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Sample records for clinical practice selective

  1. Setting priorities and selecting topics for clinical practice guidelines.

    OpenAIRE

    Battista, R N; Hodge, M J

    1995-01-01

    Setting priorities and selecting topics are important steps in guidelines development, but they have received relatively little attention to date. Responses from a survey of guidelines stakeholders in Canada suggest that the health burden of a clinical condition on the population is an important factor in priority setting. Economic considerations, cast as either costs of treatment to the health care system or the economic burden of illness to society, are given varying importance by different...

  2. [The experience with the application of selective polarized chromotherapy in the clinical practice].

    Science.gov (United States)

    Elkina, T N; Zakharova, L N; Evstropov, A N; Marinkin, I O; Nesina, I A; Liutkevich, A A; Khudonogova, Z P; Sholar', M V; Pustovetova, M G; Grachev, V I; Gribanova, O A; Tatarenko, Iu A

    2013-01-01

    A series of investigations have demonstrated the anti-inflammatory, bactericidal, analgesic, and vegetocorrective effects of extraocular selective polarized chromotherapy using blue and red light and the possibility to optimize autonomous regulation with the help of this technique. The results of the study confirmed the high clinical effectiveness and safety of the method being considered for the treatment of acute respiratory diseases, chronic tonsillitis, cervical dorsopathies, and vegetative dysfunction.

  3. A clinical trial alert tool to recruit large patient samples and assess selection bias in general practice research

    Directory of Open Access Journals (Sweden)

    Scheidt-Nave Christa

    2011-02-01

    Full Text Available Abstract Background Many research projects in general practice face problems when recruiting patients, often resulting in low recruitment rates and an unknown selection bias, thus limiting their value for health services research. The objective of the study is to evaluate the recruitment performance of the practice staff in 25 participating general practices when using a clinical trial alert (CTA tool. Methods The CTA tool was developed for an osteoporosis survey of patients at risk for osteoporosis and fractures. The tool used data from electronic patient records (EPRs to automatically identify the population at risk (net sample, to apply eligibility criteria, to contact eligible patients, to enrol and survey at least 200 patients per practice. The effects of the CTA intervention were evaluated on the basis of recruitment efficiency and selection bias. Results The CTA tool identified a net sample of 16,067 patients (range 162 to 1,316 per practice, of which the practice staff reviewed 5,161 (32% cases for eligibility. They excluded 3,248 patients and contacted 1,913 patients. Of these, 1,526 patients (range 4 to 202 per practice were successfully enrolled and surveyed. This made up 9% of the net sample and 80% of the patients contacted. Men and older patients were underrepresented in the study population. Conclusion Although the recruitment target was unreachable for most practices, the practice staff in the participating practices used the CTA tool successfully to identify, document and survey a large patient sample. The tool also helped the research team to precisely determine a slight selection bias.

  4. Does pulmonary rehabilitation work in clinical practice? A review on selection and dropout in randomized controlled trials on pulmonary rehabilitation

    Directory of Open Access Journals (Sweden)

    Bodil Bjoernshave

    2010-04-01

    Full Text Available Bodil Bjoernshave1, Jens Korsgaard2, Claus Vinther Nielsen31Medical Department, Horsens Regional Hospital, Denmark; 2Aalborg Hospital Science and Innovation Centre, 3Department of Clinical Social Medicine and Rehabilitation, Institute of Public Health, Aarhus University, DenmarkAim: To analyze randomized controlled trials (RCTs on pulmonary rehabilitation (PR to determine whether the patients who complete PR form a representative subset of the chronic obstructive pulmonary disease (COPD target population and to discuss what impact this may have for the generalizability and implementation of PR in practice.Material and methods: A review of 26 RCTs included in a Cochrane Review 2007. We analyzed the selection at three different levels: 1 sampling; 2 inclusion and exclusion; 3 and dropout. Results: Of 26 studies only 3 (12% described the sampling as the number of patients contacted. In these studies 28% completed PR. In all we found, that 75% of the patients suitable for PR programs were omitted due to sampling exclusion and dropout. Most of the study populations are not representative of the target population.Conclusion: The RCTs selected for the Cochrane review gave sparse information about the sampling procedure. The demand for high internal validity in studies on PR reduced their external validity. The patients completing PR programs in RCTs were not drawn from a representative subset of the target population. The ability to draw conclusions relevant to clinical practice from the results of the RCTs on PR is impaired.Keywords: COPD, rehabilitation, selection, dropout, external validity

  5. Myocarditis in Clinical Practice.

    Science.gov (United States)

    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

  6. Data Mining and Electronic Health Records: Selecting Optimal Clinical Treatments in Practice

    CERN Document Server

    Bennett, Casey

    2011-01-01

    Electronic health records (EHR's) are only a first step in capturing and utilizing health-related data - the problem is turning that data into useful information. Models produced via data mining and predictive analysis profile inherited risks and environmental/behavioral factors associated with patient disorders, which can be utilized to generate predictions about treatment outcomes. This can form the backbone of clinical decision support systems driven by live data based on the actual population. The advantage of such an approach based on the actual population is that it is "adaptive". Here, we evaluate the predictive capacity of a clinical EHR of a large mental healthcare provider (~75,000 distinct clients a year) to provide decision support information in a real-world clinical setting. Initial research has achieved a 70% success rate in predicting treatment outcomes using these methods.

  7. Characteristics of new P2Y12 inhibitors: selection of P2Y12 inhibitors in clinical practice.

    Science.gov (United States)

    Golino, Paolo

    2013-12-01

    The options for antithrombotic therapy have recently been expanded, facilitating optimal tailored treatment. Dual antiplatelet therapy with aspirin and an approved adenosine diphosphate P2Y12 receptor antagonist is recommended for the management of patients with acute coronary syndromes (ACS). However, there are a number of controversies: which P2Y12 inhibitor to choose; how long should antiplatelet therapy be used so as to prevent thrombotic events and minimize bleeding risks; whether to use drug-eluting (DES) or bare-metal stents (BMS) and how to manage the individual variability in response to clopidogrel. Clopidogrel in combination with aspirin has been the standard dual antiplatelet regimen for ACS. The new, more potent P2Y12 inhibitors, prasugrel and ticagrelor, have shown improved antithrombotic effects compared with clopidogrel in patients with ACS (with or without ST-segment elevation myocardial infarction) in landmark trials, even if they were associated with an increased risk of major bleeding. Different pharmacogenetic and pharmacodynamic characteristics may explain, in part, the different pharmacologic and clinical responses to these antiplatelet agents. Importantly, both clopidogrel and prasugrel are prodrugs, i.e., they need to be converted in vivo into active metabolites that selectively and irreversibly bind the P2Y12 receptor. Unlike clopidogrel, however, common functional cytochrome P450 genetic variants do not affect prasugrel active metabolite levels or inhibition of platelet aggregation. In contrast, ticagrelor is not a prodrug (i.e., does not require hepatic metabolism to exert its antiplatelet effect) and represents the first oral P2Y12 receptor antagonist that is reversibly bound. Similar to prasugrel, ticagrelor achieves greater and more rapid inhibition of platelet function than clopidogrel. Evidence suggests that the new P2Y12 antagonists may offer improved antithrombotic effects compared with clopidogrel in selected patients for the

  8. Computerizing clinical practice guidelines

    DEFF Research Database (Denmark)

    Lyng, Karen Marie

    It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application and comp......It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application...... and compliance with CPGs in most areas of clinical practice are deficient. Computerization of CPGs has been brought forward as a method to disseminate and to support application of CPGs. Until now, CPG-computerization has focused on development of formal expressions of CPGs. The developed systems have, however......, not gained any extensive application in clinical practice. The basic assumption in this thesis is that the scanty penetration is due to an inappropriate design process when designing computerized CPGs for clinical work practice. This thesis examines the application of guidance within areas where CPG...

  9. Hyponatraemia in clinical practice

    OpenAIRE

    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...

  10. PRIME – PRocess modelling in ImpleMEntation research: selecting a theoretical basis for interventions to change clinical practice

    Directory of Open Access Journals (Sweden)

    Pitts Nigel

    2003-12-01

    Full Text Available Abstract Background Biomedical research constantly produces new findings but these are not routinely translated into health care practice. One way to address this problem is to develop effective interventions to translate research findings into practice. Currently a range of empirical interventions are available and systematic reviews of these have demonstrated that there is no single best intervention. This evidence base is difficult to use in routine settings because it cannot identify which intervention is most likely to be effective (or cost effective in a particular situation. We need to establish a scientific rationale for interventions. As clinical practice is a form of human behaviour, theories of human behaviour that have proved useful in other similar settings may provide a basis for developing a scientific rationale for the choice of interventions to translate research findings into clinical practice. The objectives of the study are: to amplify and populate scientifically validated theories of behaviour with evidence from the experience of health professionals; to use this as a basis for developing predictive questionnaires using replicable methods; to identify which elements of the questionnaire (i.e., which theoretical constructs predict clinical practice and distinguish between evidence compliant and non-compliant practice; and on the basis of these results, to identify variables (based on theoretical constructs that might be prime targets for behaviour change interventions. Methods We will develop postal questionnaires measuring two motivational, three action and one stage theory to explore five behaviours with 800 general medical and 600 general dental practitioners. We will collect data on performance for each of the behaviours. The relationships between predictor variables (theoretical constructs and outcome measures (data on performance in each survey will be assessed using multiple regression analysis and structural equation

  11. Handbook of clinical nursing practice

    Energy Technology Data Exchange (ETDEWEB)

    Asheervath, J.; Blevins, D.R.

    1986-01-01

    Written in outline format, this reference will help nurses further their understanding of advanced nursing procedures. Information is provided on the physiological, psychological, environmental, and safety considerations of nursing activities associated with diagnostic and therapeutic procedures. Special consideration is given to the areas of pediatric nursing, nursing assessment, and selected radiologic and nuclear medicine procedures for each system. Contents: Clinical Introduction. Clinical Nursing Practice: Focus on Basics. Focus on Cardiovascular Function. Focus on Respiratory Function. Focus on Gastrointestinal Function. Focus on Renal and Genito-Urological Function. Focus on Neuro-Skeletal and Muscular Function. Appendices.

  12. Clinical Practice Guidelines and Industry

    Directory of Open Access Journals (Sweden)

    Ajai R. Singh

    2007-01-01

    this is that it helps condense multiple recommendations into a single protocol which can have a measurable effect on patient outcomes. Moreover, such bundled performance measures are readymade standards for insurance and other pay-for-performance initiatives, since these agencies can base reimbursement on compliance with such bundle components (Eichacker et al., 2006. [No abstract available.]Concluding remarksClinical Practice Guidelines are another example of an excellent idea likely to go to seed due to sponsor manipulation and forces of the market place camouflaging as evidence based medicine. The need to weed out conflicted experts and make the process of therapy selection transparent must go hand in hand with laying down clear-cut criteria for guideline formulation and rejection of conflicted submissions by vigilant journal publication policies and editors

  13. Impella ventricular support in clinical practice

    DEFF Research Database (Denmark)

    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 ...

  14. Expert systems in clinical practice

    International Nuclear Information System (INIS)

    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

  15. Photodynamic therapy in clinical practice

    OpenAIRE

    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...

  16. Pharmacogenetics in clinical practice

    NARCIS (Netherlands)

    Derijks, Luc J. J.; Derijks, H. Jeroen; Touw, Daan J.; Conemans, Jean M. H.; Egberts, Antoine C. G.

    2008-01-01

    The availability of data from pharmacogenetic studies is reflected in therapeutic practice, and pharmacogenetics is slowly entering the medical arena. Preconditions for the utilisation of pharmacogenetic knowledge are that: 1) genetic variation and prevalence are known 2) pharmacological consequence

  17. Mindfulness Meditation in Clinical Practice

    Science.gov (United States)

    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…

  18. Does pulmonary rehabilitation work in clinical practice? A review on selection and dropout in randomized controlled trials on pulmonary rehabilitation

    OpenAIRE

    Bodil Bjoernshave; Jens Korsgaard; Claus Vinther Nielsen

    2010-01-01

    Bodil Bjoernshave1, Jens Korsgaard2, Claus Vinther Nielsen31Medical Department, Horsens Regional Hospital, Denmark; 2Aalborg Hospital Science and Innovation Centre, 3Department of Clinical Social Medicine and Rehabilitation, Institute of Public Health, Aarhus University, DenmarkAim: To analyze randomized controlled trials (RCTs) on pulmonary rehabilitation (PR) to determine whether the patients who complete PR form a representative subset of the chronic obstructive pulmonary disease (COPD) ta...

  19. Dabigatran in clinical practice

    DEFF Research Database (Denmark)

    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 advantage of few drug or diet interactions. Dabigatran is effective for stroke and systemic thromboembolism in AF and for the prophylaxis and treatment of VTE. The drug has a good safety profile and consistently shows a reduction in intracranial hemorrhage risk compared to warfarin. A specific reversal...... 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....

  20. [Postoperative Adjuvant Chemotherapy for Stage III Colon Cancer--Drug Selection, Tolerability, and Safety in Clinical Practice].

    Science.gov (United States)

    Okada, Kazutake; Sadahiro, Sotaro; Saito, Gota; Tanaka, Akira; Suzuki, Toshiyuki

    2016-05-01

    In the National Comprehensive Cancer Network (NCCN) guidelines, oxaliplatin (L-OHP)-based chemotherapeutic regimens, including 5-fluorouracil, Leucovorin (LV), and L-OHP (FOLFOX); capecitabine and L-OHP (CapeOX); and 5-fluorouracil, folinic acid, and L-OHP (FLOX) are designated as category 1 recommendations for postoperative adjuvant chemotherapy in Stage III colon cancer, followed by capecitabine and 5-fluorouracil plus LV as category 2A recommendations. We studied the selection of drugs for adjuvant chemotherapy and assessed the tolerability and safety of CapeOX and tegafur-uracil (UFT) plus LV (UFT/LV) in patients with Stage III colon cancer. The study group included 104 consecutive patients with Stage III colon cancer who underwent curative surgery. One patient changed hospitals immediately after surgery. Among the remaining 103 patients, 82 (80%) received adjuvant chemotherapy and 21 (20%) did not. CapeOX was administered to 32 patients (31%), UFT/LV to 49 patients (48%), and capecitabine to 1 patient (1%). In 59 patients, the treatment choice was determined according to the patient's preference; 32 patients (54%) selected CapeOX, 26 (44%) selected UFT/LV, and 1 (2%) selected no chemotherapy. The treatment completion rate was 80% for CapeOX and 84% for UFT/LV. Among patients who completed chemotherapy, dose reduction and drug withdrawal were not required in 22% of patients who received CapeOX and 80% of those who received UFT/LV. Neither CapeOX nor UFT/LV was associated with any serious adverse events. The tolerability and safety of CapeOX and UFT/LV were acceptable. However, CapeOX dose had to be carefully adjusted according to each patient's condition.

  1. Clinical Practice. Postmenopausal Osteoporosis.

    Science.gov (United States)

    Black, Dennis M; Rosen, Clifford J

    2016-01-21

    Key Clinical Points Postmenopausal Osteoporosis Fractures and osteoporosis are common, particularly among older women, and hip fractures can be devastating. Treatment is generally recommended in postmenopausal women who have a bone mineral density T score of -2.5 or less, a history of spine or hip fracture, or a Fracture Risk Assessment Tool (FRAX) score indicating increased fracture risk. Bisphosphonates (generic) and denosumab reduce the risk of hip, nonvertebral, and vertebral fractures; bisphosphonates are commonly used as first-line treatment in women who do not have contraindications. Teriparatide reduces the risk of nonvertebral and vertebral fractures. Osteonecrosis of the jaw and atypical femur fractures have been reported with treatment but are rare. The benefit-to-risk ratio for osteoporosis treatment is strongly positive for most women with osteoporosis. Because benefits are retained after discontinuation of alendronate or zoledronic acid, drug holidays after 5 years of alendronate therapy or 3 years of zoledronic acid therapy may be considered for patients at lower risk for fracture.

  2. Recombinant erythropoietin in clinical practice

    OpenAIRE

    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. Pulse Pressure in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Jiri Parenica

    2012-02-01

    Full Text Available The review presents basic information about the pulse pressure. The variables related to pulse pressure are briefly explained - arterial stiffness, arterial compliance, pulse wave velocity, pulse pressure amplification and augmentation index. We present some recent trials and observational studies that show the importance of pulse pressure in clinical practice. Briefly the possibilities of influencing the pulse pressure are discussed.

  4. Recommendations for a standard UK approach to incorporating umbilical cord blood into clinical transplantation practice: an update on cord blood unit selection, donor selection algorithms and conditioning protocols.

    Science.gov (United States)

    Hough, Rachael; Danby, Robert; Russell, Nigel; Marks, David; Veys, Paul; Shaw, Bronwen; Wynn, Rob; Vora, Ajay; Mackinnon, Stephen; Peggs, Karl S; Crawley, Charles; Craddock, Charlie; Pagliuca, Antonio; Cook, Gordon; Snowden, John A; Clark, Andrew; Marsh, Judith; Querol, Sergio; Parkes, Guy; Braund, Henny; Rocha, Vanderson

    2016-02-01

    Allogeneic haemopoietic stem cell transplantation offers a potentially curative treatment option for a wide range of life-threatening malignant and non-malignant disorders of the bone marrow and immune system in patients of all ages. With rapidly emerging advances in the use of alternative donors, such as mismatched unrelated, cord blood and haploidentical donors, it is now possible to find a potential donor for almost all patients in whom an allograft is indicated. Therefore, for any specific patient, the transplant physician may be faced with a myriad of potential choices, including decisions concerning which donor to prioritize where there is more than one, the optimal selection of specific umbilical cord blood units and which conditioning and graft-versus-host disease prophylactic schedule to use. Donor choice may be further complicated by other important factors, such as urgency of transplant, the presence of alloantibodies, the disease status (homozygosity or heterozygosity) of sibling donors affected by inherited disorders and the cytomegalovirus serostatus of patient and donor. We report UK consensus guidelines on the selection of umbilical cord blood units, the hierarchy of donor selection and the preferred conditioning regimens for umbilical cord blood transplantation, with a summary of rationale supporting these recommendations. PMID:26577457

  5. Research and Clinical Practice Relationship

    OpenAIRE

    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. Good clinical practices in phase I studies.

    Science.gov (United States)

    Decousus, H; Perpoint, B; Mismetti, P; Ollagnier, M; Queneau, P

    1990-01-01

    In France, official guidelines for good clinical practices in clinical trials were issued in 1987. In December 1988, a law was passed that fixed the requirements for carrying out experiments in healthy subjects. It will be completed by official guidelines for the structures in which experiments on healthy subjects (and patients as well, when the investigation would not benefit the health of the patients) may be conducted. Hence a battery of recent legal instructions precisely state what good clinical practices are in the setting of phase I studies. Of particular importance are: subject recruitment and selection methods and procedures; specific competence of the investigator, in particular to interpret the pre-trial data; necessary and sufficient facilities to guarantee the subjects' safety; careful quality control to check all laboratory procedures; necessity of written standard operating procedures.

  7. Are clinical practice guidelines impartial?

    Science.gov (United States)

    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.

  8. Proton therapy in clinical practice

    Institute of Scientific and Technical Information of China (English)

    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. Supernumerary teeth in clinical practice

    Directory of Open Access Journals (Sweden)

    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.

  10. Body composition in clinical practice.

    Science.gov (United States)

    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

  11. Body composition in clinical practice.

    Science.gov (United States)

    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.

  12. Research and clinical practice relationship

    Directory of Open Access Journals (Sweden)

    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.

  13. Is DAS28-CRP with three and four variables interchangeable in individual patients selected for biological treatment in daily clinical practice?

    DEFF Research Database (Denmark)

    Madsen, Ole Rintek

    2011-01-01

    DAS28 is a widely used composite score for the assessment of disease activity in patients with rheumatoid arthritis (RA) and is often used as a treatment decision tool in the daily clinic. Different versions of DAS28 are available. DAS28-CRP(3) is calculated based on three variables: swollen...... selected for initiating biological treatment. Data were extracted from the Danish registry for biological treatment in rheumatology (DANBIO). Multiple regression analysis was used to assess the predictability of the DAS28 scores by several measures of disease activity. The overall mean DAS28-CRP was 4...

  14. How GPs implement clinical guidelines in everyday clinical practice

    DEFF Research Database (Denmark)

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

    2015-01-01

    . 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...

  15. Selecting general practice specialty trainees: where next?

    OpenAIRE

    Irish, Bill; Patterson, Fiona

    2010-01-01

    Selection into GP speciality training is based on results of a multi-method job analysis study. Six key competency domains were identified as priorities to assess through the current national selection process, including empathy, communication, integrity, clinical expertise, problem-solving, and resilience. Each applicant is assessed using clinical problem-solving and situational judgement machine marked tests, followed by high fidelity exercises at regional selection centres. These show good...

  16. A Critical Approach to Clinical Practice Guidelines

    Directory of Open Access Journals (Sweden)

    John K Marshall

    2000-01-01

    Full Text Available The rate of publication of clinical practice guidelines for the management of common medical illnesses continues to accelerate. The appropriate dissemination and uptake of high quality practice guidelines can synthesize evidence, improve patient outcomes and enhance the efficiency of health care delivery. However, the methodological rigour and relevance of the growing number of publications labelled ’clinical practice guidelines’ vary widely. Health care payers, providers and advocates must learn to appraise and interpret guideline recommendations critically. A simple and practical nine-question approach to evaluating the quality, relevance and effectiveness of clinical practice guidelines is presented.

  17. Lubrication a practical guide to lubricant selection

    CERN Document Server

    Lansdown, A R

    1982-01-01

    Lubrication: A Practical Guide to Lubricant Selection provides a guide to modern lubrication practice in industry, with emphasis on practical application, selection of lubricants, and significant factors that determine suitability of a lubricant for a specific application. Organized into 13 chapters, this book begins with a brief theoretical opening chapter on the basic principles of lubrication. A chapter then explains the choice of lubricant type, indicating how to decide whether to use oil, grease, dry lubricant, or gas lubrication. Subsequent chapters deal with detailed selection of lubric

  18. Is DAS28-CRP with three and four variables interchangeable in individual patients selected for biological treatment in daily clinical practice?

    DEFF Research Database (Denmark)

    Madsen, Ole Rintek

    2011-01-01

    DAS28 is a widely used composite score for the assessment of disease activity in patients with rheumatoid arthritis (RA) and is often used as a treatment decision tool in the daily clinic. Different versions of DAS28 are available. DAS28-CRP(3) is calculated based on three variables: swollen...... and tender joint counts and CRP. DAS28-CRP(4) also includes patient global assessment. Thresholds for low and high disease activity are the same for the two scores. Based on the Bland-Altman method, the interchangeability between DAS28-CRP with three and four variables was examined in 319 RA patients...... selected for initiating biological treatment. Data were extracted from the Danish registry for biological treatment in rheumatology (DANBIO). Multiple regression analysis was used to assess the predictability of the DAS28 scores by several measures of disease activity. The overall mean DAS28-CRP was 4...

  19. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    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...

  20. [Toxoplasmosis in pregnancy - questions in clinical practice].

    Science.gov (United States)

    Geleneky, Markéta

    2013-06-01

    Toxoplasmosis acquired during pregnancy is a serious disease that may significantly affect fetal development and cause irreversible or therapeutically hardly influenced damage to the newborn. Early and correct diagnosis of the disease in the mother is essential for determining prognosis and further diagnostic and therapeutic procedures. The case study combines a number of factors to be encountered in clinical practice which may complicate diagnostic considerations. One of them is the existence of a rare phenomenon of reinfection - its possible effects on prenatal screening and other interpretations of such findings. Another problem is the evaluation of the origin of sonographically confirmed fetopathy in relation to Toxoplasma etiology and the choice of next steps that should follow in this situation. Finally, the text discusses the selection of postnatal examinations so that they sufficiently contribute to decision-making about the newborn's treatment initiation.

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    Bugaj, T. J.

    2016-08-01

    Full Text Available 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.

  3. Understanding change in clinical nursing practice.

    Science.gov (United States)

    Copnell, B

    1998-03-01

    The present paper employs a poststructural framework to explore the construction of change in clinical nursing practice, as portrayed in nursing literature. In it a critique of two specific bodies of literature is offered: that which deals with the 'abstract' conception of change (but which is heavily influenced by organizational discourses) and that which describes changes in the clinical setting of critical care nursing practice. It is argued that the discursive constitution of change that is revealed in this analysis disadvantages clinical nurses. Because the context in which change occurs is largely unacknowledged, clinical nursing practice, as experienced and understood by nurses, is also marginalized. Change in clinical practice is under-researched, and such inquiry should be undertaken from the perspective of nurses themselves, and requires an exploration of the discursive context of nursing work. PMID:9611575

  4. Utilization of incontinence clinical practice guidelines.

    Science.gov (United States)

    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

  5. Positron emission tomography clinical practice

    CERN Document Server

    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

  6. Placebo interventions, placebo effects and clinical practice

    OpenAIRE

    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...

  7. Loop Diuretics in Clinical Practice.

    Science.gov (United States)

    Oh, Se Won; Han, Sang Youb

    2015-06-01

    Diuretics are commonly used to control edema across various clinical fields. Diuretics inhibit sodium reabsorption in specific renal tubules, resulting in increased urinary sodium and water excretion. Loop diuretics are the most potent diuretics. In this article, we review five important aspects of loop diuretics, in particular furosemide, which must be considered when prescribing this medicine: (1) oral versus intravenous treatment, (2) dosage, (3) continuous versus bolus infusion, (4) application in chronic kidney disease patients, and (5) side effects. The bioavailability of furosemide differs between oral and intravenous therapy. Additionally, the threshold and ceiling doses of furosemide differ according to the particular clinical condition of the patient, for example in patients with severe edema or chronic kidney disease. To maximize the efficiency of furosemide, a clear understanding of how the mode of delivery will impact bioavailability and the required dosage is necessary.

  8. Positive interventions in clinical practice.

    Science.gov (United States)

    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. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    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...... research are carefully considered and minimised, research results will be more valid and this will benefit patients and heath care systems....

  10. Social media in clinical practice

    CERN Document Server

    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. Impella ventricular support in clinical practice

    DEFF Research Database (Denmark)

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

    2015-01-01

    and 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...

  12. Reshaping Clinical Practice for the New Millennium.

    Science.gov (United States)

    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…

  13. Lexical Concept Distribution Reflects Clinical Practice

    OpenAIRE

    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.

  14. Clinical Practice Guidelines for intestinal occlusion.

    OpenAIRE

    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.

  15. Clinical Practice Guidelines for Cerebral Abscess Treatment

    Directory of Open Access Journals (Sweden)

    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.

  16. Mayo Clinic Jacksonville electronic radiology practice

    Science.gov (United States)

    Morin, Richard L.; Berquist, Thomas H.; Rueger, Wolfgang

    1996-05-01

    We have begun a project to implement an Electronic (Filmless) Radiology Practice (ERP) at Mayo Clinic Jacksonville. This project is integrated with the implementation of a project (Automated Clinical Practice--ACP) to eliminate circulation and archival of the current paper Medical Record. The ERP will result in elimination of screen/film radiography and the transmittal of film throughout the institution by the end of 1996. In conjunction with the ACP, paper and film will not circulate within the clinic by the end of this year.

  17. George Engel's Epistemology of Clinical Practice.

    Science.gov (United States)

    Saraga, Michael; Fuks, Abraham; Boudreau, J Donald

    2014-01-01

    George Engel's (1913-1999) biopsychosocial model, one of the most significant proposals for the renewal of medicine in the latter half of the 20th century, has been understood primarily as a multi-factorial approach to the etiology of disease and as a call to re-humanize clinical practice. This common reading of Engel's model misses the central aspect of his proposal, that the biopsychosocial model is an epistemology for clinical work. By stating the simple fact that the clinician is not dealing directly with a body, but first, and inevitably, with a person, Engel challenged the epistemology implicit in the classical clinical method-a method predicated on the possibility of direct access to the body. Framed in epistemological terms, the issue at stake is not the need to complement medical science with humane virtues, but rather to acknowledge that the object of clinical practice is not the body but the patient.

  18. Peer review practicalities in clinical medicine

    Directory of Open Access Journals (Sweden)

    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

  19. Ethical practice and clinical legal education

    OpenAIRE

    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...

  20. Clinical Practice Guidelines Infective Endocarditis Treatment.

    Directory of Open Access Journals (Sweden)

    Lázaro de la Cruz Avilés

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Infective Endocarditis Treatment. Infectious disease affecting the endocardium produces vegetations and could also affect the septum, the chordae tendinae or mural endocardium. It includes concept, risk factors, classification (and special groups and an update and review of the main clinical aspects, complications and treatment stressing the antibiotic therapy. It includes assessment guidelines focused on the most important aspects to be accomplished.

  1. Clinical Practice Guidelines for Exogenous Poisoning.

    Directory of Open Access Journals (Sweden)

    Alexis Díaz Mesa

    2009-03-01

    Full Text Available 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 important aspects to be accomplished.

  2. Clinical Practice Guidelines for Potential Donors Management

    Directory of Open Access Journals (Sweden)

    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.

  3. Clinical Practice Guidelines for Cardiogenic Shock.

    Directory of Open Access Journals (Sweden)

    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.

  4. Selective Nodal Irradiation for Head and Neck Cancer Using Intensity-Modulated Radiotherapy: Application of RTOG Consensus Guidelines in Routine Clinical Practice

    International Nuclear Information System (INIS)

    Purpose: We have been using intensity-modulated radiotherapy (IMRT) for selective neck irradiation. This article presents an analysis of patterns of failure and their dosimetric correlation. Methods and Materials: Between October 2003 and January 2008, 83 patients with head-and-neck cancer were treated with IMRT. Nodal levels were contoured as per the Radiation Therapy Oncology Group (RTOG) consensus guidelines. Results: There were 32 relapses with 23 local relapses (21 local relapses alone and 2 local and regional relapses, simultaneously), 9 regional relapses (including 2 simultaneous local and regional relapses), and 5 distant relapses, of which 2 patients had local relapses. At 2 and 3 years, the locoregional relapse-free survival rates were was 68.3% and 60.8%, respectively, while the overall survival rates were 84.1% and 81.7%, respectively. Subgroup analyses revealed significant differences in locoregional relapse-free survival rates for total treatment times of 53 days, a volume of CTV1PTV (i.e., the volume prescribed 70 Gy) 177 cc, a V100 for CTV1PTV of 91%, and a minimum dose to CTV1PTV of 54 Gy. There were no failures in the elective nodal volume, substantiating both the nodal selection criteria and the RTOG consensus guidelines for delineation of neck node levels. Conclusions: IMRT for head-neck cancer is feasible, using elective nodal selection criteria along with RTOG consensus guidelines for the radiological boundaries of levels of neck nodes.

  5. Clinical Practice Guidelines for Encephalic Death Treatment

    Directory of Open Access Journals (Sweden)

    José Roque Nodal Arruebarrena

    2009-03-01

    Full Text Available 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.

  6. Clinical Practice Guidelines for paroxysmal supraventricular tachycardia.

    Directory of Open Access Journals (Sweden)

    Brandy Viera Valdés

    2009-03-01

    Full Text Available 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.

  7. Clinical Practice Guidelines for Critical Patients’ Nutrition.

    Directory of Open Access Journals (Sweden)

    Marta Patricia Casanova González

    2009-03-01

    Full Text Available 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.

  8. An epistemology for clinical medicine: an argument for reflection on the ends of medical practice and ways of knowing with implications for the selection and training of physician.

    Science.gov (United States)

    Leblond, Richard F

    2013-01-01

    Today physicians and scientists have a detailed understanding of human biology and have developed diagnostic and therapeutic tools that were unimaginable a century ago. Yet physicians have provided care and counsel for more than 3000 years. Some, such as Hippocrates and Osler, remain exemplars of the excellent physician. They did not have our scientific knowledge or tools, but they knew something important and performed some task of great value to their patients. What did they know and what did they do? This article explores the questions every ill patient asks, the timeless nature of patient as person, and the forms of non-factual knowing (described as know-how, know-what, know-who, and know-how-it-feels) that are essential to patient care. From this, it is suggested that the combination of understanding, insight, and judgment used for practical action, what Aristotle called "phronesis," is the core competency of excellent physicians which has remained unchanged across the centuries.

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

    OpenAIRE

    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 al...

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

    Directory of Open Access Journals (Sweden)

    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

  11. Uses of internet technology in clinical practice

    International Nuclear Information System (INIS)

    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)

  12. Clinical photography in the dermatology practice.

    Science.gov (United States)

    Witmer, William K; Lebovitz, Peter J

    2012-09-01

    Photography has been accepted for decades as a standard means for documenting dermatologic conditions and as an adjunct to their treatment, in both medical practice and research. The emergence of low-cost easy-to-use digital imaging systems has made good-quality photography more accessible to practitioners, while providing improved functionality in the clinical environment. Primary concerns are controlling lighting and positioning to provide a clear record of the patients skin condition and maintaining consistency over time to assure meaningful comparison of clinical end points.

  13. [Clinical pharmacology and the selection of drugs].

    Science.gov (United States)

    Stanulović, M

    1989-01-01

    Yugoslavia has a modern drug legislature and a selective drug market. With about 910 substances and 1250 brand names the number of drugs is among the lowest among the European countries. Most products on the market satisfy high criteria of safety to efficacy ratio. Still, the regional health insurance authorities of the Federal republics of Serbia and of Croatia limited the number of drugs to be reimbursed by the insurance scheme. The reason for this move and its justification is given by--the inertia of the complicated procedure of withdrawal from the market of a drug which is obsolete or considered today not possess the ascribed efficacy, existence of unjustly high expectations regarding the efficacy of certain drugs by both the medical profession and the layman and which lead to overprescribing (i.e. vitamin combinations, laxatives and drugs, cerebrovascular insufficiency), and--the responsibility of the public health administration for setting priorities in spending of the available funds. The allocation of funds available for medicinal drugs have been without any kind of regulation and control until now. The introduction of limitations in the reimbursement of price for certain drugs is the first measure initiated to stimulate the optimal use of drugs. As the optimal drug use is considered the therapy with the most favorable safety/efficacy and cost/efficiency ratios. The other measures available and which ought to be initiated are those based on the drug utilization studies. The prescriptions are already computerized im most settings, so the feedback of information ot the prescribing physicians could be possible after adequate analysis of the data. The team of clinical pharmacologist already active in drug utilization studies is available and ready to meet the challenge of improving therapeutic practices. PMID:2642196

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

    OpenAIRE

    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...

  15. Clinic Practical Guides for Cerebrovascular Diseases

    OpenAIRE

    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

  16. Penile Cancer: Clinical Practice Guidelines in Oncology

    OpenAIRE

    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...

  17. Clinical decision making in veterinary practice

    OpenAIRE

    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...

  18. Caring during clinical practice: Midwives’ perspective

    Directory of Open Access Journals (Sweden)

    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.

  19. Selective laser hyperthermia of malignant neoplasms: experimental and clinical research

    Science.gov (United States)

    Gelfond, Mark L.; Mizgirev, I. V.; Barchuk, A. S.; Hudoley, V. V.; Vasilyev, D. V.; Balluzek, F. V.; Venkov, A. A.; Chaly, Viktor P.; Ter-Martirosyan, Alexander L.

    1999-12-01

    Experimental study of various modes of the semiconductor laser irradiation upon Ehrlich carcinoma in mice was carried out. Optimal patterns for distance laser scanning irradiation resulting in practically complete healing of experimental animals, were found. Selective damage of tumor tissue subjected to laser irradiation at 800 nm was evidenced in the absence of a photosensitizing agent. The results of a clinical trial completely corresponded to the experimental data. The treatment proved to be efficient in all 28 patients.

  20. Potential Uses of Probiotics in Clinical Practice

    OpenAIRE

    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...

  1. Clinical practice is not applied scientific method.

    Science.gov (United States)

    Cox, K

    1995-08-01

    Practice is often described as applied science, but real life is far too complex and interactive to be handled by analytical scientific methods. The limitations of usefulness of scientific method in clinical practice result from many factors. The complexity of the large number of ill-defined variables at many levels of the problem. Scientific method focuses on one variable at a time across a hundred identical animals to extract a single, generalizable 'proof' or piece of 'truth'. Clinical practice deals with a hundred variables at one time within one animal from among a clientele of non-identical animals in order to optimize a mix of outcomes intended to satisfy that particular animal's current needs and desires. Interdependence among the variables. Most factors in the illness, the disease, the patient and the setting are interdependent, and cannot be sufficiently isolated to allow their separate study. Practice as a human transaction involving at least two people is too complex to be analysed one factor at a time when the interaction stimulates unpredictable responses. Ambiguous data. Words have many usages. People not only assign different interpretations to the same words, they assign different 'meanings', especially according to the threat or hope they may imply. The perceptual data gleaned from physical examination may be difficult to specify exactly or to confirm objectively. The accuracy and precision of investigational data and their reporting can be low, and are frequently unknown. Differing goals between science and practice. Science strives for exact points of propositional knowledge, verifiable by logical argument using objective data and repetition of the experiment.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7661793

  2. Clinical Application of Same-Name Channel Point Selection

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@ The namesake channel point selection is a method adopted in acupuncture treatment, in which the points on the six pairs of channels on the upper and lower extremities with same names are selected and needled. Clinically, this method is mainly used for some acute soft tissue injuries, for instance, needling point Yangchi (TE 4) with reducing method for sprain of external malleolus, needling Qiuxu (GB 40) with reducing method for sprain of dorsal carpus, and needling Tiaokou (ST 38) for lateral shoulder pain. The therapeutic effect given by this point selection method is often superior to that given by the conventional needling method. In clinical practice, the author has found some typical cases, which respond well to this method, and reports them below.

  3. Litigations and the Obstetrician in Clinical Practice.

    Science.gov (United States)

    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

  4. The basics of coding a rehabilitation diagnosis in clinical practice for the physical therapist.

    Directory of Open Access Journals (Sweden)

    Romanyshyn M.J.

    2012-01-01

    Full Text Available Directions of the use international classification of functioning are considered, limitations of vital functions and health in clinical activity of physical physical therapist. Bases for the construction of rehabilitation diagnosis in clinical practice are shown. The analysis of publications of Worldwide organization of health protection and World confederation of physical therapy is presented. The necessity of the use of foregoing classification for clinical practice of physical therapist is set. The constituents of clinical activity of physical therapist are selected.

  5. [Asthma clinical practice guidelines: advantages and pitfalls].

    Science.gov (United States)

    Plaza, Vicente; Bellido-Casado, Jesús; Alonso-Coello, Pablo; Rodrigo, Gustavo

    2009-01-01

    The Clinical Practice Guidelines on asthma have contributed towards unifying concepts and reaching a consensus on performances between different professional groups. However, they have failed in the overall improvement in the management of asthma, the final objective that they are meant to achieve. Today, almost 20 years after they appeared, the majority of asthmatic patients are still inadequately controlled, partly due to lack of follow up by doctors and the rest of health care staff who have to look after them. This lack of follow up of these recommendations is probably associated with a lack of well structured planning in their circulation and implementation. Also, although the recommendations of these guidelines agree in what is essential, they differ in other aspects, which in turn could be determining factors in clinical practice. The purpose of this article has been to establish the main differences in the recommendations that the principal clinical practice guidelines on the disease propose on the diagnosis, classification and treatment of asthma. To do this we have compared, The British Guideline on the Management of Asthma 2007, The Global Strategy for Asthma Management and Prevention/Global Initiative for Asthma 2006 (GINA), the National Prevention program for Education on Asthma (Programa Nacional de Prevención para la Educación del Asma) (NAEPP), the Spanish Guide for the Management of Asthma (Guía Española para el Manejo del Asma 2003) (GEMA) and the ALAT y SEPAR guides, Latin-America and Spain. Recommendations for the Prevention and Treatment of Asthma Exacerbation (América Latina y España. Recomendaciones para la Prevención y el Tratamiento de la Exacerbación Asmática 2008) (ALERTA).

  6. Using Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) Complemented with Selected 16S rRNA and gyrB Genes Sequencing to Practically Identify Clinical Important Viridans Group Streptococci (VGS).

    Science.gov (United States)

    Zhou, Menglan; Yang, Qiwen; Kudinha, Timothy; Zhang, Li; Xiao, Meng; Kong, Fanrong; Zhao, Yupei; Xu, Ying-Chun

    2016-01-01

    There are challenges in viridans group streptococci (VGS) identification especially for the mitis group. Few studies have investigated the performance of MALDI-TOF MS system in VGS identification. Using 16S rRNA gene and gyrB gene sequencing as a gold standard, the performance of two MALDI-TOF MS instruments in the identification of 181 VGS clinical isolates was studied. The Bruker Biotyper and Vitek MS IVD systems correctly identified 88.4% and 98.9% of the 181 isolates, respectively. The Vitek MS RUO system was the least reliable, only correctly identifying 38.7% of the isolates to species level with several misidentifications and invalid results. The Bruker Biotyper system was very unreliable in the identification of species within the mitis group. Among 22 non-pneumococci isolates (S. mitis/S. oralis/S. pseudopneumoniae), Biotyper misidentified 21 of them as S. pneumoniae leading to a low sensitivity and low positive predictive value in these species. In contrast, the Vitek MS IVD demonstrated a better resolution for pneumococci and non-pneumococci despite the inability to distinguish between S. mitis/S. oralis. For more accurate species-level identification, further improvements in the VGS spectra databases are needed. Based on MALDI-TOF analysis and selected 16S rRNA gene plus gyrB genes sequencing, we designed a practical VGS identification algorithm.

  7. Using Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) Complemented with Selected 16S rRNA and gyrB Genes Sequencing to Practically Identify Clinical Important Viridans Group Streptococci (VGS).

    Science.gov (United States)

    Zhou, Menglan; Yang, Qiwen; Kudinha, Timothy; Zhang, Li; Xiao, Meng; Kong, Fanrong; Zhao, Yupei; Xu, Ying-Chun

    2016-01-01

    There are challenges in viridans group streptococci (VGS) identification especially for the mitis group. Few studies have investigated the performance of MALDI-TOF MS system in VGS identification. Using 16S rRNA gene and gyrB gene sequencing as a gold standard, the performance of two MALDI-TOF MS instruments in the identification of 181 VGS clinical isolates was studied. The Bruker Biotyper and Vitek MS IVD systems correctly identified 88.4% and 98.9% of the 181 isolates, respectively. The Vitek MS RUO system was the least reliable, only correctly identifying 38.7% of the isolates to species level with several misidentifications and invalid results. The Bruker Biotyper system was very unreliable in the identification of species within the mitis group. Among 22 non-pneumococci isolates (S. mitis/S. oralis/S. pseudopneumoniae), Biotyper misidentified 21 of them as S. pneumoniae leading to a low sensitivity and low positive predictive value in these species. In contrast, the Vitek MS IVD demonstrated a better resolution for pneumococci and non-pneumococci despite the inability to distinguish between S. mitis/S. oralis. For more accurate species-level identification, further improvements in the VGS spectra databases are needed. Based on MALDI-TOF analysis and selected 16S rRNA gene plus gyrB genes sequencing, we designed a practical VGS identification algorithm. PMID:27617008

  8. The Sherlock Holmes method in clinical practice.

    Science.gov (United States)

    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.

  9. Clinical practice guideline: screening and diagnosing autism.

    Science.gov (United States)

    Blackwell, J

    2001-12-01

    The clinical practice guideline (CPG) reviewed in this month's column concerns the screening and diagnosis of autism. Autism is the third most common developmental disability and affects more than 1 in 500 children, or nearly 400,000 people in the United States, in some form. Primary care providers of children, including pediatric nurse practitioners (PNPs) and family nurse practitioners (FNPs), should reasonably expect to care for at least one child with autism (CWA). The American Academy of Neurology (AAN) has therefore developed guidelines to help healthcare providers facilitate the early identification of children with autism.

  10. The Sherlock Holmes method in clinical practice.

    Science.gov (United States)

    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

  11. Biosensors in Clinical Practice: Focus on Oncohematology

    Directory of Open Access Journals (Sweden)

    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.

  12. CLINICAL EVALUATION OF SELECTED COLOURING HERBALS IN SAVARNIKARAN

    Directory of Open Access Journals (Sweden)

    Wadikar Sujata Surendra

    2013-03-01

    Full Text Available A Clinical study on "Clinical Evaluation of Selected Colouring Herbals in Savarnikaran" was carried out at shalya tantra dept. of M.A.Podar Hospital, Worli, Mumbai 18. The prime aim of the study is to make available an effective, alternative colouring cosmetic preparations which will be useful in post burn, post acne and post wound colour morbidity.Ayurvedic herbal drugs are abundant, easily available and cost effective but their use is not observed in all forms. The trial drug is prepared in powder-paste, oil and ointment form. Further the efficacy of the different preparation is also evaluated separately. Cosmetic aspect of ayurvedic surgery is neglected, here we attempt to bring this aspect in routine practice.Total number of 40 patients were studied in this clinical study.Observations were documented through specially designed clinical record form and relevant conclusions were drawn.

