PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Institutional Practice”

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 19 recordsLinked to original sources
PubMed2000

Dietary restrictions for patients with neutropenia: a survey of institutional practices.

PURPOSE/OBJECTIVES: To describe institutional practices related to dietary restrictions for patients with neutropenia to determine whether restrictions are used and when they are implemented and discontinued. DESIGN: Descriptive survey. SAMPLE: 156 institutions belonging to the Association of Community Cancer Centers. METHODS: Mailed survey. FINDINGS: Of the institutions surveyed, 78% (n = 120) placed patients with neutropenia on restricted diets. Participating institutions responded that patients were placed on restricted diets at a variety of different white blood cell and neutrophil counts, including neutrophils < 1,000 (43%) and < 500 (46%). The majority of institutions (92%) placed patients on restricted diets once neutropenia was documented, while only 9% of institutions restricted diets when cancer treatment was initiated. Of the participating institutions, 83% (n = 96) restricted diets only when patients were neutropenic rather than throughout the duration of the chemotherapy regimen. The most commonly restricted foods were fresh fruits and juices (92%), fresh vegetables (95%), and raw eggs (74%). Few institutions restricted tap water (12%). Wine was restricted at 39% of institutions, and beer was restricted at 40% of institutions. CONCLUSIONS: The role of diet in the development of infection in patients with neutropenia is unclear. This unclear role contributes to the variation in dietary restrictions among institutions. IMPLICATIONS FOR NURSING PRACTICE: Additional research should focus on dietary factors contributing to neutropenic infections and establishing criteria for implementation of specific dietary modifications. Nursing assessment should include nutritional status and risk factors for neutropenia and bacterial translocation. Nursing protocols for neutropenic dietary restrictions should be based on research findings.

Bacterial Infections↗
PubMed1999

Changing the institutional practice of prolonged mechanical ventilation after coronary artery bypass graft surgery to early extubation.

Since 1997 some of our cardiac anaesthetists have, whenever possible, extubated the patients early after cardiac surgery to improve their level of comfort, to allow an early return of the cardiopulmonary physiological function, and to help reduce health care costs. After a few months of implementing this practice, an audit was carried out to evaluate the success of early extubation after coronary artery bypass graft (CABG) surgery. Over a 6-month period starting from May 1997, the perioperative data of 110 consecutive patients with good or moderate left ventricular function scheduled for elective CABG were prospectively collected and analysed. The anaesthetic regime was according to the preference of the anaesthetists. Initially consent was obtained from the surgeons when the extubation criteria were fulfilled, but subsequently as the practice became more accepted by the surgeons, extubation was initiated by the anaesthetists. Within 4 hours of admission into the intensive care unit (ICU), 50 (45.5%) of the 110 patients satisfied the early extubation criteria and were extubated. The extubation criteria are described in the article. For the remaining patients, the median duration of mechanical ventilation was 14.3 hours. The profiles of the two groups of patients and the possible reasons for not extubating early are discussed. Forty-five per cent of the patients with moderate to good ventricular function were extubated safely within 4 hours of admission into the ICU after CABG surgery. With gradual acceptance of the practice and a change in mindset amongst all the care givers, more patients can benefit from this practice. This article highlights the challenges associated with changing institutional practices with respect to the postoperative care of cardiac patients.

Analysis of Variance↗
PubMed1994

The Council on Clinical Optometric Care (CCOC): The American Optometric Association's Institutional-Practice Reviewer 1967-1993.

BACKGROUND: For 26 years the CCOC served professional optometry as its institutional-practice reviewer. METHODS: The council used nine standards for accrediting clinical institutions. RESULTS: The benefits of the accreditation process were many, with improved patient care as its cornerstone. CONCLUSION: During its 26 year existence, the Council on Clinical Optometric Care (CCOC) had a major influence on the quality of optometric care.

Accreditation↗
PubMed1994

Anaesthesia in institutional practice in Singapore.

