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Sample records for actual clinical practice

  1. Copy number variants in a sample of patients with psychotic disorders: is standard screening relevant for actual clinical practice?

    Van de Kerkhof NW

    2012-07-01

    Full Text Available Noortje WA Van de Kerkhof,1 Ilse Feenstra,2 Jos IM Egger,1,3,4 Nicole de Leeuw,2 Rolph Pfundt,2 Gerald Stöber,5 Frank MMA van der Heijden,1 Willem MA Verhoeven1,61Vincent van Gogh Institute for Psychiatry, Centre of Excellence for Neuropsychiatry, Venray, The Netherlands; 2Radboud University Nijmegen Medical Centre, Department of Human Genetics, Nijmegen, The Netherlands; 3Donders Institute for Brain, Cognition and Behaviour, 4Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; 5University of Würzburg, Department of Psychiatry, Psychosomatics and Psychotherapy, Würzburg, Germany; 6Erasmus University Medical Centre, Department of Psychiatry, Rotterdam, The NetherlandsAbstract: With the introduction of new genetic techniques such as genome-wide array comparative genomic hybridization, studies on the putative genetic etiology of schizophrenia have focused on the detection of copy number variants (CNVs, ie, microdeletions and/or microduplications, that are estimated to be present in up to 3% of patients with schizophrenia. In this study, out of a sample of 100 patients with psychotic disorders, 80 were investigated by array for the presence of CNVs. The assessment of the severity of psychiatric symptoms was performed using standardized instruments and ICD-10 was applied for diagnostic classification. In three patients, a submicroscopic CNV was demonstrated, one with a loss in 1q21.1 and two with a gain in 1p13.3 and 7q11.2, respectively. The association between these or other CNVs and schizophrenia or schizophrenia-like psychoses and their clinical implications still remain equivocal. While the CNV affected genes may enhance the vulnerability for psychiatric disorders via effects on neuronal architecture, these insights have not resulted in major changes in clinical practice as yet. Therefore, genome-wide array analysis should presently be restricted to those patients in whom psychotic symptoms are paired with other

  2. Imagined and actual practices using ICT

    Levinsen, Karin; Henningsen, Birgitte Sølbeck; Paasch, Sofie

    2014-01-01

    nformation and Communication Technologies (ICT) play an increasing role in public schools as a whole; at the same time, ICT is championed as part of a proposed solution (in Danish educational policies) to strengthen inclusion of children with various difficulties in ordinary classes. However......, the vision of ICT as a solution rests upon the teachers’ ability to implement ICT into their teaching methods in ways that are supportive and inclusive. Furthermore, the general perspective on ICT is that it is a tool that mediates between a user and that user’s intention to achieve some specific aim....... In relation to inclusion, this means that ICT is used as a tool to bridge the gap produced by a child’s disability and mediate between the child and learning. However, recent research shows that ICT has multiple representations and also emerges as an actor in its own right in educational practices. Another...

  3. Statistics in clinical practice

    Coggon, David

    2002-01-01

    These days a basic knowledge of statistics is essential for good clinical practice, which presents a daunting challenge to health professionals who are not mathematically inclined. This book is aimed at clinicians and students who view statistics as a necessary evil. It covers the summary and presentation of data as might be required for a clinical meeting, audit or the planning of services, and explains how to interpret the p-values and confidence intervals that are reported in medical and scientific journals.

  4. Actual issues of clinical radiobiology and their experimental study

    Information being collector for some tens years in frame of clinical study of radiation effects in man in broad range of dose and exposure variant has been summarised and systematized. It has been formulated the questions which could be answered under only clinical observation with many difficulties: diagnostical and prognostical criteria for evaluation of therapy efficiency in non-bonemarrow syndrome of acute radiation disease choice and confirmaty of methods of bonemarrow syndrome therapy in overlethal range of dose; improving of preclinical examination of means and methods of acute radiation syndrome prophylaxis and treatment; comparative analysis of the role of various radiation factory in development of oncological and severe somatic disease and possibility of these effects modification. Some limitations in extrapolation of experimental data onto clinical practice has been discussed and optimal forms of cooperation are shown

  5. Are clinical practice guidelines impartial?

    Cohen, Joshua

    2004-01-01

    In A Theory of Justice, John Rawls demands from citizens who decide upon principles of justice and the rules derived from such principles that they abstract from all particularities that constitute their identity as unique individuals. This demand is unrealistic in policy settings where actual policy-makers convene to provide guidance, establish rules regarding public good, and enact legislation. In practice, I argue, policy-makers, legislators, and others involved in developing social rules that pertain to distributive justice formulate such rules as reasonably partial spectators. To illustrate, I show how clinical practice guidelines are established and mediated by a reasonably partial expert panel whose partial action is publicly justifiable, yet whose claims to impartiality are not. PMID:15609789

  6. Hyponatraemia in clinical practice

    Biswas, M.; Davies, J S

    2007-01-01

    Hyponatraemia is defined as a serum sodium concentration below 135 mmol/l. It causes major diagnostic and management problems in practice. Hyponatraemic disorders are divided into euvolaemic, hypervolaemic and hypovolaemic. In the evaluation of the hyponatraemic patient, history taking should focus on identifying the potential cause, duration and symptomatology. Clinical examination should include assessment of volume status. Acute hyponatraemia of less than 48 h duration requires prompt corr...

  7. Myocarditis in Clinical Practice.

    Sinagra, Gianfranco; Anzini, Marco; Pereira, Naveen L; Bussani, Rossana; Finocchiaro, Gherardo; Bartunek, Jozef; Merlo, Marco

    2016-09-01

    Myocarditis is a polymorphic disease characterized by great variability in clinical presentation and evolution. Patients presenting with severe left ventricular dysfunction and life-threatening arrhythmias represent a demanding challenge for the clinician. Modern techniques of cardiovascular imaging and the exhaustive molecular evaluation of the myocardium with endomyocardial biopsy have provided valuable insight into the pathophysiology of this disease, and several clinical registries have unraveled the disease's long-term evolution and prognosis. However, uncertainties persist in crucial practical issues in the management of patients. This article critically reviews current information for evidence-based management, offering a rational and practical approach to patients with myocarditis. For this review, we searched the PubMed and MEDLINE databases for articles published from January 1, 1980, through December 31, 2015, using the following terms: myocarditis, inflammatory cardiomyopathy, and endomyocardial biopsy. Articles were selected for inclusion if they represented primary data or were review articles published in high-impact journals. In particular, a risk-oriented approach is proposed. The different patterns of presentation of myocarditis are classified as low-, intermediate-, and high-risk syndromes according to the most recent evidence on prognosis, clinical findings, and both invasive and noninvasive testing, and appropriate management strategies are proposed for each risk class. PMID:27489051

  8. Thiamin in Clinical Practice.

    Frank, Laura L

    2015-07-01

    Thiamin is a water-soluble vitamin also known as vitamin B1. Its biologically active form, thiamin pyrophosphate (TPP), is a cofactor in macronutrient metabolism. In addition to its coenzyme roles, TPP plays a role in nerve structure and function as well as brain metabolism. Signs and symptoms of thiamin deficiency (TD) include lactic acidosis, peripheral neuropathy, ataxia, and ocular changes (eg, nystagmus). More advanced symptoms include confabulation and memory loss and/or psychosis, resulting in Wernicke's encephalopathy and/or Wernicke's Korsakoff syndrome, respectively. The nutrition support clinician should be aware of patients who may be at risk for TD. Risk factors include those patients with malnutrition due to 1 or more nutrition-related etiologies: decreased nutrient intake, increased nutrient losses, or impaired nutrient absorption. Clinical scenarios such as unexplained heart failure or lactic acidosis, renal failure with dialysis, alcoholism, starvation, hyperemesis gravidarum, or bariatric surgery may increase the risk for TD. Patients who are critically ill and require nutrition support may also be at risk for TD, especially those who are given intravenous dextrose void of thiamin repletion. Furthermore, understanding thiamin's role as a potential therapeutic agent for diabetes, some inborn errors of metabolism, and neurodegenerative diseases warrants further research. This tutorial describes the absorption, digestion, and metabolism of thiamin. Issues pertaining to thiamin in clinical practice will be described, and evidence-based practice suggestions for the prevention and treatment of TD will be discussed. PMID:25564426

  9. Out-of-Hospital Surgical Airway Management: Does Scope of Practice Equal Actual Practice?

    Furin, Molly; Kohn, Melissa; Overberger, Ryan; Jaslow, David

    2016-01-01

    Introduction: Pennsylvania, among other states, includes surgical airway management, or cricothyrotomy, within the paramedic scope of practice. However, there is scant literature that evaluates paramedic perception of clinical competency in cricothyrotomy. The goal of this project is to assess clinical exposure, education and self-perceived competency of ground paramedics in cricothyrotomy. Methods: Eighty-six paramedics employed by four ground emergency medical services...

  10. A study of clinical opinion and practice regarding circumcision

    Farshi, Z; Atkinson, K; Squire, R

    2000-01-01

    AIM—To establish clinical opinion regarding appropriate indications for circumcision and to examine actual clinical practice.
METHODS—A questionnaire was sent to all NHS hospital consultants in the Yorkshire region of the UK identified as having a role to play in the management of boys (under 16 years of age) requiring circumcision. Retrospective data on actual clinical practice during a three month study period were also collected via a simple proforma.
RESULTS—Of 153 quest...

  11. Improving clinical practice guidelines for practicing cardiologists.

    Benhorin, Jesaia; Bodenheimer, Monty; Brown, Mary; Case, Robert; Dwyer, Edward M; Eberly, Shirley; Francis, Charles; Gillespie, John A; Goldstein, Robert E; Greenberg, Henry; Haigney, Mark; Krone, Ronald J; Klein, Helmut; Lichstein, Edgar; Locati, Emanuela; Marcus, Frank I; Moss, Arthur J; Oakes, David; Ryan, Daniel H; Bloch Thomsen, Poul E; Zareba, Wojciech

    2015-06-15

    Cardiac-related clinical practice guidelines have become an integral part of the practice of cardiology. Unfortunately, these guidelines are often long, complex, and difficult for practicing cardiologists to use. Guidelines should be condensed and their format upgraded, so that the key messages are easier to comprehend and can be applied more readily by those involved in patient care. After presenting the historical background and describing the guideline structure, we make several recommendations to make clinical practice guidelines more user-friendly for clinical cardiologists. Our most important recommendations are that the clinical cardiology guidelines should focus exclusively on (1) class I recommendations with established benefits that are supported by randomized clinical trials and (2) class III recommendations for diagnostic or therapeutic approaches in which quality studies show no benefit or possible harm. Class II recommendations are not evidence based but reflect expert opinions related to published clinical studies, with potential for personal bias by members of the guideline committee. Class II recommendations should be published separately as "Expert Consensus Statements" or "Task Force Committee Opinions," so that both majority and minority expert opinions can be presented in a less dogmatic form than the way these recommendations currently appear in clinical practice guidelines. PMID:25918027

  12. Evidence-based clinical practice

    Gluud, Christian

    2002-01-01

    Evidence-based medicine combines the patient's preferences with clinical experience and the best research evidence. Randomized clinical trials are considered the most valid research design for evaluating health-care interventions. However, empirical research shows that intervention effects may be...... evidence in clinical practice. By investments in education, applied research, and The Cochrane Collaboration, evidence-based medicine may form a stronger basis for clinical practice....

  13. Good clinical practice in clinical interventional studies

    Pieterse, Herman; Diamant, Zuzana

    2014-01-01

    Good clinical practice (GCP) guidelines should always be implemented and obeyed in clinical interventional studies. In this mini-review, we will address several burning questions relating to GCP in a concise ‘frequently asked questions’ format.While compliance to current rules and regulations is our mission, we also wish to play devil’s advocate attempting to translate the rules into sizeable chunks using a high dose of common sense.Keywords: clinical interventional studies; quality; safety; ...

  14. Photodynamic therapy in clinical practice

    E. V. Filonenko; L. G. Serova

    2016-01-01

    The review is on opportunities and possibilities of application of photodynamic therapy in clinical practice. The advantages of this method are the targeting of effect on tumor foci and high efficiency along with low systemic toxicity. The results of the set of recent Russian and foreign clinical trials are represented in the review. The method is successfully used in clinical practice with both radical (for early vulvar, cervical cancer and pre-cancer, central early lung cancer, esophageal a...

  15. CLINICAL PSYCHOLOGY – ACTUAL DIRECTION IN GROUNDING OF HEALTH MANPOWER

    M.G. Kucherov; E.S. Olenсo; A.I. Kodochigova; V.F. Kirichuk; A. A. Svistunov; P.V. Glybochko; E.A. Krovaykova

    2007-01-01

    In 90-ies years of last century in our country happened the crash of the system of values with transition to the standards of capitalistic society, and it lead to the formation of chronicle psychosocial stress of high and medium levels. Medics of all directions started to face functional psychosomatic diseases. Raised the necessity in grounding of health manpower in discipline of clinical psychology, with the learning of psychophisiological bases of diseases and possibilities if their correct...

  16. CLINICAL PSYCHOLOGY – ACTUAL DIRECTION IN GROUNDING OF HEALTH MANPOWER

    M.G. Kucherov

    2007-09-01

    Full Text Available In 90-ies years of last century in our country happened the crash of the system of values with transition to the standards of capitalistic society, and it lead to the formation of chronicle psychosocial stress of high and medium levels. Medics of all directions started to face functional psychosomatic diseases. Raised the necessity in grounding of health manpower in discipline of clinical psychology, with the learning of psychophisiological bases of diseases and possibilities if their correction. This direction of development of soviet medical education and health service in general seems progressive and prospective.

  17. Magnesium in Clinical Practice

    E.L. Trisvetova

    1989-01-01

    Magnesium is a macronutrient that is needed for normal body functions. Magnesium deficiency resulting from the influence of exogenous and endogenous factors, is diagnosed by clinical manifestations, resembling the known disease. Magnesium deficiency corrected with the magnesium therapy. Studies show the effectiveness of magnesium orotate for many cardiovascular diseases.

  18. Dabigatran in clinical practice

    Ageno, Walter; Eikelboom, John; Lip, Gregory Y H

    2016-01-01

    confirmed, but VKA use is complicated by need for regular monitoring of the international normalized ratio and multiple drug and food interactions. Dabigatran is an oral direct thrombin inhibitor that can be used with fixed doses, without the need for routine anticoagulation laboratory monitoring and the...... agent for dabigatran has been approved by FDA and EU. This review provides a summary of publications assessing clinical utility of dabigatran for different indications....

  19. Mindfulness Meditation in Clinical Practice

    Salmon, Paul; Sephton, Sandra; Weissbecker, Inka; Hoover, Katherine; Ulmer, Christi; Studts, Jamie L.

    2004-01-01

    The practice of mindfulness is increasingly being integrated into contemporary clinical psychology. Based in Buddhist philosophy and subsequently integrated into Western health care in the contexts of psychotherapy and stress management, mindfulness meditation is evolving as a systematic clinical intervention. This article describes…

  20. Salient Key Features of Actual English Instructional Practices in Saudi Arabia

    Al-Seghayer, Khalid

    2015-01-01

    This is a comprehensive review of the salient key features of the actual English instructional practices in Saudi Arabia. The goal of this work is to gain insights into the practices and pedagogic approaches to English as a foreign language (EFL) teaching currently employed in this country. In particular, we identify the following central features…

  1. Out-of-Hospital Surgical Airway Management: Does Scope of Practice Equal Actual Practice?

    Molly Furin

    2016-05-01

    Full Text Available Introduction: Pennsylvania, among other states, includes surgical airway management, or cricothyrotomy, within the paramedic scope of practice. However, there is scant literature that evaluates paramedic perception of clinical competency in cricothyrotomy. The goal of this project is to assess clinical exposure, education and self-perceived competency of ground paramedics in cricothyrotomy. Methods: Eighty-six paramedics employed by four ground emergency medical services agencies completed a 22-question written survey that assessed surgical airway attempts, training, skills verification, and perceptions about procedural competency. Descriptive statistics were used to evaluate responses. Results: Only 20% (17/86, 95% CI [11-28%] of paramedics had attempted cricothyrotomy, most (13/17 or 76%, 95% CI [53-90%] of whom had greater than 10 years experience. Most subjects (63/86 or 73%, 95% CI [64-82%] did not reply that they are well-trained to perform cricothyrotomy and less than half (34/86 or 40%, 95% CI [30-50%] felt they could correctly perform cricothyrotomy on their first attempt. Among subjects with five or more years of experience, 39/70 (56%, 95% CI [44-68%] reported 0-1 hours per year of practical cricothyrotomy training within the last five years. Half of the subjects who were able to recall (40/80, 50% 95% CI [39-61%] reported having proficiency verification for cricothyrotomy within the past five years. Conclusion: Paramedics surveyed indicated that cricothyrotomy is rarely performed, even among those with years of experience. Many paramedics felt that their training in this area is inadequate and did not feel confident to perform the procedure. Further study to determine whether to modify paramedic scope of practice and/or to develop improved educational and testing methods is warranted.

  2. Recombinant erythropoietin in clinical practice

    Ng, T; Marx, G.; Littlewood, T; Macdougall, I

    2003-01-01

    The introduction of recombinant human erythropoietin (RHuEPO) has revolutionised the treatment of patients with anaemia of chronic renal disease. Clinical studies have demonstrated that RHuEPO is also useful in various non-uraemic conditions including haematological and oncological disorders, prematurity, HIV infection, and perioperative therapies. Besides highlighting both the historical and functional aspects of RHuEPO, this review discusses the applications of RHuEPO in clinical practice a...

  3. Clinical Practice Guidelines and Industry

    Ajai R. Singh

    2007-01-01

    Full Text Available In this section we shall see what Clinical Practice Guidelines (CPGs should be and what they are, the recent case of Xigris and a thriller-like manipulation by the concerned company to enter a performance 'bundle', CPG effectiveness/cost effectiveness and other considerations, how they serve Industry needs, and what methods can possibly assist them actualise their enormous potential.Introduction From the early nineties, a number of Clinical Practice Guidelines (CPGs have been created and published by many different associations and organizations at considerable expense. CPGs are supposed to serve an important purpose. They offer objective consensus of expert opinion on treatment and hence are trusted by hospitals and practicing physicians alike. They can reduce the possibility of inappropriate care being delivered, while helping introduce new knowledge into clinical practice (Grimshaw and Russell, 1993; Merritt et al. , 1997; Woolf et al. , 1999. They are a distillate of biomedical wisdom at a certain point of time applied to better and more efficient patient care. Hence, rigorously developed guidelines can translate complicated research findings into actionable recommendations of clinical care (Shiffman et al. , 2003; Haines and Jones, 1994. Clinical practice guidelines have generally been accepted as an objective consensus on evidence (Baird, 2003. Practice guidelines approved by expert panels are intended to standardize care in such a way as to improve health outcomes (Eichacker et al. , 2006. Major hospitals and knowledge updated physicians feel reassured they are doing the very best by following CPGs. State of the art, and such other fancy labels, can be justifiably applied to them.McMaster et al., (2007 have talked recently of getting guidelines to work in practice. In an effort to make CPGs more effective, developers of such guidelines have started grouping evidence-based interventions into what are called 'bundles'. The justification for

  4. An empirical study of desired versus actual compensation practices in determining intrapreneurial behaviour

    Ugochukwu O. Madu; Boris Urban

    2014-01-01

    Orientation: Past research recognises that human resources management practices may influence innovative behaviour, particularly as compensation systems can be used as a tool to increase intrapreneurial activity.Research purpose: The aim of this study is to determine the relationship between actual versus desired compensation practices and elevated intrapreneurial behaviour. This is in line with research that focuses on how to promote business innovation, rather than merely research whether i...

  5. Research and Clinical Practice Relationship

    Ashammakhi N

    2008-01-01

    To The Editor: I highly value and greet the authors for their editorial. Many important issues related to medical education and its future in Libya have been discussed in this paper [1]. One important point that has been addressed and I feel deserves attention is the “abnormal” relationship between clinical practice and research in Libya. From discussions with colleagues, this problem somehow has evolved from a misconception about educational and training systems that may have occurred in the...

  6. Evaluation of clinical practice guidelines.

    Basinski, A S

    1995-01-01

    Compared with the current focus on the development of clinical practice guidelines the effort devoted to their evaluation is meagre. Yet the ultimate success of guidelines depends on routine evaluation. Three types of evaluation are identified: evaluation of guidelines under development and before dissemination and implementation, evaluation of health care programs in which guidelines play a central role, and scientific evaluation, through studies that provide the scientific knowledge base fo...

  7. Key Management Practices that Influence Actual ICT Application among Three to Five Star Hotels in Kenya

    Obonyo, George Otieno; Okeyo, David Omondi; Kambona, Oscar Ouma

    2016-01-01

    ICTs are considered strategic tool for business management worldwide and fast finding wider application within the hotel industry. However, their use has not always been fruitful due to poor application of the ICTs. This study therefore sought to determine management practices that influence actual ICT application among three to five star hotels in Kenya. The study adopted multiple case study approach to data collection where face-to-face interviews were conducted with 36 hotel managers drawn...

  8. Proton therapy in clinical practice

    Hui Liu; Joe Y. Chang

    2011-01-01

    Radiation dose escalation and acceleration improves local control but also increases toxicity. Proton radiation is an emerging therapy for localized cancers that is being sought with increasing frequency by patients. Compared with photon therapy, proton therapy spares more critical structures due to its unique physics. The physical properties of a proton beam make it ideal for clinical applications. By modulating the Bragg peak of protons in energy and time, a conformal radiation dose with or without intensity modulation can be delivered to the target while sparing the surrounding normal tissues. Thus, proton therapy is ideal when organ preservation is a priority. However, protons are more sensitive to organ motion and anatomy changes compared with photons. In this article, we review practical issues of proton therapy, describe its image-guided treatment planning and delivery, discuss clinical outcome for cancer patients, and suggest challenges and the future development of proton therapy.

  9. Official recommendations and actual practice in physiotherapy: managing troubles of physical performance.

    Parry, Ruth Helen

    2005-01-01

    This paper explores relations between official written recommendations for physiotherapists and actual practice. It does so by presenting and discussing findings from a conversation analytic study of 74 physiotherapy treatment sessions video-recorded in four English hospitals. Various practices are described by which therapists address troubles of ongoing or recent physical performance by patients during phases of sessions that are occupied with therapists' instructions in treatment activities and patients' physical responses. Divergence between practice and official guidance can be observed, particularly regarding recommendations that therapists always be unambiguous and clear in their communication with patients. Also, there seem to be conflicting demands between maintaining performance of physical treatment activities, whilst also spending time giving patients information and explanation about troubles of performance, and checking their understanding (as is recommended). There are also conflicting demands between individual recommendations. These observations inform a discussion of the wider challenges involved in formulating relevant, appropriate official guidance on communication practice. I argue that the difficulties of auditing actual conduct against official recommendations on interaction should be acknowledged, and that recommendations should be explicitly tentative and broad. Conversation analytic studies can provide resources and understandings to complement and augment such official guidance. PMID:16808720

  10. Expert systems in clinical practice

    The first expert systems prototypes intended for advising physicians on diagnosis or therapy selection have been designed more than ten years ago. However, a few of them are already in use in clinical practice after years of research and development efforts. The capabilities of these systems to reason symbolically and to mimic the hypothetico-deductive processes used by physicians distinguishes them from conventional computer programs. Their power comes from their knowledge-base which embeds a large quantity of high-level, specialized knowledge captured from medical experts. Common methods for knowledge representation include production rules and frames. These methods also provide a mean for organizing and structuring the knowledge according to hierarchical or causal links. The best expert-systems perform at the level of the experts. They are easy to learn and use, and can communicate with the user in pseudo-natural language. Moreover they are able to explain their line of reasoning. These capabilities make them potentially useful, usable and acceptable by physicians. However if the problems related to difficulties and costs in building expert-systems are on the way to be solved within the next few years, forensic and ethical issues should have to be addressed before one can envisage their routine use in clinical practice

  11. An empirical study of desired versus actual compensation practices in determining intrapreneurial behaviour

    Ugochukwu O. Madu

    2014-02-01

    Full Text Available Orientation: Past research recognises that human resources management practices may influence innovative behaviour, particularly as compensation systems can be used as a tool to increase intrapreneurial activity.Research purpose: The aim of this study is to determine the relationship between actual versus desired compensation practices and elevated intrapreneurial behaviour. This is in line with research that focuses on how to promote business innovation, rather than merely research whether innovation is desirable for businesses or not.Motivation for the study: Recognising that entrepreneurial actions are the bedrock of intrapreneurial behaviour and that these behaviours may be critical to the long-term vitality of a firm and economy, it is important to facilitate the empirical study of them in an underresearched, emerging market environment. Moreover, compensation such as reward preferences and variable pay schemes remain controversial in terms of their costs versus contributions, and these constructs deserve more empirical research.Research approach, design and method: The study employed a quantitative research design, using a cross-sectional and empirical approach with primary data sources. A structured webbased instrument rendered a sample of 209 respondents from a diverse set of businesses. Canonical correlational analysis was carried out to test the hypotheses.Main findings: The results reveal that a gap exists between an employee’s perception of desired compensation practices and the actual compensation practices. The results further highlight that non-outcome-based measures like pay risk, job risk and expectations of success play a role in determining whether employees decide to be intrapreneurial or not.Practical/managerial implications: Due to the potential impact rewards have on intrapreneurial behaviour, it is necessary to design relevant compensation systems as part of organisational architecture in order to foster

  12. [ACTUAL PROBLEMS OF HYGIENE SCIENCE AND PRACTICE IN THE PRESERVATION OF PUBLIC HEALTH].

