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Results for “harmonization of care”

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PubMed1994

[Apropos of Swiss research in psychogeriatrics. A critical analysis].

Psychogeriatrics is the general psychiatry of old age. It is closely related with the biological and human fundamental sciences and with the medical disciplines concerned with the care of old patients. Its issues are ubiquitous and also interest non psychiatrists, particularly geriatricians, internists, neurologists and psychologists. Therefore there is a risk for research to be spread out. As a medicine of synthesis, it must assert itself as a convergence point for the related branches. Its very vast field of research is confronted with particular methodological problems, like the chronological and biological age, the heterogeneity of the population, the polymorbidity. Psychogeriatrics is young and still requires an important involvement in the clinical tasks, in the medico-social coordination and in the teaching to medical and paramedical circles. Rare are centers having the critical mass for developing good research with complete peace of mind, Switzerland is an example of this. An analysis of the 1992 international literature shows a certain scattering of the psychogeriatric themes with a 50% predominance of papers devoted to dementias. In the future, psychogeriatrics must well limit its territory, particularly by developing services where care, teaching and research are harmonized.

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PubMed2005

Harmonic scalpel reduces bleeding and postoperative complications in redo cardiac surgery.

BACKGROUND: Intraoperative and postoperative bleeding and injuries to cardiac structures are among the main determinants of complications and hospital and intensive care unit stay after cardiac reinterventions. The harmonic scalpel has been reported to achieve optimal tissue dissection with little blood loss. The present retrospective work was performed to evaluate the safety and usefulness of this device in redo cardiac surgery. METHODS: Ninety-six redo cardiac surgery patients were operated on with the use of harmonic scalpel, and 105 redo patients operated on by traditional electrocautery and scissors were selected from our database and served as controls. Intraoperative and postoperative data of the two groups were collected and compared. Univariate and multiple logistic regression analyses were performed for identification of factors associated with death and with major and minor complications in the overall study population and in both groups, separately. RESULTS: Although mortality and major postoperative morbidity were comparable in the two groups, harmonic scalpel patients presented markedly reduced postoperative bleeding, lower incidence of minor complications, cardiac injuries, major arrhythmias, and need for transfusions. Operative time and mean intensive care unit stay were shorter. Use of ultrascissor was found to be a protective factor against minor morbidity at multivariate analysis. CONCLUSIONS: Our data suggest that harmonic scalpel is safe and is associated with better in-hospital outcome and lower postoperative blood loss in redo cardiac surgery.

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PubMed2005

The experiences of family caregiving in a chronic care unit.

PURPOSE: The main purpose of this critical ethnography was to examines the process and discourses through which family caregivers experience while caring for their sick family member in a hospital. METHODS: This was achieved by conducting in-depth interviews with 12 family caregivers, and by observing their caring activities and daily lives in natural settings. The study field was a unit for neurologic patients. Data was analyzed using taxonomy, discourse analysis, and proxemics. All research work was iteratively processed from March 2003 to December 2004. RESULTS: Constant comparative analysis of the data yielded the process of becoming a successful family caregiver: encountering the differences and chaos as novice; constructing their world of skilled caregivers; and becoming a hospital family as experienced caregivers. During the process of becoming an experienced hospital family, the discourse of family centered idea guided their caring behaviors and daily lives. CONCLUSION: The paternalistic family caregivers struggled, cooperated, and harmonized with the patriarchal world of professional health care system. During this process of becoming hospital family, professional nurses must act as cultural brokers between the lay family caring system and the professional caring system.

Adaptation, Psychological↗
PubMed1994

Should vitamin-mineral supplements be recommended for all women with childbearing potential?

