Patient Care Resource Research Articles

Nursing Staff Talk: Resource or Obstacle for Forensic Psychiatric Patient Care?

Although forensic psychiatric care is located at the intersection of health care and the Swedish legal system, nursing research has not yet evaluated how language is context bound or its consequences for understanding patient care. The aim of this study was to explore how nursing staff talk about patient care in Swedish forensic psychiatric care and the implications for the care given to patients. The theoretical framework is based on social constructionism and sheds light on how language use can be understood as a social action. Twelve interviews were conducted with nursing staff working in forensic psychiatric settings. The questions focused on patient care in relation to activities, security, relationships with patients, and rules and routines. The results show that nursing staff assignments are encouraging them to use various interpretative repertoires to make meaning about their practice. The three interpretative repertoires were "taking responsibility for correcting patients' behavior," "justifying patient care as contradictory practice," and "patients as unpredictable." However, although forensic psychiatric care emphasizes both security and care, nursing staff's use of these interpretative repertoires provided multiple interpretations that lead to contradictory ways of understanding patient care. These findings show that talk itself can be understood as problematic in various situations. A possible implication for clinical forensic nursing practice might be that the nurse-patient relationship does not support patients' best interests. For example, when language endows the patient with certain characteristics, this talk is justified and given meaning by its context and thus has an influence on a patient's individual need for care.

Complexity of care of hospitalized older adults and its relationship with sociodemographic characteristics and functional independence

Abstract Objectives: To investigate the relationship between the complexity of care of hospitalized older adults and sociodemographic and functional independence characteristics. Method: A quantitative cross-sectional and descriptive study was carried out in the medical and surgical clinics of the University Hospital of the Universidade de São Paulo, in the state of São Paulo SP, Brazil. A total of 382 older adults were assessed through a socio-demographic inventory, the Mini Mental State Exam, the Katz Index of Independence in Activities of Daily Living and the Interdisciplinary Medicine Instrument Method. Results: The complexity of care of participants was associated with the female sex (p=0.003), not having a partner (p=0.003), having a lower income (p=0.022), cognitive decline (p<0.001) and dependence in basic activities of daily living (BADL) (p<0.001). In the multiple logistic regression model, variables such as the female sex (OR=1.76; p=0.018), dependence in one or more activities of daily living (OR=1.26; p<0.001) and cognitive decline (OR=3.31; p<0.001) remained associated with complexity of care. Conclusion: The complexity of care of hospitalized older adults, as it is associated with limitations in BADL and cognitive decline, requires actions by the interprofessional team to ensure the rehabilitation, integration of long-term care and planning of care resources for older patients. Thus, it is necessary to adopt integrated services that include home care and care networks for the elderly, in order to provide qualified post-hospital discharge care and promote the health of the hospitalized older population.

Understanding the Impact of Chronic Pain in the Emergency Department: Prevalence and Characteristics of Patients Visiting the Emergency Department for Chronic Pain at an Urban Academic Health Sciences Centre

ABSTRACT Background Canadians make approximately 16 million visits to the emergency department (ED) each year. ED visits for non-urgent reasons contribute to suboptimal patient care and ineffective resource use. Aims To estimate the proportion of ED visits related to chronic pain at our institution. Methods. We conducted a retrospective review of 1000 randomly selected ED visits at TOH during the 2012–2013 fiscal year (April 1, 2012 to March 31, 2013). Visits for chronic pain were identified using pre-defined criteria. Demographic and medical data were extracted from medical charts. Results 104 visits during this time period were related to chronic pain (10.4%; 95% CI: 8.2–12.6). All visits were from unique patients (i.e., no patients contributed more than 1 visit). Patients were predominantly women (71%), with a mean age of 45.9 years. Seventy-eight percent of patients had a primary care provider. The most common location of pain included the abdomen (24%), the head or face (21%), and the low back (21%). Only 5% of patients had consultation with a pain medicine specialist while 78% were awaiting a consultation. More than 2/3 of patients (71%) reported using opioids for their pain. Conclusion Presenting to the ED for chronic pain was found to occur among a sample of ED visits reviewed. This can result in ineffective care for patients with chronic pain. Cost-effective solutions to improve clinical outcomes and reduce ED use for chronic pain may yield significant improvements in health outcomes of patients and benefits for the health care system.

