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 1,387 records · Page 77Linked to original sources
PubMed2000

Clinical pathways--an evaluation of its impact on the quality of care in an acute care general hospital in Singapore.

A critical or clinical pathway defines the optimal care process, sequencing and timing of interventions by healthcare professionals for a particular diagnosis or procedure. It is a relatively new clinical process improvement tool that has been gaining popularity across hospitals and various healthcare organisations in many parts of the world. It is now slowly gaining momentum and popularity in Asia and Singapore. Clinical pathways are developed through collaborative efforts of clinicians, case managers, nurses, and other allied healthcare professionals with the aim of improving the quality of patient care, while minimising cost to the patient. Clinical pathways have been shown to reduce unnecessary variation in patient care, reduce delays in discharge through more efficient discharge planning, and improve the cost-effectiveness of clinical services. The approach and objectives of clinical pathways are consistent with those of total quality management (TQM) and continuous clinical quality improvement (CQI), and is essentially the application of these principles at the patient's bedside. However, despite the growing popularity of pathways, their impact on clinical outcomes and their clinical effectiveness remains largely untested and unproven through rigorous clinical trials. This paper begins with an overview of the nature of clinical pathways and the analysis of variances from the pathway, their benefits to the healthcare organisation, their application as a tool for CQI activities in direct relation to patient care, and their effectiveness in a variety of healthcare settings. The paper describes an evaluation of the impact of a clinical pathway on the quality of care for patients admitted for uncomplicated acute myocardial infarction (AMI) through an analysis of variances. The author carried out a one year evaluation of a clinical pathway on uncomplicated AMI in Changi General Hospital (CGH) to determine its effectiveness and impact on a defined set of outcomes. A before and after nonrandomized study of two groups of patients admitted to the Hospital for uncomplicated AMI was done. A total of 169 patients were managed on the clinical pathway compared to 100 patients in the control (historical comparison) group. Outcomes were compared between the two groups of patients. Restriction and matching of study subjects in both groups ensured that the patients selected were comparable in terms of severity of illness. The results showed that the patients on the clinical pathway and the comparison group were similar with respect to demographic variables, prevalence of risk factors and comorbidities. There was a statistically significant reduction in the average length of stay after implementation of the clinical pathway. This was achieved without any adverse effect on short term clinical outcomes such as in-hospital mortality, complication rate and morbidity. There were no significant difference in readmission rates at 6 months after discharge. The paper concludes that clinical pathways, implemented in the context of an acute care general hospital, is able to significantly improve care processes through better collaboration among healthcare professionals and improvements in work systems.

Analysis of Variance↗
PubMed2000

Induction, binding specificity and function of human ICOS.

Recently, we have identified the inducible co-stimulator (ICOS), an activation-dependent, T cell-specific cell surface molecule related to CD28 and CTLA-4. Detailed analysis of human ICOS presented here shows that it is a 55-60-kDa homodimer with differently N-glycosylated subunits of 27 and 29 kDa. ICOS requires both phorbol 12-myristate 13-acetate and ionomycin for full induction, and is sensitive to Cyclosporin A. ICOS is up-regulated early on all T cells, including the CD28- subset, and continues to be expressed into later phases of T cell activation. On stimulation of T cells by antigen-presenting cells, the CD28/B7, but not the CD40 ligand/CD40 pathway is critically involved in the induction of ICOS. ICOS does not bind to B7-1 or B7-2, and CD28 does not bind to ICOS ligand; thus the CD28 and ICOS pathways do not cross-interact on the cell surface. In vivo, ICOS is expressed in the medulla of the fetal and newborn thymus, in the T cell zones of tonsils and lymph nodes, and in the apical light zones of germinal centers (predominant expression). Functionally, ICOS co-induces a variety of cytokines including IL-4, IL-5, IL-6, IFN-gamma, TNF-alpha, GM-CSF, but not IL-2, and superinduces IL-10. Furthermore, ICOS co-stimulation prevents the apoptosis of pre-activated T cells. The human ICOS gene maps to chromosome 2q33 - 34.

Antigens, Differentiation, T-Lymphocyte↗
PubMed1991

Predictive accuracy of electrophysiologic localization of accessory pathways.

Operative ablation of accessory pathways depends critically on preoperative localization when technical limitations preclude complete intraoperative mapping. To assess the accuracy of localization, 345 patients undergoing operative ablation were studied; 316 (91.6%) had a single accessory pathway and 29 (8.4%) had multiple accessory pathways. The electrophysiologic study was diagnostically complete and accurate in 294 patients (93%) with a single accessory pathway and 19 (61%) with multiple accessory pathways. A left lateral accessory pathway was most accurately localized with excellent sensitivity (99%) and positive predictive value (98.5%). Diagnostic errors occurred in 33 patients because of 1) incorrect localization (n = 16), 2) failure to detect a second pathway (n = 9), and 3) diagnosis of a second pathway not verified intraoperatively (n = 8). Multiple pathways were more prevalent in the group with errors (33.3% vs. 5.8%, p = 0.0001), as were unidirectional pathways (48.5% vs. 24.3%, p = 0.003). It is concluded that preoperative localization of accessory pathways is sufficiently accurate to allow intraoperative mapping to be brief and focused.

