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Imfeld K Keith M Stoyanoff L Fletcher H Miles S McLaughlin J 《Journal of the Academy of Nutrition and Dietetics》2012,112(10):1656-1661
In January 2009, registered dietitians (RDs) at St Michael's Hospital (Toronto, Ontario, Canada) were granted approval for nonmedication order entry of physician-approved nutrition-related orders for the patients to whom RDs provided care. The aim of this project was to document any changes in the numbers and types of diet order errors and time delays that were associated with this policy change. A retrospective chart audit was conducted to document the error rate in 672 nutrition-related orders placed before, and in 633 orders placed after, implementation of RD diet order entry on high-risk inpatient units. Error rates for all nutrition-related orders decreased by 15% after RD order entry access (P<0.01). Error rates for diet orders entered by RDs were significantly lower in comparison with those entered by clerical assistants or registered nurses (P<0.001). Time delays for orders electronically entered were reduced by 39% (from 9.1 to 5.7 hours; P<0.01). Allowing RDs access to the electronic order entry system has improved overall timeliness of nonmedication order entries and improved patient safety by decreasing error rates in diet orders. This study supports this institutional policy change and provides evidence that RDs have the knowledge and skills to accurately process nonmedication order entries for the patients they have assessed. Finally, the current findings support the need for ongoing education and training of all health professionals in nonmedication order entry to reduce errors and improve safety. 相似文献
54.
Francis KL CHAN 《Journal of digestive diseases》2005,6(1):1-5
Whether Helicobacter pylori infection alters the risk of ulcer disease in patients receiving nonsteroidal anti‐inflammatory drugs (NSAIDs) or low‐dose aspirin is one of the most controversial topics in peptic ulcer research. This is an important management issue, particularly in countries where peptic ulcer disease is common and the prevalence of H. pylori infection is high. Current evidence shows that H. pylori infection increases the ulcer risk associated with NSAIDs or low‐dose aspirin. Eradication of H. pylori reduces the subsequent risk of endoscopic and complicated ulcers in patients who are about to start long‐term NSAIDs. Among patients with H. pylori infection and a history of ulcer bleeding who continue to use low‐dose aspirin, 1 week of eradication therapy prevents recurrent ulcer bleeding. Failure of eradication and concomitant use of NSAIDs, however, account for most cases of recurrent bleeding with low‐dose aspirin. The apparent protective effect of H. pylori in long‐term NSAIDs users reported in some studies was actually the weeding out of susceptible patients who were intolerant to NSAIDs. There is no convincing evidence that eradication of H. pylori has any clinically important adverse effect on the healing and prevention of ulcers in NSAIDs users. 相似文献
55.
世界胃肠病学组织(WGO-OMGE)临床指南——发展中国家幽门螺杆菌感染 总被引:16,自引:1,他引:16
Hunt RH Xiao SD Megraud F Leon-Barua R Bazzoli F Van der Merwe S vaz Coelho LG Fock KM Fedail S Cohen H Malfertheiner P Vakil N Hamid S Goh KL Wong BC Krabshuis JH 杜颖 丛衍群 戴宁 《胃肠病学》2007,12(1):40-52
我非常高兴向大家推荐这份发展中国家幽门螺杆菌(H.priori)临床指南。该指南的编译是由数位在该领域具有丰富临床经验的世界知名专家共同完成的。 相似文献
56.
Background
Pneumocystis jiroveci pneumonia (PCP) is an important opportunistic infection among immunosuppressed patients, especially in those infected with human immunodeficiency virus (HIV). The clinical presentation of PCP in immunosuppressed patients have been well-reported in the literature. However, the clinical importance of PCP manifesting in the setting of an immunorestitution disease (IRD), defined as an acute symptomatic or paradoxical deterioration of a (presumably) preexisting infection, which is temporally related to the recovery of the immune system and is due to immunopathological damage associated with the reversal of immunosuppressive processes, has received relatively little attention until recently. 相似文献57.
Priming of human neutrophils with N-formyl-methionyl-leucyl- phenylalanine by a calcium-independent, pertussis toxin-insensitive pathway 总被引:1,自引:0,他引:1
Resting neutrophils may be "primed" to augmented effector function, eg, superoxide (O2-) production in the respiratory burst, upon a second stimulation with a variety of soluble agonists including formylated methionyl-leucyl-phenylalanine (FMLP) and phorbol myristate acetate (PMA). At priming concentrations of FMLP (5 x 10(-9) mol/L) that did not initiate O2- generation, two metabolic activities were noted: (1) approximately a threefold increase in the baseline intracellular calcium (Ca++i) level, that was not dependent on extracellular Ca++, and (2) a rapid rise in intracellular pH that was blocked by 5-(N,N- dimethyl) amiloride (DA), that had no effect on the Ca++i response to priming. Furthermore, there were no significant increases in inositol metabolites in cells primed and stimulated with FMLP compared with cells receiving the stimulating dose of FMLP alone and pretreatment with pertussis toxin (PT) (before the addition of the priming -5 x 10(- 9) mol/L dose of FMLP), whereas abolishing the response to FMLP during the second stage of stimulation, had (1) no effect on FMLP-primed cells subsequently stimulated with PMA, and (2) only partially ablated the rise in Ca++i initiated with FMLP. That FMLP priming involved distinctive processes to those of the well characterized FMLP-coupled Ca++-dependent activation cascade was shown by the full priming effect attained in a Ca++-free buffer, which did not sustain an O2- response to a second-stage FMLP stimulation, but sustained a primed response to PMA. These data demonstrate that FMLP primes human neutrophils by a Ca++-independent and PT-insensitive pathway, offering a functional model for studying heterogeneous FMLP receptor-coupled reactions. 相似文献
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59.
NICHOLAS J TALLEY SK LAM KL GOH KM FOCK 《Journal of gastroenterology and hepatology》1998,13(4):335-353
Dyspepsia is most optimally defined as pain or discomfort centred in the upper abdomen. The symptom complex may be caused by peptic ulcer disease, gastro-oesophageal reflux, or gastric cancer but is most often due to functional (or non-ulcer) dyspepsia. While upper endoscopy is the method of choice to determine the underlying cause of dyspepsia, it is expensive. A more pragmatic approach is needed in the Asia-Pacific region where health services are limited. A detailed treatment algorithm is given for managing patients presenting with new-onset dyspepsia and documented functional dyspepsia after endoscopy, and evidence to support this approach is reviewed. Prompt endoscopy is recommended for patients with alarm features. In patients without alarm features, treatment for 2–4 weeks with an empirical anti-secretory or prokinetic agent, followed by investigation using non-invasive Helicobacter pylori testing and treatment for patients who do not respond or relapse, is recommended. Trials of management strategies are now needed to establish the efficacy and cost-effectiveness of the approaches recommended. 相似文献
60.
ZJ Daruwalla KL Davies A Shafighian NR Gillham 《Annals of the Royal College of Surgeons of England》2012,94(7):496-501