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At least 235 records · Page 13Linked to original sources

PubMed2003

Hormonal responses after various resistance exercise protocols.

PURPOSE: This study examined the effects of the number of sets on testosterone, cortisol, and growth hormone (hGH) responses after maximum strength (MS), muscular hypertrophy (MH), and strength endurance (SE) protocols. METHODS: Eleven young men performed multi-joint dynamic exercises using MS (5 reps at 88% of one-repetition maximum (1-RM), 3-min rest) and MH (10 reps at 75% of 1-RM, 2-min rest) protocols with 2, 4, and 6 sets at each exercise; and an SE (15 reps at 60% of 1-RM, 1-min rest) with 2 and 4 sets. Hormonal concentrations were measured before exercise, immediately after, and at 15 and 30 min of recovery. RESULTS: The number of sets did not affect the hormonal responses after the MS protocol. Cortisol and hGH were higher (P < 0.05) after the four-set compared with the two-set sessions in the MH and SE protocols. No differences were observed between the six-set and the four-set sessions in the MH protocol. Cortisol and hGH were higher (P < 0.05) than the MS after the SE and MH protocols, and only when four and six sets were performed in the latter. hGH was higher than the MH after the SE protocol, whether two or four sets were executed, whereas cortisol (P < 0.05) was higher after the SE protocol only when two sets were performed. Testosterone did not change with any workout. CONCLUSION: The number of sets functions up to a point as a stimulus for increased hormonal concentrations in order to optimize adaptations with MH and SE protocols, and has no effect on a MS protocol. Furthermore, the number of sets may differentiate long-term adaptations with MS, MH, and SE protocols causing distinct hormonal responses.

Adaptation, Physiological↗

PubMed2006

A practical approach to hyperglycemia management in the intensive care unit: evaluation of an intensive insulin infusion protocol.

STUDY OBJECTIVES: To evaluate the effectiveness and safety of maintaining a target blood glucose concentration of 91-130 mg/dl with a standardized, nurse-managed, intensive insulin infusion protocol outside a study setting, and to determine if a statistically significant favorable effect on morbidity and mortality was achieved. DESIGN: Retrospective, observational, chart review. SETTING: Medical and surgical intensive care units (ICUs) in a community teaching hospital. PATIENTS: One hundred forty-three adult patients who received insulin infusions managed at the discretion of the physician over a 1-year period before initiation of the protocol (control group), and 70 patients who received insulin infusions over a 6-month period with infusion dosages titrated by using the protocol (protocol group). MEASUREMENTS AND MAIN RESULTS: Episodes of hypoglycemia, time within target range, mean blood glucose concentration, frequency of measurement, length of ICU stay, duration of mechanical ventilation, and overall mortality were collected. Hypoglycemic episodes were not significantly different between the groups. Blood glucose concentrations were within target range in 34% of all measurements in the protocol group compared with 23% in the control group (p<0.001, relative risk [RR] 1.48, 95% confidence interval [CI] 1.38-1.58). Once target range was reached on one measurement, 43% of concentrations remained in target range in the protocol group compared with 29% in the control group (p<0.001, RR 1.47, 95% CI 1.38-1.56). Frequency of measurements was higher in the protocol group versus control group (p=0.01); however, clinical difference was minimal. Protocol group had lower overall mortality rate (27% [19/70] vs 32% [46/143], p=0.45), reduced mean ICU length of stay (16.7 +/- 10.6 vs 18.4 +/- 16.0 days, p=0.37), and less mechanical ventilation time (16.5 +/- 9.7 vs 17.0 +/- 15.0 days, p=0.79). CONCLUSION: The nurse-managed insulin infusion protocol improved glycemic control with minimal hypoglycemic episodes compared with baseline practice. A trend toward decreased mortality, ICU length of stay, sand days of mechanical ventilation was observed. When compared with other published protocols, our insulin protocol displays comparable effectiveness with the use of less-frequent blood glucose measurements.

Adult↗

PubMed2006

Cardiac 16-MDCT for anatomic and functional analysis: assessment of a biphasic contrast injection protocol.