Adult↗
PubMed2003

What are the initial perceptions of multidisciplinary personnel new to integrated care pathway development?

Initial perceptions of programmatic shifts are important to gauge if organizational change is to be successful. We used qualitative methods to understand the perceptions of multidisciplinary team members who were responsible for developing integrated care pathways for chronic heart disease in an attempt to improve continuity of care. Members viewed continuity of care as problematic and perceived ICPs as a template for increasing knowledge and enhancing communication. Numerous barriers to ICP use were noted. Information collected in this study may assist others who are developing integrated care pathways.

Canada↗
PubMed1998

A clinical pathway for ostomy care in the home: process and development.

The health care environment is changing rapidly both in form and funding. Recognition of the need for organized, cost-efficient services across the health care continuum has resulted in a model identified as a clinical pathway. This article compares and contrasts key elements of the clinical pathway model as they apply to the acute care setting versus the home care setting. An example of a clinical pathway for ostomy patients in the home care setting is presented, followed by a discussion of its development, pilot testing, and outcomes evaluation. Conclusions regarding the validity of clinical pathways in home care are discussed, and the need for further research is considered.

Community Health Nursing↗
PubMed1996

Signal transduction-based strategies for the treatment of chronic myelogenous leukemia.

Recent studies of the BCR-ABL fusion protein, the product of the oncogene responsible for chronic myelogenous leukemia, have identified a number of signal transduction pathways that are activated by this tyrosine kinase. In some cases, these pathways are critical mediators of the growth stimulatory effects of the oncogene on hemopoietic cells. This knowledge has been translated into therapeutic strategies that directly target BCR-ABL or the signaling pathways that BCR-ABL activates. Promising results in animal models have led to the design of Phase I clinical trials, which are in progress or will be under way shortly. These studies are among the first to target a specific genetic abnormality in human cancer.

Animals↗
PubMed2002

Novel targets of Akt, p21(Cipl/WAF1), and MDM2.

The phosphatidylinositol-3-OH kinase (PI-3K)/Akt signaling pathway plays a critical role in tumorigenesis. This pathway is activated by the amplification or overexpression of HER2/neu, which occurs in 30% of human breast and ovarian cancers. The recent identification of a number of Akt substrates suggests that Akt can enhance cell proliferation and inhibit apoptosis. In this review we will discuss the theme of action of Akt in regulating the cellular localization of its substrates to control proliferation and apoptosis in light of two new identified Akt substrates, p21(Cip1/WAF1) and MDM2.

Cyclin-Dependent Kinase Inhibitor p21↗
PubMed2001

Pathways to quality improvement for boarding homes: a Washington State model.

A quality improvement service delivery model was developed, implemented, and evaluated during a boarding home consultation program in Washington State. Standardized quality improvement (QI) pathways were utilized to define resident issues related to quality of life, quality of care, and safety. The pathways assisted boarding homes (n = 126) volunteering for on-site visits with QI consultants to identify and address resident needs and meet statutory requirements. After 6 months in the program, 78 percent of participating residents demonstrated objective clinical improvement. Assisting providers in meeting resident needs by using QI pathways will improve residents' quality of life, quality of care and safety.

Critical Pathways↗
PubMedDate not supplied

Pediatric pain management: a research-based clinical pathway.

Nurses want to provide pain management for pediatric patients, but different approaches lead to inconsistent pain management. This article presents a pediatric pain management clinical pathways developed as a result of research in the pediatric intensive care unit and based on pain management research. Using this pathway can help nurses deliver consistent pain management to pediatric patients.

Adult↗
PubMedDate not supplied

Evaluation of a pediatric scald burn clinical pathway.

Scald burns make up more than 75% of the pediatric burns patients who are admitted to our burns unit. A pediatric scald burn pathway was implemented at our center in November 1999, the aim of which was to improve consistency in the management of the acute phase of injury. This study assessed the effectiveness of the first 18 months of this scald burn pathway. Aspects of the management of pediatric scald burn patients were reviewed. This included all the patients admitted over a 6-month period 1 year before the implementation of the pathway and the first 6 months and between 12 and 18 months after the implementation of the pathway. Data collected included patient demographics, total body surface area burned, and key management guidelines, including nasogastric feeding, intravenous cannulation, analgesia prescription, multidisciplinary referrals, and family education Thirty-seven patients were enrolled in the first 6 months of the pathway's use. Between 12 and 18 months, a further 38 patients were enrolled. The patients within the three groups were similar in age and burn size. A comparison among the groups with respect to compliance with the treatment guidelines is presented graphically. In conclusion, the management of pediatric scald burns in the acute phase is more consistent since the implementation of the clinical pathway.

