DOCSLIB.ORG

Introduction to the Clinical Practice Guidelines

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Introduction to the Clinical Practice Guidelines INTRODUCTION TO THE CLINICAL PRACTICE GUIDELINES First Nations and Inuit Health Branch (FNIHB) Clinical Practice Guidelines for Nurses in Primary Care. The content of this chapter was revised in December 2011. Table of Contents PURPOSE .................................................................................................................I–1 STRUCTURE ............................................................................................................I–1 Format of Body System Chapters .......................................................................I–1 Format of Medical Diagnosis/Condition Descriptions .........................................I–1 CULTURE ..................................................................................................................I–2 Commonly Cited Value ........................................................................................I–2 Culture and Health ..............................................................................................I–2 Culture and Health Care .....................................................................................I–3 TRAUMA INFORMED CARE ....................................................................................I–4 COMMUNICATION ....................................................................................................I–4 Therapeutic Relationships ..................................................................................I–4 History Taking ......................................................................................................I–4 Use of an Interpreter ...........................................................................................I–6 Communication between Health Care Providers ................................................I–6 HEALTH ASSESSMENT ...........................................................................................I–7 Age Definitions ....................................................................................................I–7 History .................................................................................................................I–7 Physical Assessment ..........................................................................................I–9 CRITICAL THINKING ................................................................................................I–9 Establishing a Diagnosis .....................................................................................I–9 MANAGEMENT .......................................................................................................I–10 Non-Pharmacological Interventions ..................................................................I–10 Pharmacological Intervention Considerations ...................................................I–10 CLINICAL RESOURCES .........................................................................................I–11 Multidisciplinary Teams .....................................................................................I–11 Nursing Clinical Resources ..............................................................................I–11 Clinical Practice Guidelines for Nurses in Primary Care 2011 Introduction DOCUMENTATION .................................................................................................I–12 Objectives of Documentation ............................................................................I–12 Essential Components and Features ................................................................I–12 SOAP Documentation .......................................................................................I–13 CONSENT TO MEDICAL TREATMENT ..................................................................I–14 Refusal or withdrawal of consent ......................................................................I–14 Age of consent to medical treatment ................................................................I–14 When consent is impossible or impractical to obtain ........................................I–15 PRIVACY AND ACCESS ISSUES – RECORDS AND CONFIDENTIALITY ............I–15 General .............................................................................................................I–15 Disclosure of Personal Information ...................................................................I–15 Confidentiality ...................................................................................................I–17 APPENDIX A – SAMPLE DOCUMENTATION FOR A PEDIATRIC EPISODIC ASSESSMENT.......................................................I–18 APPENDIX B – SAMPLE DOCUMENTATION FOR A COMPREHENSIVE HEALTH ASSESSMENT .............................................I–20 SOURCES ...............................................................................................................I–23 2011 Clinical Practice Guidelines for Nurses in Primary Care Introduction I–1 PURPOSE The First Nations Inuit Health Branch Clinical The guidelines provide a broad range of topics Practice Guidelines for Nurses in Primary Care and health conditions aimed at complementing are practice tools designed to support community individual nurses’ self-assessment of knowledge, health nurses’ clinical decisions when delivering skills and judgment and do not necessarily represent primary health care within First Nations and Inuit provincially legislated scope of practice. In regions communities. As an educational tool, the guidelines where a transfer of authority is recognized by aim to support nursing practice for pediatric, regulatory bodies, the guidelines grant the registered adolescent and adult clients. nurse employed by