WorldWideScience

Sample records for everyday clinical practice

  1. How GPs implement clinical guidelines in everyday clinical practice

    DEFF Research Database (Denmark)

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

    2015-01-01

    BACKGROUND: Clinical guidelines are considered to be essential for improving quality and safety of health care. However, interventions to promote implementation of guidelines have demonstrated only partial effectiveness and the reasons for this apparent failure are not yet fully understood....... OBJECTIVE: To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices. METHODS: Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form....... Interviews were recorded, transcribed verbatim and then analysed using systematic text condensation. RESULTS: Analysis of the interviews revealed three different approaches to the implementation of guidelines in clinical practice. In some practices the GPs prioritized time and resources on collective...

  2. Bruxism and TMD disorders of everyday dental clinical practice.

    Science.gov (United States)

    Kapusevska, Biljana; Dereban, Nikola; Popovska, Mirjana; Nikolovska, Julijana; Popovska, Lidija

    2013-01-01

    Bruxism, as an etiological factor for the development of TMD, includes different disorders of the TMJ and the masticatory muscles, exhibiting pain and disruption of the stomatognathic functions. Our goal was to study patients with bruxism and TMD from everyday dental clinical practice, in terms of diagnosis, identification of etiological factors, classification and treatment of these disorders. We treated 120 patients, divided into 2 groups of 60 patients. The first group had disorders of the TMJ, and the second of the masticatory muscles. The groups were divided into subgroups of 20 patients with dislocation of the articular disk with or without reduction and inflammation of TMJ. The second group was organized from patients with myofascial pain, myositis and muscular trismus. Our conservative treatment consisted of patient education, NSAID, myorelaxants, fabrication of prosthetics, repositioning and stabilization splints. The progress of the patients was followed immediately after the delivery of the prosthetics and the splint, after 1, 6 and 12 months. The results showed that in patients with disorders of the TMJ there were visible signs of recovery after 6 months in 68.3% patients, and in 85% after 12 months. In the second group we achieved faster results with the elimination of symptoms. Patients with afflictions of the muscles in 88.3% of cases noticed relief of symptoms even after 6 months and in 98.3% after 12 months. As therapists we concluded that timely treated complications of bruxism and TMD prevent the destruction of the TMJ, masticatory muscles and the entire stomatognatic system.

  3. How GPs implement clinical guidelines in everyday clinical practice--a qualitative interview study.

    Science.gov (United States)

    Le, Jette V; Hansen, Helle P; Riisgaard, Helle; Lykkegaard, Jesper; Nexøe, Jørgen; Bro, Flemming; Søndergaard, Jens

    2015-12-01

    Clinical guidelines are considered to be essential for improving quality and safety of health care. However, interventions to promote implementation of guidelines have demonstrated only partial effectiveness and the reasons for this apparent failure are not yet fully understood. To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices. Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form. Interviews were recorded, transcribed verbatim and then analysed using systematic text condensation. Analysis of the interviews revealed three different approaches to the implementation of guidelines in clinical practice. In some practices the GPs prioritized time and resources on collective implementation activities and organized their everyday practice to support these activities. In other practices GPs discussed guidelines collectively but left the application up to the individual GP whilst others again saw no need for discussion or collective activities depending entirely on the individual GP's decision on whether and how to manage implementation. Approaches to implementation of clinical guidelines vary substantially between practices. Supporting activities should take this into account. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Nocebo phenomena in medicine: their relevance in everyday clinical practice.

    Science.gov (United States)

    Häuser, Winfried; Hansen, Ernil; Enck, Paul

    2012-06-01

    Nocebo phenomena are common in clinical practice and have recently become a popular topic of research and discussion among basic scientists, clinicians, and ethicists. We selectively searched the PubMed database for articles published up to December 2011 that contained the key words "nocebo" or "nocebo effect." By definition, a nocebo effect is the induction of a symptom perceived as negative by sham treatment and/or by the suggestion of negative expectations. A nocebo response is a negative symptom induced by the patient's own negative expectations and/or by negative suggestions from clinical staff in the absence of any treatment. The underlying mechanisms include learning by Pavlovian conditioning and reaction to expectations induced by verbal information or suggestion. Nocebo responses may come about through unintentional negative suggestion on the part of physicians and nurses. Information about possible complications and negative expectations on the patient's part increases the likelihood of adverse effects. Adverse events under treatment with medications sometimes come about by a nocebo effect. Physicians face an ethical dilemma, as they are required not just to inform patients of the potential complications of treatment, but also to minimize the likelihood of these complications, i.e., to avoid inducing them through the potential nocebo effect of thorough patient information. Possible ways out of the dilemma include emphasizing the fact that the proposed treatment is usually well tolerated, or else getting the patient's permission to inform less than fully about its possible side effects. Communication training in medical school, residency training, and continuing medical education would be desirable so that physicians can better exploit the power of words to patients' benefit, rather than their detriment.

  5. Are There Any Downsides, Barriers, or Challenges in Delivering Hemodiafiltration in Everyday Clinical Practice?

    Science.gov (United States)

    Blankestijn, Peter J; Grooteman, Muriel; Nube, Menso

    2017-01-01

    There is considerable evidence to suggest that on-line hemodiafiltration (HDF) is superior to standard hemodialysis when comparing effects on clinical end points, especially when a certain minimum convection volume can be achieved. In this chapter we address the question of whether there are any downsides, challenges, or barriers in delivering on-line HDF in everyday clinical practice. We discuss the subject from a medical/practical point of view and briefly from a financial/economic perspective. © 2017 S. Karger AG, Basel.

  6. Entrepreneurship as everyday practice

    DEFF Research Database (Denmark)

    Blenker, Per; Frederiksen, Signe Hedeboe; Korsgaard, Steffen

    2012-01-01

    Adopting the perspective of ‘entrepreneurship as an everyday practice’ in education, the authors conceptualize opportunities as arising from the everyday practice of individuals. Opportunities are thus seen as emanating from the individual entrepreneur’s ability to disclose anomalies and disharmo......Adopting the perspective of ‘entrepreneurship as an everyday practice’ in education, the authors conceptualize opportunities as arising from the everyday practice of individuals. Opportunities are thus seen as emanating from the individual entrepreneur’s ability to disclose anomalies...... and disharmonies in their personal life. The paper illustrates how opportunities unfold depending on regional differences, local heritage and gender, to show how entrepreneurship education must take into account differences in context, culture and circumstance. Rather than perceiving entrepreneurship education...... as universalistic and searching for a generally applicable teaching approach, the authors argue that there is a need to tailor entrepreneurship education to the particular. They therefore propose that the pedagogy of entrepreneurship education should be personalized and they build a conceptual framework...

  7. Everyday Comfort Practice

    DEFF Research Database (Denmark)

    Jaffari, Svenja

    engineering praxis only, in order to address these issues. The empirical work is based on a user-driven innovation project (Indoor Climate & Quality of Life), where engineers, designers, sociologists and anthropologists met in order to exchange their different perspectives and collaboratively form new ideas...... the outdoor. This can be seen, for instance, in 'tight' low-energy buildings that host indoor climate products, which are often controlled by automated systems, to deliver optimal comfort conditions (i.e. temperature, humidity, air quality, noise, and light) to occupants. Buildings' indoor climate is designed......, engineering scientists and practitioners still seem to struggle with the kinds of alternative processes and products that are needed to achieve sustainable comfort. This dissertation applies everyday practice-oriented design ethnography to a field that has traditionally been investigated by scientific...

  8. The experience and awareness of laparoendoscopic procedures among Polish surgeons in everyday clinical practice.

    Science.gov (United States)

    Mitura, Kryspin; Dąbrowiecki, Stanisław; Śmietański, Maciej; Matyja, Andrzej

    2017-01-01

    In 2012, a total of 56 647 inguinal hernia repairs were performed in Poland. However, the absence of a uniform hernia repair register obscures the current herniology status in Poland, especially regarding laparoendoscopic procedures. To determine the awareness of laparoendoscopic procedures among Polish surgeons and to ascertain their everyday clinical practice. The data were collected at the national hernia conference in 2016, during an interactive session for surgeons with a special interest in herniology. They could respond to the survey items using the VoxVote application. All items and response options were displayed on participants' smartphones. The questions were related to transabdominal preperitoneal/totally extraperitoneal (TAPP/TEP) hernia repair. The surgeons responded to 27 questions regarding routine inguinal hernia repair. One hundred and six surgeons from all regions of Poland participated in the survey. 19.2% of respondents never inform patients about the possibility of performing laparoendoscopic repair. 45.2% admitted that they had referred a patient with a difficult inguinal hernia to another hospital or surgeon. Seventy-five percent stated they would be willing to perform TAPP/TEP if the reimbursement rates were more favourable. In bilateral hernias, 61.6% of the respondents perform a two-step open repair, while only 25% perform a single-stage laparoendoscopic repair of bilateral hernia. In women, only 13.3% perform laparoendoscopic hernia repairs, and 19.0% do not use mesh. The skill level to perform TAPP/TEP repair is still inadequate among Polish surgeons. The absence of accurate data makes it impossible to verify whether the treatment methods used are compliant with the guidelines.

  9. How to measure kyphosis in everyday clinical practice: a reliability study on different methods.

    Science.gov (United States)

    Zaina, Fabio; Donzelli, Sabrina; Lusini, Monia; Negrini, Stefano

    2012-01-01

    The sagittal plane measures have a relevant role both in Idiopathic Scoliosis (AIS) and in Hyperkyphosis (HK) management. Nevertheless, clinical tools for everyday use are scarce and not adequately studied. To assess the repeatability of different methods for the collection of the sagittal profile of patients with spinal deformities during everyday clinics. We performed 4 different studies in 4 different populations of AIS and HK patients. In the first study we reported the normative data and measurement error of the plumbline measures in a general population of 180 adolescents. In the second study we compared the sagittal distances from the plumbline of C7, T12, L3, and Sagittal Index (SI = C7+L3) with the measures of the Video Rasterstereography at the same levels and the angles of kyphosis and lordosis in 100 AIS patients. In the third study we evaluated the intra and inter-rater repeatability and the measurement error of kyphosis and lordosis angles measured with the Inclimed in 100 AIS patients. In the last study we evaluated the repeatability of the sagittal distances from the plumbline, by using a 1 mm change instead of 5 mm in a population of 40 patients. repeatability has been evaluated according to Bland and Altman, to identify the limits of variation that are clinically significant. Results. Study 1: the normative data were: females: 34 ± 11 mm for C7; 34 ± 15 mm for L3, males: 34 ± 10 mm for C7; 48 ± 10 mm for L3;. Study 2: a coefficient of correlation was calculated in order to compare measures. Study 3: the k value for Inclimed varied from fair to good. Study 4: the repeatability was fair for this measure. Some clinical instruments are now available for sagittal plane assessment in AIS and hyperkyphosis. The results of the present study report the limits during measurements in a clinical setting of parameters that are routinely collected by some clinicians.

  10. Connecting to Everyday Practices

    DEFF Research Database (Denmark)

    Iversen, Ole Sejer; Smith, Rachel Charlotte

    2012-01-01

    construction and reproduction of cultural heritage creating novel connections between self and others and between past, present and future. We present experiences from a current research project, the Digital Natives exhibition, in which social media was designed as an integral part of the exhibition to connect...... focusing on the connections between audiences practices and the museum exhibition....

  11. Professional Knowledge and Everyday Practice

    DEFF Research Database (Denmark)

    Schmidt, Camilla

    their professional knowledge with regards to collective reflection and creating coherent practices and everyday lives for children and families. I propose an alternative perspective on development of professional knowledge, which takes aspects of professional knowledge and everyday practice......Professional care work in preschools in Denmark is faced with a knowledge crisis, due to increasing influence by regulations from state and market. As a consequence the professionals seem more inclined to focus on how to meet demands for documentation, rather than focusing on developing...... and professional knowledge must involve an understanding of the importance of routines, habits and practical tasks. The analysis takes its point of departure in observations and interviews in a daycare institution with a combined nursery and preschool (age 0-6 years) In order to grasp the knowledge quality...

  12. Evidence-Based Dentistry in Everyday Practice.

    Science.gov (United States)

    Gudray, Kiran; Walmsley, Anthony Damien

    2016-12-01

    This article informs readers of a method of implementing evidence-based dentistry in practice. Following these steps, practitioners should be able to use this skill in an efficient manner. The importance of evidence-based dentistry and its relevance to situations encountered in everyday practice is also highlighted. Clinical relevance: This article highlights a series of steps to be followed by practitioners to ensure that treatment provided is supported by the most recent, good quality evidence.

  13. Disclosing the truth: a dilemma between instilling hope and respecting patient autonomy in everyday clinical practice.

    Science.gov (United States)

    Sarafis, Pavlos; Tsounis, Andreas; Malliarou, Maria; Lahana, Eleni

    2013-12-20

    While medical ethics place a high value on providing truthful information to patients, disclosure practices are far from being the norm in many countries. Transmitting bad news still remains a big problem that health care professionals face in their every day clinical practice. Through the review of relevant literature, an attempt to examine the trends in this issue worldwide will be made. Various electronic databases were searched by the authors and through systematic selection 51 scientific articles were identified that this literature review is based on. There are many parameters that lead to the concealment of truth. Factors related to doctors, patients and their close environment, still maintain a strong resistance against disclosure of diagnosis and prognosis in terminally ill patients, while cultural influences lead to different approaches in various countries. Withholding the truth is mainly based in the fear of causing despair to patients. However, fostering a spurious hope, hides the danger of its' total loss, while it can disturb patient-doctor relationship.

  14. Understanding the essential elements of work-based learning and its relevance to everyday clinical practice.

    Science.gov (United States)

    Williams, Caroline

    2010-09-01

    To critically review the work-based learning literature and explore the implications of the findings for the development of work-based learning programmes. With NHS budgets under increasing pressure, and challenges to the impact of classroom-based learning on patient outcomes, work-based learning is likely to come under increased scrutiny as a potential solution. Evidence from higher education institutions suggests that work-based learning can improve practice, but in many cases it is perceived as little more than on-the-job training to perform tasks. The CINAHL database was searched using the keywords work-based learning, work-place learning and practice-based learning. Those articles that had a focus on post-registration nursing were selected and critically reviewed. Using the review of the literature, three key issues were explored. Work-based learning has the potential to change practice. Learning how to learn and critical reflection are key features. For effective work-based learning nurses need to take control of their own learning, receive support to critically reflect on their practice and be empowered to make changes to that practice. A critical review of the literature has identified essential considerations for the implementation of work-based learning. A change in culture from classroom to work-based learning requires careful planning and consideration of learning cultures. To enable effective work-based learning, nurse managers need to develop a learning culture in their workplace. They should ensure that skilled facilitation is provided to support staff with critical reflection and effecting changes in practice. CONTRIBUTION TO NEW KNOWLEDGE: This paper has identified three key issues that need to be considered in the development of work-based learning programmes. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

  15. Everyday ethics issues in the outpatient clinical practice of pediatric residents.

    Science.gov (United States)

    Moon, Margaret; Taylor, Holly A; McDonald, Erin L; Hughes, Mark T; Carrese, Joseph A

    2009-09-01

    To describe the ethics issues that pediatric residents encounter during routine care in an outpatient teaching clinic. Qualitative study including in-depth interviews with pediatric residents and direct observation of interactions between preceptors and residents in a pediatric teaching clinic. The Johns Hopkins Harriet Lane Pediatric Primary Care Clinic, March 20 through April 11, 2006. A convenience sample including all pediatric faculty preceptors supervising at the clinic during the 19 half-day sessions that occurred during the observation period (N = 15) and the pediatric residents seeing patients during these clinic sessions (N = 50). Main Outcome Measure Field notes of preceptor-resident discussions about patient care were made and transcribed for qualitative analysis. Qualitative analysis of the ethics content of cases presented by residents in this pediatric teaching clinic identified 5 themes for categorizing ethics challenges: (1) promoting the child's best interests in complex and resource-poor home and social settings; (2) managing the therapeutic alliance with parents and caregivers; (3) protecting patient privacy and confidentiality; (4) balancing the dual roles of learner and health care provider; and (5) using professional authority appropriately. Qualitative analysis of the ethics content of directly observed preceptor-resident case discussions yielded a set of themes describing the ethics challenges facing pediatric residents. The themes are somewhat different from the lists of residents' ethics experiences developed using recall or survey methods and may be very different from the ideas usually included in hospital-based ethics discussions. This may have implications for improving ethics education during residency training.

  16. Everyday Ethics: Reflections on Practice

    Science.gov (United States)

    Rossman, Gretchen B.; Rallis, Sharon F.

    2010-01-01

    This introductory article frames the contributions for this issue on everyday ethics--moments that demand moral considerations and ethical choices that researchers encounter. We discuss concerns raised within the research community about the tendency to observe merely obligatory ethical procedures as outlined in Human Subjects Review regulations.…

  17. Comparison of paclitaxel- and sirolimus-eluting stents in everyday clinical practice: the SORT OUT II randomized trial

    DEFF Research Database (Denmark)

    Galløe, Anders M; Thuesen, Leif; Kelbaek, Henning

    2008-01-01

    Approval of drug-eluting coronary stents was based on results of relatively small trials of selected patients; however, in routine practice, stents are used in a broader spectrum of patients.......Approval of drug-eluting coronary stents was based on results of relatively small trials of selected patients; however, in routine practice, stents are used in a broader spectrum of patients....

  18. Effect of agomelatine treatment on C-reactive protein levels in patients with major depressive disorder: an exploratory study in "real-world," everyday clinical practice.

    Science.gov (United States)

    De Berardis, Domenico; Fornaro, Michele; Orsolini, Laura; Iasevoli, Felice; Tomasetti, Carmine; de Bartolomeis, Andrea; Serroni, Nicola; De Lauretis, Ida; Girinelli, Gabriella; Mazza, Monica; Valchera, Alessandro; Carano, Alessandro; Vellante, Federica; Matarazzo, Ilaria; Perna, Giampaolo; Martinotti, Giovanni; Di Giannantonio, Massimo

    2017-08-01

    Agomelatine is a newer antidepressant but, to date, no studies have been carried out investigating its effects on C-reactive protein (CRP) levels in major depressive disorder (MDD) before and after treatment. The present study aimed (i) to investigate the effects of agomelatine treatment on CRP levels in a sample of patients with MDD and (ii) to investigate if CRP variations were correlated with clinical improvement in such patients. 30 adult outpatients (12 males, 18 females) with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis of MDD were recruited in "real-world," everyday clinical practice and treated with a flexible dose of agomelatine for 12 weeks. The Hamilton Rating Scale for Depression (HAM-D) and the Snaith-Hamilton Pleasure Scale (SHAPS) were used to evaluate depressive symptoms and anhedonia, respectively. Moreover, serum CRP was measured at baseline and after 12 weeks of treatment. Agomelatine was effective in the treatment of MDD, with a significant reduction in HAM-D and SHAPS scores from baseline to endpoint. CRP levels were reduced in the whole sample, with remitters showing a significant difference in CRP levels after 12 weeks of agomelatine. A multivariate stepwise linear regression analysis showed that higher CRP level variation was associated with higher baseline HAM-D scores, controlling for age, gender, smoking, BMI, and agomelatine dose. Agomelatine's antidepressant properties were associated with a reduction in circulating CRP levels in MDD patients who achieved remission after 12 weeks of treatment. Moreover, more prominent CRP level variation was associated with more severe depressive symptoms at baseline.

  19. 45.2 THE EFFECTIVENESS OF PARENT TRAINING AS A TREATMENT FOR PRESCHOOL ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: A MULTI-CENTER RANDOMIZED CONTROLLED TRIAL OF THE NEW FOREST PARENTING PROGRAM IN EVERYDAY CLINICAL PRACTICE

    DEFF Research Database (Denmark)

    Lange, Anne-Mette

    2016-01-01

    to investigate whether the NFPP can be delivered effectively for children who are referred through official community pathways in everyday clinical practice. Methods A multicenter randomized controlled parallel arm trial design was incorporated. There were two treatment arms, NFPP and treatment as usual. NFPP...... behaviors during child’s solo play; observation of parent–child interaction; parent sense of competence; and family stress. Conclusions This trial will provide evidence on whether NFPP is a more effective treatment for preschool ADHD than the treatment usually offered in everyday clinical practice....... consisted of eight individually delivered parenting sessions where the child attended three of the sessions. Outcomes were examined at three time points as follows: T1, baseline; T2, week 12, postintervention; and T3, 6-month follow-up. Children (N = 165; ages 3–7 years) with a clinical diagnosis of ADHD...

  20. Everyday Life with ALS: A Practical Guide

    Science.gov (United States)

    ... some- one or even for getting into a restaurant or shop. One caution: They may have Everyday ... systems that follow eye movement to activate a selection. Wireless sensors/switches, which can attach to virtually ...

  1. [Iron-deficiency anaemia in everyday gynaecological practice].

    Science.gov (United States)

    Lukanova, M; Popov, I

    2004-01-01

    Iron-deficiency anaemia /IDA/ is of utmost significance to clinical practice. Chronic haemorrhages from the genital tract are the major etiological factor for its appearance in 60-70% of the patients. Abnormal genital bleeding for the specialist in Obstetrics and gynaecology and IDA for the haematologist are frequently met problems in their everyday practice, which require detailed examination, good colaboration and synchronization between the work of both specialists. Diagnosing and etiological treatment of IDA of gynaecologic origin by mutual timely and adequate co-operation of gynaecologist and haematologist. Clinical survey based on the algorithm worked out. Its everyday application started in July-August 2001 and till today /30.04.2003/ 253 cases with IDA in the Department of Gynaecology are taken in. A record of proceedings was made for every patient and that helped the further diagnostic and therapeutic activity and respective data processing. The data and results obtained verify the achievement of final diagnostic specification of IDA, the role of the algorithm as a stepping-stone to its etiological treatment, complete and durable correction of iron deficiency.

  2. Important interactional strategies for everyday public health nursing practice.

    Science.gov (United States)

    Porr, Caroline J

    2015-01-01

    This Clinical Concepts article concerns the relational tools required by public health nurses to establish relationships with single mothers living on public assistance, mothers who are vulnerable and often stigmatized. The implications of stigmatization for relationship building are highlighted based on previous research investigating how public health nurses working in Canadian jurisdictions establish professional caring relationships with this cohort of mothers. Public health nurses employed interactional strategies including engaging in a positive manner and offering verbal commendations which served as effective relational tools to break through mothers' walls of defensiveness and to resume the dynamic process of relationship building. Building Relationship is a key practice standard for public health nurses and is instrumental to their work at both individual and community levels to improve social determinants of health. The author concludes with recommendations to facilitate building relationships during everyday public health nursing practice. © 2013 Wiley Periodicals, Inc.

  3. Can practice theory inspire studies of ICTs in everyday life?

    DEFF Research Database (Denmark)

    Christensen, Toke Haunstrup; Røpke, Inge

    2010-01-01

    a new ‘normality’ in everyday life: the expectations and conventions regarding a normal home’s necessary ‘infrastructure’ and the ordinary gear for a normal way of life are changing, and the changes are proceeding rapidly. This chapter takes a closer look at the construction of a new normality...... in everyday life and discusses how this development can be studied from the perspective of practice theory. We show how a practice theory approach shifts the analytic focus away from the consumption of ICT as such and toward the practices that integrate ICT as one element among many others. Thereby......, a practice theory approach helps us to avoid the risk of ending up with a ‘media-centric’ understanding of the use of new media and adds interesting details and subtleties to the study of the construction of a new normality in everyday life. Our application of practice theory in the study...

  4. The everyday challenges of Pro-environmental practices

    DEFF Research Database (Denmark)

    Berthou, Sara Kristine Gløjmar

    2013-01-01

    Much research and policy planning aimed at climate change mitigation currently focuses on individual behavioural change as a means to reduce carbon emissions. An often used approach in order to achieve this is the attempt to influence behaviour through transfers of knowledge and information...... guiding everyday pro-environmental practices, the aim was to examine the challenges experienced in this regard. Based on visits to households in Copenhagen, four major challenges are identified and discussed. The paper argues that everyday life, as the starting point of individual pro......-environmental practices, is characterised by a complexity which people have to navigate, and thus that pro-environmental practices should not be seen as one demarcated field, but as interlinked with other practices in everyday life....

  5. Everyday Humanitarianism: Ethics, Affects and Practices

    DEFF Research Database (Denmark)

    Richey, Lisa Ann; Chouliaraki, Lillie

    2017-01-01

    Our starting point in this special issue is in opening up traditional understandings and practices of humanitarianism to bring multi-faceted approaches to a classical area of political inquiry. As the rhetoric and practice of humanitarian good-doing becomes increasingly widespread in our public...... life—from celebrity culture to Twitter messaging and from Christmas shopping to concert-going—key questions arise. What does humanitarianism look like in the age of market-driven, digital media-based action? What happens to traditional humanitarian ideals, at the time of increasing bureaucratization...... and celebrification of humanitarian practice? What are the implications of such practices for the ethics and politics of contemporary benevolence? Do we live in an age of “post-humanitarianism” where doing good for others is intrinsically linked with feelings of gratification for the self? Universal questions...

  6. The Management of Difference in Everyday School Practice

    DEFF Research Database (Denmark)

    Mottelson, Martha

    The paper will present and discuss our field study of everyday life in a Danish fifth grade classroom. Our aim has been to observe, describe and analyze those everyday practices in the classroom that ultimately result in offering students different positions, identities and opportunities...... for participation. Our goal is to create knowledge about the way difference is constructed and managed in schools. How is the concept of ‘difference’ conceived of, produced and reproduced through everyday practices and how is the management of difference embedded in school culture. Further our goal is to create...... knowledge about the consequences that occur for different students as a result of specific ways of managing differences by teachers....

  7. The materiality of everyday practices in urban greenspace

    DEFF Research Database (Denmark)

    Petersen, Lars Kjerulf

    2013-01-01

    This paper investigates how urban greenspace is integrated in everyday practices of urban populations. What are the social functions that green areas serve, and how do people interact with the materiality of urban greenspace – its bio-physical structures and its nature and landscape. The paper re...

  8. Materialities shape practices and notions of comfort in everyday life

    DEFF Research Database (Denmark)

    Madsen, Line Valdorff

    2018-01-01

    The development of residential energy technologies aims to ensure thermal comfort in an increasingly energy-efficient manner. This development influences everyday practices related to comfort in everyday life in dwellings. Therefore, an empirical analysis of interviews with residents in three types...... in heating systems between the housing types and shows how changes in technologies and material structures shape the practices of heating and airing. A shift in technology from radiators to underfloor heating was found to make a clear difference in both how houses are heated and thermal comfort is perceived...... of Danish detached houses, related to the building age, is used to understand how changes in technologies influence residents’ practices and notions of comfort. Detached houses are the most widespread type of housing in Denmark, constituting 44% of the housing stock. The analysis focuses on differences...

  9. Negotiating clinical knowledge:a field study of psychiatric nurses' everyday communication

    DEFF Research Database (Denmark)

    Buus, Niels

    2008-01-01

    Nursing practices at psychiatric hospitals have changed significantly over the last decades. In this paper, everyday nursing practices were interpreted in light of these institutional changes. The objective was to examine how mental health nurses' production of clinical knowledge was influenced b...... knowledge influenced processes of clinical decision-making among the nurses as the game added to a distorted widening of a 'fictional distance' between patients and the representations produced by the nurses.......Nursing practices at psychiatric hospitals have changed significantly over the last decades. In this paper, everyday nursing practices were interpreted in light of these institutional changes. The objective was to examine how mental health nurses' production of clinical knowledge was influenced...... by the particular social relations on hospital wards. Empirical data stemming from an extended fieldwork at two Danish psychiatric hospital wards were interpreted using interactionistic theory and the metaphor: 'the game of clinical knowledge'. The results indicated that the nurses' production of clinical knowledge...

  10. Teacher Leadership: Everyday Practices Surrounding Work- Related Stress

    Directory of Open Access Journals (Sweden)

    Chiweshe Nigel

    2015-06-01

    Full Text Available This interpretivist study contributes to our scholarly understanding of how everyday practices surrounding work-related stress in education affect teacher leadership and successful learning outcomes. Insights are drawn from our long-standing engagement in the field where we observed how teaching staff, students, and management interacted. These observations were supplemented by in-depth interviews with 20 teaching staff. Our findings reveal competing demands and practices across the individual intrapersonal environment and the work related environment. There were three key themes that emerged in answer to the core research question: 1 the role of relational practices in managing teacher burnout, 2 the role of surveillance practices in education and 3 the role of assimilating practices in education. Drawing insights from these practices, we develop a conceptual framework that will help us to see relations at work anew, and develop a deeper understanding of ‘sickies’, motivation, learning outcomes and teacher leadership opportunities in education

  11. 'It's a matter of patient safety': understanding challenges in everyday clinical practice for achieving good care on the surgical ward - a qualitative study.

    Science.gov (United States)

    Jangland, Eva; Nyberg, Berit; Yngman-Uhlin, Pia

    2017-06-01

    Surgical care plays an important role in the acute hospital's delivery of safe, high-quality patient care. Although demands for effectiveness are high in surgical wards quality of care and patient safety must also be secured. It is therefore necessary to identify the challenges and barriers linked to quality of care and patient safety with a focus on this specific setting. To explore situations and processes that support or hinder good safe patient care on the surgical ward. This qualitative study was based on a strategic sample of 10 department and ward leaders in three hospitals and six surgical wards in Sweden. Repeated reflective interviews were analysed using systematic text condensation. Four themes described the leaders' view of a complex healthcare setting that demands effectiveness and efficiency in moving patients quickly through the healthcare system. Quality of care and patient safety were often hampered factors such as a shift of care level, with critically ill patients cared for without reorganisation of nurses' competencies on the surgical ward. There is a gap between what is described in written documents and what is or can be performed in clinical practice to achieve good care and safe care on the surgical ward. A shift in levels of care on the surgical ward without reallocation of the necessary competencies at the patient's bedside show consequences for quality of care and patient safety. This means that surgical wards should consider reviewing their organisation and implementing more advanced nursing roles in direct patient care on all shifts. The ethical issues and the moral stress on nurses who lack the resources and competence to deliver good care according to professional values need to be made more explicit as a part of the patient safety agenda in the surgical ward. © 2016 Nordic College of Caring Science.

  12. Children's Development as Participation in Everyday Practices across Different Institutions

    DEFF Research Database (Denmark)

    Fleer, Marilyn; Hedegaard, Mariane

    2010-01-01

    Children participate in different institutional collectives in their everyday life. Home, school, and kindergarten are the institutional contexts that most children share. Although there are variations between home practices and school practices, they collectively share a common core framed...... by societal conditions. In drawing upon Vygotsky's (1998) theory of the social situation of development and Hedegaard's (2009) theory of development conceptualised as the child's participation within and across several institutions at the same time, it has been possible to examine how school practices......, were invisible to the educators in this study. The findings suggest foregrounding an understanding of children's development as changes in children's activities and thereby changing their relations to reality across institutional practices in order to support a broader view of development in early...

  13. Practical wisdom, understanding of coherence and competencies for everyday life

    DEFF Research Database (Denmark)

    Benn, Jette

    2009-01-01

    The focus of this article is the subject home economics education in the primary and lower secondary school in the 21st century. Practical wisdom, understanding of coherence and competencies for everyday life are suggested as aims of home economics education. It is argued that these elements should...... and experiencing the profession   [1] Bildung is the German word for education, but it is used as a pedagogical term in English literature as it has another and more specific meaning than the word education. The word in Danish is dannelse....

  14. Everyday ethics: ethical issues and stress in nursing practice.

    Science.gov (United States)

    Ulrich, Connie M; Taylor, Carol; Soeken, Karen; O'Donnell, Patricia; Farrar, Adrienne; Danis, Marion; Grady, Christine

    2010-11-01

    This paper is a report of a study of the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice. Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care. A self-administered survey was sent in 2004 to 1000 nurses in four states in four different census regions of the United States of America. The adjusted response rate was 52%. Data were analysed using descriptive statistics, cross-tabulations and Pearson correlations. A total of 422 questionnaires were used in the analysis. The five most frequently occurring and most stressful ethical and patient care issues were protecting patients' rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making. Other common occurrences were unethical practices of healthcare professionals; breaches of patient confidentiality or right to privacy; and end-of-life decision-making. Younger nurses and those with fewer years of experience encountered ethical issues more frequently and reported higher levels of stress. Nurses from different regions also experienced specific types of ethical problems more commonly. Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed. © 2010 Blackwell Publishing Ltd.

  15. Telemedicine in interdisciplinary work practices: On an IT system that met the criteria for success set out by its sponsors, yet failed to become part of every-day clinical routines

    Directory of Open Access Journals (Sweden)

    Bal Roland

    2008-10-01

    Full Text Available Abstract Background Information systems can play a key role in care innovations including task redesign and shared care. Many demonstration projects have presented evidence of clinical and cost effectiveness and high levels of patient satisfaction. Yet these same projects often fail to become part of everyday clinical routines. The aim of the paper is to gain insight into a common paradox that a technology can meet the criteria for success set out at the start of the project yet fail to become part of everyday clinical routines. Methods We evaluated a telecare service set up to reduce the workload of ophthalmologists. In this project, optometrists in 10 optical shops made digital images to detect patients with glaucoma which were further assessed by trained technicians in the hospital. Over a period of three years, we conducted interviews with the project team and the users about the workability of the system and its integration in practice. Beside the interviews, we analyzed record data to measure the quality of the images. We compared the qualitative accounts with these measurements. Results According to our measurements, the quality of the images was at least satisfactory in 90% of the cases, i.e. the images could be used to screen the patients – reducing the workload of the ophthalmologist considerably. However, both the ophthalmologist and the optometrists became increasingly dissatisfied respectively with the perceived quality of the pictures and the perceived workload. Through a detailed analysis of how the professionals discussed the quality of the pictures, we re-constructed how the notion of quality of the images and being a good professional were constructed and linked. The IT system transformed into a quality system and, at the same time, transformed the notions of being a good professional. While a continuous dialogue about the quality of the pictures became an emblem for the quality of care, this dialogue was hindered by the

  16. Ultra high performance liquid chromatography-tandem mass spectrometry vs. commercial immunoassay for determination of vancomycin plasma concentration in children. Possible implications for everyday clinical practice.

    Science.gov (United States)

    Barco, Sebastiano; Castagnola, Elio; Gennai, Iulian; Barbagallo, Laura; Loy, Anna; Tripodi, Gino; Cangemi, Giuliana

    2016-10-01

    Vancomycin therapeutic drug monitoring (TDM) is necessary for effective and safetherapy. The aim of the this paper was to develop a specific and robust ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method for vancomycin quantification starting from low plasma volumes to be applied for the routine TDM in children. Samples from children receiving intravenous vancomycin were analysed using a TSQ Quantum Access MAX Triple Quadrupole system coupled with an Accela 1250 UHPLC system after a rapid protein precipitation. Gradient separation chromatography was carried out using a Hypersil GOLD aQ C18 column (50 × 2.1 mm, particle size 1.9 μm). Method performance was validated following international guidelines. UHPLC-MS/MS allowed a rapid and specific quantification of vancomycin over the range 0.1-128 μg/mL from 50 μL of plasma with high reproducibility and accuracy in the absence of matrix effect. The comparison with the commercial immunoassay performed on 138 samples demonstrated the presence of a proportional bias. The concentrations of vancomycin measured with immunoassay were found to be 4.5% (95% CI: 1.3-7.7) higher than those determined with UHPLC-MS/MS. Importantly, a clinical discordance was found in about 10% of samples analysed. This new UHPLC-MS/MS method is accurate and specific for the measurement of vancomycin starting from small (50 μL) plasma volumes. The use of UHPLC-MS/MS is recommended to prevent a misclassification of therapeutic or toxic vancomycin levels in paediatrics.

  17. Nurse ethical awareness: Understanding the nature of everyday practice.

    Science.gov (United States)

    Milliken, Aimee; Grace, Pamela

    2017-08-01

    Much attention has been paid to the role of the nurse in recognizing and addressing ethical dilemmas. There has been less emphasis, however, on the issue of whether or not nurses understand the ethical nature of everyday practice. Awareness of the inherently ethical nature of practice is a component of nurse ethical sensitivity, which has been identified as a component of ethical decision-making. Ethical sensitivity is generally accepted as a necessary precursor to moral agency, in that recognition of the ethical content of practice is necessary before consistent action on behalf of patient interests can take place. This awareness is also compulsory in ensuring patient good by recognizing the unique interests and wishes of individuals, in line with an ethic of care. Scholarly and research literature are used to argue that bolstering ethical awareness and ensuring that nurses understand the ethical nature of the role are an obligation of the profession. Based on this line of reasoning, recommendations for education and practice, along with directions for future research, are suggested.

  18. Tiny Moments Matter: Promoting Professionalism in Everyday Practice.

    Science.gov (United States)

    Bernabeo, Elizabeth C; Chesluk, Benjamin; Lynn, Lorna

    2018-01-01

    Professionalism rests upon a number of individual, environmental, and societal level factors, leading to specific professional behavior in specific situations. Focusing on professional lapses to identify and remediate unprofessional physicians is incomplete. We explored professionalism in practicing internal medicine physicians in the context of everyday practice, to highlight how typical experiences contribute to positive, yet often unnoticed, professional behavior. In-depth interviews were used to uncover 13 physicians' most meaningful experiences of professionalism. Data were collected and analyzed using a grounded theory approach. Results revealed several themes around which physicians embody professionalism in their daily lives. Physicians feel most professional when they are able to connect and establish trust with patients and colleagues and when they serve as positive role models to others. Physicians conceptualize professionalism as a dynamic and evolving competency, one that requires a lifelong commitment and that provides opportunities for lifelong learning. Focusing on actual perceptions of experiences in practice offers important insights into how physicians think about professionalism beyond a traditional remediation and lapses perspective. Physicians often go out of their way to connect with patients and colleagues, serving and modeling for others, often at the expense of their own work-life balance. These moments help to infuse energy and positivity into physician practices during a time when physicians may feel overburdened, overscheduled, and overregulated. Understanding professionalism as developmental helps frame professionalism as a lifelong competency subject to growth and modification over time.

  19. [Everyday practice in psychiatry and the politics of civilisation].

    Science.gov (United States)

    Touzet, Patrick

    2015-01-01

    Daily clinical practice confronts us not only with the clinical aspect but also with the political. Political orientation has a direct impact on the way in which we carry out this clinical practice, as well as on the place of those who are outside the system. The politics of civilisation are therefore an option in the face of neoliberalism. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. Everyday classroom assessment practices in science classrooms in Sweden

    Science.gov (United States)

    Gómez, María del Carmen; Jakobsson, Anders

    2014-12-01

    The focus of this study is to examine to what extent and in what ways science teachers practice assessment during classroom interactions in everyday activities in an upper-secondary school in Sweden. We are science teachers working now with a larger research project on assessment in science education that seeks to examine teachers' assessment practices in the upper-secondary school. Framing questions include: are teachers performing an integrated assessment of students' skills as the national curriculum mandates? If so, what do the instructional discourses look like in those situations and what are students' experiences regarding their agency on learning and assessment? We emphasize the social, cultural and historic character of assessment and sustain a situated character of learning instead of the notion that learning is "stored inside the head". Teacher led lessons in three science classrooms were video-recorded and analyzed by combining ethnographic and discourse methods of analysis. Both methods are appropriate to the theoretical foundation of our approach on learning and can give some answers to questions about how individuals interact socially, how their experience is passed on to next generations through language and how language use may reveal cultural changes in the studied context. Making the study of action in a classroom the focal point of sociocultural analysis supports the examination of assessment processes and identification of the social roles in which teachers and students are immersed. Such an approach requires observations of how teachers act in authentic teaching situations when they interact with their students in classroom making possible to observe negotiation processes, agencies when both teachers and students are involved in every-day activities. Our study showed that teachers mostly ignored students' questions and that students solved their own problems by helping each other. Teachers did not provide opportunities for students to discuss

  1. Entrepreneurship as Everyday Practice: Towards a Personalized Pedagogy of Enterprise Education

    Science.gov (United States)

    Blenker, Per; Frederiksen, Signe Hedeboe; Korsgaard, Steffen; Muller, Sabine; Neergaard, Helle; Thrane, Claus

    2012-01-01

    Adopting the perspective of "entrepreneurship as an everyday practice" in education, the authors conceptualize opportunities as arising from the everyday practice of individuals. Opportunities are thus seen as emanating from the individual entrepreneur's ability to disclose anomalies and disharmonies in their personal life. The paper illustrates…

  2. Anytime-Anywhere? Mobile Communicative Practices and the Management of Relationships in Everyday Life

    Science.gov (United States)

    Moreno Becerra, Tabita Alejandra

    2015-01-01

    The present study examines how mobile practices of social-media use are integrated into individuals' everyday lives as a way to manage their relationships. Mobile communication technologies and social-media use intersect in people's everyday communicative practices, allowing individuals to engage in continuous interactions that take place on the…

  3. Dose information – how to use it in everyday practice

    International Nuclear Information System (INIS)

    Seuri, R.

    2013-01-01

    Full text: Patients life-time dose tracking has usually been discussed as a benefit for the individual because of the risks of radiation. There has been less been discussion of the use of stored dose information for the benefit of imaging professionals, in controlling and developing of the everyday work. For justification the referring doctors need information of the patients previous imaging and results, but even they might know the possibilities of different modalities, they often lack the knowledge of the radiation exposure in different procedures. If the dose indicators are stored to pacs together with the images, also the referring physician is able to see the dose difference in e.g. abdominal plain film and CT, or routine head CT compared to limited CT for ventricular dilatation. The same information might be important to both the radiographer and the radiologist when judging the justification of a procedure. Even more important the dose information is for the optimization process. In digital radiography the only way to really know the dose is if it is numerically available, too high dose is not obvious in the image as it was in the film era. In CT we can use the dose information in optimization the same way: comparing image quality, dose indicators and imaging parameters. The same information can also be compared to examinations performed with different scanners or even in different hospitals. This way it serves both optimization and quality control purposes. For quality control the dose information is priceless. Doses for certain procedures are easily collected to be compared to DRLs. Even if dose collection would be a task for a physicist, the results should be evaluated together with image quality. It should be evaluated together with all the imaging professionals: the radiographers, radiologists, physicists, engineers and so on, also especially with new equipment also the vendor’s application specialists. The dose information is very practical in

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  5. Persistent barriers and strategic practices: why (asking about) the everyday matters in diabetes care.

    Science.gov (United States)

    Rendle, Katharine A S; May, Suepattra G; Uy, Visith; Tietbohl, Caroline K; Mangione, Carol M; Frosch, Dominick L

    2013-01-01

    The purpose of this study was to explore the everyday barriers to and practices of low-income patients managing their diabetes. The study team conducted semistructured qualitative interviews with 20 patients with type 2 diabetes who were receiving care at safety-net clinics in Southern California. Transcripts were analyzed using grounded theory to identify emergent themes across participants. Participants described managing diabetes with limited financial resources as often a game of balance and negotiation, whereby purchasing healthy foods is abandoned because of a more pressing concern in their life. Although participants described strategic attempts at incorporating healthy dietary practices for diabetes management into their daily decisions, these efforts were significantly impeded by the existence of persistent and seemingly insurmountable barriers. Although the challenges that low-income patients face in managing their diabetes may seem insurmountable at times, there are several ways that health care providers can help reduce the burden of these challenges, including tailoring their recommendations to incorporate the everyday socioeconomic environment of patients and engaging in clear, open communication with patients.

  6. Beyond a code of ethics: phenomenological ethics for everyday practice.

    Science.gov (United States)

    Greenfield, Bruce; Jensen, Gail M

    2010-06-01

    Physical therapy, like all health-care professions, governs itself through a code of ethics that defines its obligations of professional behaviours. The code of ethics provides professions with a consistent and common moral language and principled guidelines for ethical actions. Yet, and as argued in this paper, professional codes of ethics have limits applied to ethical decision-making in the presence of ethical dilemmas. Part of the limitations of the codes of ethics is that there is no particular hierarchy of principles that govern in all situations. Instead, the exigencies of clinical practice, the particularities of individual patient's illness experiences and the transformative nature of chronic illnesses and disabilities often obscure the ethical concerns and issues embedded in concrete situations. Consistent with models of expert practice, and with contemporary models of patient-centred care, we advocate and describe in this paper a type of interpretative and narrative approach to moral practice and ethical decision-making based on phenomenology. The tools of phenomenology that are well defined in research are applied and examined in a case that illustrates their use in uncovering the values and ethical concerns of a patient. Based on the deconstruction of this case on a phenomenologist approach, we illustrate how such approaches for ethical understanding can help assist clinicians and educators in applying principles within the context and needs of each patient. (c) 2010 John Wiley & Sons, Ltd.

  7. Bridging the gap between research-supported interventions and everyday social work practice: a new approach.

    Science.gov (United States)

    Rubin, Allen

    2014-07-01

    This article describes a rationale for a focus on case studies that would provide a database of single-group pre-post mean effect sizes that could be analyzed to identify which service provision characteristics are associated with more desirable outcomes when interventions supported by randomized clinical trials are adapted in everyday practice settings. In addition, meta-analyses are proposed that would provide benchmarks that agency practitioners could compare with their mean effect size to inform their decisions about whether to continue, modify, or replace existing efforts to adopt or adapt a specific research-supported treatment. Social workers should be at the forefront of the recommended studies in light of the profession's emphasis on applied research in real-world settings and the prominence of social work practitioners in such settings.

  8. Registered Nurses’ Patient Education in Everyday Primary Care Practice

    Science.gov (United States)

    Bergh, Anne-Louise; Friberg, Febe; Persson, Eva; Dahlborg-Lyckhage, Elisabeth

    2015-01-01

    Nurses’ patient education is important for building patients’ knowledge, understanding, and preparedness for self-management. The aim of this study was to explore the conditions for nurses’ patient education work by focusing on managers’ discourses about patient education provided by nurses. In 2012, data were derived from three focus group interviews with primary care managers. Critical discourse analysis was used to analyze the transcribed interviews. The discursive practice comprised a discourse order of economic, medical, organizational, and didactic discourses. The economic discourse was the predominant one to which the organization had to adjust. The medical discourse was self-evident and unquestioned. Managers reorganized patient education routines and structures, generally due to economic constraints. Nurses’ pedagogical competence development was unclear, and practice-based experiences of patient education were considered very important, whereas theoretical pedagogical knowledge was considered less important. Managers’ support for nurses’ practical- and theoretical-based pedagogical competence development needs to be strengthened. PMID:28462314

  9. Hypothyroidism in clinical practice

    Directory of Open Access Journals (Sweden)

    Faiza Qari

    2014-01-01

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

  10. Radioimmunoassay in clinical practice

    Energy Technology Data Exchange (ETDEWEB)

    Ametov, A S

    1982-01-01

    A wide application of radioimmunoassay in clinical practice is shown. The main theoretical aspects of radioimmunoassay and the fields of application in clinical practice - endocrinology, oncology, allergology, cardiology, pharmacology, pediatrics, hematology, obstetrics and gynecology, are presented.

  11. When "Research Ethics" Become "Everyday Ethics": The Intersection of Inquiry and Practice in Practitioner Research

    Science.gov (United States)

    Mockler, Nicole

    2014-01-01

    The act of engaging in sound and ethical practitioner research, regardless of context, encourages and indeed demands an alignment between the ethical framework employed in the research enterprise and the "everyday ethics" of practice. This paper explores the ethical dimensions of what Cochran-Smith and Lytle have termed the dialectic of…

  12. Institutional Violence in the Everyday Practices of School: The Narrative of a Young Lesbian.

    Science.gov (United States)

    Herr, Kathryn

    1999-01-01

    Explores the role of institutionalized violence in one young lesbian's decision to drop out of high school. Casting this young woman as a school failure masks the school's unwillingness to interrupt everyday practices (errors of alienation, omission, and repression) that diminished her sense of self and learning capacity. (29 references) (MLH)

  13. Practical Chronic Pain Assessment Tools in Clinical Practice

    OpenAIRE

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

    2016-01-01

    The aim of the study was to show the role of tools in the evaluation of chronic pain (CP) in general practitioner (GP) everyday clinical practice. The study was done by analyzing electronic database of the first visits of 1090 CP patients referred to the Pain Clinic of the Karlovac General Hospital, Karlovac, Croatia, by their GPs. All patient records were analyzed according to the cause of CP, strongest pain a week before the examination, quality of sleep, and the Patients’ Global Impression...

  14. The use of antibiotic drugs in everyday dental practice

    OpenAIRE

    Terzieva, Olivera; Petrovski, Mihajlo; Maksimov, Zlatko; Markoska, Aleksandra

    2017-01-01

    produce a severe illness or even become fatal. Antibiotics are antimicrobial agents useful in numerous bacterial infections. Increasingly we're seeing the inappropriate use of antibiotics. The purpose of this our study was to determine which are the most commonly used antibiotics and who are the most frequently antibiotic treated diseases. Materials and methods: For the realization of our purpose in our study were included 20 dental clinics. We registered the total number...

  15. Everyday practice and unnoticed professional competence in day care work

    DEFF Research Database (Denmark)

    Ahrenkiel, Annegrethe; Warring, Niels; Nielsen, Birger Steen

    In Denmark more than 9 out 10 children attend day care centers that are publicly funded and regulated. The main part of employees, the social educators, at day care centers have attended a 3½ years educational programme with both theoretical and practical elements. Nevertheless it has been hard...... for the social educators to get recognition for their professional competencies and the societal importance of their work. Neoliberal governance has imposed a lot of demands for documentation, evaluation etc., and a growing focus on children’s learning in day care centers has resulted in national goals...... hand it can tend to underestimate the value of a large part of their work which is embedded in what in the paper will be explored as unnoticed professional competences. Building on empirical results from research in day care centers based on mixed methods (observations, interviews and action research...

