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At least 253 records · Page 14Linked to original sources
PubMed1997

Measurement of post-traumatic amnesia: how reliable is it?

OBJECTIVE: To develop and test a clinical protocol for determining post-traumatic amnesia by retrospective questioning. To establish its limits and factors which influence reliability. DESIGN: Two independent assessments using the Rivermead post-traumatic amnesia protocol were undertaken by separate observers on various groups of patients at various time intervals. Analysis investigated the correlations between assessments, the percentage difference between assessments, the number of patients changing category, and the differences between these analyses in the different patient subgroups. Assessments were undertaken both in hospital and in the patients' homes. Four different patient groups were studied. These were group A: 12 inpatients with very severe head injury late after injury; Group B: 40 patients interviewed at home six months after injury; group C: 22 patients interviewed within a few weeks of injury at home; group D: 116 patients interviewed initially within a few weeks and then at six months, on both occasions at home. The Rivermead post-traumatic amnesia protocol involved clinical questioning of the patient to establish how long after injury (in hours/days/weeks) the patient regained continuous day to day memory. All periods of coma were included. Severity was categorised with standard criteria. RESULTS: Overall correlation was good (Spearman's r 0.79), but the correlation was lower for patients with post-traumatic amnesia < 24 hours and when there was a long delay between assessments. In all groups 19%-25% of patients changed categories between assessments, but only 2% changed by two categories. CONCLUSIONS: The assessment of post-traumatic amnesia with the Rivermead post-traumatic amnesia protocol is reasonably reliable. The misclassification rate however, is significant enough that some caution should be taken in individual cases. Other evidence does show post-traumatic amnesia to be valid, and it probably remains the best simple prognostic item available. In clinical practice one should avoid placing too much weight on post-traumatic amnesia alone.

Adult↗
PubMed1993

Development of the Personality Inventory for Youth: a self-report companion to the Personality Inventory for Children.

This research explored the ability of parent-informant Personality Inventory for Children (PIC; Lachar, 1982) questionnaire items to form the foundation for self-report scales. An iterative rational and internal consistency approach using 585 clinical protocols constructed nine nonoverlapping clinical scales. Twenty-four complementary subscales were also constructed through scale item analysis. Acceptable estimates of scale reliability and internal consistency were established in substantial, diverse normal and clinical samples. Personality Inventory for Youth scales effectively separated normal and clinical protocols. Age and sex effects were investigated as were correlations with parent-informant PIC scales. Follow-up research includes the development of validity and adjustment screening scales, as well as the collection of diverse psychometric and clinical rating data to advance scale construct validity.

Adolescent↗
PubMed1999

AAPM's TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams.

A protocol is prescribed for clinical reference dosimetry of external beam radiation therapy using photon beams with nominal energies between 60Co and 50 MV and electron beams with nominal energies between 4 and 50 MeV. The protocol was written by Task Group 51 (TG-51) of the Radiation Therapy Committee of the American Association of Physicists in Medicine (AAPM) and has been formally approved by the AAPM for clinical use. The protocol uses ion chambers with absorbed-dose-to-water calibration factors, N(60Co)D,w which are traceable to national primary standards, and the equation D(Q)w = MkQN(60Co)D,w where Q is the beam quality of the clinical beam, D(Q)w is the absorbed dose to water at the point of measurement of the ion chamber placed under reference conditions, M is the fully corrected ion chamber reading, and kQ is the quality conversion factor which converts the calibration factor for a 60Co beam to that for a beam of quality Q. Values of kQ are presented as a function of Q for many ion chambers. The value of M is given by M = PionP(TP)PelecPpolMraw, where Mraw is the raw, uncorrected ion chamber reading and Pion corrects for ion recombination, P(TP) for temperature and pressure variations, Pelec for inaccuracy of the electrometer if calibrated separately, and Ppol for chamber polarity effects. Beam quality, Q, is specified (i) for photon beams, by %dd(10)x, the photon component of the percentage depth dose at 10 cm depth for a field size of 10x10 cm2 on the surface of a phantom at an SSD of 100 cm and (ii) for electron beams, by R50, the depth at which the absorbed-dose falls to 50% of the maximum dose in a beam with field size > or =10x10 cm2 on the surface of the phantom (> or =20x20 cm2 for R50>8.5 cm) at an SSD of 100 cm. R50 is determined directly from the measured value of I50, the depth at which the ionization falls to 50% of its maximum value. All clinical reference dosimetry is performed in a water phantom. The reference depth for calibration purposes is 10 cm for photon beams and 0.6R50-0.1 cm for electron beams. For photon beams clinical reference dosimetry is performed in either an SSD or SAD setup with a 10x10 cm2 field size defined on the phantom surface for an SSD setup or at the depth of the detector for an SAD setup. For electron beams clinical reference dosimetry is performed with a field size of > or =10x10 cm2 (> or =20x20 cm2 for R50>8.5 cm) at an SSD between 90 and 110 cm. This protocol represents a major simplification compared to the AAPM's TG-21 protocol in the sense that large tables of stopping-power ratios and mass-energy absorption coefficients are not needed and the user does not need to calculate any theoretical dosimetry factors. Worksheets for various situations are presented along with a list of equipment required.

