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Sample records for surveys clinical investigations

  1. Clinical Investigations

    Science.gov (United States)

    1977-09-30

    Radionuclide Blood Pool Imaging: Case Report. Clin Nucl Med 2:16, 1977. Gluck, F.B., Nusynowitz, M.L. , Montqomery M.: Primary Hypothyroidism and...To ascertain the etiology and pathophysiology of patients admitted to I- the Trauma Center who develop post-traumatic hepatic dysfunction. TECHNICAL...Investigation of the Etiology and Pathophysiology of Post-T Traumatic Hepatic Dysfunction WORK UNIT NO: 76/13 ;•<L _PRINCIPAL INVESTIGATOR: MAJ Hartong, MC i

  2. Clinical Investigation.

    Science.gov (United States)

    1979-09-30

    normal postprandial blood glucose and glucoreguiatory hormone concentrations following a test meal whicii provides more physiologic stimulus than pure...hypo- glycemia do in fact have low postprandial blood glucose on altered levels of glucoregulatory hormones associated with clinical findings...Fertility and Sterility 30:560-564, 1978. 00~3 Ma Endocrinology Service - continued Hofeldt, F.D.: Transitional Low Blood Glucose States. Rocky

  3. The Impact of Institutional Review Boards (IRBs) on Clinical Innovation: A Survey of Investigators and IRB Members.

    Science.gov (United States)

    Stryjewski, Tomasz P; Kalish, Brian T; Silverman, Benjamin; Lehmann, Lisa Soleymani

    2015-12-01

    We conducted a survey to assess the perspectives of principal investigators and Institutional Review Board (IRB) members on the impact of the IRB structure on the conduct of research and innovative therapy, defined as a nonstandard treatment intended to enhance the well-being of an individual patient. Although investigators and IRB members agreed that the IRB provides adequate protection to study subjects (97% vs. 100%) and an ethically insightful review (88% vs. 100%), a third of clinical investigators felt that the IRB review process limits clinical innovation, in comparison with only 4% of IRB representatives. Limitations of the current IRB review process were explored. We propose several measures to improve the IRB review process while maintaining the protection of human research subjects, including the use of centralized IRBs, the opening of IRB meetings to investigators, the development of metrics and outcome measures for the IRB, and the promotion of guidelines that distinguish research and innovative therapy. © The Author(s) 2015.

  4. Opinions and perceptions regarding the impact of new regulatory guidelines: A survey in Indian Clinical Trial Investigators

    Directory of Open Access Journals (Sweden)

    Rashmi Kadam

    2016-01-01

    Full Text Available Background: Clinical research in India experienced dramatic changes with series of stringent guidelines introduced by regulatory authorities. These guidelines posed significant challenges for the clinical trial industry. Objective: To assess the perceptions and opinion of Indian Investigators about the new regulatory guidelines. Methods: We developed a survey questionnaire on recent regulatory guidelines which was hosted on a web portal. Seventy-three investigators from India participated in the survey. Results: Central registration of Ethics Committees (ECs was agreed by 90.1% participants, 76.8% participants agreed to compensation of subjects for study related Serious Adverse Events (SAE's. The compulsion to include government sites in clinical trials was not agreed by 49.3% participants while 21.2% agreed to it. Restriction on a number of trials per investigator was agreed by 49.3% of participants while 40.9% disagreed. Participants (50.7% disagreed to the introduction of audio-video (AV recording of informed consent, 36.6% agreed and 12.7% were neutral. Discussion: Participants observed that post central registration; ECs have improved systems with adequate member composition, functional Standard Operating Procedures, and timely approvals. Participants agreed that compensation of study related SAE's would assure subject protection and safety. The introduction of AV consenting was strongly debated sighting sociocultural issues in the implementation of the same. Conclusion: Participants endorsed guidelines pertaining to the central registration of ECs, SAE related compensation. Restrictions on a number of trials per investigator and AV consenting were debated ardently. The response of the survey participants who are clinical trial investigators in India showed general acceptance, effectiveness and anticipated compliance to the new regulatory guidelines.

  5. Prevalence and Severity of Depression and Anxiety in Patients With Systemic Sclerosis: An Epidemiologic Survey and Investigation of Clinical Correlates.

    Science.gov (United States)

    Faezi, Seyedeh Tahereh; Paragomi, Pedram; Shahali, Ashraf; Akhlaghkhah, Maryam; Akbarian, Mahmood; Akhlaghi, Maassoomeh; Kheirandish, Masoumeh; Gharibdoost, Farhad

    2017-03-01

    Systemic sclerosis (SSc) is a chronic multisystem connective tissue disorder with detrimental impact on quality of life. Patients with SSc face emotional distress and frequently meet criteria for a psychiatric disorder. However, the pattern of psychiatric manifestations may vary according to socioethnic background. We investigated the prevalence of depressive and anxiety symptoms and examined their association with sociodemographic and clinical factors in Iranian SSc patients. Depressive and anxiety symptoms were evaluated by Beck Depression Inventory and Cattell questionnaire in 114 SSc patients. The associations between sociodemographic and clinical factors and depressive/anxiety symptoms were examined via multivariate analysis. The prevalence of depressive symptoms was 68.4%. There was a significant association between depressive symptoms and pulmonary and gastrointestinal manifestations. Also, diffuse SSc patients were more prone to depressive symptoms. Mean Rodnan scores were significantly higher in patients with depressive symptoms in comparison with subjects with no depressive symptoms. The prevalence of anxiety symptoms was 23.6%. Anxiety symptoms were not associated with demographic characteristics, SSc subtype, disease duration, Rodnan score, other clinical features, and previous history of depression in the patients or their family. The coincidence of anxiety and depression was 82.8%. Depressive and anxiety symptoms are prevalent among Iranian SSc population. The depressive symptoms showed correlation with pulmonary and gastrointestinal involvement, as well as diffuse SSc subtype.

  6. Clinical Investigation Program Report

    Science.gov (United States)

    1992-10-01

    BENNING, GA 1980 Intraocular Lens Study. (T) 183 78-14 USA MEDDAC, FT CAMPBELL, KY 1981 Intraocular Lens Study. (0) 184 78-14 1990 Pediatric ...Tympanic Thermometry to Rectal Thermometry 191 91-83 in an Ambulatory Pediatric Clinic. (C) USA MEDDAC. FT RUCKER. AL 1990 Comparison of Cefpodoxime...oral macrolide therapy. Technical Approach: Randomized, investigator blind, multicenter trial. Subjects enrolled to date: 0 Progress: Prepared for

  7. Clinical Investigation Program.

    Science.gov (United States)

    1987-09-30

    1 V TILE COPY q Laboratory N Report No. 23 CLINICAL INVESTIGATION PROGRAM ANNUAL PROGRESS REPORT DTIC 30 September 1987 TLE CTE JAN 2 8 IM Approved...1987. Kucera RF, Blue PW, Thomas HM, Bowden WD: Anomalous Origin of the Right Coronary Artery from the Left Sinus of Valsalva - A Case Report. Cath...University of New York at Buffalo . Civilian Hospital Savitz DA, Hamman RF, Grace C, and Stroo K: Respondents’ At- titudes Regarding Participation in

  8. Future requirements. Clinical investigations

    DEFF Research Database (Denmark)

    Qvist, V.

    2002-01-01

    Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics......Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics...

  9. Canine mammary tumors - clinical survey

    Directory of Open Access Journals (Sweden)

    Elena Atanaskova Petrov

    2014-10-01

    Full Text Available Mammary tumours are the second most frequent neoplasia in dogs, mainly affecting older female patients. Approximately 50% of the mammary tumours are malignant with high percentage of mortality if not treated in time. The aim of this study was to analyze the data of canine patients with mammary tumours, to evaluate the type of tumours, as well as the relationship between tumour incidence and dogs’ age, reproductive cycle and sterilization. The survey was used to retrieve the information in the period of two years from the patient data base of the University Veterinary Hospital at the Faculty of Veterinary medicine in Skopje. Patients included in this survey were subjected to routine clinical investigation and additional laboratory tests (cytological examination, x-rays imaging, CBC and biochemical profile, histopathology of the tumor samples. Aged female patients (12 – 13 years are the most susceptible category for development of mammary tumours. The reproductive history showed that five of the patients with malignant mammary tumourshave never whelped and were not treated with any exogenous hormones. Malignant tumours (adenocarcinoma were diagnosed in 90% of the patients. Three patients died due to lung metastasis. Late diagnosis is one of the major problems that results in lethal outcome due to lung metastases. Since ovarian steroids play an important role in the aetiology, the most effective prevention of mammary tumoursis elective ovariectomy of the bitch at an early age.

  10. Movement: A Clinical Investigation

    Directory of Open Access Journals (Sweden)

    Kazem Dalaie

    2015-10-01

    Full Text Available Objectives: One major drawback of orthodontic treatment is its long duration due to slow tooth movement and the pain at the onset of treatment following application of forces. There is controversy regarding the efficacy of laser for decreasing the treatment time and pain of orthodontic treatment. The purpose of this study was to investigate the effect of low level diode laser on the rate of orthodontic tooth movement and the associated pain.Materials and Methods: In this double blind randomized controlled clinical trial, 12 or- thodontic patients referring to Shahid Beheshti School of Dentistry for first premolar ex- traction were randomly selected and allocated to gallium aluminum-arsenide laser (Ga,Al,As diode laser, 880 nm, 100 mW, 5 j/cm2, 8 points, 80 seconds, continuous mode or control group. The patients initially underwent leveling and alignment using the sectional system. Force (150 gr was applied to each canine tooth via sectional closing loops. The loops were activated every month. The rate of tooth movement and pain were monitored over the treatment period and recorded on days 1, 3, 7, 30, 33, 37, 60, 63 and 67. Two-way ANOVA was used for comparison of groups.Results: There was no significant difference in terms of tooth movement and pain scores between the irradiated and non-irradiated sides at any time point (P>0.05.Conclusion: Although laser enhanced orthodontic tooth movement in the upper jaw, we failed to provide solid evidence to support the efficacy of laser for expediting tooth move- ment or reducing the associated pain.

  11. Clinical Investigator Inspector List (CLIIL)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Clinical Investigator Inspection List (CLIIL) contains names, addresses, and other pertinent information gathered from inspections of clinical investigators who...

  12. Clinical Investigation Program.

    Science.gov (United States)

    1979-10-01

    fish responsible for clinical scombroid poisoning. This will be attempted by correlating known patients, fish, specimens, and suspected outbreaks ...by parents, special program, and TAHC staff to evaluate the level of psychotic behavior. After one month, the procedure will be reversed, in that

  13. Clinical Investigations Service.

    Science.gov (United States)

    1979-09-30

    Proposal for Joint Study by Orthopedic Service, Dept of Clinics and Radiology ........... 183 11 PACE Work Unit No. 77/24 (FY77,O) Pathophysiology and...measurements in hyperthyroid, euthyroid and hypothyroid patients and to evaluate the possible tse of these parameters in monitoring therapeutic...interventions. T OINI CAL APPROAO I Prior to initiation of therapy, hypothyroid and hyperthyroid patients will be screened for factors influencing 2,3-1PC levels

  14. Clinical Investigation Program Report.

    Science.gov (United States)

    1983-10-01

    Expense 6,019.00 Military Pay 160,982.00 TOTAL $ 618,369.00 E. Dispotion of Protocols- FY 1983 -.97 Ongoing 5-..: 29 C o m pleted 15 Terminated 1...Spring, MD LAMC D ept/Svc: Associate Investigators: Radiology T McDonald, MD K Kumar, MD CPT W Marx , DO Key Words: retroperitoneal gas, CT...135, 50 M MANSOUR, RP, 91, 93, 95 MARX , W, 125 M ASSIE, B, 34 * - McDONALD, PT, 125, 143 MELLICK, P, 53 MITCHELL, M, 113 MOORE, T, 145 MOORES, WY, 137

  15. 75 FR 57472 - Clinical Investigator Training Course

    Science.gov (United States)

    2010-09-21

    ... days in advance. SUPPLEMENTARY INFORMATION: Clinical trial investigators play a critical role in the... investigational medicine; Promote communication between clinical investigators and FDA; Enhance investigators... HUMAN SERVICES Food and Drug Administration Clinical Investigator Training Course AGENCY: Food and Drug...

  16. Clinical Data Warehousing - A Survey

    DEFF Research Database (Denmark)

    Pedersen, Torben Bach; Jensen, Christian Søndergaard

    1998-01-01

    In this article we present the concept of data warehousing, and its use in the clinical area. Clinical data warehousing will become very important in the near future, as healthcare enterprises need to gain more information from their clinical, administrative, and financial data, in order to impro...... in the area, and providing criteria for comparing clinical data warehouse systems.......In this article we present the concept of data warehousing, and its use in the clinical area. Clinical data warehousing will become very important in the near future, as healthcare enterprises need to gain more information from their clinical, administrative, and financial data, in order to improve...... quality and reduce costs. Adoption of data warehousing in health care has been slowed by lack of understanding of the benefits offered by the technology. This paper contributes by providing needed understanding, by introducing the opportunities offered by data warehousing, describing current efforts...

  17. Biennial survey of clinical nutrition training programs.

    Science.gov (United States)

    Morgan, S L; Merritt, R J; Jackson, J R; Brooks, C M; Rombeau, J

    1990-07-01

    Three posttraining program surveys have been done by The American Society for Clinical Nutrition Committee on Subspecialty Training to evaluate the status of training programs in clinical nutrition. This survey updates demographic data about programs and determines which classes are offered or required as a part of basic nutrition-science requirements for nutrition training programs. In addition, the importance of board certification and accreditation of training programs is examined.

  18. Investigator experiences with financial conflicts of interest in clinical trials

    OpenAIRE

    Van Laethem Marleen; Kalkar Sunila R; Wu Wei; Moher David; Ferris Lorraine E; Lexchin Joel; Hoey John; Sekeres Melanie; Rochon Paula A; Gruneir Andrea; Gold Jennifer; Maskalyk James; Streiner David L; Taback Nathan; Chan An-Wen

    2011-01-01

    Abstract Background Financial conflicts of interest (fCOI) can introduce actions that bias clinical trial results and reduce their objectivity. We obtained information from investigators about adherence to practices that minimize the introduction of such bias in their clinical trials experience. Methods Email survey of clinical trial investigators from Canadian sites to learn about adherence to practices that help maintain research independence across all stages of trial preparation, conduct,...

  19. A UK national survey of investigations for beta-lactam hypersensitivity - heterogeneity in practice and a need for national guidelines - on behalf of British Society for Allergy and Clinical Immunology (BSACI).

    Science.gov (United States)

    Richter, A G; Nasser, S M; Krishna, M T

    2013-08-01

    Beta lactams (BL) are the most widely prescribed antibiotics in the UK and the commonest cause of hypersensitivity reactions. There are no UK guidelines for BL testing and the most relevant guidelines were devised by the European Network for Drug Allergy (ENDA) on behalf of the European Academy of Allergy and Clinical Immunology. Delivery of allergy services differs across Europe, so this survey was designed to investigate how closely UK practice adhered to these guidelines. An online survey, using surveymonkey.com software, was sent to all consultants offering an allergy service in the UK and who were members of either BSACI or 'Travellers' (Immunology consultant group). The response rate was 48% (n=81/165) and BL allergy testing was undertaken by 78% of respondents. All responders requested SsIgE, although four responders stated they rarely requested. Skin testing was undertaken by 87% of respondents who perform beta lactam testing with 17% undertaking skin prick testing (SPT) only, 77% SPT followed by intra-dermal testing (IDT) if the former were negative or indeterminate and 6% SPT and IDT in all cases. The drugs, doses and protocols for skin testing varied considerably. Drug provocation testing was undertaken by 87% of respondents who undertake beta lactam testing with significant heterogeneity in protocols. Respondents that investigated ≤ 20 patients per year demonstrated lower adherence to ENDA recommendations compared to those who saw > 20. Following positive testing, 79% advised avoidance of all penicillins only and the remainder advised additional drug avoidance. This survey revealed variation in the investigation and management of BL hypersensitivity in the UK with some centres reporting procedures that could potentially put patients at risk of anaphylaxis if allergy was falsely excluded. This survey highlights an urgent need for evidence based national guidelines and standardisation of practice. © 2013 John Wiley & Sons Ltd.

  20. Porcelain laminate veneers: Clinical survey for evaluation of failure

    OpenAIRE

    Alhekeir, Diemah F.; Al-Sarhan, Rana A.; Al Mashaan, Abdulmohsen F.

    2014-01-01

    Objective: To investigate the association of the failure of porcelain laminate veneers with factors related to the patient, material, and operator. Methods: This clinical survey involved 29 patients (19 women and 10 men) and their dentists, including undergraduate and postgraduate dental students and dental interns. Two questionnaires were distributed to collect information from participants. All patients were clinically examined. Criteria for failure of the porcelain laminate veneers incl...

  1. 77 FR 60440 - Clinical Investigator Training Course

    Science.gov (United States)

    2012-10-03

    ... information (toxicology, animal studies, and chemistry/ manufacturing information) that supports initial... HUMAN SERVICES Food and Drug Administration Clinical Investigator Training Course AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration's (FDA) Center for Drug Evaluation...

  2. 78 FR 63988 - Clinical Investigator Training Course

    Science.gov (United States)

    2013-10-25

    ... (toxicology, animal studies, and chemistry/ manufacturing information) that supports initial clinical trials... HUMAN SERVICES Food and Drug Administration Clinical Investigator Training Course AGENCY: Food and Drug Administration, HHS. ACTION: Notice. The Food and Drug Administration's (FDA's) Center for Drug Evaluation and...

  3. What constitutes a "clinical trial"?: A survey of oncology professionals

    Directory of Open Access Journals (Sweden)

    Kowaleski Brenda

    2008-03-01

    Full Text Available Abstract Background What constitutes a "clinical trial" is inconsistently defined in the medical literature. With an initiative by Cancer Care Ontario (CCO to report institutional clinical trials activity across the province of Ontario, Canada, we sought to investigate the variability in the interpretation of the term by local oncology professionals. Methods A survey amongst the physicians and nurses at the Juravinski Cancer Centre at Hamilton Health Sciences, Ontario was conducted. The survey included 12 summaries of local clinical research studies, and respondents were asked which they believed represented a clinical trial. Subsequently, they were asked which of the same 12 studies they believed should be labeled as clinical trials when considering separate definitions provided by CCO and by the Ontario Cancer Research Network (OCRN. Results A total of 66 (54% of 123 surveys were completed; 32/46 (70% by physicians, 21/59 (36% by primary care nurses, and 13/18 (72% by clinical trial nurses. Without a standardized definition, all studies, 12/12, were considered to be clinical trials by at least 50% of respondents. When provided with the CCO definition only 6/12 studies were considered to be clinical trials by the majority of respondents, while with the OCRN definition it was 9/12 studies. Studies evaluating natural health products, non-traditional medical interventions, and non-randomized studies with standard interventions consistently ranked the lowest, regardless of the definition used. Conclusion Oncology professionals appear to have a broadly inclusive baseline definition of what constitutes a clinical trial. Establishing rigor and consistency in the definition of a clinical trial is important for any program, institutional or jurisdictional based comparisons of clinical trials activity, especially when used as a quality indicator of patient care.

  4. What constitutes a "clinical trial"?: a survey of oncology professionals.

    Science.gov (United States)

    Wright, James R; Kowaleski, Brenda; Sussman, Jonathan

    2008-03-03

    What constitutes a "clinical trial" is inconsistently defined in the medical literature. With an initiative by Cancer Care Ontario (CCO) to report institutional clinical trials activity across the province of Ontario, Canada, we sought to investigate the variability in the interpretation of the term by local oncology professionals. A survey amongst the physicians and nurses at the Juravinski Cancer Centre at Hamilton Health Sciences, Ontario was conducted. The survey included 12 summaries of local clinical research studies, and respondents were asked which they believed represented a clinical trial. Subsequently, they were asked which of the same 12 studies they believed should be labeled as clinical trials when considering separate definitions provided by CCO and by the Ontario Cancer Research Network (OCRN). A total of 66 (54%) of 123 surveys were completed; 32/46 (70%) by physicians, 21/59 (36%) by primary care nurses, and 13/18 (72%) by clinical trial nurses. Without a standardized definition, all studies, 12/12, were considered to be clinical trials by at least 50% of respondents. When provided with the CCO definition only 6/12 studies were considered to be clinical trials by the majority of respondents, while with the OCRN definition it was 9/12 studies. Studies evaluating natural health products, non-traditional medical interventions, and non-randomized studies with standard interventions consistently ranked the lowest, regardless of the definition used. Oncology professionals appear to have a broadly inclusive baseline definition of what constitutes a clinical trial. Establishing rigor and consistency in the definition of a clinical trial is important for any program, institutional or jurisdictional based comparisons of clinical trials activity, especially when used as a quality indicator of patient care.

  5. A European Approach to Clinical Investigator Training

    Directory of Open Access Journals (Sweden)

    Jean-Marie eBoeynaems

    2013-09-01

    Full Text Available A better education and training of clinical investigators and their teams is one of the factors that could foster the development of clinical research in Europe, a key objective of the Innovative Medicines Initiative (IMI. PharmaTrain (an IMI programme on training in medicines development and ECRIN (European Clinical Research Infrastructures Network have joined forces to address this issue. An advisory group composed of representatives of universities, pharmaceutical companies and other organisations met four times between June 2011 and July 2012. This resulted in a position paper proposing a strategy to improve and harmonize clinical investigator training in Europe, and including a detailed syllabus and list of learning outcomes. Major recommendations are the establishment of minimal and mutually recognized certification requirement for investigators throughout the EU and the creation of a European platform to provide a suitable course and examination infrastructure.

  6. Investigating the Reliability and Factor Structure of Kalichman's "Survey 2

    DEFF Research Database (Denmark)

    Holm, Søren; Hofmann, Bjørn

    2017-01-01

    A precondition for reducing scientific misconduct is evidence about scientists' attitudes. We need reliable survey instruments, and this study investigates the reliability of Kalichman's "Survey 2: research misconduct" questionnaire. The study is a post hoc analysis of data from three surveys among...

  7. Nursing students' clinical competencies: a survey on clinical education objectives.

    Science.gov (United States)

    Arrigoni, C; Grugnetti, A M; Caruso, R; Gallotti, M L; Borrelli, P; Puci, M

    2017-01-01

    Developing clearly defined competencies and identifying strategies for their measurement remain unfortunately a critical aspect of nursing training. In the current international context, which continues to be characterised by deep economic crisis, universities have a fundamental role to play in redefining the educational goals to respond to the expectations of certain geographical areas of interest, as underscored in the Bologna Process (Joint Declaration of the European Ministers of Education Convened in Bologna 19 June 1999). The aim of this observational study was to examine the clinical learning context of nursing students using a tool developed by a team of teachers for the analysis of clinical learning. Redefinition of the clinical learning objectives with reference to the competencies set out in the questionnaire validated by Venturini et al. (2012) and the subsequent use of the tool created by the team of teachers for students in the first, second and third-year courses of the 2013/14 academic year, covering all the internships called for in those years. All nursing students enrolled in the first, second and third year of the nursing undergraduate degree program at the University of Pavia (no. 471) participated in this survey. A total of 1,758 clinical internships were carried out: 461 for the first year, 471 for the second year and 826 for the third year. Setting objectives, beginning with the educational offerings in the several clinical contexts, represents a strong point for this process. The results highlight a level of heterogeneity and complexity intrinsic to the University of Pavia educational system, characterized by clinical settings with different clinical levels (Research hospital and other traditional hospitals) that offering different levels of training. The use of the self-evaluation form for clinical learning made it possible to perform real-time observations of the training activities of the entire student body. An educational model

  8. 76 FR 45577 - Clinical Investigator Training Course

    Science.gov (United States)

    2011-07-29

    ...., the preclinical information (toxicology, animal studies, and chemistry/manufacturing information) that... HUMAN SERVICES Food and Drug Administration Clinical Investigator Training Course AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA), Office of Critical Path...

  9. Investigator experiences with financial conflicts of interest in clinical trials

    Directory of Open Access Journals (Sweden)

    Van Laethem Marleen

    2011-01-01

    Full Text Available Abstract Background Financial conflicts of interest (fCOI can introduce actions that bias clinical trial results and reduce their objectivity. We obtained information from investigators about adherence to practices that minimize the introduction of such bias in their clinical trials experience. Methods Email survey of clinical trial investigators from Canadian sites to learn about adherence to practices that help maintain research independence across all stages of trial preparation, conduct, and dissemination. The main outcome was the proportion of investigators that reported full adherence to preferred trial practices for all of their trials conducted from 2001-2006, stratified by funding source. Results 844 investigators responded (76% and 732 (66% provided useful information. Full adherence to preferred clinical trial practices was highest for institutional review of signed contracts and budgets (82% and 75% of investigators respectively. Lower rates of full adherence were reported for the other two practices in the trial preparation stage (avoidance of confidentiality clauses, 12%; trial registration after 2005, 39%. Lower rates of full adherence were reported for 7 practices in the trial conduct (35% to 43% and dissemination (53% to 64% stages, particularly in industry funded trials. 269 investigators personally experienced (n = 85 or witnessed (n = 236 a fCOI; over 70% of these situations related to industry trials. Conclusion Full adherence to practices designed to promote the objectivity of research varied across trial stages and was low overall, particularly for industry funded trials.

  10. Investigator experiences with financial conflicts of interest in clinical trials.

    Science.gov (United States)

    Rochon, Paula A; Sekeres, Melanie; Hoey, John; Lexchin, Joel; Ferris, Lorraine E; Moher, David; Wu, Wei; Kalkar, Sunila R; Van Laethem, Marleen; Gruneir, Andrea; Gold, Jennifer; Maskalyk, James; Streiner, David L; Taback, Nathan; Chan, An-Wen

    2011-01-12

    Financial conflicts of interest (fCOI) can introduce actions that bias clinical trial results and reduce their objectivity. We obtained information from investigators about adherence to practices that minimize the introduction of such bias in their clinical trials experience. Email survey of clinical trial investigators from Canadian sites to learn about adherence to practices that help maintain research independence across all stages of trial preparation, conduct, and dissemination. The main outcome was the proportion of investigators that reported full adherence to preferred trial practices for all of their trials conducted from 2001-2006, stratified by funding source. 844 investigators responded (76%) and 732 (66%) provided useful information. Full adherence to preferred clinical trial practices was highest for institutional review of signed contracts and budgets (82% and 75% of investigators respectively). Lower rates of full adherence were reported for the other two practices in the trial preparation stage (avoidance of confidentiality clauses, 12%; trial registration after 2005, 39%). Lower rates of full adherence were reported for 7 practices in the trial conduct (35% to 43%) and dissemination (53% to 64%) stages, particularly in industry funded trials. 269 investigators personally experienced (n = 85) or witnessed (n = 236) a fCOI; over 70% of these situations related to industry trials. Full adherence to practices designed to promote the objectivity of research varied across trial stages and was low overall, particularly for industry funded trials.

  11. National Human Resources Survey of Clinical Neurophysiologists in Canada.

    Science.gov (United States)

    Chan, K Ming; Young, G Bryan; Warren, Sharon

    2009-05-01

    Although electromyography (EMG), electroencephalography (EEG) and evoked potential (EP) studies are common investigation tools for patients with neurologic illnesses, no formal data on the manpower supply in Canada exists. Because of the importance of these on training requirements and future planning, the purpose of this study was to establish a comprehensive profile of the human resources situation in clinical neurophysiological services across Canada. A questionnaire was sent to all clinical neurophysiologists in Canada. To capture the maximal number of respondents, a total of three rounds of mail out were done. In addition, to obtain accurate demographic data on supporting technologists, a separate survey was also carried out by the Association of Electrophysiological Technologists of Canada. Of the 450 clinical neurophysiologists identified and surveyed, the provincial response rate was 59 +/- 14% (mean +/- SD). Of these, the vast majority practiced in urban centres. There was substantial regional disparity in different provinces. While the wait time for most EEG and EP laboratories was less than six weeks, the wait time for EMG was substantially longer. With the age of the largest number of practitioners in their sixth decade, projected retirement over the next 15 years was 58%. The demographic distribution of the supporting technologists showed a similar trend. In addition to considerable regional disparity and urban/rural divide, a large percentage of clinical neurophysiologists and supporting technologists planned to retire within the coming decade. To ensure secure and high standard services to Canadians, solutions to fill this void are urgently needed.

  12. [Survey on clinical characteristics of pediatric allergic rhinitis].

    Science.gov (United States)

    Sha, Ji-Chao; Zhu, Dong-Dong; Dong, Zhen; Jiang, Xiao-Dan; Li, Lin; Zhu, Xue-Wei; Cui, Na; Wang, Qian

    2011-01-01

    To investigate the clinical symptom, precipitating factor, associated symptom, family history and life quality of pediatric patients with allergic rhinitis, and to analyze the characteristic of clinical symptoms. A questionnaire survey on pediatric AR patients since June 2008 to June 2010, one hundred and forty-eight pediatric AR patients were divided into 2 groups, group A (n = 43) included children aged from 3.2 to 6.0, group B (n = 105) included children aged from 6.1 to 14.8. The severity degree of clinical symptom was assessed by visual analogue scale. Preschool age children had more severe rhinocleisis, more severe cough and less rhinorrhea than school age children (χ(2) value were 29.194, 12.277 and 16.904, respectively, P allergic disease history was 11.5% (17/148). Quality of sleep that 66.2% (98/148) were upset and 62.2% (92/148) had no cathexis. The preschool children have different clinical symptom characteristic from the school age children, and we got some clinical data of pediatric AR patients, those were beneficial to the diagnose and therapy of pediatric AR. The clinical data obtained in this study from pediatric AR patients are beneficial to the diagnosis and therapy of pediatric AR.

  13. [An Investigation of the Role Responsibilities of Clinical Research Nurses in Conducting Clinical Trials].

    Science.gov (United States)

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

    2015-06-01

    Clinical research nurses (CRNs) play an important role in improving the quality of clinical trials. In Taiwan, the increasing number of clinical trials has increased the number of practicing CRNs. Understanding the role responsibilities of CRNs is necessary to promote professionalism in this nursing category. This study investigates the role responsibilities of CRNs in conducting clinical trials / research. A questionnaire survey was conducted in a medical center in Taipei City, Taiwan. Eighty CRNs that were registered to facilitate and conduct clinical trials at this research site completed the survey. "Subject protection" was the CRN role responsibility most recognized by participants, followed by "research coordination and management", "subject clinical care", and "advanced professional nursing". Higher recognition scores were associated with higher importance scores and lower difficulty scores. Participants with trial training had significantly higher difficulty scores for "subject clinical care" and "research coordination and management" than their peers without this training (p role responsibilities" (p management" (p role responsibilities, explaining 21.9% of the total variance. To further promote CRN as a professional career in Taiwan, the findings of this study recommend identifying the core competences of CRNs and adding CRN-related study materials into the advanced nursing curriculum. Long-term and systematic educational training may help CRNs understand the importance of their role responsibilities, better recognize their professional role, and reflect these responsibilities in clinical practice.

  14. Clinical and immunological surveys in bee keepers.

    Science.gov (United States)

    Bousquet, J; Coulomb, Y; Robinet-Levy, M; Michel, F B

    1982-07-01

    Two hundred and fifty bee keepers in the South of France, working seasonally, were clinically investigated by means of a questionnaire. Forty-three per cent had presented anaphylactic symptoms and 7.0% toxic reactions when stung by bees. The personal atopic history was found to be significantly (P less than 0.01) elevated in bee keepers who experienced anaphylaxis. Total serum IgE and been venom-specific IgE were titrated in 100 subjects. Total serum IgE was significantly elevated in allergic bee keepers (P = 0.02). Although bee venom-specific IgE were significantly (P less than 0.01) higher in allergic bee keepers this parameter cannot discriminate between allergic and non-allergic bee keepers owing to a considerable overlap. Bee venom-specific IgG was assayed in seventy subjects. Their level was significantly (P less than 0.001) higher in allergic and non-allergic bee keepers as compared with non-allergic blood donors and non-bee-keeping allergic patients. In both bee keeper groups there was no difference in bee venom-specific IgG titres.

