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Clinical practice guidelines in the emergency room

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https://www.readbyqxmd.com/read/29130608/impact-of-web-based-clinical-practice-guidelines-on-paediatric-fracture-clinics
#1
Mark W Camp, James R Barnes, Mohita Damany, Leo T Donnan
BACKGROUND: In an effort to standardize management and reduce over-treatment of uncomplicated paediatric fractures, the Victorian Pediatric Orthopaedic Network and the Royal Children's Hospital, Melbourne, created publically available web-based paediatric fracture pathways. The aim of this study was to determine the impact of web-based fracture pathways on the clinic volume at a tertiary-care paediatric fracture clinic. METHODS: A comparative retrospective review was performed at a large, urban, tertiary-care children's hospital...
November 12, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29068170/antidote-availability-in-saudi-arabia-hospitals-in-the-riyadh-province
#2
Abdullah AlTamimi, Nidal K Malhis, Najla M Khojah, Saleh A Manea, Abdulrahman AlTamimi, Sami Ayed AlShammary
Inadequate antidote stocking is a global problem in hospitals. Insufficient supplies and delays in the administration of antidotes could lead to death and additional potentially negative clinical consequences. Our objective was to determine the availability of antidotes in hospitals listed on the Saudi Ministry of Health website in the Riyadh Province and to evaluate the leading poison in Saudi Arabia. A cross-sectional study was conducted using questionnaires. The questionnaires were distributed to pharmacist directors and emergency room-treating physicians in 17 public hospitals throughout the Riyadh Province...
October 25, 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/29018076/protocol-for-a-prospective-interventional-trial-to-develop-a-diagnostic-index-test-for-stroke-as-a-cause-of-vertigo-dizziness-and-imbalance-in-the-emergency-room-emvert-study
#3
Ken Möhwald, Stanislavs Bardins, Hans-Helge Müller, Klaus Jahn, Andreas Zwergal
INTRODUCTION: Identifying stroke as a cause of acute vertigo, dizziness and imbalance in the emergency room is still a clinical challenge. Many patients are admitted to stroke units, but only a minority will have strokes. This imposes a heavy financial burden on the healthcare system. The aim of this study is to develop a diagnostic index test to identify patients with a high risk of having a stroke as the cause of acute vertigo and imbalance. METHODS AND ANALYSIS: Patients with acute onset of vertigo, dizziness, postural imbalance or double vision within the last 24 hours lasting for at least 10 min are eligible to be included in the study...
October 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28844294/cervical-spine-collar-removal-by-emergency-room-nurses-a-quality-improvement-project
#4
Guillaume Fontaine, Massimo Forgione, Francis Lusignan, Marc-André Lanoue, Simon Drouin
INTRODUCTION: The Canadian C-Spine Rule (CCR) is a clinical decision aid to facilitate the safe removal of cervical collars in the alert, orientated, low-risk adult trauma patient. Few health care settings have assessed initiatives to train charge nurses to use the CCR. This practice improvement project conducted in a secondary trauma center in Canada aimed to (1) train charge nurses of the emergency room to use the CCR, (2) monitor its use throughout the project period, and (3) compare the assessments of the charge nurses with those of emergency physicians...
August 22, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28830854/a-mobile-device-app-to-reduce-medication-errors-and-time-to-drug-delivery-during-pediatric-cardiopulmonary-resuscitation-study-protocol-of-a-multicenter-randomized-controlled-crossover-trial
#5
Johan N Siebert, Frederic Ehrler, Christian Lovis, Christophe Combescure, Kevin Haddad, Alain Gervaix, Sergio Manzano
BACKGROUND: During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusions is complex and time-consuming. The need for individual specific weight-based drug dose calculation and preparation places children at higher risk than adults for medication errors. Following an evidence-based and ergonomic driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion...
August 22, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28813753/pre-guideline-trends-associated-with-chest-radiograph-usage-for-pediatric-community-acquired-pneumonia-in-emergency-department-settings
#6
Eric W Jones, Benjamin Meyer, Aaron M Berg, Benson S Hsu
BACKGROUND: Health care spending in the U.S. totaled $3 trillion in 2014 and continues to increase rapidly. Minimizing waste through clinical guidelines is a promising strategy to reduce spending without compromising patient care. In 2011, clinical guidelines recommended against the use of chest X-ray (CXR) for diagnosis of community-acquired pneumonia (CAP) in pediatric ambulatory settings. However, use of CXR has not changed post-guideline. Thus, understanding the drivers of CXR utilization prior to guideline implementation could improve guideline adherence...