Biophysical Phenomena↗
PubMed2002

Rhinosinusitis treatment protocol: changing provider habits in primary care.

OBJECTIVE: Sinus infections are common and represent a high cost to the health care industry. Clinical protocols can be used to develop cost-effective treatment strategies. Our objective was to show that a protocol for rhinosinusitis can change provider practice patterns in primary care. STUDY DESIGN AND SETTING: We used a literature search, survey of primary caregivers, and chart review from an academic health center to define and document current patterns. A protocol was developed and evaluated using the Rhinosinusitis Disability Index. RESULTS: Survey and chart review identified that primary caregivers do not elicit a detailed history for rhinosinusitis. Protocol use increased this to 100%. First-line antibiotic therapy was used for only 49.4% of the patients before protocol use and for 68.5% after protocol use. Patients felt better after treatment 84.1% of the time; the Rhinosinusitis Disability Index could not measure improvement. CONCLUSION: Provider practice patterns were positively influenced by use of the protocol. SIGNIFICANCE: Clinical protocols should be developed to direct provider treatment practices.

Clinical Protocols↗
PubMed2003

Effect of MTAD on the bond strength to enamel and dentin.

The purpose of this study was to compare the effect of MTAD (a mixture of a tetracycline isomer [doxycycline], an acid [citric acid], and a detergent [Tween 80]) and phosphoric acid on the bond strength to enamel and dentin using a conventional OptiBond Solo Plus dentin adhesive system. One hundred flat surfaces (50 enamel/50 dentin) were prepared for bonding. Specimens were embedded in acrylic with the flat surface exposed. One of the following surface treatments was applied before bonding composite with Optibond Solo Plus (Kerr Corp): 1 min NaOCl/1 min EDTA; 1 min NaOCl/1 min MTAD; 30 s etch with H3PO4 (positive control), 2 min saline (negative control), or 20 min NaOCl/5 min MTAD (clinical protocol for MTAD). Shear bond strength was tested 30 min after bonding. Data were analyzed using a one-way ANOVA followed by the Student-Newman-Keuls multiple comparison method. Surface pretreatment with acid etch resulted in the greatest enamel bond strengths (p < 0.05). All surface pretreatments were superior to saline for dentinal bonding (p < 0.05). On the basis of our findings, it appears that teeth endodontically treated with the MTAD protocol for clinical use (20 min 1.3% NaOCl/5 min MTAD) may not need any additional dentin conditioning before the application of the dental adhesive.

Analysis of Variance↗
PubMed1996

Assessing quality of life in patients with epilepsy.

The importance of quality-of-life (QOL) assessments in providing quantified information about the impact of chronic illness and its treatment is now generally accepted. For epilepsy, QOL assessment is a relatively recent development, but it is increasingly included within clinical trial protocols. Clinical trials in epilepsy that have included a comprehensive QOL assessment, although still relatively few in number, have examined the effectiveness both of broad management policies and of individual drug therapies. There are a number of important conceptual, methodological and practical issues behind the measurement of quality of life as an outcome of care in epilepsy that are being addressed through current efforts to develop standardised QOL instruments. In trying to assess quality of life in epilepsy, as in any other condition, it is important to satisfy the universal requirements of a scientific instrument-that it be valid, reliable, sensitive in change and practical. To date, the main 'formal' approaches to QOL assessment in epilepsy have involved the development of a novel QOL measure from first principles, customising of a previously developed generic measure, identification of a battery of generic and disease-specific scales addressing specific QOL domains, and adoption of an individual patient-generated approach. These various efforts have produced a battery of potentially valuable tools and approaches. Although QOL assessment is now mainly on the epilepsy research agenda, some important challenges remain to be met. These include the development of comprehensive, age-related measures for children with epilepsy, further investigation of the psychometric properties of the available measures for adults, issues of cross-cultural application and use with proxy informants, and the development of utility-based measures.

