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Results for “Clinical Protocols”

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At least 19 recordsLinked to original sources
PubMed1999

[The evaluation of the quality of so-called "clinical protocols" in primary care developed in the Autonomous Community of Murcia. The Group for the Evaluation and Improvement of Clinical Protocols].

OBJECTIVE: To evaluate the quality of the design (structural) of the clinical protocols worked out in the Murcia region. DESIGN: Descriptive evaluation. Retrospective, over 8 years. SETTING: Primary health care. PARTICIPANTS: The professionals from the 31 health centres in the Murcia Region with activities covered by protocols. MEASUREMENTS AND MAIN RESULTS: The 519 documents written between January 1985 and January 1994, of which 470 were obtained and classified, were the object of the study. 11 criteria for the design quality of the protocols were worked out, based on the bibliography and a previous experiment. The inter-observer reliability of these criteria were assessed and two of them were rejected. Then the quality of the protocols design was evaluated through rates of compliance with the 9 standard and previously validated explicit criteria. 55.1% (259) of the documents fitted the accepted definition of protocol. 42.3% (199) had a recording system. 20.2% (95) had foreseen their evaluation. 41.7% (196) had some algorithm. 38.1% (179) had an anamnesis and/or examination page. 88.9% (418) were under 20 pages. Only 11.9% (56) had an index. 57.7% (271) had no formal defects of hand-writing or legibility. Only 14.7% (69) had a bibliography. Only three of the nine criteria were satisfied in over 50% of cases; three more, in under 30%. Overall, the clinical protocols had 2488 defects, with an average per protocol of 5.29. CONCLUSIONS: The formal quality of the primary care clinical protocols worked out in the Autonomous Community of Murcia is very low. Corrective measures to improve this situation should be taken.

Clinical Protocols↗
PubMed1999

[The factors that influence the use of clinical protocols according to the opinion of health center coordinators. The Research Group on the Evaluation and Improvement of Clinical Protocols].

OBJECTIVES: To find the factors that affect the use of clinical protocols in primary care, in the view of primary care team coordinators, and the reasons why they are little followed, and to bring together suggestions for improvement. DESIGN: An opinion study, through a telephone survey. SETTING: Primary health care. The health centres in Murcia with protocolized activity: 31 at the start of the project. PARTICIPANTS: The coordinators and those in charge of nursing, 62 people in all. MEASUREMENTS AND MAIN RESULTS: After a pilot study, a structured telephone survey was carried out, administered by a trained interviewer who posed two open questions: why do you think that the professionals at your centre do not use the existing protocols more often? and: what suggestions would you make to improve the protocols and have them used more? A specialist company did the field-work in June and July 1996. There was a 98% reply rate. To the first question, coordinators thought that low use could be explained by excess demand and lack of time for consultations (33% of all replies), although they also cited other organisational problems in the centre, defects in protocols and lack of training. Those in charge of nursing gave very similar replies, with excess demand (39%) predominating. To the second question, on increasing the use of protocols, coordinators suggested that the protocols needed to be improved (44.8% of replies), and also cited the need for improvements in organisation and on-going training. Very similar answers came from the nursing side, where 43.5% highlighted the need to improve the protocol documents. CONCLUSIONS: The coordinators assumed that the clinical protocols were used little and could be improved. In their view the basic reason for their low use is excessive pressure from the patient-load. The key to using them more is improvement in the protocol documents.

Attitude of Health Personnel↗
PubMed1998

Outcomes in abdominal hysterectomy patients with benign disease. Use of physician-developed clinical protocols.

OBJECTIVE: To develop a clinical protocol for standardizing preoperative and postoperative care in abdominal hysterectomy patients with benign disease while maintaining quality and increasing efficiency. STUDY DESIGN: Protocol and nonprotocol groups of patients were compared with respect to key quality and efficiency outcomes in a non-randomized study. Patient group outcomes were compared using descriptive, Student's t, chi 2 and log-rank statistics. Statistical tests were performed at a .05 level of significance. RESULTS: Results from two separate protocol study periods conducted in 1996 and 1997 are reported. In both study periods statistical analyses and graphic presentations illustrate that protocol implementation improved quality of care by increasing the percentage of patients receiving appropriate antibiotic prophylaxis; maintained quality as monitored through 30-day readmission rates and a postdischarge patient survey; and improved efficiency, as evidenced by shorter times to incision and length of hospital stay. CONCLUSION: At Toledo Hospital, the clinical practice protocol directed at abdominal hysterectomy patients has been an effective tool in efforts to improve quality and efficiency in patient care.

