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Triage theory

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https://www.readbyqxmd.com/read/29548304/coordinating-resources-for-prospective-medication-risk-management-of-older-home-care-clients-in-primary-care-procedure-development-and-rct-study-design-for-demonstrating-its-effectiveness
#1
Terhi Toivo, Maarit Dimitrow, Juha Puustinen, Eeva Savela, Katariina Pelkonen, Valtteri Kiuru, Tuula Suominen, Sirkka Kinnunen, Mira Uunimäki, Sirkka-Liisa Kivelä, Saija Leikola, Marja Airaksinen
BACKGROUND: The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. METHODS: Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy...
March 16, 2018: BMC Geriatrics
https://www.readbyqxmd.com/read/29543847/expectations-of-medical-specialists-about-image-based-teleconsultation-a-qualitative-study-on-acute-burns-in-south-africa
#2
Lisa Blom, Lucie Laflamme, Helle Mölsted Alvesson
BACKGROUND: Image-based teleconsultation between medical experts and healthcare staff at remote emergency centres can improve the diagnosis of conditions which are challenging to assess. One such condition is burns. Knowledge is scarce regarding how medical experts perceive the influence of such teleconsultation on their roles and relations to colleagues at point of care. METHODS: In this qualitative study, semi-structured interviews were conducted with 15 medical experts to explore their expectations of a newly developed App for burns diagnostics and care prior to its implementation...
2018: PloS One
https://www.readbyqxmd.com/read/29455699/existing-approaches-to-chemical-biological-radiological-and-nuclear-cbrn-education-and-training-for-health-professionals-findings-from-an-integrative-literature-review
#3
Mayumi Kako, Karen Hammad, Satoko Mitani, Paul Arbon
OBJECTIVES: This review was conducted to explore the literature to determine the availability, content, and evaluation of existing chemical, biological, radiological, and nuclear (CBRN) education programs for health professionals. METHODS: An integrative review of the international literature describing disaster education for CBRN (2004-2016) was conducted. The following relevant databases were searched: Proquest, Pubmed, Science Direct, Scopus, Journals @ OVID, Google Scholar, Medline, and Ichuschi ver...
April 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29110667/a-complex-intervention-to-improve-implementation-of-world-health-organization-guidelines-for-diagnosis-of-severe-illness-in-low-income-settings-a-quasi-experimental-study-from-uganda
#4
Matthew J Cummings, Elijah Goldberg, Savio Mwaka, Olive Kabajaasi, Eric Vittinghoff, Adithya Cattamanchi, Achilles Katamba, Nathan Kenya-Mugisha, Shevin T Jacob, J Lucian Davis
BACKGROUND: To improve management of severely ill hospitalized patients in low-income settings, the World Health Organization (WHO) established a triage tool called "Quick Check" to provide clinicians with a rapid, standardized approach to identify patients with severe illness based on recognition of abnormal vital signs. Despite the availability of these guidelines, recognition of severe illness remains challenged in low-income settings, largely as a result of infrequent vital sign monitoring...
November 6, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28793374/pain-assessment-by-emergency-nurses-at-triage-in-the-emergency-department-a-qualitative-study
#5
Marilène Vuille, Maryline Foerster, Eliane Foucault, Olivier Hugli
AIMS AND OBJECTIVES: To investigate the assessment of pain intensity in the specific context of triage. BACKGROUND: Acute pain affects most patients admitted to emergency departments, but pain relief in this setting remains insufficient. Evaluation of pain and its treatment at the time of patient triage expedites the administration of analgesia, but may be awkward at this time-pressured moment. The assessment of pain intensity by a validated pain scale is a critical initial step, and a patient's self-reporting is widely considered as the key to effective pain management...
February 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28768680/improving-specialist-palliative-care-in-residential-care-for-older-people-a-checklist-to-guide-practice
#6
Liz Forbat, Michael Chapman, Clare Lovell, Wai-Man Liu, Nikki Johnston
OBJECTIVES: Palliative care needs rounds are triage meetings that have been introduced in residential care for older adults to help identify and prioritise care for people most at risk for unplanned dying with inadequately controlled symptoms. This study sought to generate an evidence-based checklist in order to support specialist palliative care clinicians integrate care in residential nursing homes for older people. METHODS: A grounded theory ethnographic study, involving non-participant observation and qualitative interviews...