  15. Survey Response Rates and Survey Administration in Counseling and Clinical Psychology: A Meta-Analysis

    Science.gov (United States)

    Van Horn, Pamela S.; Green, Kathy E.; Martinussen, Monica

    2009-01-01

    This article reports results of a meta-analysis of survey response rates in published research in counseling and clinical psychology over a 20-year span and describes reported survey administration procedures in those fields. Results of 308 survey administrations showed a weighted average response rate of 49.6%. Among possible moderators, response…

  16. 2015 Military Investigation and Justice Experience Survey (MIJES). Overview Report

    Science.gov (United States)

    2016-03-16

    other member of the Armed Forces who reports a criminal offense. The section further requires that violation of those regulations be punishable under...2016 Military Investigation and Justice Experience Survey (MIJES) DMDC | iii Executive Summary The Department of Defense (DoD) has a strong...did not result in a criminal investigation by a Military Criminal Investigator (MCIO), whose alleged perpetrator was not a military member, and who

  17. The clinical implementation of pain neuroscience education: A survey study.

    Science.gov (United States)

    Louw, Adriaan; Puentedura, Emilio J; Zimney, Kory; Cox, Terry; Rico, Debbie

    2017-11-01

    Pain neuroscience education (PNE) has gained considerable attention in research. Three systematic reviews have shown increasing efficacy of PNE decreasing pain, disability, pain catastrophization, movement restrictions, and healthcare utilization. In the development of any new therapeutic approach, it is proposed that there are three stages: development, validation, and implementation. To date, the development and validation of PNE have been well-established. The third stage, implementation, however, lacks when it comes to PNE. The purpose of this study was to survey physical therapists (PT) on their experience and implementation of PNE, following a 15-hour PNE class. Upon development and validation of a PT-PNE survey, a random sample of PTs was invited to take the online survey. Two hundred and eighty-six PTs (female 56%) completed the PNE questionnaire. Ninety-one percent of PTs reported not being taught PNE in PT school. PT's are applying PNE into clinical practice to a variety of patients, experience outcomes in line with the current best-evidence, but struggle establishing which patients are ideal for PNE. The same five patient characteristics associated with success were also associated with failure, albeit in a different ranking order. This finding highlight the need to further investigate the factors associated with success and failure of PNE.

  18. A clinical survey of paraquat formulation workers.

    Science.gov (United States)

    Howard, J K

    1979-08-01

    A group of 18 male Caucasian workers from the United Kingdom and a further group of 18 male mixed race (mainly Malay) workers from Malaysia employed in the formulation of paraquat-based herbicides were examined for evidence of chronic ill health after long-term exposure to paraquat. Clinical records were examined, medical and occupational histories were obtained and a clinical examination, particularly of the skin, was undertaken. Skin rashes, nail damage and epistaxes were encountered by most workers as a result of direct contact of skin and mucous membranes with paraquat. These conditions subsided rapidly and no worker reported any sequelae. There was no clinical evidence of long-term effects on skin, mucous membranes or general health following exposure to paraquat over several years in these workers.

  19. Adding Clinical Validity to the Statistical Power of Large-Scale Epidemiological Surveys on Internet Addiction in Adolescence: A Combined Approach to Investigate Psychopathology and Development-Specific Personality Traits Associated With Internet Addiction.

    Science.gov (United States)

    Müller, Kai W; Dreier, Michael; Duven, Eva; Giralt, Sebastian; Beutel, Manfred E; Wölfling, Klaus

    2017-03-01

    Research has indicated that internet addiction is associated with psychosocial maladjustment in adolescence. Many epidemiologic surveys are lacking representativeness, and knowledge on disorder-specific risk factors is scarce. One weakness of epidemiologic studies often regards their lack of generalizability to clinical reality. The aim of this study was to provide a detailed description of internet addiction among adolescents, focusing on its prevalence in a population-based context, psychopathological correlates, and predisposing factors. The main analyses were based on 2 large representative samples of German adolescents (N = 9,293; 12-19 years) collected in 2012, and the results were validated on a consecutive sample of 237 treatment-seeking adolescents (from 2009-2014). The Scale for the Assessment of Internet and Computer Game Addiction (AICA-S), Strengths and Difficulties Questionnaire (SDQ), Symptom Checklist-90 Revised (SCL-90R), and NEO-Five Factor Inventory (NEO-FFI) were administered. Internet addiction occurred in 2.6% of adolescents, with almost comparable rates in both genders, whereas female patients (1.3%) were underrepresented among the treatment seekers. Internet-addicted adolescents from the clinical and the nonclinical setting displayed higher psychopathology (SDQ: P adolescents with nonproblematic internet use. Low conscientiousness (in boys: β = -0.161 to -0.220; in girls: β = -0.103 to -0.240) and high negative affect (in boys: β = 0.141 to -0.193; in girls: β = 0.175 to 0.290) were personality correlates of internet addiction. Internet addiction is a widespread problematic behavior among male and female adolescents, and it is related to psychopathological symptoms. Low conscientiousness and high negative affect were identified as stable correlates for internet addiction independent of age and gender and can therefore be considered as risk factors for internet addiction.

  20. 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.

  1. Porcelain laminate veneers: Clinical survey for evaluation of failure

    Science.gov (United States)

    Alhekeir, Diemah F.; Al-Sarhan, Rana A.; Al Mashaan, Abdulmohsen F.

    2014-01-01

    Objective To investigate the association of the failure of porcelain laminate veneers with factors related to the patient, material, and operator. Methods This clinical survey involved 29 patients (19 women and 10 men) and their dentists, including undergraduate and postgraduate dental students and dental interns. Two questionnaires were distributed to collect information from participants. All patients were clinically examined. Criteria for failure of the porcelain laminate veneers included color change, cracking, fracture, and/or debonding. Results A total of 205 porcelain laminate veneers were evaluated. All of the restorations were fabricated from IPS e.max Press and cemented with Variolink Veneer (Ivoclar Vivadent, Schaan, Principality of Liechtenstein) or RelyX veneer cement (3M ESPE, St. Paul, MN, USA). The preparations were generally located in enamel (58.6%), and most veneers had an overlapped design (89.7%). Ten patients (34.48%) showed veneer failure, most often in terms of color change (60%). Overall, 82.8% of patients were satisfied with their restorations. Conclusion Insufficient clinical skills or operator experience resulted in restoration failure in one-third of patients. PMID:25408598

  2. Porcelain laminate veneers: Clinical survey for evaluation of failure.

    Science.gov (United States)

    Alhekeir, Diemah F; Al-Sarhan, Rana A; Al Mashaan, Abdulmohsen F

    2014-04-01

    To investigate the association of the failure of porcelain laminate veneers with factors related to the patient, material, and operator. This clinical survey involved 29 patients (19 women and 10 men) and their dentists, including undergraduate and postgraduate dental students and dental interns. Two questionnaires were distributed to collect information from participants. All patients were clinically examined. Criteria for failure of the porcelain laminate veneers included color change, cracking, fracture, and/or debonding. A total of 205 porcelain laminate veneers were evaluated. All of the restorations were fabricated from IPS e.max Press and cemented with Variolink Veneer (Ivoclar Vivadent, Schaan, Principality of Liechtenstein) or RelyX veneer cement (3M ESPE, St. Paul, MN, USA). The preparations were generally located in enamel (58.6%), and most veneers had an overlapped design (89.7%). Ten patients (34.48%) showed veneer failure, most often in terms of color change (60%). Overall, 82.8% of patients were satisfied with their restorations. Insufficient clinical skills or operator experience resulted in restoration failure in one-third of patients.

  3. A national survey of memory clinics in Australia.

    Science.gov (United States)

    Woodward, Michael Clifford; Woodward, Erin

    2009-08-01

    There is limited information describing memory clinics at a national level in Australia. The aim of this study was to gather information about the resourcing, practices and clinical diagnoses of Australian memory clinics. A postal survey was sent to all Australian memory clinics identified by key specialists working in dementia assessment services. Of 23 surveys sent out, 14 were returned. Most clinics are located in Victoria where they receive Victorian state funding. The average clinic has 1.67 effective full time clinical staff including 0.42 medical staff, 0.24 allied health staff, 0.53 clinical nursing staff and 0.48 psychologists. Clinics are open on average twice a week and each half-day clinic has two new and three review patients, seeing new patients twice initially then once more over 12 months. Patients wait 10 weeks for initial assessment with 59% referred by general practitioners. The Mini-mental State Examination and clock drawing are utilized universally. The most common diagnoses are Alzheimer's disease (37.8%) and mild cognitive impairment (19.8%) but 6.9% of patients have no cognitive impairment. This survey has provided useful benchmarking data on Australian memory clinics which can also be used by other countries for comparative analyses.

  4. A survey of patients' attitudes to clinical research.

    LENUS (Irish Health Repository)

    Desmond, A

    2011-04-01

    Every year hundreds of patients voluntarily participate in clinical trials across Ireland. However, little research has been done as to how patients find the experience. This survey was conducted in an attempt to ascertain clinical trial participants\\' views on their experience of participating in a clinical trial and to see and how clinical trial participation can be improved. One hundred and sixty-six clinical trial participants who had recently completed a global phase IV cardiovascular endpoint clinical trial were sent a 3-page questionnaire. Ninety-one (91%) respondents found the experience of participating in a clinical trial a good one with 85 (84.16%) respondents saying they would recommend participating in a clinical trial to a friend or relative and eighty-five (87.63%) respondents feeling they received better healthcare because they had participated in a clinical trial.

  5. Clinical survey to detect diabetes mellitus, Hiroshima

    Energy Technology Data Exchange (ETDEWEB)

    Rudnick, P.A.; Anderson, P.S. Jr.

    1961-07-19

    Data from this study are in agreement with the general observations that diabetes is not uncommon in Japan. In an adult study population in Hiroshima 108 patients with diabetes were detected, yielding the prevalence rate of 3.02 percent. Nearly one-half of the patients were diagnosed initially as a result of the routine detection program. Although in females a trend with exposure is suggested by the raw data no statistically significant differences could be demonstrated. However, the size of the sample involved does not permit confident negative conclusions. Additional clinical and laboratory observations were completed in order to characterize the manifestation of diabetes in these subjects. Late manifestations of diabetes frequently were found, but atherosclerotic complications were nonexistent. This is considered to be related to the low fat, high carbohydrate diet of the Japanese. The lack of ketosis, apparently low prevalence rate for juveniles, and male preponderance suggest that diabetes in Japan differs from the disease found in many Western countries. 69 references, 1 figure, 9 tables.

  6. Marine Neotectonic Investigations Using Integrated AUV and ROV Surveys

    Science.gov (United States)

    Paull, C. K.; Caress, D. W.; Gwiazda, R.; Lundsten, E. M.; Anderson, K.; Sumner, E. J.; McGann, M.; Brothers, D. S.; Herguera, J. C.

    2014-12-01

    Detailed investigations of 15 sites associated with seafloor faults and/or slope failures have been conducted with MBARI's Autonomous Underwater Vehicles (AUVs) and Remotely Operated Vehicles (ROVs). The motivation for these surveys is to better constrain neotectonic deformation of the seafloor and thus to evaluate potential seafloor geohazards. The coupled use of AUVs and ROVs has enabled marine neotectonic investigations to be achieved at similar observational detail to that previously only possible on land. The AUV surveys provide 1-m resolution bathymetric grids with vertical resolutions of ~10 cm along with chirp sub-bottom profiles that allow subtle deformation on and near the seafloor to be detected. ROV surveys enable precisely located push core and vibracore samples. Sampling strategies include taking transects of closely spaced cores across faults (comparable to trenching on land), and taking transects of horizontal push cores along the faces of scarps where reflectors in chirp profiles crop out or occur in the shallow subsurface. The timing of fault movement can then be established via radiocarbon dating of appropriate material within the sediment samples. The marine environment offers some inherent advantages for neotectonic investigations over the terrestrial environment, as the seafloor geomorphology is relatively unaffected by the deleterious effects of human development (agriculture and urbanization), has no vegetative cover, and is likely to experience continuous deposition of 14C datable materials. Examples will be shown of how AUV and ROV technologies help to constrain the extent, style, and timing of deformation associated with: the San Gregorio fault, offshore central California; the Palos Verdes and San Diego trough faults off southern California; transform faults within the Gulf of California; and young slump scars off Monterey, California. The increased resolution provided by these tools frequently leads to interpretations that differ from

  7. The value of DCIP geophysical surveys for contaminated site investigations

    DEFF Research Database (Denmark)

    Balbarini, Nicola; Rønde, Vinni Kampman; Maurya, Pradip Kumar

    Geophysical methods are increasingly being used in contaminant hydrogeology to map lithology, hydraulic properties, and contaminant plumes with a high ionic strength. Advances in the Direct Current resistivity and Induced Polarization (DCIP) method allow the collection of high resolution three...... dimensional (3D) data sets. The DC resistivity can describe both soil properties and the water electrical conductivity, while the IP can describe the lithology and give information on hydrogeological properties. The aim of the study was to investigate a large contaminant plume discharging to a stream from...... water and below the streambed. Surface DCIP surveys supported the characterization of the spatial variability in geology, hydraulic conductivity and contaminant concentration. Though DCIP data interpretation required additional borehole data, the DCIP survey reduced the number of boreholes required...

  8. CLINICAL AND INVESTIGATIONAL STUDY OF DIABETIC KETOACIDOSIS

    Directory of Open Access Journals (Sweden)

    Narasimham

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: To compare the clinical features and biochemical profile in DKA. To assess the response in the patients with standard treatment of DKA. Clinical descriptions of polyuric states resembling diabetes mellitus have been described in the Ebers papyrus of Egypt in 15th century BC . 1,2 A yurvedic literature from the times of Charaka and Sushrutha, the ancient Indian physicians identified two forms of “MadhuMeha” ( H oneyed Urine in 400 BC . 3 John Rolo of England in 1797 was one of 1st who coined the term diabetes mellitus. William Prout of E ngland described diabetic coma during 1810 – 20. In 1886, Dreschfeld8 described DKA and HHNS (Hyper osmolar Hyperglycemic Non - ketotic Syndrome. In 1922 Banting , Best, Collip and Macleod isolated and clinically used insulin and later won Nobel prize for that memorable invention. SETTING: Inpatients of king George Hospital attached to Andhra Medical College, Visakhapatnam . METHODS: Diagnosis of diabetic ketoacidosis was made according to the inclusion criteria. Hyperglycemia >250 mg/dl, acidosis with blood pH <7.3, serum bicarbonate <15 mEq/l, urine positive for ketones. RESULTS: Of the 100 patients admitted for diabetic ketoacidosis; 84 had type 2 diabetes (84% and 16(16% were type I diabetes. Average age at the time of presentation was 42.9±12.9 years. Th e commonest precipitating factor was infection (56% followed by other factors (28% and irregular treatment (16%. The most common clinical features at the time of presentation were vomiting, abdominal pain, acidotic breathing and dehydration. The values for RBS, HCO3, and pH were 355.3±69.1, 14.9±3.4 and 7.2±0.1 respectively. INTERPRETATION AND CONCLUSION: Most common precipitating factors are infection and omission of insulin or irregular treatment. Most common clinical features at the time of presentati on are vomiting, abdominal pain, dehydration, acidotic breathing and tachycardia. Mortality rate in diabetic

  9. Clinical Investigation Program Report FY90

    Science.gov (United States)

    1990-10-01

    reserve. Technical Approach: Patients admitted to the hospital with the diagnosis of hypertrophic cardiomyopathy , dildted cardiomyopathy , left...Gooden SM: Complications of percutaneous endoscopic gastrostomy. Submitted to Am Surg. 7 PRESENTATIUNS DEPARTMENT CF uLINICAL INVESTIGATION Runner RR... Complications of surgery for ulcer disease. Medical College of Georgia, Augusta, GA, Nov 1989. Martindale RG: Nutrition in the chronic care facility

  10. Clinical Investigation Program. Annual Progress Report.

    Science.gov (United States)

    1981-09-30

    Kingston, DVM (9) Dept/Sec: _ (10) Assoc Investigators: (11) Key Words: canine parvovirus John W. Harbe.l, Ph.D.,CPTMSC cerebellar hypoplasia SP5 Leslie ...Words: Acupuncture MAJ Ernie Lin, M.D. Trigger Point Stimulation ILT Joan Beebe , Physical Therapist (12) Accumulative MEDCASE: 1(13) Est Accumulative (14...050 Bailey, S.R.------------------------053,113 Barber, J.A.------------------------088,216,217 Beebe , J

  11. Clinical Investigation Program Annual Progress Report.

    Science.gov (United States)

    1985-09-30

    TmDact of Decisional Control on Patient Satisfaction and Selected Health Care Outcome (T).. 278 FAMC TENANT 83/800 The Health Evaluation Project (of the...Lenses (5) Start Date. ]qgg (6) Est Compi Date: UNKNOWN (7) Principal Investigator: (8) Facility: FAMC TOMAS CORONADO, M.D. ENERAL LEONARD WOOD ARMY...85/702 (3) Status: Terminated (4) Title: The Impact of Decisional Controi on Patient Satisfaction and Selected Health Care Outcomes (5) Start Date

  12. Clinical Investigation Program Annual Progress Report.

    Science.gov (United States)

    1984-09-30

    Bornemann, M. and Hofeldt, F.D.: Insulin Induced Hypoglycemia in Type I Diabetics. (In Press, Diabetes Educator , 1984). Bornemann, M., Kidd, G.S. and...physician experience in research and investigative procedures by furnishing a highly educated and trained staff of specialists, laboratory facilities...Mechanics During Frequency Jet Ventilation with CPAP . (Abst) Syllabus of the Postgraduate Course on High Frequency Ventilation. p 81-82 1983, Memorial

  13. A survey of UK clinical librarianship: February 2004.

    Science.gov (United States)

    Ward, Linda

    2005-03-01

    This article will describe a survey carried out in February 2004, the aim of which was to summarize the form and content of clinical librarian (CL) and other similar outreach information services to UK health professionals in the acute (secondary or tertiary) sector. (i) To survey the activities and views of UK information professionals offering information services involving the librarians' presence in the clinical setting, (ii) to develop a tool to explore critical aspects of this form of information work, (iii) to create a contacts database for UK CLs, to be made available on the Internet. All known information specialists/librarians offering CL or similar services were surveyed. The semi-structured questionnaire was piloted. Respondents were asked to consider their activity over a period of 4 weeks. Twenty-six people responded to the invitation to take part and met the inclusion criteria. A summary of a 'typical' clinical librarian revealed by this survey is given, with a major conclusion that there is a very mixed picture of activity. Opinion on how far CLs should go in fully appraising search results is uncertain. The survey suggests reasons for this and the developments that may influence change are discussed. Recommendations for future research and development are offered.

  14. A survey of pregnant and postnatal women, clinic attendees and ...

    African Journals Online (AJOL)

    A survey of pregnant and postnatal women, clinic attendees and maternity staff regarding the presence of birth companions during labour and delivery. ... The opinions of obstetricians were obtained through consultations held at a central government hospital. Responses were recorded, analysed and grouped under themes ...

  15. Coupled Interpretation of Geoelectrical Surveying Results in Environmental Site Investigations

    Science.gov (United States)

    Skold, M.; Hubbard, S. S.; Karaoulis, M.; Revil, A.; Spycher, N.; Watson, D. B.; Wu, Y.

    2011-12-01

    Geoelectric methods are sensitive to material properties which can be used to investigate subsurficial processes at contaminated sites. Electrical resistivity tomography (ERT) measures the electrical resistivity distribution in the ground; the self-potential (SP) method is based on source current densities resulting from ground water flow; and induced polarization (IP) responds to geochemical interactions between mineral surfaces and pore fluids. Ground water flow patterns and contaminant migration may be better understood if the results of these survey methods are interpreted jointly rather than separately. The purpose of this project is to jointly interpret results of geophysical surveying and laboratory characterization of soil and ground water samples to assess ground water flow patterns and contaminant migration at a site within the Oak Ridge National Laboratory. Historical disposal of liquid waste containing nitric acid and uranium in unlined ponds has resulted in contamination of soil and ground water. ERT, SP, and IP surveying was performed downgradient of the source area and the geophysical behavior of sediment and ground water samples was investigated in the laboratory. Measured electrical conductivity and self-potential anomalies coincided with elevated nitrate and uranium concentrations indicating preferential flow from the source area. The self-potential response can be related to ground water flow either by calculating the excess of charge in the diffuse layer surrounding mineral surfaces or by the streaming potential coupling coefficient. Geochemical reactions between pore water and minerals and their surfaces were modeled using the contaminant transport software TOUGHREACT. Surface complexation modeling using the Gouy-Chapman diffuse double layer was used to simulate charge density-surface potential relationship. Laboratory measurements of the streaming potential coupling coefficient of sediment samples at various pH and salt concentrations were

  16. Oligocone trichromacy: clinical and molecular genetic investigations

    DEFF Research Database (Denmark)

    Andersen, Mette K G; Christoffersen, Nynne L B; Sander, Birgit

    2010-01-01

    ERG). Five patients also underwent multifocal (mf)ERG, autofluorescence recording, and optical coherence tomography (OCT). Genetic analysis included sequencing of all coding regions and flanking introns of CNGA3, CNGB3, GNAT2, KCNV2, and PDE6C. RESULTS: All patients had subnormal visual acuity, a history...... investigations showed either complete absence of recordable cone responses or severely reduced amplitudes. All retinal layers were identifiable by OCT, which also showed thinning of the peripheral retina. Genetic analysis revealed two causative CNGB3 mutations in one patient and single heterozygous mutations...... of unknown significance in CNGB3 and PDE6C in two other patients. CONCLUSIONS: Oligocone trichromacy is a heterogeneous condition with respect to both phenotypic appearance and genetic background. The finding of mutations in genes known to be involved in complete and incomplete achromatopsia supports...

  17. Sesame seed allergy: Clinical manifestations and laboratory investigations

    Directory of Open Access Journals (Sweden)

    Fazlollahi MR.

    2007-10-01

    Full Text Available Background: Plant-origin foods are among the most important sources of food allergic reactions. An increase in the incidence of sesame seed allergy among children and adults has been reported in recent years. The aim of this preliminary study was to investigate the prevalence, importance and clinical manifestations of sesame allergy among Iranian patients.Methods: In a cross-sectional survey, 250 patients with suspected IgE-mediated food allergies completed a questionnaire and underwent skin prick tests with sesame extract as well as cross-reacting foods (walnut, soya and peanut. Total IgE and sesame-specific IgE levels were measured. Patients with positive skin test reactions and/or IgE specific for sesame without clinical symptoms were considered sensitive to sesame. The patients who also had clinical symptoms with sesame consumption were diagnosed as allergic to sesame.Results: Of the 250 patients enrolled in this study, 129 were male and 121 female, with a mean age of 11.7 years. The most common food allergens were cow's milk, egg, curry, tomato and sesame. Sesame sensitivity was found in 35 patients (14.1%. Only five patients (2% had sesame allergy. Sesame-sensitive patients had a significantly higher frequency of positive prick test to cross-reacting foods when compared to non-sensitized patients (p=0.00. The type of symptom was independent of gender and age of the patients, but urticaria and dermatitis-eczema were significantly more frequent in sensitized patients (p=0.008.Conclusions: This is the first study addressing the prevalence of sesame seed allergy in Iranian population. We found sesame to be a common and important cause of food allergy. The panel of foods recommended for use in diagnostic allergy tests should be adjusted.

  18. Assessment of technical documentation of medical devices for clinical investigation

    NARCIS (Netherlands)

    Roszek B; Bruijn ACP de; Drongelen AW van; Geertsma RE; BMT

    2007-01-01

    The technical documentation on non-market approved medical devices intended for clinical investigation contains major shortcomings. This could imply increased risks which could affect patient safety. The investigation described here focused on the availability and quality of the technical

  19. 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.

  20. VLBI telescopes' gravitational deformations investigated with terrestrial surveying methods

    Science.gov (United States)

    Sarti, P.; Abbondanza, C.; Negusini, M.; Vittuari, L.

    2008-09-01

    Large VLBI telescopes undergo gravitational deformations which affect both geodetic and astronomic observations. In order to assess the extent and magnitude of such deformations and to evaluate their effect on telescopes' performances, terrestrial surveying methods can be applied to monitor the telescopes' structure at different pointing elevations. Finite Element Model analysis, laser scanner surveying, trilateration and triangulation have been applied on the telescope in Medicina to estimate i) the deformations of the primary mirror and to monitor ii) the position of the feed horn located at the primary focus and iii) the position of the vertex of the paraboloid. If detectable, these deformations modify the position of the primary focus and the signal path length and may therefore reduce the antenna gain and bias the phase of the incoming signal. We are presenting the investigations performed on the Medicina VLBI telescope, quantifying the magnitude of the deformations of the primary dish, the quadrupode and the vertex and we are also presenting an elevation dependent model for signal path corrections.

  1. Biennial survey of physician clinical nutrition training programs.

    Science.gov (United States)

    Merritt, R J; Heymsfield, S B; Howard, L; Rombeau, J

    1988-05-01

    This is the third survey of physician clinical nutrition training programs. Current training programs were identified, descriptive information obtained, and training program content was compared with that recommended at the 1984 Conference on Clinical Nutrition Training. In general, goals as to the quantity of research, clinical, and teaching training are being met. Virtually all programs provide training in nutritional support activities. Most training programs are not as broad in scope of exposure to the less clinical aspects of nutrition nor to all the illness and age groups recommended by the 1984 conference. Consideration of broadening the scope of physician training programs or redefinition of training guidelines is warranted. A program-certifying agency may be helpful in identifying programs achieving certain minimal standards.

  2. Spirituality in tobacco dependence: a Mayo Clinic survey.

    Science.gov (United States)

    McFadden, David; Croghan, Ivana T; Piderman, Kathryn M; Lundstrom, Carl; Schroeder, Darrell R; Hays, J Taylor

    2011-01-01

    With widespread interest in natural remedies and "wholistic" treatments, there has been a renewed focus on the impact of spirituality related alternative therapy for many current chronic diseases. To assess the potential impact of spiritual beliefs on lifestyle choices such as tobacco use, we conducted a patient survey. This cross-section study was conducted using a 27-question survey of patients seen at the Mayo Clinic over a 14-week period. We invited all patients (smokers and nonsmokers) seen in several Mayo Clinic divisions to participate in this voluntary survey. The survey included demographic information, history of tobacco use or nonuse, and assessment of spirituality. Among the 501 patients who participated, 370 were nonsmokers and 131 were smokers. Compared with smokers, nonsmokers more often participated in religious activities such as regular weekly church attendance (48% vs. 24%), daily prayer, and Bible study (49% vs. 24%; P Bible study, and regular church attendance. Further studies may be helpful to clearly define the potential impact of spirituality on smoking cessation. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Activity and education of clinical dental technicians: a UK survey.

    Science.gov (United States)

    Ross, M K; Ibbetson, R J; Turner, S

    2007-11-24

    This survey aimed to determine the clinical activity of clinical dental technicians (CDTs) in the UK and to establish their employment status, views of statutory registration and need for further education. Until 2006, this practise was illegal in the UK. A postal questionnaire was sent to 128 members of the Clinical Dental Technicians' Association (CDTA) who had agreed to participate in this study. Analysis was conducted using standard non-parametric statistical tests and quantitative techniques. A response rate of 54% was achieved. Qualifications in clinical dental technology from George Brown College, Toronto, Canada were held by 68%, with 16% currently undergoing training and 16% neither qualified nor in training. The majority (90%) owned a laboratory with 61% stating they had between one and four dental surgeries on site. CDTs with Canadian qualifications tended to provide a wider range of procedures, coupled with patient lists and recall systems, compared to those not so qualified. Eighty-one percent welcomed the prospect of statutory registration with 82% indicating that it would enhance their professional profile. This small but significant survey gives some insight of the work which has been undertaken by CDTs for many years, albeit illegally. With appropriate training and education, and consequent GDC registration, CDTs will be in a position to make a positive contribution to the clinical care of patients.

  4. The partnership of patient advocacy groups and clinical investigators in the rare diseases clinical research network.

    Science.gov (United States)

    Merkel, Peter A; Manion, Michele; Gopal-Srivastava, Rashmi; Groft, Stephen; Jinnah, H A; Robertson, David; Krischer, Jeffrey P

    2016-05-18

    Among the unique features of the Rare Diseases Clinical Research Network (RDCRN) Program is the requirement for each Consortium to include patient advocacy groups (PAGs) as research partners. This development has transformed the work of the RDCRN and is a model for collaborative research. This article outlines the roles patients and PAGs play in the RDCRN and reports on the PAGs' impact on the Network's success. Principal Investigators from the 17 RDCRN Consortia and 28 representatives from 76 PAGs affiliated with these Consortia were contacted by email to provide feedback via an online RDCRN survey. Impact was measured in the key areas of 1) Research logistics; 2) Outreach and communication; and 3) Funding and in-kind support. Rating choices were: 1-very negative, 2-somewhat negative, 3-no impact, 4-somewhat positive, and 5-very positive. Twenty-seven of the PAGs (96 %) disseminate information about the RDCRN within the patient community. The Consortium Principal Investigators also reported high levels of PAG involvement. Sixteen (94 %) Consortium Principal Investigators and 25 PAGs (89 %) reported PAGs participation in protocol review, study design, Consortium conference calls, attending Consortium meetings, or helping with patient recruitment. PAGs are actively involved in shaping Consortia's research agendas, help ensure the feasibility and success of research protocols by assisting with study design and patient recruitment, and support training programs. This extensive PAG-Investigator partnership in the RDCRN has had a strongly positive impact on the success of the Network.

  5. Emergency medicine resident clinical hours: a national survey.

    Science.gov (United States)

    Stowell, Jeffrey R; Vohra, Taher T; Luber, Samuel D

    2015-04-01

    Emergency medicine (EM) residency programs have significant scheduling flexibility. As a result, there is potentially significant variation in scheduling practices. Few studies have previously sought to describe this variation. It is unknown how this affects training time in the emergency department. The purpose of this study was to describe the current variation in clinical training practices through clinical hour, shift length, and rotation survey data. A 21-item questionnaire was distributed to all allopathic EM training programs utilizing an online survey during the 2011-2012 academic year. Questions included demographic data, number of EM rotations per year, shifts, average hours, shift length, and scheduling practices. A total of 122 responses were received and 82 programs were analyzed (51.6% of 159 allopathic programs). EM residents work, on average, 45.50 h per week. Postgraduate year 1-3 programs utilizing 28-day schedules averaged two additional EM rotations and 338.2 more clinical EM hours compared with calendar-month rotations. The residents of 4-year programs work approximately 1300 additional hours during residency, with an average of 1279.26 h and 7.9 clinical EM rotations in the fourth year. Clinical hour ranges of 2670-5112 and 4248-6113 were observed for 3-year and 4-year programs, respectively. There are different scheduling modalities used to create resident schedules. This flexibility results in a large amount of diversity in scheduling practices, with certain patterns allowing for significantly more clinical time. This may result in a vastly different training experience for EM residents. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Investigators' perspectives on translating human microbiome research into clinical practice.

    Science.gov (United States)

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

    2013-01-01

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

  7. Acute Fatty Liver of Pregnancy: A Clinical-Paraclinical Survey

    Directory of Open Access Journals (Sweden)

    Mohammad Jafari

    2015-02-01

    Full Text Available Background Acute Fatty Liver of Pregnancy (AFLP is one of the serious complications of the pregnancy period. Surveying the laboratory and clinical signs is effective in timely prognosis and fast treatment of this illness. Objectives The current study aimed to evaluate AFLP among the hospitalized subjects. Patients and Methods This retrospective study was conducted on clinical and preclinical records of 25 females with AFLP for maternal and perinatal prognosis from 2000 to 2009. The data was analyzed using SPSS ver. 19. Results The patients aged 16 - 45 years old with one to four pregnancies (pregnancy; they were 24 to 39 weeks pregnant with the mean of 33.56 weeks, and 56% were multifarious. The most prevalent clinical symptoms were nausea, vomiting, abdominal pain, headache, pruritus, and icterus. The laboratory signs included disorders of liver, coagulation, kidney, and hypoglycemia. Nausea and vomiting in the first and second age groups (Group 1, patients were 35 years. were the most prevalent symptoms. No patient had fever, ascites, and polydipsia. There was one case of mother and fetal death. Conclusions In the current study, the clinical and paraclinical signs of AFLP were mostly - liver, coagulation, kidney, and hypoglycemia disorders. Considering that patients mostly refer in three phases of clinical, laboratory, and complications, it is essential to evaluate the suspected ones who present clinical symptoms especially nausea, vomiting and abdominal pain.

