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"order set" or "order sets" or "carepath" or "care path"

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https://www.readbyqxmd.com/read/28210553/impact-of-value-based-breast-cancer-care-pathway-implementation-on-pre-operative-breast-magnetic-resonance-imaging-utilization
#1
Devina K S McCray, Stephen R Grobmyer, Holly J Pederson
BACKGROUND: Bilateral breast magnetic resonance imaging (MRI) is commonly used in the diagnostic workup of breast cancer (BC) to assess extent of disease and identify occult foci of disease. However, evidence for routine use of pre-operative MRI is lacking. Breast MRI is costly and can lead to unnecessary tests and treatment delays. Clinical care pathways (care paths) are value-based guidelines, which define management recommendations derived by expert consensus and available evidence based data...
February 2017: Gland Surgery
https://www.readbyqxmd.com/read/28194729/design-and-implementation-of-decision-support-for-tobacco-dependence-treatment-in-an-inpatient-electronic-medical-record-a-randomized-trial
#2
Steven L Bernstein, June Rosner, Michelle DeWitt, Jeanette Tetrault, Allen L Hsiao, James Dziura, Scott Sussman, Patrick O'Connor, Benjamin Toll
: Tobacco dependence treatment for hospitalized smokers results in long-term cessation if treatment continues at least 30 days post-discharge. Health information technology may facilitate ongoing tobacco dependence treatment after hospital discharge. To describe the use and impact of a new decision support tool and order set for inpatient physicians, addressing tobacco dependence treatment for hospitalized smokers, embedded in an electronic health record (EHR). In a cluster-randomized trial, 254 physicians were randomized (1:1) to either receive or not receive the decision support tool and order set, which were embedded in the Epic (Madison, WI) EHR used at 2 hospitals in a single city...
February 13, 2017: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/28179250/impact-of-pharmacist-management-of-pain-agitation-and-delirium-in-the-intensive-care-unit-through-participation-in-multidisciplinary-bundle-rounds
#3
Patricia Louzon, Heath Jennings, Mahmood Ali, Marijo Kraisinger
PURPOSE: A two-phase program to increase pharmacist involvement in management of pain, agitation and delirium (PAD) at a large community teaching hospital is described. SUMMARY: Florida Orlando Hospital implemented a two-phase initiative to decrease intensive care unit (ICU) length of stay (LOS), ventilator use, sedative use, and hospital expenditures while advancing pharmacists' scope of practice. Phase 1 of the initiative involved a pilot project to evaluate pharmacist management of sedative therapy for mechanically ventilated patients...
February 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28176924/high-stakes-and-high-emotions-providing-safe-care-in-canadian-emergency-departments
#4
Samina Ali, Denise Thomson, Timothy A D Graham, Sean E Rickard, Antonia S Stang
BACKGROUND: The high-paced, unpredictable environment of the emergency department (ED) contributes to errors in patient safety. The ED setting becomes even more challenging when dealing with critically ill patients, particularly with children, where variations in size, weight, and form present practical difficulties in many aspects of care. In this commentary, we will explore the impact of the health care providers' emotional reactions while caring for critically ill patients, and how this can be interpreted and addressed as a patient safety issue...
2017: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/28152960/appropriateness-of-testing-for-heparin-induced-thrombocytopenia-in-hospitalized-patients
#5
Debasmita Saha, Gresa Ajeti, Brandon Bair, Karen Hook, Enrique Ballesteros, Lisa Holle
: 252 Background: Heparin induced thrombocytopenia (HIT) is a devastating thrombotic complication of heparin therapy and occurs in 0.2 to 5% of patients receiving heparin products and is a clinicopathologic diagnosis. The American Society of Hematology Guidelines, recommend the use of the "4Ts" scoring system to determine the pre-test probability of suspected cases. Also, a presumptive clinical diagnosis of HIT must be followed by immediate cessation of all forms of heparin and initiation of alternate anticoagulation...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152944/a-single-institution-s-experience-with-the-value-of-fdg-pet-ct-imaging-in-patients-with-newly-diagnosed-stage-iib-iiib-breast-cancer
#6
Katherine Glass, Chad W Cummings, Alberto J Montero, Jame Abraham, Halle C F Moore, G Thomas Budd
: 123 Background: The Cleveland Clinic is utilizing disease specific teams to craft care paths for value based disease management. The report by Groheux (JNCI 2012; 104:1879-1887), reported (18) FDG-PET-CT detected distant metastasis in 10.7, 17.5 and 36.5% of stage IIB- IIIB breast cancer patients. Based on this report, the breast team incorporated (18) FDG-PET- CT imaging for initial staging of IIB-IIIB patients. METHODS: Treatment algorithms were developed by a multi-disciplinary breast cancer team...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152900/hardwiring-advance-directives-into-an-electronic-medical-record
#7
Tyler Buckley, Andrew Badke, Amy Horyna, Julie Howell, Lisa Gren, Anna Catherine Beck
: 146 Background: Patient preference at the end of life has been extensively researched and documented. Advance Directives (AD) have been shown to make a difference for patients in the areas of quality, cost, and patient satisfaction. Organizations struggle with meeting federal laws and accreditation expectations due to our complex systems. Literature supports "hardwiring" AD documentation into the EMR and providing "one click" accessibility to AD's. Changing EMR vendors provides a unique opportunity to optimize access to AD's, both through patient education /endorsement, review of providers' role, and engagement of IT...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152868/compliance-with-national-comprehensive-cancer-network-guidelines-for-antiemesis-in-cisplatin-regimens