OBJECTIVE: The purpose of this study was to determine the optimal contrast injection protocol for clear delineation of the endocardial and epicardial contours and coronary vessels in anatomic and functional imaging with cardiac 16-MDCT. SUBJECTS AND METHODS: Thirty-eight patients were allocated to three groups according to contrast injection protocol: a long-duration biphasic protocol in which diluted contrast material was used in the latter phase (protocol A, 13 patients); a uniphasic protocol with saline flush (protocol B, 12 patients); a uniphasic protocol without a flush (protocol C, 13 patients). Six regions of interest were drawn within the left ventricle (LV), right ventricle (RV), and interventricular septum along the z-axis. Mean ventricular attenuation, mean difference between maximum and minimum ventricular attenuation, and ventricular-myocardial contrast-to-noise ratio (CNR) were calculated. Attenuation and visualization of the coronary vessels also were compared. RESULTS: The difference between maximum and minimum RV attenuation was significantly smaller in group A (58.1 H) than in groups B (179.5 H) and C (157.0 H). RV-myocardial CNR was significantly higher in group A (9.0) than in group B (5.5). The mean LV attenuation, difference between maximum and minimum LV attenuation, and LV-myocardial CNR were not significantly different among three groups. In protocol A, both endocardial and epicardial contours were clearly delineated, and cardiac functional analysis was feasible in all cases. Average attenuation and visualization of the coronary vessels were not significantly different among groups. The diagnostic accuracies in detection of coronary stenosis were 92%, 93%, and 91%, respectively, for protocols A, B, and C. CONCLUSION: The long-duration contrast injection protocol with diluted contrast material is optimal for assessing the coronary vessels and cardiac function.

Aged↗

PubMed2002

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.

OBJECT: Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. METHODS: A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. CONCLUSIONS: Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Adenoma↗

PubMed2001

Clinical pregnancy rates in an IVF program. Use of the flare-up protocol after failure with long regimens of GnRH-a.

OBJECTIVE: To examine the efficacy of flare-up protocols in patients who failed to respond to a long protocol using gonadotropin-releasing hormone agonist (GnRH-a). STUDY DESIGN: In this retrospective study, a total of 144 patients who underwent an in vitro fertilization/embryo transfer cycle with the flare-up protocol were analyzed. Of these, 111 patients (group I) had not responded well to ovulation induction with long-term down-regulation with GnRH-a (long protocol), and 33 (group II) had responded to ovulation induction with at least four follicles but failed to conceive after embryo transfer. The average age of the patients were 37.3 +/- 3.9 years (range, 28-43) and 36.5 +/- 3.7 (range, 24-44), respectively. All patients underwent a flare-up protocol with GnRH-a (leuprolide acetate, 0.5 mg/d) on day 2 and at least 6 ampules of gonadotropins on day 3 within 6 months following failure with the long protocol. Unresponsiveness was defined as having fewer than three developing follicles on day 7, with an estradiol level < 200 pg/mL. Patients with a cycle day 2 follicle stimulating hormone (FSH) level > 15 mIU/mL before initiating GnRH-a were not included in the flare-up protocol. The average day 2 FSH levels of the patients on the flare-up protocol cycles were 9.1 +/- 3.0 in group I and 7.1 +/- 2.0 in group II. RESULTS: In group I, 44 of 111 (39.6%) patients did not respond to the flare-up protocol even with an increased dose of gonadotropins. In 67 patients, an average of 7.2 +/- 2.3 oocytes were obtained. Embryo transfer was performed on 64 patients with an average of 3.2 +/- 0.6 embryos. Fertilization did not occur in three patients. Eleven women conceived, eight of them miscarried, and three delivered. The pregnancy rate per cycle initiated was 9.9% (11/111) and live birth rate per cycle initiated, 2.5% (3/111). In group II, 3 of 33 patients were cancelled. The reasons were inadequate ovarian response, risk of hyperstimulation and absence of oocytes after aspiration. In 28 patients the average number of oocytes obtained was 6.9 +/- 3.9, and the average number of embryos replaced was 2.7 +/- 1.0. Six patients conceived, and all miscarried. The pregnancy rate per cycle initiated was 6/33 (18.1%), and no live births were achieved. CONCLUSION: Although the flare-up protocol after an unsuccessful luteal phase long protocol increases the pregnancy rate per cycle slightly, the live birth rate is not improved in poor responders.

