Sample records for clinical review critical
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Lee, Daphne Sk; Abdullah, Khatijah Lim; Subramanian, Pathmawathi; Bachmann, Robert Thomas; Ong, Swee Leong
2017-12-01
To explore whether there is a correlation between critical thinking ability and clinical decision-making among nurses. Critical thinking is currently considered as an essential component of nurses' professional judgement and clinical decision-making. If confirmed, nursing curricula may be revised emphasising on critical thinking with the expectation to improve clinical decision-making and thus better health care. Integrated literature review. The integrative review was carried out after a comprehensive literature search using electronic databases Ovid, EBESCO MEDLINE, EBESCO CINAHL, PROQuest and Internet search engine Google Scholar. Two hundred and 22 articles from January 1980 to end of 2015 were retrieved. All studies evaluating the relationship between critical thinking and clinical decision-making, published in English language with nurses or nursing students as the study population, were included. No qualitative studies were found investigating the relationship between critical thinking and clinical decision-making, while 10 quantitative studies met the inclusion criteria and were further evaluated using the Quality Assessment and Validity Tool. As a result, one study was excluded due to a low-quality score, with the remaining nine accepted for this review. Four of nine studies established a positive relationship between critical thinking and clinical decision-making. Another five studies did not demonstrate a significant correlation. The lack of refinement in studies' design and instrumentation were arguably the main reasons for the inconsistent results. Research studies yielded contradictory results as regard to the relationship between critical thinking and clinical decision-making; therefore, the evidence is not convincing. Future quantitative studies should have representative sample size, use critical thinking measurement tools related to the healthcare sector and evaluate the predisposition of test takers towards their willingness and ability to think
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Models of clinical reasoning with a focus on general practice: A critical review.
Yazdani, Shahram; Hosseinzadeh, Mohammad; Hosseini, Fakhrolsadat
2017-10-01
Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed.
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Models of clinical reasoning with a focus on general practice: a critical review
Directory of Open Access Journals (Sweden)
SHAHRAM YAZDANI
2017-10-01
Full Text Available Introduction: Diagnosis lies at the heart of general practice. Every day general practitioners (GPs visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings Methods: A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized Results: Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. Conclusion: A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties
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Reproducibility of clinical research in critical care: a scoping review.
Niven, Daniel J; McCormick, T Jared; Straus, Sharon E; Hemmelgarn, Brenda R; Jeffs, Lianne; Barnes, Tavish R M; Stelfox, Henry T
2018-02-21
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
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Critical thinking versus clinical reasoning versus clinical judgment: differential diagnosis.
Victor-Chmil, Joyce
2013-01-01
Concepts of critical thinking, clinical reasoning, and clinical judgment are often used interchangeably. However, they are not one and the same, and understanding subtle difference among them is important. Following a review of the literature for definitions and uses of the terms, the author provides a summary focused on similarities and differences in the processes of critical thinking, clinical reasoning, and clinical judgment and notes suggested methods of measuring each.
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Clinical reasoning and critical thinking.
da Silva Bastos Cerullo, Josinete Aparecida; de Almeida Lopes Monteiro da Cruz, Diná
2010-01-01
This study identifies and analyzes nursing literature on clinical reasoning and critical thinking. A bibliographical search was performed in LILACS, SCIELO, PUBMED and CINAHL databases, followed by selection of abstracts and the reading of full texts. Through the review we verified that clinical reasoning develops from scientific and professional knowledge, is permeated by ethical decisions and nurses values and also that there are different personal and institutional strategies that might improve the critical thinking and clinical reasoning of nurses. Further research and evaluation of educational programs on clinical reasoning that integrate psychosocial responses to physiological responses of people cared by nurses is needed.
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Resveratrol and diabetes: A critical review of clinical studies.
Öztürk, Ebru; Arslan, Ayşe Kübra Karaboğa; Yerer, Mükerrem Betül; Bishayee, Anupam
2017-11-01
Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia. The disease results from the defects of insulin secretion and/or action. Resveratrol is a non-flavonoid polyphenol that naturally occurs as phytoalexin. The shell and stem of Vitis vinifera L. (Vitaceae) are the richest source of this compound. In addition to various in vitro and in vivo studies revealing the effectiveness of resveratrol in DM, there are many clinical trials indicating that resveratrol has the potential to benefit in DM patients. The therapeutic action of this compound in relation to diabetes is complex and involves in several beneficial roles. In view of this, clinical studies are necessary to elucidate these roles. In the near future, the use of resveratrol, alone or in combination with current anti-diabetic therapies, might be a conventional approach to effectively manage DM or its complications. This mini-review provides a critical overview of currently available clinical studies examining the effects of resveratrol in DM last decade. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
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Management of language discordance in clinical nursing practice--A critical review.
Probst, Sebastian; Imhof, Lorenz
2016-05-01
Language plays an essential role in the provision of nursing care, since successful communication is a vital prerequisite to being able to provide appropriate nursing care efficiently and effectively. It is not known what kinds of interventions are effective in overcoming language discordance in nursing practice. This critical review aimed to examine the interventions that are most successfully used to overcome language discordance in nursing. A critical review of the literature was performed and 24 relevant research papers were included. A search was carried out between January 2004 and September 2014 in MEDLINE, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychinfo, Germanistic online, Pragmatis and Linguistic & Language Behaviour Abstracts (LLBA). Both authors independently screened the titles (n=299), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) articles examine the problem of language discordance in various health care settings and (2) articles published in English, German, French or Italian. Articles were included irrespective of their design. Data were analysed using the Critical Appraisal Skills Program Tool (CASP). In total, 24 publications met the inclusion criteria. Most of the studies (n=20) were focused on the nursing intervention of using an interpreter and three were describing the nursing assessment. The study designs of the included studies were mainly non-experimental studies, qualitative studies or reviews. The only suggested intervention described in the articles is the use of ad-hoc or professional interpreters for communicating with patients who do not speak the local language. Health care institutions should provide more strategies for clinical practice to overcome language discordance. Copyright © 2015 Elsevier Inc. All rights reserved.
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DEFF Research Database (Denmark)
Rosenbaum, Ralph K.; Olsen, Stig Irving
2018-01-01
Manipulation and mistakes in LCA studies are as old as the tool itself, and so is its critical review. Besides preventing misuse and unsupported claims, critical review may also help identifying mistakes and more justifiable assumptions as well as generally improve the quality of a study. It thus...... supports the robustness of an LCA and increases trust in its results and conclusions. The focus of this chapter is on understanding what a critical review is, how the international standards define it, what its main elements are, and what reviewer qualifications are required. It is not the objective...... of this chapter to learn how to conduct a critical review, neither from a reviewer nor from a practitioner perspective. The foundation of this chapter and the basis for any critical review of LCA studies are the International Standards ISO 14040:2006, ISO 14044:2006 and ISO TS 14071:2014....
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[Clinical reasoning in undergraduate nursing education: a scoping review].
Menezes, Sáskia Sampaio Cipriano de; Corrêa, Consuelo Garcia; Silva, Rita de Cássia Gengo E; Cruz, Diná de Almeida Monteiro Lopes da
2015-12-01
This study aimed at analyzing the current state of knowledge on clinical reasoning in undergraduate nursing education. A systematic scoping review through a search strategy applied to the MEDLINE database, and an analysis of the material recovered by extracting data done by two independent reviewers. The extracted data were analyzed and synthesized in a narrative manner. From the 1380 citations retrieved in the search, 23 were kept for review and their contents were summarized into five categories: 1) the experience of developing critical thinking/clinical reasoning/decision-making process; 2) teaching strategies related to the development of critical thinking/clinical reasoning/decision-making process; 3) measurement of variables related to the critical thinking/clinical reasoning/decision-making process; 4) relationship of variables involved in the critical thinking/clinical reasoning/decision-making process; and 5) theoretical development models of critical thinking/clinical reasoning/decision-making process for students. The biggest challenge for developing knowledge on teaching clinical reasoning seems to be finding consistency between theoretical perspectives on the development of clinical reasoning and methodologies, methods, and procedures in research initiatives in this field.
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Clinical Pharmacology Studies in Critically Ill Children
Thakkar, Nilay; Salerno, Sara; Hornik, Christoph P.; Gonzalez, Daniel
2016-01-01
Developmental and physiological changes in children contribute to variation in drug disposition with age. Additionally, critically ill children suffer from various life-threatening conditions that can lead to pathophysiological alterations that further affect pharmacokinetics (PK). Some factors that can alter PK in this patient population include variability in tissue distribution caused by protein binding changes and fluid shifts, altered drug elimination due to organ dysfunction, and use of medical interventions that can affect drug disposition (e.g., extracorporeal membrane oxygenation and continuous renal replacement therapy). Performing clinical studies in critically ill children is challenging because there is large inter-subject variability in the severity and time course of organ dysfunction; some critical illnesses are rare, which can affect subject enrollment; and critically ill children usually have multiple organ failure, necessitating careful selection of a study design. As a result, drug dosing in critically ill children is often based on extrapolations from adults or non-critically ill children. Dedicated clinical studies in critically ill children are urgently needed to identify optimal dosing of drugs in this population. This review will summarize the effect of critical illness on pediatric PK, the challenges associated with performing studies in this vulnerable subpopulation, and the clinical PK studies performed to date for commonly used drugs. PMID:27585904
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Smith, Valerie; Muldoon, Kathryn; Biesty, Linda
2012-09-01
In Ireland, to register as a midwife, all student midwives must be deemed competent to practice with the assessment of competence an essential component of midwifery education. A variety of assessment strategies, including observed practice, clinical interviews, portfolios of reflection, the Objective Structured Clinical Examination (OSCE) and written examination papers, are utilised to assess midwifery students' clinical competence. In this paper, a critical review of the OSCE as a strategy for assessing clinical competence in one third level institution in Ireland is offered. Although utilised for assessing competence across a range of areas (e.g. obstetric emergencies and pharmacology/drug administration), the use of the OSCE for assessing midwifery students' competence in lactation and infant feeding practices, as an example for this paper, is described. The advantages, disadvantages, validity and reliability of the OSCE, as an assessment strategy, are critically explored. Recognising that no single assessment strategy can provide all the information required to assess something as complex as clinical performance, the OSCE, when viewed alongside other forms of assessment, and with relevance to the topic under examination, may be considered a valuable strategy for enhancing the assessment of students' clinical competence, and for embracing diversity within midwifery education and training. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Evaluating clinical librarian services: a systematic review.
Brettle, Alison; Maden-Jenkins, Michelle; Anderson, Lucy; McNally, Rosalind; Pratchett, Tracey; Tancock, Jenny; Thornton, Debra; Webb, Anne
2011-03-01
Previous systematic reviews have indicated limited evidence and poor quality evaluations of clinical librarian (CL) services. Rigorous evaluations should demonstrate the value of CL services, but guidance is needed before this can be achieved. To undertake a systematic review which examines models of CL services, quality, methods and perspectives of clinical librarian service evaluations. Systematic review methodology and synthesis of evidence, undertaken collaboratively by a group of 8 librarians to develop research and critical appraisal skills. There are four clear models of clinical library service provision. Clinical librarians are effective in saving health professionals time, providing relevant, useful information and high quality services. Clinical librarians have a positive effect on clinical decision making by contributing to better informed decisions, diagnosis and choice of drug or therapy. The quality of CL studies is improving, but more work is needed on reducing bias and providing evidence of specific impacts on patient care. The Critical Incident Technique as part of a mixed method approach appears to offer a useful approach to demonstrating impact. This systematic review provides practical guidance regarding the evaluation of CL services. It also provides updated evidence regarding the effectiveness and impact of CL services. The approach used was successful in developing research and critical appraisal skills in a group of librarians. © 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.
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Critical thinking of student nurses during clinical accompaniment.
Uys, B Y; Meyer, S M
2005-08-01
The purpose of this study was to investigate the methods of clinical accompaniment used by clinical facilitators in practice. The findings of the study also reflected facilitators' perceptions regarding critical thinking and the facilitation thereof. A quantitative research design was used. A literature study was conducted to identify the methods of accompaniment that facilitate critical thinking. Data was collected by means of a questionnaire developed for that purpose. Making a content-related validity judgment, and involving seven clinical facilitators in an academic institution, ensured the validity of the questionnaire. The results of the study indicated that various clinical methods of accompaniment were used. To a large extent, these methods correlated with those discussed in the literature review. The researcher further concluded that the concepts 'critical thinking' and 'facilitation' were not interpreted correctly by the respondents, and would therefore not be implemented in a proper manner in nursing practice. Furthermore, it seemed evident that tutor-driven learning realised more often than student-driven learning. In this regard, the requirement of outcomes-based education was not satisfied. The researcher is therefore of the opinion that a practical programme for the development of critical thinking skills during clinical accompaniment must be developed within the framework of outcomes-based education.
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Critical thinking of student nurses during clinical accompaniment
Directory of Open Access Journals (Sweden)
BY Uys
2005-09-01
Full Text Available The purpose of this study was to investigate the methods of clinical accompaniment used by clinical facilitators in practice. The findings of the study also reflected facilitators’ perceptions regarding critical thinking and the facilitation thereof. A quantitative research design was used. A literature study was conducted to identify the methods of accompaniment that facilitate critical thinking. Data was collected by means of a questionnaire developed for that purpose. Making a content-related validity judgment, and involving seven clinical facilitators in an academic institution, ensured the validity of the questionnaire. The results of the study indicated that various clinical methods of accompaniment were used. To a large extent, these methods correlated with those discussed in the literature review. The researcher further concluded that the concepts ‘critical thinking’ and ‘facilitation’ were not interpreted correctly by the respondents, and would therefore not be implemented in a proper manner in nursing practice. Furthermore, it seemed evident that tutor-driven learning realised more often than student-driven learning. In this regard, the requirement of outcomes-based education was not satisfied. The researcher is therefore of the opinion that a practical programme for the development of critical thinking skills during clinical accompaniment must be developed within the framework of outcomes-based education.
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2011-01-01
In modern critical care, the paradigm of 'therapeutic nutrition' is replacing traditional 'supportive nutrition'. Standard enteral formulas meet basic macro- and micronutrient needs; therapeutic enteral formulas meet these basic needs and also contain specific pharmaconutrients that may attenuate hyperinflammatory responses, enhance the immune responses to infection, or improve gastrointestinal tolerance. Choosing the right enteral feeding formula may positively affect a patient's outcome; targeted use of therapeutic formulas can reduce the incidence of infectious complications, shorten lengths of stay in the ICU and in the hospital, and lower risk for mortality. In this paper, we review principles of how to feed (enteral, parenteral, or both) and when to feed (early versus delayed start) patients who are critically ill. We discuss what to feed these patients in the context of specific pharmaconutrients in specialized feeding formulations, that is, arginine, glutamine, antioxidants, certain ω-3 and ω-6 fatty acids, hydrolyzed proteins, and medium-chain triglycerides. We summarize current expert guidelines for nutrition in patients with critical illness, and we present specific clinical evidence on the use of enteral formulas supplemented with anti-inflammatory or immune-modulating nutrients, and gastrointestinal tolerance-promoting nutritional formulas. Finally, we introduce an algorithm to help bedside clinicians make data-driven feeding decisions for patients with critical illness. PMID:22136305
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Critical Care Follow-up Clinics: A Scoping Review of Interventions and Outcomes.
Lasiter, Sue; Oles, Sylwia K; Mundell, James; London, Susan; Khan, Babar
2016-01-01
The purpose of this scoping review is to identify evidence describing benefits of interventions provided in intensive care unit (ICU) survivor follow-up clinics. Advances in ICU treatments have increased the number of survivors who require specialized care for ICU-related sequelae. Intensive care unit survivor follow-up clinics exist, yet little is known about the nature and impact of interventions provided in such clinics. A scoping review of publications about in-person post-ICU follow-up care was undertaken. Ten databases were searched yielding 111 relevant unique publication titles and abstracts. Sample heterogeneity supported using a scoping review method. After excluding nonrelated publications, 33 reports were fully reviewed. Twenty international publications were included that described ICU follow-up clinic interventions and/or outcomes. Authors discussed very diverse interventions in 15 publications, and 9 reported some level of intervention effectiveness. Evidence was strongest that supported the use of prospective diaries as an intervention to prevent or improve psychological symptoms, whereas evidence to support implementation of other interventions was weak. Although ICU follow-up clinics exist, evidence for interventions and effectiveness of treatments in these clinics remains underexplored. Intensive care unit survivor follow-up clinics provide a venue for further interdisciplinary intervention research that could lead to better health outcomes for ICU survivors.
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Haloperidol for delirium in critically ill patients - protocol for a systematic review
DEFF Research Database (Denmark)
Barbateskovic, M; Kraus, S R; Collet, M O
2018-01-01
, relatives, and societies is considerable. The objective of this systematic review was to critically access the evidence of randomised clinical trials on the effects of haloperidol vs. placebo or any other agents for delirium in critically ill patients. METHODS: We will search for randomised clinical trials...... decision makers on the use of or future trials with haloperidol for the management of delirium in critically ill patients....
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Metaphor-related figurative language comprehension in clinical populations: a critical review
Directory of Open Access Journals (Sweden)
Maity Siqueira
2016-12-01
Full Text Available This paper aims to critically review current studies with respect to definitions,methods, and results on the comprehension of metaphor, metonymy,idioms, and proverbs under the following clinical conditions: aphasia,Alzheimer’s disease, autism, brain injuries, specific language impairment,and Williams Syndrome. A comprehensive search of experimentalpsycholinguistic research was conducted using EBSCOhost, PsychInfo,PUBMED, and Web of Science databases. Thirty-eight studies met thereview inclusion criteria. Results point to deficits in figurative languagecomprehension in all conditions considered, lack of clear definitions ofthe phenomena investigated, and varied methods throughout the sample.Patients’ difficulties are attributed to multiple factors, such as a lack ofTheory of Mind, executive dysfunctions, and poor semantic knowledge.The study of nonliteral aspects of language comprehension in clinicalpopulations reveals a range of disparate impairments. There was no specificfeature about metaphor-related phenomena identified that could, on its own,account for the difficulty some populations have to understand figurativelanguage. Rather, metaphor-related language comprehension difficultiesare often part of pragmatic, linguistic, and/or cognitive impairments.Keywords: Figurative language. Metaphor. Metonymy. Proverb. Clinicalpopulations
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Critical review of willingness to pay for clinical oral health interventions.
Tan, Sharon Hui Xuan; Vernazza, Christopher R; Nair, Rahul
2017-09-01
This critical review aimed to identify, consolidate and evaluate the quality of Willingness to Pay (WTP) studies applied to clinical contexts in the field of dentistry. PubMed and Web of Science databases were systematically searched for relevant publications. Screening and data extraction was then performed. Primary literature in English-language were included to assess the WTP for oral health interventions, when the valuations were applied to a clinical measure. Twenty-six publications met the inclusion criteria. WTP was elicited mainly via face-to-face interviews (13 publications) and questionnaires (12 publications). The majority (24) of publications selected an out-of-pocket payment vehicle. Eleven publications adopted a bidding method, nine publications adopted an open-ended format, and the remaining six studies adopted a payment card or choice method. Pre-testing was reported in only nine publications, and few studies accounted for starting point bias. Eight of 11 publications found that higher incomes were associated with higher WTP values. The female gender, a younger age and higher education levels were associated with a higher WTP in select studies. Only a small minority of the studies used strategies to avoid well documented biases related to WTP elicitation. Cost versus benefit of many clinical scenarios remain uninvestigated. WTP studies in dentistry may benefit from pre-testing and the inclusion of a script to minimise hypothetical bias. They may also be better conducted face-to-face and via a shuffled payment card method. Income levels, and potentially education levels, gender and age, should be assessed for their influence on WTP values. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
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A systematic review of critical thinking in nursing education.
Chan, Zenobia C Y
2013-03-01
This review aimed to explore how critical thinking is perceived in previous studies of nursing education, and analyse the obstacles and strategies in teaching and learning critical thinking mentioned in these studies. Systematic review. This review was based on the following five databases: The British Nursing Index, Ovid Medline, CINAHL, PsycINFO and Scopus. After the screening process and evaluation through using the Critical Appraisal Skills Programme tool, 17 studies were identified that met the inclusion and quality criteria. The studies were read through several times and analysed through thematic synthesis. A total of three themes were developed. The first theme, components for critical thinkers, suggests the abilities and attitudes that critical thinkers should have. The other two themes, influential factors of critical thinking in nursing education, and strategies to promote critical thinking, describe the obstacles and strategies in teaching and learning critical thinking. The 17 studies illustrated that the definition and concept of critical thinking may change from time to time, and hence there is a need to clarify educators' perspective towards critical thinking. There is also a need to evaluate the efficacy of the new strategies mentioned in several selected studies, such as art-based, questioning, cross-cultural nursing experience, and preceptorship. With a better understanding of critical thinking in nursing education, educators and nursing faculty are able to develop better strategies in enhancing critical thinking development in nursing students, in turn preparing them for future clinical practice. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Koster, Geert; Bekema, Hanneke J; Wetterslev, Jørn; Gluud, Christian; Keus, Frederik; van der Horst, Iwan C C
2016-09-01
Milrinone is an inotrope widely used for treatment of cardiac failure. Because previous meta-analyses had methodological flaws, we decided to conduct a systematic review of the effect of milrinone in critically ill adult patients with cardiac dysfunction. This systematic review was performed according to The Cochrane Handbook for Systematic Reviews of Interventions. Searches were conducted until November 2015. Patients with cardiac dysfunction were included. The primary outcome was serious adverse events (SAE) including mortality at maximum follow-up. The risk of bias was evaluated and trial sequential analyses were conducted. The quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation criteria. A total of 31 randomised clinical trials fulfilled the inclusion criteria, of which 16 provided data for our analyses. All trials were at high risk of bias, and none reported the primary composite outcome SAE. Fourteen trials with 1611 randomised patients reported mortality data at maximum follow-up (RR 0.96; 95% confidence interval 0.76-1.21). Milrinone did not significantly affect other patient-centred outcomes. All analyses displayed statistical and/or clinical heterogeneity of patients, interventions, comparators, outcomes, and/or settings and all featured missing data. The current evidence on the use of milrinone in critically ill adult patients with cardiac dysfunction suffers from considerable risks of both bias and random error and demonstrates no benefits. The use of milrinone for the treatment of critically ill patients with cardiac dysfunction can be neither recommended nor refuted. Future randomised clinical trials need to be sufficiently large and designed to have low risk of bias.
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Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients.
Esquinas Rodriguez, Antonio M; Papadakos, Peter J; Carron, Michele; Cosentini, Roberto; Chiumello, Davide
2013-04-25
Non-invasive mechanical ventilation (NIV) has proved to be an excellent technique in selected critically ill patients with different forms of acute respiratory failure. However, NIV can fail on account of the severity of the disease and technical problems, particularly at the interface. The helmet could be an alternative interface compared to face mask to improve NIV success. We performed a clinical review to investigate the main physiological and clinical studies assessing the efficacy and related issues of NIV delivered with a helmet. A computerized search strategy of MEDLINE/PubMed (January 2000 to May 2012) and EMBASE (January 2000 to May 2012) was conducted limiting the search to retrospective, prospective, nonrandomized and randomized trials. We analyzed 152 studies from which 33 were selected, 12 physiological and 21 clinical (879 patients). The physiological studies showed that NIV with helmet could predispose to CO₂ rebreathing and increase the patients' ventilator asynchrony. The main indications for NIV were acute cardiogenic pulmonary edema, hypoxemic acute respiratory failure (community-acquired pneumonia, postoperative and immunocompromised patients) and hypercapnic acute respiratory failure. In 9 of the 21 studies the helmet was compared to a face mask during either continous positive airway pressure or pressure support ventilation. In eight studies oxygenation was similar in the two groups, while the intubation rate was similar in four and lower in three studies for the helmet group compared to face mask group. The outcome was similar in six studies. The tolerance was better with the helmet in six of the studies. Although these data are limited, NIV delivered by helmet could be a safe alternative to the face mask in patients with acute respiratory failure.
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Clinical implications of in silico mathematical modeling for glioblastoma: a critical review.
Protopapa, Maria; Zygogianni, Anna; Stamatakos, Georgios S; Antypas, Christos; Armpilia, Christina; Uzunoglu, Nikolaos K; Kouloulias, Vassilis
2018-01-01
Glioblastoma remains a clinical challenge in spite of years of extensive research. Novel approaches are needed in order to integrate the existing knowledge. This is the potential role of mathematical oncology. This paper reviews mathematical models on glioblastoma from the clinical doctor's point of view, with focus on 3D modeling approaches of radiation response of in vivo glioblastomas based on contemporary imaging techniques. As these models aim to provide a clinically useful tool in the era of personalized medicine, the integration of the latest advances in molecular and imaging science and in clinical practice by the in silico models is crucial for their clinical relevance. Our aim is to indicate areas of GBM research that have not yet been addressed by in silico models and to point out evidence that has come up from in silico experiments, which may be worth considering in the clinic. This review examines how close these models have come in predicting the outcome of treatment protocols and in shaping the future of radiotherapy treatments.
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A Critical Review of Low Back Pain Guidelines.
Chetty, Laran
2017-09-01
Low back pain (LBP) remains one of the most common and challenging musculoskeletal conditions encountered by health care professionals and is a leading cause of absenteeism. Clinical guidelines are often considered best evidence in health care. The aim of this critical review was to assess the quality and recommendations of LBP guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Electronic databases were used to identify LBP guidelines published between 2000 and 2015. Nine guidelines were selected for review from a total of 17. Only five guidelines effectively addressed the AGREE scoring. On the basis of the appraisal and domain scores, only four guidelines were strongly recommended. Improved translation of research evidence from guidelines to clinical practice is needed.
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Evaluating critical thinking in clinical practice.
Oermann, M H
1997-01-01
Although much has been written about measurement instruments for evaluating critical thinking in nursing, this article describes clinical evaluation strategies for critical thinking. Five methods are discussed: 1) observation of students in practice; 2) questions for critical thinking, including Socratic questioning; 3) conferences; 4) problem-solving strategies; and 5) written assignments. These methods provide a means of evaluating students' critical thinking within the context of clinical practice.
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Semper, Julie; Halvorson, Betty; Hersh, Mary; Torres, Clare; Lillington, Linda
2016-01-01
The aim of the study was to describe the clinical nurse specialist role in developing and implementing a staff nurse education program to promote practice accountability using peer review principles. Peer review is essential for professional nursing practice demanding a significant culture change. Clinical nurse specialists in a Magnet-designated community hospital were charged with developing a staff nurse peer review education program. Peer review is a recognized mechanism of professional self-regulation to ensure delivery of quality care. The American Nurses Association strongly urges incorporating peer review in professional nursing practice models. Clinical nurse specialists play a critical role in educating staff nurses about practice accountability. Clinical nurse specialists developed an education program guided by the American Nurses Association's principles of peer review. A baseline needs assessment identified potential barriers and learning needs. Content incorporated tools and strategies to build communication skills, collaboration, practice change, and peer accountability. The education program resulted in increased staff nurse knowledge about peer review and application of peer review principles in practice. Clinical nurse specialists played a critical role in helping staff nurses understand peer review and its application to practice. The clinical nurse specialist role will continue to be important in sustaining the application of peer review principles in practice.
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Clinical education and student satisfaction: An integrative literature review
Directory of Open Access Journals (Sweden)
Karen F. Phillips, EdD, MSN, IBCLC, ICCE
2017-04-01
Full Text Available The clinical component of undergraduate clinical education is a critical area in nursing programs. Faculty shortages have made recruitment of clinical faculty and clinical teaching more challenging. As such, alternate models of clinical faculty assignments are being explored to address faculty shortages. This article contains an extensive literature review conducted to survey models of clinical education and student satisfaction with the clinical environment. The purpose of this paper is to examine student satisfaction in the clinical learning environment using articles employing the Clinical Learning Environment Inventory (CLEI along with examining the use of alternate clinical staffing models in differing levels of undergraduate nursing students. A literature search focusing on studies published between 2002 and 2015 was conducted from 5 electronic databases. Thirty-five articles were reviewed and 22 were selected for this literature review. The studies reviewed concluded that students favored a more positive and favorable clinical environment than they perceived as being actually present. A supportive clinical learning environment is of paramount importance in securing positive teaching learning outcomes. Nurse educators can apply the results of this review in order to develop and maintain quality clinical teaching and to promote a positive, student-centric, clinical learning environment.
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Nutritional risk assessment in critically ill cancer patients: systematic review
Fruchtenicht, Ana Valéria Gonçalves; Poziomyck, Aline Kirjner; Kabke, Geórgia Brum; Loss, Sérgio Henrique; Antoniazzi, Jorge Luiz; Steemburgo, Thais; Moreira, Luis Fernando
2015-01-01
Objective To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature. Methods The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words “nutritional risk assessment”, “critically ill” and “cancer”. Results Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values < 87 were significantly associated with mortality. A high Prognostic Inflammatory and Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found. Conclusion None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic
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Houghton, Pamela; Anthony, Joseph; Rennie, Sandy; Shay, Barbara L.; Hoens, Alison M.
2017-01-01
Purpose: In response to requests from physiotherapists for guidance on optimal stimulation of muscle using neuromuscular electrical stimulation (NMES), a review, synthesis, and extraction of key data from the literature was undertaken by six Canadian physical therapy (PT) educators, clinicians, and researchers in the field of electrophysical agents. The objective was to identify commonly treated conditions for which there was a substantial body of literature from which to draw conclusions regarding the effectiveness of NMES. Included studies had to apply NMES with visible and tetanic muscle contractions. Method: Four electronic databases (CINAHL, Embase, PUBMED, and SCOPUS) were searched for relevant literature published between database inceptions until May 2015. Additional articles were identified from bibliographies of the systematic reviews and from personal collections. Results: The extracted data were synthesized using a consensus process among the authors to provide recommendations for optimal stimulation parameters and application techniques to address muscle impairments associated with the following conditions: stroke (upper or lower extremity; both acute and chronic), anterior cruciate ligament reconstruction, patellofemoral pain syndrome, knee osteoarthritis, and total knee arthroplasty as well as critical illness and advanced disease states. Summaries of key details from each study incorporated into the review were also developed. The final sections of the article outline the recommended terminology for describing practice using electrical currents and provide tips for safe and effective clinical practice using NMES. Conclusion: This article provides physiotherapists with a resource to enable evidence-informed, effective use of NMES for PT practice. PMID:29162949
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Weber, Scott
2007-11-01
The purposes of this review are to examine the types of clinical decision support systems in use and to identify patterns of how critical care advanced practice nurses (APNs) have integrated these systems into their nursing care patient management practices. The decision-making process itself is analyzed with a focus on how automated systems attempt to capture and reflect human decisional processes in critical care nursing, including how systems actually organize and process information to create outcome estimations based on patient clinical indicators and prognosis logarithms. Characteristics of APN clinicians and implications of these characteristics on decision system use, based on the body of decision system user research, are introduced. A review of the Medline, Ovid, CINAHL, and PubMed literature databases was conducted using "clinical decision support systems,"computerized clinical decision making," and "APNs"; an examination of components of several major clinical decision systems was also undertaken. Use patterns among APNs and other clinicians appear to vary; there is a need for original research to examine how APNs actually use these systems in their practices in critical care settings. Because APNs are increasingly responsible for admission to, and transfer from, critical care settings, more understanding is needed on how they interact with this technology and how they see automated decision systems impacting their practices. APNs who practice in critical care settings vary significantly in how they use the clinical decision systems that are in operation in their practice settings. These APNs must have an understanding of their use patterns with these systems and should critically assess whether their patient care decision making is affected by the technology.
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A review of costing methodologies in critical care studies.
Pines, Jesse M; Fager, Samuel S; Milzman, David P
2002-09-01
Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. We performed a narrative review of published costing studies in critical care during the past 6 years. A total of 282 articles were found, of which 68 met our search criteria. They involved a mean of 508 patients (range, 20-13,907). A total of 92.6% of the studies (63 of 68) used traditional cost analysis, whereas the remaining 7.4% (5 of 68) used cost-effectiveness analysis. None (0 of 68) used cost-benefit analysis or cost-utility analysis. A total of 36.7% (25 of 68) used hospital charges as a surrogate for actual costs. Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques. Copyright 2002, Elsevier Science (USA). All rights reserved.
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Yang, Shuofei; Wu, Xingjiang; Yu, Wenkui; Li, Jieshou
2014-02-01
Early enteral nutrition (EEN) in critically ill patients is associated with significant benefit as well as elevated risk of complications. Concomitant use of EEN with vasopressors has been associated with nonocclusive bowel necrosis in critically ill patients with hemodynamic instability. The decision when to initiate enteral nutrition in hemodynamically unstable patients that require vasoactive substances remains a clinical dilemma. This review summarizes the effect of EEN and vasoactive agents on gastrointestinal blood flow and perfusion in critically ill patients, based on current evidence. Animal and clinical data involving simultaneous administration of EEN and vasoactive agents for hemodynamic instability are reviewed, and the factors related to the safety and effectiveness of EEN support in this patient population are analyzed. Moreover, practical recommendations are provided. Additional randomized clinical trials are warranted to provide cutting-edge evidence-based guidance about this issue for practitioners of critical care.
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Integration of Mobile Health Technology in the Treatment of Chronic Pain: A Critical Review.
Sundararaman, Lalitha V; Edwards, Robert R; Ross, Edgar L; Jamison, Robert N
This article provides a critical overview and best-evidence synthesis of the use of mobile health (mHealth) technology among persons with chronic pain and their health care providers and examines the future benefits and barriers of implementing mHealth technology in clinical care. We critically review articles about electronic pain diaries, pain assessment programs, text messaging, and smartphone pain apps for management of persons with pain. Also presented are findings on the utility of activity trackers and use of telehealth to deliver cognitive behavioral therapy. Finally, barriers, study gaps, and future challenges of incorporating mobile technology for chronic pain are discussed. Although the future of mHealth technology and telemedicine in clinical practice is promising, this critical review highlights the need for rigorous studies to establish an association of the use of mHealth technology with improved quality of life, functional autonomy, and decreased hospital use.
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Critical value reporting: a survey of 36 clinical laboratories in South Africa.
Schapkaitz, Elise; Mafika, Zipho
2013-10-11
Critical value policies are used by clinical laboratories to decide when to notify caregivers of life-threatening results. Despite their widespread use, critical value policies have not been published locally. A survey was designed to determine critical value policies for haematology tests in South Africa. A survey was carried out on 136 identified laboratories across South Africa in January 2013. Of these, 36 responded. Data collected included critical value policies, critical values for haematology parameters, and critical value reporting. Of the 36 laboratories surveyed, 11.1% (n=4) were private, 33.3% (n=12) were affiliated to academic institutions and 55.6% (n=20) were peripheral or regional National Health Laboratory Service laboratories. All the laboratories confirmed that they had a critical value policy, and 83.3% of such policies were derived from local clinical opinion. Mean low and high critical limits for the most frequently listed tests were as follows: haemoglobin 20 g/dl, platelet count 1 000 ×10(9)/l, white cell count 46 ×10(9)/l, activated partial thromboplastin time >101 seconds, and international normalised ratio >6. In almost all cases critical value reporting was performed by the technologist on duty (97.2%). The majority of laboratories required that the person notified of the critical value be the doctor who ordered the test or the caregiver directly involved in the patient's care (83.3%); 73.3% of laboratories indicated that they followed an algorithm if the doctor/caregiver could not be reached. Each laboratory is responsible for establishing clinically relevant critical limits. Clinicians should be involved in developing the laboratory's critical value policy. The findings of this survey may be of value to local laboratories that are in the process of establishing or reviewing critical value policies.
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Carvalho, Diana P S R P; Azevedo, Isabelle C; Cruz, Giovanna K P; Mafra, Gabriela A C; Rego, Anna L C; Vitor, Allyne F; Santos, Viviane E P; Cogo, Ana L P; Ferreira Júnior, Marcos A
2017-10-01
Identifying the strategies used to promote critical thinking (CT) during undergraduate education in nursing courses. Systematic review. Five electronic databases were searched without language, publication time or geographic filters. A systematic review of the literature. Including experimental studies that considered at least one teaching strategy to promote critical thinking of undergraduate students in Nursing courses. The search for studies occurred in three phases: title and summary review, complete text and implementation of a clinical form of selection according to predetermined criteria. All included studies were assessed for quality through a classification tool for experimental studies. Six studies were selected. The results were grouped into three key themes: an evaluation of the quality of the selected studies, characterization of the studies and the strategies used to promote critical thinking. All selected studies were in English, with significant conceptual similarity of Critical Thinking and dominance in choosing the approached theme during strategies in clinical nursing education with an emphasis on the nursing process. The most widely used teaching intervention was Problem-Based Learning. Nursing education mediated by strategies that stimulate CT is considered a positive difference in undergraduate curriculums. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Critical thinking in clinical nurse education: application of Paul's model of critical thinking.
Andrea Sullivan, E
2012-11-01
Nurse educators recognize that many nursing students have difficulty in making decisions in clinical practice. The ability to make effective, informed decisions in clinical practice requires that nursing students know and apply the processes of critical thinking. Critical thinking is a skill that develops over time and requires the conscious application of this process. There are a number of models in the nursing literature to assist students in the critical thinking process; however, these models tend to focus solely on decision making in hospital settings and are often complex to actualize. In this paper, Paul's Model of Critical Thinking is examined for its application to nursing education. I will demonstrate how the model can be used by clinical nurse educators to assist students to develop critical thinking skills in all health care settings in a way that makes critical thinking skills accessible to students. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Factors associated with clinical inertia: an integrative review
Aujoulat, Isabelle; Jacquemin, Patricia; Rietzschel, Ernst; Scheen, André; Tréfois, Patrick; Wens, Johan; Darras, Elisabeth; Hermans, Michel P
2014-01-01
Failure to initiate or intensify therapy according to evidence-based guidelines is increasingly being acknowledged as a phenomenon that contributes to inadequate management of chronic conditions, and is referred to as clinical inertia. However, the number and complexity of factors associated with the clinical reasoning that underlies the decision-making processes in medicine calls for a critical examination of the consistency of the concept. Indeed, in the absence of information on and justification of treatment decisions that were made, clinical inertia may be only apparent, and actually reflect good clinical practice. This integrative review seeks to address the factors generally associated with clinical inaction, in order to better delineate the concept of true clinical inertia. PMID:24868181
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Energy Technology Data Exchange (ETDEWEB)
None
1982-01-01
Report XI, Technical Audit, is a compendium of research material used during the Initial Effort in making engineering comparisons and decisions. Volumes 4 and 5 of Report XI present those studies which provide a Critical Review of the Design Basis. The Critical Review Report, prepared by Intercontinental Econergy Associates, Inc., summarizes findings from an extensive review of the data base for the H-Coal process design. Volume 4 presents this review and assessment, and includes supporting material; specifically, Design Data Tabulation (Appendix A), Process Flow Sheets (Appendix B), and References (Appendix C). Volume 5 is a continuation of the references of Appendix C. Studies of a proprietary nature are noted and referenced, but are not included in these volumes. They are included in the Limited Access versions of these reports and may be reviewed by properly cleared personnel in the offices of Ashland Synthetic Fuels, Inc.
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Oxygen supplementation for critically ill patients
DEFF Research Database (Denmark)
Barbateskovic, M; Schjørring, O L; Jakobsen, J C
2018-01-01
. The objective of this systematic review is to critically assess the evidence of randomised clinical trials on the effects of higher versus lower inspiratory oxygen fractions or targets of arterial oxygenation in critically ill adult patients. METHODS: We will search for randomised clinical trials in major......BACKGROUND: In critically ill patients, hypoxaemia is a common clinical manifestation of inadequate gas exchange in the lungs. Supplemental oxygen is therefore given to all critically ill patients. This can result in hyperoxaemia, and some observational studies have identified harms with hyperoxia...... in international guidelines despite lack of robust evidence of its effectiveness. To our knowledge, no systematic review of randomised clinical trials has investigated the effects of oxygen supplementation in critically ill patients. This systematic review will provide reliable evidence to better inform future...
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Directory of Open Access Journals (Sweden)
Tadashi Kamio
2017-06-01
Full Text Available Introduction: Early identification of patients with unexpected clinical deterioration is a matter of serious concern. Previous studies have shown that early intervention on a patient whose health is deteriorating improves the patient outcome, and machine-learning-based approaches to predict clinical deterioration may contribute to precision improvement. To date, however, no systematic review in this area is available. Methods: We completed a search on PubMed on January 22, 2017 as well as a review of the articles identified by study authors involved in this area of research following the preferred reporting items for systematic reviews and meta-analyses (PRISMA guidelines for systematic reviews. Results: Twelve articles were selected for the current study from 273 articles initially obtained from the PubMed searches. Eleven of the 12 studies were retrospective studies, and no randomized controlled trials were performed. Although the artificial neural network techniques were the most frequently used and provided high precision and accuracy, we failed to identify articles that showed improvement in the patient outcome. Limitations were reported related to generalizability, complexity of models, and technical knowledge. Conclusions: This review shows that machine-learning approaches can improve prediction of clinical deterioration compared with traditional methods. However, these techniques will require further external validation before widespread clinical acceptance can be achieved.
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Short- and long-term impact of critical illness on relatives: literature review.
Paul, Fiona; Rattray, Janice
2008-05-01
This paper is a report of a literature review undertaken to identify the short- and long-term impact of critical illness on relatives. Patients in intensive care can experience physical and psychological consequences, and their relatives may also experience such effects. Although it is recognized that relatives have specific needs, it is not clear whether these needs are always met and whether further support is required, particularly after intensive care. The following databases were searched for the period 1950-2007: Medline, British Nursing Index and Archive, EMBASE, CINAHL, PsycINFO and EMB Reviews--Cochrane Central Register of Clinical Trials. Search terms focused on adult relatives of critically ill adult patients during and after intensive care. Recurrent topics were categorized to structure the review, i.e. 'relatives needs', 'meeting relatives' needs', 'interventions', 'satisfaction', 'psychological outcomes' and 'coping'. Studies have mainly identified relatives' immediate needs using the Critical Care Family Needs Inventory. There are few studies of interventions to meet relatives' needs and the short- and long-term effects of critical illness on relatives. Despite widespread use of the Critical Care Family Needs Inventory, factors such as local or cultural differences may influence relatives' needs. Relatives may also have unidentified needs, and these needs should be explored. Limited research has been carried out into interventions to meet relatives' needs and the effects of critical illness on their well-being, yet some relatives may experience negative psychological consequences far beyond the acute phase of the illness.
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Oligometastases. The new paradigm and options for radiotherapy. A critical review
Energy Technology Data Exchange (ETDEWEB)
Badakhshi, H.; Gruen, A.; Stromberger, C.; Budach, V.; Boehmer, D. [Charite Universitaetsmedizin Berlin (Germany). Dept. for Radiation Oncology
2013-05-15
Traditional oncology distinguishes between two separate and incommensurable states in the evolution of solid malignancies: the localized disease, which is curable; and the disseminated status, which is per se palliative. Recently, a huge body of evidence suggests a fundamental change in the understanding of cancer, indicating an intermediate state in the trajectory of solid malignancies: the oligometastatic state. The following review will critically analyse existing hypotheses and facts from the basic sciences and try to contextualize it in regard to the clinical evidence available to date. Consecutively, it will try to draw possible clinical consequences for application of radiotherapy in this specific clinical scenario. (orig.)
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DEFF Research Database (Denmark)
Groth, Kristian; Skakkebæk, Anne; Høst, Christian
2013-01-01
Recently, new clinically important information regarding Klinefelter syndrome (KS) has been published. We review aspects of epidemiology, endocrinology, metabolism, body composition, and neuropsychology with reference to recent genetic discoveries.......Recently, new clinically important information regarding Klinefelter syndrome (KS) has been published. We review aspects of epidemiology, endocrinology, metabolism, body composition, and neuropsychology with reference to recent genetic discoveries....
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SPI Project Criticality Task Force initial review and assessment
International Nuclear Information System (INIS)
McKinley, K.B.; Cannon, J.W.; Marsden, R.S.; Worle, H.A.
1980-03-01
The Slagging Pyrolysis Incinerator (SPI) Facility is being developed to process transuranic waste stored and buried at the Idaho National Engineering Laboratory (INEL) into a chemically inert, physically stable, basalt-like residue acceptable for a Federal Repository. A task force was established by the SPI Project Division to review and assess all aspects of criticality safety for the SPI Facility. This document presents the initial review, evaluations, and recommendations of the task force and includes the following: background information on waste characterization, and criticality control approaches and philosophies, a description of the SPI Facility Waste Processing Building, a review and assessment of potentially relevant codes and regulations; a review and assessment of the present state of criticality and assaying/monitoring studies, and recommendations for changes in and additions to these studies. The review and assessment of potentially relevant codes and regulations indicate that ERDAM 0530, Nuclear Criticality Safety should be the controlling document for criticality safety for the SPI Project. In general, the criticality control approaches and philosophies for the SPI Project comply with this document
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Cultivating Critical Thinking in the Clinical Learning Environment.
Behar-Horenstein, Linda S.; Dolan, Teresa A.; Courts, Frank J.; Mitchell, Gail S.
2000-01-01
Used qualitative research methods to assess the frequency and nature of teaching critical thinking skills in the University of Florida College of Dentistry predoctoral student clinics. Observation of 13 faculty and 44 students in six clinics found critical thinking skills were infrequently taught and teacher-dominated instruction predominated.…
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Critical care clinician perceptions of factors leading to Medical Emergency Team review.
Currey, Judy; Allen, Josh; Jones, Daryl
2018-03-01
The introduction of rapid response systems has reduced the incidence of in-hospital cardiac arrest; however, many instances of clinical deterioration are unrecognised. Afferent limb failure is common and may be associated with unplanned intensive care admissions, heightened mortality and prolonged length of stay. Patients reviewed by a Medical Emergency Team are inherently vulnerable with a high in-hospital mortality. To explore perceptions of intensive care unit (ICU) staff who attend deteriorating acute care ward patients regarding current problems, barriers and potential solutions to recognising and responding to clinical deterioration that culminates in a Medical Emergency Team review. A descriptive exploratory design was used. Registered intensive care nurses and medical staff (N=207) were recruited during a professional conference using purposive sampling for experience in attending deteriorating patients. Written response surveys were used to address the study aim. Data were analysed using content analysis. Four major themes were identified: Governance, Teamwork, Clinical Care Delivery and End of Life Care. Participants perceived there was a lack of sufficient and senior staff with the required theoretical knowledge; and inadequate assessment and critical thinking skills for anticipating, recognising and responding to clinical deterioration. Senior doctors were perceived to inappropriately manage End of Life Care issues and displayed Teamwork behaviours rendering ward clinicians feeling fearful and intimidated. A lack of System and Clinical Governance hindered identification of clinical deterioration. To improve patient safety related to recognising and responding to clinical deterioration, suboptimal care due to professionals' knowledge, skills and behaviours need addressing, along with End of Life Care and Governance. Copyright © 2017 Australian College of Critical Care Nurses Ltd. All rights reserved.
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Spondylolysis: a critical review
Standaert, C; Herring, S
2000-01-01
Aim—To provide an understanding of the current concepts in the natural history, pathophysiology, diagnosis, and treatment of spondylolysis based on the available medical literature. Methods—Articles were selected for review by the following methods: (a) MEDLINE searches with review of abstracts to select relevant articles; (b) review of multiple textbooks considered likely to contain information on spondylolysis; (c) review of references in articles identified by (a) and (b). Over 125 articles were ultimately reviewed fully. Publications were selected for inclusion in this article on the basis of perceived scientific and historical merit, particularly as thought to be relevant to achieving the stated purpose of this review. As no controlled clinical trials were identified, this could not be used as an inclusion criterion. Conclusions—Isthmic spondylolysis is considered to represent a fatigue fracture of the pars interarticularis of the neural arch. There is a relatively high incidence of radiographically identified spondylolysis in the general population, but the vast majority of these lesions probably occur without associated symptoms. Symptomatic pars lesions appear to be particularly a clinical problem in adolescents, especially adolescent athletes. The optimal diagnostic and treatment algorithms are not well identified in the current literature. Multiple imaging studies may have a role in the diagnosis of a pars lesion, and treatment seems likely to require at least relative rest and physical rehabilitation with consideration of bracing or, rarely, surgical intervention depending on the clinical context. Key Words: spondylolysis; spondylolisthesis; spine; back; neural arch; pars interarticularis PMID:11131228
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Characteristics of leadership that influence clinical learning: a narrative review.
Walker, Rachel; Cooke, Marie; Henderson, Amanda; Creedy, Debra K
2011-11-01
Leadership has been consistently implied in fostering clinical learning. However there is a lack of clarity about the form leadership should take. Limited quantitative research indicated a narrative approach to review literature from a broad perspective. A framework to guide the synthesis was developed to ensure a rigorous review process. Preliminary reading and review of papers using search terms nursing and leadership and clinical learning and learning culture narrowed the inclusion criteria to 245 papers published between 2000 and 2010. Given the diversity of the papers' focus, aim and context, a refined screening process justified the inclusion of twenty-six papers in the review. A critical appraisal of these peer-reviewed quantitative, qualitative and commentary papers identified factors/elements integral to effective leadership. Across the literature leadership was discussed in relation to two broad themes: influence of leadership on organisational learning and development and; influence of leadership on undergraduate clinical education. The factors central to leadership emerged as transformative principles, the role of the nurse unit/ward manager, collaboration and relationship building and role-modelling. The review has raised some suggestions for future research aimed at examining the impact of a leadership capacity building intervention that supports clinical learning. Copyright © 2010 Elsevier Ltd. All rights reserved.
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Clinical examination, critical care ultrasonography and outcomes in the critically ill
DEFF Research Database (Denmark)
Hiemstra, Bart; Eck, Ruben J; Koster, Geert
2017-01-01
PURPOSE: In the Simple Intensive Care Studies-I (SICS-I), we aim to unravel the value of clinical and haemodynamic variables obtained by physical examination and critical care ultrasound (CCUS) that currently guide daily practice in critically ill patients. We intend to (1) measure all available...... patient used for guiding diagnostics, prognosis and interventions. Repeated evaluations of these sets of variables are needed for continuous improvement of the diagnostic and prognostic models. Future plans include: (1) more advanced imaging; (2) repeated clinical and haemodynamic measurements; (3...... clinical and haemodynamic variables, (2) train novices in obtaining values for advanced variables based on CCUS in the intensive care unit (ICU) and (3) create an infrastructure for a registry with the flexibility of temporarily incorporating specific (haemodynamic) research questions and variables...
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International Nuclear Information System (INIS)
Rathbun, R.
1993-01-01
Review of NMP-NCS-930087, open-quotes Nuclear Criticality Safety Evaluation 93-04 Enriched Uranium Receipt (U), July 30, 1993, close quotes was requested of SRTC (Savannah River Technology Center) Applied Physics Group. The NCSE is a criticality assessment to determine the mass limit for Engineered Low Level Trench (ELLT) waste uranium burial. The intent is to bury uranium in pits that would be separated by a specified amount of undisturbed soil. The scope of the technical review, documented in this report, consisted of (1) an independent check of the methods and models employed, (2) independent HRXN/KENO-V.a calculations of alternate configurations, (3) application of ANSI/ANS 8.1, and (4) verification of WSRC Nuclear Criticality Safety Manual procedures. The NCSE under review concludes that a 500 gram limit per burial position is acceptable to ensure the burial site remains in a critically safe configuration for all normal and single credible abnormal conditions. This reviewer agrees with that conclusion
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Tank farm nuclear criticality review
International Nuclear Information System (INIS)
Bratzel, D.R.
1996-01-01
The technical basis for the nuclear criticality safety of stored wastes at the Hanford Site Tank Farm Complex was reviewed by a team of senior technical personnel whose expertise covered all appropriate aspects of fissile materials chemistry and physics. The team concluded that the detailed and documented nucleonics-related studies underlying the waste tanks criticality safety basis were sound. The team concluded that, under current plutonium inventories and operating conditions, a nuclear criticality accident is incredible in any of the Hanford single-shell tanks (SST), double-shell tanks (DST), or double-contained receiver tanks (DCRTS) on the Hanford Site
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[Second victim : Critical incident stress management in clinical medicine].
Schiechtl, B; Hunger, M S; Schwappach, D L; Schmidt, C E; Padosch, S A
2013-09-01
Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.
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Rethinking Heat Injury in the SOF Multipurpose Canine: A Critical Review.
Baker, Janice L; Hollier, Paul J; Miller, Laura; Lacy, Ward A
2012-01-01
Heat injury is a significant concern of the Special Operations Forces Multipurpose Canine (SOF MPC). The unique athletic abilities and working environment of the SOF MPC differ from that of companion dogs or even conventional military working dogs. This should be considered in the prevention, diagnosis, and treatment of heat injury of the SOF MPC. A critical review of the literature on canine heat injury as it pertains to working dogs demonstrates limited scientific evidence on best practices for immediate clinical management of heat injury in SOF MPCs. A majority of management guidelines for heat injury in veterinary reference books and journals are based on review articles or professional opinion of the author vs. evidence from original research. In addition, guidelines are written primarily for companion animal populations vs. SOF MPCs and focus on measures to be undertaken in a clinical setting vs. point of injury. The phenomenon of ?circular referencing? is also prevalent in the heat injury literature. Current guidelines supported by review articles and textbooks often provide no citation or cite other review articles for clinical standards such as normal temperature ranges, treatment methods, and recurrence of heat injury. This ?circular referencing? phenomenon misrepresents anecdotal evidence and professional opinion as scientifically validated, reinforcing concepts and recommendations that are not truly supported by the evidence. Further study is needed to fully understand heat injury in SOF MPCs and how this applies to prevention, diagnosis and treatment guidelines. In order to provide SOF canine programs with best clinical advice and care, SOF Veterinarians must make clinical judgments based on evaluation of the most accurate and valid information possible. Clinical guidelines are fluid and should be reviewed regularly for relevance to the defined population in question. Clinical Guidelines should also be utilized as guiding principles in conjunction with
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Feasibility and reliability of frailty assessment in the critically ill: a systematic review.
Pugh, Richard J; Ellison, Amy; Pye, Kate; Subbe, Christian P; Thorpe, Chris M; Lone, Nazir I; Clegg, Andrew
2018-02-26
For healthcare systems, an ageing population poses challenges in the delivery of equitable and effective care. Frailty assessment has the potential to improve care in the intensive care setting, but applying assessment tools in critical illness may be problematic. The aim of this systematic review was to evaluate evidence for the feasibility and reliability of frailty assessment in critical care. Our primary search was conducted in Medline, Medline In-process, EMBASE, CINAHL, PsycINFO, AMED, Cochrane Database of Systematic Reviews, and Web of Science (January 2001 to October 2017). We included observational studies reporting data on feasibility and reliability of frailty assessment in the critical care setting in patients 16 years and older. Feasibility was assessed in terms of timing of evaluation, the background, training and expertise required for assessors, and reliance upon proxy input. Reliability was assessed in terms of inter-rater reliability. Data from 11 study publications are included, representing 8 study cohorts and 7761 patients. Proxy involvement in frailty assessment ranged from 58 to 100%. Feasibility data were not well-reported overall, but the exclusion rate due to lack of proxy availability ranged from 0 to 45%, the highest rate observed where family involvement was mandatory and the assessment tool relatively complex (frailty index, FI). Conventional elements of frailty phenotype (FP) assessment required modification prior to use in two studies. Clinical staff tended to use a simple judgement-based tool, the clinical frailty scale (CFS). Inter-rater reliability was reported in one study using the CFS and although a good level of agreement was observed between clinician assessments, this was a small and single-centre study. Though of unproven reliability in the critically ill, CFS was the tool used most widely by critical care clinical staff. Conventional FP assessment required modification for general application in critical care, and an FI
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Learning from critical case reviews: emergent themes and their impact on practice.
Crofts, Linda
2006-12-01
This paper describes the process of conducting critical case reviews as part of a leadership programme for critical care. Forty-five cases were reviewed over 2 years in five different hospitals and permission was sought from local research ethics committees and research and development committees for the discussions to be treated as research data. Typically the cases presented were patients with complex needs whose trajectory of care had not gone smoothly. Key themes to emerge from the case reviews were: The case reviews themselves were: Communication failures between professional groups, between professional themselves, between staff and families, between wards and departments and between different hospitals. Documentation was also often less than satisfactory. Teams often had problems in working together as a team and different professionals often had different expectations of other members of the team. Individual action may compensate for weaknesses in formal clinical risk system. The case reviews themselves were showcases of the difficulties the health service faces every day and the challenges of communicating effectively. The case reviews provided an effective medium to both resolve those difficulties and model a means through which teams could effectively manage and communicate patient care issues. Furthermore their strength as a learning tool was attributed to team learning as a powerful catalyst for change.
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SRTC criticality safety technical review of SRT-CMA-930039
International Nuclear Information System (INIS)
Rathbun, R.
1993-01-01
Review of SRT-CMA-930039, ''Nuclear Criticality Safety Evaluation (NCSE): DWPF Melter-Batch 1,'' December 1, 1993, has been performed by the Savannah River Technical Center (SRTC) Applied Physics Group. The NCSE is a criticality assessment of the Melt Cell in the DWPF. Additionally, this pertains only to Batch 1 operation, which differs from batches to follow. Plans for subsequent batch operations call for fissile material in the Salt Cell feed-stream, which necessitates a separate criticality evaluation in the future. The NCSE under review concludes that the process is safe from criticality events, even in the event that all lithium and boron neutron poisons are lost, provided uranium enrichments are less than 40%. Furthermore, if all the lithium and as much as 98% of the boron would be lost, uranium enrichments of 100% would be allowable. After a thorough review of the NCSE, this reviewer agrees with that conclusion. This technical review consisted of: an independent check of the methods and models employed, independent calculations application of ANSI/ANS 8.1, verification of WSRC Nuclear Criticality Safety Manual( 2 ) procedures
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What is bizarre in bizarre delusions? A critical review
DEFF Research Database (Denmark)
Cermolacce, Michel René Joseph; Jensen, Lars Meldgaard Sass; Parnas, J
2010-01-01
. These studies provide highly heterogenous results because they are based on different experimental paradigms, in terms of definition, clinical sample, and number of raters. Here, we first discuss the psychopathological sources of the concept of BD, which were initially described as either nonsensical...... or incomprehensible. Then, we provide a critical review of contemporary studies on the reliability of BD and their methodological and conceptual limitations. Current approaches have focused intensely on BD's reliability and have defined BD strictly in terms of delusional content--mainly in terms of the physical...... impossibility or the cultural or historical incomprehensibility of the delusional claims. These approaches have neglected formal features of experience that underlie BD and the crucial issue of the nature and validity of BD. In the discussion, we argue that clinical diagnosis of BD cannot be limited...
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Tulbure, Bogdan T.; Szentagotai, Aurora; Dobrean, Anca; David, Daniel
2012-01-01
Investigating the empirical support of various assessment instruments, the evidence based assessment approach expands the scientific basis of psychotherapy. Starting from Hunsley and Mash's evaluative framework, we critically reviewed the rating scales designed to measure social anxiety or phobia in youth. Thirteen of the most researched social…
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Critical thinking competence and disposition of clinical nurses in a medical center.
Feng, Rung-Chuang; Chen, Mei-Jung; Chen, Mei-Chuan; Pai, Yu-Chu
2010-06-01
Critical thinking is essential in nursing practice. Promoting critical thinking competence in clinical nurses is an important way to improve problem solving and decision-making competence to further improve the quality of patient care. However, using an adequate tool to test nurses' critical thinking competence and disposition may provide the reference criteria for clinical nurse characterization, training planning, and resource allocation for human resource management. The purpose of this study was to measure the critical thinking competence and critical thinking disposition of clinical nurses as well as to explore the related factors of critical thinking competence. Clinical nurses from four different clinical ladders selected from one medical center were stratified randomly. All qualified subjects who submitted valid questionnaires were included in the study. A Taiwan version of the modified Watson-Glaser Critical Thinking Appraisal and Critical Thinking Disposition Inventory was developed to measure the critical thinking competence and critical thinking disposition of clinical nurses. Validity was evaluated using the professional content test (content validity index = .93). Reliability was assessed with a Cronbach's alpha coefficient of .85. Data were analyzed using the SPSS for Windows (Version 12.0; SPSS Inc., Chicago, IL). Results showed that competence of interpretation was the highest critical thinking competence factor. Inference was the lowest, and reflective thinking as a critical thinking disposition was more positive. In addition, age, years of nursing experience, and experiences in other hospitals significantly influenced critical thinking competence (p critical thinking disposition scores. Clinical ladder N4 nurses had the highest scores in both competence and disposition. A significant relationship was found between critical thinking competence and disposition scores, with 29.3% of the variance in critical thinking competence potentially explained
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DEFF Research Database (Denmark)
Brekke, Anders Falk
2015-01-01
Title: Promoting Clinical Reasoning in Undergraduate Physical Therapy Education: A Review of Strategies and Approaches Juneja H1, Brekke A F2 1,2 Physical Therapy Education, University College Zealand, Denmark Background: Clinical reasoning (CR) also referred to as “critical thinking” or “decision....... It is imperative that physical therapy educators utilize innovative pedagogical methods to facilitate learning of reasoning skills in students. Purpose: The review is an attempt to highlight and discuss selected pedagogical strategies and approaches to enhance clinical reasoning skills in undergraduate physical...... programs was shortlisted for the review. References of pertinent literature were scanned to identify further relevant citations. Results: The review provides a detailed insight into the interwoven nature of pedagogical techniques to promote clinical reasoning being used by different physical therapy...
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Static Magnetic Field Therapy: A Critical Review of Treatment Parameters
Directory of Open Access Journals (Sweden)
Agatha P. Colbert
2009-01-01
Full Text Available Static magnetic field (SMF therapy, applied via a permanent magnet attached to the skin, is used by people worldwide for self-care. Despite a lack of established SMF dosage and treatment regimens, multiple studies are conducted to evaluate SMF therapy effectiveness. Our objectives in conducting this review are to: (i summarize SMF research conducted in humans; (ii critically evaluate reporting quality of SMF dosages and treatment parameters and (iii propose a set of criteria for reporting SMF treatment parameters in future clinical trials. We searched 27 electronic databases and reference lists. Only English language human studies were included. Excluded were studies of electromagnetic fields, transcranial magnetic stimulation, magnets placed on acupuncture points, animal studies, abstracts, posters and editorials. Data were extracted on clinical indication, study design and 10 essential SMF parameters. Three reviewers assessed quality of reporting and calculated a quality assessment score for each of the 10 treatment parameters. Fifty-six studies were reviewed, 42 conducted in patient populations and 14 in healthy volunteers. The SMF treatment parameters most often and most completely described were site of application, magnet support device and frequency and duration of application. Least often and least completely described were characteristics of the SMF: magnet dimensions, measured field strength and estimated distance of the magnet from the target tissue. Thirty-four (61% of studies failed to provide enough detail about SMF dosage to permit protocol replication by other investigators. Our findings highlight the need to optimize SMF dosing parameters for individual clinical conditions before proceeding to a full-scale clinical trial.
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Pre-treatment risk stratification of prostate cancer patients: A critical review.