Validation of the Korean criteria for trauma team activation.

ObjectiveWe conducted a study to validate the effectiveness of the Korean criteria for trauma team activation (TTA) and compared its results with a two-tiered system.MethodsThis observational study was based on data from the Korean Trauma Data Bank. Within the study period, 1,628 trauma patients visited our emergency department, and 739 satisfied the criteria for TTA. The rates of overtriage and undertriage in the Korean one-tiered system were compared with the two-tiered system recommended by the American College of Surgery-Committee on Trauma.ResultsMost of the patient’s physiologic factors reflected trauma severity levels, but anatomical factors and mechanism of injury did not show consistent results. In addition, while the rate of overtriage (64.4%) was above the recommended range according to the Korean criteria, the rate of undertriage (4.0%) was within the recommended range. In the simulated two-tiered system, the rate of overtriage was reduced by 5.5%, while undertriage was increased by 1.8% compared to the Korean activation system.ConclusionThe Korean criteria for TTA showed higher rates of overtriage and similar undertriage rates compared to the simulated two-tier system. Modification of the current criteria to a two-tier system with special considerations would be more effective for providing optimum patient care and medical resource utilization.

Human resource management in Australian hospitals: the role of controls in influencing the effectiveness of performance management systems

This study examines the association between two aspects of HRM, the use of controls (beliefs, interactive, boundary, diagnostic) and the effectiveness of performance management systems (PMSs), which are assessed in respect to the achievement of process outcomes and hospital performance. The findings indicate that the achievement of process outcomes (both performance-related and staff-related outcomes) mediates the relationship between controls and hospital performance. Specifically, the achievement of performance-related outcomes mediates the associations between belief systems and the use of diagnostic controls with hospital performance (medical facilities), and the achievement of staff-related outcomes mediates the association between the use of diagnostic controls with the support facilities and effectiveness dimensions of hospital performance. In addition, the use of specific controls exhibits a direct impact on hospital performance with beliefs systems directly positively associated with all five hospital performance dimensions, the use of interactive controls positively associated with three dimensions (medical facilities, patient care, and staff resources), the diagnostic use of controls associated with the patient care dimension, and boundary controls positively associated with all dimensions of hospital performance except staff resources. The findings inform hospital management of their significant role in incorporating these HRM practices to effectively manage the workplace in hospitals.

Should Spinal MRI Be Routinely Performed in Patients With Clinically Isolated Optic Neuritis?

Should Spinal MRI Be Routinely Performed in Patients With Clinically Isolated Optic Neuritis?

How to optimize critical care resources in surgical patients: intensive care without physical borders

Timely identification of surgery patients at risk of postoperative complications is important to improve the care process, including critical care. This review discusses epidemiology and impact of postoperative complications; prediction scores used to identify surgical patients at risk of complications, and the role of critical care in the postoperative management. It also discusses how critical care may change, with respect to admission to the ICU. Optimization of postoperative outcome, next to preoperative and intraoperative optimization, consists of using risk scores to early identify patients at risk of developing complications. Critical care consultancy should be performed in the ward after surgery, if necessary. ICUs could work at different levels of intensity, but remain preferably multidisciplinary, combining care for surgical and medical patients. ICU admission should still be considered for those patients at very high risk of postoperative complications, and for those receiving complex or emergency interventions. To optimize critical care resources for surgery patients at high risk of postoperative complications, the care process should not only include critical care and monitoring in ICUs, but also strict monitoring in the ward. Prediction scores could help to timely identify patients at risk. More intense care (monitoring) outside the ICU could improve outcome. This concept of critical care without borders could be implemented in the near future to optimize the local resources and improve patient safety. Predict more, do less in ICUs, and more in the ward.