    Onishchenko, G G

    2015-01-01

    In the article there are designated the state and actual hygiene tasks on the issue of environmental pollution and its effects on health of the population. There was emphasized the growing importance of chemical contamination of various objects of environment--air water, soil, and living environment. There is presented the analysis of data on different types of treatment of municipal waste in selected countries. There were shown the significance of the developed Guidance on risk assessmentfor public health as a toolfor making sound management decisions, prospects of using of the methodology of epidemiological mapping based on geoinformational technology (GIS technology). There was marked an important role of the younger generation of hygienists and health officers in further work on both preservation and improvement the health of the population in their countries, harmonization of scientific and practical solutions of actual problems of hygiene. PMID:26302549

  13. How GPs implement clinical guidelines in everyday clinical practice

    Videbæk Le, Jette; Hansen, Helle P; Riisgaard, Helle;

    2015-01-01

    . OBJECTIVE: To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices. METHODS: Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form....... Interviews were recorded, transcribed verbatim and then analysed using systematic text condensation. RESULTS: Analysis of the interviews revealed three different approaches to the implementation of guidelines in clinical practice. In some practices the GPs prioritized time and resources on collective......'s decision on whether and how to manage implementation. CONCLUSION: Approaches to implementation of clinical guidelines vary substantially between practices. Supporting activities should take this into account....

  14. Supernumerary teeth in clinical practice

    Anna K. Szkaradkiewicz

    2011-07-01

    Full Text Available Introduction: Hyperdontia is the condition of having supernumerary teeth, or teeth which appear in addition to the regular number of teeth. The prevalence rates of supernumerary teeth in the permanent dentition amounts 0.1-6.9%, and in deciduous dentition 0.4-0.8%. The presence of supernumerary teeth can be found in everyday dental practice.Case presentation: We describe 3 cases of patients with supernumerary teeth. First patient had supernumerary lateral incisor 12s, second - premolar fused, multicuspid, supernumerary deciduous tooth 64s of having several interconnected roots, and third - erupted odontoma between teeth 13 and 14. In all cases treatment involved the removal of the supernumerary tooth.Conclusions: The decision on proceeding with the supernumerary teeth should be based on the full clinical picture and interview. Early diagnosis and removal of supernumerary teeth allow to avoid or reduce possible complications.

  15. Body composition in clinical practice.

    Andreoli, Angela; Garaci, Francesco; Cafarelli, Francesco Pio; Guglielmi, Giuseppe

    2016-08-01

    Nutritional status is the results of nutrients intake, absorption and utilization, able to influence physiological and pathological conditions. Nutritional status can be measured for individuals with different techniques, such as CT Body Composition, quantitative Magnetic Resonance Imaging, Ultrasound, Dual-Energy X-Ray Absorptiometry and Bioimpendance. Because obesity is becoming a worldwide epidemic, there is an increasing interest in the study of body composition to monitor conditions and delay in development of obesity-related diseases. The emergence of these evidence demonstrates the need of standard assessment of nutritional status based on body weight changes, playing an important role in several clinical setting, such as in quantitative measurement of tissues and their fluctuations in body composition, in survival rate, in pathologic condition and illnesses. Since body mass index has been shown to be an imprecise measurement of fat-free and fat mass, body cell mass and fluids, providing no information if weight changes, consequently there is the need to find a better way to evaluate body composition, in order to assess fat-free and fat mass with weight gain and loss, and during ageing. Monitoring body composition can be very useful for nutritional and medical interventional. This review is focused on the use of Body Composition in Clinical Practice. PMID:26971404

  16. Research and clinical practice relationship

    Ashammakhi N

    2008-01-01

    Full Text Available To The Editor: I highly value and greet the authors for their editorial. Many important issues related to medical education and its future in Libya have been discussed in this paper [1]. One important point that has been addressed and I feel deserves attention is the “abnormal” relationship between clinical practice and research in Libya. From discussions with colleagues, this problem somehow has evolved from a misconception about educational and training systems that may have occurred in the past. It may also be related to the lack of attention to research that has long existed in Libya [2,3]. The other aspect, shared with many other developing countries, is the misconception of research as unimportant or a luxury aspect of medicine. When it comes to understanding how a system (including healthcare can be updated and developed, the answer is vague! One important reason is a lack of understanding of the impact that research has on developing methods. In developed countries, research is the main academic distinction that leads to appointments for coveted positions in the system and is an important factor for academic promotion. In Libya, there remain arguments about who will be awarded Chair of university clinical departments. Such a post should no doubt be given to those with established academic achievements. When highly qualified persons are at the top of the pyramid this leads to further progress and enhanced research and advancement. The authors have discussed the point of having proper search committees for leadership and faculty positions. I believe that it will help eliminate the current stagnation and help to create innovative solutions. This should lead to improved medical education, health services, and ultimately impact the quality of life of all Libyan citizens.

  17. Virtual science instructional strategies: A set of actual practices as perceived by secondary science educators

    Gillette, Tammy J.

    2009-12-01

    The purpose of this proposed research study was to identify actual teaching practices/instructional strategies for online science courses. The identification of these teaching practices/instructional strategies could be used to compile a set of teaching practices/instructional strategies for virtual high school and online academy science instructors. This study could assist online science instructors by determining which teaching practices/instructional strategies were preferred for the online teaching environment. The literature reviewed the role of online and face-to-face instructional strategies, then discussed and elaborated on the science instructional strategies used by teachers, specifically at the secondary level. The current literature did not reflect an integration of these areas of study. Therefore, the connectedness of these two types of instructional strategies and the creation of a set of preferred instructional practices for online science instruction was deemed necessary. For the purpose of this study, the researcher designed a survey for face-to-face and online teachers to identify preferred teaching practices, instructional strategies, and types of technology used when teaching high school science students. The survey also requested demographic data information from the faculty members, including years of experience, subject(s) taught, and whether the teacher taught in a traditional classroom or online, to determine if any of those elements affect differences in faculty perceptions with regard to the questions under investigation. The findings from the current study added to the literature by demonstrating the differences and the similarities that exist between online and face-to-face instruction. Both forms of instruction tend to rely on student-centered approaches to teaching. There were many skills that were similar in that both types of instructors tend to focus on implementing the scientific method. The primary difference is the use of

  18. [Clinical practice guidelines and primary care. SESPAS report 2012].

    Atienza, Gerardo; Bañeres, Joaquim; Gracia, Francisco Javier

    2012-03-01

    Clinical practice guidelines are intended to serve as a bridge between the decision levels and the sources of knowledge, giving decision makers the best synthesis of scientific evidence and an analysis of context, to provide elements of judgement and to transfer scientific knowledge into clinical practice. However, the actual impact on health care is variable and effectiveness in changing medical practice, moderate. Qualitative and quantitative studies show that most primary care physicians consider that the guides are a valuable source of advice and training and a kind of improving the quality of healthcare. However, they underline its rigidity, the difficulty to apply to individual patients and that their main goal is to reduce healthcare costs. In Spain, there are several experiences as GuíaSalud in developing clinical practice guidelines aimed specifically at primary care. However, the proper implementation of a clinical practice guideline includes not only the quality and thoroughness of the evidence, but the credibility of professionals and organizations and other contextual factors such as characteristics of patients, providers and organizations or systems. An important step in future research is to develop a better theoretical understanding of organizational change that is required for management and professionals to give appropriate guidance to the implementation of the clinical practice guidelines. PMID:21993072

  19. The Oxford Practice Skills Project: teaching ethics, law and communication skills to clinical medical students.

    Hope, T; Fulford, K. W.

    1994-01-01

    We describe the teaching programme in ethics, law and communication skills for clinical medical students which is being developed as part of the Oxford Practice Skills Project. These three elements of practice are approached in an integrated teaching programme which aims to address everyday clinical practice. The role of a central value of patient-centred health care in guiding the teaching is described. Although the final aim of the teaching is to improve actual practice, we have found three...

  20. Utilization of incontinence clinical practice guidelines.

    Roe, B; Moore, K N

    2001-11-01

    Clinical practice guidelines (CPGs) are evidence-based recommendations for best practice and have been developed with the assumption they will be embraced by practitioners; a further assumption is that clinical practice guidelines will improve the delivery of care. In this article, we provide a working definition of evidence-based practice, discuss the strengths and limitations of CPGs, describe the implementation of CPGs in the context of urinary incontinence, and consider the steps that the WOCN has taken to initiate evidence-based practice. Current issues are presented along with initiatives that have resulted in clinical practice guidelines on incontinence from the United States, United Kingdom, and Canada. On the basis of the current literature, it is concluded that clinical practice guidelines can play an important role in WOCN practice and that the implementation of guidelines may improve clinical practice. However, guidelines are only as valid as the evidence on which they are based and may not take into account gender or cultural differences or the effect that comorbid conditions can have on treatment outcomes. Finally, guidelines must follow a comprehensive approach that involves management and staff and includes education, facilitation, evaluation, feedback, and an understanding of change strategies. PMID:11707762

  1. Impella ventricular support in clinical practice

    Burzotta, Francesco; Trani, Carlo; Doshi, Sagar N;

    2015-01-01

    Mechanical circulatory support represents an evolving field of clinical research and practice. Currently, several cardiac assist devices have been developed but, among different institutions and countries, a large variation in indications for use and device selection exists. The Impella platform is...... the operative protocols, this working group attempted to establish the best clinical practice with the technology. The present paper reviews the main theoretical principles of Impella and provides an up-to-date summary of the best practical aspects of device use which may help others gain the maximal...... advantage with Impella technology in a variety of clinical settings....

  2. Positron emission tomography clinical practice

    Valk, Peter E; Bailey, Dale L; Townsend, David W; Maisey, Michael N

    2006-01-01

    This book provides a contemporary reference to the science, technology and clinical applications of PET and PET/CT. The opening chapters summarize the scientific aspects of PET and PET/CT including physics, instrumentation, radiation dosimetry and radiation protection. A chapter on normal variants in FDG PET imaging serves as an introduction to the clinical chapters, which cover oncology applications and have been updated to include the impact of FDG PET/CT imaging in oncology. The book concludes with chapters on the use of PET and PET/CT in cardiology and neurology and PET imaging of infectio

  3. Digital clinical photography: Practical tips

    Sharad Mutalik

    2010-01-01

    Full Text Available Photographs are the most preferred and easiest way of documentation of patient visual features. In aesthetic and cutaneous surgery, there is an increased need for proper photographic documentation, from a medicolegal view point. This article discusses the basic aspects of camera and photography which a dermatologist should be aware before he/she starts with clinical photography.

  4. Evidence-based clinical practice

    Garattini, Silvio; Jakobsen, Janus C; Wetterslev, Jørn;

    2016-01-01

    Using the best quality of clinical research evidence is essential for choosing the right treatment for patients. How to identify the best research evidence is, however, difficult. In this narrative review we summarise these threats and describe how to minimise them. Pertinent literature was consi...

  5. Supernumerary teeth in clinical practice

    Szkaradkiewicz, Anna K; Karpiński, Tomasz M.

    2011-01-01

    Introduction: Hyperdontia is the condition of having supernumerary teeth, or teeth which appear in addition to the regular number of teeth. The prevalence rates of supernumerary teeth in the permanent dentition amounts 0.1-6.9%, and in deciduous dentition 0.4-0.8%. The presence of supernumerary teeth can be found in everyday dental practice. Case presentation: We describe 3 cases of patients with supernumerary teeth. First patient had supernumerary lateral incisor 12s, second - premolar fu...

  6. Clinical Practice Guidelines for Subarachnoid Haemorrhage Treatment

    José Ramón Tejera del Valle; Danny Barrueta Reyes; Joaquín Aguilar Trujillo; José Gómez Cruz; Líder Tejera Sánchez

    2009-01-01

    Clinical Practice Guidelines for Subarachnoid Haemorrhage Treatment. The concept, diagnosis, classification and treatment are reviewed in its different stages, including aspects of the neurosurgical treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  7. Clinical Practice Guidelines for Intracranial Tumours Treatment

    Danny Barrueta Reyes; Juan Guillermo Trigo Naranjo

    2009-01-01

    Clinical Practice Guidelines for Intracranial Tumours Treatment. We review the physiopathology, diagnosis (stressing screening studies) and treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  8. Positive interventions in clinical practice.

    Rashid, Tayyab

    2009-05-01

    Mainstream psychotherapy has made huge strides in treating symptoms and disorders, but it has largely overlooked happiness as a therapeutic goal despite frequently hearing from clients, "Doctor, I want to be happy." This issue of Journal of Clinical Psychology: In Session describes a number of positive interventions for specific clinical problems, such as depression, anxiety, schizophrenia, loss, grief, and relationship distress. Although the name may suggest it, positive interventions do not imply that rest of psychotherapies are negative. Neither are negatives denied nor minimized. Distinct from self-help recipes proffering instant changes, positive psychology interventions refer to systematic approaches to overcome challenges by using clients' strengths and assets. A hybrid psychotherapy-coaching model and strength-based assessment can ask a client "What is right with you?" All articles are supplemented with rich case illustrations. PMID:19294745

  9. Placebo interventions, placebo effects and clinical practice

    Linde, Klaus; Fässler, Margrit; Meissner, Karin

    2011-01-01

    This article reviews the role of placebo interventions and placebo effects in clinical practice. We first describe the relevance of different perspectives among scientists, physicians and patients on what is considered a placebo intervention in clinical practice. We then summarize how placebo effects have been investigated in randomized controlled trials under the questionable premise that such effects are produced by placebo interventions. We further discuss why a shift of focus from the pla...

  10. Social media in clinical practice

    Meskó, Bertalan

    2013-01-01

    The number of patients using social media and the number of applications and solutions used by medical professionals online have been sky-rocketing in the past few years, therefore the rational behind creating a well-designed, clear and tight handbook of practical examples and case studies with simple pieces of suggestions about different social media platforms is evident. While the number of e-patients is rising, the number of web-savvy doctors who can meet the expectations of these new generations of patients is not, this huge gap can only be closed by providing medical professionals with ea

  11. Making the user visible: analysing irrigation practices and farmers’ logic to explain actual drip irrigation performance

    Benouniche, M.; Kuper, M.; Hammani, A.; Boesveld, H.

    2014-01-01

    The actual performance of drip irrigation (irrigation efficiency, distribution uniformity) in the field is often quite different from that obtained in experimental stations. We developed an approach to explain the actual irrigation performance of drip irrigation systems by linking measured performan

  12. Clinical Practice Guidelines for Acute Pericarditis Treatment

    Félix Rolando Jorrín Román; Lázaro De la Cruz Aviles; Roberto Vega Hernández; Francisco Riverón Mena

    2009-01-01

    Clinical Practice Guidelines for Acute Pericarditis Treatment. It has been defined as a syndrome caused by the inflammation of the pericardium for diverse aetiologies. The etiological agents, clinical presentation, diagnostic methods and steps that must be taken are described in this document. It includes assessment guidelines focused on the most important aspects to be accomplished.

  13. Clinical Practice Guidelines for Acute Pancreatitis Treatment.

    Francisco García Valdés; Jorge Luis Ulloa Capestany; Reinaldo Jiménez Prendes; Rudis Miguel Monzón Rodríguez; Carlos Jaime Geroy Gómez

    2009-01-01

    Clinical Practice Guidelines for Acute Pancreatitis Treatment. It is the acute inflammatory reaction of the pancreas, affecting a gland that was previously healthy and causes its self-digestion with variable complications of local and distal systems of organs. Its etiological agents, clinical presentation, diagnostic methods and therapy are described. It includes assessment guidelines focused on the most important aspects to be accomplished.

  14. Clinical Practice Guidelines for Exogenous Poisoning.

    Alexis Díaz Mesa; Eddy Pereira Valdés; Alba Enseñat Álvarez; Carlos Alberto Rodríguez Armada

    2009-01-01

    Clinical Practice Guidelines for Exogenous Poisoning. Medical emergencies determined by the exposure to different substances (drugs, medicines, physical or chemical corrosive agents, etc). It includes the classification of toxic substances, clinical diagnosis (main syndromes), and description of therapeutic variations (vital support, antidotes, absorption measurements and increase of elimination and depuration of the toxic substance). It includes assessment guidelines focused on the most impo...

  15. Reshaping Clinical Practice for the New Millennium.

    Dietz, Christine A.

    2000-01-01

    Discusses the need to train clinical practitioners in social work to address ongoing issues of oppression. Describes a second-year Master's in Social Work clinical practice sequence taught from feminist, poststructuralist, postmodern, and social constructionist perspectives, where students learn to assess the impacts of oppression, discover…

  16. Lexical Concept Distribution Reflects Clinical Practice

    Breydo, Eugene; Shubina, Maria; Shalaby, James W.; Einbinder, Jonathan S.; Turchin, Alexander

    2012-01-01

    It is not known whether narrative medical text directly reflects clinical reality. We have tested the hypothesis that the pattern of distribution of lexical concept of medication intensification in narrative provider notes correlates with clinical practice as reflected in electronic medication records.

  17. Clinical Practice Guidelines for intestinal occlusion.

    Rudis Miguel Monzón Rodríguez; Carlos Jaime Geroy Gómez; Francisco García Valdéz; Jorge Luis Ulloa Capestany; Maribel Misas Menéndez

    2009-01-01

    Clinical Practice Guidelines for intestinal occlusion. This document includes the main aspects related with classification, physiopathology, clinical diagnosis, complementary examinations and therapy aimed at the post-operatory treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  18. Clinical Practice Guidelines for Cerebral Abscess Treatment

    Danny Barrueta Reyes; Néstor Pulido Ríos

    2009-01-01

    Clinical Practice Guidelines for Cerebral Abscess Treatment. It has been defined as a festering process caused by any germ and placed inside the cerebral parenchyma; this is a diagnostic and therapeutic challenge for surgeons and general doctors since the clinical and radiological manifestations are often imprecise. This document describes its etiological agents, clinical presentation, diagnosis and treatment. It includes assessment guidelines focused on the most important aspects to be accom...

  19. Clinical Practice Guidelines for Cerebral Abscess Treatment

    Danny Barrueta Reyes

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Cerebral Abscess Treatment. It has been defined as a festering process caused by any germ and placed inside the cerebral parenchyma; this is a diagnostic and therapeutic challenge for surgeons and general doctors since the clinical and radiological manifestations are often imprecise. This document describes its etiological agents, clinical presentation, diagnosis and treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  20. Clinical Practice Update: Pediculosis Capitis.

    Bohl, Brittany; Evetts, Jessica; McClain, Kymberli; Rosenauer, Amanda; Stellitano, Emily

    2015-01-01

    A review of the current evidence on primary treatment modalities of head lice demonstrates increasing resistance to current regimens. New and alternative therapies are now available. A treatment algorithm was created to address safety and efficacy of treatments, as well as to guide clinicians through navigation of the regimens. Through an online journal search, 59 articles were selected for the review. Literature searches were performed through PubMed, Medline, Ebsco Host, and CINAHL, with key search words of "Pediculosis capitis" and "head lice" in the title, abstract, and index. Meta-analyses and controlled clinical trials were viewed with greater weight if they had a large sample size, were statistically significant, and did not allude to bias. When resistant infestations are well-documented in a locality, changes to the treatment regimen are indicated, and alternative treatments should be considered. Recent studies and U.S. Food and Drug Administration (FDA) approvals have changed the available treatment options for Pediculosis capitis, including benzyl alcohol, topical ivermectin, spinosad, and the LouseBuster. Further, environmental management and prevention measures should be taken to avoid reinfestation and to prevent the spread of head lice. Continued study is recommended to establish long-term safety of new and alternative agents. PMID:26665422

  1. Clinical Engineering: Experiences of assisted professional practices

    In the curricula of the Biomedical Engineering career of the Facultad de Ciencias Exactas y TecnologIa of the Universidad Nacional de Tucuman, Argenitna, there are the Assisted Professional Practices. Within this framework, the students have the possibility of performing practices in the clinic Sanatorio 9 de Julio. One of the objectives of these practices is to apply the concepts, methods and procedures studied along the career in the field work under real work conditions. From the point of view of the host institution, the objective is to improve the performance of the different services and areas applying the tools of Biomedical Engineering. The present work shows an example of such practices where an equipment preliminary analysis was made, its use and maintenance corresponding to the surgical unit of the clinic

  2. Clinical Engineering: Experiences of assisted professional practices

    Langone, Luis; Vanetta, Marcos; Vazquez, Marcelo; Rotger, Viviana; Olivera, Juan Manuel

    2007-11-01

    In the curricula of the Biomedical Engineering career of the Facultad de Ciencias Exactas y Tecnología of the Universidad Nacional de Tucumán, Argenitna, there are the Assisted Professional Practices. Within this framework, the students have the possibility of performing practices in the clinic Sanatorio 9 de Julio. One of the objectives of these practices is to apply the concepts, methods and procedures studied along the career in the field work under real work conditions. From the point of view of the host institution, the objective is to improve the performance of the different services and areas applying the tools of Biomedical Engineering. The present work shows an example of such practices where an equipment preliminary analysis was made, its use and maintenance corresponding to the surgical unit of the clinic.

  3. Peer review practicalities in clinical medicine

    Matthew J Metcalfe

    2010-10-01

    Full Text Available Matthew J Metcalfe1, MAL Farrant2, JM Farrant31Department of Vascular Surgery, Imperial College NHS Trust, St Mary’s Hospital, London, UK; 2Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole Hospital, Dorset, UK; 3Department of Radiology, Royal Free Hampstead NHS Trust, Royal Free Hospital, London, UKAbstract: Peer review processes in teaching requires a reviewer to observe a teacher’s practice in a planned manner. Conversation between the two enables the teacher to reflect on their own teaching, promoting self-improvement. Although a central part of the teaching process, and despite its crucial role in continuing professional development, peer review is not widely practiced in hospital settings. This article explains the process and its benefits. Practical implementations of the process in busy clinical settings are suggested. Its evaluation and incorporation into undergraduate learning and postgraduate clinical practice are described. With enthusiastic support for colleagues and allowances for its implementation, it should become part of the regular teaching practice, improving the quality of teaching delivered.Keywords: teaching, education, clinical practice, peer review

  4. Ethical practice and clinical legal education

    Duncan, N. J.

    2005-01-01

    This article is designed to explore a variety of ways in which clinical methods can achieve the goals of educators and the professions in the preparation of student lawyers. In particular I intend to show how clinical methods assist in the development of: - a deeper understanding of the law, and the law in context; - general transferable skills; - legal professional skills; - a sound values basis for ethical practice. In addition, I hope to show that there are ways of using cli...

  5. Clinical Practice Guidelines for Pulmonary Thromboembolism.

    Aymara Marcia Hernández Cardoso; Maribel Misas Menéndez; Carlos Jaime Geroy Gómez; Diosdania Alfonso Falcón

    2009-01-01

    Clinical Practice Guidelines for Pulmonary Thromboembolism. This condition is caused by the obstruction of pulmonary arterial circulation as a result of an embolus originated in the profound venous system of the in the lower extremities (95%). It includes the concept, risk factors, clinical presentations, diagnosis, and therapy based on the possibilities of our environment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  6. Clinical Practice Guidelines for Potential Donors Management

    José Roque Nodal Arruebarrena; José Noel Marrero Rodríguez; Yenisey Quintero Menéndez; Aida M. Reyes Pérez; Julio Jova Dueñas

    2009-01-01

    Clinical Practice Guidelines for Potential Donors Management. It has been defined as the patient in Glasgow coma with scale higher or equal to 8 who doesn´t present contradictions for transplant (possible donor) and who has been diagnosed of encephalic death. This document reviews and updates concepts, lists indications and contraindications for different organs donation, clinical assessment of the donor and its treatment. It includes assessment guidelines focused on the most important aspect...

