Clinical pathways: from the hospital to the home.
Explore the source record for details and available documents.
Community Health Nursing↗
SEARCH · Search PubMed
Results for “Critical Pathways”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Idiopathic constipation management pathway.
Explore the source record for details and available documents.
Algorithms↗
[Clinical pathways for early rehabilitation program in patients with acute myocardial infarction].
Explore the source record for details and available documents.
Critical Pathways↗
Clinical pathways: the careplans of the 90s: an independent study (continuing education credit).
Explore the source record for details and available documents.
Case Management↗
Regulation of matrix metalloproteinase-9 (MMP-9) in TNF-stimulated neutrophils: novel pathways for tertiary granule release.
Matrix metalloproteinase-9 (MMP-9) is present in the tertiary granules of neutrophils and is rapidly released following stimulation. We examined the pathways that regulate tumor necrosis factor (TNF)-mediated MMP-9 release and found this to be dependent on the TNF receptor I. TNF rapidly activated extracellular signal-regulated kinase and p38 mitogen-activated protein kinases, but neither of these pathways was critical for MMP-9 release. Many neutrophil responses to TNF require beta2-integrin-dependent signaling and subsequent Src family kinase activation. In contrast, we found that MMP-9 release from tertiary granules was only partially affected by blocking beta2-integrin-mediated adhesion. Similarly, blocking Src family kinases with the inhibitor PP2 only attenuated TNF-induced MMP-9 release. Blocking beta2-integrin-mediated adhesion and Src family kinases did not result in additive inhibition of MMP-9 release. In contrast, inhibiting protein kinase C (PKC) with a pan-specific inhibitor blocked greater than 85% of MMP-9 release. Inhibitors against specific PKC isoforms suggested a role for PKC alpha and PKC delta in maximal MMP-9 release. These data suggest that MMP-9 release from tertiary granules uses beta2-integrin-independent signaling pathways. Furthermore, PKC isoforms play a critical role in regulating tertiary granule release.
CD18 Antigens↗
Gene activating and proapoptotic potential are independent properties of different CD4 epitopes.
CD4 engagement triggers an early signaling cascade which initiates late events such as transcription factor activation. The outcome of CD4 engagement is T-cell commitment to alternative, dramatically different fates, such as activation and apoptosis. We have tested a panel of anti-CD4 mAbs specific for different CD4 epitopes, as well as HIV-1 gp120, for the capacity to activate crucial early events such as enhancement of p56(lck) kinase activity and Shc phosphorylation. The same CD4 epitopes were characterized for their capacity both to deliver a gene activating signal and to program T-cells to activation dependent death. No correlation could be found between capacity of specific CD4 epitopes to deliver a gene activating signal and capacity to prime T-cells to apoptosis, suggesting that gene activating and proapoptotic potential are independent functions of CD4 epitopes. Furthermore, while triggering of the calcium pathway appears critical in NF-AT activation, optimal p56(lck) activation and Shc phosphorylation might be required for initiation of the apoptotic pathway.
Antibodies, Monoclonal↗
[Clinical pathways: a way to integrate a standardized treatment and patient-orientation?].
The implementation of Diagnosis Related Groups (DRGs) as the payment system for hospital work requires to optimise the processes and the use of resources while maintaining the quality of care. To achieve these goals hospitals implement clinical pathways. The systematic structure of these pathways was developed in the industrial context during the 1950s. This history led to the assumption that a process begins and ends in a previously-planned most linear motion. This assumption creates various problems. First of all, the conditions of the situation and the individual's personal needs are ignored. Both aspects are relevant for the quality of care as well as for the calculation of the expenditures. Another problem is the disregard of communicative understanding, the core of nursing. As a result of these problems, the contradictory goals satisfying the rationale and communicative needs conflict. This situation creates the risk of the functional-orientated orders of the clinical pathways determining the relationship between the nurse and the patient. The next risk is that the patient will only be a marginal part of the process. In addition, the nurses may loose their caring competence. Despite these arguments, the use of clinical pathways can be well supported. For the pathway to be successful, the stipulation that remains important is for the system to allow flexibility. To achieve this flexibility, one must utilize assessment instruments. The steps of the intervention process have to be guided by the results of the assessment along with the outcome. The art of professional nursing should successfully combine the clinical pathway with the patient's individual needs.
Clinical Competence↗
The development of a group B streptococcus prevention policy at a community hospital.