  13. Taking PDT into mainstream clinical practice

    Science.gov (United States)

    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.

  14. How to critically appraise a clinical practice guideline

    OpenAIRE

    Clubb, Adrian B.; Dahm, Philipp

    2011-01-01

    Purpose: Clinical practice guidelines play a critical role in guiding the evidence-based clinical practice of urology. We describe a systematic approach to critical appraisal of urology guidelines. Materials and Methods: Based on a focused clinical question derived from a clinical scenario, we identified a relevant clinical practice guideline that we critically appraised using the Users’ Guide to the Medical Literature framework as to whether the results are valid, what are the results, and c...

  15. Detecting referral and selection bias by the anonymous linkage of practice, hospital and clinic data using Secure and Private Record Linkage (SAPREL: case study from the evaluation of the Improved Access to Psychological Therapy (IAPT service

    Directory of Open Access Journals (Sweden)

    Parry Glenys

    2011-10-01

    Full Text Available Abstract Background The evaluation of demonstration sites set up to provide improved access to psychological therapies (IAPT comprised the study of all people identified as having common mental health problems (CMHP, those referred to the IAPT service, and a sample of attenders studied in-depth. Information technology makes it feasible to link practice, hospital and IAPT clinic data to evaluate the representativeness of these samples. However, researchers do not have permission to browse and link these data without the patients' consent. Objective To demonstrate the use of a mixed deterministic-probabilistic method of secure and private record linkage (SAPREL - to describe selection bias in subjects chosen for in-depth evaluation. Method We extracted, pseudonymised and used fuzzy logic to link multiple health records without the researcher knowing the patient's identity. The method can be characterised as a three party protocol mainly using deterministic algorithms with dynamic linking strategies; though incorporating some elements of probabilistic linkage. Within the data providers' safe haven we extracted: Demographic data, hospital utilisation and IAPT clinic data; converted post code to index of multiple deprivation (IMD; and identified people with CMHP. We contrasted the age, gender, ethnicity and IMD for the in-depth evaluation sample with people referred to IAPT, use hospital services, and the population as a whole. Results The in IAPT-in-depth group had a mean age of 43.1 years; CI: 41.0 - 45.2 (n = 166; the IAPT-referred 40.2 years; CI: 39.4 - 40.9 (n = 1118; and those with CMHP 43.6 years SEM 0.15. (n = 12210. Whilst around 67% of those with a CMHP were women, compared to 70% of those referred to IAPT, and 75% of those subject to in-depth evaluation (Chi square p Conclusions The sample studied in-depth were older, more likely female, and less deprived than people with CMHP, and fewer had recorded ethnic minority status. Anonymous

  16. Detecting referral and selection bias by the anonymous linkage of practice, hospital and clinic data using Secure and Private Record Linkage (SAPREL): case study from the evaluation of the Improved Access to Psychological Therapy (IAPT) service

    Science.gov (United States)

    2011-01-01

    Background The evaluation of demonstration sites set up to provide improved access to psychological therapies (IAPT) comprised the study of all people identified as having common mental health problems (CMHP), those referred to the IAPT service, and a sample of attenders studied in-depth. Information technology makes it feasible to link practice, hospital and IAPT clinic data to evaluate the representativeness of these samples. However, researchers do not have permission to browse and link these data without the patients' consent. Objective To demonstrate the use of a mixed deterministic-probabilistic method of secure and private record linkage (SAPREL) - to describe selection bias in subjects chosen for in-depth evaluation. Method We extracted, pseudonymised and used fuzzy logic to link multiple health records without the researcher knowing the patient's identity. The method can be characterised as a three party protocol mainly using deterministic algorithms with dynamic linking strategies; though incorporating some elements of probabilistic linkage. Within the data providers' safe haven we extracted: Demographic data, hospital utilisation and IAPT clinic data; converted post code to index of multiple deprivation (IMD); and identified people with CMHP. We contrasted the age, gender, ethnicity and IMD for the in-depth evaluation sample with people referred to IAPT, use hospital services, and the population as a whole. Results The in IAPT-in-depth group had a mean age of 43.1 years; CI: 41.0 - 45.2 (n = 166); the IAPT-referred 40.2 years; CI: 39.4 - 40.9 (n = 1118); and those with CMHP 43.6 years SEM 0.15. (n = 12210). Whilst around 67% of those with a CMHP were women, compared to 70% of those referred to IAPT, and 75% of those subject to in-depth evaluation (Chi square p < 0.001). The mean IMD score for the in-depth evaluation group was 36.6; CI: 34.2 - 38.9; (n = 166); of those referred to IAPT 38.7; CI: 37.9 - 39.6; (n = 1117); and of people with CMHP 37.6; CI 37

  17. Clinical application of pharmacogenetics: focusing on practical issues.

    Science.gov (United States)

    Chang, Matthew T; McCarthy, Jeanette J; Shin, Jaekyu

    2015-01-01

    Recent large-scale genetic-based studies have transformed the field of pharmacogenetics to identify, characterize and leverage genetic information to inform patient care. Genetic testing can be used to alter drug selection, optimize drug dosing and prevent unnecessary adverse events. As precision medicine becomes the mainstay in the clinic, it becomes critical for clinicians to utilize pharmacogenetics to guide patient care. One primary challenge is identifying patients where genetic tests that can potentially impact patient care. To address this challenge, our review highlights many practical issues clinicians may encounter: identifying candidate patients and clinical laboratories for pharmacogenetic testing, selecting highly curated resources to help asses test validity, reimbursing costs of pharmacogenetic tests, and interpreting of pharmacogenetic test results.

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

    Science.gov (United States)

    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

  19. PRACTICAL CHRONIC PAIN ASSESSMENT TOOLS IN CLINICAL PRACTICE.

    Science.gov (United States)

    Loncarić-Katušin, Mirjana; Milošević, Milan; Žilić, Antonio; Mišković, Petar; Majerić-Kogler, Višnja; Žunić, Josip

    2016-03-01

    The aim of the study was to show the role of tools in the evaluation of chronic pain (CP) in general practitioner (GP) everyday clinical practice. The study was done by analyzing electronic database of the first visits of 1090 CP patients referred to the Pain Clinic of the Karlovac General Hospital, Karlovac, Croatia, by their GPs. All patient records were analyzed according to the cause of CP, strongest pain a week before the examination, quality of sleep, and the Patients' Global Impression of Change scale. All statistical analyses were done using the IBM SPSS Statistics version 19.0.0.1 (www.spss.com). CP predominantly occurs in older age group. Patients with musculoskeletal pain accounted for the highest percentage (n = 316; 29%), followed by those with neuropathic pain (n = 253; 23.20%) and those with low back pain (n = 225; 20.60%). The mean pain intensity rating scale score was 8.3 ± 1.8 a week before the examination and the mean quality of sleep score was 6.8 ± 1.9. Moderate and severe sleep quality disorder was significantly present in patients over 65 years of age (p = 0.007), patients with musculoskeletal and neuropathic pain, back pain, and those having rated Patients' Global Impression of Change scale as worsening (p = 0.001). The severity of pain and poor quality of sleep are the leading causes of deterioration of the Patients' Global Impression of Change scale in patients suffering from musculoskeletal and neuropathic pain. In order to treat CP comprehensively, it is important for GPs to evaluate the outcomes of clinical treatment using tools for CP assessment. PMID:27276768

  20. Hand kinematics: Application in clinical practice

    Directory of Open Access Journals (Sweden)

    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.

  1. Nurses' intention to apply clinical practice guidelines.

    Science.gov (United States)

    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

  2. Integrating nurse researchers in clinical practice

    DEFF Research Database (Denmark)

    Hølge-Hazelton, Bibi; Kjerholt, Mette; Bertelsen, Connie Bøttcher;

    2016-01-01

    on the approaches to evidence-based practice seen in the cases. Results: Regardless of same position, formal level of research expertise and overall responsibility, different approaches related to each ANPs professional profile, interest, academic ambitions and personality were seen. Conclusion: Nurse leaders must......Aim: To create awareness among nurse leaders, of what they may need toconsider, when integrating nurse researchers as advanced nurse practitioners(ANP) at PhD-level among their staff. Background: In a time of transition nurse leaders may be challenged by the change towards evidence-based clinical...... ensure a process where the content and expectations of the particular role are mutually clarified and adjusted to the individual ANP and to the specific context, in order to create a harmonious match. Implications for nursing management In order to clarify expectations regarding the inclusion of nurse...

  3. Ten practical, theory-based tips for clinical course planners

    DEFF Research Database (Denmark)

    Balslev, T.; Westphall, I.; Blichfeldt, S.;

    2008-01-01

    A list of practical advice and examples are given based on the literature. E-learning with cliffhanger text-cases can activate prior knowledge, and selected examination skills can be trained with simulated patients. Patient video recordings can be used to train clinical reasoning skills, including...... pattern recognition and hypothetic-deductive approaches. Interactive approaches, for example, questioning, quizzes or buzz groups imply active involvement and participation. Quizzes and MCQ-testing can provide a formative 'check-up' on learning and point to gaps in understanding for the teachers...

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

    OpenAIRE

    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...

  5. Application of scientific developments into clinical practice

    International Nuclear Information System (INIS)

    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

  6. Incorporation of pharmacogenomics into routine clinical practice: the Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline development process.

    Science.gov (United States)

    Caudle, Kelly E; Klein, Teri E; Hoffman, James M; Muller, Daniel J; Whirl-Carrillo, Michelle; Gong, Li; McDonagh, Ellen M; Sangkuhl, Katrin; Thorn, Caroline F; Schwab, Matthias; Agundez, Jose A G; Freimuth, Robert R; Huser, Vojtech; Lee, Ming Ta Michael; Iwuchukwu, Otito F; Crews, Kristine R; Scott, Stuart A; Wadelius, Mia; Swen, Jesse J; Tyndale, Rachel F; Stein, C Michael; Roden, Dan; Relling, Mary V; Williams, Marc S; Johnson, Samuel G

    2014-02-01

    The Clinical Pharmacogenetics Implementation Consortium (CPIC) publishes genotype-based drug guidelines to help clinicians understand how available genetic test results could be used to optimize drug therapy. CPIC has focused initially on well-known examples of pharmacogenomic associations that have been implemented in selected clinical settings, publishing nine to date. Each CPIC guideline adheres to a standardized format and includes a standard system for grading levels of evidence linking genotypes to phenotypes and assigning a level of strength to each prescribing recommendation. CPIC guidelines contain the necessary information to help clinicians translate patient-specific diplotypes for each gene into clinical phenotypes or drug dosing groups. This paper reviews the development process of the CPIC guidelines and compares this process to the Institute of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines.

  7. Potential uses of probiotics in clinical practice.

    Science.gov (United States)

    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

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

    Institute of Scientific and Technical Information of China (English)

    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.

  9. An innovative clinical practicum to teach evidence-based practice.

    Science.gov (United States)

    Brancato, Vera C

    2006-01-01

    A clinical practicum was successfully implemented for RN to BSN students to apply evidence-based practice to actual clinical problems affecting nursing practice. The author describes how this practicum was implemented and the requisite resources and support systems. This senior-level capstone course enabled students to understand and value a lifelong learning approach to evidence-based practice.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Variable selection: Current practice in epidemiological studies

    NARCIS (Netherlands)

    S. Walter (Stefan); H.W. Tiemeier (Henning)

    2009-01-01

    textabstractSelection of covariates is among the most controversial and difficult tasks in epidemiologic analysis. Correct variable selection addresses the problem of confounding in etiologic research and allows unbiased estimation of probabilities in prognostic studies. The aim of this commentary i

  12. Translating guidelines into practice: a systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines

    OpenAIRE

    Davis, D A; Taylor-Vaisey, A

    1997-01-01

    OBJECTIVE: To recommend effective strategies for implementing clinical practice guidelines (CPGs). DATA SOURCES: The Research and Development Resource Base in Continuing Medical Education, maintained by the University of Toronto, was searched, as was MEDLINE from January 1990 to June 1996, inclusive, with the use of the MeSH heading "practice guidelines" and relevant text words. STUDY SELECTION: Studies of CPG implementation strategies and reviews of such studies were selected. Randomized con...

  13. Study of Clinical Practical Model of Urinary System Injury

    Directory of Open Access Journals (Sweden)

    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.

  14. Conceptualizing clinical nurse leader practice: an interpretive synthesis.

    OpenAIRE

    Bender, M

    2015-01-01

    BACKGROUND: The Institute of Medicine's Future of Nursing report identifies the clinical nurse leader as an innovative new role for meeting higher health-care quality standards. However, specific clinical nurse leader practices influencing documented quality outcomes remain unclear. Lack of practice clarity limits the ability to articulate, implement and measure clinical nurse leader-specific practice and quality outcomes. PURPOSE AND METHODS: Interpretive synthesis design and grounded theory...

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

    OpenAIRE

    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.

  16. 29 CFR 1605.3 - Selection practices.

    Science.gov (United States)

    2010-07-01

    ... the conduct of the business”. 29 CFR 1605.1(a)(2), 31 FR 3870 (1966). In 1967, the Commission revised... create an “undue hardship”. 29 CFR 1605.1(b)(c), 32 FR 10298. In 1972, Congress amended title VII to...: —Observance of a Sabbath or religious holidays; —Need for prayer break during working hours; —Practice...

  17. Research Mathematicians' Practices in Selecting Mathematical Problems

    Science.gov (United States)

    Misfeldt, Morten; Johansen, Mikkel Willum

    2015-01-01

    Developing abilities to create, inquire into, qualify, and choose among mathematical problems is an important educational goal. In this paper, we elucidate how mathematicians work with mathematical problems in order to understand this mathematical process. More specifically, we investigate how mathematicians select and pose problems and discuss to…

  18. Towards a more rational use of psychoactive substances in clinical practice.

    NARCIS (Netherlands)

    Hyfte, D. van; Vries Robbé, P.F. de; Tjandra-Maga, T.B.; Maas, A.A.F. van der; Zitman, F.G.

    2001-01-01

    Complex knowledge and data intensive nature of the psychoactive drug selection and prescription process often makes for irrational and inconsistent use of psychoactive drugs in clinical practice. After describing the state of the art with respect to psychoactive drug prescription practices and selec

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

    Science.gov (United States)

    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

  20. Pareto Fronts in Clinical Practice for Pinnacle

    Energy Technology Data Exchange (ETDEWEB)

    Janssen, Tomas; Kesteren, Zdenko van; Franssen, Gijs; Damen, Eugène [Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Vliet, Corine van, E-mail: c.v.vliet@nki.nl [Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands)

    2013-03-01

    Purpose: Our aim was to develop a framework to objectively perform treatment planning studies using Pareto fronts. The Pareto front represents all optimal possible tradeoffs among several conflicting criteria and is an ideal tool with which to study the possibilities of a given treatment technique. The framework should require minimal user interaction and should resemble and be applicable to daily clinical practice. Methods and Materials: To generate the Pareto fronts, we used the native scripting language of Pinnacle{sup 3} (Philips Healthcare, Andover, MA). The framework generates thousands of plans automatically from which the Pareto front is generated. As an example, the framework is applied to compare intensity modulated radiation therapy (IMRT) with volumetric modulated arc therapy (VMAT) for prostate cancer patients. For each patient and each technique, 3000 plans are generated, resulting in a total of 60,000 plans. The comparison is based on 5-dimensional Pareto fronts. Results: Generating 3000 plans for 10 patients in parallel requires on average 96 h for IMRT and 483 hours for VMAT. Using VMAT, compared to IMRT, the maximum dose of the boost PTV was reduced by 0.4 Gy (P=.074), the mean dose in the anal sphincter by 1.6 Gy (P=.055), the conformity index of the 95% isodose (CI{sub 95%}) by 0.02 (P=.005), and the rectal wall V{sub 65} {sub Gy} by 1.1% (P=.008). Conclusions: We showed the feasibility of automatically generating Pareto fronts with Pinnacle{sup 3}. Pareto fronts provide a valuable tool for performing objective comparative treatment planning studies. We compared VMAT with IMRT in prostate patients and found VMAT had a dosimetric advantage over IMRT.

  1. Evaluation and treatment of hypertriglyceridemia: an endocrine society clinical practice guideline.

    NARCIS (Netherlands)

    Berglund, L.; Brunzell, J.D.; Goldberg, A.C.; Goldberg, I.J.; Sacks, F.; Murad, M.H.; Stalenhoef, A.F.H.

    2012-01-01

    Objective: The aim was to develop clinical practice guidelines on hypertriglyceridemia. Participants: The Task Force included a chair selected by The Endocrine Society Clinical Guidelines Subcommittee (CGS), five additional experts in the field, and a methodologist. The authors received no corporate

  2. Developing a Critical Practice of Clinical Supervision.

    Science.gov (United States)

    Smyth, W. John

    1985-01-01

    The etymology of the term "clinical supervision" is discussed. How clinical supervision can be used with teachers as an active force toward reform and change is then examined. Through clinical supervision teachers can assist each other to gain control over their own professional lives and destinies. (RM)

  3. Research mathematicians’ practices in selecting mathematical problems

    DEFF Research Database (Denmark)

    Misfeldt, Morten; Johansen, Mikkel Willum

    2015-01-01

    and suggest that mathematics education research could further investigate how students select and develop problems, work with multiple problems over a longer period of time, and use the solutions to problems to support the development of new problems. Furthermore, the negative emotional aspects of being stuck...... in problem solving and students’ conceptions of solvability and relevance of or interest in a mathematical problem are areas of research suggested by our study.......Developing abilities to create, inquire into, qualify, and choose among mathematical problems is an important educational goal. In this paper, we elucidate how mathematicians work with mathematical problems in order to understand this mathematical process. More specifically, we investigate how...

  4. Defining Clinical Excellence in Adult Infectious Disease Practice.

    Science.gov (United States)

    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

  5. Defining Clinical Excellence in Adult Infectious Disease Practice

    Science.gov (United States)

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

    2016-01-01

    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

  6. Selected fascial aspects of osteopathic practice.

    Science.gov (United States)

    Tozzi, Paolo

    2012-10-01

    Fascia is a connective tissue organised as a three-dimensional network that surrounds, supports, suspends, protects, connects and divides muscular, skeletal and visceral components of the body. Studies suggest that fascia reorganises itself along the lines of tension imposed or expressed in the body, and in ways that may cause repercussions to fascial restriction that are body-wide. This may potentially create stress on any structures enveloped by fascia itself, with consequent mechanical and physiological effects. From an osteopathic perspective, fascial techniques aim to release such tensions, decrease pain and restore function. The proposed mechanism for fascial techniques is based on various studies that have looked at the plastic, viscoelastic and piezoelectric properties of connective tissue. This review explores some of the features described above, together with evidence supporting the therapeutic efficacy of fascial manipulation, offering a selected overview of the fascial component in osteopathic assessment and treatment. PMID:23036882

  7. Evidence-based clinical practice guidelines for liver cirrhosis 2015.

    Science.gov (United States)

    Fukui, Hiroshi; Saito, Hidetsugu; Ueno, Yoshiyuki; Uto, Hirofumi; Obara, Katsutoshi; Sakaida, Isao; Shibuya, Akitaka; Seike, Masataka; Nagoshi, Sumiko; Segawa, Makoto; Tsubouchi, Hirohito; Moriwaki, Hisataka; Kato, Akinobu; Hashimoto, Etsuko; Michitaka, Kojiro; Murawaki, Toshikazu; Sugano, Kentaro; Watanabe, Mamoru; Shimosegawa, Tooru

    2016-07-01

    The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for

  8. The role of fluorescence diagnosis in clinical practice

    Directory of Open Access Journals (Sweden)

    Sieroń A

    2013-07-01

    Full Text Available Aleksander Sieroń,1 Karolina Sieroń-Stołtny,1 Aleksandra Kawczyk-Krupka,1 Wojciech Latos,1 Sebastian Kwiatek,1 Dariusz Straszak,1 Andrzej M Bugaj1,2 1Clinical Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Silesian Medical University, Bytom, 2College of Health, Beauty Care and Education, Poznan, Poland Abstract: Fluorescence diagnosis is a fast, easy, noninvasive, selective, and sensitive diagnostic tool for estimation of treatment results in oncology. In clinical practice the use of photodynamic diagnosis is focused on five targets: detection for prevention of malignant transformation precancerous changes, detection of neoplasmatic tissue in the early stages for fast removal, prevention of expansion and detection of recurrence of the cancer, monitoring therapy, and the possibility of excluding neoplasmatic disease. In this article, selected applications of fluorescence diagnosis at the Center for Laser Diagnostics and Therapy in Bytom, Poland, for each of these targets are presented. Keywords: autofluorescence, cancer, fluorescence, imaging, photodynamic diagnosis, photodynamic therapy 

  9. Relationships among Selected Practice Behaviours and Achievement in Jazz Improvisation

    Science.gov (United States)

    Watson, Kevin E.

    2015-01-01

    The purpose of this exploratory study was to examine the practice strategies that collegiate music majors chose to employ in preparing for a jazz improvisation performance, and the relationships among selected practice behaviours and achievement in instrumental jazz improvisation. Participants for the study (N = 62) were enrolled as music majors…

  10. Advancing evidence-based practice in primary care physiotherapy : Guideline implementation, clinical practice, and patient preferences

    OpenAIRE

    Bernhardsson, Susanne

    2015-01-01

    Research on physiotherapy treatment interventions has increased dramatically in the past 25 years and it is a challenge to transfer research findings into clinical practice, so that patients benefit from effective treatment. Development of clinical practice guidelines is a potentially useful strategy to implement research evidence into practice. However, the impact of guideline implementation in Swedish primary care physiotherapy is unknown. To achieve evidence-based practice (EBP), research ...

  11. PRINCIPLES AND PRACTICES OF SEED SELECTION NOWADAYS

    Directory of Open Access Journals (Sweden)

    Efremova V. V.

    2015-02-01

    Full Text Available The article presents the author’s insight into the theoretical foundations of plant breeding for self-pollinators and cross-pollinators. From the author’s point of view, plant breeding techniques depend on a type of pollination, population propagation and isolation from other variety pollen. Adaptive properties of crops are described as ones depending on a genetic type (genetically pure lines, populations, hybrids, pure varieties and clones. The key role of seeds in preserving a plant variety, or a cultivar, is emphasized. In the article, cultivar and yield qualities of seeds are characterized. The reasons for seed deterioration and yield decrease have been looked into. Improvement of main crops such as wheat, barley, rye, rice, soybeans, maize, triticale, sunflowers, potatoes, sugar beets is characterized in detail. The author shares the traditional point of view on the seed breeding program. It includes following steps: development phase (breeder’s seed, maintenance phase (in which a quantity of seed is maintained under high standards and the distribution phase (production of commercial seed for distribution to the public. The difference between primary and secondary seed selection is explained. The best periods for crop rotation and crop renovation are also described. The legally enforceable standards of quality and genetic purity for different crops are presented in the article. It is pointed out that it is vital to maintain high cultivar qualities after multiplication and distribution of the new variety. Only large-scale pedigree system for seed production promotes it

  12. Communication course for midwives teaching students in clinical practice

    DEFF Research Database (Denmark)

    Nielsen, Annegrethe; Pedersen, Pernille Mølholt

    2016-01-01

    -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...... taking place in clinical practice and try to align the educational efforts in school and clinical settings for the benefit of the students PERSPECTIVES It is known that students in medical education find that clinical learning experiences do not reinforce the communication skills they learn pre...

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

    OpenAIRE

    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 ...

  14. Using socioeconomic evidence in clinical practice guidelines

    OpenAIRE

    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

  15. Study of Clinical Practical Model of Urinary System Injury

    Institute of Scientific and Technical Information of China (English)

    Gang Li; Yuan-Yi Wu; Wei-Jun Fu; Ying-Xin Jia; Bing-Hong Zhang; Yong-De Xu; Zhong-Xin Wang

    2015-01-01

    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.

  16. Radiopharmacy - clinical reality and selected research demands

    International Nuclear Information System (INIS)

    My presentation aims at focusing on clinical reality of 18F-fluorodeoxyglucose (FDG)-PET in three major medical specialities and to touch some of the demands in clinical PET research out of the sight of my view. Using of FDG in nuclear medicine is reviewed. (author)

  17. Asymptomatic Bacteriuria in Clinical Urological Practice

    DEFF Research Database (Denmark)

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

    2016-01-01

    issues in everyday urological practice that require special attention: the role of ABU in pre-operative prophylaxis and in women affected by recurrent urinary tract infections (rUTIs). Nowadays, this is the time to think over our practice and change our way of thinking. Here, we aimed to summarize...... the current literature knowledge in terms of ABU management in patients undergoing urological surgery and in patients with rUTIs. In the last years, the approach to patient with ABU has changed totally. Prior to all surgical procedures that do not enter the urinary tract, ABU is generally not considered...

  18. Student-selected components in surgery: providing practical experience and increasing student confidence.

    LENUS (Irish Health Repository)

    Falk, G A

    2009-09-01

    Reviews of the medical school curriculum in the UK and Ireland have recommended the introduction of student-selected components (SSCs). The Department of Surgery in The Royal College of Surgeons in Ireland (RCSI) has introduced a 6-week surgical SSC, which aims to develop practical clinical skills, provide mentorship and prepare students for internship.

  19. A study on the perception of students in the radiologic technology study on the clinical practices

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Ryul; Kim, Hyun Gil; Yoon, Myeong Kwan; Lee, Gi Jong; Cha, Sang Young [Dept. of Diagnostic Radiology, Inha University Hospital, Incheon (Korea, Republic of); Lim, Cheong Hwan [Dept. of Radiological Science, Hanseo University, Seosan (Korea, Republic of)

    2014-09-15

    The clinical practices provide the students with a good opportunity to study the practical experiences in their field through the clinical training education in hospital. Now, in this study, comparing the perceptions of the clinic teachers with those of students at the clinical site. The study was conducted to the students attending universities located in Seoul and who finished the clinical practices in 2013. The questionnaires were distributed to the student and collected from them. The study were conducted to 275 questionnaires with frequency analysis, crosstabs, chi-square test and McNemar test. The major motivation was of the select radiography course was high employment rate(44.0%) and the satisfaction of radiography course was general(53.1%). 51.3% of the study answered 8 weeks current duration of clinical practices is proper. The 3-year course students answered that the period of clinical practices would be proper if it is performed in the winter vacation in their second year in college(47.3%). The 4-year course students answered that the first semester in their third years is proper for clinical practices(27.7%). The students answered that they felt the lack in their knowledge on the professional field(32.4%) during the clinical practices and some of the practical training is different from the education performed at school(68.4%). Most of answered that they were satisfied with the clinical practices and among them they recognized the importance of the clinical practices (3.94 ± 0.89). After the clinical practices, their desire for getting job as a radiography has changed from 84.1% to 82.9%. The reason why they want the job related to the radiation is because the job is stable (changed from 49.0% to 46.0% after the clinical practice) while the reason why they do not want be a radigrapher because that job is not proper for them (changed from 37.0% to 40.7% after the clinical practice) The effort should be made to enhance the position of radiation

  20. A study on the perception of students in the radiologic technology study on the clinical practices

    International Nuclear Information System (INIS)

    The clinical practices provide the students with a good opportunity to study the practical experiences in their field through the clinical training education in hospital. Now, in this study, comparing the perceptions of the clinic teachers with those of students at the clinical site. The study was conducted to the students attending universities located in Seoul and who finished the clinical practices in 2013. The questionnaires were distributed to the student and collected from them. The study were conducted to 275 questionnaires with frequency analysis, crosstabs, chi-square test and McNemar test. The major motivation was of the select radiography course was high employment rate(44.0%) and the satisfaction of radiography course was general(53.1%). 51.3% of the study answered 8 weeks current duration of clinical practices is proper. The 3-year course students answered that the period of clinical practices would be proper if it is performed in the winter vacation in their second year in college(47.3%). The 4-year course students answered that the first semester in their third years is proper for clinical practices(27.7%). The students answered that they felt the lack in their knowledge on the professional field(32.4%) during the clinical practices and some of the practical training is different from the education performed at school(68.4%). Most of answered that they were satisfied with the clinical practices and among them they recognized the importance of the clinical practices (3.94 ± 0.89). After the clinical practices, their desire for getting job as a radiography has changed from 84.1% to 82.9%. The reason why they want the job related to the radiation is because the job is stable (changed from 49.0% to 46.0% after the clinical practice) while the reason why they do not want be a radigrapher because that job is not proper for them (changed from 37.0% to 40.7% after the clinical practice) The effort should be made to enhance the position of radiation

  1. 77 FR 49448 - Food and Drug Administration Clinical Trial Requirements, Compliance, and Good Clinical Practice...

    Science.gov (United States)

    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,...

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

    DEFF Research Database (Denmark)

    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 Den...

  3. Ambulatory Blood Pressure Monitoring – Clinical Practice Recommendations

    Directory of Open Access Journals (Sweden)

    Katalin Mako

    2016-09-01

    Full Text Available Ambulatory blood pressure monitoring (ABPM became a subject of considerable scientific interest. Due to the increasing use of the ABPM in everyday clinical practice it is important that all the users have a correct knowledge on the clinical indications, the methodology of using the device including some technical issues and the interpretation of results. In the last years several guidelines and position papers have been published with recommendations for the monitoring process, reference values, for clinical practice and research. This paper represents a summary of the most important aspects related to the use of ABPM in daily practice, being a synthesis of recommendations from the recent published guidelines and position papers. This reference article presents the practical and technical issues of ABPM, the use of this method in special situations, the clinical interpretation of measured values including the presentation of different ABPM patterns, derived parameters, the prognostic significance and the limitations of this method.

  4. Orienting Nursing Students to Cost Effective Clinical Practice.

    Science.gov (United States)

    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)

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

    OpenAIRE

    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 ...

  6. Evaluating clinical dermatology practice in medical undergraduates.

    Science.gov (United States)

    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

  7. [Hypnotic communication and hypnosis in clinical practice].

    Science.gov (United States)

    Wehrli, Hans

    2014-07-01

    In addition to usual medical care it is often critical to consider the patient's inner world in order to sensitively differentiate between harmful and helpful suggestive elements. The respective abilities in terms of hypnotic communication can be easily learned. Confident, empathic attention and a calm, understanding and figurative language narrowing the focus on positive emotions and positive change, which have been shown to improve the patient's chances of healing, are of particular importance. Proper clinical hypnosis goes one step further: it makes explicit use of suggestions, trance, and trance phenomena. The major clinical indications for hypnosis include psychosomatic disorders, anxiety disorders, obsessive-compulsive disorders, depression, and pain syndromes. Hypnosis can also be employed as an adjunct for surgical therapy.

  8. MRI with cardiac pacing devices – Safety in clinical practice

    International Nuclear Information System (INIS)

    Objectives: The aim of this study was to introduce a single centre “real life” experience of performing MRI examinations in clinical practice on patients with cardiac pacemaker systems. Additionally, we aimed to evaluate the safety of using a dedicated safety protocol for these patients. Materials and methods: We used a 1.5 T MRI scanner to conduct 68 MRI scans of different body regions in patients with pacing systems. Of the cardiac devices, 32% were MR-conditional, whereas the remaining 68% were MR-unsafe. We recorded the functional parameters of the devices prior, immediately after, and approximately one month after the MRI scanning, and compared the device parameters to the baseline values. Results: All MRI examinations were completed safely, and each device could be interrogated normally following the MRI. We observed no changes in the programmed parameters of the devices. For most of the participants, the distributions of the immediate and one-month changes in the device parameters were within 20% of the baseline values, although some changes approached clinically important thresholds. Furthermore, we observed no differences in the variable changes between MR-conditional and MR-unsafe pacing systems, or between scans of the thorax area and other scanned areas. Conclusion: MRI in patients with MR-conditional pacing systems and selected MR-unsafe systems could be performed safely under strict conditions in this study

  9. Clinical Activity in General Practice and Cancer

    DEFF Research Database (Denmark)

    Hjertholm, Peter

    2015-01-01

    disease was present in 6% of GP consultations, and the suspicion was associated with an increased use referrals and diagnostic imaging. The suspicion was associated with an increased risk of being diagnosed with serious disease including cancer and had a positive predictive value for a new diagnosis...... to reduce patients’ mortality and morbidity from cancer, but also because it probably pays to do so from a cost-effectiveness perspective. The findings in Study II underscore that the current guidelines regarding PSA testing for general practice should be followed to avoid inflicting iatrogenic harm...

  10. Characteristics and Clinical Practices of Rural Marriage and Family Therapists

    Science.gov (United States)

    Morris, James

    2007-01-01

    This report presents a subset of data collected from the American Association for Marriage and Family Therapy (AAMFT) Practice Research Network project conducted in 2002. A sample of 47 clinical members of AAMFT who indicated they practiced in a rural community provided descriptive information on demographic characteristics, training, clinical…

  11. Active Interventions in Clinical Practice: Contributions of Gestalt Therapy.

    Science.gov (United States)

    Lammert, Marilyn; Dolan, Mary M.

    1983-01-01

    Describes two dimensions of Gestalt therapy that can enhance clinical practice--orientation to the present and active-experimental style--and examines them in relation to some traditional principles of practice. Gestalt theory offers a method of discovery that is a combination of phenomenology and behaviorism. (JAC)

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

    Science.gov (United States)

    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

  13. Literature and medicine: contributions to clinical practice.

    Science.gov (United States)

    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

  14. Literature and medicine: contributions to clinical practice.

    Science.gov (United States)

    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.

  15. Prioritization strategies in clinical practice guidelines development: a pilot study

    Directory of Open Access Journals (Sweden)

    Torres Marcela

    2010-03-01

    Full Text Available Abstract Objective Few methodological studies address the prioritization of clinical topics for the development of Clinical Practice Guidelines (CPGs. The aim of this study was to validate a methodology for Priority Determination of Topics (PDT of CPGs. Methods and results Firstly, we developed an instrument for PDT with 41 criteria that were grouped under 10 domains, based on a comprehensive systematic search. Secondly, we performed a survey of stakeholders involved in CPGs development, and end users of guidelines, using the instrument. Thirdly, a pilot testing of the PDT procedure was performed in order to choose 10 guideline topics among 34 proposed projects; using a multi-criteria analysis approach, we validated a mechanism that followed five stages: determination of the composition of groups, item/domain scoring, weights determination, quality of the information used to support judgments, and finally, topic selection. Participants first scored the importance of each domain, after which four different weighting procedures were calculated (including the survey results. The process of weighting was determined by correlating the data between them. We also reported the quality of evidence used for PDT. Finally, we provided a qualitative analysis of the process. The main domains used to support judgement, having higher quality scores and weightings, were feasibility, disease burden, implementation and information needs. Other important domains such as user preferences, adverse events, potential for health promotion, social effects, and economic impact had lower relevance for clinicians. Criteria for prioritization were mainly judged through professional experience, while good quality information was only used in 15% of cases. Conclusion The main advantages of the proposed methodology are supported by the use of a systematic approach to identify, score and weight guideline topics selection, limiting or exposing the influence of personal biases

  16. Clinical practice guidelines and patient decision aids. An inevitable relationship.

    NARCIS (Netherlands)

    Weijden, T. van der; Boivin, A.; Burgers, J.S.; Schunemann, H.J.; Elwyn, G.

    2012-01-01

    As health professionals and patients are moving toward shared models of decision making, there is a growing need for integrated decision support tools that facilitate uptake of best evidence in routine clinical practice in a patient-centered manner. This article charts the landscape of clinical prac

  17. Improving Clinical Practices for Children with Language and Learning Disorders

    Science.gov (United States)

    Kamhi, Alan G.

    2014-01-01

    Purpose: This lead article of the Clinical Forum addresses some of the gaps that exist between clinical practice and current knowledge about instructional factors that influence learning and language development. Method: Topics reviewed and discussed include principles of learning, generalization, treatment intensity, processing interventions,…

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

    Science.gov (United States)

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

    1999-09-01

    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 ecology, as well as evidence from systematic literature reviews on the effectiveness of various behaviour change strategies. The framework emphasises the need for preimplementation assessment of (a) readiness of clinicians to adopt guidelines into practice, (b) barriers to change as experienced by clinicians, and (c) the level at which interventions should be targeted. It also incorporates the need for multifaceted interventions, identifies the type of barriers which will be addressed by each strategy, and develops the concept of progression through stages of guideline adoption by clinicians, with the use of appropriately targeted support strategies. The potential value of the model is that it may enable those involved in the process of guideline dissemination and implementation to direct strategies to target groups more effectively. Clearly, the effectiveness and utility of the model in facilitating guideline dissemination and implementation requires validation by further empirical research. Until such research is available, it provides a theoretical framework that may assist in the selection of appropriate guideline dissemination and implementation strategies. PMID:10847875

  19. Clinical Practice Guideline for Vitamin D

    Science.gov (United States)

    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.

  20. Clinical practice: Helicobacter pylori infection in childhood.

    Science.gov (United States)

    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

  1. Nutritional aspects of detoxification in clinical practice.

    Science.gov (United States)

    Cline, John C

    2015-01-01

    Detoxification is a vital cellular task that, if lacking, can lead to early morbidity and mortality. The process of detoxification involves the mobilization, biotransformation, and elimination of toxicants of exogenous and endogenous origin. This article discusses the phase I and phase II detoxification and biotransformation pathways and promotes using food to support these highly complex processes. The author identifies the comprehensive elimination diet as a useful therapeutic tool for clinicians and patients to use to achieve detoxification. Using this diet, the patient removes the most common allergenic foods and beverages from the diet and replaces them with nonallergenic choices for a period of 4 wk, gradually adding back the eliminated foods and observing their effects. Another effective clinical tool that the author discusses is the detox-focused core food plan, which identifies the variety of foods required to supply key nutrients that can maximize the effectiveness of detoxification. Finally, the author provides a case study in which these tools were used to help a patient suffering from major, debilitating illnesses that resulted from exposure to malathion, including severe vomiting and diarrhea, headaches, night sweats, severe arthralgias and myalgias, episcleritis, and shortness of breath. The article details the interventions used and the clinical results (ie, successful resolution of most issues after 3 mo). PMID:26026145

  2. Functional MRI in clinical practice: a pictorial essay

    International Nuclear Information System (INIS)

    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.

  3. Exploring accountability of clinical ethics consultants: practice and training implications.

    Science.gov (United States)

    Weise, Kathryn L; Daly, Barbara J

    2014-01-01

    Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice.

  4. Clinical Practice Guidelines for Cutaneous Lymphomas.

    Science.gov (United States)

    Sutton, Angela M; Hurley, M Yadira

    2015-01-01

    Primary cutaneous lymphomas are non-Hodgkin lymphomas, which are broadly divided into cutaneous T-cell lymphomas and cutaneous B-cell lymphomas. These classifications include numerous distinct entities, all with varying clinical presentations and disease courses. Herein, we will review the cutaneous T-cell lymphomas, including Mycosis Fungoides, Sézary syndrome, CD30+ lymphoproliferative disorders, as well as other less common entities. Cutaneous B-cell lymphomas will also be discussed, including primary cutaneous marginal zoned lymphoma, cutaneous follicle-center lymphoma, diffuse large B-cell lymphoma, leg type, as well as other less common entities. Accurate and early diagnosis is key, as the treatment and prognosis varies significantly between conditions. PMID:26455060

  5. Canadian Clinical Practice Guidelines for Rosacea.

    Science.gov (United States)

    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

  6. Knowledge management practices at selected banks in South Africa

    Directory of Open Access Journals (Sweden)

    Joel Chigada

    2015-02-01

    Full Text Available Background: Effective knowledge organisations (EKO create dynamic capabilities through the acquisition, creation, sharing and retention of knowledge. These EKOs are designed to enable an organisation to improve best practices in business. As knowledge is different from other organisational resources, decision-makers ought to understand the importance of knowledge to an organisation. In order to fully utilise knowledge-management (KM practices and to enhance efficiency, management should appreciate and understand the importance of KM. A proper understanding of KM will add value to organisational knowledge. Objective: This study focused on investigating the knowledge-management practices at selected banks in South Africa. The objective was to establish the extent to which selected banks had implemented knowledge-management practices such as the acquisition, sharing and retention of knowledge.Method: Quantitative and qualitative data for this study were collected through the use of a multi-methods approach. Data were collected from middle and senior managers through the use of questionnaires and an interview protocol. All usable quantitative data were analysed using Survey Monkey and Microsoft Excel 2010 whilst thematic analysis was used to extract detailed, rich and complex data accounts from interviews. Results: Though the study revealed the presence of KM practices at selected banks, KM concepts were not universally understood, thus impeding the organisation-wide implementation of KM practices. Knowledge-management practices were only discussed as a footnote because no formal policies existed to add value to KM initiatives. Conclusion: The study concludes that organisations such as banks should perform a knowledge inventory. Knowledge inventories will become handy during the process of developing KM policies and practices for integrating work processes, collaborating and sharing (including the efficient use of knowledge technology platforms and

  7. A model for reflection for good clinical practice.

    Science.gov (United States)

    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

  8. Daptomycin, a lipopeptide antibiotic in clinical practice.

    Science.gov (United States)

    Weis, Florian; Beiras-Fernandez, Andres; Schelling, Gustav

    2008-08-01

    Gram-positive cocci are one of the leading causes of infections in clinical medicine. Since the invention of antibiotic substances, multidrug resistance is a major problem in the treatment of such infections. Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for 60% of nosocomial infections in the US. The first-choice drug used in these cases is the glycopeptide vancomycin; however, vancomycin is associated with a significant number of adverse side effects, such as nephro- and ototoxicity. Thus, the discovery of new drugs against MRSA and other multidrug-resistant cocci is of utmost interest. Daptomycin, a lipopeptide, is one of these new drugs and has been successfully used in the treatment of complicated skin and skin-structure infections and right-sided endocarditis. Because of its potency and pharmacological profile, it is increasingly used for new indications not yet approved by the FDA. The purpose of this article is to provide an overview of daptomycin, with particular emphasis on potential new indications for which it could be used in the future.

  9. Clinical practice: Obstructive renal candidiasis in infancy.

    Science.gov (United States)

    Bisht, Veena; Voort, Judith VanDer

    2011-10-01

    Renal candidiasis is an increasingly common condition affecting predominantly premature infants receiving neonatal intensive care or term infants with urogenital tract anomalies. Multiple risk factors are usually present. Although rare, some infants develop an obstructive uropathy due to fungal balls, and this requires prompt detection and intervention to preserve kidney function. The management of obstructive renal bezoars is challenging and not well summarised in the past. This is mainly due to scarce literature confined to case reports or case series only. This review clarifies various definitions used in relation to renal candidiasis and identifies infants particularly at risk of obstruction. Clinical presentation, diagnosis and the role of imaging are discussed. A summary of the recent literature is provided to outline the range of existing treatment options available with published drug dosages and mode of delivery used. No single approach is successful in all cases and clinicians need to be aware of the different options available: apart from adequate urinary drainage and use of systemic +/- local antifungal agents, additional treatment with fibrinolytic agents and/or endoscopic or open surgical removal may be required. A new simplified algorithm for use in management is proposed. We hope this review will help clinicians in their management of patients presenting with this complex and challenging diagnosis.

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

    Science.gov (United States)

    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

  11. Academic physiatry. Balancing clinical practice and academic activities.

    Science.gov (United States)

    Grabois, M

    1992-04-01

    The need for continued and diversified growth of both scholarly and clinical activities within academic physical medicine and rehabilitation (PM&R) departments is discussed with reference to the demands placed on academic departments by the various components of their mission, such as administration, clinical service, education and research. The expansion and improvement of clinical services should include the following components: program development, resources needed, finances required and marketing. Clinical subspecialization of faculty and solid affiliation with nonacademic hospitals and rehabilitation facilities is essential for academic PM&R. The faculty should include three categories: clinical faculty, clinical-research faculty and research faculty. Adequate financial resources must comprise an appropriate balance of academic funds, clinical income and grant sources. Clinical funds will play a greater role as other sources of funds diminish. Any practice plan must recognize the equality of the differing faculty members' practices, whether their interests are clinical, educational or research-oriented. The expansion and intensification of clinical programs by academy PM&R departments could increase competition in the medical community. Sensitivity to the perceptions of other practitioners and institutions, careful planning and cooperation will help the field grow and improve levels of care for the patients we serve in light of the changing medical care environment.

