SEARCH · PubMed Health

Results for “Protocol”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 919 records · Page 51Linked to original sources

PubMed1998

Disseminating multimedia protocols over Internet for emergency and catastrophe management.

Over the last years we have developed various computing methods to assist specialized personnel on various aspects of catastrophe and emergency management. New models can address tasks such as patient triage; stabilization, resource coordination and hospital alertness and techniques based on information technologies. In this paper we present various tools (written on Java and C+2) that we created to store, represent, and disseminate practice guidelines and protocols over the World Wide Web. Guidelines and protocols are stored using a standard database program (e.g., Microsoft Access), and represented in a flowchart format linked to multimedia information such as text, pictures, sound, video or external sources of data. Using our JAVA tool, protocols can be disseminated over the Web and viewed with any browser with JAVA compliance. We have implemented 15 emergency protocols that we developed in collaboration with specialized military personnel from the Ministry of Defense, Spain. Users can access remotely those electronic protocols comparing their procedures and methods. Our goal is to enhance agreement and consensus among remote medical centers regarding emergency and catastrophe management, establishing discussions over the network. Our tools have also a potential for training medical and paramedical personnel for emergency situations.

Clinical Protocols↗

PubMed1998

Presenting treatment protocols with Web technology.

This paper describes a Web-based version of a protocol information system (ProtoVIEW) with which a wide range of diagnostic or therapeutic protocols can be retrieved and viewed. The Web-based version contains all functionalities of the non web-based version plus several new functionalities. The web version contains an X-ray viewer and a great deal of interactivity such as validation of electronic patient data forms. The most important additional function is the context sensitive protocol support which may lead to improved protocol adherence. Finally, the web-based version can be accessed from any working place since patient data and protocols are stored centrally.

Clinical Protocols↗

PubMed2000

Acute lymphoblastic leukemia in young adults: two chemotherapeutic protocols for the treatment of 46 patients.

BACKGROUND: Acute lymphoblastic leukemia (ALL) in adults has a very poor prognosis. Many chemotherapeutic protocols have been designed to try to improve treatment results for adult ALL. Two chemotherapeutic protocols were used to treat young adult ALL patients in our institute and treatment results are reported. METHODS: From 1984 through 1997, 46 young adult patients with ALL were treated. There were 43 males and three females. Their ages ranged from 16 to 38 years, with a median of 24 years. Thirty-two patients (group A) received a four-week conventional induction regimen with daunomycin, vincristine, prednisolone, and L-asparaginase, followed by prophylaxis of the central nervous system (CNS) with intrathecal methotrexate and cranial irradiation, as well as maintenance therapy with oral 6-mercaptopurine and methotrexate. Fourteen patients (group B) received the modified protocol of the German multicenter trial for adult ALL (GMALL) with a two-phase induction regimen, CNS prophylaxis and maintenance therapy. RESULTS: In group A, 25 of 32 patients achieved complete remission (CR), three obtained partial remission and four died of treatment-related complications during induction therapy. The median duration of remission (DR) was 12 months (range, 3-39 months) and the median overall survival time (OST) was 13 months (range, 0.5-50 months). Of the 25 patients who achieved CR, 21 relapsed and died. In group B, 11 of 14 patients obtained CR and three died of leukopenia-related infectious complications during induction. The median DR was 12 months (range, 8-37 months) and the median OST was 15 months (range, 0.5-39 months). During follow-up, 10 of 11 patients relapsed from ALL and died. Only one patient who received allogeneic bone marrow transplantation first CR is still alive. No statistical differences between the two groups were noted in terms of CR rate, DR (p = 0.87) and OST (p = 0.34). However, the the GMALL protocol had during the significantly more hematologic toxicity during induction therapy. CONCLUSIONS: Our results suggest that young adult ALL is a disease with a very poor prognosis and conventional chemotherapy is not adequate for its treatment. The notion that GMALL protocol is better than conventional therapy in the treatment of adult ALL cannot be justified by our data.

Adolescent↗

PubMed2000

[Immunology in medical practice. XXXV. Screening of suspected immunodeficiency: diagnostic protocols for patients with opportunistic or recurrent severe infections, wasting and failure to thrive].

With a multistage laboratory protocol immunodeficiencies can be efficiently identified. The article presents a diagnostic protocol that consists of three schemes. Scheme 1 describes the diagnostic protocol for the large group of patients with recurrent pulmonary and ENT-infections, where an antibody deficiency can occasionally be found. Scheme 2 presents the diagnostic protocol for the much smaller group of patients with opportunistic infections, wasting or failure to thrive. Several of these patients suffer from a severe T-lymphocyte disorder. Early diagnosis and treatment is important for the prognosis in these patients. Scheme 3 shows the diagnostic protocol for patients with recurrent infections of surface areas and deeper organs; these patients may suffer from a phagocyte disorder.