Interest in maternal nutritional status as a critical factor for prenatal development has increased. When supplemented before conception, iodine prevents cretinism and folic acid reduces neural tube defect risks. Other nutrient supplements may also reduce pregnancy complications. Thus, should supplements be advocated for all women with childbearing potential? Potential supplementation benefits include 1) improved nutritional status, 2) reduced risk of some developmental defects, 3) improved antioxidant and immune defense systems, 4) lower incidence and/or slower progression of some diseases, and 5) harmonization of government and health care professionals' dietary recommendations for optimal health. Potential questions are, will the supplement reduce a woman's motivation to maintain and/or improve dietary quality? Will the supplement result in excessive nutrient intakes and/or adverse nutrient-nutrient interactions? Will supplement use encourage the perception that all women are, by definition, well nourished? These issues should be clarified before widespread supplementation programs are implemented.

Congenital Abnormalities↗
PubMed1994

Paediatric cardiology in Europe--medical/scientific statement of the Association of European Paediatric Cardiologists. Definition of profession and training requirements.

The treatment of growing and developing individuals with heart and circulation diseases demands expertise and organization. Due to the unification of Europe, international exchange of doctors can take place. The Association of European Paediatric Cardiologists had laid down professional and training requirements to harmonize the field of patient care, training and training institutes all over Europe.

Cardiology↗
PubMed2006

The objectives of the Banca Dati Italiana Ictus Acuto (BADIA) Project.

The rationale for the realisation of a stroke databank (BADIA: Banca Dati Italiana Ictus Acuto) is discussed on the basis of the recent development in Italy of interesting models (mostly web-based) for the validation of SPREAD guidelines, the definition of outcome indicators, the identification of therapeutic response to rt-PA and the evaluation of the real approach to acute stroke care in Italy in large groups of Italian hospitals distributed in almost all the national regions. The BADIA Project is considered on the basis of possible advantages and objectives but also difficulties in the realisation of the informatics platform adequate to a harmonic and homogeneous approach to stroke care in the different settings presented by Italian hospitals.

Databases, Factual↗
PubMed2000

Assessing animal care and use programs internationally.

As international collaborations become commonplace, new issues arise concerning the potentially variable quality of laboratory animals. The Associate Director and the Director of AAALAC International discuss efforts to harmonize facility procedures and practices of animal care and use globally.

Journal Article↗
PubMed2006

Approved IFCC recommendation on reporting results for blood glucose: International Federation of Clinical Chemistry and Laboratory Medicine Scientific Division, Working Group on Selective Electrodes and Point-of-Care Testing (IFCC-SD-WG-SEPOCT).

In current clinical practice, plasma and blood glucose are used interchangeably with a consequent risk of clinical misinterpretation. In human blood, glucose is distributed, like water, between erythrocytes and plasma. The molality of glucose (amount of glucose per unit water mass) is the same throughout the sample, but the concentration is higher in plasma, because the concentration of water and therefore glucose is higher in plasma than in erythrocytes. Different devices for the measurement of glucose may detect and report fundamentally different quantities. Different water concentrations in the calibrator, plasma, and erythrocyte fluid can explain some of the differences. Results for glucose measurements depend on the sample type and on whether the method requires sample dilution or uses biosensors in undiluted samples. If the results are mixed up or used indiscriminately, the differences may exceed the maximum allowable error for glucose determinations for diagnosing and monitoring diabetes mellitus, thus complicating patient treatment. The goal of the International Federation of Clinical Chemistry and Laboratory Medicine, Scientific Division, Working Group on Selective Electrodes and Point of Care Testing (IFCC-SD-WG-SEPOCT) is to reach a global consensus on reporting results. The document recommends reporting the concentration of glucose in plasma (in the unit mmol/L), irrespective of sample type or measurement technique. A constant factor of 1.11 is used to convert concentration in whole blood to the equivalent concentration in plasma. The conversion will provide harmonized results, facilitating the classification and care of patients and leading to fewer therapeutic misjudgments.

Biosensing Techniques↗
PubMed2005

Approved IFCC recommendation on reporting results for blood glucose (abbreviated).