Health Canada, limited authority to diagnose, request diagnostic tests (for example, The guidelines are based on best practices and laboratory tests and diagnostic imaging), and treat evidence available at the time they were written. They clients as per each health condition included in the are to be used in concert with regional and/or national guidelines. Provincial regulations, regional decisional guidelines, as well as the First Nations Inuit Health support tools, protocols, transfer of function or Branch Formulary and Drug Classification System, delegation tool may supersede this authority. the latter in regions where it is used. STRUCTURE The First Nations Inuit Health Branch Clinical FORMAT OF MEDICAL DIAGNOSIS/ Practice Guidelines for Nurses in Primary Care are CONDITION DESCRIPTIONS set up in a specific manner to make it easier for the users of the guidelines. The majority of the chapters in The chapters that describe medical diagnoses/ the guidelines are based on a specific body system and conditions describe each condition by using the then present the more common and associated medical following headings (if applicable to the condition): diagnoses/conditions. These chapters use the formats that follow. Medical Diagnosis/Condition – Causes FORMAT OF BODY – History SYSTEM CHAPTERS – Physical Findings – Differential Diagnoses Each chapter that corresponds to a body system is set – Complications up in the following format: – Diagnostic Tests – Management Assessment of the Body System – Cardinal Symptoms (in some chapters) – Goals of Treatment – History of Present Illness and Review of Systems – Appropriate Consultation – Physical Examination – Adjuvant Therapy – Nonpharmacologic Interventions Common Problems of the Body System – Pharmacologic Interventions – Conditions – Monitoring and Follow-Up Emergencies for the Body System – Referral – Conditions – Prognosis (present occasionally) Clinical Practice Guidelines for Nurses in Primary Care 2011 I–2 Introduction CULTURE1,2,3,4 Culture refers “to shared patterns of learned COOPERATION behaviours and values that are transmitted over time, Competition can interfere with group cohesiveness. and that distinguish the members of one group from Cooperation increases the sense of solidarity and another…. [It] can include: ethnicity, language, pools effort, talent and resources. religion and spiritual beliefs, gender, socio-economic class, age, sexual orientation, geographic origin, group EXCELLENCE history, education, upbringing and life experiences”.5 Each individual First Nations and Inuit community Gratitude is rarely shown or verbalized because each has their own specific culture which includes individual is expected to behave at a “normal” (that is, traditional and/or Western practices. They are diverse. excellent) level. The Inuit Way: A Guide to Inuit Culture can serve as an introduction to Inuit culture6 (available at: CULTURE AND HEALTH http://pauktuutit.ca/pdf/publications/pauktuutit/ Health beliefs and practices (traditional and/or InuitWay_e.pdf). Western) influence a client’s illness experience: how they define, understand and manage the COMMONLY CITED VALUES6 health problem. Mainly for purposes of illustration, some commonly Health for many First Nations and Inuit individuals cited values of First Nations and Inuit people are focuses on wholeness: achieving balance, strength given below. It must be emphasized that these values and interconnectedness of body, mind, emotions, and do not necessarily hold true for all First Nations and spirit. Each person is also linked to the health of the Inuit people and/or communities, but they do alert environment (for example, plants, animals, earth, the healthcare practitioner to the kinds of differences sky, water), community and family dependently and that can exist and to the possible consequences,
Load more

Recommended publications
  • The Stethoscope: Some Preliminary Investigations
    695 ORIGINAL ARTICLE The stethoscope: some preliminary investigations P D Welsby, G Parry, D Smith Postgrad Med J: first published as on 5 January 2004. Downloaded from ............................................................................................................................... See end of article for Postgrad Med J 2003;79:695–698 authors’ affiliations ....................... Correspondence to: Dr Philip D Welsby, Western General Hospital, Edinburgh EH4 2XU, UK; [email protected] Submitted 21 April 2003 Textbooks, clinicians, and medical teachers differ as to whether the stethoscope bell or diaphragm should Accepted 30 June 2003 be used for auscultating respiratory sounds at the chest wall. Logic and our results suggest that stethoscope ....................... diaphragms are more appropriate. HISTORICAL ASPECTS note is increased as the amplitude of the sound rises, Hippocrates advised ‘‘immediate auscultation’’ (the applica- resulting in masking of higher frequency components by tion of the ear to the patient’s chest) to hear ‘‘transmitted lower frequencies—‘‘turning up the volume accentuates the sounds from within’’. However, in 1816 a French doctor, base’’ as anyone with teenage children will have noted. Rene´The´ophile Hyacinth Laennec invented the stethoscope,1 Breath sounds are generated by turbulent air flow in the which thereafter became the identity symbol of the physician. trachea and proximal bronchi. Airflow in the small airways Laennec apparently had observed two children sending and alveoli is of lower velocity and laminar in type and is 6 signals to each other by scraping one end of a long piece of therefore silent. What is heard at the chest wall depends on solid wood with a pin, and listening with an ear pressed to the conductive and filtering effect of lung tissue and the the other end.2 Later, in 1816, Laennec was called to a young characteristics of the chest wall.
