Journal of evaluation in clinical practice
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This paper explores the lessons learned from a series of three randomized controlled trials that included 498 community-living frail older adults (≥65 years) using home care services in Southern Ontario, Canada. Each study was designed to evaluate the effectiveness of different multi-component nurse-led health promotion and disease prevention (HPDP) interventions. ⋯ The results of the three trials underscore the need to reinvest in nurse-led HPDP interventions in home care to optimize HRQOL and promote ageing in place in the target population of frail older adults. More studies are needed to evaluate the effectiveness of additional nurse-led HPDP interventions in other contexts and settings.
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The objective of this study was to analyse whether electronic medical records (EMRs) of total hip and knee arthroplasty can be used to manage the optimal time of surgery. ⋯ Data from electronic patient entries complemented with data of the operable condition can be used for defining the optimal operation time with regard to the pre-operative condition of the patients. The implication of prolonged waiting times was not very profound, but elderly patients benefit from a short waiting time.
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Multiple treatments are available for osteoporosis; however, little is known about treatment change patterns and associated factors. Osteoporosis treatment change patterns, discontinuation and factors associated with treatment change in members of a large national health plan were examined. ⋯ Osteoporosis treatment change occurred in approximately 12% of members, while a greater proportion of members discontinued treatment completely within 12 months. Member characteristics may be used to predict therapy change for evaluation and quality initiatives within a health plan.
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In the absence of a gold-standard tool to measure chronic pelvic pain (CPP), most studies on the prevalence of CPP use the NIH-chronic prostatitis symptom index (CPSI) questionnaire. However, its suitability and relevance for use in both sexes have not yet been evaluated, and generalized interpretation of the results is therefore questionable. Accordingly, we designed a questionnaire that discriminates between patients with and without symptoms of CPP. ⋯ The CPPQ-Mohedo questionnaire presented discriminating power in men and women with symptoms of CPP. This questionnaire may be used as a screening tool to identify patients and include them in treatment programmes, as an outcome assessment tool for treatment and clinical trials, or as a tool to assess the prevalence of CPP in epidemiologic studies.
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The Scottish Intercollegiate Guideline Network (SIGN) published Postoperative Management in Adults in 2004, advocating post-operative assessments to optimize post-operative care. Our aim was to improve post-operative assessments in a surgical high-dependency unit (HDU). ⋯ Clinical practice was improved by a tailored multi-modal approach. Educating staff, improving communication and documentation, and re-audit has shown significant improvement. However, further improvements are required to reach best practice.