Related Experiment Videos
Effectiveness of disseminating consensus management recommendations for ulcer bleeding: a cluster randomized trial
Alan N Barkun1, Mamatha Bhat, David Armstrong
1McGill University Health Centre, McGill University, Montréal, Quebec. alan.barkun@muhc.mcgill.ca
Summary
A national intervention failed to improve adherence to guidelines for nonvariceal upper gastrointestinal bleeding management. This study highlights challenges in changing healthcare provider behavior regarding clinical practice guidelines.
Area of Science:
- Gastroenterology
- Clinical Practice Guidelines
- Health Services Research
Background:
- International guidelines for nonvariceal upper gastrointestinal bleeding (NUGIB) management lack widespread clinical adoption.
- A need exists to improve adherence, particularly for high-risk NUGIB patients.
Purpose of the Study:
- To evaluate if a national, multifaceted intervention can enhance adherence to NUGIB management guidelines.
- To assess the impact of the intervention on high-risk NUGIB patient care.
Main Methods:
- A randomized trial involving 43 hospitals stratified by region and size.
- Intervention group received guidelines, algorithms, scoring systems, reminders, education, and workshops.
- Adherence rates determined by chart review before and after a 12-month intervention period.
Main Results:
- No significant difference in guideline adherence rates between the experimental and control groups post-intervention (9.8% vs. 4.8%).
- Adherence rates remained low and decreased over time, varying widely (5%-93%) for other recommendations.
- The educational intervention did not significantly alter healthcare provider behavior.
Conclusions:
- National knowledge translation efforts showed poor adherence to NUGIB guidelines.
- The educational intervention was ineffective in improving adherence, underscoring the complexity of altering provider behavior.
- Further strategies are needed to improve guideline implementation in clinical practice.
Related Concept Videos
01:26Peptic Ulcer Disease IV: Management
Medical treatment strategies for peptic ulcers encompass various methods. The primary goal of treatment is to diminish gastric acidity and strengthen mucosal defense mechanisms.
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
01:28Esophageal Varices-II: Clinical Features and Management
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:30Venous Thrombosis IV: Nursing Management
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
01:24Drugs for Peptic Ulcer Disease: Sucralfate as Mucosal Protective Agents
In the intricate landscape of the gastric lumen, excessive acid secretion disrupts the natural defense mechanisms, weakening the mucus-bicarbonate barrier. This vulnerability allows pepsin to infiltrate epithelial cells, digesting mucosal proteins and triggering erosion, leading to ulcer formation.
In this scenario, mucosal protective agents like sucralfate play an essential role. Sucralfate, a complex of sulfated sucrose and aluminum hydroxide, demonstrates its usefulness in acidic conditions,...
In this scenario, mucosal protective agents like sucralfate play an essential role. Sucralfate, a complex of sulfated sucrose and aluminum hydroxide, demonstrates its usefulness in acidic conditions,...
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical management and nursing care are crucial in treating Peptic Ulcer Disease (PUD). Here is an organized and enhanced overview of the surgical interventions and the associated nursing care for PUD:
Surgical Interventions for Peptic Ulcer Disease
Surgical Interventions for Peptic Ulcer Disease