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1
Belanger, Anne C. "Joint Commission on Accreditation of Healthcare Organizations' Expectations for Transfusion Medicine in Health Care Organizations." Archives of Pathology & Laboratory Medicine 123, no. 6 (June 1, 1999): 472–74. http://dx.doi.org/10.5858/1999-123-0472-jcoaoh.
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Abstract This article provides an overview of the Joint Commission on Accreditation of Healthcare Organizations' standards related to transfusion medicine found in its hospital, laboratory, and home care accreditation manuals. Hospital standards focus on the review and evaluation of the entire transfusion process from the order through the outcome to the patient, with special attention to the blood use review process. Laboratory standards provide the structure for the detailed review of the technical procedures and practices for collecting, processing, storing, testing, and transporting blood products. Home care standards relate to policies and procedures, infection control practices, education of the patient and family, and monitoring of adverse events and complications for transfusions of blood products performed in the home.
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Holroyd, B. R., M. S. Beeson, T. Hughes, L. Kurland, J. Sherbino, M. Truesdale, and W. Hersh. "P071: Content of clinical informatics in international training standards for emergency medicine specialists." CJEM 20, S1 (May 2018): S82. http://dx.doi.org/10.1017/cem.2018.269.
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Introduction: The field of Clinical Informatics (CI) and specifically the electronic health record, has been identified as a key facilitator to achieve a sustainable evidence-based healthcare system for the future. International graduate medical education programs have been challenged to ensure their trainees are provided with appropriate skills to deliver effective and efficient healthcare in an evolving environment. This study explored how international Emergency Medicine (EM) specialist training standards address training in relevant areas of CI. Methods: A list of categories of CI competencies relative to EM was developed following a thematic review of published references documenting CI curriculum and competencies. Publically available, published documents outlining core content, curriculum and competencies from international organizations responsible for specialty graduate medical education and/or credentialing in EM for the United States, Canada, Australasia, the United Kingdom and Europe. These EM training standards were reviewed to identify inclusion of topics related to the relevant categories of CI competencies. Results: A total of 23 EM curriculum documents were included in the thematic analysis. Curricula content related to critical appraisal/evidence based medicine, leadership, quality improvement and privacy/security were included in all EM curricula. The CI topics related to fundamental computer skills, computerized provider order entry and patient-centered informatics were only included in the EM curricula documents for the United States and were absent for each other organization. Conclusion: There is variation in the CI related content of the international EM specialty training standards which were reviewed. Given the increasing importance of CI in the future delivery of healthcare, organizations responsible for training and credentialing specialist emergency physicians must ensure their training standards incorporate relevant CI content, thus ensuring their trainees gain competence in essential aspects of CI.
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Chia, Elisha Wan Ying, Kuang Teck Tay, Shiwei Xiao, Yao Hao Teo, Yun Ting Ong, Min Chiam, Ying Pin Toh, Stephen Mason, Annelissa Mien Chew Chin, and Lalit Kumar Radha Krishna. "The Pivotal Role of Host Organizations in Enhancing Mentoring in Internal Medicine: A Scoping Review." Journal of Medical Education and Curricular Development 7 (January 2020): 238212052095664. http://dx.doi.org/10.1177/2382120520956647.
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In undergraduate and postgraduate medical education, mentoring offers personalized training and plays a key role in continuing medical education and the professional development of healthcare professionals. However, poor structuring of the mentoring process has been attributed to failings of the host organization and, as such, we have conducted a scoping review on the role of the host organization in mentoring programs. Guided by Levac et al’s methodological framework and a combination of thematic and content analysis, this scoping review identifies their “defining” and secondary roles. Whilst the “defining” role of the host is to set standards, nurture, and oversee the mentoring processes and relationships, the secondary roles comprise of supporting patient care and specific responsibilities toward the mentee, mentor, program, and organization itself. Critically, striking a balance between structure and flexibility within the program is important to ensure consistency in the mentoring approach whilst accounting for the changing needs and goals of the mentees and mentors.
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Tishkina, S. N., V. E. Matskevich, Yu A. Ledovskikh, E. V. Semakova, and V. V. Omelyanovskiy. "Regulatory framework of the oncological medical care provision." FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology 13, no. 3 (November 18, 2020): 304–15. http://dx.doi.org/10.17749/2070-4909/farmakoekonomika.2020.052.
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Aim. To conduct an analytical review of the regulatory legal framework on the resources provision required in medical organizations for the provision of oncological medical care based on clinical guidelines.Materials and methods. Using Russian normative legal and regulative documents on the oncological medical care, the authors studied the normative regulation of the issues of both resources’ provision for medical organizations and resources’ demand assessment, including the need for financial support from various sources of the budgetary system of the Russian Federation. The analysis was carried out in two regulatory areas: financing and organization of the provision of medical care. The authors examined the main legislation acts relating to oncological medical care, including documents of the compulsory medical insurance, the annual decrees of the Government of the Russian Federation on the program of state guarantees of free provision of medical care to citizens for the coming year and the planned period, the decree of the Government of the Russian Federation regulating the provision of medicines and medical products, provisions on the organization of medical care by type of medical care, procedures for the provision of oncological medical care, regulatory documents on clinical guidelines and standards of medical care.Results. The content analysis of the studied materials showed that certain components of the resources’ provision, including the financial provision of oncological medical care, are regulated by various regulatory documents, and there is no methodology for assessing the resources’ demand based on clinical guidelines.Conclusion. New approaches to assessing the resources’ demand for the provision of medical care and the required financial support based on clinical guidelines need to be developed.
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Miniati, MS, Roberto, Fabrizio Dori, MS, Ernesto Iadanza, MS, Marco Lo Sardo, BSEE, and Sergio Boncinelli, MD. "Longitudinal expandable shelter for medical response during disasters." American Journal of Disaster Medicine 5, no. 4 (July 1, 2010): 221–27. http://dx.doi.org/10.5055/ajdm.2010.0027.
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Introduction: During medical emergencies, hospitals represent the final point of the whole rescue process. Therefore, effective health mobile structures have to be inserted between hospitals and the place of the event with the aim of giving the best of cures (using appropriate and easy to use equipment) for a safer and faster evacuation to hospitals.Methods: Literature review and national and international disaster medicine standards were the basis for this study to provide clinical, hygienical, and organizational needs to satisfy for the medical structure design. Project requirements have been obtained by analyzing structural, organizational, and clinical process necessities. Structural requirements respond to the possibility of installation on every ground type, resistance to every weather condition, and necessity of easy and fast transportation. Technological equipment is obtained from clinical evaluation for patient stabilization.Results: The designed structure results to be a longitudinal expandable shelter (LES) for medical emergencies response organized in three internal functional areas. Possibility of automatic expandability allows rapid transportation and easy deployment. The functional internal organization provides three areas: “Diagnostic,” “Therapeutic,” and “Pre-evacuation monitoring.” Further, longitudinal expandability supports the basic hygienical rules in healthcare processes allowing the unidirectional flow of casualties from dirtier to cleaner areas of the structure.Conclusions: LES represents the answer to expressed requisites by disaster medicine standards and guidelines. It aims to provide an efficient and effective support for sanitary aid in response to disasters or emergencies, by improving aspects related to effectiveness, hygiene, and quality of clinical performances especially for highest critical cases.
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Foucar, Elliott. "Pathology Expert Witness Testimony and Pathology Practice: A Tale of 2 Standards." Archives of Pathology & Laboratory Medicine 129, no. 10 (October 1, 2005): 1268–76. http://dx.doi.org/10.5858/2005-129-1268-pewtap.
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Abstract Context.—Pathologists work in an environment in which, to the extent possible, diagnostic decisions are based on scientific principles. It can therefore be a rather shocking experience when a pathologist finds one of his or her diagnostic decisions being evaluated by a legal system developed and controlled by lawyers and judges rather than by scientists or pathologists. This experience can be even more troubling when a key participant in the proceedings is a fellow pathologist guiding a jury toward an unfamiliar interpretation of the pathology standard of care. Objective.—To provide the interested pathologist with the background information necessary to (1) understand the role of expert testimony in malpractice litigation and (2) understand why there can be a gap between expert opinions expressed in court and expert opinions expressed in a medical care context. Data Sources.—Medical literature review supplemented by review of subspecialty position papers, selected articles from newspapers and magazines, and legal decisions. The medical literature review was limited to articles published in English and was based largely on articles retrieved using the MeSH terms expert testimony/legislation & jurisprudence, and pathology/legislation & jurisprudence. Conclusions.—Medical error has become an increasingly important topic for pathologists, and although errors or allegations of error are evaluated in many ways, the evaluation with the most impact on the individual pathologist is a malpractice case. During the last decade physicians have increasingly become aware of the critical role played by expert testimony in malpractice litigation. Some physicians have asserted that providing expert testimony is the practice of medicine, and that it is unacceptable for juries to be presented with expert testimony that incorrectly describes medical practice standards. However, this opinion has been vigorously opposed by attorneys who feel that juries are best able to come to a correct conclusion if they base their deliberations on a broad spectrum of opinion. Gaining an increased role in the oversight of expert testimony would allow physicians to establish a closer alignment between opinions expressed in court testimony and opinions expressed in clinical practice. However, despite some physician success in inserting themselves into the oversight process, both physicians and physician organizations attempting to take action against misleading expert testimony continue to be vulnerable to legal attack.
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Lepre, Breanna, Kylie J. Mansfield, Sumantra Ray, and Eleanor Beck. "Reference to nutrition in medical accreditation and curriculum guidance: a comparative analysis." BMJ Nutrition, Prevention & Health 4, no. 1 (March 8, 2021): 307–18. http://dx.doi.org/10.1136/bmjnph-2021-000234.
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ObjectivePoor diet is a leading cause of death worldwide. Doctors are well placed to provide dietary advice, yet nutrition remains insufficiently integrated into medical education. Enforcement of curriculum or accreditation requirements such as nutrition requires relevant regulatory frameworks. The aim of this review was to identify nutrition content or requirements for nutrition education in accreditation standards or formal curriculum guidance for medical education internationally.DesignNon-systematic comparative analysis.Data sourcesAn internet search using the Google Search engine, the WHO Directory of Medical Schools and Foundation for Advancement of International Medical Education and Research Directory of Organizations that Recognise/Accredit Medical Schools was conducted through September 2020 to identify government and organisational reports as well as publications from regulatory and professional bodies relevant to medical education.Eligibility criteriaEligible publications included (A) accreditation standards, (B) competency standards or a framework, (C) curricula, and (D) assessment content.Data extraction and synthesisWe stratified findings by country or region and both preregistration and postregistration education. Findings were synthesised based on the existence of nutrition content or requirements for nutrition education within systems used to guide medical education internationally.ResultsThis review found that despite an emphasis on meeting the needs of the community and the demands of the labour market, only 44% of accreditation and curriculum guidance included nutrition. Nutrition remains inadequately represented in accreditation and curriculum guidance for medical education at all levels internationally. Accreditation standards provide a mandated framework for curricula and inclusion of nutrition in accreditation frameworks provides an incentive for the integration of nutrition into medical education.ConclusionsThis review is a call to action for the medical profession including government, health agencies and educational and accreditation entities. The inclusion of nutrition in medical education has appeared throughout medical education literature for more than five decades, yet without consensus standards there is little likelihood of uniform adoption.