Adult↗

PubMed1992

A protocol system to satisfy research specific, disease specific, physician specific, and patient specific informational needs.

The Department of Medicine at Loyola University Medical Center Chicago (LUMC) has developed and is utilizing a Patient Information Protocol System (PIPS) to address clinical and research informational needs. PIPS, an integrated module of the department's Patient Information Management System (PIMS), enables end-users to access pre-defined informational templates or "protocols". Protocols detail pre-defined data requirements for patient management or clinical research needs. Each protocol consists of a defined collection of protocol elements. Protocol elements belong to an object group which has several defined attributes (e.g. description, acceptable ranges or inputs, units, and grouping keywords). Approximately 3,500 protocol elements have been identified to define treatments/drugs, symptoms/toxicity, clinical labs, x-rays/scans, physical findings, and lesion groups. Utilizing protocols, PIPS permits end-users to selectively review or capture clinical information. Patients may have several active protocols. PIPS interacts with a specialized database gateway to permit automatic capture of clinical laboratories information, and with reporting systems to produce one of several "chart-ready", time-oriented protocol summary reports. Data extraction programs operate in conjunction with PIPS to facilitate exporting of data for statistical analysis. PIPS has been in operation for over 24 months and has 63 defined protocols (40 clinical research and 23 patient care).

Evaluation Studies as Topic↗

PubMed1994

Comparison of two protocols used in exercise testing in chronic heart failure patients.

UNLABELLED: Spiroergometrical testing with the load graded upto symptom-limited maximum with the determination of anaerobic threshold begins to be a routine method in exercise testing of cardiac patients. Functional parameters according to available data depend on the source of load and may be influenced by the protocol of testing, too. That is why we decided to compare two protocols used in chronic heart failure patients exercise testing. 11 male and 3 female patients (NYHA II, III) suffering from chronic heart failure were subjected to the symptom-limited tests (protocol A-0.25 W.kg (-1/3 minutes with one minute breaks; protocol B-25 W + 10 W/2 minutes). There was no statistically significant differences in the symptom-limited values of main functional parameters. The AT level parameters did not differ significantly, as well. Anaerobic threshold could be determined in all patients using the protocol A and in 11 cases using the protocol B. The difference in rates was not statistically significant. The workload duration using the protocol B was significantly shorter (9.7 +/- 3.8 minutes vs. 16.4 +/- 3.6 minutes). CONCLUSIONS: Protocol B is less time demanding and therefore it is more suitable for determination of the symptom-limited parameters in the clinical routine. Anaerobic threshold can be determined by protocol A more often than by protocol B. Therefore, protocol A appears to be more suitable for the individual prescription of the appropriate physical activity and for scientific purposes, too.

Anaerobic Threshold↗

PubMed1996

Clinical and cost comparison of three postoperative skin preparation protocols in CABG patients.

This descriptive pilot study includes a clinical and cost comparison of three preoperative skin preparation protocols (razor, clipper, and depilatory cream, in combination with whole body disinfection) in 82 patients undergoing coronary artery bypass graft (CABG) surgery. The clinical research protocol included an evaluation of body surface area, index of body hair growth, depilatory effect, skin integrity after depilation, and side effects of body disinfection with chlorhexidine solution, as well as protocol-specific evaluation criteria. The cost comparison was performed by keeping a record of the materials used and the workload for each separate activity associated with the three preoperative skin preparation protocols. Material and labor costs were calculated for each of the different aspects of the protocols. Clinical evaluation revealed that the clipper protocol (if necessary, in combination with cream depilation) is most convenient for depilation of patients with heavy hair growth. The depilatory cream protocol is an appropriate method to depilate patients with slight or moderate hair growth. The razor method should be eliminated from clinical practice due to previous documented evidence of an associated increased risk of postoperative wound infection. Cost calculations revealed that the median hospital cost (standardized for differences in hair growth index, working hours and nurse qualification levels) of the razor, clipper, and cream protocols is $6.13, $9.84, and $8.16 (U.S. dollars), respectively. In 1995, yearly raw (i.e. non-standardized) hospital costs for the three procedures were $14,402, $16,114, and $16,765, respectively, with 708 CABG procedures performed. Although changing to a clipper and/or cream protocol may be associated with an initial, although moderate, increase in hospital costs, compared to the razor method, substantial cost savings could be expected long-term. The superiority of these protocols is primarily due to a decreased incidence of postoperative wound infections, as compared to that associated with the razor protocol.