  8. Barriers to clinical leadership development: findings from a national survey.

    Science.gov (United States)

    Fealy, Gerard M; McNamara, Martin S; Casey, Mary; Geraghty, Ruth; Butler, Michelle; Halligan, Phil; Treacy, Margaret; Johnson, Maree

    2011-07-01

    To describe self-reported barriers to clinical leadership development among nurses and midwives in Ireland. Effective clinical leadership is essential for optimising care and improving patient outcomes. Clinical leadership development is concerned with intrapersonal and interpersonal capabilities and is context bound. Barriers to clinical leadership development among nurses and midwives are associated with interdisciplinary and organisational factors, such as lack of influence in interdisciplinary care planning and policy. A national postal survey of nurses and midwives was administered to a simple random sample of 3000 nurses and midwives in Ireland. The method of data collection was the Clinical Leadership Analysis of Need Questionnaire (CLAN-Q) Barriers Scale (CLAN-QBS), a self-administered, self-report questionnaire developed to measure the barriers to clinical leadership development. Mean scores for the CLAN-Q barriers subscales showed that barriers to clinical leadership development were perceived as lower in the dimension 'quality care factors', when compared with the dimensions 'interdisciplinary relationships, recognition and influence'. Staff and other promotional grades differed significantly in self-perceived barriers related to interdisciplinary working, influence and recognition of the disciplinary contribution. Differential experiences of barriers among higher and lower grades suggest that grade level may influence ability to negotiate work-related and organisational barriers to clinical leadership development. Overcoming the barriers to clinical leadership development requires attention to interdisciplinary relationships in the practicum and to the actual and perceived degree of relative influence that nurses and midwives have at wider departmental and organisational levels. © 2011 Blackwell Publishing Ltd.

  9. 2016 Military Investigation and Justice Experience Survey: Overview Report

    Science.gov (United States)

    2017-05-01

    former Director of the Defense Research, Surveys, and Statistics Center for Health and Resilience (RSSC[H& R ]) and Ms. Kristin Williams, acting...Research, Surveys, and Statistics Center (RSSC) within the Office of People Analytics (OPA) was tasked with this effort. The 2016 MIJES focuses...2014). The Defense Research, Surveys, and Statistics Center (RSSC), within the Office of People Analytics (OPA), was tasked with this effort. 7 For

  10. Disclosure of investigators' recruitment performance in multicenter clinical trials

    DEFF Research Database (Denmark)

    Dal-Ré, Rafael; Moher, David; Gluud, Christian

    2011-01-01

    Rafael Dal-Ré and colleagues argue that the recruitment targets and performance of all site investigators in multi-centre clinical trials should be disclosed in trial registration sites before a trial starts, and when it ends.......Rafael Dal-Ré and colleagues argue that the recruitment targets and performance of all site investigators in multi-centre clinical trials should be disclosed in trial registration sites before a trial starts, and when it ends....

  11. Survey of clinical nutrition practices of Canadian gastroenterologists

    Science.gov (United States)

    Singh, Harminder; Duerksen, Donald R

    2006-01-01

    OBJECTIVE: Nutrition education is a required part of gastrointestinal training programs. The involvement of gastroenterologists in clinical nutrition once their training has been completed is unknown. The aim of the present study was to determine the practice pattern of gastroenterologists in clinical nutrition and their perceived adequacy of nutrition training during their gastroenterology (GI) fellowship. METHODS: The Canadian Association of Gastroenterology mailed a survey to all of its 463 Canadian clinician members and 88 trainee members. Components of the survey included knowledge of nutritional assessment and total parenteral nutrition, involvement in a nutrition support service, physician involvement in nutritional assessment and nutrition support teams, obesity management, insertion of gastrostomy (G) tubes and management of tube-related complications, and adequacy of training in clinical nutrition. RESULTS: Sixty per cent (n=279) of the Canadian Association of Gastroenterology clinicians and 38% (n=33) of the fellows responded. Of the clinicians, 80% were practicing adult gastroenterologists with the following demographics: those practicing full time in academic centres (42%), community practice (45%), completed training in the last 10 years (32%) and those that completed training in the United States (14%). Although only 6% had a primary focus of nutrition in their GI practices, 65% were involved in nutrition support (including total parenteral nutrition), 74% placed G tubes and 68% managed at least one of the major complications of G tube insertion. Respondents felt a gastroenterologist should be the physician’s consultant on nutrition support services (89%). Areas of potential inadequate training included nutritional assessment, indications for nutrition support, management of obesity and management of G tube-related complications. The majority of clinicians (67%) and trainees (73%) felt that nutrition training in their GI fellowship was

  12. Survey of scholastic athletic health care and sports medicine clinics.

    Science.gov (United States)

    Kegerreis, S; Malone, T R; Greenwald, L; Knoeppel, D E

    1983-01-01

    The increasing number of athletes requiring health care has spurred the growth of the development of sports medicine clinics. The diversity of such clinics is readily apparent. These clinics primarily function to provide evaluative and rehabilitative measures to all groups of athletic participants. Scholastic health care for athletic participants has not proceeded in a similar pattern. Sports medicine clinics are not effectively meeting the needs of the scholastic athlete, primarily because of location and financial limitations. This survey was conducted to collect information to further delineate the problems associated with scholastic health care of athletic participants. It appears that sports medicine clinics are manned by several levels of health care professionals. Scholastic athletes are least adequately covered by insurance and also suffer from being within a somewhat isolated environment. The need for on-field care and follow-up care within the school system remains a key problem associated with scholastic health care. Further research into the relationship of insurance policies which will adequately meet the needs of the scholastic population must be pursued. J Orthop Sports Phys Ther 1983;5(2):78-81.

  13. Serious violence by people with mental illness: national clinical survey.

    Science.gov (United States)

    Flynn, Sandra; Rodway, Cathryn; Appleby, Louis; Shaw, Jenny

    2014-05-01

    This study aimed to estimate the prevalence of mental disorder in offenders convicted of serious violence, examine their social and clinical characteristics, and compare them with patients convicted of homicide. We examined a national clinical survey of all people convicted of serious violence in England and Wales in 2004. Mental disorder was measured by contact with mental health services within 12 months of the offense. Of the 5,966 serious violent offenders, 293 (5%) had been in recent contact with mental health services. Personality disorder (63, 22%) and schizophrenia (55, 19%) were the most common diagnoses. Most had previous convictions for violence (168, 61%). Seventy-two (25%) patients were at high risk of violence and 34 (49%) were not subject to the Care Programme Approach. Compared with serious violence offenders, homicide offenders were more likely to have been patients (293, 5% vs. 65, 10%; p violence, and weapon carriage.

  14. Nasogastric feeding practices: a survey using clinical scenarios.

    Science.gov (United States)

    Chan, Ee-Yuee; Ng, Isabel Hui-Ling; Tan, Sherrie Lee-Hong; Jabin, Kamilah; Lee, Leng-Noey; Ang, Ching-Ching

    2012-03-01

    Bolus nasogastric tube feeding is common. Unsafe practices such as failure to confirm tube placement can result in death. It is vital to ensure that nurses are adopting safe practices. To evaluate nurses' practices on bolus nasogastric feeding relating to verification of tube placement, management of gastric residual volume, and response to complications during feeding. Cross-sectional, self-administered survey using clinical scenarios. All nurses who worked in the general wards in a tertiary hospital in August 2008. We developed six clinical scenarios to describe common clinical situations in nurses' daily practices. Participants were instructed to choose the responses that best reflected their practices, and to return the completed questionnaires to the study member present. The survey participation rate was 99.5% (1203 nurses). Seventy-six percent would choose two or more methods to verify placement when they were in doubt. Percentage of hydrogen (pH) testing was the most common first method of checking tube placement. The second and third self-reported methods were auscultation and the bubble test. Few chose radiography to confirm tube placement. When the aspirate was pH 7, and in the presence of positive auscultation, most participants would take further steps to confirm placement. There were variations in the nurses' responses on managing the gastric residual volume, with 78.1% indicating that they would return the aspirate. Most nurses lacked the knowledge to effectively manage patients' distress during tube feeding. The findings showed that the majority of participants reported that they would exercise due caution by taking additional measures to check tube placement when in doubt. The practice gaps identified in the study highlighted a need to realign our care to best practices. Following the study, we revised the institution's guideline, reinforced specific safety precautions on nasogastric feeding, and incorporated clinical scenarios in our training

  15. Marine geophysical surveys off Kaverppattinam for archaeological investigations

    Digital Repository Service at National Institute of Oceanography (India)

    Rao, T.C.S.

    Marine geophysical surveys were carried out in Madras, 1990 in the offshore regions of Tranquebar and Kaverippattinam covering the area between 5 and 15 m water depth. In addition to several isolated objects, a continuous belt of small objects...

  16. Clinical investigations for SUS, the Brazilian public health system.

    Science.gov (United States)

    Paula, Ana Patrícia de; Giozza, Silvana Pereira; Pereira, Michelle Zanon; Boaventura, Patrícia Souza; Santos, Leonor Maria Pacheco; Sachetti, Camile Giaretta; Tamayo, César Omar Carranza; Kowalski, Clarissa Campos Guaragna; Elias, Flavia Tavares Silva; Serruya, Suzanne Jacob; Guimarães, Reinaldo

    2012-01-01

    Scientific and technological development is crucial for advancing the Brazilian health system and for promoting quality of life. The way in which the Brazilian Ministry of Health has supported clinical research to provide autonomy, self-sufficiency, competitiveness and innovation for the healthcare industrial production complex, in accordance with the National Policy on Science, Technology and Innovation in Healthcare, was analyzed. Descriptive investigation, based on secondary data, conducted at the Department of Science and Technology, Ministry of Health. The Ministry of Health's research management database, PesquisaSaúde, was analyzed from 2002 to 2009, using the key word "clinical research" in the fields "primary sub-agenda" or "secondary sub-agenda". The 368 projects retrieved were sorted into six categories: basic biomedical research, preclinical studies, expanded clinical research, clinical trials, infrastructure support and health technology assessment. From a structured review on "clinical research funding", results from selected countries are presented and discussed. The amount invested was R$ 140 million. The largest number of projects supported "basic biomedical research", while the highest amounts invested were in "clinical trials" and "infrastructure support". The southeastern region had the greatest proportion of projects and financial resources. In some respects, Brazil is ahead of other BRICS countries (Russia, India, China and South Africa), especially with regard to establishing a National Clinical Research Network. The Ministry of Health ensured investments to encourage clinical research in Brazil and contributed towards promoting cohesion between investigators, health policies and the healthcare industrial production complex.

  17. Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey.

    Science.gov (United States)

    Patrick, Allison; Laschinger, Heather K Spence; Wong, Carol; Finegan, Joan

    2011-05-01

    To test the psychometric properties of a newly developed measure of staff nurse clinical leadership derived from Kouzes and Posner's model of transformational leadership. While nurses have been recognized for their essential role in keeping patients safe, there has been little empirical research that has examined clinical leadership at the staff nurse level.   A non-experimental survey design was used to test the psychometric properties of the clinical leadership survey (CLS). Four hundred and eighty registered nurses (RNs) providing direct patient care in Ontario acute care hospitals returned useable questionnaires.   Confirmatory factor analysis provided preliminary evidence for the construct validity for the new measure of staff nurse clinical leadership. Structural empowerment fully mediated the relationship between nursing leadership and staff nurse clinical leadership. The results provide encouraging evidence for the construct validity of the CLS. Nursing administrators must create empowering work environments to ensure staff nurses have access to work structures which enable them to enact clinical leadership behaviours while providing direct patient care. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

  18. Zirconia abutments and restorations: from laboratory to clinical investigations.

    Science.gov (United States)

    Ferrari, M; Vichi, A; Zarone, F

    2015-03-01

    In last years the use of zirconia in dentistry has become very popular. Unfortunately, the clinical indications for a dental use of zirconia are not completely clear yet, neither are their limitations. The objective of this review was to evaluate the basic science knowledge on zirconia and to discuss some aspects of the clinical behavior of zirconia-based restorations. In particular, one of the goals was highlighting the possible correlation between in vitro and in vivo studies. The definition of concepts like success, survival and failure was still debated and the correlation between in vitro results and predictability of clinical behavior was investigated. Published by Elsevier Ltd.

  19. Nurse awareness of clinical research: a survey in a Japanese University Hospital.

    Science.gov (United States)

    Yanagawa, Hiroaki; Takai, Shigemi; Yoshimaru, Michiko; Miyamoto, Toshiko; Katashima, Rumi; Kida, Kikue

    2014-07-02

    Clinical research plays an important role in establishing new treatments and improving the quality of medical practice. Since the introduction of the concept of clinical research coordinators (CRC) in Japan, investigators and CRC work as a clinical research team that coordinates with other professionals in clinical trials leading to drug approval (registration trials). Although clinical nurses collaborate with clinical research teams, extended clinical research teams that include clinical nurses may contribute to the ethical and scientific pursuit of clinical research. As knowledge of clinical research is essential for establishing an extended clinical research team, we used questionnaires to survey the knowledge of clinical nurses at Tokushima University Hospital. Five-point and two-point scales were used. Questions as for various experiences were also included and the relationship between awareness and experiences were analyzed. Among the 597 nurses at Tokushima University Hospital, 453 (75.9%) responded to the questionnaires. In Japan, registration trials are regulated by pharmaceutical affairs laws, whereas other types of investigator-initiated research (clinical research) are conducted based on ethical guidelines outlined by the ministries of Japan. Approximately 90% of respondents were aware of registration trials and clinical research, but less than 40% of the nurses were aware of their difference. In clinical research terminology, most respondents were aware of informed consent and related issues, but ≤50% were aware of other things, such as the Declaration of Helsinki, ethical guidelines, Good Clinical Practice, institutional review boards, and ethics committees. We found no specific tendency in the relationship between awareness and past experiences, such as nursing patients who were participating in registration trials and/or clinical research or taking a part in research involving patients as a nursing student or a nurse. These findings suggest that

  20. What do clinical pharmacologists do? A questionnaire survey of senior UK clinical pharmacologists.

    Science.gov (United States)

    Aronson, Jeffrey K

    2012-02-01

    Since the discipline expanded during 1970-1990, the number of UK consultant clinical pharmacologists has fallen. This paper describes the results of a questionnaire survey of the work patterns of 53 UK consultant clinical pharmacologists, including 35 (66%) employed by universities and 13 (25%) employed by the National Health Service (NHS). The range of activities undertaken includes: teaching medical students and others the principles of clinical pharmacology and practical therapeutics; research in a wide range of pharmacological and therapeutic areas; patient care, mostly in acute and general hospital medicine and in out-patient clinics; service both locally and nationally on a wide range of committees related to drug therapy; editorial work on learned journals and preparation of written teaching materials, including journal articles, didactic textbooks, reference books, and e-learning materials. The median amount of time that a UK consultant clinical pharmacologist spends on these activities is 50 hours per week; several work more than that. The time is spent as follows: teaching 10%; research 40%; clinical work 30%; policy and administration 12%; editorial work and writing 8%. The numbers of physicians who have been newly registered with the General Medical Council as clinical pharmacologists each year has so far been undiminished, but the number of consultant posts has fallen in 1990-2010. Many trainees therefore leave the discipline when they become consultants. © 2011 The Author. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.

  1. Financial conflict-of-interest policies in clinical research: issues for clinical investigators.

    Science.gov (United States)

    Boyd, Elizabeth A; Cho, Mildred K; Bero, Lisa A

    2003-08-01

    As industry sponsorship of clinical research grows, investigators' personal financial relationships with those sponsors are under increasing scrutiny. The federal government, some states, and many universities have enacted conflict-of-interest policies to monitor and regulate investigators' financial relationships. Little is known, however, about investigators' awareness of or support for these policies or their attitudes toward regulatory efforts. To explore the possible implications of conflict-of-interest policies for clinical researchers, the authors interviewed active clinical investigators at two institutions where the conflict-of-interest policies differ. The most striking feature of the interviews was the range of perceptions and attitudes expressed by clinical investigators and their implications for administrators, professional societies, and policymakers concerned with conflicts of interest. Fewer than half of the interviewed investigators could accurately describe their campus' conflict-of-interest policy. Many investigators felt that professional societies, the public, and individual investigators were appropriate monitors of conflicts of interest. Many investigators recognized the general risks associated with conflicts of interest, but felt that they personally were not at risk. A fundamental challenge facing administrators and policymakers is to demonstrate to all investigators, both clinical and nonclinical, that the potential for bias, pressure and conflict is relevant to all investigators with industry relationships.

  2. 76 FR 20575 - Disqualification of a Clinical Investigator

    Science.gov (United States)

    2011-04-13

    ..., biologics, devices, animal drugs, and food additives)'' (Ref. 1 at page 41). The GAO concluded that it is...., drugs) later conducted a clinical investigation studying a different type of test article (e.g., devices... proposed changes to Sec. Sec. 312.70(a) and 511.1(c)(1), we propose to change the language in Sec. 812.119...

  3. Correlation of radiological investigations with clinical findings in ...

    African Journals Online (AJOL)

    Background: The aim of the following study is to find out the accuracy of clinical examination and radiological investigations in determining the organ of origin and diagnosis in cases of abdominal mass. Patients and Methods: This prospective study included patients presenting with a palpable abdominal mass. Complete ...

  4. A Qualitative Investigation of Clinical Supervisor Value Conflicts.

    Science.gov (United States)

    Veach, Pat McCarthy; Yoon, Eunju; Miranda, Cacy; Ergun, Damla; Tuicomepee, Arunya

    Eighteen clinical supervisors participated in focus groups or an individual interview designed to investigate their personal experiences with value conflicts in supervision. Participants described the types of value conflicts they had experiences and their personal impact, effective and ineffective approaches for addressing these issues, resources…

  5. The effect of question wording in questionnaire surveys on placebo use in clinical practice.

    Science.gov (United States)

    Babel, Przemyslaw

    2012-12-01

    To identify factors that contribute to the high variability of the rates of use of placebo interventions reported in questionnaire surveys, the author investigated the effect of the explicit use of the word "placebo" in questionnaire surveys on placebo use in clinical practice on the results obtained. 190 primary care physicians in Poland were divided randomly into two groups. The groups received a questionnaire in which either the word placebo or the term "nonspecific methods of treatment" was used. The respondents who were asked explicitly about the use of placebo interventions declared that they never used placebo interventions significantly more often than participants asked about the use of nonspecific treatment methods. Moreover, the former reported significantly rarer use of placebo interventions than the latter. The study demonstrates that differences in the wording of questions in questionnaire surveys on placebo use can create statistically significant differences in results.

  6. NCCN Oncology Research Program's Investigator Steering Committee and NCCN Best Practices Committee Molecular Profiling Surveys.

    Science.gov (United States)

    Kurzrock, Razelle; Colevas, A Dimitrios; Olszanski, Anthony; Akerley, Wallace; Arteaga, Carlos L; Carson, William E; Clark, Jeffrey W; DiPersio, John F; Ettinger, David S; Morgan, Robert J; Schwartzberg, Lee S; Venook, Alan P; Gocke, Christopher D; Tait, Jonathan; Stewart, F Marc

    2015-11-01

    With advances such as next-generation sequencing (NGS) increasing understanding of the basis of cancer and its response to treatment, NCCN believes it is important to understand how molecular profiling/diagnostic testing is being performed and used at NCCN Member Institutions and their community affiliates. The NCCN Oncology Research Program's Investigator Steering Committee and the NCCN Best Practices Committee gathered baseline information on the use of cancer-related molecular testing at NCCN Member Institutions and community members of the NCCN Affiliate Research Consortium through 2 separate surveys distributed in December 2013 and September 2014, respectively. A total of 24 NCCN Member Institutions and 8 affiliate sites provided quantitative and qualitative data. In the context of these surveys, "molecular profiling/diagnostics" was defined as a panel of at least 10 genes examined as a diagnostic DNA test in a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory. Results indicated that molecular profiling/diagnostics are used at 100% of survey respondents' institutions to make patient care decisions. However, challenges relating to reimbursement, lack of data regarding actionable targets and targeted therapies, and access to drugs on or off clinical trials were cited as barriers to integration of molecular profiling into patient care. Frameworks for using molecular diagnostic results based on levels of evidence, alongside continued research into the predictive value of biomarkers and targeted therapies, are recommended to advance understanding of the role of genomic biomarkers. Greater evidence and consensus regarding the clinical and cost-effectiveness of molecular profiling may lead to broader insurance coverage and increased integration into patient care. Copyright © 2015 by the National Comprehensive Cancer Network.

  7. Clinical investigations for SUS, the Brazilian public health system

    Directory of Open Access Journals (Sweden)

    Ana Patrícia de Paula

    Full Text Available CONTEXT AND OBJECTIVE: Scientific and technological development is crucial for advancing the Brazilian health system and for promoting quality of life. The way in which the Brazilian Ministry of Health has supported clinical research to provide autonomy, self-sufficiency, competitiveness and innovation for the healthcare industrial production complex, in accordance with the National Policy on Science, Technology and Innovation in Healthcare, was analyzed. DESIGN AND SETTING: Descriptive investigation, based on secondary data, conducted at the Department of Science and Technology, Ministry of Health. METHODS: The Ministry of Health's research management database, PesquisaSaúde, was analyzed from 2002 to 2009, using the key word "clinical research" in the fields "primary sub-agenda" or "secondary sub-agenda". The 368 projects retrieved were sorted into six categories: basic biomedical research, preclinical studies, expanded clinical research, clinical trials, infrastructure support and health technology assessment. From a structured review on "clinical research funding", results from selected countries are presented and discussed. RESULTS: The amount invested was R$ 140 million. The largest number of projects supported "basic biomedical research", while the highest amounts invested were in "clinical trials" and "infrastructure support". The southeastern region had the greatest proportion of projects and financial resources. In some respects, Brazil is ahead of other BRICS countries (Russia, India, China and South Africa, especially with regard to establishing a National Clinical Research Network. CONCLUSION: The Ministry of Health ensured investments to encourage clinical research in Brazil and contributed towards promoting cohesion between investigators, health policies and the healthcare industrial production complex.

  8. Usefulness of a Survey on Underage Drinking in a Rural American Indian Community Health Clinic

    Science.gov (United States)

    Gilder, David A.; Luna, Juan A.; Roberts, Jennifer; Calac, Daniel; Grube, Joel W.; Moore, Roland S.; Ehlers, Cindy L.

    2013-01-01

    This study examined the usefulness of a survey on underage drinking in a rural American Indian community health clinic. One hundred ninety-seven youth (90 male, 107 female; age range 8-20 years) were recruited from clinic waiting rooms and through community outreach. The study revealed that the usefulness of the survey was twofold: Survey results…

  9. A Survey of Preoperative Radiological Investigation Among Dental ...

    African Journals Online (AJOL)

    Twenty-nine (60.4%) respondents do not bother about radiological investigation before surgical procedure while 19 (:39.6%) insisted on preoperative radiological investigations before surgery. Out ofthese 19 respondents, all recommend periapical x-ray while 5 (26.3%) had a cause to recommend .oblique lateral of the jaw ...

  10. Education of research ethics for clinical investigators with Moodle tool.

    Science.gov (United States)

    Halkoaho, Arja; Matveinen, Mari; Leinonen, Ville; Luoto, Kirsi; Keränen, Tapani

    2013-12-12

    In clinical research scientific, legal as well as ethical aspects are important. It is well known that clinical investigators at university hospitals have to undertake their PhD-studies alongside their daily work and reconciling work and study can be challenging. The aim of this project was to create a web based course in clinical research bioethics (5 credits) and to examine whether the method is suitable for teaching bioethics. The course comprised of six modules: an initial examination (to assess knowledge in bioethics), information on research legislation, obtaining permissions from authorities, writing an essay on research ethics, preparing one's own study protocol, and a final exam. All assignments were designed with an idea of supporting students to reflect on their learning with their own research. 57 PhD-students (medical, nursing and dental sciences) enrolled and 46 completed the course. Course evaluation was done using a questionnaire. The response rate was 78%. Data were analyzed using quantitative methods and qualitative content analysis. The course was viewed as useful and technically easy to perform. Students were pleased with the guidance offered. Personal feedback from teachers about students' own performance was seen advantageous and helped them to appreciate how these aspects could be applied their own studies. The course was also considered valuable for future research projects. Ethical issues and legislation of clinical research can be understood more easily when students can reflect the principles upon their own research project. Web based teaching environment is a feasible learning method for clinical investigators.

  11. Clinical roles in clinical biochemistry: a national survey of practice in the UK.

    Science.gov (United States)

    Choudhury, Sirazum M; Williams, Emma L; Barnes, Sophie C; Alaghband-Zadeh, Jamshid; Tan, Tricia M; Cegla, Jaimini

    2017-05-01

    Background Using an online survey, we collected data to present a picture of how clinical authorization is performed in the UK. Methods A 21-question survey was uploaded to www.surveymonkey.com , and responses were invited via the mail base of the Association for Clinical Biochemistry and Laboratory Medicine. The questionnaire examined the intensity and function of the duty biochemist role and how different types of authorization are used to handle and release results. Results Of 70 responses received, 60 were suitable for analysis. Responses were received from every region of the UK. A typical duty biochemist shift started on average at 8:50, and finished at 17:25. The mean duration was 8 h 58 min. Clinical scientists are the most abundantly represented group on duty biochemist rotas. Higher banded clinical scientists and chemical pathologists covered out-of-hours shifts. Results were handled differently depending on the level of abnormality and the requesting area. Normal results tended to be released either directly from the analyser or after technical then autoauthorization (90%). A greater preference for clinical authorization was seen for abnormal and critical results originating from outpatients (49% and 69%, respectively) or general practice (51% and 71%) than for inpatients (33% and 53%) or A&E (25% and 37%). Conclusions The handling and authorization of biochemistry results varies greatly between laboratories. The role is clearly heterogeneous in the UK. Guidance from the Association for Clinical Biochemistry and Royal College of Pathologists may help to clarify the essential roles of the duty biochemist.

  12. A survey of prosthetic eye wearers to investigate mucoid discharge.

    Science.gov (United States)

    Pine, Keith; Sloan, Brian; Stewart, Joanna; Jacobs, Robert J

    2012-01-01

    This study aimed to better understand the causes and treatments of mucoid discharge associated with prosthetic eye wear by reviewing the literature and surveying anophthalmic patients. An anonymous questionnaire was completed by 429 prosthetic eye wearers who used visual analog scales to self-measure their discharge experience for four discharge characteristics: frequency, color, volume, and viscosity. These characteristics were analyzed with age, ethnicity, years wearing a prosthesis, eye loss cause, removal and cleaning regimes, hand-washing behavior, age of current prosthesis, and professional repolishing regimes as explanatory variables. Eighteen ocularists' Web sites containing comments on the cause and treatment of discharge were surveyed. Associations were found between discharge frequency and cleaning regimes with more frequent cleaning accompanying more frequent discharge. Color was associated with years of wearing and age, with more years of wearing and older people having less colored discharge. Volume was associated with cleaning regimes with more frequent cleaners having more volume. Viscosity was associated with cleaning regimes and years of wearing with more frequent cleaning and shorter wearing time accompanying more viscous discharge. No associations were found between discharge characteristics and ethnicity, eye loss cause, hand washing, age of current prosthesis, or repolishing regimes. Forty-seven percent of ocularists' Web sites advised that discharge was caused by surface deposits on the prosthesis, 29% by excessive handling of the prosthesis, and 24% by other causes. A standardized treatment protocol for managing discharge is lacking. More frequent prosthesis removal and cleaning was associated with more severe discharge, but the direction of cause and effect has not been established. Professional repolishing regimes had limited impact on discharge experience. Further research into the socket's response to prosthetic eye wear, including the

  13. A history of the American Society for Clinical Investigation

    Science.gov (United States)

    Howell, Joel D.

    2009-01-01

    One hundred years ago, in 1909, the American Society for Clinical Investigation (ASCI) held its first annual meeting. The founding members based this new society on a revolutionary approach to research that emphasized newer physiological methods. In 1924 the ASCI started a new journal, the Journal of Clinical Investigation. The ASCI has also held an annual meeting almost every year. The society has long debated who could be a member, with discussions about whether members must be physicians, what sorts of research they could do, and the role of women within the society. The ASCI has also grappled with what else the society should do, especially whether it ought to take a stand on policy issues. ASCI history has reflected changing social, political, and economic contexts, including several wars, concerns about the ethics of biomedical research, massive increases in federal research funding, and an increasingly large and specialized medical environment. PMID:19348041

  14. A survey of prosthetic eye wearers to investigate mucoid discharge

    Directory of Open Access Journals (Sweden)

    Pine K

    2012-05-01

    Full Text Available Keith Pine1, Brian Sloan2, Joanna Stewart3, Robert J Jacobs11Department of Optometry and Vision Science, 2Department of Ophthalmology, New Zealand National Eye Centre, 3Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New ZealandBackground: This study aimed to better understand the causes and treatments of mucoid discharge associated with prosthetic eye wear by reviewing the literature and surveying anophthalmic patients.Methods: An anonymous questionnaire was completed by 429 prosthetic eye wearers who used visual analog scales to self-measure their discharge experience for four discharge characteristics: frequency, color, volume, and viscosity. These characteristics were analyzed with age, ethnicity, years wearing a prosthesis, eye loss cause, removal and cleaning regimes, hand-washing behavior, age of current prosthesis, and professional repolishing regimes as explanatory variables. Eighteen ocularists’ Web sites containing comments on the cause and treatment of discharge were surveyed.Results: Associations were found between discharge frequency and cleaning regimes with more frequent cleaning accompanying more frequent discharge. Color was associated with years of wearing and age, with more years of wearing and older people having less colored discharge. Volume was associated with cleaning regimes with more frequent cleaners having more volume. Viscosity was associated with cleaning regimes and years of wearing with more frequent cleaning and shorter wearing time accompanying more viscous discharge. No associations were found between discharge characteristics and ethnicity, eye loss cause, hand washing, age of current prosthesis, or repolishing regimes. Forty-seven percent of ocularists’ Web sites advised that discharge was caused by surface deposits on the prosthesis, 29% by excessive handling of the prosthesis, and 24% by other causes.Conclusions: A standardized treatment

  15. Investigation of background acoustical effect on online surveys: A case study of a farmers' market customer survey

    Science.gov (United States)

    Tang, Xingdi

    Since the middle of 1990s, internet has become a new platform for surveys. Previous studies have discussed the visual design features of internet surveys. However, the application of acoustics as a design characteristic of online surveys has been rarely investigated. The present study aimed to fill that research gap. The purpose of the study was to assess the impact of background sound on respondents' engagement and satisfaction with online surveys. Two forms of background sound were evaluated; audio recorded in studios and audio edited with convolution reverb technique. The author recruited 80 undergraduate students for the experiment. These students were assigned to one of three groups. Each of the three groups was asked to evaluate their engagement and satisfaction with a specific online survey. The content of the online survey was the same. However, the three groups was exposed to the online survey with no background sound, with background sound recorded in studios; and with background sound edited with convolution reverb technique. The results showed no significant difference in engagement and satisfaction in the three groups of online surveys; without background sound, background sound recorded in studios, and background sound edited with convolution reverb technique. The author suggests that background sound does not contribute to online surveys in all the contexts. The industry practitioners should be careful to evaluate the survey context to decide whether the background sound should be added. Particularly, ear-piercing noise or acoustics which may link to respondents' unpleasant experience should be avoided. Moreover, although the results did not support the advantage of the revolution reverb technique in improving respondents' engagement and satisfaction, the author suggests that the potential of the revolution reverb technique in the applications of online surveys can't be totally denied, since it may be useful for some contexts which need further

  16. Clinical trials in orthopaedics and the future direction of clinical investigations for femoroacetabular impingement

    DEFF Research Database (Denmark)

    Clohisy, John C; Kim, Young-Jo; Lurie, Jon

    2013-01-01

    options for FAI and to define the predictors of surgical and nonsurgical outcomes. Future randomized controlled trials and large observational cohort studies targeted at these clinical research deficiencies will strengthen the evidence and improve informed decision making regarding the management...... to be further defined. To date, clinical research reports have included primarily surgical case series. Future clinical investigations are needed to establish improved clinical evidence to guide patient care. Most urgent is the need to better understand the potential role of standardized nonsurgical treatment...

  17. Clinical supervisors' perspectives on delivering work integrated learning: a survey study.

    Science.gov (United States)

    Mather, Carey A; McKay, Angela; Allen, Penny

    2015-04-01

    Previous research has indicated a disconnect between academic nursing programmes and workplace learning environments. Nurse supervisors and clinical practitioners have reported inadequate information and training on how to support students of nursing to learn in the clinical setting. This study aimed to investigate the level of confidence that clinical supervisors have in relation to specific components of supporting student learning in the work place. Survey of clinical nurse supervisors. Simulation-based clinical reasoning workshops. Sixty participants: fifty nine registered nurses, including nurse managers and clinical nurse educators, and one allied health professional. Survey using Likert scales and free-text questions. The findings indicated that clinicians were confident in sharing their knowledge and experience with students and making them feel welcome in the work place, they were less confident about what were the significant learnings in relation to students' academic programme. Registered nurses supervising students were experienced clinicians with many role responsibilities, which were perceived as barriers to the role of clinical supervisor. Participants reported that they would like tools to assist them with developing links to the academic programme. They considered that these tools would support student learning and remediation in the work place. This study found that the abilities of supervisors to support student learning is an identified gap impacting on work integrated learning. The results indicated the need for a professional development workshop, to enable clinical supervisors to move beyond promoting a supervision model, towards a theoretical framework for assisting and guiding students to learn. Addressing this deficit will improve growth and change in student learning in the work place. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Characterization Investigation Study: Volume 3, Radiological survey of surface soils

    Energy Technology Data Exchange (ETDEWEB)

    Solow, A.J.; Phoenix, D.R.

