Escalation System in Clinical Practice

This assignment focuses on the topic of escalation system in clinical practices, including its support in healthcare organizations. It includes a critical analysis of relevant articles, methods used, and recommendations for further research and practice implications.

Escalation System in the Clinical
Practice

Table of Contents
Introduction......................................................................................................................................1
Methods............................................................................................................................................1
Critical Analysis...............................................................................................................................1
Article 9: Decrease in Inpatient Telemetry Utilization Through a System-Wide Electronic Health
Record Change and a Multifaceted Hospitalist Intervention...........................................................6
Summary of the Literature...............................................................................................................7
Recommendations for further Research and Practice Implications.................................................7
References........................................................................................................................................9
Appendices.....................................................................................................................................11

Introduction
Escalation system refers to an effective process which helps to move complaints or concerns of
client directly to more senior representative or one who initiated the relevant procedure. It
includes the set of two categories of escalation such as hierarchical and functional from which
suitable one is adopted by healthcare organisation to respond feedbacks of patient effectively.
However, this can be considered as an effective system that should be used in clinical practices
so that complaints of patient can be addressed as soon as possible (Ganasegeran, Renganathan,
Rashid and Al-Dubai, 2017). It will facilitate to deliver appropriate care services by improving
clinical procedures in order to satisfy patients by resolving their concerns effectively. In context
of this project, it is based on the topic of escalation system in clinical practices including its
support in healthcare organisation. This assignment will focus in critical analysis of relevant
articles along with discussing used methods. It will also include the summary of literature related
to escalation system in clinical practices and recommendations for the same.
Methods
There are mainly two types of data collection methods that is used by researcher in order to
investigate on particular topic that is primary and secondary method. For the present research,
secondary data collection method is used that include journal papers, newspaper, articles, books
and many more. It is analysed that collecting secondary information is cost effective and easily
available for researchers. In the present research, 12 articles is used and analysed in order to gain
knowledge about particular topic in a proper manner.
Critical Analysis
Article 1: Factors that might impact intrathecal drug delivery (IDD) dose escalation: A
longitudinal study
Considering selected article, it has been analysed that IDD system with implantable pumps can
be utilised for treating cancer related pain and non-cancer related chronic pain. It includes the
utilisation of opioids such as morphine and hydromorphone that are generally used intrathecal
agents. It is observed that dose escalation increase rapidly in non-cancer pain among people by
use of technology and advanced techniques (Mekhail, Mahboobi, Farajzadeh Deroee, Costandi,
Dalton, Guirguis and Mehta, 2020). However, it has been founded that median dosage escalation
has figure of 17% every year for patient suffering from neuropathic pain as compared to 12 % of
1

people having other pain modalities. Moreover, it includes the fact that people with neuropathic
pain indicates annual increase about daily use of opioid dose as compared to people with
different pain modalities.
Article 2: Management of benzodiazepine-resistant alcohol withdrawal across a healthcare
system: Benzodiazepine dose-escalation with or without propofol
As mentioned above, it has been identified that severe cases of alcohol withdrawal syndrome
(AWS) may not resolve despite escalating doses of benzodiazepines (BZDs). It includes the
benzodiazepine-resistant alcohol withdrawal (RAW) can be considered as subset of severe
alcohol withdrawal defined by the need of more than or equal to 40 mg of diazepam. The review
of adult patients was carried out with RAW in which that were categorised into BZD dose
escalation or BZD plus propofol. It has been founded that the severe AWS condition was
identified among around 1083 participants and 66 RAW patients were evaluated who met
inclusion (Wong, Benedict, Lohr, Pizon, and Kane-Gill, 2015). It is observed that the median
time was examined to AWS resolution was 5.0 whereas 7.0 days for BZD vs. BZD plus
propofol. However, it has been evaluated that escalation related to this medications is observed
which is helpful for healthcare practitioners to increase effectiveness of providing dosage in
order to reduce relevant problems in clinical practices.
Article 3: A call for better doctor–nurse collaboration: A qualitative study of the
experiences of junior doctors and nurses in escalating care for deteriorating ward patients
By considering selected article, it has evaluated that implementation of medical emergency
teams (METs) in hospitals for providing immediate interventions for their wellbeing. It is
necessary for healthcare professionals to focus on effective clinical practices for delivering better
quality of services for patient’s wellbeing. Meanwhile, it is observed that junior doctors and
nurses escalate for deteriorating ward patients in healthcare organisation with formulated MET
services. The emergency situations in health may occur anytime when professional re required to
take immediate action then possibility of mistakes takes place. It is required for healthcare
management authority to train the staff for increasing accuracy of care practices.
In addition to this, it has been founded that the experience of doctors and nursing staff influence
the escalation which should be responded as soon as possible for authorised person for client
concerns. The group of participants has 24 individuals including 10 junior doctors and 14
registered nurses working in general hospital in MET services (Chua, Legido-Quigley, Jones, D.,
2

