International journal of clinical practice
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Int. J. Clin. Pract. · Mar 2009
ReviewDying in an acute hospital setting: the challenges and solutions.
More than half of all UK deaths occur in hospital, yet evidence suggests that the quality of inpatient end of life care is suboptimal at best. Over half of all NHS complaints pertain to problems with care in the dying phase, particularly with regard to poor communication. This is a hugely topical area following the recent publication of the Department of Health's End of Life Care Strategy. With reference to current literature, we seek to investigate the challenges associated with providing 'a good death' in hospital and construct a framework of strategies for improvement; including communication skills training, use of integrated care pathways, advance planning, educational initiatives and the role of the palliative care team.
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Int. J. Clin. Pract. · Mar 2009
Review Comparative StudyCost-effectiveness analysis of linezolid vs. vancomycin in treating methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections using a decision analytic model.
To evaluate the cost-effectiveness of vancomycin vs. linezolid in complicated skin and soft tissue infections (cSSTIs) with methicillin-resistant Staphylococcus aureus (MRSA) using a decision analytic (DA) model. ⋯ Alternative vancomycin strategies (VAN-2 and VAN-3) that take advantage of early discharge opportunities were cost-effective compared with LIN. However, LIN's higher efficacy would make it cost-effective for payers with a high WTP threshold.
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The worldwide prevalence of chronic obstructive pulmonary disease (COPD) is growing faster in women than in men. Over the past two decades, COPD-related mortality rates have also grown faster in women, and since the year 2000 more women than men have died from COPD. The greater prevalence of COPD and related mortality reported for men in earlier epidemiological studies may be due to under-diagnosis of women. ⋯ Despite these differences, the current guidelines for the diagnosis and treatment of men or women with COPD are the same. It is important for healthcare professionals to recognise the gender differences in patients with COPD to optimise assessment, monitoring and treatment of this disease. This article reviews the clinical differences between men and women with COPD, current treatment guidelines and its implications for improvement in the management of women with COPD.
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Int. J. Clin. Pract. · Mar 2009
Self blood glucose monitoring in type 2 diabetes. A financial impact analysis based on UK primary care.
UK consensus guidelines recommend limited use of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes using diet and exercise, metformin and/or a glitazone. This analysis quantifies the usage of and costs associated with SMBG in type 2 diabetes according to treatment regimen. ⋯ Based on the assumptions that the treatment regimen is the sole factor in determining the appropriate level of SMBG frequency, this study demonstrates that the use of SMBG exceeds current guidelines in certain treatment groups. The study estimates that the potential savings of up to 17 million pound sterling could be made each year if guidelines were followed more closely. There is a need for further research into SMBG use in patients with type 2 diabetes.
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Int. J. Clin. Pract. · Mar 2009
An emergency physician activated protocol, 'Code STEMI' reduces door-to-balloon time and length of stay of patients presenting with ST-segment elevation myocardial infarction.
National consensus guidelines recommend that ST-segment elevation myocardial infarction (STEMI) patients achieve a door-to-balloon time of < 90 min. We sought to determine if emergency physician initiated simultaneous activation of the cardiac catheterisation laboratory team and the on-call interventional cardiologist has any impact on reducing door-to-balloon-times at our hospital. ⋯ Emergency physician activation of the Code STEMI significantly reduces door-to-balloon time to within national standards of care, and length of stay in STEMI patients.