    1987-12-01

    The Feed Materials Production Center was constructed to produce high purity uranium metal for use at various Department of Energy facilities. The waste products from these operations include general uncontaminated scrap and refuse, contaminated and uncontaminated metal scrap, waste oils, low-level radioactive waste, co-contaminated wastes, mixed waste, toxic waste, sludges from water treatment, and fly ash from the steam plant. This material is estimated to total more than 350,000 cubic meters. Other wastes stored in this area include laboratory chemicals and other combustible materials in the burn pit; fine waste stream sediments in the clear well; fly ash and waste oils in the two fly ash areas; lime-alum sludges and boiler plant blowdown in the lime sludge ponds; and nonradioactive sanitary waste, construction rubble, and asbestos in the sanitary landfill. A systematic survey of the surface soils throughout the Waste Storage Area, associated on-site drainages, and the fly ash piles was conducted using a Field Instrument for Detecting Low-Energy Radiation (FIDLER). Uranium is the most prevalent radioactive element in surface soil; U-238 is the principal radionuclide, ranging from 2.2 to 1790 pCi/g in the general Waste Storage Area. The maximum values for the next highest activity concentrations in the same area were 972 pCi/g for Th-230 and 298 pCi/g for U-234. Elevated activity concentrations of Th-230 were found along the K-65 slurry line, the maximum at 3010 pCi/g. U-238 had the highest value of 761 pCi/g in the drainage just south of pit no. 5. The upper fly ash area had the highest radionuclide activity concentrations in the surface soils with the maximum values for U-238 at 8600 pCi/g, U-235 at 2190 pCi/g, U-234 at 11,400 pCi/g, Tc-99 at 594 pCi/g, Ra-226 at 279 pCi/g, and Th-230 at 164 pCi/g.

  19. [A survey of knowledge on common cold in outpatient clinics].

    Science.gov (United States)

    Liu, Guo-liang; Lin, Jiang-tao; Liu, Guan-jian; Lin, Yan-ping; Yin, Kai-sheng; Bai, Chun-xue; Ma, Li-jun; Qiu, Chen; Liu, Chun-tao; Chen, Ming-wei; Liu, Hua; Chen, Ping

    2012-04-01

    To investigate outpatients' cognition towards common cold and their habituated medication so as to provide evidence for future public healthcare education. Patients who attended hospital for diagnosis and treatment of common cold at least within past three months were asked to fill a questionnaire independently so as to learn their cognition towards common cold and medication habit. Among the patients underwent survey, 52.21% had incorrect knowledge about common cold; 12.99% didn't know about the hazards of common cold; 34.80% couldn't distinguish common cold from influenza; 30.07% considered common cold couldn't get relief without treatment; 68.24% didn't know about the proper effects of influenza vaccination; 61.14% often took oral medicine even intravenous injection when they caught a common cold; 59.77% often took medication from drugstore without prescription by doctor, and a few asked doctors to prescribe medicine on their request; 19.42% didn't know about the side effects of drug for cold treatment; and 19.72% didn't know about the active ingredients of drug for cold treatment. There were significant differences in the common cold cognition among population of different ages and education background. The older or the higher education status patients had a better cognition (P common cold among patients of different literacy degree and different age. Public health education on common cold need to be further strengthened.

  20. Curvature affects Doppler investigation of vessels: implications for clinical practice.

    Science.gov (United States)

    Balbis, S; Roatta, S; Guiot, C

    2005-01-01

    In clinical practice, blood velocity estimations from Doppler examination of curved vascular segments are normally different from those of nearby straight segments. The observed "accelerations," sometimes considered as a sort of stochastic disturbances, can actually be related to very specific physical effects due to vessel curvature (i.e., the development of nonaxial velocity [NAV] components) and the spreading of the axial velocity direction in the Doppler sample volume with respect to the insonation axis. The relevant phenomena and their dependence on the radius of curvature of the vessels and on the insonation angle are investigated with a beam-vessel geometry as close as possible to clinical setting, with the simplifying assumptions of steady flow, mild vessel curvature, uniform ultrasonic beam and complete vessel insonation. The insonation angles that minimize the errors are provided on the basis of the study results.

  1. 76 FR 50484 - Draft Guidance for Industry, Clinical Investigators, and Food and Drug Administration Staff...

    Science.gov (United States)

    2011-08-15

    ... Agency's current thinking on design considerations for pivotal clinical investigations for medical... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry, Clinical Investigators, and Food and Drug Administration Staff; Design Considerations for Pivotal Clinical Investigations for...

  2. 59th Medical Wing Clinical Research Division Clinical Investigations Program Pathology Poster

    Science.gov (United States)

    2017-04-28

    MDW staff member, we can forward your request for funds to the designated Wing POC at the Chief Scientist’s Office, Ms. Alice Houy, office phone: 210...DEPARTMENT OF THE AIR FORCE 59TH MEDICAL WING (AETC) JOINT BASE SAN ANTONIO - LACKLAND TEXAS 28 APR 2017 MEMORANDUM FORSGVU ATTN: JOSHUA CALCOTE FROM...59 MDW/SGVU SUBJECT: Professional Presentation Approval 1. Your paper, entitled 59th Medical Wing Clinical Research Division Clinical Investigations

  3. Patient engagement: an investigation at a primary care clinic.

    Science.gov (United States)

    Gill, Preetinder Singh

    2013-01-01

    Engaged employees are an asset to any organization. They are instrumental in ensuring good commercial outcomes through continuous innovation and incremental improvement. A health care facility is similar to a regular work setting in many ways. A health care provider and a patient have roles akin to a team leader and a team member/stakeholder, respectively. Hence it can be argued that the concept of employee engagement can be applied to patients in health care settings in order to improve health outcomes. Patient engagement data were collected using a survey instrument from a primary care clinic in the northern Indian state of Punjab. Canonical correlation equations were formulated to identify combinations which were strongly related to each other. In addition, the cause-effect relationship between patient engagement and patient-perceived health outcomes was described using structural equation modeling. Canonical correlation analysis showed that the first set of canonical variables had a fairly strong relationship, ie, a magnitude > 0.80 at the 95% confidence interval, for five dimensions of patient engagement. Structural equation modeling analysis yielded a β ≥ 0.10 and a Student's t statistic ≥ 2.96 for these five dimensions. The threshold Student's t statistic was 1.99. Hence it was found the β values were significant at the 95% confidence interval for all census regions. A scaled reliable survey instrument was developed to measured patient engagement. Better patient engagement is associated with better patient-perceived health outcomes. This study provides preliminary evidence that patient engagement has a causal relationship with patient-perceived health outcomes.

  4. Patient engagement: an investigation at a primary care clinic

    Directory of Open Access Journals (Sweden)

    Gill PS

    2013-03-01

    Full Text Available Preetinder Singh Gill College of Technology, Eastern Michigan University, Ypsilanti, MI, USA Background: Engaged employees are an asset to any organization. They are instrumental in ensuring good commercial outcomes through continuous innovation and incremental improvement. A health care facility is similar to a regular work setting in many ways. A health care provider and a patient have roles akin to a team leader and a team member/stakeholder, respectively. Hence it can be argued that the concept of employee engagement can be applied to patients in health care settings in order to improve health outcomes. Methods: Patient engagement data were collected using a survey instrument from a primary care clinic in the northern Indian state of Punjab. Canonical correlation equations were formulated to identify combinations which were strongly related to each other. In addition, the cause-effect relationship between patient engagement and patient-perceived health outcomes was described using structural equation modeling. Results: Canonical correlation analysis showed that the first set of canonical variables had a fairly strong relationship, ie, a magnitude > 0.80 at the 95% confidence interval, for five dimensions of patient engagement. Structural equation modeling analysis yielded a β ≥ 0.10 and a Student's t statistic ≥ 2.96 for these five dimensions. The threshold Student's t statistic was 1.99. Hence it was found the β values were significant at the 95% confidence interval for all census regions. Conclusion: A scaled reliable survey instrument was developed to measured patient engagement. Better patient engagement is associated with better patient-perceived health outcomes. This study provides preliminary evidence that patient engagement has a causal relationship with patient-perceived health outcomes. Keywords: patient engagement, health outcomes, communication, provider effectiveness, patient incentive

  5. Factors Associated with Clinical Research Recruitment in a Pediatric Academic Medical Center?A Web-Based Survey

    OpenAIRE

    Erica Rose Denhoff; Milliren, Carly E.; de Ferranti, Sarah D.; Sarah K Steltz; Osganian, Stavroula K.

    2015-01-01

    Background One of the most difficult aspects of conducting clinical research is the ability to successfully recruit participants. Pediatric clinical research presents unique recruitment challenges that relate to the need for parental consent on behalf of a minor, child assent, and school attendance. Yet, this has been less well studied. We conducted a survey of investigators performing human subjects research in a single large academic pediatric hospital to better understand characteristics o...

  6. Emotion Understanding in Clinically Anxious Children: A Preliminary Investigation

    Science.gov (United States)

    Bender, Patrick K.; Pons, Francisco; Harris, Paul L.; Esbjørn, Barbara H.; Reinholdt-Dunne, Marie L.

    2015-01-01

    Children’s understanding of the nature, origins and consequences of emotions has been intensively investigated over the last 30–40 years. However, few empirical studies have looked at the relation between emotion understanding and anxiety in children and their results are mixed. The aim of the present study was to perform a preliminary investigation of the relationships between emotion understanding, anxiety, emotion dysregulation, and attachment security in clinically anxious children. A sample of 16 clinically anxious children (age 8–12, eight girls/boys) was assessed for emotion understanding (Test of Emotion Comprehension), anxiety (Screening for Child Anxiety Related Emotional Disorders-Revised and Anxiety Disorder Interview Schedule), emotion dysregulation (Difficulties in Emotion Regulation Scale) and attachment security (Security Scale). Children who reported more overall anxiety also reported greater difficulties in regulating their emotions, and were less securely attached to their parents. The results also showed that more specific symptoms of anxiety (i.e., OCD and PTSD) correlated not only with emotion dysregulation and attachment insecurity but also with emotion understanding. Finally, there were interrelations among emotion understanding, attachment security, and emotion dysregulation. The present results provide the first comprehensive evidence for a socio-emotional framework and its relevance to childhood anxiety. PMID:26733909

  7. Emotion understanding in clinically anxious children: A preliminary investigation

    Directory of Open Access Journals (Sweden)

    Patrick K. Bender

    2015-12-01

    Full Text Available Children’s understanding of the nature, origins and consequences of emotions has been intensively investigated over the last 30-40 years. However, few empirical studies have looked at the relation between emotion understanding and anxiety in children and their results are mixed. The aim of the present study was to perform a preliminary investigation of the relationships between emotion understanding, anxiety, emotion dysregulation, and attachment security in clinically anxious children. A sample of 16 clinically anxious children (age 8-12, 8 girls/boys was assessed for emotion understanding (Test of Emotion Comprehension, anxiety (Screening for Child Anxiety Related Emotional Disorders-Revised and Anxiety Disorder Interview Schedule, emotion dysregulation (Difficulties in Emotion Regulation Scale and attachment security (Security Scale. Children who reported more overall anxiety also reported greater difficulties in regulating their emotions, and were less securely attached to their parents. The results also showed that more specific symptoms of anxiety (i.e., OCD and PTSD correlated not only with emotion dysregulation and attachment insecurity but also with emotion understanding. Finally, there were interrelations among emotion understanding, attachment security, and emotion dysregulation. The present results provide the first comprehensive evidence for a socio-emotional framework and its relevance to childhood anxiety.

  8. Clinical Presentation of Acute Pulmonary Embolism: Survey of 800 Cases

    Science.gov (United States)

    Miniati, Massimo; Cenci, Caterina; Monti, Simonetta; Poli, Daniela

    2012-01-01

    Background Pulmonary embolism (PE) is a common and potentially fatal disease that is still underdiagnosed. The objective of our study was to reappraise the clinical presentation of PE with emphasis on the identification of the symptoms and signs that prompt the patients to seek medical attention. Methodology/Principal Findings We studied 800 patients with PE from two different clinical settings: 440 were recruited in Pisa (Italy) as part of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISAPED); 360 were diagnosed with and treated for PE in seven hospitals of central Tuscany, and evaluated at the Atherothrombotic Disorders Unit, Firenze (Italy), shortly after hospital discharge. We interviewed the patients directly using a standardized, self-administered questionnaire originally utilized in the PISAPED. The two samples differed significantly as regards age, proportion of outpatients, prevalence of unprovoked PE, and of active cancer. Sudden onset dyspnea was the most frequent symptom in both samples (81 and 78%), followed by chest pain (56 and 39%), fainting or syncope (26 and 22%), and hemoptysis (7 and 5%). At least one of the above symptoms was reported by 756 (94%) of 800 patients. Isolated symptoms and signs of deep vein thrombosis occurred in 3% of the cases. Only 7 (1%) of 800 patients had no symptoms before PE was diagnosed. Conclusions/Significance Most patients with PE feature at least one of four symptoms which, in decreasing order of frequency, are sudden onset dyspnea, chest pain, fainting (or syncope), and hemoptysis. The occurrence of such symptoms, if not explained otherwise, should alert the clinicians to consider PE in differential diagnosis, and order the appropriate objective test. PMID:22383978

  9. The relationship between senior management team culture and clinical governance: Empirical investigation and managerial implications.

    Science.gov (United States)

    Prenestini, Anna; Calciolari, Stefano; Lega, Federico; Grilli, Roberto

    2015-01-01

    Health care organizations are pressured to improve the cost-effectiveness of service delivery. Clinical governance is an important trigger to improve care quality and safety and rank high in the reform agenda of health systems. The senior management team culture plays a major role in establishing clinical governance practices, because it strongly influences the values, attitudes, and behaviors of the members of an organization. The aim of this study was to investigate the relationship between senior management team culture and clinical governance in the public health care organizations of three Italian regions. The assessment of senior management culture was conducted using the Competing Values Framework and a corresponding instrument adapted for the Italian context. Clinical governance was assessed using an ad hoc instrument focused on the senior management team's perception and attitude toward clinical governance. The survey achieved a 54% response rate. The results of four different models demonstrate that organizations characterized by different dominant cultures are associated with significant differences in attitudes toward clinical governance. In particular, on average, dominant cultures with a prevailing external focus are associated with a more positive attitude toward clinical governance. The selection and appointments of top managers should consider the style of leadership that is most apt to facilitate the growth of rational and developmental cultures. Furthermore, the training of top managers and leading doctors should reinforce leadership aptitude and approaches that are consistent with the desired organizational cultures.

  10. Clinical Use of Smartphones Among Medical and Nursing Staff in Greece: A Survey.

    Science.gov (United States)

    Stergiannis, Pantelis; Intas, Georgios; Toulia, Georgia; Tsolakoglou, Ioannis; Kostagiolas, Petros; Christodoulou, Eleni; Chalari, Eleftheria; Kiriakopoulos, Vasilios; Filntisis, Georgios

    2017-09-01

    The aim of this study was to investigate the clinical use of smartphones among medical and nursing staff in Greece. This study used a 17-item questionnaire that was administered to the participants by the authors. The sample consists of 974 participants of 1200 who were asked to participate (ie, a response rate of 81.3%). The survey was open to all categories of medical and nursing staff (junior doctors, specialized doctors, assistant nurses, and RNs). In total, 167 participants (18.5%) were nurse assistants; 385 participants (42.6%), nurses; 154 participants (17%), specialized doctors; and 198 participants (21.9%), junior doctors. The data analysis was performed using SPSS Statistics (version 21), and the significance level was set to .05. Medical doctors own smartphones on a higher percentage in comparison with nurses. Among smartphone owners, medical doctors use their devices for clinical issues more frequently compared with nurses. Although medical doctors believe that smartphones can be a great tool for their work, they state that they do not use it for clinical reasons. Nurses state that they do not use their smartphones for clinical reasons because they are not aware of the existence of applications that can be used to assist them in their daily clinical tasks.

  11. [Clinical investigation of the positioning accuracy of acute pulpitis pain].

    Science.gov (United States)

    Wang, Jin; Sun, Wei; Ji, Aiping

    2013-10-01

    This study aims to investigate the positioning accuracy of acute pulpitis pain and its possible factors. The clinical symptoms and physical signs of 3 432 cases of acute pulpitis were recorded and analyzed by using questionnaire forms, which included age, gender, tooth position, infection origin, pain history, time of acute attack, duration and nature of pain, pain frequency, referred pain areas, percussion examination, temperature pulp test, pulp bleeding, and positioning accuracy. Univariate analysis and multivariate stepwise regression analysis were used for data processing. Pain location was accurately identified by 39.1% of the patients with acute pulpitis. Referred pain could reduce the positioning accuracy of pain (P 0.05). Some cases of acute pulpitis pain can be located accurately. Referred pain and periodontium infection origin are related to the positioning accuracy of acute pulpitis pain. The exact cause of this correlation needs further study.

  12. Infarction of the corpus callosum: a retrospective clinical investigation.

    Directory of Open Access Journals (Sweden)

    Shen Li

    Full Text Available The aim of this study was to investigate patients with ischemic infarctions in the territory of the corpus callosum to advance our understanding of this rare stroke subtype by providing comprehensive descriptive and epidemiological data.From January 1, 2010 to June 30, 2014, all cases of acute ischemic stroke diagnosed by clinical manifestation and diffusion weighted imaging in Dalian Municipal Central Hospital were investigated. The patients presenting with corpus callosum infarctions were selected and further allocated into genu and/or body and splenium infarction groups. Proportion, lesion patterns, clinical features, risk factors and etiology of corpus callosum infarction were analyzed.Out of 1,629 cases, 59 patients (3.6% with corpus callosum infarctions were identified by diffusion weighted imaging, including 7 patients who had ischemic lesions restricted to the corpus callosum territory. Thirty six patients had lesions in the splenium (61.0%. Corpus callosum infarction patients suffered from a broad spectrum of symptoms including weakness and/or numbness of the limbs, clumsy speech, and vertigo, which could not be explained by lesions in corpus callosum. A classical callosal disconnection syndrome was found in 2 out of all patients with corpus callosum infarctions. Statistical differences in the risk factor and infarct pattern between the genu and/or body group and splenium group were revealed.Corpus callosum infarction and the callosal disconnection syndrome were generally rare. The most susceptible location of ischemic corpus callosum lesion was the splenium. Splenium infarctions were often associated with bilateral cerebral hemisphere involvement (46.2%. The genu and/or body infarctions were associated with atherosclerosis. The most common cause of corpus callosum infarction probably was embolism.

  13. Summative clinical competency assessment: A survey of ultrasound practitioners’ views

    OpenAIRE

    Harrison, Gill

    2014-01-01

    Clinical competency and the assessment of core skills is a crucial element of any programme leading to an award with a clinical skills component. This has become a more prominent feature of current reports on quality health care provision. This project aimed to determine ultrasound practitioners’ opinions about how best to assess clinical competency. An on-line questionnaire was sent to contacts from the Consortium for the Accreditation of Sonographic Education and details distributed at the ...

  14. National survey of pain clinics in Croatia: Organization and services

    Directory of Open Access Journals (Sweden)

    Mahir Fidahić

    2015-05-01

    Full Text Available Objective. To analyze organization and therapeutic procedures administered in tertiary outpatient pain clinics in Croatia. Methods. Data about organization of pain clinics, its personnel, equipment, continuing medical education, therapeutic procedures, research activities and relations with pharmaceutical industry were collected using questionnaires. Results. Twenty-two Croatian pain clinics were included in the study. Most of the pain clinics employ exclusively anesthesiologists and nurses. The most frequently prescribed therapeutic procedures in pain clinics were pharmacotherapy, transcutaneous electrical nerve stimulation, acupuncture and trigger point injections. Almost all pain clinics provide educational material for patients. Most of the pain clinics have regular interactions with pharmaceutical companies. Prescribing decisions were based mostly on information from scientific meetings, research articles and consultations with colleagues. Information sources which are considered to be the gold standard – the systematic reviews of The Cochrane Collaboration – were used less frequently (n=12; 57% than advertising materials from pharmaceutical companies (n=16; 76%. Few physicians and other pain clinics staff had scientific degrees or academic titles or were involved in a research project. Conclusion. The national study about pain clinics in Croatia pointed out that there is room for improvement of their organization and services. Pain clinics should employ health-care professionals with diverse backgrounds. They should offer treatments backed by the highest-level of scientific evidence. Since pain is a major public health issue, pain clinic staff should engage more in research to contribute to the growing field of pain research, to enhance capacities for pain research in Croatia, to incorporate scientific evidence into their daily decision-making and to enable evidence-based practice.

  15. Summative clinical competency assessment: A survey of ultrasound practitioners' views.

    Science.gov (United States)

    Harrison, Gill

    2015-02-01

    Clinical competency and the assessment of core skills is a crucial element of any programme leading to an award with a clinical skills component. This has become a more prominent feature of current reports on quality health care provision. This project aimed to determine ultrasound practitioners' opinions about how best to assess clinical competency. An on-line questionnaire was sent to contacts from the Consortium for the Accreditation of Sonographic Education and details distributed at the British Medical Ultrasound Society conference in 2011. One hundred and sixteen responses were received from a range of clinical staff with an interest in ultrasound assessment. The majority of respondents suggested that competency assessments should take place in the clinical departments with or without an element of assessment at the education centre. Moderation was an important area highlighted by respondents, with 84% of respondents suggesting that two assessors were required and 66% of those stating some element of external moderation should be included. The findings suggest that respondents' preference is for some clinical competency assessments to take place on routine lists within the clinical department, assessed by two people one of which would be an external assessor. In view of recent reports relating to training and assessment of health care professionals, the ultrasound profession needs to begin the debate about how best to assess clinical competence and ensure appropriate first post-competency of anyone undertaking ultrasound examinations.

  16. A survey of clinical teaching fellowships in UK medical schools.

    Science.gov (United States)

    Wilson, Sam; Denison, Alan R; McKenzie, Hamish

    2008-02-01

    Undergraduate medical education in the UK has changed considerably over the last decade. One development has involved the creation of teaching-specific posts for junior doctors by medical schools. These posts are generally termed 'clinical teaching fellowships', but it is not known how many of them exist, or whether they are similar in terms of educational activities, professional development, and research and clinical experience opportunities. Teaching deans in all UK medical schools were sent a questionnaire relating to clinical teaching fellowships, and were asked to distribute a second set of different questionnaires to their clinical teaching fellows, which were to be returned to the authors separately. A total of 28 deans and 46 fellows responded. Fifteen medical schools had clinical teaching fellows and there appeared to be a total of 77 such posts in the UK. There was little uniformity in the activities undertaken within the posts. Deans who employed clinical teaching fellows were unanimously positive regarding the posts. Fellows were generally positive but expressed reservations relating to approval for postgraduate training, career development, deterioration in clinical skills, financial disincentives, credibility within one's own specialty, and provision of training and support. Clinical teaching fellow posts are generally enjoyed by fellows and valued by deans. Fellows carry out differing duties and their training in medical education is variable. The posts can be unstructured and may lack credibility to doctors outside medical education. Providing specific structured training in medical education, recognised at a national level, would help deal with these concerns.

  17. 59th Medical Wing Clinical Research Division Clinical Investigations Program Posters (Count: 2)

    Science.gov (United States)

    2017-05-08

    non-DoD commercial entity or an entity seeking to do business with the government, then your presentation should have an ethics review. If your...we will need the date (month, day and year) along with the location of your presentation. It is important to update this information so that we can...Section will route the request form to clinical investigations, S02 ISGIJAC ( Ethics Review) and Public Affairs (Sg MDWIPA) for review and then forward

  18. University Clinics as Field Placements in School Psychology Training: A National Survey.

    Science.gov (United States)

    Hughes, Jan N.; Benson, A. Jerry

    Although many school psychology programs use university-based clinics as field placements for school psychology students, there is little information in the literature on how these clinics are organized, administered, and funded or on the nature, duration, and sequencing of clinic field experiences. A national telephone survey of 71 directors of…

  19. 76 FR 11821 - Submission for OMB Review; Comment Request Survey of Principal Investigators on Earthquake...

    Science.gov (United States)

    2011-03-03

    ... Submission for OMB Review; Comment Request Survey of Principal Investigators on Earthquake Engineering... Investigators on Earthquake Engineering Research Awards Made by the National Science Foundation, 2003-2009. Type... George E. Brown, Jr. Network for Earthquake Engineering Simulation (NEES). The purpose of the proposed...

  20. 76 FR 70151 - Draft Guidance for Industry, Clinical Investigators, Institutional Review Boards, and Food and...

    Science.gov (United States)

    2011-11-10

    ... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry, Clinical Investigators, Institutional Review Boards, and Food and Drug Administration Staff; Food and Drug Administration Decisions for Investigational Device Exemption Clinical Investigations; Availability AGENCY: Food and Drug Administration, HHS...

  1. Investigations into near-real-time surveying for geophysical data collection using an autonomous ground vehicle

    Science.gov (United States)

    Phelps, Geoffrey A.; Ippolito, C.; Lee, R.; Spritzer, R.; Yeh, Y.

    2014-01-01

    The U.S. Geological Survey and the National Aeronautics and Space Administration are cooperatively investigating the utility of unmanned vehicles for near-real-time autonomous surveys of geophysical data collection. Initially focused on unmanned ground vehicle collection of magnetic data, this cooperative effort has brought unmanned surveying, precision guidance, near-real-time communication, on-the-fly data processing, and near-real-time data interpretation into the realm of ground geophysical surveying, all of which offer advantages over current methods of manned collection of ground magnetic data. An unmanned ground vehicle mission has demonstrated that these vehicles can successfully complete missions to collect geophysical data, and add advantages in data collection, processing, and interpretation. We view the current experiment as an initial phase in further unmanned vehicle data-collection missions, including aerial surveying.

  2. Dosimetry investigation of MOSFET for clinical IMRT dose verification.

    Science.gov (United States)

    Deshpande, Sudesh; Kumar, Rajesh; Ghadi, Yogesh; Neharu, R M; Kannan, V

    2013-06-01

    In IMRT, patient-specific dose verification is followed regularly at each centre. Simple and efficient dosimetry techniques play a very important role in routine clinical dosimetry QA. The MOSFET dosimeter offers several advantages over the conventional dosimeters such as its small detector size, immediate readout, immediate reuse, multiple point dose measurements. To use the MOSFET as routine clinical dosimetry system for pre-treatment dose verification in IMRT, a comprehensive set of experiments has been conducted, to investigate its linearity, reproducibility, dose rate effect and angular dependence for 6 MV x-ray beam. The MOSFETs shows a linear response with linearity coefficient of 0.992 for a dose range of 35 cGy to 427 cGy. The reproducibility of the MOSFET was measured by irradiating the MOSFET for ten consecutive irradiations in the dose range of 35 cGy to 427 cGy. The measured reproducibility of MOSFET was found to be within 4% up to 70 cGy and within 1.4% above 70 cGy. The dose rate effect on the MOSFET was investigated in the dose rate range 100 MU/min to 600 MU/min. The response of the MOSFET varies from -1.7% to 2.1%. The angular responses of the MOSFETs were measured at 10 degrees intervals from 90 to 270 degrees in an anticlockwise direction and normalized at gantry angle zero and it was found to be in the range of 0.98 ± 0.014 to 1.01 ± 0.014. The MOSFETs were calibrated in a phantom which was later used for IMRT verification. The measured calibration coefficients were found to be 1 mV/cGy and 2.995 mV/cGy in standard and high sensitivity mode respectively. The MOSFETs were used for pre-treatment dose verification in IMRT. Nine dosimeters were used for each patient to measure the dose in different plane. The average variation between calculated and measured dose at any location was within 3%. Dose verification using MOSFET and IMRT phantom was found to quick and efficient and well suited for a busy radiotherapy

  3. Adult-onset cerebellar Ataxia: a clinical and genetic Survey

    NARCIS (Netherlands)

    E. Brusse (Esther)

    2011-01-01

    textabstractCerebellar ataxias represent a heterogeneous group of neurodegenerative disorders. Two main categories are distinguished: hereditary and sporadic ataxias. Sporadic ataxias may be symptomatic or idiopathic. The clinical classification of hereditary ataxias is nowadays being replaced by

  4. Clinical survey of lens care in contact lens patients.

    Science.gov (United States)

    Ky, W; Scherick, K; Stenson, S

    1998-10-01

    Overall, contact lenses provide a safe and effective modality for vision correction. However, problems do occasionally arise. Up to 80% of contact lens complications can be traced to poor patient compliance with recommended lens care guidelines. We conducted a survey to evaluate the level of patient compliance in specific areas of lens care and maintenance and to assess patient knowledge of basic contact lens information. Patients were asked to complete an anonymous 15 question survey that focused on lens care--specifically the use of contact lens cleaners, methods of disinfection, enzyme treatments, use of rewetting drops, and the frequency of follow-up exams. In addition, the survey included six true/false questions relating to contact lens care and safety. There were a total of 103 participants in the study. Approximately 24% of patients stated they never cleaned their lenses prior to disinfection, and 5% used saline solutions as their primary mode of disinfection. A sizable portion of those surveyed (43% of soft lens wearers and 71% of rigid gas permeable lens wearers) either never used enzyme cleaners or used them less than once a month. Seventy percent of patients either never used rewetting drops or used them less than once a day. Twenty-nine percent of patients consulted their eye care professionals every 2 years and 6% less often than every two years. Six questions assessed patient knowledge of contact lens care safety. Of a possible six out of six correct answers, the mean number of correct responses was 3.74. A sizable proportion of contact lens wearers do not adequately adhere to recommended contact lens care, and many have an inadequate understanding of contact lens care guidelines. Therefore, it is important that practitioners place more emphasis on patient education at the time of initial contact lens fitting and reinforce such instruction during follow-up visits.

  5. Denial of lineage: clinical investigation of 50 cases.

    Science.gov (United States)

    Tsai, N; Kao, Z X; Lenz, H

    1987-01-01

    Fifty randomly selected Chinese schizophrenic patients with denial of lineage were investigated. This delusion concerns the generation of parents, sisters, but not the offspring. Twenty-four of them manifested delusion of high-ranking lineage or of distinguished leadership lineage. Denial of lineage, involving the delusion of high-ranking lineage and the delusion of leadership lineage, may occur at the onset or during the course of schizophrenia. The clinical characteristics of this delusion are described and its concept, diagnosis, differential diagnosis, course and also possible mechanism are discussed. One possible mechanism is of psychodynamical origin. Emotional conflicts resulting from dissatisfaction of the primary need of being loved from birth may contribute to the onset of the denial of lineage. The second possible mechanism is a sociocultural fact. Far Eastern culture is based on the clan whereas occidental culture is based on the self. Thus can observe the denial of lineage in the Far East, but in the occident we can experience instead the idea of surmounting our self so as to be god or now to experience the omnipotence in form of technical ideas, e.g. the rays.

  6. Science without meritocracy. Discrimination among European specialists in infectious diseases and clinical microbiology: a questionnaire survey

    Science.gov (United States)

    Tacconelli, Evelina; Poljak, Mario; Cacace, Marina; Caiati, Giovanni; Benzonana, Nur; Nagy, Elisabeth; Kortbeek, Titia

    2012-01-01

    Objective In 2009, in a European survey, around a quarter of Europeans reported witnessing discrimination or harassment at their workplace. The parity committee from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) designed a questionnaire survey to investigate forms of discrimination with respect to country, gender and ethnicity among medical professionals in hospitals and universities carrying out activities in the clinical microbiology (CM) and infectious diseases (ID) fields. Design The survey consisted of 61 questions divided into five areas (sociodemographic, professional census and environment, leadership and generic) and ran anonymously for nearly 3 months on the ESCMID website. Subjects European specialists in CM/ID. Results Overall, we included 1274 professionals. The majority of respondents (68%) stated that discrimination is present in medical science. A quarter of them reported personal experience with discrimination, mainly associated with gender and geographic region. Specialists from South-Western Europe experienced events at a much higher rate (37%) than other European regions. The proportion of women among full professor was on average 46% in CM and 26% in ID. Participation in high-level decision-making committees was significantly (>10 percentage points) different by gender and geographic origin. Yearly gross salary among CM/ID professionals was significantly different among European countries and by gender, within the same country. More than one-third of respondents (38%) stated that international societies in CM/ID have an imbalance as for committee member distribution and speakers at international conferences. Conclusions A quarter of CM/ID specialists experienced career and research discrimination in European hospitals and universities, mainly related to gender and geographic origin. Implementing proactive policies to tackle discrimination and improve representativeness and balance in career among CM

  7. Science without meritocracy. Discrimination among European specialists in infectious diseases and clinical microbiology: a questionnaire survey.