Hassan, Tee and Liaw, 2020). However, it has been analysed that emergency situations has
increased complaints and concerns of people due to which escalation system is helpful to gain
factors need improvements for enhancing contingency medical facilities for welfare of patients.
It is necessary to focus on MET activations vs. primary team doctors, challenges in obtaining
medical reviews and unspoken rules of escalation of care for improving effectiveness of
emergency services by working in team effectively.
Article 4: Polymeric micelles: Basic research to clinical practice
As mentioned above, it has been analysed that polymeric micelles can be defined as Nano
carriers which are formed via spontaneous arrangement of amphiphilic block copolymers in
aqueous solutions. It includes the criterion of rapid developing polymeric micelles because of
potential targeting carriers which had intensified requirement for better understanding of the
underlying principles. Basically, it consist the several principles that are related to selection of
favourable delivery substances in order to design, characterisation, drug loading, improving
stability, target ability, biosafety and efficacy. Meanwhile, common use of advanced analytical
tools including inflorescence resonance energy transfer along with dissipative particle dynamics
has identified fresh elements of these nano structures and their detailed behaviour.
On the other hand, it has evaluated that development of polymeric micelles in terms of several
aspects such as architecture, formulation strategy and targeting possibilities as well as their
preclinical & clinical aspects (Deshmukh, Chauhan, Noolvi, Chaturvedi, Ganguly, Shukla, S.S.,
Nadagouda and Aminabhavi, 2017). It involves the use of polymeric micelles for providing
treatment in more effective as well as efficient manner. It has been founded that management
authorities are required to utilise escalation for system for determining relevant complaints and
feedbacks of patients to improve clinical practices along with providing better quality of
facilities. Moreover, it is observed that use of escalation system is favourable for clinical
practices to analyse threats of medical services to solve them for improving facilities.
Article 5: Clinical trial of blood-brain barrier disruption by pulsed ultrasound
According to given article, it has been identified that blood-brain barrier (BBB) disruption by
pulsed ultrasound with the help of providing specific dosage to patient. It is observed that brain
rumours are considered as extreme level of complicated health problem which is difficult for
care professionals to treat. Meanwhile, it includes the difficulty of using chemotherapy for
treating brain tumour due to the blood barrier greatly limits the delivery of drugs into brain. It
3

