scholarly journals Telehealth Best Practice: A Call for Standards of Care

2021 ◽  
Vol 1 (1) ◽  
pp. 27-35
Author(s):  
Donna Sheperis ◽  
Arielle Smith
Keyword(s):  
Best Practice ◽  
Standards Of Care

Measuring standards of care for early breast cancer in an insured population.

1997 ◽  
Vol 15 (4) ◽  
pp. 1401-1408 ◽  
Author(s):  
B E Hillner ◽  
M K McDonald ◽  
L Penberthy ◽  
C E Desch ◽  
T J Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ct Scan ◽  
Bone Scan ◽  
Best Practice ◽  
Clinical Stage ◽  
Primary Treatment ◽  
Standards Of Care ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
International Consensus

PURPOSE To demonstrate the use of a combined data base to evaluate the care for local/regional invasive breast cancer in a large insured population of women aged less than 64 years. PATIENTS AND METHODS We linked the procedural and hospital claims from Blue Cross Blue Shield (BCBS) of Virginia with clinical stage data from the Virginia Cancer Registry (VCR) from 1989 to 1991. A total of 918 women were assessed with a median age of 50 years; 68% had tumors less than 2 cm, 30% had positive axillary nodes, and 68% were assessed as having local summary stage. A quality-of-care "report card" was used based on standards of care from international Consensus Conferences. RESULTS Eight percent had a mastectomy as the initial biopsy procedure. Sixty-nine percent of women ultimately underwent mastectomy. Of those women who underwent lumpectomy, 86% had subsequent radiation. Within 3 months of diagnosis, 43% had a bone scan and 20% a computed tomography (CT) scan. Of women with positive axillary lymph nodes, 83% aged less than 51 years and 52% aged 51 to 64 years received chemotherapy. Fifty-six percent of all women had claims from a medical oncologist. Of women having a total mastectomy, 27% had claims from a plastic surgeon. Sixty-six percent to 76% of women had a mammogram, 24% a bone scan, and 14% a CT scan in the 0-18 and 18-36 month intervals following primary treatment. CONCLUSION This study confirms the feasibility of linking sources of data that provide complementary information needed to develop measurements regarding standards of quality and efficiency of oncologic care. This report should serve as an initial benchmark while we await reports from other populations to define the best practice.

scholarly journals Neurorehabilitation in Multiple Sclerosis – Resilience in Practice

2017 ◽  
Vol 12 (01) ◽  
pp. 31 ◽  
Author(s):  
Jürg Kesselring ◽  
Keyword(s):  
Multiple Sclerosis ◽  
Best Practice ◽  
Healthcare Providers ◽  
Brain Regions ◽  
Standards Of Care ◽  
Key Factors ◽  
Disease Modifying Drugs ◽  
Randomised Controlled ◽  
The Impact ◽  
The Brain

In recent years, enormous strides have been made in increasing the range and efficacy of disease-modifying drugs available for the treatment of multiple sclerosis (MS) in its early and remitting stages, and more continue to emerge. Another equally important concept of successful treatment of MS is neurorehabilitation, which must be pursued alongside these medications. Key factors that contribute to the impact of neurorehabilitation include resilience and neuroplasticity. In the former, components such as nutrition, self-belief and physical activity provide a stronger response to the disease and improved responses to treatment. Neuroplasticity is the capacity of the brain to establish new neuronal networks after lesion damage has occurred and distant brain regions assume control of lost functions. In MS, it is vital that each patient is treated by a coordinated multidisciplinary team. This enables all aspects of the disease including problems with mobility, gait, bladder/bowel disturbances, fatigue and depression to be effectively treated. It is also important that the treating team adopts current best practice and provides internationally agreed standards of care. A further vital aspect of MS management is patient engagement, in which individuals are fully involved and are encouraged to strive and put effort into meeting treatment goals. In this approach, healthcare providers become motivators and patients need less intervention and consume fewer resources. Numerous interventions that promote neurorehabilitation are available, though evidence to support their use is limited by a lack of data from large randomised controlled trials. Combining interventions that promote neurorehabilitation with newer, more effective treatments creates a promising potential to substantially improve the outlook for patients at all stages of MS.