Algorithms↗

PubMed2001

Clinical outcomes of a diagnostic and treatment protocol in allergy/sensitivity patients.

OBJECTIVES: This level II outcome study was conducted to examine the efficacy and toxicity of a diagnostic and treatment protocol using electrodermal screening (EDS) in allergy/sensitivity patients. METHODS: Ninety-six patients with a diagnosis of allergy or sensitivity entered the study between 1994 and 1998; 90 participants completed the study. All participants followed the same protocol, and all interactions were with a single clinician at a single site. The Allergy Symptom Severity Index (ASSI) was developed to record symptomatic information. EDS - conductance measurement 1/( - of specific acupuncture points was used as an objective endpoint (indicator of outcome) and for identification of antigens, according to Voll criteria. All measurements were taken before and after treatment, and EDS was carried out at all treatment sessions. Outcome criteria suggesting efficacy were reduction in ASSI score, reduction in number of items testing positive, and normalization of conductance measurements. A statistical analysis of the outcomes was performed using the student's paired t-test. RESULTS: There was a statistically significant change in pre- and post-treatment measurements of the ASSI. The conductance measurements normalized and the number of items testing positive decreased compared to pre-treatment testing. In addition to these parameters, 87.2 percent of subjects rated efficacy as good to excellent, and less than one-percent rated the outcome as poor. The outcome demonstrated longevity, meaning that people who had their post-treatment evaluation up to three years after primary treatment were still showing minimal ASSI scores, with no additional treatment. The treatment appeared to work equally well across age groups and gender. Forty-eight percent of participants had an aggravation of symptoms after treatment, lasting an average of 10 hours, with reactions described as mild to moderate. Average cost of the desensitization protocol (all costs included) was $822.16. CONCLUSIONS: This protocol demonstrated efficacy without serious toxicity and no long-term adverse effects. It is natural, non-invasive, and does not require long periods of avoidance of offending foods or environmental stimuli. The desensitization protocol is a low-cost, effective therapy for the treatment of patients suffering from symptoms of allergy/sensitivity disease.

Acupressure↗

PubMedDate not supplied

Integration of pressure ulcer treatment protocol into practice: clinical outcomes and care environment attributes.

The purpose of this study was to determine if a research-based protocol for pressure ulcer treatment that had been successfully implemented in a long-term care facility was sustained over time. A secondary aim was to describe the attributes of the care environment that may have contributed to or impeded the maintenance of this protocol. A retrospective chart review was conducted of all patients who developed incident stage II, III, or IV pressure ulcers in the facility over a one-year period five years after initial implementation of a pressure ulcer treatment protocol. Data regarding ulcer characteristics and type, frequency, and duration of treatments were collected. Subjects were followed until the ulcer healed, the subject died or was discharged, or the 1-year study period ended. Care environment attributes, including patient care hours, turnover and stability rates, salaries, decision-making structures, and facility mission were obtained from the facility's Human Resource Department and existing databases in the Nursing Services Department. Outcomes of protocol implementation were defined as ulcer healing and costs associated with treatment. Costs were calculated from the provider perspective and included cost of supplies and labor consumed in providing direct pressure ulcer care. Of the 46 incident ulcers treated during the one-year study period, 40 (87%) healed and five (11%) were unhealed when the subject died. One ulcer remained unhealed at the end of the study. The total cost for treatment of these incident ulcers was $18,688, with nursing labor comprising 80% of the total expenditures. Adherence to the protocol, which contained predominantly inexpensive moist wound healing treatment options, resulted in complete healing of most pressure ulcers at a relatively low cost to the facility. The organizational environment of the facility, which maintains staffing levels and salaries at higher than national averages and promotes staff nurse accountability and decision making, may have provided the necessary climate to overcome barriers to clinical integration and sustain the desired care practices.

Aged↗

PubMed2002

[Influence of the application of a rational, consensual protocol on the use of antibiotics in a general hospital].