BACKGROUND AND OBJECTIVES: In 1996, the Centers for Disease Control (CDC) issued guidelines for antepartum antibiotic prophylaxis of group B streptococcal (GBS)-positive women. The objective of this study is to document results of a GBS prophylaxis policy at one nonacademically affiliated, community hospital and discern its effectiveness with regard to compliance as well as in decreasing the incidence of early onset GBS (EOGBS) disease. METHODS: The development of a GBS-prevention policy at the Women's Hospital of Greensboro (WHG) was documented by means of interviews and examination of minutes of meetings. Effectiveness of the policy was assessed by calculating the percentage of all GBS+ or unknown mothers who received antepartum antibiotics during a 1-year period. Additionally, all newborns with any positive GBS culture during the past 13 years at WHG were identified. RESULTS: The policy was formulated and distributed during a 6-month period by strong leadership, community "buy-in," and an educational seminar. A preprinted physician order was written so that all GBS-positive/unknown mothers would receive antepartum antibiotics. Additionally, a clinical pathway was used to track and monitor maternal GBS status. During October 1, 1999 to September 30, 2000, 1124 (23.1%) mothers were found to be GBS positive/unknown. Of those who delivered an infant >37 weeks' gestation and who could be linked to the pharmacy database, 777 (91.1%) received antepartum antibiotics. The incidence of EOGBS disease at WHG before 1996 was 1.93 +/- 0.7/1000 births compared to 0.4 +/- 0.05/1000 after the issuance of the guidelines (p = 0.002, t-test). CONCLUSIONS: Over 90% of GBS-positive mothers were treated with antibiotics at WHG. Associated with this high adherence rate to the CDC guidelines has been a five-fold decrease in the incidence of EOGBS disease. We attribute these results to the implementation of a preprinted physician order sheet to direct intrapartum antibiotics for women with GBS positive or unknown colonization and the use of a clinical pathway to track GBS colonization status.
Antibiotic Prophylaxis↗
Issues for the development of care pathways in mental health services.
AIMS: This paper seeks to discuss some of the issues for the development of care pathways for inpatients with schizophrenia. BACKGROUND: Managed care pathways are becoming increasingly popular for general adult conditions. Little is known about the development or application of care pathways for mental health services, and in particular, for inpatients diagnosed with schizophrenia. METHODS: Action research principles were adopted to engage and develop support to examine care pathways. Participant observation and unstructured interviews were the primary methods used during this phase of the research. The paper draws on the experiences of one of the authors (AJ) and his attempt to discuss the potential development of a care pathway for in-patients with schizophrenia in one inner city locality in London. FINDINGS: Four central issues were identified by the group; individualized care versus standardized care, generic practice and generic education. CONCLUSIONS: The development and application of care pathways for mental health services requires the consent and commitment from the work force. Many crucial barriers to development arose during the discussion groups and these will require further attention by prospective organizations wishing to apply care pathways to complex diagnostic groups such as schizophrenia.
Adult↗
A tale of three pathways: the experience of RBWH Mental Health.
OBJECTIVES: Australian research has identified that there are significant variations between service providers in terms of clinical management of patients with comparable presenting problems. Internal audits within the facility at Royal Brisbane and Women's Hospital revealed that these variations occurred between wards, treating teams and psychiatric consultants. Given the increasing emphasis on evidence-based practice, it was decided that the literature should be reviewed to determine what the standard of care should be. The paper then examines how clinical pathways for psychosis and for depression were developed and how they eventually evolved into an acute inpatient pathway. It identifies the framework used and examines important aspects relating to the adaptation of these frameworks to mental health issues. The process for the development and implementation of the clinical pathway is discussed. Recommendations for their future use in a mental health setting are also presented. CONCLUSIONS: Mental Health care is complex. For this reason, mental health clinical pathways have to remain flexible and innovative. With the present project, it was found that the pathways were not suited for specific diagnoses so that they evolved into a single acute inpatient pathway.
Australia↗
Implementation and evaluation of Nursing Interventions Classification and Nursing Outcomes Classification in a patient education plan.
Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) are recognized examples of standardized nursing languages used to describe the contribution nursing makes to patient care. Columbus Regional Hospital nursing leadership recognized the need to use standardized nursing interventions and nursing-sensitive patient outcomes to describe the unique contribution nursing makes to patient education. In collaboration with the University of Iowa, NIC/NOC languages were implemented in the development of a patient education plan for a clinical pathway population.
Critical Pathways↗
Implementing clinical pathways: one agency's experience.
The shift to managed care is forcing home health agencies to evaluate their methods of service delivery and documentation. Managed-care organizations are demanding that agencies demonstrate that they can provide cost-effective, quality services within a specified period. The outcomes of care, per visit or per admission, represent the indicators of whether these demands are being met. Many home health agencies are turning to clinical pathways to delineate their services and strengthen their documentation. This article provides a description of one agency's experience in implementing clinical pathways.
Community Health Nursing↗
A liability checklist for clinical pathways.
To ensure safe, responsible use of clinical pathways, follow written policies and procedures and document all patient care.
Critical Pathways↗
Clinical pathway audit tools: a systematic review.
