Clinical performance and quality health care
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Clin Perform Qual Health Care · Jan 2000
Comparative StudyIntroducing ropivacaine into a department's epidural analgesic practice. Improving acute pain service practice.
The results of introducing a new licensed local anaesthetic drug, ropivacaine, into routine practice were evaluated by measuring the efficacy and adverse effects of patient controlled epidural analgesia (PCEA), using ropivacaine 2 mg/ml (R), or the mixtures in current use: fentanyl 5 (micrograms/ml with bupivacaine 1 mg/ml (BF5) and fentanyl 10 (micrograms/ml) with bupivacaine 1 mg/ml (BF10). All patients were nursed on general wards after surgery. For two months, 102 consecutive patients were studied. ⋯ Older patients demanded less analgesia (p < 0.001). Postoperatively BF5 provided better pain relief with trends demonstrating fewer side-effects and complications than BF10 or R. We now use fentanyl 5 (micrograms/ml and bupivacaine 1 mg/ml as our standard epidural infusion mixture.
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The pre-operative anaesthetic records of 195 patients were analysed for the presence of 12 agreed core items of pre-operative assessment. This study showed that anaesthetists recorded 26.8 per cent of this information. In up to one-third of patients the following were recorded: smoking history, family history, gastro-oesophageal reflux, airway assessment, dental assessment, chest examination, heart-sounds and blood pressure. ⋯ With a view to improving the level of record-keeping, a formatted, pre-printed pre-operative assessment record was introduced into practice and two months later the audit was repeated. A small but non-significant improvement in record keeping was observed. An argument is made for the introduction of an interdisciplinary, unified anaesthetic pre-operative record.
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The Plastic Surgery Department undertook an audit of the rate of excision of basal cell carcinomas (BCCs) at St George's Hospital. The aim of the audit was to determine the rate of incomplete excision of BCCs excised by the department over a six-month period and compare it with national audit figures. The rate of incomplete excision was 13.73 per cent or seven out of 51 BCCs, which compared favourably with the rates quoted in the literature. No change in the management of basal cell carcinomas was made.
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Clin Perform Qual Health Care · Apr 1999
How do regulatory agencies ensure the release of a safe medical device?
This article describes the current regulatory activities of the Food and Drug Administration (FDA), in particular the FDA techniques for regulating medical-device approvals, medical-device reporting, and medical-device-company inspections. Also discussed are the FDA Modernization Act and the methods the FDA is using to implement the act.
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Clin Perform Qual Health Care · Apr 1999
Comparative StudyEmergence of highly antibiotic-resistant Pseudomonas aeruginosa in relation to duration of empirical antipseudomonal antibiotic treatment.
This study examines antibiotic resistance in Pseudomonas aeruginosa in hospitalized patients in relation to prior empirical antibiotic therapy. ⋯ Duration of empirical antipseudomonal antibiotic treatment influences selection of resistant strains of P aeruginosa; the longer the duration, the broader the pattern of resistance.