Sample records for clinical research practice

  1. On research in clinical practice

    Directory of Open Access Journals (Sweden)

    Arun Nanivadekar


    Full Text Available Clinical research implies advancing current knowledge about health care by continually developing and testing new ideas about diseases, products, procedures, and strategies. Although this trait is inherent in human nature, it needs to be encouraged, nurtured, groomed, and channelized by creating a suitable atmosphere for it, providing the necessary resources, inculcating the necessary conceptual and manual skills, and rewarding the efforts and achievements suitably. Language, logic, statistics, and psychology play an important role in acquiring and developing research capability. To be socially relevant and economically viable, clinical research will need to partner with patients and their doctors in identifying what their goals of health care are, what they value, and what they are willing to "buy" in terms of goods and services. Besides, clinical research will need to bring on one platform the sponsors, the researchers, the patients, the payers, and the regulators to ensure that they do not work at cross purposes, that the cost of developing health care measures is scaled down through innovative approaches such as large simple trials, sequential trials, early marketing conditional on post-marketing surveillance, and so on. All these will be possible if day-to-day practice is slowly and systemically transformed into the largest laboratory of clinical research, which it ought to be, by forming networks of research-oriented practices, and popularizing the use of data collection and analysis tools such as Epi Info which are in the public domain.

  2. Research and clinical practice relationship

    Directory of Open Access Journals (Sweden)

    Ashammakhi N


    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.

  3. Heart Failure: From Research to Clinical Practice. (United States)

    Islam, Md Shahidul


    "Heart failure: from research to clinical practice", a collection of selected reviews, which comes out also as a book, covers essentially all important aspects of heart failure, including the pathogenesis, clinical features, biomarkers, imaging techniques, medical treatment and surgical treatments, use of pacemakers and implantable cardioverter defibrillators, and palliative care. The reviews include essential background information, state of the art, critical and in-depth analysis, and directions for future researches for elucidation of the unresolved issues. Everyone interested in heart failure is expected to find this compilation helpful for a deeper understanding of some of the complex issues.

  4. Cancer vaccines: from research to clinical practice

    National Research Council Canada - National Science Library

    Bot, Adrian; Obrocea, Mihail; Marincola, Francesco M


    ..., for both solid and blood borne cancers. Cancer Vaccines: Challenges and Opportunities in Translation is the first text in the field to bring immunotherapy treatments from the laboratory trial to the bedside for the practicing oncologist. Cancer Vaccines...

  5. Conducting research in clinical psychology practice: Barriers, facilitators, and recommendations. (United States)

    Smith, Kirsten V; Thew, Graham R


    The combination of clinical psychologists' therapeutic expertise and research training means that they are in an ideal position to be conducting high-quality research projects. However, despite these skills and the documented benefits of research to services and service users, research activity in practice remains low. This article aims to give an overview of the advantages of, and difficulties in conducting research in clinical practice. We reviewed the relevant literature on barriers to research and reflected on our clinical and research experiences in a range of contexts to offer practical recommendations. We considered factors involved in the planning, sourcing support, implementation, and dissemination phases of research, and outline suggestions to improve the feasibility of research projects in post-qualification roles. We suggest that research leadership is particularly important within clinical psychology to ensure the profession's continued visibility and influence within health settings. Clinical implications Emerging evidence suggests that clinical settings that foster research are associated with better patient outcomes. Suggestions to increase the feasibility of research projects in clinical settings are detailed. Limitations The present recommendations are drawn from the authors' practical experience and may need adaptation to individual practitioners' settings. This study does not attempt to assess the efficacy of the strategies suggested. © 2017 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

  6. Investigators' perspectives on translating human microbiome research into clinical practice. (United States)

    Slashinski, M J; Whitney, S N; Achenbaum, L S; Keitel, W A; McCurdy, S A; McGuire, A L


    Human microbiome research has the potential to transform the practice of medicine, fundamentally shifting the ways in which we think not only about human health, illness and disease, but also about clinical practice and public health interventions. Drawing from a larger qualitative study on ethical, legal and social dimensions of human microbiome research, in this article, we document perspectives related to the translation of human microbiome research into clinical practice, focusing particularly on implications for health, illness and disease. We conducted 60 in-depth, semi-structured interviews (2009-2010) with 63 researchers and National Institutes of Health project leaders ('investigators') involved with human microbiome research. The interviews explored a range of ethical, legal and social implications of human microbiome research, including investigators' perspectives on potential strategies for translating findings to clinical practice. Using thematic content analysis, we identified and analyzed emergent themes and patterns. We identified 3 themes: (1) investigators' general perspectives on the clinical utility of human microbiome research, (2) investigators' perspectives on antibiotic use, overuse and misuse, and (3) investigators' perspectives concerning future challenges of translating data to clinical practice. The issues discussed by investigators concerning the clinical significance of human microbiome research, including embracing a new paradigm of health and disease, the importance of microbial communities, and clinical utility, will be of critical importance as this research moves forward. Copyright © 2013 S. Karger AG, Basel.

  7. Investigators’ Perspectives on Translating Human Microbiome Research into Clinical Practice (United States)

    Slashinski, Melody J.; Whitney, Simon N.; Achenbaum, Laura S.; Keitel, Wendy A.; McCurdy, Sheryl A.; McGuire, Amy L.


    Background Human microbiome research has the potential to transform the practice of medicine, fundamentally shifting the ways in which we think not only about human health, illness, and disease, but also about clinical practice and public health interventions. Drawing from a larger qualitative study on ethical, legal, and social dimensions of human microbiome research, in this article we document perspectives related to the translation of human microbiome research into clinical practice, focusing particularly on implications for health, illness, and disease. Methods We conducted 60 in-depth, semi-structured interviews (2009–2010) with 63 researchers and National Institutes of Health project leaders (“investigators”) involved with human microbiome research. Interviews explored a range of ethical, legal, and social implications of human microbiome research, including investigators’ perspectives on potential strategies for translating findings to clinical practice. Using thematic content analysis, we identified and analyzed emergent themes and patterns. Results We identified three themes: (1) Investigators’ general perspectives on the clinical utility of human microbiome research, (2) Investigators’ perspectives on antibiotic use, overuse, and misuse, and (3) Investigators’ perspectives concerning future challenges of translating data to clinical practice. Conclusion The issues discussed by investigators concerning the clinical significance of human microbiome research, including embracing a new paradigm of health and disease, the importance of microbial communities, and clinical utility, will be of critical importance as this research moves forward. PMID:23615375

  8. Binge eating disorder: from clinical research to clinical practice. (United States)

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


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

  9. Guidelines on good clinical laboratory practice: bridging operations between research and clinical research laboratories. (United States)

    Ezzelle, J; Rodriguez-Chavez, I R; Darden, J M; Stirewalt, M; Kunwar, N; Hitchcock, R; Walter, T; D'Souza, M P


    A set of Good Clinical Laboratory Practice (GCLP) standards that embraces both the research and clinical aspects of GLP were developed utilizing a variety of collected regulatory and guidance material. We describe eleven core elements that constitute the GCLP standards with the objective of filling a gap for laboratory guidance, based on IND sponsor requirements, for conducting laboratory testing using specimens from human clinical trials. These GCLP standards provide guidance on implementing GLP requirements that are critical for laboratory operations, such as performance of protocol-mandated safety assays, peripheral blood mononuclear cell processing and immunological or endpoint assays from biological interventions on IND-registered clinical trials. The expectation is that compliance with the GCLP standards, monitored annually by external audits, will allow research and development laboratories to maintain data integrity and to provide immunogenicity, safety, and product efficacy data that is repeatable, reliable, auditable and that can be easily reconstructed in a research setting.

  10. Core outcome sets for research and clinical practice

    NARCIS (Netherlands)

    Chiarotto, Alessandro; Ostelo, Raymond W.; Turk, Dennis C.; Buchbinder, Rachelle; Boers, Maarten


    Background This masterclass introduces the topic of core outcome sets, describing rationale and methods for developing them, and providing some examples that are relevant for clinical research and practice. Method A core outcome set is a minimum consensus-based set of outcomes that should be

  11. 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


    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...

  12. Alternative medicine research in clinical practice: a US national survey. (United States)

    Tilburt, Jon C; Curlin, Farr A; Kaptchuk, Ted J; Clarridge, Brian; Bolcic-Jankovic, Dragana; Emanuel, Ezekiel J; Miller, Franklin G


    Little is known about whether federally funded complementary and alternative medicine (CAM) research is translating into clinical practice. We sought to describe the awareness of CAM clinical trials, the ability to interpret research results, the acceptance of research evidence, and the predictors of trial awareness among US clinicians. We conducted a cross-sectional mailed survey of 2400 practicing US acupuncturists, naturopaths, internists, and rheumatologists. A total of 1561 clinicians (65%) responded. Of the respondents, 59% were aware of at least 1 major CAM clinical trial; only 23% were aware of both trials. A minority of acupuncturists (20%), naturopaths (25%), internists (17%), and rheumatologists (33%) were "very confident" in interpreting research results (P research experience (OR, 1.45 [95% CI, 1.13-1.86]), institutional or academic practice setting (ORs, 1.98 [95% CI, 1.01-3.91], and 1.23 [95% CI, 0.73-2.09], respectively), and rating randomized trials as "very useful" (OR, 1.46 [95% CI, 1.12-1.91]) (P clinical decision making were positively associated with CAM trial awareness. Acupuncturists, naturopaths, and internists (ORs, 0.15 [95% CI, 0.10-0.23], 0.15 [95% CI, 0.09-0.24], and 0.18 [95% CI, 0.12-0.28], respectively) were all similarly less aware of CAM trial results compared with rheumatologists. For clinical research in CAM to achieve its social value, concerted efforts must be undertaken to train clinicians and improve the dissemination of research results.

  13. Closing the Gap between Research Evidence and Clinical Practice: Jordanian Nurses' Perceived Barriers to Research Utilisation (United States)

    Al Khalaileh, Murad; Al Qadire, Mohammad; Musa, Ahmad S.; Al-Khawaldeh, Omar A.; Al Qudah, Hani; Alhabahbeh, Atalla


    Background: The nursing profession is a combination of theory and practical skill, and nurses are required to generate and develop knowledge through implementing research into clinical practice. Considerable number of barriers could hind implementing research findings into practice. Barriers to research utilisation are not identified in the…

  14. Digital pathology in nephrology clinical trials, research, and pathology practice. (United States)

    Barisoni, Laura; Hodgin, Jeffrey B


    In this review, we will discuss (i) how the recent advancements in digital technology and computational engineering are currently applied to nephropathology in the setting of clinical research, trials, and practice; (ii) the benefits of the new digital environment; (iii) how recognizing its challenges provides opportunities for transformation; and (iv) nephropathology in the upcoming era of kidney precision and predictive medicine. Recent studies highlighted how new standardized protocols facilitate the harmonization of digital pathology database infrastructure and morphologic, morphometric, and computer-aided quantitative analyses. Digital pathology enables robust protocols for clinical trials and research, with the potential to identify previously underused or unrecognized clinically useful parameters. The integration of digital pathology with molecular signatures is leading the way to establishing clinically relevant morpho-omic taxonomies of renal diseases. The introduction of digital pathology in clinical research and trials, and the progressive implementation of the modern software ecosystem, opens opportunities for the development of new predictive diagnostic paradigms and computer-aided algorithms, transforming the practice of renal disease into a modern computational science.

  15. The Brave New World of clinical cancer research: Adaptive biomarker-driven trials integrating clinical practice with clinical research. (United States)

    Berry, Donald A


    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. Copyright © 2015 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

  16. A practical approach to clinical and research biobanking. (United States)

    Yong, William H; Dry, Sarah M; Shabihkhani, Maryam


    Powerful technologies critical to personalized medicine and targeted therapeutics require the analysis of carefully validated, procured, stored, and managed biospecimens. Reflecting advancements in biospecimen science, the National Cancer Institute and the International Society for Biological and Environmental Repositories are periodically publishing best practices that can guide the biobanker. The modern biobank will operate more like a clinical laboratory with formal accreditation, standard operating procedures, and quality assurance protocols. This chapter highlights practical issues of consent, procurement, storage, quality assurance, disbursement, funding, and space. Common topics of concern are discussed including the differences between clinical and research biospecimens, stabilization of biospecimens during procurement, optimal storage temperatures, and technical validation of biospecimen content and quality. With quickly expanding biospecimen needs and limited healthcare budgets, biobanks may need to be selective as to what is stored. Furthermore, a shift to room-temperature storage modalities where possible can reduce long-term space and fiscal requirements.

  17. Integrative Mental Health (IMH): paradigm, research, and clinical practice. (United States)

    Lake, James; Helgason, Chanel; Sarris, Jerome


    This paper provides an overview of the rapidly evolving paradigm of "Integrative Mental Health (IMH)." The paradigm of contemporary biomedical psychiatry and its contrast to non-allopathic systems of medicine is initially reviewed, followed by an exploration of the emerging paradigm of IMH, which aims to reconcile the bio-psycho-socio-spiritual model with evidence-based methods from traditional healing practices. IMH is rapidly transforming conventional understandings of mental illness and has significant positive implications for the day-to-day practice of mental health care. IMH incorporates mainstream interventions such as pharmacologic treatments, psychotherapy, and psychosocial interventions, as well as alternative therapies such as acupuncture, herbal and nutritional medicine, dietary modification, meditation, etc. Two recent international conferences in Europe and the United States show that interest in integrative mental health care is growing rapidly. In response, the International Network of Integrative Mental Health (INIMH: was established in 2010 with the objective of creating an international network of clinicians, researchers, and public health advocates to advance a global agenda for research, education, and clinical practice of evidence-based integrative mental health care. The paper concludes with a discussion of emerging opportunities for research in IMH, and an exploration of potential clinical applications of integrative mental health care. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Data Resource Profile: Clinical Practice Research Datalink (CPRD) (United States)

    Herrett, Emily; Gallagher, Arlene M; Bhaskaran, Krishnan; Forbes, Harriet; Mathur, Rohini; van Staa, Tjeerd; Smeeth, Liam


    The Clinical Practice Research Datalink (CPRD) is an ongoing primary care database of anonymised medical records from general practitioners, with coverage of over 11.3 million patients from 674 practices in the UK. With 4.4 million active (alive, currently registered) patients meeting quality criteria, approximately 6.9% of the UK population are included and patients are broadly representative of the UK general population in terms of age, sex and ethnicity. General practitioners are the gatekeepers of primary care and specialist referrals in the UK. The CPRD primary care database is therefore a rich source of health data for research, including data on demographics, symptoms, tests, diagnoses, therapies, health-related behaviours and referrals to secondary care. For over half of patients, linkage with datasets from secondary care, disease-specific cohorts and mortality records enhance the range of data available for research. The CPRD is very widely used internationally for epidemiological research and has been used to produce over 1000 research studies, published in peer-reviewed journals across a broad range of health outcomes. However, researchers must be aware of the complexity of routinely collected electronic health records, including ways to manage variable completeness, misclassification and development of disease definitions for research. PMID:26050254

  19. The DSM and Professional Practice: Research, Clinical, and Institutional Perspectives. (United States)

    Halpin, Michael


    How mental illnesses are defined has significant ramifications, given the substantial social and individual repercussions of these conditions. Using actor-network theory, I analyze how mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) in their work. Drawing on observations of a neuropsychological laboratory and interviews with 27 professionals (i.e., psychiatrists, psychologists), I investigate how the DSM is used in research, clinical, and institutional work. In research, the DSM influences study design and exclusion/inclusion criteria. In the clinic, the DSM influences how disorders are conceptualized and diagnosed. Institutionally, the DSM aligns the patient-professional encounter to insurance and pharmaceutical interests. I conclude that the DSM operates as multiple, context-specific taxonomies that pervasively influence professional practices, such that all possible actions must orient to DSM criteria, with professionals both a source and an object of institutionalized gaze. © American Sociological Association 2016.

  20. Valuing both critical and creative thinking in clinical practice: narrowing the research-practice gap? (United States)

    Seymour, Beth; Kinn, Sue; Sutherland, Norrie


    Nurturing critical thinking skills in the classroom is considered an important educational activity. It is believed that critical thinking skills are transferable and that they can be applied in practice when appraising, evaluating and implementing research. That more nurses than ever before have been judged academically knowledgeable in research has not guaranteed the transfer of such knowledge to practice. This paper discusses some of the reasons for the failure to narrow the gap between research and practice. In particular we argue that, if nurses are encouraged to develop creative and generative thinking alongside their critical thinking skills, then the art of nursing will have fuller representation in education, research and practice. The successful development of critical thinking skills for academic purposes does not necessarily mean that these skills are used in practice in relation either to research or clinical decision-making. This suggests that the transferability of critical thinking skills is less than straightforward. Indeed, there has been little narrowing of the research-practice gap since students started to learn critical thinking for academic purposes. However, we propose that thinking skills can be encouraged in the context of practice and that regular educational events, such as journal clubs, can contribute to developing critical thinking in the practice environment. The research-practice gap will reduce only if research becomes part of practitioners' ideology, which includes the art and science of nursing. Critical and creative thinking are prerequisites to narrowing the disjuncture between research and practice, and we suggest that educators and practitioners explore structured ways of meeting together to appraise literature as a possible means of making use of their thinking and knowledge in clinical practice.

  1. RESEARCH Voluntary informed consent and good clinical practice ...

    African Journals Online (AJOL)

    Voluntary informed consent for participation in clinical research is the cornerstone of health research ethics and a requirement for clinical research in South Africa. The South African-specific guidance documents concerning voluntary informed consent provisions differ and sometimes contradict international documents.

  2. Pharmacokinetic studies of neuromuscular blocking agents: Good Clinical Research Practice (GCRP)

    DEFF Research Database (Denmark)

    Viby-Mogensen, J.; Østergaard, D.; Donati, F.


    Good Clinical Research Practice (GCRP), neuromuscular blocking agents, pharmacokinetics, pharmacokinetic/pharmacodynamic modeling, population pharmacokinetics, statistics, study design......Good Clinical Research Practice (GCRP), neuromuscular blocking agents, pharmacokinetics, pharmacokinetic/pharmacodynamic modeling, population pharmacokinetics, statistics, study design...

  3. Ancillary Care: From Theory to Practice in International Clinical Research (United States)

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


    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

  4. How to estimate the health benefits of additional research and changing clinical practice

    NARCIS (Netherlands)

    Claxton, Karl; Griffin, Susan; Koffijberg, Hendrik; McKenna, Claire


    A simple extension of standard metaanalysis can provide quantitative estimates of the potential health benefits of further research and of implementing the findings of existing research, which can help inform research prioritisation and efforts to change clinical practice

  5. Clinical nurse research consultant: a clinical and academic role to advance practice and the discipline of nursing. (United States)

    Currey, Judy; Considine, Julie; Khaw, Damien


    This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role. Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians. International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant. The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus. Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support. The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  6. Evidence-based therapy relationships: research conclusions and clinical practices. (United States)

    Norcross, John C; Wampold, Bruce E


    In this closing article of the special issue, we present the conclusions and recommendations of the interdivisional task force on evidence-based therapy relationships. The work was based on a series of meta-analyses conducted on the effectiveness of various relationship elements and methods of treatment adaptation. A panel of experts concluded that several relationship elements were demonstrably effective (alliance in individual psychotherapy, alliance in youth psychotherapy, alliance in family therapy, cohesion in group therapy, empathy, collecting client feedback) while others were probably effective (goal consensus, collaboration, positive regard). Three other relationship elements (congruence/genuineness, repairing alliance ruptures, and managing countertransference) were deemed promising but had insufficient evidence to conclude that they were effective. Multiple recommendations for practice, training, research, and policy are advanced. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

  7. How to Develop an Electronic Clinical Endometriosis Research File Integrated in Clinical Practice. (United States)

    Vanhie, A; Fassbender, A; O, D; Tomassetti, C; Meuleman, C; Peeraer, K; Debrock, S; D'Hooghe, Th


    Endometriosis is associated with a range of pelvic-abdominal pain symptoms and infertility. It is a chronic disease that can have a significant impact on various aspects of women's lives, including their social and sexual relationships, work, and study. Despite several international guidelines on the management of endometriosis, there is a wide variety of clinical practice in the management of endometriosis, resulting in many women receiving delayed or suboptimal care. In this paper we discuss the possibilities and benefits of using electronic health records for clinical research in the field of endometriosis. The development of a wide range of clinical software for electronic patient records has made the registration of large datasets feasible and the integration of research files and clinical files possible. Integration of global standards on registration of endometriosis care in electronic health records could improve reporting of research data and facilitate the execution of large, multicentre randomized trials on the management of endometriosis. These highly needed trials could bring us the evidence needed for the optimisation of management of women with endometriosis.

  8. How to Develop an Electronic Clinical Endometriosis Research File Integrated in Clinical Practice

    Directory of Open Access Journals (Sweden)

    A. Vanhie


    Full Text Available Endometriosis is associated with a range of pelvic-abdominal pain symptoms and infertility. It is a chronic disease that can have a significant impact on various aspects of women’s lives, including their social and sexual relationships, work, and study. Despite several international guidelines on the management of endometriosis, there is a wide variety of clinical practice in the management of endometriosis, resulting in many women receiving delayed or suboptimal care. In this paper we discuss the possibilities and benefits of using electronic health records for clinical research in the field of endometriosis. The development of a wide range of clinical software for electronic patient records has made the registration of large datasets feasible and the integration of research files and clinical files possible. Integration of global standards on registration of endometriosis care in electronic health records could improve reporting of research data and facilitate the execution of large, multicentre randomized trials on the management of endometriosis. These highly needed trials could bring us the evidence needed for the optimisation of management of women with endometriosis.

  9. [Three-dimensional cephalometry: applications in clinical practice and research]. (United States)

    Faure, Jacques; Oueiss, Arlette; Marchal-Sixou, Christine; Braga, José; Treil, Jacques


    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.

  10. Clinical Practice

    DEFF Research Database (Denmark)

    Contarino, Maria Fiorella; Van Den Dool, Joost; Balash, Yacov


    issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were...... explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment...

  11. Typologies of Cohabitation: Implications for Clinical Practice and Research (United States)

    Gold, Joshua M.


    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…

  12. 'Nursing research culture' in the context of clinical nursing practice

    DEFF Research Database (Denmark)

    Bøttcher Berthelsen, Connie; Hølge-Hazelton, Bibi


    for efficiency, nurses’ barriers to research use and the lack of definition of the concept of nursing research culture make it difficult to establish. Design Concept analysis. Data sources Data were collected through a literature review in PubMed, CINAHL and PsycINFO during March 2016. Methods Walker and Avant...

  13. Clinical and Research Perspectives on Nonspeech Oral Motor Treatments and Evidence-Based Practice (United States)

    Muttiah, Nimisha; Georges, Katie; Brackenbury, Tim


    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…

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

    Directory of Open Access Journals (Sweden)

    Marilyn Svejda


    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.

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

    DEFF Research Database (Denmark)

    Smed, Marie; Getz, Kenneth A.


    Investigative sites participating in clinical trials play an instrumental role in aiding market adoption. Site experiences in clinical research help physician investigators and research professionals gain familiarity with and exposure to investigational treatments. This knowledge may be passed...... 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...

  16. Implications of the concept of minimal risk in research on informed choice in clinical practice. (United States)

    Wada, Kyoko; Nisker, Jeff


    The concept of a minimal risk threshold in research, beneath which exception to informed consent and ethics review processes may occur, has been codified for over 30 years in many national research regulations and by the Council for International Organizations of Medical Sciences. Although minimal risk in research constitutes one of the criteria for allowing waiver of informed consent or modification to the consent process and a large body of literature exists, discussion of a minimal risk threshold in clinical practice has not occurred. One reason for lack of discussion may be that implicit consent is accepted for a wide range of routine clinical practices. Extending the role of minimal risk in research to clinical practice might assist clinicians in identifying circumstances for which implicit consent is indeed sufficient and circumstances in which it is not. Further, concepts from minimal risk in research might assist clinicians regarding when information provision in health promotion is required. We begin by reviewing concepts in both minimal risk in research and informed choice in clinical practice. We then explore how a clinical minimal risk concept may clarify recommendations for information provision in clinical practice and support the patient's informed choice regarding therapeutic and diagnostic procedures and also health promotion. Given that clinical practice involves a broad scope of health information, professional practice guidelines on information provision based on the application of the minimal risk threshold in research could be developed to guide clinicians in what information must be provided to their patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  17. Bristol scale stool form. A still valid help in medical practice and clinical research. (United States)

    Riegler, G; Esposito, I


    The collection of clinical data concerning bowel habit is always empirical. A more extended use of visual descriptive stool form scales could contribute to a clearer and more standardized reporting of data about bowel function. This could be helpful for both clinical practice and research purposes.

  18. Integrating Research Into Clinical Internship Training Bridging the Science/Practice Gap in Pediatric Psychology (United States)

    Spirito, Anthony


    Existing literature highlights a critical gap between science and practice in clinical psychology. The internship year is a “capstone experience”; training in methods of scientific evaluation should be integrated with the development of advanced clinical competencies. We provide a rationale for continued exposure to research during the clinical internship year, including, (a) critical examination and integration of the literature regarding evidence-based treatment and assessment, (b) participation in faculty-based and independent research, and (c) orientation to the science and strategy of grantsmanship. Participation in research provides exposure to new empirical models and can foster the development of applied research questions. Orientation to grantsmanship can yield an initial sense of the “business of science.” Internship provides an important opportunity to examine the challenges to integrating the clinical evidence base into professional practice; for that reason, providing research exposure on internship is an important strategy in training the next generation of pediatric psychologists. PMID:22286345

  19. Action research as a method for changing patient education practice in a clinical diabetes setting

    DEFF Research Database (Denmark)

    Voigt, Jane Rohde; Hansen, Ulla M.; Glindorf, Mette


    Action research is potentially a useful method for changing clinical practice by involving practitioners in the process of change. The aim of this study was to explore the utility of action research in bridging the gap between research and practice. Diabetes educators in collaboration...... with researchers developed and implemented a participatory, group-based diabetes education program in a diabetes clinic in the Danish health care system. The research process included a variety of qualitative methods: workshops, classroom observations, video recordings and semi-structured interviews. These methods...... aimed at obtaining contextual sensitivity, allowing dynamic interactions with educators and people with diabetes. Despite challenges, the study demonstrates how action research methods contribute to development and change of diabetes education practice while simultaneously adding knowledge to the action...

  20. 'Nursing research culture' in the context of clinical nursing practice: addressing a conceptual problem. (United States)

    Berthelsen, Connie Bøttcher; Hølge-Hazelton, Bibi


    To report an analysis of the concept of nursing research culture in the context of clinical nursing practice. Nursing research culture should be valued for its contribution to improving patient care and should be considered as a routine hospital activity. However, the demand for efficiency, nurses' barriers to research use and the lack of definition of the concept of nursing research culture make it difficult to establish. Concept analysis. Data were collected through a literature review in PubMed, CINAHL and PsycINFO during March 2016. Walker and Avant's eight-step framework for concept analysis. Five defining attributes of nursing research culture in the context of clinical nursing practice were identified: strong monodisciplinary nursing professionalism, academic thinking and socialization, research use as a part of daily nursing practice, acceptance by colleagues and management and facilitation of resources from management and organization. Although the method of concept analysis has been criticized and heavily debated, the development of nursing research cultures based on the defining attributes and antecedents of the concept will be important to emphasize evidence-based clinical nursing care. Further research should support the development and the implementation of nursing research culture in clinical nursing practice. © 2016 John Wiley & Sons Ltd.

  1. 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

    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

  2. Overcoming practical challenges to conducting clinical research in the inpatient stroke rehabilitation setting. (United States)

    Campbell, Grace B; Skidmore, Elizabeth R; Whyte, Ellen M; Matthews, Judith T


    There is a shortage of published empirical studies conducted in acute inpatient stroke rehabilitation, though such studies are greatly needed in order to shed light on the most efficacious inpatient stroke rehabilitation interventions. The inherent challenges of inpatient research may dissuade researchers from undertaking this important work. This paper describes our institution's experience devising practical solutions to research barriers in this setting. Through concentrated efforts to overcome research barriers, such as by cultivating collaborative relationships and capitalizing on unanticipated benefits, we successfully facilitated conduct of five simultaneous inpatient stroke studies. Tangible benefits realized include increased effectiveness of research participant identification and enrollment, novel collaborative projects, innovative clinical care initiatives, and enhanced emotional and practical support for patients and their families. We provide recommendations based on lessons learned during our experience, and discuss benefits of this collaboration for our research participants, clinical staff, and the research team.

  3. Revisioning Clinical Psychology: Integrating Cultural Psychology into Clinical Research and Practice with Portuguese Immigrants


    James, Susan; Harris, Sara; Foster, Gary; Clarke, Juanne; Gadermann, Anne; Morrison, Marie; Bezanson, Birdie Jane


    This article outlines a model for conducting psychotherapy with people of diverse cultural backgrounds. The theoretical foundation for the model is based on clinical and cultural psychology. Cultural psychology integrates psychology and anthropology in order to provide a complex understanding of both culture and the individual within his or her cultural context. The model proposed in this article is also based on our clinical experience and mixed method research with the Portuguese communi...

  4. How to write a surgical clinical research protocol: literature review and practical guide. (United States)

    Rosenthal, Rachel; Schäfer, Juliane; Briel, Matthias; Bucher, Heiner C; Oertli, Daniel; Dell-Kuster, Salome


    The study protocol is the core document of every clinical research project. Clinical research in studies involving surgical interventions presents some specific challenges, which need to be accounted for and described in the study protocol. The aim of this review is to provide a practical guide for developing a clinical study protocol for surgical interventions with a focus on methodologic issues. On the basis of an in-depth literature search of methodologic literature and on some cardinal published surgical trials and observational studies, the authors provides a 10-step guide for developing a clinical study protocol in surgery. This practical guide outlines key methodologic issues important when planning an ethically and scientifically sound research project involving surgical interventions, with the ultimate goal of providing high-level evidence relevant for health care decision making in surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Beyond individualism: Is there a place for relational autonomy in clinical practice and research? (United States)

    Dove, Edward S; Kelly, Susan E; Lucivero, Federica; Machirori, Mavis; Dheensa, Sandi; Prainsack, Barbara


    The dominant, individualistic understanding of autonomy that features in clinical practice and research is underpinned by the idea that people are, in their ideal form, independent, self-interested and rational gain-maximising decision-makers. In recent decades, this paradigm has been challenged from various disciplinary and intellectual directions. Proponents of 'relational autonomy' in particular have argued that people's identities, needs, interests - and indeed autonomy - are always also shaped by their relations to others. Yet, despite the pronounced and nuanced critique directed at an individualistic understanding of autonomy, this critique has had very little effect on ethical and legal instruments in clinical practice and research so far. In this article, we use four case studies to explore to what extent, if at all, relational autonomy can provide solutions to ethical and practical problems in clinical practice and research. We conclude that certain forms of relational autonomy can have a tangible and positive impact on clinical practice and research. These solutions leave the ultimate decision to the person most affected, but encourage and facilitate the consideration of this person's care and responsibility for connected others.

  6. 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


    the Dental Practice-Based Research Network (DPBRN) completed a detailed questionnaire about how they diagnose and treat dental caries. Next, they received a customized report that compared their answers to those from all other practitioner-investigators. Then, 126 of them attended the DPBRN's first network......-wide meeting of practitioner-investigators from all five of its regions. During that meeting, certain questions were repeated and new ones were asked about the dentist's intention to change the way that he or she diagnosed or treated dental caries. Less than one-third of practitioner-investigators intended...

  7. [Psychoanalysis: a research method based on clinical practice: contributions to nursing]. (United States)

    da Silva, Teresa Cristina; Kirschbaum, Débora Isane Ratner


    Nursing, in its different fields of practice, is essentially characterized as a clinical practice. In this context, psychoanalysis can make important contributions. This article discusses some basic psychoanalytical concepts and assumptions, proposes psychoanalysis as a research method, and stresses its contributions for nursing. Essential Freudian concepts are identified, as well as the path to be followed by the researcher. As a research method, psychoanalysis can be used as a framework for the studu of human behavior based on unconscious mental processes. In several knowledge areas.

  8. Examining clinical supervision as a mechanism for changes in practice: a research protocol. (United States)

    Dilworth, Sophie; Higgins, Isabel; Parker, Vicki; Kelly, Brian; Turner, Jane


    This paper describes the research protocol for a study exploring if and how clinical supervision facilitates change in practice relating to psychosocial aspects of care for Health Professionals, who have been trained to deliver a psychosocial intervention to adults with cancer. There is a recognized need to implement care that is in line with clinical practice guidelines for the psychosocial care of adults with cancer. Clinical supervision is recommended as a means to support Health Professionals in providing the recommended psychosocial care. A qualitative design embedded within an experimental, stepped wedge randomized control trial. The study will use discourse analysis to analyse audio-recorded data collected in clinical supervision sessions that are being delivered as one element of a large randomized control trial. The sessions will be attended primarily by nurses, but including physiotherapists, radiation therapists, occupational therapists. The Health Professionals are participants in a randomized control trial designed to reduce anxiety and depression of distressed adults with cancer. The sessions will be facilitated by psychiatrists experienced in psycho-oncology and the provision of clinical supervision. The proposed research is designed specifically to facilitate exploration of the mechanisms by which clinical supervision enables Health Professionals to deliver a brief, tailored psychosocial intervention in the context of their everyday practice. This is the first study to use discourse analysis embedded within an experimental randomized control trial to explore the mechanisms of change generated within clinical supervision by analysing the discourse within the clinical supervision sessions. © 2013 John Wiley & Sons Ltd.

  9. Pharmacokinetic studies of neuromuscular blocking agents : Good Clinical Research Practice (GCRP)

    NARCIS (Netherlands)

    Viby-Mogensen, J; Ostergaard, D; Donati, F; Fisher, D; Hunter, J; Kampmann, JP; Kopman, A; Proost, JH; Rasmussen, SN; Skovgaard, LT; Varin, F; Wright, PMC


    In September 1997, an international consensus conference on standardization of studies of neuromuscular blocking agents was held in Copenhagen, Denmark. Based on the conference, a set of guidelines fur good clinical research practice (GCRT) in pharmacokinetic studies of neuromuscular blocking agents

  10. Application of three-dimensional computed tomography in craniofacial clinical practice and research. (United States)

    Anderson, P J; Yong, R; Surman, T L; Rajion, Z A; Ranjitkar, S


    Following the invention of the first computed tomography (CT) scanner in the early 1970s, many innovations in three-dimensional (3D) diagnostic imaging technology have occurred, leading to a wide range of applications in craniofacial clinical practice and research. Three-dimensional image analysis provides superior and more detailed information compared with conventional plain two-dimensional (2D) radiography, with the added benefit of 3D printing for preoperative treatment planning and regenerative therapy. Current state-of-the-art multidetector CT (MDCT), also known as medical CT, has an important role in the diagnosis and management of craniofacial injuries and pathology. Three-dimensional cone beam CT (CBCT), pioneered in the 1990s, is gaining increasing popularity in dental and craniofacial clinical practice because of its faster image acquisition at a lower radiation dose, but sound guidelines are needed to ensure its optimal clinical use. Recent innovations in micro-computed tomography (micro-CT) have revolutionized craniofacial biology research by enabling higher resolution scanning of teeth beyond the capabilities of MDCT and CBCT, presenting new prospects for translational clinical research. Even after four decades of refinement, CT technology continues to advance and broaden the horizons of craniofacial clinical practice and phenomics research. © 2014 Australian Dental Association.

  11. Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy. (United States)

    Venkatesh, Arjun K; Savage, Dan; Sandefur, Benjamin; Bernard, Kenneth R; Rothenberg, Craig; Schuur, Jeremiah D


    Over 25 years, emergency medicine in the United States has amassed a large evidence base that has been systematically assessed and interpreted through ACEP Clinical Policies. While not previously studied in emergency medicine, prior work has shown that nearly half of all recommendations in medical specialty practice guidelines may be based on limited or inconclusive evidence. We sought to describe the proportion of clinical practice guideline recommendations in Emergency Medicine that are based upon expert opinion and low level evidence. Systematic review of clinical practice guidelines (Clinical Policies) published by the American College of Emergency Physicians from January 1990 to January 2016. Standardized data were abstracted from each Clinical Policy including the number and level of recommendations as well as the reported class of evidence. Primary outcomes were the proportion of Level C equivalent recommendations and Class III equivalent evidence. The primary analysis was limited to current Clinical Policies, while secondary analysis included all Clinical Policies. A total of 54 Clinical Policies including 421 recommendations and 2801 cited references, with an average of 7.8 recommendations and 52 references per guideline were included. Of 19 current Clinical Policies, 13 of 141 (9.2%) recommendations were Level A, 57 (40.4%) Level B, and 71 (50.4%) Level C. Of 845 references in current Clinical Policies, 67 (7.9%) were Class I, 272 (32.3%) Class II, and 506 (59.9%) Class III equivalent. Among all Clinical Policies, 200 (47.5%) recommendations were Level C equivalent, and 1371 (48.9%) of references were Class III equivalent. Emergency medicine clinical practice guidelines are largely based on lower classes of evidence and a majority of recommendations are expert opinion based. Emergency medicine appears to suffer from an evidence gap that should be prioritized in the national research agenda and considered by policymakers prior to developing future quality

  12. A successful story of translational orthodontic research: Micro-osteoperforation-from experiments to clinical practice

    Directory of Open Access Journals (Sweden)

    Michelle Yuching Chou


    Full Text Available The gap between basic science research and clinical application has long existed and therefore translational research has emerged in recent years to bridge such gap. Consortium for Translational Orthodontic Research (CTOR was established with missions to integrate resources from different entities and to provide a platform for interdisciplinary groups who share the same vision to exchange ideas and inspire innovations. During its short existence, CTOR has successfully carried out several research projects which led to various innovations. Micro-osteoperforation is by far one of the most successful examples of translational research in the orthodontic field. It exemplifies how translational research can benefit scientists, clinicians, and patients. In this article, the process of its development, the rationale and scientific evidence from animal and clinical studies, and how it can be applied in daily practice will be depicted.

  13. Research methods to change clinical practice for patients with rare cancers. (United States)

    Billingham, Lucinda; Malottki, Kinga; Steven, Neil


    Rare cancers are a growing group as a result of reclassification of common cancers by molecular markers. There is therefore an increasing need to identify methods to assess interventions that are sufficiently robust to potentially affect clinical practice in this setting. Methods advocated for clinical trials in rare diseases are not necessarily applicable in rare cancers. This Series paper describes research methods that are relevant for rare cancers in relation to the range of incidence levels. Strategies that maximise recruitment, minimise sample size, or maximise the usefulness of the evidence could enable the application of conventional clinical trial design to rare cancer populations. Alternative designs that address specific challenges for rare cancers with the aim of potentially changing clinical practice include Bayesian designs, uncontrolled n-of-1 trials, and umbrella and basket trials. Pragmatic solutions must be sought to enable some level of evidence-based health care for patients with rare cancers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Developing a Culture to Facilitate Research Capacity Building for Clinical Nurse Consultants in Generalist Paediatric Practice

    Directory of Open Access Journals (Sweden)

    Lesley Wilkes


    Full Text Available This paper reports a research capacity building exercise with a group of CNCs practicing in the speciality of paediatrics in New South Wales (NSW, Australia. It explores the first step in building a research culture, through identifying the research priorities of members of the NSW Child Health Networks Paediatric Clinical Nurse Consultant group, and this forms the major focus of this paper. A nominal group technique (NGT was utilised with sixteen members to identify research topics for investigation which were considered a priority for improving children's health care. The group reviewed and prioritised 43 research topics in children's health which were identified in the literature. As a result of conducting this research prioritisation exercise, the group chose two research topics to investigate: reasons for children representing to the Emergency Department and a comparison of the use of high-flow and low-flow nasal prongs in children with bronchiolitis. The research team will continue to mentor the nurses throughout their research projects which resulted from the NGT. One bridge to leadership development in enhancing patient care is translating knowledge to practice and policy development. This study leads the way for a group of CNCs in paediatric nursing to combine their research capacity and influence clinical knowledge.

  15. Revisioning Clinical Psychology: Integrating Cultural Psychology into Clinical Research and Practice with Portuguese Immigrants (United States)

    James, Susan; Harris, Sara; Foster, Gary; Clarke, Juanne; Gadermann, Anne; Morrison, Marie; Bezanson, Birdie Jane


    This article outlines a model for conducting psychotherapy with people of diverse cultural backgrounds. The theoretical foundation for the model is based on clinical and cultural psychology. Cultural psychology integrates psychology and anthropology in order to provide a complex understanding of both culture and the individual within his or her cultural context. The model proposed in this article is also based on our clinical experience and mixed-method research with the Portuguese community. The model demonstrates its value with ethnic minority clients by situating the clients within the context of their multi-layered social reality. The individual, familial, socio-cultural, and religio-moral domains are explored in two research projects, revealing the interrelation of these levels/contexts. The article is structured according to these domains. Study 1 is a quantitative study that validates the Agonias Questionnaire in Ontario. The results of this study are used to illustrate the individual domain of our proposed model. Study 2 is an ethnography conducted in the Azorean Islands, and the results of this study are integrated to illustrate the other three levels of the model, namely family, socio-cultural, and the religio-moral levels. PMID:23720642

  16. The uses of photography in clinical nursing practice and research: a literature review. (United States)

    Riley, Robin G; Manias, Elizabeth


    The aim of this paper is to report a study to identify themes and provide a 'snap-shot' of the scope and uses of photography in clinical nursing practice and research. Despite the dominance of vision as a way of understanding the world in Western societies, the applications of photography in clinical nursing practice and research have not been well synthesized or reported in the literature. A computerized search of CINAHL database was performed using the terms photographs, photography, photographic, photovoice, videorecording and videotaping. Hand searching for additional citations was also undertaken. The identified papers on photography were categorized into broad themes that reflected the different applications to which photography had been applied: documentation and surveillance; therapeutic intervention; teaching, learning and evaluating performance; research methods; and descriptive and instructional literature. Approaches to the use of photography, as recorded in the nursing literature, are broad and include: wound surveillance, covert patient surveillance, photo essay, art therapy, self-portraits, life albums, simulated recall, participant observation, photovoice, photo hermeneutics, production of research scenarios, and video modelling. The most common applications of photography in nursing and related journals include photo elicitation to promote understanding in research, videorecording as a method of teaching and learning, and as a method of observation, with more creative approaches tending to be employed in health professions other than nursing. Few reports gave explanations of how researchers negotiated ethical concerns when seeking approval for studies in clinical settings, and few gave details of the processes of data analysis.

  17. Positive Clinical Psychology: a new vision and strategy for integrated research and practice. (United States)

    Wood, Alex M; Tarrier, Nicholas


    This review argues for the development of a Positive Clinical Psychology, which has an integrated and equally weighted focus on both positive and negative functioning in all areas of research and practice. Positive characteristics (such as gratitude, flexibility, and positive emotions) can uniquely predict disorder beyond the predictive power of the presence of negative characteristics, and buffer the impact of negative life events, potentially preventing the development of disorder. Increased study of these characteristics can rapidly expand the knowledge base of clinical psychology and utilize the promising new interventions to treat disorder through promoting the positive. Further, positive and negative characteristics cannot logically be studied or changed in isolation as (a) they interact to predict clinical outcomes, (b) characteristics are neither "positive" or "negative", with outcomes depending on specific situation and concomitant goals and motivations, and (c) positive and negative well-being often exist on the same continuum. Responding to criticisms of the Positive Psychology movement, we do not suggest the study of positive functioning as a separate field of clinical psychology, but rather that clinical psychology itself changes to become a more integrative discipline. An agenda for research and practice is proposed including reconceptualizing well-being, forming stronger collaborations with allied disciplines, rigorously evaluating the new positive interventions, and considering a role for clinical psychologists in promoting well-being as well as treating distress. Copyright © 2010 Elsevier Ltd. All rights reserved.

  18. Computerizing clinical practice guidelines

    DEFF Research Database (Denmark)

    Lyng, Karen Marie

    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....... The analysis focuses on the emergence of general clinical work practice demands on guidance • An analysis of guidance demands from clinical work practice and business strategy, focusing on implications for the design of computerised CPGs. In my research, I have applied observation studies, interviews...... it was a prerequisite that they should be easy to apply and not demand interruptions in clinical work. Based on my research, I found that computerized clinical guidance should be: • Activity specific • Present at the point of care • Embedded in work practice • Flexible • A source for coordination • Automated when...

  19. Swedish nurses' perception of nursing research and its implementation in clinical practice: a focus group study. (United States)

    Bohman, Doris M; Ericsson, Terese; Borglin, Gunilla


    Nowadays, nursing research is seen as an integral part of professional nursing although implementing knowledge derived from nursing research into the practice setting is still problematic. Current research, conducted mainly with a descriptive quantitative design, highlights the struggle experienced by Registered Nurses (RNs) to use and implement research findings in clinical practice. Therefore, the aim of this naturalistic inquiry was to explore nurses' perception of nursing research and its implementation in a clinical context. A qualitative approach was chosen, and four focus group discussions were conducted. The groups comprised a total of 16 RNs (three men and 13 women) working in a secondary care setting. The transcribed texts were analysed, inspired by Burnard's description of content analysis. The texts were interpreted as representing three predominant themes: scholastic, individual and contextual influences highlighted as influential components impacting on the RNs' views on research and its implementation as well as on their readiness to accept and support it. However, the most influential aspect permeating our themes was their educational background--the type of qualification they held. In general, the RNs with a Bachelor of Science in Nursing viewed research and the implementation of knowledge in practice more favourably than those RNs with a diploma. Our findings, although based on a small qualitative study, are congruent with others, indicating that further research is warranted concerning the impact of education on RNs' views of nursing research and its implementation. Hence, it might well be that the RNs' educational point of departure needs to be stressed more than what so far have been anticipated. In the meanwhile, it is possible that a number of strategies could be tested to promote a more favourable view in these issues and where the nursing education has the possibility to influence this endeavour. © 2012 The Authors. Scandinavian Journal of

  20. A new look at the WMS-III: new research to guide clinical practice. (United States)

    Tulsky, David S


    The Wechsler Memory Scale, Third Edition (WMS-III) was published in 1997 and marked an ambitious and substantial revision of the traditional memory scale. Since publication, however, clinical experience has led many practitioners to raise questions about the validity and clinical utility of the new subtests and new index scores. The impetus of this special issue was to address some of the questions with which clinicians have been struggling. The articles contained in this special issue present new empirical research on the WMS-III, and several include new methods and scoring techniques that go beyond what has been published in the WAIS-III-WMS-III Technical Manual (The Psychological Corporation, 1997, 2002). It is hoped that the new scores and techniques will prove useful in clinical practice and that this research will benefit future revisions of the Wechsler Memory Scale.

  1. Technology transfer from biomedical research to clinical practice: measuring innovation performance. (United States)

    Balas, E Andrew; Elkin, Peter L


    Studies documented 17 years of transfer time from clinical trials to practice of care. Launched in 2002, the National Institutes of Health (NIH) translational research initiative needs to develop metrics for impact assessment. A recent White House report highlighted that research and development productivity is declining as a result of increased research spending while the new drugs output is flat. The goal of this study was to develop an expanded model of research-based innovation and performance thresholds of transfer from research to practice. Models for transfer of research to practice have been collected and reviewed. Subsequently, innovation pathways have been specified based on common characteristics. An integrated, intellectual property transfer model is described. The central but often disregarded role of research innovation disclosure is highlighted. Measures of research transfer and milestones of progress have been identified based on the Association of University Technology Managers 2012 performance reports. Numeric milestones of technology transfer are recommended at threshold (top 50%), target (top 25%), and stretch goal (top 10%) performance levels. Transfer measures and corresponding target levels include research spending to disclosure (0.81), patents to start-up (>0.1), patents to licenses (>2.25), and average per license income (>$48,000). Several limitations of measurement are described. Academic institutions should take strategic steps to bring innovation to the center of scholarly discussions. Research on research, particularly on pathways to disclosures, is needed to improve R&D productivity. Researchers should be informed about the technology transfer performance of their institution and regulations should better support innovators.

  2. Clinical Research

    DEFF Research Database (Denmark)

    Christensen, Irene


    This paper is about the logic of problem solving and the production of scientific knowledge through the utilisation of clinical research perspective. Ramp-up effectiveness, productivity, efficiency and organizational excellence are topics that continue to engage research and will continue doing so...... for years to come. This paper seeks to provide insights into ramp-up management studies through providing an agenda for conducting collaborative clinical research and extend this area by proposing how clinical research could be designed and executed in the Ramp- up management setting....

  3. Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review. (United States)

    McGregor, Alyson J; Beauchamp, Gillian A; Wira, Charles R; Perman, Sarah M; Safdar, Basmah


    The National Institutes of Health recently highlighted the significant role of sex as a biological variable (SABV) in research design, outcome and reproducibility, mandating that this variable be accounted for in all its funded research studies. This move has resulted in a rapidly increasing body of literature on SABV with important implications for changing the clinical practice of emergency medicine (EM). Translation of this new knowledge to the bedside requires an understanding of how sex-based research will ultimately impact patient care. We use three case-based scenarios in acute myocardial infarction, acute ischemic stroke and important considerations in pharmacologic therapy administration to highlight available data on SABV in evidence-based research to provide the EM community with an important foundation for future integration of patient sex in the delivery of emergency care as gaps in research are filled.

  4. Clinical Sequencing Exploratory Research Consortium: Accelerating Evidence-Based Practice of Genomic Medicine. (United States)

    Green, Robert C; Goddard, Katrina A B; Jarvik, Gail P; Amendola, Laura M; Appelbaum, Paul S; Berg, Jonathan S; Bernhardt, Barbara A; Biesecker, Leslie G; Biswas, Sawona; Blout, Carrie L; Bowling, Kevin M; Brothers, Kyle B; Burke, Wylie; Caga-Anan, Charlisse F; Chinnaiyan, Arul M; Chung, Wendy K; Clayton, Ellen W; Cooper, Gregory M; East, Kelly; Evans, James P; Fullerton, Stephanie M; Garraway, Levi A; Garrett, Jeremy R; Gray, Stacy W; Henderson, Gail E; Hindorff, Lucia A; Holm, Ingrid A; Lewis, Michelle Huckaby; Hutter, Carolyn M; Janne, Pasi A; Joffe, Steven; Kaufman, David; Knoppers, Bartha M; Koenig, Barbara A; Krantz, Ian D; Manolio, Teri A; McCullough, Laurence; McEwen, Jean; McGuire, Amy; Muzny, Donna; Myers, Richard M; Nickerson, Deborah A; Ou, Jeffrey; Parsons, Donald W; Petersen, Gloria M; Plon, Sharon E; Rehm, Heidi L; Roberts, J Scott; Robinson, Dan; Salama, Joseph S; Scollon, Sarah; Sharp, Richard R; Shirts, Brian; Spinner, Nancy B; Tabor, Holly K; Tarczy-Hornoch, Peter; Veenstra, David L; Wagle, Nikhil; Weck, Karen; Wilfond, Benjamin S; Wilhelmsen, Kirk; Wolf, Susan M; Wynn, Julia; Yu, Joon-Ho


    Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools related to participant preferences and consent, variant classification, disclosure and management of primary and secondary findings, health outcomes, and integration with electronic health records. Future research directions will refine measures of clinical utility of CGES in both germline and somatic testing, evaluate the use of CGES for screening in healthy individuals, explore the penetrance of pathogenic variants through extensive phenotyping, reduce discordances in public databases of genes and variants, examine social and ethnic disparities in the provision of genomics services, explore regulatory issues, and estimate the value and downstream costs of sequencing. The CSER consortium has established a shared community of research sites by using diverse approaches to pursue the evidence-based development of best practices in genomic medicine. Copyright © 2016 American Society of Human Genetics. All rights reserved.

  5. Best Practices for Event-Related Potential Research in Clinical Populations. (United States)

    Kappenman, Emily S; Luck, Steven J


    The event-related potential (ERP) technique has been used for decades to answer important questions about sensory, cognitive, motor, and emotion-related processes in clinical disorders. However, ERP research with clinical populations often involves unique challenges above and beyond the general issues involved in conducting ERP studies in typical research participants. The goal of this paper is to provide an overview of the common challenges that arise in ERP research with clinical populations, including issues in experimental design, recording, analysis, and interpretation of ERPs. In addition, we provide strategies that have proven effective in each of these areas for maximizing the potential of the ERP technique to provide important insights about clinical disorders. The event-related potential (ERP) technique has been used for decades to assess sensory, cognitive, motor, and emotion-related processes in individuals with clinical disorders, and it has great promise for yielding new insights in the future. However, many complex methodological challenges arise in applying this technique to clinical populations, and these challenges must be overcome for the ERP technique to live up to its potential. The goal of this paper is to describe some of the most salient challenges and provide effective strategies for dealing with them. Our own experience has been mainly in schizophrenia, but much of the information presented here applies to any clinical population. We focus our discussion on traditional approaches to ERPs, for which methods been refined over many decades. Information about newer approaches, such as time-frequency analysis, can be found elsewhere (1; 2). We begin with a brief overview of the ERP technique, followed by a discussion of the challenges in designing experiments, practical considerations in recording and analysis, and issues in interpreting ERP effects. The present article is necessarily brief and focused, but broader reviews are available

  6. A guide to critiquing a research paper on clinical supervision: enhancing skills for practice. (United States)

    Fothergill, A; Lipp, A


    This paper aims to do two things: First, we want to show the reader how to critique a published research paper. The second aim is to take the reader through the various stages of critiquing using a guide. In the paper, we explain at each stage the research terms that can deter the novice critic from reading and understanding the findings in research. From this we hope the reader will have developed an ability to do their own critiquing, so that they are better informed about the quality of research that influences nursing practice. In this paper we have taken a previously published paper on the effectiveness of clinical supervision and undertaken a systematic critique of the merits of this quantitative research using a recognized critiquing framework compiled by Coughlan et al. (2007). Our purpose was twofold: First, we wanted to demonstrate the various stages of critiquing a paper in order that the reader might make an informed judgment of the quality and relevance of the research. The reader/critic is then able to decide whether to use this research in their own practice. Second, we wanted to assist the reader to develop their own critical, analytical skills through methodically appraising the merits of published research. Nursing as an evidence-based profession requires nurses at both pre- and post-registration level to be able to understand, synthesize and critique research, this being a fundamental part of many nursing curricula. These have become core skills to acquire because implementing up-to-date evidence is the cornerstone of contemporary nursing practice. We have provided in this paper a template for critiquing, which is based on our combined experiences as academics specifically in teaching at the bachelor, master's and doctoral levels. © 2014 John Wiley & Sons Ltd.

  7. The interface of self psychology, infant research, and neuroscience in clinical practice. (United States)

    Rustin, Judith


    This article focuses on the integration of self psychology with findings from infant research and neuroscience. While Kohut's psychology of the self provides a useful theoretical model for psychoanalytic practice, aspects of infant research and neuroscience offer specificity and nuance to basic self-psychological concepts. Kohut proposed that self-psychological psychoanalysis ameliorates derailed development through patient-analyst interaction, while a listening stance of empathic immersion begins the curative process of derailed development and sets the stage for reparative psychoanalytic work. Findings from infant research delineate much more specifically the nature of attunement both in early mother-infant and analyst-patient interactions. Findings from neuroscientific research delineate how early mother-infant experiences are encoded in implicit memory and explicates the emotional substrate of affects and feelings. This emotional substrate exists at birth and provides a means of communication both in infancy and adulthood. Additionally, infant research delineates the mutuality of the interactive process. Thus, both infant research and neuroscience add subtlety and nuance to basic self-psychological concepts. This subtlety opens up new ways of understanding patients and expands the clinical repertoire. Three clinical vignettes demonstrate how this nuance and expansion of self-psychological concepts are applied in the context of an ongoing psychoanalytic treatment.

  8. Recognising Kawasaki disease in UK primary care: a descriptive study using the Clinical Practice Research Datalink. (United States)

    Moore, Abigail; Harnden, Anthony; Mayon-White, Richard


    Kawasaki disease is a rare childhood illness that can present non-specifically, making it a diagnostic challenge. The clinical presentation of Kawasaki disease has not been previously described in primary care. To describe how children with an eventual diagnosis of Kawasaki disease initially present to primary care in the UK. The Clinical Practice Research Datalink was used to find cases coded as Kawasaki disease. Hospital Episode Statistics, hospital admissions, and hospital outpatient attendances were used to identify the children with a convincing diagnosis of Kawasaki disease. Questionnaires and a request for copies of relevant hospital summaries, discharge letters, and reports were sent to GPs of the 104 children with a diagnosis of Kawasaki disease between 2007 and 2011. Most children presented with few clinical features typical of Kawasaki disease. Of those with just one feature, a fever or a polymorphous rash were the most common. By the time that most children were admitted to hospital they had a more recognisable syndrome, with three or more clinical features diagnostic of Kawasaki disease. Most GPs did not consider Kawasaki disease among their differential diagnoses, but some GPs did suspect that the child's illness was unusual. The study highlighted the difficulty of early diagnosis, with most children having a non-specific presentation to primary care. GPs are encouraged to implement good safety netting, and to keep Kawasaki disease in mind when children present with fever and rashes. © British Journal of General Practice 2014.