AIM: To determine whether clinical/care pathway audit tools can identify the characteristics of well-organized care processes. BACKGROUND: Although pathways are used worldwide, confusion exists about the concept and impact. Evaluation Search of OVID-Medline, Cinahl, British Nursing Index; manual search of the Journal of Integrated Care Pathways; contact with Smartgroup on Clinical Pathways and board members of the European Pathway Association and Google search. KEY ISSUES: We selected seven of 15 clinical pathway audit tools for this review. Through content analysis, we identified 17 characteristics and grouped them using the realistic evaluation paradigm. The Integrated Care Pathway Appraisal Tool is the most appropriate audit tool to assess clinical pathway documents. CONCLUSIONS: It is astonishing that so little research on clinical pathway audit tools has been underwent, given the prevalent use of clinical pathways. Because the concept of clinical pathways remains unclear, a variety of audit tools are needed to help clarify the concept. Further research on the construct and criterion validity of pathway audit tools is necessary to fully understand why and under which circumstances pathways lead to improved care.
Critical Pathways↗
Assessing the efficacy of a clinical pathway in the management of older patients hospitalized with congestive heart failure.
Congestive heart failure (CHF) is the most common cause for hospitalization in older patients, and the prevalence of this condition is expected to rise as the population ages. The high cost of care has resulted in an increased emphasis on cost-effective approaches in patient management. One way to achieve this is the use of clinical pathways. This article compares outcomes in a group of older hospitalized patients managed on a CHF pathway with those of a historical cohort managed in the traditional manner. The patients on the pathway had significant reductions in length of stay and cost of care as well as more effective delivery of processes of care. Mortality rates were unchanged, at 3.5%. However, readmission rates showed a significant increase, from 9.25% to 13.5%, for patients on the pathway.
Aged↗
Direct activation of mitogen-activated protein kinase kinase kinase MEKK1 by the Ste20p homologue GCK and the adapter protein TRAF2.
Mitogen-activated protein kinase (MAPK) pathways coordinate critical cellular responses to mitogens, stresses, and developmental cues. The coupling of MAPK kinase kinase (MAP3K) --> MAPK kinase (MEK) --> MAPK core pathways to cell surface receptors remains poorly understood. Recombinant forms of MAP3K MEK kinase 1 (MEKK1) interact in vivo and in vitro with the STE20 protein homologue germinal center kinase (GCK), and both GCK and MEKK1 associate in vivo with the adapter protein tumor necrosis factor (TNF) receptor-associated factor 2 (TRAF2). These interactions may couple TNF receptors to the SAPK/JNK family of MAPKs; however, a molecular mechanism by which these proteins might collaborate to recruit the SAPKs/JNKs has remained elusive. Here we show that endogenous GCK and MEKK1 associate in vivo. In addition, we have developed an in vitro assay system with which we demonstrate that purified, active GCK and TRAF2 activate MEKK1. The RING domain of TRAF2 is necessary for optimal in vitro activation of MEKK1, but the kinase domain of GCK is not. Autophosphorylation within the MEKK1 kinase domain activation loop is required for activation. Forced oligomerization also activates MEKK1, and GCK elicits enhanced oligomerization of coexpressed MEKK1 in vivo. These results represent the first activation of MEKK1 in vitro using purified proteins and suggest a mechanism for MEKK1 activation involving induced oligomerization and consequent autophosphorylation mediated by upstream proteins.
Animals↗
Functional genomics of P450s.
Plant systems utilize a diverse array of cytochrome P450 monooxygenases (P450s) in their biosynthetic and detoxicative pathways. Those P450s in biosynthetic pathways play critical roles in the synthesis of lignins, UV protectants, pigments, defense compounds, fatty acids, hormones, and signaling molecules. Those in catabolic pathways participate in the breakdown of endogenous compounds and toxic compounds encountered in the environment. Because of their roles in this wide diversity of metabolic processes, plant P450 proteins and transcripts can serve as downstream reporters for many different biochemical pathways responding to chemical, developmental, and environmental cues. This review focuses initially on defining P450 biochemistries, nomenclature systems, and the relationships between genes in the extended P450 superfamily that exists in all plant species. Subsequently, it focuses on outlining the many approaches being used to assign function to individual P450 proteins and gene loci. The examples of assigned P450 activities that are spread throughout this review highlight the importance of understanding and utilizing P450 sequences as markers for linking biochemical pathway responses to physiological processes.
Cytochrome P-450 Enzyme System↗
Rehab center cuts LOS with interdisciplinary teams.
Faced with an average length of stay (LOS) a full twenty days longer than the national average for spinal cord-injured patients, case managers at one hospital took advantage of their rehab center's existing spirit of interdisciplinary cooperation to foster a pathway that would bring LOS in line. The pathway team rejected a discipline-specific approach, choosing instead to break the pathway down by areas of outcome for the patient. By focusing on outcomes rather than specific responsibilities, members of the spinal cord team are encouraged to act collaboratively in helping patients achieve positive outcomes. Staff perform concurrent monitoring of patient compliance with the pathway in an effort to collect outcomes measures beyond LOS and cost per case.
Critical Pathways↗