Key service elements – (b) initial assessment and treatment

2002 ◽  
pp. 42-57
Keyword(s):  
Initial Assessment ◽  
Assessment And Treatment

Abstract 3446: Inpatient Code Stroke Protocol: A Quality Improvement and Knowledge Translation Strategy for a Challenging Scenario

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jacqueline D Willems ◽  
Krsytyna Skrabka ◽  
Roseane Nisenbaum ◽  
Judith Barnaby ◽  
Pawel Kostyrko ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Robust Regression ◽  
Stroke Care ◽  
Initial Assessment ◽  
Stroke Severity ◽  
Care Hospital ◽  
Presenting Symptoms ◽  
Number Of Patients ◽  
Assessment And Treatment

Background: Stroke care faces a clinical challenge in treating inhospital strokes, which account for about 15% of all strokes. Prior studies showed an inequity in the assessment and treatment of inpatients who suffer a stroke versus out-of hospital. For example, inpatients have longer time to initial assessment, CT and are less likely (wait longer) to receive tissue plasminogen activator (t-PA). There is limited research evaluating the efficacy of inpatient code stroke protocols (ICSP) on access to and quality of hyper-acute stroke care. Objective: To evaluate the efficacy of the ICSP in a large tertiary care hospital. Methods: This prospective study evaluated a quality improvement strategy involving ICSP implementation at St Michael’s Hospital in 2009. The ICSP focuses on the identification of stroke symptoms and timely notification of most responsible physician, then leverages the Emergency Department code stroke process. A 3-month hospital-wide implementation period involved 60 min. education sessions with a minimum of 2 sessions per unit. Demographic factors, presenting symptoms, stroke severity, vascular risk factors as well as time of: symptoms onset, CT; and physician assessment were collected by chart abstraction after ethics approval. The primary outcomes was time from last seen normal (LSN) to CT scan. Secondary outcomes include time from LSN to initial assessment (IA), medical complications and number of patients receiving endovascular interventions or intravenous thrombolysis. The analysis was completed by comparing unadjusted and adjusted outcomes pre and post implementation of the ICSP. Descriptive statistics and robust regression was completed using SAS 9.0. Results: Overall, there were 245 inhospital strokes during the study period (152 pre and 93 post ICSP implementation). Mean age was 69.8 yrs, 60% were male. Most inpatient strokes occurred on cardiovascular services (42.9%). Main results summarized in table . There was no difference in the number of patients receiving thrombolysis or endovascular treatment. After adjustment for covariates, the ICS was associated with a significant reduction of 288 minutes (95%CI -566, -10) in time from LSN to CT. Similarly, there was significant reduction of 307 (95%CI -532, -82) in time from LSN to IA. Conclusions: Implementation of the ICSP resulted in improvements in the process indicators related to assessment and treatment of hyper-acute stroke. Similar quality improvement strategies can be implemented to ameliorate disparities between care for inpatients and outpatient presenting with an acute ischemic stroke.

scholarly journals Timing of Repair or Reconstruction after Knee Dislocation

2019 ◽  
Vol 33 (04) ◽  
pp. 335-338
Author(s):  
Gregory C. Fanelli
Keyword(s):  
Ligament Reconstruction ◽  
Head Injuries ◽  
Knee Dislocation ◽  
Organ System ◽  
Initial Assessment ◽  
Surgical Timing ◽  
Knee Ligament ◽  
Knee Ligament Reconstruction ◽  
Assessment And Treatment ◽  
Injured Knee

AbstractThe multiple ligament injured knee (knee dislocation) is, often times, part of a multisystem injury complex that can include not only injuries to knee ligaments but also to blood vessels, skin, nerves, bones (fractures), head injuries, and other organ system trauma. These additional injuries can affect surgical timing for knee ligament reconstruction and also affect the results of the treatment. This article will present the author's approach and experience in the initial assessment and treatment of the acute multiple ligament injured (dislocated) knee, and also present considerations in the treatment of chronic multiple ligament injured knee.

scholarly journals Evaluation of a community based service for urgent psychiatric assessment

1996 ◽  
Vol 20 (10) ◽  
pp. 592-595 ◽  
Author(s):  
M. J. Crawford ◽  
D. Kohen ◽  
J. Dalton
Keyword(s):  
General Practitioner ◽  
Initial Assessment ◽  
Medical Professionals ◽  
Hospital Services ◽  
Community Based ◽  
Psychiatric Assessment ◽  
Assessment And Treatment ◽  
Set Up

The Urgent Assessment Service (UAS) was set up to provide community based urgent psychiatric assessment to a range of referrers. The work of the service was assessed over a six month period. Results show that it was popular with a broad range of medical and non-medical professionals. Patients generally presented with depression or psychotic illnesses and those referred from non-medical sources were more likely to be suffering from schizophrenia and assessed as being at least as unwell as those referred by GPs and hospital based doctors. Rates or referral to hospital services were low with the vast majority of patients being referred back to their general practitioner after initial assessment and treatment.