Aged↗

PubMed2002

Financial analysis of patients with newly diagnosed acute myelogenous leukemia on protocol or standard therapy.

BACKGROUND: Medicare and third-party payers may be reluctant to pay for investigational (protocol) therapy for patients with cancer on the premise that such treatment is more expensive than standard therapy. However, prior studies that have attempted to compare protocol therapy with standard therapy have been difficult to interpret because of the assortment of malignancies studied and the lack of suitable control groups of patients who received standard therapy. METHODS: In the current study, the authors conducted a retrospective review of the financial charges associated with protocol or nonprotocol (standard) chemotherapy in patients with a single malignancy, newly diagnosed acute myelogenous leukemia (AML), who received their initial course of chemotherapy ("induction") at the Memorial Sloan-Kettering Cancer Center (MSKCC) between 1996 and 1999. Protocol and nonprotocol groups were analyzed according to clinical characteristics and standard prognostic features to determine whether the two groups were comparable. Median charges for all patients were determined using a database that linked clinical information, financial data, and clinical outcomes. RESULTS: A total of 353 patients with newly diagnosed AML were registered at MSKCC during the time period studied; of these, 79 patients (22%) received all of their care at the institution. Thirty patients (38%) received treatment on an investigational protocol. Forty-nine patients (62%) did not receive protocol therapy for the following reasons: 10 patients (20%) did not meet eligibility criteria, 4 patients (8%) were eligible for protocol therapy but declined, and 35 patients (71%) met protocol criteria but were not offered protocol therapy based on the judgment of their primary oncologist. The groups were not comparable because patients treated with standard therapy were older and had a poorer initial Eastern Cooperative Oncology Group (ECOG) performance status. Overall median charges for patients in the nonprotocol group were higher than for patients treated on a protocol although charges were not related to age, initial ECOG performance status, or cytogenetic risk group. CONCLUSIONS: Although charges for the nonprotocol group were higher, specific factors responsible for this difference were not identified. This study emphasizes the problems inherent in assembling suitable groups of patients for comparison.

Adult↗

PubMed1991

Prediction of the frequency and duration of ambulatory myocardial ischemia in patients with stable coronary artery disease by determination of the ischemic threshold from exercise testing: importance of the exercise protocol.

The relation between ambulatory myocardial ischemia and the results of exercise testing in patients with ischemic heart disease remains undefined, because of the dissimilar results of previous reports. To further investigate this issue and, in particular, to ascertain the importance of the exercise protocol in determining that relation, 70 patients with stable coronary artery disease underwent 48 h ambulatory electrocardiographic (ECG) monitoring and treadmill exercise tests after withdrawal of medications. Patients exercised using two different protocols with slow (National Institutes of Health [NIH] combined protocol) and brisk (Bruce protocol) work load increments. Exercise duration was longer with the NIH combined protocol (14.1 +/- 5 versus 6.8 +/- 2 min; p less than 0.0001), but the maximal work load and peak heart rate achieved were greater with the Bruce protocol (9.8 +/- 2 versus 6.5 +/- 2 METs, and 142 +/- 19 versus 133 +/- 22 beats/min, respectively; p less than 0.0001). A close inverse correlation between exercise testing and the results of ambulatory ECG monitoring was observed using the NIH combined protocol; the strongest correlation was observed between time of exercise at 1 mm of ST segment depression and number of ischemic episodes (r = -0.86; p less than 0.0001). With the Bruce protocol a significantly weaker inverse correlation was found (r = -0.35). The mean heart rate at the onset of ST segment depression was similar during monitoring and during exercise testing with the NIH combined protocol (97.2 +/- 13 versus 101.0 +/- 17 beats/min, respectively) but it was significantly higher (110.4 +/- 13) when using the Bruce protocol (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2003

Introducing the Intergroup 0116 protocol of adjuvant chemo-radiotherapy in gastric cancer into clinical practice.