  9. Caught between a rock and a hard place: An intrinsic single case study of nurse researchers' experiences of the presence of a nursing research culture in clinical practice. (United States)

    Berthelsen, Connie Bøttcher; Hølge-Hazelton, Bibi


    To explore how nurse researchers in clinical positions experience the presence of a nursing research culture in clinical practice. Higher demands in the hospitals for increasing the quality of patient care engender a higher demand for the skills of health professionals and evidence-based practice. However, the utilisation of nursing research in clinical practice is still limited. Intrinsic single case study design underlined by a constructivist perspective. Data were produced through a focus group interview with seven nurse researchers employed in clinical practice in two university hospitals in Zealand, Denmark, to capture the intrinsic aspects of the concept of nursing research culture in the context of clinical practice. A thematic analysis was conducted based on Braun and Clarke's theoretical guideline. "Caught between a rock and a hard place" was constructed as the main theme describing how nurse researchers in clinical positions experience the presence of a nursing research culture in clinical practice. The main theme was supported by three subthemes: Minimal academic tradition affects nursing research; Minimal recognition from physicians affects nursing research; and Moving towards a research culture. The nurse researchers in this study did not experience the presence of a nursing research culture in clinical practice, however; they called for more attention on removing barriers against research utilisation, promotion of applied research and interdisciplinary research collaboration, and passionate management support. The results of this case study show the pressure which nurse researchers employed in clinical practice are exposed to, and give examples on how to accommodate the further development of a nursing research culture in clinical practice. © 2017 John Wiley & Sons Ltd.

  10. Integrating nurse researchers in clinical practice – a challenging, but necessary task for nurse leaders

    DEFF Research Database (Denmark)

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


    Aim To create awareness among nurse leaders, of what they may need to consider, 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...... nursing, including integrating nurse researchers in ANP positions. Methods A collective case study including three ANPs took place at a large regional hospital in Denmark. The cases were first analysed by focusing on the generic features, functions and skills of ANPs, and second by focusing...... 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...

  11. The Palliative Outcome Scale (POS applied to clinical practice and research: an integrative review

    Directory of Open Access Journals (Sweden)

    Fernanda Capella Rugno

    Full Text Available ABSTRACT Objective: to identify and evaluate the evidence found in the international scientific literature on the application of the Palliative Outcome Scale (POS in clinical practice and research in Palliative Care (PC. Method: integrative literature review, through the search of publications in journals indexed in PubMed / MEDLINE, LILACS, SciELO and CINAHL databases, between the years 1999 and 2014. Results: the final sample consisted of 11 articles. In the data analysis, the articles were classified into 2 units of analysis (studies using the POS as a resource in research and studies using the POS in clinical practice, in which the information was presented in the form of sub-themes related to publications of the selected studies, highlighting the synthesis of the results. Conclusion: POS emerged as an important tool for measuring outcomes to assess the quality of life of patients and families, of the quality of care provided and the PC service organization. The international scientific literature on the application of POS proved to be relevant to the advancement and consolidation of the field of knowledge related to PC.

  12. 'Screening audit' as a quality assurance tool in good clinical practice compliant research environments. (United States)

    Park, Sinyoung; Nam, Chung Mo; Park, Sejung; Noh, Yang Hee; Ahn, Cho Rong; Yu, Wan Sun; Kim, Bo Kyung; Kim, Seung Min; Kim, Jin Seok; Rha, Sun Young


    With the growing amount of clinical research, regulations and research ethics are becoming more stringent. This trend introduces a need for quality assurance measures for ensuring adherence to research ethics and human research protection beyond Institutional Review Board approval. Audits, one of the most effective tools for assessing quality assurance, are measures used to evaluate Good Clinical Practice (GCP) and protocol compliance in clinical research. However, they are laborious, time consuming, and require expertise. Therefore, we developed a simple auditing process (a screening audit) and evaluated its feasibility and effectiveness. The screening audit was developed using a routine audit checklist based on the Severance Hospital's Human Research Protection Program policies and procedures. The measure includes 20 questions, and results are summarized in five categories of audit findings. We analyzed 462 studies that were reviewed by the Severance Hospital Human Research Protection Center between 2013 and 2017. We retrospectively analyzed research characteristics, reply rate, audit findings, associated factors and post-screening audit compliance, etc. RESULTS: Investigator reply rates gradually increased, except for the first year (73% → 26% → 53% → 49% → 55%). The studies were graded as "critical," "major," "minor," and "not a finding" (11.9, 39.0, 42.9, and 6.3%, respectively), based on findings and number of deficiencies. The auditors' decisions showed fair agreement with weighted kappa values of 0.316, 0.339, and 0.373. Low-risk level studies, single center studies, and non-phase clinical research showed more prevalent frequencies of being "major" or "critical" (p = 0.002, < 0.0001, < 0.0001, respectively). Inappropriateness of documents, failure to obtain informed consent, inappropriateness of informed consent process, and failure to protect participants' personal information were associated with higher audit grade (p

  13. The effect of HapMap on cardiovascular research and clinical practice. (United States)

    Skelding, Kimberly A; Gerhard, Glenn S; Simari, Robert D; Holmes, David R


    The Haplotype Genetic Map (HapMap) is an invaluable resource to the cardiovascular researcher, enabling a decrease in cost and an increase in the efficiency and speed of discoveries in the laboratory. As cardiologists, we need to understand the vocabulary of genomics because the translation of scientific findings using HapMap could provide insight for improved care and therapeutic guidance of our patients. Genomics is the evaluation of genes as a dynamic system, in which genes interact to influence biologic pathways, networks and physiology. The HapMap promises to increase the efficiency of genomics in identifying cardiovascular-disease-related genes that could become vital for choosing relevant tests and providing preventative and curative therapies. In this Review, the HapMap will be described, to provide insight into the relevance of this work to cardiovascular practice, to clinical research in cardiovascular disease and to future discoveries in diagnostic and therapeutic modalities.

  14. An official multi-society statement: the role of clinical research results in the practice of critical care medicine. (United States)

    Tonelli, Mark R; Curtis, J Randall; Guntupalli, Kalpalatha K; Rubenfeld, Gordon D; Arroliga, Alejandro C; Brochard, Laurent; Douglas, Ivor S; Gutterman, David D; Hall, Jesse R; Kavanagh, Brian P; Mancebo, Jordi; Misak, Cheryl J; Simpson, Steven Q; Slutsky, Arthur S; Suffredini, Anthony F; Thompson, B Taylor; Ware, Lorraine B; Wheeler, Arthur P; Levy, Mitchell M


    While the results of clinical research are clearly valuable in the care of critically ill patients, the limitations of such information and the role of other forms of medical knowledge for clinical decision making have not been carefully examined. The leadership of three large professional societies representing critical care practitioners convened a diverse group representing a wide variety of views regarding the role of clinical research results in clinical practice to develop a document to serve as a basis for agreement and a framework for ongoing discussion. Consensus was reached on several issues. While the results of rigorous clinical research are important in arriving at the best course of action for an individual critically ill patient, other forms of medical knowledge, including clinical experience and pathophysiologic reasoning, remain essential. No single source of knowledge is sufficient to guide clinical decisions, nor does one kind of knowledge always take precedence over others. Clinicians will find clinical research compelling for a variety of reasons that go beyond study design. While clinical practice guidelines and protocols based upon clinical research may improve care and decrease variability in practice, clinicians must be able to understand and articulate the rationale as to why a particular protocol or guideline is used or why an alternative approach is taken. Making this clinical reasoning explicit is necessary to understand practice variability. Understanding the strengths and weaknesses of different kinds of medical knowledge for clinical decision making and factors beyond study design that make clinical research compelling to clinicians can provide a framework for understanding the role of clinical research in practice.

  15. Analytical Methods for Quantification of Vitamin D and Implications for Research and Clinical Practice. (United States)

    Stokes, Caroline S; Lammert, Frank; Volmer, Dietrich A


    A plethora of contradictory research surrounds vitamin D and its influence on health and disease. This may, in part, result from analytical difficulties with regard to measuring vitamin D metabolites in serum. Indeed, variation exists between analytical techniques and assays used for the determination of serum 25-hydroxyvitamin D. Research studies into the effects of vitamin D on clinical endpoints rely heavily on the accurate assessment of vitamin D status. This has important implications, as findings from vitamin D-related studies to date may potentially have been hampered by the quantification techniques used. Likewise, healthcare professionals are increasingly incorporating vitamin D testing and supplementation regimens into their practice, and measurement errors may be also confounding the clinical decisions. Importantly, the Vitamin D Standardisation Programme is an initiative that aims to standardise the measurement of vitamin D metabolites. Such a programme is anticipated to eliminate the inaccuracies surrounding vitamin D quantification. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Guckenberger Matthias


    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.

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

    Directory of Open Access Journals (Sweden)

    Hong Zhang


    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.

  18. [The research of basic medical education with clinical practice and culturing of discovering and creative ability for students]. (United States)

    Yang, Kang-Juan; Jin, Ying-Zi; Zhang, Zi-Bo; Jin, Yan-Hua; Jin, Xiong-Ji; Xiu, Jing-Hui; Sun, Lian-Ping; Liu, Yang; Sheng, Tian-Xin


    In order to explore the educational model of combined research aidding basic medical education and clinical practice, the educational form of combined research, teaching and clinical practice was adopted and brought into the education of medical genetics for medical students. The consequence of five-year educational practice has revealed that the educational effects and quality have been obviously increased, and the deeply activated studying initiative, self-studying ability, ability of cooperation, discovering and creative ability have been achieved in culturing practical general medical students with in-depth basic knowledge, great ability and high quality.

  19. Validation of asthma recording in the Clinical Practice Research Datalink (CPRD). (United States)

    Nissen, Francis; Morales, Daniel R; Mullerova, Hana; Smeeth, Liam; Douglas, Ian J; Quint, Jennifer K


    The optimal method of identifying people with asthma from electronic health records in primary care is not known. The aim of this study is to determine the positive predictive value (PPV) of different algorithms using clinical codes and prescription data to identify people with asthma in the United Kingdom Clinical Practice Research Datalink (CPRD). 684 participants registered with a general practitioner (GP) practice contributing to CPRD between 1 December 2013 and 30 November 2015 were selected according to one of eight predefined potential asthma identification algorithms. A questionnaire was sent to the GPs to confirm asthma status and provide additional information to support an asthma diagnosis. Two study physicians independently reviewed and adjudicated the questionnaires and additional information to form a gold standard for asthma diagnosis. The PPV was calculated for each algorithm. 684 questionnaires were sent, of which 494 (72%) were returned and 475 (69%) were complete and analysed. All five algorithms including a specific Read code indicating asthma or non-specific Read code accompanied by additional conditions performed well. The PPV for asthma diagnosis using only a specific asthma code was 86.4% (95% CI 77.4% to 95.4%). Extra information on asthma medication prescription (PPV 83.3%), evidence of reversibility testing (PPV 86.0%) or a combination of all three selection criteria (PPV 86.4%) did not result in a higher PPV. The algorithm using non-specific asthma codes, information on reversibility testing and respiratory medication use scored highest (PPV 90.7%, 95% CI (82.8% to 98.7%), but had a much lower identifiable population. Algorithms based on asthma symptom codes had low PPVs (43.1% to 57.8%)%). People with asthma can be accurately identified from UK primary care records using specific Read codes. The inclusion of spirometry or asthma medications in the algorithm did not clearly improve accuracy. The protocol for this research was approved

  20. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Gluud, Christian


    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...... practice. By investments in education, applied research, and The Cochrane Collaboration, evidence-based medicine may form a stronger basis for clinical practice.......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......, and single clinics. Accordingly, there is an urgent need to improve this situation. Guidelines for Good Clinical (Research) Practice, conduct of more trials as multicentre trials, The Consort Statement, and The Cochrane Collaboration may all help in the application of the best research evidence in clinical...

  1. 76 FR 72957 - 4th Annual Trauma Spectrum Conference: Bridging the Gap Between Research and Clinical Practice of... (United States)


    ... Health (NIH), Bethesda, Maryland. This year's event focuses on bridging the gap between research and... Conference: Bridging the Gap Between Research and Clinical Practice of Psychological Health and Traumatic... is hereby given of the ``4th Annual Trauma Spectrum Conference: Bridging the Gap Between Research and...

  2. Balancing collaborative and independent practice roles in clinical pharmacy: a qualitative research study. (United States)

    McCullough, Megan B; Solomon, Jeffrey L; Petrakis, Beth Ann; Park, Angela M; Ourth, Heather; Morreale, Anthony P; Rose, Adam J


    Clinical pharmacists (CPs) with a scope of practice operate as direct care providers and health care team members. Research often focuses on one role or the other; little is understood about the dynamic relationship between roles in practice settings. To identify the challenges CPs face in balancing dual roles as direct care providers and health care team members and the implications for CP effectiveness and quality of care. Pharmacists were interviewed with a primary purpose of informing an implementation effort. Besides the implementation, there were emergent themes regarding the challenges posed for CPs in negotiating dual roles. This study is, therefore, a secondary analysis of semistructured interviews and direct observation of 48 CPs, addressing this phenomenon. Interview data were entered into NVivo 10 and systematically analyzed using an emergent thematic coding strategy. Pharmacists describe role ambiguity, where they perform as direct providers or team members simultaneously or in quick succession. They note the existence of a "transaction cost," where switching causes loss of momentum or disruption of work flow. Additionally, pharmacists feel that fellow providers lack an understanding of what they do and that CP contributions are not evaluated accurately by other health professionals. It is a challenge for CPs to balance the distinct roles of serving as collaborators and primary providers. Frequent role switching is not conducive to optimal work efficiency or patient care. Our findings suggest concrete steps that medical centers can take to improve both CP worklife and quality of patient care. © The Author(s) 2014.

  3. The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice

    Directory of Open Access Journals (Sweden)

    Frank E. DiLiberto

    Full Text Available ABSTRACT Background Implementation of interprofessional clinical guidelines for the prevention of neuropathic diabetic foot ulceration has demonstrated positive effects regarding ulceration and amputation rates. Current foot care recommendations are primarily based on research regarding the prevention of ulcer recurrence and focused on reducing the magnitude of plantar stress (pressure overload. Yet, foot ulceration remains to be a prevalent and debilitating consequence of Diabetes Mellitus. There is limited evidence targeting the prevention of first-time ulceration, and there is a need to consider additional factors of plantar stress to supplement current guidelines. Objectives The first purpose of this article is to discuss the biomechanical theory underpinning diabetic foot ulcerations and illustrate how plantar tissue underloading may precede overloading and breakdown. The second purpose of this commentary is to discuss how advances in biomechanical foot modeling can inform clinical practice in the prevention of first-time ulceration. Discussion Research demonstrates that progressive weight-bearing activity programs to address the frequency of plantar stress and avoid underloading do not increase ulceration risk. Multi-segment foot modeling studies indicate that dynamic foot function of the midfoot and forefoot is compromised in people with diabetes. Emerging research demonstrates that implementation of foot-specific exercises may positively influence dynamic foot function and improve plantar stress in people with diabetes. Conclusion Continued work is needed to determine how to best design and integrate activity recommendations and foot-specific exercise programs into the current interprofessional paradigm for the prevention of first-time ulceration in people with Diabetes Mellitus.

  4. [Good practice is a means for preventing fraud in clinical research]. (United States)

    Maisonneuve, H


    The aim of this article is to present the findings concerning scientific fraud that have appeared in case reports. Deliberate scientific fraud does exist. The fact that most of the documented cases have occurred in Anglo-Saxon countries seems to indicate, not that Anglo-Saxons are more prone to scientific fraud, but rather that they have been more successful in bringing it to light. Since 1974, 72 cases have been reported in which there was either conclusive evidence or else a strong presumption of fraud: one case in Switzerland, one in Canada, four in Australia, 14 in Great Britain and 52 in the United States. Fraud is estimated to affect 2-5% of clinical research trials. Referees and readers do not set out to track fraud. The American Commission has proposed the terms "misappropriation, interference, misrepresentation" to define fraud. Voluntary fraud is hidden and its detection delayed. In well-known cases, more than 5 years elapsed before the information reached the scientific community. Whistle blowers must sustain a determined effort to denounce fraud over a period of 1-3 years if they are to trigger an investigation. Some whistle blowers have themselves been accused of fraud because their claims proved so embarrassing. Fraud can lead to severe accidents and generate expenditure that those responsible, or the institutions they work for, will never pay back. Frauders are usually motivated by the desire for material gain or the desire to become well-known. The motivating factor may be personal enrichment, or a need for funds for a not-for-profit association. People found guilt of fraud always have good excuses. Some simply do not realize what they have done. A knowledge of research methodology and critical appraisal methods can help to prevent fraud. Good clinical, laboratory and manufacturing practice can help to prevent misconduct and trickery. Audits and inspections are another essential means of combatting fraud.

  5. Action to Support Practices Implement Research Evidence (ASPIRE): protocol for a cluster-randomised evaluation of adaptable implementation packages targeting 'high impact' clinical practice recommendations in general practice. (United States)

    Willis, Thomas A; Hartley, Suzanne; Glidewell, Liz; Farrin, Amanda J; Lawton, Rebecca; McEachan, Rosemary R C; Ingleson, Emma; Heudtlass, Peter; Collinson, Michelle; Clamp, Susan; Hunter, Cheryl; Ward, Vicky; Hulme, Claire; Meads, David; Bregantini, Daniele; Carder, Paul; Foy, Robbie


    There are recognised gaps between evidence and practice in general practice, a setting which provides particular challenges for implementation. We earlier screened clinical guideline recommendations to derive a set of 'high impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. We aim to evaluate the effectiveness and cost-effectiveness of a multifaceted, adaptable intervention package to implement four targeted, high impact recommendations in general practice. The research programme Action to Support Practice Implement Research Evidence (ASPIRE) includes a pair of pragmatic cluster-randomised trials which use a balanced incomplete block design. Clusters are general practices in West Yorkshire, United Kingdom (UK), recruited using an 'opt-out' recruitment process. The intervention package adapted to each recommendation includes combinations of audit and feedback, educational outreach visits and computerised prompts with embedded behaviour change techniques selected on the basis of identified needs and barriers to change. In trial 1, practices are randomised to adapted interventions targeting either diabetes control or risky prescribing and those in trial 2 to adapted interventions targeting either blood pressure control in patients at risk of cardiovascular events or anticoagulation in atrial fibrillation. The respective primary endpoints comprise achievement of all recommended target levels of haemoglobin A1c (HbA1c), blood pressure and cholesterol in patients with type 2 diabetes, a composite indicator of risky prescribing, achievement of recommended blood pressure targets for specific patient groups and anticoagulation prescribing in patients with atrial fibrillation. We are also randomising practices to a fifth, non-intervention control group to further assess Hawthorne effects. Outcomes will be assessed using routinely collected data

  6. Hypothyroidism in clinical practice

    Directory of Open Access Journals (Sweden)

    Faiza Qari


    Full Text Available Background: Hypothyroidism is the most common endocrine disease that was seen in the clinical practice especially for family physicians. Methods: This review article covered the important practical clinical issues for managing overt hypothyroidism, subclinical hypothyroidism and hypothyroidism during pregnancy. Conclusions: The clinical issues were addressed by clinical scenario followed by questions and stressed on the important clinical points.

  7. Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network. (United States)

    Holub, Jennifer L; Morris, Cynthia; Fagnan, Lyle J; Logan, Judith R; Michaels, LeAnn C; Lieberman, David A


    Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings. The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites. No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P 9mm 16.6% vs 18.7% (P = .106). ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings. © 2016 National Rural Health Association.

  8. Does integrating research into the prosthetics and orthotics undergraduate curriculum enhance students' clinical practice? An interview study on students' perception. (United States)

    Al Qaroot, Bashar S; Sobuh, Mohammad


    Problem-based learning (where rather than feeding students the knowledge, they look for it themselves) has long been thought of as an ideal approach in teaching because it would encourage students to acquire knowledge from an undetermined medium of wrong and right answers. However, the effect of such approach in the learning experience of prosthetics and orthotics students has never been investigated. This study explores the implications of integrating problem-based learning into teaching on the students' learning experience via implementing a research-informed clinical practice module into the curriculum of last year prosthetics and orthotics undergraduate students at the University of Jordan (Amman, Jordan). Qualitative research pilot study. Grounded theory approach was used based on the data collected from interviewing a focus group of four students. Students have identified a number of arguments from their experience in the research-informed clinical practice where, generally speaking, students described research-informed clinical practice as a very good method of education. Integrating problem-based learning into teaching has many positive implications. In particular, students pointed out that their learning experience and clinical practice have much improved after the research-informed clinical practice. Findings from this investigation demonstrate that embedding problem-based learning into prosthetics and orthotics students' curriculum has the potential to enhance students' learning experience, particularly students' evidence-based practice. This may lead to graduates who are more knowledgeable and thus who can offer the optimal patient care (i.e. clinical practice). © The International Society for Prosthetics and Orthotics 2014.

  9. Neuropathic pain: an updated grading system for research and clinical practice (United States)

    Finnerup, Nanna B.; Haroutounian, Simon; Kamerman, Peter; Baron, Ralf; Bennett, David L.H.; Bouhassira, Didier; Cruccu, Giorgio; Freeman, Roy; Hansson, Per; Nurmikko, Turo; Raja, Srinivasa N.; Rice, Andrew S.C.; Serra, Jordi; Smith, Blair H.; Treede, Rolf-Detlef; Jensen, Troels S.


    Abstract The redefinition of neuropathic pain as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system,” which was suggested by the International Association for the Study of Pain (IASP) Special Interest Group on Neuropathic Pain (NeuPSIG) in 2008, has been widely accepted. In contrast, the proposed grading system of possible, probable, and definite neuropathic pain from 2008 has been used to a lesser extent. Here, we report a citation analysis of the original NeuPSIG grading paper of 2008, followed by an analysis of its use by an expert panel and recommendations for an improved grading system. As of February, 2015, 608 eligible articles in Scopus cited the paper, 414 of which cited the neuropathic pain definition. Of 220 clinical studies citing the paper, 56 had used the grading system. The percentage using the grading system increased from 5% in 2009 to 30% in 2014. Obstacles to a wider use of the grading system were identified, including (1) questions about the relative significance of confirmatory tests, (2) the role of screening tools, and (3) uncertainties about what is considered a neuroanatomically plausible pain distribution. Here, we present a revised grading system with an adjusted order, better reflecting clinical practice, improvements in the specifications, and a word of caution that even the “definite” level of neuropathic pain does not always indicate causality. In addition, we add a table illustrating the area of pain and sensory abnormalities in common neuropathic pain conditions and propose areas for further research. PMID:27115670

  10. Confronting the Inevitable: A Conceptual Model of Miscarriage for Use in Clinical Practice and Research (United States)

    Wojnar, Danuta M.; Swanson, Kristen M.; Adolfsson, Ann-Sofie


    In spite of scientific evidence that miscarriage has negative psychological consequences for many individuals and couples, silence and dismissal continue to surround this invisible loss in North American culture and beyond. The grief and sorrow of miscarriage has important implications for clinical practice. It indicates a need for therapeutic…

  11. Developmental Coordination Disorder and Joint Hypermobility Syndrome--overlapping disorders? Implications for research and clinical practice. (United States)

    Kirby, A; Davies, R


    Joint Hypermobility Syndrome (JHS) and Developmental Coordination Disorder (DCD) are two childhood disorders usually identified separately. DCD is a heterogeneous condition with little known of the underlying aetiology of the disorder. This paper examines the potential overlap between DCD and JHS and examines children with DCD for symptoms which may be consistent with a diagnosis of JHS. Implications for research and clinical practice are considered. A questionnaire covering a range of symptoms consistent with a diagnosis of JHS and related autonomic nervous systemic symptoms was completed by parents from 27 children with DCD and compared with responses from parents of 27 typically developing children. Children with DCD showed a significant difference from the group of typically developing children on questions regarding hypermobility, pain and autonomic nervous system symptoms, typifying JHS. This study has shown a similarity in symptoms seen in some DCD children to those with a diagnosis of JHS. In addition, children are also presenting with multi-system symptomatology including those involving the autonomic nervous system. This study reinforces other recent work showing the reverse pattern of JHS children showing similar functional similarities to DCD children. This has implications for future research in DCD in order to understand the underlying aetiology of this complex disorder. In addition, it is important for clinicians to be aware of these findings in order to provide appropriate and tailored support and treatment for children presenting with differing patterns of co-ordination difficulties. Children with DCD and JHS may require appropriate podiatry as well as recognition of their symptoms of pain and how this may affect participation in physical activity.

  12. Health-related quality of life measurement in pediatric clinical practice: An appraisal and precept for future research and application

    Directory of Open Access Journals (Sweden)

    Lane Mariella M


    Full Text Available Abstract Health-related quality of life (HRQOL measurement has emerged as an important health outcome in clinical trials, clinical practice improvement strategies, and healthcare services research and evaluation. HRQOL measures are also increasingly proposed for use in clinical practice settings to inform treatment decisions. In settings where HRQOL measures have been utilized with adults, physicians report such measures as useful, some physicians alter their treatment based on patient reports on such instruments, and patients themselves generally feel the instruments to be helpful. However, there is a dearth of studies evaluating the clinical utility of HRQOL measurement in pediatric clinical practice. This paper provides an updated review of the literature and proposes a precept governing the application of pediatric HRQOL measurement in pediatric clinical practice. Utilizing HRQOL measurement in pediatric healthcare settings can facilitate patient-physician communication, improve patient/parent satisfaction, identify hidden morbidities, and assist in clinical decision-making. Demonstrating the utility of pediatric HRQOL measurement in identifying children with the greatest needs, while simultaneously demonstrating the cost advantages of providing timely, targeted interventions to address those needs, may ultimately provide the driving force for incorporating HRQOL measurement in pediatric clinical practice.

  13. Systematic implementation of evidence-based practice in a clinical nursing setting: a participatory action research project. (United States)

    Friesen-Storms, Jolanda H H M; Moser, Albine; van der Loo, Sandra; Beurskens, Anna J H M; Bours, Gerrie J J W


    To describe the process of implementing evidence-based practice in a clinical nursing setting. Evidence-based practice has become a major issue in nursing, it is insufficiently integrated into daily practice and its implementation is complex. Participatory action research. The main participants were nurses working in a lung unit of a rural hospital. A multi-method process of data collection was used during the observing, reflecting, planning and acting phases. Data were continuously gathered during a 24-month period from 2010 to 2012, and analysed using an interpretive constant comparative approach. Patients were consulted to incorporate their perspective. A best-practice mode of working was prevalent on the ward. The main barriers to the implementation of evidence-based practice were that nurses had little knowledge of evidence-based practice and a rather negative attitude towards it, and that their English reading proficiency was poor. The main facilitators were that nurses wanted to deliver high-quality care and were enthusiastic and open to innovation. Implementation strategies included a tailored interactive outreach training and the development and implementation of an evidence-based discharge protocol. The academic model of evidence-based practice was adapted. Nurses worked according to the evidence-based practice discharge protocol but barely recorded their activities. Nurses favourably evaluated the participatory action research process. Action research provides an opportunity to empower nurses and to tailor evidence-based practice to the practice context. Applying and implementing evidence-based practice is difficult for front-line nurses with limited evidence-based practice competencies. Adaptation of the academic model of evidence-based practice to a more pragmatic approach seems necessary to introduce evidence-based practice into clinical practice. The use of scientific evidence can be facilitated by using pre-appraised evidence. For clinical practice

  14. Structured clinical documentation in the electronic medical record to improve quality and to support practice-based research in epilepsy. (United States)

    Narayanan, Jaishree; Dobrin, Sofia; Choi, Janet; Rubin, Susan; Pham, Anna; Patel, Vimal; Frigerio, Roberta; Maurer, Darryck; Gupta, Payal; Link, Lourdes; Walters, Shaun; Wang, Chi; Ji, Yuan; Maraganore, Demetrius M


    Using the electronic medical record (EMR) to capture structured clinical data at the point of care would be a practical way to support quality improvement and practice-based research in epilepsy. We describe our stepwise process for building structured clinical documentation support tools in the EMR that define best practices in epilepsy, and we describe how we incorporated these toolkits into our clinical workflow. These tools write notes and capture hundreds of fields of data including several score tests: Generalized Anxiety Disorder-7 items, Neurological Disorders Depression Inventory for Epilepsy, Epworth Sleepiness Scale, Quality of Life in Epilepsy-10 items, Montreal Cognitive Assessment/Short Test of Mental Status, and Medical Research Council Prognostic Index. The tools summarize brain imaging, blood laboratory, and electroencephalography results, and document neuromodulation treatments. The tools provide Best Practices Advisories and other clinical decision support when appropriate. The tools prompt enrollment in a DNA biobanking study. We have thus far enrolled 231 patients for initial visits and are starting our first annual follow-up visits and provide a brief description of our cohort. We are sharing these EMR tools and captured data with other epilepsy clinics as part of a Neurology Practice Based Research Network, and are using the tools to conduct pragmatic trials using subgroup-based adaptive designs. © 2016 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

  15. Best practices sharing: Setting up a professional clinical research unit in India

    Directory of Open Access Journals (Sweden)

    Uma Divate


    Full Text Available The Drug Controller General of India has recently come up with very stringent laws to tighten the regulatory framework around clinical trials. One-way of improving the credibility of India and its researchers in the eyes of the regulators, sponsors and the general public is through professional site management team or setting up clinical research unit (CRU. The CRU acts as a bridge between the sponsor and the investigator. The CRU model has been better explained with the help of a good example of a clinical research institute. Since, a successful clinical trial needs high quality data, timeliness and clear communication between all parties, a professional CRU with a team of dedicated and trained professionals and infrastructure with written procedures and policies may be a solution to the pain and agony of poor site performance and investigator insufficiency and pressure.

  16. The National Drug Abuse Treatment Clinical Trials Network: forging a partnership between research knowledge and community practice

    Directory of Open Access Journals (Sweden)

    Liu D


    Full Text Available Betty Tai, Steven Sparenborg, David Liu, Michele StrausCenter for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, USAAbstract: The National Drug Abuse Treatment Clinical Trials Network (CTN has faced many challenges over its first eleven years. This review explores some of these challenges and the paths the CTN took to meet these challenges, including: designing clinical trials that reflect the CTN’s mission and changing public health needs, finding the synergies in the varied expertise of clinical treatment providers and academic researchers, promoting evidence-based practices and expanding the Network into mainstream medical practices to reach a broader patient population. Included in this exploration are specific examples from CTN clinical trials.Keywords: Clinical Trials Network, drug abuse, addiction 

  17. [Quality management and practice-oriented research in a clinic-network of mother-/father-child rehabilitation centres]. (United States)

    Otto, F; Arnhold-Kerri, S


    The Research Network Prevention and Rehabilitation for Mothers and Children is an association of currently 24 rehabilitation centres for mothers, fathers and their children, and a scientific team at the Hannover Medical School. The Research Network combines practice-oriented research on mother and child health with the further development of treatment programmes and the implementation of internal quality management in mother-/father-child rehabilitation centres in accordance with DIN EN ISO 9001. The present paper describes the concept of the Research Network and the work contents addressed over the last three years. The advantages and disadvantages of this association and the changes initiated in practice were evaluated from the point of view of 19 quality managers of the participating clinics. The data were collected by means of semi-structured interviews, and a qualitative content analysis was performed in order to quantify the responses. The concept of the Research Network has proven successful. In the view of the quality managers of the clinics, implementation of DIN EN ISO 9001 has lead to structuring of the processes, improved internal communication, and increased motivation in the team. The major obstacles were the lack of time and human resources. In all clinics, the participation in practice-related research projects und scientifically monitored concept development has contributed to optimizing everyday practice. The exchange between the quality managers in external quality circle meetings was of central importance. The conjunction of internal quality management, practice-related research and concept development in a network can be recommended also for other associations of clinics, health centres or medical practices. Georg Thieme Verlag KG Stuttgart.New York.

  18. Quantifying discipline practices using absolute versus relative frequencies: clinical and research implications for child welfare. (United States)

    Lindhiem, Oliver; Shaffer, Anne; Kolko, David J


    In the parent intervention outcome literatures, discipline practices are generally quantified as absolute frequencies or, less commonly, as relative frequencies. These differences in methodology warrant direct comparison as they have critical implications for study results and conclusions among treatments targeted at reducing parental aggression and harsh discipline. In this study, we directly compared the absolute frequency method and the relative frequency method for quantifying physically aggressive, psychologically aggressive, and nonaggressive discipline practices. Longitudinal data over a 3-year period came from an existing data set of a clinical trial examining the effectiveness of a psychosocial treatment in reducing parental physical and psychological aggression and improving child behavior (N = 139). Discipline practices (aggressive and nonaggressive) were assessed using the Conflict Tactics Scale. The two methods yielded different patterns of results, particularly for nonaggressive discipline strategies. We suggest that each method makes its own unique contribution to a more complete understanding of the association between parental aggression and intervention effects.

  19. Towards an ecology of eating disorders: creating sustainability through the integration of scientific research and clinical practice. (United States)

    Clinton, David


    The field of eating disorders is currently at a crossroads and faces important challenges of sustainability. These challenges include problems with the current diagnostic classification of eating disorders and the divide between scientific research and clinical practice. If not addressed, there is a danger that the field will fail to evolve adaptively, risking increased stagnation and reduced relevance. To meet these challenges, researchers and clinicians must work toward a more holistic ecology of eating disorders based on the interaction of theory, research and practice. The present paper proposes six steps towards increased sustainability based on developing clinically relevant diagnosis, using systematic quality assurance, expanding the scope of treatment research and the definition of evidence, promoting therapist development, as well as stimulating diversity and discourse. If we rise to the occasion and face these challenges, then we will be better equipped to meet the evolving needs of clinicians, researchers, and most importantly patients.

  20. Clinical Practice as Natural Laboratory for Psychotherapy Research: A Guide to Case-Based Time-Series Analysis (United States)

    Borckardt, Jeffrey J.; Nash, Michael R.; Murphy, Martin D.; Moore, Mark; Shaw, Darlene; O'Neil, Patrick


    Both researchers and practitioners need to know more about how laboratory treatment protocols translate to real-world practice settings and how clinical innovations can be systematically tested and communicated to a skeptical scientific community. The single-case time-series study is well suited to opening a productive discourse between practice…

  1. Use of the Menopause-Specific Quality of Life (MENQOL) questionnaire in research and clinical practice: a comprehensive scoping review. (United States)

    Sydora, Beate C; Fast, Hilary; Campbell, Sandy; Yuksel, Nese; Lewis, Jacqueline E; Ross, Sue


    The Menopause-Specific Quality of Life (MENQOL) questionnaire was developed as a validated research tool to measure condition-specific QOL in early postmenopausal women. We conducted a comprehensive scoping review to explore the extent of MENQOL's use in research and clinical practice to assess its value in providing effective, adequate, and comparable participant assessment information. Thirteen biomedical and clinical databases were systematically searched with "menqol" as a search term to find articles using MENQOL or its validated derivative MENQOL-Intervention as investigative or clinical tools from 1996 to November 2014 inclusive. Review articles, conference abstracts, proceedings, dissertations, and incomplete trials were excluded. Additional articles were collected from references within key articles. Three independent reviewers extracted data reflecting study design, intervention, sample characteristics, MENQOL questionnaire version, modifications and language, recall period, and analysis detail. Data analyses included categorization and descriptive statistics. The review included 220 eligible papers of various study designs, covering 39 countries worldwide and using MENQOL translated into more than 25 languages. A variety of modifications to the original questionnaire were identified, including omission or addition of items and alterations to the validated methodological analysis. No papers were found that described MENQOL's use in clinical practice. Our study found an extensive and steadily increasing use of MENQOL in clinical and epidemiological research over 18 years postpublication. Our results stress the importance of proper reporting and validation of translations and variations to ensure outcome comparison and transparency of MENQOL's use. The value of MENQOL in clinical practice remains unknown.

  2. The Acceptability Among Health Researchers and Clinicians of Social Media to Translate Research Evidence to Clinical Practice: Mixed-Methods Survey and Interview Study


    Tunnecliff, Jacqueline; Ilic, Dragan; Morgan, Prue; Keating, Jennifer; Gaida, James E; Clearihan, Lynette; Sadasivan, Sivalal; Davies, David; Ganesh, Shankar; Mohanty, Patitapaban; Weiner, John; Reynolds, John; Maloney, Stephen


    Background Establishing and promoting connections between health researchers and health professional clinicians may help translate research evidence to clinical practice. Social media may have the capacity to enhance these connections. Objective The aim of this study was to explore health researchers? and clinicians? current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence. Methods This study used a mixed-methods approach ...

  3. New approaches to the Doppler echocardiographic assessment of diastolic function: from research laboratory to clinical practice (United States)

    Pasquet, A.; Garcia, M. J.; Thomas, J. D.


    Over the past decade, Doppler echocardiography has become a well-established tool for the diagnosis of left ventricular diastolic dysfunction. Unfortunately, in many clinical situations traditional Doppler indices of transmittal and pulmonary venous flow are inconclusive, primarily due to their dependence on left atrial pressure. Recently, new Doppler indices that are much less dependent on preload have been developed, based on intraventricular flow propagation and intrinsic myocardial velocity. These methodologies provide direct assessment of ventricular relaxation and the small intraventricular pressure gradients essential to efficient filling of the ventricle. We review in this article the theoretical and experiment background of these new echo techniques as well as how they can be implemented in routine clinical practice.

  4. Comparison of Approaches for Notification and Authorization in Pragmatic Clinical Research Evaluating Commonly Used Medical Practices. (United States)

    Weinfurt, Kevin P; Bollinger, Juli M; Brelsford, Kathleen M; Bresciani, Martina; Lampron, Zachary; Lin, Li; Topazian, Rachel J; Sugarman, Jeremy


    For pragmatic clinical research comparing commonly used treatments, questions exist about if and how to notify participants about it and secure their authorization for participation. To determine how patients react when they seek clinical care and encounter one of several different pragmatic clinical research studies. In an online survey using a between-subjects experimental design, respondents read and responded to 1 of 24 hypothetical research scenarios reflecting different types of studies and approaches to notification and authorization (eg, general notification, oral consent, written consent). English-speaking US adults 18 years and older. Willingness to participate in the hypothetical study, acceptability of the notification and authorization approach, understanding of the study, perceptions of benefit/harm, trust, and perception of amount of study information received. Willingness to participate did not differ by notification and authorization approach. Some (21%-36%) of the patients randomized to general notification with an explicit opt-out provision were not aware they would be enrolled by default. Acceptability was greatest for and similar among notification and authorization approaches that actively engaged the patient (eg, oral or written consent) and lower for approaches with less engagement (eg, general notification). Problems of understanding were found among 20%-55% of respondents, depending on the particular scenario. Most respondents (77%-94%) felt that participation in the hypothetical study posed no risks of harm to their health or privacy. Current attitudes about notification and authorization approaches and difficulties understanding pragmatic clinical research pose significant challenges for pragmatic research. Data from this study provide a starting point to developing solutions to these surprisingly complex issues.

  5. Novel survey disseminated through Twitter supports its utility for networking, disseminating research, advocacy, clinical practice and other professional goals. (United States)

    Borgmann, Hendrik; DeWitt, Sasha; Tsaur, Igor; Haferkamp, Axel; Loeb, Stacy


    Twitter use has grown exponentially within the urological community. We aimed to determine the perceptions of the impact of Twitter on users' clinical practice, research, and other professional activities. We performed an 11-item online survey of Twitter contributors during two major urological meetings: the European Association of Urology (EAU) and the American Urological Association (AUA) annual meetings. During the EAU 2014 meeting, we distributed the survey via the meeting official Twitter feed. During the AUA 2014 meeting, we applied a new method by directly sending the survey to Twitter contributors. We performed a subset analysis for assessing the perceived impact of Twitter on the clinical practice of physicians. Among 312 total respondents, the greatest perceived benefits of Twitter among users were for networking (97%) and disseminating information (96%), followed by research (75%), advocacy (74%) and career development (62%). In total, 65% of Twitter users have dealt with guidelines on online medical professionalism and 71% of physician users found that Twitter had an impact on their clinical practice, and 33% had made a clinical decision based on an online case discussion. Our results suggest that Twitter users in the urological community perceive important benefits. These benefits extend to multiple professional domains, particularly networking, disseminating information, remote conference participation, research, and advocacy. This is the first study that has been disseminated to targeted individuals from the urological community directly through tweets, providing a proof of principle for this research method.

  6. The Palliative Outcome Scale (POS) applied to clinical practice and research: an integrative review. (United States)

    Rugno, Fernanda Capella; Carlo, Marysia Mara Rodrigues do Prado De


    to identify and evaluate the evidence found in the international scientific literature on the application of the Palliative Outcome Scale (POS) in clinical practice and research in Palliative Care (PC). integrative literature review, through the search of publications in journals indexed in PubMed / MEDLINE, LILACS, SciELO and CINAHL databases, between the years 1999 and 2014. the final sample consisted of 11 articles. In the data analysis, the articles were classified into 2 units of analysis (studies using the POS as a resource in research and studies using the POS in clinical practice), in which the information was presented in the form of sub-themes related to publications of the selected studies, highlighting the synthesis of the results. POS emerged as an important tool for measuring outcomes to assess the quality of life of patients and families, of the quality of care provided and the PC service organization. The international scientific literature on the application of POS proved to be relevant to the advancement and consolidation of the field of knowledge related to PC. identificar e avaliar as evidências encontradas na literatura científica internacional, referentes à aplicação da Palliative Outcome Scale (POS) na prática clínica e nas pesquisas em Cuidados Paliativos (CPs). revisão integrativa da literatura, por meio da busca de publicações nos periódicos indexados nas bases de dados PubMed/MEDLINE, LILACS, SciELO e CINAHL, entre os anos de 1999 e 2014. a amostra final do estudo constituiu-se de 11 artigos. Na análise dos dados, os artigos foram classificados em 2 unidades de análise (estudos que utilizam a POS como recurso na pesquisa e estudos que utilizam a POS na prática clínica), nas quais as informações foram apresentadas na forma de subtemas referentes às publicações dos estudos selecionados, com destaque para a síntese dos resultados. a POS se destacou como um importante instrumento de medidas de resultados para a avalia

  7. Analyzing the blood-brain barrier: the benefits of medical imaging in research and clinical practice. (United States)

    Chassidim, Yoash; Vazana, Udi; Prager, Ofer; Veksler, Ronel; Bar-Klein, Guy; Schoknecht, Karl; Fassler, Michael; Lublinsky, Svetlana; Shelef, Ilan


    A dysfunctional BBB is a common feature in a variety of brain disorders, a fact stressing the need for diagnostic tools designed to assess brain vessels' permeability in space and time. Biological research has benefited over the years various means to analyze BBB integrity. The use of biomarkers for improper BBB functionality is abundant. Systemic administration of BBB impermeable tracers can both visualize brain regions characterized by BBB impairment, as well as lead to its quantification. Additionally, locating molecular, physiological content in regions from which it is restricted under normal BBB functionality undoubtedly indicates brain pathology-related BBB disruption. However, in-depth research into the BBB's phenotype demands higher analytical complexity than functional vs. pathological BBB; criteria which biomarker based BBB permeability analyses do not meet. The involvement of accurate and engineering sciences in recent brain research, has led to improvements in the field, in the form of more accurate, sensitive imaging-based methods. Improvements in the spatiotemporal resolution of many imaging modalities and in image processing techniques, make up for the inadequacies of biomarker based analyses. In pre-clinical research, imaging approaches involving invasive procedures, enable microscopic evaluation of BBB integrity, and benefit high levels of sensitivity and accuracy. However, invasive techniques may alter normal physiological function, thus generating a modality-based impact on vessel's permeability, which needs to be corrected for. Non-invasive approaches do not affect proper functionality of the inspected system, but lack in spatiotemporal resolution. Nevertheless, the benefit of medical imaging, even in pre-clinical phases, outweighs its disadvantages. The innovations in pre-clinical imaging and the development of novel processing techniques, have led to their implementation in clinical use as well. Specialized analyses of vessels' permeability

  8. Quantifying Discipline Practices Using Absolute vs. Relative Frequencies: Clinical and Research Implications for Child Welfare (United States)

    Lindhiem, Oliver; Shaffer, Anne; Kolko, David J.


    In the parent intervention outcome literatures, discipline practices are generally quantified as absolute frequencies or, less commonly, as relative frequencies. These differences in methodology warrant direct comparison as they have critical implications for study results and conclusions among treatments targeted at reducing parental aggression and harsh discipline. In this study, we directly compared the absolute frequency method and the relative frequency method for quantifying physically aggressive, psychologically aggressive, and nonaggressive discipline practices. Longitudinal data over a 3-year period came from an existing data set of a clinical trial examining the effectiveness of a psychosocial treatment in reducing parental physical and psychological aggression and improving child behavior (N = 139; Kolko et al., 2009). Discipline practices (both aggressive and nonaggressive) were assessed using the Conflict Tactics Scale (CTS; Straus et al., 1998). The two methods yielded different patterns of results, particularly for nonaggressive discipline strategies. We suggest that each method makes its own unique contribution to a more complete understanding of the association between parental aggression and intervention effects. PMID:24106146

  9. The difficulty of making psychology research and clinical practice relevant to medicine: experiences and observations. (United States)

    Kessler, Rodger


    Psychology and medicine research and practice have demonstrated substantial and unique bodies of knowledge designed to both improve patient care and respond to contemporary health care needs for use of evidence and cost consciousness. At their full potential they represent a significant paradigm shift in healthcare. Despite impressive successes, it is clear that we are just on the cusp of such a change. These findings have had limited impact and penetration into medical practice, particularly outside of academic medicine and large, organized systems of health care, and there are multiple examples of such limitations in various arenas of health care. There also appear to be common themes to such examples which provide us opportunities to consider how psychologists might move things ahead. They also suggest how our unique position in academic medicine can both limit our impact and provide ways of creating continued shifts in the healthcare paradigm.

  10. The role of neuropsychology in UK pediatric HIV care: Relevance to clinical practice and research. (United States)

    Freeman, Anita


    There has been a dramatic improvement in the survival of children with perinatally-acquired HIV (PHIV) following the introduction of effective treatment in 1990s. The care for children living with PHIV is now focused on more accurately understanding the effects of both HIV and HIV treatment on the developing body and brain. An evaluation of current HIV neuroimaging, and neurocognitive research, when combined with clinical experience in the area of HIV, could help to inform United Kingdom (UK) PHIV service provision. This paper argues that an understanding from a neuropsychological perspective will help these young people to optimize their health, quality of life, and future functioning. The aim of the paper is to bring together research and clinical understanding of HIV and its treatment effects on the developing brain, together with an understanding of other potential neurological risk factors. It is argued here that there is a need for targeted neuropsychology assessment and preventative interventions, supported by clinical and preliminary research on the neurocognitive effects of HIV and its treatments.

  11. «Something the lord made» (2004. From research to clinical practice

    Directory of Open Access Journals (Sweden)



    Full Text Available Something the lord made is a biopic focused on the life of a young Afro?American carpenter getting involved in medical research, together with a renowned surgeon in Nashville (Tennessee during the 1930s.It does not only show related aspects with Cardiology, Surgery and Medical Practice but also exposes the difficulties who the aforesaid carpenter had to face in the beginning of the 20th century firstly pursuing an utopia (cardiac surgery and achieving at last a successful development in what constituted a relevant breakthrough in Medicine.

  12. A qualitative study examining methods of accessing and identifying research relevant to clinical practice among rehabilitation clinicians

    Directory of Open Access Journals (Sweden)

    Patel D


    Full Text Available Drasti Patel,1 Christine Koehmstedt,1 Rebecca Jones,1 Nathan T Coffey,1 Xinsheng Cai,2 Steven Garfinkel,2 Dahlia M Shaewitz,2 Ali A Weinstein1 1Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA, 2American Institutes for Research, Washington, DC, USA Purpose: Research examining the utilization of evidence-based practice (EBP specifically among rehabilitation clinicians is limited. The objective of this study was to examine how various rehabilitative clinicians including physical therapists, occupational therapists, rehabilitation counselors, and physiatrists are gaining access to literature and whether they are able to implement the available research into practice.Methods: A total of 21 total clinicians were interviewed via telephone. Using NVivo, a qualitative analysis of the responses was performed.Results: There were similarities found with respect to the information-seeking behaviors and translation of research across the different clinician types. Lack of time was reported to be a barrier for both access to literature and implementation of research across all clinician types. The majority of clinicians who reported having difficulty with utilizing the published literature indicated that the literature was not applicable to their practice, the research was not specific enough to be put into practice, or the research found was too outdated to be relevant. In addition, having a supportive work environment aided in the search and utilization of research through providing resources central to assisting clinicians in gaining access to health information.Conclusion: Our study identified several barriers that affect EBP for rehabilitation clinicians. The findings suggest the need for researchers to ensure that their work is applicable and specific to clinical practice for implementation to occur. Keywords: health information, information behavior, knowledge utilization

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

    Directory of Open Access Journals (Sweden)

    Pitts Nigel


    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

  14. Thiamin in Clinical Practice. (United States)

    Frank, Laura L


    Thiamin is a water-soluble vitamin also known as vitamin B1. Its biologically active form, thiamin pyrophosphate (TPP), is a cofactor in macronutrient metabolism. In addition to its coenzyme roles, TPP plays a role in nerve structure and function as well as brain metabolism. Signs and symptoms of thiamin deficiency (TD) include lactic acidosis, peripheral neuropathy, ataxia, and ocular changes (eg, nystagmus). More advanced symptoms include confabulation and memory loss and/or psychosis, resulting in Wernicke's encephalopathy and/or Wernicke's Korsakoff syndrome, respectively. The nutrition support clinician should be aware of patients who may be at risk for TD. Risk factors include those patients with malnutrition due to 1 or more nutrition-related etiologies: decreased nutrient intake, increased nutrient losses, or impaired nutrient absorption. Clinical scenarios such as unexplained heart failure or lactic acidosis, renal failure with dialysis, alcoholism, starvation, hyperemesis gravidarum, or bariatric surgery may increase the risk for TD. Patients who are critically ill and require nutrition support may also be at risk for TD, especially those who are given intravenous dextrose void of thiamin repletion. Furthermore, understanding thiamin's role as a potential therapeutic agent for diabetes, some inborn errors of metabolism, and neurodegenerative diseases warrants further research. This tutorial describes the absorption, digestion, and metabolism of thiamin. Issues pertaining to thiamin in clinical practice will be described, and evidence-based practice suggestions for the prevention and treatment of TD will be discussed. © 2015 American Society for Parenteral and Enteral Nutrition.

  15. Representativeness and optimal use of body mass index (BMI) in the UK Clinical Practice Research Datalink (CPRD)


    Bhaskaran, Krishnan; Forbes, Harriet J; Douglas, Ian; Leon, David A; Smeeth, Liam


    Objectives: To assess the completeness and representativeness of body mass index (BMI) data in the Clinical Practice Research Datalink (CPRD), and determine an optimal strategy for their use. Design: Descriptive study. Setting: Electronic healthcare records from primary care. Participants: A million patient random sample from the UK CPRD primary care database, aged ≥16 years. Primary and secondary outcome measures: BMI completeness in CPRD was evaluated by age, sex and calendar period. CPR...

  16. Delirium superimposed on dementia: a survey of delirium specialists shows a lack of consensus in clinical practice and research studies. (United States)

    Richardson, Sarah; Teodorczuk, Andrew; Bellelli, Giuseppe; Davis, Daniel H J; Neufeld, Karin J; Kamholz, Barbara A; Trabucchi, Marco; MacLullich, Alasdair M J; Morandi, Alessandro


    Despite advances in delirium knowledge and the publication of best practice guidelines, uncertainties exist regarding assessment of Delirium Superimposed on Dementia (DSD). An international survey of delirium specialists was undertaken to evaluate current practice. Invitations to participate in an online survey were distributed by email among members of four international delirium associations with additional publication on their websites. The survey covered the assessment and diagnosis of DSD in clinical practice and research studies. Questions were structured around current practice and attitudes. The 205 responders were mostly confident that they could detect DSD with 60% rating their confidence at 7 or above on a likert scale of 0 (none) to 10 (excellent). Seventy-six percent felt that Dementia with Lewy Bodies (DLB) was the most challenging dementia subtype in which to diagnose DSD. Several scales were used to assess for the presence of DSD including the Confusion Assessment Method (CAM) (54%), DSM-5 criteria (25%) and CAM-ICU (15%). Responders stated that attention (71%), fluctuation in cognitive status (65%), and arousability (41%) were the most clinically useful features to assess when diagnosing DSD. Motor fluctuations were also deemed important but 61% had no specific test to monitor these. The largest survey of DSD practice to date demonstrates that despite good levels of confidence in recognizing DSD, there exists a lack of consensus concerning assessment and diagnosis globally. These findings suggest the need for the development of more research leading to precise diagnostic criteria and comprehensive guidelines regarding the assessment and diagnosis of DSD.

  17. Clinical trial registries: a practical guide for sponsors and researchers of medicinal products

    National Research Council Canada - National Science Library

    Foote, MaryAnn


    ... Industry perspective on public clinical trial registries and results databases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...

  18. Optimizing the Definitions of Stroke, Transient Ischemic Attack, and Infarction for Research and Application in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Anne L. Abbott


    Full Text Available Background and purposeUntil now, stroke and transient ischemic attack (TIA have been clinically based terms which describe the presence and duration of characteristic neurological deficits attributable to intrinsic disorders of particular arteries supplying the brain, retina, or (sometimes the spinal cord. Further, infarction has been pathologically defined as death of neural tissue due to reduced blood supply. Recently, it has been proposed we shift to definitions of stroke and TIA determined by neuroimaging results alone and that neuroimaging findings be equated with infarction.MethodsWe examined the scientific validity and clinical implications of these proposals using the existing published literature and our own experience in research and clinical practice.ResultsWe found that the proposals to change to imaging-dominant definitions, as published, are ambiguous and inconsistent. Therefore, they cannot provide the standardization required in research or its application in clinical practice. Further, we found that the proposals are scientifically incorrect because neuroimaging findings do not always correlate with the clinical status or the presence of infarction. In addition, we found that attempts to use the proposals are disrupting research, are otherwise clinically unhelpful and do not solve the problems they were proposed to solve.ConclusionWe advise that the proposals must not be accepted. In particular, we explain why the clinical focus of the definitions of stroke and TIA should be retained with continued sub-classification of these syndromes depending neuroimaging results (with or without other information and that infarction should remain a pathological term. We outline ways the established clinically based definitions of stroke and TIA, and use of them, may be improved to encourage better patient outcomes in the modern era.

  19. Updating to the WAIS-III and WMS-III: considerations for research and clinical practice. (United States)

    Tulsky, David S; Ledbetter, Mark F


    The Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the Wechsler Memory Scale-Revised (WMS-R) are the most commonly used intelligence and memory scales in both clinical and neuropsychology. In 1997, updated versions of these instruments (the WAIS-III and WMS-III) were published. Because of the extensive use of the WAIS-R and WMS-R in the field and the body of accumulated research, there is naturally some reluctance by clinicians and researchers to update to the new versions. It is sometimes difficult for clinicians who test individuals on repeated occasions to switch over to the new versions of the scales because of the difficulty of interpreting score discrepancy between the 2 versions. Researchers, especially those conducting longitudinal research, have a similar difficulty in changing measurement devices because of the possible threat of internal validity. This article reviews the substantive revisions of the scales and outlines those issues that users should take into consideration when updating to the new versions.

  20. Family Medicine-Specific Practice-Based Research Network Productivity and Clinical and Translational Sciences Award Program Affiliation. (United States)

    Haggerty, Treah; Cole, Allison M; Xiang, Jun; Mainous, Arch G; Seehusen, Dean


    Practice-based research networks (PBRNs) are groups of practices that work together to conduct research. Little is known about the degree to which PBRNs may be achieving success. This is the first general survey of family medicine-based PBRN directors in the United States and Canada to examine research productivity outcomes of PBRNs and explore the association between Clinical and Translational Science Awards (CTSA) program affiliation and PBRN outcomes. The Council of Academic Family Medicine Educational Research Alliance conducted the survey and e-mailed it to 102 PBRN directors from the Agency for Healthcare Research and Quality's registration. A total of 54 (56%) PBRN directors responded to the survey. PBRNs with an affiliation with a CTSA program were more likely to report completion of quality improvement research and participation in multiple PBRN collaboration research projects. PBRNs affiliated with CTSA programs were less likely to report maintaining funding as a significant barrier. CTSA involvement with PBRNs results in family physician scientists' completing research and disseminating this research through publication. Also, PBRNs with CTSA partnerships have more funding availability. PBRN partnership with a CTSA is beneficial in furthering research in family medicine.

