Journal of general internal medicine
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Spinal epidural abscesses are difficult to diagnose and are associated with high morbidity and mortality. A 61-year-old Chinese woman fell and was admitted 5 days later with constant epigastric pain and constipation. Clinical examination was initially normal. ⋯ Emergent neurosurgical intervention revealed an epidural abscess, which was drained. She responded to a 9-week course of antibiotics and recovered fully. Radicular pain from thoracic pathology can mimic intraabdominal pathology, and a high index of suspicion and prompt surgical intervention are essential to avoid the potentially devastating consequences of delayed recognition of epidural abscesses.
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Multicenter Study
Using the six sigma process to implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 intensive care units.
The Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health Care Settings was issued in 2002. In 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) established complying with the CDC Guideline as a National Patient Safety Goal for 2004. This goal has been maintained through 2006. The CDC's emphasis on the use of alcohol-based hand rubs (ABHRs) rather than soap and water was an opportunity to improve compliance, but the Guideline contained over 40 specific recommendations to implement. ⋯ The Six Sigma process was effective for organizing the knowledge, opinions, and actions of a group of professionals to implement the CDC's evidence-based hand hygiene practices in 4 ICUs. Several tools were developed for widespread use.
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Excellent diabetes care and self-management depends heavily on the flow of timely, accurate information to patients and providers. Recent developments in information technology (IT) may, therefore, hold great promise. ⋯ There is growing evidence that emerging IT may improve diabetes care. Future research should characterize benefits in the long term (>1 year), establish methods to evaluate clinical outcomes, and determine the cost-effectiveness of using IT.
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Multicenter Study Comparative Study
Patient and physician perceptions of timely access to care.
Timeliness of care is 1 of 6 dimensions of quality identified in Crossing the Quality Chasm. We compared patient and physician perceptions of appropriate timing of visits for common medical problems. ⋯ Patients expected to be seen sooner than physicians thought necessary for many common chronic medical conditions, but are in agreement about timeliness for some acute problems. Understanding patient expectations may help physicians respond to requests for urgent evaluation of chronic conditions.
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To determine effectiveness and costs of different guideline dissemination and implementation strategies. ⋯ Current guideline dissemination and implementation strategies can lead to improvements in care within the context of rigorous evaluative studies. However, there is an imperfect evidence base to support decisions about which guideline dissemination and implementation strategies are likely to be efficient under different circumstances. Decision makers need to use considerable judgment about how best to use the limited resources they have for quality improvement activities.