Rodrigues, George; Warde, Padraig; Pickles, Tom; Crook, Juanita; Brundage, Michael; Souhami, Luis; Lukka, Himu
2012-04-01
The use of accepted prostate cancer risk stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated risk stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer risk stratification schema to assess the feasibility and need for changes to existing risk stratification systems. A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and risk stratification in prostate cancer. Search terms included risk stratification, risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing risk stratification schema. The critical review identified three specific clinically relevant potential changes to the most commonly used three-group risk stratification system: (1) the creation of a very-low risk category; (2) the splitting of intermediate-risk into a low- and high-intermediate risk groups; and (3) the clarification of the interface between intermediate- and high-risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important risk-stratification factors. Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer risk stratification systems. We propose potential changes to existing systems.
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A critical scoping review of external uses of comfrey (Symphytum spp.).
Frost, R; MacPherson, H; O'Meara, S
2013-12-01
External preparations of the herb comfrey (most commonly Symphytum officinale L.) are widely available for over-the-counter, practitioner and healthcare professional usage. Traditional practice suggests comfrey can be used to treat musculoskeletal disorders, wounds and various other conditions; however a full and critical coverage of the evidence base has not yet been undertaken. A critical scoping review was undertaken. Six bibliographic databases, 10 grey literature databases and nine trials registers were searched plus reference lists of included studies and a descriptive overview of comfrey. Randomised or non-randomised clinical trials assessing the external use of comfrey for any indication were included and methodological and reporting quality were assessed. Observational studies were included only in the assessment of adverse events. Studies were grouped and summarised according to the type of indication treated. Of 1348 identified records, 64 full texts were screened for inclusion and 26 were included in the review - 13 RCTs, 5 non-randomised controlled trials and 8 observational studies evaluating treatments for ankle distortion, back pain, abrasion wounds, venous leg ulcers and osteoarthritis. The majority of included trials had an overall unclear risk of bias due to poor quality of reporting. Few adverse events were reported. Individual clinical trials showed evidence of benefit for ankle distortion, back pain, abrasion wounds and osteoarthritis. Topical application appears to be safe but further rigorous assessment is needed. Systematic reviews focussing on particular indications may clarify the treatment effect and safety of external comfrey preparations. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Bruxism and prosthetic treatment: a critical review.
Johansson, Anders; Omar, Ridwaan; Carlsson, Gunnar E
2011-07-01
Based on the findings from available research on bruxism and prosthetic treatment published in the dental literature, an attempt was made to draw conclusions about the existence of a possible relationship between the two, and its clinical relevance. MEDLINE/PubMed searches were conducted using the terms 'bruxism' and 'prosthetic treatment', as well as combinations of these and related terms. The few studies judged to be relevant were critically reviewed, in addition to papers found during an additional manual search of reference lists within selected articles. Bruxism is a common parafunctional habit, occurring both during sleep and wakefulness. Usually it causes few serious effects, but can do so in some patients. The etiology is multifactorial. There is no known treatment to stop bruxism, including prosthetic treatment. The role of bruxism in the process of tooth wear is unclear, but it is not considered a major cause. As informed by the present critical review, the relationship between bruxism and prosthetic treatment is one that relates mainly to the effect of the former on the latter. Bruxism may be included among the risk factors, and is associated with increased mechanical and/or technical complications in prosthodontic rehabilitation, although it seems not to affect implant survival. When prosthetic intervention is indicated in a patient with bruxism, efforts should be made to reduce the effects of likely heavy occlusal loading on all the components that contribute to prosthetic structural integrity. Failure to do so may indicate earlier failure than is the norm. Copyright © 2011 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.
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Kalil, Andre C; Sun, Junfeng
2014-10-01
To review Bayesian methodology and its utility to clinical decision making and research in the critical care field. Clinical, epidemiological, and biostatistical studies on Bayesian methods in PubMed and Embase from their inception to December 2013. Bayesian methods have been extensively used by a wide range of scientific fields, including astronomy, engineering, chemistry, genetics, physics, geology, paleontology, climatology, cryptography, linguistics, ecology, and computational sciences. The application of medical knowledge in clinical research is analogous to the application of medical knowledge in clinical practice. Bedside physicians have to make most diagnostic and treatment decisions on critically ill patients every day without clear-cut evidence-based medicine (more subjective than objective evidence). Similarly, clinical researchers have to make most decisions about trial design with limited available data. Bayesian methodology allows both subjective and objective aspects of knowledge to be formally measured and transparently incorporated into the design, execution, and interpretation of clinical trials. In addition, various degrees of knowledge and several hypotheses can be tested at the same time in a single clinical trial without the risk of multiplicity. Notably, the Bayesian technology is naturally suited for the interpretation of clinical trial findings for the individualized care of critically ill patients and for the optimization of public health policies. We propose that the application of the versatile Bayesian methodology in conjunction with the conventional statistical methods is not only ripe for actual use in critical care clinical research but it is also a necessary step to maximize the performance of clinical trials and its translation to the practice of critical care medicine.
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Critical thinking of student nurses during clinical accompaniment
BY Uys; SM Meyer
2005-01-01
The purpose of this study was to investigate the methods of clinical accompaniment used by clinical facilitators in practice. The findings of the study also reflected facilitators’ perceptions regarding critical thinking and the facilitation thereof. A quantitative research design was used. A literature study was conducted to identify the methods of accompaniment that facilitate critical thinking. Data was collected by means of a questionnaire developed for that purpose. Making a content-rela...
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Silva, Camila F A; de Vasconcelos, Simone G; da Silva, Thales A; Silva, Flávia M
2018-01-26
The aim of this study was to systematically review the effect of permissive underfeeding/trophic feeding on the clinical outcomes of critically ill patients. A systematic review of randomized clinical trials to evaluate the mortality, length of stay, and mechanical ventilation duration in patients randomized to either hypocaloric or full-energy enteral nutrition was performed. Data sources included PubMed and Scopus and the reference lists of the articles retrieved. Two independent reviewers participated in all phases of this systematic review as proposed by the Cochrane Handbook, and the review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 7 randomized clinical trials that included a total of 1,717 patients were reviewed. Intensive care unit length of stay and mechanical ventilation duration were not statistically different between the intervention and control groups in all randomized clinical trials, and mortality rate was also not different between the groups. In conclusion, hypocaloric enteral nutrition had no significantly different effects on morbidity and mortality in critically ill patients when compared with full-energy nutrition. It is still necessary to determine the safety of this intervention in this group of patients, the optimal amount of energy provided, and the duration of this therapy. © 2018 American Society for Parenteral and Enteral Nutrition.
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Nutrition in acute pancreatitis: a critical review
Lodewijkx, Piet J.; Besselink, Marc G.; Witteman, Ben J.; Schepers, Nicolien J.; Gooszen, Hein G.; van Santvoort, Hjalmar C.; Bakker, Olaf J.
Severe acute pancreatitis poses unique nutritional challenges. The optimal nutritional support in patients with severe acute pancreatitis has been a subject of debate for decades. This review provides a critical review of the available literature. According to current literature, enteral nutrition
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Radically Reducing the Costs of Panel Critical Reviews According to ISO 14040
DEFF Research Database (Denmark)
Weidema, Bo Pedersen; Christiansen, Kim; Wernet, Gregor
2013-01-01
We suggest a procedure that radically reduces the critical review costs without compromising their thoroughness and overall quality. This procedure has 3 elements: A fixed panel for all reviews, an already critically reviewed background database, and a software-supported review procedure. The pre....... The presentation discusses these elements in the light of the upcoming ISO 14071 on critical review....
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Utility of repeat testing of critical values: a Q-probes analysis of 86 clinical laboratories.
Lehman, Christopher M; Howanitz, Peter J; Souers, Rhona; Karcher, Donald S
2014-06-01
A common laboratory practice is to repeat critical values before reporting the test results to the clinical care provider. This may be an unnecessary step that delays the reporting of critical test results without adding value to the accuracy of the test result. To determine the proportions of repeated chemistry and hematology critical values that differ significantly from the original value as defined by the participating laboratory, to determine the threshold differences defined by the laboratory as clinically significant, and to determine the additional time required to analyze the repeat test. Participants prospectively reviewed critical test results for 4 laboratory tests: glucose, potassium, white blood cell count, and platelet count. Participants reported the following information: initial and repeated test result; time initial and repeat results were first known to laboratory staff; critical result notification time; if the repeat result was still a critical result; if the repeat result was significantly different from the initial result, as judged by the laboratory professional or policy; significant difference threshold, as defined by the laboratory; the make and model of the instrument used for primary and repeat testing. Routine, repeat analysis of critical values is a common practice. Most laboratories did not formally define a significant difference between repeat results. Repeated results were rarely considered significantly different. Median repeated times were at least 17 to 21 minutes for 10% of laboratories. Twenty percent of laboratories reported at least 1 incident in the last calendar year of delayed result reporting that clinicians indicated had adversely affected patient care. Routine repeat analysis of automated chemistry and hematology critical values is unlikely to be clinically useful and may adversely affect patient care.
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The effect of chronotherapy on delirium in critical care - a systematic review.
Luther, Roseanne; McLeod, Anne
2017-05-15
Delirium is highly prevalent within critical care and is linked to adverse clinical outcomes, increased mortality and impaired quality of life. Development of delirium is thought to be caused by multiple risk factors, including disruption of the circadian rhythm. Chronotherapeutic interventions, such as light therapy, music and use of eye shades, have been suggested as an option to improve circadian rhythm within intensive care units. This review aims to answer the question: Can chronotherapy reduce the prevalence of delirium in adult patients in critical care? This study is a systematic review of quantitative studies. Six major electronic databases were searched, and a hand search was undertaken using selected key search terms. Research quality was assessed using the critical appraisal skills programme tools. The studies were critically appraised by both authors independently, and data were extracted. Four themes addressing the research question were identified and critically evaluated. Six primary research articles that investigated different methods of chronotherapy were identified, and the results suggest that multi-component non-pharmacological interventions are the most effective for reducing the prevalence of delirium in critical care. The melatonergic agonist Ramelteon demonstrated statistically significant reductions in delirium; however, the reliability of the results in answering the review question was limited by the research design. The use of bright light therapy (BLT) and dynamic light application had mixed results, with issues with the research design and outcomes measured limiting the validity of the findings. Multi-component non-pharmacological interventions, such as noise and light control, can reduce delirium in critical care, whereas other interventions, such as BLT, have mixed outcomes. Melatonin, as a drug, may be a useful alternative to sedative-hypnotics. Chronotherapy can reduce the incidence of delirium within critical care, although
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Year in review 2010: Critical Care - infection
DEFF Research Database (Denmark)
Pagani, Leonardo; Afshari, Arash; Harbarth, Stephan
2011-01-01
established approaches to the optimal management of infections in the intensive care unit. Rapid infection diagnosis, antibiotic dosing and optimization through pharmacologic indices, progress in the implementation of effective antimicrobial stewardship and infection control programs, and management of fungal...... infections are some of the most relevant issues in this special patient population. During the last 18 months, Critical Care and other journals have provided a wide array of descriptive and interventional clinical studies and scientific reports helping clinical investigators and critical care physicians...
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Glucose monitoring as a guide to diabetes management. Critical subject review.
Koch, B
1996-06-01
To encourage a balanced approach to blood glucose monitoring in diabetes by a critical review of the history, power and cost of glucose testing. The Cambridge Data Base was searched and was supplemented by a random review of other relevant sources, including textbooks, company pamphlets, and laboratory manuals. Keywords used were "glucosuria diagnosis," "blood glucose self-monitoring," "glycosylated hemoglobin," and "fructosamine" for the 10-year period ending 1992, restricted to English language and human. About 200 titles were retrieved and reviewed according to the author's judgment of relevance. "Snapshot tests" (venous and capillary blood glucose) and "memory tests" (urine glucose, glycated hemoglobin fractions and fructosamine) must be employed according to individual patients treatment goals. Day-to-day metabolic guidance is facilitated by capillary blood glucose testing for patients receiving insulin and by urine glucose testing for others. Capillary blood glucose testing is mandatory in cases of hypoglycemia unawareness (inability to sense hypoglycemia because of neuropathy) but is not a substitute for a knowledge of clinical hypoglycemia self-care. Criteria by reason (clinical judgement and cost effectiveness) must be separated from criteria by emotion (preoccupation with technology and marketing). No randomized studies show that any of these tests consistently improve clinical outcome. Optimal metabolic control and cost savings can be expected from a rational selection of tests.
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International Nuclear Information System (INIS)
Rathbun, R.
1993-01-01
Separate review of NMP-NCS-930058, open-quotes Nuclear Criticality Safety Evaluation 93-18 Uranium Solidification Facility's Waste Handling Facility (U), August 17, 1993,close quotes was requested of SRTC Applied Physics Group. The NCSE is a criticality assessment to determine waste container uranium limits in the Uranium Solidification Facility's Waste Handling Facility. The NCSE under review concludes that the NDA room remains in a critically safe configuration for all normal and single credible abnormal conditions. The ability to make this conclusion is highly dependent on array limitation and inclusion of physical barriers between 2x2x1 arrays of boxes containing materials contaminated with uranium. After a thorough review of the NCSE and independent calculations, this reviewer agrees with that conclusion
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The Clinical Use of Robots for Individuals with Autism Spectrum Disorders: A Critical Review
Diehl, Joshua J.; Schmitt, Lauren M.; Villano, Michael; Crowell, Charles R.
2012-01-01
We examined peer-reviewed studies in order to understand the current status of empirically based evidence on the clinical applications of robots in the diagnosis and treatment of Autism Spectrum Disorders (ASD). Studies are organized into four broad categories: (a) the response of individuals with ASD to robots or robot-like behavior in comparison…
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International Nuclear Information System (INIS)
Mc Inerney, J.; Baird, M.
2016-01-01
Background: The capacity to apply critical thinking clinically is no longer an option for radiographers. Radiographers are obliged by their registration board to embrace a contemporary and integrated conceptualisation of competence, including the capacity to think critically and reflectively to resolve clinical challenges. The study examines the complexity of critical thinking, identifies the skill set and personal traits necessary to enact it practically. Methods: Third and final year radiography students' perceptions of three teaching approaches used within the undergraduate course were explored using peer reviewed survey instruments. Thematic analysis and descriptive analyses were applied to the data to make sense of the responses. Conclusions: Students are exhibiting the capacity to formulate, evaluate and revise their own work practices through critical thinking. Educational activities that have been proven effective in empowering students with the skills necessary to meet professional standards and the personal traits required to enact them should be prioritised in curricula. The study has shown that establishment of an audit trail for the educational activities in use within radiography programs can facilitate the acquisition of evidence-based and reflective practice skills amongst students. An assessment of student's perceptions of the learning activities they engage with is an important step on this trail, though a before and after measure could be applied. - Highlights: • Examines the concept of critical thinking including the personal traits required to enact it. • Reviews three teaching activities aimed at teaching critical thinking. • Assesses student perceptions of the activities in facilitating critical thinking skills. • Students who acquire critical thinking skills can undergo transformative learning. • Establishing an audit trail can ensure teaching activities are having desired effect.
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Dental Students' Use of AMSTAR to Critically Appraise Systematic Reviews.
Teich, Sorin T; Heima, Masahiro; Lang, Lisa
2015-09-01
The idea of basing clinical procedures upon evidence gathered by observation is less than 200 years old, with the first set of evidence-based position papers dating back only to the early 1970s. The relationship between evidence-based education and health outcomes is difficult to test and may be indirect, but teaching critical appraisal skills may be beneficial in developing knowledge. Systematic reviews have a central role in the process of clinical decision making in practice and therefore should be of high quality, following a rigorous protocol that can be evaluated with validated tools. The aim of this study was to assess how dental students utilized the Assessment of Multiple Systematic Reviews (AMSTAR) appraisal tool to evaluate systematic reviews in the context of a treatment planning course. During the in-class final exam, students were required to appraise the quality of a systematic review and to justify their answers. Of the 74 third-year students who took the exam, 100% answered all questions on the AMSTAR form. The mean number of correct answers was nine (SD=1.047, Min=6, Max=10), with no student providing all 11 correct answers. The fact that nearly 90% of the students provided eight or more correct answers suggests that AMSTAR can be used by students to evaluate the methodological quality of systematic reviews. It also was evident that although the AMSTAR tool requires less than 15 minutes to complete an evaluation, using it requires extensive training and repetition to achieve consistent and reliable results.
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Lee, Jaebum; Wikesjö, Ulf M E
2014-08-01
Growth/differentiation factor-5 (GDF-5) plays critical roles in mesenchymal cell differentiation and stimulates human periodontal ligament cell proliferation. Potentially, GDF-5 may also play roles in wound healing including periodontal regeneration and alveolar augmentation. The objective of this review was to provide up-to-date information from pre-clinical/clinical studies evaluating GDF-5 for these indications. A comprehensive search using PubMed and Google search engines was conducted to identify reports on GDF-5 applied to periodontal and alveolar indications. Two reviewers independently screened the titles and abstracts from a total of 479 reports. Full-length articles of 17 pre-clinical and four clinical studies were selected and reviewed. Canine-, porcine- and non-human primate-based models as well as human clinical trials were used in the evaluation of GDF-5 in support of periodontal regeneration and alveolar augmentation. An absorbable collagen sponge (ACS), β-tricalcium phosphate (β-TCP) and a poly(lactic-co-glycolic) acid (PLGA) were evaluated as candidate carriers for GDF-5 using various dose and healing intervals demonstrating significantly enhanced periodontal regeneration/alveolar augmentation including cementum, periodontal ligament and alveolar bone with limited, if any, adverse effects. Growth/differentiation factor-5 supports periodontal regeneration/alveolar augmentation without aberrant healing events documented in qualified pre-clinical models and clinical pilot studies. In perspective, GDF-5 appears a promising technology for periodontal regeneration/alveolar augmentation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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International Nuclear Information System (INIS)
Rathbun, R.
1994-01-01
Review of NMP-NCS-94-0087, ''Nuclear Criticality Safety Evaluation 94-02: Uranium Solidification Facility Pencil Tank Module Spacing (U), April 18, 1994,'' was requested of the SRTC Applied Physics Group. The NCSE is a criticality assessment to show that the USF process module spacing, as given in Non-Conformance Report SHM-0045, remains safe for operation. The NCSE under review concludes that the module spacing as given in Non-Conformance Report SHM-0045 remains in a critically safe configuration for all normal and single credible abnormal conditions. After a thorough review of the NCSE, this reviewer agrees with that conclusion
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Kino, Shuichi; Suwabe, Akira
2014-12-01
In 2007, "the Guidelines for Actions against Intraoperative Critical Hemorrhage" were established by the Japanese Society of Anaesthesiologists and the Japanese Society of Blood transfusion and Cell Therapy. The documentation of in-hospital procedures for critical hemorrhage, especially about how to select RBC units, has widely standardized hospital practice. Patients with intraoperative critical hemorrhage sometimes suffer from massive blood loss. In this situation, some patients develop coagulopathy. To treat them, we need to evaluate their coagulation status based on laboratory test results. So, we performed a nationwide questionnaire survey on the current status of hospital clinical laboratories evaluating critical hemorrhage. From the results of this survey, it was recommended that central hospital laboratories should try to reduce the turn-around time required to test for coagulation parameters as much as possible for appropriate substitution therapy. (Review).
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Yue, Meng; Zhang, Meng; Zhang, Chunmei; Jin, Changde
2017-05-01
As an essential skill in daily clinical nursing practice, critical thinking ability has been an important objective in nursing education. Concept mapping enables nursing students connect new information to existing knowledge and integrates interdisciplinary knowledge. However, there is a lack of evidence related to critical thinking ability and concept mapping in nursing education. The purpose of this systematic review and meta-analysis was to assess the effect of concept mapping in developing critical thinking in nursing education. This systematic review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A search was conducted in PubMed, Web of science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health (CINAHL) and China National Knowledge Infrastructure (CNKI). Randomized controlled trials (RCT) comparing concept mapping and traditional teaching method were retrieved. Data were collected by two reviewers according to the data extraction tables. The methodological quality of included studies was assessed by other two reviewers. The results of meta-analysis were presented using mean difference (MD). Thirteen trials were summarized in the systematic review and eleven trials were included in the meta-analysis. The pooled effect size showed that, comparing with traditional methods, concept mapping could improve subjects' critical thinking ability measured by California Critical Thinking Disposition Inventory (CCTDI), California Critical Thinking Skill Test (CCTST) and Critical Thinking Scale (CTS). The subgroup analyses showed that concept mapping improved the score of all subscales. The result of this review indicated that concept mapping could affect the critical thinking affective dispositions and critical thinking cognitive skills. Further high quality research using uniform evaluation is required. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Scholtes, Vanessa A. B.; Becher, Jules G.; Beelen, Anita; Lankhorst, Gustaaf J.
2006-01-01
This study reviews the instruments used for the clinical assessment of spasticity in children with cerebral palsy, and evaluates their compliance with the concept of spasticity, defined as a velocity-dependent increase in muscle tone to passive stretch. Searches were performed in Medline, Embase,
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Review of teaching methods and critical thinking skills.
Kowalczyk, Nina
2011-01-01
Critical information is needed to inform radiation science educators regarding successful critical thinking educational strategies. From an evidence-based research perspective, systematic reviews are identified as the most current and highest level of evidence. Analysis at this high level is crucial in analyzing those teaching methods most appropriate to the development of critical thinking skills. To conduct a systematic literature review to identify teaching methods that demonstrate a positive effect on the development of students' critical thinking skills and to identify how these teaching strategies can best translate to radiologic science educational programs. A comprehensive literature search was conducted resulting in an assessment of 59 full reports. Nineteen of the 59 reports met inclusion criteria and were reviewed based on the level of evidence presented. Inclusion criteria included studies conducted in the past 10 years on sample sizes of 20 or more individuals demonstrating use of specific teaching interventions for 5 to 36 months in postsecondary health-related educational programs. The majority of the research focused on problem-based learning (PBL) requiring standardized small-group activities. Six of the 19 studies focused on PBL and demonstrated significant differences in student critical thinking scores. PBL, as described in the nursing literature, is an effective teaching method that should be used in radiation science education. ©2011 by the American Society of Radiologic Technologists.
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Chiu, Ada W; Contreras, Sofia; Mehta, Sangeeta; Korman, Jennifer; Perreault, Marc M; Williamson, David R; Burry, Lisa D
2017-12-01
To (1) provide an overview of the epidemiology, clinical presentation, and risk factors of iatrogenic opioid withdrawal in critically ill patients and (2) conduct a literature review of assessment and management of iatrogenic opioid withdrawal in critically ill patients. We searched MEDLINE (1946-June 2017), EMBASE (1974-June 2017), and CINAHL (1982-June 2017) with the terms opioid withdrawal, opioid, opiate, critical care, critically ill, assessment tool, scale, taper, weaning, and management. Reference list of identified literature was searched for additional references as well as www.clinicaltrials.gov . We restricted articles to those in English and dealing with humans. We identified 2 validated pediatric critically ill opioid withdrawal assessment tools: (1) Withdrawal Assessment Tool-Version 1 (WAT-1) and (2) Sophia Observation Withdrawal Symptoms Scale (SOS). Neither tool differentiated between opioid and benzodiazepine withdrawal. WAT-1 was evaluated in critically ill adults but not found to be valid. No other adult tool was identified. For management, we identified 5 randomized controlled trials, 2 prospective studies, and 2 systematic reviews. Most studies were small and only 2 studies utilized a validated assessment tool. Enteral methadone, α-2 agonists, and protocolized weaning were studied. We identified 2 validated assessment tools for pediatric intensive care unit patients; no valid tool for adults. Management strategies tested in small trials included methadone, α-2 agonists, and protocolized sedation/weaning. We challenge researchers to create validated tools assessing specifically for opioid withdrawal in critically ill children and adults to direct management.
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Relationships between critical thinking ability and nursing competence in clinical nurses.
Chang, Mei Jen; Chang, Ying-Ju; Kuo, Shih-Hsien; Yang, Yi-Hsin; Chou, Fan-Hao
2011-11-01
To examine the relationships between critical thinking ability and nursing competence in clinical nurses. There are few evidance-based data related to the relationship between critical thinking ability and nursing competence of clinical nurses. A cross-sectional and correlation research design was used. A total of 570 clinical nurses at a medical centre in southern Taiwan were recruited into this study. Two self-report questionnaires, the Watson-Glaser Critical Thinking Appraisal (WGCTA) and the Nursing Competence Scale (NCS), were used to collect data. The critical thinking ability of clinical nurses was at the middle level. The highest score for the subscales of the WGCTA was 'interpretation ability' and the lowest was 'inference ability'. The nursing competence of clinical nurses was at the middle level and above. The highest score for the subscales was 'caring ability' and the lowest was 'research ability'. Critical thinking ability had a significantly positive correlation with nursing competence. Critical thinking, working years, educational levels and position/title were the significant predictors of nursing competence, accounting for 32·9% of the variance. Critical thinking ability had a significantly positive correlation with nursing competence. The critical thinking ability of clinical nurses with a master's degree was significantly better than those with a bachelor's degree or a diploma and nurses with over five working years was significantly better than those with under five years. The findings of this study can further serve as a reference for nursing education to improve nursing curricula and teaching strategies for nurse preparation. It could also be a guideline for nursing administration personnel in on-the-job training and orientation programs for nursing staff. © 2011 Blackwell Publishing Ltd.
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An Integrative Review of the Concealed Connection: Nurse Educators' Critical Thinking.
Raymond, Christy; Profetto-McGrath, Joanne; Myrick, Florence; Strean, William B
2017-11-01
The role of nurse educators in the development of students' critical thinking has been overlooked despite the emphasized need for effective teaching methods. An integrative review was performed to examine both quantitative and qualitative research published from 2000 to 2015 related to nurse educators' critical thinking. Many barriers and facilitators existing on individual, interpersonal, and contextual levels affected nurse educators' critical thinking. Various tools have been used to measure nurse educators' critical thinking. This review also highlighted the continued lack of a consensus definition of critical thinking and the limited presence of conceptual models to guide the use of critical thinking in nursing education. Continued examination of nurse educators' critical thinking is needed, given the limited number of studies that have been completed. Much needs to be explored further, including conceptualizations of critical thinking and confirmation of emerging themes identified in this review. [J Nurs Educ. 2017;56(11):648-654.]. © 2017 Raymond, Profetto-McGrath, Myrick, et al.
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Randomized clinical trials in pediatric critical care: Rarely done but desperately needed.
Randolph, Adrienne G.; Lacroix, Jacques
2002-04-01
OBJECTIVE: To review the benefits and challenges of using the randomized, controlled trial (RCT) study design to evaluate preventive and therapeutic interventions in pediatric critical care medicine. CONCLUSIONS: The RCT design is able to control for many sources of potential bias that other types of study designs cannot. The findings of RCTs often contradict the findings of less rigorous study designs. Before performing an RCT, there must exist a state of clinical equipoise, a sufficient number of eligible patients must be available, and the epidemiology of the disorder in question must be well studied. There are many challenges to performing high-quality RCTs. Studying multiple element support strategies in the critically ill patient population is more complex than studying a single drug therapy. High patient and practice variability and hazy diagnostic definitions can dilute the signal-to-noise ratio. Most interventions in critical care are expected to have a modest or small effect. This markedly increases the requisite sample size. There is a paucity of accepted clinically important measurements of the outcome of critical care, making mortality a common outcome to evaluate with a not-so-common incidence. Developmental issues, the inability to give informed consent, and the failure to perform the appropriate pharmacokinetic and safety studies are additional challenges facing pediatric investigators. Despite these limitations, a good RCT remains the best way to prove that an intervention is working or not. Indeed, RCTs are and will remain the "gold standard" method to estimate the efficacy of a therapeutic or prophylactic intervention.
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A critical review of objective personality inventories with sex offenders.
Davis, Karen M; Archer, Robert P
2010-12-01
This review provides a critical analysis of the ability of multiscale inventories to distinguish between sex offender and nonoffender control groups, as well as to discriminate sex offenders from other types of offenders. In addition to expanding upon previous reviews that examined the utility of the Minnesota Multiphasic Personality Inventory (MMPI) with this population (e.g., Levin & Stava, 1987), the current review included studies that utilized other multiscale inventories commonly used in forensic practice (i.e., MMPI-2, Millon Clinical Multiaxial Inventory-III [MCMI-III], Personality Assessment Inventory) and, when possible, provides effect sizes to evaluate group differences. Based on the review, the various forms of the MMPI and MCMI are clearly the most widely used instruments in sex offender populations. The MMPI Pd scale has shown moderate to large effect sizes when distinguishing between sex offender and nonsex offender groups, but this relationship may be reflective of antisocial behavior in general rather than traits specific to sex offenders. Recommendations to standardize future research classification strategies and more effectively utilize these instruments when assessing sex offenders are also provided. © 2010 Wiley Periodicals, Inc.
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Challenges of assessing critical thinking and clinical judgment in nurse practitioner students.
Gorton, Karen L; Hayes, Janice
2014-03-01
The purpose of this study was to determine whether there was a relationship between critical thinking skills and clinical judgment in nurse practitioner students. The study used a convenience, nonprobability sampling technique, engaging participants from across the United States. Correlational analysis demonstrated no statistically significant relationship between critical thinking skills and examination-style questions, critical thinking skills and scores on the evaluation and reevaluation of consequences subscale of the Clinical Decision Making in Nursing Scale, and critical thinking skills and the preceptor evaluation tool. The study found no statistically significant relationships between critical thinking skills and clinical judgment. Educators and practitioners could consider further research in these areas to gain insight into how critical thinking is and could be measured, to gain insight into the clinical decision making skills of nurse practitioner students, and to gain insight into the development and measurement of critical thinking skills in advanced practice educational programs. Copyright 2014, SLACK Incorporated.
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[Clinical decision making and critical thinking in the nursing diagnostic process].
Müller-Staub, Maria
2006-10-01
The daily routine requires complex thinking processes of nurses, but clinical decision making and critical thinking are underestimated in nursing. A great demand for educational measures in clinical judgement related with the diagnostic process was found in nurses. The German literature hardly describes nursing diagnoses as clinical judgements about human reactions on health problems / life processes. Critical thinking is described as an intellectual, disciplined process of active conceptualisation, application and synthesis of information. It is gained through observation, experience, reflection and communication and leads thinking and action. Critical thinking influences the aspects of clinical decision making a) diagnostic judgement, b) therapeutic reasoning and c) ethical decision making. Human reactions are complex processes and in their course, human behavior is interpreted in the focus of health. Therefore, more attention should be given to the nursing diagnostic process. This article presents the theoretical framework of the paper "Clinical decision making: Fostering critical thinking in the nursing diagnostic process through case studies".
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A critical review of clarifier modelling
DEFF Research Database (Denmark)
Plósz, Benedek; Nopens, Ingmar; Rieger, Leiv
This outline paper aims to provide a critical review of secondary settling tank (SST) modelling approaches used in current wastewater engineering and develop tools not yet applied in practice. We address the development of different tier models and experimental techniques in the field...
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Ward, Amanda M
2016-11-01
Episodic future thinking is defined as the ability to mentally simulate a future event. Although episodic future thinking has been studied extensively in neuroscience, this construct has not been explored in depth from the perspective of clinical neuropsychology. The aim of this critical narrative review is to assess the validity and clinical implications of episodic future thinking. A systematic review of episodic future thinking literature was conducted. PubMed and PsycInfo were searched through July 2015 for review and empirical articles with the following search terms: "episodic future thinking," "future mental simulation," "imagining the future," "imagining new experiences," "future mental time travel," "future autobiographical experience," and "prospection." The review discusses evidence that episodic future thinking is important for adaptive functioning, which has implications for neurological populations. To determine the validity of episodic future thinking, the construct is evaluated with respect to related constructs, such as imagination, episodic memory, autobiographical memory, prospective memory, narrative construction, and working memory. Although it has been minimally investigated, there is evidence of convergent and discriminant validity for episodic future thinking. Research has not addressed the incremental validity of episodic future thinking. Practical considerations of episodic future thinking tasks and related constructs in a clinical neuropsychological setting are considered. The utility of episodic future thinking is currently unknown due to the lack of research investigating the validity of episodic future thinking. Future work is discussed, which could determine whether episodic future thinking is an important missing piece in standard clinical neuropsychological assessment. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
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Radium-223 in the Treatment of Osteoblastic Metastases: A Critical Clinical Review
Energy Technology Data Exchange (ETDEWEB)
Humm, John L. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Sartor, Oliver [Departments of Medicine and Urology, Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana (United States); Parker, Chris [Department of Clinical Oncology, Institute of Cancer Research, Sutton (United Kingdom); Bruland, Oyvind S. [Department of Oncology, Norwegian Radium Hospital and Institute for Clinical Medicine, University of Oslo, Oslo (Norway); Macklis, Roger, E-mail: rmmacklis@gmail.com [Department of Radiation Oncology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio (United States)
2015-04-01
The element radium (Ra) was discovered by the Curies in 1898 and within a decade was in broad scientific testing for the management of several forms of cancer. The compound was known to give rise to a series of both high-energy particulate and penetrating γ-emissions. The latter found an important role in early 20th century brachytherapy applications, but the short-range α-particles seemed much less useful. Although highly cytotoxic when released within a few cell diameters of critical cell nuclei, the dense double-strand break damage was poorly repaired, and concerns regarding treatment-related toxicities and secondary malignancies halted clinical development. Moreover, the most common isotope of Ra has an exceptionally long half-life (>1600 years for {sup 226}Ra) that proved daunting when aiming for a systemic cancer therapy. Fortunately, other radium isotopes have more convenient half-lives while still producing cytotoxic α particles. Radium-223 dichloride has a half-life of 11.4 days, and this isotope was identified as an excellent candidate for radionuclide therapy of cancers metastatic to bone. The calcium-mimetic chemical properties of the radium allowed intravenous infusion with rapid uptake to sites of new bone formation. The highly efficient bone localization suggested a potential therapeutic role for osteoblastic bone metastases, and a series of phase 1, 2, and 3 clinical trials was undertaken to explore this possibility. This series of clinical explorations culminated in the ALSYMPCA trial, an international, placebo-controlled, phase 3 study that accrued 921 symptomatic men with bone-metastatic, castrate-resistant prostate cancer. Results of this trial demonstrated a prolongation of overall survival, and regulatory agencies around the world have now approved this product as a treatment for advanced prostate cancer.
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Bear, Danielle E; Wandrag, Liesl; Merriweather, Judith L; Connolly, Bronwen; Hart, Nicholas; Grocott, Michael P W
2017-08-26
The lack of benefit from randomised controlled trials has resulted in significant controversy regarding the role of nutrition during critical illness in terms of long-term recovery and outcome. Although methodological caveats with a failure to adequately appreciate biological mechanisms may explain these disappointing results, it must be acknowledged that nutritional support during early critical illness, when considered alone, may have limited long-term functional impact.This narrative review focuses specifically on recent clinical trials and evaluates the impact of nutrition during critical illness on long-term physical and functional recovery.Specific focus on the trial design and methodological limitations has been considered in detail. Limitations include delivery of caloric and protein targets, patient heterogeneity, short duration of intervention, inappropriate clinical outcomes and a disregard for baseline nutritional status and nutritional intake in the post-ICU period.With survivorship at the forefront of critical care research, it is imperative that nutrition studies carefully consider biological mechanisms and trial design because these factors can strongly influence outcomes, in particular long-term physical and functional outcome. Failure to do so may lead to inconclusive clinical trials and consequent rejection of the potentially beneficial effects of nutrition interventions during critical illness.
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Clinical review: Riedel's thyroiditis: a clinical review.
Hennessey, James V
2011-10-01
Riedel's thyroiditis is a rare inflammatory process involving the thyroid and surrounding cervical tissues and is associated with various forms of systemic fibrosis. Riedel's presentation is complex, including a thyroid mass associated with local symptoms, characteristic biochemical abnormalities such as hypocalcemia and hypothyroidism, as well as the involvement of a wide range of other organ systems. Diagnosis of Riedel's thyroiditis requires histopathological confirmation, but due to high complication rates, the role of surgical intervention is limited to airway decompression and diagnostic tissue retrieval. Unique among processes of the thyroid, Riedel's is commonly treated with long-term antiinflammatory medications to arrest progression and maintain a symptom-free course. Due to its rarity, Riedel's may not be immediately diagnosed, so clinicians benefit from recognizing the constellation of findings that should make prompt diagnosis possible. A review of print and electronic reviews was conducted. Source references were identified, and available literature was reviewed. A search of the PubMed database using the search term "Riedel's thyroiditis" was cross-referenced with associated clinical findings, systemic fibrosis diagnoses, and therapeutic search terms. Because most of the literature consisted of case reports and very small series, inclusion of identified articles was based on clinical descriptions of the subjects included and the criteria for diagnosis reported. More weight was attributed to series, using contemporary criteria for diagnosis. Case reports were included if the diagnosis was clear and clinical presentation was unique to illustrate the spectrum of disease. Because the majority of therapeutic intervention data were based upon case reports and very small series, an evidence-based approach was problematic, but information is presented as objectively and with as much balance as the limited quality of the data allows. Clinical awareness of the
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De Jong, I.K.E.; Burgers, C.F.
2013-01-01
Consumers often base their choices to purchase experience goods like movies on online reviews. These reviews can be written by professional critics or by other consumers. However, little is known on the issue how the texts written by these two groups of reviewers differ. To answer this question, we
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Herbal Medicine in Mexico: A Cause of Hepatotoxicity. A Critical Review.
Valdivia-Correa, Bárbara; Gómez-Gutiérrez, Cristina; Uribe, Misael; Méndez-Sánchez, Nahum
2016-02-15
In Mexico, herbal products are commonly used as therapeutic tools. The analysis of several publications reveals that there are dozens of different herbs and herbal products used for different reasons, some of which have been implicated in causing toxic liver disease. However, methodological aspects limit the attribution of causality, and the precise incidence and clinical manifestations of herb-induced liver injury have not been well characterized. This review outlines the history of traditional herbal medicine in Mexico, critically summarizes the mechanisms and adverse effects of commonly used herbal plants, and examines the regulatory issues regarding the legal use of these products.
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Notes on critical care-review of seminal management and leadership papers in the United Kingdom.
Coombs, Maureen
2009-06-01
Review of recent critical care provision reveals substantial changes in clinical unit operating, and policy drivers influencing international critical care delivery. Practitioners who have worked in healthcare environments over this time, will have witnessed substantial shifts in healthcare policy, changes in professional body guidance and greater service evaluation have impacted on critical care management and leadership. This paper offers a personal perspective on seminal management and leadership papers published in the critical care literature over the past decade. Presenting a range of national and international work that utilise diverse approaches, ten key papers are highlighted that have impacted in the United Kingdom setting. Through this, the influence of the modernisation agenda, the increasing significance of outcome studies, and the need for flexible, interdependent practice emerges. A key message to surface from this paper is the need for all in critical care to engage with, and understand the wider implications of management and leadership change for critical care delivery.
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Clinical review: International comparisons in critical care - lessons learned.
Murthy, Srinivas; Wunsch, Hannah
2012-12-12
Critical care medicine is a global specialty and epidemiologic research among countries provides important data on availability of critical care resources, best practices, and alternative options for delivery of care. Understanding the diversity across healthcare systems allows us to explore that rich variability and understand better the nature of delivery systems and their impact on outcomes. However, because the delivery of ICU services is complex (for example, interplay of bed availability, cultural norms and population case-mix), the diversity among countries also creates challenges when interpreting and applying data. This complexity has profound influences on reported outcomes, often obscuring true differences. Future research should emphasize determination of resource data worldwide in order to understand current practices in different countries; this will permit rational pandemic and disaster planning, allow comparisons of in-ICU processes of care, and facilitate addition of pre- and post-ICU patient data to better interpret outcomes.
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Healthcare disparities in critical illness.
Soto, Graciela J; Martin, Greg S; Gong, Michelle Ng
2013-12-01
To summarize the current literature on racial and gender disparities in critical care and the mechanisms underlying these disparities in the course of acute critical illness. MEDLINE search on the published literature addressing racial, ethnic, or gender disparities in acute critical illness, such as sepsis, acute lung injury, pneumonia, venous thromboembolism, and cardiac arrest. Clinical studies that evaluated general critically ill patient populations in the United States as well as specific critical care conditions were reviewed with a focus on studies evaluating factors and contributors to health disparities. Study findings are presented according to their association with the prevalence, clinical presentation, management, and outcomes in acute critical illness. This review presents potential contributors for racial and gender disparities related to genetic susceptibility, comorbidities, preventive health services, socioeconomic factors, cultural differences, and access to care. The data are organized along the course of acute critical illness. The literature to date shows that disparities in critical care are most likely multifactorial involving individual, community, and hospital-level factors at several points in the continuum of acute critical illness. The data presented identify potential targets as interventions to reduce disparities in critical care and future avenues for research.
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Critical review of directional neutron survey meters
International Nuclear Information System (INIS)
Balmer, Matthew J.I.; Gamage, Kelum A.A.; Taylor, Graeme C.
2014-01-01
Having been overlooked for many years, research is now starting to take into account the directional distribution of the neutron work place field. The impact of not taking this into account has led to overly conservative estimates of dose in neutron workplace fields. This paper provides a critical review of this existing research into directional survey meters which could improve these estimates of dose. Instruments which could be adapted for use as directional neutron survey meters are also considered within this review. Using Monte-Carlo techniques, two of the most promising existing designs are evaluated; a boron-doped liquid scintillator and a multi-detector directional spectrometer. As an outcome of these simulations, possible adaptations to these instruments are suggested with a view to improving the portability of the instrument. -- Highlights: • We critically review the existing literature into directional survey meters. • Instruments which could be adapted for this purpose are also reviewed. • Investigate the potential of much lighter portable real-time instrument. • Improvements to existing instruments are suggested to improve their design. • Boron-Doped liquid scintillator design is the most promising, but needs further work
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Reasons For Physicians Not Adopting Clinical Decision Support Systems: Critical Analysis.
Khairat, Saif; Marc, David; Crosby, William; Al Sanousi, Ali
2018-04-18
Clinical decision support systems (CDSSs) are an integral component of today's health information technologies. They assist with interpretation, diagnosis, and treatment. A CDSS can be embedded throughout the patient safety continuum providing reminders, recommendations, and alerts to health care providers. Although CDSSs have been shown to reduce medical errors and improve patient outcomes, they have fallen short of their full potential. User acceptance has been identified as one of the potential reasons for this shortfall. The purpose of this paper was to conduct a critical review and task analysis of CDSS research and to develop a new framework for CDSS design in order to achieve user acceptance. A critical review of CDSS papers was conducted with a focus on user acceptance. To gain a greater understanding of the problems associated with CDSS acceptance, we conducted a task analysis to identify and describe the goals, user input, system output, knowledge requirements, and constraints from two different perspectives: the machine (ie, the CDSS engine) and the user (ie, the physician). Favorability of CDSSs was based on user acceptance of clinical guidelines, reminders, alerts, and diagnostic suggestions. We propose two models: (1) the user acceptance and system adaptation design model, which includes optimizing CDSS design based on user needs/expectations, and (2) the input-process-output-engagemodel, which reveals to users the processes that govern CDSS outputs. This research demonstrates that the incorporation of the proposed models will improve user acceptance to support the beneficial effects of CDSSs adoption. Ultimately, if a user does not accept technology, this not only poses a threat to the use of the technology but can also pose a threat to the health and well-being of patients. ©Saif Khairat, David Marc, William Crosby, Ali Al Sanousi. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 18.04.2018.
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Jiang, Jian; Peng, Wenbo; Gu, Tieguang; King, Catherine; Yin, J Kevin
2016-01-01
The increasing acceptance of traditional Chinese medicine (TCM) worldwide has highlighted the importance of ensuring the provision of high-quality TCM clinical education. This clinical training should be partly guided by a robust assessment of patient data outcomes in TCM teaching clinics. We undertook a comprehensive literature review to examine the data evaluation in TCM teaching clinics outside China and its implications for TCM education. Literature was retrieved via MEDLINE (from 1946 to January 2015), EMBASE (from 1980 to February 2015), and Google Scholar for studies conducted outside China. The search was restricted to English articles reporting empirical findings related to the assessments of patient data in TCM teaching clinics, with implications for TCM education in countries other than China. Only seven articles from six studies met the inclusion criteria. The characteristics and main symptoms of patients who received any TCM treatment in the context of teaching clinics among all included studies were similar. Symptom relief as well as a high level of patient satisfaction with TCM treatment were found in TCM teaching clinics. Conventional healthcare providers and other complementary practitioners were not the main source of referral to TCM practitioners but rather patients׳ friends/relatives. Patients received acupuncture treatment more frequently than treatments utilizing Chinese herbal medicine in teaching clinics. A standardized and consistent framework for patient records within TCM teaching clinics is currently lacking. There was no robust study which "translated" TCM clinic data evaluation findings into implications for TCM education and clinical training. Recognizing that TCM evolves over time and its practice varies in different settings, there is an urgent need to conduct large-scale, rigorous evaluations of TCM clinic data to address the findings of our review, with the purpose of better informing TCM education and clinical training in
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Review and classification of variability analysis techniques with clinical applications
2011-01-01
Analysis of patterns of variation of time-series, termed variability analysis, represents a rapidly evolving discipline with increasing applications in different fields of science. In medicine and in particular critical care, efforts have focussed on evaluating the clinical utility of variability. However, the growth and complexity of techniques applicable to this field have made interpretation and understanding of variability more challenging. Our objective is to provide an updated review of variability analysis techniques suitable for clinical applications. We review more than 70 variability techniques, providing for each technique a brief description of the underlying theory and assumptions, together with a summary of clinical applications. We propose a revised classification for the domains of variability techniques, which include statistical, geometric, energetic, informational, and invariant. We discuss the process of calculation, often necessitating a mathematical transform of the time-series. Our aims are to summarize a broad literature, promote a shared vocabulary that would improve the exchange of ideas, and the analyses of the results between different studies. We conclude with challenges for the evolving science of variability analysis. PMID:21985357
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Review and classification of variability analysis techniques with clinical applications.
Bravi, Andrea; Longtin, André; Seely, Andrew J E
2011-10-10
Analysis of patterns of variation of time-series, termed variability analysis, represents a rapidly evolving discipline with increasing applications in different fields of science. In medicine and in particular critical care, efforts have focussed on evaluating the clinical utility of variability. However, the growth and complexity of techniques applicable to this field have made interpretation and understanding of variability more challenging. Our objective is to provide an updated review of variability analysis techniques suitable for clinical applications. We review more than 70 variability techniques, providing for each technique a brief description of the underlying theory and assumptions, together with a summary of clinical applications. We propose a revised classification for the domains of variability techniques, which include statistical, geometric, energetic, informational, and invariant. We discuss the process of calculation, often necessitating a mathematical transform of the time-series. Our aims are to summarize a broad literature, promote a shared vocabulary that would improve the exchange of ideas, and the analyses of the results between different studies. We conclude with challenges for the evolving science of variability analysis.
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A critical appraisal of clinical practice guidelines for the treatment of lower-limb osteoarthritis
Pencharz, James N; Grigoriadis, Elizabeth; Jansz, Gwenderlyn F; Bombardier, Claire
2002-01-01
Clinical practice guidelines are important tools to assist clinical decision-making. Recently, several guidelines addressing the management of osteoarthritis (OA) have been published. Clinicians treating patients with OA must ensure that these guidelines are developed with consistency and methodological rigour. We undertook a qualitative summary and critical appraisal of six medical treatment guidelines for the management of lower-limb OA published in the medical literature within the past 5 years. A review of these six guidelines revealed that each possesses strengths and weakness. While most described the scope and intended patient populations, the guidelines varied considerably in the rigour of their development, coverage of implementation issues, and disclosure of conflicts of interest. PMID:11879536
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Hypersexuality: A Critical Review and Introduction to the "Sexhavior Cycle".
Walton, Michael T; Cantor, James M; Bhullar, Navjot; Lykins, Amy D
2017-11-01
An empirical review of hypersexuality is timely as "compulsive sexual behavior" is being considered as an impulse control disorder for inclusion in the forthcoming International Classification of Diseases, 11th ed. Specifically, hypersexuality has been conceptualized in the literature as the inability to regulate one's sexual behavior that is a source of significant personal distress. Various theoretical models have been posited in an attempt to understand the occurrence of hypersexuality, although disagreement about these divergent conceptualizations of the condition has made assessment and treatment of hypersexual clients more challenging. Theories of sexual compulsivity, sexual impulsivity, dual control (sexual inhibition/excitation), and sex addiction are critically examined, as are the diagnostic criteria for clinically assessing hypersexuality as a sexual disorder. Our discussion of hypersexuality covers a diversity of research and clinical perspectives. We also address various challenges associated with reliably defining, psychometrically measuring, and diagnosing hypersexuality. Furthermore, literature is reviewed that expresses concerns regarding whether hypersexuality (conceptualized as a disorder) exists, whether it is simply normophilic behavior at the extreme end of sexual functioning, or alternatively is a presenting problem that requires treatment rather than a clinical diagnosis. Following our literature review, we developed the "sexhavior cycle of hypersexuality" to potentially explain the neuropsychology and maintenance cycle of hypersexuality. The sexhavior cycle suggests that, for some hypersexual persons, high sexual arousal may temporarily and adversely impact cognitive processing (cognitive abeyance) and explain a repeated pattern of psychological distress when interpreting one's sexual behavior (sexual incongruence). We also suggest that further research is required to validate whether hypersexuality is a behavioral disorder (such as
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Knowledge translation interventions for critically ill patients: a systematic review*.
Sinuff, Tasnim; Muscedere, John; Adhikari, Neill K J; Stelfox, Henry T; Dodek, Peter; Heyland, Daren K; Rubenfeld, Gordon D; Cook, Deborah J; Pinto, Ruxandra; Manoharan, Venika; Currie, Jan; Cahill, Naomi; Friedrich, Jan O; Amaral, Andre; Piquette, Dominique; Scales, Damon C; Dhanani, Sonny; Garland, Allan
2013-11-01
We systematically reviewed ICU-based knowledge translation studies to assess the impact of knowledge translation interventions on processes and outcomes of care. We searched electronic databases (to July, 2010) without language restrictions and hand-searched reference lists of relevant studies and reviews. Two reviewers independently identified randomized controlled trials and observational studies comparing any ICU-based knowledge translation intervention (e.g., protocols, guidelines, and audit and feedback) to management without a knowledge translation intervention. We focused on clinical topics that were addressed in greater than or equal to five studies. Pairs of reviewers abstracted data on the clinical topic, knowledge translation intervention(s), process of care measures, and patient outcomes. For each individual or combination of knowledge translation intervention(s) addressed in greater than or equal to three studies, we summarized each study using median risk ratio for dichotomous and standardized mean difference for continuous process measures. We used random-effects models. Anticipating a small number of randomized controlled trials, our primary meta-analyses included randomized controlled trials and observational studies. In separate sensitivity analyses, we excluded randomized controlled trials and collapsed protocols, guidelines, and bundles into one category of intervention. We conducted meta-analyses for clinical outcomes (ICU and hospital mortality, ventilator-associated pneumonia, duration of mechanical ventilation, and ICU length of stay) related to interventions that were associated with improvements in processes of care. From 11,742 publications, we included 119 investigations (seven randomized controlled trials, 112 observational studies) on nine clinical topics. Interventions that included protocols with or without education improved continuous process measures (seven observational studies and one randomized controlled trial; standardized
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Added value of FM – a critical review
DEFF Research Database (Denmark)
Jensen, Per Anker; van der Voordt, Theo
2015-01-01
The purpose of this paper is to provide a state of the art of how the topic “Added value of FM” has been treated recently in research and practice. The paper is based on research papers from EFMC 2013 and 2014. The paper provides an overview and a critical review of this research. A main focus...... is to examine to which degree there is a cumulative knowledge building in this field. The paper also summarises findings about value adding management in practice and reflects on implications for research and practice. The critical review shows that some of the papers have a strong foundation in former research...
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DEFF Research Database (Denmark)
Krag, Mette; Perner, Anders; Wetterslev, Jørn
2014-01-01
PURPOSE: To assess the effects of stress ulcer prophylaxis (SUP) versus placebo or no prophylaxis on all-cause mortality, gastrointestinal (GI) bleeding and hospital-acquired pneumonia in adult critically ill patients in the intensive care unit (ICU). METHODS: We performed a systematic review using...... meta-analysis and trial sequential analysis (TSA). Eligible trials were randomised clinical trials comparing proton pump inhibitors or histamine 2 receptor antagonists with either placebo or no prophylaxis. Two reviewers independently assessed studies for inclusion and extracted data. The Cochrane...... of bias. There was no statistically significant difference in mortality (fixed effect: RR 1.00, 95% CI 0.84-1.20; P = 0.87; I(2) = 0%) or hospital-acquired pneumonia (random effects: RR 1.23, 95% CI 0.86-1.78; P = 0.28; I(2) = 19%) between SUP patients and the no prophylaxis/placebo patients...
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[Elaboration and critical evaluation of clinical guidelines].
García Villar, C
2015-11-01
Clinical guidelines are documents to help professionals and patients select the best diagnostic or therapeutic option. Elaborating guidelines requires an efficient literature search and a critical evaluation of the articles found to select the most appropriate ones. After that, the recommendations are formulated and then must be externally evaluated before they can be disseminated. Even when the guidelines are very thorough and rigorous, it is important to know whether they fulfill all the methodological requisites before applying them. With this aim, various scales have been developed to critically appraise guidelines. Of these, the AGREE II instrument is currently the most widely used. This article explains the main steps in elaborating clinical guidelines and the main aspects that should be analyzed to know whether the guidelines are well written. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.
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Facilitating critical thinking within the nursing process framework: A ...
African Journals Online (AJOL)
Facilitating critical thinking within the nursing process framework: A literature review. ... Journal Home > Vol 12, No 4 (2007) > ... critical clinical decisions and also make astute clinical judgment that are logical to solve health related problems.
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Relevance of collagen piezoelectricity to "Wolff's Law": a critical review.
Ahn, Andrew C; Grodzinsky, Alan J
2009-09-01
According to "Wolff's Law", bone is deposited and reinforced at areas of greatest stress. From a clinical perspective, this "law" is supported by the strong association between bone density and physical activity. From a mechanistic standpoint, however, the law presents a challenge to scientists seeking to understand how osteocytes and osteoblasts sense the mechanical load. In the 1960s, collagen piezoelectricity was invoked as a potential mechanism by which osteocytes could detect areas of greater stress but piezoelectricity diminished in importance as more compelling mechanisms, such as streaming potential, were identified. In addition, accumulating evidence for the role of fluid-related shear stress in osteocyte's mechanosensory function has made piezoelectricity seemingly more obsolete in bone physiology. This review critically evaluates the role of collagen piezoelectricity (if any) in Wolff's Law--specifically, the evidence regarding its involvement in strain-generated potentials, existing alternate mechanisms, the present understanding of bone mechanosensation, and whether piezoelectricity serves an influential role within the context of this newly proposed mechanism. In addition to reviewing the literature, this review generates several hypotheses and proposes future research to fully address the relevance of piezoelectricity in bone physiology.
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Critical review of Compton imaging
International Nuclear Information System (INIS)
Guzzardi, R.; Licitra, G.
1987-01-01
This paper reviews the basic aspects, problems, and applications of Compton imaging including those related to nonmedical applications. The physics and technology at the base of this specific methodology are analyzed and the relative differences and merits with respect to other imaging techniques, using ionizing radiations, are reviewed. The basic Compton imaging approaches, i.e., point-by-point, line-by-line, and plane-by-plane, are analyzed. Specifically, physical design and technological aspects are reviewed and discussed. Furthermore, the most important clinical applications of the different methods are presented and discussed. Finally, possibilities and applications of the Compton imaging method to other nonmedical fields, as in the case of the important area of object defects recognition, are analyzed and reviewed. 56 references
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Plant safety review from mass criticality accident
International Nuclear Information System (INIS)
Susanto, B.G.
2000-01-01
The review has been done to understand the resent status of the plant in facing postulated mass criticality accident. From the design concept of the plant all the components in the system including functional groups have been designed based on favorable mass/geometry safety principle. The criticality safety for each component is guaranteed because all the dimensions relevant to criticality of the components are smaller than dimensions of 'favorable mass/geometry'. The procedures covering all aspects affecting quality including the safety related are developed and adhered to at all times. Staff are indoctrinated periodically in short training session to warn the important of the safety in process of production. The plant is fully equipped with 6 (six) criticality detectors in strategic places to alert employees whenever the postulated mass criticality accident occur. In the event of Nuclear Emergency Preparedness, PT BATAN TEKNOLOGI has also proposed the organization structure how promptly to report the crisis to Nuclear Energy Control Board (BAPETEN) Indonesia. (author)
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Kroenke, K; Swindle, R
2000-01-01
Few treatments for somatization have been proven effective. In the past decade, however, clinical trials of cognitive-behavioral therapy (CBT) have been promising. Our aim was to critically review and synthesize the evidence from these trials. A search of the Medline database from 1966 through July 1999 was conducted to identify controlled trials designed to evaluate the efficacy of CBT in patients with somatization or symptom syndromes. A total of 31 controlled trials (29 randomized and 2 nonrandomized) were identified. Twenty-five studies targeted a specific syndrome (e.g. chronic fatigue, irritable bowel, pain) while 6 focused on more general somatization or hypochondriasis. Primary outcome assessment included physical symptoms, psychological distress and functional status in 28, 26 and 19 studies, respectively. Physical symptoms appeared the most responsive: CBT-treated patients improved more than control subjects in 71% of the studies and showed possibly greater improvement (i.e., a trend) in another 11% of the studies. A definite or possible advantage of CBT for reducing psychological distress was demonstrated in only 38 and 8% of studies, and for improving functional status in 47 and 26%. Group therapy and interventions as brief as 5 sessions proved efficacious. Benefits were sustained for up to 12 months. CBT can be an effective treatment for patients with somatization or symptom syndromes. Benefits can occur whether or not psychological distress is ameliorated. Since chronic symptoms are exceptionally common and most studies were conducted in referral populations, the optimal sequencing of CBT in treating primary care patients and the identification of those most likely to accept and respond to therapy should be further evaluated. Copyright 2000 S. Karger AG, Basel.
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Identifying critical thinking indicators and critical thinker attributes in nursing practice.
Chao, Shu-Yuan; Liu, Hsing-Yuan; Wu, Ming-Chang; Clark, Mary Jo; Tan, Jung-Ying
2013-09-01
Critical thinking is an essential skill in the nursing process. Although several studies have evaluated the critical thinking skills of nurses, there is limited information related to the indicators of critical thinking or evaluation of critical thinking in the context of the nursing process. This study investigated the potential indicators of critical thinking and the attributes of critical thinkers in clinical nursing practice. Knowledge of these indicators can aid the development of tools to assess nursing students' critical thinking skills. The study was conducted between September 2009 and August 2010. In phase 1, a literature review and four focus groups were conducted to identify the indicators of critical thinking in the context of nursing and the attributes of critical thinkers. In phase 2, 30 nursing professionals participated in a modified Delphi research survey to establish consensus and the appropriateness of each indicator and attribute identified in phase 1. We identified 37 indicators of critical thinking and 10 attributes of critical thinkers. The indicators were categorized into five subscales within the context of the nursing process toreflect nursing clinical practice: assessment, 16 indicators of ability to apply professional knowledge and skills to analyze and interpret patient problems; diagnosis, five indicators of ability to propose preliminary suppositions; planning, five indicators of ability to develop problem-solving strategies; implementation, five indicators of ability to implement planning; and evaluation, six indicators of ability to self-assess and reflect. The study operationalized critical thinking into a practical indicator suitable for nursing contexts in which critical thinking is required for clinical problem solving. Identified indicators and attributes can assist clinical instructors to evaluate student critical thought skills and development-related teaching strategies.
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USING POWDERED ACTIVATED CARBON: A CRITICAL REVIEW
Because the performance of powdered activated carbon (PAC) for uses other than taste and odor control is poorly documented, the purpose of this article is to critically review uses that have been reported (i.e., pesticides and herbicides, synthetic organic chemicals, and trihalom...
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Pediatric Critical Care Telemedicine Program: A Single Institution Review.
Hernandez, Maria; Hojman, Nayla; Sadorra, Candace; Dharmar, Madan; Nesbitt, Thomas S; Litman, Rebecca; Marcin, James P
2016-01-01
Rural and community emergency departments (EDs) often receive and treat critically ill children despite limited access to pediatric expertise. Increasingly, pediatric critical care programs at children's hospitals are using telemedicine to provide consultations to these EDs with the goal of increasing the quality of care. We conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital. Between the years 2000 and 2014, we reviewed all telemedicine consultations provided to children in rural and community EDs, classified the visits using a comprehensive evidence-based set of chief complaints, and reported the consultations' impact on patient disposition. We also reviewed the total number of pediatric ED visits to calculate the relative frequency with which telemedicine consultations were provided. During the study period, there were 308 consultations provided to acutely ill and/or injured children for a variety of chief complaints, most commonly for respiratory illnesses, acute injury, and neurological conditions. Since inception, the number of consultations has been increasing, as has the number of participating EDs (n = 18). Telemedicine consultations were conducted on 8.6% of seriously ill children, the majority of which resulted in admission to the receiving hospital (n = 150, 49%), with a minority of patients requiring transport to the university children's hospital (n = 103, 33%). This single institutional, university children's hospital-based review demonstrates that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community EDs is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.
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DEFF Research Database (Denmark)
Thyssen, Jacob P; Giménez-Arnau, Elena; Lepoittevin, Jean-Pierre
2012-01-01
To identify specific cases, classes or specific use situations of chemicals for which 'safety thresholds' or 'safety limits' were set (in regulations, standards, in scientific research/clinical work, etc.) and critically review the scientific and methodological parameters used to set those limits....
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English language learning materials a critical review
Tomlinson
2010-01-01
This research collection presents a critical review of the materials used for learning English around the world. The first section includes a discussion of materials for specific learners and purposes, such as young learners, self-study, academic writing and general proficiency. The second section presents a detailed study of the materials used in Europe, Asia, North America, South America, Africa and Australia, and critically evaluates their effectiveness in the teaching of English to speakers of other languages. Taking both the teacher's and the learner's needs into consideration, the book m
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Clinical concept mapping: Does it improve discipline-based critical thinking of nursing students?
Moattari, Marzieh; Soleimani, Sara; Moghaddam, Neda Jamali; Mehbodi, Farkhondeh
2014-01-01
Background: Enhancing nursing students’ critical thinking is a challenge faced by nurse educators. This study aimed at determining the effect of clinical concept mapping on discipline-based critical thinking of nursing students. Materials and Methods: In this quasi-experimental post-test only design, a convenient sample of 4th year nursing students (N = 32) participated. They were randomly divided into two groups. The experimental group participated in a 1-day workshop on clinical concept mapping. They were also assigned to use at least two clinical concepts mapping during their clinical practice. Post-test was done using a specially designed package consisting of vignettes for measurement of 17 dimensions of critical thinking in nursing under two categories of cognitive critical thinking skills and habits of mind. They were required to write about how they would use a designated critical thinking skills or habits of mind to accomplish the nursing actions. The students’ responses were evaluated based on identification of critical thinking, justification, and quality of the student's response. The mean score of both groups was compared by Mann-Whitney test using SPSS version 16.5. Results: The results of the study revealed a significant difference between the two groups’ critical thinking regarding identification, justification, and quality of responses, and overall critical thinking scores, cognitive thinking skills, and habits of mind. The two groups also differed significantly from each other in 11 out of 17 dimensions of critical thinking. Conclusion: Clinical concept mapping is a valuable strategy for improvement of critical thinking of nursing students. However, further studies are recommended to generalize this result to nursing students in their earlier stage of education. PMID:24554963
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Clinical concept mapping: Does it improve discipline-based critical thinking of nursing students?