  7. Clinical Practice Guidelines for Acute Myocardial Infarction.

    Francisco de Jesús Valladares Carvajal; Arelys Falcón Hernández; Félix Rolando Jorrín Román; Juan Emilio García Rivas

    2009-01-01

    Clinical Practice Guidelines for Acute Myocardial Infarction. It has been defined as the clinical condition caused by the ischemic myocardial necrosis, usually caused by abrupt reduction of coronary blood irrigation affecting one or more myocardial areas. The document includes a review and update of the concept, classification, diagnosis and therapy. Risk stratification and main aspects of rehabilitation are also stressed. It includes assessment guidelines focused on the most important aspect...

  8. Clinical Practice Guidelines for Acute Renal Failure.

    Argelio Alberto Santana Cano; Marta Patricia Casanova González; Belkys Rodríguez Llerena.; Eddy Pereira Valdés

    2009-01-01

    Clinical Practice Guidelines for Acute Renal Failure. It a syndrome characterized by the abrupt deterioration of basal renal functions (abrupt reduction of glomerular filtration) and the consequent increase of nitrogenous products in the blood as well as the homeostasis of the body. It aetiological agents, clinical presentation, therapeutic and diagnostic methods are described. It includes assessment guidelines focused on the most important aspects to be accomplished.

  9. Clinical Practice Guidelines for Severe Sepsis Treatment.

    Julio Héctor Jova Dueñas; Diosdania Alfonso Falcón; Marcos Diosdado Iraola Ferrer; Inti Santana Carballosa; José Noel Marrero.

    2009-01-01

    Clinical Practice Guidelines for Severe Sepsis Treatment. It is a syndrome of inflammatory systemic response caused by documented infection (clinical and/or microbiological), associated with organic dysfunction (respiratory, renal, hepatic, cardiovascular, haematological and neurological), hypotension or hypoperfusion. This document includes a review and update of the concept, risk factors, diagnosis and treatment. It includes assessment guidelines focused on the most important aspects to be ...

  10. Clinical Practice Guidelines for Coma Management

    Julio Alonso Cortizo Hernández; Maribel Misas Menéndez; Zenia Lisset Hernández Millán; Diosdania Alfonso Falcón; Tania Pérez Ramos

    2009-01-01

    Clinical Practice Guidelines for Coma Management. It has been defined as acute alteration of wakefulness state, in which patients have a primitive response (or no response at all) to nociceptive stimulus without waking up and could reach the total absence of all reflex. This document includes a review and update of the main clinical aspects, concepts, aetiology and therapy for this condition. It includes assessment guidelines focused on the most important aspects to be accomplished.

  11. Clinical Practice Guidelines for Cardiogenic Shock.

    Arelys Falcón Hernández

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Cardiogenic Shock. It has been defined as the persistence of tissue hypoperfusion, usually associated to blood hypotension as the result of heart pumping failure. This document includes a review of the main aspects as concepts, aetiology, diagnosis and treatment. It includes the concept, risk factors, clinical presentations, diagnosis, and therapy based on the possibilities of our environment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  12. Clinical Practice Guidelines for Potential Donors Management

    José Roque Nodal Arruebarrena

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Potential Donors Management. It has been defined as the patient in Glasgow coma with scale higher or equal to 8 who doesn´t present contradictions for transplant (possible donor and who has been diagnosed of encephalic death. This document reviews and updates concepts, lists indications and contraindications for different organs donation, clinical assessment of the donor and its treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  13. Clinical Practice Guidelines for Acute Myocardial Infarction.

    Francisco De Jesús Valladares Carvajal

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Acute Myocardial Infarction. It has been defined as the clinical condition caused by the ischemic myocardial necrosis, usually caused by abrupt reduction of coronary blood irrigation affecting one or more myocardial areas. The document includes a review and update of the concept, classification, diagnosis and therapy. Risk stratification and main aspects of rehabilitation are also stressed. It includes assessment guidelines focused on the most important aspects to be accomplished.

  14. Clinical Practice Guidelines for Acute Renal Failure.

    Argelio Alberto Santana Cano

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Acute Renal Failure. It a syndrome characterized by the abrupt deterioration of basal renal functions (abrupt reduction of glomerular filtration and the consequent increase of nitrogenous products in the blood as well as the homeostasis of the body. It aetiological agents, clinical presentation, therapeutic and diagnostic methods are described. It includes assessment guidelines focused on the most important aspects to be accomplished.

  15. Good Practice of Clinical Dosimetry Reporting

    The intention of the guidance of this paper, Good Practice of Clinical Dosimetry Reporting, by the Dosimetry Committee of the European Association for Nuclear Medicine, is to guide the reader through a series of suggestions for reporting dosimetric approaches in nuclear medicine. (author)

  16. Clinical Practice Guidelines for paroxysmal supraventricular tachycardia.

    Brandy Viera Valdés; Francisco de Jesús Valladares Carvajal; Félix Rolando Jorrín Román; Pablo Rodríguez Díaz

    2009-01-01

    Clinical Practice Guidelines for paroxysmal supraventricular tachycardia. These are arrhythmias in which structures placed above the bifurcation of the bundle of His are involved; characterized by tachycardia with abrupt starting and ending. We comment its classification, common characteristics, general treatment and specific conduct for its different variables. It includes assessment guidelines focused on the most important aspects to be accomplished.

  17. Clinical Practice Guidelines for Critical Patients’ Nutrition.

    Marta Patricia Casanova González; Roberto Travieso Peña; Félix Molina Díaz

    2009-01-01

    Clinical Practice Guidelines for Critical Patients’ Nutrition. This document includes a review and update of aspects related with nutritional assessment of patients in critical condition; indications, contraindications and procedures for enteral and parenteral nutrition and its follow up. It includes assessment guidelines focused on the most important aspects to be accomplished.

  18. Clinical Practice Guidelines for Encephalic Death Treatment

    José Roque Nodal Arruebarrena; José Noel Marrero Rodríguez; Argelio Santana Cano; Julio Jova Dueñas

    2009-01-01

    Clinical Practice Guidelines for Encephalic Death Treatment. It has been defined as the irreversible ceasing of all encephalic functions (cerebral hemispheres, of the encephalic stalk and cerebellum). This document includes the diagnostic criteria and its workflow and comments on the diagnostic tests and its legal aspects. It includes assessment guidelines focused on the most important aspects to be accomplished.

  19. Clinical Practice Guidelines for Ventilation Associated Pneumonia.

    Marcos Diosdado Iraola Ferrer; Belkys Rodríguez Llerena.; Héctor Cruz de los Santos.; Eddy Pereira Valdés

    2009-01-01

    Clinical Practice Guidelines for Ventilation Associated Pneumonia. Conceptualized as the bacterial pneumonia that develops in patients receiving mechanical ventilation for more than 48 hours, which is not present at the beginning of the ventilation. We review the concept, prevention and treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  20. Clinical Practice Guidelines for Auricular Fibrillation.

    Lázaro De la Cruz Avilés; Félix Rolando Jorrín Román; Francisco de Jesús Valladares Carvajal; Pablo Rodríguez Díaz

    2009-01-01

    Clinical Practice Guidelines for Auricular Fibrillation. This is the most common cardiac arrhythmia and can bring about deleterious consequences on the cardiac function and risk of systemic embolism. It includes important aspects as aetiology and trigger aspects, diagnosis, classification and treatment with emphasis on therapeutic emergencies. It includes assessment guidelines focused on the most important aspects to be accomplished.

  1. Clinical Practice Guidelines for Unstable Angina Treatment.

    Juan José Navarro López; Claudio Manuel González Rodríguez

    2009-01-01

    Clinical Practice Guidelines for Unstable Angina Treatment. It has been defined as the oppressive pain or uneasiness mainly thoracic, which is caused by a transitory myocardial ischemia. This document includes important aspects as classification, diagnosis, treatment (aimed at its principal strategies) and risk stratification. It includes assessment guidelines focused on the most important aspects to be accomplished.

  2. Clinical Practice Guidelines for Peritonitis Treatment.

    Frank Carlos Alvarez Li; Carlos Jaime Geroy Gómez; Diosdania Alfonso Falcón; Alexis Díaz Mesa

    2009-01-01

    Clinical Practice Guidelines for Peritonitis Treatment. It is a general or local inflammatory process of the peritoneal membrane after a chemical irritation, bacterial invasion (intra-abdominal infection), local necrosis or direct contusion. It includes concept, classification, diagnosis, and medical and surgical treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  3. Facilitating Critical Thinking in Clinical Practice.

    Persaud, Deanna; And Others

    Activities to promote the transfer of theoretical knowledge into clinical practice have been developed to facilitate learning by individuals with various learning styles, reduce student stress, and improve teaching methods in a baccalaureate nursing program at the California State University, Chico. Specific activities included innovative…

  4. Clinical PET: changing the practice of oncology

    Until recently positron emission tomography (PET) has been largely confined to academic institutions with the capital and human resources to support this technologically advanced modality. More recently its utility in oncology has fuelled the wider dissemination of this modality into routine clinical practice. Small animal PET scanners allow tracers to be validated prior to use in human subjects. The Peter MacCallum Cancer Institute clinical PET program began operation in 1996 and since that time has grown to be the first Australian centre with 2 PET scanners, including the first combined PET/CT. Although the majority of the almost 10,000 studies performed in our facility have utilised FDG, new tracers are increasingly being used in clinical trials, particularly for therapeutic monitoring of novel chemotherapeutic agents. In establishing our facility we have sought to influence referral patterns to those situations where epidemiological and case control data suggest that conventional diagnostic algorithms currently fail us. This is particularly the case in situation where recognition of this failure leads to routine use of either a morbid procedure or treatment in an entire population of patients, even in the absence of abnormality after conventional staging. For example, CT scanning is recognised to have insufficient accuracy for staging the status of mediastinal lymph node spread of non-small cell lung cancer to determine operability. Accordingly, a large number of patients undergo mediastinoscopy and pathological sampling of lymph nodes. Other patients are subjected to futile open and close thoracotomies due to incorrect staging. FDG PET has convincingly been shown to be more accurate than CT for staging the mediastinum and in a recent randomised control trial was shown to significantly reduce unnecessary thoractomies. By trying to limit the use of PET to situations where a range of different management options are available depending on the true extent of

  5. Clinical Decision Support Systems: A Useful Tool in Clinical Practice

    Kolostoumpis G.

    2012-01-01

    Full Text Available The possibility of supporting in decision – making shows an increase in recent years. Based on mathematic simulation tools, knowledge databases, processing methods, medical data and methods, artificial intelligence for coding of the available knowledge and for resolving complex problems arising into clinical practice. Aim: the aim of this review is to present the development of new methods and modern services, in clinical practice and the emergence in their implementation. Data and methods: the methodology that was followed included research of articles that referred to health sector and modern technologies, at the electronic data bases “pubmed” and “medline”. Results: Is a useful tool for medical experts using characteristics and medical data used by the doctors. Constitute innovation for the medical community, and ensure the support of clinical decisions with an overall way by providing a comprehensive solution in the light of the integration of computational decision support systems into clinical practice. Conclusions: Decision Support Systems contribute to improving the quality of health services with simultaneous impoundment of costs (i.e. avoid medical errors

  6. Binge eating disorder: from clinical research to clinical practice.

    Goracci, Arianna; Casamassima, Francesco; Iovieno, Nadia; di Volo, Silvia; Benbow, Jim; Bolognesi, Simone; Fagiolini, Andrea

    2015-01-01

    This case report describes the clinical course of a young woman suffering from binge eating disorder (BED) associated with obesity. It illustrates the efficacy of different medications in the treatment of BED and related conditions and is followed by the comments and clinical observations of 2 practicing psychiatrists. The issues described in this paper have important clinical implications and are topical, given that BED is now recognized as a specific disorder in the new Diagnostic and Statistical Manual of Mental Disorders, fifth edition classification system, but neither the US Food and Drug Administration nor any other regulatory agency has yet approved a drug for treatment of this disease, despite its very prevalent and disabling nature. Growing evidence from the fields of psychopathology and neurobiology, including preclinical and clinical studies, converges to support the idea that "overeating" has much in common with other behavioral addictions, and substance abuse treatment agents may show promise for the treatment of BED. PMID:25629882

  7. Clinical Epidemiology, Evidence Based Medicine and Good Clinical Practice Guidelines vs. Clinical Method?

    Luis Alberto Corona Martínez; Mercedes Fonseca Hernández

    2009-01-01

    Evidence Based Medicine, as a trend or approach to the medical practice nowadays, and the use of Good Clinical Practice Guidelines in the assistance activities are core elements that contribute to improve the professional practice and the decision making process in diagnosis and therapy; but they do not substitute the professional method for patients assistance: the clinical method. The purpose of this article is to analyze the role of clinical epidemiology, evidence based medicine and good c...

  8. Uses of internet technology in clinical practice

    The practice of medicine has extended itself to vast areas and requires active clinicians to systematize and organize their workload through the use of the most up-to-date digital and computer communication technologies. Computerization and worldwide accessibility of information has especially provided great assistance in this regard. The explosive growth of medical information increases the need for the use of these new methods of organizing and accessing data. This article briefly summarizes a few of the vital tools that internet technology has provided clinical practice, with the aid of basic concepts of internet, database systems, hospital systems and data security and reliability. (author)

  9. COPD management: role of symptom assessment in routine clinical practice

    van der Molen, Thys; Miravitlles, Marc; Kocks, Janwillem WH

    2013-01-01

    Patients with chronic obstructive pulmonary disease (COPD) present with a variety of symptoms that significantly impair health-related quality of life. Despite this, COPD treatment and its management are mainly based on lung function assessments. There is increasing evidence that conventional lung function measures alone do not correlate well with COPD symptoms and their associated impact on patients’ everyday lives. Instead, symptoms should be assessed routinely, preferably by using patient-centered questionnaires that provide a more accurate guide to the actual burden of COPD. Numerous questionnaires have been developed in an attempt to find a simple and reliable tool to use in everyday clinical practice. In this paper, we review three such patient-reported questionnaires recommended by the latest Global Initiative for Chronic Obstructive Lung Disease guidelines, ie, the modified Medical Research Council questionnaire, the clinical COPD questionnaire, and the COPD Assessment Test, as well as other symptom-specific questionnaires that are currently being developed. PMID:24143085

  10. Clinical practice guidelines for dementia in Australia.

    Laver, Kate; Cumming, Robert G; Dyer, Suzanne M; Agar, Meera R; Anstey, Kaarin J; Beattie, Elizabeth; Brodaty, Henry; Broe, Tony; Clemson, Lindy; Crotty, Maria; Dietz, Margaret; Draper, Brian M; Flicker, Leon; Friel, Margeret; Heuzenroeder, Louise Mary; Koch, Susan; Kurrle, Susan; Nay, Rhonda; Pond, C Dimity; Thompson, Jane; Santalucia, Yvonne; Whitehead, Craig; Yates, Mark W

    2016-03-21

    About 9% of Australians aged 65 years and over have a diagnosis of dementia. Clinical practice guidelines aim to enhance research translation by synthesising recent evidence for health and aged care professionals. New clinical practice guidelines and principles of care for people with dementia detail the optimal diagnosis and management in community, residential and hospital settings. The guidelines have been approved by the National Health and Medical Research Council. The guidelines emphasise timely diagnosis; living well with dementia and delaying functional decline; managing symptoms through training staff in how to provide person-centred care and using non-pharmacological approaches in the first instance; and training and supporting families and carers to provide care. PMID:26985848

  11. A Nordic comparison of national objectives for reading instruction and teachers' responses about actual reading practice

    Rønberg, Louise; Mejding, Jan

    2014-01-01

    texts a higher priority than literary texts – and the opposite is apparent for Danish teachers. The Finnish and Norwegian teachers prioritise activities that enhance students’ oral reading fluency, which is important for reading comprehension development, to a greater extent than teachers in Denmark...... to the other Nordic countries. It is important that national objectives correspond with empirical research on reading instruction and that they are functional and transparent as they set the stage for the actual instruction in class.......This article presents a comparison of the Nordic countries’ official objectives for reading and analyses of 1005 Nordic teachers’ responses regarding their reading instruction. The specificity and transparency vary greatly in the objectives, from broad outlines in Norway to more specific...

  12. Penile Cancer: Clinical Practice Guidelines in Oncology

    Clark, Peter E.; Philippe E. Spiess; Agarwal, Neeraj; Biagioli, Matthew C.; Eisenberger, Mario A.; Greenberg, Richard E.; Herr, Harry W.; Inman, Brant A.; Kuban, Deborah A.; Kuzel, Timothy M.; Lele, Subodh M.; Michalski, Jeff; Pagliaro, Lance; Pal, Sumanta K.; Patterson, Anthony

    2013-01-01

    Squamous cell carcinoma of the penis represents approximately 0.5% of all cancers among men in the United States and other developed countries. Although rare, it is associated with significant disfigurement, and only half of the patients survive beyond 5 years. Proper evaluation of both the primary lesion and lymph nodes is critical, because nodal involvement is the most important factor of survival. The NCCN Clinical Practice Guidelines in Oncology for Penile Cancer provide recommendations o...

  13. Clinical Practice Guidelines for Hypertensive Emergency Treatment

    Carlos Garcia Gomez; Raúl Nieto Cabrera

    2009-01-01

    Clinical Practice Guidelines for Hypertensive Emergency Treatment. It has been defined as the abrupt increase of systolic and diastolic blood pressure (usually ≥ 220/140 mmHg) associated with organic damage mainly of the central nervous system, heart or kidneys. This document includes concepts, different presentations, diagnosis and treatment, stressing the function of the most frequent hypotensive medications. It includes assessment guidelines focused on the most important aspects to be acco...

  14. Clinical Practice Guidelines for Severe Asthma Treatment.

    Eddy Pereira Valdes; Moisés Santos Peña; Belkys Rodríguez Llerena.

    2009-01-01

    Clinical Practice Guidelines for Severe Asthma Treatment. This disease is characterized by an overreaction of the tracheobronchial tree with hyperactivity after certain stimulus consisting of a diffuse narrowing of the respiratory ways related with an excessive contraction of the bronchial smooth muscle, hyper-secretion of mucus and mucosa edema. It is spontaneously reversible or reversible after treatment. We include a review of its definition, classification and development, stressing those...

  15. Clinical Practice Guidelines for Herniated Disk Treatment

    José Ramón Tejera del Valle; Joaquín Aguilar Trujillo; Danny Barrueta Reyes; José Gómez Cruz; Líder Tejera Sánchez

    2009-01-01

    Clinical Practice Guidelines for Herniated Disk Treatment. The current concept is not only limited to the disorder caused by the rupture of the intervertebral disk, it also includes primary disk degeneration and the resulting spondylosis, and disk disorders associated with this degeneration, traumas and aseptic and granulomatous discitis. Concept, diagnosis, treatment and aetiology are defined and commented stressing the neurosurgical aspects. It includes assessment guidelines focused on the ...

  16. Clinical Practice Guidelines for Bacterial Meningoencephalitis.

    Belkys Rodríguez Llerena.; Luciano Núñez Almoguea.

    2009-01-01

    Clinical Practice Guidelines for Bacterial Meningoencephalitis. It has been defined as an acute inflammatory process caused by bacteria, often purulent, which involves the meninges, subarachnoid space around the brain, spinal cord and usually includes the ventricles. It is caused in the 80% of the patients by three bacteria: Haemophilus influenzae, Neisseria meningitides and Streptococcus pneumonia. Concepts, classification, diagnosis and treatment were reviewed. It includes assessment guidel...

  17. Clinic Practical Guides for Cerebrovascular Diseases

    Miguel Angel Buergo Zuaznábar; Otman Fernández Concepción; Jesús Pérez Nellar; Gloria Lara Fernández; Carlos Maya Entenza; Alejandro Pando Cabrera

    2007-01-01

    The clinic practical guides for cerebrovascular diseases are presented. They include different aspects as its concept, classification, and epidemiological data in Cuba as well as worldwide. They also offer its diagnosis, classification, complications and treatment. The frequency of assessment of its application including the tools to measure the quality of life in patients with cerebrovascular accident and the way to proceed with them are shown

  18. Clinical decision making in veterinary practice

    Everitt, Sally

    2011-01-01

    Aim The aim of this study is to develop an understanding of the factors which influence veterinary surgeons’ clinical decision making during routine consultations. Methods The research takes a qualitative approach using video-cued interviews, in which one of the veterinary surgeon’s own consultations is used as the basis of a semi-structured interview exploring decision making in real cases. The research focuses primarily on small animal consultations in first opinion practice, how...

  19. Clinical Practice Guidelines for Cerebrovascular Disease Treatment

    Rubén Bembibre Taboada; Diosdania Alfonso Falcón; Julio Héctor Jova Dueñas; Tania Pérez Ramos

    2009-01-01

    Clinical Practice Guidelines for Cerebrovascular Disease Treatment. Even when this term makes reference to the whole process affecting part of cerebral vessel system and cerebral tissue, this document focuses on the cerebrovascular or acute neurological event abruptly affecting the cerebral tissue and the neurological condition of the patient. This condition is usually cause by an abrupt vessel occlusion, of thrombotic or embolic origin, or by subarachnoid or intraventricular intraparenchymat...

  20. Caring during clinical practice: Midwives’ perspective

    Mmajapi E. Chokwe

    2013-09-01

    Full Text Available Background: Caring forms the core of nursing and midwifery. Despite caring being an important emotional aspect of midwifery and nursing, there are general public complaints about uncaring behaviour in midwifery. Therefore, there is a need to explore caring from midwives’ point of view with the hope of identifying solutions and recommendations for midwifery practice. Furthermore, the study aimed to stimulate debate and discussion about the caring behaviour of midwives.Objective: To explore caring during clinical practice as perceived and experienced by midwives.Method: The study was contextual, exploratory and qualitative. The participants were midwives working in state and private hospitals in Tshwane,South Africa where BTech II and III midwifery learners were allocated for work integrated learning (WIL. Data collection was carried out through self-report using a questionnaire and focus group. Questionnaires were distributed to 40 midwives at private and state hospitals in Tshwane. This was followed by two focus group sessions to ensure that data is enriched. The hermeneutic interpretive approach was used to analyse data, and analysis continued until saturation.Results: Themes of caring and uncaring related to patient care and midwives emerged. Thefindings illustrated that the midwives had excellent theoretical knowledge of caring, but someof them did not display caring behaviour during clinical practice.Conclusion: Some of the midwives did not display caring behaviour. Implication for practicewas provided based on the research findings. Recommendations included measures of improving caring behaviours during midwifery practice.

  1. Mismatch repair deficiency testing in clinical practice.

    Buza, Natalia; Ziai, James; Hui, Pei

    2016-05-01

    Lynch syndrome, an autosomal dominant inherited disorder, is caused by inactivating mutations involving DNA mismatch repair (MMR) genes. This leads to profound genetic instability, including microsatellite instability (MSI) and increased risk for cancer development, particularly colon and endometrial malignancies. Clinical testing of tumor tissues for the presence of MMR gene deficiency is standard practice in clinical oncology, with immunohistochemistry and PCR-based microsatellite instability analysis used as screening tests to identify potential Lynch syndrome families. The ultimate diagnosis of Lynch syndrome requires documentation of mutation within one of the four MMR genes (MLH1, PMS2, MSH2 and MSH6) or EPCAM, currently achieved by comprehensive sequencing analysis of germline DNA. In this review, the genetic basis of Lynch syndrome, methodologies of MMR deficiency testing, and current diagnostic algorithms in the clinical management of Lynch syndrome, are discussed. PMID:26895074

  2. Actually Digital : personal Electronic Libraries and a Reconstruction of Academic Reading Practices

    2012-01-01

    This thesis studies academic reading practices through the use of, Docear, a new software program with a module that combines PDF and mind mapping technologies. Five in-depth Skype interviews designed to reveal situated uses of Docear were conducted. The author’s experience as an academic librarian serves in investigating the surrounding “infrastructure of relations” and has a reflexive role in the analysis. Actor Network Theory (ANT) and Science and Technology Studies (STS) form a theoreti...

