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Biomedical subjects

N L Greengold

Publications and source records attributed to N L Greengold.

16 recordsLinked to original sources
PubMed2001

Ultrasonography performed by primary care residents for abdominal aortic aneurysm screening.

A prospective pilot study was undertaken to assess a protocol to educate primary care residents in how to personally perform ultrasonography for abdominal aortic aneurysm screening. Resident exams were proctored by a primary care physician trained in ultrasonography and were scored on the level of competence in doing the examination. Patients had ultrasound performed by a resident, followed by repeat examination by the vascular lab. Primary care resident abdominal aortic imaging was achieved in 79 of 80 attempts. Four abdominal aortic aneurysms were identified. There were 75 normal examinations; resident ultrasonography results were consistent with the results of the vascular lab. Ten residents achieved an abdominal aortic ultrasound-independent competence level after an average of 3.4 proctored exams. The main outcome of this study is that a primary care resident, with minimal training in ultrasonography imaging, is able to rapidly learn the technique of ultrasonography imaging of the abdominal aorta.

Aortic Aneurysm, Abdominal↗
PubMed1999

On the road.

Explore the source record for details and available documents.

Job Satisfaction↗
PubMed1997

The relation between systematic reviews and practice guidelines.

Clinical practice guidelines have been developed to improve the process and outcomes of health care and to optimize resource utilization. By addressing such issues as prevention, diagnosis, and treatment, they can aid in health care decision making at many levels. Several other decision aids are cast in the guideline lexicon, regardless of their focus, formulation, or format; this can foster misunderstanding of the term "guideline." Whether created or adapted locally or nationally, most guidelines are an amalgam of clinical experience, expert opinion, and research evidence. Approaches to practice guideline development vary widely. Given the resources required to identify all relevant primary studies, many guidelines rely on systematic reviews that were either previously published or created de novo by guideline developers. Systematic reviews can aid in guideline development because they involve searching for, selecting, critically appraising, and summarizing the results of primary research. The more rigorous the review methods used and the higher the quality of the primary research that is synthesized, the more evidence-based the practice guideline is likely to be. Summaries of relevant research incorporated into guideline documents can help to keep practitioners up to date with the literature. Systematic reviews have also been published on the dissemination and implementation strategies most likely to change clinician behavior and improve patient outcomes. These can be useful in more effectively translating research evidence into practice.

Evidence-Based Medicine↗
PubMed1996

Developing evidence-based practice guidelines and pathways: the experience at the local hospital level.

BACKGROUND: Using an evidence-based approach to developing clinical practice guidelines at the local level promotes implementation by clinicians. In 1994 Cedars-Sinai Health System embarked on a joint project with VHA, Inc, to pilot test a software program, Clinical Cost-Reduction System (CCRS), featuring length-of-stay guidelines for low-risk patients with specific conditions. Data currently are being collected on the effect of the software on length-of-stay reductions and other important patient outcomes. THE NEED FOR A MORE COMPREHENSIVE SOFTWARE PROGRAM: To involve clinicians more actively in the development of guidelines, Cedars-Sinai sought to develop a software system for presenting organized medical information to hospitals interested in designing their own evidence-based clinical pathways. DEVELOPING THE CLINICAL PATHWAY CONSTRUCTOR (CPC): The CPC is a computerized grid for writing clinical pathways, backed by a database of information for select clinical conditions and categories of care. Multidisciplinary teams are to review the evidence presented in the database and then determine those guidelines they wish to encode into an actual pathway, which can then be printed out. The decision regarding which guidelines to use and which not to use rests entirely with the team designing a pathway; the program is intended to aid the team in developing appropriate guidelines that are evidence based, not to legislate guidelines. Data on the "portability" of the program are still being collected. SEARCHING AND SUMMARIZING THE LITERATURE: There are many challenges involved in searching, summarizing, and classifying the medical literature.

Cost Control↗
PubMedDate not supplied

Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association.

OBJECTIVE: To establish, in a single resource, up-to-date recommendations for primary care physicians regarding prevention strategies for a first stroke. PARTICIPANTS: Members of the National Stroke Association's (NSA's) Stroke Prevention Advisory Board and Cedars-Sinai Health System Department of Health Services Research convened on April 9, 1998, in an open meeting. The conference attendees, selected to participate by the NSA, were recognized experts in neurology (9), cardiology (2), family practice (1), nursing (1), physician assistant practices (1), and health services research (2). EVIDENCE: A literature review was carried out by the Department of Health Services Research, Cedars-Sinai Health System, Los Angeles, Calif, using the MEDLINE database search for 1990 through April 1998 and updated in November 1998. English-language guidelines, statements, meta-analyses, and overviews on prevention of a first stroke were reviewed. CONSENSUS PROCESS: At the meeting, members of the advisory board identified 6 important stroke risk factors (hypertension, myocardial infarction [MI], atrial fibrillation, diabetes mellitus, blood lipids, asymptomatic carotid artery stenosis), and 4 lifestyle factors (cigarette smoking, alcohol use, physical activity, diet). CONCLUSIONS: Several interventions that modify well-documented and treatable cardiovascular and cerebrovascular risk factors can reduce the risk of a first stroke. Good evidence for direct stroke reduction exists for hypertension treatment; using warfarin for patients after MI who have atrial fibrillation, decreased left ventricular ejection fraction, or left ventricular thrombus; using 3-hydroxy-3 methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors for patients after MI; using warfarin for patients with atrial fibrillation and specific risk factors; and performing carotid endarterectomy for patients with stenosis of at least 60%. Observational studies support the role of modifying lifestyle-related risk factors (eg, smoking, alcohol use, physical activity, diet) in stroke prevention. Measures to help patients improve adherence are an important component of a stroke prevention plan.

Alcohol Drinking↗