August 2, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28727521/ethical-guidance-for-disaster-response-specifically-around-crisis-standards-of-care-a-systematic-review
#7
REVIEW
Jonathon P Leider, Debra DeBruin, Nicole Reynolds, Angelica Koch, Judy Seaberg
BACKGROUND: Terrorism, disease outbreaks, and other natural disasters and mass casualty events have pushed health care and public health systems to identify and refine emergency preparedness protocols for disaster response. Ethical guidance, alongside legal and medical frameworks, are increasingly common components of disaster response plans. OBJECTIVES: To systematically review the prevalence and content of ethical guidance offered for disaster response, specifically around crisis standards of care (CSCs)...
September 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/28716152/development-of-a-theory-informed-implementation-intervention-to-improve-the-triage-treatment-and-transfer-of-stroke-patients-in-emergency-departments-using-the-theoretical-domains-framework-tdf-the-t-3-trial
#8
Louise E Craig, Natalie Taylor, Rohan Grimley, Dominique A Cadilhac, Elizabeth McInnes, Rosemary Phillips, Simeon Dale, Denise O'Connor, Chris Levi, Mark Fitzgerald, Julie Considine, Jeremy M Grimshaw, Richard Gerraty, N Wah Cheung, Jeanette Ward, Sandy Middleton
BACKGROUND: Theoretical frameworks and models based on behaviour change theories are increasingly used in the development of implementation interventions. Development of an implementation intervention is often based on the available evidence base and practical issues, i.e. feasibility and acceptability. The aim of this study was to describe the development of an implementation intervention for the T(3) Trial (Triage, Treatment and Transfer of patients with stroke in emergency departments (EDs)) using theory to recommend behaviour change techniques (BCTs) and drawing on the research evidence base and practical issues of feasibility and acceptability...
July 17, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28689048/the-impact-of-hypothermia-on-serum-potassium-concentration-a-systematic-review
#9
REVIEW
Sarah Buse, Marc Blancher, Damien Viglino, Mathieu Pasquier, Maxime Maignan, Pierre Bouzat, Thorsten Annecke, Guillaume Debaty
BACKGROUND: Blood potassium is the main prognostic biomarker used for triage in hypothermic cardiac arrest. The aim of this review was to assess the impact of hypothermia on blood potassium levels and compare the underlying pathophysiological theories. METHODS: The Medline electronic database was searched via PubMed for articles published from January 1970 to December 2016. The search strategy included studies related to hypothermia and potassium levels. The relevant literature on clinical studies and experimental studies was reviewed by the authors...
September 2017: Resuscitation
https://www.readbyqxmd.com/read/28625711/why-parents-seek-care-for-acute-illness-in-the-clinic-or-the-ed-the-role-of-health-literacy
#10
Meghan May, David C Brousseau, David A Nelson, Kathryn E Flynn, Michael S Wolf, Bryn Lepley, Andrea K Morrison
OBJECTIVE: To explore the decision to seek care and decision-making regarding location of care among parents with low and adequate health literacy. METHODS: Parents of children 8 years old or younger who presented for 'sick child' visits at a clinic or a nonurgent emergency department (ED) visit (triage level 5) were interviewed. The Newest Vital Sign was used to categorize parental health literacy. Interviewers followed a semistructured interview guide to understand: 1) care-seeking for current illness, and 2) choice of clinic or ED...