  3. The Challenges of Using an Existing Cross-Device Interaction Prototype for Supporting Actual Curation Practices

    Brudy, F.; Marquardt, N.; Y.; Rogers; Sellen, A; O'Hara, K.

    2016-01-01

    Volunteer-driven organisations curating historic documents, such as societies and charities, often work within a bring-your-own-device (BYOD) practice and their meetings are in varying situations. A recurring challenge is finding lightweight ways to enable them to share and collectively work with documents using their own devices while in situ. We are working on building novel interaction techniques and applications (prototyped with a custom developer toolkit) for supporting the curation of d...

  4. Effect of 11 months of yoga training on cardiorespiratory responses during the actual practice of Surya Namaskar

    Biswajit Sinha

    2014-01-01

    Full Text Available Background: Surya Namaskar (SN, a popular traditional Indian yogic practice, includes practicing 12 physical postures with alternate forward and backward bending movement of the body along with deep breathing maneuvers. The practice of SN has become popular among yoga practitioners and other fitness conscious people. The long-term effect of practicing SN and other yogic practices on cardiorespiratory responses during SN are lacking. Aim: The present study was conducted to study the effect of yogic training on various cardiorespiratory responses during the SN practice in yoga trainees after a time interval of 3, 6, and 11 months. Materials and Methods: The present study was conducted on 9 healthy male Army soldiers who underwent training in various yoga postures including SN, meditation, and pranayama for 1 h daily for 11 months. First, second, and third phase of the study was conducted in the laboratory after completion of 3, 6, and 11 months of the yoga training. The participants performed SN along with other yogic practices in the laboratory as per their daily practice schedule. The cardiorespiratory responses of the volunteers were recorded during actual practice of SN. Statistical Analysis: One-way repeated measure ANOVA followed by Tukey HSD. Results: Oxygen consumption and heart rate during actual practice of SN was 0.794 ± 0.252, 0.738 ± 0.229, and 0.560 ± 0.165 L/min and 92.1 ± 11.6, 97.9 ± 7.3 and 87.4 ± 9.2 beats/min respectively at 1 st , 2 nd , and 3 rd phase of yoga training. Minute ventilation and tidal volume also reduced from 19.9 ± 4.65 to 17.8 ± 4.41 L/min and 1.091 ± 0.021 to 0.952 L/breath from 1 st phase to 3 rd phase of yoga training. However, respiratory parameters like breathing rate (f R did not show any reduction across the three phases. Conclusion: The results of the present study indicated that yogic training caused conditioning of cardiorespiratory parameters except f R, which did not reduce across three

  5. Role modeling excellence in clinical nursing practice.

    Perry, R N Beth

    2009-01-01

    Role modeling excellence in clinical nursing practice is the focus of this paper. The phenomenological research study reported involved a group of 8 nurses identified by their colleagues as exemplary. The major theme revealed in this study was that these exemplary nurses were also excellent role models in the clinical setting. This paper details approaches used by these nurses that made them excellent role models. Specifically, the themes of attending to the little things, making connections, maintaining a light-hearted attitude, modeling, and affirming others are presented. These themes are discussed within the framework of Watson [Watson, J., 1989. Human caring and suffering: a subjective model for health services. In: Watson, J., Taylor, R. (Eds.), They Shall Not Hurt: Human Suffering and Human Caring. Colorado University, Boulder, CO] "transpersonal caring" and [Bandura, A., 1997. Social Learning Theory. Prentice Hall, Englewood Cliffs, NJ] "Social Learning Theory." Particular emphasis in the discussion is on how positive role modeling by exemplary practitioners can contribute to the education of clinical nurses in the practice setting. PMID:18590978

  6. Litigations and the Obstetrician in Clinical Practice.

    Adinma, Jib

    2016-01-01

    The expectation of obstetrics is a perfect outcome. Obstetrics malpractice can cause morbidity and mortality that may engender litigation. Globally, increasing trend to litigation in obstetrics practice has resulted in high indemnity cost to the obstetrician with consequent frustration and overall danger to the future of obstetrics practice. The objective was to review litigations and the Obstetrician in Clinical Practice, highlighting medical ethics, federation of gynecology and obstetrics (FIGO's) ethical responsibility guideline on women's sexual and reproductive health and right; examine the relationship between medical ethics and medical laws; X-ray medical negligence and litigable obstetrics malpractices; and make recommendation towards the improvement of obstetrics practices to avert misconduct that would lead to litigation. Review involves a literature search on the internet in relevant journals, textbooks, and monographs. Knowledge and application of medical ethics are important to the obstetricians to avert medical negligence that will lead to litigation. A medical negligence can occur in any of the three triads of medicare viz: Diagnosis, advice/counseling, and treatment. Lawsuits in obstetrics generally center on errors of omission or commission especially in relation to the failure to perform caesarean section or to perform the operation early enough. Fear of litigation, high indemnity cost, and long working hours are among the main reasons given by obstetricians for ceasing obstetrics practice. Increasing global trend in litigation with high indemnity cost to the obstetrician is likely to jeopardize the future of obstetrics care especially in countries without medical insurance coverage for health practitioners. Litigation in obstetrics can be prevented through the Obstetrician's mindfulness of its possibility; acquainting themselves of the medical laws and guidelines related to their practice; ensuring adequate communication with, and consent of

  7. The Sherlock Holmes method in clinical practice.

    Sopeña, B

    2014-04-01

    This article lists the integral elements of the Sherlock Holmes method, which is based on the intelligent collection of information through detailed observation, careful listening and thorough examination. The information thus obtained is analyzed to develop the main and alternative hypotheses, which are shaped during the deductive process until the key leading to the solution is revealed. The Holmes investigative method applied to clinical practice highlights the advisability of having physicians reason through and seek out the causes of the disease with the data obtained from acute observation, a detailed review of the medical history and careful physical examination. PMID:24457141

  8. Clinical Practice Guidelines for Cerebrovascular Disease Treatment

    Rubén Bembibre Taboada

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Cerebrovascular Disease Treatment. Even when this term makes reference to the whole process affecting part of cerebral vessel system and cerebral tissue, this document focuses on the cerebrovascular or acute neurological event abruptly affecting the cerebral tissue and the neurological condition of the patient. This condition is usually cause by an abrupt vessel occlusion, of thrombotic or embolic origin, or by subarachnoid or intraventricular intraparenchymatous hemorrhage, of aneurism origin, related with hypertension or with a tumour or arteriovenous defects. The main concepts, classification and conduct are reviewed, stressing the cerebrovascular accident. It includes assessment guidelines focused on the most important aspects to be accomplished.

  9. Biosensors in Clinical Practice: Focus on Oncohematology

    Agostino Cortelezzi

    2013-05-01

    Full Text Available Biosensors are devices that are capable of detecting specific biological analytes and converting their presence or concentration into some electrical, thermal, optical or other signal that can be easily analysed. The first biosensor was designed by Clark and Lyons in 1962 as a means of measuring glucose. Since then, much progress has been made and the applications of biosensors are today potentially boundless. This review is limited to their clinical applications, particularly in the field of oncohematology. Biosensors have recently been developed in order to improve the diagnosis and treatment of patients affected by hematological malignancies, such as the biosensor for assessing the in vitro pre-treatment efficacy of cytarabine in acute myeloid leukemia, and the fluorescence resonance energy transfer-based biosensor for assessing the efficacy of imatinib in chronic myeloid leukemia. The review also considers the challenges and future perspectives of biosensors in clinical practice.

  10. Whiteboards: mediating professional tensions in clinical practice.

    Riley, Robin; Forsyth, Rowena; Manias, Elizabeth; Iedema, Rick

    2007-01-01

    In this paper we argue that whiteboards in clinical settings play a hybrid role: communicating inter- and intraprofessional directives, mediating professional tensions, and mitigating potentially face-threatening acts. The data upon which this paper is based emanate from two independently conducted ethnographic studies: the first explored a range of nurse-nurse and nurse-doctor communication practices in operating rooms, while the second explored work routines and communication methods in oncology wards. Data collection included fieldwork using observations, interviews assisted by photographic methods, and in the first study, a personal diary. A deconstructive analysis was independently undertaken. As a communication method, the use of whiteboards in clinical settings provided a focal point for the coordination of clinical work activities and for the dissemination of information to large groups of people. Whiteboards were a conduit for potentially face-threatening information in that they facilitated the policing and disciplining of staff, while distancing communicators from one another. We conclude that whiteboards are 'pseudo-synchronous' in nature, enabling 'communication at a distance'. In doing so, whiteboards may facilitate and economize clinical communication but they also perpetuate the invisibility of nurses' contribution to ensuring safe care, and they mask the symbolic violence that is committed within and between health professionals. PMID:18052816

  11. Taking PDT into mainstream clinical practice

    Bown, Stephen G.

    2009-06-01

    Many individuals in the field are frustrated by the slow progress getting PDT established in mainstream clinical practice. The five key reasons are: 1. Lack of adequate evidence of safety and efficacy and optimization of dosimetry. These are fundamental. The number of randomized controlled studies is still small. For some cancer applications, it is difficult to get patients to agree to be randomised, so different approaches must be taken. Anecdotal results are not acceptable to sceptics and regulators. 2. The regulatory processes. The rules get more complex every day, but there is no choice, they must be met. The full bureaucratic strength of the pharmaceutical industry is needed to address these issues. 3. Conservatism of the medical profession. Established physicians are reluctant to change practice, especially if it means referring patients to different specialists. 4. Lack of education. It is amazing how few physicians have even heard of PDT and many that have, are sceptical. The profile of PDT to both the medical profession and the general public needs to be raised dramatically. Patient demand works wonders! 5. Money. Major investment is required to run clinical trials. Pharmaceutical companies may see PDT as a threat (eg reduced market for chemotherapy agents). Licensed photosensitisers are expensive. Why not reduce the price initially, to get the technique established and stimulate demand? PDT has the potential for enormous cost savings for health service providers. With appropriate motivation and resources these problems can be addressed. Possible routes forward will be suggested.

  12. Practical Clinical Training in Skills Labs: Theory and Practice.

    Bugaj, T J; Nikendei, C

    2016-01-01

    Today, skills laboratories or "skills labs", i.e. specific practical skill training facilities, are a firmly established part of medical education offering the possibility of training clinical procedures in a safe and fault-forging environment prior to real life application at bedside or in the operating room. Skills lab training follows a structured teaching concept, takes place under supervision and in consideration of methodological-didactic concepts, ideally creating an atmosphere that allows the repeated, anxiety- and risk-free practice of targeted skills. In this selective literature review, the first section is devoted to (I) the development and dissemination of the skills lab concept. There follows (II) an outline of the underlying idea and (III) an analysis of key efficacy factors. Thereafter, (IV) the training method's effectiveness and transference are illuminated, before (V) the use of student tutors, in the sense of peer-assisted-learning, in skills labs is discussed separately. Finally, (VI) the efficiency of the skills lab concept is analyzed, followed by an outlook on future developments and trends in the field of skills lab training. PMID:27579363

  13. Hand kinematics: Application in clinical practice

    Santosh Rath

    2011-01-01

    Full Text Available Pathological conditions of the hand consequent to injuries, paralysis, disease, arthritis and congenital difference results in loss or limitation of function, deformities, stiffness, inadequate power and poor position for pinch. The pathogenesis of deformities is influenced by bio-mechanical principles of joints and muscle function. The crippling impact of secondary changes due to edema, soft tissue contractures, muscle shortening and functional adaptations also have a mechanical basis. For clinicians and hand therapists, it is necessary to understand these fundamental principles of biomechanics to plan treatment modalities. Interpretation of mechanics of hand deformities in rheumatoid arthritis and paralysis will enable the treating team to identify the appropriate interventions of splinting, therapy and surgical procedures. Basic knowledge of the principles of hand clinical bio-mechanics will help the beginner to sail through the multitude of tendon transfers described in the text books of hand surgery and find the best solution for a particular clinical presentation. Similarly, knowledge of bio-mechanics will provide solutions to an experienced surgeon to plan treatment protocols for complex situations. The article presents a concise summary of the basic principles of hand bio-mechanics for common hand conditions seen in clinical practice. Understanding and applying these principles will help clinicians in planning and devising treatment options for common and complex hand conditions.

  14. Nurses' intention to apply clinical practice guidelines.

    Kogan, Ella; Tabak, Nili

    2012-12-01

    Using Ajzen and Madden's Theory of Planned Behavior, this study investigates factors which influence nurses' intention to apply clinical practice guidelines in their daily ward work. A convenience sample of 91 nurses in internal medicine wards in three Israeli hospitals answered four questionnaires. Data were processed by Pearson correlation coefficients and multivariate regression. The main findings were that burnout was negatively correlated with the intention to work according to guidelines and that professionalism (in the sense of a tendency to follow taught procedure rather than personal judgment) was positively correlated with it. Furthermore, nurses who perceive their behavioral control and subjective norms to be positive will be the most determined to work according to guidelines, provided they personally command the necessary resources to do so. PMID:23447906

  15. Differential associations between actual and expected GP practice prescribing rates for statins, ACE inhibitors, and beta-blockers: a cross-sectional study in England

    Ward, Paul R; Noyce, Peter R; St Leger, Antony S

    2005-01-01

    Aim To explore the relationship between actual and expected general medical practitioner (GP) practice prescribing rates for statins, angiotensin converting enzyme (ACE) inhibitors, and beta-blockers. Background There is a growing body of literature highlighting inequities in GP practice prescribing rates for many drug therapies. The equity of prescribing is of central importance in the area of therapeutics since it explores the interface between those patients who should and those who actual...

  16. [Clinical practice guideline: a complete geriatric evaluation].

    Medina-Chávez, Juan Humberto; Torres-Arreola, Laura Del Pilar; Cortés-González, Rosa María; Durán-Gómez, Verónica; Martínez-Hernández, Fernando; Esquivel-Romero, Gustavo

    2011-01-01

    The care of elderly patients requires an evaluation that deserves a host of special considerations, such as biological aspects of aging, those related to activities of daily living and functionality, neuro-psychological conceptions, family dynamics and economic conditions. The growth of the aging population in our country is accompanied by an increase in chronic diseases and more individuals have greater vulnerability, requiring a more consumption of resources because of the high demand for services. This requires the incorporation of specialized care in the institutional system, which has caused serious consequences in the current health system, benefiting specialization and technology, but with a loss of an integrated and horizontal view of the patient. Therefore it is necessary to develop a practical tool that allows the family physician to identify and differentiate the geriatric population that requires specialized care from who does not, identifying problems that may improve and allow the design of strategies to improve health status and maintain functional autonomy of the elderly. Comprehensive Geriatric Assessment (CGA) is a fundamental tool for clinical practice of any medical care to the elderly. PMID:22176832

  17. Integrating wound care research into clinical practice.

    Ho, Chester H; Bogie, Kath M

    2007-10-01

    The process of integrating wound care research into clinical practice incorporates research methodology--i.e., the standardized practices, procedures, and rules by which research is performed--and an evidence-based approach. Using examples from the literature and clinician experience treating pressure ulcers in a 32-bed regional spinal cord injury unit in a tertiary referral center in Cleveland, Ohio, the authors describe this process and review the challenges faced by an interdisciplinary skin care team tasked with implementing evidence-based care. Additional considerations include determining the amount of current wound care that is evidence-based and whether wound prevention and care outcomes are improved through the use of evidence-based medicine. Five years after establishing the skin care team and implementing evidence-based care, improvements in care processes and short-term outcomes--specifically, pressure ulcer prevention and treatment protocols including documentation--have been realized. Studies to ascertain the effects of these changes on long-term outcomes are planned. PMID:17978411

  18. Evidence-based practice: a trainee clinical psychologist perspective

    Chapman, Lynn

    2010-01-01

    Evidence-based practice (EBP) is now the dominant model in health care; its aim is to increase the use of research evidence to inform clinical decision making. Clinical practice guidelines are the predominant method by which research is distilled into practice recommendations. Clinical psychology has its own model which promotes the integration of research evidence with clinical expertise, the scientist practitioner model (SPM). Recent developments within the United Kingdom health service, su...

  19. Application of scientific developments into clinical practice

    In 2002, in the Republic of Belarus, the incidence rate of thyroid cancer in comparison with 1986 increased by a factor of 5.7, and amounted to 8,6 cases per 100 000. The increase of prevalence of thyroid cancer continues, especially for adolescents and young adults. For the period of 17 years in the republic have been operated 9526 patients, including 728 children, 414 adolescents and 856 young adults under 35 years. In this group consisting of 1998 patients, in 184 (9.2 %) lung metastases have been diagnosed. In the long-term period after the treatment 19 (0.9 %) died of tumor progression. The remaining 1979 (99.5 %) survived. The minimum lethality of young patients with thyroid cancer is achieved due to the excellent qualification of doctors and technical equipment of the Center, improvement of cancer detection in regions at the pre-hospital stage and timely rehabilitation in case of arisen complications. Scientific developments of the Republican Center contributed to the improvement of treatment of patients with thyroid cancer. Standardization of treatment modes of patients have been developed based on latest developments of the world science in the thyroid research area. The method of optimal treatment of children and adolescents has been developed and introduced into practice. Radioiodine treatment with the use of new technologies has been introduced into clinical practice. The surgical technique has been improved for recurrent, locally-spread and cervical- mediastinal cancer. Clinical-biological features of radiation-induced cancer, including the study on the molecular-genetic level have been studied, and its highly aggressive nature have been determined being revealed by early and multiple metastatic disease. Necessity has been justified to carry out preventive cervical neck lympho-dissection for patients with radiogenic cancer, if metastases have been not clinically revealed. All these developments are represented in the instruction and the treatment

  20. Current Clinical Practice Scenario of Osteoporosis Management in India

    Jhaveri, Shailesh; Upashani, Tejas; Bhadauria, Jitendra; Patel, Kamlesh

    2015-01-01

    Background Various osteoporosis guidelines are available for practice. Aim To understand the current clinical practice scenario from the perspective of Indian orthopaedicians, especially about the epidemiology, clinical manifestations, approach to diagnosis and management and patient compliance patterns to long term treatment. Materials and Methods A pre-validated structured questionnaire containing questions (mostly objective, some open-ended) catering to various objectives of the study was circulated amongst orthopaedic surgeons across India by means of post/courier, after giving a brief overview of the study telephonically. Data was extracted from the completed questionnaires, and analysed using Microsoft Excel software. Results The questionnaire was filled by a total of 84 orthopaedicians throughout India. The prevalence of osteoporosis in India according to the orthopaedic surgeons was 38.4% and there was a female preponderance. Most of the respondents felt out of every 100 osteoporosis patients in India, less than 20 patients are actually diagnosed and treated for osteoporosis. The most common initial presenting feature of established osteoporosis cases was general symptoms. Most respondents preferred Dual-energy X-ray absorptiometry (DEXA) as the initial investigation for the diagnosis of osteoporosis in a patient presenting with typical features. While most respondents preferred once-a-month oral over intravenous (IV) bisphosphonates, they agreed that IV administration had advantages such as lower gastrointestinal side effects and improved compliance. The average duration of therapy of oral bisphosphonates was the longest (27.04 months) among the other anti- osteoporosis therapies that they used. On an average, the patient compliance rate in osteoporosis management was around 64%. IV Zoledronic acid (ZA) and intranasal calcitonin were infrequently used than other anti- osteoporosis therapies. While concerns about cost and availability deterred more frequent

  1. How to Connect the Gap between Clinical Trials and Clinical Practice

    SHANG Hong-cai; XU Hong-juan; CHEN Jing; ZHANG Bo-li; LI You-ping; Mike J Clarke

    2008-01-01

    Clinical research methods have been rapidly developing, and the design of clinical trials including traditional Chinese medicine is advancing. To a certain extent, all of these ensure that the results of clinical research are objective and scientific, but whether these results and the resulting guidelines or consensus have much practical significance on clinical practice is still controversial. The authors engage in both clinical practice and clinical research; they strongly feel that it is necessary to discuss the relationship between clinical trials and clinical practice. This essay discusses this relationship in four parts.

  2. PRACTICAL ASPECTS OF APIXABAN USE IN CLINICAL PRACTICE: VIEW POINT OF CLINICAL PHARMACOLOGIST

    D. A. Sychev

    2015-09-01

    Full Text Available Apixaban is a "new" oral anticoagulant, direct Xa factor inhibitor with a good evidence base of the efficacy in the prevention of ischemic stroke in patients with atrial fibrillation. The article is devoted to apixaban use in clinical practice: examination before apixaban administration, clinical situation when laboratory control and monitoring are needed, drugs interactions (at the level of CYP3A4, P-gp, management of patients with bleeding because of apixaban therapy (including antidotes application, perioperative management of patients receiving apixaban.

  3. Laparoscopic cholecystectomy: a clinical practice audit

    To evaluate laparoscopic cholecystectomy by a clinical practice audit at Military Hospital, Rawalpindi. Study Design: Prospective study. Place and Duration of Study: Surgical department Military Hospital from Jul 2011-Dec 2013. Material and Methods: A total of 1020 patients who underwent laparoscopic cholecystectomy for acute or chronic cholecystitis and gallstone pancreatitis were included in our study while those who had previously undergone abdominal surgeries, those with high risk for general anesthesia, immunocompromised patients, with age greater than 70 years and having comorbidities like cardiac insufficiency, severe asthma, chronic liver disease with ascites and compromised renal functions were excluded from the study. Patients demographic data, operative time, intra-operative findings, intra-operative difficulties, post-operative complications, conversion rate to open cholecystectomy and post-operative recovery time were recorded. Data was analyzed by using SPSS version 21. Results: Out of 1020 patients 907 were females while 113 were males with male to female ratio of 1:8.02. Age range was 20-70 with mean age of 50 ± 10.456 years. 44.7% patients presented with the clinical features of acute cholecystitis, 540 (52.94%) with chronic cholecystitis and 23 (2.28%) with acute pancreatitis. Mean operative time was 20 minutes in asymptomatic patients, while 40 minutes in acute cholecystitis and 35 minutes in chronic gallstone disease. Gall bladder perforation, bleeding from cystic artery and bile spillage were mostly encountered per-operative difficulties. Only 37 (3.6%) patients were converted to open cholecystectomy. Post-operative complications occur in only 122 (12%) patients. 938 (92%) patients were discharged within 48 hours. of surgery. Conclusion: Laparoscopic cholecystectomy in our setup has comparable results to the data available from other surgical facilities around the world and it has become a gold standard technique for the treatment of non

  4. The practice-unit centered clinical database--the implementation.

    Bryner, U. M.

    1991-01-01

    A clinical database system under the name ClinTrac has been developed for the purpose of acquiring, processing, storing, analyzing, and communicating clinical information. The core of this system consists of a practice-unit centered database.

  5. Clinical practice guideline: Otitis media with effusion.

    Rosenfeld, Richard M; Culpepper, Larry; Doyle, Karen J; Grundfast, Kenneth M; Hoberman, Alejandro; Kenna, Margaret A; Lieberthal, Allan S; Mahoney, Martin; Wahl, Richard A; Woods, Charles R; Yawn, Barbara

    2004-05-01

    The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline "Otitis Media With Effusion in Young Children," which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children aged 1 to 3 years with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the OME guideline. The subcommittee made a strong recommendation that clinicians use pneumatic otoscopy as the primary diagnostic method and distinguish OME from acute otitis media (AOM). The subcommittee made recommendations that clinicians should (1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME; (2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk; and (3) manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known), or from the date of diagnosis (if onset is unknown). The subcommittee also made recommendations that (4) hearing testing be conducted when OME persists for 3 months or longer, or at any time that

  6. Defining Clinical Excellence in Adult Infectious Disease Practice.

    Chida, Natasha M; Ghanem, Khalil G; Auwaerter, Paul G; Wright, Scott M; Melia, Michael T

    2016-09-01

    Clinical excellence should be recognized, particularly in the current climate that appropriately prioritizes relationship-centered care. In order to develop a recognition model, a definition of clinical excellence must be created and agreed upon. A paradigm recently suggested by C. Christmas describes clinical excellence through the following domains: diagnostic acumen, professionalism and humanism, communication and interpersonal skills, skillful negotiation of the healthcare system, knowledge, taking a scholarly approach to clinical practice, and having passion for clinical medicine. This work references examples of infectious disease (ID) clinical excellence across Christmas' domains and, in doing so, both examines how the definition of clinical excellence applies to ID practice and highlights the importance of ID physicians. Emphasizing such aspirational standards may not only inspire trainees and practicing physicians to pursue their own fulfilling clinical ID careers, it may also encourage health systems to fully value outstanding ID physicians who labor tirelessly to provide patients with exceptional care. PMID:27419186

  7. Effective student feedback in clinical practice

    Warman, Sheena M; Bell, Catriona; Rhind, Susan M

    2014-01-01

    This article, the third in a series aimed at providing veterinary staff and students with tips and tools to enhance teaching and learning, considers how to give feedback to students in a constructive manner that enhances learning in practice.