consist the criterion of using pulsed ultrasound device that can be implanted into skull of sick
people with glioblastoma which is known as an aggressive as well as difficult for treating the
problem of brain tumour accordingly (Carpentier, Canney, Vignot, Reina, Beccaria, Horodyckid,
Karachi, Leclercq, Lafon, Chapelon, and Capelle, 2020). It is observed that method are available
for circumvent the BBB which are developed by scientists but no one of these techniques are
utilised in respect of standards clinical practices for wellness of human beings.
However, it has been founded that an ultrasound dose-escalating phase 1/2a clinical trial using an
implantable ultrasound device system, SonoCloud, before treatment with carboplatin in patients
with recurrent glioblastoma (GBM). It includes the outcome that BBB of every sick person was
disrupted on monthly basis with the help of utilising pulsed ultrasound in combination with
systematic injected micro bubbles respectively. In contrary to this, it has been determined that
use of MRI (magnetic resonance imaging) shows about BBB that it get disrupted at acoustic
pressure levels up to 1.1. It is required for hospital managements authority to analyse about the
problem occurring in patients of brain tumour regarding given treatment process vi escalation
system for improving care facilities to make them disease free.
Article 6: Radiation Therapy Dose Escalation for Glioblastoma Multiforme in the Era of
Temozolomide
Considering the selected research article, it has been analysed that it is based on the aim of
reviewing clinical outcomes for moderate dose escalating with the help of using high dosage
radiation therapy (HDRT) in setting of concurrent temozolomide (TMZ). It includes the sick
people with newly assessed gliobalstoma multiforme (GBM) as compared to standard dose
radiation therapy (SDRT). Meanwhile, it is observed that escalation system can be used in
healthcare organisation to increase accuracy of diagnosing procedures and outcomes because it
facilitate to the formulation of suitable care plan for wellness of an individual (Badiyan,
Markovina, Simpson, Robinson, DeWees, Tran, Linette, Jalalizadeh, Dacey, Rich, and Chicoine,
2014).
In addition to this, the adult patients were considered as respondents having age less than 70
years having biopsy proven GBM who were treated by SDRT or with HDRT and TMZ. It has
been founded that moderate radiation therapy dose escalation is observed above 60 Gy with
concurrent TMZ does not seem for improvement in clinical outputs in regards to patients with
GBM. It is observed that use of escalation system is favourable to analyse about complaints of
4

people regarding selected treatment methods to prefer more suitable one for further care and
treatment of people.
Article 7: Gene Therapy in Neovascular Age-related Macular Degeneration: Three-Year
Follow-up of a Phase 1 Randomized Dose Escalation Trial
As mentioned above, it is based on the gene therapy with having purpose of assessing the safety
of rAAV.sFlt-1 sub retinal injection in neovascular age-related macular degeneration (wet AMD)
over 36 months. It includes the utilisation of research design including phase 1 dose escalation
trial in clinical settings. Meanwhile, it has been analysed that use of eight subjects consider with
advanced, treatment experienced wet AMD who were assigned in random manner is ratio of 3:1
for treatment and non-gene therapy control groups. It involves the escalation system use for
analysed effectiveness of selected treatment procedures to analyse the effective one in different
situations to address concerns of people. It will favourable to improve patient outcomes
improving clinical practices with the help of utilising escalation system in clinical practice.
On the other hand, it has been founded that only 6 out if the 8 subjects completed the study of 36
months in which is observed that sub retinal injection with pars plana vitrectomy was tolerated
on the given cohort in proper manner (Constable, Lai, Magno, French, Barone, Schwartz,
Blumenkranz, Degli-Esposti, and Rakoczy, 2017). It includes the fact that there is no ocular or
systemic safety signals were observed at the time of long term follow up duration respectively.
However, it has been evaluated that utilisation of exploratory data analysis is responsible for
suggesting the stability of wet AMD over the duration of 36 months. Moreover, it is observed
that escalation system can be used in clinical practice for improving effectiveness of given
treatment method for wellbeing of patients.
Article 8: Risk of Late Toxicity in Men Receiving Dose-Escalated Hypofractionated
Intensity Modulated Prostate Radiation Therapy: Results From a Randomized Trial
Considering the selected research paper, it is based on the research objective of reporting about
late toxicity outcomes from a randomised trail for comparing it to conventional and hypo
fractionated prostate radiation therapy. It includes the aim of determining dosimetric and clinical
parameters associated with late toxicity after hypo fractionated treatment. However, it consist the
participants group including men with localised prostate cancer enrolled in trial to gain accurate
outcomes (Hoffman, Voong, Pugh, Skinner, Levy, Takiar, Choi, Du, Frank, Johnson and Kanke,
2014). In addition to this, it has been founded that use of moderate hypo fractionation regimen
5

