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At least 1,027 records · Page 57Linked to original sources
PubMed1998

Patient education: a guide for success.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards call for a more holistic approach to patient education. Health care professionals can coordinate their efforts by developing a patient-education guide. The guide, a supplement to staff-patient interaction, can give patients information on many conditions and stages of care.

Humans↗
PubMed1998

Initial experience with quality assurance of multi-institutional 3D radiotherapy clinical trials. A brief report.

In 1992, a 3D Quality Assurance (3D QA) Center was established at the Mallinckrodt Institute of Radiology under the auspices of the Radiation Therapy Oncology Group (RTOG). The role of the 3D QA Center is to provide quality assurance reviews of external beam treatment planning and verification (TPV) information for patients enrolled in multi-institutional 3D radiotherapy treatment protocols. Computer hardware and software components have been implemented which allow participating institutions to submit (via either the Internet or magnetic tape) common format 3D TPV data for QA review including: volumetric CT image data, normal structure, tumor and target volume contours, digitally reconstructed radiographs or simulator (prescription) and portal radiographs, beam geometry, dose distributions, fractionation information, and dose-volume histograms. Prior to enrolling patients on a 3D radiotherapy treatment protocol, each participating institution is required to complete a 3D Facility Questionnaire documenting their 3D treatment planning capability. In addition, the successful completion of a protocol "dry run" test is required to demonstrate the participating institution's ability to submit a protocol complaint digital data set to the 3D QA Center prior to placing patients on the 3D CRT study. Two site specific (prostate and lung) phase I/II 3D dose escalation trials are currently accruing patients. The QA center reviews at a minimum the first 5 cases from each participating institution and spot checks subsequent submissions. For each case review the following parameters are evaluated: 1. data exchange compliance, 2. CT data quality, 3. target volume contours, 4. normal structure contours, 5. field placement, 6. field shape, 7. dose prescription, 8. dose uniformity, and 9. dose conformity. By April 1997, over 300 protocol patient TPV data sets have been submitted and reviewed by the 3D QA Center.

Clinical Protocols↗
PubMed1998

A guide to understanding informed consent.

Anesthesia providers are expected to provide information to the patient during the preanesthesia interview that enables the patient to make informed choices. Adequate disclosure during the informed consent process ensures the equalization of the practitioner/patient relationship and the decision-making rights of the patient. Both certified registered nurse anesthetists (CRNAs) and anesthesiologists are not only legally required to provide information that will allow a patient to make an informed judgment about how to proceed with various anesthetic modalities but are also obligated by their standards of practice. This article informs the CRNA about the principles of informed consent so that they can better understand their role in the informed consent process.

Algorithms↗
PubMed1999

Screening for genetic risk of breast cancer.

Approximately 10 to 15 percent of all breast cancers are thought to be familial and about one third of these cases are due to an inherited mutation in a BRCA1 or BRCA2 breast cancer-susceptibility gene. The lifetime incidence of breast cancer in mutation carriers is above 50 percent, and carriers of BRCA1 mutation also have a substantially increased risk of ovarian cancer. BRCA1 and 2 mutations are associated with early-onset breast cancer, and some experts call for aggressive screening of affected persons. Monthly self-examination of the breasts beginning at age 18 and annual clinical examinations and mammography after age 25 have been recommended but are of unproven benefit. Prophylactic mastectomy and oophorectomy have been advocated by some authorities, but these interventions are disfiguring and for some carriers of the gene, they are unnecessary. The patient's decision to undergo genetic screening is complicated by the technical difficulty of the test, the substantial cost and the still incomplete understanding of the penetrance of disease in known mutation carriers.

Algorithms↗
PubMedDate not supplied

Is antiviral treatment (IFN alpha and/or ribavirin) justified in cirrhosis related to hepatitis C virus? Société Royale Belge de Gastro-entérologie.

AIM: To assess the benefit risk ratio of interferon and ribavirin in the treatment of patients with post hepatitis C cirrhosis we summarize the spontaneous over mortality of this disease, and made an overview of the randomized trials and of other controlled studies. RESULTS: In comparison to controls, patients with post hepatitis C cirrhosis have a 17 fold increase risk of dying from a liver disease that a control population, and a 6 fold increase from primary liver cancer. In France the hepatitis C epidemic which start in the sixties explains now the observed dramatic increase in mortality by primary liver cancer, both in men and women. Meta-analysis of randomized trials and controlled retrospective studies showed that interferon treatment is associated with a significant increase in ALT response at the end of the treatment, with a decrease in hepatocellular incidence as well as a decrease in mortality in comparison with controls. Very few data are published concerning ribavirin alone or in combination with interferon in patients with cirrhosis. Preliminary data suggest that this combination during 48 weeks permit to obtain in patients with compensated cirrhosis 20% of sustained virological response. The safety was acceptable but patients with low initial blood cells count must be carefully followed. In conclusion this overview clearly demonstrates a benefit-risk ratio in favor of treatment in patients with post hepatitis C cirrhosis by interferon.

Antiviral Agents↗
PubMed1999

Flexible sigmoidoscopy: screening for colorectal cancer.

Flexible sigmoidoscopy is an important screening procedure because of its ability to detect early changes in the distal colon. The 60-cm flexible sigmoidoscope provides excellent visualization with minimal discomfort to patients. Successful sigmoidoscopy requires adequate patient preparation, proper equipment and an experienced examiner who can recognize both normal and abnormal findings. Complications arising from sigmoidoscopy are rare, but patients may experience some cramping, gas or watery stools. Screening and primary preventive measures, including regular exercise and increased dietary fiber intake, can lower the morbidity and mortality associated with colorectal cancer.

Colorectal Neoplasms↗
PubMed2004

Asthma management by general practitioners in Pakistan.

