Journal of evaluation in clinical practice
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Observational Study
Intensive care unit readmission prevention checklist: is it worth the effort?
Checklists have been adopted by various institutions to improve patient outcomes. In particular, readmission prevention checklists may be of potential value to improve patient care and reduce medical costs. As a result, a prior quality improvement study was conducted to create an intensive care unit readmission prevention checklist. The previous pilot demonstrated zero readmissions when the readmission prevention checklist was utilized but yielded low compliance (30%). Thus, a subsequent quality initiative was undertaken to refine the readmission prevention checklist with the primary aim of improved compliance while maintaining a reduced readmission rate that was observed with the original quality improvement study. ⋯ In conclusion, the findings of the current quality improvement study may serve to rethink the process of health care delivery that applies paper tools in an electronic medical environment.
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Comparative Study
The timing of introduction of pharmaceutical innovations in seven European countries.
Differences in the performance of medical care may be due to variation in the introduction and diffusion of medical innovations. The objective of this paper is to compare seven European countries (United Kingdom, the Netherlands, West Germany, France, Spain, Estonia and Sweden) with regard to the year of introduction of six specific pharmaceutical innovations (antiretroviral drugs, cimetidine, tamoxifen, cisplatin, oxalaplatin and cyclosporin) that may have had important population health impacts. ⋯ The total length of the period between first and last introduction varied between 8 years for antiretroviral drugs and 22 years for cisplatin. Introduction in Estonia was generally delayed until the 1990s. The average time lags were smallest in France (2.2 years), United Kingdom (2.8 years) and the Netherlands (3.5 years). Similar rank orders were seen for year of registration suggesting that introduction lags are not only explained by differences in the process of registration. We discuss possible reasons for these between-country differences and implications for the evaluation of medical care.
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This study aimed to apply the 'systems approach' to patient safety in order to identify causes for delays and errors in lung cancer diagnoses following an abnormal chest radiograph. ⋯ Both reporting radiologists and referring clinicians have a responsibility to ensure appropriate action following an abnormal chest radiograph. The main error lies in communication between the referring clinicians and the radiologists. Direct electronic communication is potentially a more robust method to overcome this.
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Walking speed is an important performance variable, but information on the minimal clinically important difference (MCID) for the measure has not been consolidated. In this review, we aimed to summarize information on the MCID for change in comfortable gait speed measurements for patients with pathology. ⋯ Changes in gait speed of 0.10 to 0.20 m s(-1) may be important across multiple patient groups.
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Pressure ulcers (PUs) are a common and serious complication in critically ill patients. The aim of this study was to evaluate the relationship between the development of a PU and hospital mortality in patients requiring mechanical ventilation (MV) in an intensive care unit (ICU). ⋯ Within the limitations of a single-centre approach, PU development appears to be associated with an increase in mortality among patients requiring MV for 24 hours or longer.