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Barr, Justin, and Theodore N. Pappas. "The Role of the American Board of Surgery in the Development of Surgical Residencies in Post–World War II America." American Surgeon 85, no. 3 (March 2019): 245–51. http://dx.doi.org/10.1177/000313481908500326.
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The creation of Boards fundamentally altered the American medical landscape and transformed the process of educating physicians. The American Board of Surgery, founded in 1937, epitomized this role. It established expectations, implemented an inspection system to enforce those standards, and ultimately collaborated with other professional organizations to create the Residency Review Committee that endures today. Using surgery as an example, we show how the appeal of board certification imbued Boards with the power and authority to reshape graduate medical education in their image in post–World War II America.
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Shah, Manish A., Thomas K. Oliver, Douglas E. Peterson, Kaitlin Einhaus, Bryan J. Schneider, Neelima Denduluri, and Mariana Chavez-MacGregor. "ASCO Clinical Practice Guideline Endorsements and Adaptations." Journal of Clinical Oncology 38, no. 8 (March 10, 2020): 834–40. http://dx.doi.org/10.1200/jco.19.02839.
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ASCO engages in the endorsement and adaptation of clinical practice guidelines to recognize the high-quality work of other guideline-developing organizations, to avoid duplication of effort, and to offer harmonized recommendations across guideline development groups. ASCO develops guidelines in accordance with the principles of the National Academy of Medicine and Council of Medical Specialty Societies. Guidelines developed in a similar manner by other organizations make endorsement by ASCO more likely. If allowed by the partnering organization, ASCO may consider an adaptation of a guideline, building on the original guideline with further inquiry or modifications. Organizations seeking ASCO endorsement consideration are provided with ASCO’s endorsement and adaptation procedures at the time of endorsement submission They can request either Endorsement or Endorsement or Adaptation. ASCO endorsement entails a formal review by an independent ASCO Expert Panel, and, if modifications to the recommendations are made, depending upon the original endorsement request, guidelines will be adapted or discontinued, rather than endorsed. The process begins with approval from ASCO’s Clinical Practice Guideline Committee (CPGC) leadership to proceed with endorsement development. An ASCO Expert Panel of approximately 10 multidisciplinary content experts, patient representatives, community oncologists, and relevant health providers is formed to develop an ASCO endorsement. ASCO’s Conflict of Interest Policy Implementation for Clinical Practice Guidelines and procedures apply to all ASCO expert panels. The CPGC reviews and approves all ASCO guideline products on behalf of ASCO. The endorsement process described in this report is designed to preserve a high-quality and resource-efficient approach for potential ASCO endorsement or adaptation of guidelines developed by other health professional organizations, while maintaining the objectivity, quality, and high standards reflective of ASCO’s guiding principles.
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Diachuk, D. D., O. L. Ziukov, O. M. Lishchyshyna, and A. V. Stepanenko. "INFORMATION SOURCES SUPPORTING MANAGERIAL DECISIONS ON HEALTH CARE IN EMERGENCY MEDICAL AND BIOLOGICAL SITUATIONS (ON THE EXAMPLE OF COVID-19 MANAGEMENT)." Клінічна та профілактична медицина 4, no. 14 (December 20, 2020): 4–16. http://dx.doi.org/10.31612/2616-4868.4(14).2020/covid-19.
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Abstract. In light of the coronavirus pandemic (COVID-19), we carried out a regular review of the information resources of international organizations specializing in combating infectious diseases, as well as governmental and intergovernmental organizations of the world's leading countries with strong economies and stringent regulatory systems in January-December 2020.
The analysis of the materials accumulated on the monitoring results revealed some differences in the legislation and practice of health care organization in Ukraine. First of all, this is a small number of registered clinical trials on COVID-19 prevention and treatment, as well as the lack of permit to use medicines for the indications which are not in basic prescribing information, in particular, "compassionate treatment" programs or emergency access to medicines, which are in clinical trials.
In the absence of traditional evidence of the health interventions effectiveness, it is necessary to emphasize the importance of identifying reliable information sources, transparency, quick and widespread information disclosure and experience exchange on challenging issues of resource and risk management, communication and public health activities, discussion of organizational forms and clinical activities in public health in the vast majority of countries. The establishment of independent monitoring and analytical centers, the participation of professional communities in various studies is an example of the rapid scientific data acquisition and supporting recommendations on various aspects of countering the pandemic.
Based on the analysis of international data published in reliable sources, the legislation has been changed in Ukraine, the approaches to planning the transformation of the health care system have been identified to increase its resistance to the infectious diseases epidemic, the quarantine measures and other restrictions have been justified, the standards of medical and pharmaceutical care have been presented, the measures to ensure the availability of medical care for patients with health disorders of other etiologies and priority areas for the development of health care facilities to protect medical staff and patients have been identified.
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Emons, Matthew F. "Integrated Patient Data for Optimal Patient Management: The Value of Laboratory Data in Quality Improvement." Clinical Chemistry 47, no. 8 (August 1, 2001): 1516–20. http://dx.doi.org/10.1093/clinchem/47.8.1516.
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Abstract Managed care organizations are shifting from traditional utilization management programs to focus on initiatives that improve the health of an insured population. This strategy requires sophisticated data integration to identify at-risk individuals and track outcomes. Laboratory data are becoming increasingly valuable tools for managed care organizations and healthcare providers. The HEDIS® Effectiveness of Care measures have incorporated laboratory data into several key performance indicators. By building a comprehensive repository of laboratory data that includes both procedure codes and laboratory values, managed care organizations can realize substantial savings by avoiding the costly medical record reviews required when administrative data are incomplete. In addition to tracking clinical outcomes, laboratory data provide the ability to risk-stratify a population to target high-risk individuals for case management and disease management interventions. Healthcare organizations face several challenges in the integration of laboratory data into medical databases and practice management software. Confidentiality is a key consideration in view of recent healthcare regulations. Providers of laboratory services should work collaboratively with organizations setting standards for healthcare informatics to facilitate the pooling of data for quality improvement and outcomes research. Health Level Seven, Inc. (HL7), Logical Observation Identifier Names and Codes (LOINC®), and Systematized Nomenclature of Medicine (SNOMED) will likely play a key role in this process.
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Broglio, Steven P., Kevin M. Guskiewicz, and John Norwig. "If You're Not Measuring, You're Guessing: The Advent of Objective Concussion Assessments." Journal of Athletic Training 52, no. 3 (March 1, 2017): 160–66. http://dx.doi.org/10.4085/1062-6050-51.9.05.
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Sport-related concussion remains one of the most complex injuries presented to sports medicine professionals. Although the injury has been recognized since ancient times, the concussion-assessment process has seen significant advances over the last 30 years. This review outlines the addition of objective measures to the clinical evaluation of the concussed athlete, beginning in the 1980s and continuing through the modern age. International and domestic organizations now describe standardized symptom reports, neurostatus and neurocognitive-function evaluations, and postural-control measures as standards of medical care, a significant shift from a short time ago. Despite this progression, much about the injury remains unknown, including new clinical and research-based assessment techniques and how the injury may influence the athlete's cognitive health over the long term.
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Rauzina, S. E., V. A. Shelgunov, and T. V. Zarubina. "PROBLEMS AND PROSPECTS OF THE ELECTRONIC PRESCRIBTION SYSTEM IN RUSSIA. SYSTEMATIC REVIEW." Social Aspects of Population Health 66, no. 5 (2020): 8. http://dx.doi.org/10.21045/2071-5021-2020-66-5-8.
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Development and implementation of the electronic prescription system is one of the priority areas of eHealth which fulfils a number of functions from prescribing medicines to comprehensive analysis of information and support for medical and management decisions. The current Russian legal framework legitimizes a doctor's prescription in the form of an electronic document. However, there is no definition of the following concepts in the legal acts: “Electronic prescription” and “Electronic prescription system”. The subject of the study is information space in the field of electronic prescription. The purpose is to study the Russian and foreign experience in its implementation, problems and prospects for its introduction at the national and cross-border level on the basis of descriptive and analytical methods. Analysis of the situation in the developed countries shows that currently most of the countries have implemented the electronic prescription system which involves physicians, pharmacists, regulatory organizations, insurance companies, and patients. This system ensures rapid interaction between all parties, lower medical errors, monitoring of medicines’ use, information analysis, and enables the patient to see the prescribed and provided medicines. Large-scale European eHealth projects of the last decade have initiated the exchange of digital prescriptions at the cross-border level, when a patient can get medicines from a pharmacy in the country of temporal residence with a prescription issued in the country of permanent resistance. Information support for the processes of prescribing and dispensing medicines in different regions of the Russian Federation is uneven, from its almost complete absence to full-fledged information systems close to the best analogues in the developed countries by functionality. Specific features of implementing the electronic prescription system in Russia are related to the obligatory registration of information related to supply of medicines to benefit recipients, involvement into circulation of medicines of systems and subsystems of various organizations: registration, keeping the state register of medicines, monitoring of medicine movement, monitoring of procurement, prescription and write off in health care facilities, dispensing within the pharmacy network, circulation of medicines and medical devices of the Eurasian Economic Union countries. It is impossible to develop a full-fledged system of electronic prescription in the Russian Federation without consolidated efforts of all parties, legislative consolidation of basic concepts, a unified information space, and standard data management approaches. Keywords: eHealth; electronic prescription (e-prescription); electronic prescription system; system of electronic drug prescription; medical information system; information system of drug provision to benefit recipients; information support for prescription.
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Trokhimchuk, V. V., O. I. Belyaeva, and L. M. Unhurian. "Organization of medical care for children in Ukraine (review of literature)." Farmatsevtychnyi zhurnal, no. 1 (August 14, 2018): 20–29. http://dx.doi.org/10.32352/0367-3057.1.17.03.
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The realization of high quality medical measures for protecting children’s health remains an important issue at the stage of reforming the domestic medicine. The aim of this work was to study and analyze the system of medical aid for children in Ukraine. The research focused on normative-legal acts regulating the organization of medical aid for children. The research methods are informative, retrospective, historical, logical and analytical.
The analysis of normative-legal documents regulating the organization of rendering of medical aid for children established their formality and economic groundlessness.
According to January 2017, only 35 documents were included into the Registry of medical technological documents in the direction of «Pediatrics». It means that many children’s pathological states are not covered by standardization, what reduces the quality of medical aid.
The national programs for the improvement of health status of children remained unrealized due to the lack of funding, ill-coordinated links between program implementers, the lack of effective monitoring of the quality and results of realizing the state programs. The implementation result of IMChI strategy was the reduction of mortality rate in children of different age groups in the pilot regions. In terms of reforming the combined model (model III) is the most effective and acceptable for pediatric care rendering.
The population expenses reach nearly half of the total funding of the sector, what demonstrates the inconsistencies between the real state of children’s assurance in the health care system of Ukraine and national normative acts.
It was determined the necessity of structural reorganization of the system, the optimization of beds number, the increase of medical care funding from state and local budgets, the raising of resource efficiency of health care system and the continued development and implementation of modern protocols (standards) for the treatment of children pathologies.
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Shamsi-Gooshki, Ehsan, Hasan Bagheri, and Mahmood Salesi. "Evaluation of Iranian Medical Journals from the Perspective of Publication Ethics." Archives of Iranian Medicine 23, no. 10 (October 1, 2020): 697–703. http://dx.doi.org/10.34172/aim.2020.88.
