scholarly journals The Romanian Society of Internal Medicine’s Choosing Wisely Campaign

2019 ◽  
Vol 57 (2) ◽  
pp. 181-194
Author(s):  
Caterina Delcea ◽  
Camelia Badea ◽  
Ciprian Jurcut ◽  
Adrian Purcarea ◽  
Silvia Sovaila ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Scientific Evidence ◽  
Early Mobilization ◽  
Hemoglobin Concentration ◽  
Diagnostic Procedures ◽  
Bed Rest ◽  
Convincing Evidence ◽  
Choosing Wisely ◽  
Motor Vehicles ◽  
European Federation

Abstract Quality of care in medicine is not necessarily proportional to quantity of care and excess is often useless or even more, potentially detrimental to our patients. Adhering to the European Federation of Internal Medicine’s initiative, the Romanian Society of Internal Medicine (SRMI) launched the Choosing Wisely in Internal Medicine Campaign, aiming to cut down diagnostic procedures or therapeutics overused in our country. A Working Group was formed and from 200 published recommendations from previous international campaigns, 36 were voted as most important. These were submitted for voting to the members of the SRMI and posted on a social media platform. After the two voting rounds, the top six recommendations were established. These were: 1. Stop medicines when no further benefit is achieved or the potential harms outweigh the potential benefits for the individual patient. 2. Don’t use antibiotics in patients with recent C. difficile without convincing evidence of need. 3. Don’t regularly prescribe bed rest and inactivity following injury and/or illness unless there is scientific evidence that harm will result from activity. Promote early mobilization. 4. Don’t initiate an antibiotic without an identified indication and a predetermined length of treatment or review date. 5. Don’t prescribe opioids for treatment of chronic or acute pain for sensitive jobs such as operating motor vehicles, forklifts, cranes or other heavy equipment. 6. Transfuse red cells for anemia only if the hemoglobin concentration is less than 7 g/dL or if the patient is hemodynamically unstable or has significant cardiovascular or respiratory comorbidity. Don’t transfuse more units of blood than absolutely necessary.

scholarly journals MOBILIZAÇÃO PRECOCE EM CRIANÇAS CRITICAMENTE DOENTES: UMA REVISÃO INTEGRATIVA

2019 ◽  
Vol 8 (2) ◽  
pp. 1-13
Author(s):  
Susana Lígia Da Silva Rodrigues ◽  
Bárbara Carla De Araújo Rodrigues ◽  
Eliza Juliana Da Costa Eulálio ◽  
Renata Cavalcanti Farias ◽  
Andressa Bomfim Lugon Favero
Keyword(s):  
Critically Ill ◽  
Scientific Evidence ◽  
Adult Population ◽  
Pediatric Intensive Care ◽  
Early Mobilization ◽  
Bed Rest ◽  
Critically Ill Children ◽  
Critical Patients ◽  
Therapeutic Activities ◽  
Critical Ill