scholarly journals Nursing and medical contribution to Defence Healthcare Engagement: initial experiences of the UK Defence Medical Services

2018 ◽  
Vol 165 (3) ◽  
pp. 143-146 ◽  
Author(s):  
Douglas M Bowley ◽  
D Lamb ◽  
P Rumbold ◽  
P Hunt ◽  
J Kayani ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Healthcare Workers ◽  
Best Practice ◽  
Healthcare Services ◽  
Medical Services ◽  
Standards Of Care ◽  
Transformative Change ◽  
Urban Hospital ◽  
Audit Cycle ◽  
The Uk

IntroductionThe WHO Constitution enshrines ‘…the highest attainable standard of health as a fundamental right of every human being.’ Strengthening delivery of health services confers benefits to individuals, families and communities, and can improve national and regional stability and security. In attempting to build international healthcare capability, UK Defence Medical Services (DMS) assets can contribute to the development of healthcare within overseas nations in a process that is known as Defence Healthcare Engagement (DHE).MethodsIn the first bespoke DMS DHE tasking, a team of 12 DMS nurses and doctors deployed to a 1000-bedded urban hospital in a partner nation and worked alongside indigenous healthcare workers (doctors, nurses and paramedical staff) during April and May 2016. The DMS nurses focused on nursing hygiene skills by demonstrations of best practice and DMS care standards, clinical leadership and female empowerment. A Quality Improvement Programme was initiated that centred on hand hygiene (HH) compliance before and after patient contact, and the introduction of peripheral cannula care and surveillance.ResultsAfter a brief induction on the ward, it was apparent that compliance with HH was poor. Peripheral cannulas were secured with adhesive zinc oxide tape and no active surveillance process (such as venous infusion phlebitis (VIP) scoring) was in place. After intensive education and training, initial week-long audits were undertaken and repeated after a further 2 weeks of training and coworking. In the second audit cycle, HH compliance had increased to 69% and VIP scoring compliance to 99%. In the final audit cycle, it was noted that nursing compliance with HH (75/98: 77%) was significantly higher than the doctors’ HH compliance (76/200: 38%); p<0.0001.ConclusionsDHE is a long-term collaborative process based on the establishment and development of comprehensive relationships that can help transform indigenous healthcare services towards patient-centred systems with a focus on safety and quality of care. Short deployments to allow clinical immersion of UK healthcare workers within indigenous teams can have an immediate impact. Coworking is a powerful method of demonstrating standards of care and empowering staff to institute transformative change. A multidisciplinary group of Quality Improvement Champions has been identified and a Hospital Oversight Committee established, which will offer the prospect of longer term sustainability and development.

scholarly journals The heart failure epidemic: a UK perspective

2017 ◽  
Vol 4 (1) ◽  
pp. R15-R20 ◽  
Author(s):  
Martin R Cowie
Keyword(s):  
Heart Failure ◽  
Best Practice ◽  
Health Care Expenditure ◽  
Models Of Care ◽  
Standards Of Care ◽  
Limiting Factor ◽  
Patients With Heart Failure ◽  
Speed Up ◽  
Trained Staff ◽  
Biochemical Testing

Heart failure is appropriately described as an epidemic, with 1–2% of health care expenditure being directed at its management. In England, the National Institute for Health and Care Excellence (NICE) has issued guidance on the best practice for the diagnosis and treatment of acute and chronic heart failure. Echocardiography is key to the diagnosis of the underlying cardiac abnormalities, and access to this (with our without biochemical testing using natriuretic peptides) is key to high-quality and speedy diagnosis. New models of care aim to speed up access to echocardiography, but a shortage of technically trained staff remains a limiting factor in improving standards of care. The NHS audits the quality of care and outcome for patients admitted to hospital with heart failure, and this continues to show wide variation in practice, particularly, where patients are not reviewed by the local heart failure multidisciplinary team. Recently, the All Party Parliamentary Group on Cardiac Disease issued 10 suggestions for improvement in care for patients with heart failure – access to echocardiography being one of the key suggestions. Time will tell as to whether this support from law makers will assist in the implementation of NICE-recommended standards of care consistently across the country.

