Safer clinical systems : interim report, August 2010

Safer Clinical Systems is the Health Foundation’s new five year programme of work to test and demonstrate ways to improve healthcare systems and processes, to develop safer systems that improve patient safety. It builds on learning from the Safer Patients Initiative (SPI) and models of system improvement from both healthcare and other industries. Learning from the SPI highlighted the need to take a clinical systems approach to improving safety. SPI highlighted that many hospitals struggle to implement improvement in clinical areas due to inherent problems with support mechanisms. Clinical processes and systems, rather than individuals, are often the contributors to breakdown in patient safety. The Safer Clinical Systems programme aimed to measure the reliability of clinical processes, identify defects within those processes, and identify the systems that result in those defects. Methods to improve system reliability were then to be tested and re-developed in order to reduce the risk of harm being caused to patients. Such system-level awareness should lead to improvements in other patient care pathways. The relationship between system reliability and actual harm is challenging to identify and measure. Specific, well-defined, small-scale processes have been used in other programmes, and system reliability has been shown to have a direct causal relationship with harm (e.g. care bundle compliance in an intensive care unit can reduce the incidence of ventilator-associated pneumonia). However, it has become evident that harm can be caused by a variety of factors over time; when working in broader, more complex and dynamic systems, change in outcome can be difficult to attribute to specific improvements and difficulties are also associated with relating evidence to resulting harm. The overall aim of Phase 1 of the Safer Clinical Systems programme was to demonstrate proof-of-concept that using a systems-based approach could contribute to improved patient safety. In Phase 1, experienced NHS teams from four locations worked together with expert advisers to co-design the Safer Clinical Systems programme

2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs

This report represents a scientific and working clinical consensus statement on seizure management in dogs based on current literature and clinical expertise. The goal was to establish guidelines for a predetermined, concise, and logical sequential approach to chronic seizure management starting with seizure identification and diagnosis (not included in this report), reviewing decision‐making, treatment strategies, focusing on issues related to chronic antiepileptic drug treatment response and monitoring, and guidelines to enhance patient response and quality of life. Ultimately, we hope to provide a foundation for ongoing and future clinical epilepsy research in veterinary medicine

Eltrombopag for the treatment of chronic idiopathic (immune) thrombocytopenic purpura : A Single Technology Appraisal

Evidence Review Group (ERG) final report for the National Institute for Health and Clinical ExcellencePublisher PD

Probable Early-Onset Alzheimer's Disease in an Apolipoprotein E2 Homozygote

Objective: To describe a case of early-onset Alzheimer's disease (AD) in an apolipoprotein (Apo) epsilon 2/epsilon 2 homozygote. Background: Apo epsilon 2/epsilon 2 is the rarest of the ApoE genotypes, representing only 1.4% of the population. Cognitive decline in ApoE epsilon 2 homozygotes has rarely been reported. Case Report/Methods: We report a 58-year-old Apo epsilon 2/epsilon 2 female who meets clinical criteria for probable AD as confirmed by neuropsychological testing, positron emission/computed tomography scan, CSF analysis and genetic screening for known mutations. Results: The clinical course is typical of AD, with progressive cognitive and functional decline. Conclusion: Clinically confirmed early-onset AD is atypical in ApoE2 homozygotes but can occur. Copyright (C) 2010 S. Karger AG, Base

Changes in the 2017 Pediatric Hypertension Clinical Guidelines.

The clinical practice guidelines on diagnosis and management of high blood pressure in children and adolescents have been periodically modified and updated since the original publication in 1977.1 Since the last pediatric blood pressure guideline was published in 2004, known as the Fourth Report,2 the literature on child BP and hypertension has expanded considerably. There has been a recognized need to update the Fourth Report for several years. However, the National Heart, Lung, and Blood Institute (NHLBI) who sponsored previous pediatric BP guidelines announced that NHLBI would no longer sponsor development of new clinical guidelines.3 Subsequently, in 2014 the American Academy of Pediatrics (AAP) agreed to sponsor development of a new pediatric BP clinical practice guideline (CPG). The new CPG for screening and management of high BP in children and adolescents was recently published in Pediatrics.4 This CPG was developed using the rigorous evidence-based approach recommended by the Institute of Medicine in 2011.5 This methodology was consistent with recent NHLBI recommendations on development of CPGs for cardiovascular disease.3 The new pediatric hypertension CPG contains several modifications from the previous guideline to guide clinicians in diagnosis and management of elevated BP and hypertension in children and adolescents. This summary describes those changes made since the 2004 Fourth Report

Review of Positron Emission Tomography at Royal Prince Alfred Hospital, CHERE Project Report No 18

This report is a review of the clinical uses, impacts on clinical management, clinical outcome and resource use of Positron Emission Tomography (PET) at Royal Prince Alfred Hospital (RPAH).Positron emission tomography