can be provided securely via limited grade 2 or 3 late toxicity. Moreover, it is observed that
people receiving moderate or high dose are responsible for reducing risk of late rectal toxicity
after the hypo fractionation regimen.
Article 9: Decrease in Inpatient Telemetry Utilization Through a System-Wide Electronic
Health Record Change and a Multifaceted Hospitalist Intervention
According to the research paper, it state that unnecessary telemetry evaluation contributes to the
healthcare waste. It is determine that in the hospitalist service, there is a telemetry reduction that
include routine feedback, process change and so on, Escalation system help in clinical service to
properly solve issues of its staff whether it is in low level or at middle level (Edholm, K.,
Kukhareva, Ciarkowski, Carr, Gill, Rupp, Morshedzadeh, Wanner, and Kawamoto, 2018). The
initial outcome of the research was that telemetry utilization measured as percentage of daily
charges or room and the secondary outcome is code event rate, escalation of care &
appropriateness of telemetry utilization.
Article 10: Is there a role for patients and their relatives in escalating clinical deterioration
in hospital
As per the article published in the year 2020, it has been identified that in the present scenario
escalation is a process which plays very crucial as well as essential role in a healthcare institution
or clinical practices. It has been said that patients are empowered as the active partners within the
health care or clinical sector. It is examined that in the present environment there is a direct link
between patient, their relatives and the health care staff (Albutt, O'Hara, Conner, Fletcher, and
Lawton, 2017). With the help of direct link between doctors and patients, the personal feel safe
and secure and can easily open up and share their problems. With the help of there experience,
healthcare professionals can easily identify the issues faced by patient and can eliminate further
delay in different procedures.
Article 11: Role of Early De-escalation of Antimicrobial Therapy on Risk of Clostridioides
difficile Infection Following Enterobacteriaceae Bloodstream Infections
Considering the above research paper, there is paucity of data that impact of early de-escalation
on therapy rates of CDI. It is determine that therapy within 48 hours leads to bloodstream
infection. The paper show that use of Antimicrobial therapy for more than 48 hours is consider
as an independent risk factor for Clostridioides difficile infection (Seddon, Bookstaver, Justo,
Kohn, Rac, Haggard, Mediwala, Dash and Al-Hasan, 2019).
6

Article 12: Antibiotic Use in the Intensive Care Unit: Optimization and De-Escalation
The research paper states that a proper antimicrobial therapy is important in order to ensure
positive outcome of patient. It is determine that inappropriate utilization of antibiotics sometimes
leads to raise in the length of stay and mortality. The overall result of the paper is that optimising
antibiotic dosing by prolonged infusions can be suitable and beneficial in intensive care of a
patient (Campion, M. and Scully, G., 2018).
Summary of the Literature
Considering the above data, it has been summarised that escalation system can be described as
system which has set parameters of moving complaints or concerns of client directly high
management authority. It includes an effective as well as efficient method of responding with
clients in order to increase effectiveness of clinical procedures which facilitate to gain improved
outcomes. This system is beneficial for top level authorities of healthcare organisations to
evaluate about actual problem and challenges faced by people while seeking care services and
treatment so that it can be improved (Odell, 2015). It is necessary for healthcare professionals to
focus on this aspect to increase their performance and respond about concerns of clients as soon
as possible. Meanwhile, it has been analysed that it is favourable to analyse the areas of
improvement for improving patient outcomes.
Recommendations for further Research and Practice Implications
For better implementation of escalation system clinical services can opt for the making better
their services, such recommendations are as follows:
By analyzing the case: The case should be analyzed properly and accordingly it should set
for escalation system. Through classifying the cases the operational activities into the clinics
would catch up a speed. This would result into effective and efficient services into the premises.
The activities should be set up such that the patient case should not hold on a wait until there is
another issue. By analyzing the cases the clinical staff would know about which case needs an
escalation and which does not.
Adjustments in communication styles: communication is a factor which has to be very
much transparent and clear. Any barrier into communication can create confusion and
complexity into the operational activities of organization. The proper adjustment or flow of
communication helps into better and transparent activities. This also would result into fast and
7

