Audit of therapeutic interventions in inpatient children using two scores: are they evidence-based in developing countries?

BACKGROUND: The evidence base of clinical interventions in paediatric hospitals of developing countries has not been formally assessed. We performed this study to determine the proportion of evidence-based therapeutic interventions in a paediatric referral hospital of a developing country METHODS: The medical records of 167 patients admitted in one-month period were revised. Primary diagnosis and primary therapeutic interventions were determined for each patient. A systematic search was performed to assess the level of evidence for each intervention. Therapeutic interventions were classified using the Ellis score and the Oxford Centre for Evidence Based Medicine Levels of Evidence RESULTS: Any dehydration due to diarrhoea (59 cases) and pneumonia (42 cases) were the most frequent diagnoses. Based on Ellis score, level I evidence supported the primary therapeutic intervention in 21%, level II in 73% and level III in 6% cases. Using the Oxford classification 16%, 8%, 1% and 75% therapeutic interventions corresponded to grades A, B, C, and D recommendations, respectively. Overall, according to Ellis score, 94% interventions were evidence based. However, out of the total, 75% interventions were based on expert opinion or basic sciences. Most children with mild to moderate dehydration (52 cases) were inappropriately treated with slow intravenous fluids, and most children with non-complicated community acquired pneumonia (42 cases) received intravenous antibiotics CONCLUSIONS: Most interventions were inappropriate, despite the availability of effective therapy for several of them. Diarrhoeal dehydration and community acquired pneumonia were the most common diagnoses and were inappropriately managed. Existing effective interventions for dehydration and pneumonia need to be put into practice at referral hospitals of developing countries. For the remaining problems, there is the need to conduct appropriate clinical studies. Caution must be taken when assigning the level of evidence supporting therapeutic interventions, as commonly used classifications may be misleadin

Remote patient management for home dialysis patients

Remote Patient Management (RPM) offers renal health care providers and patients with end stage kidney disease (ESKD) opportunities to embrace home dialysis therapies with greater confidence and the potential to obtain better clinical outcomes. Barriers and evidence required to increase adoption of RPM by the nephrology community need to be clearly defined. Ten healthcare providers from specialties including nephrology, cardiology, pediatrics, epidemiology, nursing, and health informatics with experience in home dialysis and the use of RPM systems gathered in Vienna, Austria to discuss opportunities, barriers, and system requirements of RPM as it applies to the home dialysis patient. While improved outcomes and cost effectiveness of RPM have been demonstrated in patients with diabetes mellitus and heart disease, only observational data on RPM has been gathered in patients on dialysis. The current review focused on RPM systems currently in use, on how RPM should be integrated into future care, and the evidence needed for optimized implementation in order to improve clinical and economic outcomes. Randomized controlled trials and/or large observational studies could inform the most effective and economical use of RPM in home dialysis. These studies are needed to establish the value of existing and/or future RPM models among patients, policy makers, and healthcare providers

Congenital tracheal stenosis: Role of CT and high kV films

Congenital tracheal stenosis is an intrinsic narrowing of the tracheal lumen due to complete cartilaginous rings. We evaluated the role of the chest radiograph, high kV films, CT and bronchoscopy in five patients with congenital tracheal stenosis. CT was superior to chest radiography and high kV films in the evaluation of the presence and extent of the stenosis. CT was superior to bronchoscopy in the evaluation of the distal extent of the stenosis in two patients. In addition, CT is useful in ruling out external compression of the trachea by a mass or associated vascular anomaly.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46684/1/247_2006_Article_BF02388158.pd