Search PubMed⌕ Search

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.

At least 1,351 records · Page 75Linked to original sources
PubMed2003

Factors affecting cost and length of stay associated with the ileal pouch-anal anastomosis.

PURPOSE: The purpose of this study was to evaluate the costs associated with the ileal pouch-anal anastomosis procedure and identify those factors that most affected or determined such costs. Specifically evaluated were the costs, complication rates, and length of stay associated with the ileal pouch-anal anastomosis done as a one-stage, two-stage, two-stage modified, or three-stage procedure. METHODS: Costs from the hospital accounting database and clinical data from retrospective chart review of 135 ileal pouch-anal anastomosis patients from a ten-year period were compiled. Overall costs and length of stay (the sum of all hospitalizations for all surgeries and any related complications) for each group were compared by analysis of variance. Linear regression was used to compute net costs and length of stay excluding contributions from other relevant factors such as number of operative stages, complications, demographics, and nonelective operations. RESULTS: The average overall cost and length of stay of the ileal pouch-anal anastomosis ranged from a low of $12,738 and 13.5 days for the one-stage procedure to a high of $32,758 and 23.9 days for the three-stage pathway. Overall costs, length of stay, and incidence of complications increased with the number of operations necessary to complete the ileal pouch-anal anastomosis. This pattern of increased costs and length of stay with the greater number of stages persisted even after demographic and preoperative characteristics were controlled for in the analyses. The occurrence of a complication added an average of $9,304 (P < 0.0001) and 7.4 days to the procedure (P = 0.0002), whereas an urgent presentation added an average of $5,258 (P = 0.15) and 6.1 days (P = 0.04). CONCLUSIONS: The two most definitive determinants of cost and length of stay after ileal pouch-anal anastomosis are complications and number of operative stages used to complete the operation. Elective ileal pouch-anal anastomosis operations done in the fewest stages with the least complications provide the least costly result and the shortest hospital stay. For patients with severe disease, the two-stage modified pathway (total abdominal colectomy followed by pouch creation without a protecting ileostomy) appears to have fewer complications, lower costs, and a shorter length of stay than the traditional three-stage pathway.

Adult↗
PubMed1997

Why use clinical pathways rather than practice guidelines?

BACKGROUND: Financial pressures from managed care organizations, the government, and other "stakeholders" have resulted in the production of practice guidelines and clinical pathways. Clinical pathways involve all segments of a health care system and may prove to be more beneficial and less hazardous to patients and health care providers. METHODS: A historical narrative describing the development of clinical pathways by the Southwestern Surgical Congress (SWSC) and the Southeastern Surgical Congress (SESC) is made. The motivations, the benefits, and the hazards of both clinical pathways and practice guidelines are discussed. RESULTS: Clinical pathways have proven to reduce length of stay (LOS), complications, and cost, and provide increased patient satisfaction whereas practice guidelines from some specialties show improved quality of care when compared with nonspecialists. However, many practice guidelines are developed by specialists on "best practice" standards, and few have documented studies proving their effectiveness. CONCLUSIONS: Eleven clinical pathways were developed by the SWSC and the SESC and are in the process of revision and study for efficacy. They will be disseminated in the American Surgeon and on the SWSC web site for review and comment. In 1998, both congresses hope to publish the efficacy of selected pathways by describing their effect on LOS and charge for those diagnostic-related groups.

Critical Pathways↗
PubMed1998

Development of an alcohol withdrawal clinical pathway: an interdisciplinary process.

Studies show that as many as 40 percent of all patients in general hospitals are admitted because of complications related to alcoholism. However, the literature has little in specific clinical pathways, treatment protocols, or guidelines for the interdisciplinary care of these patients in the acute care setting. Furthermore, the little information that is published shows a lack of consistency in recommended treatment regimes. This article reviews a coordinated, interdisciplinary effort in developing and implementing a clinical pathway for alcohol withdrawal.

Alcoholic Beverages↗
PubMed2002

Cellular mechanisms of neurogenic inflammation.

