RESUMO
Guidelines for the prevention of glucocorticoid (GC) induced osteoporosis (GIOP) were implemented in a level 5 Irish Hospital with cross sectional audit of inpatient prescribing undertaken before and after. Prior to guideline implementation, elemental calcium (Ca) with Vitamin D (VitD) was prescribed for 11/66 (17%) of patients on GCs with 2/66 (3%) also receiving bisphosphonate (BP) therapy. Subsequent to guideline implementation, Ca with VitD was prescribed for 19/55 (35%) of patients on GCs with 11/55 (20%) also receiving BP therapy, representing a 2 and 6 fold respective increase. Internal promotion of guidelines is an effective strategy for healthcare improvement but needs refinement with or without repetition to achieve better patient outcomes.
Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Glucocorticoides/efeitos adversos , Fidelidade a Diretrizes/estatística & dados numéricos , Osteoporose , Padrões de Prática Médica/estatística & dados numéricos , Densidade Óssea/efeitos dos fármacos , Cálcio da Dieta/uso terapêutico , Auditoria Clínica , Estudos Transversais , Difosfonatos/uso terapêutico , Glucocorticoides/administração & dosagem , Humanos , Irlanda , Osteoporose/induzido quimicamente , Osteoporose/prevenção & controle , Guias de Prática Clínica como Assunto , Prevenção Secundária/métodos , Vitamina D/uso terapêuticoAssuntos
Dermatite/tratamento farmacológico , Detecção Precoce de Câncer/estatística & dados numéricos , Imunossupressores/administração & dosagem , Auditoria Médica/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Doença Crônica/tratamento farmacológico , Estudos de Coortes , Dermatite/imunologia , Detecção Precoce de Câncer/métodos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Irlanda , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Teste de Papanicolaou/estatística & dados numéricos , Educação de Pacientes como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Neoplasias do Colo do Útero/imunologiaRESUMO
Accurate hospital admission/initial history and physical examination [H&P] notes are vital to support patient care. We aimed to assess the quality of H&P notes and to compare medical/surgical, and inpatient/outpatient H&P notes. A cross-sectional study examined 154 initial H&P notes for the adherence to a standard protocol in a tertiary referral hospital. 134 doctors (87.1%) adhered to the correct layout in accordance with the standard. Only 77 doctors (50%) recorded the names of the patient's medications. 106 (68.8%) documented the allergy status. Six doctors (3.9%) omitted an objective record of their own identity. Surgeons were superior at recording admission type (p = 0.0001) and past surgical history (p = 0.002) only. The data in this study show that the standard o completeness of the H&P documentation among doctors is suboptimal. We recommend the introduction of a standardised H&P template to reduce errors.
Assuntos
Documentação/normas , Anamnese/normas , Exame Físico/normas , Estudos Transversais , HumanosAssuntos
Dermatite/tratamento farmacológico , Imunossupressores/efeitos adversos , Displasia do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Doença Crônica , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Programas de Rastreamento/estatística & dados numéricos , Auditoria Médica , Pessoa de Meia-Idade , Infecções por Papillomavirus/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricosRESUMO
The closure of fasciotomy wounds creates problems for patient and surgeon alike. Split thickness skin grafting results in unsightly and insensate wounds and often requires general anaesthesia and prolonged inpatient care. We describe an improvement of a previously reported technique which is as effective as proprietary medical devices currently available. The technique may also be applied to the delayed primary closure of traumatic wounds.
Assuntos
Fasciotomia , Técnicas de Sutura , Fios Ortopédicos , Humanos , Técnicas de Sutura/instrumentaçãoRESUMO
The method of insertion of the Herbert screw for scaphoid fractures and its long-term presence in the scaphotrapezial joint may predispose to degeneration in that joint. We examined a group of patients with long-term follow-up to assess this risk and found it to be insignificant.
Assuntos
Parafusos Ósseos , Ossos do Carpo/lesões , Fixação Interna de Fraturas/instrumentação , Osteoartrite/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Adulto , Ossos do Carpo/diagnóstico por imagem , Ossos do Carpo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Fatores de Risco , Traumatismos do Punho/diagnóstico por imagemRESUMO
We report four cases with six episodes of concurrent carpal and elbow fractures or dislocations. Few such combinations of injuries have been reported in the literature. We discuss the mechanism and management of such injuries and conclude that elbow injuries should be suspected in severe carpal injuries. Surgical treatment may be required in their management.
Assuntos
Ossos do Carpo/lesões , Lesões no Cotovelo , Fraturas Ósseas/terapia , Traumatismos do Punho/terapia , Adulto , Ossos do Carpo/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/terapia , Masculino , Radiografia , Traumatismos do Punho/diagnóstico por imagemRESUMO
Impingement syndromes have been described in relation to accessory or anomalous bony additions to the foot skeleton. We describe a hitherto undescribed accessory bone in the hindfoot causing posterolateral impingement in a 28-year-old woman.
Assuntos
Articulação do Tornozelo/anormalidades , Ossos do Pé/anormalidades , Artropatias/etiologia , Adulto , Feminino , Humanos , Artropatias/patologia , Artropatias/cirurgia , SíndromeRESUMO
Since its inception, the Internet has created many new opportunities for the dissemination of knowledge. We have developed an Internet-based orthopaedic discussion group. There are 93 members from Ireland and elsewhere in the world. Precautions are taken to ensure the confidentiality of all cases submitted to the group. All patient identifiers are removed from images, radiographs and reports before submission. In the first 18 months more than 100 cases were discussed by the group. The use of an Internet-based discussion group in orthopaedics has expanded the educational and communication opportunities for the Irish orthopaedic profession both nationally and internationally.