effective performance of the staff members. To establish the good and proper communication
there should a proper flow or system which needs to get establish into the structure. Every staff
member should be accountable to his manager and the manager should be accountable to his
head. The staff member should receive the orders from only one head because this would
eliminate the confusions and duplication of activities.
Define clear paths for escalations: The paths for the activities should be clearly specified
to the patients or the family members of those patients. The people who visit the clinic must be
very clear about its process so that they don’t waste any time regarding asking the process for the
things. The system should be adopted such that gives clear instructions and shows right paths to
the people. This activity would result into the escalation of activities.
Coach ownership: There should be a person who must be responsible to handle the
complex and difficult cases or issues of the clinic. The job responsibility of that person is to
solve such special cases or issues so that they don’t create any chaos into the normal and regular
working activities because such chaos creates delay into the work of people and it also makes the
other people wait for their number to solve their queries. This can help the clinic people in
eliminating any kind of delay into their work and re-establish the discipline environment.
Avoid skipping escalations or delay: The management team should avoid any kind of
skipping into the activities of delay. Any avoidance or skipping of work would result into more
or increase in work process. Any grievances or barrier should get should at the same day and the
same time only. This activity will result into deceasing of burden upon the shoulders of staff
members as the issue or the problem has been solved at that time only. All these activities enable
the clinic in making its operational activities better and effective. This also increases the sound of
performance of that organization good.
8

References
Books and journals
Ganasegeran, K., Renganathan, P., Rashid, A. and Al-Dubai, S.A.R., 2017. The m-Health
revolution: Exploring perceived benefits of WhatsApp use in clinical practice. International
journal of medical informatics, 97, pp.145-151.
Odell, M., 2015. Detection and management of the deteriorating ward patient: an evaluation of
nursing practice. Journal of Clinical Nursing, 24(1-2), pp.173-182.
1. Mekhail, N., Mahboobi, R., Farajzadeh Deroee, A., Costandi, S., Dalton, J., Guirguis,
M. and Mehta, P., 2020. Factors That Might Impact Intrathecal Drug Delivery (IDD )
Dose Escalation: A Longitudinal Study. [Online]. Available
through:<https://onlinelibrary.wiley.com/doi/abs/10.1111/papr.12096>
2. Wong, A., Benedict, N.J., Lohr, B.R., Pizon, A.F. and Kane-Gill, S.L., 2015.
Management of benzodiazepine-resistant alcohol withdrawal across a healthcare
system: Benzodiazepine dose-escalation with or without propofol. [Online]. Available
through:< 4>
3. Chua, W.L., Legido-Quigley, H., Jones, D., Hassan, N.B., Tee, A. and Liaw, S.Y.,
2020. A call for better doctor–nurse collaboration: A qualitative study of the
experiences of junior doctors and nurses in escalating care for deteriorating ward
patients. [Online]. Available through:<
https://www.sciencedirect.com/science/article/pii/S1036731418302753>
4. Deshmukh, A.S., Chauhan, P.N., Noolvi, M.N., Chaturvedi, K., Ganguly, K., Shukla,
S.S., Nadagouda, M.N. and Aminabhavi, T.M., 2017. Polymeric micelles: Basic
research to clinical practice. [Online]. Available through:<
https://www.sciencedirect.com/science/article/pii/S0378517317308517>
5. Carpentier, A., Canney, M., Vignot, A., Reina, V., Beccaria, K., Horodyckid, C.,
Karachi, C., Leclercq, D., Lafon, C., Chapelon, J.Y. and Capelle, L., 2020. Clinical
trial of blood-brain barrier disruption by pulsed ultrasound. [Online]. Available
through:< https://stm.sciencemag.org/content/8/343/343re2?
__hstc=12316075.07430159d50a3c91e72c280a7921bf0d.1525478400142.152547840
0143.1525478400144.1&__hssc=12316075.1.1525478400145&__hsfp=1773666937
>
6. Badiyan, S.N., Markovina, S., Simpson, J.R., Robinson, C.G., DeWees, T., Tran,
D.D., Linette, G., Jalalizadeh, R., Dacey, R., Rich, K.M. and Chicoine, M.R., 2014.
Radiation Therapy Dose Escalation for Glioblastoma Multiforme in the Era of
Temozolomide. [Online]. Available through:<
https://www.sciencedirect.com/science/article/pii/S0360301614034932>
7. Constable, I.J., Lai, C.M., Magno, A.L., French, M.A., Barone, S.B., Schwartz, S.D.,
Blumenkranz, M.S., Degli-Esposti, M.A. and Rakoczy, E.P., 2017. Gene Therapy in
Neovascular Age-related Macular Degeneration: Three-Year Follow-up of a Phase 1
Randomized Dose Escalation Trial. [Online]. Available through:<
https://www.sciencedirect.com/science/article/pii/S0002939417300855>
8. Hoffman, K.E., Voong, K.R., Pugh, T.J., Skinner, H., Levy, L.B., Takiar, V., Choi,
S., Du, W., Frank, S.J., Johnson, J. and Kanke, J., 2014. Risk of Late Toxicity in Men
Receiving Dose-Escalated Hypofractionated Intensity Modulated Prostate Radiation
9