  12. DYNAMICALLY EVOLVING CLINICAL PRACTICES AND IMPLICATIONS FOR PREDICTING MEDICAL DECISIONS

    Science.gov (United States)

    CHEN, JONATHAN H; GOLDSTEIN, MARY K; ASCH, STEVEN M; ALTMAN, RUSS B

    2015-01-01

    Automatically data-mining clinical practice patterns from electronic health records (EHR) can enable prediction of future practices as a form of clinical decision support (CDS). Our objective is to determine the stability of learned clinical practice patterns over time and what implication this has when using varying longitudinal historical data sources towards predicting future decisions. We trained an association rule engine for clinical orders (e.g., labs, imaging, medications) using structured inpatient data from a tertiary academic hospital. Comparing top order associations per admission diagnosis from training data in 2009 vs. 2012, we find practice variability from unstable diagnoses with rank biased overlap (RBO)0.6. Predicting admission orders for future (2013) patients with associations trained on recent (2012) vs. older (2009) data improved accuracy evaluated by area under the receiver operating characteristic curve (ROC-AUC) 0.89 to 0.92, precision at ten (positive predictive value of the top ten predictions against actual orders) 30% to 37%, and weighted recall (sensitivity) at ten 2.4% to 13%, (P<10−10). Training with more longitudinal data (2009-2012) was no better than only using recent (2012) data. Secular trends in practice patterns likely explain why smaller but more recent training data is more accurate at predicting future practices. PMID:26776186

  13. Practices of Selected Foodservice Establishments in Iloilo City, Philippines

    Directory of Open Access Journals (Sweden)

    Raymund B. Moreno

    2015-02-01

    Full Text Available This study aimed to determine the practices of foodservice establishments in Iloilo City. The subjects of this study were selected foodservice establishments in Iloilo City which were selected purposively. The findings of the study showed that the number of foodservice establishments as respondents was equally divided into fast foods and specialty foodservice establishments in Iloilo City. Majority of the foodservice establishment was located uptown or outside of the City of Iloilo and has operated for more than five years. All specialty establishments have undergone accreditation by the Department of Tourism. Since the foodservice establishments practiced all times the different foodservice practices in purchasing, receiving, storage, inventory and safety it is recommended that the owners and managers should continue to perform the different practices to ensure quality service and satisfaction to the customers. It is recommended that the hotel and restaurant management teachers should disseminate the result of the study through their lecture and discussion so that the students could be aware of the good practices employed in the foodservice establishments and enable them to apply this in their future career as effective and productive foodservice worker. Similar study can be conducted to validate the results of this study using other variables and respondents.

  14. [Use of antihistamines in a physician's clinical practice].

    Science.gov (United States)

    Luss, L V

    2014-01-01

    Histamine that belongs to one of the most important mediators involved in the regulation of the body's vital functions plays a great role in the pathogenesis of different diseases. Histamine is released during inflammatory and allergic reactions, anaphylactic and anaphylactoid shock, pseudoallergic reactions, and others. Acting through histamine receptors, it leads to increased intracellular concentration of cyclic guanosine monophosphate, enhanced chemotaxis of eosinophils and neutrophils, production of prostaglandins and thromboxane B, suppressed synthesis of lymphokines, etc. and causes contraction of smooth muscles of particularly the bronchi and intestine, dilation of vessels and their increased permeability, mucus hypersecretion in the upper airways, lower blood pressure, angioedema and itch, etc. In this connection, antihistamines that block histamine-induced reactions in various ways: by inhibiting its biosynthesis, enhancing its neutralization, blocking the access to receptors, and suppressing the release from mast cells, occupy a prominent place in clinical practice. The review covers the classification, main mechanisms of pharmacological action, and indications for the use of antihistamines that not only have the well-known antihistamine properties, but have also a broad spectrum of anti-inflammatory activity. There are data on the benefits of a group of antihistamines, the quinuclidine derivatives (quifenadine, sequifenadine) that were designed by Academician M.D. Mashkovsky and are one of the first examples of designing new classes of multifunctional non-sedating antihistamines, which combines a high selective activity to block histamine type 1 receptors and an ability to block serotonin and to break down histamine directly in tissues. PMID:25306755

  15. Feedback: an essential element of student learning in clinical practice.

    Science.gov (United States)

    Clynes, Mary P; Raftery, Sara E C

    2008-11-01

    Clinical practice is an essential component of the nursing curriculum. In order for the student to benefit fully from the experience regular performance feedback is required. Feedback should provide the student with information on current practice and offer practical advice for improved performance. The importance of feedback is widely acknowledged however it appears that there is inconsistency in its provision to students. The benefits of feedback include increased student confidence, motivation and self-esteem as well as improved clinical practice. Benefits such as enhanced interpersonal skills and a sense of personal satisfaction also accrue to the supervisor. Barriers to the feedback process are identified as inadequate supervisor training and education, unfavourable ward learning environment and insufficient time spent with students. In addition to the appropriate preparation of the supervisor effective feedback includes an appreciation of the steps of the feedback process, an understanding of the student response to feedback and effective communication skills.

  16. The Brave New World of clinical cancer research: Adaptive biomarker-driven trials integrating clinical practice with clinical research.

    Science.gov (United States)

    Berry, Donald A

    2015-05-01

    Clinical trials are the final links in the chains of knowledge and for determining the roles of therapeutic advances. Unfortunately, in an important sense they are the weakest links. This article describes two designs that are being explored today: platform trials and basket trials. Both are attempting to merge clinical research and clinical practice.

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

    Science.gov (United States)

    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.

  18. Utilization of FibroScan in clinical practice.

    Science.gov (United States)

    Bonder, Alan; Afdhal, Nezam

    2014-02-01

    The evaluation of liver fibrosis is critical, particularly to rule out cirrhosis. Novel non-invasive tests such as transient ultrasound elastography are widely used to stage liver fibrosis as an alternative to liver biopsy, and this technology has recently been approved in the US. In this review, we discuss the performance characteristics of elastography for a variety of liver diseases and highlight practical appropriate suggestions for how to incorporate this technology into clinical practice.

  19. The psychiatric cultural formulation: translating medical anthropology into clinical practice.

    Science.gov (United States)

    Aggarwal, Neil Krishan

    2012-03-01

    This article reviews proposed revisions to the DSM-IV Outline for Cultural Formulation for clinical practice. The author begins by exploring the theoretical development of and assumptions involved in the Cultural Formulation. A case presentation is then used to demonstrate shortcomings in the current implementation of the Cultural Formulation based on older definitions of culture. Finally, the author recommends practical questions based on the growing anthropological literature concerning the interpersonal elements of culture and the social course of illness. A simple clear format that clinically translates social science concepts has the potential to increase use of the Cultural Formulation by all psychiatrists, not just those specializing in cultural psychiatry.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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…

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

    Directory of Open Access Journals (Sweden)

    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.

  3. A model for ethical practices in clinical phonetics and linguistics.

    Science.gov (United States)

    Powell, Thomas W

    2007-01-01

    The emergence of clinical phonetics and linguistics as an area of scientific inquiry gives rise to the need for guidelines that define ethical and responsible conduct. The diverse membership of the International Clinical Phonetics and Linguistics Association (ICPLA) and the readership of this journal are uniquely suited to consider ethical issues from diverse perspectives. Accordingly, this paper introduces a multi-tiered six-factor model for ethical practices to stimulate discussion of ethical issues.

  4. Survey of clinical nutrition practices of Canadian gastroenterologists

    OpenAIRE

    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...

  5. Clinical Practice Guidelines for Vascular Catheter Infections Treatment.

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    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. Evaluation of clinical teaching models for nursing practice.

    Science.gov (United States)

    Croxon, Lyn; Maginnis, Cathy

    2009-07-01

    Clinical placements provide opportunities for student nurses to learn experientially. To create a constructive learning environment staff need to be friendly, approachable, available and willing to teach. There must be adequate opportunities for students to develop confidence and competence in clinical skills with a focus on student learning needs rather than service needs of facilities. A popular model for clinical teaching of nursing students is the preceptor model. This model involves a student working under the supervision of individual registered nurses who are part of the clinical staff. This model was failing to meet students' needs in acute nursing practice areas, largely due to Registered Nurse staff shortages and demanding workloads. The students' evaluations led to the trial of a 'cluster' or group model of eight students, with a clinical facilitator who is paid by the university, in each acute nursing ward. Evaluation of twenty nursing students' perceptions of their acute nursing practice clinical placements was conducted using a mixed method approach to evaluate the two models of student supervision. Results indicate that the students prefer small groups with the clinical facilitator in one area. Thus evaluation and feedback from students and the perceptions of their clinical placement is essential. PMID:18722161

  8. SELECTED PRACTICES OF TALENT MANAGEMENT: INSIGHT INTO SLOVAK ORGANIZATIONS

    OpenAIRE

    Viktória Ali Taha; Michaela Sirková; Martina Ferencová

    2013-01-01

    The paper examines selected areas of talent management. Based on the present literature, the aim was to identify individual processes and practices of talent management. Subsequently, questionnaire survey was conducted to obtain primary data - to determine the prevalence and implementation of talent management in Slovak organizations. The article is focused on presentation of partial results of the survey –how Slovak organizations define talents, declare talent management strategy and impleme...

  9. [Clinical practice as an arborescent and rhizomorphic practice in surgical nursing work].

    Science.gov (United States)

    de Sousa, Lenice Dutra; Lunardi, Wilson Danilo Filho; Cezar-Vaz, Marta Regina; de Figueiredo, Paula Pereira

    2013-12-01

    A qualitative and exploratory case study was conducted in a surgery unit of a university hospital. The study aimed to analyze the nurses' work from the perspective of health care production and clinical practice. The subjects of the study were six nurses. Non-participant observations, documentary research and in-depth interviews were carried out, followed by discursive textual analysis. Nursing work is organized according to two interconnected and interdependent perspectives: a clinical model, which forms the central structure of its practice, and a structure formed by multiple and heterogeneous elements. in this way, the clinical model of health care is organized as a centered structure that enables the fulfillment of biological needs and acts as a basis for connecting disparate knowledge and practices that expand practice through interconnections with the work environment. PMID:24626366

  10. [Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

    Science.gov (United States)

    Godény, Sándor

    2012-02-01

    The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

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

    LENUS (Irish Health Repository)

    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.

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

    International Nuclear Information System (INIS)

    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.

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

    International Nuclear Information System (INIS)

    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.

  14. Best practices for clinical pathology testing in carcinogenicity studies.

    Science.gov (United States)

    Young, Jamie K; Hall, Robert L; O'Brien, Peter; Strauss, Volker; Vahle, John L

    2011-02-01

    The Society of Toxicologic Pathology (STP) and American Society for Veterinary Clinical Pathology (ASCVP) convened a Clinical Pathology in Carcinogenicity Studies Working Group to recommend best practices for inclusion of clinical pathology testing in carcinogenicity studies. Regulatory guidance documents and literature were reviewed, and veterinary pathologists from North America, Japan, and Europe were surveyed regarding current practices, perceived value, and recommendations for clinical pathology testing in carcinogenicity studies. For two-year rodent carcinogenicity studies, the Working Group recommends that clinical pathology testing be limited to collection of blood smears at scheduled and unscheduled sacrifices to be examined only if indicated to aid in the diagnosis of possible hematopoietic neoplasia following histopathologic evaluation. Additional clinical pathology testing is most appropriately used to address specific issues from prior toxicity studies or known test article-related class effects. Inadequate data were available to make a recommendation concerning clinical pathology testing for alternative six-month carcinogenicity assays using genetically modified mice, although the Working Group suggests that it may be appropriate to use the same approach as for two-year carcinogenicity studies since the study goal is the same.

  15. Supporting Clinical Practice Candidates in Learning Community Development

    Science.gov (United States)

    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…

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

    NARCIS (Netherlands)

    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

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

    OpenAIRE

    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.

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

    OpenAIRE

    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...

  19. A practical clinical approach to management of the difficult airway

    NARCIS (Netherlands)

    Eindhoven, GB; Dercksen, B; Regtien, JG; Borg, PAJ; Wierda, JMKH

    2001-01-01

    Difficult airway management represents a challenge in anaesthesia. In the last decades airway difficulty awareness has improved as a result of better anticipation and decision-making. Airway algorithms and protocols have a more prominent role in training and in clinical anaesthesia practice. In addi

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

    DEFF Research Database (Denmark)

    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...

  1. The Use of Bone Age in Clinical Practice - Part 1

    NARCIS (Netherlands)

    D.D. Martin; J.M. Wit; Z.E. Hochberg; L. Sävendahl; R.R. van Rijn; O. Fricke; N. Cameron; J. Caliebe; T. Hertel; D. Kiepe; K. Albertsson-Wikland; H.H. Thodberg; G. Binder; M.B. Ranke

    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 addressed

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

    Science.gov (United States)

    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)

  3. Multifunction laser systems in clinical and resort practice

    OpenAIRE

    ZABULONOV, Yuriy; Vladimirov, Alexander; Chukhraiev, Nikolay; Elmehsenawi, Yousry; Zukow, Walery

    2016-01-01

    SHUPYKNATIONALMEDICALACADEMY OF POSTGRADUATE EDUCATION UKRAINIANSOCIETY OFPHYSICAL AND REHABILITATION MEDICINE RADOM UNIVERSITY       Yuriy Zabulonov, Alexander Vladimirov, Nikolay Chukhraiev, Yousry Elmehsenawi, Walery Zukow       MULTIFUNCTION LASER SYSTEMS IN CLINICAL AND RESORT PRACTICE   Edited by Yuriy Zabulonov, Alexander Vladimirov, Nikolay Chukhraiev, Yousry Elmehsenawi, Walery Zukow  ...

  4. Theory and practice of clinical pharmacodynamics in oncology drug development.

    Science.gov (United States)

    Parchment, Ralph E; Doroshow, James H

    2016-08-01

    The clinical development of molecularly targeted cancer therapies is enhanced by proof of mechanism of action as well as proof of concept, which relate molecular pharmacodynamics to efficacy via changes in cancer cell biology and physiology resulting from drug action on its intended target. Here, we present an introduction to the field of clinical pharmacodynamics, its medical and laboratory aspects, and its practical incorporation into clinical trials. We also describe key success factors that are useful for judging the quality of clinical pharmacodynamic studies, including biopsy quality and suitability, specimen handling, assay fitness-for-purpose, and reagent quality control. This introduction provides not only context for the following articles in this issue, but also an appreciation of the role of well-conducted clinical pharmacodynamic studies in oncology drug development. PMID:27663474

  5. Grading journals in clinical practice: a delicate issue.

    Science.gov (United States)

    Holmes, V

    1997-12-01

    Offering students opportunities to gain a strong sense of self, a positive professional image, and a chance to articulate their clinical practice is a challenge for nurse educators. Writing journals in clinical placements is one way in which students can create a dialogue with their teacher and reflect upon and explore their clinical experiences in the context in which these experiences occur. However, grading journals according to numerous predetermined criteria can sabotage the benefits and opportunities of writing journals. Judgment and control are two aspects of evaluation and subsequent grading that can sabotage the benefits. Limiting predetermined criteria and not assigning grades to students' journals are two answers to this delicate issue. To function as competent practitioners, nursing students must be able to meet standards of practice; they must achieve a strong sense of self and a positive professional image. Clinical placements offer students the opportunity to explore the experience of clinical nursing and the context in which these experiences unfold. As students acquire skills and explore the practice of nursing, they also face the reality that their instructors will award a judgment of worth to their efforts. This evaluation is necessary to determine whether students have met the required standards. Evaluation and subsequent grades, therefore, must be an integral part of the students' clinical experience. Writing journals is often used as a method of exploring experiences in clinical nursing. Journals are also used as a method of clinical evaluation. Assigning a grade to student journals has a detrimental effect on the purpose of the assignment. An emphasis on exploring the purpose of writing journals and an analysis of the impact that grading has on this exercise will expose the incompatibility between writing and grading journals.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

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

    International Nuclear Information System (INIS)

    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)

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

    Science.gov (United States)

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

    Science.gov (United States)

    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…

  12. 77 FR 49449 - Food and Drug Administration Clinical Trial Requirements, Compliance, and Good Clinical Practice...

    Science.gov (United States)

    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...

  13. Differences in stress and challenge in clinical practice among ADN and BSN students in varying clinical courses.

    Science.gov (United States)

    Oermann, M H; Standfest, K M

    1997-05-01

    There is limited research on student perceptions of their clinical experiences particularly in different clinical courses and settings. The purpose of this study was to examine the degree of stress, challenge, and threat associated with clinical practice experiences among ADN and BSN nursing students enrolled in various clinical courses and settings. The Pagana Clinical Stress Questionnaire was used to assess the clinical experiences of 416 undergraduate nursing students from 10 randomly selected associate degree (ADN) and baccalaureate (BSN) programs in the midwest. Significant differences were found across clinical courses (F[5,399] = 9.58, p < .0001) and settings (F[2,386] = 4.63, p = .01) in terms of students' stress. Stress was highest for students enrolled in pediatric nursing courses. ANOVA indicated significant differences across clinical courses in the degree of challenge and threat experienced by students. There were no differences in any of the variables studied when students had faculty from the nursing program or preceptors from the clinical setting as their teachers.

  14. Accuracy of radiographer plain radiograph reporting in clinical practice: a meta-analysis

    International Nuclear Information System (INIS)

    AIM: To determine the accuracy of radiographer plain radiograph reporting in clinical practice. MATERIALS AND METHODS: Studies were identified from electronic sources and by hand searching journals, personal communication and checking reference lists. Eligible studies assessed radiographers' plain radiograph reporting in clinical practice compared with a reference standard, and provided accuracy data to construct 2x2 contingency tables. Data were extracted on study eligibility and characteristics, quality and accuracy. Summary estimates of sensitivity and specificity and receiver operating characteristic curves were used to pool the accuracy data. RESULTS: Radiographers compared with a reference standard, report plain radiographs in clinical practice at 92.6% and 97.7% sensitivity and specificity, respectively. Studies that compared selectively trained radiographers and radiologists of varying seniority against a reference standard showed no evidence of a difference between radiographer and radiologist reporting accuracy of accident and emergency plain radiographs. Selectively trained radiographers were also found to report such radiographs as accurately as those not solely from accident and emergency, although some variation in reporting accuracy was found for different body areas. Training radiographers improved their accuracy when reporting normal radiographs. CONCLUSION: This study systematically synthesizes the literature to provide an evidence-base showing that radiographers can accurately report plain radiographs in clinical practice

  15. A Method of Determining Selectivity Coefficients Based on the Practical Slope of Ion Selective Electrodes

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    It is a problem to be solved that the experimental selectivity coefficients of ion selective electrodes (ISEs) depend on the activity.This paper studied the new method of determining selectivity coefficients.A mixed ion response equation,which was similar to Nicolsky-Eisenman (N-E) equation recommended by IUPAC,was proposed.The equation includes the practical response slope of ISEs to the primary ion and the interfering ion.The selectivity coefficient was defined by the equation instead of the N-E equation.The experimental part of the method is similar to that based on the N-E equation.The values of selectivity coefficients obtained with this method do not depend on the activity whether the electrodes exhibit the Nernst response or non-Nernst response.The feasibility of the new method is illustrated experimentally.

  16. The good laboratory practice and good clinical practice requirements for the production of radiopharmaceuticals in clinical research

    NARCIS (Netherlands)

    De Vos, FJ; De Decker, M; Dierckx, RA

    2005-01-01

    Radiopharmaceuticals account for more than 95% of the group of sterile pharmaceutical products and should therefore be handled and produced with care. Since the introduction of the European directive, all pharmaceuticals used in clinical studies must be prepared under good manufacturing practice (GM

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

    OpenAIRE

    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...

  18. Sunscreen compliance with regional clinical practice guidelines and product labeling standards in New Zealand.

    Science.gov (United States)

    Sporer, Matthias E; Mathy, Joanna E; Kenealy, John; Mathy, Jon A

    2016-03-01

    INTRODUCTION For general practitioners, practice nurses and community pharmacists in New Zealand, a core duty is to educate patients about sun protection. We aimed to evaluate compliance of locally available sunscreens with regional clinical practice guidelines and sunscreen labelling standards, to assist clinicians in advising consumers on sunscreen selection. METHODS We audited all sunscreens available at two Auckland stores for three New Zealand sunscreen retailers. We then assessed compliance with accepted regional clinical practice guidelines for sun protection from the New Zealand Guidelines Group. We further assessed compliance with regional Australia/New Zealand consumer standards for sunscreen labelling. RESULTS All sunscreens satisfied clinical guidelines for broad-spectrum protection, and 99% of sunscreens met or exceeded clinical guidelines for minimal Sun Protection Factor. Compliance with regional standardized labelling guidelines is voluntary in New Zealand and 27% of audited sunscreens were not fully compliant with SPF labelling standards. DISCUSSION Sunscreens were generally compliant with clinical guidelines for minimal sun protection. However there was substantial noncompliance with regional recommendations for standardized sunscreen labelling. Primary health care clinicians should be aware that this labelling noncompliance may mislead patients into thinking some sunscreens offer more sun protection than they do. Mandatory compliance with the latest regional labelling standards would simplify sunscreen selection by New Zealand consumers. KEYWORDS Sunscreen; Sun Protection Factor; SPF; Skin Neoplasms; Melanoma; Skin Cancer Prevention. PMID:27477372

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

    OpenAIRE

    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...

  20. Cancer-related fatigue. Clinical practice guidelines in oncology.

    Science.gov (United States)

    2003-07-01

    These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue using a brief screening instrument, and are treated as indicated by their fatigue level. The algorithm's goal is to identify and treat all patients with fatigue that causes distress or interferes with their daily activities or functioning. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point the patient is assessed for current disease and treatment status, a review of body systems, and an in-depth fatigue evaluation. In addition, the patient is assessed for the presence of seven treatable factors known to contribute to fatigue: pain, emotional distress, sleep disturbance, anemia, alterations in nutrition, deconditioning, and comorbidities. If any of these conditions are present, they should be treated according to practice guidelines, with referral to other care professionals as appropriate, and the patient's fatigue should be reevaluated regularly. If none of the seven factors are present or the fatigue is unresolved, selection of appropriate fatigue management and treatment strategies is considered within the context of the patient's clinical status: receiving active cancer treatment, receiving disease-free long-term follow-up, or receiving care at the end of life. Management of fatigue is cause-specific when conditions known to cause fatigue can be identified and treated. When specific causes, such as infection, fluid and electrolyte imbalances, or cardiac dysfunction, cannot be identified and corrected, nonpharmacologic and pharmacologic treatment of the fatigue should be considered. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, psychosocial programs to manage stress and

  1. Clinical applications of calixarene based sodium-selective electrodes

    OpenAIRE

    Walsh, Suzanne

    1997-01-01

    Since their beginnings in the late 1960's ion-selective electrodes have rapidly become one of the most important types of chemical sensor. They are commercially available for a large variety of ions, are widely used and have been characterised thoroughly by many investigators. Having attained this level of sophistication, research in this area today is often directed towards novel applications of such sensors. This thesis represents a study of certain clinical applications of sodium-selective...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    International Nuclear Information System (INIS)

    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

  4. Good Practice for Introducing Radiopharmaceuticals for Clinical Use

    International Nuclear Information System (INIS)

    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

  5. Clinical implications of spirituality to mental health: review of evidence and practical guidelines

    Directory of Open Access Journals (Sweden)

    Alexander Moreira-Almeida

    2014-04-01

    Full Text Available Objective: Despite empirical evidence of a relationship between religiosity/spirituality (R/S and mental health and recommendations by professional associations that these research findings be integrated into clinical practice, application of this knowledge in the clinic remains a challenge. This paper reviews the current state of the evidence and provides evidence-based guidelines for spiritual assessment and for integration of R/S into mental health treatment. Methods: PubMed searches of relevant terms yielded 1,109 papers. We selected empirical studies and reviews that addressed assessment of R/S in clinical practice. Results: The most widely acknowledged and agreed-upon application of R/S to clinical practice is the need to take a spiritual history (SH, which may improve patient compliance, satisfaction with care, and health outcomes. We found 25 instruments for SH collection, several of which were validated and of good clinical utility. Conclusions: This paper provides practical guidelines for spiritual assessment and integration thereof into mental health treatment, as well as suggestions for future research on the topic.

  6. Experimental Psychopathology: From laboratory studies to clinical practice

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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

  8. Vitamin D dose response is underestimated by Endocrine Society's Clinical Practice Guideline

    OpenAIRE

    McKenna, Malachi J; Murray, Barbara F

    2013-01-01

    Objective The recommended daily intakes of vitamin D according to the recent Clinical Practice Guideline (CPG) of the Endocrine Society are three- to fivefold higher than the Institute of Medicine (IOM) report. We speculated that these differences could be explained by different mathematical approaches to the vitamin D dose response. Methods Studies were selected if the daily dose was ≤2000 IU/day, the duration exceeded 3 months, and 25-hydroxyvitamin D (25OHD) concentrations were measured at...

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

    Directory of Open Access Journals (Sweden)

    Frank Carlos Alvarez Li

    2009-03-01

    Full Text Available 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.

  10. MRI Contrast Agents: Evolution of Clinical Practice and Dose Optimization.

    Science.gov (United States)

    Khan, Rihan

    2016-08-01

    Accurate detection of lesions throughout the body is of paramount importance in contrast-enhanced magnetic resonance imaging (MRI). Optimal contrast agent performance is therefore of great importance and given the number of MRI contrast agent options today, this topic is of much ongoing study. The goal of this review article is to bring the read up to date on pertinent articles that relate to the evolution of radiological clinical practice and dose optimization pertaining to gadolinium contrast agents. PMID:27367313

  11. REMAXOL: MECHANISMS OF ACTION AND APPLICATION IN REAL CLINICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    L. Yu. Ilchenko

    2016-01-01

    Full Text Available The main pathogenic effects of the original nativedrug — remaxol combining properties of balanced polyionic solution (methionine, inosine, nicotinamide and succinic acid were introduced additionally, antioxidant, antihypoxant and hepatotropic agent are considered in review. The results of its application in clinical practice among patients with alcoholic fatty liver disease, metabolic disorders, viral hepatitis, drug hepatotoxicity and in the perioperative period are presented.

  12. Clinical practice of risk assessment of sexual violence

    OpenAIRE

    Judge, Joseph Gerard

    2012-01-01

    Background: Risk assessment of sexual violence involves evidence based evaluation of the risks posed by sexual offenders. It informs risk management; the provision of treatment that reduces the risk of future sexual violence. Previous research has focused on assessment of the predictive accuracy of different risk assessment tools, as well as the identification of risk factors that are associated with recidivism. In contrast, the clinical practice of risk assessment is a research a...

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

    Directory of Open Access Journals (Sweden)

    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

  14. SELF WOUND MANAGEMENT PRACTICES BEFORE ATTENDING ANTIRABIES VACCINE CLINIC

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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

  16. Transition questions in clinical practice - validity and reproducibility

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein

    2008-01-01

    of construct validity and reproducibility of a TQ and make proposals for standardised use. One-hundred-and-ninety-one patients with low back pain and/or leg pain were followed over an 8-week period receiving 3 disability and 2 pain questionnaires together with a 7-point TQ. Reproducibility was determined using...... are reproducible in patients with low back pain and/or leg pain. Despite critique of several biases, our results have reinforced the construct validity of TQ’s as an outcome measure since only 1 hypothesis was rejected. On the basis of our findings we have outlined a proposal for a standardised use of transition......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...

  17. Planning practice-based clinical teaching: Part I.

    Science.gov (United States)

    Barrington, D L

    1997-01-01

    Among the many roles clinicians are expected to perform is that of educator of junior colleagues. However, most clinicians have received little or no developmental instruction for this role. Furthermore, the nature of medical education is changing, and the skills required of new graduates are being refocused. This series of three articles presents a guide to some of the philosophical and educational issues at the heart of current changes in medical education. As well as developing an argument for making practice-based clinical teaching student-centred and problem-orientated, suggestions for planning and implementing teaching which utilise these approaches are outlined. In this first article the changing nature of clinical teaching is discussed and the educational principles of problem-based and student-centred learning are defined. The second article looks at the steps involved in planning a clinical teaching session. The third and final article looks at the development and implementation of teaching sessions. PMID:9009018

  18. Justification and Optimization in Clinical Practice. Chapter 23

    International Nuclear Information System (INIS)

    All medical exposures must be subject to the principles of justification and optimization of radiological protection, which are common to all practices dealing with potential exposures of humans to ionizing radiation. Justification of medical exposures requires that all medical imaging exposures must show a sufficient net benefit when balanced against possible detriment that the examination might cause. For patients undergoing medical diagnosis or treatment, there are different levels of justification (see Section 23.2). The practice involving exposure to radiation must be justified in principle through the endorsement of relevant professional societies, as matters of effective medical practice will be central to this judgement. Also, each procedure should be subject to a further, case by case, justification by both the referring clinician who is responsible for the management of the patient and the radiologist who selects the most appropriate imaging examination to answer the referrer’s question

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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. Best Practice of Selecting Strategic International Agency Banking

    Directory of Open Access Journals (Sweden)

    Chan Leslie Soon-Lim

    2014-12-01

    Full Text Available International agency or correspondent banking (corbanking is cross border bank to bank businesses that agent banks act on behalf of principals. Despite drastic changing banking environment, corbanking remains from doing business by mainly fee based, packaging reciprocal products and services, and so on. Corbanking is therefore identified as an alternative to serve clients worldwide in a strategic low cost way. Best practice to identify for entering corbanking relationships and selecting their correspondents are the themes of this paper, which are useful for financial institutions to make strategic and operational decisions for their expansion. Eighteen determinant factors to establish corbanking relationships and nineteen selection criteria of correspondents were identified through literature reviews, case studies, and exploratory surveys. Empirical surveys were conducted on 43 sample banks in Australia, which were further categorized in ten bank groups. Analytical methods included descriptive statistics and stepwise least square regression with case studies. The findings were: the most significant factor for financial institutions to enter correspondent banking systems was the bank size and a lower ranking factor was location not physically present, whereas there was different consensus for different bank groups about the selection criteria for agents overseas.

  2. Clinical practice guidelines for translating pharmacogenomic knowledge to bedside. Focus on anticancer drugs.

    Directory of Open Access Journals (Sweden)

    José A G Agúndez

    2014-08-01

    Full Text Available The development of clinical practice recommendations or guidelines for the clinical use of pharmacogenomics data is an essential issue for improving drug therapy, particularly for drugs with high toxicity and/or narrow therapeutic index such as anticancer drugs. Although pharmacogenomic-based recommendations have been formulated for over 40 anticancer drugs, the number of clinical practice guidelines available is very low. The guidelines already published indicate that pharmacogenomic testing is useful for patient selection, but final dosing adjustment should be carried out on the basis of clinical or analytical parameters rather than on pharmacogenomic information.Patient selection may seem a modest objective, but it constitutes a crucial improvement with regard to the pre-pharmacogenomics situation and it saves patients’ lives. However we should not overstate the current power of pharmacogenomics. At present the pharmacogenomics of anticancer drugs is not sufficiently developed for dose adjustments based on pharmacogenomics only, and no current guidelines recommend such adjustments without considering clinical and/or analytical parameters.

  3. Psychiatrists' Comfort Using Computers and Other Electronic Devices in Clinical Practice.

    Science.gov (United States)

    Duffy, Farifteh F; Fochtmann, Laura J; Clarke, Diana E; Barber, Keila; Hong, Seung-Hee; Yager, Joel; Mościcki, Eve K; Plovnick, Robert M

    2016-09-01

    This report highlights findings from the Study of Psychiatrists' Use of Informational Resources in Clinical Practice, a cross-sectional Web- and paper-based survey that examined psychiatrists' comfort using computers and other electronic devices in clinical practice. One-thousand psychiatrists were randomly selected from the American Medical Association Physician Masterfile and asked to complete the survey between May and August, 2012. A total of 152 eligible psychiatrists completed the questionnaire (response rate 22.2 %). The majority of psychiatrists reported comfort using computers for educational and personal purposes. However, 26 % of psychiatrists reported not using or not being comfortable using computers for clinical functions. Psychiatrists under age 50 were more likely to report comfort using computers for all purposes than their older counterparts. Clinical tasks for which computers were reportedly used comfortably, specifically by psychiatrists younger than 50, included documenting clinical encounters, prescribing, ordering laboratory tests, accessing read-only patient information (e.g., test results), conducting internet searches for general clinical information, accessing online patient educational materials, and communicating with patients or other clinicians. Psychiatrists generally reported comfort using computers for personal and educational purposes. However, use of computers in clinical care was less common, particularly among psychiatrists 50 and older. Information and educational resources need to be available in a variety of accessible, user-friendly, computer and non-computer-based formats, to support use across all ages. Moreover, ongoing training and technical assistance with use of electronic and mobile device technologies in clinical practice is needed. Research on barriers to clinical use of computers is warranted. PMID:26667248

  4. Selection and Evaluation Guidelines for Clinical Education Settings in Athletic Training.

    Science.gov (United States)

    Weidner, Thomas G.; Laurent, Tim

    2001-03-01

    OBJECTIVE: To develop and test standards and associated criteria for the selection and evaluation of a clinical education setting in athletic training. DESIGN AND SETTING: A previously validated set of 20 standards for physical therapy clinical education settings, the associated criteria, and 2 related evaluation forms were systematically judged, revised, and adapted through a survey process. SUBJECTS: Program directors, clinical instructors, and students involved with athletic training clinical education from 28 athletic training education programs approved by the National Athletic Trainers' Association or accredited by the Commission on Accreditation of Allied Health Education Programs. MEASUREMENTS: We tabulated respondents' critiques and ratings by type of respondent. Items were judged as to whether they were relevant, practical, and suggestive of high-quality clinical education settings. RESULTS: We accepted a final set of 12 standards and 31 associated criteria to measure these standards. The student form lists 23 criteria relevant to these accepted standards. The accepted standards include the following: learning environment, program planning, ethical standards, administrative support, and Setting Coordinator of Clinical Education. CONCLUSIONS: The 12 standards, criteria, and related forms developed in this research project should be used as guidelines rather than as minimal requirements. They could be helpful in forming an impression not only about a particular clinical setting but also about the requirements of clinical education in general. Further research should include evaluating and comparing perceptions between sexes and among ethnic groups concerning their clinical education experiences. Also, standards and criteria for clinical instruction in athletic training should be systematically developed.

  5. Selection and Evaluation Guidelines for Clinical Education Settings in Athletic Training.

    Science.gov (United States)

    Weidner, Thomas G.; Laurent, Tim

    2001-03-01

    OBJECTIVE: To develop and test standards and associated criteria for the selection and evaluation of a clinical education setting in athletic training. DESIGN AND SETTING: A previously validated set of 20 standards for physical therapy clinical education settings, the associated criteria, and 2 related evaluation forms were systematically judged, revised, and adapted through a survey process. SUBJECTS: Program directors, clinical instructors, and students involved with athletic training clinical education from 28 athletic training education programs approved by the National Athletic Trainers' Association or accredited by the Commission on Accreditation of Allied Health Education Programs. MEASUREMENTS: We tabulated respondents' critiques and ratings by type of respondent. Items were judged as to whether they were relevant, practical, and suggestive of high-quality clinical education settings. RESULTS: We accepted a final set of 12 standards and 31 associated criteria to measure these standards. The student form lists 23 criteria relevant to these accepted standards. The accepted standards include the following: learning environment, program planning, ethical standards, administrative support, and Setting Coordinator of Clinical Education. CONCLUSIONS: The 12 standards, criteria, and related forms developed in this research project should be used as guidelines rather than as minimal requirements. They could be helpful in forming an impression not only about a particular clinical setting but also about the requirements of clinical education in general. Further research should include evaluating and comparing perceptions between sexes and among ethnic groups concerning their clinical education experiences. Also, standards and criteria for clinical instruction in athletic training should be systematically developed. PMID:12937517

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

    Science.gov (United States)

    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

  7. CLINICAL EVALUATION OF SELECTED COLOURING HERBALS IN SAVARNIKARAN

    OpenAIRE

    Wadikar Sujata Surendra; Reddy Govind R.

    2013-01-01

    A Clinical study on "Clinical Evaluation of Selected Colouring Herbals in Savarnikaran" was carried out at shalya tantra dept. of M.A.Podar Hospital, Worli, Mumbai 18. The prime aim of the study is to make available an effective, alternative colouring cosmetic preparations which will be useful in post burn, post acne and post wound colour morbidity.Ayurvedic herbal drugs are abundant, easily available and cost effective but their use is not observed in all forms. The trial drug is prepared in...

  8. A practical approach for selecting optimum wind rotors

    Energy Technology Data Exchange (ETDEWEB)

    Maalawi, K.Y.; Badr, M.A. [National Research Center, Dokki, Cairo (Egypt). Dept. of Mechanical Engineering

    2003-04-01

    The main objective of this paper is to categorize practical families of horizontal-axis wind turbine rotors, which are optimized to produce the largest possible power output. Refined blade geometry is obtained from the best approximation of the calculated theoretical optimum chord and twist distributions of the rotating blade. The mathematical formulation is based on dimensionless quantities so as to make the aerodynamic analysis valid for any arbitrary turbine models having different rotor sizes and operating at different wind regimes. The selected design parameters include the number of blades, type of airfoil section and the blade root offset from hub center. The effects of wind shear as well as tower shadow are also examined. A computer program has been developed to automate the overall analysis procedures, and several numerical examples are given showing the variation of the power and thrust coefficients with the design tip speed ratio for various rotor configurations. (Author)

  9. Best Practices in Clinical Supervision: another step in delineating effective supervision practice.

    Science.gov (United States)

    Borders, L Dianne

    2014-01-01

    Across the helping professions, we have arrived at a point where it is possible to create statements of best practices in supervision that are based on available empirical research; credentialing, ethical, and legal guidelines; and consensus opinion. Best practices are different from, but certainly complementary to, statements of supervision competencies. In this paper, I highlight the differences between competencies and best practices, and then describe the development and content of one comprehensive statement, the Best Practices in Clinical Supervision created for the field of counseling and counselor education. I then illustrate the applicability of the Best Practices across disciplines and countries through a comparison and contrast with several other existing documents. I conclude with a brief look at the development of supervisor expertise, which requires not only declarative knowledge (competencies) and procedural knowledge (statements of best practices), but also reflective knowledge. The latter is composed of insights built over years of supervision education, experience, and self-reflection regarding necessary adaptions and improvisations that inform an individualized approach to supervision practice.

  10. 2011 Clinical Practice Guidelines for Type 2 Diabetes in Korea

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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

  12. Corporate Governance Practices In Selected Indian Financial Institutions

    Directory of Open Access Journals (Sweden)

    Suman Kalyan Chaudhury

    2012-06-01

    Full Text Available It has been realized that Corporate Governance is vital for better management of any organization. Financial reporting and disclosure of any information are the key factors of corporate governance. Financial Institutions are no exceptions and there has been increasing demand for transparency in functioning of these Institutions in view of several scams.In this paper a modest effort is made to discuss the reporting pattern of India’s twelve financial institutions namely SBI, IDBI, SIDBI, IFCI, NABARD, PNB, UBI, BOB, BOI, KMB, NHB and HDFC. Top Six commercial banks namely (SBI, BOB, PNB, KMB UBI & BOI, six developments banks viz. SIDBI, IFCI, HFDC, IDBI, NHB, and NABARD  are selected under study .The rationale for selection of these institutes is that being incorporated organizations, they should have same Corporate Governance standards. In view of transparency in functioning, the role of different Committees has a vital role to play. Six parameters have been chosen for comparison of various corporate governance practices in all these twelve financial institutions namely, Company’s philosophy on Corporate Governance, Formation of Board of Directors, Composition of Board of Directors, Particulars of Director’s, Organizational Committees, and Additional Information supplied in CG report or in the Annual report. 

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  17. Relevance of guideline-based ICD indications to clinical practice.

    Science.gov (United States)

    Al-Jefairi, Nora; Burri, Haran

    2014-01-01

    The implantable cardioverter-defibrillator (ICD) has established itself as life-saving therapy in patients at risk for sudden cardiac death. Remarkable technological advances have made ICDs easier and safer to implant, with improved therapeutic and diagnostic functions and reduced morbidity. Guidelines on ICD indications have been proposed by American and European scientific societies since a number of years, based upon trials and expert opinion. In the context of variable economic and political constraints, it is questionable whether these guidelines may be applied to all settings. This review discusses the guideline-based indications, critically examines their applicability to clinical practice, and discusses alternatives to ICD therapy.

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

    DEFF Research Database (Denmark)

    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......-up in BA that is usually appropriate for the height of the child. Response to GH is dependent on BA delay in young children with idiopathic short stature, and GH dosage appears to affect BA acceleration. In chronic renal failure, BA is delayed until puberty but then increases due to increased sensitivity...

  19. The development of precision medicine in clinical practice.

    Science.gov (United States)

    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

  20. Measuring Effects on the Clinical Practice from a Configured EHR

    DEFF Research Database (Denmark)

    Møller-Jensen, John; Simonsen, Jesper; K. Iversen, Rikke

    2006-01-01

    The objective of the project was to measure the clinical usability of an EHR configured by use of participatory design with clinicians from a neurological stroke unit in order to get input to the County’s future strategy for incremental implementation of EHR. The content of the EHR was defined...... during a series of workshops with the clinicians after which the XML configuration files were written and deployed. In parallel with this, the participants from the University specified a number of effects related to the clinical practice to be measured. Measurements were focused on the requested effects...... and acquired using various techniques including questionnaires, interviews, observations, and Task Load Index (TLX) ratings. In total, 15 nursing handovers, 8 ward rounds, and 11 patient conferences involving a total of 35 patients and more than 20 clinicians were included in the measurements. Data from...

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

    DEFF Research Database (Denmark)

    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...

  2. A JAVA-based multimedia tool for clinical practice guidelines.

    Science.gov (United States)

    Maojo, V; Herrero, C; Valenzuela, F; Crespo, J; Lazaro, P; Pazos, A

    1997-01-01

    We have developed a specific language for the representation of Clinical Practice Guidelines (CPGs) and Windows C++ and platform independent JAVA applications for multimedia presentation and edition of electronically stored CPGs. This approach facilitates translation of guidelines and protocols from paper to computer-based flowchart representations. Users can navigate through the algorithm with a friendly user interface and access related multimedia information within the context of each clinical problem. CPGs can be stored in a computer server and distributed over the World Wide Web, facilitating dissemination, local adaptation, and use as a reference element in medical care. We have chosen the Agency for Health Care and Policy Research's heart failure guideline to demonstrate the capabilities of our tool.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Successful clinical and organisational change in endodontic practice: a qualitative study.

    Science.gov (United States)

    Koch, M; Englander, M; Tegelberg, Å; Wolf, E

    2014-08-01

    The aim of this study was to explicate and describe the qualitative meaning of successful clinical and organizational change in endodontic practice, following a comprehensive implementation program, including the integration of the nickel-titanium-rotary-technique. After an educational intervention in the Public Dental Service in a Swedish county, thematic in-depth interviews were conducted, with special reference to the participants' experience of the successful change. Interviews with four participants, were purposively selected on the basis of occupation (dentist, dental assistant, receptionist, clinical manager), for a phenomenological human scientific analysis. Four constituents were identified as necessary for the invariant, general structure of the phenomenon: 1) disclosed motivation, 2) allowance for individual learning processes, 3) continuous professional collaboration, and 4) a facilitating educator. The perceived requirements for achieving successful clinical and organizational change in endodontic practice were clinical relevance, an atmosphere which facilitated discussion and allowance for individual learning patterns. The qualities required in the educator were acknowledged competence with respect to scientific knowledge and clinical expertise, as well as familiarity with conditions at the dental clinics. The results indicate a complex interelationship among various aspects of the successful change process.

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

    Science.gov (United States)

    ... 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 ...

  6. Clinical use of amyloid-positron emission tomography neuroimaging: Practical and bioethical considerations.

    Science.gov (United States)

    Witte, Michael M; Foster, Norman L; Fleisher, Adam S; Williams, Monique M; Quaid, Kimberly; Wasserman, Michael; Hunt, Gail; Roberts, J Scott; Rabinovici, Gil D; Levenson, James L; Hake, Ann Marie; Hunter, Craig A; Van Campen, Luann E; Pontecorvo, Michael J; Hochstetler, Helen M; Tabas, Linda B; Trzepacz, Paula T

    2015-09-01

    Until recently, estimation of β-amyloid plaque density as a key element for identifying Alzheimer's disease (AD) pathology as the cause of cognitive impairment was only possible at autopsy. Now with amyloid-positron emission tomography (amyloid-PET) neuroimaging, this AD hallmark can be detected antemortem. Practitioners and patients need to better understand potential diagnostic benefits and limitations of amyloid-PET and the complex practical, ethical, and social implications surrounding this new technology. To complement the practical considerations, Eli Lilly and Company sponsored a Bioethics Advisory Board to discuss ethical issues that might arise from clinical use of amyloid-PET neuroimaging with patients being evaluated for causes of cognitive decline. To best address the multifaceted issues associated with amyloid-PET neuroimaging, we recommend this technology be used only by experienced imaging and treating physicians in appropriately selected patients and only in the context of a comprehensive clinical evaluation with adequate explanations before and after the scan. PMID:27239516

  7. A Clinical Librarian-Nursing Partnership to Bridge Clinical Practice and Research in an Oncology Setting.

    Science.gov (United States)

    Ginex, Pamela K; Hernandez, Marisol; Vrabel, Mark

    2016-09-01

    Nurses today work in practice settings where the expectation is to "draw upon the best evidence to provide the care most appropriate to each patient" (Olsen, Goolsby, & McGinnis, 2009, p. 10) while caring for patients with high acuity in highly specialized settings. Within the nursing profession, the Magnet Recognition Program® advocates for exemplary professional practice and the generation of new knowledge through research and clinical innovation. Nurses working in a clinical setting are often the best resource to identify important clinical questions and gaps in practice, but a lack of resources presents challenges to nurses in fully developing their questions and identifying the most appropriate methods to answer them. These challenges often fall into three broad categories: individual nurse characteristics, organizational characteristics, and environmental characteristics (Dobbins, Ciliska, Cockerill, Barnsley, & DiCenso, 2002). Creating a dedicated partnership between nurses and library staff is one method that can overcome these challenges to use existing resources and support nurses who are asking and answering important clinical questions (DePalma, 2005; Vrabel, 2005). 
. PMID:27541547

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

    Science.gov (United States)

    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…

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

    Science.gov (United States)

    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.