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Background: Scientific journals will gain real credit when they meet publication ethics standards. This study seeks to evaluate the current status of medical journals’ adherence to some ethical standards. Methods: The 412 scientific journals approved by the Ministry of Health and Medical Education were included in this study. The process of downloading articles and data extraction for seven general and specific indicators related to publication ethics was conducted by trained researchers. Different methods were implemented by the team of colleagues to prevent possible errors in data extraction. After data integration, data analysis was performed using SPSS version 23. Results: Overall, 408 journals and 3948 articles met the inclusion criteria. The distribution of journals according to the highest journal index was 5.4%, 13.7%, 8.3%, 8.1% and 64.5% for ISI, ESCI, PubMed, Scopus and Other indexes, respectively. In 27.7% of the articles, the review process took over 6 months. According to the results, 6.6% and 31.7% of the articles belonged to the journals’ editors and owner universities, respectively. Journal self-citation was seen in 19.2% of articles and in fewer than half of the articles (45.5%), the status of conflict of interest was declared. In 36.9% of the articles, the code of ethics or university ethics committee approval, and in 36.5% of clinical trial articles, the clinical trial registration code was reported. Conclusion: Modifying processes or introducing new rules for indicators of publication ethics by trustee organizations can improve the current status. These seven indicators can also be used to rank journals.
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Hudon, G., R. Laprise, and L. Guindon. "46. Did the CME/CPD train leave with half the passengers? A needs assessment of Québec specialist associations' CPD units." Clinical & Investigative Medicine 30, no. 4 (August 1, 2007): 52. http://dx.doi.org/10.25011/cim.v30i4.2806.
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This presentation reports on the results of a needs assessment conducted amongst the 34 Quebec specialist associations, which are accredited as CME/CPD providers by Quebec’s College of Physicians, in accordance with the Canadian Association of Continuing Medical Education’s criteria.
In 2006, a mix of methods (survey, semi-structured interviews and program documentation review) were used to assess CPD units’ learning needs in the areas of CME and CPD, the extent to which they carried out a list of specific tasks associated to providers’ responsibilities, barriers encountered in meeting standards, and the kind of help needed to improve performance.
Although CME/CPD fields have evolved considerably in the past 20 years, results indicate that few of the advances have made their way down to the associations. The majority still provides education in the form of traditional CME, where speakers talk about new developments in medicine. Whereas the systematic approach of CME is well integrated in most units, few go beyond perceptions in their needs assessments, use problem-based learning methods, enablers, reinforcement and outcome evaluations, or help specialists self-evaluate and reflect on their practice. These methods and approaches are believed to increase CME effectiveness.
Most Canadian specialists get a large proportion of their CE from non academic medical organizations such as professional associations and learned societies. However, information available in the literature does not allow generalization of our observations to other organizations of this nature. Since non academic organizations are important CME/CPD providers, we propose that more attention be given on the way trainers are trained and innovations are shared in our CE system. What minimal knowledge and skills should be required of a CME/CPD professional today? Together with its affiliated associations and academic partners, the Federation of Medical Specialists of Quebec (FMSQ) has decided to tackle this important issue in the coming years.
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Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet 2003; 362:1225-30.
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Sawasdipanich, Nantaga, Supa Puektes, Supaporn Wannasuntad, Ankana Sriyaporn, Chulepon Chawmathagit, Jirapa Sintunava, and Gamjad Paungsawad. "Development of healthcare facility standards for Thai female inmates." International Journal of Prisoner Health 14, no. 3 (September 10, 2018): 163–74. http://dx.doi.org/10.1108/ijph-07-2017-0032.
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Purpose The purpose of this paper is to develop and evaluate the Standards of Healthcare Facility for Thai Female Inmates (SHF-TFI) through healthcare service improvement. Design/methodology/approach This research and quality improvement project was comprised of three phases. Surveying healthcare facilities and in-depth interviews with female inmates as well as prison nurses were employed in Phase I. Expert reviews and public hearing meetings were used for developing the SHF-TFI in Phase II. Satisfaction questionnaires, focus group interviews of the female inmates, and in-depth interviews with nurses and prison wardens were utilized to evaluate feasibility and effectiveness of SHF-TFI implementation in Phase III. Findings The SHF-TFI was elaborated in order to be more specific to the context of the correctional institutes and correspond with healthcare as to the needs of female inmates. It was divided into three main aspects: administrative standards, health service standards and outcome standards. After implementation, nurses reflected on the feasibility and benefits of the SHF-TFI on the organizations, inmates and nurses. The female inmates perceived remarkable improvement in the healthcare services including physical activity promotion and screening programs for non-communicable diseases, the physical environment and sufficiency of medical equipment. Moreover, the pregnant inmates and incarcerated mothers with children shared their views on better antenatal and child developmental care, as well as availability of baby supplies. Originality/value The findings support the feasibility and effectiveness of the SHF-TFI for quality care improvement and applicability of the Bangkok Rules in women’s correctional institutes.
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Lewis, Ariane, Richard J. Bonnie, Thaddeus Pope, Leon G. Epstein, David M. Greer, Matthew P. Kirschen, Michael Rubin, and James A. Russell. "Determination of Death by Neurologic Criteria in the United States: The Case for Revising the Uniform Determination of Death Act." Journal of Law, Medicine & Ethics 47, S4 (2019): 9–24. http://dx.doi.org/10.1177/1073110519898039.
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Although death by neurologic criteria (brain death) is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: (1) the medical standards used to determine death by neurologic criteria, (2) management of family objections before determination of death by neurologic criteria, and (3) management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address variation in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act (UDDA) and the rationale for these recommendations.
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Yarema, V. I., E. Kh Barinov, and I. V. Osipova. "Medical expert assessment of defects in the provision of medical care for emergency surgical abdominal pathology." Hirurg (Surgeon), no. 9-10 (September 13, 2020): 72–80. http://dx.doi.org/10.33920/med-15-2005-07.
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The article presents a literature review on the assessment of defects and medical care, as well as the prevention of defects and conflict situations that arise during the treatment of patients with emergency surgical abdominal pathology. Unfortunately, mortality among urgent surgical patients and diseases of the abdominal organs is in the leading positions among all causes of death, despite the improvement of diagnostic methods, the emergence of new medical equipment and drugs, as well as the developed standards of approaches to the treatment of this category of patients. The paper presents statistics on the incidence of abdominal pathology and the mortality rate among the population of our country. We have studied clinical guidelines and standards for the provision of medical care to patients with acute abdominal pathology and analyzed the work on the assessment of medical care, medical errors, conflicts between the patient and the surgeon, as well as the works describing the individual characteristics of various diseases over the past decades. The article discusses in detail the causes of professional errors and defects in medical care, which include: information and deontological defects, defects in the organization of the treatment process, defects in diagnosis and defects in the treatment itself. Studied in detail the stages of the examination to assess the medical care provided. Examples of the course of the main surgical diseases of the abdominal organs in various groups of patients are described. The possible measures to prevent professional errors in doctors and patients have been studied in detail.
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Siedler, Madelin R., Priscila Lamadrid, Megan N. Humphries, Reem A. Mustafa, Yngve Falck-Ytter, Philipp Dahm, Shahnaz Sultan, M. Hassan Murad, and Rebecca L. Morgan. "The quality of physical activity guidelines, but not the specificity of their recommendations, has improved over time: a systematic review and critical appraisal." Applied Physiology, Nutrition, and Metabolism 46, no. 1 (January 2021): 34–45. http://dx.doi.org/10.1139/apnm-2020-0378.
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While numerous guidelines for the prescription of physical activity are released each year, the quality and practicability of these guidelines is unknown. We assessed the quality of 95 guidance documents published since 2000 that included recommendations about physical activity for the promotion of general health and prevention of cardiometabolic disease. We used 3 tools: Appraisal of Guidelines for Research and Evaluation (AGREE II), the National Academy of Medicine’s (NAM) Standards for Trustworthy Clinical Practice Guidelines, and the Frequency, Intensity, Time, and Type (FITT) score. Average AGREE II domain scores ranged from 38%−84%, and the portion of criteria fulfilled per NAM domain ranged from 7%–39%. The average FITT score for all recommendations was 2.48 out of 4. While guidelines improved according to both AGREE II and the NAM standards over time, their practicability as assessed by FITT score did not improve. Guidelines produced by governmental agencies or other nonprofit organizations, using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, or fulfilling a higher number of NAM criteria tended to be of higher quality. Organizations producing physical activity guidelines can improve their quality by establishing and reporting processes for public representation, external review, and conflict of interest (COI) management. Future recommendations about physical activity should be more specific and include strategies to improve implementation. Registration no.: PROSPERO CRD42019126364. Novelty: Most physical activity recommendations are not sufficiently specific to be practically implemented. The overall quality of guidelines has improved over time, but the specificity of recommendations has not. Improved public representation, external review, and COI disclosure and management processes would improve guideline quality.
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Osby, Melanie A., Sunita Saxena, Janice Nelson, and Ira Shulman. "Safe Handling and Administration of Blood Components: Review of Practical Concepts." Archives of Pathology & Laboratory Medicine 131, no. 5 (May 1, 2007): 690–94. http://dx.doi.org/10.5858/2007-131-690-shaaob.
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Abstract Context.—The more advanced we become, the more evident are the infectious and noninfectious risks of the blood supply. Infectious risks are somewhat straightforward and are addressed by implementing stricter donor criteria and testing. The noninfectious risks, however, are more complicated. Each step in the transfusion process, beginning with the physician who orders a transfusion to the actual transfusion of the component, is subject to adverse outcomes and increases the noninfectious risks of transfusion. The challenges to provide the safest blood possible with zero risk have resulted in the implementation of stringent standards from both the American Association of Blood Banks and the Joint Commission on Accreditation of Healthcare Organizations. Objective.—A series of case scenarios serve as the basis for discussion of the risks, which affect the safety and administration of blood components, inherent in the transfusion process. Data Sources.—Journals, textbooks, Internet. Conclusions.—The transfusion process is a complex multistep process with inherent risks. Infectious risks of transfusion are being adequately addressed such that the noninfectious risks of transfusion are becoming much more evident. Patient safety can be compromised if each step of the transfusion process is not completed according to established policies and procedures at each individual institution.
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Kendler, K. S., and M. Solomon. "Expert consensus v. evidence-based approaches in the revision of the DSM." Psychological Medicine 46, no. 11 (April 13, 2016): 2255–62. http://dx.doi.org/10.1017/s003329171600074x.
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The development of DSM-III through DSM-5 has relied heavily on expert consensus. In this essay, we provide an historical and critical perspective on this process. Over the last 40 years, medicine has struggled to find appropriate methods for summarizing research results and making clinical recommendations. When such recommendations are issued by authorized organizations, they can have widespread influence (i.e. DSM-III and its successors). In the 1970s, expert consensus conferences, led by the NIH, reviewed research about controversial medical issues and successfully disseminated results. However, these consensus conferences struggled with aggregating the complex available evidence. In the 1990s, the rise of evidence-based medicine cast doubt on the reliability of expert consensus. Since then, medicine has increasingly relied on systematic reviews, as developed by the evidence-based medicine movement, and advocated for their early incorporation in expert consensus efforts. With the partial exception of DSM-IV, such systematic evidence-based reviews have not been consistently integrated into the development of the DSMs, leaving their development out of step with the larger medical field. Like the recommendations made for the NIH consensus conferences, we argue that the DSM process should be modified to require systematic evidence-based reviews before Work Groups make their assessments. Our suggestions – which would require leadership and additional resources to set standards for appropriate evidence hierarchies, carry out systematic reviews, and upgrade the group process – should improve the objectivity of the DSM, increase the validity of its results, and improve the reception of any changes in nosology.
