Translating medical science into medical practice: do we need a National Medical Standards Board?

Article Abstract:

A National Medical Standards Board is necessary to set and disseminate uniform standards for medical care. Research published in 1995 revealed that many diabetic Medicare patients do not receive the diagnostic tests recommended in practice guidelines. Primary care physicians in various specialities and geographic locations underused the tests. This lack of adherence to practice guidelines may be due to unawareness, social influences, or physician resistance. Standards, which are stronger than practice guidelines, require physicians to provide cost-effective, scientifically-proven services that offer significant patient benefits. In the 1990s, many managed care companies are setting private standards that apply to narrow groups of people. A national body would have the authority to produce uniform care standards that apply to all Americans. Insurers could monitor compliance and publicly report the rates each year.

Editorial, Standards, Medical care

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A Controlled Trial of a Critical Pathway for Treatment of Community-Acquired Pneumonia

Article Abstract:

A critical pathway can reduce the use of health care services with minimal adverse impact on patients. Critical pathways define the essential steps of a complex process. They are often used by health care organizations to control costs but still ensure the delivery of high-quality care. Of 19 hospitals caring for 1,743 patients with community-acquired pneumonia, 9 followed a critical pathway and 10 used conventional management. Patients in the critical pathway group spent less time in the hospital and received fewer days of treatment. There was no adverse effect on the health of the patients in the critical pathway group.

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Does this patient have ventilator-associated pneumonia?

Article Abstract:

The precision and accuracy of clinical, radiographic, and laboratory data to diagnose bacterial Ventilator-associated pneumonia (VAP) relative to a histological gold standard is reviewed. It is suggested that clinicians caring for ventilated patients with a clinical syndrome consistent with VAP should be ready to consider additional diagnoses and further investigations, particularly when an empirical trial of antibiotics does not lead to improvement within 48 to 72 hours.

United States, Diagnosis, Risk factors, Bacterial infections, Bacterial pneumonia, Clinical report

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