Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Concurrent Review”

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 163 records · Page 9Linked to original sources
PubMed1990

Therapeutic drug monitoring: improved performance through educational intervention.

A pilot study done at our institution and previous studies in the literature indicate that therapeutic drug monitoring (TDM) is frequently performed without a proper indication. In addition, samples are often improperly collected or interpreted by physicians. The purpose of this study was to determine if a pharmacy-based educational intervention could positively influence the performance of TDM in a teaching institution. A cost-savings analysis on the reduction of drug levels not indicated or improperly sampled was also performed. The study consisted of a preliminary data collection period, an educational intervention, and a postintervention data collection period. The pre- and posteducational intervention periods consisted of a 1-month concurrent review of aminoglycosides, digoxin, and theophylline serum levels. The educational intervention consisted of in-service programs and newsletter. There were 188 and 211 serum drug levels analyzed during the pre- and postintervention periods, respectively. Overall, the educational intervention significantly increased the number of drug levels obtained for rational indications, correctly sampled and appropriately interpreted by physicians (p less than 0.001, chi 2 analysis). Cost savings associated with this program was +2,788 in patient charges (+559 in hospital costs) per month. This study demonstrated that TDM may be significantly improved through education.

Aged↗
PubMed1988

Unit or service standards.

As competition in the health-care market increases, issues such as accountability, patient satisfaction, and evaluation after quality of patient care have become progressively more important. This article describes the evaluation of a quality assurance program from a centralized, retrospective system to a unit-based, concurrent review process. Issues related to problem management, research, and education are identified.

Florida↗
PubMed1988

Impact of staff education on pressure sore development in elderly hospitalized patients.

To test the hypothesis that an educational program alone without the introduction of new technology could result in both higher quality care and cost savings, the incidence of development of pressure sores among patients over the age of 65 years was concurrently reviewed before and after an education program developed and disseminated by a skin care team composed of physicians and nurses. Before the education program, 18 (14.6%) of 123 patients with no pressure sores developed pressure sores during their hospital admission. After the education program, only six (5.4%) of 105 patients who entered the hospital with intact skin developed a pressure sore during their hospital stay. The data show that an educational program was effective in decreasing by 63% the development of pressure sores in an elderly hospitalized population. Furthermore, a cost savings of $74,372 in the use of special care beds was realized.

Aged↗
PubMed1979

Prescribing patterns in a family medicine residency program.

The methodology and results of a concurrent review of prescribing practices in a family practice residency are discussed. A clinical pharmacist reviewed copies of prescriptions returned to him during a six-month period, and he tabulated information to allow comparisons of clinic prescribing patterns with national patterns. Additionally, peer group comparisons within the residency were made. It was found that tricyclic antidepressants were prescribed more frequently than anxiolytic drugs, a distinct difference when compared to national prescribing reports. Peer group comparisons showed apparent autonomy in prescribing habits among residents and faculty, and the drug "repertoire" and number of prescriptions written increased as the number of years in the residency progressed.

Ambulatory Care Facilities↗
PubMed1995

Current nursing practices in fever management.

Data regarding fever management were obtained through a retrospective or concurrent review of the medical records of 150 patients. For 41% of the patients studied, nurses notified physicians of the fever episode. The decision to treat fever was significantly influenced by fever intensity and the drawing of blood cultures, but not by age, length of hospital stay, or the duration of the fever episode. Despite recent evidence of the protective value of fever, the majority of fever episodes were treated. Acetaminophen alone, and acetaminophen in combination with physical cooling methods, were effective in lowering fever.

Adult↗
PubMed1996

Assessment of cytomegalovirus retinitis. Clinical evaluation vs centralized grading of fundus photographs. Studies of Ocular Complications of AIDS Research Group, AIDS Clinical Trials Group.

