Breast Elastography: How to Perform and Integrate Into a “Best‐Practice” Patient Treatment Algorithm

2019 ◽  
Vol 39 (1) ◽  
pp. 7-17 ◽  
Author(s):  
Richard G. Barr
Keyword(s):  
Best Practice ◽  
Treatment Algorithm ◽  
Patient Treatment ◽  
Practice Patient ◽  
Breast Elastography

Multidisciplinary approach for improvement of immunotherapy utilization in solid tumors with H MSI /dMMR –An action plan from a single oncology center

2021 ◽  
Vol 3 (1) ◽  
pp. 1-5
Author(s):  
Nagwa Ibrahim ◽  
Muneerah Alzouman ◽  
Abdulaziz Alhamad ◽  
Muneera AlMajed ◽  
Mohamed Almeziny ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mismatch Repair ◽  
Solid Tumors ◽  
Immune Checkpoint Inhibitors ◽  
Best Practice ◽  
Multidisciplinary Approach ◽  
Checkpoint Inhibitors ◽  
Action Plan ◽  
Oncology Center ◽  
Practice Patient

Immune checkpoint inhibitors such as nivolumab and pembrolizumab are approved by Food and Drug Administration for patients diagnosed with metastatic solid tumors with high microsatellite instability (MSI) or mismatch repair deficient (dMMR). The prognosis of these patients is generally poor, that is why it is very essential to identify the targeted patients who can benefit from immunotherapy. Pembrolizumab is approved in our institution for this indication. In order to ensure proper utilization of available resources, we decided to make a pilot retrospective review to evaluate pembrolizumab utilization, to identify the problems we are facing then to set an action plan through multidisciplinary approach. Based on the results we set recommendations. This paper is innovative and the first in kind. It could be used as guidance for other centers using immunotherapy and could be applied for other drugs as well to ensure best practice, patient safety and maximize utilization of resources.

scholarly journals Antimicrobial Management of Complicated Skin and Soft Tissue Infections in an Era of Emerging Multi-Drug Resistance: Perspectives from 5 Gulf Countries

2021 ◽  
Vol 11 (3) ◽  
pp. 89-101
Author(s):  
Wadha Alfouzan ◽  
Zainab Al-Balushi ◽  
Muna Al-Maslamani ◽  
Asmaa Al-Rashed ◽  
Salman Al-Sabah ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Best Practice ◽  
Arabian Gulf ◽  
Epidemiological Data ◽  
Patient Treatment ◽  
Multi Drug Resistance ◽  
Multidisciplinary Teams ◽  
Soft Tissue Infections ◽  
Gulf Region ◽  
Complicated Skin

The number of complicated skin and soft tissue infections (cSSTIs) in the Arabian Gulf region has risen in recent years, particularly those caused by multi-drug resistant (MDR) pathogens. The high prevalence of diabetes, obesity, and associated cardio-metabolic comorbidities in the region renders medical and surgical management of cSSTI patients with MDR infections challenging. An experienced panel of international and regional cSSTI experts (consensus group on cSSTIs) was convened to discuss clinical considerations for MDR infections from societal, antimicrobial stewardship, and cost perspectives, to develop best practice recommendations. This article discusses antibiotic therapies suitable for treating MDR cSSTIs in patients from the Gulf region and recommends that these should be tailored according to the local bacterial ecology by country and region. The article highlights the need for a comprehensive patient treatment pathway and defined roles of each of the multidisciplinary teams involved with managing patients with MDR cSSTIs. Aligned and inclusive definitions of cSSTIs for clinical and research purposes, thorough and updated epidemiological data on cSSTIs and methicillin-resistant Staphylococcus aureus in the region, clearcut indications of novel agents and comprehensive assessment of comparative data should be factored into decision-making are necessary.

scholarly journals Clinical Approach After Complicated Ear Mold Fitting: A Case Series of Six Patients and Evaluation of Literature