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

    LENUS (Irish Health Repository)

    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.

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

    LENUS (Irish Health Repository)

    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.

  12. What impact does anatomy education have on clinical practice?

    Science.gov (United States)

    Smith, Claire France; Mathias, Haydn Socrates

    2011-01-01

    There is continuing debate regarding doctors' knowledge of anatomy as an appropriate preparation for professional practice. This exploratory case study examined alumni's experiences of learning anatomy. The aim was to inform curriculum development and to gain a better understanding of how anatomy knowledge is applied in practice. A total of 140 medical student alumni from the University of Southampton participated in this study (49% males, 51% females). Participants completed a Likert scale questionnaire with free comment sections. Descriptive results found that: using cadaveric material was an effective way of learning anatomy; assessment was a major motivator; and around half of students forgot a lot of anatomy but that knowledge came back easily. Statistical analysis revealed associations between certain positive and negative factors in learning. Links were also seen with current job role, revealing that those who responded to positive factors were involved in careers which involved a great deal of anatomy and vice versa. To facilitate learning, anatomy should be taught throughout the curriculum and use human cadavers. Relating knowledge to practice requires transformation of knowledge and is best facilitated by the learning being situated in clinical contexts.

  13. Hispanic mothers' beliefs and practices regarding selected children's health problems.

    Science.gov (United States)

    Mikhail, B I

    1994-12-01

    The purpose of this study was to identify and describe the Hispanic mothers' initial sources of advice and help with children's illnesses; beliefs about the etiology and seriousness of certain children's illnesses, namely, fever, cough, diarrhea, vomiting, conjunctivitis, skin rash, minor wounds, and burns; practices for the management of these children's health problems, including the use of home remedies, if any. Interviews were conducted with 100 women of Hispanic origin who had at least one child age 5 years or less and who were attending a community clinic in a rural area of central California. Mothers' beliefs about problem etiologies varied widely and revealed several misconceptions, folk beliefs, and lack of knowledge. The findings also revealed that only 32% of the mothers used or would use health professionals as the initial source of advice or help with children's problems. The majority of the subjects (81%) admitted to using home remedies to manage children's problems; 17% sought the help of a folk healer (mainly for the treatment of empacho). The various types of home remedies used by mothers were described and included the ingestion or application of certain foods, fluids, herbal teas, or other materials as well as methods to eliminate the perceived causes of the problems. It is important to note that 11% of the mothers had used azarcon or greta (substances containing lead) for treating empacho and other stomach problems in children. The need for culturally responsive and sensitive health care is discussed.

  14. Enteral nutrition formula selection: current evidence and implications for practice.

    Science.gov (United States)

    Brown, Britta; Roehl, Kelly; Betz, Melanie

    2015-02-01

    Many new enteral nutrition (EN) formulas have been created over the past several decades with a variety of intended uses. Although each is intended to promote improved outcomes, research is often unclear and, in many cases, conflicting. It is important to note that EN products are considered medical foods by the U.S. Food and Drug Administration and therefore do not have to complete premarket review or approval and are not regulated to the same extent as pharmaceuticals. While standard EN formulas are designed to meet the basic macro- and micronutrient requirements of individuals who cannot meet nutrition needs orally, specialty EN products have been developed to exhibit pharmacologic properties, such as immune-enhancing formulas containing arginine, glutamine, nucleotides, and ω-3 fatty acids. With the vast number of products available, rising costs of healthcare, and the drive toward evidence-based practice, it is imperative that clinicians carefully consider research regarding use of specialty formulas, paying close attention to the quality, patient population, clinical end points, and cost to patient and/or facility. PMID:25516537

  15. Integrating feedback from a clinical data warehouse into practice organisation.

    Science.gov (United States)

    Grant, Andrew; Moshyk, Andriy; Diab, Hassan; Caron, Philippe; de Lorenzi, Fabien; Bisson, Guy; Menard, Line; Lefebvre, Richard; Gauthier, Patricia; Grondin, Richard; Desautels, Michel

    2006-01-01

    A patient oriented hospital information system (ARIANE) was inaugurated at the Sherbrooke University hospital (CHUS) in 1990 and a clinical data warehouse (CDW) completed 2004. The CDW is updated from ARIANE every 24h and includes ICD discharge diagnosis data, visit DRG and SNOMED encoding. The data is encrypted on storage. Data is accessed according to institutional approval. To facilitate data access two levels of tool have been made accessible using a web-browser. The first level consists of a 'dashboard' that has a defined design and enables a set of pre-determined dynamic queries about a patient population. This level can be operated with minimal training. The second level uses a convivial database query tool, which requires some prior training. Two prototype dashboards have been designed and evaluated for acceptability. The first for the emergency department enables analysis of patient occupancy. The second for the biochemistry department enables quality assurance evaluation. In most cases worldwide the clinical data warehouse is only beginning to be exploited, often impeded by lack of connection between different enterprise databases. Our CDW is expected rapidly to create a culture change so that clinical practice can be continuously evaluated using compiled data readily available from the electronic health record/hospital information system.

  16. Do pressure ulcer risk assessment scales improve clinical practice?

    Directory of Open Access Journals (Sweden)

    Jan Kottner

    2010-07-01

    Full Text Available Jan Kottner1, Katrin Balzer21Department of Nursing Science, Charité-Universitätsmedizin Berlin, Germany; 2Nursing Research Group, Institute for Social Medicine, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyAbstract: Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulness. From a measurement point of view pressure ulcer (PU risk assessment scales have serious limitations. Empirical evidence supporting the validity of PU risk assessment scale scores is weak and obtained scores contain varying amounts of measurement error. The concept of pressure ulcer risk is strongly related to the general health status and severity of illness. A clinical impact due do the application of these scales could also not be demonstrated. It is questionable whether completion of standardized pressure ulcer risk scales in clinical practice is really needed.Keywords: Braden pressure ulcer, prevention, risk assessment, nursing assessment, predictive value, clinical effectiveness, review

  17. Lactation management clinic-positive reinforcement to hospital breastfeeding practices.

    Science.gov (United States)

    Nanavati, R N; Mondkar, J A; Fernandez, A R; Raghavan, K R

    1994-11-01

    Supportive breastfeeding policies in the hospital constitute the foundation for initiation of successful breastfeeding by mothers, constant reinforcement and support to all lactating mothers is however essential to maintain lactation. The objective, methodology and outcome of the Lactation Management Clinic which constitutes a hospital-based mother support group is described. The study was carried out over a period of 2 1/2 years and 519 mothers had attended this clinic. Analysis of the data revealed that at the time of the 1st visit to the clinic, 65.9% mothers had already started supplementary top feeds and the commonest reason encountered was mother's own assessment of inadequate milk seen in 73.6% mothers. Two-thirds (66.9%) of babies in our study were roomed in right from the first day of life, 75.3% of babies had received colostrum and 67.1% babies had not received any prelacteal feeds and yet faced problems at lactation. Mother and infant evaluation revealed no complications with 86.5% mothers and with 54.5% babies. Local breast problems were detected in 19.3% mothers. Faulty positioning was observed in 47.2% patients. Psychological support to mothers was the most important form of therapy given. Seventy eight per cent mothers practiced exclusive breastfeeding subsequently while 21.2% of mothers were partially successful in lactation. Only 3 mothers had lactation failure.

  18. Application of the CIT concept in the clinical environment: hurdles, practicalities, and clinical benefits.

    Science.gov (United States)

    Sterr, Annette; Szameitat, Andre; Shen, Shan; Freivogel, Susanna

    2006-03-01

    Basic neuroscience research on brain plasticity, motor learning, and recovery has stimulated new concepts in motor rehabilitation. Combined with the development of methodological goal standards in clinical outcome research, these findings have effectuated the introduction of a double-paradigm shift in physical rehabilitation: (a) the move toward evidence-based procedures and disablement models for the assessment of clinical outcome and (b) the introduction of training-based concepts that are theoretically founded in learning theory. A major drive for new interventions has further come from recent findings on the adaptive capacities of neural networks and their linkage to perception, performance, and long-term recovery. In this context, constraint-induced movement therapy, an intervention initially designed for upper-limb hemiparesis, represents the theoretically and empirically most thoroughly founded training concept. Several clinical trials on constraint-induced therapy (CIT) have shown its efficacy in higher functioning patients; however, the transfer of the treatment into standard health care seems slow. Survey research further suggests a rather poor acceptance of CIT among clinical staff and it seems that the implementation of CIT is hindered by barriers constructed of beliefs and assumptions that demand a critical and evidence-based discussion. Within this context, we have conducted a series of experiments on amended CIT protocols and their application in the clinical environment which addressed the following issues: (1) massed practice: are 6 hours of daily training inevitable to achieve clinical benefits? (2) practicality: what is feasible in the standard care setting and what are the clinical benefits achieved by "feasible compromise CIT protocols?" (3) apprehensions: are concerns on increased muscular tone and pathologic movement patterns justified, and (4) learned nonuse: is the assumption of "hidden" residual abilities valid so that it warrants the

  19. Clinical laboratories, the select agent program, and biological surety (biosurety).

    Science.gov (United States)

    Pastel, Ross H; Demmin, Gretchen; Severson, Grant; Torres-Cruz, Rafael; Trevino, Jorge; Kelly, John; Arrison, Jay; Christman, Joy

    2006-06-01

    The threat of bioterrorism has led to increased concerns over the availability of biological select agents and toxins (BSAT). Congress has implemented several public laws that have led to the development of federal regulations by the Centers for Disease Control and Prevention (CDC) and the US Department of Agriculture. The CDC regulation 42 CFR 73 has a direct impact on all clinical laboratories that may at some time identify BSAT in a clinical specimen. The Department of Defense has imposed a more stringent layer of regulation called biological surety (biosurety) on top of the requirements of 42 CFR 73 for military laboratories that possess BSAT. However,42 CFR 73 falls into the framework of biosurety. Both sets of regulations have four pillars (safety, physical security, agent account-ability, and personnel reliability) that are built on a foundation of training and covered by a roof of management (operations and plans).

  20. Family meetings in palliative care: Multidisciplinary clinical practice guidelines

    Directory of Open Access Journals (Sweden)

    O'Hanlon Brendan

    2008-08-01

    Full Text Available Abstract Background Support for family carers is a core function of palliative care. Family meetings are commonly recommended as a useful way for health care professionals to convey information, discuss goals of care and plan care strategies with patients and family carers. Yet it seems there is insufficient research to demonstrate the utlility of family meetings or the best way to conduct them. This study sought to develop multidisciplinary clinical practice guidelines for conducting family meetings in the specialist palliative care setting based on available evidence and consensus based expert opinion. Methods The guidelines were developed via the following methods: (1 A literature review; (2 Conceptual framework; (3 Refinement of the guidelines based on feedback from an expert panel and focus groups with multidisciplinary specialists from three palliative care units and three major teaching hospitals in Melbourne, Australia. Results The literature review revealed that no comprehensive exploration of the conduct and utility of family meetings in the specialist palliative care setting has occurred. Preliminary clinical guidelines were developed by the research team, based on relevant literature and a conceptual framework informed by: single session therapy, principles of therapeutic communication and models of coping and family consultation. A multidisciplinary expert panel refined the content of the guidelines and the applicability of the guidelines was then assessed via two focus groups of multidisciplinary palliative care specialists. The complete version of the guidelines is presented. Conclusion Family meetings provide an opportunity to enhance the quality of care provided to palliative care patients and their family carers. The clinical guidelines developed from this study offer a framework for preparing, conducting and evaluating family meetings. Future research and clinical implications are outlined.

  1. Problems and opportunity of personality inventories in clinical - psychological practice

    Directory of Open Access Journals (Sweden)

    Emil Benedik

    2002-12-01

    Full Text Available The article deals with possibilities and problems of usage of personality inventories in psychological diagnostic of persons with "heavy pathology", from aspect of validity and applicability in the first place. Personality inventories are usually designed for health population. By their usage in clinical psychology we often meet problems like specific tendencies when answering defined questions. This could be the result of situational factors but also the impact of their disorders and personality. The possibilities of classical interpretation of results are in this way limited. Do we have the opportunity of development of the diagnostic instruments that we could, not only recognise, but use such deformations (which represent cognitive style or defence of person in diagnostic purpose? The MMPI-2, most famous inventory in this field, offer us great aid, especially because its items are selected empirically. By the analysis of its items from aspect of sensing and localisation of subjects problems, we found differences between clinical scales which represent patients of different clinical groups. These differences are in accordance with psychoanalytical assumptions about characteristics of sensing self and other people.

  2. Clinical roundtable monograph: a multidisciplinary approach to the use of oncotype DX in clinical practice.

    Science.gov (United States)

    Gradishar, William J; Hansen, Nora M; Susnik, Barbara

    2009-04-01

    Recently, recommendations for the use of the Oncotype DX assay in estrogen receptor-positive node-negative breast cancer patients were incorporated into guidelines from both the American Society of Clinical Oncology and the National Comprehensive Cancer Network. The Oncotype DX assay is a diagnostic test which measures changes in a set of 21 genes in order to predict the likelihood of disease recurrence and also to predict which patients are most likely to respond to chemotherapy. Oncotype DX has been available commercially since January 2004 and has been used for more than 85,000 patients. Drs. William J. Gradishar, Nora M. Hansen, and Barbara Susnik answered questions regarding the incorporation of the Oncotype DX breast cancer assay into routine clinical practice. This expert dialog offers an update and clinical insights into when, how, and why clinicians might incorporate the Oncotype DX assay into the management of their breast cancer patients. Also, the latest research into the benefit of the Oncotype DX assay in node-positive patients is discussed. Finally, sample case studies offer clinically relevant examples of the practical application of the Oncotype DX assay.

  3. Safety of bevacizumab in clinical practice for recurrent ovarian cancer: A retrospective cohort study

    Science.gov (United States)

    SELLE, FRÉDÉRIC; EMILE, GEORGE; PAUTIER, PATRICIA; ASMANE, IRÈNE; SOARES, DANIELE G.; KHALIL, AHMED; ALEXANDRE, JEROME; LHOMMÉ, CATHERINE; RAY-COQUARD, ISABELLE; LOTZ, JEAN-PIERRE; GOLDWASSER, FRANÇOIS; TAZI, YOUSSEF; HEUDEL, PIERRE; PUJADE-LAURAINE, ERIC; GOUY, SÉBASTIEN; TREDAN, OLIVIER; BARBAZA, MARIE O.; ADY-VAGO, NORA; DUBOT, CORALINE

    2016-01-01

    The poor outcome of patients with recurrent ovarian cancer constitutes a continuous challenge for decision-making in clinical practice. In this setting, molecular targets have recently been identified, and novel compounds are now available. Bevacizumab has been introduced for the treatment of patients with ovarian cancer and is, to date, the most extensively investigated targeted therapy in this setting. However, potential toxicities are associated with the use of this monoclonal antibody. These toxicities have been reported in clinical trials, and can also be observed outside of trials. As limited data is currently available regarding the safety of bevacizumab treatment in daily clinical practice, the current retrospective study was designed to evaluate this. Data from 156 patients with recurrent ovarian cancer who had received bevacizumab treatment between January 2006 and June 2009 were retrospectively identified from the institutional records of five French centers. In contrast to clinical trials, the patients in the present study were not selected and had a heterogeneous profile according to their prior medical history, lines of treatment prior to bevacizumab introduction and number of relapses. The results first confirm the effect of heavy pretreatment on the occurrence of serious and fatal adverse events in clinical practice, as previously reported for clinical trials and for other retrospective cohort studies. Importantly, the data also demonstrates, for the first time, that medical history of hypertension is an independent predictive risk factor for the development of high-grade hypertension during bevacizumab treatment. These results thus suggest that treating physicians must consider all risk factors for managing bevacizumab toxicity prior to its introduction. Such risk factors include the time of bevacizumab introduction, a patient's history of hypertension and a low incidence of pre-existing obstructive disease. PMID:26998090

  4. Site Characteristics Influencing the Translation of Clinical Research Into Clinical Practice

    DEFF Research Database (Denmark)

    Smed, Marie; Getz, Kenneth A.

    2014-01-01

    , although both academic and independent sites generate the same level of knowledge, academic sites share more of this knowledge with sponsor companies. This study suggests new strategies that sponsors can leverage to drive greater transfer of clinical research knowledge into clinical practice and ultimately...... on to sponsor companies and may ultimately assist in positioning new products and driving commercialization success. This study evaluates site characteristics that influence the acquisition and sharing of knowledge gained through clinical trial experience. The impact of 2 central site characteristics...... on the process of translating drug experience is assessed: site location (North America/rest of the world) and site type or setting (academic/independent). The results show that investigative sites located outside North America generate and share more knowledge than those within North America. Furthermore...

  5. Cost-effectiveness evaluations of spinal neuromodulation with ziconotide continuous infusion in cancer pain in a real clinical practice

    OpenAIRE

    Orietta Zaniolo; Sergio Iannazzo; Gian Piero Patrucco; Roberto Bellini

    2011-01-01

    Introduction and objective: ziconotide is the first-in-class drug of selective N-type voltage-sensitive calcium-channel blockers used to control severe chronic pain. The present study is developed in order to analyze clinical and economical outcomes of spinal neuromodulation with ziconotide continuous infusion in cancer pain in a real clinical practice.Methods: costs and effects of ziconotide are compared with those of traditional neuromodulation with morphine and adjuvant drugs, administered...

  6. [Analysis of an intercultural clinical practice in a judicial setting].

    Science.gov (United States)

    Govindama, Yolande

    2007-01-01

    This article analyses an intercultural clinical practice in a legal setting from an anthropological and psychoanalytical perspective, demonstrating necessary reorganizations inherent to the framework. The culture of the new country and its founding myth being implicit to the judicial framework, the professional intervening introduces psychoanalytical references particularly totemic principles and the symbolic father by making genealogy, a universal object of transmission as guarantee of fundamental taboos of humanity. The metacultural perspective in this approach integrates ethnopsychoanalytical principles put forth by Devereux as well as the method although this latter has been adapted to the framework. This approach allows to re-question Devereux's ethnopsychoanalytical principles by opening the debate on the perspective of a psychoanalytical as well as psychiatric. PMID:18253668

  7. [Clinical practice guidelines and knowledge management in healthcare].

    Science.gov (United States)

    Ollenschläger, Günter

    2013-10-01

    Clinical practice guidelines are key tools for the translation of scientific evidence into everyday patient care. Therefore guidelines can act as cornerstones of evidence based knowledge management in healthcare, if they are trustworthy, and its recommendations are not biased by authors' conflict of interests. Good medical guidelines should be disseminated by means of virtual (digital/electronic) health libraries - together with implementation tools in context, such as guideline based algorithms, check lists, patient information, a.s.f. The article presents evidence based medical knowledge management using the German experiences as an example. It discusses future steps establishing evidence based health care by means of combining patient data, evidence from medical science and patient care routine, together with feedback systems for healthcare providers. PMID:24326702

  8. Mechanical Lumbar Traction: What Is Its Place in Clinical Practice?

    Science.gov (United States)

    2016-03-01

    Summary evidence concludes that mechanical lumbar traction is not effective for treating acute or chronic nonspecific low back pain (LBP). However, many physical therapists continue to use it, primarily as an additional modality. Indeed, expert clinical opinion, theoretical models, and some research evidence suggest that certain patients with LBP respond positively to traction. A study published in the March 2016 issue of JOSPT investigates the effectiveness of traction in prone as an adjunct to an extension-oriented exercise program in patients with LBP and leg pain and explores whether a previously identified set of patient characteristics is associated with better outcomes from traction. In this Perspectives for Practice, the authors explain the impact of their findings for clinicians treating these patients. PMID:26928736

  9. Neuroplasticity and Clinical Practice: Building Brain Power for Health.

    Science.gov (United States)

    Shaffer, Joyce

    2016-01-01

    The focus of this review is on driving neuroplasticity in a positive direction using evidence-based interventions that also have the potential to improve general health. One goal is to provide an overview of the many ways new neuroscience can inform treatment protocols to empower and motivate clients to make the lifestyle choices that could help build brain power and could increase adherence to healthy lifestyle changes that have also been associated with simultaneously enhancing vigorous longevity, health, happiness, and wellness. Another goal is to explore the use of a focus in clinical practice on helping clients appreciate this new evidence and use evolving neuroscience in establishing individualized goals, designing strategies for achieving them and increasing treatment compliance. The timing is urgent for such interventions with goals of enhancing brain health across the lifespan and improving statistics on dementia worldwide. PMID:27507957

  10. Glucose Biosensors: An Overview of Use in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Eun-Hyung Yoo

    2010-05-01

    Full Text Available Blood glucose monitoring has been established as a valuable tool in the management of diabetes. Since maintaining normal blood glucose levels is recommended, a series of suitable glucose biosensors have been developed. During the last 50 years, glucose biosensor technology including point-of-care devices, continuous glucose monitoring systems and noninvasive glucose monitoring systems has been significantly improved. However, there continues to be several challenges related to the achievement of accurate and reliable glucose monitoring. Further technical improvements in glucose biosensors, standardization of the analytical goals for their performance, and continuously assessing and training lay users are required. This article reviews the brief history, basic principles, analytical performance, and the present status of glucose biosensors in the clinical practice.

  11. [Clinical practice guidelines and knowledge management in healthcare].

    Science.gov (United States)

    Ollenschläger, Günter

    2013-10-01

    Clinical practice guidelines are key tools for the translation of scientific evidence into everyday patient care. Therefore guidelines can act as cornerstones of evidence based knowledge management in healthcare, if they are trustworthy, and its recommendations are not biased by authors' conflict of interests. Good medical guidelines should be disseminated by means of virtual (digital/electronic) health libraries - together with implementation tools in context, such as guideline based algorithms, check lists, patient information, a.s.f. The article presents evidence based medical knowledge management using the German experiences as an example. It discusses future steps establishing evidence based health care by means of combining patient data, evidence from medical science and patient care routine, together with feedback systems for healthcare providers.

  12. Neuroplasticity and Clinical Practice: Building Brain Power for Health.

    Science.gov (United States)

    Shaffer, Joyce

    2016-01-01

    The focus of this review is on driving neuroplasticity in a positive direction using evidence-based interventions that also have the potential to improve general health. One goal is to provide an overview of the many ways new neuroscience can inform treatment protocols to empower and motivate clients to make the lifestyle choices that could help build brain power and could increase adherence to healthy lifestyle changes that have also been associated with simultaneously enhancing vigorous longevity, health, happiness, and wellness. Another goal is to explore the use of a focus in clinical practice on helping clients appreciate this new evidence and use evolving neuroscience in establishing individualized goals, designing strategies for achieving them and increasing treatment compliance. The timing is urgent for such interventions with goals of enhancing brain health across the lifespan and improving statistics on dementia worldwide.

  13. Neuroplasticity and Clinical Practice: Building Brain Power for Health

    Science.gov (United States)

    Shaffer, Joyce

    2016-01-01

    The focus of this review is on driving neuroplasticity in a positive direction using evidence-based interventions that also have the potential to improve general health. One goal is to provide an overview of the many ways new neuroscience can inform treatment protocols to empower and motivate clients to make the lifestyle choices that could help build brain power and could increase adherence to healthy lifestyle changes that have also been associated with simultaneously enhancing vigorous longevity, health, happiness, and wellness. Another goal is to explore the use of a focus in clinical practice on helping clients appreciate this new evidence and use evolving neuroscience in establishing individualized goals, designing strategies for achieving them and increasing treatment compliance. The timing is urgent for such interventions with goals of enhancing brain health across the lifespan and improving statistics on dementia worldwide. PMID:27507957

  14. Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

    DEFF Research Database (Denmark)

    Gadegaard Jensen, Anders; Callesen, T; Hagemo, J S;

    2010-01-01

    Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care...... Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients...... influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1-1.5 mg/kg is preferred. Outside...

  15. The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines

    Directory of Open Access Journals (Sweden)

    Aertgeerts Bert

    2009-09-01

    Full Text Available Abstract Background Evidence-based medicine has broadened its scope and is starting to reach insurance medicine. Although still in its initial stages, physicians in the area of insurance medicine should keep up-to-date with the evidence on various diseases in order to correctly assess disability and to give appropriate advice about health care reimbursement. In order to explore future opportunities of evidence-based medicine to improve daily insurance medicine, there is a need for qualitative studies to better understand insurance physicians' perceptions of EBM. The present study was designed to identify the attitude of insurance physicians towards evidence-based medicine and clinical practice guidelines, and to determine their ability to access, retrieve and appraise the health evidence and the barriers for applying evidence to practice. Methods A cross-sectional survey study was carried out among all Dutch-speaking insurance physicians employed at one of the six Belgian social insurance sickness funds and at the National Institute of Disability and Health care Insurance (n = 224. Chi-square tests were used to compare nominal and ordinal variables. Student's t-tests, ANOVA, Mann-Whitney and Kruskal-Wallis were used to compare means of continuous variables for different groups. Results The response rate was 48.7%. The majority of respondents were positive towards evidence-based medicine and clinical practice guidelines. Their knowledge of EBM was rather poor. Perceived barriers for applying evidence to practice were mainly time and lack of EBM skills. Conclusion Although the majority of physicians were positive towards EBM and welcomed more guidelines, the use of evidence and clinical practice guidelines in insurance medicine is low at present. It is in the first place important to eradicate the perceived inertia which limits the use of EBM and to further investigate the EBM principles in the context of insurance medicine. Available high

  16. Clinical usefulness of teleradiology in general dental practice

    International Nuclear Information System (INIS)

    This study was performed to investigate the clinical usefulness of teleradiology in general dental practice. Two hundred and seventy five cases were submitted for inquiry to the case presentation board of the website of The Korean Academy of Oral and Maxillofacial Radiology for a 5 year periods. The diagnosis results of those cases were analyzed according to the disease classification, the correlation with the patient's chief complaint, the necessity of additional examinations or treatments, the image modalities, and the number of dentists inquiring. Differential diagnoses of normal anatomic structures were the most frequently submitted cases, covering 15.6% of all cases. Among 275 cases, 164 cases required no additional treatments or examinations. Panoramic radiographs were the most frequently submitted images, accounting for 248 inquiries. The 275 cases were submitted by 96 dentists. Fifty-two dentists wrote one inquiry, and 44 inquired 2 or more times. The average inquiry number of the latter group was 5.0 cases. A teleradiology system in general dental practice could be helpful in the differential diagnosis of common lesions and reduce unnecessary costs.

  17. Swiss clinical practice guidelines on field cancerization of the skin.

    Science.gov (United States)

    Hofbauer, Günther; Anliker, Mark; Boehncke, Wolf-Henning; Brand, Christoph; Braun, Ralph; Gaide, Olivier; Hafner, Jürg; Hunger, Robert; Itin, Peter; Kaeuper, Gina; Lautenschlager, Stephan; Mainetti, Carlo; Streit, Markus

    2014-01-01

    Actinic keratosis (AK) affects millions of people worldwide, and its prevalence continues to increase. AK lesions are caused by chronic ultraviolet radiation exposure, and the presence of two or more AK lesions along with photodamage should raise the consideration of a diagnosis of field cancerization. Effective treatment of individual lesions as well as field cancerization is essential for good long-term outcomes. The Swiss Registry of Actinic Keratosis Treatment (REAKT) Working Group has developed clinical practice guidelines for the treatment of field cancerization in patients who present with AK. These guidelines are intended to serve as a resource for physicians as to the most appropriate treatment and management of AK and field cancerization based on current evidence and the combined practical experience of the authors. Treatment of AK and field cancerization should be driven by consideration of relevant patient, disease, and treatment factors, and appropriate treatment decisions will differ from patient to patient. Prevention measures and screening recommendations are discussed, and special considerations related to management of immunocompromised patients are provided. PMID:25539459

  18. [Birth of clinical practice--in a historical perspective].

    Science.gov (United States)

    Hofmann, B

    1993-11-30

    Modern medicine is rooted in the science and the clinical practice of the 18th and 19th century. Here it finds its aims and methods, its view of life and death, and of health and disease. The french philosopher Michel Foucault has made an original contribution to the understanding of the social and cultural aspects of the development of medicine. He seeks its foundation in the classificatory medicine of the nosology of the 18th century. The diseases were then organized in a botanical model by their essence. The doctor revealed and confirmed the natural development of the diseases. He practised an art of medicine founded on local conditions. Following the social and political demands for regulation in the 18th century, the first grand hospitals were built. Here the doctors had the opportunity to study a large number of patients, and the statistical methods led to a bloom of clinical medicine. However, before medical science was able to use the microscope, before it could find the solution to life and disease in the obduced body, much had to change. Man had to alter his view of life and death, of subject and object, of doctor and patient. Only then was it possible to carry out pathological anatomy. Michel Foucault has presented a view of the history of medicine which counterbalances deterministic management of the Asclepian heritage by science.

  19. Common recurrent microduplication syndromes: diagnosis and management in clinical practice.

    Science.gov (United States)

    Berg, Jonathan S; Potocki, Lorraine; Bacino, Carlos A

    2010-05-01

    Details on the phenotypic consequences of genomic microdeletions and microduplications are rapidly emerging in the wake of increased utilization of high-resolution methods for the detection of genomic copy number variants (CNVs). Due to their recent discovery, the complete phenotypic characterization of these syndromes is still in progress. For practicing clinicians, this unprecedented molecular diagnostic capability has in many cases outpaced our ability to convey conclusive information regarding these conditions to patients and family members. In particular, genomic microduplication syndromes are frequently associated with variable phenotypes and incomplete penetrance, leading to difficulty in counseling regarding the potential future consequences of a given microduplication. In this review, we have attempted to provide an initial set of recommendations for the management of patients with recurrent microduplication syndromes. We summarize the clinical information for microduplications of 14 different genomic regions and provide a framework for clinical evaluation and anticipatory guidance in these conditions. It is our expectation that these preliminary guidelines will be revised further for each microduplication syndrome as more information becomes available.

  20. Optical Coherence Tomography: Clinical Applications in Medical Practice

    Directory of Open Access Journals (Sweden)

    Abdullah Al-Mujaini

    2013-03-01

    Full Text Available Optical Coherence Tomography (OCT is a success story of scientific and technological co-operation between a physicist and a clinician. The concept of cross-sectional imaging revolutionalized the applicability of OCT in the medical profession. OCT is a non-contact, topographic, biomicroscopic device that provides high resolution, cross-sectional digital images of live biological tissues in vivo and in real time. OCT is based on the property of tissues to reflect and backscatter light involving low-coherence interferometry. The spatial resolution of as little as 3 microns or even less has allowed us to study tissues almost at a cellular level. Overall, OCT is an invaluable adjunct in the diagnosis and follow up of many diseases of both anterior and posterior segments of the eye, primarily or secondary to systemic diseases. The digitalization and advanced software has made it possible to store and retrieve huge patient data for patient services, clinical applications and academic research. OCT has revolutionized the sensitivity and specificity of diagnosis, follow up and response to treatment in almost all fields of clinical practice involving primary ocular pathologies and secondary ocular manifestations in systemic diseases like diabetes mellitus, hypertension, vascular and neurological diseases, thus benefitting non-ophthalmologists as well. Systemically, OCT is proving to be a helpful tool in substantiating early diagnosis in diseases like multiple sclerosis and drug induced retinopathies by detecting early changes in morphology of the retinal nerve fiber layer.

  1. Usefulness of factor V Leiden mutation testing in clinical practice

    Science.gov (United States)

    Blinkenberg, Ellen Ø; Kristoffersen, Ann-Helen; Sandberg, Sverre; Steen, Vidar M; Houge, Gunnar

    2010-01-01

    We have investigated the clinical usefulness of the activated protein C resistance (APCR)/factor V Leiden mutation (FVL) test by sending out questionnaires to all Norwegian physicians who ordered these tests from our publicly funded service laboratory during a 3-month period, and of whom 70% (267/383) responded. Indications for testing, patient follow-up, the use of APCR versus FVL tests and differences in practice between hospital doctors and GPs were examined. We found that 46% of the tests were predictive, ordered for risk assessment in healthy individuals with no previous history of venous thromboembolism (VTE). Among these, 42% of the tests were taken on the initiative of the patient and 24% were screening tests before prescription of oral contraceptives. In total, 54% of the tests were classified as diagnostic, among which 42% were ordered owing to a previous history of VTE and 22% to a history of brain stroke or myocardial infarction. The prevalence of FVL heterozygotes was not significantly different between the predictive and diagnostic test groups, that is, 26 and 20%, respectively. Only the predictive tests influenced patient follow-up. Here, the physician's advice to patients depended on the test result. In general, the clinical usefulness of APCR/FVL testing was low. Many tests were performed on unsubstantiated or vague indications. Furthermore, normal test results led to unwarranted refrain from giving advice about antithrombotic measures, leading to potential harm to the patient. PMID:20332812

  2. Standardized clinical outcome rating scale for depression for use in clinical practice.

    Science.gov (United States)

    Zimmerman, Mark; Posternak, Michael A; Chelminski, Iwona; Friedman, Michael

    2005-01-01

    The integration of research into clinical practice to conduct effectiveness studies faces multiple obstacles. One obstacle is the burden of completing research measures of outcome. A simple, reliable, and valid measure that could be rated at every visit, incorporated into a clinician's progress note, and reflect the DSM-IV definition of a major depressive episode (including partial and full remission from the episode) would enhance the ability to conduct effectiveness research. The goal of the present study was to examine the reliability and validity of such a measure. Three hundred and three psychiatric outpatients who were being treated for a DSM-IV major depressive episode were rated on the Standardized Clinical Outcome Rating for Depression (SCOR-D), 17-item Hamilton Rating Scale for Depression, Montgomery-Asberg Depression Rating Scale, and the Global Assessment of Functioning. We examined the correlation between the SCOR-D and the other measures, and conducted an analyses of variance to compare mean values on these measures for each rating point on the SCOR-D. The inter-rater reliability of the SCOR-D dimensional ratings and categorical determination of remission were high. The SCOR-D was highly correlated with the other scales, and there were significant differences on the other measures of depression severity between each adjacent rating level of the SCOR-D. The SCOR-D is a brief standardized outcome measure linked to the DSM-IV approach toward defining remission that can be incorporated into routine clinical practice without adding undue burden to the treating clinician with some evidence of reliability and validity. This measure could make it more feasible to conduct effectiveness studies in clinical practice.

  3. Diagnostic Methods for Bile Acid Malabsorption in Clinical Practice

    Science.gov (United States)

    Vijayvargiya, Priya; Camilleri, Michael; Shin, Andrea; Saenger, Amy

    2013-01-01

    Altered bile acid (BA) concentrations in the colon may cause diarrhea or constipation. BA malabsorption (BAM) accounts for >25% of patients with irritable bowel syndrome (IBS) with diarrhea and chronic diarrhea in Western countries. As BAM is increasingly recognized, proper diagnostic methods are desired in clinical practice to help direct the most effective treatment course for the chronic bowel dysfunction. This review appraises the methodology, advantages and disadvantages of 4 tools that directly measure BAM: 14C-glycocholate breath and stool test, 75Selenium HomotauroCholic Acid Test (SeHCAT), 7 α-hydroxy-4-cholesten-3-one (C4) and fecal BAs. 14C-glycocholate is a laborious test no longer widely utilized. 75SeHCAT is validated, but not available in the United States. Serum C4 is a simple, accurate method that is applicable to a majority of patients, but requires further clinical validation. Fecal measurements to quantify total and individual fecal BAs are technically cumbersome and not widely available. Regrettably, none of these tests are routinely available in the U.S., and a therapeutic trial with a BA binder is used as a surrogate for diagnosis of BAM. Recent data suggest there is an advantage to studying fecal excretion of the individual BAs and their role in BAM; this may constitute a significant advantage of the fecal BA method over the other tests. Fecal BA test could become a routine addition to fecal fat measurement in patients with unexplained diarrhea. In summary, availability determines the choice of test among C4, SeHCAT and fecal BA; more widespread availability of such tests would enhance clinical management of these patients. PMID:23644387

  4. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain.

    Science.gov (United States)

    Saulino, Michael; Kim, Philip S; Shaw, Erik

    2014-01-01

    Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of "last resort", intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a "critical mass" intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients' needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents - morphine and ziconotide - are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been assessed in three double-blind, placebo-controlled trials of 457 patients, and safety has been assessed in 1,254 patients overall, with severe chronic cancer, noncancer, and acquired immunodeficiency syndrome pain types. Both agents are highlighted as first-line intrathecal therapy for the management of neuropathic or nociceptive pain. The purpose of this review is to discuss practical considerations for intrathecal

  5. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

    Science.gov (United States)

    Saulino, Michael; Kim, Philip S; Shaw, Erik

    2014-01-01

    Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of “last resort”, intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a “critical mass” intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients’ needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents – morphine and ziconotide – are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been assessed in three double-blind, placebo-controlled trials of 457 patients, and safety has been assessed in 1,254 patients overall, with severe chronic cancer, noncancer, and acquired immunodeficiency syndrome pain types. Both agents are highlighted as first-line intrathecal therapy for the management of neuropathic or nociceptive pain. The purpose of this review is to discuss practical considerations

  6. Neuroimaging as a Selection Tool and Endpoint in Clinical and Pre-clinical Trials.

    Science.gov (United States)

    Muir, Keith W; Macrae, I Mhairi

    2016-10-01

    Standard imaging in acute stroke enables the exclusion of non-stroke structural CNS lesions and cerebral haemorrhage from clinical and pre-clinical ischaemic stroke trials. In this review, the potential benefit of imaging (e.g., angiography and penumbral imaging) as a translational tool for trial recruitment and the use of imaging endpoints are discussed for both clinical and pre-clinical stroke research. The addition of advanced imaging to identify a "responder" population leads to reduced sample size for any given effect size in phase 2 trials and is a potentially cost-efficient means of testing interventions. In pre-clinical studies, technical failures (failed or incomplete vessel occlusion, cerebral haemorrhage) can be excluded early and continuous multimodal imaging of the animal from stroke onset is feasible. Pre- and post-intervention repeat scans provide real time assessment of the intervention over the first 4-6 h. Negative aspects of advanced imaging in animal studies include increased time under general anaesthesia, and, as in clinical studies, a delay in starting the intervention. In clinical phase 3 trial designs, the negative aspects of advanced imaging in patient selection include higher exclusion rates, slower recruitment, overestimated effect size and longer acquisition times. Imaging may identify biological effects with smaller sample size and at earlier time points, compared to standard clinical assessments, and can be adjusted for baseline parameters. Mechanistic insights can be obtained. Pre-clinically, multimodal imaging can non-invasively generate data on a range of parameters, allowing the animal to be recovered for subsequent behavioural testing and/or the brain taken for further molecular or histological analysis. PMID:27543177

  7. Standardized Clinical Assessment And Management Plans (SCAMPs) Provide A Better Alternative To Clinical Practice Guidelines

    Science.gov (United States)

    Farias, Michael; Jenkins, Kathy; Lock, James; Rathod, Rahul; Newburger, Jane; Bates, David W.; Safran, Dana G.; Friedman, Kevin; Greenberg, Josh

    2014-01-01

    Variability in medical practice in the United States leads to higher costs without achieving better patient outcomes. Clinical practice guidelines, which are intended to reduce variation and improve care, have several drawbacks that limit the extent of buy-in by clinicians. In contrast, standardized clinical assessment and management plans (SCAMPs) offer a clinician-designed approach to promoting care standardization that accommodates patients’ individual differences, respects providers’ clinical acumen, and keeps pace with the rapid growth of medical knowledge. Since early 2009 more than 12,000 patients have been enrolled in forty-nine SCAMPs in nine states and Washington, D.C. In one example, a SCAMP was credited with increasing clinicians’ rate of compliance with a recommended specialist referral for children from 19.6 percent to 75 percent. In another example, SCAMPs were associated with an 11–51 percent decrease in total medical expenses for six conditions when compared with a historical cohort. Innovative tools such as SCAMPs should be carefully examined by policy makers searching for methods to promote the delivery of high-quality, cost-effective care. PMID:23650325

  8. Screening EEG in Aircrew Selection: Clinical Aerospace Neurology Perspective

    Science.gov (United States)

    Clark, Jonathan B.; Riley, Terrence

    2001-01-01

    As clinical aerospace neurologists we do not favor using screening EEG in pilot selection on unselected and otherwise asymptomatic individuals. The role of EEG in aviation screening should be as an adjunct to diagnosis, and the decision to disqualify a pilot should never be based solely on the EEG. Although a policy of using a screening EEG in an unselected population might detect an individual with a potentially increased relative risk, it would needlessly exclude many applicants who would probably never have a seizure. A diagnostic test performed on an asymptomatic individual without clinical indications, in a population with a low prevalence of disease (seizure) may be of limited or possibly detrimental value. We feel that rather than do EEGs on all candidates, a better approach would be to perform an EEG for a specific indication, such as family history of seizure, single convulsion (seizure) , history of unexplained loss of consciousness or head injury. Routine screening EEGs in unselected aviation applications are not done without clinical indication in the U.S. Air Force, Navy, or NASA. The USAF discontinued routine screening EEGs for selection in 1978, the U.S. Navy discontinued it in 1981 , and NASA discontinued it in 1995. EEG as an aeromedical screening tool in the US Navy dates back to 1939. The US Navy routinely used EEGs to screen all aeromedical personnel from 1961 to 1981. The incidence of epileptiform activity on EEG in asymptomatic flight candidates ranges from 0.11 to 2.5%. In 3 studies of asymptomatic flight candidates with epileptiform activity on EEG followed for 2 to 15 years, 1 of 31 (3.2%), 1 of 30 (3.3%), and 0 of 14 (0%) developed a seizure, for a cumulative risk of an individual with an epileptiform EEG developing a seizure of 2.67% (2 in 75). Of 28,658 student naval aviation personnel screened 31 had spikes and/or slow waves on EEG, and only 1 later developed a seizure. Of the 28,627 who had a normal EEG, 4 later developed seizures, or

  9. CLINICAL DECISION MAKING IN NURSING CARE: EVIDENCE BASED PRACTICE AND SENIORITY

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    Sivasangari Subramaniam

    2015-03-01

    Full Text Available In the nursing profession, EBP makes a positive contribution to healthcare outcomes, care delivery, clinical teaching and research. The research objective was to determine the nurses' knowledge, attitude, practice towards EBP and barriers to use EBP in four (4 Government Hospitals in Malaysia, Hospital Universiti Sains Malaysia (HUSM, Hospital Pulau Pinang (HPP, Hospital Sultan Abdul Halim (HSAH and Hospital Seberang Jaya (HSJ. A cross-sectional study was conducted from January until December 2012 among (n=600 nurses working in all disciplines, on shift or day time duties in four selected hospitals. The questionnaire was adapted from a Singapore study (Majid, 2011. Results showed that among the nurses working in 4 different Malaysian hospitals, close to fifty percent (53 % knew what the evidence based practice meant. The items assessing the attitude showed a large number nurses responding that they did neither agree nor disagree with statements provided. The majority of the remaining nurses tended to show a rather positive attitude except when asked about how the workload interfered with their EBP practice. The practice level of EBP scored a mean of more than 3 out of maximal five for most items. Most nurses recognized there were many barriers to EBP in their working place. In conclusion, this study may have helped to increase our understanding of knowledge, attitudes, practice and barriers towards to use of EBP to the utilization of research by nurses through an exploration of perceived barriers and facilitators on the part of nurses.

  10. One state's effort to improve recruitment, retention, and practice through multifaceted clinical supervision interventions.

    Science.gov (United States)

    Collins-Camargo, Crystal; Sullivan, Dana J; Washeck, Bonnie; Adams, Jeff; Sundet, Paul

    2009-01-01

    The professional literature has described the critical role child welfare supervisors play in the recruitment and retention (R&R) of a competent workforce and in practice enhancement to produce positive outcomes for children and families. Building on findings from a federally funded demonstration project related to implementation of clinical supervision in the child welfare setting, this article provides a description of a comprehensive approach to achievement of these outcomes: an integrated implementation of an employee selection protocol, 360-degree evaluation and employee development planning, and peer consultation and support groups for supervisors. An outline of the evaluation designed to assess relative effectiveness of each component on organizational culture, staff R&R, and practice is provided. PMID:20187564

  11. Selecting clinical diagnoses: logical strategies informed by experience.

    Science.gov (United States)

    Stanley, Donald Edward; Campos, Daniel G

    2016-08-01

    This article describes reasoning strategies used by clinicians in different diagnostic circumstances and how these modes of inquiry may allow further insight into the evaluation and treatment of patients. Specifically, it aims to make explicit the implicit logical considerations that guide a variety of strategies in the diagnostic process, as exemplified in specific clinical cases. It focuses, in particular, in strategies that clinicians use to move from a large set of possible diagnoses initially suggested by abductive inferences - the process of hypothesis generation that creates a diagnostic space - to a narrower set or even to a single 'best' diagnosis, where the criteria to determine what is 'best' may differ according to different strategies. Experienced clinicians should have a diversified kit of strategies - for example, Bayesian probability or inference to a lovely explanation - to select from among previously generated hypotheses, rather than rely on any one approach every time.

