AN INTERNATIONAL POSITION STATEMENT ON THE MANAGEMENT OF FRAILTY IN DIABETES MELLITUS: SUMMARY OF RECOMMENDATIONS 2017

2017 ◽  
pp. 1-11
Author(s):  
A.J. SINCLAIR ◽  
A. ABDELHAFIZ ◽  
T. DUNNING ◽  
M. IZQUIERDO ◽  
L. RODRIGUEZ MANAS ◽  
...  
Keyword(s):  
New England ◽  
American Medical ◽  
Best Practice ◽  
English Language ◽  
Quality Care ◽  
Position Statement ◽  
Evidence Based ◽  
Medicine Journal ◽  
Wide Range ◽  
International Experts

Aim: the the International Position Statement provides the opportunity to summarise all existing clinical trial and best practice evidence for older people with frailty and diabetes. It is the first document of its kind and is intended to support clinical decisions that will enhance safety in management and promote high quality care. Methods: the Review Group sought evidence from a wide range of studies that provide sufficient confidence (in the absence of grading) for the basis of each recommendation. This was supported by a given rationale and key references for our recommendations in each section, all of which have been reviewed by leading international experts. Searches for any relevant clinical evidence were generally limited to English language citations over the previous 15 years. The following databases were examined: Embase, Medline/PubMed, Cochrane Trials Register, Cinahl, and Science Citation. Hand searching of 16 key major peer-reviewed journals was undertaken by two reviewers (AJS and AA) and these included Lancet, Diabetes, Diabetologia, Diabetes Care, British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Journal of Frailty & Aging, Journal of the American Medical Directors Association, and Journals of Gerontology – Series A Biological Sciences and Medical Sciences. Results: two scientific supporting statements have been provided that relate to the area of frailty and diabetes; this is accompanied by evidence-based decisions in 9 clinical domains. The Summary has been supported by diagrammatic figures and a table relating to the inter-relations between frailty and diabetes, a frailty assessment pathway, an exercise-based programme of intervention, a glucose-lowering algorithm with a description of available therapies. Conclusions: we have provided an up to date evidence-based approach to practical decision-making for older adults with frailty and diabetes. This Summary document includes a user-friendly set of recommendations that should be considered for implementation in primary, community-based and secondary care settings.

American Academy of Otolaryngology–Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities

2021 ◽  
pp. 019459982098413
Author(s):  
Cecelia E. Schmalbach ◽  
Jean Brereton ◽  
Cathlin Bowman ◽  
James C. Denneny
Keyword(s):  
American Academy ◽  
Head And Neck ◽  
Best Practice ◽  
Medical Center ◽  
Quality Care ◽  
Academic Medical Center ◽  
Neck Surgery ◽  
Performance Measure ◽  
Head And Neck Surgery ◽  
Evidence Based

Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.

Moving toward patient-based funding through quality-based procedures (QBPs) for GI endoscopy and colposcopy.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 43-43
Author(s):  
Nabeela Ratansi ◽  
Aimee Langan ◽  
Irene Blais ◽  
Erin Svara ◽  
Karla Houser ◽  
...  
Keyword(s):  
Best Practices ◽  
Performance Management ◽  
Capacity Planning ◽  
Best Practice ◽  
Care Delivery ◽  
Clinical Pathways ◽  
Quality Care ◽  
Practice Variation ◽  
Evidence Based ◽  
Gi Endoscopy

