder clinicians should be aware of these shared vulnerabilities and, ideally, be equipped to treat comorbid anxiety issues with a working knowledge of best practice treatment approaches. Furthermore, for patients with a dual diagnosis, clinicians must construct an integrative treatment approach taking into account impairments from both illnesses.

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