    Science.gov (United States)

    Tacconelli, Evelina; Poljak, Mario; Cacace, Marina; Caiati, Giovanni; Benzonana, Nur; Nagy, Elisabeth; Kortbeek, Titia

    2012-01-01

    In 2009, in a European survey, around a quarter of Europeans reported witnessing discrimination or harassment at their workplace. The parity committee from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) designed a questionnaire survey to investigate forms of discrimination with respect to country, gender and ethnicity among medical professionals in hospitals and universities carrying out activities in the clinical microbiology (CM) and infectious diseases (ID) fields. The survey consisted of 61 questions divided into five areas (sociodemographic, professional census and environment, leadership and generic) and ran anonymously for nearly 3 months on the ESCMID website. European specialists in CM/ID. Overall, we included 1274 professionals. The majority of respondents (68%) stated that discrimination is present in medical science. A quarter of them reported personal experience with discrimination, mainly associated with gender and geographic region. Specialists from South-Western Europe experienced events at a much higher rate (37%) than other European regions. The proportion of women among full professor was on average 46% in CM and 26% in ID. Participation in high-level decision-making committees was significantly (>10 percentage points) different by gender and geographic origin. Yearly gross salary among CM/ID professionals was significantly different among European countries and by gender, within the same country. More than one-third of respondents (38%) stated that international societies in CM/ID have an imbalance as for committee member distribution and speakers at international conferences. A quarter of CM/ID specialists experienced career and research discrimination in European hospitals and universities, mainly related to gender and geographic origin. Implementing proactive policies to tackle discrimination and improve representativeness and balance in career among CM/ID professionals in Europe is urgently needed.

  8. A survey of challenges and career aspirations of clinical dental ...

    African Journals Online (AJOL)

    Method: A cross-sectional study in which all clinical dental students were evaluated. Data collection was by self-administered questionnaires distributed to the study population, which required demographic information location of dental school, entry qualification, choice of dentistry as a career, assessment of the dental ...

  9. Customer satisfaction survey with clinical laboratory and phlebotomy services at a tertiary care unit level.

    Science.gov (United States)

    Koh, Young Rae; Kim, Shine Young; Kim, In Suk; Chang, Chulhun L; Lee, Eun Yup; Son, Han Chul; Kim, Hyung Hoi

    2014-09-01

    We performed customer satisfaction surveys for physicians and nurses regarding clinical laboratory services, and for outpatients who used phlebotomy services at a tertiary care unit level to evaluate our clinical laboratory and phlebotomy services. Thus, we wish to share our experiences with the customer satisfaction survey for clinical laboratory and phlebotomy services. Board members of our laboratory designed a study procedure and study population, and developed two types of questionnaire. A satisfaction survey for clinical laboratory services was conducted with 370 physicians and 125 nurses by using an online or paper questionnaire. The satisfaction survey for phlebotomy services was performed with 347 outpatients who received phlebotomy services by using computer-aided interviews. Mean satisfaction scores of physicians and nurses was 58.1, while outpatients' satisfaction score was 70.5. We identified several dissatisfactions with our clinical laboratory and phlebotomy services. First, physicians and nurses were most dissatisfied with the specimen collection and delivery process. Second, physicians and nurses were dissatisfied with phlebotomy services. Third, molecular genetic and cytogenetic tests were found more expensive than other tests. This study is significant in that it describes the first reference survey that offers a survey procedure and questionnaire to assess customer satisfaction with clinical laboratory and phlebotomy services at a tertiary care unit level.

  10. Fair reckoning: a qualitative investigation of responses to an economic health resource allocation survey.

    Science.gov (United States)

    Giacomini, Mita; Hurley, Jeremiah; DeJean, Deirdre

    2014-04-01

    To investigate how participants in an economic resource allocation survey construct notions of fairness. Qualitative interview study guided by interpretive grounded theory methods. Qualitative interviews were conducted with volunteer university- (n=39) and community-based (n =7) economic survey participants. INTERVENTION OR MAIN VARIABLES STUDIED: We explored how participants constructed meanings to guide or explain fair survey choices, focusing on rationales, imagery and additional desired information not provided in the survey scenarios. Data were transcribed and coded into qualitative categories. Analysis iterated with data collection iterated through three waves of interviews. Participants compared the survey dilemmas to domains outside the health system. Most compared them with other micro-level, inter-personal sharing tasks. Participants raised several fairness-relevant factors beyond need or capacity to benefit. These included age, weight, poverty, access to other options and personal responsibility for illness; illness duration, curability or seriousness; life expectancy; possibilities for sharing; awareness of other's needs; and ability to explain allocations to those affected. They also articulated a fairness principle little considered by equity theories: that everybody must get something and nobody should get nothing. Lay criteria for judging fairness are myriad. Simple scenarios may be used to investigate lay commitments to abstract principles. Although principles are the focus of analysis and inference, participants may solve simplified dilemmas by imputing extraneous features to the problem or applying unanticipated principles. These possibilities should be taken into account in the design of resource allocation surveys eliciting the views of the public. © 2012 John Wiley & Sons Ltd.

  11. Typical investigational medicinal products follow relatively uniform regulations in 10 European Clinical Research Infrastructures Network (ECRIN countries

    Directory of Open Access Journals (Sweden)

    Gluud Christian

    2012-03-01

    Full Text Available Abstract Background In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe. Methods We conducted a survey in order to identify the national regulatory requirements for major categories of clinical research in ten European Clinical Research Infrastructures Network (ECRIN countries-Austria, Denmark, France, Germany, Hungary, Ireland, Italy, Spain, Sweden, and United Kingdom-covering approximately 70% of the EU population. Here we describe the results for regulatory requirements for typical investigational medicinal products, in the ten countries. Results Our results show that the ten countries have fairly harmonised definitions of typical investigational medicinal products. Clinical trials assessing typical investigational medicinal products require authorisation from a national competent authority in each of the countries surveyed. The opinion of the competent authorities is communicated to the trial sponsor within the same timelines, i.e., no more than 60 days, in all ten countries. The authority to which the application has to be sent to in the different countries is not fully harmonised. Conclusion The Directive 2001/20/EC defined the term 'investigational medicinal product' and all regulatory requirements described therein are applicable to investigational medicinal products. Our survey showed, however, that those requirements had been adopted in ten European countries, not for investigational medicinal products overall, but rather a narrower category which we term 'typical' investigational medicinal products. The result is partial EU harmonisation of requirements and a relatively navigable landscape for the sponsor regarding typical investigational medicinal products.

  12. A Clinic-based Survey of Clinical Characteristics and Practice Pattern of Dry Eye in Japan.

    Science.gov (United States)

    Kawashima, Motoko; Yamada, Masakazu; Suwaki, Kazuhisa; Shigeyasu, Chika; Uchino, Miki; Hiratsuka, Yoshimune; Yokoi, Norihiko; Tsubota, Kazuo

    2017-03-01

    The aim of this study was to investigate the clinical characteristics and practice pattern of patients with dry eye disease (DED) in eye clinics across Japan. A multi-center, cross-sectional study was conducted among patients with DED who visited eye clinics in Japan. Subjective symptoms, patient's background, ocular surface features, and tear function were evaluated. Main outcome measures were tear break-up time (TBUT), Schirmer I value, kerato-conjunctival staining score, and dry eye symptom questionnaire score. Initially, 463 subjects were enrolled, and 449 cases (63 male and 386 female; mean age, 62.6 ± 15.7 years) were included in the final analysis. Overall, 94.9% of patients had a shortened TBUT (≤5 s), and 54.6% had an aqueous tear deficiency (Schirmer I value ≤5 mm). The most prevalent subtype of dry eye was aqueous-deficient dry eye, which was present in 35.0% of all patients, followed by short-BUT-type dry eye, which was seen in 26.7%. The two most common DED subtypes were aqueous-deficient and short-BUT-type dry eye. Shortened TBUT is the most common feature of dry eye, regardless of subtype. The current treatment choice mainly consisted of hyaluronic acid, two novel mucin secretagogues, diquafosol and rebamipide, and steroidal eye drops. University Hospital Medical Information Network: UMIN (registries no. UMIN 000015890). Japan Dry Eye Society, Tokyo, Japan, and Santen Pharmaceutical Co., Ltd., Osaka, Japan.

  13. Developing a guideline for clinical trial protocol content: Delphi consensus survey

    Directory of Open Access Journals (Sweden)

    Tetzlaff Jennifer

    2012-09-01

    Full Text Available Abstract Background Recent evidence has highlighted deficiencies in clinical trial protocols, having implications for many groups. Existing guidelines for randomized clinical trial (RCT protocol content vary substantially and most do not describe systematic methodology for their development. As one of three prespecified steps for the systematic development of a guideline for trial protocol content, the objective of this study was to conduct a three-round Delphi consensus survey to develop and refine minimum content for RCT protocols. Methods Panellists were identified using a multistep iterative approach, met prespecified minimum criteria and represented key stakeholders who develop or use clinical trial protocols. They were asked to rate concepts for importance in a minimum set of items for RCT protocols. The main outcome measures were degree of importance (scale of 1 to 10; higher scores indicating higher importance and level of consensus for items. Results were presented as medians, interquartile ranges, counts and percentages. Results Ninety-six expert panellists participated in the Delphi consensus survey including trial investigators, methodologists, research ethics board members, funders, industry, regulators and journal editors. Response rates were between 88 and 93% per round. Overall, panellists rated 63 of 88 concepts of high importance (of which 50 had a 25th percentile rating of 8 or greater, 13 of moderate importance (median 6 or 7 and 12 of low importance (median less than or equal to 5 for minimum trial protocol content. General and item-specific comments and subgroup results provided valuable insight for further discussions. Conclusions This Delphi process achieved consensus from a large panel of experts from diverse stakeholder groups on essential content for RCT protocols. It also highlights areas of divergence. These results, complemented by other empirical research and consensus meetings, are helping guide the development of

  14. Hospital clinicians' information behaviour and attitudes towards the 'Clinical Informationist': an Irish survey.

    LENUS (Irish Health Repository)

    Flynn, Maura G

    2012-02-01

    BACKGROUND: Hospital clinicians are increasingly expected to practice evidence-based medicine (EBM) in order to minimize medical errors and ensure quality patient care, but experience obstacles to information-seeking. The introduction of a Clinical Informationist (CI) is explored as a possible solution. AIMS: This paper investigates the self-perceived information needs, behaviour and skill levels of clinicians in two Irish public hospitals. It also explores clinicians\\' perceptions and attitudes to the introduction of a CI into their clinical teams. METHODS: A questionnaire survey approach was utilised for this study, with 22 clinicians in two hospitals. Data analysis was conducted using descriptive statistics. RESULTS: Analysis showed that clinicians experience diverse information needs for patient care, and that barriers such as time constraints and insufficient access to resources hinder their information-seeking. Findings also showed that clinicians struggle to fit information-seeking into their working day, regularly seeking to answer patient-related queries outside of working hours. Attitudes towards the concept of a CI were predominantly positive. CONCLUSION: This paper highlights the factors that characterise and limit hospital clinicians\\' information-seeking, and suggests the CI as a potentially useful addition to the clinical team, to help them to resolve their information needs for patient care.

  15. Knowledge, attitudes, and values among physicians working with clinical genomics: a survey of medical oncologists.

    Science.gov (United States)

    Chow-White, Peter; Ha, Dung; Laskin, Janessa

    2017-06-27

    It has been over a decade since the completion of the Human Genome Project (HGP), genomic sequencing technologies have yet to become parts of standard of care in Canada. This study investigates medical oncologists' (MOs) genomic literacy and their experiences based on their participation in a cancer genomics trial in British Columbia, Canada. The authors conducted a survey of MOs from British Columbia, Canada (n = 31, 52.5% response rate), who are actively involved in a clinical genomics trial called Personalized Onco-Genomics (POG). The authors also measured MOs' level of genomic knowledge and attitudes about clinical genomics in cancer medicine. The findings show a low to moderate level of genomic literacy among MOs. MOs located outside the Vancouver area (the major urban center) reported less knowledge about new genetics technologies compared to those located in the major metropolitan area (26.7 vs 73.3%, P data suggest a high need to increase genomic literacy among MOs and other doctors in medical school training programs and beyond, especially to physicians in regional areas who may need more educational interventions. Initiatives like POG play a critical role in the education of MOs and the integration of big data clinical genomics into cancer care.

  16. Clinical management of gastric cancer: results of a multicentre survey

    Directory of Open Access Journals (Sweden)

    Xu Feng

    2011-08-01

    Full Text Available Abstract Background The National Comprehensive Cancer Network clinical practice guidelines in oncology-gastric cancer guidelines have been widely used to provide appropriate recommendations for the treatment of patients with gastric cancer. The aim of this study was to examine the adherence of surgical oncologists, medical oncologists, and radiation oncologists' to the recommended guidelines. Methods A questionnaire asking the treatment options for gastric cancer cases was sent to 394 Chinese oncology specialists, including surgical oncologists, medical oncologists, and radiation oncologists working in hospitals joined in The Western Cooperative Gastrointestinal Oncology Group of China. The questionnaire involved a series of clinical scenarios regarding the interpretation of surgery, neoadjuvant, adjuvant, and advanced treatment planning of gastric cancer. Results Analysis of 358 respondents (91% showed variations between each specialization and from the recommended guidelines in the management approaches to specific clinical scenarios. The majority of specialists admitted that less than 50% of patients received multidisciplinary evaluation before treatment. The participants gave different responses to questions involving adjuvant, neoadjuvant, and advanced settings, compared to the recommended guidelines. Conclusions These results highlight the heterogeneity of the treatment of gastric cancer. Surgical oncologists, medical oncologists, and radiation oncologists are not adhering to the recommended guidelines.

  17. Survey of Clinical Evidence in Newborns with Hypernatremic Dehydration

    Directory of Open Access Journals (Sweden)

    Hasan Boskabadi

    2016-01-01

    Full Text Available Background & objectives: Weight loss and hypernatremic dehydration is a common problem in infants with inadequate nutrition. Determination of risk factors and clinical characteristics of these neonates may help to prevent or early detection of hypernatremia. This study designed to determine the prevalence of clinical signs and risk factors for hypernatremic dehydration. Methods: This study is a sectional descriptive study that conducted on 418 newborns during 1385 to 1393 AHS that referred to Ghaem hospital in Mashhad. The hypernatremic group consisted of 197 neonates with serum sodium level higher than 150 mg/dl and 221 isonatremic newborns with sodium level less than 150 mmol/L were included as controls. Both groups were compared in terms of clinical symptoms of dehydration and maternal risk factors. All data were recorded and coded. Data analysis performed using paired T test and chi square tests by SPSS 16 software. Results: In the present study, 2.8% of infants were hypernatremic. The most common symptoms were neonatal jaundice (62.2%, hyperthermia (25.8%, lethargy (23.6%, agitation (20.8 % and mucous membranes dryness (17.2%. Problems in pregnancy (p=0.002, inappropriate feeding techniques (p=0.000, the first lactation duration (p=0.022 and frequency per day (p=0.000 had statistically significant difference between case and control groups. Conclusion: Prevalence of hypernatremic dehydrationis considerable in our study and identifying the risk factors may help to reduce its incidence or exacerbation. Weight loss, especially in newborns having jaundice, hyperthermia and irritability, may be helpful in the early diagnosis of hypernatremic dehydration

  18. 76 FR 32367 - Draft Guidance for Clinical Investigators, Industry, and FDA Staff: Financial Disclosure by...

    Science.gov (United States)

    2011-06-06

    ... HUMAN SERVICES Food and Drug Administration Draft Guidance for Clinical Investigators, Industry, and FDA Staff: Financial Disclosure by Clinical Investigators; Correction AGENCY: Food and Drug Administration, HHS. ACTION: Notice; correction. SUMMARY: The Food and Drug Administration (FDA) is correcting a...

  19. Mentor Relationships in Clinical Psychology Doctoral Training: Results of a National Survey.

    Science.gov (United States)

    Clark, Richard A.; Harden, Sherry L.; Johnson, W. Brad

    2000-01-01

    Provides a contemporary picture of mentor relationships in clinical psychology, focusing on 787 survey respondents who were U.S. members or associates of the American Psychological Association and graduated with a PhD or PsyD in clinical psychology in 1994, 1995, or 1996. Presents the results and discusses implications for graduate education. (CMK)

  20. A Clinical Survey Efficacy Of Frankincense In Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Nahid Jivad

    2017-02-01

    Full Text Available Background &Aims: Ischemic stroke is the most common cause of stroke ,and paralysis and movement disorders are the most symptoms of stroke. Therefore, it is important to find a method for improving the disorders. This study aimed to examine the clinical efficacy of frankincense in patients with the acute ischemic stroke. Methods: In this clinical trial, 60 patients with ischemic stroke were randomly allocated into the treatment and control groups (n=30. In the treatment group, in addition to routine treatment of stroke, four capsules containing 500 mg powdered frankincense was given daily  , but in the control group, was performed only the treatment of stroke (no frankincense. The treatment lasted for 1 month. The NIHSS scale (for assessment of speech and muscle strength at the beginning,  the seventh day and end of the study for each patient was completed. Statistical analysis was performed using independent t-test, chi-square, mann withney in SPSS software. Results: Results showed that only improvement of muscle strength in patients left limb increased significantly in stage II in the treatment group than the control group. Conclusion: Adding frankincense to treatment of patients with stroke can be effective on improvement muscle strength in patients with muscle weakness and non-dominant side in acute neurological disorders. While that is not effective on improving muscle strength of the right limb or speech.

  1. Clinical Investigation Program Report, RCS MED-300 (R1).

    Science.gov (United States)

    1986-10-31

    cells and the effect of pluronic F-68. Comparison with dog and rat cells. Chapter in: Swine in Biomedical Research, M. Tumblesome, (ed). (In Press...endoscopy on laboratory animals ( dogs ) in order to develop clinical skills in endoscopy. Also, creation of clinical gastrointestinal entities (pathology...birth, as additional information gained from prenatal ultrasonography , were compared with patents who did not have this prior knowledge. The purposes of

  2. Proteogenomic Investigation of Strain Variation in Clinical Mycobacterium tuberculosis Isolates

    KAUST Repository

    Heunis, Tiaan

    2017-08-18

    Mycobacterium tuberculosis consists of a large number of different strains that display unique virulence characteristics. Whole-genome sequencing has revealed substantial genetic diversity among clinical M. tuberculosis isolates, and elucidating the phenotypic variation encoded by this genetic diversity will be of utmost importance to fully understand M. tuberculosis biology and pathogenicity. In this study we integrated whole-genome sequencing and mass spectrometry (GeLC-MS/MS) to reveal strain-specific characteristics in the proteomes of two clinical M. tuberculosis Latin American-Mediterranean isolates. Using this approach we identified 59 peptides containing single amino acid variants, which covered ~9% of all total coding nonsynonymous single nucleotide variants detected by whole-genome sequencing. Furthermore, we identified 29 distinct peptides that mapped to a hypothetical protein not present in the M. tuberculosis H37Rv reference proteome. Here we provide evidence for the expression of this protein in the clinical M. tuberculosis SAWC3651 isolate. The strain-specific databases enabled confirmation of genomic differences (i.e. large genomic regions of difference and nonsynonymous single nucleotide variants) in these two clinical M. tuberculosis isolates and allowed strain differentiation at the proteome level. Our results contribute to the growing field of clinical microbial proteogenomics and can improve our understanding of phenotypic variation in clinical M. tuberculosis isolates.

  3. Parental influence on clinical management during neonatal intensive care: a survey of US neonatologists.

    Science.gov (United States)

    Bailey, Sean M; Hendricks-Muñoz, Karen D; Mally, Pradeep

    2013-08-01

    Family-centered care (FCC), which includes involving parents in conversations about medical management, is increasingly employed in the neonatal intensive care unit (NICU). Our aim was to determine which care decisions are discussed by neonatologists with families most frequently and the percentage of clinicians influenced by such conversations. Anonymous web-based survey provided to 2137 neonatologists assessing information sharing and parental involvement. Thousand and two neonatologists responded in which 893 fully completed the surveys. 88% practice FCC. Topics most frequently discussed with parents were blood transfusion, steroids for lung disease and patent ductus arteriosus (PDA) surgery, each being reported and discussed by more than 90% of respondents. Many therapies, including aminoglycoisdes, total parenteral nutrition, and phototherapy, were discussed with parents by far fewer clinicians. Additionally, parents had most influence on clinicians in two categories, blood transfusion and steroids, with more than 70% reporting that their practice was influenced by parental opinion if communicated. For some topics, such as PDA surgery and central line placement, conversations impacted few clinicians. FCC appears to have an impact on NICU clinical decision-making processes, some more than others. Further investigation in this area may provide information on how to best communicate with families and run effective, efficient FCC rounds.

  4. The use of electronic data capture tools in clinical trials: Web-survey of 259 Canadian trials.

    Science.gov (United States)

    El Emam, Khaled; Jonker, Elizabeth; Sampson, Margaret; Krleza-Jerić, Karmela; Neisa, Angelica

    2009-03-09

    Electronic data capture (EDC) tools provide automated support for data collection, reporting, query resolution, randomization, and validation, among other features, for clinical trials. There is a trend toward greater adoption of EDC tools in clinical trials, but there is also uncertainty about how many trials are actually using this technology in practice. A systematic review of EDC adoption surveys conducted up to 2007 concluded that only 20% of trials are using EDC systems, but previous surveys had weaknesses. Our primary objective was to estimate the proportion of phase II/III/IV Canadian clinical trials that used an EDC system in 2006 and 2007. The secondary objectives were to investigate the factors that can have an impact on adoption and to develop a scale to assess the extent of sophistication of EDC systems. We conducted a Web survey to estimate the proportion of trials that were using an EDC system. The survey was sent to the Canadian site coordinators for 331 trials. We also developed and validated a scale using Guttman scaling to assess the extent of sophistication of EDC systems. Trials using EDC were compared by the level of sophistication of their systems. We had a 78.2% response rate (259/331) for the survey. It is estimated that 41% (95% CI 37.5%-44%) of clinical trials were using an EDC system. Trials funded by academic institutions, government, and foundations were less likely to use an EDC system compared to those sponsored by industry. Also, larger trials tended to be more likely to adopt EDC. The EDC sophistication scale had six levels and a coefficient of reproducibility of 0.901 (PCanada is higher than the literature indicated: a large proportion of clinical trials in Canada use some form of automated data capture system. To inform future adoption, research should gather stronger evidence on the costs and benefits of using different EDC systems.

  5. Investigating Multiple Household Water Sources and Uses with a Computer-Assisted Personal Interviewing (CAPI Survey

    Directory of Open Access Journals (Sweden)

    Morgan C. MacDonald

    2016-12-01

    Full Text Available The investigation of multiple sources in household water management is considered overly complicated and time consuming using paper and pen interviewing (PAPI. We assess the advantages of computer-assisted personal interviewing (CAPI in Pacific Island Countries (PICs. We adapted an existing PAPI survey on multiple water sources and expanded it to incorporate location of water use and the impacts of extreme weather events using SurveyCTO on Android tablets. We then compared the efficiency and accuracy of data collection using the PAPI version (n = 44 with the CAPI version (n = 291, including interview duration, error rate and trends in interview duration with enumerator experience. CAPI surveys facilitated high-quality data collection and were an average of 15.2 min faster than PAPI. CAPI survey duration decreased by 0.55% per survey delivered (p < 0.0001, whilst embedded skip patterns and answer lists lowered data entry error rates, relative to PAPI (p < 0.0001. Large-scale household surveys commonly used in global monitoring and evaluation do not differentiate multiple water sources and uses. CAPI equips water researchers with a quick and reliable tool to address these knowledge gaps and advance our understanding of development research priorities.

  6. Clinical evaluation and grading practices in schools of nursing: national survey findings part II.

    Science.gov (United States)

    Oermann, Marilyn H; Yarbrough, Suzanne S; Saewert, Karen J; Ard, Nell; Charasika, Margie E

    2009-01-01

    To better understand how nurse educators evaluate and grade students' clinical practice, the Evaluation of Learning Advisory Council of the National League for Nursing conducted a survey of faculty (N = 1,573) in all types of prelicensure RN programs. This article describes the findings of that survey in relation to clinical evaluation and grading clinical practice. Nearly all faculty used a clinical evaluation tool to rate students' performance in the clinical setting (n = 1,534, 98 percent); most programs had the same basic tool in all courses, but modified to reflect the unique aspects of each course (n = 1,095, 70 percent). Faculty (n = 1,116, 83 percent) reported using pass/fail for grading in clinical courses rather than a letter or numerical grade.

  7. Traditional Chinese medicine ZHENG identification of bronchial asthma: Clinical investigation of 2500 adult cases.

    Science.gov (United States)

    Wang, Zhiwan; Li, Jiansheng; Xie, Yang; Yu, Xueqing; Zhang, Zhaowang

    2017-02-01

    This study aims to employ more comprehensive approaches to analyze the primary and secondary symptoms of clinical common TCM ZHENG of bronchial asthma according to the clinical investigation of 2500 adult cases. Patients met the inclusion criteria were surveyed by associate chief physician or chief physician through the TCM Clinical investigation questionnaire containing general demographic information, signs and symptoms, tongue and pulse conditions. Firstly, absolute frequency, cumulative frequency, Chi-squared test were adopted to reflect the clinical common ZHENG in three asthma stages, then the logistic regression analyses, the frequency methods were combined to distinguish the primary and secondary symptoms of the common ZHENG. Of the 2500 questionnaires, 2428 valid questionnaires were got, with the number in acute exacerbation stage was 1273, and that 586 in chronic persistent stage, and 569 in clinical remission stage, in which the number of excess syndromes, the deficiency-excess complex syndromes and deficiency syndromes corresponding to the above three stage respectively accounted on 55.7%, 69.97%, and 76.50%. According to the distribution of each ZHENG, ten clinical common ZHENG were distinguished by criteria of the frequency percent value at least 10.0% and cumulative percent value reach to 70% or above. Then based on the OR and frequency value of each symptom, the primary symptoms were tentative identified by OR value≧3 with percent value≧50%, and that of the secondary symptoms were OR value between 1 and 3 with percent value between 25% and 50%. Ten common ZHENG of asthma with each primary and secondary symptoms in three stages are identified through the clinical investigation: Exterior cold with interior fluid retention, Phlegm-turbidity obstructing the lung, Phlegm-heat obstructing the lung, Wind-phlegm obstructing the lung, Blood stasis, Qi deficiency of the lung, Qi deficiency of the lung and spleen, Qi deficiency of the lung and kidney, Qi

  8. CANVAS an update: clinical presentation, investigation and management.

    Science.gov (United States)

    Szmulewicz, David J; McLean, Catriona A; MacDougall, Hamish G; Roberts, Leslie; Storey, Elsdon; Halmagyi, G Michael

    2014-01-01

    Cerebellar Ataxia with Neuropathy and bilateral Vestibular Areflexia Syndrome (CANVAS) is a multi-system ataxia which results in cerebellar ataxia, a bilateral vestibulopathy and a somatosensory deficit. This sensory deficit has recently been shown to be a neuronopathy, with marked dorsal root ganglia neuronal loss. The characteristic oculomotor clinical sign is an abnormal visually enhanced vestibulo-ocular reflex. To outline the expanding understanding of the pathology in this condition, as well as diagnostic and management issues encountered in clinical practice. Retrospective data on 80 CANVAS patients is reviewed. In addition to the triad of cerebellar impairment, bilateral vestibulopathy and a somatosensory deficit, CANVAS patients may also present with orthostatic hypotension, a chronic cough and neuropathic pain. Management of falls risk and dysphagia is a major clinical priority. CANVAS is an increasingly recognised cause of late-onset ataxia and disequilibrium, and is likely to be a recessive disorder.

  9. Acute traumatic coagulopathy: clinical characterization and mechanistic investigation.

    Science.gov (United States)

    Cohen, Mitchell Jay

    2014-05-01

    Trauma remains the leading cause of death and morbidity worldwide and bleeding is the primary reason for this mortality. Over the past 11 years there has been a paradigm shift in our understanding of coagulopathy after trauma. Specifically its incidence, biological drivers, clinical sequelae have been elucidated. From this understanding a concurrent change in resuscitation practices has occurred. This manuscript will review the history of resuscitation after injury, the discovery and clinical and biological characterization of acute traumatic coagulopathy and the changes in resuscitation practices aimed at combating coagulopathy and inflammatory perturbation after trauma. Finally it will discuss the ongoing state of the science and suggest topics for continued biological and clinical study. Copyright © 2014. Published by Elsevier Ltd.

  10. Clinical survey on type of restoration in deciduous teeth.

    Science.gov (United States)

    Fukuyama, Tatsuro; Oda, Shinya; Yamashita, Haruto; Sekiguchi, Hiroshi; Yakushiji, Masashi

    2008-02-01

    This study was conducted in 533 children with 1,634 treated teeth who visited the Pediatric Dentistry Department at the Chiba Hospital of Tokyo Dental College between January and December, 2003. Restorations on deciduous tooth were categorized by age of patient and tooth type. The following observations were made: Children aged 4 (17.9%) visited the clinic most frequently and this group had the highest number of deciduous restorations (21.3%). Among the 1,634 deciduous teeth restored, metal inlays were provided in 29.4% of total teeth restored, composite resin restorations in 27.2%, stainless-steel crowns in 25.7%, composite resin full crowns in 7.7%, glass-ionomer cement restorations in 6.6%, and amalgam restorations in 3.4%. By age, composite resin was most frequently used in children aged 1 to 3. In children aged 5 to 9, metal inlay was most frequently used. Those aged 4 received mostly stainless-steel crowns. Composite resin restorations were used mostly in anterior deciduous teeth, and metal inlays mostly in deciduous molars. Previous research indicated an increasing trend towards composite resin restorations and composite resin full crowns. The present study also confirmed such a trend. While the use of metal inlays and stainless-steel crowns tended to increase until 1987, the present study indicated a trend to decrease.

  11. Endometrial carcinoma clinical management: results of a regional survey.

    Science.gov (United States)

    Carlomagno, G

    2009-01-01

    In Southern regions of Italy, many women affected by oncologic pathology go to larger towns to referral hospitals to be treated. However there is the impression that this does not apply to endometrial cancer, which affects older women less prone to seek care far from home. To verify this premise and to ascertain the quality of treatment these patients received, and the degree of compliance of their treatment with the International Federation of Gynecology and Obstetrics (FIGO) recommendations, a database was created collecting information concerning the clinical management of endometrial cancer in 13 different gynecological units in the Campania region. We confirmed that endometrial carcinoma, the most frequent oncologic pathology in all participating units, was treated independently from the dimensions of all of these units. The adopted diagnostic and therapeutic procedures seemed to be largely compliant with FIGO guidelines. Limited dishomogeneity only regarded the smallest units. Overall, a good quality of treatment seemed to be given to women affected by this pathology who wanted to be treated in, or close to, their town of residence.

  12. Surgeons’ approach toward clinical nutrition: A survey-based study

    Science.gov (United States)

    Bozkırlı, Bahadır Osman; Gündoğdu, Rıza Haldun; Akbaba, Soner; Sayın, Turgay; Ersoy, Pamir Eren

    2017-01-01

    Objective Although many surgical patients face postoperative problems due to a poor nutritional status, there is evidence that many cases of malnutrition still go unnoticed and untreated in surgical wards. This study aims to define the current attitudes of surgeons toward nutritional screening and support. Material and Methods A questionnaire with 13 questions was e-mailed to 1500 surgeons. Cross-queries were made over the responses. Results The response rate was 20.9%. Most of the respondents (89.5%) implemented nutritional screening. However, only 24.6% of these surgeons screened every patient for malnutrition. The time to initiate nutritional support varied among respondents, and only 25.5% started nutritional support early enough prior to surgery. Only 9.9% of respondents implemented evidence based practices for preoperative fasting, and 21.2% preferred immunonutrition products for patients undergoing major abdominal surgery for cancer. The responses of surgeons, who participated in at least one scientific meeting on nutrition per year, were more coherent with the nutrition guidelines. Conclusions The results of this study reveal that the awareness and knowledge of clinical nutrition need improving amongst surgeons. To increase this awareness and knowledge, continuous learning throughout their career seems essential. PMID:28944324

  13. Surgeons' approach toward clinical nutrition: A survey-based study.

    Science.gov (United States)

    Bozkırlı, Bahadır Osman; Gündoğdu, Rıza Haldun; Akbaba, Soner; Sayın, Turgay; Ersoy, Pamir Eren

    2017-01-01

    Although many surgical patients face postoperative problems due to a poor nutritional status, there is evidence that many cases of malnutrition still go unnoticed and untreated in surgical wards. This study aims to define the current attitudes of surgeons toward nutritional screening and support. A questionnaire with 13 questions was e-mailed to 1500 surgeons. Cross-queries were made over the responses. The response rate was 20.9%. Most of the respondents (89.5%) implemented nutritional screening. However, only 24.6% of these surgeons screened every patient for malnutrition. The time to initiate nutritional support varied among respondents, and only 25.5% started nutritional support early enough prior to surgery. Only 9.9% of respondents implemented evidence based practices for preoperative fasting, and 21.2% preferred immunonutrition products for patients undergoing major abdominal surgery for cancer. The responses of surgeons, who participated in at least one scientific meeting on nutrition per year, were more coherent with the nutrition guidelines. The results of this study reveal that the awareness and knowledge of clinical nutrition need improving amongst surgeons. To increase this awareness and knowledge, continuous learning throughout their career seems essential.