Moattari, Marzieh; Soleimani, Sara; Moghaddam, Neda Jamali; Mehbodi, Farkhondeh
2014-01-01
Enhancing nursing students' critical thinking is a challenge faced by nurse educators. This study aimed at determining the effect of clinical concept mapping on discipline-based critical thinking of nursing students. In this quasi-experimental post-test only design, a convenient sample of 4(th) year nursing students (N = 32) participated. They were randomly divided into two groups. The experimental group participated in a 1-day workshop on clinical concept mapping. They were also assigned to use at least two clinical concepts mapping during their clinical practice. Post-test was done using a specially designed package consisting of vignettes for measurement of 17 dimensions of critical thinking in nursing under two categories of cognitive critical thinking skills and habits of mind. They were required to write about how they would use a designated critical thinking skills or habits of mind to accomplish the nursing actions. The students' responses were evaluated based on identification of critical thinking, justification, and quality of the student's response. The mean score of both groups was compared by Mann-Whitney test using SPSS version 16.5. The results of the study revealed a significant difference between the two groups' critical thinking regarding identification, justification, and quality of responses, and overall critical thinking scores, cognitive thinking skills, and habits of mind. The two groups also differed significantly from each other in 11 out of 17 dimensions of critical thinking. Clinical concept mapping is a valuable strategy for improvement of critical thinking of nursing students. However, further studies are recommended to generalize this result to nursing students in their earlier stage of education.
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Koster, Geert; Bekema, Hanneke J.; Wetterslev, Jorn; Gluud, Christian; Keus, Frederik; van der Horst, Iwan C. C.
Milrinone is an inotrope widely used for treatment of cardiac failure. Because previous meta-analyses had methodological flaws, we decided to conduct a systematic review of the effect of milrinone in critically ill adult patients with cardiac dysfunction. This systematic review was performed
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Jefferies, Diana; McNally, Stephen; Roberts, Katriona; Wallace, Anna; Stunden, Annette; D'Souza, Suzanne; Glew, Paul
2018-01-01
This systematic review was designed to assess the importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice. It aimed to explore the link between academic literacy and writing in an undergraduate nursing degree and the development of critical thinking skills for their future professional clinical practice. A systematic review of qualitative studies and expert opinion publications. A systematic literature search was undertaken of the following databases: ERIC, PubMed, CINAHL, MEDLINE and Scopus. All papers reviewed were from 2000 to 2016 and were written in English. We identified 981 studies and expert opinion papers from the selected databases. After reviewing key words and abstracts for the inclusion and exclusion criteria, 48 papers were selected for review. These were read and reread, with 22 papers, including one thesis, selected for quality appraisal. One paper was discarded due to the exclusion criteria. Three major themes were evident from this study. First, students need assistance to develop tertiary level academic literacy skills when they commence their undergraduate nursing degree. Second, that teaching practices need to be consistent in both designing assessments and in giving feedback to students, in order to assist improvement of academic literacy skills. And finally, academic literacy can facilitate critical thinking when students are assessed using discipline specific genres that relate to their future professional nursing practice. This review highlights the importance of critical thinking in clinical nursing practice and its strong relationship with academic writing skills. It has shown critical thinking is discipline specific and nursing students need to be taught discipline specific literacy genres in undergraduate nursing degrees. Nursing has a diverse educational and cultural mix of students, and educators should not assume academic literacy skills upon commencement of an
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Miller, Adam B.; Esposito-Smythers, Christianne; Weismoore, Julie T.; Renshaw, Keith D.
2013-01-01
A large body of research suggests that child maltreatment (CM) is associated with adolescent suicidal ideation and attempts. These studies, however, have not been critically examined and summarized in a manner that allows us to draw firm conclusions and make recommendations for future research and clinical work in this area. In this review, we…
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Energy Technology Data Exchange (ETDEWEB)
Chan, Raymond Javan, E-mail: email.rchan@gmail.com [Cancer Care Services, Royal Brisbane and Women' s Hospital (Australia); School of Nursing and Midwifery, University of Queensland, and Research Centre for Clinical and Community Practice Innovation, Griffith University (Australia); Larsen, Emily; Chan, Philip [Cancer Care Services, Royal Brisbane and Women' s Hospital (Australia)
2012-11-01
Purpose: To provide an overview and a critical appraisal of systematic reviews (SRs) of published interventions for the prevention/management of radiation dermatitis. Methods and Materials: We searched Medline, CINAHL, Embase, and the Cochrane Library. We also manually searched through individual reference lists of potentially eligible articles and a number of key journals in the topic area. Two authors screened all potential articles and included eligible SRs. Two authors critically appraised and extracted key findings from the included reviews using AMSTAR (the measurement tool for 'assessment of multiple systematic reviews'). Results: Of 1837 potential titles, 6 SRs were included. A number of interventions have been reported to be potentially beneficial for managing radiation dermatitis. Interventions evaluated in these reviews included skin care advice, steroidal/nonsteroidal topical agents, systemic therapies, modes of radiation delivery, and dressings. However, all the included SRs reported that there is insufficient evidence supporting any single effective intervention. The methodological quality of the included studies varied, and methodological shortfalls in these reviews might create biases to the overall results or recommendations for clinical practice. Conclusions: An up-to-date high-quality SR in the prevention/management of radiation dermatitis is needed to guide practice and direction for future research. We recommend that clinicians or guideline developers critically evaluate the information of SRs in their decision making.
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Schram, Andrew W; Hougham, Gavin W; Meltzer, David O; Ruhnke, Gregory W
2017-11-01
There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development. Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar. Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified. Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.
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TWTF project criticality task force final review and assessment
International Nuclear Information System (INIS)
McKinley, K.B.; Cannon, J.W.; Wheeler, F.J.; Worle, H.A.
1980-11-01
The Transuranic Waste Treatment Facility (TWTF) is being developed to process transuranic waste, stored and buried at the Idaho National Engineering Laboratory, into a chemically inert, physically stable basalt-like residue acceptable at a federal repository. A task force was assembled by the TWTF Project Division to review and assess all aspects of criticality safety for the TWTF. This document presents the final review, assessments, and recommendations of this task force. The following conclusions were made: Additional criticality studies are needed for the entire envelope of feed compositions and temperature effects. Safe operating k/sub eff/'s need to be determined for process components. Criticality analyses validation experiments may also be required. SRP neutron interrogation should be replaced by DDT neutron interrogation. Accuracy studies need to be performed for the proposed assaying techniques. Time-correlated neutron monitoring needs to be mocked up for process components to prove feasibility and determine accuracy. The criticality control techniques developed for the TWTF conceptual design are in compliance with ERDAM 0530, including the Double Contingency Rule. Detailed procedures and controls need to be developed
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The Role and Impact of Critical Review as Perceived by an Implementer
International Nuclear Information System (INIS)
Thegerstroem, Claes; Laarouchi Engstroem, Saida; Olsson, Olle
2006-01-01
The quality and success of a nuclear waste management programme is based on the amalgamation of the interests of a wide number of stakeholders, integration of many different scientific disciplines, and merging of scientific, technical, ethical and social issues. In this process, a broad and structured review of all aspects of the program is necessary and we find the process with submission and review by stakeholders, regulators and government every third year very useful. High-quality critical review of is always a real benefit to the implementer - as it gives the implementer the possibility to see where improvements can be made. However, a close dialogue and a dynamic reviewing process, where questions are raised throughout the process, are essential in order to optimize the quality of the final applications. Naturally, critical review should not be used for pushing specific general research interests or issues that belong to the political arena rather than nuclear waste management itself. Moreover, critical review provides additional insight and promotes confidence by the general public. However, sometimes the public might be confused and have difficulties in judging the importance and relevance of critical comments. The implementer and regulatory authorities have a special duty to provide an overall perspective of safety-related issues. Even if critical review is valuable, the implementer can not only rely on this. The implementers' own internal quality assurance practise, internal review process as well as its overall safety culture is all crucial. Indeed, a successful management of radio-active waste, including operational aspects as well as siting process, starts with the implementers' own wish to perform state-of-the art-work both in terms of technology and overall approach
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The Role and Impact of Critical Review as Perceived by an Implementer
Energy Technology Data Exchange (ETDEWEB)
Thegerstroem, Claes; Laarouchi Engstroem, Saida; Olsson, Olle [Swedish Nuclear Fuel and Waste Management Co, Stockholm (Sweden)
2006-09-15
The quality and success of a nuclear waste management programme is based on the amalgamation of the interests of a wide number of stakeholders, integration of many different scientific disciplines, and merging of scientific, technical, ethical and social issues. In this process, a broad and structured review of all aspects of the program is necessary and we find the process with submission and review by stakeholders, regulators and government every third year very useful. High-quality critical review of is always a real benefit to the implementer - as it gives the implementer the possibility to see where improvements can be made. However, a close dialogue and a dynamic reviewing process, where questions are raised throughout the process, are essential in order to optimize the quality of the final applications. Naturally, critical review should not be used for pushing specific general research interests or issues that belong to the political arena rather than nuclear waste management itself. Moreover, critical review provides additional insight and promotes confidence by the general public. However, sometimes the public might be confused and have difficulties in judging the importance and relevance of critical comments. The implementer and regulatory authorities have a special duty to provide an overall perspective of safety-related issues. Even if critical review is valuable, the implementer can not only rely on this. The implementers' own internal quality assurance practise, internal review process as well as its overall safety culture is all crucial. Indeed, a successful management of radio-active waste, including operational aspects as well as siting process, starts with the implementers' own wish to perform state-of-the art-work both in terms of technology and overall approach.
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Stene, L C; Rewers, M
2012-01-01
OTHER THEMES PUBLISHED IN THIS IMMUNOLOGY IN THE CLINIC REVIEW SERIES Metabolic diseases, host responses, cancer, autoinflammatory diseases, allergy. The hypothesis that under some circumstances enteroviral infections can lead to type 1 diabetes (T1D) was proposed several decades ago, based initially on evidence from animal studies and sero-epidemiology. Subsequently, enterovirus RNA has been detected more frequently in serum of patients than in control subjects, but such studies are susceptible to selection bias and reverse causality. Here, we review critically recent evidence from human studies, focusing on longitudinal studies with potential to demonstrate temporal association. Among seven longitudinal birth cohort studies, the evidence that enterovirus infections predict islet autoimmunity is quite inconsistent in our interpretation, due partially, perhaps, to heterogeneity in study design and a limited number of subjects studied. An association between enterovirus and rapid progression from autoimmunity to T1D was reported by one longitudinal study, but although consistent with evidence from animal models, this novel observation awaits replication. It is possible that a potential association with initiation and/or progression of islet autoimmunity can be ascribed to a subgroup of the many enterovirus serotypes, but this has still not been investigated properly. There is a need for larger studies with frequent sample intervals and collection of specimens of sufficient quality and quantity for detailed characterization of enterovirus. More research into the molecular epidemiology of enteroviruses and enterovirus immunity in human populations is also warranted. Ultimately, this knowledge may be used to devise strategies to reduce the risk of T1D in humans. PMID:22385232
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Abortion law, policy and services in India: a critical review.
Hirve, Siddhivinayak S
2004-11-01
Despite 30 years of liberal legislation, the majority of women in India still lack access to safe abortion care. This paper critically reviews the history of abortion law and policy in India since the 1960s and research on abortion service delivery. Amendments in 2002 and 2003 to the 1971 Medical Termination of Pregnancy Act, including devolution of regulation of abortion services to the district level, punitive measures to deter provision of unsafe abortions, rationalisation of physical requirements for facilities to provide early abortion, and approval of medical abortion, have all aimed to expand safe services. Proposed amendments to the MTP Act to prevent sex-selective abortions would have been unethical and violated confidentiality, and were not taken forward. Continuing problems include poor regulation of both public and private sector services, a physician-only policy that excludes mid-level providers and low registration of rural compared to urban clinics; all restrict access. Poor awareness of the law, unnecessary spousal consent requirements, contraceptive targets linked to abortion, and informal and high fees also serve as barriers. Training more providers, simplifying registration procedures, de-linking clinic and provider approval, and linking policy with up-to-date technology, research and good clinical practice are some immediate measures needed to improve women's access to safe abortion care.
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Kumeria, Tushar; McInnes, Steven J P; Maher, Shaheer; Santos, Abel
2017-12-01
Porous silicon (pSi) engineered by electrochemical etching has been used as a drug delivery vehicle to address the intrinsic limitations of traditional therapeutics. Biodegradability, biocompatibility, and optoelectronic properties make pSi a unique candidate for developing biomaterials for theranostics and photodynamic therapies. This review presents an updated overview about the recent therapeutic systems based on pSi, with a critical analysis on the problems and opportunities that this technology faces as well as highlighting pSi's growing potential. Areas covered: Recent progress in pSi-based research includes drug delivery systems, including biocompatibility studies, drug delivery, theranostics, and clinical trials with the most relevant examples of pSi-based systems presented here. A critical analysis about the technical advantages and disadvantages of these systems is provided along with an assessment on the challenges that this technology faces, including clinical trials and investors' support. Expert opinion: pSi is an outstanding material that could improve existing drug delivery and photodynamic therapies in different areas, paving the way for developing advanced theranostic nanomedicines and incorporating payloads of therapeutics with imaging capabilities. However, more extensive in-vivo studies are needed to assess the feasibility and reliability of this technology for clinical practice. The technical and commercial challenges that this technology face are still uncertain.
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Mobile technology and its use in clinical nursing education: a literature review.
O'Connor, Siobhan; Andrews, Tom
2015-03-01
Nursing students face a variety of challenges to learning in clinical practice, from the theory-practice gap, to a lack of clinical supervision and the ad hoc nature of learning in clinical environments. Mobile technology is proposed as one way to address these challenges. This article comprehensively summarizes and critically reviews the available literature on mobile technology used in undergraduate clinical nursing education. It identifies the lack of clear definitions and theory in the current body of evidence; the variety of mobile devices and applications used; the benefits of mobile platforms in nursing education; and the complexity of sociotechnical factors, such as the cost, usability, portability, and quality of mobile tools, that affect their use in undergraduate clinical nursing education. Implications for nursing education and practice are outlined, and recommendations for future research are discussed. Copyright 2015, SLACK Incorporated.
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A national survey on pediatric critical values used in clinical laboratories across Canada.
Gong, Yanping; Adeli, Khosrow
2009-11-01
Notification of critical values to clinical staff is an important post-analytical process in all acute care clinical laboratories. No data are available however on how laboratories obtain or establish critical values, particularly in pediatric settings. This study was designed to examine and compare critical values used for pediatric patients in biochemistry laboratories in Canada and assess potential interlaboratory variability. Fourteen clinical laboratories, including two in pediatric hospitals and twelve in hospitals caring for both children and adults, participated in a survey that included 14 pre-selected STAT chemistry tests and 19 pre-selected therapeutic drug monitoring (TDM) tests. Among fourteen chemistry tests, good agreement was observed for critical values used for sodium and pH at both low and high levels within 14 participant laboratories. Significant interlaboratory variability existed for glucose critical values at the high end, magnesium at high end, and PO2 at the low end. For 19 TDM tests, the majority of laboratories did not have alert values to report values over the therapeutic level but not toxic. For critical values greater than the toxic range, significant variability existed at both trough and peak levels among laboratories surveyed. When asked to provide the source for critical values established at each site, only a limited number of laboratories identified their sources as either internal decision or published references. Although all laboratories have established and routinely use critical values to alert clinical staff, considerable variability exists in both the critical limits reported as well as the source of such values. There is a clear need for new national efforts to standardize pediatric critical value reporting and establish evidence-based critical limits for all medical laboratories across Canada.
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Application of Higuchi's fractal dimension from basic to clinical neurophysiology: A review.
Kesić, Srdjan; Spasić, Sladjana Z
2016-09-01
For more than 20 years, Higuchi's fractal dimension (HFD), as a nonlinear method, has occupied an important place in the analysis of biological signals. The use of HFD has evolved from EEG and single neuron activity analysis to the most recent application in automated assessments of different clinical conditions. Our objective is to provide an updated review of the HFD method applied in basic and clinical neurophysiological research. This article summarizes and critically reviews a broad literature and major findings concerning the applications of HFD for measuring the complexity of neuronal activity during different neurophysiological conditions. The source of information used in this review comes from the PubMed, Scopus, Google Scholar and IEEE Xplore Digital Library databases. The review process substantiated the significance, advantages and shortcomings of HFD application within all key areas of basic and clinical neurophysiology. Therefore, the paper discusses HFD application alone, combined with other linear or nonlinear measures, or as a part of automated methods for analyzing neurophysiological signals. The speed, accuracy and cost of applying the HFD method for research and medical diagnosis make it stand out from the widely used linear methods. However, only a combination of HFD with other nonlinear methods ensures reliable and accurate analysis of a wide range of neurophysiological signals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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A systematic review of peer teaching and learning in clinical education.
Secomb, Jacinta
2008-03-01
The purpose of this review is to provide a framework for peer teaching and learning in the clinical education of undergraduate health science students in clinical practice settings and make clear the positive and negative aspects of this teaching and learning strategy. The practice of using peers incidentally or purposefully in the clinical education of apprentice or undergraduate health science students is a well-established tradition and commonly practiced, but lacks definition in its implementation. The author conducted a search of health science and educational electronic databases using the terms peer, clinical education and undergraduate. The set limitations were publications after 1980 (2005 inclusive), English language and research papers. Selection of studies occurred: based on participant, intervention, research method and learning outcomes, following a rigorous critical and quality appraisal with a purposefully developed tool. The results have been both tabled and collated in a narrative summary. Twelve articles met the inclusion criteria, representing five countries and four health science disciplines. This review reported mostly positive outcomes on the effectiveness of peer teaching and learning; it can increase student's confidence in clinical practice and improve learning in the psychomotor and cognitive domains. Negative aspects were also identified; these include poor student learning if personalities or learning styles are not compatible and students spending less individualized time with the clinical instructor. Peer teaching and learning is an effective educational intervention for health science students on clinical placements. Preclinical education of students congruent with the academic timetable increases student educational outcomes from peer teaching and learning. Strategies are required prior to clinical placement to accommodate incompatible students or poor student learning. The findings from this systematic review, although not
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Lipman, Timothy O
2013-04-01
The volume of medical literature grows exponentially. Yet we are faced with the necessity to make clinical decisions based on the availability and quality of scientific information. The general strength (reliability, robustness) of any interpretation that guides us in clinical decision making is dependent on how information was obtained. All information and medical studies and, consequently, all conclusions are not created equal. It is incumbent upon us to be able to assess the quality of the information that guides us in the care of our patients. Being able to assess medical literature critically requires use of critical reading and critical thinking skills. To achieve these skills, to be able to analyze medical literature critically, takes a combination of education and practice, practice, and more practice.
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A Review of Vitamin D Deficiency in the Critical Care Population
Directory of Open Access Journals (Sweden)
Kelly Massey
2014-01-01
Full Text Available It is well documented that a large percentage of the general population is either vitamin D insufficient or deficient. Vitamin D deficiency adversely affects bone health. More recently, it has been reported that vitamin D is an important component in immune function and glycemic control Substantial data exist that demonstrate an association between vitamin D insufficiency/deficiency and mortality/clinical outcomes of critically ill patients. The larger clinical trials addressing this association have demonstrated an increased odds ratio for mortality in both vitamin D insufficient and deficient patients when compared to those with sufficient vitamin D. There is also some evidence that vitamin D status worsens during critical illness without supplementation of this vitamin. Supplementation of vitamin D during critical illness of patients with vitamin D deficiency has been studied, but not in great detail. Daily supplementation of the recommended dietary allowance (RDA of vitamin D does very little to improve the 25(OHD serum concentrations in the critically ill patients with vitamin D insufficiency or deficiency. There is some evidence that high-dose therapy of vitamin D improves the depressed serum concentrations of this vitamin; however, there are no clinical outcome data available yet. The association between vitamin D insufficiency or deficiency and clinical outcome in the critically ill appears to be important. Supplementation of vitamin D will increase the serum concentrations of this vitamin; however the optimal dose needs to be identified along with an assessment of clinical outcome.
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Chiropractic Treatment for Gastrointestinal Problems: A Systematic Review of Clinical Trials
Directory of Open Access Journals (Sweden)
E Ernst
2011-01-01
Full Text Available Many chiropractors believe that chiropractic treatments are effective for gastrointestinal disorders. The aim of the present systematic review was to critically evaluate the evidence from controlled clinical trials supporting or not supporting this notion. Six electronic databases were searched for relevant studies. No limits were applied to language or publication date. Prospective, controlled, clinical trials of any type of chiropractic treatment for any type of gastrointestinal problem, except infant colic, were included. Only two trials were found – one was a pilot study, and the other had reached a positive conclusion; however, both had serious methodological flaws. There is no supportive evidence that chiropractic is an effective treatment for gastrointestinal disorders.
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Activity trackers: a critical review.
Lee, Jeon; Finkelstein, Joseph
2014-01-01
The wearable consumer health devices can be mainly divided into activity trackers, sleep trackers, and stress management devices. These devices are widely advertised to provide positive effects on the user's daily behaviours and overall heath. However, objective evidence supporting these claims appears to be missing. The goal of this study was to review available evidence pertaining to performance of activity trackers. A comprehensive review of available information has been conducted for seven representative devices and the validity of marketing claims was assessed. The device assessment was based on availability of verified output metrics, theoretical frameworks, systematic evaluation, and FDA clearance. The review identified critical absence of supporting evidence of advertised functions and benefits for the majority of the devices. Six out of seven devices did not provide any information on sensor accuracy and output validity at all. Possible underestimation or overestimation of specific health indicators reported to consumers was not clearly disclosed to the public. Furthermore, significant limitations of these devices which can be categorized into user restrictions, user responsibilities and company disclaimers could not be easily found or comprehended by unsophisticated users and may represent a serious health hazard.
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CAR-T Cells: A Systematic Review and Mixed Methods Analysis of the Clinical Trial Landscape.
Pettitt, David; Arshad, Zeeshaan; Smith, James; Stanic, Tijana; Holländer, Georg; Brindley, David
2018-02-07
CAR-T cells are a promising new therapy that offer significant advantages compared with conventional immunotherapies. This systematic review and clinical trial landscape identifies and critiques published CAR-T cell clinical trials and examines the critical factors required to enable CAR-T cells to become a standard therapy. A review of the literature was conducted to identify suitable studies from the MEDLINE and Ovid bibliographic databases. The literature and database searches identified 20 studies for inclusion. The average number of participants per clinical trial examined was 11 patients. All studies included in this systematic review investigated CAR-T cells and were prospective, uncontrolled clinical studies. Leukemia is the most common cancer subtype and accounts for 57.4% (n = 120) of disease indications. The majority of studies used an autologous cell source (85%, n = 17) rather than an allogeneic cell source. Translational challenges encompass technical considerations relating to CAR-T cell development, manufacturing practicability, clinical trial approaches, CAR-T cell quality and persistence, and patient management. Copyright © 2017 The American Society of Gene and Cell Therapy. Published by Elsevier Inc. All rights reserved.
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Evidence review and clinical guidance for the use of ziprasidone in Canada
Directory of Open Access Journals (Sweden)
Gardner David M
2013-01-01
Full Text Available Abstract While indicated for schizophrenia and acute mania, ziprasidone’s evidence base and use in clinical practice extends beyond these regulatory approvals. We, an invited panel of experts led by a working group of 3, critically examined the evidence and our collective experience regarding the effectiveness, tolerability and safety of ziprasidone across its clinical uses. There was no opportunity for manufacturer input into the content of the review. As anticipated, ziprasidone was found to be effective for its indicated uses, although its utility in mania and mixed states lacked comparative data. Beyond these uses, the available data were either unimpressive or were lacking. An attractive characteristic is its neutral effect on weight thereby providing patients with a non-obesogenic long-term treatment option. Key challenges in practice include the need for dosing on a full stomach and managing its early onset adverse effect of restlessness. Addressing these issues are critical to its long-term success
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Music in Peacebuilding: A Critical Literature Review
Sandoval, Elaine
2016-01-01
The critical literature review summarizes and appraises studies that have been pursued by music scholars examining the contributions of music to peacebuilding as well as the role of music in violence. These two bodies of literature are rarely brought into dialogue, but I juxtapose them in order to confront the idea of music's exceptionalism as…
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Five-year review of an international clinical research-training program
Suemoto, Claudia Kimie; Ismail, Sherine; Corrêa, Paulo César Rodrigues Pinto; Khawaja, Faiza; Jerves, Teodoro; Pesantez, Laura; Germani, Ana Claudia Camargo Gonçalves; Zaina, Fabio; dos Santos, Augusto Cesar Soares; de Oliveira Ferreira, Ricardo Jorge; Singh, Priyamvada; Paulo, Judy Vicente; Matsubayashi, Suely Reiko; Vidor, Liliane Pinto; Andretta, Guilherme; Tomás, Rita; Illigens, Ben MW; Fregni, Felipe
2015-01-01
The exponential increase in clinical research has profoundly changed medical sciences. Evidence that has accumulated in the past three decades from clinical trials has led to the proposal that clinical care should not be based solely on clinical expertise and patient values, and should integrate robust data from systematic research. As a consequence, clinical research has become more complex and methods have become more rigorous, and evidence is usually not easily translated into clinical practice. Therefore, the instruction of clinical research methods for scientists and clinicians must adapt to this new reality. To address this challenge, a global distance-learning clinical research-training program was developed, based on collaborative learning, the pedagogical goal of which was to develop critical thinking skills in clinical research. We describe and analyze the challenges and possible solutions of this course after 5 years of experience (2008–2012) with this program. Through evaluation by students and faculty, we identified and reviewed the following challenges of our program: 1) student engagement and motivation, 2) impact of heterogeneous audience on learning, 3) learning in large groups, 4) enhancing group learning, 5) enhancing social presence, 6) dropouts, 7) quality control, and 8) course management. We discuss these issues and potential alternatives with regard to our research and background. PMID:25878518
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Five-year review of an international clinical research-training program.
Suemoto, Claudia Kimie; Ismail, Sherine; Corrêa, Paulo César Rodrigues Pinto; Khawaja, Faiza; Jerves, Teodoro; Pesantez, Laura; Germani, Ana Claudia Camargo Gonçalves; Zaina, Fabio; Dos Santos, Augusto Cesar Soares; de Oliveira Ferreira, Ricardo Jorge; Singh, Priyamvada; Paulo, Judy Vicente; Matsubayashi, Suely Reiko; Vidor, Liliane Pinto; Andretta, Guilherme; Tomás, Rita; Illigens, Ben Mw; Fregni, Felipe
2015-01-01
The exponential increase in clinical research has profoundly changed medical sciences. Evidence that has accumulated in the past three decades from clinical trials has led to the proposal that clinical care should not be based solely on clinical expertise and patient values, and should integrate robust data from systematic research. As a consequence, clinical research has become more complex and methods have become more rigorous, and evidence is usually not easily translated into clinical practice. Therefore, the instruction of clinical research methods for scientists and clinicians must adapt to this new reality. To address this challenge, a global distance-learning clinical research-training program was developed, based on collaborative learning, the pedagogical goal of which was to develop critical thinking skills in clinical research. We describe and analyze the challenges and possible solutions of this course after 5 years of experience (2008-2012) with this program. Through evaluation by students and faculty, we identified and reviewed the following challenges of our program: 1) student engagement and motivation, 2) impact of heterogeneous audience on learning, 3) learning in large groups, 4) enhancing group learning, 5) enhancing social presence, 6) dropouts, 7) quality control, and 8) course management. We discuss these issues and potential alternatives with regard to our research and background.
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Critical Discourse Analysis in Literacy Education: A Review of the Literature
Rogers, Rebecca; Schaenen, Inda
2014-01-01
This article is a critical, integrative literature review of scholarship in literacy studies from 2004 to 2012 that draws on critical discourse analysis (CDA). We discuss key issues, trends, and criticisms in the field. Our methodology was carried out in three stages. First, we searched educational databases to locate literacy-focused CDA…
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Critical thinking and the role of the clinical ultrasound tutor
International Nuclear Information System (INIS)
Edwards, Hazel
2006-01-01
As radiographers continue to extend their role and take on more procedures associated traditionally with radiologists, it is essential that their critical thinking abilities keep pace with the new practical skills they are learning. This is particularly important in ultrasound where student sonographers must master a number of new skills including the technical dexterity required to perform a scan, the ability to form and discard hypotheses when trying to interpret the image, and the communication of their findings as a written report. Interpreting the image and producing an accurate, appropriate report involves the higher level cognitive processes of analysis, synthesis and evaluation. In other words, the student sonographer must be able to think critically to become a successful practitioner. This paper attempts to define and discuss critical thinking, and considers a range of simple strategies that the clinical teacher of ultrasound can employ to help develop critical thinking skills in their students. These methods are appropriate for use not only by clinical teachers of ultrasound but for all teachers and mentors wishing to improve reasoning skills in their pupils
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Birth-weight charts and immigrant populations: A critical review.
Urquia, Marcelo L; Sørbye, Ingvil K; Wanigaratne, Susitha
2016-04-01
There is an increasing body of literature focusing on differences in newborn size between different population subgroups defined by racial, ethnic, and immigration status. The interpretation of these differences as pathological or as merely reflecting normal variability is not straightforward and may have consequences for the provision of obstetric and neonatal care to minority populations. In this review, we critically assess some methodological issues affecting the assessment of newborn size and their potential implications for minority populations. In particular, we discuss the pros and cons of different types of newborn birth-weight (BW) charts (i.e., single local population-based references, minority-specific references, and a single international standard) to determine abnormal newborn size, with emphasis on immigrant populations. We conclude that size alone is not enough to inform clinical decisions and that all newborn size charts should be used as screening tools, not as diagnostic tools. Parental minority status may be regarded as a marker and used to further inquire about individual risk factors, particularly among immigrants who may not have a complete medical history in the new country. Finally, we outline areas for further research and recommendations for clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Alessandri, Elena; Williamson, Victoria J; Eiholzer, Hubert; Williamon, Aaron
2015-01-01
Critical reviews offer rich data that can be used to investigate how musical experiences are conceptualized by expert listeners. However, these data also present significant challenges in terms of organization, analysis, and interpretation. This study presents a new systematic method for examining written responses to music, tested on a substantial corpus of music criticism. One hundred critical reviews of Beethoven's piano sonata recordings, published in the Gramophone between August 1934 and July 2010, were selected using in-depth data reduction (qualitative/quantitative approach). The texts were then examined using thematic analysis in order to generate a visual descriptive model of expert critical review. This model reveals how the concept of evaluation permeates critical review. It also distinguishes between two types of descriptors. The first characterizes the performance in terms of specific actions or features of the musical sound (musical parameters, technique, and energy); the second appeals to higher-order properties (artistic style, character and emotion, musical structure, communicativeness) or assumed performer qualities (understanding, intentionality, spontaneity, sensibility, control, and care). The new model provides a methodological guide and conceptual basis for future studies of critical review in any genre.
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International Nuclear Information System (INIS)
Chan, Raymond Javan; Larsen, Emily; Chan, Philip
2012-01-01
Purpose: To provide an overview and a critical appraisal of systematic reviews (SRs) of published interventions for the prevention/management of radiation dermatitis. Methods and Materials: We searched Medline, CINAHL, Embase, and the Cochrane Library. We also manually searched through individual reference lists of potentially eligible articles and a number of key journals in the topic area. Two authors screened all potential articles and included eligible SRs. Two authors critically appraised and extracted key findings from the included reviews using AMSTAR (the measurement tool for “assessment of multiple systematic reviews”). Results: Of 1837 potential titles, 6 SRs were included. A number of interventions have been reported to be potentially beneficial for managing radiation dermatitis. Interventions evaluated in these reviews included skin care advice, steroidal/nonsteroidal topical agents, systemic therapies, modes of radiation delivery, and dressings. However, all the included SRs reported that there is insufficient evidence supporting any single effective intervention. The methodological quality of the included studies varied, and methodological shortfalls in these reviews might create biases to the overall results or recommendations for clinical practice. Conclusions: An up-to-date high-quality SR in the prevention/management of radiation dermatitis is needed to guide practice and direction for future research. We recommend that clinicians or guideline developers critically evaluate the information of SRs in their decision making.
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Cabrini, Luca; Landoni, Giovanni; Baiardo Radaelli, Martina; Saleh, Omar; Votta, Carmine D; Fominskiy, Evgeny; Putzu, Alessandro; Snak de Souza, Cézar Daniel; Antonelli, Massimo; Bellomo, Rinaldo; Pelosi, Paolo; Zangrillo, Alberto
2018-01-20
We performed a systematic review of randomized controlled studies evaluating any drug, technique or device aimed at improving the success rate or safety of tracheal intubation in the critically ill. We searched PubMed, BioMed Central, Embase and the Cochrane Central Register of Clinical Trials and references of retrieved articles. Finally, pertinent reviews were also scanned to detect further studies until May 2017. The following inclusion criteria were considered: tracheal intubation in adult critically ill patients; randomized controlled trial; study performed in Intensive Care Unit, Emergency Department or ordinary ward; and work published in the last 20 years. Exclusion criteria were pre-hospital or operating theatre settings and simulation-based studies. Two investigators selected studies for the final analysis. Extracted data included first author, publication year, characteristics of patients and clinical settings, intervention details, comparators and relevant outcomes. The risk of bias was assessed with the Cochrane Collaboration's Risk of Bias tool. We identified 22 trials on use of a pre-procedure check-list (1 study), pre-oxygenation or apneic oxygenation (6 studies), sedatives (3 studies), neuromuscular blocking agents (1 study), patient positioning (1 study), video laryngoscopy (9 studies), and post-intubation lung recruitment (1 study). Pre-oxygenation with non-invasive ventilation (NIV) and/or high-flow nasal cannula (HFNC) showed a possible beneficial role. Post-intubation recruitment improved oxygenation , while ramped position increased the number of intubation attempts and thiopental had negative hemodynamic effects. No effect was found for use of a checklist, apneic oxygenation (on oxygenation and hemodynamics), videolaryngoscopy (on number and length of intubation attempts), sedatives and neuromuscular blockers (on hemodynamics). Finally, videolaryngoscopy was associated with severe adverse effects in multiple trials. The limited available
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A review of criticality accidents
International Nuclear Information System (INIS)
Stratton, W.R.; Smith, D.R.
1989-03-01
Criticality accidents and the characteristics of prompt power excursions are discussed. Forty-one accidental power transients are reviewed. In each case where available, enough detail is given to help visualize the physical situation, the cause or causes of the accident, the history and characteristics of the transient, the energy release, and the consequences, if any, to personnel and property. Excursions associated with large power reactors are not included in this study, except that some information on the major accident at the Chernobyl reactor in April 1986 is provided in the Appendix. 67 refs., 21 figs., 2 tabs
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Highly effective cystic fibrosis clinical research teams: critical success factors.
Retsch-Bogart, George Z; Van Dalfsen, Jill M; Marshall, Bruce C; George, Cynthia; Pilewski, Joseph M; Nelson, Eugene C; Goss, Christopher H; Ramsey, Bonnie W
2014-08-01
Bringing new therapies to patients with rare diseases depends in part on optimizing clinical trial conduct through efficient study start-up processes and rapid enrollment. Suboptimal execution of clinical trials in academic medical centers not only results in high cost to institutions and sponsors, but also delays the availability of new therapies. Addressing the factors that contribute to poor outcomes requires novel, systematic approaches tailored to the institution and disease under study. To use clinical trial performance metrics data analysis to select high-performing cystic fibrosis (CF) clinical research teams and then identify factors contributing to their success. Mixed-methods research, including semi-structured qualitative interviews of high-performing research teams. CF research teams at nine clinical centers from the CF Foundation Therapeutics Development Network. Survey of site characteristics, direct observation of team meetings and facilities, and semi-structured interviews with clinical research team members and institutional program managers and leaders in clinical research. Critical success factors noted at all nine high-performing centers were: 1) strong leadership, 2) established and effective communication within the research team and with the clinical care team, and 3) adequate staff. Other frequent characteristics included a mature culture of research, customer service orientation in interactions with study participants, shared efficient processes, continuous process improvement activities, and a businesslike approach to clinical research. Clinical research metrics allowed identification of high-performing clinical research teams. Site visits identified several critical factors leading to highly successful teams that may help other clinical research teams improve clinical trial performance.
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Scapulothoracic bursitis and snapping scapula syndrome: a critical review of current evidence.
Warth, Ryan J; Spiegl, Ulrich J; Millett, Peter J
2015-01-01
Symptomatic scapulothoracic disorders, such as painful scapular crepitus and/or bursitis, are uncommon; however, they can produce significant pain and disability in many patients. To review the current knowledge pertaining to snapping scapula syndrome and to identify areas of further research that may be helpful to improve clinical outcomes and patient satisfaction. Systematic review. We performed a preliminary search of the PubMed and Embase databases using the search terms "snapping scapula," "scapulothoracic bursitis," "partial scapulectomy," and "superomedial angle resection" in September 2013. All nonreview articles related to the topic of snapping scapula syndrome were included. The search identified a total of 167 unique articles, 81 of which were relevant to the topic of snapping scapula syndrome. There were 36 case series of fewer than 10 patients, 16 technique papers, 11 imaging studies, 9 anatomic studies, and 9 level IV outcomes studies. The level of evidence obtained from this literature search was inadequate to perform a formal systematic review or meta-analysis. Therefore, a critical review of current evidence is presented. Snapping scapula syndrome, a likely underdiagnosed condition, can produce significant shoulder dysfunction in many patients. Because the precise origin is typically unknown, specific treatments that are effective for some patients may not be effective for others. Nevertheless, bursectomy with or without partial scapulectomy is currently the most effective primary method of treatment in patients who fail nonoperative therapy. However, many patients experience continued shoulder disability even after surgical intervention. Future studies should focus on identifying the modifiable factors associated with poor outcomes after operative and nonoperative management for snapping scapula syndrome in an effort to improve clinical outcomes and patient satisfaction. © 2014 The Author(s).
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Directory of Open Access Journals (Sweden)
Parmin -
2012-10-01
Full Text Available Penelitian bertujuan untuk meningkatkan kemampuan mahasiswa dalam menyusun proposal skripsi melalui penerapan critical review artikel ilmiah bersumber dari jurnal. Penelitian dirancang dengan metode penelitian tindakan kelas. Hasil penelitian menunjukkan 63% proposal skripsi mahasiswa pada mata kuliah Metodologi Penelitian mendapatkan nilai diatas 80. Berdasarkan hasil yang telah diperoleh dapat disimpulkan penerapan critical review atau kajian kritis terhadap artikel ilmiah dapat meningkatkan kemampuan mahasiswa dalam menyusun proposal penelitian. Â The aims of this research is to improve students' ability in developing a proposal thesis by applying critical review of scientific articles come from journals. The research is designed by class action research. The results showed 63% of students thesis proposals on Research Methodology course scored above 80. Based on the results obtained it can be concluded that the application has been critical review or critical study of scientific articles can enhance students' ability in preparing research proposals.
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Systems pathology: a critical review.
Costa, Jose
2012-02-01
The technological advances of the last twenty years together with the dramatic increase in computational power have injected new life into systems-level thinking in Medicine. This review emphasizes the close relationship of Systems Pathology to Systems Biology and delineates the differences between Systems Pathology and Clinical Systems Pathology. It also suggests an algorithm to support the application of systems-level thinking to clinical research, proposes applying systems-level thinking to the health care systems and forecasts an acceleration of preventive medicine as a result of the coupling of personal genomics with systems pathology. Copyright © 2011 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.
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International Nuclear Information System (INIS)
Lara, Francisco J.; Airado-Rodríguez, Diego; Moreno-González, David; Huertas-Pérez, José F.; García-Campaña, Ana M.
2016-01-01
This paper reviews the latest developments and analytical applications of chemiluminescence detection coupled to capillary electrophoresis (CE-CL). Different sections considering the most common CL systems have been included, such as the tris(2,2′-bipyridine)ruthenium(II) system, the luminol and acridinium derivative reactions, the peroxyoxalate CL or direct oxidations. Improvements in instrumental designs, new strategies for improving both resolution and sensitivity, and applications in different fields such as clinical, pharmaceutical, environmental and food analysis have been included. This review covers the literature from 2010 to 2015. - Highlights: • An up-to-date critical review about the evolution of CE-CL is presented. • Tris(2,2′-bipyridine)ruthenium(II) and luminol as the most used CL systems. • Instrumental designs and strategies for improving resolution and sensitivity. • Applications in clinical, pharmaceutical, environmental and food analysis.
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Amblyaudia: Review of Pathophysiology, Clinical Presentation, and Treatment of a New Diagnosis.
Kaplan, Alyson B; Kozin, Elliott D; Remenschneider, Aaron; Eftekhari, Kian; Jung, David H; Polley, Daniel B; Lee, Daniel J
2016-02-01
Similar to amblyopia in the visual system, "amblyaudia" is a term used to describe persistent hearing difficulty experienced by individuals with a history of asymmetric hearing loss (AHL) during a critical window of brain development. Few clinical reports have described this phenomenon and its consequent effects on central auditory processing. We aim to (1) define the concept of amblyaudia and (2) review contemporary research on its pathophysiology and emerging clinical relevance. PubMed, Embase, and Cochrane databases. A systematic literature search was performed with combinations of search terms: "amblyaudia," "conductive hearing loss," "sensorineural hearing loss," "asymmetric," "pediatric," "auditory deprivation," and "auditory development." Relevant articles were considered for inclusion, including basic and clinical studies, case series, and major reviews. During critical periods of infant brain development, imbalanced auditory input associated with AHL may lead to abnormalities in binaural processing. Patients with amblyaudia can demonstrate long-term deficits in auditory perception even with correction or resolution of AHL. The greatest impact is in sound localization and hearing in noisy environments, both of which rely on bilateral auditory cues. Diagnosis and quantification of amblyaudia remain controversial and poorly defined. Prevention of amblyaudia may be possible through early identification and timely management of reversible causes of AHL. Otolaryngologists, audiologists, and pediatricians should be aware of emerging data supporting amblyaudia as a diagnostic entity and be cognizant of the potential for lasting consequences of AHL. Prevention of long-term auditory deficits may be possible through rapid identification and correction. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
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[Clinical pharmacy and surgery: Review].
Jarfaut, A; Nivoix, Y; Vigouroux, D; Kehrli, P; Gaudias, J; Kempf, J-F; Levêque, D; Gourieux, B
2014-05-01
Clinical pharmacy has been developed and evaluated in various medical hospital activities. Reviews conducted in this area reported a higher value of this discipline. In surgical services, evenly adverse drug events may occur, so clinical pharmacy activities must also help to optimize the management of drug's patient. The objectives of this literature review is to determine the profile of clinical pharmacy activities developed in surgical services and identify indicators. The research was conducted on Pubmed(®) database with the following keywords (2000-2013), "surgery", "pharmacy", "pharmacist", "pharmaceutical care", "impact" and limited to French or English papers. Studies dealing on simultaneously medical and surgical areas were excluded. Twenty-one papers were selected. The most frequently developed clinical pharmacy activities were history and therapeutic drug monitoring (antibiotics or anticoagulants). Two types of indicators were identified: activity indicators with the number of pharmaceutical interventions, their description and clinical signification, the acceptance rate and workload. Impact indicators were mostly clinical and economic impacts. The development of clinical pharmacy related to surgical patients is documented and appears to have, as for medical patients, a clinical and economical value. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
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Fürbass, F; Hartmann, M M; Halford, J J; Koren, J; Herta, J; Gruber, A; Baumgartner, C; Kluge, T
2015-09-01
Continuous EEG from critical care patients needs to be evaluated time efficiently to maximize the treatment effect. A computational method will be presented that detects rhythmic and periodic patterns according to the critical care EEG terminology (CCET) of the American Clinical Neurophysiology Society (ACNS). The aim is to show that these detected patterns support EEG experts in writing neurophysiological reports. First of all, three case reports exemplify the evaluation procedure using graphically presented detections. Second, 187 hours of EEG from 10 critical care patients were used in a comparative trial study. For each patient the result of a review session using the EEG and the visualized pattern detections was compared to the original neurophysiology report. In three out of five patients with reported seizures, all seizures were reported correctly. In two patients, several subtle clinical seizures with unclear EEG correlation were missed. Lateralized periodic patterns (LPD) were correctly found in 2/2 patients and EEG slowing was correctly found in 7/9 patients. In 8/10 patients, additional EEG features were found including LPDs, EEG slowing, and seizures. The use of automatic pattern detection will assist in review of EEG and increase efficiency. The implementation of bedside surveillance devices using our detection algorithm appears to be feasible and remains to be confirmed in further multicenter studies. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
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Enteral nutrition therapy for critically ill adult patients; critical review and algorithm creation.
Araújo-Junqueira, L; De-Souza, Daurea A
2012-01-01
Undernutrition directly affects critically ill patient's clinical outcome and mortality rates. Interdisciplinar algorithm creation aiming to optimize the enteral nutrition therapy for critically ill adult patients. Pubmed, SciELO, Scholar Google, Web of Science, Scopus, with research of these key words: protocols, enteral nutrition, nutritional support, critical care, undernutrition, fasting. Intensive Care Unit, Hospital de Clínicas, Federal University of Uberlándia, MG, Brazil. Were established in the algorithm a following sequential steps: After a clinical-surgical diagnosis, including the assessment of hemodynamic stability, were requested passage of a feeding tube in post-pyloric position and a drainage tube in gastric position. After hemodynamic stability it should be done the nutritional status diagnosis, calculated nutritional requirements, as well as chosen formulation of enteral feeding. Unless contraindicated, aiming to increase tolerance was started infusion with small volumes (15 ml/h) of a semi-elemental diet, normocaloric, hypolipidic (also hyperproteic, with addition of glutamine). To ensure infusion of the diet, as well as the progressive increase of infusion rates, the patient was monitored for moderate or severe intestinal intolerance. The schedule and infusion rates were respected and diet was not routinely suspended for procedures and diagnostic tests, unless indicated by the medical team. For nutrition therapy success it is essential routine monitoring and extensive interaction between the professionals involved. Nutritional conducts should be reevaluated and improved, seeking complete and specialized care to the critically ill patients. Adherence to new practices is challenging, though instruments such as protocols and algorithms help making information more accessible and comprehensible.
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Bowles, Kathleen
2000-01-01
Nursing graduates (n=65) completed a critical thinking instrument and clinical decision-making scale. The critical thinking subscales of inference and inductive reasoning were positively correlated to clinical judgment. A significant relationship was found between critical thinking score and grade point average in nursing. (SK)
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Miller, Kristen; Mosby, Danielle; Capan, Muge; Kowalski, Rebecca; Ratwani, Raj; Noaiseh, Yaman; Kraft, Rachel; Schwartz, Sanford; Weintraub, William S; Arnold, Ryan
2018-05-01
Provider acceptance and associated patient outcomes are widely discussed in the evaluation of clinical decision support systems (CDSSs), but critical design criteria for tools have generally been overlooked. The objective of this work is to inform electronic health record alert optimization and clinical practice workflow by identifying, compiling, and reporting design recommendations for CDSS to support the efficient, effective, and timely delivery of high-quality care. A narrative review was conducted from 2000 to 2016 in PubMed and The Journal of Human Factors and Ergonomics Society to identify papers that discussed/recommended design features of CDSSs that are associated with the success of these systems. Fourteen papers were included as meeting the criteria and were found to have a total of 42 unique recommendations; 11 were classified as interface features, 10 as information features, and 21 as interaction features. Features are defined and described, providing actionable guidance that can be applied to CDSS development and policy. To our knowledge, no reviews have been completed that discuss/recommend design features of CDSS at this scale, and thus we found that this was important for the body of literature. The recommendations identified in this narrative review will help to optimize design, organization, management, presentation, and utilization of information through presentation, content, and function. The designation of 3 categories (interface, information, and interaction) should be further evaluated to determine the critical importance of the categories. Future work will determine how to prioritize them with limited resources for designers and developers in order to maximize the clinical utility of CDSS. This review will expand the field of knowledge and provide a novel organization structure to identify key recommendations for CDSS.
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Wood, F M; Kolybaba, M L; Allen, P
2006-06-01
The need to achieve rapid wound closure in patients with massive burns and limited skin donor sites led to the investigation of in vitro cellular expansion of keratinocytes. The use of cultured epithelial autografts (CEA) was first reported in the treatment of major burns in 1981. Since that time, support for the use of CEA has varied, ranging from 'a useful agent' to having 'no demonstrable effect on the outcome of extensively burned patients'. This critical review of the literature examines issues associated with the use of CEA and the introduction of the technology into clinical practice. The factors potentially limiting the use of cultured CEA are the time necessary to culture CEA sheets, the reliability of 'take', vulnerability of grafts on the newly healed surface, long-term durability and the cost implications of such treatment. The available literature was located and critically evaluated using the Australian National Health and Medical Research Council Guidelines. In the identified literature, the level of evidence to support the use of CEA in major burn injures is limited and often restricted to case studies and case series with no Level 1 evidence currently available. The main question arising 'Does CEA have a role in the treatment of major burns?' has proven difficult to answer due to the wide variation in both the quality of study design and the findings. At best, the literature review has highlighted areas of concern that have hindered the successful use of CEA. Our review critically evaluates the use of CEA and explores the advances in techniques towards attempting to improve reliable clinical implementation of CEA. The need for higher level research into the use of CEA is emphasised by this review.
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REVIEWS OF TOPICAL PROBLEMS: Critical opalescence
Zubkov, L. A.; Romanov, Vadim P.
1988-04-01
Studies of critical opalescence near phase transitions in different systems are reviewed. The fundamentals of the modern approach to the description of the propagation and scattering of light in media with large nonuniformities are presented. The experimental data on the coefficient of extinction and integrated intensity of the scattered light are analyzed and different models for the correlation function are discussed. Different methods for studying multiple scattering of light and methods for eliminating it from the measured intensity are examined. The kinetic properties of systems in the critical region are examined. Attention is devoted primarily to the experimental data obtained by the methods of correlation spectroscopy and to the comparison of these data with the predictions of different theoretical models. Significant attention is devoted to the study of phase transitions in liquids by the methods of light scattering as well as the problem of propagation and scattering of light in the nematic phase, where fluctuations of the director exhibit the same behavior as at the critical point. In conclusion, phase transformations in micellar solutions, to which a great deal of attention has been devoted in recent years, are studied.
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RELEVANCE OF COLLAGEN PIEZOELECTRICITY TO “WOLFF’S LAW”: A CRITICAL REVIEW
Ahn, Andrew C.; Grodzinsky, Alan J.
2009-01-01
According to “Wolff’s Law”, bone is deposited and reinforced at areas of greatest stress. From a clinical perspective, this “law” is supported by the strong association between bone density and physical activity. From a mechanistic standpoint, however, the law presents a challenge to scientists seeking to understand how osteocytes and osteoblasts sense the mechanical load. In the 1960’s, collagen piezoelectricity was invoked as a potential mechanism by which osteocytes could detect areas of greater stress but piezoelectricity diminished in importance as more compelling mechanisms, such as streaming potential, were identified. In addition, accumulating evidence for the role of fluid-related shear stress in osteocyte’s mechanosensory function has made piezoelectricity seemingly more obsolete in bone physiology. This review critically evaluates the role of collagen piezoelectricity (if any) in Wolff’s Law – specifically, the evidence regarding its involvement in strain-generated potentials, existing alternate mechanisms, the present understanding of bone mechanosensation, and whether piezoelectricity serves an influential role within the context of this newly proposed mechanism. In addition to reviewing the literature, this review generates several hypotheses and proposes future research to fully address the relevance of piezoelectricity in bone physiology. PMID:19286413
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Fission, critical mass and safety-a historical review
International Nuclear Information System (INIS)
Meggitt, Geoff
2006-01-01
Since the discovery of fission, the notion of a chain reaction in a critical mass releasing massive amounts of energy has haunted physicists. The possibility of a bomb or a reactor prompted much of the early work on determining a critical mass, but the need to avoid an accidental critical excursion during processing or transport of fissile material drove much that took place subsequently. Because of the variety of possible situations that might arise, it took some time to develop adequate theoretical tools for criticality safety and the early assessments were based on direct experiment. Some extension of these experiments to closely similar situations proved possible, but it was not until the 1960s that theoretical methods (and computers to run them) developed enough for them to become reliable assessment tools. Validating such theoretical methods remained a concern, but by the end of the century they formed the backbone of criticality safety assessment. This paper traces the evolution of these methods, principally in the UK and USA, and summarises some related work concerned with the nature of criticality accidents and their radiological consequences. It also indicates how the results have been communicated and used in ensuring nuclear safety. (review)
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Alper, Brian S; Fedorowicz, Zbys; van Zuuren, Esther J
2015-08-01
To determine how often clinical conclusions derived from Cochrane Reviews have uncertain validity due to review conduct and reporting deficiencies. We evaluated 5142 clinical conclusions in DynaMed (an evidence-based point-of-care clinical reference) based on 4743 Cochrane Reviews. Clinical conclusions with level 2 evidence due to shortcomings in the review's conduct or reporting (rather than deficiencies in the underlying evidence) were confirmed by a DynaMed editor and two Cochrane Review authors. Thirty-one Cochrane Reviews (0.65%) had confirmed deficiencies in conduct and reporting as the reason for classifying 37 assessed clinical conclusions (0.72%) as level 2 evidence. In all cases, it was not feasible for the assessors to specify a clear criticism of the studies included in the reviews. The deficiencies were specific to not accounting for dropouts (2) or inadequate assessment and reporting of allocation concealment (11), other specific trial quality criteria (14), or all trial quality criteria (4). Cochrane Reviews provide high-quality assessment and synthesis of evidence, with fewer than 1% of Cochrane Reviews having limitations which hinder the summary of best current evidence for clinical decision-making. We expect this will further decrease following recent Cochrane quality initiatives. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.
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An analysis of narratives to identify critical thinking contexts in psychiatric clinical practice.
Mun, Mi Suk
2010-02-01
The development of students' critical thinking abilities is one of the greatest challenges facing contemporary nursing educators. Nursing educators should know about what kind of contents or situations need critical thinking. The research was undertaken to identify the critical thinking contexts that nursing students confront in psychiatric clinical practices. Students were asked to document their everyday experience. The narratives were analysed and interpreted from the philosophical notion of hermeneutics. Four themes emerged as critical thinking contexts: anxiety, conflict, hyper-awareness, dilemmas. Writing narratives appear to provide opportunities for reflection in addition to facilitating critical thinking and communicative skills in students. Also, for the instructor, students' clinical narratives could provide insight to understand how students are thinking and to share student's personal difficulties.
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A Method to Evaluate Critical Factors for Successful Implementation of Clinical Pathways.
Dong, W; Huang, Z
2015-01-01
Clinical pathways (CPs) have been viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care. Despite widespread enthusiasm for CPs, research has shown that many CP initiatives are unsuccessful. To this end, this study provides a methodology to evaluate critical success factors (CSFs) that can aid healthcare organizations to achieve successful CP implementation. This study presents a new approach to evaluate CP implementation CSFs, with the aims being: (1) to identify CSFs for implementation of CPs through a comprehensive literature review and interviews with collaborative experts; (2) to use a filed study data with a robust fuzzy DEMATEL (the decision making trial and evaluation laboratory) approach to visualize the structure of complicated causal relationships between CSFs and obtain the influence level of these factors. The filed study data is provided by ten clinical experts of a Chinese hospital. 23 identified CSF factors which are initially identified through a review of the literature and interviews with collaborative experts. Then, a number of direct and indirect relationships are derived from the data such that different perceptions can be integrated into a compromised cause and effect model of CP implementation. The results indicate that the proposed approach can systematically evaluate CSFs and realize the importance of each factor such that the most common causes of failure of CP implementation could be eliminated or avoided. Therefore, the tool proposed would help healthcare organizations to manage CP implementation in a more effective and proactive way.
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Enhancing Critical Thinking Via a Clinical Scholar Approach.
Simpson, Vicki; McComb, Sara A; Kirkpatrick, Jane M
2017-11-01
Safety, quality improvement, and a systems perspective are vital for nurses to provide quality evidence-based care. Responding to the call to prepare nurses with these perspectives, one school of nursing used a clinical scholar approach, enhanced by systems engineering to more intentionally develop the ability to clinically reason and apply evidence-based practice. A two-group, repeated-measures control trial was used to determine the effects of systems engineering content and support on nursing students' clinical judgment and critical thinking skills. Findings indicated this approach had a positive effects on student's clinical judgment and clinical reasoning skills. This approach helped students view health care issues from a broader perspective and use evidence to guide solution development, enhancing the focus on evidence-based practice, and quality improvement. Intentional integration of an evidence-based, systems perspective by nursing faculty supports development of nurses who can function safely and effectively in the current health care system. [J Nurs Educ. 2017;56(11):679-682.]. Copyright 2017, SLACK Incorporated.
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Radio-frequency glow discharge spectrometry: A critical review
International Nuclear Information System (INIS)
Winchester, Michael R.; Payling, Richard
2004-01-01
This paper presents a critical review of analytical radio frequency glow discharge spectrometry (rf-GDS). The historical foundations of rf-GDS are described, and current knowledge of the fundamental physics of analytical rf glow discharges is discussed. Additionally, instrumentation, methodologies, and applications of rf glow discharge optical emission spectrometry (rf-GDOES) and mass spectrometry (rf-GDMS) are reviewed. Although other rf-GDS techniques have appeared [e.g. rf glow discharge atomic absorption spectrophotometry (rf-GDAAS)], the emphasis is placed upon rf-GDOES and rf-GDMS, because they have received by far the most interest from analytical chemical metrologists. This review also provides explanations of some developments that are needed for further progress in the field of analytical rf-GDS
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Merisier, Sophia; Larue, Caroline; Boyer, Louise
2018-06-01
Problem-based learning is an educational method promoting clinical reasoning that has been implemented in many fields of health education. Questioning is a learning strategy often employed in problem-based learning sessions. To explore what is known about the influence of questioning on the promotion of clinical reasoning of students in health care education, specifically in the field of nursing and using the educational method of problem-based learning. A scoping review following Arksey and O'Malley's five stages was conducted. The CINAHL, EMBASE, ERIC, Medline, and PubMed databases were searched for articles published between the years of 2000 and 2017. Each article was summarized and analyzed using a data extraction sheet in relation to its purpose, population group, setting, methods, and results. A descriptive explication of the studies based on an inductive analysis of their findings to address the aim of the review was made. Nineteen studies were included in the analysis. The studies explored the influence of questioning on critical thinking rather than on clinical reasoning. The nature of the questions asked and the effect of higher-order questions on critical thinking were the most commonly occurring themes. Few studies addressed the use of questioning in problem-based learning. More empirical evidence is needed to gain a better understanding of the benefit of questioning in problem-based learning to promote students' clinical reasoning. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Autologous Matrix-Induced Chondrogenesis: A Systematic Review of the Clinical Evidence.
Gao, Liang; Orth, Patrick; Cucchiarini, Magali; Madry, Henning
2017-11-01
The addition of a type I/III collagen membrane in cartilage defects treated with microfracture has been advocated for cartilage repair, termed "autologous matrix-induced chondrogenesis" (AMIC). To examine the current clinical evidence regarding AMIC for focal chondral defects. Systematic review. A systematic review was performed by searching PubMed, ScienceDirect, and Cochrane Library databases. Inclusion criteria were clinical studies of AMIC for articular cartilage repair, written in English. Relative data were extracted and critically analyzed. PRISMA guidelines were applied, the methodological quality of the included studies was assessed by the modified Coleman Methodology Score (CMS), and aggregate data were generated. Twenty-eight clinical articles were included: 12 studies (245 patients) of knee cartilage defects, 12 studies (214 patients) of ankle cartilage defects, and 4 studies (308 patients) of hip cartilage defects. The CMS demonstrated a suboptimal study design in the majority of published studies (knee, 57.8; ankle, 55.3; hip, 57.7). For the knee, 1 study reported significant clinical improvements for AMIC compared with microfracture for medium-sized cartilage defects (mean defect size 3.6 cm 2 ) after 5 years (level of evidence, 1). No study compared AMIC with matrix-assisted autologous chondrocyte implantation (ACI) in the knee. For the ankle, no clinical trial was available comparing AMIC versus microfracture or ACI. In the hip, only one analysis (level of evidence, 3) compared AMIC with microfracture for acetabular lesions. For medium-sized acetabular defects, one study (level of evidence, 3) found no significant differences between AMIC and ACI at 5 years. Specific aspects not appropriately discussed in the currently available literature include patient-related factors, membrane fixation, and defect properties. No treatment-related adverse events were reported. This systematic review reveals a paucity of high-quality, randomized controlled
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International Nuclear Information System (INIS)
Rathbun, R.
1994-01-01
Review of SRT-CMA-940003, ''Phase I Criticality Analysis For The 9972-9975 Family Of Shipping Casks (U). (SRT-CMA-940003).'' January 22, 1994, has been performed by the SRTC Applied Physics Group. The NCSE is a criticality assessment of the 9972-9975 family of shipping casks. This work is a follow-on of a previous criticality safety evaluation, with the differences between this and the previous evaluation are that now wall tolerances are modeled and more sophisticated analytical methods are applied. The NCSE under review concludes that, with one exception, the previously specified plutonium and uranium mass limits for 9972-9975 family of shipping casks do ensure that WSRC Nuclear Criticality Safety Manual requirements (ref. 1) are satisfied. The one exception is that the plutonium mass limit for the 9974 cask had to be reduced from 4.4 to 4.3 kg. In contrast, the 7.5 kg uranium mass limit for the 9974 cask was raised to 14.5 kg, making the uranium mass identical for all casks in this family. This technical review consisted of an independent check of the methods and models employed, application of ANSI/ANS 8.1 and 8.15, and verification of WSRC Nuclear Criticality Safety Manual procedures
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Technical review of WSRC-TR-93-614 criticality safety evaluation for disassembly basin sand filter
International Nuclear Information System (INIS)
Reed, R.L.
1994-01-01
The study documented in WSRC-TR-93-614 performed an evaluation of the criticality potential associated with the Disassembly Basin Sand Filter for K and L Areas. The document reviewed incorporated results of calculations documented in the engineering calculation N-CLC-K-00151. Analyses of the contents of disassembly basin sludge has indicated that the sludge contains fissile material in excess of subcritical mass limits as specified in ANSI/ANS standards. Previous studies had determined that the fissile material can not collect into a critical configuration in the basin. Since the sand filter is intended to remove suspended particles from the basin water and could serve as a mechanism to collect the fissile material into a critical configuration, the study examined conditions under which criticality could occur in the sand filter. The study shows that criticality is not considered possible in the sand filter. This review emphasized the technical accuracy and presentation of the evaluation. The evaluation was also examined for the elements required for NCSEs. The review was performed in accordance with the NRTSC technical review requirements and procedures and the E7 Manual technical review requirements. The technical review (per the E7 manual) of the engineering calculation (N-CLC-K-0 1 5 1) was previously performed by this reviewer
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Evidence based evaluation of immuno-coagulatory interventions in critical care
DEFF Research Database (Denmark)
Afshari, Arash
2011-01-01
Cochrane systematic reviews with meta-analyses of randomised trials provide guidance for clinical practice and health-care decision-making. In case of disagreements between research evidence and clinical practice, high quality systematic reviews can facilitate implementation or deimplementation o...... of medical interventions into clinical practice. This applies especially to treatment of critically ill patients where interventions are most often costly and the clinical conditions are associated with high mortality....
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Critical factors for EIA implementation: literature review and research options.