    [Show full text]
  • New Patient Medical History Form
    NEW PATIENT MEDICAL HISTORY FORM Full Name: Date: Birth Date: Age: ALLERGIES o NO ALLERGIES ALLERGY ALLERGIC REACTION MEDICATIONS MEDICATIONS DOSE TIMES PER DAY (Please list ALL) (Mg., pill, etc.) If you need more room to list medications, please write them on a blank sheet of paper with the required information HEALTH MAINTENANCE SCREENING TEST HISTORY CHolesterol Date: Facility/Provider: Abnormal Result? Y N Colonoscopy/SIGMOID Date: Facility/Provider: Abnormal Result? Y N Mammogram Date: Facility/Provider: Abnormal Result? Y N PAP SMEAR Date: Facility/Provider: Abnormal Result? Y N BONE density Date: Facility/Provider: Abnormal Result? Y N VACCINATION HISTORY Last Tetanus Booster or TdaP: Last Pnuemovax (Pneumonia): Last Flu Vaccine: Last Prevnar: Last Zoster Vaccine (Shingles): PERSONAL MEDICAL HISTORY DISEASE/CONDITION CURRENT PAST COMMENTS Alcoholism/Drug Abuse Asthma Cancer (type:_________________________________) Depression/Anxiety/Bipolar/Suicidal Diabetes (type:_______________________________) Emphysema (COPD) Heart Disease High Blood Pressure (hypertension) High Cholesterol Hypothyroidism/Thyroid Disease Renal (kidney) Disease Migraine Headaches Stroke Other: Other: SURGERIES TYPE (specify left/right) Date Location/Facility WOMEN’S HEALTH HISTORY Date of Last Menstrual Cycle: Age of First Menstruation: _____ Age of Menopause: _____ Total Number of Pregnancies: Number of Live Births: Pregnancy Complications: Patient Name: DOB: family MEDICAL HISTORY o NO Significant Family History IS KNOWN 4 CHECK ALL THat apply Stroke Cancer
    [Show full text]
  • Advanced Interpretation of Adult Vital Signs in Trauma William D
    Advanced Interpretation of Adult Vital Signs in Trauma William D. Hampton, DO Emergency Physician 26 March 2015 Learning Objectives 1. Better understand vital signs for what they can tell you (and what they can’t) in the assessment of a trauma patient. 2. Appreciate best practices in obtaining accurate vital signs in trauma patients. 3. Learn what teaching about vital signs is evidence-based and what is not. 4. Explain the importance of vital signs to more accurately triage, diagnose, and confidently disposition our trauma patients. 5. Apply the monitoring (and manipulation of) vital signs to better resuscitate trauma patients. Disclosure Statement • Faculty/Presenters/Authors/Content Reviewers/Planners disclose no conflict of interest relative to this educational activity. Successful Completion • To successfully complete this course, participants must attend the entire event and complete/submit the evaluation at the end of the session. • Society of Trauma Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Vital Signs Vital Signs Philosophy: “View vital signs as compensatory to the illness/complaint as opposed to primary.” Crowe, Donald MD. “Vital Sign Rant.” EMRAP: Emergency Medicine Reviews and Perspectives. February, 2010. Vital Signs Truth over Accuracy: • Document the true status of the patient: sick or not? • Complete vital signs on every patient, every time, regardless of the chief complaint. • If vital signs seem misleading or inaccurate, repeat them! • Beware sending a patient home with abnormal vitals (especially tachycardia)! •Treat vital signs the same as any other diagnostics— review them carefully prior to disposition. The Mother’s Vital Sign: Temperature Case #1 - 76-y/o homeless ♂ CC: 76-y/o homeless ♂ brought to the ED by police for eval.