2019 ◽  
Vol 128 (12) ◽  
pp. 1141-1146
Author(s):  
Cindy van den Boer ◽  
Erik van Spronsen ◽  
Carlijn T. Q. Holland ◽  
Fenna A. Ebbens ◽  
Jérôme J. Waterval
Keyword(s):  
Middle Ear ◽  
Best Practice ◽  
Adverse Outcome ◽  
Treatment Algorithm ◽  
Significant Risk ◽  
Case Series ◽  
Mold Material ◽  
Clinical Approach ◽  
Temporal Bone Ct ◽  
Clinical Strategies

Objectives: Insertion of mold material into the middle ear is a complication of molding procedure for ear impression. These cases are referred to an ENT specialist. There is no standardized approach to this problem. Literature shows different clinical strategies. The aim of this study is to share our experience and to analyze the adverse outcome of different clinical approaches. Methods: A case series of six patients with molding material inside the middle ear after complicated molding procedure for swimming earplugs are described. Additionally, available literature was reviewed to analyze results of the clinical approach after iatrogenic molding procedures. Forty-nine ears were included. Results: In-office removal of the material is associated with a significant risk of adverse outcome if the eardrum cannot be examined. This also accounts for ossicular involvement. Conclusions: Temporal bone CT is advised in patients after complicated ear mold fitting if the tympanic membrane cannot be examined completely or the middle ear is involved. Blind removal should be avoided. Retroauricular transcanal tympanotomy or transmastoidal tympanotomy with facial recess approach is best practice in case the mold material has entered the middle ear. A clinical treatment algorithm is presented.

The impact of ‘best-practice’ patient care in fibromyalgia on practice economics

2011 ◽  
Vol 18 (4) ◽  
pp. 793-798 ◽  
Author(s):  
T. Michelle Brown ◽  
Suchita Garg ◽  
Arthi B. Chandran ◽  
Michael McNett ◽  
Stuart L. Silverman ◽  
...  
Keyword(s):  
Patient Care ◽  
Best Practice ◽  
The Impact ◽  
Practice Patient

scholarly journals A comparison of Australasian jurisdictional ambulance services’ paramedic clinical practice guidelines series: Adult sepsis

2021 ◽  
Vol 18 ◽  
Author(s):  
Matt Wilkinson-Stokes ◽  
Elena Ryan ◽  
Michael Williams ◽  
Maddison Spencer ◽  
Sonja Maria ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
Patient Treatment ◽  
Meningococcal Sepsis ◽  
Meningococcal Septicaemia ◽  
Sequence Induction

IntroductionThis article forms part of a series that seeks to identify interjurisdictional differences in the scope of paramedic practice and differences in patient treatment based upon which jurisdiction a patient is geographically located within at the time of their complaint. Methods The current CPGs of each JAS were accessed during June 2020, and updated in August 2021. Content was extracted and verified. ResultsNine services provide antibiotics for meningococcal septicaemia, with dosage ranging from 1 – 4 grams. Five services provide antibiotics for non-meningococcal sepsis (three under doctor approval), with choice of antibiotic including Ceftriaxone, Benzylpenicillin, Amoxicillin, and Gentamicin. Three services provide antipyretics, one provides corticosteroids under doctor approval, and all provide fluids (with dosage ranging from 20 – 60 ml/kg). ICPs are allowed to provide adrenaline infusions in nine services, noradrenaline in three services (one requiring doctor approval), and metaraminol in three services. Two additional services restrict metaraminol to specialist paramedics, with one of these requiring doctor approval. Two services perform phlebotomy and one takes lactate. Paramedics perform unassisted intubation in one service, with nine restricting this to ICPs. Facilitated or Ketamine-only intubation is performed by ICPs in one service. Rapid or delayed sequence induction is performed by ICPs in six services, and restricted to specialists in two services. ConclusionThe domestic jurisdictional ambulance services in Australasia have each created unique treatment clinical practice guidelines that are heterogeneous in their treatments and scopes of practice. A review of the evidence underlying each intervention is appropriate to determining best practice.