RESUMO A mobilização precoce vem se destacando na última década por ser uma estratégia alternativa para minimizar os efeitos deletérios do imobilismo no leito no paciente crítico. Consiste de atividades terapêuticas progressivas que se iniciam logo após a estabilização das alterações fisiológicas do paciente e oferece benefícios a curto, médio e longo prazo. Vários trabalhos evidenciam seus efeitos na população adulta, entretanto, pesquisas feitas com crianças são escassas. Objetivo: Verificar e reunir as evidências científicas disponíveis na literatura sobre mobilização precoce em crianças criticamente doentes. Metodologia: Trata-se de uma revisão sistemática de literatura do tipo integrativa, por meio da busca de artigos científicos nas bases de dados SciELO, BVS e PubMed, utilizando os descritores “children”, “critical ill”, “early mobilization”, “pediatrics” e “rehabilitation”, nos idiomas português e inglês, com textos completos publicados entre os anos de 2013 e 2018. Resultados: Foram encontrados 183 artigos elegíveis, dos quais 9 foram selecionados para serem revisados. Os trabalhos abordaram, principalmente, as barreiras, os benefícios, a segurança e a viabilidade da mobilização precoce nas Unidades de Terapia Intensiva Pediátricas (UTIPs), bem como o envolvimento do fisioterapeuta na reabilitação precoce da criança criticamente doente. Conclusões: A mobilização precoce é segura, viável, oferece poucos riscos ao paciente, favorece o aumento da mobilidade das crianças e pressupõe um menor tempo de internação. O fortalecimento da equipe multidisciplinar pode contribuir para a implementação da mobilização precoce em UTIPs. PALAVRAS-CHAVE: Criança; Doença Crítica; Mobilização Precoce; Reabilitação.EARLY MOBILIZATION IN CRITICALLY ILL CHILDREN: A INTEGRATIVE REVIEWABSTRACTEarly mobilization has been highlighted in the last decade as an alternative strategy to minimize the deleterious effects of bed rest in critical patients. It consists of progressive therapeutic activities that begin soon after stabilizing the physiological changes of the patient and offers benefits in the short, medium and long term. Several studies show its effects on the adult population, however, research on children is scarce. Objective: To verify and gather the scientific evidence available in the literature on early mobilization in critically ill children. Methodology: This is a systematic review of literature of the integrative type, through the search of scientific articles in the SciELO, BVS and PubMed, using the descriptors "children", "critical ill", "early mobilization", "pediatrics" and "rehabilitation", in Portuguese and English, with full texts published between 2013 and 2018. Results: 183 eligible articles, of which 9 were selected for review. The work focused on the barriers, benefits, safety and feasibility of early mobilization in Pediatric Intensive Care Units (PICUs), as well as the involvement of the physiotherapist in the early rehabilitation of critically ill children. Conclusions: Early mobilization is safe, viable, offers few risks to the patient, favors the increase of children’s mobility and presupposes a shorter hospitalization time. The strengthening of the multidisciplinary team can contribute to the implementation of early mobilization in PICUs.KEYWORDS: Child; Critical Illness; Early Mobilization; Rehabilitation.

An Insight Into Unani Hypoglycemic Drugs And Their Mechanism of Action

2019 ◽  
Vol 05 ◽  
Author(s):  
Sadia Nikhat ◽  
Mohd. Fazil
Keyword(s):  
Adverse Events ◽  
Scientific Evidence ◽  
Public Health Problem ◽  
Convincing Evidence ◽  
Major Public Health Problem ◽  
Significant Activity ◽  
Preparation Methods ◽  
Diabetes Mellitus Type Ii ◽  
Unani Medicine ◽  
Action Mechanisms

Background: Diabetes mellitus type-II is a major public health problem characterized by hypo-insulinemia and insulin resistance leading to hyperglycemia and its complications. In Unani medicine, it is known as ziyābetus. Several drugs are prescribed in Unani medicine as single and compound formulations for various abnormalities caused by the disease. Most of these drugs have been studied on scientific parameters and have shown significant activity in reducing the symptoms and complications of diabetes. Objectives: The literature research was planned with the objective to find out the action mechanisms of certain selected herbal drugs of Unani medicine, with evidence of their efficacy. Methods: Unani literature was first reviewed extensively and the most frequently-prescribed and easily available drugs for diabetes were selected, followed by a search on major internet search engines for scientific evidence of their efficacy alongwith information of their active ingredient and dosage. Ten drugs were selected for the present review. Results and Conclusion: There is convincing evidence to suggest that the selected drugs have a promising action against diabetes and its complications. Also, there are largely no adverse events reported and some of the preparation methods described in Unani medicine have been proven to reduce or eliminate the adverse events, if any.

scholarly journals Review of Current Spinal Robotic Orthoses

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 70
Author(s):  
Siu Kei David Mak ◽  
Dino Accoto
Keyword(s):  
New Technologies ◽  
Current Knowledge ◽  
Axial Loading ◽  
Early Mobilization ◽  
Bed Rest ◽  
Field Application ◽  
Symptomatic Management ◽  
Spinal Brace ◽  
Potential Improvement ◽  
Spinal Orthosis

