RESUMEN
BACKGROUND: Our centre's median forced expiratory volume in one second (FEV1) reported in the 2005 Cystic Fibrosis (CF) Foundation Patient Registry was below the national median. The focus of our quality improvement initiative was to improve lung function through re-education of airway clearance techniques (REACT). AIM: The global aim was to improve the median FEV1 in our patients. The specific aim was to encourage adherence to airway clearance techniques (ACT). To achieve these goals we implemented the REACT programme for patients. METHODS: Educational sessions introduced the concept of improving clinical outcomes and the importance of airway clearance in achieving optimal lung function. The REACT programme utilised an anonymous survey, in-clinic questionnaire and ACT demonstration to assess knowledge, practices and barriers to ACT. Patients were then categorised as non-adherent or adherent with correct or incorrect technique. Improper techniques were corrected. All patients were re-educated on the rationale for ACT. RESULTS: Our surveys revealed that 43% of patients had barriers to ACT and 53% were non-adherent. Following implementation of REACT, median FEV1 increased from 84% to 92% (national median 91-94%) from 2005 to 2010 for patients aged 6-17. For patients 18 and older, median FEV1 increased from 56% to 64% (national median 62-65%) from 2005 to 2010. CONCLUSIONS: By introducing a programme focused on technique and adherence, we were able to improve median FEV1 in patients with CF. Sustained improvement of FEV1 was accomplished by continued use of the REACT programme.
Asunto(s)
Fibrosis Quística/terapia , Drenaje Postural/métodos , Enfermedades Pulmonares/terapia , Depuración Mucociliar , Educación del Paciente como Asunto/métodos , Adolescente , Adulto , Manejo de la Vía Aérea/métodos , Niño , Estudios Transversales , Fibrosis Quística/fisiopatología , Drenaje Postural/estadística & datos numéricos , Femenino , Volumen Espiratorio Forzado , Humanos , Enfermedades Pulmonares/fisiopatología , Masculino , Cooperación del Paciente/estadística & datos numéricos , Pruebas de Función Respiratoria , Encuestas y Cuestionarios , Estados Unidos , Adulto JovenRESUMEN
OBJECTIVE: Urinary tract infections are a common cause of hospitalization in the pediatric population. Hospitalization for urinary tract infections in children usually involves intravenous antibiotics, invasive methods of obtaining sterile urine specimens, and imaging studies to assess the anatomy of the urinary system. The objective of this study was to determine the frequency of positive repeat urine cultures that are obtained after 2 days of antibiotics among pediatric inpatients who are admitted with diagnosed or suspected infections of the urinary tract. METHODS: A retrospective survey was conducted of all pediatric patients (< or = 18 years of age) who were admitted to Elmhurst Hospital in Queens, New York, with a suspected or diagnosed urinary infection from December 1998 through December 2004. Results of repeat urine cultures that were obtained after 2 days of antibiotics were abstracted from a computerized medical charts database. Nominal data analysis was used to establish the frequency of positive repeat urine cultures. RESULTS: A total of 328 (54.8%) of 599 eligible admissions met inclusion criteria. Of these 328 admissions, only 1 (0.3%) repeat urine culture was positive after 2 days of antimicrobial therapy. CONCLUSIONS: Positive repeat urine cultures after 2 days of antibiotics are exceedingly rare. Elimination of mandatory "proof-of-bacteriologic-cure" benchmarks before hospital discharge is supported by this study.