In current clinical practice, plasma and blood glucose are used interchangeably with a consequent risk of clinical misinterpretation. In human blood, glucose, like water, is distributed between erythrocytes and plasma. The molality of glucose (amount of glucose per unit of water mass) is the same throughout the sample, but the concentration is higher in plasma because the concentration of water and, therefore, glucose is higher in plasma than in erythrocytes. Different devices for the measurement of glucose may detect and report fundamentally different quantities. Different water concentrations in calibrators, plasma, and erythrocyte fluid can explain some of the differences. Results of glucose measurements depend on sample type and on whether methods require sample dilution or use biosensors in undiluted samples. If the results are mixed up or used indiscriminately, the differences may exceed the maximum allowable error of glucose determinations for diagnosing and monitoring diabetes mellitus, and complicate the treatment. The goal of the IFCC Scientific Division Working Group on Selective Electrodes and Point of Care Testing (IFCC-SD, WG-SEPOCT) is to reach a global consensus on reporting results. The document recommends reporting the concentration of glucose in plasma (with the unit mmol/L), irrespective of sample type or measurement technique. A constant factor of 1.11 is used to convert concentration in whole blood to the equivalent concentration in the pertinent plasma. The conversion will provide harmonized results, facilitating the classification and care of patients and leading to fewer therapeutic misjudgments.

Blood Chemical Analysis↗
PubMed1996

Restructuring critical care services. Part III: Successful implementation preparation.

Successful implementation in a redesigning organization does not happen without a sound design, good implementation planning and effective leadership. The focus of the implementation preparation must change prior to and after the "go live" implementation date. Implementation preparation requires intentional steps to build systems, communicate effectively and develop operational understanding among clinicians, physicians and management. Early effort should focus on planning for efficient day-to-day operations, development of measurement systems and contingency planning. Immediately prior to and after implementation the focus should be on communication, goal setting, issues prioritization and fact-based issues resolution. After the first couple of months of implementation, the focus should move toward mentoring teams/individuals, building outcome measurement systems, identifying sources of future improvement and transferring more authority as appropriate to teams. Commit to comprehensive implementation preparation. Time spent on implementation preparation will pay large dividends during the challenging times of transitioning your organization to a redesigned world.

Communication↗
PubMed2005

Functional assessment of mitral regurgitation by transthoracic echocardiography using standardized imaging planes diagnostic accuracy and outcome implications.

OBJECTIVES: We sought to assess the value of transthoracic echocardiography (TTE) using standardized imaging planes for the functional analysis of mitral regurgitation (MR) as well as for postoperative outcome implications. BACKGROUND: The feasibility of mitral valve repair is based on functional assessment of MR, mainly by transesophageal echocardiography (TEE). Considering the recent advances in TTE imaging, the incremental value of TEE in this setting needs to be re-examined. METHODS: Consecutive patients (n = 279; 181 men; median age 68 years [quartiles, 61 to 74]) who underwent surgery for MR were enrolled prospectively in two tertiary care centers. The accuracy of TTE (harmonic imaging) versus TEE for functional assessment of MR was evaluated against surgical findings. RESULTS: Valve repair (n = 237 patients, 85%) or replacement (n = 42) was predicted accurately by TTE in 97% of cases; TEE added significant information for only two patients. In the subgroup of degenerative MR (n = 190), agreement with surgical findings for the localization of prolapsed segments was 91% for TTE (kappa, 0.81) and 93% for TEE (kappa, 0.85) without incremental value of TEE (p = 0.40). Patients with single prolapse of the middle posterior scallop (P2) had a better postoperative outcome as compared with patients who had non-P2 lesions (p = 0.008). Furthermore, mitral replacement predicted by TTE was an independent predictor for postoperative long-term mortality (odds ratio 5.7, 95% confidence interval 1.97 to 16.4, p = 0.001). CONCLUSIONS: In experienced hands, functional assessment of MR by TTE can predict accurately valve repairability and has a strong influence on postoperative outcome. Thus, in most cases preoperative TEE is not mandatory, provided intraoperative TEE is performed.

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