  8. Transition questions in clinical practice - validity and reproducibility

    Lauridsen, Henrik Hein

    2008-01-01

    Transition questions in CLINICAL practice - validity and reproducibility Lauridsen HH1, Manniche C3, Grunnet-Nilsson N1, Hartvigsen J1,2 1   Clinical Locomotion Science, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. e-mail: hlauridsen......@health.sdu.dk 2   Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark 3   Backcenter Funen, Part of Clinical Locomotion Science, Ringe, Denmark   Abstract  Understanding a change score is indispensable for interpretation of results from clinical studies...

  9. Using socioeconomic evidence in clinical practice guidelines

    Aldrich, Rosemary; Kemp, Lynn; Williams, Jenny Stewart; Harris, Elizabeth; Simpson, Sarah; Wilson, Amanda; McGill, Katie; Byles, Julie; Lowe, Julia; Jackson, Terri

    2003-01-01

    The effects of socioeconomic position on health have been largely ignored in clinical guidelines. Australia's National Health and Medical Research Council has produced a framework to ensure that they are taken into account

  10. Enhancing reflective practice through online learning: impact on clinical practice

    Sim, J; Radloff, A

    2008-01-01

    Purpose Traditionally, radiographers and radiation therapists function in a workplace environment that is protocol-driven with limited functional autonomy. The workplace promotes a culture of conformity and discourages practitioners from reflective and critical thinking, essential attributes for continuing learning and advancing workplace practices. As part of the first author’s doctoral study, a continuing professional development (CPD) educational framework was used to design and implement ...

  11. Elementary Classroom Teacher Actual Practices and Perceived Importance of English Language Arts Professional Development in High and Low Mastery, Low Needs Schools

    Smalley, Christopher

    2014-01-01

    The purpose of this study was to compare elementary classroom teachers' actual practice and perceived importance of English Language Arts professional development in five professional development dimensions: alignment, content and modeling, active learning, collaboration, and follow-up, in high and low mastery, low needs schools. The schools…

  12. Comparison between the ideal reference dose level and the actual reference dose level from clinical 3D radiotherapy treatment plans

    Purpose: Retrospective study of 3D clinical treatment plans based on radiobiological considerations in the choice of the reference dose level from tumor dose-volume histograms. Methods and materials: When a radiation oncologist evaluates the 3D dose distribution calculated by a treatment planning system, a decision must be made on the percentage dose level at which the prescribed dose should be delivered. Much effort is dedicated to deliver a dose as uniform as possible to the tumor volume. However due to the presence of critical organs, the result may be a rather inhomogeneous dose distribution throughout the tumor volume. In this study we use a formulation of tumor control probability (TCP) based on the linear quadratic model and on a parameter, the F factor. The F factor allows one to write TCP, from the heterogeneous dose distribution (TCP{(εj,Dj)}), as a function of TCP under condition of homogeneous irradiation of tumor volume (V) with dose D (TCP(V,D)). We used the expression of the F factor to calculate the 'ideal' percentage dose level (iDLr) to be used as reference level for the prescribed dose D delivery, so as to render TCP{(εj,Dj)} equal to TCP(V,D). The 3D dose distributions of 53 clinical treatment plans were re-evaluated to derive the iDLr and to compare it with the one (DtpL) to which the dose was actually administered. Results: For the majority of prostate treatments, we observed a low overdosing following the choice of a DtpL lower than the iDLr. While for the breast and head-and-neck treatments, the method showed that in many cases we underdosed choosing a DtpL greater than the iDLr. The maximum difference between the iDLr and the DtpL was -3.24% for one of the head-and-neck treatments. Conclusions: Using the TCP model, the probability of tumor control is compromised following an incorrect choice of DtpL; so we conclude that the application of the F factor is an effective tool and clinical aid to derive the optimal reference dose level from

  13. 77 FR 49448 - Food and Drug Administration Clinical Trial Requirements, Compliance, and Good Clinical Practice...

    2012-08-16

    ... HUMAN SERVICES Food and Drug Administration Food and Drug Administration Clinical Trial Requirements, Compliance, and Good Clinical Practice; Public Workshop AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public workshop. The Food and Drug Administration (FDA), Baltimore District Office,...

  14. Neurobiology of Addictions: Implications for Clinical Practice.

    Spence, Richard T., Ed.; DiNitto, Diana M., Ed.; Straussner, Shulamith Lala Ashenberg, Ed.

    This book offers helping professionals an introduction to the neurobiological aspects of substance abuse. It presents the basic information on the subject, including the various neurobiological theories of addiction, and places them in a psychosocial context. In addition to connecting the theoretical information with practical applications, the…

  15. Imperfection, practice and humility in clinical ethics.

    Garchar, Kim

    2012-10-01

    In this essay, I provide a description of the discipline of ethics using the philosophies of Aristotle and the American pragmatist John Dewey. Specifically, I argue that ethics is an active undertaking that is ambiguous and pluralistic. I then normatively prescribe the way in which clinical ethicists ought to approach their work in medicine. Rather than endeavouring to become, or behaving as if they are, experts, clinical ethicists must be humble. They must practise ethics. That is, they must admit ethics is the study and pursuit of the good life but that this study and pursuit occurs imperfectly in the face of problematic situations. PMID:22995007

  16. Clinical Scientists Improving Clinical Practices: In Thoughts and Actions

    Apel, Kenn

    2014-01-01

    Purpose: In this article, the author comments on aspects of Kamhi's (2014) article, which caused the author to think more deeply about definitions of language, theories of learning, and how these two core components of intervention prepare clinical scientists as they search the literature for new knowledge. Interprofessional collaborative…

  17. Orienting Nursing Students to Cost Effective Clinical Practice.

    Lessner, Muriel W.; And Others

    1994-01-01

    Describes five principles for cost-effective clinical practice: efficient use of self, efficient use of equipment and supplies, delegation of work, critical path method, and organization of the environment. (SK)

  18. Evaluating clinical dermatology practice in medical undergraduates.

    Casanova, J M; Sanmartín, V; Martí, R M; Morales, J L; Soler, J; Purroy, F; Pujol, R

    2014-06-01

    The acquisition of competences (the set of knowledge, skills and attitudes required to perform a job to a professional level) is considered a fundamental part of medical training. Dermatology competences should include, in addition to effective clinical interviewing and detailed descriptions of skin lesions, appropriate management (diagnosis, differentiation, and treatment) of common skin disorders and tumors. Such competences can only be acquired during hospital clerkships. As a way of certifying these competences, we propose evaluating the different components as follows: knowledge, via clinical examinations or critical incident discussions; communication and certain instrumental skills, via structured workplace observation and scoring using a set of indicators; and attitudes, via joint evaluation by staff familiar with the student. PMID:23664251

  19. Potential Uses of Probiotics in Clinical Practice

    Reid, Gregor; Jass , Jana; Sebulsky, M. Tom; McCormick, John K.

    2003-01-01

    Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. There is now mounting evidence that selected probiotic strains can provide health benefits to their human hosts. Numerous clinical trials show that certain strains can improve the outcome of intestinal infections by reducing the duration of diarrhea. Further investigations have shown benefits in reducing the recurrence of urogenital infections in women, while promisi...

  20. Effects of feedback of information on clinical practice: a review.

    Mugford, M; Banfield, P; O'Hanlon, M

    1991-01-01

    OBJECTIVE--To establish what is known about the role of feedback of statistical information in changing clinical practice. DESIGN--Review of 36 studies of interventions entailing the use of statistical information for audit or practice review, which used a formal research design. SUBJECTS--Papers identified from computer searches of medical and health service management publications, of which 36 describing studies of interventions designed to influence clinical care and including information ...

  1. Rethinking the Role of Clinical Practice Guidelines in Pharmacy Education.

    Brown, Daniel L

    2015-12-25

    Clinical practice guidelines (CPGs) play a major role in pharmacy education. Students learn to locate, retrieve, and apply CPGs in didactic coursework and practice experiences. However, they often memorize and quote recommendations without critical analysis, which tends to undermine their clinical growth. Students should become genuine drug experts, based on strong critical-thinking skills and the ability to assimilate extensive clinical and scientific knowledge. Clinical practice guidelines improve health care, and students should be familiar with them, but there are legitimate criticisms of CPGs, stemming largely from potential conflicts of interest and limitations in the quality and scope of available evidence. Despite such flaws, CPGs can be used to facilitate the clinical growth of students if the emphasis is placed on critically analyzing and evaluating CPG recommendations, as opposed to blindly accepting them. From that perspective, the role that CPGs have come to play in education may need to be reconsidered. PMID:26889060

  2. [Impact of digital technology on clinical practices: perspectives from surgery].

    Zhang, Y; Liu, X J

    2016-04-01

    Digital medical technologies or computer aided medical procedures, refer to imaging, 3D reconstruction, virtual design, 3D printing, navigation guided surgery and robotic assisted surgery techniques. These techniques are integrated into conventional surgical procedures to create new clinical protocols that are known as "digital surgical techniques". Conventional health care is characterized by subjective experiences, while digital medical technologies bring quantifiable information, transferable data, repeatable methods and predictable outcomes into clinical practices. Being integrated into clinical practice, digital techniques facilitate surgical care by improving outcomes and reducing risks. Digital techniques are becoming increasingly popular in trauma surgery, orthopedics, neurosurgery, plastic and reconstructive surgery, imaging and anatomic sciences. Robotic assisted surgery is also evolving and being applied in general surgery, cardiovascular surgery and orthopedic surgery. Rapid development of digital medical technologies is changing healthcare and clinical practices. It is therefore important for all clinicians to purposefully adapt to these technologies and improve their clinical outcomes. PMID:27117211

  3. Clinical practice guideline: tonsillitis II. Surgical management.

    Windfuhr, Jochen P; Toepfner, Nicole; Steffen, Gregor; Waldfahrer, Frank; Berner, Reinhard

    2016-04-01

    In 2013, a total of 84,332 patients had undergone extracapsular tonsillectomies (TE) and 11,493 a tonsillotomy (TT) procedure in Germany. While the latter is increasingly performed, the number of the former is continually decreasing. However, a constant number of approximately 12,000 surgical procedures in terms of abscess-tonsillectomies or incision and drainage are annually performed in Germany to treat patients with a peritonsillar abscess. The purpose of this part of the clinical guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through the surgical treatment options to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical treatment options encompass intracapsular as well as extracapsular tonsil surgery and are related to three distinct entities: recurrent episodes of (1) acute tonsillitis, (2) peritonsillar abscess and (3) infectious mononucleosis. Conservative management of these entities is subject of part I of this guideline. (1) The quality of evidence for TE to resolve recurrent episodes of tonsillitis is moderate for children and low for adults. Conclusions concerning the efficacy of TE on the number of sore throat episodes per year are limited to 12 postoperative months in children and 5-6 months in adults. The impact of TE on the number of sore throat episodes per year in children is modest. Due to the heterogeneity of data, no firm conclusions on the effectiveness of TE in adults can be drawn. There is still an urgent need for further research to reliably estimate the value of TE compared to non-surgical therapy of tonsillitis/tonsillo-pharyngitis. The impact of TE on quality of life is considered as being positive, but further research is mandatory to establish appropriate inventories and standardized evaluation procedures, especially in children. In contrast to TE, TT or comparable procedures are characterized by a substantially lower postoperative

  4. Literature and medicine: contributions to clinical practice.

    Charon, R; Banks, J T; Connelly, J E; Hawkins, A H; Hunter, K M; Jones, A H; Montello, M; Poirer, S

    1995-04-15

    Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine. PMID:7887555

  5. Asymptomatic Bacteriuria in Clinical Urological Practice

    Cai, Tommaso; Mazzoli, Sandra; Lanzafame, Paolo;

    2016-01-01

    Asymptomatic bacteriuria (ABU) is a common clinical condition that often leads to unnecessary antimicrobial use. The reduction of antibiotic overuse for ABU is consequently an important issue for antimicrobial stewardship and to reduce the emergence of multidrug resistant strains. There are two...... risk factor, and screening and treatment are not considered necessary. On the other hand, in the case of all procedures entering the urinary tract, ABU should be treated in line with the results of a urine culture obtained before the procedure. In patients affected by rUTIs, ABU can even have a...

  6. [Antibiotic-associated diarrhea in clinical practice].

    Luzina, E V; Lareva, N V

    2013-01-01

    Antibiotic-associated diarrhea (AAD) is considered to mean at least 3 shapeless stool episodes within 2 or more consecutive days when using antibacterial agents. Due to the fact that antibiotics are used most commonly to treat many diseases, AAD is one of the topical problems for different clinical specialists. There has recently been increased interest in this condition due to its higher morbidity and mortality rates and the emergence of novel treatment-resistant virulent strains of Clostridium difficile 027 and 078/126. The paper discusses the possible risk of developing AAD depending on the class of the antibiotic used, as well as the mechanisms of its development. Infectious diarrhea most frequently results from bacterial overgrowth due to that the obligate intestinal microflora is suppressed by antibacterial drugs. C. difficile, Clostridium perfringers, Staphylococcus aureus, Salmonella spp., Klebsiella oxytoca, and Candida spp. are etiological factors in the development of this diarrhea. The severest intestinal lesions include pseudomembranous colitis (PMC) caused by C. difficile. The clinical and endoscopic picture and methods for the diagnosis and treatment of PMC are described. Therapy for this menacing condition is traditionally based on the use of metronidazole and vancomycin. In 2011, the US Food and Drug Administration approved the new drug fidaxomycin whose superiority over vancomycin has been demonstrated by a recurrence criterion. The paper discusses in detail other treatment options, including the use of probiotics. PMID:23653946

  7. Clinical practice: Helicobacter pylori infection in childhood.

    Ertem, Deniz

    2013-11-01

    Helicobacter pylori infection is recognised as a cause of gastritis and peptic ulcer disease (PUD) and usually acquired during the first years of life. While there is a decline in the prevalence of H. pylori infection in northern and western European countries, the infection is still common in southern and eastern parts of Europe and Asia. Symptoms of H. pylori-related PUD are nonspecific in children and may include epigastric pain, nausea and/or vomiting, anorexia, iron deficiency anaemia and hematemesis. Besides, only a small proportion of children develop symptoms and clinically relevant gastrointestinal disease. H. pylori infection can be diagnosed either by invasive tests requiring endoscopy and biopsy or non-invasive tests including the (13)C-urea breath test, detection of H. pylori antigen in stool and detection of antibodies in serum, urine and saliva. The aim of treatment is at least 90 % eradication rate of the bacteria, and a combination of two antibiotics plus a proton pump inhibitor has been recommended as first-line treatment. However, frequent use of antibiotics during childhood is associated with a decline in eradication rates and the search for new treatment strategies as well. This is an overview of the latest knowledge and evidence-based guidelines regarding clinical presentation, diagnosis and treatment of H. pylori infection in childhood. PMID:23015042

  8. Potential uses of probiotics in clinical practice.

    Reid, Gregor; Jass, Jana; Sebulsky, M Tom; McCormick, John K

    2003-10-01

    Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. There is now mounting evidence that selected probiotic strains can provide health benefits to their human hosts. Numerous clinical trials show that certain strains can improve the outcome of intestinal infections by reducing the duration of diarrhea. Further investigations have shown benefits in reducing the recurrence of urogenital infections in women, while promising studies in cancer and allergies require research into the mechanisms of activity for particular strains and better-designed trials. At present, only a small percentage of physicians either know of probiotics or understand their potential applicability to patient care. Thus, probiotics are not yet part of the clinical arsenal for prevention and treatment of disease or maintenance of health. The establishment of accepted standards and guidelines, proposed by the Food and Agriculture Organization of the United Nations and the World Health Organization, represents a key step in ensuring that reliable products with suitable, informative health claims become available. Based upon the evidence to date, future advances with single- and multiple-strain therapies are on the horizon for the management of a number of debilitating and even fatal conditions. PMID:14557292

  9. Clinical Practice Guideline for Vitamin D

    Tarver, William J.

    2013-01-01

    Vitamin D and its metabolites have clinical significance because they play a critical function in calcium homeostasis and bone metabolism. Although not all of the pathologic mechanisms have been adequately described, vitamin D insufficiency and deficiency, as measured by low levels of 25-OH vitamin D, are associated with a variety of clinical conditions including osteoporosis, falls and fractures in the elderly, decreased immune function, bone pain, and possibly colon cancer and cardiovascular health.2 Apart from inadequate dietary intake, patients may present with low levels of vitamin D if they receive inadequate sunlight. The astronaut population is potentially vulnerable to low levels of vitamin D for several reasons. Firstly, they may train for long periods in Star City, Russia, which by virtue of its northern latitude receives less sunlight in winter months. Secondly, astronauts are deprived of sunlight while aboard the International Space Station (ISS). In addition, ISS crew members are exposed to microgravity for prolonged durations and are likely to develop low bone mineral density despite the use of countermeasures. Therefore, closely monitoring and maintaining adequate vitamin D levels is important for the astronaut corps.

  10. Clinical Activity in General Practice and Cancer

    Hjertholm, Peter

    2015-01-01

    BACKGROUND AND AIMS Cancer is a common, serious disease and early diagnosis is a cornerstone in the effort to improve the outcome from cancer disease. The general practitioner (GP) plays a crucial role in achieving this goal. Little is known about GPs’ suspicion of cancer and the activities the GPs...... institute in relation to such suspicion. Knowledge is also sparse on any effects of different diagnostic activities in general practice. The overall aims of this thesis were therefore: -to describe how often Danish GPs suspected cancer or other serious diseases and how they acted on the suspicion......, and to analyse how a suspicion influenced the demand for health care services and predicted a future diagnosis of serious disease - to investigate whether variation in GPs’ diagnostic activity influences cancer patients’ prognosis in relation to prostate-specific antigen (PSA) testing and prostate cancer...

  11. Machine learning on Parkinson's disease? Let's translate into clinical practice.

    Cerasa, Antonio

    2016-06-15

    Machine learning techniques represent the third-generation of clinical neuroimaging studies where the principal interest is not related to describe anatomical changes of a neurological disorder, but to evaluate if a multivariate approach may use these abnormalities to predict the correct classification of previously unseen clinical cohort. In the next few years, Machine learning will revolutionize clinical practice of Parkinson's disease, but enthusiasm should be turned down before removing some important barriers. PMID:26743974

  12. Fuzzy Logic in Clinical Practice Decision Support Systems

    Warren, Jim; Beliakov, Gleb; Zwaag, van der, B.J.

    2000-01-01

    Computerized clinical guidelines can provide significant benefits to health outcomes and costs, however, their effective implementation presents significant problems. Vagueness and ambiguity inherent in natural (textual) clinical guidelines is not readily amenable to formulating automated alerts or advice. Fuzzy logic allows us to formalize the treatment of vagueness in a decision support architecture. This paper discusses sources of fuzziness in clinical practice guidelines. We consider how ...

  13. Functional MRI in clinical practice: a pictorial essay

    In clinical practice, functional magnetic resonance imaging (fMRI) is a valuable non-invasive tool particularly during preoperative work-up of brain tumour and epilepsy patients. In this pictorial essay, we review expected areas of eloquent cortical activation during the four major clinical paradigms, discuss pitfalls related to fMRI and look at clinical examples where fMRI was particularly valuable in preoperative planning.

  14. Canadian Clinical Practice Guidelines for Rosacea.

    Asai, Yuka; Tan, Jerry; Baibergenova, Akerke; Barankin, Benjamin; Cochrane, Chris L; Humphrey, Shannon; Lynde, Charles W; Marcoux, Danielle; Poulin, Yves; Rivers, Jason K; Sapijaszko, Mariusz; Sibbald, R Gary; Toole, John; Ulmer, Marcie; Zip, Catherine

    2016-09-01

    Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review "Interventions in Rosacea" was used as a source of clinical trial evidence on which to base the recommendations. PMID:27207355

  15. Clinical practice in BNCT to the brain

    Our concept of Boron Neutron Capture Therapy (BNCT) is to selectively destroy tumour cells using the high LET particles yielded from the 10B(n,α)7Li reactions. The effort of clinical investigators has concentrated on how to escalate the radiation dose at the target point. BNCT in Japan combines thermal neutrons and BSH (Na2B12H11SH). The radiation dose is determined by the neutron fluence at the target point and the boron concentration in the tumour tissue. According to the recent analysis, the ratio of boron concentration (BSH) in tumour tissue and blood is nearly stable at around 1.2 to 1.69. Escalation of the radiation dose was carried out by means of improving the penetration of the thermal neutron beam. Since 1968, 175 patients with glioblastoma (n=83), anaplastic astrocytoma (n=44), low grade astrocytoma (n=16) or other types of tumour (n=32) were treated by BNCT at 5 reactors (HTR n=13, JRR-3 n=1, MulTR n=98, KUR n=30, JRR-2 n=33). The retrospective analysis revealed that the important factors related to the clinical results and QOL of the patients were minimum tumour volume radiation dose, more than 18Gy of physical dose and maximum vascular radiation dose (less than 15Gy) in the normal cortex. We have planned several trials to escalate the target radiation dose. One trial makes use of a cavity in the cortex following debulking surgery of the tumour tissue to improve neutron penetration. The other trial is introduction of epithermal neutron. KUR and JRR-4 were reconstructed and developed to be able to irradiate using epithermal neutrons. The new combination of surgical procedure and irradiation using epithermal neutrons should remarkably improve the target volume dose compared to the radiation dose treated by thermal neutrons. (author)

  16. A model for reflection for good clinical practice.

    Balla, John I; Heneghan, Carl; Glasziou, Paul; Thompson, Matthew; Balla, Margaret E

    2009-12-01

    Rationale and aim The rapidly changing knowledge base of clinical practice highlights the need to keep abreast of knowledge changes that are most relevant for the practitioner. We aimed to develop a model for reflection on clinical practice that identified the key elements of medical knowledge needed for good medical practice. Method The dual theory of cognition, an integration of intuitive and analytic processes, provided the framework for the study. The design looked at the congruence between the clinical thinking process and the dual theory. A one-year study was conducted in general practice clinics in Oxfordshire, UK. Thirty-five general practitioners participated in 20-minute interviews to discuss how they worked through recently seen clinical cases. Over a one-year period 72 cases were recorded from 35 interviews. These were categorized according to emerging themes, which were manually coded and substantiated with verbatim quotations. Results There was a close fit between the dual theory and participants' clinical thinking processes. This included instant problem framing, consistent with automatic intuitive thinking, focusing on the risk and urgency of the case. Salient features accounting for these choices were recognizable. There was a second reflective phase, leading to the review of initial judgements. Conclusions The proposed model highlights the critical steps in decision making. This allows regular recalibration of knowledge that is most critical at each of these steps. In line with good practice, the model also links the crucial knowledge used in decision making, to value judgments made in relation to the patient. PMID:20367693

  17. From evidence to clinical practice in blood and marrow transplantation.

    Khera, Nandita

    2015-11-01

    Clinical practice in the field of blood and marrow transplantation (BMT) has evolved over time, as a result of thousands of basic and clinical research studies. While it appears that scientific discovery and adaptive clinical research may be well integrated in case of BMT, there is lack of sufficient literature to definitively understand the process of translation of evidence to practice and if it may be selective . In this review, examples from BMT and other areas of medicine are used to highlight the state of and potential barriers to evidence uptake. Strategies to help improve knowledge transfer are discussed and the role of existing framework provided by the Center for International Blood and Marrow Transplant Registry (CIBMTR) to monitor uptake and BMT Clinical Trials Network (BMT CTN) to enhance translation of evidence into practice is highlighted. PMID:25934009