Clinical Protocols↗
PubMed2002

Current protocol of a research phase I clinical trial of full-length dystrophin plasmid DNA in Duchenne/Becker muscular dystrophies. Part II: clinical protocol.

A phase I open clinical study on gene therapy in Duchenne and Becker muscular dystrophy, without direct individual benefit for the patient, is being performed at the Pitié-Salpêtrière Hospital, Paris. The aims of this project are: (a) to determine the tolerance and the safety of the intramuscular administration of dystrophin cDNA and (b) to study the quality of the gene transfer in vivo in human patients affected by Duchenne and Becker muscular dystrophy. This clinical trial is conducted sequentially and includes three cohorts of three patients each. Patients must be at least 15 years of age. Diagnosis of Duchenne and Becker muscular dystrophy was confirmed by molecular analysis of the dystrophin gene and for each patient the abnormal expression of dystrophin was confirmed, in skeletal muscle, with antibodies directed against the deleted part of the dystrophin. This phase I study is scheduled to be completed by the end of 2002.

Adult↗
PubMed1996

Standard clinical protocols are important to your survival.

Standard clinical protocols will allow busy physicians to meet the increasing demands made on them to evaluate and perform, if appropriate, in a given manner for a particular problem. When tracked, standard clinical protocols allow the demonstration that the right thing was done every time at the right time and place.

Clinical Protocols↗
PubMed1997

[An evaluation of the protocols of the CME program. Do they satisfy the criteria for the working out of clinical protocols?].

OBJECTIVE: To evaluate the protocols published in the journal Formación Médica Continuada (FMC) since its appearance. DESIGN: An evaluation study. SETTING: The journal FMC in Primary Care. PARTICIPANTS: Clinical protocols (11) published by the journal, and the people who have composed them. INTERVENTIONS: An evaluation based on the criteria for composing clinical protocols proposed by Saura et al. MAIN RESULTS: Overall these proposals complied with 56.9% of the proposed criteria. None of them (0%) complied with all the norms that a protocol must meet. On analysing independently each criterion, the following were satisfied in all the protocols evaluated: the designation, index of pages, definition of the problem and bibliography. The protocol for COPE in Primary Care satisfied 75% of the criteria and was the protocol which complied with most criteria. The battered child protocol satisfied 41.66% of the criteria and was the protocol satisfying the least number of criteria. CONCLUSIONS: These are good protocols, in that overall they satisfy a large part of the proposed criteria, despite the fact that these are demanding criteria. However they can and must improve.

Clinical Protocols↗
PubMed1997

Clinical protocol development using Inter/IntraNet technology: the FENARETE system.

In this work we present FENARETE, a software tool to design and distribute clinical protocols in an Inter/IntraNet framework. We consider a medical protocol as a clinical behaviour scheme, formally and clearly defined with sufficient details. Our work allows the knowledge content of any clinical protocol to be fully represented in a symbolic style. A computer based support tool that works as an interface between clinicians and the protocol knowledge base is regarded by the authors as a basic building block developing an integrated environment for medical protocols design and management. The FENARETE application has been developed in Java and it is available for any Internet-linked machine with a Java-compatible browser.

Clinical Protocols↗
PubMed2000

Intense training, monitoring helps carry clinical protocols from trials to actual practice.

Can't get a clinical protocol to work in the real world? The problem might lie in training. Intense training and steady monitoring are the keys to getting good results from protocols in actual clinical practice, according to the Center for Behavioral Health in Bloomington, IN. Examining the performance of its panic disorder program, the center found it equaled the results of clinical research trials.

