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psnet.ahrq.gov/node/49872/psn-pdf
August 08, 2019 - use
disorder.(7) In a patient with back pain, several "red flags" can be identified as part of the … Certainly, a focal neurologic finding (e.g., left leg weakness
on examination) may be evidence of a … Prior spine
surgery 1 year ago should have minimal impact on the possibility of having a distant area … history data, ordering of the wrong
test, too much weight on competing/coexisting diagnosis, and failure … Use of a novel, modified fishbone diagram to analyze
diagnostic errors.
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psnet.ahrq.gov/node/49799/psn-pdf
July 01, 2017 - a contaminant, if the culture had not speciated on the day of discharge, withholding
antibiotics and … The hazard of using additional data.
JAMA. 1976;236:1259-1263. [go to PubMed]
3. … of the microbiology, epidemiology, and outcome of
bacteremia and fungemia in adults. … clinical outcome. … Research and Quality (AHRQ), U.S.
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psnet.ahrq.gov/node/49400/psn-pdf
May 01, 2003 - , heart rate of 120, a RR of 35, and an O2 sat of 90% on 100%
non-rebreather. … Outcome of pediatric thromboembolic disease: a report from
the Canadian Childhood Thrombophilia Registry … Benefit of heparin use in central venous and
pulmonary artery catheters: a meta-analysis of randomized … heparin exposure
LMWH
prophylaxis
No data on efficacy in children
Heparin-bonded
catheters
One … This project was funded under contract number 75Q80119C00004 from the Agency for Healthcare
Research
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psnet.ahrq.gov/perspective/conversation-withjoseph-britto-md
February 01, 2007 - For me, the message from Friedman's work is that if you're going to rely on the confidence of a physician … Yes, we might use a set of digital questionnaires to help us ask all the right questions, but finally … Many a baseball game hinges on the accuracy of calls made by the men in black behind home plate. … best chance of the correct outcome. … November 27, 2013
Assessment of the potential impact of a reminder system on the reduction
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psnet.ahrq.gov/node/49561/psn-pdf
May 01, 2008 - drug use (21%). … would have led to a change in the overall outcome. … testing.(17-19)
In the absence of direct clinical data showing benefits of routine screening, several … of
antibiotics during the current admission would have changed the ultimate outcome given the seriousness … test, the yield of repeat HIV testing is dependent on the incidence of HIV infection.(38) In those
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psnet.ahrq.gov/node/73515/psn-pdf
August 01, 2022 - In addition to the APRN, the MOQI involves nursing home teams focused on use of tools
to better detect … feedback reports to the
nursing homes on resident outcome measures associated with hospital transfer … the Innovation
The MOQI was developed based on research conducted by the Quality Improvement Program … inclusion of a dedicated APRN on the clinical team. … and communication of a plan outlining how implementation will be monitored,
what data will be collected
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psnet.ahrq.gov/node/49741/psn-pdf
September 01, 2015 - The use of contrast typically enhances diagnostic accuracy
with the potential increase in fetal harm … The use of the algorithm as well as the clinical outcomes of pregnant patients with
abdominal pain should … led to an earlier diagnosis and a
better outcome. … on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy. … Agency for Healthcare
Research and Quality (AHRQ), U.S.
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psnet.ahrq.gov/perspective/surveillance-monitoring-improve-patient-safety-acute-hospital-care-units
April 26, 2023 - a distraction and change of attention from the task on hand. … Understanding the volume-outcome effect in cardiovascular surgery: the role of failure to rescue. … We centered on the use of pulse oximetry because you can get a lot of valuable information from a single … A lot of patients in the hospital are on opioids. … use it as a tool.
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psnet.ahrq.gov/web-mm/procedure-complications-who-responsible-follow
July 31, 2023 - There was a significant delay in the patient’s care based on communication issues involving the thoracic … and therapeutic purposes, with continued expansion of its use as a safer alternative to traditional … data underscore the importance of maintaining high clinical suspicion for perforation to aid in timely … with subsequent triage to a surgical or medical service, depending on the results of imaging. … Impact of trainee involvement on the outcome of ERCP procedures: results of a prospective multicenter
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psnet.ahrq.gov/perspective/conversation-david-m-gaba-md
March 01, 2013 - We consider a level one study as one where the outcome is measured in simulation. … The only way you would get out of doing simulation on a recurrent basis is if you retire from the business … the use of simulation to improve care. … DG : It really depends on where they believe they could use the most improvement. … Cost: the missing outcome in simulation-based medical education research: a systematic review.
