In summary, we believe that if clinical audit is accepted and prosecuted as the third clinical science, it has the potential to deliver substantial benefits to patients and health professionals. (+info)
Failure of many ophthalmologists to use lasers safely.
(10/2665)
In 1990, after the detection of impairment of colour discrimination in laser operators, the College of Ophthalmologists recommended safety guidelines for the use of lasers. We measured the effectiveness of these guidelines and their impact on ophthalmological practice in the United Kingdom. Previously, in ophthalmologists not following the guidelines, there was a deterioration in colour discrimination after a laser session. No such deterioration was found in 10 ophthalmologists tested who adhered to the guidelines, but their colour discrimination was significantly worse than that of controls. Replies to a questionnaire disclosed that one third of senior ophthalmologists were unaware of the practices recommended. (+info)
The dangers of managerial perversion: quality assurance in primary health care.
(11/2665)
The promotion of primary health care (PHC) at the Alma Ata conference has been followed by a variety of managerial initiatives in support of the development of PHC. One of the more promising vehicles has been the implementation of quality assurance mechanisms. This paper reviews recent examples of this genre and argues that the thrust of both primary health care and quality assurance are in danger of being distorted by a rather antiquated approach to management. (+info)
Use of PRISM scores in triage of pediatric patients with diabetic ketoacidosis.
(12/2665)
Triage guidelines are needed to help in the decision process of intensive care unit (ICU) versus non-ICU admission for patients with diabetic ketoacidosis (DKA). Pediatric risk of mortality (PRISM) scores have long been used to assess mortality risk. This study assess the usefulness of the traditional PRISM score and adaptation of that score (PRISM-ED, which uses presentation data only) in predicting hospital stay in pediatric patients with DKA. PRISM and PRISM-ED were tested for correlation with length of stay and length of ICU stay. A medical record review was conducted for patients admitted to The Children's Hospital of Alabama with DKA during an 18-month period (n = 79). Two scores were calculated for each study entrant: PRISM using the worst recorded values over the first 24 hours and PRISM-ED using arrival values. Median scores, median test, and Spearman rank correlations were determined for both tests. Median PRISM scores were PRISM = 11 and PRISM-ED = 12; Median PRISM and PRISM-ED scores for patients admitted to the ICU were less than median scores among floor-admitted patients: [table: see text] Spearman rank correlations were significant for both scores versus total stay: PRISM, rs = 0.29; P = 0.009; PRISM-ED, rs = 0.60, P < 0.001. Also, correlations were significant for both scores versus ICU stay: PRISM rs = 0.22, P = 0.05; PRISM-ED, rs = 0.41, P < 0.001. Triage guidelines for ICU versus floor admission for DKA patients could have significant economic impact (mean ICU charge = $11,417; mean charge for floor admission = $4,447). PRISM scores may be an important variable to include in a multiple regression model used to predict the need for ICU monitoring. (+info)
Breast reconstruction after mastectomy.
(13/2665)
This activity is designed for primary care physicians. GOAL: To appreciate the significant advances and current techniques in breast reconstruction after mastectomy and realize the positive physical and emotional benefits to the patient. OBJECTIVES: 1. Understand basic and anatomic principles of breast reconstruction. 2. Discuss the options for breast reconstruction: a) immediate versus delayed; b) autologous tissue versus implant; and c) stages of reconstruction and ancillary procedures. 3. Provide a comprehensive overview of the risks and benefits of, as well as the alternatives to, each approach so primary care physicians can counsel patients effectively. (+info)
Managed care guidelines for the economic evaluation of pharmaceuticals.
(14/2665)
Foundation Health Corporation, through its National Pharmacy and Therapeutics Committee, requires all pharmaceutical manufacturers and others who wish products to be considered for formulary listing to meet evidentiary and analytical standards in their submission documentation. This article details the evidentiary and analytical standards required from those making submissions and describes the methodological basis of the guidelines. This is the first time, as far as the authors are aware, that a managed care health system in the United States has required formulary submissions not only to meet clinical and economic evaluation standards, but also to take explicit account of the perspective of the managed care group in applying these techniques. Submissions are required to take what is described as a systems impact perspective. This approach is quite different, in both evidentiary and analytical terms, from standards required by health systems in other countries and standards for the economic evaluation of pharmaceuticals proposed by expert groups in the United States. (+info)
Outcome measures for routine use in dementia services: some practical considerations.
(15/2665)
OBJECTIVES: To work with specialist community teams to assess the practicality and acceptability of identified outcome measures for routine use in dementia services. SETTING: Seven specialist dementia services: four multidisciplinary teams, a specialist service for carers, a community psychiatric nurse team, and a day hospital. SUBJECTS: 20 members of staff from the specialist dementia services including psychiatry, community psychiatric nursing, social work, occupational therapy, Admiral nursing, ward management, geriatric nursing. MAIN MEASURE: A questionnaire designed to assess staff views on the use of six outcome measures in routine practice in terms of practicality, relevance, acceptability, and use in improving care. RESULTS: Each of the outcome measures took 15 to 30 minutes to administer. All were rated as easy to use and as relevant to dementia services and to carers. Staff commented that the measures could be useful in routine practice for structured assessment and service evaluation, but highlighted the need for sensitive use of measures with carers. CONCLUSIONS: These measures consider the main domains of functioning for people with dementia and their carers. The measures are suitable for use in routine practice in dementia services and are acceptable to staff and carers. The project underlined the need for management support, staff ownership of measures, and training in using outcome measures. Staff concerns about service evaluation need to be acknowledged. (+info)
Technology assessment, coverage decisions, and conflict: the role of guidelines.
(16/2665)
As pressure grows for health plans to be accountable for increasing quality of care within a cost-control environment, coverage of new technologies becomes a particularly challenging issue. For a number of reasons, health plans have adopted evidence-based methods for guiding technology decisions. The implementation of these methods has not been free of controversy, and conflicts have arisen between plans and proponents of technologies who often use the political and legal arena in an attempt to secure coverage. Unless these conflicts are resolved, the healthcare system may have difficulty meeting cost and quality objectives. Technology assessment and coverage process guidelines and flexible coverage approaches may be possible ways of resolving these conflicts. (+info)