AIMS: The results of techniques from a well-conducted clinical trial are often difficult to reproduce when implemented in community oncology practice. The U.S. Intergroup 0116 protocol of adjuvant chemo-radiotherapy in gastric cancer presented in mid-2000 produced a survival advantage over surgery alone. The current study aims to determine the adherence with protocol design and delivery of radiation therapy (radiotherapy) in the initial 20 patients managed with the Intergroup 0116 protocol at The National University Hospital, Singapore. MATERIALS AND METHODS: A formal quality assurance audit was performed on clinical features, radiotherapy treatment charts and simulation films of the first 20 patients treated with the Intergroup 0116 protocol from July 2000 to September 2001. Specific details were audited for their consistency with described protocol in domains of eligibility criteria, radiotherapy prescription, target volume coverage and adherence to dose-limiting normal tissue tolerances. Compliance and toxicity with the protocol was assessed by audit of delivered radiotherapy dose, treatment interruptions, inpatient admissions and weight loss during radiotherapy. RESULTS: The 20 audited patients were appropriately selected on the basis of eligibility criteria of Intergroup 0116 protocol. There was only one minor variation of radiotherapy target volume coverage resulting from marginal coverage of the porta hepatis region. Adherence to the protocol was satisfactory, with 19 patients completing the radiotherapy protocol as planned and only one major variation in treatment delivery resulting from gastrointestinal toxicity. One major and one minor variation in normal tissue-dose constraints occurred on the heart and spinal cord, respectively. Compliance with treatment delivery was good, with only one patient failing to complete the prescribed radiotherapy dose owing to toxicity, although seven patients required treatment interruption. CONCLUSION: This audit showed good compliance with radiotherapy design and delivery. A formal medical quality assurance audit may provide a useful tool to assess complex new protocols introduced into routine departmental practice.

Adult↗

PubMed2002

A search for guidance: examining prenatal substance exposure protocols.

OBJECTIVES: To describe key elements of a set of hospital prenatal substance exposure protocols, and to relate variations in protocol content to the state legislative environment and hospital characteristics. METHODS: Nurse managers and hospital administrators with responsibility for perinatal care were asked to provide their hospital's prenatal substance exposure protocol. Using a structured coding form, two independent coders read and abstracted information from the 87 protocols received. Hospital and patient characteristics and the state's legal environment were cross-tabulated. RESULTS: Only half of coded protocols included an implementation date; 37% lacked any goal or statement of purpose. Most covered the key components of prenatal substance exposure management, such as precipitants and guidelines for toxicology screening, but failed to present their contents clearly. Only a few discussed whether specific maternal consent is required for a maternal or a newborn toxicology screen. Protocols from states that had made some legislative response to prenatal substance exposure were more likely to provide reporting guidelines and a discussion of consent for a toxicology screen for mothers and newborns. Protocols were more likely to be found in larger hospitals and were more detailed in hospitals serving more affluent and less minority patient populations. CONCLUSIONS: More attention needs to be devoted to the development of prenatal substance exposure protocols, as their lack of clarity precludes most from meeting protocol development goals, such as encouraging standardized care. Associations between hospital characteristics, state legislative environment and protocol features suggest that legislative mandates could shape their development and features.

Clinical Protocols↗

PubMedDate not supplied

National prevalence of palliative care protocols in emergency medical services.

OBJECTIVES: There are approximately 500,000 hospice patients in the United States. While hospice patients may desire only palliative care, they often access the emergency medical services (EMS) system, unaware that many EMS systems do not have specific palliative care protocols. This study was undertaken to determine the prevalence of palliative care protocols among EMS agencies in the United States, and to estimate the percentage of the U.S. population covered by such protocols. METHODS: A survey requesting information about out-of-hospital palliative care protocols was mailed to the EMS agencies serving the 200 most populous U.S. cities. After four weeks a follow-up telephone call was made to those agencies that had not yet responded. The number of agencies with a palliative care protocol was determined, and the populations served by those agencies with and without palliative care protocols were calculated. RESULTS: Responses were received from 121 (60.5%) of the cities. Only seven (5.8%) of the responding cities' EMS agencies had a palliative care protocol. The population of cities covered by a palliative care protocol was just under 3 million, or slightly more than 6% of the 47.2 million people living in the responding cities. CONCLUSIONS: Most of the U.S. population is not served by an EMS agency with specific palliative care protocols. Until more EMS systems enact specific palliative care protocols, physicians treating the terminally ill should educate patients and families about appropriate use of the EMS system, and that EMS professionals may be required to provide more than supportive care.