Assuntos
Cooperação Internacional , Internet , Ortopedia/métodos , Telemetria/métodos , Educação Médica Continuada/métodos , Humanos , Irlanda , Ortopedia/educaçãoRESUMO
Since its inception, the Internet has created many new opportunities for the dissemination of knowledge between individuals. One of the areas most affected by these changes has been healthcare, both in terms of service provision and in the arena of medical education. Other healthcare professionals have described the educational resources available on the Net but few have illustrated the advantages of educational and conversant interaction between members of a surgical speciality or the maturing process that takes place within that group. We describe how the initiation and continued development of an Internet-based discussion group has benefited the orthopaedic profession in Ireland. We identify problems detected to date and possible difficulties in the future of the discussion group.
Assuntos
Educação de Pós-Graduação em Medicina , Grupos Focais , Internet , Ortopedia/educação , Humanos , Irlanda , Consulta RemotaRESUMO
OBJECTIVE: More people are living beyond their 90s, yet this group has not been much studied. This study aimed to describe a sample of non-agenarians and centerians attending an old age psychiatry service with a focus on pharmacotherapy. METHODS: Retrospective, cross-sectional survey of patients aged >90 in contact with the Department of Old Age Psychiatry in a university hospital over a 1-year period. Results were compared with the Beers, the Canadian and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria. RESULTS: A total of 65 nonagenarians or centerians were identified (mean age 93, 82% female). The majority (65%) resided in a nursing home; dementia was the most common diagnosis (77%), followed by depression (29%). The most commonly prescribed psychotropics were antidepressants (58%), followed by antipsychotics (45%), hypnotics (42%), anti-dementia agents (31%) and anxiolytics (26%). Overall, patients were on a mean of 2.1 (S.D. 1.3, range 0-5) psychotropics and 4.99 (S.D. 2.7, range 0-11) non-psychotropics. Mean Mini Mental State Examination (MMSE) score was 15 (S.D. 8.1). Increasing anticholinergic burden was negatively associated with MMSE scores (B = -1.72, p = 0.013). Residing in a nursing home was associated with a higher rate of antidepressant [OR 5.71 (95% CI 1.9-17.4)], anxiolytic [OR 13.5 (95% CI 1.7-110.4)] and antipsychotic [OR 3.4 (95% CI 1.1-10.4)] use. Potentially inappropriate prescribing included long-term benzodiazepine use (26%) and long-term antipsychotic use (25%). CONCLUSIONS: Our sample had a high psychiatric morbidity burden with high levels of psychotropic use. Ongoing review and audit of psychotropic use in elderly patients can identify potentially inappropriate prescribing in a group vulnerable to high levels of polypharmacy and extended psychotropic use.
RESUMO
BACKGROUND: Pneumococcal disease, especially in its invasive form, is a significant cause of morbidity and mortality worldwide. However, with the advent of vaccination, invasive disease is potentially avoidable. This study aimed to assess the documentation of pneumococcal vaccination status in elderly patients by healthcare professionals in a busy teaching hospital environment. METHODS: One hundred and fifty-seven open (active) medical records of inpatients and outpatients aged over 65 years were reviewed, to examine for evidence of documentation of pneumococcal vaccination status. RESULTS: From the medical records, 338 patient encounters were studied. Overall, there was a mean of 2.4±1.2 indications for pneumococcal vaccination, with more indications in medical than in surgical patients (P=0.04). The rate of recording in respiratory outpatient clinics was 71.4% in comparison to 0% in other medical and surgical outpatient clinics. Overall the documentation rate was 2.1%. CONCLUSIONS: Only respiratory physicians had demonstrable evidence of actively asking about pneumococcal vaccination on a regular basis. There is considerable need for increased awareness among healthcare professionals and improvement in methods of recording vaccination status.
Assuntos
Pacientes Internados/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Vacinação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Documentação , Feminino , Hospitais de Ensino , Humanos , Masculino , Prontuários MédicosRESUMO
BACKGROUND: Timeliness of response from referral to consultation is necessary to provide best standards of care to inpatients in the general hospital setting. AIMS: To measure the length of time from referral to consultation in a liaison psychiatry service, and improve service delivery by introducing guidelines for time to consultation. METHODS: Time to consultation was measured on all patients presenting to a liaison psychiatry consultation service over an initial 6-month period, with subsequent repeat measurement following the introduction of guidelines. RESULTS: There were significant reductions for time to consultation in the service for the second cycle of the audit (χ(2) = 43.84, P < 0.001), and targets based on international standards were achieved. CONCLUSIONS: Introduction of guidelines for time to consultation, may improve response times, leading to improved quality of service for inpatient consultation services.
Assuntos
Hospitais de Ensino/normas , Transtornos Mentais/diagnóstico , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Auditoria Clínica , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Irlanda , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Melhoria de Qualidade , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Tempo , Adulto JovemRESUMO
INTRODUCTION: Infliximab, a chimeric monoclonal antibody to tumour necrosis factor alpha, is administered as an intravenous infusion requiring a costly hospital day case or inpatient admission. METHODS: An audit of all current therapies given by intravenous infusions in an outpatient setting in St Vincent's University Hospital (SVUH) was undertaken. Furthermore, in conjunction with TCP homecare, we established in a general practise health clinic, the first Irish community infusion centre for the administration of infliximab in August 2006. RESULTS: All outpatient departments indicated that they would favour a centralized hospital infusion unit. There were no adverse events and the mean global satisfaction improved in the community infliximab infusion pilot programme of seven patients. CONCLUSION: This study suggests efficiencies in providing centralized infusion facilities, while the community based infusion of infliximab is feasible and safe in this small cohort and identifies the community infusion unit as a viable and cost efficient alternative for administration of infliximab.