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Jensen, Guy, Elhanan Bar-On, Jane Thorley Wiedler, Stefanie C. Hautz, Harald Veen, Alan R. Kay, Ian Norton, Richard A. Gosselin, and Johan von Schreeb. "Improving Management of Limb Injuries in Disasters and Conflicts." Prehospital and Disaster Medicine 34, no. 03 (April 26, 2019): 330–34. http://dx.doi.org/10.1017/s1049023x19004242.
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AbstractIt has become clear that disaster relief needs to transition from good intentions or a charity-based approach to a professional, outcome-oriented response. The practice of medicine in disaster and conflict is a profession practiced in environments where lack of resources, chaos, and unpredictability are the norm rather than the exception. With this consideration in mind, the World Health Organization (WHO; Geneva, Switzerland) and its partners set out to improve the disaster response systems. The resulting Emergency Medical Team (EMT) classification system requires that teams planning on engaging in disaster response follow common standards for the delivery of care in resource-constraint environments. In order to clarify these standards, the WHO EMT Secretariat collaborated with the International Committee of the Red Cross (ICRC; Geneva, Switzerland) and leading experts from other stakeholder non-governmental organizations (NGOs) to produce a guide to the management of limb injuries in disaster and conflict.The resulting text is a free and open-access resource to provide guidance for national and international EMTs caring for patients in disasters and conflicts. The content is a result of expert consensus, literature review, and an iterative process designed to encourage debate and resolution of existing open questions within the field of disaster and conflict medical response.The end result of this process is a text providing guidance to providers seeking to deliver safe, effective care within the EMT framework that is now part of the EMT training and verification system and is being distributed to ICRC teams deploying to the field.This work seeks to encourage professionalization of the field of disaster and conflict response, and to contribute to the existing EMT framework, in order to provide for better care for future victims of disaster and conflict.Jensen G, Bar-On E, Wiedler JT, Hautz SC, Veen H, Kay AR, Norton I, Gosselin RA, von Schreeb J. Improving management of limb injuries in disasters and conflicts. Prehosp Disaster Med. 2019;34(3):330–334.
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Kim, Sang Hyun, and Jung Yul Park. "Global trends in continuing medical education and continuing development: A proposal for implementation in Korea." Journal of the Korean Medical Association 63, no. 12 (December 10, 2020): 782–88. http://dx.doi.org/10.5124/jkma.2020.63.12.782.
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This study is to introduce an effective and systematic accreditation and evaluation system of continuing medical education (CME) and continuing professional development (CPD) in Korea, suitable for the future development, and based on the review of the characteristics of well-recognized systems implemented in western countries such as the US and Canada. CME and CPD comprise programs that expand the clinical knowledge and skills required of physicians as well as educational activities aiming to maintain, develop, and increase knowledge, specialized skills, or performance standards for provision of better medical services. These include not only self-directed activities but also official activities, such as leadership activities, professional development, and evaluation of the practitioner’s level of knowledge and competence. Recently, continuing education for doctors has emphasized CPD, centered around learners, in a departure from CME, centered around educators. Each CME/CPD program in the US and Canada has unique features. However, they share common features of self-directed learning, competency-based education, and evaluation. Although there are remain problems, the Continuing Medical Education Accreditation and Evaluation Council of the Korean Medical Association, as a unique accreditation authority for CME, is currently developing a new CME/CPD system, which would constitute an idealistic onesystem for Korean physicians oriented toward future development, designed to fulfill standards equivalent to that of the Accreditation Council for Continuing Medical Education or any other internationally well-recognized organization.
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Berezin, konstantin, Aleksey Shulaev, Rinat Saleev, Irina Usmanova, Elena Statseva, Veniamin Berezin, and Oskar Ismagilov. "MODERN ASPECTS OF THE ORGANIZATION OF MEDICAL CARE FOR PATIENTS WITH LEUKOPLAKIA OF THE ORAL MUCOSA." Actual problems in dentistry 16, no. 4 (February 9, 2021): 6–12. http://dx.doi.org/10.18481/2077-7566-20-16-4-6-12.
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Subject. At the present stage, the organization of medical care for patients with precancerous diseases of the oral mucosa is one of the most important tasks of the dental service. This is due to the fact that timely detection and treatment of patients at the early stages of the disease provide a long-term and persistent clinical effect and allows you to achieve satisfactory clinical results.
The purpose of the review: the work contains a review of the literature of recent years with a detailed review of measures in the management of medical care for patients with keratosis of the oral mucosa.
Methodology. The article deals with current issues about the key points of early detection and treatment of precancerous diseases of the oral mucosa. It is noted that approaches to solving the problems of medical and social care for patients with leukoplakia of the oral mucosa are not only in the field of medicine, but also in the social side of human activity. Attention is paid to the discussion of the use of the screening method for determining diseases of the oral mucosa. The issues of perspective development of issues of improvement of scientifically based and acceptable for dental institutions methods of conducting medical preventive examinations are highlighted. Measures to improve the detection of patients with hyperkeratosis of the oral mucosa, as well as to improve the results of treatment of identified patients, are due to the interaction of various practical health services and should be solved comprehensively from the standpoint of a single systematic approach. The necessity of conducting this study as a criterion for evaluating the system of organization of dental services for patients with keratosis is shown.
Results and conclusions. The conducted research review allowed us to identify areas for improving the organization of dental care for patients with hyperkeratosis of the oral mucosa. The study of the results obtained should be taken into account when forming prevention programs, taking into account the implementation of the developed standards and recommendations.
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WPRIM, APAME IMSEAR. "Tokyo Declaration on Research Integrity and Ethical Publication in Science and Medicine in the Asia Pacific Region." Philippine Journal of Otolaryngology-Head and Neck Surgery 28, no. 2 (December 1, 2013): 7. http://dx.doi.org/10.32412/pjohns.v28i2.473.
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We, the participants in the Joint Meeting of the Asia Pacific Association of Medical Journal Editors (APAME), the Index Medicus for the South-East Asian Region (IMSEAR), and the Western Pacific Region Index Medicus (WPRIM) held in Tokyo from 2 to 4 August 2013:
CONSIDERING
That overwhelming data in science and medicine may differ in their reliability and that quality control is important for compiling scientific and health information;
That equitable circulation of scientific and health information is facilitated by fair collaboration among policy makers, researchers, and industry sectors including pharmaceuticals and publishers;
That APAME, IMSEAR, and WPRIM are important collaborative initiatives that can implement global guidelines for publication and dissemination of scientific and medical knowledge in an equitable and ethical manner;
CONFIRM
Our commitment to endorse that scientific and medical knowledge is imperishable and should not be assessed or evaluated by only economic or temporal considerations;
Our commitment to improve quality and reliability of scientific and medical knowledge through the IMSEAR and WPRIM;
Our commitment to publish reliable and high-quality information by education of researchers, implementation of fair review processes, and organization of networks through APAME;
Our commitment to collaborate with publishers, academic or public libraries, and research bodies to achieve equitable and ethical publication and dissemination of scientific and medical knowledge;
COMMIT
Ourselves, to publishing reliable and high-quality information, thereby setting the ethical standard for our colleagues, editors, and librarians in the Region;
Our publishers, to disseminating scientific and medical knowledge fairly and impartially through digital library services including, but not limited to, IMSEAR, WPRIM, and the Global Health Library;
Our organization, APAME, to building further networks, convening conferences, and organizing events to educate and empower editors, peer reviewers, and authors to achieve internationally acceptable, but regionally realistic, scholarly standards.
4 August 2013, Tokyo
This declaration was adopted at the 2013 Convention of the Asia Pacific Association of Medical Journal Editors (APAME) held in Tokyo from 2 to 4 August 2013. It is concurrently published by Journals linked to APAME and listed in the Index Medicus for the South East Asian Region (IMSEAR) and the Western Pacific Region Index Medicus (WPRIM). Copyright © APAME. www.wpro.who.int/apame apame@wpro.who.int
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Cazap, Eduardo. "Breast Cancer in Latin America: A Map of the Disease in the Region." American Society of Clinical Oncology Educational Book, no. 38 (May 2018): 451–56. http://dx.doi.org/10.1200/edbk_201315.
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In the next few decades, breast cancer will become a leading global public health problem as it increases disproportionately in low- and middle-income countries. Disparities are clear when comparisons are made with rates in Europe and the United States, but they also exist between the countries of the region or even within the same country in Latin America. Large cities or urban areas have better access and resource availability than small towns or remote zones. This article presents the status of the disease across 12 years with data obtained through three studies performed in 2006, 2010, and 2013 and based on surveys, reviews of literature, patient organizations, and public databases. The first study provided a general picture of breast cancer control in the region (Latin America); the second compared expert perceptions with medical care standards; and the third was a review of literature and public databases together with surveys of breast cancer experts and patient organizations. We conclude that breast cancer is the most frequent cancer and kills more women than any other cancer; we also suggest that aging is the principal risk factor, which will drive the incidence to epidemic levels as a result of demographic transition in Latin America. The economic burden also is large and can be clearly observed: in countries that today allocate insufficient resources, women go undiagnosed or uncared for or receive treatment with suboptimal therapies, all of which results in high morbidity and the associated societal costs. The vast inequities in access to health care in countries translates into unequal results in outcomes. National cancer control plans are the fundamental building block to an organized governance, financing, and delivery of health care for breast cancer.
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Santoso, Rahmat, and Stefanus Nova. "Preliminary Review of the Effects of Electronic Medical Administration Records (eMAR) and Electronic Doctor Order Entry (CPOE) on Patient Safety Culture in the Era of Universal Health Services." SOEPRA 5, no. 2 (April 2, 2020): 243. http://dx.doi.org/10.24167/shk.v5i2.2462.
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In the era of universal health service [UHC], medicine was always used as part of curative, preventive, and promotive. Following pharmaceutical service standards in hospitals, health centers, and pharmacies, that medicines must be managed properly, including in their use. Medication errors are a leading cause of death in many parts of the world. The factors causing the increase in medication errors related to individuals, such as heavy workload on health care facilities and pharmaceutical service facilities, are often experienced by medical staff (General Practitioners and Specialists) and pharmaceutical personnel (Pharmacists and Pharmaceutical Technical Personnel / TTK), or organizational-related factors, such as inadequate facilities and infrastructure to document medication administration records and the entry of physician orders electronically. The study was conducted cross-sectionally retrospectively, by sharing the results of an initial literature review on the impact of electronic medication administration records (eMAR) and doctor's order entry (CPOE) on patient safety. Using PubMed and Google Scholar, we search for the following terms: "eMAR", "CPOE", "medication error", and "patient safety". Our initial findings reveal that eMAR and CPOE can have an impact on the pharmaceutical workflow, and reduce medication errors, thereby increasing patient safety. Based on the initial review, eMAR and CPOE influence the insight of pharmaceutical personnel, pharmaceutical workflows and impact on patient safety. On the other hand, there is a regulatory direction which is still in the form of a Regulation of the Minister of Health Regulation on Providers of Electronic Pharmaceutical Facilities (PSEF), but it is unfortunate that "eMAR" and "CPOE" have not become clauses governed by the government. Our plan for future research is to conduct a systematic review study to further study the impact of eMAR and CPOE on patient safety.
