RESUMO
A joint hospital, health authority and PCG initiative to improve prescribing has produced significant savings in the PCG involved. The venture included the appointment of a medicines management pharmacist to work with practices, and a survey to ascertain GPs' prescribing needs. GPs considered the most important issues to be developing local disease management guidelines, education and repeat prescribing. Guidelines on dyspepsia management have resulted in a 4.9 per cent reduction in the cost of prescribing gastrointestinal drugs. Antibiotic prescribing has also fallen.
Assuntos
Custos de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Revisão de Uso de Medicamentos/economia , Medicina de Família e Comunidade/normas , Antibacterianos/uso terapêutico , Redução de Custos , Gerenciamento Clínico , Dispepsia/tratamento farmacológico , Inglaterra , Medicina de Família e Comunidade/economia , Guias de Prática Clínica como Assunto , Medicina Estatal , Estados UnidosRESUMO
Growth assessment is crucial in the evaluation of all children. The growth of children with chronic conditions is often inadequately assessed by subspecialty services because of the following beliefs: (1) short stature is secondary to the disorder and therefore the cause is known, (2) poor growth is caused by a syndrome and is untreatable, and (3) growth is assessed adequately by the children's primary care providers. In reality, growth failure in children with chronic conditions may be caused by other factors and may be treatable. In addition, growth is often inadequately assessed by primary health care providers. Growth abnormalities should never be ignored or minimized in populations of children having other significant health care problems.
Assuntos
Desenvolvimento Infantil , Doença Crônica , Transtornos do Crescimento/diagnóstico , Profissionais de Enfermagem , Criança , Humanos , Atenção Primária à SaúdeRESUMO
Decisions about optimal treatment for critically ill children are qualitatively different from those related to adults. Technological advances over the past several decades have resulted in myriad treatment options that leave many children chronically, critically ill. These children are often technology dependent. With new technologies and new patient populations comes the responsibility to understand how, when, and why these technologies are applied and when technology should not be used or should be withdrawn. Much has been written about ethical decision making in the care of chronically, critically ill adults and newborns. In this article, relevant factors about the care of children older than neonates are described: standards, decision makers, age of the child, and pain management. A case study is used as a mechanism to explore these issues. Dimensions of futility, discontinuing aggressive treatment, and a consideration of benefits and burdens are integrated throughout the discussion to inform nurse practitioner practice.
Assuntos
Doença Crônica/terapia , Cuidados Críticos , Eutanásia Passiva , Futilidade Médica , Profissionais de Enfermagem , Pré-Escolar , Tomada de Decisões , Feminino , Humanos , Respiração ArtificialRESUMO
Pathophysiologic, psychosocial, and economic considerations are important in nutritional assessment of infants and children who are HIV-infected. Nutritional assessment guidelines vary based on the child's circumstances. Specific assessment guidelines are proposed for (a) ongoing ambulatory care; (b) when growth decelerates or its below the fifth percentile; (c) acute illness; and (d) home and community care. The guidelines are based on data collected from a sample of 16 children who were HIV-infected and their families during a pilot study of transitional nursing care using advanced practice nurses. The guidelines were inductively derived from patient care records and from a review of the literature.