  12. Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

    Directory of Open Access Journals (Sweden)

    Clark Michael E

    2010-04-01

    Full Text Available Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR, and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The

  13. Variability of CSF Alzheimer's disease biomarkers: implications for clinical practice.

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    Stephanie J B Vos

    Full Text Available BACKGROUND: Cerebrospinal fluid (CSF biomarkers are increasingly being used for diagnosis of Alzheimer's disease (AD. OBJECTIVE: We investigated the influence of CSF intralaboratory and interlaboratory variability on diagnostic CSF-based AD classification of subjects and identified causes of this variation. METHODS: We measured CSF amyloid-β (Aβ 1-42, total tau (t-tau, and phosphorylated tau (p-tau by INNOTEST enzyme-linked-immunosorbent assays (ELISA in a memory clinic population (n = 126. Samples were measured twice in a single or two laboratories that served as reference labs for CSF analyses in the Netherlands. Predefined cut-offs were used to classify CSF biomarkers as normal or abnormal/AD pattern. RESULTS: CSF intralaboratory variability was higher for Aβ1-42 than for t-tau and p-tau. Reanalysis led to a change in biomarker classification (normal vs. abnormal of 26% of the subjects based on Aβ1-42, 10% based on t-tau, and 29% based on p-tau. The changes in absolute biomarker concentrations were paralleled by a similar change in levels of internal control samples between different assay lots. CSF interlaboratory variability was higher for p-tau than for Aβ1-42 and t-tau, and reanalysis led to a change in biomarker classification of 12% of the subjects based on Aβ1-42, 1% based on t-tau, and 22% based on p-tau. CONCLUSIONS: Intralaboratory and interlaboratory CSF variability frequently led to change in diagnostic CSF-based AD classification for Aβ1-42 and p-tau. Lot-to-lot variation was a major cause of intralaboratory variability. This will have implications for the use of these biomarkers in clinical practice.

  14. Evaluation of features to support safety and quality in general practice clinical software

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    Schattner Peter

    2011-05-01

    Full Text Available Abstract Background Electronic prescribing is now the norm in many countries. We wished to find out if clinical software systems used by general practitioners in Australia include features (functional capabilities and other characteristics that facilitate improved patient safety and care, with a focus on quality use of medicines. Methods Seven clinical software systems used in general practice were evaluated. Fifty software features that were previously rated as likely to have a high impact on safety and/or quality of care in general practice were tested and are reported here. Results The range of results for the implementation of 50 features across the 7 clinical software systems was as follows: 17-31 features (34-62% were fully implemented, 9-13 (18-26% partially implemented, and 9-20 (18-40% not implemented. Key findings included: Access to evidence based drug and therapeutic information was limited. Decision support for prescribing was available but varied markedly between systems. During prescribing there was potential for medicine mis-selection in some systems, and linking a medicine with its indication was optional. The definition of 'current medicines' versus 'past medicines' was not always clear. There were limited resources for patients, and some medicines lists for patients were suboptimal. Results were provided to the software vendors, who were keen to improve their systems. Conclusions The clinical systems tested lack some of the features expected to support patient safety and quality of care. Standards and certification for clinical software would ensure that safety features are present and that there is a minimum level of clinical functionality that clinicians could expect to find in any system.

  15. Integrated monitoring: Setting new standards for the next decade of clinical trial practice

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    Kamala Rai

    2011-01-01

    Full Text Available The new age clinical research professional is now geared toward an "integrated monitoring" approach. A number of critical activities at the site level and at the sponsor′s organization need convergence to harness rich dividends in early study start and quick close of the study. The field monitor needs full integration to ensure standard of care, train the site in protocol, select the right site, ensure regulatory support, ensure excellent project management skills, coach, support the logistics team, manage the vendor, ensure good documentation practices, develop patient recruitment and retention, lean the applicable process, as well as ensure effective site management amongst the myriad activities assigned toward developing the drug in the clinic.

  16. How to calibrate Grenz-beams in clinical practice?

    Energy Technology Data Exchange (ETDEWEB)

    Schaeken, B. [Algemeen Ziekenhius Middelheim, Antwerp (Belgium); Bressers, E. [Virga jesse Ziekenhius, Hasselt (Belgium)

    1995-12-01

    In recent years, considerable efforts have been spent improving the precision and consistency in the whole process of calibration of high energy photon and electron beams (national protocols, primary calibration facilities ....). The reading in air of 5 different ionisation chambers (NE2532, NE2536, NE2571, PTWM23342, Markus) in an X-ray beam (RT50, HVL=0.35 mm Al) has been compared. Ali NE chambers were provided with a calibration factor Nk, the PTW chamber was directly calibrated in dose water ND,W. The polarisation and recombination effects were measured. In our reference field (ssd=4cm, field diameter 40 mm), the readings in air for the dedicated plan parallel chambers deviated by not more than 8%. The measurements with the NE2571 chamber did not correspond very well with the other measurements. For the equipment in our hospital, the dose rate in air for the reference field was measured from 1971 on and found to be very stable: 17.36 Gy/min (0.48) (1sd). An attempt was made to measure the BSF for the field defining cones used in clinical practice using a Markus plane parallel chamber, but the resulting BSF did not correspond to those reported in BJR/suppl. 17. Special attention has been be paid to the calibration of beams with field size comparable to the dimension of the chamber window- chamber body.

  17. Korean clinical practice guidelines: otitis media in children.

    Science.gov (United States)

    Lee, Hyo-Jeong; Park, Su-Kyoung; Choi, Kyu Young; Park, Su Eun; Chun, Young Myung; Kim, Kyu-Sung; Park, Shi-Nae; Cho, Yang-Sun; Kim, Young-Jae; Kim, Hyung-Jong; Korean Otologic Society

    2012-08-01

    Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media.

  18. Clinical applications of laser therapy on the dental practice

    Science.gov (United States)

    Pinheiro, Antonio L. B.

    2004-09-01

    Dental practice consists of a series of laboring procedures which demands the use of several types of equipment and materials. Usually patient"s fears brings additional burden to the Dentists. The use of Lasers for treating and diagnosis in Dentistry is quite new comparing to other medical areas. Initially Laser technology was used as an alternative method for treating dental caries in order to substitute the use of the drill. Lately surgical Lasers have shown themselves very useful for treating several pathologies and began to be used as a powerful tool on the treatment of several conditions affecting the maxillofacial complex and later on, the era of the use of Laser therapy began. The advent of the diode Lasers made possible the introduction of small units at the dental office and Laser therapy was used to improve healing and later included also caries diagnosis. This paper discuss the use of Laser therapy on Restorative Dentistry, Periodondology, Oral and Maxillofacial Surgery, Oral implantology and other. Clinical and laboratorial experience has demonstrated that Laser therapy does improve the healing of both mineralized and soft tissues, reduces pain and inflammation, and also reduces both cost and length of the dental treatment.

  19. Daily Practice Clinic of Scientific Evidence in the Physiotherapy Management of Chronic Nonspecific Low Back Pain

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    María Constanza Trillos Chacón

    2015-05-01

    Full Text Available Introduction: 80 % of adults experience back pain at least once in their life. Back pain is the third leading cause of consultation in the emergency room, the fourth in general practice, the second of disability pension and the first job relocation. Objective: To compare the criteria that guide decision making of a group of physiotherapists in Bogota Colombia for the management of chronic nonspecific low back pain management criteria contained in the guide COST B13 (European Guidelines For The Management Of Chronic Non- specific Low Back Pain, 2004. Material and methods: This was a descriptive study, for which clinical practice guideline COST B13 for the management of chronic nonspecific low back pain through the AGREE tool is selected and a survey was applied to 50 physiotherapists through a convenience sample with to compare the clinical practices that are performed with the recommendations given guidance. Results: 56 % of respondents had some type of training for the management of chronic nonspecific low back pain (DLCI. 94 % of patients with DLCI served range in age from 40 to 59, with female predominance. In 80 % of respondents stated that physiotherapists diagnostic help with counting for the management of patients is the radiological image. 80 % of physiotherapists evaluated variable lumbar pain experienced by the patient and 54 % stance. Other aspects were reported in lower percentage. In the treatment of DLCI, physiotherapists reported use of stretching in 80 % of cases, the superficial thermotherapy in 70 % and isometric muscle strength in 70 %, all with favorable results.Conclusion: There are differences between clinical practice of physiotherapists and guidelines contained in the recommendations of the guide in the cost DLCI B13. Mainly in the processes of physiotherapy assessment of the surveyed population as they are often focused on observation and not always in the rigorous measurement, which makes it difficult to establish

  20. Electroencephalographic neurofeedback: Level of evidence in mental and brain disorders and suggestions for good clinical practice.

    Science.gov (United States)

    Micoulaud-Franchi, J-A; McGonigal, A; Lopez, R; Daudet, C; Kotwas, I; Bartolomei, F

    2015-12-01

    The technique of electroencephalographic neurofeedback (EEG NF) emerged in the 1970s and is a technique that measures a subject's EEG signal, processes it in real time, extracts a parameter of interest and presents this information in visual or auditory form. The goal is to effectuate a behavioural modification by modulating brain activity. The EEG NF opens new therapeutic possibilities in the fields of psychiatry and neurology. However, the development of EEG NF in clinical practice requires (i) a good level of evidence of therapeutic efficacy of this technique, (ii) a good practice guide for this technique. Firstly, this article investigates selected trials with the following criteria: study design with controlled, randomized, and open or blind protocol, primary endpoint related to the mental and brain disorders treated and assessed with standardized measurement tools, identifiable EEG neurophysiological targets, underpinned by pathophysiological relevance. Trials were found for: epilepsies, migraine, stroke, chronic insomnia, attentional-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, major depressive disorder, anxiety disorders, addictive disorders, psychotic disorders. Secondly, this article investigates the principles of neurofeedback therapy in line with learning theory. Different underlying therapeutic models are presented didactically between two continua: a continuum between implicit and explicit learning and a continuum between the biomedical model (centred on "the disease") and integrative biopsychosocial model of health (centred on "the illness"). The main relevant learning model is to link neurofeedback therapy with the field of cognitive remediation techniques. The methodological specificity of neurofeedback is to be guided by biologically relevant neurophysiological parameters. Guidelines for good clinical practice of EEG NF concerning technical issues of electrophysiology and of learning are suggested. These require validation by

  1. Translation of clinical prediction rules for febrile children to primary care practice: an observational cohort study

    Science.gov (United States)

    van Ierland, Yvette; Elshout, Gijs; Berger, Marjolein Y; Vergouwe, Yvonne; de Wilde, Marcel; van der Lei, Johan; Mol, Henriëtte A; Oostenbrink, Rianne

    2015-01-01

    Background Clinical prediction rules (CPRs) to identify children with serious infections lack validation in low-prevalence populations, which hampers their implementation in primary care practice. Aim To evaluate the diagnostic value of published CPRs for febrile children in primary care. Design and setting Observational cohort study among febrile children (<16 years) who consulted five GP cooperatives (GPCs) in the Netherlands. Method Alarm signs of serious infection and clinical management were extracted from routine clinical practice data and manually recoded with a structured electronic data-entry program. Eight CPRs were selected from literature. CPR-variables were matched with alarm signs and CPRs were applied to the GPC-population. ‘Referral to emergency department (ED)’ was used as a proxy outcome measure for ‘serious infection’. CPR performance was assessed by calibration analyses, sensitivity, specificity, and area under the ROC-curve (ROC-area). Results A total of 9794 GPC-contacts were eligible, 54% male, median age 2.3 years (interquartile range 1.0–4.6 years) and 8.1% referred to ED. Frequencies of CPR-variables varied from 0.5% (cyanosis, drowsy) to 25% (temperature ≥40°C). Alarm signs frequently included in CPRs were ‘ill appearance’, ‘inconsolable’, and ‘abnormal circulatory or respiratory signs’. The height of the CPR’s predicted risks generally corresponded with being (or not being) referred to the ED in practice. However, calibration-slopes indicated that three CPRs underestimated the risk of serious infection in the GPC-population. Sensitivities ranged from 42% to 54%, specificities from 68% to 89%. ROC-areas ranged from 0.52 to 0.81, with best performance of CPRs for children aged <3 months. Conclusion Published CPRs performed moderately well in the primary out-of-hours care population. Advice is given on how to improve translation of CPRs to primary care practice. PMID:25824182

  2. Nonpalpable thyroid carcinoma: clinical controversies on preoperative selection.

    Science.gov (United States)

    Carpi, Angelo; Nicolini, Andrea; Casara, Dario; Rubello, Domenico; Rosa Pelizzo, Maria

    2003-06-01

    This article emphasizes some controversies concerning the preoperative selection of nonpalpable thyroid tumors. The prevalence of occult thyroid carcinoma in surgical series (1.8-10%) is not higher than in autopsy thyroid series (2.7-24%). The prevalence of occult thyroid carcinoma in thyroid glands examined in the same institution by ultrasound, for a clinical thyroid abnormality or for investigation of other neck structures without clinically evident or suspected thyroid disease, varies from 3% to 8% and is very similar independent of the fact that a thyroid abnormality is or is not the indication for ultrasonography. These data suggest that the presence of a thyroid disease is not a risk factor for harboring an occult thyroid carcinoma (except for C-cell hyperplasia in the rare case of MEN 2 syndromes). As it is not cost effective to examine all the nonpalpable lesions with fine-needle aspiration (FNA) guided by ultrasounds, it is necessary to define to which extent ultrasound is useful in selecting those lesions to be examined cytologically by FNA. The use of ultrasound to select these lesions is very controversial. Ultrasound-guided cytologic diagnosis of nonpalpable nodules is not as accurate as in the case of palpable nodules. Sampling of material adequate for cytologic analysis depends on the lesion size; it is 64% for a 0.7-cm lesion and it increases to 86.7% for a mean size of 1.1 cm. For the diagnosis of occult thyroid carcinomas (limit for dividing thyroid nodules in probably innocuous or potentially dangerous categories and because the cytologic diagnosis of nodules of this size is sufficiently reliable. For the smaller incidentally discovered thyroid nodules following ultrasound, physicians should discuss with the patient whether and when to perform an ultrasound-guided FNA considering the patient's data (risk factors, age, health state, etc.), the natural history of a small thyroid carcinoma, as well as the accuracy of ultrasound and ultrasound

  3. Lack of Preparation: Iranian Nurses' Experiences During Transition From College to Clinical Practice.

    Science.gov (United States)

    Zamanzadeh, Vahid; Jasemi, Madineh; Valizadeh, Leila; Keogh, Brian; Taleghani, Fariba

    2015-01-01

    Graduate nurse transition from college to professional practice is an important matter in a nurse's professional life. In many cases, this period is characterized by unhealthy physical and mental reactions, loss of interest in one's profession, and unacceptable caregiving. By examining the phenomenon from the point of view of experienced nurses, we can recognize the major factors in a successful transition from college life to professional life. This is a qualitative study and was conducted based on conventional qualitative content analysis method; 14 nurses were selected through purposive sampling, and the data were collected using semistructured interviews in teaching hospitals in Iran. Eight subthemes emerged from the analysis of the interviews: lack of practical skills, limited academic knowledge, inadequate social skills, poor self-confidence, lack of independence, frustration, stress, and loneliness. These items, in turn, fall under 3 themes: poor efficiency, low self-assurance, and unhealthy emotional reactions. The findings of this study indicate that the participants were not well prepared to assume their clinical roles, which in turn gives rise to other problems; to eliminate this defect, the curriculum needs to be revised, proper training programs should accompany the students' studies, and management in clinical environments recommended should be improved in order to facilitate nurses' transition from college to practice. PMID:26194969

  4. Conceptual framework for facilitating reflective practice by nurses in the clinical setting

    OpenAIRE

    Lucia Nelumbu; Louise Pretorius

    2015-01-01

    Problems or incidents occurring in clinical settings are often seen as indicators of poor nursing care and even indicators of a lack of reflective practice skills. This paper presents the description of the conceptual framework to facilitate reflective practice for registered nurses in clinical settings. It focuses on the characteristics of the agent (lecturer as a facilitator) and recipients (registered nurses), the context of the clinical practice, the procedures for the facilitation of ref...

  5. The research and practice based on the full-time visitation model in clinical medical education

    OpenAIRE

    Hong Zhang(Department of Physics and Center for Quantum Spacetime (CQUeST), Sogang University, 35 Baekbeom-ro, Mapo-gu, Seoul, 121-742 Korea); Jing Leng; Shu-juan Xu; Zuofeng Zhang; Gangping Wang

    2015-01-01

    Most of the higher medical colleges and universities teaching hospital carry certain clinical teaching tasks, but the traditional teaching pattern of "two stage", including the early stage of the theory of teaching, the late arrangement of clinical practice, had some drawbacks such as practice time is too concentrated and the chasm between students' theory and practice. It is suggested that students contact clinical diagnosis and treatment earlier, visit more patients and increase the ratio o...

  6. Feasibility of streamlining an interactive Bayesian-based diagnostic support tool designed for clinical practice

    Science.gov (United States)

    Chen, Po-Hao; Botzolakis, Emmanuel; Mohan, Suyash; Bryan, R. N.; Cook, Tessa

    2016-03-01

    In radiology, diagnostic errors occur either through the failure of detection or incorrect interpretation. Errors are estimated to occur in 30-35% of all exams and contribute to 40-54% of medical malpractice litigations. In this work, we focus on reducing incorrect interpretation of known imaging features. Existing literature categorizes cognitive bias leading a radiologist to an incorrect diagnosis despite having correctly recognized the abnormal imaging features: anchoring bias, framing effect, availability bias, and premature closure. Computational methods make a unique contribution, as they do not exhibit the same cognitive biases as a human. Bayesian networks formalize the diagnostic process. They modify pre-test diagnostic probabilities using clinical and imaging features, arriving at a post-test probability for each possible diagnosis. To translate Bayesian networks to clinical practice, we implemented an entirely web-based open-source software tool. In this tool, the radiologist first selects a network of choice (e.g. basal ganglia). Then, large, clearly labeled buttons displaying salient imaging features are displayed on the screen serving both as a checklist and for input. As the radiologist inputs the value of an extracted imaging feature, the conditional probabilities of each possible diagnosis are updated. The software presents its level of diagnostic discrimination using a Pareto distribution chart, updated with each additional imaging feature. Active collaboration with the clinical radiologist is a feasible approach to software design and leads to design decisions closely coupling the complex mathematics of conditional probability in Bayesian networks with practice.

  7. Clinical practice guidelines on cancer-associated thrombosis: a review on scope and methodology.

    Science.gov (United States)

    Lee, Agnes Y Y; Peterson, Erica A; Wu, Cynthia

    2016-04-01

    Cancer-associated thrombosis is a well-recognized complication in patients with cancer. It imposes significant patient morbidity and anxiety, increases personal and societal financial burden, and is the second-leading cause of death in this population. There have been increasing research efforts to reduce the incidence of venous thromboembolism (VTE) and optimize its treatment but the quality of evidence is diverse. To assist clinicians in providing care based on best-available evidence, many international and national organizations have issued clinical practice guidelines. Among these, the most highly cited resources include those developed by the American College of Chest Physicians, the American Society of Clinical Oncology and the European Society of Medical Oncology. Nationally-based guidelines have also been published by various groups, including the Italian Association of Medical Oncology, the National Comprehensive Cancer Network, the French National Federation of the League of Centers Against Cancer, and the British Committee for Standards in Haematology. This review will cover fundamental aspects of clinical practice guideline development and evaluation, summarize the scope and methodology of published guidelines on the management of cancer-associated thrombosis and assess the quality of selected, international guidelines using the validated Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Areas of consensus and uncertainties will be briefly highlighted. PMID:27067964

  8. Bourdieu's Distinction between Rules and Strategies and Secondary Principal Practice: A Review of Selected Literature

    Science.gov (United States)

    Anderson, Karen

    2016-01-01

    This paper reviews a selection of literature on secondary principal practice from which to propose an approach for further research. The review demonstrates that applications of Bourdieu's theory of practice have contributed to understandings about secondary principal practice, and that the distinction he made between rules and strategies has the…

  9. Selective Welfare: Paradigmatic Twists in Social Work Practice

    Directory of Open Access Journals (Sweden)

    Gisela Hauss

    2014-09-01

    Full Text Available The social investment paradigm has been gaining importance within the social policy of post-industrial countries. Investments are made in human capital and aim at shaping productive citizens capable of satisfying the demands of flexible labour markets. The article refers to a research project that aims to explore contemporary changes within everyday practice. The article adopts an ethnographic perspective to analyse the current transformations of everyday practice in the field of unemployment insurance and welfare in the context of activation policies and the investment paradigm

  10. Clinical practice guideline on the optimal radiotherapeutic management of brain metastases

    Directory of Open Access Journals (Sweden)

    Wong Rebecca KS

    2005-04-01

    Full Text Available Abstract Background An evidence-based clinical practice guideline on the optimal radiotherapeutic management of single and multiple brain metastases was developed. Methods A systematic review and meta-analysis was performed. The Supportive Care Guidelines Group formulated clinical recommendations based on their interpretation of the evidence. External review of the report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from Cancer Care Ontario's Practice Guidelines Coordinating Committee (PGCC. Results One hundred and nine Ontario practitioners responded to the survey (return rate 44%. Ninety-six percent of respondents agreed with the interpretation of the evidence, and 92% agreed that the report should be approved. Minor revisions were made based on feedback from external reviewers and the PGCC. The PGCC approved the final practice guideline report. Conclusions For adult patients with a clinical and radiographic diagnosis of brain metastases (single or multiple we conclude that, • Surgical excision should be considered for patients with good performance status, minimal or no evidence of extracranial disease, and a surgically accessible single brain metastasis. • Postoperative whole brain radiotherapy (WBRT should be considered to reduce the risk of tumour recurrence for patients who have undergone resection of a single brain metastasis. • Radiosurgery boost with WBRT may improve survival in select patients with unresectable single brain metastases. • The whole brain should be irradiated for multiple brain metastases. Standard dose-fractionation schedules are 3000 cGy in 10 fractions or 2000 cGy in 5 fractions. • Radiosensitizers are not recommended outside research studies. • In select patients, radiosurgery may be considered as boost therapy with WBRT to improve local tumour control. Radiosurgery boost may improve survival in select patients. • Chemotherapy as primary therapy or

  11. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

    Directory of Open Access Journals (Sweden)

    Saulino M

    2014-11-01

    Full Text Available Michael Saulino,1,2 Philip S Kim,3,4 Erik Shaw5 1MossRehab, Elkins Park, PA, USA; 2Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA, USA; 3Helen F Graham Cancer Center, Christiana Care Health System, Newark, DE, USA; 4Center for Interventional Pain Spine, LLC., Bryn Mawr, PA, USA; 5Shepherd Pain Institute, Shepherd Center, Atlanta, GA, USA Abstract: Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of “last resort”, intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a "critical mass" intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients' needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents – morphine and ziconotide – are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been

  12. Integrative medicine selects best practice from public health and biomedicine

    Directory of Open Access Journals (Sweden)

    Terence J Ryan

    2013-01-01

    Full Text Available The meaning of terms Integrated and Integrative are described variously by an amalgam of latest scientific advances with ancient healing systems, of complementary medicine and biomedicine, and sexually transmitted infections and HIV/AIDS. It means seamless good quality care between hospital and primary care. They provoke approval mostly from patients and disapproval mostly from advocates of science and evidence-based medicine. The Institute of Applied Dermatology in Kasaragod, Kerala, India has championed a mix of Biomedicine, Yoga and herbals from Ayurvedic medicine, partly based on publications from the Department of Dermatology of the University of Oxford. In Oxford dermatology, acceptance of value of integrative medicine (IM is demonstrated, especially in wound healing and the skin′s blood supply. This has long featured in the university′s research program. A variety of approaches to the practice of medicine are illustrated with reference to Osler, Garrod, and Doll. IM is believed to underlie contemporarily best practice. Particular emphasis is given to the control of heat, pain, redness, and swelling, all manifestations of inflammation, and the importance of emotion as a stimulus or inhibitor carried by neural pathways. These may explain some unbelievable Asian practices and one of the many roles of Yoga. The concept of Integrative is expanded to include care of the earth and nutrition, the hazards of climate change, Gardens for Health, do (k no (w harm as a key to good practice.

  13. Selecting information technology for physicians' practices: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Eden Karen

    2002-04-01

    Full Text Available Abstract Background Many physicians are transitioning from paper to electronic formats for billing, scheduling, medical charts, communications, etc. The primary objective of this research was to identify the relationship (if any between the software selection process and the office staff's perceptions of the software's impact on practice activities. Methods A telephone survey was conducted with office representatives of 407 physician practices in Oregon who had purchased information technology. The respondents, usually office managers, answered scripted questions about their selection process and their perceptions of the software after implementation. Results Multiple logistic regression revealed that software type, selection steps, and certain factors influencing the purchase were related to whether the respondents felt the software improved the scheduling and financial analysis practice activities. Specifically, practices that selected electronic medical record or practice management software, that made software comparisons, or that considered prior user testimony as important were more likely to have perceived improvements in the scheduling process than were other practices. Practices that considered value important, that did not consider compatibility important, that selected managed care software, that spent less than $10,000, or that provided learning time (most dramatic increase in odds ratio, 8.2 during implementation were more likely to perceive that the software had improved the financial analysis process than were other practices. Conclusion Perhaps one of the most important predictors of improvement was providing learning time during implementation, particularly when the software involves several practice activities. Despite this importance, less than half of the practices reported performing this step.

  14. Enhancing medical-surgical nursing practice: using practice tests and clinical examples to promote active learning and program evaluation.

    Science.gov (United States)

    DuHamel, Martha B; Hirnle, Constance; Karvonen, Colleen; Sayre, Cindy; Wyant, Sheryl; Colobong Smith, Nancy; Keener, Sheila; Barrett, Shannon; Whitney, Joanne D

    2011-10-01

    In a 14-week medical-surgical nursing review course, two teaching strategies are used to promote active learning and assess the transfer of knowledge to nursing practice. Practice tests and clinical examples provide opportunities for participants to engage in self-assessment and reflective learning and enhance their nursing knowledge, skills, and practice. These strategies also contribute to program evaluation and are adaptable to a variety of course formats, including traditional classroom, web conference, and online self-study.

  15. Teaching Reflective Practice in Practice Settings: Students' Perceptions of Their Clinical Educators

    Science.gov (United States)

    Trede, Franziska; Smith, Megan

    2012-01-01

    Reflective practice in practice settings can enhance practice knowledge, self-assessment and lifelong learning, develop future practice capability and professional identity, and critically appraise practice traditions rather than reproduce them. The inherent power imbalance between student and educator runs the risk for the reflective practice…

  16. Positron Emission Tomography (PET) and breast cancer in clinical practice

    International Nuclear Information System (INIS)

    The landscape of oncologic practice has changed deeply during the past few years and there is now a need, through a multidisciplinary approach, for imaging to provide accurate evaluation of morphology and function and to guide treatment (Image Guided Therapy). Increasing emphasis has been put on Position Emission Tomography (PET) role in various cancers among clinicians and patients despite a general context of healthcare expenditure limitation. Positron Emission Tomography has currently a limited role in breast cancer, but also general radiologists and specialists should be aware of these indications, especially when staging aggressive cancers and looking for recurrence. Currently, the hybrid systems associating PET and Computed Tomography (CT) and in the same device [Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology 2004;231:305-32; Blodgett TM, Meltzer CM, Townsend DW. PET/CT: form and function. Radiology 2007;242:360-85; von Schulthess GK, Steinert HC, Hany TF. Integrated PET/CT: current applications and futures directions. Radiology 2006;238(2):405-22], or PET-CT, are more commonly used and the two techniques are adding their potentialities. Other techniques, MRI in particular, may also compete with PET in some instance and as far as ionizing radiations dose limitation is considered, some breast cancers becoming some form of a chronic disease. Breast cancer is a very complex, non-uniform, disease and molecular imaging at large may contribute to a better knowledge and to new drugs development. Ongoing research, Positron Emission Mammography (PEM) and new tracers, are likely to bring improvements in patient care [Kelloff GJ, Hoffman JM, Johnson B, et al. Progress and promise of FDG-PET Imaging for cancer patient management and oncologic drug development. Clin Cancer Res 2005;1(April (8)): 2005

  17. Positron Emission Tomography (PET) and breast cancer in clinical practice

    Energy Technology Data Exchange (ETDEWEB)

    Lavayssiere, Robert [Centre d' Imagerie Paris-Nord, 1, avenue Charles Peguy, 95200 Sarcelles (France); Institut du Sein Henri Hartmann (ISHH), 1, rue des Dames Augustines, 92200 Neuilly sur Seine (France)], E-mail: cab.lav@wanadoo.fr; Cabee, Anne-Elizabeth [Centre d' Imagerie Paris-Nord, 1, avenue Charles Peguy, 95200 Sarcelles (France); Institut du Sein Henri Hartmann (ISHH), 1, rue des Dames Augustines, 92200 Neuilly sur Seine (France); Centre RMX, 80, avenue Felix Faure, 75105 Paris (France); Filmont, Jean-Emmanuel [Institut du Sein Henri Hartmann (ISHH), 1, rue des Dames Augustines, 92200 Neuilly sur Seine (France); American Hospital of Paris, Nuclear Medicine, 63, boulevard Victor Hugo - BP 109, 92202 Neuilly sur Seine Cedex (France)

    2009-01-15

    The landscape of oncologic practice has changed deeply during the past few years and there is now a need, through a multidisciplinary approach, for imaging to provide accurate evaluation of morphology and function and to guide treatment (Image Guided Therapy). Increasing emphasis has been put on Position Emission Tomography (PET) role in various cancers among clinicians and patients despite a general context of healthcare expenditure limitation. Positron Emission Tomography has currently a limited role in breast cancer, but also general radiologists and specialists should be aware of these indications, especially when staging aggressive cancers and looking for recurrence. Currently, the hybrid systems associating PET and Computed Tomography (CT) and in the same device [Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology 2004;231:305-32; Blodgett TM, Meltzer CM, Townsend DW. PET/CT: form and function. Radiology 2007;242:360-85; von Schulthess GK, Steinert HC, Hany TF. Integrated PET/CT: current applications and futures directions. Radiology 2006;238(2):405-22], or PET-CT, are more commonly used and the two techniques are adding their potentialities. Other techniques, MRI in particular, may also compete with PET in some instance and as far as ionizing radiations dose limitation is considered, some breast cancers becoming some form of a chronic disease. Breast cancer is a very complex, non-uniform, disease and molecular imaging at large may contribute to a better knowledge and to new drugs development. Ongoing research, Positron Emission Mammography (PEM) and new tracers, are likely to bring improvements in patient care [Kelloff GJ, Hoffman JM, Johnson B, et al. Progress and promise of FDG-PET Imaging for cancer patient management and oncologic drug development. Clin Cancer Res 2005;1(April (8)): 2005].

  18. Building the Clinical Bridge to Advance Education, Research, and Practice Excellence

    Directory of Open Access Journals (Sweden)

    Marilyn Svejda

    2012-01-01

    Full Text Available The University of Michigan School of Nursing and the Health System partnered to develop an undergraduate clinical education model as part of a larger project to advance clinical education, practice, and scholarship with education serving as the clinical bridge that anchors all three areas. The clinical model includes clusters of clinical units as the clinical home for four years of a student's education, clinical instruction through team mentorship, clinical immersion, special skills preparation, and student portfolio. The model was examined during a one-year pilot with junior students. Stakeholders were largely positive. Findings showed that Clinical Faculty engaged in more role modeling of teaching strategies as Mentors assumed more direct teaching used more clinical reasoning strategies. Students reported increased confidence and competence in clinical care by being integrated into the team and the Mentor's assignment. Two new full time faculty roles in the Health System support education, practice, and research.

  19. Framework for Selecting Best Practices in Public Health: A Systematic Literature Review.

    Science.gov (United States)

    Ng, Eileen; de Colombani, Pierpaolo

    2015-11-17

    Evidence-based public health has commonly relied on findings from empirical studies, or research-based evidence. However, this paper advocates that practice-based evidence derived from programmes implemented in real-life settings is likely to be a more suitable source of evidence for inspiring and guiding public health programmes. Selection of best practices from the array of implemented programmes is one way of generating such practice-based evidence. Yet the lack of consensus on the definition and criteria for practice-based evidence and best practices has limited their application in public health so far. To address the gap in literature on practice-based evidence, this paper hence proposes measures of success for public health interventions by developing an evaluation framework for selection of best practices. The proposed framework was synthesised from a systematic literature review of peer-reviewed and grey literature on existing evaluation frameworks for public health programmes as well as processes employed by health-related organisations when selecting best practices. A best practice is firstly defined as an intervention that has shown evidence of effectiveness in a particular setting and is likely to be replicable to other situations. Regardless of the area of public health, interventions should be evaluated by their context, process and outcomes. A best practice should hence meet most, if not all, of eight identified evaluation criteria: relevance, community participation, stakeholder collaboration, ethical soundness, replicability, effectiveness, efficiency and sustainability. Ultimately, a standardised framework for selection of best practices will improve the usefulness and credibility of practice-based evidence in informing evidence-based public health interventions. Significance for public healthBest practices are a valuable source of practice-based evidence on effective public health interventions implemented in real-life settings. Yet, despite the

  20. Framework for Selecting Best Practices in Public Health: A Systematic Literature Review.

    Science.gov (United States)

    Ng, Eileen; de Colombani, Pierpaolo

    2015-11-17

    Evidence-based public health has commonly relied on findings from empirical studies, or research-based evidence. However, this paper advocates that practice-based evidence derived from programmes implemented in real-life settings is likely to be a more suitable source of evidence for inspiring and guiding public health programmes. Selection of best practices from the array of implemented programmes is one way of generating such practice-based evidence. Yet the lack of consensus on the definition and criteria for practice-based evidence and best practices has limited their application in public health so far. To address the gap in literature on practice-based evidence, this paper hence proposes measures of success for public health interventions by developing an evaluation framework for selection of best practices. The proposed framework was synthesised from a systematic literature review of peer-reviewed and grey literature on existing evaluation frameworks for public health programmes as well as processes employed by health-related organisations when selecting best practices. A best practice is firstly defined as an intervention that has shown evidence of effectiveness in a particular setting and is likely to be replicable to other situations. Regardless of the area of public health, interventions should be evaluated by their context, process and outcomes. A best practice should hence meet most, if not all, of eight identified evaluation criteria: relevance, community participation, stakeholder collaboration, ethical soundness, replicability, effectiveness, efficiency and sustainability. Ultimately, a standardised framework for selection of best practices will improve the usefulness and credibility of practice-based evidence in informing evidence-based public health interventions. Significance for public healthBest practices are a valuable source of practice-based evidence on effective public health interventions implemented in real-life settings. Yet, despite the

  1. Fuzzy Logic in Clinical Practice Decision Support Systems

    NARCIS (Netherlands)

    Warren, Jim; Beliakov, Gleb; Zwaag, van der Berend

    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

  2. World Best Practice Energy Intensity Values for Selected Industrial Sectors

    OpenAIRE

    Worrell, Ernst; Price, Lynn; Neelis, Maarten; Galitsky, Christina; Zhou, Nan

    2007-01-01

    "World best practice" energy intensity values, representing the most energy-efficient processes that are in commercial use in at least one location worldwide, are provided for the production of iron and steel, aluminium, cement, pulp and paper, ammonia, and ethylene. Energy intensity is expressed in energy use per physical unit of output for each of these commodities; most commonly these are expressed in metric tonnes (t). The energy intensity values are provided by major energy-consumin...

  3. Comparison of different clinical development plans for confirmatory subpopulation selection.

    Science.gov (United States)

    Rufibach, Kaspar; Chen, Meng; Nguyen, Hoa

    2016-03-01

    Given ever increasing costs to develop a new drug and intense competition, adaptive enrichment designs are an attractive option for a development program that allows selecting a potential subgroup defined by a binary biomarker. Such designs explicitly factor in the possibility that the new drug might differentially benefit distinct biomarker subgroups. We have compared three clinical development plans for a time-to-event endpoint, such as overall survival, that all lead to a decision in a pivotal trial either in all comers only, in allcomers and biomarker positive, in the biomarker positive only, or to declare the drug futile. The decision about which hypothesis to test at the final analysis is made based on a fast time-to-event endpoint, such as progression-free survival, at an interim analysis. We quantify the time gain when using an adaptive enrichment Phase II/III design versus alternative development approaches and we outline what type of biomarker needs to be available prior to Phase II in each scenario. We conclude with a discussion of further features of each of the considered development plans. PMID:26744231

  4. Selective Mutism: Practice and Intervention Strategies for Children

    Science.gov (United States)

    Hung, Shu-Lan; Spencer, Michael S.; Dronamraju, Rani

    2012-01-01

    The onset of selective mutism (SM) is usually between the ages of three and five years, when the children first go to preschool. However, these children are most commonly referred for treatment between the ages of six and 11, when they are entering the elementary school system. Early detection and early intervention is suggested for effective SM…

  5. Asthma control limitations in selected primary health care clinics

    Directory of Open Access Journals (Sweden)

    Jan J. Gerber

    2009-04-01

    Full Text Available Primary health care services worldwide are currently experiencing many quality-related problems. Efforts to improve these services appear to be sporadic and unsatisfactory. Investigations have revealed (Sharma & Sharma 2007 that one of the main causes for this state of affairs can be identif ed as neglected or inadequate documentation of patient/case history. The health care provider (HCP should be equipped to improve the quality of health care and to take the lead in assuaging the predicament.

    The present study was undertaken to assess the correlation between asthma control and patient-related case history notes as recorded via the HCP. The data were obtained retrospectively from the patient notes of all asthmatic patients (including children and pregnant women who attended six selected clinics in the North West Province of South Africa (Dr Kenneth Kaunda Municipal District.

    The analysis of the data collected from the patient clinic books confirmed the suspicion of poor quality of documentation, although the documentation in certain categories rendered some positive results. When compared to the GINA® guidelines, none of the patients had been controlled properly and only a small number (18.4% had been controlled partly (GINA 2008. Asthma control may be enhanced when a standard template is developed for completion by the HCP. It is envisaged that this will ensure that vital information regarding asthma control is documented in order to contribute to satisfactory chronic disease control.

    Opsomming

    Primêre gesondheidsorgdienste wêreldwyd ondervind tans menige gehaltediens-verwante probleme, terwyl pogings om dit te verbeter sporadies en onbevredigend voorkom. Navorsing toon (Sharma & Sharma, 2007 dat een van die hoofoorsake hiervan die onvoldoende dokumentasie van die pasiënt of die geval se geskiedenis of nalating om te dokumenteer, is. Die gesondheidsorgverskaffer (GSV moet toegerus word om die gehalte

  6. Common clinical practice versus new PRIM score in predicting coronary heart disease risk

    DEFF Research Database (Denmark)

    Frikke-Schmidt, Ruth; Tybjærg-Hansen, Anne; Schnohr, Peter;

    2010-01-01

    To compare the new Patient Rule Induction Method (PRIM) Score and common clinical practice with the Framingham Point Score for classification of individuals with respect to coronary heart disease (CHD) risk.......To compare the new Patient Rule Induction Method (PRIM) Score and common clinical practice with the Framingham Point Score for classification of individuals with respect to coronary heart disease (CHD) risk....

  7. Placebo Analgesia — Understanding the Mechanisms and Implications for Clinical Practice

    OpenAIRE

    Finniss, Damien G; Nicholas, Michael K.; Benedetti, Fabrizio

    2009-01-01

    There are neurobiological, cognitive and conditioning processes involved in placebo mechanismsMechanisms research has demonstrated that there is not one placebo effect, but manyPlacebo effects are an inherent element in routine clinical practiceModulation of placebo mechanisms in routine practice could provide an opportunity for improving clinical care.

  8. Knowledge Systems, Health Care Teams, and Clinical Practice: A Study of Successful Change

    Science.gov (United States)

    Olson, Curtis A.; Tooman, Tricia R.; Alvarado, Carla J.

    2010-01-01

    Clinical teams are of growing importance to healthcare delivery, but little is known about how teams learn and change their clinical practice. We examined how teams in three US hospitals succeeded in making significant practice improvements in the area of antimicrobial resistance. This was a qualitative cross-case study employing Soft Knowledge…

  9. Molecular Biology of Pancreatic Cancer: How Useful Is It in Clinical Practice?

    Directory of Open Access Journals (Sweden)

    George H Sakorafas

    2012-07-01

    Full Text Available Context During the recent two decades dramatic advances of molecular biology allowed an in-depth understanding of pancreatic carcinogenesis. It is currently accepted that pancreatic cancer has a genetic component. The real challenge is now how these impressive advances could be used in clinical practice. Objective To critically present currently available data regarding clinical application of molecular biology in pancreatic cancer. Methods Reports about clinical implications of molecular biology in patients with pancreatic cancer were retrieved from PubMed. These reports were selected on the basis of their clinical relevance, and the data of their publication (preferentially within the last 5 years. Emphasis was placed on reports investigating diagnostic, prognostic, and therapeutic implications. Results Molecular biology can be used to identify individuals at high-risk for pancreatic cancer development. Intensive surveillance is indicated in these patients to detect pancreatic neoplasia ideally at a preinvasive stage, when curative resection is still possible. Molecular biology can also be used in the diagnosis of pancreatic cancer, with molecular analysis on samples of biologic material, such as serum or plasma, duodenal fluid or preferentially pure pancreatic juice, pancreatic cells or tissue, and stools. Molecular indices have also prognostic significance. Finally, molecular biology may have therapeutic implications by using various therapeutic approaches, such as antiangiogenic factors, purine synthesis inhibitors, matrix metalloproteinase inhibitors, factors modulating tumor-stroma interaction, inactivation of the hedgehog pathway, gene therapy, oncolytic viral therapy, immunotherapy (both passive as well as active etc. Conclusion Molecular biology may have important clinical implications in patients with pancreatic cancer and represents one of the most active areas on cancer research. Hopefully clinical applications of molecular biology

  10. An Investigation of Planning Practices in Select Companies

    Directory of Open Access Journals (Sweden)

    Wyrozębski Paweł

    2014-06-01

    Full Text Available The aim of the article is to answer two research questions concerning the influence of organizational factors and shape of project portfolio on the content and scope, as well as on the stakeholders engagement in project planning. The research strategy included a questionnairebased method. The respondents were representatives of the chosen companies located in Poland, from varied types of industries. The key research finding is that most frequently addressed areas of project planning are those of the iron-triangle of project constraints. There is still lack of understanding for communication, risk and quality planning in projects, which is consonant with recent studies of maturity in project management areas. There are significant differences between industries in terms of areas of project planning. Power engineering seems to be more mature in terms of more frequent practices of planning the project schedule, resources and risk. The research showed a number of significant correlations between components of project planning and both organizational and project portfolio factors, which justifies the statement that those factors can be seen as determinants of project planning practices.

  11. Significant alterations in reported clinical practice associated with increased oversight of organ transplant center performance.

    Science.gov (United States)

    Schold, Jesse D; Arrington, Charlotte J; Levine, Greg

    2010-09-01

    In the past several years, emphasis on quality metrics in the field of organ transplantation has increased significantly, largely because of the new conditions of participation issued by the Centers for Medicare and Medicaid Services. These regulations directly associate patients' outcomes and measured performance of centers with the distribution of public funding to institutions. Moreover, insurers and marketing ventures have used publicly available outcomes data from transplant centers for business decision making and advertisement purposes. We gave a 10-question survey to attendees of the Transplant Management Forum at the 2009 meeting of the United Network for Organ Sharing to ascertain how centers have responded to the increased oversight of performance. Of 63 responses, 55% indicated a low or near low performance rating at their center in the past 3 years. Respondents from low-performing centers were significantly more likely to indicate increased selection criteria for candidates (81% vs 38%, P = .001) and donors (77% vs 31%, P < .001) as well as alterations in clinical protocols (84% vs 52%, P = .007). Among respondents indicating lost insurance contracts (31%), these differences were also highly significant. Based on respondents' perceptions, outcomes of performance evaluations are associated with significant changes in clinical practice at transplant centers. The transplant community and policy makers should practice vigilance that performance evaluations and regulatory oversight do not inadvertently lead to diminished access to care among viable candidates or decreased transplant volume. PMID:20929114

  12. Next-generation sequencing of common osteogenesis imperfecta-related genes in clinical practice.

    Science.gov (United States)

    Árvai, Kristóf; Horváth, Péter; Balla, Bernadett; Tobiás, Bálint; Kató, Karina; Kirschner, Gyöngyi; Klujber, Valéria; Lakatos, Péter; Kósa, János P

    2016-01-01

    Next generation sequencing (NGS) is a rapidly developing area in genetics. Utilizing this technology in the management of disorders with complex genetic background and not recurrent mutation hot spots can be extremely useful. In this study, we applied NGS, namely semiconductor sequencing to determine the most significant osteogenesis imperfecta-related genetic variants in the clinical practice. We selected genes coding collagen type I alpha-1 and-2 (COL1A1, COL1A2) which are responsible for more than 90% of all cases. CRTAP and LEPRE1/P3H1 genes involved in the background of the recessive forms with relatively high frequency (type VII and VIII) represent less than 10% of the disease. In our six patients (1-41 years), we identified 23 different variants. We found a total of 14 single nucleotide variants (SNV) in COL1A1 and COL1A2, 5 in CRTAP and 4 in LEPRE1. Two novel and two already well-established pathogenic SNVs have been identified. Among the newly recognized mutations, one results in an amino acid change and one of them is a stop codon. We have shown that a new full-scale cost-effective NGS method can be developed and utilized to supplement diagnostic process of osteogenesis imperfecta with molecular genetic data in clinical practice. PMID:27335225

  13. Next-generation sequencing of common osteogenesis imperfecta-related genes in clinical practice

    Science.gov (United States)

    Árvai, Kristóf; Horváth, Péter; Balla, Bernadett; Tobiás, Bálint; Kató, Karina; Kirschner, Gyöngyi; Klujber, Valéria; Lakatos, Péter; Kósa, János P.