Understanding and evaluating new models of Child and Adolescent Mental Health Services in South-East England: a study protocol for an observational mixed-methods study

IntroductionIncreased demand for Child and Adolescent Mental Health Services (CAMHS), alongside concerns that services should be better commissioned to meet the needs of the most vulnerable, has contributed to a...

Quality of Care Indicators in Patients with Sickle Cell Disease (SCD): Influenza Vaccination and Routine Eye Examination Are Associated with Outpatient Utilization but Not Acute Hospital Care, Whereas Comorbidity Indexes Are Strongly Associated with Both

Although SCD-related mortality has improved over the last 3 decades, mortality from acute pulmonary causes remains relatively unchanged.(Payne, 2017)Acute chest syndrome (ACS) occurs in patients with SCD of all ages and influenza infection is one of its cause. Although influenza vaccination is recommend by the CDC for patients with SCD, and was proposed as a quality of care indicator(Wang CJ, 2010), its use is not mentioned in 2014 SCD NIH guidelines. This study examined influenza vaccination in patients with SCD as a potential marker of quality of care delivery. The study population included black individuals aged 1 to < 60 years, continuously enrolled on Medicaid from January 1 2008 until July 31 2009 in Georgia (CMS Data Use Agreement: 25585) to identify disparities in influenza vaccination uptake among Medicaid enrollees with a diagnosis of SCD. Patients with one inpatient claim or two outpatient claims with an ICD-9 code for SCD were considered to have a diagnosis of SCD. The association between influenza vaccination and health care utilization was measured by logistic regression models. Outcomes included: outpatient visits (<median outpatient visits versus >=median outpatient visits), emergency department (ED) visit or any hospitalization and influenza specific hospitalization during the study period. The fully adjusted models included the following covariates: age, gender, rural status, residing in two index counties (Fulton, Rockdale; a state sponsored SCD center is located in Fulton county), eye examination (as per SCD NIH guidelines), Elixhauser and a SCD comorbidity index. For the SCD comorbidity index, a score of one was given for each of the following 5 groups of sickle cell disease complications: CNS complications (>=1 diagnosis of stroke, TIA or epilepsy/recurrent seizures); cardio pulmonary complications (>=1 diagnosis of chronic pulmonary heart disease, pulmonary hypertension, malaise and fatigue, edema, chest pain or hypoxemia); kidney disease (>=1 diagnosis of chronic kidney disease/renal failure, proteinuria), avascular necrosis or ulcer of lower limbs (adapted from Afenyi-Annan, 2008, Candrilli. 2011, Elmariah. 2014). A total of 1544 patients with SCD were included in the study. Having influenza vaccination (aOR=1.77, p-value=0.004) and eye examination (aOR=1.74, p-value=0.0004) were significantly associated with higher number of outpatient visits. There was no statistically significant association between receipt of influenza vaccination with ED visits and hospitalizations. Hospitalizations for influenza were also not significantly associated with vaccination status, possibly due to ineffectiveness of the vaccine during the 2009 H1N1 pandemic. Women were more likely to be seen as outpatients or to be hospitalized when compared to men. No gender differences were observed in ED visits. Residence in a poor or rural county had no significant association with health care utilization. A modest decrease in ED utilization was noted among patients not residing in the two index counties (OR=0.71, p-value=0.045). Both comorbidity indices were strongly associated with increased healthcare utilization. Strength of association between the Elixhauser index and hospital admissions was greater than with outpatient visits, whereas the reverse was noted with the SCD index (Elixhauser index score >=2 outpatient aOR=6.8, p-value <.0001, ED aOR=4.07, p-value <.0001, ED aOR=23.65, p-value <.0001; SCD index score >=1 outpatient aOR=4.20, p-value <.0001, ED aOR=2.82, p-value <.0001, ED aOR=2.57, p-value <.0001). Although adult age was strongly associated with utilization in unadjusted models, it was not significant in the fully adjusted models. This suggests that increases in utilization observed when children transition to adulthood may be driven by increasing disease severity over time. In conclusion, outpatient-based candidate quality indicators of care examined (influenza vaccination and eye examination), were associated with increased outpatient utilization, but not acute visits or hospitalizations. Co-morbidity indexes have significant confounding effects on outpatient and hospital utilization. Administrative data based quality indicators of care such as influenza vaccination, as well as SCD specific comorbidity indexes warrant further studies as these may help better understand optimal allocation of health care resources for patients with SCD. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

