Search

Presents a critical report on the events of the Association Typographique Internationale's 1998 conference held in Lyons, France. Discusses papers presented and the state of the field of typography. Notes that, although attending the conference was expensive, the real reward for the author and students he spoke to was the chance to socialize with others in the field. (RS)

Objective: The objective of this study was to assess the impact of introduction of a new pulmonary embolism (PE) diagnostic guideline with a raised D‐dimer threshold. Methods: This is a single‐site, observational, cohort study with a historical comparison. The new guideline raised the D‐dimer threshold to 1000 ng/mL for most patients with a Wells' score of 4 or less. Patients investigated for PE with a D‐dimer level and/or definitive imaging in 6‐month periods before and after the introduction of the guideline were eligible. Patients with D‐dimers of 500–1000 ng/mL were prospectively followed up at 3 months for missed PE. Results: During the pre‐intervention period, 688 patients were investigated for PE, 366 (53.2%) received definitive imaging and 39 PE were diagnosed (5.7% overall, 10.7% of those imaged). For the 121 patients with D‐dimers ≥500 and <1000 ng/mL, 87 (71.9%) were imaged with 7 (5.8%) having a PE diagnosed. Post intervention there were 930 patients, of which 426 (45.8%) received definitive chest imaging and there were 50 patients with PE diagnosed (5.4% overall, 11.7% of those imaged). For the 185 patients with D‐dimers ≥500 and <1000 ng/mL, 60 (32.4%) were imaged with 5 (2.7%) having PE diagnosed. No cases of missed PE were identified at 3 months. Conclusion: The introduction of the new guideline was associated with a reduction in overall imaging rates without evidence of missed PE. Further evaluation in other settings is recommended. [ABSTRACT FROM AUTHOR]

Objective: The Interagency Integrated Triage Tool (IITT) is a novel, three‐tier triage system recommended by the World Health Organization. The present study sought to assess the validity and reliability of a pilot version of the tool in a resource‐limited ED in regional Papua New Guinea. Methods: This pragmatic prospective observational study, conducted at Mount Hagen Provincial Hospital, commenced 1 month after IITT implementation. The facility did not have a pre‐existing triage system. All ED patients presenting within a 5‐month period were included. The primary outcome was sensitivity for the detection of time‐critical illness, defined by 10 pre‐specified diagnoses. The association between triage category and ED outcomes was examined using Cramer's V correlation coefficient. Reliability was assessed by inter‐rater agreement between a local and an experienced external triage officer. Results: There were 9437 presentations during the study period and 9175 (97.2%) had a triage category recorded. Overall, 138 (1.5%) were classified as category 1 (emergency), 1438 (15.7%) as category 2 (priority) and 7599 (82.8%) as category 3 (non‐urgent). When applied by a mix of community health workers, nurses, health extension officers and doctors, the tool's sensitivity for the detection of time‐critical illness was 77.8% (95% confidence interval 64.4–88.0). The admission rate was 14.5% (20/138) among emergency patients, 12.0% (173/1438) among priority patients and 0.4% (30/7599) among non‐urgent patients (P = 0.00). Death in the ED occurred in 13 (9.4%) of 138 emergency patients, 34 (2.4%) of 1438 priority patients and four (0.1%) of 7599 non‐urgent patients (P = 0.00). The negative predictive value for these outcomes was >99.5%. Among 170 observed triage assessments, weighted κ was 0.81 (excellent agreement). On average, it took clinicians 2 min 43 s (standard deviation 1:10) to complete a triage assessment. Conclusion: There is limited published data regarding the predictive validity and inter‐rater reliability of the IITT. In this pragmatic study, the pilot version of the tool demonstrated adequate performance. Evaluation in other emergency care settings is recommended. [ABSTRACT FROM AUTHOR]

Aims and objectives: To measure renal nurses' perceptions on assessing medication adherence in patients undergoing dialysis. Background: Renal nurses play a vital role in caring for patients undergoing dialysis. Despite the high prevalence of medication nonadherence in chronic dialysis patients, little is known about renal nurses' perceptions and current adherence assessment practices. Design: A cross‐sectional survey. Methods: Participants completed an online survey between March–May 2016. Five psychometric scales were used to measure perception on prevalence and contributors of nonadherence, effective methods of assessment, barriers to assessment and confidence to assess adherence. The survey also captured current adherence assessment practices using a 4‐point graded response (1 = do not practice at all to 4 = practice for every patient). Results: A total of 113 dialysis nurses completed the survey. The majority agreed that patients in their unit are nonadherent to their medicines (74.5%, n = 82; median = 8). Most nurses agreed that having dedicated professionals conducting medication history interviews can be effective in identifying nonadherence (88.9%, n = 96; median = 8). Objective assessment through blood results was the most frequently used method to determine nonadherence (83.2%, n = 89), with little attention being paid to patients' self‐reports of adherence (55.1%, n = 59). Time constraints, administrative support and patients' disinterest in discussing medication‐related issues with the nurses were perceived as barriers to assessing adherence. Conclusions: Patient self‐reported measures to assess adherence were underutilised by the renal nurses, whereas objective blood monitoring was routinely used. Overcoming dialysis nurses' work‐related barriers may facilitate the effective monitoring and promotion of medication adherence in chronic dialysis patients. Relevance to clinical practice: Results from this study emphasise the need for proper assessment of dialysis patient's medication‐taking behaviour during routine dialysis to ensure the benefits of prescribed therapies. [ABSTRACT FROM AUTHOR]