    2016-01-01

    Next generation sequencing (NGS) is a rapidly developing area in genetics. Utilizing this technology in the management of disorders with complex genetic background and not recurrent mutation hot spots can be extremely useful. In this study, we applied NGS, namely semiconductor sequencing to determine the most significant osteogenesis imperfecta-related genetic variants in the clinical practice. We selected genes coding collagen type I alpha-1 and-2 (COL1A1, COL1A2) which are responsible for more than 90% of all cases. CRTAP and LEPRE1/P3H1 genes involved in the background of the recessive forms with relatively high frequency (type VII and VIII) represent less than 10% of the disease. In our six patients (1–41 years), we identified 23 different variants. We found a total of 14 single nucleotide variants (SNV) in COL1A1 and COL1A2, 5 in CRTAP and 4 in LEPRE1. Two novel and two already well-established pathogenic SNVs have been identified. Among the newly recognized mutations, one results in an amino acid change and one of them is a stop codon. We have shown that a new full-scale cost-effective NGS method can be developed and utilized to supplement diagnostic process of osteogenesis imperfecta with molecular genetic data in clinical practice. PMID:27335225

  14. Peer influence in clinical workplace learning : A study of medical students’ use of social comparison in clinical practice

    NARCIS (Netherlands)

    Raat, Adriana

    2015-01-01

    Undergraduate students in clinical workplace frequently compare their own experiences with those of peers. The research reported in this thesis shows that these so called social comparisons are vital to the process of learning in clinical practice. The first study confirms students’ tendency to comp

  15. Does Ownership Matter? Employee Selection Practices in Private and Public Sectors

    OpenAIRE

    Codruţa OSOIAN; Monica ZAHARIE; Ioan LAZĂR

    2011-01-01

    The continuous need to adapt to the dynamics of the environment requires employers from both public and private sectors to select qualified human resources. It is people who lead the organization towards performance, and selecting competent employees is critical for competitive success. The paper is focused on the job selection practices implemented by hiring organizations in a developing country. Due to the differences that exist regarding the employee selection policy between public and pri...

  16. Bridging the gap between basic science and clinical practice: The role of organizations in addressing clinician barriers

    Directory of Open Access Journals (Sweden)

    Taylor Stephanie

    2011-04-01

    Full Text Available Abstract Background New National Institutes of Health policies call for expansion of practice-based research to improve the clinical research enterprise and facilitate dissemination of evidence-based medicine. Objective This paper describes organizational strategies that influence clinicians' decisions to participate in clinical research. Design We reviewed the literature and interviewed over 200 clinicians and stakeholders. Results The most common barriers to community clinician participation in clinical research relate to beliefs that clinical research is too burdensome and has little benefit for the participating clinician or patient. We identified a number of approaches healthcare organizations can use to encourage clinicians to participate in research, including an outreach campaign to promote the benefits of clinical research; selection of study topics of interest to clinicians; establishment and enforcement of a set of research principles valuing the clinician and patient; development of a transparent schedule of reimbursement for research tasks; provision of technological and technical assistance to practices as needed; and promotion of a sense of community among clinicians involved in practice-based research. Conclusions Many types of existing healthcare organizations could provide the technical and intellectual assistance community clinicians need to participate in clinical research. Multiple approaches are possible.

  17. An exploration of the role of pharmacists within general practice clinics: the protocol for the pharmacists in practice study (PIPS

    Directory of Open Access Journals (Sweden)

    Tan Edwin

    2012-08-01

    Full Text Available Abstract Background Medication-related problems are a serious concern in Australian primary care. Pharmacist interventions have been shown to be effective in identifying and resolving these problems. Collaborative general practitioner-pharmacist services currently available in Australia are limited and underused. Limitations include geographical isolation of pharmacists and lack of communication and access to patient information. Co-location of pharmacists within the general practice clinics is a possible solution. There have been no studies in the Australian setting exploring the role of pharmacists within general practice clinics. The aim of this study is to develop and test a multifaceted practice pharmacist role in primary care practices to improve the quality use of medicines by patients and clinic staff. Methods/design This is a multi-centre, prospective intervention study with a pre-post design and a qualitative component. A practice pharmacist will be located in each of two clinics and provide short and long patient consultations, drug information services and quality assurance activities. Patients receiving long consultation with a pharmacist will be followed up at 3 and 6 months. Based on sample size calculations, at least 50 patients will be recruited for long patient consultations across both sites. Outcome measures include the number, type and severity of medication-related problems identified and resolved; medication adherence; and patient satisfaction. Brief structured interviews will be conducted with patients participating in the study to evaluate their experiences with the service. Staff collaboration and satisfaction with the service will be assessed. Discussion This intervention has the potential to optimise medication use in primary care clinics leading to better health outcomes. This study will provide data about the effectiveness of the proposed model for pharmacist involvement in Australian general practice clinics

  18. Does Ownership Matter? Employee Selection Practices in Private and Public Sectors

    Directory of Open Access Journals (Sweden)

    Codruţa OSOIAN

    2011-06-01

    Full Text Available The continuous need to adapt to the dynamics of the environment requires employers from both public and private sectors to select qualified human resources. It is people who lead the organization towards performance, and selecting competent employees is critical for competitive success. The paper is focused on the job selection practices implemented by hiring organizations in a developing country. Due to the differences that exist regarding the employee selection policy between public and private organizations, the paper aims to understand the characteristics of the job selection process according to the ownership of the employer agent. Based on a quantitative survey applied on 64 companies, the results analyze the main selection stages implemented in private vs. public sector employers in a developing country. While in private companies the most frequently used selection stages are the job selection interview, CVs screening and trial period, in public institutions the hiring process is based on the job selection interview, written knowledge tests, and practical tests. Compared to private companies, in public institutions the written knowledge tests rank a higher position in the selection stages hierarchy, but the private employers rely more on CVs screening stage than public institutions. Emphasis is laid on understanding the reasons leading to variations in job selection practices according to the ownership of the employing agent. The predictive validity of the job selection stages implemented by the companies is also discussed.

  19. CLINICAL ASPECTS OF PATIENT SELECTION FOR CORONARY ANGIOGRAPHY IN NON-ST ELEVATION ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    K. A. Kireev

    2015-01-01

    Full Text Available Own clinical experience in the selection of patients with non-ST elevation acute coronary syndrome for coronary angiography based on clinical guidelines of the European Society of Cardiology (2011 is presented.

  20. Foot care and footwear practices among patients attending a specialist diabetes clinic in Jamaica

    OpenAIRE

    Gayle, Krystal A.T.; Tulloch-Reid, Marshall K.; Younger, Novie O; Francis, Damian K.; Shelly R. McFarlane; Wright-Pascoe, Rosemarie A.; Boyne, Michael S.; Wilks, Rainford J; Ferguson, Trevor S

    2012-01-01

    This study aimed to estimate the proportion of patients at the University Hospital of the West Indies (UHWI) Diabetes Clinic who engage in recommended foot care and footwear practices. Seventy-two participants from the UHWI Diabetes Clinic completed an interviewer-administered questionnaire on foot care practices and types of footwear worn. Participants were a subset of a sex-stratified random sample of clinic attendees and were interviewed in 2010. Data analysis included frequency estimates ...

  1. Clinical practice guidelines for translating pharmacogenomic knowledge to bedside. Focus on anticancer drugs.

    OpenAIRE

    Agúndez, José A. G.; Gara eEsguevillas; Gemma eAmo; Elena eGarcía-Martín

    2014-01-01

    The development of clinical practice recommendations or guidelines for the clinical use of pharmacogenomics data is an essential issue for improving drug therapy, particularly for drugs with high toxicity and/or narrow therapeutic index such as anticancer drugs. Although pharmacogenomic-based recommendations have been formulated for over 40 anticancer drugs, the number of clinical practice guidelines available is very low. The guidelines already published indicate that pharmacogenomic testing...

  2. Clinical practice guidelines for translating pharmacogenomic knowledge to bedside. Focus on anticancer drugs

    OpenAIRE

    Agúndez, José A. G.; Esguevillas, Gara; Amo, Gemma; García-Martín, Elena

    2014-01-01

    The development of clinical practice recommendations or guidelines for the clinical use of pharmacogenomics data is an essential issue for improving drug therapy, particularly for drugs with high toxicity and/or narrow therapeutic index such as anticancer drugs. Although pharmacogenomic-based recommendations have been formulated for over 40 anticancer drugs, the number of clinical practice guidelines available is very low. The guidelines already published indicate that pharmacogenomic testing...

  3. A qualitative grounded theory study of the conceptions of clinical practice in osteopathy - a continuum from technical rationality to professional artistry.

    Science.gov (United States)

    Thomson, Oliver P; Petty, Nicola J; Moore, Ann P

    2014-02-01

    How practitioners conceive clinical practice influences many aspects of their clinical work including how they view knowledge, clinical decision-making, and their actions. Osteopaths have relied upon the philosophical and theoretical foundations upon which the profession was built to guide clinical practice. However, it is currently unknown how osteopaths conceive clinical practice, and how these conceptions develop and influence their clinical work. This paper reports the conceptions of practice of experienced osteopaths in the UK. A constructivist grounded theory approach was taken in this study. The constant comparative method of analysis was used to code and analyse data. Purposive sampling was employed to initially select participants. Subsequent theoretical sampling, informed by data analysis, allowed specific participants to be sampled. Data collection methods involved semi-structured interviews and non-participant observation of practitioners during a patient appointment, which was video-recorded and followed by a video-prompted reflective interview. Participants' conception of practice lay on a continuum, from technical rationality to professional artistry and the development of which was influenced by their educational experience, view of health and disease, epistemology of practice knowledge, theory-practice relationship and their perceived therapeutic role. The findings from this study provide the first theoretical insight of osteopaths' conceptions of clinical practice and the factors which influence such conceptions. PMID:23911356

  4. A Pharmaceutical Industry Elective Course on Practice Experience Selection and Fellowship Pursuit by Pharmacy Students

    OpenAIRE

    Hartman, Rhea; Blustein, Leona; Morel, Diane; Davis, Lisa

    2014-01-01

    Objective. To design and implement 2 pharmaceutical industry elective courses and assess their impact on students’ selection of advanced pharmacy practice experiences (APPEs) and pursuit of pharmaceutical industry fellowships.

  5. Knowledge and Practice of Personal Hygiene and Sanitation: A Study in Selected Slums of Dhaka City

    OpenAIRE

    Shayela Farah; Mohoshina Karim; Nasreen Akther; Meherunnessa Begum; Nadia Begum

    2015-01-01

    Background: : Slum dwellers are likely to be among the most deprived people in urban areas. Poor hygiene practices and inadequate sanitary conditions play major roles in the increased burden of communicable diseases within developing countries like ours. Objective: To assess the knowledge and practice about personal hygiene and environmental sanitation in selected slums of Dhaka city. Materials and method: This cross sectional study was conducted in purposively selected urban slum are...

  6. Allergen immunotherapy: clinical and practical education of Italian trainees in allergy and clinical immunology schools.

    Science.gov (United States)

    Ridolo, E; Incorvaia, C; Senna, G E; Montagni, M; Olivieri, E; Canonica, G W

    2013-01-01

    We performed a survey, based on a questionnaire including 20 items, submitted anonymously to Italian trainees in Allergology and Clinical Immunology, in order to obtain information about their specific allergen immunotherapy (AIT) practices. The questionnaire was sent to 40 trainees, who had attended the last two years of the training course. Thirty-four subjects (mean age: 27 years, 65% females) adequately completed the survey. The answers to the questionnaire showed that only 60% of the training programs included lectures on AIT. Among the trainees using AIT, only 40% declared being able to prescribe it independently, while 60% were guided by a tutor. Of the trainees who were able to prescribe AIT autonomously, 60% were familiar with both routes of administration, i.e. subcutaneous (SCIT) and sublingual immunotherapy (SLIT), while 25% of these used only SLIT. In 80% of the training institutions involved, the trainees could attend a dedicated AIT outpatient ward for SCIT administration; only 40% administered AIT personally, and in half of these cases, they were guided by a tutor. Only 70% of trainees had experience in the follow-up of patients still under treatment and of patients who had completed treatment. Analysis of the answers obtained for questions on venom immunotherapy (VIT) showed that, in 90% of cases, the trainees attended a dedicated outpatients ward where VIT is administered, but with a role limited to observation/cooperation. Only 30% were involved in the follow-up of patients who were under treatment or who had completed VIT. Only 20% of the trainees felt confident enough about VIT to prescribe this treatment independently, 80% knew there were several administration protocols, and the majority prescribed products from three different manufacturers. These findings suggest that there is significant room for improving the instructions provided regarding allergology and clinical immunology to trainees in Italy with respect to AIT.

  7. Effect of Professional Development on Classroom Practices in Some Selected Saudi Universities

    Science.gov (United States)

    Alghamdi, AbdulKhaliq Hajjad; Bin Sihes, Ahmad Johari

    2016-01-01

    "Scientific studies found the impact of professional development on effective classroom practices in Higher Education." This paper hypothesizes no statistically significant effect of lecturers' professional development on classroom practices in some selected Saudi Universities not as highlighted in the model. Hierarchical multiple…

  8. Socio-Demographic Aspects of Selected Menstrual Hygienic Practices among Adolescent School Girls in Pondicherry

    Directory of Open Access Journals (Sweden)

    Abhijit Vinodrao Boratne

    2016-06-01

    Conclusion: The place of residence has emerged as a significant factor for adolescent school girls to practice selected menstrual hygienic practices such as usage of sanitary pads during menstruation. [Natl J Community Med 2016; 7(6.000: 510-514

  9. Evaluation of selected postural parameters in children who practice kyokushin karate

    Directory of Open Access Journals (Sweden)

    Drzał-Grabiec Justyna

    2014-10-01

    Full Text Available Study aim: martial arts can be traced back thousands of years. Karate is one of the most common martial arts, and both children and adults practice it. The aim of the study was to evaluate selected body posture parameters in children aged 7–10 years who regularly practice karate.

  10. Practice of clinical forensic medicine in Sri Lanka: does it need a new era?

    Science.gov (United States)

    Kodikara, Sarathchandra

    2012-07-01

    Clinical forensic medicine is a sub-specialty of forensic medicine and is intimately associated with the justice system of a country. Practice of clinical forensic medicine is evolving, but deviates from one jurisdiction to another. Most English-speaking countries practice clinical forensic medicine and forensic pathology separately while most non-English-speaking countries practice forensic medicine which includes clinical forensic medicine and forensic pathology. Unlike the practice of forensic pathology, several countries have informal arrangements to deal with forensic patients and there are no international standards of practice or training in this discipline. Besides, this is rarely a topic of discussion. In the adversarial justice system in Sri Lanka, the designated Government Medical Officers practice both clinical forensic medicine and forensic pathology. Practice of clinical forensic medicine, and its teaching and training in Sri Lanka depicts unique features. However, this system has not undergone a significant revision for many decades. In this communication, the existing legal framework, current procedure of practice, examination for drunkenness, investigations, structure of referrals, reports, subsequent legal procedures, undergraduate, in-service, and postgraduate training are discussed with suggestions for reforms.

  11. The research and practice based on the full-time visitation model in clinical medical education

    Directory of Open Access Journals (Sweden)

    Hong Zhang

    2015-01-01

    Full Text Available Most of the higher medical colleges and universities teaching hospital carry certain clinical teaching tasks, but the traditional teaching pattern of "two stage", including the early stage of the theory of teaching, the late arrangement of clinical practice, had some drawbacks such as practice time is too concentrated and the chasm between students' theory and practice. It is suggested that students contact clinical diagnosis and treatment earlier, visit more patients and increase the ratio of visitation and course. But as more and more students flood into university, clinical visitation has turned into a difficulty to improve students’ ability. To resolve this problem, we have made some efficient practice and exploration in Rizhao City People's Hospital from September 2005 to July 2014. The students were divided into full-time visitation model group and “two stage” pattern group randomly. The single factors are of great difference between the two groups. The full-time visitation model in clinical medical education builds a new mode of practice of clinical practice teaching in the medical stuents' concept of doctor-patient communication, humanistic care to patients, basic theoretical knowledge, clinical practice skills and graduate admission rate increased significantly. Continuous improvement of OSCE exam is needed to make evaluation more scientific, objective and fair.

  12. Useful Tests for Hepatic Encephalopathy in Clinical Practice

    OpenAIRE

    Nabi, Eiman; Bajaj, Jasmohan S

    2014-01-01

    Hepatic encephalopathy (HE) is a serious complication of liver disease and portosystemic shunting that represents a continuum of neuropsychiatric changes and altered consciousness. It is classified as overt hepatic encephalopathy (OHE) when clinically apparent or as covert hepatic encephalopathy (CHE) in its mildest form. Progression of CHE to OHE and its impact of quality of life make its early diagnosis imperative. Several diagnostic techniques ranging from simple clinical scales to sophist...

  13. Turning guidelines into clinical practice : Findings from an implementation study

    OpenAIRE

    Forsner, Tord

    2010-01-01

    Aim: The general aim of this thesis is to describe factors of importance when implementing clinical guidelines in psychiatry, and more specifically contribute to a better understanding of the implementation process. The specific aims are: Study I, to investigate a tailored implementation programme for implementing clinical guidelines for depression and suicidal patients, and to evaluate the compliance to guidelines after 6 months. In Study II, to further investigate complian...

  14. Likelihood ratios: Clinical application in day-to-day practice

    Directory of Open Access Journals (Sweden)

    Parikh Rajul

    2009-01-01

    Full Text Available In this article we provide an introduction to the use of likelihood ratios in clinical ophthalmology. Likelihood ratios permit the best use of clinical test results to establish diagnoses for the individual patient. Examples and step-by-step calculations demonstrate the estimation of pretest probability, pretest odds, and calculation of posttest odds and posttest probability using likelihood ratios. The benefits and limitations of this approach are discussed.

  15. Evaluation of Clinical Outcome after Laparoscopic Antireflux Surgery in Clinical Practice: Still a Controversial Issue

    Directory of Open Access Journals (Sweden)

    Sandro Contini

    2011-01-01

    Full Text Available Background. Laparoscopic antireflux surgery has shown to be effective in controlling gastroesophageal reflux (GERD. Yet, a universally accepted definition and evaluation for treatment success/failure in GERD is still controversial. The purpose of this paper is to assess if and how the outcome variables used in the different studies could possibly lead to an homogeneous appraisal of the limits and indications of LARS. Methods. We analyzed papers focusing on the efficacy and outcome of LARS and published in English literature over the last 10 years. Results. Symptoms scores and outcome variables reported are dissimilar and not uniform. The most consistent parameter was patient's satisfaction (mean satisfaction rate: 88.9%. Antireflux medications are not a trustworthy outcome index. Endoscopy and esophageal manometry do not appear very helpful. Twenty-four hours pH metry is recommended in patients difficult to manage for recurrent typical symptoms. Conclusions. More uniform symptoms scales and quality of life tools are needed for assessing the clinical outcome after laparoscopic antireflux surgery. In an era of cost containment, objective evaluation tests should be more specifically addressed. Relying on patient's satisfaction may be ambiguous, yet from this study it can be considered a practical and simple tool.

  16. Clinical practice guidelines and consensus statements in oncology--an assessment of their methodological quality.

    Directory of Open Access Journals (Sweden)

    Carmel Jacobs

    Full Text Available BACKGROUND: Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. METHODS: Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. FINDINGS: Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice

  17. Quantification of HBsAg: Basic virology for clinical practice

    Institute of Scientific and Technical Information of China (English)

    Jung Min Lee; Sang Hoon Ahn

    2011-01-01

    Hepatitis B surface antigen (HBsAg) is produced and secreted through a complex mechanism that is still not fully understood. In clinical fields, HBsAg has longserved as a qualitative diagnostic marker for hepatitis B virus infection. Notably, advances have been made in the development of quantitative HBsAg assays, whichhave allowed viral replication monitoring, and there is an opportunity to make maximal use of quantitative HBsAg to elucidate its role in clinical fields. Yet, it needs to be underscored that a further understanding of HBsAg, not only from clinical point of view but also from a virologic point of view, would enable us to deepen our insights, so that we could more widely expand and applyits utility. It is also important to be familiar with HBsAg variants and their clinical consequences in terms of immune escape mutants, issues resulting from overlap with corresponding mutation in the P gene, and detection problems for the HBsAg variants. In this article, we review current concepts and issues on the quantificationof HBsAg titers with respect to their biologic nature, method principles, and clinically relevant topics.

  18. Stem cells in clinical practice: applications and warnings

    Directory of Open Access Journals (Sweden)

    Palmieri Beniamino

    2011-01-01

    Full Text Available Abstract Stem cells are a relevant source of information about cellular differentiation, molecular processes and tissue homeostasis, but also one of the most putative biological tools to treat degenerative diseases. This review focuses on human stem cells clinical and experimental applications. Our aim is to take a correct view of the available stem cell subtypes and their rational use in the medical area, with a specific focus on their therapeutic benefits and side effects. We have reviewed the main clinical trials dividing them basing on their clinical applications, and taking into account the ethical issue associated with the stem cell therapy. Methods We have searched Pubmed/Medline for clinical trials, involving the use of human stem cells, using the key words "stem cells" combined with the key words "transplantation", "pathology", "guidelines", "properties" and "risks". All the relevant clinical trials have been included. The results have been divided into different categories, basing on the way stem cells have been employed in different pathological conditions.

  19. 77 FR 13513 - Modernizing the Regulation of Clinical Trials and Approaches to Good Clinical Practice; Public...

    Science.gov (United States)

    2012-03-07

    ... the conduct of clinical trials of FDA-regulated products. Clinical trials are a critical source of... the conduct of clinical trials may result in inefficiencies or increased cost and may not facilitate... is involved in an effort to modernize the regulatory framework that governs clinical trials...

  20. Issues on the selection of non-inferiority margin in clinical trials

    Institute of Scientific and Technical Information of China (English)

    HOU Yan; WU Xiao-yan; LI Kang

    2009-01-01

    Objective The determination of non-inferiority margin is an important and confusing issue which directly influences the acceptability of a new medication. We reviewed the published literature, International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Guidelines and Committee for Proprietary Medicinal Products (CPMP) papers on the selection of non-inferiority margin and the corresponding statistical tests in clinical trials, in order to provide practical recommendations and suggestions for establishing reference criteria for the non-inferiority margin in China.Data sources The literature on the selection of a non-inferiority margin and statistical tests was mainly extracted from relevant English articles on non-inferior clinical trials published from 1990 to 2007. The starting point (1990) was chosen due to lack of such papers published prior to 1990. This literature was searched via PubMed, Medline and Chinese Knowledge Information (CNKI). ICH guidelines and CPMP papers were downloaded from their official websites. The keywords "clinical trial", "non-inferiority" and "non-inferiority margin" were used.Study selection Forty-three original articles and critical reviews, ICH E10 guideline and CPMP papers were selected.Results The non-inferiority testing with treatment difference and ratio are commonly used, where the non-inferiority margin is determined with and without historical data. Traditionally, this margin is treated as a fixed value, while developed methods take the variation into account in the determination of this margin, on which the test depends is more convincing. The mixed margin consisting of a margin based on treatment difference and a margin based on treatment ratio can exactly control the type Ⅰ error at the desirable level and obtain a better power. In this review, we also provide some recommendations and suggestions for the selection of the non-inferiority margin in the western

  1. Typologies of Cohabitation: Implications for Clinical Practice and Research

    Science.gov (United States)

    Gold, Joshua M.

    2012-01-01

    This article will explore the current evolution in the practice of cohabitation. The intent of this literature- and web-based article is to acquaint counselors with three typologies of cohabitation. These categories can be utilized in the development of psychoeducational and remedial interventions and in the identification of areas of future…

  2. Risk Management in Clinical Laboratory: from Theory to Practice

    OpenAIRE

    Eliza David Remona; Minodora Dobreanu

    2015-01-01

    Clinical laboratory tests ensure approximately 70% of the medical decisions, so that the time until the release of the results and its accuracy are critical for the diagnosis and the efficiency of the treatment [1]. Risk management involves both the anticipation of what could happen erroneous and the assessment of errors’ frequency as well as the consequences or the severity of the effects caused by it, and finally to decide what can be done in order to reduce the risk to an acceptable clinic...

  3. [Feedback in relation to training of practical clinical skills

    DEFF Research Database (Denmark)

    Hansen, C.S.; Ringsted, Charlotte Vibeke

    2008-01-01

    Feedback has been identified as an essential component of motor learning. However, feedback principles derived from motor learning theories cannot uncritically be applied to clinical skills training because this knowledge is based primarily on the study of very simple motor skills. Research into...... feedback in relation to clinical skills training is currently limited. Theories on motor learning can serve as the basis for designing research in this domain, especially the importance of including retention tests when measuring permanent learning outcomes Udgivelsesdato: 2008/10/27...

  4. Dextrocardia: practical clinical points and comments on terminology.

    Science.gov (United States)

    Evans, William N; Acherman, Ruben J; Collazos, Juan C; Castillo, William J; Rollins, Robert C; Kip, Katrinka T; Restrepo, Humberto

    2010-01-01

    Dextrocardia is defined by the authors as a right-sided heart with a base-apex axis directed rightward, resulting from a variation in cardiac development, and not used as a general term indicating any heart in the right chest. Dextrocardia occurs in approximately 0.01% of live births and can be discovered in various clinical settings and at various patient ages. The authors review their experience with dextrocardia, discuss useful clinical points that aid in evaluating complex anatomy, recount the history of dextrocardia terminology, and note the current inconsistent nomenclature.

  5. Best practices in nursing homes. Clinical supervision, management, and human resource practices.

    Science.gov (United States)

    Dellefield, Mary Ellen

    2008-07-01

    Human resource practices including supervision and management are associated with organizational performance. Evidence supportive of such an association in nursing homes is found in the results of numerous research studies conducted during the past 17 years. In this article, best practices related to this topic have been culled from descriptive, explanatory, and intervention studies in a range of interdisciplinary research journals published between 1990 and 2007. Identified best practices include implementation of training programs on supervision and management for licensed nurses, certified nursing assistant job enrichment programs, implementation of consistent nursing assignments, and the use of electronic documentation. Organizational barriers and facilitators of these best practices are described. PMID:20077964

  6. Prevalence of Dental Fear and Anxiety amongst Patients in Selected Dental Clinics in Ghana

    Science.gov (United States)

    Ofori, Marian A.; Adu-Ababio, F.; Nyako, E. A.; Ndanu, Tom A.

    2009-01-01

    Objective: To find out the prevalence of dental anxiety and fear amongst patients in various selected dental clinics in Accra, Ghana. Study design: Dental patients (n = 279) who had either been exposed to dental treatments or had no prior dental exposure, attending four selected dental clinics in Accra were randomly sampled. They were interviewed…

  7. Clinical Education, the lessons learned from practical applications - Albanian issues, East Europe and the advanced international practices on Clinical Education

    Directory of Open Access Journals (Sweden)

    Alban Koci

    2015-01-01

    In legal clinics, students perform various tasks just as an attorney would do in the same job position, such as doing legal research, drafting briefs and other legal documents, and interviewing clients. Many jurisdictions even allow students to appear in court on behalf of clients, even in criminal defense. Legal clinics is part of the academic law program in the most of the law faculties all over the world and it has a great impact in the community’s life. Throughout legal clinics students not only get the opportunity to be part of an important experience, but also they can be effective and help the people in need with their work. This paper aims to bring attention to the importance of clinical education in the formation of young lawyers and how one can learn from experience. There will be discussed important issues about legal clinic, the objectives and its mission, how to apply it and the benefits legal clinic brings not only for the academic area but also for the society.

  8. Third universal definition of myocardial infarction. Implications for clinical practice

    International Nuclear Information System (INIS)

    In general, the conceptual meaning of the term myocardial infarction has not changed, although have developed new sensitive diagnostic methods. In this way the clinical diagnosis is based on patient symptoms, electrocardiogram's (ECG) changes and sensitive biochemical markers, as well as the information obtained from various imaging techniques

  9. Underreporting of conflicts of interest in clinical practice guidelines

    DEFF Research Database (Denmark)

    Bindslev, Julie Bolette Brix; Schroll, Jeppe; Gøtzsche, Peter C;

    2013-01-01

    Conflicts of interest affect recommendations in clinical guidelines and disclosure of such conflicts is important. However, not all conflicts of interest are disclosed. Using a public available disclosure list we determined the prevalence and underreporting of conflicts of interest among authors...

  10. Risk Management in Clinical Laboratory: from Theory to Practice

    Directory of Open Access Journals (Sweden)

    Eliza David Remona

    2015-12-01

    Full Text Available Clinical laboratory tests ensure approximately 70% of the medical decisions, so that the time until the release of the results and its accuracy are critical for the diagnosis and the efficiency of the treatment [1]. Risk management involves both the anticipation of what could happen erroneous and the assessment of errors’ frequency as well as the consequences or the severity of the effects caused by it, and finally to decide what can be done in order to reduce the risk to an acceptable clinical level. For this reason, organizations should not see the risk management as a compliance issue, but as an integral part of the decision-making process. EP23-A is a guideline of CLSI that introduces the risk management principles in the clinical laboratory and encourages the laboratories to develop plans of risk management which are addressed to the risks of each laboratory. EP18-A2 proposes 2 techniques for identifying and controlling the errors in the laboratory: FMEA (Failure Mode and Effects Analysis and FRACAS (Failure Reporting, Analysis and Corrective Action System. The European Committee of Experts and Management of Safety and Quality in Health Care proposed to use the quality indicators to identify the critical stages of each process, thus being possible to assess continuously the medical processes with the aim of identifying the errors when they occur. This review summarizes the principles of the risk management in the clinical laboratory, thus it can achieve its aims to report valid, accurate and reliable test results

  11. Smartphone Applications for the Clinical Oncologist in UK Practice.

    Science.gov (United States)

    Rozati, Hamoun; Shah, Sonya Pratik; Shah, Neha

    2015-06-01

    A number of medical smartphone applications have been developed to assist clinical oncology specialists. Concerns have arisen that the information provided may not be under sufficient scrutiny. This study aims to analyse the current applications available for clinical oncologists in the UK. Applications aimed specifically at physician clinical oncologists were searched for on the major smartphone operating systems: Apple iOS; Google Android; Microsoft Windows OS; and Blackberry OS. All applications were installed and analysed. The applications were scrutinised to assess the following information: cost; whether the information included was referenced; when the information was last updated; and whether they made any reference to UK guidelines. A novel rating score based on these criteria was applied to each application. Fifty applications were identified: 24 for Apple's iOS; 23 for Google's Android; 2 for Blackberry OS; and 1 for Windows OS. The categories of applications available were: drug reference; journal reference; learning; clinical calculators; decision support; guidelines; and dictionaries. Journal reference and guideline applications scored highly on our rating system. Drug reference application costs were prohibitive. Learning tools were poorly referenced and not up-to-date. Smartphones provide easy access to information. There are numerous applications devoted to oncology physicians, many of which are free and contain referenced, up-to-date data. The cost and quality of drug reference and learning applications have significant scope for improvement. A regulatory body is needed to ensure the presence of peer-reviewed, validated applications to ensure their reliability. PMID:24903139

  12. Culturally Sensitive Dementia Caregiving Models and Clinical Practice

    Science.gov (United States)

    Daire, Andrew P.; Mitcham-Smith, Michelle

    2006-01-01

    Family caregiving for individuals with dementia is an increasingly complex issue that affects the caregivers' and care recipients' physical, mental, and emotional health. This article presents 3 key culturally sensitive caregiver models along with clinical interventions relevant for mental health counseling professionals.

  13. Recent NIMH Clinical Trials and Implications for Practice

    Science.gov (United States)

    Vitiello, Benedetto; Kratochvil, Christopher J.

    2008-01-01

    Optimal treatment of adolescent depression requires the use of antidepressants such as fluoxetine, and the addition of cognitive-behavioral therapy (CBT) offers better potential. Second-step pharmacological treatment of the disorder offers a success rate of around 50%. Clinical trial for the use of sertraline and CBT in treating…

  14. Addiction and psychopathology: a multidimensional approach to clinical practice

    NARCIS (Netherlands)

    V. Hendriks (Vincent)

    1990-01-01

    textabstractThe etiology of addiction has a long history of clinical and scientific interest, which is characterized by differences in conceptual approach, conflicting data and public controversy. There have been numerous attempts to describe the antecedents and consequences of addiction in theoreti

  15. Paediatric acute asthma management in Australia and New Zealand : practice patterns in the context of clinical practice guidelines

    NARCIS (Netherlands)

    Babl, F. E.; Sheriff, N.; Borland, M.; Acworth, J.; Neutze, J.; Krieser, D.; Ngo, P.; Schutz, J.; Thomson, F.; Cotterell, E.; Jamison, S.; Francis, P.

    2008-01-01

    Objectives: To compare clinical practice guideline (CPG) recommendations and reported physician management of acute paediatric asthma in the 11 largest paediatric emergency departments, all of which have CPGs, in Australia (n= 9) and New Zealand (n= 2). All 11 sites participate in the Paediatric Res

  16. Psoriasis: severity assessment in clinical practice. Conclusions from workshop discussions and a prospective multicentre survey of psoriasis severity.

    NARCIS (Netherlands)

    Kerkhof, P.C.M. van de; Kragballe, K.; Austad, J.; Berth-Jones, J.; Cambazard, F.; Brassinne, M. de la; Ljungberg, A.; Murphy, G.; Papp, K.; Wozel, G.

    2006-01-01

    Psoriasis treatment is highly individualized. Although a standardized assessment of psoriasis severity for clinical practice may be theoretically advantageous for the purposes of determining treatment, the relevance of currently available research tools in clinical practice is uncertain. Our objecti

  17. Exploratory subgroup analysis in clinical trials by model selection.

    Science.gov (United States)

    Rosenkranz, Gerd K

    2016-09-01

    The interest in individualized medicines and upcoming or renewed regulatory requests to assess treatment effects in subgroups of confirmatory trials requires statistical methods that account for selection uncertainty and selection bias after having performed the search for meaningful subgroups. The challenge is to judge the strength of the apparent findings after mining the same data to discover them. In this paper, we describe a resampling approach that allows to replicate the subgroup finding process many times. The replicates are used to adjust the effect estimates for selection bias and to provide variance estimators that account for selection uncertainty. A simulation study provides some evidence of the performance of the method and an example from oncology illustrates its use. PMID:27230820

  18. Careful science? Bodywork and care practices in randomised clinical trials

    DEFF Research Database (Denmark)

    Jespersen, Astrid Pernille; Bønnelycke, Julie; Eriksen, Hanne Hellerup

    2013-01-01

    Concern about obesity has prompted numerous public health campaigns that urge people to be more physically active. The campaigns often include normative statements and attempt to impose restrictions on individuals' lives without considering the complexities of daily life. We suggest that broadening...... the focus to reflect everyday practices would foster better targeted public health campaigns. This article is based on our participation in FINE, a multidisciplinary Danish research project. The core methodology of FINE was a randomised controlled trial in which 61 moderately overweight men were put...... into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday lives...

  19. Student Pharmacists’ Clinical Interventions in Advanced Pharmacy Practice Experiences at a Community Nonteaching Hospital

    OpenAIRE

    Shogbon, Angela O.; Lundquist, Lisa M.

    2014-01-01

    Objective. To assess student pharmacists’ clinical interventions in advanced pharmacy practice experiences (APPEs) at a community nonteaching hospital and evaluate completed interventions based on the type of documentation method used.

  20. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer

    NARCIS (Netherlands)

    Farge, D.; Debourdeau, P.; Beckers, M.; Baglin, C.; Bauersachs, R. M.; Brenner, B.; Brilhante, D.; Falanga, A.; Gerotzafias, G. T.; Haim, N.; Kakkar, A. K.; Khorana, A. A.; Lecumberri, R.; Mandala, M.; Marty, M.; Monreal, M.; Mousa, S. A.; Noble, S.; Pabinger, I.; Prandoni, P.; Prins, M. H.; Qari, M. H.; Streiff, M. B.; Syrigos, K.; Bounameaux, H.; Buller, H. R.

    2013-01-01

    . Background: Guidelines addressing the management of venous thromboembolism (VTE) in cancer patients are heterogeneous and their implementation has been suboptimal worldwide. Objectives: To establish a common international consensus addressing practical, clinically relevant questions in this settin

  1. ILAE official report: a practical clinical definition of epilepsy.

    Science.gov (United States)

    Fisher, Robert S; Acevedo, Carlos; Arzimanoglou, Alexis; Bogacz, Alicia; Cross, J Helen; Elger, Christian E; Engel, Jerome; Forsgren, Lars; French, Jacqueline A; Glynn, Mike; Hesdorffer, Dale C; Lee, B I; Mathern, Gary W; Moshé, Solomon L; Perucca, Emilio; Scheffer, Ingrid E; Tomson, Torbjörn; Watanabe, Masako; Wiebe, Samuel

    2014-04-01

    Epilepsy was defined conceptually in 2005 as a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. This definition is usually practically applied as having two unprovoked seizures >24 h apart. The International League Against Epilepsy (ILAE) accepted recommendations of a task force altering the practical definition for special circumstances that do not meet the two unprovoked seizures criteria. The task force proposed that epilepsy be considered to be a disease of the brain defined by any of the following conditions: (1) At least two unprovoked (or reflex) seizures occurring >24 h apart; (2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years; (3) diagnosis of an epilepsy syndrome. Epilepsy is considered to be resolved for individuals who either had an age-dependent epilepsy syndrome but are now past the applicable age or who have remained seizure-free for the last 10 years and off antiseizure medicines for at least the last 5 years. "Resolved" is not necessarily identical to the conventional view of "remission or "cure." Different practical definitions may be formed and used for various specific purposes. This revised definition of epilepsy brings the term in concordance with common use. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.

  2. Innovations in American Society of Clinical Oncology Practice Guideline Development.

    Science.gov (United States)

    Somerfield, Mark R; Bohlke, Kari; Browman, George P; Denduluri, Neelima; Einhaus, Kaitlin; Hayes, Daniel F; Khorana, Alok A; Miller, Robert S; Mohile, Supriya G; Oliver, Thomas K; Ortiz, Eduardo; Lyman, Gary H

    2016-09-10

    Since the beginning of its guidelines program in 1993, ASCO has continually sought ways to produce a greater number of guidelines while maintaining its commitment to using the rigorous development methods that minimize the biases that threaten the validity of practice recommendations. ASCO is implementing a range of guideline development and implementation innovations. In this article, we describe innovations that are designed to (1) integrate consideration of multiple chronic conditions into practice guidelines; (2) keep more of its guidelines current by applying evolving signals or (more) rapid, for-cause updating approaches; (3) increase the number of high-quality guidelines available to its membership through endorsement and adaptation of other groups' products; (4) improve coverage of its members' guideline needs through a new topic nomination process; and (5) enhance dissemination and promote implementation of ASCO guidelines in the oncology practice community through a network of volunteer ambassadors. We close with a summary of ASCO's plans to facilitate the integration of data from its rapid learning system, CancerLinQ, into ASCO guidelines and to develop tactics through which guideline recommendations can be embedded in clinicians' workflow in digital form. We highlight the challenges inherent in reconciling the need to provide clinicians with more interactive, point-of-care guidance with ASCO's abiding commitment to methodologic rigor in guideline development.

  3. Compliance of psychotropic drug prescription with clinical practice guidelines in older inpatients.

    Science.gov (United States)

    Etchepare, Fanny; Pambrun, Elodie; Bégaud, Bernard; Verdoux, Hélène; Tournier, Marie

    2016-02-01

    Several practice guidelines were published by French regulatory agencies between 2006 and 2009 to improve psychotropic drug use in older patients. The objectives of the study were to assess compliance with these guidelines in older patients hospitalized in psychiatric units and to identify characteristics associated with compliance. A cross-sectional study was conducted in 117 patients aged 65 years and older hospitalized in two psychiatric departments of a public hospital, at three dates randomly chosen between January and May 2014. Medical and sociodemographic characteristics were collected from electronic medical records. In all, 8% of psychotropic prescriptions were compliant with guidelines. A total of 98% of antidepressant prescriptions complied with guidelines for product selection (no tricyclics) and 72% for initial dosage (half of that recommended for younger adults). Regarding benzodiazepines, short half-life drugs were chosen in 73% of treatments, low maintenance dosage was found in 64% of treatments, and a discontinuous administration rhythm was noted in 33% of treatments. Regarding antipsychotics, initial dosage was a quarter of the allowed initial dosage for younger adults in 39% of prescriptions and metabolic blood testing was performed in 17% of prescriptions. Neurological and cognitive tolerance was monitored in 41% and 61% of prescriptions, respectively. Few clinical factors were found to be associated with compliance or noncompliance with guidelines in older psychiatric inpatients. Practice guidelines on psychotropic drug prescription were partially respected in older inpatients. Practitioners should take into account the risks associated with non-recommended patterns of psychotropic drug use in this vulnerable population. PMID:26555674

  4. School based oral health promotional intervention: Effect on knowledge, practices and clinical oral health related parameters

    Directory of Open Access Journals (Sweden)

    Arjun Gauba

    2013-01-01

    Full Text Available Background: No organized school oral health program is existent in India. Aim: The aim of this study is to test the feasibility and efficacy of an economical school oral health promotional intervention with educational and preventive components. Settings and Design: School oral health promotional intervention carried out in one of the randomly selected school and evaluated through short duration prospective model. Materials and Methods: A total of 100 children with an age range of 10-12 years with no previous history of dental intervention were enrolled. Interventions comprised of oral health education (delivered through lecture and demonstrations by an undergraduate dental student and topical antibacterial therapy (fluoride varnish and povidone iodine. Outcomes consisted of Knowledge and practices (KAP regarding oral health, clinical oral health related parameters such as plaque index (PI, gingival index (GI and caries activity as per Modified Snyder′s test. These were reported at baseline, 3 weeks and 6 months follow-up examination by a calibrated examiner. Statistical Analysis: McNemar Bowker′s test, Student′s t-test, Pearson Chi-square tests were used. Results: Highly significant (P < 0.001 improvements in KAP scores, PI scores, GI scores and caries activity were reported at 3 weeks and 6 months follow-up examination. Conclusion: This small economical school oral health program positively influenced oral health related practices and parameters of oral health such as oral cleanliness, gingival health and caries activity.

  5. Peer influence in clinical workplace learning: A study of medical students’ use of social comparison in clinical practice

    OpenAIRE

    Raat, Adriana

    2015-01-01

    Undergraduate students in clinical workplace frequently compare their own experiences with those of peers. The research reported in this thesis shows that these so called social comparisons are vital to the process of learning in clinical practice. The first study confirms students’ tendency to compare themselves with peers and shows that their responses to the comparisons are more often stimulating for learning than discouraging. After that, an experimental study demonstrates how students’ e...

  6. Best Clinical Practices for Male Adult Survivors of Childhood Sexual Abuse: “Do No Harm”

    OpenAIRE

    Gallo-Silver, Les; Anderson, Christopher M; Romo, Jaime

    2014-01-01

    The health care literature describes treatment challenges and recommended alterations in practice procedures for female survivors of childhood sexual abuse, a subtype of adverse childhood experiences. Currently, there are no concomitant recommendations for best clinical practices for male survivors of childhood sexual abuse or other adverse clinical experiences. Anecdotal information suggests ways physicians can address the needs of adult male survivors of childhood sexual abuse by changes in...