  16. Surgeons' Emotional Experience of Their Everyday Practice - A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Massimiliano Orri

    Full Text Available Physicians' emotions affect both patient care and personal well-being. Surgeons appear at particularly high risk, as evidenced by the high rate of burnout and the alarming consequences in both their personal lives and professional behavior. The aim of this qualitative study is to explore the emotional experiences of surgeons and their impact on their surgical practice.27 purposively selected liver and pancreatic surgeons from 10 teaching hospitals (23 men, 4 women participated. Inclusion took place until data saturation was reached. Data were collected through individual interviews and thematically analyzed independently by 3 researchers (a psychologist, a psychiatrist, and a surgeon. 7 themes emerged from the analysis, categorized in 3 main or superordinate themes, which described surgeons' emotional experience before, during, and after surgery. Burdensome emotions are present throughout all 3 periods (and invade life outside the hospital-surgeons' own emotions, their perception of patients' emotions, and their entwinement. The interviewees described the range of emotional situations they face (with patients, families, colleagues, the influence of the institutional framework (time pressure and fatigue, cultural pressure to satisfy the ideal image of a surgeon, as well as the emotions they feel (including especially anxiety, fear, distress, guilt, and accountability.Emotions are ubiquitous in surgeons' experience, and their exposure to stress is chronic rather than acute. Considering emotions only in terms of their relations to operative errors (as previous studies have done is limiting. Although complications are quite rare events, the concern for possible complications is an oppressive experience, regardless of whether or not they actually occur.

  17. Xeroderma pigmentosum clinical practice guidelines.

    Science.gov (United States)

    Moriwaki, Shinichi; Kanda, Fumio; Hayashi, Masaharu; Yamashita, Daisuke; Sakai, Yoshitada; Nishigori, Chikako

    2017-10-01

    Xeroderma pigmentosum (XP) is a genetic photosensitive disorder in which patients are highly susceptibe to skin cancers on the sun-exposed body sites. In Japan, more than half of patients (30% worldwide) with XP show complications of idiopathic progressive, intractable neurological symptoms with poor prognoses. Therefore, this disease does not merely present with dermatological symptoms, such as photosensitivity, pigmentary change and skin cancers, but is "an intractable neurological and dermatological disease". For this reason, in March 2007, the Japanese Ministry of Health, Labor and Welfare added XP to the neurocutaneous syndromes that are subject to government research initiatives for overcoming intractable diseases. XP is one of the extremely serious photosensitive disorders in which patients easily develop multiple skin cancers if they are not completely protected from ultraviolet radiation. XP patients thus need to be strictly shielded from sunlight throughout their lives, and they often experience idiopathic neurodegenerative complications that markedly reduce the quality of life for both the patients and their families. Hospitals in Japan often see cases of XP as severely photosensitive in children, and as advanced pigmentary disorders of the sun-exposed area with multiple skin cancers in adults (aged in their 20-40s), making XP an important disease to differentiate in everyday clinical practice. It was thus decided that there was a strong need for clinical practice guidelines dedicated to XP. This process led to the creation of new clinical practice guidelines for XP. © 2017 Japanese Dermatological Association.

  18. "Salvation Armany": Gay sensibility between high fashion and everyday dressing practices

    Directory of Open Access Journals (Sweden)

    Ildiko Erdei

    2016-03-01

    Full Text Available The paper considers the link between gay people and the fashion world, their role and and relationship to clothing in different fashion registries, as pointed out by Jennifer Craik, in high and in everyday fashion. Based on secondary literature the paper will outline current problematizations of the relationship between gays and high fashion, as well as their importance for the history of high, elite, designer fashion. In the second part of the paper, based on empirical research on the behavior of gay people in Belgrade fashion-wise, the discourses and practices of everyday fashion within the gay population of the capital of Serbia are presented, with a focus on three aspects of dressing practices: consumption of fashionable clothing and accessories with a focus on shopping, evaluation and hierarchization of branded clothing and the skill of combining them which respondents believe represents the key to their unique styles.

  19. Everyday practices at the medical ward: a 16-month ethnographic field study

    OpenAIRE

    Wolf, Axel; Ekman, Inger; Dellenborg, Lisen

    2012-01-01

    Abstract Background Modern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda. This study aimed to describe the everyday practices of professionals and patients in a coronary care unit, and analyse how the routines, structures and physical design of the care environment influenced their actions and relationships. Methods Ethnographic fieldwork was conducted over a 16-month period (...

  20. Supernumerary teeth in clinical practice

    Directory of Open Access Journals (Sweden)

    Anna K. Szkaradkiewicz

    2011-07-01

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

  1. The Role of Everyday Life Products and Social Practices in Sustainable Transitions

    DEFF Research Database (Denmark)

    Jensen, Charlotte Louise; Remmen, Arne

    2011-01-01

    and the way we live. When opting for a low carbon society, the innovation dynamics of everyday life products as well as consumption and practice patterns become an important field of investigation. Hence, to approach consumption aspects of using and interacting with energy using products, it is important...... to kill (Røpke, 2009), so in order to make people change practice, alternate routines that work has to be proposed and accepted. Practice theory can help understanding how practices work, and thus clarifying what has to be included in a study of potentials for a sustainable transition. Social practices...... to understand what practices the products are a part of when in use. According to Røpke (2009) “Primarily, people are practitioners who indirectly, through the performance of various practices, draw on resources”. Therefore, in order to make consumers aware of their actions in an environmental perspective...

  2. Therapeutic Drug Monitoring of Venlafaxine in an Everyday Clinical Setting

    DEFF Research Database (Denmark)

    Hansen, Morten Rix; Kuhlmann, Ida Berglund; Pottegård, Anton

    2017-01-01

    Venlafaxine is a commonly used antidepressant agent. We aimed to provide detailed information on the associations between venlafaxine dose and concentrations of venlafaxine, by patient age and sex. From a therapeutic drug monitoring (TDM) database located at Odense University Hospital, Denmark, we...... identified all adults for whom the treating physician had requested clinical advice on the TDM result for venlafaxine between 2002 and 2012. We identified 1,077 TDM samples of venlafaxine from 334 males and 743 females (median age 45 years), and the median daily dose was 225 mg. Median plasma concentration...... of venlafaxine and o-desmethyvenlafaxine (ODV) were 306 nmol/L and 861 nmol/L, respectively. The median dose-corrected serum level for venlafaxine was 1.49 nmol/L/mg., while the dose-corrected serum level of men and women were 1.21 nmol/L/mg and 1.60 nmol/L/mg, respectively. The dose-corrected sum of venlafaxine...

  3. Family food practices: relationships, materiality and the everyday at the end of life.

    Science.gov (United States)

    Ellis, Julie

    2018-02-01

    This article draws on data from a research project that combined participant observation with in-depth interviews to explore family relationships and experiences of everyday life during life-threatening illness. In it I suggest that death has often been theorised in ways that make its 'mundane' practices less discernible. As a means to foreground the everyday, and to demonstrate its importance to the study of dying, this article explores the (re)negotiation of food and eating in families facing the end of life. Three themes that emerged from the study's broader focus on family life are discussed: 'food talk' and making sense of illness; food, family and identity; and food 'fights'. Together the findings illustrate the material, social and symbolic ways in which food acts relationally in the context of dying, extending conceptual work on materiality in death studies in novel directions. The article also contributes new empirical insights to a limited sociological literature on food, families and terminal illness, building on work that theorises the entanglements of materiality, food, bodies and care. The article concludes by highlighting the analytical value of everyday materialities such as food practices for future research on dying as a relational experience. © 2018 The Author. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.

  4. Recruitment for a Guided Self-Help Binge Eating Trial: Potential Lessons for Implementing Programs in Everyday Practice Settings

    Science.gov (United States)

    DeBar, Lynn L.; Yarborough, Bobbi Jo; Striegel-Moore, Ruth H.; Rosselli, Francine; Perrin, Nancy; Wilson, G. Terence; Kraemer, Helena C.; Green, Rory; Lynch, Frances

    2009-01-01

    Objective To explore effects of various recruitment strategies on randomized clinical trial (RCT)-entry characteristics for patients with eating disorders within an everyday health-plan practice setting. Methods Randomly selected women, aged 25-50, in a Pacific Northwest HMO were invited to complete a self-report binge-eating screener for two treatment trials. We publicized the trials within the health plan to allow self-referral. Here, we report differences on eating-disorder status by mode and nature of recruitment (online, mail, self-referred) and assessment (comprehensive versus abbreviated) and on possible differences in enrollee characteristics between those recruited by strategy (self-referred versus study-outreach efforts). Results Few differences emerged among those recruited through outreach who responded by different modalities (internet versus mail), early-versus-late responders, and those enrolling under more comprehensive or abbreviated assessment. Self-referred were more likely to meet binge-eating thresholds and reported higher average BMI than those recruited by outreach and responding by mail; however, in most respects the groups were more similar than anticipated. Fewer than 1% of those initially contacted through outreach enrolled. Conclusions Aggressive outreach and screening is likely not feasible for broader dissemination in everyday practice settings and recruits individuals with more similar demographic and clinical characteristics to those recruited through more abbreviated and realistic screening procedures than anticipated. PMID:19275947

  5. Everyday politics, social practices and movement networks: daily life in Barcelona's social centres.

    Science.gov (United States)

    Yates, Luke

    2015-06-01

    The relations between everyday life and political participation are of interest for much contemporary social science. Yet studies of social movement protest still pay disproportionate attention to moments of mobilization, and to movements with clear organizational boundaries, tactics and goals. Exceptions have explored collective identity, 'free spaces' and prefigurative politics, but such processes are framed as important only in accounting for movements in abeyance, or in explaining movement persistence. This article focuses on the social practices taking place in and around social movement spaces, showing that political meanings, knowledge and alternative forms of social organization are continually being developed and cultivated. Social centres in Barcelona, Spain, autonomous political spaces hosting cultural and educational events, protest campaigns and alternative living arrangements, are used as empirical case studies. Daily practices of food provisioning, distributing space and dividing labour are politicized and politicizing as they unfold and develop over time and through diverse networks around social centres. Following Melucci, such latent processes set the conditions for social movements and mobilization to occur. However, they not only underpin mobilization, but are themselves politically expressive and prefigurative, with multiple layers of latency and visibility identifiable in performances of practices. The variety of political forms - adversarial, expressive, theoretical, and routinized everyday practices, allow diverse identities, materialities and meanings to overlap in movement spaces, and help explain networks of mutual support between loosely knit networks of activists and non-activists. An approach which focuses on practices and networks rather than mobilization and collective actors, it is argued, helps show how everyday life and political protest are mutually constitutive. © London School of Economics and Political Science 2014.

  6. Everyday ethics in internal medicine resident clinic: an opportunity to teach.

    Science.gov (United States)

    Carrese, Joseph A; McDonald, Erin L; Moon, Margaret; Taylor, Holly A; Khaira, Kiran; Catherine Beach, Mary; Hughes, Mark T

    2011-07-01

    Being a good doctor requires competency in ethics. Accordingly, ethics education during residency training is important. We studied the everyday ethics-related issues (i.e. ordinary ethics issues commonly faced) that internal medical residents encounter in their out-patient clinic and determined whether teaching about these issues occurred during faculty preceptor-resident interactions. This study involved a multi-method qualitative research design combining observation of preceptor-resident discussions with preceptor interviews. The study was conducted in two different internal medicine training programme clinics over a 2-week period in June 2007. Fifty-three residents and 19 preceptors were observed, and 10 preceptors were interviewed. Transcripts of observer field notes and faculty interviews were carefully analysed. The analysis identified several themes of everyday ethics issues and determined whether preceptors identified and taught about these issues. Everyday ethics content was considered present in 109 (81%) of the 135 observed case presentations. Three major thematic domains and associated sub-themes related to everyday ethics issues were identified, concerning: (i) the Doctor-Patient Interaction (relationships; communication; shared decision making); (ii) the Resident as Learner (developmental issues; challenges and conflicts associated with training; relationships with colleagues and mentors; interactions with the preceptor), and; (iii) the Doctor-System Interaction (financial issues; doctor-system issues; external influences; doctor frustration related to system issues). Everyday ethics issues were explicitly identified by preceptors (without teaching) in 18 of 109 cases (17%); explicit identification and teaching occurred in only 13 cases (12%). In this study a variety of everyday ethics issues were frequently encountered as residents cared for patients. Yet, faculty preceptors infrequently explicitly identified or taught these issues during their

  7. Sustained multiplicity in everyday cholesterol reduction: repertoires and practices in talk about 'healthy living'.

    Science.gov (United States)

    Will, Catherine M; Weiner, Kate

    2014-02-01

    This article is concerned with talk about and the practices of healthy living in relation to cholesterol reduction. It draws on qualitative interviews with 89 people who are current or former users of either cholesterol-lowering functional foods or statins for cardiovascular risk reduction. Focusing on data about everyday activities including food preparation, shopping and exercise, we illustrate four repertoires that feature in talk about cholesterol reduction (health, pleasure, sociality and pragmatism). Using Gilbert and Mulkay's notion of a 'reconciliation device', we suggest ways in which apparently contradictory repertoires are combined (for example, through talk about moderation) or kept apart. We suggest that, in contrast to the interactiveness of the repertoires of health and pleasure, a pragmatic repertoire concerning food provisioning, storage and cooking as well as the realities of exercise, appears distinct from talk about health and is relatively inert. Finally we consider the implications of these discursive patterns for daily practices. Our data suggest there is little emphasis on coherence in people's practices and illustrate the significance of temporal, spatial and social distribution in allowing people to pursue different priorities in their everyday lives. Rather than the calculated trade-offs of earlier medical sociology we draw on Mol to foreground the possibility of sustained multiplicity in daily practices. © 2014 The Authors. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

  8. Telemedicine in interdisciplinary work practices: On an IT system that met the criteria for success set out by its sponsors, yet failed to become part of every-day clinical routines

    NARCIS (Netherlands)

    A.A. de Bont (Antoinette); R.A. Bal (Roland)

    2008-01-01

    textabstractBackground. Information systems can play a key role in care innovations including task redesign and shared care. Many demonstration projects have presented evidence of clinical and cost effectiveness and high levels of patient satisfaction. Yet these same projects often fail to become

  9. Everyday Innovation

    DEFF Research Database (Denmark)

    Lippke, Lena; Wegener, Charlotte

    2014-01-01

    Purpose – The purpose of this paper is to explore how vocational teachers’ everyday practices can constitute innovative learning spaces that help students to experience engagement and commitment towards education and thus increase their possibilities for completing their studies despite notable...... difficulties. Design/methodology/approach – Based on two ethnographic field studies, we analyse vocational teaching situations in which teachers and students engage in daily remaking of the vocational educational training practice. It is argued that these everyday situations can be understood as innovative....... Practical implications – Based on the analysis, we argue that students’ engagement in education can be enhanced by transforming the educational settings on various parameters such as buildings, artefacts, emotions and experiences. Thus, innovation should be recognised as emerging everyday activities...

  10. Understanding health through social practices: performance and materiality in everyday life.

    Science.gov (United States)

    Maller, Cecily Jane

    2015-01-01

    The importance of recognising structure and agency in health research to move beyond methodological individualism is well documented. To progress incorporating social theory into health, researchers have used Giddens' and Bourdieu's conceptualisations of social practice to understand relationships between agency, structure and health. However, social practice theories have more to offer than has currently been capitalised upon. This article delves into contemporary theories of social practice as used in consumption and sustainability research to provide an alternative, and more contextualised means, of understanding and explaining human action in relation to health and wellbeing. Two key observations are made. Firstly, the latest formulations of social practice theory distinguish moments of practice performance from practices as persistent entities across time and space, allowing empirical application to explain practice histories and future trajectories. Secondly, they emphasise the materiality of everyday life, foregrounding things, technologies and other non-humans that cannot be ignored in a technologically dependent social world. In concluding, I argue the value of using contemporary social practice theories in health research is that they reframe the way in which health outcomes can be understood and could inform more effective interventions that move beyond attitudes, behaviour and choices. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

  11. 'Chasing for Water': Everyday Practices of Water Access in Peri-Urban Ashaiman, Ghana

    Directory of Open Access Journals (Sweden)

    Megan Peloso

    2014-02-01

    Full Text Available Despite recent reports suggesting that access to improved sources of drinking water is rising in Ghana, water access remains a daily concern for many of those living in the capital region. Throughout the Greater Accra Metropolitan Area (GAMA, the urban poor manage uncertainty and establish themselves in the city by leveraging a patchwork system of basic services that draws importantly from informal systems and supplies. This paper takes a case study approach, using evidence gathered from two-months of fieldwork in a peri-urban informal settlement on the fringe of Accra, to explore everyday practices involved in procuring water for daily needs that routinely lead residents outside of the official water supply system. Findings from this case study demonstrate that respondents make use of informal water services to supplement or 'patch up' gaps left by the sporadic water flow of the official service provider, currently Ghana Water Company Ltd. (GWCL. Basic water access is thus constructed through an assemblage of coping strategies and infrastructures. This analysis contributes to understandings of heterogeneity in water access by attending to the everyday practices by which informality is operationalised to meet the needs of the urban poor, in ways that may have previously been overshadowed. This research suggests, for example, that although water priced outside of the official service provider is generally higher per unit, greater security may be obtained from smaller repetitive transactions as well as having the flexibility to pursue multiple sources of water on a day-to-day basis.

  12. Pharmacotherapy of elderly patients in everyday anthroposophic medical practice: a prospective, multicenter observational study

    Directory of Open Access Journals (Sweden)

    Bockelbrink Angelina

    2010-07-01

    .14-0.22, or metabolic disorders (AOR = 0.17; CI: 0.13-0.22. Conclusion The present study is the first to provide a systematic overview of everyday anthroposophic medical practice in primary care for elderly patients. Practitioners of anthroposophic medicine prescribe both conventional and complementary treatments. Our study may facilitate further CAM-research on indications of, for example, dementia or adverse drug reactions in the elderly.

  13. Making use of research: clinical views on an evaluation of everyday technology use.

    Science.gov (United States)

    Nygård, Louise; Kottorp, Anders; Rosenberg, Lena

    2015-01-01

    The study aim was to investigate how and when an evaluation of perceived difficulty in use of everyday technology (Everyday Technology Use Questionnaire, ETUQ) could be used in clinical occupational therapy. Eight focus-group interviews were undertaken with a total of 42 participants (occupational therapists), and data were analysed with a constant comparative approach. The findings are presented in four main categories, including (i) appropriate purposes and contexts for using ETUQ, (ii) standardization versus individual flexibility, (iii) approaching everyday technology use and occupation as one whole, and (iv) synthesizing and documentation. In conclusion, the participants considered ability to use technology to be an important topic for occupational therapy, particularly in investigations of clients with subtle disabilities and in connection with discharge from hospital - but not in inpatient care. They had different views on how to integrate ETUQ with evaluations of occupational performance, and new ideas on how information about clients' ability to use technology could be utilized in interventions. They held standardized evaluations in high regard, but a paradox appeared in that many of them would use ETUQ in a non-standardized way, while simultaneously asking for a standardized output to be used in clients' medical files and to guide interventions.

  14. Growing Everyday Multiculturalism: Practice-Based Learning of Chinese Immigrants through Community Gardens in Canada

    Science.gov (United States)

    Shan, Hongxia; Walter, Pierre

    2015-01-01

    While official rhetoric of multiculturalism claims to value cultural diversity, everyday multiculturalism focuses on how people of diverse cultural backgrounds live together in their everyday lives. Research on everyday multiculturalism has documented ways through which people negotiate senses, sensibilities, emotionality, and relationality across…

  15. Treating panic symptoms within everyday clinical settings: the feasibility of a group cognitive behavioural intervention

    DEFF Research Database (Denmark)

    Austin, S.F.; Sumbundu, A.D.; Lykke, J.

    2008-01-01

    of significant clinical change displayed and resources required to carry out the intervention. A small sample of GP-referred patients displaying panic symptoms completed a 2-week intensive cognitive-behavioural intervention. Results collected post-intervention revealed significant clinical reductions in panic......Panic disorder is a common and debilitating disorder that has a prevalence rate of 3-5% in the general population. Cognitive-behavioural interventions have been shown to be an efficacious treatment for panic, although a limited number of studies have examined the effectiveness of such interventions...... implemented in everyday clinical settings. The aim of the following pilot study was to examine the feasibility of a brief group cognitive-behavioural intervention carried out in a clinical setting. Salient issues in determining feasibility include: representativeness of patient group treated, amount...

  16. [Educational obstacles in the everyday living of the nurse teacher's pedagogical practice].

    Science.gov (United States)

    Rodrigues, Malvina Thaís Pacheco; Mendes Sobrinho, José Augusto de Carvalho

    2008-01-01

    University teaching emerges as a theme frequently discussed in the educational scene. This article aims to investigate the educational obstacles emerging in the everyday living of the pedagogical practice of the nurse teacher from the Nursing Graduation Course at UEPSI, wishing to subsidize the elaboration of proposals for overcoming of these obstacles. It is a study of qualitative approach with data collection, questionnaire and semi-structured interview and data analysis through content analysis. According to the analysis, it is clear that the educational obstacles relate to the teacher person, to the students and to the institution. Thus, an establishment of a continuing education program in the action-reflection-action perspective is proposed as a way of overcoming the obstacles.

  17. Ethical issues experienced by intensive care unit nurses in everyday practice.

    Science.gov (United States)

    Fernandes, Maria I D; Moreira, Isabel M P B

    2013-02-01

    This research aims to identify the ethical issues perceived by intensive care nurses in their everyday practice. It also aims to understand why these situations were considered an ethical issue and what interventions/strategies have been or are expected to be developed so as to minimize them. Data were collected using a semi-structured interview with 15 nurses working at polyvalent intensive care units in 4 Portuguese hospitals, who were selected by the homogenization of multiple samples. The qualitative content analysis identified end-of-life decisions, privacy, interaction, team work, and health-care access as emerging ethical issues. Personal, team, and institutional aspects emerge as reasons behind the experience of these issues. Personal and team resources are used in and for solving these issues. Moral development and training are the most significant strategies.

  18. Uses of media in everyday practices of grief among bereaved parents

    DEFF Research Database (Denmark)

    Sandvik, Kjetil; Christensen, Dorthe Refslund

    continues the bonds (Cf. Walter 1999) to the dead child so that the bereaved can re-integrate the dead into their everyday life. This perspective implies that grieving is not allocated to a specific period of time (a time of mourning) but that grieving and the uses of social technologies like media related...... functionalities that are specifically fit for a certain use) may be understood as a matter of dimensions, as complex systems of communication whether we see this in the use of objects on children’s graves embedded with media affordances (Christensen & Sandvik 2014a) or social media used as communicational tools...... in a one-way cause-and-effect way implying that media produce new practices. The paper argues that at the same time we can observe how people turn objects into media or create new ways of using existing media employing them as new tools for communicating with or about the dead (see Jensen 2010, Christensen...

  19. Gaming practices in everyday life. An analytical operationalization of field theory by means of practice theory

    Directory of Open Access Journals (Sweden)

    Claus Toft-Nielsen

    2015-05-01

    Full Text Available This article investigates digital game play (gaming as a specific media field (Bourdieu, 1984, p. 72, in which especially gaming capital (Consalvo, 2007 functions as a theoretical lens. We aim to analyse the specific practices that constitute and are constituted in and around gaming. This multitude of practices is theoretically qualified by the second generation of practice theorists, including (Bruchler & Postill, 2010; Reckwitz, 2002; Schatzki, 2008; Warde, 2005. The empirical data are drawn from qualitative studies of gamers and gaming practices (focus groups as well as participant observations, and function as exemplary cases that illustrate our theoretical arguments. Our purpose is to analytically operationalize field theory, by means of practice theory, to enhance our understanding of digital games as new media and the specific contexts and media practices herein.

  20. Gaming practices in everyday life. An analytical operationalization of field theory by means of practice theory

    DEFF Research Database (Denmark)

    Toft-Nielsen, Claus; Krogager, Stinne Gunder Strøm

    2015-01-01

    This article investigates digital game play (gaming) as a specific media field (Bourdieu, 1984, p. 72), in which especially gaming capital (Consalvo, 2007) functions as a theoretical lens. We aim to analyse the specific practices that constitute and are constituted in and around gaming....... This multitude of practices is theoretically qualified by the second generation of practice theorists, including (Bruchler & Postill, 2010; Reckwitz, 2002; Schatzki, 2008; Warde, 2005). The empirical data are drawn from qualitative studies of gamers and gaming practices (focus groups as well as participant...... observations), and function as exemplary cases that illustrate our theoretical arguments. Our purpose is to analytically operationalize field theory, by means of practice theory, to enhance our understanding of digital games as new media and the specific contexts and media practices herein....

  1. Semi-Spontaneous Oral Text Production: Measurements in Clinical Practice

    Science.gov (United States)

    Lind, Marianne; Kristoffersen, Kristian Emil; Moen, Inger; Simonsen, Hanne Gram

    2009-01-01

    Functionally relevant assessment of the language production of speakers with aphasia should include assessment of connected speech production. Despite the ecological validity of everyday conversations, more controlled and monological types of texts may be easier to obtain and analyse in clinical practice. This article discusses some simple…

  2. Children's Everyday Learning by Assuming Responsibility for Others: Indigenous Practices as a Cultural Heritage Across Generations.

    Science.gov (United States)

    Fernández, David Lorente

    2015-01-01

    This chapter uses a comparative approach to examine the maintenance of Indigenous practices related with Learning by Observing and Pitching In in two generations--parent generation and current child generation--in a Central Mexican Nahua community. In spite of cultural changes and the increase of Western schooling experience, these practices persist, to different degrees, as a Nahua cultural heritage with close historical relations to the key value of cuidado (stewardship). The chapter explores how children learn the value of cuidado in a variety of everyday activities, which include assuming responsibility in many social situations, primarily in cultivating corn, raising and protecting domestic animals, health practices, and participating in family ceremonial life. The chapter focuses on three main points: (1) Cuidado (assuming responsibility for), in the Nahua socio-cultural context, refers to the concepts of protection and "raising" as well as fostering other beings, whether humans, plants, or animals, to reach their potential and fulfill their development. (2) Children learn cuidado by contributing to family endeavors: They develop attention and self-motivation; they are capable of responsible actions; and they are able to transform participation to achieve the status of a competent member of local society. (3) This collaborative participation allows children to continue the cultural tradition and to preserve a Nahua heritage at a deeper level in a community in which Nahuatl language and dress have disappeared, and people do not identify themselves as Indigenous. © 2015 Elsevier Inc. All rights reserved.

  3. Computerizing clinical practice guidelines

    DEFF Research Database (Denmark)

    Lyng, Karen Marie

    It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application and comp......It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application...... is comprised by fieldwork in three oncology departments and a case study of advanced life support. Although close to all patients within oncology are treated according to a CPG, I found limited application of physical CPGs and web-based CPG portals. However, I found comprehensive application of activity...... of the business strategic aims, and 3) analysis and formalization of CPGs. This will imply orchestration of design teams with competencies from a wide array of disciplines such as health practice, business management, knowledge management and information systems....

  4. Clinical Practice in Teacher Training

    Directory of Open Access Journals (Sweden)

    Hidayet Tok

    2011-12-01

    Full Text Available Recently, it seems that there has been a concept change in the aspect of teaching practice course which is regarded as one of the most significant course in teacher education program. This new concept requires the increase period of teaching practice in teacher education program and parallel to this, it also requires the change in the function of practice schools and highlighted “clinical practice in teacher education” concept. In this study, “clinical practice in teacher education” concept and its implementation processes were explained. Furthermore, clinical practice and traditional school practices were presented and the parallels between teaching and clinical practices were explained as well

  5. Local bureaucrats as bricoleurs. The everyday implementation practices of county environment officers in rural Kenya

    Directory of Open Access Journals (Sweden)

    Mikkel Funder

    2015-03-01

    Full Text Available Bricolage in natural resource governance takes place through the interplay of a variety of actors. This article explores the practices of a group whose agency as bricoleurs has received little attention, namely the government officers who represent the state in the everyday management of water, land, forests and other resources across rural Africa. Specifically we examine how local Environment Officers in Taita Taveta County in Kenya go about implementing the national environmental law on the ground, and how they interact with communities in this process. As representatives of “the local state”, the Environment Officers occupy an ambiguous position in which they are expected to implement lofty laws and policies with limited means and in a complex local reality. In response to this they employ three key practices, namely (i working through personal networks, (ii tailoring informal agreements, and (iii delegating public functions and authority to civil society. As a result, the environmental law is to a large extent implemented through a blend of formal and informal rules and governance arrangements, produced through the interplay of the Environment Officers, communities and other local actors.

  6. L2 Teaching in the Wild: A Closer Look at Correction and Explanation Practices in Everyday L2 Interaction

    Science.gov (United States)

    Theodorsdottor, Gudrun

    2018-01-01

    This article argues for a reconceptualization of the concept of "corrective feedback" for the investigation of correction practices in everyday second language (L2) interaction ("in the wild"). Expanding the dataset for L2 research as suggested by Firth and Wagner (1997) to include interactions from the wild has consequences…

  7. [Coping with everyday stress in different problem areas- comparison of clinically referred and healthy adolescents].

    Science.gov (United States)

    Escher, Fabian; Seiffge-Krenke, Inge

    2013-09-01

    Studies are lacking that analyze how clinically referred adolescents and healthy adolescents cope with everyday stressors. Clinically referred adolescents from three problematic domains (diverse disorders including delinquency, drug abuse, and depression) were compared to healthy adolescents using the Coping Across Situations Questionnaire (Seiffge-Krenke, 1995) and a short version of the Youth Self-Report (Achenbach, 1991). The different clinical groups (n = 469) showed unique patterns concerning their coping styles. The group of depressed youth altogether showed lower coping activities. The youth from institutions for drug abusive youth used more dysfunctional coping. The adolescents from youth welfare services (diverse disorders including delinquency) were more active in both dysfunctional and functional coping than the other two clinically referred groups. The control group showed more functional and less dysfunctional coping. The clinically referred adolescents did not differentiate in their coping behavior, depending on the type of stressor. Gender effects were apparent, albeit negligible. Clinically referred youth are unable to adapt their coping behavior according to the given situation.

  8. Everyday practices at the medical ward: a 16-month ethnographic field study

    Directory of Open Access Journals (Sweden)

    Wolf Axel

    2012-07-01

    Full Text Available Abstract Background Modern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda. This study aimed to describe the everyday practices of professionals and patients in a coronary care unit, and analyse how the routines, structures and physical design of the care environment influenced their actions and relationships. Methods Ethnographic fieldwork was conducted over a 16-month period (between 2009 and 2011 by two researchers working in parallel in a Swedish coronary care unit. Observations, informal talks and formal interviews took place with registered nurses, assistant nurses, physicians and patients in the coronary care unit. The formal interviews were conducted with six registered nurses (five female, one male including the chief nurse manager, three assistant nurses (all female, two cardiologists and three patients (one female, two male. Results We identified the structures that either promoted or counteracted the various actions and relationships of patients and healthcare professionals. The care environment, with its minimalistic design, strong focus on routines and modest capacity for dialogue, restricted the choices available to both patients and healthcare professionals. This resulted in feelings of guilt, predominantly on the part of the registered nurses. Conclusions The care environment restricted the choices available to both patients and healthcare professionals. This may result in increased moral stress among those in multi-professional teams who work in the grey area between biomedical and person-centred care.

  9. Speaking Up: Veterinary Ethical Responsibilities and Animal Welfare Issues in Everyday Practice

    OpenAIRE

    Elein Hernandez; Anne Fawcett; Emily Brouwer; Jeff Rau; Patricia V. Turner

    2018-01-01

    Although expectations for appropriate animal care are present in most developed countries, significant animal welfare challenges continue to be seen on a regular basis in all areas of veterinary practice. Veterinary ethics is a relatively new area of educational focus but is thought to be critically important in helping veterinarians formulate their approach to clinical case management and in determining the overall acceptability of practices towards animals. An overview is provided of how ve...

  10. [Roles and competences of nurses with postgraduate master degree in nursing science in everyday practice. Multicentre descriptive survey].

    Science.gov (United States)

    Dante, Angelo; Occoffer, Elisa Maria; Miniussi, Claudia; Margetic, Helga; Palese, Alvisa; Saiani, Luisa

    2014-01-01

    Roles and competences of nurses with postgraduate master degree in nursing science in everyday practice. Multicentre descriptive survey. Few information are available on the role and activities of Italian nurses with Laurea Magistrale (postgraduate master degree in nursing science). To describe the implementation of the advanced competences acquired after Laurea Magistrale by nurses, as well as changes in their professional career. A multicenter descriptive study on 7 consecutive cohorts (from 2004/2005 to 2011/2012) of nurses of 3 universities of northern Italy was conducted. Data on managerial, teaching, research and clinical competences and changes in the professional role were collected with semi-structured questionnaires. 232/285 graduates completed the questionnaire; 216 (88.8%) used their managerial competences, 178 (76.7%) educational competences, 122 (52.6%) clinical competences and 115 (49.5%) research competences. Eigthy graduates (34.4%) changed their professional roles, occupying managerial positions (from 89 to 212, +123, 14.5%) and in the education field (from 33 to 44 +11, 4.8%) while the number of nurses with a clinical role decreased (from 110 to 65, -45, -19.4%). The role changes occured mainly after three years from graduation (p = 0.006) with significant differences across areas (p = 0.018). Until recently the main field of occupation of Laureati magistrali was in management but the changing needs of the organizations require a major focus on the clinical competences. The characteristics of contexts that favour or prevent the implementation of the new compentences and the upgrade of the roles should be studied.

  11. The reliability and validity of the Everyday Feelings Questionnaire in a clinical population.

    Science.gov (United States)

    Mann, Joanna; Henley, William; O'Mahen, Heather; Ford, Tamsin

    2013-06-01

    Depression could be considered to be on a continuum with well-being and some have argued that it is important to measure well-being as well as distress. The Everyday Feelings Questionnaire was designed to measure both these aspects. Its validity has been assessed in a nonclinical population. This project aims to assess the validity and reliability of the EFQ in a clinical population. The EFQ was completed by 105 clients within a mental health clinical setting. The following aspects of the EFQ were explored: its internal structure, concurrent validity, re-test reliability and internal consistency. The EFQ had good internal consistency and correlated highly with other measures of anxiety and depression. The correlation between total EFQ scores on the two occasions was reasonable and there was no effect of time during completion. A Bland-Altman plot showed no obvious pattern between the difference between EFQ scores and the mean score. A one factor model showed a moderate fit to the data. This study does not explore the acceptability or sensitivity to change of the EFQ, and a larger sample size would be needed to extend the analysis conducted. The EFQ is a valid and reliable measure when used in this clinical population. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. Validation of the Society for Vascular Surgery's objective performance goals for critical limb ischemia in everyday vascular surgery practice.

    Science.gov (United States)

    Goodney, Philip P; Schanzer, Andres; Demartino, Randall R; Nolan, Brian W; Hevelone, Nathanael D; Conte, Michael S; Powell, Richard J; Cronenwett, Jack L

    2011-07-01

    To develop standardized metrics for expected outcomes in lower extremity revascularization for critical limb ischemia (CLI), the Society for Vascular Surgery (SVS) has developed objective performance goals (OPGs) based on aggregate data from randomized trials of lower extremity bypass (LEB). It remains unknown, however, if these targets can be achieved in everyday vascular surgery practice. We applied SVS OPG criteria to 1039 patients undergoing 1039 LEB operations for CLI with autogenous vein (excluding patients on dialysis) within the Vascular Study Group of New England (VSGNE). Each of the individual OPGs was calculated within the VSGNE dataset, along with its surrounding 95% confidence intervals (CIs) and compared to published SVS OPGs using χ(2) comparisons and survival analysis. Across most risk strata, patients in the VSGNE and SVS OPG cohorts were similar (clinical high-risk [age >80 years and tissue loss]: 15.3% VSGNE; 16.2% SVS OPG; P = .58; anatomic high risk [infrapopliteal target artery]: 57.8% VSGNE; 60.2% SVS OPG; P = .32). However, the proportion of VSGNE patients designated as conduit high-risk (lack of single-segment great saphenous vein) was lower (10.2% VSGNE; 26.9% SVS OPG;P Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  13. Transforming practice into clinical scholarship.

    Science.gov (United States)

    Limoges, Jacqueline; Acorn, Sonia

    2016-04-01

    The aims of this paper were to explicate clinical scholarship as synonymous with the scholarship of application and to explore the evolution of scholarly practice to clinical scholarship. Boyer contributed an expanded view of scholarship that recognized various approaches to knowledge production beyond pure research (discovery) to include the scholarship of integration, application and teaching. There is growing interest in using Boyer's framework to advance knowledge production in nursing but the discussion of clinical scholarship in relation to Boyer's framework is sparse. Discussion paper. Literature from 1983-2015 and Boyer's framework. When clinical scholarship is viewed as a synonym for Boyer's scholarship of application, it can be aligned to this well established framework to support knowledge generated in clinical practice. For instance, applying the three criteria for scholarship (documentation, peer review and dissemination) can ensure that the knowledge produced is rigorous, available for critique and used by others to advance nursing practice and patient care. Understanding the differences between scholarly practice and clinical scholarship can promote the development of clinical scholarship. Supporting clinical leaders to identify issues confronting nursing practice can enable scholarly practice to be transformed into clinical scholarship. Expanding the understanding of clinical scholarship and linking it to Boyer's scholarship of application can assist nurses to generate knowledge that addresses clinical concerns. Further dialogue about how clinical scholarship can address the theory-practice gap and how publication of clinical scholarship could be expanded given the goals of clinical scholarship is warranted. © 2016 John Wiley & Sons Ltd.

  14. Everyday conversation in dementia: a review of the literature to inform research and practice

    Science.gov (United States)

    Keady, John; Sage, Karen; Wilkinson, Ray

    2016-01-01

    Abstract Background There has been increasing interest in dementia care in recent years, including how practitioners, service providers and society in general can help individuals to live well with the condition. An important aspect to this is provision of advice to ensure conversation partners effectively support the person with dementia in conversation. Aims To provide a descriptive review of the literature examining everyday conversation in dementia in order to inform practice and research. Methods & Procedures This review used a method specifically developed for reviewing conversation analytic and related literature. A range of databases were searched using key words and explicitly described inclusion criteria leading to a final corpus of 50 titles. Using this qualitative methodology, each paper was examined and data extracted. The contribution of each of these is described and the implications for practice and research are outlined. Main Contribution This review examined studies into conversation in Alzheimer's disease, vascular dementia and Lewy body dementia, grouping these into: early influential studies; work drawing on positioning theory; studies using social and linguistic approaches; collaborative storytelling; formulaic language; studies specifically using conversation analysis; and conversation as a target for individualized therapy. In addition, more recent work examining primary progressive aphasia and behavioural variant frontotemporal dementia was explored. Overall, this review indicates that research examining conversation in natural settings provides a rich source of data to explore not just the challenges within conversation for those taking part, but also the skills retained by the person with dementia. An important aspect of this understanding is the notion that these skills relate not only to information exchange but also aspects of social interaction. The role of others in scaffolding the conversation abilities of the person with dementia

  15. Everyday conversation in dementia: a review of the literature to inform research and practice.

    Science.gov (United States)

    Kindell, Jacqueline; Keady, John; Sage, Karen; Wilkinson, Ray

    2017-07-01

    There has been increasing interest in dementia care in recent years, including how practitioners, service providers and society in general can help individuals to live well with the condition. An important aspect to this is provision of advice to ensure conversation partners effectively support the person with dementia in conversation. To provide a descriptive review of the literature examining everyday conversation in dementia in order to inform practice and research. This review used a method specifically developed for reviewing conversation analytic and related literature. A range of databases were searched using key words and explicitly described inclusion criteria leading to a final corpus of 50 titles. Using this qualitative methodology, each paper was examined and data extracted. The contribution of each of these is described and the implications for practice and research are outlined. This review examined studies into conversation in Alzheimer's disease, vascular dementia and Lewy body dementia, grouping these into: early influential studies; work drawing on positioning theory; studies using social and linguistic approaches; collaborative storytelling; formulaic language; studies specifically using conversation analysis; and conversation as a target for individualized therapy. In addition, more recent work examining primary progressive aphasia and behavioural variant frontotemporal dementia was explored. Overall, this review indicates that research examining conversation in natural settings provides a rich source of data to explore not just the challenges within conversation for those taking part, but also the skills retained by the person with dementia. An important aspect of this understanding is the notion that these skills relate not only to information exchange but also aspects of social interaction. The role of others in scaffolding the conversation abilities of the person with dementia and the potential of this for developing interventions are

  16. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Gluud, Christian

    2002-01-01

    , and single clinics. Accordingly, there is an urgent need to improve this situation. Guidelines for Good Clinical (Research) Practice, conduct of more trials as multicentre trials, The Consort Statement, and The Cochrane Collaboration may all help in the application of the best research evidence in clinical......Evidence-based medicine combines the patient's preferences with clinical experience and the best research evidence. Randomized clinical trials are considered the most valid research design for evaluating health-care interventions. However, empirical research shows that intervention effects may...... practice. By investments in education, applied research, and The Cochrane Collaboration, evidence-based medicine may form a stronger basis for clinical practice....

  17. Nigerian Journal of Clinical Practice

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH ... The Nigerian Journal of Clinical Practice is the official publication of the Medical ... Its purpose is to promote clinical and academic excellence in Medicine and Dentistry and allied sciences.

  18. "I'm Just Trying to Be Tough, Okay": Masculine Performances of Everyday Practices

    Science.gov (United States)

    Collier, Diane R.

    2015-01-01

    Everyday cultural resources that originate outside school offer possibilities for multimodal creativity and identity play, as children consume, transform and produce multimodal texts. In this study, Kyle, a boy in elementary school, fluidly performed social identities and engaged in playful and parodic rescripting of identities and resources from…

  19. Towards ICT in Everyday Life in Finnish Schools: Seeking Conditions for Good Practices

    Science.gov (United States)

    Niemi, Hannele; Kynaslahti, Heikki; Vahtivuori-Hanninen, Sanna

    2013-01-01

    The article discusses how to strengthen educational use of information and communication technology (ICT) in Finnish schools. The conceptions and experiences of the successful integration of ICT in everyday school settings are reported. Participant observations in 20 schools in different parts of Finland were carried out, including discussions…

  20. Exploring the Everyday Life Information Needs, Practices, and Challenges of Emerging Adults with Intellectual Disabilities

    Science.gov (United States)

    Hanson-Baldauf, Dana

    2013-01-01

    This dissertation research addresses a gap in the library and information science literature on everyday life information (ELI) needs and experiences of emerging adults with intellectual disabilities (I/DD). Emerging adulthood refers to the period between the late teen years and mid-twenties. Although this is a period of significant change for all…

  1. Clinical librarians as facilitators of nurses' evidence-based practice.

    Science.gov (United States)

    Määttä, Sylvia; Wallmyr, Gudrun

    2010-12-01

    The aim of this study was to explore nurses' and ward-based clinical librarians' reflections on ward-based clinical librarians as facilitators for nurses' use of evidences-based practice. Nurses' use of evidence-based practice is reported to be weak. Studies have suggested that clinical librarians may promote evidence-based practice. To date, little is known about clinical librarians participating nurses in the wards. A descriptive, qualitative design was adopted for the study. In 2007, 16 nurses who had been attended by a clinical librarian in the wards were interviewed in focus groups. Two clinical librarians were interviewed by individual interviews. In the analysis, a content analysis was used. Three themes were generated from the interviews with nurses: 'The grip of everyday work', 'To articulate clinical nursing issues' and 'The clinical librarians at a catalyst'. The nurses experienced the grip of everyday work as a hindrance and had difficulties to articulate and formulate relevant nursing issues. In such a state, the nurses found the clinical librarian presence in the ward as enhancing the awareness of and the use of evidence-based practice. Three themes emerged from the analysis with the librarians. They felt as outsiders, had new knowledge and acquired a new role as ward-based clinical librarians. Facilitation is needed if nurses' evidence-based practice is going to increase. The combined use of nurses and clinical librarians' knowledge and skills can be optimised. To achieve this, nurses' skills in consuming and implementing evidence ought to be strengthened. The fusion of the information and knowledge management skill of the ward-based clinical librarian and the clinical expertise of the nurses can be of value. With such a collaborative model, nurse and ward-based clinical librarian might join forces to increase the use of evidence-based practice. © 2010 Blackwell Publishing Ltd.

  2. Pharmacogenetics in clinical practice

    NARCIS (Netherlands)

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

    2008-01-01

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

  3. Validity of the Italian Code of Ethics for everyday nursing practice.

    Science.gov (United States)

    Gobbi, Paola; Castoldi, Maria Grazia; Alagna, Rosa Anna; Brunoldi, Anna; Pari, Chiara; Gallo, Annamaria; Magri, Miriam; Marioni, Lorena; Muttillo, Giovanni; Passoni, Claudia; Torre, Anna La; Rosa, Debora; Carnevale, Franco A

    2016-12-07

    The research question for this study was as follows: Is the Code of Ethics for Nurses in Italy (Code) a valid or useful decision-making instrument for nurses faced with ethical problems in their daily clinical practice? Focus groups were conducted to analyze specific ethical problems through 11 case studies. The analysis was conducted using sections of the Code as well as other relevant documents. Each focus group had a specific theme and nurses participated freely in the discussions according to their respective clinical competencies. The executive administrative committee of the local nursing licensing council provided approval for conducting this project. Measures were taken to protect the confidentiality of consenting participants. The answer to the research question posed for this investigation was predominantly positive. Many sections of the Code were useful for discussion and identifying possible solutions for the ethical problems presented in the 11 cases. We concluded that the Code of Ethics for Nurses in Italy can be a valuable aid in daily practice in most clinical situations that can give rise to ethical problems. © The Author(s) 2016.

  4. Clinical Practice in Portuguese Sexology.

    Science.gov (United States)

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

    2017-11-17

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

  5. Developmental Defects of Enamel : an increasing reality in the everyday practice

    Directory of Open Access Journals (Sweden)

    Fabrizio Guerra

    2014-09-01

    Full Text Available Developmental defects of enamel (DDE are daily encountered in clinical practice. DDE are alteration in quality and quantity of the enamel, caused by disruption and/or damage to the enamel organ during the amelogenesis process. Several clinical indices have been developed to categorize enamel defects based on their nature, appearance, microscopic features or their cause. The aetiology of DDE is not completely clear. Enamel fluorosis is a hypo-mineralization of enamel characterised by subsurface porosity as a result of excess fluoride intake during the period of enamel formation. Several types of treatment have been reported, related to the degree of enamel defect. Correct diagnosis according to lesion depth and prognosis of the technique are fundamental factors in the treatment decision-making process.

  6. Ambulatory Blood Pressure Monitoring – Clinical Practice Recommendations

    Directory of Open Access Journals (Sweden)

    Katalin Mako

    2016-09-01

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

  7. Electrogastroenterography in clinical practice

    Directory of Open Access Journals (Sweden)

    Pavel M. Kosenko

    2013-05-01

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

  8. Patient obesity and the practical experience of the plain radiography professional: On everyday ethics, patient positioning and infelicitous equipment

    International Nuclear Information System (INIS)

    Woods, A.L.; Miller, P.K.; Sloane, C.

    2016-01-01

    Patient obesity is increasingly placing significant and multifaceted strain upon medical imaging departments, and professionals, in (particularly Western) healthcare systems. The majority of obesity-related studies in radiology are, however, primarily focused only upon the technical business of collecting diagnostically-efficacious images. This study, using Interpretative Phenomenological Analysis (IPA), qualitatively explores the everyday clinical experiences of eight expert UK diagnosticians working in plain radiography. Focus herein falls particularly upon (a) problems with patient positioning during examination, and (b) challenges arising around available equipment. In line with extant research, participants reported that difficulties with positioning obese patients could have negative impacts on image quality, and that insufficient table weight limits and widths, and inadequate detector sizes, can adversely affect examination. They also raised some more novel issues, such as how the impact of available gown sizes upon a patient's sense of dignity can cause practical and ethical dilemmas for a clinician in situ. The issue of how one might ‘train’ experience in positioning patients without bony landmarks as a reference point was also made salient, with strong implications for undergraduate radiography curricula. It is finally highlighted how the participating radiographers themselves seldom conceptualised any given problem as a purely ‘technical’ one, instead recurrently recognising the interlinking of material, socio-economic and moral matters in real healthcare contexts. By better understanding such nuance and complexity as lived by real radiographers, it is contended, a more context-sensitive and flexible path to effective training and guideline-production can be mapped. - Highlights: • Difficulties with positioning obese patients can have negative impacts on image quality. • Positioning patients without bony landmarks as a reference point is

  9. Clinical practice of radiotherapy

    International Nuclear Information System (INIS)

    Horiuchi, Junichi; Masaki, Norie; Onoyama, Yasuto

    1987-01-01

    This chapter presents in greater detail radiotherapy used in each clinical setting. The descriptions are given under the following sections: the tongue and oral cavity; the maxilla, larynx, and pharynx; brain tumors; the eyes and orbit; pediatric tumors; lung cancer; the esophagus; breast cancer; the abdominal digestive system; the urogenital system; the uterine cervix; the ovaries and vulva; bone and soft tissues; the skin; hematopoietic tumors; lymph node metastases; and radiotherapy as palliative treatment. (Namekawa, K.)