  1. Clinical Practice in Portuguese Sexology. (United States)

    Alarcão, Violeta; Ribeiro, Sofia; Almeida, Joana; Giami, Alain


    Few studies explore the clinicians' knowledge, attitudes, and practices regarding sexuality, despite their role in the sexual-health socialization process. This study focuses on Portuguese sexologists engaged in clinical practice. It aims to characterize sexologists' sex education and training and their clinical practices, including diagnostic and therapeutic approaches. This research followed the methodology of an European survey on sexology as a profession (Euro-Sexo). From the 91 respondents who completed questionnaires, 51 (56%) were active in clinical practice. Results indicate that the Portuguese clinical sexologist is significantly older, predominantly male, has had training in sexology, performs more scientific research, and is more engaged in teaching activities when compared to nonclinical working sexologists. This article describes the main sexual problems presented by patients to Portuguese clinical sexologists and highlights differences in the professional groups and approaches toward treating these problems by medical doctors and nonmedical professionals. Results reinforce the idea that there are intra-European differences in the educational background of sexologists and reveal important variations in Portuguese sexologists' education, training, and clinical practice. The representations and practices of the sexologists in Portugal, as in other European countries, are embedded in cultural scenarios and sexual cultures, with implications for the clinical practice.

  2. Seizure diaries for clinical research and practice: limitations and future prospects. (United States)

    Fisher, Robert S; Blum, David E; DiVentura, Bree; Vannest, Jennifer; Hixson, John D; Moss, Robert; Herman, Susan T; Fureman, Brandy E; French, Jacqueline A


    An NINDS-sponsored conference in April of 2011 reviewed issues in epilepsy clinical trials. One goal was to clarify new electronic methods for recording seizure information and other data in clinical trials. This selective literature review and compilation of expert opinion considers advantages and limitations of traditional paper-based seizure diaries in comparison to electronic diaries. Seizure diaries are a type of patient-reported outcome. All seizure diaries depend first on accurate recognition and recording of seizures, which is a problem since about half of seizures recorded during video-EEG monitoring are not known to the patient. Reliability of recording is another key issue. Diaries may not be at hand after a seizure, lost or not brought to clinic visits. On-line electronic diaries have several potential advantages over paper diaries. Smartphones are increasingly accessible as data entry gateways. Data are not easily lost and are accessible from clinic. Entries can be time-stamped and provide immediate feedback, validation or reminders. Data can also can be graphed and pasted into an EMR. Disadvantages include need for digital sophistication, higher cost, increased setup time, and requiring attention to potential privacy issues. The Epilepsy Diary by and Irody, Inc. has over 13,000 registrants and SeizureTracker over 10,000, and both are used for clinical and research purposes. Some studies have documented patient preference and increased compliance for electronic versus paper diaries. Seizure diaries can be challenging in the pediatric population. Children often have multiple seizure types and limited reporting of subjective symptoms. Multiple caregivers during the day require more training to produce reliable and consistent data. Diary-based observational studies have the advantages of low cost, allowing locus-of-control by the patient and testing in a "real-world" environment. Diary-based studies can also be useful as descriptive

  3. Patient Engagement Practices in Clinical Research among Patient Groups, Industry, and Academia in the United States: A Survey.

    Directory of Open Access Journals (Sweden)

    Sophia K Smith

    Full Text Available Patient-centered clinical trial design and execution is becoming increasingly important. No best practice guidelines exist despite a key stakeholder declaration to create more effective engagement models. This study aims to gain a better understanding of attitudes and practices for engaging patient groups so that actionable recommendations may be developed.Individuals from industry, academic institutions, and patient groups were identified through Clinical Trials Transformation Initiative and Drug Information Association rosters and mailing lists. Objectives, practices, and perceived barriers related to engaging patient groups in the planning, conduct, and interpretation of clinical trials were reported in an online survey. Descriptive and inferential statistical analysis of survey data followed a literature review to inform survey questions.Survey respondents (n = 179 valued the importance of involving patient groups in research; however, patient group respondents valued their contributions to research protocol development, funding acquisition, and interpretation of study results more highly than those contributions were valued by industry and academic respondents (all p < .001. Patient group respondents placed higher value in open communications, clear expectations, and detailed contract execution than did non-patient group respondents (all p < .05. Industry and academic respondents more often cited internal bureaucratic processes and reluctance to share information as engagement barriers than did patient group respondents (all p < .01. Patient groups reported that a lack of transparency and understanding of the benefits of collaboration on the part of industry and academia were greater barriers than did non-patient group respondents (all p< .01.Despite reported similarities among approaches to engagement by the three stakeholder groups, key differences exist in perceived barriers and benefits to partnering with patient groups among the

  4. Therapeutic Change in Group Therapy For Interpersonal Trauma: A Relational Framework for Research and Clinical Practice. (United States)

    Chouliara, Zoë; Karatzias, Thanos; Gullone, Angela; Ferguson, Sandra; Cosgrove, Katie; Burke Draucker, Claire


    Our understanding of therapeutic change processes in group therapy for complex interpersonal trauma has been limited. The present study aimed at addressing this gap by developing a framework of therapeutic change in this field from a survivor and therapist perspective. This is a qualitative study, which utilized semistructured individual interviews. Transcripts were analyzed using interpretative phenomenological analysis (IPA) to identify recurrent themes. A final sample of n = 16 patients and n = 5 facilitators completed the interview. Main change processes identified by survivors were as follows: self versus others, trust versus threat, confrontation versus avoidance, and "patching up" versus true healing. Therapeutic processes identified by therapist facilitators included managing group dynamics, unpredictability and uncertainty, and process versus content. The proposed framework explains therapeutic change in group therapy in relational terms, that is, therapeutic dissonance, the dynamic interaction of self and experience as well as building empathic trusting relations. The importance of managing dissonance to aid personally meaningful recovery was highlighted. These findings have implications for the usefulness of relational and person-centered approaches to clinical practice in the area of interpersonal and complex trauma, especially in the early identification, prevention, and management of dropouts.

  5. Neuroethics and Disorders of Consciousness: Discerning Brain States in Clinical Practice and Research. (United States)

    Fins, Joseph J


    Decisions about end-of-life care and participation in clinical research for patients with disorders of consciousness begin with diagnostic discernment. Accurately distinguishing between brain states clarifies clinicians' ethical obligations and responsibilities. Central to this effort is the obligation to provide neuropalliative care for patients in the minimally conscious state who can perceive pain and to restore functional communication through neuroprosthetics, drugs, and rehabilitation to patients with intact but underactivated neural networks. Efforts to bring scientific advances to patients with disorders of consciousness are reviewed, including the investigational use of deep brain stimulation in patients in the minimally conscious state. These efforts help to affirm the civil rights of a population long on the margins. © 2016 American Medical Association. All Rights Reserved.

  6. [How to assess insulin action in man in research and clinical practice]. (United States)

    Scheen, A J


    Various methods have been proposed to assess insulin action in vivo, from the most complex to the simplest. All methods are based on the comparison of plasma concentrations of glucose and insulin, but can be differentiated by some important characteristics: evaluation in the basal state, after administration of exogenous insulin or after stimulation of insulin secretion; measurement in conditions of normo, hyper- or hypoglycaemia; and assessment using or not a modeling approach. For research purpose, the most informative techniques, such as the "euglycaemic hyperinsulinaemic clamp" or the intravenous glucose tolerance test combined with the minimal model approach, should be preferred. Easier tests may be used as alternative approaches, such as the fixed insulin-glucose infusion or the continuous infusion of glucose with model assessment (CIGMA). In daily practice, the clinician can often use simpler indices, such as fasting insulin concentrations, eventually analysed in comparison with corresponding glucose levels using the HOMA method. The only easy to perform dynamic maneuver is the short insulin tolerance test, but it is subject to several criticisms. As every approach for measuring insulin action has its own advantages and disadvantages, the selection essentially depends on studied populations (diabetic or not), primary objectives and, most importantly, available means.

  7. Digital goniometric measurement of knee joint motion. Evaluation of usefulness for research settings and clinical practice. (United States)

    Cleffken, Berry; van Breukelen, Gerard; Brink, Peter; van Mameren, Henk; Olde Damink, Steven


    An accurate and reproducible measurement method for joint motion is essential for classification of success or failure in therapeutic intervention. Digital goniometry is increasingly used as a method of classification for knee joint excursion. The reliability of goniometry however remains debatable. Aim of the study was to determine both intra- and inter-rater reproducibility in degrees, with an electronic digital inclinometer (EDI 320) for active and passive maximum flexion and active maximum extension of the knee joint and to determine the reproducibility of active and passive range of motion. A classical crossover design, with strict measurement protocol was used. Two raters measured 72 knee motions each, in 42 healthy subjects in four sessions. The smallest detectable difference (SDD) was calculated by using adjusted Bland and Altman plots for each knee excursion. No differences in joint excursions between the sexes were found. Passive maximum flexion showed larger excursions than active maximum flexion with additional higher levels of reproducibility. SDDs for inter-rater comparisons yielded: 0+/-3.9 degrees for active maximum extension, 0+/-7.4 degrees for active maximum flexion, 0+/-6.4 degrees for passive maximum flexion, 0+/-7.6 degrees for AROM and 0+/-5.4 degrees for PROM. Intra-rater SDDs showed increased reproducibility by 0.4-1.9 degrees. We conclude that interpretation of knee joint excursions in clinical settings is with these SDDs. Clinical and statistical differences in research settings within these SDDs are not a true difference but should be attributed to measurement error.

  8. Integrating substance abuse care with community diabetes care: implications for research and clinical practice

    Directory of Open Access Journals (Sweden)

    Ghitza UE


    Full Text Available Udi E Ghitza,1 Li-Tzy Wu,2 Betty Tai11Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, 2Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USAAbstract: Cigarette smoking and alcohol use are prevalent among individuals with diabetes in the US, but little is known about screening and treatment for substance use disorders in the diabetic population. This commentary discusses the scope and clinical implications of the public health problem of coexisting substance use and diabetes, including suggestions for future research. Diabetes is the seventh leading cause of death in the US, and is associated with many severe health complications like cardiovascular disease, stroke, kidney damage, and limb amputations. There are an estimated 24 million adults in the US with type 2 diabetes. Approximately 20% of adults aged 18 years or older with diabetes report current cigarette smoking. The prevalence of current alcohol use in the diabetic population is estimated to be around 50%–60% in epidemiological surveys and treatment-seeking populations. Cigarette smoking is associated with an increased risk of type 2 diabetes in a dose-dependent manner and is an independent modifiable risk factor for development of type 2 diabetes. Diabetic patients with an alcohol or other drug use disorder show a higher rate of adverse health outcomes. For example, these patients experience more frequent and severe health complications as well as an increased risk of hospitalization, and require longer hospital stays. They are also less likely to seek routine care for diabetes or adhere to diabetes treatment than those without an alcohol or other drug use disorder. The Affordable Care Act of 2010 and the Mental Health Parity Act and Addiction Equity Act of 2008 provide opportunities for facilitating integration of

  9. Globalisation as we enter the 21st century: reflections and directions for nursing education, science, research and clinical practice. (United States)

    Davidson, Patricia M; Meleis, Afaf; Daly, John; Douglas, Marilyn Marty


    The events of September 11th, 2001 in the United States and the Bali bombings of October 2002 are chastening examples of the entangled web of the religious, political, health, cultural and economic forces we experience living in a global community. To view these forces as independent, singular, linearly deterministic entities of globalisation is irrational and illogical. Understanding the concept of globalisation has significant implications not only for world health and international politics, but also the health of individuals. Depending on an individual's political stance and world-view, globalisation may be perceived as an emancipatory force, having the potential to bridge the chasm between rich and poor or, in stark contrast, the very essence of the divide. It is important that nurses appreciate that globalisation does not pertain solely to the realms of economic theory and world politics, but also that it impacts on our daily nursing practice and the welfare of our patients. Globalisation and the closer interactions of human activity that result, have implications for international governance, policy and theory development as well as nursing education, research and clinical practice. Nurses, individually and collectively, have the political power and social consciousness to influence the forces of globalisation to improve health for all. This paper defines and discusses globalisation in today's world and its implications for contemporary nursing education, science, research and clinical practice.

  10. International clinical trials, cardiovascular disease and treatment options in the Russian Federation: research and treatment in practice. (United States)

    Zvonareva, Olga; Engel, Nora; Martsevich, Sergey; de Wert, Guido; Horstman, Klasien


    The issue of balance between research and treatment in clinical trials conduct has been surrounded by controversies. Scientific characteristics of trials may compromise medical care available to participants, while conceiving research participation as having therapeutic value may foster the therapeutic misconception. However, it has also been questioned whether research can and should always be separated from medical care provision. In this paper we analyze how these concerns played out in practice settings of the three trial sites in Russia, specialized in trials in cardiovascular diseases. Using in-depth interviews with participants of phase II and III trials (n = 21) and discussions with physician-investigators (n = 7), we found that trial enrollment allowed participants to establish continuous supportive relationships with the physician-investigators. In the context of unresponsive health care, chronically ill participants received regular monitoring, treatment recommendations and help in case of problems and emergencies through such relationships. The trial designs in the three sites did not preclude the provision of individualized treatment. We suggest that debates about the research/treatment interface in trials need to become more attuned to the conditions in locations of their conduct, views and experiences of actors involved and evolving trial methodologies. Too much focus on categorical differentiation of research and treatment may obscure the fact that globalizing clinical trials proceed amidst profound health disparities, dismiss diverse concerns of people on the ground and risk attenuating responsibilities of trial organizers, sponsors and investigators towards research participants. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Clinical trial registries: a practical guide for sponsors and researchers of medicinal products

    National Research Council Canada - National Science Library

    Foote, MaryAnn


    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix MaryAnn Foote Clinical trial registries and publication of results - a primer . . . . . . . . . . . . . . . . . . 1 Ana Marušić and Charlotte Haug The journal...

  12. [Introduction of a Clinical Research Experience Program in Hospital Practical Training for Pharmacy Students and Its Evaluation]. (United States)

    Takahashi, Katsuyuki; Suda, Yasuki; Kawaguchi, Hiroshi; Nakamura, Yasutaka; Kawabata, Shiho; Kawakami, Noriko; Nishikawa, Takeshi; Nagayama, Katsuya


    Long-term clinical training based on a model core curriculum was conducted to nurture highly competent pharmacists in the clinical field. Pharmacists' responsibilities are expanding, and a system has been developed to help pharmacists gain accreditation, identify specialties, and improve their training. However, this system requires research competency. Therefore clinical research should be considered a part of clinical training to encourage high competency among pharmacists. Because the model core curriculum does not include a section on clinical research. Osaka City University Hospital introduced a hands-on clinical research experience program and evaluated its usefulness. A significant improvement in the level of knowledge and awareness of clinical research was seen among students who underwent the clinical research experience program. In addition, the level of student satisfaction was higher. These findings suggest that a clinical research experience program may be useful to nurture a greater awareness of clinical research and knowledge acquisition among pharmacists.

  13. Promoting integrative medicine by computerization of traditional Chinese medicine for scientific research and clinical practice: The SuiteTCM Project. (United States)

    Ferreira, Arthur de Sá


    Chinese and contemporary Western medical practices evolved on different cultures and historical contexts and, therefore, their medical knowledge represents this cultural divergence. Computerization of traditional Chinese medicine (TCM) is being used to promote the integrative medicine to manage, process and integrate the knowledge related to TCM anatomy, physiology, semiology, pathophysiology, and therapy. We proposed the development of the SuiteTCM software, a collection of integrated computational models mainly derived from epidemiology and statistical sciences for computerization of Chinese medicine scientific research and clinical practice in all levels of prevention. The software includes components for data management (DataTCM), simulation of cases (SimTCM), analyses and validation of datasets (SciTCM), clinical examination and pattern differentiation (DiagTCM, TongueTCM, and PulseTCM), intervention selection (AcuTCM, HerbsTCM, and DietTCM), management of medical records (ProntTCM), epidemiologic investigation of sampled data (ResearchTCM), and medical education, training, and assessment (StudentTCM). The SuiteTCM project is expected to contribute to the ongoing development of integrative medicine and the applicability of TCM in worldwide scientific research and health care. The SuiteTCM 1.0 runs on Windows XP or later and is freely available for download as an executable application.

  14. Cost-effectiveness analysis alongside clinical trials II-An ISPOR Good Research Practices Task Force report. (United States)

    Ramsey, Scott D; Willke, Richard J; Glick, Henry; Reed, Shelby D; Augustovski, Federico; Jonsson, Bengt; Briggs, Andrew; Sullivan, Sean D


    Clinical trials evaluating medicines, medical devices, and procedures now commonly assess the economic value of these interventions. The growing number of prospective clinical/economic trials reflects both widespread interest in economic information for new technologies and the regulatory and reimbursement requirements of many countries that now consider evidence of economic value along with clinical efficacy. As decision makers increasingly demand evidence of economic value for health care interventions, conducting high-quality economic analyses alongside clinical studies is desirable because they broaden the scope of information available on a particular intervention, and can efficiently provide timely information with high internal and, when designed and analyzed properly, reasonable external validity. In 2005, ISPOR published the Good Research Practices for Cost-Effectiveness Analysis Alongside Clinical Trials: The ISPOR RCT-CEA Task Force report. ISPOR initiated an update of the report in 2014 to include the methodological developments over the last 9 years. This report provides updated recommendations reflecting advances in several areas related to trial design, selecting data elements, database design and management, analysis, and reporting of results. Task force members note that trials should be designed to evaluate effectiveness (rather than efficacy) when possible, should include clinical outcome measures, and should obtain health resource use and health state utilities directly from study subjects. Collection of economic data should be fully integrated into the study. An incremental analysis should be conducted with an intention-to-treat approach, complemented by relevant subgroup analyses. Uncertainty should be characterized. Articles should adhere to established standards for reporting results of cost-effectiveness analyses. Economic studies alongside trials are complementary to other evaluations (e.g., modeling studies) as information for decision

  15. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. (United States)

    Seel, Ronald T; Sherer, Mark; Whyte, John; Katz, Douglas I; Giacino, Joseph T; Rosenbaum, Amy M; Hammond, Flora M; Kalmar, Kathleen; Pape, Theresa Louise-Bender; Zafonte, Ross; Biester, Rosette C; Kaelin, Darryl; Kean, Jacob; Zasler, Nathan


    To conduct a systematic review of behavioral assessment scales for disorders of consciousness (DOC); provide evidence-based recommendations for clinical use based on their content validity, reliability, diagnostic validity, and ability to predict functional outcomes; and provide research recommendations on DOC scale development and validation. Articles published through March 31, 2009, using MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Biomedical Reference Collection, and PsycINFO. Thirteen primary terms that defined DOC were paired with 30 secondary terms that defined aspects of measurement. Scale names, abbreviations, and authors were also used as search terms. Task force members identified additional articles by using personal knowledge and examination of references in reviewed articles. Primary criteria included the following: (1) provided reliability, diagnostic validity, and/or prognostic validity data; (2) examined a cohort, case control, or case series sample of persons with DOC who were age older than or equal to 18 years; and (3) assessed in an acute care or rehabilitation setting. Articles were excluded if peer review was not conducted, original data were not reported, or an English language article was not available. The initial search yielded 580 articles. After paired rater review of study abstracts, guideline development was based on 37 articles representing 13 DOC scales. Rater pairs classified studies addressing diagnostic and prognostic validity by using the American Academy of Neurology 4-tier level of evidence scheme, and reliability by using a task force-developed 3-tier evidence scheme. An independent quality review of ratings was conducted, and corrections were made. The Coma Recovery Scale-Revised (CRS-R), Sensory Stimulation Assessment Measure (SSAM), Wessex Head Injury Matrix (WHIM

  16. Quality control of the translation of the laboratory research into clinical practice

    International Nuclear Information System (INIS)

    Denekamp, J.


    This paper discusses the biological basis of new treatment strategies that are being introduced into the clinic in the form of controlled clinical trials. There is an increasing awareness of the need for quality assurance in the design, execution and analysis of these trials. However there is little awareness of the need to critically assess the biological basis of the trial design, to ensure that no other biological principles have been contravened in the attempt to optimise just one of the many parameters that determine the differential in sensitivity between tumours and normal tissues. Some examples are given of the changes that have recently occurred in the laboratory interpretation of both the mechanism of action and the therapeutic gain of several novel approaches. If these are not considered, the carefully controlled clinical trials may be wasted, because of being based on an incomplete consideration of all the interconnected biological factors. (author)

  17. Development of Best practices document for Peptide Standards | Office of Cancer Clinical Proteomics Research (United States)

    The Assay Development Working Group (ADWG) of the CPTAC Program is currently drafting a document to propose best practices for generation, quantification, storage, and handling of peptide standards used for mass spectrometry-based assays, as well as interpretation of quantitative proteomic data based on peptide standards. The ADWG is seeking input from commercial entities that provide peptide standards for mass spectrometry-based assays or that perform amino acid analysis.

  18. Participatory Action Research in clinical nursing practice in a medical ward

    DEFF Research Database (Denmark)

    Kjerholt, Mette; Wagner, Lis; Lindhardt, Tove


    Background: Action research with a participatory approach (PAR) was used as research design in a medical ward but stopped midway because of lack of active actor participation in the actions. Aim: To describe challenges and barriers influencing lack of participation. Setting: A medical hospital ward...... framework and conditions are present not only prior to but during the entire project process. Implications. The study shows that PAR is not always suitable as research approach in a busy hospital ward. Furthermore, the study outlines methodological questions in relation to use of PAR....

  19. “Think Research” in Everyday Clinical Practice: Fostering Research Culture in Health Care Settings

    Directory of Open Access Journals (Sweden)

    Valsa Thomas


    Full Text Available “No development without research; No research without development” Yvo Nuyens1TThe quest for knowledge has helped mankind evolve over the years, from discovery of fire through Dolly the sheep clone to Chandrayan moon mission, leaving behind a record of discoveries and inventions in science and technology. Each generation can begin the search for knowledge where the last one left off and contribute their share to the benefit of humanity, cutting across culture and boundaries.

  20. Validity of Preoperative Clinical Findings to Identify Dental Pulp Status: A National Dental Practice-Based Research Network Study. (United States)

    Pigg, Maria; Nixdorf, Donald R; Nguyen, Ruby H N; Law, Alan S


    Endodontic diagnostic tests are often used clinically to assess pulp status as a basis for the diagnosis and determination of whether root canal treatment (RCT) is indicated. Response to cold and pain on percussion are 2 common tests, yet their validity in identifying nonvital pulp in regular dental practice has not been reported. We assessed the validity of cold and percussion tests to identify nonvital pulp in teeth requiring RCT in a dental practice setting performed by 46 general dentists and 16 endodontists in the National Dental Practice-Based Research Network. The influence of patient-, tooth-, and dentist-related characteristics was investigated. Observed bleeding from the pulp chamber was the clinical reference. Sensitivity (SN), specificity (SP), overall test accuracy (TA), positive (PPV) and negative (NPV) predictive values, and likelihood and diagnostic odds ratios (LR+, LR-, dORs) were calculated for each single test and the combined cold and percussion tests. Seven hundred eight patient teeth were included. Cold test showed high validity to identify a nonvital pulp status (SN = 89%, SP = 80%, TA = 84%, PPV = 81%, NPV = 88%, LR+ = 4.35, LR- = 0.14, dOR = 31.4), whereas pain on percussion had lower validity (SN = 72%, SP = 41%, TA = 56%, PPV = 54%, NPV = 60%, LR+ = 1.22, LR- = 0.69, dOR = 1.78). Combining the 2 tests did not increase validity, whereas preoperative pain, medication intake, patient age and sex, and dentist training level affected test validity significantly. In regular dental practice, the cold test exhibits higher validity to discriminate between vital and nonvital pulp than the tooth percussion test. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  1. Regression assumptions in clinical psychology research practice-a systematic review of common misconceptions. (United States)

    Ernst, Anja F; Albers, Casper J


    Misconceptions about the assumptions behind the standard linear regression model are widespread and dangerous. These lead to using linear regression when inappropriate, and to employing alternative procedures with less statistical power when unnecessary. Our systematic literature review investigated employment and reporting of assumption checks in twelve clinical psychology journals. Findings indicate that normality of the variables themselves, rather than of the errors, was wrongfully held for a necessary assumption in 4% of papers that use regression. Furthermore, 92% of all papers using linear regression were unclear about their assumption checks, violating APA-recommendations. This paper appeals for a heightened awareness for and increased transparency in the reporting of statistical assumption checking.

  2. Evidence-Based Assessment of Child Obsessive Compulsive Disorder: Recommendations for Clinical Practice and Treatment Research (United States)

    Lewin, Adam B.; Piacentini, John


    Obsessive-compulsive disorder (OCD) presents heterogeneously and can be difficult to assess in youth. This review focuses on research-supported assessment approaches for OCD in childhood. Content areas include pre-visit screening, diagnostic establishment, differential diagnosis, assessment of comorbid psychiatric conditions, tracking symptom…

  3. Comorbidity of Anxiety and Conduct Problems in Children: Implications for Clinical Research and Practice (United States)

    Cunningham, Natoshia Raishevich; Ollendick, Thomas H.


    Given the relative lack of research on the comorbidity of anxiety disorders (ADs) and conduct problems (oppositional defiant disorder, conduct disorder) in youth, we examine this comorbidity from both basic and applied perspectives. First, we review the concept of comorbidity and provide a framework for understanding issues pertaining to…

  4. [Neuroethics in clinical practice]. (United States)

    Krug, H


    In recent years the ability of neuroscience to identify and intervene in mental functions has progressed immensely, which raises several anthropologic and ethical questions. Meanwhile neuroethics arose as a new interdisciplinary field for critical analysis of neuroscientific actions and ethical reflection on the increasing knowledge of the human brain, with regard to society and politics. This article provides a survey of neuroethical implications for clinical practice.

  5. Definition and measurement of guilt: Implications for clinical research and practice (United States)

    Tilghman-Osborne, Carlos; Cole, David A.; Felton, Julia W.


    Research on the relation of guilt to psychopathology is highly inconsistent. Some studies suggest that guilt contributes to psychopathology; others suggest that guilt serves a protective role. This review of 23 theory-based definitions of guilt and 25 measures of guilt suggests that a lack of conceptual clarity may be to blame. Measures of guilt do not correspond well to the definitions from which they derive. Many definitions and measures reflect the intrusion of extraneous constructs that could confound guilt research. Furthermore, definitions and measures of guilt change with developmental level. Nevertheless, two broad conceptualizations of guilt emerge. Central to both is a focus on one’s action or inactions involving real or imagined moral transgressions. Distinguishing the two conceptualizations is whether or not guilt is inherently adaptive construct, generating remorse, augmenting a sense of responsibility, and motivating reparation. Recommendations for the definition and measurement of guilt are discussed. PMID:20451312

  6. Participant retention practices in longitudinal clinical research studies with high retention rates

    Directory of Open Access Journals (Sweden)

    Martha Abshire


    Full Text Available Abstract Background There is a need for improving cohort retention in longitudinal studies. Our objective was to identify cohort retention strategies and implementation approaches used in studies with high retention rates. Methods Longitudinal studies with ≥200 participants, ≥80% retention rates over ≥1 year of follow-up were queried from an Institutional Review Board database at a large research-intensive U.S. university; additional studies were identified through networking. Nineteen (86% of 22 eligible studies agreed to participate. Through in-depth semi-structured interviews, participants provided retention strategies based on themes identified from previous literature reviews. Synthesis of data was completed by a multidisciplinary team. Results The most commonly used retention strategies were: study reminders, study visit characteristics, emphasizing study benefits, and contact/scheduling strategies. The research teams were well-functioning, organized, and persistent. Additionally, teams tailored their strategies to their participants, often adapting and innovating their approaches. Conclusions These studies included specialized and persistent teams and utilized tailored strategies specific to their cohort and individual participants. Studies’ written protocols and published manuscripts often did not reflect the varied strategies employed and adapted through the duration of study. Appropriate retention strategy use requires cultural sensitivity and more research is needed to identify how strategy use varies globally.

  7. Clinical Trials Network / Building Infrastructure to Accelerate Transfer of Basic Research in Spinal Cord Injury (SCI) to Clinical Practice (United States)


    serious adverse effects or death. Increase in liver enzyme and bilirubin levels were found in 14–70% of patients, but these elevations returned to...Mexiletine – Oral contraceptives – Phenylpropanolamine – Thiabendazole – Zileuton Inducers: – Montelukast – Phenytoin *Note: no washout period required; if...clinical trials of the comparative effectiveness of new therapies for spinal cord injury using an established consortium of neurosurgery departments at

  8. Shared Learning and Clinical Teamwork: New Directions in Education for Multiprofessional Practice. Researching Professional Education Research Report Series. (United States)

    Miller, Carolyn; Ross, Nick; Freeman, Marnie

    The role of collaborative/shared learning in nursing, midwifery, and visiting nurse education in the United Kingdom was explored to identify the qualities and skills needed by practitioners to work effectively in multiprofessional contexts and establish the fit between the knowledge and skills needed in multiprofessional practice and the teaching…

  9. The acceptability among health researchers and clinicians of social media to translate research evidence to clinical practice: mixed-methods survey and interview study. (United States)

    Tunnecliff, Jacqueline; Ilic, Dragan; Morgan, Prue; Keating, Jennifer; Gaida, James E; Clearihan, Lynette; Sadasivan, Sivalal; Davies, David; Ganesh, Shankar; Mohanty, Patitapaban; Weiner, John; Reynolds, John; Maloney, Stephen


    Establishing and promoting connections between health researchers and health professional clinicians may help translate research evidence to clinical practice. Social media may have the capacity to enhance these connections. The aim of this study was to explore health researchers' and clinicians' current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence. This study used a mixed-methods approach to obtain qualitative and quantitative data. Participation was open to health researchers and clinicians. Data regarding demographic details, current use of social media, and beliefs and attitudes towards the use of social media for professional purposes were obtained through an anonymous Web-based survey. The survey was distributed via email to research centers, educational and clinical institutions, and health professional associations in Australia, India, and Malaysia. Consenting participants were stratified by country and role and selected at random for semistructured telephone interviews to explore themes arising from the survey. A total of 856 participants completed the questionnaire with 125 participants declining to participate, resulting in a response rate of 87.3%. 69 interviews were conducted with participants from Australia, India, and Malaysia. Social media was used for recreation by 89.2% (749/840) of participants and for professional purposes by 80.0% (682/852) of participants. Significant associations were found between frequency of professional social media use and age, gender, country of residence, and graduate status. Over a quarter (26.9%, 229/852) of participants used social media for obtaining research evidence, and 15.0% (128/852) of participants used social media for disseminating research evidence. Most participants (95.9%, 810/845) felt there was a role for social media in disseminating or obtaining research evidence. Over half of the participants (449/842, 53.3%) felt they had a

  10. Chronic obstructive pulmonary disease and heart failure: research and clinical practice in primary care

    Directory of Open Access Journals (Sweden)

    Francesco Chiumeo


    Full Text Available The treatment of chronic obstructive pulmonary disease (COPD and comorbidities, increasing with age, is the challenge that nowadays health care systems are facing to better care treat these patients. For this reason a clinical trial was conducted in the province of Trento by a group of 30 volunteer general practitioners members of SNAMID (Scientific Society for Continuing Medical Education of General Practitioners. The objectives were to identify: i prevalence of COPD in patients (65-98 years in the province of Trento; ii presence and incidence of heart failure (HF in COPD patients; iii early detection of other chronic diseases; and iv improving electronic medical records (EMR as an innovation way of professional care management. From May 2011 to October 2013, 17 doctors completed the two-year work using the EMR. The studied patients were men and women (65-98 years, suffering from COPD; the considered data included: anthropometric information, smoking status, International Classification of Diseases (ICD-9 diagnosis of COPD, HF and chronic diseases, specific blood and instrumental tests. The extracted results were then linked with data of sentinel therapies, collected by the EMR. The database obtained identified patients with COPD or HF not previously recognized with ICD-9 diagnosis. The study identified the sentinel drugs chosen for COPD and HF, excluding other drugs not selective for the study or confusing for a proper statistical evaluation.

  11. The Use of Finite Element Analysis to Enhance Research and Clinical Practice in Orthopedics. (United States)

    Pfeiffer, Ferris M


    Finite element analysis (FEA) is a very powerful tool for the evaluation of biomechanics in orthopedics. Finite element (FE) simulations can effectively and efficiently evaluate thousands of variables (such as implant variation, surgical techniques, and various pathologies) to optimize design, screening, prediction, and treatment in orthopedics. Additionally, FEA can be used to retrospectively evaluate and troubleshoot complications or failures to prevent similar future occurrences. Finally, FE simulations are used to evaluate implants, procedures, and techniques in a time- and cost-effective manner. In this work, an overview of the development of FE models is provided and an example application is presented to simulate knee biomechanics for a specimen with medial meniscus insufficiency. FE models require the development of the geometry of interest, determination of the material properties of the tissues simulated, and an accurate application of a numerical solver to produce an accurate solution and representation of the field variables. The objectives of this work are to introduce the reader to the application of FEA in orthopedic analysis of the knee joint. A brief description of the model development process as well as a specific application to the investigation of knee joint stability in geometries with normal or compromised medial meniscal attachment is included. Significant increases in stretch of the anterior cruciate ligament were predicted in specimens with medial meniscus insufficiency (such behavior was confirmed in corresponding biomechanical testing). It can be concluded from this work that FE analysis of the knee can provide significant new information with which more effective clinical decisions can be made. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. Use of cone beam computed tomography in implant dentistry: current concepts, indications and limitations for clinical practice and research. (United States)

    Bornstein, Michael M; Horner, Keith; Jacobs, Reinhilde


    Diagnostic radiology is an essential component of treatment planning in the field of implant dentistry. This narrative review will present current concepts for the use of cone beam computed tomography imaging, before and after implant placement, in daily clinical practice and research. Guidelines for the selection of three-dimensional imaging will be discussed, and limitations will be highlighted. Current concepts of radiation dose optimization, including novel imaging modalities using low-dose protocols, will be presented. For preoperative cross-sectional imaging, data are still not available which demonstrate that cone beam computed tomography results in fewer intraoperative complications such as nerve damage or bleeding incidents, or that implants inserted using preoperative cone beam computed tomography data sets for planning purposes will exhibit higher survival or success rates. The use of cone beam computed tomography following the insertion of dental implants should be restricted to specific postoperative complications, such as damage of neurovascular structures or postoperative infections in relation to the maxillary sinus. Regarding peri-implantitis, the diagnosis and severity of the disease should be evaluated primarily based on clinical parameters and on radiological findings based on periapical radiographs (two dimensional). The use of cone beam computed tomography scans in clinical research might not yield any evident beneficial effect for the patient included. As many of the cone beam computed tomography scans performed for research have no direct therapeutic consequence, dose optimization measures should be implemented by using appropriate exposure parameters and by reducing the field of view to the actual region of interest. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Major depressive disorder in DSM-5: implications for clinical practice and research of changes from DSM-IV. (United States)

    Uher, Rudolf; Payne, Jennifer L; Pavlova, Barbara; Perlis, Roy H


    The changes in diagnostic criteria for major depressive disorder (MDD) from the fourth to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) may appear small but have important consequences for how the diagnosis is used. In DSM-5, MDD is part of the new "Depressive disorders" section, which is separate from "Bipolar disorders", marking a division in what had been known as "Mood disorders". A small wording change has expanded the core mood criterion to include hopelessness, potentially broadening the diagnosis. The replacement of an operationalized bereavement exclusion with a call for clinical judgment in distinguishing normal reactions to significant loss from a disorder in need of clinical attention makes the diagnosis less objective and complicates investigations of the relationship between adversity and depression. A new persistent depressive disorder category is intended to encompass both dysthymia and chronic depression, but its relationship to MDD is ambiguous with conflicting statements on whether the two diagnoses should be concurrent if both sets of criteria are fulfilled. Clarification is also needed on whether MDD can be concurrent with the new broad "other specified bipolar and related disorders". New specifiers of MDD "with anxious distress" and "with mixed features" allow characterization of additional symptoms. The specifier "with perinatal onset" expands on the DSM-IV "postnatal onset" to include onset during pregnancy. We review the changes in MDD definition, provide guidance on their implementation and discuss their implications for clinical practice and research. © 2013 Wiley Periodicals, Inc.

  14. Religion, spirituality, and medicine: research findings and implications for clinical practice. (United States)

    Koenig, Harold G


    A growing body of scientific research suggests connections between religion, spirituality, and both mental and physical health. The findings are particularly strong in patients with severe or chronic illnesses who are having stressful psychologic and social changes, as well as existential struggles related to meaning and purpose. Recent studies indicate that religious beliefs influence medical decisions, such as the use of chemotherapy and other life-saving treatments, and at times may conflict with medical care. This article addresses the ways physicians can use such information. Spirituality is an area that makes many physicians uncomfortable, since training in medical schools and continuing medical education programs are limited. Not only do most physicians lack the necessary training, they worry about spending additional time with patients and overstepping ethical boundaries. While these concerns are valid, each can be addressed in a sensible way. Taking a spiritual history, supporting the patient's beliefs, and orchestrating the fulfillment of spiritual needs are among the topics this article will address. The goal is to help physicians provide medical care that is sensitive to the way many patients understand and cope with medical illness.

  15. Systematic implementation of evidence-based practice in a clinical nursing setting : a participatory action research project

    NARCIS (Netherlands)

    Sandra van der Loo; Gerrie Bours; Anna Beurskens; Albine Moser; Jolanda Friesen-Storms


    Aims and objectives: To describe the process of implementing evidence-based practice (EBP) in a clinical nursing setting. Background: EBP has become a major issue in nursing, it is insufficiently integrated in daily practice and its implementation is complex. Design: Participatory action

  16. Research ethics for clinical researchers. (United States)

    Harnett, John D; Neuman, Richard


    This chapter describes the history of the development of modern research ethics. The governance of research ethics is discussed and varies according to geographical location. However, the guidelines used for research ethics review are very similar across a wide variety of jurisdictions. The paramount importance of protecting the privacy and confidentiality of research participants is discussed at length. Particular emphasis is placed on the process of informed consent, and step-by-step practical guidelines are described. The issue of research in vulnerable populations is touched upon and guidelines are provided. Practical advice is provided for researchers to guide their interactions with research ethics boards. Issues related to scientific misconduct and research fraud are not dealt with in this paper.

  17. Clinical Orofacial Examination in Juvenile Idiopathic Arthritis: International Consensus-based Recommendations for Monitoring Patients in Clinical Practice and Research Studies. (United States)

    Stoustrup, Peter; Twilt, Marinka; Spiegel, Lynn; Kristensen, Kasper Dahl; Koos, Bernd; Pedersen, Thomas Klit; Küseler, Annelise; Cron, Randy Q; Abramowicz, Shelly; Verna, Carlalberta; Peltomäki, Timo; Alstergren, Per; Petty, Ross; Ringold, Sarah; Nørholt, Sven Erik; Saurenmann, Rotraud K; Herlin, Troels


    To develop international consensus-based recommendations for the orofacial examination of patients with juvenile idiopathic arthritis (JIA), for use in clinical practice and research. Using a sequential phased approach, a multidisciplinary task force developed and evaluated a set of recommendations for the orofacial examination of patients with JIA. Phase 1: A Delphi survey was conducted among 40 expert physicians and dentists with the aim of identifying and ranking the importance of items for inclusion. Phase 2: The task force developed consensus about the domains and items to be included in the recommendations. Phase 3: A systematic literature review was performed to assess the evidence supporting the consensus-based recommendations. Phase 4: An independent group of orofacial and JIA experts were invited to assess the content validity of the task force's recommendations. Five recommendations were developed to assess the following 5 domains: medical history, orofacial symptoms, muscle and temporomandibular joint function, orofacial function, and dentofacial growth. After application of data search criteria, 56 articles were included in the systematic review. The level of evidence for the 5 recommendations was derived primarily from descriptive studies, such as cross-sectional and case-control studies. Five recommendations are proposed for the orofacial examination of patients with JIA to improve the clinical practice and aid standardized data collection for future studies. The task force has formulated a future research program based on the proposed recommendations.

  18. Biomechanics in clinical practice. (United States)

    Deusinger, R H


    Evidence from dynamic biomechanical analyses of physical activities has greatly expanded our knowledge about the mechanical bases for human movement function with potential implications for further understanding movement dysfunction. The purpose of this review is to relate these findings to present knowledge about the effect on human joints during movement, the role of muscle action on human skeletal levers during movement, and the application of this information to functional tasks by physical therapy clinicians. Also presented are some thoughts regarding what must be accomplished so that this material can be generalized to clinical practice.

  19. Connecting pre-marketing clinical research and medical practice : opinion-based study of core issues and possible changes in drug regulation

    NARCIS (Netherlands)

    Wieringa, N.F; Peschar, J.L.; Denig, P; de Graeff, P.A.; Vos, R


    Objectives: To identify core issues that contribute to the gap between pre-marketing clinical research and practice as seen from the perspective of medical practice, as well as possible changes and potential barriers for closing this gap. Methods: Interviews with 47 physicians and pharmacists who

  20. Architectural Practice as Research

    DEFF Research Database (Denmark)

    Hougaard, Anna Katrine


    The paper discusses a kind of research which lies between ‘research by design’ and ‘artistic research’. The term ‘research by design’ is reconstructed to include artistic ways of working, and the paper is an exemplification of a research practice, which seeks to let subjective and objective, qual...... in them, is the very research. This approach is framed by Deleuze’s reading of Bergson’s intuitive method and Peirce’s concept abduction, both methods which concern creative processes, material production and organisation, and the breakthrough of novelty....

  1. Lansoprazole use and tuberculosis incidence in the United Kingdom Clinical Practice Research Datalink: A population based cohort.

    Directory of Open Access Journals (Sweden)

    Tom A Yates


    Full Text Available Recent in vitro and animal studies have found the proton pump inhibitor (PPI lansoprazole to be highly active against Mycobacterium tuberculosis. Omeprazole and pantoprazole have no activity. There is no evidence that, in clinical practice, lansoprazole can treat or prevent incident tuberculosis (TB disease.We studied a cohort of new users of lansoprazole, omeprazole, or pantoprazole from the United Kingdom Clinical Practice Research Datalink to determine whether lansoprazole users have a lower incidence of TB disease than omeprazole or pantoprazole users. Negative control outcomes of myocardial infarction (MI and herpes zoster were also studied. Multivariable Cox proportional hazards regression was used to adjust for potential confounding by a wide range of factors. We identified 527,364 lansoprazole initiators and 923,500 omeprazole or pantoprazole initiators. Lansoprazole users had a lower rate of TB disease (n = 86; 10.0 cases per 100,000 person years; 95% confidence interval 8.1-12.4 than omeprazole or pantoprazole users (n = 193; 15.3 cases per 100,000 person years; 95% confidence interval 13.3-17.7, with an adjusted hazard ratio (HR of 0.68 (0.52-0.89. No association was found with MI (adjusted HR 1.04; 95% confidence interval 1.00-1.08 or herpes zoster (adjusted HR 1.03; 95% confidence interval 1.00-1.06. Limitations of this study are that we could not determine whether TB disease was due to reactivation of latent infection or a result of recent transmission, nor could we determine whether lansoprazole would have a beneficial effect if given to people presenting with TB disease.In this study, use of the commonly prescribed and cheaply available PPI lansoprazole was associated with reduced incidence of TB disease. Given the serious problem of drug resistance and the adverse side effect profiles of many TB drugs, further investigation of lansoprazole as a potential antituberculosis agent is warranted.

  2. Lansoprazole use and tuberculosis incidence in the United Kingdom Clinical Practice Research Datalink: A population based cohort. (United States)

    Yates, Tom A; Tomlinson, Laurie A; Bhaskaran, Krishnan; Langan, Sinead; Thomas, Sara; Smeeth, Liam; Douglas, Ian J


    Recent in vitro and animal studies have found the proton pump inhibitor (PPI) lansoprazole to be highly active against Mycobacterium tuberculosis. Omeprazole and pantoprazole have no activity. There is no evidence that, in clinical practice, lansoprazole can treat or prevent incident tuberculosis (TB) disease. We studied a cohort of new users of lansoprazole, omeprazole, or pantoprazole from the United Kingdom Clinical Practice Research Datalink to determine whether lansoprazole users have a lower incidence of TB disease than omeprazole or pantoprazole users. Negative control outcomes of myocardial infarction (MI) and herpes zoster were also studied. Multivariable Cox proportional hazards regression was used to adjust for potential confounding by a wide range of factors. We identified 527,364 lansoprazole initiators and 923,500 omeprazole or pantoprazole initiators. Lansoprazole users had a lower rate of TB disease (n = 86; 10.0 cases per 100,000 person years; 95% confidence interval 8.1-12.4) than omeprazole or pantoprazole users (n = 193; 15.3 cases per 100,000 person years; 95% confidence interval 13.3-17.7), with an adjusted hazard ratio (HR) of 0.68 (0.52-0.89). No association was found with MI (adjusted HR 1.04; 95% confidence interval 1.00-1.08) or herpes zoster (adjusted HR 1.03; 95% confidence interval 1.00-1.06). Limitations of this study are that we could not determine whether TB disease was due to reactivation of latent infection or a result of recent transmission, nor could we determine whether lansoprazole would have a beneficial effect if given to people presenting with TB disease. In this study, use of the commonly prescribed and cheaply available PPI lansoprazole was associated with reduced incidence of TB disease. Given the serious problem of drug resistance and the adverse side effect profiles of many TB drugs, further investigation of lansoprazole as a potential antituberculosis agent is warranted.

  3. [Good clinical practices in clinical trials: the responsibility of the researcher. A survey of 827 hospital physicians (I). Availability. Monitoring. Safety. Contract]. (United States)

    Dal-Ré, R


    The Law of Medicaments establishes that clinical trials (CT) with drugs must be carried out following the of Good Clinical Practice guidelines (GCP). The attitude of hospital physicians to the GCP prior to its implementation as mandatory in accordance with Spanish legislation was considered to be of interest. An anonymous survey was used with closed response questions. Questions referring to the responsibilities of the investigator included in the GCP were included. From December 1988 to February 1990 the survey was distributed among 1,706 hospital medical staff members, of any specialty, who had or had not participated in CT. In this article the results of the questions regarding the availability of the investigative team, CT monitorization, management of adverse reactions, the safety of the participants in the CT and the contract between the sponsor and the researcher are presented. A total of 827 hospital doctors replied to the survey. Fifty-nine percent had intervened in CT with drugs. At least 94% of those surveyed considered that the researcher must have the time and number of eligible patients which the CT requires. There was high acceptance (> or = 78%) of the clinical audits to be performed by the health authorities and the sponsor company of the CT. The need of urgent communication of the severe adverse reactions is admitted by a great majority (> or = 95%) of those surveyed. Eighty-five percent believe that patients should be insured against damage derived from CT with 76% considering that the investigator should sign a contract with the sponsor; 68% and 59% would hand in a copy of the same to the CT committee and the remainder of the research team, respectively. According to the Good Clinical Practice dealt with in this article, the responsibilities of the investigator have been widely accepted by the hospital physicians surveyed, therefore no problems should be expected upon the implementation of the same in this country. However, the economic

  4. Communication is the key to success in pragmatic clinical trials in Practice-based Research Networks (PBRNs). (United States)

    Bertram, Susan; Graham, Deborah; Kurland, Marge; Pace, Wilson; Madison, Suzanne; Yawn, Barbara P


    Effective communication is the foundation of feasibility and fidelity in practice-based pragmatic research studies. Doing a study with practices spread over several states requires long-distance communication strategies, including E-mails, faxes, telephone calls, conference calls, and texting. Compared with face-to-face communication, distance communication strategies are less familiar to most study coordinators and research teams. Developing and ensuring comfort with distance communications requires additional time and use of different talents and expertise than those required for face-to-face communication. It is necessary to make sure that messages are appropriate for the medium, clearly crafted, and presented in a manner that facilitates practices receiving and understanding the information. This discussion is based on extensive experience of 2 groups who have worked collaboratively on several large, federally funded, pragmatic trials in a practice-based research network. The goal of this article is to summarize lessons learned to facilitate the work of other research teams.

  5. Ageism and clinical research. (United States)

    Briggs, R; Robinson, S; O'Neill, D


    Despite being the most significant consumers of health care resources and medications worldwide, recent international research has highlighted the under-representation of older participants from clinical trials. This creates problems for physicians as the patients seen in clinical practice are not representative of those on which medical treatments and interventions have been trialled, and we need to consider whether results (both negative and positive) from these trials are applicable to these patients. Our aim was to gauge whether exclusion of older people was prevalent in research proposals submitted to Dublin teaching hospitals. We audited all clinical research proposals submitted to the Research Ethics committee (REC) covering the teaching hospitals attached to Trinity College Dublin (TCD) from July 2008 to July 2011 inclusive, recording exclusion of patients based on an arbitrary upper age limit. Of the 226 relevant trials studied, 31(13.7%) excluded participants based solely on an arbitrary upper age limit. 22 (9.8%) of the relevant trials were submitted by geriatricians, none of which excluded patients based solely on age. Over 50% (12 of 22) trials submitted by neurology/psychiatry excluded patients based on an upper age limit. The mean upper age limit used over all trials as a cut-off was 69.2 years of age. As well as this, the majority of the remaining trials also contained other exclusion criteria, especially those based on cognitive function which further limited participation of older people. While we found that a significant proportion of clinical trials submitted to the TCD REC still excluded patients based arbitrarily on an upper age limit, participation rates of older people seem to be higher in this Irish centre than that seen in international trials. Significant room for improvement still remains however and there needs to be a promotion of greater awareness of the need for developing, testing and licensing medicines so that it mirrors the

  6. Photographing Injuries in the Acute Care Setting: Development and Evaluation of a Standardized Protocol for Research, Forensics, and Clinical Practice. (United States)

    Bloemen, Elizabeth M; Rosen, Tony; Cline Schiroo, Justina A; Clark, Sunday; Mulcare, Mary R; Stern, Michael E; Mysliwiec, Regina; Flomenbaum, Neal E; Lachs, Mark S; Hargarten, Stephen


    Photographing injuries in the acute setting allows for improved documentation as well as assessment by clinicians and others who have not personally examined a patient. This tool is important, particularly for telemedicine, tracking of wound healing, the evaluation of potential abuse, and injury research. Despite this, protocols to ensure standardization of photography in clinical practice, forensics, or research have not been published. In preparation for a study of injury patterns in elder abuse and geriatric falls, our goal was to develop and evaluate a protocol for standardized photography of injuries that may be broadly applied. We conducted a literature review for techniques and standards in medical, forensic, and legal photography. We developed a novel protocol describing types of photographs and body positioning for eight body regions, including instructional diagrams. We revised it iteratively in consultation with experts in medical photography; forensics; and elder, child, and domestic abuse. The resulting protocol requires a minimum of four photos of each injury at multiple distances with and without a ruler/color guide. To evaluate the protocol's efficacy, multiple research assistants without previous photography experience photographed injuries from a convenience sample of elderly patients presenting to a single large, urban, academic emergency department. A selection of these patients' images were then evaluated in a blinded fashion by four nontreating emergency medicine physicians and the inter-rater reliability between these physicians was calculated. Among the 131 injuries, from 53 patients, photographed by 18 photographers using this protocol, photographs of 25 injuries (10 bruises, seven lacerations, and eight abrasions) were used to assess characterization of the injury. Physicians' characterizations of the injuries were reliable for the size of the injury (κ = 0.91, 95% confidence interval [CI] = 0.77 to 1.00), side of the body (κ = 0.97, 95

  7. Opinions of sports clinical practice chiropractors, with sports specialty training and those without, about chiropractic research priorities in sports health care: a centering resonance analysis (United States)

    Lee, Alexander D; Szabo, Kaitlyn; McDowell, Kirstie; Granger, Sydney


    Introduction: A Canadian sports chiropractic research agenda has yet to be defined. The Delphi method can be utilized to achieve this purpose; however, the sample of experts who participate can influence the results. To better inform sample selection for future research agenda development, we set out to determine if differences in opinions about research priorities exist between chiropractors who have their sports specialty designation and those who do not. Methods: Fifteen sports clinical practice chiropractors who have their sports fellowship designation and fifteen without, were interviewed with a set of standardized questions about sports chiropractic research priorities. A centering resonance analysis and cluster analysis were conducted on the interview responses. Results: The two practitioner groups differed in their opinions about the type of research that they would like to see conducted, the research that would impact their clinical practice the most, and where they believed research was lacking. However, both groups were similar in their opinions about research collaborations. Conclusion: Sports clinical practice chiropractors, with their sports specialty designation and those without, differed in their opinions about sports chiropractic research priorities; however, they had similar opinions about research collaborations. These results suggest that it may be important to sample from both practitioner groups in future studies aimed at developing research agendas for chiropractic research in sport. PMID:28065995

  8. [Alzheimer's disease cerebro-spinal fluid biomarkers: A clinical research tool sometimes useful in daily clinical practice of memory clinics for the diagnosis of complex cases]. (United States)

    Magnin, E; Dumurgier, J; Bouaziz-Amar, E; Bombois, S; Wallon, D; Gabelle, A; Lehmann, S; Blanc, F; Bousiges, O; Hannequin, D; Jung, B; Miguet-Alfonsi, C; Quillard, M; Pasquier, F; Peoc'h, K; Laplanche, J-L; Hugon, J; Paquet, C


    The role of biomarkers in clinical research was recently highlighted in the new criteria for the diagnosis of Alzheimer's disease. Cerebro-spinal fluid (CSF) biomarkers (total Tau protein, threonine 181 phosphorylated Tau protein and amyloid Aβ1-42 peptide) are associated with cerebral neuropathological lesions observed in Alzheimer's disease (neuronal death, neurofibrillary tangle with abnormal Tau deposits and amyloid plaque). Aβ1-40 amyloid peptide dosage helps to interpret Aβ1-42 results. As suggested in the latest international criteria and the French HAS (Haute Autorité de santé) recommendations, using theses CSF biomarkers should not be systematic but sometimes could be performed to improve confidence about the diagnostic of Alzheimer's disease in young subjects or in complex clinical situations. Future biomarkers actually in development will additionally help in diagnostic process (differential diagnosis) and in prognostic evaluation of neurodegenerative diseases. Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  9. Prevalence of hypercalcemia of malignancy among cancer patients in the UK: analysis of the Clinical Practice Research Datalink database. (United States)

    Jick, Susan; Li, Lin; Gastanaga, Victor M; Liede, Alexander


    The reported proportion of cancer patients who experience hypercalcemia of malignancy (HCM) ranges between 3% and 30%. HCM can be observed with any type of tumor and occurs most commonly in lung cancer, breast cancer and multiple myeloma. While HCM is a potentially fatal condition, the prevalence of HCM is not well defined. Using the United Kingdom Clinical Practice Research Datalink, we identified adult cancer patients with recorded corrected serum calcium (CSC). Hypercalcemic patients (CSC ≥ 10.8 mg/dL) were classified into 4 CSC levels. We estimated annual prevalence of HCM overall, stratified by cancer type, and in patients with stage IV cancer. Among 37,442 cancer patients in 2003-2012 the prevalence of grade 1 HCM increased from 0.13% to 0.45% and the prevalence of HCM overall (grade 1 or higher) increased from 0.20% to 0.67% over the study period. Prevalence estimates varied across cancer type and were highest for lung cancer, multiple myeloma and patients with stage IV cancer. We provide the first systematic analysis using a UK population-based data source to estimate number of cancer patients affected with HCM by grade. The increase in HCM prevalence over the 10-year study period is likely due to the increased recording of laboratory values, particularly comparing more recent data to 2003. Our findings suggest that HCM in general is not a common condition. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Which Patients with Giant Cell Arteritis Will Develop Cardiovascular or Cerebrovascular Disease? A Clinical Practice Research Datalink Study. (United States)

    Robson, Joanna C; Kiran, Amit; Maskell, Joe; Hutchings, Andrew; Arden, Nigel; Dasgupta, Bhaskar; Hamilton, William; Emin, Akan; Culliford, David; Luqmani, Raashid


    To evaluate the risk of cerebrovascular disease and cardiovascular disease (CVD) in patients with giant cell arteritis (GCA), and to identify predictors. The UK Clinical Practice Research Datalink 1991-2010 was used for a parallel cohort study of 5827 patients with GCA and 37,090 age-, sex-, and location-matched controls. A multivariable competing risk model (non-cerebrovascular/CV-related death as the competing risk) determined the relative risk [subhazard ratio (SHR)] between patients with GCA compared with background controls for cerebrovascular disease, CVD, or either. Each cohort (GCA and controls) was then analyzed individually using the same multivariable model, with age and sex now present, to identify predictors of CVD or cerebrovascular disease. Patients with GCA, compared with controls, had an increased risk SHR (95% CI) of cerebrovascular disease (1.45, 1.31-1.60), CVD (1.49, 1.37-1.62), or either (1.47, 1.37-1.57). In the GCA cohort, predictors of "cerebrovascular disease or CVD" included increasing age, > 80 years versus cerebrovascular disease or CVD than age-, sex-, and location-matched controls. In common with the non-GCA cohort, patients who are older, male, and from the most deprived compared with least deprived areas have a higher risk of cerebrovascular disease or CVD. Further work is needed to understand how this risk may be mediated by specific behavioral, social, and economic factors.