43 Background: As part of the Ministry’s Health System Funding Reform initiative, Cancer Care Ontario is tasked to develop and implement Quality-Based Procedures (QBPs) for programs such as GI Endoscopy and Colposcopy. QBPs are clusters of patients with clinically related diagnoses or treatments that have been identified by an evidence-based framework as providing opportunity for improving quality outcomes and reducing costs. As stated by the Ministry, the goal is to reimburse providers for the types and numbers of patients treated, using evidence-informed rates associated with the quality of care delivered. Methods: QBPs are multiyear and have four key deliverables: Clinical: developing clinical best practices. Funding: tying best practices to pricing. Capacity Planning: understanding procedure types/volumes for capacity management. Monitoring/Evaluation: measuring the QBP’s impact. Developing the QBPs has involved: Creating Clinical Expert Advisory Groups (CEAG) of clinicians who are recognized for their knowledge and expertise. Tasking the CEAG to define quality and develop best practices informed by literature reviews, jurisdictional scans, and guidelines. Documenting these standards and clinical pathways in a clinical handbook, providing information on the practices that should be implemented to ensure consistent care delivery. The development of best practices is imperative to the foundation of the QBP and spans multiple years. Once best practice development is complete, it will be tied to pricing, where the procedure will be micro-costed based on workload, equipment, supplies, and other administrative costs. Results: The QBPs continue to evolve and aim to: Reduce practice variation. Improve patient outcomes. Improve system accountability. Improve cost-effectiveness of services. Effectiveness will be measured through a performance management framework, including an integrated QBP scorecard measuring appropriateness, access, and efficiency. Conclusions: The underpinning for moving towards an evidence-based, patient-based funding model involves defining quality standards and clincal best practices, and applying these guidelines to determine the cost of quality care.

Abstract WP400: Simulation Training is a Feasible Implementation Strategy for Evidence Based Stroke Swallowing Screening

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Karen Stonecypher ◽  
Racquell Garrett ◽  
Barbara Kimmel ◽  
Stephanie Daniels ◽  
Jane Anderson
Keyword(s):  
Nursing Staff ◽  
Best Practice ◽  
Simulation Training ◽  
Quality Care ◽  
Video Clip ◽  
Implementation Strategies ◽  
Oral Intake ◽  
Evidence Based ◽  
Train The Trainer ◽  
Swallowing Screening

Backgroud and Purpose: A well-established best practice in providing safe, high quality care for patients with stroke is screening swallowing prior to oral intake. Effective implementation strategies are needed to support evidence based swallowing screening. The use of simulation is now being widely used to train healthcare professionals in evidence based practices. The purpose of this project was to assess the feasibility of simulation training modules (STMs) to support delivery of evidence based swallowing screening with frontline emergency department (ED) nurses. Methods: A train-the-trainer approach was used with (n=8) nurse champions who received didactic instruction and training with video clips and medical mannequins programmed to simulate auditory elements of stroke swallowing screening. After demonstration of mastery, each nurse champion then trained their peers using the same format. Feasibility for implementation of the STMs was evaluated through process mapping. Acquisition of skills was evaluated with a competency checklist and medical mannequins simulated with various stroke patient profiles. Knowledge was assessed using a pre/posttest. Results: A portable simulation lab was set up in the ED and nurse champions trained 100% of nursing staff over a two-month period. A total of 16 simulation sessions were needed to train all nursing staff (N=42). Didactic and video clip review was completed in 45-minute group sessions followed by 30-minute simulation practice sessions. Competency and knowledge was assessed 2-weeks after completing STMs. Competency checkoff sessions were completed in approximately 15-minutes. There was a significant increase in nurses’ knowledge and skills from baseline to posttest. Conclusions: It is feasible to implement STMs with frontline ED nurses. The STMs were beneficial for training and acquisition of skills in a controlled environment with a variety of patient examples. Repeated practice is critical to develop the auditory perceptual skills necessary for swallowing screening interpretation. STMs can be used in the ED for nurses to independently practice and improve swallowing screening skills.