Therapy: Results From a Randomized Trial. [Online]. Available through:<
https://www.sciencedirect.com/science/article/pii/S036030161400073X>
9. Edholm, K., Kukhareva, P., Ciarkowski, C., Carr, J., Gill, D., Rupp, A.,
Morshedzadeh, J., Wanner, N. and Kawamoto, K., 2018. Decrease in Inpatient
Telemetry Utilization Through a System-Wide Electronic Health Record Change and
a Multifaceted Hospitalist Intervention. [Online]. Available through:<
https://europepmc.org/article/med/29444195>
10. Albutt, A.K., O'Hara, J.K., Conner, M.T., Fletcher, S.J. and Lawton, R.J., 2017. Is
there a role for patients and their relatives in escalating clinical deterioration in
hospital. [Online]. Available through<
https://onlinelibrary.wiley.com/doi/full/10.1111/hex.12496>
11. Seddon, M.M., Bookstaver, P.B., Justo, J.A., Kohn, J., Rac, H., Haggard, E.,
Mediwala, K.N., Dash, S. and Al-Hasan, M.N., 2019. Role of early de-escalation of
antimicrobial therapy on risk of Clostridioides difficile infection following
Enterobacteriaceae bloodstream infections. Clinical Infectious Diseases. [Online].
Available through < https://academic.oup.com/cid/article-abstract/69/3/414/5127158
>
12. Campion, M. and Scully, G., 2018. Antibiotic use in the intensive care unit:
optimization and de-escalation. Journal of intensive care medicine, 33(12). [Online].
Available through< https://journals.sagepub.com/doi/abs/10.1177/0885066618762747
>
10

13.Appendices
First author ,
year & country
Methodology,
Research
Design and
level of
Evidence
Study
aim/purpose
Participants Analysis Findings/theme
Mekhail, N.,
Mahboobi, R.,
Farajzadeh
Deroee, A.,
Costandi, S.,
Dalton, J.,
Guirguis, M. and
Mehta, P., 2020.
Factors That
Might Impact
Intrathecal Drug
Delivery (IDD )
Dose Escalation:
A Longitudinal
Study
A longitudinal
study
To analyse the
factors That Might
Impact Intrathecal
Drug Delivery
(IDD ) Dose
Escalation
Retrospective
chart review
of IDD pump
patients
It has been
analysed that
dosage
escalation is
17% in
patients with
neuropathic
pain whereas
12% in other
pain
modalities.
It has been
founded that
usage of opioids
is higher
annually among
patients with
neuropathic
pain.
Wong, A.,
Benedict, N.J.,
Lohr, B.R., Pizon,
A.F. and Kane-
Gill, S.L., 2015.
Management of
benzodiazepine-
resistant alcohol
withdrawal across
a healthcare
system:
Benzodiazepine
dose-escalation
with or without
propofol.
A longitudinal
study
To evaluate the
management of
benzodiazepine-
resistant alcohol
withdrawal across
a healthcare
system including
Benzodiazepine
dose-escalation
with or without
propofol.
1083
participants
It has been
evaluated that
severe AWS
condition is
founded
among more
participants.
It is founded
that AWS
condition
become severe
and complicated
in most of the
cases observed
during the
investigation.
Chua, W.L.,
Legido-Quigley,
H., Jones, D.,
Hassan, N.B., Tee,
A. and Liaw, S.Y.,
2020. A call for
The
qualitative
method with
use of
interview
A call for better
doctor–nurse
collaboration: A
qualitative study
24
individuals
It is observed
that escalation
system is
beneficial in
It has been
founded that
escalation
system is not
11