BACKGROUND: In the Foscarnet-Ganciclovir Cytomegalovirus (CMV) Retinitis Trial, time to first progression of newly diagnosed CMV retinitis was similar in the 2 treatment groups but was shorter when assessed by grading of fundus photographs at a central reading center than when assessed at the participating clinical centers. This report describes the extent and causes of this disagreement and considers the implications of the findings for clinical practice and future research. METHODS: Clinical findings and photographic gradings were compared for extent and activity of retinitis at baseline and during follow-up. In selected cases of disagreement, the photographs and summaries of gradings and clinical findings were reviewed concurrently to determine the cause of disagreement. RESULTS: Movement of the border of retinitis was observed sooner and activity of the border was considered to have increased more often at the reading center than at the clinical centers. Disagreements on time to first progression were more frequent when degree of border movement was small (odds ratios [ORs] for several comparisons ranged from 1.7 to 5.2), when border activity was judged to have decreased or remained the same since the preceding visit (OR, 2.0-193), and when retinitis at baseline did not involve zone 1 (the area within 1 disc diameter of the disc or within 2 disc diameters of the center of the macula [OR, 1.4-3.6]). There were 2 important causes of disagreement between clinical center and reading center. First, difficulty was encountered clinically in recognizing retinitis border movement in the absence of an obvious increase in border activity. Second, the reading center used a threshold for border movement small enough to be crossed by an initial expansion of retinitis borders occurring within 2 to 5 weeks of enrollment in some patients who were responding favorably to treatment (in that retinitis was becoming inactive and showed no further progression for many weeks). CONCLUSIONS: Comparisons of photographs from the current visit with those from several previous visits may increase clinicians' abilities to detect progression promptly. The use of additional outcome measures by reading centers, such as border movement of 1500 microns or more and change in area of retina involved by retinitis, may provide more accurate and useful comparisons of treatments. In making such comparisons, centralized photographic grading has the advantages of greater reproducibility and lesser risk of observer bias.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Changing behaviors. Nurse educators and clinical nurse specialists design a discharge planning program.

In this article, the authors describe a discharge planning program developed for geriatric and maternal-child nurses at Mount Sinai Medical Center. King's theory of goal attainment was used in the program design and teach strategies were selected that matched behavioral objectives in the cognitive, psychomotor, and affective domain. Evaluation methods include participants' pre- and post-surveys regarding their comfort in implementing discharge planning and concurrent review of their documentation 1 month after the program. After participating in the program, staff nurses displayed a change in behavior in terms of increased documentation relating to discharge planning.

Education, Nursing, Continuing↗
PubMed1996

Detection and classification of inappropriate hospital stay.

OBJECTIVE: To study the reliability and validity of concurrent review of hospital-bed utilization carried out by a trained nurse. DESIGN: Analysis of interrater reliability and validity of utilization review. SETTING: Tertiary care hospital associated with a university. PATIENTS: Eighty patients randomly selected from 203 patients admitted to the hospital. INTERVENTIONS: Appropriateness of days of stay in hospital was classified prospectively, on the basis of clinical judgement, by two nurses working independently, by a third nurse working with the Appropriateness Evaluation Protocol (AEP) and by a multidisciplinary review panel of nurses and physicians working retrospectively with the use of data gathered by the first nurse. MAIN OUTCOME MEASURES: Agreement between different rates on the number of and reason for inappropriate admission days, total number of inappropriate days and of inappropriate days due to delayed discharge, to diagnostic procedures or to inefficient medical management. RESULTS: Agreement between the two nurses who used clinical judgement was substantial (kappa or the intraclass correlation coefficient [RI] 0.77 to 0.98 on the number of and reason for inappropriate admission days, on the total number of inappropriate hospital days and on days due to delayed discharge, diagnostic procedures or inefficient medical management. Agreement was moderate (RI 0.47) on the number of inappropriate day's stay awaiting surgery. Agreement was substantial (kappa or RI 0.69 to 0.94) between the two nurses who used clinical judgement and the panel, except on the total number of inappropriate days; however, for this variable, exclusion of one case increased the RI from 0.35 to 0.80. Agreement was substantial between the two nurses who used clinical judgement and the nurse who used the AEP on appropriateness of admission days and the number of inappropriate days. Agreement between the panel and the nurse who used the AEP on the number of inappropriate days rose from 0.36 to 0.88 when the one outlying case was excluded. Some admissions were classified as premature when the AEP was used, whereas other raters considered the admissions unnecessary. There was poor agreement between the nurse who used the AEP and the other raters on the number of inappropriate days' stay awaiting surgery or diagnostic tests. CONCLUSIONS: Data collection and judgement of appropriateness of hospital stay by a trained nurse is feasible and reliable. A nurse working prospectively and a panel working retrospectively sometimes disagree. The AEP provides a similar estimate of the number of inappropriate days but may be insensitive to patient factors that influence the timing of admission.

