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At least 145 records · Page 8Linked to original sources
PubMed1999

Tuberculosis management practices in Kentucky: comparison with national guidelines.

BACKGROUND: We assessed the quality of tuberculosis management practices in a predominantly rural state. METHODS: Medical records of persons reported to the Centers for Disease Control and Prevention (CDC) with the diagnosis of tuberculosis were audited; management practices were compared with guidelines from the American Thoracic Society (ATS) and CDC. RESULTS: We reviewed 207 records from 24 health districts in Kentucky. These records represented 30% of the cases reported to the CDC during the 17-month study. Tuberculosis was diagnosed by culture in 66% of patients; 12 different antibiotic regimens for antibiotic sensitive bacteria were prescribed; human immunodeficiency virus testing was documented in only 39%; monitoring for drug toxicity and bacteriologic cure was appropriate in < 65%; directly observed therapy was used in only 38%, and only 23% of close contacts were reevaluated at 12 weeks. CONCLUSIONS: Tuberculosis management practices in Kentucky fall short of ATS/CDC guidelines. Continuing quality-improvement efforts are warranted.

Aged↗
PubMed2004

A multi-district audit of the management of syphilis in genitourinary medicine clinics in Yorkshire.

An audit against standards and guidelines of a representative sample of syphilis cases managed in genitourinary medicine clinics in Yorkshire was carried out. Satisfactory serological endpoints could be determined for about two-thirds of treated early and less than one-third of treated late syphilis cases. HIV antibody testing was obtained for less than half of all cases. Recently available national guidelines suggest inadequacy of both the dose and duration of treatments with procaine penicillin of asymptomatic late syphilis cases where lumbar puncture was not carried out. The diagnosis and management of syphilis is complex, and this audit demonstrates the importance of the systematic approach developed by genitourinary medicine clinic and laboratory services.

Adolescent↗
PubMed1998

Barriers to evidence-based practice.

OBJECTIVES: This paper reports the findings of a study which aimed to identify the barriers to evidence-based practice in an acute National Health Service (NHS) trust. The study was carried out as part of an action research project designed to promote evidence-based practice. DESIGN: A rapid organizational appraisal design was used. This involved formal and informal interviews, focus groups, and observation of staff interactions at meetings and in clinical practice in an acute hospital NHS trust. Interviews were undertaken with key stakeholders within the organization and focus groups held with nurse managers, audit staff, staff nurses, and junior medical staff. Observation took place in meetings and in clinical areas. RESULTS: At an organizational level, the main issues identified were: (1) evidence-based practice was a low management priority, (2) problems with dissemination, (3) inadequate systems for personal and professional development, (4) difficulties in the management of innovations, (5) accessing evidence and resource constraints. At the individual practice level, the main issues were motivation, a lack of clarity about roles and practice, and a culture of practice which emphasizes 'routine' patient care. CONCLUSIONS: The results of this study demonstrate that structures and cultures within organizations can be important barriers to evidence-based practice. Factors which are external to individual trusts are also important. Existing hierarchical structures both in the NHS and within and between the different professional groups, are manifest in the existence of a largely deferential culture which emphasizes the routine in practice decision making. Given this reality, organizations will have to adopt multiple strategies to facilitate and promote the use of evidence in practice decision making.

Attitude of Health Personnel↗
PubMed2005

Quantifying the influence of safety management on the reliability of safety barriers.

A methodology is described that enables to use safety management audit assessments and safety culture questionnaire results for estimating the reductions in the reliability of safety barriers in major hazard plants. The critical issue is the establishment of weight factors in combination with the anchoring of "good" safety management. A method is proposed to derive weight factors from statistical accident analysis in combination with a statistical analysis of safety management assessments at a representative sample of major hazard industries. A preliminary set of weight factors is presented with some examples of resulting reductions in reliability--this demonstration confirms that the set of weight factors needs further development.

Accidents, Occupational↗
PubMedDate not supplied

Pain management documenting the decision making process.

From patient admission to discharge, pain is a critical symptom of concern to the nurse case manager. This descriptive study examined nurses' decision-making regarding pain management as documented in clinical records of patients after orthopedic surgery. Using a Nurses' Pain Management Audit Tool, data analysis revealed that during the first 24 hours after emergence from the Post-Anesthesia Care Unit, these patients received less than 50% of the narcotic doses available for their pain relief. Nurses documented less than 25% of the "ideal occurrences" possible for pain assessment, as described in the Agency for Health Care Policy and Research Guidelines. Incomplete databases for guiding patient outcomes of effective pain management were perpetuated by insufficient documentation. Nurse case managers could stimulate increased commitment and quality improvement in pain management as a crucial aspect of patient care.