Response to Drs Bergman and Zurhellen

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 842-844
Author(s):  
John B. Coombs
Keyword(s):  
Best Practice ◽  
Medical Condition ◽  
Quality Care ◽  
Biomedical Literature ◽  
Evidence Based ◽  
New Information ◽  
Accuracy And Precision ◽  
Practice Parameters ◽  
Practice Style ◽  
Solo Practitioner

In composing a response to these two articles, I must congratulate both presenters. Each created a stimulating summary of key components of what I consider to be the greatest challenge for practicing physicians in the future: information management. Dr Zurhellen has described an office information system that, in all probability, is enjoyed by fewer than 1 in 50 practitioners currently. Taking advantage of his position as a solo practitioner with a strong interest in computers, he has developed a system that brings greater simplicity, efficiency, and—I dare say—accuracy and precision to his office practice. The greatest challenge for the rest of us will be how to create the transition and the tremendous investment of time, financial resources, and risk that it will surely take to get where he is today. Given the need for improvement in the daily handling of office information, and given the estimated 7500 new articles entered daily in the peer-reviewed biomedical literature, futurists predict that practitioners during the next 15 years will need to adjust both their practice style and their continuing education. They will need to assimilate new information in accordance with this estimate: 75% of what one needs to know to provide top-quality care in any given patient encounter will change during a 12-month period. Dr Bergman has provided an up-to-date glimpse of how we are preparing to meet this challenge. Practice parameters condense new acientific information that is evidence based into defined best practice for a given medical condition. Gaps in evidence-based information are filled by selected expert opinion.

Treatment and management of schizophrenia

2012 ◽  
pp. 578-595 ◽  
Author(s):  
D. G. Cunningham Owens ◽  
E. C. Johnstone
Keyword(s):  
Quality Care ◽  
Single Agent ◽  
Psychosocial Interventions ◽  
Service Development ◽  
Evidence Based ◽  
Care Planning ◽  
Individualized Care ◽  
Wide Range ◽  
Drug Treatments ◽  
Provide Quality Care

The above might be interpreted as inferring that nothing much has changed in the treatment and management of schizophrenia, which remains a somewhat pessimistic, even unrewarding, area of therapeutic endeavour: one that is regressing far less moving on. This is far from our experience and the opposite of the impression we wish to create. Certainly, as far as drug treatments are concerned, no single agent or type of agent now seems more satisfactory across the board than any other, but the challenge to ‘atypicality’ as a valid subgrouping of antipsychotics does not limit options—rather it broadens them, restoring to the treatment repertoire the wide range of choices that is the key to individualized care planning. With psychosocial interventions, there does remain more work to be done in proving absolute efficacy and/or effectiveness and the relative place of each, but in service development and care planning, risk:benefit appraisal is sophisticated enough to encompass what has qualitative value as well as what is quantitatively proven. As in all branches of medicine where chronic and relapsing disease is encountered, restoring order on chaos, fostering engagement and lighting a way forward when none may be obvious are for the highest levels of skill, in which evidence-based practice can provide the direction but not yet the specific path. We are fortunate in now having available to us the greatest ever range of interventions to bring to the care of those who suffer from this most complex and fell disorder. None is comprehensive, all have limitations, but if we wish to provide quality care, care that accounts for the multifarious manifestations patients present, it is our duty to apply not only the experience of others but of ourselves too. There is no ‘quick fix’ in gaining competence in the treatment and management of schizophrenia—and, as yet, no curative ‘holy grail’ either. But there is, more than ever, the opportunity for clinicians to demonstrate real expertise in moulding the range of therapeutics now at our disposal. If that is not reason for medical optimism, what is!

scholarly journals COVID-19 en Panamá y el Mundo: Una Revisión

2020 ◽  
Vol 32 ◽  
pp. 37-60
Author(s):  
René de Jesús Rivera Gutiérrez ◽  
María Ramírez ◽  
Alicia Rodríguez ◽  
Jorge Hernández
Keyword(s):  
Medical Journal ◽  
England Journal ◽  
British Medical Journal ◽  
American Medical Association ◽  
Medical Association ◽  
New England ◽  
American Medical ◽  
Medicine Journal ◽  
Distribución Geográfica

