Processes to ensure world-wide best-practice for critical care delivery is likely to minimize preventable death, disability and costly complications for any healthcare system's sickest patients, but no large-scale...Processes to ensure world-wide best-practice for critical care delivery is likely to minimize preventable death, disability and costly complications for any healthcare system's sickest patients, but no large-scale efforts have so far been undertaken towards these goals. The advances in medical informatics and human factors engineering have provided possibility for novel and user-friendly clinical decision support tools that can be applied in a complex and busy hospital setting. To facilitate timely and accurate best-practice delivery in critically ill patients international group of intensive care unit(ICU) physicians and researchers developed a simple decision support tool: Checklist for Early Recognition and Treatment of Acute Illness(CERTAIN). The tool has been refined and tested in high fidelity simulated clinical environment and has been shown to improve performance of clinical providers faced with simulated emergencies. The aim of this international educational intervention is to implement CERTAIN into clinical practice in hospital settings with variable resources(included those in low income countries) and evaluate the impact of the tool on the care processes and patient outcomes. To accomplish our aims, CERTAIN will be uniformly available on either mobile or fixed computing devices(as well as a backup paper version) and applied in a standardized manner in the ICUs of diverse hospitals. To ensure the effectiveness of the proposed intervention, access to CERTAIN is coupled with structured training of bedside ICU providers.展开更多
With the rising global prevalence in diabetes, healthcare systems are facing a growing challenge to provide efficient and effective diabetes care management in the face of spiralling treatment costs. Diabetes is a maj...With the rising global prevalence in diabetes, healthcare systems are facing a growing challenge to provide efficient and effective diabetes care management in the face of spiralling treatment costs. Diabetes is a major cause of premature mortality and associated with devastating complications especially if managed poorly. Although diabetes care is improving in England and Wales, recent audit data suggests care remains imperfect with wide geographical variations in quality. Diabetes care is expensive with a sizeable amount of available expenditure used for treating the complications of diabetes. A target driven, long-term, multifactorial intervention in patients with type 2 diabetes has been shown to reduce mortality and morbidity. The alphabet strategy is a novel approach to effective diabetes care provision, aiming to address patient education and empowerment, provide consistent comprehensive care delivered in a timely fashion, and allowing multidisciplinary team work.展开更多
目的通过设计《ICU呼吸机相关性肺炎预防控制质量核查单》(简称核查单),指导护理人员在临床工作中进行质量核查,以降低呼吸机相关性肺炎的发生率,促进呼吸机相关性肺炎预防的质量改进。方法采用类实验性研究方法,2015年5—7月,将核查单...目的通过设计《ICU呼吸机相关性肺炎预防控制质量核查单》(简称核查单),指导护理人员在临床工作中进行质量核查,以降低呼吸机相关性肺炎的发生率,促进呼吸机相关性肺炎预防的质量改进。方法采用类实验性研究方法,2015年5—7月,将核查单应用于ICU的机械通气患者,对呼吸机相关性肺炎预防控制措施进行每日核查;将使用核查单的2015年5—7月患者作为干预组,未使用核查单的2015年1—3月患者作为对照组,比较两组呼吸机相关性肺炎预防控制措施的总执行率、单项执行率和呼吸机相关性肺炎的发生率。结果使用核查单干预后,呼吸机相关性肺炎预防控制措施的总执行率提高(31.8%vs 54.5%),呼吸机相关性肺炎发生率明显下降(34.2‰ vs 14.6‰)。预防控制措施中"手卫生"、"抬高床头30°~45°"、"口腔护理"、"镇静休假"、"深静脉血栓预防"、"人工气道管理"的单项执行率均提高,使用前后上述各指标的差异有统计学意义(P<0.05),"消化道溃疡预防"的单项执行率未提高。结论应用《ICU呼吸机相关性肺炎预防控制质量核查单》有助于提高多项呼吸机相关性肺炎预防控制措施的执行率,降低呼吸机相关性肺炎的发生率。展开更多
文摘Processes to ensure world-wide best-practice for critical care delivery is likely to minimize preventable death, disability and costly complications for any healthcare system's sickest patients, but no large-scale efforts have so far been undertaken towards these goals. The advances in medical informatics and human factors engineering have provided possibility for novel and user-friendly clinical decision support tools that can be applied in a complex and busy hospital setting. To facilitate timely and accurate best-practice delivery in critically ill patients international group of intensive care unit(ICU) physicians and researchers developed a simple decision support tool: Checklist for Early Recognition and Treatment of Acute Illness(CERTAIN). The tool has been refined and tested in high fidelity simulated clinical environment and has been shown to improve performance of clinical providers faced with simulated emergencies. The aim of this international educational intervention is to implement CERTAIN into clinical practice in hospital settings with variable resources(included those in low income countries) and evaluate the impact of the tool on the care processes and patient outcomes. To accomplish our aims, CERTAIN will be uniformly available on either mobile or fixed computing devices(as well as a backup paper version) and applied in a standardized manner in the ICUs of diverse hospitals. To ensure the effectiveness of the proposed intervention, access to CERTAIN is coupled with structured training of bedside ICU providers.
文摘With the rising global prevalence in diabetes, healthcare systems are facing a growing challenge to provide efficient and effective diabetes care management in the face of spiralling treatment costs. Diabetes is a major cause of premature mortality and associated with devastating complications especially if managed poorly. Although diabetes care is improving in England and Wales, recent audit data suggests care remains imperfect with wide geographical variations in quality. Diabetes care is expensive with a sizeable amount of available expenditure used for treating the complications of diabetes. A target driven, long-term, multifactorial intervention in patients with type 2 diabetes has been shown to reduce mortality and morbidity. The alphabet strategy is a novel approach to effective diabetes care provision, aiming to address patient education and empowerment, provide consistent comprehensive care delivered in a timely fashion, and allowing multidisciplinary team work.
文摘目的通过设计《ICU呼吸机相关性肺炎预防控制质量核查单》(简称核查单),指导护理人员在临床工作中进行质量核查,以降低呼吸机相关性肺炎的发生率,促进呼吸机相关性肺炎预防的质量改进。方法采用类实验性研究方法,2015年5—7月,将核查单应用于ICU的机械通气患者,对呼吸机相关性肺炎预防控制措施进行每日核查;将使用核查单的2015年5—7月患者作为干预组,未使用核查单的2015年1—3月患者作为对照组,比较两组呼吸机相关性肺炎预防控制措施的总执行率、单项执行率和呼吸机相关性肺炎的发生率。结果使用核查单干预后,呼吸机相关性肺炎预防控制措施的总执行率提高(31.8%vs 54.5%),呼吸机相关性肺炎发生率明显下降(34.2‰ vs 14.6‰)。预防控制措施中"手卫生"、"抬高床头30°~45°"、"口腔护理"、"镇静休假"、"深静脉血栓预防"、"人工气道管理"的单项执行率均提高,使用前后上述各指标的差异有统计学意义(P<0.05),"消化道溃疡预防"的单项执行率未提高。结论应用《ICU呼吸机相关性肺炎预防控制质量核查单》有助于提高多项呼吸机相关性肺炎预防控制措施的执行率,降低呼吸机相关性肺炎的发生率。