#8
Dana Ann Little
: 280 Background: The members of a network of community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines. To determine guideline compliance, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting.The community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines for treatment plans...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152763/multidisciplinary-optimization-of-oral-chemotherapy-delivery-at-the-uw-carbone-cancer-center
#9
Mary Mably, Jason Bergsbaken, Kari Schuhmacher, Chris Nemergut, Aaron Bohler, Jessica Fischer
: 58 Background: Use of oral chemotherapy is expanding and offers advantages but introduces unique safety challenges. ASCO and ONS addressed these issues with inclusion of oral chemotherapy in published chemotherapy administration safety standards. METHODS: The updated ASCO/ONS standards offered a framework for the University of Wisconsin Carbone Cancer Center to evaluate and improve our practice with the goal of full compliance with these standards. Gap analysis revealed noncompliance with five and partial compliance with eleven standards...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152727/a-prospective-study-of-an-inpatient-febrile-neutropenia-clinical-practice-guideline-in-oncology-patients
#10
Tanya Thomas, Joshua Reuss, Gina Degennaro, Elizabeth Daniels, Jin Li, Mark Smolkin, Michael Kenneth Keng
: 114 Background: Febrile neutropenia (FN) is a common complication in oncology patients and is associated with significant morbidity and mortality if untreated. Because of this, it is regarded as a medical emergency. FN treatment guidelines universally recommend the prompt initiation ( < 60 minutes) of intravenous antibiotic therapy. We hypothesized that a quality initiative project creating a new FN clinical practice guideline (CPG) would reduce the time to antibiotic administration (TTA) for inpatient oncology patients with FN...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152683/hiv-testing-in-a-cancer-center-emergency-department
#11
Kelly W Merriman, Zeena Shelal, Hadil Bazerbashi, Patricia A Brock, Carmen E Gonzalez, Harrys A Torres, Terry Rice
: 225 Background: HIV is a cancer-associated virus classically associated with KS, NHL, and cervical cancer, but more recently with anal cancer, lung, and head and neck cancers. HIV testing and treatment are important for cancer patients for three reasons: 1) HIV treatment is associated with reduced transmission of a cancer-associated virus. 2) HIV treatment is associated with improved outcomes of cancer therapy in many cancers. 3) HIV testing optimizes quality of care, since testing is recommended by the Centers for Disease Control and Prevention (CDC) and the US Preventive Services Task Force (USPSTF)(A level recommendation) for patients between the ages of 15 and 65 years of age...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28147424/rehabilitation-after-cardiac-arrest-integration-of-neurologic-and-cardiac-rehabilitation
#12
Liesbeth W Boyce, Paulien H Goossens
Cognitive impairments are common after resuscitation. Severe cognitive impairments are easily recognized. Mild cognitive impairments are much more difficult to spot. Given the influence of cognitive problems in daily functioning, it is important to identify cognitive impairments at an early stage. Also, emotional problems, mainly depression and fear, are common in this group of patients. To optimize the care for patients after an out-of-hospital cardiac arrest, rehabilitation should focus on the physical approach through cardiac rehabilitation and on brain injury and associated cognitive impairments...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28126530/use-of-clinical-decision-support-to-increase-premedication-regimen-homogeneity
#13
John C Benson, Alexander M McKinney, Paul Hines, Zeke McKinney
PURPOSE: Patients with prior allergic reactions to iodinated contrast require premedication. This study aimed to increase the homogeneity of premedication orders in such patients. METHODS: A point-of-care (POC) clinical decision support (CDS) alert accompanied by an order set was implemented in the electronic health record (EHR) to notify providers of a prior allergic reaction upon ordering an examination involving iodinated contrast. Premedication regimens were retrospectively compared 11 months pre- and 11 months post-alert implementation, with the different regimens being classified as follows: (1) "preferred" (per ACR recommendations), (2) "nonpreferred" (corticosteroid administered <24 hours before examination, but not per ACR recommendations), or (3) "no premedication...
January 23, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28077045/association-of-time-to-antibiotics-and-clinical-outcomes-in-adult-hematologic-malignancy-patients-with-febrile-neutropenia
#14
Allison R Butts, Christina Carracedo Bachmeier, Emily V Dressler, Meng Liu, Ann Cowden, Jeff Talbert, Val R Adams
Objective The objective of this study was to determine the clinical impact of time to antibiotic administration in adult inpatients who have hematologic malignancies and develop febrile neutropenia. Methods A retrospective chart review was conducted to screen for all febrile neutropenia events amongst adult hematologic malignancy patients between 1 January 2010 and 1 September 2014. All included patients were admitted to the hospital at the time of fever onset, having been admitted for a diagnosis other than febrile neutropenia...
