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At least 217 records · Page 12Linked to original sources
PubMedDate not supplied

California healthy and ready to work transition health care guide: developmental guidelines for teaching health care self-care skills to children.

This article presents developmental guidelines that can be used by parents and nurses for teaching children health care self-care skills. These guidelines are intended to provide a framework for instructing parents and nurses about the developmentally appropriate skills children can learn to become self sufficient in managing their own health care needs. The guidelines are based on the developmental frameworks of Piaget and Erikson and self-care models of Orem. Although general in scope, these guidelines can be individualized to the needs of each child.

Adolescent↗
PubMed2006

A review of records from follow-up visits for immigrant and Swedish patients at a heart failure clinic.

UNLABELLED: Today, nearly 20% of the Swedish population originates from multiethnic backgrounds. Patients' symptom expressions, adherence to health regimens, and communication with health-care professionals have been shown to be related to their ethnic and cultural backgrounds. PURPOSE: To describe documented care of immigrant patients and matched Swedish patients at a heart failure clinic. METHOD: Journal audit of records of 25 immigrant and 25 matched Swedish patients with HF included from the patient registration database at the hospital where they were cared for. RESULTS: In the immigrant group, significantly fewer clinical parameters were assessed during their visits and fewer patients were scheduled for follow-up visits. Analyses revealed that some of the items recommended in the European Society of Cardiology guidelines for non-pharmacological HF care were overlooked for both of the groups. CONCLUSIONS: We found that medication adjustments and information about the condition and treatment were fairly similarly documented between Swedish and immigrant patients while significantly fewer clinical measurements and follow-up visits were documented for the immigrant group.

Aftercare↗
PubMedDate not supplied

National Cholesterol Education Program: Adult Treatment Panel III--new recommendations for lifestyle and medical management of dyslipidemia.

In the 1990s a number of randomized controlled trials provided compelling evidence for the importance of aggressively managing hypercholesterolemia. Control of low-density lipoprotein cholesterol reduces cardiac events and stroke in at risk individuals without known cardiac disease and in patients with coronary heart disease. The National Cholesterol Education Program Adult Treatment Panel has published 3 sets of guidelines. The most recent expanded definitions of those at risk by defining new risk categories and increased the numbers of persons who could benefit from more intensive cholesterol-lowering. These new definitions moved millions of people into more intensive treatment categories compared to previously published guidelines. This article focuses on the latest National Cholesterol Education Program guidelines for identification and treatment of persons with or at risk for coronary heart disease.

Adult↗
PubMed2000

Assessing the risk of hypoxia in flight: the need for more rational guidelines.

This study aimed to test the hypothesis that advice currently given by respiratory physicians to potentially hypoxic patients planning air travel varies and is not evidence-based. A prospective observational study was performed, surveying respiratory physicians in England and Wales. Sixty-two per cent responded. Nearly two-thirds worked in district general hospitals, a quarter in university hospitals, and the rest in tertiary referral (specialist) centres or a combination thereof. Most provide advice routinely; most of the remainder do on request or if concerned. Assessments comprise spirometry, blood gas level measurement, oximetry, predictive equations and hypoxic challenge tests. Twenty-five per cent of physicians measuring blood gas levels recommend in-flight oxygen when arterial oxygen tension (Pa,O2) <7.3 kPa, 50% when Pa,O2 is 7.3-8.0 kPa. Over two-thirds using spirometry recommend oxygen when the forced expiratory volume in one second <40% of the predicted value. Half recommend oxygen when arterial oxygen saturation (Sa,O2) <90%, 33% when Sa,O2 is 90-94%. Fewer than 10% of district hospital physicians (and none in other hospitals) use predictive equations. More than half of specialists but fewer than 10% of district hospital physicians perform hypoxic challenge tests. The risk of hypoxia at altitude is recognized by most respiratory physicians in England and Wales, but assessment methods and criteria for recommending oxygen vary widely. This suggests that most current advice is not evidence-based. Evidence-based guidelines are required.

Aircraft↗
PubMed1999

Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature.

CONTEXT: Practice guidelines play an important role in medicine. Methodological principles have been formulated to guide their development. OBJECTIVE: To determine whether practice guidelines in peer-reviewed medical literature adhered to established methodological standards for practice guidelines. DESIGN: Structured review of guidelines published from 1985 through June 1997 identified by a MEDLINE search. MAIN OUTCOME MEASURES: Mean number of standards met based on a 25-item instrument and frequency of adherence. RESULTS: We evaluated 279 guidelines, published from 1985 through June 1997, produced by 69 different developers. Mean overall adherence to standards by each guideline was 43.1% (10.77/25). Mean (SD) adherence to methodological standards on guideline development and format was 51.1% (25.3%); on identification and summary of evidence, 33.6% (29.9%); and on the formulation of recommendations, 46% (45%). Mean adherence to standards by each guideline improved from 36.9% (9.2/25) in 1985 to 50.4% (12.6/25) in 1997 (P<.001). However, there was little improvement over time in adherence to standards on identification and summary of evidence from 34.6% prior to 1990 to 36.1 % after 1995 (P = .11). There was no difference in the mean number of standards satisfied by guidelines produced by subspecialty medical societies, general medical societies, or government agencies (P = .55). Guideline length was positively correlated with adherence to methodological standards (P = .001). CONCLUSION: Guidelines published in the peer-reviewed medical literature during the past decade do not adhere well to established methodological standards. While all areas of guideline development need improvement, greatest improvement is needed in the identification, evaluation, and synthesis of the scientific evidence.