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Manchikanti, Laxmaiah. "Breakthrough Pain in Chronic Non-Cancer Pain: Fact, Fiction, or Abuse." Pain Physician 3;14, no. 2;3 (March 14, 2011): E103—E117. http://dx.doi.org/10.36076/ppj.2011/14/e103.
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Treatment of chronic non-cancer pain with opioid therapy has escalated in recent years, resulting in exploding therapeutic use and misuse of prescription opioids and multiple adverse drug events. Breakthrough pain is defined as a transient exacerbation of pain experienced by individuals who have relatively stable and adequately controlled baseline cancer pain. Further, the definition of breakthrough pain, prevalence, characteristics, implications, and treatment modalities have been extensively described for chronic cancer pain. However, the literature for breakthrough pain in chronic non-cancer pain including its terminology, prevalence, relevance, characteristics, and treatments, have been poorly described and continue to be debated. The philosophy of breakthrough pain in chronic non-cancer pain raises multiple issues leading almost all patients to be on high dose long-acting opioids, followed by supplementing with short-acting drugs, instead of treating the patients with only shortacting drugs as required. Consequently, the subject of breakthrough pain in chronic non-cancer pain is looked at with suspicion due to the lack of evidence and inherent bias associated with its evaluation, followed by escalating use and abuse of opioids. Multiple issues related to the concept of breakthrough pain in chronic non-cancer pain evolve around extensive use, overuse, misuse, and abuse of opioids. In the era of eliminating opioids or significantly curtailing their use to only appropriate indications, the concept of breakthrough pain raises multiple questions without any scientific evidence. This review illustrates that there is no significant evidence for any type of breakthrough pain in chronic non-cancer pain based on available literature, methodology utilized, and response to opioids in chronic non-cancer pain. The advocacy for increased usage of opioids in the treatment of chronic pain dates back to the liberalization of laws governing opioid prescription for the treatment of chronic non-cancer pain by state medical boards in the late 1990s, and is exploding with new pain management standards for inpatient and outpatient medical care implemented by the Joint Commission on Accreditation of Health Care Organizations in 2000, and the advocacy by many physicians and organizations for increased use of opioids. This comprehensive review critically evaluates the available evidence of breakthrough pain in chronic non-cancer pain including its existence, prevalence, and managing symptoms which are described as breakthrough pain or episodic pain. Key words: Breakthrough pain, opioids, chronic non-cancer pain, opioid abuse, opioid misuse, addiction, opioid hyperalgesia, interventional techniques
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Thiagarajan, Ravi R., Geoffrey L. Bird, Karen Harrington, John R. Charpie, Richard C. Ohye, James M. Steven, Michael Epstein, and Peter C. Laussen. "Improving safety for children with cardiac disease." Cardiology in the Young 17, S4 (September 2007): 127–32. http://dx.doi.org/10.1017/s1047951107001230.
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AbstractThe complexity of the modern systems providing health care presents a unique challenge in delivering care of the required quality in a safe environment. Issues of safety have been thrust into the limelight because of adverse events highly publicized in the general media.In the United States of America, improving the safety and quality in health care has been set forth as a priority for improvements in the 21st century in the report from the Institute of Medicine. Many measures have now been initiated for improving the safety of patients at hospital, regional, and national level, and through initiatives sponsored by governments and private organizations. In this review, we summarize known concepts and current issues on the safety of patients, and their applicability to children with congenital cardiac disease. Prior to examining the issues of medical error and safety, it is important to define the terminology.An error is defined as the failure of a planned action to be completed as intended, also known as an execution error, or the use of a wrong plan to achieve an aim, this representing a planning error. An active error is an error that occurs at the level of the frontline operator, and the effects of which are felt immediately. A latent error is an error in the design, organization, training and maintenance, that leads to operator errors, and the effects of which are typically dormant in the system for lengthy periods of time. Latent errors may cause harm given the right circumstances and environment.An adverse event is defined as an injury resulting from medical intervention. A preventable adverse event is an adverse event that occurs due to medical error. Negligent adverse events are a subset of preventable adverse events where the care provided did not meet the standard of care expected of that practitioner.The study of improving the delivery of safe care for our patients is a rapidly growing field. Important components for development of programmes to improve the safety of patients include the leadership for the programme, the implementation of process design based on human limitations, the promotion of teamwork and function, the anticipation of unexpected events, and the creation of a learning environment.Much is yet to be learned about the risk and incidence of adverse events during hospitalization of children with congenital cardiac disease. Errors due to human factors, such as poor communication, poor coordination, and suboptimal team work, have shown to be important causes of adverse outcomes in children undergoing cardiac surgery, and should be a focus for improvement. Future research on evaluating causes and prevention of medical errors and adverse events in this population at high risk, and consuming high resources, is essential.Issues of inadequate safeguards for patients have been prominent in the media, and have been highlighted in reports from the Institute of Medicine. Our review discusses research on the causes of medical error, and proposes concepts to design successful programmes to improve safety for the patients on a local level.
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Yates, Allison A., Johanna T. Dwyer, John W. Erdman, Janet C. King, Barbara J. Lyle, Barbara O. Schneeman, and Connie M. Weaver. "Perspective: Framework for Developing Recommended Intakes of Bioactive Dietary Substances." Advances in Nutrition 12, no. 4 (May 7, 2021): 1087–99. http://dx.doi.org/10.1093/advances/nmab044.
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ABSTRACT Dietary bioactives are food substances that promote health but are not essential to prevent typical deficiency conditions. Examples include lutein and zeaxanthin, omega-3 fatty acids, and flavonoids. When quality evidence is available, quantified intake recommendations linking dietary bioactives with specific health benefits will enable health professionals to provide evidence-based information to consumers. Without evidence-based recommendations, consumers use information from available sources that often lack standards and rigor. This article describes a framework to develop guidance based on quality evidence fully vetted for efficacy and safety by qualified experts, and designed to communicate the amounts of specific dietary bioactive compounds with identified health benefits. The 4-step Framework described here can be adapted by credible health organizations to work within their guideline development process. Standards of practice used in clinical guidelines are adapted to quantify dietary bioactive intake recommendations from foods consumed by the general public, by taking into account that side effects and trade-offs are often needed for medical treatments but are not acceptable for dietary bioactives. In quantifying dietary bioactive recommendations, this Framework establishes 4 decision-making steps: 1) characterize the bioactive, determine amounts in specific food sources, and quantify intakes; 2) evaluate safety; 3) quantify the causal relation between the specific bioactive and accepted markers of health or normal function via systematic evidence reviews; and 4) translate the evidence into a quantified bioactive intake statement. This Framework provides a working model that can be updated as new approaches are advanced.
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Pietrantonio, Filomena, Paola Aperti, Luca Tonoli, Elaine Tyndall, and Orietta Meneghetti. "The correct setting to improve the quality of health care process: a retrospective study in Internal Medicine Department." Italian Journal of Medicine 12, no. 4 (December 4, 2018): 285–95. http://dx.doi.org/10.4081/itjm.2018.1035.
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The definition of the role of hospitals and communities in terms of the response to patients’ health care needs is essential in the Lombardy region health-care reform development (LR. 23/2015). The stratification of patients according to clinical severity and care complexity for adequate clinical health care, is achieved by delineating care settings, staff standards, required technical equipment and crucial aspects of clinical pathways. An observational and retrospective study at Manerbio Hospital Internal Medicine Unit (IMU) was carried out to define: i) characteristics of IMU patients; ii) role of IMU physician in management of poly-pathological patients; iii) alternative organizational models. After a Literature review, clinical severity was defined by modifying early warning score, complexity and co-morbidities by cumulative illness rating scale (CIRS) and by intensity of care through care intensity index (IIA). All medical records of patients admitted in the first quarter of 2016 were analyzed. A total of 393 medical records were examined: 199 M/194 F, median age 81 years. Critical patients (requiring continuous monitoring using advanced equipment): 27% of the sample (10% with intensive care transfer criteria). Co-morbidity: between 5 and 6 active diseases for most of the sample; 53% with CIRS between 7 and 12. Elevated care intensity (IIA) was found in 46% of the sample, remaining constant throughout hospital stay. Medium stay: 9.35 days. 27% of IMU patients needs subintensive care. About a quarter of patients has unresolved social problems contributing to acute presentations in the emergency room. Agreement on appropriate links between hospital and community care structures is advisable to reduce hospital stay, adequately responding to patients’ needs.
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Costa, Andreu F., Christian B. van der Pol, Pejman Jabehdar Maralani, Matthew D. F. McInnes, Jason R. Shewchuk, Raman Verma, Casey Hurrell, and Nicola Schieda. "Gadolinium Deposition in the Brain: A Systematic Review of Existing Guidelines and Policy Statement Issued by the Canadian Association of Radiologists." Canadian Association of Radiologists Journal 69, no. 4 (November 2018): 373–82. http://dx.doi.org/10.1016/j.carj.2018.04.002.
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Emerging evidence has confirmed that, following administration of a gadolinium-based contrast agent (GBCA), very small amounts of gadolinium will deposit in the brain of humans with intact blood-brain barriers. The literature is evolving rapidly and the degree to which gadolinium will deposit for a particular GBCA or class of GBCAs remains undetermined. Several studies suggest that linear GBCAs deposit more gadolinium in the brain compared with macrocyclic GBCAs; however, our understanding of the molecular composition of deposited gadolinium is preliminary, and the clinical significance of gadolinium deposition remains unknown. To date, there is no conclusive evidence linking gadolinium deposition in the brain with any adverse patient outcome. A panel of radiologists representing the Canadian Association of Radiologists was assembled to assist the Canadian medical imaging community in making informed decisions regarding the issue of gadolinium deposition in the brain. The objectives of the working group were: 1) to review the evidence from animal and human studies; 2) to systematically review existing guidelines and position statements issued by other organizations and health agencies; and 3) to formulate an evidence-based position statement on behalf of the Canadian Association of Radiologists. Based on our appraisal of the evidence and systematic review of 9 guidelines issued by other organizations, the working group established the following consensus statement. GBCA administration should be considered carefully with respect to potential risks and benefits, and only used when required. Standard dosing should be used and repeat administrations should be avoided unless necessary. Gadolinium deposition is one of several issues to consider when prescribing a particular GBCA. Currently there is insufficient evidence to recommend one class of GBCA over another. The panel considered it inappropriate to withhold a linear GBCA if a macrocyclic agent is unavailable, if hepatobiliary phase imaging is required, or if there is a history of severe allergic reaction to a macrocyclic GBCA. Further study in this area is required, and the evidence should be monitored regularly with policy statements updated accordingly.
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Upadhyay, Vivek A., Adam B. Landman, and Michael J. Hassett. "Landscape Analysis of Oncology Mobile Health Applications." JCO Clinical Cancer Informatics, no. 5 (May 2021): 579–87. http://dx.doi.org/10.1200/cci.20.00156.