  10. Speaking Up: Veterinary Ethical Responsibilities and Animal Welfare Issues in Everyday Practice

    Science.gov (United States)

    Hernandez, Elein; Fawcett, Anne; Brouwer, Emily; Rau, Jeff

    2018-01-01

    Simple Summary Veterinarians have an ethical obligation to provide good care for the animals that they see in practice. However, at times, there may be conflicts between the interests of animal caregivers or owners, the interests of veterinarians and the interests of animals. We provide an overview of why and how veterinary ethics is taught to veterinary students, as well as providing a context for thinking about veterinary ethical challenges and animal welfare issues. We argue that veterinarians are ethically obliged to speak up and ask questions when problems arise or are seen and provide a series of clinical case examples in which there is scope for veterinarians to improve animal welfare by ‘speaking up’. Abstract Although expectations for appropriate animal care are present in most developed countries, significant animal welfare challenges continue to be seen on a regular basis in all areas of veterinary practice. Veterinary ethics is a relatively new area of educational focus but is thought to be critically important in helping veterinarians formulate their approach to clinical case management and in determining the overall acceptability of practices towards animals. An overview is provided of how veterinary ethics are taught and how common ethical frameworks and approaches are employed—along with legislation, guidelines and codes of professional conduct—to address animal welfare issues. Insufficiently mature ethical reasoning or a lack of veterinary ethical sensitivity can lead to an inability or difficulty in speaking up about concerns with clients and ultimately, failure in their duty of care to animals, leading to poor animal welfare outcomes. A number of examples are provided to illustrate this point. Ensuring that robust ethical frameworks are employed will ultimately help veterinarians to “speak up” to address animal welfare concerns and prevent future harms. PMID:29361786

  11. Elastography in clinical practice.

    Science.gov (United States)

    Barr, Richard G

    2014-11-01

    Elastography is a new technique that evaluates tissue stiffness. There are two elastography methods, strain and shear wave elastography. Both techniques are being used to evaluate a wide range of applications in medical imaging. Elastography of breast masses and prostates have been shown to have high accuracy for characterizing masses and can significantly decrease the need for biopsies. Shear wave elastography has been shown to be able to detect and grade liver fibrosis and may decrease the need for liver biopsy. Evaluation of other organs is still preliminary. This article reviews the principles of elastography and its potential clinical applications. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Medical Genetics In Clinical Practice

    African Journals Online (AJOL)

    1974-08-24

    Aug 24, 1974 ... Genetics is now an important facet of medical practice. and clinical ... facilities for cytogenetic and biochemical investigation are an essential ..... mem, and Rehabilitation (WHO Technical Report Series No. 497). Geneva: WHO ...

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

    Science.gov (United States)

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

    2013-01-01

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

  14. Ubiquitous media in everyday practices of grief and commemoration on children’s graves and online memorial sites

    DEFF Research Database (Denmark)

    Sandvik, Kjetil; Christensen, Dorthe Refslund

    is not allocated to a specific period of time (a time of mourning) but that grieving and the social technologies like media, materiality and ritualization related to it are embedded in everyday life practices and have to be conceived of as processes rather than events that (suddenly) occur and then are over......’s graves in urban cemeteries. It is, however, also similarly apparent in the formation of network and peer-to-peer associations and, not the least, in the establishment of online networks and sites of grief and commemoration on social media. Facebook, Twitter and YouTube are media alive with discussions...... as such (Featherstone 1992, Elias 1998) and in relation to death practices (Gibson 2008). In recent years, media research has contributed to the field of death studies. Mediatization studies have focused on how various societal practices are influenced by media logics (Livingstone 2009, Lundby 2009) including religious...

  15. NMR in clinical practice

    International Nuclear Information System (INIS)

    Smith, F.W.

    1987-01-01

    The development of NMR for clinical use has been complicated by a number of controversies, the largest of these being the question of what is the optimum field strength for proton imaging. Many workers believe that diagnostically useful images can only be produced at high field strength (i.e. 0.5 - 2.0 T), where in fact diagnostically useful images are made using field strengths of as low as 0.02 T. Because the method is more complex than X-ray CT, which relies on the measurement of only one parameter, tissue density, many new users have difficulty in selecting the correct imaging pulse sequence to provide the most useful image for diagnosis. NMR imaging pulse sequence may be selected to produce images of the proton density, T/sub 1/ or T/sub 2/ signals, or combinations of them. When this facility is used, images which are T/sub 1/ or T/sub 2/ weighted can be selected. Inversion-recovery sequences are more appropriate for imaging the abdomen where by selecting a short TR interval the signal from subcutaneous fat, which is the major cause of image artefact in abdominal imaging, is suppressed thereby improving image quality. The use of surface receiver coils, which are applied closely to the area of the body being examined is becoming more widespread and is of particular value when examining the orbits, facial structures, neck, breast, spine and limbs. The use of these coils together with a discussion of patient selection for NMR imaging, image interpretation and data storage follow

  16. Development of clinical practice guidelines.

    Science.gov (United States)

    Hollon, Steven D; Areán, Patricia A; Craske, Michelle G; Crawford, Kermit A; Kivlahan, Daniel R; Magnavita, Jeffrey J; Ollendick, Thomas H; Sexton, Thomas L; Spring, Bonnie; Bufka, Lynn F; Galper, Daniel I; Kurtzman, Howard

    2014-01-01

    Clinical practice guidelines (CPGs) are intended to improve mental, behavioral, and physical health by promoting clinical practices that are based on the best available evidence. The American Psychological Association (APA) is committed to generating patient-focused CPGs that are scientifically sound, clinically useful, and informative for psychologists, other health professionals, training programs, policy makers, and the public. The Institute of Medicine (IOM) 2011 standards for generating CPGs represent current best practices in the field. These standards involve multidisciplinary guideline development panels charged with generating recommendations based on comprehensive systematic reviews of the evidence. The IOM standards will guide the APA as it generates CPGs that can be used to inform the general public and the practice community regarding the benefits and harms of various treatment options. CPG recommendations are advisory rather than compulsory. When used appropriately, high-quality guidelines can facilitate shared decision making and identify gaps in knowledge.

  17. Towards a new analytical approach to the challenges of communication difficulties and aquired brain damage in everyday practices

    DEFF Research Database (Denmark)

    Klemmensen, Charlotte Marie Bisgaard

    part of where the participants mainly are persons with acquired brain damage and occupational therapists. I will discuss how a new approach to sense-making practice may be designed in order to study more closely a participants’ perspective in unique situations as they arise. I am interested......The approach of language psychology is grounded in the persons communicating; where as the approach of discursive psychology is grounded in social interaction. There is a lack of scientific knowledge on the social/communicative/interactional challenges of communication difficulties and brain injury...... in everyday life. A sense-making-in-practice approach may help form a new discourse. How may a new analytical approach be designed? May ‘communication’ be described as ‘participation abilities’, using the framework from language psychology combined with discursive psychology and the conventions...

  18. Role of clinical questionnaires in optimizing everyday care of chronic obstructive pulmonary disease

    Science.gov (United States)

    Jones, Paul W; Price, David; van der Molen, Thys

    2011-01-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of disability in all its stages, and death in patients with moderate or severe obstruction. At present, COPD is suboptimally managed; current health is often not measured properly and hardly taken into account in management plans, and the future risk for patients with regard to health status and quality of life is not being evaluated. This review addresses the effect of COPD on the lives of patients and examines ways in which existing assessment tools meet physicians’ needs for a standardized, simple method to measure consistently the full impact of COPD on patients in routine clinical practice. Current assessment of COPD severity tends to focus on airflow limitation, but this does not capture the full impact of the disease and is not well correlated with patient perception of symptoms and health-related quality of life. Qualitative studies have demonstrated that patients usually consider COPD impact in terms of frequency and severity of symptoms, and physical and emotional wellbeing. However, patients often have difficulty expressing their disease burden and physicians generally have insufficient time to collect this information. Therefore, it is important that methods are implemented to help generate a more complete understanding of the impact of COPD. This can be achieved most efficiently using a quick, reliable, and standardized measure of disease impact, such as a short questionnaire that can be applied in daily clinical practice. Questionnaires are precision instruments that contribute sensitive and specific information, and can potentially help physicians provide optimal care for patients with COPD. Two short, easy-to-use, specific measures, ie, the COPD Assessment Test and the Clinical COPD Questionnaire, enable physicians to assess patients’ health status accurately and improve disease management. Such questionnaires provide important measurements that can assist primary care physicians to

  19. Preventive psychiatry in clinical practice

    Directory of Open Access Journals (Sweden)

    Mamta Sood

    2017-01-01

    Full Text Available In the last two and a half decades, there have been series of global burden of disease studies which have highlighted significant disability attributable to mental and behavioral disorders with a huge treatment gap. Integration of the preventive strategies in the clinical practice has the potential to reduce the disability due to mental illnesses. The patients come to the clinic with an intention to get treated and investigated for the symptoms they have. At this point, they may also be amenable to the advice related to prevention. Therefore, the clinical encounter can be seen as an opportunity to implement preventive strategies. Preventive efforts in clinical practice must be guided by knowledge about the epidemiological data related to specific mental illnesses and about the evidence-based preventive strategies available for specific mental illnesses. These should be directed toward all those persons (patients, caregivers accompanying and at home, teachers, employers, etc. who are present and also toward those who are not present during the clinical encounter and must be age, gender, and culture sensitive. Sociodemographic characteristics of a person seeking relief from a problem in the clinical encounter help in directing the preventive efforts. The preventive efforts are also driven by the fact that the patient has the first episode or established or treatment refractory mental illness and the short or long duration of illness. For prevention-minded clinical practice, it helps to have a template so that the assessments and interventions relevant for prevention can be carried out as per that scheme; it also helps in orienting the practicing mental health professionals. While making various assessments, making a list of the likely issues to be addressed by preventive efforts during clinical encounter ( first and subsequent is also helpful.

  20. Leadership theory in clinical practice

    OpenAIRE

    Jie-Hui Xu

    2017-01-01

    In current clinical settings, effective clinical leadership ensures a high-quality health care system that consistently provides safe and efficient care. It is useful, then, for health care professionals to be able to identify the leadership styles and theories relevant to their nursing practice. Being adept in recognizing these styles not only enables nurses to develop their skills to become better leaders but also improves relationships with colleagues and leaders who have previously been c...

  1. Role of clinical questionnaires in optimizing everyday care of chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Jones PW

    2011-05-01

    Full Text Available Paul W Jones1, David Price2, Thys van der Molen31Cardiac and Vascular Medicine, St George’s, University of London, UK; 2Centre of Academic Primary Care, University of Aberdeen, UK; 3Department of General Practice, University Medical Center Groningen, The NetherlandsAbstract: Chronic obstructive pulmonary disease (COPD is a leading cause of disability in all its stages, and death in patients with moderate or severe obstruction. At present, COPD is suboptimally managed; current health is often not measured properly and hardly taken into account in management plans, and the future risk for patients with regard to health status and quality of life is not being evaluated. This review addresses the effect of COPD on the lives of patients and examines ways in which existing assessment tools meet physicians’ needs for a standardized, simple method to measure consistently the full impact of COPD on patients in routine clinical practice. Current assessment of COPD severity tends to focus on airflow limitation, but this does not capture the full impact of the disease and is not well correlated with patient perception of symptoms and health-related quality of life. Qualitative studies have demonstrated that patients usually consider COPD impact in terms of frequency and severity of symptoms, and physical and emotional wellbeing. However, patients often have difficulty expressing their disease burden and physicians generally have insufficient time to collect this information. Therefore, it is important that methods are implemented to help generate a more complete understanding of the impact of COPD. This can be achieved most efficiently using a quick, reliable, and standardized measure of disease impact, such as a short questionnaire that can be applied in daily clinical practice. Questionnaires are precision instruments that contribute sensitive and specific information, and can potentially help physicians provide optimal care for patients with COPD

  2. The ethics of everyday practice in primary medical care: responding to social health inequities

    Science.gov (United States)

    2010-01-01

    Background Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities. Results Some see doctors as bound by a notion of care that is blind to a patient's social position, while others respond to this issue through invoking notions of justice and human rights where access to care is a prime focus. Both care and justice orientations however conceal important tensions linked to the presence of bioethical principles underpinning these. Other normative ethical theories like deontology, virtue ethics and utilitarianism do not provide adequate guidance on the problem of social health inequities either. Conclusion This paper explores if Bauman's notion of "forms of togetherness" provides the basis of a relational ethical theory that can help to develop a response to social health inequities of relevance to individual physicians. This theory goes beyond silence on the influence of social position of health and avoids amoral regulatory approaches to monitoring equity of care provision. PMID:20438627

  3. The ethics of everyday practice in primary medical care: responding to social health inequities

    Directory of Open Access Journals (Sweden)

    Palmer Victoria J

    2010-05-01

    Full Text Available Abstract Background Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities. Results Some see doctors as bound by a notion of care that is blind to a patient's social position, while others respond to this issue through invoking notions of justice and human rights where access to care is a prime focus. Both care and justice orientations however conceal important tensions linked to the presence of bioethical principles underpinning these. Other normative ethical theories like deontology, virtue ethics and utilitarianism do not provide adequate guidance on the problem of social health inequities either. Conclusion This paper explores if Bauman's notion of "forms of togetherness" provides the basis of a relational ethical theory that can help to develop a response to social health inequities of relevance to individual physicians. This theory goes beyond silence on the influence of social position of health and avoids amoral regulatory approaches to monitoring equity of care provision.

  4. The ethics of everyday practice in primary medical care: responding to social health inequities.

    Science.gov (United States)

    Furler, John S; Palmer, Victoria J

    2010-05-03

    Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities. Some see doctors as bound by a notion of care that is blind to a patient's social position, while others respond to this issue through invoking notions of justice and human rights where access to care is a prime focus. Both care and justice orientations however conceal important tensions linked to the presence of bioethical principles underpinning these. Other normative ethical theories like deontology, virtue ethics and utilitarianism do not provide adequate guidance on the problem of social health inequities either. This paper explores if Bauman's notion of "forms of togetherness" provides the basis of a relational ethical theory that can help to develop a response to social health inequities of relevance to individual physicians. This theory goes beyond silence on the influence of social position of health and avoids amoral regulatory approaches to monitoring equity of care provision.

  5. Implementing ABPM into Clinical Practice.

    Science.gov (United States)

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

    2018-02-05

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

  6. Introducing guidelines into clinical practice.

    Science.gov (United States)

    Fowkes, F G; Roberts, C J

    1984-04-01

    The impetus for guidelines of practice has been accelerated by a worldwide trend towards insurance based systems of health care. In the past it has been the tradition for the clinician to order all the diagnostic procedures that conceivably might help to clarify what is wrong with a patient, or what course of treatment should be followed. This traditional view ignores the stubborn economic reality that resources are finite and that it is no longer possible to be both endlessly generous and continually fair. Making judgements about the need for, and value of, services now forms an important part of coping with this problem. Clinical practice has to strive to be as safe as possible and to produce a given benefit at a socially acceptable cost. Guidelines are recommendations, preferably developed by clinicians themselves, which describe how and when individual clinical activities should be offered in order to achieve these objectives. Utilisation review of current practice is a valuable source of information for the development of guidelines. In the United Kingdom the Royal College of Radiologists attempted to do this in connection with the use of pre-operative chest X-rays. In 1979 they published the findings of a multicentre review of 10,619 consecutive cases of elective non-cardiopulmonary surgery undertaken in 8 centres throughout the United Kingdom. Substantial variations were found in national practice. Use of pre-operative chest X-rays varied from 11.5% of patients in one centre to 54.2% of patients in another centre. The study also found that the chest X-ray report did not seem to have much influence on the decision to operate nor on the decision to use inhalation anaesthesia. The College study failed to find "any evidence at all for the effectiveness of pre-operative chest X-ray when used routinely" and it was estimated that even if the procedure was 10% effective the costs of avoiding one death would be approximately 1 million pounds. These findings provided

  7. Clinical practice recommendations for depression.

    Science.gov (United States)

    Malhi, G S; Adams, D; Porter, R; Wignall, A; Lampe, L; O'Connor, N; Paton, M; Newton, L A; Walter, G; Taylor, A; Berk, M; Mulder, R T

    2009-01-01

    To provide clinically relevant evidence-based recommendations for the management of depression in adults that are informative, easy to assimilate and facilitate clinical decision making. A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. The recommendations then underwent consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives. The clinical practice recommendations for depression (Depression CPR) summarize evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative. These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of depression. Further, the novel style and practical approach should promote uptake and implementation.

  8. Integrating mobile-phone based assessment for psychosis into people's everyday lives and clinical care: a qualitative study.

    Science.gov (United States)

    Palmier-Claus, Jasper E; Rogers, Anne; Ainsworth, John; Machin, Matt; Barrowclough, Christine; Laverty, Louise; Barkus, Emma; Kapur, Shitij; Wykes, Til; Lewis, Shôn W

    2013-01-23

    Over the past decade policy makers have emphasised the importance of healthcare technology in the management of long-term conditions. Mobile-phone based assessment may be one method of facilitating clinically- and cost-effective intervention, and increasing the autonomy and independence of service users. Recently, text-message and smartphone interfaces have been developed for the real-time assessment of symptoms in individuals with schizophrenia. Little is currently understood about patients' perceptions of these systems, and how they might be implemented into their everyday routine and clinical care. 24 community based individuals with non-affective psychosis completed a randomised repeated-measure cross-over design study, where they filled in self-report questions about their symptoms via text-messages on their own phone, or via a purpose designed software application for Android smartphones, for six days. Qualitative interviews were conducted in order to explore participants' perceptions and experiences of the devices, and thematic analysis was used to analyse the data. Three themes emerged from the data: i) the appeal of usability and familiarity, ii) acceptability, validity and integration into domestic routines, and iii) perceived impact on clinical care. Although participants generally found the technology non-stigmatising and well integrated into their everyday activities, the repetitiveness of the questions was identified as a likely barrier to long-term adoption. Potential benefits to the quality of care received were seen in terms of assisting clinicians, faster and more efficient data exchange, and aiding patient-clinician communication. However, patients often failed to see the relevance of the systems to their personal situations, and emphasised the threat to the person centred element of their care. The feedback presented in this paper suggests that patients are conscious of the benefits that mobile-phone based assessment could bring to clinical care

  9. Integrating mobile-phone based assessment for psychosis into people’s everyday lives and clinical care: a qualitative study

    Directory of Open Access Journals (Sweden)

    Palmier-Claus Jasper E

    2013-01-01

    Full Text Available Abstract Background Over the past decade policy makers have emphasised the importance of healthcare technology in the management of long-term conditions. Mobile-phone based assessment may be one method of facilitating clinically- and cost-effective intervention, and increasing the autonomy and independence of service users. Recently, text-message and smartphone interfaces have been developed for the real-time assessment of symptoms in individuals with schizophrenia. Little is currently understood about patients’ perceptions of these systems, and how they might be implemented into their everyday routine and clinical care. Method 24 community based individuals with non-affective psychosis completed a randomised repeated-measure cross-over design study, where they filled in self-report questions about their symptoms via text-messages on their own phone, or via a purpose designed software application for Android smartphones, for six days. Qualitative interviews were conducted in order to explore participants’ perceptions and experiences of the devices, and thematic analysis was used to analyse the data. Results Three themes emerged from the data: i the appeal of usability and familiarity, ii acceptability, validity and integration into domestic routines, and iii perceived impact on clinical care. Although participants generally found the technology non-stigmatising and well integrated into their everyday activities, the repetitiveness of the questions was identified as a likely barrier to long-term adoption. Potential benefits to the quality of care received were seen in terms of assisting clinicians, faster and more efficient data exchange, and aiding patient-clinician communication. However, patients often failed to see the relevance of the systems to their personal situations, and emphasised the threat to the person centred element of their care. Conclusions The feedback presented in this paper suggests that patients are conscious of the

  10. Reflections in the clinical practice.

    Science.gov (United States)

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

    2014-03-01

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

  11. Mutational profiling in patients with MDS: ready for every-day use in the clinic?

    Science.gov (United States)

    Bacher, Ulrike; Kohlmann, Alexander; Haferlach, Torsten

    2015-03-01

    Multiple recurrent somatic mutations were identified in the majority of patients with myelodysplastic syndromes (MDS), but investigating the broad spectrum of molecular markers in MDS exceeds many laboratories' capacity when traditional molecular techniques are used. High-throughput second generation sequencing (=next-generation sequencing, NGS) has proven to be applicable for comprehensive biomarker mutation analyses allowing to increase diagnostic sensitivity and accuracy and to improve risk stratification and prognostication in addition to cytomorphology and cytogenetic analysis in patients with MDS. Amplicon deep-sequencing enables comprehensive biomarker analysis in a multitude of patients per investigation in an acceptable turn-around time and at affordable costs. Comprehensive myeloid marker panels were successfully introduced into diagnostic practice. Therefore, molecular mutation analysis is ready for use in all patients with suspected MDS, may contribute to risk stratification in possible candidates for allogeneic stem cell transplantation, and should become an integral part of clinical research studies in MDS patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Material Enactments of Identities and Learning in Everyday Community Practices: Implications for Pedagogy

    Science.gov (United States)

    Aberton, Helen

    2012-01-01

    In recent years there has been an upsurge of interest in applying actor-network theory (ANT) to educational research and analysis. This article presents an account of how an ANT analysis of socio-material practices with a focus on objects can bring informal learning and identity formation to view. It is based on a doctoral study of the everyday…

  13. Communicative Interactions in Everyday and College-Assessed Digital Literacy Practices: Transcribing and Analysing Multimodal Texts

    Science.gov (United States)

    Creer, Adele

    2017-01-01

    This paper explores integrating a range of digital media into classroom practice to establish the effectiveness of the media and its encompassing modes as a pedagogical tool with a focus on assessment. Directing attention on a communication skills module, research indicated that bringing a range of digital media into the classroom motivated and…

  14. Semi-spontaneous oral text production: measurements in clinical practice.

    Science.gov (United States)

    Lind, Marianne; Kristoffersen, Kristian Emil; Moen, Inger; Simonsen, Hanne Gram

    2009-12-01

    Functionally relevant assessment of the language production of speakers with aphasia should include assessment of connected speech production. Despite the ecological validity of everyday conversations, more controlled and monological types of texts may be easier to obtain and analyse in clinical practice. This article discusses some simple measurements for the analysis of semi-spontaneous oral text production by speakers with aphasia. Specifically, the measurements are related to the production of verbs and nouns, and the realization of different sentence types. The proposed measurements should be clinically relevant, easily applicable, and linguistically meaningful. The measurements have been applied to oral descriptions of the 'Cookie Theft' picture by eight monolingual Norwegian speakers, four with an anomic type of aphasia and four without any type of language impairment. Despite individual differences in both the clinical and the non-clinical group, most of the measurements seem to distinguish between speakers with and without aphasia.

  15. Homeless Women and Shelter Regimes : A Glimpse of Everyday Practice through Social Workers´Narratives

    OpenAIRE

    Phiri, Cynthia

    2016-01-01

    Homelessness in South Africa is a multi-faceted issue with enormous dimensions; an issue which is deeply interrelated with questions of power, human dignity and social justice. In South Africa, women have been frequently neglected and marginalized with regard to contemporary housing policy and practice. In seeking to understand the nature of this marginalization, this paper focuses on structural disadvantages faced by homeless women in relation to the shelter regimes. To illustrate the latter...

  16. Attitudes and evaluative practices: category vs. item and subjective vs. objective constructions in everyday food assessments.

    Science.gov (United States)

    Wiggins, Sally; Potter, Jonathan

    2003-12-01

    In social psychology, evaluative expressions have traditionally been understood in terms of their relationship to, and as the expression of, underlying 'attitudes'. In contrast, discursive approaches have started to study evaluative expressions as part of varied social practices, considering what such expressions are doing rather than their relationship to attitudinal objects or other putative mental entities. In this study the latter approach will be used to examine the construction of food and drink evaluations in conversation. The data are taken from a corpus of family mealtimes recorded over a period of months. The aim of this study is to highlight two distinctions that are typically obscured in traditional attitude work ('subjective' vs. 'objective' expressions, category vs. item evaluations). A set of extracts is examined to document the presence of these distinctions in talk that evaluates food and the way they are used and rhetorically developed to perform particular activities (accepting/refusing food, complimenting the food provider, persuading someone to eat). The analysis suggests that researchers (a) should be aware of the potential significance of these distinctions; (b) should be cautious when treating evaluative terms as broadly equivalent and (c) should be cautious when blurring categories and instances. This analysis raises the broader question of how far evaluative practices may be specific to particular domains, and what this specificity might consist in. It is concluded that research in this area could benefit from starting to focus on the role of evaluations in practices and charting their association with specific topics and objects.

  17. Power, empowerment, and person-centred care: using ethnography to examine the everyday practice of unregistered dementia care staff.

    Science.gov (United States)

    Scales, Kezia; Bailey, Simon; Middleton, Joanne; Schneider, Justine

    2017-02-01

    The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on 'empowered' direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own 'dis/empowerment' in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service (NHS) wards and one private care home in England, are presented as a narrative exploration of carers' general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings. © 2016 Foundation for the Sociology of Health & Illness.

  18. ‘Getting things done’: an everyday-life perspective towards bridging the gap between intentions and practices in health-related behavior

    NARCIS (Netherlands)

    Woerkum, van C.M.J.; Bouwman, L.I.

    2014-01-01

    In this paper, we aim to add a new perspective to supporting health-related behavior. We use the everyday-life view to point at the need to focus on the social and practical organization of the concerned behavior. Where most current approaches act disjointedly on clients and the social and physical

  19. [Burning sensation in oral cavity--burning mouth syndrome in everyday medical practice].

    Science.gov (United States)

    Gerlinger, Imre

    2012-09-30

    Burning mouth syndrome (BMS) refers to chronic orofacial pain, unaccompanied by mucosal lesions or other evident clinical signs. It is observed principally in middle-aged patients and postmenopausal women. BMS is characterized by an intense burning or stinging sensation, typically on the tongue or in other areas of the oral mucosa. It can be accompanied by other sensory disorders such as dry mouth or taste alterations. Probably of multifactorial origin, and often idiopathic, with a still unknown etiopathogenesis in which local, systemic and psychological factors are implicated. Currently there is no consensus on the diagnosis and classification of BMS. This study reviews the literature on this syndrome, with special reference to the etiological factors that may be involved and the clinical aspects they present. The diagnostic criteria that should be followed and the therapeutic management are discussed with reference to the most recent studies.

  20. Photodynamic therapy in clinical practice

    Directory of Open Access Journals (Sweden)

    E. V. Filonenko

    2016-01-01

    Full Text Available The review is on opportunities and possibilities of application of photodynamic therapy in clinical practice. The advantages of this method are the targeting of effect on tumor foci and high efficiency along with low systemic toxicity. The results of the set of recent Russian and foreign clinical trials are represented in the review. The method is successfully used in clinical practice with both radical (for early vulvar, cervical cancer and pre-cancer, central early lung cancer, esophageal and gastric cancer, bladder cancer and other types of malignant tumors, and palliative care (including tumor pleuritis, gastrointestinal tumors and others. Photodynamic therapy delivers results which are not available for other methods of cancer therapy. Thus, photodynamic therapy allows to avoid gross scars (that is very important, for example, in gynecology for treatment of patients of reproductive age with cervical and vulvar cancer, delivers good cosmetic effect for skin tumors, allows minimal trauma for intact tissue surrounding tumor. Photodynamic therapy is also used in other fields of medicine, such as otorhinolaryngology, dermatology, ophthalmology, orthopaedics, for treatment of papilloma virus infection and purulent wounds as antibacterial therapy.

  1. Standardisation of neonatal clinical practice.

    Science.gov (United States)

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

    2013-09-01

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

  2. Digital practices in everyday lives of 4 to 6 years old Romanian children

    Directory of Open Access Journals (Sweden)

    Gyöngyvér Tőkés

    2016-12-01

    Full Text Available The purpose of this study is to present some findings of a broader research called Digital literacy and multimodal practices of young children from Romania. The mentioned research was part of the EU COST Action IS1410 involving similar endeavours from over 30 countries (COST 2014; Bakó, 2016: p. 146. In our research we used several sources for data collection such as children and their parents, as well as kindergarten educators. We collected qualitative data using three methods: the visual method of drawing, semi-structured interviews and observation. In this study we present digital practices of 4 to 6 years old Romanian children based on interviews made with the children’s parents. We found similar results to other Romanian (Velicu, Mitarcă, 2016 and European (Chaudron, 2015 research such as: the access and use of digital technology is present but not dominant in the daily routines of Romanian young children; Romanian young children’s favourite digital devices are tablets and smartphones; Romanian young children’s familiar digital activities are watching YouTube videos, playing games, making or watching photos and videos about themselves and their families; Romanian young children learn the use of digital devices by observation and imitation, and through testing; the level of Romanian young children’s digital skills is basic; the digitally unexperienced Romanian parents are not supportive with children’s digital endeavours.

  3. Making Everyday Mobility

    DEFF Research Database (Denmark)

    Wind, Simon

    2013; Urry 2007) and family theory (Holdsworth 2013; Morgan 2011), it is argued that family mobility is far from only an instrumental phenomenon, displacing family members back and forth between activities and doings, but also a type of family practice (Morgan, 2011) carrying social and emotional...... coping process in the family, it is argued that making and performing mobility practices is to be understood as creating elasticity. Following this, it is elasticity that enables family members to stretch to accommodate the family’s practical, social and emotional conditions as well as adapt......Based upon a qualitative PhD study of 11 families everyday mobility, this paper inquiries into the everyday mobility of families with children in the Greater Copenhagen Area and the role mobility plays in contributing to coping in the families’ everyday life. Drawing on Mobilities theory (Jensen...

  4. Doripenem: position in clinical practice.

    Science.gov (United States)

    Dedhia, Harakh V; McKnight, Richard

    2009-06-01

    Doripenem is a novel carbapenem with a broad spectrum of activity against Gram-positive pathogens, anerobes and Gram-negative bacteria, including Pseudomonas aeruginosa. Doripenem exhibits rapid bactericidal activity with two- to fourfold lower MIC values for Gram-negative bacteria, compared with other carbapenems such as imipenem. Doripenem is approved for the treatment of complicated intra-abdominal infection and urinary tract infections. It has been successfully used in the treatment of nosocomial and ventilator-associated pneumonia. It has a potential to be the drug of choice for these conditions. This evaluation focuses on the general review of the drug, including mechanisms of resistance, clinical efficacy and the position of doripenem in clinical practice. Stability against numerous beta-lactamases, low adverse-event potential and more potent in vitro and possibly in vivo activity against P. aeruginosa and Acinetobacter baumanni compared with existing carbapenems are attractive features.

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

    Directory of Open Access Journals (Sweden)

    van der Molen T

    2013-10-01

    Full Text Available Thys van der Molen,1,2 Marc Miravitlles,3 Janwillem WH Kocks1,21Department of General Practice, 2GRIAC (Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 3Pneumology Department, Hospital Universitari Vall d'Hebron, Biomedical Research Networking Centre in Respiratory Diseases (CIBERES, Barcelona, SpainAbstract: Patients with chronic obstructive pulmonary disease (COPD present with a variety of symptoms that significantly impair health-related quality of life. Despite this, COPD treatment and its management are mainly based on lung function assessments. There is increasing evidence that conventional lung function measures alone do not correlate well with COPD symptoms and their associated impact on patients' everyday lives. Instead, symptoms should be assessed routinely, preferably by using patient-centered questionnaires that provide a more accurate guide to the actual burden of COPD. Numerous questionnaires have been developed in an attempt to find a simple and reliable tool to use in everyday clinical practice. In this paper, we review three such patient-reported questionnaires recommended by the latest Global Initiative for Chronic Obstructive Lung Disease guidelines, ie, the modified Medical Research Council questionnaire, the clinical COPD questionnaire, and the COPD Assessment Test, as well as other symptom-specific questionnaires that are currently being developed.Keywords: chronic obstructive pulmonary disease, symptoms, questionnaires

  6. [Between everyday practices and interventions: narrative fragments on environmental degradation and health in Aracaju, Brazil].

    Science.gov (United States)

    da Fonseca, Lázaro Batista; Nobre, Maria Teresa; dos Santos, João José Gomes

    2014-10-01

    The scope of this paper is to describe the relationship between health production, urban growth and environmental degradation in the community of the "Urban Expansion Zone" of Aracaju in the State of Sergipe. It also touches on the impacts on the health of the population due to tourism and real estate speculation associated with the absence of basic services. Based on the assumption that illnesses caused by such changes only appear on the public health care system as a worsening of symptoms, neglecting the complex health-environment relationship, this paper highlights the possibility of pondering the bases upon which urban growth occurs in the light of imminent environmental degradation. The activities of health community agents were monitored duly connecting them to regional growth and environmental degradation. This was done from March 2010 and June 2011 adopting the ethnographic perspective as the method of choice. Other ways of inclusion in the community were mapped: contact with older residents, religious leaderships and the members of the traditional professions, etc. The results show the changes that have been occurring in the region, especially with respect to the extinction of traditional practices, increase in violence, unemployment, loss of community ties and illness.

  7. Expert systems in clinical practice

    International Nuclear Information System (INIS)

    Renaud-Salis, J.L.

    1987-01-01

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

  8. Everyday clothing of the Goranci females in Belgrade - between traditional and modern cultural practices

    Directory of Open Access Journals (Sweden)

    Đorđević-Crnobrnja Jadranka

    2015-01-01

    Full Text Available The paper presents and discusses changes in certain dress and clothing practices and their effects on conflict within oneself and others. In this context, the paper analyzes certain conflict situations faced by the Goranci females in Belgrade. This conflict was brought about by the changes that have occurred in the females clothing during the second half of 20th and the first decade of 21st century. The focus is placed on changes that were initiated by external factors - legislation, migration and fashion trends. Accepting novelties in dress and clothing was not always simple and easy, especially if they implied the elimination of those garments implying a certain symbolic significance within the Goranci community and female subculture. Besides, changes in clothing imply and initiate changes in other spheres of life, especially in the sphere of (self identification, on several levels at the same time (gender, religious, ethnic, etc.. The initiation of the clothing changes impacted the women in such a way to become somewhat at odds with themselves, to feel discomfort because of the fear that the (non acceptance of the novelty could cause conflicts with some family members and relatives. A reconciliation with oneself and others imply that a women accepts a new way of dressing, but also the rest of whatever this may imply. Such reconciliation - assessed in this way - is not an end in itself. It is a process that involves several aspects simultaneously, and clothing is just one among them. In addition, a reconciliation on a personal level does not imply in itself reconciliation with others, and vice versa. Conflicts due to clothing do not represent an exception in this respect, but proved to be indicative for understanding complex socio-cultural processes such as reconciliation.

  9. Everyday Tectonics?

    DEFF Research Database (Denmark)

    Beim, Anne; Hvejsel, Marie Frier

    2016-01-01

    Frascari and Kenneth Frampton (Harris & Berke 1997, Read 2000, Frascari 1984, Frampton 1995kilder). Whereas the focus upon everyday architecture seems to have lost its momentum too quickly, tectonic theory in architecture has been steadily growing as a field of research in architecture, especially related...

  10. Effects of Everyday Life Events on Glucose, Insulin, and Glucagon Dynamics in Continuous Subcutaneous Insulin Infusion–Treated Type 1 Diabetes: Collection of Clinical Data for Glucose Modeling

    DEFF Research Database (Denmark)

    Schmidt, Signe; Finan, Daniel Aaron; Duun-Henriksen, Anne Katrine

    2012-01-01

    metabolism, we designed and conducted a clinical study.Methods: Patients with insulin pump–treated T1D were recruited to perform everyday life events on two separate days. During the study, patients wore their insulin pumps and, in addition, a continuous glucose monitor and an activity monitor to estimate...

  11. Clinical practice guideline on diagnosis and treatment of hyponatraemia.

    Science.gov (United States)

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

    2014-03-01

    Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

  12. The intersection of everyday life and group prenatal care for women in two urban clinics.

    Science.gov (United States)

    Novick, Gina; Sadler, Lois S; Knafl, Kathleen A; Groce, Nora Ellen; Kennedy, Holly Powell

    2012-05-01

    Women from vulnerable populations encounter challenging circumstances that generate stress and may adversely affect their health. Group prenatal care (GPNC) incorporates features that address social stressors, and has been demonstrated to improve pregnancy outcomes and prenatal care experiences. In this qualitative study, we describe the complex circumstances in the lives of women receiving care in two urban clinics and how GPNC attenuated them. Stressors included problems with transportation and child care, demanding jobs, poverty, homelessness, difficult relationships with partners, limited family support, and frustrating health care experiences. Receiving prenatal care in groups allowed women to strengthen relationships with significant others, gain social support, and develop meaningful relationships with group leaders. By eliminating waits and providing the opportunity to participate in care, GPNC also offered sanctuary from frustrations encountered in receiving individual care. Reducing such stressors may help improve pregnancy outcomes; however, more evidence is needed on mechanisms underlying these effects.

  13. Research and clinical practice relationship

    Directory of Open Access Journals (Sweden)

    Ashammakhi N

    2008-01-01

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

  14. Test-Retest Reliability of Computerized, Everyday Memory Measures and Traditional Memory Tests.

    Science.gov (United States)

    Youngjohn, James R.; And Others

    Test-retest reliabilities and practice effect magnitudes were considered for nine computer-simulated tasks of everyday cognition and five traditional neuropsychological tests. The nine simulated everyday memory tests were from the Memory Assessment Clinic battery as follows: (1) simple reaction time while driving; (2) divided attention (driving…

  15. Mathematics in everyday life

    CERN Document Server

    Haigh, John

    2016-01-01

    How does mathematics impact everyday events? The purpose of this book is to show a range of examples where mathematics can be seen at work in everyday life. From money (APR, mortgage repayments, personal finance), simple first and second order ODEs, sport and games (tennis, rugby, athletics, darts, tournament design, soccer, snooker), business (stock control, linear programming, check digits, promotion policies, investment), the social sciences (voting methods, Simpson’s Paradox, drug testing, measurements of inequality) to TV game shows and even gambling (lotteries, roulette, poker, horse racing), the mathematics behind commonplace events is explored. Fully worked examples illustrate the ideas discussed and each chapter ends with a collection of exercises. Everyday Mathematics supports other first year modules by giving students extra practice in working with calculus, linear algebra, geometry, trigonometry and probability. Secondary/high school level mathematics is all that is required for students to und...

  16. Clinical practice guideline: Allergic rhinitis.

    Science.gov (United States)

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

    2015-02-01

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

  17. Engagement and practical wisdom in clinical practice: a phenomenological study.

    Science.gov (United States)

    Saraga, Michael; Boudreau, Donald; Fuks, Abraham

    2018-05-08

    In order to understand the lived experiences of physicians in clinical practice, we interviewed eleven expert, respected clinicians using a phenomenological interpretative methodology. We identified the essence of clinical practice as engagement. Engagement accounts for the daily routine of clinical work, as well as the necessity for the clinician to sometimes trespass common boundaries or limits. Personally engaged in the clinical situation, the clinician is able to create a space/time bubble within which the clinical encounter can unfold. Engagement provides an account of clinical practice as a unitary lived experience. This stands in stark contrast to the prevailing notion, referred to as a dual discourse, that describes medicine as the addition of humanism to science. Drawing on Aristotle's notion of phronesis and Sartre's definition of the situation, we illustrate how this novel perspective entwines clinical practice, the person of the clinician, and the clinician's situation.

  18. Methods to Succeed in Effective Knowledge Translation in Clinical Practice.

    Science.gov (United States)

    Kitson, Alison L; Harvey, Gillian

    2016-05-01

    To explore the evidence around facilitation as an intervention for the successful implementation of new knowledge into clinical practice. The revised version of the Promoting Action on Research Implementation in Health Services (PARIHS) framework, called the integrated or i-PARIHS framework, is used as the explanatory framework. This framework posits that evidence is a multidimensional construct embedded within innovation and operationalized by clinicians (individuals and within teams), working across multiple layers of context. Facilitation is the active ingredient that promotes successful implementation. An emerging body of evidence supports facilitation as a mechanism to getting new knowledge into clinical practice. Facilitation roles are divided into beginner, experienced, and expert facilitators. Facilitators can be internal or external to the organization they work in, and their skills and attributes complement other knowledge translation (KT) roles. Complex KT projects require facilitators who are experienced in implementation methods. Facilitation is positioned as the active ingredient to effectively introduce new knowledge into a clinical setting. Levels of facilitation experience are assessed in relation to the complexity of the KT task. Three core facilitation roles are identified, and structured interventions are established taking into account the nature and novelty of the evidence, the receptiveness of the clinicians, and the context or setting where the new evidence is to be introduced. Roles such as novice, experienced, and expert facilitators have important and complementary parts to play in enabling the successful translation of evidence into everyday practice in order to provide effective care for patients. © 2016 Sigma Theta Tau International.

  19. Clinical practice guidelines in patient management

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    2001-01-01

    Full Text Available Efforts have always been made to evolve certain prin-ciples to reduce the variability in the management of patients and make medical care more appropriate. These efforts have become almost a movement since 1980s as evidenced in the development of clinical practice guide-lines in all medical disciplines. This article describes the need for clinical practice guidelines and their de-velopment methods and qualities. Advantages and limi-tations of clinical practice guidelines are enumerated. The salient features of various available clinical prac-tice guidelines in urology are also described.

  20. 'Getting things done': an everyday-life perspective towards bridging the gap between intentions and practices in health-related behavior.

    Science.gov (United States)

    van Woerkum, Cees; Bouwman, Laura

    2014-06-01

    In this paper, we aim to add a new perspective to supporting health-related behavior. We use the everyday-life view to point at the need to focus on the social and practical organization of the concerned behavior. Where most current approaches act disjointedly on clients and the social and physical context, we take the clients' own behavior within the dynamics of everyday context as the point of departure. From this point, healthy behavior is not a distinguishable action, but a chain of activities, often embedded in other social practices. Therefore, changing behavior means changing the social system in which one lives, changing a shared lifestyle or changing the dominant values or existing norms. Often, clients experience that this is not that easy. From the everyday-life perspective, the basic strategy is to support the client, who already has a positive intention, to 'get things done'. This strategy might be applied to those cases, where a gap is found between good intentions and bad behavior.

  1. Everyday sexism

    CERN Document Server

    Bates, Laura

    2014-01-01

    'If Caitlin Moran's How To Be A Womanis the fun-filled manual for female survival in the 21st century, everyday sexism is its more politicised sister' (Independent on Sunday). After experiencing a series of escalating sexist incidents, Laura Bates started theeveryday sexism projectand has gone on to write 'a pioneering analysis of modern day misogyny' (Telegraph). After an astounding response from the wide range of stories that came pouring in from all over the world, the project quickly became one of the biggest social media success stories of the internet. From being harassed and wolf-whistled at on the street, to discrimination in the workplace and serious sexual assault, it is clear that sexism had become normalised. But Bates inspires women to lead a real change and writes this 'extremely powerful book that could, and should, win hearts and minds right across the spectrum' (Financial Times). Often shocking, sometimes amusing and always poignant, everyday sexism is a protest against inequality and a manif...

  2. Professional roles in physiotherapy practice: Educating for self-management, relational matching, and coaching for everyday life.

    Science.gov (United States)

    Solvang, Per Koren; Fougner, Marit

    2016-11-01

    The patient's active participation in treatment and rehabilitation represents a cultural change in clinical practice as well as a major change in physiotherapist and patient roles. This article presents findings from a study aimed at gaining a better understanding of how physiotherapists in actual practice understand their interactions with patients during the treatment process. This article reports on the findings from focus-group interviews with physiotherapists working in three different settings. Analyses of the interview data identified three modes of physiotherapy practice. In one, physiotherapists educate their patients to be self-managing in conducting exercise programs based on sound evidence. Educational films available on the Internet are included in these efforts to teach patients. In another, physiotherapists emphasize the importance of a close relationship to the patient. A good personal chemistry is believed to improve the treatment process. And finally, what physiotherapists learn about the living conditions and the biographies of their patients was shown to be very important. Understanding the importance of the life-world and taking this into consideration in the treatment process were factors considered to be central to good practice. The article concludes with a discussion linking these findings to those of other studies identifying those factors contributing to our knowledge of what is involved in biopsychosocial practice in physiotherapy.

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

    Science.gov (United States)

    Ollenschläger, Günter

    2013-10-01

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

  4. Psychology and the conduct of everyday life

    DEFF Research Database (Denmark)

    Psychology and the Conduct of Everyday Life moves psychological theory and research practice out of the laboratory and into the everyday world. Drawing on recent developments across the social and human sciences, it examines how people live as active subjects within the contexts of their everyday...

  5. Evidence-based clinical practice

    DEFF Research Database (Denmark)

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

    2016-01-01

    was considered through literature searches combined with personal files. Treatments should generally not be chosen based only on evidence from observational studies or single randomised clinical trials. Systematic reviews with meta-analysis of all identifiable randomised clinical trials with Grading...

  6. Grief to everyday life:

    DEFF Research Database (Denmark)

    Christensen, Dorthe Refslund; Sandvik, Kjetil

    2016-01-01

    This chapter demonstrates how everyday practices among parents who suffer the loss of a child include the use of both analogue and digital means, both established media and materialities occasionally functioning as media in order to create meaning-making relations to the dead child, the bereaved...... as well as to the surrounding world. Based on an in-depth interview with a mother to a dead child combined with 8 years of observation studies and qualitative content analyses of both children’s graves and online memory profiles, this chapter explains how these are articulated through everyday media use....... The chapter focuses on the cross media connection between offline and online activities and demonstrates how the loss of a child initiates processes which are not about letting go and moving on but rather keeping hold while moving on articulated through communicational practices of keeping a sense of presence...

  7. The implication of transcultural psychiatry for clinical practice.

    Science.gov (United States)

    Moldavsky, Daniel

    2003-01-01

    This article deals with the main concepts of Transcultural Psychiatry and their applications to everyday psychiatric practice. Transcultural psychiatry has undergone a conceptual reformulation in the last two decades. Having started with a comparative approach, which focused on the diverse manifestations of mental disorders among different societies, it broadened its scope, aiming at present to incorporate social and cultural aspects of illness into the clinical framework. Therefore, transcultural psychiatry now focuses more on what is called the illness experience than on the disease process, the latter understood as illness as it is viewed by health practitioners. Western medicine, of which psychiatry is a part, is grounded in positivist epistemological principles that stress the biological processes of disease. The intention of the paper is to develop an interest in alternative but also complementary ways of thinking. Modern transcultural psychiatry interprets some epidemiological and clinical aspects of major mental disorders (such as schizophrenia and depression) in a different light. However, it also distances itself from the absolute relativism of antipsychiatry, centering on clinical facts and helping clinicians in their primary task of alleviating suffering. An important contribution in addressing this task is the formulation of a cultural axis within the DSM model of multiaxial evaluation. A clinical vignette of a cultural formulation applied to a clinical discussion of a case is described.

  8. MRD Testing in Multiple Myeloma: From a Surrogate Marker of Clinical Outcomes to an Every-Day Clinical Tool.

    Science.gov (United States)

    Landgren, Ola

    2018-01-01

    Minimal residual disease (MRD) testing in multiple myeloma is here to stay. Studies show that MRD negativity is consistently associated with longer progression-free survival (PFS). It is just a matter of time until MRD negativity will become a regulatory endpoint for drug approval. Until that can happen, more analysis will be required to define the exact details of MRD in the regulatory setting. For example, for randomized studies there is need to define the amount of improvement in MRD negativity between the experimental arm and the control arm at a given time-point for a drug to obtain regulatory accelerated approval. Such efforts are underway. For the multiple myeloma field as a whole, important tasks for the (near) coming future are as follows: (1) to conduct or finalize the expanded analysis to define the exact details of MRD in the regulatory setting, (2) to develop new and better MRD assays-both more sensitive MRD assays for bone marrow aspirates and nonbone marrow aspirate-based assays (eg, blood-based and imaging-based MRD assays), and (3) to design novel clinical studies to formally assess the effect of MRD negativity in clinical decision making. The aim with this issue of the Journal is to provide a deep and comprehensive summary of the latest MRD knowledge in the field, and to outline future directions. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project

    NARCIS (Netherlands)

    Thangaratinam, Shakila; Barnfield, Gemma; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N.; Horvath, Andrea R.; Zanrei, Gianni; Kunz, Regina; Suter, Katja; Walczak, Jacek; Kaleta, Anna; Oude Rengerink, Katrien; Gee, Harry; Mol, Ben W. J.; Khan, Khalid S.

    2009-01-01

    ABSTRACT: BACKGROUND: Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However,

  10. "HIV is irrelevant to our company": everyday practices and the logic of relationships in HIV/AIDS management by Japanese multinational corporations in northern Thailand.

