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1.
Impact of a Nursing Skill‐Improvement Intervention on Newborn‐Specific Delivery Practices: An Experience from Bihar,India
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Beverly EA Ritholz MD Brooks KM Hultgren BA Lee Y Abrahamson MJ Weinger K 《Journal of general internal medicine》2012,27(9):1180-1187
BACKGROUND
Despite new treatment therapies and the emphasis on patient activation, nearly 50?% of diabetes patients have hemoglobin A1c levels above target. Understanding the impact of unmet treatment goals on the physician-patient relationship is important for maintaining quality care in clinical practice.OBJECTIVE
To explore physicians?? and type 2 diabetes patients?? views of patients?? difficulty achieving diabetes treatment goals.DESIGN
Qualitative study using in-depth interviews with a semi-structured interview guide.PARTICIPANTS
Nineteen endocrinologists and primary care physicians and 34 patients diagnosed with type 2 diabetes at least two years prior.MAIN MEASURES
In-depth interviews with physicians and patients. A multidisciplinary research team performed content and thematic analyses.KEY RESULTS
Qualitative analysis revealed two main findings, organized by physician and patient perspectives. Physician Perspective: Physicians?? Perceived Responsibility for Patients?? Difficulty Achieving Treatment Goals: Physicians assumed responsibility for their patients not achieving goals and expressed concern that they may not be doing enough to help their patients achieve treatment goals. Physicians?? Perceptions of Patients?? Reactions: Most speculated that their patients may feel guilt, frustration, or disappointment when not reaching goals. Physicians also felt that many patients did not fully understand the consequences of diabetes. Patient Perspective: Patients?? Self-Blame for Difficulty Achieving Treatment Goals: Patients attributed unmet treatment goals to their inability to carry out self-care recommendations. Most patients blamed themselves for their lack of progress and directed their frustration and disappointment inwardly through self-deprecating comments. Patients?? Perceptions of Physicians?? Reactions: Several patients did not know how their physician felt, while others speculated that their physicians might feel disappointed or frustrated.CONCLUSIONS
Physicians?? perceived responsibility and patients?? self-blame for difficulty achieving treatment goals may serve as barriers to an effective relationship. Physicians and patients may benefit from a greater understanding of each other??s frustrations and challenges in diabetes management. 相似文献4.
A comparison of propensity score‐based approaches to health service evaluation: a case study of a preoperative physician‐led clinic for high‐risk surgical patients
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Harmatz P Ketteridge D Giugliani R Guffon N Teles EL Miranda MC Yu ZF Swiedler SJ Hopwood JJ;MPS VI Study Group 《Pediatrics》2005,115(6):e681-e689
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David Markenson George Foltin MD Michael Tunik MD Arthur Cooper MD Marsha Treiber MPS Karen Caravaglia MSOL 《Prehospital emergency care》2004,8(1):34
Objectives
1) To evaluate the ability to train emergency medical technicians-basic (EMT-Bs) to accurately identify bronchospasm and, based on a treatment protocol, administer albuterol sulfate via nebulization as a standing order. 2) To measure the improvement in patient condition after treatment.Methods
Following approval by the Commissioner of Health and Institutional Review Board, EMS agencies were enrolled to participate in the study and EMT-Bs were trained using a four-hour curriculum. For each patient, a prehospital data collection form was completed including identifying data for the EMT-B, patient assessment, and history information; and pre- and posttreatment assessments and a hospital data collection form were completed including the emergency department physician's diagnosis, assessment of bronchospasm, number of albuterol treatments received in the emergency department, and final disposition of the patient.Results
During a one-year study period, EMT-Bs treated 190 patients as part of the project. Across all values patients showed a clinical improvement as a result of the therapy. Concurrence in the assessment of bronchospasm by the EMT-B with an emergency department physician was found in 87.4% of the cases. When including allergic reaction, anaphylaxis, bronchiolitis, and chronic obstructive pulmonary disease in the diagnosis list of bronchospasm, the accuracy rate increased to more than 94%.Conclusion
This study indicated EMT-Bs were highly successful in their evaluation of bronchospasm. Based on this level of accuracy, the authors suggest that it is safe for emergency medical service systems and medical directors to develop protocols that allow EMT-Bs to administer albuterol via nebulizer for bronchospasm based on their assessment. 相似文献7.
EM Keane MRCGP DOM H Wilson MPS D McGrane MB BCh D Coakley MD JB Walsh FRCP 《International journal of clinical practice》1995,49(2):71-72
SUMMARY In this test a course of 4 drops twice a day for 5 days of ear wax solvents, a cerumenolytic, sodium bicarbonate, or sterile water significantly increased the clearance of wax from ears by natural expulsion and eliminated the requirement for ear syringing in 50% of cases. 相似文献
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D. Freitag BPharm BA MPS R. Bebee MBA GradDipPharm BAppSci FPS B. Sunderlandt PhD FPS MRPharmS † 《Journal of clinical pharmacy and therapeutics》1995,20(3):179-183
An extensive scrutiny of 19,460 patients' charts was carried out by clinical pharmacists in six Australian Repatriation Hospitals. The incidence of the prescribing of digoxin–quinidine and digoxin–amiodarone combinations was 018% and 022% of patients, respectively, giving an overall level of 04% (4/1000). For both combinations, digoxin was prescribed long term in 81% of the cases and quinidine or amiodarone recently added to digoxin therapy in 44% of patients identified. Therapeutic drug monitoring of digoxin therapy was initiated by clinical pharmacists in 41% of patients and resulted in modifications to digoxin therapy in 63% of this sub–group of patients. Quinidine and amiodarone therapies were also changed in nine patients. Of particular note was the number (15 or 58%) of dosage changes or therapy cessations made to digoxin therapy for patients also receiving amiodarone which occurred as a result of clinical pharmacist intervention. 相似文献