scholarly journals Collaboration between patient organisations and a clinical research sponsor in a rare disease condition: learnings from a community advisory board and best practice for future collaborations

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039473
Author(s):  
Annelise Roennow ◽  
Maureen Sauvé ◽  
Joep Welling ◽  
Robert J Riggs ◽  
Ann Tyrrell Kennedy ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Research ◽  
Rare Disease ◽  
Best Practice ◽  
Advisory Board ◽  
Community Advisory Board ◽  
Standards Of Care ◽  
Trial Participant ◽  
Patient Organisations ◽  
Disease Condition

Introduction Transparent collaborations between patient organisations (POs) and clinical research sponsors (CRS) can identify and address the unmet needs of patients and caregivers. These insights can improve clinical trial participant experience and delivery of medical innovations necessary to advance health outcomes and standards of care. We share our experiences from such a collaboration undertaken surrounding the SENSCIS® clinical trial (NCT02597933), and discuss its impact during, and legacy beyond, the trial.Summary We describe the establishment of a community advisory board (CAB): a transparent, multiyear collaboration between the scleroderma patient community and a CRS. We present shared learnings from the collaboration, which is split into three main areas: (1) the implementation and conduct of the clinical trial; (2) analysis and dissemination of the results; and (3) aspects of the collaboration not related to the trial.1. The scleroderma CAB reviewed and provided advice on trial conduct and reporting. This led to the improvement and optimisation of trial procedures; meaningful, patient-focused adaptations were made to address challenges relevant to scleroderma-associated interstitial lung disease patients.2. To ensure that results of the trial were accessible to lay audiences and patients, written lay summaries were developed by the trial sponsor with valuable input from the CAB to ensure that language and figures were understandable.3. The CAB and the CRS also collaborated to co-develop opening tools for medication blister packs and bottles. In addition, to raise disease awareness among physicians, patients and caregivers, educational materials to improve diagnosis and management of scleroderma were co-created and delivered by the CAB and CRS.Conclusions This collaboration between POs and a CRS, in a rare disease condition, led to meaningful improvements in patient safety, comfort and self-management and addressed information needs. This collaboration may serve as a template of best practice for future collaborations between POs, research sponsors and other healthcare stakeholders.

scholarly journals Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Adult Populations: Part 1

2021 ◽  
pp. 1-25
Author(s):  
Susan E. Langmore ◽  
Donna R. Scarborough ◽  
Lisa N. Kelchner ◽  
Nancy B. Swigert ◽  
Joseph Murray ◽  
...  
Keyword(s):  
Best Practices ◽  
Best Practice ◽  
Adult Population ◽  
Swallowing Disorders ◽  
Standards Of Care ◽  
Endoscopic Evaluation ◽  
Training Requirements ◽  
Best Practice Guidelines ◽  
Technical Report ◽  
And Training

Purpose: Representatives of the American Board of Swallowing and Swallowing Disorders (AB-SSD) and American Speech-Language-Hearing Association (ASHA) Special Interest Group (SIG) 13: Swallowing and Swallowing Disorders (Dysphagia) developed this tutorial to identify and recommend best practice guidelines for speech-language pathologists who conduct and interpret fiberoptic endoscopic evaluation of swallowing (FEES) procedures in adults. This document also includes proposed training needs and methods for achieving competency. Expert opinion is provided regarding indications for performing the FEES exam, potential contraindications, adverse effects and safety, equipment and personal protection, the exam protocol, interpretation and documentation of findings, and training requirements to perform and interpret the exam. Conclusions: This tutorial by the AB-SSD and SIG 13 represents the first update about the FEES procedure since ASHA's position paper and technical report published in 2004. Creation of this document by members of the AB-SSD and SIG 13 is intended to guide professionals who are training for or practicing FEES in the adult population toward established best practices and the highest standards of care.

scholarly journals Sedation in non-invasive ventilation: do we know what to do (and why)?