A large increase in the use of wide-spectrum antibiotics has occurred in Spain. The objective of our study was to evaluate the influence of applying protocols for the use of such antibiotics. A prospective, observational study was carried out based on the information provided by the pharmacy service about prescriptions of ceftriaxone, cefotaxime, ceftazidime, imipenem and ciprofloxacin at the single-dosing department of the hospital. Two groups were included in the study: 1) control group (October-December 1995), which did not take into account the protocols for antibiotic treatment; and 2) the study group, during the same months in 1996, which took into account the consensual protocols. The criteria for the type of patient, infection and outcome, and type of antibiotic treatment were evaluated according to the rules of the international literature for this type of study. The baseline characteristics of both groups of patients were similar. Following the application of the protocol, a decrease in the use of antibiotics was observed (108 cases in group 2 vs. 207 cases in group 1); an increase in the appropriateness of treatment (50.72% in group vs. 77.57% in group 2); an increase in the cure rate (78.26% in group 1 vs. 91.67% in group 2); and a decrease of 5.01 days in the length of hospital stay (22.99 days in group 1 vs. 17.98 days in group 2), which was statistically significant, and thus led to a savings of 2073.74 Euros per cured patient. The application and adherence to a consensual protocol is a beneficial method of using antibiotics since it improves the quality of their use and makes it more cost-effective.

Anti-Bacterial Agents↗

PubMed2001

[Partial nephrectomy in unilateral Wilms tumor. New draft for a protocol of the SIOP].

Unilateral Wilms' tumor has been treated according to 9301 SIOP protocol, with good results. The new pre protocol that SIOP is developing has a high inclusion rate. From 1993 to 1999, 11 patients with unilateral Wilms' tumor were treated in our center; in 6 cases preop chemotherapy was done, in the other 5 cases pre and postoperative chemotherapy were used. Nine of the 11 patients could be included in the pre protocol this was due to a thrombosis of the vena cava in one case, and in the other the middle renal in area was widely affected. Wilms' tumor has a good prognosis with the actual protocol, SIOP. New pre protocol could give a better quality of life due to the amount of functional renal parenchyma, without decreasing the actual high cure rate.

Adolescent↗

PubMedDate not supplied

[Results of treatment in non-Hodgkin's lymphoma in children using the YU-77, YU-84 and YU-87 protocols].

Fifty-eight children with non-Hodgkin's lymphomas (NHL) were treated with three different chemotherapeutic protocols at the Division of Hematology and Oncology, Department of Pediatrics Salata during the period from 1977-1989. Twelve (20%) patients had lymphocytic and 46 (80%) lymphoblastic type of NHL. There was no statistical difference in the incidence of the 1st complete remission induced by different chemotherapeutic protocols (YU-77 86% YU-84 72% and YU-87 81%). However, the 1st relapse occurred in 8% of the patients treated with YU-87 protocol, compared to 30% in those treated with YU-84 and 58% treated with YU-77 (p < 0.01). The probability of 36-month survival was highest in patients treated with the most aggressive chemotherapeutic protocol YU-87 (81%), whereas it was 63% in those treated with YU-84 and 32% treated with YU-77 (p < 0.01). All patients that did not enter the 1st complete remission died during the first year of treatment. The median survival of patients that achieved the 1st complete remission was 28.3 months, while the probability of 36-month survival was 62% (p < 0.001). The survival strongly correlated with the protocol employed and clinical stage, but was independent of the histologic type of NHL.

Adolescent↗

PubMedDate not supplied

Hospital response protocols for child sexual abuse and sexually transmitted diseases in children.

Hospitals are significant portals of entry to the health care system for children who have been sexually abused. Hospital staff have the opportunity to investigate, intervene in and prevent the cycle of abuse. Accordingly, several Canadian hospitals have standardized responses to meet the needs of the sexually abused child; however, the prevalence of protocols and the degree of standardization across the country have not been documented. A survey of hospitals in Canada indicated that 46% of hospitals that treated children had a response protocol for child sexual abuse and only 17% had a response protocol for sexually transmitted diseases in children. Protocols were more likely to be in place in hospitals that were accredited, specialized in paediatrics, were designated as teaching facilities for medicine, nursing and social work, and had more than 200 beds. In hospitals without protocols, staff were often not convinced of their need or desirability.

Attitude of Health Personnel↗

PubMed2003

Hyperbaric oxygen treatment protocols for mandibular osteoradionecrosis.