  11. Multiple factors are involved in the dysarthria associated with Parkinson's disease: a review with implications for clinical practice and research. (United States)

    Sapir, Shimon


    Motor speech abnormalities are highly common and debilitating in individuals with idiopathic Parkinson's disease (IPD). These abnormalities, collectively termed hypokinetic dysarthria (HKD), have been traditionally attributed to hypokinesia and bradykinesia secondary to muscle rigidity and dopamine deficits. However, the role of rigidity and dopamine in the development of HKD is far from clear. The purpose of the present study was to offer an alternative view of the factors underlying HKD. The authors conducted an extensive, but not exhaustive, review of the literature to examine the evidence for the traditional view versus the alternative view. The review suggests that HKD is a highly complex and variable phenomenon including multiple factors, such as scaling and maintaining movement amplitude and effort; preplanning and initiation of movements; internal cueing; sensory and temporal processing; automaticity; emotive vocalization; and attention to action (vocal vigilance). Although not part of the dysarthria, nonmotor factors, such as depression, aging, and cognitive-linguistic abnormalities, are likely to contribute to the overall speech symptomatology associated with IPD. These findings have important implications for clinical practice and research.

  12. Planning Practice and Research

    DEFF Research Database (Denmark)


    Urban planning has dramatically shifted when compared with its former logics and styles. Increasingly, the dynamics of large urban agglomerations spanning multiple boundaries put significant pressure on planning institutions to scale up. In this shifting context, how can both planning theory...... and practice co- evolve in adapting to the ever-increasing transformation of cities and urban regions? In this context, Planning Practice and Research (PPR) is seeking perspectives from the young academic community in planning. We propose to publish at least one special edition of PPR with a number of short...... papers from Young Academics. The contributions should address the question of how planning theory and practice can respond to the increasing complexity of cities and regions....

  13. Promoting physical therapists' of research evidence to inform clinical practice: part 1--theoretical foundation, evidence, and description of the PEAK program. (United States)

    Tilson, Julie K; Mickan, Sharon


    There is a need for theoretically grounded and evidence-based interventions that enhance the use of research evidence in physical therapist practice. This paper and its companion paper introduce the Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program, an educational program designed to promote physical therapists' integration of research evidence into clinical decision-making. The pedagogical foundations for the PEAK educational program include Albert Bandura's social cognitive theory and Malcolm Knowles's adult learning theory. Additionally, two complementary frameworks of knowledge translation, the Promoting Action on Research Implementation in Health Services (PARiHS) and Knowledge to Action (KTA) Cycle, were used to inform the organizational elements of the program. Finally, the program design was influenced by evidence from previous attempts to facilitate the use of research in practice at the individual and organizational levels. The 6-month PEAK program consisted of four consecutive and interdependent components. First, leadership support was secured and electronic resources were acquired and distributed to participants. Next, a two-day training workshop consisting of didactic and small group activities was conducted that addressed the five steps of evidence based practice. For five months following the workshop, participants worked in small groups to review and synthesize literature around a group-selected area of common clinical interest. Each group contributed to the generation of a "Best Practices List" - a list of locally generated, evidence-based, actionable behaviors relevant to the groups' clinical practice. Ultimately, participants agreed to implement the Best Practices List in their clinical practice. This, first of two companion papers, describes the underlying pedagogical theories, knowledge translation frameworks, and research evidence used to derive the PEAK program - an educational program designed to

  14. Research Areas - Clinical Trials (United States)

    Information about NCI programs and initiatives that sponsor, conduct, develop, or support clinical trials, including NCI’s Clinical Trial Network (NCTN) and NCI Community Oncology Research Program (NCORP) initiatives.

  15. Clinical research informatics

    CERN Document Server

    Richesson, Rachel L


    This book provides foundational coverage of key areas, concepts, constructs, and approaches of medical informatics as it applies to clinical research activities, in both current settings and in light of emerging policies. The field of clinical research is fully characterized (in terms of study design and overarching business processes), and there is emphasis on information management aspects and informatics implications (including needed activities) within various clinical research environments. The purpose of the book is to provide an overview of clinical research (types), activities, and are

  16. Assessing quality of life in the treatment of patients with age-related macular degeneration: clinical research findings and recommendations for clinical practice

    Directory of Open Access Journals (Sweden)

    Yuzawa M


    Full Text Available Mitsuko Yuzawa,1 Kyoko Fujita,1 Erika Tanaka,2 Edward C Y Wang21Department of Ophthalmology, Nihon University School of Medicine, Surugadai, Kanda, Chiyoda-ku, Tokyo, Japan; 2Health Economics and Outcomes Research, Bayer Yakuhin Ltd, Marunouchi, Chiyoda-ku, Tokyo, JapanBackground: The importance of incorporating quality-of-life (QoL assessments into medical practice is growing as health care practice shifts from a “disease-based” to a “patient-centered” model. The prevalence of age-related macular degeneration (AMD is increasing in today’s aging population. The purpose of this paper is: (1 to discuss, by reviewing the current literature, the impact of AMD on patients’ QoL and the utility of QoL assessments in evaluating the impact of AMD and its treatment; and (2 to make a recommendation for incorporating QoL into clinical practice.Methods: We conducted a PubMed and an open Internet search to identify publications on the measurement of QoL in AMD, as well as the impact of AMD and the effect of treatment on QoL. A total of 28 articles were selected.Results: AMD has been found to cause a severity-dependent decrement in QoL that is comparable to systemic diseases such as cancer, ischemic heart disease, and stroke. QoL impairment manifests as greater social dependence, difficulty with daily living, higher rates of clinical depression, increased risk of falls, premature admission to nursing homes, and suicide. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25 is the most widely used eye disease-specific QoL instrument in AMD. It has been shown to correlate significantly with visual acuity (VA. QoL reflects aspects of AMD including psychological well-being, functional capacity, and the ability to perform patients’ valued activities, which are not captured by a single, numerical VA score.Conclusion: The literature shows that the adverse impact of AMD on QoL is comparable to serious systemic disease. Eye disease

  17. Using the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) model in clinical research: Application to refine a practice-based research network (PBRN) study. (United States)

    Elder, William G; Munk, Niki


    Pragmatic clinical trials (PCTs) are increasingly recommended to evaluate interventions in real-world conditions. Although PCTs share a common approach of evaluating variables from actual clinical practice, multiple characteristics can differ. These differences affect interpretation of the trial. The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) model was developed in 2009 by the CONSORT Work Group on Pragmatic Trials, published by Thorpe et al, to aid in trial design. PRECIS provides clarity about the generalizability and applicability of a trial by depicting multiple study characteristics. We recently completed a National Institutes of Health-sponsored pilot study examining health-related outcomes for 2 complementary therapies for chronic low back pain in patients referred by primary care providers in the Kentucky Ambulatory Network. In preparation for a larger study, we sought to characterize the pragmatic features of the study to aid in our design decisions. The purpose of this article is to introduce clinical researchers to the PRECIS model while demonstrating its application to refine a practice based research network study. We designed an exercise using an audience response system integrated with a Works in Progress presentation to experienced researchers at the University of Kentucky to examine our study methodologies of parameters suggested by the PRECIS model. The exercise went smoothly and participants remained engaged throughout. The study received an overall summary score of 30.17 (scale of 0 to 48; a higher score indicates a more pragmatic approach), with component scores that differentiate design components of the study. A polar chart is presented to depict the pragmatism of the overall study methodology across each of these components. The study was not as pragmatic as expected. The exercise results seem to be useful in identifying necessary refinements to the study methodology that may benefit future study design and increase

  18. Cost-benefit assessment of using electronic health records data for clinical research versus current practices: Contribution of the Electronic Health Records for Clinical Research (EHR4CR) European Project. (United States)

    Beresniak, Ariel; Schmidt, Andreas; Proeve, Johann; Bolanos, Elena; Patel, Neelam; Ammour, Nadir; Sundgren, Mats; Ericson, Mats; Karakoyun, Töresin; Coorevits, Pascal; Kalra, Dipak; De Moor, Georges; Dupont, Danielle


    The widespread adoption of electronic health records (EHR) provides a new opportunity to improve the efficiency of clinical research. The European EHR4CR (Electronic Health Records for Clinical Research) 4-year project has developed an innovative technological platform to enable the re-use of EHR data for clinical research. The objective of this cost-benefit assessment (CBA) is to assess the value of EHR4CR solutions compared to current practices, from the perspective of sponsors of clinical trials. A CBA model was developed using an advanced modeling approach. The costs of performing three clinical research scenarios (S) applied to a hypothetical Phase II or III oncology clinical trial workflow (reference case) were estimated under current and EHR4CR conditions, namely protocol feasibility assessment (S1), patient identification for recruitment (S2), and clinical study execution (S3). The potential benefits were calculated considering that the estimated reduction in actual person-time and costs for performing EHR4CR S1, S2, and S3 would accelerate time to market (TTM). Probabilistic sensitivity analyses using Monte Carlo simulations were conducted to manage uncertainty. Should the estimated efficiency gains achieved with the EHR4CR platform translate into faster TTM, the expected benefits for the global pharmaceutical oncology sector were estimated at €161.5m (S1), €45.7m (S2), €204.5m (S1+S2), €1906m (S3), and up to €2121.8m (S1+S2+S3) when the scenarios were used sequentially. The results suggest that optimizing clinical trial design and execution with the EHR4CR platform would generate substantial added value for pharmaceutical industry, as main sponsors of clinical trials in Europe, and beyond. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Applying self-determination theory for improved understanding of physiotherapists' rationale for using research in clinical practice: a qualitative study in Sweden. (United States)

    Dannapfel, Petra; Peolsson, Anneli; Ståhl, Christian; Öberg, Birgitta; Nilsen, Per


    Physiotherapists are generally positive to evidence-based practice (EBP) and the use of research in clinical practice, yet many still base clinical decisions on knowledge obtained during their initial education and/or personal experience. Our aim was to explore motivations behind physiotherapists' use of research in clinical practice. Self-Determination Theory was applied to identify the different types of motivation for use of research. This theory posits that all behaviours lie along a continuum of relative autonomy, reflecting the extent to which a person endorses their actions. Eleven focus group interviews were conducted, involving 45 physiotherapists in various settings in Sweden. Data were analysed using qualitative content analysis and the findings compared with Self-Determination Theory using a deductive approach. Motivations underlying physiotherapists use of research in clinical practice were identified. Most physiotherapists expressed autonomous forms of motivation for research use, but some exhibited more controlled motivation. Several implications about how more evidence-based physiotherapy can be achieved are discussed, including the potential to tailor educational programs on EBP to better account for differences in motivation among participants, using autonomously motivated physiotherapists as change agents and creating favourable conditions to encourage autonomous motivation by way of feelings of competence, autonomy and a sense of relatedness.

  20. Representativeness and optimal use of body mass index (BMI) in the UK Clinical Practice Research Datalink (CPRD) (United States)

    Bhaskaran, Krishnan; Forbes, Harriet J; Douglas, Ian; Leon, David A; Smeeth, Liam


    Objectives To assess the completeness and representativeness of body mass index (BMI) data in the Clinical Practice Research Datalink (CPRD), and determine an optimal strategy for their use. Design Descriptive study. Setting Electronic healthcare records from primary care. Participants A million patient random sample from the UK CPRD primary care database, aged ≥16 years. Primary and secondary outcome measures BMI completeness in CPRD was evaluated by age, sex and calendar period. CPRD-based summary BMI statistics for each calendar year (2003–2010) were age-standardised and sex-standardised and compared with equivalent statistics from the Health Survey for England (HSE). Results BMI completeness increased over calendar time from 37% in 1990–1994 to 77% in 2005–2011, was higher among females and increased with age. When BMI at specific time points was assigned based on the most recent record, calendar–year-specific mean BMI statistics underestimated equivalent HSE statistics by 0.75–1.1 kg/m2. Restriction to those with a recent (≤3 years) BMI resulted in mean BMI estimates closer to HSE (≤0.28 kg/m2 underestimation), but excluded up to 47% of patients. An alternative strategy of imputing up-to-date BMI based on modelled changes in BMI over time since the last available record also led to mean BMI estimates that were close to HSE (≤0.37 kg/m2 underestimation). Conclusions Completeness of BMI in CPRD increased over time and varied by age and sex. At a given point in time, a large proportion of the most recent BMIs are unlikely to reflect current BMI; consequent BMI misclassification might be reduced by employing model-based imputation of current BMI. PMID:24038008

  1. Representativeness and optimal use of body mass index (BMI) in the UK Clinical Practice Research Datalink (CPRD). (United States)

    Bhaskaran, Krishnan; Forbes, Harriet J; Douglas, Ian; Leon, David A; Smeeth, Liam


    To assess the completeness and representativeness of body mass index (BMI) data in the Clinical Practice Research Datalink (CPRD), and determine an optimal strategy for their use. Descriptive study. Electronic healthcare records from primary care. A million patient random sample from the UK CPRD primary care database, aged ≥16 years. BMI completeness in CPRD was evaluated by age, sex and calendar period. CPRD-based summary BMI statistics for each calendar year (2003-2010) were age-standardised and sex-standardised and compared with equivalent statistics from the Health Survey for England (HSE). BMI completeness increased over calendar time from 37% in 1990-1994 to 77% in 2005-2011, was higher among females and increased with age. When BMI at specific time points was assigned based on the most recent record, calendar-year-specific mean BMI statistics underestimated equivalent HSE statistics by 0.75-1.1 kg/m(2). Restriction to those with a recent (≤3 years) BMI resulted in mean BMI estimates closer to HSE (≤0.28 kg/m(2) underestimation), but excluded up to 47% of patients. An alternative strategy of imputing up-to-date BMI based on modelled changes in BMI over time since the last available record also led to mean BMI estimates that were close to HSE (≤0.37 kg/m(2) underestimation). Completeness of BMI in CPRD increased over time and varied by age and sex. At a given point in time, a large proportion of the most recent BMIs are unlikely to reflect current BMI; consequent BMI misclassification might be reduced by employing model-based imputation of current BMI.

  2. Understanding flucloxacillin prescribing trends and treatment non-response in UK primary care: a Clinical Practice Research Datalink (CPRD) study. (United States)

    Francis, Nick A; Hood, Kerenza; Lyons, Ronan; Butler, Christopher C


    The volume of prescribed antibiotics is associated with antimicrobial resistance and, unlike most other antibiotic classes, flucloxacillin prescribing has increased. We aimed to describe UK primary care flucloxacillin prescribing and factors associated with subsequent antibiotic prescribing as a proxy for non-response. Clinical Practice Research Datalink patients with acute prescriptions for oral flucloxacillin between January 2004 and December 2013, prescription details, associated Read codes and patient demographics were identified. Monthly prescribing rates were plotted and logistic regression identified factors associated with having a subsequent antibiotic prescription within 28 days. 3 031 179 acute prescriptions for 1 667 431 patients were included. Average monthly prescription rates increased from 4.74 prescriptions per 1000 patient-months in 2004 to 5.74 (increase of 21.1%) in 2013. The highest prescribing rates and the largest increases in rates were seen in older adults (70+ years), but the overall increase in prescribing was not accounted for by an ageing population. Prescribing 500 mg tablets/capsules rather than 250 mg became more common. Children were frequently prescribed low doses and small volumes (5 day course) and prescribing declined for children, including for impetigo. Only 4.2% of new prescriptions involved co-prescription of another antibiotic. Age (antibiotic prescription, which occurred after 17.6% of first prescriptions. There is a need to understand better the reasons for increased prescribing of flucloxacillin in primary care, optimal dosing (and the need to co-prescribe other antibiotics) and the reasons why one in five patients are prescribed a further antibiotic within 4 weeks. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

  3. Validation of Stevens-Johnson syndrome or toxic epidermal necrolysis diagnoses in the Clinical Practice Research Datalink. (United States)

    Frey, Noel; Bircher, Andreas; Bodmer, Michael; Jick, Susan S; Meier, Christoph R; Spoendlin, Julia


    To evaluate the validity of recorded diagnoses of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in the Clinical Practice Research Datalink (CPRD). We identified patients with a diagnosis of SJS or TEN between 1995 and 2013 in the CPRD. We reviewed information from patient records, free text, and hospital episode statistics (HES) data, and excluded patients with no indication of a secondary care referral. Remaining patients were classified as probable, possible, or unlikely cases of SJS/TEN by two specialised clinicians or based on pre-defined classification criteria. We quantified positive predictive values (PPV) for all SJS/TEN patients and for patients categorised as 'probable/possible' cases of SJS/TEN, based on a representative subsample of 118 patients for whom we had unequivocal information (original discharge letters or HES data). We identified 1324 patients with a diagnosis of SJS/TEN, among whom 638 had a secondary care referral recorded. Of those, 565 were classified as probable or possible cases after expert review. We calculated a PPV of 0.79 (95% CI, 0.71-0.86) for all SJS/TEN patients with a recorded secondary care referral, and a PPV of 0.87 (95% CI, 0.81-0.93) for probable/possible cases. After excluding 14 false positive patients, our study population consisted of 551 SJS/TEN patients. Diagnoses of SJS/TEN are recorded with moderate diagnostic accuracy in the CPRD, which was substantially improved by additional expert review of all available information. We established a large population-based SJS/TEN study population of high diagnostic validity from the CPRD. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  4. Clinical research before informed consent. (United States)

    Miller, Franklin G


    Clinical research with patient-subjects was routinely conducted without informed consent for research participation prior to 1966. The aim of this article is to illuminate the moral climate of clinical research at this time, with particular attention to placebo-controlled trials in which patient-subjects often were not informed that they were participating in research or that they might receive a placebo intervention rather than standard medical treatment or an experimental treatment for their condition. An especially valuable window into the thinking of clinical investigators about their relationship with patient-subjects in the era before informed consent is afforded by reflection on two articles published by psychiatric researchers in 1966 and 1967, at the point of transition between clinical research conducted under the guise of medical care and clinical research based on consent following an invitation to participate and disclosure of material information about the study. Historical inquiry relating to the practice of clinical research without informed consent helps to put into perspective the moral progress associated with soliciting consent following disclosure of pertinent information; it also helps to shed light on an important issue in contemporary research ethics: the conditions under which it is ethical to conduct clinical research without informed consent.

  5. Clinical Outcome Assessments: Conceptual Foundation-Report of the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force. (United States)

    Walton, Marc K; Powers, John H; Hobart, Jeremy; Patrick, Donald; Marquis, Patrick; Vamvakas, Spiros; Isaac, Maria; Molsen, Elizabeth; Cano, Stefan; Burke, Laurie B


    An outcome assessment, the patient assessment used in an endpoint, is the measuring instrument that provides a rating or score (categorical or continuous) that is intended to represent some aspect of the patient's health status. Outcome assessments are used to define efficacy endpoints when developing a therapy for a disease or condition. Most efficacy endpoints are based on specified clinical assessments of patients. When clinical assessments are used as clinical trial outcomes, they are called clinical outcome assessments (COAs). COAs include any assessment that may be influenced by human choices, judgment, or motivation. COAs must be well-defined and possess adequate measurement properties to demonstrate (directly or indirectly) the benefits of a treatment. In contrast, a biomarker assessment is one that is subject to little, if any, patient motivational or rater judgmental influence. This is the first of two reports by the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force. This report provides foundational definitions important for an understanding of COA measurement principles. The foundation provided in this report includes what it means to demonstrate a beneficial effect, how assessments of patients relate to the objective of showing a treatment's benefit, and how these assessments are used in clinical trial endpoints. In addition, this report describes intrinsic attributes of patient assessments and clinical trial factors that can affect the properties of the measurements. These factors should be considered when developing or refining assessments. These considerations will aid investigators designing trials in their choice of using an existing assessment or developing a new outcome assessment. Although the focus of this report is on the development of a new COA to define endpoints in a clinical trial, these principles may be applied more generally. A critical element in appraising or developing a COA is to

  6. Dissemination of research in clinical nursing journals. (United States)

    Oermann, Marilyn H; Nordstrom, Cheryl K; Wilmes, Nancy A; Denison, Doris; Webb, Sue A; Featherston, Diane E; Bednarz, Hedi; Striz, Penelope; Blair, Darlene A; Kowalewski, Kathleen


    The purposes of the study were to describe the extent of research, clinical and evidence-based practice articles published in clinical nursing journals and to explore the communication of research and practice knowledge in the clinical nursing literature using citation analysis. For nursing research to have an impact on clinical practice and build evidence for practice, findings from research must transfer into the clinical practice literature. By analysing the extent of research published in clinical nursing journals, the citations in those articles, and other characteristics of the nursing literature, we can learn more about the linkages between research and practice in nursing. This was a descriptive study of 768 articles and 18901 citations in those articles. Feature articles were classified into four groups - (i) original research reports; (ii) clinical practice articles (non-data based papers on a clinical topic); (iii) systematic reviews, integrative literature reviews, guidelines and papers describing evidence-based practice; and (iv) others. Each citation was then examined to determine if it was a reference to a research study or to a document on clinical practice. Nearly a third of the articles in clinical nursing journals were reports on research studies; another third addressed clinical practice. Of the 14232 citations analysed in clinical nursing journals, 6142 were to research reports (43.2%) and about the same number of citations were to clinical documents (n = 5844, 41.1%). Medical research articles were cited most frequently - 27.1% of the citations in clinical journal articles. Nursing research articles were only 7.6% of the cited documents in clinical publications. Dissemination of research findings in the clinical nursing literature occurred at two levels: through articles that reported studies of potential value to the nurse's practice and citations to research publications within articles. Relevance to clinical practice. Disseminating research

  7. A survey among Korea Medicine doctors (KMDs) in Korea on patterns of integrative Korean Medicine practice for lumbar intervertebral disc displacement: Preliminary research for clinical practice guidelines. (United States)

    Shin, Ye-sle; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-riong; Ahn, Yong-jun; Park, Ki Byung; Shin, Byung-Cheul; Lee, Myeong Soo; Kim, Joo-Hee; Cho, Jae-Heung; Ha, In-Hyuk


    Patients seek Korean Medicine (KM) treatment for a broad range of complaints in Korea, but predominantly for musculoskeletal disorders. We investigated lumbar Intervertebral Disc Displacement (IDD) practice patterns of Korean Medicine doctors (KMDs) within a hospital/clinic network specializing in KM treatment of spinal disorders through survey of diagnosis and treatment methods. Questionnaires on clinical practice patterns of KM treatment for lumbar IDD were distributed to 149 KMDs on January 25th, 2015. The questionnaire included items on sociodemographic characteristics, clinical practice patterns, and preferred method of lumbar IDD diagnosis and treatment. KMDs were asked to grade each treatment method for absolute and relative importance in treatment and prognosis, and safety. A total 79.19 % KMDs (n = 118/149) completed the survey, and results showed that integrative care mainly consisting of acupuncture, herbal medicine, Chuna manipulation, and pharmacopuncture was administered to IDD patients. The participant KMDs largely relied on radiological findings (MRI and X-ray) for diagnosis. 'Eight principle pattern identification', 'Qi and Blood syndrome differentiation' and 'Meridian system syndrome differentiation' theories were generally used for KM syndrome differentiation. The most frequently prescribed herbal medication was Chungpa-jun, and most commonly used Chuna technique was 'sidelying lumbar extension displacement treatment'. IDD patients received 1.9 ± 0.3 treatment sessions/week, and KMDs estimated that an average 9.6 ± 3.5 weeks were needed for 80 % pain relief. This is the first study to investigate expert opinion on KM treatment of IDD. Further randomized controlled trials and clinical guidelines based on clinical practice patterns of KM are called for.

  8. How I do it: a practical database management system to assist clinical research teams with data collection, organization, and reporting. (United States)

    Lee, Howard; Chapiro, Julius; Schernthaner, Rüdiger; Duran, Rafael; Wang, Zhijun; Gorodetski, Boris; Geschwind, Jean-François; Lin, MingDe


    The objective of this study was to demonstrate that an intra-arterial liver therapy clinical research database system is a more workflow efficient and robust tool for clinical research than a spreadsheet storage system. The database system could be used to generate clinical research study populations easily with custom search and retrieval criteria. A questionnaire was designed and distributed to 21 board-certified radiologists to assess current data storage problems and clinician reception to a database management system. Based on the questionnaire findings, a customized database and user interface system were created to perform automatic calculations of clinical scores including staging systems such as the Child-Pugh and Barcelona Clinic Liver Cancer, and facilitates data input and output. Questionnaire participants were favorable to a database system. The interface retrieved study-relevant data accurately and effectively. The database effectively produced easy-to-read study-specific patient populations with custom-defined inclusion/exclusion criteria. The database management system is workflow efficient and robust in retrieving, storing, and analyzing data. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

  9. Clinical practice guideline: tinnitus. (United States)

    Tunkel, David E; Bauer, Carol A; Sun, Gordon H; Rosenfeld, Richard M; Chandrasekhar, Sujana S; Cunningham, Eugene R; Archer, Sanford M; Blakley, Brian W; Carter, John M; Granieri, Evelyn C; Henry, James A; Hollingsworth, Deena; Khan, Fawad A; Mitchell, Scott; Monfared, Ashkan; Newman, Craig W; Omole, Folashade S; Phillips, C Douglas; Robinson, Shannon K; Taw, Malcolm B; Tyler, Richard S; Waguespack, Richard; Whamond, Elizabeth J


    Tinnitus is the perception of sound without an external source. More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. Despite the high prevalence of tinnitus and its potential significant effect on quality of life, there are no evidence-based, multidisciplinary clinical practice guidelines to assist clinicians with management. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6 months or longer), which often negatively affects the patient's quality of life. The target audience for the guideline is any clinician, including nonphysicians, involved in managing patients with tinnitus. The target patient population is limited to adults (18 years and older) with primary tinnitus that is persistent and bothersome. The purpose of this guideline is to provide evidence-based recommendations for clinicians managing patients with tinnitus. This guideline provides clinicians with a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus. It will discuss the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the effect of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers. The development group made a strong recommendation that clinicians distinguish patients with bothersome tinnitus from patients with nonbothersome tinnitus. The development group made a strong recommendation against obtaining imaging studies of the head and neck in patients with tinnitus, specifically to evaluate tinnitus that does not localize to 1 ear, is nonpulsatile

  10. SU-F-P-33: Combining Research and Professional Practice in the Clinical Setting: A Medical Physicist Personal Experience

    Energy Technology Data Exchange (ETDEWEB)

    Lopez-Tarjuelo, J [Consorcio Hospitalario Provincial de Castello, Castello de la Plana (Spain)


    Purpose: To initiate a discussion on the current and evolving role of Medical Physicists based on author’s professional and research experience in patient safety and quality control. Methods: Several professionals of the departments of Medical Physics and Radiation Oncology, chiefly devoted to clinical tasks, began a research program on patient safety and quality control in a framework provided by the implementation of intraoperative radiotherapy (IORT). We performed studies on virtual simulation for IORT, in vivo dosimetry, failure mode and effect analysis (FMEA), statistical process control (SPC), and receiver operating characteristics of dosimetric equipment. This was done with the support of our research foundation and different grants while continuing with our departmental clinical routine involving about 1600 annual treatments with two linacs and different brachytherapy techniques. Results: We published 5 papers in international journals in the last two years. This author conducted a doctoral research which resulted in a dissertation in 2015. The extra time spent after treatments was essential to succeed. Funding and support achieved via our foundation played a crucial role; but this would have not been possible without punctual external mentoring and partnership. FMEA conclusions were able to be implemented only with staff commitment; however, conclusions concerning equipment cannot be easily communicated to manufacturers. These tasks required extra training in the appropriated methods. Conclusion: Research needed the support of a dedicated foundation, which would have been very difficult to obtain with the sole participation of our departments. FMEA and SPC results may need engagement of staff and manufacturers, respectively, hard to achieve without strong recommendations or even a regulatory framework. All these fields need evolution of Medical Physicists’ roles and additional training. Devotion to both clinical tasks and research could be unfeasible

  11. SU-F-P-33: Combining Research and Professional Practice in the Clinical Setting: A Medical Physicist Personal Experience

    International Nuclear Information System (INIS)

    Lopez-Tarjuelo, J


    Purpose: To initiate a discussion on the current and evolving role of Medical Physicists based on author’s professional and research experience in patient safety and quality control. Methods: Several professionals of the departments of Medical Physics and Radiation Oncology, chiefly devoted to clinical tasks, began a research program on patient safety and quality control in a framework provided by the implementation of intraoperative radiotherapy (IORT). We performed studies on virtual simulation for IORT, in vivo dosimetry, failure mode and effect analysis (FMEA), statistical process control (SPC), and receiver operating characteristics of dosimetric equipment. This was done with the support of our research foundation and different grants while continuing with our departmental clinical routine involving about 1600 annual treatments with two linacs and different brachytherapy techniques. Results: We published 5 papers in international journals in the last two years. This author conducted a doctoral research which resulted in a dissertation in 2015. The extra time spent after treatments was essential to succeed. Funding and support achieved via our foundation played a crucial role; but this would have not been possible without punctual external mentoring and partnership. FMEA conclusions were able to be implemented only with staff commitment; however, conclusions concerning equipment cannot be easily communicated to manufacturers. These tasks required extra training in the appropriated methods. Conclusion: Research needed the support of a dedicated foundation, which would have been very difficult to obtain with the sole participation of our departments. FMEA and SPC results may need engagement of staff and manufacturers, respectively, hard to achieve without strong recommendations or even a regulatory framework. All these fields need evolution of Medical Physicists’ roles and additional training. Devotion to both clinical tasks and research could be unfeasible

  12. Towards a national genomics medicine service: the challenges facing clinical-research hybrid practices and the case of the 100 000 genomes project. (United States)

    Dheensa, Sandi; Samuel, Gabrielle; Lucassen, Anneke M; Farsides, Bobbie


    Clinical practice and research are governed by distinct rules and regulations and have different approaches to, for example, consent and providing results. However, genomics is an example of where research and clinical practice have become codependent. The 100 000 genomes project (100kGP) is a hybrid venture where a person can obtain a clinical investigation only if he or she agrees to also participate in ongoing research-including research by industry and commercial companies. In this paper, which draws on 20 interviews with professional stakeholders involved in 100kGP, we investigate the ethical issues raised by this project's hybrid nature. While some interviewees thought the hybrid nature of 100kGP was its vanguard, interviewees identified several tensions around hybrid practice: how to decide who should be able to participate; how to determine whether offering results might unduly influence participation into wide-ranging but often as yet unknown research and how to ensure that patients/families do not develop false expectations about receiving results. These areas require further debate as 100kGP moves into routine healthcare in the form of the national genomic medicine service. To address the tensions identified, we explore the appropriateness of Faden et al.'s framework of ethical obligations for when research and clinical care are completely integrated. We also argue that enabling ongoing transparent and trustworthy communication between patients/families and professionals around the kinds of research that should be permitted in 100kGP will help to understand and ensure that expectations remain realistic. Our paper aims to encourage a focused discussion about these issues and to inform a new 'social contract' for research and clinical care in the health service. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Parent Refusal of Topical Fluoride for Their Children: Clinical Strategies and Future Research Priorities to Improve Evidence-Based Pediatric Dental Practice. (United States)

    Chi, Donald L


    A growing number of parents are refusing topical fluoride for their children during preventive dental and medical visits. This nascent clinical and public health problem warrants attention from dental professionals and the scientific community. Clinical and community-based strategies are available to improve fluoride-related communications with parents and the public. In terms of future research priorities, there is a need to develop screening tools to identify parents who are likely to refuse topical fluoride and diagnostic instruments to uncover the reasons for topical fluoride refusal. This knowledge will lead to evidence-based strategies that can be widely disseminated into clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Functional recovery measures for spinal cord injury: an evidence-based review for clinical practice and research

    DEFF Research Database (Denmark)

    Anderson, K.; Aito, S.; Atkins, M.


    BACKGROUND/OBJECTIVE: The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome......), the Functional Independence Measure (FIM), the Quadriplegia Index of Function (QIF), and the Spinal Cord Independence Measure (SCIM). The MBI and the QIF were found to have minimal evidence for validity, whereas the FIM and the SCIM were found to be reliable and valid. The MBI has little clinical utility for use...... in the SCI population. Likewise, the FIM applies mainly when measuring burden of care, which is not necessarily a reflection of functional recovery. The QIF is useful for measuring functional recovery but only in a subpopulation of people with SCI, and substantial validity data are still required. The SCIM...

  15. The uses of emotion maps in research and clinical practice with families and couples: methodological innovation and critical inquiry. (United States)

    Gabb, Jacqui; Singh, Reenee


    We explore how "emotion maps" can be productively used in clinical assessment and clinical practice with families and couples. This graphic participatory method was developed in sociological studies to examine everyday family relationships. Emotion maps enable us to effectively "see" the dynamic experience and emotional repertoires of family life. Through the use of a case example, in this article we illustrate how emotion maps can add to the systemic clinicians' repertoire of visual methods. For clinicians working with families, couples, and young people, the importance of gaining insight into how lives are lived, at home, cannot be understated. Producing emotion maps can encourage critical personal reflection and expedite change in family practice. Hot spots in the household become visualized, facilitating dialogue on prevailing issues and how these events may be perceived differently by different family members. As emotion maps are not reliant on literacy or language skills they can be equally completed by parents and children alike, enabling children's perspective to be heard. Emotion maps can be used as assessment tools, to demonstrate the process of change within families. Furthermore, emotion maps can be extended to use through technology and hence are well suited particularly to working with young people. We end the article with a wider discussion of the place of emotions and emotion maps within systemic psychotherapy. © 2014 The Authors. Family Process published by Wiley Periodicals, Inc. on behalf of Family Process Institute.

  16. Extending the rails: how research reshapes clinics. (United States)

    Petty, JuLeigh; Heimer, Carol A


    The purpose of clinical research is to create the scientific foundation for medical practice. In this way of thinking, the effect on medical practice occurs after the research has been completed. Social studies of science have debunked the standard model of scientific research, observing that changes in practice associated with research occur not just because of the results of research but also because of the practice of research. Drawing on fieldwork in HIV clinics in the US, South Africa,Thailand, and Uganda, we argue that clinical trials shape medical practice by altering the organizations in which both medical treatment and clinical trials take place. Three general processes are central to this transformation: the modification of material environments, the reorganization of bureaucratic relations, and the prioritization of research values. These processes unfold somewhat differently in the clinics of poorer countries than in those of wealthier ones.

  17. Learning clinical practice

    African Journals Online (AJOL)

    feedback, support and encouragement. To ensure they get the right experience they need to work to a curriculum, and within a programme, so that their learning can be managed. So, postgraduate medical education (PGME) should offer young doctors teaching, clinical experience, supervision and support. It should be able.

  18. Electrogastroenterography in clinical practice

    Directory of Open Access Journals (Sweden)

    Pavel M. Kosenko


    Full Text Available The review contains the information on the basics of electrophysiological evaluation of motor-evacuator function of stomach. It describes the main methods for registration of electric activity of stomach and intestine, characterizes the registered parameters, and gives modern data on its clinical application.

  19. From Action Research to Practice Research

    Directory of Open Access Journals (Sweden)

    Goran Goldkuhl


    Full Text Available Action research (AR has gained more acceptance as an approach to qualitative research in information systems (IS. The complexities of organisational and technical change makes this approach a suitable one in IS research. There are, however, still some controversies and confusions about the relation between “action” and “research”. The many types of AR and similar approaches (not labelled as AR that have emerged demands further conceptual clarification of AR. A conceptual inquiry of AR, presented in the paper, has led to the identification of several unresolved issues concerning intervention research like AR. An alternative research approach is presented: practice research. This research approach is well founded in pragmatism and it builds on the two premises: 1 to contribute to general practice through abstract and useful knowledge and 2 to study the empirical field as interconnected practices. Several important concepts of practice research are described as: local practice contribution vs. general practice contribution; theorizing vs. situational inquiry. Practice research is seen as a broader notion encompassing AR and other research approaches as e.g. design research and evaluation research. Two case examples of practice research are briefly presented and compared: one AR-based study in the social welfare sector and one evaluation study of a taxation e-service.

  20. Questionable research practices among italian research psychologists (United States)

    Wicherts, Jelte M.; Veldkamp, Coosje L. S.; Albiero, Paolo; Cubelli, Roberto


    A survey in the United States revealed that an alarmingly large percentage of university psychologists admitted having used questionable research practices that can contaminate the research literature with false positive and biased findings. We conducted a replication of this study among Italian research psychologists to investigate whether these findings generalize to other countries. All the original materials were translated into Italian, and members of the Italian Association of Psychology were invited to participate via an online survey. The percentages of Italian psychologists who admitted to having used ten questionable research practices were similar to the results obtained in the United States although there were small but significant differences in self-admission rates for some QRPs. Nearly all researchers (88%) admitted using at least one of the practices, and researchers generally considered a practice possibly defensible if they admitted using it, but Italian researchers were much less likely than US researchers to consider a practice defensible. Participants’ estimates of the percentage of researchers who have used these practices were greater than the self-admission rates, and participants estimated that researchers would be unlikely to admit it. In written responses, participants argued that some of these practices are not questionable and they have used some practices because reviewers and journals demand it. The similarity of results obtained in the United States, this study, and a related study conducted in Germany suggest that adoption of these practices is an international phenomenon and is likely due to systemic features of the international research and publication processes. PMID:28296929

  1. Promoting physical therapists' use of research evidence to inform clinical practice: part 2--a mixed methods evaluation of the PEAK program. (United States)

    Tilson, Julie K; Mickan, Sharon; Sum, Jonathan C; Zibell, Maria; Dylla, Jacquelyn M; Howard, Robbin


    Clinicians need innovative educational programs to enhance their capacity for using research evidence to inform clinical decision-making. This paper and its companion paper introduce the Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program, an educational program designed to promote physical therapists' integration of research evidence into clinical decision-making. This, second of two, papers reports a mixed methods feasibility study of the PEAK program among physical therapists at three university-based clinical facilities. A convenience sample of 18 physical therapists participated in the six-month educational program. Mixed methods were used to triangulate results from pre-post quantitative data analyzed concurrently with qualitative data from semi-structured interviews and focus groups. Feasibility of the program was assessed by evaluating change in participants' attitudes, self-efficacy, knowledge, skills, and self-reported behaviors in addition to their perceptions and reaction to the program. All 18 therapists completed the program. The group experienced statistically significant improvements in evidence based practice self-efficacy and self-reported behavior (p research evidence; 3. Participants' need to understand how to interpret statistics was not fully met; 4. Participants believed that the utilization of research evidence in their clinical practice would lead to better patient outcomes. The PEAK program is a feasible educational program for promoting physical therapists' use of research evidence in practice. A key ingredient seems to be guided small group work leading to a final product that guides local practice. Further investigation is recommended to assess long-term behavior change and to compare outcomes to alternative educational models.

  2. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Gluud, Christian


    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...

  3. Good clinical practice in clinical interventional studies. (United States)

    Pieterse, Herman; Diamant, Zuzana


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

  4. Reasons given by elderly men and women for not owning a pet, and the implications for clinical practice and research. (United States)

    Chur-Hansen, Anna; Winefield, Helen; Beckwith, Melinda


    There is inadequate understanding about why people might not own pets. This qualitative study asked eight elderly women and men to discuss why they do not have a pet, whether pets were deemed beneficial to health, and whether they had plans for future pet ownership. Reasons for not owning a pet were Emotional or Pragmatic. Pragmatic reasons were categorized as relating to Convenience, Negative aspects of companion animals and Competing demands on time or energy. Participants expressed mixed feelings in their plans for future pet ownership. Clinical and research implications of these findings are discussed.

  5. Research practices and assessment of research misconduct

    NARCIS (Netherlands)

    Hartgerink, C.H.J.; Wicherts, J.M.


    This article discusses the responsible conduct of research, questionable research practices, and research misconduct. Responsible conduct of research is often defined in terms of a set of abstract, normative principles, professional standards, and ethics in doing research. In order to accommodate

  6. Logotherapy for clinical practice. (United States)

    Schulenberg, Stefan E; Hutzell, Robert R; Nassif, Carrie; Rogina, Julius M


    Logotherapy is based on the meaning-focused existential philosophy of Viktor E. Frankl (1905-1997). Numerous mental health professionals have been inspired by his most popular book, Man's Search for Meaning; however, many are unfamiliar with the depth of Frankl's work. The purpose of this article is to discuss the tenets of logotherapy, including fundamental concepts, applicability and techniques, roles of the therapist, and assessment tools and new research findings. Logotherapy can readily be integrated with techniques that mental health professionals frequently use, and thus it has much to offer mental health professionals regardless of their theoretical orientation. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  7. Voluntary informed consent and good clinical practice for clinical ...

    African Journals Online (AJOL)

    Most differences, shortcomings and contradictions regarding voluntary informed consent for participation in clinical research relate to the South African-specific guidance documents, i.e. South African Guidelines for Good Practice in the Conduct of Clinical Trials with Human Participants in South Africa (2006) and Ethics in ...

  8. Clinical Practice. Postmenopausal Osteoporosis. (United States)

    Black, Dennis M; Rosen, Clifford J


    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.

  9. Mindfulness Meditation in Clinical Practice (United States)

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


    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…

  10. Nigerian Journal of Clinical Practice

    African Journals Online (AJOL)

    The Nigerian Journal of Clinical Practice is the official publication of the Medical and Dental Consultants Association of Nigeria (MDCAN) established in 1997 and published regularly twice yearly in June and December. Its purpose is to promote clinical and academic excellence in Medicine and Dentistry and allied sciences ...

  11. Research in dental practice: a 'SWOT' analysis. (United States)

    Burke, F J T; Crisp, R J; McCord, J F


    Most dental treatment, in most countries, is carried out in general dental practice. There is therefore a potential wealth of research material, although clinical evaluations have generally been carried out on hospital-based patients. Many types of research, such as clinical evaluations and assessments of new materials, may be appropriate to dental practice. Principal problems are that dental practices are established to treat patients efficiently and to provide an income for the staff of the practice. Time spent on research therefore cannot be used for patient treatment, so there are cost implications. Critics of practice-based research have commented on the lack of calibration of operative diagnoses and other variables; however, this variability is the stuff of dental practice, the real-world situation. Many of the difficulties in carrying out research in dental practice may be overcome. For the enlightened, it may be possible to turn observations based on the volume of treatment carried out in practice into robust, clinically related and relevant research projects based in the real world of dental practice.

  12. Changing Research Practices and Research Infrastructure Development (United States)

    Houghton, John W.


    This paper examines changing research practices in the digital environment and draws out implications for the development of research infrastructure. Reviews of the literature, quantitative indicators of research activities and our own field research in Australia suggest that there is a new mode of knowledge production emerging, changing research…

  13. Functional Recovery Measures for Spinal Cord Injury: An Evidence-Based Review for Clinical Practice and Research (United States)

    Anderson, Kim; Aito, Sergio; Atkins, Michal; Biering-Sørensen, Fin; Charlifue, Susan; Curt, Armin; Ditunno, John; Glass, Clive; Marino, Ralph; Marshall, Ruth; Mulcahey, Mary Jane; Post, Marcel; Savic, Gordana; Scivoletto, Giorgio; Catz, Amiram


    Background/Objective: The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome measures designed to assess functional status relevant to SCI are important to develop. Method: Evaluation of currently available SCI functional outcome measures by a multinational work group. Results: The 4 measures that fit the prespecified inclusion criteria were the Modified Barthel Index (MBI), the Functional Independence Measure (FIM), the Quadriplegia Index of Function (QIF), and the Spinal Cord Independence Measure (SCIM). The MBI and the QIF were found to have minimal evidence for validity, whereas the FIM and the SCIM were found to be reliable and valid. The MBI has little clinical utility for use in the SCI population. Likewise, the FIM applies mainly when measuring burden of care, which is not necessarily a reflection of functional recovery. The QIF is useful for measuring functional recovery but only in a subpopulation of people with SCI, and substantial validity data are still required. The SCIM is the only functional recovery outcome measure designed specifically for SCI. Conclusions: The multinational work group recommends that the latest version of the SCIM (SCIM III) continue to be refined and validated and subsequently implemented worldwide as the primary functional recovery outcome measure for SCI. The QIF may continue to be developed and validated for use as a supplemental tool for the nonambulatory tetraplegic population. PMID:18581660

  14. Developing a provisional, international minimal dataset for Juvenile Dermatomyositis: for use in clinical practice to inform research. (United States)

    McCann, Liza J; Arnold, Katie; Pilkington, Clarissa A; Huber, Adam M; Ravelli, Angelo; Beard, Laura; Beresford, Michael W; Wedderburn, Lucy R


    Juvenile dermatomyositis (JDM) is a rare but severe autoimmune inflammatory myositis of childhood. International collaboration is essential in order to undertake clinical trials, understand the disease and improve long-term outcome. The aim of this study was to propose from existing collaborative initiatives a preliminary minimal dataset for JDM. This will form the basis of the future development of an international consensus-approved minimum core dataset to be used both in clinical care and inform research, allowing integration of data between centres. A working group of internationally-representative JDM experts was formed to develop a provisional minimal dataset. Clinical and laboratory variables contained within current national and international collaborative databases of patients with idiopathic inflammatory myopathies were scrutinised. Judgements were informed by published literature and a more detailed analysis of the Juvenile Dermatomyositis Cohort Biomarker Study and Repository, UK and Ireland. A provisional minimal JDM dataset has been produced, with an associated glossary of definitions. The provisional minimal dataset will request information at time of patient diagnosis and during on-going prospective follow up. At time of patient diagnosis, information will be requested on patient demographics, diagnostic criteria and treatments given prior to diagnosis. During on-going prospective follow-up, variables will include the presence of active muscle or skin disease, major organ involvement or constitutional symptoms, investigations, treatment, physician global assessments and patient reported outcome measures. An internationally agreed minimal dataset has the potential to significantly enhance collaboration, allow effective communication between groups, provide a minimal standard of care and enable analysis of the largest possible number of JDM patients to provide a greater understanding of this disease. This preliminary dataset can now be developed into

  15. Pain management practices in paediatric emergency departments in Australia and New Zealand: a clinical and organizational audit by National Health and Medical Research Council's National Institute of Clinical Studies and Paediatric Research in Emergency Departments International Collaborative. (United States)

    Herd, David W; Babl, Franz E; Gilhotra, Yuri; Huckson, Sue


    To audit pain management practices and organization in paediatric ED across Australia and New Zealand. Retrospective audit of pain management practices in Paediatric Research in Emergency Departments International Collaborative ED in 20 cases each of migraine, abdominal pain and femoral shaft fracture. Review of organizational status of pain management at Paediatric Research in Emergency Departments International Collaborative sites. Of 14 ED, 10 participated in the clinical audit. A total of 196 migraine, 197 abdominal pain and 177 femur fracture cases were reviewed. Less than half had degree of pain measured or had pain score documented on triage. Migraine received analgesia in 62% of cases (opioids in 11%). Abdominal pain received analgesia in 62% of cases (opioids in 14%). Fractured femurs received analgesia in 78% of cases (opioids 49%, femoral nerve blocks 40%). Median minutes to enteral medication were 100, 85 and 75, and for parenteral medication (mainly opiates) 103, 137 and 26, for migraine, abdominal pain and femur fracture, respectively. Thirteen hospitals participated in the organizational audit. Of all ED, 92% had pain management policies or guidelines, 92% taught pain management topics in education programmes and 62% used mandatory pain competencies. Only 15% had quality improvement programmes for pain reduction. We found a notable lack of pain assessment documentation and delays to analgesia. There is a need to improve pain assessment and management, although a majority of paediatric ED surveyed had important organizational and educational structures in place. Issues to explore include use of opioids in migraine and the underuse of femoral nerve blocks.

  16. Clinical Research and Clinical Trials (United States)

    ... Research Information Find a Study Resources and Publications HIV/AIDS Condition Information NICHD Research Information Find a ... Videos Get to Know NICHD Podcasts and Audio Social Media Join ... aims to advance medical knowledge by studying people, either through direct interaction or through the collection and analysis of blood, ...

  17. ESCAP Expert Article: borderline personality disorder in adolescence: an expert research review with implications for clinical practice. (United States)

    Fonagy, Peter; Speranza, Mario; Luyten, Patrick; Kaess, Michael; Hessels, Christel; Bohus, Martin


    Borderline personality disorder (BPD) has onset in adolescence, but is typically first diagnosed in young adulthood. This paper provides a narrative review of the current evidence on diagnosis, comorbidity, phenomenology and treatment of BPD in adolescence. Instruments available for diagnosis are reviewed and their strengths and limitations discussed. Having confirmed the robustness of the diagnosis and the potential for its reliable clinical assessment, we then explore current understandings of the mechanisms of the disorder and focus on neurobiological underpinnings and research on psychological mechanisms. Findings are accumulating to suggest that adolescent BPD has an underpinning biology that is similar in some ways to adult BPD but differs in some critical features. Evidence for interventions focuses on psychological therapies. Several encouraging research studies suggest that early effective treatment is possible. Treatment development has just begun, and while adolescent-specific interventions are still in the process of evolution, most existing therapies represent adaptations of adult models to this developmental phase. There is also a significant opportunity for prevention, albeit there are few data to date to support such initiatives. This review emphasizes that there can be no justification for failing to make an early diagnosis of this enduring and pervasive problem.

  18. Ecohealth Research in Practice

    International Development Research Centre (IDRC) Digital Library (Canada)

    The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of ... Although achieving social equity is a main driving force in the design of ecosystem interventions, current practice does not go far enough in recognizing the ...

  19. Action Research in Practice (United States)

    Piggot-Irvine, Eileen


    Action research places a powerful tool for school improvement in the hands of teachers. By highlighting the outcomes that are possible and presenting clear steps in the research process, this book is one to encourage anyone who is seeking to implement evidence-based school improvement. Eileen Piggot-Irvine uses her Problem Resolving Action…

  20. Clinical results of randomized trials and 'real-world' data exploring the impact of Bevacizumab for breast cancer: opportunities for clinical practice and perspectives for research. (United States)

    Zambonin, Valentina; De Toma, Alessandro; Carbognin, Luisa; Nortilli, Rolando; Fiorio, Elena; Parolin, Veronica; Pilotto, Sara; Cuppone, Federica; Pellini, Francesca; Lombardi, Davide; Pollini, Giovanni Paolo; Tortora, Giampaolo; Bria, Emilio


    Angiogenesis plays a fundamental role in breast cancer (BC) growth, progression and metastatic spread. After the promising introduction of bevacizumab for the treatment of advanced BC, the initial enthusiasm decreased when the FDA withdrew its approval in 2011. Nevertheless, several clinical studies exploring the role of bevacizumab have been subsequently published. Areas covered: The aim of this study is to review the available clinical trials exploring the potential effectiveness of bevacizumab in BC, regardless of the disease setting. Expert opinion: Even if the evidence suggests that bevacizumab must be ruled out from the HER2-positive and adjuvant setting, bevacizumab's benefit remains uncertain in the neoadjuvant setting and in the advanced treatment of HER2-negative patients. In the first setting, the addition of bevacizumab to chemotherapy increased the pathological complete response (pCR) rate in most clinical trials. However, the current absence of evidence that pCR is a trial-level surrogate for survival requires waiting for long-term results. In the advanced setting, all trials showed a benefit in progression-free survival, but not in overall survival, highlighting an increase of adverse events. The lack of predictors of response represents the main unmet need in which future clinical research will undoubtedly invest.

  1. Research and clinical practice: constructing theoretical links / Pesquisa e prática clínica: construindo articulações teóricas

    Directory of Open Access Journals (Sweden)

    Terezinha Féres-Carneiro


    Full Text Available In this text, which was presented at the Inaugural Lecture from the Graduate Program of Developmental Psychology at Universidade Federal do Rio Grande do Sul (UFRGS on March 03, 2008, are discussed the links constructed by this author in the academic work as well as in the clinical practice. The history of a 36-year journey as both a professor-researcher and also as a clinical psychologist is reported here, with emphasis on the inseparable way of conceiving such functions. In this account it is explained and discussed the possibilities of articulating different theoretical-technical approaches in the clinic. The proposal for family and couple psychological assistance is a tripartite key of reading which takes into consideration the intra-psychological, the interactional and the social aspects of the aforementioned ones.

  2. A general method for describing sources of variance in clinical trials, especially operator variance, in order to improve transfer of research knowledge to practice. (United States)

    Chambers, David W; Leknius, Casimir; Reid, Laura


    The purpose of this study was to demonstrate how the skill level of the operator and the clinical challenge provided by the patient affect the outcomes of clinical research in ways that may have hidden influences on the applicability of that research to practice. Rigorous research designs that control or eliminate operator or patient factors as sources of variance achieve improved statistical significance for study hypotheses. These procedures, however, mask sources of variance that influence the applicability of the conclusions. There are summary data that can be added to reports of clinical trials to permit potential users of the findings to identify the most important sources of variation and to predict the likely outcomes of adopting products and procedures reported in the literature. Provisional crowns were constructed in a laboratory setting in a fully crossed, random-factor model with two levels of material (Treatment), two skill levels of students (Operator), and restorations of two levels of difficulty (Patient). The levels of the Treatment, Operator, and Patient factors used in the study were chosen to ensure that the findings from the study could be transferred to practice settings in a predictable fashion. The provisional crowns were scored independently by two raters using the criteria for technique courses in the school where the research was conducted. The Operator variable accounted for 38% of the variance, followed by Treatment-by-Operator interaction (17%), Treatment (17%), and other factors and their combinations in smaller amounts. Regression equations were calculated for each Treatment material that can be used to predict outcomes in various potential transfer applications. It was found that classical analyses for differences between materials (the Treatment variable) would yield inconsistent results under various sampling systems within the parameters of the study. Operator and Treatment-by-Operator interactions appear to be significant and

  3. Implementing ABPM into Clinical Practice. (United States)

    Hinderliter, Alan L; Voora, Raven A; Viera, Anthony J


    To review the data supporting the use of ambulatory blood pressure monitoring (ABPM), and to provide practical guidance for practitioners who are establishing an ambulatory monitoring service. ABPM results more accurately reflect the risk of cardiovascular events than do office measurements of blood pressure. Moreover, many patients with high blood pressure in the office have normal blood pressure on ABPM-a pattern known as white coat hypertension-and have a prognosis similar to individuals who are normotensive in both settings. For these reasons, ABPM is recommended by the US Preventive Services Task Force to confirm the diagnosis of hypertension in patients with high office blood pressure before medical therapy is initiated. Similarly, the 2017 ACC/AHA High Blood Pressure Clinical Practice Guideline advocates the use of out-of-office blood pressure measurements to confirm hypertension and evaluate the efficacy of blood pressure-lowering medications. In addition to white coat hypertension, blood pressure phenotypes that are associated with increased cardiovascular risk and that can be recognized by ABPM include masked hypertension-characterized by normal office blood pressure but high values on ABPM-and high nocturnal blood pressure. In this review, best practices for starting a clinical ABPM service, performing an ABPM monitoring session, and interpreting and reporting ABPM data are described. ABPM is a valuable adjunct to careful office blood pressure measurement in diagnosing hypertension and in guiding antihypertensive therapy. Following recommended best practices can facilitate implementation of ABPM into clinical practice.

  4. Distress management. Clinical practice guidelines. (United States)


    clergy who are trained to deal with cancer-related distress. The benefits of treating distress in cancer accrue to the patients and their families, to the treating staff, and to improved efficiencies in clinic operations. Health care contracts often allow these services to "fall through the cracks" by failing to reimburse for them through either behavioral health or medical insurance. Reimbursement for services to treat psychosocial distress must be included in medical health care contracts to prevent fragmentation of services for the medically ill. For patients with cancer, integration, not separation, of mental health services and medical services is critically important. Also outcomes research studies that include quality-of-life assessment and analysis of cost-effectiveness are needed. Patients and families should be informed that management of distress is part of their total medical care. Finally, the multidisciplinary committee, office practice, or institution must be responsible for evaluating the quality of the distress management (see guidelines algorithm [page 368]), with CQI studies making an important contribution. Presently, the quality of the psychological care patients receive is not routinely monitored. Accrediting bodies have not directly examined the quality of psychosocial care, nor have they established minimal performance standards for its delivery. The panel believes that psychosocial care should and will eventually be on our institution's report cards.

  5. Design (research) practice

    DEFF Research Database (Denmark)

    Binder, Thomas; Brandt, Eva


    problem and solution through iterations of naming and framing, re-naming and re-framing the situation. Designers typically work from a (design) brief or a program that sets goals for what is to be achieved by the design The program operates as the first framing of a design space within which to explore...... that resides outside the program. Still exploring the possible can only be pursued through adhering to a program (Brandt and Binder 2007). Figure 1 shows our early attempts to visualize the relationship between overall research question, design research program and experiments in various ways. The main diagram...

