Documentation Of Examination Findings Research Articles

ANTIFUNGAL STEWARDSHIP: MITIGATING INAPPROPRIATE PRESCRIPTIONS IN VULVOVAGINAL CANDIDIASIS IN TERTIARY CARE HOSPITAL, CENTRAL INDIA

This study aims to reduce the inappropriate prescriptions of antifungal medications for vulvovaginitis candidiasis in a tertiary care hospital in central India. An ambispective, observational study was conducted in the Department of Pharmacology of MGM Medical College and Maharaja Yashwantrao Hospital in Indore, MP, over three months (i.e.,12 w from August to October 2023). The study encompassed a retrospective analysis of prescriptions for vaginal candidiasis over a period of five weeks in August-September 2023, followed by a prospective analysis over the subsequent five weeks of September-October 2023post-implementation of interactive training sessions, discussions, and antifungal guidelines for two weeks. From a total of 130 randomly selected prescriptions, 69 prescriptions were perused retrospectively, while 61 prescriptions received prospective analysis. The post-implemented audit showed a marked reduction in antifungal prescriptions with a difference of 12.4%. An increase in the documentation of examination findings was also observed, from 46.7% to 69.7%. This implementation successfully mitigated inappropriate prescriptions of antifungals, with sustained reductions demonstrated over the 3 mo of the study period, emphasizing the effectiveness of educational interventions.

The feasibility of a clinical audit tool to investigate stillbirth in Australia - a single centre experience.

The stillbirth rate in Australia is 7 per 1000 births (Australia's Mothers and Babies 2014-in brief. Perinatal Statistics Series no. 32. Cat no. PER 87, Canberra, AIHW, 2016). The Perinatal Society of Australia and New Zealand (PSANZ) developed guidelines to standardise the investigations into stillbirth. To identify causes of stillbirths and stillbirth care using the National Perinatal Death Clinical Audit Tool (National Perinatal Death Clinical Audit Tool, Australian and New Zealand Stillbirth Alliance [ANZSA]/Perinatal Society of Australia and New Zealand [PSANZ]) and compare it to the PSANZ recommendations. Documentation of examination findings and follow-up after stillbirth were also reviewed. From the total of 515 registered stillbirths at a Queensland hospital, 170 stillbirths were considered unexplained after chart review between July 2004 and September 2014. The National Perinatal Death Clinical Audit Tool was applied and resulting underlying causes of stillbirths were classified using the PSANZ perinatal mortality classification system. The stillbirth rate for this centre was 11.2 per 1000 births. A cause of fetal death was established in 55.4% (93/168) and 75 cases (44.6%) remained unexplained corresponding to 14.6% of all registered stillbirths (75/515). Over half of the women (52.7%) were nulliparous. High rates of autopsy (47.3%), bereavement support (99.4%) and placental histopathology (98.8%) were noted. The general practitioner was notified in 98.7% of cases at the time of stillbirth; 34.1% of babies were small for gestational age at birth, 18.9% were growth-restricted at birth and 21.4% of women were current smokers. The National Perinatal Death Clinical Audit Tool facilitates and streamlines stillbirth investigations and thus helps to identify underlying causes of stillbirth.

Impact of telemedicine on the quality of forensic sexual abuse examinations in rural communities

To assess the quality and diagnostic accuracy of pediatric sexual abuse forensic examinations conducted at rural hospitals with access to telemedicine compared with examinations conducted at similar hospitals without telemedicine support. Medical records of children less than 18 years of age referred for sexual abuse forensic examinations were reviewed at five rural hospitals with access to telemedicine consultations and three comparison hospitals with existing sexual abuse programs without telemedicine. Forensic examination quality and accuracy were independently evaluated by expert review of state mandated forensic reporting forms, photo/video documentation, and medical records using two structured implicit review instruments. Among the 183 patients included in the study, 101 (55.2%) children were evaluated at telemedicine hospitals and 82 (44.8%) were evaluated at comparison hospitals. Evaluation of state mandatory sexual abuse examination reporting forms demonstrated that hospitals with telemedicine had significantly higher quality scores in several domains including the general exam, the genital exam, documentation of examination findings, the overall assessment, and the summed total quality score (p<0.05 for each). Evaluation of the photos/videos and medical records documenting the completeness and accuracy of the examinations demonstrated that hospitals with telemedicine also had significantly higher scores in several domains including photo/video quality, completeness of the examination, and the summed total completeness and accuracy score (p<0.05 for each). Rural hospitals using telemedicine for pediatric sexual abuse forensic examination consultations provided significantly higher quality evaluations, more complete examinations, and more accurate diagnoses than similar hospitals conducting examinations without telemedicine support.