  14. A clinical and molecular investigation of two South African families ...

    African Journals Online (AJOL)

    Simpson-Golabi-Behmel syndrome (SGBS) (OMIM. #312870) is an X-linked overgrowth syndrome characterised by distinctive facial features, macro- somia and multiple congenital abnormalities. [1] This is a rare condition, with only about 100 molecularly confirmed cases reported in the literature.[2] The clinical picture can.

  15. Clinical Investigation of Treatment Failure in Type 2 Diabetic ...

    African Journals Online (AJOL)

    HP

    pharmacogenetics as a possible cause of treatment failure in diabetes, which affects patients' response to anti-diabetic agents. Genetic variation in Transcription Factor 7 Like-2. (TF7L-2) was shown by Pearson et al [9] to result in clinically significant difference in the therapeutic response to sulphonylurea leading to.

  16. Clinical risk in rehabilitation: an exploratory investigation in Campania region.

    Science.gov (United States)

    Corrado, B; Di Meglio, C; Montuori, P

    2014-01-01

    Clinical risk management is a comprehensive programme that encompasses all the measures implemented to improve the quality of the healthcare service and ensure patient safety, which is based on learning through error. This process is intended to bring about ongoing improvements in clinical practice, starting with risk identification, before moving on to risk assessment and analysis, in order to reduce risks where possible. When clinical risk management is applied in rehabilitation, the first step involves identifying errors by assessing adverse events, which are considered to indicate the existing risk. Our work aims to explore the characteristics of the clinical risk in rehabilitation so as to learn more about its extent, its components, and its implications for the user. Our study involved numerous workers operating in four different branches of rehabilitation - speech therapy, physiotherapy, psychomotor education and occupational therapy - at forty-nine private rehabilitation centres in the province of Naples, an area that has not been studied before. A questionnaire was drafted regarding the main errors committed in the rehabilitation sector. It was then distributed and collected in again, after which the results were analysed and outcomes measured. Out of a total of 556 questionnaires distributed, 493 were returned (88.6% response rate.). The study revealed that for all the rehabilitation branches considered, the macro-category of errors linked to technical and professional aspects accounted for the highest percentage of the total errors (39%). In this study, the most frequent errors linked to technical and professional aspects were: wrong dose errors, treatment planning errors and functional assessment errors. There is an evident need to take action in order to manage the clinical risk in rehabilitation: to promote a concept of errors as opportunities for learning and improvement; to maintain the focus on both individual responsibility and on any systemic

  17. Text messaging to support off-campus clinical nursing facilitators: a descriptive survey.

    Science.gov (United States)

    Howard, Christine; Fox, Amanda R; Coyer, Fiona

    2014-06-01

    Managing large student cohorts can be a challenge for university academics, coordinating these units. Bachelor of Nursing programmes have the added challenge of managing multiple groups of students and clinical facilitators whilst completing clinical placement. Clear, time efficient and effective communication between coordinating academics and clinical facilitators is needed to ensure consistency between student and teaching groups and prompt management of emerging issues. This study used a descriptive survey to explore the use of text messaging via a mobile phone, sent from coordinating academics to off-campus clinical facilitators, as an approach to providing direction and support. The response rate was 47.8% (n=22). Correlations were found between the approachability of the coordinating academic and clinical facilitator perception that, a) the coordinating academic understood issues on clinical placement (r=0.785, pacademics and clinical facilitators. Findings suggest improved connection, approachability and collaboration between the coordinating academic and clinical facilitation staff. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. THE FLORENCE BAPTISTERY: 3-D SURVEY AS A KNOWLEDGE TOOL FOR HISTORICAL AND STRUCTURAL INVESTIGATIONS

    Directory of Open Access Journals (Sweden)

    G. Tucci

    2016-06-01

    Full Text Available The Baptistery of San Giovanni is one of the most important pieces of architecture in Florence. It is an octagonal building, encrusted with marble both internally and externally (including the pyramidal roof and covered inside by a magnificent dome with sparkling gold mosaics. During Dante’s time, it appeared much older than the other monuments, so its origins were considered as hailing straight from Florence’s most remote and mythical history. Even though we have much more data now, scholars still disagree over the interpretations on the origin and construction sequence of the monument. Survey has always been considered a main instrument for understanding historical architecture, mostly from constructional and structural points of view. During the last century, the Baptistery was surveyed using both traditional techniques and the most up-to-date instruments available at the time, such as topography, close-range photogrammetry and laser scanning. So, a review of those early applications, even if partial or isolated, can significantly attest to the state of the art and evolution of survey techniques. During recent years, the Opera di Santa Maria del Fiore promoted new research and a wide range of diagnostic investigations aimed at acquiring greater knowledge of the monument in anticipation of the cleaning and restoration of the outer wall surfaces during 2015. Among this research, GeCo Lab carried out a new systematic and complete laser scanner survey of the whole Baptistery, acquiring data for the more inaccessible parts that were given little attention during other survey campaigns. First of all, the paper analyses recent contributions given by instrumental surveys in advancing knowledge of the building, with references to the cutting-edge techniques and measurement tools used at the time. Then, it describes the new survey campaign, illustrating the approach followed in the planning, data acquisition and data elaboration phases; finally, it

  19. Investigating motorists' behaviors in response to supplementary traffic control devices at land surveying work sites.

    Science.gov (United States)

    Yang, Hong; Bartin, Bekir; Ozbay, Kaan; Chien, Steven I-Jy

    2014-01-01

    Since land surveyors working alongside live traffic encounter unique safety challenges there is a great need for innovative and effective traffic control devices (TCDs) that alert motorists approaching short-term land surveying work sites. Unlike the volume of research that has been completed on traditional work zones, however, there is a limited amount of information that has been collected on how motorists respond to TCDs at land surveying work sites. This article aims to fill the void by investigating motorists' behaviors in response to the use of 2 supplementary TCDs at land surveying work sites: portable plastic rumble strips (PPRS) and warning lights. Extensive field tests were conducted at various land surveying work sites on 2-lane 2-way urban roadways in New Jersey. Scenarios with and without the use of the supplemental TCDs were designed. Motorists' behavior changes were then statistically examined by using surrogate safety measures including mean speed, speed variance, speed limit compliance, and braking action. Statistical analyses showed that the traffic speed variations did not significantly increase when the selected supplemental TCD was used; rather, motorists significantly reduced their driving speed. When warning lights and PPRS were separately deployed at the land surveying work sites the average reduction in mean speed was 6.7 and 15.2 percent, respectively. The mean speed was reduced by 19.7 percent when both of these supplementary TCDs were used. Logistic regression models developed to examine the speeding and braking behavior also showed that motorists were more likely to comply with the speed limit and increase their braking rate when the selected TCDs were used. The use of supplemental TCDs can greatly contribute to the changes in motorists' behaviors at surveying work sites. The changes in motorists' driving behaviors imply that the motorists reacted favorably to the deployed TCDs at the land-surveying work sites.

  20. [Preanalytical guidelines for clinical proteomics investigation of biological fluids].

    Science.gov (United States)

    Lehmann, S; Roche, S; Allory, Y; Barthelaix, A; Beaudeux, J-L; Berger, F; Betsou, F; Borg, J; Dupuy, A; Garin, J; Quillard, M; Lizard, G; Peoc'h, K; Riviere, M; Ducoroy, P

    2009-01-01

    Research of new diagnosis or prognosis biomarkers is a major challenge for the management of patients with complex pathologies like cancer. Clinical proteomics is one of the recent approaches to identify these biomarkers in biological fluids. Over the last five years, many problems related to the variability and the quality control of these analyses have been observed. This was notably related to the different preanalytical status of each sample. A strong need for standardization of the critical preanalytical phases (collection, transport, processing, storage...) has been therefore recognized. With this goal in mind, working groups of the "Institut national du cancer" (INCa) and the "Société française de biologie clinique" (SFBC) proposed here preanalytical proteomics guidelines for the most common biological fluids: plasma, serum, urine and cerebrospinal fluid. To goal is to provide the basis for the harmonization of the procedures in clinical laboratories and biobanks to allow an optimal use of biological collections.

  1. A survey investigation of UK physiotherapists' use of online search engines for continuing professional development.

    Science.gov (United States)

    Harland, Nicholas; Drew, Benjamin T

    2013-09-01

    The purpose of this study was to discover the frequency and type of use of online resources for continuing professional development displayed by physiotherapists in the UK. Therapists' skills, needs and frustrations using these resources were explored. With the relatively recent release and saturated use of the internet the potential presence of a skills gap between therapists at different stages of their career was also investigated. National online survey study. The online survey was carried out using the international online service 'Survey Monkey'. 774 physiotherapists from students to band 8c completed the survey. The online survey was advertised through Frontline, the Interactive Chartered Society of Physiotherapy, Journal of Physiotherapy Pain Association and cascade email through research and other networks. Most physiotherapists reported using the internet for professional purposes daily (40%) or 2 to 4 times a week (37%), with only 8% of respondents using it less than once a week. Overall the results suggest band 6 and 7 physiotherapists had the least skills and most frustrations when using online search engines. History and the nature of rapid technological advancement, specifically of the internet, appears to have created a generational skills gap within the largest group of the physiotherapy workforce band 6 and 7 therapists. Students, band 5 and band 8a therapists appear to most successfully use online resources and the reasons for this are explored. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  2. Department of Clinical Investigation Annual Progress Report: Fiscal Year 1989

    Science.gov (United States)

    1989-01-01

    Psychology Service, in-service training, Jan, 1989, and San Francisco Academy of Hypnosis , June 1989. - 133 - ANNUAL PROGRESS REPORT Date: 1 October 1989...Hyperuricemia, 92 Hypnosis , 133 Hypnotizability, 133 Hypospadias, 150 Hypotension, 106 Hypothermic, 1 Hypothesis, 20, 25, 99 Iacono, 206, 213 ICAAC, 27 ICU...and Clinical Neurosciences ) - 248 - Publications and Presentations for Fiscal Year 1989--First Quarter Strain JJ (Mount Sinai School of Medicine

  3. Variation in Direct Access to Tests to Investigate Cancer: A Survey of English General Practitioners.

    Directory of Open Access Journals (Sweden)

    Brian D Nicholson

    Full Text Available The 2015 NICE guidelines for suspected cancer recommend that English General Practitioners have direct access to diagnostic tests to investigate symptoms of cancer that do not meet the criteria for urgent referral. We aimed to identify the proportion of GPs in England with direct access to these tests.We recruited 533 English GPs through a national clinical research network to complete an online survey about direct access to laboratory, radiology, and endoscopy tests in the three months leading up to the release of the 2015 NICE guidance. If they had direct access to a diagnostic test, GPs were asked about the time necessary to arrange a test and receive a report. Results are reported by NHS sub-region and, adjusting for sampling, for England as a whole.Almost all GPs reported direct access to x-ray and laboratory investigations except faecal occult blood testing (54%, 95% CI 49-59% and urine protein electrophoresis (89%, 95% CI 84-92%. Fewer GPs had direct access to CT scans (54%, 95% CI 49-59% or endoscopy (colonoscopy 32%, 95% CI 28-37%; gastroscopy 72%, 95% CI 67-77%. There was significant variation in direct access between NHS regions for the majority of imaging tests-for example, from 20 to 85% to MRI. Apart from x-ray, very few GPs (1-22% could access radiology and endoscopy within the timescales recommended by NICE. The modal request to test time was 2-4 weeks for routine radiology and 4-6 weeks for routine endoscopy with results taking another 1-2 weeks.At the time that the 2015 NICE guideline was released, local investment was required to not only provide direct access but also reduce the interval between request and test and speed up reporting. Further research using our data as a benchmark is now required to identify whether local improvements in direct access have been achieved in response to the NICE targets. If alternative approaches to test access are to be proposed they must be piloted comprehensively and underpinned by robust

  4. Attitudes and Beliefs of Pathology Residents Regarding the Subspecialty of Clinical Chemistry: Results of a Survey.

    Science.gov (United States)

    Haidari, Mehran; Yared, Marwan; Olano, Juan P; Alexander, C Bruce; Powell, Suzanne Z

    2017-02-01

    -Previous studies suggest that training in pathology residency programs does not adequately prepare pathology residents to become competent in clinical chemistry. -To define the beliefs of pathology residents in the United States regarding their preparation for practicing clinical chemistry in their career, their attitude toward the discipline, and the attractiveness of clinical chemistry as a career. -The residents of all pathology residency programs in the United States were given the opportunity to participate in an online survey. -Three hundred thirty-six pathology residents responded to the survey. Analysis of the survey results indicates that pathology residents are more likely to believe that their income may be lower if they select a career that has a clinical chemistry focus and that their faculty do not value clinical chemistry as much as the anatomic pathology part of the residency. Residents also report that clinical chemistry is not as enjoyable as anatomic pathology rotations during residency or preferable as a sole career path. A large proportion of residents also believe that they will be slightly prepared or not prepared to practice clinical chemistry by the end of their residency and that they do not have enough background and/or time to learn clinical chemistry during their residency programs to be able to practice this specialty effectively post graduation. -Our survey results suggest that many pathology residents do not have a positive attitude toward clinical chemistry and do not experience a supportive learning environment with an expectation that they will become competent in clinical chemistry with a residency alone.

  5. Study on Developments in Accident Investigation Methods: A Survey of the "State-of-the-Art

    OpenAIRE

    Hollnagel, Erik; Speziali, Josephine

    2008-01-01

    Available on: http://www.stralsakerhetsmyndigheten.se/Global/Publikationer/Rapport/Sakerhet-vid-karnkraftverken/2008/SKI-Rapport-2008-50.pdf; SKI Report 2008:50 (Swedish Nuclear Power Inspectorate) - ISSN 1104-1374; The objective of this project was to survey the main accident investigation methods that have been developed since the early or mid-1990s. The motivation was the increasing frequency of accidents that defy explanations in simple terms, for instance cause-effect chains or “human er...

  6. Experimental studies as an inspiration for clinical investigation.

    Science.gov (United States)

    Małecka-Panas, E; Talar-Wojnarowska, R; Kotynia, J; Majumdar, A P N

    2004-07-01

    This study represents an attempt of showing own author's example of using basic research data as an inspiration for the clinical studies. The project evaluates the role of gastrin in colorectal carcinogenesis as well as the differences of its action in proximal and distal colon. Colonocytes were isolated from Fischer-344 rats and incubated for 2 minutes with gastrin (10(-8)M). This treatment resulted with 60-70% rise in tyrosine kinase (Tyr-k) and 150-200% - in phospholipase C activity as regards to basal levels. In vivo infusion of gastrin for 5 days to Fischer-344 rats resulted with 90-150% increase in distal but not proximal colonic mucosal proliferative activity as well as tyrosine phosphorylation of several colonic mucosal proteins. In clinical study, the mean fasting gastrin level in the control group was significantly lower (p<0.01) than in patients with colorectal cancer before surgery. Mean plasma gastrin level in patients with distal tumor yielded 105,31 +/- 12,5 microU/l and was significantly higher than in patients with the proximal tumor site (42, 2 +/- 3,1 microU/l) (p<0,001). We conclude, that Tyr-k is involved in the mechanism of the trophic action of gastrin, particularly in distal colon. The differences in gastrin concentration in patients with distal and proximal tumors may probably contribute to the distinct pathogenesis and biological properties of those cancers.

  7. German ambulatory care physicians' perspectives on clinical guidelines – a national survey

    Directory of Open Access Journals (Sweden)

    Böcken Jan

    2006-07-01

    Full Text Available Abstract Background There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a clinical practice guidelines (CPG and b evidence based medicine (EBM The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. Methods Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale. 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi2 test was used to investigate distribution of two or more categorical variables. Results Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP as well as general practitioners (GP agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP or specialists (S (Student's t-test mean GP 2.57, S 2.84, p Conclusion Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs.

  8. Investigation of paramedics' compliance with clinical practice guidelines for the management of chest pain.

    LENUS (Irish Health Repository)

    Figgis, Ken

    2012-01-31

    BACKGROUND: Acute coronary syndromes remain a leading cause of preventable early deaths. However, previous studies have indicated that paramedics\\' compliance with chest pain protocols is suboptimal and that many patients do not receive the benefits of appropriate prehospital treatment. AIMS: To evaluate paramedics\\' level of compliance with national clinical practice guidelines and to investigate why, in certain circumstances, they may deviate from the clinical guidelines. SETTING: The Health Service Executive Mid-Western Regional Ambulance Service which serves a mixed urban and rural population across three counties in the west of Ireland. METHOD: A retrospective review of completed ambulance Patient Care Report Forms was conducted for all adult patients with non-traumatic chest pain treated between 1 December 2007 and 31 March 2008. During the same study period, paramedics were asked to complete a prospective questionnaire survey investigating the rationale behind their treatment decisions, their estimation of patient risk and their attitudes towards the clinical practice guidelines and training. RESULTS: 382 completed Patient Care Report Forms were identified for patients with chest pain, of whom 84.8% received ECG monitoring, 75.9% were given oxygen, 44.8% were treated with sublingual glyceryl trinitrate (GTN) and 50.8% were treated with aspirin. Only 20.4% of patients had a prehospital 12-lead ECG recorded. 58 completed questionnaires were returned (response rate 15%); 64% of respondents said they had received insufficient training to identify ECG abnormalities. CONCLUSIONS: Prehospital treatment with oxygen, aspirin, sublingual GTN and ECG monitoring remains underused by paramedics, even though only a small number of patients had documented contraindications to their use. The small number of patients who received a prehospital 12-lead ECG is a cause of particular concern and suggests that incomplete patient assessment may contribute to undertreatment

  9. Investigation of paramedics' compliance with clinical practice guidelines for the management of chest pain.

    Science.gov (United States)

    Figgis, Ken; Slevin, Oliver; Cunningham, J Brian

    2010-02-01

    Acute coronary syndromes remain a leading cause of preventable early deaths. However, previous studies have indicated that paramedics' compliance with chest pain protocols is suboptimal and that many patients do not receive the benefits of appropriate prehospital treatment. To evaluate paramedics' level of compliance with national clinical practice guidelines and to investigate why, in certain circumstances, they may deviate from the clinical guidelines. The Health Service Executive Mid-Western Regional Ambulance Service which serves a mixed urban and rural population across three counties in the west of Ireland. A retrospective review of completed ambulance Patient Care Report Forms was conducted for all adult patients with non-traumatic chest pain treated between 1 December 2007 and 31 March 2008. During the same study period, paramedics were asked to complete a prospective questionnaire survey investigating the rationale behind their treatment decisions, their estimation of patient risk and their attitudes towards the clinical practice guidelines and training. 382 completed Patient Care Report Forms were identified for patients with chest pain, of whom 84.8% received ECG monitoring, 75.9% were given oxygen, 44.8% were treated with sublingual glyceryl trinitrate (GTN) and 50.8% were treated with aspirin. Only 20.4% of patients had a prehospital 12-lead ECG recorded. 58 completed questionnaires were returned (response rate 15%); 64% of respondents said they had received insufficient training to identify ECG abnormalities. Prehospital treatment with oxygen, aspirin, sublingual GTN and ECG monitoring remains underused by paramedics, even though only a small number of patients had documented contraindications to their use. The small number of patients who received a prehospital 12-lead ECG is a cause of particular concern and suggests that incomplete patient assessment may contribute to undertreatment. Further provision of training and equipment is necessary to

  10. Need for enforcement of ethicolegal education – an analysis of the survey of postgraduate clinical trainees

    Directory of Open Access Journals (Sweden)

    Takase Kozo

    2005-08-01

    Full Text Available Abstract Background The number of medical lawsuits in Japan was between 14 and 21 each year before 1998, but increased to 24 to 35 per year after 1999. There were 210 lawsuits during this 10-year period. There is a need for skills and knowledge related to ethics, which is as fundamental to the practice of medicine as basic sciences or clinical skills. in Japan education in ethics is relatively rare and its importance is not yet recognized. Establishing ethics education using legal precedents, which has already been achieved in Western countries, will be a very important issue in Japan. In the present study, a questionnaire survey was conducted among graduate intern doctors, in order to investigate whether ethics education using precedents might have a positive effect in Japan. Methods In 2002, a questionnaire survey entitled Physicians' Clinical Ethics was carried out in a compulsory orientation lecture given to trainees before they started clinical practice in our hospital. The attendees at this lecture were trainees who came from colleges in various districts of Japan. During the lecture, 102 questionnaires were distributed, completed by attendees and collected. The recovery rate was 100%. The questionnaire consisted of 22 questions (in three categories, of which 20 were answered by multiple choices, and the other two were answered by description. The time required to complete the questionnaire was about 10 minutes. Results The recovered questionnaires were analyzed using statistical analysis software (SPSS for Windows, Release 10.07J-1/June/2000, in addition to simple statistical analysis. answers using multiple choices for the 20 questions in the questionnaire were input into SPSS. The principal component analysis was performed for each question. As a result, the item that came to the fore was "legal precedent". Since many intern doctors were interested in understanding laws and precedents, learning about ethical considerations through

  11. Familial amyotrophic chorea with acanthocytosis. New clinical and laboratory investigations.

    Science.gov (United States)

    Gross, K B; Skrivanek, J A; Carlson, K C; Kaufman, D M

    1985-08-01

    A 46-year-old man, the son of normal nonconsanguinous parents, had a rare progressive neurological illness that began in midlife and was characterized by seizures, buccolingual dyskinesia, orofacial tics, choreiform movements, areflexia, and neurogenic muscle atrophy. Acanthocytosis was present. The serum creatine kinase level was elevated and normobetalipoproteinemia was noted. A brother had a similar disorder. These clinical and laboratory characteristics are consistent with those of previously reported cases of neuroacanthocytosis, ie, familial amyotrophic chorea with acanthocytosis (FACWA). Features not previously reported in cases of FACWA and noted in our index patient are as follows: an increased level of free sialic acid was detected in the serum; haloperidol administered in high doses decreased the orofacial tics; absence of the McLeod blood group phenotype was noted; and Hispanic-Puerto Rican ancestry was documented.

  12. Future directions in clinical child and adolescent psychology: a Delphi survey.

    Science.gov (United States)

    James, Rochelle L; Roberts, Michael C

    2009-10-01

    This study sought to identify the future directions in three domains: clinical practice, research, and training of clinical child and adolescent psychologists in the upcoming decade. Doctoral-level active members in the field were surveyed via a two-round Delphi survey (45 in round 1; 35 in round 2). Evidence-based practice received the greatest consensus by the participants and highest rank in each of the three domains. Other highly ranked clinical practice directions included prevention and early diagnosis and treatment, and clinical services for specific psychological problems. Research directions focused on biological and social factors interactions in the etiology and treatment and specific child and adolescent disorders. In the training domain, major directions included the pursuit of specialty training in child and adolescent psychology and training emphasizing the biological basis of behavior. Implications of these future directions are discussed.

  13. Toward generally accepted forensic assessment practices among clinical neuropsychologists: a survey of professional practice and common test use.

    Science.gov (United States)

    LaDuke, Casey; Barr, William; Brodale, Donald L; Rabin, Laura A

    2018-01-01

    This study investigated professional practice and common test use among clinical neuropsychologists engaging in forensic assessment.  Doctorate-level psychologists active in the practice of neuropsychology and on the INS and NAN membership listings (n = 502) were surveyed about their demographics, professional practice, and common test use. Participants who reported engaging in forensic practice (n = 255) were further surveyed about their forensic practice. Forensic participants were more likely to be male and Caucasian, and reported higher ages, more years of professional experience, and a higher prevalence of board certification. While characteristics of their professional and forensic practice varied, forensic participants reported spending most of their professional time conducting neuropsychological assessments with adult clients in a private or group practice setting, focusing on civil referrals and civil legal questions involving older adult issues, developmental issues, head injury, and psychiatric issues. Common test use across neuropsychological assessment domains is presented for board-certified forensic participants (n = 77). An examination of these results reveals that the current pattern of test use is similar to the results of a more general survey of neuropsychological test use.  The findings provide insight into the practice of forensic neuropsychological assessment, and further establish the admissibility of neuropsychological evidence in the United States legal system. Results will be useful for clinical neuropsychologists, field leaders, and legal professionals hoping to gain insight into the role of clinical neuropsychology in civil and criminal legal decision-making.

  14. Clinical investigations of receptive and expressive musical functions after stroke.

    Science.gov (United States)

    Rosslau, Ken; Steinwede, Daniel; Schröder, C; Herholz, Sibylle C; Lappe, Claudia; Dobel, Christian; Altenmüller, Eckart

    2015-01-01

    There is a long tradition of investigating various disorders of musical abilities after stroke. These impairments, associated with acquired amusia, can be highly selective, affecting only music perception (i.e., receptive abilities/functions) or expression (music production abilities), and some patients report that these may dramatically influence their emotional state. The aim of this study was to systematically test both the melodic and rhythmic domains of music perception and expression in left- and right-sided stroke patients compared to healthy subjects. Music perception was assessed using rhythmic and melodic discrimination tasks, while tests of expressive function involved the vocal or instrumental reproduction of rhythms and melodies. Our approach revealed deficits in receptive and expressive functions in stroke patients, mediated by musical expertise. Those patients who had experienced a short period of musical training in childhood and adolescence performed better in the receptive and expressive subtests compared to those without any previous musical training. While discrimination of specific musical patterns was unimpaired after a left-sided stroke, patients with a right-sided stroke had worse results for fine melodic and rhythmic analysis. In terms of expressive testing, the most consistent results were obtained from a test that required patients to reproduce sung melodies. This implies that the means of investigating production abilities can impact the identification of deficits.

  15. Clinical investigations of receptive and expressive musical functions after stroke

    Directory of Open Access Journals (Sweden)

    Ken eRosslau

    2015-06-01

    Full Text Available There is a long tradition of investigating various disorders of musical abilities after stroke. These impairments, associated with acquired amusia, can be highly selective, affecting only music perception (i.e., receptive abilities/functions or expression (music production abilities, and some patients report that these may dramatically influence their emotional state. The aim of this study was to systematically test both the melodic and rhythmic domains of music perception and expression in left- and right-sided stroke patients compared to healthy subjects. Music perception was assessed using rhythmic and melodic discrimination tasks, while tests of expressive function involved the vocal or instrumental reproduction of rhythms and melodies. Our approach revealed deficits in receptive and expressive functions in stroke patients, mediated by musical expertise. Those patients who had experienced a short period of musical training in childhood and adolescence performed better in the receptive and expressive subtests compared to those without any previous musical training. While discrimination of specific musical patterns was unimpaired after a right-sided stroke, patients with a left-sided stroke had worse results for fine melodic and rhythmic analysis. In terms of expressive testing, the most consistent results were obtained from a test that required patients to reproduce sung melodies. This implies that the means of investigating production abilities can impact the identification of deficits.

  16. A national survey of Chinese medicine doctors and clinical practice guidelines in China.

    Science.gov (United States)

    Liu, Mengyu; Zhang, Chi; Zha, Qinglin; Yang, Wei; Yuwen, Ya; Zhong, Linda; Bian, Zhaoxiang; Han, Xuejie; Lu, Aiping

    2017-09-06

    Clinical practice guidelines (CPGs) for Chinese medicine (CM) are being developed to assist doctors with appropriate decisions concerning CM care. To date, there has been little investigation on the perspectives of those to whom the guidelines are directed. A self-administered questionnaire was sent to 4503 doctors in 28 provinces of China in the latter half of 2012. Questions were organized around the topics of knowledge, application, practice changes, beliefs and outcomes of implementation. Basic classificatory data on specialties and years of qualification were also collected. Replies were received from 4495 CM doctors (99.82%). Of these, 85.56% of CM doctors reported being familiar with CPG recommendations, but the overall adherence rate was only 50.39%. The length of time practicing CM may influence the rate of adherence, since 709 doctors (51.90%) with less than 5 years of experience reported never having followed CPGs. Doctors in nine specialties showed a modest degree of homogeneity in their attitudes towards CM diagnosis and treatment, which were generally positive. Most doctors regarded CPG-recommended therapies as safe (92%), economic (84%), and effective (76%). Approximately four-fifths of those questioned selected 'acceptable' (60.84%) and 'acceptable after revision' (19.23%) regarding their comprehensive assessment of the CPGs. An encouraging result from this survey is that the majority of CM doctors support the concept of CPGs for the practice of CM. However, the results of this survey also suggest that improving the adherence of CM doctors to the guidelines remains a major challenge to improving the practice standards for CM.

  17. A clinical survey about commercial games in lower limb prosthetic rehabilitation.

    Science.gov (United States)

    Imam, Bita; Miller, William C; Finlayson, Heather C; Eng, Janice J; Jarus, Tal

    2017-11-01

    Despite the popularity of commercial games in lower limb prosthetic rehabilitation, data about their prevalence of use as well as therapists' perspectives about these games are still lacking. To learn about the prevalence of use of commercial games in lower limb prosthetic rehabilitation and therapists' perspectives about these games. Cross-sectional. An online survey was sent to physical and occupational therapists across prosthetic rehabilitation facilities in Canada. The survey had questions about the use of commercial games and therapists' perspectives. Data were collected from 82 therapists. Overall, 46.3% (38/82) reported that they use commercial games; of those, 94.7% (36/38) used the Nintendo Wii Fit. The most reported perceived benefits were the Wii Fit helping to improve weight shifting ( n = 76/82, 92.7%) and balance ( n = 75/82, 91.5%), and being motivating and complementing traditional therapy ( n = 75/82, 91.5%). The most reported perceived barriers/challenges were lack of time and familiarity with the games ( n = 58/82, 70.7%). Commercial games, particularly the Wii Fit, are commonly used in lower prosthetic rehabilitation in Canada. Most of the queried therapists view the Wii Fit positively. Knowledge translation activities and developing standard treatment protocols would be helpful in minimizing the barriers identified in this study. Clinical relevance The Wii Fit is prevalent in lower limb prosthetic rehabilitation in Canada and it is viewed positively by therapists as having the potential to improve balance and weight bearing, making rehabilitation more motivating, and complementing traditional therapy. Future studies should investigate the efficacy of the Wii Fit in prosthetic rehabilitation.

  18. Web-conferenced simulation sessions: a satisfaction survey of clinical simulation encounters via remote supervision.

    Science.gov (United States)

    Hayden, Emily M; Navedo, Deborah D; Gordon, James A

    2012-09-01

    A critical barrier to expanding simulation-based instruction in medicine is the availability of clinical instructors. Allowing instructors to remotely observe and debrief simulation sessions may make simulation-based instruction more convenient, thus expanding the pool of instructors available. This study compared the impact of simulation sessions facilitated by in-person (IP) faculty versus those supervised remotely using Web-conferencing software (WebEx(®), Cisco [ www.webex.com/ ]). A convenience sample of preclinical medical students volunteered to "care for" patients in a simulation laboratory. Students received either standard IP or Web-conferenced (WC) instruction. WC sessions were facilitated by off-site instructors. A satisfaction survey (5-point Likert scale, where 1=strongly disagree and 5=strongly agree) was completed immediately following the sessions. Forty-four surveys were analyzed (WC n=25, IP n=19). In response to the question "Was the communication between faculty and students a barrier to understanding the case?," the average student responses were 2.8 (95% confidence interval [CI] 2.4-3.2) for WC and 4.5 (95% CI 4.0-5.0) for IP (p4.0-4.5) for WC and 4.9 (95% CI 4.6-5.2) for IP (p=0.0003). Both groups agreed that they acquired new skills (4.2 for WC, 4.5 for IP; p=0.39) and new knowledge (4.6 for WC, 4.7 for IP; p=0.41). Telecommunication can successfully enhance access to simulation-based instruction. In this study, a Web interface downgraded the quality of student-faculty communication. Future investigation is needed to better understand the impact of such an effect on the learning process and to reduce barriers that impede implementation of technology-facilitated supervision.