Adult↗
PubMed1998

Documentation on track with protocols.

To make sure nurses and other disciplines teaching patients were following teaching standards (and to improve documentation), one hospital created teaching protocols for several top diagnoses. As a result, its documentation jumped from 58% to 92%. The hospital took the following steps to ensure the success of the protocols: Existing protocol committees wrote teaching protocols. Clinical educators conducted staff in-services. Guidelines for implementation were created.

Case Management↗
PubMed1998

Telephone triage improves demand management effectiveness.

Telephone triage, or telephone advice counseling, is becoming a key managed care point-of-entry tool for patients and health plan members accessing the health system. Telephone triage functions as a logical front-end for health plans, integrated physician groups, or integrated delivery systems that want to shift their managed care efforts toward demand management. Key components of telephone triage include patient education, patient information, and guided access to appropriate care. Telephone triage generally requires 24-hour staffing by registered nurses and a computer software package based on either clinical protocols or clinical algorithms. Organizations can either install an in-house system or purchase this service from a vendor, health plan, or another provider. The decision to develop a telephone triage service in-house or to out-source it is determined largely by volume and the user's strategy for moving to successive levels of risk management.

Algorithms↗
PubMed2002

Capecitabine and tegafur + uracil: new preparations. Metastatic colorectal cancer: two oral fluorouracil precursors, few advantages.

(1) The standard chemotherapy for metastatic colorectal cancer is intravenous fluorouracil combined with calcium folinate. This treatment improves the median survival time by approximately 4-6 months compared with optimal palliative care. (2) Two metabolic precursors of fluorouracil are now available in the European Union for first-line oral treatment of metastatic colorectal cancer, namely capecitabine and tegafur + uracil. According to the licensing terms, only the tegafur-uracil combination must be given with calcium folinate. (3) The evaluation files on each of these two cytotoxic agents contain data from two comparative unblinded trials versus intravenous fluorouracil + calcium folinate (Mayo Clinic protocol). None of these trials showed a difference in survival. (4) Both drugs caused severe diarrhoea in 12% of patients. Severe palmoplantar erythrodysesthesia was more frequent on capecitabine. Longer postmarketing follow-up is available for the tegafur + uracil combination, which has been used in Japan for many years. (5) Patients receiving capecitabine or tegafur + uracil + calcium folinate have to take large numbers of tablets or capsules. (6) In practice, the standard treatment for metastatic colorectal cancer remains the fluorouracil + calcium folinate combination. The tegafur + uracil + calcium folinate combination is only useful for patients who prefer oral administration. Capecitabine has no documented advantage over this latter combination.

Administration, Oral↗
PubMed2006

[Deployment of a computerized physician order entry: description of the process and challenges].

The introduction of a system of computerized physician order entry (CPOE) decreases medication error rates by formalizing the drafting of the orders and providing alarms which announce potential side effects, drug interactions and overly high doses. The quality of the CPOE does not insure its success. Its deployment must be preceded by an assessment and update of the available computer resources, by training of the users and setting up a help-desk attainable 24 hours a day. The project must be lead by senior medical and nursing staff. A joint effort is the key to ensure the success of CPOE and facilitate its acceptability. CPOE provides opportunities for improving: patient safety, training of professionals, quality and efficiency of care. CPOE systems are an ideal basis to set up clinical protocols and clinical pathways.

Medical Order Entry Systems↗
PubMed1997

Assessment and management of urinary incontinence among homebound older adults: a clinical trial protocol.

Urinary incontinence is a common and costly problem among homebound older adults. This article describes the assessment and management protocols utilized in a clinical trial examining the effectiveness of behavioral interventions in treating urinary incontinence in homebound older adults. Individuals with urinary incontinence were identified and referred to the study by home care nurses from two large home health agencies. Following in-home assessment, eligible subjects were randomized to an immediate treatment group or a delayed treatment group (control group). Subjects who were cognitively intact were treated with biofeedback-assisted pelvic floor muscle training, while subjects with cognitive impairments were treated with a program of prompted voiding. Two nurse practitioners assessed and treated subjects participating in the study.

Aged↗
PubMed1998

[Criteria for clinical studies exemplified by immuno- and immunochemotherapy of renal cell carcinoma].