June 16, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/27835981/testing-a-videogame-intervention-to-recalibrate-physician-heuristics-in-trauma-triage-study-protocol-for-a-randomized-controlled-trial
#11
RANDOMIZED CONTROLLED TRIAL
Deepika Mohan, Matthew R Rosengart, Baruch Fischhoff, Derek C Angus, Coreen Farris, Donald M Yealy, David J Wallace, Amber E Barnato
BACKGROUND: Between 30 and 40 % of patients with severe injuries receive treatment at non-trauma centers (under-triage), largely because of physician decision making. Existing interventions to improve triage by physicians ignore the role that intuition (heuristics) plays in these decisions. One such heuristic is to form an initial impression based on representativeness (how typical does a patient appear of one with severe injuries). We created a video game (Night Shift) to recalibrate physician's representativeness heuristic in trauma triage...
November 11, 2016: BMC Emergency Medicine
https://www.readbyqxmd.com/read/27756434/triage-treatment-and-transfer-of-patients-with-stroke-in-emergency-department-trial-the-t-3-trial-a-cluster-randomised-trial-protocol
#12
RANDOMIZED CONTROLLED TRIAL
Sandy Middleton, Chris Levi, Simeon Dale, N Wah Cheung, Elizabeth McInnes, Julie Considine, Catherine D'Este, Dominique A Cadilhac, Jeremy Grimshaw, Richard Gerraty, Louise Craig, Verena Schadewaldt, Patrick McElduff, Mark Fitzgerald, Clare Quinn, Greg Cadigan, Sonia Denisenko, Mark Longworth, Jeanette Ward
BACKGROUND: Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T3 ) of patients with acute stroke to improve 90-day death and dependency...
October 18, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27735929/international-variations-in-application-of-the-best-interest-standard-across-the-age-spectrum
#13
N Laventhal, A A E Verhagen, T W R Hansen, E Dempsey, P G Davis, G A Musante, A Wiles, W Meadow, A Janvier
OBJECTIVE: Ethically and legally, assertions that resuscitation is in a patient's best interest should be inversely correlated with willingness to forego intensive care (and accept comfort care) at the surrogate's request. Previous single country studies have demonstrated a relative devaluation of neonates when compared with other critically ill patients. STUDY DESIGN: In this international study, physicians in Argentina, Australia, Canada, Ireland, The Netherlands, Norway and the United States were presented with eight hypothetical vignettes of incompetent critically ill patients of different ages...
February 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/27712055/discovery-and-characterization-of-allosteric-wnk-kinase-inhibitors
#14
Ken Yamada, Ji-Hu Zhang, Xiaoling Xie, Juergen Reinhardt, Amy Qiongshu Xie, Daniel LaSala, Darcy Kohls, David Yowe, Debra Burdick, Hajime Yoshisue, Hiromichi Wakai, Isabel Schmidt, Jason Gunawan, Kayo Yasoshima, Q Kimberley Yue, Mitsunori Kato, Muneto Mogi, Neeraja Idamakanti, Natasha Kreder, Peter Drueckes, Pramod Pandey, Toshio Kawanami, Waanjeng Huang, Yukiko I Yagi, Zhan Deng, Hyi-Man Park
Protein kinases are known for their highly conserved adenosine triphosphate (ATP)-binding site, rendering the discovery of selective inhibitors a major challenge. In theory, allosteric inhibitors can achieve high selectivity by targeting less conserved regions of the kinases, often with an added benefit of retaining efficacy under high physiological ATP concentration. Although often overlooked in favor of ATP-site directed approaches, performing a screen at high ATP concentration or stringent hit triaging with high ATP concentration offers conceptually simple methods of identifying inhibitors that bind outside the ATP pocket...
December 16, 2016: ACS Chemical Biology
https://www.readbyqxmd.com/read/27603141/acute-gastroenteritis-and-campylobacteriosis-in-swiss-primary-care-the-viewpoint-of-general-practitioners
#15
Philipp J Bless, Joan Muela Ribera, Claudia Schmutz, Andreas Zeller, Daniel Mäusezahl
Acute gastroenteritis (AG) is frequently caused by infectious intestinal diseases (IID) including food- and waterborne pathogens of public health importance. Among these pathogens, Campylobacter spp. plays a major role. Many European countries monitor selected IIDs within disease surveillance systems. In Switzerland, the information on IIDs is restricted to limited surveillance data, while no data is available for AG. We conducted a qualitative study among Swiss general practitioners (GPs) to investigate the case management of AG and campylobacteriosis patients, the associated disease burden and the determinants leading to registration in the National Notification System for Infectious Diseases (NNSID)...
