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At least 1,045 records · Page 58Linked to original sources
PubMed1994

Safe handling practices of cytotoxic drugs: the results of a chapter survey.

PURPOSE/OBJECTIVES: To describe how nurses from a local Oncology Nursing Society (ONS) Chapter Implement Occupational Safety and Health Administration (OSHA) guidelines for handling cytotoxic drugs (CDs) in their individual practices and to identify barriers to implementing these guidelines. DESIGN: Mailed survey. SETTING: ONS chapter in a large midwestern city. SAMPLE: 103 nurses, 83 of whom handle CDs. Mean years in oncology nursing was 7.5. METHODS: Mailed survey consisting of 48 questions on seven topics, as well as demographic questions. MAIN RESEARCH VARIABLES: Roles in preparation and administration of CDs, management spills, patient care, and use of protective equipment in patient and family education practices; barriers to use of protective practices. FINDINGS: Subjects used some protective equipment when preparing and administering CDs, but the type of equipment and its frequency of use did not specifically meet OSHA Guidelines. Rates of compliance with guidelines were better for management of spills and disposal of equipment. Verbal instructions for patients and families were employed but very few provided written instructions or explanations. Barriers to using protective equipment included a lack of time, problems with availability, and concerns about patient reactions. CONCLUSIONS: Barriers must be overcome and better safe-handling practices incorporated into practice to ensure the safety of nurses. More education is needed for family members who come into contact with patients receiving CDs. IMPLICATIONS FOR NURSING PRACTICE: Future research to document the extent of the problem, including stratification of responses according to the quantity and frequency with which a nurse administers CDs. Better, and perhaps more frequent, staff and family education efforts are needed.

Adult↗
PubMed2006

Cluster randomized trial of a multifaceted primary care decision-support intervention for inherited breast cancer risk.

BACKGROUND: GPs are increasingly expected to meet the needs of patients concerned about their risk of inherited breast cancer, but may lack skills or confidence to use complex management guidelines. We developed an evidence-based, multifaceted intervention intended to promote confidence and skills in this area. OBJECTIVE: To evaluate the effectiveness of the intervention in improving GP confidence in managing patients concerned about genetic risk of breast cancer. METHODS DESIGN: Cluster randomized controlled trial. SETTING: General practices in the Grampian region of Scotland. SUBJECTS: GPs and the patients they referred for genetic counselling for risk of breast cancer. MAIN OUTCOME MEASURES: GPs' self-reported confidence in four activities related to genetics; rates of referral of patients at elevated genetic risk; and referred patients' understanding of cancer risk factors. RESULTS: No statistically significant differences were observed between intervention and control arms in the primary or secondary outcomes. A possible effect of the intervention on the proportion of referred patients who were at elevated risk could not be discounted. Only a small proportion of intervention GPs attended the educational session, were aware or the software, or made use of it in practice. CONCLUSIONS: No convincing evidence of the effectiveness of the intervention was found, probably reflecting barriers to its use in routine practice.

Breast Neoplasms↗
PubMed2006

Are physicians asking about tobacco use and assisting with cessation? Results from the 2001-2004 national ambulatory medical care survey (NAMCS).

OBJECTIVE: The objective of this study was to determine if providers asked patients about tobacco and assisted tobacco users with cessation. METHODS: The data source is the 2001-2004 National Ambulatory Medical Care Survey, which is an annual survey of outpatient visits. The prevalence of "asking" about tobacco use, providing "assistance" with tobacco cessation, and prescription of pharmacotherapy for cessation were estimated. A logistic regression model was fit to the data to determine if any variables were related to "asking" about tobacco use and providing "assistance" with cessation. RESULTS: Overall, 32% of patient charts did not include information about tobacco use, 81% of smokers did not receive assistance and less than 2% received a prescription for pharmacotherapy. Asking about tobacco use varied with presence of chronic disease, cardiovascular disease counseling, geographical region, whether the physician was the patient's primary provider, time spent with physician, age, and gender. Providing assistance with cessation varied with the presence of chronic diseases, cardiovascular disease counseling, region of the country, provider type, insurance type, and time spent with the physician. CONCLUSIONS: Methods for improving adherence to the Clinical Practice Guideline for cessation, such as medical school curricula or educational programs for practicing providers, should be examined.

Adult↗
PubMedDate not supplied

Clinical practice improvement: management of the patient with chronic asthma.