  6. Research-Practice

    Directory of Open Access Journals (Sweden)

    Laura M. Desimone


    Full Text Available Recent attention on partnerships between researchers and practitioners highlights the potential of these relationships to provide high-quality usable knowledge for improving schools. But how do we translate guiding partnership principles into specific actionable steps? How do we build and maintain an effective partnership? How do we reconcile and integrate multiple partnership frameworks to establish a coherent set of partnership activities? How do we evaluate partnership progress and outcomes? Building on the recent insightful work on partnerships, we offer a framework for planning, building, implementing, and monitoring partnerships, based on the literature and our experiences in a partnership between a university-based school of education at a major research university and the research office of a big-city school district. Using a theory describing attributes that define a policy’s strength, we propose an organizing framework to transform insights about partnerships into concrete activities and mechanisms to help achieve the potential of these partnerships to use research to improve schooling.

  7. Investigación y práctica clínica en una cátedra universitaria Research and clinical practice in an University chair

    Directory of Open Access Journals (Sweden)

    Sara Slapak


    Full Text Available Se presentan resultados preliminares de un estudio exploratorio acerca de los efectos de la práctica investigativa sobre la práctica clínica; ambas actividades son realizadas por integrantes de una cátedra universitaria cuyo objetivo docente es la enseñanza de una teoría psicoanalítica. Los profesionales psicólogos se desempeñan como docentes de grado y de postgrado, como psicoterapeutas de niños en una unidad asistencial y participan asimismo de una investigación empírica sobre cambio psíquico en niños y cambios en la contención emocional de sus adultos responsables, sobre la base de material clínico recogido en la unidad asistencial. Es un equipo heterogéneo respecto de la experiencia docente, asistencial e investigativa, que incluye estudiantes avanzados y graduados recientes de la carrera de Psicología y profesionales de larga y reconocida trayectoria. Se analizan las respuestas a una pregunta abierta formulada a cada docente-psicoterapeuta-investigador a fin de recabar su percepción respecto de los efectos de su actividad investigativa en su práctica asistencial. En la práctica clínica los docentes-psicoterapeutas-investigadores registran cambios en la percepción y en la organización del material clínico y mayor precisión en sus intervenciones.In this paper we present preliminary results obtained in an exploratory study about research practice effects on clinical practice; both activities are carried out by members of an university chair whose educational objective is tutoring of a psychoanalytic theory. The professional psychologists perform their activities as degree or posdegree teachers, as children psychotherapists in an welfare unit and also participate in an empirical investigation about psychic change in children and changes in the emotional support of their adults in charge, based on the clinical material gathered in the welfare unit. This is an heterogeneous working team regarding the teaching, assisting

  8. Research versus educational practice

    DEFF Research Database (Denmark)

    de Graaff, Erik


    Over the past years, the European Journal of Engineering Education (EJEE), the journal of the European Society for Engineering Education (SEFI) developed as a more research oriented journal. Bibliometric analyses show that EJEE keeps pace with other leading journals in the field of Engineering...... for this phenomenon, it is argued that EJEE keeps on publishing papers that are appreciated by practitioners in the field, even if they do not generate a lot of citations in scientific journals....

  9. Research-Practice


    Laura M. Desimone; Tonya Wolford; Kirsten Lee Hill


    Recent attention on partnerships between researchers and practitioners highlights the potential of these relationships to provide high-quality usable knowledge for improving schools. But how do we translate guiding partnership principles into specific actionable steps? How do we build and maintain an effective partnership? How do we reconcile and integrate multiple partnership frameworks to establish a coherent set of partnership activities? How do we evaluate partnership progress and outcome...

  10. Understanding practice-based research participation: The differing motivations of engaged vs. non-engaged clinicians in pragmatic clinical trials

    Directory of Open Access Journals (Sweden)

    Donna A. Messner


    Conclusions: We conclude that clinicians not already participating in practice-based trials may have a narrower range of motivations than those already participating. The lack of a broader view of possible benefits to participation may also translate into more obdurate recruiting challenges. These results point to the need for recruitment, engagement, and messaging approaches differentially tailored to the needs and interests of non-participating practices.

  11. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences

    Directory of Open Access Journals (Sweden)

    de Vries Martine C


    Full Text Available Abstract Background Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. Methodology An empirical ethical approach, combining (1 a narrative review of (primarily qualitative studies on parents' and physicians' experiences of the pediatric oncology research practice, and (2 comparison of these experiences with existing theoretical ethical concepts about (pediatric research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Results Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist. True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the

  12. Linking research to practice

    DEFF Research Database (Denmark)

    Pinto-Correia, T.; Kristensen, L.


    , and cultural ones, all converging in the rural landscape, at multiple scales. The landscape, as, the spatial entity, in its material and immaterial dimensions, is presented in this paper as the most, comprehensive basis for the required step forward. This does not mean a disciplinary landscape, analysis......, questions on the changes affecting the rural, addressed by society to the scientific community, are of a, new character and require novel research approaches. This paper argues that landscape based, approaches can be useful basis for the required conceptual innovation. The paper presents and, discusses...

  13. Litigations and the Obstetrician in Clinical Practice

    African Journals Online (AJOL)

    and the Obstetrician in Clinical Practice, highlighting medical ethics, federation of gynecology and obstetrics ... of litigation, high indemnity cost, and long working hours are among the main reasons given by obstetricians for ... Annals of Medical and Health Sciences Research | Mar-Apr 2016 | Vol 6 | Issue 2 |. 75 countries ...

  14. Implications of ICD-10 for Sarcopenia Clinical Practice and Clinical Trials: Report by the International Conference on Frailty and Sarcopenia Research Task Force. (United States)

    Vellas, B; Fielding, R A; Bens, C; Bernabei, R; Cawthon, P M; Cederholm, T; Cruz-Jentoft, A J; Del Signore, S; Donahue, S; Morley, J; Pahor, M; Reginster, J-Y; Rodriguez Mañas, L; Rolland, Y; Roubenoff, R; Sinclair, A; Cesari, M


    Establishment of an ICD-10-CM code for sarcopenia in 2016 was an important step towards reaching international consensus on the need for a nosological framework of age-related skeletal muscle decline. The International Conference on Frailty and Sarcopenia Research Task Force met in April 2017 to discuss the meaning, significance, and barriers to the implementation of the new code as well as strategies to accelerate development of new therapies. Analyses by the Sarcopenia Definitions and Outcomes Consortium are underway to develop quantitative definitions of sarcopenia. A consensus conference is planned to evaluate this analysis. The Task Force also discussed lessons learned from sarcopenia trials that could be applied to future trials, as well as lessons from the osteoporosis field, a clinical condition with many constructs similar to sarcopenia and for which ad hoc treatments have been developed and approved by regulatory agencies.

  15. Caught between a rock and a hard place: An intrinsic single-case study of nurse researchers’ experiences of the presence of a nursing research culture in clinical practice

    DEFF Research Database (Denmark)

    Bøttcher Berthelsen, Connie; Hølge-Hazelton, Bibi


    for the skills of health professionals and evidence-based practice. However, the utilization of nursing research in clinical practice is still limited. DESIGN: Intrinsic single-case study design underlined by a constructivist perspective. METHODS: Data were produced through a focus group interview with seven......: 'Caught between a rock and a hard place' was constructed as the main theme describing how nurse researchers in clinical positions experience the presence of a nursing research culture in clinical practice. The main theme was supported by three sub-themes: Minimal academic tradition affects nursing...

  16. [Seborrheic dermatitis in clinical practice]. (United States)

    Rovelli, Francesca; Mercuri, Santo Raffaele; Naldi, Luigi


    Seborrheic dermatitis is a chronic relapsing inflammatory skin condition characterized by scaling and poorly defined erythematous patches in areas rich in sebaceous glands. It is one of the most frequent skin disorders and may be socially embarrassing. Fungi of the genus Malassezia, lipid-dependent, ubiquitous skin residents, play a pathogenic role. Topical antifungal agents (e.g., ketoconazole) are the mainstay of treatment, and if used intermittently they can maintain remission. The vehicle itself may also play a relevant role. Improvements in diagnostic criteria, severity measures and outcome variables are needed to better design clinical trials and inform clinical practice.

  17. Reflections in the clinical practice. (United States)

    Borrell-Carrió, F; Hernández-Clemente, J C


    The purpose of this article is to analyze some models of expert decision and their impact on the clinical practice. We have analyzed decision-making considering the cognitive aspects (explanatory models, perceptual skills, analysis of the variability of a phenomenon, creating habits and inertia of reasoning and declarative models based on criteria). We have added the importance of emotions in decision making within highly complex situations, such as those occurring within the clinical practice. The quality of the reflective act depends, among other factors, on the ability of metacognition (thinking about what we think). Finally, we propose an educational strategy based on having a task supervisor and rectification scenarios to improve the quality of medical decision making. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  18. Sports Medicine and Athletic Training in the 21st Century: Bridging the Gap between Research and Clinical Practice (United States)

    Guskiewicz, Kevin M.


    Sport and recreational activity is a vital part of today's society, and athletic training researchers are playing an important role in gaining a better understanding of how to promote safe and healthy participation for athletes of all ages. This article aims to illustrate the importance of research to prevent and effectively treat sport and…

  19. The practice of clinical neuropsychology in Australia. (United States)

    Ponsford, Jennie


    This paper describes the development and practice of clinical neuropsychology in Australia. Clinical Neuropsychology has shown rapid growth in Australia over the past three decades. Comprehensive and specialized training programs are producing high quality graduates who are employed in a broad range of settings or private practice. Australia now has a substantial number of clinical neuropsychologists with specialist training. Whilst the majority of Australian clinical neuropsychologists still undertake assessment predominantly, there are growing opportunities for clinical neuropsychologists in rehabilitation and in a broad range of research contexts. Cultural issues relating to the assessment of Indigenous Australians and immigrants from many countries present significant challenges. Some major contributions have been made in the realms of test development and validation across various age groups. Australian clinical neuropsychologists are also contributing significantly to research in the fields of traumatic brain injury, aging and dementias, epilepsy, memory assessment, rehabilitation, substance abuse, and other psychiatric disorders. Expansion of roles of clinical neuropsychologists, in domains such as rehabilitation and research is seen as essential to underpin continuing growth of employment opportunities for the profession.

  20. 'Mind the gap' between the development of therapeutic innovations and the clinical practice in oncology: A proposal of the European Organisation for Research and Treatment of Cancer (EORTC) to optimise cancer clinical research. (United States)

    Kempf, Emmanuelle; Bogaerts, Jan; Lacombe, Denis; Liu, Lifang


    In Europe, most of the cancer clinical research dedicated to therapeutic innovations aims primarily at regulatory approval. Once an anticancer drug enters the common market, each member state determines its real-world use based on its own criteria: pricing, reimbursement and clinical indications. Such an innovation-centred clinical research landscape might neglect patient-relevant issues in real-world setting, such as comparative effectiveness of distinct treatment options or long-term safety monitoring. The European Organisation for Research and Treatment of Cancer (EORTC) advocates reforming the current 'innovation-centred' system to a truly 'patient-centred' paradigm with systematically coordinated applied clinical research in conjunction with drug development, featuring the following strategy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Promoting physical therapists' use of research evidence to inform clinical practice: part 3--long term feasibility assessment of the PEAK program. (United States)

    Tilson, Julie K; Mickan, Sharon; Howard, Robbin; Sum, Jonathan C; Zibell, Maria; Cleary, Lyssa; Mody, Bella; Michener, Lori A


    Evidence is needed to develop effective educational programs for promoting evidence based practice (EBP) and knowledge translation (KT) in physical therapy. This study reports long-term outcomes from a feasibility assessment of an educational program designed to promote the integration of research evidence into physical therapist practice. Eighteen physical therapists participated in the 6-month Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program. The participant-driven active learning program consisted of four consecutive, interdependent components: 1) acquiring managerial leadership support and electronic resources in three clinical practices, 2) a 2-day learner-centered EBP training workshop, 3) 5 months of guided small group work synthesizing research evidence into a locally relevant list of, actionable, evidence-based clinical behaviors for therapists treating persons with musculoskeletal lumbar conditions--the Best Practices List, and 4) review and revision of the Best Practices List, culminating in participant agreement to implement the behaviors in practice. Therapists' EBP learning was assessed with standardized measures of EBP-related attitudes, self-efficacy, knowledge and skills, and self-reported behavior at baseline, immediately-post, and 6 months following conclusion of the program (long-term follow-up). Therapist adherence to the Best Practice List before and after the PEAK program was assessed through chart review. Sixteen therapists completed the long-term follow-up assessment. EBP self-efficacy and self-reported behaviors increased from baseline to long-term follow-up (p < 0.001 and p = 0.002, respectively). EBP-related knowledge and skills showed a trend for improvement from baseline to long-term follow-up (p = 0.05) and a significant increase from immediate-post to long-term follow-up (p = 0.02). Positive attitudes at baseline were sustained throughout (p = 0.208). Eighty-nine charts were

  2. Asymmetry of the ULNT1 elbow extension range-of-motion in a healthy population: consequences for clinical practice and research. (United States)

    Van Hoof, Tom; Vangestel, Carl; Shacklock, Michael; Kerckaert, Ingrid; D'Herde, Katharina


    To investigate the effect of isolated muscular variance, side and hand dominance on elbow-extension range-of-motion (EE-ROM) of the median nerve upper limb neurodynamic test (ULNT1). This study analyzes these variables potential to influence ULNT1 EE-ROM symmetry and the possible consequences for clinical practice and research. Controlled laboratory study, cross-sectional. No normative data exist to interpret correctly EE-ROM. Clinical interpretation is based on bilateral comparison. This procedure assumes natural EE-ROM symmetry, with lack of scientific evidence. Nineteen participants with Langer's axillary arch (LAA), a muscular variant bridging the brachial plexus, were selected from 640 healthy volunteers, together with a matched control group. ULNT1 EE-ROM's were measured using the Vicon(®) optoelectronic system. A full mixed model revealed no significant effects on EE-ROM for LAA and the variable side. Significant differences were found in EE-ROM between dominant and non-dominant sides (standard ULNT1 test position: 2.84° ± 1.60°, p = 0.0004; ULNT1 with differentiating maneuver: 3.05° ± 1.98°, p = 0.003). Approximately 30% of the subjects showed clinically detectable restriction (≥10°) of the dominant side EE-ROM. Hand dominance is significantly associated with restriction of EE-ROM, which results in a clinically detectable asymmetry. This compromises the clinical procedure of comparing the patient's EE-ROM to the opposite side. Erroneous conclusions could result in side to side analyses, if the effect is not taken into account in neurodynamic research. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Translating the Theoretical into Practical: A Logical Framework of Functional Analytic Psychotherapy Interactions for Research, Training, and Clinical Purposes (United States)

    Weeks, Cristal E.; Kanter, Jonathan W.; Bonow, Jordan T.; Landes, Sara J.; Busch, Andrew M.


    Functional analytic psychotherapy (FAP) provides a behavioral analysis of the psychotherapy relationship that directly applies basic research findings to outpatient psychotherapy settings. Specifically, FAP suggests that a therapist's in vivo (i.e., in-session) contingent responding to targeted client behaviors, particularly positive reinforcement…

  4. Overseas Research. A Practical Guide. (United States)

    Barrett, Christopher B.; Cason, Jeffrey W.

    This guide is intended to give practical advice that prepares graduate student researchers for the realities and challenges of living and working abroad, with a particular focus on that area of research experience that is between participation and observation. Drawing on the experiences of 150 scholars, funded over a 6-year period by the MacArthur…

  5. [Qualitative translational science in clinical practice]. (United States)

    Mu, Pei-Fan


    Qualitative translational research refers to the "bench-to-bedside" enterprise of harnessing knowledge from the basic sciences to produce new treatment options or nursing interventions for patients. Three evidence-based translational problems related to qualitative translational research discussed this year address the interfaces among the nursing paradigm, the basic sciences, and clinical nursing work. This article illustrates the definition of translational science and translational blocks of evidence-based practice; discusses the qualitative research perspective in evidence synthesis, evidence translation and evidence utilization; and discusses the research questions that must be answered to solve the problems of the three translational gaps from the qualitative research perspective. Qualitative inquiry has an essential role to play in efforts to improve current healthcare-provider nursing interventions, experiences, and contexts. Thus, it is vital to introduce qualitative perspectives into evidence-based practice from the knowledge discovery through to the knowledge implementation process.

  6. Standardisation of neonatal clinical practice. (United States)

    Bhutta, Z A; Giuliani, F; Haroon, A; Knight, H E; Albernaz, E; Batra, M; Bhat, B; Bertino, E; McCormick, K; Ochieng, R; Rajan, V; Ruyan, P; Cheikh Ismail, L; Paul, V


    The International Fetal and Newborn Growth Consortium for the 21(st) Century (INTERGROWTH-21(st) ) is a large-scale, population-based, multicentre project involving health institutions from eight geographically diverse countries, which aims to assess fetal, newborn and preterm growth under optimal conditions. Given the multicentre nature of the project and the expected number of preterm births, it is vital that all centres follow the same standardised clinical care protocols to assess and manage preterm infants, so as to ensure maximum validity of the resulting standards as indicators of growth and nutrition with minimal confounding. Moreover, it is well known that evidence-based clinical practice guidelines can reduce the delivery of inappropriate care and support the introduction of new knowledge into clinical practice. The INTERGROWTH-21(st) Neonatal Group produced an operations manual, which reflects the consensus reached by members of the group regarding standardised definitions of neonatal morbidities and the minimum standards of care to be provided by all centres taking part in the project. The operational definitions and summary management protocols were developed by consensus through a Delphi process based on systematic reviews of relevant guidelines and management protocols by authoritative bodies. This paper describes the process of developing the Basic Neonatal Care Manual, as well as the morbidity definitions and standardised neonatal care protocols applied across all the INTERGROWTH-21(st) participating centres. Finally, thoughts about implementation strategies are presented. © 2013 Royal College of Obstetricians and Gynaecologists.

  7. Practice research under changing conditions

    DEFF Research Database (Denmark)

    Dreier, Ole

    particularly important in unraveling what is glossed over or reinterpreted beyond recognition. Doing so helps putting psychology back on its feet. But practice research was developed under other social, political and professional conditions and under other regimes of knowledge than we find today where...... research in critical psychology is based on a science of the subject – as opposed to the science of control dominating psychology. Of course, projects involve many subjects with diverse perspectives on the issues at hand. Descriptions of practices from subject positions previously considered negligible......The tradition of practice research emerged in critical psychology in Germany and Denmark about twenty-five years ago. It emphasizes the relevance of knowledge - above all knowledge for change - by researching exemplary scopes of possibilities for agents in particular kinds of situations. A key...

  8. Workshop Euratom Directive 97/43. New trends in radiation protection in clinical practice, in research and in regulation

    International Nuclear Information System (INIS)

    Mazzei, F.


    The Euratom Directive 97/43 on health protection of individuals against the dangers of ionizing radiation in relation to medical exposure is presented. In particular the following topics are focused, with a multidisciplinary approach, on: diagnostic reference levels in radiodiagnostics and nuclear medicine; radiation protection in paediatrics, in interventional radiology and in computer tomography; radiation protection radiotherapy, radiation protection in medical research; radiation protection in prenatal and neonatal exposure; radiation protection in medical-legal exposures [it

  9. The Bobath concept - a model to illustrate clinical practice. (United States)

    Michielsen, Marc; Vaughan-Graham, Julie; Holland, Ann; Magri, Alba; Suzuki, Mitsuo


    The model of Bobath clinical practice provides a framework identifying the unique aspects of the Bobath concept in terms of contemporary neurological rehabilitation. The utilisation of a framework to illustrate the clinical application of the Bobath concept provides the basis for a common understanding with respect to Bobath clinical practice, education, and research. The development process culminating in the model of Bobath clinical practice is described. The use of the model in clinical practice is illustrated using two cases: a client with a chronic incomplete spinal cord injury and a client with a stroke. This article describes the clinical application of the Bobath concept in terms of the integration of posture and movement with respect to the quality of task performance, applying the Model of Bobath Clinical Practice. Facilitation, a key aspect of Bobath clinical practice, was utilised to positively affect motor control and perception in two clients with impairment-related movement problems due to neurological pathology and associated activity limitations and participation restrictions - the outcome measures used to reflect the individual clinical presentation. Implications for Rehabilitation The model of Bobath clinical practice provides a framework identifying the unique aspects of the Bobath-concept. The model of Bobath clinical practice provides the basis for a common understanding with respect to Bobath clinical practice, education, and research. The clinical application of the Bobath-concept highlights the integration of posture and movement with respect to the quality of task performance. Facilitation, a key aspect of Bobath clinical practice, positively affects motor control, and perception.

  10. Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy. (United States)

    Harper, Joyce; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo J; Gianaroli, Luca; Harton, Gary; Milachich, Tanya; Kääriäinen, Helena; Liebaers, Inge; Morris, Michael; Sequeiros, Jorge; Sermon, Karen; Shenfield, Françoise; Skirton, Heather; Soini, Sirpa; Spits, Claudia; Veiga, Anna; Vermeesch, Joris Robert; Viville, Stéphane; de Wert, Guido; Macek, Milan


    How has the interface between genetics and assisted reproduction technology (ART) evolved since 2005? The interface between ART and genetics has become more entwined as we increase our understanding about the genetics of infertility and we are able to perform more comprehensive genetic testing. In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and ART and published an extended background paper, recommendations and two Editorials. An interdisciplinary workshop was held, involving representatives of both professional societies and experts from the European Union Eurogentest2 Coordination Action Project. In March 2012, a group of experts from the European Society of Human Genetics, the European Society of Human Reproduction and Embryology and the EuroGentest2 Coordination Action Project met to discuss developments at the interface between clinical genetics and ART. As more genetic causes of reproductive failure are now recognized and an increasing number of patients undergo testing of their genome prior to conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and PGD may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from RCTs to substantiate that the technique is both effective and efficient. Whole genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving, but still remains very

  11. Qualitative analysis of clinical research coordinators' role in phase I cancer clinical trials


    Noriko Fujiwara; Ryota Ochiai; Yuki Shirai; Yuko Saito; Fumitaka Nagamura; Satoru Iwase; Keiko Kazuma


    Background: Clinical research coordinators play a pivotal role in phase I cancer clinical trials. Purpose: We clarified the care coordination and practice for patients provided by clinical research coordinators in phase I cancer clinical trials in Japan and elucidated clinical research coordinators' perspective on patients' expectations and understanding of these trials. Method: Fifteen clinical research coordinators participated in semi-structured interviews regarding clinical practice...

  12. Evidence-Based Psychological Interventions for the Management of Pediatric Chronic Pain: New Directions in Research and Clinical Practice (United States)

    Coakley, Rachael; Wihak, Tessa


    Over the past 20 years our knowledge about evidence-based psychological interventions for pediatric chronic pain has dramatically increased. Overall, the evidence in support of psychological interventions for pediatric chronic pain is strong, demonstrating positive psychological and behavioral effects for a variety of children with a range of pain conditions. However, wide scale access to effective psychologically-based pain management treatments remains a challenge for many children who suffer with pain. Increasing access to care and reducing persistent biomedical biases that inhibit attainment of psychological services are a central focus of current pain treatment interventions. Additionally, as the number of evidence-based treatments increase, tailoring treatments to a child or family’s particular needs is increasingly possible. This article will (1) discuss the theoretical frameworks as well as the specific psychological skills and strategies that currently hold promise as effective agents of change; (2) review and summarize trends in the development of well-researched outpatient interventions over the past ten years; and (3) discuss future directions for intervention research on pediatric chronic pain. PMID:28165415

  13. Evidence-Based Psychological Interventions for the Management of Pediatric Chronic Pain: New Directions in Research and Clinical Practice

    Directory of Open Access Journals (Sweden)

    Rachael Coakley


    Full Text Available Over the past 20 years our knowledge about evidence-based psychological interventions for pediatric chronic pain has dramatically increased. Overall, the evidence in support of psychological interventions for pediatric chronic pain is strong, demonstrating positive psychological and behavioral effects for a variety of children with a range of pain conditions. However, wide scale access to effective psychologically-based pain management treatments remains a challenge for many children who suffer with pain. Increasing access to care and reducing persistent biomedical biases that inhibit attainment of psychological services are a central focus of current pain treatment interventions. Additionally, as the number of evidence-based treatments increase, tailoring treatments to a child or family’s particular needs is increasingly possible. This article will (1 discuss the theoretical frameworks as well as the specific psychological skills and strategies that currently hold promise as effective agents of change; (2 review and summarize trends in the development of well-researched outpatient interventions over the past ten years; and (3 discuss future directions for intervention research on pediatric chronic pain.

  14. Proton therapy in clinical practice (United States)

    Liu, Hui; Chang, Joe Y.


    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. PMID:21527064

  15. Construction of ethics in clinical research: clinical trials registration

    Directory of Open Access Journals (Sweden)

    C. A. Caramori


    Full Text Available Scientific development that has been achieved through decades finds in clinical research a great possibility of translating findings to human health application. Evidence given by clinical trials allows everyone to have access to the best health services. However, the millionaire world of pharmaceutical industries has stained clinical research with doubt and improbability. Study results (fruits of controlled clinical trials and scientific publications (selective, manipulated and with wrong conclusions led to an inappropriate clinical practice, favoring the involved economic aspect. In 2005, the International Committee of Medical Journal Editors (ICMJE, supported by the World Association of Medical Editors, started demanding as a requisite for publication that all clinical trials be registered at the database In 2006, the World Health Organization (WHO created the International Clinical Trial Registry Platform (ICTRP, which gathers several registry centers from all over the world, and required that all researchers and pharmaceutical industries register clinical trials. Such obligatory registration has progressed and will extend to all scientific journals indexed in all worldwide databases. Registration of clinical trials means another step of clinical research towards transparency, ethics and impartiality, resulting in real evidence to the forthcoming changes in clinical practice as well as in the health situation.

  16. Potential for new technologies in clinical practice. (United States)

    Burridge, Jane H; Hughes, Ann-Marie


    Cost-effective neurorehabilitation is essential owing to financial constraints on healthcare resources. Technologies have the potential to contribute but without strong clinical evidence are unlikely to be widely reimbursed. This review presents evidence of new technologies since 2008 and identifies barriers to translation of technologies into clinical practice. Technology has not been shown to be superior to intensively matched existing therapies. Research has been undertaken into the development and preliminary clinical testing of novel technologies including robotics, electrical stimulation, constraint-induced movement therapy, assistive orthoses, noninvasive brain stimulation, virtual reality and gaming devices. Translation of the research into clinical practice has been impeded by a lack of robust evidence of clinical effectiveness and usability. Underlying mechanisms associated with recovery are beginning to be explored, which may lead to more targeted interventions. Improvements in function have been demonstrated beyond the normal recovery period, but few trials demonstrate lasting effects. Technologies, alone or combined, may offer a cost-effective way to deliver intensive neurorehabilitation therapy in clinical and community environments, and have the potential to empower patients to take more responsibility for their rehabilitation and continue with long-term exercise.

  17. Central Sleep Apnea with Cheyne-Stokes Breathing in Heart Failure - From Research to Clinical Practice and Beyond. (United States)

    Terziyski, K; Draganova, A


    Characterized by periodic crescendo-decrescendo pattern of breathing alternating with central apneas, Central sleep apnea (CSA) with Cheyne-Stokes Breathing represents a highly prevalent, yet underdiagnosed comorbidity in chronic heart failure (CHF). A diverse body of evidence demonstrates increased morbidity and mortality in the presence of CSB. CSB has been described in both CHF patients with preserved and reduced ejection fraction, regardless of drug treatment. Risk factors for CSB are older age, male gender, high BMI, atrial fibrillation and hypocapnia.The pathophysiology of CSB has been explained by the loop gain theory, where a controller (the respiratory center) and a plant (the lungs) are operating in a reciprocal relationship (negative feedback) to regulate a key parameter (partial pressure of carbon dioxide (pCO 2 )). The temporal interaction between these elements is dependent on the circulatory delay. Increased chemosensitivity/chemoresponsiveness of the respiratory center and/or augmented ascending non- CO 2 stimuli from the C-fibers in the lungs (interstitial pulmonary edema), overly efficient ventilation when breathing at low volumes and prolonged circulation time are involved. An alternative hypothesis of CSB being an adaptive response of the failing heart has its merits as well. The clinical manifestation of CSB is usually poor, lacking striking symptoms and complaints. Witnessed apneas and snoring are infrequently reported by the sleep partner. Sometimes patients may report poor sleep quality with frequent awakenings, paroxysmal nocturnal dyspnea and frequent urination at night. Standard instrumental and laboratory studies, performed in CHF patients, may present clues to the presence of CSB. Concentric remodeling of the left ventricle and dilated left atrium (echocardiography), high BNP and C-reactive protein levels, increased ventilation-carbon dioxide output (VEVCO 2 ) and lower end-tidal CO 2 (cardiopulmonary exercise testing), reduced

  18. Patient safety in clinical research articles. (United States)

    Vintzileos, Anthony M; Finamore, Peter S; Sicuranza, Genevieve B; Ananth, Cande V


    Patient safety has remained one of the most important priorities over the past decade, particularly in hospital settings. Implementation of patient safety measures has focused not only on reducing medication and surgical errors but also on the development of a culture of safety, including enhanced communication among all healthcare stakeholders. Academic medicine may further contribute to the culture of safety if all relevant clinical article submissions address patient safety. In order to improve communication between the authors of clinical research articles and practicing physicians, we propose that each clinical research article may be accompanied by a clear statement from the authors regarding practice implications and patient safety. © 2013.

  19. Impella ventricular support in clinical practice

    DEFF Research Database (Denmark)

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


    Mechanical circulatory support represents an evolving field of clinical research and practice. Currently, several cardiac assist devices have been developed but, among different institutions and countries, a large variation in indications for use and device selection exists. The Impella platform...... is an easy to use percutaneous circulatory support device which is increasingly used worldwide. During 2014, we established a working group of European physicians who have collected considerable experience with the Impella device in recent years. By critically comparing the individual experiences...

  20. Clinical pharmacy services in heart failure: an opinion paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network. (United States)

    Milfred-Laforest, Sherry K; Chow, Sheryl L; Didomenico, Robert J; Dracup, Kathleen; Ensor, Christopher R; Gattis-Stough, Wendy; Heywood, J Thomas; Lindenfeld, Joann; Page, Robert L; Patterson, J Herbert; Vardeny, Orly; Massie, Barry M


    Heart failure (HF) care takes place in multiple settings, with a variety of providers, and generally involves patients who have multiple comorbidities. This situation is a "perfect storm" of factors that predispose patients to medication errors. The goals of this paper are to outline potential roles for clinical pharmacists in a multidisciplinary HF team, to document outcomes associated with interventions by clinical pharmacists, to recommend minimum training for clinical pharmacists engaged in HF care, and to suggest financial strategies to support clinical pharmacy services within a multidisciplinary team. As patients transition from inpatient to outpatient settings and between multiple caregivers, pharmacists can positively affect medication reconciliation and education, assure consistency in management that results in improvements in patient satisfaction and medication adherence, and reduce medication errors. For mechanical circulatory support and heart transplant teams, the Centers for Medicare and Medicaid Services considers the participation of a transplant pharmacology expert (e.g., clinical pharmacist) to be a requirement for accreditation, given the highly specialized and complex drug regimens used. Although reports of outcomes from pharmacist interventions have been mixed owing to differences in study design, benefits such as increased use of evidence-based therapies, decreases in HF hospitalizations and emergency department visits, and decreases in all-cause readmissions have been demonstrated. Clinical pharmacists participating in HF or heart transplant teams should have completed specialized postdoctoral training in the form of residencies and/or fellowships in cardiovascular and/or transplant pharmacotherapy, and board certification is recommended. Financial mechanisms to support pharmacist participation in the HF teams are variable. Positive outcomes associated with clinical pharmacist activities support the value of making this resource available

  1. Action research in pharmacy practice

    DEFF Research Database (Denmark)

    Nørgaard, Lotte Stig; Sørensen, Ellen Westh


    -based study. Concepts related to AR are described; in addition, the multifaceted role of the action researcher is described, along with a set of data quality criteria for evaluating the quality of an AR-based study. Then follows a thorough description of a Danish AR-based pharmacy practice study. The chapter...

  2. Thermal comfort: research and practice

    NARCIS (Netherlands)

    Ir. Joost van Hoof; Mitja Mazej; Jan Hensen


    Thermal comfort -the state of mind, which expresses satisfaction with the thermal environment- is an important aspect of the building design process as modern man spends most of the day indoors. This paper reviews the developments in indoor thermal comfort research and practice since the second half

  3. From research to practice: one organisational model for promoting research based practice. (United States)

    Kitson, A


    This paper describes a framework used by the National Institute for Nursing in Oxford to integrate research, development and practice. With the increasing attention given to the topic of how research findings are implemented into clinical practice, it was felt important to share the challenges that have arisen in attempting to combine traditional research activities with more practice based development work. The emerging conceptual framework, structures and functions are described highlighting the variety of partnerships to be established in order to achieve the goal of integrating research into practice. While the underpinning principles of the framework--generating knowledge, implementing research into practice and evaluating the effectiveness of programmes--are not new, it is the way they have been combined within an organisational structure that could be helpful to others considering such a strategy. Both the strengths and weaknesses of the model are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication.

  4. Supernumerary teeth in clinical practice

    Directory of Open Access Journals (Sweden)

    Anna K. Szkaradkiewicz


    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.

  5. Bullous pemphigoid: clinical practice guidelines. (United States)

    Fuertes de Vega, I; Iranzo-Fernández, P; Mascaró-Galy, J M


    Bullous pemphigoid (BP) is an autoimmune subepidermal bullous disease in which autoantibodies are directed against components of the basement membrane. Most of these antibodies belong to the immunoglobulin G class and bind principally to 2 hemidesmosomal proteins: the 180-kD antigen (BP180) and the 230-kD antigen (BP230). It is the most common blistering disease in the adult population in developed countries, with an estimated incidence in Spain of 0.2 to 3 cases per 100,000 inhabitants per year. The disease primarily affects older people, although it can also occur in young people and even in children. In recent years, advances in clinical practice have led to a better understanding and improved management of this disorder. These advances include new diagnostic techniques, such as enzyme-linked immunosorbent assay for BP180 and new drugs for the treatment of BP, with diverse therapeutic targets. There is, however, still no international consensus on guidelines for the management of BP. This article is an updated review of the scientific literature on the treatment of BP. It focuses primarily on evidence-based recommendations and is written from a practical standpoint based on experience in the routine management of this disease. Copyright © 2012 Elsevier España, S.L. y AEDV. All rights reserved.

  6. A systematic review of the utility of 1.5 versus 3 Tesla magnetic resonance brain imaging in clinical practice and research. (United States)

    Wardlaw, Joanna M; Brindle, Will; Casado, Ana M; Shuler, Kirsten; Henderson, Moira; Thomas, Brenda; Macfarlane, Jennifer; Muñoz Maniega, Susana; Lymer, Katherine; Morris, Zoe; Pernet, Cyril; Nailon, William; Ahearn, Trevor; Mumuni, Abdul Nashirudeen; Mugruza, Carlos; McLean, John; Chakirova, Goultchira; Tao, Yuehui Terry; Simpson, Johanna; Stanfield, Andrew C; Johnston, Harriet; Parikh, Jehill; Royle, Natalie A; De Wilde, Janet; Bastin, Mark E; Weir, Nick; Farrall, Andrew; Valdes Hernandez, Maria C


    MRI at 3 T is said to be more accurate than 1.5 T MR, but costs and other practical differences mean that it is unclear which to use. We systematically reviewed studies comparing diagnostic accuracy at 3 T with 1.5 T. We searched MEDLINE, EMBASE and other sources from 1 January 2000 to 22 October 2010 for studies comparing diagnostic accuracy at 1.5 and 3 T in human neuroimaging. We extracted data on methodology, quality criteria, technical factors, subjects, signal-to-noise, diagnostic accuracy and errors according to QUADAS and STARD criteria. Amongst 150 studies (4,500 subjects), most were tiny, compared old 1.5 T with new 3 T technology, and only 22 (15 %) described diagnostic accuracy. The 3 T images were often described as "crisper", but we found little evidence of improved diagnosis. Improvements were limited to research applications [functional MRI (fMRI), spectroscopy, automated lesion detection]. Theoretical doubling of the signal-to-noise ratio was not confirmed, mostly being 25 %. Artefacts were worse and acquisitions took slightly longer at 3 T. Objective evidence to guide MRI purchasing decisions and routine diagnostic use is lacking. Rigorous evaluation accuracy and practicalities of diagnostic imaging technologies should be the routine, as for pharmacological interventions, to improve effectiveness of healthcare. • Higher field strength MRI may improve image quality and diagnostic accuracy. • There are few direct comparisons of 1.5 and 3 T MRI. • Theoretical doubling of the signal-to-noise ratio in practice was only 25 %. • Objective evidence of improved routine clinical diagnosis is lacking. • Other aspects of technology improved images more than field strength.

  7. Body composition in clinical practice. (United States)

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


    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. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. The Bobath concept in contemporary clinical practice. (United States)

    Graham, Julie Vaughan; Eustace, Catherine; Brock, Kim; Swain, Elizabeth; Irwin-Carruthers, Sheena


    Future development in neurorehabilitation depends upon bringing together the endeavors of basic science and clinical practice. The Bobath concept is widely utilized in rehabilitation following stroke and other neurological conditions. This concept was first developed in the 1950s, based on the neuroscience knowledge of those times. The theoretical basis of the Bobath concept is redefined based on contemporary neuroscience and rehabilitation science. The framework utilized in the Bobath concept for the analysis of movement and movement dysfunction is described. This framework focuses on postural control for task performance, the ability to move selectively, the ability to produce coordinated sequences of movement and vary movement patterns to fit a task, and the role of sensory input in motor behaviour and learning. The article describes aspects of clinical practice that differentiate this approach from other models of practice. Contemporary practice in the Bobath concept utilizes a problem-solving approach to the individual's clinical presentation and personal goals. Treatment is focused toward remediation, where possible, and guiding the individual towards efficient movement strategies for task performance. The aim of this article is to provide a theoretical framework on which future research into the Bobath concept can be based.

  9. Infliximab in Russian clinical practice

    Directory of Open Access Journals (Sweden)

    G V Lukina


    Full Text Available The study of infliximab began (INF in Russia in 2001. It was the first genetically engineered biological agent (GEBA registered in our country to treat patients with rheumatoid arthritis (RA. With the advent of infliximab, a Russian biological rheumatoid arthritis therapy registry started its work. In October 2005, it was set up on the basis of GEBA centers founded in the leading rheumatology clinics of Russia. Objective: to generalize the Russian experience in using INF (its efficacy, tolerance, and side effects in patients with RA in real clinical practice within the framework of a multicenter observational study. Subjects and methods. The register included patients with a valid diagnosis of RA in whom INF treatment was first started. The main indication for this was previous basic therapy failure. This investigation analyzed 396 patients receiving INF therapy. Prior to INF administration, all the patients were examined to identify whether they had possible latent tuberculosis, by applying chest X-ray study and Mantoux test. The European League Against Rheumatism criteria were used to evaluate the efficiency of INF therapy. The relationship between the therapeutic effects of the drug and its cumulative dose was specially used. The trend in X-ray progression was estimated using the Sharp method modified by van der Heijde. INF was given in a dose of 3 mg/kg by the classical regimen: at 0, 2, and 6 weeks, then every 8 weeks. The main assessment periods were at 22 and 46—54 weeks. Results. Analysis of the data of real clinical practice in Russia demonstrates that the use of INF in RA patients with the inadequate effect of traditional disease-modifying antirheumatic drugs (DMARDs is able to cause a rapid and pronounced reduction in disease activity. There is significant evidence that the IFN-treated patients with RA had also suppressed bone destruction. INF treatment for early RA gives rise to remissions more frequently in the early stage of

  10. Medical Ethics in Contemporary Clinical Practice

    Directory of Open Access Journals (Sweden)

    John R. Williams


    Full Text Available This review article describes and analyzes ethical issues in medical practice, particularly those issues encountered by physicians in their relationships with their patients. These relationships often involve ethical conflicts between 2 or more interests, which physicians need to recognize and resolve. The article deals with 4 topics in clinical practice in which ethical conflicts occur: physicians' duty of confidentiality in a digital environment, their responsibilities for dealing with abuses of the human rights of patients, their role in clinical research, and their relationships with commercial enterprises. The ethical policies of the World Medical Association provide the basis for determining appropriate physician conduct on these matters. The article concludes with reflections on the need for international standards of medical ethics.

  11. Medical ethics in contemporary clinical practice. (United States)

    Williams, John R


    This review article describes and analyzes ethical issues in medical practice, particularly those issues encountered by physicians in their relationships with their patients. These relationships often involve ethical conflicts between 2 or more interests, which physicians need to recognize and resolve. The article deals with 4 topics in clinical practice in which ethical conflicts occur: physicians' duty of confidentiality in a digital environment, their responsibilities for dealing with abuses of the human rights of patients, their role in clinical research, and their relationships with commercial enterprises. The ethical policies of the World Medical Association provide the basis for determining appropriate physician conduct on these matters. The article concludes with reflections on the need for international standards of medical ethics.

  12. Applying ‘science’ in chiropractic clinical practice


    Jamison, Jennifer R


    The chiropractic profession is increasingly expressing the sentiment that chiropractic clinical intervention should rest upon a scientific foundation. Before ‘scientific research’ can become meaningful in chiropractic clinical practice, it is necessary that field practitioners be conversant with research terminology. If chiropractic clinical practice is to achieve credibility as a scientific mode of health care and if the benefits of a ‘scientific’ practice model are to enhance patient care, ...

  13. Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare. (United States)

    Richter Sundberg, Linda; Garvare, Rickard; Nyström, Monica Elisabeth


    The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease. A qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data. The guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: 'clinical knowledge and experience', 'potential guideline consequences' and 'needs of vulnerable groups'. The frequency of the use of various criteria in discussions varied over time. Gender, professional status

  14. Researching literacy practices in transition

    DEFF Research Database (Denmark)

    Holm, Lars

    and methodological challenges in researching literacy practices in transition by examining (1) how migrants position themselves in narratives and provide ideological stances towards language learning and literacy, (2) how to research literacies presently in multilingual, multimodal global-local setting in the North...... and South, (3) how children´s investment in literacy draws on different figured worlds as interactional resources when constructing their identity, (4) how local and global norms meet in the discourses of writing on an international Master´s programme, and (5) how supranational conceptualizations...

  15. Confronting the caring crisis in clinical practice. (United States)

    Ma, Fang; Li, Jiping; Zhu, Dan; Bai, Yangjuan; Song, Jianhua


    In light of the call for humanistic caring in the contemporary health care system globally and in China, the issue of improving the caring skills that are essential to student success, high-quality nursing practice and positive patient outcomes is at the forefront of nursing education. The aim of this mixed-methods quantitative and qualitative study was to investigate baccalaureate nursing students' caring ability in the context of China and to explore the role of clinical practice learning in the development of students' caring skills. A two-phase, descriptive study utilising a mixed methodology consisting of a caring ability survey and focus group interviews was conducted. In the quantitative phase, 598 baccalaureate nursing students at two colleges in Yunnan Province in southwest China were surveyed using the Caring Ability Inventory (CAI). In the qualitative phase, 16 of the students who had participated in the quantitative phase were interviewed. Students obtained lower scores on the CAI than have been reported elsewhere by other researchers. In addition, students in the clinical stage of training scored lower than students in the pre-clinical stage. Three themes concerning facilitation by and three themes concerning the obstructive effects of clinical practice learning in the development of caring ability were identified. Themes pertaining to facilitation were: (i) promoting a sense of professional responsibility and ethics; (ii) providing an arena in which to practise caring, and (iii) learning from positive role models. Themes pertaining to obstruction were: (i) a critical practice learning environment; (ii) encountering inappropriate clinical teachers, and (iii) experiencing shock at the contrast between an idealised and the real environment. The key to developing students' ability to care lies in highlighting caring across the entire health care system. By diminishing exposure to negative role models, and adopting appropriate pedagogical ideas about

  16. Improvement of Clinical Skills through Pharmaceutical Education and Clinical Research. (United States)

    Ishizaki, Junko


    Professors and teaching staff in the field of pharmaceutical sciences should devote themselves to staying abreast of relevant education and research. Similarly those in clinical pharmacies should contribute to the advancement of pharmaceutical research and the development of next generation pharmacists and pharmaceuticals. It is thought that those who work in clinical pharmacies should improve their own skills and expertise in problem-finding and -solving, i.e., "clinical skills". They should be keen to learn new standard treatments based on the latest drug information, and should try to be in a position where collecting clinical information is readily possible. In the case of pharmacists in hospitals and pharmacies, they are able to aim at improving their clinical skills simply through performing their pharmaceutical duties. On the other hand, when a pharmaceutical educator aims to improve clinical skills at a level comparable to those of clinical pharmacists, it is necessary to devote or set aside considerable time for pharmacist duties, in addition to teaching, which may result in a shortage of time for hands-on clinical practice and/or in a decline in the quality of education and research. This could be a nightmare for teaching staff in clinical pharmacy who aim to take part in such activities. Nonetheless, I believe that teaching staff in the clinical pharmacy area could improve his/her clinical skills through actively engaging in education and research. In this review, I would like to introduce topics on such possibilities from my own experiences.

  17. Clinical practice guideline: Allergic rhinitis. (United States)

    Seidman, Michael D; Gurgel, Richard K; Lin, Sandra Y; Schwartz, Seth R; Baroody, Fuad M; Bonner, James R; Dawson, Douglas E; Dykewicz, Mark S; Hackell, Jesse M; Han, Joseph K; Ishman, Stacey L; Krouse, Helene J; Malekzadeh, Sonya; Mims, James Whit W; Omole, Folashade S; Reddy, William D; Wallace, Dana V; Walsh, Sandra A; Warren, Barbara E; Wilson, Meghan N; Nnacheta, Lorraine C


    Allergic rhinitis (AR) is one of the most common diseases affecting adults. It is the most common chronic disease in children in the United States today and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5 billion in direct health expenditures annually. It can impair quality of life and, through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually. Not surprisingly, myriad diagnostic tests and treatments are used in managing this disorder, yet there is considerable variation in their use. This clinical practice guideline was undertaken to optimize the care of patients with AR by addressing quality improvement opportunities through an evaluation of the available evidence and an assessment of the harm-benefit balance of various diagnostic and management options. The primary purpose of this guideline is to address quality improvement opportunities for all clinicians, in any setting, who are likely to manage patients with AR as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The guideline is intended to be applicable for both pediatric and adult patients with AR. Children under the age of 2 years were excluded from the clinical practice guideline because rhinitis in this population may be different than in older patients and is not informed by the same evidence base. The guideline is intended to focus on a limited number of quality improvement opportunities deemed most important by the working group and is not intended to be a comprehensive reference for diagnosing and managing AR. The recommendations outlined in the guideline are not intended to represent the standard of care for patient management, nor are the recommendations intended to limit treatment or care provided to individual patients. The development group made a strong

  18. The clinical applicability of music therapy research

    DEFF Research Database (Denmark)

    Wigram, Anthony Lewis

    practitioners in all three areas (and beyond) can demonstrate, through previous and current research, that the music therapy service and interventions they provide are relevant and effective (Ansdell, Pavicevic & Proctor, 2004; Gold, Voracek and Wigram, 2004; Vink, 2003; Wigram 2002). Documentation of research......Research serves the functions of informing the clinical field, guiding future research, establishing new knowledge and theory, and meeting criteria for evidence based practice. Given the demands of health, education and social services today and there is an increasing expectation that clinical...... in lengthy and complex theses is seldom accessible to the practitioner working ‘at the coal-face’; and sometimes lacks clear direction on how the results are applicable in everyday therapy. For results to be implemented in clinical practice and disseminated to colleagues in related fields as well as senior...

  19. Regulating the placebo effect in clinical practice. (United States)

    Chan, Tracey E


    Recent research and ethical analysis have forced a clinical and ethical reappraisal of the utility of placebos in medical practice. The main concern of ethics and law is that using placebos in health care involves deception, which is antithetical to patient autonomy and trust in the physician-patient relationship. This article reviews the various, more nuanced scientific conceptions of the placebo effect, and evaluates the ethical and legal objections to deploying placebos in clinical practice. It argues that the placebo effect may be legitimately accommodated on the basis that it does not engage the requirement for material or quasi-fiduciary disclosures of information, and may also be justified by therapeutic privilege. In addition, this reconceptualisation of the placebo effect offers a new justification for therapeutic privilege in these contexts. Notwithstanding this, using the placebo effect in clinical practice raises regulatory issues that will require special regulatory supervision. © The Author [2014]. Published by Oxford University Press; all rights reserved. For Permissions, please email:

  20. Caring during clinical practice: Midwives’ perspective

    Directory of Open Access Journals (Sweden)

    Mmajapi E. Chokwe


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

  1. Clinical neuropsychology practice and training in Canada. (United States)

    Janzen, Laura A; Guger, Sharon


    This invited paper provides information about professional neuropsychology issues in Canada and is part of a special issue addressing international perspectives on education, training, and practice in clinical neuropsychology. Information was gathered from literature searches and personal communication with other neuropsychologists in Canada. Canada has a rich neuropsychological history. Neuropsychologists typically have doctoral-level education including relevant coursework and supervised practical experience. Licensure requirements vary across the 10 provinces and there are regional differences in salary. While training at the graduate and internship level mirrors that of our American colleagues, completion of a two-year postdoctoral fellowship in neuropsychology is not required to obtain employment in many settings and there are few postdoctoral training programs in this country. The majority of neuropsychologists are employed in institutional settings (e.g. hospitals, universities, rehabilitation facilities), with a growing number entering private practice or other settings. There are challenges in providing neuropsychological services to the diverse Canadian population and a need for assessment measures and normative data in multiple languages. Canadian neuropsychologists face important challenges in defining ourselves as distinct from other professions and other psychologists, in maintaining funding for high-quality training and research, in establishing neuropsychology-specific training and practice standards at the provincial or national level, and ensuring the clinical care that we provide is efficient and effective in meeting the needs of our patient populations and consumers, both within and outside of the publically funded health care system.

  2. Learning Styles of Radiography Students during Clinical Practice (United States)

    Ward, L. Patrice


    The purpose of this study was to identify and describe the common learning styles of radiography students during clinical practice. Quantitative, descriptive research methodology identified the learning styles of radiography students. A single self-report questionnaire, developed to assess learning styles in clinical practice, was administered…

  3. A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink. (United States)

    Crooks, Colin J; West, Joe; Jepsen, Peter


    The CirCom score has been developed from Danish data as a specific measure of comorbidity for cirrhosis to predict all-cause mortality. We compared its performance with the Charlson Comorbidity Index (CCI) in an English cirrhosis population. We used comorbidity scores in a survival model to predict mortality in a cirrhosis cohort in the Clinical Practice Research Datalink. The discrimination of each score was compared by age, gender, socioeconomic status, cirrhosis etiology, cirrhosis stage, and year after cirrhosis diagnosis. We also measured their ability to predict liver-related versus non-liver-related death. There was a small improvement in the C statistic from the model using the CirCom score (C=0.63) compared to the CCI (C=0.62), and there was an overall improvement in the net reclassification index of 1.5%. The improvement was more notable in younger patients, those with an alcohol etiology, and those with compensated cirrhosis. Both scores performed better (C statistic >0.7) for non-liver-related deaths than liver-related deaths (C statistic cause and non-liver mortality, but not liver-related mortality. Therefore, it is important to include a measure of comorbidity in studies of cirrhosis survival, alongside a measure of cirrhosis severity.

  4. Appraisal of clinical practice guidelines for ischemic stroke management in Chinese medicine with appraisal of guidelines for research and evaluation instrument: A systematic review. (United States)

    Yuwen, Ya; Shi, Nan-nan; Han, Xue-Jie; Gao, Ying; Xu, Jian-long; Liu, Da-sheng; Ng, Bacon; Tsui, Dora; Zhong, Li-dan; Ziea, Eric; Bian, Zhao-xiang; Lu, Ai-ping


    To systematically review the clinical practice guidelines (CPGs) for ischemic stroke in Chinese medicine (CM) with the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. CM CPGs for ischemic stroke were searched in 5 online databases and hand-searches in CPGrelated handbooks published from January 1990 to December 2012. The CPGs were categorized into evidence based (EB) guideline, consensus based with no explicit consideration of evidence based (CB-EB) guideline and consensus based (CB) guideline according to the development method. Three reviewers independently appraised the CPGs based on AGREE II instrument, and compared the CPGs' recommendations on CM pattern classification and treatment. Five CM CPGs for ischemic stroke were identified and included. Among them, one CPG was EB guideline, two were CB guidelines and two were CB-EB guidelines. The quality score of the EB guideline was higher than those of the CB-EB and CB guidelines. Five CM patterns in the CPGs were recommended in the EB CPG. The comprehensive protocol of integrative Chinese and Western medicine recommended in the EB CPG was mostly recommended for ischemic stroke in the CPGs. The recommendations varied based on the CM patterns. The quality of EB CPG was higher than those of CB and CB-EB CPGs in CM for ischemic stroke and integrative approaches were included in CPGs as major interventions.

  5. Prevalence, incidence, indication, and choice of antidepressants in patients with and without chronic kidney disease: a matched cohort study in UK Clinical Practice Research Datalink. (United States)

    Iwagami, Masao; Tomlinson, Laurie A; Mansfield, Kathryn E; McDonald, Helen I; Smeeth, Liam; Nitsch, Dorothea


    People with chronic kidney disease (CKD) have an increased prevalence of depression, anxiety, and neuropathic pain. We examined prevalence, incidence, indication for, and choice of antidepressants among patients with and without CKD. Using the UK Clinical Practice Research Datalink, we identified patients with CKD (two measurements of estimated glomerular filtration rate antidepressant prescribing in the six months prior to index date (prevalence), the first prescription after index date among non-prevalent users (incidence), and recorded diagnoses (indication). We compared antidepressant choice between patients with and without CKD among patients with a diagnosis of depression. There were 242 349 matched patients (median age 76 [interquartile range 70-82], male 39.3%) with and without CKD. Prevalence of antidepressant prescribing was 16.3 and 11.9%, and incidence was 57.2 and 42.4/1000 person-years, in patients with and without CKD, respectively. After adjusting for confounders, CKD remained associated with higher prevalence and incidence of antidepressant prescription. Regardless of CKD status, selective serotonin reuptake inhibitors were predominantly prescribed for depression or anxiety, while tricyclic antidepressants were prescribed for neuropathic pain or other reasons. Antidepressant choice was similar in depressed patients with and without CKD. The rate of antidepressant prescribing was nearly one and a half times higher among people with CKD than in the general population. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.

  6. Practical statistics in pain research. (United States)

    Kim, Tae Kyun


    Pain is subjective, while statistics related to pain research are objective. This review was written to help researchers involved in pain research make statistical decisions. The main issues are related with the level of scales that are often used in pain research, the choice of statistical methods between parametric or nonparametric statistics, and problems which arise from repeated measurements. In the field of pain research, parametric statistics used to be applied in an erroneous way. This is closely related with the scales of data and repeated measurements. The level of scales includes nominal, ordinal, interval, and ratio scales. The level of scales affects the choice of statistics between parametric or non-parametric methods. In the field of pain research, the most frequently used pain assessment scale is the ordinal scale, which would include the visual analogue scale (VAS). There used to be another view, however, which considered the VAS to be an interval or ratio scale, so that the usage of parametric statistics would be accepted practically in some cases. Repeated measurements of the same subjects always complicates statistics. It means that measurements inevitably have correlations between each other, and would preclude the application of one-way ANOVA in which independence between the measurements is necessary. Repeated measures of ANOVA (RMANOVA), however, would permit the comparison between the correlated measurements as long as the condition of sphericity assumption is satisfied. Conclusively, parametric statistical methods should be used only when the assumptions of parametric statistics, such as normality and sphericity, are established.

  7. Functional recovery measures for spinal cord injury : An evidence-based review for clinical practice and research - Functional recovery outcome measures work group

    NARCIS (Netherlands)

    Anderson, Kim; Aito, Sergio; Atkins, Michal; Biering-Sorensen, Fin; Charlifue, Susan; Curt, Armin; Ditunno, John; Glass, Clive; Marino, Ralph; Marshall, Ruth; Mulcahey, Mary Jane; Post, Marcel; Savic, Gordana; Scivoletto, Giorgio; Catz, Amiram


    Background/Objective: The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome

  8. Current clinical research in orthodontics: a perspective. (United States)

    Baumrind, Sheldon


    This essay explores briefly the approach of the Craniofacial Research Instrumentation Laboratory to the systematic and rigorous investigation of the usual outcome of orthodontic treatment in the practices of experienced clinicians. CRIL's goal is to produce a shareable electronic database of reliable, valid, and representative data on clinical practice as an aid in the production of an improved environment for truly evidence-based orthodontic treatment.