    Science.gov (United States)

    Michinobu, Ryoko

    2009-03-01

    Multinational corporations (MNCs) are important participants in workplace initiatives on HIV/AIDS as they collaborate with international organizations to globally promote various policies and guidelines. To date, MNCs have enacted the majority of such initiatives in North America, Europe and South Africa, but we have little information on how MNCs elsewhere, especially in Japan, have responded to the issue of HIV/AIDS in the workplace. This study examines the actual on the ground situation of HIV/AIDS management in Japanese MNCs, specifically investigating everyday corporate practices in the context of internal interactions and relationships and the resulting practices and outlook concerning HIV/AIDS. It is based on a secondary analysis of ethnographic case studies conducted in 10 Japanese-affiliated companies in northern Thailand. Japanese managers, Thai managers and ordinary Thai workers all considered HIV/AIDS to be "irrelevant" to their company and/or themselves. HIV/AIDS measures in the companies were limited to provision of information. This perception and management of HIV/AIDS developed from their everyday interactions governed by the logic of relationships in the companies. In these interactions, they categorized others based on their ascriptive status, primarily based on class, ethnicity and nationality. They sought scapegoat groups that were lower than them in the class- and ethnicity/nationality-based hierarchical system, and cast the risk of HIV infection upon the scapegoat groups, thus reducing their own sense of risk. The paper shows that the relational logic, not ideals or principles, influences their views of and actions concerning HIV/AIDS management in the companies. This is why Japanese companies are unable to deal with HIV/AIDS in terms of international policies and guidelines that are based on the logic of human rights and the logic of business principles. The results suggest a need for international policymakers to pay more attention to

  11. Positron emission tomography clinical practice

    CERN Document Server

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

    2006-01-01

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

  12. Digital clinical photography: Practical tips

    Directory of Open Access Journals (Sweden)

    Sharad Mutalik

    2010-01-01

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

  13. Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice : the EU-EBM project

    OpenAIRE

    Thangaratinam, S.; Barnfield, Gemma; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N.; Horvath, Andrea R.; Zanrei, Gianni; Kunz, Regina; Suter, Katja; Walczak, Jacek; Kaleta, Anna; Rengerink, Katrien; Gee, Harry FRCOG‏; Mol, Ben W. J.; Khan, Khalid Saeed

    2009-01-01

    Background:\\ud Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional developme...

  14. Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project

    OpenAIRE

    Thangaratinam, Shakila; Barnfield, Gemma; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N; Horvath, Andrea R; Zanrei, Gianni; Kunz, Regina; Suter, Katja; Walczak, Jacek; Kaleta, Anna; Rengerink, Katrien; Gee, Harry; Mol, Ben WJ; Khan, Khalid S

    2009-01-01

    Abstract Background Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional deve...

  15. Communities of clinical practice: the social organization of clinical learning.

    Science.gov (United States)

    Egan, Tony; Jaye, Chrystal

    2009-01-01

    The social organization of clinical learning is under-theorized in the sociological literature on the social organization of health care. Professional scopes of practice and jurisdictions are formally defined by professional principles and standards and reflected in legislation; however, these are mediated through the day-to-day clinical activities of social groupings of clinical teams. The activities of health service providers typically occur within communities of clinical practice. These are also major sites for clinical curriculum delivery, where clinical students learn not only clinical skills but also how to be health professionals. In this article, we apply Wenger's model of social learning within organizations to curriculum delivery within a health service setting. Here, social participation is the basis of learning. We suggest that it offers a powerful framework for recognizing and explaining paradox and incongruence in clinical teaching and learning, and also for recognizing opportunities, and devising means, to add value to students' learning experiences.

  16. Social media in clinical practice

    CERN Document Server

    Meskó, Bertalan

    2013-01-01

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

  17. Pharmacogenetics in the oncological clinical practice

    International Nuclear Information System (INIS)

    Gruber, S.

    2004-01-01

    The genetic control of drug metabolism allows new insights into the bioavailability, toxicity, and efficacy of chemotherapy. In addition, molecular expression profiles of tumors offers the potential for targeted therapy to be directed more specifically to the biologic behavior of the cancer. Together these strategies are likely to change the practice of clinical oncology. However, appropriate clinical trials will be required to demonstrate the utility of these approaches before they are broadly implemented the biologic behavior of the cancer. Together these strategies are likely to change the practice of clinical oncology. However, appropriate clinical trials will be required to demonstrate the utility of these approaches before they are broadly implemented

  18. Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project.

    Science.gov (United States)

    Thangaratinam, Shakila; Barnfield, Gemma; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N; Horvath, Andrea R; Zanrei, Gianni; Kunz, Regina; Suter, Katja; Walczak, Jacek; Kaleta, Anna; Oude Rengerink, Katrien; Gee, Harry; Mol, Ben W J; Khan, Khalid S

    2009-09-10

    Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD) courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments. We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers) to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process. The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection. This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical situations to teach various steps of EBM and demonstrate their

  19. Suspected cow's milk allergy in everyday general practice: a retrospective cohort study on health care burden and guideline adherence.

    Science.gov (United States)

    van den Hoogen, Sharayke C T A; van de Pol, Alma C; Meijer, Yolanda; Toet, Jaap; van Klei, Céline; de Wit, Niek J

    2014-08-09

    Cow's milk allergy (CMA) is the most common food allergy among infants. No data are available on the health care burden of suspected CMA in general practice. This study was conducted to evaluate the burden of suspected CMA in general practice (GP): (a) prevalence, (b) presenting symptoms, (c) diagnostic process, (d) guideline adherence, and (e) dietary measures. A retrospective cohort study was carried out in four Julius Healthcare Centers (JHCs). These JHCs form the core primary care academic network of the department of general practice of the University Medical Center of Utrecht. Electronic records of the first year of infants born May 2009 - April 2010 registered in the JHCs were screened for possible CMA suspicion. Preventive child healthcare (PCH) records were reviewed for additional information. Clinical presentation, diagnostic strategies and dietary measures were extracted. Of 804 infants evaluated, 55 presented with symptoms fitting the suspicion of CMA (prevalence of 7%). Presenting complaints involved the skin (71%); the gastrointestinal tract (60%); the respiratory tract (13%) or other symptoms (36%) and 23 infants presented with symptoms of two or more organ systems. In 31 children (56%) a food challenge was performed (n = 28 open and n = 3 double-blind). Open challenge test results were difficult to interpret due to inadequate implementation or reporting. None had confirmed CMA after an adequate challenge test. Long term milk substitute formulas were prescribed in 39 (71%) infants. On a yearly basis seven percent of children visit their GP for suspected CMA. A positive CMA diagnosis was rarely established after adequate implementation and reporting of diagnostics, yet long term dietary measures were prescribed in >70% of patients. There is definitely need for improvement of diagnosing CMA in primary care.

  20. Science education and everyday action

    Science.gov (United States)

    McCann, Wendy Renee Sherman

    2001-07-01

    This dissertation addresses three related tasks and issues in the larger field of science education. The first is to review of the several uses of "everydayness" at play in the science education literature, and in the education and social science literatures more generally. Four broad iterations of everydayness were found in science education, and these were traced and analyzed to develop their similarities, and contradictions. It was concluded that despite tendencies in science education research to suppose a fundamental demarcation either between professional science and everyday life, or between schools and everyday life, all social affairs, including professional science and activity in schools, are continuous with everyday life, and consist fundamentally in everyday, ordinary mundane actions which are ordered and organized by the participants to those social activities and occasions. The second task for this dissertation was to conduct a naturalistic, descriptive study of undergraduate-level physics laboratory activities from the analytic perspective of ethnomethodology. The study findings are presented as closely-detailed analysis of the students' methods of following their instructions and 'fitting' their observed results to a known scientific concept or principle during the enactment of their classroom laboratory activities. Based on the descriptions of students' practical work in following instructions and 'fitting'. The characterization of school science labs as an "experiment-demonstration hybrid" is developed. The third task of this dissertation was to synthesize the literature review and field study findings in order to clarify what science educators could productively mean by "everydayness", and to suggest what understandings of science education the study of everyday action recommends. It is argued that the significance of the 'experiment-demo hybrid' characterization must be seen in terms of an alternate program for science education research, which

  1. Evaluating critical thinking in clinical practice.

    Science.gov (United States)

    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.

  2. Hyponatraemia diagnosis and treatment clinical practice guidelines

    NARCIS (Netherlands)

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

    2017-01-01

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

  3. Hormone Therapy in Clinical Equine Practice.

    Science.gov (United States)

    McCue, Patrick M

    2016-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Valsa Thomas

    2011-03-01

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

  5. Distinguishing benign and malignant pelvic masses : The value of different diagnostic methods in everyday clinical practice

    NARCIS (Netherlands)

    Engelen, Mirjam J. A.; Bongaerts, Alphons H. H.; Sluiter, Wim J.; De Haan, Harm H.; Bogchelman, Dick H.; TenVergert, Els M.; Willemse, Pax H. B.; van der Zee, Ate G. J.

    Objective: To optimize referral to specialized gynaecologists for surgical treatment of ovarian cancer by improving preoperative discrimination between benign and malignant pelvic tumours. Study design: In a prospective multicentre study 143 patients with a pelvic mass were included. At several

  6. Efficient imaging of the knee. A update for everyday clinical practice

    International Nuclear Information System (INIS)

    Maeurer, J.

    2004-01-01

    This is a systematic, precise and clear introduction to the current state of knowledge on diseases of the knee. All available imaging techniques, their indications and diagnostic value are presented. While newcomers will get a systematic introduction, experienced diagnostic experts will find occasion to remember and enhance their knowledge. Each chapter ends with a systematic summary. Keywords at the top of each page enable fast access to the issue of interest. (orig.)

  7. Don't rest in peace: cross media uses in everyday practices of grief and commemoration on children’s graves and online memorial sites

    DEFF Research Database (Denmark)

    Sandvik, Kjetil; Christensen, Dorthe Refslund

    This paper demonstrates how everyday practices among those who suffer the loss of a child include the use of both analogue and digital means and media to create meaningful relations to the dead child, the bereaved as well as to the surrounding world. A dead child – be it a stillborn or dead....... In this situation, the process of grief becomes a way of reinstalling meaning by establishing an ongoing relationship to the dead child by which the child – who in life was barely there – gains existence and through which the identity as parents (however to a dead child) is established, communicated and socially...... acknowledged. Based on observation studies and qualitative content analyses of both children’s graves and online memory profiles (Christensen & Sandvik 2013, 2014) combined with interviews with bereaved parents, we present some reflections on how these practices of commemoration, meaning...

  8. Implementing Home Health Standards in Clinical Practice.

    Science.gov (United States)

    Gorski, Lisa A

    2016-02-01

    In 1986, the American Nurses Association (ANA) published the first Standards of Home Health Practice. Revised in 1992 and expanded in 1999 to become Home Health Nursing: Scope and Standards of Practice, it was revised in 2008 and again in 2014. In the 2014 edition, there are 6 standards of home healthcare nursing practice and 10 standards of professional performance for home healthcare nursing. The focus of this article is to describe the home healthcare standards and to provide guidance for implementation in clinical practice. It is strongly encouraged that home healthcare administrators, educators, and staff obtain a copy of the standards and fully read this essential home healthcare resource.

  9. Contemporary management of pericardial effusion: practical aspects for clinical practice.

    Science.gov (United States)

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

    2017-03-01

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

  10. Implementing human factors in clinical practice

    Science.gov (United States)

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

    2015-01-01

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

  11. Clinical Engineering: Experiences of assisted professional practices

    International Nuclear Information System (INIS)

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

    2007-01-01

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

  12. The Red Book and clinical practice.

    Science.gov (United States)

    Bygott, Catherine

    2012-09-01

    Jung's work is fundamentally an experience, not an idea. From this perspective, I attempt to bridge conference, consulting room and living psyche by considering the influence of the 'Red Book' on clinical practice through the subtle and imaginal. Jung's journey as a man broadens out to have relevance for women. His story is individual but its archetypal foundation finds parallel expression in analytic practice today. © 2012, The Society of Analytical Psychology.

  13. The daily digital practice as a form of self-care: Using photography for everyday well-being.

    Science.gov (United States)

    Brewster, Liz; Cox, Andrew M

    2018-04-01

    Interest in the connection between involvement in digital communities and well-being has increased as these communities become more commonplace. Specific models of interaction that affect well-being have emerged; here, we examine one of those models, termed 'digital daily practice'. Digital daily practices involve a commitment to doing one thing - exercise, photography and writing - every day and sharing it online. Participants in these practices agree that they provide an unexpected benefit of improving well-being. This article makes an in-depth examination of one digital daily practice, photo-a-day, using a practice theory framework to understand the affordances it offers for well-being. We engage with the literature on well-being and self-care, critiquing its presentation of well-being as an individual trait. We present data from an ethnographic study including interviews and observations to highlight how photo-a-day as a practice functions as self-care and how communities are formed around it. Photo-a-day is not a simple and uncomplicated practice; rather it is the complex affordances and variance within the practice that relate it to well-being. We conclude that this practice has multi-faceted benefits for improving well-being.

  14. Everyday imagery

    DEFF Research Database (Denmark)

    Peters, Chris; Allan, Stuart

    2016-01-01

    the gradual disappearance of media from personal consciousness in a digital age. If ceaselessness is a defining characteristic of the current era, our analysis reveals that the use of smartphone cameras is indicative of people affectively and self-consciously deploying the technology to try to arrest......User-based research into the lived experiences associated with smartphone camera practices – in particular, the taking, storing, curating, and sharing of personal imagery in the digital media sphere – remains scarce, especially in contrast to their increasing ubiquity. Accordingly, this article...... social bonds, and encompass a future-oriented perspective. Relatedly, in terms of photographic composition, visual content tends to circulate around the social presence of others, boundedness of event, perceived aesthetic value, and intended shareability. Our findings question certain formulations about...

  15. Organs at risk in the brain and their dose-constraints in adults and in children: A radiation oncologist’s guide for delineation in everyday practice

    International Nuclear Information System (INIS)

    Scoccianti, Silvia; Detti, Beatrice; Gadda, Davide; Greto, Daniela; Furfaro, Ilaria; Meacci, Fiammetta; Simontacchi, Gabriele; Di Brina, Lucia; Bonomo, Pierluigi; Giacomelli, Irene; Meattini, Icro; Mangoni, Monica; Cappelli, Sabrina; Cassani, Sara; Talamonti, Cinzia; Bordi, Lorenzo; Livi, Lorenzo

    2015-01-01

    Purpose: Accurate organs at risk definition is essential for radiation treatment of brain tumors. The aim of this study is to provide a stepwise and simplified contouring guide to delineate the OARs in the brain as it would be done in the everyday practice of planning radiotherapy for brain cancer treatment. Methods: Anatomical descriptions and neuroimaging atlases of the brain were studied. The dosimetric constraints used in literature were reviewed. Results: A Computed Tomography and Magnetic Resonance Imaging based detailed atlas was developed jointly by radiation oncologists, a neuroradiologist and a neurosurgeon. For each organ brief anatomical notion, main radiological reference points and useful considerations are provided. Recommended dose-constraints both for adult and pediatric patients were also provided. Conclusions: This report provides guidelines for OARs delineation and their dose-constraints for the treatment planning of patients with brain tumors

  16. The practice of clinical neuropsychology in Australia.

    Science.gov (United States)

    Ponsford, Jennie

    2016-11-01

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

  17. Experience with Fingolimod in Clinical Practice

    Science.gov (United States)

    Hersh, Carrie M.; Hara-Cleaver, Claire; Rudick, Richard A.; Cohen, Jeffrey A.; Bermel, Robert A.; Ontaneda, Daniel

    2015-01-01

    Aim To report experience with fingolimod in clinical practice. Design/Methods Patients in an academic medical center who were prescribed fingolimod from October 2010 to August 2011 were identified through the electronic medical record and followed for 12 months after fingolimod initiation. Adverse effects, clinical measures, MRI data, and quality of life measures were assessed. Results Three hundred seventeen patients started fingolimod. Eleven patients were treatment naïve (3.5%) and 76 (24.0%) had remote disease modifying therapy use prior to fingolimod. One hundred fifty-one (47.6%) switched because of patient preference and 79 (24.9%) switched because of breakthrough disease. About 11.6% transitioned from natalizumab. Follow-up data were available for 306 patients (96.5%) with mean follow-up time 332 days. Fingolimod was discontinued in 76 of 306 patients (24.8%) at mean 248 days after fingolimod start. Discontinuation most often was due to adverse effects (n=40) or breakthrough disease (n=22). Among patients who started fingolimod with available 12 month follow-up data, 267 (87.3%) remained relapse free and 256 (83.7%) had no relapses or gadolinium enhancement. Time to first relapse occurred at mean 282 days after fingolimod initiation. Quality of life measures remained stable at follow-up. Conclusions Fingolimod was discontinued at a higher rate in clinical practice than in clinical trials. Discontinuation was primarily due to adverse effects or breakthrough disease. Disease activity was adequately controlled in most patients who started fingolimod. This clinical practice cohort is consistent with efficacy data from phase 3 trials and describes the most common tolerability issues in clinical practice. PMID:25271798

  18. Clinical practice recommendations for bipolar disorder.

    Science.gov (United States)

    Malhi, G S; Adams, D; Lampe, L; Paton, M; O'Connor, N; Newton, L A; Walter, G; Taylor, A; Porter, R; Mulder, R T; Berk, M

    2009-01-01

    To provide clinically relevant evidence-based recommendations for the management of bipolar disorder in adults that are informative, easy to assimilate and facilitate clinical decision-making. A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. These preliminary recommendations underwent extensive consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives. The clinical practice recommendations for bipolar disorder (bipolar CPR) summarise evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative. These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of bipolar disorder. Further, the novel style and practical approach should promote their uptake and implementation.

  19. The Bobath concept in contemporary clinical practice.

    Science.gov (United States)

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

    2009-01-01

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

  20. Uses of internet technology in clinical practice

    International Nuclear Information System (INIS)

    Mansoor, I.

    2001-01-01

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

  1. "Seeing the Everyday through New Lenses": Pedagogies and Practices of Literacy Teacher Educators with a Critical Stance

    Science.gov (United States)

    Dharamshi, Pooja

    2018-01-01

    This article explores the practices and pedagogies of six literacy teacher educators with a critical stance. In this qualitative research study, three semi-structured interviews were conducted with each participant over a three-year period. They were able to negotiate a critical stance into their teacher education courses in several ways: using an…

  2. Heart Failure: From Research to Clinical Practice.

    Science.gov (United States)

    Islam, Md Shahidul

    2018-01-01

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

  3. Do Clinical Practice Guidelines Improve Quality?

    Science.gov (United States)

    Baldassari, Cristina M

    2017-07-01

    Controversy exists surrounding how to best define and assess quality in the health care setting. Clinical practice guidelines (CPGs) have been developed to improve the quality of medical care by highlighting key clinical recommendations based on recent evidence. However, data linking CPGs to improvements in outcomes in otolaryngology are lacking. Numerous barriers contribute to difficulties in translating CPGs to improvements in quality. Future initiatives are needed to improve CPG adherence and define the impact of CPG recommendations on the quality of otolaryngologic care provided to our patients.

  4. Mediating epistemic access through everyday language resources ...

    African Journals Online (AJOL)

    In most rural and township English additional language classrooms, everyday language discursive practices of bi/multilingual students are underutilised. This study reports on how grade 4 emergent isiZulu-English bilingual children used their everyday language resources as a tool for epistemic access. Drawing on ...

  5. Reflexive fatherhood in everyday life

    DEFF Research Database (Denmark)

    Westerling, Allan

    2015-01-01

    This article looks at fathering practices in Denmark, using the findings from a research project on everyday family life in Denmark. It takes a social psychological perspective and employs discursive psychology and theories about reflexive modernisation. It shows how fathers orient towards intimacy...... in their relationships with their children. Moreover, it discusses how fathers’ relatedness reflects individualisation and detraditionalisation. It is argued that reflexive modernisation entails subjective orientations that enable novel pathways to intimacy in contemporary father–child relationships. Through...... this analysis and discussion, the article offers a way to understand the complexities of fathering in everyday life from the perspective of fathers....

  6. Medical Ethics in Contemporary Clinical Practice

    Directory of Open Access Journals (Sweden)

    John R. Williams

    2005-11-01

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

  7. Laser flare photometry in clinical practice

    Directory of Open Access Journals (Sweden)

    Yury S Astakhov

    2016-06-01

    Full Text Available Laser flare photometry (LFP is the only quantitative and objective method for the evaluation of aqueous flare. There are numerous opportunities to use LFP in clinical practice, and they are discussed in the paper. It is especially helpful in management of uveitis patients, because it allows estimating the correct diagnosis, managing the patient during the treatment with noninvasive method and predicting relapses and complications.

  8. Impella ventricular support in clinical practice

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  9. Clinical decision making in veterinary practice

    OpenAIRE

    Everitt, Sally

    2011-01-01

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

  10. Medical Malpractice Implications of Clinical Practice Guidelines.

    Science.gov (United States)

    Ruhl, Douglas S; Siegal, Gil

    2017-08-01

    Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

  11. Implementing human factors in clinical practice.

    Science.gov (United States)

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

    2015-05-01

    To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. Qualitative, longitudinal study using semi-structured interviews and focus groups, of a multiprofessional group of UK NHS staff (from the emergency department and operating theatres) who have received aviation-derived human factors training. The human factors training was evaluated positively, and thought to be both acceptable and relevant to practice. However, the staff found it harder to implement what they had learned in their own clinical areas, and this was principally attributed to features of the informal organisational cultures. In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Leadership and the everyday practice of Consultant Radiographers in the UK: Transformational ideals and the generation of self-efficacy

    International Nuclear Information System (INIS)

    Booth, L.; Henwood, S.; Miller, P.K.

    2017-01-01

    Introduction: This paper outlines findings from a broader, two-year project investigating the role of Consultant Radiographers (CRs) in the UK, focussing specifically on the leadership aspect of that role. Methods: Using a qualitative-thematic approach, the leadership-related experiences of a purposive sample of six participating CRs are explored, alongside the systems through which they evaluated how successful they had been as leaders. Results: It is evidenced that many of the ways in which participants describe their own leadership practice, particularly in the intra-team domain, is consistent with the precepts of the Transformational Leadership Model. For example, they highlight how they have asserted positive influence and encouraged collective action and decision-making. However, the experiential focus of the analysis reveals that in specific examples of practice, the transformational approach was not always seen as the most useful route to a productive outcome given constrictions on time and other resources within real professional environments. More ‘direct’ managerial approaches were sometimes deemed necessary, and at others leadership was reduced to simply ‘solving other people's problems'. It was also found that the manner in which participants evaluated their own success as leaders was a practical concern, based in part upon having satisfied ‘hard’ institutional goals, but also on the more personal business of having affirmatively ‘surprised’ oneself, or a general sense of feeling trusted by colleagues. Conclusion: These findings may help support CRs in the business of real leadership, not least through better understanding how even apparently mundane outcomes can have significant impacts on professional self-efficacy. - Highlights: • CRs report a rich variety of diverse tasks emerging from their leadership roles. • The leadership role is both inward and outward facing. • Transformational leadership strategies are often

  13. Clinical neuropsychology practice and training in Canada.

    Science.gov (United States)

    Janzen, Laura A; Guger, Sharon

    2016-11-01

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

  14. Developing a stone database for clinical practice.

    Science.gov (United States)

    Turney, Benjamin W; Noble, Jeremy G; Reynard, John M

    2011-09-01

    Our objective was to design an intranet-based database to streamline stone patient management and data collection. The system developers used a rapid development approach that removed the need for laborious and unnecessary documentation, instead focusing on producing a rapid prototype that could then be altered iteratively. By using open source development software and website best practice, the development cost was kept very low in comparison with traditional clinical applications. Information about each patient episode can be entered via a user-friendly interface. The bespoke electronic stone database removes the need for handwritten notes, dictation, and typing. From the database, files may be automatically generated for clinic letters, operation notes. and letters to family doctors. These may be printed or e-mailed from the database. Data may be easily exported for audits, coding, and research. Data collection remains central to medical practice, to improve patient safety, to analyze medical and surgical outcomes, and to evaluate emerging treatments. Establishing prospective data collection is crucial to this process. In the current era, we have the opportunity to embrace available technology to facilitate this process. The database template could be modified for use in other clinics. The database that we have designed helps to provide a modern and efficient clinical stone service.

  15. Leadership and the everyday practice of Consultant Radiographers in the UK: Transformational ideals and the generation of self-efficacy.

    Science.gov (United States)

    Booth, L; Henwood, S; Miller, P K

    2017-05-01

    This paper outlines findings from a broader, two-year project investigating the role of Consultant Radiographers (CRs) in the UK, focussing specifically on the leadership aspect of that role. Using a qualitative-thematic approach, the leadership-related experiences of a purposive sample of six participating CRs are explored, alongside the systems through which they evaluated how successful they had been as leaders. It is evidenced that many of the ways in which participants describe their own leadership practice, particularly in the intra-team domain, is consistent with the precepts of the Transformational Leadership Model. For example, they highlight how they have asserted positive influence and encouraged collective action and decision-making. However, the experiential focus of the analysis reveals that in specific examples of practice, the transformational approach was not always seen as the most useful route to a productive outcome given constrictions on time and other resources within real professional environments. More 'direct' managerial approaches were sometimes deemed necessary, and at others leadership was reduced to simply 'solving other people's problems'. It was also found that the manner in which participants evaluated their own success as leaders was a practical concern, based in part upon having satisfied 'hard' institutional goals, but also on the more personal business of having affirmatively 'surprised' oneself, or a general sense of feeling trusted by colleagues. These findings may help support CRs in the business of real leadership, not least through better understanding how even apparently mundane outcomes can have significant impacts on professional self-efficacy. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  16. Elizabeth Shove, Mika Pantzar, Matt Watson, The Dynamics of Social Practice. Everyday Life and how it Changes

    OpenAIRE

    Ortar, Nathalie

    2012-01-01

    The dynamics of social practice s’inscrit dans une filiation qui marque depuis quelques années le paysage de la recherche de la sociologie de la consommation et de l’énergie. Son ambition est à la hauteur de l’importance prise par ces travaux puisque les auteurs souhaitent faire une différence grâce à la théorisation sociale pour influer sur les politiques publiques. L’ouvrage se veut également une critique de la théorie des choix rationnels et s’applique à démontrer pourquoi cette théorie es...

  17. The self-created outdoor class-room "Michelbachpark": Practical experiences of 5 years project work in every-day school life

    Science.gov (United States)

    Brake, Jens; Istler, Katharina; Kisser, Thomas

    2015-04-01

    project is positioned in every-day school-life, the presentation is about practical experiences and given feedback by pupils (class 10 and primary school), teachers (gymnasia and primary school), partners and people. This way, the presentation may also give hints, what are determinants for success and how to overcome barriers in every-day school life and practice. In the future, we are going to found a company leaded by the pupils. Younger classes can book the whole equipment together with tutors. This will lead to the economic aspect of sustainability.

  18. Everyday tactics in local moral worlds: E-cigarette practices in a working-class area of the UK.

    Science.gov (United States)

    Thirlway, Frances

    2016-12-01

    Research into e-cigarette use has largely focused on their health effects and efficacy for smoking cessation, with little attention given to their potential effect on health inequalities. Drawing on three years of ethnographic research between 2012 and 2015, I investigate the emerging e-cigarette practices of adult smokers and quitters in a working-class area of the UK. I first use de Certeau's notion of 'tactics' to describe the informal economy of local e-cigarette use. Low-priced products were purchased through personal networks and informal sources for financial reasons, but also as a solution to the moral problems of addiction and expenditure on the self, particularly for older smokers. E-cigarette practices were produced in local moral worlds where smoking and cessation had a complex status mediated through norms of age and gender. For younger men, smoking cessation conflicted with an ethic of working-class hedonism but e-cigarette use allowed cessation to be incorporated into male sociality. Continued addiction had moral implications which older men addressed by constructing e-cigarette use as functional rather than pleasurable, drawing on a narrative of family responsibility. The low priority which older women with a relational sense of identity gave to their own health led to a lower tolerance for e-cigarette unreliability. I draw on Kleinman's local moral worlds to make sense of these findings, arguing that smoking cessation can be a risk to moral identity in violating local norms of age and gender performance. I conclude that e-cigarettes did have some potential to overcome normative barriers to smoking cessation and therefore to reduce health inequalities, at least in relation to male smoking. Further research which attends to local meanings of cessation in relation to age and gender will establish whether e-cigarettes have similar potential elsewhere. Copyright © 2016 The Author. Published by Elsevier Ltd.. All rights reserved.

  19. Cardiac magnetic resonance imaging in clinical practice

    Directory of Open Access Journals (Sweden)

    Adriana Dias Barranhas

    2014-01-01

    Full Text Available Objective To evaluate and describe indications, mainly diagnoses and cardiac magnetic resonance imaging findings observed in clinical practice. Materials and Methods Retrospective and descriptive study of cardiac magnetic resonance performed at a private hospital and clinic in the city of Niterói, RJ, Brazil, in the period from May 2007 to April 2011. Results The sample included a total of 1000 studies performed in patients with a mean age of 53.7 ± 16.2 years and predominance for male gender (57.2%. The majority of indications were related to assessment of myocardial perfusion at rest and under pharmacological stress (507/1000; 51%, with positive results in 36.2% of them. Suspected myocarditis was the second most frequent indication (140/1000; 14%, with positive results in 63.4% of cases. These two indications were followed by study of arrhythmias (116/1000; 12%, myocardial viability (69/1000; 7% and evaluation of cardiomyopathies (47/1000; 5%. In a subanalysis, it was possible to identify that most patients were assessed on an outpatient basis (58.42%. Conclusion Cardiac magnetic resonance has been routinely performed in clinical practice, either on an outpatient or emergency/inpatient basis, and myocardial ischemia represented the main indication, followed by investigation of myocarditis, arrhythmogenic right ventricular dysplasia and myocardial viability.

  20. Role modeling excellence in clinical nursing practice.

    Science.gov (United States)

    Perry, R N Beth

    2009-01-01

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

  1. The experience of Australian project leaders in encouraging practitioners to adopt research evidence in their clinical practice.

    Science.gov (United States)

    Henderson, Amanda J; Davies, Jan; Willet, Michaela R

    2006-11-01

    This paper describes a qualitative program evaluation which sought to identify factors that either assist or impede the adoption of clinical evidence in everyday practice. Thirteen Australian projects were funded in a competitive grant program to adopt innovative strategies to improve the uptake of research evidence in everyday clinical practice. Project leaders' reports were analysed to collate common themes related to 1) critical elements in successful application of research knowledge, 2) barriers to implementing evidence, and 3) lessons for other organisations that might implement a similar project. Despite the diversity of the methods used to establish projects and the range of topics and clinical settings, many similarities were identified in the perceived critical success elements, barriers, and lessons for adopting clinical evidence. Eighteen themes emerged across the data including: leadership support; key stakeholder involvement; practice changes; communication; resources; education of staff; evaluation of outcomes; consumers; knowledge gaps; adoption/implementing staff; access to knowledge; risk assessment; collaboration; effectiveness of clinical research evidence; structure/organisation; cultural barriers; previous experiences; and information technology. Leaders of projects to adopt evidence in clinical practice identified barriers, critical success elements and lessons that impacted on their projects. A range of influences on the adoption of evidence were identified, and this knowledge can be used to assist others undertaking similar projects.

  2. [Qualitative translational science in clinical practice].

    Science.gov (United States)

    Mu, Pei-Fan

    2013-10-01

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

  3. Ethics in the practice of clinical psychology.

    Science.gov (United States)

    Isaac, Rathna

    2009-01-01

    The paper presents an overview of ethical issues in clinical psychology. Specifically, it addresses the broad philosophical ideas and views on mental illness on which ethical principles are based, including Greek philosophy and Christianity. It goes on to describe the ethical code of the American Psychological Association as it pertains to general principles, psychological assessment or psychometry, education or training and psychological interventions. The principles of the code and research on the same are discussed with relevance to issues and challenges to ethical practice in India, and suggestions for ethical conduct are made. The paper emphasises the need to consider different viewpoints and take individual responsibility for difficult decisions.

  4. The Sherlock Holmes method in clinical practice.

    Science.gov (United States)

    Sopeña, B

    2014-04-01

    This article lists the integral elements of the Sherlock Holmes method, which is based on the intelligent collection of information through detailed observation, careful listening and thorough examination. The information thus obtained is analyzed to develop the main and alternative hypotheses, which are shaped during the deductive process until the key leading to the solution is revealed. The Holmes investigative method applied to clinical practice highlights the advisability of having physicians reason through and seek out the causes of the disease with the data obtained from acute observation, a detailed review of the medical history and careful physical examination. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  5. Chronic pancreatitis: from guidelines to clinical practice

    Directory of Open Access Journals (Sweden)

    Generoso Uomo

    2012-10-01

    Full Text Available Introduction The paucity of specific standardized criteria leads to uncertainties in clinical practice regarding the management of chronic pancreatitis (CP.Objectives This paper reports some of the systematic guidelines for the diagnosis and treatment of CP recently elaborated by an Italian multicenter study group. We review recommendations on clinical and nutritional aspects of the disease, assessment of pancreatic function, treatment of exocrine pancreatic failure and secondary diabetes, treatment of pain, and prevention of painful relapses. The review also looks at the role of endoscopy in the management of pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications; the appropriate use of various imaging techniques, including endoscopic ultrasound; and the indications for and techniques used in surgical management of CP.

  6. [Breaking bad news in clinical practice].

    Science.gov (United States)

    Herrera, Andrea; Ríos, Matías; Manríquez, José Manuel; Rojas, Gonzalo

    2014-10-01

    Breaking bad news is a complex task that requires multiple communication skills from health professionals. Clinical practice demands to communicate all type of bad news, from a diagnosis of cancer to adverse effects of a treatment. On the other hand, since the beginning of the health reform in 2003, the need to improve the quality of services was proposed, among which the concern about the rights and duties of patients stands out. Therefore, the health care provider-patient relationship becomes again the subject of discussion and study, and a topic of great importance for clinical work. We revise the consequences of breaking bad news for the patient and for the health care provider, as well as the current protocols available for this purpose. The importance of developing communication skills both for future health professionals as for those who currently work in the area is emphasized.

  7. Biosensors in Clinical Practice: Focus on Oncohematology

    Directory of Open Access Journals (Sweden)

    Agostino Cortelezzi

    2013-05-01

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

  8. The Sociomateriality of Creativity in Everyday Life

    DEFF Research Database (Denmark)

    Tanggaard, Lene

    2013-01-01

    This paper explores the sociomateriality of creativity in everyday life. Whilst creativity research has traditionally been concerned with the intellectual and individual skills promoting creativity, such as the ability to apply divergent thinking, this author anchors creativity in social practice...

  9. Taking PDT into mainstream clinical practice

    Science.gov (United States)

    Bown, Stephen G.

    2009-06-01

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

  10. Clinical Practices in Collegiate Concussion Management.

    Science.gov (United States)

    Baugh, Christine M; Kroshus, Emily; Stamm, Julie M; Daneshvar, Daniel H; Pepin, Michael J; Meehan, William P

    2016-06-01

    In recent years, sports leagues and sports medicine experts have developed guidelines for concussion management. The extent to which current clinical practice is consistent with guideline recommendations is unclear. At the collegiate level, there have been few examinations of concussion management practices and the extent to which meaningful differences across divisions of competition exist. The purposes of this study were to (1) examine current practices in concussion diagnosis and management at National Collegiate Athletic Association (NCAA) member colleges, (2) explore the extent to which current practices reflect current recommendations for concussion diagnosis and management, and (3) determine whether there are differences in management patterns across divisions of competition. Descriptive epidemiology study. An electronic questionnaire was sent to sports medicine clinicians at all NCAA member colleges during September and October 2013. Clinicians were asked about baseline assessments, diagnosis and management practices, return-to-play protocols, the perceived prevalence of underdiagnosis, and basic demographic information. Approximately 30% (n = 866) of contacted clinicians, representing nearly 50% (n = 527) of NCAA member colleges, responded to the questionnaire. Preparticipation baseline examinations were administered at the majority of schools (95%), but most (87.5%) administered baseline assessments only to selected high-risk athletes. Computerized neurocognitive testing and balance assessments were most commonly used as preseason baseline and postinjury assessments. Multimodal examination in line with NCAA and other guidance was used only at a minority of institutions. Athletic trainers most commonly administered and interpreted the preseason baseline examination. Most clinicians reported that their institutions' practices were in line with NCAA guidelines during the first 24 hours of an athlete's concussion diagnosis, with exact percentages varying

  11. Agreement between Estimated and Measured Renal Function in an Everyday Clinical Outpatient Setting of Human Immunodeficiency Virus-Infected Individuals

    DEFF Research Database (Denmark)

    Ahlström, Magnus Glindvad; Kjær, Andreas; Gerstoft, Jan

    2017-01-01

    serum-creatinine-based equations and the eRF reported by the Department of Clinical Biochemistry. We evaluated performance characteristics of the different eRFs, with concordance correlation coefficient, total deviation index, coverage probability, relative accuracy, and Bland Altman plots. We also...

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

    Directory of Open Access Journals (Sweden)

    Bugaj, T. J.

    2016-08-01

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

  13. Encountering the Everyday

    DEFF Research Database (Denmark)

    life traditions such as Chicago sociology, phenomenology, American pragmatism, symbolic interactionism, existentialism and critical everyday life sociologies, but also to the later developments by Erving Goffman, French everyday life thinkers, the ethnomethodologists, conversation analysts...... and the absurdists. Finally, a section deals with the most recent approaches such as the specifically Scandinavian everyday life perspectives, the sociology of emotions, social semiotics, cultural studies and postmodern interpretive interactionism. The chapters all accessibly introduce the reader to the ‘core...

  14. Validity and everyday clinical applicability of lumbar muscle fatigue assessment methods in patients with chronic non-specific low back pain: a systematic review.

    Science.gov (United States)

    Villafañe, Jorge H; Gobbo, Massimiliano; Peranzoni, Matteo; Naik, Ganesh; Imperio, Grace; Cleland, Joshua A; Negrini, Stefano

    2016-09-01

    This systematic literature review aimed at examining the validity and applicability in everyday clinical rehabilitation practise of methods for the assessment of back muscle fatiguability in patients with chronic non-specific low back pain (CNSLBP). Extensive research was performed in MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Physiotherapy Evidence Database (PEDro) and Cochrane Central Register of Controlled Trials (CENTRAL) databases from their inception to September 2014. Potentially relevant articles were also manually looked for in the reference lists of the identified publications. Studies examining lumbar muscle fatigue in people with CNSLBP were selected. Two reviewers independently selected the articles, carried out the study quality assessment and extracted the results. A modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scale was used to evaluate the scientific rigour of the selected works. Twenty-four studies fulfilled the selection criteria and were included in the systematic review. We found conflicting data regarding the validity of methods used to examine back muscle fatigue. The Biering-Sorensen test, performed in conjunction with surface electromyography spectral analysis, turned out to be the most widely used and comparatively, the most optimal modality currently available to assess objective back muscle fatigue in daily clinical practise, even though critical limitations are discussed. Future research should address the identification of an advanced method for lower back fatigue assessment in patients with CNSLBP which, eventually, might provide physical therapists with an objective and reliable test usable in everyday clinical practise. Implications for Rehabilitation Despite its limitations, the Biering-Sorensen test is currently the most used, convenient and easily available fatiguing test for lumbar muscles. To increase validity and reliability of the Biering

  15. Teaching trainers to incorporate evidence-based medicine (EBM teaching in clinical practice: the EU-EBM project

    Directory of Open Access Journals (Sweden)

    Kaleta Anna

    2009-09-01

    Full Text Available Abstract Background Evidence based medicine (EBM is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments. Methods We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process. Results The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection. Conclusion This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical

  16. Clinical practice guidelines in breast cancer

    Science.gov (United States)

    Tyagi, N. Kumar; Dhesy-Thind, S.

    2018-01-01

    Background A number of clinical practice guidelines (cpgs) concerning breast cancer (bca) screening and management are available. Here, we review the strengths and weaknesses of cpgs from various professional organizations and consensus groups with respect to their methodologic quality, recommendations, and implementability. Methods Guidelines from four groups were reviewed with respect to two clinical scenarios: adjuvant ovarian function suppression (ofs) in premenopausal women with early-stage estrogen receptor–positive bca, and use of sentinel lymph node biopsy (slnb) after neoadjuvant chemotherapy (nac) for locally advanced bca. Guidelines from the American Society of Clinical Oncology (asco); Cancer Care Ontario’s Program in Evidence Based Care (cco’s pebc); the U.S. National Comprehensive Cancer Network (nccn); and the St. Gallen International Breast Cancer Consensus Conference were reviewed by two independent assessors. Guideline methodology and applicability were evaluated using the agree ii tool. Results The quality of the cpgs was greatest for the guidelines developed by asco and cco’s pebc. The nccn and St. Gallen guidelines were found to have lower scores for methodologic rigour. All guidelines scored poorly for applicability. The recommendations for ofs were similar in three guidelines. Recommendations by the various organizations for the use of slnb after nac were contradictory. Conclusions Our review demonstrated that cpgs can be heterogeneous in methodologic quality. Low-quality cpg implementation strategies contribute to low uptake of, and adherence to, bca cpgs. Further research examining the barriers to recommendations—such as intrinsic guideline characteristics and the needs of end users—is required. The use of bca cpgs can improve the knowledge-to-practice gap and patient outcomes.

  17. [Progress in methodological characteristics of clinical practice guideline for osteoarthritis].

    Science.gov (United States)

    Xing, D; Wang, B; Lin, J H

    2017-06-01

    At present, several clinical practice guidelines for the treatment of osteoarthritis have been developed by institutes or societies. The ultimate purpose of developing clinical practice guidelines is to formulate the process in the treatment of osteoarthritis effectively. However, the methodologies used in developing clinical practice guidelines may place an influence on the transformation and application of that in treating osteoarthritis. The present study summarized the methodological features of individual clinical practice guideline and presented the tools for quality evaluation of clinical practice guideline. The limitations of current osteoarthritis guidelines of China are also indicated. The review article might help relevant institutions improve the quality in developing guide and clinical transformation.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    Concern about obesity has prompted numerous public health campaigns that urge people to be more physically active. The campaigns often include normative statements and attempt to impose restrictions on individuals' lives without considering the complexities of daily life. We suggest that broadening...... into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday lives....... Care practices are an inherent part of producing scientific facts but they are removed from the recognised results of scientific practice and thus from common public health recommendations. However, knowledge about the strategic use of care practices in lifestyle interventions is important for public...

  19. Expertise in Everyday Nurse–Patient Conversations

    Directory of Open Access Journals (Sweden)

    Lindsay M. Macdonald

    2016-04-01

    Full Text Available A great deal of nursing activity is embedded in what is considered to be everyday conversation. These conversations are important to health professionals because communication can affect health outcomes, and they are important to patients who want to know they are being heard and cared for. How do nurses talk with patients and what are the features of effective communication in practice? In this exploratory study, two expert nurses recorded conversations with patients during domiciliary visits. Linguistic discourse analysis, informed by contextual knowledge of domiciliary nursing shows the nurses skillfully used small talk to support their clinical work. In their conversations, nurses elicit specific information, normalize unpleasant procedures, manage the flow of the interaction, and strengthen the therapeutic relationship. Small talk can be big talk in achieving nursing goals. Critically reflecting on recorded clinical interactions can be a useful method of professional development and a way of demonstrating nursing expertise.

  20. The Bobath concept - a model to illustrate clinical practice.

    Science.gov (United States)

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

    2017-12-17

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

  1. Partying as Everyday Life

    DEFF Research Database (Denmark)

    Demant, Jakob; Østergaard, Jeanette

    2007-01-01

    situates the event in everyday life. By drawing on Maffesoli's (1996) concept of ‘sociality' and Lincoln's (2005) concept of zoning the spatial and social logic of the house, partying is analysed using both qualitative and quantitative material. The analysis suggests that the consumption of alcohol (i...... to reaffirm friendship and is therefore an integrated part of adolescents' everyday life.  ...

  2. Everyday Ageing in Copenhagen

    DEFF Research Database (Denmark)

    Stald-Bolow, Nina Rose; Malmborg, Lone; Brandt, Eva

    2015-01-01

    Senior life in Copenhagen is lived in numerous ways. Through three seniors' stories from their everyday life, we give an insight into this diversity. We lookig into how they imagine a good senior life can unfold in Copenhagen today. The three senior lives portrayed here were part of the everyday ...

  3. Everyday ageing in Copenhagen

    DEFF Research Database (Denmark)

    Stald-Bolow, Nina Rose; Malmborg, Lone; Brandt, Eva

    2015-01-01

    Senior life in Copenhagen is lived in numerous ways. Through three seniors' stories from their everyday life, we give an insight into this diversity. We lookig into how they imagine a good senior life can unfold in Copenhagen today. The three senior lives portrayed here were part of the everyday ...

  4. Code of practice for clinical proton dosimetry

    International Nuclear Information System (INIS)

    Vynckier, S.

    1991-01-01

    The objective of this document is to make recommendations for the determination of absorbed dose to tissue for clinical proton beams and to achieve uniformity in proton dosimetry. A Code of Practice (CoP) has been chosen, providing specific guidelines for the choice of the detector and the method of determination of absorbed dose for proton beams only. This CoP is confined specifically to the determination of absorbed dose and is not concerned with the biological effects of proton beams. It is recommended that dosimeters be calibrated by comparison with a calorimeter. If this is not available, a Faraday cup, or alter-natively, an ionization chamber, with a 60 Co calibration factor should be used. Physical parameters for determining the dose from tissue-equivalent ionization chamber measurements are given together with a worksheet. It is recommended that calibrations be carried out in water at the centre of the spread-out-Bragg-peak and that dose distributions be measured in a water phantom. It is estimated that the error in the calibrations will be less than +-5 per cent (1 S.D.) in all cases. Adoption and implementation of this CoP will facilitate the exchange of clinical information. (author). 34 refs.; 5 figs.; 5 tabs

  5. Risk assessment instruments in clinical practice.

    Science.gov (United States)

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

    2012-04-01

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

  6. Does diet-beverage intake affect dietary consumption patterns? Results from the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial123

    Science.gov (United States)

    Piernas, Carmen; Tate, Deborah F; Wang, Xiaoshan

    2013-01-01

    Background: Little is understood about the effect of increased consumption of low-calorie sweeteners in diet beverages on dietary patterns and energy intake. Objective: We investigated whether energy intakes and dietary patterns were different in subjects who were randomly assigned to substitute caloric beverages with either water or diet beverages (DBs). Design: Participants from the Choose Healthy Options Consciously Everyday randomized clinical trial (a 6-mo, 3-arm study) were included in the analysis [water groups: n = 106 (94% women); DB group: n = 104 (82% women)]. For energy, macronutrient, and food and beverage intakes, we investigated the main effects of time, treatment, and the treatment-by-time interaction by using mixed models. Results: Overall, the macronutrient composition changed in both groups without significant differences between groups over time. Both groups reduced absolute intakes of total daily energy, carbohydrates, fat, protein, saturated fat, total sugar, added sugar, and other carbohydrates. The DB group decreased energy from all beverages more than the water group did only at month 3 (P-group-by-time dessert intake than the water group did at month 6 (P-group-by-time beverages and specifically reduced more desserts than the water group did. Our study does not provide evidence to suggest that a short-term consumption of DBs, compared with water, increases preferences for sweet foods and beverages. This trial was registered at clinicaltrials.gov as NCT01017783. PMID:23364015

  7. Does diet-beverage intake affect dietary consumption patterns? Results from the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial.

    Science.gov (United States)

    Piernas, Carmen; Tate, Deborah F; Wang, Xiaoshan; Popkin, Barry M

    2013-03-01

    Little is understood about the effect of increased consumption of low-calorie sweeteners in diet beverages on dietary patterns and energy intake. We investigated whether energy intakes and dietary patterns were different in subjects who were randomly assigned to substitute caloric beverages with either water or diet beverages (DBs). Participants from the Choose Healthy Options Consciously Everyday randomized clinical trial (a 6-mo, 3-arm study) were included in the analysis [water groups: n = 106 (94% women); DB group: n = 104 (82% women)]. For energy, macronutrient, and food and beverage intakes, we investigated the main effects of time, treatment, and the treatment-by-time interaction by using mixed models. Overall, the macronutrient composition changed in both groups without significant differences between groups over time. Both groups reduced absolute intakes of total daily energy, carbohydrates, fat, protein, saturated fat, total sugar, added sugar, and other carbohydrates. The DB group decreased energy from all beverages more than the water group did only at month 3 (P-group-by-time dessert intake than the water group did at month 6 (P-group-by-time beverages and specifically reduced more desserts than the water group did. Our study does not provide evidence to suggest that a short-term consumption of DBs, compared with water, increases preferences for sweet foods and beverages. This trial was registered at clinicaltrials.gov as NCT01017783.

  8. An analysis of narratives to identify critical thinking contexts in psychiatric clinical practice.

    Science.gov (United States)

    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.

  9. Clinical practice: new challenges for the advanced practice nurse.

    Science.gov (United States)

    Bartel, J C; Buturusis, B

    2000-12-01

    This report describes the challenges for advanced practice nurses (APNs) relative to supply and demand issues. The article also includes opportunities with the Balanced Budget Act, physician acceptance of Advanced Practice Nurses, and expanding practice opportunities. The challenges include the nursing shortage (both in nursing students and faculty), the aging of the nursing workforce, and a lag in nursing salaries; increased demand for nursing based on aging baby boomers, increasing patient acuity and technology, and new arenas for practice. The Balanced Budget Act of 1997 provided new opportunities for advanced practice nurses, including enhanced autonomy to provide services and bill independently of physicians. With these changes come new opportunities for advanced practice nurse entrepreneurs in the areas of independent practice, including opportunities to positively impact the health of families and communities in alignment with the Federal government's vision for "Healthy People 2010." As physician acceptance of advanced practice nurses continues to grow and in light of the changes in medical practice and education (residency reduction), opportunities to expand collaborative practice arrangements also exist. APNs are best suited to make the most of these changes. One example of an opportunity for independent practice, a Community Wellness Center, is developed as an entrepreneurial venture benefiting both the APN and the health of a community. Who better than registered nurses (RNs), especially those practicing at the advanced level, can ensure that these opportunities and challenges are addressed in an ethical manner and focused on the needs and health of the community?

  10. [Philosophy of psychiatry and phenomenology of everyday life: The disruptions of ordinary experience in schizophrenia].