Acute Disease↗
PubMed2003

Care pathways: the road to better health services?

This paper describes the development and implementation of care pathways in two orthopaedic units in Scotland. Although originally developed as a tool of project management, care pathways have been promoted internationally as a response to concerns for patient safety, variability in care and increasing costs. Generally, care pathways can be seen as an example of clinician led rather than management led reform. However, it does reflect a wider shift towards process and away from hierarchical approaches to management. Within the UK care pathways have been promoted as a response to the modernization initiative of the Labour Government. While the initiative was a success in both units it was more difficult to implement care pathways in a trauma rather than an elective unit. In conclusion, it is questionable whether care pathways are a universal response to the requirement for modernization and service redesign in the NHS.

Critical Pathways↗
PubMedDate not supplied

Practical tools for medication safety in acute care.

Identifying goals in the areas of institutional culture, infrastructure, clinical practice, and technology in hospitals minimizes the risk of medication errors among inpatients. As part of the Pathways for Medication Safety project, a model strategic plan provides seven goals for hospitals to consider in their medication safety efforts. A view of risk assessment from individual health care practitioners can aid a team effort to decease medication errors. Preparing for point-of-care bar-coding for medications will help easy implementation of this new technology. Pathways for Medication Safety provides a toolbox with useful methods and techniques for acute care settings.

Critical Pathways↗
PubMed2001

Cutting edge: the class II transactivator prevents activation-induced cell death by inhibiting Fas ligand gene expression.

The Fas:Fas ligand pathway is critical in regulating immune homeostasis by eliminating activated T cells that proliferated in response to an infection. Here, we show that the MHC class II transactivator (CIITA) can suppress this pathway by inhibiting transcription of the Fas ligand gene. CIITA can effectively repress transcription from the Fas ligand promoter in both T cell lines as well as primary cells. The repression appears to be at least partly due to interference of NFAT-mediated induction of Fas ligand gene transcription. T cells that express CIITA constitutively do not up-regulate Fas ligand on the cell surface after activation via the TCR. Consequently, these cells lack the ability to undergo activation-induced cell death, and to kill Fas-bearing target cells.

Animals↗
PubMed2000

Radical prostatectomy and collaborative care pathways.

The purpose of this study was to describe the development, implementation, and evaluation of a collaborative care pathway for radical retropubic prostatectomy. The experience of Vanderbilt University Medical Center is described, and the literature was reviewed. In addition, an example of the radical prostatectomy care pathway is provided for an illustration of a care path. The experience of using collaborative care pathways at Vanderbilt Medical Center has resulted in decreased length of stays, decreased blood utilization, and decreased overall costs. Also, staff satisfaction has improved all without compromising patient care. Collaborative care pathways have been shown to be a cost effective way of standardizing patient care without sacrificing the quality of patient care. In addition, they allow for an easier way to critically evaluate outcomes, costs, and patient and staff satisfaction.

Cost-Benefit Analysis↗
PubMed2001

Pleural space disease in pediatric patients: a retrospective analysis.

Pleural space disease, pleural effusions, and parapneumonic empyema present a therapeutic dilemma regarding the most appropriate medical and surgical management (i.e., performing a thoracentesis on admission versus delayed, placing a pigtail catheter versus a regular chest tube, and performing early versus late thoracoscopy). Other questions remain about early surgical intervention to decrease morbidity, shorten hospital stay, and produce cost-effective results. To define a clinical approach for a prospective study, the charts of all patients who were discharged with ICD-9 codes 511.8, 511.9, and 510.9, between June 5, 1991, and May 7, 1995, were reviewed. Thirty-one patients were identified. A database was developed and the results were analyzed. This paper presents a clinical pathway suggested by this retrospective study with cost analysis.

Adolescent↗
PubMed2001

Clinical pathways or case management.

Clinical pathways are increasingly being used internationally as a mechanism for managing patient care to achieve improved outcomes with more efficient resource use. They are a structured templates guiding multi-professional treatment and care for specific patient groups or procedures, through a sequence of essential treatment and care steps based on the best available evidence. This paper defines clinical pathways, describes their historical context and application, and discusses benefits and concerns about their use.

Case Management↗
PubMed2004

[The collaborative nursing care plan: integration of the clinical pathway with the traditional nursing care plan].

The nursing care plan is a commonly used teaching tool in nursing education. By developing individualized nursing care plans for specific clients, students practice use of nursing process and making clinical judgments and decisions. However, the system of managed care has impacted current clinical practice, and many health care agencies have shifted their emphasis from requiring the traditional columnar nursing care plans to use of clinical pathways and standards of care. As result of this trend, nursing educators are faced with the problem of preparing students to cope with today's reality in clinical practice. In response to this problem, this article reexamines the practical utility of the traditional nursing care plan in nursing education. The article also introduces a collaborative nursing care plan, the integration of the clinical pathway with the traditional nursing care plan, and its application in teaching.

Critical Pathways↗