  9. Trends in the incidence of chronic fatigue syndrome and fibromyalgia in the UK, 2001-2013: a Clinical Practice Research Datalink study. (United States)

    Collin, Simon M; Bakken, Inger J; Nazareth, Irwin; Crawley, Esther; White, Peter D


    Objective Trends in recorded diagnoses of chronic fatigue syndrome (CFS, also known as 'myalgic encephalomyelitis' (ME)) and fibromyalgia (FM) in the UK were last reported more than ten years ago, for the period 1990-2001. Our aim was to analyse trends in incident diagnoses of CFS/ME and FM for the period 2001-2013, and to investigate whether incidence might vary by index of multiple deprivation (IMD) score. Design Electronic health records cohort study. Setting NHS primary care practices in the UK. Participants Participants: Patients registered with general practices linked to the Clinical Practice Research Datalink (CPRD) primary care database from January 2001 to December 2013. Main outcome measure Incidence of CFS/ME, FM, post-viral fatigue syndrome (PVFS), and asthenia/debility. Results The overall annual incidence of recorded cases of CFS/ME was 14.8 (95% CI 14.5, 15.1) per 100,000 people. Overall annual incidence per 100,000 people for FM was 33.3 (32.8-33.8), for PVFS 12.2 (11.9, 12.5), and for asthenia/debility 7.0 (6.8, 7.2). Annual incidence rates for CFS/ME diagnoses decreased from 17.5 (16.1, 18.9) in 2001 to 12.6 (11.5, 13.8) in 2013 (annual percent change -2.8% (-3.6%, -2.0%)). Annual incidence rates for FM diagnoses decreased from 32.3 (30.4, 34.3) to 27.1 (25.5, 28.6) in 2007, then increased to 38.2 (36.3, 40.1) per 100,000 people in 2013. Overall annual incidence of recorded fatigue symptoms was 2246 (2242, 2250) per 100,000 people. Compared with the least deprived IMD quintile, incidence of CFS/ME in the most deprived quintile was 39% lower (incidence rate ratio (IRR) 0.61 (0.50, 0.75)), whereas rates of FM were 40% higher (IRR 1.40 (0.95, 2.06)). Conclusion These analyses suggest a gradual decline in recorded diagnoses of CFS/ME since 2001, and an increase in diagnoses of fibromyalgia, with opposing socioeconomic patterns of lower rates of CFS/ME diagnoses in the poorest areas compared with higher rates of FM diagnoses.

  10. Researching literacy practices in transition

    DEFF Research Database (Denmark)

    Holm, Lars

    Researching literacy practices in transition Postmodern societies are characterized by constant, fast and unpredictable mobility of people, goods, ideas and values. These mobilities are often visualized as a movement from one place to another, as a temporary interference of the stability of fixed...... places. An alternative take on mobilty sees movement as the default and change as the normal way of being rather than the exception (Barton, 2012). This understanding of change is central to the framing concept of this symposium: transition. Transitional processes around literacy are significant because...... literacy is something that is taught and learned, that is adopted, transformed and appropriated and that is used to categorize and classify people (Holm & Pitkänen-Huhta, 2012). Based on detailed empirical studies in the Nordic countries, the aim of this symposium is to discuss how to explore and research...

  11. Dissemination of research into clinical nursing literature. (United States)

    Oermann, Marilyn H; Shaw-Kokot, Julia; Knafl, George J; Dowell, Jo


    The purpose of our study was to describe the dissemination of research into the clinical nursing literature. The literature provides a means of transferring knowledge from a research study through citations of the work by other authors. This was a citation analysis study to explore the dissemination of research into the clinical nursing literature, beginning with the publication of an original research study and including all of the citations to that article through 2009. The authors searched five academic nursing research journal titles, using CINAHL, for original research reports that had clinical relevance and were published between 1990-1999. The search process yielded a final data set of 28 research articles. For each of the articles, the authors searched three databases, CINAHL, Web of Science(®) and Google Scholar, to determine the citation patterns from the date of publication to August 2009. All of the research studies were cited in articles published in clinical journals although there was a wide range in the number of citations, from 3-80. The 28 research articles had a total of 759 citations; 717 (94.5%) of those citations were in articles published in clinical nursing journals. The median length of time between publication of the original study and the first citation was 1.5 years. Some of the studies were still being cited for 18 years after publication of the original work. All of the original research reports examined in this study were cited in articles in clinical journals, disseminating the research beyond the original work to reach clinicians. Clinical nursing journals keep readers up-to-date and informed about new practices in nursing and serve another important role: they disseminate research that is clinically relevant by publishing original studies and papers that cite research reports. © 2010 Blackwell Publishing Ltd.

  12. A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink

    Directory of Open Access Journals (Sweden)

    Crooks CJ


    Full Text Available Colin J Crooks,1,2 Joe West,1,2 Peter Jepsen3,4 1Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; 2Nottingham Digestive Diseases Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK; 3Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Purpose: The CirCom score has been developed from Danish data as a specific measure of comorbidity for cirrhosis to predict all-cause mortality. We compared its performance with the Charlson Comorbidity Index (CCI in an English cirrhosis population. Patients and methods: We used comorbidity scores in a survival model to predict mortality in a cirrhosis cohort in the Clinical Practice Research Datalink. The discrimination of each score was compared by age, gender, socioeconomic status, cirrhosis etiology, cirrhosis stage, and year after cirrhosis diagnosis. We also measured their ability to predict liver-related versus non-liver-related death.Results: There was a small improvement in the C statistic from the model using the CirCom score (C=0.63 compared to the CCI (C=0.62, and there was an overall improvement in the net reclassification index of 1.5%. The improvement was more notable in younger patients, those with an alcohol etiology, and those with compensated cirrhosis. Both scores performed better (C statistic >0.7 for non-liver-related deaths than liver-related deaths (C statistic <0.6, as comorbidity was only weakly predictive of liver-related death.Conclusion: The CirCom score provided a small improvement in performance over the CCI in the prediction of all-cause and non-liver mortality, but not liver-related mortality. Therefore, it is important to include a measure of comorbidity in studies of cirrhosis survival, alongside a measure of cirrhosis severity. Keywords: cirrhosis, mortality, comorbidity, prognosis

  13. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences.

    NARCIS (Netherlands)

    Vries, M.C. de; Houtlosser, M.; Wit, J.M.; Engberts, D.P.; Bresters, D.; Kaspers, G.J.L.; Leeuwen, E. van


    BACKGROUND: Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences


    Directory of Open Access Journals (Sweden)

    Maria Fedorova


    Full Text Available The aim of the study is to consider the problem of students’ research both worldwide and in Russia.Methods. The methods involve review and analysis of the foreign and Russian scientific literature on studied subjects; surveys on the management and realisation of student’s scientific activity in different countries; comparative analysis of the data received during surveys.Results and scientific novelty. At the first stage literature concerning the question of doing research in different countries is analyzed. Then the problems existing in the sphere of students’ research worldwide are identified. Among them are students’ motivation, supervisors’ motivation, developing friendly scientific environment at various levels, communication in science. Then, two surveys were held to support the theoretical issues. The first concerned general aspects of students’ research internationally such as when they start doing it, how they are motivated, what are the relations with supervisors etc. The second included questions about general age of getting scientific degrees (bachelor, master, and PhD, and was divided into two parts: for international and Russian staff. Procedures and results of the surveys undertaken for revealing of scientists’ opinion on quality and features of the specified kind of students’ activity in different countries across the world are described. It is shown, that some problems are common for Russia and global scientific society.Practical significance. On the basis of world experience, some solutions on development of scientific activity of the Russian students have been proposed by the author.

  15. Converging clinical and engineering research on neurorehabilitation

    CERN Document Server

    Torricelli, Diego; Pajaro, Marta


    Restoring human motor and cognitive function has been a fascinating research area during the last century. Interfacing the human nervous system with electro-mechanical rehabilitation machines is facing its crucial passage from research to clinical practice, enhancing the potentiality of therapists, clinicians and researchers to rehabilitate, diagnose and generate knowledge. The 2012 International Conference on Neurorehabilitation (ICNR2012, brings together researchers and students from the fields of Clinical Rehabilitation, Applied Neurophysiology and Biomedical Engineering, covering a wide range of research topics:   · Clinical Impact of Technology · Brain-Computer Interface in Rehabilitation · Neuromotor & Neurosensory modeling and processing · Biomechanics in Rehabilitation · Neural Prostheses in Rehabilitation · Neuro-Robotics in Rehabilitation · Neuromodulation   This Proceedings book includes general contributions from oral and poster sessions, as well as from special sess...

  16. Role modeling excellence in clinical nursing practice. (United States)

    Perry, R N Beth


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

  17. Incidence rates of suicidal behaviors and treated depression in patients with and without psoriatic arthritis using the Clinical Practice Research Datalink. (United States)

    Hagberg, Katrina Wilcox; Li, Lin; Peng, Michael; Shah, Kamal; Paris, Maria; Jick, Susan


    To estimate rates of suicidal behaviors and treated depression in patients with psoriatic arthritis (PsA) in comparison to non-PsA patients. Using the Clinical Practice Research Datalink, we conducted a cohort study of patients with PsA compared to non-PsA patients. Patients with codes for suicidal behaviors (ideation, attempts, and suicide) and treated depression (diagnosis plus anti-depressant prescription) recorded during follow-up were identified as cases. We estimated incidence rates (IRs) and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) for each outcome and stratified results in the PsA cohort by receipt of systemic PsA drugs. The rates of suicide ideation, attempt, and suicide were similar for PsA and non-PsA patients [IRR = 0.99 (95%CI: 0.67-1.47), IRR = 1.07 (95%CI: 0.86-1.34), and 0.34 (95%CI: 0.05-2.48), respectively] and rates of suicidal behaviors were slightly higher among PsA patients who received PsA drugs compared to those who did not. PsA patients had slightly higher rate of treated depression compared to non-PsA patients [IRR = 1.38 (95%CI: 1.27-1.49)] and were significantly higher in PsA patients who received drugs [IRR = 1.59 (95%CI: 1.35-1.86)]. Rate of depression was higher in patients with PsA compared to non-PsA patients. The rate of suicidal behaviors was similar between the two cohorts.

  18. Interval between onset of psoriasis and psoriatic arthritis comparing the UK Clinical Practice Research Datalink with a hospital-based cohort. (United States)

    Tillett, William; Charlton, Rachel; Nightingale, Alison; Snowball, Julia; Green, Amelia; Smith, Catherine; Shaddick, Gavin; McHugh, Neil


    To describe the time interval between the onset of psoriasis and PsA in the UK primary care setting and compare with a large, well-classified secondary care cohort. Patients with PsA and/or psoriasis were identified in the UK Clinical Practice Research Datalink (CPRD). The secondary care cohort comprised patients from the Bath PsA longitudinal observational cohort study. For incident PsA patients in the CPRD who also had a record of psoriasis, the time interval between PsA diagnosis and first psoriasis record was calculated. Comparisons were made with the time interval between diagnoses in the Bath cohort. There were 5272 eligible PsA patients in the CPRD and 815 in the Bath cohort. In both cohorts, the majority of patients (82.3 and 61.3%, respectively) had psoriasis before their PsA diagnosis or within the same calendar year (10.5 and 23.8%), with only a minority receiving their PsA diagnosis first (7.1 and 14.8%). Excluding those who presented with arthritis before psoriasis, the median time between diagnoses was 8 years [interquartile range (IQR) 2-15] in the CPRD and 7 years (IQR 0-20) in the Bath cohort. In the CPRD, 60.1 and 75.1% received their PsA diagnosis within 10 and 15 years of their psoriasis diagnosis, respectively; this was comparable with 57.2 and 67.7% in the Bath cohort. A similar distribution for the time interval between psoriasis and arthritis was observed in the CPRD and secondary care cohort. These data can inform screening strategies and support the validity of data from each cohort. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email:

  19. Evaluation of methods to estimate missing days' supply within pharmacy data of the Clinical Practice Research Datalink (CPRD) and The Health Improvement Network (THIN). (United States)

    Lum, Kirsten J; Newcomb, Craig W; Roy, Jason A; Carbonari, Dena M; Saine, M Elle; Cardillo, Serena; Bhullar, Harshvinder; Gallagher, Arlene M; Lo Re, Vincent


    The extent to which days' supply data are missing in pharmacoepidemiologic databases and effective methods for estimation is unknown. We determined the percentage of missing days' supply on prescription and patient levels for oral anti-diabetic drugs (OADs) and evaluated three methods for estimating days' supply within the Clinical Practice Research Datalink (CPRD) and The Health Improvement Network (THIN). We estimated the percentage of OAD prescriptions and patients with missing days' supply in each database from 2009 to 2013. Within a random sample of prescriptions with known days' supply, we measured the accuracy of three methods to estimate missing days' supply by imputing the following: (1) 28 days' supply, (2) mode number of tablets/day by drug strength and number of tablets/prescription, and (3) number of tablets/day via a machine learning algorithm. We determined incidence rates (IRs) of acute myocardial infarction (AMI) using each method to evaluate the impact on ascertainment of exposure time and outcomes. Days' supply was missing for 24 % of OAD prescriptions in CPRD and 33 % in THIN (affecting 48 and 57 % of patients, respectively). Methods 2 and 3 were very accurate in estimating days' supply for OADs prescribed at a consistent number of tablets/day. Method 3 was more accurate for OADs prescribed at varying number of tablets/day. IRs of AMI were similar across methods for most OADs. Missing days' supply is a substantial problem in both databases. Method 2 is easy and very accurate for most OADs and results in IRs comparable to those from method 3.

  20. Archives: Nigerian Journal of Clinical Practice

    African Journals Online (AJOL)

    Items 1 - 50 of 73 ... Archives: Nigerian Journal of Clinical Practice. Journal Home > Archives: Nigerian Journal of Clinical Practice. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives ...

  1. MR spectroscopy in clinical research

    DEFF Research Database (Denmark)

    Henriksen, O


    MR spectroscopy (MRS) offers unique possibilities for non-invasive evaluation of biochemistry in vivo. During recent years there has been a growing body of evidence from clinical research studies on human beings using 31P and 1H MRS. The results indicate that it is possible to evaluate phosphorous...... for non-invasive follow-up of treatment. Taken together, the evidence obtained so far certainly shows some trends for clinical applications of MRS. Methods are now available for the clinical research necessary for establishing routine clinical MRS examinations....... energy metabolism, loss of neurones, and lactate production in a large number of brain diseases. Furthermore, 31P and 1H MRS may be particularly clinically useful in evaluation of various disorders in skeletal muscle. In the heart 31P MRS seems at the moment the most suitable for evaluation of global...

  2. MR spectroscopy in clinical research

    DEFF Research Database (Denmark)

    Henriksen, O


    for non-invasive follow-up of treatment. Taken together, the evidence obtained so far certainly shows some trends for clinical applications of MRS. Methods are now available for the clinical research necessary for establishing routine clinical MRS examinations.......MR spectroscopy (MRS) offers unique possibilities for non-invasive evaluation of biochemistry in vivo. During recent years there has been a growing body of evidence from clinical research studies on human beings using 31P and 1H MRS. The results indicate that it is possible to evaluate phosphorous...... energy metabolism, loss of neurones, and lactate production in a large number of brain diseases. Furthermore, 31P and 1H MRS may be particularly clinically useful in evaluation of various disorders in skeletal muscle. In the heart 31P MRS seems at the moment the most suitable for evaluation of global...

  3. Clinical Practice Informs Secure Messaging Benefits and Best Practices. (United States)

    Haun, Jolie N; Hathaway, Wendy; Chavez, Margeaux; Antinori, Nicole; Vetter, Brian; Miller, Brian K; Martin, Tracey L; Kendziora, Lisa; Nazi, Kim M; Melillo, Christine


    Background Clinical care team members in Department of Veterans' Affairs (VA) facilities nationwide are working to integrate the use of Secure Messaging (SM) into care delivery and identify innovative uses. Identifying best practices for proactive use of SM is a key factor in its successful implementation and sustained use by VA clinical care team members and veterans. Objectives A collaborative project solicited input from VA clinical care teams about their local practices using SM to provide access to proactive patient-centered care for veterans and enhance workflow. Methods This project implemented a single-item cross-sectional qualitative electronic survey via internal e-mail to local coordinators in all 23 Veterans Integrated Service Networks (VISNs). Content analysis was used to manage descriptive data responses. Descriptive statistics described sample characteristics. Results VA clinical care team members across 15 of 23 VISNs responded to the questionnaire. Content analysis of 171 responses produced two global domains: (1) benefits of SM and (2) SM best practices. Benefits of SM use emphasize enhanced and efficient communication and increased access to care. Care team members incorporate SM into their daily clinical practices, using it to provide services before, during, and after clinical encounters as a best practice. SM users suggest improvements in veteran care, clinical team workflow, and efficient use of health resources. Clinical team members invested in the successful implementation of SM integrate SM into their daily practices to provide meaningful and useful veteran-centered care and improve workflow. Conclusion VA clinical care team members can use SM proactively to create an integrated SM culture. With adequate knowledge and motivation to proactively use this technology, all clinical team members within the VA system can replicate best practices shared by other clinical care teams to generate meaningful and useful interactions with SM

  4. Writing a clinical research paper. (United States)

    Ajao, O G


    A well-known unwritten law in institutions of higher learning is that of "Publish or perish". The duties of a University teacher, in order of priority are teaching, research and service. Reasons for writing clinical research papers are to get promoted, to get research grants and to make known, one's findings in order to improve patients' care. Writing papers is also a means of delivering continuous education, therefore publication is essential for any one pursuing an academic career. Research papers can be in the form of case reports, retrospective studies, prospective studies and laboratory or animal research. Two popular formats of writing papers are: The Vancouver Style and the Harvard System.

  5. Maintenance of Clinical Expertise and Clinical Research by the Clinical Professors at Gifu Pharmaceutical University. (United States)

    Tachi, Tomoya; Noguchi, Yoshihiro; Teramachi, Hitomi


    The clinical professors at Gifu Pharmaceutical University (GPU) provide pharmaceutical services at GPU Pharmacy, Gifu University Hospital, and Gifu Municipal Hospital to keep their clinical skills up-to-date; they also perform clinical research in collaboration with many clinical institutes. The Laboratory of Clinical Pharmacy is part of the Department of Pharmacy Practice and Science, to which the clinical professors belong, and is composed of three clinical professors (a professor, an associate professor, and an assistant professor). The professor administers the GPU Pharmacy as its director, while the associate professor and assistant professor provide pharmaceutical services to patients at Gifu Municipal Hospital, and also provide practical training for students in the GPU Pharmacy. Collectively, they have performed research on such topics as medication education for students, clinical communication education, and analysis of clinical big data. They have also conducted research in collaboration with clinical institutes, hospitals, and pharmacies. Here, we introduce the collaborative research between the Laboratory of Clinical Pharmacy and Gifu Municipal Hospital. These studies include "Risk factors contributing to urinary protein expression resulting from bevacizumab combination chemotherapy", "Hyponatremia and hypokalemia as risk factors for falls", "Economic evaluation of adjustments of levofloxacin dosage by dispensing pharmacists for patients with renal dysfunction", and "Effect of patient education upon discharge for use of a medication notebook on purchasing over-the-counter drugs and health foods". In this symposium, we would like to demonstrate one model of the association and collaborative research between these clinical professors and clinical institutes.

  6. Clinical application of a robotic ankle training program for cerebral palsy compared to the research laboratory application: does it translate to practice? (United States)

    Sukal-Moulton, Theresa; Clancy, Theresa; Zhang, Li-Qun; Gaebler-Spira, Deborah


    To determine the clinical efficacy of an ankle robotic rehabilitation protocol for patients with cerebral palsy. The clinic cohort was identified from a retrospective chart review in a before-after intervention trial design and compared with a previously published prospective research cohort. Rehabilitation hospital. Children (N=28; mean age, 8.2±3.62 y) with Gross Motor Function Classification System levels I, II, or III who were referred for ankle stretching and strengthening used a robotic ankle device in a clinic setting. Clinic results were compared with a previously published cohort of participants (N=12; mean age, 7.8±2.91 y) seen in a research laboratory-based intervention protocol. Patients in the clinic cohort were seen 2 times per week for 75-minute sessions for a total of 6 weeks. The first 30 minutes of the session were spent using the robotic ankle device for ankle stretching and strengthening, and the remaining 45 minutes were spent on functional movement activities. There was no control group. We compared pre- and postintervention measures of plantarflexor and dorsiflexor range of motion, strength, spasticity, mobility (Timed Up and Go test, 6-minute walk test, 10-m walk test), balance (Pediatric Balance Scale), Selective Control Assessment of the Lower Extremity (SCALE), and gross motor function measure (GMFM). Significant improvements were found for the clinic cohort in all main outcome measures except for the GMFM. These improvements were equivalent to those reported in the research cohort, except for larger SCALE test changes in the research cohort. These findings suggest that translation of repetitive, goal-directed biofeedback training into the clinic setting is both feasible and beneficial for patients with cerebral palsy. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  7. Ethics and the practice of qualitative research

    DEFF Research Database (Denmark)

    Shaw, Ian Frank


    Ethics and the practice of qualitative research? Qualitative Social Work 7 (4): 400-414. Reprinted......Ethics and the practice of qualitative research? Qualitative Social Work 7 (4): 400-414. Reprinted...

  8. Journal of Civil Engineering Research and Practice

    African Journals Online (AJOL)

    The Journal of Civil Engineering Research and Practice aims to publish original research papers of high standard, containing material of significant contribution to civil engineering, with emphasis being placed on material that is applicable to the solution of practical problems.

  9. Research in a dental practice setting. (United States)

    Fardal, Oystein


    There is a shortage of research from dental practice. The aim of this article is to stimulate more interest in dental research. This is done by explaining the basic principles of doing research in a dental practice setting. Examples are taken from the author's own practice. Emphasis is placed on the following points: how to develop and research ideas; factors specific to dental practice; how articles and journals are rated; making a protocol for the study; examiners' reliability and statistical analysis.

  10. Risk assessment instruments in clinical practice. (United States)

    Côté, Gilles; Crocker, Anne G; Nicholls, Tonia L; Seto, Michael C


    To determine whether the items in one of the most widely validated instruments of violence risk assessment, the Historical-Clinical-Risk Management-20 (HCR-20), are used in review board hearings to assess the risk of violence by people found Not Criminally Responsible on account of Mental Disorder (NCRMD). This study was conducted from October 2004 to August 2006 in Quebec's sole forensic psychiatric hospital and 2 large civil psychiatric hospitals designated for the care of people declared NCRMD in the Montreal metropolitan area. The risk assessments presented by clinicians at annual review board hearings and the boards' rationale for the release or detention of people found NCRMD were contrasted with the risk assessments conducted by the research team using the HCR-20. The final sample was comprised of 96 men. Very few of the risk factors identified by prior research (HCR-20 items) were mentioned in the hearing process, whether in clinical reports, discussions during the hearing, or in the disposition justification. The findings confirm that there remains a significant gap between research evidence and risk assessment practice.

  11. [Research activity in clinical biochemistry

    DEFF Research Database (Denmark)

    Jorgensen, H.L.; Larsen, B.; Ingwersen, P.


    BACKGROUND: Quantitative bibliometric measurements of research activity are frequently used, e.g. for evaluating applicants for academic positions. The purpose of this investigation is to assess research activity within the medical speciality of Clinical Biochemistry by comparing it with a matched...... Clinical Biochemistry, 57 fulfilled the inclusion criteria. Each of these 57 was matched according to medical title with two randomly chosen specialists from other specialities, totaling 114. Using Medline and the Web of Science, the number of publications and the number of citations were then ascertained....... RESULTS: 25% of the 11,691 specialists held a PhD degree or doctoral degree, DMSci, (Clinical Biochemistry: 61%). The 171 specialists included in the study had 9,823 papers in Medline and 10,140 papers in the Web of Science. The number of Medline papers per specialist was 71 for Clinical Biochemistry...

  12. Visual research in clinical education. (United States)

    Bezemer, Jeff


    The aim of this paper is to explore what might be gained from collecting and analysing visual data, such as photographs, scans, drawings, video and screen recordings, in clinical educational research. Its focus is on visual research that looks at teaching and learning 'as it naturally occurs' in the work place, in simulation centres and other sites, and also involves the collection and analysis of visual learning materials circulating in these sites. With the ubiquity of digital recording devices, video data and visual learning materials are now relatively cheap to collect. Compared to other domains of education research visual materials are not widely used in clinical education research. The paper sets out to identify and reflect on the possibilities for visual research using examples from an ethnographic study on surgical and inter-professional learning in the operating theatres of a London hospital. The paper shows how visual research enables recognition, analysis and critical evaluation of (1) the hidden curriculum, such as the meanings implied by embodied, visible actions of clinicians; (2) the ways in which clinical teachers design multimodal learning environments using a range of modes of communication available to them, combining, for instance, gesture and speech; (3) the informal assessment of clinical skills, and the intricate relation between trainee performance and supervisor feedback; (4) the potentialities and limitations of different visual learning materials, such as textbooks and videos, for representing medical knowledge. The paper concludes with theoretical and methodological reflections on what can be made visible, and therefore available for analysis, explanation and evaluation if visual materials are used for clinical education research, and what remains unaccounted for if written language remains the dominant mode in the research cycle. Opportunities for quantitative analysis and ethical implications are also discussed. © 2016 John Wiley

  13. Positron emission tomography clinical practice

    CERN Document Server

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


    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

  14. Evidence-based clinical practice

    DEFF Research Database (Denmark)

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


    was considered through literature searches combined with personal files. Treatments should generally not be chosen based only on evidence from observational studies or single randomised clinical trials. Systematic reviews with meta-analysis of all identifiable randomised clinical trials with Grading...... of Recommendations Assessment, Development and Evaluation (GRADE) assessment represent the highest level of evidence. Even though systematic reviews are trust worthier than other types of evidence, all levels of the evidence hierarchy are under threats from systematic errors (bias); design errors (abuse of surrogate...

  15. Supernumerary teeth in clinical practice


    Anna K. Szkaradkiewicz; Tomasz M. Karpiński


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

  16. Role of Anorectal Manometry in Clinical Practice. (United States)

    Staller, Kyle


    Physiologic assessment of the anorectum and pelvic floor by anorectal manometry and balloon expulsion testing provides important insights into the pathologic processes underlying defecatory disorders and guides treatment, specifically the use of biofeedback for the treatment of dyssynergic defecation and the identification of possible structural abnormalities of the pelvic floor. While symptoms and digital rectal examination may suggest pelvic floor dysfunction to the clinician, only pelvic floor testing provides definitive diagnoses of these often treatable abnormalities. The use of anorectal manometry in clinical practice is currently limited by substantial variation in performance of the test and interpretation of the results, but anorectal manometry with the addition of balloon expulsion test to improve specificity provides the best current modality for the diagnosis of dyssynergic defecation. With the introduction of high-resolution and three-dimensional, high-definition probes, our ability to characterize the structure and function of the anorectum has never been better, though further research is still needed to improve our ability to diagnose pelvic floor dysfunction and refer appropriate patients to treatment. In areas where the availability of anorectal manometry (ARM) is limited, a thorough digital rectal exam performed by an experienced clinician plus the balloon expulsion test alone may identify appropriate patients to refer for additional testing. This review describes the appropriate indications for and appropriate performance of anorectal manometry in clinical practice with an eye toward the diagnosis of dyssynergic defecation in patients with chronic constipation, fecal incontinence, and chronic proctalgia.

  17. Opioid detoxification : from controlled clinical trial to clinical practice

    NARCIS (Netherlands)

    Dijkstra, Boukje A G; De Jong, Cor A J; Wensing, Michel; Krabbe, Paul F M; van der Staak, Cees P F


    Controlled clinical trials have high internal validity but suffer from difficulties in external validity. This study evaluates the generalizability of the results of a controlled clinical trial on rapid detoxification in the everyday clinical practice of two addiction treatment centers. The results

  18. How GPs implement clinical guidelines in everyday clinical practice

    DEFF Research Database (Denmark)

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


    . OBJECTIVE: To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices. METHODS: Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form......BACKGROUND: Clinical guidelines are considered to be essential for improving quality and safety of health care. However, interventions to promote implementation of guidelines have demonstrated only partial effectiveness and the reasons for this apparent failure are not yet fully understood....... 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...

  19. Medical Genetics In Clinical Practice

    African Journals Online (AJOL)


    Aug 24, 1974 ... Laboratory facilities for cytogenetic and biochemical investigation are an essential feature of such a genetic department. The purpose of this article is to review the clinical activities during 1973 of the Department of Human. Genetics, University of Cape Town, to present an analysis of the medical problems ...

  20. Theorizing practice research in social work

    DEFF Research Database (Denmark)

    Uggerhøj, Lars


    The article focuses on theories, definitions, interests, possibilities and barriers in practice research in social work. It points out that both practice and research will be influenced by participating in and developing practice research. – and that both parts must and will learn from the process....... To elaborate and define practice research in social work, it is necessary to consider connected approaches and theories. The article will show that practice research is both connected to and can use the theoretical frames of Actual science and Mode 2 knowledge production. To understand and develop research...... practice research they do at the same time have different interests which will challenge both parts. Practice research must be looked upon as both an area of collaboration and a meeting point for different stakeholders: users, social workers, administrative management/organizers, politicians...

  1. Understanding patient values and the manifestations in clinical research with traditional chinese medicine-with practical suggestions for trial design and implementation. (United States)

    Mu, Wei; Shang, Hongcai


    Objective. To define patient values, identify their manifestations in a randomized clinical trial, and investigate the possible implications for clinical research of traditional Chinese medicine. Methods. We categorized patient values manifestations into patient choice, preference, compliance, and patient-reported outcomes and summarized the underlying personal values through purposeful electronic searches for relevant reports. By hypothesizing a set of positive versus negative circumstances occurring in the enrollment, intervention allocation, treatment, and the follow-up stage of a trial, it is possible to discuss the potential implications of patient values manifestation on a trial with traditional Chinese medicine. Results. Patient values and its manifestations are ubiquitous in the process of clinical research with traditional Chinese medicine. These values may provide motivation for participation or engender the internal and external validity of the study. Conclusions. Trialists should attach sufficient importance to the needs and concerns of individual participant. To incorporate patient values into the design and conduct of a clinical study with traditional Chinese medicine, researchers are recommended to adopt participant-friendly design and use patient-reported outcomes, take convenience-for-patients measures, and help foster rational beliefs and behaviors of trial participants.

  2. Social media in clinical practice

    CERN Document Server

    Meskó, Bertalan


    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

  3. Hepatic gammagraphy in clinic practice

    Energy Technology Data Exchange (ETDEWEB)

    Falcon, S.; Torres, A. (Instituto Peruano de Energia Nuclear, Lima)


    Results from 91 patients submitted to hepatic gammagraphy are interpreted and the correlation with the clinic, the anatome-pathological exam and the laboratory is established. 22% were normal, 78% were not. Of the anomalous figures, 41% showed localized injuries, 37% were dispersed. When the anatome-pathological correlation was established, the sensibility was of 95%, the accuracy was 94% and the specificity 88% and when the correlation of the laboratory was made the gammagraphy showed 92% of good correlation meanwhile the alcaline phosphatase and the bilirubin were less appropriate (66 and 62% of good correlation, respectively).

  4. Neuropsychiatric Lupus in clinical practice

    Directory of Open Access Journals (Sweden)

    Helena Alessi

    Full Text Available ABSTRACT Systemic lupus erythematosus (SLE is a chronic autoimmune disease involving multiple organs, characterized by the production of autoantibodies and the development of tissue injury. The etiology of SLE is partially known, involving multiple genetic and environmental factors. As many as 50% of patients with SLE have neurological involvement during the course of their disease. Neurological manifestations are associated with impaired quality of life, and high morbidity and mortality rates. Nineteen neuropsychiatric syndromes have been identified associated with SLE, and can be divided into central and peripheral manifestations. This article reviews major neuropsychiatric manifestations in patients with SLE and discusses their clinical features, radiological findings and treatment options.

  5. Genetic testing in clinical practice. (United States)

    Lamberts, Steven W J; Uitterlinden, André G


    In the practice of internal medicine, the value of genetic testing in common (mono)genetic diseases such as familial hemochromatosis, hypercholesterolemia, Mediterranean fever, and thrombophilia is limited. The genotype insufficiently predicts the phenotype because of the powerful effects of other modifying genes, environmental influences, and lifestyle factors. Many common diseases, including diabetes mellitus, osteoporosis, and cardiovascular disease, have strong genetic influences but are called complex genetic traits. The underlying genetic factors are currently investigated using new molecular tools such as genome-wide association studies, analyzing up to 500,000 markers in huge numbers of patients. Many new (often unexpected) markers have been identified, and in many instances their functional significance is unknown. Genomic profiles play a rapidly growing role in the field of pharmacogenomics. A number of recently identified pharmacogenomic biomarkers are helpful to predict drug-related toxic effects.

  6. Case study and case-based research in emergency nursing and care: Theoretical foundations and practical application in paramedic pre-hospital clinical judgment and decision-making of patients with mental illness. (United States)

    Shaban, Ramon Z; Considine, Julie; Fry, Margaret; Curtis, Kate


    Generating knowledge through quality research is fundamental to the advancement of professional practice in emergency nursing and care. There are multiple paradigms, designs and methods available to researchers to respond to challenges in clinical practice. Systematic reviews, randomised control trials and other forms of experimental research are deemed the gold standard of evidence, but there are comparatively few such trials in emergency care. In some instances it is not possible or appropriate to undertake experimental research. When exploring new or emerging problems where there is limited evidence available, non-experimental methods are required and appropriate. This paper provides the theoretical foundations and an exemplar of the use of case study and case-based research to explore a new and emerging problem in the context of emergency care. It examines pre-hospital clinical judgement and decision-making of mental illness by paramedics. Using an exemplar the paper explores the theoretical foundations and conceptual frameworks of case study, it explains how cases are defined and the role researcher in this form of inquiry, it details important principles and the procedures for data gathering and analysis, and it demonstrates techniques to enhance trustworthiness and credibility of the research. Moreover, it provides theoretically and practical insights into using case study in emergency care. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  7. Electronic health records to facilitate clinical research. (United States)

    Cowie, Martin R; Blomster, Juuso I; Curtis, Lesley H; Duclaux, Sylvie; Ford, Ian; Fritz, Fleur; Goldman, Samantha; Janmohamed, Salim; Kreuzer, Jörg; Leenay, Mark; Michel, Alexander; Ong, Seleen; Pell, Jill P; Southworth, Mary Ross; Stough, Wendy Gattis; Thoenes, Martin; Zannad, Faiez; Zalewski, Andrew


    Electronic health records (EHRs) provide opportunities to enhance patient care, embed performance measures in clinical practice, and facilitate clinical research. Concerns have been raised about the increasing recruitment challenges in trials, burdensome and obtrusive data collection, and uncertain generalizability of the results. Leveraging electronic health records to counterbalance these trends is an area of intense interest. The initial applications of electronic health records, as the primary data source is envisioned for observational studies, embedded pragmatic or post-marketing registry-based randomized studies, or comparative effectiveness studies. Advancing this approach to randomized clinical trials, electronic health records may potentially be used to assess study feasibility, to facilitate patient recruitment, and streamline data collection at baseline and follow-up. Ensuring data security and privacy, overcoming the challenges associated with linking diverse systems and maintaining infrastructure for repeat use of high quality data, are some of the challenges associated with using electronic health records in clinical research. Collaboration between academia, industry, regulatory bodies, policy makers, patients, and electronic health record vendors is critical for the greater use of electronic health records in clinical research. This manuscript identifies the key steps required to advance the role of electronic health records in cardiovascular clinical research.

  8. Clinical outcomes research in gynecologic oncology. (United States)

    Melamed, Alexander; Rauh-Hain, J Alejandro; Schorge, John O


    Clinical outcomes research seeks to understand the real-world manifestations of clinical care. In particular, outcomes research seeks to reveal the effects of pharmaceutical, procedural, and structural aspects of healthcare on patient outcomes, including mortality, disease control, toxicity, cost, and quality of life. Although outcomes research can utilize interventional study designs, insightful use of observational data is a defining feature of this field. Many questions in gynecologic oncology are not amenable to investigation in randomized clinical trials due to cost, feasibility, or ethical concerns. When a randomized trial is not practical or has not yet been conducted, well-designed observational studies have the potential to provide the best available evidence about the effects of clinical care. Such studies may use surveys, medical records, disease registries, and a variety of administrative data sources. Even when a randomized trial has been conducted, observational studies can be used to estimate the real-world effect of an intervention, which may differ from the results obtained in the controlled setting of a clinical trial. This article reviews the goals, methodologies, data sources, and limitations of clinical outcomes research, with a focus on gynecologic oncology. Copyright © 2017. Published by Elsevier Inc.

  9. Public information about clinical trials and research. (United States)

    Plétan, Yannick; Zannad, Faïez; Jaillon, Patrice


    Be it to restore the confused image of clinical research in relation to the lay public, or to develop new ways of accruing healthy volunteers or patients for clinical trials, there is a need to draft some guidance on how best to provide information on research. Although the French legal and regulatory armamentarium in this area is essentially liberal, there is currently little-justified reluctance among study sponsors to advertise publicly. A group of academic and pharmaceutical industry researchers, assembled for a workshop, together with regulators, journalists, representatives from ethics committees, social security, patient and health consumer groups and other French institutional bodies, has suggested the following series of recommendations: there is no need for additional legal or regulatory constraints; sponsors should be aware of and make use of direct public information on trials; a 'good practice charter' on public communication about clinical trials should be developed; all professionals should be involved in this communication platform; communication in the patient's immediate vicinity should be preferred (primary-care physician, local press); clinical databases and websites accessible to professionals, but also to patients and non-professionals, should be developed; genuine instruction on clinical trials for physicians and health professionals unfamiliar with such trials should be developed and disseminated; media groups should receive at least some training in the fundamentals of clinical research.

  10. Computerization of clinical practice in Hong Kong. (United States)

    Leung, G M; Johnston, J M; Ho, L M; Wong, F K; Cameo, S C


    The objective of this study was to assess the current level of computerization in clinical practice in Hong Kong through a population-based, physician survey conducted in 2000.A self-completed, 20-question, postal questionnaire was sent to 4850 randomly selected doctors in Hong Kong. We received 897 completed responses. Over one-third of doctors in the overall sample were already recording patient summaries, processing laboratory results and specialist reports, and preparing referral notes electronically. Patient registration (52.2%), billing systems (40.2%), appointment scheduling (39.9%), and payroll (36.9%), were the commonest administrative functions to have been computerized. Seventy per cent of doctors in solo or small-group ('individual') practices did not yet have any clinical function computerized compared with only 30.7% for those working in large, corporate organizations. Similarly, approximately two-thirds of administrative tasks in 'individual' clinics were not computerized, while corporate physicians reported a corresponding percentage of 39.3%. Younger age, male gender, specialist qualifications, more computers in the practice, higher numbers of administrative tasks already computerized, higher levels of knowledge about and positive attitudes towards computer applications in clinical practice were all positively associated with more clinical tasks already computerized in the practice. The present study has systematically documented the extent of clinical computer use in Hong Kong and identified areas for improvement as well as specific groups of physicians who might benefit from targeted efforts promoting computerization in practice.

  11. Research findings with clinical implications. (United States)

    Bjugn, Roger


    Medical and health research may yield findings that are of direct clinical significance for project participants. The Council of Europe has stated that information on such findings shall be offered to participants, and that applications to research ethics committees shall include plans for managing such findings. The purpose of the study was to investigate how the management of such findings had been described in research projects that had been granted prior approval by a regional committee for medical and health research ethics (REK). Research projects that were associated with Oslo University Hospital and had a start-up date in 2011 were identified in the database of the regional ethics committee. Copies of the application form submitted to the committee, project protocols, participant information/consent forms and letters of approval were reviewed with regard to information on the management of findings with possible clinical implications. Of the 87 projects found in the database, 70 were included in the study. Of these, 57 studies involved direct interaction with humans, whereof 45 with intended use of biological material. In 21 studies, the management of findings with possible clinical implications was described in one or more documents. In all of these projects, the applicant him-/herself had referred to this topic in the initial application. The absence of written information on the management of research findings with possible clinical implications is not in conformity with the recommendations issued by the Council of Europe. By introducing a separate item for this in the form to be submitted to the regional ethics committee for application of prior approval, this issue could be made subject to better assessment.

  12. Research to Practice in School Psychology: Challenges Ahead and the Role of NASP's "School Psychology Forum" (United States)

    Shaw, Steven R.


    The goal of "School Psychology Forum" is to promote and disseminate research-to-practice scholarship for the benefit of school psychologists in their clinical practice. This goal has evolved from a desired practice to a mandatory component of any clinical practice. Research to practice is of importance as the concept of evidence-based…

  13. Bias in clinical intervention research

    DEFF Research Database (Denmark)

    Gluud, Lise Lotte


    Research on bias in clinical trials may help identify some of the reasons why investigators sometimes reach the wrong conclusions about intervention effects. Several quality components for the assessment of bias control have been suggested, but although they seem intrinsically valid, empirical...... evidence is needed to evaluate their effects on the extent and direction of bias. This narrative review summarizes the findings of methodological studies on the influence of bias in clinical trials. A number of methodological studies suggest that lack of adequate randomization in published trial reports...

  14. Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: A practical review for clinical researchers-Part I. general guidance and tips

    International Nuclear Information System (INIS)

    Kim, Kyung Won; Choi, Sang Hyun; Huh, Jimi; Park, Seong Ho; Lee, June Young


    In the field of diagnostic test accuracy (DTA), the use of systematic review and meta-analyses is steadily increasing. By means of objective evaluation of all available primary studies, these two processes generate an evidence-based systematic summary regarding a specific research topic. The methodology for systematic review and meta-analysis in DTA studies differs from that in therapeutic/interventional studies, and its content is still evolving. Here we review the overall process from a practical standpoint, which may serve as a reference for those who implement these methods

  15. NIH Clinical Research Trials and You (United States)

    ... Info Lines Health Services Locator NIH Clinical Research Trials and You Talking to Your Doctor Science ... Labs & Clinics Training Opportunities Library Resources Research Resources Clinical Research Resources Safety, Regulation and Guidance More » Quick Links ...

  16. Hyponatraemia diagnosis and treatment clinical practice guidelines

    NARCIS (Netherlands)

    Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout J.; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; van der Veer, Sabine; van Biesen, Wim; Nagler, Evi; Gonzalez-Espinoza, Liliana; Ortiz, Alberto


    Hyponatremia, defined as a serum sodium concentration <135 mmol/l, is the most common water-electrolyte imbalance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from mild to severe or even life threatening, and is associated with increased mortality, morbidity

  17. Hormone Therapy in Clinical Equine Practice. (United States)

    McCue, Patrick M


    A wide variety of hormone therapies are used in clinical practice in the reproductive management of horses. The goal of this article is to review therapeutic options for a variety of clinical indications. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Nigerian Journal of Clinical Practice: Submissions

    African Journals Online (AJOL)

    Author Guidelines. Mission Statement The purpose of the Nigerian Journal of Clinical Practice is to promote clinical and academic excellence in Medicine and Dentistry and allied sciences. To this end the Journal will publish its issues regularly and will ensure their prompt distribution to all subscribers and libraries ...

  19. The Marriage and Family Therapy Practice Research Network (MFT-PRN): Creating a More Perfect Union Between Practice and Research. (United States)

    Johnson, Lee N; Miller, Richard B; Bradford, Angela B; Anderson, Shayne R


    This article describes the Marriage and Family Therapy Practice Research Network (MFT-PRN). The MFT-PRN is designed to build a professional community based on practice-informed research and research-informed practice, increase the diversity of participants in MFT research, and unify researchers and clinicians. Clinics choose measures from a list that best represent their clinic needs. Clients' outcomes are assessed regularly, and therapists receive immediate graphical feedback on how clients are progressing or digressing. Data are pooled to create a large and diverse database, while improving client outcomes. We will discuss advantages of the MFT-PRN for researchers, therapists, clients, and agencies, and provide one model that we hope will inform other collaborative clinical-research models in the field of marriage and family therapy. Video Abstract is found in the online version of the article. © 2017 American Association for Marriage and Family Therapy.

  20. An effective multisource informed consent procedure for research and clinical practice: an observational study of patient understanding and awareness of their roles as research stakeholders in a cancer biobank. (United States)

    Cervo, Silvia; Rovina, Jane; Talamini, Renato; Perin, Tiziana; Canzonieri, Vincenzo; De Paoli, Paolo; Steffan, Agostino


    process in several fields, from clinical practice to research.Further studies are needed to explore the effects on the study comprehension by each source of information, and by other sources suggested by participants in the questionnaire.

  1. An effective multisource informed consent procedure for research and clinical practice: an observational study of patient understanding and awareness of their roles as research stakeholders in a cancer biobank (United States)


    contribute to a well-informed decision making process in several fields, from clinical practice to research. Further studies are needed to explore the effects on the study comprehension by each source of information, and by other sources suggested by participants in the questionnaire. PMID:23899250

  2. Contemporary management of pericardial effusion: practical aspects for clinical practice. (United States)

    Imazio, Massimo; Gaido, Luca; Battaglia, Alberto; Gaita, Fiorenzo


    A pericardial effusion (PE) is a relatively common finding in clinical practice. It may be either isolated or associated with pericarditis with or without an underlying disease. The aetiology is varied and may be either infectious (especially tuberculosis as the most common cause in developing countries) or non-infectious (cancer, systemic inflammatory diseases). The management is essentially guided by the hemodynamic effect (presence or absence of cardiac tamponade), the presence of concomitant pericarditis or underlying disease, and its size and duration. The present paper reviews the current knowledge on the aetiology, classification, diagnosis, management, therapy, and prognosis of PE in clinical practice.

  3. [Clinical judgment and decision, pedagogy and practice]. (United States)

    Lacronique, J F


    The interactive systems of logical interference represent but one of the computer applications to medicine. While the potential of computers in medical practice is beyond question, their actual use is not widespread. After the stage of practical demonstration of the working features of the hardware, one needs to define accurately the purpose to which the computer is intended in order to perform efficiently in its everyday use. To a certain extent, this unavoidable specialisation contrasts with the ubiquitous presence of computers and the availability of software the use of which does not, in principle, require particular training. A teaching experience directed to a number of different user groups in various fields has prompted us to examine the bases of the difficulties we met with. While some of them are related to cultural (or even religious) grounds, other, being of more technical nature, are more readily amendable to a methodological inquiry. Briefly, this analysis has led us to suggest a revision of various computer applications, including the interactive systems of logical interference, in the field of clinical research. A minimal theoretical training is essential in order to prevent delusions caused by an improvident autodidactic approach. The formal analysis of decision making appears as an excellent teaching guideline since it allows to refresh the elementary statistical concepts and then to approach economical aspects of health management (especially the cost/benefit and cost/effectiveness studies), as well as the sciences of administration as applied to health problems. Oncology represents a particularly suitable field of application on several accounts. It covers various and complex clinical domains, constant conceptual developments and finally, owing to the need for a systematic organisation of the data collection, it offers persuasive applications whose lasting features should warrant the necessary initial effort of investment.

  4. Clinical learning spaces: Crucibles for practice development in physiotherapy clinical education. (United States)

    Patton, Narelle; Higgs, Joy; Smith, Megan


    This paper, through a deep examination of clinical workplaces as learning spaces, uses a holistic interpretation of clinical education and offers a practice development crucible metaphor as a useful way to deepen how clinical education can be conceptualized. An in-depth conceptualization of clinical education is needed if educators are able to develop wise educational practice and optimize the time students spend in clinical learning settings. The research reported here was undertaken in the qualitative paradigm guided by philosophical hermeneutics. Data collection strategies included observation, semi-structured interviews, focus groups and photo-elicitation. Twenty-four undergraduate physiotherapy students and twelve physiotherapy clinical supervisors participated in this research. Consistent with hermeneutic principles of dialogue of question and answer and hermeneutic circle, data analysis was achieved through an iterative process of reading, interpreting and re-reading the transcripts resulting in the emergence of a deeper understanding of clinical education that is represented for the reader. Clinical education has been revealed as a multidimensional learning space where workplace influences, engagement in professional practices, clinical supervisors' intentions and actions in combination with students' dispositions interact to shape and challenge students' clinical learning. A practice development crucible metaphor has been introduced as a way to represent this complexity and conceptualize clinical education, not as a set of techniques or supervision ratios but as a relational, fluid, complex space where learning is catalyzed. Importantly, the crucible metaphor assists academics, clinical supervisors and students to harness the power of clinical education to facilitate learning during clinical placements.

  5. Clinical Understanding of Spasticity: Implications for Practice

    Directory of Open Access Journals (Sweden)

    Rozina Bhimani


    Full Text Available Spasticity is a poorly understood phenomenon. The aim of this paper is to understand the effect of spasticity on daily life and identify bedside strategies that enhance patient’s function and improve comfort. Spasticity and clonus result from an upper motor neuron lesion that disinhibits the tendon stretch reflex; however, they are differentiated in the fact that spasticity results in a velocity dependent tightness of muscle whereas clonus results in uncontrollable jerks of the muscle. Clinical strategies that address function and comfort are paramount. This is a secondary content analysis using a qualitative research design. Adults experiencing spasticity associated with neuromuscular disorder were asked to participate during inpatient acute rehabilitation. They were asked to complete a semistructured interview to explain and describe the nature of their experienced spasticity on daily basis. Spasticity affects activities of daily living, function, and mobility. Undertreated spasticity can lead to pain, immobility, and risk of falls. There were missed opportunities to adequately care for patients with spasticity. Bedside care strategies identified by patients with spasticity are outlined. Uses of alternative therapies in conjunction with medications are needed to better manage spasticity. Patient reports on spasticity are important and should be part of clinical evaluation and practice.

  6. Ambulatory Blood Pressure Monitoring – Clinical Practice Recommendations

    Directory of Open Access Journals (Sweden)

    Katalin Mako


    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.

  7. Sex differences in health research and clinical guideline development

    NARCIS (Netherlands)

    Keuken, D.G.


    In current medical practice, research based evidence is an important foundation for clinical decision making. Clinical practice guidelines are a major instrument for keeping physicians up-to-date about this evidence. In order to provide optimal care to both men and women, it is important that sex

  8. SASPREN - a new development in family practice research in South ...

    African Journals Online (AJOL)

    Thirdly, family practice stresses the importance of the doctor's awareness of self and the impact of his/her values, attitudes and approaches on the healing process. The doctor-patient relationship is consequently an important aspect of family practice research. Finally, clinical methods, procedures and therapies developed at ...

  9. A systematic review of the utility of 1.5 versus 3 Tesla magnetic resonance brain imaging in clinical practice and research

    Energy Technology Data Exchange (ETDEWEB)

    Wardlaw, Joanna M. [Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh (United Kingdom); University of Edinburgh, Division of Clinical Neurosciences, Edinburgh (United Kingdom); Western General Hospital, SINAPSE Collaboration, Brain Research Imaging Centre, Division of Clinical Neurosciences, Edinburgh (United Kingdom); Brindle, Will; Casado, Ana M.; Thomas, Brenda; Morris, Zoe [University of Edinburgh, Division of Clinical Neurosciences, Edinburgh (United Kingdom); Shuler, Kirsten; Henderson, Moira; Munoz Maniega, Susana; Lymer, Katherine; Pernet, Cyril; Tao, Yuehui [Terry; Parikh, Jehill; Royle, Natalie A.; Bastin, Mark E.; Farrall, Andrew; Valdes Hernandez, Maria C. [Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh (United Kingdom); University of Edinburgh, Division of Clinical Neurosciences, Edinburgh (United Kingdom); Macfarlane, Jennifer [Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh (United Kingdom); University of Dundee, Dundee (United Kingdom); Nailon, William [University of Edinburgh, Edinburgh Cancer Centre, Edinburgh (United Kingdom); Ahearn, Trevor [Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh (United Kingdom); University of Aberdeen, Institute of Medical Sciences, Aberdeen (United Kingdom); Mumuni, Abdul Nashirudeen [Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh (United Kingdom); University of Glasgow, Department of Clinical Physics, Glasgow (United Kingdom); Mugruza, Carlos [Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh (United Kingdom); University of Dundee, School of Psychology, Dundee (United Kingdom); McLean, John [Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh (United Kingdom); University of Glasgow, Institute of Neurological Sciences, Glasgow (United Kingdom); Chakirova, Goultchira [Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh (United Kingdom); University of Edinburgh, Division of Psychiatry, Edinburgh (United Kingdom); Simpson, Johanna [Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh (United Kingdom); University of Stirling, Department of Psychology, Stirling (United Kingdom); Stanfield, Andrew C. [University of Edinburgh, Division of Psychiatry, Edinburgh (United Kingdom); Johnston, Harriet [Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh (United Kingdom); University of St Andrews, Department of Psychology, St Andrews (United Kingdom); De Wilde, Janet [Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh (United Kingdom); University of Edinburgh, Division of Clinical Neurosciences, Edinburgh (United Kingdom); The Higher Education Academy, York (United Kingdom); Weir, Nick [Royal Infirmary of Edinburgh, Department of Medical Physics, Edinburgh (United Kingdom); Collaboration: SINAPSE Collaborative Group


    MRI at 3 T is said to be more accurate than 1.5 T MR, but costs and other practical differences mean that it is unclear which to use. We systematically reviewed studies comparing diagnostic accuracy at 3 T with 1.5 T. We searched MEDLINE, EMBASE and other sources from 1 January 2000 to 22 October 2010 for studies comparing diagnostic accuracy at 1.5 and 3 T in human neuroimaging. We extracted data on methodology, quality criteria, technical factors, subjects, signal-to-noise, diagnostic accuracy and errors according to QUADAS and STARD criteria. Amongst 150 studies (4,500 subjects), most were tiny, compared old 1.5 T with new 3 T technology, and only 22 (15 %) described diagnostic accuracy. The 3 T images were often described as ''crisper'', but we found little evidence of improved diagnosis. Improvements were limited to research applications [functional MRI (fMRI), spectroscopy, automated lesion detection]. Theoretical doubling of the signal-to-noise ratio was not confirmed, mostly being 25 %. Artefacts were worse and acquisitions took slightly longer at 3 T. Objective evidence to guide MRI purchasing decisions and routine diagnostic use is lacking. Rigorous evaluation accuracy and practicalities of diagnostic imaging technologies should be the routine, as for pharmacological interventions, to improve effectiveness of healthcare. (orig.)

  10. A Practical Guide to Check the Consistency of Item Response Patterns in Clinical Research Through Person-Fit Statistics: Examples and a Computer Program. (United States)

    Meijer, Rob R; Niessen, A Susan M; Tendeiro, Jorge N


    Although there are many studies devoted to person-fit statistics to detect inconsistent item score patterns, most studies are difficult to understand for nonspecialists. The aim of this tutorial is to explain the principles of these statistics for researchers and clinicians who are interested in applying these statistics. In particular, we first explain how invalid test scores can be detected using person-fit statistics; second, we provide the reader practical examples of existing studies that used person-fit statistics to detect and to interpret inconsistent item score patterns; and third, we discuss a new R-package that can be used to identify and interpret inconsistent score patterns. © The Author(s) 2015.

  11. Action research: changing nursing practice. (United States)

    Hegney, Desley Gail; Francis, Karen


    This article describes action research as a methodology and gives two examples of its application to nursing and health services research. Action research is cyclical in nature and involves the development, evaluation and redefining of an action plan using four basic steps: planning, action, observation and reflection. These cycles of action continue until the research group is satisfied that its objectives have been met. Data generation and analysis are iterative processes that occur continuously throughout the project, which is usually time-limited. Factors that should be taken into account to ensure success include: engaging the community, consideration of 'insider' versus 'outsider' perspectives, competing agendas, expectations not being met and the integrity of the research methodology.

  12. Implementing human factors in clinical practice (United States)

    Timmons, Stephen; Baxendale, Bryn; Buttery, Andrew; Miles, Giulia; Roe, Bridget; Browes, Simon


    Objectives To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. Methods Qualitative, longitudinal study using semi-structured interviews and focus groups, of a multiprofessional group of UK NHS staff (from the emergency department and operating theatres) who have received aviation-derived human factors training. Results The human factors training was evaluated positively, and thought to be both acceptable and relevant to practice. However, the staff found it harder to implement what they had learned in their own clinical areas, and this was principally attributed to features of the informal organisational cultures. Conclusions In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice. PMID:24631959

  13. Clinical Engineering: Experiences of assisted professional practices

    International Nuclear Information System (INIS)

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


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

  14. Interpretation of correlations in clinical research. (United States)

    Hung, Man; Bounsanga, Jerry; Voss, Maren Wright


    Critically analyzing research is a key skill in evidence-based practice and requires knowledge of research methods, results interpretation, and applications, all of which rely on a foundation based in statistics. Evidence-based practice makes high demands on trained medical professionals to interpret an ever-expanding array of research evidence. As clinical training emphasizes medical care rather than statistics, it is useful to review the basics of statistical methods and what they mean for interpreting clinical studies. We reviewed the basic concepts of correlational associations, violations of normality, unobserved variable bias, sample size, and alpha inflation. The foundations of causal inference were discussed and sound statistical analyses were examined. We discuss four ways in which correlational analysis is misused, including causal inference overreach, over-reliance on significance, alpha inflation, and sample size bias. Recent published studies in the medical field provide evidence of causal assertion overreach drawn from correlational findings. The findings present a primer on the assumptions and nature of correlational methods of analysis and urge clinicians to exercise appropriate caution as they critically analyze the evidence before them and evaluate evidence that supports practice. Critically analyzing new evidence requires statistical knowledge in addition to clinical knowledge. Studies can overstate relationships, expressing causal assertions when only correlational evidence is available. Failure to account for the effect of sample size in the analyses tends to overstate the importance of predictive variables. It is important not to overemphasize the statistical significance without consideration of effect size and whether differences could be considered clinically meaningful.