DeepTag: inferring diagnoses from veterinary clinical notes

Large scale veterinary clinical records can become a powerful resource for patient care and research. However, clinicians lack the time and resource to annotate patient records with standard medical diagnostic codes and most veterinary visits are captured in free-text notes. The lack of standard coding makes it challenging to use the clinical data to improve patient care. It is also a major impediment to cross-species translational research, which relies on the ability to accurately identify patient cohorts with specific diagnostic criteria in humans and animals. In order to reduce the coding burden for veterinary clinical practice and aid translational research, we have developed a deep learning algorithm, DeepTag, which automatically infers diagnostic codes from veterinary free-text notes. DeepTag is trained on a newly curated dataset of 112,558 veterinary notes manually annotated by experts. DeepTag extends multitask LSTM with an improved hierarchical objective that captures the semantic structures between diseases. To foster human-machine collaboration, DeepTag also learns to abstain in examples when it is uncertain and defers them to human experts, resulting in improved performance. DeepTag accurately infers disease codes from free-text even in challenging cross-hospital settings where the text comes from different clinical settings than the ones used for training. It enables automated disease annotation across a broad range of clinical diagnoses with minimal preprocessing. The technical framework in this work can be applied in other medical domains that currently lack medical coding resources.

Establishing Accra Population-Based Cancer Registry

Background: The African Cancer Organization (ACO) seeks to establish Accra Population-Based Cancer Registry (ACR). The whole idea is to collect, store and analyze data on persons with cancer to provide complete, accurate and timely cancer report for interventional programs. Such information would guide us to monitor patient care, prioritize and allocate resources effectively, give understanding of the things we do not yet know, and also act as a driver for policy development for the urgent need of comprehensive cancer control in Ghana. Countries require cancer surveillance programs to collect and analyze data on the scale of the cancer burden in each country. These are urgently needed in Africa as cancer data sources are scarce. Data can help to evaluate the impact of prevention, early detection/screening, treatment and palliative care programs. The proposed population-based cancer registry will help to act as a driver for policy development and program evaluation as recommended by the WHO. ACR intends to capture cancer cases diagnosed and/or treated within the Greater Accra region of Ghana and then further extend to cover the Central, Eastern, Western and the Volta regions of Ghana later. Aim: The goal of ACR to collect, store and analyze data on persons with cancer to generate incidence, prevalence, trends, mortality, and survival rates which is required to help develop a realistic and sustainable cancer control plan for Ghana. Methods: Cancer registry staff will be trained to abstract cancer cases diagnosed and/or treated within the southern regional geography of Ghana using a customized cancer notification form designed to capture detailed information on cancer patient demographics, tumor details, treatment, reporting sources and follow-up information based on both analytic and nonanalytic active case-finding reportability methods. These cases will then be classified and coded using the ICD-O-3, FIGO and/or SEER Summary Staging 2000 Manual. The data will be stored in customized cancer registry software which will be configured with various address codes from the registry geography. The cancer registry software checks for duplicate cases, data edits and consolidation. The software tracks down duplicate records and multiple primaries using a probability matching and consistency checking for impossible or rare cases. Conclusion: Establishing a cancer registry in Africa is challenging but very possible. Conflicts of interests are common norms among new cancer registries. With a good budget and working plan backed by few sincere and dedicated staff, it will be very possible to sustain the registry to capture all cancer cases within the catchment area, to take advantage of available modern technology to produce timely results. ACO is by this seeking for partnership to raise the needed support to embark on this national cancer registry campaign in the region.