Whiplash injury – initial assessment and treatment of long-term sequellae

2000 ◽  
Vol 57 (12) ◽  
pp. 716-719
Author(s):  
Radanov
Keyword(s):  
Whiplash Injury ◽  
Initial Assessment ◽  
Assessment And Treatment

Voraussetzung für adäquates Management der Verletzten nach HWS-Distorsion sind die genaue Kenntnis der Symptome und Risikofaktoren eines verzögerten Heilverlaufs sowie der empirischen Grundlage der Therapie. Diese Kenntnisse ermöglichen eine integrative initiale Beurteilung, welche zu einer entsprechenden Therapie und Verhinderung von Chronifizierung führen kann.

Progression of visual loss and time between initial assessment and treatment of wet age-related macular degeneration

2005 ◽  
Vol 40 (3) ◽  
pp. 313-319 ◽  
Author(s):  
Alejandro Oliver-Fernandez ◽  
Jeff Bakal ◽  
Shaun Segal ◽  
Gaurav K. Shah ◽  
Ashish Dugar ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Visual Loss ◽  
Age Related Macular Degeneration ◽  
Initial Assessment ◽  
Age Related ◽  
Assessment And Treatment

scholarly journals Sepsis in children: Initial assessment and treatment

2017 ◽  
Vol 64 (1) ◽  
pp. 49-53
Author(s):  
Izabella Fabri ◽  
Goran Rakic ◽  
Danica Stanic ◽  
Biljana Draskovic
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Clinical Symptoms ◽  
Cost Effective ◽  
Initial Assessment ◽  
Hemodynamic Stability ◽  
Early Administration ◽  
Early Management ◽  
Assessment And Treatment ◽  
Vasoactive Medications

Severe sepsis is the leading cause of mortality among children aged under the age of 5 years. The four main causes of sepsis in children are pneumonia, malaria, measles and diarrhoea. Preventing sepsis is extremely important and immunization of children and regular hand hygiene proved to be very efficient and cost effective in avoiding the development of diseases that may lead to sepsis. Clinical symptoms of all stadiums of sepsis in children are often non specific, but early diagnosis is extremely important. The initial treatment of sepsis in children has to be adjusted to the developmental stadium, age, the capacity of its immune system and the likely cause of infection. In studies on children early administration of antimicrobial therapy proved to be efficient. Early management of septic shock should consist of rapid boluses of crystalloids and 5% albumin solutions and administration of vasoactive medications until hemodynamic stability is achieved.

Behavioral Assessment and Treatment of Aerophagia

2021 ◽  
pp. 153465012110645
Author(s):  
Mirela Cengher ◽  
Craig W. Strohmeier
Keyword(s):  
Problem Behavior ◽  
Divided Attention ◽  
Differential Reinforcement ◽  
Behavioral Assessment ◽  
Social Consequences ◽  
Initial Assessment ◽  
Negative Effects ◽  
Assessment And Treatment ◽  
Clinically Significant ◽  
Graduated Exposure

Aerophagia is characterized by excessive air swallowing and can have serious negative effects on one’s health. We present the assessment and treatment of a 16-year-old girl, Khloe, with developmental disabilities and aerophagia. The initial assessment indicated that aerophagia occurred primarily to access attention in a divided attention context; however, our function-based treatment did not result in a clinically significant reduction in problem behavior. We then conducted a second assessment that indicated that Khloe’s aerophagia indeed occurred primarily in a divided attention context, but that it persisted independent of social consequences. We concluded that the divided attention context served as a motivating variable for aerophagia. Our second treatment consisted of differential reinforcement of other behavior, noncontingent access to competing stimuli, and graduated exposure to contextual variables (i.e., people and divided attention) that occasioned aerophagia. The treatment was successful in reducing rates of aerophagia. We discuss implications for assessment and treatment, as well as recommendations for clinicians and students.

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