  19. Investigational antiarrhythmic agents: promising drugs in early clinical development.

    Science.gov (United States)

    Heijman, Jordi; Ghezelbash, Shokoufeh; Dobrev, Dobromir

    2017-08-01

    Although there have been important technological advances for the treatment of cardiac arrhythmias (e.g., catheter ablation technology), antiarrhythmic drugs (AADs) remain the cornerstone therapy for the majority of patients with arrhythmias. Most of the currently available AADs were coincidental findings and did not result from a systematic development process based on known arrhythmogenic mechanisms and specific targets. During the last 20 years, our understanding of cardiac electrophysiology and fundamental arrhythmia mechanisms has increased significantly, resulting in the identification of new potential targets for mechanism-based antiarrhythmic therapy. Areas covered: Here, we review the state-of-the-art in arrhythmogenic mechanisms and AAD therapy. Thereafter, we focus on a number of antiarrhythmic targets that have received significant attention recently: atrial-specific K+-channels, the late Na+-current, the cardiac ryanodine-receptor channel type-2, and the small-conductance Ca2+-activated K+-channel. We highlight for each of these targets available antiarrhythmic agents and the evidence for their antiarrhythmic effect in animal models and early clinical development. Expert opinion: Targeting AADs to specific subgroups of well-phenotyped patients is likely necessary to detect improved outcomes that may be obscured in the population at large. In addition, specific combinations of selective AADs may have synergistic effects and may enable a mechanism-based tailored antiarrhythmic therapy.

  20. Molecular epidemiology of dermatophytes in Tehran, Iran, a clinical and microbial survey

    NARCIS (Netherlands)

    Rezaei-Matehkolaei, A.; Makimura, K.; de Hoog, S.; Shidfar, M.R.; Zaini, F.; Eshraghian, M.; Naghan, P.A.; Mirhendi, H.

    2013-01-01

    In the framework of a survey on dermatophytoses, 14,619 clinical specimens taken from outpatients with symptoms suggestive of tinea and referred to a Medical Mycology laboratory in Tehran, Iran, were analyzed by direct microscopy and culture. In total, 777 dermatophyte strains recovered in culture

  1. A Delphi survey on expert opinion on key signs for clinical diagnosis ...

    African Journals Online (AJOL)

    A Delphi survey on expert opinion on key signs for clinical diagnosis of bovine trypanosomosis, tick-borne diseases and helminthoses. ... For theileriosis, they included lymph node enlargement, pyrexia, age, breed and reduced milk yield. For trypanosomosis, they included, anaemia, weightloss, staring coat, lymph node ...

  2. The Clinical Treatment of School Refusal Behavior: A Survey of Referral and Practice Characteristics.

    Science.gov (United States)

    Kearney, Christopher A.; Beasley, Julie F.

    1994-01-01

    Surveyed 63 professional psychologists specializing in youth and family practice about recently referred and treated cases of school refusal behavior. Obtained data on clinical prevalence; demographic characteristics; length of absenteeism; severity; etiology; and length, type, and success of treatments used. Results revealed that children…

  3. Uterine fibroid embolisation for symptomatic uterine fibroids: a survey of clinical practice in Europe

    NARCIS (Netherlands)

    Voogt, M.J.; Arntz, M.; Lohle, P.N.; Mali, W.P.Th.; Lampmann, L.E.

    2011-01-01

    PURPOSE: To assess current uterine fibroid embolisation (UFE) practice in European countries and determine the clinical environment for UFE in different hospitals. MATERIAL AND METHODS: In May 2009, an invitation for an online survey was sent by e-mail to all members of the Cardiovascular and

  4. Cross-Gender Mentorship in Clinical Psychology Doctoral Programs: An Exploratory Survey Study

    Science.gov (United States)

    Harden, Sherry L.; Clark, Richard A.; Johnson, W. Brad; Larson, Joshua

    2009-01-01

    The mentorship experiences of recent clinical psychology doctorates reporting a primary mentor in graduate school were assessed by means of a survey. Among 518 responding psychologists, male graduates were significantly more likely to have a same-gender mentor, and female graduates were more likely to report receiving support from mentors of both…

  5. Characteristics and Clinical Practices of Marriage and Family Therapists: A National Survey

    Science.gov (United States)

    Northey, William F., Jr.

    2002-01-01

    This report presents data from a telephone survey of a randomly selected sample of 292 marriage and family therapists (MFTs) who were Clinical Members of the American Association for Marriage and Family Therapy. The study, designed to better understand the current state of the field of MFT, provides descriptive data on the demographic…

  6. Annual Progress Report FY 93 (Walter Reed Army Medical Center, Department of Clinical Investigation). Clinical Investigation Program. Volume 2

    Science.gov (United States)

    1993-01-01

    in response to prolonged and sev.--e gastroesophageal reflux (GER). The study objective is to normalize the intraesophageal pH with omeprazole (Losec...esophagitis with omeprazole . However, serum zinc levels remained low after healing, suggesting a longer period to replace the plasma zinc pool. 183 REPORT...investigators explore the data. 273 REPORT DATE: 12/16/92 WORK UNIT # 7521 DETAIL SUMMARY SHE"T TITLE: Pregnancy Attitudes, Ambivalence and Symptom Distress

  7. Investigation of coastal areas in Northern Germany using airborne geophysical surveys

    Science.gov (United States)

    Miensopust, Marion; Siemon, Bernhard; Wiederhold, Helga; Steuer, Annika; Ibs-von Seht, Malte; Voß, Wolfgang; Meyer, Uwe

    2014-05-01

    Since 2000, the German Federal Institute for Geosciences and Natural Resources (BGR) carried out several airborne geophysical surveys in Northern Germany to investigate the coastal areas of the North Sea and some of the North and East Frisian Islands. Several of those surveys were conducted in cooperation with the Leibniz Institute for Applied Geophysics (LIAG). Two helicopter-borne geophysical systems were used, namely the BGR system, which collects simultaneously frequency-domain electromagnetic, magnetic and radiometric data, and the SkyTEM system, a time-domain electromagnetic system developed by the University of Aarhus. Airborne geophysical surveys enable to investigate huge areas almost completely with high lateral resolution in a relatively short time at economic cost. In general, the results can support geological and hydrogeological mapping. Of particular importance are the airborne electromagnetic results, as the surveyed parameter - the electrical conductivity - depends on both lithology and groundwater status. Therefore, they can reveal buried valleys and the distribution of sandy and clayey sediments as well as salinization zones and fresh-water occurrences. The often simultaneously recorded magnetic and radiometric data support the electromagnetic results. Lateral changes of Quaternary and Tertiary sediments (shallow source - several tens of metres) as well as evidences of the North German Basin (deep source - several kilometres) are revealed by the magnetic results. The radiometric data indicate the various mineral compositions of the soil sediments. This BGR/LIAG project aims to build up a geophysics data base (http://geophysics-database.de/) which contains all airborne geophysical data sets. However, the more significant effort is to create a reference data set as basis for monitoring climate or man-made induced changes of the salt-water/fresh-water interface at the German North Sea coast. The significance of problems for groundwater extraction

  8. Good clinical practice regulatory inspections: Lessons for Indian investigator sites

    Directory of Open Access Journals (Sweden)

    R Marwah

    2010-01-01

    Full Text Available Regulatory inspections are important to evaluate the integrity of the data submitted to health authorities (HAs, protect patient safety, and assess adequacy of site/sponsor quality systems to achieve the same. Inspections generally occur after submission of data for marketing approval of an investigational drug. In recent years, there has been a significant increase in number of inspections by different HAs, including in India. The assessors/inspectors generally do a thorough review of site data before inspections. All aspects of ICH-GCP, site infrastructure, and quality control systems are assessed during the inspection. Findings are discussed during the close out meeting and a detailed inspection report issued afterward, which has to be responded to within 15-30 days with effective Corrective and Preventive Action Plan (CAPA. Protocol noncompliance, inadequate/inaccurate records, inadequate drug accountability, informed consent issues, and adverse event reporting were some of the most common findings observed during recent Food and Drug Administration (FDA inspections. Drug development is being increasingly globalized and an increased number of patients enrolled in studies submitted as part of applications come from all over the world including India. Because of the steep increase in research activity in the country, inexperienced sites, and more stakeholders, increased efforts will be required to ensure continuous quality and compliance. HAs have also made clear that enforcement will be increased and be swift, aggressive, and effective.

  9. Can a clinical senate enhance state-wide clinician engagement? A survey study.

    Science.gov (United States)

    Quinlivan, Julie A; Miller, Mary; Hutton, Marani

    2017-12-01

    Objective Clinician engagement correlates with quality, safety and efficacy outcomes. The aim of the present study was to explore whether a clinical senate model achieves clinical input into system manager and operational health service boards. Methods A mixed-methods survey was undertaken. Participants were current or immediate past members of the Clinical Senate of Western Australia (CS). For the 124 surveys sent out, the response rate was 60%. Results Respondents stated the CS played a role in clinician engagement (95%), contributed to healthcare reform (82%), knowledge of contemporary health issues (92%), feedback to decision makers (82%), clinician networking (94%), debate on important issues (93%), enabled clinicians to work on recommendations to improve health at a state level (87%), contributed to clinician thinking on health reform (88%) and enabled clinicians to share their knowledge (91%). Four major themes emerged in the qualitative analysis: (1) the need for a strong independent clinician forum and voice at a state level; (2) the need to strengthen clinician interactions with operational healthcare boards; (3) a strong belief that clinician engagement strengthened quality and safety outcomes at a state level; and (4) that membership was important and needed to be diverse, multidisciplinary and independent, but structurally representative of clinicians in the state. Conclusion A clinical senate model can facilitate state-wide clinician engagement. What is known about the topic? High levels of clinical engagement foster a culture within healthcare organisations that is associated with the delivery of sustained high-quality, safe and efficient services. This has led to a focus on strategies to optimise clinical engagement in healthcare planning and reform. However, there is limited data exploring how to achieve clinical engagement at a state, rather than local, level within the healthcare system. What does this paper add? This survey study evaluates the

  10. Influence of isoproterenol on myocardial energetics. Experimental and clinical investigations.

    Science.gov (United States)

    Hasenfuss, G; Holubarsch, C; Blanchard, E M; Mulieri, L A; Alpert, N R; Just, H

    1989-01-01

    The influence of isoproterenol on myocardial performance and energetics was investigated in normal guinea pig myocardium and in patients with normal left ventricular function. The in vitro experiments were performed by simultaneous isometric force and heat measurements using sensitive antimony-bismuth thermopiles. Following the application of isoproterenol (10(-8) M) isometric peak twitch tension and tension-time integral increased significantly by 185% and 142%, respectively. Tension-independent heat which reflects high energy phosphate hydrolysis of excitation-contraction coupling increased by 183%. Tension-dependent heat reflecting the high energy phosphate hydrolysis of the crossbridges increased by 417%. The ratio of tension-dependent heat to tension-time integral increased by 131%. The recovery/initial heat ratio, reflecting the efficiency of the recovery metabolism, and the resting metabolism did not significantly change. In the patients the effect of isoproterenol on myocardial energetics was evaluated in terms of myocardial efficiency. Following isoproterenol administration, left ventricular systolic stress-time integral decreased by 49% due to reductions in end-diastolic pressure, end-diastolic volume and duration of systole. Pressure-volume work remained unchanged. Myocardial oxygen consumption per minute increased in proportion to heart rate. The ratio of myocardial oxygen consumption per beat to left ventricular systolic stress-time integral increased significantly by 95%. External myocardial efficiency was unaltered. Thus, isoproterenol increases the energy turnover of excitation-contraction coupling and increases the energy consumption of the crossbridges disproportionately to developed tension-time integral in the guinea pig heart.

  11. Clinical and laboratory investigation of allergy to genetically modified foods.

    Science.gov (United States)

    Bernstein, Jonathan A; Bernstein, I Leonard; Bucchini, Luca; Goldman, Lynn R; Hamilton, Robert G; Lehrer, Samuel; Rubin, Carol; Sampson, Hugh A

    2003-06-01

    Technology has improved the food supply since the first cultivation of crops. Genetic engineering facilitates the transfer of genes among organisms. Generally, only minute amounts of a specific protein need to be expressed to obtain the desired trait. Food allergy affects only individuals with an abnormal immunologic response to food--6% of children and 1.5-2% of adults in the United States. Not all diseases caused by food allergy are mediated by IgE. A number of expert committees have advised the U.S. government and international organizations on risk assessment for allergenicity of food proteins. These committees have created decision trees largely based on assessment of IgE-mediated food allergenicity. Difficulties include the limited availability of allergen-specific IgE antisera from allergic persons as validated source material, the utility of specific IgE assays, limited characterization of food proteins, cross-reactivity between food and other allergens, and modifications of food proteins by processing. StarLink was a corn variety modified to produce a (Italic)Bacillus thuringiensis(/Italic) (Bt) endotoxin, Cry9C. The Centers for Disease Control and Prevention investigated 51 reports of possible adverse reactions to corn that occurred after the announcement that StarLink, allowed for animal feed, was found in the human food supply. Allergic reactions were not confirmed, but tools for postmarket assessment were limited. Workers in agricultural and food preparation facilities have potential inhalation exposure to plant dusts and flours. In 1999, researchers found that migrant health workers can become sensitized to certain Bt spore extracts after exposure to Bt spraying.

  12. Clinical evaluation tools: a survey of doctors of chiropractic and students at one chiropractic college.

    Science.gov (United States)

    Mansholt, Barbara A; Vining, Robert D

    2016-03-01

    The reliability and validity of many evaluation tools leading to clinical decision-making for spinal manipulation are varied. We surveyed senior students and DC employees at one chiropractic college regarding 1) which analysis tools should be used and 2) factors that influence their choices. The survey queried which tools should be used on a routine patient encounter. Clinical evaluation tools included palpation, skin temperature analysis, leg length analysis, and radiographs. Surveys were collected from 58 doctors of chiropractic (DCs) and 74 students. Respondents from both groups reported to most commonly use static palpation, followed by motion palpation and leg length analysis. DC respondents ranked evidence and personal experience high for rationale; student respondents frequently chose patient preference. DC and student respondents reported use of clinical evaluation tools consistently. However, some variations in rationale were noted. It is important for educators to provide a balanced presentation of the strengths and limitations of clinical analysis procedures to support the development of well-justified evidence-based clinical decision-making skills.

  13. [The bone bank--a standardized procedure? Results of a federal survey of German surgical clinics].

    Science.gov (United States)

    Knaepler, H; Laubach, S; Gotzen, L

    1990-11-01

    An inquiry at German surgical departments about their bone bank techniques showed that 45% of clinical hospitals use allogeneic bone implants among other implants. In 1989, the year of the official survey, allogeneic bone was transplanted about 6000 times in these clinical hospitals. Despite of this high transplantation frequency important differences turn out regarding selection and testing of recipients, transplantation storage and treatment. A lot of clinical hospitals do not perform important donor examinations inspite of proven transmission risks of bacterial and viral diseases by deep frozen bone. A trend analysis shows that despite of the risk of an HIV-transmission and the resulting difficulties in the logistic of the bone bank, the transplantation frequency allogeneic bone stays constant. The official surveys prove the large range of bone bank techniques and should give rise to make efforts to take note of the recommendations for bone banking techniques.

  14. The American Society for Clinical Pathology's 2014 vacancy survey of medical laboratories in the United States.

    Science.gov (United States)

    Garcia, Edna; Ali, Asma M; Soles, Ryan M; Lewis, D Grace

    2015-09-01

    To determine the extent and distribution of workforce shortages within the nation's medical laboratories. Historically, the results of this biennial survey have served as a basis for additional research on laboratory recruitment, retention, education, marketing, certification, and advocacy. The 2014 Vacancy Survey was conducted through collaboration between American Society for Clinical Pathology's Institute of Science, Technology, and Policy in Washington, DC, and the Evaluation, Measurement, and Assessment Department and Board of Certification in Chicago, Illinois. Data were collected via an Internet survey that was distributed to individuals who were able to report on staffing and certifications for their laboratories. Data reveal increased overall vacancy rates since 2012 for all departments surveyed except cytology and cytogenetics. Also, results show higher anticipated retirement rates for both staff and supervisors. Overall certification rates are highest among laboratory personnel in cytogenetics, hematology/coagulation, and flow cytometry departments and lowest among phlebotomy, specimen processing, and anatomic pathology. Factors such as retirement and the improving economy are driving the need for more laboratory professionals. Recruitment of qualified laboratory professionals in the workforce and students in laboratory programs will be the key in fulfilling the higher vacancies revealed from the survey results in 2014. Copyright© by the American Society for Clinical Pathology.

  15. Adult Dental Health Survey 2009: implications of findings for clinical practice and oral health policy.

    Science.gov (United States)

    Watt, R G; Steele, J G; Treasure, E T; White, D A; Pitts, N B; Murray, J J

    2013-01-01

    This is the final paper in a series reporting on the results of the 2009 Adult Dental Health Survey. Since 1968 national adult surveys have been repeated every decade with broadly similar methods providing a unique overview of trends in oral health over a 40-year period. This paper aims to explore the implications for dentists and oral health policy of the key results from the Adult Dental Health Survey 2009. Although repeat, cross-sectional, epidemiological surveys provide very valuable data on trends in disease patterns, they do not provide answers to test causal relationships and therefore cannot identify the causes for the significant improvements in oral health over the last 40 years. Evidence would indicate, however, that broad societal shifts in population norms and behaviours, combined with changes in clinical diagnostic criteria, treatment planning and clinical procedures are the main reasons for the changes that have taken place. Key implications of the survey results include the need to monitor, support and maintain the good state of oral health of the increasing proportion of younger adults with relatively simple treatment needs. A smaller number of young and middle aged adults but a significant proportion of older adults will have far more complex treatment needs requiring advanced restorative and periodontal care. Future oral health policy will need to address oral health inequalities, encourage skill mix and promote and facilitate the dental profession to deliver appropriate and high quality care relevant to the needs of their local population.

  16. Linkage of clinical trial and administrative data: a survey of cancer patient preferences.

    Science.gov (United States)

    Hay, A E; Leung, Y W; Pater, J L; Brown, M C; Bell, E; Howell, D; Kassam, Z; Willing, S; Tian, C; Liu, G

    2017-06-01

    Personal health information, including diagnoses and hospital admissions, is routinely collected in administrative databases. Patients enrolling on clinical trials consent to separate collection and storage of their personal health information. We evaluated patient preferences for linking long-term data from administrative databases with clinical trials. Adults with cancer attending outpatient clinics at 3 Ontario hospitals were surveyed about their willingness, when faced with the hypothetical scenario of participating in a clinical trial, to provide potentially identifying information such as initials and date of birth to facilitate long-term research access to normally deidentified publicly collected databases. Of 569 patients surveyed, 335 (59%) were women, 452 (79%) were white, 385 (68%) had a post-secondary education, and 386 (68%) had never participated in a clinical trial. Median age in the group was 59 years. Most participants (93%, cohort 1) would allow long-term access to their information and allow personal information to be used to match clinical trial with administrative data. At the time of clinical trial closure, two thirds of participants (68%, cohort 2) preferred to make additional clinical information available through linkage with administrative databases, and 8 (9%) preferred to have no further information made available to researchers. No significant differences were found in the subset of patients who were part of a clinical trial and those who had never participated (p = 0.65). Almost all patients would allow a clinical trial research team to access their confidential information, providing a more comprehensive assessment of an intervention's long-term risks and benefits.

  17. Clinical patient registry recruitment and retention: a survey of patients in two chronic disease registries

    Directory of Open Access Journals (Sweden)

    Daniel H. Solomon

    2017-04-01

    Full Text Available Abstract Background The collection of routine clinical data in the setting of research registries can serve an important role in understanding real world care. However, relatively little is known about the patient experience in registries, motivating us to survey patients enrolled in two chronic disease registries. Methods We conducted similar surveys in two disease-based registries based at one academic medical center in the US. One group of patients with rheumatoid arthritis (RA had been enrolled in a registry, and we focused on retention factors. In a second group of patients with inflammatory bowel disease (IBD recently enrolled or considering enrollment, we examined factors that would influence their enrollment and willingness to answer frequent questionnaires and give biospecimens. The surveys were analyzed using descriptive statistics and the two cohorts were compared using nonparametric and chi-square tests. Results We received 150 (50% completed surveys from RA and 169 (63% from IBD patients. Mean age of subjects was 62 years in RA and 43 in IBD with more women respondents with RA (83% than IBD (62%. The two groups described very similar factors as the top three motivations for participation: desire to help others, desire to improve care of own disease, and ease of volunteering. Preferred methods of surveying included mail, e-mail, but telephone was not favored; age was an important correlate of this preference. Respondents preferred surveys either every 1–3 months (28.7% RA and 55.0% IBD or every 4–6 months (50.7% RA and 29.0% IBD. They differed in the preference for payment for answering surveys with 68.0% with RA answering that no payment was necessary but only 36.1% with IBD felt similarly. Conclusions Patients engaged in clinical registries demonstrate a high level of commitment to improve care and many report a willingness to answer questions relatively frequently.

  18. Clinical patient registry recruitment and retention: a survey of patients in two chronic disease registries.

    Science.gov (United States)

    Solomon, Daniel H; Shadick, Nancy A; Weinblatt, Michael E; Frits, Michelle; Iannaccone, Christine; Zak, Agnes; Korzenik, Joshua R

    2017-04-17

    The collection of routine clinical data in the setting of research registries can serve an important role in understanding real world care. However, relatively little is known about the patient experience in registries, motivating us to survey patients enrolled in two chronic disease registries. We conducted similar surveys in two disease-based registries based at one academic medical center in the US. One group of patients with rheumatoid arthritis (RA) had been enrolled in a registry, and we focused on retention factors. In a second group of patients with inflammatory bowel disease (IBD) recently enrolled or considering enrollment, we examined factors that would influence their enrollment and willingness to answer frequent questionnaires and give biospecimens. The surveys were analyzed using descriptive statistics and the two cohorts were compared using nonparametric and chi-square tests. We received 150 (50%) completed surveys from RA and 169 (63%) from IBD patients. Mean age of subjects was 62 years in RA and 43 in IBD with more women respondents with RA (83%) than IBD (62%). The two groups described very similar factors as the top three motivations for participation: desire to help others, desire to improve care of own disease, and ease of volunteering. Preferred methods of surveying included mail, e-mail, but telephone was not favored; age was an important correlate of this preference. Respondents preferred surveys either every 1-3 months (28.7% RA and 55.0% IBD) or every 4-6 months (50.7% RA and 29.0% IBD). They differed in the preference for payment for answering surveys with 68.0% with RA answering that no payment was necessary but only 36.1% with IBD felt similarly. Patients engaged in clinical registries demonstrate a high level of commitment to improve care and many report a willingness to answer questions relatively frequently.

  19. Factors Associated with Clinical Research Recruitment in a Pediatric Academic Medical Center--A Web-Based Survey.

    Directory of Open Access Journals (Sweden)

    Erica Rose Denhoff

    Full Text Available One of the most difficult aspects of conducting clinical research is the ability to successfully recruit participants. Pediatric clinical research presents unique recruitment challenges that relate to the need for parental consent on behalf of a minor, child assent, and school attendance. Yet, this has been less well studied. We conducted a survey of investigators performing human subjects research in a single large academic pediatric hospital to better understand characteristics of studies with successful recruitment.We conducted a web-based survey from September 2011 to December 2011 of all principal investigators with an Institutional Review Board approved human subjects protocol at Boston Children's Hospital, a pediatric Academic Medical Center. The survey captured various characteristics of the protocols including study design, staffing, resources, and investigator experience and training as well as respondents' perceived barriers and facilitators to recruitment. We used chi square tests and Mantel-Haenszel test for linear trend to examine the relationship between selected predictor variables and the binary outcome of successful vs. unsuccessful recruitment and multivariable logistic regression analyses to examine the simultaneous influence of potential predictors on each outcome.Among the 349 eligible investigators, 52% responded to the survey, and 181 with valid data were included in the analyses. Two-thirds of the 87 protocols closed to enrollment reached 80% or more of their target enrollment, whereas, only one-third of the 94 protocols actively recruiting were meeting 80% of their target. Recruitment method appeared to be the only significant and independent factor associated with achieving 80% or more of target enrollment in closed to enrollment protocols. Closed to enrollment protocols that used recruitment in person were 4.55 times (95% CI 1.30 to 15.93; p = 0.02 more likely to achieve 80% or more of their target enrollment when

  20. Factors Associated with Clinical Research Recruitment in a Pediatric Academic Medical Center—A Web-Based Survey

    Science.gov (United States)

    Denhoff, Erica Rose; Milliren, Carly E.; de Ferranti, Sarah D.; Steltz, Sarah K.; Osganian, Stavroula K.

    2015-01-01

    Background One of the most difficult aspects of conducting clinical research is the ability to successfully recruit participants. Pediatric clinical research presents unique recruitment challenges that relate to the need for parental consent on behalf of a minor, child assent, and school attendance. Yet, this has been less well studied. We conducted a survey of investigators performing human subjects research in a single large academic pediatric hospital to better understand characteristics of studies with successful recruitment. Methods We conducted a web-based survey from September 2011 to December 2011 of all principal investigators with an Institutional Review Board approved human subjects protocol at Boston Children’s Hospital, a pediatric Academic Medical Center. The survey captured various characteristics of the protocols including study design, staffing, resources, and investigator experience and training as well as respondents’ perceived barriers and facilitators to recruitment. We used chi square tests and Mantel-Haenszel test for linear trend to examine the relationship between selected predictor variables and the binary outcome of successful vs. unsuccessful recruitment and multivariable logistic regression analyses to examine the simultaneous influence of potential predictors on each outcome. Results Among the 349 eligible investigators, 52% responded to the survey, and 181 with valid data were included in the analyses. Two-thirds of the 87 protocols closed to enrollment reached 80% or more of their target enrollment, whereas, only one-third of the 94 protocols actively recruiting were meeting 80% of their target. Recruitment method appeared to be the only significant and independent factor associated with achieving 80% or more of target enrollment in closed to enrollment protocols. Closed to enrollment protocols that used recruitment in person were 4.55 times (95% CI 1.30 to 15.93; p = 0.02) more likely to achieve 80% or more of their target

  1. Factors Associated with Clinical Research Recruitment in a Pediatric Academic Medical Center--A Web-Based Survey.

    Science.gov (United States)

    Denhoff, Erica Rose; Milliren, Carly E; de Ferranti, Sarah D; Steltz, Sarah K; Osganian, Stavroula K

    2015-01-01

    One of the most difficult aspects of conducting clinical research is the ability to successfully recruit participants. Pediatric clinical research presents unique recruitment challenges that relate to the need for parental consent on behalf of a minor, child assent, and school attendance. Yet, this has been less well studied. We conducted a survey of investigators performing human subjects research in a single large academic pediatric hospital to better understand characteristics of studies with successful recruitment. We conducted a web-based survey from September 2011 to December 2011 of all principal investigators with an Institutional Review Board approved human subjects protocol at Boston Children's Hospital, a pediatric Academic Medical Center. The survey captured various characteristics of the protocols including study design, staffing, resources, and investigator experience and training as well as respondents' perceived barriers and facilitators to recruitment. We used chi square tests and Mantel-Haenszel test for linear trend to examine the relationship between selected predictor variables and the binary outcome of successful vs. unsuccessful recruitment and multivariable logistic regression analyses to examine the simultaneous influence of potential predictors on each outcome. Among the 349 eligible investigators, 52% responded to the survey, and 181 with valid data were included in the analyses. Two-thirds of the 87 protocols closed to enrollment reached 80% or more of their target enrollment, whereas, only one-third of the 94 protocols actively recruiting were meeting 80% of their target. Recruitment method appeared to be the only significant and independent factor associated with achieving 80% or more of target enrollment in closed to enrollment protocols. Closed to enrollment protocols that used recruitment in person were 4.55 times (95% CI 1.30 to 15.93; p = 0.02) more likely to achieve 80% or more of their target enrollment when compared to those

  2. Temporal abstraction and temporal Bayesian networks in clinical domains: a survey.

    Science.gov (United States)

    Orphanou, Kalia; Stassopoulou, Athena; Keravnou, Elpida

    2014-03-01

    Temporal abstraction (TA) of clinical data aims to abstract and interpret clinical data into meaningful higher-level interval concepts. Abstracted concepts are used for diagnostic, prediction and therapy planning purposes. On the other hand, temporal Bayesian networks (TBNs) are temporal extensions of the known probabilistic graphical models, Bayesian networks. TBNs can represent temporal relationships between events and their state changes, or the evolution of a process, through time. This paper offers a survey on techniques/methods from these two areas that were used independently in many clinical domains (e.g. diabetes, hepatitis, cancer) for various clinical tasks (e.g. diagnosis, prognosis). A main objective of this survey, in addition to presenting the key aspects of TA and TBNs, is to point out important benefits from a potential integration of TA and TBNs in medical domains and tasks. The motivation for integrating these two areas is their complementary function: TA provides clinicians with high level views of data while TBNs serve as a knowledge representation and reasoning tool under uncertainty, which is inherent in all clinical tasks. Key publications from these two areas of relevance to clinical systems, mainly circumscribed to the latest two decades, are reviewed and classified. TA techniques are compared on the basis of: (a) knowledge acquisition and representation for deriving TA concepts and (b) methodology for deriving basic and complex temporal abstractions. TBNs are compared on the basis of: (a) representation of time, (b) knowledge representation and acquisition, (c) inference methods and the computational demands of the network, and (d) their applications in medicine. The survey performs an extensive comparative analysis to illustrate the separate merits and limitations of various TA and TBN techniques used in clinical systems with the purpose of anticipating potential gains through an integration of the two techniques, thus leading to a

  3. Towards Horizon 2020: challenges and advances for clinical mental health research - outcome of an expert survey.

    Science.gov (United States)

    van der Feltz-Cornelis, Christina M; van Os, Jim; Knappe, Susanne; Schumann, Gunter; Vieta, Eduard; Wittchen, Hans-Ulrich; Lewis, Shôn W; Elfeddali, Iman; Wahlbeck, Kristian; Linszen, Donald; Obradors-Tarragó, Carla; Haro, Josep Maria

    2014-01-01

    The size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders. The research was conducted as an expert survey and expert panel discussion during a scientific workshop. Eighty-nine experts in clinical research and representing most European countries participated in this survey. Identified top priorities were the need for new intervention studies, understanding the diagnostic and therapeutic implications of mechanisms of disease, and research in the field of somatic-psychiatric comorbidity. The "subjectivity gap" between basic neuroscience research and clinical reality for patients with mental disorders is considered the main challenge in psychiatric research, suggesting that a shift in research paradigms is required. Innovations in clinical mental health research should bridge the gap between mechanisms underlying novel therapeutic interventions and the patient experience of mental disorder and, if present, somatic comorbidity. Clinical mental health research is relatively underfunded and should receive specific attention in Horizon 2020 funding programs.

  4. Assessment of surveys for the management of hospital clinical pharmacy services.

    Science.gov (United States)

    Čufar, Andreja; Mrhar, Aleš; Robnik-Šikonja, Marko

    2015-06-01

    Survey data sets are important sources of data, and their successful exploitation is of key importance for informed policy decision-making. We present how a survey analysis approach initially developed for customer satisfaction research in marketing can be adapted for an introduction of clinical pharmacy services into a hospital. We use a data mining analytical approach to extract relevant managerial consequences. We evaluate the importance of competences for users of a clinical pharmacy with the OrdEval algorithm and determine their nature according to the users' expectations. For this, we need substantially fewer questions than are required by the Kano approach. From 52 clinical pharmacy activities we were able to identify seven activities with a substantial negative impact (i.e., negative reinforcement) on the overall satisfaction of clinical pharmacy services, and two activities with a strong positive impact (upward reinforcement). Using analysis of individual feature values, we identified six performance, 10 excitement, and one basic clinical pharmacists' activity. We show how the OrdEval algorithm can exploit the information hidden in the ordering of class and attribute values, and their inherent correlation using a small sample of highly relevant respondents. The visualization of the outputs turns out highly useful in our clinical pharmacy research case study. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. A Survey of Attitudes towards the Clinical Application of Systemic Inflammation Based Prognostic Scores in Cancer

    Directory of Open Access Journals (Sweden)

    David G. Watt

    2015-01-01

    Full Text Available Introduction. The systemic inflammatory response (SIR plays a key role in determining nutritional status and survival of patients with cancer. A number of objective scoring systems have been shown to have prognostic value; however, their application in routine clinical practice is not clear. The aim of the present survey was to examine the range of opinions internationally on the routine use of these scoring systems. Methods. An online survey was distributed to a target group consisting of individuals worldwide who have reported an interest in systemic inflammation in patients with cancer. Results. Of those invited by the survey (n=238, 65% routinely measured the SIR, mainly for research and prognostication purposes and clinically for allocation of adjuvant therapy or palliative chemotherapy. 40% reported that they currently used the Glasgow Prognostic Score/modified Glasgow Prognostic Score (GPS/mGPS and 81% reported that a measure of systemic inflammation should be incorporated into clinical guidelines, such as the definition of cachexia. Conclusions. The majority of respondents routinely measured the SIR in patients with cancer, mainly using the GPS/mGPS for research and prognostication purposes. The majority reported that a measure of the SIR should be adopted into clinical guidelines.