Zhang, Jie; Kørnøv, Lone; Christensen, Per
2013-01-15
After decades of development, the gap between expectations of Environment Impact Assessments (EIA) and their practical performance remains significant. Research has been done to identify the critical factors for an effective implementation of EIA. However, this research, to a large extent, has not been cumulated and analysed comprehensively according to the stages of the EIA process. This paper contributes to the critical review of the literature on EIA implementation and effectiveness by cumulating mainly empirical findings in an implementation theoretical perspective. It focuses on the links between different critical factors and how they relate to different stages in the EIA and thus influence the decision making process. After reviewing 33 refereed journal articles published between 1999 and 2011, we identified 203 notions of critical factors. Of these, 102 related to different stages defined in our comprehensive EIA implementation model, and 101 were identified as general factors related to the whole EIA system. The number of notions of stage factors and general factors is thus about equal. An overlap between stage factors and general factors was found, which demonstrates that critical factors function differently in different cases. The function of the critical factors is complex and it is difficult to determine contingencies and causations. In the sources we examined, there is evidently an imbalance between in-depth empirical research and general knowledge, and the paper offers some suggestions for future research. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Belard, Arnaud; Buchman, Timothy; Forsberg, Jonathan; Potter, Benjamin K; Dente, Christopher J; Kirk, Allan; Elster, Eric
2017-04-01
Improving diagnosis and treatment depends on clinical monitoring and computing. Clinical decision support systems (CDSS) have been in existence for over 50 years. While the literature points to positive impacts on quality and patient safety, outcomes, and the avoidance of medical errors, technical and regulatory challenges continue to retard their rate of integration into clinical care processes and thus delay the refinement of diagnoses towards personalized care. We conducted a systematic review of pertinent articles in the MEDLINE, US Department of Health and Human Services, Agency for Health Research and Quality, and US Food and Drug Administration databases, using a Boolean approach to combine terms germane to the discussion (clinical decision support, tools, systems, critical care, trauma, outcome, cost savings, NSQIP, APACHE, SOFA, ICU, and diagnostics). References were selected on the basis of both temporal and thematic relevance, and subsequently aggregated around four distinct themes: the uses of CDSS in the critical and surgical care settings, clinical insertion challenges, utilization leading to cost-savings, and regulatory concerns. Precision diagnosis is the accurate and timely explanation of each patient's health problem and further requires communication of that explanation to patients and surrogate decision-makers. Both accuracy and timeliness are essential to critical care, yet computed decision support systems (CDSS) are scarce. The limitation arises from the technical complexity associated with integrating and filtering large data sets from diverse sources. Provider mistrust and resistance coupled with the absence of clear guidance from regulatory bodies further retard acceptance of CDSS. While challenges to develop and deploy CDSS are substantial, the clinical, quality, and economic impacts warrant the effort, especially in disciplines requiring complex decision-making, such as critical and surgical care. Improving diagnosis in health care
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Kalateh Sadati, Ahmad; Iman, Mohammad Taghi; Bagheri Lankarani, Kamran
2014-01-01
Background: Despite its benefits and importance, clinical counseling affects the patient both psychosocially and socially. Illness labeling not only leads to many problems for patient and his/her family but also it imposes high costs to health care system. Among various factors, doctor-patient relationship has an important role in the clinical counseling and its medical approach. The goal of this study is to evaluate the nature of clinical counseling based on critical approach. Methods: The context of research is the second major medical training center in Shiraz, Iran. In this study, Critical Conversation Analysis was used based on the methodologies of critical theories. Among about 50 consultation meetings digitally recorded, 33 were selected for this study. Results: Results show that the nature of doctor-patient relationship in these cases is based on paternalistic model. On the other hand, in all consultations, the important values that were legitimated with physicians were medical paraclinical standards. Paternalism in one hand and standardization on the other leads to dependency of patients to the clinic. Conclusion: Although we can’t condone the paraclinical standards, clinical counseling and doctor-patient relationship need to reduce its dominance over counseling based on interpretation of human relations, paying attention to social and economical differences of peoples and biosocial and biocultural differences, and focusing on clinical examinations. Also, we need to accept that medicine is an art of interaction that can’t reduce it to instrumental and linear methods of body treatment. PMID:25349858
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Kalateh Sadati, Ahmad; Iman, Mohammad Taghi; Bagheri Lankarani, Kamran
2014-07-01
Despite its benefits and importance, clinical counseling affects the patient both psychosocially and socially. Illness labeling not only leads to many problems for patient and his/her family but also it imposes high costs to health care system. Among various factors, doctor-patient relationship has an important role in the clinical counseling and its medical approach. The goal of this study is to evaluate the nature of clinical counseling based on critical approach. The context of research is the second major medical training center in Shiraz, Iran. In this study, Critical Conversation Analysis was used based on the methodologies of critical theories. Among about 50 consultation meetings digitally recorded, 33 were selected for this study. RESULTS show that the nature of doctor-patient relationship in these cases is based on paternalistic model. On the other hand, in all consultations, the important values that were legitimated with physicians were medical paraclinical standards. Paternalism in one hand and standardization on the other leads to dependency of patients to the clinic. Although we can't condone the paraclinical standards, clinical counseling and doctor-patient relationship need to reduce its dominance over counseling based on interpretation of human relations, paying attention to social and economical differences of peoples and biosocial and biocultural differences, and focusing on clinical examinations. Also, we need to accept that medicine is an art of interaction that can't reduce it to instrumental and linear methods of body treatment.
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Critical Review of Membrane Bioreactor Models
DEFF Research Database (Denmark)
Naessens, W.; Maere, T.; Ratkovich, Nicolas Rios
2012-01-01
Membrane bioreactor technology exists for a couple of decades, but has not yet overwhelmed the market due to some serious drawbacks of which operational cost due to fouling is the major contributor. Knowledge buildup and optimisation for such complex systems can heavily benefit from mathematical...... modelling. In this paper, the vast literature on hydrodynamic and integrated modelling in MBR is critically reviewed. Hydrodynamic models are used at different scales and focus mainly on fouling and only little on system design/optimisation. Integrated models also focus on fouling although the ones...
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Hepatic lipidosis: Clinical review drawn from collective effort.
Webb, Craig B
2018-03-01
Practical relevance: Hepatic lipidosis (HL) is the most common form of liver dysfunction in cats. If recognized early and treated appropriately, the prognosis is good; if not, the prognosis is grave. Clinical challenges: Distinguishing HL as idiopathic or secondary is critical since the presence of a concurrent disease affects the therapeutic plan and the prognosis. Despite the unique and severe nature of a cat's response to anorexia and the complexity of the metabolic changes underlying this condition, the clinical acumen and technical ability to effectively diagnose and treat HL are readily available to all small animal practitioners. Patient group: Although many species develop a 'fatty liver', the cat is one of relatively few species that suffer from HL. The classic presentation is that of an overweight cat that stops eating for days to weeks, losing weight in the process. Equipment: Abdominal ultrasound is frequently employed in the diagnostic work-up of an anorectic cat; ultrasonographic findings often support a presumptive diagnosis, provide samples for cytology and, perhaps most importantly, help identify concurrent conditions that must be addressed for therapeutic success. All of the equipment necessary for essential nutritional intervention in an anorectic cat is readily available and easily affordable. Evidence base: The material for this review draws heavily on a relatively large number of original studies, excellent reviews by recognized experts, and informative communication with experienced clinicians, hence the term 'collective effort'.
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Tank waste remediation system nuclear criticality safety program management review
International Nuclear Information System (INIS)
BRADY RAAP, M.C.
1999-01-01
This document provides the results of an internal management review of the Tank Waste Remediation System (TWRS) criticality safety program, performed in advance of the DOE/RL assessment for closure of the TWRS Nuclear Criticality Safety Issue, March 1994. Resolution of the safety issue was identified as Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) Milestone M-40-12, due September 1999
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Carey, Matthew C; Kent, Bridie; Latour, Jos M
2018-05-01
methodological quality independently by two reviewers, using the Joanna Briggs Institute Critical Appraisal Form for Interpretive and Critical Research. Qualitative data was extracted using the standardized JBI qualitative data extraction tool. Qualitative research findings were synthesized using JBI methodology. From the eight included studies, 37 findings were extracted. These findings were further aggregated into seven categories, and then into three synthesized findings. These three synthesized findings are: 1) Challenges of clinical practice are mitigated by peer support; 2) Peers are role models for enhancing clinical knowledge; and 3) Support and feedback develop competence and confidence, and reduce stress and anxiety. Peer-assisted learning exists in clinical practice in both formal and informal circumstances. Friendship and community are often expressed as occurring when peers work together. Support and feedback help students develop in their clinical role and enhance clinical knowledge. Outcomes include enhancing the competency and confidence of peers, and reducing stress and anxiety. Challenges of clinical practice are mitigated through PAL.
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Naber, Jessica L; Hall, Joanne; Schadler, Craig Matthew
2014-09-01
This study sought to identify characteristics of clinically situated critical thinking in nursing students' reflections, originally part of a study guided by Richard Paul's model of critical thinking. Nurses are expected to apply critical thinking in all practice situations to improve health outcomes, including patient safety and satisfaction. In a previous study, Paul's model of critical thinking was used to develop questions for reflective writing assignments. Within that study, 30 nursing students completed six open-ended narratives of nurse-patient clinical encounters during an 8-week period. Improvements were seen in critical thinking scores after the intervention. This article reports the qualitative analysis of the content of six open-ended narratives. Six overarching themes were identified and combined into a tentative conceptual model. Faculty's understanding of the characteristics of critical thinking in the context of clinical education will help them to teach and evaluate students' progress and competencies for future practice.
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McCutcheon, Karen; Lohan, Maria; Traynor, Marian
2016-01-01
Aim: This paper is a review protocol that will be used to identify, critically appraise and synthesise the best current evidence relating to the use of online learning and blended learning approaches in teaching clinical skills in undergraduate health professionals. Background: Although previous systematic reviews on online learning vs. face to…
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Andreou, Christos; Papastavrou, Evridiki; Merkouris, Anastasios
2014-03-01
Critical thinking is a desirable competency for contemporary nurses although there are growing concerns supporting a disturbing paucity in its achievement. Learning styles reflect habitual behaviors which determine distinct preferences within learning situations. Evidence suggests that critical thinking could evolve through learning processes. Variances in critical thinking achievement by nursing students might therefore be influenced by individual learning preferences. The concepts "learning styles" and "critical thinking" have been independently examined in the nursing literature. No reviews were found however exploring their association in nursing education. To identify the potential relationships between learning styles and critical thinking in baccalaureate nursing students. Systematic review. Eleven electronic databases were utilized without geographical and time publishing filters. Hand-searching journals and scanning references from retrieved studies were also performed. Databases were searched for descriptive correlational studies which considered the relationship between learning styles and critical thinking in baccalaureate nursing students. The authors independently progressed three stage screening. Retrieved articles were reviewed at title, abstract and full text levels according to predetermined criteria. All included studies were quality appraised using a rating tool for descriptive studies. Six studies were finally included. Findings were grouped under four key themes: predominant learning styles, critical thinking scoring, critical thinking evolution across academic progress and learning styles-critical thinking correlations. Learning styles' diversities, weak critical thinking and inconsistent evolution through academic progress were revealed across studies. Critical thinking differed significantly between learning styles. Commonly accepted models in nursing education were lacking in both learning styles and critical thinking. Within studies
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Alexithymia and eating disorders: a critical review of the literature
2013-01-01
Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed. PMID:24999402
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Review of critical factors for SEA implementation
Energy Technology Data Exchange (ETDEWEB)
Zhang Jie, E-mail: jasmine@plan.aau.dk; Christensen, Per; Kornov, Lone
2013-01-15
The implementation process involved in translating Strategic Environmental Assessment (SEA) intention into action is vital to an effective SEA. Many factors influence implementation and thus the effectiveness of an SEA. Empirical studies have identified and documented some factors influencing the implementation of an SEA. This research is fragmented, however, and it is still not clear what are the most critical factors of effective SEA performance, and how these relate to different stages of the implementation process or other contextual circumstances. The paper takes its point of departure in implementation theory. Firstly, we introduce implementation theory, and then use it in practice to establish a more comprehensive model related to the stages in the implementation process. Secondly, we identify the critical factors in order to see how they are related to the different stages of SEA or are more general in character. Finally we map the different critical factors and how they influence the overall results of an SEA. Based on a literature review, we present a comprehensive picture of the critical factors and where they are found in the process. We conclude that most of the critical factors identified are of a more general character influencing the SEA process as such, while only one out of four of these factors relates to the specific stages of the SEA. Based on this mapping we can sketch a picture of the totality of critical factors. In this study 266 notions of critical factors were identified. Seen at the level of notions of critical factors, only 24% of these relate to specific stages while for 76% the critical factors are of a more general nature. These critical factors interact in complex ways and appear in different combinations in different stages of the implementation process so tracing the cause and effect is difficult. The pervasiveness of contextual and general factors also clearly suggests that there is no single way to put SEA into practice. The
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Review of critical factors for SEA implementation
International Nuclear Information System (INIS)
Zhang Jie; Christensen, Per; Kørnøv, Lone
2013-01-01
The implementation process involved in translating Strategic Environmental Assessment (SEA) intention into action is vital to an effective SEA. Many factors influence implementation and thus the effectiveness of an SEA. Empirical studies have identified and documented some factors influencing the implementation of an SEA. This research is fragmented, however, and it is still not clear what are the most critical factors of effective SEA performance, and how these relate to different stages of the implementation process or other contextual circumstances. The paper takes its point of departure in implementation theory. Firstly, we introduce implementation theory, and then use it in practice to establish a more comprehensive model related to the stages in the implementation process. Secondly, we identify the critical factors in order to see how they are related to the different stages of SEA or are more general in character. Finally we map the different critical factors and how they influence the overall results of an SEA. Based on a literature review, we present a comprehensive picture of the critical factors and where they are found in the process. We conclude that most of the critical factors identified are of a more general character influencing the SEA process as such, while only one out of four of these factors relates to the specific stages of the SEA. Based on this mapping we can sketch a picture of the totality of critical factors. In this study 266 notions of critical factors were identified. Seen at the level of notions of critical factors, only 24% of these relate to specific stages while for 76% the critical factors are of a more general nature. These critical factors interact in complex ways and appear in different combinations in different stages of the implementation process so tracing the cause and effect is difficult. The pervasiveness of contextual and general factors also clearly suggests that there is no single way to put SEA into practice. The
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"Theorizing Teacher Mobility": A Critical Review of Literature
Vagi, Robert; Pivovarova, Margarita
2017-01-01
In this critical review of literature, we summarize the major theoretical frameworks that have been used to study teacher mobility. In total we identified 40 teacher mobility studies that met our inclusion criteria. We conclude that relatively few theoretical frameworks have been used to study teacher mobility and those that have been used are…
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Critical appraisal of nonrandomized studies-A review of recommended and commonly used tools.
Quigley, Joan M; Thompson, Juliette C; Halfpenny, Nicholas J; Scott, David A
2018-02-27
When randomized controlled trial data are limited or unavailable, or to supplement randomized controlled trial evidence, health technology assessment (HTA) agencies may rely on systematic reviews of nonrandomized studies (NRSs) for evidence of the effectiveness of health care interventions. NRS designs may introduce considerable bias into systematic reviews, and several methodologies by which to evaluate this risk of bias are available. This study aimed to identify tools commonly used to assess bias in NRS and determine those recommended by HTA bodies. Appraisal tools used in NRS were identified through a targeted search of systematic reviews (January 2013-March 2017; MEDLINE and EMBASE [OVID SP]). Recommendations for the critical appraisal of NRS by expert review groups and HTA bodies were reviewed. From the 686 studies included in the narrative synthesis, 48 critical appraisal tools were identified. Commonly used tools included the Newcastle-Ottawa Scale, the methodological index for NRS, and bespoke appraisal tools. Neither the Cochrane Handbook nor the Centre for Reviews and Dissemination recommends a particular instrument for the assessment of risk of bias in NRS, although Cochrane has recently developed their own NRS critical appraisal tool. Among HTA bodies, only the Canadian Agency for Drugs and Technologies in Health recommends use of a specific critical appraisal tool-SIGN 50 (for cohort or case-control studies). Several criteria including reporting, external validity, confounding, and power were examined. There is no consensus between HTA groups on the preferred appraisal tool. Reviewers should select from a suite of tools on the basis of the design of studies included in their review. © 2018 John Wiley & Sons, Ltd.
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Energy Technology Data Exchange (ETDEWEB)
Redmond, Kristin J., E-mail: kjanson3@jhmi.edu [Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (United States); Lo, Simon S. [Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio (United States); Fisher, Charles [Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia (Canada); Sahgal, Arjun [Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario (Canada)
2016-08-01
Postoperative stereotactic body radiation therapy (SBRT) for metastatic spinal tumors is increasingly being performed in clinical practice. Whereas the fundamentals of SBRT practice for intact spinal metastases are established, there are as yet no comprehensive practice guidelines for the postoperative indications. In particular, there are unique considerations for patient selection and treatment planning specific to postoperative spine SBRT that are critical for safe and effective management. The purpose of this critical review is to discuss the rationale for treatment, describe those factors affecting surgical decision making, introduce modern surgical trends, and summarize treatment outcomes for both conventional postoperative external beam radiation therapy and postoperative spine SBRT. Lastly, an in-depth practical discussion with respect to treatment planning and delivery considerations is provided to help guide optimal practice.
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Critical Care Organizations: Business of Critical Care and Value/Performance Building.
Leung, Sharon; Gregg, Sara R; Coopersmith, Craig M; Layon, A Joseph; Oropello, John; Brown, Daniel R; Pastores, Stephen M; Kvetan, Vladimir
2018-01-01
New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1). The goal of this article was to provide a roadmap and call attention to key factors that adult critical care medicine leadership in both academic and nonacademic setting should consider when planning for value-based care. Relevant medical literature was accessed through a literature search. Material published by federal health agencies and other specialty organizations was also reviewed. Collaboratively and iteratively, taskforce members corresponded by electronic mail and held monthly conference calls to finalize this report. The business and value/performance critical care organization building section comprised of leaders of critical care organizations with expertise in critical care administration, healthcare management, and clinical practice. Two phases of critical care organizations care integration are described: "horizontal," within the system and regionalization of care as an initial phase, and "vertical," with a post-ICU and postacute care continuum as a succeeding phase. The tools required for the clinical and financial transformation are provided, including the essential prerequisites of forming a critical care organization; the manner in which a critical care organization can help manage transformational domains is considered. Lastly, how to achieve organizational health system support for critical care organization implementation is discussed. A critical care organization that incorporates functional clinical horizontal and
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BIOCHAR: PYROGENIC CARBON FOR AGRICULTURAL USE - A CRITICAL REVIEW
Directory of Open Access Journals (Sweden)
Etelvino Henrique Novotny
2015-04-01
Full Text Available Biochar (carbonized biomass for agricultural use has been used worldwide as soil amendment and is a technology of particular interest for Brazil, since its "inspiration" is from the historical Terra Preta de Índios(Amazon Dark Earth, and also because Brazil is the world's largest charcoal producer, generating enormous residue quantities in form of fine charcoal and due to the availability of different residual biomasses, mainly from agroindustry (e.g., sugar-cane bagasse; wood and paper-mill wastes; residues from biofuel industries; sewage sludge etc, that can be used for biochar production, making Brazil a key actor in the international scenario in terms of biochar research and utilization. In the last decade, numerous studies on biochar have been carried out and now a vast literature, and excellent reviews, are available. The objective of this paper is therefore to deliver a critical review with some highlights on biochar research, rather than an exhaustive bibliographic review. To this end, some key points considered critical and relevant were selected and the pertinent literature "condensed", with a view to guide future research, rather than analyze trends of the past.
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Clinical course teaching in transport of critically ill patients: Small group methods
Directory of Open Access Journals (Sweden)
Mohammad Taghi Beigmohammadi
2016-10-01
Full Text Available Critically ill patient transfer is potentially risky and may be lead to morbidity and mortality. Physicians' skill is very important for safe transport. We want to evaluate the effect of clinical course teaching on the promotion of physicians' abilities in the transport of critically ill patients. In an interventional study, 320 interns, male and female, were taught about patient transfer in two groups include in one day clinical course as the small group system (n=160 and other group the lecture base learning (n=160. In the clinical course, each participant under observation of an anesthesiologist in the operation room and ICU was acquainted with mask ventilation, intubation and learned to work with a defibrillator, infusion pump, portable ventilator and pulse oximeter. In lecture group, the anesthesiologist explained the topics by video and dummy. At the end of education course, the interns’ abilities were evaluated based on checklist method and scored by the project colleague in all educational items. Three hundred twenty interns, 122 males, and 198 females; were enrolled, two groups. The clinical course training caused improvements in the interns’ knowledge and abilities in intubation and use of the defibrillator and portable ventilator vs.lecture group significantly (P<0.005. The males were better than females in laryngoscopy, but the progress of the females was significantly better than males (P=0.003. The rate of adverse events was reduced significantly after clinical course teaching (P=0.041 Clinical course teaching could promote interns' clinical competencies in the transport of critically ill patients.
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Review on modeling and simulation of interdependent critical infrastructure systems
International Nuclear Information System (INIS)
Ouyang, Min
2014-01-01
Modern societies are becoming increasingly dependent on critical infrastructure systems (CISs) to provide essential services that support economic prosperity, governance, and quality of life. These systems are not alone but interdependent at multiple levels to enhance their overall performance. However, recent worldwide events such as the 9/11 terrorist attack, Gulf Coast hurricanes, the Chile and Japanese earthquakes, and even heat waves have highlighted that interdependencies among CISs increase the potential for cascading failures and amplify the impact of both large and small scale initial failures into events of catastrophic proportions. To better understand CISs to support planning, maintenance and emergency decision making, modeling and simulation of interdependencies across CISs has recently become a key field of study. This paper reviews the studies in the field and broadly groups the existing modeling and simulation approaches into six types: empirical approaches, agent based approaches, system dynamics based approaches, economic theory based approaches, network based approaches, and others. Different studies for each type of the approaches are categorized and reviewed in terms of fundamental principles, such as research focus, modeling rationale, and the analysis method, while different types of approaches are further compared according to several criteria, such as the notion of resilience. Finally, this paper offers future research directions and identifies critical challenges in the field. - Highlights: • Modeling approaches on interdependent critical infrastructure systems are reviewed. • I mainly review empirical, agent-based, system-dynamics, economic, network approaches. • Studies by each approach are sorted out in terms of fundamental principles. • Different approaches are further compared with resilience as the main criterion
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Neutrophils in critical illness.
McDonald, Braedon
2018-03-01
During critical illness, dramatic alterations in neutrophil biology are observed including abnormalities of granulopoeisis and lifespan, cell trafficking and antimicrobial effector functions. As a result, neutrophils transition from powerful antimicrobial protectors into dangerous mediators of tissue injury and organ dysfunction. In this article, the role of neutrophils in the pathogenesis of critical illness (sepsis, trauma, burns and others) will be explored, including pathological changes to neutrophil function during critical illness and the utility of monitoring aspects of the neutrophil phenotype as biomarkers for diagnosis and prognostication. Lastly, we review findings from clinical trials of therapies that target the harmful effects of neutrophils, providing a bench-to-bedside perspective on neutrophils in critical illness.
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Development of critical digital review procedure
International Nuclear Information System (INIS)
Huang Huiwen; Liao Benching; Tseng Maosheng; Chung Hsianghan; Cheng Tsungchieh; Chen Minghuei
2011-01-01
This paper describes the critical digital review (CDR) procedure, which was developed by Institute of Nuclear Energy Research (INER), and sponsored by Taiwan Power Company (TPC). A preliminary CDR application experience which was performed by INER, is also described in this paper. Currently, CDR becomes one of the policies for digital Instrumentation and Control (I and C) system replacement in TPC. The contents of this CDR procedure include: Scope, Responsibility, Operation Procedure, Operation Flow Chart, CDR review items. The 'CDR Review Items' chapter proposes optional review items, including the comparison of the design change, Software Verification and Validation (SV and V), Failure Mode and Effects Analysis (FMEA), Evaluation of Watchdog Timer, Evaluation of Electromagnetic Compatibility (EMC), Evaluation of Grounding for System/Component, Seismic Evaluation, HFE Evaluation, Witness and Inspection, Lessons Learnt from the Digital I and C Failure Events. Since CDR has become a TPC policy, Chin Shan Nuclear Power Plant (NPP) performed the CDR practice of Automatic Voltage Regulator (AVR) digital I and C replacement, even though the project had been on the half way. The major review items of this CDR were: the comparison of the design change, SV and V, FMEA, Evaluation of Watchdog Timer, Evaluation of Electromagnetic Compatibility (EMC), Evaluation of Grounding for System/ Component, Witness and Inspection, Lessons Learnt from the Digital I and C Failure Events. The experience of the CDR showed the importance of preparation of the documents by the vendor. This means the communication with the vendors for the bid preparation is crucial. (author)
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Directory of Open Access Journals (Sweden)
Iole Macchia
2013-01-01
Full Text Available The development of immune monitoring assays is essential to determine the immune responses against tumor-specific antigens (TSAs and tumor-associated antigens (TAAs and their possible correlation with clinical outcome in cancer patients receiving immunotherapies. Despite the wide range of techniques used, to date these assays have not shown consistent results among clinical trials and failed to define surrogate markers of clinical efficacy to antitumor vaccines. Multiparameter flow cytometry- (FCM- based assays combining different phenotypic and functional markers have been developed in the past decade for informative and longitudinal analysis of polyfunctional T-cells. These technologies were designed to address the complexity and functional heterogeneity of cancer biology and cellular immunity and to define biomarkers predicting clinical response to anticancer treatment. So far, there is still a lack of standardization of some of these immunological tests. The aim of this review is to overview the latest technologies for immune monitoring and to highlight critical steps involved in some of the FCM-based cellular immune assays. In particular, our laboratory is focused on melanoma vaccine research and thus our main goal was the validation of a functional multiparameter test (FMT combining different functional and lineage markers to be applied in clinical trials involving patients with melanoma.
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Kombucha: a systematic review of the clinical evidence.
Ernst, E
2003-04-01
Kombucha has become a popular complementary remedy. The aim of this systematic review was to critically evaluate the evidence related to its efficacy and safety. Computerised literature searches were carried out to locate all human medical investigations of kombucha regardless of study design. Data were extracted and validated by the present author and are reported in narrative form. No clinical studies were found relating to the efficacy of this remedy. Several case reports and case series raise doubts about the safety of kombucha. They include suspected liver damage, metabolic acidosis and cutaneous anthrax infections. One fatality is on record. On the basis of these data it was concluded that the largely undetermined benefits do not outweigh the documented risks of kombucha. It can therefore not be recommended for therapeutic use. Copyright 2003 S. Karger GmbH, Freiburg
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Clinical nursing and midwifery research in African countries: a scoping review.
Sun, Carolyn; Larson, Elaine
2015-05-01
Globally, the nursing shortage has been deemed a crisis, but African countries have been hit hardest. Therefore, it is of utmost importance nurses use the best available evidence and that nursing research is targeted to address gaps in the evidence. To achieve this, an understanding of what is currently available and identification of gaps in clinical nursing research is critical. We performed a scoping review of existing literature to assess clinical nursing research conducted in all African countries over the past decade, identify gaps in clinical nursing and midwifery research, determine whether they match with health priorities for countries, and define priorities for regional clinical nursing research agendas to improve health outcomes. This is a scoping review of published clinical nursing research conducted in African countries. Systematic searches of literature published between January 01, 2004 and September 15, 2014 were performed in PubMed, Medline, CINHAL, and Embase. Research was included if it was conducted by nurses, included data obtained in African countries or regions within the African continent, published in a peer-reviewed journal with an abstract, and included patient outcomes. Abstracts were independently reviewed for inclusion by two authors. The following data were extracted: countries of publication and study, study type and design, journal, language, and topics of research. Gaps in the literature were identified. Initially, 1091 papers were identified with a final sample of 73 articles meeting inclusion criteria. Studies used 12 designs, were published in 35 journals published in five countries (including two African countries); 29% of the research was published in a single journal (Curatonis). Research was mostly qualitative (57%) and included twenty countries in Africa (38%). There were 12 major topics of study, most often midwifery/maternal/child health (43%), patient experiences (38%), and human immunodeficiency virus (HIV
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Directory of Open Access Journals (Sweden)
p parmin
2016-02-01
Full Text Available The aims of this research is to improve students’ ability in develop- ing a proposal thesis by applying critical review of scientific articles come from journals. The research is designed by class action research. The results showed 63% of students thesis proposals on Research Methodology course scored above 80. Based on the results obtained it can be concluded that the application has been critical review or critical study of scientific articles can enhance students’ ability in preparing research proposals.
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Do Dental X-Rays Induce Genotoxicity and Cytotoxicity in Oral Mucosa Cells? A Critical Review.
Angelieri, Fernanda; Yujra, Veronica Quispe; Oshima, Celina Tizuko Fujiyama; Ribeiro, Daniel Araki
2017-10-01
Dental X-rays are widely used in clinical practice, since the technique is an important approach for diagnosing diseases in dental and periodontal tissues. However, it is widely known that radiation is capable of causing damage to cellular systems, such as genotoxicity or cytotoxicity. Thus, the aim of this review was to present a critical analysis regarding the studies published on genotoxicity and cytotoxicity induced by dental X-rays in oral mucosa cells. Such studies have revealed that some oral cell types are more sensitive than others following exposure to dental X-rays. Certainly, this review will contribute to a better understanding of this matter as well as to highlighting perspectives for further studies. Ultimately, such data will promote better safety for both patients and dental professionals. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Critical success factors in implementing clinical pathways/case management.
Choo, J
2001-07-01
With the advent of casemix reimbursement implementation, rapid technological changes, an ageing population and changing consumer behaviour, the Singapore health care industry is faced with the impetus to provide a cost-effective and efficient care delivery system. One ubiquitous tool used is the establishment of a clinical pathway/case management programme within the hospital. As the concept of clinical pathway for patient care is a relatively new concept in Singapore, several critical factors must be considered to ensure successful implementation of clinical pathway/case management programme. One key success factor lies in continued clinician support and acceptance. Other factors include top management leadership and support and a dedicated team of case managers, nurses and paramedical professionals.
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A CRITICAL REVIEW OF THE MODEL MINORITY STEREOTYPE SHIBBOLETH
Directory of Open Access Journals (Sweden)
Nicholas Daniel Hartlep
2012-04-01
Full Text Available The author conducted a thematic review of the literature on the model minority stereotype (MMS. MMS writings (n = 246 included peer-reviewed and non-peer-reviewed materials spanning from the 1960s to present. Writings were reviewed if their title included “model minority.” The purpose was to review the MMS critically. Six major themes were found to recurrently appear in the MMS literature. Those themes were the following: (1 critiquing colorblindness, (2 countering meritocracy, (3 demystifying Asian American exceptionalism, (4 uncovering divide and conquer stratagem, (5 problematizing Asian American homogenization, and (6 unmasking the “yellow peril” stereotype. Implications for the education of Asian students in America and abroad are shared.
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Consumer sleep tracking devices: a critical review.
Lee, Jeon; Finkelstein, Joseph
2015-01-01
Consumer sleep tracking devices are widely advertised as effective means to monitor and manage sleep quality and to provide positive effects on overall heath. However objective evidence supporting these claims is not always readily available. The goal of this study was to perform a comprehensive review of available information on six representative sleep tracking devices: BodyMedia FIT, Fitbit Flex, Jawbone UP, Basis Band, Innovative Sleep Solutions SleepTracker, and Zeo Sleep Manager Pro. The review was conducted along the following dimensions: output metrics, theoretical frameworks, systematic evaluation, and FDA clearance. The review identified a critical lack of basic information about the devices: five out of six devices provided no supporting information on their sensor accuracy and four out of six devices provided no information on their output metrics accuracy. Only three devices were found to have related peer-reviewed articles. However in these articles wake detection accuracy was revealed to be quite low and to vary widely (BodyMedia, 49.9±3.6%; Fitbit, 19.8%; Zeo, 78.9% to 83.5%). No supporting evidence on how well tracking devices can help mitigate sleep loss and manage sleep disturbances in practical life was provided.
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CALDAS, Waleska; CONTI, Ana Cláudia de Castro Ferreira; JANSON, Guilherme; Paulo César Rodrigues, CONTI
2016-01-01
ABSTRACT The relationship between Temporomandibular Disorders (TMD) and malocclusion is an extremely critical issue in dentistry. Contrary to the old concept that malocclusion causes TMD, occlusal changes, especially those observed as sudden, may be secondary and reflect joint or muscle disorders due to the obvious connection between these structures and the dental occlusion. Objectives The aim of this article is to present the most commonly occlusal changes secondary to TMD. Methods The clinical presentation of these conditions is discussed. Details regarding diagnosis, treatment, and follow-up of patients presenting TMD prior or during treatment are also presented. Conclusions All plans for irreversible therapy should be preceded by a meticulous analysis of TMD signs and symptoms in such a way that patients are not submitted to irreversible treatment, based on an untrue occlusal relationship, secondary to articular and/or muscular disorders. When present, TMD symptoms must always be controlled to reestablish a “normal” occlusion and allow proper treatment strategy. PMID:27556214
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Critical thinking in nursing: Scoping review of the literature.
Zuriguel Pérez, Esperanza; Lluch Canut, Maria Teresa; Falcó Pegueroles, Anna; Puig Llobet, Montserrat; Moreno Arroyo, Carmen; Roldán Merino, Juan
2015-12-01
This article seeks to analyse the current state of scientific knowledge concerning critical thinking in nursing. The methodology used consisted of a scoping review of the main scientific databases using an applied search strategy. A total of 1518 studies published from January 1999 to June 2013 were identified, of which 90 met the inclusion criteria. The main conclusion drawn is that critical thinking in nursing is experiencing a growing interest in the study of both its concepts and its dimensions, as well as in the development of training strategies to further its development among both students and professionals. Furthermore, the analysis reveals that critical thinking has been investigated principally in the university setting, independent of conceptual models, with a variety of instruments used for its measurement. We recommend (i) the investigation of critical thinking among working professionals, (ii) the designing of evaluative instruments linked to conceptual models and (iii) the identification of strategies to promote critical thinking in the context of providing nursing care. © 2014 Wiley Publishing Asia Pty Ltd.
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Sidhu, Navdeep S; Edwards, Morgan
2018-04-27
We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity. Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs. Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.
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Clinical accompaniment: the critical care nursing students’ experiences in a private hospital
Directory of Open Access Journals (Sweden)
N. Tsele
2000-09-01
Full Text Available The quality of clinical accompaniment of the student enrolled for the post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General is an important dimension of the educational/learning programme. The clinical accompanist/mentor is responsible for ensuring the student’s compliance with the clinical outcomes of the programme in accordance with the requirements laid down by the Nursing Education Institution and the South African Nursing Council. The purpose of this study was to explore and describe the experiences of the students enrolled for a post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General, in relation to the clinical accompaniment in a private hospital in Gauteng. An exploratory, descriptive and phenomenological research design was utilised and individual interviews were conducted with the ten students in the research hospital. A content analysis was conducted and the results revealed both positive and negative experiences by the students in the internal and external worlds. The recommendations include the formulation of standards for clinical accompaniment of students. the evaluation of the quality of clinical accompaniment of students and empowerment of the organisation, clinical accompanists/mentors and clinicians.
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Directory of Open Access Journals (Sweden)
Louise Rose
2016-11-01
Full Text Available Abstract Background Critically ill patients frequently experience severe agitation placing them at risk of harm. Physical restraint is common in intensive care units (ICUs for clinician concerns about safety. However, physical restraint may not prevent medical device removal and has been associated with negative physical and psychological consequences. While professional society guidelines, legislation, and accreditation standards recommend physical restraint minimization, guidelines for critically ill patients are over a decade old, with recommendations that are non-specific. Our systematic review will synthesize evidence on physical restraint in critically ill adults with the primary objective of identifying effective minimization strategies. Methods Two authors will independently search from inception to July 2016 the following: Ovid MEDLINE, CINAHL, Embase, Web of Science, Cochrane Library, PROSPERO, Joanna Briggs Institute, grey literature, professional society websites, and the International Clinical Trials Registry Platform. We will include quantitative and qualitative study designs, clinical practice guidelines, policy documents, and professional society recommendations relevant to physical restraint of critically ill adults. Authors will independently perform data extraction in duplicate and complete risk of bias and quality assessment using recommended tools. We will assess evidence quality for quantitative studies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE approach and for qualitative studies using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual guidelines. Outcomes of interest include (1 efficacy/effectiveness of physical restraint minimization strategies; (2 adverse events (unintentional device removal, psychological impact, physical injury and associated benefits including harm prevention; (3 ICU outcomes (ventilation duration, length of stay, and mortality; (4
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Critical Review of NOAA's Observation Requirements Process
LaJoie, M.; Yapur, M.; Vo, T.; Templeton, A.; Bludis, D.
2017-12-01
NOAA's Observing Systems Council (NOSC) maintains a comprehensive database of user observation requirements. The requirements collection process engages NOAA subject matter experts to document and effectively communicate the specific environmental observation measurements (parameters and attributes) needed to produce operational products and pursue research objectives. User observation requirements documented using a structured and standardized manner and framework enables NOAA to assess its needs across organizational lines in an impartial, objective, and transparent manner. This structure provides the foundation for: selecting, designing, developing, acquiring observing technologies, systems and architectures; budget and contract formulation and decision-making; and assessing in a repeatable fashion the productivity, efficiency and optimization of NOAA's observing system enterprise. User observation requirements are captured independently from observing technologies. Therefore, they can be addressed by a variety of current or expected observing capabilities and allow flexibility to be remapped to new and evolving technologies. NOAA's current inventory of user observation requirements were collected over a ten-year period, and there have been many changes in policies, mission priorities, and funding levels during this time. In light of these changes, the NOSC initiated a critical, in-depth review to examine all aspects of user observation requirements and associated processes during 2017. This presentation provides background on the NOAA requirements process, major milestones and outcomes of the critical review, and plans for evolving and connecting observing requirements processes in the next year.
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Nanostructured delivery systems with improved leishmanicidal activity: a critical review.
Bruni, Natascia; Stella, Barbara; Giraudo, Leonardo; Della Pepa, Carlo; Gastaldi, Daniela; Dosio, Franco
2017-01-01
Leishmaniasis is a vector-borne zoonotic disease caused by protozoan parasites of the genus Leishmania , which are responsible for numerous clinical manifestations, such as cutaneous, visceral, and mucocutaneous leishmaniasis, depending on the site of infection for particular species. These complexities threaten 350 million people in 98 countries worldwide. Amastigotes living within macrophage phagolysosomes are the principal target of antileishmanial treatment, but these are not an easy target as drugs must overcome major structural barriers. Furthermore, limitations on current therapy are related to efficacy, toxicity, and cost, as well as the length of treatment, which can increase parasitic resistance. Nanotechnology has emerged as an attractive alternative as conventional drugs delivered by nanosized carriers have improved bioavailability and reduced toxicity, together with other characteristics that help to relieve the burden of this disease. The significance of using colloidal carriers loaded with active agents derives from the physiological uptake route of intravenous administered nanosystems (the phagocyte system). Nanosystems are thus able to promote a high drug concentration in intracellular mononuclear phagocyte system (MPS)-infected cells. Moreover, the versatility of nanometric drug delivery systems for the deliberate transport of a range of molecules plays a pivotal role in the design of therapeutic strategies against leishmaniasis. This review discusses studies on nanocarriers that have greatly contributed to improving the efficacy of antileishmaniasis drugs, presenting a critical review and some suggestions for improving drug delivery.
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Critical review of directional neutron survey meters
Balmer, Matthew J. I.; Gamage, Kelum A. A.; Taylor, Graeme C.
2014-01-01
Having been overlooked for many years, research is now starting to take into account the directional distribution of the neutron work place field. The impact of not taking this into account has led to overly conservative estimates of dose in neutron workplace fields. This paper provides a critical review of this existing research into directional survey meters which could improve these estimates of dose. Instruments which could be adapted for use as directional neutron survey meters are also considered within this review. Using Monte-Carlo techniques, two of the most promising existing designs are evaluated; a boron-doped liquid scintillator and a multi-detector directional spectrometer. As an outcome of these simulations, possible adaptations to these instruments are suggested with a view to improving the portability of the instrument.
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Critical Review of Directional Neutron Survey Meters
International Nuclear Information System (INIS)
Balmer, M.J.I.; Gamage, K.A.A.; Taylor, G.C.
2013-06-01
Having been overlooked for many years, research is now starting to take into account the directional distribution of the neutron work place field. The impact of not taking this into account has led to overly conservative estimates of dose in neutron workplace fields. This paper provides a critical review of this existing research into directional survey meters which could improve these estimates of dose. Instruments which could be adapted for use as directional neutron survey meters are also considered within this review. Using Monte-Carlo techniques, two of the most promising existing designs are evaluated; a boron-doped liquid scintillator and a multi-detector directional spectrometer. As an outcome of these simulations, possible adaptations to these instruments are suggested with a view to improving the portability of the instrument. (authors)
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Rutstein, Sarah E; Ananworanich, Jintanat; Fidler, Sarah; Johnson, Cheryl; Sanders, Eduard J; Sued, Omar; Saez-Cirion, Asier; Pilcher, Christopher D; Fraser, Christophe; Cohen, Myron S; Vitoria, Marco; Doherty, Meg; Tucker, Joseph D
2017-06-28
The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI. We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years. Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI - evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting. There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective
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Mixed-methods research in nursing - a critical review.
Bressan, Valentina; Bagnasco, Annamaria; Aleo, Giuseppe; Timmins, Fiona; Barisone, Michela; Bianchi, Monica; Pellegrini, Ramona; Sasso, Loredana
2017-10-01
To review the use of mixed-methods research in nursing with a particular focus on the extent to which current practice informs nurse researchers. It also aimed to highlight gaps in current knowledge, understanding and reporting of this type of research. Mixed-methods research is becoming increasingly popular among nurses and healthcare professionals. Emergent findings from this type of research are very useful for nurses in practice. The combination of both quantitative and qualitative methods provides a scientific base for practice but also richness from the qualitative enquiry. However, at the same time mixed-methods research is underdeveloped. This study identified mixed-methods research papers and critically evaluated their usefulness for research practice. To support the analysis, we performed a two-stage search using CINAHL to find papers with titles that included the key term 'mixed method'. An analysis of studies that used mixed-methods research revealed some inconsistencies in application and reporting. Attempts to use two distinct research methods in these studies often meant that one or both aspects had limitations. Overall methods were applied in a less rigorous way. This has implications for providing somewhat limited direction for novice researchers. There is also potential for application of evidence in healthcare practice that limited validity. This study highlights current gaps in knowledge, understanding and reporting of mixed-methods research. While these methods are useful to gain insight into clinical problems nurses lack guidance with this type of research. This study revealed that the guidance provided by current mixed-methods research is inconsistent and incomplete and this compounds the lack of available direction. There is an urgent need to develop robust guidelines for using mixed-methods research so that findings may be critically implemented in practice. © 2016 John Wiley & Sons Ltd.
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A Critical Review of the Literature on Electronic Records ...
African Journals Online (AJOL)
This article provides a critical review of existing articles addressing the management of electronic records in the Eastern and Southern African Regional Branch of the International Council on Archives (ESARBICA) region. The article argues that while the literature in developed countries has come up with practical solutions ...
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EPR and Bell's theorem: A critical review
International Nuclear Information System (INIS)
Stapp, H.P.
1991-01-01
The argument of Einstein, Podolsky, and Rosen is reviewed with attention to logical structure and character of assumptions. Bohr's reply is discussed. Bell's contribution is formulated without use of hidden variables, and efforts to equate hidden variables to realism are critically examined. An alternative derivation of nonlocality that makes no use of hidden variables, microrealism, counterfactual definiteness, or any other assumption alien to orthodox quantum thinking is described in detail, with particular attention to the quartet or broken-square question
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Protein nutrition and exercise survival kit for critically ill
Weijs, Peter J.M.
2017-01-01
PURPOSE OF REVIEW: Protein delivery as well as exercise of critically ill in clinical practice is still a highly debated issue. Here we discuss only the most recent updates in the literature concerning protein nutrition and exercise of the critically ill. RECENT FINDINGS: By lack of randomized
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Directory of Open Access Journals (Sweden)
Jennifer Foster
2016-11-01
Full Text Available Abstract Background Delirium is a syndrome characterized by acute fluctuations and alterations in attention and arousal. Critically ill patients are at particularly high risk, and those that develop delirium are more likely to experience poor clinical outcomes such as prolonged duration of ICU and hospital length of stay, and increased mortality. Melatonin and melatonin agonists (MMA have the potential to decrease the incidence and severity of delirium through their hypnotic and sedative-sparing effects, thus improving health-related outcomes. The objective of this review is to synthesize the available evidence pertaining to the efficacy and safety of MMA for the prevention and treatment of ICU delirium. Methods We will search Ovid MEDLINE, Web of Science, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL, and CINAHL to identify studies evaluating MMA in critically ill populations. We will also search http://apps.who.int/trialsearch for ongoing and unpublished studies and PROSPERO for registered reviews. We will not impose restrictions on language, date, or journal of publication. Authors will independently screen for eligible studies using pre-defined criteria; data extraction from eligible studies will be performed in duplicate. The Cochrane Risk of Bias Scale and the Newcastle-Ottawa Scale will be used to assess the risk of bias and quality of randomized and non-randomized studies, respectively. Our primary outcome of interest is delirium incidence, and secondary outcomes include duration of delirium, number of delirium- and coma-free days, use of physical and chemical (e.g., antipsychotics or benzodiazepines restraints, duration of mechanical ventilation, ICU and hospital length of stay, mortality, long-term neurocognitive outcomes, hospital discharge disposition, and adverse events. We will use Review Manager (RevMan to pool effect estimates from included studies. We will present results as relative risks with
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Using clinical journaling to capture critical thinking across the curriculum.
Ruthman, Jacklyn; Jackson, Janet; Cluskey, Maureen; Flannigan, Peggy; Folse, Victoria N; Bunten, Jo
2004-01-01
Clinical journaling is used as an integrated teaching methodology throughout the practicum component of a baccalaureate nursing curriculum. Two disciplines, Nursing and English, collaborated to develop clinical journaling guidelines to provide a consistent framework for student learning and evaluation in a variety of clinical settings. Students complete a weekly log for each clinical rotation. They identify learning goals, analyze events and relate them to nursing practice, use critical thinking to connect theory and practice, and reflect on the experience.A collegiate standard of writing is used. As the student advances through the program, a pattern of accomplishments and a cumulative integration of skills is evidenced to provide consistent standards for student evaluation.
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Applicable or non-applicable: investigations of clinical heterogeneity in systematic reviews
Directory of Open Access Journals (Sweden)
Laura E. Chess
2016-02-01
Full Text Available Abstract Background Clinical heterogeneity can be defined as differences in participant characteristics, types or timing of outcome measurements and intervention characteristics. Clinical heterogeneity in systematic reviews has the possibility to significantly affect statistical heterogeneity leading to inaccurate conclusions and misled decision making. The aim of this study is to identify to what extent investigators are assessing clinical heterogeneity in both Cochrane and non-Cochrane systematic reviews. Methods The most recent 100 systematic reviews from the top five journals in medicine—JAMA, Archives of Internal Medicine, British Medical Journal, The Lancet, and PLOS Medicine—and the 100 most recently published and/or updated systematic reviews from Cochrane were collected. Various defined items of clinical heterogeneity were extracted from the included reviews. Investigators used chi-squared tests, logarithmic modeling and linear regressions to determine if the presence of such items served as a predictor for clinical heterogeneity when comparing Cochrane to non-Cochrane reviews. Extracted variables include number of studies, number of participants, presence of quantitative synthesis, exploration of clinical heterogeneity, heterogeneous characteristics explored, basis and methods used for investigating clinical heterogeneity, plotting/visual aids, author contact, inferences from clinical heterogeneity investigation, reporting assessment, and the presence of a priori or post-hoc analysis. Results A total of 317 systematic reviews were considered, of which 199 were in the final analysis. A total of 81 % of Cochrane reviews and 90 % of non-Cochrane reviews explored characteristics that are considered aspects of clinical heterogeneity and also described the methods they planned to use to investigate the influence of those characteristics. Only 1 % of non-Cochrane reviews and 8 % of Cochrane reviews explored the clinical
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Antidiabetic plant-derived nutraceuticals: a critical review.
Naveen, Jayapal; Baskaran, Vallikannan
2018-06-01
Diabetes mellitus (DM) is one of the major health problems in the world, especially amongst the urban population. Chemically synthesized drugs used to decrease the ill effects of DM and its secondary complications cause adverse side effects, viz., weight gain, gastrointestinal disturbances, and heart failure. Currently, various other approaches, viz., diet control, physical exercise and use of antidiabetic plant-derived molecules/foods are advocated to manage DM, as they are economical with fewer or no side effects. This review mainly focuses on antidiabetic plants, chemically characterized plant molecules and plant-based foods in the treatment of DM. Very little science-based evidence is available on the mechanism of action of plant-derived food molecules on the DM targets. Critical DM targets include α-amylase, α-glucosidase, DPP-IV, aldose reductase, PPAR-γ, AMP kinase and GLUT4. In-depth studies carried out on a few of those targets with specific mechanisms of action are addressed in this review. This review may help future researchers in identifying a right plant molecule to treat DM or to develop food formulations for DM management.
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Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel
2011-01-01
Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.
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[The clinic of apathy in schizophrenia: a critical review of the issue].
Yazbek, H; Raffard, S; Del-Monte, J; Pupier, F; Larue, A; Boulenger, J-P; Gély-Nargeot, M-C; Capdevielle, D
2014-06-01
Today the concept of apathy is subject to many questions. This psychological state is present and predominant in different disorders such as neurodegenerative and psychiatric diseases or neurological acquired disorders. Apathy is a part of the clinical vocabulary, however, we can note that in the literature there remains confusion in its definition, and we can find an amalgam with other clinical symptoms. The aim of this review is to provide a clarification of the concept of apathy in clinical practice in schizophrenia as well as to highlight the gaps that exist. Apathy belongs to the negative symptoms of schizophrenia. For its understanding, it is necessary to define apathy as a multidimensional syndrome (cognitive, emotional, and behavioral) manifesting as a quantitative reduction of voluntary behaviors directed toward one or several goals. However, at present, we are witnessing a reductionist and simplistic conception of the syndrome of apathy and this especially in the Anglo-Saxon literature. Several authors reduce apathy to its behavioral component, so in other words, to avolition/amotivation. Avolition refers to a loss of self-initiated and spontaneous behaviors. In this definition only observable behavior is taken into account and not the underlying mechanisms (cognitive and emotional). In order to understand the syndrome of apathy, it is necessary to have a holistic and multidimensional outlook. Some authors have proposed diagnostic criteria for apathy by taking into account the different dimensions of apathy. Moreover not only is apathy confused with avolition, but it is also still difficult to distinguish it from depression. Apathy and depression share common clinical signs (i.e. loss of interest), but they also have distinct clinical signs (lack of motivation for apathy, and suicidal ideation for depression). Authors have shown that the presence of one symptom (apathy or depression) does not predict the presence of the other. An apathetic patient does
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Peer-to-Peer Teaching in Higher Education: A Critical Literature Review
Stigmar, Martin
2016-01-01
The aim of my critical literature review is to identify studies where students are engaged as partners in teaching in higher education and to analyze how tutors and tutees benefit from peer teaching. Thirty studies were included for review. Thirteen countries are represented and two thirds of the studies conducted in the United States of America…
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Venous thromboembolism and coffee: critical review and meta-analysis.
Lippi, Giuseppe; Mattiuzzi, Camilla; Franchini, Massimo
2015-07-01
Among the various risk factors of venous thromboembolism (VTE), nutrients seem to play a significant role in the pathogenesis of this condition. This study aimed to clarify the relationship between coffee intake and venous thrombosis, and we performed a critical review of clinical studies that have been published so far. An electronic search was carried out in Medline, Scopus and ISI Web of Science with the keywords "coffee" AND "venous thromboembolism" OR "deep vein thrombosis" OR "pulmonary embolism" in "Title/Abstract/Keywords", with no language and date restriction. According to our criteria, three studies (two prospective and one case-control) were finally selected (inter-study heterogeneity: 78%; P<0.001). Cumulative data suggests that a modest intake of coffee (i.e., 1-4 cups/day) may be associated with an 11% increased risk of VTE compared to abstainers, whereas a larger intake (i.e., ≥5 coffee/day) may be associated with a 25% decreased risk. Our analysis of published data seemingly confirm the existence of a U-shape relationship between coffee intake and VTE, thus exhibiting a trend that overlaps with that previously reported for cardiovascular disease (CVD).
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Encouraging Critical Clinical Thinking (CCT) Skills in First-Year Veterinary Students.
Ferguson, Duncan C; McNeil, Leslie Klis; Schaeffe, David J; Mills, Eric M
First-year didactic course instructors at the University of Illinois College of Veterinary Medicine leverage earlier clinical rotation experiences with weekly "Clinical Correlations" exercises to provide early exposure to critical clinical thinking (CCT). This study evaluated the efficacy of individual and paired group exercises on CCT development. Before and after instruction, the Cornell Critical Thinking Test (Level Z) (CCTTZ) was administered. Based on the hypothesis that students with higher scores would coach lower-scoring colleagues during group exercises, heterogeneous groups with similar mean scores were established for the year. Students completed 14 individual and paired group exercises over 6 months. Exercises were designed to increase in complexity and decline in scaffolding. Seven of the exercises were cases using the Applied Learning Platform (ALP) at http://www.whenknowingmatters.com . Student analyses were scored according to a six-category critical-thinking rubric using a 5-point scale. Consistent with our hypothesis, individual and group rubric scores increased significantly, plateauing near the end of the year. Contrary to our hypothesis, mean overall CCTTZ scores did not change, but there was a small statistically significant increase in the ability to assess the validity of an argument. Student attitudes were mixed. Positive comments focused on reinforcement of prior didactic instruction, while negative comments focused on preparation time needed to conduct research on clinical concepts, and on a lack of explicit evaluation by summative examinations. Nonetheless, end-of-year GPAs correlated linearly with cumulative individual rubric scores. In summary, the value of early curriculum CCT training was confirmed when discipline-specific criteria were applied.
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Motivation Measures in Sport: A Critical Review and Bibliometric Analysis
Clancy, Rachel B.; Herring, Matthew P.; Campbell, Mark J.
2017-01-01
Motivation is widely-researched, in both sport psychology and other fields. As rigorous measurement is essential to understanding this latent construct, a critical appraisal of measurement instruments is needed. Thus, the purpose of this review was to evaluate the six most highly cited motivation measures in sport. Peer-reviewed articles published prior to August 2016 were searched to identify the six most highly cited motivation questionnaires in sport: Sport Motivation Scale (SMS), Intrinsi...
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OʼDonoghue, Katriona Jane Marie; Reed, Rhiannon D; Knight, Simon R; O'Callaghan, John M; Ayaz-Shah, Anam A; Hassan, Sevda; Weissenbacher, Annemarie; Morris, Peter J; Pengel, Liset H M
2018-05-22
Whilst Clinical Practice Guidelines (CPGs) are used for the development of local protocols in kidney transplantation (Ktx), the quality of their methodology is variable. This systematic review aimed to critically appraise international CPGs in all aspects of Ktx using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. CPGs in Ktx and donation published between 2010 and 2017 were identified from MEDLINE, Embase, National Guideline Clearinghouse, NHS and NICE Evidence Searches, and the websites of transplant societies. Using AGREE II, 3 appraisers assessed the quality of CPGs. Interrater reliability was measured using the intraclass correlation coefficient (ICC). Searches identified 3,168 records and 115 CPGs were included. The highest scoring AGREE II domain was 'Scope and Purpose' (80%; Range 30-100%), followed by 'Clarity of Presentation' (77%; Range 43-98%), 'Editorial independence' (52%; Range 0-94%), 'Rigour of Development' (47%; Range 6-97%) and 'Stakeholder Involvement' (41%; Range 11-85%). The poorest scoring domain was 'Applicability' (31%; Range 3-74%). Most CPGs were recommended for future use either with (63%) or without modifications (18%). A small number were not recommended for future use (14%) or reviewers did not agree on recommending the CPG (5%). The overall mean CPG quality score was 4 out of 7 (Range 2-7). The mean ICC of 0.74 indicated substantial agreement between reviewers. The quality of international CPGs in Ktx was variable, and most CPGs lacked key aspects of methodological robustness and transparency. Improvements in methodology, patient involvement and strategies for implementation are required.
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Roberts, Jason A.; Aziz, Mohd Hafiz Abdul; Lipman, Jeffrey; Mouton, Johan W.; Vinks, Alexander A.; Felton, Timothy W.; Hope, William W.; Farkas, Andras; Neely, Michael N.; Schentag, Jerome J.; Drusano, George; Frey, Otto R.; Theuretzbacher, Ursula; Kuti, Joseph L.
2014-01-01
Summary Infections in critically ill patients are associated with persistently poor clinical outcomes. These patients have severely altered and variable antibiotic pharmacokinetics and are infected by less susceptible pathogens. Antibiotic dosing that does not account for these features is likely to result in sub-optimal outcomes. In this paper, we review the patient- and pathogen-related challenges that contribute to inadequate antibiotic dosing and discuss how a process for individualised antibiotic therapy, that increases the accuracy of dosing, can be implemented to further optimise care for the critically ill patient. The process for optimised antibiotic dosing firstly requires determination of the physiological derangements in the patient that can alter antibiotic concentrations including altered fluid status, microvascular failure, serum albumin concentrations as well as altered renal and hepatic function. Secondly, knowledge of the susceptibility of the infecting pathogen should be determined through liaison with the microbiology laboratory. The patient and pathogen challenges can then be solved by combining susceptibility data with measured antibiotic concentration data (where possible) into a clinical dosing software. Such software uses pharmacokinetic-pharmacodynamic (PK/PD) models from critically ill patients to accurately predict the dosing requirements for the individual patient with the aim of optimising antibiotic exposure and maximising effectiveness. PMID:24768475
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Detailed clinical models: a review.
Goossen, William; Goossen-Baremans, Anneke; van der Zel, Michael
2010-12-01
Due to the increasing use of electronic patient records and other health care information technology, we see an increase in requests to utilize these data. A highly level of standardization is required during the gathering of these data in the clinical context in order to use it for analyses. Detailed Clinical Models (DCM) have been created toward this purpose and several initiatives have been implemented in various parts of the world to create standardized models. This paper presents a review of DCM. Two types of analyses are presented; one comparing DCM against health care information architectures and a second bottom up approach from concept analysis to representation. In addition core parts of the draft ISO standard 13972 on DCM are used such as clinician involvement, data element specification, modeling, meta information, and repository and governance. SIX INITIATIVES WERE SELECTED: Intermountain Healthcare, 13606/OpenEHR Archetypes, Clinical Templates, Clinical Contents Models, Health Level 7 templates, and Dutch Detailed Clinical Models. Each model selected was reviewed for their overall development, involvement of clinicians, use of data types, code bindings, expressing semantics, modeling, meta information, use of repository and governance. Using both a top down and bottom up approach to comparison reveals many commonalties and differences between initiatives. Important differences include the use of or lack of a reference model and expressiveness of models. Applying clinical data element standards facilitates the use of conceptual DCM models in different technical representations.
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Automatic Generation and Ranking of Questions for Critical Review
Liu, Ming; Calvo, Rafael A.; Rus, Vasile
2014-01-01
Critical review skill is one important aspect of academic writing. Generic trigger questions have been widely used to support this activity. When students have a concrete topic in mind, trigger questions are less effective if they are too general. This article presents a learning-to-rank based system which automatically generates specific trigger…
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Delgado-Aros, S; Camilleri, M
2003-12-01
Intestinal pseudoobstruction is a clinical syndrome characterized by impairment of intestinal propulsion, which may resemble intestinal obstruction, in the absence of a mechanical cause. It usually affects the colon but the small intestine may also be involved, and may present in acute, subacute or chronic forms. We have performed a systematic review of the acute form of pseudoobstruction, also referred to as Ogilvie's syndrome. We discuss proposed pathophysiological mechanisms, manifestations and management of this clinical condition in post-surgery and critically ill patients. The hallmark of the syndrome is massive intestinal distension, which is detected on clinical inspection and plain abdominal radiography. The underlying pathophysiological mechanisms are not fully understood. Therefore, treatment has focussed on preventing intestinal perforation, which is associated with a 21% mortality rate.
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A critical review on tablet disintegration.
Quodbach, Julian; Kleinebudde, Peter
2016-09-01
Tablet disintegration is an important factor for drug release and can be modified with excipients called tablet disintegrants. Tablet disintegrants act via different mechanisms and the efficacy of these excipients is influenced by various factors. In this review, the existing literature on tablet disintegration is critically reviewed. Potential disintegration mechanisms, as well as impact factors on the disintegration process will be discussed based on experimental evidence. Search terms for Scopus and Web of Science included "tablet disintegration", "mechanism tablet disintegration", "superdisintegrants", "disintegrants", "swelling force", "disintegration force", "disintegration mechanisms", as well as brand names of commonly applied superdisintegrants. References of identified papers were screened as well. Experimental data supports swelling and shape recovery as main mechanisms of action of disintegrants. Other tablet excipients and different manufacturing techniques greatly influence the disintegration process. The use of different excipients, experimental setups and manufacturing techniques, as well as the demand for original research led to a distinct patchwork of knowledge. Broader, more systematic approaches are necessary not only to structure the past but also future findings.
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The analysis of verbal interaction sequences in dyadic clinical communication: a review of methods.
Connor, Martin; Fletcher, Ian; Salmon, Peter
2009-05-01
To identify methods available for sequential analysis of dyadic verbal clinical communication and to review their methodological and conceptual differences. Critical review, based on literature describing sequential analyses of clinical and other relevant social interaction. Dominant approaches are based on analysis of communication according to its precise position in the series of utterances that constitute event-coded dialogue. For practical reasons, methods focus on very short-term processes, typically the influence of one party's speech on what the other says next. Studies of longer-term influences are rare. Some analyses have statistical limitations, particularly in disregarding heterogeneity between consultations, patients or practitioners. Additional techniques, including ones that can use information about timing and duration of speech from interval-coding are becoming available. There is a danger that constraints of commonly used methods shape research questions and divert researchers from potentially important communication processes including ones that operate over a longer-term than one or two speech turns. Given that no one method can model the complexity of clinical communication, multiple methods, both quantitative and qualitative, are necessary. Broadening the range of methods will allow the current emphasis on exploratory studies to be balanced by tests of hypotheses about clinically important communication processes.
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Risk factors for suicide in schizophrenia: systematic review and clinical recommendations.
Popovic, D; Benabarre, A; Crespo, J M; Goikolea, J M; González-Pinto, A; Gutiérrez-Rojas, L; Montes, J M; Vieta, E
2014-12-01
To identify risk factors associated with suicide of patients with schizophrenia and provide clinical recommendations, which integrate research findings into a consensus based on clinical experience and evidence. A task force formed of experts and clinicians iteratively developed consensus through serial revisions using the Delphi method. Initial survey items were based on systematic literature review published up to June 2013. Various risk factors were reported to be implicated in suicide in schizophrenia. Our findings indicate that suicide risk in schizophrenia is mainly related to affective symptoms, history of a suicide attempt and number of psychiatric admissions. Other risk factors identified are given by younger age, closeness to illness onset, older age at illness onset, male sex, substance abuse and period during or following psychiatric discharge. Integrating the evidence and the experience of the task force members, a consensus was reached on 14 clinical recommendations. Identification of risk factors for suicide in individuals diagnosed with schizophrenia is imperative to improve clinical management and develop strategies to reduce the incidence of suicide in this population. This study provides the critical overview of available data and clinical recommendations on recognition and management of the above-mentioned risk factors. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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School Uniforms: A Critical Review of the Literature. From Inquiry to Practice.