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PURPOSE More than 325,000 mobile health (mhealth) applications (apps) have been developed. We sought to describe the state of oncology-specific apps and to highlight areas of strength and opportunities for future development. METHODS We searched for oncology apps in the Apple iOS and Google Play app stores in January 2020. Apps were classified by English language support, date of last update, downloads, intended audience, intended purpose, and developer type. RESULTS We identified 794 oncology-specific, English language applications; only 257 (32%) met basic recency standards and were considered evaluable. Of evaluable apps, almost half (47%) were found in the Medical Store Category and the majority were free (88%). The most common intended audience was health care professionals (45%), with 28% being geared toward the general public and 27% being intended for patients. The intended function was education for 36%, clinical decision support for 19.5%, and patient support for 18%. Only 23% of education apps and 40% of clinical decision support apps reported any formal app content review process. Web developers created 61.5% of apps, scientific societies created 10%, and hospitals or health care organizations created just 6%. Of 54 studies that used mobile apps in oncology identified by a recent meta-analysis, only two could be matched to commercially available apps from our study, suggesting a substantial divide between investigation and product dissemination. CONCLUSION Relatively few oncology-related apps exist in the commercial marketplace, up-to-date apps are uncommon, and there is a notable absence of key oncology stakeholders in app development. Meaningful development opportunities exist.
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Williams, Laurina O., Eugene C. Cole, Ira M. Lubin, Norma I. Iglesias, Ruth L. Jordan, and Lauren E. Elliott. "Quality Assurance in Human Molecular Genetics Testing: Status and Recommendations." Archives of Pathology & Laboratory Medicine 127, no. 10 (October 1, 2003): 1353–58. http://dx.doi.org/10.5858/2003-127-1353-qaihmg.
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Abstract Objective.—The role of genetic testing has expanded with rapidly developing technology and completion of the International Human Genome Project. Development of universally acceptable quality control methods and quality assurance standards trails technology. The principle that high-quality genetic testing is important for public health motivated the Centers for Disease Control and Prevention to formulate ways for improving quality assurance of human molecular genetics testing. Participants.—Twenty-eight panelists were chosen based on expertise in molecular genetics testing and knowledge of quality assurance practices. Representatives of professional organizations, industries, and federal agencies participated in one or more of 3 panel meetings. Consensus recommendations were developed by the 15 panelists in the third meeting. Evidence.—Evidence was derived from experts' opinion during 3 panel meetings. Data compiled through laboratory visits and literature review were used as reference information. Need for this project was derived from the Final Report of the Task Force on Genetic Testing, produced by the National Institutes of Health and the Department of Energy in 1997, and the Summary Report of the Subcommittee Meeting on Genetics of the Clinical Laboratory Improvement Act Advisory Committee in 1997. Consensus Process.—Research and development needs were identified using a participatory visioning approach. A modified nominal group process was used to reach consensus. Conclusions.—Five core consensus recommendations were made: research for developing positive samples for quality assurance purposes, performance evaluation programs supplementing those in existence, establishment and support of laboratory-oriented consortia, establishment of a laboratory-focused database, and support of molecular genetics training programs.
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Ivantsova, M. A., G. N. Belova, P. L. Shcherbakov, and N. V. Vernik. "Risks of the working environment in the safety ensuring in endoscopy." Experimental and Clinical Gastroenterology, no. 12 (December 23, 2020): 5–15. http://dx.doi.org/10.31146/1682-8658-ecg-184-12-5-15.
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The working environment is forming from the organizational conditions, motivation and the willingness of employees to fulfill their duties in the best way on the one hand, and is determined by the team ethical standards, on the other hand. Risks associated with the working environment are composed of compliance risks associated with ensuring compliance with legal requirements for labor protection and regulation, ensuring of infectious safety, as well as risks associated with the physical and psycho-emotional status of medical workers, determining the impact of the “human” factor on the work results. The purpose of this review article is to identify the risks of the working environment in endoscopy, as the first stage of risk management, in order to be able for further assessment of their impact on the safety of medical activities in endoscopy, as well as to identify the ways to reduce or eliminate these types of risks. The article includes the following relevant sections: 1. Compliance risks in endoscopy, as a part of the modern healthcare risk-management system—general questions. 2. Risks of the work environment in endoscopy in the conditions of epidemiological threats associated with a new coronavirus infection SARS-CoV-2 (COVID-19). 3. Risks of the work environment tips and tricks associated with the psychosomatic status and professional burnout of medical personnel in endoscopy.
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Wicklund, Alissa, Shayla D. Foster, and Ashley A. Roy. "Getting Back on the Horse: Sport-Specific Return to Play in Rodeo Athletes After Concussion Injury." Journal of Athletic Training 53, no. 7 (July 1, 2018): 657–61. http://dx.doi.org/10.4085/1062-6050-310-17.
Full textAbstract:
Context: Despite a high incidence of injury in their sport, rodeo athletes have been underrepresented in the concussion literature. No standard postconcussion protocols are available across rodeo organizations for evaluating fitness to return to competition. Objective: To review the literature on concussion in rodeo, examine published guidelines, and offer an active return-to-play (RTP) protocol specific to rodeo athletes. Background: Unique barriers complicate the management and treatment of rodeo athletes with concussion, such as the solo nature of the sport, lack of consistent access to health care professionals, and athletic conditioning that often occurs outside of a traditional gym-based exercise regimen. In addition, the rodeo culture encourages a swift return to competition after injury. Description: Best practices for managing concussion are removal from activity, proper diagnostic evaluation, and gradual return to sport, with medical clearance when an athlete is symptom free and able to tolerate cognitive and physical exertion. An RTP protocol for rodeo events needs to capture the distinctive features and challenges of the sport and its athletes. Clinical Advantages: Rodeo athletes would benefit from an RTP protocol that can be initiated by an athletic trainer or medical professional in the acute stage of injury, integrates exercise into activities of daily living, and is appropriate for athletes who travel frequently. At the organizational sport level, a formal RTP protocol could enhance consistency in medical-clearance techniques among providers responsible for the return to sport of rodeo athletes. Conclusions: Rodeo athletes represent a sport population that has received little formal guidance on the diagnosis, management, and RTP after concussion. A sport-specific RTP protocol sensitive to the particular culture of these athletes is an important first step in protecting the health and safety of rodeo athletes after a concussive injury.
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Lederer, Agnes Maria, Per Morten Fredriksen, Benedicta Ngwenchi Nkeh-Chungag, Frans Everson, Hans Strijdom, Patrick De Boever, and Nandu Goswami. "Cardiovascular effects of air pollution: current evidence from animal and human studies." American Journal of Physiology-Heart and Circulatory Physiology 320, no. 4 (April 1, 2021): H1417—H1439. http://dx.doi.org/10.1152/ajpheart.00706.2020.
Full textAbstract:
Air pollution is a global health concern. Particulate matter (PM)2.5, a component of ambient air pollution, has been identified by the World Health Organization as one of the pollutants that poses the greatest threat to public health. Cardiovascular health effects have been extensively documented, and these effects are still being researched to provide an overview of recent literature regarding air pollution-associated cardiovascular morbidity and mortality in humans. Additionally, potential mechanisms through which air pollutants affect the cardiovascular system are discussed based on human and additional animal studies. We used the strategy of a narrative review to summarize the scientific literature of studies that were published in the past 7 yr. Searches were carried out on PubMed and Web of Science using predefined search queries. We obtained an initial set of 800 publications that were filtered to 78 publications that were relevant to include in this review. Analysis of the literature showed significant associations between air pollution, especially PM2.5, and the risk of elevated blood pressure (BP), acute coronary syndrome, myocardial infarction (MI), cardiac arrhythmia, and heart failure (HF). Prominent mechanisms that underlie the adverse effects of air pollution include oxidative stress, systemic inflammation, endothelial dysfunction, autonomic imbalance, and thrombogenicity. The current review underscores the relevance of air pollution as a global health concern that affects cardiovascular health. More rigorous standards are needed to reduce the cardiovascular disease burden imposed by air pollution. Continued research on the health impact of air pollution is needed to provide further insight.
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Kalra, J., H. Neufeld, and A. Mulla. "12. Disclosure of medical errors: A view through a global lens." Clinical & Investigative Medicine 30, no. 4 (August 1, 2007): 33. http://dx.doi.org/10.25011/cim.v30i4.2772.
Full textAbstract:
There are ongoing efforts worldwide to minimize the occurrence of medical errors. However, the issue of honest disclosure of a medical error to the patient or their family has been relatively unattended. We have previously reported the Canadian provincial initiatives encouraging open disclosure of a critical event and have suggested its integration into a ‘no-fault’ model. In the absence of uniform policies directing appropriate disclosure of a medical error, substantial scope exists for breaching the patient’s trust if errors during the process of care are not disclosed. We reviewed the various medical error disclosure initiatives across the globe to analyze the progress made in this key area. In 2001, the United States (US) Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandated an open disclosure of any critical event during care to the patient or their families. This was deemed as an essential accreditation standard for the institution. In Australia, the Australian Council for Safety and Quality in Health Care integrates the disclosure process with a risk management analysis towards investigating the critical event. In New Zealand, the patients suffering a medical error are rehabilitated and compensated through a no-fault, state-funded compensation scheme. The National Health Services (NHS) of the United Kingdom directs the doctors and managers to inform a patient of an act of negligence or omission that causes harm. The NHS scheme offers a remedial package to the patient including an apology and financial compensation in return for the patients waiving their right to litigate. The Canadian provincial initiatives, though similar in content, remain isolated because of their non-mandatory nature and absence of federal or provincial laws on disclosure. In Conclusion, we suggest that a uniform national policy centered on addressing errors in a non-punitive manner and respecting the patient’s right to an honest disclosure be implemented.
Kalra J, Massey KL, Mulla A. Disclosure of medical error: policies and practice. Journal of the Royal Society of Medicine 2005; 98(7): 307-09.
Hebert PC, Levin AV, Robertson G. Bioethics for clinicians: 23. Disclosure of medical error. CMAJ 2001; 164(4):509-13.
Mazor KM, Simon SR, Gurwitz JH. Communicating with patients about medical errors: a review of the literature. Arch Intern Med. 2004; 164(15):1690-7.
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Peter Sarantopoulos, G., Dorina Gui, Peter Shintaku, Longshen Hong, Ya-Ying Wang, Cecilia S. Yap, and Michael C. Fishbein. "Immunohistochemical Analysis of Lung Carcinomas With Pure or Partial Bronchioloalveolar Differentiation." Archives of Pathology & Laboratory Medicine 128, no. 4 (April 1, 2004): 406–14. http://dx.doi.org/10.5858/2004-128-406-iaolcw.
Full textAbstract:
Abstract Context.—In 1999, the World Health Organization redefined bronchioloalveolar carcinomas (BACs) as those neoplasms with only a pure lepidic growth pattern and no invasion. Objectives.—The present study examined 45 lung cancers with a BAC component (1) to determine whether these tumors would be classified as BACs by current World Health Organization standards, (2) to quantitate the BAC component within these tumors, and (3) to see if phenotypic differences exist between the so-called invasive and noninvasive regions of these tumors. Design.—Retrospective review of hematoxylin-eosin–stained slides and classification of histologic grade, tumor subtype, and percentage of pure BAC pattern, with further characterization by immunohistochemical staining for thyroid transcription factor 1, cytokeratin 7, cytokeratin 20, and Ki-67 antibodies. Results.—Only 7 (15.6%) of the 45 tumors examined could be classified as BAC by current strict World Health Organization criteria. Those tumors, classified as nonmucinous and mixed, showed similar immunohistochemical staining for cytokeratin 7, cytokeratin 20, and thyroid transcription factor 1; mucinous tumors showed disparate staining. Significant differences in immunohistochemical staining and tumor cell proliferation were seen for the regions of tumors designated as lepidic, infiltrative, and leading edge and for the regions of tumors with different histologic grades (ie, well, moderately, and poorly differentiated). Conclusions.—Nonmucinous and mixed BACs are phenotypically similar and show identical immunohistochemical staining patterns; mucinous tumors, on the other hand, show disparate immunohistochemical staining. Pulmonary neoplasms designated as adenocarcinomas with a BAC component represent a heterogenous group with a range of cell types, differentiation, growth, and immunophenotypes. Within an individual neoplasm, there are regional differences in these parameters as well.