Antecedentes: El virus SARS-CoV-2, causante de la Enfermedad por Coronavirus de 2019 (COVID-19) emergió en Wuhan, China, en diciembre de 2019, y tiene un alcance pandémico en la actualidad. Su fisiopatología, distribución geográfica y características clínicas son objetivo de estudio y análisis continuo, con resultados prometedores e influyentes, pero difíciles de reunir y sintetizar considerando las numerosas fuentes de información y el dinamismo de la curva epidemiológica de esta pandemia. Objetivo: Esta revisión tiene como objetivo sintetizar la literatura actual sobre la pandemia del COVID-19, con el propósito de establecer de forma transparente y concisa la información de origen nacional e internacional disponible, de manera que esta sirva como una fuente confiable de la evidencia publicada.  Diseño: Se utilizaron artículos científicos publicados entre diciembre de 2019 y marzo de 2020, que fueron seleccionados por su relevancia, validez y calidad de contenido, obtenidos a través de revistas científicas como New England Journal of Medicine, Journal of the American Medical Association, The Lancet y el British Medical Journal, además de la información proporcionada por instituciones reconocidas a nivel mundial, como lo son la Organización Mundial de la Salud y  el Centro para el Control y la Prevención de Enfermedades. Conclusiones: La información actual sobre la pandemia del SARS-CoV-2 está renovándose continuamente y se espera que continúe haciéndolo por los próximos meses. Se torna complicado el mantenerse a la vanguardia, por lo cual confiamos en que esta revisión será útil para distintos estudiantes y profesionales de la salud.

COVID-19: INFORMAÇÕES SOBRE TRANSMISSIBILIDADE, SINTOMAS, POPULAÇÃO DE RISCO, FATORES DE PREVENÇÃO E INTERVENÇÕES TERAPÊUTICAS

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Diogo Martins Ribeiro
Keyword(s):  
England Journal ◽  
American Medical Association ◽  
Severe Acute Respiratory Syndrome ◽  
Medical Association ◽  
New England ◽  
American Medical ◽  
Medical Virology ◽  
Medicine Journal

A transmissão do novo coronavírus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2, causador da doença coronavírus 2019 ou COVID-19) de pessoa a pessoa, para diferentes países, áreas ou territórios, gera intensa preocupação entre pesquisadores e a população em geral. Até o dia 9 de maio já foram registrados quase 4 milhões de casos confirmados do COVID-19 em todo o mundo, com quase 270 mil mortes associadas (taxa de fatalidade próxima a 7%). Objetivando disponibilizar informações importantes sobre o novo coronavírus, para auxiliar a comunidade científica e orientar a população em geral, esta revisão de literatura foi elaborada a partir de informações coletadas na base de dados Pubmed, na plataforma ScienceDirect, e especificamente na revista científica Nature Research e nos jornais científicos The Lancet, The New England Journal of Medicine, Journal of Medical Virology, Journal of the American Medical Association (JAMA), bem como nos repositórios BioRxiv e MedRxiv e diferentes órgãos internacionais de saúde. Ainda são recentes os estudos referentes a intervenções terapêuticas a serem consideradas contra o SARS-CoV-2, bem como há a necessidade de maiores investigações quanto à patogenicidade e transmissibilidade desse vírus, e quanto aos seus efeitos em crianças, gestantes e animais.

American Medical Society for Sports Medicine position statement on concussion in sport

2019 ◽  
Vol 53 (4) ◽  
pp. 213-225 ◽  
Author(s):  
Kimberly G Harmon ◽  
James R Clugston ◽  
Katherine Dec ◽  
Brian Hainline ◽  
Stanley Herring ◽  
...  
Keyword(s):  
American Medical ◽  
Sports Medicine ◽  
Health And Safety ◽  
Position Statement ◽  
Medical Society ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Practices ◽  
Writing Group ◽  
Patient Values