  15. Medical Ethics in Contemporary Clinical Practice


    John R. Williams


    This review article describes and analyzes ethical issues in medical practice, particularly those issues encountered by physicians in their relationships with their patients. These relationships often involve ethical conflicts between 2 or more interests, which physicians need to recognize and resolve. The article deals with 4 topics in clinical practice in which ethical conflicts occur: physicians' duty of confidentiality in a digital environment, their responsibilities for dealing with abus...

  16. George Engel's Epistemology of Clinical Practice. (United States)

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


    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.

  17. [An Investigation of the Role Responsibilities of Clinical Research Nurses in Conducting Clinical Trials]. (United States)

    Kao, Chi-Yin; Huang, Guey-Shiun; Dai, Yu-Tzu; Pai, Ya-Ying; Hu, Wen-Yu


    Clinical research nurses (CRNs) play an important role in improving the quality of clinical trials. In Taiwan, the increasing number of clinical trials has increased the number of practicing CRNs. Understanding the role responsibilities of CRNs is necessary to promote professionalism in this nursing category. This study investigates the role responsibilities of CRNs in conducting clinical trials / research. A questionnaire survey was conducted in a medical center in Taipei City, Taiwan. Eighty CRNs that were registered to facilitate and conduct clinical trials at this research site completed the survey. "Subject protection" was the CRN role responsibility most recognized by participants, followed by "research coordination and management", "subject clinical care", and "advanced professional nursing". Higher recognition scores were associated with higher importance scores and lower difficulty scores. Participants with trial training had significantly higher difficulty scores for "subject clinical care" and "research coordination and management" than their peers without this training (p research coordination and management" (p clinical practice.

  18. Kevlar: Transitioning Helix from Research to Practice (United States)


    KEVLAR : TRANSITIONING HELIX FROM RESEARCH TO PRACTICE UNIVERSITY OF VIRGINIA APRIL 2015 FINAL TECHNICAL REPORT...DATES COVERED (From - To) FEB 2013 – NOV 2014 4. TITLE AND SUBTITLE KEVLAR : TRANSITIONING HELIX FROM RESEARCH TO PRACTICE 5a. CONTRACT NUMBER...possible exploitation. Our technology, called Kevlar , includes key security technologies are protective transformations and targeted recovery. The

  19. Kevlar: Transitioning Helix for Research to Practice (United States)


    KEVLAR : TRANSITIONING HELIX FROM RESEARCH TO PRACTICE UNIVERSITY OF VIRGINIA MARCH 2016 FINAL TECHNICAL REPORT...REPORT 3. DATES COVERED (From - To) FEB 2015 – SEP 2015 4. TITLE AND SUBTITLE KEVLAR : TRANSITIONING HELIX FROM RESEARCH TO PRACTICE 5a. CONTRACT...subject to possible exploitation. Our technology, called Kevlar , includes key security technologies are protective transformations and targeted

  20. Researching language teaching: Understanding practice through ...

    African Journals Online (AJOL)

    However, to engage critically with practice, SLA research must be situated in its institutional, social and cultural settings. We argue that situated research into classroom interaction provides second language teachers with opportunities to theorize and improve practice. (S/ern Af Linguistics & Applied Language Stud: 2001 ...

  1. Better Outcomes through Learning, Data, Engagement, and Research (BOLDER – a system for improving evidence and clinical practice in low and middle income countries [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    BOLDER Research Group


    Full Text Available Despite the many thousands of research studies published every year, evidence for making clinical decisions is often lacking. The main problem is that the evidence available is generated in conditions very different from those that prevail in routine clinical practice and with patients who are different. This is particularly a problem for low and middle income countries as most evidence is generated in high income countries. A group of clinicians, researchers, and policy makers met at Bellagio in Italy to consider how more relevant evidence might be generated. One answer is to conduct more pragmatic trials—those undertaken in routine clinical practice. The group thought that this might best be achieved by developing “learning health systems” in low and middle income countries. Learning health systems develop in communities that include clinicians, patients, researchers, improvement specialists, information technology specialists, managers, and policy makers and have a governance system that gives a voice to all those in the community. The systems focus on improving outcomes for patients, use a common dataset, and promote quality improvement and pragmatic research. Plans have been developed to create at least two learning systems in Africa.

  2. Nurturing communities of practice for transdisciplinary research


    Georgina Cundill; Dirk J. Roux; John N. Parker


    Transdisciplinary research practice has become a core element of global sustainability science. Transdisciplinary research brings with it an expectation that people with different backgrounds and interests will learn together through collective problem solving and innovation. Here we introduce the concept of "transdisciplinary communities of practice, " and draw on both situated learning theory and transdisciplinary practice to identify three key lessons for people working in, managing, or fu...

  3. Clinical practice guideline: Otitis media with effusion. (United States)

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


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

  4. Teaching Reading: Research into Practice (United States)

    Macalister, John


    In pre-service and in-service language teacher education, and in curriculum-related projects in second and foreign language settings, a recurrent issue is the failure to relate the teaching of reading to reading as a meaning-making activity. In this paper, I will consider what current research on second language (L2) reading has actually succeeded…

  5. Practical Applications of Reading Research. (United States)

    Harris, Albert J.

    There are three main reasons why reading research has not had a stronger influence on what goes on in schools. The first reason is the powerful impact of social forces such as the bandwagon effect, the pendulum swing, and the prevailing climate of opinion. These factors determine to an unfortunately large degree whether or not particular research…

  6. Frequently Asked Questions about Clinical Research (United States)

    ... You Ask? []. Clinical Research at NHGRI Clinical researchers at the National Human Genome Research Institute (NHGRI) are developing advanced methods for studying the fundamental mechanisms of inherited and ...

  7. Partners in research: building academic-practice partnerships to educate and mentor advanced practice nurses. (United States)

    Harbman, Patricia; Bryant-Lukosius, Denise; Martin-Misener, Ruth; Carter, Nancy; Covell, Christine L; Donald, Faith; Gibbins, Sharyn; Kilpatrick, Kelley; McKinlay, James; Rawson, Krista; Sherifali, Diana; Tranmer, Joan; Valaitis, Ruta


    Clinical practice is the primary focus of advanced practice nursing (APN) roles. However, with unprecedented needs for health care reform and quality improvement (QI), health care administrators are seeking new ways to utilize all dimensions of APN expertise, especially related to research and evidence-based practice. International studies reveal research as the most underdeveloped and underutilized aspect of these roles. To improve patient care by strengthening the capacity of advanced practice nurses to integrate research and evidence-based practice activities into their day-to-day practice. An academic-practice partnership was created among hospital-based advanced practice nurses, nurse administrators, and APN researchers to create an innovative approach to educate and mentor advanced practice nurses in conducting point-of-care research, QI, or evidence-based practice projects to improve patient, provider, and/or system outcomes. A practice-based research course was delivered to 2 cohorts of advanced practice nurses using a range of teaching strategies including 1-to-1 academic mentorship. All participants completed self-report surveys before and after course delivery. Through participation in this initiative, advanced practice nurses enhanced their knowledge, skills, and confidence in the design, implementation, and/or evaluation of research, QI, and evidence-based practice activities. Evaluation of this initiative provides evidence of the acceptability and feasibility of academic-practice partnerships to educate and mentor point-of-care providers on how to lead, implement, and integrate research, QI and evidence-based activities into their practices. © 2016 John Wiley & Sons, Ltd.

  8. South African Guidelines Excellence (SAGE): Clinical practice ...

    African Journals Online (AJOL)

    Without adherence to rigorous guideline development and reporting standards, the considerable time and effort put into ... the important role that CPGs play in setting standards of clinical practice in SA, and introduced a formalised ..... Almeida CM, Stine N, Stine AR, Wolfe SM. Financial conflict of interest disclosure and.

  9. Computer applications in clinical practice: An overview

    International Nuclear Information System (INIS)

    Levinson, D.


    This book reviews computer applications in clinical and nuclear medicine. Specifically discussed are: Diagnostic uses of computerized tomography; hyperthermia; research programs on x-radiation and medicine, and data acquisition systems of radiology

  10. Intervention Research and Bridging the Gap between Research and Practice (United States)

    Deshler, Donald D.


    Getting research-based instructional practices into the hands of professionals who teach students with learning disabilities is one of the most significant challenges for educators. This paper describes some of the major factors accounting for the gaps that exist between the special education research and classroom practice and presents four major…

  11. A Translational Model of Research-Practice Integration (United States)

    Vivian, Dina; Hershenberg, Rachel; Teachman, Bethany A.; Drabick, Deborah A. G.; Goldfried, Marvin R.; Wolfe, Barry


    We propose a four-level, recursive Research-Practice Integration framework as a heuristic to (a) integrate and reflect on the articles in this Special Section as contributing to a bidirectional bridge between research and practice, and (b) consider additional opportunities to address the research–practice gap. Level 1 addresses Treatment Validation studies and includes an article by Lochman and colleagues concerning the programmatic adaptation, implementation, and dissemination of the empirically supported Coping Power treatment program for youth aggression. Level 2 translation, Training in Evidence-Based Practice, includes a paper by Hershenberg, Drabick, and Vivian, which focuses on the critical role that predoctoral training plays in bridging the research–practice gap. Level 3 addresses the Assessment of Clinical Utility and Feedback to Research aspects of translation. The articles by Lambert and Youn, Kraus, and Castonguay illustrate the use of commercial outcome packages that enable psychotherapists to integrate ongoing client assessment, thus enhancing the effectiveness of treatment implementation and providing data that can be fed back to researchers. Lastly, Level 4 translation, the Cross-Level Integrative Research and Communication, concerns research efforts that integrate data from clinical practice and all other levels of translation, as well as communication efforts among all stakeholders, such as researchers, psychotherapists, and clients. Using a two-chair technique as a framework for his discussion, Wolfe's article depicts the struggle inherent in research–practice integration efforts and proposes a rapprochement that highlights advancements in the field. PMID:22642522

  12. Seborrheic dermatitis: a clinical practice snapshot. (United States)

    Schmidt, Jennifer A


    Seborrheic dermatitis is a chronic, recurring skin disorder that has no cure.Current clinical research has implicated Malassezia yeast in the etiology. Using a clear, concise clinical picture and a thorough patient history, even the novice NP can formulate an effective treatment plan.

  13. Reflections on Speech-Language Therapists' Talk: Implications for Clinical Practice and Education. Clinical Forum (United States)

    Ferguson, Alison; Armstrong, Elizabeth


    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…

  14. A systematic review of management strategies for children's mental health care in the emergency department: update on evidence and recommendations for clinical practice and research. (United States)

    Newton, Amanda S; Hartling, Lisa; Soleimani, Amir; Kirkland, Scott; Dyson, Michele P; Cappelli, Mario


    Children with mental health crises require access to specialised resources and services which are not yet standard in general and paediatric EDs. In 2010, we published a systematic review that provided some evidence to support the use of specialised care models to reduce hospitalisation, return ED visits and length of ED stay. We perform a systematic review to update the evidence base and inform current policy statements. Twelve databases and the grey literature were searched up to January 2015. Seven studies were included in the review (four newly identified studies). These studies compared ED-based strategies designed to assess, treat and/or therapeutically support or manage a mental health presentation. The methodological quality of six studies was assessed using the Cochrane Effective Practice and Organization of Care Risk of Bias tool (one interrupted time series study) and a modified Newcastle-Ottawa Scale (three retrospective cohort and two before-after studies). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to rate overall evidence quality (high, moderate, low or very low) for individual outcomes from these six studies. An additional study evaluated the psychometric properties of a clinical instrument and was assessed using criteria developed by the Society of Pediatric Psychology Assessment Task Force (well-established, approaching well-established or promising assessment). There is low to very low overall evidence quality that: (1) use of screening laboratory tests to medically clear mental health patients increases length of ED stay and costs, but does not increase the risk of clinical management or disposition change if not conducted; and (2) specialised models of ED care reduce lengths of ED stay, security man-hours and restraint orders. One mental health assessment tool of promising quality, the home, education, activities and peers, drugs and alcohol, suicidality, emotions and behaviour, discharge

  15. From Research to Practical Application

    DEFF Research Database (Denmark)

    Madsen, Sabine; Bødker, Keld; Tøth, Thomas


    aim to support operational managers responsible for outsourced IT activities in carrying out the concrete task of knowledge transfer planning and execution. We report from a longitudinal project conducted in a major financial company headquartered in Denmark and an offshore development center located...... in India. We identify the three main knowledge transfer challenges experienced by the case company. The identified challenges inform the design of a systematic five-step approach to the company’s knowledge transfer. Our main contribution is to illustrate how extant research can be applied to understand...

  16. Use of clinical practice guidelines to promote best practice when managing clinical interventions for liver transplant candidates. (United States)

    Jarrett, Maree


    Limited organ availability and an increasing demand for organ transplantation has extended transplant waiting times and thus increased morbidity and mortality for potential recipients on waiting lists. The Queensland Liver Transplant Service identified use of clinical practice guidelines developed from evidence-based practice as a strategic clinical management/workflow tool that could improve clinical outcomes for patients awaiting liver transplant. An extensive review of publications related to the management of advanced liver disease in potential transplant recipients was undertaken and the supporting evidence was identified. In all stages of development of the guidelines, the multidisciplinary collaborative team of clinicians used recommended principles from The Appraisal of Guidelines, Research and Evaluation collaboration. The liver transplant recipient coordinator acted as facilitator for the project, identifying positive factors and resolving obstacles. Key focus areas in optimizing medical management before liver transplant were identified with the aim of preventing disease progression and complications that would jeopardize patients' outcome. Clinical practice guidelines were developed for each key area to optimize care by promoting appropriate timing of clinical interventions. Practices that required change to comply with identified best practice were investigated, and clinical practice for the outpatient medical management of potential liver transplant recipients with chronic liver disease were developed collaboratively. These guidelines have been accepted and are being implemented within the gastroenterology and hepatology department at the Princess Alexandra Hospital.

  17. Hyponatraemia diagnosis and treatment clinical practice guidelines. (United States)

    Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout J; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; van der Veer, Sabine; van Biesen, Wim; Nagler, Evi; Gonzalez-Espinoza, Liliana; Ortiz, Alberto

    Hyponatremia, defined as a serum sodium concentration <135mmol/l, is the most common water-electrolyte imbalance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from mild to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay. Despite this, the management of hyponatremia patients remains problematic. The prevalence of hyponatremia in a wide variety of conditions and the fact that hyponatremia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and specialty-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed clinical practice guidelines on the diagnostic approach and treatment of hyponatremia as a joint venture of 3societies representing specialists with a natural interest in hyponatremia. In addition to a rigorous approach to the methodology and evaluation of the evidence, the document focuses on patient-positive outcomes and on providing a useful tool for clinicians involved in everyday practice. In this article, we present an abridged version of the recommendations and suggestions for the diagnosis and treatment of hyponatremia extracted from the full guide. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  18. Decision making in clinical veterinary practice | Anene | Nigerian ...

    African Journals Online (AJOL)

    Decision making in clinical veterinary practice. BM Anene. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  19. Malingering in clinical practice with specific reference to psychiatry ...

    African Journals Online (AJOL)

    Malingering in clinical practice with specific reference to psychiatry and psychology. Frans J Hugo, Frances Hemp. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers ...

  20. Bringing ayahuasca to the clinical research laboratory. (United States)

    Riba, Jordi; Barbanoj, Manel J


    Since the winter of 1999, the authors and their research team have been conducting clinical studies involving the administration of ayahuasca to healthy volunteers. The rationale for conducting this kind of research is twofold. First, the growing interest of many individuals for traditional indigenous practices involving the ingestion of natural psychotropic drugs such as ayahuasca demands the systematic study of their pharmacological profiles in the target species, i.e., human beings. The complex nature of ayahuasca brews combining a large number of pharmacologically active compounds requires that research be carried out to establish the safety and overall pharmacological profile of these products. Second, the authors believe that the study of psychedelics in general calls for renewed attention. Although the molecular and electrophysiological level effects of these drugs are relatively well characterized, current knowledge of the mechanisms by which these compounds modify the higher order cognitive processes in the way they do is still incomplete, to say the least. The present article describes the development of the research effort carried out at the Autonomous University of Barcelona, commenting on several methodological aspects and reviewing the basic clinical findings. It also describes the research currently underway in our laboratory, and briefly comments on two new studies we plan to undertake in order to further our knowledge of the pharmacology of ayahuasca.

  1. (Re)Searching for Persons in Practice

    DEFF Research Database (Denmark)

    Huniche, Lotte


    to be consistent with a development of the critical psychological conception of subjects as persons in practice. Via an examination of anthropological notions of the field and discussions of concrete research projects in Nigeria and Denmark, the article considers what it means to appropriate field work methods......This article explores the degree to which anthropological field work can contribute to constructively reconfigure approaches to the critical psychological study of persons in practice. We argue that a line of development within German/Danish critical psychological practice research ought...... to the critical psychological practice research tradition of studying subjects. The paper shows how the anthropological clarification of the socio-political contexts of subjects' lives qualifies the study of persons in practice. We also warn of the dangers of predefining and delimiting the field to such an extent...

  2. Uses of internet technology in clinical practice

    International Nuclear Information System (INIS)

    Mansoor, I.


    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)

  3. Negotiation skills for clinical research professionals

    Directory of Open Access Journals (Sweden)

    Sanjay Hake


    Full Text Available Negotiation as a skill is a key requirement for each and every job profile where dealing with multiple parties is involved. The important focus while negotiating should be on the interest then position. Key to every successful negotiation is advance planning, preparation, and patience as the objective is to create value and establish the terms on which parties with differing and often conflicting aims will co-operate. While preparing one should collect facts, know priorities, principles, identify common ground, decide on walk-away position, and try and identify the next best alternative. Negotiation is a set of skills that can be learned and practiced so that your ability to utilize relationship, knowledge, money, power, time, and personality to negotiate improves with each negotiation. In a successful negotiation, all parties win. Important thing to note is that not every negotiation involves money. Anytime you want something from someone else and anytime someone wants something from you, you are negotiating. Everything is negotiable and every day you negotiate with customers, suppliers, colleagues, your wife, and even your children. Negotiation is a game, and like any game it has its rules and tactics. Clinical Research professionals deal with various parties for different purposes at the same time; hence, they require excellent negotiation skills. Project Mangers and Clinical Research Associates are the two most important roles in clinical research industry who require negotiation skills as they deal with various internal and external customers and vendors.

  4. Negotiation skills for clinical research professionals (United States)

    Hake, Sanjay; Shah, Tapankumar


    Negotiation as a skill is a key requirement for each and every job profile where dealing with multiple parties is involved. The important focus while negotiating should be on the interest then position. Key to every successful negotiation is advance planning, preparation, and patience as the objective is to create value and establish the terms on which parties with differing and often conflicting aims will co-operate. While preparing one should collect facts, know priorities, principles, identify common ground, decide on walk-away position, and try and identify the next best alternative. Negotiation is a set of skills that can be learned and practiced so that your ability to utilize relationship, knowledge, money, power, time, and personality to negotiate improves with each negotiation. In a successful negotiation, all parties win. Important thing to note is that not every negotiation involves money. Anytime you want something from someone else and anytime someone wants something from you, you are negotiating. Everything is negotiable and every day you negotiate with customers, suppliers, colleagues, your wife, and even your children. Negotiation is a game, and like any game it has its rules and tactics. Clinical Research professionals deal with various parties for different purposes at the same time; hence, they require excellent negotiation skills. Project Mangers and Clinical Research Associates are the two most important roles in clinical research industry who require negotiation skills as they deal with various internal and external customers and vendors. PMID:21897886

  5. Research nurse manager perceptions about research activities performed by non-nurse clinical research coordinators. (United States)

    Jones, Carolynn Thomas; Hastings, Clare; Wilson, Lynda Law


    There has been limited research to document differences in roles between nurses and non-nurses who assume clinical research coordination and management roles. Several authors have suggested that there is no acknowledged guidance for the licensure requirements for research study coordinators and that some non-nurse research coordinators may be assuming roles that are outside of their legal scopes of practice. There is a need for further research on issues related to the delegation of clinical research activities to non-nurses. This study used nominal group process focus groups to identify perceptions of experienced research nurse managers at an academic health science center in the Southern United States about the clinical research activities that are being performed by non-nurse clinical research coordinators without supervision that they believed should only be performed by a nurse or under the supervision of a nurse. A total of 13 research nurse managers volunteered to be contacted about the study. Of those, 8 participated in two separate nominal group process focus group sessions. The group members initially identified 22 activities that they felt should only be performed by a nurse or under the direct supervision of a nurse. After discussion and clarification of results, activities were combined into 12 categories of clinical research activities that participants believed should only be performed by a nurse or under the direct supervision of a nurse. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Qualitative methods in pharmacy practice research

    DEFF Research Database (Denmark)

    Kaae, Susanne; Traulsen, Janine Marie


    Qualitative research within pharmacy practice is concerned with understanding the behavior of actors such as pharmacy staff, pharmacy owners, patients, other healthcare professionals, and politicians to explore various types of existing practices and beliefs in order to improve them. As qualitative...

  7. Practical Wisdom and the Workplace Researcher (United States)

    Gibbs, Paul


    This paper addresses the form of enquiry appropriate for the workplace researcher. The first part of the paper is used to introduce the main themes of "phronesis" and relies heavily on Aristotle and Heidegger. It is argued that practical wisdom developed through experience of practical judgements offers a form of enquiry appropriate for…

  8. Researching language teaching: Understanding practice through ...

    African Journals Online (AJOL)

    In this article we argue that second language acquisition (SLA) research and theory have a significant role to play in teacher education, especially at the masters level. The danger of overly practical approaches is that they cannot challenge current practice in ways that are both critical and rigorous. However, to engage ...

  9. Reproducibility of clinical research in critical care: a scoping review. (United States)

    Niven, Daniel J; McCormick, T Jared; Straus, Sharon E; Hemmelgarn, Brenda R; Jeffs, Lianne; Barnes, Tavish R M; Stelfox, Henry T


    The ability to reproduce experiments is a defining principle of science. Reproducibility of clinical research has received relatively little scientific attention. However, it is important as it may inform clinical practice, research agendas, and the design of future studies. We used scoping review methods to examine reproducibility within a cohort of randomized trials examining clinical critical care research and published in the top general medical and critical care journals. To identify relevant clinical practices, we searched the New England Journal of Medicine, The Lancet, and JAMA for randomized trials published up to April 2016. To identify a comprehensive set of studies for these practices, included articles informed secondary searches within other high-impact medical and specialty journals. We included late-phase randomized controlled trials examining therapeutic clinical practices in adults admitted to general medical-surgical or specialty intensive care units (ICUs). Included articles were classified using a reproducibility framework. An original study was the first to evaluate a clinical practice. A reproduction attempt re-evaluated that practice in a new set of participants. Overall, 158 practices were examined in 275 included articles. A reproduction attempt was identified for 66 practices (42%, 95% CI 33-50%). Original studies reported larger effects than reproduction attempts (primary endpoint, risk difference 16.0%, 95% CI 11.6-20.5% vs. 8.4%, 95% CI 6.0-10.8%, P = 0.003). More than half of clinical practices with a reproduction attempt demonstrated effects that were inconsistent with the original study (56%, 95% CI 42-68%), among which a large number were reported to be efficacious in the original study and to lack efficacy in the reproduction attempt (34%, 95% CI 19-52%). Two practices reported to be efficacious in the original study were found to be harmful in the reproduction attempt. A minority of critical care practices with research published

  10. Wisdom in clinical reasoning and medical practice. (United States)

    Edmondson, Ricca; Pearce, Jane; Woerner, Markus H


    Exploring informal components of clinical reasoning, we argue that they need to be understood via the analysis of professional wisdom. Wise decisions are needed where action or insight is vital, but neither everyday nor expert knowledge provides solutions. Wisdom combines experiential, intellectual, ethical, emotional and practical capacities; we contend that it is also more strongly social than is usually appreciated. But many accounts of reasoning specifically rule out such features as irrational. Seeking to illuminate how wisdom operates, we therefore build on Aristotle's work on informal reasoning. His account of rhetorical communication shows how non-formal components can play active parts in reasoning, retaining, or even enhancing its reasonableness. We extend this account, applying it to forms of healthcare-related reasoning which are characterised by the need for wise decision-making. We then go on to explore some of what clinical wise reasoning may mean, concluding with a case taken from psychotherapeutic practice.

  11. Pediatric gastroenterology and nutrition in clinical practice

    National Research Council Canada - National Science Library

    Lifschitz, Carlos H


    ... facts in molecular biology and genetics, as well as recently acquired clinical information, in conjunction with a practical approach to pediatric gastroenterology and nutrition. The idea is to provide new information that seems to be here to stay, along with a comprehensive update on the management of nutritional and gastrointestinal problems that affect the pediatric population, from the newborn to the adolescent. We have also provided, when appropriate, a section on "what can go wrong." This section lists c...

  12. Medical Malpractice Implications of Clinical Practice Guidelines. (United States)

    Ruhl, Douglas S; Siegal, Gil


    Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

  13. Practice-based research networks: the laboratories of primary care research. (United States)

    Lindbloom, Erik J; Ewigman, Bernard G; Hickner, John M


    Medical research has traditionally been based in academic centers, and the findings are frequently not applicable in community primary care settings. The result is a large gap between the possible and the practical in delivering high-quality primary medical care in the United States. Practice-based research networks (PBRNs), laboratories for primary care clinical research, are the appropriate vehicles for uniting the worlds of community primary care practice and clinical research. Although they have received little attention in the mainstream of clinical and health services research, PBRNs have already reported a variety of findings useful for primary care providers, and these networks have helped to identify key issues in healthcare delivery that affect important outcomes. In this report, we outline the rationale for and history of PBRNs. We describe the organization and work of several productive PBRNs, giving examples of their studies that have changed the standards of modern primary care practice. Finally, we describe a developing electronic process for identifying research questions obtained directly from primary care providers that can be used to focus the national primary care research agenda on questions of clinical relevance and importance. As electronic technologies are fully developed and tested, they will facilitate communication between clinicians and researchers, thereby improving the effectiveness and efficiency of practice-based research.

  14. Nurturing communities of practice for transdisciplinary research

    Directory of Open Access Journals (Sweden)

    Georgina Cundill


    Full Text Available Transdisciplinary research practice has become a core element of global sustainability science. Transdisciplinary research brings with it an expectation that people with different backgrounds and interests will learn together through collective problem solving and innovation. Here we introduce the concept of "transdisciplinary communities of practice, " and draw on both situated learning theory and transdisciplinary practice to identify three key lessons for people working in, managing, or funding such groups. (1 Opportunities need to be purposefully created for outsiders to observe activities in the core group. (2 Communities of practice cannot be artificially created, but they can be nurtured. (3 Power matters in transdisciplinary communities of practice. These insights challenge thinking about how groups of people come together in pursuit of transdisciplinary outcomes, and call for greater attention to be paid to the social processes of learning that are at the heart of our aspirations for global sustainability science.

  15. Can experiential-didactic training improve clinical STD practices? (United States)

    Dreisbach, Susan; Devine, Sharon; Fitch, John; Anderson, Teri; Lee, Terry; Rietmeijer, Cornelis; Corbett, Kitty K


    High rates of sexually transmitted diseases (STDs) present an ongoing costly public health challenge. One approach to reduce STD transmission is to increase the number of clinicians adopting the Centers for Disease Control and Prevention's STD Treatment Guidelines. This evaluation assesses the effectiveness of a 3-day experiential and didactic training to translate recommendations into practice by increasing clinician knowledge and skills and helping participants anticipate and overcome barriers to implementation. Between 2001 and 2004, 110 direct care clinicians from 10 states participated in one of 27 standardized 3-day interactive trainings offered by the Denver STD/human immunodeficiency virus (HIV) Prevention Training Center. STD/HIV knowledge and clinical skills were measured before, immediately after, and 6 months after training. Practice patterns were assessed before training and after 6 months. Structural barriers to implementation were identified 6 months post-training. Trainees demonstrated significant post-training gains in mean knowledge scores immediately post-training (P STD risk assessment, clinical examination, diagnosis, and treatment. Self-reported improvement in practice patterns was significant for 23 of 35 practices (P STD/HIV training can modestly improve knowledge, clinical skills, and implementation of STD recommended practices 6 months after training. Further research is needed to identify the impact of improved clinical practices on STD/HIV transmission.

  16. Stuttering: Clinical and research update. (United States)

    Perez, Hector R; Stoeckle, James H


    To provide an update on the epidemiology, genetics, pathophysiology, diagnosis, and treatment of developmental stuttering. The MEDLINE and Cochrane databases were searched for past and recent studies on the epidemiology, genetics, pathophysiology, diagnosis, and treatment of developmental stuttering. Most recommendations are based on small studies, limited-quality evidence, or consensus. Stuttering is a speech disorder, common in persons of all ages, that affects normal fluency and time patterning of speech. Stuttering has been associated with differences in brain anatomy, functioning, and dopamine regulation thought to be due to genetic causes. Attention to making a correct diagnosis or referral in children is important because there is growing consensus that early intervention with speech therapy for children who stutter is critical. For adults, stuttering can be associated with substantial psychosocial morbidity including social anxiety and low quality of life. Pharmacologic treatment has received attention in recent years, but clinical evidence is limited. The mainstay of treatment for children and adults remains speech therapy. A growing body of research has attempted to uncover the pathophysiology of stuttering. Referral for speech therapy remains the best option for children and adults. Copyright© the College of Family Physicians of Canada.

  17. Ensuring rigour and trustworthiness of qualitative research in clinical pharmacy. (United States)

    Hadi, Muhammad Abdul; José Closs, S


    The use of qualitative research methodology is well established for data generation within healthcare research generally and clinical pharmacy research specifically. In the past, qualitative research methodology has been criticized for lacking rigour, transparency, justification of data collection and analysis methods being used, and hence the integrity of findings. Demonstrating rigour in qualitative studies is essential so that the research findings have the "integrity" to make an impact on practice, policy or both. Unlike other healthcare disciplines, the issue of "quality" of qualitative research has not been discussed much in the clinical pharmacy discipline. The aim of this paper is to highlight the importance of rigour in qualitative research, present different philosophical standpoints on the issue of quality in qualitative research and to discuss briefly strategies to ensure rigour in qualitative research. Finally, a mini review of recent research is presented to illustrate the strategies reported by clinical pharmacy researchers to ensure rigour in their qualitative research studies.

  18. Mismatch repair deficiency testing in clinical practice. (United States)

    Buza, Natalia; Ziai, James; Hui, Pei


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

  19. A Practical School Public Relations Research Primer (United States)

    Moore, Edward H.


    Advances in communication technology have created many new tools for school communicators--as well as increasing complexities for their programs. As a result, solid school communication research programs offering practical research insights for planning, tracking, and assessing school communication efforts are more important than ever. Still, many…

  20. Enabling Critical Reflection on Research Supervisory Practice (United States)

    Pearson, Margot; Kayrooz, Carole


    This paper describes the development of an instrument--The Reflective Supervisor Questionnaire (RSQ). The RSQ maps the domain of research supervisory practice as a facilitative process involving educational tasks and activities. It is designed to assist research supervisors explore, by means of self-reflection and reflection on feedback from…

  1. Researcher Practice: Embedding Creative Practice Within Doctoral Research in Industrial Design

    Directory of Open Access Journals (Sweden)

    Mark Evans


    Full Text Available This article considers the potential for a researcher to use their own creative practice as a method of data collection. Much of the published material in this field focuses on more theoretical positions, with limited use being made of specific PhDs that illustrate the context in which practice was undertaken by the researcher. It explores strategies for data collection and researcher motivation during what the author identifies as "researcher practice." This is achieved through the use of three PhD case studies. Methods of data collection focus on: (a the use of output from practice for quantitative data collection (i.e., for comparative analysis, (b the use of output from practice for qualitative data collection (i.e., reflection on new working practice, and (c the use of output from practice for data translation (i.e., using research output to produce a creative design solution for a tool that can be used for further data collection and validation. The article discusses the methodologies employed in the case studies to identify themes which enable the definition of a generic researcher practitioner methodology. It notes the significance of creative practice in support of data collection and the differences between researcher practice and commercial practice, and emphasises the contribution of researcher practice towards personal motivation.

  2. The feasibility of a clinical trial of pain related to temporomandibular muscle and joint disorders: the results of a survey from the Collaboration on Networked Dental and Oral Research dental practice-based research networks. (United States)

    Velly, Ana M; Schiffman, Eric L; Rindal, D Brad; Cunha-Cruz, Joana; Gilbert, Gregg H; Lehmann, Maryann; Horowitz, Allan; Fricton, James


    The authors conducted a survey to characterize the strategies used by general dentists to manage pain related to temporomandibular muscle and joint disorders (TMJDs) and to assess the feasibility of conducting a randomized controlled trial (RCT) to determine the effectiveness of these strategies. Dentists from three dental practice-based research networks (PBRNs) (The Dental Practice-Based Research Network, Practitioners Engaged in Applied Research and Learning Network and Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry) agreed to participate in this survey. Of 862 dentists surveyed, 654 were general dentists who treated TMJDs; among these, 80.3 percent stated they would participate in a future RCT. Dentists treated an average of three patients with TMJD-related pain per month. Splints or mouthguards (97.6 percent), self-care (85.9 percent) and over-the-counter or prescribed medications (84.6 percent) were the treatments most frequently used. The treatments dentists preferred to compare in an RCT were splint or mouthguard therapy (35.8 percent), self-care (27.4 percent) and medication (17.0 percent). Most general dentists treat TMJD-related pain, and initial reversible care typically is provided. It is feasible to conduct an RCT in a dental PBRN to assess the effectiveness of splint or mouthguard therapy, self-care or medication for the initial management of painful TMJD. There is an opportunity to do an RCT in a dental PBRN, which could lead to the development of evidence-based treatment guidelines for the initial treatment of TMJD-related pain by primary care dentists.

  3. Recent Changes in Humanistic Research Practices

    DEFF Research Database (Denmark)

    Johansson, Lasse Gøhler; Vikman, Jutta Maria; Liljenstrøm, Andreas Jan


    The present paper analyzes changes in research practices in the humanities around the turn of the millennium. The analysis is based on a reading of all humanistic PhD dissertations in Denmark between 1992 and 2012 (N=1,958). For every dissertation we recorded not only language, format, co...... in the national and transnational scientific fields and in the light of Danish and European research policy around the turn of the millennium. The paper contributes to the history of the humanities by offering a detailed analysis of changes in research practices across all humanistic disciplines. It also...

  4. Translating Pharmacogenomics Discoveries into Clinical Practice: The Role of Curated Databases (United States)

    Nadkarni, Prakash M.; Wiepert, Mathieu


    Pharmacogenomics-related genotype information is growing at a supra-linear rate, and phenotype-related information, as determined by computer simulations, in vitro experiments and clinical studies, is also growing. Even when phenotypic information is confirmed via clinical research, numerous barriers exist in translating these discoveries into clinical practice. We consider two of them here: the uncertainty regarding the practical relevance of research observations, and translation of significant research findings into clinical practice and research through electronic information access. This form of access is critical because even leading clinical pharmacologists cannot fully retain mentally today’s large volume of drug-related information. PMID:16013993

  5. Implementation of a New Kiosk Technology for Blood Pressure Management in a Family Medicine Clinic: from the WWAMI Region Practice and Research Network. (United States)

    Chung, Chia-Fang; Munson, Sean A; Thompson, Matthew J; Baldwin, Laura-Mae; Kaplan, Jeffrey; Cline, Randall; Green, Beverly B


    Using a self-service kiosk to measure blood pressure (BP) has the potential to increase patients' awareness of their BP control and free up medical assistant (MA) time. The objective of this study was to evaluate BP kiosk acceptability and usability, as well as its effects on the workflow of patient BP self-measurement in a primary care clinic. We used qualitative and quantitative assessments of kiosk implementation via meetings with clinic leaders, focus groups with clinic providers and staff, observations of kiosk users, and surveys of kiosk users at 2 and 8 months. Most patients were comfortable using the kiosk (82% at 2 months, 87% at 8 months). Initial provider concerns included accuracy, but most gained confidence after comparing it with other monitors and reviewing the literature supporting its accuracy. Patients and providers saw many benefits: easier BP checks, increased patient engagement, and saved MA time for other tasks. The clinic addressed early concerns (eg, infection control, confusing instructions, perceived loss of personal touch). Most patients (86%) supported the clinic continuing to use the kiosks. Providers, staff, and patients adapted to the use of BP kiosks, providing value by engaging patients in their own care and saving MA time. The clinic decided to keep the self-service kiosk after the pilot period. © Copyright 2016 by the American Board of Family Medicine.

  6. Importance of clinical epidemiology research in studies on respiratory diseases. (United States)

    Iwanaga, Takashi; Tohda, Yuji


    Evidence-based medicine (EBM) has generated great interest since the 1990s and many physicians worldwide have based their clinical practice on this idea. Its underlying concepts include a diverse array of findings from clinical epidemiological research. In western countries, many clinical databases of clinical epidemiology are in circulation. Clinical epidemiological research using these data in western countries constitutes the majority worldwide. However, because race, lifestyle, culture, etc., differ among western countries and Japan, it is difficult to apply the results of clinical epidemiological research obtained in Japan to western countries. Unfortunately, there is no large-scale database for respiratory diseases prevalent in Japan. Many specialists agree with the opinion that it is necessary to collect medical information specific to the Japanese population and analyze the clinical data. KiHAC (Kinki Hokuriku Airway Disease Conference) was established in September 2001 with the aim of generating evidence through clinical epidemiological research for airway diseases by targeting physicians practicing respiratory medicine, pediatrics, and otorhinolaryngology, primarily in the Kinki and Hokuriku regions located in the central to western parts of Japan. As a part of the KiHAC, clinical research societies will attempt to cooperate with each other to make joint research possible and to share and utilize information, in addition to further promoting clinical research in the field of respiratory medicine. Copyright © 2013 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  7. Grounded theory for radiotherapy practitioners: Informing clinical practice

    International Nuclear Information System (INIS)

    Walsh, N.A.


    Radiotherapy practitioners may be best placed to undertake qualitative research within the context of cancer, due to specialist knowledge of radiation treatment and sensitivity to radiotherapy patient's needs. The grounded theory approach to data collection and analysis is a unique method of identifying a theory directly based on data collected within a clinical context. Research for radiotherapy practitioners is integral to role expansion within the government's directive for evidence-based practice. Due to the paucity of information on qualitative research undertaken by radiotherapy radiographers, this article aims to assess the potential impact of qualitative research on radiotherapy patient and service outcomes.

  8. Research utilisation in sonographic practice: Attitudes and barriers

    International Nuclear Information System (INIS)

    Elliott, Vicki; Wilson, Stephanie E.; Svensson, Jon; Brennan, Patrick


    Statutory agents have stipulated that research activity is a fundamental component of the healthcare professional's activity. Whilst the College of Radiographers have emphasised the importance of imaging personnel embracing this research ethos, there is little available data on the level of research activity within sonographic practice or on the factors that influence a sonographer's involvement in research activities. This work attempts to address these deficiencies. A questionnaire was sent to 300 UK-based sonographers of whom 218 responded (72%). The questionnaire was specifically designed to establish the level of involvement in research, the utilisation of research findings, attitudes towards research and perceived barriers to active research involvement. Responses were analysed investigating any correlations with the population demographics. The data collected showed the majority of sonographers (89%) were enthusiastic about research but with only 33% and 60% currently or previously performing research, respectively, and 73% using research findings to modify their clinical practice. Certain barriers to an active research involvement were shown, with 63%, 55% and 40% citing lack of time, education and collegial support, respectively. A range of statistical findings were linked to particular sonographer groups. The importance of good organisational structures and effective support from fellow health professionals was highlighted. The results confirm sonographers' appreciation of the benefits of research and it is suggested that if this enthusiasm is translated into effective research strategies, research output from ultrasound and other clinical departments should be enhanced.

  9. Clinical research and medical care: towards effective and complete integration. (United States)

    Sacristán, José A


    Despite their close relationship, clinical research and medical care have become separated by clear boundaries. The purpose of clinical research is to generate generalizable knowledge useful for future patients, whereas medical care aims to promote the well-being of individual patients. The evolution towards patient-centered medicine and patient-oriented research, and the gradual standardization of medicine are contributing to closer ties between clinical research and medical practice. But the integration of both activities requires addressing important ethical and methodological challenges. From an ethical perspective, clinical research should evolve from a position of paternalistic beneficence to a situation in which the principle of non-maleficence and patient autonomy predominate. The progressive adoption of "patient-oriented informed consent", "patient equipoise", and "altruism-based research", and the application of risk-based ethical oversight, in which the level of regulatory scrutiny is adapted to the potential risk for patients, are crucial steps to achieve the integration between research and care. From a methodological standpoint, careful and systematic observations should have greater relevance in clinical research, and experiments should be embedded into usual clinical practice. Clinical research should focus on individuals through the development of patient-oriented research. In a complementary way, the integration of experiments into medical practice through the systematic application of "point of care research" could help to generate knowledge for the individuals and for the populations. The integration of clinical research and medical care will require researchers, clinicians, health care managers, and patients to reevaluate the way they understand both activities. The development of an integrated learning health care system will contribute to generating and applying clinically relevant medical knowledge, producing benefits for present and future

  10. Suicide assessment and treatment: Gaps between theory, research, and practice. (United States)

    Kene, Prachi; Yee, Elena T; Gimmestad, Katherine D


    A considerable body of literature focuses on suicide risk assessment, treatment, and prevention. However, incorporation of these research and theoretical advances in routine care by practitioners has been largely unexamined. We examine the challenges - lack of training, fear, complexities of decision-making, practical barriers, lack of usage of assessment tools, and violations of psychometric principles by assessment tools - that confront practitioners when utilizing advances in the field. Identifying and addressing these barriers has implications to help bridge the gaps between theory, research, and practice to improve quality of care. Clinical, training, policy implications and future research directions are reviewed.

  11. Document control practices in 120 clinical laboratories. (United States)

    Valenstein, Paul N; Stankovic, Ana K; Souers, Rhona J; Schneider, Frank; Wagar, Elizabeth A


    A variety of document control practices are required of clinical laboratories by US regulation, laboratory accreditors, and standard-setting organizations. To determine how faithfully document control is being implemented in practice and whether particular approaches to document control result in better levels of compliance. Contemporaneous, structured audit of 8814 documents used in 120 laboratories for conformance with 6 generally accepted document control requirements: available, authorized, current, reviewed by management, reviewed by staff, and archived. Of the 8814 documents, 3113 (35%) fulfilled all 6 document control requirements. The requirement fulfilled most frequently was availability of the document at all shifts and locations (8564 documents; 97%). Only 4407 (50%) of documents fulfilled Clinical Laboratory Improvement Amendment requirements for being properly archived after updating or discontinuation. Policies and procedures were more likely to fulfill document control requirements than forms and work aids. Documents tended to be better controlled in some laboratory sections (eg, transfusion service) than in others (eg, microbiology and client services). We could not identify document control practices significantly associated with higher compliance rates. Most laboratories are not meeting regulatory and accreditation requirements related to control of documents. It is not clear whether control failures have any impact on the quality of laboratory results or patient outcomes.

  12. Sodium glucose co-transporter inhibitors for the management of diabetes mellitus: an opinion paper from the Endocrine and Metabolism Practice and Research Network of the American College of Clinical Pharmacy. (United States)

    Clements, Jennifer N; Whitley, Heather P; D'Souza, Jennifer J; Gross, Benjamin; Hess, Rick; Reece, Sara; Gentry, Chad; Shealy, Kayce


    Type 2 diabetes mellitus (T2DM) carries a high prevalence in the United States and worldwide. Therefore, the number of medication classes being developed and studied has grown. The individualized management of diabetes is accomplished by evaluating a medication's efficacy, safety, and cost, along with the patient's preference and tolerance to the medication. Sodium glucose co-transporter 2 inhibitors are a new therapeutic class indicated for the treatment of diabetes and have a unique mechanism of action, independent of beta-cell function. The first agent approved by the Food and Drug Administration (FDA) was canagliflozin in March 2013. Two agents - dapagliflozin and empagliflozin - were FDA-approved in January and July 2014, respectively. A clear understanding of the new class is needed to identify its appropriate use in clinical practice. Members of the American College of Clinical Pharmacy Endocrine and Metabolism Practice and Research Network reviewed available literature regarding this therapeutic class. The article addresses the advantages, disadvantages, emerging role, and patient education for sodium glucose co-transporter 2 inhibitors. Key limitations for this article include limited access to clinical trial data not published by the pharmaceutical company and limited data on products produced outside the United States.

  13. Clinical education in private practice: an interdisciplinary project. (United States)

    Doubt, Lorna; Paterson, Margo; O'Riordan, Anne


    Education of rehabilitation professionals traditionally has occurred in acute care hospitals, rehabilitation centres, and other publicly funded institutions, but increasing numbers of rehabilitation professionals are now working in the community in private agencies and clinics. These privately owned clinics and community agencies represent underutilized resources for the clinical training of students. Historically, private practitioners have been less likely to participate in clinical education because of concerns over patient satisfaction and quality of care, workload, costs, and liability. Through a program funded by the Ministry of Health of Ontario, we conducted a series of interviews and focus groups with private practitioners, which identified that several incentives could potentially increase the numbers of clinical placements in private practices, including participation in the development of student learning objectives related to private practice, professional recognition, and improved relationships with the university departments. Placement in private practices can afford students skills in administration, business management, marketing and promotion, resource development, research, consulting, networking, and medical-legal assessments and processes. This paper presents a discussion of clinical education issues from the perspective of private practitioners, based on the findings of a clinical education project undertaken at Queen's University, Kingston, Ontario, and previous literature.

  14. Cardiac magnetic resonance imaging in clinical practice

    Directory of Open Access Journals (Sweden)

    Adriana Dias Barranhas


    Full Text Available Objective To evaluate and describe indications, mainly diagnoses and cardiac magnetic resonance imaging findings observed in clinical practice. Materials and Methods Retrospective and descriptive study of cardiac magnetic resonance performed at a private hospital and clinic in the city of Niterói, RJ, Brazil, in the period from May 2007 to April 2011. Results The sample included a total of 1000 studies performed in patients with a mean age of 53.7 ± 16.2 years and predominance for male gender (57.2%. The majority of indications were related to assessment of myocardial perfusion at rest and under pharmacological stress (507/1000; 51%, with positive results in 36.2% of them. Suspected myocarditis was the second most frequent indication (140/1000; 14%, with positive results in 63.4% of cases. These two indications were followed by study of arrhythmias (116/1000; 12%, myocardial viability (69/1000; 7% and evaluation of cardiomyopathies (47/1000; 5%. In a subanalysis, it was possible to identify that most patients were assessed on an outpatient basis (58.42%. Conclusion Cardiac magnetic resonance has been routinely performed in clinical practice, either on an outpatient or emergency/inpatient basis, and myocardial ischemia represented the main indication, followed by investigation of myocarditis, arrhythmogenic right ventricular dysplasia and myocardial viability.

  15. Narrative medicine in clinical genetics practice. (United States)

    Nowaczyk, Małgorzata J M


    Over the last 30 years medicine has undergone a significant paradigm shift. Due to the tremendous advances of modern medicine more and more people are living longer with their illnesses. These people have stories to tell, and they want these stories to be heard: They are reclaiming their voices. As clinical geneticists we need to hear what these voices are telling us, especially so in our area of clinical care where cures are rare, and disease states can be permanent. Narrative medicine is an important new skill set that hones abilities to do just that.This article highlights how integral narrative medicine is to clinical genetics practice, how geneticists already employ many of its tools and how they practice it diligently every day. I will show how geneticists can further improve their abilities to hear and honor patients' stories by writing and sharing stories with patients and with each other as doctors, counselors, and nurses, social workers and chaplains. The review presents the skills of close reading and how they improve patient care and illustrates how geneticists can, by using reflective writing, reshape their emotions in order to understand them, to let them go, and to make room for more. It presents the major types of illness narratives whose recognition allows us to hear and understand patients' stories. When used, the tools of narrative medicine can result in better patient care. Copyright © 2012 Wiley Periodicals, Inc.

  16. Bridging the gap between outputs of clinical research and utilisation ...

    African Journals Online (AJOL)

    Worldwide clinical research efforts do not necessarily translate to improved outcomes in clinical practice. However, with the rising challenge facing clinicians in the midst of an environment of increasing health care choices, rising expectations and limited resources, the awareness of this lag is rising globally and health ...

  17. Good science, bad science: Questioning research practices in psychological research

    NARCIS (Netherlands)

    Bakker, M.


    In this dissertation we have questioned the current research practices in psychological science and thereby contributed to the current discussion about the credibility of psychological research. We specially focused on the problems with the reporting of statistical results and showed that reporting

  18. Adapting research activity: AHRC review of practice-led research


    Till, J; Mottram, J; Rust, C


    In 2005 the Arts and Humanities Research Council initiated a review of practice-led research in art, design and architecture. The purpose of the review was to develop a ‘comprehensive map of recent and current research activity in the area’. What quickly became obvious to the team that won the bid to run the review (led by the three authors) was that to map activity one first had to attempt to define it. The term ‘practice-led research’ means many different things to different people and so i...

  19. 59th Clinical Research Division Research Day Briefing (United States)


    59th Medical Wing a ’r’. ’ ( ~ ~ ’ ""· ~... ’ .,,,. lS! lflof!’~l. 59th Clinical Research Division Research Day Briefing Colonel Linda Steel...oversight and guidance to researchers in the development, performance, and dissemination of clinical investigations. CRD directly supports wing... Clinical Investigation Support 2. Training 3. Support of RDT&E protocols 4. Research Subject Protection • Human Subjects: IRS - Institutional

  20. Knowledge Creation in Clinical Product Development Management Research

    DEFF Research Database (Denmark)

    Karlsson, Christer; Sköld, Martin


    This paper explores the clinical approach to management research and positions it in relation to other similar approaches. It achieves this by pointing out the most important historical milestones in the development of such approaches. The literature on the approach is mapped, including...... of the approaches, the paper discusses the research issues to which clinical research is relevant and how the research framework should be designed, then practical issues relating to how to approach the study objects, the design of the research instruments, and the conducting of the field research. Finally......, it presents the method for analysing and drawing conclusions....

  1. Hypothesis Validity of Clinical Research. (United States)

    Wampold, Bruce E.; And Others


    Describes hypothesis validity as extent to which research results reflect theoretically derived predictions about relations between or among constructs. Discusses role of hypotheses in theory testing. Presents four threats to hypothesis validity: (1) inconsequential research hypotheses; (2) ambiguous research hypotheses; (3) noncongruence of…

  2. How to emerge from the conservatism in clinical research methodology? (United States)

    Kotecki, Nuria; Penel, Nicolas; Awada, Ahmad


    Despite recent changes in clinical research methodology, many challenges remain in drug development methodology. Advances in molecular biology and cancer treatments have changed the clinical research landscape. Thus, we moved from empirical clinical oncology to molecular and immunological therapeutic approaches. Along with this move, adapted dose-limiting toxicities definitions, endpoints, and dose escalation methods have been proposed. Moreover, the classical frontier between phase I, phase II, and phase III has become unclear in particular for immunological approaches. So, investigators are facing major challenges in drug development methodology. We propose to individualize clinical research using innovative approaches to significantly improve patient outcomes and targeting what is considered unmet need. Integrating high level of translational research and performing well designed biomarker studies with great potential for clinical practice are of utmost importance. This could be performed within new models of clinical research networks and by building a strong collaboration between academic, cooperative groups, on-site investigators, and pharma.

  3. The Sherlock Holmes method in clinical practice. (United States)

    Sopeña, B


    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. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  4. From Research Assistant to Professional Research Assistance: Research Consulting as a Form of Research Practice

    Directory of Open Access Journals (Sweden)

    Dawn E. Pollon


    Full Text Available Research assistantships have long been viewed as an extension of the formal education process, a form of apprenticeship, and a pathway into the professional practice of research in institutional settings. However, there are other contexts in which researchers practice research. This self-study documents the formative role research assistantships played in the authors’ development as professional research consultants. Four professional research consultants who held research assistant positions during their master’s and doctoral studies describe the contributions of their research assistantship experiences to the advancement of their knowledge, skills, and passion for research and subsequently to their career decisions. Professional research consulting is identified as a natural extension of research assistant roles and a potential career path. The article enhances current understandings about the ways research assistantships contribute to the development of researchers, and specifically to the development of professional research consultants. The analysis will be of interest to students contemplating entering into research assistantships, current research assistants, current research assistant supervisors, academic staff looking to improve their research productivity, and department chairs.

  5. Applying Behavior Change Theories and Qualitative Methods in Substance Misuse Implementation Research: Conceptualizing the Adoption of Breaking Free Online in Real-World Clinical Practice. (United States)

    Dugdale, Stephanie; Elison, Sarah; Davies, Glyn; Ward, Jonathan


    There is insufficient research examining the implementation of complex novel interventions within health care. This may be due to a lack of qualitative research providing subjective insights into these implementation processes. The authors investigate the advantages of applying behavior change theories to conceptualize qualitative data describing the processes of implementation of complex interventions. Breaking Free Online (BFO), a digital treatment intervention for substance misuse, is described as an example of a complex intervention. The authors review previous qualitative research which explored initial diffusion, or spread, of the BFO program, and its subsequent normalization as part of standard treatment for substance misuse within the health and social care charity, "Change, Grow, Live" (CGL). The use of behavior change models to structure qualitative interview findings enabled identification of facilitators and barriers to the use of BFO within CGL. These findings have implications for the development of implementation research in novel health care interventions.

  6. [Breaking bad news in clinical practice]. (United States)

    Herrera, Andrea; Ríos, Matías; Manríquez, José Manuel; Rojas, Gonzalo


    Breaking bad news is a complex task that requires multiple communication skills from health professionals. Clinical practice demands to communicate all type of bad news, from a diagnosis of cancer to adverse effects of a treatment. On the other hand, since the beginning of the health reform in 2003, the need to improve the quality of services was proposed, among which the concern about the rights and duties of patients stands out. Therefore, the health care provider-patient relationship becomes again the subject of discussion and study, and a topic of great importance for clinical work. We revise the consequences of breaking bad news for the patient and for the health care provider, as well as the current protocols available for this purpose. The importance of developing communication skills both for future health professionals as for those who currently work in the area is emphasized.

  7. Biosensors in Clinical Practice: Focus on Oncohematology

    Directory of Open Access Journals (Sweden)

    Agostino Cortelezzi


    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.

  8. Implementation Research Workshop in Argentina: Moving Research into Practice (United States)

    Research on implementation science addresses the level to which health interventions can fit within real-world public health and clinical service systems. The overall goal of the Introduction to Cancer Program Planning and Implementation Research Workshop was to train a critical mass of researchers, program managers, practitioners, and policy makers that can apply the knowledge gained on implementation and dissemination research to promote evidence-based interventions to reduce the cancer burden in the country and globally.

  9. Estradiol RIA kit in clinical practice

    International Nuclear Information System (INIS)

    Friedrich, W.; Lisse, K.; Bienert, R.; Flentje, H.; Koerner, H.; Wilken, T.; Akademie der Wissenschaften der DDR, Berlin-Buch. Zentralinstitut fuer Isotopen- und Strahlenforschung)


    First clinical experience with a estradiol RIA kit developed in the Central Institute for Isotope- and Radiation Research is reported. The kit was used for the daily control of estradiol level in patients, which were treated within the program for in vitro fertilization and embryo transfer. The time of incubation could be shortened by means of a double antibody technique and by use of a precipitation mixture to 2 h. The intraassay variation is 9.2%, the interassay variation is 15.1%, the recovery rate is 94%. The sensitivity of the test (B 0 -3SD) is about 120 pmol/l. The estradiol RIA kit satisfies clinical requirements. (author)

  10. Post-mortem MRI as an alternative to non-forensic autopsy in foetuses and children: from research into clinical practice (United States)

    Addison, S; Arthurs, O J


    Although post-mortem MRI (PMMR) was proposed as an alternative to conventional autopsy more than a decade ago, the lack of systematic validation has limited its clinical uptake. Minimally invasive autopsy (MIA) using PMMR together with ancillary investigations has now been shown to be as accurate as conventional autopsy in foetuses, newborns and infants and is particularly useful for cerebral, cardiac and genitourinary imaging. Unlike conventional autopsy, PMMR provides a permanent three-dimensional auditable record, with accurate estimation of internal organ volumes. MIA is becoming highly acceptable to parents and professionals, and there is widespread political support and public interest in its clinical implementation in the UK. In the short to medium term, it is desirable that a supraregional network of specialist centres should be established to provide this service within the current National Health Service framework. PMID:24288400

  11. Practice-oriented research in service of designing interventions ...

    African Journals Online (AJOL)

    The strength of the practice-oriented research strategy is to develop knowledge about the improvement of practices. Practice oriented research is research in which the research goal is coming from the professional practice and in which the knowledge created in the research contributes directly to this professional practice.