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Nazarko, Yuliya, Oleksandr Iliashko, and Natalіa Kaminska. "IMPLEMENTATION OF THE RIGHT TO HEALTH CARE IN THE COUNTRIES OF THE EUROPEAN UNION." Wiadomości Lekarskie 72, no. 7 (2019): 1337–42. http://dx.doi.org/10.36740/wlek201907120.
Full textAbstract:
Introduction: The right to health is exercised through a complex system of state and social measures of legal, economic, social, scientific, cultural, educational, organizational, technical, sanitary and hygienic nature, aimed at preserving and improving the health of people , lengthening the life expectancy and working capacity, creating good living and working conditions, providing physical and mental development for children and young people, and preventing and managing illnesses and their treatment. The aim: Investigate the international legal and constitutional legal regulation of the right to health care in the countries of the European Union. Materials and methods: The article analyzes the Constitution of the European Union, a number of international legal acts and judgments of the European Court of Human Rights. Review: Each country defines the conditions for realizing the right to health care, according to which people should be healthy, the state itself assumes the obligations of the controller and the protection of this right. These provisions should primarily be enshrined in the Basic Laws - the constitutions. The main direction of state policy in reforming social relations is the achievement of European international legal standards in all spheres of public life. These standards fix the principles, guarantees of norms that determine the scope of human rights, in particular the right to health care. Conclusions: The main problem of ensuring and realizing the right to health in the European Union, as in many countries, is the financing of this industry, because in general, it is impossible to talk about free medical care in the European Union. There are also problems in the field of investment in health care. The urgent issues of primary health care and public health and the elderly dependence period.
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Manchikanti, Laxmaiah. "Opioid Epidemic in the United States." July 2012 3S;15, no. 3S;7 (July 14, 2012): ES9—ES38. http://dx.doi.org/10.36076/ppj.2012/15/es9.
Full textAbstract:
Over the past two decades, as the prevalence of chronic pain and health care costs have exploded, an opioid epidemic with adverse consequences has escalated. Efforts to increase opioid use and a campaign touting the alleged undertreatment of pain continue to be significant factors in the escalation. Many arguments in favor of opioids are based solely on traditions, expert opinion, practical experience and uncontrolled anecdotal observations. Over the past 20 years, the liberalization of laws governing the prescribing of opioids for the treatment of chronic non-cancer pain by the state medical boards has led to dramatic increases in opioid use. This has evolved into the present stage, with the introduction of new pain management standards by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) in 2000, an increased awareness of the right to pain relief, the support of various organizations supporting the use of opioids in large doses, and finally, aggressive marketing by the pharmaceutical industry. These positions are based on unsound science and blatant misinformation, and accompanied by the dangerous assumptions that opioids are highly effective and safe, and devoid of adverse events when prescribed by physicians. Results of the 2010 National Survey on Drug Use and Health (NSDUH) showed that an estimated 22.6 million, or 8.9% of Americans, aged 12 or older, were current or past month illicit drug users, The survey showed that just behind the 7 million people who had used marijuana, 5.1 million had used pain relievers. It has also been shown that only one in 6 or 17.3% of users of non-therapeutic opioids indicated that they received the drugs through a prescription from one doctor. The escalating use of therapeutic opioids shows hydrocodone topping all prescriptions with 136.7 million prescriptions in 2011, with all narcotic analgesics exceeding 238 million prescriptions. It has also been illustrated that opioid analgesics are now responsible for more deaths than the number of deaths from both suicide and motor vehicle crashes, or deaths from cocaine and heroin combined. A significant relationship exists between sales of opioid pain relievers and deaths. The majority of deaths (60%) occur in patients when they are given prescriptions based on prescribing guidelines by medical boards, with 20% of deaths in low dose opioid therapy of 100 mg of morphine equivalent dose or less per day and 40% in those receiving morphine of over 100 mg per day. In comparison, 40% of deaths occur in individuals abusing the drugs obtained through multiple prescriptions, doctor shopping, and drug diversion. The purpose of this comprehensive review is to describe various aspects of crisis of opioid use in the United States. The obstacles that must be surmounted are primarily inappropriate prescribing patterns, which are largely based on a lack of knowledge, perceived safety, and inaccurate belief of undertreatment of pain. Key words: Opioid abuse, opioid misuse, nonmedical use of psychotherapeutic drugs, nonmedical use of opioids, National Survey on Drug Use and Health, opioid guidelines.
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ISI-SENAI-CIMATEC Group. "Diagnostic of COVID-19: Chest Computer Tomography or RT-PCR?" JOURNAL OF BIOENGINEERING AND TECHNOLOGY APPLIED TO HEALTH 3, no. 2 (December 1, 2020): 177–83. http://dx.doi.org/10.34178/jbth.v3i2.124.
Full textAbstract:
In this review article, we presented a gold-standard method to detect the SARS-CoV-2, the novel virus that is causing the COVID-19 outbreak, and the use of a computer tomography (CT) method to detect the complications of the disease. We showed the controversial analysis about which method is the best to detect the disease earlier due to the COVID-19 complications. We searched the articles in the main database (PubMed/Medline, Elsevier Science Direct, Scopus, Isi Web of Science, Embase, Excerpta Medica, UptoDate, Lilacs, Novel Coronavirus Resource Directory from Elsevier), in the high-impact international scientific Journals (Scimago Journal and Country Rank - SJR - and Journal Citation Reports - JCR), such as The Lancet, Science, Nature, The New England Journal of Medicine, Physiological Reviews, Journal of the American Medical Association, Plos One, Journal of Clinical Investigation, and in the data from Center for Disease Control (CDC), National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID) and World Health Organization (WHO). We prior selected meta-analysis, systematic reviews, article reviews, and original articles in this order. We reviewed 96 articles and used 45 from March to June 2020, using the terms coronavirus, SARS-CoV-2, novel coronavirus, Wuhan coronavirus, severe acute respiratory syndrome, 2019-nCoV, 2019 novel coronavirus, n-CoV-2, covid, n-SARS-2, COVID-19, corona virus, coronaviruses, RT-PCR, computer tomography (CT), diagnostic methods, with the tools MeSH (Medical Subject Headings), AND, OR, and the characters [,“,; /., to ensure the best review topics. We concluded that chest CT plays an important role in the timely detection of lung infection abnormalities in the early phase of COVID-19 infection. However, the RT-PCR is the gold standard method to detect SARS-CoV-2.
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Wolff, Antonio C., M. Elizabeth H. Hammond, Jared N. Schwartz, Karen L. Hagerty, D. Craig Allred, Richard J. Cote, Mitchell Dowsett, et al. "American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer." Archives of Pathology & Laboratory Medicine 131, no. 1 (January 1, 2007): 18–43. http://dx.doi.org/10.5858/2007-131-18-asocco.
Full textAbstract:
Abstract Purpose.—To develop a guideline to improve the accuracy of human epidermal growth factor receptor 2 (HER2) testing in invasive breast cancer and its utility as a predictive marker. Methods.—The American Society of Clinical Oncology and the College of American Pathologists (CAP) convened an expert panel, which conducted a systematic review of the literature and developed recommendations for optimal HER2 testing performance. The guideline was reviewed by selected experts and approved by the board of directors for both organizations. Results.—Approximately 20% of current HER2 testing may be inaccurate. When carefully validated testing is performed, available data do not clearly demonstrate the superiority of either immunohistochemistry (IHC) or in situ hybridization (ISH) as a predictor of benefit from anti-HER2 therapy. Recommendations.—The panel recommends that HER2 status should be determined for all invasive breast cancer. A testing algorithm that relies on accurate, reproducible assay performance, including newly available types of brightfield ISH, is proposed. Elements to reliably reduce assay variation (for example, specimen handling, assay exclusion, and reporting criteria) are specified. An algorithm defining positive, equivocal, and negative values for both HER2 protein expression and gene amplification is recommended: a positive HER2 result is IHC staining of 3+ (uniform, intense membrane staining of > 30% of invasive tumor cells), a fluorescent in situ hybridization (FISH) result of more than 6 HER2 gene copies per nucleus, or a FISH ratio (HER2 gene signals to chromosome 17 signals) of more than 2.2; a negative result is an IHC staining of 0 or 1+, a FISH result of less than 4.0 HER2 gene copies per nucleus, or a FISH ratio of less than 1.8. Equivocal results require additional action for final determination. It is recommended that to perform HER2 testing, laboratories show 95% concordance with another validated test for positive and negative assay values. The panel strongly recommends validation of laboratory assay or modifications, use of standardized operating procedures, and compliance with new testing criteria to be monitored with the use of stringent laboratory accreditation standards, proficiency testing, and competency assessment. The panel recommends that HER2 testing be done in a CAP-accredited laboratory or in a laboratory that meets the accreditation and proficiency testing requirements set out by this document.
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Salvagno, Gian Luca, Elisa Danese, and Giuseppe Lippi. "Mass spectrometry and total laboratory automation: opportunities and drawbacks." Clinical Chemistry and Laboratory Medicine (CCLM) 58, no. 6 (June 25, 2020): 994–1001. http://dx.doi.org/10.1515/cclm-2019-0723.
Full textAbstract:
AbstractThe diffusion of laboratory automation, initiated nearly 50 years ago with consolidation of preanalytical, clinical chemistry and immunochemistry workstations, is now also gradually embracing mass spectrometry (MS). As for other diagnostic disciplines, the automation of MS carries many advantages, such as efficient personnel management (i.e. improving working atmosphere by decreasing manual activities, lowering health risks, simplifying staff training), better organization (i.e. reducing workloads, improving inventory handling, increasing analytical process standardization) and the possibility to reduce the number of platforms. The development and integration of different technologies into automated MS analyzers will also generate technical and practical advantages, such as prepackaged and ready-to-use reagents, automated dispensing, incubation and measurement, automated sample processing (e.g. system fit for many models of laboratory automation, bar code readers), multiplex testing, automatic data processing, also including quality control assessment, and automated validation/interpretation (e.g. autoverification). A new generation of preanalytical workstations, which can be directly connected to MS systems, will allow the automation of manual extraction and elimination of time-consuming activities, such as tube labeling and capping/decapping. The use of automated liquid-handling platform for pipetting samples, along with addition of internal standards, may then enable the optimization of some steps of extraction and protein precipitation, thus decreasing turnaround time and increasing throughput in MS testing. Therefore, this focused review is aimed at providing a brief update on the importance of consolidation and integration of MS platforms in laboratory automation.
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Peddecord, K. M. "A critical review of personnel standards." Clinical Chemistry 42, no. 5 (May 1, 1996): 790–96. http://dx.doi.org/10.1093/clinchem/42.5.790.