Adult↗
PubMed1997

A multidistrict audit on the management of Chlamydia trachomatis in genitourinary medicine clinics in Yorkshire.

Nine genitourinary clinics (one teaching hospital and 8 district general hospitals) within the Yorkshire Deanery audited the management of uncomplicated genital chlamydial infections in male and female patients attending between January and December 1995. Standards set included: 100% of chlamydia-positive patients to be treated within 2 weeks of diagnosis; 100% of patients to return for test of cure within one month of treatment; 100% of patients to be referred for contact tracing. Four hundred and thirty-six of a total 1356 cases were audited. Eighty-nine per cent received treatment within 2 weeks; 64% returned for a test of cure within one month; 93% were referred for contact tracing. Changes in practice and a region-wide multidisciplinary audit initiative resulted from the study.

Chlamydia Infections↗
PubMed1998

Designing the integrated multidisciplinary record review.

Good documentation is a cornerstone of data quality. But how can an organization ensure that all disciplines will take responsibility for the comprehensiveness and accuracy of their documentation? The authors describe the steps one facility took to implement a process of record review involving numerous departments.

Documentation↗
PubMed2000

Improving care or professional advantage? What makes clinicians do audit and how well do they fare?

OBJECTIVE: To find out why clinicians undertake audit, the extent to which they complete the process of audit and their perception of the benefits of taking part. DESIGN: Semi-structured interviews. SETTING: Twelve trusts in three Scottish Health Boards. SUBJECTS: One hundred and forty five respondents of different status from a wide range of clinical specialities. RESULTS: Sixty six per cent of respondents defined clinical audit as a means of making changes with a view to improving care, but 62% reported the purpose of audit as the examination of the usefulness of treatment or the observation of practice. Personal reasons for taking part included justifying practice (32%) and as a means of professional development (15%). Twenty one percent held formal minuted meetings, the majority were informal. Sixty six percent of clinicians completed a project plan but pilot studies (49%) and re-audits (26%) were less common. Twenty four percent changed practice as a result of the audit. The extent to which the audit process had been completed predicted clinicians' ability to make changes. CONCLUSION: Clinicians' understanding of the concept of audit was not translated into practical projects. The main reasons for this are the organisational difficulties clinicians are faced with when carrying out audit and a lack of attention to all parts of the audit process. Despite this failure to achieve change, many clinicians felt they had benefited from their experience of audit. Management should appeal to these motivations of employees and provide a culture which enforces their importance over and above changing practice.

Attitude of Health Personnel↗
PubMed1994

The influence of medical audit on the management of epistaxis in three district general Hospitals.

The implementation of audit in most hospital departments in the UK has been instigated by the guidelines set out by the Royal Colleges. This paper aims to demonstrate the results of regular subregional audit meetings in the ENT departments involving three District Hospitals in East Anglia. We report the effects of audit meetings in improving the management of epistaxis, whereby a protocol for treatment and discharge was established, the duration of the nasal pack left in situ was reduced, and the material of the pack was changed.

Adolescent↗
PubMed2005

Standards for gene therapy clinical trials based on pro-active risk assessment in a London NHS Teaching Hospital Trust.

Conducting gene therapy clinical trials with genetically modified organisms as the vectors presents unique safety and infection control issues. The area is governed by a range of legislation and guidelines, some unique to this field, as well as those pertinent to any area of clinical work. The relevant regulations covering gene therapy using genetically modified vectors are reviewed and illustrated with the approach taken by a large teaching hospital NHS Trust. Key elements were Trust-wide communication and involvement of staff in a pro-active approach to risk management, with specific emphasis on staff training and engagement, waste management, audit and record keeping. This process has led to the development of proposed standards for clinical trials involving genetically modified micro-organisms.

Bacteria↗
PubMed2001

A prospective regional audit of surgical management of endometrial cancer in the South and West of England.

The results of a prospective audit of surgical management of endometrial cancer in the South and West of England is presented. A minimum data set was defined and information collected prospectively. There was limited tertiary referral to a gynaecological oncologist. The role of centralisation of endometrial cancer care has been questioned, as surgery has traditionally been simple in patients perceived to be at increased risk of more radical surgery. However, this audit demonstrates that standards of even this simple care within the region are often inadequate, with only one-third of patients having basic staging procedures performed fully. This has important implications for patients management, future interpretation of outcome data and clinical governance in endometrial cancer care.