    Science.gov (United States)

    Troubé, Sarah

    2016-12-01

    The paper considers the philosophy of psychiatry from the perspective of everyday life, as a particular structure of experience. We outline some questions raised by disturbances typical of psychotic disorders with regard to a phenomenology of the everyday and common sense. As a link between philosophy and clinical psychopathology, this phenomenology implies a transcendental point of view, embedded in concrete and practical forms of ordinary experience, along with social norms. This opens the possibility of a mutual questioning between philosophy and psychiatry, drawing on its clinical, epistemological, and ethical dimensions.

  11. Factors affecting Korean nursing student empowerment in clinical practice.

    Science.gov (United States)

    Ahn, Yang-Heui; Choi, Jihea

    2015-12-01

    Understanding the phenomenon of nursing student empowerment in clinical practice is important. Investigating the cognition of empowerment and identifying predictors are necessary to enhance nursing student empowerment in clinical practice. To identify empowerment predictors for Korean nursing students in clinical practice based on studies by Bradbury-Jones et al. and Spreitzer. A cross-sectional design was used for this study. This study was performed in three nursing colleges in Korea, all of which had similar baccalaureate nursing curricula. Three hundred seven junior or senior nursing students completed a survey designed to measure factors that were hypothesized to influence nursing student empowerment in clinical practice. Data were collected from November to December 2011. Study variables included self-esteem, clinical decision making, being valued as a learner, satisfaction regarding practice with a team member, perception on professor/instructor/clinical preceptor attitude, and total number of clinical practice fields. Data were analyzed using stepwise multiple regression analyses. All of the hypothesized study variables were significantly correlated to nursing student empowerment. Stepwise multiple regression analysis revealed that clinical decision making in nursing (t=7.59, pempowerment in clinical practice will be possible by using educational strategies to improve nursing student clinical decision making. Simultaneously, attitudes of nurse educators are also important to ensure that nursing students are treated as valued learners and to increase student self-esteem in clinical practice. Finally, diverse clinical practice field environments should be considered to enhance experience. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Laparoscopic cholecystectomy: a clinical practice audit

    International Nuclear Information System (INIS)

    Masud, M.; Adil, M.; Ashraf, F.; Aqil, A.

    2015-01-01

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

  13. Conducting everyday life

    DEFF Research Database (Denmark)

    Juhl, Pernille

    , they are involved in preventive interventions. I conducted participatory observations with the children in their everyday life. Overall, the study stresses that even small children must be perceived as active participants who act upon and struggle with different conditions and meaning making processes across......In the paper I discuss how small children (0-4 year) develop through ‘conducting everyday life’ across contexts (Holzkamp 2013). I discuss how this process of conducting everyday life is essential when discussing the ‘good life for children’ from a child perspective. These issues are addressed...... contexts (home, day care, part-time foster family) and in relation to other co-participants....

  14. Interventions in everyday lives

    DEFF Research Database (Denmark)

    Dreier, Ole

    2015-01-01

    The purpose of psychotherapy is to help clients address and overcome problems troubling them in their everyday lives. Therapy can therefore only work if clients include it in their ongoing lives to deal with their problems. Detailed, systematic research is needed on how clients do so...... clients change their everyday lives to overcome their troubles. They also highlight what it involves for clients to accomplish this. It is concluded that we need more research on how to understand intervention; on the interaction between interventions and clients’ conduct of their everyday life...

  15. Clinical practice guideline: Bell's Palsy executive summary.

    Science.gov (United States)

    Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

    2013-11-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. There are myriad treatment options for Bell's palsy; some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, there are numerous diagnostic tests available that are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have an unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy.

  16. Measuring Cutaneous Lesions: Trends in Clinical Practice.

    Science.gov (United States)

    Zhang, Shali; Blalock, Travis W

    2018-03-01

    Knowing the size of a cutaneous lesion can be important for tracking its progression over time, selecting the proper treatment modality, surgical planning, determining prognosis, and accurate billing. However, providers vary in their consistency, accuracy, and methods of measuring cutaneous lesions. To investigate the clinical practices of US dermatologists and dermatologic surgeons regarding how they determine the size of cutaneous lesions. A survey was electronically distributed to members of the American Society for Dermatologic Surgery. Four hundred twenty-six dermatologists completed the online survey. When a lesion is suspected to be malignant, 85% of respondents obtained exact measurements most, if not all, of the time; however, only 8% did for benign lesions. Most providers determined lesion sizes themselves rather than delegating to staff. When performing visual estimation, approximately three-quarters believed that they were accurate to within 1 to 2 mm. The top reasons for obtaining exact measurements were for tracking atypical pigmented lesions, determining treatment pathways, and accurate billing. The majority of respondents believed that lesion size affected management decisions; however, the need for exact measurement remains controversial, particularly for benign lesions. Future studies may investigate whether taking exact versus estimated measurements has an effect on outcomes.

  17. Management of sarcoidosis in clinical practice

    Directory of Open Access Journals (Sweden)

    Florence Jeny

    2016-06-01

    Full Text Available Sarcoidosis is a systemic disease of unknown cause with very diverse presentation, outcome, severity and need for treatments. While some presentations may be very typical, for many patients, the presentation is nonspecific, with shared associations with other diseases at times being by far more frequent or misleading, which can be a cause of significant delay and often several consultations before a diagnosis of sarcoidosis can be confirmed. This is particularly the case when pulmonary manifestations are in the forefront. The diagnosis relies on three well-known criteria. In clinical practice, these criteria are not easily implemented, particularly by physicians without expertise in sarcoidosis, which can lead to a risk of either under- or over-diagnosis. Qualifying the presentation according to sarcoidosis diagnosis is essential. However, it is often not easy to classify the presentation as typical versus compatible or compatible versus inconsistent. Further investigations are needed before any other hypothesis is to be considered. It is important to detect events and to determine whether or not they are indicative of a flare of sarcoidosis. Eventually, treatment needs to be related to the correct indications. The evaluation of the efficacy and safety of treatments is crucial. To address such issues, we present five emblematic cases that illustrate this.

  18. Clinical anatomy as practiced by ancient Egyptians.

    Science.gov (United States)

    Loukas, Marios; Hanna, Michael; Alsaiegh, Nada; Shoja, Mohammadali M; Tubbs, R Shane

    2011-05-01

    Egypt is famously known for its Nile and pyramids, yet not many people know that Egypt made possible the origin of the anatomical sciences. Several ancient papyri guide us through the Egyptians' exploration of the human body and how they applied anatomical knowledge to clinical medicine to the best of their knowledge. It is through records, such as the Edwin Smith, Ebers, and Kahun papyri and other literature detailing the work of the Egyptian embalmers, physicians, and Greek anatomists, that we are able to take a glimpse into the evolution of the anatomical sciences from 3000 B.C. to 250 B.C. It is through the Egyptian embalmer that we were able to learn of some of the first interactions with human organs and their detailed observation. The Egyptian physician's knowledge, being transcribed into the Ebers and Edwin Smith papyri, enabled future physicians to seek reference to common ailments for diagnosing and treating a variety of conditions ranging from head injuries to procedures, such as trans-sphenoidal surgery. In Alexandria, Herophilus, and Erasistratus made substantial contributions to the anatomical sciences by beginning the practice of human dissection. For instance, Herophilus described the anatomy of the heart valves along with Erasistratus who demonstrated how blood was prevented from flowing retrograde under normal conditions. Hence, from various records, we are able to unravel how Egypt paved the road for study of the anatomical sciences. Copyright © 2011 Wiley-Liss, Inc.

  19. Adherence to EBM guidelines in clinical practice.

    Science.gov (United States)

    Khafizianova, R Kh; Burykin, I M

    2015-01-01

    Adequate and rational pharmacotherapy is an important element of rehabilitation of patients with myocardial infarction. Orders of the Ministry of Health of the Russian Federation, domestic and international guidelines, and scientific publications - all contain a complete algorithm for rational pharmacotherapy [1, 2]. These documents are based on the principles of evidence-based medicine (EBM) and help practicing physicians to carry out individualized and rational pharmacotherapy. However, clinical studies have shown low adherence of physicians to clinical guidelines. In the Russian Federation the death rate from cardiovascular diseases is higher than in developed countries. Thus, studies of the causes of high cardiovascular mortality are needed. To assess adherence of practicing physicians to principles of evidence-based medicine in treating patients after myocardial infarction at the stage of rehabilitation. A retrospective analysis of 157 cases of patients in rehabilitation after myocardial infarction for the years 2006 and 2009 was undertaken.We analyzed the list of drugs, prescribed to patients during the period of rehabilitation, drug combinations, regimens and pharmacoepidemiological parameters. We used the following rehabilitation criteria: blood pressure control, smoking cessation, and weight control. Recommendations of controlled physical activities have also been studied. Patient care was compared with the guideline recommendations. Statistical analysis was performed using the OLAP system. 65 patients with myocardial infarction received rehabilitation therapy in 2006, and 92 - in 2009. It was found, that in 2006 physicians prescribed an average of 4.5 drugs per patient, and in 2009 - 4.6 drugs per patient. The average number of cardiovascular drugs (category C of ATC classification) per patient was 2.9 in 2006, and 2.6 - in 2009. Polypharmacy was found in half of the patients.In terms of evidence-based medicine, an important element in the rehabilitation

  20. Clinical practice guideline: management of acute pancreatitis

    Science.gov (United States)

    Greenberg, Joshua A.; Hsu, Jonathan; Bawazeer, Mohammad; Marshall, John; Friedrich, Jan O.; Nathens, Avery; Coburn, Natalie; May, Gary R.; Pearsall, Emily; McLeod, Robin S.

    2016-01-01

    There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone–induced pancreatitis. Une hausse de l’incidence de pancréatite aiguë a été constatée à l’échelle mondiale. Malgré l’amélioration de l’accès aux soins et aux techniques d’imagerie et d’intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu’il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l’importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu’elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire. PMID:27007094

  1. The Challenges of Clinical Practice as Experienced by First Year ...

    African Journals Online (AJOL)

    UNISWA Research Journal of Agriculture, Science and Technology ... Nursing students internalise the art of nursing through clinical practice. ... These findings have implications for nursing education, practice, administration and research.

  2. Pareto fronts in clinical practice for pinnacle.

    Science.gov (United States)

    Janssen, Tomas; van Kesteren, Zdenko; Franssen, Gijs; Damen, Eugène; van Vliet, Corine

    2013-03-01

    Our aim was to develop a framework to objectively perform treatment planning studies using Pareto fronts. The Pareto front represents all optimal possible tradeoffs among several conflicting criteria and is an ideal tool with which to study the possibilities of a given treatment technique. The framework should require minimal user interaction and should resemble and be applicable to daily clinical practice. To generate the Pareto fronts, we used the native scripting language of Pinnacle(3) (Philips Healthcare, Andover, MA). The framework generates thousands of plans automatically from which the Pareto front is generated. As an example, the framework is applied to compare intensity modulated radiation therapy (IMRT) with volumetric modulated arc therapy (VMAT) for prostate cancer patients. For each patient and each technique, 3000 plans are generated, resulting in a total of 60,000 plans. The comparison is based on 5-dimensional Pareto fronts. Generating 3000 plans for 10 patients in parallel requires on average 96 h for IMRT and 483 hours for VMAT. Using VMAT, compared to IMRT, the maximum dose of the boost PTV was reduced by 0.4 Gy (P=.074), the mean dose in the anal sphincter by 1.6 Gy (P=.055), the conformity index of the 95% isodose (CI(95%)) by 0.02 (P=.005), and the rectal wall V(65 Gy) by 1.1% (P=.008). We showed the feasibility of automatically generating Pareto fronts with Pinnacle(3). Pareto fronts provide a valuable tool for performing objective comparative treatment planning studies. We compared VMAT with IMRT in prostate patients and found VMAT had a dosimetric advantage over IMRT. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Pareto Fronts in Clinical Practice for Pinnacle

    International Nuclear Information System (INIS)

    Janssen, Tomas; Kesteren, Zdenko van; Franssen, Gijs; Damen, Eugène; Vliet, Corine van

    2013-01-01

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

  4. Erving Goffman and Everyday Life Mobility

    DEFF Research Database (Denmark)

    Jensen, Ole B.

    2009-01-01

    the subway, biking to work or the freeway commute are by no means neither just instrumental practices of getting from A to B, nor are they trivial acts of physical displacement. Goffman's insights into the ‘little practices' of social life substantiates that contemporary everyday life mobility is produced...

  5. Librarian contributions to clinical practice guidelines.

    Science.gov (United States)

    Cruse, Peggy; Protzko, Shandra

    2014-01-01

    Librarians have become more involved in developing high quality systematic reviews. Evidence-based practice guidelines are an extension of systematic reviews and offer another significant area for librarian involvement. This column highlights opportunities and challenges for the librarian working on guideline panels and provides practical considerations for meaningful contributions to the guideline creation process.

  6. Clinical Practice Guideline: Hoarseness (Dysphonia) (Update).

    Science.gov (United States)

    Stachler, Robert J; Francis, David O; Schwartz, Seth R; Damask, Cecelia C; Digoy, German P; Krouse, Helene J; McCoy, Scott J; Ouellette, Daniel R; Patel, Rita R; Reavis, Charles Charlie W; Smith, Libby J; Smith, Marshall; Strode, Steven W; Woo, Peak; Nnacheta, Lorraine C

    2018-03-01

    prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids for patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Disclaimer This clinical practice guideline is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and it may not provide the only appropriate approach to diagnosing and managing this problem. Differences from Prior Guideline (1) Incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia.

  7. Design Laboratories as Everyday Theater

    DEFF Research Database (Denmark)

    Binder, Thomas

    2014-01-01

    . Together with a small network of mobile phone users we had explored the everyday transition going to work and returning back home. We had played design games with visual materials gathered through our participation in these transitions and together we had enacted a small series of fictional video stories...... was no longer a blind search for openings in the company product strategy (or for that sake in the mundaneness of established user practices), but instead a completely open and contingent landscape unfolding in front of us. It is such moments of encountering the possible that I will address in the following...

  8. Clinical practice guidelines for rest orthosis, knee sleeves, and unloading knee braces in knee osteoarthritis.

    Science.gov (United States)

    Beaudreuil, Johann; Bendaya, Samy; Faucher, Marc; Coudeyre, Emmanuel; Ribinik, Patricia; Revel, Michel; Rannou, François

    2009-12-01

    To develop clinical practice guidelines concerning the use of bracing--rest orthosis, knee sleeves and unloading knee braces--for knee osteoarthritis. The French Physical Medicine and Rehabilitation Society (SOFMER) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by multidisciplinary expert panel, was used. Few high-level studies of bracing for knee osteoarthritis were found. No evidence exists for the effectiveness of rest orthosis. Evidence for knee sleeves suggests that they decrease pain in knee osteoarthritis, and their use is associated with subjective improvement. These actions do not appear to depend on a local thermal effect. The effectiveness of knee sleeves for disability is not demonstrated for knee osteoarthritis. Short- and mid-term follow-up indicates that valgus knee bracing decreases pain and disability in medial knee osteoarthritis, appears to be more effective than knee sleeves, and improves quality of life, knee proprioception, quadriceps strength, and gait symmetry, and decreases compressive loads in the medial femoro-tibial compartment. However, results of response to valgus knee bracing remain inconsistent; discomfort and side effects can result. Thrombophlebitis of the lower limbs has been reported with the braces. Braces, whatever kind, are infrequently prescribed in clinical practice for osteoarthritis of the lower limbs. Modest evidence exists for the effectiveness of bracing--rest orthosis, knee sleeves and unloading knee braces--for knee osteoarthritis, with only low level recommendations for its use. Braces are prescribed infrequently in French clinical practice for osteoarthritis of the knee. Randomized clinical trials concerning bracing in knee osteoarthritis are still necessary.

  9. Statistics for clinical nursing practice: an introduction.

    Science.gov (United States)

    Rickard, Claire M

    2008-11-01

    Difficulty in understanding statistics is one of the most frequently reported barriers to nurses applying research results in their practice. Yet the amount of nursing research published each year continues to grow, as does the expectation that nurses will undertake practice based on this evidence. Critical care nurses do not need to be statisticians, but they do need to develop a working knowledge of statistics so they can be informed consumers of research and so practice can evolve and improve. For those undertaking a research project, statistical literacy is required to interact with other researchers and statisticians, so as to best design and undertake the project. This article is the first in a series that guides critical care nurses through statistical terms and concepts relevant to their practice.

  10. Clinical practice: neonatal resuscitation. A Dutch consensus

    NARCIS (Netherlands)

    van den Dungen, F.A.M.; van Veenendaal, M.B.; Mulder, A.L.M.

    2010-01-01

    The updated Dutch guidelines on Neonatal Resuscitation assimilate the latest evidence in neonatal resuscitation. Important changes with regard to the 2004 guidelines and controversial issues concerning neonatal resuscitation are reviewed, and recommendations for daily practice are provided and

  11. Learning Styles of Radiography Students during Clinical Practice

    Science.gov (United States)

    Ward, L. Patrice

    2009-01-01

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

  12. Everyday Struggels with Technology

    DEFF Research Database (Denmark)

    Mahnke, Martina; Schwartz, Sander Andreas

    2017-01-01

    Technology has not only become an integral part of people’s lives but also of people’s everyday struggles. Struggles with technology are complex in nature; we tend to not only struggle with their basic functions but also with how they make us feel. During the course of our life we tend to master...... and struggle with technology in different ways. This struggle has been studied in relation to media literacy (Livingstone, 2004), to domestication theory (Silverstone et al. 1992), or in everyday life (Bakardjieva, 2005). This work enhances these lines of studies by exploring everyday struggles with technology...... from a life stage (Erikson, 1959) point of view. In particular, we explore what are common struggles people have with technology and what are distinct struggles in relation to life stages. In conclusion, we will present our findings by outlining what we call ‘technological biographies’. Those...

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

    Science.gov (United States)

    Bender, Miriam

    2016-01-01

    The Institute of Medicine's Future of Nursing report identifies the clinical nurse leader as an innovative new role for meeting higher health-care quality standards. However, specific clinical nurse leader practices influencing documented quality outcomes remain unclear. Lack of practice clarity limits the ability to articulate, implement and measure clinical nurse leader-specific practice and quality outcomes. Interpretive synthesis design and grounded theory analysis were used to develop a theoretical understanding of clinical nurse leader practice that can facilitate systematic and replicable implementation across health-care settings. The core phenomenon of clinical nurse leader practice is continuous clinical leadership, which involves four fundamental activities: facilitating effective ongoing communication; strengthening intra and interprofessional relationships; building and sustaining teams; and supporting staff engagement. Clinical nurse leaders continuously communicate and develop relationships within and across professions to promote and sustain information exchange, engagement, teamwork and effective care processes at the microsystem level. Clinical nurse leader-integrated care delivery systems highlight the benefits of nurse-led models of care for transforming health-care quality. Managers can use this study's findings to frame an implementation strategy that addresses theoretical domains of clinical nurse leader practice to help ensure practice success. © 2015 John Wiley & Sons Ltd.

  14. [What everybody should know about good clinical practices].

    Science.gov (United States)

    Osorio, Lyda

    2015-01-01

    An increasing number of countries are adopting good clinical practices guidelines as part of the regulation of clinical studies to register pharmaceutical products and other health-related products. Consequently, all parties involved in the research and development of these products should know them, implement them and ensure their compliance. However, good clinical practices guidelines are just one of the initiatives seeking to achieve the highest ethical and scientific standards in health research and in other areas where humans are research subjects. This review defines such practices and their objectives presenting in a practical manner their legal framework in Colombia, and clarifying their application in studies where interventions use no medications or those that are not clinical trials. Finally, the work discusses the challenges to ensure that good clinical practices contribute to the protection of research participants, the education of trustworthy health professionals, and a culture of respect for human beings.

  15. [Beat therapeutic inertia in dyslipidemic patient management: A challenge in daily clinical practice] [corrected].

    Science.gov (United States)

    Morales, Clotilde; Mauri, Marta; Vila, Lluís

    2014-01-01

    Beat therapeutic inertia in dyslipidemic patient management: a challenge in daily clinical practice. In patients with dyslipidemia, there is the need to reach the therapeutic goals in order to get the maximum benefit in the cardiovascular events risk reduction, especially myocardial infarction. Even having guidelines and some powerful hypolipidemic drugs, the goals of low-density lipoprotein-cholesterol (LDL-c) are often not reached, being of special in patients with a high cardiovascular risk. One of the causes is the therapeutic inertia. There are tools to plan the treatment and make the decisions easier. One of the challenges in everyday clinical practice is to know the needed percentage of reduction in LDL-c. Moreover: it is hard to know which one is the treatment we should use in the beginning of the treatment but also when the desired objective is not reached. This article proposes a practical method that can help solving these questions. Copyright © 2013 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  16. Integration of technology into clinical practice.

    Science.gov (United States)

    Doern, Christopher D

    2013-09-01

    It is an exciting time in clinical microbiology. New advances in technology are revolutionizing every aspect of the microbiology laboratory, from processing of specimens to bacterial identification; as a result, the microbiology laboratory is rapidly changing. With this change comes the challenge of selecting and implementing the technology that is most appropriate for each laboratory and clinical setting. This review focuses on issues surrounding implementation of new technology such that the improvements to clinical care are maximized. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. [Network clusters of symptoms as elementary syndromes of psychopathology: implications for clinical practice].

    Science.gov (United States)

    Goekoop, R; Goekoop, J G

    2016-01-01

    In a recent publication we reported the existence of around 11 (to 15) 'elementary syndromes' that may combine in various ways, rather like 'building blocks', to explain the wide range of psychiatric symptoms. 'Bridge symptoms' seem to be responsible both for combining large sets of symptoms into elementary syndromes and for combining the various elementary syndromes to form one globally connected network structure. To discuss the implication of these findings for clinical practice. We performed a network analysis of symptom scores. Elementary syndromes provide a massive simplification of the description of psychiatric disease. Instead of the more than 300 categories in DSM-5, we now need to consider only a handful of elementary syndromes and personality domains. This modular representation of psychiatric illnesses allows us to make a complete, systematic and efficient assessment of patients and a systematic review of treatment options. Clinicians, patients, managerial staff and insurance companies can verify whether symptom reduction is taking place in the most important domains of psychopathology. Unlike classic multidimensional methods of disease description, network models of psychopathology can be used to explain comorbidity patterns, predict the clinical course of psychopathology and to designate primary targets for therapeutic interventions. A network view on psychopathology could significantly improve everyday clinical practice.

  18. Value of FFR in clinical practice

    Directory of Open Access Journals (Sweden)

    Anil Mehra

    2015-01-01

    Full Text Available Fractional flow reserve is an important tool in the cardiac catheterization lab to assess the physiological significance of coronary lesions. This article discusses the basic concepts about FFR and its utility in clinical decision making.

  19. Safe clinical practice for patients hospitalised in a suicidal crisis: a study protocol for a qualitative case study.

    Science.gov (United States)

    Berg, Siv Hilde; Rørtveit, Kristine; Walby, Fredrik A; Aase, Karina

    2017-01-27

    Suicide prevention in psychiatric care is arguably complex and incompletely understood as a patient safety issue. A resilient healthcare approach provides perspectives through which to understand this complexity by understanding everyday clinical practice. By including suicidal patients and healthcare professionals as sources of knowledge, a deeper understanding of what constitutes safe clinical practice can be achieved. This planned study aims to adopt the perspective of resilient healthcare to provide a deeper understanding of safe clinical practice for suicidal patients in psychiatric inpatient care. It will describe the experienced components and conditions of safe clinical practice and the experienced practice of patient safety. The study will apply a descriptive case study approach consisting of qualitative semistructured interviews and focus groups. The data sources are hospitalised patients in a suicidal crisis and healthcare professionals in clinical practice. This study was approved by the Regional Ethics Committee (2016/34). The results will be disseminated through scientific articles, a PhD dissertation, and national and international conferences. These findings can generate knowledge to be integrated into the practice of safety for suicidal inpatients in Norway and to improve the feasibility of patient safety measures. Theoretical generalisations can be drawn regarding safe clinical practice by taking into account the experiences of patients and healthcare professionals. Thus, this study can inform the conceptual development of safe clinical practice for suicidal patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  20. Compliance with practice guidelines: clinical autonomy revisited

    NARCIS (Netherlands)

    Klazinga, N.

    1994-01-01

    The development of practice guidelines is gaining popularity in both North America and Europe. This review article explores the different reasons behind guideline development, the methodologies used and the effects assessed so far. Experience since 1982 with a guideline development programme at CBO

  1. Communication course for midwives teaching students in clinical practice

    DEFF Research Database (Denmark)

    Nielsen, Annegrethe; Pedersen, Pernille Mølholt

    taking place in clinical practice and try to align the educational efforts in school and clinical settings for the benefit of the students PERSPECTIVES It is known that students in medical education find that clinical learning experiences do not reinforce the communication skills they learn pre......-clinically (Rosenbaum et al. 2013) and our own experience teaching Danish midwifery students indicates the same problem in our program. Providing an opportunity for the clinical teachers to learn, discuss and practice communication issues with each other and with theoretical teachers can represent an important...

  2. Feasibility of automatic evaluation of clinical rules in general practice.

    NARCIS (Netherlands)

    Opondo, D.; Visscher, S.; Eslami, S.; Medlock, S.; Verheij, R.; Korevaar, J.C.; Abu-Hanna, A.

    2017-01-01

    Purpose: To assess the extent to which clinical rules (CRs) can be implemented for automatic evaluationof quality of care in general practice.Methods: We assessed 81 clinical rules (CRs) adapted from a subset of Assessing Care of Vulnerable Elders(ACOVE) clinical rules, against Dutch College of

  3. Morality in everyday life

    NARCIS (Netherlands)

    Hofmann, W.; Wisneski, D.C.; Brandt, M.J.; Skitka, L.J.

    2014-01-01

    The science of morality has drawn heavily on well-controlled but artificial laboratory settings. To study everyday morality, we repeatedly assessed moral or immoral acts and experiences in a large (N = 1252) sample using ecological momentary assessment. Moral experiences were surprisingly frequent

  4. Estradiol RIA kit in clinical practice

    International Nuclear Information System (INIS)

    Friedrich, W.; Lisse, K.; Bienert, R.; Flentje, H.; Koerner, H.; Wilken, T.; Akademie der Wissenschaften der DDR, Berlin-Buch. Zentralinstitut fuer Isotopen- und Strahlenforschung)

    1985-01-01

    First clinical experience with a estradiol RIA kit developed in the Central Institute for Isotope- and Radiation Research is reported. The kit was used for the daily control of estradiol level in patients, which were treated within the program for in vitro fertilization and embryo transfer. The time of incubation could be shortened by means of a double antibody technique and by use of a precipitation mixture to 2 h. The intraassay variation is 9.2%, the interassay variation is 15.1%, the recovery rate is 94%. The sensitivity of the test (B 0 -3SD) is about 120 pmol/l. The estradiol RIA kit satisfies clinical requirements. (author)

  5. Breast tomosynthesis in clinical practice: initial results

    International Nuclear Information System (INIS)

    Teertstra, Hendrik J.; Loo, Claudette E.; Bosch, Maurice A.A.J. van den; Muller, Sara H.; Gilhuijs, Kenneth G.A.; Tinteren, Harm van; Rutgers, Emiel J.T.

    2010-01-01

    The purpose of this study was to assess the potential value of tomosynthesis in women with an abnormal screening mammogram or with clinical symptoms. Mammography and tomosynthesis investigations of 513 woman with an abnormal screening mammogram or with clinical symptoms were prospectively classified according to the ACR BI-RADS criteria. Sensitivity and specificity of both techniques for the detection of cancer were calculated. In 112 newly detected cancers, tomosynthesis and mammography were each false-negative in 8 cases (7%). In the false-negative mammography cases, the tumor was detected with ultrasound (n=4), MRI (n=2), by recall after breast tomosynthesis interpretation (n=1), and after prophylactic mastectomy (n=1). Combining the results of mammography and tomosynthesis detected 109 cancers. Therefore in three patients, both mammography and tomosynthesis missed the carcinoma. The sensitivity of both techniques for the detection of breast cancer was 92.9%, and the specificity of mammography and tomosynthesis was 86.1 and 84.4%, respectively. Tomosynthesis can be used as an additional technique to mammography in patients referred with an abnormal screening mammogram or with clinical symptoms. Additional lesions detected by tomosynthesis, however, are also likely to be detected by other techniques used in the clinical work-up of these patients. (orig.)

  6. Tools for monitoring spondyloarthritis in clinical practice

    NARCIS (Netherlands)

    van Tubergen, Astrid M.; Landewé, Robert B. M.

    2009-01-01

    Spondyloarthritis (SpA) usually follows a chronic disease course that requires regular medical care and monitoring to control for increased disease activity and to maintain physical function. This Review describes the instruments and imaging techniques available for monitoring SpA in clinical

  7. Thinking outside the box in clinical practice.

    Science.gov (United States)

    Williams, Andrew N

    2017-12-01

    During difficult times we forget that as healthcare practitioners we are immensely privileged. We have a job, with regular work and generally don't have to worry about putting food on our families' table. But from a humanities perspective, we also have front row seats on the drama of life and no two days can be the same. Yet as we struggle to master our profession, the day to day realities of the job itself struggles to master us. If we become 'too hard' we may be fully competent yet fail to discharge our duties properly; however, should we become 'too soft', we may find ourselves not being able to discharge those duties at all. Striking that 'happy' balance is a decision we each make for ourselves every day during our decades of practice. For me, it has been necessary from the outset to include medical humanities within the clinico-medical perspective of daily practice. My definition of Medical Humanities will not only include medical history but also, stories, films and plays. This article relates some practices which I have found useful. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

    Science.gov (United States)

    Apel, Kenn

    2014-01-01

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

  9. The equivalent Histograms in clinical practice

    International Nuclear Information System (INIS)

    Pizarro Trigo, F.; Teijeira Garcia, M.; Zaballos Carrera, S.

    2013-01-01

    Is frequently abused of The tolerances established for organ at risk [1] in diagrams of standard fractionation (2Gy/session, 5 sessions per week) when applied to Dose-Volume histograms non-standard schema. The purpose of this work is to establish when this abuse may be more important and realize a transformation of fractionation non-standard of histograms dosis-volumen. Is exposed a case that can be useful to make clinical decisions. (Author)

  10. Humor During Clinical Practice: Analysis of Recorded Clinical Encounters.

    Science.gov (United States)

    Phillips, Kari A; Singh Ospina, Naykky; Rodriguez-Gutierrez, Rene; Castaneda-Guarderas, Ana; Gionfriddo, Michael R; Branda, Megan; Montori, Victor

    2018-01-01

    Little is known about humor's use in clinical encounters, despite its many potential benefits. We aimed to describe humor during clinical encounters. We analyzed 112 recorded clinical encounters. Two reviewers working independently identified instances of humor, as well as information surrounding the logistics of its use. Of the 112 encounters, 66 (59%) contained 131 instances of humor. Humor was similarly frequent in primary care (36/61, 59%) and in specialty care (30/51, 59%), was more common in gender-concordant interactions (43/63, 68%), and was most common during counseling (81/112, 62%). Patients and clinicians introduced humor similarly (63 vs 66 instances). Typically, humor was about the patient's medical condition (40/131, 31%). Humor is used commonly during counseling to discuss the patient's medical condition and to relate to general life events bringing warmth to the medical encounter. The timing and topic of humor and its use by all parties suggests humor plays a role in the social connection between patients and physicians and allows easier discussion of difficult topics. Further research is necessary to establish its impact on clinicians, patients, and outcomes. © Copyright 2018 by the American Board of Family Medicine.

  11. Nigerian Journal of Clinical Practice - Vol 19, No 4 (2016)

    African Journals Online (AJOL)

    Nigerian Journal of Clinical Practice. ... Salivary glucose as a diagnostic tool in Type II diabetes mellitus: A case-control study · EMAIL ... Dentists' knowledge of occlusal splint therapy for bruxism and temporomandibular joint disorders · EMAIL ...

  12. knowledge and adherence to clinical practice guidelines amongst ...

    African Journals Online (AJOL)

    ABEOLUGBENGAS

    Objective: The therapeutic management of patients with Low Back Pain (LBP) has long been characterized ... Keywords: Low back pain, Clinical practice Guidelines, Knowledge, Adherence ..... discourage the use of modalities such as TENS,.

  13. Clinical Practice Guideline for Vitamin D

    Science.gov (United States)

    Tarver, William J.

    2013-01-01

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

  14. Translating Regenerative Biomaterials Into Clinical Practice.

    Science.gov (United States)

    Stace, Edward T; Dakin, Stephanie G; Mouthuy, Pierre-Alexis; Carr, Andrew J

    2016-01-01

    Globally health care spending is increasing unsustainably. This is especially true of the treatment of musculoskeletal (MSK) disease where in the United States the MSK disease burden has doubled over the last 15 years. With an aging and increasingly obese population, the surge in MSK related spending is only set to worsen. Despite increased funding, research and attention to this pressing health need, little progress has been made toward novel therapies. Tissue engineering and regenerative medicine (TERM) strategies could provide the solutions required to mitigate this mounting burden. Biomaterial-based treatments in particular present a promising field of potentially cost-effective therapies. However, the translation of a scientific development to a successful treatment is fraught with difficulties. These barriers have so far limited translation of TERM science into clinical treatments. It is crucial for primary researchers to be aware of the barriers currently restricting the progression of science to treatments. Researchers need to act prospectively to ensure the clinical, financial, and regulatory hurdles which seem so far removed from laboratory science do not stall or prevent the subsequent translation of their idea into a treatment. The aim of this review is to explore the development and translation of new treatments. Increasing the understanding of these complexities and barriers among primary researchers could enhance the efficiency of biomaterial translation. © 2015 Wiley Periodicals, Inc.

  15. Bridging between basic theory and clinical practice.

    Science.gov (United States)

    Barnard, Philip J

    2004-09-01

    This paper articulates and discusses the parts played by different processes and representations in the overall conduct of applied clinical science. It distinguishes two sorts of representation, theories in the science base and bridging representations needed to map from real world behaviour to basic theory and from theory back to the real world. It is then argued that macro-theories of the "normal" human mental architecture could help synthesise basic theoretical accounts of diverse psychopathologies, without recourse to special purpose clinical cognitive theories of particular psychopathologies or even specific symptoms. Using the Interacting Cognitive Subsystems model [Affect, Cognition and Change: Re-modelling Depressive Thought, Lawrence Erlbaum Associates, Hove, 1993], some specific macro-theoretic variables are identified. Concrete illustrations are given of how the essence of quite complex basic theory can be translated into a simpler representational format to help clinicians conceptualise a psychopathological state and pinpoint relevant variables that might be changed by therapeutic interventions. Some suggestions are also offered about how the inevitable problem of complexity in multiple component theories might be directly confronted.

  16. Social phobia: research and clinical practice.

    Science.gov (United States)

    Alnaes, R

    2001-01-01

    Social phobia is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity, occurring in about 18% of the clinical population. Despite good results with cognitive-behavioural treatment, social phobia seems to be a chronic disorder with several complications. The author describes an analysis of a divorced woman who was exposed to an early premature sexual seduction by her father, abruptly terminated because of an accident. The loss of the father was repaired by a delusional system as defence against the re-emergence of a catastrophic situation. Her compulsion to repeat the traumatic situation was seen in symbolic attempts to reproduce the lost experience of forbidden pleasure with other men, ending in hopeless affairs. According to DSM-IV the patient had-besides social phobia-several personality disturbances, clinically manifested by weak ego boundaries, an unclear identity, and low self-esteem. Cognitive-behavioural therapy and psychopharmaca were without any effect. The childhood experiences were repeated in the context of the analysis and worked through, especially the pre-oedipal and oedipal conflicts. Important repeating themes were "crime", guilt, and punishment. After 3 years of analysis it was possible for the patient to expose herself to anxiety-producing situations with less symptoms. It was possible for her to withdraw the projections and take more responsibility for the unconscious sexual and aggressive impulses. At the 5-year follow-up her satisfactions had become more realistic and she became involved in a positive relationship.

  17. Optical coherence tomography: potentialities in clinical practice

    Science.gov (United States)

    Zagaynova, Elena; Gladkova, Natalia D.; Shakhov, Andrey; Terentjeva, Anna; Snopova, Ludmila B.; Kuznetzova, Irina A.; Streltzova, Olga; Shakhova, Natalia M.; Kamensky, Vladislav A.; Gelikonov, Grigory V.; Gelikonov, Valentin M.; Kuranov, Roman V.; Myakov, Alex

    2004-08-01

    Clinical studies using OCT involved 2000 patients in various fields of medicine such as gastroenterology, urology, laryngology, gynecology, dermatology, stomatology, etc. Layered high-contrast images were typical for benign epithelial conditions. OCT distinguish in mucosae: epithelium, connective tissue layer, and smooth-muscle layer. Various benign processes occurring in mucosa manifest in OCT images as changes in the epithelial height, scattering properties and the course of the basement membrane. Lack of the layered structural pattern is the main criterion for dysplastic / malignant images. In clinic: OCT data may be critical for choosing a tissue site for excisional biopsy, OCT can detect tumor borders and their linear dimensions, OCT can be used to plan a resection line in operations and to control adequacy of resection, to monitor whether reparative processes are timely and adequate. OCT sensitivity of the uterine cervix, urinary bladder and larynx is 82, 98, 77%, respectively, specificity - 78, 71, 96%, diagnostic accuracy - 81, 85, 87% with significantly good agreement index of clinicians kappa - 0.65, 0.79, 0.83 (confidence intervals: 0.57-0.73; 0.71-0.88; 0.74-0.91). Error in detection of high grade dysplasia and microinvasive cancer is 21.4% in average. Additional modification of OCT (cross-polarisation OCT, OCM), development of the procedure (biotissue compression, application of chemical agents) can improve the specificity and sensitivity of traditional modality.

  18. Viral asthma: implications for clinical practice

    Directory of Open Access Journals (Sweden)

    Roger Menendez

    2010-07-01

    Full Text Available Roger Menendez1, Michael D Goldman21Allergy and Asthma Center of El Paso, El Paso, TX, USA; 2Pulmonary Division, UCLA Gaffen School of Medicine, Los Angeles, CA, USAAbstract: The natural history of asthma appears to be driven primarily by the timing and duration of viral respiratory infections. From the very high rate of infections in childhood, to the more sporadic pattern seen in adults, the cycle of acute injury followed by an inefficient repair process helps explain the clinical patterns of asthma severity currently recognized by asthma guidelines. Why the asthmatic host responds to viral injury in a particular way is largely a mystery and the subject of intense investigation. The role of viruses in asthma extends not just to intermittent but to persistent disease, and to both the atopic as well as nonatopic phenotypes. Future therapeutic strategies should include primary prevention via the development of antiviral innate immunity-enhancing vaccines, as well as secondary prevention via the use of antiviral agents, or immunomodulators designed to boost the antiviral response or interrupt the proinflammatory cascade.Keywords: asthma, rhinoviruses, exacerbations, epidemiology, phenotypes, clinical trials

  19. Morality in everyday life.

    Science.gov (United States)

    Hofmann, Wilhelm; Wisneski, Daniel C; Brandt, Mark J; Skitka, Linda J

    2014-09-12

    The science of morality has drawn heavily on well-controlled but artificial laboratory settings. To study everyday morality, we repeatedly assessed moral or immoral acts and experiences in a large (N = 1252) sample using ecological momentary assessment. Moral experiences were surprisingly frequent and manifold. Liberals and conservatives emphasized somewhat different moral dimensions. Religious and nonreligious participants did not differ in the likelihood or quality of committed moral and immoral acts. Being the target of moral or immoral deeds had the strongest impact on happiness, whereas committing moral or immoral deeds had the strongest impact on sense of purpose. Analyses of daily dynamics revealed evidence for both moral contagion and moral licensing. In sum, morality science may benefit from a closer look at the antecedents, dynamics, and consequences of everyday moral experience. Copyright © 2014, American Association for the Advancement of Science.

  20. Partying as Everyday Life

    DEFF Research Database (Denmark)

    Demant, Jakob; Østergaard, Jeanette

    2007-01-01

    situates the event in everyday life. By drawing on Maffesoli's (1996) concept of ‘sociality' and Lincoln's (2005) concept of zoning the spatial and social logic of the house, partying is analysed using both qualitative and quantitative material. The analysis suggests that the consumption of alcohol (i.......e. collective intoxication) is one way the parents' dining room is transformed creatively into a space for teenage partying. Hence, the social logic of a party is to consume alcohol collectively as it symbolises commitment to both the party and to the specific group of friends. Finally, attention is drawn...... to reaffirm friendship and is therefore an integrated part of adolescents' everyday life.  ...

  1. Everyday Family Life

    DEFF Research Database (Denmark)

    Westerling, Allan

    2010-01-01

    and methods and it illustrates this by presenting a research design which comprises a multi-methodological approach combining quantitative and qualitative methods in the study of the relationship between the individual and the social (the individual/social), thus enabling analysis of both meaning...... project takes a social psychological approach, combining quantitative and qualitative methods in a longitudinal study of family life. The knowledge interest of the project is the constitution of communality and individuality in everyday family life. This article presents the theoretical framework......What are the implications of ongoing processes of modernization and individualization for social relations in everyday life? This overall research question is the pivotal point in empirical studies at the Centre of Childhood-, Youth- and Family Life Research at Roskilde University. One research...

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

    Science.gov (United States)

    Zhang, Y; Liu, X J

    2016-04-09

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

  3. Ketamine use in current clinical practice

    Science.gov (United States)

    Gao, Mei; Rejaei, Damoon; Liu, Hong

    2016-01-01

    After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug's mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control in emergency department, with its anti-hyperalgesic and anti-inflammatory effects being revealed in acute and chronic pain management. Recently, new insights have been gained on ketamine's potential anti-depressive and antisuicidal effects. This article provides an overview of the drug's pharmacokinetics and pharmacodynamics while also discussing the potential benefits and risks of ketamine administration in various clinical settings. PMID:27018176

  4. Topical steroids in the current clinical practice

    Directory of Open Access Journals (Sweden)

    T. A. Belousova

    2014-01-01

    Full Text Available The article discusses issues related to current criteria for selection of glucocorticosteroids for external use as the basic therapy for a great number of allergic and inflammatory skin diseases. The authors emphasize that non-fluorinated GCSs having the best efficacy-to-safety ratio must be the drugs of first choice. The article provides data on a positive clinical experience of using a non-halogenated glucocorticosteroid for external use - hydrocortisone 17-butyrate (Laticort - for treatment of steroid-sensitive dermatoses in children and adults. The drug has a high anti-inflammatory action and minimum risk of the development of side effects, which is sufficient for using it in sensitive areas of skin (face, neck, folds, genitals both in children and in adults. The availability of three forms of the drug (solution, cream and ointment ensures the expedience and convenience of its application at any stage of the inflammatory process and for any localization.

  5. [Diagnostic of secondary hypertension in clinical practice].

    Science.gov (United States)

    Somlóová, Z; Rosa, J; Petrák, O; Strauch, B; Zelinka, T; Holaj, R; Widimský, J

    2011-09-01

    Arterial hypertension is a common worldwide disease with a prevalence of approximately 26%. Secondary cause is known in 5-10% of patients with hypertension. We should think of secondary hypertension in all patients with resistant hypertension, in patients with sudden deterioration in the control of hypertension and in patients with laboratory and clinical signs of diseases associated with secondary hypertension. It is important to distinguish between secondary hypertension and pseudo-resistance (noncompliance to treatment, white coat syndrome). Secondary causes of hypertension can be divided into endocrine (primary aldosteronism, pheochromocytoma, hypercortisolism, hyperparathyreoidism), renal - renovascular and renal parenchymal hypertension, and other causes as sleep apnoe syndrome, hypertension in pregnancy, coarctation of the aorta and intracranial tumors.

  6. Clinical practice in BNCT to the brain

    International Nuclear Information System (INIS)

    Nakagawa, Y.

    2001-01-01

    Our concept of Boron Neutron Capture Therapy (BNCT) is to selectively destroy tumour cells using the high LET particles yielded from the 10B(n,α)7Li reactions. The effort of clinical investigators has concentrated on how to escalate the radiation dose at the target point. BNCT in Japan combines thermal neutrons and BSH (Na 2 B 12 H 11 SH). The radiation dose is determined by the neutron fluence at the target point and the boron concentration in the tumour tissue. According to the recent analysis, the ratio of boron concentration (BSH) in tumour tissue and blood is nearly stable at around 1.2 to 1.69. Escalation of the radiation dose was carried out by means of improving the penetration of the thermal neutron beam. Since 1968, 175 patients with glioblastoma (n=83), anaplastic astrocytoma (n=44), low grade astrocytoma (n=16) or other types of tumour (n=32) were treated by BNCT at 5 reactors (HTR n=13, JRR-3 n=1, MulTR n=98, KUR n=30, JRR-2 n=33). The retrospective analysis revealed that the important factors related to the clinical results and QOL of the patients were minimum tumour volume radiation dose, more than 18Gy of physical dose and maximum vascular radiation dose (less than 15Gy) in the normal cortex. We have planned several trials to escalate the target radiation dose. One trial makes use of a cavity in the cortex following debulking surgery of the tumour tissue to improve neutron penetration. The other trial is introduction of epithermal neutron. KUR and JRR-4 were reconstructed and developed to be able to irradiate using epithermal neutrons. The new combination of surgical procedure and irradiation using epithermal neutrons should remarkably improve the target volume dose compared to the radiation dose treated by thermal neutrons. (author)

  7. Emotions in Everyday Life.

    Science.gov (United States)

    Trampe, Debra; Quoidbach, Jordi; Taquet, Maxime

    2015-01-01

    Despite decades of research establishing the causes and consequences of emotions in the laboratory, we know surprisingly little about emotions in everyday life. We developed a smartphone application that monitored real-time emotions of an exceptionally large (N = 11,000+) and heterogeneous participants sample. People's everyday life seems profoundly emotional: participants experienced at least one emotion 90% of the time. The most frequent emotion was joy, followed by love and anxiety. People experienced positive emotions 2.5 times more often than negative emotions, but also experienced positive and negative emotions simultaneously relatively frequently. We also characterized the interconnections between people's emotions using network analysis. This novel approach to emotion research suggests that specific emotions can fall into the following categories 1) connector emotions (e.g., joy), which stimulate same valence emotions while inhibiting opposite valence emotions, 2) provincial emotions (e.g., gratitude), which stimulate same valence emotions only, or 3) distal emotions (e.g., embarrassment), which have little interaction with other emotions and are typically experienced in isolation. Providing both basic foundations and novel tools to the study of emotions in everyday life, these findings demonstrate that emotions are ubiquitous to life and can exist together and distinctly, which has important implications for both emotional interventions and theory.

  8. Emotions in Everyday Life

    Science.gov (United States)

    2015-01-01

    Despite decades of research establishing the causes and consequences of emotions in the laboratory, we know surprisingly little about emotions in everyday life. We developed a smartphone application that monitored real-time emotions of an exceptionally large (N = 11,000+) and heterogeneous participants sample. People’s everyday life seems profoundly emotional: participants experienced at least one emotion 90% of the time. The most frequent emotion was joy, followed by love and anxiety. People experienced positive emotions 2.5 times more often than negative emotions, but also experienced positive and negative emotions simultaneously relatively frequently. We also characterized the interconnections between people’s emotions using network analysis. This novel approach to emotion research suggests that specific emotions can fall into the following categories 1) connector emotions (e.g., joy), which stimulate same valence emotions while inhibiting opposite valence emotions, 2) provincial emotions (e.g., gratitude), which stimulate same valence emotions only, or 3) distal emotions (e.g., embarrassment), which have little interaction with other emotions and are typically experienced in isolation. Providing both basic foundations and novel tools to the study of emotions in everyday life, these findings demonstrate that emotions are ubiquitous to life and can exist together and distinctly, which has important implications for both emotional interventions and theory. PMID:26698124

  9. Emotions in Everyday Life.

    Directory of Open Access Journals (Sweden)

    Debra Trampe

    Full Text Available Despite decades of research establishing the causes and consequences of emotions in the laboratory, we know surprisingly little about emotions in everyday life. We developed a smartphone application that monitored real-time emotions of an exceptionally large (N = 11,000+ and heterogeneous participants sample. People's everyday life seems profoundly emotional: participants experienced at least one emotion 90% of the time. The most frequent emotion was joy, followed by love and anxiety. People experienced positive emotions 2.5 times more often than negative emotions, but also experienced positive and negative emotions simultaneously relatively frequently. We also characterized the interconnections between people's emotions using network analysis. This novel approach to emotion research suggests that specific emotions can fall into the following categories 1 connector emotions (e.g., joy, which stimulate same valence emotions while inhibiting opposite valence emotions, 2 provincial emotions (e.g., gratitude, which stimulate same valence emotions only, or 3 distal emotions (e.g., embarrassment, which have little interaction with other emotions and are typically experienced in isolation. Providing both basic foundations and novel tools to the study of emotions in everyday life, these findings demonstrate that emotions are ubiquitous to life and can exist together and distinctly, which has important implications for both emotional interventions and theory.

  10. Mandatory Clinical Practice for Dental and Dental Hygiene Faculty.

    Science.gov (United States)

    Cameron, Cheryl A.; And Others

    1982-01-01

    Dental and dental hygiene faculty should maintain their clinical skills through regular practice, to improve their ability to relate to students through instruction, provide an additional source of income, and improve their image in the community. Institutional policies fostering and regulating faculty practice plans are suggested. (Author/MSE)

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

    Science.gov (United States)

    Lammert, Marilyn; Dolan, Mary M.

