scholarly journals Clinical Care Guidelines: Too Much of a Good Thing?

Diabetes Care ◽  
2010 ◽  
Vol 33 (12) ◽  
pp. 2716-2718 ◽  
Author(s):  
D. Kirk ◽  
J. B. Buse
2021 ◽  
Author(s):  
Jennifer Lavin ◽  
Abbey Studer ◽  
Dana Thompson ◽  
Jonathan Ida ◽  
Jeff Rastatter ◽  
...  

2021 ◽  
Author(s):  
Angela Lumba-Brown ◽  
Eric M Prager ◽  
Nicole Harmon ◽  
Michael McCrea ◽  
Michael J. Bell ◽  
...  

2021 ◽  
Vol 10 (3) ◽  
pp. e001529
Author(s):  
Martina Compton ◽  
Rhonda List ◽  
Elissa Starheim ◽  
Lindsay Somerville ◽  
Lauren Williamson ◽  
...  

IntroductionThe Cystic Fibrosis (CF) Foundation chronic care guidelines recommend monitoring spirometry during quarterly multidisciplinary visits to identify early lung function decline. During the COVID-19 pandemic, the CF adult clinic at University of Virginia (UVA) transitioned from the classic CF care model to a model that included quarterly multidisciplinary telemedicine visits. While using telemedicine, CF care needed to include spirometry monitoring. Only a fraction of adult CF patients at UVA owned and used home spirometers (HS) in March 2020.AimThe specific aims of this quality improvement (QI) project were to increase the percentage of eligible adult CF patients who owned an HSs from 37% to 85% and to increase the percentage of adult CF patients seen at UVA with available spirometry in telemedicine from 50% to 95% by 31 December 2020.MethodsFollowing the Model for Improvement QI methodology, a standardised process was developed for monitoring forced expiratory volume in 1 s with HS during multidisciplinary telemedicine visits during the COVID-19 pandemic.Intervention(1) HSs were distributed to eligible patients and (2) Home spirometry was monitored in eligible patients with each telemedicine visit and results were used for clinical care decisions.ResultsBoth specific aims were achieved ahead of expected date. In March 2020, the beginning of the pandemic, 37% (49/131) of patients owned an HS and 50% (9/18) of patients seen via telemedicine performed spirometry at home. By September 2020, 97% (127/131) of adult patients at UVA owned an HS and by October 2020, 96% (24/25) of patients provided spirometry results during their telemedicine encounters.ConclusionEmploying QI tools to standardise the process of monitoring spirometry data with home devices via telemedicine is reliable and sustainable and can be replicated across centres that provide care for patients with CF.


2013 ◽  
Vol 21 (7) ◽  
pp. 1911-1917 ◽  
Author(s):  
Kimberley Cullen ◽  
Karen Fergus ◽  
Tracey DasGupta ◽  
Iwa Kong ◽  
Marg Fitch ◽  
...  

2015 ◽  
Vol 12 (3) ◽  
pp. 539-545 ◽  
Author(s):  
Michael J. Rovito ◽  
Janna Manjelievskaia ◽  
James E. Leone ◽  
Michael Lutz ◽  
Chase T. Cavayero ◽  
...  

The phrase “standard of care” is primarily a legal term representing what procedure a reasonable person (i.e., health practitioner) would administer to patients across similar circumstances. One major concern for health practitioners is delivering and advocating for treatments not defined as a standard of care. While providing such treatments may meet certain ethical imperatives, doing so may unwittingly trigger medical malpractice litigation fears from practitioners. Apprehension to deviate, even slightly, from the standard of care may (seem to) put the practitioner at significant risk for litigation, which, in turn, may limit options for treatment and preventive measures recommended by the practitioner. Specific to testicular treatment, certain guidelines exist for cancer, torsion, vasectomy, and scrotal masses, among others. As it relates to screening, practitioner examination is expected for patients presenting with testicular abnormalities. Testicular self-examination (TSE) advocacy, however, is discouraged by the U.S. Preventive Services Task Force, which may prompt a general unwillingness among health practitioners to promote the behavior. Considering the benefits TSE has beyond cancer detection, and the historical support it has received among health practitioners, it is paramount to consider the ethical implications of its official “exclusion” from preventive health and clinical care recommendations (i.e., standard of care). Since good ethics should lead practitioner patient care guidelines, not fear of increased malpractice risks, we recommend the development of a standard of care for counseling males to perform TSE.


Author(s):  
Elizabeth M. McNally ◽  
Douglas L. Mann ◽  
Yigal Pinto ◽  
Deepak Bhakta ◽  
Gordon Tomaselli ◽  
...  

Abstract Myotonic dystrophy is an inherited systemic disorder affecting skeletal muscle and the heart. Genetic testing for myotonic dystrophy is diagnostic and identifies those at risk for cardiac complications. The 2 major genetic forms of myotonic dystrophy, type 1 and type 2, differ in genetic etiology yet share clinical features. The cardiac management of myotonic dystrophy should include surveillance for arrhythmias and left ventricular dysfunction, both of which occur in progressive manner and contribute to morbidity and mortality. To promote the development of care guidelines for myotonic dystrophy, the Myotonic Foundation solicited the input of care experts and organized the drafting of these recommendations. As a rare disorder, large scale clinical trial data to guide the management of myotonic dystrophy are largely lacking. The following recommendations represent expert consensus opinion from those with experience in the management of myotonic dystrophy, in part supported by literature‐based evidence where available.


2017 ◽  
Vol 4 (Suppl 2) ◽  
pp. s4-s4
Author(s):  
Robin Baschal ◽  
Susan Graham ◽  
Karen Whalen ◽  
Deborah Burke ◽  
Patrick Carry ◽  
...  

2011 ◽  
Vol 142 (10) ◽  
pp. 1133-1142 ◽  
Author(s):  
James Fricton ◽  
D. Brad Rindal ◽  
William Rush ◽  
Thomas Flottemesch ◽  
Gabriela Vazquez ◽  
...  

2011 ◽  
Vol 20 (10) ◽  
pp. 2085-2092 ◽  
Author(s):  
Melissa M. Hudson ◽  
Wendy Landier ◽  
Patricia A. Ganz

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