Brunsma, David L.
The debate surrounding the effectiveness of school-uniform policies, as well as discussions concerning when and how to implement them, is rooted in anecdote. This review summarizes anecdotal literature on which the current debate is based and critically reviews the empirical literature, including theoretical underpinnings, findings, and…
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Clinical librarian support for rapid review of clinical utility of cancer molecular biomarkers.
Geng, Yimin; Fowler, Clara S; Fulton, Stephanie
2015-01-01
The clinical librarian used a restricted literature searching and quality-filtering approach to provide relevant clinical evidence for the use of cancer molecular biomarkers by institutional policy makers and clinicians in the rapid review process. The librarian-provided evidence was compared with the cited references in the institutional molecular biomarker algorithm. The overall incorporation rate of the librarian-provided references into the algorithm was above 80%. This study suggests the usefulness of clinical librarian expertise for clinical practice. The searching and filtering methods for high-level evidence can be adopted by information professionals who are involved in the rapid literature review.
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A critical review of clinical trials in systemic lupus erythematosus
Mahieu, Mary A.; Strand, Vibeke; Simon, Lee S.; Lipsky, Peter E.; Ramsey-Goldman, Rosalind
2016-01-01
One challenge in caring for patients with systemic lupus erythematosus (SLE) is a paucity of approved therapeutics for treatment of the diverse disease manifestations. In the last 60 years, only one drug, belimumab, has been approved for SLE treatment. Critical evaluation of investigator initiated and pharma-sponsored randomized controlled trials (RCTs) highlights barriers to successful drug development in SLE, including disease heterogeneity, inadequate trial size or duration, insufficient dose finding before initiation of large trials, handling of background medications, and choice of primary endpoint. Herein we examine lessons learned from landmark SLE RCTs and subsequent advances in trial design, as well as discuss efforts to address limitations in current SLE outcome measures that will improve detection of true therapeutic responses in future RCTs. PMID:27497257
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Physiotherapy-led arthroplasty review clinic: a preliminary outcomes analysis.
Large, Kate E; Page, Carolyn J; Brock, Kim; Dowsey, Michelle M; Choong, Peter F M
2014-11-01
With the rising demand for Orthopaedics in the healthcare sector, service delivery innovations need to be explored to accommodate the increasing workload. Senior Musculoskeletal Physiotherapists have the specialised skills in the assessment of musculoskeletal conditions to determine the impact of surgery on patient outcomes. The aim of the present study was to compare outcomes between a physiotherapy-led arthroplasty review clinic (PT clinic) and the traditional model of orthopaedic surgeon review (OS clinic) after hip and knee replacement. This study was a retrospective case-controlled audit using a comprehensive database. Twenty-four patients who had a hip arthroplasty and 52 patients who had a knee arthroplasty were reviewed solely by the PT clinic at 3, 6 and 12 months after surgical reviews. These patients were matched 1:2 against patients seen only by the OS clinic. The outcome measures included International Knee Score (IKS), Harris Hip Score (HHS) and the Short Form (SF)-12. There were no significant differences in HHS or SF-12 scores for patients after hip arthroplasty. Significant differences for knee arthroplasty were observed favouring the PT clinic; IKS, PT clinic 147.6 (37.07), OS clinic 135.4 (35.68), P≤0.01, and physical component of the SF-12, PT clinic 41.98 (10.45), OS clinic 37.20 (10.44), Pphysiotherapy-led arthroplasty review clinic appears to be a safe and effective service alternative to reviews conducted by orthopaedic surgeons. WHAT IS KNOWN ABOUT THE TOPIC?: Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability and the burden of the disease is rapidly increasing. Joint arthroplasty surgery is the mainstay of treatment for people with end-stage OA; it is a high-cost, high-volume procedure that dominates surgical wait lists around Australia. Long-term follow up is encouraged by the Arthroplasty Society of Australia and endorsed by the Australian Orthopaedics Association, but it is acknowledged that it is impossible
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A Review of Accident Modelling Approaches for Complex Critical Sociotechnical Systems
National Research Council Canada - National Science Library
Qureshi, Zahid H
2008-01-01
.... This report provides a review of key traditional accident modelling approaches and their limitations, and describes new system-theoretic approaches to the modelling and analysis of accidents in safety-critical systems...
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Recognition of clinical deterioration: a clinical leadership opportunity for nurse executive.
Swartz, Colleen
2013-01-01
Recognition and avoidance of further clinical deterioration can be termed a critical success factor in every care delivery model. As care resources become more constrained and allocated to the most critical of patients, some patients are being shifted to less intense and costly care settings where continuous physiologic monitoring may not be an option. Nurse executives are facing these complex issues as they work with clinical experts to develop systems of safety in the patient care arena. A systematic review of the literature related to the recognition of clinical deterioration is needed to identify areas for further leadership, research, and practice advancements.
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A Decade of Critical Information Literacy: A Review of the Literature
Directory of Open Access Journals (Sweden)
Eamon Tewell
2015-06-01
Full Text Available As information literacy continues in its centrality to many academic libraries’ missions, a line of inquiry has developed in response to ACRL’s charge to develop information literate citizens. The literature of critical information literacy questions widely held assumptions about information literacy and considers in what ways librarians may encourage students to engage with and act upon information’s complex and inherently political nature. This review explores the research into critical information literacy, including critical pedagogy and critiques of information literacy, in order to provide an entry point for this emerging and challenging approach to information literacy.
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Toss, M; Miligy, I; Thompson, A M; Khout, H; Green, A R; Ellis, I O; Rakha, E A
2017-10-01
The high proportion of ductal carcinoma in situ (DCIS) presented in mammographic screening and the relatively low risk of progression to invasive disease have raised questions related to overtreatment. Following a review of current DCIS management protocols a more conservative approach has been suggested. Clinical trials have been introduced to evaluate the option of avoiding surgical intervention in a proportion of patients with DCIS defined as "low-risk" using certain clinicopathological criteria. These trials can potentially provide evidence-based models of active surveillance (with or without endocrine therapy) as a future management approach. Despite the undisputable fact of our need to address the obvious overtreatment of screen-detected DCIS, some important questions need to be considered regarding these trials including the eligibility criteria and definition of risk, the proportion of patient eligible for inclusion, and the length of time required for proper analysis of the trials' outcome in view of the long-term natural history of DCIS progression particularly the low-risk group. These factors can potentially affect the practicality and future impact of such trials. This review provides critical analysis of current DCIS management trials and highlights critical issues related to their practicality and the expected outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Gaudry, Stéphane; Messika, Jonathan; Ricard, Jean-Damien; Guillo, Sylvie; Pasquet, Blandine; Dubief, Emeline; Boukertouta, Tanissia; Dreyfuss, Didier; Tubach, Florence
2017-12-01
Intensivists' clinical decision making pursues two main goals for patients: to decrease mortality and to improve quality of life and functional status in survivors. Patient-important outcomes are gaining wide acceptance in most fields of clinical research. We sought to systematically review how well patient-important outcomes are reported in published randomized controlled trials (RCTs) in critically ill patients. Literature search was conducted to identify eligible trials indexed from January to December 2013. Articles were eligible if they reported an RCT involving critically ill adult patients. We excluded phase II, pilot and physiological crossover studies. We assessed study characteristics. All primary and secondary outcomes were collected, described and classified using six categories of outcomes including patient-important outcomes (involving mortality at any time on the one hand and quality of life, functional/cognitive/neurological outcomes assessed after ICU discharge on the other). Of the 716 articles retrieved in 2013, 112 RCTs met the inclusion criteria. Most common topics were mechanical ventilation (27%), sepsis (19%) and nutrition (17%). Among the 112 primary outcomes, 27 (24%) were patient-important outcomes (mainly mortality, 21/27) but only six (5%) were patient-important outcomes besides mortality assessed after ICU discharge (functional disability = 4; quality of life = 2). Among the 598 secondary outcomes, 133 (22%) were patient-important outcomes (mainly mortality, 92/133) but only 41 (7%) were patient-important outcomes besides mortality assessed after ICU discharge (quality of life = 20, functional disability = 14; neurological/cognitive performance = 5; handicap = 1; post-traumatic stress = 1). Seventy-three RCTs (65%) reported at least one patient-important outcome but only 11 (10%) reported at least one patient-important outcome besides mortality assessed after ICU discharge. Patient-important outcomes are rarely primary
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A Critical Review of Recent Literature on Populism
Directory of Open Access Journals (Sweden)
John Abromeit
2017-12-01
Full Text Available This is a review article of the following five recent studies on populism: 1 Ruth Wodak’s The Politics of Fear: What Right-Wing Populist Discourses Mean (Sage, 2015; 2 Benjamin Moffitt’s The Global Rise of Populism: Performance, Political Style and Representation (Stanford University Press, 2016; 3 Cas Mudde and Cristóbal Rovira Kaltwasser’s Populism: A Very Short Introduction (Oxford University Press, 2017; 4 Jan-Werner Müller’s What is Populism? (University of Pennsylvania Press, 2016; and 5 John B. Judis’ The Populist Explosion: How the Great Recession Transformed American and European Politics (Columbia Global Reports, 2016. The review argues for a return to early Frankfurt School Critical Theory to address some of the shortcomings of these studies.
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Energy Technology Data Exchange (ETDEWEB)
Mulryan, Kathryn; Leech, Michelle; Forde, Elizabeth, E-mail: eforde@tcd.ie
2015-01-01
Stereotactic body radiation therapy (SBRT) delivers a high biologically effective dose while minimizing toxicities to surrounding tissues. Within the scope of clinical trials and local practice, there are inconsistencies in dosimetrics used to evaluate plan quality. The purpose of this critical review was to determine if dosimetric parameters used in SBRT plans have an effect on local control (LC), overall survival (OS), and toxicities. A database of relevant trials investigating SBRT for patients with early-stage non–small cell lung cancer was compiled, and a table of dosimetric variables used was created. These parameters were compared and contrasted for LC, OS, and toxicities. Dosimetric end points appear to have no effect on OS or LC. Incidences of rib fractures correlate with a lack of dose-volume constraints (DVCs) reported. This review highlights the great disparity present in clinical trials reporting dosimetrics, DVCs, and toxicities for lung SBRT. Further evidence is required before standard DVCs guidelines can be introduced. Dosimetric end points specific to stereotactic treatment planning have been proposed but require further investigation before clinical implementation.
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Santos, Eduardo; Cardoso, Daniela; Neves, Hugo; Cunha, Madalena; Rodrigues, Manuel; Apóstolo, João
2017-05-01
Delirium is associated with increased intensive care unit and hospital length of stay, prolonged duration of mechanical ventilation, unplanned removal of tubes and catheters, and increased morbidity and mortality. Prophylactic treatment with low-dose haloperidol may have beneficial effects for critically ill patients with a high risk of delirium. To identify the effectiveness of haloperidol prophylaxis in critically ill patients with a high risk for delirium. Patients with a predicted high risk of delirium, aged 18 years or over, and in intensive care units. Patients with a history of concurrent antipsychotic medication use were excluded. Haloperidol prophylaxis for preventing delirium. Experimental and epidemiological study designs. Primary outcome is the incidence of delirium. Secondary outcomes are duration of mechanical ventilation, incidence of re-intubation, incidence of unplanned/accidental removal of tubes/lines and catheters, intensive care unit and hospital length of stay, and re-admissions to both settings. An initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies from January 1967 to September 2015 in major healthcare-related electronic databases. Studies in English, Spanish and Portuguese were included. Two independent reviewers assessed the methodological quality of five studies using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. There was general agreement among the reviewers to exclude one relevant study due to methodological quality. Data were extracted using the JBI data extraction form for experimental studies and included details about the interventions, populations, study methods and outcomes of significance to the review questions. Significant differences were found between participants, interventions, outcome measures (clinical heterogeneity) and designs (methodological heterogeneity
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Clinical implications of calcifying nanoparticles in dental diseases: a critical review
Directory of Open Access Journals (Sweden)
Alenazy MS
2013-12-01
Full Text Available Mohammed S Alenazy,1 Hezekiah A Mosadomi2,3 1Restorative Dentistry Department, 2Oral and Maxillofacial Pathology Department, 3Research Center, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia Background: Unknown cell-culture contaminants were described by Kajander and Ciftçioğlu in 1998. These contaminants were called nanobacteria initially and later calcifying nanoparticles (CNPs. Their exact nature is unclear and controversial. CNPs have unique and unusual characteristics, which preclude placing them into any established evolutionary branch of life. Aim: The aim of this systematic review was to assess published data concerning CNPs since 1998 in general and in relation to dental diseases in particular. Materials and methods: The National Library of Medicine (PubMed and Society of Photographic Instrumentation Engineers (SPIE electronic and manual searches were conducted. Nanobacteria and calcifying nanoparticles were used as keywords. The search yielded 135 full-length papers. Further screening of the titles and abstracts that followed the review criteria resulted in 43 papers that met the study aim. Conclusion: The review showed that the existence of nanobacteria is still controversial. Some investigators have described a possible involvement of CNPs in pulpal and salivary gland calcifications, as well as the possible therapeutic use of CNPs in the treatment of cracked and/or eroded teeth. Keywords: calcifying nanoparticles, nanobacteria, sialolith, pulp stone, enamel repair
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Advances in Biomarkers in Critical Ill Polytrauma Patients.
Papurica, Marius; Rogobete, Alexandru F; Sandesc, Dorel; Dumache, Raluca; Cradigati, Carmen A; Sarandan, Mirela; Nartita, Radu; Popovici, Sonia E; Bedreag, Ovidiu H
2016-01-01
The complexity of the cases of critically ill polytrauma patients is given by both the primary, as well as the secondary, post-traumatic injuries. The severe injuries of organ systems, the major biochemical and physiological disequilibrium, and the molecular chaos lead to a high rate of morbidity and mortality in this type of patient. The 'gold goal' in the intensive therapy of such patients resides in the continuous evaluation and monitoring of their clinical status. Moreover, optimizing the therapy based on the expression of certain biomarkers with high specificity and sensitivity is extremely important because of the clinical course of the critically ill polytrauma patient. In this paper we wish to summarize the recent studies of biomarkers useful for the intensive care unit (ICU) physician. For this study the available literature on specific databases such as PubMed and Scopus was thoroughly analyzed. Each article was carefully reviewed and useful information for this study extracted. The keywords used to select the relevant articles were "sepsis biomarker", "traumatic brain injury biomarker" "spinal cord injury biomarker", "inflammation biomarker", "microRNAs biomarker", "trauma biomarker", and "critically ill patients". For this study to be carried out 556 original type articles were analyzed, as well as case reports and reviews. For this review, 89 articles with relevant topics for the present paper were selected. The critically ill polytrauma patient, because of the clinical complexity the case presents with, needs a series of evaluations and specific monitoring. Recent studies show a series of either tissue-specific or circulating biomarkers that are useful in the clinical status evaluation of these patients. The biomarkers existing today, with regard to the critically ill polytrauma patient, can bring a significant contribution to increasing the survival rate, by adapting the therapy according to their expressions. Nevertheless, the necessity remains to
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Psychosocial Interventions for Women with HIV/AIDS: A Critical Review
Hernandez, Julieta P.; Macgowan, Mark J.
2015-01-01
Objective: Recent research on psychosocial interventions addressing the well-being of women with HIV/AIDS has brought new options for practitioners. This study critically reviews the treatment features, methodological quality, and efficacy of these interventions. Methods: A comprehensive search between 2000 and 2011 identified 19 studies employing…
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Benham, Brian; Hawley, Diane
2015-05-15
resolved through discussion or with a third reviewer. Data was extracted independently by each reviewer from papers included in the review using a Microsoft Excel spreadsheet. Included data included study type, 'r' values, number of subjects and reported 'p' values. These were indexed by author, year and study title. The meta-analysis was performed using the method for effect size analysis from Hunter and Schmidt. The syntax for equations was transposed into a Microsoft Excel spreadsheet for data entry, analysis and graph creation. No articles or paper addressing unique tools for ascertaining critical decision making skills met the inclusion criteria. Standard tools, which were represented in the literature, assess critical decision making skills via prediction of academic and clinical success, which indicates the presence of critical decision making skills in graduate healthcare students. A total of 16 studies addressing standard tools were included in this review. All were retrospective case series studies. The date range for the included studies was 1970 to 2009. The strongest relationship was undergraduate grade point average's correlation to graduate grade point average (small effect size with an 'r' value of 0.27, credibility interval of 0.18-0.37). The second strongest relationship was between Graduate Record Examination’s verbal section and graduate grade point average (small effect size with an r value of 0.24, CrI of 0.11-0.37). An applicant’s undergraduate GPA has the strongest correlation with graduate healthcare program success of the indicators analyzed (r = 0.27, small effect size). The next best predictor of graduate healthcare program success was the GRE Verbal score (r = 0.24, small effect size). However, all of the variables carried positive correlations with graduate success, just of lesser effect size strength. This review supports the continued use of traditional indicators of graduate school potential in the undergraduate grade point average and
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Glucose monitoring as a guide to diabetes management. Critical subject review.
Koch, B.
1996-01-01
PURPOSE: To encourage a balanced approach to blood glucose monitoring in diabetes by a critical review of the history, power and cost of glucose testing. DATA SOURCES: The Cambridge Data Base was searched and was supplemented by a random review of other relevant sources, including textbooks, company pamphlets, and laboratory manuals. STUDY SELECTION: Keywords used were "glucosuria diagnosis," "blood glucose self-monitoring," "glycosylated hemoglobin," and "fructosamine" for the 10-year period...
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Outcome measures for adult critical care: a systematic review.
Hayes, J A; Black, N A; Jenkinson, C; Young, J D; Rowan, K M; Daly, K; Ridley, S
2000-01-01
1. To identify generic and disease specific measures of impairment, functional status and health-related quality of life that have been used in adult critical care (intensive and high-dependency care) survivors. 2. To review the validity, reliability and responsiveness of the measures in adult critical care survivors. 3. To consider the implications for future policy and to make recommendations for further methodological research. 4. To review what is currently known of the outcome of adult critical care. Searches of electronic databases (MEDLINE, EMBASE, CINAHL, PsycLIT, The Cochrane Library and SIGLE) from 1970 to August 1998. Manual searches of five journals (1985-98) not indexed in electronic databases and relevant conference proceedings (1993-98). Reference lists of six existing reviews, plus snowballing from reference lists of all relevant articles identified. Randomised trials, non-randomised trials (cohort studies) and case series that included data on outcomes after discharge from adult (16 years and over) critical care. If reported, the following data were extracted from each paper: patient characteristics (age, gender, severity of illness, diagnostic category) number of patients eligible for study, follow-up period, number of deaths before follow-up, number and proportion of survivors included in follow-up method of presentation of outcome data - proportion normal as defined by reference values, or aggregate value (e.g. mean or median), or aggregate values plus an indication of variance (e.g. standard deviation or inter-quartile range). Evidence for three measurement properties was sought for each outcome measure that had been used in at least two studies - their validity, reliability and responsiveness in adult critical care. If the authors did not report these aspects explicitly, an attempt was made to use the data provided to provide these measurement properties. For measures that were used in at least ten studies, information on actual reported
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Blood parasites of penguins: a critical review.
Vanstreels, Ralph Eric Thijl; Braga, Érika Martins; Catão-Dias, José Luiz
2016-07-01
Blood parasites are considered some of the most significant pathogens for the conservation of penguins, due to the considerable morbidity and mortality they have been shown to produce in captive and wild populations of these birds. Parasites known to occur in the blood of penguins include haemosporidian protozoans (Plasmodium, Leucocytozoon, Haemoproteus), piroplamid protozoans (Babesia), kinetoplastid protozoans (Trypanosoma), spirochete bacteria (Borrelia) and nematode microfilariae. This review provides a critical and comprehensive assessment of the current knowledge on these parasites, providing an overview of their biology, host and geographic distribution, epidemiology, pathology and implications for public health and conservation.
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Radiopharmaceuticals drug interactions: a critical review
International Nuclear Information System (INIS)
Santos-Oliveira, Ralph; Smith, Sheila W.; Carneiro-Leao, Ana Maria A.
2008-01-01
Radiopharmaceuticals play a critical role in modern medicine primarily for diagnostic purposes, but also for monitoring disease progression and response to treatment. As the use of image has been increased, so has the use of prescription medications. These trends increase the risk of interactions between medications and radiopharmaceuticals. These interactions which have an impact on image by competing with the radiopharmaceutical for binding sites for example can lead to false negative results. Drugs that accelerate the metabolism of the radiopharmaceutical can have a positive impact (i.e. speeding its clearance) or, if repeating image is needed, a negative impact. In some cases, for example in cardiac image among patients taking doxirubacin, these interactions may have a therapeutic benefit. The incidence of drug-radiopharmaceuticals adverse reactions is unknown, since they may not be reported or even recognized. Here, we compiled the medical literature, using the criteria of a systematic review established by the Cochrane Collaboration, on pharmaceutical-drug interactions to provide a summary of documented interactions by organ system and radiopharmaceuticals. The purpose is to provide a reference on drug interactions that could inform the nuclear medicine staff in their daily routine. Efforts to increase adverse event reporting, and ideally consolidate reports worldwide, can provide a critically needed resource for prevention of drug-radiopharmaceuticals interactions. (author)
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Clinical efficacy and effectiveness of 3D printing: a systematic review.
Diment, Laura E; Thompson, Mark S; Bergmann, Jeroen H M
2017-12-21
To evaluate the clinical efficacy and effectiveness of using 3D printing to develop medical devices across all medical fields. Systematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Web of Science, OVID, IEEE Xplore and Google Scholar. A double-blinded review method was used to select all abstracts up to January 2017 that reported on clinical trials of a three-dimensional (3D)-printed medical device. The studies were ranked according to their level of evidence, divided into medical fields based on the International Classification of Diseases chapter divisions and categorised into whether they were used for preoperative planning, aiding surgery or therapy. The Downs and Black Quality Index critical appraisal tool was used to assess the quality of reporting, external validity, risk of bias, risk of confounding and power of each study. Of the 3084 abstracts screened, 350 studies met the inclusion criteria. Oral and maxillofacial surgery contained 58.3% of studies, and 23.7% covered the musculoskeletal system. Only 21 studies were randomised controlled trials (RCTs), and all fitted within these two fields. The majority of RCTs were 3D-printed anatomical models for preoperative planning and guides for aiding surgery. The main benefits of these devices were decreased surgical operation times and increased surgical accuracy. All medical fields that assessed 3D-printed devices concluded that they were clinically effective. The fields that most rigorously assessed 3D-printed devices were oral and maxillofacial surgery and the musculoskeletal system, both of which concluded that the 3D-printed devices outperformed their conventional comparators. However, the efficacy and effectiveness of 3D-printed devices remain undetermined for the majority of medical fields. 3D-printed devices can play an important role in healthcare, but more rigorous and long-term assessments are needed to determine if 3D-printed devices are
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Rose, Louise; Dale, Craig; Smith, Orla M; Burry, Lisa; Enright, Glenn; Fergusson, Dean; Sinha, Samir; Wiesenfeld, Lesley; Sinuff, Tasnim; Mehta, Sangeeta
2016-11-21
Critically ill patients frequently experience severe agitation placing them at risk of harm. Physical restraint is common in intensive care units (ICUs) for clinician concerns about safety. However, physical restraint may not prevent medical device removal and has been associated with negative physical and psychological consequences. While professional society guidelines, legislation, and accreditation standards recommend physical restraint minimization, guidelines for critically ill patients are over a decade old, with recommendations that are non-specific. Our systematic review will synthesize evidence on physical restraint in critically ill adults with the primary objective of identifying effective minimization strategies. Two authors will independently search from inception to July 2016 the following: Ovid MEDLINE, CINAHL, Embase, Web of Science, Cochrane Library, PROSPERO, Joanna Briggs Institute, grey literature, professional society websites, and the International Clinical Trials Registry Platform. We will include quantitative and qualitative study designs, clinical practice guidelines, policy documents, and professional society recommendations relevant to physical restraint of critically ill adults. Authors will independently perform data extraction in duplicate and complete risk of bias and quality assessment using recommended tools. We will assess evidence quality for quantitative studies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and for qualitative studies using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) guidelines. Outcomes of interest include (1) efficacy/effectiveness of physical restraint minimization strategies; (2) adverse events (unintentional device removal, psychological impact, physical injury) and associated benefits including harm prevention; (3) ICU outcomes (ventilation duration, length of stay, and mortality); (4) prevalence, incidence, patterns of use
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Functional MRI in children: clinical and research applications
International Nuclear Information System (INIS)
Leach, James L.; Holland, Scott K.
2010-01-01
Functional MRI has become a critical research tool for evaluating brain function and developmental trajectories in children. Its clinical use in children is becoming more common. This presentation will review the basic underlying physiologic and technical aspects of fMRI, review research applications that have direct clinical relevance, and outline the current clinical uses of this technology. (orig.)
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A systematic review on critical thinking in medical education.
Chan, Zenobia C Y
2016-04-18
Critical thinking is the ability to raise discriminating questions in an attempt to search for better ideas, a deeper understanding and better solutions relating to a given issue. This systematic review provides a summary of efforts that have been made to enhance and assess critical thinking in medical education. Nine databases [Ovid MEDLINE(R), AMED, Academic Search Premier, ERIC, CINAHL, Web of Science, JSTOR, SCOPUS and PsycINFO] were searched to identify journal articles published from the start of each database to October 2012. A total of 41 articles published from 1981 to 2012 were categorised into two main themes: (i) evaluation of current education on critical thinking and (ii) development of new strategies about critical thinking. Under each theme, the teaching strategies, assessment tools, uses of multimedia and stakeholders were analysed. While a majority of studies developed teaching strategies and multimedia tools, a further examination of their quality and variety could yield some insights. The articles on assessment placed a greater focus on learning outcomes than on learning processes. It is expected that more research will be conducted on teacher development and students' voices.
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How Many Dystonias? Clinical Evidence.
Albanese, Alberto
2017-01-01
Literary reports on dystonia date back to post-Medieval times. Medical reports are instead more recent. We review here the early descriptions and the historical establishment of a consensus on the clinical phenomenology and the diagnostic features of dystonia syndromes. Lumping and splitting exercises have characterized this area of knowledge, and it remains largely unclear how many dystonia types we are to count. This review describes the history leading to recognize that focal dystonia syndromes are a coherent clinical set encompassing cranial dystonia (including blepharospasm), oromandibular dystonia, spasmodic torticollis, truncal dystonia, writer's cramp, and other occupational dystonias. Papers describing features of dystonia and diagnostic criteria are critically analyzed and put into historical perspective. Issues and inconsistencies in this lumping effort are discussed, and the currently unmet needs are critically reviewed.
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A Review of Critical Conditions for the Onset of Nonlinear Fluid Flow in Rock Fractures
Directory of Open Access Journals (Sweden)
Liyuan Yu
2017-01-01
Full Text Available Selecting appropriate governing equations for fluid flow in fractured rock masses is of special importance for estimating the permeability of rock fracture networks. When the flow velocity is small, the flow is in the linear regime and obeys the cubic law, whereas when the flow velocity is large, the flow is in the nonlinear regime and should be simulated by solving the complex Navier-Stokes equations. The critical conditions such as critical Reynolds number and critical hydraulic gradient are commonly defined in the previous works to quantify the onset of nonlinear fluid flow. This study reviews the simplifications of governing equations from the Navier-Stokes equations, Stokes equation, and Reynold equation to the cubic law and reviews the evolutions of critical Reynolds number and critical hydraulic gradient for fluid flow in rock fractures and fracture networks, considering the influences of shear displacement, normal stress and/or confining pressure, fracture surface roughness, aperture, and number of intersections. This review provides a reference for the engineers and hydrogeologists especially the beginners to thoroughly understand the nonlinear flow regimes/mechanisms within complex fractured rock masses.
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Peer review: a tool to enhance clinical teaching.
Gusic, Maryellen; Hageman, Heather; Zenni, Elisa
2013-10-01
The system used by academic health centres to evaluate teaching must be valued by the large number of faculty staff that teach in clinical settings. Peer review can be used to evaluate and enhance clinical teaching. The objective of this study was to determine the perceptions of clinical faculty about the effects of participating in peer review. Faculty members were observed teaching in a clinical setting by trained peer observers. Feedback was provided using a checklist of behaviours and descriptive comments. Afterwards, semi-structured interviews were conducted to assess the faculty member's perception about the process. Notes from the interviews were analysed using a grounded theory approach. The study was approved by the institutional review boards of all the institutions involved. Three themes emerged from the interviews with faculty members: (1) they found the process to be valuable - they received information that affirmed "good" teaching behaviours, and were prompted to be more focused on their teaching; (2) they were motivated to enhance their teaching by being more deliberate, interactive and learner-centred; and (3) they were inspired to explore other opportunities to improve their teaching skills. Peer review is a process that promotes the open discussion and exchange of ideas. This conversation advances clinical teaching skills and allows high-quality teaching behaviours to be strengthened. © 2013 John Wiley & Sons Ltd.
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McCormick, Kiyan
2014-01-01
Simulated learning experiences using high-fidelity human patient simulators (HPS) are increasingly being integrated into baccalaureate nursing programs. Thus, the purpose of this study was to examine relationships among learning style, critical thinking disposition, critical thinking, and clinical judgment during high-fidelity human patient…
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A missing ethical competency? A review of critical reflection in health promotion.
Tretheway, Rebecca; Taylor, Jane; O'Hara, Lily; Percival, Nikki
2015-12-01
There is increasing emphasis in the health promotion literature on the ethical imperative for the profession to move towards critical practice. A key challenge for health promotion is that critical practice appears both under-developed and under-practiced. This is evident in the omission of critical reflection from Australian and international competencies for health promotion practitioners. A narrative literature review was undertaken to explore the current use of critical reflection in health promotion. Critical reflection models relevant to health promotion were identified and critiqued. There was a dearth of literature on critical reflection within health promotion, despite recognition of its potential to support critical practice. The discipline of critical social work provided literature on the use, effect and outcome of critical reflection in practice. The interdisciplinary critical reflection model was identified as the model most applicable to health promotion. Underpinned by critical theory, this model emphasises both critical and ethical practice. Critical reflection is a core competency for health promotion practitioners to address the ethical imperative to move towards critical practice. There is a need to explore the application of a critical reflection model in health promotion to determine how it may support critical and ethical practice. So what? If health promotion is to meet its ethical responsibilities, then critical reflection needs to be articulated as a core health promotion competency and a model for its application in health promotion developed.
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Conde-Taboada, A; Aranegui, B; García-Doval, I; Dávila-Seijo, P; González-Castro, U
2014-04-01
Systematic reviews -the most comprehensive type of literature review-should be taken into account before a clinical trial or a narrative review on a topic is undertaken. The objective of this study was to describe the use of systematic reviews in clinical trials and narrative reviews in dermatology. This was a descriptive cross-sectional study. We selected randomized clinical trials and narrative reviews from the dermatological clinical research journals identified as most important (according to impact factor) and from Actas Dermosifiliográficas, and studied the bibliographies to ascertain whether the authors made reference to existing systematic reviews and Cochrane reviews. Of the 72 clinical trials for which a systematic review was available, 24 (33.3%) cited at least 1 review; reference was made to relevant Cochrane reviews in 15.6% of cases and to non-Cochrane reviews in 32%. In the case of the 24 narrative reviews for which a review was available, 10 (41.7%) cited at least 1 review; Cochrane reviews were cited in 20% and non-Cochrane reviews in 35.3%.In the case of Actas Dermosifiliográficas, very few clinical trials were found and the findings for narrative review articles were similar to those observed for the other journals. Systematic reviews are not often taken into account by the authors of clinical trials and narrative reviews and this may lead to redundant studies and publications. Authors appear to use Cochrane reviews even less than non-Cochrane reviews and are therefore ignoring one of the main sources of available evidence. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.
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Peters, Frank T; Remane, Daniela
2012-06-01
In the last decade, liquid chromatography coupled to (tandem) mass spectrometry (LC-MS(-MS)) has become a versatile technique with many routine applications in clinical and forensic toxicology. However, it is well-known that ionization in LC-MS(-MS) is prone to so-called matrix effects, i.e., alteration in response due to the presence of co-eluting compounds that may increase (ion enhancement) or reduce (ion suppression) ionization of the analyte. Since the first reports on such matrix effects, numerous papers have been published on this matter and the subject has been reviewed several times. However, none of the existing reviews has specifically addressed aspects of matrix effects of particular interest and relevance to clinical and forensic toxicology, for example matrix effects in methods for multi-analyte or systematic toxicological analysis or matrix effects in (alternative) matrices almost exclusively analyzed in clinical and forensic toxicology, for example meconium, hair, oral fluid, or decomposed samples in postmortem toxicology. This review article will therefore focus on these issues, critically discussing experiments and results of matrix effects in LC-MS(-MS) applications in clinical and forensic toxicology. Moreover, it provides guidance on performance of studies on matrix effects in LC-MS(-MS) procedures in systematic toxicological analysis and postmortem toxicology.
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HYPNOSIS FOR ACUTE PROCEDURAL PAIN: A Critical Review
Kendrick, Cassie; Sliwinski, Jim; Yu, Yimin; Johnson, Aimee; Fisher, William; Kekecs, Zoltán; Elkins, Gary
2015-01-01
Clinical evidence for the effectiveness of hypnosis in the treatment of acute, procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions. PMID:26599994
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Hypnosis for Acute Procedural Pain: A Critical Review.
Kendrick, Cassie; Sliwinski, Jim; Yu, Yimin; Johnson, Aimee; Fisher, William; Kekecs, Zoltán; Elkins, Gary
2016-01-01
Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions.
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Hoerbst, A; Schweitzer, M
2015-08-13
Clinical Information Systems (CIS) have ever since the introduction of information technology in healthcare played an important role to support healthcare professionals and the process of treatment. With the rise of the concept of integrated care organizational borders, the sole focus on data aggregation or healthcare professionals as users disappear more and more. The manuscript discusses the concept of CISs and investigates critical success factors for CISs in the context of integrated care and in the course of time. In order to identify critical success factors and barriers for CISs a systematic literature review was conducted based on the results from PubMed and Cochrane, using MaxQDA. Search results were thereby limited to reviews or meta-analysis. We have found 1919 references of which 40 met the inclusion criteria. The analysis of the manuscripts resulted in a comprehensive list of success factors and barriers related to CISs in integrated care settings. Most barriers were user-related whereas for the success factors an even distribution of organizational, technical and user-related factors was observed. The vast majority of publications was focused on healthcare professionals. It is important to incorporate experiences made/ collected over time, as the problems encountered seem to remain almost unvaried. In order to support further systematic investigations on the topic it is necessary to rethink existing concepts and definitions to realign them with the ideas of integrated care.
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Clinical decision regret among critical care nurses: a qualitative analysis.
Arslanian-Engoren, Cynthia; Scott, Linda D
2014-01-01
Decision regret is a negative cognitive emotion associated with experiences of guilt and situations of interpersonal harm. These negative affective responses may contribute to emotional exhaustion in critical care nurses (CCNs), increased staff turnover rates and high medication error rates. Yet, little is known about clinical decision regret among CCNs or the conditions or situations (e.g., feeling sleepy) that may precipitate its occurrence. To examine decision regret among CCNs, with an emphasis on clinical decisions made when nurses were most sleepy. A content analytic approach was used to examine the narrative descriptions of clinical decisions by CCNs when sleepy. Six decision regret themes emerged that represented deviations in practice or performance behaviors that were attributed to fatigued CCNs. While 157 CCNs disclosed a clinical decision they made at work while sleepy, the prevalence may be underestimated and warrants further investigation. Copyright © 2014 Elsevier Inc. All rights reserved.
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Ambe, Peter C; Kaptanis, Sarantos; Papadakis, Marios; Weber, Sebastian A; Zirngibl, Hubert
2015-05-30
Acute cholecystitis is a common diagnosis. However, the heterogeneity of presentation makes it difficult to standardize management. Although surgery is the mainstay of treatment, critically ill patients have been managed via percutaneous cholecystostomy. However, the role of percutaneous cholecystostomy in the management of such patients has not been clearly established. This systematic review will compare the outcomes of critically ill patients with acute cholecystitis managed with percutaneous cholecystostomy to those of similar patients managed with cholecystectomy. Systematic searches will be conducted across relevant health databases including the Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Embase, and Scopus using the following keywords: (acute cholecystitis OR severe cholecystitis OR cholecystitis) AND (cholecystectomy OR laparoscopic cholecystectomy OR open cholecystectomy) AND (Cholecystostomy OR percutaneous cholecystectomy OR gallbladder drain OR gallbladder tube OR transhepatic gallbladder drain OR transhepatic gallbladder tube OR cholecystostomy tube). The reference lists of eligible articles will be hand searched. Articles from 2000-2014 will be identified using the key terms "acute cholecystitis, cholecystectomy, and percutaneous cholecystostomy". Studies including both interventions will be included. Relevant data will be extracted from eligible studies using a specially designed data extraction sheet. The Newcastle-Ottawa scale will be used to assess the quality of non-randomized studies. Central tendencies will be reported in terms of means and standard deviations where necessary, and risk ratios will be calculated where possible. All calculations will be performed with a 95 % confidence interval. Furthermore, the Fisher's exact test will be used for the calculation of significance, which will be set at p < 0.05. Pooled estimates will be presented after consideration of both clinical and
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Green Adsorbents for Wastewaters: A Critical Review
Directory of Open Access Journals (Sweden)
George Z. Kyzas
2014-01-01
Full Text Available One of the most serious environmental problems is the existence of hazardous and toxic pollutants in industrial wastewaters. The major hindrance is the simultaneous existence of many/different types of pollutants as (i dyes; (ii heavy metals; (iii phenols; (iv pesticides and (v pharmaceuticals. Adsorption is considered to be one of the most promising techniques for wastewater treatment over the last decades. The economic crisis of the 2000s led researchers to turn their interest in adsorbent materials with lower cost. In this review article, a new term will be introduced, which is called “green adsorption”. Under this term, it is meant the low-cost materials originated from: (i agricultural sources and by-products (fruits, vegetables, foods; (ii agricultural residues and wastes; (iii low-cost sources from which most complex adsorbents will be produced (i.e., activated carbons after pyrolysis of agricultural sources. These “green adsorbents” are expected to be inferior (regarding their adsorption capacity to the super-adsorbents of previous literature (complex materials as modified chitosans, activated carbons, structurally-complex inorganic composite materials etc., but their cost-potential makes them competitive. This review is a critical approach to green adsorption, discussing many different (maybe in some occasions doubtful topics such as: (i adsorption capacity; (ii kinetic modeling (given the ultimate target to scale up the batch experimental data to fixed-bed column calculations for designing/optimizing commercial processes and (iii critical techno-economical data of green adsorption processes in order to scale-up experiments (from lab to industry with economic analysis and perspectives of the use of green adsorbents.
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Green Adsorbents for Wastewaters: A Critical Review
Kyzas, George Z.; Kostoglou, Margaritis
2014-01-01
One of the most serious environmental problems is the existence of hazardous and toxic pollutants in industrial wastewaters. The major hindrance is the simultaneous existence of many/different types of pollutants as (i) dyes; (ii) heavy metals; (iii) phenols; (iv) pesticides and (v) pharmaceuticals. Adsorption is considered to be one of the most promising techniques for wastewater treatment over the last decades. The economic crisis of the 2000s led researchers to turn their interest in adsorbent materials with lower cost. In this review article, a new term will be introduced, which is called “green adsorption”. Under this term, it is meant the low-cost materials originated from: (i) agricultural sources and by-products (fruits, vegetables, foods); (ii) agricultural residues and wastes; (iii) low-cost sources from which most complex adsorbents will be produced (i.e., activated carbons after pyrolysis of agricultural sources). These “green adsorbents” are expected to be inferior (regarding their adsorption capacity) to the super-adsorbents of previous literature (complex materials as modified chitosans, activated carbons, structurally-complex inorganic composite materials etc.), but their cost-potential makes them competitive. This review is a critical approach to green adsorption, discussing many different (maybe in some occasions doubtful) topics such as: (i) adsorption capacity; (ii) kinetic modeling (given the ultimate target to scale up the batch experimental data to fixed-bed column calculations for designing/optimizing commercial processes) and (iii) critical techno-economical data of green adsorption processes in order to scale-up experiments (from lab to industry) with economic analysis and perspectives of the use of green adsorbents. PMID:28788460
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Zarbo, Cristina; Brugnera, Agostino; Frigerio, Luigi; Malandrino, Chiara; Rabboni, Massimo; Bondi, Emi; Compare, Angelo
2018-02-01
Endometriosis is a disabling and long-term medical condition affecting quality of life and mental health. Behavioral, cognitive, and emotional coping strategies, emotional intelligence, and metacognition could in part explain the link between the disease and impaired psychological and life functioning. This critical narrative review aimed at examining the state of the art of the relationships between endometriosis and these factors. According to PRISMA principles, we performed a systematic search for quantitative and qualitative studies on multiple electronic databases as regards coping strategies, emotional intelligence, and metacognition in women with endometriosis. Studies were subjected to interpretative and critical narrative synthesis. A total of 9 papers were included in the review. Three main categories were identified in thematic analysis and resumed in the manuscript. Findings suggested that (a) pain is considered the major stressor; (b) they usually use both adaptive and maladaptive coping strategies; (c) women with endometriosis and related chronic pain seem to repress emotions more likely than healthy ones; (d) suppressing own emotions, pain catastrophizing, and having a passive coping style are related to higher self-reported pain; and (e) emotional and avoidance coping styles are associated to poor mental status, while positive coping strategies focusing on the problem or on emotions, detached and rational styles are associated to better mental health. Few studies with mixed results and some methodological flaws have focused on coping strategies in women with endometriosis. No studies focusing on metacognition or emotional intelligence were found. Methodological biases, suggestions for future research, and implications for clinical practice were discussed.
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DEFF Research Database (Denmark)
Langhorn, Leanne; Sorensen, Jens C; Pedersen, Preben U
2010-01-01
A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care......A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care...
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Hidaka, Hiroshi; Yamaguchi, Takuhiro; Hasegawa, Jun; Yano, Hisakazu; Kakuta, Risako; Ozawa, Daiki; Nomura, Kazuhiro; Katori, Yukio
2015-10-01
Diabetes mellitus has been recognized as the most common systemic disease associated with deep neck infection. We report the first systematic review and meta-analysis of the influence of diabetes on clinical and bacteriological characteristics of deep neck infection. Articles were retrieved from PubMed, EMBASE, and the Japan Medical Abstracts Society database. A critical review of 227 studies identified 20 studies eligible for quantitative synthesis. Diabetes was associated with higher prevalences of multispace spread of infection, complications, and failure to identify pathogenesis, with risk ratios (RRs) of 1.96, 2.42, and 1.29, respectively. Bacteriologically, patients with diabetes showed a higher prevalence of culture identification of Klebsiella pneumoniae (RR, 3.28), and lower prevalences of Streptococcus spp. (RR, 0.57) and anaerobes (RR, 0.54). Deep neck infection with diabetes differs from that without in several clinical aspects. Again, bacteriological differences imply that diabetic infections might be populated by different bacterial flora. © 2014 Wiley Periodicals, Inc.
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Salsali, Mahvash; Tajvidi, Mansooreh; Ghiyasvandian, Shahrzad
2013-09-26
Critical thinking disposition represents an inclination of a person to use possessed skills in relation to critical thinking. The trend of critical thinking has been described as inner motivation to solve problems and make decisions by thinking. In nursing as a practical profession, the concept of critical thinking dispositions is important component in helping to manage complex health situations and to deal with patient issues effectively. Willingness to think critically is a prerequisite for safe and subtly performance. The results of studies show critical thinking dispositions of nursing students in Asian countries are different from non-Asian countries. Aim of this literature review was to compare critical thinking dispositions of nursing students in Asian and non-Asian countries. Literature review was done in English and Persian databases. The results showed of the 795 articles published in English and Persian language that studied critical thinking, 73 ones studied critical thinking skills and dispositions in nursing education, and relationship between teaching methods and critical thinking skills and dispositions in nursing education of different countries. Fifteen of seventy three articles assessed critical thinking dispositions in nursing students. Limited studies showed that the Asian nursing students had mostly undermining score of the critical thinking dispositions, while non-Asian countries tend to positive scores. The reasons for these differences could be due to issues such as environmental, educational methods and cultural differences. However, future studies should measure critical thinking disposition by discipline-based tools.
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Salsali, Mahvash; Tajvidi, Mansooreh; Ghiyasvandian, Shahrzad
2013-01-01
Critical thinking disposition represents an inclination of a person to use possessed skills in relation to critical thinking. The trend of critical thinking has been described as inner motivation to solve problems and make decisions by thinking. In nursing as a practical profession, the concept of critical thinking dispositions is important component in helping to manage complex health situations and to deal with patient issues effectively. Willingness to think critically is a prerequisite for safe and subtly performance. The results of studies show critical thinking dispositions of nursing students in Asian countries are different from non-Asian countries. Aim of this literature review was to compare critical thinking dispositions of nursing students in Asian and non-Asian countries. Literature review was done in English and Persian databases. The results showed of the 795 articles published in English and Persian language that studied critical thinking, 73 ones studied critical thinking skills and dispositions in nursing education, and relationship between teaching methods and critical thinking skills and dispositions in nursing education of different countries. Fifteen of seventy three articles assessed critical thinking dispositions in nursing students. Limited studies showed that the Asian nursing students had mostly undermining score of the critical thinking dispositions, while non-Asian countries tend to positive scores. The reasons for these differences could be due to issues such as environmental, educational methods and cultural differences. However, future studies should measure critical thinking disposition by discipline-based tools. PMID:24171885
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2018-01-01
Artificial intelligence (AI) is projected to substantially influence clinical practice in the foreseeable future. However, despite the excitement around the technologies, it is yet rare to see examples of robust clinical validation of the technologies and, as a result, very few are currently in clinical use. A thorough, systematic validation of AI technologies using adequately designed clinical research studies before their integration into clinical practice is critical to ensure patient benefit and safety while avoiding any inadvertent harms. We would like to suggest several specific points regarding the role that peer-reviewed medical journals can play, in terms of study design, registration, and reporting, to help achieve proper and meaningful clinical validation of AI technologies designed to make medical diagnosis and prediction, focusing on the evaluation of diagnostic accuracy efficacy. Peer-reviewed medical journals can encourage investigators who wish to validate the performance of AI systems for medical diagnosis and prediction to pay closer attention to the factors listed in this article by emphasizing their importance. Thereby, peer-reviewed medical journals can ultimately facilitate translating the technological innovations into real-world practice while securing patient safety and benefit.
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Park, Seong Ho; Kressel, Herbert Y
2018-05-28
Artificial intelligence (AI) is projected to substantially influence clinical practice in the foreseeable future. However, despite the excitement around the technologies, it is yet rare to see examples of robust clinical validation of the technologies and, as a result, very few are currently in clinical use. A thorough, systematic validation of AI technologies using adequately designed clinical research studies before their integration into clinical practice is critical to ensure patient benefit and safety while avoiding any inadvertent harms. We would like to suggest several specific points regarding the role that peer-reviewed medical journals can play, in terms of study design, registration, and reporting, to help achieve proper and meaningful clinical validation of AI technologies designed to make medical diagnosis and prediction, focusing on the evaluation of diagnostic accuracy efficacy. Peer-reviewed medical journals can encourage investigators who wish to validate the performance of AI systems for medical diagnosis and prediction to pay closer attention to the factors listed in this article by emphasizing their importance. Thereby, peer-reviewed medical journals can ultimately facilitate translating the technological innovations into real-world practice while securing patient safety and benefit.
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Ali, Syed Mustafa; Giordano, Richard; Lakhani, Saima; Walker, Dawn Marie
2016-03-01
A gap between current diabetes care practice and recommended diabetes care standards has consistently been reported in the literature. Many IT-based interventions have been developed to improve adherence to the quality of care standards for chronic illness like diabetes. The widespread implementation of electronic medical/health records has catalyzed clinical decision support systems (CDSS) which may improve the quality of diabetes care. Therefore, the objective of the review is to evaluate the effectiveness of CDSS in improving quality of type II diabetes care. Moreover, the review aims to highlight the key indicators of quality improvement to assist policy makers in development of future diabetes care policies through the integration of information technology and system. Setting inclusion criteria, a systematic literature search was conducted using Medline, Web of Science and Science Direct. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of studies. Eight randomized controlled trials (RCTs) were selected for the review. In the selected studies, seventeen clinical markers of diabetes care were discussed. Three quality of care indicators were given more importance in monitoring the progress of diabetes care, which is consistent with National Institute for Health and Care Excellence (NICE) guidelines. The presence of these indicators in the studies helped to determine which studies were selected for review. Clinical- and process-related improvements are compared between intervention group using CDSS and control group with usual care. Glycated hemoglobin (HbA1c), low density lipid cholesterol (LDL-C) and blood pressure (BP) were the quality of care indicators studied at the levels of process of care and clinical outcome. The review has found both inconsistent and variable results for quality of diabetes care measures. A significant improvement has been found in the process of care for all three measures of quality of diabetes care
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Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice
Hajjaj, FM; Salek, MS; Basra, MKA; Finlay, AY
2010-01-01
This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional co...
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Why general practitioners and consultants change their clinical practice: a critical incident study.
Allery, L. A.; Owen, P. A.; Robling, M. R.
1997-01-01
OBJECTIVE: To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change. DESIGN: Interviews using the critical incident technique. SETTING: Primary and secondary care. SUBJECTS: Random sample of 50 general practitioners and 50 consultants. MAIN OUTCOME MEASURES: Categories of reasons for change in clinical practice. RESULTS: Doctors described 361 changes in clinical practice, with an av...
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A review of the clinical implications of bisphosphonates in dentistry.
Borromeo, G L; Tsao, C E; Darby, I B; Ebeling, P R
2011-03-01
Bisphosphonates are drugs that suppress bone turnover and are commonly prescribed to prevent skeletal related events in malignancy and for benign bone diseases such as osteoporosis. Bisphosphonate associated jaw osteonecrosis (ONJ) is a potentially debilitating, yet poorly understood condition. A literature review was undertaken to review the dental clinical implications of bisphosphonates. The present paper briefly describes the postulated pathophysiology of ONJ and conditions with similar clinical presentations. The implications of bisphosphonates for implantology, periodontology, orthodontics and endodontics are reviewed. Whilst bisphosphonates have potential positive applications in some clinical settings, periodontology particularly, further clinical research is limited by the risk of ONJ. Prevention and management are reviewed, including guidelines for reducing cumulative intravenous bisphosphonate dose, cessation of bisphosphonates prior to invasive dental treatment or after ONJ development, and the use of serum beta-CTX-1 in assessing risk. In the context of substantial uncertainty, the implications of bisphosphonate use in the dental clinical setting are still being determined. © 2010 Australian Dental Association.
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Entropy in the Critical Zone: A Comprehensive Review
Directory of Open Access Journals (Sweden)
Juan Quijano
2014-06-01
Full Text Available Thermodynamic entropy was initially proposed by Clausius in 1865. Since then it has been implemented in the analysis of different systems, and is seen as a promising concept to understand the evolution of open systems in non-equilibrium conditions. Information entropy was proposed by Shannon in 1948, and has become an important concept to measure information in different systems. Both thermodynamic entropy and information entropy have been extensively applied in different fields related to the Critical Zone, such as hydrology, ecology, pedology, and geomorphology. In this study, we review the most important applications of these concepts in those fields, including how they are calculated, and how they have been utilized to analyze different processes. We then synthesize the link between thermodynamic and information entropies in the light of energy dissipation and organizational patterns, and discuss how this link may be used to enhance the understanding of the Critical Zone.
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Online counseling: a narrative and critical review of the literature.
Richards, Derek; Viganó, Noemi
2013-09-01
This article aimed to critically review the literature on online counseling. Database and hand-searches were made using search terms and eligibility criteria, yielding a total of 123 studies. The review begins with what characterizes online counseling. Outcome and process research in online counseling is reviewed. Features and cyberbehaviors of online counseling such as anonymity and disinhibition, convenience, time-delay, the loss of social signaling, and writing behavior in cyberspace are discussed. Ethical behavior, professional training, client suitability, and clients' and therapists' attitudes and experiences of online counseling are reviewed. A growing body of knowledge to date is positive in showing that online counseling can have a similar impact and is capable of replicating the facilitative conditions as face-to-face encounters. A need remains for stronger empirical evidence to establish efficacy and effectiveness and to understand better the unique mediating and facilitative variables. © 2013 Wiley Periodicals, Inc.
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A critical review of the nursing shortage in Malaysia.
Barnett, T; Namasivayam, P; Narudin, D A A
2010-03-01
This paper describes and critically reviews steps taken to address the nursing workforce shortage in Malaysia. To address the shortage and to build health care capacity, Malaysia has more than doubled its nursing workforce over the past decade, primarily through an increase in the domestic supply of new graduates. Government reports, policy documents and ministerial statements were sourced from the Ministry of Health Malaysia website and reviewed and analysed in the context of the scholarly literature published about the health care workforce in Malaysia and more generally about the global nursing shortage. An escalation in student numbers and the unprecedented number of new graduates entering the workforce has been associated with other impacts that have been responded to symptomatically rather than through workplace reform. Whilst growing the domestic supply of nurses is a critical key strategy to address workforce shortages, steps should also be taken to address structural and other problems of the workplace to support both new graduates and the retention of more experienced staff. Nursing shortages should not be tackled by increasing the supply of new graduates alone. The creation of a safe and supportive work environment is important to the long-term success of current measures taken to grow the workforce and retain nurses within the Malaysian health care system.
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Tablet Use in Schools: A Critical Review of the Evidence for Learning Outcomes
Haßler, B.; Major, L.; Hennessy, S.
2016-01-01
The increased popularity of tablets in general has led to uptake in education. We critically review the literature reporting use of tablets by primary and secondary school children across the curriculum, with a particular emphasis on learning outcomes. The systematic review methodology was used, and our literature search resulted in 33 relevant…
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Critical Discourse Analysis in Education: A Review of the Literature, 2004 to 2012
Rogers, Rebecca; Schaenen, Inda; Schott, Christopher; O'Brien, Kathryn; Trigos-Carrillo, Lina; Starkey, Kim; Chasteen, Cynthia Carter
2016-01-01
This article reviews critical discourse analysis scholarship in education research from 2004 to 2012. Our methodology was carried out in three stages. First, we searched educational databases. Second, we completed an analytic review template for each article and encoded these data into a digital spreadsheet to assess macro-trends in the field.…
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[Teaching methods for clinical settings: a literature review].
Brugnolli, Anna; Benaglio, Carla
2017-01-01
. Teaching Methods for clinical settings: a review. The teaching process during internship requires several methods to promote the acquisition of more complex technical skills such as relational, decisional and planning abilities. To describe effective teaching methods to promote the learning of relational, decisional and planning skills. A literature review of the teaching methods that have proven most effective, most appreciated by students, and most frequently used in Italian nursing schools. Clinical teaching is a central element to transform clinical experiences during internship in professional competences. The students are gradually brought to become more independent, because they are offered opportunities to practice in real contexts, to receive feedback, to have positive role models, to become more autonomous: all elements that facilitate and potentiate learning. Clinical teaching should be based on a variety of methods. The students value a gradual progression both in clinical experiences and teaching strategies from more supervised methods to methods more oriented towards reflecting on clinical practice and self-directed learning.
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Healthcare avoidance: a critical review.
Byrne, Sharon K
2008-01-01
The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.
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McQuilten, Z K; Zatta, A J; Andrianopoulos, N; Aoki, N; Stevenson, L; Badami, K G; Bird, R; Cole-Sinclair, M F; Hurn, C; Cameron, P A; Isbister, J P; Phillips, L E; Wood, E M
2017-04-01
To evaluate the use of routinely collected data to determine the cause(s) of critical bleeding in patients who receive massive transfusion (MT). Routinely collected data are increasingly being used to describe and evaluate transfusion practice. Chart reviews were undertaken on 10 randomly selected MT patients at 48 hospitals across Australia and New Zealand to determine the cause(s) of critical bleeding. Diagnosis-related group (DRG) and International Classification of Diseases (ICD) codes were extracted separately and used to assign each patient a cause of critical bleeding. These were compared against chart review using percentage agreement and kappa statistics. A total of 427 MT patients were included with complete ICD and DRG data for 427 (100%) and 396 (93%), respectively. Good overall agreement was found between chart review and ICD codes (78·3%; κ = 0·74, 95% CI 0·70-0·79) and only fair overall agreement with DRG (51%; κ = 0·45, 95% CI 0·40-0·50). Both ICD and DRG were sensitive and accurate for classifying obstetric haemorrhage patients (98% sensitivity and κ > 0·94). However, compared with the ICD algorithm, DRGs were less sensitive and accurate in classifying bleeding as a result of gastrointestinal haemorrhage (74% vs 8%; κ = 0·75 vs 0·1), trauma (92% vs 62%; κ = 0·78 vs 0·67), cardiac (80% vs 57%; κ = 0·79 vs 0·60) and vascular surgery (64% vs 56%; κ = 0·69 vs 0·65). Algorithms using ICD codes can determine the cause of critical bleeding in patients requiring MT with good to excellent agreement with clinical history. DRG are less suitable to determine critical bleeding causes. © 2016 British Blood Transfusion Society.
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McCutcheon, Karen; Lohan, Maria; Traynor, Marian; Martin, Daphne
2015-02-01
To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing. The need to adequately support and develop students in clinical skills is now arguably more important than previously considered due to reductions in practice opportunities. Online and blended teaching methods are being developed to try and meet this requirement, but knowledge about their effectiveness in teaching clinical skills is limited. Mixed methods systematic review, which follows the Joanna Briggs Institute User guide version 5. Computerized searches of five databases were undertaken for the period 1995-August 2013. Critical appraisal and data extraction were undertaken using Joanna Briggs Institute tools for experimental/observational studies and interpretative and critical research. A narrative synthesis was used to report results. Nineteen published papers were identified. Seventeen papers reported on online approaches and only two papers reported on a blended approach. The synthesis of findings focused on the following four areas: performance/clinical skill, knowledge, self-efficacy/clinical confidence and user experience/satisfaction. The e-learning interventions used varied throughout all the studies. The available evidence suggests that online learning for teaching clinical skills is no less effective than traditional means. Highlighted by this review is the lack of available evidence on the implementation of a blended learning approach to teaching clinical skills in undergraduate nurse education. Further research is required to assess the effectiveness of this teaching methodology. © 2014 John Wiley & Sons Ltd.
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A critical review of regional economic integration in China
Wang RUI
2015-01-01
Under the circumstances of economic globalization, regional economic integration has become the mainstream of current economic development for each country, so China has to pay more attention to it. The critical review on regional economic integration in China can lay a certain foundation and provide experience for the in-depth research. Main contents of regional economic integration are refined according to the previous studies and realities, including the integration of regional economic re...
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A Cross-Industry Review of B2B Critical Success Factors.
Eid, Riyad; Trueman, Myfanwy; Ahmed, Abdel Moneim
2002-01-01
Presents a comprehensive review of B2B (business-to- business) international Internet marketing and identifies 21 critical success factors in five categories: marketing strategy, including management support, strategic goals, and collaboration; Web site factors, including Web site design; global factors, including multilanguage sites and cultural…
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A Review of Vitamin D Deficiency in the Critical Care Population
Kelly Massey; Roland N. Dickerson; Rex O. Brown
2014-01-01
It is well documented that a large percentage of the general population is either vitamin D insufficient or deficient. Vitamin D deficiency adversely affects bone health. More recently, it has been reported that vitamin D is an important component in immune function and glycemic control Substantial data exist that demonstrate an association between vitamin D insufficiency/deficiency and mortality/clinical outcomes of critically ill patients. The larger clinical trials addressing this associat...
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Fontaine, Nathalie; Carbonneau, Rene; Vitaro, Frank; Barker, Edward D.; Tremblay, Richard E.
2009-01-01
Background: Knowledge on the onset and the development of antisocial behavior in females is limited, because most of the research in this domain is based on males. Methods: We critically reviewed 46 empirical studies that examined developmental trajectories of antisocial behavior in females, notably to help determine whether or not an…
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Web-based resources for critical care education.
Kleinpell, Ruth; Ely, E Wesley; Williams, Ged; Liolios, Antonios; Ward, Nicholas; Tisherman, Samuel A
2011-03-01
reviews of the benefits of utilizing e-learning. Review of the Web sites of relevant critical care organizations revealed the existence of a number of e-learning resources, including online critical care courses, tutorials, podcasts, webcasts, slide sets, and continuing medical education resources, some requiring membership or a fee to access. Respondents to listserve queries (>100) and critical care medicine fellowship director and advanced practice nursing educator e-mail queries (>50) identified the use of a number of tutorials, self-directed learning modules, and video-enhanced programs for critical care education and practice. In all, >135 Web-based education resources exist, including video Web resources for critical care education in a variety of e-learning formats, such as tutorials, self-directed learning modules, interactive case studies, webcasts, podcasts, and video-enhanced programs. As identified by critical care educators and practitioners, e-learning is actively being integrated into critical care medicine and nursing training programs for continuing medical education and competency training purposes. Knowledge of available Web-based educational resources may enhance critical care practitioners' ongoing learning and clinical competence, although this has not been objectively measured to date.
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Raymond, J; Guillemin, F; Proust, F; Molyneux, A J; Fox, A J; Claiborne, J S; Meder, J F; Rouleau, I
2008-03-30
The preventive treatment of unruptured aneurysms has been performed for decades despite the lack of evidence of a clinical benefit. Reports of observational studies such as the International Study of Unruptured Intracranial Aneurysms (ISUIA) suggest that preventive treatments are rarely justified. Are these reports compelling enough to guide clinical practice? The ISUIA methods and data are reviewed and analysed in a more conventional manner. The design of the appropriate clinical research program is approached by steps, reviewing potential problems, from the formulation of the precise research question to the interpretation of subgroup analyses, including sample size, representativity, duration of observation period, blinding, definition of outcome events, analysis of cross-overs, losses to follow-up, and data reporting. Unruptured intracranial aneurysms observed in ISUIA ruptured at a minimal annual rate of 0.8% (0.5-1%), despite multiple methodological difficulties biased in favour of a benign natural history. Available registries do not have the power or the design capable of providing normative guidelines for clinical decisions. The appropriate method to solve the clinical dilemma is a multicentric trial comparing the incidence of a hard clinical outcome events in approximately 2000 patients randomly allocated to a treatment group and a deferred treatment group, all followed for ten years or more. Observational studies have failed to provide reliable evidence in favour or against the preventive treatment of unruptured aneurysms. A randomized trial is in order to clarify what is the role of prevention in this common clinical problem.