Sport-related concussion (SRC) is a common injury in recreational and organised sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment and management of SRC. In addition to a growing need for knowledgeable healthcare professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. The American Medical Society for Sports Medicine (AMSSM) formed a writing group to review the existing literature on SRC, update its previous position statement, and to address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short-term and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The AMSSM is committed to best clinical practices, evidence-based research and educational initiatives that positively impact the health and safety of athletes.

scholarly journals Family-Centred Care for Children with Biopsychosocial Support Needs: A Scoping Review

Disabilities ◽  
2021 ◽  
Vol 1 (4) ◽  
pp. 301-330
Author(s):  
Lizz Carrington ◽  
Leigh Hale ◽  
Claire Freeman ◽  
Ayesha Qureshi ◽  
Meredith Perry
Keyword(s):  
Outcome Measures ◽  
Best Practice ◽  
English Language ◽  
Health Condition ◽  
Future Research ◽  
Support Needs ◽  
Health And Wellness ◽  
Number Of Children ◽  
Meaningful Participation ◽  
Wide Range

Children’s health and wellness are influenced by a wide range of biological, psychological or social factors with a rising number of children requiring supportive healthcare. Family-centred care is considered best practice paediatric healthcare; however, processes and actions are not well explored in the literature. This research aimed to synthesise the evidence on the processes of implementation of family-centred care for children with biopsychosocial support needs and identify outcome measures used in the studies. A scoping search across Cinahl, Medline, Web of Science, Scopus, Psyc INFO, Embase and Education Research Complete for English language publications published between 2005 and 14 October 2020 was conducted. A total of 42 studies met the inclusion criteria: a focus on the processes of implementation of family-centred care for children aged 0–21 years with biopsychosocial needs. Diversity in the implementation of interventions of family-centred care was evident due to heterogeneity in study populations, methodology and reporting. Health condition or impairment focused outcome measures were found to be standard with a paucity of outcomes measuring participation or activity. Theoretical and practical elements of implementing interventions were identified as novel and key attributes of family-centred care and contributed to a new standardised framework for the processes of implementation of family-centred care. Future research should address whether mapping family-centred care to the International Classification of Function model helps families and health professionals identify meaningful participation and activity outcomes, which in turn may guide the processes of implementation of family-centred care interventions.

Achieving high-quality care: a view from NICE

Heart ◽  
2017 ◽  
Vol 104 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Gillian Leng ◽  
Gemma Partridge
Keyword(s):  
Best Practice ◽  
Quality Care ◽  
Evidence Based ◽  
Implantable Cardioverter Defibrillators ◽  
Barriers To Change ◽  
Change In Practice ◽  
Nice Guidance ◽  
Pharmaceutical Agents ◽  
Cardioverter Defibrillators ◽  
Organisational Level

The National Institute for Health and Care Excellence (NICE) was established in 1999 to provide evidence-based guidance. The task of producing guidance by reviewing primary research data and using an advisory committee to develop evidence-based recommendations, is not straightforward. Guidance production is, however, less challenging than the task of putting evidence-based recommendations into practice.NICE is very sensitive to this challenge as, since 1999, over 1500 pieces of NICE guidance have been published. A number of pieces of guidance relate to heart disease, including pharmaceutical agents, new medical technologies and clinical guidelines. Examples include guidelines on acute heart failure and atrial fibrillation, and advice on technologies including edoxaban and implantable cardioverter defibrillators.The research evidence is clear that a change in practice rarely comes about as a result of simply disseminating guidance on best practice. Simple dissemination is particularly ineffective if the guidance has not been produced by a well-respected, credible organisation. It is also clear from the literature that implementation is more successful when more than one approach is taken, and when there is alignment between efforts at organisational, local and national levels.At an organisational level, there should be support from the Board for quality improvement, with ongoing measurement of progress. Resources should be provided for targeted change programmes, particularly where new guidance suggests improvements are required. A systematic process for putting change in place should include identifying barriers to change, agreeing interventions to overcome the barriers and drive forward improvement and planning for implementation and evaluation.

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