January 1, 2017: Journal of Oncology Pharmacy Practice
https://www.readbyqxmd.com/read/28068437/association-between-early-lactate-levels-and-30-day-mortality-in-clinically-suspected-sepsis-in-children
#15
Halden F Scott, Lina Brou, Sara J Deakyne, Allison Kempe, Diane L Fairclough, Lalit Bajaj
Importance: Improving emergency care of pediatric sepsis is a public health priority, but optimal early diagnostic approaches are unclear. Measurement of lactate levels is associated with improved outcomes in adult septic shock, but pediatric guidelines do not endorse its use, in part because the association between early lactate levels and mortality is unknown in pediatric sepsis. Objective: To determine whether the initial serum lactate level is associated with 30-day mortality in children with suspected sepsis...
January 9, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28000331/exploring-the-potential-role-of-the-advanced-nurse-practitioner-within-a-care-path-for-patients-with-chronic-fatigue-syndrome
#16
Hannah Ryckeghem, Liesbeth Delesie, Els Tobback, Stefaan Lievens, Dirk Vogelaers, An Mariman
AIMS: To explore the experiences and expectations of patients with chronic fatigue syndrome and general practitioners to develop the potential role of an advanced nurse practitioner at the diagnostic care path of abnormal fatigue developed for regional transmural implementation in the Belgian provinces of East and West Flanders. BACKGROUND: Patients with chronic fatigue syndrome experience an incapacitating chronic fatigue that is present for at least 6 months. Since many uncertainties exist about the causes and progression of the disease, patients have to cope with disbelief and scepticism...
December 21, 2016: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/27989196/structure-and-magnetic-properties-of-kruo4
#17
Casey A Marjerrison, Cole Mauws, Arzoo Z Sharma, Christopher R Wiebe, Shahab Derakhshan, Chad Boyer, Bruce D Gaulin, John E Greedan
The crystal structure of KRuO4 is refined at both 280 and 3.5 K from neutron powder data, and magnetic properties are reported for the first time. The scheelite structure, I41/a, is confirmed at both temperatures. Atomic positions of greater accuracy than the original 1954 X-ray study are reported. The rare Ru(7+) ion resides in a site of distorted tetrahedral symmetry with nominal electronic configuration 4d(1)(e(1)). Curie-Weiss parameters are near free ion values for the effective moment and θ = -77 K, indicating dominant antiferromagnetic (AF) correlations...
December 19, 2016: Inorganic Chemistry
https://www.readbyqxmd.com/read/27940668/reliable-pregnancy-testing-before-intravenous-cyclophosphamide-a-quality-improvement-study
#18
Kristen Hayward, Wren L Haaland, Jennifer Hrachovec, Michael Leu, Surabhi Vora, Holly Clifton, Nanci Rascoff, Claudia S Crowell
BACKGROUND AND OBJECTIVE: Cyclophosphamide is a teratogenic medication used in the treatment of adolescents with autoimmune disorders. This adolescent population is sexually active, does not receive adequate contraceptive care, and is at risk for unintended pregnancy. We undertook a quality improvement initiative to improve rates of pregnancy screening before intravenous cyclophosphamide administration in our adolescent girl patients. METHODS: Data were collected from the electronic medical record...
December 2016: Pediatrics
https://www.readbyqxmd.com/read/27936990/improving-postpartum-glucose-monitoring-in-women-with-gestational-diabetes
#19
Marti D Soffer, S H Factor, A Rosenman, C Levy, J Stone
OBJECTIVE: To improve 6-week postpartum visit attendance, glucose test ordering, and test completion among postpartum patients with a history of gestational diabetes (GDM). METHODS: Pre- and post-intervention GDM women at Mount Sinai were studied via chart review. Interventions included advanced order sets for glucose monitoring at the 35-week pregnancy visit, educational modules, and nutritionist phone calls reminding patients to attend postpartum visits fasting...
December 11, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27936934/pathtimex-joint-inference-of-mutually-exclusive-cancer-pathways-and-their-progression-dynamics
#20
Simona Cristea, Jack Kuipers, Niko Beerenwinkel
High-throughput sequencing technologies have facilitated the generation of an unprecedented amount of genomic cancer data, opening the way to a more profound understanding of tumorigenesis. In this endeavor, two fundamental questions have emerged, namely (1) which alterations drive tumor progression and (2) in which order do they occur? Answering these questions is crucial for therapeutic decisions involving targeted agents. Because of interpatient heterogeneity, progression at the level of pathways is more reproducible than progression at the level of single genes...
December 12, 2016: Journal of Computational Biology: a Journal of Computational Molecular Cell Biology
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