May 2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28754601/magnesium-sulfate-infusion-for-acute-asthma-in-the-emergency-department
#7
REVIEW
Jose Enrique Irazuzta, Nicolas Chiriboga
OBJECTIVES: To describe the role of intravenous magnesium sulfate (MgSO4) as therapy for acute severe asthma in the pediatric emergency department (ED). SOURCE: Publications were searched in the PubMed and Cochrane databases using the following keywords: magnesium AND asthma AND children AND clinical trial. A total of 53 publications were retrieved using this criteria. References of relevant articles were also screened. The authors included the summary of relevant publications where intravenous magnesium sulfate was studied in children (age <18 years) with acute asthma...
November 2017: Jornal de Pediatria
https://www.readbyqxmd.com/read/28730847/canadian-guidelines-for-the-assessment-and-diagnosis-of-patients-with-schizophrenia-spectrum-and-other-psychotic-disorders
#8
Donald Addington, Sabina Abidi, Iliana Garcia-Ortega, William G Honer, Zahinoor Ismail
OBJECTIVE: The objective of this article is to identify best practices in the diagnosis and assessment of patients with schizophrenia spectrum and other psychotic disorders. The diagnosis and assessment may occur in a range of situations from the emergency room to the outpatient clinic and at different stages of the disorder. The focus may be on acute exacerbations of illness, residual symptoms, levels of function, or changes in the response to treatment. METHODS: A systematic search was conducted for guidelines published in the last 5 years for schizophrenia and schizophrenia spectrum disorders...
September 2017: Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
https://www.readbyqxmd.com/read/28570379/promoting-evidence-based-practice-at-a-primary-stroke-center-a-nurse-education-strategy
#9
Christina Anne Case
BACKGROUND: Promoting a culture of evidence-based practice within a health care facility is a priority for health care leaders and nursing professionals; however, tangible methods to promote translation of evidence to bedside practice are lacking. OBJECTIVES: The purpose of this quality improvement project was to design and implement a nursing education intervention demonstrating to the bedside nurse how current evidence-based guidelines are used when creating standardized stroke order sets at a primary stroke center, thereby increasing confidence in the use of standardized order sets at the point of care and supporting evidence-based culture within the health care facility...
July 2017: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/28465716/acute-care-surgery-a-means-for-providing-cost-effective-quality-care-for-gallstone-pancreatitis
#10
Patrick B Murphy, Dave Paskar, Richard Hilsden, Jennifer Koichopolos, Tina S Mele
BACKGROUND: Modern practice guidelines recommend index cholecystectomy (IC) for patients admitted with gallstone pancreatitis (GSP). However, this benchmark has been difficult to widely achieve. Previous work has demonstrated that dedicated acute care surgery (ACS) services can facilitate IC. However, the associated financial costs and economic effectiveness of this intervention are unknown and represent potential barriers to ACS adoption. We investigated the impact of an ACS service at two hospitals before and after implementation on cost effectiveness, patient quality-adjusted life years (QALY) and impact on rates of IC...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28321299/successful-emergency-department-interventions-that-reduce-time-to-antibiotics-in-febrile-pediatric-cancer-patients
#11
Sandra Spencer, MIchele Nypaver, Katherine Hebert, Christopher Benner, Rachel Stanley, Daniel Cohen, Alexander Rogers, Jason Goldstick, Prashant Mahajan
Children with cancer and fever are at high risk for sepsis related death. Rapid antibiotic delivery (< 60 minutes) has been shown to reduce mortality. We compared patient outcomes and describe interventions from three separate quality improvement (QI) projects conducted in three United States (US) tertiary care pediatric emergency departments (EDs) with the shared aim to reduce time to antibiotic (TTA) to < 60 minutes in febrile pediatric oncology patients (Temperature > 38.0 C). A secondary objective was to identify interventions amenable to translation to other centers...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28188188/locally-advanced-colon-cancer-evaluation-of-current-clinical-practice-and-treatment-outcomes-at-the-population-level
#12
Charlotte E L Klaver, Lieke Gietelink, Willem A Bemelman, Michel W J M Wouters, Theo Wiggers, Rob A E M Tollenaar, Pieter J Tanis
Background: The goal of this study was to evaluate current clinical practice and treatment outcomes regarding locally advanced colon cancer (LACC) at the population level. Methods: Data were used from the Dutch Surgical Colorectal Audit from 2009 to 2014. A total of 34,527 patients underwent resection for non-LACC and 6,918 for LACC, which was defined as cT4 and/or pT4 stage. LACC was divided into those with multivisceral resection (LACC-MV; n=3,385) and without (LACC-noMV; n=1,595). Guideline adherence, treatment strategy, and short-term outcomes were evaluated...