Peer Review, Research↗
PubMedDate not supplied

Guidelines for the diagnosis and management of heart failure.

Heart failure has reached epidemic proportions. Five million Americans have been diagnosed with heart failure, and this number is expected to double within the next 30 years. One million patients are hospitalized annually with decompensated heart failure, and half will be readmitted for recurrent symptoms within 6 months. Heart failure primarily affects the elderly and is the most common reason for hospitalization in this age group. The prognosis for heart failure is poor, worse than most malignancies. Heart failure accounts for 280,000 deaths annually, and the 5-year survival rate is less than 50% despite multiple therapeutic advances. Poor survival may be attributed in part to poor application of evidence-based heart failure therapies and patient noncompliance. This review describes current guidelines for diagnosing and managing patients with heart failure.

Aged↗
PubMedDate not supplied

Innovative ways of responding to the information needs of people with MS.

There have been a number of studies looking into the information needs of people with multiple sclerosis (MS). All the studies have shown that people with MS want information tailored to their individual requirements, delivered in different formats and within a time-frame to suit them. This article reviews the studies and demonstrates how two neurology centres in Leeds and York have striven to meet the needs and expectations of the client group. By continuing to include service users in developments, and carrying out audits, these centres are continually aiming to improve services for people with MS, as well as responding to the recommendations in the National Institute for Clinical Excellence guidelines for MS and the recently published Department of Health "National Service Framework for Long-term Conditions".

Attitude to Health↗
PubMed2006

An audit of corneal abrasion management following the introduction of local guidelines in an accident and emergency department.

BACKGROUND AND OBJECTIVES: Corneal abrasions are a common presentation to accident and emergency (A&E) departments. Patients can be treated and discharged by A&E staff without the need for an ophthalmologist's attention; complicated cases, however, should be recognised and referred. Inexperience and limited training in ophthalmology may lead to suboptimal patient care and inappropriate use of ophthalmology outpatient clinics. Issues of poor documentation may also arise. The purpose of this audit was to assess the effect of guidelines on the management of corneal abrasion by A&E staff. METHODS: A retrospective case note audit was performed to assess current management of corneal abrasions. Guidelines for management of corneal abrasions were formulated following a literature search and collaboration between A&E and ophthalmology staff. A prospective case note audit was undertaken to assess management after introduction of the guidelines. RESULTS: A total of 51 cases were audited before the introduction of the guidelines and 57 cases after. Following the introduction of the guidelines documentation of visual acuity increased to 93% and specific enquiry into contact lens wear rose from 35.3% to 71.9%. A&E staff stopped giving out local anaesthetic eye drops. The follow up profile also improved; appropriate patient discharges increased by 40% whereas inappropriate referrals to eye clinic dropped by 75%. More patients were given abrasion advice (a 101% increase). CONCLUSIONS: A&E staff members are capable of managing corneal abrasions if they are given guidance and some training. This audit identified shortcomings in current management and showed that guidelines can significantly improve clinical practice.

Anesthetics↗
PubMed1997

New asthma guidelines emphasize preventive care.

The National Heart, Lung, and Blood Institute has released the first revision in six years of its groundbreaking asthma guidelines. The guidelines heavily emphasize the inflammatory nature of asthma and stress the use of anti-inflammatory drugs such as inhaled corticosteroids and cromolyn. Patients should receive aggressive treatment at first, and then cut back once their condition is under control, according to the guidelines. Changes from the previous edition include revised severity classifications, new guidelines for referral of patients, and renewed emphasis on patient education.

Algorithms↗
PubMed1999

What is recommended for healthy women during pregnancy? A comparison of seven prenatal clinical practice guideline documents.

BACKGROUND: Several countries have developed clinical practice guidelines for the content of prenatal care. This study examines the consistency of recommendations in clinical practice guidelines describing routine prenatal care. METHODS: The recommendations for low-risk women in seven guideline documents were examined: two from Australia, two from the United States, two from Canada, and one from Germany. The recommendations were listed into the four areas of "general health screening and health promotion during pregnancy," "organization of care," "clinical tests and screening," and "education specific for pregnancy." RESULTS: A total of 69 recommendations were identified within the seven documents, most of which fell within the "clinical tests and screening" domain. Notable differences were identified in the number of recommendations made within the same country. Of the 69 recommendations, only four were included in all seven documents. CONCLUSION: Little consistency was demonstrated within or among countries in terms of the content of their prenatal care guidelines, suggesting a need to reexamine their content and the evidence on which such recommendations are based.

Australia↗
PubMed1998

Managing patients with irritable bowel syndrome in general practice. How to promote and reinforce self-care activities.

In this paper the development and implementation of a set of guidelines for the management of irritable bowel syndrome (IBS) patients in primary care is presented. The guidelines are based on the knowledge that has emerged from research in the past decade on factors that influence the course and prognosis of IBS. These include lifestyle factors, avoidance behaviour and reaction patterns from family and friends. The guidelines contain elements of psychotherapeutic techniques that have been found to be successful in outpatients with IBS. They comprise instructions to promote and reinforce self-care activities. The guidelines have been applied in daily practice by a group of Dutch general practitioners and various aspects of the feasibility of the guidelines are discussed.

Colonic Diseases, Functional↗