Clinical Protocols↗

PubMed1999

Economic and clinical impact of a pharmacy-based filgrastim protocol in oncology patients.

The effects of a clinical protocol for filgrastim use in oncology patients were studied. A chart review was conducted for every fourth oncology inpatient who received filgrastim at a community hospital between January and June 1996 to determine how filgrastim was being used in the hospital's oncology patients. The results were presented to the oncology committee, and a filgrastim protocol was implemented. The protocol stated that filgrastim would be discontinued when the absolute neutrophil count (ANC) was > or =1500 cells/mm3 for two days after the neutrophil nadir. Six months after the protocol was implemented, a follow-up evaluation was conducted by reviewing the chart for every fourth oncology patient who received filgrastim between November 1996 and April 1997. Twenty-one patient charts were reviewed before the protocol was implemented, and 34 charts were reviewed after implementation. The results showed there was compliance with the protocol for 19 (76%) of the 25 patients evaluable for compliance. Sixty-seven percent of patients were febrile before the protocol was implemented, and 56% were febrile afterward. Ten percent of patients had documented infections before implementation, compared with 12% afterward. The average ANC at which filgrastim was discontinued before and after the protocol was implemented was 6839 and 5538 cells/mm3, respectively. Filgrastim was discontinued by a pharmacist in 32% of cases. A $22,416 cost saving was achieved in the first six months after protocol implementation, with no compromise in clinical efficacy. A pharmacy-based protocol for discontinuing filgrastim therapy in oncology patients saved a community hospital more than $22,000 in the first six months withno adverse impact on the drug's effectiveness.

Adult↗

PubMedDate not supplied

Potassium protocols: in search of evidence.

PURPOSE: The purpose of this triangulated study was to evaluate potassium protocols used in clinical practice. RATIONALE: Hypokalemia occurs frequently in the clinical setting and can have serious consequences. It is further complicated by the fact that it has multiple causes and patient symptoms can range from asymptomatic to death. considering the complexity and potential seriousness of hypokalemia, it is important that treatment be appropriate. DESCRIPTION OF THE PROCESS: The triangulated approach included an examination of the empirical evidence, a comparison of potassium protocols currently in use, and an evaluation of the potential benefits and risks of using a potassium protocol in a sample of patients. OUTCOME: There is wide variation in potassium protocols and no empirical evidence in support of or opposition to these protocols. An evaluation of the use of a potassium protocol in a sample of patients indicates that patients not on protocols are not being routinely treated according to general protocol potassium replacement recommendations. CONCLUSIONS: The use of narrowly defined potassium protocols may lead to overtreatment or incorrect treatment in the complex setting of hypokalemia. IMPLICATIONS FOR NURSING PRACTICE: Findings suggest the need for validation of clinically significant hypokalemia, the addition of other electrolyte measures when evaluating and treating hypokalemia, and the use of routine serum potassium levels and maintenance of serum potassium levels equal to or more than 4.0 mmol/L in certain patient populations. Most important, the etiology of hypokalemia, not used in qualifying criteria on any of the potassium protocols examined, should form the basis for treatment.

Clinical Protocols↗

PubMed1995

Significant reduction in methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia associated with the institution of a prevention protocol.

OBJECTIVE: To determine whether the institution of a methicillin-resistant Staphylococcus aureus prevention protocol was associated with a decrease in methicillin-resistant S. aureus ventilator-associated pneumonia in long-term, acute care ventilator patients. DESIGN: A retrospective chart review comparing the number of episodes of clinical pneumonia per patient ventilator day in the 12 months preceding and 24 months following the introduction of the protocol. SETTING: University affiliated, long-term, acute care ventilator hospital. PATIENTS: Long-term, acute care ventilated patients who presented with clinical pneumonia. INTERVENTIONS: Addition of a methicillin-resistant S. aureus prevention protocol. In addition to universal precautions, the protocol consisted of mupirocin 2% ointment applied to the anterior nares, and whole body washing with chlorhexidine. All patients were given mupirocin and chlorhexidine twice weekly. Patients were cohorted in the same room if they were, or had been, infected or colonized with methicillin-resistant S. aureus in any anatomical location or at any time. This procedure replaced strict isolation of methicillin-resistant S. aureus-infected or colonized individuals. MEASUREMENTS AND MAIN RESULTS: Clinical pneumonia was diagnosed when a patient developed fever, bronchorrhea, increased white blood cell count, methicillin-resistant S. aureus isolated from the tracheal aspirate, and new or increasing infiltrate on chest roentgenograph. During the 12 months preceding the protocol, there were 0.2% episodes of methicillin-resistant S. aureus ventilator-associated pneumonia per ventilated patient day compared with 0.026% in the 24 months after the protocol (p < .001). The relative and absolute risk reductions associated with the introduction of the protocol were 87% and 6, respectively. CONCLUSIONS: The period following the institution of the protocol showed a significant reduction in episodes of clinical pneumonia compared with the 12-month period preceding the use of the protocol (p < .001). Thus, we conclude that the introduction of this protocol is associated with a significant decrease in methicillin-resistant S. aureus ventilator-associated pneumonia.