Documentation of the early development of anaesthesia in Singapore is scanty. Before World War II the anaesthetic agents used were mainly chloroform, ether and ethyl-chloride. They were usually administered by the surgeons themselves or by apothecaries under the supervision of the operating surgeon. After World War II, anaesthetists were sent from the United Kingdom to be in charge of all anaesthetics administered in Singapore. From 1956 to 1971, local doctors were sent to the United Kingdom for training and to obtain the specialist degree FFARCS. From 1968 onwards, the Faculty of Anaesthetists of the Royal Australasian College of Surgeons held examinations in Singapore for candidates appearing for FFARACS. This continued until our M Med Anaesthesia examinations, which began in 1974, were well established. The number of specialists has increased over the years. With the decentralisation of the anaesthetic departments in the various hospitals in 1975, and the recent restructuring of Government hospitals, many changes have taken place in the anaesthetic scene. The long-awaited University Department of Anaesthesia was eventually established in 1985. Keeping pace with progress made in the various surgical disciplines, and in other fields of medicine, the duties of anaesthetists in institutional practice have increased enormously. They have extended beyond the operating theatre.

Anesthesia Department, Hospital↗
PubMed2006

Jeffrey J. Magnavita: award for distinguished professional contributions to independent or institutional practice in the private sector.

Presents the citation for Jeffrey J. Magnavita, who received the Award for Distinguished Professional Contributions to Independent or Institutional Practice in the Private Sector "for his passionate devotion to the advancement of the practice and science of psychotherapy." Accompanying the citation are a brief profile and a selected bibliography, as well as Magnavita's award address, entitled In Search of the Unifying Principles of Psychotherapy: Conceptual, Empirical, and Clinical Convergence. ((c) 2006 APA, all rights reserved).

Awards and Prizes↗
PubMed2005

Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference?

BACKGROUND: The management of patients with hemodynamic instability related to pelvic fracture is a major challenge, with high morbidity and mortality. Evidence-based institutional practice guidelines (PG) were developed as a strategy to optimize the care of these patients. The aims of this study were to evaluate the adherence to the new PG and compare the outcomes before and after their implementation. METHODS: Major blunt trauma patients (Injury Severity Score [ISS] > 15) with hemodynamic instability (initial base deficit > 6 mEq/L or received > 6 units of packed red blood cells [PRBCs] during the first 12 hours) related to pelvic fracture were investigated. Patients presenting with ongoing bleeding from other regions or with severe head injury (Glasgow Coma Scale score < 9) were excluded. The pre-PG group (n = 17) were patients managed during the 18 months ending on December 31, 2001. The post-PG group (n = 14) consisted of patients managed during the subsequent 18 months. Demographics, ISS, shock severity, resuscitation, and outcome data were prospectively collected. The adherence to the key steps of PG was evaluated retrospectively in the pre-PG and prospectively in the post-PG group, including abdominal clearance (AC) with diagnostic peritoneal aspiration/lavage or ultrasound (<15 minutes), noninvasive pelvic binding (PB) (<15 minutes), pelvic angiography (PA) (<90 minutes after admission), and minimally invasive orthopedic fixation (MIOF) (<24 hours). Data are presented as mean +/- SEM or percentages. RESULTS: The pre-PG and post-PG groups were similar regarding age (40 +/- 4 years vs. 42 +/- 6 years), gender (both 71% male), ISS (39 +/- 3 vs. 37 +/- 4), admission base deficit (9 +/- 1 vs. 10 +/- 1) admission systolic blood pressure (116 +/- 7 vs. 112 +/- 6 mm Hg), Glasgow Coma Scale score (12 +/- 1 vs. 12 +/- 1), and PRBC transfusion in the first 12 hours (9 +/- 2 U vs. 9 +/- 2 U). The adherence to the guidelines in the post-PG period was as follows: AC, 100%; PB, 86% (p < 0.05 based on t test or chi test); PA, 93% (p < 0.05 based on t test or chi test); and MIOF, 86%. In the pre-PG period, adherence to the guidelines was as follows: AC, 65%; PB, 0%; PA, 30%; and MIOF 52%. In the post-PG period, the 24-hour PRBC transfusion decreased from 16 +/- 2 U to 11 +/- 1 U and the mortality decreased from 35% to 7% (p < 0.05 based on t test or chi test for both). CONCLUSION: The adherence to the PG as a reflection of optimal management was significantly improved. PG focusing particular on timely hemorrhage control reduced the 24-hour transfusion requirements and the mortality rate in the post-PG group.