2016: PloS One
https://www.readbyqxmd.com/read/27538946/process-evaluation-for-complex-interventions-in-health-services-research-analysing-context-text-trajectories-and-disruptions
#16
Jamie Murdoch
BACKGROUND: Process evaluations assess the implementation and sustainability of complex healthcare interventions within clinical trials, with well-established theoretical models available for evaluating intervention delivery within specific contexts. However, there is a need to translate conceptualisations of context into analytical tools which enable the dynamic relationship between context and intervention implementation to be captured and understood. METHODS: In this paper I propose an alternative approach to the design, implementation and analysis of process evaluations for complex health interventions through a consideration of trial protocols as textual documents, distributed and enacted at multiple contextual levels...
August 19, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27534740/prediction-and-prevention-of-hypertensive-disorders-of-pregnancy
#17
Akihide Ohkuchi, Chikako Hirashima, Kayo Takahashi, Hirotada Suzuki, Shigeki Matsubara
The most common classifications of hypertensive disorders of pregnancy consist of chronic hypertension, gestational hypertension, preeclampsia (PE) and superimposed PE. A common final pathophysiology of PE is endothelial dysfunction. The most successful translational research model for explaining the cause-effect relationship in the genesis of PE is the angiogenic/angiostatic balance theory, involving soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and soluble endoglin (sEng). In a systematic review of articles on the prediction of early-onset PE using angiogenesis-related factors, we revealed that the prediction of early-onset PE in the first trimester is clinically possible, but the prediction of early-onset PE in the early third trimester might be ideal...
January 2017: Hypertension Research: Official Journal of the Japanese Society of Hypertension
https://www.readbyqxmd.com/read/27532472/experiences-of-adults-with-cystic-fibrosis-in-adhering-to-medication-regimens-a-qualitative-systematic-review
#18
Marilyn Macdonald, Ruth Martin-Misener, Melissa Helwig, Lisa Janette Smith, Christina M Godfrey, Janet Curran, Andrea Murphy
BACKGROUND: Adherence of adults with cystic fibrosis (CF) to medication regimens has been documented as problematic. Research related to adherence from the perspectives of adults with CF has been recommended for a further understanding of adherence. This review synthesized the qualitative evidence on adherence of adults with CF to medication regimens and should be of interest to healthcare providers. REVIEW QUESTION: The question addressed in this review is, what are the experiences and perceptions of adults with CF and their adherence to a medication regimen? TYPES OF PARTICIPANTS: Adults with CF who are maintaining a medication regimen...
May 2016: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/27492901/primary-triage-in-a-mass-casualty-event-possesses-a-risk-of-increasing-informational-confusion-a-simulation-study-using-shannon-s-entropy
#19
Yasuhiko Ajimi, Masaru Sasaki, Yasuyuki Uchida, Ichiro Kaneko, Shinya Nakahara, Tetsuya Sakamoto
UNLABELLED: Introduction Primary triage in a mass-casualty event setting using low-visibility tags may lead to informational confusion and difficulty in judging triage attribution of patients. In this simulation study, informational confusion during primary triage was investigated using a method described in a prior study that applied Shannon's Information Theory to triage. Hypothesis Primary triage using a low-visibility tag leads to a risk of informational confusion in prioritizing care, owing to the intermingling of pre- and post-triage patients...
October 2016: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/27425036/a-simulated-emergency-department-for-medical-students
#20
Patricia Johnson, Victoria Brazil, Éliane Raymond-Dufresne, Tracy Nielson
BACKGROUND: During their training, medical students often undertake a rotation in an emergency department (ED), where they are exposed to a wide variety of patient presentations. Simulation can be an effective teaching strategy to help prepare learners for the realities of the clinical environment. Simulating an ED shift can provide students with the opportunity to perform a range of clinical activities, within their scope of practice, in a supervised and supportive learning environment...
August 2017: Clinical Teacher
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