Clinical practice improvement (CPI) includes research on practice patterns, access, utilization of resources, and patient perceptions of outcomes; development of practice guidelines; and education of both patients and providers. Using the CPI format, a team of healthcare professionals selected the management of the asthma patient as a project. The team's goals were to evaluate current practice patterns, review and recommend practice guidelines, recommend indicators to monitor patient outcomes and changes in practice patterns, and provide recommendations for implementing educational activities. A survey mailed to primary care physicians and selected specialists (allergists and pulmonologists) was used to determine present methods of managing asthma. A patient outcomes survey tool was piloted as part of the CPI process. The pilot indicated that this tool was appropriate for use in physician offices for both longitudinal and aggregate analysis of asthma patient outcomes. Patient and provider educational materials were developed and disseminated to providers.

Adolescent↗
PubMed2004

Overcoming information overload: an information system for the primary care physician.

Primary Care Office InSite (PCOI) is a Web-based intranet application that provides ready access to a collection of information useful in primary care. The PCOI Web site was developed by, and is widely used within, the Massachusetts General Hospital (MGH) and its affiliated community practices. Over 1600 users logged 60,000 separate sessions in the past year. The site contains clinical practice guidelines, patient educational material, drug prescription and cost information and referral information, all designed for use during routine patient care activity. A continuing and dynamic collaboration between the users and developers of the system, just-in-time access and a "one-stop portal" to a variety of resources have resulted in a very high approval rating by the users. This paper discusses the important characteristics of the Web site, specific functions that improve the workflow of the practicing clinician, and limitations of the present implementation.

Ambulatory Care Information Systems↗
PubMed1998

Physician office-based diabetes care: comparison to guidelines for care.

Over the past decade, we have seen a significant increase in hospitalizations in South Carolina for the major complications of diabetes: myocardial infarcts (+68 percent), amputations (+61 percent), end stage renal disease (+85 percent), diseases of blood vessels (+100 percent), and eye complications (+52 percent). Many of these late stage complications can be prevented or their progression slowed down by early recognition and institution of intensive, well-defined preventive strategies. Independent surveys reviewed above indicate that such preventive practices are not being fully utilized in South Carolina. As one key example, less than 50 percent of people with diabetes receive self-management education. A number of simple and relatively inexpensive laboratory and physical examinations which would trigger preventive and remedial therapy are also performed at less than adequate frequency. The challenge is for all to use these examinations to guide therapy and to continue to monitor and intervene to prevent complications of diabetes. The DSC Board of South Carolina has developed a Ten Year Strategic Plan with nine major goals to improve diabetes care and outcomes in South Carolina. To improve office-based care of diabetes in South Carolina, all health professionals must assume responsibility for closely monitoring each person with diagnosed diabetes and assure that glycemic control is optimized. Early signs of complications must be recognized and interventions to limit their progression utilized. Screening of high-risk individuals to identify the estimated one-third of persons with diabetes who are undiagnosed, targeted education programs to the primary care professionals who deliver the majority of care to individuals with diabetes, implementation of the proven, cost-effective measures that can prevent (postpone) the complications of diabetes, monitoring of the health care delivery system and addressing the potential barriers to adequate care for all persons with diabetes are essential steps to decrease the burden of diabetes for South Carolinians (Table 1).

Diabetes Mellitus↗
PubMed2003

[The GCP directive--consequences for clinical drug research].

The contents and implications of the EU Directive on good clinical (research) practice (GCP) regarding drug trials are described. As of May 2003, clinical researchers in Denmark must have standard operation procedures, conduct monitoring, consider quality assurance, and expect inspections. The industry may be better prepared, but the Directive makes GCP part of the law and phase IV studies become subject to GCP. Patients will be assured the same quality in trials irrespective of the industry or investigator being the sponsor and may look forward to quality improvement of drug trials.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

[Chronic rhinosinusitis. What is new from the last 25 years?].

Chronic rhinosinusitis (CRS) appears to be of increasing relevance epidemiologically. Despite progress in elucidating the role of eosinophilia as well as aspirin intolerance and eicosanoid mediators, the pathophysiology remains obscure. Endonasal sinus surgery has become the treatment of the choice for CRS patients with and without nasal polyposis, particularly if conservative treatment fails. Long-term studies indicate that a minimally invasive approach with microscopic and endoscopic procedures is preferable to radical surgery. Powered instrumentation or computer-aided surgery are still controversially discussed, but certainly can be very helpful in the hands of an experienced surgeon, especially to minimize surgical trauma and save surgical time. The complex therapeutic concept needs to be individually tailored to the disease of the patients and to the heterogeneous etiologic aspects.