Since the initial observations that stimulation of sensory neurons produces vasodilation, plasma extravasation, and hypersensitivity, much progress has been made in understanding the etiology of neurogenic inflammation. Studies have focused largely on the role of the neuropeptides, substance P and calcitonin gene-related peptide, which are released in the periphery by activation of small diameter sensory neurons. Recent work, however, has begun to emphasize the cellular mechanisms involved in regulating the release of proinflammatory substances from sensory neurons. In this perspective, discussion centers on a number of inflammatory mediators that activate various signal transduction pathways to augment excitability of and transmitter release from sensory neurons. Emphasis is placed on those pathways where multiple lines of evidence support their importance in initiating neurogenic inflammation. Recent studies, however, support the notion that there are novel compounds released during injury that can stimulate or sensitize sensory neurons. Furthermore, only now are intracellular signaling pathways that have been identified in other cell systems being studied in sensory neurons to establish their role in neurogenic inflammation. The challenge remains to ascertain the critical transduction pathways that regulate transmitter release from sensory neurons since this phenomenon triggers neurogenic inflammation. In addition, the cellular mechanisms involved in alterations in neuronal excitability during injury and the cellular pathways that maintain the inflammatory response over time need to be determined. With these advances, we will be able to develop therapeutic interventions to minimize deleterious consequences of neurogenic inflammation.

Animals↗
PubMed2004

Ethics, EBM, and hospital management.

Matters of hospital management do not figure prominently on the medical ethics agenda. However, management decisions that have to be taken in the area of hospital care are in fact riddled with ethical questions and do have significant impact on patients, staff members, and the community being served. In this decision making process evidence based medicine (EBM) plays an increasingly important role as a tool for rationalising as well as rationing health care resources. In this article, ethical issues of hospital management and the role of EBM will be explored, with particular reference to disease management programs, diagnosis related groups, and clinical pathways as recent developments in the German health care system.

Critical Pathways↗
PubMedDate not supplied

The development of mental health care pathways: friend or foe?

Greater emphasis is being placed on mental health services to be more responsive to clinical variation. Care pathways can standardize clinician response to established diagnostic groups such as schizophrenia. This article discusses care pathways using the findings of a research study carried out in London to explore the development and implementation of a care pathway. Respondents encountered many difficulties such as the principles behind individualized care and generic roles and responsibilities in preformulating their work into a care pathway sequence. This article concludes with areas for further application and research.

Attitude of Health Personnel↗
PubMedDate not supplied

The Pendine pathways project in the independent sector.

Recruitment and retention of staff, and the drive to provide quality care are challenges currently faced by nursing and residential homes in the independent sector. This article describes an innovative approach to tackling these issues. Under a teaching company scheme, a partnership was formed between the Pendine Park Nursing Home and the Centre for Learning Development to develop care and career pathways that are specific to the independent sector.

Career Mobility↗
PubMed2005

Education earns high comparative AMI rankings.

Initiatives enable facility to gain high rankings in five clinical measures. Even though physicians know what they should do, reminders still are necessary. Physicians who are not compliant with new pathways are talked to by department chairs.

Adrenergic beta-Antagonists↗
PubMed2006

Perceptions of health care professionals concerning development of clinical pathways.

The purpose of this survey was to investigate the perceptions of health care professionals concerning the development of clinical pathways before the implementation of the regional electronic health record. The data of this study were collected from health care professionals working with conservative heart patients and surgical hip joint patients by means of a questionnaire. The professionals were working at one central hospital and two primary care units. In this hospital region, the process of regional electronic health record implementation is ongoing. The data from this survey were analyzed using statistical methods. The participants in this study set great store by developing and describing the current clinical pathways, and believed it was important to plan the changes in clinical pathways before implementing the electronic health record. However, the clinical pathways development work has not yet fully commenced.

Attitude of Health Personnel↗
PubMed1999

Inhibition of cyclin-dependent kinase 2 by p21 is necessary for retinoblastoma protein-mediated G1 arrest after gamma-irradiation.

