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Results for “Critical Pathways”

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At least 1,189 records · Page 66Linked to original sources
PubMed2000

The role of the nurse in urinary incontinence.

Specialist nursing is dynamic and needs to be sensitive, flexible and responsive to changes in care delivery. Clinical, educational, managerial, audit and research activities are all integral to the role of the specialist continence nurse. Nurse specialists need to be careful that they do not de-skill the role of more generalist nurses, but rather enhance their contribution to continence care. They also need to work collaboratively with their Specialist Continence Physiotherapist colleagues. There is evidence that care in the community setting and on ward areas is sub-optimal. Recent audit activities have shown that nurses feel comfortable about assessing the person with continence problems but less certain about treatment. One way to address this imbalance is through the use of care pathways, examples of which are illustrated.

Community Health Nursing↗
PubMed1999

CMs fight for acceptance of premature infant path.

Responding to benchmarking data indicating that their length of stay for premature infants was above the national average, case managers at University Hospital-University of Colorado Health Sciences Center in Denver formed a multidisciplinary team to develop a pathway designed to address the problem. But they encountered stiff initial resistance from both staff nurses and physicians, many of whom regarded the pathway as "cookbook medicine." The main appeal to nurses was that the pathway's preprinted orders would help standardize care--a key selling point at this teaching hospital, where attending physicians and interns rotate in and out on a monthly basis. Case managers also changed the pathway's documentation requirements at the suggestion of the nurses, adopting a charting-by-exception approach. Physicians have been slower to come around, but the case managers are optimistic that outcomes data on the revised pathway, due within six months, will demonstrate the pathway's benefits.

Attitude of Health Personnel↗
PubMed2002

Improving treatment outcomes with a clinical pathway for hysterectomy and myomectomy.

OBJECTIVE: To determine if using a postoperative clinical pathway for women having hysterectomy or myomectomy would improve clinical care. STUDY DESIGN: Data from the literature and patient focus groups guided development of a clinical pathway. Nurses, pharmacists and physicians participated in the development process. Implementation relied on accepted quality improvement methods. We used a case-control design to compare administrative and clinical data for patients managed with (n = 28) and without (n = 28) the aid of the clinical pathway between June 1997 and January 1998. RESULTS: Case and control groups did not differ in age, race, payer status, severity of illness or procedure type. Clinical differences between pathway and nonpathway patients included a mean six-hour-shorter period of indwelling bladder catheters (P = .019), mean 11-hour more rapid return to regular diet (P = .014) and more pain assessments among pathway patients (mean, five vs. two; P < .001). There was no significant difference in length of stay between groups. Clinicians used the pathway for approximately one year, but with personnel changes the pathway gradually fell out of use. CONCLUSION: Clinical pathways can improve quality of care, even if they do not reduce length of stay. A team approach that focuses on patient concerns during pathway development may help ensure that quality improvement, rather than simply cost reduction, arises from the use of clinical pathways.

Adult↗
PubMedDate not supplied

Best practice: clinical pathways for uncomplicated births.

BACKGROUND: A level II hospital with births exceeding 2000 annually was challenged by managed care companies to develop high-quality, cost-effective, and clinically efficient obstetric and newborn care under the constraints of a reduced length of stay. METHODS: As a result of the challenge, clinical pathways were initiated for vaginal and cesarean section births and for normal newborns. RESULTS: Successful implementation of the clinical pathways has decreased the average length of stay for uncomplicated deliveries from 2.02 to 1.67 days and for normal newborns from 1.99 to 1.43 days. CONCLUSIONS: Data from quality outcome indicators that measure the rate of occurrence of emergency department admissions or hospital readmissions for either mother or newborn within 14 days of birth reveal no increase in either variance since the clinical pathways were implemented.

Cost-Benefit Analysis↗
PubMed1998

Ovarian cancer surgery: a clinical pathway.

Clinical pathways are useful tools in providing quality care while decreasing the cost of that care. Pathways help to facilitate managed care, identify patient and family educational needs, encourage multidisciplinary communication, and expedite patient discharge. This article discusses a clinical pathway for ovarian cancer surgery.

Critical Pathways↗
PubMed2005

Critical function of the CD40 pathway in parvovirus B19 infection revealed by a hypomorphic CD40 ligand mutation.

Parvovirus B19-induced chronic anemia has been associated with failure to mount an effective neutralizing antibody response. We describe an adolescent male with a 13-year history of parvovirus B19-induced anemia as the primary manifestation of X-linked hyper IgM immunodeficiency (XHIM). This patient, whose serum IgG concentration was at the low end of the normal range and who mounted IgG antibody responses to T cell-dependent antigens, suffered from a nonsense mutation (R11 --> X) in the CD40 ligand (CD40L) gene. This resulted in low-level expression of a mutant CD40L predicted to lack the cytoplasmic domain. Intravenous immunoglobulin therapy alone or in combination with interferon gamma, given in the context of impaired Th1 cytokine production, suppressed but did not eradicate the infection. These results highlight the critical function of the CD40/CD40L pathway in parvovirus B19 infection and suggest that subtle defects in this pathway may underlie cases of chronic parvovirus B19 infection atypical of XHIM.

Adolescent↗
PubMed2000

A critical role for B7/CD28 costimulation in experimental autoimmune encephalomyelitis: a comparative study using costimulatory molecule-deficient mice and monoclonal antibody blockade.

The B7/CD28 pathway provides critical costimulatory signals required for complete T cell activation and has served as a potential target for immunotherapeutic strategies designed to regulate autoimmune diseases. This study was designed to examine the roles of CD28 and its individual ligands, B7-1 and B7-2, in experimental autoimmune encephalomyelitis (EAE), a Th1-mediated inflammatory disease of the CNS. EAE induction in CD28- or B7-deficient nonobese diabetic (NOD) mice was compared with the effects of B7/CD28 blockade using Abs in wild-type NOD mice. Disease severity was significantly reduced in CD28-deficient as well as anti-B7-1/B7-2-treated NOD mice. B7-2 appeared to play the more dominant role as there was a moderate decrease in disease incidence and severity in B7-2-deficient animals. EAE resistance was not due to the lack of effective priming of the myelin peptide-specific T cells in vivo. T cells isolated from CD28-deficient animals produced equivalent amounts of IFN-gamma and TNF-alpha in response to the immunogen, proteolipid protein 56-70. In fact, IFN-gamma and TNF-alpha production by Ag-specific T cells was enhanced in both the B7-1 and B7-2-deficient NOD mice. In contrast, peptide-specific delayed-type hypersensitivity responses in these animals were significantly decreased, suggesting a critical role for CD28 costimulation in in vivo trafficking and systemic immunity. Collectively, these results support a critical role for CD28 costimulation in EAE induction.

Amino Acid Sequence↗