Overcoming the problem of diagnostic heterogeneity in applying measurement-based care in clinical practice: the concept of psychiatric vital signs

2012 ◽  
Vol 53 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Mark Zimmerman ◽  
Diane Young ◽  
Iwona Chelminski ◽  
Kristy Dalrymple ◽  
Janine N. Galione
Keyword(s):  
Clinical Practice ◽  
Vital Signs ◽  
Measurement Based Care

Abstract 65: Timing of Complications Related to Current Post tPA Protocol

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Katja Bryant ◽  
Kim Anda ◽  
Leslie Busby ◽  
Deborah Camp ◽  
Kerrin Connely ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Practice Guidelines ◽  
Vital Signs ◽  
Current Clinical Practice ◽  
Neurological Assessment ◽  
Symptomatic Intracranial Hemorrhage ◽  
The Mean ◽  
Q 30 ◽  
Assessment Frequency ◽  
Mean Time

The current clinical practice guidelines (CPG) based on the NINDS trial from 1995 recommend that vital signs and neuro checks are completed Q15 min x 2 hrs., Q 30 min x 6 hrs., Q 1 hour x 16 hrs. post administration of IV t-PA. The half-life (t ½α ) of Alteplase is <5 min, therefore the current vigilance of neurological assessments may not be necessary. The purpose of this study was to evaluate the timing of when a symptomatic intracranial hemorrhage (sICH) occured in relation to the administration of IV t-PA. Results: A total of 569 patients who received IV t-PA were reviewed. Nine patients, with a mean age of 70 ± 17 years and mean NIHSS of 11, were diagnosed with a sICH within 36 hrs. post IV t-PA administration. The mean time of detecting sICH post IV t-PA administration was 294 minutes. The shortest time was 77 min and the longest time was 814 min (13 hrs and 34 min). The vast majority (77%) of the sICH complications were diagnosed in less than 6 hrs. Conclusions: This analysis suggests that sICH occurs early in the course after administration of IV t-PA. Future guidelines may consider reducing the neurological assessment frequency after 12 hours from IV t-PA administration. Prospective controlled studies are required to validate these results.

The global elements of vital signs' assessment: a guide for clinical practice

2021 ◽  
Vol 30 (16) ◽  
pp. 956-962
Author(s):  
Malcolm Elliott
Keyword(s):  
Clinical Practice ◽  
Outcomes Research ◽  
Quality Care ◽  
Vital Signs ◽  
Clinical Judgement ◽  
Evidence Based ◽  
Valuable Insight ◽  
High Quality ◽  
Culture Tradition ◽  
Insight Into

The assessment of vital signs is critical for safe, high-quality care. Vital signs' data provide valuable insight into the patient's condition, including how they are responding to medical treatment and, importantly, whether the patient is deteriorating. Although abnormal vital signs have been associated with poor clinical outcomes, research has consistently found that vital signs' assessment is often neglected in clinical practice. Factors contributing to this include nurses' knowledge, clinical judgement, culture, tradition and workloads. To emphasise the importance of vital signs' assessment, global elements of vital signs' assessment are proposed. The elements reflect key principles underpinning vital signs' assessment and are informed by evidence-based literature.

Evaluation of Outcomes With Citalopram for Depression Using Measurement-Based Care in STAR*D: Implications for Clinical Practice

2006 ◽  
Vol 163 (1) ◽  
pp. 28-40 ◽  
Author(s):  
Madhukar H. Trivedi ◽  
A. John Rush ◽  
Stephen R. Wisniewski ◽  
Andrew A. Nierenberg ◽  
Diane Warden ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Measurement Based Care

What can the randomness of missing values tell you about clinical practice in large data sets of children’s vital signs?

2020 ◽  
Author(s):  
Damian Roland ◽  
Neslihan Suzen ◽  
Timothy J. Coats ◽  
Jeremy Levesley ◽  
Alexander N. Gorban ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Missing Values ◽  
Vital Signs ◽  
Large Data ◽  
Large Data Sets ◽  
Data Sets

scholarly journals Patient, family and provider views of measurement-based care in an early-psychosis intervention programme

BJPsych Open ◽  
2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Ari B. Cuperfain ◽  
Katrina Hui ◽  
Suze G. Berkhout ◽  
George Foussias ◽  
David Gratzer ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Healthcare Delivery ◽  
Early Psychosis ◽  
Shared Decision ◽  
Structured Interviews ◽  
National Guidelines ◽  
Intervention Programme ◽  
Measurement Based Care

Background Measurement-based care (MBC) in mental health improves patient outcomes and is a component of many national guidelines for mental healthcare delivery. Nevertheless, MBC is not routinely integrated into clinical practice. Several known reasons for the lack of integration exist but one lesser explored variable is the subjective perspectives of providers and patients about MBC. Such perspectives are critical to understand facilitators and barriers to improve the integration of MBC into routine clinical practice. Aims This study aimed to uncover the perspectives of various stakeholders towards MBC within a single treatment centre. Method Researchers conducted qualitative semi-structured interviews with patients (n = 15), family members (n = 7), case managers (n = 8) and psychiatrists (n = 6) engaged in an early-psychosis intervention programme. Data were analysed using thematic analysis, informed by critical realist theory. Results Analysis converged on several themes. These include (a) implicit negative assumptions; (b) relevance and utility to practice; (c) equity versus flexibility; and (d) shared decision-making. Providers assumed patients’ perspectives of MBC were negative. Patients’ perspectives of MBC were actually favourable, particularly if MBC was used as an instrument to engage patients in shared decision-making and communication rather than as a dogmatic and rigid clinical decision tool. Conclusions This qualitative study presents the views of various stakeholders towards MBC, providing an in-depth examination of the barriers and facilitators to MBC through qualitative investigation. The findings from this study should be used to address the challenges organisations have experienced in implementing MBC.

scholarly journals Design of a nursing objective structured clinical examination of a first-year clinical practice program

2020 ◽  
Vol 54 ◽  
Author(s):  
Cristina Castro-Yuste ◽  
María Jesús Rodríguez-Cornejo ◽  
María José García-Cabanillas ◽  
María de Carmen Paublete-Herrera ◽  
Juan Carlos Paramio-Cuevas ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Learning Outcomes ◽  
Clinical Examination ◽  
Vital Signs ◽  
Objective Structured Clinical Examination ◽  
First Year ◽  
Care Plans ◽  
Clinical Nursing ◽  
Assessment And Monitoring ◽  
Clinical Cases

ABSTRACT Objective: The aim of the present study was to design a content-valid nursing objective structured clinical examination attending a first-year clinical nursing practice program. Method: The examination was designed following a procedure based on the consensus of experts which was comprised of three phases: selection of the activities in which students should be competent according to the learning outcomes of the course, clinical case design, and integration of the clinical cases designed into the stations of the test. Results: Of the 44 surveys submitted for the design of the stations, 37 were answered, of which 31 respondents met the inclusion criteria of the panel of experts. The activities on which the experts reached the highest degrees of consensus were: basic physical assessment and monitoring of vital signs, assessment of hygiene and skin status, ability to develop care plans, management of safety principles in administration of medication and administration of oral medication. Based on the selected activities, the experts developed 20 clinical cases, from which a four-station nursing objective structured clinical examination was designed. Conclusion: The structured methodology based on the design of experts enabled the design of a content-valid objective structured clinical examination appropriate for the evaluation of the learning outcomes achieved by the students attending a clinical practice program.

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