Postgraduate medical journal
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Research evidence is insufficient to change physicians' behaviour. In 1996, Pathman developed a four step model: that physicians need to be aware of, agree with, adopt, and adhere to guidelines. ⋯ Leakage from research publication to guideline utilisation occurs in a wide variety of clinical settings and at all steps of the awareness-to-adherence pathway. This review confirms that clinical guidelines are insufficient to implement research and suggests there may be different factors influencing clinicians at each step of this pathway. Recommendations to improve guideline adherence need to be tailored to each step.
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The incidence and prevalence of obesity are increasing world wide. In the UK, obesity governmental strategy has primarily focused on prevention measures, with less focus on the demands of treating obese patients in hospital. Increasing service demand by obese patients coupled with a lack of adequate provision for care of these patients may lead to an increase in patient safety incidents. By classifying patient safety incidents associated with obesity reported to the National Patient Safety Agency, this report aims to identify areas for improvement in the quality and safety of care of the obese patient. ⋯ This report identifies that the majority of safety incidents associated with obesity were related to infrastructure, suggesting that there is inadequate provision in place for the care of obese patients. While levels of harm were mostly low, the occurrence of incidents resulting in severe harm or death highlights the specific dangers associated with the care of the obese patient. A global approach to improving the safety of care delivery for obese patients is recommended, including obesity specific training, management structures, care pathways, and equipment provisioning.Further planning and development of operation policies is needed to ensure the safe delivery of healthcare to obese patients in the future.
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Acute ischaemic stroke (AIS) is the leading cause of death and disability in developed nations. In the past decade pharmacologic and endovascular therapy has been approved for use in treatment of patients presenting with AIS. The time window from symptom onset to be eligible for treatment is narrow, allowing for only a small proportion of these patients to be treated. ⋯ Several studies have shown a high rate of vessel recanalisation with endovascular techniques; however, their efficacy and translation to improved patient outcome is not yet established. Advanced imaging techniques may help select patients who would predictably benefit from endovascular intervention. In the light of existing controversies, this review discusses the current evidence for intravenous and intra-arterial thrombolytics, intra-arterial mechanical thrombectomy devices, and intracranial stent placement for treatment of AIS.