  18. Electrical stimulation: a reflection on current clinical practices.

    Bertoti, D B

    2000-01-01

    This paper briefly reviews the basic principles of several clinical applications of electrical stimulation for therapeutic purposes. It is intended to facilitate the integration of electrical stimulation into routine clinical practice by clarifying the terminology and standard conventions of the field, explaining the delivery capabilities of common electrical stimulators commercially available for clinical use, summarizing several examples of evidence-based therapeutic applications, and providing guidelines for selection of most commonly used treatment parameters. Rather than an exhaustive survey of the field, the presentation touches broadly on guidelines for use of transcutaneous electrical stimulation employing surface electrodes for the purposes of analgesia (TENS), drug delivery (iontophoresis), or neuromuscular rehabilitation (NMES), as well as other selected clinical applications. The paper is a general review of common clinical practices of electrotherapy and should serve as an introduction to the important factors for clinicians to consider when contemplating electrical stimulation as a treatment option. PMID:11067575

  19. Reexamination of the ethics of placebo use in clinical practice.

    Asai, Atsushi; Kadooka, Yasuhiro

    2013-05-01

    A placebo is a substance or intervention believed to be inactive, but is administered by the healthcare professional as if it was an active medication. Unlike standard treatments, clinical use of placebo usually involves deception and is therefore ethically problematic. Our attitudes toward the clinical use of placebo, which inevitably includes deception or withholding information, have a tremendous effect on our practice regarding truth-telling and informed consent. A casual attitude towards it weakens the current practice based on shared decision-making and mutual trust between patients and healthcare professionals. Issues concerning the clinical use of placebo are thus intimately related to patient-provider relationships, the public's trust in medicine, and medical education. A review of recent survey studies suggests that the clinical use of placebo appears to be fairly well accepted among healthcare professionals and is common in clinical settings in various countries. However, we think that an ethical discussion is urgently needed because of its controversial nature. If judged to be ethically wrong, the practice should end. In the present paper, we discuss the ethicality of the clinical use of placebo with deception and argue against it, concluding that it is unethical and should be banned. We will show that most arguments in favor of the clinical use of placebo can be refuted and are therefore incorrect or weak. These arguments will be presented and examined individually. Finally, we will briefly consider issues relevant to the clinical use of placebo without deception. PMID:22296589

  20. Innovation in clinical pharmacy practice and opportunities for academic--practice partnership.

    Gubbins, Paul O; Micek, Scott T; Badowski, Melissa; Cheng, Judy; Gallagher, Jason; Johnson, Samuel G; Karnes, Jason H; Lyons, Kayley; Moore, Katherine G; Strnad, Kyle

    2014-05-01

    Clinical pharmacy has a rich history of advancing practice through innovation. These innovations helped to mold clinical pharmacy into a patient-centered discipline recognized for its contributions to improving medication therapy outcomes. However, innovations in clinical pharmacy practice have now waned. In our view, the growth of academic–practice partnerships could reverse this trend and stimulate innovation among the next generation of pioneering clinical pharmacists. Although collaboration facilitates innovation,academic institutions and health care systems/organizations are not taking full advantage of this opportunity. The academic–practice partnership can be optimized by making both partners accountable for the desired outcomes of their collaboration, fostering symbiotic relationships that promote value-added clinical pharmacy services and emphasizing continuous quality improvement in the delivery of these services. Optimizing academic–practice collaboration on a broader scale requires both partners to adopt a culture that provides for dedicated time to pursue innovation, establishes mechanisms to incubate ideas, recognizes where motivation and vision align, and supports the purpose of the partnership. With appropriate leadership and support, a shift in current professional education and training practices, and a commitment to cultivate future innovators, the academic–practice partnership can develop new and innovative practice advancements that will improve patient outcomes. PMID:24877189

  1. Using clinical audit in practice: a pilot peer review project.

    Holt, V P; Earp, D P

    1996-09-01

    A well-established study group undertook a pilot peer review project testing the use of clinical audit in members' practices. Two peer review groups were formed involving a total of 16 practices. Practice visits were undertaken and a series of meetings were held to prepare and discuss the various projects. The progress of the groups was monitored by questionnaires. All practitioners reported benefits from the project (specifically, from the practice visits) and made changes in areas of their practice other than those specifically chosen for their project. The benefits of carrying out audit projects in a peer review setting are stressed as are the benefits of reciprocal practice visits. The importance of prior establishment of mutual trust and confidence in the peer review group is emphasised. PMID:10332335

  2. Good Clinical Practice Guidance and Pragmatic Clinical Trials: Balancing the Best of Both Worlds.

    Mentz, Robert J; Hernandez, Adrian F; Berdan, Lisa G; Rorick, Tyrus; O'Brien, Emily C; Ibarra, Jenny C; Curtis, Lesley H; Peterson, Eric D

    2016-03-01

    Randomized, clinical trials are commonly regarded as the highest level of evidence to support clinical decisions. Good Clinical Practice guidelines have been constructed to provide an ethical and scientific quality standard for trials that involve human subjects in a manner aligned with the Declaration of Helsinki. Originally designed to provide a unified standard of trial data to support submission to regulatory authorities, the principles may also be applied to other studies of human subjects. Although the application of Good Clinical Practice principles generally led to improvements in the quality and consistency of trial operations, these principles have also contributed to increasing trial complexity and costs. Alternatively, the growing availability of electronic health record data has facilitated the possibility for streamlined pragmatic clinical trials. The central tenets of Good Clinical Practice and pragmatic clinical trials represent potential tensions in trial design (stringent quality and highly efficient operations). In the present article, we highlight potential areas of discordance between Good Clinical Practice guidelines and the principles of pragmatic clinical trials and suggest strategies to streamline study conduct in an ethical manner to optimally perform clinical trials in the electronic age. PMID:26927005

  3. Exploring nursing students’ experience of peer learning in clinical practice

    Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

    2015-01-01

    Background: Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students’ experiences of peer learning in clinical practice. Materials and Methods: A qualitative content analysis was conducted. Focus groups were used to find the students’ experienc...

  4. Teaching Effectiveness: Preparing Occupational Therapy Students for Clinical Practice

    Jane C. OBrien PhD, MS.MEdL, OTR/L

    2013-06-01

    Full Text Available Medical educators must examine the ability of teaching methodologies to prepare students for clinical practice. Two types of assessment methods commonly used in medical education include the Short Objective Structured Clinical Examination (OSCE and the Integrated Performance Procedural Instrument (IPPI. The use of these methods in occupational therapy (OT education is less understood. With the increasing number of students enrolled in programs, faculty face challenges to examine how clinical competence is established using data to determine teaching effectiveness. This study examines two educational methodologies used in OT curriculum: the long written case study (IPPI and short performance-based OSCE. The authors describe the effectiveness of each examination as it relates to student performance in clinical practice (as measured by the Fieldwork Performance Evaluation [FWPE]. The findings obtained from separate focus group sessions with faculty and students further provide insight into the advantages and disadvantages of the educational methodologies.

  5. Clinical Psychologists’ Firearm Risk Management Perceptions and Practices

    Traylor, Andrea; Price, James H.; Telljohann, Susan K; King, Keith; Thompson, Amy

    2010-01-01

    The purpose of this study was to investigate the current perceptions and practices of discussing firearm risk management with patients diagnosed with selected mental health problems. A three-wave survey was mailed to a national random sample of clinical psychologists and 339 responded (62%). The majority (78.5%) believed firearm safety issues were greater among those with mental health problems. However, the majority of clinical psychologists did not have a routine system for identifying pati...

  6. Impact of an audiology clinic in one general practice.

    Khunti, K; Carr, M

    1997-01-01

    There is a large demand for the provision of hearing aids. However, there are lengthy delays involved between referral and fitment of National Health Service (NHS) hearing aids. This report shows that a general practice based audiology clinic can lead to an increase in the number of patients referred and fitted with a hearing aid. The introduction of the clinic also led to reduced waiting times for patients to be fitted with hearing aids.

  7. Clinical Practice Guidelines for Pre-eclampsia and Eclampsia Treatment.

    Frank Carlos Alvarez Li

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Pre-eclampsia and Eclampsia Treatment. This disease is part of a group of conditions known as hypertensive disease in pregnancy that have in common the existence of high blood pressure. This document includes a review and update of the main clinical aspects, concepts, classification and treatment stressing the use of drugs that cause hypotension and magnesium sulphate. It includes assessment guidelines focused on the most important aspects to be accomplished.

  8. Survey of clinical nutrition practices of Canadian gastroenterologists

    Singh, Harminder; Duerksen, Donald R

    2006-01-01

    OBJECTIVE: Nutrition education is a required part of gastrointestinal training programs. The involvement of gastroenterologists in clinical nutrition once their training has been completed is unknown. The aim of the present study was to determine the practice pattern of gastroenterologists in clinical nutrition and their perceived adequacy of nutrition training during their gastroenterology (GI) fellowship.METHODS: The Canadian Association of Gastroenterology mailed a survey to all of its 463...

  9. Clinical Practice Guidelines for Vascular Catheter Infections Treatment.

    Belkys Rodríguez Llerena

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Vascular Catheter Infections Treatment. It has been defined as the presence of local or systemic signs without other obvious infection site, plus the microbiologic evidence involving the catheter. This document includes a review and update of concepts, main clinical aspects, and treatment and stresses the importance of prophylactic treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  10. Clinical Practice Guidelines for Vascular Catheter Infections Treatment.

    Belkys Rodríguez Llerena.; Marcos Diosdado Iraola Ferrer

    2009-01-01

    Clinical Practice Guidelines for Vascular Catheter Infections Treatment. It has been defined as the presence of local or systemic signs without other obvious infection site, plus the microbiologic evidence involving the catheter. This document includes a review and update of concepts, main clinical aspects, and treatment and stresses the importance of prophylactic treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  11. Dual Perspectives on Theory in Clinical Practice: Practice Makes Perfect: The Incompatibility of Practicing Speech and Meaningful Communication.

    Kamhi, Alan G.

    2000-01-01

    This article uses a case study to suggest that some children view speech-language therapy as a separate situation for learning practicing new sounds and language forms whereas the purpose of talking outside of therapy is meaningful communication. Clinical implications of this potential incompatibility between practicing speech and communicating…

  12. Change in stated clinical practice associated with participation in the Dental Practice-Based Research Network

    Gilbert, Gregg H; Richman, Joshua S; Qvist, Vibeke;

    2010-01-01

    Clinical researchers have attempted many methods to translate scientific evidence into routine clinical practice, with varying success. Practice-based research networks (PBRNs) provide an important, practitioner-friendly venue to test these methods. Dentist practitioner-investigators from the...... Dental Practice-Based Research Network (DPBRN) completed a detailed questionnaire about how they diagnose and treat dental caries. Next, they received a customized report that compared their answers to those from all other practitioner-investigators. Then, 126 of them attended the DPBRN's first network...... with the idea that a highly interactive meeting with fellow practitioner-investigators may be an effective means to translate scientific findings into clinical practice. Practitioner-investigators are open to changing how they treat patients as a result of engaging fellow practitioner-investigators in...

  13. Communication course for midwives teaching students in clinical practice

    Nielsen, Annegrethe; Pedersen, Pernille Mølholt

    2016-01-01

    BACKGROUND The course was initiated by the midwifery department at University College North Denmark in cooperation with the leaders of the maternity units where the affiliated students have their clinical education. The purpose of the course was to enhance the quality of communication education......-clinically (Rosenbaum et al. 2013) and our own experience teaching Danish midwifery students indicates the same problem in our program. Providing an opportunity for the clinical teachers to learn, discuss and practice communication issues with each other and with theoretical teachers can represent an important...... educational quality development....

  14. The Clinical Practice of Interventional Radiology: A European Perspective

    The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management's refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently.

  15. The clinical practice of interventional radiology: a European perspective.

    Keeling, Aoife N

    2009-05-01

    The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management\\'s refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently.

  16. From Paper Based Clinical Practice Guidelines to Declarative Workflow Management

    Lyng, Karen Marie; Hildebrandt, Thomas; Mukkamala, Raghava Rao

    2009-01-01

    We present a field study of oncology workflow, involving doctors, nurses and pharmacists at Danish hospitals and discuss the obstacles, enablers and challenges for the use of computer based clinical practice guidelines. Related to the CIGDec approach of Pesic and van der Aalst we then describe how...

  17. Terminal sedation and euthanasia: A comparison of clinical practices

    J.A.C. Rietjens (Judith); J.J.M. van Delden (Johannes); A. van der Heide (Agnes); A.M. Vrakking (Astrid); B.D. Onwuteaka-Philipsen (Bregje); P.J. van der Maas (Paul); G. van der Wal (Gerrit)

    2006-01-01

    textabstractBackground: An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands. Methods: Personal interviews were held with a nationwide stratified sample o

  18. Supporting Clinical Practice Candidates in Learning Community Development

    DeJarnette, Nancy K.; Sudeck, Maria

    2015-01-01

    The purpose of this qualitative research study was to monitor pre-service teacher candidates' progression and implementation of the learning community philosophy along with classroom management strategies. The study took place during their final semester of clinical practice. Data were collected from self-reports, surveys, university supervisor…

  19. Clinical Practice Guidelines for Transfusion of Patients in Critical Condition.

    Rafael Alejandro Gómez Baute; Diosdania Alfonso Falcón; Liermis Dita Salabert; Luciano Núñez Almoguea.

    2009-01-01

    Clinical Practice Guidelines for Transfusion of Patients in Critical Condition. We stress transfusion criteria (blood cells, platelets, granulocyte concentrations, plasma and cryoprecipitate), doses, diagnosis and treatment of post-transfusion reactions. It includes assessment guidelines focused on the most important aspects to be accomplished.

  20. The use of bone age in clinical practice - Part 1

    Martin, D.D.; Caliebe, J.; Binder, Gitte Sommer;

    2011-01-01

    This review examines the role of skeletal maturity ('bone age', BA) assessment in clinical practice. BA is mainly used in children with the following conditions: short stature (addressed in part 1 of this review), tall stature, early or late puberty, and congenital adrenal hyperplasia (all...

  1. Clinical Practice Guidelines for Early Weaning from Mechanical Ventilation.

    Eddy Pereira Valdés

    2009-01-01

    Clinical Practice Guidelines for Early Weaning from Mechanical Ventilation. Weaning is the process, gradual or rapid, that leads to the turn off of mechanical ventilation and allows restoring spontaneous ventilation. The guidelines describe the procedure for rapid weaning from mechanical ventilation and emphasizes on spontaneous ventilation test. It includes assessment guidelines focused on the most important aspects to be accomplished.

  2. Clinical Practice Guidelines for Severe Chronic Obstructive Pulmonary Disease.

    Niurka Mercedes Galende Hernández; Diosdania Alfonso Falcón; Carlos Alberto Martell Alonso; Alexis Díaz Mesa; Inti Santana Carballosa

    2009-01-01

    Clinical Practice Guidelines for Severe Chronic Obstructive Pulmonary Disease. This concept includes simple chronic bronchitis, asthmatic bronchitis, chronic obstructive bronchitis, and pulmonary emphysema; although this two last are the most commonly included. Risk factors, classification and treatment are commented, stressing the strategy of mechanical ventilation and the indications for mechanical invasive and no invasive ventilation. It includes assessment guidelines focused on the most i...

  3. Normal Personality Assessment in Clinical Practice: The NEO Personality Inventory.

    Costa, Paul T.; McCrae, Robert R.

    1992-01-01

    The NEO Personality Inventory (NEO-PI) is described as a measure of five factors of personality and its use in clinical assessment and treatment practice is reviewed. Data from 17 adult men and women show links between NEO-PI scales and other measures of psychopathology. (SLD)

  4. Rules for the certification of good practices in clinical laboratories. No regulation. 3-2009. Good Laboratory Practice

    Regulation for Certification of Good Practices in clinical laboratories, hereinafter Regulation establishes the methodology and procedures for clinical laboratories to demonstrate their state of compliance with good practices, according to Regulation 3-2009, and that the CECMED can verify.

  5. 77 FR 49449 - Food and Drug Administration Clinical Trial Requirements, Compliance, and Good Clinical Practice...

    2012-08-16

    ... HUMAN SERVICES Food and Drug Administration Food and Drug Administration Clinical Trial Requirements, Compliance, and Good Clinical Practice; Public Workshop AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public workshop. The Food and Drug Administration (FDA), Office of Regulatory Affairs...

  6. Reflections on Speech-Language Therapists' Talk: Implications for Clinical Practice and Education. Clinical Forum

    Ferguson, Alison; Armstrong, Elizabeth

    2004-01-01

    Background: Research into the practices of speech-language therapists in clinical sessions is beginning to identify the way communication in clinical interactions both facilitates and potentially impedes the achievement of therapy goals. Aims: This target article aims to raise the issues that arise from critical reflections on the communication of…

  7. Clinical audit: Development of the criteria of good practices

    Clinical audit is a systematic review of the procedures in order to improve the quality and the outcome of patient care, whereby the procedures are examined against agreed standards for good medical Radiological procedures. The criteria of good procedures (i.e. the good practice) are thus the cornerstones for development of clinical audits: these should be the basis of assessments regardless of the type of the audit-external, internal, comprehensive or partial. A lot of criteria for good practices are available through the recommendations and publications by international and national professional societies and other relevant organisations. For practical use in clinical audits, the criteria need to be compiled, sorted out and agreed on for the particular aims of an audit (comprehensive or partial, external or internal). The national professional and scientific societies can provide valuable contribution to this development. For examination-or treatment-specific criteria- preliminary consensus needs to be obtained with the help of clinical experts, while clinical audits can be useful as a benchmarking tool to improve the criteria. (authors)

  8. Clinical audit: Development of the criteria of good practices.

    Soimakallio, S; Alanen, A; Järvinen, H; Ahonen, A; Ceder, K; Lyyra-Laitinen, T; Paunio, M; Sinervo, T; Wigren, T

    2011-09-01

    Clinical audit is a systematic review of the procedures in order to improve the quality and the outcome of patient care, whereby the procedures are examined against agreed standards for good medical RADIOLOGICAL procedures. The criteria of good procedures (i.e. the good practice) are thus the cornerstones for development of clinical audits: these should be the basis of assessments regardless of the type of the audit--external, internal, comprehensive or partial. A lot of criteria for good practices are available through the recommendations and publications by international and national professional societies and other relevant organisations. For practical use in clinical audits, the criteria need to be compiled, sorted out and agreed on for the particular aims of an audit (comprehensive or partial, external or internal). The national professional and scientific societies can provide valuable contribution to this development. For examination--or treatment-specific criteria--preliminary consensus needs to be obtained with the help of clinical experts, while clinical audits can be useful as a benchmarking tool to improve the criteria. PMID:21979432

  9. The frontline clinical manager identifying direct reports' level of practice.

    Longo, M Anne; Roussel, Linda; Pennington, Sandra L; Hoying, Cheryl

    2013-01-01

    Patricia Benner applied the Dreyfus Model of Skill Acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice. Operational definitions for the 5 levels of her original Novice to Expert Theory were used by the study participants in a large Midwestern pediatric hospital to self-identify their level of practice. The frontline clinical managers of these direct care registered nurses (RNs) used the same tool to rate their direct reports. The aim of this portion of a larger study was to determine if the clinical manager's perception of their direct reports was the same as that of the RNs. The results of this study are being used by one study unit's clinical managers as the basis for implementing the Hersey and Blanchard Situational Leadership Model. The clinical managers work with their direct reports depending on the level of practice and the details of the task to be performed. One example is creating therapeutic relationships with each other and with families to ensure a safe environment for all. PMID:23934257

  10. Queering know-how: clinical skill acquisition as ethical practice.

    Heyes, Cressida J; Thachuk, Angela

    2015-06-01

    Our study of queer women patients and their primary health care providers (HCPs) in Halifax, Nova Scotia, reveals a gap between providers' theoretical knowledge of "cultural competency" and patients' experience. Drawing on Patricia Benner's Dreyfusian model of skill acquisition in nursing, we suggest that the dissonance between the anti-heteronormative principles expressed in interviews and the relative absence of skilled anti-heteronormative clinical practice can be understood as a failure to grasp the field of practice as a whole. Moving from "knowing-that" to "knowing-how" in terms of anti-heteronormative clinical skills is not only a desirable epistemological trajectory, we argue, but also a way of understanding better and worse ethical practice. PMID:25037245

  11. Practical measuring system for the ambient equivalent dose rate by PSF driven by USB and its actual results

    This paper describes the detailed system in the title developed, and results obtained by its actual application to a contaminated region around Fukushima prefecture. The system is driven by USB, measures the linear distribution of the dose with plastic scintillation fiber (PSF), by parallel moving of which, the plane distribution of the dose can be measurable. The system is composed from 4 components of the radio-sensor PSF, photon detectors, pulse processor where the photon signal is converted to position information with time-of-flight principle, and display on PC. Three kinds of exchangeable PSF (length 20 m) with different bundle numbers (12, 7 and 1) are prepared to measure the low, middle and high dose levels of radiation, respectively, and each is rigidified by insertion in the individual metal flexible tube. The processor can convert the count rate to dose rate with linearity corrected by 137Cs gamma source; e.g., for the low dose rate, 0.1-10 mcSv, linearity is confirmed. The processor has 3 cables and 550 g weight in contrast to the ordinary machine's 12 cables and 20 kg. PSF and processor are waterproof for outdoor use. A software for mapping the measured results is also developed for color display. Mapping results of the application of the system to 80 m x 60 m site around a public hall and the swimming pool of a primary school are quite persuasive before and after de-contamination work like disappearance of hot spots after the work, and suggestive of its usefulness in dealing with the Fukushima contamination problems. (T.T.)

  12. Educational impact of in-training assessment (ITA) in postgraduate medical education. A qualitative study of an ITA programme in actual practice

    Skaarup, Anne Marie; Ringsted, Charlotte Vibeke; Henriksen, Ann-Helen;

    2004-01-01

    The aim of this study was to investigate the experiences and thoughts of the programme directors, the assessors, and the trainees about a recently introduced ITA programme. Firstly we wanted to explore how the programme works in actual practice: how the administration af the ITA programme was...... organised, how the individual assessments were administered, and what perceived benefits or barriers the users had experienced. Secondly, we wanted to explore what perceived impact the introduction af ITA had on the educational process: what was the effect on training, teaching and learning, and what...

  13. Hyperthermia - its actual role in radiation oncology. Pt. 3. Clinical rationale and results in deep seated tumors

    Combined hyperthermia and radiation therapy has been reported to yield higher complete and durable responses than radiotherapy alone in superficial tumors. In deep seated tumors the effect of the combined treatment is still under research. The literature and own clinical data are reviewed with regard to biological and physical fundamentals and clinical results. Clinical phase I to II studies have applied regional hyperthermia in the abdomen, the pelvic region and the extremities. Usually primary advanced, persistent or local recurrent and metastatic tumors were selected for treatment either due to poor response to conventional therapy or for effective palliation. The clinical data are presented concerning the following topics: Invasive thermometry, temperature parameter in tumor and normal tissue, toxicity, tumor response, treatment planning, clinical trials and prognostic factors. Clinical results of thermoradiotherapy for advanced or recurrent rectal cancer, cervical cancer and soft tissue sarcomas are reviewed in detail. In addition, the prognostic relevance of temperature parameters and physiological conditions such as global tumor perfusion are discussed. (orig.)

  14. A framework for effective management of change in clinical practice: dissemination and implementation of clinical practice guidelines

    Moulding, N. T.; Silagy, C. A.; Weller, D P

    1999-01-01

    Theories from social and behavioural science can make an important contribution to the process of developing a conceptual framework for improving use of clinical practice guidelines and clinician performance. A conceptual framework for guideline dissemination and implementation is presented which draws on relevant concepts from diffusion of innovation theory, the transtheoretical model of behaviour change, health education theory, social influence theory, and social ec...

  15. Continuing education program evaluation for course improvement, participant effect and utilization in clinical practice.

    Faulk, L G

    1984-04-01

    An evaluation of a single continuing education (CE) program was conducted by the presenter to assess impact of the offering and gather information for course improvement. The purpose of this evaluation was to document if and to what extent the learners attained the program's objectives and also to systematically examine the program to see how it might be improved. The third purpose was to document if participants' interest was stimulated by the program and if they actually used the information in clinical practice or at least found it helpful. Fifty-five nurses participated in completing a pretest and posttest, reactionnaire at the conclusion of the program and follow-up questionnaire. Participants made significantly (p less than .05) better scores on the posttests as compared to the pretest. On the evaluation form, 98% of the nurses responded that they had learned new facts, and 75% indicated that information was moderately new. In addition, a slight majority (58%) responded that they changed their beliefs about assertiveness. Of returned follow-up questionnaires, 95% told others about the program, and 59% read articles. All nurses indicated they had found the information useful, and 87% had actually used the information in clinical practice. This study documents a method for CE administrators and educators to evaluate the impact of CE and provide information for course improvement. The evaluation supports the program's worth. Participants benefited in terms of knowledge and interest. In addition, program strengths/weaknesses were identified. PMID:6325622

  16. Clinical Nurse Leader Integration Into Practice: Developing Theory To Guide Best Practice

    Bender, M.