Female↗
PubMed1990

Drug-use review program for concurrent histamine H2-receptor antagonist-sucralfate therapy.

The effect of drug-use review on concomitant histamine H2-receptor antagonist-sucralfate therapy at a 600-bed, university-affiliated Veterans Affairs medical center was studied. In an effort to curtail the concomitant use of H2-antagonist plus sucralfate therapy, the department of pharmacy, in conjunction with the gastroenterology service, developed and introduced criteria for the appropriate use of combination therapy. The extent of prescribing of concomitant histamine H2-receptor antagonist-sucralfate therapy before and after implementation of criteria-based guidelines and the appropriateness of current H2-receptor antagonist-sucralfate combination therapy, based on the guidelines, were assessed. The effectiveness of the intervention process was evaluated, and cost savings associated with intervention were calculated. After intervention, the number of treatment courses of histamine H2-receptor antagonist-sucralfate combination therapy decreased by 30%. However, of the 109 evaluable postintervention combination treatment courses, only one complied with both the indication and the duration of treatment criteria. This review of prescribing patterns and the implementation of criteria-based guidelines proved an effective means of reducing inappropriate combination therapy and resulted in annual cost savings of $25,000.

Costs and Cost Analysis↗
PubMed1986

Concurrent antibiotic-use review in a small hospital.

A method of concurrent antibiotic-use review in a 60-bed pediatric hospital is described. The pharmacy department monitors appropriateness of antibiotic prescribing using criteria specified by the pharmacy and therapeutics committee. Antibiotic orders are reviewed by the pharmacist for compliance with the criteria at the time that the orders are written. At three-month intervals, information about the infections treated and the percentage compliance for all physicians, as well as for each individual physician, is compiled and reported to the pharmacy and therapeutics committee. Written and oral feedback are provided to each physician to further improve compliance. This comprehensive monitoring system has resulted in substantial improvement in antibiotic prescribing by physicians at this hospital.

Anti-Bacterial Agents↗
PubMed1988

Concurrence of ovarian cancer and dermatomyositis. A report of two cases and literature review.

The concurrence of dermatomyositis and ovarian carcinoma deserves special attention owing to the gravity of its prognosis. Until now, only scattered case reports on women suffering from this disease combination had been published. In this paper the information available in the literature on 28 women afflicted with these diseases is collated. In addition, two such patients treated in our hospital are described in detail. The review highlights the various aspects of this disease combination, emphasizing the quadrupled incidence, advanced stage and uniform epithelial origin of the malignancy as compared with that in the general female population with ovarian carcinoma. The value of a meticulous gynecologic evaluation was proven in one of our patients with dermatomyositis; in her, ovarian carcinoma was detected in its early phase.

Adult↗
PubMed2002

Methodology to improve data quality from chart review in the managed care setting.