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Coker, Patty
2010-01-01
This study examined the effects of participation in a 1-week, experiential, hands-on learning program on the critical thinking and clinical reasoning skills of occupational therapy students. A quasi-experimental, nonrandomized pre- and post-test design was used with a sample of 25 students. The students had completed three semesters of didactic lecture coursework in a master's level OT educational program prior to participation in a hands-on therapy program for children with hemiplegic cerebral palsy. Changes in critical thinking and clinical reasoning skills were evaluated using the following dependent measures: Self-Assessment of Clinical Reflection and Reasoning (SACRR) and the California Critical Thinking Skills Test (CCTST). Changes in pretest and posttest scores on the SACRR and the CCTST were statistically significant (p>0.05) following completion of the experiential learning program. This study supports the use of hands-on learning to develop clinical reasoning and critical thinking skills in healthcare students, who face ever more diverse patient populations upon entry-level practice. Further qualitative and quantitative investigations are needed to support the results of this study and determine which components of experiential learning programs are essential for developing clinical reasoning and critical thinking skills in future allied health professionals.
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Critical review: medical students' motivation after failure.
Holland, Chris
2016-08-01
About 10 % of students in each years' entrants to medical school will encounter academic failure at some stage in their programme. The usual approach to supporting these students is to offer them short term remedial study programmes that often enhance approaches to study that are orientated towards avoiding failure. In this critical review I will summarise the current theories about student motivation that are most relevant to this group of students and describe how they are enhanced or not by various contextual factors that medical students experience during their programme. I will conclude by suggesting ways in which support programmes for students who have encountered academic failure might be better designed and researched in the future.
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The role of melatonin in anaesthesia and critical care
Directory of Open Access Journals (Sweden)
Madhuri S Kurdi
2013-01-01
Full Text Available Melatonin is a neurohormone secreted by the pineal gland. It is widely present in both plant and animal sources. In several countries, it is sold over the counter as tablets and as food supplement or additive. Currently, it is most often used to prevent jet lag and to induce sleep. It has been and is being used in several clinical trials with different therapeutic approaches. It has sedative, analgesic, anti-inflammatory, anti-oxidative and chronobiotic effects. In the present review, the potential therapeutic benefits of melatonin in anaesthesia and critical care are presented. This article aims to review the physiological properties of melatonin and how these could prove useful for several clinical applications in perioperative management, critical care and pain medicine. The topic was handsearched from textbooks and journals and electronically from PubMed, and Google scholar using text words.
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The role of melatonin in anaesthesia and critical care.
Kurdi, Madhuri S; Patel, Tushar
2013-03-01
Melatonin is a neurohormone secreted by the pineal gland. It is widely present in both plant and animal sources. In several countries, it is sold over the counter as tablets and as food supplement or additive. Currently, it is most often used to prevent jet lag and to induce sleep. It has been and is being used in several clinical trials with different therapeutic approaches. It has sedative, analgesic, anti-inflammatory, anti-oxidative and chronobiotic effects. In the present review, the potential therapeutic benefits of melatonin in anaesthesia and critical care are presented. This article aims to review the physiological properties of melatonin and how these could prove useful for several clinical applications in perioperative management, critical care and pain medicine. The topic was handsearched from textbooks and journals and electronically from PubMed, and Google scholar using text words.
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Evans, N.; Bausewein, C.; Meñaca, A.; Andrew, E.V.W.; Higginson, I.J.; Harding, R.; Pool, R.; Gysels, M.
2012-01-01
Objective Recent legal changes in Germany make non-compliance with advance directives (ADs) a criminal offence. This article assesses the evidence on attitudes towards, use of, and physician compliance with ADs in Germany. Methods Critical review: studies on ADs, identified from a systematic review
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Attributes of clinical leadership in contemporary nursing: an integrative review.
Mannix, Judy; Wilkes, Lesley; Daly, John
2013-08-01
Effective clinical leadership is offered as the key to healthy, functional and supportive work environments for nurses and other health professionals. However, as a concept it lacks a standard definition and is poorly understood. This paper reports on an integrative review undertaken to uncover current understandings of defining attributes of contemporary clinical leadership in nursing. Data collection involved a search of relevant electronic databases for a 10-year period. Keywords for the search were 'clinical leadership' and 'nursing'. Ten research papers met the inclusion criteria for the integrative review. Analysis of these studies indicated clinical leadership attributes had a clinical focus, a follower/team focus or a personal qualities focus; attributes necessary to sustain supportive workplaces and build the capacity and resilience of nursing workforces. The small number of research-based studies yielded for the review indicates the need for further research in the area of clinical leadership.
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Burry, L D; Hutton, B; Guenette, M; Williamson, D; Mehta, S; Egerod, I; Kanji, S; Adhikari, N K; Moher, D; Martin, C M; Rose, L
2016-09-08
Delirium is characterized by acute changes in mental status including inattention, disorganized thinking, and altered level of consciousness, and is highly prevalent in critically ill adults. Delirium has adverse consequences for both patients and the healthcare system; however, at this time, no effective treatment exists. The identification of effective prevention strategies is therefore a clinical and research imperative. An important limitation of previous reviews of delirium prevention is that interventions were considered in isolation and only direct evidence was used. Our systematic review will synthesize all existing data using network meta-analysis, a powerful statistical approach that enables synthesis of both direct and indirect evidence. We will search Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science from 1980 to March 2016. We will search the PROSPERO registry for protocols and the Cochrane Library for published systematic reviews. We will examine reference lists of pertinent reviews and search grey literature and the International Clinical Trials Registry Platform for unpublished studies and ongoing trials. We will include randomized and quasi-randomized trials of critically ill adults evaluating any pharmacological, non-pharmacological, or multi-component intervention for delirium prevention, administered in or prior to (i.e., peri-operatively) transfer to the ICU. Two authors will independently screen search results and extract data from eligible studies. Risk of bias assessments will be completed on all included studies. To inform our network meta-analysis, we will first conduct conventional pair-wise meta-analyses for primary and secondary outcomes using random-effects models. We will generate our network meta-analysis using a Bayesian framework, assuming a common heterogeneity parameter across all comparisons, and accounting for correlations in multi-arm studies. We will perform analyses using WinBUGS software. This systematic review
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A Critical Review of Instructional Design Process of Distance Learning System
Chaudry, Muhammad Ajmal; ur-Rahman, Fazal
2010-01-01
Instructional design refers to planning, development, delivery and evaluation of instructional system. It is an applied field of study aiming at the application of descriptive research outcomes in regular instructional settings. The present study was designed to critically review the process of instructional design at Allama Iqbal Open University…
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Kiss, A.N.; Danis, W.D.; Cavusgil, S.T.
This article systematically reviews and critically examines international entrepreneurship research in emerging economies (IEEE research), and articulates its importance, timeliness and relevance in consideration of the growing influence of emerging markets in the global economy. A systematic
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Directory of Open Access Journals (Sweden)
Martínez-García Ana I
2010-10-01
Full Text Available Abstract Background The health care sector is an area of social and economic interest in several countries; therefore, there have been lots of efforts in the use of electronic health records. Nevertheless, there is evidence suggesting that these systems have not been adopted as it was expected, and although there are some proposals to support their adoption, the proposed support is not by means of information and communication technology which can provide automatic tools of support. The aim of this study is to identify the critical adoption factors for electronic health records by physicians and to use them as a guide to support their adoption process automatically. Methods This paper presents, based on the PRISMA statement, a systematic literature review in electronic databases with adoption studies of electronic health records published in English. Software applications that manage and process the data in the electronic health record have been considered, i.e.: computerized physician prescription, electronic medical records, and electronic capture of clinical data. Our review was conducted with the purpose of obtaining a taxonomy of the physicians main barriers for adopting electronic health records, that can be addressed by means of information and communication technology; in particular with the information technology roles of the knowledge management processes. Which take us to the question that we want to address in this work: "What are the critical adoption factors of electronic health records that can be supported by information and communication technology?". Reports from eight databases covering electronic health records adoption studies in the medical domain, in particular those focused on physicians, were analyzed. Results The review identifies two main issues: 1 a knowledge-based classification of critical factors for adopting electronic health records by physicians; and 2 the definition of a base for the design of a conceptual
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Castillo, Víctor H; Martínez-García, Ana I; Pulido, J R G
2010-10-15
The health care sector is an area of social and economic interest in several countries; therefore, there have been lots of efforts in the use of electronic health records. Nevertheless, there is evidence suggesting that these systems have not been adopted as it was expected, and although there are some proposals to support their adoption, the proposed support is not by means of information and communication technology which can provide automatic tools of support. The aim of this study is to identify the critical adoption factors for electronic health records by physicians and to use them as a guide to support their adoption process automatically. This paper presents, based on the PRISMA statement, a systematic literature review in electronic databases with adoption studies of electronic health records published in English. Software applications that manage and process the data in the electronic health record have been considered, i.e.: computerized physician prescription, electronic medical records, and electronic capture of clinical data. Our review was conducted with the purpose of obtaining a taxonomy of the physicians main barriers for adopting electronic health records, that can be addressed by means of information and communication technology; in particular with the information technology roles of the knowledge management processes. Which take us to the question that we want to address in this work: "What are the critical adoption factors of electronic health records that can be supported by information and communication technology?". Reports from eight databases covering electronic health records adoption studies in the medical domain, in particular those focused on physicians, were analyzed. The review identifies two main issues: 1) a knowledge-based classification of critical factors for adopting electronic health records by physicians; and 2) the definition of a base for the design of a conceptual framework for supporting the design of knowledge
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Maneval, Rhonda; Fowler, Kimberly A; Kays, John A; Boyd, Tiffany M; Shuey, Jennifer; Harne-Britner, Sarah; Mastrine, Cynthia
2012-03-01
This study was conducted to determine whether the addition of high-fidelity patient simulation to new nurse orientation enhanced critical thinking and clinical decision-making skills. A pretest-posttest design was used to assess critical thinking and clinical decision-making skills in two groups of graduate nurses. Compared with the control group, the high-fidelity patient simulation group did not show significant improvement in mean critical thinking or clinical decision-making scores. When mean scores were analyzed, both groups showed an increase in critical thinking scores from pretest to posttest, with the high-fidelity patient simulation group showing greater gains in overall scores. However, neither group showed a statistically significant increase in mean test scores. The effect of high-fidelity patient simulation on critical thinking and clinical decision-making skills remains unclear. Copyright 2012, SLACK Incorporated.
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Clinical leadership in pre-registration nursing programmes--an international literature review.
Brown, Angela; Crookes, Patrick; Dewing, Jan
2015-01-01
Clinical leadership and the safety, quality and efficiency of patient/client care are inextricably linked in government reports, major inquiries and the professional literature. This review explores the literature on clinical leadership development within pre-registration nursing programmes. The literature retrieved from a scoping review was evaluated to identify what is already published on the development of clinical leadership within pre-registration nursing programmes. Twenty-seven publications matched the inclusion criteria and were included in this review, 14 journal articles, one thesis and 11 chapters within one book were analysed and three themes were identified: clinical leadership; curriculum content and pedagogy. RESULTS AND MAIN OUTCOMES: This review identified a paucity of literature specifically relating to clinical leadership and pre-registration nursing programmes and what is available is inconclusive and unconvincing. Academics, curriculum development leaders and accreditation bodies have a responsibility to influence how nurses are prepared for the profession as such clinical leadership and the new graduate should be considered an area of greater importance.
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Exploring the Group Prenatal Care Model: A Critical Review of the Literature
Thielen, Kathleen
2012-01-01
Few studies have compared perinatal outcomes between individual prenatal care and group prenatal care. A critical review of research articles that were published between 1998 and 2009 and involved participants of individual and group prenatal care was conducted. Two middle range theories, Pender’s health promotion model and Swanson’s theory of caring, were blended to enhance conceptualization of the relationship between pregnant women and the group prenatal care model. Among the 17 research studies that met inclusion criteria for this critical review, five examined gestational age and birth weight with researchers reporting longer gestations and higher birth weights in infants born to mothers participating in group prenatal care, especially in the preterm birth population. Current evidence demonstrates that nurse educators and leaders should promote group prenatal care as a potential method of improving perinatal outcomes within the pregnant population. PMID:23997549
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Wandrag, L; Brett, S J; Frost, G; Hickson, M
2015-08-01
Muscle wasting during critical illness impairs recovery. Dietary strategies to minimise wasting include nutritional supplements, particularly essential amino acids. We reviewed the evidence on enteral supplementation with amino acids or their metabolites in the critically ill and in muscle wasting illness with similarities to critical illness, aiming to assess whether this intervention could limit muscle wasting in vulnerable patient groups. Citation databases, including MEDLINE, Web of Knowledge, EMBASE, the meta-register of controlled trials and the Cochrane Collaboration library, were searched for articles from 1950 to 2013. Search terms included 'critical illness', 'muscle wasting', 'amino acid supplementation', 'chronic obstructive pulmonary disease', 'chronic heart failure', 'sarcopenia' and 'disuse atrophy'. Reviews, observational studies, sport nutrition, intravenous supplementation and studies in children were excluded. One hundred and eighty studies were assessed for eligibility and 158 were excluded. Twenty-two studies were graded according to standardised criteria using the GRADE methodology: four in critical care populations, and 18 from other clinically relevant areas. Methodologies, interventions and outcome measures used were highly heterogeneous and meta-analysis was not appropriate. Methodology and quality of studies were too varied to draw any firm conclusion. Dietary manipulation with leucine enriched essential amino acids (EAA), β-hydroxy-β-methylbutyrate and creatine warrant further investigation in critical care; EAA has demonstrated improvements in body composition and nutritional status in other groups with muscle wasting illness. High-quality research is required in critical care before treatment recommendations can be made. © 2014 The British Dietetic Association Ltd.
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Measuring culture: a critical review of acculturation and health in Asian immigrant populations.
Salant, Talya; Lauderdale, Diane S
2003-07-01
The number of studies examining how acculturation affects the health of Asian immigrants has increased in recent years. The proliferation of studies reflects the growing size and heterogeneity of Asian immigrant populations in the United States, Canada, Australia, New Zealand, and the United Kingdom. This paper compares various approaches to acculturation within the health literature on Asian immigrants by reviewing the literature in three-health domains (1) mental health (2) physical health and (3) health services use. The review critically examines the conceptualizations and measures of acculturation in these three domains and presents major findings. We observe that measurement difficulties posed by the experiences of heterogeneous Asian groups compound theoretical and disciplinary disparities between acculturation instruments. The extent to which conceptual and methodological critiques of acculturation studies in Hispanic populations apply to studies of Asian populations is also discussed. The critical review thus provides insights into the diverse ways that the relationship between culture and health is measured in this complicated and growing literature.
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Fructose Intake, Serum Uric Acid, and Cardiometabolic Disorders: A Critical Review.
Caliceti, Cristiana; Calabria, Donato; Roda, Aldo; Cicero, Arrigo F G
2017-04-18
There is a direct relationship between fructose intake and serum levels of uric acid (UA), which is the final product of purine metabolism. Recent preclinical and clinical evidence suggests that chronic hyperuricemia is an independent risk factor for hypertension, metabolic syndrome, and cardiovascular disease. It is probably also an independent risk factor for chronic kidney disease, Type 2 diabetes, and cognitive decline. These relationships have been observed for high serum UA levels (>5.5 mg/dL in women and >6 mg/dL in men), but also for normal to high serum UA levels (5-6 mg/dL). In this regard, blood UA levels are much higher in industrialized countries than in the rest of the world. Xanthine-oxidase inhibitors can reduce UA and seem to minimize its negative effects on vascular health. Other dietary and pathophysiological factors are also related to UA production. However, the role of fructose-derived UA in the pathogenesis of cardiometabolic disorders has not yet been fully clarified. Here, we critically review recent research on the biochemistry of UA production, the relationship between fructose intake and UA production, and how this relationship is linked to cardiometabolic disorders.
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Fructose Intake, Serum Uric Acid, and Cardiometabolic Disorders: A Critical Review
Directory of Open Access Journals (Sweden)
Cristiana Caliceti
2017-04-01
Full Text Available There is a direct relationship between fructose intake and serum levels of uric acid (UA, which is the final product of purine metabolism. Recent preclinical and clinical evidence suggests that chronic hyperuricemia is an independent risk factor for hypertension, metabolic syndrome, and cardiovascular disease. It is probably also an independent risk factor for chronic kidney disease, Type 2 diabetes, and cognitive decline. These relationships have been observed for high serum UA levels (>5.5 mg/dL in women and >6 mg/dL in men, but also for normal to high serum UA levels (5–6 mg/dL. In this regard, blood UA levels are much higher in industrialized countries than in the rest of the world. Xanthine-oxidase inhibitors can reduce UA and seem to minimize its negative effects on vascular health. Other dietary and pathophysiological factors are also related to UA production. However, the role of fructose-derived UA in the pathogenesis of cardiometabolic disorders has not yet been fully clarified. Here, we critically review recent research on the biochemistry of UA production, the relationship between fructose intake and UA production, and how this relationship is linked to cardiometabolic disorders.
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A critical review of treatment approaches for gambling disorders.
Stea, Jonathan N; Hodgins, David C
2011-06-01
This review presents the theoretical model, evidence base, and theoretical and methodological issues for seven treatment approaches to gambling disorders: 1) psychoanalytic and psychodynamic treatments, 2) Gamblers Anonymous, 3) behavioural treatments, 4) cognitive and cognitive-behavioural therapies, 5) brief, motivational, and self-directed interventions, 6) pharmacotherapies, and 7) family therapy approaches. Throughout the review, broader clinical and research issues are also discussed, including barriers to treatment-seeking, controlled gambling versus abstinence as a treatment goal, comorbidity, and the evaluation of treatment efficacy and effectiveness.
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How do psychiatrists in India construct their professional identity? A critical literature review
Bayetti, Clement; Jadhav, Sushrut; Deshpande, Smita N.
2017-01-01
Psychiatric practice in India is marked by an increasing gulf between largely urban-based mental health professionals and a majority rural population. Based on the premise that any engagement is a mutually constructed humane process, an understanding of the culture of psychiatry including social process of local knowledge acquisition by trainee psychiatrists is critical. This paper reviews existing literature on training of psychiatrists in India, the cultural construction of their professional identities and autobiographical reflections. The results reveal a scarcity of research on how identities, knowledge, and values are constructed, contested, resisted, sustained, and operationalized through practice. This paper hypothesizes that psychiatric training and practice in India continues to operate chiefly in an instrumental fashion and bears a circular relationship between cultural, hierarchical training structures and patient–carer concerns. The absence of interpretative social science training generates a professional identity that predominantly focuses on the patient and his/her social world as the site of pathology. Infrequent and often superfluous critical cultural reflexivity gained through routine clinical practice further alienates professionals from patients, caregivers, and their own social landscapes. This results in a peculiar brand of theory and practice that is skewed toward a narrow understanding of what constitutes suffering. The authors argue that such omissions could be addressed through nuanced ethnographies on the professional development of psychiatrists during postgraduate training, including the political economies of their social institutions and local cultural landscapes. Further research will also help enhance culturally sensitive epistemology and shape locally responsive mental health training programs. This is critical for majority rural Indians who place their trust in State biomedical care. PMID:28529358
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Critical Review of rate constants for reacitons of hydrated electrons
International Nuclear Information System (INIS)
Buxton, G.V.; Greenstock, C.L.; Phillips Helman, W.; Ross, A.B.
1988-01-01
Kinetic data for the radicals Hx and xOH in aqueous solution,and the corresponding radical anions, xO - and e/sub =/, have been critically reviewed. Reactions of the radicals in aqueous solution have been studied by pulse radiolysis, flash photolysis and other methods. Rate constants for over 3500 reaction are tabulated, including reaction with molecules, ions and other radicals derived from inorganic and organic solutes
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Sedighi, M.; Zand, F.
2012-01-01
Knowledge management is a critical issue in today's business world. Knowledge is considered as one of the most strategic resources of the firm and sources of competitive advantage. This research provides a comprehensive review of the literature on the Critical Success Factors (CSFs) and identifies
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Rationing in health systems: A critical review.
Keliddar, Iman; Mosadeghrad, Ali Mohammad; Jafari-Sirizi, Mehdi
2017-01-01
Background: It is difficult to provide health care services to all those in need of such services due to limited resources and unlimited demands. Thus, priority setting and rationing have to be applied. This study aimed at critically examining the concept of rationing in health sector and identifying its purposes, influencing factors, mechanisms, and outcomes. Methods: The critical interpretive synthesis methodology was used in this study. PubMed, Cochrane, and Proquest databases were searched using the related key words to find related documents published between 1970 and 2015. In total, 161 published reports were reviewed and included in the study. Thematic content analysis was applied for data analysis. Results: Health services rationing means restricting the access of some people to useful or potentially useful health services due to budgetary limitation. The inherent features of the health market and health services, limited resources, and unlimited needs necessitate health services rationing. Rationing can be applied in 4 levels: health care policy- makers, health care managers, health care providers, and patients. Health care rationing can be accomplished through fixed budget, benefit package, payment mechanisms, queuing, copayments, and deductibles. Conclusion: This paper enriched our understanding of health services rationing and its mechanisms at various levels and contributed to the literature by broadly conceptualizing health services rationing.
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Reflective blogs in clinical education to promote critical thinking in dental hygiene students.
Wetmore, Ann O'Kelley; Boyd, Linda D; Bowen, Denise M; Pattillo, Robin E
2010-12-01
One challenge facing dental hygiene, as well as dental, education is to identify clinical teaching strategies promoting critical thinking and clinical reasoning. These skills are crucial elements in the practice of dental hygiene. A two-group design (intervention, n=28, and control, n=30) assessed first-year dental hygiene students using pre-and post-Health Science Reasoning Test (HSRT) scores to evaluate the effect of reflective blogging on critical thinking skills. A reflective blog rubric, based on Mezirow's levels of reflection, determined if reflective blogging increased the level of reflection for dental hygiene students. The results suggest within this nonprobability sample that reflective blogging did not produce a significant change in students' HSRT scores (p>0.05). However, analyses of reflective blog rubric scores demonstrated statistically significant improvements (pcritical thinking.
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Han, Kyung-Ja; Kim, Hesook Suzie; Kim, Mae-Ja; Hong, Kyung-Ja; Park, Sungae; Yun, Soon-Nyoung; Song, Misoon; Jung, Yoenyi; Kim, Haewon; Kim, Dong-Oak Debbie; Choi, Heejung; Kim, Kyungae
2007-06-01
The purpose of the paper is to discover the patterns and processes of decision-making in clinical nursing practice. A set of think-aloud data from five critical care nurses during 40 to 50 minutes of caregiving in intensive care units were obtained and analyzed by applying the procedures recommended by Ericsson and Simon for protocol analysis. Four thinking processes before acting were identified to constitute various sorts of thoughts in which the nurses were engaged during patient care: reviewing, validation, consideration, rationalization, and action. In addition, three patterns of sequential streaming of thinking (short, intermediate, long) were identified to reveal various ways the nurses dealt with clinical situations involving nursing tasks and responsibilities. This study specifies the initial categories of thoughts for each of the processes and various patterns with which these processes are sequentially combined, providing insights into the ways nurses think about problems and address their concerns. The findings suggest that the thinking in clinical practice involves more than focused decision-making and reasoning, and needs to be examined from a broader perspective.
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A Review of Criticality Accidents 2000 Revision
Energy Technology Data Exchange (ETDEWEB)
Thomas P. McLaughlin; Shean P. Monahan; Norman L. Pruvost; Vladimir V. Frolov; Boris G. Ryazanov; Victor I. Sviridov
2000-05-01
Criticality accidents and the characteristics of prompt power excursions are discussed. Sixty accidental power excursions are reviewed. Sufficient detail is provided to enable the reader to understand the physical situation, the chemistry and material flow, and when available the administrative setting leading up to the time of the accident. Information on the power history, energy release, consequences, and causes are also included when available. For those accidents that occurred in process plants, two new sections have been included in this revision. The first is an analysis and summary of the physical and neutronic features of the chain reacting systems. The second is a compilation of observations and lessons learned. Excursions associated with large power reactors are not included in this report.
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A Review of Criticality Accidents 2000 Revision
International Nuclear Information System (INIS)
McLaughlin, Thomas P.; Monahan, Shean P.; Pruvost, Norman L.; Frolov, Vladimir V.; Ryazanov, Boris G.; Sviridov, Victor I.
2000-01-01
Criticality accidents and the characteristics of prompt power excursions are discussed. Sixty accidental power excursions are reviewed. Sufficient detail is provided to enable the reader to understand the physical situation, the chemistry and material flow, and when available the administrative setting leading up to the time of the accident. Information on the power history, energy release, consequences, and causes are also included when available. For those accidents that occurred in process plants, two new sections have been included in this revision. The first is an analysis and summary of the physical and neutronic features of the chain reacting systems. The second is a compilation of observations and lessons learned. Excursions associated with large power reactors are not included in this report
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Nitrogen Balance and Protein Requirements for Critically Ill Older Patients
Directory of Open Access Journals (Sweden)
Roland N. Dickerson
2016-04-01
Full Text Available Critically ill older patients with sarcopenia experience greater morbidity and mortality than younger patients. It is anticipated that unabated protein catabolism would be detrimental for the critically ill older patient. Healthy older subjects experience a diminished response to protein supplementation when compared to their younger counterparts, but this anabolic resistance can be overcome by increasing protein intake. Preliminary evidence suggests that older patients may respond differently to protein intake than younger patients during critical illness as well. If sufficient protein intake is given, older patients can achieve a similar nitrogen accretion response as younger patients even during critical illness. However, there is concern among some clinicians that increasing protein intake in older patients during critical illness may lead to azotemia due to decreased renal functional reserve which may augment the propensity towards worsened renal function and worsened clinical outcomes. Current evidence regarding protein requirements, nitrogen balance, ureagenesis, and clinical outcomes during nutritional therapy for critically ill older patients is reviewed.
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Directory of Open Access Journals (Sweden)
L.F. Coelho
2008-01-01
Full Text Available The muscular flexibility training put in evidence a train of neurophysiological principals and an intricate amount of muscular and viscous-elastic properties. There are a lot of stretching methods, used on the clinical and sport contexts. Despite its common utilization, it isn’t usual the health and educational professionals reflect about the compounds and efficacy of the diverse stretching methods. In this article, we realize a critical review about the diverse methods used on the flexibility training, as the principles and parameters related with that. We will done special emphasis to the principles of the proprioceptive neuromuscular facilitation and the diverse local relaxation methods, like warming. We will also have in count the revealing data relating to the Elasticity Coefficient paradox, witch can help to conceive an intervention philosophy of the flexibility training different from what it have being defended and practiced.
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Lee, Jong Woo; LaRoche, Suzette; Choi, Hyunmi; Rodriguez Ruiz, Andres A; Fertig, Evan; Politsky, Jeffrey M; Herman, Susan T; Loddenkemper, Tobias; Sansevere, Arnold J; Korb, Pearce J; Abend, Nicholas S; Goldstein, Joshua L; Sinha, Saurabh R; Dombrowski, Keith E; Ritzl, Eva K; Westover, Michael B; Gavvala, Jay R; Gerard, Elizabeth E; Schmitt, Sarah E; Szaflarski, Jerzy P; Ding, Kan; Haas, Kevin F; Buchsbaum, Richard; Hirsch, Lawrence J; Wusthoff, Courtney J; Hopp, Jennifer L; Hahn, Cecil D
2016-04-01
The rapid expansion of the use of continuous critical care electroencephalogram (cEEG) monitoring and resulting multicenter research studies through the Critical Care EEG Monitoring Research Consortium has created the need for a collaborative data sharing mechanism and repository. The authors describe the development of a research database incorporating the American Clinical Neurophysiology Society standardized terminology for critical care EEG monitoring. The database includes flexible report generation tools that allow for daily clinical use. Key clinical and research variables were incorporated into a Microsoft Access database. To assess its utility for multicenter research data collection, the authors performed a 21-center feasibility study in which each center entered data from 12 consecutive intensive care unit monitoring patients. To assess its utility as a clinical report generating tool, three large volume centers used it to generate daily clinical critical care EEG reports. A total of 280 subjects were enrolled in the multicenter feasibility study. The duration of recording (median, 25.5 hours) varied significantly between the centers. The incidence of seizure (17.6%), periodic/rhythmic discharges (35.7%), and interictal epileptiform discharges (11.8%) was similar to previous studies. The database was used as a clinical reporting tool by 3 centers that entered a total of 3,144 unique patients covering 6,665 recording days. The Critical Care EEG Monitoring Research Consortium database has been successfully developed and implemented with a dual role as a collaborative research platform and a clinical reporting tool. It is now available for public download to be used as a clinical data repository and report generating tool.
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On critical reflection : A review of Mezirow’s theory and its operationalization
Lundgren, H.; Poell, R.F.
2016-01-01
In this article, we review empirical studies that research critical reflection based on Mezirow’s definition. The concepts of content, process, and premise reflection have often been cited, and operationalizing Mezirow’s high-level transformative learning theory and its components has been the
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Military service member and veteran reintegration: A critical review and adapted ecological model.
Elnitsky, Christine A; Blevins, Cara L; Fisher, Michael P; Magruder, Kathryn
2017-01-01
Returning military service members and veterans (MSMVs) experience a wide range of stress-related disorders in addition to social and occupational difficulties when reintegrating to the community. Facilitating reintegration of MSMVs following deployment is a societal priority. With an objective of identifying challenges and facilitators for reintegration of MSMVs of the current war era, we critically review and identify gaps in the literature. We searched 8 electronic databases and identified 1,764 articles. Screening of abstracts and full-text review based on our inclusion/exclusion criteria, yielded 186 articles for review. Two investigators evaluating relevant articles independently found a lack of clear definition or comprehensive theorizing about MSMV reintegration. To address these gaps, we linked the findings from the literature to provide a unified definition of reintegration and adapted the social ecological systems theory to guide research and practice aimed at MSMV reintegration. Furthermore, we identified individual, interpersonal, community, and societal challenges related to reintegration. The 186 studies published from 2001 (the start of the current war era) to 2015 included 6 experimental studies or clinical trials. Most studies do not adequately account for context or more than a narrow set of potential influences on MSMV reintegration. Little evidence was found that evaluated interventions for health conditions, rehabilitation, and employment, or effective models of integrated delivery systems. We recommend an ecological model of MSMV reintegration to advance research and practice processes and outcomes at 4 levels (individual, interpersonal, organizational, and societal). (PsycINFO Database Record (c) 2017 APA, all rights reserved).
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Review of studies on criticality safety evaluation and criticality experiment methods
International Nuclear Information System (INIS)
Naito, Yoshitaka; Yamamoto, Toshihiro; Misawa, Tsuyoshi; Yamane, Yuichi
2013-01-01
Since the early 1960s, many studies on criticality safety evaluation have been conducted in Japan. Computer code systems were developed initially by employing finite difference methods, and more recently by using Monte Carlo methods. Criticality experiments have also been carried out in many laboratories in Japan as well as overseas. By effectively using these study results, the Japanese Criticality Safety Handbook was published in 1988, almost the intermediate point of the last 50 years. An increased interest has been shown in criticality safety studies, and a Working Party on Nuclear Criticality Safety (WPNCS) was set up by the Nuclear Science Committee of Organisation Economic Co-operation and Development in 1997. WPNCS has several task forces in charge of each of the International Criticality Safety Benchmark Evaluation Program (ICSBEP), Subcritical Measurement, Experimental Needs, Burn-up Credit Studies and Minimum Critical Values. Criticality safety studies in Japan have been carried out in cooperation with WPNCS. This paper describes criticality safety study activities in Japan along with the contents of the Japanese Criticality Safety Handbook and the tasks of WPNCS. (author)
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Directory of Open Access Journals (Sweden)
Irfannuddin Irfannuddin
2009-03-01
Full Text Available Aim Clinical reasoning is one of the essential competencies for medical practitioners, so that it must be exercised by medical students. Studies on quantitative evidence of factors influencing clinical reasoning abilicy of students are limited. The aim of this study was to determine the influence of knowledge and other factors on the clinical reasoning abiliry ofthe students, which can serve as reference to establish methods for learning ctinical reasoning.Methods This is a cross-sectional study on fourth semester students enrolled in the Competency-based Curriculum of the Medical Faculty, University of Sriwijaya. Data on clinical reasoning abilily and risk factors during urogenital blockwere collected inApril 2008, when the students have just completed the btock. Clinical reasoning abiliry was tested using the Script Concordance test and the risk factors were evaluated based on formative tests, block summative assessments, and student characteristics. Data were analyzed by Cox regression.Results The prevalence of low clinical reasoning ability of the 132 students was 38.6%. The group with low basic knowledge was found to have 63% risk ol low clinical reasoning abiliry when compared to those with high basic knowledge (adjusted RR = 1.63; 95% conidence intewal (Ct: 1.10 -2.42. When compared to students with high critical thinking skitls, those with lory critical thinking skills had 2.3 time to be low clinical reasoning abitity (adjusted RR : 2.30; 95% CI: 1.55 - 3.41.Conclusion Students with low critical thinking skills or with inadequate knowledge had a higher risk of low clinical reasoning ability. (Med J Indones 2009; 18: 53-9Keywords: clinical reasoning, basic knowledge, critical thinking, competency-based curriculum
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DEFF Research Database (Denmark)
Fava, Giovanni A.; Tomba, Elena; Bech, Per
2017-01-01
of its most representative expressions and reference to current challenges of clinical research, with particular reference to clinimetrics. The domains of clinical pharmacopsychology encompass the clinical benefits of psychotropic drugs, the characteristics that predict responsiveness to treatment...... effects, (b) treatment-induced unwanted side effects, and (c) the patient's own personal experience of a change in terms of well-being and/or quality of life. Clinical pharmacopsychology offers a unifying framework for the understanding of clinical phenomena in medical and psychiatric settings. Research......The aim of this critical review was to outline emerging trends and perspectives of clinical pharmacopsychology, an area of clinical psychology that is concerned with the psychological effects of medications. The historical development of clinical pharmacopsychology is outlined, with discussion...
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Clinical management of alcohol withdrawal: A systematic review
Directory of Open Access Journals (Sweden)
Shivanand Kattimani
2013-01-01
Full Text Available Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed.
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Silver (Ag) Transport Mechanisms in TRISO coated particles: A Critical Review
Energy Technology Data Exchange (ETDEWEB)
I J van Rooyen; J H Neethling; J A A Engelbrecht; P M van Rooyen; G Strydom
2012-10-01
Transport of 110mAg in the intact SiC layer of TRISO coated particles has been studied for approximately 30 years without arriving at a satisfactory explanation of the transport mechanism. In this paper the possible mechanisms postulated in previous experimental studies, both in-reactor and out-of reactor research environment studies are critically reviewed and of particular interest are relevance to very high temperature gas reactor operating and accident conditions. Among the factors thought to influence Ag transport are grain boundary stoichiometry, SiC grain size and shape, the presence of free silicon, nano-cracks, thermal decomposition, palladium attack, transmutation products, layer thinning and coated particle shape. Additionally new insight to nature and location of fission products has been gained via recent post irradiation electron microscopy examination of TRISO coated particles from the DOE’s fuel development program. The combined effect of critical review and new analyses indicates a direction for investigating possible the Ag transport mechanism including the confidence level with which these mechanisms may be experimentally verified.
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Silver (Ag) transport mechanisms in TRISO coated particles: A critical review
Energy Technology Data Exchange (ETDEWEB)
Rooyen, I.J. van, E-mail: isabella.vanrooyen@inl.gov [Idaho National Laboratory, Idaho Falls, ID 83415-6188 (United States); Dunzik-Gougar, M.L. [Department of Nuclear Engineering, Idaho State University, ID (United States); Rooyen, P.M. van [Philip M. van Rooyen Network Consultants, Midlands Estates (South Africa)
2014-05-01
Transport of {sup 110m}Ag in the intact SiC layer of TRISO coated particles has been studied for approximately 30 years without arriving at a satisfactory explanation of the transport mechanism. In this paper the possible mechanisms postulated in previous experimental studies, both in-reactor and out-of reactor research environment studies are critically reviewed and of particular interest are relevance to very high temperature gas reactor operating and accident conditions. Among the factors thought to influence Ag transport are grain boundary stoichiometry, SiC grain size and shape, the presence of free silicon, nano-cracks, thermal decomposition, palladium attack, transmutation products, layer thinning and coated particle shape. Additionally new insight to nature and location of fission products has been gained via recent post irradiation electron microscopy examination of TRISO coated particles from the DOE's fuel development program. The combined effect of critical review and new analyses indicates a direction for investigating possible the Ag transport mechanism including the confidence level with which these mechanisms may be experimentally verified.
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Computerized tomography and schizophrenia: critical review of the literature
International Nuclear Information System (INIS)
Krakauer Huebner, C.V.; Gattaz, W.F.
1988-01-01
A critical review of the literature regarding structural brain abnormalities in Schizophrenia is presented. It is reported that the prevalence and the localization of the abnormalities vary widely among studies. These differences might stem from samples heterogeneity, from the choice of the computer tomographic (CT) parameter to be investigated and from the use of different criteria for defining abnormalities. It seems established that at least one subgroup of Schizophrenia patients shows mild or moderate brain atrophy, in spite of some contradictory findings. (M.A.C.)
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Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.
Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y
2010-05-01
This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.
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A critical review of the neuroimaging literature on synesthesia.
Directory of Open Access Journals (Sweden)
Jean-Michel eHupé
2015-03-01
Full Text Available Synesthesia refers to additional sensations experienced by some people for specific stimulations, such as the systematic arbitrary association of colors to letters for the most studied type. Here we review all the studies (based mostly on functional and structural MRI that have searched for the neural correlates of this subjective experience, as well as structural differences related to synesthesia. Most differences claimed for synesthetes are unsupported, due mainly to low statistical power, statistical errors and methodological limitations. Our critical review therefore casts some doubts on whether any neural correlate of the synesthetic experience has been established yet. Rather than being a neurological condition (i.e., a structural or functional brain anomaly, synesthesia could be reconsidered as a special kind of childhood memory, whose signature in the brain may be out of reach with present brain imaging techniques.
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Usefulness of Cochrane Skin Group reviews for clinical practice.
Davila-Seijo, P; Batalla, A; Garcia-Doval, I
2013-10-01
Systematic reviews are one of the most important sources of information for evidence-based medicine. However, there is a general impression that these reviews rarely report results that provide sufficient evidence to change clinical practice. The aim of this study was to determine the percentage of Cochrane Skin Group reviews reporting results with the potential to guide clinical decision-making. We performed a bibliometric analysis of all the systematic reviews published by the Cochrane Skin Group up to 16 August, 2012. We retrieved 55 reviews, which were analyzed and graded independently by 2 investigators into 3 categories: 0 (insufficient evidence to support or reject the use of an intervention), 1 (insufficient evidence to support or reject the use of an intervention but sufficient evidence to support recommendations or suggestions), and 2 (sufficient evidence to support or reject the use of an intervention). Our analysis showed that 25.5% (14/55) of the studies did not provide sufficient evidence to support or reject the use of the interventions studied, 45.5% (25/25) provided sufficient but not strong evidence to support recommendations or suggestions, and 29.1% (16/55) provided strong evidence to support or reject the use of 1 or more of the interventions studied. Most of the systematic reviews published by the Cochrane Skin Group provide useful information to improve clinical practice. Clinicians should read these reviews and reconsider their current practice. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.
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The Reasons Requirement in International Investment Arbitration: Critical Case Studies (book review)
DEFF Research Database (Denmark)
Tang, Yi Shin
2008-01-01
3. In the article, the Researcher reviews the work of Professors Guillermo A. Alvarez and W. Michael Reisman from Yale Law School, regarding the mechanisms of international investment arbitration and their importance for developing countries. The article provides a critical perspective on the aut...
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Validation of a clinical critical thinking skills test in nursing
Shin, Sujin; Jung, Dukyoo; Kim, Sungeun
2015-01-01
Purpose: The purpose of this study was to develop a revised version of the clinical critical thinking skills test (CCTS) and to subsequently validate its performance. Methods: This study is a secondary analysis of the CCTS. Data were obtained from a convenience sample of 284 college students in June 2011. Thirty items were analyzed using item response theory and test reliability was assessed. Test-retest reliability was measured using the results of 20 nursing college and graduate school stud...
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[Critical role of clinical laboratories in hospital infection control].
Yagi, Tetsuya
2010-11-01
The hospital infection control and prevention is recognized to be more and more important according to the advances in modern medical treatment and care. Clinical microbiology laboratory play critical roles in the hospital infection control as a member of infection control team (ICT). They are the first in a hospital to identify outbreak of MRSA in NICU and molecular epidemiological analysis of the isolates lead proper intervention of ICT to the concerned ward. From a viewpoint of infectious disease specialist, rapid and precise microbiological information is essential for the appropriate diagnosis and treatment of infectious diseases. Each medical technologist need to make efforts to understand the characteristics of the examinations for infectious diseases and send out information useful for clinical practices. In our hospital, with the participation of all members of medical technologists, rapid reporting system was developed for blood culture examinations, which greatly contribute to the appropriate treatment of bloodstream infections. Collaborations of clinical microbiology laboratory with other members of ICT realize high quality hospital infection control. They also need to be aware of themselves as good practitioners of infection control measures to prevent hospital infections.
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Zuriguel-Pérez, Esperanza; Falcó-Pegueroles, Anna; Roldán-Merino, Juan; Agustino-Rodriguez, Sandra; Gómez-Martín, Maria Del Carmen; Lluch-Canut, Maria Teresa
2017-08-01
A complex healthcare environment, with greater need for care based on the patient and evidence-based practice, are factors that have contributed to the increased need for critical thinking in professional competence. At the theoretical level, Alfaro-LeFevre () put forward a model of critical thinking made up of four components. And although these explain the construct, instruments for their empirical measurement are lacking. The purpose of the study was to develop and validate the psychometric properties of an instrument, the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice), designed to evaluate the critical thinking abilities of nurses in the clinical setting. A cross-sectional survey design was used. A pool of items was generated for evaluation by a panel of experts who considered their validity for the new instrument, which was finally made up of 109 items. Following this, validation was carried out using a sample of 339 nurses at a hospital in Barcelona, Spain. Reliability was determined by means of internal consistency and test-retest stability over time, although the validity of the construct was assessed by means of confirmatory factor analysis. The content validity index of the N-CT-4 Practice was .85. Cronbach's alpha coefficient for the whole instrument was .96. The intraclass correlation coefficient was .77. Confirmatory factor analysis showed that the instrument was in line with the four-dimensional model proposed by Alfaro-LeFevre (). The psychometric properties of theN-CT-4 Practice uphold its potential for use in measuring critical thinking and in future research related with the examination of critical thinking. © 2017 The Authors Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.
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Connolly, Bronwen; O'Neill, Brenda; Salisbury, Lisa; Blackwood, Bronagh
2016-01-01
Background Physical rehabilitation interventions aim to ameliorate the effects of critical illness-associated muscle dysfunction in survivors. We conducted an overview of systematic reviews (SR) evaluating the effect of these interventions across the continuum of recovery. Methods Six electronic databases (Cochrane Library, CENTRAL, DARE, Medline, Embase, and Cinahl) were searched. Two review authors independently screened articles for eligibility and conducted data extraction and quality appraisal. Reporting quality was assessed and the Grading of Recommendations Assessment, Development and Evaluation approach applied to summarise overall quality of evidence. Results Five eligible SR were included in this overview, of which three included meta-analyses. Reporting quality of the reviews was judged as medium to high. Two reviews reported moderate-to-high quality evidence of the beneficial effects of physical therapy commencing during intensive care unit (ICU) admission in improving critical illness polyneuropathy/myopathy, quality of life, mortality and healthcare utilisation. These interventions included early mobilisation, cycle ergometry and electrical muscle stimulation. Two reviews reported very low to low quality evidence of the beneficial effects of electrical muscle stimulation delivered in the ICU for improving muscle strength, muscle structure and critical illness polyneuropathy/myopathy. One review reported that due to a lack of good quality randomised controlled trials and inconsistency in measuring outcomes, there was insufficient evidence to support beneficial effects from physical rehabilitation delivered post-ICU discharge. Conclusions Patients derive short-term benefits from physical rehabilitation delivered during ICU admission. Further robust trials of electrical muscle stimulation in the ICU and rehabilitation delivered following ICU discharge are needed to determine the long-term impact on patient care. This overview provides recommendations for
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Epigenetics of psoriatic disease: A systematic review and critical appraisal.
Pollock, Remy A; Abji, Fatima; Gladman, Dafna D
2017-03-01
Psoriasis is an inflammatory disease of the skin that is sometimes accompanied by an auto-inflammatory arthritis called psoriatic arthritis (PsA). Psoriasis and PsA are multifactorial diseases that result from complex interactions of environmental and genetic risk factors. Epigenetic marks, which are labile chemical marks with diverse functions, form a layer of biological information that sits at the interface of genetics and the environment. Aberrant epigenetic regulation has been previously implicated in other rheumatological disorders. The purpose of this review is to summarize and critically evaluate the nascent literature on epigenetics in psoriasis and PsA. A systematic review yielded 52 primary articles after applying inclusion and exclusion criteria. Data were extracted using a standardized template and study quality assessed using a methodological quality checklist. Studies reflect a broad range of epigenetic sub-disciplines, the most common being DNA methylation, followed by the parent of origin effect or genomic imprinting, expression or activity of epigenetic modifying enzymes, and histone modifications. Epidemiological studies demonstrating excessive paternal transmission provided the earliest evidence of epigenetic deregulation in psoriatic disease, however few studies have examined its molecular mechanisms. Methylation studies evolved rapidly from low resolution global to targeted analyses of known psoriatic disease susceptibility loci such as HLA-C*0602. The recent explosion of epigenome-wide association studies has provided us with novel insights into psoriasis pathogenesis, and the mechanism of action of UVB, methotrexate, and anti-TNF therapies, as well as molecular signatures of psoriasis that may have clinical relevance. Finally, recent studies of pharmacological inhibitors of epigenetic modifier enzymes demonstrate their potential applicability as novel treatment modalities for psoriasis. Challenges of epigenetics research in psoriasis and Ps
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Openness in Adoption: What We Know So Far--A Critical Review of the Literature
Wolfgram, Susan M.
2008-01-01
What are the factors that keep adoptive parents and birth parents connected and sustain their kinship relationships over time? This is the central research question critically reviewed across studies dating from 1987 to 2000. A preliminary review of the literature revealed 15 to 20 studies within this 13-year scope limited to the perspective of…
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Coyne, Elisabeth; Rands, Hazel; Frommolt, Valda; Kain, Victoria; Plugge, Melanie; Mitchell, Marion
2018-04-01
The aim of this review is to inform future educational strategies by synthesising research related to blended learning resources using simulation videos to teach clinical skills for health students. An integrative review methodology was used to allow for the combination of diverse research methods to better understand the research topic. This review was guided by the framework described by Whittemore and Knafl (2005), DATA SOURCES: Systematic search of the following databases was conducted in consultation with a librarian using the following databases: SCOPUS, MEDLINE, COCHRANE, PsycINFO databases. Keywords and MeSH terms: clinical skills, nursing, health, student, blended learning, video, simulation and teaching. Data extracted from the studies included author, year, aims, design, sample, skill taught, outcome measures and findings. After screening the articles, extracting project data and completing summary tables, critical appraisal of the projects was completed using the Mixed Methods Appraisal Tool (MMAT). Ten articles met all the inclusion criteria and were included in this review. The MMAT scores varied from 50% to 100%. Thematic analysis was undertaken and we identified the following three themes: linking theory to practice, autonomy of learning and challenges of developing a blended learning model. Blended learning allowed for different student learning styles, repeated viewing, and enabled links between theory and practice. The video presentation needed to be realistic and culturally appropriate and this required both time and resources to create. A blended learning model, which incorporates video-assisted online resources, may be a useful tool to teach clinical skills to students of health including nursing. Blended learning not only increases students' knowledge and skills, but is often preferred by students due to its flexibility. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Clinical peer review in the United States: history, legal development and subsequent abuse.
Vyas, Dinesh; Hozain, Ahmed E
2014-06-07
The Joint Commission on Accreditation requires hospitals to conduct peer review to retain accreditation. Despite the intended purpose of improving quality medical care, the peer review process has suffered several setbacks throughout its tenure. In the 1980s, abuse of peer review for personal economic interest led to a highly publicized multimillion-dollar verdict by the United States Supreme Court against the perpetrating physicians and hospital. The verdict led to decreased physician participation for fear of possible litigation. Believing that peer review was critical to quality medical care, Congress subsequently enacted the Health Care Quality Improvement Act (HCQIA) granting comprehensive legal immunity for peer reviewers to increase participation. While serving its intended goal, HCQIA has also granted peer reviewers significant immunity likely emboldening abuses resulting in Sham Peer Reviews. While legal reform of HCQIA is necessary to reduce sham peer reviews, further measures including the need for standardization of the peer review process alongside external organizational monitoring are critical to improving peer review and reducing the prevalence of sham peer reviews.
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Review of criticality safety benchmark data of plutonium solution in ICSBEP handbook
International Nuclear Information System (INIS)
Yamamoto, Toshihiro; Miyoshi, Yoshinori; Okubo, Kiyoshi
2003-01-01
The criticality data of plutonium solutions published in the ICSBEP Handbook were reviewed. Criticality data for lower plutonium concentration and higher 240 Pu content, which correspond to a reprocessing process condition, are very scarce and hence the criticality data in this area are desired. While the calculated k eff 's with ENDF/B-V show the dependence of the plutonium concentration, the dependence has been corrected in JENDL-3.3 because of energy distribution of the capture cross section of 239 Pu. Based on the generalized perturbation theory, the sensitivity coefficient of k eff with respect to fission and capture cross section in plutonium solutions were obtained. In a plutonium solution with a lower concentration, cross sections in the thermal energy less than 0.1 eV have significant effects on the criticality. On the other hand, the criticality of higher concentration plutonium solutions is mostly dominated by cross sections in the energy range larger than 0.1 eV. Regarding the effect of 240 Pu on criticality, the capture cross section 240 Pu around the resonance peak near 1 eV is dominant regardless of the concentration. (author)
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Dissemination bias in systematic reviews of animal research: a systematic review.
Directory of Open Access Journals (Sweden)
Katharina F Mueller
Full Text Available Systematic reviews of preclinical studies, in vivo animal experiments in particular, can influence clinical research and thus even clinical care. Dissemination bias, selective dissemination of positive or significant results, is one of the major threats to validity in systematic reviews also in the realm of animal studies. We conducted a systematic review to determine the number of published systematic reviews of animal studies until present, to investigate their methodological features especially with respect to assessment of dissemination bias, and to investigate the citation of preclinical systematic reviews on clinical research.Eligible studies for this systematic review constitute systematic reviews that summarize in vivo animal experiments whose results could be interpreted as applicable to clinical care. We systematically searched Ovid Medline, Embase, ToxNet, and ScienceDirect from 1st January 2009 to 9th January 2013 for eligible systematic reviews without language restrictions. Furthermore we included articles from two previous systematic reviews by Peters et al. and Korevaar et al.The literature search and screening process resulted in 512 included full text articles. We found an increasing number of published preclinical systematic reviews over time. The methodological quality of preclinical systematic reviews was low. The majority of preclinical systematic reviews did not assess methodological quality of the included studies (71%, nor did they assess heterogeneity (81% or dissemination bias (87%. Statistics quantifying the importance of clinical research citing systematic reviews of animal studies showed that clinical studies referred to the preclinical research mainly to justify their study or a future study (76%.Preclinical systematic reviews may have an influence on clinical research but their methodological quality frequently remains low. Therefore, systematic reviews of animal research should be critically appraised before
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A critical appraisal of the clinical utility of proton therapy in oncology
Wang, Dongxu
2015-01-01
Proton therapy is an emerging technology for providing radiation therapy to cancer patients. The depth dose distribution of a proton beam makes it a preferable radiation modality as it reduces radiation to the healthy tissue outside the tumor, compared with conventional photon therapy. While theoretically beneficial, its clinical values are still being demonstrated from the increasing number of patients treated with proton therapy, from several dozen proton therapy centers around the world. High equipment and facility costs are often the major obstacle for its wider adoption. Because of the high cost and lack of definite clinical evidence of its superiority, proton therapy treatment faces criticism on its cost-effectiveness. Technological development is causing a gradual lowering of costs, and research and clinical studies are providing further evidence on its clinical utility. PMID:26604838
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Sajnóg, Adam; Hanć, Anetta; Barałkiewicz, Danuta
2018-05-15
Analysis of clinical specimens by imaging techniques allows to determine the content and distribution of trace elements on the surface of the examined sample. In order to obtain reliable results, the developed procedure should be based not only on the properly prepared sample and performed calibration. It is also necessary to carry out all phases of the procedure in accordance with the principles of chemical metrology whose main pillars are the use of validated analytical methods, establishing the traceability of the measurement results and the estimation of the uncertainty. This review paper discusses aspects related to sampling, preparation and analysis of clinical samples by laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) with emphasis on metrological aspects, i.e. selected validation parameters of the analytical method, the traceability of the measurement result and the uncertainty of the result. This work promotes the introduction of metrology principles for chemical measurement with emphasis to the LA-ICP-MS which is the comparative method that requires studious approach to the development of the analytical procedure in order to acquire reliable quantitative results. Copyright © 2018 Elsevier B.V. All rights reserved.
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Peer group reflection helps clinical teachers to critically reflect on their teaching.
Boerboom, Tobias B B; Jaarsma, Debbie; Dolmans, Diana H J M; Scherpbier, Albert J J A; Mastenbroek, Nicole J J M; Van Beukelen, Peter
2011-01-01
Student evaluations can help clinical teachers to reflect on their teaching skills and find ways to improve their teaching. Studies have shown that the mere presentation of student evaluations is not a sufficient incentive for teachers to critically reflect on their teaching. We evaluated and compared the effectiveness of two feedback facilitation strategies that were identical except for a peer reflection meeting. In this study, 54 clinical teachers were randomly assigned to two feedback strategies. In one strategy, a peer reflection was added as an additional step. All teachers completed a questionnaire evaluating the strategy that they had experienced. We analysed the reflection reports and the evaluation questionnaire. Both strategies stimulated teachers to reflect on feedback and formulate alternative actions for their teaching practice. The teachers who had participated in the peer reflection meeting showed deeper critical reflection and more concrete plans to change their teaching. All feedback strategies were considered effective by the majority of the teachers. Strategies with student feedback and self-assessment stimulated reflection on teaching and helped clinical teachers to formulate plans for improvement. A peer reflection meeting seemed to enhance reflection quality. Further research should establish whether it can have lasting effects on teaching quality.
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The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective.
Peña, Adolfo
2010-06-14
The Dreyfus model describes how individuals progress through various levels in their acquisition of skills and subsumes ideas with regard to how individuals learn. Such a model is being accepted almost without debate from physicians to explain the 'acquisition' of clinical skills. This paper reviews such a model, discusses several controversial points, clarifies what kind of knowledge the model is about, and examines its coherence in terms of problem-solving skills. Dreyfus' main idea that intuition is a major aspect of expertise is also discussed in some detail. Relevant scientific evidence from cognitive science, psychology, and neuroscience is reviewed to accomplish these aims. Although the Dreyfus model may partially explain the 'acquisition' of some skills, it is debatable if it can explain the acquisition of clinical skills. The complex nature of clinical problem-solving skills and the rich interplay between the implicit and explicit forms of knowledge must be taken into consideration when we want to explain 'acquisition' of clinical skills. The idea that experts work from intuition, not from reason, should be evaluated carefully.
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Paniccia, Melissa; Paniccia, David; Thomas, Scott; Taha, Tim; Reed, Nick
2017-12-01
Heart rate variability (HRV), a measure of cardiac autonomic nervous system functioning, has emerged as a physiological indicator for emotional regulation and psychological well-being. HRV is understudied in the context of depression and anxiety in young people (10-24years old). Main objectives: (1) describe the nature and breadth of reviewed studies; and (2) synthesize main findings in the context of clinical and non-clinical populations of young people with depression and/or anxiety. The Arksey and O'Malley methodology was utilized for this scoping review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched. Two reviewers screened titles, abstracts and full papers for inclusion. A total of 20 citations were included in the final review (19 citations peer-reviewed journal articles, 1 journal abstract). Numerical and thematic analysis was used to summarize study findings. In clinical populations of either depression or anxiety, HRV was lower compared to controls. In non-clinical populations of either depression or anxiety, HRV was found to be lower in those who reported more depression or anxiety symptoms. The quality of the reviewed articles was not assessed which limits the ability to generate conclusions regarding study findings. Changes in HRV were found across the spectrum of clinical and non-clinical populations of young people with depression or anxiety. Neurophysiological research on depression and anxiety in young people can act as a first step to understanding how physiological flexibility (i.e. HRV) is related to psychological flexibility (i.e. adaptive or maladaptive responses to life events). Copyright © 2017 Elsevier B.V. All rights reserved.
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Runge, Val M
2013-12-01
The last 5 years of technological advances with major impact on clinical magnetic resonance (MR) are discussed, with greater emphasis on those that are most recent. These developments have already had a critical positive effect on clinical diagnosis and therapy and presage continued rapid improvements for the next 5 years. This review begins with a discussion of 2 topics that encompass the breadth of MR, in terms of anatomic applications, contrast media, and MR angiography. Subsequently, innovations are discussed by anatomic category, picking the areas with the greatest development, starting with the brain, moving forward to the liver and kidney, and concluding with the musculoskeletal system, breast, and prostate. Two final topics are then considered, which will likely, with time, become independent major fields in their own right, interventional MR and MR positron emission tomography (PET).The next decade will bring a new generation of MR contrast media, with research focused on substantial improvements (>100-fold) in relaxivity (contrast effect), thus providing greater efficacy, safety, and tissue targeting. Magnetic resonance angiography will see major advances because of the use of compressed sensing, in terms of spatial and temporal resolution, with movement away from nondynamic imaging. The breadth of available techniques and tissue contrast has greatly expanded in brain imaging, benefiting both from the introduction of new basic categories of imaging techniques, such as readout-segmented echo planar imaging and 3D fast spin echo imaging with variable flip angles, and from new refinements specific to anatomic areas, such as double inversion recovery and MP2RAGE. Liver imaging has benefited from the development of techniques to easily and rapidly assess lipid, and will see, overall, a marked improvement in the next 5 years from new techniques on the verge of clinical introduction, such as controlled aliasing in parallel imaging results in higher acceleration
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A critical review of "internet addiction" criteria with suggestions for the future
A.J. van Rooij (Antonius); N. Prause (Nicole)
2014-01-01
textabstractAims: In the last 5 years a deluge of articles on the topic of Internet addiction (IA) has proposed many candidate symptoms as evidence of this proposed disease. We critically reviewed the current approach to the measurement and identification of this new excessive behavior syndrome.
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Timing of the initiation of parenteral nutrition in critically ill children.
Jimenez, Lissette; Mehta, Nilesh M; Duggan, Christopher P
2017-05-01
To review the current literature evaluating clinical outcomes of early and delayed parenteral nutrition initiation among critically ill children. Nutritional management remains an important aspect of care among the critically ill, with enteral nutrition generally preferred. However, inability to advance enteral feeds to caloric goals and contraindications to enteral nutrition often leads to reliance on parenteral nutrition. The timing of parenteral nutrition initiation is varied among critically ill children, and derives from an assessment of nutritional status, energy requirements, and physiologic differences between adults and children, including higher nutrient needs and lower body reserves. A recent randomized control study among critically ill children suggests improved clinical outcomes with avoiding initiation of parenteral nutrition on day 1 of admission to the pediatric ICU. Although there is no consensus on the optimal timing of parenteral nutrition initiation among critically ill children, recent literature does not support the immediate initiation of parenteral nutrition on pediatric ICU admission. A common theme in the reviewed literature highlights the importance of accurate assessment of nutritional status and energy expenditure in deciding when to initiate parenteral nutrition. As with all medical interventions, the initiation of parenteral nutrition should be considered in light of the known benefits of judiciously provided nutritional support with the known risks of artificial, parenteral feeding.
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Addressing Clinical Faculty Need: Creating a Process and Evaluation for Peer Review of Practice
Directory of Open Access Journals (Sweden)
Jean Y. Moon
2014-01-01
Full Text Available Objectives: To describe the evolving process and evaluate the perceived value of peer review for clinical faculty. Methods: Using a 5-point Likert scale, clinical faculty rated the value of an electronic peer review process by completing an electronic 30 item survey across six areas of clinical faculty practice-related activity. Based on feedback, modifications were made and faculty were re-surveyed the following year. Results: Initially, 78% of faculty found peer review to be beneficial, mostly in the area of practice development and portions of practice dissemination. After modifications, 45% found peer review to be beneficial. Conclusions: Clinical faculty are challenged to leverage their practice into teaching and scholarly activities; however, clinical faculty often need feedback to accomplish this. Although the peer review process was designed to address perceived needs of clinical faculty, the process is dynamic and needs further refinement. Overall, clinical faculty find value in a peer review process. This evaluation of peer review illustrates the challenges to provide feedback across six key areas of clinical faculty activity. Type: Original Research
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What is bizarre in bizarre delusions? A critical review
DEFF Research Database (Denmark)
Cermolacce, Michel René Joseph; Jensen, Lars Meldgaard Sass; Parnas, J
2010-01-01
or incomprehensible. Then, we provide a critical review of contemporary studies on the reliability of BD and their methodological and conceptual limitations. Current approaches have focused intensely on BD's reliability and have defined BD strictly in terms of delusional content--mainly in terms of the physical...... to delusional contents alone and requires taking into account the subjective side of BD (how altered experience manifests itself) as well as the conditions of intersubjective encounter (how BD are expressed to and experienced by the clinician). The notion of "bizarreness" in schizophrenia is not purely...
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Energy Technology Data Exchange (ETDEWEB)
Giovacchini, Giampiero; Giovannini, Elisabetta; Leoncini, Rossella; Riondato, Mattia; Ciarmiello, Andrea [S. Andrea Hospital, Nuclear Medicine Department, La Spezia (Italy)
2017-09-15
We here aim to provide a comprehensive and critical review of the literature concerning the clinical applications of positron emission tomography/computed tomography (PET/CT) with radiolabeled choline in patients with prostate cancer (PCa). We will initially briefly summarize the historical context that brought to the synthesis of [{sup 11}C]choline, which occurred exactly 20 years ago. We have arbitrarily grouped the clinical studies in three different periods, according to the year in which they were published and according to their relation with their applications in urology, radiotherapy and oncology. Studies at initial staging and, more extensively, studies in patients with biochemical failure, as well as factors predicting positive PET/CT will be reviewed. The capability of PET/CT with radiolabeled choline to provide prognostic information on PCa-specific survival will also be examined. The last sections will be devoted to the use of radiolabeled choline for monitoring the response to androgen deprivation therapy, radiotherapy, and chemotherapy. The accuracy and the limits of the technique will be discussed according to the information available from standard validation processes, including biopsy or histology. The clinical impact of the technique will be discussed on the basis of changes induced in the management of patients and in the evaluation of the response to therapy. Current indications to PET/CT, as officially endorsed by guidelines, or as routinely performed in the clinical practice will be illustrated. Emphasis will be made on methodological factors that might have influenced the results of the studies or their interpretation. Finally, we will briefly highlight the potential role of positron emission tomography/magnetic resonance and of new radiotracers for PCa imaging. (orig.)