To determine hyperbaric oxygen (HBO2) treatment practices for osteoradionecrosis (ORN) of the mandible in North America, we surveyed hyperbaric facilities listed in the 1998 UHMS Chamber Directory. A survey response rate of 99.7% was achieved. Among the 316 facilities listed, 280 treat or would treat mandibular ORN with HBO2. Twelve different hyperbaric treatment protocols for the condition were reported. Approximately three-quarters of facilities utilize a protocol administering 90 minutes of 100% oxygen breathing at a treatment pressure of 2.4-2.5 atmospheres absolute (atm abs). The remaining one-quarter of facilities apply alternate hyperbaric treatment protocols. In summary, mandibular ORN is commonly treated at North American hyperbaric facilities but there is a lack of uniformity with regard to the protocol utilized for hyperbaric oxygen administration. There are no clinical data to support that any one treatment protocol is superior in out come to any other.

Clinical Protocols↗

PubMedDate not supplied

Early effects of different cytostatic protocols for head and neck cancer on oncogene activation in animal experiments.

In vivo investigations on oncogenes and onco-suppressor genes may provide new findings on the potential carcinogenic effects of various cytostatic protocols inducing secondary tumours of the head and neck. Further surgeries are often necessary due to regional recurrence after the Cisplatin-supplemented BVM (Bleomycin, Vincristine, Methotrexate) protocol in the treatment of human head and neck tumours. Our earlier studies have illustrated the carcinogenic and mutagenic potential of Cisplatin. The effect of Cisplatin on the alteration of different onco- and suppressor genes has also been proven. Our present study aimed at investigating the early effects of the BVM and the CFu (Cisplatin, 5-Fluorouracil) protocols on early oncogene and tumour suppressor gene expressions in mice. Body weight equivalent amounts of cytostatics were administered intraperitoneally to 6- to 8-week-old, inbred, female CBA/Ca mice. Twenty-four, 48 and 72 hours after the treatment, RNA was isolated from the target organs and the quantitative expression of c-myc, Ha-ras and p53 genes were examined. The protocols caused detectable changes. A "short-term" in vivo test, the 24-hour examination of gene expression, is suitable for detecting early effects of carcinogen exposure. The alterations of gene expression, caused by the Cisplatin-containing protocol, draw attention to the probable role of Cisplatin in the development of regional recurrence and to the possibility of prevention.

Animals↗

PubMed1996

Practice protocol for the examination of specimens removed from patients with carcinoma of the urinary bladder, ureter, renal pelvis, and urethra.

This article details a practice protocol for the examination and reporting of specimens removed from patients with carcinoma of the urinary bladder, ureter, renal pelvis, or urethra. It was created by a multidisciplinary task force of pathologists and oncologists established by the Cancer Committee of the College of American Pathologists. Documentation for the protocol was obtained from the previously published protocol, the medical literature, personal experience, and consultation with colleagues. After creation and review by the task force, the protocol was sent to 1000 randomly selected practicing pathologists as a survey. Their comments and suggestions were addressed in the final version. The protocol was approved by the Board of Governors of the College of American Pathologists.

Adenocarcinoma↗

PubMed2004

Immediate restoration and loading of dental implants: clinical considerations and protocols.

The use of dental implants to assist in the treatment of partial and complete edentulism is well documented. Most of the implant literature, however, reports results associated with implant survival and success when there has been adherence to rigid placement and loading protocols. Conventionally, these protocols call for the undisturbed healing of the implant-3 months in the mandible and 4 to 6 months in the maxilla. This article evaluates the literature and develops protocols for clinical procedures for the early or immediate restoration or loading of dental implants. Criteria are established for defining immediate loading, immediate restoration, early loading, and early restoration as compared to conventional protocols. The review assesses factors that influence accelerated loading and restoration decisions, including bone quality and quantity, implant design, splinting of implants, and prosthetic design. Conclusions and recommendations are made based on the experience of the consensus group charged with considering these procedures and on the current literature published on these protocols.

Bone Density↗

PubMed2005

Investigating stillbirths using a simplified obstetric events-based protocol.

INTRODUCTION: A stillbirth remains a distressing enigma to parents and clinicians alike as the cause often remains elusive. Few papers describe a protocol for the investigation of stillbirths. We evaluate the first obstetric events-based protocol designed for local use with an aim to adequately investigate stillbirths in a cost-effective manner. METHODS: A prospective cohort study was performed on 61 stillbirths at KK Women's and Children's Hospital. There were a total of 16,980 births in the year 2000. RESULTS: 37.7 percent of cases remained unexplained. There was protocol compliance in 51 cases (83.6 percent) with deviation in 10 cases (16.4 percent). The protocol helped to minimise costs in 18 cases (29.5 percent) as selected investigations were performed in view of obvious causes. The overall postmortem rate was 27.9 percent with the lowest rates in the Malay population. CONCLUSION: An obstetric events-based protocol allows clinicians to tailor their investigations easily and appropriately. It helps to provide optimal investigations and minimise unnecessary costs. It could be further fine-tuned by initiating detailed serum investigations only after delivery so as to exclude an obvious cause, like cord accidents, where full investigations are unnecessary.