Use of internet as health information resource by community pharmacists in Nigeria

PurposeThe internet has become one of the most commonly used sources for medical and health information. Research that explored the extent to which Nigerian community pharmacists use internet resources for patient care is limited. This study aims to examine the extent to which community pharmacists use the internet for professional practice.Design/methodology/approachData were collected using a questionnaire which was completed by 115 community pharmacists using convenience sampling technique. Descriptive and inferential statistics were used for data analysis.FindingsThe results revealed that community pharmacists use a variety of online resources, although only about 25 per cent or less use each of the online resources. The critical challenges that hinder their use of the internet were inadequate power supply, lack of funds to procure personal internet facilities, among others. There is significant relative contribution of demographic variables (gender, age, educational qualification and number of years in professional practice) on frequency of internet use among community pharmacists.Practical implicationsThe Association of Community Pharmacists of Nigeria (ACPN), Lagos Chapter, should organize continuing professional education for their members to expose them to online resources and emerging trends in professional practice. The community pharmacist should also address the problem of inadequate communication with patients by stepping up communication with the patients about their drug therapy not only through the conventional media but also through internet facilities such as email, WhatsApp and so on.Originality/valueThis study examined the extent to which community pharmacists use the internet for professional activities. This study also empirically investigated the significant relative contribution of demographic variables (gender, age, educational qualification and number of years in professional practice) on the frequency of internet use among community pharmacists.

Should Emergency Department Patients with End-of-Life Directives be Admitted to the ICU?

BackgroundWhether emergency physicians should utilize critical care resources for patients with advance care planning directives is a complex question. Because the cost of intensive care unit (ICU)-level care, in terms of human suffering and financial burden, can be considerable, ICU-level care ought to be provided only to those patients who would consent and who would benefit from it. ObjectivesIn this article, we discuss the interplay between clinical indications, patient preferences, and advance care directives, and make recommendations about what the emergency physician must consider when deciding whether a patient with an advance care planning document should be admitted to the ICU. DiscussionAlthough some patients may wish to avoid certain aggressive or invasive measures available in an ICU, there may be a tendency, reinforced by recent Society of Critical Care Medicine guidelines, to presume that such patients will not benefit as much as other patients from the specialized care of the ICU. The ICU still may be the most appropriate setting for hospitalization to access care outside of the limitations set forward in those end-of-life care directives. On the other hand, ICU beds are a scarce and expensive resource that may offer aggressive treatments that can inflict suffering onto patients unlikely to benefit from them. Goals-of-care discussions are critical to align patient end-of-life care preferences with hospital resources, and therefore, the appropriateness of ICU disposition. ConclusionsEnd-of-life care directives should not automatically exclude patients from the ICU. Rather, ICU admission should be based upon the alignment of uniquely beneficial treatment offered by the ICU and patients’ values and stated goals of care.

The current evidence base for the feasibility of 48-hour continuous subcutaneous infusions (CSCIs): A systematically-structured review.

BackgroundA continuous subcutaneous infusion (CSCI) is an effective method of multiple drug administration commonly encountered in end of life care when the oral route is compromised. At present, current practice is to limit syringe driver infusion time to a maximum of 24 hours as dictated by available chemical stability data. However, the ability to deliver prescribed medication by a CSCI over 48 hours may have numerous benefits in both patient care and health service resource utilisation.AimTo examine and present the current evidence base for the stability of 48-hour multiple-drug CSCIs in current clinical practice.DesignA systematically-structured review following PRISMA guidelines.Data sourcesThree electronic databases and the grey literature were searched with no time limits. Empirical studies reporting data on the chemical stability of continuous subcutaneous infusions or solutions stored in polypropylene syringes were included.ResultsTwenty-one empirical studies were included in this review reporting chemical compatibility and stability of 32 discrete combinations of twenty-four drugs tested at a variety of different drug concentrations. The majority of combinations reported were assessed as being chemically compatible. The greatest risk of clinically significant chemical degradation was observed with midazolam. Only one study reported the microbiological stability of the solution examined.ConclusionsThere is currently limited evidence for the physical, chemical and microbiological stability of solutions for continuous subcutaneous infusion over a period of 48 hours. More stability data is required before the use of 48-hour CSCIs can be evaluated for use within clinical practice.