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Hodge, Chad M; Narus, Scott P
2018-05-01
Problem list data is a driving force for many beneficial clinical tools, yet these data remain underutilized. We performed a systematic literature review, pulling insights from previous research, aggregating insights into themes, and distilling themes into actionable advice. We sought to learn what changes we could make to existing applications, to the clinical workflow, and to clinicians' perceptions that would improve problem list utilization and increase the prevalence of problems data in the electronic medical record. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to systematically curate a corpus of pertinent articles. We performed a thematic analysis, looking for interesting excerpts and ideas. By aggregating excerpts from many authors, we gained broader, more inclusive insights into what makes a good problem list and what factors are conducive to its success. Analysis led to a list of 7 benefits of using the problem list, 15 aspects critical to problem list success, and knowledge to help inform policy development, such as consensus on what belongs on the problem list, who should maintain the problem list, and when. A list of suggestions is made on ways in which the problem list can be improved to increase utilization by clinicians. There is also a need for standard measurements of the problem list, so that lists can be measured, compared, and discussed with rigor and a common vocabulary.
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Clinical case in digital technology for nursing students' learning: An integrative review.
Hara, Cristina Yuri Nakata; Aredes, Natália Del Angelo; Fonseca, Luciana Mara Monti; Silveira, Renata Cristina de Campos Pereira; Camargo, Rosangela Andrade Aukar; de Goes, Fernanda Santos Nogueira
2016-03-01
This review aimed to analyze the available evidences in literature about clinical case studies inserted in digital technologies for nursing education, characterizing the technology resources and cognitive, procedural and attitudinal learnings. Integrative review of literature with the following steps: development of the research problem, data collection, data extraction and critic evaluation, data analysis and interpretation and presentation of results. The research question was: how does the clinical case study inserted in educational digital technology collaborate for cognitive, attitudinal and procedural learning of nursing students? data bases LILACS, PUBMED, CINAHL and Scopus. the search resulted in 437 studies: 136 from LILACS, 122 from PUBMED, 104 from Scopus and 75 from CINAHL. Of these, 143 did not meet the including criteria, 93 were duplicated and four studies were unavailable. After analyzing all abstracts based on inclusion and exclusion criteria, there were selected 197 studies and after full text analysis the final sample resulted in 21 primary studies. Case study use in educational digital technologies allowed the students to build different types of learning: cognitive learning (n 16 studies), attitudinal learning (n=12 studies) and procedural learning (n=8 studies). It is possible to conclude that case studies can collaborate with the students to develop different learnings which can be built integrate, continuous, informative and formative, aiming integral formation and aligned to policies of formation in nursing, both national and international. Copyright © 2015 Elsevier Ltd. All rights reserved.
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A systematic review of clinical audit in companion animal veterinary medicine.
Rose, Nicole; Toews, Lorraine; Pang, Daniel S J
2016-02-26
Clinical audit is a quality improvement process with the goal of continuously improving quality of patient care as assessed by explicit criteria. In human medicine clinical audit has become an integral and required component of the standard of care. In contrast, in veterinary medicine there appear to have been a limited number of clinical audits published, indicating that while clinical audit is recognised, its adoption in veterinary medicine is still in its infancy. A systematic review was designed to report and evaluate the veterinary literature on clinical audit in companion animal species (dog, cat, horse). A systematic search of English and French articles using Proquest Dissertations and Theses database (February 6, 2014), CAB Abstracts (March 21, 2014 and April 4, 2014), Scopus (March 21, 2014), Web of Science Citation index (March 21, 2014) and OVID Medline (March 21, 2014) was performed. Included articles were those either discussing clinical audit (such as review articles and editorials) or reporting parts of, or complete, audit cycles. The majority of articles describing clinical audit were reviews. From 89 articles identified, twenty-one articles were included and available for review. Twelve articles were reviews of clinical audit in veterinary medicine, five articles included at least one veterinary clinical audit, one thesis was identified, one report was of a veterinary clinical audit website and two articles reported incomplete clinical audits. There was no indication of an increase in the number of published clinical audits since the first report in 1998. However, there was evidence of article misclassification, with studies fulfilling the criteria of clinical audit not appropriately recognised. Quality of study design and reporting of findings varied considerably, with information missing on key components, including duration of study, changes in practice implemented between audits, development of explicit criteria and appropriate statistical
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Directory of Open Access Journals (Sweden)
Imam Mohamed A.
2017-01-01
Full Text Available Tendon pathologies are a group of musculoskeletal conditions frequently seen in clinical practice. They can be broadly classified into traumatic, degenerative and overuse-related tendinopathies. Rotator cuff tears, Achilles tendinopathy and tennis elbow are common examples of these conditions. Conventional treatments have shown inconsistent outcomes and might fail to provide satisfactory clinical improvement. With the growing trend towards the use of mesenchymal stem cells (MSCs in other branches of medicine, there is an increasing interest in treating tendon pathologies using the bone marrow MSC. In this article, we provide a systematic literature review documenting the current status of the use of bone marrow aspirate concentrate (BMAC for the treatment of tendon pathologies. We also asked the question on the safety of BMAC and whether there are potential complications associated with BMAC therapy. Our hypothesis is that the use of BMAC provides safe clinical benefit when used for the treatment of tendinopathy or as a biological augmentation of tendon repair. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA checklist while preparing this systematic review. A literature search was carried out including the online databases of PubMed, EMBASE, ClinicalTrial.gov and the Cochrane Library from 1960 to the end of May 2015. Relevant studies were selected and critically appraised. Data from eligible studies were extracted and classified per type of tendon pathology. We included 37 articles discussing the application and use of BMAC for the treatment of tendon pathologies. The Critical Appraisal Skills Program (CASP appraisal confirmed a satisfactory standard of 37 studies. Studies were sub-categorised into: techniques of extraction, processing and microscopic examination of BMAC (n = 18, where five studies looked at the evaluation of aspiration techniques (n = 5, augmentation of rotator cuff tears (n = 5
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Harrington, Jennifer; Palmert, Mark R
2012-09-01
Determining the etiology of delayed puberty during initial evaluation can be challenging. Specifically, clinicians often cannot distinguish constitutional delay of growth and puberty (CDGP) from isolated hypogonadotropic hypogonadism (IHH), with definitive diagnosis of IHH awaiting lack of spontaneous puberty by age 18 yr. However, the ability to make a timely, correct diagnosis has important clinical implications. The aim was to describe and evaluate the literature regarding the ability of diagnostic tests to distinguish CDGP from IHH. A PubMed search was performed using key words "puberty, delayed" and "hypogonadotropic hypogonadism," and citations within retrieved articles were reviewed to identify studies that assessed the utility of basal and stimulation tests in the diagnosis of delayed puberty. Emphasis was given to a test's ability to distinguish prepubertal adolescents with CDGP from those with IHH. Basal gonadotropin and GnRH stimulation tests have limited diagnostic specificity, with overlap in gonadotropin levels between adolescents with CDGP and IHH. Stimulation tests using more potent GnRH agonists and/or human chorionic gonadotropin may have better discriminatory value, but small study size, lack of replication of diagnostic thresholds, and prolonged protocols limit clinical application. A single inhibin B level in two recent studies demonstrated good differentiation between groups. Distinguishing IHH from CDGP is an important clinical issue. Basal inhibin B may offer a simple, discriminatory test if results from recent studies are replicated. However, current literature does not allow for recommendation of any diagnostic test for routine clinical use, making this an important area for future investigation.
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Teaching Critical Thinking Skills in Higher Education: A Review of the Literature
Behar-Horenstein, Linda S.; Niu, Lian
2011-01-01
The authors reviewed 42 empirical studies of teaching of critical thinking skills in postsecondary education published between 1994 and 2009. The instructional intervention, test measure, and research design of the studies were analyzed. Study results suggest that: (1) the same instructional interventions can lead to different results, depending…
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Explaining Differences in Age at Autism Spectrum Disorder Diagnosis: A Critical Review
Daniels, Amy M.; Mandell, David S.
2014-01-01
The diagnosis of autism is often delayed, which translates into a missed opportunity to provide treatment during a critical developmental period. This study reviews studies that assessed factors associated with age at autism spectrum disorder diagnosis and provides recommendations on future research, programs, and policies to improve early…
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Plasma-Lyte 148: A clinical review
Weinberg, Laurence; Collins, Neil; Van Mourik, Kiara; Tan, Chong; Bellomo, Rinaldo
2016-01-01
AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine. METHODS We performed an electronic literature search from Medline and PubMed (via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: “surgery”, “anaesthesia”, “anesthesia”, “anesthesiology”, “anaesthesiology”, “fluids”, “fluid therapy”, “crystalloid”, “saline”, “plasma-Lyte”, “plasmalyte”, “hartmann’s”, “ringers” “acetate”, “gluconate”, “malate”, “lactate”. All relevant articles were accessed in full. We summarized the data and reported the data in tables and text. RESULTS We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness, surgery and perioperative medicine. We analyzed the data and reported the results in tables and text. CONCLUSION Plasma-Lyte 148 is an isotonic, buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma. Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes. Further large randomized controlled trials assessing the comparative effectiveness of Plasma-Lyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed. PMID:27896148
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[Ethic review on clinical experiments of medical devices in medical institutions].
Shuai, Wanjun; Chao, Yong; Wang, Ning; Xu, Shining
2011-07-01
Clinical experiments are always used to evaluate the safety and validity of medical devices. The experiments have two types of clinical trying and testing. Ethic review must be done by the ethics committee of the medical department with the qualification of clinical research, and the approval must be made before the experiments. In order to ensure the safety and validity of clinical experiments of medical devices in medical institutions, the contents, process and approval criterions of the ethic review were analyzed and discussed.
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Interventions to reduce cognitive impairments following critical illness
DEFF Research Database (Denmark)
Nedergaard, H K; Jensen, H I; Toft, P
2017-01-01
and sleep quality improvement. Data were synthesized to provide an overview of interventions, quality, follow-up assessments and neuropsychological outcomes. CONCLUSION: None of the interventions had significant positive effects on cognitive impairments following critical illness. Quality was negatively......BACKGROUND: Critical illness is associated with cognitive impairments. Effective treatment or prevention has not been established. The aim of this review was to create a systematic summary of the current evidence concerning clinical interventions during intensive care admission to reduce cognitive...... impairments after discharge. METHODS: Medline, Embase, Cochrane Central, PsycInfo and Cinahl were searched. Inclusion criteria were studies assessing the effect of interventions during intensive care admission on cognitive function in adult patients. Studies were excluded if they were reviews or reported...
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The policy challenges of tradable credits: A critical review of eight markets
International Nuclear Information System (INIS)
Sovacool, Benjamin K.
2011-01-01
This article offers a critical review of eight tradable permit markets: water permits at Fox River, Wisconsin; the U.S. leaded gasoline phase-out; sulfur dioxide credits under the U.S. Clean Air Act Amendments of 1990; the Regional Clean Air Incentives Market (RECLAIM) for controlling ozone and acid rain in Southern California; renewable energy credit trading at the regional level in the United States; individual transferrable quotas for fisheries at the national level in New Zealand; carbon credits traded under the European Union-Emissions Trading Scheme; and carbon offsets permitted under the Clean Development Mechanism of the Kyoto Protocol. By 'critical' the article does not fully weigh the costs and benefits of each tradable credit scheme and instead identifies key challenges and problems. By 'review' the author relied exclusively on secondary data from an interdisciplinary review of the academic literature. Rather than performing as economic theory suggests, the article shows that in many cases credit markets are prone to compromises in program design, transaction costs, price volatility, leakage, and environmental degradation. The article concludes by discussing the implications of these problems for those seeking to design more equitable and effective public policies addressing environmental degradation and climate change. - Research Highlights: →This study reviews eight tradable credit markets. →It finds that markets are prone to common problems. →It concludes that tradable permit markets are political instruments as much as they are economic ones.
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Social science research of HIV in Vietnam: A critical review and future directions
Dao, Amy; Hirsch, Jennifer; Giang, Le Minh; Parker, Richard G.
2013-01-01
Social science research, with theoretical and methodological tools that are well suited to capture the complexities of Vietnam’s rapidly changing social and political context, could contribute important insights that would enhance the response to Vietnam’s growing HIV epidemic. The present paper reviews the published, peer-reviewed English-language social science literature on HIV in Vietnam in order to identify critical theoretical and substantive gaps and lay the groundwork for future resea...
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Bidwell, Jonathan; Khuwatsamrit, Thanin; Askew, Brittain; Ehrenberg, Joshua Andrew; Helmers, Sandra
2015-11-01
This review surveys current seizure detection and classification technologies as they relate to aiding clinical decision-making during epilepsy treatment. Interviews and data collected from neurologists and a literature review highlighted a strong need for better distinguishing between patients exhibiting generalized and partial seizure types as well as achieving more accurate seizure counts. This information is critical for enabling neurologists to select the correct class of antiepileptic drugs (AED) for their patients and evaluating AED efficiency during long-term treatment. In our questionnaire, 100% of neurologists reported they would like to have video from patients prior to selecting an AED during an initial consultation. Presently, only 30% have access to video. In our technology review we identified that only a subset of available technologies surpassed patient self-reporting performance due to high false positive rates. Inertial seizure detection devices coupled with video capture for recording seizures at night could stand to address collecting seizure counts that are more accurate than current patient self-reporting during day and night time use. Copyright © 2015. Published by Elsevier Ltd.
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Heat adaptation of bioabsorbable craniofacial plates: a critical review of science and technology.
Pietrzak, William S
2009-11-01
Bioabsorbable fixation plates often require adaptation to the bone. This is typically accomplished by heating the plates to above the glass transition temperature and placing the softened plates against the bone or a prebent template until cool. Upon cooling, the plates regain stiffness and can be attached to bone to obtain anatomic fixation. This procedure is both efficient and effective and has been used throughout the craniofacial skeleton. There are many types of equipment available to heat the plates, each with advantages and disadvantages. Although a conceptually simple process, there are several nuances that have been reported in the literature, including transient effects on plate mechanical properties, memory effects, differences between wet and dry heating, and others. Upon the backdrop of the overwhelming clinical success of heat adaptation, this review critically evaluates the method and provides a comprehensive examination and explanation of the basic science and technology involved. This should help give surgeons a better understanding of the process that can help improve their use and further advance the technology.
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A critical review of simulation-based medical education research: 2003-2009.
McGaghie, William C; Issenberg, S Barry; Petrusa, Emil R; Scalese, Ross J
2010-01-01
This article reviews and critically evaluates historical and contemporary research on simulation-based medical education (SBME). It also presents and discusses 12 features and best practices of SBME that teachers should know in order to use medical simulation technology to maximum educational benefit. This qualitative synthesis of SBME research and scholarship was carried out in two stages. Firstly, we summarised the results of three SBME research reviews covering the years 1969-2003. Secondly, we performed a selective, critical review of SBME research and scholarship published during 2003-2009. The historical and contemporary research synthesis is reported to inform the medical education community about 12 features and best practices of SBME: (i) feedback; (ii) deliberate practice; (iii) curriculum integration; (iv) outcome measurement; (v) simulation fidelity; (vi) skill acquisition and maintenance; (vii) mastery learning; (viii) transfer to practice; (ix) team training; (x) high-stakes testing; (xi) instructor training, and (xii) educational and professional context. Each of these is discussed in the light of available evidence. The scientific quality of contemporary SBME research is much improved compared with the historical record. Development of and research into SBME have grown and matured over the past 40 years on substantive and methodological grounds. We believe the impact and educational utility of SBME are likely to increase in the future. More thematic programmes of research are needed. Simulation-based medical education is a complex service intervention that needs to be planned and practised with attention to organisational contexts.
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Major publications in the critical care pharmacotherapy literature: January-December 2017.
Hammond, Drayton A; Baumgartner, Laura; Cooper, Craig; Donahey, Elisabeth; Harris, Serena A; Mercer, Jessica M; Morris, Mandy; Patel, Mona K; Plewa-Rusiecki, Angela M; Poore, Alia A; Szaniawski, Ryan; Horner, Deanna
2018-06-01
To summarize selected meta-analyses and trials related to critical care pharmacotherapy published in 2017. The Critical Care Pharmacotherapy Literature Update (CCPLU) Group screened 32 journals monthly for impactful articles and reviewed 115 during 2017. Two meta-analyses and eight original research trials were reviewed here from those included in the monthly CCPLU. Meta-analyses on early, goal-directed therapy for septic shock and statin therapy for acute respiratory distress syndrome were summarized. Original research trials that were included evaluate thrombolytic therapy in severe stroke, hyperoxia and hypertonic saline in septic shock, intraoperative ketamine for prevention of post-operative delirium, intravenous ketorolac dosing regimens for acute pain, angiotensin II for vasodilatory shock, dabigatran reversal with idarucizumab, bivalirudin versus heparin monotherapy for myocardial infarction, and balanced crystalloids versus saline fluid resuscitation. This clinical review provides perspectives on impactful critical care pharmacotherapy publications in 2017. Copyright © 2018 Elsevier Inc. All rights reserved.
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School effectiveness research: a review of criticisms and some proposals to address them.
Directory of Open Access Journals (Sweden)
Andres Sandoval-Hernandez
2008-03-01
Full Text Available Based on Lakato’s notion of research programmes, the paper analyses the structure of the School Effectiveness Research (SER programme and reviews the main criticisms that have arisen, stressing those regarding its objectivity and theoretical limitations. Then, some proposals are made to address these criticisms, namely: to adopt a critical realist approach to the study of SE and an Abductive Theory of Scientific Method that lead to the development of sound theory in the field. Based on this analysis the paper concludes that, in terms of Lakatos, a movement towards a new research programme is needed in order to ensure that the main objectives originally set for SER can be eventually reached.
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Spoelstra, Symen K.; Borg, Charmaine; Schultz, Willibrord C. M. Weijmar
Anticonvulsant therapy has occasionally been recommended to treat vulvodynia. However, convincing evidence to support this therapeutic option is lacking. The goal of this study was to critically review studies published on the effectiveness of anticonvulsants for the treatment of vulvodynia.
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Developing and understanding biofluid vibrational spectroscopy: a critical review.
Baker, Matthew J; Hussain, Shawn R; Lovergne, Lila; Untereiner, Valérie; Hughes, Caryn; Lukaszewski, Roman A; Thiéfin, Gérard; Sockalingum, Ganesh D
2016-04-07
Vibrational spectroscopy can provide rapid, label-free, and objective analysis for the clinical domain. Spectroscopic analysis of biofluids such as blood components (e.g. serum and plasma) and others in the proximity of the diseased tissue or cell (e.g. bile, urine, and sputum) offers non-invasive diagnostic/monitoring possibilities for future healthcare that are capable of rapid diagnosis of diseases via specific spectral markers or signatures. Biofluids offer an ideal diagnostic medium due to their ease and low cost of collection and daily use in clinical biology. Due to the low risk and invasiveness of their collection they are widely welcomed by patients as a diagnostic medium. This review underscores recent research within the field of biofluid spectroscopy and its use in myriad pathologies such as cancer and infectious diseases. It highlights current progresses, advents, and pitfalls within the field and discusses future spectroscopic clinical potentials for diagnostics. The requirements and issues surrounding clinical translation are also considered.
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Public titles of clinical trials should have ethics review.
Saenz, Carla; Reveiz, Ludovic; Tisdale, John F
2015-09-01
A key aspect to guarantee that research with human subjects is ethical is being overlooked. Ethics review committees invest great effort examining the informed consent documents of research protocols to ensure that potential participants can provide consent validly and are not deluded into thinking that the experimental intervention they may sign up for is already known to be therapeutic. However, these efforts to avoid what is called the "therapeutic misconception" might be in vain if the title with which the studies are being introduced to the potential participants escapes ethics review. Research participants might be deceived by clinical trials entitled "novel therapy" when the point of the trial is precisely to find out whether the intervention at stake is therapeutic or not. Providing potential research participants with such misleading information hampers their ability to make informed decisions. The well-established scrutiny that ethics review committees exercise with regard to consent forms is limited if the registration of clinical trials, for which a public title is chosen, constitutes a process that is independent from the ethics review. In this article, we examine this problem, assess recent measures to integrate clinical trial registration with ethics review processes, and provide specific recommendations to solve the problem and ultimately enhance the accountability, transparency, and ethics of research with human subjects. Copyright © 2015 Pan American Health Organization. Published by Elsevier Inc. All rights reserved.
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Photodesorption: a critical review
International Nuclear Information System (INIS)
Lichtman, D.; Shapira, Y.
1975-01-01
A critical review of the literature in the field of photodesorption is presented. Material is covered through December 1975. Although it is impossible to include every paper ever published which is in some way related to photodesorption, it is felt that the material covered is sufficiently complete to permit reasonable conclusions to be reached. The literature naturally falls into two basic categories, namely, papers involved with metal substrates and those involved with semiconductor substrates. Since the effects on these two kinds of surfaces are very different, they are each considered in separate sections. Photodesorption from metals seems to be an extremely inefficient process if it occurs at all. That is, cross sections are equal to or less than 10 -23 cm 2 . The reason for this extremely low cross section is not yet well understood. Photodesorption from semiconductors seems to be a very efficient process with cross sections as high as 10 -17 cm 2 . On most substrates studied, e.g. ZnO, TiO 2 , CdS, the chrome oxide surface of stainless steel, etc., impurity carbon atoms play a very significant role. On all these materials, the single or dominant process involves chemisorption of molecular oxygen onto the impurity carbon surface atoms. Electrons are captured from the conduction band to produce a chemisorbed CO 2 - complex. The application of band gap and higher energy radiation produces electron-hole pairs. Some of the photogenerated holes migrate to the surface where they combine with the negative ion complex. The resulting physisorbed CO 2 is then thermally desorbed
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Epidemiologic and clinical updates on impulse control disorders: a critical review
Altamura, A. Carlo; Allen, Andrea; Marazziti, Donatella; Hollander, Eric
2006-01-01
The article reviews the current knowledge about the impulse control disorders (ICDs) with specific emphasis on epidemiological and pharmacological advances. In addition to the traditional ICDs present in the DSM-IV—pathological gambling, trichotillomania, kleptomania, pyromania and intermittent explosive disorder—a brief description of the new proposed ICDs—compulsive–impulsive (C–I) Internet usage disorder, C–I sexual behaviors, C–I skin picking and C–I shopping—is provided. Specifically, the article summarizes the phenomenology, epidemiology and comorbidity of the ICDs. Particular attention is paid to the relationship between ICDs and obsessive–compulsive disorder (OCD). Finally, current pharmacological options for treating ICDs are presented and discussed. PMID:16960655
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Informed consent for clinical trials: a review | Lema | East African ...
African Journals Online (AJOL)
Data sources: Published original research findings and reviews in the English literature, together with anecdotal information from our current professional experiences with clinical trials. Design: Review of peer-reviewed articles. Data extraction: Online searches were done and requests for reprints from corresponding ...
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Clinical Research Nursing: A Critical Resource in the National Research Enterprise
Hastings, Clare E.; Fisher, Cheryl A.; McCabe, Margaret A.
2012-01-01
Translational clinical research has emerged as an important priority for the national research enterprise, with a clearly stated mandate to deliver prevention strategies, treatments and cures based on scientific innovations faster to the public. Within this national effort, a lack of consensus persists concerning the need for clinical nurses with expertise and specialized training in study implementation and the delivery of care to research participants. This paper reviews efforts to define and document the role of practicing nurses in implementing studies and coordinating clinical research in a variety of clinical settings and differentiates this clinical role from the role of nurses as scientists and principal investigators. We propose an agenda for building evidence that having nurses provide and coordinate study treatments and procedures can potentially improve research efficiency, participant safety, and the quality of research data. We also provide recommendations for the development of the emerging specialty of clinical research nursing. PMID:22172370
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A Critical Review on the Concept of Social Technology
Directory of Open Access Journals (Sweden)
Bettina Leibetseder
2013-08-01
Full Text Available Purpose—A critical analysis of the term social technology from a social science point of view.Design/Methodology/Approach—Review of the term “social technology” from a social science point of perspective in connection to the study of governmentality and power in a Foucauldian way.Findings—The article covers the perspective that social technology provides social science knowledge for a purpose. Such a notion allows an in depth debate about the meaning of social order in modern societies. Establishing distinctive techniques now forms the basis of the modern state and governance. Social technology forms the basis of governmental decisions; it allows for a use of social theories and methods for a purpose in politics and introduces a specific conception of power between the individual and public powers. Therefore, it alters government in three ways: It provides expert power to define solutions for social problems based on social science knowledge. It transforms government. Social technology exemplifies a support system for an ordered method of the way of government, it allows for the conduct of others and self based on scientific expertise. It can define new areas of problems in need of a change of government.Research limitations/implications—Consequently, social technology requests a critical analysis using a governmental approach. Such an approach focuses on problems on the governed subject and how governing works and why it has evolved in that way towards the subject and what kind of ideas and thinking lies within the discourse.Research type—general review.
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Energy Requirements in Critically Ill Patients
2018-01-01
During the management of critical illness, optimal nutritional support is an important key for achieving positive clinical outcomes. Compared to healthy people, critically ill patients have higher energy expenditure, thereby their energy requirements and risk of malnutrition being increased. Assessing individual nutritional requirement is essential for a successful nutritional support, including the adequate energy supply. Methods to assess energy requirements include indirect calorimetry (IC) which is considered as a reference method, and the predictive equations which are commonly used due to the difficulty of using IC in certain conditions. In this study, a literature review was conducted on the energy metabolic changes in critically ill patients, and the implications for the estimation of energy requirements in this population. In addition, the issue of optimal caloric goal during nutrition support is discussed, as well as the accuracy of selected resting energy expenditure predictive equations, commonly used in critically ill patients.
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Energy Requirements in Critically Ill Patients.
Ndahimana, Didace; Kim, Eun-Kyung
2018-04-01
During the management of critical illness, optimal nutritional support is an important key for achieving positive clinical outcomes. Compared to healthy people, critically ill patients have higher energy expenditure, thereby their energy requirements and risk of malnutrition being increased. Assessing individual nutritional requirement is essential for a successful nutritional support, including the adequate energy supply. Methods to assess energy requirements include indirect calorimetry (IC) which is considered as a reference method, and the predictive equations which are commonly used due to the difficulty of using IC in certain conditions. In this study, a literature review was conducted on the energy metabolic changes in critically ill patients, and the implications for the estimation of energy requirements in this population. In addition, the issue of optimal caloric goal during nutrition support is discussed, as well as the accuracy of selected resting energy expenditure predictive equations, commonly used in critically ill patients.
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Pain research in complementary and alternative medicine in Australia: a critical review.
Zheng, Zhen; Xue, Charlie C L
2013-02-01
Sixty percent (60%) to 80% of patients who visit chiropractic, osteopathic, or Chinese medicine practitioners are seeking pain relief. This article aimed to identify the amount, quality, and type of complementary and alternative medicine (CAM) pain research in Australia by systematically and critically reviewing the literature. PubMed, Scopus, Australasian Medical Index, and Cochrane library were searched from their inception to July 2009. Australian and New Zealand Clinical Trial Registration and National Health and Medical Research Council databases were searched for human studies yet to be completed. Predefined search terms and selection criteria were used for data identification. Of 204 studies selected, 54% were on chiropractic, 27% on Chinese medicine, 15% about multitherapy, and 4% on osteopathy. Chronic spinal pain was the most studied condition, with visceral pain being the least studied. Half of the articles in Chinese medicine or multitherapy were systematic reviews or randomized control trials. In comparison, only 5% of chiropractic and none of osteopathy studies were in these categories. Government funding was rare, and most studies were self-funded or internally funded. All chiropractic, osteopathic, and Chinese herbal medicine studies were conducted by the researchers of the professions. In contrast, half of the acupuncture studies and all t'ai chi studies were conducted by medical doctors or physiotherapists. Multidisciplinary collaboration was uncommon. The quantity and the quality of CAM pain research in Australia are inconsistent with the high utilization of the relevant CAM therapies by Australians. A substantial increase in government funding is required. Collaborative research examining the multimodality or multidisciplinary approach is needed.
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Clinical review: Percutaneous dilatational tracheostomy
Al-Ansari, Mariam A; Hijazi, Mohammed H
2006-01-01
As the number of critically ill patients requiring tracheotomy for prolonged ventilation has increased, the demand for a procedural alternative to the surgical tracheostomy (ST) has also emerged. Since its introduction, percutaneous dilatational tracheostomies (PDT) have gained increasing popularity. The most commonly cited advantages are the ease of the familiar technique and the ability to perform the procedure at the bedside. It is now considered a viable alternative to (ST) in the intensive care unit. Evaluation of PDT procedural modifications will require evaluation in randomized clinical trials. Regardless of the PDT technique, meticulous preoperative and postoperative management are necessary to maintain the excellent safety record of PDT. PMID:16356203
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Use of Social Desirability Scales in Clinical Psychology: A Systematic Review.
Perinelli, Enrico; Gremigni, Paola
2016-06-01
There is still an open debate about the utility of social desirability indicators. This report systematically reviewed the use of social desirability scales in studies addressing social desirability in clinical psychology. A systematic review (January 2010-March 2015) was conducted, including 35 studies meeting the inclusion criteria of being published in peer-reviewed journals and describing quantitative findings about an association of social desirability with clinical psychology variables using a cross-sectional or longitudinal design. Social desirability was associated with self-reports of various clinical-psychological dimensions. Most of the included studies treated social desirability as a 1-dimensional variable and only 10 of 35 disentangled the impression management and self-deception components. Although theoretical literature does not consider social desirability a mere response bias, only 4 of the reviewed articles controlled for the possible suppressor effect of personality variables on social desirability, while the majority focused upon the stylistic (response bias) rather than the substantive (personality) nature of this construct. The present review highlighted some limitations in the use of social desirability scales in recent clinical psychology research and tried to offer a few suggestions for handling this issue. © 2016 Wiley Periodicals, Inc.
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Pope, Megan A; Malla, Ashok K; Iyer, Srividya N
2018-05-01
Individuals with mental health problems have many support needs that are often inadequately met; however, perceptions of who should be responsible for meeting these needs have been largely unexplored. Varying perceptions may influence whether, how, and to what extent relevant stakeholders support individuals with mental health problems. To critically evaluate the literature to determine who different stakeholders believe should be responsible for supporting individuals with mental health problems, what factors shape these perceptions, and how they relate to one another. A critical literature review was undertaken. Following an extensive literature search, the conceptual contributions of relevant works were critically evaluated. A concept map was created to build a conceptual framework of the topic. Views of individual versus societal responsibility for need provision and health; the morality of caring; and attributions of responsibility for mental illness offered valuable understandings of the review questions. Creating a concept map revealed that various interrelated factors may influence perceptions of responsibility. Varying perceptions of who should be responsible for supporting individuals with mental health problems may contribute to unmet support needs among this group. Our critical review helps build a much-needed conceptual framework of factors influencing perceptions of responsibility. Such a framework is essential as these views iteratively shape and reflect the complex divisions of mental healthcare roles and responsibilities. Understanding these perceptions can help define relevant stakeholders' roles more clearly, which can improve mental health services and strengthen stakeholder accountability.
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Clinical profile and outcome of critically ill pregnant females with H1N1 influenza
Directory of Open Access Journals (Sweden)
Minal Shastri
2016-12-01
Full Text Available Background Record based review of the 2009 H1N1 Influenza pandemic suggests that pregnant women are at higher risk for hospitalization and death due to H1N1 Influenza. Aims To study the clinical profile and outcome of critically ill pregnant females admitted in intensive care unit (ICU with real-time recombinant polymerase chain reaction (rRT-PCR proven positive H1N1 cases. Methods A retrospective record-review based study was conducted at Sir SayajiRao General Hospital (SSGH and Medical College, Vadodara on data of confirmed rRT-PCR H1N1 pregnant females admitted during the pandemics of 2010and 2015. Demographics, clinical profile and laboratory investigations were recorded and outcomes (survived or expired were analysed. Results There were a total of 20 H1N1 positive pregnant females requiring ICU admission. With equal demographic distribution among rural and urban population, cough and fever were the most common presenting complaints. 65 per cent were in third trimester, the subgroup which also had the highest mortality. Mean days from onset until presentation was 5.05 days. 12 (60 per cent patients’ required invasive mode of ventilation and all died. Average hospital stay was 7 days. Foetus had favourable outcome in patients who recovered from H1N1 acute illness. Conclusion Pregnant females in our study had 60 per cent mortality. Thus, awareness, early diagnosis and treatment should be provided to them. Guidelines, policy changes and government protocols are required specifically for pregnant females with H1N1 Influenza A infection. Our study was an observational study and comparisons with non-pregnant females were not done, conclusions applicable to entire pregnant population was not derived.
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White Hughto, Jaclyn M.; Reisner, Sari L.; Pachankis, John E.
2015-01-01
Rationale Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. Objective This critical review aims to integrate the literature on stigma towards transgender people in the US. Results This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. Conclusion Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted. PMID:26599625
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Clinical Ethics Support for Healthcare Personnel: An Integrative Literature Review.
Rasoal, Dara; Skovdahl, Kirsti; Gifford, Mervyn; Kihlgren, Annica
2017-12-01
This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different countries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a "bottom-up" perspective might give healthcare personnel opportunities to think and reflect more than a "top-down" perspective. A "bottom-up" approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a "top-down" approach risks removing such moral responsibility.
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International Nuclear Information System (INIS)
Watanabe, Norio; Tamaki, Hitoshi
2000-04-01
On September 30, 1999, a criticality accident occurred at the Tokai-mura uranium processing plant operated by JCO Co., Ltd., which resulted in the first nuclear accident involving a fatality, in Japan, and forced the residents in the vicinity of the site to be evacuated and be sheltered indoors. There have now been 21 criticality accidents reported in nuclear fuel processing facilities in foreign countries: seven in the United States, one in the United Kingdom and thirteen in Russia. Most of them occurred during the period from mid-1950's to mid-1960's, but one criticality accident tool place in Russian in 1997. This report reviews and compiles the published information on these accidents, including the latest information, focusing on the event sequence, the consequence of accident, and the cause of accident. The observations from the reviews are summarized as follows: Twenty of the 21 accidents occurred with the fissile material in a liquid. Twenty of the 21 accidents occurred in vessels/tanks with unfavorable geometry but one occurred in the vessel with favorable geometry. There were seven fatalities that were involved in five accidents. Three accidents involved a re-criticality condition caused by inadequate operator actions and two of them led to the death of the operators. One accident reached a re-criticality condition several hours after the first excursion was terminated by injecting borated water into the affected vessel. This accident implies the possibility that the borated water injection might not be effective to the criticality termination due to solubility of boric acid. Mechanisms of the criticality termination vary as follows: ejection or splashing of the solution at the time of power excursion, boiling or evaporation, addition of neutron poisons, or manual draining of solutions. (author)
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Energy Technology Data Exchange (ETDEWEB)
Watanabe, Norio [Planning and Analysis Division, Nuclear Safety Research Center, Tokai Research Establishment, Japan Atomic Energy Research Institute, Tokai, Ibaraki (Japan); Tamaki, Hitoshi [Department of Safety Research Technical Support, Tokai Research Establishment, Japan Atomic Energy Research Institute, Tokai, Ibaraki (Japan)
2000-04-01
On September 30, 1999, a criticality accident occurred at the Tokai-mura uranium processing plant operated by JCO Co., Ltd., which resulted in the first nuclear accident involving a fatality, in Japan, and forced the residents in the vicinity of the site to be evacuated and be sheltered indoors. There have now been 21 criticality accidents reported in nuclear fuel processing facilities in foreign countries: seven in the United States, one in the United Kingdom and thirteen in Russia. Most of them occurred during the period from mid-1950's to mid-1960's, but one criticality accident tool place in Russian in 1997. This report reviews and compiles the published information on these accidents, including the latest information, focusing on the event sequence, the consequence of accident, and the cause of accident. The observations from the reviews are summarized as follows: Twenty of the 21 accidents occurred with the fissile material in a liquid. Twenty of the 21 accidents occurred in vessels/tanks with unfavorable geometry but one occurred in the vessel with favorable geometry. There were seven fatalities that were involved in five accidents. Three accidents involved a re-criticality condition caused by inadequate operator actions and two of them led to the death of the operators. One accident reached a re-criticality condition several hours after the first excursion was terminated by injecting borated water into the affected vessel. This accident implies the possibility that the borated water injection might not be effective to the criticality termination due to solubility of boric acid. Mechanisms of the criticality termination vary as follows: ejection or splashing of the solution at the time of power excursion, boiling or evaporation, addition of neutron poisons, or manual draining of solutions. (author)
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A systematic review of systematic reviews of homeopathy
Ernst, E
2002-01-01
Homeopathy remains one of the most controversial subjects in therapeutics. This article is an attempt to clarify its effectiveness based on recent systematic reviews. Electronic databases were searched for systematic reviews/meta-analysis on the subject. Seventeen articles fulfilled the inclusion/exclusion criteria. Six of them related to re-analyses of one landmark meta-analysis. Collectively they implied that the overall positive result of this meta-analysis is not supported by a critical analysis of the data. Eleven independent systematic reviews were located. Collectively they failed to provide strong evidence in favour of homeopathy. In particular, there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo. It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice. PMID:12492603
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Fregni, F; Nitsche, MA; Loo, C.K.; Brunoni, AR; Marangolo, P; Leite, J; Carvalho, S; Bolognini, N; Caumo, W; Paik, NJ; Simis, M; Ueda, K; Ekhitari, H; Luu, P; Tucker, DM; Tyler, WJ; Brunelin, J; Datta, A; Juan, CH; Venkatasubramanian, G; Boggio, PS; Bikson, M
2014-01-01
The field of transcranial electrical stimulation (tES) has experienced significant growth in the past 15 years. One of the tES techniques leading this increased interest is transcranial direct current stimulation (tDCS). Significant research efforts have been devoted to determining the clinical potential of tDCS in humans. Despite the promising results obtained with tDCS in basic and clinical neuroscience, further progress has been impeded by a lack of clarity on international regulatory pathways. We therefore convened a group of research and clinician experts on tDCS to review the research and clinical use of tDCS. In this report, we review the regulatory status of tDCS, and we summarize the results according to research, off-label and compassionate use of tDCS in the following countries: Australia, Brazil, France, Germany, India, Iran, Italy, Portugal, South Korea, Taiwan and United States. Research use, off label treatment and compassionate use of tDCS are employed in most of the countries reviewed in this study. It is critical that a global or local effort is organized to pursue definite evidence to either approve and regulate or restrict the use of tDCS in clinical practice on the basis of adequate randomized controlled treatment trials. PMID:25983531
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A Year of Progress: NASA's Space Launch System Approaches Critical Design Review
Askins, Bruce; Robinson, Kimberly
2015-01-01
NASA's Space Launch System (SLS) made significant progress on the manufacturing floor and on the test stand in 2014 and positioned itself for a successful Critical Design Review in mid-2015. SLS, the world's only exploration-class heavy lift rocket, has the capability to dramatically increase the mass and volume of human and robotic exploration. Additionally, it will decrease overall mission risk, increase safety, and simplify ground and mission operations - all significant considerations for crewed missions and unique high-value national payloads. Development now is focused on configuration with 70 metric tons (t) of payload to low Earth orbit (LEO), more than double the payload of the retired Space Shuttle program or current operational vehicles. This "Block 1" design will launch NASA's Orion Multi-Purpose Crew Vehicle (MPCV) on an uncrewed flight beyond the Moon and back and the first crewed flight around the Moon. The current design has a direct evolutionary path to a vehicle with a 130t lift capability that offers even more flexibility to reduce planetary trip times, simplify payload design cycles, and provide new capabilities such as planetary sample returns. Every major element of SLS has successfully completed its Critical Design Review and now has hardware in production or testing. In fact, the SLS MPCV-to-Stage-Adapter (MSA) flew successfully on the Exploration Flight Test (EFT) 1 launch of a Delta IV and Orion spacecraft in December 2014. The SLS Program is currently working toward vehicle Critical Design Review in mid-2015. This paper will discuss these and other technical and programmatic successes and challenges over the past year and provide a preview of work ahead before the first flight of this new capability.
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A critical review of classical bouncing cosmologies
Energy Technology Data Exchange (ETDEWEB)
Battefeld, Diana, E-mail: dbattefe@astro.physik.uni-goettingen.de [Institut for Astrophysics, University of Goettingen, Friedrich-Hund Platz 1, D-37077 (Germany); Peter, Patrick, E-mail: peter@iap.fr [Institut d’Astrophysique de Paris, UMR 7095-CNRS, Université Pierre et Marie Curie, 98 bis boulevard Arago, 75014 Paris (France)
2015-04-01
Given the proliferation of bouncing models in recent years, we gather and critically assess these proposals in a comprehensive review. The PLANCK data shows an unmistakably red, quasi scale-invariant, purely adiabatic primordial power spectrum and no primary non-Gaussianities. While these observations are consistent with inflationary predictions, bouncing cosmologies aspire to provide an alternative framework to explain them. Such models face many problems, both of the purely theoretical kind, such as the necessity of violating the NEC and instabilities, and at the cosmological application level, as exemplified by the possible presence of shear. We provide a pedagogical introduction to these problems and also assess the fitness of different proposals with respect to the data. For example, many models predict a slightly blue spectrum and must be fine-tuned to generate a red spectral index; as a side effect, large non-Gaussianities often result. We highlight several promising attempts to violate the NEC without introducing dangerous instabilities at the classical and/or quantum level. If primordial gravitational waves are observed, certain bouncing cosmologies, such as the cyclic scenario, are in trouble, while others remain valid. We conclude that, while most bouncing cosmologies are far from providing an alternative to the inflationary paradigm, a handful of interesting proposals have surfaced, which warrant further research. The constraints and lessons learned as laid out in this review might guide future research.
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Historical and Critical Review on Biophysical Economics
Adigüzel, Yekbun
2016-07-01
Biophysical economics is initiated with the long history of the relation of economics with ecological basis and biophysical perspectives of the physiocrats. It inherently has social, economic, biological, environmental, natural, physical, and scientific grounds. Biological entities in economy like the resources, consumers, populations, and parts of production systems, etc. could all be dealt by biophysical economics. Considering this wide scope, current work is a “biophysical economics at a glance” rather than a comprehensive review of the full range of topics that may just be adequately covered in a book-length work. However, the sense of its wide range of applications is aimed to be provided to the reader in this work. Here, modern approaches and biophysical growth theory are presented after the long history and an overview of the concepts in biophysical economics. Examples of the recent studies are provided at the end with discussions. This review is also related to the work by Cleveland, “Biophysical Economics: From Physiocracy to Ecological Economics and Industrial Ecology” [C. J. Cleveland, in Advances in Bioeconomics and Sustainability: Essay in Honor of Nicholas Gerogescu-Roegen, eds. J. Gowdy and K. Mayumi (Edward Elgar Publishing, Cheltenham, England, 1999), pp. 125-154.]. Relevant parts include critics and comments on the presented concepts in a parallelized fashion with the Cleveland’s work.
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Impact of stress on dentists' clinical performance. A systematic review.
Plessas, A; Delgado, M B; Nasser, M; Hanoch, Y; Moles, D R
2018-03-01
Dentistry is recognised as a stressful profession and dentists perceive their profession to be more stressful than other healthcare professions. While earlier studies have shown a link between stress and well-being among dentists, whether stress negatively impacts their clinical performance is an important and open question. We do know, however, that stress is associated with reduced performance in other health (and non-health) related professions. This systematic review aimed to answer the question: how does stress impact on dentists' clinical performance? This systematic review was registered in PROSPERO (CRD42016045756). The CINHAL, Embase, Medline, PsycINFO, EThOS and OpenGrey electronic databases were searched according to PRISMA guidelines. Two reviewers independently screened the citations for relevance. The citation list of potentially eligible papers was also searched. Prospective empirical studies were considered for inclusion. The inclusion criteria were applied at the full-text stage by the two same reviewers independently. The search yielded 3535 titles and abstracts. Twelve publications were considered potentially eligible, eleven of which were excluded as they did not meet the predefined inclusion criteria. This systematic review identified a gap in the literature as it found no empirical evidence quantifying the impact of stress on dentists' clinical performance. Prospective well-designed experimental simulation studies, comparing stress with non-stress situations on clinical performance and decision making, as well studies evaluating prospectively real-life dentists' performance under stress are warranted. Copyright© 2018 Dennis Barber Ltd.
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Not the Sum of Its Parts: A Critical Review of the MacDonald Triad.
Parfitt, Charlotte Hannah; Alleyne, Emma
2018-01-01
The MacDonald triad posits that animal cruelty, fire setting, and bed wetting in childhood is indicative of later aggressive and violent behavior in adults. Researchers refer to this phenomenon as a precursor to later antisocial behaviors including serial and sexual murder; while practitioners cite the triad in clinical formulations and risk assessments. However, there is yet to be a critical review and consolidation of the literature that establishes whether there is empirical support. This article explores the validity of the triad. We conducted a narrative review of the relevant studies examining the MacDonald triad and its individual constituents. There is evidence that any one of the triad behaviors could predict future violent offending, but it is very rare to find all three behaviors together as predictors. Thus, the empirical research on the MacDonald triad does not fully substantiate its premise. Rather, it would appear that the triad, or its individual constituents, is better used as an indicator of dysfunctional home environments, or poor coping skills in children. Future research is needed with robust and rigorous methodologies (e.g., adequate control groups, longitudinal designs) to fully establish the MacDonald triad's validity. Finally, further consideration is needed as to whether the triad behaviors are more indicative of other problematic outcomes (e.g., maladaptive coping to life stressors).
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Teamwork in obstetric critical care.
Guise, Jeanne-Marie; Segel, Sally
2008-10-01
Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well trained and competent medically, they have not traditionally been trained in how to work well as part of a team. Given the complexity and acuity of critical care medicine, which often relies on more than one medical team, teamwork skills are essential. This chapter discusses the history and importance of teamwork in high-reliability fields, reviews key concepts and skills in teamwork, and discusses approaches to training and working in teams.
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Clinical review: Management of difficult airways
Langeron, Olivier; Amour, Julien; Vivien, Benoît; Aubrun, Frédéric
2006-01-01
Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainly at induction of anesthesia. Nevertheless, claim reports emphasize that airway emergencies, tracheal extubation and/or recovery of anesthesia phases are still associated with death or brain damage, indicating that additional educational support and management strategies to improve patient safety are required. The present brief review analyses specific problems of airway management related to difficult tracheal intubation and to difficult mask ventilation prediction. The review will focus on basic airway management including preoxygenation, and on some oxygenation and tracheal intubation techniques that may be performed to solve a difficult airway. PMID:17184555
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Clinical review: management of difficult airways.
Langeron, Olivier; Amour, Julien; Vivien, Benoît; Aubrun, Frédéric
2006-01-01
Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainly at induction of anesthesia. Nevertheless, claim reports emphasize that airway emergencies, tracheal extubation and/or recovery of anesthesia phases are still associated with death or brain damage, indicating that additional educational support and management strategies to improve patient safety are required. The present brief review analyses specific problems of airway management related to difficult tracheal intubation and to difficult mask ventilation prediction. The review will focus on basic airway management including preoxygenation, and on some oxygenation and tracheal intubation techniques that may be performed to solve a difficult airway.
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Contending Claims to Causality: A Critical Review of Mediation Research in HRD
Ghosh, Rajashi; Jacobson, Seth
2016-01-01
Purpose: The purpose of this paper is to conduct a critical review of the mediation studies published in the field of Human Resource Development (HRD) to discern if the study designs, the nature of data collection and the choice of statistical methods justify the causal claims made in those studies. Design/methodology/approach: This paper conducts…
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Manzanares, W; Langlois, P L
2016-01-01
Third-generation lipid emulsions (LE) are soybean oil sparing strategies with immunomodulatory and antiinflammatory effects. Current evidence supporting the use of intravenous (i.v) fish oil (FO) LE in critically ill patients requiring parenteral nutrition or receiving enteral nutrition (pharmaconutrient strategy) mainly derives from small phase ii clinical trials in heterogenous intensive care unit patient's population. Over the last three years, there have been published different systematic reviews and meta-analyses evaluating the effects of FO containing LE in the critically ill. Recently, it has been demonstrated that i.v FO based LE may be able to significantly reduce the incidence of infections as well as mechanical ventilation days and hospital length of stay. Nonetheless, more robust evidence is required before giving a definitive recommendation. Finally, we strongly believe that a dosing study is required before new phase iii clinical trials comparing i.v FO containing emulsions versus other soybean oil strategies can be conducted. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.
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International Nuclear Information System (INIS)
Wilson, Susan C.; Lockwood, Peter V.; Ashley, Paul M.; Tighe, Matthew
2010-01-01
This article provides a critical review of the environmental chemistry of inorganic antimony (Sb) in soils, comparing and contrasting findings with those of arsenic (As). Characteristics of the Sb soil system are reviewed, with an emphasis on speciation, sorption and phase associations, identifying differences between Sb and As behaviour. Knowledge gaps in environmentally relevant Sb data for soils are identified and discussed in terms of the limitations this imposes on understanding the fate, behaviour and risks associated with Sb in environmental soil systems, with particular reference to mobility and bioavailability. - A critical and comparative review of Sb and As chemistry and associations in soil systems identifies research directions needed for better understanding of risks.
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Promotion of Critical Thinking in Clinical Nursing Post Conferences: A Peer Interactive Approach
Stevens, Joanne
2009-01-01
Several workshops presented at the 2005 Lilly Conference on College Teaching in Oxford, Ohio, provided the inspiration for redesigning the clinical post conference for a foundational nursing course. Given the complexity and acuity of patient conditions today, fostering critical thinking in student nurses is central to quality patient care. The…
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Lithium safety and tolerability in mood disorders: a critical review
Directory of Open Access Journals (Sweden)
Ivan Aprahamian
2014-04-01
Full Text Available Background : Lithium is a first-line treatment for bipolar disorder in all phases, also indicated as add-on drug for unipolar depression and suicide prevention. This study encompasses a broad critical review on the safety and tolerability of lithium for mood disorders. Methods : A computerized search for English written human studies was made in MEDLINE, using the keywords “lithium” and “mood disorders”, starting from July 1993 through July 2013 (n = 416. This initial search aimed to select clinical trials, prospective data, and controlled design studies of lithium treatment for mood disorders reporting adverse effects (n = 36. The final selection yielded 91 studies. Results : The most common general side effects in patients on lithium treatment were thirst, frequent urination, dry mouth, weight gain, fatigue and cognitive complaints. Lithium users showed a high prevalence of hypothyroidism, hyperparathyroidism, and decrease in urinary concentration ability. Reduction of glomerular filtration rate in patients using lithium was also observed, but in a lesser extent. The evidence of teratogenicity associated with lithium use is not well established. Anti-inflammatory non-steroidal drugs, thiazide diuretics, angiotensin-converting enzyme inhibitors, and alprazolam may increase serum lithium and the consequent risk for intoxication. Discussion : Short-term lithium treatment is associated with mild side effects. Medium and long-term lithium treatment, however, might have effects on target organs which may be prevented by periodical monitoring. Overall, lithium is still a safe option for the treatment of mood disorders.
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McClintic, James A; Snyder, Clifford L; Brown, Kimberly M
2018-03-12
Although key clinical skills have been defined in the Core Entrustable Professional Activities, there is a need to improve medical school curricula with standardized training opportunities and assessments of these skills. Thus, we aimed to develop an innovative curriculum that emphasized critical thinking and clinical skills. We hypothesized that we would be able to observe measurable improvement on assessments of students' critical thinking and clinical skills after the implementation of the new curriculum. Prospective, Quasi-Experimental study with the use of historical controls. This study took place through the third-year surgical clerkship at the University of Texas Medical Branch at the Galveston, Houston, and Austin, Texas, locations. A total of 214 students taking the third-year surgical clerkship for the first time during the periods of interest were included. Although the students with traditional curriculum improved 9.5% on a short answer exam from preclerkship to postclerkship completion, the students with new curriculum improved by 40%. Students under the new curriculum performed significantly better on the Objective Structured Clinical Exam; however, their shelf scores were lower. Under this new curriculum and grading system, we demonstrated that students can be incentivized to improve critical thinking and clinical skills, but this needs to be balanced with knowledge-based incentives. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
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Tianeptine - A Clinical Review.
Directory of Open Access Journals (Sweden)
More Patil Vidita
2016-06-01
Full Text Available Depression is a wide spread disorder. The development of effective pharmacotherapy for major depression is important because it is such a widespread and debilitating mental disorder. The following review is based on the preclinical and clinical studies carried out on Tianeptine, an atypical antidepressant that lowers the adverse effects of stress on brain and memory. It is one of the many drugs being tested these days in the market as nootropics; it is presented as a “Smart Drug”. These are believed to be of low-risk and work to improve, enhance, or repair damage done to the brain via injury or disease.
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A Review of Clinical Data for Currently Approved Hysteroscopic Sterilization Procedures
Basinski, Cindy M
2010-01-01
Two hysteroscopic permanent sterilization procedures are approved for use in the United States: Essure® Permanent Birth Control System (Conceptus Incorporated, Mountain View, CA) and Adiana® Permanent Contraception (Hologic, Inc., Bedford, MA). This review compares the clinical trial data for these procedures. A notable difference is the resultant clinical pregnancy risk. The clinical trials for the Essure procedure have reported no pregnancies in 643 relying women in the 9 years since initiation of the studies. The clinical trial for the Adiana procedure has reported 12 pregnancies in 570 relying women in nearly 5 years of collected data. Other clinical outcome parameters concerning Essure and Adiana are examined in this review. PMID:21364861
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White Hughto, Jaclyn M; Reisner, Sari L; Pachankis, John E
2015-12-01
Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. This critical review aims to integrate the literature on stigma towards transgender people in the U.S. This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Fleseriu, Maria; Hamrahian, Amir H; Hoffman, Andrew R; Kelly, Daniel F; Katznelson, Laurence
2016-12-01
Recurrence of hypercortisolemia after initial treatment of Cushing disease (CD) is more common than previously thought, with a third of patients suffering a recurrence over their lifetime. Awareness of this high rate and delayed timeline (sometimes decades) of potential recurrence is critical and patients with CD should be monitored at regular intervals throughout their lives. In this manuscript, we review the complex evaluation needed for defining CD remission versus persistent disease after surgery, and focus on challenges in diagnosing early recurrent hypercortisolemia. Late night salivary cortisol appears to be an earlier predictor of recurrence when compared with urinary free cortisol (UFC) excretion. We also review the criteria suggested to define recurrence of hypercortisolemia in patients treated with medical therapy. Further research is needed to determine the optimal way to evaluate a patient with CD recurrence as well as the riskbenefit ratio of treatment in early, mild recurrent disease. ACTH = adrenocorticotropic hormone AI = adrenal insufficiency CD = Cushing disease CDDT = coupled dexamethasone desmopressin test CR = circadian rhythm CRH = corticotropin-releasing hormone GC = glucocorticoid GCR = global clinical response HPA = hypothalamic-pituitary-adrenal LDDST = low-dose dexamethasone suppression test LNSC = late-night salivary cortisol ODST = overnight dexamethasone suppression test TSS = trans-sphenoidal surgery.
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A critical review of simulation-based mastery learning with translational outcomes.
McGaghie, William C; Issenberg, Saul B; Barsuk, Jeffrey H; Wayne, Diane B
2014-04-01
This article has two objectives. Firstly, we critically review simulation-based mastery learning (SBML) research in medical education, evaluate its implementation and immediate results, and document measured downstream translational outcomes in terms of improved patient care practices, better patient outcomes and collateral effects. Secondly, we briefly address implementation science and its importance in the dissemination of innovations in medical education and health care. This is a qualitative synthesis of SBML with translational (T) science research reports spanning a period of 7 years (2006-2013). We use the 'critical review' approach proposed by Norman and Eva to synthesise findings from 23 medical education studies that employ the mastery learning model and measure downstream translational outcomes. Research in SBML in medical education has addressed a range of interpersonal and technical skills. Measured outcomes have been achieved in educational laboratories (T1), and as improved patient care practices (T2), patient outcomes (T3) and collateral effects (T4). Simulation-based mastery learning in medical education can produce downstream results. Such results derive from integrated education and health services research programmes that are thematic, sustained and cumulative. The new discipline of implementation science holds promise to explain why medical education innovations are adopted slowly and how to accelerate innovation dissemination. © 2014 John Wiley & Sons Ltd.
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Life Cycle Assessment Application to the Wine Sector: A Critical Review
Directory of Open Access Journals (Sweden)
Carmen Ferrara
2018-02-01
Full Text Available Life Cycle Assessment (LCA is a powerful tool that allows evaluation of the environmental performances of a product, service or process considering the whole life cycle or a part of it. In the wine sector, the application of LCA has grown significantly in recent years and several studies have been carried out about this topic that are similar to other research fields. Nowadays, LCA is an important and acknowledged environmental assessment tool but its application to the wine sector is still in a developing phase. For this reason, the present study proposes a critical review of papers dealing with both the wine sector and LCA. The critical review points out that the main wine hotspots are the viticulture phase (mainly due to fuel, fertilizer and pesticides consumption and the wine primary packaging production (due to glass bottles. Furthermore, the papers taken into consideration have a wide variability in the system boundaries definition as well as a shortage of availability of original and site-specific inventory data. Such key factors are sensitive aspects that have a huge influence on the results of a study and they are also affected by a wide variability: these issues need further scientific contribution through future studies.
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Snodgrass, Suzanne
2011-01-01
Health professionals use critical thinking, a key problem solving skill, for clinical reasoning which is defined as the use of knowledge and reflective inquiry to diagnose a clinical problem. Teaching these skills in traditional settings with growing class sizes is challenging, and students increasingly expect learning that is flexible and…
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Ferlie, Ewan; Crilly, Tessa; Jashapara, Ashok; Peckham, Anna
2012-04-01
The health policy domain has displayed increasing interest in questions of knowledge management and knowledge mobilisation within healthcare organisations. We analyse here the findings of a critical review of generic management and health-related literatures, covering the period 2000-2008. Using 29 pre-selected journals, supplemented by a search of selected electronic databases, we map twelve substantive domains classified into four broad groups: taxonomic and philosophical (e.g. different types of knowledge); theoretical discourse (e.g. critical organisational studies); disciplinary fields (e.g. organisational learning and Information Systems/Information Technology); and organisational processes and structures (e.g. organisational form). We explore cross-overs and gaps between these traditionally separate literature streams. We found that health sector literature has absorbed some generic concepts, notably Communities of Practice, but has not yet deployed the performance-oriented perspective of the Resource Based View (RBV) of the Firm. The generic literature uses healthcare sites to develop critical analyses of power and control in knowledge management, rooted in neo-Marxist/labour process and Foucauldian approaches. The review generates three theoretically grounded statements to inform future enquiry, by: (a) importing the RBV stream; (b) developing the critical organisational studies perspective further; and (c) exploring the theoretical argument that networks and other alternative organisational forms facilitate knowledge sharing. Copyright © 2012 Elsevier Ltd. All rights reserved.
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A critical review on the scaling theory of dispersion
Zech, Alraune; Mai, Juliane; Attinger, Sabine; Dietrich, Peter; Teutsch, Georg; Fiori, Aldo; Rubin, Yoram
2014-05-01
The phenomenon of dispersive mixing of solutes in aquifers is subject of research since decades. The characterization of dispersivity at a particular field site is a prerequisite to predict the movement and spreading of a contaminant plume. Experimental investigations have shown, that field-scale dispersivities vary over orders of magnitude, which apparently depends on the scale of measurement. Gelhar et al. [1992] and Schulze-Makuch [2005] have reviewed a large number of transport experiments reported in the literature. Based on that data Schulze-Makuch [2005] performed a trend analysis of longitudinal dispersivity, fostering the empirical relationship of a power law between dispersivities and the scale of measurement without an upper bound. The goal of our study is to critically revisit not only the data used for the trend analysis but the power-law scale dependence of longitudinal dispersivity (e.g. Neuman [1990], Xu and Eckstein [1995]). Our particular focus is on the reported dispersivities of large amount (larger than 100m) and large measurement scales (in the order of kilometers). We aim to evaluate current theories of transport against a critical "mass" of field experiments and to bracket the conditions of their applicability. We further aim to evaluate the adequacy of the field sampling techniques that were employed from the perspective of more than 30 years development in modeling and field characterization. Given the tremendous progress in field data acquisition techniques and new insights gained, it is reasonable to expect that interpretations of past experiments may be flawed due to the limitations or inadequacy of field sampling techniques. Gelhar, L.W., C. Welty, and K.R. Rehfeldt, 1992, A critical review of data on field-scale dispersion in aquifers, Water Resources Research 28, No. 7: 1955-1974. Schulze-Makuch, D., 2005, Longitudinal dispersivity data and implications for scaling behavior, Ground Water, Vol. 43, No. 3, 443-456. Neuman, S.P., 1990
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Clinical placements in mental health: a literature review.
Happell, Brenda; Gaskin, Cadeyrn J; Byrne, Louise; Welch, Anthony; Gellion, Stephen
2015-01-01
Gaining experience in clinical mental health settings is central to the education of health practitioners. To facilitate the ongoing development of knowledge and practice in this area, we performed a review of the literature on clinical placements in mental health settings. Searches in Academic Search Complete, CINAHL, Medline and PsycINFO databases returned 244 records, of which 36 met the selection criteria for this review. Five additional papers were obtained through scanning the reference lists of those papers included from the initial search. The evidence suggests that clinical placements may have multiple benefits (e.g. improving students' skills, knowledge, attitudes towards people with mental health issues and confidence, as well as reducing their fears and anxieties about working in mental health). The location and structure of placements may affect outcomes, with mental health placements in non-mental health settings appearing to have minimal impact on key outcomes. The availability of clinical placements in mental health settings varies considerably among education providers, with some students completing their training without undertaking such structured clinical experiences. Students have generally reported that their placements in mental health settings have been positive and valuable experiences, but have raised concerns about the amount of support they received from education providers and healthcare staff. Several strategies have been shown to enhance clinical placement experiences (e.g. providing students with adequate preparation in the classroom, implementing learning contracts and providing clinical supervision). Educators and healthcare staff need to work together for the betterment of student learning and the healthcare professions.
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Vascular access in critical limb ischemia.
Kang, Won Yu; Campia, Umberto; Ota, Hideaki; Didier, Romain J; Negi, Smita I; Kiramijyan, Sarkis; Koifman, Edward; Baker, Nevin C; Magalhaes, Marco A; Lipinski, Michael J; Escarcega, Ricardo O; Torguson, Rebecca; Waksman, Ron; Bernardo, Nelson L
2016-01-01
Currently, percutaneous endovascular intervention is considered a first line of therapy for treating patients with critical limb ischemia. As the result of remarkable development of techniques and technologies, percutaneous endovascular intervention has led to rates of limb salvage comparable to those achieved with bypass surgery, with fewer complications, even in the presence of lower rates of long-term patency. Currently, interventionalists have a multiplicity of access routes including smaller arteries, with both antegrade and retrograde approaches. Therefore, the choice of the optimal access site has become an integral part of the success of the percutaneous intervention. By understanding the technical aspects, as well as the advantages and limitations of each approach, the interventionalists can improve clinical outcomes in patients with severe peripheral arterial disease. This article reviews the access routes in critical limb ischemia, their advantages and disadvantages, and the clinical outcomes of each. Copyright © 2016 Elsevier Inc. All rights reserved.
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Wheeler, Patricia; And Others
This formative review of a project designed to help high school students become more discriminating television viewers (1) presents a description of the curriculum designed during the project to foster critical television viewing in teenagers, (2) outlines the major tasks involved in the formative review of the curriculum, and (3) presents and…
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Developments in solar still desalination systems: A critical review
Ayoub, George M.