    [Show full text]
  • Improving the Accuracy of Medical Diagnosis with Causal Machine Learning ✉ Jonathan G
    ARTICLE https://doi.org/10.1038/s41467-020-17419-7 OPEN Improving the accuracy of medical diagnosis with causal machine learning ✉ Jonathan G. Richens 1 , Ciarán M. Lee1,2 & Saurabh Johri 1 Machine learning promises to revolutionize clinical decision making and diagnosis. In medical diagnosis a doctor aims to explain a patient’s symptoms by determining the diseases causing them. However, existing machine learning approaches to diagnosis are purely associative, 1234567890():,; identifying diseases that are strongly correlated with a patients symptoms. We show that this inability to disentangle correlation from causation can result in sub-optimal or dangerous diagnoses. To overcome this, we reformulate diagnosis as a counterfactual inference task and derive counterfactual diagnostic algorithms. We compare our counterfactual algorithms to the standard associative algorithm and 44 doctors using a test set of clinical vignettes. While the associative algorithm achieves an accuracy placing in the top 48% of doctors in our cohort, our counterfactual algorithm places in the top 25% of doctors, achieving expert clinical accuracy. Our results show that causal reasoning is a vital missing ingredient for applying machine learning to medical diagnosis. 1 Babylon Health, 60 Sloane Ave, Chelsea, London SW3 3DD, UK. 2 University College London, Gower St, Bloomsbury, London WC1E 6BT, UK. ✉ email: [email protected] NATURE COMMUNICATIONS | (2020)11:3923 | https://doi.org/10.1038/s41467-020-17419-7 | www.nature.com/naturecommunications 1 ARTICLE NATURE COMMUNICATIONS | https://doi.org/10.1038/s41467-020-17419-7 roviding accurate and accessible diagnoses is a fundamental Since its formal definition31, model-based diagnosis has been challenge for global healthcare systems.
    [Show full text]
  • Cardiovascular Assessment
    Cardiovascular Assessment A Home study Course Offered by Nurses Research Publications P.O. Box 480 Hayward CA 94543-0480 Office: 510-888-9070 Fax: 510-537-3434 No unauthorized duplication photocopying of this course is permitted Editor: Nurses Research 1 HOW TO USE THIS COURSE Thank you for choosing Nurses Research Publication home study for your continuing education. This course may be completed as rapidly as you desire. However there is a one-year maximum time limit. If you have downloaded this course from our website you will need to log back on to pay and complete your test. After you submit your test for grading you will be asked to complete a course evaluation and then your certificate of completion will appear on your screen for you to print and keep for your records. Satisfactory completion of the examination requires a passing score of at least 70%. No part of this course may be copied or circulated under copyright law. Instructions: 1. Read the course objectives. 2. Read and study the course. 3. Log back onto our website to pay and take the test. If you have already paid for the course you will be asked to login using the username and password you selected when you registered for the course. 4. When you are satisfied that the answers are correct click grade test. 5. Complete the evaluation. 6. Print your certificate of completion. If you have a procedural question or “nursing” question regarding the materials, call (510) 888-9070 for assistance. Only instructors or our director may answer a nursing question about the test.
