ABSTRACT
BACKGROUND: Despite the widely known and well-established benefits of advance care planning, it is estimated that 15-30% of American adults have completed advance directives (ADs). Evidence suggests that the best place for advance care planning (ACP) is in primary care, but many barriers to this practice exist. LOCAL PROBLEM: Providers in a Northern Arizona private practice primary care clinic expressed frustration with their current ability and standard of care regarding ADs. Only 0.8% of their established adult patients had ADs. METHODS: Project Five Wishes was a 16-week trial designed to increase the number of ADs recorded at a Northern Arizona primary practice. The secondary purpose was to increase primary care provider knowledge, comfort, confidence, perceived importance, and frequency of discussions about ADs with patients. INTERVENTIONS: Interventions used in this project aimed to eliminate common barriers to ACP through a 30-minute presentation for providers and by integrating a user-friendly AD form into the office workflow. RESULTS: The number of ADs recorded increased by 25.4%. There were no statistically significant changes in the providers' reported knowledge, comfort, confidence, perceived importance, and frequency of discussions regarding ADs. CONCLUSIONS: The feasibly reproducible process used in Project Five Wishes was successful at increasing the number of patients with ADs in this 16-week trial and could lead to improvement in this area for other clinics as well.
Subject(s)
Advance Directives , General Practice/instrumentation , Primary Health Care/standards , Arizona , Female , General Practice/methods , General Practice/statistics & numerical data , Humans , Male , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Program Development/methods , Quality Improvement , Surveys and QuestionnairesABSTRACT
BACKGROUND: Peritoneal tuberculosis represents 0, 1 to 4% of all forms of tuberculosis. AIM: The aim of our study is to describe clinical, therapeutic characteristics and the outcome of peritoneal tuberculosis. METHODS: Retrospective study of all cases of peritoneal tuberculosis diagnosed in gastroenterology B department - Rabta Hospital during a 12 years period (1996 to 2007). RESULTS: Forty three cases of peritoneal tuberculosis were included: 15 male and 28 female with mean age of 38years (extremes: 16 to 85years). Five patients were cirrhotic. Clinical manifestations were dominated by ascitis (83%). Ascitic fluid were exsudative in 97% of cases and lymphocytic in all cases. The diagnostic was based on coelioscopy with peritoneal biopsy in 26 cases demonstrating caseating granulomatous lesions in 64% of cases. Extra peritoneal tuberculosis was noted in 60, 4% dominated by pleuro-pulmonary localisations. Patients were given antituberculous therapy for a mean duration of 9, 8 months and the outcome was favourable in 93%. CONCLUSION: Peritoneal tuberculosis is still a medical problem in Tunisia. It is more common in young female. Diagnosis is based on the results of peritoneal biopsies during celioscopy. The outcome is good in most cases after antituberculous treatment.
Subject(s)
Peritonitis, Tuberculous/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Antitubercular Agents/therapeutic use , Ascites/microbiology , Female , Humans , Male , Middle Aged , Peritonitis, Tuberculous/drug therapy , Peritonitis, Tuberculous/epidemiology , Retrospective Studies , Young AdultABSTRACT
During 2 months (01.01.95-28.02.95), we noted for each Staphylococcus aureus (SA) isolates, identification and susceptibility methods, hospital size, medical speciality, source, penicillin (P) and methicillin (M) susceptibility. For each non repetitive methicillin resistant SA we noted phenotype of aminoglycoside resistance of SA to 6 antistaphylococci drugs. We isolated 399 SA, SAP sensitives 6.5%, methicillin resistant SA (MRSA) 31.8%. MRSA in acute care unit 28.4%, non acute care unit 61.7%, surgery 28.6%, medicine 36.5%, orthopedics 34.5%, pédiatrics 4%, ICU 38.8%, others 10.3%. MRSA from wound 28.2%, respiratory tract 38.3% blood 22.5%, urine 58.5%, others 25.8% - MRSA kanamycin 1.7%, kanamycin tobramycin 36.2%, kanamycin, tobramycin, gentamicin 56.9% - MRSA erythromycin 79.5%, pefloxacin 91.3%, rifampicin 53.5%, acide fusidique 8.7%, fosfomycine 18.9%, TMP SMZ 5.5%. The proportion MRSA is equivalent among medical specialities predominant in urine cultures and respiratory tract. It should be better to carry on the survey for more than two months in each hospital.