February 2017: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/28125373/health-care-resource-utilization-and-costs-in-patients-with-chronic-myeloid-leukemia-with-better-adherence-to-tyrosine-kinase-inhibitors-and-increased-molecular-monitoring-frequency
#13
Dominick Latremouille-Viau, Annie Guerin, Patrick Gagnon-Sanschagrin, Katherine Dea, Benjamin G Cohen, George J Joseph
BACKGROUND: Frequent molecular monitoring (qPCR tests), as recommended by evidence-based monitoring guidelines, is associated with higher adherence to tyrosine kinase inhibitors (TKIs) in the management of chronic myeloid leukemia (CML); both factors have been associated with better clinical and economic outcomes. OBJECTIVES: To (a) estimate the effect of more frequent qPCR tests on health care resource utilization (HRU) and associated costs, including direct (effect of qPCR test frequency on HRU) and indirect (through TKI adherence) effects, and (b) develop an economic model applicable to multiple clinical practice scenarios...
February 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27852427/monitoring-the-hospital-management-of-acute-asthma-the-italian-pediatric-network-experience
#14
A G Martelli, R Bianchi, B Boldrighini, M Bosoni, A De Vuono, A Flores D'Arcais, G Gargantini, R Longhi, M T Ortisi, E Racchi, L Parola
BACKGROUND: The Study Group on Accreditation and Quality Improvement of the Italian Society of Pediatrics has developed an observational study about the hospital management of pediatric patients affected by severe asthma, in order to evaluate how the Guidelines for severe asthma in childhood are applied in the daily practice. METHODS: This study included patients between 2 and 17 years, hospitalized or under short intensive observation for acute asthma. The data collection was carried out through the compilation of on-line forms...
November 2016: European Annals of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/27777546/pre-burn-centre-management-of-the-airway-in-patients-with-face-burns
#15
D Costa Santos, F Barros, M Frazão, M Maia
Face burns expose patients to a higher respiratory risk, and early prophylactic intubation before they enter the burn unit might be life-saving. However, unnecessary intubation may compromise their clinical evolution. Hence, the decision to perform pre-burn centre endotracheal intubation remains a clinical challenge. A retrospective study was developed to characterize the experience of the tertiary burn unit of the Hospital da Prelada with face burn patients arriving endotracheally-intubated between January 2009 and September 2013...
December 31, 2015: Annals of Burns and Fire Disasters
https://www.readbyqxmd.com/read/27662389/effects-of-antibiotic-timing-on-culture-results-and-clinical-outcomes-in-pediatric-musculoskeletal-infection
#16
Michael A Benvenuti, Thomas J An, Megan E Mignemi, Jeffrey E Martus, Isaac P Thomsen, Jonathan G Schoenecker
INTRODUCTION: Musculoskeletal infection (MSI) is a common cause of morbidity and hospital resource utilization in the pediatric population. Many physicians prefer to withhold antibiotics until tissue cultures can be taken in an effort to improve culture yields. However, there is little evidence that this practice improves culture results or outcomes in pediatric MSI. Therefore, investigating the effects of antibiotic timing may lead to improved clinical practice guidelines for treating children with MSI...