    1983-01-01

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

  12. Variation in clinical practice: forests and trees revisited.

    Science.gov (United States)

    Wallis, Christopher J D; Naylor, C David; Detsky, Allan S

    2017-09-01

    Variations in clinical practice are commonly viewed as a sign of uneven quality of care and attributed to provider self-interest. However, patient preferences, physician practice patterns, and diagnostic and therapeutic uncertainty also cause variations. Greater attention to both doctor-patient interactions and limits to the available evidence might enable more effective assessment and improvement of health-care quality.

  13. Ethical decision making in clinical practice.

    Science.gov (United States)

    Fowler, M D

    1989-12-01

    Contemporary nursing ethics education focuses on the use of an analytical model of ethical decision making for both its process and its content. Perhaps this is the case because it bears some resemblance to the nursing process, which is taught in a similar fashion. Thus, a deductivist method of ethical decision making fits within the same general schema of the hypotheticodeductive method of decision making that is taught for nursing diagnosis. Ethics requires that nurses respect persons, inform patients and secure their consent, not inflict harm, preserve the patient's quality of life, prevent harm and remove harmful conditions, do good for patients, and minimize risk to themselves. These are among the norms of obligation that guide ethical analysis and judgment in nursing practice and are the substance of the analytical model of ethical decision making. Nursing's ethics has established high ideals and strong demands for nurses. These are demands which nurses have met and ideals which have often been realized. Whatever the strength of our science, nursing is an inherently moral endeavor and is only as strong as its commitment to its ethical obligations and values. Between the grinding edges of the forces that affect it, nursing must establish its priorities among the aspects of its environment that it attempts to control. Ethics must be chief among those priorities.

  14. Clinical sexological practice at the largest outpatient clinic in Denmark

    DEFF Research Database (Denmark)

    Hald, Gert Martin; Kristensen, Ellids

    2010-01-01

    This study investigated sexual function in women with a history of severe intrafamilial childhood sexual abuse (CSA) and the correlation between sexual problems and the severity of CSA, adult support during childhood and current psychiatric symptoms. The sample consisted of 158 women who...... subsequently began specialized group psychotherapy for CSA sequellae. Clinical interview and questionnaires (Present Sexual Function, Sexual and Body Satisfaction, Symptom Check List 90-R) were used for data collection in a cross sectional study design. Non-parametric analysis, linear and logistic regression...... analysis were applied. Of the women, 63% were unsatisfied with their current sexual life, 39% felt uncomfortable with physical endearments and 71% were unsatisfied with their body. Only 82% had an active sexual life and, of these, 73% reported at least one sexual problem, 48% orgasmic problems and 45...

  15. Neuropathic low back pain in clinical practice.

    Science.gov (United States)

    Baron, R; Binder, A; Attal, N; Casale, R; Dickenson, A H; Treede, R-D

    2016-07-01

    Low back pain (LBP) is one of the most common chronic pain conditions. This paper reviews the available literature on the role of neuropathic mechanisms in chronic LBP and discusses implications for its clinical management, with a particular focus on pharmacological treatments. Literature searches were performed in PubMed, key pain congresses and ProQuest Dialog to identify published evidence on neuropathic back pain and its management. All titles were assessed for relevant literature. Chronic LBP comprises both nociceptive and neuropathic components, however, the neuropathic component appears under-recognized and undertreated. Neuropathic pain (NP) is challenging to manage. Many patients with chronic LBP have pain that is refractory to existing treatments. Typically, less than half of patients experience clinically meaningful analgesia with oral pharmacotherapies; these are also associated with risks of adverse effects. Paracetamol and NSAIDs, although widely used for LBP, are unlikely to ameliorate the neuropathic component and data on the use of NP medications such as antidepressants and gabapentin/pregabalin are limited. While there is an unmet need for improved treatment options, recent data have shown tapentadol to have efficacy in the neuropathic component of LBP, and studies suggest that the capsaicin 8% patch and lidocaine 5% medicated plaster, topical analgesics available for the treatment of peripheral NP, may be a valuable additional approach for the management of neuropathic LBP. Chronic LBP often has an under-recognized neuropathic component, which can be challenging to manage, and requires improved understanding and better diagnosis and treatment. WHAT DOES THIS REVIEW ADD?: Increased recognition and improved understanding of the neuropathic component of low back pain raises the potential for the development of mechanism-based therapies. Open and retrospective studies suggest that agents like tapentadol and topical analgesics - such as the capsaicin

  16. Conducting research in clinical psychology practice: Barriers, facilitators, and recommendations.

    Science.gov (United States)

    Smith, Kirsten V; Thew, Graham R

    2017-09-01

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

  17. Characteristics of effective clinical guidelines for general practice.

    NARCIS (Netherlands)

    Burgers, J.S.; Grol, R.P.T.M.; Zaat, J.O.M.; Spies, T.H.; Bij, A.K. van der; Mokkink, H.G.A.

    2003-01-01

    BACKGROUND: The use of clinical guidelines in general practice is often limited. Research on barriers to guideline adherence usually focuses on attitudinal factors. Factors linked to the guideline itself are much less studied. AIM: To identify characteristics of effective clinical guidelines for

  18. Clinical trials attitudes and practices of Latino physicians.

    Science.gov (United States)

    Ramirez, Amelie G; Wildes, Kimberly; Talavera, Greg; Nápoles-Springer, Anna; Gallion, Kipling; Pérez-Stable, Eliseo J

    2008-07-01

    Ethnic differences in physicians' attitudes and behaviors related to clinical trials might partially account for disparities in clinical trial participation among Latino patients. Literature regarding Latino physicians' clinical trials attitudes and practices, in comparison to White physicians, was lacking. Cross-sectional data from randomly selected physicians (N=695), stratified by ethnicity, were analyzed to test associations of ethnicity with physicians' participation in and attitudes toward referral of patients to clinical trials. Chi-square analyses showed significant (pLatino physicians were significantly less involved in clinical trials than White physicians and found less scientific value in them, highlighting areas for future education and intervention.

  19. Practical Approach for the Clinical Use of Dopamine Transporter Imaging

    International Nuclear Information System (INIS)

    Kim, Jae Seung

    2008-01-01

    Dopamine transporter imaging is useful in the diagnosis of Parkinson's disease and the most successful technique in the clinical use of neuroreceptor imaging. Recently, several radiopharmaceuticals including I-123 FP-CIT, Tc-99m TRODAT, and F-18 FP-CIT for dopamine transporter imaging have been approved for the routine clinical use in several European countries, Taiwan and Korea, respectively. This review summarized the practical issue for the routine clinical examination of dopamine transporter imaging

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

    Science.gov (United States)

    Weise, Kathryn L; Daly, Barbara J

    2014-01-01

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

  1. Use of clinical practice guidelines to promote best practice when managing clinical interventions for liver transplant candidates.

    Science.gov (United States)

    Jarrett, Maree

    2009-06-01

    Limited organ availability and an increasing demand for organ transplantation has extended transplant waiting times and thus increased morbidity and mortality for potential recipients on waiting lists. The Queensland Liver Transplant Service identified use of clinical practice guidelines developed from evidence-based practice as a strategic clinical management/workflow tool that could improve clinical outcomes for patients awaiting liver transplant. An extensive review of publications related to the management of advanced liver disease in potential transplant recipients was undertaken and the supporting evidence was identified. In all stages of development of the guidelines, the multidisciplinary collaborative team of clinicians used recommended principles from The Appraisal of Guidelines, Research and Evaluation collaboration. The liver transplant recipient coordinator acted as facilitator for the project, identifying positive factors and resolving obstacles. Key focus areas in optimizing medical management before liver transplant were identified with the aim of preventing disease progression and complications that would jeopardize patients' outcome. Clinical practice guidelines were developed for each key area to optimize care by promoting appropriate timing of clinical interventions. Practices that required change to comply with identified best practice were investigated, and clinical practice for the outpatient medical management of potential liver transplant recipients with chronic liver disease were developed collaboratively. These guidelines have been accepted and are being implemented within the gastroenterology and hepatology department at the Princess Alexandra Hospital.

  2. Exchange students crossing language boundaries in clinical nursing practice.

    Science.gov (United States)

    Myhre, K

    2011-12-01

    This article examines challenges and learning outcomes for nursing students from a Central European university of applied sciences who completed 3 months of clinical practice in Norway. The clinical practice was supervised in English by Norwegian nurses and nursing teachers. English is not the primary language in any of the countries. Increases in global migration have contributed to the need for an international dimension in nursing education. Personal mobility is a crucial part of the European Union's goal of becoming a knowledge society. Clinically based experiences pose challenges that are additional to and often more complex than traditional course-based experiences. Students who come from a non-English-speaking country for clinical practice in Norway face challenges regarding language. Accepting incoming students is a way of achieving higher quality and more relevant education in nursing. The study shows that clinical practice in a foreign country gives added value compared with clinical practice at home. Greater self-confidence and understanding of core concepts in nursing is described by the participants. Language differences are not regarded as a problem but as a way of developing personal and professional competence. The ability to compare healthcare systems in the two counties is important in developing competencies in nursing. © 2011 The Author. International Nursing Review © 2011 International Council of Nurses.

  3. Colon cleansing protocol in children: research conditions vs. clinical practice.

    Science.gov (United States)

    Elitsur, Yoram; Balfaqih, Yaslam; Preston, Deborah

    2018-04-01

     Colon preparation rates are the limiting factor for a successful diagnostic colonoscopy in children. Different colon cleansing protocols have been published for use in children. Unfortunately, the applicability of those published research protocols has not been formally evaluated in routine clinical practice. We investigated the success rate of our previously published colon cleansing protocol as utilized in our clinical practice.  This was a retrospective study. In the clinical practice, the colon cleansing protocol included PEG-3350 at a dose of 2 g/kg/day plus Dulcolax (Bisacodyl, Boehringer Ingelheim, TX USA) 5 mg/day for 2 days. Adequate colon preparation was graded between 1 - 5, as previously described, and grade ≥ 4.0 was considered an adequate preparation. Patients were instructed to complete a questionnaire that included PEG-3350 dose, number of stools per day, consistency of each stool, and side effects (vomiting, abdominal pain). Clinical and endoscopic results were compared between the protocol under research conditions and routine practice.  The success rate of the colon preparation in our clinical practice was similar to the results observed under our research protocol (75 % vs. 73.6 %). Moreover, the total number of stools, stool consistency, and the intubation rate of the terminal ileum were also similar. We concluded, that in our experience, the colon cleansing protocol used under research conditions was effective and appropriate for use in routine clinical practice.  We recommend testing each new protocol under the routine conditions of clinical practice to confirm its applicability for general practitioners.

  4. [Scientific, practical and educational aspects of clinical epidemiology].

    Science.gov (United States)

    Briko, N I

    2012-01-01

    This article defines clinical epidemiology and describes its goal and objectives. The author claims that clinical epidemiology is a section of epidemiology which underlies the development of evidence-based standards for diagnostics, treatment and prevention and helps to select the appropriate algorithm for each clinical case. The study provides a comprehensive overview of the relationship between clinical epidemiology and evidence-based medicine. Epidemiological research is shown to be methodological basis of clinical epidemiology and evidence-based medicine with randomized controlled trials being the "gold standard" for obtaining reliable data. The key stages in the history of clinical epidemiology are discussed and further development of clinical epidemiology and the integration of courses on clinical epidemiology in education is outlined for progress in medical research and health care practice.

  5. The discrepancy between patients and informants on clinician-rated measures in major depressive disorder: implications for clinical trials and clinical practice.

    Science.gov (United States)

    Peselow, Eric D; Karamians, Reneh; Lord, Marie; Tobia, Gabriel; IsHak, Waguih William

    2014-03-01

    Clinician-rated measures are used in clinical trials and measurement-based clinical care settings to assess baseline symptoms and treatment outcomes of major depressive disorder (MDD), with a widely held dictum that they are sufficient in assessing the patient's clinical status. In this study, we examined clinician-rated measures of depressive and global symptom severity, obtained by interviewing patients as well as informants in an attempt to examine the potential difference or similarity between these two sources of information. The sample consisted of 89 treatment seeking, DSM-IV diagnosed MDD outpatients treated between 1995 and 2004. The clinician-rated measures used included the Montgomery Åsberg Depression Rating Scale (MADRS), and the Clinical Global Impression Scale (CGI) for Severity. The scores of the clinician-rated measures collected from patients' interviews were compared with those collected from informants' interviews. Clinician-rated scores, collected by interviewing patients, were significantly higher and indicative of greater symptom severity when compared with those collected by interviewing informants. This was true for both the MADRS before (Ppractical in MDD clinical trials or everyday clinical care. The discrepancies observed between the clinician-rated scores obtained from patients and informants emphasize the importance of incorporating collateral information during the assessment and rating of depressive symptom severity in both clinical trials as well as in clinical practice.

  6. Replication of clinical innovations in multiple medical practices.

    Science.gov (United States)

    Henley, N S; Pearce, J; Phillips, L A; Weir, S

    1998-11-01

    Many clinical innovations had been successfully developed and piloted in individual medical practice units of Kaiser Permanente in North Carolina during 1995 and 1996. Difficulty in replicating these clinical innovations consistently throughout all 21 medical practice units led to development of the interdisciplinary Clinical Innovation Implementation Team, which was formed by using existing resources from various departments across the region. REPLICATION MODEL: Based on a model of transfer of best practices, the implementation team developed a process and tools (master schedule and activity matrix) to quickly replicate successful pilot projects throughout all medical practice units. The process involved the following steps: identifying a practice and delineating its characteristics and measures (source identification); identifying a team to receive the (new) practice; piloting the practice; and standardizing, including the incorporation of learnings. The model includes the following components for each innovation: sending and receiving teams, an innovation coordinator role, an innovation expert role, a location expert role, a master schedule, and a project activity matrix. Communication depended on a partnership among the location experts (local knowledge and credibility), the innovation coordinator (process expertise), and the innovation experts (content expertise). Results after 12 months of working with the 21 medical practice units include integration of diabetes care team services into the practices, training of more than 120 providers in the use of personal computers and an icon-based clinical information system, and integration of a planwide self-care program into the medical practices--all with measurable improved outcomes. The model for sequential replication and the implementation team structure and function should be successful in other organizational settings.

  7. Rivaroxaban for venous thromboembolism prevention after major orthopedic surgery: translating trial data into routine clinical practice

    Directory of Open Access Journals (Sweden)

    Beyer-Westendorf J

    2017-01-01

    Full Text Available Jan Beyer-Westendorf,1 Patrick Mouret,2 Alexander GG Turpie3 1Thrombosis Research and Angiology, Dresden University Clinic, Dresden, Germany; 2Orthopedic Clinic, Klinikum Frankfurt Höchst GmbH, Frankfurt, Germany; 3Department of Medicine, General Division, Hamilton Health Sciences, Hamilton, ON, Canada Abstract: An established standard of care for the prevention of venous thromboembolism after major orthopedic surgery has been subcutaneous low-molecular-weight heparin. The non-vitamin K antagonist oral anticoagulant rivaroxaban has demonstrated superior efficacy and similar safety to all tested regimens of enoxaparin in large Phase III clinical studies of venous thromboembolism prevention after elective hip and knee arthroplasty. Despite regulatory approval of rivaroxaban for this indication, concerns remain among physicians regarding its optimal and effective use in routine clinical practice. Real-life studies, such as XAMOS and ORTHO-TEP, are providing physicians with more information on the routine use of rivaroxaban for venous thromboembolism prevention after orthopedic surgery, helping to establish its safety and effectiveness in everyday clinical care. Among the most important issues are the risk of bleeding complications, wound healing, timing of first dose, impact of type of anesthesia on thromboprophylaxis effectiveness, patient comorbidities and comedication use, periprocedural management, associated costs, and clinical outcomes in trauma-related fractures. Many of these issues are difficult to study in randomized, double-blind, Phase III trials, and can be assessed more readily using real-life data. In particular, real-life or noninterventional studies lack many of the strict inclusion and exclusion criteria associated with Phase III trials and involve unselected patients who often present with significant comorbidities or comedication use. Keywords: anticoagulants, arthroplasty, orthopedics, rivaroxaban, thrombosis

  8. Truth telling in medical practice: students' opinions versus their observations of attending physicians' clinical practice.

    Science.gov (United States)

    Tang, Woung-Ru; Fang, Ji-Tseng; Fang, Chun-Kai; Fujimori, Maiko

    2013-07-01

    Truth telling or transmitting bad news is a problem that all doctors must frequently face. The purpose of this cross-sectional study was to investigate if medical students' opinions of truth telling differed from their observations of attending physicians' actual clinical practice. The subjects were 275 medical clerks/interns at a medical center in northern Taiwan. Data were collected on medical students' opinions of truth telling, their observations of physicians' clinical practice, students' level of satisfaction with truth telling practiced by attending physicians, and cancer patients' distress level when they were told the truth. Students' truth-telling awareness was significantly higher than the clinical truth-telling practice of attending physicians (pmedical students' opinions on truth telling and attending physicians' actual clinical practice. More research is needed to objectively assess physicians' truth telling in clinical practice and to study the factors affecting the method of truth telling used by attending physicians in clinical practice. Copyright © 2012 John Wiley & Sons, Ltd.

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

    Science.gov (United States)

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

    2014-05-01

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

  10. Resistance in Everyday Life

    DEFF Research Database (Denmark)

    This book is about resistance in everyday life, illustrated through empirical contexts from different parts of the world. Resistance is a widespread phenomenon in biological, social and psychological domains of human cultural development. Yet, it is not well articulated in the academic literature....... The contributors deal with strategies for handling dissent by individuals or groups, specifically dissent through resistance. Resistance can be a location of intense personal, interpersonal and cultural negotiation, and that is the primary reason for interest in this phenomenon. Ordinary life events contain...

  11. Asymptomatic Bacteriuria in Clinical Urological Practice: Preoperative Control of Bacteriuria and Management of Recurrent UTI

    Directory of Open Access Journals (Sweden)

    Tommaso Cai

    2016-01-01

    Full Text Available Asymptomatic bacteriuria (ABU is a common clinical condition that often leads to unnecessary antimicrobial use. The reduction of antibiotic overuse for ABU is consequently an important issue for antimicrobial stewardship and to reduce the emergence of multidrug resistant strains. There are two issues in everyday urological practice that require special attention: the role of ABU in pre-operative prophylaxis and in women affected by recurrent urinary tract infections (rUTIs. Nowadays, this is the time to think over our practice and change our way of thinking. Here, we aimed to summarize the current literature knowledge in terms of ABU management in patients undergoing urological surgery and in patients with rUTIs. In the last years, the approach to patient with ABU has changed totally. Prior to all surgical procedures that do not enter the urinary tract, ABU is generally not considered as a risk factor, and screening and treatment are not considered necessary. On the other hand, in the case of all procedures entering the urinary tract, ABU should be treated in line with the results of a urine culture obtained before the procedure. In patients affected by rUTIs, ABU can even have a protective role in preventing symptomatic recurrence, particularly when Enterococcus faecalis (E. faecalis has been isolated.

  12. Asymptomatic Bacteriuria in Clinical Urological Practice: Preoperative Control of Bacteriuria and Management of Recurrent UTI.

    Science.gov (United States)

    Cai, Tommaso; Mazzoli, Sandra; Lanzafame, Paolo; Caciagli, Patrizio; Malossini, Gianni; Nesi, Gabriella; Wagenlehner, Florian M E; Köves, Bela; Pickard, Robert; Grabe, Magnus; Bjerklund Johansen, Truls E; Bartoletti, Riccardo

    2016-01-05

    Asymptomatic bacteriuria (ABU) is a common clinical condition that often leads to unnecessary antimicrobial use. The reduction of antibiotic overuse for ABU is consequently an important issue for antimicrobial stewardship and to reduce the emergence of multidrug resistant strains. There are two issues in everyday urological practice that require special attention: the role of ABU in pre-operative prophylaxis and in women affected by recurrent urinary tract infections (rUTIs). Nowadays, this is the time to think over our practice and change our way of thinking. Here, we aimed to summarize the current literature knowledge in terms of ABU management in patients undergoing urological surgery and in patients with rUTIs. In the last years, the approach to patient with ABU has changed totally. Prior to all surgical procedures that do not enter the urinary tract, ABU is generally not considered as a risk factor, and screening and treatment are not considered necessary. On the other hand, in the case of all procedures entering the urinary tract, ABU should be treated in line with the results of a urine culture obtained before the procedure. In patients affected by rUTIs, ABU can even have a protective role in preventing symptomatic recurrence, particularly when Enterococcus faecalis (E. faecalis) has been isolated.

  13. Practice databases and their uses in clinical research.

    Science.gov (United States)

    Tierney, W M; McDonald, C J

    1991-04-01

    A few large clinical information databases have been established within larger medical information systems. Although they are smaller than claims databases, these clinical databases offer several advantages: accurate and timely data, rich clinical detail, and continuous parameters (for example, vital signs and laboratory results). However, the nature of the data vary considerably, which affects the kinds of secondary analyses that can be performed. These databases have been used to investigate clinical epidemiology, risk assessment, post-marketing surveillance of drugs, practice variation, resource use, quality assurance, and decision analysis. In addition, practice databases can be used to identify subjects for prospective studies. Further methodologic developments are necessary to deal with the prevalent problems of missing data and various forms of bias if such databases are to grow and contribute valuable clinical information.

  14. 77 FR 49449 - Food and Drug Administration Clinical Trial Requirements, Compliance, and Good Clinical Practice...

    Science.gov (United States)

    2012-08-16

    ... investigator initiated research. Topics for discussion include the following: (1) What FDA Expects in a...] Food and Drug Administration Clinical Trial Requirements, Compliance, and Good Clinical Practice...-sponsorship with the Society of Clinical Research Associates (SoCRA) is announcing a public workshop. The...

  15. Transition questions in clinical practice - validity and reproducibility

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein

    2008-01-01

    Transition questions in CLINICAL practice - validity and reproducibility Lauridsen HH1, Manniche C3, Grunnet-Nilsson N1, Hartvigsen J1,2 1   Clinical Locomotion Science, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. e-mail: hlauridsen......@health.sdu.dk 2   Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark 3   Backcenter Funen, Part of Clinical Locomotion Science, Ringe, Denmark   Abstract  Understanding a change score is indispensable for interpretation of results from clinical studies...... are reproducible in patients with low back pain and/or leg pain. Despite critique of several biases, our results have reinforced the construct validity of TQ’s as an outcome measure since only 1 hypothesis was rejected. On the basis of our findings we have outlined a proposal for a standardised use of transition...

  16. Measuring treatment effects on dual-task performance: a framework for research and clinical practice

    Directory of Open Access Journals (Sweden)

    Prudence ePlummer

    2015-04-01

    Full Text Available The relevance of dual-task walking to everyday ambulation is widely acknowledged, and numerous studies have demonstrated that dual-task interference can significantly impact recovery of functional walking in people with neurological disorders. The magnitude and direction of dual-task interference is influenced by the interaction between the two tasks, including how individuals spontaneously prioritize their attention. Therefore, to accurately interpret and characterize dual-task interference and identify changes over time, it is imperative to evaluate single and dual-task performance in both tasks, as well as the tasks relative to each other. Yet, reciprocal dual-task effects are frequently ignored. The purpose of this perspective paper is to present a framework for measuring treatment effects on dual-task interference, specifically taking into account the interactions between the two tasks and how this can provide information on whether overall dual-task capacity has improved or a different attentional strategy has been adopted. In discussing the clinical implications of using this framework, we provide specific examples of using this method and provide some explicit recommendations for research and clinical practice.

  17. Impact of clinical trials on neurosurgical practice: an assessment of case volume.

    Science.gov (United States)

    Simon, Scott D; Koyama, Tatsuki; Zacharia, Brad E; Schirmer, Clemens M; Cheng, Joseph S

    2015-04-01

    To evaluate the effect of important trials on the practice of neurosurgery. We hypothesized that evidence from trials addressing the management of intracranial aneurysms (International Subarachnoid Aneurysm Trial [ISAT]) and nontraumatic intracerebral hemorrhages (Surgical Trial in Intracerebral Hemorrhage [STICH]) and vertebral augmentation for osteoporotic vertebral body fractures had a significant impact on the frequency of the corresponding neurosurgical procedures. A Medicare administrative database was queried for corresponding Common Procedural Terminology codes and units billed per calendar year. The effects of ISAT and STICH were evaluated using a generalized linear model. The effect of the vertebral augmentation study was evaluated using a t test. After publication of ISAT in 2002, the rate of increase in proportion of cerebral aneurysms that were treated with embolization (Common Procedural Terminology code 61624) per year increased from 3.9% to 5.5% (P = 0.01). After publication of STICH in 2005, the number of craniotomies performed for intracerebral hematoma decreased from 2341 in 2002 to 1646 in 2011 (P = 0.03). After 2 publications in 2009, performance of vertebral augmentation decreased from a high of 99,961 in 2009 per year to 77,108 in 2013 (P = 0.002). Randomized clinical trials remain the gold standard in the medical community to demonstrate efficacy, but their true impact relies on rapid and extensive assimilation into everyday medical practice. However, the described methodology establishes a temporal relationship only and does not prove causation. Nonetheless, trends in procedural volume suggest that the results of these select randomized clinical trials had a significant effect on neurosurgical practice affecting Medicare patients within an interval of a few years. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Developing an advanced practice nurse-led liver clinic.

    Science.gov (United States)

    McAfee, Jean L

    2012-01-01

    End-stage liver disease (ESLD) is a leading cause of digestive disease deaths in the United States and continues to increase exponentially every year. Best practice does not currently recognize or utilize a clinic practice model for ESLD management. Advanced practice registered nurses (APRNs) can impact ESLD disease management by implementing an outpatient clinic care model to focus on treatment compliance, patient education, improvement of patient outcomes, and reduction in hospital admission rates for ESLD patients. A review of 15 research articles was completed to determine the impact APRNs can make on chronic care of ESLD patients. Results from the review support APRN analysis, assessment, diagnosis, treatment, intervention, and evaluation of ESLD patients. The literature reviewed also demonstrates that ESLD patients have improved symptom management when maintained in an outpatient setting, allowing for decreased hospital and insurance expenditures. Following evaluation of the evidence, it was concluded that an APRN-led ESLD clinic merits further study.

  19. Outcome Measures in Myasthenia Gravis: Incorporation Into Clinical Practice.

    Science.gov (United States)

    Muppidi, Srikanth

    2017-03-01

    The development of validated assessment tools for evaluating disease status and response to interventions in patients with myasthenia gravis (MG) has been driven by clinical studies of emerging MG therapies. However, only a small proportion of MG-focused neurology practices have adopted these assessment tools for routine clinical use. This article reviews the suitability of 5 assessment instruments for incorporation into clinical practice, which should be driven by their ability to contribute to improved patient outcomes, and to be implemented within practice personnel and resource constraints. It is recommended that assessments based on both physician-evaluated and patient-reported outcomes be selected, to adequately evaluate both point-in-time symptom load and functional impact of MG symptoms over time. Provider resource allocation and reimbursement issues may be the most significant roadblocks to successful ongoing use of these tools; to that end, the addition of regular assessments to MG standards of care is recommended.

  20. Clinical indications for antibiotic use in Danish general practice

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Hansen, Malene Plejdrup; Siersma, Volkert Dirk

    2017-01-01

    of routine electronic antibiotic prescriptions from Danish general practice. Subjects: All 975,626 patients who redeemed an antibiotic prescription at outpatient pharmacies during the 1-year study period (July 2012 to June 2013). Main outcome measures: Number of prescriptions per clinical indication. Number......Objective: To assess the availability and applicability of clinical indications from electronic prescriptions on antibiotic use in Danish general practice. Design: Retrospective cohort register-based study including the Danish National Prescription Register. Setting: Population-based study...... from electronic prescriptions are accessible and available to provide an overview of drug use, in casu antibiotic prescriptions, in Danish general practice. These clinical indications may be further explored in detail to assess rational drug use and congruence with guidelines, but validation...

  1. Expense comparison of a telemedicine practice versus a traditional clinical practice.

    Science.gov (United States)

    Barker, Gail P; Krupinski, Elizabeth A; Schellenberg, Bonnie; Weinstein, Ronald S

    2004-01-01

    This paper compares the expenses of a telemedicine program to those of a traditional clinical practice using data from two fiscal years (FY) 1998/1999 and 2000/2001. As part of that evaluation, we compared expenses of the University of Arizona's clinical practice group, the University Physicians Incorporated (UPI), to those of the Arizona Telemedicine Program (ATP) practice. For this study, we used the reporting categories published in the year-end UPI financial statement. These categories included clinical services, administration, equipment depreciation, and overhead. Results showed that clinical service expenses and administrative expenses for FY 2000/2001 were higher in the traditional UPI practice, whereas equipment depreciation and overhead expenses are higher in the telemedicine practice. This differs somewhat from FY 1998/1999, where clinical expenses and overhead were higher in the UPI practice and administration and equipment depreciation were higher in the telemedicine practice. We will discuss the relevance of these results and the critical factors that contribute to these differences.

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

    Science.gov (United States)

    Clynes, Mary P; Raftery, Sara E C

    2008-11-01

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

  3. Clinical education in private practice: an interdisciplinary project.

    Science.gov (United States)

    Doubt, Lorna; Paterson, Margo; O'Riordan, Anne

    2004-01-01

    Education of rehabilitation professionals traditionally has occurred in acute care hospitals, rehabilitation centres, and other publicly funded institutions, but increasing numbers of rehabilitation professionals are now working in the community in private agencies and clinics. These privately owned clinics and community agencies represent underutilized resources for the clinical training of students. Historically, private practitioners have been less likely to participate in clinical education because of concerns over patient satisfaction and quality of care, workload, costs, and liability. Through a program funded by the Ministry of Health of Ontario, we conducted a series of interviews and focus groups with private practitioners, which identified that several incentives could potentially increase the numbers of clinical placements in private practices, including participation in the development of student learning objectives related to private practice, professional recognition, and improved relationships with the university departments. Placement in private practices can afford students skills in administration, business management, marketing and promotion, resource development, research, consulting, networking, and medical-legal assessments and processes. This paper presents a discussion of clinical education issues from the perspective of private practitioners, based on the findings of a clinical education project undertaken at Queen's University, Kingston, Ontario, and previous literature.

  4. Survey of clinical infant lung function testing practices.

    Science.gov (United States)

    Peterson-Carmichael, Stacey L; Rosenfeld, Margaret; Ascher, Simon B; Hornik, Christoph P; Arets, H G M; Davis, Stephanie D; Hall, Graham L

    2014-02-01

    Data supporting the clinical use of infant lung function (ILF) tests are limited making the interpretation of clinical ILF measures difficult. To evaluate current ILF testing practices and to survey users regarding the indications, limitations and perceived clinical benefits of ILF testing. We created a 26-item survey hosted on the European Respiratory Society (ERS) website between January and May 2010. Notifications were sent to members of the ERS, American Thoracic Society and the Asian Pacific Society of Respirology. Responses were sought from ILF laboratory directors and pediatric respirologists. The survey assessed the clinical indications, patient populations, equipment and reference data used, and perceived limitations of ILF testing. We received 148 responses with 98 respondents having ILF equipment and performing testing in a clinical capacity. Centers in North America were less likely to perform ≥50 studies/year than centers in Europe or other continents (13% vs. 41%). Most respondents used ILF data to either "start a new therapy" (78%) or "help decide about initiation of further diagnostic workup such as bronchoscopy, chest CT or serological testing" (69%). Factors reported as limiting clinical ILF testing were need for sedation, uncertainty regarding clinical impact of study results and time intensive nature of the study. Clinical practices associated with ILF testing vary significantly; centers that perform more studies are more likely to use the results for clinical purposes and decision making. The future of ILF testing is uncertain in the face of the limitations perceived by the survey respondents. © 2013 Wiley Periodicals, Inc.

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

    Directory of Open Access Journals (Sweden)

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

    2013-06-01

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

  6. Clinical neuropsychology in Israel: history, training, practice and future challenges.

    Science.gov (United States)

    Vakil, Eli; Hoofien, Dan

    2016-11-01

    This is an invited paper for a special issue on international perspectives on training and practice in clinical neuropsychology. We provide a review of the status of clinical neuropsychology in Israel, including the history of neuropsychological, educational, and accreditation requirements to become a clinical neuropsychologist and to practice clinical neuropsychology. The information is based primarily on the personal knowledge of the authors who have been practicing clinical neuropsychology for over three decades and hold various administrative and academic positions in this field. Second, we conducted three ad hoc surveys among clinical and rehabilitation psychologists; heads of academic programs for rehabilitation and neuropsychology; and heads of accredited service providers. Third, we present a literature review of publications by clinical neuropsychologists in Israel. Most of the clinical neuropsychologists are graduates of either rehabilitation or clinical training programs. The vast majority of neuropsychologists are affiliated with rehabilitation psychology. The training programs (2-3 years of graduate school) provide solid therapeutic and diagnostic skills to the students. Seventy-five percent of the participants in this survey are employed at least part-time by public or state-funded institutions. Israeli neuropsychologists are heavily involved in case management, including vocational counseling, and rehabilitation psychotherapy. Conclusions and future goals: Although clinical neuropsychologists in Israel are well educated and valued by all health professionals, there are still several challenges that must be addressed in order to further advance the field and the profession. These included the need for Hebrew-language standardized and normalized neuropsychological tests and the application of evidence-based interventions in neuropsychological rehabilitation.

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

    Science.gov (United States)

    Powell, Thomas W

    2007-01-01

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

  8. Clinical exome sequencing reports: current informatics practice and future opportunities.

    Science.gov (United States)

    Swaminathan, Rajeswari; Huang, Yungui; Astbury, Caroline; Fitzgerald-Butt, Sara; Miller, Katherine; Cole, Justin; Bartlett, Christopher; Lin, Simon

    2017-11-01

    The increased adoption of clinical whole exome sequencing (WES) has improved the diagnostic yield for patients with complex genetic conditions. However, the informatics practice for handling information contained in whole exome reports is still in its infancy, as evidenced by the lack of a common vocabulary within clinical sequencing reports generated across genetic laboratories. Genetic testing results are mostly transmitted using portable document format, which can make secondary analysis and data extraction challenging. This paper reviews a sample of clinical exome reports generated by Clinical Laboratory Improvement Amendments-certified genetic testing laboratories at tertiary-care facilities to assess and identify common data elements. Like structured radiology reports, which enable faster information retrieval and reuse, structuring genetic information within clinical WES reports would help facilitate integration of genetic information into electronic health records and enable retrospective research on the clinical utility of WES. We identify elements listed as mandatory according to practice guidelines but are currently missing from some of the clinical reports, which might help to organize the data when stored within structured databases. We also highlight elements, such as patient consent, that, although they do not appear within any of the current reports, may help in interpreting some of the information within the reports. Integrating genetic and clinical information would assist the adoption of personalized medicine for improved patient care and outcomes. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  9. Clinical diagnostic ultrasound

    International Nuclear Information System (INIS)

    Barnett, E.; Morley, P.

    1986-01-01

    This textbook on diagnostic ultrasound covers the main systems, with emphasis being placed on the clinical application of diagnostic ultrasound in everyday practice. It provides not only a textbook for postgraduates (particularly FRCR candidates), but also a reference work for practitioners of clinical ultrasound and clinicians generally

  10. Everyday-Oriented Innovation

    DEFF Research Database (Denmark)

    Munnecke, Max

    The exploration of radical innovation has long been regarded as fundamental to business growth. In the 21st century, modern organisations increasingly seek to combine business innovation with the broader goal to confront social and environmental challenges. Vision projects are related phenomena...... which explore and map radical innovation opportunities within everyday activities. The aim of a vision project is to produce an innovation map that can empower an organisation to navigate between potential innovation opportunities and pro‐actively confront modern challenges for the benefit of people......, business, and society. The study addresses the concern that vision projects do not produce sufficient navigational innovation maps, and seeks to improve their quality by modelling a new methodological framework. The study was conducted as a series of four research cycles which modelled and experimented...

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

    International Nuclear Information System (INIS)

    Keeling, Aoife N.; Reekers, Jim A.; Lee, Michael J.

    2009-01-01

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

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

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2009-05-01

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

  13. Professional practice assessment. Pertinence of positron emission tomography clinical indications in oncology

    International Nuclear Information System (INIS)

    Le Stanc, E.; Tainturier, C.; Swaenepoel, J.

    2009-01-01

    Introduction As part of the health care quality and safety policy in France, Professional Practice Assessment (P.P.A.) are mandatory in the health services 'certification' process. We present our study regarding the pertinence of Positron Emission Tomography (PET) indications in oncology. Materials and methods A multidisciplinary task group used the Quick Audit method with two rounds of 100 request forms each. The assessment list of criteria comprised four items of decreasing relevance grading the PET scans clinical indications, which were derived from the three French published guidelines (S.O.R. [F.N.C.L.C.C]., 'Guide du bon usage des examens d'imagerie medicale' [S.F.R.-S.F.M.N.], 'Guide pour la redaction de protocoles pour la TEP au F.D.G. en cancerologie' [S.F.M.N.]) and five additional items: clinical information, patient's body weight, previous treatments dates, diabetes, claustrophobia. Results The first round showed that 68% of the requested scans corresponded to the two most relevant groups of indications (S.O.R. Standards and Options). The request forms were correctly filled in regarding the clinical information, but this was not the case for the other items we tested. Several actions were conducted: dedicated PET request form, availability of the S.O.R. on the hospital intranet, boost of the referring physicians awareness during the multidisciplinary oncology meetings (Reunions de Concertation Pluridisciplinaires RCP). The second round showed a better pertinence of the PET scans indications (75% versus 68%); the patient's body weight was more frequently mentioned on the request form. Discussion This study is an example of P.P.A. in our discipline. It led to an improvement of the oncologic PET scans clinical indications in our hospital. This work is pursued in everyday discussion with the referring clinicians, especially during the RCP. (authors)

  14. What Is Everyday Ethics? A Review and a Proposal for an Integrative Concept.

    Science.gov (United States)

    Zizzo, Natalie; Bell, Emily; Racine, Eric

    2016-01-01

    "Everyday ethics" is a term that has been used in the clinical and ethics literature for decades to designate normatively important and pervasive issues in healthcare. In spite of its importance, the term has not been reviewed and analyzed carefully. We undertook a literature review to understand how the term has been employed and defined, finding that it is often contrasted to "dramatic ethics." We identified the core attributes most commonly associated with everyday ethics. We then propose an integrative model of everyday ethics that builds on the contribution of different ethical theories. This model proposes that the function of everyday ethics is to serve as an integrative concept that (1) helps to detect current blind spots in bioethics (that is, shifts the focus from dramatic ethics) and (2) mobilizes moral agents to address these shortcomings of ethical insight. This novel integrative model has theoretical, methodological, practical, and pedagogical implications, which we explore. Because of the pivotal role that moral experience plays in this integrative model, the model could help to bridge empirical ethics research with more conceptual and normative work. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

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

    Science.gov (United States)

    Godény, Sándor

    2012-02-05

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

  16. Multifunction laser systems in clinical and resort practice

    OpenAIRE

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

    2016-01-01

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

  17. Improving clinical practice through simulation: A case study of ...

    African Journals Online (AJOL)

    Acquisition of knowledge and skills by nursing students before real-life practice is a familiar nursing education challenge. The use of clinical simulation in nursing education provides many opportunities for students to learn and apply theoretical principles of nursing care in a safe environment. The purpose of this study was ...

  18. Clinical Effectiveness and Dose Titration in Pediatric Practice

    Directory of Open Access Journals (Sweden)

    Yu.V. Marushko

    2016-02-01

    Full Text Available The paper is devoted to the questions of usage of one of the popular antipyretic and anesthetic drug in pediatric practice — ibuprofen. In the article there are generalized literature data and own experience in ibuprofen dose titration in single dose 5 and 10 mg/kg depending on clinical situation.

  19. Clinical practice guideline on diagnosis and treatment of hyponatraemia

    NARCIS (Netherlands)

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

    2014-01-01

    Hyponatraemia, defined as a serum sodium concentration <135 mmol/L, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. Hyponatraemia is present in 15-20 % of emergency admissions to hospital and occurs in up to 20 % of critically ill patients.

  20. Supporting Clinical Practice Candidates in Learning Community Development

    Science.gov (United States)

    DeJarnette, Nancy K.; Sudeck, Maria

    2015-01-01

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

  1. Core outcome sets for research and clinical practice

    NARCIS (Netherlands)

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

    2017-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  3. The role of hypnotherapy in evidence-based clinical practice.

    Science.gov (United States)

    Griffiths, M J

    2017-05-01

    The purpose of this review was to discuss the place of hypnotherapy in a modern medical world dominated by so-called evidence-based clinical practice. Hypnosis is an easily learned technique that is a valuable adjuvant to many medical, dental and psychological interventions. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    NARCIS (Netherlands)

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

    2006-01-01

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

  5. Malingering in clinical practice with specific reference to psychiatry ...

    African Journals Online (AJOL)

    Malingering in clinical practice with specific reference to psychiatry and psychology. Frans J Hugo, Frances Hemp. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers ...

  6. The creative pathways of everyday life

    DEFF Research Database (Denmark)

    Tanggaard, Lene

    2015-01-01

    interested in the simultaneous development of persons and social practices. Pathways are created in ordinary life; their formation may involve creativity and the improvisational co-creation of opportunities for action. Studying pathways may therefore direct creativity researchers toward the potentials...... in the mundane processes of everyday life is, however, seldom highlighted by researchers working explicitly on creativity. The premise of the present paper is that a focus on everyday life can help us understand creative processes in broader terms. I “creative pathways” may serve as a useful term for researchers...... of creativity in daily life and shed light of the processes of creativity. Creative pathways are present in existing ways of moving and doing things; they are also created in the here-and-now by persons acting in correspondence with the affordances in social practices. A focus on creative pathways is consistent...

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

    DEFF Research Database (Denmark)

    Bøttcher Berthelsen, Connie; Hølge-Hazelton, Bibi

    2017-01-01

    for efficiency, nurses’ barriers to research use and the lack of definition of the concept of nursing research culture make it difficult to establish. Design Concept analysis. Data sources Data were collected through a literature review in PubMed, CINAHL and PsycINFO during March 2016. Methods Walker and Avant......Aim To report an analysis of the concept of nursing research culture in the context of clinical nursing practice. Background Nursing research culture should be valued for its contribution to improving patient care and should be considered as a routine hospital activity. However, the demand......'s eight-step framework for concept analysis. Results Five defining attributes of nursing research culture in the context of clinical nursing practice were identified: strong monodisciplinary nursing professionalism, academic thinking and socialization, research use as a part of daily nursing practice...

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

    International Nuclear Information System (INIS)

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

    2011-01-01

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

  9. The Dynamic Structure of Everyday Life

    Science.gov (United States)

    1988-10-12

    1986. Available as Technical Report 918, MIT Artificial Intelligence Lab- oratory, 1986. Pierre Bourdieu , Outline of a theory of practice, Cambridge...Department of Electrical Engineering and Computer Science on October 12, 1988 in partial fulfillment of the requirements for the degree of Doctor of...everyday cognition (see for example Bourdieu 1977, Garfinkel 1967, Lave 1988, Rogoff and Lave 1984, Scribner 198-1, Wertsch 1985). Much of this work is

  10. Talking politics in everyday family lives

    OpenAIRE

    Nolas, Sevasti-Melissa; Varvantakis, Christos; Aruldoss, Vinnarasan

    2017-01-01

    How do children encounter and relate to public life? Drawing on evidence from ethnographic fieldwork conducted between 2014 and 2016 for the ERC-funded Connectors Study on the relationship between childhood and public life, this paper explores how children encounter public life in their everyday family environments. Using the instance of political talk as a practice through which public life is encountered in the home, the data presented fill important gaps in knowledge about the lived experi...

  11. Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice.

    Science.gov (United States)

    Jacobi, Judith; Ray, Shaunta'; Danelich, Ilya; Dodds Ashley, Elizabeth; Eckel, Stephen; Guharoy, Roy; Militello, Michael; O'Donnell, Paul; Sam, Teena; Crist, Stephanie M; Smidt, Danielle

    2016-05-01

    This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed. © 2016 Pharmacotherapy Publications, Inc.

  12. How to Address Citizens' Practices and Policies on Sustainability? A Consultative Tool for Brokering Policy-Related Knowledge between the Worlds of Policymaking and Everyday

    Science.gov (United States)

    Espluga, Josep; Konrad, Wilfried; Mays, Claire; Oltra, Christian; Poumadére, Marc; Prades, Ana

    2016-01-01

    An innovative investigative approach (STAVE), combining elements of research, engagement and brokerage, was used to uncover policy assumptions and daily experiences related to energy use practices. Exploratory work within three policymaker institutions and eight reconvened focus groups were carried out in three different European countries…

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

    International Nuclear Information System (INIS)

    2015-01-01

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

  14. Drug-Induced QTc Interval Prolongation: A Multicenter Study to Detect Drugs and Clinical Factors Involved in Every Day Practice.

    Science.gov (United States)

    Keller, Guillermo A; Alvarez, Paulino A; Ponte, Marcelo L; Belloso, Waldo H; Bagnes, Claudia; Sparanochia, Cecilia; Gonzalez, Claudio D; Villa Etchegoyen, M Cecilia; Diez, Roberto A; Di Girolamo, Guillermo

    2016-01-01

    The actual prevalence of drug induced QTc prolongation in clinical practice is unknown. Our objective was to determine the occurrence and characteristics of drug-induced QT prolongation in several common clinical practices. Additionally, a subgroup of patients treated with dextropropoxyphene of particular interest for the regulatory authority was analysed. Medical history and comorbidities predisposing to QT interval prolongation were registered for 1270 patient requiring medical assistance that involved drug administration. Three ionograms and ECGs were performed: baseline, intra- and after treatment; QT interval was corrected with Bazzet formula. Among patients, 9.9% presented QTc >450/470 ms, 3% QTc > 500 ms, 12.7% ΔQTc >30 ms and 5.2% ΔQTc >60 ms. QTc prolongation associated with congestive heart failure, ischemic cardiopathy, diabetes, renal failure, arrhythmias, hypothyroidism, and bradycardia. At univariate analysis, clarithromycin, haloperidol, tramadol, amiodarone, glyceryl trinitrate, amoxicillin + clavulanic acid, amoxicillin + sulbactam, ampicillin + sulbactam, fentanyl, piperacillin + tazobactam, and diazepam prolonged QTc. Prolongation remained significantly associated with furosemide, clarithromycin, glyceryl trinitrate and betalactamase inhibitors after multivariate analysis. QT interval prolongation in everyday practice is frequent, in association to clinical factors and drugs that can be easily identified for monitoring and prevention strategies.

  15. An overview of clinical governance policies, practices and initiatives.

    Science.gov (United States)

    Braithwaite, Jeffrey; Travaglia, Joanne F

    2008-02-01

    To map the emergence of, and define, clinical governance; to discuss current best practices, and to explore the implications of these for boards of directors and executives wishing to promote a clinical governance approach in their health services. Review and analysis of the published and grey literature on clinical governance from 1966 to 2006. Medline and CINAHL databases, key journals and websites were systematically searched. Central issues were identified in the literature as key to effective clinical governance. These include: ensuring that links are made between health services' clinical and corporate governance; the use of clinical governance to promote quality and safety through a focus on quality assurance and continuous improvement; the creation of clinical governance structures to improve safety and quality and manage risk and performance; the development of strategies to ensure the effective exchange of data, knowledge and expertise; and the sponsoring of a patient-centred approach to service delivery. A comprehensive approach to clinical governance necessarily includes the active participation of boards and executives in sponsoring and promoting clinical governance as a quality and safety strategy. Although this is still a relatively recent development, the signs are promising.

  16. Domestic Violence as Everyday Terrorism

    DEFF Research Database (Denmark)

    Cooper-Cunningham, Dean

    2016-01-01

    Seeing bride kidnapping and domestic violence as everyday terrorism unpacks the political nature of so-called “private” phenomena and how they reify patriarchal society.......Seeing bride kidnapping and domestic violence as everyday terrorism unpacks the political nature of so-called “private” phenomena and how they reify patriarchal society....

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

    Science.gov (United States)

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

    2016-09-01

    Nurses in clinical settings in which evidence-based, individualized care is expected are often the best resource to identify important clinical questions and gaps in practice. These nurses are frequently challenged by a lack of resources to fully develop their questions and identify the most appropriate methods to answer them. A strategic and ongoing partnership between medical library services and nursing can support nurses as they embark on the process of answering these questions and, ultimately, improving patient care and clinical outcomes

  18. Physician to investigator: clinical practice to clinical research--ethical, operational, and financial considerations.

    Science.gov (United States)

    Pierre, Christine

    2008-01-01

    Physicians who participate in clinical research studies gain benefits for themselves, their practice, and their patients. Historically, private practice physicians have chosen to defer to their counterparts in academic medicine when it comes to contributing to scientific advancement through clinical studies. A growing number of private practice physicians are now taking a serious second look and deciding that there are unique benefits for both the practice and the patient. Physicians who decide to participate in clinical research should give serious consideration to the time and resources that are required to meet both federal regulations and industry standards. In addition, ethical and scientific principles for assuring the protection of human research subjects must be a paramount commitment.

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

    NARCIS (Netherlands)

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

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

  20. Exploring the Sacred-Secular Dialect in Everyday Social Work Practice: An Analysis of Religious Responses to Managerialism among Outreach Social Workers in Hong Kong.