2012-10-01
Solar still desalination uses a sustainable and pollution-free source to produce high-quality water. The main limitation is low productivity and this has been the focus of intensive research. A major concern while increasing productivity is to maintain economic feasibility and simplicity. The authors present a critical review of the research work conducted on solar stills development. Studies addressing each parameter of concern are grouped together and results compared. Novelty in design and newly introduced features are presented. Modeling efforts of flow circulation within the still and methods to estimate internal heat transfer coefficients are discussed and future research needs are outlined. © 2012 Taylor & Francis Group, LLC.
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Critical Factors of E-Learning Adoption and Acceptance in Pakistan: A Literature Review
Directory of Open Access Journals (Sweden)
F. Kanwal
2017-08-01
Full Text Available This review paper examines the prior studies on critical factors of e-learning adoption in Pakistan. The search terms identified 40 papers reporting 25 conceptual and qualitative and 15 quantitative evidence about the e-learning adoption and critical factors that may influence the adoption of e-learning in Pakistan. The findings revealed that modern paradigm shift requires the in-depth analysis of government policies, institutional and management role, students and faculty attitude, social norms, cultural values as well as technological advancement. These factors may directly or indirectly affect the intention of students towards e-learning adoption. The lack of quantitative evidences illustrate that policy makers, practitioners and researchers need to pay attention for further research of identifying and analyzing the critical factors which enhances the e-learning adoption in Pakistan.
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International Nuclear Information System (INIS)
Bogusz-Czerniewicz, M.
2009-01-01
Background: Between 1996 and 1999 project team of ExPeRT, catalogued four external review systems of health care facilities in the European Union and countries associated with EU. Aim: The aim of this paper is a/ to identify and compare currently existing external review systems for radiation oncology facilities and b/ to distinguish main differences between clinical audit and other external evaluation models and c/ to identify where those models are currently used in European Union member states. Materials and Methods: Based on the literature review and the survey conducted between January and April 2007 among representatives of 67 national societies (for diagnostic radiology, radiotherapy and nuclear medicine) in European Union member states, the analysis of existing external review systems in radiation oncology was performed. Relevant information about purpose, scope and methodology of evaluation process for those systems were surveyed. Results: The response to the questionnaire was 72%. Only a few countries did not supply any reply in spite of repeated enquiries to several recipients. Six main categories of systems aiming at measuring the quality of service management and delivery were identified: professional peer review -based schemes, hospital accreditation, accreditation in terms of ISO standards, award seeking, certification by International Standards Organization, and clinical audit. Conclusions: Though the methodology and terminology of the five main external review systems differ, a constant movement towards collaboration and convergence of those models has been observed. Due to the social, political, and economical aspects of each European country, the different audit systems have been implemented either on voluntary or mandatory basis. (author)
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Long-Term Outcomes of Youth Treated for an Anxiety Disorder: A Critical Review.
Gibby, Brittany A; Casline, Elizabeth P; Ginsburg, Golda S
2017-06-01
Pediatric anxiety disorders are common, disabling, and chronic conditions. Efforts over the past two decades have focused on developing and testing effective treatments. Short-term efficacy of both Cognitive Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors has been established. Data are emerging on the long-term (i.e., 2 years or longer) effectiveness of these treatments, but this literature has yet to be adequately synthesized. This study presents a systematic and critical qualitative review of published long-term follow-up (LTFU) studies of youth treated for an anxiety disorder. A comprehensive search of several databases identified 21 published reports (representing 15 LTFU cohorts of treated youth) meeting specified inclusion criteria. LTFU assessments occurred a mean of 5.85 years after initial treatment (range 2-19 years). Diagnostic rates at LTFU and predictors (e.g., demographic, baseline child clinical variables, treatment type) of outcomes at LTFU were also examined. A discussion of the limitations of this literature is provided to qualify interpretations of findings and to inform future studies. Findings can aid clinicians and families in making treatment decisions and setting reasonable expectations for the long-term prognosis after treatment for anxiety.
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Harder, Thomas
2014-10-01
Decisions in healthcare should be based on information obtained according to the principles of Evidence-Based Medicine (EBM). An increasing number of systematic reviews are published which summarize the results of prevalence studies. Interpretation of the results of these reviews should be accompanied by an appraisal of the methodological quality of the included data and studies. The critical appraisal tool for prevalence studies developed and tested by Munn et al. comprises 10 items and aims at targeting all kinds of prevalence studies. This comment discusses the pros and cons of different designs of quality appraisal tools and highlights their importance for systematic reviews of prevalence studies. Beyond piloting, which has been performed in the study by Munn et al., it is suggested here that the validity of the tool should be tested, including reproducibility and inter-rater reliability. It is concluded that studies as the one by Munn et al. will help to establish a critical understanding of methodological quality and will support the use of systematic reviews of non-intervention studies for health policy making.
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Critical review of the literature on the corrosion of copper by water
International Nuclear Information System (INIS)
King, Fraser
2010-12-01
The conventional belief that copper is thermodynamically stable in oxygen-free water has been questioned by a research group from the Royal Inst. of Technology, Stockholm lead by Dr. Gunnar Hultquist. A critical review of the literature both in support of the proposed mechanism and that which argues against it has been conducted. The critical review has been supported by supplementary analyses, with particular focus on the scientific validity of the reported observations and their significance for the corrosion of a copper canister. It is found that: - the scientific evidence in support of the suggestion that water oxidises copper is not conclusive and there are many aspects which are unclear and contradictory, - despite a number of attempts, no other researchers have been able to reproduce the observations of Hultquist and co-workers, - even if correct, the mechanism is not important for copper canisters in a repository, both because of differences in the environmental conditions and because, even if corrosion did occur by this mechanism, it would quickly stop, and - there is no adverse impact on the lifetime of copper canisters due to this proposed, but unproven, mechanism
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Critical review of the literature on the corrosion of copper by water
Energy Technology Data Exchange (ETDEWEB)
King, Fraser (Integrity Corrosion Consulting Limited (Canada))
2010-12-15
The conventional belief that copper is thermodynamically stable in oxygen-free water has been questioned by a research group from the Royal Inst. of Technology, Stockholm lead by Dr. Gunnar Hultquist. A critical review of the literature both in support of the proposed mechanism and that which argues against it has been conducted. The critical review has been supported by supplementary analyses, with particular focus on the scientific validity of the reported observations and their significance for the corrosion of a copper canister. It is found that: - the scientific evidence in support of the suggestion that water oxidises copper is not conclusive and there are many aspects which are unclear and contradictory, - despite a number of attempts, no other researchers have been able to reproduce the observations of Hultquist and co-workers, - even if correct, the mechanism is not important for copper canisters in a repository, both because of differences in the environmental conditions and because, even if corrosion did occur by this mechanism, it would quickly stop, and - there is no adverse impact on the lifetime of copper canisters due to this proposed, but unproven, mechanism
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Müller-Staub, Maria; Stuker-Studer, Ursula
2006-10-01
Case studies, based on actual patients' situations, provide a method of clinical decision making to foster critical thinking in nurses. This paper describes the method and process of group case studies applied in continuous education settings. This method bases on Balints' case supervision and was further developed and combined with the nursing diagnostic process. A case study contains different phases: Pre-phase, selection phase, case delineation and case work. The case provider narratively tells the situation of a patient. This allows the group to analyze and cluster signs and symptoms, to state nursing diagnoses and to derive nursing interventions. Results of the case study are validated by applying the theoretical background and critical appraisal of the case provider. Learning effects of the case studies were evaluated by means of qualitative questionnaires and analyzed according to Mayring. Findings revealed the following categories: a) Patients' problems are perceived in a patient centred way, accurate nursing diagnoses are stated and effective nursing interventions implemented. b) Professional nursing tasks are more purposefully perceived and named more precise. c) Professional nursing relationship, communication and respectful behaviour with patients were perceived in differentiated ways. The theoretical framework is described in the paper "Clinical decision making and critical thinking in the nursing diagnostic process". (Müller-Staub, 2006).
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A microbiological and clinical review on Corynebacterium kroppenstedtii
Directory of Open Access Journals (Sweden)
Andreas Tauch
2016-07-01
Full Text Available The genus Corynebacterium represents a taxon of Gram-positive bacteria with a high G + C content in the genomic DNA. Corynebacterium kroppenstedtii is an unusual member of this taxon as it lacks the characteristic mycolic acids in the cell envelope. Genome sequence analysis of the C. kroppenstedtii type strain has revealed a lipophilic (lipid-requiring lifestyle and a remarkable repertoire of carbohydrate uptake and utilization systems. Clinical isolates of C. kroppenstedtii have been obtained almost exclusively from female patients and mainly from breast abscesses and cases of granulomatous mastitis. However, the role of C. kroppenstedtii in breast pathologies remains unclear. This review provides a comprehensive overview of the taxonomy, microbiology, and microbiological identification of C. kroppenstedtii, including polyphasic phenotypic approaches, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and the use of 16S rRNA gene sequencing. A clinical review presents reported cases, various antimicrobial treatments, antibiotic susceptibility assays, and antibiotic resistance genes detected during genome sequencing. C. kroppenstedtii must be considered a potential opportunistic human pathogen and should be identified accurately in clinical laboratories.
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A review of shear wave splitting in the crack-critical crust
Crampin, Stuart; Chastin, Sebastien
2003-10-01
Over the last 15 years, it has become established that crack-induced stress-aligned shear wave splitting, with azimuthal anisotropy, is an inherent characteristic of almost all rocks in the crust. This means that most in situ rocks are pervaded by fluid-saturated microcracks and consequently are highly compliant. The evolution of such stress-aligned fluid-saturated grain-boundary cracks and pore throats in response to changing conditions can be calculated, in some cases with great accuracy, using anisotropic poro-elasticity (APE). APE is tightly constrained with no free parameters, yet dynamic modelling with APE currently matches a wide range of phenomena concerning anisotropy, stress, shear waves and cracks. In particular, APE has allowed the anisotropic response of a reservoir to injection to be calculated (predicted with hindsight), and the time and magnitude of an earthquake to be correctly stress-forecast. The reason for this calculability and predictability is that the microcracks in the crust are so closely spaced that they form critical systems. This crack-critical crust leads to a new style of geophysics that has profound implications for almost all aspects of pre-fracturing deformation of the crust and for solid-earth geophysics and geology. We review past, present and speculate about the future of shear wave splitting in the crack-critical crust. Shear wave splitting is seen to be a dynamic measure of the deformation of the rock mass. There is some good news and some bad news for conventional geophysics. Many accepted phenomena are no longer valid at high spatial and temporal resolution. A major effect is that the detailed crack geometry changes with time and varies from place to place in response to very small previously negligible changes. However, at least in some circumstances, the behaviour of the rock in the highly complex inhomogeneous Earth may be calculated and the response predicted, opening the way to possible control by feedback. The need is
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Book Review: Critical Condition: Replacing Critical Thinking with Creativity by Patrick Finn
Matthews, Jodie
2016-01-01
In Critical Condition: Replacing Critical Thinking with Creativity, Patrick Finn expands upon his 2011 TEDx Talk, ‘Loving Communication’, to suggest that critical thinking implies disapproval and unnecessary judgement originating from a particular mode of Classical thought. Jodie Matthews argues that Finn’s discussion is dependent upon a crudely drawn straw man and neglects to consider thinking critically as a necessary corollary, rather than antithesis, to thinking creatively.
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Clinical reasoning in undergraduate nursing education: a scoping review
Menezes,Sáskia Sampaio Cipriano de; Corrêa,Consuelo Garcia; Silva,Rita de Cássia Gengo e; Cruz,Diná de Almeida Monteiro Lopes da
2015-01-01
Abstract OBJECTIVE This study aimed at analyzing the current state of knowledge on clinical reasoning in undergraduate nursing education. METHODS A systematic scoping review through a search strategy applied to the MEDLINE database, and an analysis of the material recovered by extracting data done by two independent reviewers. The extracted data were analyzed and synthesized in a narrative manner. RESULTS From the 1380 citations retrieved in the search, 23 were kept for review and their co...
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Microfinance institutions' failure to address poverty: A narrative critical literature review
Guðjónsson, Sigurður
2017-01-01
This critical literature review begins by giving a short introduction to the microfinance industry. Microfinance institutions (MFIs) are explained and an account is given of their dual performance goals of financial performance (‘financial sustainability’) and social performance (‘outreach’). While MFIs’ social performance is directly aimed at poverty reduction, it is noteworthy that often they fail to address poverty (i.e., they fail to deliver outreach). The aim of the paper is to answer th...
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Additive Manufacturing Techniques in Prosthodontics: Where Do We Currently Stand? A Critical Review.
Alharbi, Nawal; Wismeijer, Daniel; Osman, Reham B
The aim of this article was to critically review the current application of additive manufacturing (AM)/3D-printing techniques in prosthodontics and to highlight the influence of various technical factors involved in different AM technologies. A standard approach of searching MEDLINE, EMBASE, and Google Scholar databases was followed. The following search terms were used: (Prosth* OR Restoration) AND (Prototype OR Additive Manufacture* OR Compute* OR 3D-print* OR CAD/CAM) AND (Dentistry OR Dental). Hand searching the reference lists of the included articles and personal connections revealed additional relevant articles. Selection criteria were any article written in English and reporting on the application of AM in prosthodontics from 1990 to February 2016. From a total of 4,290 articles identified, 33 were seen as relevant. Of these, 3 were narrative reviews, 18 were in vitro studies, and 12 were clinical in vivo studies. Different AM technologies are applied in prosthodontics, directly and indirectly for the fabrication of fixed metal copings, metal frameworks for removable partial dentures, and plastic mock-ups and resin patterns for further conventional metal castings. Technical factors involved in different AM techniques influence the overall quality, the mechanical properties of the printed parts, and the total cost and manufacturing time. AM is promising and offers new possibilities in the field of prosthodontics, though its application is still limited. An understanding of these limitations and of developments in material science is crucial prior to considering AM as an acceptable method for the fabrication of dental prostheses.
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Is it time to drop the 'knowledge translation' metaphor? A critical literature review.
Greenhalgh, Trisha; Wieringa, Sietse
2011-12-01
The literature on 'knowledge translation' presents challenges for the reviewer because different terms have been used to describe the generation, sharing and application of knowledge and different research approaches embrace different philosophical positions on what knowledge is. We present a narrative review of this literature which deliberately sought to highlight rather than resolve tensions between these different framings. Our findings suggest that while 'translation' is a widely used metaphor in medicine, it constrains how we conceptualise and study the link between knowledge and practice. The 'translation' metaphor has, arguably, led to particular difficulties in the fields of 'evidence-based management' and 'evidence-based policymaking' - where it seems that knowledge obstinately refuses to be driven unproblematically into practice. Many non-medical disciplines such as philosophy, sociology and organization science conceptualise knowledge very differently, as being (for example) 'created', 'constructed', 'embodied', 'performed' and 'collectively negotiated' - and also as being value-laden and tending to serve the vested interests of dominant élites. We propose that applying this wider range of metaphors and models would allow us to research the link between knowledge and practice in more creative and critical ways. We conclude that research should move beyond a narrow focus on the 'know-do gap' to cover a richer agenda, including: (a) the situation-specific practical wisdom (phronesis) that underpins clinical judgement; (b) the tacit knowledge that is built and shared among practitioners ('mindlines'); (c) the complex links between power and knowledge; and (d) approaches to facilitating macro-level knowledge partnerships between researchers, practitioners, policymakers and commercial interests.
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Jayakaran, Prasath; Johnson, Gillian M.; Sullivan, S. John; Nitz, Jennifer C.
2012-01-01
Measurement of balance and postural performance that underpins activities of daily living is important in the rehabilitation of individuals with a lower limb amputation (LLA), and there are a number of methods and strategies available for this purpose. To provide an evidence-based choice of approach, this review aims to critically review the tasks…
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A review of molecular imaging studies reaching the clinical stage
International Nuclear Information System (INIS)
Wong, Franklin C.; Kim, E. Edmund
2009-01-01
The practice of molecular imaging in the clinics is examined across various imaging modalities to assess the current status of clinical molecular imaging. The various physiologic and scientific bases of clinical molecular imaging are surveyed to assess the possibilities and opportunities for the deployment of the different imaging modalities in the near future. The requisites for successful candidate(s) of clinical molecular imaging are reviewed for future development.
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Uhrenfeldt, Lisbeth; Martinsen, Bente; Jørgensen, Lene Bastrup; Sørensen, Erik Elgaard
2018-03-01
Nursing was established in Denmark as a scholarly tradition in the late nineteen eighties, and ethnography was a preferred method. No critical review has yet summarised accomplishments and gaps and pointing at directions for the future methodological development and research herein. This review critically examines the current state of the use of ethnographic methodology in the body of knowledge from Danish nursing scholars. We performed a systematic literature search in relevant databases from 2003 to 2016. The studies included were critically appraised by all authors for methodological robustness using the ten-item instrument QARI from Joanna Briggs Institute. Two hundred and eight studies met our inclusion criteria and 45 papers were included; the critical appraisal gave evidence of studies with certain robustness, except for the first question concerning the congruity between the papers philosophical perspective and methodology and the seventh question concerning reflections about the influence of the researcher on the study and vice versa. In most studies (n = 34), study aims and arguments for selecting ethnographic research are presented. Additionally, method sections in many studies illustrated that ethnographical methodology is nurtured by references such as Hammersley and Atkinson or Spradley. Evidence exists that Danish nursing scholars' body of knowledge nurtures the ethnographic methodology mainly by the same few authors; however, whether this is an expression of a deliberate strategy or malnutrition in the form of lack of knowledge of other methodological options appears yet unanswered. © 2017 Nordic College of Caring Science.
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Directory of Open Access Journals (Sweden)
Jernej Amon Prodnik
2012-10-01
Full Text Available This article is a review of Thomas Allmer’s book “Towards a Critical Theory of Surveillance in Informational Capitalism”. The book was published in 2012 by the publishing house Peter Lang (in Frankfurt am Main, Berlin, New York, Oxford […]. In the start of the article the author also poses the question whether there is a new school of thought emerging, namely the “Austrian School of Critical Political Economy”.
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A literature review of comfort in the paediatric critical care patient.
Bosch-Alcaraz, Alejandro; Falcó-Pegueroles, Anna; Jordan, Iolanda
2018-03-08
To investigate the meaning of comfort and to contextualise it within the framework of paediatric critical care. The concept of comfort is closely linked to care in all health contexts. However, in specific settings such as the paediatric critical care unit, it takes on particular importance. A literature review was conducted. A literature search was performed of articles in English and Spanish in international health science databases, from 1992-March 2017, applying the quality standards established by the PRISMA methodology and the Joanna Briggs Institute. A total of 1,203 publications were identified in the databases. Finally, 59 articles which met the inclusion criteria were entered in this literature review. Almost all were descriptive studies written in English and published in Europe. The concept of comfort was defined as the immediate condition of being strengthened through having the three types of needs (relief, ease and transcendence) addressed in the four contexts of experience (physical, psychospiritual, social and environmental). Only two valid and reliable tools for assessing comfort were found: the Comfort Scale and the Comfort Behavior Scale. Comfort is subjective and difficult to assess. It has four facets: physical, emotional, social and environmental. High levels of noise and light are the inputs that cause the most discomfort. Comfort is a holistic, universal concept and an important component of quality nursing care. © 2018 John Wiley & Sons Ltd.
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Electron beam processing of fresh produce - A critical review
Pillai, Suresh D.; Shayanfar, Shima
2018-02-01
To meet the increasing global demand for fresh produce, robust processing methods that ensures both the safety and quality of fresh produce are needed. Since fresh produce cannot withstand thermal processing conditions, most of common safety interventions used in other foods are ineffective. Electron beam (eBeam) is a non-thermal technology that can be used to extend the shelf life and ensure the microbiological safety of fresh produce. There have been studies documenting the application of eBeam to ensure both safety and quality in fresh produce, however, there are still unexplored areas that still need further research. This is a critical review on the current literature on the application of eBeam technology for fresh produce.
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McCullough, Laurence B
2011-02-01
This paper introduces the 2011 number of the Journal on Clinical Ethics. Philosophical critical appraisal is essential for the success of philosophical analysis and argument in clinical ethics. To clear away conceptual underbrush, papers in this Clinical Ethics number of the Journal address genetic engineering, conscience-based objections to forms of health care, placebos, and preventing exploitation of patients to be recruited to become research subjects.
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International nursing students and what impacts their clinical learning: literature review.
Edgecombe, Kay; Jennings, Michele; Bowden, Margaret
2013-02-01
This paper reviews the sparse literature about international nursing students' clinical learning experiences, and also draws on the literature about international higher education students' learning experiences across disciplines as well as nursing students' experiences when undertaking international clinical placements. The paper aims to identify factors that may impact international nursing students' clinical learning with a view to initiating further research into these students' attributes and how to work with these to enhance the students' clinical learning. Issues commonly cited as affecting international students are socialisation, communication, culture, relationships, and unmet expectations and aspirations. International student attributes tend to be included by implication rather than as part of the literature's focus. The review concludes that recognition and valuing of international nursing students' attributes in academic and clinical contexts are needed to facilitate effective strategies to support their clinical practice in new environments. Copyright © 2012. Published by Elsevier Ltd.
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Clinical Pharmacology of Furosemide in Neonates: A Review
Directory of Open Access Journals (Sweden)
Gian Maria Pacifici
2013-09-01
Full Text Available Furosemide is the diuretic most used in newborn infants. It blocks the Na+-K+-2Cl− symporter in the thick ascending limb of the loop of Henle increasing urinary excretion of Na+ and Cl−. This article aimed to review the published data on the clinical pharmacology of furosemide in neonates to provide a critical, comprehensive, authoritative and, updated survey on the metabolism, pharmacokinetics, pharmacodynamics and side-effects of furosemide in neonates. The bibliographic search was performed using PubMed and EMBASE databases as search engines; January 2013 was the cutoff point. Furosemide half-life (t1/2 is 6 to 20-fold longer, clearance (Cl is 1.2 to 14-fold smaller and volume of distribution (Vd is 1.3 to 6-fold larger than the adult values. t1/2 shortens and Cl increases as the neonatal maturation proceeds. Continuous intravenous infusion of furosemide yields more controlled diuresis than the intermittent intravenous infusion. Furosemide may be administered by inhalation to infants with chronic lung disease to improve pulmonary mechanics. Furosemide stimulates prostaglandin E2 synthesis, a potent dilator of the patent ductus arteriosus, and the administration of furosemide to any preterm infants should be carefully weighed against the risk of precipitation of a symptomatic patent ductus arteriosus. Infants with low birthweight treated with chronic furosemide are at risk for the development of intra-renal calcifications.
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Mobile clinical decision support systems and applications: a literature and commercial review.
Martínez-Pérez, Borja; de la Torre-Díez, Isabel; López-Coronado, Miguel; Sainz-de-Abajo, Beatriz; Robles, Montserrat; García-Gómez, Juan Miguel
2014-01-01
The latest advances in eHealth and mHealth have propitiated the rapidly creation and expansion of mobile applications for health care. One of these types of applications are the clinical decision support systems, which nowadays are being implemented in mobile apps to facilitate the access to health care professionals in their daily clinical decisions. The aim of this paper is twofold. Firstly, to make a review of the current systems available in the literature and in commercial stores. Secondly, to analyze a sample of applications in order to obtain some conclusions and recommendations. Two reviews have been done: a literature review on Scopus, IEEE Xplore, Web of Knowledge and PubMed and a commercial review on Google play and the App Store. Five applications from each review have been selected to develop an in-depth analysis and to obtain more information about the mobile clinical decision support systems. Ninety-two relevant papers and 192 commercial apps were found. Forty-four papers were focused only on mobile clinical decision support systems. One hundred seventy-one apps were available on Google play and 21 on the App Store. The apps are designed for general medicine and 37 different specialties, with some features common in all of them despite of the different medical fields objective. The number of mobile clinical decision support applications and their inclusion in clinical practices has risen in the last years. However, developers must be careful with their interface or the easiness of use, which can impoverish the experience of the users.
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The social and psychological impact of endometriosis on women's lives: a critical narrative review
Culley, Lorraine; Law, Caroline; Hudson, Nicky; Denny, E.; Mitchell, H.; Baumgarten, M.; Raine-Fenning, N.
2013-01-01
The attached file is a pre – copy – editing, author produced PDF of an article accepted for publication in Human Reproduction Update following peer review. The definitive publisher – authenticated version (Culley, L, Law, C, Hudson, N, Denny, E, Mitchell, H, Baumgarten, M, Raine – Fenning, N (2013) The social and psychological impact of endometriosis on women’s lives: a critical narrative review. Hum. Reprod. Update 19 (6): 625 – 639) is available online at: http://humupd.oxfordjournals.org/...
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Clinical code set engineering for reusing EHR data for research: A review.
Williams, Richard; Kontopantelis, Evangelos; Buchan, Iain; Peek, Niels
2017-06-01
The construction of reliable, reusable clinical code sets is essential when re-using Electronic Health Record (EHR) data for research. Yet code set definitions are rarely transparent and their sharing is almost non-existent. There is a lack of methodological standards for the management (construction, sharing, revision and reuse) of clinical code sets which needs to be addressed to ensure the reliability and credibility of studies which use code sets. To review methodological literature on the management of sets of clinical codes used in research on clinical databases and to provide a list of best practice recommendations for future studies and software tools. We performed an exhaustive search for methodological papers about clinical code set engineering for re-using EHR data in research. This was supplemented with papers identified by snowball sampling. In addition, a list of e-phenotyping systems was constructed by merging references from several systematic reviews on this topic, and the processes adopted by those systems for code set management was reviewed. Thirty methodological papers were reviewed. Common approaches included: creating an initial list of synonyms for the condition of interest (n=20); making use of the hierarchical nature of coding terminologies during searching (n=23); reviewing sets with clinician input (n=20); and reusing and updating an existing code set (n=20). Several open source software tools (n=3) were discovered. There is a need for software tools that enable users to easily and quickly create, revise, extend, review and share code sets and we provide a list of recommendations for their design and implementation. Research re-using EHR data could be improved through the further development, more widespread use and routine reporting of the methods by which clinical codes were selected. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.
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Contesting the science/ethics distinction in the review of clinical research
Dawson, Angus J; Yentis, Steve M
2007-01-01
Recent policy in relation to clinical research proposals in the UK has distinguished between two types of review: scientific and ethical. This distinction has been formally enshrined in the recent changes to research ethics committee (REC) structure and operating procedures, introduced as the UK response to the EU Directive on clinical trials. Recent reviews and recommendations have confirmed the place of the distinction and the separate review processes. However, serious reservations can be mounted about the science/ethics distinction and the policy of separate review that has been built upon it. We argue here that, first, the science/ethics distinction is incoherent, and, second, that RECs should not only be permitted to consider a study's science, but that they have anobligation do so. PMID:17329389
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A Critical Review of the Critical Period Research.
Scovel, Thomas
2000-01-01
Discusses how perspectives on the critical period hypothesis (CPH) have shifted over the last 20-20 years, because of the work of applied linguistics and other disciplines. Advises caution into translating CPH research into personal practice or public policy. (Author/VWL)
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Comi, Alice; Eppler, Martin J.
2009-01-01
In this article, we critically review the current literature on alliance formation and management with a particular emphasis on small businesses, and on managerial implications for start-up enterprises. In the beginning of the article, we discuss the advantages and the challenges of inter-organizational collaboration, by taking the perspective of technology-driven start-ups operating in highly competitive environments. We then review the managerial advice suggested by the current liter...
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Recognizing Binge-Eating Disorder in the Clinical Setting: A Review of the Literature.
Kornstein, Susan G; Kunovac, Jelena L; Herman, Barry K; Culpepper, Larry
2016-01-01
Review the clinical skills needed to recognize, diagnose, and manage binge-eating disorder (BED) in a primary care setting. A PubMed search of English-language publications (January 1, 2008-December 11, 2014) was conducted using the term binge-eating disorder . Relevant articles known to the authors were also included. Publications focusing on preclinical topics (eg, characterization of receptors and neurotransmitter systems) without discussing clinical relevance were excluded. A total of 101 publications were included in this review. Although BED is the most prevalent eating disorder, it is underdiagnosed and undertreated. BED can be associated with medical (eg, type 2 diabetes and metabolic syndrome) and psychiatric (eg, depression and anxiety) comorbidities that, if left untreated, can impair quality of life and functionality. Primary care physicians may find diagnosing and treating BED challenging because of insufficient knowledge of its new diagnostic criteria and available treatment options. Furthermore, individuals with BED may be reluctant to seek treatment because of shame, embarrassment, and a lack of awareness of the disorder. Several short assessment tools are available to screen for BED in primary care settings. Pharmacotherapy and psychotherapy should focus on reducing binge-eating behavior, thereby reducing medical and psychiatric complications. Overcoming primary care physician- and patient-related barriers is critical to accurately diagnose and appropriately treat BED. Primary care physicians should take an active role in the initial recognition and assessment of suspected BED based on case-finding indicators (eg, eating habits and being overweight), the initial treatment selection, and the long-term follow-up of patients who meet DSM-5 BED diagnostic criteria.
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Does Peer Review of Radiation Plans Affect Clinical Care? A Systematic Review of the Literature
International Nuclear Information System (INIS)
Brunskill, Kelsey; Nguyen, Timothy K.; Boldt, R. Gabriel; Louie, Alexander V.; Warner, Andrew; Marks, Lawrence B.; Palma, David A.
2017-01-01
Purpose: Peer review is a recommended component of quality assurance in radiation oncology; however, it is resource-intensive and its effect on patient care is not well understood. We conducted a systematic review of the published data to assess the reported clinical impact of peer review on radiation treatment plans. Methods and Materials: A systematic review of published English studies was performed in accordance with the PRISMA guidelines using the MEDLINE and EMBASE databases and abstracts published from major radiation oncology scientific meeting proceedings. For inclusion, the studies were required to report the effect of peer review on ≥1 element of treatment planning (eg, target volume or organ-at-risk delineation, dose prescription or dosimetry). Results: The initial search strategy identified 882 potentially eligible studies, with 11 meeting the inclusion criteria for full-text review and final analysis. Across a total of 11,491 patient cases, peer review programs led to modifications in a weighted mean of 10.8% of radiation treatment plans. Five studies differentiated between major and minor changes and reported weighted mean rates of change of 1.8% and 7.3%, respectively. The most common changes were related to target volume delineation (45.2% of changed plans), dose prescription or written directives (24.4%), and non-target volume delineation or normal tissue sparing (7.5%). Conclusions: Our findings suggest that peer review leads to changes in clinical care in approximately 1 of every 9 cases overall. This is similar to the reported rates of change in peer review studies from other oncology-related specialties, such as radiology and pathology.
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Stable isotope analysis in primatology: a critical review.
Sandberg, Paul A; Loudon, James E; Sponheimer, Matt
2012-11-01
Stable isotope analysis has become an important tool in ecology over the last 25 years. A wealth of ecological information is stored in animal tissues in the relative abundances of the stable isotopes of several elements, particularly carbon and nitrogen, because these isotopes navigate through ecological processes in predictable ways. Stable carbon and nitrogen isotopes have been measured in most primate taxonomic groups and have yielded information about dietary content, dietary variability, and habitat use. Stable isotopes have recently proven useful for addressing more fine-grained questions about niche dynamics and anthropogenic effects on feeding ecology. Here, we discuss stable carbon and nitrogen isotope systematics and critically review the published stable carbon and nitrogen isotope data for modern primates with a focus on the problems and prospects for future stable isotope applications in primatology. © 2012 Wiley Periodicals, Inc.
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Evaluating clinical ethics support in mental healthcare: a systematic literature review.
Hem, M.H.; Pedersen, R.; Norvoll, R.; Molewijk, A.C.
2015-01-01
A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five
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Rudokas, Mindaugas; Najlah, Mohammad; Alhnan, Mohamed Albed; Elhissi, Abdelbary
2016-01-01
This is a critical review on research conducted in the field of pulmonary delivery of liposomes. Issues relating to the mechanism of nebulisation and liposome composition were appraised and correlated with literature reports of liposome formulations used in clinical trials to understand the role of liposome size and composition on therapeutic outcome. A major highlight was liposome inhalation for the treatment of lung cancers. Many in vivo studies that explored the potential of liposomes as anticancer carrier systems were evaluated, including animal studies and clinical trials. Liposomes can entrap anticancer drugs and localise their action in the lung following pulmonary delivery. The safety of inhaled liposomes incorporating anticancer drugs depends on the anticancer agent used and the amount of drug delivered to the target cancer in the lung. The difficulty of efficient targeting of liposomal anticancer aerosols to the cancerous tissues within the lung may result in low doses reaching the target site. Overall, following the success of liposomes as inhalable carriers in the treatment of lung infections, it is expected that more focus from research and development will be given to designing inhalable liposome carriers for the treatment of other lung diseases, including pulmonary cancers. The successful development of anticancer liposomes for inhalation may depend on the future development of effective aerosolisation devices and better targeted liposomes to maximise the benefit of therapy and reduce the potential for local and systemic adverse effects. © 2016 S. Karger AG, Basel.
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Clinical review: Ethnic differences in bone mass--clinical implications.
Leslie, William D
2012-12-01
Differences in bone mineral density (BMD) as assessed with dual-energy x-ray absorptiometry are observed between geographic and ethnic groups, with important implications in clinical practice. PubMed was employed to identify relevant studies. A review of the literature was conducted, and data were summarized and integrated. The available data highlight the complex ethnic variations in BMD, which only partially account for observed variations in fracture rates. Factors contributing to ethnic differences include genetics, skeletal size, body size and composition, lifestyle, and social determinants. Despite BMD differences, the gradient of risk for fracture from BMD and other clinical risk factors appears to be similar across ethnic groups. Furthermore, BMD variation is greater within an ethnic population than between ethnic populations. New imaging technologies have identified ethnic differences in bone geometry, volumetric density, microarchitecture, and estimated bone strength that may contribute to a better understanding of ethnic differences in fracture risk. Factors associated with ethnicity affect BMD and fracture risk through direct and indirect mechanisms.
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Boluyt, Nicole; van der Lee, Johanna H.; Moyer, Virginia A.; Brand, Paul L. P.; Offringa, Martin
2007-01-01
OBJECTIVE: Our goal was to evaluate clinical, methodologic, and reporting aspects of systematic reviews on the management of acute asthma in children. METHODS: We undertook a systematic review of systematic reviews on acute asthma management in children. We identified eligible reviews by searching
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Improving critical thinking and clinical reasoning with a continuing education course.
Cruz, Dina Monteiro; Pimenta, Cibele Mattos; Lunney, Margaret
2009-03-01
Continuing education courses related to critical thinking and clinical reasoning are needed to improve the accuracy of diagnosis. This study evaluated a 4-day, 16-hour continuing education course conducted in Brazil.Thirty-nine nurses completed a pretest and a posttest consisting of two written case studies designed to measure the accuracy of nurses' diagnoses. There were significant differences in accuracy from pretest to posttest for case 1 (p = .008) and case 2 (p = .042) and overall (p = .001). Continuing education courses should be implemented to improve the accuracy of nurses' diagnoses.
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Ludin, Salizar Mohamed
2018-02-01
A critical thinker may not necessarily be a good decision-maker, but critical care nurses are expected to utilise outstanding critical thinking skills in making complex clinical judgements. Studies have shown that critical care nurses' decisions focus mainly on doing rather than reflecting. To date, the link between critical care nurses' critical thinking and decision-making has not been examined closely in Malaysia. To understand whether critical care nurses' critical thinking disposition affects their clinical decision-making skills. This was a cross-sectional study in which Malay and English translations of the Short Form-Critical Thinking Disposition Inventory-Chinese Version (SF-CTDI-CV) and the Clinical Decision-making Nursing Scale (CDMNS) were used to collect data from 113 nurses working in seven critical care units of a tertiary hospital on the east coast of Malaysia. Participants were recruited through purposive sampling in October 2015. Critical care nurses perceived both their critical thinking disposition and decision-making skills to be high, with a total score of 71.5 and a mean of 48.55 for the SF-CTDI-CV, and a total score of 161 and a mean of 119.77 for the CDMNS. One-way ANOVA test results showed that while age, gender, ethnicity, education level and working experience factors significantly impacted critical thinking (pnurses' critical thinking and clinical decision-making (r=0.637, p=0.001). While this small-scale study has shown a relationship exists between critical care nurses' critical thinking disposition and clinical decision-making in one hospital, further investigation using the same measurement tools is needed into this relationship in diverse clinical contexts and with greater numbers of participants. Critical care nurses' perceived high level of critical thinking and decision-making also needs further investigation. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Human Resource Management in Sports: A Critical Review of its Importance and Pertaining Issues
Directory of Open Access Journals (Sweden)
Weerakoon Ranjan Kumara
2016-03-01
Full Text Available This paper will illustrate the meaning and importance of human resource management (HRM, human resource planning, and strategic human resource management, which are critically important for an organization’s effectiveness and must be effectively managed (Doherty, 1998. This study used the literature review method to acquire its final results. The relevant HRM literature review was done according to the purpose of the study. It used the purposive random sample method for selecting relevant literature. This study shows the current economic environment in the sports industry; the second part of the study critically analyzes the value of the strategic management of employees for the effective and efficient operation of sports organizations. It also critically evaluates human resource planning and other pertinent issues in terms of legislation, recruitment, selection, training, induction, and reward management from different international examples in sports management. Over the past few decades, increasing competition, globalization, and continuous changes in the market and in technology have emphasized the need to rethink the management of the organization and of human resources for the sake of overcoming significant challenges (Taylor et al., 2006. Therefore, managers should use strategic human resource management to overcome significant issues and to form well-planned strategies so that the organization may succeed.
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Valgimigli, Simona; Padovani, Roberto; Donati, Cristina; Mazzi, Fausto
2013-01-01
The study of the neuropsychological profile of schizophrenic patients has provided systematic results in linking specific deficit (working memory, verbal learning, attentive and executive functioning, social cognition) to the functional outcome of subjects. More recently this approach has been applied to younger subjects, from the age of 14, that show prodromal signs of a possible psychotic conversion (ultra-risk subjects). The review is at first intended to describe the clinical and experimental studies that investigated the cognitive and neuropsychological profile of subjects at ultra-risk for psychosis. These studies show the presence of minor cognitive difficulties in several specific areas (working memory, verbal learning, attentive and executive functioning) that can be indicative of both a possible conversion to psychosis and a need for cognitive remediation programs. Secondarily, the article describes several neuropsychological tools, standardized for the Italian population, that can be used to approach the clinical assessment of ultra-risk subjects considering some critical aspects such as their typical age range (adolescents and young adults).
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Clinical TVA-based studies: a general review
Directory of Open Access Journals (Sweden)
Thomas eHabekost
2015-03-01
Full Text Available In combination with whole report and partial report tasks, the Theory of Visual Attention (TVA can be used to estimate individual differences in five basic attentional parameters: The visual processing speed, the storage capacity of visual short-term memory, the perceptual threshold, the efficiency of top-down selectivity, and the spatial bias of attentional weighting. TVA-based assessment has been used in about 30 studies to investigate attentional deficits in a range of neurological and psychiatric conditions: (a neglect and simultanagnosia, (b reading disturbances, (c aging and neurodegenerative diseases, and most recently (d neurodevelopmental disorders. The article introduces TVA based assessment, discusses its methodology and psychometric properties, and reviews the progress made in each of the four research fields. The empirical results demonstrate the general usefulness of TVA-based assessment for many types of clinical neuropsychological research. The method’s most important qualities are cognitive specificity and theoretical grounding, but it is also characterized by good reliability and sensitivity to minor deficits. The review concludes by pointing to promising new areas for clinical TVA-based research.
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Review of Nuclear Criticality Safety Requirements Implementation for Hanford Tank Farms Facility
International Nuclear Information System (INIS)
DEFIGH PRICE, C.
2000-01-01
In November 1999, the Deputy Secretary of the Department of Energy directed a series of actions to strengthen the Department's ongoing nuclear criticality safety programs. A Review Plan describing lines of inquiry for assessing contractor programs was included. The Office of River Protection completed their assessment of the Tank Farm Contractor program in May 2000. This document supports that assessment by providing a compliance statement for each line of inquiry
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Review of criticality safety and shielding analysis issues for transportation packages
International Nuclear Information System (INIS)
Parks, C.V.; Broadhead, B.L.
1995-01-01
The staff of the Nuclear Engineering Applications Section (NEAS) at Oak Ridge National Laboratory (ORNL) have been involved for over 25 years with the development and application of computational tools for use in analyzing the criticality safety and shielding features of transportation packages carrying radioactive material (RAM). The majority of the computational tools developed by ORNL/NEAS have been included within the SCALE modular code system (SCALE 1995). This code system has been used throughout the world for the evaluation of nuclear facility and package designs. With this development and application experience as a basis, this paper highlights a number of criticality safety and shielding analysis issues that confront the designer and reviewer of a new RAM package. Changes in the types and quantities of material that need to be shipped will keep these issues before the technical community and provide challenges to future package design and certification
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Childhood bruxism: a clinical review and case report.
Gupta, B; Marya, C M; Anegundi, R
2010-01-01
The present case report refers to a patient who reported to the department with the complaint of teeth grinding (Bruxism). A brief review of the literature is reported concerning the aetiology, clinical diagnosis and the therapeutic approach of the disease.
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Directory of Open Access Journals (Sweden)
Thomas Harder
2014-10-01
Full Text Available Decisions in healthcare should be based on information obtained according to the principles of Evidence-Based Medicine (EBM. An increasing number of systematic reviews are published which summarize the results of prevalence studies. Interpretation of the results of these reviews should be accompanied by an appraisal of the methodological quality of the included data and studies. The critical appraisal tool for prevalence studies developed and tested by Munn et al. comprises 10 items and aims at targeting all kinds of prevalence studies. This comment discusses the pros and cons of different designs of quality appraisal tools and highlights their importance for systematic reviews of prevalence studies. Beyond piloting, which has been performed in the study by Munn et al., it is suggested here that the validity of the tool should be tested, including reproducibility and inter-rater reliability. It is concluded that studies as the one by Munn et al. will help to establish a critical understanding of methodological quality and will support the use of systematic reviews of non-intervention studies for health policy making.
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Evidence and its uses in health care and research: the role of critical thinking.
Jenicek, Milos; Croskerry, Pat; Hitchcock, David L
2011-01-01
Obtaining and critically appraising evidence is clearly not enough to make better decisions in clinical care. The evidence should be linked to the clinician's expertise, the patient's individual circumstances (including values and preferences), and clinical context and settings. We propose critical thinking and decision-making as the tools for making that link. Critical thinking is also called for in medical research and medical writing, especially where pre-canned methodologies are not enough. It is also involved in our exchanges of ideas at floor rounds, grand rounds and case discussions; our communications with patients and lay stakeholders in health care; and our writing of research papers, grant applications and grant reviews. Critical thinking is a learned process which benefits from teaching and guided practice like any discipline in health sciences. Training in critical thinking should be a part or a pre-requisite of the medical curriculum.
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Evidence and its uses in health care and research: The role of critical thinking
Jenicek, Milos; Croskerry, Pat; Hitchcock, David L.
2011-01-01
Summary Obtaining and critically appraising evidence is clearly not enough to make better decisions in clinical care. The evidence should be linked to the clinician’s expertise, the patient’s individual circumstances (including values and preferences), and clinical context and settings. We propose critical thinking and decision-making as the tools for making that link. Critical thinking is also called for in medical research and medical writing, especially where pre-canned methodologies are not enough. It is also involved in our exchanges of ideas at floor rounds, grand rounds and case discussions; our communications with patients and lay stakeholders in health care; and our writing of research papers, grant applications and grant reviews. Critical thinking is a learned process which benefits from teaching and guided practice like any discipline in health sciences. Training in critical thinking should be a part or a pre-requisite of the medical curriculum. PMID:21169920
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Nadia Dedy, Aimie; Zakuan, Norhayati; Zaidi Bahari, Ahamad; Ariff, Mohd Shoki Md; Chin, Thoo Ai; Zameri Mat Saman, Muhamad
2016-05-01
TQM is a management philosophy embracing all activities through which the needs and expectations of the customer and the community and the goals of the companies are satisfied in the most efficient and cost effective way by maximizing the potential of all workers in a continuing drive for total quality improvement. TQM is very important to the company especially in automotive industry in order for them to survive in the competitive global market. The main objective of this study is to review a relationship between TQM and employee performance. Authors review updated literature on TQM study with two main targets: (a) evolution of TQM considering as a set of practice, (b) and its impacts to employee performance. Therefore, two research questions are proposed in order to review TQM constructs and employee performance measure: (a) Is the set of critical success factors associated with TQM valid as a whole? (b) What is the critical success factors should be considered to measure employee performance in automotive industry?
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Clinical tooth preparations and associated measuring methods: a systematic review.
Tiu, Janine; Al-Amleh, Basil; Waddell, J Neil; Duncan, Warwick J
2015-03-01
The geometries of tooth preparations are important features that aid in the retention and resistance of cemented complete crowns. The clinically relevant values and the methods used to measure these are not clear. The purpose of this systematic review was to retrieve, organize, and critically appraise studies measuring clinical tooth preparation parameters, specifically the methodology used to measure the preparation geometry. A database search was performed in Scopus, PubMed, and ScienceDirect with an additional hand search on December 5, 2013. The articles were screened for inclusion and exclusion criteria and information regarding the total occlusal convergence (TOC) angle, margin design, and associated measuring methods were extracted. The values and associated measuring methods were tabulated. A total of 1006 publications were initially retrieved. After removing duplicates and filtering by using exclusion and inclusion criteria, 983 articles were excluded. Twenty-three articles reported clinical tooth preparation values. Twenty articles reported the TOC, 4 articles reported margin designs, 4 articles reported margin angles, and 3 articles reported the abutment height of preparations. A variety of methods were used to measure these parameters. TOC values seem to be the most important preparation parameter. Recommended TOC values have increased over the past 4 decades from an unachievable 2- to 5-degree taper to a more realistic 10 to 22 degrees. Recommended values are more likely to be achieved under experimental conditions if crown preparations are performed outside of the mouth. We recommend that a standardized measurement method based on the cross sections of crown preparations and standardized reporting be developed for future studies analyzing preparation geometry. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.
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Dallan, Iacopo; Castelnuovo, Paolo; de Notaris, Matteo; Sellari-Franceschini, Stefano; Lenzi, Riccardo; Turri-Zanoni, Mario; Battaglia, Paolo; Prats-Galino, Alberto
2013-05-01
The superior orbital fissure is a critical three-dimensional space connecting the middle cranial fossa and the orbit. From an endoscopic viewpoint, only the medial aspect has a clinical significance. It presents a critical relationship with the lateral sellar compartment, the pterygopalatine fossa and the middle cranial fossa. The connective tissue layers and neural and vascular structures of this region are described. The role of Muller's muscle is confirmed, and the utility of the maxillary and optic strut is outlined. Muller's muscle extends for the whole length of the inferior orbital fissure, passes over the maxillary strut and enters the superior orbital fissure, representing a critical surgical landmark. Dividing the tendon between the medial and inferior rectus muscle allows the identification of the main trunk of the oculomotor nerve, and a little laterally, it is usually possible to visualize the first part of the ophthalmic artery. Based on a better knowledge of anatomy, we trust that this area could be readily addressed in clinical situations requiring an extended approach in proximity of the orbital apex.
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Landslide Susceptibility Statistical Methods: A Critical and Systematic Literature Review
Mihir, Monika; Malamud, Bruce; Rossi, Mauro; Reichenbach, Paola; Ardizzone, Francesca
2014-05-01
Landslide susceptibility assessment, the subject of this systematic review, is aimed at understanding the spatial probability of slope failures under a set of geomorphological and environmental conditions. It is estimated that about 375 landslides that occur globally each year are fatal, with around 4600 people killed per year. Past studies have brought out the increasing cost of landslide damages which primarily can be attributed to human occupation and increased human activities in the vulnerable environments. Many scientists, to evaluate and reduce landslide risk, have made an effort to efficiently map landslide susceptibility using different statistical methods. In this paper, we do a critical and systematic landslide susceptibility literature review, in terms of the different statistical methods used. For each of a broad set of studies reviewed we note: (i) study geography region and areal extent, (ii) landslide types, (iii) inventory type and temporal period covered, (iv) mapping technique (v) thematic variables used (vi) statistical models, (vii) assessment of model skill, (viii) uncertainty assessment methods, (ix) validation methods. We then pulled out broad trends within our review of landslide susceptibility, particularly regarding the statistical methods. We found that the most common statistical methods used in the study of landslide susceptibility include logistic regression, artificial neural network, discriminant analysis and weight of evidence. Although most of the studies we reviewed assessed the model skill, very few assessed model uncertainty. In terms of geographic extent, the largest number of landslide susceptibility zonations were in Turkey, Korea, Spain, Italy and Malaysia. However, there are also many landslides and fatalities in other localities, particularly India, China, Philippines, Nepal and Indonesia, Guatemala, and Pakistan, where there are much fewer landslide susceptibility studies available in the peer-review literature. This
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Sigal, Amanda; Sandler, Irwin; Wolchik, Sharlene; Braver, Sanford
2009-01-01
Most parent education programs are designed to improve child well-being following divorce by changing some aspect of parenting. However, there has been relatively little discussion of what aspects of parenting are most critical and the effectiveness of programs to change different aspects of parenting. This paper addresses these issues by: 1. Distinguishing three aspects of post-divorce parenting that have been targeted in parent education programs; 2. Reviewing evidence of the relations between each aspect of parenting and the well-being of children and; 3. Critically reviewing evidence that parent education programs have been successful in changing each aspect of post-divorce parenting. PMID:21552360
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Critical factors for the success of orthodontic mini-implants: a systematic review.
Chen, Yan; Kyung, Hee Moon; Zhao, Wen Ting; Yu, Won Jae
2009-03-01
This systematic review was undertaken to discuss factors that affect mini-implants as direct and indirect orthodontic anchorage. The data were collected from electronic databases (Medline [Entrez PubMed], Embase, Web of Science, Cochrane Library, and All Evidence Based Medicine Reviews). Randomized clinical trials, prospective and retrospective clinical studies, and clinical trials concerning the properties, affective factors, and requirements of mini-implants were considered. The titles and abstracts that appeared to fulfill the initial selection criteria were collected by consensus, and the original articles were retrieved and evaluated with a methodologic checklist. A hand search of key orthodontic journals was performed to identify recent unindexed literature. The search strategy resulted in 596 articles. By screening titles and abstracts, 126 articles were identified. After the exclusion criteria were applied, 16 articles remained. The analyzed results of the literature were divided into 2 topics: placement-related and loading-related factors. Mini-implants are effective as anchorage, and their success depends on proper initial mechanical stability and loading quality and quantity.
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Directory of Open Access Journals (Sweden)
Danielle Faye Tran
2013-01-01
Full Text Available Review of the monograph:Derek Hook, A Critical Psychology of the Postcolonial: The Mind of Apartheid, London: Routledge, 2012, ISBN 978-0-415-58757-0, 251 pagesBesprechung der Monographie:Derek Hook, A Critical Psychology of the Postcolonial: The Mind of Apartheid, London: Routledge, 2012, ISBN 978-0-415-58757-0, 251 Seiten
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Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation
Directory of Open Access Journals (Sweden)
Luca Masotti
2008-06-01
Full Text Available Luca Masotti1,8, Patrick Ray2, Marc Righini3, Gregoire Le Gal4, Fabio Antonelli5, Giancarlo Landini1, Roberto Cappelli6, Domenico Prisco7, Paola Rottoli81Internal Medicine, Cecina Hospital, Cecina, Italy; 2Department of Emergency Medicine, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Université Pierre et Marie Curie-Paris 6, Paris, France; 3Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland; 4Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France; 5Clinical Chemistry, Cecina Hospital, Cecina, Italy; 6Department of Internal, Cardiovascular and Geriatric Medicine, University of Siena, Siena, Italy; 7Department of Critical Care Medicine, Thrombosis Centre, Careggi Hospital, Florence, Italy; 8Departiment of Clinical Medicine and Immunological Sciences, Division of Respiratory Diseases, University of Siena, Siena, ItalyObjective: Diagnosis of pulmonary embolism (PE remains difficult and is often missed in the elderly due to nonspecific and atypical presentation. Diagnostic algorithms able to rule out PE and validated in young adult patients may have reduced applicability in elderly patients, which increases the number of diagnostic tools use and costs. The aim of the present study was to analyze the reported clinical presentation of PE in patients aged 65 and more.Materials and Methods: Prospective and retrospective English language studies dealing with the clinical, instrumental and laboratory aspects of PE in patients more than 65 and published after January 1987 and indexed in MEDLINE using keywords as pulmonary embolism, elderly, old, venous thromboembolism (VTE in the title, abstract or text, were reviewed.Results: Dyspnea (range 59%–91.5%, tachypnea (46%–74%, tachycardia (29%–76%, and chest pain (26%–57% represented the most common clinical symptoms and signs. Bed rest was the most frequent risk factor for VTE (15%–67%; deep vein
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A new prescription for empirical ethics research in pharmacy: a critical review of the literature
Cooper, R J; Bissell, P; Wingfield, J
2007-01-01
Empirical ethics research is increasingly valued in bioethics and healthcare more generally, but there remain as yet under-researched areas such as pharmacy, despite the increasingly visible attempts by the profession to embrace additional roles beyond the supply of medicines. A descriptive and critical review of the extant empirical pharmacy ethics literature is provided here. A chronological change from quantitative to qualitative approaches is highlighted in this review, as well as differi...
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Conceptualizations of clinical leadership: a review of the literature
Mianda, Solange; Voce, Anna S
2017-01-01
Introduction Poor patient outcomes in South African maternal health settings have been associated with inadequately performing health care providers and poor clinical leadership at the point of care. While skill deficiencies among health care providers have been largely addressed, the provision of clinical leadership has been neglected. In order to develop and implement initiatives to ensure clinical leadership among frontline health care providers, a need was identified to understand the ways in which clinical leadership is conceptualized in the literature. Design Using the systematic quantitative literature review, papers published between 2004 and 2016 were obtained from search engines (Google Scholar and EBSCOhost). Electronic databases (CINHAL, PubMed, Medline, Academic Search Complete, Health Source: Consumer, Health Source: Nursing/Academic, ScienceDirect and Ovid®) and electronic journals (Contemporary Nurse, Journal of Research in Nursing, Australian Journal of Nursing and Midwifery, International Journal of Clinical Leadership) were also searched. Results Using preselected inclusion criteria, 7256 citations were identified. After screening 230 potentially relevant full-text papers for eligibility, 222 papers were excluded because they explored health care leadership or clinical leadership among health care providers other than frontline health care providers. Eight papers met the inclusion criteria for the review. Most studies were conducted in high-income settings. Conceptualizations of clinical leadership share similarities with the conceptualizations of service leadership but differ in focus, with the intent of improving direct patient care. Clinical leadership can be a shared responsibility, performed by every competent frontline health care provider, regardless of the position in the health care system. Conclusion Conceptualizations of clinical leadership among frontline health care providers arise mainly from high-income settings. Understanding the
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Conceptualizations of clinical leadership: a review of the literature.
Mianda, Solange; Voce, Anna S
2017-01-01
Poor patient outcomes in South African maternal health settings have been associated with inadequately performing health care providers and poor clinical leadership at the point of care. While skill deficiencies among health care providers have been largely addressed, the provision of clinical leadership has been neglected. In order to develop and implement initiatives to ensure clinical leadership among frontline health care providers, a need was identified to understand the ways in which clinical leadership is conceptualized in the literature. Using the systematic quantitative literature review, papers published between 2004 and 2016 were obtained from search engines (Google Scholar and EBSCOhost). Electronic databases (CINHAL, PubMed, Medline, Academic Search Complete, Health Source: Consumer, Health Source: Nursing/Academic, ScienceDirect and Ovid ® ) and electronic journals ( Contemporary Nurse , Journal of Research in Nursing , Australian Journal of Nursing and Midwifery , International Journal of Clinical Leadership ) were also searched. Using preselected inclusion criteria, 7256 citations were identified. After screening 230 potentially relevant full-text papers for eligibility, 222 papers were excluded because they explored health care leadership or clinical leadership among health care providers other than frontline health care providers. Eight papers met the inclusion criteria for the review. Most studies were conducted in high-income settings. Conceptualizations of clinical leadership share similarities with the conceptualizations of service leadership but differ in focus, with the intent of improving direct patient care. Clinical leadership can be a shared responsibility, performed by every competent frontline health care provider, regardless of the position in the health care system. Conceptualizations of clinical leadership among frontline health care providers arise mainly from high-income settings. Understanding the influence of context on
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Five-year review of an international clinical research-training program
Directory of Open Access Journals (Sweden)
Suemoto CK
2015-04-01
Center, Orthopedics and Traumatology Institute, University of Sao Paulo Medical School, São Paulo, Brazil; 15Department of Medical Science, Faculty of Medicine, University Federal of Rio Grande do Sul, Porto Alegre, Brazil; 16Quintiles Transnational, São Paulo, Brazil; 17Department of Physical Medicine and Rehabilitation, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal; 18Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 19Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA Abstract: The exponential increase in clinical research has profoundly changed medical sciences. Evidence that has accumulated in the past three decades from clinical trials has led to the proposal that clinical care should not be based solely on clinical expertise and patient values, and should integrate robust data from systematic research. As a consequence, clinical research has become more complex and methods have become more rigorous, and evidence is usually not easily translated into clinical practice. Therefore, the instruction of clinical research methods for scientists and clinicians must adapt to this new reality. To address this challenge, a global distance-learning clinical research-training program was developed, based on collaborative learning, the pedagogical goal of which was to develop critical thinking skills in clinical research. We describe and analyze the challenges and possible solutions of this course after 5 years of experience (2008–2012 with this program. Through evaluation by students and faculty, we identified and reviewed the following challenges of our program: 1 student engagement and motivation, 2 impact of heterogeneous audience on learning, 3 learning in large groups, 4 enhancing group learning, 5 enhancing social presence, 6 dropouts, 7 quality control, and 8 course management. We discuss
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Radiation-Induced Cataractogenesis: A Critical Literature Review for the Interventional Radiologist
Energy Technology Data Exchange (ETDEWEB)
Seals, Kevin F., E-mail: KSeals@mednet.ucla.edu; Lee, Edward W., E-mail: EdwardLee@mednet.ucla.edu [David Geffen School of Medicine at UCLA, Division of Interventional Radiology, Department of Radiology, UCLA Medical Center (United States); Cagnon, Christopher H., E-mail: CCagnon@mednet.ucla.edu [University of California at Los Angeles, Department of Radiology (United States); Al-Hakim, Ramsey A., E-mail: RAlhakim@mednet.ucla.edu; Kee, Stephen T., E-mail: SKee@mednet.ucla.edu [David Geffen School of Medicine at UCLA, Division of Interventional Radiology, Department of Radiology, UCLA Medical Center (United States)
2016-02-15
Extensive research supports an association between radiation exposure and cataractogenesis. New data suggests that radiation-induced cataracts may form stochastically, without a threshold and at low radiation doses. We first review data linking cataractogenesis with interventional work. We then analyze the lens dose typical of various procedures, factors modulating dose, and predicted annual dosages. We conclude by critically evaluating the literature describing techniques for lens protection, finding that leaded eyeglasses may offer inadequate protection and exploring the available data on alternative strategies for cataract prevention.
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Clinical review: Ethics and end-of-life care for critically ill patients in China
Li, Li Bin
2013-01-01
Critical care medicine in China has made great advances in recent decades. This has led to an unavoidable issue: end-of-life ethics. With advances in medical technology and therapeutics allowing the seemingly limitless maintenance of life, the exact time of death of an individual patient is often determined by the decision to limit life support. How to care for patients at the end of life is not only a medical problem but also a social, ethical, and legal issue. A lot of factors, besides cult...
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Temporal discounting in life cycle assessment: A critical review and theoretical framework
International Nuclear Information System (INIS)
Yuan, Chris; Wang, Endong; Zhai, Qiang; Yang, Fan
2015-01-01
Temporal homogeneity of inventory data is one of the major problems in life cycle assessment (LCA). Addressing temporal homogeneity of life cycle inventory data is important in reducing the uncertainties and improving the reliability of LCA results. This paper attempts to present a critical review and discussion on the fundamental issues of temporal homogeneity in conventional LCA and propose a theoretical framework for temporal discounting in LCA. Theoretical perspectives for temporal discounting in life cycle inventory analysis are discussed first based on the key elements of a scientific mechanism for temporal discounting. Then generic procedures for performing temporal discounting in LCA is derived and proposed based on the nature of the LCA method and the identified key elements of a scientific temporal discounting method. A five-step framework is proposed and reported in details based on the technical methods and procedures needed to perform a temporal discounting in life cycle inventory analysis. Challenges and possible solutions are also identified and discussed for the technical procedure and scientific accomplishment of each step within the framework. - Highlights: • A critical review for temporal homogeneity problem of life cycle inventory data • A theoretical framework for performing temporal discounting on inventory data • Methods provided to accomplish each step of the temporal discounting framework
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Integration technique of digital I and C replacement and its Critical Digital Review procedure
International Nuclear Information System (INIS)
Huang, Hui-Wen; Yang, Wen-Long
2013-01-01
Highlights: ► A digital I and C replacement integration technique have been developed. ► Establishment of Nuclear Power Plant Digital Replacement Integration Guideline. ► Preliminary Investigation on I and C System Digitalization. ► Evaluation on I and C System Digitalization. ► Establishment of I and C System Digitalization Architectures. -- Abstract: Institute of Nuclear Energy Research (INER) developed a digital Instrumentation and Control (I and C) replacement integration technique on the basis of requirement of the three existing nuclear power plants (NPPs), which are Chin–Shan (CS) NPP, Kuo–Sheng (KS) NPP, and Maanshan (MS) NPP, in Taiwan, and also developed the related Critical Digital Review (CDR) procedure. The digital I and C replacement integration technique includes: (1) Establishment of Nuclear Power Plant Digital Replacement Integration Guideline, (2) Preliminary Investigation on I and C System Digitalization, (3) Evaluation on I and C System Digitalization, and (4) Establishment of I and C System Digitalization Architectures. These works can be a reference for performing I and C system digital replacement integration of the three existing NPPs of Taiwan Power Company (TPC). A CDR is the review for a critical system digital I and C replacement. The major reference of this procedure is EPRI TR-1011710 (2005) “Handbook for Evaluating Critical Digital Equipment and Systems” which was published by the Electric Power Research Institute (EPRI). With this document, INER developed a TPC-specific CDR procedure. Currently, CDR becomes one of the policies for digital I and C replacement in TPC. The contents of this CDR procedure include: Scope, Responsibility, Operation Procedure, Operation Flow Chart, CDR review items. The CDR review items include the comparison of the design change, Software Verification and Validation (SV and V), Failure Mode and Effects Analysis (FMEA), Evaluation of Diversity and Defense-in-depth (D3), Evaluation of
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SERVICE MARKETING MIX OF INDIAN HOSPITALS: A CRITICAL REVIEW
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Dharmesh, MOTWANI
2014-07-01
Full Text Available Sreenivas, Srinivasarao and Srinivasa (2013 said that “The health care market has become consumer centered and expecting high quality care at a reasonable price. The mushroomed development of corporate hospitals in India, competition is also bringing massive changes in industry structure. In this context, hospital services’ marketing is slowly and surely coming of age and is being woven into the fabric of hospitals planning and public relations programmes.” The essence of any marketing activity is marketing mix, and the central theme of the present paper revolves around the contemporary service marketing mix offered by Indian hospitals. In this paper author has critically reviewed 51 papers to describe elements of hospital service marketing mix; product, price, place, promotion, people, process and physical evidence.