Journal Article↗
PubMed2003

The development of a clinical trial to determine if watchful waiting is an acceptable alternative to routine herniorrhaphy for patients with minimal or no hernia symptoms.

BACKGROUND: This article describes the development and implementation of a randomized clinical trial designed to answer the question: Is watchful waiting an acceptable alternative to operation for men with asymptomatic or minimally symptomatic inguinal hernias? STUDY DESIGN: A clinical trial has been designed to compare watchful waiting and operation for men with an asymptomatic or a relatively asymptomatic inguinal hernia. Men are randomized to watchful waiting or a standard open operation, the Lichtenstein tension-free hernia repair, and are followed for a minimum of 2 years. The target sample size of 753 patients was chosen so that the trial would have power sufficiently high to detect a clinically meaningful difference between treatment groups in either of the two primary outcomes as measured at 2 years: pain or discomfort interfering with normal activities and the physical component summary score of the SF-36 health-related quality-of-life survey. The study was begun in five centers located in both community and academic environments. At 18 months, a sixth site was added and at 28 months, after enrollment of 145 patients, one of the centers was terminated for reasons related to inadequate followup; all data from this center were deleted. As a routine measure, an independent experienced trial manager audited all clinical sites. RESULTS: Enrollment of patients began in January 2000 and will end on December 31, 2002. As of November 1, 2002, 637 patients had been randomized, 85% of the target enrollment. An additional 2,115 patients were screened but not randomized, yielding a recruitment rate of 23.1%. Analysis and publication of the results of the study will take place on completion of the minimum 2-year followup period for all patients. CONCLUSIONS: A trial to compare the outcomes of watchful waiting and operation for management of inguinal hernias in men is needed to provide data to surgeons and to patients that can aid in choice of treatment. A description of the design of such a trial is presented.

Follow-Up Studies↗
PubMed2002

Audit of the management of suspected giant cell arteritis in a large teaching hospital.

BACKGROUND: The diagnosis of giant cell arteritis (GCA) is often confirmed by an early temporal artery (TA) biopsy of adequate length. Treatment of this condition with high-dose corticosteroids may be associated with significant morbidity, including osteoporosis. AIM: To audit current management of patients with suspected GCA at Auckland Healthcare, a large teaching hospital. METHODS: We performed a retrospective chart review of all TA biopsies from January 1996 to June 2000. A total of 117 biopsies from 111 patients was audited. Of these patients, 37/111 (33%) had a final clinical diagnosis of GCA (GCA patients). The areas of interest for audit were waiting time for TA biopsy, length of sample, initial corticosteroid therapy and osteoporosis prophylaxis. RESULTS: The mean waiting time for biopsy for all patients was 5.6 days (range 0-42 days). This time varied from 9.3 days for rheumatology patients to 2.6 days for ophthalmology patients (P = 0.003). Only 44/117 (37.6%) specimens measured more than 10 mm. For GCA patients, the median initial oral prednisone dose was 60 mg/day. Osteoporosis prophylaxis was prescribed in 24/37 (65%) GCA patients, most commonly cyclical etidronate. CONCLUSIONS: There is significant variation in the management of GCA within our institution. This audit has highlighted several areas where improvement could be made, particularly in streamlining the process of obtaining TA biopsy and in promoting the use of osteoporosis prophylaxis.

Aged↗
PubMed2001

[Managing chronic wounds. Knowledge and practice of nurses].

BACKGROUND: Recommendations on chronic wound management have greatly evolved during the last years. Practice in the medical units of the Civil Hospital of Colmar (France) appears to controversy these recommendations. Since nurses have a central place in such cares, we conducted a management audit among those working in different departments, before organising an educational program. METHODS: One hundred and ten nurses (20 p. 100), randomly selected among the 546 concerned by chronic wounds working in the hospital were invited to participate in this audit composed of 23 questions. RESULTS: Participation rate was 72 p. 100. Response rates were higher than 80 p. 100 for 18 of 23 questions. The percentages below are those of the expressed answers. For 58 p. 100 of nurses executing the care after medical prescription, 31 p. 100 did so without medical advice and 11 p. 100 in collaboration with a doctor. Five and 14 p. 100 respectively knew all the classical clinical characteristics of venous and arterial leg ulcers. Some important risk factors for pressure sores were not well known, and only 15 p. 100 of nurses regularly used an evaluation scale of this risk. The massage-kneading of a stage I pressure ulcer was practiced by 49 p. 100 of nurses. Depending on the questions, 64 to 82 p. 100 of them routinely used antiseptics, and 82 p. 100 thought it was more important than compression for the healing of a venous leg ulcer. In more than one third of the answers, the dressing of a chronic wound was described as sterile. Finally, if an average knowledge of hydrocolloids was observed, there was little on alginates, foams and hydrogels, with a majority of nurses avoiding to answer these questions. COMMENTS: Although important is the management of chronic wounds, basic knowledge was insufficient to hope for the nurses' collaboration. Prevention policy of pressure sores was not optimal. There were discrepancies between local practices and actual knowledge. Knowledge of new dressings was inadequate, and there was a risk for limited clinical benefit. We believe the results would have been similar if the audit had conducted among the doctors. Hense, a vast educational program has been initiated.