    Science.gov (United States)

    Groves, Julian M; Ho, Wai-Yip; Siu, Kaxton

    2016-07-01

    We examine the recent proliferation of religious discourses among front line social workers in the former British Colony of Hong Kong in order to explore the nature of 're-enchantment' in modern social work practice. In-depth qualitative interviews with twenty social workers who identify as 'Christian social workers' in a variety of social work organisations (both religious and secular) reveal the adoption of religious identities and discourses to navigate the encroachment of managerialism. A systematic analysis of these narratives suggests that Christian social workers evoke religion to reclaim feelings of authenticity in their work, to facilitate more personalised relationships with their clients, and to empower themselves following the introduction of managerialist policies. We illuminate the dialectical relationship between religious discourses and managerialism to critique claims in the literature about a 're-enchantment' in social work, and to understand the essence of religion in modern social work practice.

  1. Doctors' experience with handheld computers in clinical practice: qualitative study.

    Science.gov (United States)

    McAlearney, Ann Scheck; Schweikhart, Sharon B; Medow, Mitchell A

    2004-05-15

    To examine doctors' perspectives about their experiences with handheld computers in clinical practice. Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists. 54 doctors who did or did not use handheld computers. Doctors who used handheld computers in clinical practice seemed generally satisfied with them and reported diverse patterns of use. Users perceived that the devices helped them increase productivity and improve patient care. Barriers to use concerned the device itself and personal and perceptual constraints, with perceptual factors such as comfort with technology, preference for paper, and the impression that the devices are not easy to use somewhat difficult to overcome. Participants suggested that organisations can help promote handheld computers by providing advice on purchase, usage, training, and user support. Participants expressed concern about reliability and security of the device but were particularly concerned about dependency on the device and over-reliance as a substitute for clinical thinking. Doctors expect handheld computers to become more useful, and most seem interested in leveraging (getting the most value from) their use. Key opportunities with handheld computers included their use as a stepping stone to build doctors' comfort with other information technology and ehealth initiatives and providing point of care support that helps improve patient care.

  2. Theory-practice integration in selected clinical situations

    Directory of Open Access Journals (Sweden)

    M Davhana-Maselesele

    2001-09-01

    Full Text Available The current changes in health care systems challenge knowledgeable, mature and independent practitioners to integrate theoretical content with practice. The aim of this study was to investigate the problems of integrating theory with practice in selected clinical nursing situations. The study focused on rendering of family planning services to clients as a component of Community Nursing Science. Structured observation schedules were used to observe the theoretical content of the curriculum as well as the practical application of what has been taught in the clinical area. The findings of the study revealed that there was a need for an integrated holistic curriculum, which would address the needs of the community. It was concluded that a problem-based and community-based curriculum, intersectoral collaboration between college and hospital managements and student involvement in all processes of teaching and learning would improve the integration of theory and practice. There also appeared to be a need for tutors to be more involved in clinical teaching and accompaniment.

  3. Health Professionals Facing Suicidal Patients: What Are Their Clinical Practices?

    Directory of Open Access Journals (Sweden)

    Inês Rothes

    2018-06-01

    Full Text Available Clinical work with suicidal people is a demanding area. Little is known about health professionals’ practices when faced with suicidal patients. The aims of this study were to: (1 describe the practices most likely to be adopted by professionals facing a suicidal patient and (2 analyze the differences according to professional characteristics (group, specific training on suicide, and experience with suicidal patients. A self-report questionnaire that was developed for this study was filled out by 239 participants. Participants were psychologists, psychiatrists, and general practitioners who work in different contexts: hospitals, public health centres, schools or colleges, and community centres. Principal components analysis, analyses of variance, and t-tests were used. Four components were identified: (1 Comprehensive risk assessment; (2 protocols, psychotherapy and connectedness; (3 multidisciplinary clinical approach; and, (4 family, explaining a total of variance of 44%. Positive associations between suicide-related variables (training and experience and practices were found. In general, health professionals’ practices are evidence-based, however a relevant percentage of professionals can benefit from training and improve their practices.

  4. Clinical practice in community medicine: Challenges and opportunities

    Directory of Open Access Journals (Sweden)

    Rajesh Kumar

    2017-01-01

    Full Text Available Clinical practice with community health perspective makes community medicine a unique specialty. In their health centers, community physicians not only implement disease prevention programs, assess community health needs, manage healthcare teams and advocate for health promoting policies but also diagnose and treat diseases. However, participation of community medicine faculty in the delivery of clinical care varies from place to place due to administrative constraints. Health centers attached with medical college are not dependent on community medicine faculty for clinical service as these centers have their own medical and paramedical staff; whereas, other clinical departments in medical colleges depend on their faculty for delivery of clinical care in the hospital. Consequently, a perception is gaining ground that community medicine is a para-clinical specialty. Strategies for a fixed tenured rotation of faculty in the health centers should be evolved. All faculty members of community medicine must also provide clinical care in the health centers and the quantum of clinical services provided by each one of them should be reported widely to all stakeholders. Community medicine residency programs must ensure that trainee community physicians acquire competency to deliver comprehensive primary health care (promotive, preventive, curative, and rehabilitative in a health center.

  5. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for use of tumor markers in clinical practice

    DEFF Research Database (Denmark)

    Sturgeon, Catharine M; Hoffman, Barry R; Chan, Daniel W

    2008-01-01

    BACKGROUND: This report presents updated National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines summarizing quality requirements for the use of tumor markers. METHODS: One subcommittee developed guidelines for analytical quality relevant to serum and tissue-based tumor...... questions to ensure selection of the appropriate test, adherence to good clinical and laboratory practices (e.g., minimization of the risk of incorrect patient and/or specimen identification, tube type, or timing), use of internationally standardized and well-characterized methods, careful adherence...... records. Also mandatory is extensive validation encompassing all stages of analysis before introduction of new technologies such as microarrays and mass spectrometry. Provision of high-quality tumor marker services is facilitated by dialogue involving researchers, diagnostic companies, clinical...

  6. Evaluating Industry Payments Among Dermatology Clinical Practice Guidelines Authors.

    Science.gov (United States)

    Checketts, Jake X; Sims, Matthew Thomas; Vassar, Matt

    2017-12-01

    It is well documented that financial conflicts of interest influence medical research and clinical practice. Prior to the Open Payments provisions of the Affordable Care Act, financial ties became apparent only through self-disclosure. The nature of financial interests has not been studied among physicians who develop dermatology clinical practice guidelines. To evaluate payments received by physicians who author dermatology clinical practice guidelines, compare disclosure statements for accuracy, determine whether pharmaceutical companies from which the authors received payments manufactured products related to the guidelines, and examine the extent to which the American Academy of Dermatology enforced their Administrative Regulations for guideline development. Three American Academy of Dermatology guidelines published from 2013 to 2016 were retrieved. Double data extraction was used to record financial payments received by 49 guideline authors using the Open Payments database. Payments received by the authors from the date of the initial literature search to the date of publication were used to evaluate disclosure statement accuracy, detail the companies providing payments, and evaluate Administrative Regulations enforcement. This study is applicable to clinical practice guideline panels drafting recommendations, physicians using clinical practice guidelines to inform patient care, and those establishing policies for guideline development. Our main outcomes are the monetary values and types of payments received by physicians who author dermatology guidelines and the accuracy of disclosure statements. Data were collected from the Open Payments database and analyzed descriptively. Of the 49 authors evaluated, 40 received at least 1 reported industry payment, 31 accepted more than $1000, 25 accepted more than $10 000, and 18 accepted more than $50 000. Financial payments amounted to a mean of $157 177 per author. The total reimbursement among the 49 authors

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

    Directory of Open Access Journals (Sweden)

    Lisa J. Knecht-Sabres DHS, OTR/L

    2013-06-01

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

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

    International Nuclear Information System (INIS)

    Jaervinen, H.

    2003-01-01

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

  9. Digital pathology in nephrology clinical trials, research, and pathology practice.

    Science.gov (United States)

    Barisoni, Laura; Hodgin, Jeffrey B

    2017-11-01

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

  10. Good Practice for Introducing Radiopharmaceuticals for Clinical Use

    International Nuclear Information System (INIS)

    2016-02-01

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

  11. Promoting interventional radiology in clinical practice of emergency medicine

    International Nuclear Information System (INIS)

    Zhou Bing; Yuan Jianhua

    2009-01-01

    Interventional radiology has lot of advantages in dealing with various emergencies. The technique is minimally-invasive, highly-effective and immediately-efficient, moreover, it integrates the diagnosis with the therapy perfectly. Besides, the interventional techniques applied in emergency medicine include not only the vascular interventions,such as embolization, embolectomy, etc, but also the nonvascular interventions, such as tracheal s tent implantation, percutaneous vertebroplasty and so forth. However, importance has not been attached to the clinical use of interventional therapy in emergency medicine so far. It is imperative for us to promote the acceptance of interventional therapy in emergency medicine as well as to popularize the technique in clinical practice. (authors)

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

    Science.gov (United States)

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

    2016-01-01

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

  13. How can we teach EBM in clinical practice? An analysis of barriers to implementation of on-the-job EBM teaching and learning.

    Science.gov (United States)

    Oude Rengerink, Katrien; Thangaratinam, Shakila; Barnfield, Gemma; Suter, Katja; Horvath, Andrea R; Walczak, Jacek; Wełmińska, Anna; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N; Onody, Rita; Zanrei, Gianni; Kunz, Regina; Arditi, Chantal; Burnand, Bernard; Gee, Harry; Khan, Khalid S; Mol, Ben W J

    2011-01-01

    Evidence-based medicine (EBM) improves the quality of health care. Courses on how to teach EBM in practice are available, but knowledge does not automatically imply its application in teaching. We aimed to identify and compare barriers and facilitators for teaching EBM in clinical practice in various European countries. A questionnaire was constructed listing potential barriers and facilitators for EBM teaching in clinical practice. Answers were reported on a 7-point Likert scale ranging from not at all being a barrier to being an insurmountable barrier. The questionnaire was completed by 120 clinical EBM teachers from 11 countries. Lack of time was the strongest barrier for teaching EBM in practice (median 5). Moderate barriers were the lack of requirements for EBM skills and a pyramid hierarchy in health care management structure (median 4). In Germany, Hungary and Poland, reading and understanding articles in English was a higher barrier than in the other countries. Incorporation of teaching EBM in practice faces several barriers to implementation. Teaching EBM in clinical settings is most successful where EBM principles are culturally embedded and form part and parcel of everyday clinical decisions and medical practice.

  14. Clinical leadership in contemporary clinical practice: implications for nursing in Australia.

    Science.gov (United States)

    Davidson, P M; Elliott, D; Daly, J

    2006-04-01

    Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians. The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making. Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians. Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.

  15. Understanding implementation processes of clinical pathways and clinical practice guidelines in pediatric contexts: a study protocol

    Directory of Open Access Journals (Sweden)

    Scott Shannon D

    2011-12-01

    Full Text Available Abstract Background Canada is among the most prosperous nations in the world, yet the health and wellness outcomes of Canadian children are surprisingly poor. There is some evidence to suggest that these poor health outcomes are partly due to clinical practice variation, which can stem from failure to apply the best available research evidence in clinical practice, otherwise known as knowledge translation (KT. Surprisingly, clinical practice variation, even for common acute paediatric conditions, is pervasive. Clinical practice variation results in unnecessary medical treatments, increased suffering, and increased healthcare costs. This study focuses on improving health outcomes for common paediatric acute health concerns by evaluating strategies that improve KT and reduce clinical practice variation. Design/Methods Using a multiple case study design, qualitative and quantitative data will be collected from four emergency departments in western Canada. Data sources will include: pre- and post-implementation focus group data from multidisciplinary healthcare professionals; individual interviews with the local champions, KT intervention providers, and unit/site leaders/managers; Alberta Context Tool (ACT survey data; and aggregated patient outcome data. Qualitative and quantitative data will be systematically triangulated, and matrices will be built to do cross-case comparison. Explanations will be built about the success or lack of success of the clinical practice guidelines (CPG and clinical pathways (CPs uptake based upon the cross-case comparisons. Significance This study will generate new knowledge about the potential causal mechanisms and factors which shape implementation. Future studies will track the impact of the CPG/CPs implementation on children's health outcome, and healthcare costs.

  16. From clinical practice guidelines, to clinical guidance in practice - implications for design of computerized guidance

    DEFF Research Database (Denmark)

    Lyng, Karen Marie

    2010-01-01

    an extensive application of what we have named second order guiding artifacts. The deployed protocols underwent a local adaptation and transformation process when initiated. The protocols were adapted to match the local resources and transformed into several activity specific second order guiding artifacts....... The transformation from protocols was executed according to a standard operating procedure. Each activity type had a standardized template ensuring uniformity across second order guiding artifacts within a clinic. The guiding artifacts were multi-functional and a wide variety of standardized graphical attributes...

  17. Clinical Practice Guidelines and Helicobacter pylori Infection in Children

    Directory of Open Access Journals (Sweden)

    Colin Macarthur

    1999-01-01

    Full Text Available The objective of this paper is to review the principles, methods and issues behind the development of clinical practice guidelines. Practice guidelines have been defined as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. The ultimate goal of guidelines is to improve patient outcomes; however, they may also be used as tools to decrease health care costs, improve medical education and enhance quality assurance. Evidence-based guidelines use explicit methods to link recommendations to the quality of the underlying research. Following development of the guideline, implementation and evaluation are key steps. The ultimate aim of guideline development is to influence physician knowledge, attitudes and behaviour.

  18. Experimental Psychopathology: From laboratory studies to clinical practice

    Directory of Open Access Journals (Sweden)

    Pierre Philippot

    2006-03-01

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

  19. Practical clinical applications of the computer in nuclear medicine

    International Nuclear Information System (INIS)

    Price, R.R.; Erickson, J.J.; Patton, J.A.; Jones, J.P.; Lagan, J.E.; Rollo, F.D.

    1978-01-01

    The impact of the computer on the practice of nuclear medicine has been felt primarily in the area of rapid dynamic studies. At this time it is difficult to find a clinic which routinely performs computer processing of static images. The general purpose digital computer is a sophisticated and flexible instrument. The number of applications for which one can use the computer to augment data acquisition, analysis, or display is essentially unlimited. In this light, the purpose of this exhibit is not to describe all possible applications of the computer in nuclear medicine but rather to illustrate those applications which have generally been accepted as practical in the routine clinical environment. Specifically, we have chosen examples of computer augmented cardiac, and renal function studies as well as examples of relative organ blood flow studies. In addition, a short description of basic computer components and terminology along with a few examples of non-imaging applications are presented

  20. Neck Pain: Clinical Practice Guidelines Help Ensure Quality Care.

    Science.gov (United States)

    2017-07-01

    In 2008, physical therapists published the first neck pain clinical practice guidelines. These guidelines have been updated and are now available in the July 2017 issue of JOSPT. To update these guidelines, physical therapists teamed with the International Collaboration on Neck Pain to identify leading practices. These revised guidelines provide direction to clinicians as they screen, evaluate, diagnose, and make treatment-based classifications of neck pain. They also outline the best nonsurgical treatment options based on the published literature. At the end of the day, the best care is a combination of the leading science, the clinical expertise of your health care provider, and your input as the patient. These guidelines help inform the first step in this process. J Orthop Sports Phys Ther 2017;47(7):513. doi:10.2519/jospt.2017.0508.

  1. A survey of Korean medicine doctors' clinical practice patterns for autism spectrum disorder: preliminary research for clinical practice guidelines.

    Science.gov (United States)

    Lee, Jihong; Lee, Sun Haeng; Lee, Boram; Yang, In Jun; Chang, Gyu Tae

    2018-03-13

    The aim of this study was to investigate autism spectrum disorder (ASD) clinical practice patterns of Korean medicine doctors (KMDs) through questionnaire survey. Questionnaires on Korean medicine (KM) treatment for ASD were distributed to 255 KMDs on December 5, 2016. The KMDs were psychiatrists, pediatricians, or general practitioners, who treated patients with ASD. The questionnaire covered items on treatment methods, aims of treatment, KM syndrome differentiation, diagnostic tools, and sociodemographic characteristics. Frequency analysis was conducted to describe the participants and their practices. A total 22.4% KMDs (n = 57/255) completed the questionnaires and 54 KMDs (21.2%) matched the inclusion criteria. The KMDs utilized herbal medicine (27.3%), body acupuncture (17.6%), scalp acupuncture (10.7%), moxibustion (6.4%), and Korean medical psychotherapy (5.9%) to treat ASD. The most commonly prescribed herbal medicine was Yukmijihwang-tang. Forty-eight (88.9%) KMDs responded that they used KM syndrome differentiation. 'Organ system, Qi, Blood, Yin, Yang, Fluid and Humor diagnosis' was most frequently used for syndrome differentiation. ASD was mainly diagnosed based on the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and DSM-5. The present study demonstrated the current status of KMDs' diagnosis and treatment of ASD. In future clinical trials and clinical practice guidelines, these findings will provide meaningful information on the actual practice patterns of KMDs.

  2. The clinical practice guideline for falls and fall risk

    OpenAIRE

    Vance, Jacqueline

    2011-01-01

    Falling is a significant cause of injury and death in frail older adults. Residents in long-term care (LTC) facilities fall for a variety of reasons and are more likely to endure injuries after a fall than those in the community The American Medical Directors Association (AMDA) Clinical Practice Guideline is written to give LTC staff an understanding of risk factors for falls and provide guidance for a systematic approach to patient assessment and selection of appropriate interventions. It is...

  3. Learning in clinical practice: findings from CT, MRI and PACS

    OpenAIRE

    Sinozic, Tanja

    2014-01-01

    This thesis explores learning in clinical practice in the cases of CT, MRI and PACS in\\ud UK hospitals. It asks the questions of how and why certain evolutionary features of\\ud technology condition learning and change in medical contexts.\\ud Using an evolutionary perspective of cognitive and social aspects of technological\\ud change, this thesis explores the relationships between technology and organisational\\ud learning processes of intuition, interpretation, integration and institutionalisa...

  4. Everyday and Exotic Foodborne Parasites

    Directory of Open Access Journals (Sweden)

    Marilyn B Lee

    2000-01-01

    Full Text Available Everyday foodborne parasites, which are endemic in Canada, include the protozoans Entamoeba histolytica, Giardia lamblia and Cryptosporidium parvum. However, these parasites are most frequently acquired through unfiltered drinking water, homosexual activity or close personal contact such as in daycare centres and occasionally via a food vehicle. It is likely that many foodborne outbreaks from these protozoa go undetected. Transmission of helminth infections, such as tapeworms, is rare in Canada because of effective sewage treatment. However, a common foodborne parasite of significance is Toxoplasma gondii. Although infection can be acquired from accidental ingestion of oocysts from cat feces, infection can also result from consumption of tissue cysts in undercooked meat, such as pork or lamb. Congenital transmission poses an immense financial burden, costing Canada an estimated $240 million annually. Also of concern is toxoplasmosis in AIDS patients, which may lead to toxoplasmosis encephalitis, the second most common AIDS-related opportunistic infection of the central nervous system. Exotic parasites (ie, those acquired from abroad or from imported food are of growing concern because more Canadians are travelling and the number of Canada?s trading partners is increasing. Since 1996, over 3000 cases of Cyclospora infection reported in the United States and Canada were epidemiologically associated with importation of Guatemalan raspberries. Unlike toxoplasmosis, where strategies for control largely rest with individual practices, control of cyclosporiasis rests with government policy, which should prohibit the importation of foods at high risk.

  5. The marginalisation of dreams in clinical psychological practice.

    Science.gov (United States)

    Leonard, Linda; Dawson, Drew

    2018-04-22

    The longstanding human interest in dreams has led to a significant body of psychological and philosophical discourse, including research. Recently, however, dreams have been relegated to the periphery of clinical psychological practice. This is potentially problematic as clients continue to bring dreams to therapy and many psychologists lack the confidence or competence to respond effectively to dream material. Building on the structural, professional and research cultures surrounding psychology using a cultural-historical activity theory framework, we argue the marginalisation of dreams is due to cultural-historical factors. These factors include the political and economic context in which psychology developed; psychology's early attempts to differentiate from psychoanalysis by identifying with behaviourism and the natural sciences; and a discipline-specific definition of what constitutes evidence-based practice. These factors led to professional discourses within which dreams are seen as of little clinical or therapeutic value, or that dream work is only for long-term therapy and requires extensive therapist training. However, there are diverse models of dream work consistent with most theoretical orientations within contemporary psychological practice. We conclude with recommendations on how to rebuild clinical confidence and competence in the use of dream material within the current professional environment. Copyright © 2018 Elsevier Ltd. All rights reserved.

  6. Korean Clinical Practice Guidelines for Aneurysmal Subarachnoid Hemorrhage

    Science.gov (United States)

    Cho, Won-Sang; Park, Sukh Que; Ko, Jun Kyeung; Kim, Dae-Won; Park, Jung Cheol; Yeon, Je Young; Chung, Seung Young; Chung, Joonho; Joo, Sung-Pil; Hwang, Gyojun; Kim, Deog Young; Chang, Won Hyuk; Choi, Kyu-Sun; Lee, Sung Ho; Sheen, Seung Hun; Kang, Hyun-Seung; Kim, Byung Moon; Bae, Hee-Joon; Oh, Chang Wan; Park, Hyeon Seon

    2018-01-01

    Despite advancements in treating ruptured cerebral aneurysms, an aneurysmal subarachnoid hemorrhage (aSAH) is still a grave cerebrovascular disease associated with a high rate of morbidity and mortality. Based on the literature published to date, worldwide academic and governmental committees have developed clinical practice guidelines (CPGs) to propose standards for disease management in order to achieve the best treatment outcomes for aSAHs. In 2013, the Korean Society of Cerebrovascular Surgeons issued a Korean version of the CPGs for aSAHs. The group researched all articles and major foreign CPGs published in English until December 2015 using several search engines. Based on these articles, levels of evidence and grades of recommendations were determined by our society as well as by other related Quality Control Committees from neurointervention, neurology and rehabilitation medicine. The Korean version of the CPGs for aSAHs includes risk factors, diagnosis, initial management, medical and surgical management to prevent rebleeding, management of delayed cerebral ischemia and vasospasm, treatment of hydrocephalus, treatment of medical complications and early rehabilitation. The CPGs are not the absolute standard but are the present reference as the evidence is still incomplete, each environment of clinical practice is different, and there is a high probability of variation in the current recommendations. The CPGs will be useful in the fields of clinical practice and research. PMID:29526058

  7. Accounting for Medication Particularities: Designing for Everyday Medication Management

    DEFF Research Database (Denmark)

    Dalgaard, Lea Gulstav; Grönvall, Erik; Verdezoto, Nervo

    2013-01-01

    Several projects have shown that self-management of medication in private homes can be challenging. Many projects focused on specific illness-related approaches (e.g. diabetes) or practical issues such as how to handle medication while travelling. However, designing for everyday medication manage....... These medication particularities can enhance the individual’s medication overview and support the understanding of medication intake in everyday life. The study also presents five design principles for future design of PHMMS....

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

    Science.gov (United States)

    Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

    2015-01-01

    Background: Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students’ experiences of peer learning in clinical practice. Materials and Methods: A qualitative content analysis was conducted. Focus groups were used to find the students’ experiences about peerlearning. Twenty-eight baccalaureate nursing students at Bushehr University of Medical Sciences were selected purposively, and were arranged in four groups of seven students each. The focus group interviews were conducted using a semi-structured interview schedule. All interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis method. Results: The analysis identified four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice. Gained advantages and perceived disadvantages created paradoxical dualism, and peer exploitation resulted from peer selection and peer training. Conclusion: Nursing students reported general satisfaction concerning peer learning due to much more in-depth learning with little stress than conventional learning methods. Peer learning is a useful method for nursing students for practicing educational leadership and learning the clinical skills before they get a job. PMID:26097860

  9. Phronesis: practical wisdom the role of professional practice knowledge in the clinical reasoning of Bobath instructors.

    Science.gov (United States)

    Vaughan-Graham, Julie; Cott, Cheryl

    2017-10-01

    Clinical reasoning is an essential aspect of clinical practice, however is largely ignored in the current rehabilitation sciences evidence base. Literature related to clinical reasoning and clinical expertise has evolved concurrently although rehabilitation reasoning frameworks remain relatively generic. The purpose of this study was to explicate the clinical reasoning process of Bobath instructors of a widely used neuro-rehabilitation approach, the Bobath concept. A qualitative interpretive description approach consisting of stimulated recall using video-recorded treatment sessions and in-depth interviews. Purposive sampling was used to recruit members of the International Bobath Instructors Training Association (IBITA). Interview transcripts were transcribed verbatim providing the raw data. Data analysis was progressive, iterative, and inductive. Twenty-two IBITA instructors from 7 different countries participated. Ranging in clinical experience from 12 to 40 years, and instructor experience from 1 to 35 years. Three themes were developed, (a) a Bobath clinical framework, (b) person-centered, and (c) a Bobath reasoning approach, highlighting the role of practical wisdom, phronesis in the clinical reasoning process. In particular the role of visuospatial-kinesthetic perception, an element of technical expertise, was illuminated as an integral aspect of clinical reasoning in this expert group. This study provides an interpretive understanding of the clinical reasoning process used by IBITA instructors illustrating an inactive embodied view of clinical reasoning, specifically the role of phronesis, requiring further investigation in nonexpert Bobath therapists, as well as in novice and experienced therapists in other specialty areas. © 2016 John Wiley & Sons, Ltd.

  10. Smartphones and hyper everyday life

    Directory of Open Access Journals (Sweden)

    Bernardo Amigo

    2016-07-01

    Full Text Available In this paper we present some results from our research on technological media convergence and everyday life. The results suggest that new changes would be happening on the space-temporal dimension of daily experience on people and in the way in which those give stability, structure and meaning to the intersubjective world, as a consequence of uses, appropriations and meanings about smartphones. We propose the concept of enriched everyday life or hyper everyday life in order to explain what we consider one of the principal transformations in daily life to people in the contemporary world related to the incorporation of smartphones.

  11. Walking the Everyday

    Directory of Open Access Journals (Sweden)

    Matthew Bissen

    2014-11-01

    Full Text Available Since 2010, @matthewalking (Bissen, 2013 has published real-time public texts of walks in the city. This text-based Twitter feed has developed a narrative of a particular everyday life and developed a space of interface with others that represents a centering of perspective within an urban landscape. Walking the city provides a spatial, tactile, social, and embodied knowledge of the environment as each of us emerges into a space, orients ourselves, and determines a path that is highly localized, but is in connection with distant spaces and cultures. According to Ben Jacks in “Walking the City: Manhattan Projects,” “for urban dwellers and designers, walking is a fundamental tool for laying claim to, understanding, and shaping a livable city. Walking yields bodily knowing, recovers place memory, creates narrative, prioritizes human scale, and reconnects people to places” (75. @matthewalking’s walks, at times for as long as 5 hours, attempt to center an experience of an urban existence in a spatial narrative of the city that at once prioritizes a connection to place, but also is projected outward into a mediated relationship with others. The project is a series of unbounded walks, or dérives (drift, through the city that are logged on Twitter and traced to create an archive map of a set of particular urban experiences. The dérive concept as outlined in “The Theory of the Dérive,” by Guy Debord is when “one or more persons during a certain period drop their relations, their work and leisure activities, and all their other usual motives for movement and action, and let themselves be drawn by the attractions of the terrain and the encounters they find there” (62.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    Clinical researchers have attempted many methods to translate scientific evidence into routine clinical practice, with varying success. Practice-based research networks (PBRNs) provide an important, practitioner-friendly venue to test these methods. Dentist practitioner-investigators from...... the Dental Practice-Based Research Network (DPBRN) completed a detailed questionnaire about how they diagnose and treat dental caries. Next, they received a customized report that compared their answers to those from all other practitioner-investigators. Then, 126 of them attended the DPBRN's first network......-wide meeting of practitioner-investigators from all five of its regions. During that meeting, certain questions were repeated and new ones were asked about the dentist's intention to change the way that he or she diagnosed or treated dental caries. Less than one-third of practitioner-investigators intended...

  13. SELF WOUND MANAGEMENT PRACTICES BEFORE ATTENDING ANTIRABIES VACCINE CLINIC

    Directory of Open Access Journals (Sweden)

    Amit Kumar Mishra, Smita Panda, Prakash Chandra Panda

    2015-07-01

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

  14. Bimodal Programming: A Survey of Current Clinical Practice.

    Science.gov (United States)

    Siburt, Hannah W; Holmes, Alice E

    2015-06-01

    The purpose of this study was to determine the current clinical practice in approaches to bimodal programming in the United States. To be specific, if clinicians are recommending bimodal stimulation, who programs the hearing aid in the bimodal condition, and what method is used for programming the hearing aid? An 11-question online survey was created and sent via email to a comprehensive list of cochlear implant programming centers in the United States. The survey was sent to 360 recipients. Respondents in this study represented a diverse group of clinical settings (response rate: 26%). Results indicate little agreement about who programs the hearing aids, when they are programmed, and how they are programmed in the bimodal condition. Analysis of small versus large implant centers indicated small centers are less likely to add a device to the contralateral ear. Although a growing number of cochlear implant recipients choose to wear a hearing aid on the contralateral ear, there is inconsistency in the current clinical approach to bimodal programming. These survey results provide evidence of large variability in the current bimodal programming practices and indicate a need for more structured clinical recommendations and programming approaches.

  15. Evidence-based clinical practice guidelines for chronic pancreatitis 2015.

    Science.gov (United States)

    Ito, Tetsuhide; Ishiguro, Hiroshi; Ohara, Hirotaka; Kamisawa, Terumi; Sakagami, Junichi; Sata, Naohiro; Takeyama, Yoshifumi; Hirota, Morihisa; Miyakawa, Hiroyuki; Igarashi, Hisato; Lee, Lingaku; Fujiyama, Takashi; Hijioka, Masayuki; Ueda, Keijiro; Tachibana, Yuichi; Sogame, Yoshio; Yasuda, Hiroaki; Kato, Ryusuke; Kataoka, Keisho; Shiratori, Keiko; Sugiyama, Masanori; Okazaki, Kazuichi; Kawa, Shigeyuki; Tando, Yusuke; Kinoshita, Yoshikazu; Watanabe, Mamoru; Shimosegawa, Tooru

    2016-02-01

    Chronic pancreatitis is considered to be an irreversible progressive chronic inflammatory disease. The etiology and pathology of chronic pancreatitis are complex; therefore, it is important to correctly understand the stage and pathology and provide appropriate treatment accordingly. The newly revised Clinical Practice Guidelines of Chronic Pancreatitis 2015 consist of four chapters, i.e., diagnosis, staging, treatment, and prognosis, and includes a total of 65 clinical questions. These guidelines have aimed at providing certain directions and clinically practical contents for the management of chronic pancreatitis, preferentially adopting clinically useful articles. These revised guidelines also refer to early chronic pancreatitis based on the Criteria for the Diagnosis of Chronic Pancreatitis 2009. They include such items as health insurance coverage of high-titer lipase preparations and extracorporeal shock wave lithotripsy, new antidiabetic drugs, and the definition of and treatment approach to pancreatic pseudocyst. The accuracy of these guidelines has been improved by examining and adopting new evidence obtained after the publication of the first edition.

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

    Science.gov (United States)

    Bender, Miriam

    2016-01-01

    Numerous policy bodies have identified the clinical nurse leader (CNL) as an innovative new role for meeting higher health care quality standards. Although there is growing evidence of improved care environment and patient safety and quality outcomes after redesigning care delivery microsystems to integrate CNL practice, significant variation in CNL implementation has been noted across reports, making it difficult to causally link CNL practice to reported outcomes. This variability reflects the overall absence in the literature of a well-defined CNL theoretical framework to help guide standardized application in practice. To address this knowledge gap, an interpretive synthesis with a grounded theory analysis of CNL narratives was conducted to develop a theoretical model for CNL practice. The model clarifies CNL practice domains and proposes mechanisms by which CNL-integrated care delivery microsystems improve health care quality. The model highlights the need for a systematic approach to CNL implementation including a well-thought out strategy for care delivery redesign; a consistent, competency-based CNL workflow; and sustained macro-to-micro system leadership support. CNL practice can be considered an effective approach to organizing nursing care that maximizes the scope of nursing to influence the ways care is delivered by all professions within a clinical microsystem. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Using Relational Reasoning Strategies to Help Improve Clinical Reasoning Practice.

    Science.gov (United States)

    Dumas, Denis; Torre, Dario M; Durning, Steven J

    2018-05-01

    Clinical reasoning-the steps up to and including establishing a diagnosis and/or therapy-is a fundamentally important mental process for physicians. Unfortunately, mounting evidence suggests that errors in clinical reasoning lead to substantial problems for medical professionals and patients alike, including suboptimal care, malpractice claims, and rising health care costs. For this reason, cognitive strategies by which clinical reasoning may be improved-and that many expert clinicians are already using-are highly relevant for all medical professionals, educators, and learners.In this Perspective, the authors introduce one group of cognitive strategies-termed relational reasoning strategies-that have been empirically shown, through limited educational and psychological research, to improve the accuracy of learners' reasoning both within and outside of the medical disciplines. The authors contend that relational reasoning strategies may help clinicians to be metacognitive about their own clinical reasoning; such strategies may also be particularly well suited for explicitly organizing clinical reasoning instruction for learners. Because the particular curricular efforts that may improve the relational reasoning of medical students are not known at this point, the authors describe the nature of previous research on relational reasoning strategies to encourage the future design, implementation, and evaluation of instructional interventions for relational reasoning within the medical education literature. The authors also call for continued research on using relational reasoning strategies and their role in clinical practice and medical education, with the long-term goal of improving diagnostic accuracy.

  18. Multidisciplinary Treatment for Adults with Autism Spectrum Disorder and Co-Occurring Mental Health Disorders: Adapting Clinical Research Tools to Everyday Clinical Practice

    Science.gov (United States)

    Battaglia, Maurizio; Detrick, Susan; Fernandez, Anna

    2016-01-01

    In California, individuals with autism and co-occurring mental disorders, and their families, face two serious barriers when attempting to access the mental health services they need. The first is that the State Mental Health Specialty Service guidelines specifically exclude autism as a qualifying primary diagnosis for eligibility for mental…

  19. School Everyday Life in Images

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Ferraço

    2017-04-01

    Full Text Available This article aims at questioning school everyday life in images, based on intercessors and concepts from Deleuze and Guattari’s Philosophy of Difference. It is based on data-image-graffiti produced during investigations developed by us with public schools’ everyday life in the city of Vitória, ES, Brazil. The text claims that, in order to speak about school everyday life in images to favor the sudden, the production of meaning and the multiplicity of knowledge, it is necessary to invest in another research attitude - one that considers chaos, chance and permanent openness and complexity of school everyday life as forces to constitute an immanence plane and create concepts. The article affirms the idea of impossibility of choosing images that would be considered the most representative to speak about events in the schools.

  20. Through the eyes of the student: Best practices in clinical facilitation

    Directory of Open Access Journals (Sweden)

    Immaculate S. Muthathi

    2017-08-01

    Conclusion: There is a need for all nurses involved in undergraduate nursing education to reflect on how they approach clinical facilitation, in both clinical skills laboratory and clinical learning environment. There is also a need to improve consistency in clinical practices between the nursing education institution and the clinical learning environment so as to support students’ adaptation to clinical practice.

  1. Roles of Cognitive Status and Intelligibility in Everyday Communication in People with Parkinson's Disease: A Systematic Review.

    Science.gov (United States)

    Barnish, Maxwell S; Whibley, Daniel; Horton, Simon M C; Butterfint, Zoe R; Deane, Katherine H O

    2016-03-16

    Communication is fundamental to human interaction and the development and maintenance of human relationships and is frequently affected in Parkinson's disease (PD). However, research and clinical practice have both tended to focus on impairment rather than participation aspects of communicative deficit in PD. In contrast, people with PD have reported that it is these participation aspects of communication that are of greatest concern to them rather than physical speech impairment. To systematically review the existing body of evidence regarding the association between cognitive status and/or intelligibility and everyday communication in PD. Five online databases were systematically searched in May 2015 (Medline Ovid, EMBASE, AMED, PsycINFO and CINAHL) and supplementary searches were also conducted. Two reviewers independently evaluated retrieved records for inclusion and then performed data extraction and quality assessment using standardised forms. Articles were eligible for inclusion if they were English-language original peer-reviewed research articles, book chapters or doctoral theses investigating the associations between at least one of cognitive status and level of intelligibility impairment and an everyday communication outcome in human participants with PD. 4816 unique records were identified through database searches with 16 additional records identified through supplementary searches. 41 articles were suitable for full-text screening and 15 articles (12 studies) met the eligibility criteria. 10 studies assessed the role of cognitive status and 9 found that participants with greater cognitive impairment had greater everyday communication difficulties. 4 studies assessed the role of intelligibility and all found that participants with greater intelligibility impairment had greater everyday communication difficulties, although effects were often weak and not consistent. Both cognitive status and intelligibility may be associated with everyday communicative

  2. Provision and practice of specialist preterm labour clinics: a UK survey of practice.

    Science.gov (United States)

    Sharp, A N; Alfirevic, Z

    2014-03-01

    To identify the current status of specialist preterm labour (PTL) clinic provision and management within the UK. Postal survey of clinical practice. All consultant-led obstetric units within the UK. A questionnaire was sent by post to all 210 NHS consultant-led obstetric units within the UK. Units that had a specialist PTL clinic were asked to complete a further 20 questions defining their protocol for risk stratification and management. Current practice in specialist preterm labour clinics. We have identified 23 specialist clinics; the most common indications for attendance were previous PTL (100%), preterm prelabour rupture of membranes (95%), two large loop excisions of the transformation zone (95%) or cone biopsy (95%). There was significant heterogeneity in the indications for and method of primary treatment for short cervix, with cervical cerclage used in 45% of units, progesterone in 18% of units and Arabin cervical pessary in 5%. A further 23% used multiple treatment modalities in combination. A significant heterogeneity in all topics surveyed suggests an urgent need for networking, more evidence-based guidelines and prospective comparative audits to ascertain the real impact of specialist PTL clinics on the reduction in preterm birth and its sequelae. © 2013 Royal College of Obstetricians and Gynaecologists.

  3. Value and limitations of clinical practice guidelines in neonatology.

    Science.gov (United States)

    Polin, Richard A; Lorenz, John M

    2015-12-01

    Given the overwhelming size of the neonatal literature, clinicians must rely upon expert panels such as the Committee on Fetus and Newborn in the USA and the National Institute for Healthcare and Excellence in the UK for guidance. Guidelines developed by expert panels are not equivalent to evidence-based medicine and are not rules, but do provide evidence-based recommendations (when possible) and at minimum expert consensus reports. The standards used to develop evidence-based guidelines differ among expert panels. Clinicians must be able judge the quality of evidence from an expert panel, and decide whether a recommendation applies to their neonatal intensive care unit or infant under their care. Furthermore, guidelines become outdated within a few years and must be revised or discarded. Clinical practice guidelines should not always be equated with standard of care. However, they do provide a framework for determining acceptable care. Clinicians do not need to follow guidelines if the recommendations are not applicable to their population or infant. However, if a plan of care is not consistent with apparently applicable clinical practice guidelines, the medical record should include an explanation for the deviation from the relevant practice guideline. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

    2007-11-19

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

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

    Directory of Open Access Journals (Sweden)

    Travison Thomas G

    2007-11-01

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

  6. Integrative Mental Health (IMH): paradigm, research, and clinical practice.

    Science.gov (United States)

    Lake, James; Helgason, Chanel; Sarris, Jerome

    2012-01-01

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

  7. Translation of oral care practice guidelines into clinical practice by intensive care unit nurses.

    Science.gov (United States)

    Ganz, Freda DeKeyser; Ofra, Raanan; Khalaila, Rabia; Levy, Hadassa; Arad, Dana; Kolpak, Orly; Ben Nun, Maureen; Drori, Yardena; Benbenishty, Julie

    2013-12-01

    found to be significant with the time of participation (2004-2005 vs. 2012) and priority level of oral care significantly contributing to the regression model. The national effort was partially successful in improving evidence-based oral care practices; however, increased awareness to EBP also might have come from other sources. Other strategies related to knowledge translation need to be attempted and researched in this clinical setting such as the use of opinion leaders, audits and feedback, small group consensus, provider reminder systems, incentives, clinical information systems, and computer decision support systems. This national effort to improve EBP did reap some rewards; however, other knowledge translation strategies should be used to further improve clinical practice. © 2013 Sigma Theta Tau International.

  8. Bridging between basic medical science and clinical practice

    Directory of Open Access Journals (Sweden)

    Bakir Mehić

    2012-02-01

    Full Text Available Translating the extraordinary scientific and technological advances from the biomedical research laboratory into actual patient care practices and other processes aimed at promoting health has been a major challenge, particularly for patients in community settings. Because of that the increased participation of clinicians from primary health care in clinical research would have a number of benefits. As experts in the delivery of clinical care in one society, they have much to contribute providing health care for patients in the whole spectrum of illnesses1. They are among the first to recognize changes in patients’ which come us as result of disease and conditions associated with demographic shiftings. Very often these are unexpected events such as trauma, natural disasters, pandemic infections, etc. They are also directly in contact with the policy-related matters (e.g., health consequences associated with increase in price of medications or the clinical consequences of war, such as the rapid increase in the number of individuals with prosthetic limbs and post traumatic stress syndrome2. Finally, participation in clinical research would benefit clinicians from primary health care in more ways, such as: contributing the mission of medicine and improving the scientific basis for medical practice; allowing clinicians to stay with new innovations ie. the development up to-date of information systems to improve data-gathering associated with the research3.A major goal is the development of teams of investigators from various research disciplines, is to turm the scientific discoveries from the laboratories into treatments and strategies for patients in communities. However, even with that introduction only a small part of the community will provide participation in clinical research. The barriers for this in USA recognised from clinicians community and showed in down table4.

  9. Challenges of implementing fibromyalgia treatment guidelines in current clinical practice.

    Science.gov (United States)

    Arnold, Lesley M; Clauw, Daniel J

    2017-09-01

    The current diagnostic and treatment pathway for patients with fibromyalgia (FM) is lengthy, complex, and characterized by multiple physician visits with an average 2-year wait until diagnosis. It is clear that effective identification and appropriate treatment of FM remain a challenge in current clinical practice. Ideally, FM management involves a multidisciplinary approach with the preferable patient pathway originating in primary care but supported by a range of health care providers, including referral to specialist care when necessary. After the publication of individual clinical studies, high-quality reviews, and meta-analyses, recently published FM treatment guidelines have transitioned from an expert consensus to an evidence-based approach. Evidence-based guidelines provide a framework for ensuring early diagnosis and timely adoption of appropriate treatment. However, for successful outcomes, FM treatments must adopt a more holistic approach, which addresses more than just pain. Impact on the associated symptoms of fatigue and cognitive problems, sleep and mood disturbances, and lowered functional status are also important in judging the success of FM therapy. Recently published guidelines recommend the adoption of a symptom-based approach to guide pharmacologic treatment. Emerging treatment options for FM may be best differentiated on the basis of their effect on comorbid symptoms that are often associated with pain (e.g. sleep disturbance, mood, fatigue). The current review discusses the most recently published Canadian guidelines and the implications of the recent European League Against Rheumatism (EULAR) recommendations, with a focus on the challenges of implementing these guidelines in current clinical practice.

  10. Isotonic saline nasal irrigation in clinical practice: a literature review

    Directory of Open Access Journals (Sweden)

    Sabrina Costa Lima

    Full Text Available Abstract Introduction: Nasal instillation of saline solution has been used as part of the treatment of patients with upper respiratory tract diseases. Despite its use for a number of years, factors such as the amount of saline solution to be used, degree of salinity, method and frequency of application have yet to be fully explained. Objective: Review the reported outcomes of saline nasal irrigation in adults with allergic rhinitis, acute or chronic sinusitis and after functional endoscopic sinus surgery (FESS, and provide evidence to assist physiotherapists in decision making in clinical practice. Methods: A search was conducted of the Pubmed and Cochrane Library databases between 2007 and 2014. A combination of the following descriptors was used as a search strategy: nasal irrigation, nasal lavage, rhinitis, sinusitis, saline, saline solution. Results: Eight clinical trials were included, analyzed according to participant diagnosis. Conclusion: The evidence found was heterogeneous, but contributed to elucidating uncertainties regarding the use of nasal lavage in the clinical practice of physical therapy, such as the protocols used.

  11. Clinical ethics and values: how do norms evolve from practice?

    Science.gov (United States)

    Spranzi, Marta

    2013-02-01

    Bioethics laws in France have just undergone a revision process. The bioethics debate is often cast in terms of ethical principles and norms resisting emerging social and technological practices. This leads to the expression of confrontational attitudes based on widely differing interpretations of the same principles and values, and ultimately results in a deadlock. In this paper I would like to argue that focusing on values, as opposed to norms and principles, provides an interesting perspective on the evolution of norms. As Joseph Raz has convincingly argued, "life-building" values and practices are closely intertwined. Precisely because values have a more indeterminate meaning than norms, they can be cited as reasons for action by concerned stakeholders, and thus can help us understand how controversial practices, e.g. surrogate motherhood, can be justified. Finally, norms evolve when the interpretations of the relevant values shift and cause a change in the presumptions implicit in the norms. Thus, norms are not a prerequisite of the ethical solution of practical dilemmas, but rather the outcome of the decision-making process itself. Struggling to reach the right decision in controversial clinical ethics situations indirectly causes social and moral values to change and principles to be understood differently.

  12. Patient engagement in clinical trials: The Clinical Trials Transformation Initiative's leadership from theory to practical implementation.

    Science.gov (United States)

    Patrick-Lake, Bray

    2018-02-01

    Patient engagement is an increasingly important aspect of successful clinical trials. Over the past decade, as patient group involvement in clinical trials has continued to increase and diversify, the Clinical Trials Transformation Initiative has not only recognized the crucial role patients play in improving the clinical trial enterprise but also made a deep commitment to help grow and shape the emerging field of patient engagement. This article describes the evolution of patient engagement including the origins of the patient engagement movement; barriers to successful engagement and remaining challenges to full and valuable collaboration between patient groups and trial sponsors; and Clinical Trials Transformation Initiative's role in influencing the field through organizational practices, formal project work and resulting recommendations, and external advocacy efforts.

  13. Priority setting in clinical nursing practice: literature review.

    Science.gov (United States)

    Hendry, Charles; Walker, Anne

    2004-08-01

    Time is a valuable resource. When nurses experience demands on their services which exceed their available time, then 'rationing' must occur. In clinical practice such rationing requires practitioners to set priorities for care. The aim of this paper is establish what is currently known about priority setting in nursing, including how nurses set priorities and what factors influence this. CINAHL, Medline, ASSIA, and PsychLit databases for the years 1982-2002 were searched, using the terms (clinical decision-making or problem-solving or planning) and (setting priorities or prioriti*). The publications found were used in a selective, descriptive review. Priority setting is an important skill in nursing, and a skill deficit can have serious consequences for patients. Recent studies have suggested that it is a difficult skill for newly qualified nurses to acquire and may not be given sufficient attention in nurse education. Priority setting can be defined as the ordering of nursing problems using notions of urgency and/or importance, in order to establish a preferential order for nursing actions. A number of factors that may impact on priority setting have been identified in the literature. These include: the expertise of the nurse; the patient's condition; the availability of resources; ward organization; philosophies and models of care; the nurse-patient relationship; and the cognitive strategy used by the nurse to set priorities. However, very little empirical work has been conducted in this area. Further study of priority setting in a range of clinical practice settings is necessary. This could inform both practice and education, promote better use of limited resources and maximize patient outcomes.

  14. Usefulness of Cochrane Skin Group reviews for clinical practice.

    Science.gov (United States)

    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.

  15. Rufinamide from clinical trials to clinical practice in the United States and Europe.

    Science.gov (United States)

    Resnick, Trevor; Arzimanoglou, Alexis; Brown, Lawrence W; Flamini, Robert; Kerr, Michael; Kluger, Gerhard; Kothare, Sanjeev; Philip, Sunny; Harrison, Miranda; Narurkar, Milind

    2011-05-01

    Rufinamide is a triazole derivative structurally unrelated to other antiepileptic drugs that is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients aged ≥4 years. Originally granted orphan drug status, marketing authorisation was obtained on the basis of a randomised, double-blind, placebo-controlled trial conducted in 138 LGS patients. An open-label extension study subsequently demonstrated that rufinamide's efficacy and tolerability were maintained over the longer term (median duration of treatment, 432 days). Recently published reports from Europe and the United States have described the use of adjunctive rufinamide to treat LGS in clinical practice. These data complement the clinical trial results, by providing information on the efficacy and tolerability of rufinamide when used on an individualised basis in real-world practice, under less tightly restricted conditions in terms of patient population and dosing strategies. A comparison of the data reveals that a "lower and slower" dosing strategy tends to be adopted in clinical practice, in comparison with the clinical trial, which does not appear to compromise efficacy, but may provide improvements in tolerability. Individual case reports provide additional valuable information on how rufinamide is being used to treat different seizure types associated with LGS. Since clinical experience with rufinamide is currently at an early stage, there are still unanswered questions relating to its use, and it is likely that its place in the adjunctive treatment of LGS will evolve as further data emerge.

  16. [Identifying indicators of good practice in clinical and healthcare management].