Full textAbstract:
Abstract Qualified personnel are necessary to ensure quality results, but there is no evidence on what minimal educational requirements are necessary. In the future, cost-effectiveness analysis may be useful for policy questions such as the utility of personnel regulations. CLIA '88 regulations require explicit assessment of personnel competency. Survey evidence suggests that previously regulated laboratories tend to have highly formalized competency assessment programs, while physician office laboratory programs are minimal. Responding laboratory supervisors had no uniform definition of competency, but technical abilities, productivity, and professionalism were regarded as essential. Suggestions for contemporary strategies by laboratory professionals and their organizations in the current increasingly competitive managed care environment are described. Faced with limited empirical evidence on personnel, laboratory directors and supervisors should focus on the total testing process, the needs of clinicians, and the uses of testing information to guide personnel assignments.
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Bukhtiyarov, Igor V., Nikolay V. Shestopalov, Denis V. Vinnikov, Dmitry V. Glukhov, Elena S. Pochtareva, and Svetlana L. Dgergeniya. "State and prospects of hygienic regulation of the production environment with a reduced oxygen content (literature review)." Hygiene and sanitation 100, no. 6 (June 28, 2021): 594–97. http://dx.doi.org/10.47470/0016-9900-2021-100-6-594-597.
Full textAbstract:
The work is devoted to the physiological and hygienic foundations of the safety of activities in the conditions of the changed gas environment and characteristics of the main medical measures for the employees’ protection in a hypoxic environment, the analysis of domestic and foreign data, the study of working conditions in the environment with the reduced oxygen concentration in the air. Investigations were carried out on premises with various technological processes, a changing environment, and a reduced oxygen concentration when employees perform multiple operations. The health status of workers was assessed depending on the time spent in the changed gas environment and the percentage of oxygen. Having analyzed the regulatory documents currently existing in the Russian Federation on the assessment and control of production factors, working conditions in confined spaces with a low oxygen concentration in the air, air environment to maintain health, high performance, and prevent diseases, experts concluded that it is necessary to develop Sanitary Rules and Norms, SanPiN “Sanitary and Epidemiological Requirements for Habitability (Stay) in Confined Spaces with a Low Oxygen Concentration in the Air” because currently there is no document existing specifically on this issue. The literature was searched in the databases Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health, CyberLeninka, RSCI. There were prepared draft sanitary plans and standards “Sanitary and epidemiological requirements for the environment with a reduced concentration of oxygen in the air,” which establish sanitary and epidemiological requirements for the environment with a reduced concentration of oxygen in the air, as well as for the organization of control, methods measurements of air components at workplaces and measures to prevent harmful effects on the health of workers. They apply to work conditions in the living environment for all premises with a reduced oxygen concentration in the air.
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Dedov, Ivan I., Marina V. Shestakova, Aleksandr Y. Mayorov, Olga K. Vikulova, Gagik R. Galstyan, Tamara L. Kuraeva, Valentina A. Peterkova, et al. "Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 9th edition." Diabetes mellitus 22, no. 1S1 (December 3, 2019): 1–121. http://dx.doi.org/10.14341/dm12211.
Full textAbstract:
Dear Colleagues!
We are glad to present the 9th Edition (revised) of Standards of Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation.
The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), American Diabetes Association (ADA, 2018, 2019), American Association of Clinical Endocrinologists (AACE, 2019), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2014, 2018) and Russian Association of Endocrinologists (RAE, 2011, 2012, 2015). Current edition of the Standards also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EXAMINE, ELIXA, SUSTAIN, DEVOTE, EMPA-REG OUTCOME, CANVAS, DECLARE, CARMELINA, REWIND, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals.
Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 463 million patients by the end of 2019. According to the current estimation by the International Diabetes Federation, 578 million patients will be suffering from diabetes mellitus by by 2030 and 700 million by 2045.
Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4 584 575 patients with DM in this country by the end of 2018 (3,1% of population) with 92% (4 238 503) Type 2 DM, 6% (256 202) Type 1 DM and 2% (89 870) other types of DM, including 8 006 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) con- firmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 9 million patients (about 6% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they dont receive any treatment ant have high risk of vascular complications.
Severe consequences of the global pandemics of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral, coronary and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death.
In сurrent edition of the Standards:
New goals of glycemic control for the elderly, based on the presence of functional dependence, as well as for pregnant women, children and adolescents, are given.
Added a snippet that describes the continuous glucose monitoring.
Only low-density lipoprotein cholesterol level is used as a target for lipid metabolism.
Proposes more stringent target levels of blood pressure.
It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes: the excess of the initial level of HbA1c over the target level was used as a criterion.
In the recommendations for the personalization of the choice of antidiabetic agents, it is taken into account that in certain clinical situations (the presence of atherosclerotic cardiovascular diseases and their risk factors, chronic heart failure, chronic kidney disease, obesity, the risk of hypoglycemia) certain classes of hypoglycemic agents (or individual drugs) have proven advantages.
Recommendations for psychosocial support are added.
The position of metabolic surgery as a method of treatment of DM with morbid obesity is updated.
Recommendations for diagnostic and treatment of hypogonadism syndrome in men with DM are added.
For the first time, evidence levels of confidence and credibility levels of recommendations for diagnostic, therapeutic, rehabilitative and preventive interventions based on a systematic review of the literature are given in accordance with the recommendations of the Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation.
This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discus- sions held at national meetings and forums.
These guidelines are intended for endocrinologists, primary care physicians and other medical professionals involved in the treatment of DM.
On behalf of the Working Group
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Dedov, Ivan I., Marina V. Shestakova, Aleksandr Y. Mayorov, Olga K. Vikulova, Gagik R. Galstyan, Tamara L. Kuraeva, Valentina A. Peterkova, et al. "Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 9th edition." Diabetes mellitus 22, no. 1S1 (December 3, 2019): 1–121. http://dx.doi.org/10.14341/dm221s1.
Full textAbstract:
Dear Colleagues!
We are glad to present the 9th Edition (revised) of Standards of Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation.
The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), American Diabetes Association (ADA, 2018, 2019), American Association of Clinical Endocrinologists (AACE, 2019), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2014, 2018) and Russian Association of Endocrinologists (RAE, 2011, 2012, 2015). Current edition of the Standards also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EXAMINE, ELIXA, SUSTAIN, DEVOTE, EMPA-REG OUTCOME, CANVAS, DECLARE, CARMELINA, REWIND, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals.
Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 463 million patients by the end of 2019. According to the current estimation by the International Diabetes Federation, 578 million patients will be suffering from diabetes mellitus by by 2030 and 700 million by 2045.
Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4 584 575 patients with DM in this country by the end of 2018 (3,1% of population) with 92% (4 238 503) Type 2 DM, 6% (256 202) Type 1 DM and 2% (89 870) other types of DM, including 8 006 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) con- firmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 9 million patients (about 6% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they dont receive any treatment ant have high risk of vascular complications.
Severe consequences of the global pandemics of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral, coronary and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death.
In сurrent edition of the Standards:
New goals of glycemic control for the elderly, based on the presence of functional dependence, as well as for pregnant women, children and adolescents, are given.
Added a snippet that describes the continuous glucose monitoring.
Only low-density lipoprotein cholesterol level is used as a target for lipid metabolism.
Proposes more stringent target levels of blood pressure.
It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes: the excess of the initial level of HbA1c over the target level was used as a criterion.
In the recommendations for the personalization of the choice of antidiabetic agents, it is taken into account that in certain clinical situations (the presence of atherosclerotic cardiovascular diseases and their risk factors, chronic heart failure, chronic kidney disease, obesity, the risk of hypoglycemia) certain classes of hypoglycemic agents (or individual drugs) have proven advantages.
Recommendations for psychosocial support are added.
The position of metabolic surgery as a method of treatment of DM with morbid obesity is updated.
Recommendations for diagnostic and treatment of hypogonadism syndrome in men with DM are added.
For the first time, evidence levels of confidence and credibility levels of recommendations for diagnostic, therapeutic, rehabilitative and preventive interventions based on a systematic review of the literature are given in accordance with the recommendations of the Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation.
This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discus- sions held at national meetings and forums.
These guidelines are intended for endocrinologists, primary care physicians and other medical professionals involved in the treatment of DM.
On behalf of the Working Group
50
Manchikanti, Laxmaiah. "Review of Occupational Medicine Practice Guidelines for Interventional Pain Management and Potential Implications." Pain Physician 3;11, no. 5;3 (May 14, 2008): 271–89. http://dx.doi.org/10.36076/ppj.2008/11/271.
Full textAbstract:
In the modern day environment, workers’ compensation costs continue to be a challenge, with a need to balance costs, benefits, and quality of medical care. The cost of workers’ compensation care affects all stakeholders including workers, employers, providers, regulators, legislators, and insurers. Consequently, a continued commitment to quality, accessibility to care, and cost containment will help ensure that workers are afforded accessible, high quality, and cost-effective care. In 2004, workers’ compensation programs in all 50 states, the District of Columbia, and federal programs in the United States combined received an income of $87.4 billion while paying out only $56 billion in medical and cash benefits with $31.4 billion or 37% in administrative expenses and profit. Occupational diseases represented only 8% of the workers’ compensation claims and 29% of the cost. The American College of Occupational and Environmental Medicine (ACOEM) has published several guidelines; though widely adopted by WCPs, these guidelines evaluate the practice of medicine of multiple specialties without adequate expertise and expert input from the concerned specialties, including interventional pain management. An assessment of the ACOEM guidelines utilizing Appraisal of Guidelines for Research and Evaluation (AGREE) criteria, the criteria developed by the American Medical Association (AMA), the Institute of Medicine (IOM), and other significantly accepted criteria, consistently showed very low scores (< 30%) in most aspects of the these guidelines. The ACOEM recommendations do not appear to have been based on a careful review of the literature, overall quality of evidence, standard of care, or expert consensus. Based on the evaluation utilizing appropriate and current evidence-based medicine (EBM) principles, the evidence ratings for diagnostic techniques of lumbar discography; cervical, thoracic, and lumbar facet joint nerve blocks and sacroiliac joint nerve blocks; therapeutic cervical and lumbar medial branch blocks and radiofrequency neurolysis; cervical interlaminar epidural steroid injections, caudal epidural steroid injections, and lumbar transforaminal epidural injections; caudal percutaneous adhesiolysis; abd spinal cord stimulation were found to be moderate with strong recommendation applying for most patients in most circumstances. The evidence ratings for intradiscal electrothermal therapy (IDET), an automated percutaneous disc decompression and also deserve further scrutiny and analysis. In conclusion, these ACOEM guidelines for interventional pain management have no applicability in modern patient care due to lack of expertise by the developing organization (ACOEM), lack of utilization of appropriate and current EBM principles, and lack of significant involvement of experts in these techniques resulting in a lack of clinical relevance. Thus, they may result in reduced medical quality of care; may severely hinder access to appropriate, medically needed and essential medical care; and finally, they may increase costs for injured workers, third party payors, and the government by transferring the injured worker into a non-productive disability system. Key words: Guidelines, ACOEM, ASIPP, interventional pain management, interventional techniques, evidence-based medicine, systematic reviews, guideline development, AHCPR, AHRQ, IOM, AMA, AGREE, workers’ compensation, chronic pain guidelines, low back pain guidelines