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PubMed2006

Defining pathways.

AIMS AND BACKGROUND: The term 'clinical pathway' is internationally accepted in all settings of healthcare management. The way in which clinical pathways have been developed in the United Kingdom differs from that in the USA. Besides the international differences in the purpose, many alternative names also can be found. These have led to confusion. There is no single, widely accepted definition of a clinical pathway. The aim of the study was to survey the definitions used in describing the concept and to derive key characteristics of clinical pathways. METHOD: Using the PubMed, we conducted a review of literature published between January 2000 and December 2003 using the following terms: critical pathway, clinical pathway, integrated care pathway, care pathway and care map. All reports reviewed had to use the concept, as defined by the Medical Subject Headings term, to be considered. To assess all definitions, the concept analysis method was used. RESULTS: In 82 of the 263 eligible articles, the definition of pathway was given. Totally, we found 84 different definitions. Each definition was rephrased by taking into consideration the following three features inherent to pathways: nouns, characteristics and aims and outcomes. Every feature was further divided into categories. CONCLUSIONS: A clinical pathway is a method for the patient-care management of a well-defined group of patients during a well-defined period of time. A clinical pathway explicitly states the goals and key elements of care based on Evidence Based Medicine (EBM) guidelines, best practice and patient expectations by facilitating the communication, coordinating roles and sequencing the activities of the multidisciplinary care team, patients and their relatives; by documenting, monitoring and evaluating variances; and by providing the necessary resources and outcomes. The aim of a clinical pathway is to improve the quality of care, reduce risks, increase patient satisfaction and increase the efficiency in the use of resources.

Critical Pathways↗
PubMed1994

Scope for change.

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Cerebral Palsy↗
PubMed1997

Design of hollow fiber modules for uniform shear elution affinity cell separation.

Large-scale monoclonal antibody based systems for the selection of cell subsets will play a prominent role in the development of hematotherapy and graft engineering. Hollow fiber systems for affinity cell separation rely on the generation of uniform fluid shear stress at the lumenal attachment interface. Potential mechanisms for nonuniformity of lumenal wall shear stress are fiber wall permeation fluxes driven by the pressure gradient along individual fibers and the influence of inlet header dynamic pressure on the radial distribution of axial flow within the fiber module. Dimensional analysis and numerical solution of the flow field within the lumen of a hollow fiber module illustrate the main physical criteria for design of hollow fiber modules. There will be a nearly uniform distribution of flow within the fiber bundle provided that the dynamic inlet pressure is small in comparison with the pressure drop along fibers. Fiber wall permeation fluxes will have a negligible effect on axial flow rate for nonporous membranes such as Cuprophan.

Antibodies, Monoclonal↗
PubMedDate not supplied

Chronic daily headache: correlation between the 2004 and the 1988 International Headache Society diagnostic criteria.

BACKGROUND: In a previous study, we compared the 1988 International Headache Society (IHS) criteria and the Silberstein-Lipton criteria (S-L) in a subspeciality clinic sample of 638 patients with chronic daily headache (CDH) assessed both clinically and with headache diaries. Both systems allowed for the classification of most patients with CDH. The 1988 IHS classification required multiple diagnoses and was more complex to apply. OBJECTIVES: The aim of this study was to revisit the same database, now comparing the prior classification systems with the new 2004 IHS classification. In contrast with the 1st edition, the 2nd edition includes criteria for chronic migraine (CM), new daily persistent headache (NDPH), and hemicrania continua (HC). METHODS: We reviewed the clinical records and the headache diaries of 638 patients seen between 1980 and 2001 at a headache center. All patients had primary CDH according to the S-L criteria. RESULTS: Using the S-L criteria as a reference, of the 158 patients with transformed migraine (TM) without medication overuse, just 9 (5.6%) met 2004 IHS criteria for CM. Most of the subjects were classified using combinations of migraine and CTTH diagnoses, much like the 1988 IHS classification. Similarly, using the new IHS system, just 41/399 (10.2%) subjects with TM with medication overuse were classified as probable CM with probable medication overuse. Most patients with NDPH without overuse were easily classified using the 2004 criteria (95.8%). Regarding NDPH with medication overuse, the diagnostic groups were much like results for the 1st edition. All patients with chronic tension-type headache (CTTH) and hemicrania continua (HC) according to the S-L system were easily classified using the 2004 IHS criteria. CONCLUSIONS: We conclude that the 2004 IHS criteria facilitate the classification of NDPH without medication overuse and HC. For subjects with TM according to the S-L system, the new IHS criteria are complex to use and require multiple diagnoses. Very few patients with TM in the S-L system could be classified with a single diagnosis in the 2004 IHS classification. In fact, CM was so rare that it would be virtually impossible to conduct clinical trials of this entity using the 2004 IHS criteria. Clinical trials of this entity should therefore be conducted using the S-L criteria. Finally, we propose that in the 3rd edition of the IHS classification, the diagnosis of NDPH be revised so as not to exclude migraine features.

Adolescent↗
PubMedDate not supplied

From hemicrania lunaris to hemicrania continua: an overview of the revised International Classification of Headache Disorders.

The International Headache Society's (IHS) Classification of Headache Disorders, published in 1988, is largely responsible for stimulating the rapid scientific and therapeutic advances that have revolutionized the field of headache. By establishing consistent operational diagnostic criteria for primary and secondary headache disorders, the IHS Classification has facilitated epidemiological and genetic studies as well as the multinational clinical trials that provide the basis for our present treatment guidelines. Fifteen years after its original release, a revised 2nd edition has been unveiled. Modifications are small but significant. We hope to introduce clinicians to the salient changes in the 2nd edition by highlighting the newly included headache types, acknowledging the renamed headache types, and reviewing the modifications in diagnostic criteria for existing headache types. Physicians involved in the care of headache patients need to be aware of these changes and should continue to consult the IHS criteria to ensure accurate diagnosis, to continue to refine the diagnostic criteria, and to contribute to the body of knowledge necessary to make further advances in the classification as well as in the field of headache.

Europe↗
PubMed1989

Clinical support for eliminating the nursing diagnosis of knowledge deficit.

An investigation of the appropriateness of the use of the nursing diagnosis, Knowledge Deficit, in specific clinical instances and examination of the diagnosis in light of validation criteria provided clinical support for eliminating it. The authors conclude that Knowledge Deficit falls outside of the boundaries of the discipline and that the label encourages nurses to focus attention on the promotion of knowledge as an entity rather than addressing a behavior related to the patients' lack of information. Removal of Knowledge Deficit from The North American Nursing Diagnosis Association (1986) taxonomy would force nurses to use other diagnostic labels.

Adult↗
PubMedDate not supplied

The Papanicolaou smear: its impact on the promotion of women's health.

Since the introduction of the Papanicolaou (Pap) smear in 1942, deaths from cervical cancer have decreased. The Healthy People 2000 objectives for women include a further decrease in the cervical cancer death rate and an increase in the number of women consistently receiving Pap smears. An overview of the life of Dr. Papanicolaou, the risk factors that have been established to determine Pap smear intervals, and improvements in managing results are presented. The false-negative Pap smear rate, reported at between 5% and 30%, may be a barrier to detection. To correct this, new regulations and new technology have been introduced. However, thousands of women have never received a Pap smear or receive it sporadically. To reduce deaths from cervical cancer, lowering the false-negative rate may not be as important as having regular Pap smears.

False Negative Reactions↗
PubMedDate not supplied

Biennial chances.

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Congresses as Topic↗