    Science.gov (United States)

    Bermúdez Tamayo, C; Olry de Labry Lima, A; García Mochón, L

    2018-03-06

    To identify good practices in order to develop and implement indicators of health outcomes for clinical and healthcare management, as well as the characteristics for an indicator to be considered adequate. A scoping review was performed, with the following phases: 1) Search and identification of bibliography. 2) Selection of relevant documents. Including those studies that discussed issues related to good practices for the use of health indicators in the management field. Those published in a language other than English or Spanish or before 2006 were excluded. 3) Analysis and extraction of information. 4) Consultation with stakeholders, using a qualitative methodology through Concept Mapping, with the participation of 40 experts (decision-makers, scientific societies, and health professionals). The data collection process included an inductive and structured procedure, with prioritisation of ideas grouped into clusters, according to feasibility and importance criteria (0-10 scale). Good practices identified 2 levels: 1) macro-management: Define a framework for the evaluation of indicators and establish a benchmark of indicators. 2) meso-management: Establish indicators according to evidence and expert consensus, taking into account priority areas and topics, testing before final use, and communicate results adequately. The characteristics of a suitable indicator are: 1) Approach of an important issue, 2) Scientific validity, 3) Possibility of measurement with reliable data, 4) Meaning of useful and applicable measurement, and 5) Wide scope. The best practices for the use of indicators in clinical and healthcare management can make it easier to monitor performance and accountability, as well as to support the decision-making addressed at the development of initiatives for quality improvement. Copyright © 2018 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Teleradiology in clinical practices and teaching of pediatric radiology

    International Nuclear Information System (INIS)

    O'Connor, J.F.

    1987-01-01

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

  18. [Clinical ethics consultation - an integrative model for practice and reflection].

    Science.gov (United States)

    Reiter-Theil, Stella

    2008-07-01

    Broad evidence exists that health care professionals are facing ethical difficulties in patient care demanding a spectrum of useful ethics support services. Clinical ethics consultation is one of these forms of ethics support being effective in the acute setting. An authentic case is presented as an illustration. We introduce an integrative model covering the activities being characteristic for ethics consultation and going beyond "school"-specific approaches. Finally, we formulate some do's and don'ts of ethics consultation that are considered to be key issues for successful practice.

  19. Grounded theory for radiotherapy practitioners: Informing clinical practice

    International Nuclear Information System (INIS)

    Walsh, N.A.

    2010-01-01

    Radiotherapy practitioners may be best placed to undertake qualitative research within the context of cancer, due to specialist knowledge of radiation treatment and sensitivity to radiotherapy patient's needs. The grounded theory approach to data collection and analysis is a unique method of identifying a theory directly based on data collected within a clinical context. Research for radiotherapy practitioners is integral to role expansion within the government's directive for evidence-based practice. Due to the paucity of information on qualitative research undertaken by radiotherapy radiographers, this article aims to assess the potential impact of qualitative research on radiotherapy patient and service outcomes.

  20. Aeroionic Diagnosis of Nutritional Disorders in the Clinical Practice

    Directory of Open Access Journals (Sweden)

    Yu.I. Reshetilov

    2016-08-01

    Full Text Available The article presents the results of a study of air ions in the exhaled air in 310 patients with combined patho­logy of the digestive system. The data are presented on the new non-invasive method of diagnosis and individualization of a comprehensive treatment of patients, in particular diet therapy. There is substantiated the selection of food in accordance with the basic electrochemical characteristics. The prospects of ­using the method of aeroionic testing in the clinical practice as a technology for primary screening and non-invasive monitoring of treatment outcomes were evaluated.

  1. Routine pharmacogenetic testing in clinical practice: dream or reality?

    Science.gov (United States)

    Grossman, Iris

    2007-10-01

    Pharmacogenetics (PGx) has become progressively popular in recent years, thanks to growing anticipation among scientists, healthcare providers and the general public for the incorporation of genetic tests into the diagnostic arsenal at the physician's disposal. Indeed, much research has been dedicated to elucidation of genetic determinants underlying interindividual variability in pharmacokinetic parameters, as well as drug safety and efficacy. However, few PGx applications have thus far been realized in healthcare management. This review uses examples from PGx research of psychiatric drugs to illustrate why the current published findings are inadequate and insufficient for utilization as routine clinical predictors of treatment safety, efficacy or dosing. I therefore suggest the necessary steps to demonstrate the validity, utility and cost-effectiveness of PGx. These recommendations include a whole range of aspects, starting from standardization of criteria and assessment of the technical quality of genotyping assays, up to design of prospective PGx studies, providing the basis for reimbursement programs to be recognized in routine clinical practice.

  2. The DSM and Professional Practice: Research, Clinical, and Institutional Perspectives.

    Science.gov (United States)

    Halpin, Michael

    2016-06-01

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

  3. Clinical Practice Guidelines for the Management of Atopic Dermatitis 2016.

    Science.gov (United States)

    Saeki, Hidehisa; Nakahara, Takeshi; Tanaka, Akio; Kabashima, Kenji; Sugaya, Makoto; Murota, Hiroyuki; Ebihara, Tamotsu; Kataoka, Yoko; Aihara, Michiko; Etoh, Takafumi; Katoh, Norito

    2016-10-01

    Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. Most patients have an atopic predisposition. The definitive diagnosis of AD requires the presence of all three features: (i) pruritus; (ii) typical morphology and distribution of the eczema; and (iii) chronic and chronically relapsing course. The current strategies to treat AD in Japan from the perspective of evidence-based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice. © 2016 Japanese Dermatological Association.

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

    DEFF Research Database (Denmark)

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

    2006-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  6. Middle East respiratory syndrome clinical practice guideline for hemodialysis facilities

    Directory of Open Access Journals (Sweden)

    Hayne Cho Park

    2017-06-01

    Full Text Available The Korean Society of Nephrology participated in the task force team consisting of government authorities and civilian experts to prevent and control the spread of Middle East respiratory syndrome (MERS in 2015. The Korean Society of Nephrology MERS Task Force Team took an immediate action and drafted ‘the clinical recommendation for hemodialysis facilities’ to follow when the first and the only confirmed case was reported in the hemodialysis unit. Owing to the dedicated support from medical doctors, dialysis nurses, and related medical companies, we could prevent further transmission of MERS infection successfully in hemodialysis units. This special report describes the experience of infection control during MERS outbreak in 2015 and summarizes the contents of ‘the clinical practice guideline for hemodialysis facilities dealing with MERS patients’ built upon our previous experience.

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

    Directory of Open Access Journals (Sweden)

    B S Porshinsky

    2011-01-01

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

  8. Utilization of the American Telemedicine Association's Clinical Practice Guidelines

    Science.gov (United States)

    Antoniotti, Nina; Bernard, Jordana

    2013-01-01

    Abstract Background: The American Telemedicine Association (ATA) Standards and Guidelines Committee develops practice standards and guidelines. Key to the Committee's mission is dissemination so the standards can be used in the practice of telemedicine. Over a 2-year period, when a standards document was accessed from the ATA Web site, a short survey was completed, but it did not assess how the documents were used once downloaded. A more formal survey was conducted to determine the impact ATA standards and guidelines are having on healthcare delivery via telemedicine. Materials and Methods: A survey was developed and distributed via SurveyMonkey to 13,177 ATA members and nonmembers in November 2011. Results were compiled and analyzed after a 90-day open period for responses to be submitted. Results: The majority of respondents (96%) believe the practice of telemedicine/telehealth should have standards and guidelines and that the ATA and other professional societies/associations should be responsible for developing them. The top uses of guidelines include guidance for clinical practice, training, gaining reimbursement, and research. Respondents indicating a need for standards and guidelines said the ATA (78.7%) and other professional societies/associations (74.5%) should be responsible for development. When asked to list specific practice guidelines or standards they are using for telehealth, the majority (21.5%) are using in-house (e.g., hospital, company)-developed guidelines, followed by those from professional associations/societies (20.4%) and those developed by the ATA (18.2%). Conclusions: Overall, the survey results indicate guidelines documents developed by the ATA and other professional societies and those developed in-house are being regularly accessed and used in both public and private sectors. Practitioners of telemedicine believe that standards and guidelines are needed for guidance for clinical practice, training, gaining reimbursement, and research

  9. Preparing medical students for clinical practice: easing the transition.

    Science.gov (United States)

    Teagle, Alexandra R; George, Maria; Gainsborough, Nicola; Haq, Inam; Okorie, Michael

    2017-08-01

    The transition from medical student to junior doctor is a challenge; the UK General Medical Council has issued guidance emphasizing the importance of adequate preparation of medical students for clinical practice. This study aimed to determine whether a junior doctor-led simulation-based course is an effective way of preparing final year medical students for practice as a junior doctor.We piloted a new 'preparation for practice' course for final year medical students prior to beginning as Foundation Year 1 (first year of practice) doctors. The course ran over three days and consisted of four simulated stations: ward round, prescribing, handover, and lessons learnt. Quantitative and qualitative feedback was obtained.A total of 120 students attended (40 on each day) and feedback was collected from 95 of them. Using a scale of 1 (lowest) to 5 (highest), feedback was positive, with 99% and 96% rating 4 or 5 for the overall quality of the program and the relevance of the program content, respectively. A score of 5 was awarded by 67% of students for the ward round station; 58% for the handover station; 71% for the prescribing station, and 35% for the lessons learnt station. Following the prescribing station, students reported increased confidence in their prescribing.Preparation for practice courses and simulation are an effective and enjoyable way of easing the transition from medical student to junior doctor. Together with 'on-the-job' shadowing time, such programs can be used to improve students' confidence, competence, and ultimately patient safety and quality of care.

  10. The uses of emotion maps in research and clinical practice with families and couples: methodological innovation and critical inquiry.

    Science.gov (United States)

    Gabb, Jacqui; Singh, Reenee

    2015-03-01

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

  11. Application of The APA Practice Guidelines on Suicide to Clinical Practice.

    Science.gov (United States)

    Jacobs, Douglas G; Brewer, Margaret L

    2006-06-01

    This article presents charts from The American Psychiatric Association Practice Guideline for the Assessment and Treatment of Patients with Suicidal Behaviors, part of the Practice Guidelines for the Treatment of Psychiatric Disorders Compendium, and a summary of the assessment information in a format that can be used in routine clinical practice. Four steps in the assessment process are presented: the use of a thorough psychiatric examination to obtain information about the patient's current presentation, history, diagnosis, and to recognize suicide risk factors therein; the necessity of asking very specific questions about suicidal ideation, intent, plans, and attempts; the process of making an estimation of the patient's level of suicide risk is explained; and the use of modifiable risk and protective factors as the basis for treatment planning is demonstrated. Case reports are used to clarify use of each step in this process.

  12. FCET2EC (From controlled experimental trial to = 2 everyday communication): How effective is intensive integrative therapy for stroke-induced chronic aphasia under routine clinical conditions? A study protocol for a randomized controlled trial.

    Science.gov (United States)

    Baumgaertner, Annette; Grewe, Tanja; Ziegler, Wolfram; Floel, Agnes; Springer, Luise; Martus, Peter; Breitenstein, Caterina

    2013-09-23

    Therapy guidelines recommend speech and language therapy (SLT) as the "gold standard" for aphasia treatment. Treatment intensity (i.e., ≥5 hours of SLT per week) is a key predictor of SLT outcome. The scientific evidence to support the efficacy of SLT is unsatisfactory to date given the lack of randomized controlled trials (RCT), particularly with respect to chronic aphasia (lasting for >6 months after initial stroke). This randomized waiting list-controlled multi-centre trial examines whether intensive integrative language therapy provided in routine in- and outpatient clinical settings is effective in improving everyday communication in chronic post-stroke aphasia. Participants are men and women aged 18 to 70 years, at least 6 months post an ischemic or haemorrhagic stroke resulting in persisting language impairment (i.e., chronic aphasia); 220 patients will be screened for participation, with the goal of including at least 126 patients during the 26-month recruitment period. Basic language production and comprehension abilities need to be preserved (as assessed by the Aachen Aphasia Test).Therapy consists of language-systematic and communicative-pragmatic exercises for at least 2 hours/day and at least 10 hours/week, plus at least 1 hour self-administered training per day, for at least three weeks. Contents of therapy are adapted to patients' individual impairment profiles.Prior to and immediately following the therapy/waiting period, patients' individual language abilities are assessed via primary and secondary outcome measures. The primary (blinded) outcome measure is the A-scale (informational content, or 'understandability', of the message) of the Amsterdam-Nijmegen Everyday Language Test (ANELT), a standardized measure of functional communication ability. Secondary (unblinded) outcome measures are language-systematic and communicative-pragmatic language screenings and questionnaires assessing life quality as viewed by the patient as well as a relative

  13. Young skateboarders their everyday

    Directory of Open Access Journals (Sweden)

    Marcelo Rampazzo

    2016-09-01

    Full Text Available In this research, we focus on young people and their daily lives, bringing elements discussing leisure, family, education and work. Research conducted with a group of young skaters in a public track skating in the city of Porto Alegre - RS. In a total nine months of direct observation, each reported in Field Diaries. We seek to understand how the leisure of young people who gave the practice of skateboarding, was related to other aspects of their daily lives. After completing the work, we consider that - to remain in practice the skateboard - young people needed to reconcile the charges of their families, in addition to labels and stereotypes imposed from "outside" the universe of practitioners of this sport. We noticed also that young people go through all this in order to keep their "projects" on the skateboard.

  14. Expanding the use of empiricism in nursing: can we bridge the gap between knowledge and clinical practice?

    Science.gov (United States)

    Giuliano, Karen K

    2003-04-01

    The philosophy of Aristotle and its impact on the process of empirical scientific inquiry has been substantial. The influence of the clarity and orderliness of his thinking, when applied to the acquisition of knowledge in nursing, can not be overstated. Traditional empirical approaches have and will continue to have an important influence on the development of nursing knowledge through nursing research. However, as nursing is primarily a practice discipline, the transition from empirical and syllogistic reasoning is problematic. Other types of inquiry are essential in the application of nursing knowledge obtained by empirical scientific approaches and to understand how that knowledge can best be used in the care of patients. This paper reviews the strengths and limitations of syllogistic reasoning by applying it to a recently published study on temperature measurement in nursing. It then discusses possible ways that the empirical knowledge gained from that study and confirmed in its reasoning by logical analysis could be used in the daily care of critically ill patients. It concludes by highlighting the utility of broader approaches to knowledge development, including interpretative approaches and contemporary empiricism, as a way to bridge the gap between factual empirical knowledge and the practical application of that knowledge in everyday clinical nursing practice.

  15. Management of advanced pancreatic cancer in daily clinical practice.

    Science.gov (United States)

    Giuliani, Jacopo; Piacentini, Paolo; Bonetti, Andrea

    2016-01-01

    The aim of this outcome study was to evaluate the management of advanced pancreatic cancer in a real-world clinical practice; few such experiences have been reported in the literature. A retrospective analysis was performed of all consecutive patients with advanced pancreatic ductal adenocarcinoma followed at our medical oncology unit between January 2003 and December 2013. We evaluated 78 patients, mostly with metastatic disease (64.1%). Median follow-up was 10.77 months, by which time 74 patients (94.9%) had died. Median overall survival was 8.29 months. Median age was 67 years. In univariate analysis, pain at onset (p = 0.020), ECOG performance status (p<0.001), stage (p = 0.047), first-line chemotherapy (p<0.001), second-line chemotherapy (p<0.001) and weight loss at diagnosis (p = 0.029) were factors that had an impact on overall survival. In multivariate analysis, the presence of pain at onset (p = 0.043), stage (p = 0.003) and second-line chemotherapy (p = 0.004) were confirmed as independent prognostic factors. Our data, derived from daily clinical practice, confirmed advanced pancreatic cancer as an aggressive malignant disease with a very short expected survival. Second-line treatment seems to provide an advantage in terms of overall survival in patients who showed a partial response as their best response to first-line treatment.

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

    LENUS (Irish Health Repository)

    Davenport, Colin

    2011-03-10

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

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

    LENUS (Irish Health Repository)

    Davenport, Colin

    2012-02-01

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

  18. [Adult congenital heart disease--between guidelines and clinical practice].

    Science.gov (United States)

    Chessa, Massimo

    2011-01-01

    Advances in medical and surgical management of congenital heart disease have changed the prognosis of infants and children with cardiac defects, so that an increasing number of patients reach adolescence and adult life, even those with complex defects. Recent data suggest that the number of adults with congenital heart disease, either repaired or not, approaches the number of children with the disorder. A cure is rarely achieved and ongoing surveillance and management in conjunction with specialists in this highly specialized field is mandatory to provide optimal care for patients. The profile of this patient population is going to change over the next few decades. Ideally specialist units should be established in appropriate geographic locations; patients need to be concentrated for expertise, experience, and optimal management. Less specialized regional centers and outpatient clinics in districts in connection with grown-up congenital heart disease units should be created. Specialist units should accept responsibility for educating the professionals, training the specialists, and sharing particular skills between each other. Guidelines and recommendations should help physicians to make decision in their daily practice. However, the final judgment regarding the care of an individual patient must be made by his/her physician. This article will briefly discuss some aspects of these dedicated guidelines and how they influence the clinical daily practice.

  19. Why to Integrate KM into everyday practices?

    International Nuclear Information System (INIS)

    Chavez Flores, A.T.

    2014-01-01

    Researchers have argued that one process to achieve a succesful KM initiative is the creation of a culture that values the transfer and creation of knowledge. Therefore, it’s neccesary for organizations to set up mechanisms by which new ideas may be shared in order to produce innovative changes

  20. Insights and their emergence in everyday practices

    DEFF Research Database (Denmark)

    Trasmundi, Sarah Bro; Linell, Per

    2017-01-01

    of sense-making, problem-solving and task performance in naturalistic contexts. Second, it presents a promising method for the analysis of cognitive activities, Cognitive Event Analysis (CEA), with which we investigate real-life medical interactions, especially the emergence of insights in procedural task......-cultural patterns of behaviour....

  1. Dietary education must fit into everyday life

    DEFF Research Database (Denmark)

    Folmann Hempler, Nana; Nicic, Sara; Ewers, Bettina

    2015-01-01

    explores perspectives on dietary diabetes education and healthy food choices of people living in Denmark who have a Pakistani background and type 2 diabetes. METHODS: In-depth interviews were conducted between October 2012 and December 2013 with 12 participants with type 2 diabetes who had received dietary...... that is sensitive to the attitudes, wishes, and preferences of the participants and that aims at establishing a connection to the everyday life of the participants might facilitate successful changes in dietary practices among people with a Pakistani background and type 2 diabetes. The findings suggest that more...

  2. Novel ethical dilemmas arising in geriatric clinical practice.

    Science.gov (United States)

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

    2015-05-01

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

  3. Measures of rheumatoid arthritis disease activity in Australian clinical practice.

    Science.gov (United States)

    Taylor, Andrew; Bagga, Hanish

    2011-01-01

    Objectives. To investigate which rheumatoid arthritis (RA) disease activity measures are being collected in patients receiving glucocorticoids, non-biologic or biologic disease-modifying antirheumatic drugs (DMARDs) in Australian rheumatology practice. Methods. A retrospective audit of medical records was conducted from eight rheumatology practices around Australia. Each rheumatologist recruited 30 consecutive eligible patients into the review, 10 of whom must have been receiving a biological agent for rheumatoid arthritis. Disease activity measures and radiographic assessments were collected from each patient's last consultation. For biologic patients, disease activity measures were also collected from when the patient was first initiated on the biological agent. Results. At last consultation, the disease measures that were recorded most often were ESR (89.2%), haemoglobin (87.5%), and CRP (84.2%). DAS28 was infrequently recorded (16.3%). The rate of recording disease activity measures for patients receiving biologic DMARDs decreased over time (mean 27 months). Conclusion. This review has shown inconsistency of RA activity measures being recorded in Australian rheumatology clinical practice. An accurate assessment of the disease process is necessary to effectively target rheumatoid arthritis patients to treat in order to achieve optimal outcomes.

  4. Assessment of Clinical Practices for Crushing Medication in Geriatric Units.

    Science.gov (United States)

    Fodil, M; Nghiem, D; Colas, M; Bourry, S; Poisson-Salomon, A-S; Rezigue, H; Trivalle, C

    2017-01-01

    To assess the modification of the form of medication and evaluate staff observance of good clinical practices. One-day assessment of clinical practices. 17 geriatrics units in the 3 Teaching Hospitals of Paris-Sud (APHP), France. Elderly in-patients with difficulties swallowing capsules and tablets. Assessment of target-patient prescriptions and direct observation of nurses' medical rounds. 155/526 in-patients (29.5%) were unable to swallow tablets or capsules: 98 (40.3%) in long-term care, 46 patients (23.8%) in the rehabilitation unit and 11 (12.2%) in the acute care unit (p = .005). In thirty-nine (27.3%) of the 143 prescriptions studied all tablets were safe to crush and all capsules were safe to open. In 104 cases, at least one medication could not be safely modified, including 26 cases (18.2%) in which none of the prescribed drugs were safe to crush or open. In 48.2% of the 110 medications that were crushed, crushing was forbidden, and presented a potential threat in 12.7% of cases or a reduced efficacy in 8.2% of cases. Crushing methods were rarely appropriate: no specific protective equipment was used (81.8%), crushing equipment was shared between patients without cleaning (95.1%), medications were spilled or lost (69.9%). The method of administration was appropriate (water, jellified water) in 25% of the cases, questionable (soup, coffee, compote, juice, cream) in 55% of the cases and unacceptable (laxative) in 21% of the cases. Management of drug prescriptions in patients with swallowing difficulties is not optimal, and may even have iatrogenic effects. In this study, 12.7% of the modifications of the drug form could have been harmful. Doctors, pharmacists and nurses need to reevaluate their practices.

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

    DEFF Research Database (Denmark)

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

    2000-01-01

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

  6. Qualitative Inquiry in Everyday Life

    DEFF Research Database (Denmark)

    Brinkmann, Svend

    This book is a 'survival guide' for students and researchers who would like to conduct a qualitative study with limited resources. Brinkmann shows how everyday life materials such as books, television, the internet, the media and everyday conversations and interactions can help us to understand...... larger social issues. As living human beings in cultural worlds, we are constantly surrounded by 'data' that call for analysis, and as we cope with the different situations and episodes of our lives, we are engaged in understanding and interpreting the world as a form of qualitative inquiry. The book...... helps its reader develop a disciplined and analytic awareness informed by theory, and shows how less can be more in qualitative research. Each chapter introduces theoretical tools to think with, and demonstrates how they can be put to use in working concretely with everyday life materials....

  7. Evaluation of gastric emptying function in clinical practice.

    Science.gov (United States)

    Poitras, P; Picard, M; Déry, R; Giguère, A; Picard, D; Morais, J; Plourde, V; Boivin, M

    1997-11-01

    In this retrospective analysis, we compared different methods to evaluate gastric emptying function, aiming to improve the sensitivity and the clinical availability of our diagnostic testing. In the first study, we compared, in 72 patients clinically suspected of gastroparesis, the emptying of a meal containing two solid nutrients with different disintegration rates: 111In-labeled scrambled eggs and 99Tc-labeled liver cubes. Gastric emptying of 111In-labeled egg was delayed in 12 of our patients and the evacuation of the 99Tc-labeled liver was prolonged in 19 patients. The choice of the nutrient was not important for the identification of diabetic gastroparesis (43% vs 57%; NS), but it was determinant in the case of patients suspected of idiopathic gastroparesis (12% were positive with the egg and 25% with the liver; P egg as a radiolabeled tracer in order to improve the sensitivity of the test for detection of gastroparesis; and (2) the radiological detection of radiopaque markers is a reliable and convenient method for the detection of gastroparesis in clinical practice. It is possibly more sensitive than scintigraphy.

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

    Directory of Open Access Journals (Sweden)

    Jan Kottner

    2010-07-01

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

  9. The formality of learning science in everyday life

    DEFF Research Database (Denmark)

    Bonderup Dohn, Niels

    2010-01-01

    The terms non-formal and informal are attributed to learning in everyday life by many authors, often linked to their interests in particular learning practices. However, many authors use the terms without any clear definition, or employ conflicting definitions and boundaries. An analysis of relev......The terms non-formal and informal are attributed to learning in everyday life by many authors, often linked to their interests in particular learning practices. However, many authors use the terms without any clear definition, or employ conflicting definitions and boundaries. An analysis...

  10. Children’s everyday transitions

    DEFF Research Database (Denmark)

    Kousholt, Dorte

    2017-01-01

    meanings and experiences of action possibilities (Chaiklin, Hedegaard, & Jensen, 1999). Employing the concept of conduct of everyday life (Dreier, 2008, 2011; Holzkamp, 2013; Højholt & Kousholt, 2017), this chapter analyses the active, creative and coordinating processes involved in leading a compound...... caregivers. The chapter emphasizes the significance of children’s communities in relation to children’s everyday transitions, parental care and parents’ collaboration with day-care professionals. The chapter is based on empirical material consisting of participant observations conducted across children......’s various life contexts and of interviews with children and parents....

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

    Science.gov (United States)

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

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

  12. Using Patient-Reported Information to Improve Clinical Practice.

    Science.gov (United States)

    Schlesinger, Mark; Grob, Rachel; Shaller, Dale

    2015-12-01

    To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries. We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians. First, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the

  13. Irritable bowel syndrome: diagnostic approaches in clinical practice

    Directory of Open Access Journals (Sweden)

    Eugene J Burbige

    2010-09-01

    Full Text Available Eugene J BurbigeDivision of Gastroenterology, Gastrointestinal and Liver Research, John Muir Medical Center, Concord, CA, USABackground: Irritable bowel syndrome (IBS, a functional gastrointestinal disorder long considered a diagnosis of exclusion, has chronic symptoms that vary over time and overlap with those of non-IBS disorders. Traditional symptom-based criteria effectively identify IBS patients but are not easily applied in clinical practice, leaving >40% of patients to experience symptoms up to 5 years before diagnosis.Objective: To review the diagnostic evaluation of patients with suspected IBS, strengths and weaknesses of current methodologies, and newer diagnostic tools that can augment current symptom-based criteria.Methods: The peer-reviewed literature (PubMed was searched for primary reports and reviews using the limiters of date (1999–2009 and English language and the search terms irritable bowel syndrome, diagnosis, gastrointestinal disease, symptom-based criteria, outcome, serology, and fecal markers. Abstracts from Digestive Disease Week 2008–2009 and reference lists of identified articles were reviewed.Results: A disconnect is apparent between practice guidelines and clinical practice. The American Gastroenterological Association and American College of Gastroenterology recommend diagnosing IBS in patients without alarm features of organic disease using symptom-based criteria (eg, Rome. However, physicians report confidence in a symptom-based diagnosis without further testing only up to 42% of the time; many order laboratory tests and perform sigmoidoscopies or colonoscopies despite good evidence showing no utility for this work-up in uncomplicated cases. In the absence of diagnostic criteria easily usable in a busy practice, newer diagnostic methods, such as stool-form examination, fecal inflammatory markers, and serum biomarkers, have been proposed as adjunctive tools to aid in an IBS diagnosis by increasing physicians

  14. Systematic evaluation of clinical practice guidelines for pharmacogenomics.

    Science.gov (United States)

    Beckett, Robert D; Kisor, David F; Smith, Thomas; Vonada, Brooke

    2018-06-01

    To systematically assess methodological quality of pharmacogenomics clinical practice guidelines. Guidelines published through 2017 were reviewed by at least three independent reviewers using the AGREE II instrument, which consists of 23 items grouped into 6 domains and 2 items representing an overall assessment. Items were assessed on a seven-point rating scale, and aggregate quality scores were calculated. 31 articles were included. All guidelines were published as peer-reviewed articles and 90% (n = 28) were endorsed by professional organizations. Mean AGREE II domain scores (maximum score 100%) ranged from 46.6 ± 11.5% ('applicability') to 78.9 ± 11.4% ('clarity of presentation'). Median overall quality score was 72.2% (IQR: 61.1-77.8%). Quality of pharmacogenomics guidelines was generally high, but variable, for most AGREE II domains.

  15. Systemic relational therapy and the case from the clinical practice

    Directory of Open Access Journals (Sweden)

    Tatjana Rožič

    2003-06-01

    Full Text Available In the present article are represented the principal guidelines of the systemic relational model of psychotherapy and an example of clinical practice where the pacient was incluced in this kind of therapy. In the essence of systemic relational model there is a person which is captured in the repetition of old patterns in spite of its painfulness and hardness. Captured and helpless in old patterns, the person not only repeats but also recreates them, because they promise safety, belonging and connectedness. From the review of the therapy it is evident that behind the pacient's concrete problems stands her family system to which she is loyal in the way that only deepens her distress. By the increasing the responsability for herself, for her feelings and her acts, it increases the pacient's funcionality, too.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care...... Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients...... breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor...

  17. The practice of humanitarianism: a village birthing clinic in Palestine.

    Science.gov (United States)

    Wick, Livia

    2011-01-01

    Discourses and practices surrounding humanitarian organisations have changed over time. This is certainly the case for Palestinian non-governmental organisations, which have followed the structural and ideological transformations observed in local, regional and international contexts. There have been three successive but interlocking generations of groups active in health in Palestine: charitable societies, popular committees, and donor-based entities. Against this background, a village clinic in the West Bank is seen to have gone through various incarnations in the context of an emerging neo-liberal economic, administrative and political environment. Despite the critiques justifiably addressed towards them, non-governmental organisations may in some cases be functionally fluid. Communities and people continue to use them strategically in their relations with states, political groups, individuals and receivers of aid, making them potential networking sites in the context of an ongoing occupation.

  18. [Molecular characterization of breast cancer in clinical practice].

    Science.gov (United States)

    Zemmouri, Y; De Croze, D; Vincent Salomon, A; Rouzier, R; Bonneau, C

    2016-05-01

    Breast cancer involves various types of tumors. The objective of this review was to provide a summary of the main methods currently available in clinical practice to characterize breast cancers at a molecular level and to discuss their prognostic and predictive values. Hormonal receptors expression and the HER2 status are prognostic markers and can also predict the response to targeted therapies. Their analysis through immunohistochemistry is systematical. Ki67 is an effective prognostic marker, but its reliability is debated because of its low reproducibility between laboratories and between pathologists. Commercial genomic signatures are all considered valid prognostic tools and may guide physicians to make therapeutic choices. These signatures are costly and should therefore be restricted to situations in which the use of chemotherapy remains equivocal. Copyright © 2016. Published by Elsevier SAS.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    addressed in part 2). Various manual and automatic methods of BA assessment have been developed. Healthy tall children tend to have advanced BA and healthy short children tend to have delayed BA in comparison to chronological age. Growth hormone (GH) treatment of children with GH deficiency leads to a catch......This review examines the role of skeletal maturity ('bone age', BA) assessment in clinical practice. BA is mainly used in children with the following conditions: short stature (addressed in part 1 of this review), tall stature, early or late puberty, and congenital adrenal hyperplasia (all...... of the growth plate to sex steroids, thus further impairing adult height. The assessment of BA provides an important contribution to the diagnostic workup and management of children with short stature....

  20. Systematic review of clinical practice guidelines related to multiple sclerosis.

    Directory of Open Access Journals (Sweden)

    Jia Guo

    Full Text Available BACKGROUND: High quality clinical practice guidelines (CPGs can provide clinicians with explicit recommendations on how to manage health conditions and bridge the gap between research and clinical practice. Unfortunately, the quality of CPGs for multiple sclerosis (MS has not been evaluated. OBJECTIVE: To evaluate the methodological quality of CPGs on MS using the AGREE II instrument. METHODS: According to the inclusion and exclusion criteria, we searched four databases and two websites related to CPGs, including the Cochrane library, PubMed, EMBASE, DynaMed, the National Guideline Clearinghouse (NGC, and Chinese Biomedical Literature database (CBM. The searches were performed on September 20th 2013. All CPGs on MS were evaluated by the AGREE II instrument. The software used for analysis was SPSS 17.0. RESULTS: A total of 27 CPGs on MS met inclusion criteria. The overall agreement among reviews was good or substantial (ICC was above 0.70. The mean scores for each of all six domains were presented as follows: scope and purpose (mean ± SD: 59.05 ± 16.13, stakeholder involvement (mean ± SD: 29.53 ± 17.67, rigor of development (mean ± SD: 31.52 ± 21.50, clarity of presentation (mean ± SD: 60.39 ± 13.73, applicability (mean ± SD: 27.08 ± 17.66, editorial independence (mean ± SD: 28.70 ± 22.03. CONCLUSIONS: The methodological quality of CPGs for MS was acceptable for scope, purpose and clarity of presentation. The developers of CPGs need to pay more attention to editorial independence, applicability, rigor of development and stakeholder involvement during the development process. The AGREE II instrument should be adopted by guideline developers.

  1. Insights into implementation of sacubitril/valsartan into clinical practice.

    Science.gov (United States)

    Martens, Pieter; Beliën, Hanne; Dupont, Matthias; Mullens, Wilfried

    2018-06-01

    Sacubitril/valsartan significantly reduced heart failure hospitalization and mortality in PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With an Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure). However, real-world data from its use are lacking. We retrospectively assessed all baseline and follow-up data of consecutive heart failure patients with reduced ejection fraction receiving therapy with sacubitril/valsartan for Class I recommendation between December 2016 and July 2017. Baseline characteristics and dose titration of sacubitril/valsartan were compared between patients in clinical practice and in PARADIGM-HF. A total of 120 patients (81% male) were switched from angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to sacubitril/valsartan. A total of 20.1% of patients received dose uptitration. Patients were treated with an equipotential dose of renin-angiotensin system blockers before and after uptitration of sacubitril/valsartan (57 ± 29% vs. 53 ± 29% of target dose indicated by European Society of Cardiology guidelines; P = 0.286). However, they received a lower dose of sacubitril/valsartan in comparison with those in the PARADIGM-HF (219 ± 12 vs. 375 ± 75 mg; P sacubitril/valsartan in PARADIGM-HF, patients in clinical practice were older and had a higher serum creatinine, higher New York Heart Association functional classification, and lower left ventricular ejection fraction (all P-value sacubitril/valsartan, New York Heart Association class significantly improved (P sacubitril/valsartan therapy to reduce the risk of heart failure hospitalization and all-cause mortality. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

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

    Science.gov (United States)

    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.

  3. [New intensifying screens in clinical radiology. II. Examinations in clinical practice].

    Science.gov (United States)

    Freyschmidt, J; Saure, D; Hagemann, G

    1976-09-01

    A clinically applicable procedure for testing new intensifying rare earth screens, as well as the special Siemens' screen is described. The results are related to universal screens. The film-screen combination alpha 4XD (gadolinium oxysulphide with normal, green sensitive film) results in a reduction of radiation dose to half with detail comparable with universal screens. The Siemens' special screen has similar advantages. Screens with a higher intensification factor and reduction of the mAs to one sixth results in loss of detail. This does not necessarily reduce their clinical use if they are used for appropriate purposes. The results of this clinically orientated technique agreed well with physically objective methods using lead grids. The advantages of the new screens are discussed in terms of their practical application.

  4. Technical basis of radiation therapy. Practical clinical applications. 5. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Levitt, Seymour H. [Karolinska Institutet Stockholm (Sweden). Dept. of Oncol-Pathol; Perez, Carlos A. [Washington Univ. Medical Center, St. Louis, MO (United States). Dept. of Radiation Oncology; Purdy, James A. [California Univ., Sacramento, CA (United States). Dept. of Radiation Oncology; Poortmans, Philip [Institute Verbeeten, Tilburg (Netherlands). Dept. of Radiation Oncology

    2012-07-01

    This well-received book, now in its fifth edition, is unique in providing a detailed description of the technological basis of radiation therapy. Another novel feature is the collaborative writing of the chapters by North American and European authors. This considerably broadens the book's perspective and increases its applicability in daily practice throughout the world. The book is divided into two sections. The first covers basic concepts in treatment planning, including essential physics and biological principles related to time-dose-fractionation, and explains the various technological approaches to radiation therapy, such as intensity-modulated radiation therapy, tomotherapy, stereotactic radiotherapy, and high and low dose rate brachytherapy. Issues relating to quality assurance, technology assessment, and cost-benefit analysis are also reviewed. The second part of the book discusses in depth the practical clinical applications of the different radiation therapy techniques in a wide range of cancer sites. All of the chapters have been written by leaders in the field. This book will serve to instruct and acquaint teachers, students, and practitioners in the various fields of oncology with the basic technological factors and approaches in radiation therapy. (orig.)

  5. Expanding role of MR angiography in clinical practice

    International Nuclear Information System (INIS)

    Prince, M.R.; Meaney, J.F.M.

    2006-01-01

    MRA has higher accuracy, less operator dependence, a larger field-of-view, three-dimensionality and superior contrast resolution than ultrasonography. Additionally, MRA offers a safer alternative to the patient than CTA as neither ionizing radiation nor iodinated contrast agents are used. Contrast-enhanced MRA with extra cellular contrast agents is fast and flow-independent, offers substantially higher spatial and temporal resolution compared to non-contrast techniques and has become the standard of practice. The highly accurate but static anatomical road-map thus generated can be supplemented with time-resolved MRA and blood flow measurement techniques for a more comprehensive assessment of systemic vascular disease. In the context of burgeoning technological advances with rapid translation into clinical MRA practice, this review explores the current position of MRA and the potential role for the new and exciting blood-pool contrast agents for diagnosing and characterizing vascular disease. Blood-pool agents offer the potential to take MRA to the next level by combining first-pass arterial phase imaging with steady state high-resolution images that exploit the persistent high intravascular enhancement generated by blood-pool agents and which is significantly greater than with extra cellular agents. Additional benefits derive from the ability to characterize plaque and to detect internal bleeding. (orig.)

  6. Relevance of human anatomy in daily clinical practice.

    Science.gov (United States)

    Arráez-Aybar, Luis-Alfonso; Sánchez-Montesinos, Indalecio; Mirapeix, Rosa-M; Mompeo-Corredera, Blanca; Sañudo-Tejero, Jose-Ramón

    2010-12-20

    the aim of this study has been to evaluate the relevance of gross human anatomy in daily clinical practice and to compare it to that of other basic sciences (biochemistry, bioethics, cytohistology, microbiology, pharmacology, physiology, psychology). a total of 1250 questionnaires were distributed among 38 different medical speciality professionals. Answers were analyzed taking into account speciality (medical, surgery and others), professional status (training physician or staff member) and professional experience. the response rate was 42.9% (n=536). Gross human anatomy was considered the most relevant basic discipline for surgical specialists, while pharmacology and physiology were most relevant for medical specialists. Knowledge of anatomy was also considered fundamental for understanding neurological or musculoskeletal disorders. In undergraduate programmes, the most important focuses in teaching anatomy were radiological, topographical and functional anatomy followed by systematic anatomy. In daily medical practice anatomy was considered basic for physical examination, symptom interpretation and interpretation of radiological images. When professional status or professional experience was considered, small variations were shown and there were no significant differences related to gender or community. our results underline the relevance of basic sciences (gross anatomy, physiology, and pharmacology) in daily professional activity. Evidence-based studies such as ours, lend greater credibility and objectivity to the role of gross anatomy in the undergraduate training of health professionals and should help to establish a more appropriate curriculum for future professionals. 2010 Elsevier GmbH. All rights reserved.

  7. Clinical usefulness of teleradiology in general dental practice

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo [Dept. of Oral and Maxillofacial Radiology, Dankook University College of Dentistry, Cheonan (Korea, Republic of)

    2013-06-15

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

  8. Exploring parents everyday life and emotion work related to school-home cooperation

    DEFF Research Database (Denmark)

    Krab, Jimmy

    The paper will be based on an ongoing Ph.D. project using a critical ethnographic approach following families with children who experience difficulties in school in their everyday life. The project purpose is to explore parents perspectiv and everyday life. The paper will highlight a number of ex...... of examples of parents experience with school-home relations and discuss methodological challenges in researching everyday life practices and discuss how emotionwork – and management are connected to social differentierings processes in education...

  9. Catholicism and Everyday Morality: Filipino women's narratives on reproductive health.

    Science.gov (United States)

    Natividad, Maria Dulce F

    2018-05-07

    This study examines the relationship between state policies, religion, reproductive politics, and competing understandings of embodied sexual and reproductive morality. Using ethnographic and life history interviews, this study looks at the lives of Filipino urban poor women and how they interpret, follow and resist Catholic Church doctrines and practices as these relate to sexuality and reproduction. Taking everyday morality as embedded in social practice, this paper argues that women's subjective reinterpretations of Catholic teachings regarding contraception and abortion render religion pliant in a way that restores moral equilibrium in women's lives. It is in this process of adjusting and re-adjusting this moral order that women are able to construct their moral worlds. Further, this article investigates how social class, gender and religion work in tension with one another in women's everyday decisions and how the constraints and opportunities that poor women encounter in their everyday lives are enabled by the state and its institutions.

  10. Interrogating Biosensing in Everyday Life

    DEFF Research Database (Denmark)

    Merrill, Nick; Wong, Richmond; Howell, Noura

    2017-01-01

    This workshop seeks to expand our understanding and imaginations regarding the possible roles biosensors (sensors measuring humans) can-and should-play in everyday life. By applying a critical lens to issues of interpretation, representation, and experience around biosensing and biosensors, we ai...

  11. The genre of everyday life

    Directory of Open Access Journals (Sweden)

    Tzvetan Todorov

    2012-01-01

    Full Text Available The present essay shows the new genres of the seventeenth century Dutch painting (portrait, landscape and genre painting, viewed as painting of everyday life, as an alternative proposition to the historical painting then dominant in the academic categorization. What used to be marginal, peripheral and of secondary importance became the main motif in the majority of Dutch painting. Minor genres came to prominence and acquired autonomous status. The interest in the elements of everyday life could be traced in European art earlier but it was the seventeenth century Dutch artists that ultimately led “low” and realistic subject themes to come into their own commercially and artistically. Occasionally, even religious themes were presented as genre scenes, thus introducing to the presented images an air of ambivalence. In the works of Dutch painters, the uniqueness of high subject themes was opposed by pictures of everyday life and the repetitiveness of everyday domestic activities, not shunning, however, the allegorical potential contained in some of the depictions.

  12. Audio Satellites: Overhearing Everyday Life

    DEFF Research Database (Denmark)

    Kirkegaard, Jonas Rasmussen; Breinbjerg, M.; Højlund, M. K.

    2017-01-01

    around or displaced arbitrarily in a given landscape. In the web browser, the different sound streams from the individual satellites can be mixed together to form a cooperative soundscape. The project thus allows people to tune into and explore the overheard soundscape of everyday life in a collaborative...

  13. The arena of everyday life

    NARCIS (Netherlands)

    Butijn, C.A.A.; Ophem, van J.A.C.; Casimir, G.J.

    2013-01-01

    In 'The arena of everyday life' nine authors look back and forward at developments in the sociology of consumers and households. Nine chapters show variety in the employed methods, from multivariate analyses of survey data to classical essays. The contributions are organised around four themes. In

  14. The Everyday Condition of Metaphysics

    Directory of Open Access Journals (Sweden)

    Ştefan Afloroaei

    2010-12-01

    Full Text Available The question I intend to answer is whether one can speak of a tacit metaphysics, not expressed conceptually, but nevertheless common. If the answer is positive and providing that it is specific to day-to-day life, such metaphysics may be called everyday metaphysics. To this end, I review the meaning of everyday life and its ambivalent character. Next, I present several milestones in the debate on the subject, from authors who have focused on a kind of usual, common or ‘natural’ metaphysics. Lastly, I formulate the idea under consideration, namely that everyday life implies or underlies a certain metaphysics. I note that it is an implicit metaphysics – not expressed formally – and rather free. Embraced in experience with a certain degree of freedom, it is recognisable by means of certain representations active in our mind, by the manner of speaking or of understanding and by the common forms of expression. Its vibrancy, concrete and relaxed character makes it highly evocative of the mental life of an era. It ensures a truly essential difference in our everyday mode of being.

  15. In Pursuit of Everyday Creativity

    Science.gov (United States)

    Amabile, Teresa M.

    2017-01-01

    Creativity researchers have long paid careful attention to individual creativity, beginning with studies of well-known geniuses, and expanding to personality, biographical, cognitive, and social-psychological studies of individual creative behavior. Little is known, however, about the everyday psychological experience and associated creative…

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

    Energy Technology Data Exchange (ETDEWEB)

    Kaasalainen, Touko, E-mail: touko.kaasalainen@hus.fi [HUS Medical Imaging Center, Helsinki University Central Hospital, POB 340 (Haartmaninkatu 4), 00290 Helsinki (Finland); Department of Physics, University of Helsinki (Finland); Pakarinen, Sami, E-mail: sami.pakarinen@hus.fi [HUS Department of Cardiology, Helsinki University Central Hospital, POB 340 (Haartmaninkatu 4), 00290 Helsinki (Finland); Kivistö, Sari, E-mail: sari.kivisto@hus.fi [HUS Medical Imaging Center, Helsinki University Central Hospital, POB 340 (Haartmaninkatu 4), 00290 Helsinki (Finland); Holmström, Miia, E-mail: miia.holmstrom@hus.fi [HUS Medical Imaging Center, Helsinki University Central Hospital, POB 340 (Haartmaninkatu 4), 00290 Helsinki (Finland); Hänninen, Helena, E-mail: helena.hanninen@hus.fi [HUS Department of Cardiology, Helsinki University Central Hospital, POB 340 (Haartmaninkatu 4), 00290 Helsinki (Finland); Peltonen, Juha, E-mail: juha.peltonen@hus.fi [HUS Medical Imaging Center, Helsinki University Central Hospital, POB 340 (Haartmaninkatu 4), 00290 Helsinki (Finland); Department of Biomedical Engineering and Computational Science, School of Science, Aalto University, Helsinki (Finland); Lauerma, Kirsi, E-mail: kirsi.lauerma@hus.fi [HUS Medical Imaging Center, Helsinki University Central Hospital, POB 340 (Haartmaninkatu 4), 00290 Helsinki (Finland); Sipilä, Outi, E-mail: outi.sipila@hus.fi [HUS Medical Imaging Center, Helsinki University Central Hospital, POB 340 (Haartmaninkatu 4), 00290 Helsinki (Finland)

    2014-08-15

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

  17. Initial experience with golimumab in clinical practice for ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Luisa Castro-Laria

    Full Text Available Background: Golimumab is a TNF-blocking agent indicated as a second-line therapy in ulcerative colitis. Purpose: To research the effectiveness and safety of golimumab in patients with ulcerative colitis in clinical practice. Methods: Retrospective study of the effectiveness and safety of golimumab in patients with ulcerative colitis. All patients received golimumab 200 mg subcutaneously at week 0, and golimumab 100 mg subcutaneously at week 2. After the induction treatment, each patient received 50 mg sc. every 4 weeks in patients with body weight less than 80 kg, and 100 mg every 4 weeks in patients with body weight greater than or equal to 80 kg. Results: Study of a group of 23 ulcerative colitis patients, 7 of whom were naive to any anti-TNF therapy, and 16 patients who had previously been treated with an anti-TNF agent other than golimumab (non-naive patients. The average treatment time with golimumab was 14.3 weeks. Globally, withdrawal of corticosteroids was observed in 74% of cases. Clinical response was observed in 85.5% of patients who had not received biological treatment previously, and in patients who had previously received biological treatment the response rate was 75%. Conclusions: In this short study, golimumab seems to be an alternative treatment in naive and non-naive anti-TNF ulcerative colitis patients. It is also a safe therapy, given that there were no adverse effects in the patients studied.

  18. Effect of clinical practice on self-learning development ability

    International Nuclear Information System (INIS)

    Kim, Jung Hyun; Yang, Han Joon; Kim, Nak Sang

    2017-01-01

    In order to analyze the degree of self-learning development ability after the clinical training curriculum, the results of 121 questionnaires were analyzed for 3rd and 4th grade students in radiology in the metropolitan area. The overall average of self-learning ability according to gender was 3.07±0.85, which was statistically significant according to gender. However, the results according to educational system showed that the overall average was 3.07±0.85, which was higher than the average level of self-learning development ability. There was no statistically significant difference according to educational system. The results of the self-learning development ability according to the motivation for selecting the department showed that the students who have chosen their department due to their higher employment rate after graduation had high self-development ability level(3.58±0.85) but the students who entered the school due to self-aptitude had relatively lower self-development ability level (2.30±0.40). The overall average of self-learning ability according to direction of career path was 3.08±0.76, which was over-average of self-learning development ability. Thus, there was statistically significant difference according to career path. It is necessary to improve the self-learning ability in clinical practice. In addition, the lack of statistical significance suggests problems and diversity

  19. The role of fluorescence diagnosis in clinical practice

    Directory of Open Access Journals (Sweden)

    Sieroń A

    2013-07-01

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

  20. WhatsApp in Clinical Practice: A Literature Review.

    Science.gov (United States)

    Mars, Maurice; Scott, Richard E

    2016-01-01

    Several spontaneous telemedicine services using WhatsApp Messenger have started in South Africa raising issues of confidentiality, data security and storage, record keeping and reporting. This study reviewed the literature on WhatsApp in clinical practice, to determine how it is used, and users' satisfaction. Pubmed, Scopus, Science Direct and IEE Expert databases were searched using the search term WhatsApp and Google Scholar using the terms WhatsApp Telemedicine and WhatsApp mHealth. Thirty-two papers covering 17 disciplines were relevant with the most papers, 12, from India. Seventeen papers reported the use of WhatsApp Groups within departments, 14 of which were surgery related disciplines. Groups improved communication and advice given on patient management. Confidentiality was mentioned in 19 papers and consent in five. Data security was partially addressed in 11 papers with little understanding of how data are transmitted and stored. Telemedicine services outside of departmental groups were reported in seven papers and covered emergency triage in maxillofacial, plastic, neuro and general surgery, and cardiology and telestroke. WhatsApp is seen to be a simple, cheap and effective means of communication within the clinical health sector and its use will grow. Users have paid little attention to confidentiality, consent and data security. Guidelines for using WhatsApp for telemedicine are required including downloading. WhatsApp messages to computer for integration with electronic medical records.