Institutional Factors Affecting Utilization of Nursing Process among Nurses in Selected Public Health Care Facilities in Kenya

The nursing process is a systematic and scientific approach which is interpersonal and collaborative, with an aim of providing quality care to clients. It involves interaction between the nurse and other health care providers like the doctors, nutritionist and physiotherapists among other health care providers. The patient care approach is also universally applicable since it remains the same in whatever level or institution where it is being applied. This is made possible by the use of common nursing language and similar nursing terminologies worldwide. Despite all these advantages, utilization of the nursing process in various healthcare facilities is still quite poor, hence the current study to determine the institutional factors that influenced utilization of nursing process among the nurses in Kenya. In this study, the cross-sectional study design was used to collect data from 249 nurses who were sampled from five randomly selected health care facilities in Kenya. The data was collected using both qualitative and quantitative methods and descriptive analysis computed using STATA version 14.4 data analysis software to generate frequencies on the various responses from the study participants. The results identified various institutional factors that influenced utilization of nursing process among the respondents. These included heavy workload, shortage of nursing staff and lack of patient care resources to enable utilization of the nursing process. Other factors included poor staff motivation, lack of feedback after seminars and poor supportive supervision from the senior nurses. These called for measures to be implemented to promote utilization of the nursing process in the health care facilities in Kenya. The measures included employment of more nurses to reduce the workload and also a provision of patient care resources.

Predictive factors influencing complications and length of stay in fractured neck of femur patients

Purpose: Increased length of hospital stay has a multitude of detrimental effects on patient care and NHS resources. We wanted to explore if we could predict which patients were likely to have longer length of stay (LOS) after admission with fractured neck of femur (#NOF).

What is happening to clinical negligence claims in the NHS?

The National Health Service Litigation Authority (NHSLA) was rebranded as National Health Service Resolution, or NHSR, on 03 April 2017. The stated aim of the rebranding process, according to the National Health Executive (NHE),1 is to combine the three operating arms of NHSLA, the National Clinical Assessment Service, and the Family Health Service Appeals Unit in order “to assist the NHS to resolve litigation concerns fairly, as well as share lessons learnt to improve clinical practice and preserve resources for patient care.” The NHE document points out that “Central to the change is the need for trusts across the country to learn from litigation cases and share experiences.” What then can we learn from the latest report on clinical negligence claims in the NHS, published this year by NHSR?2 During the last year, 17 338 claims were settled. In 67.8% (11 759) of those claims, resolution was achieved without issue of formal court proceedings. Damages were paid in 5226 cases (30.1%), and no damages were paid in 6533 cases (37.7%). In the former group, one assumes that the evidence for liability was clear, with compensation being paid for commercial or other reasons. Formal court proceedings were issued in 5498 claims (31.5%), with 4400 (25.4%) resulting in damages being paid and 1058 (6.1%) resulting in no damages. It is interesting that, of the 17 338 settled claims, only 121 (0.7%) ended up in court, with 49 (0.3%) resulting in payment of damages and 72 (0.4%) successfully defended. The projected expenditure for settlement of negligence claims in 2017/18 is £1.95 billion, representing a 17.5% increase compared with that of 2016/17. This latest increase does not take into account the effect of the change in the discount rate from 2.5% to -0.75% in March 2017.3 This affects the value placed on future losses …

Comfort Discussing HIV Pre-Exposure Prophylaxis with Patients Among Physicians in an Urban Emergency Department