better doctor–
nurse
collaboration: A
qualitative study of
the experiences of
junior doctors and
nurses in
escalating care for
deteriorating ward
patients.
of the experiences
of junior doctors
and nurses in
escalating care for
deteriorating ward
patients.
healthcare to
improve
patient
outcomes.
used by junior
doctors and
nurse then
effective
training is
required to
make them
understand
whole process
and its
importance for
using in clinical
practice.
Deshmukh, A.S.,
Chauhan, P.N.,
Noolvi, M.N.,
Chaturvedi, K.,
Ganguly, K.,
Shukla, S.S.,
Nadagouda, M.N.
and Aminabhavi,
T.M., 2017.
Polymeric
micelles: Basic
research to clinical
practice
The
qualitative
method
Polymeric
micelles: Basic
research to clinical
practice
2 samples It includes the
focus on
potential of
micelle
carriers
including
several
aspects
including
delivery
materials for
designing,
characterizing,
drug loading,
improving
stability,
target ability,
biosafety and
It has been
evaluated that
polymeric
micelles are
helpful to
delivery of
drugs on
appropriate site
for better
outcomes.
12

efficacy.
Carpentier, A.,
Canney, M.,
Vignot, A., Reina,
V., Beccaria, K.,
Horodyckid, C.,
Karachi, C.,
Leclercq, D.,
Lafon, C.,
Chapelon, J.Y. and
Capelle, L., 2020.
Clinical trial of
blood-brain barrier
disruption by
pulsed ultrasound.
The
qualitative
method
Clinical trial of
blood-brain barrier
disruption by
pulsed ultrasound.
Ultrasound
dose
escalating
phase ½
clinical trial
It includes the
analysis of
using BBB in
specific
combination
to study it
benefits and
potential to
use in clinical
practice.
It has been
founded that
repeated
opening of the
BBB using our
pulsed
ultrasound
system, in
combination
with systemic
micro bubble
injection is
proved as safe
for using in
future.
Badiyan, S.N.,
Markovina, S.,
Simpson, J.R.,
Robinson, C.G.,
DeWees, T., Tran,
D.D., Linette, G.,
Jalalizadeh, R.,
Dacey, R., Rich,
K.M. and
Chicoine, M.R.,
2014. Radiation
Therapy Dose
Escalation for
Glioblastoma
Multiforme in the
Era of
Temozolomide.
The
experimental
study
Radiation Therapy
Dose Escalation
for Glioblastoma
Multiforme in the
Era of
Temozolomide.
Adult
patients aged
<70 years
with biopsy-
proven GBM
It involves the
study of
understating
effectiveness
of radiation
therapy for
patients with
GBM.
It has been
evaluated that
radiation
therapy dose
escalation
above 60 Gy
with concurrent
TMZ not have
potential to
improve clinical
outputs for
patients with
GBM.
Constable, I.J.,
Lai, C.M., Magno,
A.L., French,
The
qualitative
study
Gene Therapy in
Neovascular Age-
8 subjects
(3:1)
It includes the
study
It has been
evaluated that
13