Clinical Protocols↗
PubMedDate not supplied

Developing clinical protocols for nursing practice: improving nephrology care for children and their families.

Improving and maintaining quality patient care through the development and implementation of clinical protocols is an important facet in our health care system. Identifying the need for clinical protocols, developing and maintaining the protocols, and defining the specific role of pediatric nephrology nurses in this process is presented herein. To illustrate the process we have included two examples of current clinical protocols utilized by our division.

Algorithms↗
PubMed2006

Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism.

BACKGROUND: The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001-2002. METHODS: A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. The number and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspected PE during an eight month period prior to the clinical trial (January 2002-August 2002) were compared with the number and type of diagnostic tests in 745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were used as unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. RESULTS: The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. CONCLUSION: Extrapolating the observed cost-savings of $59.30 per patient to the whole of Australia could potentially result in annual savings between $3.1 million to $3.7 million.

Journal Article↗
PubMed2006

[Methodological thoughts about research of standardized clinical protocols of traditional Chinese medicine].

The treatment of traditional Chinese medicine (TCM) has been proved effective in clinical practice for thousands of years. To standardize the clinical protocols of TCM is absolutely necessary for enhancing the research quality of TCM and expanding the international influence of TCM. The standardization research on clinical protocols of TCM should be based on the basic theory of TCM and in the light of good clinical practice (GCP) principles. The clinical criteria for both diagnosis and efficacy evaluation of disease are also needed. To include all symptoms, tongue manifestations and pulse presentations into case report form, and to compare the differences in these clinical parameters between effective and non-effective cases by multivariate analysis may be helpful to find more specific indications for therapeutic protocol of TCM. Furthermore, It is suggested that two or more clinical trials on one therapeutic protocol are needed to identify its accurate indications.

Clinical Protocols↗
PubMed2000

Carotid endarterectomy outcomes research: reduced resource utilization using a clinical protocol.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the necessity of intensive care unit (ICU) utilization following carotid endarterectomy (CEA) and to identify patients who can be managed postoperatively on a vascular unit using a clinical protocol. METHODS: Medical records of 50 patients admitted to the ICU following elective CEA were reviewed retrospectively for patient characteristics, morbidity, mortality, length of stay (LOS), and ICU intervention. Prospectively, the next 200 patients were routed to either a vascular unit or ICU, based on a clinical protocol. Endpoints were mortality, stroke, myocardial infarction, total hospital LOS, ICU LOS, and ICU intervention. RESULTS: There were no significant differences in morbidity or mortality between patients admitted to the vascular unit and those admitted to the ICU. Of patients evaluated prospectively, 129 (63%) were admitted directly to the vascular unit. Of the 73 patients admitted to the ICU, 63% required direct intervention compared with only 54% of patients in the retrospective series (P=0.001). In addition, after institution of the protocol, ICU LOS decreased significantly from 1.4 to 0.6 days (P<0.001). The hospital cost savings using this protocol averaged $1043 per patient. CONCLUSIONS: A clinical protocol can select patients for admission to the ICU or the vascular unit following CEA without increase in morbidity or mortality. Selective use of the ICU conserved resources, decreased ICU LOS, and provided substantial cost savings.

Aged↗
PubMedDate not supplied

[99m-Tc-Technetryle mammascintigraphy: clinical protocol and first experience in clinical diagnosis of breast cancer].

Analyzing the results of 99mTc-Technetryle mammascintigraphy in 41 females with breast cancer indicated that polypositional planar mammascintigraphy ensures a high sensitivity (over 88%) in revealing a primary nodule in T1, (more than 95%) in large tumors at above 95% specificity. No nodal accumulation of 99mTc-Technetryle was observed in controls (with fibrocystic mastopathy and suspected coronary heart disease. Mammascintigraphy showed a 85% sensitivity in recognizing axillary lymph nodal metastases too and ascertained that 14 patients had suptaclavicular and subclavian lymph nodal metastases. Therefore, 99mTc-technetryle mammascintigraphy is the method of choice in early detecting a tumorous process, primarily lymphogenic metastasis in breast cancer, and in evaluating its extent.

Breast Neoplasms↗