The American journal of managed care
-
There are various interventions for guideline implementation in clinical practice, but the effects of these interventions are generally unclear. We conducted a systematic review to identify effective methods of implementing clinical research findings and clinical guidelines to change physician practice patterns, in surgical and general practice. ⋯ Active forms of continuing medical education and multifaceted interventions were found to be the most effective methods for implementing guidelines into general practice. Additionally, active approaches to changing physician performance were shown to improve practice to a greater extent than traditional passive methods. Further primary research is necessary to evaluate the effectiveness of these methods in a surgical setting.
-
Observational Study
Prognostic factors of mortality among patients with severe hyperglycemia.
Severe hyperglycemia is associated with increased morbidity and mortality in a variety of patients. We undertook this study to identify prognostic factors of mortality among patients experiencing severe hyperglycemia in the emergency department (ED). ⋯ The 90-day mortality rate among patients with severe hyperglycemia in the ED was 14.6%. Sepsis, renal impairment with electrolyte imbalance, and lower blood pressure were independent prognostic factors.
-
Multiple chronic comorbidities (MCCs) are an issue of growing significance in diabetes because they are highly prevalent and can increase disease burden and costs. We examined MCC patterns among patients with type 2 diabetes mellitus and identified specific comorbidity clusters associated with poor patient outcomes. ⋯ Patients with diabetes have substantial comorbidities, but the patterns vary considerably across patients and by age. Diabetes care remained suboptimal among many types of MCC patients, and patient outcomes varied by MCC profile. Specific management strategies should be developed for common MCC clusters, such as hypertension-hyperlipidemia-obesity.
-
Significant advancements in solid organ transplantation immunosuppressive medications and regimens have resulted in improved outcomes over the years. A multidrug approach involving medications with different mechanisms of action is commonly used. Induction therapy can involve the use of antibody agents or higher doses of medications used for maintenance therapy. ⋯ Due to the potential for nephrotoxicity with the use of calcineurin inhibitors and chronic conditions with the prolonged use of corticosteroids, various withdrawal strategies are used in practice. Antimicrobial agents are prescribed to provide prophylaxis against certain viral, fungal, and bacterial infections. Other concomitant medications in the regimens for patients who have undergone transplantation vary depending on patient-specific factors and conditions.