Osteoporotic spine fractures (OSF) are common sequelae of osteoporosis. OSF are directly correlated with increasing age and incidence of osteoporosis. OSF are treated conservatively or surgically. Associated acute pain, chronic disabilities, and progressive deformities are well documented. Conservative measures include a combination of initial bed rest, analgesia, early physiotherapy, and a spinal brace (orthosis), with the aim for early rehabilitation to prevent complications of immobile state. Spinal bracing is commonly used for symptomatic management of OSF. While traditional spinal braces aim to maintain the neutral spinal alignment and reduce the axial loading on the fractured vertebrae, they are well known for complications including discomfort with reduced compliance, atrophy of paraspinal muscles, and restriction of chest expansion leading to chest infections. Exoskeletons have been developed to passively assist and actively augment human movements with different types of actuators. Flexible, versatile spinal exoskeletons are designed to better support the spine. As new technologies enable the development of motorized wearable exoskeletons, several types have been introduced into the medical field application. We have provided a thorough review of the current spinal robotic technologies in this paper. The shortcomings in the current spinal exoskeletons were identified. Their limitations on the use for patients with OSF with potential improvement strategies were discussed. With our current knowledge of spinal orthosis for conservatively managed OSF, a semi-rigid backpack style thoracolumbar spinal robotic orthosis will reduce spinal bone stress and improve back muscle support. This will lead to back pain reduction, improved posture, and overall mobility. Early mobilization is an important part of management of patients with OSF as it reduces the chance of developing complications related to their immobile state for patients with OSF, which will be helpful for their recovery.

scholarly journals Early Detection and Intervention for Patients with Delirium Admitted to the Department of Internal Medicine: Lessons from a Pilot Initiative

2021 ◽  
pp. 134-139
Author(s):  
Ron Oliven ◽  
Meital Rotfeld ◽  
Sharon Gino-Moor ◽  
Elad Schiff ◽  
Majed Odeh ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Early Detection ◽  
Emergency Room ◽  
Early Mobilization ◽  
Pilot Project ◽  
Medical Emergency ◽  
Medical Patients ◽  
Geriatric Unit ◽  
Retrospective Comparison ◽  
Significant Difference

<b><i>Introduction:</i></b> Older patients who arrive to the emergency room with delirium have a worse prognosis than others. Early detection and treatment of this problem has been shown to improve outcome. We have launched a project at our hospital to improve the care of patients who arrive delirious to the medical emergency room. The present article describes lessons that can be learned from this pilot initiative. <b><i>Methods:</i></b> All patients older than 70 years admitted to the department of internal medicine were screened for delirium in the emergency room using the 4AT screening tool. Data of patients with a 4AT score ≥5 (or with incomplete score) were transferred to the geriatric unit of the hospital. On the ward, the presence of delirium was confirmed by a geriatric nurse that validated that the patient could walk with support and ordered mobilization and physiotherapy (M&amp;P). <b><i>Results:</i></b> Over the 2 and a half years (10 quarters) allocated for the pilot project, 1,078 medical patients with delirium were included in this survey. In 59.3%, the diagnosis of delirium could be confirmed only after admission. Due to budgetary constraints, only 54.7% received the allocated specific intervention – early M&amp;P. Since it was decided that randomization was not appropriate for our initiative, we found that patients who received M&amp;P had lower (better) 4AT scores on admission, and lower mortality. No significant difference was found between the patients who received M&amp;P and the others in length of hospitalization and discharge to nursing homes. Retrospective comparison of the two groups did not enable to determine whether M&amp;P was given to the patients for whom it was most effective. <b><i>Conclusions:</i></b> It is often not possible to verify in the emergency room that the cognitive decline is indeed new, that is, is due to delirium, and measures must be taken to verify this point as soon as possible after admission. Due to numerous constraints, the availability of early M&amp;P is often insufficient. Whenever resources are scarce and randomization is avoided, adequate criteria should be found for allocating existing dedicated staff to patients for whom early mobilization is likely to be most beneficial.

scholarly journals Are We Choosing Wisely in Canada?