    2016-01-01

    © 2015. Numerous policy bodies have identified the clinical nurse leader (CNL) as an innovative new role for meeting higher health care quality standards. Although there is growing evidence of improved care environment and patient safety and quality outcomes after redesigning care delivery microsystems to integrate CNL practice, significant variation in CNL implementation has been noted across reports, making it difficult to causally link CNL practice to reported outcomes. This variability re...

  17. Preparing Occupational Therapy Students for the Complexities of Clinical Practice

    Lisa J. Knecht-Sabres DHS, OTR/L

    2013-06-01

    Full Text Available This paper examined the effect of a unique amalgam of adult learning methodologies near the end of the occupational therapy (OT students’ didactic education as a means to enhance readiness for clinical practice. Results of quantitative and qualitative data analysis indicated that the use of standardized patients, in combination with a sequential, semistructured, and progressively challenging series of client cases, in an OT adult practice (intervention course, improved the students’ self-perception of their level of comfort and skill on various foundational, yet essential, OT-related competencies.

  18. Clinical audit and quality systems - practical implementation in Finland

    Clinical audit is a new concept of significant importance for the quality of radiological practices, introduced by the EC Medical Exposure Directive (MED, 97/43/EURATOM). By definition, clinical audit means 'a systematic examination or review of medical radiological procedures which seeks to improve the quality and the outcome of patient care, through structured review whereby radiological practices, procedures, and results are examined against agreed standards for good medical radiological procedures, with modifications of the practices where indicated and the application of new standards if necessary'. In its most profound meaning, being introduced in the medical exposure directive, clinical audit can be seen as a review of the success in implementing the justification and optimization principles, and therefore, it is to a large extent an issue of radiation safety for the patient. According to the directive, clinical audits shall be 'carried out in accordance with national procedures'. For the last few years, parallel to the development of the MED in Europe, there has been a worldwide tendency to implement appropriate quality systems (QS) in the health care organizations, in accordance with the international quality standards (ISO 9000 series etc). Such quality systems have been applied for a long time and very widely by the industry. It is a strong belief that the development of quality systems for health care would result in equal benefits as trusted in industry, in terms of efficiency and safety of health care services. For radiological practices, the quality systems are expected to become a framework for improving the optimization of practices and for maintaining good radiation safety, as well as providing a mechanism to prevent mistakes and accidents. In some countries, like the UK and The Netherlands, there are legal requirements to establish and maintain quality systems at certain type of radiological units. In some countries and some radiological units

  19. Ten tips for receiving feedback effectively in clinical practice

    Ali H. Algiraigri

    2014-07-01

    Full Text Available Background: Despite being recognized as a fundamental part of the educational process and emphasized for several decades in medical education, the influence of the feedback process is still suboptimal. This may not be surprising, because the focus is primarily centered on only one half of the process – the teachers. The learners are the targets of the feedback process and improvement needs to be shifted. Learners need to be empowered with the skills needed to receive and utilize feedback and compensate for less than ideal feedback delivery due to the busy clinical environment. Methods: Based on the available feedback literature and clinical experience regarding feedback, the author developed 10 tips to empower learners with the necessary skills to seek, receive, and handle feedback effectively, regardless of how it is delivered. Although, most of the tips are directed at the individual clinical trainee, this model can be utilized by clinical educators involved in learner development and serve as a framework for educational workshops or curriculum. Results: Ten practical tips are identified that specifically address the learner's role in the feedback process. These tips not only help the learner to ask, receive, and handle the feedback, but will also ease the process for the teachers. Collectively, these tips help to overcome most, if not all, of the barriers to feedback and bridge the gaps in busy clinical practices. Conclusions: Feedback is a crucial element in the educational process and it is shown that we are still behind in the optimal use of it; thus, learners need to be taught how to better receive and utilize feedback. The focus in medical education needs to balance the two sides of the feedback process. It is time now to invest on the learner's development of skills that can be utilized in a busy day-to-day clinical practice.

  20. Good Practice for Introducing Radiopharmaceuticals for Clinical Use

    The use of new radiopharmaceuticals can provide extremely valuable information in the evaluation of cancer, as well as heart and brain diseases. Information that often times cannot be obtained by other means. However, there is a perceived need in many Member States for a useful reference to facilitate and expedite the introduction of radiopharmaceuticals already in clinical use in other countries. This publication intends to provide practical support for the introduction of new radiotracers, including recommendations on the necessary steps needed to facilitate and expedite the introduction of radiopharmaceuticals in clinical use, while ensuring that a safe and high quality product is administered to the patient at all times

  1. [Definition of sarcopenia and diagnostic evaluation in clinical practice].

    Trombetti, A

    2015-03-18

    Aging is associated with progressive increase in body fat and a corresponding decline in lean muscle mass. When the decrease in muscle mass reaches a critical threshold, this may affect muscle strength and consequently limit the ability to cope with the activities of daily living, reducing the independence of elders. It is widely accepted to define sarcopenia as the loss of skeletal muscle mass and strength that occurs with advancing age. It is more difficult to establish cut-off points which are clinically relevant. The purpose of this paper is to summarize the definitions of sarcopenia and the assessment tools that can be used in clinical practice. PMID:25962226

  2. Neurological complications in dengue infection: a review for clinical practice

    Marzia Puccioni-Sohler

    2013-09-01

    Full Text Available Dengue is an important global public health problem. The World Health Organization estimates that 2/5 of entire world population are in risk of dengue infection. Almost 50 millions cases occur annually, with at least 20 thousand deaths. The etiological agent of this acute febrile disease is a single-strand positive-sense RNA virus of Flavivirus genus. It is an arboviral disease transmitted by Aedes sp. mosquitoes (Aedes aegypti and A. albopictus. Most infected individuals present asymptomatic infection, but some may develop clinical signs. Therefore, a wide spectrum of illness can be observed, ranging from unapparent, mild disease, called dengue fever, to a severe and occasionally fatal dengue hemorrhagic fever/dengue shock syndrome. Currently, neurological manifestations related to dengue infections are increasingly been observed and appears as a challenge for medical practice. In this study the neurological complications of dengue infection will be reviewed, focusing a better understanding of the disease for the clinical practice.

  3. Experimental Psychopathology: From laboratory studies to clinical practice

    Pierre Philippot

    2006-03-01

    Full Text Available Recently, David Barlow (2004, a pioneer in the field of anxiety disorders, has proposed that psychologists should abandon the concept of psychotherapy and rather use the one of “psychological treatment”. The provoking idea behind this proposal is that the concept of psychotherapy, relying on the notion of “therapeutic school” should be discarded by professional psychologists because it relies too much on conceptions based on pre-scientific models. Barlow (2004 insists that, today, psychology as an empirical science has gathered sufficient knowledge and know-how to found clinical practice. It is no longer necessary to rely on pre-scientific theories. Further, Barlow’s perspective opens clinical practice to the entire field of psychology, i.e. to the advances accomplished by research on emotion, cognition, learning, development, etc.

  4. Ministry of Health Clinical Practice Guidelines: Diabetes Mellitus

    Goh, Su Yen; Ang, Seng Bin; Bee, Yong Mong; Chen, Richard YT; Gardner, Daphne; Ho, Emily; Adaikan, Kala; Lee, Alvin; Lee, Chung Horn; Lim, Fong Seng; Lim, Hwee Boon; Lim, Su Chi; Seow, Julie; Soh, Abel Wah Ek; Sum, Chee Fang; Tai, E Shyong; Thai, Ah Chuan; Wong, Tien Yin; Yap, Fabian

    2014-01-01

    The Ministry of Health (MOH) have updated the clinical practice guidelines on Diabetes Mellitus to provide doctors and patients in Singapore with evidence-based treatment for diabetes mellitus. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Diabetes Mellitus, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:25017409

  5. Formulation in action: applying psychological theory to clinical practice

    Dawson, Dave; Moghaddam, Nima

    2016-01-01

    When people seek psychological support, formulation is the theory-driven methodology used by many practitioners to guide identification of the processes, mechanisms, and patterns of behaviour that appear to be contributing to the presenting difficulties. However, the process of formulating – or applying psychological theory to practice – can often seem unclear. In this volume, we present multiple demonstrations of formulation in action – written by applied psychologists embedded in clinic...

  6. Acute Myocardial Infarction. An Update of the Clinical Practice Guideline

    Yanier Coll Muñoz; Francisco de Jesús Valladares Carvajal; Claudio González Rodríguez

    2016-01-01

    Clinical practice guidelines present all relevant evidence on a particular issue in order to help physicians select the best treatment strategies. This guideline aims to optimize the diagnostic process and treatment of acute myocardial infarction, to assess adherence to issued guidelines and to propose changes based on the results obtained. It refers to patients with ischemic symptoms or their equivalents, persistent ST-segment elevation or ST-segment and T-wave changes consistent with the di...

  7. Clinical Practice Guidelines for postoperative period of thoracic surgery.

    Frank Carlos Alvarez Li; Daniel Olivera Fajardo; Félix Molina Díaz

    2009-01-01

    Clinical Practice Guidelines for postoperative period of thoracic surgery. It is the period between the suture of the surgical wound and the total rehabilitation of the patient, which usually occurs in the Intensive Care Unit. This document includes a review and update of the main aspects such as classification, postoperative treatment, stressing the actions to face any complication. It includes assessment guidelines focused on the most important aspects to be accomplished.

  8. Clinical Practice Guidelines for Valvular Prostheses Dysfunction Treatment

    Lázaro De la Cruz Avilés; Félix Rene Jorrín Román; Ernesto Falcón Pérez

    2009-01-01

    Clinical Practice Guidelines for Valve Prostheses Dysfunction Treatment. The introduction of an artificial valve allows improving life quality and expectancy of an important number of patients and can be considered a common treatment within advanced heart valve disease. However, persons with this kind of prosthesis usually present another disease caused by the potential complications associated with the uses of anti-clotting medications. This document includes the different classifications of...

  9. Clinical Practice Guidelines for Rehabilitation of Patients in critical Condition.

    José Gómez Cruz; Liliana Teresa Caneiro González; Roberto Polo Amarante; Yacqueline Madrigal Torres

    2009-01-01

    Clinical Practice Guidelines for Rehabilitation of Patients in critical Condition. It is the integral, multidisciplinary rehabilitation, including the prevention in advance of all possible sequels caused by the disease or lesion. Understood as a group of non invasive, appropriate and tolerable procedures meeting the individual needs and aimed at preserving the indemnity of structures and functions that have not been involved in the disease. We list its principles and intervention stages, inst...

  10. Clinical audit to improve obstetric practice: What is the evidence?

    Kongnyuy, Eugene

    2009-01-01

    Eugene Justine Kongnyuy1, Achille Kabore2, Pierre-Marie Tebeu31Liverpool School of Tropical Medicine, Liverpool, UK; 2Liverpool Associates in Tropical Health, Liverpool, UK; 3University of Yaoundé, Yaoundé, CameroonBackground: Clinical audit has been showed to improve professional practice from the providers’ perspective. However, little is known about the effect of audit on the quality of care from clients’ perspective.Objective: To assess the effect...

  11. Figures in clinical trial reports: current practice & scope for improvement

    Travison Thomas G; Pocock Stuart J; Wruck Lisa M

    2007-01-01

    Abstract Background Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. Purpose To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. Methods We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assess...

  12. Promoting a Strategic Approach to Clinical Nurse Leader Practice Integration.

    Williams, Marjory; Avolio, Alice E; Ott, Karen M; Miltner, Rebecca S

    2016-01-01

    The Office of Nursing Services of the Department of Veterans Affairs (VA) piloted implementation of the clinical nurse leader (CNL) into the care delivery model and established a strategic goal in 2011 to implement the CNL role across the VA health care system. The VA Office of Nursing Services CNL Implementation and Evaluation (CNL I&E) Service was created as one mechanism to facilitate that goal in response to a need identified by facility nurse executives for consultative support for CNL practice integration. This article discusses strategies employed by the CNL I&E consultative team to help facility-level nursing leadership integrate CNLs into practice. Measures of success include steady growth in CNL practice capacity as well as positive feedback from nurse executives about the value of consultative engagement. Future steps to better integrate CNL practice into the VA include consolidation of lessons learned, collaboration to strengthen the evidence base for CNL practice, and further exploration of the transformational potential of CNL practice across the care continuum. PMID:26636231

  13. General practitioners and clinical practice guidelines: a reexamination.

    Clerc, Isabelle; Ventelou, Bruno; Guerville, Marc-André; Paraponaris, Alain; Verger, Pierre

    2011-08-01

    General practitioners' (GPs') use of clinical practice guidelines (CPGs) may be influenced by various contextual and attitudinal factors. This study examines general attitudes toward CPGs to establish profiles according to these attitudes and to determine if these profiles are associated with awareness and with use of CPGs in daily practice. The authors conducted a cross-sectional telephone survey of 1,759 French GPs and measured (a) their general attitudes toward CPGs and (b) their awareness and use in daily practice of CPGs for six specific health problems. A bivariate probit model was used with sample selection to analyze the links between GPs' general attitudes and CPG awareness/use. The authors found three GP profiles according to their opinions toward CPGs and a positive association between these profiles and CPG awareness but not use. It is important to build awareness of CPGs before GPs develop negative attitudes toward them. PMID:21536601

  14. ORIGINAL ARTICLE: Identification of Practical Pharmacology Skills Useful for Good Clinical Practice

    V. Shilpa, R. Divya

    2012-07-01

    Full Text Available Background: Awareness about animal ethics is increasing everywhere. This increased awareness coupled with strict regulations discouraging the use of animals for routine experiments have tied the hands of many pharmacologists. They are now forced to develop alternative experiments without using animals. At present, there is acute need to come out with more innovative and useful practical exercises for pharmacology practical sessions. In this background, the present study was undertaken to develop the much-needed alternative experiments. Aims and Objective: To identify new pharmacological practical skills useful for good clinical practice. Material and Methods: A pre-tested questionnaire was administered to 110 doctors of different categories like house surgeons, postgraduate students, assistant professors and professors who are working in a tertiary care hospital. They were asked to give their suggestions regarding new pharmacology practical skills useful for good clinical practice. Statistical analysis: Responses of the participants to the questions asked were tabulated and analyzed. Suggestions given by them were listed out and studied. Results: Use of emergency drugs, dosage calculation, drugs used in pregnancy, case discussions and prescription writing exercises received a lot of support from the participants. Research methodology, cost calculation, animal experiments and interpretation of data of animal experiments did not receive support from the participants. Suggestions given by the participants regarding useful pharmacological skills belonged to the areas like therapeutics, safe use of drugs, recent advances, analysis of information given by the medical representatives and analyzing articles in journals for knowing the efficacy of drugs. Conclusion: Exercises relevant to the clinical practice, as identified in this study, can be introduced as practical pharmacology exercises. Steps are to be taken to highlight the importance of research

  15. Evidence-Based Practice for Children with Speech Sound Disorders: Part 2 Application to Clinical Practice

    Baker, Elise; McLeod, Sharynne

    2011-01-01

    Purpose: This article provides both a tutorial and a clinical example of how speech-language pathologists (SLPs) can conduct evidence-based practice (EBP) when working with children with speech sound disorders (SSDs). It is a companion paper to the narrative review of 134 intervention studies for children who have an SSD (Baker & McLeod, 2011).…

  16. Autonomy and Privacy in Clinical Laboratory Science Policy and Practice.

    Leibach, Elizabeth Kenimer

    2014-01-01

    Rapid advancements in diagnostic technologies coupled with growth in testing options and choices mandate the development of evidence-based testing algorithms linked to the care paths of the major chronic diseases and health challenges encountered most frequently. As care paths are evaluated, patient/consumers become partners in healthcare delivery. Clinical laboratory scientists find themselves firmly embedded in both quality improvement and clinical research with an urgent need to translate clinical laboratory information into knowledge required by practitioners and patient/consumers alike. To implement this patient-centered care approach in clinical laboratory science, practitioners must understand their roles in (1) protecting patient/consumer autonomy in the healthcare informed consent process and (2) assuring patient/consumer privacy and confidentiality while blending quality improvement study findings with protected health information. A literature review, describing the current ethical environment, supports a consultative role for clinical laboratory scientists in the clinical decision-making process and suggests guidance for policy and practice regarding the principle of autonomy and its associated operational characteristics: informed consent and privacy. PMID:26084151

  17. Examining an ethical dilemma: a case study in clinical practice.

    Narrigan, Deborah

    2004-01-01

    When clients and health care providers differ in their understanding of what is right or wrong, an ethical dilemma may arise. Such dilemmas occur in everyday clinical practice. Health care providers have the professional responsibility to analyze these dilemmas. A clinical case study of an ethical dilemma that occurred in a cross-cultural context is examined. The language of the client and provider differed, and no interpreter service was available. Given these conditions, the provider's ethical dilemma was whether, and if so how, to give safe, satisfying care that respected the needs of a client with limited English proficiency. Measuring the morality of the provider's decisions and actions using Rawls' ethical theory of social justice finds deficits. A 10-step Bioethical Decision-Making Model by Thompson is used to demonstrate one method for analyzing the moral dimension of a clinical scenario focusing on the decisions and actions taken by a midwife. Scrutinizing ethically challenging clinical encounters will result in better understanding of the moral dimensions of practice. PMID:15134678

  18. SELF WOUND MANAGEMENT PRACTICES BEFORE ATTENDING ANTIRABIES VACCINE CLINIC

    Amit Kumar Mishra, Smita Panda, Prakash Chandra Panda

    2015-07-01

    Full Text Available Introduction: In INDIA almost 20000 people die (40% of world death each year from rabies. Most of these deaths could be prevented by post exposure prophylaxis with wound washing, rabies immunoglobulin & vaccination. Local wound management alone can reduce viral load by up to 80%. Objective: To study self-wound management practices in animal exposure patients before attending a tertiary level ARV clinic. Methodology: Data regarding wound management was collected by individual interview of patients attending the ARV clinic during OCT 2011 to MAR 2012. The data collected in the form of a questionnaire. Analysis of data was done in the Department Of Community Medicine, V.S.S. Medical College, Burla. Results: Total 493 cases of animal exposure were attended during the study period. Most common biting animal was dog (94.5%. 31% of cases were under the age of 10 years & 23% belongs to the age of 10-19 years. Male to female ratio was 3:1. Most of the cases (91% were of category III exposure. Immediate management of wound was practiced by 63-77% of cases before visiting ARV clinic; only 2% wash the wound with running water & soap for 15 minutes. 39% of cases applied Dettol/savlon at the wound side & other 38% applied turmeric, red chilli, kerosene, Band-Aid & ghee locally. Most cases (61% reported to ARV clinic within 24hours.

  19. Practical clinical considerations of luting cements: A review.

    Lad, Pritam P; Kamath, Maya; Tarale, Kavita; Kusugal, Preethi B

    2014-02-01

    The longevity of fixed partial denture depends on the type of luting cement used with tooth preparation. The clinician's understating of various cements, their advantages and disadvantages is of utmost importance. In recent years, many luting agents cements have been introduced claiming clinically better performance than existing materials due to improved characteristics. Both conventional and contemporary dental luting cements are discussed here. The various agents discussed are: Zinc phosphate, Zinc polycarboxylate, Zinc oxide-eugenol, Glass-ionomer, Resin modified GIC, Compomers and Resin cement. The purpose of this article is to provide a discussion that provides a clinical perspective of luting cements currently available to help the general practitioner make smarter and appropriate choices. How to cite the article: Lad PP, Kamath M, Tarale K, Kusugal PB. Practical clinical considerations of luting cements: A review. J Int Oral Health 2014;6(1):116-20. PMID:24653615

  20. Clinical Nurse Leader Integration Into Practice: Developing Theory To Guide Best Practice.

    Bender, Miriam

    2016-01-01

    Numerous policy bodies have identified the clinical nurse leader (CNL) as an innovative new role for meeting higher health care quality standards. Although there is growing evidence of improved care environment and patient safety and quality outcomes after redesigning care delivery microsystems to integrate CNL practice, significant variation in CNL implementation has been noted across reports, making it difficult to causally link CNL practice to reported outcomes. This variability reflects the overall absence in the literature of a well-defined CNL theoretical framework to help guide standardized application in practice. To address this knowledge gap, an interpretive synthesis with a grounded theory analysis of CNL narratives was conducted to develop a theoretical model for CNL practice. The model clarifies CNL practice domains and proposes mechanisms by which CNL-integrated care delivery microsystems improve health care quality. The model highlights the need for a systematic approach to CNL implementation including a well-thought out strategy for care delivery redesign; a consistent, competency-based CNL workflow; and sustained macro-to-micro system leadership support. CNL practice can be considered an effective approach to organizing nursing care that maximizes the scope of nursing to influence the ways care is delivered by all professions within a clinical microsystem. PMID:26802589

  1. Effects of clinical practice environments on clinical teacher and nursing student outcomes.

    Babenko-Mould, Yolanda; Iwasiw, Carroll L; Andrusyszyn, Mary-Anne; Laschinger, Heather K S; Weston, Wayne

    2012-04-01

    The purpose of this study was to use a cross-sectional survey design, with an integrated theoretical perspective, to examine clinical teachers' (n = 64) and nursing students' (n = 352) empowerment, teachers' and students' perceptions of teachers' use of empowering teaching behaviors, students' perceptions of nurses' practice behaviors, and students' confidence for practice in acute care settings. In this study, teachers and students were moderately empowered. Teachers reported using a high level of empowering teaching behaviors, which corresponded with students' perceptions of teachers' use of such behaviors. Teachers' empowerment predicted 21% of their use of empowering teaching behaviors. Students reported nurses as using a high level of professional practice behaviors. Students felt confident for professional nursing practice. The findings have implications for practice contexts related to empowering teaching-learning environments and self-efficacy. PMID:22432538

  2. [Eslicarbazepine acetate in clinical practice. Efficacy and safety results].

    Serrano-Castro, Pedro J; Payán-Ortiz, Manuel; Cimadevilla, José M; Quiroga-Subirana, Pablo; Fernández-Pérez, Javier

    2013-03-16

    INTRODUCTION. Eslicarbazepine acetate (ESL) is a new antiepileptic drug (AED) licensed in Spain in February 2011 as an adjunctive therapy in adults with partial seizures with or without secondary generalization. Clinical trials with ESL have demonstrated acceptable efficacy and safety. AIM. To evaluate the results of ESL in our epilepsy unit during its first year of clinical experience with this AED. PATIENTS AND METHODS. We included all patients who started treatment with ESL at our epilepsy unit from March 2011 to May 2012. We collected the following variables: gender, aetiology of epilepsy, epileptogenic area, reason for switch to ESL, clinical response after initiation of ESL, adverse effects of ESL, refractoriness criteria and treatment discontinuation. A bivariate factor-to-factor correlation study was carried out to establish associations between the independent variables and the clinical response. RESULTS. We recruited 105 patients (51.4% male). 20,7% of patients remained seizure-free and 58.4% showed > 50% improvement after introduction of ESL. At 6 months, 18.1% had experienced some type of side effect, with cognitive disorders being the most common, and 11.5% had discontinued treatment. Combination with lacosamide proved to be significantly less effective in the control of seizures. Combination of ESL with the rest of sodium channel inhibitors was similar in efficacy to others combinations. CONCLUSIONS. ESL is a well-tolerated and effective AED when is used as adjunctive treatment with most of other AED in clinical practice. PMID:23483464

  3. Figures in clinical trial reports: current practice & scope for improvement

    Travison Thomas G

    2007-11-01

    Full Text Available Abstract Background Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. Purpose To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. Methods We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Results Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. Conclusion There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

  4. 2011 Clinical Practice Guidelines for Type 2 Diabetes in Korea

    Seung-Hyun Ko

    2011-10-01

    Full Text Available As in other countries, type 2 diabetes is major health concern in Korea. A dramatic increase in the prevalence of type 2 diabetes and its chronic complications has led to an increase in health costs and economic burdens. Early detection of high risk individuals, hidden diabetic patients, and improvement in the quality of care for the disease are the first steps to mitigate the increase in prevalence. The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the '3rd Clinical Practice Guidelines' at the end of 2010. In the guidelines, the committee recommended active screening of high risk individuals for early detection and added the hemoglobin A1c level to the diagnostic criteria for type 2 diabetes based on clinical studies performed in Korea. Furthermore, the committee members emphasized that integrating patient education and self-management is an essential part of care. The drug treatment algorithm based on the degree of hyperglycemia and patient characteristics were also updated.