  7. Identifying low-value clinical practices in critical care medicine: protocol for a scoping review

    OpenAIRE

    Niven, Daniel J; McCormick, T Jared; Straus, Sharon E; Hemmelgarn, Brenda R.; Jeffs, Lianne P.; Stelfox, Henry T

    2015-01-01

    Introduction Reducing unnecessary, low-value clinical practice (ie, de-adoption) is key to improving value for money in healthcare, especially among patients admitted to intensive care units (ICUs) where resource consumption exceeds other medical and surgical populations. Research suggests that low-value clinical practices are common in medicine, however systematically and objectively identifying them is a widely cited barrier to de-adoption. We will conduct a scoping review to identify low-v...

  8. THE USE OF AMIODARONE IN CLINICAL PRACTICE: THE PROBLEM OF SIDE EFFECTS

    Directory of Open Access Journals (Sweden)

    O. V. Gaisenok

    2016-01-01

    Full Text Available Characteristics of amiodarone in clinical practice are focused on. Amiodarone pharmacological mode of action and its pro-arrhythmic effect is presented. As well as various side effects that can happen in clinical practice. Special attention is paid to the problem of amiodarone-induced thyrotoxicosis, its classification, diagnosis and treatment. Prospects of new anti-arrhythmic drugs class III, in particular dronedaron are also discussed.

  9. The Objective structured clinical examination for general practice: design, validity and reliability

    OpenAIRE

    Thomson, Donald M.

    1987-01-01

    This paper describes and analyses an experimental clinical examination for general practice. Differences in the results obtained by fourth year students, fifth year students and trainee general practitioners highlight some of the dilemmas of medical education. It is concluded that examinations which include clinical tests can increase the credibility of general practice examinations, can be reliably applied to small groups of candidates and therefore have considerable potential for formative ...

  10. General practice-based clinical trials in Germany - a problem analysis

    Directory of Open Access Journals (Sweden)

    Hummers-Pradier Eva

    2012-11-01

    Full Text Available Abstract Background In Germany, clinical trials and comparative effectiveness studies in primary care are still very rare, while their usefulness has been recognised in many other countries. A network of researchers from German academic general practice has explored the reasons for this discrepancy. Methods Based on a comprehensive literature review and expert group discussions, problem analyses as well as structural and procedural prerequisites for a better implementation of clinical trials in German primary care are presented. Results In Germany, basic biomedical science and technology is more reputed than clinical or health services research. Clinical trials are funded by industry or a single national programme, which is highly competitive, specialist-dominated, exclusive of pilot studies, and usually favours innovation rather than comparative effectiveness studies. Academic general practice is still not fully implemented, and existing departments are small. Most general practitioners (GPs work in a market-based, competitive setting of small private practices, with a high case load. They have no protected time or funding for research, and mostly no research training or experience. Good Clinical Practice (GCP training is compulsory for participation in clinical trials. The group defined three work packages to be addressed regarding clinical trials in German general practice: (1 problem analysis, and definition of (2 structural prerequisites and (3 procedural prerequisites. Structural prerequisites comprise specific support facilities for general practice-based research networks that could provide practices with a point of contact. Procedural prerequisites consist, for example, of a summary of specific relevant key measures, for example on a web platform. The platform should contain standard operating procedures (SOPs, templates, checklists and other supporting materials for researchers. Conclusion All in all, our problem analyses revealed that

  11. Knowledge systems, health care teams, and clinical practice: a study of successful change

    OpenAIRE

    Olson, Curtis A.; Tooman, Tricia R.; Alvarado, Carla J.

    2010-01-01

    Clinical teams are of growing importance to healthcare delivery, but little is known about how teams learn and change their clinical practice. We examined how teams in three US hospitals succeeded in making significant practice improvements in the area of antimicrobial resistance. This was a qualitative cross-case study employing Soft Knowledge Systems as a conceptual framework. The purpose was to describe how teams produced, obtained, and used knowledge and information to bring about success...

  12. Relationship between practice counselling and referral to outpatient psychiatry and clinical psychology.

    OpenAIRE

    Cape, J; Parham, A.

    1998-01-01

    BACKGROUND: Although reduction in the use of secondary care mental health services is a suggested benefit of counselling in general practice, there has been little empirical investigation of this relationship. AIM: To investigate the relationship between the provision of counselling in general practice and the use of outpatient psychiatry and clinical psychology services across a geographical area. METHOD: Information on referrals to outpatient psychiatry and clinical psychology from all gene...

  13. Clinical Management of Two Root Resorption Cases in Endodontic Practice.

    Science.gov (United States)

    Mincik, Jozef; Urban, Daniel; Timkova, Silvia

    2016-01-01

    Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment. PMID:27648314

  14. Spirulina in Clinical Practice: Evidence-Based Human Applications

    Directory of Open Access Journals (Sweden)

    P. D. Karkos

    2011-01-01

    Full Text Available Spirulina or Arthrospira is a blue-green alga that became famous after it was successfully used by NASA as a dietary supplement for astronauts on space missions. It has the ability to modulate immune functions and exhibits anti-inflammatory properties by inhibiting the release of histamine by mast cells. Multiple studies investigating the efficacy and the potential clinical applications of Spirulina in treating several diseases have been performed and a few randomized controlled trials and systematic reviews suggest that this alga may improve several symptoms and may even have an anticancer, antiviral and antiallergic effects. Current and potential clinical applications, issues of safety, indications, side-effects and levels of evidence are addressed in this review. Areas of ongoing and future research are also discussed.

  15. Clinical Management of Two Root Resorption Cases in Endodontic Practice

    Science.gov (United States)

    2016-01-01

    Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment.

  16. Applications of PET CT in clinical practice: Present and future

    Science.gov (United States)

    Costa, Durval Campos

    2007-02-01

    Radionuclide imaging and specially positron emission tomography (PET) has already demonstrated its benefits in three major medical subjects, i.e. neurology, cardiology and particularly clinical oncology. More recently the combination of PET and X-ray computed tomography (CT) as PET-CT led to a significant increment of the already large number of clinical applications of this imaging modality. This "anatomy-metabolic fusion" also known as Metabolic Imaging has its future assured if we can: (1) improve resolution reducing partial volume effect, (2) achieve very fast whole body imaging, (3) obtain accurate quantification of specific functions with higher contrast resolution and, if possible, (4) reduce exposure rates due to the unavoidable use of ionizing radiation.

  17. Useful tests for hepatic encephalopathy in clinical practice.

    Science.gov (United States)

    Nabi, Eiman; Bajaj, Jasmohan S

    2014-01-01

    Hepatic encephalopathy (HE) is a serious complication of liver disease and portosystemic shunting that represents a continuum of neuropsychiatric changes and altered consciousness. It is classified as overt HE (OHE) when clinically apparent or as covert HE (CHE) in its mildest form. Progression of CHE to OHE and its impact of quality of life make its early diagnosis imperative. Several diagnostic techniques ranging from simple clinical scales to sophisticated computerized tests exist, yet diagnosis remains a challenge, due to the time, cost, and personnel involved. Psychometric tests appear promising due to their high sensitivity and low cost, but results are variable depending on age and education. The pros and cons of current diagnostic methods for OHE and CHE are reviewed, along with strategy for CHE testing. PMID:24357348

  18. Violence Experienced By Nursing Students in Clinical Practice Settings

    Directory of Open Access Journals (Sweden)

    Meltem KÜRTÜNCÜ

    2013-01-01

    Full Text Available The study was made to determine violence experienced by nurse students in clinical settings. It was applied to the School of Health Nursing Student of a university during a week in June, 2010. There were 360 students, 53 of whom were senior, 60 of whom were thirdyear, 114 of whom were sophomore, 79 of whom were first-year and 102 of whom were prep-school students, at the school. Students in preparatory classes were not included in the scope of the study since they didn't take applied courses. 70,58% of the students were reached. It was determined that the students were often exposed to verbal abuse and sexism in clinical setting and the abuse was performed by their colleagues.

  19. Clinical Management of Two Root Resorption Cases in Endodontic Practice

    Directory of Open Access Journals (Sweden)

    Jozef Mincik

    2016-01-01

    Full Text Available Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment.

  20. Nanotechnology: A new frontier in virus detection in clinical practice

    Directory of Open Access Journals (Sweden)

    Abraham A

    2008-01-01

    Full Text Available Researchers are expanding the applications of nanotechnology in the field of medicine since mid-2000. These technologies include nanoarrays, protein arrays, nanopore technology, nanoparticles as a contrivance in immunoassays and nanosensors, among others. Nanobiotechnologies are clinically applicable and possess the potential to be useful in laboratory diagnosis of infections in general and viral infections in particular. Nanotechnology is a significant advance in molecular diagnostics. The technology strengthens and expands the DNA and protein microarray methods. In particular, the waveguide technology is an emergent area with many diagnostic applications. Nanosensors are the new contrivance for detection of bioterrorism agents. All these new technologies would have to be evaluated in clinical settings before their full import is appreciated and accepted.

  1. Ischemic colitis:Clinical practice in diagnosis and treatment

    Institute of Scientific and Technical Information of China (English)

    Angeliki Theodoropoulou; Ioannis E Koutroubakis

    2008-01-01

    Ischemic colitis is the most common form of ischemic injury of the gastrointestinal tract and can present either as an occlusive or a non-occlusive form.It accounts for 1 in 1000 hospitalizations but its incidence is underestimated because it often has a mild and transient nature.The etiology of ischemic colitis is multifactorial and the clinical presentation variable.The diagnosis is based on a combination of clinical suspicion,radiographic,endoscopic and histological findings.Therapy and outcome depends on the severity of the disease.Most cases of the non-gangrenous form are transient and resolve spontaneously without complications.On the other hand,high morbidity and mortality and urgent operative intervention are the hallmarks of gangrenous ischemic colitis.

  2. Optimising translational oncology in clinical practice: strategies to accelerate progress in drug development.

    Science.gov (United States)

    Stahel, R; Bogaerts, J; Ciardiello, F; de Ruysscher, D; Dubsky, P; Ducreux, M; Finn, S; Laurent-Puig, P; Peters, S; Piccart, M; Smit, E; Sotiriou, C; Tejpar, S; Van Cutsem, E; Tabernero, J

    2015-02-01

    Despite intense efforts, the socioeconomic burden of cancer remains unacceptably high and treatment advances for many common cancers have been limited, suggesting a need for a new approach to drug development. One issue central to this lack of progress is the heterogeneity and genetic complexity of many tumours. This results in considerable variability in therapeutic response and requires knowledge of the molecular profile of the tumour to guide appropriate treatment selection for individual patients. While recent advances in the molecular characterisation of different cancer types have the potential to transform cancer treatment through precision medicine, such an approach presents a major economic challenge for drug development, since novel targeted agents may only be suitable for a small cohort of patients. Identifying the patients who would benefit from individual therapies and recruiting sufficient numbers of patients with particular cancer subtypes into clinical trials is challenging, and will require collaborative efforts from research groups and industry in order to accelerate progress. A number of molecular screening platforms have already been initiated across Europe, and it is hoped that these networks, along with future collaborations, will benefit not only patients but also society through cost reductions as a result of more efficient use of resources. This review discusses how current developments in translational oncology may be applied in clinical practice in the future, assesses current programmes for the molecular characterisation of cancer and describes possible collaborative approaches designed to maximise the benefits of translational science for patients with cancer.

  3. Rééducation Posturale Globale in musculoskeletal diseases: scientific evidence and clinical practice

    Directory of Open Access Journals (Sweden)

    D. Tosarelli

    2011-09-01

    Full Text Available Several studies on the treatment of musculoskeletal diseases with physiotherapy and clinical experiences on the basis of a method called Rééducation Posturale Globale (RPG, have highlighted the usefulness of this treatment. Although such treatment technique is commonly used in physical therapy practice, only few studies support its therapeutic effectiveness. Objective: To search the literature for evidence of RPG effectiveness, in order to identify the most appropriate therapeutic contexts for its use. Methods: A review of the literature through the following databases: PubMed, Embase, Cinahl, Pedro, and Medscape. The keywords used for the search in the databases are: Rééducation Posturale Globale, Souchard, Posture, and Manual Therapy. The following clinical studies were selected: randomized controlled studies, non-randomized controlled studies, observation studies, and case reports, in English, Spanish, Portuguese, and Italian. Results: Out of 18 studies found, 9 were analyzed: 2 randomized controlled studies, 2 non-randomized controlled studies, 3 non-controlled studies, and 2 case reports. Conclusions: The RPG method has been shown to be an effective treatment technique for musculoskeletal diseases, in particular for ankylosing spondylitis, acute and chronic low back pain, and lumbar discherniation. Although the scarcity of rigorous experimental trials on a large scale does not allow the drawing of undisputable conclusions, the results gathered up to now are an encouragement to carry on research in the field of conservative treatment.

  4. Clinical practice of image-guided spine radiosurgery - results from an international research consortium

    Directory of Open Access Journals (Sweden)

    Guckenberger Matthias

    2011-12-01

    Full Text Available Abstract Background Spinal radiosurgery is a quickly evolving technique in the radiotherapy and neurosurgical communities. However, the methods of spine radiosurgery have not been standardized. This article describes the results of a survey about the methods of spine radiosurgery at five international institutions. Methods All institutions are members of the Elekta Spine Radiosurgery Research Consortium and have a dedicated research and clinical focus on image-guided radiosurgery. The questionnaire consisted of 75 items covering all major steps of spine radiosurgery. Results Strong agreement in the methods of spine radiosurgery was observed. In particular, similarities were observed with safety and quality assurance playing an important role in the methods of all institutions, cooperation between neurosurgeons and radiation oncologists in case selection, dedicated imaging for target- and organ-at-risk delineation, application of proper safety margins for the target volume and organs-at-risk, conformal planning and precise image-guided treatment delivery, and close clinical and radiological follow-up. In contrast, three major areas of uncertainty and disagreement were identified: 1 Indications and contra-indications for spine radiosurgery; 2 treatment dose and fractionation and 3 tolerance dose of the spinal cord. Conclusions Results of this study reflect the current practice of spine radiosurgery in large academic centers. Despite close agreement was observed in many steps of spine radiosurgery, further research in form of retrospective and especially prospective studies is required to refine the details of spinal radiosurgery in terms of safety and efficacy.

  5. Pharmaco-EEG: A Study of Individualized Medicine in Clinical Practice.

    Science.gov (United States)

    Swatzyna, Ronald J; Kozlowski, Gerald P; Tarnow, Jay D

    2015-07-01

    Pharmaco-electroencephalography (Pharmaco-EEG) studies using clinical EEG and quantitative EEG (qEEG) technologies have existed for more than 4 decades. This is a promising area that could improve psychotropic intervention using neurological data. One of the objectives in our clinical practice has been to collect EEG and quantitative EEG (qEEG) data. In the past 5 years, we have identified a subset of refractory cases (n = 386) found to contain commonalities of a small number of electrophysiological features in the following diagnostic categories: mood, anxiety, autistic spectrum, and attention deficit disorders, Four abnormalities were noted in the majority of medication failure cases and these abnormalities did not appear to significantly align with their diagnoses. Those were the following: encephalopathy, focal slowing, beta spindles, and transient discharges. To analyze the relationship noted, they were tested for association with the assigned diagnoses. Fisher's exact test and binary logistics regression found very little (6%) association between particular EEG/qEEG abnormalities and diagnoses. Findings from studies of this type suggest that EEG/qEEG provides individualized understanding of pharmacotherapy failures and has the potential to improve medication selection.

  6. Clinical practice of image-guided spine radiosurgery - results from an international research consortium

    International Nuclear Information System (INIS)

    Spinal radiosurgery is a quickly evolving technique in the radiotherapy and neurosurgical communities. However, the methods of spine radiosurgery have not been standardized. This article describes the results of a survey about the methods of spine radiosurgery at five international institutions. All institutions are members of the Elekta Spine Radiosurgery Research Consortium and have a dedicated research and clinical focus on image-guided radiosurgery. The questionnaire consisted of 75 items covering all major steps of spine radiosurgery. Strong agreement in the methods of spine radiosurgery was observed. In particular, similarities were observed with safety and quality assurance playing an important role in the methods of all institutions, cooperation between neurosurgeons and radiation oncologists in case selection, dedicated imaging for target- and organ-at-risk delineation, application of proper safety margins for the target volume and organs-at-risk, conformal planning and precise image-guided treatment delivery, and close clinical and radiological follow-up. In contrast, three major areas of uncertainty and disagreement were identified: 1) Indications and contra-indications for spine radiosurgery; 2) treatment dose and fractionation and 3) tolerance dose of the spinal cord. Results of this study reflect the current practice of spine radiosurgery in large academic centers. Despite close agreement was observed in many steps of spine radiosurgery, further research in form of retrospective and especially prospective studies is required to refine the details of spinal radiosurgery in terms of safety and efficacy

  7. Clinical Practice Guideline of Acupuncture for Bell's Palsy

    Directory of Open Access Journals (Sweden)

    Xi Wu

    2016-10-01

    Full Text Available Backgroud: Acupuncture is common used for Bell's palsy in clinic, however, recent systematic reviews all shows that there is no sufficient evidence to support the effectiveness of acupuncture for Bell's palsy because ofthe poor quality and heterogeneity. It's urgently necessary to develop a guideline of acupuncture for Bell's palsy based on principles of evidence-based medicine to optimize acupuncture treating, standardize outcomes evaluating and to improve the quality of acupuncture for patients with Bell's palsy under general circumstances.

  8. Practical clinical considerations of luting cements: A review

    OpenAIRE

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

    2014-01-01

    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 pho...

  9. The First Experience of Clinical Practice on Psychology Students’ Imaginary

    OpenAIRE

    Sueli Regina Gallo-Belluzzo; Elisa Corbett; Tania Maria Jose Aiello-Vaisberg

    2013-01-01

    Considering the academic development of the psychologist as a complex process which articulates the transmission of scientific knowledge and changes in imaginative activity, we psychoanalytically investigate the collective imaginary of Psychology students regarding the first clinical consultation. We conducted a group interview with 52 undergraduate students, using the Thematic Story-Drawing Procedure as a way to open a dialogical field. The material obtained, through the psychoanalytical met...

  10. Introducing Positron Emission Tomography (PET) in Clinical Practice

    OpenAIRE

    Janevik-Ivanovska, Emilija; Avmedovski, Fatmir; Yamamoto, Mayumi; Bhonsle, Uday

    2009-01-01

    Positron emission tomography (PET) is a major diagnostic imaging technique predominantly used in determining the presence and severity of cancers, neurological conditions, and cardiovascular diseases. It is currently the most effective way to check for cancer recurrences and it offers significant advantages over other forms of imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) scans in detecting disease in many patients. In the USA, an estimated 1 129 900 clinical PE...

  11. Clinical Microbiology in Pharmacy Education: A Practice-based Approach

    OpenAIRE

    Olla Wasfi; Mary Power; Slavcev, Roderick A.

    2010-01-01

    The increasing incidence of multi-drug resistant pathogenic bacteria, alongside viral and fungal human pathogens, supports the argument that skills in microbiology and infectious disease diagnosis, treatment and prevention are of growing global importance to be held among primary care clinicians.In Canada, inevitable future astronomical health care costs largely due to an aging population, have forced eyes upon pharmacists as one of (if not) the primary clinical professions to accommodate the...

  12. Hypovitaminosis D among rheumatology outpatients in clinical practice

    OpenAIRE

    Mouyis, M.; Ostor, A. J. K.; Crisp, A J; Ginawi, A.; Halsall, D J; Shenker, N.; Poole, K. E. S.

    2008-01-01

    Objectives. A role for vitamin D in the pathogenesis of autoimmune and inflammatory diseases is emerging. We undertook an audit of 25-hydroxyvitamin D (25OHD) investigation and treatment in rheumatology outpatients. Methods. Serum 25OHD requests were matched to electronic medical records from rheumatology and metabolic bone clinics (April 2006–March 2007). Data were analysed separately for two groups, ‘Documented osteoporosis/osteopaenia’ (Group 1) and ‘General rheumatology outpatients’ (Grou...

  13. Application of radiovisiography (digital radiology) in dental clinical practice

    OpenAIRE

    Ilić Dragan V.; Stojanović Ljiljana S.

    2012-01-01

    Introduction. Radiovisiography (RVG) as the latest imaging technique in dentistry with the minimal radiation exposure of the patient and numerous possibilities to process the images has many advantages over classic radiography. Case report. We presented an interesting clinical endodontic case of primary posted diagnosis of traumatic periodontitis of upper right canine upon orthodontics treatment. As the patient previously had been exposed to alleged high dose of radiation the patient ag...

  14. Radiological and clinical pattern of pulmonary Tuberculosis in selected TB clinics in Khartoum

    International Nuclear Information System (INIS)

    160 adult tuberculous patients were selected randomly from Al shaab and Abu Anja hospital, to (1) study the clino-radiological pattern of the disease, (2) to determine the percentage of radiologically-positive patients and (3) to study the frequency of the initial presenting symptoms and to correlate them with their x-ray findings. A flow-sheet was filled and proper clinical examination was conducted for each patient. Tuberclin test, 3 sputa examinations, ESR and chest x-ray were done for every patient. Three quarters of the patients were males in the young age group and most of the patients were of low socioeconomic status. The main presenting symptoms were productive cough, chest pain, dysnoea, fever, weight loss and malaise. Patients presented rather late, with a mean period of four months. 57 % of patients were sputum positive, 80% Tuberclin-positive and 98% had a high erythrocyte sedimentation rate (ESR). 15% of patients had radiological features of primary diseases of which hilar lymph-adenopathy was the commonest, while consolidation was the commonest parenchymal lesion. In post-primary disease fibrocavitory type was the commonest and together with exudative lesions constituted 98% of parenchymal lesions. 90% of patients had typical upper or middle zone infiltrates and 10% had lower lung field tuberculosis. 14% of patients had pleural effusion. 60% of patients had moderate disease extent in the chest, 30% far-advanced and 10% minimal lesions in their chest x-ray.(Author)

  15. Best practices for veterinary toxicologic clinical pathology, with emphasis on the pharmaceutical and biotechnology industries.

    Science.gov (United States)

    Tomlinson, Lindsay; Boone, Laura I; Ramaiah, Lila; Penraat, Kelley A; von Beust, Barbara R; Ameri, Mehrdad; Poitout-Belissent, Florence M; Weingand, Kurt; Workman, Heather C; Aulbach, Adam D; Meyer, Dennis J; Brown, Diane E; MacNeill, Amy L; Bolliger, Anne Provencher; Bounous, Denise I

    2013-09-01

    The purpose of this paper by the Regulatory Affairs Committee (RAC) of the American Society for Veterinary Clinical Pathology (ASVCP) is to review the current regulatory guidances (eg, guidelines) and published recommendations for best practices in veterinary toxicologic clinical pathology, particularly in the pharmaceutical and biotechnology industries, and to utilize the combined experience of ASVCP RAC to provide updated recommendations. Discussion points include (1) instrumentation, validation, and sample collection, (2) routine laboratory variables, (3) cytologic laboratory variables, (4) data interpretation and reporting (including peer review, reference intervals and statistics), and (5) roles and responsibilities of clinical pathologists and laboratory personnel. Revision and improvement of current practices should be in alignment with evolving regulatory guidance documents, new technology, and expanding understanding and utility of clinical pathology. These recommendations provide a contemporary guide for the refinement of veterinary toxicologic clinical pathology best practices.

  16. Diabetes-Specific Antibodies and Their use in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Serpil Salman

    2011-03-01

    Full Text Available AbstractType 1A diabetes results from the destruction of the insulin-secreting islet b-cells by an immune-mediated process. In the majority of patients, the clinical course is typical and there is no doubt about the diagnosis. However, the measurement of autoimmune diabetes markers is very useful in some situations such as differential diagnosis of type 1A diabetes and early-onset type 2 diabetes, as well as in the detection of latent autoimmune diabetes in adults (LADA cases. Moreover, in the type 1A diabetes prevention studies, autoimmune markers are needed for detection of individuals under risk and for their follow-up. The autoantibodies widely used in clinical course are: ICAs, IAA, GADA and IA-2 / IA-2b. Recently, a novel marker, ZnT8A, is described as a b-cell-specific antibody. In the present paper, the assay and clinical use of diabetes-specific autoantibodies are reviewed. Turk Jem 2011; 15: 8-12

  17. Silybin and the liver: From basic research to clinical practice

    Institute of Scientific and Technical Information of China (English)

    Carmela Loguercio; Davide Festi

    2011-01-01

    Herbal products are increasingly used, mainly in chronic liver disease. Extracts of milk thistle, Silymarin and silybin, are the most prescribed natural compounds,with different indications, but with no definitive results in terms of clinical efficacy. This review analyzes the available studies on the effects of the purified product silybin, both as a free and a conjugated molecule, on liver cells or on experimentally induced liver damage,and in patients with liver disease. We searched PUBMED for articles pertaining to the in vitro and in vivo effects of silybin, its antifibrotic, anti-inflammatory, and antioxidant properties, as well as its metabolic effects,combined with the authors' own knowledge of the literature. Results indicate that the bioavailability of silybin phytosome is higher than that of silymarin and is less influenced by liver damage; silybin does not show significant interactions with other drugs and at doses < 10 g/d has no significant side effects. Experimental studies have clearly demonstrated the antifibrotic, antioxidant and metabolic effects of silybin; previous human studies were insufficient for confirming the clinical efficacy in chronic liver disease, while ongoing clinical trials are promising. On the basis of literature data, silybin seems a promising drug for chronic liver disease.

  18. Focus on PCSK9 Inhibitors: From Genetics to Clinical Practice.

    Science.gov (United States)

    Sabatine, Marc S; Underberg, James A; Koren, Michael; Baum, Seth J

    2016-10-01

    Elevation of low-density lipoprotein cholesterol (LDL-C) is an important cause of atherosclerotic cardiovascular disease (ASCVD). Over the years, clinical outcome studies with LDL-C lowering agents have revealed that reducing LCL-C levels is effective in reducing rates of major ASCVD events. Although secondary factors play a role in clinical expression, severe lipid disorders often have a strong genetic component. Genetic revelations have provided novel targets for improving LDL-C management in high-risk individuals. Most recently, researchers have explored how the inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) alters LDL metabolism and lowers LDL-C levels to achieve lipid goals and potentially reduce ASCVD risk in patients with severe lipid disorders, including familial hypercholesterolemia (FH). This CMHC Spotlight article summarizes the clinical evidence demonstrating the safety, tolerability, and efficacy of PCSK9 inhibitors in lowering LDL-C levels. Reductions in LDL-C levels by PCSK9 inhibitors alone in patients who are statin intolerant or combined with maximally tolerated statins in patients with severe lipid disorders demonstrate the potential for reduced morbidity and mortality associated with ASCVD. PMID:27422124

  19. Rural nurse specialists: clinical practice and the politics of care.

    Science.gov (United States)

    Fitzgerald, Ruth P

    2008-01-01

    Doctor flight from rural areas is an international phenomenon that places great pressure on primary health care delivery. In New Zealand, the response to these empty doctors' surgeries has been the introduction of nurse-led rural health clinics that have attracted controversy both in the media and from urban-based doctors over whether such nurse-led care is a direct substitution of medical care. This article analyzes the reflections of nurses working in some of these clinics who suggest that their situation is more complex than a direct substitution of labor. Although the nurses indicate some significant pressures moving them closer to the work of doctoring, they actively police this cross-boundary work and labor simultaneously to shore up their nursing identities. My own conclusions support their assertions. I argue that it is the maintenance of a holistic professional habitus that best secures their professional identity as nurses while they undertake the cross-boundary tasks of primary rural health care. There are clear professional benefits and disadvantages for the nurses in these situations, which make the positions highly politicized. These recurring divisions of labor within medical care giving and the elaboration of new types of care worker form an appropriate although neglected topic of study for anthropologists. The study of the social organization of clinical medicine is much enriched by paying closer attention to its interaction with allied health professions and their associated understandings of "good" care. PMID:18663640

  20. Clinical Nursing Instructor Perception of the Influence of Engagement in Bedside Nursing Practice on Clinical Teaching

    Science.gov (United States)

    Berndt, Jodi L.

    2013-01-01

    Clinical experiences are an integral component of nursing education. Because the amount of time that a student spends in clinical experiences can be as many as twelve to sixteen hours per week, the clinical instructor plays a significant role in the nursing student's development of nursing knowledge. Many nurse educators attempt to balance dual…

  1. Models of clinical expertise in American nursing practice.

    Science.gov (United States)

    Gordon, D R

    1986-01-01

    This paper analyzes nursing job descriptions that compose a career ladder. These job descriptions, an ethnomodel of expertise, are compared to the Dreyfus model that describes five stages of skill acquisition. While the Dreyfus model posits the replacement of analytic reasoning with intuitive response as the characteristic of expert practice, the ideal posited in the nursing model places theoretical knowledge at the apex. Nursing job descriptions can best be understood in the context of this profession's search for greater power and legitimacy. PMID:3738566

  2. Evidence, research, and clinical practice: a patient-centered framework for progress in wound care.

    Science.gov (United States)

    van Rijswijk, Lia; Gray, Mikel

    2012-01-01

    Traditional criteria used in selecting wound care interventions are being slowly replaced with an evidence-based practice approach. The value of such an approach for providing optimal care has been established, but the definition of evidence-based care and the process used to generate evidence continue to evolve. For example, the role of studies developed to demonstrate efficacy, randomized controlled trials, the value of effectiveness studies designed to evaluate outcomes in real world practice, and the use of disease-oriented (interim) study outcomes for wound care research, such as reduces wound fluid or improves granulation tissue formation, have been topics of international conversations and consensus documents. In addition, the use in some clinical studies and most systematic study reviews of ingredient or characteristic-based categories to group products that may not share a common operational definition of how they function has led to a high variability in outcomes, resulting in inconclusive or low-level evidence. These concerns and debates, along with their influence on practice, may cast doubt on the value of evidence-based practice guidelines for some clinicians, slowing their rate of implementation, and extending the discussion about definitions of evidence-based care and the relative merits of various research designs. At the same time, amid growing concerns about medical device safety, clinicians must answer 3 questions about an intervention and its related products or devices in order to provide safe and effective care: (1) Can it work? (2) Does it work? (3) Is it worth it? Reviewing current knowledge about wound care, wound treatment modalities, and the basic principles of research within the existing framework of questions to be answered suggests a clear path toward obtaining much-needed evidence. In wound care, using clearly defined processes to study patient-centered outcomes (eg, quality of life, complete healing) and only product groupings that

  3. Teaching to Transform? Addressing Race and Racism in the Teaching of Clinical Social Work Practice

    Science.gov (United States)

    Varghese, Rani

    2016-01-01

    Faculty members are key stakeholders to support social work students' learning about race and racism in practice and to promote the professional standards established by the field. This qualitative study examines how 15 clinical social work faculty members teaching advanced practice in the Northeast conceptualize and incorporate their…

  4. Promoting Assessment Efficacy through an Integrated System for Online Clinical Assessment of Practical Skills

    Science.gov (United States)

    Hay, Peter J.; Engstrom, Craig; Green, Anita; Friis, Peter; Dickens, Sue; Macdonald, Doune

    2013-01-01

    This paper presents evaluation outcomes from an externally funded research project involving the online clinical assessment of practical skills (eCAPS) using web-based video technologies within a university medical programme. eCAPS was implemented to trial this web-based approach for promoting the efficacy of "practical" skills assessment in knee…

  5. Factors Influencing Electronic Clinical Information Exchange in Small Medical Group Practices

    Science.gov (United States)

    Kralewski, John E.; Zink, Therese; Boyle, Raymond

    2012-01-01

    Purpose: The purpose of this study was to identify the organizational factors that influence electronic health information exchange (HIE) by medical group practices in rural areas. Methods: A purposive sample of 8 small medical group practices in 3 experimental HIE regions were interviewed to determine the extent of clinical information exchange…

  6. Nursing students’ stressors and anxiety in their first clinical practice

    Directory of Open Access Journals (Sweden)

    Ana Isabel Cobo Cuenca

    2010-11-01

    Full Text Available Nursery practices are crucial for the subsequent professional development of the nurse, but because of her contact with suffering, death and in general the human aspects of health care, mean a stressful moment for nursing students.Objectives: know the levels of anxiety and condition, as well to determine the stressors that have influence in such anxiety in the students of Nursing Schools of the University of Castilla la ManchaMethodology: A observational, longitudinal and prospective study. The Stai-R and Stai-E questionnaires will be used to know the anxiety trait and state and the Kezkak questionnaire, validated by Zupiria, will be used to know the most frequent stressors that appear in the population subject of this survey.The population is limited to the students registered for the Introductory Practicum subject, that mean the first practices and therefore the student’s first contact with the reality of the nursery care.The analysis of information will be realized by statistical package SPSS V15.0.

  7. The humanization of catheter room design: its clinical practice

    International Nuclear Information System (INIS)

    American scholar Engeer has proposed biological, psychological and sociological medicine pattern, which has been well accepted by the society, It has manifested the medical arena humanism return and has made the profound influence on the nursing development. The idea, 'the human is a whole', has gradually become the mainstream of the nurse service concept, meanwhile, the environment has more and more become a beneficial part for diagnosing and treating in hospitalization. The improvement and more user-friendly design of the diagnosing and treating environment has already become an important ring linked with the whole nursing work. At the beginning of the fitting up design for the Catheter Lab Room of Interventional Radiology in General Hospital of PLA, the authors receive the idea 'the environment experience and admiration of the patient', put more attention to the humanization in the diagnosing and treating environmental construction. The functional compartments are separated clearly. The color, the background music as well as the video are designed to be coordinated with each other in order to produce a relaxing system. Practice for the past three years indicates that the use of humanization environment design can markedly reduce the patient intense and the anxious level in perioperative period, it can also significantly promote the patient to be restored to health. This article will describe user-friendly diagnosing and treating environmental construction practice in the Catheter Lab Room of Interventional Radiology in General Hospital of PLA. (authors)

  8. What supports physiotherapists’ use of research in clinical practice? A qualitative study in Sweden

    OpenAIRE

    Dannapfel, Petra; Peolsson, Anneli; Nilsen, Per

    2013-01-01

    Background Evidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circums...

  9. Utility of strain-echocardiography in current clinical practice.

    Science.gov (United States)

    Dohi, Kaoru; Sugiura, Emiyo; Ito, Masaaki

    2016-06-01

    Myocardial strain measurement with two-dimensional speckle-tracking echocardiography (2D-STE) is of paramount importance in the early detection of subclinical left ventricular (LV) systolic dysfunction and the prediction of patient outcomes in various types of heart disease, especially when assessed with global longitudinal strain (GLS). The routine application of myocardial strain parameters requires the definition of normal values and an understanding of their reliabilities. One of the most important potential limitations to widespread clinical application of this technique is inter-vendor differences in normal strain values. Recent clinical reports indicate that the smallest differences were noted in GLS measurements among three orthogonal directions. Because the contribution of circumferential fibers to LV myocardial thickening is greater than that of longitudinal fibers, patients who have a reduced LV ejection fraction can have impaired global circumferential strain (GCS), which reflects more advanced intrinsic myocardial systolic dysfunction and is thus closely related to a poor prognosis. Since STE-derived strain analysis allows us to define the timing of the regional myocardial peak systolic deformation, it permits the assessment of LV mechanical dyssynchrony. The severity of LV mechanical dyssynchrony in the short axis plane, i.e., radial and/or circumferential strain imaging, is favorable for predicting the clinical response to cardiac resynchronization therapy. GLS in the right ventricular (RV) four-chamber view has recently been used as a surrogate for global RV function because longitudinal shortening is the major contributor to overall RV performance. Finally, 2D-STE can be used to quantify and characterize RV mechanical dyssynchrony in various diseases including acute pulmonary thromboembolism and chronic pulmonary hypertension. PMID:26936263

  10. Coenzyme Q10 therapy in current clinical practice

    Directory of Open Access Journals (Sweden)

    Abhishek Soni

    2015-04-01

    Full Text Available Coenzyme Q10 (CoQ10 is a naturally occurring, lipid soluble, essential compound and is also known as ubiquinone. CoQ10 acts as an intermediate of the electron transport chain situated in membrane of mitochondria and vital for ATP production and cellular respiration. CoQ10 also serves as an intercellular antioxidant. All the clinical use of CoQ10 are based upon these two functions. CoQ10 levels are altered in a number of oncological as well as non-oncological diseases. Furthermore, recent data indicate that CoQ10 has an impact on the expression of many genes involved in metabolism, cellular transport, transcription control, and cell signaling, making CoQ10 a potent gene regulator. CoQ10 supplementation is useful in diseases associated with CoQ10 deficiency which includes primary and secondary CoQ10 deficiencies, fibromyalgia, diabetes mellitus, mitochondrial diseases, neurodegenerative diseases, cardiovascular disease, cancer, male infertility and periodontal disease. Clinical presentations of severe CoQ10 deficiency include severe infantile multisystemic disease, encephalomyopathy, isolated myopathy cerebellar ataxia and Leigh syndrome with growth retardation. Oral CoQ10 administration can correct CoQ10 deficiency since it increases CoQ10 tissue levels. CoQ10 therapy has no serious side effects in humans and new formulations have been developed that increase CoQ10 absorption and tissue distribution. Future trends involving CoQ10 in many diseases needs more clinical trials for better understanding of CoQ10 efficacy. [Int J Res Med Sci 2015; 3(4.000: 817-825

  11. The concept of control of COPD in clinical practice

    Directory of Open Access Journals (Sweden)

    Soler-Cataluña JJ

    2014-12-01

    Full Text Available Juan José Soler-Cataluña,1,2 Bernardino Alcázar-Navarrete,3 Marc Miravitlles2,4 1Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain; 2CIBER de Enfermedades Respiratorias (CIBERES, 3Respiratory Department, Hospital de Alta Resolucion, Granada, Spain; 4Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain Abstract: Treatment of chronic obstructive pulmonary disease (COPD requires a personalized approach according to the clinical characteristics of the patients, the level of severity, and the response to the different therapies. Furthermore, patients with the same level of severity measured by the degree of airflow obstruction or even with multidimensional indices may have very different symptoms and limitations for daily activities. The concept of control has been extensively developed in asthma but has not been defined in COPD. Here, we propose a definition of COPD control based on the concepts of impact and stability. Impact is a cross-sectional concept that can be measured by questionnaires such as the COPD Assessment Test or the Clinical COPD Questionnaire. Alternatively, impact can be assessed by the degree of dyspnea, the use of rescue medication, the level of physical activity, and sputum color. Stability is a longitudinal concept that requires the absence of exacerbations and deterioration in the aforementioned variables or in the COPD Assessment Test or Clinical COPD Questionnaire scores. Control is defined by low impact (adjusted for severity and stability. The concept of control in COPD can be useful in the decision making regarding an increase or decrease in medication in the stable state. Keywords: COPD, control, CAT, CCQ, exacerbations, prognosis

  12. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline

    Science.gov (United States)

    Bornstein, Stefan R.; Allolio, Bruno; Arlt, Wiebke; Barthel, Andreas; Don-Wauchope, Andrew; Hammer, Gary D.; Husebye, Eystein S.; Merke, Deborah P.; Murad, M. Hassan; Stratakis, Constantine A.; Torpy, David J.

    2016-01-01

    Objective: This clinical practice guideline addresses the diagnosis and treatment of primary adrenal insufficiency. Participants: The Task Force included a chair, selected by The Clinical Guidelines Subcommittee of the Endocrine Society, eight additional clinicians experienced with the disease, a methodologist, and a medical writer. The co-sponsoring associations (European Society of Endocrinology and the American Association for Clinical Chemistry) had participating members. The Task Force received no corporate funding or remuneration in connection with this review. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to determine the strength of recommendations and the quality of evidence. Consensus Process: The evidence used to formulate recommendations was derived from two commissioned systematic reviews as well as other published systematic reviews and studies identified by the Task Force. The guideline was reviewed and approved sequentially by the Endocrine Society's Clinical Guidelines Subcommittee and Clinical Affairs Core Committee, members responding to a web posting, and the Endocrine Society Council. At each stage, the Task Force incorporated changes in response to written comments. Conclusions: We recommend diagnostic tests for the exclusion of primary adrenal insufficiency in all patients with indicative clinical symptoms or signs. In particular, we suggest a low diagnostic (and therapeutic) threshold in acutely ill patients, as well as in patients with predisposing factors. This is also recommended for pregnant women with unexplained persistent nausea, fatigue, and hypotension. We recommend a short corticotropin test (250 μg) as the “gold standard” diagnostic tool to establish the diagnosis. If a short corticotropin test is not possible in the first instance, we recommend an initial screening procedure comprising the measurement of morning plasma ACTH

  13. Coenzyme Q10 therapy in current clinical practice

    OpenAIRE

    Abhishek Soni; Monica Verma; Vivek Kaushal; Ghalaut, Veena S.

    2015-01-01

    Coenzyme Q10 (CoQ10) is a naturally occurring, lipid soluble, essential compound and is also known as ubiquinone. CoQ10 acts as an intermediate of the electron transport chain situated in membrane of mitochondria and vital for ATP production and cellular respiration. CoQ10 also serves as an intercellular antioxidant. All the clinical use of CoQ10 are based upon these two functions. CoQ10 levels are altered in a number of oncological as well as non-oncological diseases. Furthermore, recent dat...

  14. Accuracy - a market in radiotherapy. Reasons, requirements, clinical practice

    International Nuclear Information System (INIS)

    Accuracy requirements are specified in accordance with survival curves drawn up on the basis of clinical experience and data. Sigmoidal dose-response curves are established with the aid of the survival curves, giving information on tumour decline and the radiation effects induced in patients. In accordance with the ICRU report of 1984, Quality Assurance of External Beam Therapy, accuracy verification takes into account the two different criteria of tolerance level and action level. The dosimetric overall uncertainty is to be kept below 8 p.c. (DG)

  15. Children with Speech Difficulties: A survey of clinical practice in the Western Cape

    Directory of Open Access Journals (Sweden)

    Michelle Pascoe

    2010-12-01

    Full Text Available This paper is based on a study by Joffe and Pring (2008 which investigated assessment and therapy methods used by Speech Language Therapists (SLTs in the United Kingdom for children with phonological difficulties. Joffe and Pring reported SLTs’ most favoured assessments and therapy approaches in that context. Children with speech difficulties are likely to form a considerable part of SLT caseloads in South Africa, but the choice of assessments may not be so clearcut given the linguistic diversity of the region and the fact that few assessments have been developed specifically for the SA population. Linked to difficulties with assessment, selection of intervention approaches may also pose challenges. This study aimed to investigate the methods of assessment and intervention used by SLTs in the Western Cape when working with children with speech difficulties. A questionnaire was sent to SLTs working with pre and/ or primary school- aged children. Twenty-nine clinicians of varying experience responded. The majority of SLTs (89% use informal assessment tools in combination with formal assessment. When using formal assessments, more than 50% of SLTs make modifications to better suit the population. Participants use a variety of intervention approaches, often in combination, and based on a child’s individual profile of difficulties and available resources. Forty-six percent of SLTs felt unsure about the selection of assessments and intervention for bi/multilingual children with speech difficulties. SLTs suggested that guidelines about accepted / typical speech development in the region would be helpful for their clinical practice. Clinical implications of the findings are discussed together with some suggestions for developing knowledge of children’s speech difficulties in the South African context.