2017 ◽  
Vol 12 (3) ◽  
Author(s):  
Mitch Levine
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
Choosing Wisely ◽  
Inpatient Setting ◽  
Evidence Based ◽  
X Rays ◽  
Stress Tests ◽  
General Internists ◽  
Physician Knowledge ◽  
Geographical Regions

The Choosing Wisely Canada program is intended to facilitate the more efficient use of health care resources. The program has messages for patients to align their expectations with an evidence based delivery of health care and to increase physician knowledge regarding evidence based directives for the appropriate use of investigations and treatments. In the current issue of CJGIM, an assessment was conducted regarding physician knowledge of the program, and the message was not positive. While many physicians acknowledged awareness of the Choosing Wisely Canada program, an appreciation of the specific messages on how to steer practice to evidence based activity was lacking amongst many. As these were the 33% who agreed to participate in the survey, one can only wonder whether a greater lack of knowledge about the program resides in the 67% that refused to participate. Despite having just laid a foundation of pessimism, I still wonder whether physicians are practicing evidence-based health care even if they do not know the detailed recommendations provided by the Choosing Wisely Canada program. The array of recommendations was developed by professional societies representing different clinical specialties in Canada. The Canadian Society of Internal Medicine (CSIM) established its Choosing Wisely Canada Top 5 recommendations by convening a Committee of 20 members that represented a diverse group of general internists from across Canada, reflecting a broad range of geographical regions, practice settings, institution types and experience.1 Below is the list of the five most recent recommendations targeted for physicians practicing in the field of internal medicine. Don’t routinely obtain neuro-imaging studies (computed tomography, magnetic resonance imaging, or carotid Doppler) in the evaluation of simple syncope in patients with a normal neurological examination.Don’t place, or leave in place, urinary catheters without an acceptable indication (such as critical illness, obstruction, palliative care).Don’t transfuse red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms, active coronary disease, heart failure, or stroke.In the inpatient setting, don’t order repeated CBC and chemistry testing in the face of clinical and lab stability.Don’t routinely perform preoperative testing (such as chest X-rays, echocardiograms, or cardiac stress tests) for patients undergoing low risk surgeries.So, how are you doing in your practice? Mitchell LevineEditor, CJGIM

In-hospital symptomatic venous thromboembolism and antithrombotic prophylaxis in Internal Medicine

2009 ◽  
Vol 101 (05) ◽  
pp. 893-901 ◽  
Author(s):  
Mauro Campanini ◽  
Mauro Silingardi ◽  
Gianluigi Scannapieco ◽  
Antonino Mazzone ◽  
Giovanna Magni ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Venous Thromboembolism ◽  
Bed Rest ◽  
Primary Study ◽  
Medical Patients ◽  
Antithrombotic Prophylaxis ◽  
Increased Risk ◽  
Medical Inpatients ◽  
Hospital Acquired ◽  
Heterogeneous Setting

SummaryHospitalised medical patients are at increased risk of venous thromboembolism (VTE), but the incidence of hospitalisation-related VTE in unselected medical inpatients has not been extensively studied, and uncertainties remain about the optimal use of thromboprophylaxis in this setting. Aims of our prospective, observational study were to assess the prevalence of VTE and the incidence of symptomatic, hospitalisation-related events in a cohort of consecutive patients admitted to 27 Internal Medicine Departments, and to evaluate clinical factors associated with the use of thromboprophylaxis. Between March and September 2006, a total of 4,846 patients were included in the study. Symptomatic VTE with onset of symptoms later than 48 hours after admission (”hospital-acquired” events, primary study end-point) occurred in 26 patients (0.55٪), while the overall prevalence of VTE (including diagnosis prior to or at admission) was 3.65٪. During hospital stay antithrombotic prophylaxis was administered in 41.6٪ of patients, and in 58.7% of those for whom prophylaxis was recommended according to the 2004 Guidelines of the American College of Chest Physicians. The choice of administering thromboprophylaxis or not appeared qualitatively adherent to indications from randomised clinical trials and international guidelines, and bed rest was the strongest determinant of the use of prophylaxis. Data from our real-world study confirm that VTE is a relevant complication in patients admitted to Internal Medicine Departments, and recommended tromboprophylaxis is still under-used, in particular in some patients groups. Further efforts are needed to better define risk profile and to optimise prophylaxis in the heterogeneous setting of medical inpatients.

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