Articles: professional-practice.
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Multicenter Study Clinical Trial
Influence of replacing tuberculin skin test with ex vivo interferon γ release assays on decision to administer prophylactic antituberculosis antibiotics before anti-TNF therapy.
The recommendations for detecting latent tuberculosis infection (LTBI) before antitumour necrosis factor (anti-TNF) therapy are based on the tuberculin skin test (TST), which lacks both specificity and sensitivity and can lead to unnecessary treatment with antibiotics. A study was undertaken to investigate the effect of replacing TST with interferon γ (IFNγ) release assays (IGRA) in screening for LTBI and deciding to begin prophylactic antituberculosis (TB) antibiotics before anti-TNF therapy in immune-mediated inflammatory diseases. ⋯ Replacing TST with IGRA for determining LTBI allowed the proportion of patients with immune-mediated inflammatory diseases needing prophylactic anti-TB antibiotics before beginning anti-TNF agents to be reduced by half.
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Multicenter Study
Preventing hospital-acquired infections: a national survey of practices reported by U.S. hospitals in 2005 and 2009.
Hospital-acquired infection (HAI) is common, costly, and potentially lethal. Whether initiatives to reduce HAI--such as the Centers for Medicare and Medicaid Services (CMS) no payment rule--have increased the use of preventive practices is not known. ⋯ Since 2005, use of key practices to prevent CLABSI, VAP and CAUTI has increased in non-federal and VA hospitals, suggesting that despite its perceived importance, the non-payment rule may not be the primary driver. Moreover, while 65% of non-federal hospitals reported a moderate or large increase in preventing CAUTI as a facility priority, prevention practice use remains low.
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Multicenter Study
Tracheal intubation in the critically ill: a multi-centre national study of practice and complications.
Complications associated with tracheal intubation may occur in up to 40% of critically ill patients. Since practice in emergency airway management varies between intensive care units (ICUs) and countries, complication rates may also differ. We undertook a prospective, observational study of tracheal intubation performed by critical care doctors in Scotland to identify practice, complications, and training. ⋯ Tracheal intubation by critical care doctors in Scotland has a higher first-time success rate than described in previous reports of critical care intubation, and technical complications are few. Doctors carrying out intubation had undergone longer formal training in anaesthesia than described previously, and junior trainees are routinely supervised. Despite these good results, further work is necessary to reduce physiological complications and patient morbidity.
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Integration of palliative care with standard oncologic care improves quality of life and survival of lung cancer patients. We surveyed physicians to identify factors influencing their decisions for referral to palliative care. ⋯ Although palliative care consultation is increasingly available and recommended throughout the trajectory of lung cancer, our data indicate it is underutilized. Understanding factors influencing decisions to refer can be used to improve integration of palliative care as part of lung cancer management.
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Eur J Gastroenterol Hepatol · Feb 2012
Multicenter StudyDo guidelines influence medical practice? Changes in management of acute pancreatitis 7 years after the publication of the French guidelines.
The elaboration and publication of guidelines should help homogenizing the management of frequent diseases with high mortality and morbidity rates, such as acute pancreatitis. ⋯ Major changes were noticed since the publication of the French guidelines. Although establishing guidelines is an expensive process, it does increase compliance with best evidence-based practice.