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psnet.ahrq.gov/perspective/conversation-jack-westfall-md-mph
September 28, 2022 - I’m a family physician and the former director of the Robert Graham Center for Policy Research. … , and there’s an outcome. … A patient safety event can be the furthest downstream outcome of a series of events that starts with … use of telehealth services to reduce some of the barriers to primary care represents a third possible … In particular, use of telehealth services can eliminate the need for travel to a primary care facility
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psnet.ahrq.gov/issue/addressing-patient-safety-hazards-using-critical-incident-reporting-hospitals-systematic
June 08, 2022 - The authors observe that only one in three studies reported on corrective actions due to the incidents … in the aftermath of a patient safety incident. … July 27, 2022
Ethical issues in patient safety research: a systematic review of the literature … the global literature on medical error reporting and reporting systems from 1977 to 2021: a bibliometric … perspectives of key stakeholders: a review of the qualitative evidence.
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psnet.ahrq.gov/node/837215/psn-pdf
July 08, 2022 - This trial also showed a benefit in
functional outcome at 90 days, with 45% of treatment group versus … typically involve notification of an on-call neurologist, a radiologist, and nursing and pharmacy
team … Perfusion Imaging
The routine use of CT angiography and perfusion imaging as part of an initial stroke … In pooled patient-level data from five clinical trials, the odds of
better disability outcomes at 90 … Research and Quality (AHRQ), U.S.
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psnet.ahrq.gov/perspective/conversation-freya-spielberg-md-mph
September 28, 2022 - Right now, there's a lot of data in the literature showing the impact of community health workers, both … , focus on the integration of data. … A lot of clinics now have data visualization software, but really, I believe what's needed on the collaborative … A patient safety event can be the furthest downstream outcome of a series of events that starts with … use of telehealth services to reduce some of the barriers to primary care represents a third possible
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psnet.ahrq.gov/issue/surgical-adverse-outcomes-and-patients-evaluation-quality-care-inherent-risk-or-reduced
March 22, 2011 - Same Author(s)
Surgical adverse outcome reporting as part of routine clinical care. … after 20 years of patient safety research. … adverse events or the end of adverse events as a useful metric? … care on the administration of high-risk drug combinations, and their monitoring: a cluster randomised … January 7, 2015
A qualitative exploration of patients' attitudes towards the 'Participate
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psnet.ahrq.gov/perspective/conversation-mark-l-graber-md
January 01, 2016 - I see the development of a journal. I see a research agenda. … All the numbers we have were based on research studies. … We saw that a lot in the research study I did of diagnostic errors. … So if you're relying on the physicians to use these products, they may not. … Ebola US Patient Zero: lessons on misdiagnosis and effective use of electronic health record.
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psnet.ahrq.gov/node/49553/psn-pdf
January 01, 2008 - Perhaps the most
important factor is the failure of the health care worker (HCW) to use strict aseptic … blood culture was removed and a second sterile needle was placed on the syringe for inoculation of the … organization that publishes
guidelines based on best available data, recommends tincture of iodine, … of the microbiology, epidemiology, and outcome of
bacteremia and fungemia in adults. … of the microbiology, epidemiology, and outcome of bacteremia and fungemia in
adults.
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psnet.ahrq.gov/innovation/critical-radiology-alert-process
November 16, 2022 - The primary outcome was the proportion of ED patient visits with an identified incidental finding where … in planning and development, and establishing a data infrastructure to collect process and/or outcomes … The dedicated time of the navigator can vary depending on the volume and nature of the communicated findings … The innovators state that it is beneficial to conduct periodic data reviews to ensure the goals of the … Department of Health and Human Services, the Agency for Healthcare Research and Quality, or of the submitter
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psnet.ahrq.gov/web-mm/palliative-care-comfort-vs-harm
December 04, 2016 - Describe key principles regarding the use of opioids in palliative care. … reporting systems are rare, and empirical research on patient safety is scant.( 3 ) There is no reliable … This is difficult to assess and depends on the dosage as well as on the general health condition of the … A systematic review of the use of opioid medication for those with moderate to severe cancer pain and … Sykes N, Thorns A. The use of opioids and sedatives at the end of life.
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psnet.ahrq.gov/web-mm/inadequate-preanesthetic-evaluation-airway-trouble
November 01, 2023 - The anesthesiologist kept the patient oxygenated and asleep while attempting to use a fiberoptic bronchoscope … a patient history and physical examination on the day of surgery. … On top of that, the patient was not seen in a preanesthesia clinic for evaluation and review of his records … on the day of surgery. … of Anesthesiologists Task Force on Management of the Difficult Airway.