Chronic Disease↗
PubMed2005

[New medications for treatment of systemic mycoses].

The past few years have seen the advent of several new antifungal agents. The echinocandin, caspofungin, has greatly expanded the antifungal armamentarium by providing a cell wall-active agent with candidacidal activity as well as demonstrated clinical efficacy in the therapy of aspergillosis refractory to available therapy. In addition, in clinical trials, caspofungin exhibited efficacy comparable to amphotericin B for invasive and/or fluconazole-resistant Candida infections. According to a randomised trial, voriconazole has added a significantly improved therapeutic option for primary therapy of invasive aspergillosis. Additionally, voriconazole may be used successfully as salvage therapy for other fungal infections, i.e. cryptococcosis. Despite the advances offered by each of these drugs, the morbidity and mortality associated with invasive fungal infections remains high. Considering the adverse effects of the available antifungal agents and the considerable costs for their application, meaningful clinical trials for a precise indication in different clinical situations are urgently needed.

Antifungal Agents↗
PubMed2006

[Bronchial asthma. Update 2006].

Bronchial asthma, with a prevalence in Germany of 5% among adults and 10% among children, remains a frequent disease. Newer cell biological data show a separate regulation of the allergy (interleukin 4, IL-4, pathway) and of the eosinophilic inflammation in asthma (IL-5 pathway). Both conditions require a therapeutic approach. To prevent irreversible bronchial remodeling, early diagnosis and targeted therapy are decisive. Bronchial asthma is regarded as evident when the paroxysmal character of the disease is confirmed and an-at least intermittent-obstructive ventilation disorder is apparent which responds well to short-acting beta2-adrenergic agents. Current asthma treatment has been assured in many studies (evidence level A) and is based on therapy in stages which classifies therapeutic measures depending on four grades of severity. Accordingly, most patients are largely without complaints, and nocturnal attacks are now rare. New medications are intended to overcome any remaining therapeutic weak points. Antileukotrienes and anti-IgE antibodies can contribute to reducing the necessary corticosteroids. Pharmaceutical agents that intervene in the IL-4 or IL-5 regulation or prevent remodeling are being developed.

Asthma↗
PubMed2005

[Arterial hypertension and dementia].

Arterial hypertension (AH) is considered to be an important risk factor for vascular cognitive impairment and probably for Alzheimer's disease, too. In the current review we provide an overview of the major prospective clinical trials on this issue. With respect to the inconsistent findings of these studies one must state that the interrelations between AH and dementia are still incompletely understood. Regarding therapy there thus is a simple rule: AH should be treated until normal blood pressure values are reached. As long as the hypothesis of a J-curve between blood pressure and cognitive dysfunction has not been disproved, overaggressive blood pressure lowering cannot be recommended. Regarding the aim of preventing dementia, there is no evidence for the superiority of a specific antihypertensive treatment regimen.

Antihypertensive Agents↗
PubMed2005

[Quality assurance in echocardiography. Three-level system in formation and qualifying and concept of an external quality review].

Measures of quality assurance in echocardiography can be categorized according to standard principles into measures of reviewing structure, processing, and results. This document contains 1) the description of a three level system for education and qualifying in echocardiographic examinations (quality of structure) and 2) the draft of an external quality assurance process for reviewing the results of one echocardiographic investigator or of one laboratory of echocardiography (quality of results). The document also contains a draft description of a nationwide independent institution for certification, which is needed for both projects.A level 1 investigator should be able to perform and interpret a basic investigation. A basic investigation allows to exclude most of all cardiac diseases that can be diagnosed by echocardiography, and pathological findings should be filtered out. A level 2 investigator is able to perform an extended examination, and a comprehensive echocardiographic diagnosis can be established after her or his examination. Additional specific training and experience is necessary to be certified for TEE and stress echo examinations. A level 3 echocardiographer has done research work in echocardiography and should have performed certified teaching courses in echocardiography. The external quality assurance process should provide the possibility to certify the results and reports of a single investigator or of an echo laboratory, according to standard principles of reviewing the records. The process of certification is exclusively performed on a voluntary basis. The nationwide institution of certification should be part of the academy of education in cardiology of the German Society of Cardiology.

Cardiology↗