SETTING: Teaching university hospital in Karachi, Pakistan. OBJECTIVES: Asthma management guidelines have been developed to assist practising physicians in treating asthma patients. The objective of this study was to evaluate if the prescribing habits of practitioners in Karachi were consistent with the published asthma guidelines. DESIGN: A questionnaire survey was conducted among practitioners attending a pulmonary continuing medical education (CME) programme. Three case scenarios of asthma were given, and the doctors were asked to write a prescription for each case. Doctors were asked about their views on inhaler therapy and dietary restrictions in asthma. RESULTS: Of 120 doctors, 100 (83%) responded. Thirty different regimens of short acting beta2-agonist and 16 regimens of steroid therapy were prescribed by the practitioners. Only 35% of the doctors prescribed corticosteroids for persistent asthma symptoms. The great majority of doctors were not aware of treatment options for persistent symptoms despite the use of preventive therapy (8% prescribed long-acting beta2-agonists, 6% high-dose inhaled corticosteroids and 13% theophyllines). Misconceptions about inhaler therapy and diet were found in 20 and 50 doctors, respectively. CONCLUSION: General practitioners in Pakistan did not follow asthma management guidelines. There was serious lack of knowledge about asthma medications coupled with misconceptions about inhaler therapy and dietary factors.

Administration, Inhalation↗
PubMed2006

Antibiotic prophylaxis for bacterial endocarditis--a study of knowledge and application of guidelines among dentists and cardiologists.

UNLABELLED: Antibiotic prophylaxis and infective endocarditis is a controversial topic. The compliance with available guidelines among dentists is poor. The dental health education of patients by their cardiologists is inadequate. OBJECTIVE: The objective of this study was to investigate the knowledge and application of available guidelines on antibiotic prophylaxis to prevent infective endocarditis among general dental practitioners and cardiologists. DESIGN: Structured postal questionnaire SUBJECTS AND METHODS: A list of 515 dentists was obtained from a register held by the Postgraduate Medical and Dental Board. A list of 85 cardiologists was obtained from a national register held by the Cardiothoracic Society of Ireland. RESULTS: A 31% response rate was obtained from the cardiologists and 37% from the dentists. The majority of the cardiologists (84%) were in hospital practice and 64% of dentists were in private general practice. Cardiologists showed a preference for the AHA guidelines (50%) and more dentists use the BSAC guidelines (56%). The cardiologists were very familiar with the cardiac conditions that pose a risk for dental patients but weak at educating their patients on the importance of good dental health. The dentists were good at identifying procedures that could place their patients at risk but less informed about which cardiac conditions warranted prophylaxis. Decision-making among the dentists with regard to choice of prophylaxis and appropriate treatment intervals was poor. CONCLUSIONS: The knowledge of and compliance with the available guidelines is poor. Dental health education of at-risk patients by their cardiologists and dentists is inadequate. Further regular education of patients, dentists and medical practitioners is required.

Amoxicillin↗
PubMed2005

STD and HIV counseling practices of British Columbia primary care physicians.

This study evaluated British Columbian primary care physicians' use of sexually transmitted disease (STD) and HIV counseling guidelines. The authors sought to assess barriers to integrated HIV and STD testing and counseling, with the objective of developing and revising practice guidelines to meet the needs of primary care physicians in diverse settings. The BC College of Physicians and Surgeons membership of general practice/family medicine practitioners was stratified by practitioner location; 1200 physicians were randomly selected to receive a mailed self-administered questionnaire. Four hundred seven completed questionnaires were returned. Female physicians reported better adherence to practice guidelines on many items than their male counterparts. A minority of primary care physicians routinely integrated HIV and STD testing and counseling. Physicians in nonurban areas were more likely to report that they lacked sufficient information on HIV and STD risk and prevention. Although male primary care physicians in British Columbia were more likely to provide care for people with HIV infection, female physicians were more likely to undertake ongoing screening for sexual risk behavior and sexually transmitted infections (STIs) among their HIV-positive patients. Clinical practice guidelines are theoretically equally available to all physicians, but they are not universally used. Physicians may not receive adequate training in sexual health during their medical education; continuing education opportunities may be limited to physicians outside of urban centres. Accessible and relevant continuing medical education in novel formats are needed to address the gap between ideal and actual practice in HIV and STD prevention, treatment, and care in Canada.

Attitude of Health Personnel↗
PubMed1996

Agency for Health Care Policy and Research clinical practice guidelines.

OBJECTIVE: To review and summarize past activities of guidelines development at the Agency for Health Care Policy and Research (AHCPR) to enhance understanding of its new role and facilitate the development of new guidelines. DATA SYNTHESIS: The current Congressional climate and past criticisms of the guidelines development process have caused the AHCPR to reevaluate the way it produces guidelines. This assessment has resulted in the AHCPR restructuring its role to serve now as a science partner with private and public organizations. CONCLUSIONS: The development and role of evidence-based clinical practice guidelines are discussed, and the new roles of the AHCPR are described.

Guidelines as Topic↗
PubMed1996

Management of the febrile infant.

The management of the febrile infant is truly a complex and evolving topic in pediatrics. The clinical practice guideline provides a map for physician decision making in this important clinical issue. An individual physician may alter the course of action based on his or her treatment threshold but must recognize the limitations of that approach. Documentation of management decisions that deviate from published guidelines are important for patient care. The medical record must carefully represent the appearance of the patient, the actions taken, and the discussion with the family regarding management. Close follow-up includes phone contact with documentation and reexamination of the patient in a reasonable period of time. All who deal with the common problem of fever in infants should follow this subject closely and be ready to adopt new management strategies when evidence from outcomes-based research emerges. In the mean time, the current practice guideline offers an excellent starting point in the management of this common and vexing clinical problem.

Child, Preschool↗