  5. Treating sarcopenia in clinical practice: where are we now?

    De Spiegeleer, Anton; Petrovic, Mirko; Boeckxstaens, Pauline; Van Den Noortgate, Nele

    2016-08-01

    Sarcopenia - or the loss of muscle mass, strength and function with ageing - represents an important health issue of the twenty-first century because of its devastating effects in addition to an increased prevalence of aged people. The devastating health effects of sarcopenia are multiple: an increased falls risk, a decreased physical ability and quality of life and an independent increase of all-cause mortality. Although the ultimate remedy for sarcopenia yet has to be found, some interventions have proven their merit and might be of practical use in clinical practice, especially for geriatricians, who deal most with sarcopenia. This review intends to summarize the current therapeutic interventions, their proposed mechanism of action as well as their clinical value. The results of our review highlight the importance of exercise (50% resistance training, 50% endurance training), nutrition (25-30 g proteins with essential amino acids every meal and long-chain ω-3 fatty acids) and limitation of alcohol and smoking. In addition, studies also suggest a place for vitamin D (aim serum levels >30 ng/L), testosterone (aim serum levels >300 ng/dL) and creatine (15-20 g/d for five days, thereafter 3-5 g/d). In conclusion, although more studies are needed to elucidate the exact effectiveness and safety of many sarcopenia interventions, the current evidence already provides clinically useful information, which might benefit the patient with (pre-)sarcopenia. PMID:27112427

  6. Effects of healing touch in clinical practice: a systematic review of randomized clinical trials.

    Anderson, Joel G; Taylor, Ann Gill

    2011-09-01

    Hands-on healing and energy-based interventions have been found in cultures throughout history around the world. These complementary therapies, rooted in ancient Eastern healing practices, are becoming mainstream. Healing Touch, a biofield therapy that arose in the nursing field in the late 1980s, is used in a variety of settings (i.e., pain centers, surgical settings, and private practices) with reported benefits (i.e., decreased anxiety, pain, and depressive behaviors; increased relaxation and a sense of well-being). However, clinical trial data concerning the effectiveness of Healing Touch have not been evaluated using a systematic, evidence-based approach. Thus, this systematic review is aimed at critically evaluating the data from randomized clinical trials examining the clinical efficacy of Healing Touch as a supportive care modality for any medical condition. PMID:21228402

  7. An Appraisal of Clinical Practice Guidelines for Diabetic Retinopathy.

    Wu, Connie M; Wu, Annie M; Young, Benjamin K; Wu, Dominic J; Margo, Curtis E; Greenberg, Paul B

    2016-07-01

    The objective is to evaluate the methodological quality of clinical practice guidelines (CPGs) published by the American Academy of Ophthalmology (AAO), Canadian Ophthalmological Society (COS), and Royal College of Ophthalmologists (RCO) for diabetic retinopathy. Four evaluators independently appraised the CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which covers 6 domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence). Scores ranged from 35% to 78% (AAO), 60% to 92% (COS), and 35% to 82% (RCO). Intraclass correlation coefficients for the reliability of mean scores were 0.78, 0.78, and 0.79, respectively. The strongest domains were Scope and Purpose, and Clarity of Presentation (COS). The weakest were Stakeholder Involvement (AAO), Rigor of Development (AAO, RCO), Applicability, and Editorial Independence (RCO). Diabetic retinopathy practice guidelines can be improved by targeting Stakeholder Involvement, Rigor of Development, Applicability, and Editorial Independence. PMID:25742906

  8. Current clinical practices in stroke rehabilitation: regional pilot survey.

    Natarajan, Pradeep; Oelschlager, Ashley; Agah, Arvin; Pohl, Patricia S; Ahmad, S Omar; Liu, Wen

    2008-01-01

    This study was aimed at understanding the current physical and occupational therapy practices in stroke rehabilitation in the Midwest. The insights gained from this pilot study will be used in a future study aimed at understanding stroke rehabilitation practices across the nation. Researchers and clinicians in the field of stroke rehabilitation were interviewed, and past studies in the literature were analyzed. Through these activities, we developed a 37-item questionnaire that was sent to occupational and physical therapists practicing in Kansas and Missouri who focus on the care of people who have had a stroke (n = 320). A total of 107 respondents returned a com pleted questionnaire, which gives a response rate of about 36%. The majority of respondents had more than 12 years of experience treating patients with stroke. Consensus of 70% or more was found for 80% of the items. The preferred approaches for the rehabilitation of people who have had a stroke are the Bobath and Brunnstrom methods, which are being used by 93% and 85% of the physical and occupational therapists, respectively. Even though some variability existed in certain parts of the survey, in general clinicians agreed on different treatment approaches in issues dealing with muscle tone, weakness, and limited range of motion in stroke rehabilitation. Some newer treatment approaches that have been proven to be effective are practiced only by a minority of clinicians. The uncertainty among clinicians in some sections of the survey reveals that more evidence on clinical approaches is needed to ensure efficacious treatments. PMID:19009470

  9. The Lack Of Effective Hand Washing Practice Despite High Level Of Knowledge And Awareness In Medical Students Of Clinical Years

    S Sulaiha S A

    2010-12-01

    Full Text Available Background: Nosocomial infection is among the leading problem in many major hospitals resulting in soaring cost expenditure in managing its affect.Hand washing practice is a crucial preventive way to contain such mischief but many ignored its importance. This is perhaps due to lack of appropriate role modeling from senior practitioners.Subjects and methods: Our study examined the prevalence of hand washing practice among medical students from year 3 to 5 and compared it to their knowledge and level of awareness on its importance in clinical practice. 142 students were randomly observed during their clinical work in the wards on this practice and questionnaires were later distributed to 268 students from all semesters on their knowledge on the technique and awareness on its importance.Results: Out of 142, almost 80% washed their hands but only 41.6% performed effective hand washing. In contrary, 80 to 90% showed good level of knowledge and awareness as well as perception about its importance in clinical practice.Conclusions: The contradictory findings between the actual practice of hand washing and knowledge as well as awareness suggest that enforcement on the practice is necessary. This requires motivation and cooperation from all health alliances and higher authority in the health system. Remedial measures are much needed in order to contain high.

  10. Clinical practice recommendations for positioning of the burn patient.

    Serghiou, M A; Niszczak, J; Parry, I; Richard, R

    2016-03-01

    The objective of this review was to systematically examine whether there is clinical evidence to support recommendations for positioning patients with acute burn. Review of the literature revealed minimal evidence-based practice regarding the positioning of burn patients in the acute and intermediate phases of recovery. This manuscript describes recommendations based on the limited evidence found in the literature as well as the expert opinion of burn rehabilitation specialists. These positioning recommendations are designed to guide those rehabilitation professionals who treat burn survivors during their acute hospitalization and are intended to assist in the understanding and development of effective positioning regimens. PMID:26787131

  11. Application of Clinical Practice Guidelines for Pain, Agitation, and Delirium.

    Krupp, Anna; Balas, Michele C

    2016-06-01

    Critically ill patients experience several severe, distressing, and often life-altering symptoms during their intensive care unit stay. A clinical practice guideline released by the American College of Critical Care Medicine provides a template for improving the care and outcomes of the critically ill through evidence-based pain, agitation, and delirium assessment, prevention, and management. Key strategies include the use of valid and reliable assessment tools, setting a desired sedation level target, a focus on light sedation, choosing appropriate sedative medications, the use of nonpharmacologic symptom management strategies, and engaging and empowering patients and their family to play an active role in their intensive care unit care. PMID:27215361

  12. Pros and cons of using apps in clinical practice.

    Moore, Sally; Anderson, John; Cox, Susanne

    2012-10-01

    There is a lack of research on the use of smartphone apps among nurses in the UK, but the number of healthcare-related apps is increasing and it is likely that nurses will want to include them in practice. It will, therefore, be necessary to assess their effectiveness, appropriateness and efficacy to ensure they enhance patient care. This article looks at the literature on the subject and suggests some issues managers should consider before allowing the use of apps in their clinical areas. It also invites readers to take part in a survey on the use of apps in nursing. PMID:23252086

  13. Teleradiology in clinical practices and teaching of pediatric radiology

    A software program developed by OPTEL has been evaluated for use in consultation and interactive teaching in pediatric radiology in a university system with three interconnected hospitals. The system uses IBM PC hardware. Screen capture allows users to run graphics and text in foreground and permits conventional television images to be grabbed and stored. Images are retrieved using a graphics tablet and pen. Annotation of the graphics tablet permits arrows and other indicators to be superimposed on radiographs. Color and black-and-white images can be transmitted from any hospital site with television imaging capability and a PC. Applications in clinical practice and teaching programs via interactive telephone communication are described

  14. Clinical Practice Guideline: Otitis Media with Effusion Executive Summary (Update).

    Rosenfeld, Richard M; Shin, Jennifer J; Schwartz, Seth R; Coggins, Robyn; Gagnon, Lisa; Hackell, Jesse M; Hoelting, David; Hunter, Lisa L; Kummer, Ann W; Payne, Spencer C; Poe, Dennis S; Veling, Maria; Vila, Peter M; Walsh, Sandra A; Corrigan, Maureen D

    2016-02-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the updated "Clinical Practice Guideline: Otitis Media with Effusion." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 18 recommendations developed emphasize diagnostic accuracy, identification of children who are most susceptible to developmental sequelae from otitis media with effusion, and education of clinicians and patients regarding the favorable natural history of most otitis media with effusion and the lack of efficacy for medical therapy (eg, steroids, antihistamines, decongestants). An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. PMID:26833645

  15. The development of precision medicine in clinical practice.

    He, Mingyan; Xia, Jinglin; Shehab, Mohamed; Wang, Xiangdong

    2015-12-01

    Precision medicine allows a dramatic expansion of biological data, while there is still an urgent need to understand and insight the exact meaning of those data to human health and disease. This has led to an increasing wealth of data unanalyzed. The concept of precision medicine is about the customization of healthcare, with decisions and practices tailored to an individual patient based on their intrinsic biology in addition to clinical "signs and symptoms". Construction of a standardized model for the integration of data from various platforms is the central mission of the 'New Disease Management Model'. The model is helpful for the development of new taxonomy of diseases and subtypes, to personalize therapy based on patient genetic profiles. A rapid progression of precision therapy has been made recently. Clinical trials have shown the therapeutic efficacy of discovered and developed therapeutic agents has improved. However, next-generation drugs would be designed for disease subtypes with more specificity, efficacy and lower toxicity. PMID:26302883

  16. From asthma severity to control: a shift in clinical practice

    Pedersen, Søren

    2009-01-01

    -driven management rather than management based on disease severity. Good asthma control is associated with reductions in patients' perception of the asthma burden, reduced healthcare resource utilisation, lower levels of impairment/restriction, normal quality of life, and low risk of exacerbations. Asthma control...... involves the control of several outcomes. Its assessment should include components relevant to achievement of best possible clinical control and reduction of future risk of adverse outcomes. Focusing on a single or a few outcomes can lead to incorrect control assessment and increased risk of under......-treatment. Several validated asthma control assessment tools have been developed to facilitate correct assessment of the level of control in clinical practice. It is hoped that focusing on control will reduce the frequency of sub-optimal treatment in the primary care setting. Further validation of the best way to...

  17. Human Motion Video Analysis in Clinical Practice (Review

    V.V. Borzikov

    2015-12-01

    Full Text Available The development of new rehabilitation approaches to neurological and traumatological patients requires understanding of normal and pathological movement patterns. Biomechanical analysis of video images is the most accurate method of investigation and quantitative assessment of human normal and pathological locomotion. The review of currently available methods and systems of optical human motion analysis used in clinical practice is presented here. Short historical background is provided. Locomotion kinematics analysis using passive marker based systems is reviewed with special attention to the gait analysis. Clinical application of optical motion capture and analysis systems in the diagnosis of locomotion impairment, in Parkinson’s disease with movement control disorders, stroke sequelae, monitoring of motor function rehabilitation in patients with infantile cerebral paralysis, limb joint endo- and exoprosthetics and some other disorders is described.

  18. Clinical uses of the medicinal leech: A practical review

    B S Porshinsky

    2011-01-01

    Full Text Available The medicinal leech, Hirudo medicinalis, is an excellent example of the use of invertebrates in the treatment of human disease. Utilized for various medical indications since the ancient times, the medicinal leech is currently being used in a narrow range of well-defined and scientifically-grounded clinical applications. Hirudotherapy is most commonly used in the setting of venous congestion associated with soft tissue replantations and free flap-based reconstructive surgery. This is a comprehensive review of current clinical applications of hirudotherapy, featuring a comprehensive search of all major medical search engines (i.e. PubMed, Google Scholar, ScientificCommons and other cross-referenced sources. The authors focus on indications, contraindications, practical application/handling of the leech, and therapy-related complications.

  19. Study of Clinical Practical Model of Urinary System Injury

    Gang Li

    2015-01-01

    Full Text Available Background: In order to improve the clinical treatment level of urinary system injury, it is necessary to build up an animal model of urinary system wound, which is not only analogous to real clinical practice, but also simple and practical. Methods: We have developed the third generation of firearm fragment wound generator based on the first and the second producer. The best explosive charge of the blank cartridge was selected by gradient powder loading experiments. The firearm fragment injuries were made to the bulbous urethra of 10 New Zealand male rabbits. One week preoperatively and 2, 4 and 8 weeks postoperatively, all the animals underwent urethroscopy and urethrography. At 2, 4 and 8 weeks postoperatively, two animals were randomly selected and killed, and the urethra was cut off for pathological examination. Results: The shooting distance of the third generation of firearm fragment wound generator is 2 cm. The best explosive charge of the blank cartridge is 1 g of nitrocotton. All rabbits survived the procedures and stayed alive until they were killed. Injuries were limited to bulbous urethra and distal urethra. Round damaged areas, 1-1.5 cm in length, on the ventral wall were observed. Ureteroscopy results showed that canal diameter gradually shrank by over 50% in 9 rabbits. The rate of success was 90%. Urethrography result noted that a 1-1.3 cm stricture was formed at the bulbous urethra. Histology results of injured stricture urethra showed that fibrous connective tissue hyperplasia and hyaline degeneration caused further stricture in the canal. Conclusions: The third generation of firearm fragment wound generator imitates the bullet firing process and is more accurate and repeatable. The corresponding rabbit model of traumatic complex urethral stricture simulates the real complex clinical conditions. This animal model provides a standardized platform for clinical researches on treating traumatic injuries to the urinary system.

  20. Treatment of Anemia in Patients with Heart Disease: A Clinical Practice Guideline

    ... of Internal Medicine Summaries for Patients Treatment of Anemia in Patients With Heart Disease: A Clinical Practice ... Physicians The full report is titled “Treatment of Anemia in Patients With Heart Disease: A Clinical Practice ...

  1. Clinical applications of vibration therapy in orthopaedic practice

    Cerciello, Simone; Rossi, Silvio; Visonà, Enrico; Corona, Katia; Oliva, Francesco

    2016-01-01

    Summary Background Vibration therapy (VT) has been proposed as an option to improve physical performance and reduce the negative effects of ageing on bone, muscles and tendons. Several discrepancies exist on the type of applications, frequency and magnitude. These differences reflex on the contradictory clinical results in literature. Aim of the present study is to carry on an exhaustive review to focus on technical options on the market, clinical applications in orthopaedic practice and expected outcomes. Methods a literature review using the key words “vibration therapy” and “whole-body vibration” and “orthopaedics” was performed. After checking the available abstracts 71 full text articles were evaluated. Results fifty-one articles focused on the effects of VT on muscles and tendons reporting ways of action and clinical outcomes. In a similar way 20 studies focused on the influence of VT on bone tissue with regard on ways of action and clinical trials. Conclusions VT provides anabolic mechanical signals to bone and musculo-tendinous system. The best effects seem to be achieved with devices that deliver low-intensity stimuli at high frequencies providing linear horizontal displacement. PMID:27331044

  2. [Still the social factor: crisis in the clinical practice].

    Marzano, Fernando J

    2014-01-01

    Consultations in our hospital center are problematic, mainly due to the poor living situation which patients come from (the suburbs of Buenos Aires). The housing situation, the environment and the economic or political conditions of these patients frame "the social" emergency that sets the context and the impact in the different psychopathological symptoms that they present. These conditions should also be reviewed from our theoretical assessment together with the clinical approach that our assistance practice studies. From a perception viewpoint we observe that "self-perception is far from any ideals. The perception of their environment is threatening and has no future". We constantly note the loss of the value of words and speech, when we hear our patients, wo have turned language into just an abject joy, as in the word of the addict. These issues must be studied from a theoretical point of view to be applied clinically. Such analysis reveals that our practice takes place in a context of failure. However, we cannot move backwards in "potential treatment" as Lacan states in the ethics as regards psychosis. PMID:24887363

  3. The prevalence of adrenal incidentaloma in routine clinical practice.

    Davenport, Colin

    2012-02-01

    The prevalence of adrenal incidentaloma (AI) on computed tomography (CT) in the general population has been reported to be as high as 4.2%. However, many of the previous studies in this field utilised a prospective approach with analysis of CT scans performed by one or more radiologists with a specialist interest in adrenal tumours and a specific focus on identifying the presence of an adrenal mass. A typical radiology department, with a focus on the patient\\'s presenting complaint as opposed to the adrenal gland, may not be expected to diagnose as many adrenal incidentalomas as would be identified in a dedicated research protocol. We hypothesised that the number of AI reported in routine clinical practice is significantly lower than the published figures would suggest. We retrospectively reviewed the reports of all CT thorax and abdomen scans performed in our hospital over a 2 year period. 3,099 patients underwent imaging, with 3,705 scans performed. The median age was 63 years (range 18-98). Thirty-seven true AI were diagnosed during the time period studied. Twenty-two were diagnosed by CT abdomen (22\\/2,227) and 12 by CT thorax (12\\/1,478), a prevalence of 0.98 and 0.81% with CT abdomen and thorax, respectively, for AI in routine clinical practice.

  4. The prevalence of adrenal incidentaloma in routine clinical practice.

    Davenport, Colin

    2011-03-10

    The prevalence of adrenal incidentaloma (AI) on computed tomography (CT) in the general population has been reported to be as high as 4.2%. However, many of the previous studies in this field utilised a prospective approach with analysis of CT scans performed by one or more radiologists with a specialist interest in adrenal tumours and a specific focus on identifying the presence of an adrenal mass. A typical radiology department, with a focus on the patient\\'s presenting complaint as opposed to the adrenal gland, may not be expected to diagnose as many adrenal incidentalomas as would be identified in a dedicated research protocol. We hypothesised that the number of AI reported in routine clinical practice is significantly lower than the published figures would suggest. We retrospectively reviewed the reports of all CT thorax and abdomen scans performed in our hospital over a 2 year period. 3,099 patients underwent imaging, with 3,705 scans performed. The median age was 63 years (range 18-98). Thirty-seven true AI were diagnosed during the time period studied. Twenty-two were diagnosed by CT abdomen (22\\/2,227) and 12 by CT thorax (12\\/1,478), a prevalence of 0.98 and 0.81% with CT abdomen and thorax, respectively, for AI in routine clinical practice.

  5. Conceptions and use of play in occupational therapists clinical practice

    Maria Eduarda Diniz Fonsêca

    2015-09-01

    Full Text Available Occupational therapy aims to study the engagement of individuals in different areas of occupation and in this sense “playing” is configured as a relevant area for the pediatric population. We examined how occupational therapists working in the city of João Pessoa/PB perceive and use “playing” in the clinical practice. The participants took part in an exploratory study of quantitative and qualitative approach, with all occupational therapists who had experience in serving children and who were working in the city of João Pessoa / PB from June to July 2014. The data was collected through a questionnaire prepared based on Ferland and Blanche conceptions on “playing”, and included questions about the participants profile and their perceptions on the topic. The group of participants consisted of 23 occupational therapists, among which 69.6% graduated in the Northeast, 43.5% were specialists and 39.1% had between 6 and 10 years of training. The main “playing” learning locus was graduation (91.3%. “Playing” for skills training is used by 86.9% and as an end in itself for 52.2% of respondents. The theoretical psychologists compose the most supportive group towards the clinical practice of those surveyed. The results point to the need for further discussions on “playing” in undergraduate courses in Occupational Therapy, valuing the conceptions and characteristic intervention models commonly adopted in the profession.

  6. Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline Number 3.

    Agency for Health Care Policy and Research (DHHS/PHS), Rockville, MD.

    This package includes a clinical practice guideline, quick reference guide for clinicians, and patient's guide to predicting and preventing pressure ulcers in adults. The clinical practice guideline includes the following: overview of the incidence and prevalence of pressure ulcers; clinical practice guideline (introduction, risk assessment tools…

  7. [Clinical practice guidelines for systemic lupus erythematosus: Recommendations for general clinical management].

    Trujillo-Martín, María M; Rúa-Figueroa Fernández de Larrinoa, Iñigo; Ruíz-Irastorza, Guillermo; Pego-Reigosa, José María; Sabio Sánchez, José Mario; Serrano-Aguilar, Pedro

    2016-05-01

    Systemic lupus erythematosus (SLE) is a complex rheumatic multisystemic disease of autoimmune origin with significant potential morbidity and mortality. It is one of the most common autoimmune diseases with an estimated prevalence of 20-150 cases per 100,000 inhabitants. The clinical spectrum of SLE is wide and variable both in clinical manifestations and severity. This prompted the Spanish Ministry of Health, Social Services and Equality to promote and fund the development of a clinical practice guideline (CPG) for the clinical care of SLE patients within the Programme of CPG in the National Health System which coordinates GuiaSalud. This CPG is is intended as the reference tool in the Spanish National Health System in order to support the comprehensive clinical management of people with SLE by all health professionals involved, regardless of specialty and level of care, helping to standardize and improve the quality of clinical decisions in our context in order to improve the health outcomes of the people affected. The purpose of this document is to present and discuss the rationale of the recommendations on the general management of SLE, specifically, clinical follow-up, general therapeutic approach, healthy lifestyles, photoprotection, and training programmes for patients. These recommendationsare based on the best available scientific evidence, on discussion and the consensus of expert groups. PMID:26975887

  8. Nursing students in clinical practice--developing a model for clinical supervision.

    Häggman-Laitila, Arja; Elina, Eriksson; Riitta, Meretoja; Kirsi, Sillanpää; Leena, Rekola

    2007-11-01

    The aim of this study was to develop a model for clinical supervision to promote the clinical practice of nursing students. The study was implemented in Finland and it was carried out in three phases. Firstly, data were collected by means of a literature review and focus group interviews. Secondly, the data were analysed and described in expert groups, and finally the model itself was evaluated by 23 nursing experts. The data of literature review and focus group interviews consisted of 27 studies and four groups from three organisations: nurses (n=7), managers (n=6), teachers (n=8) and students (n=6). The data were analysed by qualitative content analysis. The model devolved from the study includes the concepts describing prerequisites, content and influence of clinical supervision. The prerequisites are nursing skills, a holistic view of the nursing curriculum, pedagogical, organisational, development, cooperation and interaction competence and decision-making skills. The content of clinical supervision includes support of professional development, pedagogical competence, research and development activities and collaborative working. Clinical supervision has influence on students' professional and personal development and conception of the future of nursing profession, students' preparedness for career planning and the teacher's and preceptor's professional development. The model could unify the notions of all parties concerned of the prerequisites, content and influence of clinical supervision. Furthermore, the entire supervision process and its control could be clarified. The model may be utilised in selecting and educating preceptors and evaluating the quality of clinical supervision. PMID:17936544

  9. Novel ethical dilemmas arising in geriatric clinical practice.

    Calleja-Sordo, Elisa Constanza; de Hoyos, Adalberto; Méndez-Jiménez, Jorge; Altamirano-Bustamante, Nelly F; Islas-Andrade, Sergio; Valderrama, Alejandro; García-Peña, Carmen; Altamirano-Bustamante, Myriam M

    2015-05-01

    The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel-patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients' life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population. PMID:25185872

  10. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.

    Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y

    2010-05-01

    This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine. PMID:20436026