high-value care

高价值护理
  • 文章类型: Journal Article
    BACKGROUND: Despite the emergence of multiple clinical practice guidelines (CPGs) for the rehabilitation of low back pain (LBP) over the last decade, self-reported levels of disability in this population have not improved. This may be explained by the numerous implementation barriers, such as the complexity of information and sheer volumes of CPGs.
    OBJECTIVE: The purpose of this study was to summarize the evidence and recommendations from the most recent and high-quality CPGs on the rehabilitation management of LBP by developing an infographic summarizing the recommendations to facilitate dissemination into clinical practice.
    METHODS: We performed a systematic review of high-quality CPGs with an emphasis on rehabilitation approaches. We searched major health-related research databases (e.g., PubMed, CINAHL, and PEDro). We performed quality assessment via the AGREE-II instrument. Contents of the CPGs were synthesized by extracting recommendations, which were then compared to one another to identify consistencies based on an iterative evaluation process.
    RESULTS: We identified and assessed 5 recent high-quality CPGs. We synthesized 13 recommendations on the rehabilitation management of LBP (2 for screening procedures, 3 for assessment procedures, and 8 involving treatment approaches) and 2 underlying principles were highlighted. These results were then synthetized and illustrated in a concise infographic that serves as a conceptual roadmap that identifies the specific behavior changes (i.e., adoption of CPGs\' recommendations) rehabilitation professionals should adopt in order to integrate an evidenced-based approach for the management of LBP.
    CONCLUSIONS: We systematically reviewed the literature for CPGs\' recommendations for the physical rehabilitation management of LBP and synthesized the information through an infographic.
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  • 文章类型: Journal Article
    高血糖与住院内科和外科患者的不良预后相关。尽管一些早期证据显示强化胰岛素治疗(IIT)的益处,最近的证据没有显示出一致的益处,甚至显示出与使用IIT相关的危害。过度使用某些治疗干预措施以及由此对患者造成的伤害是不必要的医疗保健成本的重要组成部分。本文的目的是解决高血糖的管理,并评估与使用IIT来实现有或没有糖尿病的住院患者的严格血糖控制相关的益处和危害。本文基于美国医师学会关于这一主题的证据审查和指南。最佳实践建议1:如果SICU/MICU患者使用胰岛素治疗,临床医生应将血糖水平定为7.8至11.1mmol/L(140至200mg/dL)。最佳实践建议2:临床医生应避免低于7.8mmol/L(<140mg/dL)的目标,因为随着血糖目标的降低,危害可能会增加。
    Hyperglycemia is associated with poor outcomes in hospitalized medical and surgical patients. Although some early evidence showed benefits of intensive insulin therapy (IIT), recent evidence does not show a consistent benefit and even shows harm associated with the use of IIT. The overuse of some therapeutic interventions and the resulting harms to a patient are an important component of unnecessary health care costs. The goal of this article is to address the management of hyperglycemia and evaluate the benefits and harms associated with the use of IIT to achieve tight glycemic control in hospitalized patients with or without diabetes mellitus. This article is based on the evidence review and the guideline developed by the American College of Physicians on this topic. Best Practice Advice 1: Clinicians should target a blood glucose level of 7.8 to 11.1 mmol/L (140 to 200 mg/dL) if insulin therapy is used in SICU/MICU patients. Best Practice Advice 2: Clinicians should avoid targets less than 7.8 mmol/L (<140mg/dL) because harms are likely to increase with lower blood glucose targets.
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