Adult↗

PubMed2005

Magnetic resonance (MR) imaging of lumbar spine: use of a shortened protocol for initial investigation of degenerative disease.

PURPOSE: To assess the potential use of shortened protocol MRI of lumbar spine in the investigation of degenerative disc disease in Northern Ireland. MATERIALS & METHODS: Prospective study of 35 patients having MR imaging of lumbar spine performed during a 12-month period by one consultant radiologist. T1-weighted and T2-weighted sagittal images of lumbar spine were obtained in all cases, as well as T2-weighted axial images. The detection of degenerative disc disease by sagittal T2-weighted imaging alone was compared with the diagnostic information obtained by combined use of axial T2 and sagittal T1 and T2 images. RESULTS: In comparison with the full protocol, the shortened protocol had 100% sensitivity and 100% specificity in detecting loss of disc hydration and loss of disc height. In the detection of disc prolapse, the sensitivity was 87% and the specificity was 91% using the shortened protocol. The sensitivity was 35% for detection of thecal sac indentation, and 33% for nerve root encroachment. Therefore, the shortened protocol had high sensitivity and specificity in the detection of disc degeneration and prolapse, but was less sensitive in the detection of nerve root or thecal sac encroachment.

Clinical Protocols↗

PubMedDate not supplied

Use and efficacy of a nutrition protocol for patients with burns in intensive care.

The University of Michigan Burn Center uses a protocol to standardize the assessment, initiation, and monitoring of nutritional support for patients with burns of greater than 30% total body surface area (TBSA). Six patients with 20% to 80% TBSA burns were followed for 3 weeks to determine the effect of the protocol on the assessment, initiation, monitoring, and adequacy of nutritional support. The protocol calls for resting energy expenditure (REE) measurement within 24 hours of injury, to be repeated 3 times per week, for assessment of caloric requirements. Patients experienced an average delay before first REE measurement of 3 days after burn injury because measurements were unavailable on weekends and surgical days. REE measurements were used to determine caloric requirements and to tailor nutritional support to fluctuating metabolic needs. In four of the six patients a Dobhoff feeding tube (Biosearch Medical Products, Inc., Somerville, N.J.) was placed in the small bowel and enteral nutrition was initiated within 24 hours of admission, as outlined in the protocol. Two patients received concurrent parenteral nutrition because of difficulty in placing the Dobhoff feeding tube when fluoroscopy was not available. The three patients receiving nutrition solely through enteral feeding had achieved 100% of their caloric requirements by day 2, 4, and greater than 7 days after injury, respectively. Overall, the six patients received enterally an average of 75% of their caloric requirements. The major reason for inadequate enteral support was interruption of tube feedings because of tube dislodgment or multiple surgical procedures. The protocol used weekly measurements of total iron-binding capacity and prealbumin level s parameters of nutritional support.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

[The use of a questionnaire to test the reliability of protocols for the indication of radiologic tests in emergencies].

The authors developed a series of protocols for selecting patients who need emergency radiography, based on clinical criteria that maximize the yield of abnormal radiographs. In order to test safety and reliability of the protocols and to define the reasons for requesting emergency radiographs, a prospective analysis was carried out, by means of a questionnaire, on 1000 consecutive patients referred to our Accident and Emergency Department for radiography. Seven hundred and twenty-nine patients were considered as negative according to protocol criteria: none of them was found positive on X-ray examination. Of them, 639 exams were requested for medico-legal reasons and 90 for patient reassuring. Of 271 patients considered as true positive or probably positive according to the screening criteria, all the true positive cases were such also on X-ray examinations, whereas, among the probably positives, only 31 were confirmed as positive on radiological studies. Our results demonstrate the efficacy of the suggested protocols: had these referral criteria been used for the patients in our study, only 271 examinations would have been performed with no radiographic abnormalities missed. In addition, this grid included 94 cases evaluated as "probably" positive which were subsequently found negative at X-rays, which makes a further safety margin. Our analysis also shows the low therapeutic value of emergency radiographs in both nasal bone injury and post-traumatic oblique rib views. Therefore we suggest selecting patients who need X-rays based on the clinical criteria shown in our protocols: this could result in economic saving and decreased radiation exposure, with no risks of clinical underestimation of the pattern.

Clinical Protocols↗