scholarly journals A comparison of Australasian jurisdictional ambulance services’ paramedic clinical practice guidelines series: Adult anaphylaxis

2021 ◽  
Vol 18 ◽  
Author(s):  
Matt Wilkinson-Stokes ◽  
Desiree Rowland ◽  
Maddison Spencer ◽  
Sonja Maria ◽  
Marc Colbeck
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
Ipratropium Bromide ◽  
Rapid Sequence Induction ◽  
Patient Treatment ◽  
Rapid Sequence ◽  
Nebulised Salbutamol ◽  
Sequence Induction

IntroductionThis article forms part of a series that seeks to identify interjurisdictional differences in the scope of paramedic practice and, consequently, differences in patient treatment based on which jurisdiction a patient is geographically located within at the time of their complaint. Methods The current Clinical Practice Guidelines of each Australasian domestic jurisdictional ambulance service (JAS) were accessed during June 2020 and updated in August 2021. Content was extracted and verified by 18 paramedics or managers representing all 10 JASs. ResultsAll JASs use intramuscular adrenaline as a first-line agent for adult anaphylaxis. Beyond this, significant differences exist in all treatments: five services provide nebulised adrenaline; 10 services provide adrenaline infusions (one requires doctor approval; one provides repeat boluses); six services provide nebulised salbutamol; two services provide salbutamol infusions (one requires doctor approval; one provides repeat boluses); five services provide nebulised ipratropium bromide; eight services provide corticosteroids (two restricted to intensive care paramedics (ICPs)); five services provide antihistamines for non-anaphylactic or post-anaphylactic reactions; four services provide glucagon (one requires doctor approval); magnesium is infused by ICPs in two services; 10 services allow unassisted intubation in anaphylactic arrest; one service allows ICPs to provide sedation-facilitated intubation or ketamine-only breathing intubation; eight services allow rapid sequence induction (two restricted to specialist roles). ConclusionThe JASs in Australasia have each created unique treatment clinical practice guidelines that are heterogeneous in their treatments and scopes of practice. A review of the evidence underlying each intervention is appropriate to determining best practice.

scholarly journals Postoperative Nausea and Vomiting: Development of a Management Protocol

1998 ◽  
Vol 26 (2) ◽  
pp. 152-155 ◽  
Author(s):  
M. J. Paech ◽  
T. J. G. Pavy ◽  
J. H. Kristensen ◽  
R. E. Wojnar-Horton
Keyword(s):  
Nursing Education ◽  
Program Implementation ◽  
Postoperative Nausea ◽  
Treatment Algorithm ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Patient Treatment ◽  
Continuous Quality ◽  
Antiemetic Drugs ◽  
Management Protocol

Postoperative nausea and vomiting (PONV) is still an important and common problem. Despite the introduction of new antiemetic drugs, the management of PONV remains difficult. In this article we describe the development and evaluation of a management protocol for PONV, which consists of a treatment algorithm accompanied by a nursing education program. Implementation of this management protocol has been well-accepted by staff, appears to have reduced delay in patient treatment and improved patient care, and has significantly reduced staff workload. It is planned to use continuous quality improvement techniques to further refine the algorithm and continue assessment of its efficacy and of patient satisfaction.

scholarly journals 182. Appropriateness of Treatment Duration for S. aureus Bacteremia (SAB)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S112-S112
Author(s):  
Kristin Griebe ◽  
Rachel Kenney ◽  
Susan L Davis
Keyword(s):  
Adverse Effects ◽  
Treatment Duration ◽  
Best Practice ◽  
Clinical Success ◽  
Treatment Algorithm ◽  
Kidney Injury ◽  
Positive Culture ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Hospital Length Of Stay