September 22, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/27604617/12th-winfocus-world-congress-on-ultrasound-in-emergency-and-critical-care
#17
Yahya Acar, Onur Tezel, Necati Salman, Erdem Cevik, Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-Bordomás, Mustafa Z Mahmoud, Abdelmoneim Sulieman, Abbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H Lester Kirchner, Gregor Prosen, Ajda Anzic, Paul Leeson, Maryam Bahreini, Fatemeh Rasooli, Houman Hosseinnejad, Gabriel Blecher, Robert Meek, Diana Egerton-Warburton, Edina Ćatić Ćuti, Stanko Belina, Tihomir Vančina, Idriz Kovačević, Nadan Rustemović, Ikwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun Kim, Chi-Yung Cheng, Hsiu-Yung Pan, Chia-Te Kung, Ela Ćurčić, Ena Pritišanac, Ivo Planinc, Marijana Grgić Medić, Radovan Radonić, Abiola Fasina, Anthony J Dean, Nova L Panebianco, Patricia S Henwood, Oliviero Fochi, Moreno Favarato, Ezio Bonanomi, Ivan Tomić, Youngrock Ha, Hongchuen Toh, Elizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Angela Hua, Sharon Kim, James Tsung, Isa Gunaydin, Zeynep Kekec, Mehmet Oguzhan Ay, Jinjoo Kim, Jinhyun Kim, Gyoosung Choi, Dowon Shim, Ji-Han Lee, Jana Ambrozic, Katja Prokselj, Miha Lucovnik, Gabrijela Brzan Simenc, Asta Mačiulienė, Almantas Maleckas, Algimantas Kriščiukaitis, Vytautas Mačiulis, Andrius Macas, Sharad Mohite, Zoltan Narancsik, Hugon Možina, Sara Nikolić, Jan Hansel, Rok Petrovčič, Una Mršić, Simon Orlob, Markus Lerchbaumer, Niklas Schönegger, Reinhard Kaufmann, Chun-I Pan, Chien-Hung Wu, Sarah Pasquale, Stephanie J Doniger, Sharon Yellin, Gerardo Chiricolo, Maja Potisek, Borut Drnovšek, Boštjan Leskovar, Kristine Robinson, Clara Kraft, Benjamin Moser, Stephen Davis, Shelley Layman, Yusef Sayeed, Joseph Minardi, Irmina Sefic Pasic, Amra Dzananovic, Anes Pasic, Sandra Vegar Zubovic, Ana Godan Hauptman, Ana Vujaklija Brajkovic, Jaksa Babel, Marina Peklic, Vedran Radonic, Luka Bielen, Peh Wee Ming, Nur Hafiza Yezid, Fatahul Laham Mohammed, Zainal Abidin Huda, Wan Nasarudin Wan Ismail, W Yus Haniff W Isa, Hashairi Fauzi, Praveena Seeva, Mohd Zulfakar Mazlan
A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization...
September 2016: Critical Ultrasound Journal
https://www.readbyqxmd.com/read/27583928/effect-of-opioid-prescribing-guidelines-in-primary-care
#18
Jonathan H Chen, Jason Hom, Ilana Richman, Steven M Asch, Tanya Podchiyska, Nawal Atwan Johansen
Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting.A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education...
August 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27475878/the-room-where-it-happens-a-skeptic-s-analysis-of-the-new-heart-failure-guidelines
#19
Milton Packer
New heart failure guidelines have been issued during the past several months, both in the United States and in Europe, in response to recent advances in and the approval of new drugs for the treatment of heart failure. Although guidelines documents are often viewed as authoritative and purely evidence-based, there are replete with meaningful (and inexplicable) inconsistencies, which derive from a review of the same body of scientific data by different groups. This satirical review highlights several examples of the entertaining foolishness of recent guideline documents in the good-natured hope that physicians will understand what the guidelines are, and more importantly, what they are not...
September 2016: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/27318182/shoulder-dystocia-guidelines-for-clinical-practice-from-the-french-college-of-gynecologists-and-obstetricians-cngof
#20
REVIEW
Loïc Sentilhes, Marie-Victoire Sénat, Anne-Isabelle Boulogne, Catherine Deneux-Tharaux, Florent Fuchs, Guillaume Legendre, Camille Le Ray, Emmanuel Lopez, Thomas Schmitz, Véronique Lejeune-Saada
Shoulder dystocia (SD) is defined as a vaginal delivery in cephalic presentation that requires additional obstetric maneuvers to deliver the fetus after the head has delivered and gentle traction has failed. It complicates 0.5-1% of vaginal deliveries. Risks of brachial plexus birth injury (level of evidence [LE]3), clavicle and humeral fracture (LE3), perinatal asphyxia (LE2), hypoxic-ischemic encephalopathy (LE3) and perinatal mortality (LE2) increase with SD. Its main risk factors are previous SD and macrosomia, but both are poorly predictive; 50-70% of SD cases occur in their absence, and most deliveries when they are present do not result in SD...
August 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
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