Clinical trials of phase I to III are the basis of testing drugs before their wide use among patients. In order to provide high quality treatment in oncology, particularly in palliative care of tumour patients, it is of critical importance to pay attention both to study characteristics and to the relevant German laws for clinical drug testing. For more than 20 years interleucin-2 and interferon-alpha based immunotherapy of metastatic renal cell carcinoma has been in controversy. In spite of various clinical protocols no consensus concerning the value of these concepts has been reached. Therefore, high quality oncological studies are necessary to determine the effectiveness of this type of immunotherapy and to avoid an uncritical application of a toxic and expensive treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

A practical approach to evidence-based medicine: lessons learned from developing ventilator management protocols.

Development of robust clinical protocols is a time-consuming process that requires allocation of sufficient time and resources. As outlined for the mechanical-ventilation protocol, the goals of the protocol must be clear before embarking on this journey. Critical appraisal of existing evidence is an essential first step to developing a draft protocol. The inclusion of a multidisciplinary team of clinicians, including nurses and respiratory therapists, is required to refine the logic and to ensure protocol acceptance. Extensive bedside testing of the protocol across the spectrum of patients in which it will be applied is essential for ensuring that the protocol works as intended. An effective, ongoing training program must be implemented to ensure protocol success. The final protocol should be carefully monitored in 50 to 100 patients to ensure that clinicians are complying with the protocol rules and that adverse events related to the protocol are not occurring. Finally, protocols must be tended to and updated when new evidence becomes available.

Clinical Protocols↗
PubMed1993

The impact of clinical trial protocols on patient care in a community hospital.

Although clinical research is essential in cancer control, less than 5% of cancer cases in community hospitals are entered in clinical trials. Phase III studies comprise the bulk of clinical research at our community hospital. Potential research protocols are selected by the Community Clinical Oncology Program Therapeutic Investigations Committee for referral to affiliated institutional review boards. Selection criteria include assessments of the scientific validity, relevance, and importance of the research, the match between the proposed protocol and research interests and experience of the investigators, priorities of the research bases for patient accrual, and resource availability for conduct of the study. There are serious impediments to the performance of clinical trials in the multiethnic, multilingual urban community hospital setting. These include diminution of the potential patient pool for trial entry due to language barriers and other difficulties associated with patient accrual; escalating costs (insurance coverage from some carriers in not available for clinical trial participation, and some therapies may be excluded by third-party payers); underinsurance or lack of insurance in many segments of the potential patient population; declining financial support for clinical research and the variability of payments, with restrictions even for standard or conventional treatments; the widespread belief that investigational studies are too costly or are of unproven value; potential liabilities associated with withholding cancer therapy; the unresolved legal quagmire surrounding cancer care for patients just under 18 years of age; and the potential for scientific misconduct related to the performance of clinical trials.

Clinical Trials as Topic↗
PubMedDate not supplied

Protocols for clinical care.

This paper describes the work of the DILEMMA project to provide protocol-based decision support in a variety of clinical domains. We give an outline of the generic protocol model that DILEMMA has produced, and the protocol task manager (PTM) software developed to assist protocol use in routine clinical practice. We summarise the validation of the model carried out to date, and take a quick look at the place of protocols in the wider context of clinical decision support.

Clinical Protocols↗
PubMed1986

Evaluation of abdominal pain: clinicians' performance compared with three protocols.

Clinical findings in ambulatory patients with abdominal pain, presenting themselves to general medical practitioners, were analyzed by three different protocols: an algorithm using a branched-chain logic, a linear discriminant rule, and bayesian analysis. All methods missed some serious diagnoses. None was as effective as the clinician at distinguishing nonspecific abdominal pain (NSAP) from more serious conditions.

Abdomen↗
PubMedDate not supplied

Osteosarcoma nursing care guidelines: a tool to enhance the nursing care of children and adolescents enrolled on a medical research protocol.

Clinical trials dominate the therapeutic approaches used in pediatric oncology with the majority of pediatric oncology patients receiving treatment on medical research protocols. These protocols detail the medical treatment that enrolled patients will receive. Nursing care is not described in these documents. However, nursing care must complement the medical care as written in the medical research protocol. Administering treatments safely, assessing treatment responses, educating patients and families, and communicating with the entire health care team are some of the essential nursing responsibilities that must be carefully orchestrated. Nursing care guidelines, as described here, were created to provide the careful balance between the medical research protocol and associated nursing care. These guidelines describe the nursing actions and considerations involved in caring for pediatric oncology patients enrolled on a particular medical research protocol. The purpose of this article is to describe the process used to create and evaluate nursing care guidelines.

Adolescent↗