Abstract Background An algorithm-based guide to optimal treatment duration in staphylococcus bacteremia demonstrated a non-inferior rate of clinical success compared with standard of care. The purpose of this descriptive study was to assess appropriateness of staphylococcus bacteremia duration of therapy according to the SAB treatment algorithm. Methods IRB approved, retrospective cohort describing antibiotic use in S. aureus bacteremia across a health system from January to March 2019. Patients were included if they had at least one blood culture with S. aureus. Exclusion criteria included transfer from outside hospital, concurrent osteomyelitis diagnosis, and death within 72 hours of positive culture. The primary outcome was the appropriate duration of antibiotics for uncomplicated SAB. Secondary outcomes included clinical failure, antibiotic adverse effects, 90-day mortality, and hospital length of stay. Results A total of 59 patients were included. The median age was 66 years old and 22 patients (37.3%) were female. Diagnosis: uncomplicated SAB 28 (47.5%) and complicated SAB 31 (52.5%); MRSA 32 (%) and MSSA 27 (%). Infectious Diseases Consultation 56 (94.9%). 4 patients died before treatment duration was determined. Breakdown of treatment durations and clinical failures are listed in Tables 1. Appropriate duration occurred in 9 (32.1%) of patients with SAB. Overall, 14 patients experiences antibiotic adverse effects, 11 which occurred in antibiotic use for ≥4 weeks, 4 occurred in patients with uncomplicated SAB treated for ≥4 weeks. Breakdown of adverse effects: acute kidney injury 9, myositis 1, rash 1, nausea/vomiting 1, anaphylaxis 1, hypersensitivity pneumonitis 1. Conclusion Excess treatment duration for uncomplicated SAB was common (16%), in this study, inconsistent with best practice recommendations. 79% of adverse effects occurred in patients who received a ≥4 week course. The results of this study suggest more efforts are needed to implement contemporary evidence-based treatment duration algorithms for uncomplicated SAB to minimize unnecessary antibiotic harm. Disclosures All authors: No reported disclosures.

scholarly journals Investigation of Fugitive Aerosols Released into the Environment during High-Flow Therapy

Pharmaceutics ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 254 ◽  
Author(s):  
James A. McGrath ◽  
Ciarraí O’Toole ◽  
Gavin Bennett ◽  
Mary Joyce ◽  
Miriam A. Byrne ◽  
...  
Keyword(s):  
Flow Rate ◽  
Gas Flow ◽  
Best Practice ◽  
Risk Mitigation ◽  
High Flow ◽  
Nasal Cannula ◽  
Patient Treatment ◽  
Head Model ◽  
Gas Flow Rate ◽  
Fugitive Emissions

Background: Nebulised medical aerosols are designed to deliver drugs to the lungs to aid in the treatment of respiratory diseases. However, an unintended consequence is the potential for fugitive emissions during patient treatment, which may pose a risk factor in both clinical and homecare settings. Methods: The current study examined the potential for fugitive emissions, using albuterol sulphate as a tracer aerosol during high-flow therapy. A nasal cannula was connected to a head model or alternatively, a interface was connected to a tracheostomy tube in combination with a simulated adult and paediatric breathing profile. Two aerodynamic particle sizers (APS) recorded time-series aerosol concentrations and size distributions at two different distances relative to the simulated patient. Results: The results showed that the quantity and characteristics of the fugitive emissions were influenced by the interface type, patient type and supplemental gas-flow rate. There was a trend in the adult scenarios; as the flow rate increased, the fugitive emissions and the mass median aerodynamic diameter (MMAD) of the aerosol both decreased. The fugitive emissions were comparable when using the adult breathing profiles for the nasal cannula and tracheostomy interfaces; however, there was a noticeable distinction between the two interfaces when compared for the paediatric breathing profiles. The highest recorded aerosol concentration was 0.370 ± 0.046 mg m−3 from the tracheostomy interface during simulated paediatric breathing with a gas-flow rate of 20 L/min. The averaged MMAD across all combinations ranged from 1.248 to 1.793 µm by the APS at a distance of 0.8 m away from the patient interface. Conclusions: Overall, the results highlight the potential for secondary inhalation of fugitive emissions released during simulated aerosol treatment with concurrent high-flow therapy. The findings will help in developing policy and best practice for risk mitigation from fugitive emissions.

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