BackgroundHIV pre-exposure prophylaxis (PrEP) is effective but underutilized in the United States. The emergency department offers an opportunity to access at-risk individuals for PrEP referral. While several studies have described provider awareness and acceptance of PrEP, these studies have focused largely on infectious diseases, HIV, and primary care specialty physicians. Thus, PrEP awareness, knowledge, and concerns among emergency physicians remain unknown. We sought to determine provider comfort in discussing PrEP with patients among emergency physicians in Missouri.MethodsWe conducted an online survey among 88 emergency physicians at Washington University in St. Louis from February 2017 to March 2017 in St. Louis, Missouri. The survey included demographics, comfort discussing PrEP, having ever heard of PrEP (awareness), knowledge of the current CDC prescribing guidelines, concerns with use, and knowing local PrEP referral information. The questions were asked on a Likert scale and dichotomously categorized. We evaluated predictors of physician comfort of discussing PrEP with patients using multiple logistic regression.ResultsSixty-seven participants completed the survey; 64.1% were faculty. Most (79.1%) were PrEP aware, however, only 23.9% were knowledgeable of current guidelines and 22.7% of referral information. Concerns included lack of efficacy (53.7%), side effects (89.6%), and the selection for HIV resistance (70.1%). Comfort discussing PrEP was 43.3%. When adjusting for the concern of efficacy, having PrEP knowledge (OR: 5.43; CI: 1.19–30.81) and having referral knowledge (OR: 7.82; CI: 1.93–40.98) were significantly associated with comfort in discussing PrEP.ConclusionWe found moderate PrEP awareness among emergency physicians, but also high levels of discomfort in discussing PrEP with their patients. Future provider training should include addressing misinformation surrounding the concerns with PrEP use and prescribing, reviewing current guidelines, and providing local referral resources for PrEP patient care. Emergency department settings can facilitate PrEP awareness and referral to care among at-risk patients to help reduce national HIV incidence.Disclosures All authors: No reported disclosures.

Examining the role of MEDLINE as a patient care information resource: an analysis of data from the Value of Libraries study

Objective:This study analyzed data from a study on the value of libraries to understand the specific role that the MEDLINE database plays in relation to other information resources that are available to health care providers and its role in positively impacting patient care.Methods:A previous study on the use of health information resources for patient care obtained 16,122 responses from health care providers in 56 hospitals about how providers make decisions affecting patient care and the role of information resources in that process. Respondents indicated resources used in answering a specific clinical question from a list of 19 possible resources, including MEDLINE. Study data were examined using descriptive statistics and regression analysis to determine the number of information resources used and how they were used in combination with one another.Results:Health care professionals used 3.5 resources, on average, to aid in patient care. The 2 most frequently used resources were journals (print and online) and the MEDLINE database. Using a higher number of information resources was significantly associated with a higher probability of making changes to patient care and avoiding adverse events. MEDLINE was the most likely to be among consulted resources compared to any other information resource other than journals.Conclusions:MEDLINE is a critical clinical care tool that health care professionals use to avoid adverse events, make changes to patient care, and answer clinical questions.

Deep Venous Procedures Performed in the National Health Service in England between 2005 and 2015

Recent advances in imaging technology and endovenous interventions have revolutionised the management of specific groups of patients with deep venous pathology. This study aimed to examine data published by Hospital Episode Statistics (HES) to assess trends in the number of endovascular and open surgical deep venous procedures performed in National Health Service (NHS) hospitals in England between 2005 and 2015. The main diagnosis of deep venous thrombosis (DVT), and total number of primary open and percutaneous procedures for deep venous pathology for patients admitted to the NHS hospitals in England from 2005 to 2015 were retrieved from the HES database and analysed. An overall declining trend in the annual number of admissions for a primary diagnosis of DVT was observed (linear regression r2= 0.9, p<.0001). The number of open surgical procedures for removal of thrombus remained largely unchanged (range 26-70); the frequency of percutaneous procedures increased steadily over the study period (range 0-311). The number of open surgical procedures relating to the vena cava fell between 2005 and 2009, and remained around 50 per year thereafter. Annual numbers of cases of deep venous bypass (range 17-33) and venous valve surgery (range 8-47) remained similar in trend over this period. The number of vena cava stent (range 0-405), other venous stent (range 0-316), and percutaneous venoplasty (range 0-972) procedures increased over the first 5 years of the study period. There is an increasing trend in relation to endovenous procedures but not open surgery, being carried out for deep venous pathology in the last decade in NHS hospitals in England. Despite a number of limitations with HES, the increase in the number of endovenous procedures shown is likely to have significant implications for the provision of care and healthcare resources for patients with deep venous pathology.