In mammalian cells, activation of certain checkpoint pathways as a result of exposure to genotoxic agents results in cell cycle arrest. The integrity of these arrest pathways is critical to the ability of the cell to repair mutations that otherwise might compromise viability or contribute to deregulation of cellular growth and proliferation. Here we examine the mechanism through which DNA damaging agents result in a G1 arrest that depends on the tumor suppressor p53 and its transcriptional target p21. By using primary cell lines lacking specific cell cycle regulators, we demonstrate that this pathway functions through the growth suppressive properties of the retinoblastoma protein (pRB) tumor suppressor. Specifically, gamma-irradiation inhibits the phosphorylation of pRB at cyclin-dependent kinase 2-specific, but not cyclin-dependent kinase 4-specific, sites in a p21-dependent manner. Most importantly, we show that pRB is a critical component of this DNA damage checkpoint. These data indicate that the p53 --> p21 checkpoint pathway uses the normal cell cycle regulatory machinery to induce the accumulation of the growth suppressive form of pRB and suggest that loss of pRB during the course of tumorigenesis disrupts the function of an important DNA damage checkpoint.

Animals↗
PubMed2003

Airway smooth muscle: immunomodulatory cells that modulate airway remodeling?

Although the pathogenesis of asthma remains unclear, substantial progress has been made over the past decades in the characterization of airway inflammation as a pathogenetic mechanism in asthma. New evidence suggests that airway smooth muscle (ASM), the most important cell modulating bronchomotor tone, plays an important immunomodulatory role in the orchestration and perpetuation of airway inflammation. Evidence now suggests that the signaling pathways that modulate leukocyte function may be disparate from those found in resident effector cells such as ASM, fibroblasts and epithelial cells. Further investigation and understanding of the critical signaling pathways that modulate ASM cell release, secretion of chemokines/cytokines and expression of cell adhesion molecules (CAMs) may offer new therapeutic approaches in the treatment of asthma.

Adaptation, Physiological↗
PubMed2004

Balancing Akt with S6K: implications for both metabolic diseases and tumorigenesis.

Proper regulation of the phosphoinositide 3-kinase-Akt pathway is critical for the prevention of both insulin resistance and tumorigenesis. Many recent studies have characterized a negative feedback loop in which components of one downstream branch of this pathway, composed of the mammalian target of rapamycin and ribosomal S6 kinase, block further activation of the pathway through inhibition of insulin receptor substrate function. These findings form a novel basis for improved understanding of the pathophysiology of metabolic diseases (e.g., diabetes and obesity), tumor syndromes (e.g., tuberous sclerosis complex and Peutz-Jegher's syndrome), and human cancers.

Feedback, Physiological↗
PubMed2006

[Evidence based guidelines and clinical pathways: complementation or contradiction?].

Even methodological sound guidelines will only achieve their goals when the recommendations are transferred into practice. Guideline introduction and dissemination must therefore be accompanied by active implementation measures. For inpatient care clinical pathways can serve as tools, especially taking advantage of their sequential character. Complementary evidence based guidelines can serve as an optimal source of systematically appraised evidence in developing clinical pathways. Considering them is of major help to assure that the content of clinical pathways is in accordance with evidence. The article highlights methodological requirements in guideline and pathway development and gives prospects on how both tools can be used together.

Biomedical Research↗
PubMed1998

Clinical pathways--a perioperative application.

The application of clinical pathways as a means of streamlining health care and tracking outcome data for continuous quality improvement has been evolving continually since the late 1980s. In order for the clinical pathway process to be effective, it must be collaborative, multidisciplinary, and have administrative support and institutional congruency. Members of multidisciplinary work group at the University of California Los Angeles Medical Center have developed a perioperative clinical pathway for patients undergoing coronary artery bypass graft surgery. The process of developing a perioperative clinical pathway involved extensive preliminary preparation before actually designing the pathway and identifying outcome data. Ongoing reevaluation of pathway components is essential and future opportunities for expansion are apparent.

Coronary Artery Bypass↗