An Audit of Referrals with Headaches to Paediatric Neurology at Sheffield Children's Hospital

Background and aims: Headaches are common in children and in most cases it is simply advice and reassurance that is required. Referrals to paediatric neurology in Sheffield come from general practice, and local and regional general paediatricians. We audited whether headaches were being managed in accordance with recognised guidance. Methods: We obtained a list of 73 patients referred with headache to the three paediatric neurologists by searching clinic letters filed on the network. We then reviewed the case notes of 71 of these (two were excluded as headache was not the primary problem.) A proforma was designed to record patient demographics, history, examination findings, investigations, management and follow-up. Results: The mean age at first out-patient visit was 11.5years (range 4-17 years.) The majority of cases came from general practice (41%.) 31% of children were not using simple analgesia at the time of referral. History taking was satisfactory. Documentation of examination findings was present in 100% of cases but blood pressure was only recorded in 69% of cases. MRI/CT was done in 32 cases (45%). In the majority of cases no medications were prescribed following appointment but documentation of advice given was very poor; 33% of cases. Conclusions: The history taking and diagnoses given were in line with current best practice. Blood pressure measurement is poor and although this is a common problem in paediatrics it is particularly surprising in a paediatric neurology service. Advice was not well documented and as this may be leaving families dissatisfied.

A structured examination in labour improves documentation

A structured sticker for examination of women in labour was introduced at Arrowe Park Hospital in 1998 to improve documentation of examination findings. This study was undertaken to assess whether the use of the sticker improved documentation of examination findings and second, compliance of sticker use. A retrospective analysis was performed on 64 cases randomised by random number generated on Arcus Quickstat from 470 women who were induced by prostaglandin during 1 January 1998 to 31 December 1998 at Arrowe Park Hospital. Women were induced by prostaglandin were chosen as the study population to obtain data from early labour. A total of 229 examinations were performed in these areas. Statistical analysis was undertaken on Arcus Quickstat, and χ2 and Fisher’s exact tests were applied to check for statistical significance.

Glaucoma Care and Conformance with Preferred Practice Patterns: Examination of the Private, Community-based Ophthalmologist

Practice guidelines are becoming more prominent in the provision of medical care. A previous study demonstrated a high rate of conformance with recommended patterns of care for patients with open-angle glaucoma in an academic, public clinic setting. This study seeks to examine conformance within the private, community-based setting in which the vast majority of healthcare is delivered. One-hundred ninety-three charts (average, 24 charts each from 8 different practices) of patients who received diagnoses for at least 2 years of open-angle glaucoma were evaluated retrospectively for conformance with recommendations from the American Academy of Ophthalmology's Preferred Practice Pattern (PPP) for primary open-angle glaucoma. The criteria were evaluated in three areas: (1) the performance of specified examination steps at the initial visit; (2) the performance of specified examination steps at follow-up; and (3) the time interval between follow-up visits. In 56.4% of patients who had stable moderate to severe glaucomatous damage, documentation of examination findings on the initial visit ranged from 39.4% for a pupil examination to 100% for intraocular pressure. At the initial visit, visual fields were obtained or scheduled in 90.2% of eyes, gonioscopy was performed in 51.3%, and the disc/nerve fiber layer status was noted in 97.9%. On follow-up, 44% of patients had documentation concerning the status of their glaucoma, but only 23.3% of patients had an optic nerve head drawing or photograph within 15 months of the most recent visit. In addition, the authors found that 37.8% of patient charts had neither an optic nerve head drawing nor a photograph documented after the initial visit. Finally, although 92.2% of patients with glaucoma were scheduled for follow-up within the time intervals recommended by the PPP, patients with uncontrolled or unstable glaucoma were the least likely to be followed up within PPP-recommended time intervals. Chart reviews from private, community-based ophthalmologists show that some initial examination steps such as gonioscopy and pupil examination are performed to widely varying degrees. While patients are generally likely to be scheduled for follow-up within PPP-recommended intervals, patients with unstable glaucoma are the least likely to be so scheduled. In addition, the visual appearance of the optic nerve is recorded for a relatively low percentage of patients. Additional data are needed from other geographic areas and other practice settings and for other patterns of care to more fully assess provider behavior relative to PPPs.

Conformance with Preferred Practice Patterns in Caring for Patients with Glaucoma

Practice guidelines are becoming more prominent in the provision of medical care. However, the limited data that exist suggests that conformance in ophthalmic care may be low. A retrospective study of 120 charts of patients with open-angle glaucoma was conducted to evaluate conformance with recommendations from the American Academy of Ophthalmology's Preferred Practice Pattern for open-angle glaucoma. The criteria were operationalized for evaluation of three dimensions: (1) the performance of specified examination steps at the initial visit; (2) the performance of specified examination steps at follow-up; and (3) the time interval between follow-up visits. In a sample where 70% of patients had stable moderate to severe glaucomatous damage, documentation of examination findings on the initial visit ranged from 70% for a pupil examination to 100% for intraocular pressure. At the initial visit, visual fields were obtained or scheduled in 92% of eyes, gonioscopy in 85%, and the disc/nerve fiber layer status in 98%. On follow-up, 90% of patients had an optic nerve head drawing or photograph within 9 months of the most recent visit. Finally, 100% of patients were scheduled for follow-up within the time intervals recommended by the Preferred Practice Pattern. Unlike the situation with diabetic retinopathy and corneal ulcers, there appears to be a high rate of conformance with recommended patterns of care for patients with open-angle glaucoma in a public clinic setting. Additional data are needed from other practice settings and for other patterns of care to not only assess the quality of care but to help guide revisions in preferred practice patterns.