    [Show full text]
  • (June 2000) I. INTRODUCTION WHAT IS DOCUMENTATION and WHY
    DRAFT EVALUATION & MANAGEMENT DOCUMENTATION GUIDELINES (June 2000) I. INTRODUCTION WHAT IS DOCUMENTATION AND WHY IS IT IMPORTANT? Medical record documentation is required to record pertinent facts, findings, and observations about an individual's health history including past and present illnesses, examinations, tests, treatments, and outcomes. The medical record chronologically documents the care of the patient and is an important element contributing to high quality care. The medical record facilitates: · the ability of the physician and other health care professionals to evaluate and plan the patient's immediate treatment, and to monitor his/her health care over time. · communication and continuity of care among physicians and other health care professionals involved in the patient's care; · accurate and timely claims review and payment; · appropriate utilization review and quality of care evaluations; and · collection of data that may be useful for research and education. An appropriately documented medical record can reduce many of the "hassles" associated with claims processing and may serve as a legal document to verify the care provided, if necessary. WHAT DO PAYERS WANT AND WHY? Because payers have a contractual obligation to enrollees, they may require reasonable documentation that services are consistent with the insurance coverage provided. They may request information to validate: · the site of service; · the medical necessity and appropriateness of the diagnostic and/or therapeutic services provided; and/or · that services provided have been accurately reported. II. GENERAL PRINCIPLES OF MEDICAL RECORD DOCUMENTATION The principles of documentation listed below are applicable to all types of medical and surgical Pg. 1 services in all settings. For Evaluation and Management (E/M) services, the nature and amount of physician work and documentation varies by type of service, place of service and the patient's status.
    [Show full text]
  • Patient/ Family History
    Patient/ Family Mankato History Location: Mankato Fairmont New Prague Springfield St. James Waseca PATIENT PROVIDED INFORMATION The information you provide us will greatly help us to provide the highest quality and comprehensive care for you. Date Gender Male Female Date of birth (Month/Day/Year) A. PAST MEDICAL HISTORY 1. Have you ever traveled or lived outside of the United States or Canada? Do not know No Yes 2. Have you ever received a blood transfusion? Do not know No Yes (If yes, check all that apply.) Before 1980 1980-1990 After 1990 3. Have you received the following immunizations and/or had the disease? Pneumococcal (For pneumonia) Do not know No Yes Mumps Do not know No Yes Hepatitis B Do not know No Yes Rubella Do not know No Yes Hepatitis A Do not know No Yes Polio Do not know No Yes Measles Do not know No Yes Varicella (For chicken pox) Do not know No Yes 4. Indicate whether you have ever had a medical problem or surgery related to each of the following. Check all that apply. Medical Problem Surgery/Year Medical Problem Surgery/Year Eyes Lungs Ears Esophagus (Food or swallowing pipe) Nose Stomach (Ulcer) Sinuses Bowel (Small or large intestine, rectum) Tonsils Appendix Thyroid or parathyroid gland Lymph nodes Heart problems: Spleen Heart attack Liver Heart valves Gallbladder Abnormal heart rhythm Pancreas Narrowed coronary arteries Hernia Other Kidneys Arteries (Head, arms, legs, aorta, etc.) Bladder Veins or blood clots in the veins Bones ©2014 Mayo Foundation for Medical Education and Research Page 1 of 4 1081MR rev10/14 (Label) Patient Name DOB Unit No.
    [Show full text]
  • Medical Staff Medical Record Policy
    Number: MS -012 Effective Date: September 26, 2016 BO Revised:11/28/2016; 11/27/2017; 1/22/2018; 8/27/2018 CaroMont Regional Medical Center Author: Approved: Patrick Russo, MD, Chief-of-Staff Authorized: Todd Davis, MD, EVP, GMO MEDICAL STAFF MEDICAL RECORD POLICY 1. REQUIRED COMPONENTS OF THE MEDICAL RECORD The medical record shall include information to support the patient's diagnosis and condition, justify the patient's care, treatment and services, and document the course and result of the patient's care, and services to promote continuity of care among providers. The components may consist of the following: identification data, history and physical examination, consultations, clinical laboratory findings, radiology reports, procedure and anesthesia consents, medical or surgical treatment, operative report, pathological findings, progress notes, final diagnoses, condition on discharge, autopsy report when performed, other pertinent information and discharge summary. 2. ADMISSION HISTORY AND PHYSICAL EXAMINATION FOR HOSPITAL CARE Please refer to CaroMont Regional Medical Center Medical Staff Bylaws, Section 12.E. A. The history and physical examination (H&P), when required, shall be performed and recorded by a physician, dentist, podiatrist, or privileged practitioner who has an active NC license and has been granted privileges by the hospital. The H&P is the responsibility of the attending physician or designee. Oral surgeons, dentists, and podiatrists are responsible for the history and physical examination pertinent to their area of specialty. B. If a physician has delegated the responsibility of completing or updating an H&P to a privileged practitioner who has been granted privileges to do H&Ps, the H&P and/or update must be countersigned by the supervisor physician within 30 days after discharge to complete the medi_cal record.