BACKGROUND: Because inherent variability may exist in data collected by multiple reviewers or from potential difficulties with data abstraction tools, we developed a standardized method of evaluating interrater reliability (IRR) for clinical studies, HEDIS effectiveness of care measures, and onsite/medical record reviews. OBJECTIVE: To demonstrate the ability of our standardized methods of data collection and analysis of results to determine the extent of agreement between multiple reviewers; identify areas for improvement in data collection procedures; and improve data reliability. STUDY DESIGN: A prospective chart review with concurrent IRR. METHODS: A subsample of patient records included in the Highmark Blue Cross Blue Shield/Keystone Health Plan West basic medical review for each HEDIS measure was selected for the IRR study. An experienced nurse ("gold standard") conducted a blinded concurrent review of these records. Using the kappa statistic (kappa) we evaluated interobserver agreement between results of the onsite reviewers and the "gold standard" from 1997 through 2000. Revised data collection methods and enhanced reviewer training were incorporated for measures showing areas for rater improvement. RESULTS: Results across years showed excellent IRR for most measures; however, each year 1 or 2 measures showed areas for rater improvement (1997 Papanicolaou kappa = 0.50; 1998 well-child visits 3 to 6 years kappa = 0.37; 1999 comprehensive diabetes kappa = 0.73; high blood pressure kappa = 0.73). After reevaluating these measures, the results of the kappa showed excellent interrater agreement in subsequent years. CONCLUSIONS: Standardized methods of data collection and evaluation of IRR results provides health plans increased confidence in data collection, statistical analyses, and in reaching conclusions and deriving relevant recommendations.

Blue Cross Blue Shield Insurance Plans↗
PubMed2005

Developmental venous anomalies and cavernous angiomas: a review of the concurrence, imaging, and treatment of these vascular malformations.

Deep venous anomalies and cavernous angiomas are two distinct intracranial lesions. Although these lesions can be found in association with each other, they have different pathologic characteristics and developmental mechanisms. These lesions can produce a variety of clinical symptoms or in some cases can be asymptomatic. The management of these anomalies can include conservative measures in some cases and aggressive intervention in others. Several imaging modalities can be used to evaluate these distinct lesions and often more than one are needed for a prompt and reliable diagnosis. Because of the tendency of these lesions to occur simultaneously, thorough evaluation of these anomalies and their surrounding tissues is critical in their clinical management. In this review, the characteristics and radiographic evaluation of these lesions will be presented and the therapeutic options for these anomalies will be discussed.

Brain Neoplasms↗
PubMed1996

Ultrasound-guided compression closure of postcatheterization pseudoaneurysms during concurrent anticoagulation: a review of seventy-seven patients.

PURPOSE: Data from our institution and elsewhere have demonstrated that ultrasound-guided compression closure (UGCC) is an effective method of treating postcatheterization pseudoaneurysms. Whereas patients receiving anticoagulation do not have as high a success rate as those not receiving anticoagulants, there have been no large series evaluating the factors associated with success or failure in patients receiving anticoagulation. The purpose of this study is to determine whether uninterrupted anticoagulation interferes with successful UGCC of pseudoaneurysms and to identify factors associated with success or failure. METHODS: From May 1991 to September 1994, 238 cases of attempted UGCC of pseudoaneurysms were performed in our vascular laboratory. Only patients who received uninterrupted heparin, warfarin, or both at the time of pseudoaneurysm compression were eligible for inclusion into the study. Seventy-seven patients were identified who met the study criteria. RESULTS: Successful pseudoaneurysm compression was obtained in 56 (73%) patients, whereas 21 (27%) patients had a failed UGCC. In the successfully treated group, seven (12.5%) required between two to three compression attempts to induce sustained thrombosis. There was no statistical difference in age, sex, sheath size, days after procedure, location of pseudoaneurysm, or number of chambers in the pseudoaneurysm between those patients who had a successful repair and those who did not. If the pseudoaneurysm was less than 4 cm in diameter, 51 of 65 patients (78%) had a successful repair compared with 5 of 12 patients (42%) with a pseudoaneurysm of 4 cm or greater (p = 0.013). There was no statistical difference between success and failure in patients receiving warfarin alone (3.73 mean international normalized ratio, 72% success rate), heparin alone (mean activated partial thromboplastin time of 63 seconds, 92% success rate), or heparin and warfarin (mean activated partial thromboplastin time of 70 seconds, mean international normalized ratio of 4, success rate of 67%). No arterial or venous thrombosis occurred during pseudoaneurysm compression. CONCLUSION: Successful UGCC of pseudoaneurysms occurred in a large percentage of patients receiving full-dose, uninterrupted anticoagulation. The only factor influencing success was the size of the pseudoaneurysm.

Adult↗