Adult↗
PubMed1980

Legal standard of due care for pharmacists in institutional practice.

The process by which courts determine negligence on the part of a pharmacist is discussed, and important malpractice decisions involving pharmacists and other medical professionals are summarized. Courts expect pharmacists to exercise a high level of "due care." It is unclear whether a hospital pharmacist would be held t a standard created by general practitioners or by specialists in institutional practice; but a good case can be made for a special standard. If the court finds that professional standards are deficient, the court may establish higher standards. Pharmacists should ensure that their performance meet legal expectations by keeping abreast of new developments in pharmaceutical practice.

Humans↗
PubMed2000

Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used.

PURPOSE: Previous studies have demonstrated the feasibility of sentinel lymph node (SLN) biopsy for nodal staging of patients with breast cancer. However, unacceptably high false-negative rates have been reported in several studies, raising doubt about the applicability of this technique in widespread surgical practice. Controversy persists regarding the optimal technique for correctly identifying the SLN. Some investigators advocate SLN biopsy using injection of a vital blue dye, others recommend radioactive colloid, and still others recommend the use of both agents together. PATIENTS AND METHODS: A total of 806 patients were enrolled by 99 surgeons. SLN biopsy was performed by single-agent (blue dye alone or radioactive colloid alone) or dual-agent injection at the discretion of the operating surgeon. All patients underwent attempted SLN biopsy followed by completion level I/II axillary lymph node dissection to determine the false-negative rate. RESULTS: There was no significant difference (86% v 90%) in the SLN identification rate among patients who underwent single- versus dual-agent injection. The false-negative rates were 11.8% and 5.8% for single- versus dual-agent injection, respectively (P <.05). Dual-agent injection resulted in a greater mean number of SLNs identified per patient (2. 1 v 1.5; P <.0001). The SLN identification rate was significantly less for patients older than 50 years as compared with that of younger patients (87.6% v 92.6%; P =.03). Upper-outer quadrant tumor location was associated with an increased likelihood of a false-negative result compared with all other locations (11.2% v 3. 9%; P <.05). CONCLUSION: In multi-institutional practice, SLN biopsy using dual-agent injection provides optimal sensitivity for detection of nodal metastases. The acceptable SLN identification and false-negative rates associated with the dual-agent injection technique indicate that this procedure is a suitable alternative to routine axillary dissection across a wide spectrum of surgical practice and hospital environments.

Axilla↗
PubMed1993

[Promoting competence in a model trial of a complementary course of study in health sciences/public health at the Berlin Technical University in cooperation with the Free University and other science and general practice institutions].

Since October 1992 (winter semester 92/93) graduates are being educated in Public Health at Berlin Technical University in cooperation with the Free University of Berlin as well as with the Humboldt University of Berlin and other institutions of science and practice in Berlin and Brandenburg. For the time being the course of studies is a pilot project for 4 years. The aim of the postgraduate studies is the creation of permanent structures and therefore institutionalisation. It is open to graduates and college graduates of public-health relevant subject areas of specialisation are "Health Promotion in the community and at the workplace" and "Planning and Management in Health Services". The course of studies takes 4 semesters and is divided into basic studies, studies of main points of emphasis and project studies. Social medicine and especially epidemiology are part of the basic disciplines, which are indispensable for finding the way of looking at problems concerning public health. The reason for the peculiarity with regard to establishing public health at other German universities are the main topics representing the interaction between the technical and ecological development of health. The graduate degree is "Magister of Public Health". During the time of the pilot project the course of studies is subjected to external and internal surveillance regarding quality assurance and quality optimisation of teaching and organisation of the studies. On the one hand this is done by an external advisory committee and on the other hand by internal and external evaluation.

Community Medicine↗