  16. Transforming Teacher Education through Clinical Practice: A National Strategy to Prepare Effective Teachers

    Science.gov (United States)

    Education Digest: Essential Readings Condensed for Quick Review, 2011

    2011-01-01

    The education of teachers in the United States needs to be turned upside down. Teacher education must shift away from emphasizing academic preparation and course work loosely linked to school-based experiences to programs fully grounded in clinical practice and interwoven with academic content and professional courses. This clinically based…

  17. Clinical and Research Perspectives on Nonspeech Oral Motor Treatments and Evidence-Based Practice

    Science.gov (United States)

    Muttiah, Nimisha; Georges, Katie; Brackenbury, Tim

    2011-01-01

    Purpose: Evidence-based practice (EBP) involves the incorporation of research evidence, clinical expertise, and client values in clinical decision making. One case in which these factors conflict is the use of nonspeech oral motor treatments (NSOMTs) for children with developmental speech sound disorders. Critical reviews of the research evidence…

  18. The Cardiology Audit and Registration Data Standards (CARDS), European data standards for clinical cardiology practice

    NARCIS (Netherlands)

    M.R. Flynn (Rachel); C. Barrett (Conor); F.G. Cosio (Francisco); A.K. Gitt (Anselm); L.C. Wallentin (Lars); P. Kearney (Peter); M. Lonergan (Moira); E. Shelley (Emer); M.L. Simoons (Maarten)

    2005-01-01

    textabstractAIMS: Systematic registration of data from clinical practice is important for clinical care, local, national and international registries, and audit. Data to be collected for these different purposes should be harmonized. Therefore, during Ireland's Presidency of the European Union (EU)

  19. Transcranial magnetic stimulation (TMS) in stroke: Ready for clinical practice?

    Science.gov (United States)

    Smith, Marie-Claire; Stinear, Cathy M

    2016-09-01

    The use of transcranial magnetic stimulation (TMS) in stroke research has increased dramatically over the last decade with two emerging and potentially useful functions identified. Firstly, the use of single pulse TMS as a tool for predicting recovery of motor function after stroke, and secondly, the use of repetitive TMS (rTMS) as a treatment adjunct aimed at modifying the excitability of the motor cortex in preparation for rehabilitation. This review discusses recent advances in the use of TMS in both prediction and treatment after stroke. Prediction of recovery after stroke is a complex process and the use of TMS alone is not sufficient to provide accurate prediction for an individual after stroke. However, when applied in conjunction with other tools such as clinical assessment and MRI, accuracy of prediction using TMS is increased. rTMS temporarily modulates cortical excitability after stroke. Very few rTMS studies are completed in the acute or sub-acute stages after stroke and the translation of altered cortical excitability into gains in motor function are modest, with little evidence of long term effects. Although gains have been made in both of these areas, further investigation is needed before these techniques can be applied in routine clinical care. PMID:27394378

  20. Transcranial magnetic stimulation (TMS) in stroke: Ready for clinical practice?

    Science.gov (United States)

    Smith, Marie-Claire; Stinear, Cathy M

    2016-09-01

    The use of transcranial magnetic stimulation (TMS) in stroke research has increased dramatically over the last decade with two emerging and potentially useful functions identified. Firstly, the use of single pulse TMS as a tool for predicting recovery of motor function after stroke, and secondly, the use of repetitive TMS (rTMS) as a treatment adjunct aimed at modifying the excitability of the motor cortex in preparation for rehabilitation. This review discusses recent advances in the use of TMS in both prediction and treatment after stroke. Prediction of recovery after stroke is a complex process and the use of TMS alone is not sufficient to provide accurate prediction for an individual after stroke. However, when applied in conjunction with other tools such as clinical assessment and MRI, accuracy of prediction using TMS is increased. rTMS temporarily modulates cortical excitability after stroke. Very few rTMS studies are completed in the acute or sub-acute stages after stroke and the translation of altered cortical excitability into gains in motor function are modest, with little evidence of long term effects. Although gains have been made in both of these areas, further investigation is needed before these techniques can be applied in routine clinical care.

  1. Understanding facilitators and barriers to reengineering the clinical research enterprise in community-based practice settings.

    Science.gov (United States)

    Kukafka, Rita; Allegrante, John P; Khan, Sharib; Bigger, J Thomas; Johnson, Stephen B

    2013-09-01

    Solutions are employed to support clinical research trial tasks in community-based practice settings. Using the IT Implementation Framework (ITIF), an integrative framework intended to guide the synthesis of theoretical perspectives for planning multi-level interventions to enhance IT use, we sought to understand the barriers and facilitators to clinical research in community-based practice settings preliminary to implementing new informatics solutions for improving clinical research infrastructure. The studies were conducted in practices within the Columbia University Clinical Trials Network. A mixed-method approach, including surveys, interviews, time-motion studies, and observations was used. The data collected, which incorporates predisposing, enabling, and reinforcing factors in IT use, were analyzed according to each phase of ITIF. Themes identified in the first phase of ITIF were 1) processes and tools to support clinical trial research and 2) clinical research peripheral to patient care processes. Not all of the problems under these themes were found to be amenable to IT solutions. Using the multi-level orientation of the ITIF, we set forth strategies beyond IT solutions that can have an impact on reengineering clinical research tasks in practice-based settings. Developing strategies to target enabling and reinforcing factors, which focus on organizational factors, and the motivation of the practice at large to use IT solutions to integrate clinical research tasks with patient care processes, is most challenging. The ITIF should be used to consider both IT and non-IT solutions concurrently for reengineering of clinical research in community-based practice settings. PMID:23806363

  2. Personalized medicine. Closing the gap between knowledge and clinical practice.

    Science.gov (United States)

    Anaya, Juan-Manuel; Duarte-Rey, Carolina; Sarmiento-Monroy, Juan C; Bardey, David; Castiblanco, John; Rojas-Villarraga, Adriana

    2016-08-01

    Personalized medicine encompasses a broad and evolving field informed by a patient distinctive information and biomarker profile. Although terminology is evolving and some semantic interpretations exist (e.g., personalized, individualized, precision), in a broad sense personalized medicine can be coined as: "To practice medicine as it once used to be in the past using the current biotechnological tools." A humanized approach to personalized medicine would offer the possibility of exploiting systems biology and its concept of P5 medicine, where predictive factors for developing a disease should be examined within populations in order to establish preventive measures on at-risk individuals, for whom healthcare should be personalized and participatory. Herein, the process of personalized medicine is presented together with the options that can be offered in health care systems with limited resources for diseases like rheumatoid arthritis and type 1 diabetes.

  3. CPI (clinical practice improvement): improving quality and decreasing cost in managed care.

    Science.gov (United States)

    Horn, S D

    1995-07-01

    The focus on quality has never been greater. As a result, a new concept, clinical practice improvement (CPI), is emerging. Clinical practice improvement is the application of the scientific method to the day-to-day practice of medicine and can be employed in all health care settings: inpatient or ambulatory, large or small. According to the author, CPI has proved to be effective in reducing costs and improving outcomes because it requires the committed support of clinicians who are involved directly in the process of designing studies, analyzing data, and developing more efficient forms of treatment in their own organizations. PMID:10143825

  4. Investigation of Data Representation Issues in Computerizing Clinical Practice Guidelines in China

    OpenAIRE

    Liu, Danhong; Ye, Qing; Yang, Zhe; Yang, Peng; Xu, Yongyong; Su, Jingkuan

    2014-01-01

    Objectives From the point of view of clinical data representation, this study attempted to identify obstacles in translating clinical narrative guidelines into computer interpretable format and integrating the guidelines with data in Electronic Health Records in China. Methods Based on SAGE and K4CARE formulism, a Chinese clinical practice guideline for hypertension was modeled in Protégé by building an ontology that had three components: flowchart, node, and vMR. Meanwhile, data items impera...

  5. Molecular Biology of Pancreatic Cancer: How Useful Is It in Clinical Practice?

    OpenAIRE

    Sakorafas, George H; Vasileios Smyrniotis

    2012-01-01

    Context During the recent two decades dramatic advances of molecular biology allowed an in-depth understanding of pancreatic carcinogenesis. It is currently accepted that pancreatic cancer has a genetic component. The real challenge is now how these impressive advances could be used in clinical practice. Objective To critically present currently available data regarding clinical application of molecular biology in pancreatic cancer. Methods Reports about clinical implications of molecular bio...

  6. Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management.

    Science.gov (United States)

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

    2016-04-01

    More than 120,000 patients are treated annually in Germany to resolve repeated episodes of acute tonsillitis. Therapy is aiming at symptom regression, avoidance of complications, reduction in the number of disease-related absences in school or at work, increased cost-effectiveness and improved quality of life. The purpose of this part of the guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through different conservative treatment options in order to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical management in terms of intracapsular as well as extracapsular tonsillectomy (i.e. tonsillotomy) is the subject of part II of this guideline. To estimate the probability of tonsillitis caused by β-hemolytic streptococci, a diagnostic scoring system according to Centor or McIsaac is suggested. If therapy is considered, a positive score of ≥3 should lead to pharyngeal swab or rapid test or culture in order to identify β-hemolytic streptococci. Routinely performed blood tests for acute tonsillitis are not indicated. After acute streptococcal tonsillitis, there is no need to repeat a pharyngeal swab or any other routine blood tests, urine examinations or cardiological diagnostics such as ECG. The determination of the antistreptolysin O-titer (ASLO titer) and other antistreptococcal antibody titers do not have any value in relation to acute tonsillitis with or without pharyngitis and should not be performed. First-line therapy of β-hemolytic streptococci consists of oral penicillin. Instead of phenoxymethylpenicillin-potassium (penicillin V potassium), also phenoxymethlpenicillin-benzathine with a clearly longer half-life can be used. Oral intake for 7 days of one of both the drugs is recommended. Alternative treatment with oral cephalosporins (e.g. cefadroxil, cefalexin) is indicated only in cases of penicillin failure, frequent recurrences, and whenever a more

  7. Quality Assessment of Clinical Practice Guidelines Developed by Professional Societies in Turkey

    Science.gov (United States)

    Yaşar, Ilknur; Kahveci, Rabia; Baydar Artantaş, Aylin; Ayhan Başer, Duygu; Gökşin Cihan, Fatma; Şencan, Irfan; Koç, Esra Meltem; Özkara, Adem

    2016-01-01

    Background Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. There is a limited number of studies on guidelines in Turkey. The quality of Ministry of Health guidelines have formerly been assessed whereas there is no information on the other guidelines developed in the country. Aim This study aims to assess the quality of CPGs that are developed by professional societies that work for the health sector in Turkey, and compare the findings with international guidelines. Methodology Professional societies that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. Inclusion and exclusion criteria were defined for selecting the CPGs. Guidelines containing recommendations about disease management to the doctors, accessible online, developed within the past 5 years, citing references for recommendations, about the diseases over 1% prevalence according to the “Statistical Yearbook of Turkey 2012” were included in the study. The quality of CPGs were assessed with the AGREE II instrument, which is an internationally recognized tool for this purpose. Four independent reviewers, who did not participate in the development of the selected guidelines and were trained in CPG appraisal, used the AGREE instrument for assessment of the selected guidelines. Findings 47 professional societies were defined which provided access to CPGs in their websites; 3 of them were only open to members so these could not be reached. 8 CPGs from 7 societies were selected from a total of 401 CPGs from 44 societies. The mean scores of the domains of the guidelines which were assessed by the AGREE II tool were; Scope and purpose: 64%, stakeholder involvement: 37.9%, rigour of development: 35.3%, clarity and presentation: 77.9%, applicability: 49.0% and editorial independence: 46.0%. Conclusion This is the first

  8. Therapeutic songwriting in music therapy, Part II: Comparing the literature with practice across diverse clinical populations

    DEFF Research Database (Denmark)

    Baker, Felicity; Wigram, Tony; Stott, Dave;

    2009-01-01

      A growing body of literature on therapeutic songwriting with diverse clinical populations indicates that clinicians employ a wide range of approaches. The purpose of this research was to establish trends in the clinical practice of songwriting as implemented across a range of clinical populations......, and the types of allied health professionals involved in the songwriting interventions. There is a distinct absence of songwriting literature as applied in developmental disability, autism spectrum disorder, and aged care contexts so the resulting practice trends offered here contribute to the increasing body...

  9. A model for faculty practice teaching clinics developed at the Oregon Health Sciences University.

    Science.gov (United States)

    O'Hollaren, M T; Romm, C L; Cooney, T G; Bardana, E J; Walker, J; Martin, C

    1992-01-01

    In 1988 the Oregon Health Sciences University established its first faculty practice teaching clinic wherein physicians in training were incorporated into a faculty private practice clinic; this pilot project proved very successful and has been subsequently adopted as the model for essentially all outpatient clinics (both medical and surgery) in the university system. The model encourages efficiency, overhead control, and appropriate staffing; it also compensates faculty members for their additional time spent teaching. The authors conclude this model may help other academic training centers adapt to the changing demands of medical education. PMID:1729995

  10. A commentary on the 2015 Canadian Clinical Practice Guidelines in glutamine supplementation to parenteral nutrition.

    Science.gov (United States)

    Leguina-Ruzzi, Alberto

    2016-01-08

    Glutamine is one of the conditionally essential free amino acids with multiple biological functions. Its supplementation to parenteral nutrition has been widely used for the management of complications in intensive care. However, controversial clinical reports have generated reluctance in the use of this pharmaco-nutrient. In this commentary, we address the impact of four studies that influenced the recommendations on glutamine supplementation by the Canadian Clinical Practice Guide 2015. Because of the importance of this guideline in clinical practice, we strongly believe that a more rigorous and critical evaluation is required to support recommendations in future guidelines.

  11. Clinical Photography for Periorbital and Facial Aesthetic Practice.

    Science.gov (United States)

    Nair, Akshay Gopinathan; Santhanam, Aparna

    2016-01-01

    External cutaneous photography involves photographic documentation, which helps in treatment planning, documentation of facial features, teaching, publishing and pre- and post-procedural comparisons. The key is not simply documenting, but documenting it the right way and ensuring that photography is standardised and reproducible. In this review, basic photography techniques, standardised and reproducible angles such as frontal, oblique and lateral views and specific photographic angles for conditions such as facial rejuvenation are discussed. Use of photography accessories and a few tips on how to click good photographs in the examination room and how to achieve consistency in standardised photography are also presented. External photography in ophthalmic and facial plastic surgery like any other speciality too has standardised guidelines. Even small variations cause a drastic change in the photos and it's clinical and research value. Unless stringent criteria are met, the photographs lose their relevance and impact.

  12. Rotational radiotherapy for prostate cancer in clinical practice

    DEFF Research Database (Denmark)

    Aznar, Marianne; Munck af Rosenschöld, Per; Logadottir, Ashildur;

    2010-01-01

    at risk, requiring less than 2min of beam-on time per treatment fraction. Materials and methods We report herein our experience from the first 46 patients treated for prostate cancer, clinical stage T1–3 with rotational therapy (“RapidArc®”, Varian Medical systems) (RA). This patient group is compared...... to a group of 50 patients treated with a 5-field Intensity Modulated Radiation Therapy (IMRT) technique over the same period. The comparison parameters include target coverage, dose to OAR, treatment time and number of monitor units. Daily-IGRT using implanted gold markers is used before and after treatment......Background and purpose Radiotherapy is the standard treatment in locally advanced prostate cancer. The latest technological improvement is modulated rotational radiotherapy, where one single rotation of the treatment machine is used to conform the dose delivery to the target and spare organs...

  13. Holter Monitoring and Loop Recorders: From Research to Clinical Practice.

    Science.gov (United States)

    Galli, Alessio; Ambrosini, Francesco; Lombardi, Federico

    2016-08-01

    Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holter monitoring technologies and loop recorders allow prolonged monitoring of heart rhythm for periods from a few days to several months, making it possible to detect infrequent arrhythmias in patients of all ages. This review discusses the advances in this area of arrhythmology and how Holter monitors have improved the clinical management of patients with suspected cardiac rhythm diseases.

  14. Ancillary Care: From Theory to Practice in International Clinical Research.

    Science.gov (United States)

    Pratt, Bridget; Zion, Deborah; Lwin, Khin Maung; Cheah, Phaik Yeong; Nosten, Francois; Loff, Bebe

    2013-07-01

    How international research might contribute to justice in global health has not been substantively addressed by bioethics. This article describes how the provision of ancillary care can link international clinical research to the reduction of global health disparities. It identifies the ancillary care obligations supported by a theory of global justice, showing that Jennifer Ruger's health capability paradigm requires the delivery of ancillary care to trial participants for a limited subset of conditions that cause severe morbidity and mortality. Empirical research on the Shoklo Malaria Research Unit's (SMRU) vivax malaria treatment trial was then undertaken to demonstrate whether and how these obligations might be upheld in a resource-poor setting. Our findings show that fulfilment of the ancillary care obligations is feasible where there is commitment from chief investigators and funders and is strongly facilitated by SMRU's dual role as a research unit and medical non-governmental organization. PMID:23864908

  15. Treatment of invasive candidiasis: between guidelines and daily clinical practice.

    Science.gov (United States)

    Tagliaferri, Enrico; Menichetti, Francesco

    2015-06-01

    Invasive candidiasis, including candidemia (IC/C), is a major cause of morbidity and mortality among hospitalized patients. While incidence is higher in intensive care units, the majority of cases of candidemia are documented in medical wards. Although Candida albicans is still the most frequently isolated species, IC/C due to non-albicans species, usually less susceptible to fluconazole, is increasing. Early identification of patients at risk, knowledge of local epidemiology and prompt efforts to define etiologic diagnosis play a pivotal role for appropriateness. Starting therapy with an echinocandin, switching then to fluconazole when possible, seems to represent a potentially useful strategy for the management of IC/C. The choice between the three echinocandins should be based on the specific indications, pharmacokinetic/pharmacodynamic profile, clinical experience and relative cost. PMID:25818660

  16. Silicone-based stoma accessories in clinical practice.

    Science.gov (United States)

    Cronin, Elaine

    Advanced silicone technology has transformed the treatment of wounds and peri-wound skin. Recently, there has been interest in the use of silicone-based products in stoma care. Peristomal skin issues are a common problem, and can have a negative impact on the patient's quality of life, so helping the ostomate maintain good skin health is crucial. The author, a stoma care nurse, regularly sees 3-4 patients each week in her stoma care clinic with damaged or broken peristomal skin. This article explores the 'Trio' range of silicone-based accessories, discussing how these products compare with the traditional hydrocolloid, how they are applied and used. A series of case studies illustrates the circumstances in which these products may be applied. PMID:26973010

  17. Methods for diagnosis of bile acid malabsorption in clinical practice.

    Science.gov (United States)

    Vijayvargiya, Priya; Camilleri, Michael; Shin, Andrea; Saenger, Amy

    2013-10-01

    Altered concentrations of bile acid (BA) in the colon can cause diarrhea or constipation. More than 25% of patients with irritable bowel syndrome with diarrhea or chronic diarrhea in Western countries have BA malabsorption (BAM). As BAM is increasingly recognized, proper diagnostic methods are needed to help direct the most effective course of treatment for the chronic bowel dysfunction. We review the methodologies, advantages, and disadvantages of tools that directly measure BAM: the (14)C-glycocholate breath and stool test, the (75)selenium homotaurocholic acid test (SeHCAT), and measurements of 7 α-hydroxy-4-cholesten-3-one (C4) and fecal BAs. The (14)C-glycocholate test is laborious and no longer widely used. The (75)SeHCAT has been validated but is not available in the United States. Measurement of serum C4 is a simple and accurate method that can be used for most patients but requires further clinical validation. Assays to quantify fecal BA (total and individual levels) are technically cumbersome and not widely available. Regrettably, none of these tests are routinely available in the United States; assessment of the therapeutic effects of a BA binder is used as a surrogate for diagnosis of BAM. Recent data indicate the advantages to studying fecal excretion of individual BAs and their role in BAM; these could support the use of the fecal BA assay, compared with other tests. Measurement of fecal BA levels could become a routine addition to the measurement of fecal fat in patients with unexplained diarrhea. Availability ultimately determines whether the C4, SeHCAT, or fecal BA test is used; more widespread availability of such tests would enhance clinical management of these patients.

  18. [International clinical practice guidelines and management of rheumatology in Madagascar].

    Science.gov (United States)

    Ralandison, S; Rafalimanana, E; Rakotonirainy, H; Rabenja, R

    2012-02-01

    Developed countries issue recommendations regarding healthcare that aren't constantly appropriate for emergent countries. We suggest some remarks concerning rheumatology in Madagascar, taking account of scientific data, medical ethics, equality and equity. We have studied the minimal cost of care of medical conditions found in our hospital department if we were to follow international recommendations for their management. Then, we have estimated treatment expenses as a percentage of the SMIC (Malagasy minimum monthly salary). Out of 517 patients examined yearly, we have found 62.8% osteoarthritis cases, 6.3% rheumatoid arthritis (RA), and 4,2% septic arthritis. Therefore, the first month of treatment for an arthritis of the knee would absorb 147.3% of the SMIC; diagnosis and treatment of a case of septic arthritis would take up 1762.8% of the minimum wage, and a case of RA without biotherapy would require 175%. According to the American College of Rheumatology criteria which are used as a reference, the treatment of an arthritis of the knee would take only 23% of the SMIC. Caring for septic arthritis would demand 57.5% of the SMIC and while it would yield more arguments for diagnosis such as clinical examination, CRP, and Gram coloration on joint liquid aspiration. We can proceed to RA diagnosis with an acceptable security through precise clinical examination, blood cell count, ESR, CRP, rheumatoid factor and radiography. This means 56% of the SMIC. From this 517 patients, our suggestions would reduce the expense by 35,850% of the SMIC per year. The allocation of such funds onto the treatment of complicated forms of rheumatism would be fair. By refining and evaluating these suggestions, we would come up with appropriate recommendations for emergent countries.

  19. Genomic Testing and Therapies for Breast Cancer in Clinical Practice

    Science.gov (United States)

    Haas, Jennifer S.; Phillips, Kathryn A.; Liang, Su-Ying; Hassett, Michael J.; Keohane, Carol; Elkin, Elena B.; Armstrong, Joanne; Toscano, Michele

    2011-01-01

    Purpose: Given the likely proliferation of targeted testing and treatment strategies for cancer, a better understanding of the utilization patterns of human epidermal growth factor receptor 2 (HER2) testing and trastuzumab and newer gene expression profiling (GEP) for risk stratification and chemotherapy decision making are important. Study Design: Cross-sectional. Methods: We performed a medical record review of women age 35 to 65 years diagnosed between 2006 and 2007 with invasive localized breast cancer, identified using claims from a large national health plan (N = 775). Results: Almost all women received HER2 testing (96.9%), and 24.9% of women with an accepted indication received GEP. Unexplained socioeconomic differences in GEP use were apparent after adjusting for age and clinical characteristics; specifically, GEP use increased with income. For example, those in the lowest income category (< $40,000) were less likely than those with an income of $125,000 or more to receive GEP (odds ratio, 0.34; 95% CI, 0.16 to 0.73). A majority of women (57.7%) with HER2-positive disease received trastuzumab; among these women, differences in age and clinical characteristics were not apparent, although surprisingly, those in the lowest income category were more likely than those in the high-income category to receive trastuzumab (P = .02). Among women who did not have a positive HER2 test, 3.9% still received trastuzumab. Receipt of adjuvant chemotherapy increased as GEP score indicated greater risk of recurrence. Conclusion: Identifying and eliminating unnecessary variation in the use of these expensive tests and treatments should be part of quality improvement and efficiency programs. PMID:21886507

  20. [Polyetheretherketone (PEEK). Part II: application in clinical practice].

    Science.gov (United States)

    Pokorný, D; Fulín, P; Slouf, M; Jahoda, D; Landor, I; Sosna, A

    2010-01-01

    Polyetheretherketone (PEEK) is one of the up-to-date organic polymer thermoplastics with applications in orthopaedics and trauma medicine. This study presents a detailed analysis of its tests and applications in clinical medicine. A wide range of PEEK modifications and composites are commercially available, e.g., PEEK-Classix, PEEK-Optima, Endolign and Motis. They differ in their physical properties, which makes them suitable for different applications. Other forms, so-called PEEK bioactive composites, contain beta-tricalcium phosphate and hydroxyapatite. Research in this field is also concerned with the surface finish of this polymer thermoplastic and involves macroporous titanium and hydroxyapatite layers, or treatment with laser for an exactly defined surface structure. The clinical applications of PEEK and its composites include, in addition to components for spinal surgery, osteosynthesis plates, screws, intramedullary nails or external fixators, which are implants still at the stage of prototypes. In this review, attention is paid to the use of PEEK thermoplastics for joint replacement. Mid-term studies involving hundreds of patients have shown that, for instance, the VerSys Epoch Fullcoat Hip System (Zimmer) has a markedly lower stress-shielding effect. Carbon fibre-reinforced (CFR-PEEK) composites are used to make articulating components for total hip replacement. Their convenient properties allow for production of much thinner liners and an enlargement of the femoral head diameter, thus reducing the wear of joint implants. CFR-PEEK composites are particularly effective for hip resurfacing in which the Mitch PCR (Stryker) acetabular component has been used with good results. The MOTIS polymer acetabular cup (Invibio Ltd.) is another example. Further PEEK applications include the construction of finger-joint prostheses (Mathys AG), suture anchors (Stryker) and various kinds of augmentations (Medin). Based on the information obtained, the authors suggest

  1. Unsafe clinical practices as perceived by final year baccalaureate nursing students: Q methodology

    Directory of Open Access Journals (Sweden)

    Killam Laura A

    2012-11-01

    Full Text Available Abstract Background Nursing education necessitates vigilance for clinical safety, a daunting challenge given the complex interchanges between students, patients and educators. As active learners, students offer a subjective understanding concerning safety in the practice milieu that merits further study. This study describes the viewpoints of senior undergraduate nursing students about compromised safety in the clinical learning environment. Methods Q methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning from the perspective of senior students enrolled in a baccalaureate nursing program offered at multiple sites in Ontario, Canada. Across two program sites, 59 fourth year students sorted 43 theoretical statement cards, descriptive of unsafe clinical practice. Q-analysis identified similarities and differences among participant viewpoints yielding discrete and consensus perspectives. Results A total of six discrete viewpoints and two consensus perspectives were identified. The discrete viewpoints at one site were Endorsement of Uncritical Knowledge Transfer, Non-student Centered Program and Overt Patterns of Unsatisfactory Clinical Performance. In addition, a consensus perspective, labelled Contravening Practices was identified as responsible for compromised clinical safety at this site. At the other site, the discrete viewpoints were Premature and Inappropriate Clinical Progression, Non-patient Centered Practice and Negating Purposeful Interactions for Experiential Learning. There was consensus that Eroding Conventions compromised clinical safety from the perspective of students at this second site. Conclusions Senior nursing students perceive that deficits in knowledge, patient-centered practice, professional morality and authenticity threaten safety in the clinical learning environment. In an effort to eradicate compromised safety associated with learning in the clinical milieu, students and educators

  2. Unsafe clinical practices as perceived by final year baccalaureate nursing students: Q methodology

    Science.gov (United States)

    2012-01-01

    Background Nursing education necessitates vigilance for clinical safety, a daunting challenge given the complex interchanges between students, patients and educators. As active learners, students offer a subjective understanding concerning safety in the practice milieu that merits further study. This study describes the viewpoints of senior undergraduate nursing students about compromised safety in the clinical learning environment. Methods Q methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning from the perspective of senior students enrolled in a baccalaureate nursing program offered at multiple sites in Ontario, Canada. Across two program sites, 59 fourth year students sorted 43 theoretical statement cards, descriptive of unsafe clinical practice. Q-analysis identified similarities and differences among participant viewpoints yielding discrete and consensus perspectives. Results A total of six discrete viewpoints and two consensus perspectives were identified. The discrete viewpoints at one site were Endorsement of Uncritical Knowledge Transfer, Non-student Centered Program and Overt Patterns of Unsatisfactory Clinical Performance. In addition, a consensus perspective, labelled Contravening Practices was identified as responsible for compromised clinical safety at this site. At the other site, the discrete viewpoints were Premature and Inappropriate Clinical Progression, Non-patient Centered Practice and Negating Purposeful Interactions for Experiential Learning. There was consensus that Eroding Conventions compromised clinical safety from the perspective of students at this second site. Conclusions Senior nursing students perceive that deficits in knowledge, patient-centered practice, professional morality and authenticity threaten safety in the clinical learning environment. In an effort to eradicate compromised safety associated with learning in the clinical milieu, students and educators must embody the ontological

  3. Perioperative Nursing Leaders Implement Clinical Practice Guidelines Using the Iowa Model of Evidence-Based Practice.

    Science.gov (United States)

    White, Shawna; Spruce, Lisa

    2015-07-01

    Many health care organizations, nursing leaders, and individual clinicians are not providing care consistently based on evidence and many are not aware of the evidence that is available. Preventable complications have an adverse effect on hospital reimbursement and the burden is placed on hospital personnel and nursing leaders to use current evidence to improve care and prevent complications, such as surgical site infections. Using AORN resources, leadership involvement and ownership, and implementing a theoretical model will contribute to implementing daily evidence-based practice and help to decrease the chasm between research and practice. PMID:26119609

  4. Clinical education - place and part for becoming a practically trained radiographer

    International Nuclear Information System (INIS)

    Full text: The aim is to present the crucial role of clinical education for becoming a practically trained radiographer. It's been put on review and analysis the role of the clinic practice and pre-graduate practice into the education of the future specialist. It's presenting in detail every component of the program for study and the contribution of every module in it - image diagnostic, nuclear medicine and radiotherapy. the clinical education lasts six semesters in real working environment. The gradual increase of working hours creates conditions for higher educational quality. Students gradually master techniques, acquire skills and precision at working in an X-ray department, nuclear medicine units and radiotherapy, master communication techniques and acquire teamwork skills. the clinical education provides professional training, quick adaptation to realization and facilitates starting a job

  5. Teaching during clinical practice: strategies and techniques used by preceptors in nursing education.

    Science.gov (United States)

    Elisabeth, Carlson; Christine, Wann-Hansson; Ewa, Pilhammar

    2009-07-01

    The preceptor is a nurse who teaches and supports the student and is seen as pivotal to student learning within the clinical setting. Earlier studies have shown that preceptors' pedagogical competence is significant for facilitating learning during clinical practice. However, studies describing pedagogical competence, especially in terms of teaching strategies, seem to be scarce. The aim of this study was to describe which strategies and techniques preceptors use to teach undergraduate nursing students during clinical practice. The study had an ethnographic approach; methods used were participant observations and focus group interviews with nurses who were experienced in precepting undergraduate nursing students. Findings illustrated how preceptors used different strategies and techniques in a continuous process of adjusting, performing and evaluating precepting. Increased knowledge on how the preceptors actually teach student nurses during clinical practice will help facilitate educational programmes for preceptors, which will enhance their pedagogical skills and competences.

  6. Identifying and Promoting Best Practices in Residency Application and Selection in a Complex Academic Health Network.

    Science.gov (United States)

    Bandiera, Glen; Abrahams, Caroline; Ruetalo, Mariela; Hanson, Mark D; Nickell, Leslie; Spadafora, Salvatore

    2015-12-01

    Medical education institutions have a social mandate to produce a diverse physician workforce that meets the public's needs. Recent reports have framed the admission process outcome of undergraduate and postgraduate medical education (UGME and PGME) programs as a key determinant of the collective contributions graduating cohorts will make to society, creating a sense of urgency around the issue of who gets accepted. The need for evidence-informed residency application and selection processes is growing because of the increasing size and diversity of the applicant pool and the need for equity, fairness, social accountability, and health human resource planning. The selection literature, however, is dominated by a UGME focus and emphasizes determination of desirable qualities of future physicians and selection instrument reliability and validity. Gaps remain regarding PGME selection, particularly the creation of specialty-specific selection criteria, suitable outcome measures, and reliable selection systems.In this Perspective, the authors describe the University of Toronto's centralized approach to defining system-level best practices for residency application and selection. Over the 2012-2013 academic year, the Best Practices in Application and Selection working group reviewed relevant literature and reports, consulted content experts, surveyed local practices, and conducted iterative stakeholder consultations on draft recommendations. Strong agreement arose around the resulting 13 principles and 24 best practices, which had either empirical support or face validity. These recommendations, which are shared in this article, have been adopted by the university's PGME advisory committee and will inform a national initiative to improve trainees' transition from UGME to PGME in Canada.

  7. Data Mining in Supplier Selection: A Practical Application Using Microsoft SQL Server 2005

    OpenAIRE

    Sunarya, Rajasa Utama

    2008-01-01

    The practice of Data Mining is widely used in today's information age where data is abundant. Data Mining concepts are applied in many facets of everyday activities in business. The issue of supplier selection has become a crucial decision making problem in every company. Data Mining can become a very useful tool in giving decision makers an easier task when faced with supplier selection problem. This dissertation attempts to show as such by using a popular software package Microsoft SQL Serv...

  8. A Profile of Current Employee Training Practices in Selected Businesses and Industries in Southwest Virginia

    OpenAIRE

    Hundley, Katrina M.

    2003-01-01

    The purposes of this study were to (a) establish a profile of the current training practices of selected businesses and industries in Southwest Virginia; (b) identify the type of training methods these companies are choosing -- such as traditional classroom training or web-based training programs, and (c) identify how the training methods are selected. This profile established baseline data for current business and industry employee training programs. The population of this study include...

  9. Identifying and Promoting Best Practices in Residency Application and Selection in a Complex Academic Health Network.

    Science.gov (United States)

    Bandiera, Glen; Abrahams, Caroline; Ruetalo, Mariela; Hanson, Mark D; Nickell, Leslie; Spadafora, Salvatore

    2015-12-01

    Medical education institutions have a social mandate to produce a diverse physician workforce that meets the public's needs. Recent reports have framed the admission process outcome of undergraduate and postgraduate medical education (UGME and PGME) programs as a key determinant of the collective contributions graduating cohorts will make to society, creating a sense of urgency around the issue of who gets accepted. The need for evidence-informed residency application and selection processes is growing because of the increasing size and diversity of the applicant pool and the need for equity, fairness, social accountability, and health human resource planning. The selection literature, however, is dominated by a UGME focus and emphasizes determination of desirable qualities of future physicians and selection instrument reliability and validity. Gaps remain regarding PGME selection, particularly the creation of specialty-specific selection criteria, suitable outcome measures, and reliable selection systems.In this Perspective, the authors describe the University of Toronto's centralized approach to defining system-level best practices for residency application and selection. Over the 2012-2013 academic year, the Best Practices in Application and Selection working group reviewed relevant literature and reports, consulted content experts, surveyed local practices, and conducted iterative stakeholder consultations on draft recommendations. Strong agreement arose around the resulting 13 principles and 24 best practices, which had either empirical support or face validity. These recommendations, which are shared in this article, have been adopted by the university's PGME advisory committee and will inform a national initiative to improve trainees' transition from UGME to PGME in Canada. PMID:26488571

  10. Effects of Knowledge, Attitudes, and Practices of Primary Care Providers on Antibiotic Selection, United States

    OpenAIRE

    Sanchez, Guillermo V.; Roberts, Rebecca M.; Albert, Alison P.; Johnson, Darcia D.; Hicks, Lauri A.

    2014-01-01

    Appropriate selection of antibiotic drugs is critical to optimize treatment of infections and limit the spread of antibiotic resistance. To better inform public health efforts to improve prescribing of antibiotic drugs, we conducted in-depth interviews with 36 primary care providers in the United States (physicians, nurse practitioners, and physician assistants) to explore knowledge, attitudes, and self-reported practices regarding antibiotic drug resistance and antibiotic drug selection for ...

  11. From selection hits to clinical leads: progress in aptamer discovery

    OpenAIRE

    Maier, Keith E.; Levy, Matthew

    2016-01-01

    Aptamers were discovered more than 25 years ago, yet only one has been approved by the US Food and Drug Administration to date. With some noteworthy advances in their chemical design and the enzymes we use to make them, aptamers and aptamer-based therapeutics have seen a resurgence in interest. New aptamer drugs are being approved for clinical evaluation, and it is certain that we will see increasingly more aptamers and aptamer-like drugs in the future. In this review, we will discuss the pro...

  12. Clinical Practice Guideline of Acute Respiratory Distress Syndrome

    Science.gov (United States)

    Cho, Young-Jae; Moon, Jae Young; Shin, Ein-Soon; Kim, Je Hyeong; Jung, Hoon; Park, So Young; Kim, Ho Cheol; Sim, Yun Su; Rhee, Chin Kook; Lim, Jaemin; Lee, Seok Jeong; Lee, Won-Yeon; Lee, Hyun Jeong; Kwak, Sang Hyun; Kang, Eun Kyeong; Chung, Kyung Soo

    2016-01-01

    There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

  13. How well do final year undergraduate medical students master practical clinical skills?

    Directory of Open Access Journals (Sweden)

    Störmann, Sylvère

    2016-08-01

    Full Text Available Introduction: The clinical examination and other practical clinical skills are fundamental to guide diagnosis and therapy. The teaching of such practical skills has gained significance through legislative changes and adjustments of the curricula of medical schools in Germany. We sought to find out how well final year undergraduate medical students master practical clinical skills.Methods: We conducted a formative 4-station objective structured clinical examination (OSCE focused on practical clinical skills during the final year of undergraduate medical education. Participation was voluntary. Besides the examination of heart, lungs, abdomen, vascular system, lymphatic system as well as the neurological, endocrinological or orthopaedic examination we assessed other basic clinical skills (e.g. interpretation of an ECG, reading a chest X-ray. Participants filled-out a questionnaire prior to the exam, inter alia to give an estimate of their performance.Results: 214 final year students participated in our study and achieved a mean score of 72.8% of the total score obtainable. 9.3% of participants (n=20 scored insufficiently (<60%. We found no influence of sex, prior training in healthcare or place of study on performance. Only one third of the students correctly estimated their performance (35.3%, whereas 30.0% and 18.8% over-estimated their performance by 10% and 20% respectively.Discussion: Final year undergraduate medical students demonstrate considerable deficits performing practical clinical skills in the context of a formative assessment. Half of the students over-estimate their own performance. We recommend an institutionalised and frequent assessment of practical clinical skills during undergraduate medical education, especially in the final year.

  14. The questioned p value: clinical, practical and statistical significance.

    Science.gov (United States)

    Jiménez-Paneque, Rosa

    2016-01-01

    The use of p-value and statistical significance have been questioned since the early 80s in the last century until today. Much has been discussed about it in the field of statistics and its applications, especially in Epidemiology and Public Health. As a matter of fact, the p-value and its equivalent, statistical significance, are difficult concepts to grasp for the many health professionals some way involved in research applied to their work areas. However, its meaning should be clear in intuitive terms although it is based on theoretical concepts of the field of Statistics. This paper attempts to present the p-value as a concept that applies to everyday life and therefore intuitively simple but whose proper use cannot be separated from theoretical and methodological elements of inherent complexity. The reasons behind the criticism received by the p-value and its isolated use are intuitively explained, mainly the need to demarcate statistical significance from clinical significance and some of the recommended remedies for these problems are approached as well. It finally refers to the current trend to vindicate the p-value appealing to the convenience of its use in certain situations and the recent statement of the American Statistical Association in this regard. PMID:27636600

  15. [Three-dimensional cephalometry: applications in clinical practice and research].

    Science.gov (United States)

    Faure, Jacques; Oueiss, Arlette; Marchal-Sixou, Christine; Braga, José; Treil, Jacques

    2008-03-01

    A 3D cephalometric analysis method from scanner acquisition has been developed thanks to a long collaboration between Dr Treil and the Department of Orthodontics in Toulouse III University. It allows a perfect knowledge of maxillo-facial architecture using fourteen landmarks related to the neuromatricial axis of facial growth. These landmarks can be identified without ambiguity. The marking of each tooth relative to dental arches (gravity centre coordinates and torque and tipping of each tooth), and the location of arches relative to maxillo-facial frame are given by the analysis. Description and reconstruction of dental and maxillo-facial anatomy are possible with three levels: maxillo-facial frame, maxillar and mandibular bases and dentoalveolar level. The method not only gives more precise information than conventional cephalometrics in anteroposterior and vertical directions, but it allows transversal analysis and asymmetry measurement. Applications are numerous in research as well as in clinical medicine: analyses of cases border line surgery, surgical set-up, facial asymmetry, analysis of dentoalveolar compensations, definition of therapeutic aims, occlusal analysis and set-up, study of evolution in anthropology-primatology, study of growth etc. This method of description using a pattern of landmarks is perfectly adapted to the last developments of modern research techniques: morphometric geometry with Procustes superimpositions, EDMA, TPS, FEM. PMID:18364213

  16. [Calcium polycarbophil in clinical practice. The therapy of constipation].

    Science.gov (United States)

    Pallotta, N; Rubinetto, M P; Zaccaro, C; Gizzi, G; Villani, V; Barbara, L

    1993-12-01

    The clinical efficacy of polycarbophil calcium was assessed in 57 patients of both sexes aged between 18 and 77 years old affected by chronic non-organic constipation. The multicentre study was performed using a single blind and cross-over protocol for 8 weeks, 4 with placebo and 4 with the drug (2 c.p.s 3 t.i.d). Thirteen patients failed to complete the study, 8 of them for reasons not related to the drug. In comparison to placebo, the drug caused a significant reduction in the consistency of stool and evacuatory force during the first week of stool therapy. Medical judgement was that efficacy was "very good" in 73% and "good" in 18%, whereas the drug was thought to be "non efficacious" in 9% of cases. The statistical analysis of data confirmed the efficacy of the drug. The hematochemical parameters evaluated before, during and after treatment only showed a slight increase in calcemia and calciuria which did not reach statistical significance. The therapeutic efficacy and lack of undesired effects confirm the value of polycarbophyl calcium in the treatment of chronic constipation.

  17. Venous thromboembolism and occult cancer: impact on clinical practice.

    Science.gov (United States)

    Gheshmy, Afshan; Carrier, Marc

    2016-04-01

    Unprovoked venous thromboembolism (VTE) can be the first manifestation of cancer. Given this relationship between unprovoked VTE and cancer, it is appealing for clinicians to screen their patients with a first episode of acute unprovoked VTE for a potential occult malignancy. Five different studies have compared a limited (thorough history and physical exam, basic bloodwork) to a more extensive occult cancer screening strategy (e.g. computed tomography, fludeoxyglucose positron emission tomography, etc.). Most of these studies have failed to show that an extensive occult cancer screening strategy diagnoses more occult cancer (including early cancers), misses fewer cancers during follow-up or improves overall and/or cancer-related mortality suggesting that extensive occult cancer screening should not be performed routinely. Therefore, patients with a first unprovoked VTE should undergo a limited cancer screening only and clinicians should ensure that their patients are up to date regarding age- and gender- specific cancer screening (colon, breast, cervix and prostate) as per their national recommendations. Current evidence does not support a net clinical benefit to perform an extensive occult cancer screening on all patients, and a decision to do additional testing should be made on a case by case basis.

  18. Rheumatoid Arthritis: The Stride from Research to Clinical Practice

    Directory of Open Access Journals (Sweden)

    Ill-Min Chung

    2016-06-01

    Full Text Available Over 70 different genetic variants with a significant association with rheumatoid arthritis (RA have been discovered. Anti-citrullination protein antibodies (ACPA-positive RA variants are more well-defined than their ACPA-negative counterparts. The human leukocyte antigen, HLA-DRB1 locus remains the prime suspect in anti-citrullination protein antibodies (ACPA—positive RA. Different HLA-DRB1 alleles are linked to RA susceptibility across different ethnicities. With evolving techniques, like genome-wide association studies (GWAS and single nucleotide polymorphism (SNP arrays, more non-HLA susceptibility loci have been identified for both types of RA. However, the functional significance of only a handful of these variants is known. Their roles include increasing susceptibility to RA or in determining the speed at which the disease progresses. Additionally, a couple of variations are associated with protection from RA. Defining such clear-cut biological functions can aid in the clinical diagnosis and treatment of RA. Recent research has focused on the implication of microRNAs, with miR-146a widely studied. In addition to disease susceptibility, genetic variations that influence the efficacy and toxicity of anti-RA agents have also been identified. Polymorphisms in the MTHFR gene influence the effectiveness of methotrexate, the first line of therapy in RA. Larger studies are, however, needed to identify potential biomarkers for early disease identification and monitoring disease progression.

  19. [Ethics in clinical practice and in health care].

    Science.gov (United States)

    Pintor, S; Mennuni, G; Fontana, M; Nocchi, S; Giarrusso, P; Serio, A; Fraioli, A

    2015-01-01

    The clinical ethics is the identification, analysis and solution of moral problems that can arise during the care of a patient. Given that when dealing with ethical issues in health care some risks will be encountered (talking about ethics in general, or as a problem overlapped with others in this area, or by delegation to legislative determinations) in the text certain important aspects of the topic are examined. First of all ethics as human quality of the relationship between people for the common good, especially in health services where there are serious problems like the life and the health. It is also necessary a "humanizing relationship" between those who work in these services in order to achieve quality and efficiency in this business. It is important a proper training of health professionals, especially doctors, so that they can identify the real needs and means of intervention. It is also important that scientific research must respect fundamental ethical assumptions. In conclusion, ethics in health care is not a simple matter of "cookbook" rules, but involves the responsibility and consciousness of individual operators.

  20. Pain and ketoprofen: what is its role in clinical practice?

    Science.gov (United States)

    Sarzi-Puttini, P; Atzeni, F; Lanata, L; Bagnasco, M; Colombo, M; Fischer, F; D'Imporzano, M

    2010-01-01

    Ketoprofen is a drug belonging to the family of non-steroidal anti-inflammatory drugs (NSAIDs). The present review examines the main available clinical evidence of ketoprofen in the treatment of acute and chronic pain, of both rheumatic and traumatic origin, as well as postoperative pain. Ketoprofen has shown to be an excellent choice of drug for the treatment of chronic pain in patients with osteoarthritis, rheumatoid arthritis or gout, demonstrating a high level of efficacy with good tolerability also in elderly patients. Even in the treatment of acute forms of pain such as bursitis, tendinitis and back pain, ketoprofen compares favourably to other NSAIDs (e.g., ibuprofen and diclofenac) in terms of efficacy. Ketoprofen has been shown to be effective also for the treatment of post-operative pain, particularly in the orthopaedic field, with an efficacy similar to opioids in some studies. In this setting, some evidence indicates that ketoprofen exhibits additional important benefits, showing to be effective in the prophylaxis of heterotopic calcification following hip or pelvic major intervention, without affecting the bone healing process. Moreover, the use of ketoprofen in elastomeric pump in combination with opioids or other NSAIDs has proven to be effective and safe. In conclusion, available data confirm that ketoprofen is effective and well tolerated, through different administration routes, for the treatment of various forms of rheumatic, traumatic and post-surgical pain, and may therefore be considered as a valid therapeutic option for these patients. PMID:21052564