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Current practice trends of oedema management in the hands of people with tetraplegia in Australia.

ABSTRACT: Study design:Survey research design. Objectives:To describe current practice methods for oedema management in people with tetraplegia. Setting:Australia. Methods:Online survey with open and closed questions regarding clinical practice trends in the assessment and treatment of oedema in the hands in people with tetraplegia. Results:Seventeen occupational therapists working in spinal cord injury (SCI) in Australia completed the survey. Oedema was identified by visual inspection (n?=?17, 100%) and recorded using circumferential tape measurement (n?=?13, 76%). Elevation was used by all participants in conjunction with compression gloves (n?=?13, 76%), retrograde massage (n?=?13, 76%), compression bandaging (n?=?12, 71%) and the boxing glove splint (n?=?9, 53%). Participants stated that oedema presented challenges to patients with difficulty exercising (n?=?11, 65%), changes to body image (n?=?5, 29%) and pain (n?=?4, 24%). Conclusion:Assessment and treatment practices were not consistent. Oedema in the hands in people with tetraplegia was perceived to have various impacts on a person's rehabilitation and hand function. The findings highlight the need for research evidence to guide practice.

SUBMITTER: Oh S

PROVIDER: S-EPMC6786418 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Current practice trends of oedema management in the hands of people with tetraplegia in Australia.

Oh Soo S Gustafsson Louise L Eames Sally S

Spinal cord series and cases 20190807

<h4>Study design</h4>Survey research design.<h4>Objectives</h4>To describe current practice methods for oedema management in people with tetraplegia.<h4>Setting</h4>Australia.<h4>Methods</h4>Online survey with open and closed questions regarding clinical practice trends in the assessment and treatment of oedema in the hands in people with tetraplegia.<h4>Results</h4>Seventeen occupational therapists working in spinal cord injury (SCI) in Australia completed the survey. Oedema was identified by v ...[more]

PMID: 31632729

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Project description:Trends in bone mineral density monitoring, and drug treatment for osteoporosis, in Australia were examined. Rates of DEXA scanning have increased in response to changes to government policy affecting reimbursement. The drug denosumab is being utilised at an increasing rate, while bisphosphonate use has declined. Osteoporosis prevalence remained stable over the same timeframe, while rate of hip fractures declined, suggesting that introduction of osteoporosis screening was associated with a reduction in adverse osteoporosis outcomes, but may also have been associated with overutilisation.IntroductionRadiology interventions to diagnose and medications to manage osteoporosis in Australia are reimbursed under the Medicare benefits schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). Monitoring of these databases enables changes in utilisation of these practices to be monitored over time.MethodsThis study examined rates of utilisation for bone mineral density (BMD) measurement and osteoporosis pharmacotherapy subsidised under the MBS. Rates of osteoporosis and hip fracture were estimated using data reported by the Australian Bureau of Statistics (ABS) and Australian Institute for Health and Welfare (AIHW).ResultsRates of BMD measurement increased since the technology was first reimbursed, with changes to policy regarding reimbursement for screening for individuals over 70 leading to an increase in BMD measurement after 2007. Prescribing rates also increased over time, initially with the introduction of oral bisphosphonates and subsequently for denosumab, which has subsequently become the most commonly prescribed agent for osteoporosis management in Australia, while bisphosphonate use has declined. Osteoporosis prevalence in Australia has remained relatively static at 3-4% of the population since 2001 to 2017, while rates of minimal trauma hip fracture hospitalisations have declined from 195 per 100,000 to 174 per 100,000 in the same timeframe.ConclusionAvailable data indicates that osteoporosis screening rates changed over time from 2001 to 2018 and that changes to government policy had a significant effect on the rates at which screening was performed. Over the same timeframe, there was a sustained reduction in hip fracture hospitalisation rates, with no change to reported osteoporosis prevalence. This suggests that policy changes permitting unlimited access to BMD measurement were associated with a reduction in osteoporotic fractures, but may also have been associated with overutilisation. Prospective studies to assess the efficacy of specific policies to ensure screening is performed in accordance with best-practice guidelines may be desirable.

Project description:Objectives: For decades, the role of hospital pharmacists has been instrumental in elevating pharmacy practice worldwide. Recently, the Hospital Pharmacy Section of the International Pharmaceutical Federation (FIP), the European Association of Hospital Pharmacists (EAHP), and the American Society of Health-System Pharmacists (ASHP) updated their statements about the future role and responsibilities of the pharmacy executive in hospitals and health systems. A series of surveys were conducted around the globe to better understand the current state of hospital pharmacy practice. The purpose of these surveys was to identify challenges in hospital pharmacy practice and to develop improvement strategies. The objective of this national survey is to evaluate hospital pharmacy practice in Lebanon. Methods: A cross-sectional observational study was performed among pharmacists working in hospital settings in Lebanon, from January through June 2016. Based on a literature review, a questionnaire to elicit Lebanese hospital pharmacists' practice was developed. Results: The results showed a nonsignificant difference between university teaching and nonuniversity teaching hospitals in the processes of drug procurement, preparation, dispensing, and drug administration. However, statistically significant differences were observed between university teaching and nonuniversity teaching hospitals with respect to having clinical pharmacists (P < .001) and highly qualified personnel (P < .005). Pharmacy services in teaching hospitals seemed to be more advanced cooperating with affiliated medical schools. Furthermore, teaching hospitals were more likely to have pharmacists providing information about the safety of the medications used (P = .029). Although not statistically significant, there was a higher trend toward having a designated champion for medication safety (P = .052). Conclusion: The results of our survey showed that teaching hospitals were more compliant with the International Statements of Hospital Pharmacy Practice compared with nonteaching hospitals. There is room for improvement especially if the application of the accreditation standards for safe hospital pharmacy practice becomes mandatory for all hospitals, which is expected to standardize pharmacy practice and secure both medication and patient safety.

Project description:BACKGROUND:To describe pre-hospital, emergency department and acute care assessment and management practices of senior clinicians for patients with acute traumatic spinal cord injury (TSCI) across Australia; and to describe clinical practice variation. METHODS:We used a descriptive, cross-sectional study design to survey senior clinicians (greater than 10?years practice in this field) caring for patients with acute TSCI. The assessment, management and referral practices of prehospital, emergency department/trauma and surgical expert clinicians, across prehospital, early hospital care, diagnostic imaging and haemodynamic management were surveyed. RESULTS:We invited 95 eligible senior clinicians; the response rate was 75%. Survey findings demonstrated overall lack of awareness or consistent use of evidence based published guidelines; many clinicians following 'locally written' or 'no particular' guideline. Practitioners were conflicted across multiple areas including patient assessment and diagnosis, treatment and transport decisions. Reported spinal immobilisation practices differed substantially, as did target setting for blood pressure; the majority of clinicians actively monitored risk of respiratory deterioration. Specialist care consult and specialist service bed availability was reported as problematic by more than one third of clinicians. CONCLUSIONS:Unwarranted clinical practice variation is known to contribute to different health outcomes for patients with similar etiologies. Clinical practice guidelines offer evidence based, best practice standards, however are only effective if adopted throughout the healthcare system. Wide variability in acute care practices, pathways and timing to specialist centres for TSCI was evidenced by this survey despite seniority among clinicians. This devastating injury requires prompt, consistent, evidence based care from the moment of first responder. Improved outcomes for patients with TSCI would be more likely with standardised care across pre-hospital, emergency and acute care phases of care.

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Current practice trends of oedema management in the hands of people with tetraplegia in Australia.

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Current practice trends of oedema management in the hands of people with tetraplegia in Australia.

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