Adult↗

PubMed2005

How graduate nurses use protocols to manage patients' medications.

AIMS AND OBJECTIVES: The aim of the study was to determine how graduate nurses use protocols in their medication management activities. The objectives were to: examine the extent of adherence to various protocols in relation to medication activities and determine how the ward environment impacts on graduate nurses' use of protocols to manage patients' medications. BACKGROUND: Protocols help newly qualified nurses integrate new knowledge into practice and promote effective decision-making Design. A descriptive prospective qualitative design was used. Methods. Twelve graduate nurses involved in direct patient care in medical, surgical and specialty wards of a metropolitan teaching hospital participated in the study. Participant observations were conducted with the graduate nurses during a two-hour period when medications were being administered to patients. In-depth interviews were conducted with each nurse immediately after observations and demographic data were collected on participating nurses and patients in their care, including all medications prescribed. Protocols associated with medication management activities for the clinical settings were also transcribed. RESULTS: Six themes were evident from the data: availability and use of protocols, scrutinizing patients' identity before medication administration, double-checking certain medications before administration, writing incident reports, following specific policies and timing the administration of medications. CONCLUSION: Graduate nurses adhered to protocols if they were perceived not to impede with other nursing activities. Participants were also more likely to follow protocols if they felt encouraged to make their own decisions and if there was a decreased likelihood that disciplinary action would be involved. RELEVANCE TO CLINICAL PRACTICE: Experienced health professionals should encourage graduate nurses to comply with medication protocols and to make clinically reasoned decisions about medication activities. By providing peer support and acting as role models, experienced health professionals can also demonstrate to graduate nurses how effective protocol use is an important component of quality patient care.

Adult↗

PubMed2001

The efficacy of an antibiotic protocol for community-acquired pneumonia.

OBJECTIVE: To assess the efficacy of an antibiotic protocol to avoid empirical use of third-generation cephalosporins in community-acquired pneumonia (CAP). DESIGN AND SETTING: Retrospective case review of patients with CAP one year after implementing the protocol. Comparison was made with patients with CAP treated at a metropolitan tertiary referral hospital (where use of third-generation cephalosporins was common). PARTICIPANTS: 86 patients (district hospital with an antibiotic protocol) and 72 patients (metropolitan tertiary referral hospital), January - June 1999. OUTCOME MEASURES: Rate of staff adherence to the protocol; patient characteristics associated with poor protocol adherence; demographic and prognostic features of both groups at presentation; duration of intravenous therapy, time to defervescence, length of stay; inpatient mortality rates; and drug cost savings per patient treated according to the protocol. RESULTS: Overall protocol adherence rate was 60%. Patients with penicillin allergy were significantly less likely to receive treatment according to the protocol (P<0.001). At the district hospital, patients were generally older and taking more regular medications. Patients at each hospital had similar prognostic factors and demographic features at presentation. Inhospital mortality (P=0.92; 95% CI, -0.08 to 0.07), duration of fever (P=0.57) and length of stay (P=0.78) were not significantly different between patients treated empirically with penicillin and those treated empirically with third-generation cephalosporins. Treating a patient according to the protocol saved an average of $77.44 in drug costs. CONCLUSION: One year after implementation, our protocol for treating CAP is proving efficacious, although levels of adherence could improve.

Adult↗