  12. Integrating Bioethics into Clinical and Translational Science Research: A Roadmap (United States)

    Shapiro, Robyn S.; Layde, Peter M.


    Abstract Recent initiatives to improve human health emphasize the need to effectively and appropriately translate new knowledge gleaned from basic biomedical and behavioral research to clinical and community application. To maximize the beneficial impact of scientific advances in clinical practice and community health, and to guard against potential deleterious medical and societal consequences of such advances, incorporation of bioethics at each stage of clinical and translational science research is essential. At the earliest stage, bioethics input is critical to address issues such as whether to limit certain areas of scientific inquiry. Subsequently, bioethics input is important to assure not only that human subjects trials are conducted and reported responsibly, but also that results are incorporated into clinical and community practices in a way that promotes and protects bioethical principles. At the final stage of clinical and translational science research, bioethics helps to identify the need and approach for refining clinical practices when safety or other concerns arise. The framework we present depicts how bioethics interfaces with each stage of clinical and translational science research, and suggests an important research agenda for systematically and comprehensively assuring bioethics input into clinical and translational science initiatives. PMID:20443821

  13. Clinical exome sequencing reports: current informatics practice and future opportunities. (United States)

    Swaminathan, Rajeswari; Huang, Yungui; Astbury, Caroline; Fitzgerald-Butt, Sara; Miller, Katherine; Cole, Justin; Bartlett, Christopher; Lin, Simon


    The increased adoption of clinical whole exome sequencing (WES) has improved the diagnostic yield for patients with complex genetic conditions. However, the informatics practice for handling information contained in whole exome reports is still in its infancy, as evidenced by the lack of a common vocabulary within clinical sequencing reports generated across genetic laboratories. Genetic testing results are mostly transmitted using portable document format, which can make secondary analysis and data extraction challenging. This paper reviews a sample of clinical exome reports generated by Clinical Laboratory Improvement Amendments-certified genetic testing laboratories at tertiary-care facilities to assess and identify common data elements. Like structured radiology reports, which enable faster information retrieval and reuse, structuring genetic information within clinical WES reports would help facilitate integration of genetic information into electronic health records and enable retrospective research on the clinical utility of WES. We identify elements listed as mandatory according to practice guidelines but are currently missing from some of the clinical reports, which might help to organize the data when stored within structured databases. We also highlight elements, such as patient consent, that, although they do not appear within any of the current reports, may help in interpreting some of the information within the reports. Integrating genetic and clinical information would assist the adoption of personalized medicine for improved patient care and outcomes. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  14. Transforming practices: a primer on action research. (United States)

    Acosta, Sandra; Goltz, Heather Honoré


    Action research (AR) is a powerful tool for health education and promotion practitioners who want to focus on improving the quality of their programs and services. In this Tool, we describe the characteristics and controversial aspects of AR, differentiate between traditional and action research, present the benefits of applying AR methods/techniques for investigating problems related to professional practice, and offer a four-phase methodological framework for conducting AR studies. Unlike traditional research, AR is a methodology that links theory, research, and practice; advances new knowledge and understandings via iterative action cycles; employs frontline health practitioners as researchers; and promotes collaborative practitioner-community partnerships. Egalitarian in its approach, AR offers an "insider's perspective" centered on context-specific problems and issues related to health promotion. AR falls into two categories: large-scale community-based research and small-scale practice-based research. Each cycle of the AR framework includes four phases: (a) preplanning/needs assessment, (b) planning/study organization, (c) action and observation/study implementation, and (d) reflection and planning/data analysis and interpretation. Using the AR primer in this Tool has the potential to empower health education/promotion practitioners, encourage collaborative partnerships, enhance practitioners' knowledge base, and promote social change. © 2014 Society for Public Health Education.

  15. Employment Status after Spinal Cord Injury (1992-2005): A Review with Implications For Interpretation, Evaluation, Further Research, and Clinical Practice (United States)

    Young, Amanda E.; Murphy, Gregory C.


    The purpose of this study is to review the research conducted on the topic of employment status after spinal cord injury that was published between 1992 and 2005. This study follows on from an earlier review that focused on papers published between 1976 and 1991. The current study extends the earlier review by reporting an aggregate employment…

  16. A Hierarchical Multiple-Level Approach to the Assessment of Interpersonal Relatedness and Self-Definition: Implications for Research, Clinical Practice, and DSM Planning. (United States)

    Luyten, Patrick; Blatt, Sidney J


    Extant research suggests there is considerable overlap between so-called 2-polarities models of personality development; that is, models that propose that personality development evolves through a dialectic synergistic interaction between 2 key developmental tasks across the life span-the development of self-definition on the one hand and of relatedness on the other. These models have attracted considerable research attention and play a central role in DSM planning. This article provides a researcher- and clinician-friendly guide to the assessment of these personality theories. We argue that current theoretical models focus on issues of relatedness and self-definition at different hierarchically organized levels of analysis; that is (a) at the level of broad personality features, (b) at the motivational level (i.e., the motivational processes underlying the development of these dimensions), and (c) at the level of underlying internal working models or cognitive affective schemas, and the specific interpersonal features and problems in which they are expressed. Implications for further research and DSM planning are outlined.

  17. Future methods in pharmacy practice research

    DEFF Research Database (Denmark)

    Almarsdottir, A B; Babar, Z U D


    This article describes the current and future practice of pharmacy scenario underpinning and guiding this research and then suggests future directions and strategies for such research. First, it sets the scene by discussing the key drivers which could influence the change in pharmacy practice...... research. These are demographics, technology and professional standards. Second, deriving from this, it seeks to predict and forecast the future shifts in use of methodologies. Third, new research areas and availability of data impacting on future methods are discussed. These include the impact of aging...... information technology users on healthcare, understanding and responding to cultural and social disparities, implementing multidisciplinary initiatives to improve health care, medicines optimization and predictive risk analysis, and pharmacy as business and health care institution. Finally, implications...

  18. Clinical research: Should patients pay to play? (United States)

    Emanuel, Ezekiel J; Joffe, Steven; Grady, Christine; Wendler, David; Persad, Govind


    Permitting patients to pay for participation in clinical research threatens the principles of social value and fair subject selection as well as robust clinical trial design. Copyright © 2015, American Association for the Advancement of Science.

  19. Student nurses’ experiences during clinical practice in the Limpopo Province

    Directory of Open Access Journals (Sweden)

    BT Mabuda


    Full Text Available A qualitative, exploratory, descriptive and contextual study was conducted to explore student nurses’ experiences during clinical practice at a nursing college in the Limpopo Province. Purposive sampling was used and phenomenological interviews were held with eleven (11 student nurses who were in their final year of the four year basic nursing programme. The interviews were analysed by using Tesch’s method of data analysis for qualitative research. The findings indicate that there are aspects which impact negatively on student nurses’ clinical learning experiences, such as lack of teaching and learning support, lack of opportunities for learning, poor theory-practice integration, and poor interpersonal relationships between the students, college tutors and ward staff. Recommendations to enhance the clinical learning experiences of student nurses were outlined.

  20. a postfoundationalist research paradigm of practical theology

    African Journals Online (AJOL)


    Jul 18, 2010 ... s e S tu d ie s. /T h e o lo g ic a l S tu d ie s HTS. Original Research. A rtic le #. 8. 4. 9. (page number not for citation purposes). A postfoundationalist research paradigm of practical theology. 5. Vol. 66 No. 2 Page 5 of 6 humans do and think' (Clayton 2006:95). Archbishop Desmond.

  1. Precision medicine in age-specific non-small-cell-lung-cancer patients: Integrating biomolecular results into clinical practice-A new approach to improve personalized translational research. (United States)

    Vavalà, Tiziana; Monica, Valentina; Lo Iacono, Marco; Mele, Teresa; Busso, Simone; Righi, Luisella; Papotti, Mauro; Scagliotti, Giorgio Vittorio; Novello, Silvia


    Non-small-cell-lung-cancer (NSCLC) in young adults (≤45 years-old) accounts for a very small proportion, as this disease usually occurs in people at older age. The youthful NSCLC may constitute an entity with different clinical-pathologic characteristics, having predominance of adenocarcinoma histology and affecting mostly non-smoker subjects. However, without specific guidelines, it is currently considered, both clinically and biologically, as the same disease of the older counterpart, although differences have been documented. Using formalin-fixed paraffin embedded diagnostic tissues (FFPE), targeted next-generation sequencing (NGS) technology allowed to provide insight the mutational pattern of 46 oncogenes and tumor-suppressor genes in 26 young patients (Y). Two additional populations, including a FFPE series of aged counterpart (A: 29 patients) and a group of healthy young controls (C: 21, blood provided), were also investigated to compare NGS profiles. Clinical features of enrolled young patients harmonized with literature data, being most of patients women (58%), never-smokers (38%) and with adenocarcinoma histology (96%). C group was adopted to filter all the non-synonymous genetic variations (NS-GVs) not-associated with malignant overt disease. This skimmed selection mostly highlighted three genes: TP53, EGFR and KRAS. TP53 NS-GVs were numerically more numerous in younger, many involving specific annotated hotspot (R248, R273, G245, R249 and R282); the majority of EGFR NS-GVs was detected in young patients, with higher allelic frequency and mostly represented by exon 19 deletions. On the contrary, KRAS NS-GVs were mainly detected in aged population, with a prevalent compact pattern involving p.G12 position and associated with adenocarcinoma histology. This retrospective study confirmed the feasibility of NGS approach for genetic characterization of NSCLC young adult patients, supporting the involvement of TP53, EGFR, and KRAS alterations in the early

  2. Studio Practice within a Research Context (United States)

    Knight, Katherine


    In this article, the author tells the story of a continuing body of work that she began in 2001, titled "Navigate." The author relates that she sees this extended project as a case study of her working habits and ideas bridging the moment when she began to think of her practice as research. Through the story telling and writing this…

  3. Just in Time Research: Privacy Practices (United States)

    Grama, Joanna Lyn


    The January 2014 edition of the ECAR Update subscriber newsletter included an informal poll on information privacy practices. The poll was intended to collect a quick snapshot of the higher education community's thoughts on this important topic during Data Privacy Month. Results of the poll will be used to inform EDUCAUSE research, programs,…

  4. Workplace Innovation: Theory, Research and Practice

    NARCIS (Netherlands)

    Oeij, P; Rus, Diana; Pot, F


    This book focuses on workplace innovation, which is a key element in ensuring that organizations and the people within them can adapt to and engage in healthy, sustainable change. It features a collection of multi-level, multi-disciplinary contributions that combine theory, research and practical

  5. Embodied Experience in Educational Practice and Research (United States)

    Bengtsson, Jan


    The intention of this article is to make an educational analysis of Merleau-Ponty's theory of experience in order to see what it implicates for educational practice as well as educational research. In this way, we can attain an understanding what embodied experience might mean both in schools and other educational settings and in researching…

  6. Practical Assessment, Research and Evaluation, 2001. (United States)

    Rudner, Lawrence M., Ed.; Schafer, William D., Ed.


    This document consists of articles 23 through 26 published in the electronic journal "Practical Assessment, Research & Evaluation" in 2001: (23) "Effects of Removing the Time Limit on First and Second Language Intelligence Test Performance" (Jennifer Mullane and Stuart J. McKelvie); (24) "Consequences of (Mis)use of the Texas Assessment of…

  7. Research leadership: should clinical directors be distinguished researchers? (United States)

    Allison, Stephen; Goodall, Amanda H; Bastiampillai, Tarun


    Clinical directors established research-led healthcare by combining research, teaching and clinical excellence within the teaching hospitals. This research culture created high clinical standards, which benefited patients, the workforce and healthcare organisations. The current paper explores this research leadership role for clinical directors. It reviews studies arising from the theory of expert leadership, which focuses on the relationship between a leader's core knowledge and organisational performance. More specifically, we examine the expert leader's research track record, the associations with their organisation's performance, and the influence of research activity on clinical excellence. Distinguished researchers still lead the most prestigious teaching hospitals and the most trusted departments of psychiatry in the United States where the clinical directorate structure originated. It is also known that good scholars can improve research output when appointed to leadership positions. This suggests that the clinical director's research track record should be a consideration at a time when research is being embedded in Australia's local health networks. A clinical director's leadership may influence the research performance of their department and contribute to the quality of mental healthcare. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  8. The Nephrology Clinical Research Nurse Role: Potential Role Conflicts. (United States)

    Micklos, Lisa


    Clinical research nursing is becoming more visible to nephrology professionals. As more nephrology practices and units are participating in clinical trials, clinical research nursing is gaining interest as a career niche among nephrology nurses. This unique specialty requires that nephrology clinical nurse nurses (CRNs) reconcile the roles of nurse as caregiver and nurse as researcher, which may result in a role conflict. Nephrology nurses should be aware that they may experience this role conflict when transitioning from patient care to a position as a clinical research nurse. These nurses can rely on the American Nurses Association's Code of Ethics for Nurses and the Oncology Nursing Society's Oncology Clinical Trials Nurse Competencies to help reconcile the potential role conflict.

  9. [Guidelines in clinical practice. Bioethical considerations]. (United States)

    Mazzon, D


    The adoption of guidelines in clinical practice raises questions that can be answered against a background in which professional conduct is compared with deontology, law, and the specific sociocultural context and health policies of institutions. In the scientific community, doubts are raised regarding the relationships between the general recommendations laid down in the Guidelines and the specific nature of every clinical condition; between the "duty of adhering" to Guidelines and the doctor's autonomy, as well as between the adoption, discrepancy and non-adoption of Guidelines and the juridical evaluation of medical liability. The information and individual consent of patients and citizens is of particular importance both with regard to clinical procedures and choices of allocation. In the light of these comments, the authors conclude that Guidelines should not be reduced to a form of automated procedure lacking any responsibility, but should represent a correct synthesis between the objective nature of scientific findings, the subjective condition of the patient and the doctor's autonomy. The application of correctly formulated Guidelines shared by the community means acting in such a way that the "right to health" and "freedom of treatment" can be exercised in respect of shared bioethical principles based on beneficence, autonomy and justice.

  10. Infectious Disease Clinical Research Program (IDCRP) (United States)

    Federal Laboratory Consortium — Our mission is to conduct infectious disease clinical research of importance to the military through a unique, adaptive, and collaborative network, to inform health...

  11. Research as a Respectful Practice: An Exploration of the Practice of Respect in Qualitative Research (United States)

    O'Grady, Emmanuel


    This article explores the practice of respect within qualitative research methods. As interpersonal respect plays a significant role in the esteem felt within a relationship, it can also serve to cultivate trust between researchers and their participants in a research study. This article details the findings of a research study examining respect…

  12. Clinical research on corneal perforation

    Directory of Open Access Journals (Sweden)

    Cheng-Huan Dong


    Full Text Available AIM: To study the clinical characteristics of corneal perforation(CP.METHODS: A retrospective analysis in July 1995 to July 2010 the First Affiliated Hospital of Fujian Medical University diagnosed CP 72 patients(72 eyes, clinical characteristics of all the patients were analyzed. RESULTS: The incidence of corneal ulcer perforation rised year by year, the morbidity of male and female was 17:7, the onset age focused on 48 years old. Of 23 industrial workers(32%with clear history of trauma, pathogeny identification results: top two: fungal infection and Acanthamoeba keratitis. A using history of glucocorticoid was found in 10 cases. CONCLUSION: There are plenty of primary causes of CP such as traumas, fungal infection, Acanthamoeba keratitis, eroded keratitis, etc. CP happens in middle-aged males in Fujian province, most traumas are the causes, the main pathogenic bacteria is fungal infection.

  13. The importance of Clinical Research

    Directory of Open Access Journals (Sweden)

    Frank Lizaraso Caparó


    Full Text Available Objetives: to describe the clinical and epidemiological characteristics, evolution and to identify mortality factors associated in patients with snp.Material and methods: descriptive study of a serie of cases of the intensive care unit (icu of a general hospital. medical records of patients which received medical attention and who meet the selection criteria were reviewed. Results: forty-one clinical records were evaluated. the average age was 69 old, predominantly male (68,3%. snp was the reason of admission in 60.9% and 95.1% required mechanical ventilation. hospital stay prior to diagnosis was 10 days, 65% of patients had some risk factor for multi resistence organisms, cpis of entry was 9.3, cultures were positive in 39% of the cases and of these, 48.8% received proper antibiotic according to culture results. the days of stay in icu were 20.6 days and 20 of the 41 medical records were for death patients. the clinical and epidemiological characteristics were similar between death and alive patients. an analysis of factors that could be associated with mortality snp was made and it was found that for an age ≥ 70 years, the presence of any risk factor for multidrug resistence organism and control cpis ≥ 6 were associated with higher mortality; while acquisition of the icu was associated to lower mortality. Conclusions: the clinical, epidemiological characteristics and evolution of patients with snp in our icu were similar to those describe in the literature. three factors associated with mortality in the icu were identified.

  14. Practical issues in multi-lingual research. (United States)

    Im, Eun-Ok; Kim, Sangmi; Tsai, Hsiu-Min; Nishigaki, Masakazu; Yeo, Seon Ae; Chee, Wonshik; Chee, Eunice; Mao, Jun James


    With an increasing number of ethnic minority populations, the use of multiple languages in one research study has increased in recent years. The use of multiple languages helps increase comprehensiveness of educational materials and/or survey questionnaires, and promote ethnic minorities' participation in research. However, little has been clearly known about practical issues in using multiple languages in one research study. The purpose of this paper is to explore practical issues in using multiple languages in a study among diverse sub-ethnic groups of Asian American breast cancer survivors in order to propose future directions for the use of multiple languages in research projects. Throughout the research process, research team made written records of practical issues and possible reasons for the issues as they arose. Weekly group discussions among research team members were administered, and the written records of these discussions were reviewed and analyzed using the content analysis. The unit of analysis was individual words. The words in the data (memos and written records) were classified into idea categories that emerged from the coding process. The idea categories included issues in: (a) collaborators from various sub-ethnic groups; (b) IRB protocol submissions; (c) consistencies in translation process, (d) conceptual equivalence; (e) cultural differences; (f) existing translated versions; and (g) authorship issues. Based on the issues, we made the following suggestions for multi-lingual research: (a) networking and setting multiple communication channels with potential collaborators; (b) checking the institution's IRB policies related to the use of multiple languages; (c) setting the rules and procedures for translation process; (d) checking existing different language versions of instruments; and (e) setting the rules for authorship in advance. The suggestions made in this study would help the researchers be prepared in advance to deal with the

  15. [General practice research units in Denmark: multidisciplinary research in support of practical work]. (United States)

    Reventlow, Susanne; Broholm, Katalin Alexa Király; Mäkelä, Marjukka


    In Denmark the general practice research units operating in connection with universities provide a home base, training and methodology support for researchers in the field from medical students to general practitioners carrying out practical work. Research issues frequently require a multidisciplinary approach and use of different kinds of materials. Problems arising from the practical work of general practitioners take priority in the wide selection of topics. The units have networked efficiently with organizations of general practitioners and medical education. The combination of research environments has created synergy benefiting everybody and increased the scientific productivity and visibility of the field.

  16. Effective Teamwork Practical Lessons from Organizational Research

    CERN Document Server

    West, Michael A


    Updated to reflect the latest research evidence, the third edition of Effective Teamwork provides business managers with the necessary guidance and tools to build and maintain effective teamwork strategies. A new edition of a bestselling book on teamwork from an acknowledged leader in the fieldOffers a unique integration of rigorous research with practical guidance to develop effective leadership teamsFeatures new chapters on virtual teams and top management teams, plus contemporary themes of ethics and valuesUtilizes research based on positive psychology techniques

  17. Database on veterinary clinical research in homeopathy. (United States)

    Clausen, Jürgen; Albrecht, Henning


    The aim of the present report is to provide an overview of the first database on clinical research in veterinary homeopathy. Detailed searches in the database 'Veterinary Clinical Research-Database in Homeopathy' ( The database contains about 200 entries of randomised clinical trials, non-randomised clinical trials, observational studies, drug provings, case reports and case series. Twenty-two clinical fields are covered and eight different groups of species are included. The database is free of charge and open to all interested veterinarians and researchers. The database enables researchers and veterinarians, sceptics and supporters to get a quick overview of the status of veterinary clinical research in homeopathy and alleviates the preparation of systematical reviews or may stimulate reproductions or even new studies. 2010 Elsevier Ltd. All rights reserved.

  18. Bridging between basic medical science and clinical practice

    Directory of Open Access Journals (Sweden)

    Bakir Mehić


    Full Text Available Translating the extraordinary scientific and technological advances from the biomedical research laboratory into actual patient care practices and other processes aimed at promoting health has been a major challenge, particularly for patients in community settings. Because of that the increased participation of clinicians from primary health care in clinical research would have a number of benefits. As experts in the delivery of clinical care in one society, they have much to contribute providing health care for patients in the whole spectrum of illnesses1. They are among the first to recognize changes in patients’ which come us as result of disease and conditions associated with demographic shiftings. Very often these are unexpected events such as trauma, natural disasters, pandemic infections, etc. They are also directly in contact with the policy-related matters (e.g., health consequences associated with increase in price of medications or the clinical consequences of war, such as the rapid increase in the number of individuals with prosthetic limbs and post traumatic stress syndrome2. Finally, participation in clinical research would benefit clinicians from primary health care in more ways, such as: contributing the mission of medicine and improving the scientific basis for medical practice; allowing clinicians to stay with new innovations ie. the development up to-date of information systems to improve data-gathering associated with the research3.A major goal is the development of teams of investigators from various research disciplines, is to turm the scientific discoveries from the laboratories into treatments and strategies for patients in communities. However, even with that introduction only a small part of the community will provide participation in clinical research. The barriers for this in USA recognised from clinicians community and showed in down table4.

  19. [Interpersonal psychotherapy from research to practice]. (United States)

    Rahioui, H; Blecha, L; Bottai, T; Depuy, C; Jacquesy, L; Kochman, F; Meynard, J-A; Papeta, D; Rammouz, I; Ghachem, R


    Interpersonal therapy (IPT) is a brief, structured psychotherapy initially intended to treat adult depression that was developed in the 1970s and manualized in 1984 by G. Klerman and his team. Two main theories served as a basis for its design: Bowlby's attachment theory and communication theory. Klerman theorized that tensions and problems in interpersonal relationships (i.e. disputes) cause psychological distress in vulnerable individuals that may lead to a major depressive episode. Clinical and epidemiological studies have shown that an insecure attachment style is strongly associated with lifetime depression. Severe depressive episodes have been correlated with avoidant attachment in women. IPT is based on the hypothesis that recent or ongoing disturbances in interpersonal relationships either trigger or follow the onset of mood disorder. In practice, IPT assists patients in analysing their interpersonal relationship modes, correlating their relational states with their mood and in learning to use better communication. Resolving difficulties in interpersonal relationships through the use of better communication skills promotes the improvement of depressive symptoms. Klerman identified four interpersonal areas that seem to be highly correlated with depressive episodes: grief (a close and important personal relation who has died), interpersonal disputes (conflicts with significant people such as a spouse or another close family member), role transition (significant life changes such as retirement, parenthood or chronic and invalidating illness) and interpersonal deficits (patients who have limited social contacts and few interpersonal relations). Classically, IPT is planned around 12-16 weekly sessions. During the initial sessions, the therapist will explore all existing interpersonal relations and any significant dysfunctions, both recent and ongoing. Following this interview, the area the patient considers as driving the current depressive episode will be

  20. Media | Office of Cancer Clinical Proteomics Research (United States)

    The Office of Cancer Clinical Proteomics Research (OCCPR) is committed to providing the media with timely and accurate information.  This section offers key resources for patients, cancer researchers, physicians, and media professionals.

  1. Ambulatory blood pressure monitoring in elderly patients with chronic atrial fibrillation: is it absolutely contraindicated or a useful tool in clinical practice and research? (United States)

    Giantin, Valter; Perissinotto, Egle; Franchin, Alessandro; Baccaglini, Kareen; Attanasio, Francesca; Maselli, Monica; Grosso, Giorgia; Luisa Corradin, Maria; Tramontano, Alessandra; Manzato, Enzo


    The aim of this study was to test whether ambulatory blood pressure monitoring (ABPM) in elderly patients with atrial fibrillation (AF) is as feasible and reliable as ABPM is in patients with normal sinus rhythm (SR). Studies of ABPM in the elderly remain limited, and the use of this method in patients with AF remains controversial. The Italian SIIA 2008 guidelines consider ABPM 'absolutely contraindicated' for AF patients. This study was conducted on 200 hospitalized patients aged ≥ 65 years (68% females; mean age 82.4 ± 6.3 years): 100 patients with SR and 100 patients with permanent AF. Each patient completed serial blood pressure (BP) measurements with a clinical sphygmomanometer (Sphyg) and ABPM. Differences in mean heart rate (HR) between patient groups were not statistically significant. A total of 99.5% of patients were hypertensive. There were no significant differences between SR and AF patients in mean systolic BP (SBP) and diastolic BP (DBP) values, as measured with the Sphyg or by ABPM. Compared with the Sphyg, errors associated with BP measurements obtained by ABPM did not significantly differ between the two groups. ABPM proved to be as feasible as Sphyg measurements in both AF patients (intraclass correlation coefficients=0.73, 0.67 and 0.74 for SBP, DBP and HR, respectively) and SR patients (intraclass correlation coefficients=0.74, 0.58 and 0.67 for SBP, DBP and HR, respectively). A Bland-Altman plot analysis confirmed that there was good agreement between the two methods. Stable AF (HR 60-100 b.p.m.) should not be considered as an absolute contraindication for the use of ABPM, even in the elderly; it could be a 'relative' contraindication for very unstable AF patients.

  2. Acute Care Management of the HIV-Infected Patient: A Report from the HIV Practice and Research Network of the American College of Clinical Pharmacy. (United States)

    Durham, Spencer H; Badowski, Melissa E; Liedtke, Michelle D; Rathbun, R Chris; Pecora Fulco, Patricia


    Patients infected with human immunodeficiency virus (HIV) admitted to the hospital have complex antiretroviral therapy (ART) regimens with an increased medication error rate upon admission. This report provides a resource for clinicians managing HIV-infected patients and ART in the inpatient setting. A survey of the authors was conducted to evaluate common issues that arise during an acute hospitalization for HIV-infected patients. After a group consensus, a review of the medical literature was performed to determine the supporting evidence for the following HIV-associated hospital queries: admission/discharge orders, antiretroviral hospital formularies, laboratory monitoring, altered hepatic/renal function, drug-drug interactions (DDIs), enteral administration, and therapeutic drug monitoring. With any hospital admission for an HIV-infected patient, a specific set of procedures should be followed including a thorough admission medication history and communication with the ambulatory HIV provider to avoid omissions or substitutions in the ART regimen. DDIs are common and should be reviewed at all transitions of care during the hospital admission. ART may be continued if enteral nutrition with a feeding tube is deemed necessary, but the entire regimen should be discontinued if no oral access is available for a prolonged period. Therapeutic drug monitoring is not generally recommended but, if available, should be considered in unique clinical scenarios where antiretroviral pharmacokinetics are difficult to predict. ART may need adjustment if hepatic or renal insufficiency ensues. Treatment of hospitalized patients with HIV is highly complex. HIV-infected patients are at high risk for medication errors during various transitions of care. Baseline knowledge of the principles of antiretroviral pharmacotherapy is necessary for clinicians managing acutely ill HIV-infected patients to avoid medication errors, identify DDIs, and correctly dose medications if organ

  3. Research study for an entrepreneurship practical guide


    Villar, João


    This thesis is a research study, which is aimed to be published later, in the form of a practical guide for those who have an idea and plan to go one step forward on the creation of a brand and/or a business. The main questions addressed are regarding the main concerns of an entrepreneur, identifiying the main topics that an entrepreneur's practical guide must approach. This work aims to provide relevant and important insights for those who want to start a business, taking i...

  4. Comprehension instruction research-based best practices

    CERN Document Server

    Parris, Sheri R; Morrow, Lesley Mandel


    All key issues of research and practice in comprehension instruction are addressed in this highly regarded professional resource and course text. Leading scholars examine the processes that enable students to make meaning from what they read--and how this knowledge can be applied to improve teaching at all grade levels. Best practices for meeting the needs of diverse elementary and secondary students are identified. Essential topics include strategies for comprehending different types of texts, the impact of the Common Core State Standards (CCSS), cutting-edge assessment approaches, and the gr

  5. Data management by using R: big data clinical research series. (United States)

    Zhang, Zhongheng


    Electronic medical record (EMR) system has been widely used in clinical practice. Instead of traditional record system by hand writing and recording, the EMR makes big data clinical research feasible. The most important feature of big data research is its real-world setting. Furthermore, big data research can provide all aspects of information related to healthcare. However, big data research requires some skills on data management, which however, is always lacking in the curriculum of medical education. This greatly hinders doctors from testing their clinical hypothesis by using EMR. To make ends meet, a series of articles introducing data management techniques are put forward to guide clinicians to big data clinical research. The present educational article firstly introduces some basic knowledge on R language, followed by some data management skills on creating new variables, recoding variables and renaming variables. These are very basic skills and may be used in every project of big data research.

  6. [Validation in the French language of an evaluation scale for family functioning (FACES III): a tool for research and for clinical practice]. (United States)

    Tubiana-Rufi, N; Moret, L; Bean, K; Mesbah, M; Feard, S; Deschamps, J P; Czernichow, P; Chwalow, A J


    Valid and reliable scales are necessary to describe the numerous factors associated with health status. Multiple studies have shown the impact of familial factors, i.e. family functioning (FF) on health indicators. As no scale exists in french to assess FF, we performed a study to validate the Family Adaptability and Cohesion Evaluation Scale (FACES III, Olson et al.) in french. This scale has a high level of validity and reliability and has been widely used. After 2 translations and back-translations and a pilot study to establish face validity, the final version was studied in 976 healthy subjects (457 families) who attended a preventive medical center in Nancy, France. Parents and adolescents each filled out two 20 item self-administered questionnaires. There were few missing values (0-3% per item). Construct validity was assessed by principal component factor analysis, which found the same two individualized axes as in the original scale. The reliability of the french version was excellent and comparable to Olson's scale. This study demonstrates the validity and reliability of a french version of FACES III in a french population. It provides researchers and clinicians in France with a validated instrument for assessing, in a quantified way, factors associated with family functioning that influence health status in adults, adolescents and children, particularly those with chronic diseases. This scale is especially useful for developing and evaluating health programs.

  7. Chloracne: From clinic to research

    Directory of Open Access Journals (Sweden)

    Qiang Ju


    Full Text Available Chloracne is the most sensitive and specific marker for a possible dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin intoxication. It is clinically characterized by multiple acneiform comedone-like cystic eruptions mainly involving face in the malar, temporal, mandibular, auricular/retroauricular regions, and the genitalia, often occurring in age groups not typical for acne vulgaris. Histopathology is essential for a definite diagnosis, which exhibits atrophy or absence of sebaceous glands as well as infundibular dilatation or cystic formation of hair follicles, hyperplasia of epidermis, and hyperpigmentation of stratum corneum. The appearance of chloracne and its clinical severity does not correlate with the blood levels of dioxins. Pathogenesis of chloracne remains largely unclear. An “aryl hydrocarbon receptor”-mediated signaling pathway affecting the multipotent stem cells in the pilosebaceous units is probably the major molecular mechanism inducing chloracne. Chloracne is resistant to all the available treatment modalities used to treat acne. The aim of treatment is to lower or to eliminate the accumulated dioxins in the body at the very beginning of intoxication, e.g., by using dioxin-chelating substances such as synthetic dietary fat substitutes. The problem of dioxin contamination and its potential health hazards should be taken seriously in the wave of industrial globalization in the twenty-first century. Clinicians, especially dermatologists, are in the forefront of early diagnosis of dioxin intoxication.

  8. Acceleromyography for use in scientific and clinical practice: a systematic review of the evidence

    DEFF Research Database (Denmark)

    Claudius, C.; Viby-Mogensen, J.


    This systematic review describes the evidence on the use of acceleromyography for perioperative neuromuscular monitoring in clinical practice and research. The review documents that although acceleromyography is widely used in research, it cannot be used interchangeably with mechanomyography...

  9. FM Research for Practice in Denmark

    DEFF Research Database (Denmark)

    Jensen, Per Anker

    Purpose: The purpose of this paper is to present an overview of research and development in the area of Facilities Management (FM) in Denmark. Background: Research in FM is a fairly new activity in Denmark, but there have during the 1980’s and 1990’s been a number of development activities...... environment. FM started to be developed in practice with a strong focus on benchmarking and IT systems like CAFM. Around year 2000 a number of research and development project on Whole Life Costing was carried out and around 2005 there were some development projects and publications on new offices. Digital...... handover of data from building projects to FM and Building Information Modelling also became an important field of development. Research in FM started at DTU in 2003 and got a major boost by the establishing of CFM in 2008. In recent years sustainability has emerged as a new important research area in FM...

  10. Collaborative Partnerships between Research and Practice:

    DEFF Research Database (Denmark)

    Wegener, Charlotte; Willumsen, Elisabeth

    the strengths and challenges of, an ongoing collaborative partnership in which researchers and practitioners work together, not only to solve but also to articulate problems and frame the research project from the very outset—as a case of an Open Science practice. The collaborative partnership was established...... fields (nursing, psychology, social work, health, sociology and anthropology). This paper reports on the initiation of the collaborative partnership. First, we show how the leaders in the elderly care institutions, patient organizations and professional organizations were involved in co...... between research institutions and elderly care facilities to study social innovation as a phenomenon in institution-based elderly care. We received initial funding from the Research Council of Norway to work closely together on the main proposal, which was subsequently funded. Five research institutions...

  11. Authorizing psychiatric research: principles, practices and problems. (United States)

    Chong, Siow Ann; Huxtable, Richard; Campbell, Alastair


    Psychiatric research is advancing rapidly, with studies revealing new investigative tools and technologies that are aimed at improving the treatment and care of patients with psychiatric disorders. However, the ethical framework in which such research is conducted is not as well developed as we might expect. In this paper we argue that more thought needs to be given to the principles that underpin research in psychiatry and to the problems associated with putting those principles into practice. In particular, we comment on some of the difficulties posed by the twin imperatives of ensuring that we respect the autonomy and interests of the research subject and, at the same time, enable potentially beneficial psychiatric research to flourish. We do not purport to offer a blueprint for the future; we do, however, seek to advance the debate by identifying some of the key questions to which better answers are required. © 2009 Blackwell Publishing Ltd.

  12. Developing Clinical Research Relationship: Views from Within. (United States)

    Zvonareva, Olga; Akrong, Lloyd


    The nature of the relationship between clinical investigator and research participant continues to be contested. The related discussions have largely focused on the doctor-researcher dichotomy thought to permeate the work of a clinical investigator with research participants, whom in turn occupy two corresponding roles: patient and subject. This paper contributes to current debates on the topic by providing a voice to research participants, whose perspectives have been largely invisible. It draws on 42 in-depth interviews conducted in Ghana and South Africa with respondents at different stages of involvement in clinical research, ranging from no experience in clinical research to enrollment in several clinical trials. The perspectives of all respondents were largely congruent and rooted in the common view that clinical research contributed to the improvement of local health. They went beyond the researcher/participant versus doctor/patient dichotomy, long established in research ethics, and preferred to view participants and investigators as partners working together to find ways to address local health needs. The conceptualization of investigator-participant relations as a partnership reinforced expectations of care, transparency and accountability, which were viewed as necessary expressions of mutuality and respect within equal collaborations. It is important to engage with these views in order to avoid antagonizing societal expectations and to build up long-term public trust, crucial for the continuous operation of clinical research. © 2014 John Wiley & Sons Ltd.

  13. Research Ethics Consultation: Ethical and Professional Practice Challenges and Recommendations (United States)

    Sharp, Richard R.; Taylor, Holly A.; Brinich, Margaret A.; Boyle, Mary M.; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin


    The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include: assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical Translational Science Award (CTSA) Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: 1) managing multiple institutional roles and responsibilities, 2) managing sensitive information, and 3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services. PMID:25607942

  14. Research ethics consultation: ethical and professional practice challenges and recommendations. (United States)

    Sharp, Richard R; Taylor, Holly A; Brinich, Margaret A; Boyle, Mary M; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin


    The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical and Translational Science Award Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: (1) managing multiple institutional roles and responsibilities, (2) managing sensitive information, and (3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services.

  15. Clinical practice models in nursing education: implication for students' mobility. (United States)

    Dobrowolska, B; McGonagle, I; Jackson, C; Kane, R; Cabrera, E; Cooney-Miner, D; Di Cara, V; Pajnkihar, M; Prlić, N; Sigurdardottir, A K; Kekuš, D; Wells, J; Palese, A


    In accordance with the process of nursing globalization, issues related to the increasing national and international mobility of student and qualified nurses are currently being debated. Identifying international differences and comparing similarities for mutual understanding, development and better harmonization of clinical training of undergraduate nursing students is recommended. The aim of the study was to describe and compare the nature of the nursing clinical practice education models adopted in different countries. A qualitative approach involving an expert panel of nurses was adopted. The Nominal Group Technique was employed to develop the initial research instrument for data collection. Eleven members of the UDINE-C network, representing institutions engaged in the process of professional nursing education and research (universities, high schools and clinical institutes), participated. Three data collection rounds were implemented. An analysis of the findings was performed, assuring rigour. Differences and homogeneity are reported and discussed regarding: (a) the clinical learning requirements across countries; (b) the prerequisites and clinical learning process patterns; and (c) the progress and final evaluation of the competencies achieved. A wider discussion is needed regarding nursing student exchange and internalization of clinical education in placements across European and non-European countries. A clear strategy for nursing education accreditation and harmonization of patterns of organization of clinical training at placements, as well as strategies of student assessment during this training, are recommended. There is also a need to develop international ethical guidelines for undergraduate nursing students gaining international experience. © 2015 International Council of Nurses.

  16. Antiphospholipid Syndrome Clinical Research Task Force Report

    NARCIS (Netherlands)

    Erkan, D.; Derksen, R.; Levy, R.; Machin, S.; Ortel, T.; Pierangeli, S.; Roubey, R.; Lockshin, M.

    The Antiphospholipid Syndrome (APS) Clinical Research Task Force (CRTF) was one of six Task Forces developed by the 13(th) International Congress on Antiphospholipid Antibodies (aPL) organization committee with the purpose of: a) evaluating the limitations of APS clinical research and developing

  17. Code of practice for clinical proton dosimetry

    International Nuclear Information System (INIS)

    Vynckier, S.


    The objective of this document is to make recommendations for the determination of absorbed dose to tissue for clinical proton beams and to achieve uniformity in proton dosimetry. A Code of Practice (CoP) has been chosen, providing specific guidelines for the choice of the detector and the method of determination of absorbed dose for proton beams only. This CoP is confined specifically to the determination of absorbed dose and is not concerned with the biological effects of proton beams. It is recommended that dosimeters be calibrated by comparison with a calorimeter. If this is not available, a Faraday cup, or alter-natively, an ionization chamber, with a 60 Co calibration factor should be used. Physical parameters for determining the dose from tissue-equivalent ionization chamber measurements are given together with a worksheet. It is recommended that calibrations be carried out in water at the centre of the spread-out-Bragg-peak and that dose distributions be measured in a water phantom. It is estimated that the error in the calibrations will be less than +-5 per cent (1 S.D.) in all cases. Adoption and implementation of this CoP will facilitate the exchange of clinical information. (author). 34 refs.; 5 figs.; 5 tabs

  18. Reflections on clinical research in sub-Saharan Africa. (United States)

    Kuepfer, Irene; Burri, Christian


    The urgent need for new, safe and sustainable interventions against diseases that disproportionally affect the poor is finally receiving global attention and the funding landscape for development projects has significantly improved during the past decade. For the development of new drug and vaccine candidates, clinical trials have become the most important tool to assess their safety and efficacy. Recently, there has been a seismic shift in the number of clinical trials conducted in resource-limited settings. We discuss the current framework of clinical research in sub-Saharan Africa, from building product pipelines to the capacities needed for the conduct of trials according the harmonised Good Clinical Practice (GCP) ICH E6 guideline. We place emphasis on clinical research in neglected tropical diseases which still frequently has to be conducted with limited financial, logistical and human resources. Given those short-comings we recommend minimum standards needed at the local, national and sponsor levels to provide GCP-compliant clinical research.

  19. Korean Clinical Practice Guidelines for Aneurysmal Subarachnoid Hemorrhage (United States)

    Cho, Won-Sang; Park, Sukh Que; Ko, Jun Kyeung; Kim, Dae-Won; Park, Jung Cheol; Yeon, Je Young; Chung, Seung Young; Chung, Joonho; Joo, Sung-Pil; Hwang, Gyojun; Kim, Deog Young; Chang, Won Hyuk; Choi, Kyu-Sun; Lee, Sung Ho; Sheen, Seung Hun; Kang, Hyun-Seung; Kim, Byung Moon; Bae, Hee-Joon; Oh, Chang Wan; Park, Hyeon Seon


    Despite advancements in treating ruptured cerebral aneurysms, an aneurysmal subarachnoid hemorrhage (aSAH) is still a grave cerebrovascular disease associated with a high rate of morbidity and mortality. Based on the literature published to date, worldwide academic and governmental committees have developed clinical practice guidelines (CPGs) to propose standards for disease management in order to achieve the best treatment outcomes for aSAHs. In 2013, the Korean Society of Cerebrovascular Surgeons issued a Korean version of the CPGs for aSAHs. The group researched all articles and major foreign CPGs published in English until December 2015 using several search engines. Based on these articles, levels of evidence and grades of recommendations were determined by our society as well as by other related Quality Control Committees from neurointervention, neurology and rehabilitation medicine. The Korean version of the CPGs for aSAHs includes risk factors, diagnosis, initial management, medical and surgical management to prevent rebleeding, management of delayed cerebral ischemia and vasospasm, treatment of hydrocephalus, treatment of medical complications and early rehabilitation. The CPGs are not the absolute standard but are the present reference as the evidence is still incomplete, each environment of clinical practice is different, and there is a high probability of variation in the current recommendations. The CPGs will be useful in the fields of clinical practice and research. PMID:29526058

  20. Simple fMRI postprocessing suffices for normal clinical practice. (United States)

    González-Ortiz, S; Oleaga, L; Pujol, T; Medrano, S; Rumiá, J; Caral, L; Boget, T; Capellades, J; Bargalló, N


    Whereas fMRI postprocessing tools used in research are accurate but unwieldy, those used for clinical practice are user-friendly but are less accurate. We aimed to determine whether commercial software for fMRI postprocessing is accurate enough for clinical practice. Ten volunteers underwent fMRI while performing motor and language tasks (hand, foot, and orolingual movements; verbal fluency; semantic judgment; and oral comprehension). We compared visual concordance, image quality (noise), voxel size, and radiologist preference for the activation maps obtained by using Neuro3D software (provided with our MR imaging scanner) and by using the SPM program commonly used in research. Maps obtained with the 2 methods were classified as "partially overlapping" for 70% for motor and 72% for language paradigm experiments and as "overlapping" in 30% of motor and in 15% of language paradigm experiments. fMRI is a helpful and robust tool in clinical practice for planning neurosurgery. Widely available commercial fMRI software can provide reliable information for therapeutic management, so sophisticated, less widely available software is unnecessary in most cases.

  1. Researching media through practices: an ethnographic approach

    Directory of Open Access Journals (Sweden)

    Antoni Roig


    Full Text Available Anthropological and ethnographic research on media have been largely focused on analyzing reception of media products (television, radio, press and film and media consumption related to domestic appropriation of technologies (Rothenbuhler et al., 2005. There is also a wide body of research devoted to the study of the political dimension of alternative and indigenous media (Ginsburg, 2002. However, there has been a separation between media and internet studies, and between the analysis of media reception and practices of self-production, such as family photography or home video. Current digital media practices urge reexamination of self-produced content and media flows from a broader perspective that cuts across divisions between public and private, corporative media products and people's releases, home production and cultural industry, political activism and everyday life.

  2. Health physics practices at research accelerators

    International Nuclear Information System (INIS)

    Thomas, R.H.


    A review is given of the uses of particle accelerators in health physics, the text being a short course given at the Health Physics Society Ninth Midyear Topical Symposium in February, 1976. Topics discussed include: (1) the radiation environment of high energy accelerators; (2) dosimetry at research accelerators; (3) shielding; (4) induced activity; (5) environmental impact of high energy accelerators; (6) population dose equivalent calculation; and (7) the application of the ''as low as practicable concept'' at accelerators

  3. Nurses' maths: researching a practical approach. (United States)

    Wilson, Ann

    To compare a new practical maths test with a written maths test. The tests were undertaken by qualified nurses training for intravenous drug administration, a skill dependent on maths accuracy. The literature showed that the higher education institutes (HEIs) that provide nurse training use traditional maths tests, a practical way of testing maths had not been described. Fifty five nurses undertook two maths tests based on intravenous drug calculations. One was a traditional written test. The second was a new type of test using a simulated clinical environment. All participants were also interviewed one week later to ascertain their thoughts and feelings about the tests. There was a significant improvement in maths test scores for those nurses who took the practical maths test first. It is suggested that this is because it improved their conceptualisation skills and thus helped them to achieve accuracy in their calculations. Written maths tests are not the best way to help and support nurses in acquiring and improving their maths skills and should be replaced by a more practical approach.

  4. Clinical Practice Guidelines and Helicobacter pylori Infection in Children

    Directory of Open Access Journals (Sweden)

    Colin Macarthur


    Full Text Available The objective of this paper is to review the principles, methods and issues behind the development of clinical practice guidelines. Practice guidelines have been defined as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. The ultimate goal of guidelines is to improve patient outcomes; however, they may also be used as tools to decrease health care costs, improve medical education and enhance quality assurance. Evidence-based guidelines use explicit methods to link recommendations to the quality of the underlying research. Following development of the guideline, implementation and evaluation are key steps. The ultimate aim of guideline development is to influence physician knowledge, attitudes and behaviour.

  5. Experimental Psychopathology: From laboratory studies to clinical practice

    Directory of Open Access Journals (Sweden)

    Pierre Philippot


    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.

  6. Humor During Clinical Practice: Analysis of Recorded Clinical Encounters. (United States)

    Phillips, Kari A; Singh Ospina, Naykky; Rodriguez-Gutierrez, Rene; Castaneda-Guarderas, Ana; Gionfriddo, Michael R; Branda, Megan; Montori, Victor


    Little is known about humor's use in clinical encounters, despite its many potential benefits. We aimed to describe humor during clinical encounters. We analyzed 112 recorded clinical encounters. Two reviewers working independently identified instances of humor, as well as information surrounding the logistics of its use. Of the 112 encounters, 66 (59%) contained 131 instances of humor. Humor was similarly frequent in primary care (36/61, 59%) and in specialty care (30/51, 59%), was more common in gender-concordant interactions (43/63, 68%), and was most common during counseling (81/112, 62%). Patients and clinicians introduced humor similarly (63 vs 66 instances). Typically, humor was about the patient's medical condition (40/131, 31%). Humor is used commonly during counseling to discuss the patient's medical condition and to relate to general life events bringing warmth to the medical encounter. The timing and topic of humor and its use by all parties suggests humor plays a role in the social connection between patients and physicians and allows easier discussion of difficult topics. Further research is necessary to establish its impact on clinicians, patients, and outcomes. © Copyright 2018 by the American Board of Family Medicine.

  7. Practising Research, Researching Practice: Thinking Through Contemporary Dance

    Directory of Open Access Journals (Sweden)

    Sally May Gardner


    Full Text Available Practice as research is now an accepted mode whereby artists can obtain a higher degree in our universities. But what conditions pertain for them there? Daily experiences of the misfit between the university, particularly in its current corporate guise, and the embodied practices upon which I draw have helped me, paradoxically, to clarify certain dance values which can perhaps have wider resonance. These values relate to concepts and ideas that can be found articulated by many practising artists and a number of other thinkers and practitioners including Winnicott, Alexander and Arendt. Focusing on here and now practicalities and issues, such as the nature of the studio floor, this article explores and argues for the importance of aesthetic experience and attention to life as we are living it: to experience, paradox, action, and sensation.

  8. Ethical Challenges in Contemporary FASD Research and Practice. (United States)

    DI Pietro, Nina; DE Vries, Jantina; Paolozza, Angelina; Reid, Dorothy; Reynolds, James N; Salmon, Amy; Wilson, Marsha; Stein, Dan J; Illes, Judy


    Fetal alcohol spectrum disorder (FASD) is increasingly recognized as a growing public health issue worldwide. Although more research is needed on both the diagnosis and treatment of FASD, and a broader and more culturally diverse range of services are needed to support those who suffer from FASD and their families, both research and practice for FASD raise significant ethical issues. In response, from the point of view of both research and clinical neuroethics, we provide a framework that emphasizes the need to maximize benefits and minimize harm, promote justice, and foster respect for persons within a global context.

  9. Teaching. A skill in clinical practice. (United States)

    May, B J


    I surveyed by questionnaire a random sample of 585 physical therapists and the administrators of all accredited and developing entry-level educational programs on record with the American Physical Therapy Association in March 1981 to determine attitudes toward, involvement in, and preparation for teaching as a skill in physical therapy. Results were based on responses from 367 (63%) of the physical therapists who spent at least 50 percent of their workday in direct patient-care activities and 95 (93%) of the administrators of the educational programs. Although 99 percent of the physical therapists believed that teaching was an important skill in their practice, only 34 percent had received instruction in teaching as part of their basic preparation. Ninety-eight percent were involved in teaching patients, but only 30 percent taught students in the clinic. Educational skills considered important by the clinicians included the ability to adapt teaching to individual needs, to teach by demonstration, to give and receive feedback, and to assess learner expectations. Sixty-five percent of the administrators responding to the questionnaire reported that training in educational theories and methodologies was required either as a separate course or as part of one or more other courses in the curriculum. Educational skills most frequently taught were writing learning objectives, planning the learning experience, understanding the role of the physical therapist as an educator, and teaching by lecture. Physical therapists consider teaching an important skill in physical therapy practice, but not all physical therapy programs include preparation in this area. Agreement on which skills are important is limited.

  10. Translational Bioinformatics and Clinical Research (Biomedical) Informatics. (United States)

    Sirintrapun, S Joseph; Zehir, Ahmet; Syed, Aijazuddin; Gao, JianJiong; Schultz, Nikolaus; Cheng, Donavan T


    Translational bioinformatics and clinical research (biomedical) informatics are the primary domains related to informatics activities that support translational research. Translational bioinformatics focuses on computational techniques in genetics, molecular biology, and systems biology. Clinical research (biomedical) informatics involves the use of informatics in discovery and management of new knowledge relating to health and disease. This article details 3 projects that are hybrid applications of translational bioinformatics and clinical research (biomedical) informatics: The Cancer Genome Atlas, the cBioPortal for Cancer Genomics, and the Memorial Sloan Kettering Cancer Center clinical variants and results database, all designed to facilitate insights into cancer biology and clinical/therapeutic correlations. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Clinical anatomy research in a research-driven anatomy department. (United States)

    Jones, D Gareth; Dias, G J; Mercer, S; Zhang, M; Nicholson, H D


    Clinical anatomy is too often viewed as a discipline that reiterates the wisdom of the past, characterized more by description of what is known than by active investigation and critical analysis of hypotheses and ideas. Various misconceptions follow from an acceptance of this premise: the teaching of clinical anatomists is textbook based, there is no clinical anatomy research worthy of the name, and any research that does exist fails to utilize modern technology and does not stand comparison with serious biomedical research as found in cell and molecular biology. The aim of this paper is to challenge each of these contentions by reference to ongoing clinical research studies within this department. It is argued that all teaching (including that of clinical anatomy) should be research-informed and that the discipline of clinical anatomy should have at its base a vigorous research ethos driven by clinically related problems. In interacting with physicians, the role of the clinical anatomist should be to promulgate a questioning scientific spirit, with its willingness to test and challenge accepted anatomic dicta. Copyright 2002 Wiley-Liss, Inc.

  12. [Industrial medicine in theory and research for practice (author's transl)]. (United States)

    Fruhmann, G


    The university teacher in industrial medicine is guided by an autonomous self-responsibility to public interests protected by the fundamental law of the German Federal Republic. For the medical student about 8 hours practical work and an examination in the second clinical professional examination is prescribed. The teaching of the mutual relationships between industrial work and health is divided into: prevention and clinical aspects of industrial diseases, industrial hygiene, toxicology, industrial physiology (ergonomics), industrial psychology, rehabilitation and knowledge of giving expert opinion. The following are discussed as examples of research related to practice: the constant revision of the list of maximal concentration of work places, studies on the synergism of inhaled poisons, research into the causes of chronic bronchitis, pneumoconioses due to organic dusts and the discovery of aggresive antigens in work places previously considered safe.

  13. Objective structured clinical examination and advanced practice nursing students. (United States)

    Kurz, Jane M; Mahoney, Kathleen; Martin-Plank, Lori; Lidicker, Jeff


    Educators, challenged to measure clinical competency impartially in Advanced Health Assessment courses, have used Objective Structured Clinical Examination (OSCE) and standardized patients (SP). Faculty-trained laypersons act as patients (SP) for students in a clinical laboratory setting using a standardized, scripted scenario. Students typically are evaluated during the examination and receive instant feedback from the SP. There has been little evidence that supports this as the best way to measure student's clinical competency. This study's purpose was to compare outcomes of graduate nursing students completing a traditional methods Health Assessment course to those students using OSCE and SPs. Problem-based Learning Theory guided the quasi-experimental study that included 37 students divided into research and control groups. There were statistically significant differences between the two groups for the final practical examination grades, clinical preceptor evaluations, satisfaction scores, and self-evaluations of skills at the course's end. Research group's course scores were higher than the control group. There was no difference between group's self-evaluation for their current assessment skills. This intervention had a positive impact on students' outcomes. Educators should incorporate SPs and OSCE to improve clinical competency scores, course satisfaction, and preceptor evaluations. Future studies should include a longitudinal design and qualitative student feedback.

  14. Training needs of clinical research associates

    Directory of Open Access Journals (Sweden)

    Samyuktha Ajay


    Full Text Available Clinical research is a relatively new field in our country that has seen very rapid growth in the last few years. Availability of personnel appropriately trained to the specific requirements of the role they will perform in clinical research is critical for capacity expansion. Our study attempts to understand the specific areas of knowledge and skills that are important for the role of a clinical research associate. The survey was conducted among clinical research professionals from industry and academia who had more than five years of clinical research experience and held important decision making positions in clinical research (stakeholders. The survey questionnaire was designed as a matrix of various clinical research roles on the y-axis and six knowledge modules and eight skills on the x-axis. Respondents were asked to rate the importance of the knowledge /skills to the role of clinical research associates on a three point scale. In discussing results, a significant response was considered to be 50% or greater positive response from the total group. The significant findings were that general, ethics and clinical trial execution modules were rated as critical for the role of clinical research associate. Regulatory module was rated as important for the role. The other significant responses were that three of the sub-topics in the methodology module - framing a research proposal/protocol and experimental design, designing case report forms and EDCs and conducting PK studies - were rated as important and one sub topic in the data management and statistics module was rated as not important. All the skills except leadership skills were rated as critical for the role. The findings of our survey were in general on the lines of expectations of performance of the role. The general, ethics and clinical trial execution modules are critical knowledge areas for the role of a clinical research associate. No clear trends emerged for some of the other

  15. Laparoscopic cholecystectomy: a clinical practice audit

    International Nuclear Information System (INIS)

    Masud, M.; Adil, M.; Ashraf, F.; Aqil, A.


    To evaluate laparoscopic cholecystectomy by a clinical practice audit at Military Hospital, Rawalpindi. Study Design: Prospective study. Place and Duration of Study: Surgical department Military Hospital from Jul 2011-Dec 2013. Material and Methods: A total of 1020 patients who underwent laparoscopic cholecystectomy for acute or chronic cholecystitis and gallstone pancreatitis were included in our study while those who had previously undergone abdominal surgeries, those with high risk for general anesthesia, immunocompromised patients, with age greater than 70 years and having comorbidities like cardiac insufficiency, severe asthma, chronic liver disease with ascites and compromised renal functions were excluded from the study. Patients demographic data, operative time, intra-operative findings, intra-operative difficulties, post-operative complications, conversion rate to open cholecystectomy and post-operative recovery time were recorded. Data was analyzed by using SPSS version 21. Results: Out of 1020 patients 907 were females while 113 were males with male to female ratio of 1:8.02. Age range was 20-70 with mean age of 50 ± 10.456 years. 44.7% patients presented with the clinical features of acute cholecystitis, 540 (52.94%) with chronic cholecystitis and 23 (2.28%) with acute pancreatitis. Mean operative time was 20 minutes in asymptomatic patients, while 40 minutes in acute cholecystitis and 35 minutes in chronic gallstone disease. Gall bladder perforation, ble