    [Show full text]
  • GUIDELINES for WRITING SOAP NOTES and HISTORY and PHYSICALS
    GUIDELINES FOR WRITING SOAP NOTES and HISTORY AND PHYSICALS by Lois E. Brenneman, M.S.N, C.S., A.N.P, F.N.P. © 2001 NPCEU Inc. all rights reserved NPCEU INC. PO Box 246 Glen Gardner, NJ 08826 908-537-9767 - FAX 908-537-6409 www.npceu.com Copyright © 2001 NPCEU Inc. All rights reserved No part of this book may be reproduced in any manner whatever, including information storage, or retrieval, in whole or in part (except for brief quotations in critical articles or reviews), without written permission of the publisher: NPCEU, Inc. PO Box 246, Glen Gardner, NJ 08826 908-527-9767, Fax 908-527-6409. Bulk Purchase Discounts. For discounts on orders of 20 copies or more, please fax the number above or write the address above. Please state if you are a non-profit organization and the number of copies you are interested in purchasing. 2 GUIDELINES FOR WRITING SOAP NOTES and HISTORY AND PHYSICALS Lois E. Brenneman, M.S.N., C.S., A.N.P., F.N.P. Written documentation for clinical management of patients within health care settings usually include one or more of the following components. - Problem Statement (Chief Complaint) - Subjective (History) - Objective (Physical Exam/Diagnostics) - Assessment (Diagnoses) - Plan (Orders) - Rationale (Clinical Decision Making) Expertise and quality in clinical write-ups is somewhat of an art-form which develops over time as the student/practitioner gains practice and professional experience. In general, students are encouraged to review patient charts, reading as many H/Ps, progress notes and consult reports, as possible. In so doing, one gains insight into a variety of writing styles and methods of conveying clinical information.
    [Show full text]
  • Diagnosing Diagnosis Errors: Lessons from a Multi-Institutional Collaborative Project
    Diagnosing Diagnosis Errors: Lessons from a Multi-institutional Collaborative Project Gordon D. Schiff, Seijeoung Kim, Richard Abrams, Karen Cosby, Bruce Lambert, Arthur S. Elstein, Scott Hasler, Nela Krosnjar, Richard Odwazny, Mary F. Wisniewski, Robert A. McNutt Abstract Background: Diagnosis errors are frequent and important, but represent an underemphasized and understudied area of patient safety. Diagnosis errors are challenging to detect and dissect. It is often difficult to agree whether an error has occurred, and even harder to determine with certainty its causes and consequence. The authors applied four safety paradigms: (1) diagnosis as part of a system, (2) less reliance on human memory, (3) need to open “breathing space” to reflect and discuss, (4) multidisciplinary perspectives and collaboration. Methods: The authors reviewed literature on diagnosis errors and developed a taxonomy delineating stages in the diagnostic process: (1) access and presentation, (2) history taking/collection, (3) the physical exam, (4) testing, (5) assessment, (6) referral, and (7) followup. The taxonomy identifies where in the diagnostic process the failures occur. The authors used this approach to analyze diagnosis errors collected over a 3-year period of weekly case conferences and by a survey of physicians. Results: The authors summarize challenges encountered from their review of diagnosis error cases, presenting lessons learned using four prototypical cases. A recurring issue is the sorting-out of relationships among errors in the diagnostic process, delay and misdiagnosis, and adverse patient outcomes. To help understand these relationships, the authors present a model that identifies four key challenges in assessing potential diagnosis error cases: (1) uncertainties about diagnosis and findings, (2) the relationship between diagnosis failure and adverse outcomes, (3) challenges in reconstructing clinician assessment of the patient and clinician actions, and (4) global assessment of improvement opportunities.