Chronic Disease↗
PubMed2004

Audit of the management of early syphilis at North Manchester General Hospital.

The city of Manchester has seen a sustained increase in reported cases of early (infectious) syphilis since the late 1990s. We audited the management of patients presenting with early syphilis to North Manchester General Hospital, with reference to the UK national guidelines. Between January 1999 and December 2001 72 cases of early syphilis were identified. Most (90%) occurred in men who have sex with men, 50% of whom were HIV-positive. Serology and polymerase chain reaction testing of lesions were useful diagnostic tests. Treatment regimens followed the national guidelines in 63% of cases, with adherence to the guidelines improving as the outbreak continued. The majority of patients were treated with intramuscular penicillin (78%), with only three discontinuing this treatment due to side effects. Only 4% of sexual contacts identified were traced and screened, an indication of high levels of both anonymous sex and partner change in this group.

Administration, Oral↗
PubMed2004

Audit of the management of convulsive status epilepticus in children: the need for a uniform treatment strategy.

We conducted a two-year prospective audit to review the paediatric management of Convulsive Status Epilepticus (CSE) in Ireland. Our audit showed that there is considerable variability in the management of CSE in this country. In order to provide optimum care for this potentially life-threatening condition a uniform management strategy is required. We propose a protocol for the treatment of CSE, which should ensure uniform management and optimum care and also provide a template for further study and audit of this important disorder.

Anticonvulsants↗
PubMed2000

A comprehensive clinical database for mental health care in England.

BACKGROUND: Monitoring and researching clinical care calls for comprehensive clinical databases. In mental health care these need to cover all aspects of the care of each patient and to accommodate the complexity of care which may last from weeks to years. This paper describes the pilot work for a mental health clinical database intended to be implemented throughout the English National Health Service. METHODS: In collaboration with three pilot sites, a set of data extracts was defined which could reasonably easily be produced, mostly using existing statistical data collection systems. Software was designed to integrate these extracts into patient-based records describing overall spells of mental health care. These data were extracted from their systems for a 6-month pilot period. RESULTS: Two of the three sites produced data sets, which appeared to give a reasonably complete account of the work undertaken in the pilot period. Known differences in service design and clinical perspective between the two sites were clearly reflected. CONCLUSIONS: The approach to extracting and collating the data is workable within existing resources and produces illuminating data for clinical audit, management and planning. Completeness and accuracy of data is likely to be a continuing problem, as for any routine data capture exercise. However, the process of integrating data from several channels assists this, as inconsistencies become apparent and can be tackled. The approach is now being implemented throughout England.

Adolescent↗
PubMed2006

The roles of policy and professionalism in the protection of processed clinical data: a literature review.

BACKGROUND: Routinely collected clinical data is increasingly used for health service management, audit, and research. Even apparently anonymised data are subject to data protection. The relevant principles were set out in a treaty of the Council of Europe and subsequent policy has been based on these. However, little has been written about implementing policy and the role of health informaticians in this process. OBJECTIVE: To define the elements of an effective implementation policy; the role of the health informatician in protecting processed clinical data. METHODS: We performed a literature review of bibliographic databases, a manual search of the major medical informatics associations' websites, relevant working groups and an affiliated journal. Fifty-four papers relevant to implementation were identified. RESULTS: The effective implementation of policy requires consideration of technical, organisational, personnel and professional issues. However, there is no clearly defined formula for successful implementation of data protection policy. CONCLUSIONS: Patients and professionals need a system they can trust, and processes that can be easily incorporated into everyday practice. The lack of a core generalisable theory or strong professional code in health informatics limits the ability of the health informaticians to implement policy.

Confidentiality↗