Browsing by Subject "Evidence-Based Medicine"
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Item An Assessment of Severity of Illness of Pediatric Musculoskeletal Infections: 1994-2009(2013-08-01) Sun, David Q.; Copley, Lawson A.B.Keywords: osteomyelitis, multi-disciplinary, guidelines, evidence-based treatment, musculoskeletal infections PURPOSE: Care of children with osteomyelitis requires multi-disciplinary collaboration. This study evaluates the impact of evidence-based guidelines for pediatric osteomyelitis when applied by a multi-disciplinary team. METHODS: Guidelines for pediatric osteomyelitis were developed and implemented by a multi-disciplinary team comprised of orthopedics, pediatrics, infectious disease, nursing, and social work who met daily to conduct rounds and make treatment decisions. Children who were treated according to the guidelines (g) were compared to those who had been treated prior to the guidelines (ng) by retrospective review and statistical analysis. RESULTS: 210 children of the 2002-2004 cohort (ng) were compared to 61 children of the 2009 cohort (g). No significant differences between the two cohorts were noted for age, race, gender, incidence of Methicillin-resistant Staphylococcus aureus (g=26.2%; ng=18.1%), incidence of Methicillin-sensitive Staphylococcus aureus (g=27.9%; ng=23.8%), bacteremia, or surgeries. Significant differences between cohorts were noted (p<0.05) for each of the following: timing of initial MRI (g=1.0 day; ng=2.5 days); clindamycin as initial antibiotic (g= 85.3%; ng=12.8%); blood cultures before antibiotic administration (g=91.8% ; ng=79.5%); tissue cultures from infection site (g=78.7%; ng=62.9%); identification of organism by tissue or blood culture (g=73.8%; ng=60.0%); antibiotic changes (g=1.4 changes; ng=2.0 changes); and mean oral antibiotic duration (g=43.7 days; ng=27.7 days). Children treated with guidelines had clinically important trends of a shorter total length of stay (g=9.7 days; ng=12.8 days; p=0.054), and lower readmission rate (g=6.6%; ng=11.4%; p=0.34). CONCLUSION: Evidence-based treatment guidelines applied by a multi-disciplinary team resulted in more efficient diagnostic work-up, higher rate of identifying the causative organism, improved adherence to initial antibiotic recommendations with fewer antibiotic changes during treatment. Additionally, there were trends toward lower readmission rate and lower length of hospitalization. The establishment of evidence-based treatment guidelines will allow for the standardization of evaluation and treatment of children with musculoskeletal infections for severity of illness comparisons between cohorts separated through time and geographic location.Item Design of a Patient Education Booklet Approaching Gliomas at the Cellular Level(2004-5-4) Hilborn, Nicole Marie; Calver, Lewis E.The most common brain tumors originating in the cells of the brain are a family of tumors known as gliomas that are incurable and usually require some combination of surgery, radiation, and chemotherapy to manage tumor growth and prolong the life of the patient. The central difficulty in curing gliomas lies in the motility of the tumor cells that migrate throughout the spongy tissue of the brain, invading healthy areas beyond the reach of standard treatment, and seeding the beginning of another tumor. This process continues until treatment options are exhausted. The length of the process is determined by the malignancy of the tumor cells, and gliomas can mutate into more malignant forms over the course of the disease. There are many newsletters, brochures, and websites available to patients that explain gliomas by describing tumor symptoms and treatment procedures. This is comforting to the patient because it tells him/her what to expect. However, most glioma patient collaterals rarely describe gliomas at the cellular level or explain the basic science behind radiation or chemotherapy; consequently, the patient doesn't have a grasp of the crucial disease processes going on at the cellular level, doesn't understand why his/her diagnosis might change, and doesn't understand why the treatments available have limited effectiveness against the tumor. The purpose of this thesis was to produce patient educational collateral for recently diagnosed adult patients and their caregivers to explain the concept of gliomas and their treatment options from a cellular perspective. Patients were polled to establish the relevance, scope, and form of the information included in the final product; then based on their input copy and illustrations were created and assembled into booklet form, selected as a more accessible and convenient format for fostering a better understanding of gliomas and better communication between patients and the medical staff involved in their treatment.