Articles: ninos.
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Quality of care can be measured in several dimensions: different clinical disciplines, structures/processes/outcomes of care (SPO), and also different domains of quality (effectiveness, safety, care coordination, patient-centeredness, efficiency, timeliness, and community/population health). To our knowledge, no previous study has compared different sets of performance measures in terms of how well they cover these different aspects of quality. ⋯ The measure sets we examined, which overwhelmingly measure processes of care, should be encouraged to add structure and outcomes measures. All three measure sets under-emphasize certain aspects of quality such as timeliness, care coordination, efficiency, and patient-centeredness. Finally, and most importantly, all three measure sets focused overwhelmingly on measuring the activities of family physicians; attention should be given to building measures that will examine the activities of other clinicians.
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Pol. Arch. Med. Wewn. · Jan 2025
Choice of resuscitation fluids in critically ill adults: key messages from the European Society of Intensive Care Medicine 2024 clinical practice guideline.
The 2024 European Society of Intensive Care Medicine clinical practice guideline provide clinicians with evidence-based recommendations on intravenous fluid in critically ill adults across a range of common conditions. These guidelines aim to improve the practices of fluid therapy by adopting a global perspective that considers both clinical efficacy and resource utilization in diverse healthcare settings. The guidelines address three key questions: (1) albumin versus crystalloids, (2) balanced crystalloids versus isotonic saline, and (3) small-volume hypertonic solutions versus isotonic crystalloids. ⋯ Small-volume hypertonic solutions were not shown to provide significant advantages over isotonic crystalloids, leading to a preference for the latter based on very low certainty evidence. This review provides an overview of the guideline development process and a detailed summary of their recommendations, highlighting key considerations for clinical practice. The guidelines also identify critical evidence gaps in fluid therapy research, underscoring the need for future studies to refine and optimize fluid management strategies in critically ill patients.
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Inflammatory myofibroblastic tumors (IMTs), rare soft tissue neoplasms, are characterized by a blend of myofibroblastic proliferation and inflammatory features. While generally characterized by slow growth, IMTs can exhibit locally aggressive behavior, and in rare instances, metastasize to distant sites. This study elucidated the clinical characteristics, molecular profile, and tumor microenvironment of thoracic IMTs. ⋯ Patients with thoracic IMT patients are typically young with early-stage disease. ALK fusion were the most common genetic alteration, particularly in spindle-cell patterns. Characterization of the tumor microenvironment indicates the potential of immune profiling in the tumor biology and targeted immunotherapy approaches.