2014 ◽  
Vol 9 ◽  
Author(s):  
Dan Longrois ◽  
Giorgio Conti ◽  
Jean Mantz ◽  
Andreas Faltlhauser ◽  
Riku Aantaa ◽  
...  
Keyword(s):  
Best Practice ◽  
Standards Of Care ◽  
Respiratory Drive ◽  
Invasive Ventilation ◽  
Missed Opportunities ◽  
Organizational Conditions ◽  
Non Invasive ◽  
Ideal Agent ◽  
Non Invasive Ventilation ◽  
As Effects

This review examines some of the issues encountered in the use of sedation in patients receiving respiratory support from non-invasive ventilation (NIV). This is an area of critical and intensive care medicine where there are limited (if any) robust data to guide the development of best practice and where local custom appears to exert a strong influence on patterns of care. We examine aspects of sedation for NIV where the current lack of structure may be contributing to missed opportunities to improve standards of care and examine the existing sedative armamentarium. No single sedative agent is currently available that fulfils the criteria for an ideal agent but we offer some observations on the relative merits of different agents as they relate to considerations such as effects on respiratory drive and timing, and airways patency. The significance of agitation and delirium and the affective aspect(s) of dyspnoea are also considered.We outline an agenda for placing the use of sedation in NIV on a more systematic footing, including clearly expressed criteria and conditions for terminating NIV and structural and organizational conditions for prospective multicentre trials.

scholarly journals Key Service Improvements After the Introduction of an Integrated Orthogeriatric Service

2019 ◽  
Vol 10 ◽  
pp. 215145931989389 ◽  
Author(s):  
R. P. Murphy ◽  
C. Reddin ◽  
E. P. Murphy ◽  
R. Waters ◽  
C. G. Murphy ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
Performance Indicators ◽  
Functional Outcomes ◽  
Best Practice ◽  
Standards Of Care ◽  
Fracture Care ◽  
Best Practice Guidelines ◽  
Improve Compliance

Introduction: Models of orthogeriatric care have been shown to improve functional outcomes for patients after hip fractures and can improve compliance with best practice guidelines for hip fracture care. Methods: We evaluated improvements to key performance indicators in hip fracture care after implementation of a formal orthogeriatric service. Compliance with Irish Hip Fracture standards of care was reviewed, and additional outcomes such as length of stay, access to rehabilitation, and discharge destination were evaluated. Results: Improvements were observed in all of the hip fracture standards of care. Mean length of stay decreased from 19 to 15.5 days (mean difference 3.5 days; P < .05). A higher proportion of patients were admitted to rehabilitation (16.7% vs 7.9%, P < .05), and this happened in a timelier fashion (17.8 vs 24.8 days, P < .05). We found that less patients required convalescence post-hip fracture. Discussion: A standardized approach to integrated post-hip fracture care with orthogeriatrics has improved standards of care for patients. Conclusion: Introduction of orthogeriatric services has resulted in meaningful improvements in clinical outcomes for older people with hip fractures.

scholarly journals European Cystic Fibrosis Society Standards of Care: Best Practice guidelines

2014 ◽  
Vol 13 ◽  
pp. S23-S42 ◽  
Author(s):  
Alan R. Smyth ◽  
Scott C. Bell ◽  
Snezana Bojcin ◽  
Mandy Bryon ◽  
Alistair Duff ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Practice Guidelines ◽  
Best Practice ◽  
Standards Of Care ◽  
Best Practice Guidelines
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