    [Show full text]
  • Professional Practice Medical Record Documentation Guidelines
    Professional Practice Medical Record Documentation Guidelines INTRODUCTION Consistent and complete documentation in the medical record is an essential component of quality patient care. All Participating Providers, defined as primary care and specialist practitioners, are required to keep medical records that contain patient demographics and current, detailed, medical information regarding services rendered to Members to facilitate communication and promote efficient and effective treatment. Medical records must be maintained in an organized medical record-keeping system and in compliance with Capital BlueCross’ documentation standards for Traditional, Comprehensive, PPO, POS, Keystone Health Plan® Central, SeniorBlue® PPO and SeniorBlue® HMO Members. Complete medical records must be maintained for every Member in accordance with accepted professional practice standards, State and Federal requirements. In addition, they must meet the Pennsylvania Department of Health’s guidelines for managed care organizations. Medical records and information must be protected from public access and any information released must comply with HIPAA guidelines. Upon request, all participating practitioners’ medical records must be available for utilization and quality improvement review studies, retrospective review of claims, as well as regulatory agencies’ requests and member relations’ inquiries, as stated in the Provider agreement. Medical records must be available at the practice site for other Providers who provide care and services to the patient. Guidelines have been developed for medical record review that are intended to assist Providers in maintaining complete medical records for all Members. Each provider must meet a minimum 70% compliance with medical record guidelines. If this level of compliance is not met, a corrective action plan will be required. The guidelines, included in Exhibit 3 of this Manual, were developed to comply with state and national regulatory requirements.
    [Show full text]
  • Clinical Characteristics and Prognosis Of
    Lyu et al. BMC Cardiovascular Disorders (2019) 19:209 https://doi.org/10.1186/s12872-019-1177-1 RESEARCH ARTICLE Open Access Clinical characteristics and prognosis of heart failure with mid-range ejection fraction: insights from a multi-centre registry study in China Lyu Siqi, Yu Litian* , Tan Huiqiong, Liu Shaoshuai, Liu Xiaoning, Guo Xiao and Zhu Jun Abstract Background: Heart failure (HF) with mid-range ejection fraction (EF) (HFmrEF) has attracted increasing attention in recent years. However, the understanding of HFmrEF remains limited, especially among Asian patients. Therefore, analysis of a Chinese HF registry was undertaken to explore the clinical characteristics and prognosis of HFmrEF. Methods: A total of 755 HF patients from a multi-centre registry were classified into three groups based on EF measured by echocardiogram at recruitment: HF with reduced EF (HFrEF) (n = 211), HFmrEF (n = 201), and HF with preserved EF (HFpEF) (n = 343). Clinical data were carefully collected and analyzed at baseline. The primary endpoint was all-cause mortality and cardiovascular mortality while the secondary endpoints included hospitalization due to HF and major adverse cardiac events (MACE) during 1-year follow-up. Cox regression and Logistic regression were performed to identify the association between the three EF strata and 1-year outcomes. Results: The prevalence of HFmrEF was 26.6% in the observed HF patients. Most of the clinical characteristics of HFmrEF were intermediate between HFrEF and HFpEF. But a significantly higher ratio of prior myocardial infarction (p = 0.002), ischemic heart disease etiology (p = 0.004), antiplatelet drug use (p = 0.009), angioplasty or stent implantation (p = 0.003) were observed in patients with HFmrEF patients than those with HFpEF and HFrEF.
    [Show full text]