RESUMEN
We prospectively assessed the implementation of venous thromboembolism (VTE) prophylaxis guidelines and the impact of grand round presentation of the data in changing clinical practice. Two NHS teaching hospitals were studied for 24 months from January 2003. Patients were risk stratified according to the THRIFT (thromboembolic risk factor) consensus group guidelines and compared with the recommendations of the THRIFT and ACCP (American College of Chest Physicians) consensus groups. Six months following presentation of the initial results, a further analysis was made to assess changes in clinical practice. 1128 patients were assessed of whom 1062 satisfied the inclusion criteria for thromboprophylaxis. 89% of all patients were stratified as having high or moderate risk of developing VTE. Of these only 28% were prescribed some form of thromboprophylaxis-4% received the THRIFT-recommended and 22% received the ACCP-recommended thromboprophylaxis. The vast majority (72%) received no thromboprophylaxis at all. Reassessment, following data presentation at grand rounds, showed a significant increase to 31% inpatients receiving THRIFT (P<0.0001) and ACCP (P=0.002) recommended thromboprophylaxis. However,the proportion of patients receiving no form of prophylaxis barely changed (72% to 69%: P=0.59). We found a gross underutilization of thromboprophylaxis in hospitalized medical patients. A simple grand-round presentation of the data and recommended guidelines to clinicians significantly increased the proportion of patients receiving recommended thromboprophylaxis but did not increase the overall proportion of patients receiving it. We therefore conclude that a single presentation of guidelines is not enough to achieve the desired levels. Such presentations may only serve to make DVT (deep venous thromboembolism) aware clinicians prescribe prophylaxis more accurately.
Asunto(s)
Anticoagulantes/uso terapéutico , Vendajes , Heparina de Bajo-Peso-Molecular/uso terapéutico , Hospitalización , Tromboembolia/prevención & control , Trombosis de la Vena/prevención & control , Enfermedad Aguda , Análisis Costo-Beneficio , Hospitales de Enseñanza , Humanos , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Factores de RiesgoAsunto(s)
Rehabilitación Bucal , Coronas , Coronas con Frente Estético , Humanos , Masculino , Maloclusión/complicaciones , Maloclusión/terapia , Persona de Mediana Edad , Ferulas Oclusales , Trastornos de la Articulación Temporomandibular/etiología , Trastornos de la Articulación Temporomandibular/terapia , Dimensión VerticalRESUMEN
A graphic luetic record form is used as a guide to physicians in diagnosis and management of latent syphilis. The form provides a uniform method of recording laboratory and clinical findings as well as treatment. It facilitates checking progress and forwarding of information necessary to assure continuity in treatment of patients with latent syphilis who are transferred to other medical facilities. It is designed primarily as a guide to the clinician who does not specialize in the treatment of syphilis.