M.A., Barone,
S.B., Schwartz,
S.D.,
Blumenkranz,
M.S., Degli-
Esposti, M.A. and
Rakoczy, E.P.,
2017. Gene
Therapy in
Neovascular Age-
related Macular
Degeneration:
Three-Year
Follow-up of a
Phase 1
Randomized Dose
Escalation Trial.
related Macular
Degeneration:
Three-Year
Follow-up of a
Phase 1
Randomized Dose
Escalation Trial.
effectiveness
of treatment
with and
without gene
therapy to
assess the
respective
clinical
methods.
no ocular or
systemic safety
signals were
observed during
the long-term
follow-up
period.
Hoffman, K.E.,
Voong, K.R.,
Pugh, T.J.,
Skinner, H., Levy,
L.B., Takiar, V.,
Choi, S., Du, W.,
Frank, S.J.,
Johnson, J. and
Kanke, J., 2014.
Risk of Late
Toxicity in Men
Receiving Dose-
Escalated
Hypofractionated
Intensity
Modulated
Prostate Radiation
Therapy: Results
From a
Randomized Trial.
The
qualitative
study
Risk of Late
Toxicity in Men
Receiving Dose-
Escalated
Hypofractionated
Intensity
Modulated
Prostate Radiation
Therapy: Results
From a
Randomized Trial.
Men with
localized
prostate
cancer
It consist the
to analyse the
factor of
toxicity and
use of
escalation
system for
improving
patient
outcomes.
It has been
founded that use
of hypo
fractionation
regimen can be
delivered
securely with
limited grade of
2 or 3 toxicity.
Edholm, K.,
Kukhareva, P.,
Ciarkowski, C.,
Carr, J., Gill, D.,
Rupp, A.,
Morshedzadeh, J.,
Wanner, N. and
Kawamoto, K.,
2018. Decrease in
The
qualitative
and
quantitative
study.
To analyse reduce
in inpatient
telemetry
utilization
35,871 non
intensive
care unit
It is analysed
that increase
in number of
multifaceted
study improve
more number
It has been find
that by the
assistance of
electronic
health record,
there is decline
14

Inpatient
Telemetry
Utilization
Through a System-
Wide Electronic
Health Record
Change and a
Multifaceted
Hospitalist
Intervention.
of patients. in inpatient
telemetry
utilization.
Albutt, A.K.,
O'Hara, J.K.,
Conner, M.T.,
Fletcher, S.J. and
Lawton, R.J.,
2017. Is there a
role for patients
and their relatives
in escalating
clinical
deterioration in
hospital.
Qualitative
study
To determine the
role of patients
and relatives in
escalating clinical
deterioration in
hospital
50 patients
and their
relatives
It is analysed
that patients
plat more role
than the
relatives in
escalating
clinical
deterioration.
The overall
result of the
study that
patient play
major role while
their relatives is
less but it is
effective to
consider both.
Seddon, M.M.,
Bookstaver, P.B.,
Justo, J.A., Kohn,
J., Rac, H.,
Haggard, E.,
Mediwala, K.N.,
Dash, S. and Al-
Hasan, M.N.,
2019. Role of
early de-escalation
of antimicrobial
therapy on risk of
Clostridioides
difficile infection
following
Enterobacteriaceae
bloodstream
infections. Clinical
Infectious
Diseases.
The
qualitative
method
Role of early de-
To analyse
escalation of
antimicrobial
therapy on risk of
Clostridioides
difficile infection
following
Enterobacteriaceae
bloodstream
infections.
90 day risk
of CBL
It is analysed
that
antimicrobial
therapy
consist of high
risk for
patients
It has been
found that
sometimes such
therapy leads to
infection.
Campion, M. and
Scully, G., 2018.
Antibiotic use in
Qualitative
study
To find out
antibiotic use in
Based on
recent
Analysis of
this paper
It has been find
out that
15

the intensive care
unit: optimization
and de-
escalation. Journal
of intensive care
medicine.
intensive care unit evidences involves
understanding
of antibiotic
use in
intensive care.
antibiotic are
used for patients
intensive care
and to optimize
and de-
escalation.
16