  6. Intracompartmental pressure testing: results of an international survey of current clinical practice, highlighting the need for standardised protocols.

    Science.gov (United States)

    Hislop, Matthew; Tierney, Paul

    2011-09-01

    Despite more recent non-invasive modalities generating some credence in the literature, intracompartmental pressure testing is still considered the 'gold standard' for investigating chronic exertional compartment syndrome (CECS). Intracompartmental pressure testing, when used correctly, has been shown to be accurate and reliable. However, it is a user-dependent investigation, and the manner in which the investigation is conducted plays a large role in the outcome of the test. Despite this, a standard, reproducible protocol for intracompartmental pressure testing has not been described. This results in confusion regarding interpretation of results and reduces the tests' reliability. A summary of the current understanding of CECS is presented, along with the results of a survey of specialists in Australia and New Zealand who perform intracompartmental pressure testing, which confirms that a uniform approach is currently not used in clinical practice. This highlights the need for a consensus and standardised approach to intracompartmental pressure testing.

  7. Acoustic water bottom investigation with a remotely operated watercraft survey system

    Science.gov (United States)

    Yamasaki, Shintaro; Tabusa, Tomonori; Iwasaki, Shunsuke; Hiramatsu, Masahiro

    2017-12-01

    This paper describes a remotely operated investigation system developed by combining a modern leisure-use fish finder and an unmanned watercraft to survey water bottom topography and other data related to bottom materials. Current leisure-use fish finders have strong depth sounding capabilities and can provide precise sonar images and bathymetric information. Because these sonar instruments are lightweight and small, they can be used on unmanned small watercraft. With the developed system, an operator can direct the heading of an unmanned watercraft and monitor a PC display showing real-time positioning information through the use of onboard equipment and long-distance communication devices. Here, we explain how the system was developed and demonstrate the use of the system in an area of submerged woods in a lake. The system is low cost, easy to use, and mobile. It should be useful in surveying areas that have heretofore been hard to investigate, including remote, small, and shallow lakes, for example, volcanic and glacial lakes.

  8. Factors influencing clinical trial site selection in Europe: the Survey of Attitudes towards Trial sites in Europe (the SAT-EU Study).

    Science.gov (United States)

    Gehring, Marta; Taylor, Rod S; Mellody, Marie; Casteels, Brigitte; Piazzi, Angela; Gensini, Gianfranco; Ambrosio, Giuseppe

    2013-11-15

    Applications to run clinical trials in Europe fell 25% between 2007 and 2011. Costs, speed of approvals and shortcomings of European Clinical Trial Directive are commonly invoked to explain this unsatisfactory performance. However, no hard evidence is available on the actual weight of these factors or has it been previously investigated whether other criteria may also impact clinical trial site selection. The Survey of Attitudes towards Trial sites in Europe (SAT-EU Study) was an anonymous, cross-sectional web-based survey that systematically assessed factors impacting European clinical trial site selection. It explored 19 factors across investigator-driven, hospital-driven and environment-driven criteria, and costs. It also surveyed perceptions of the European trial environment. Clinical research organisations (CROs), academic clinical trial units (CTUs) and industry invited to respond. weight assigned to each factor hypothesised to impact trial site selection and trial incidence. Secondary outcome: desirability of European countries to run clinical trials. Responses were obtained from 485 professionals in 34 countries: 49% from BioPharma, 40% from CTUs or CROs. Investigator-dependent, environment-dependent and hospital-dependent factors were rated highly important, costs being less important (p<0.0001). Within environment-driven criteria, pool of eligible patients, speed of approvals and presence of disease-management networks were significantly more important than costs or government financial incentives (p<0.0001). The pattern of response was consistent across respondent groupings (CTU vs CRO vs industry). Considerable variability was demonstrated in the perceived receptivity of countries to undertake clinical trials, with Germany, the UK and the Netherlands rated the best trial markets (p<0.0001). Investigator-dependent factors and ease of approval dominate trial site selection, while costs appear less important. Fostering competitiveness of European clinical

  9. German ambulatory care physicians' perspectives on clinical guidelines - a national survey.

    Science.gov (United States)

    Butzlaff, Martin; Kempkens, Daniela; Schnee, Melanie; Dieterle, Wilfried E; Böcken, Jan; Rieger, Monika A

    2006-07-20

    There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a) clinical practice guidelines (CPG) and b) evidence based medicine (EBM)The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale). 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi2 test was used to investigate distribution of two or more categorical variables. Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP) as well as general practitioners (GP) agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP) or specialists (S) (Student's t-test mean GP 2.57, S 2.84, p institution was substantially lower than from physician networks or medical societies (36.2% vs. 53.4% vs. 62.0%). 73.8% of doctors interpret EBM as a combination of scientific research and individual medical knowledge; 80% regard EBM as the best basis for patient care. Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary

  10. Clinical features of dysthyroid optic neuropathy: a European Group on Graves' Orbitopathy (EUGOGO) survey

    NARCIS (Netherlands)

    McKeag, David; Lane, Carol; Lazarus, John H.; Baldeschi, Lelio; Boboridis, Kostas; Dickinson, A. Jane; Hullo, A. Iain; Kahaly, George; Krassas, Gerry; Marcocci, Claudio; Marinò, Michele; Mourits, Maarten P.; Nardi, Marco; Neoh, Christopher; Orgiazzi, Jacques; Perros, Petros; Pinchera, Aldo; Pitz, Susanne; Prummel, Mark F.; Sartini, Maria S.; Wiersinga, Wilmar M.

    2007-01-01

    BACKGROUND: This study was performed to determine clinical features of dysthyroid optic neuropathy (DON) across Europe. METHODS: Forty seven patients with DON presented to seven European centres during one year. Local protocols for thyroid status, ophthalmic examination and further investigation

  11. Clinical approach to inherited metabolic diseases in the neonatal period: a 20-year survey

    NARCIS (Netherlands)

    Saudubray, J. M.; Ogier, H.; Bonnefont, J. P.; Munnich, A.; Lombes, A.; Hervé, F.; Mitchel, G.; Poll The, B.; Specola, N.; Parvy, P.

    1989-01-01

    Every newborn with unexplained neurological deterioration, ketosis, metabolic acidosis or hypoglycaemia should be suspected of having an inherited error of intermediary metabolism. Many of these conditions can be diagnosed clinically with the aid of simple laboratory investigations. Since a

  12. Granulomatous prostatitis: clinical and histomorphologic survey of the disease in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Prakriti Shukla

    2017-03-01

    Conclusion: Despite present-day advances in imaging modalities and serological investigations, it is virtually impossible to identify granulomatous prostatitis clinically. Histopathology remains the gold standard in diagnosing the disease. However, assigning an etiologic cause to the wide spectrum of granulomas in granulomatous prostatitis requires a pathologist’s expertise and proper clinical correlation for appropriate patient management.

  13. Prevalence of lower urinary tract symptoms (LUTS) in stroke patients: a cross-sectional, clinical survey

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Gard, Gunvor; Klarskov, Peter

    2008-01-01

    The aims of this study were primarily to investigate the prevalence, severity and impact on daily life of Lower Urinary Tract Symptoms (LUTS) in a clinical sample of stroke patients and secondly to identify factors associated with LUTS.......The aims of this study were primarily to investigate the prevalence, severity and impact on daily life of Lower Urinary Tract Symptoms (LUTS) in a clinical sample of stroke patients and secondly to identify factors associated with LUTS....

  14. A facilitative versus directive approach in training clinical skills? Investigating students' clinical performance and perceptions.

    Science.gov (United States)

    Berghmans, Inneke; Druine, Nathalie; Dochy, Filip; Struyven, Katrien

    2012-08-01

    Over the years, many medical school curricula have started implementing diverse student-centred teaching and learning methodologies. Previous studies, however, have indicated that students prefer more traditional and directive methodologies instead, raising questions on which training approach should be advocated. This study contrasts the effects of a student-centred (i.e. facilitative) training approach on students' clinical skills learning with students' perceptions. More specifically, a quasi-experimental study was set up in which students experienced either a directive or facilitative training approach. Data were collected by means of an OSCE on the one hand, and a questionnaire on students' perceptions of the training sessions, and two open-ended questions about students' likes and dislikes on the other hand. While no general differences were found in terms of clinical knowledge and understanding, and actual clinical performance, an interaction between students' course-specific prior knowledge and the training approach was found. Especially students with low levels of knowledge benefited more from the facilitative training approach in terms of clinical knowledge, while highly knowledgeable students experienced a negative effect of this training approach. Moreover, students' perceptions revealed that facilitative-trained students reported more deep-level learning, while the directive training approach turned out to score higher in terms of quality and perceived effects.

  15. Report of the results of the International Clinical Cytometry Society and American Society for Clinical Pathology workload survey of clinical flow cytometry laboratories.

    Science.gov (United States)

    Wolniak, Kristy; Goolsby, Charles; Choi, Sarah; Ali, Asma; Serdy, Nina; Stetler-Stevenson, Maryalice

    2017-11-01

    Thorough review of current workload, staffing, and testing practices in clinical laboratories allows for optimization of laboratory efficiency and quality. This information is largely missing with regard to clinical flow cytometry laboratories. The purpose of this survey is to provide comprehensive, current, and accurate data on testing practices and laboratory staffing in clinical laboratories performing flow cytometric studies. Survey data was collected from flow cytometry laboratories through the ASCP website. Data was collected on the workload during a 1-year time period of full-time and part-time technical and professional (M.D./D.O./Ph.D. or equivalent) flow cytometry employees. Workload was examined as number of specimens and tubes per full time equivalent (FTE) technical and professional staff. Test complexity, test result interpretation, and reporting practices were also evaluated. There were 205 respondent laboratories affiliated predominantly with academic and health system institutions. Overall, 1,132 FTE employees were reported with 29% professional FTE employees and 71% technical. Fifty-one percent of the testing performed was considered high complexity and 49% was low complexity. The average number of tubes per FTE technologist was 1,194 per year and the average number of specimens per FTE professional was 1,659 per year. The flow cytometry reports were predominantly written by pathologists (57%) and were typically written as a separate report (58%). This survey evaluates the overall status of the current practice of clinical flow cytometry and provides a comprehensive dataset as a framework to help laboratory departments, directors, and managers make appropriate, cost-effective staffing decisions. © 2016 International Clinical Cytometry Society. © 2016 International Clinical Cytometry Society.

  16. A Survey of Clinical Uncertainty from the Paediatric Basic Specialist Trainee Perspective

    LENUS (Irish Health Repository)

    O’Neill, MB

    2017-06-01

    This study was undertaken to evaluate uncertainty from the Basic Specialist Trainee perspective. The survey of trainees explored 1) factors in decision making, 2) the personal impact of uncertainty, 3) the responses to both clinical errors and challenges to their decision making and 4) the potential strategies to address uncertainty. Forty-one (93%) of trainees surveyed responded. Important factors in decision making were clinical knowledge and senior colleague’s opinion. Sixty percent experienced significant anxiety post call as a consequence of their uncertainty. When errors are made by colleagues, the trainee’s response is acceptance (52.5%), and sympathy (32%).Trainees are strongly influenced by the opinions of senior colleagues often changing their opinions having made confident decisions. Solutions to address uncertainty include enhanced knowledge translation, and to a lesser extent, enhanced personal awareness and resilience awareness. To enhance the training experience for BST and lessen the uncertainty experienced these strategies need to be enacted within the training milieu.

  17. A National Survey of Mentoring Practices for Young Investigators in Circulatory and Respiratory Health.

    Science.gov (United States)

    Mottillo, Salvatore; Boyle, Pierre; Jacobi Cadete, Lindsay D; Rouleau, Jean-Lucien; Eisenberg, Mark J

    2016-01-01

    Background. Improving mentorship may help decrease the shortage of young investigators (graduate students, postdoctoral fellows, and new investigators) available to work as independent researchers in cardiovascular and respiratory health. Objectives. To determine (1) the mentoring practices for trainees affiliated with the Canadian Institutes of Health Research (CIHR), Institute of Circulatory and Respiratory Health (ICRH), (2) the positive attributes of mentors, and (3) the recommendations regarding what makes good mentorship. Methods. We conducted a survey and descriptive analysis of young investigators with a CIHR Training and Salary Award from 2010 to 2013 or who submitted an abstract to the ICRH 2014 Young Investigators Forum. Clinicians were compared to nonclinicians. Results. Of 172 participants, 7.0% had no mentor. Only 43.6% had defined goals and 40.7% had defined timelines, while 54.1% had informal forms of mentorship. A significant proportion (33.1%) felt that their current mentorship did not meet their needs. Among clinicians, 22.2% would not have chosen the same mentor again versus 11.4% of nonclinicians. All participants favored mentors who provided guidance on career and work-life balance. Suggestions for improved mentoring included formal mentorship, increased networking, and quality assurance. Conclusion. There is an important need to improve mentoring in cardiovascular and respiratory health.

  18. A National Survey of Mentoring Practices for Young Investigators in Circulatory and Respiratory Health

    Directory of Open Access Journals (Sweden)

    Salvatore Mottillo

    2016-01-01

    Full Text Available Background. Improving mentorship may help decrease the shortage of young investigators (graduate students, postdoctoral fellows, and new investigators available to work as independent researchers in cardiovascular and respiratory health. Objectives. To determine (1 the mentoring practices for trainees affiliated with the Canadian Institutes of Health Research (CIHR, Institute of Circulatory and Respiratory Health (ICRH, (2 the positive attributes of mentors, and (3 the recommendations regarding what makes good mentorship. Methods. We conducted a survey and descriptive analysis of young investigators with a CIHR Training and Salary Award from 2010 to 2013 or who submitted an abstract to the ICRH 2014 Young Investigators Forum. Clinicians were compared to nonclinicians. Results. Of 172 participants, 7.0% had no mentor. Only 43.6% had defined goals and 40.7% had defined timelines, while 54.1% had informal forms of mentorship. A significant proportion (33.1% felt that their current mentorship did not meet their needs. Among clinicians, 22.2% would not have chosen the same mentor again versus 11.4% of nonclinicians. All participants favored mentors who provided guidance on career and work-life balance. Suggestions for improved mentoring included formal mentorship, increased networking, and quality assurance. Conclusion. There is an important need to improve mentoring in cardiovascular and respiratory health.

  19. Developing the Clinical Nurse Leader Survey Instrument: A Modified Delphi Study.

    Science.gov (United States)

    Bender, Miriam; Avolio, Alice; Baker, Patricia; Harris, James L; Hilton, Nancy; Hites, Lisle; Roussel, Linda; Shirley, Bobbi; Thomas, Patricia L; Williams, Marjory

    2017-12-13

    Clinical nurse leader (CNL)-integrated care delivery is an emerging nursing model, with growing adoption in diverse health systems. To generate a robust evidence base for this promising nursing model, it is necessary to measure CNL practice to explicitly link it to observed quality and safety outcome improvements. This study used a modified Delphi approach with an expert CNL panel to develop and test the face, content, and construct validity of the CNL Practice Survey instrument.

  20. Disinfection methods in general practice and health authority clinics: a telephone survey

    OpenAIRE

    Farrow, S.C.; Kaul, S.; Littlepage, B.C.

    1988-01-01

    Concern about the epidemic of the acquired immune deficiency syndrome led to discussions in one health district about the dangers of cross-infection from instruments in general practice and health authority clinics. In order to establish what current disinfection practices were in use a telephone survey was adopted as a quick and easy method of data collection. Information was collected on who was responsible for disinfection as well as details of how each instrument was disinfected. Results ...

  1. Delphi Survey of Clinical Nursing and Midwifery Research Priorities in the Eastern Mediterranean Region.

    Science.gov (United States)

    Sun, Carolyn; Dohrn, Jennifer; Oweis, Arwa; Huijer, Huda Abu-Saad; Abu-Moghli, Fathieh; Dawani, Hania; Ghazi, Cheherezade; Larson, Elaine

    2017-03-01

    As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranean region concomitantly with a growing focus on achievement of universal health coverage, nurses and midwives are expected to fill major gaps in health care. Hence, the need for a solid evidence base for nursing practice and a clear direction for clinical nursing research are paramount. Therefore, a Delphi survey was conducted to determine clinical (research focused on patient outcomes) nursing and midwifery priorities for research within this region. A Delphi survey, using iterative rounds of an online survey of regional clinical nursing and midwifery research experts, was conducted between January and April 2016. Consensus was determined by percentage agreement on level of priority for topics as determined by participants. Additionally, results were compared between countries within the region by income and mortality levels using Kendall's tau. Critical research topics were focused on public/community/primary care as well as emergency preparedness for disasters, and these priorities are well aligned with gaps in the literature for this region. There were statistically significant differences between priority level and country mortality group for geriatrics, self-management of disease, and sexually transmitted infections. Critical research priorities should focus on population-based health topics. Between-country differences should be analyzed further. A clinical research database for the region may help improve research access for nurses and midwives. Practicing nurses and midwives lack extensive evidence (including culturally relevant evidence) on which to practice. Increasing research in areas identified in this survey may improve patient outcomes and quality of care regionally. © 2017 Sigma Theta Tau International.

  2. Subjective and clinical assessment criteria suggestive for five clinical patterns discernible in nonspecific neck pain patients. A Delphi-survey of clinical experts.

    Science.gov (United States)

    Dewitte, Vincent; Peersman, Wim; Danneels, Lieven; Bouche, Katie; Roets, Arne; Cagnie, Barbara

    2016-12-01

    Nonspecific neck pain patients form a heterogeneous group with different musculoskeletal impairments. Classifying nonspecific neck pain patients into subgroups based on clinical characteristics might lead to more comprehensive diagnoses and can guide effective management. To establish consensus among a group of experts regarding the clinical criteria suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central' and 'sensorimotor control' dysfunction patterns distinguishable in patients with nonspecific neck pain. Delphi study. A focus group with 10 academic experts was organized to elaborate on the different dysfunction patterns discernible in neck pain patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 distinct dysfunction patterns resulting from the focus group. A total of 21 musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating neck pain patients completed the 3-round Delphi-survey. Respectively, 33 (response rate, 100.0%), 27 (81.8%) and 21 (63.6%) respondents replied to rounds 1, 2 and 3. Eighteen 'articular', 16 'myofascial', 20 'neural', 18 'central' and 10 'sensorimotor control' clinical indicators reached a predefined ≥80% consensus level. These indicators suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns may help clinicians to assess and diagnose patients with nonspecific neck pain. Future validity testing is needed to determine how these criteria may help to improve the outcome of physical therapy interventions in nonspecific neck pain patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. How did we learn best? A retrospective survey of clinical psychology training in the United Kingdom.

    Science.gov (United States)

    Nel, Pieter W; Pezzolesi, Cinzia; Stott, Dave J

    2012-09-01

    This U.K.-based study aimed to investigate qualified clinical psychologists' perceptions of the value and usefulness of the learning activities experienced during their training in clinical psychology. Members (N = 357) of the Division of Clinical Psychology of the British Psychological Society (BPS) completed a self-report questionnaire about their training as clinical psychologists. The results indicate that most clinical psychologists believe that they learnt mainly through doing and by observing others' clinical practice. They also highlight the importance of the learning relationship and the value of personal therapy for learning. The findings point to the need for more training of trainers, especially clinical supervisors. They also draw attention to the need for more research to establish which learning activities contribute most / least to trainees' developing competence. © 2012 Wiley Periodicals, Inc.

  4. Large-scale survey to describe acne management in Brazilian clinical practice

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    Seité S

    2015-11-01

    Full Text Available Sophie Seité,1 Clarice Caixeta,2 Loan Towersey3 1La Roche-Posay Dermatological Laboratories, Asnières, France; 2La Roche-Posay Dermatological Laboratories, Rio de Janeiro, RJ, Brazil; 3AIDS Division, Hospital Municipal Carlos Tortelly, Niterói, RJ, Brazil Background: Acne is a chronic disease of the pilosebaceous unit that mainly affects adolescents. It is the most common dermatological problem, affecting approximately 80% of teenagers between 12 and 18 years of age. Diagnosis is clinical and is based on the patient's age at the time the lesions first appear, and on its polymorphism, type of lesions, and their anatomical location. The right treatment for the right patient is key to treating acne safely. The aim of this investigational survey was to evaluate how Brazilian dermatologists in private practice currently manage acne.Materials and methods: Dermatologists practicing in 12 states of Brazil were asked how they manage patients with grades I, II, III, and IV acne. Each dermatologist completed a written questionnaire about patient characteristics, acne severity, and the therapy they usually prescribe for each situation.Results: In total, 596 dermatologists were interviewed. Adolescents presented as the most common acneic population received by dermatologists, and the most common acne grade was grade II. The doctors could choose more than one type of treatment for each patient, and treatment choices varied according to acne severity. A great majority of dermatologists considered treatment with drugs as the first alternative for all acne grades, choosing either topical or oral presentation depending on the pathology severity. Dermocosmetics were chosen mostly as adjunctive therapy, and their inclusion in the treatment regimen decreased as acne grades increased.Conclusion: This survey illustrates that Brazilian dermatologists employ complex treatment regimens to manage acne, choosing systemic drugs, particularly isotretinoin, even in some

  5. Heterogeneity prevails: the state of clinical trial data management in Europe - results of a survey of ECRIN centres.

    Science.gov (United States)

    Kuchinke, Wolfgang; Ohmann, Christian; Yang, Qin; Salas, Nader; Lauritsen, Jens; Gueyffier, Francois; Leizorovicz, Alan; Schade-Brittinger, Carmen; Wittenberg, Michael; Voko, Zoltán; Gaynor, Siobhan; Cooney, Margaret; Doran, Peter; Maggioni, Aldo; Lorimer, Andrea; Torres, Ferràn; McPherson, Gladys; Charwill, Jim; Hellström, Mats; Lejeune, Stéphane

    2010-07-21

    The use of Clinical Data Management Systems (CDMS) has become essential in clinical trials to handle the increasing amount of data that must be collected and analyzed. With a CDMS trial data are captured at investigator sites with "electronic Case Report Forms". Although more and more of these electronic data management systems are used in academic research centres an overview of CDMS products and of available data management and quality management resources for academic clinical trials in Europe is missing. The ECRIN (European Clinical Research Infrastructure Network) data management working group conducted a two-part standardized survey on data management, software tools, and quality management for clinical trials. The questionnaires were answered by nearly 80 centres/units (with an overall response rate of 47% and 43%) from 12 European countries and EORTC. Our survey shows that about 90% of centres have a CDMS in routine use. Of these CDMS nearly 50% are commercial systems; Open Source solutions don't play a major role. In general, solutions used for clinical data management are very heterogeneous: 20 different commercial CDMS products (7 Open Source solutions) in addition to 17/18 proprietary systems are in use. The most widely employed CDMS products are MACRO and Capture System, followed by solutions that are used in at least 3 centres: eResearch Network, CleanWeb, GCP Base and SAS. Although quality management systems for data management are in place in most centres/units, there exist some deficits in the area of system validation. Because the considerable heterogeneity of data management software solutions may be a hindrance to cooperation based on trial data exchange, standards like CDISC (Clinical Data Interchange Standard Consortium) should be implemented more widely. In a heterogeneous environment the use of data standards can simplify data exchange, increase the quality of data and prepare centres for new developments (e.g. the use of EHR for clinical

  6. Heterogeneity prevails: the state of clinical trial data management in Europe - results of a survey of ECRIN centres

    Directory of Open Access Journals (Sweden)

    Doran Peter

    2010-07-01

    Full Text Available Abstract Background The use of Clinical Data Management Systems (CDMS has become essential in clinical trials to handle the increasing amount of data that must be collected and analyzed. With a CDMS trial data are captured at investigator sites with "electronic Case Report Forms". Although more and more of these electronic data management systems are used in academic research centres an overview of CDMS products and of available data management and quality management resources for academic clinical trials in Europe is missing. Methods The ECRIN (European Clinical Research Infrastructure Network data management working group conducted a two-part standardized survey on data management, software tools, and quality management for clinical trials. The questionnaires were answered by nearly 80 centres/units (with an overall response rate of 47% and 43% from 12 European countries and EORTC. Results Our survey shows that about 90% of centres have a CDMS in routine use. Of these CDMS nearly 50% are commercial systems; Open Source solutions don't play a major role. In general, solutions used for clinical data management are very heterogeneous: 20 different commercial CDMS products (7 Open Source solutions in addition to 17/18 proprietary systems are in use. The most widely employed CDMS products are MACRO™ and Capture System™, followed by solutions that are used in at least 3 centres: eResearch Network™, CleanWeb™, GCP Base™ and SAS™. Although quality management systems for data management are in place in most centres/units, there exist some deficits in the area of system validation. Conclusions Because the considerable heterogeneity of data management software solutions may be a hindrance to cooperation based on trial data exchange, standards like CDISC (Clinical Data Interchange Standard Consortium should be implemented more widely. In a heterogeneous environment the use of data standards can simplify data exchange, increase the quality of

  7. Comparative clinical and haematological investigations in lactating cows with subclinical and clinical ketosis

    Directory of Open Access Journals (Sweden)

    Vania Marutsova

    2015-10-01

    Full Text Available Ketosis of lactating cows is among the most common metabolic diseases in modern dairy farms. The economic importance of the disease is caused by the reduced milk yield and body weight loss, poor feed conversion, lower conception rates, culling and increased mortality of affected animals. In the present study, a total of 47 high-yielding dairy cows up to 45 days in milk (DIM are included. All animals were submitted to physical examination wich included checking the rectal body temperature, heart rate, respiratory and rumen contraction rates, and inspection of visible mucous coats. The body condition was scored, and blood β-hydroxybutyrate (BHBA concentrations were assayed. The cows were divided into 3 groups: first group (control (n=24 with blood β-hydroxybutyrate level 2.6 mmol/l (clinical ketosis. Whole blood samples were obtained and analyzed for Red Blood Cell (RBC, 1012/l, Hemoglobin (HGB, g/l, Hematocrit (HCT, %, Mean Corpuscular Volume (MCV, fl, Mean Corpuscular Hemoglobin (MCH, pg, Mean Corpuscular Hemoglobin Concentration (MCHC, g/l, White Blood Cell (WBC, 109/l, Lymphocytes (LYM, 109/l, Monocytes (MON, 109/l, Granulocytes (GRA, 109/l, Red Blood Distribution Width (RDW, %, Red Blood Cell Distribution Width Absolute (RDWa, fl, Platelets (PLT, 109/l and Mean Platelet Volume (MPV, fl. In this study, deviations in the clinical parameters in the control group and in those with subclinical ketosis were not identified. The cows from the third group (clinical ketosis exhibited hypotonia, anorexia and body weight loss vs. control group. Hematological analysis showed leukocytosis and lymphocytosis in cows with subclinical ketosis vs. control group. In cows with clinical ketosis WBC counts decreased (leukopenia, while hemoglobin content and hematocrit values are higher vs. control group. Blood BHBA values are higher in both groups of ketotic cows vs. the control group. The other analyzed parameters (RBC, MCH, MCHC, MCV, RDW, RDWa, MON, GRA, PLT

  8. Investigational nanomedicines in 2016: a review of nanotherapeutics currently undergoing clinical trials.

    Science.gov (United States)

    Caster, Joseph M; Patel, Artish N; Zhang, Tian; Wang, Andrew

    2017-01-01

    Nanomedicine is a relatively new field that is rapidly evolving. Formulation of drugs on the nanoscale imparts many physical and biological advantages. Such advantages can in turn translate into improved therapeutic efficacy and reduced toxicity. While approximately 50 nanotherapeutics have already entered clinical practice, a greater number of drugs are undergoing clinical investigation for a variety of indications. This review aims to examine all the nanoformulations that are currently undergoing clinical investigation and their outlook for ultimate clinical translation. WIREs Nanomed Nanobiotechnol 2017, 9:e1416. doi: 10.1002/wnan.1416 For further resources related to this article, please visit the WIREs website. © 2016 Wiley Periodicals, Inc.

  9. A survey of investigative entrepreneurship in physical education office of Isfahan province

    Directory of Open Access Journals (Sweden)

    Khodayar Momeni

    2012-09-01

    Full Text Available The purpose of this study is to investigative entrepreneur in Physical Education Office of Isfahan province. This research is performed in the administration office associated with sport in Isfahan providence. The method of research is deceptive and of the correlation-type, which is based on the survey. The statistic population includes all of expert staffs, official conventional and contract, which have been announced to be 205 in year 2012. According to Morgan table, the sample was equal to 132 people selected, randomly. Questionnaire of Wisbird entrepreneur organization is used to perform the study. The validity and reliability of the survey is confirmed using Cronback alpha (α=0.91. In this study, descriptive statistic (Frequency, Distribution, Percentage, Mean & Standard deviation and inferential statistic (Pearson correlation test have been used. The result of the study showed that Mean and standard deviation of organization entrepreneurship were 2.79 and. 0.28, respectively. The highest and lowest scores were calculated 4 and 1.54, respectively. Furthermore, we found out that in the distribution of aspects organizational entrepreneurship, the lowest average was related to reward and the highest was related to goal and relation.

  10. Health professionals' expectations versus experiences of internet-based telemonitoring: survey among heart failure clinics.

    Science.gov (United States)

    de Vries, Arjen E; van der Wal, Martje H L; Nieuwenhuis, Maurice M W; de Jong, Richard M; van Dijk, Rene B; Jaarsma, Tiny; Hillege, Hans L

    2013-01-10

    Although telemonitoring is increasingly used in heart failure care, data on expectations, experiences, and organizational implications concerning telemonitoring are rarely addressed, and the optimal profile of patients who can benefit from telemonitoring has yet to be defined. To assess the actual status of use of telemonitoring and to describe the expectations, experiences, and organizational aspects involved in working with telemonitoring in heart failure in the Netherlands. In collaboration with the Netherlands Organization for Applied Scientific Research (TNO), a 19-item survey was sent to all outpatient heart failure clinics in the Netherlands, addressed to cardiologists and heart failure nurses working in the clinics. Of the 109 heart failure clinics who received a survey, 86 clinics responded (79%). In total, 31 out of 86 (36%) heart failure clinics were using telemonitoring and 12 heart failure clinics (14%) planned to use telemonitoring within one year. The number of heart failure patients receiving telemonitoring generally varied between 10 and 50; although in two clinics more than 75 patients used telemonitoring. The main goals for using telemonitoring are "monitoring physical condition", "monitoring signs of deterioration" (n=39, 91%), "monitoring treatment" (n=32, 74%), "adjusting medication" (n=24, 56%), and "educating patients" (n=33, 77%). Most patients using telemonitoring were in the New York Heart Association (NYHA) functional classes II (n=19, 61%) and III (n=27, 87%) and were offered the use of the telemonitoring system "as long as needed" or without a time limit. However, the expectations of the use of telemonitoring were not met after implementation. Eight of the 11 items about expectations versus experiences were significantly decreased (Ptelemonitoring in their work, in particular with respect to "keeping up with current development" (before 7.2, after 6.8, P=.15), "being innovative" (before 7.0, after 6.1, P=.003), and "better guideline

  11. Bridging clinical investigators and statisticians: writing the statistical methodology for a research proposal.

    Science.gov (United States)

    Adams-Huet, Beverley; Ahn, Chul

    2009-12-01

    Clinical investigators often find the thought of writing the statistical analysis plan daunting. Early collaboration between the clinical investigator and statistician can improve the study design and validity of the results by developing the statistical methodology that specifically addresses the research hypothesis. With the clinical investigator, a statistician often writes the statistical methods section that includes sample size and power analyses, randomization and blinding procedures, interim analysis, and data monitoring plans, in addition to the statistical analysis plan. To make this process less mysterious, we describe how the statistical methods section is developed in collaboration with a statistician.

  12. Investigation of Axial Electric Field Measurements with Grounded-Wire TEM Surveys

    Science.gov (United States)

    Zhou, Nan-nan; Xue, Guo-qiang; Li, Hai; Hou, Dong-yang

    2017-09-01

    The grounded-wire transient electromagnetic (TEM) surveying is often performed along the equatorial direction with its observation lines paralleling to the transmitting wire with a certain transmitter-receiver distance. However, such method takes into account only the equatorial component of the electromagnetic field, and a little effort has been made on incorporating the other major component along the transmitting wire, here denoted as axial field. To obtain a comprehensive understanding of its fundamental characteristics and guide the designing of the corresponding observation system for reliable anomaly detection, this study for the first time investigates the axial electric field from three crucial aspects, including its decay curve, plane distribution, and anomaly sensitivity, through both synthetic modeling and real application to one major coal field in China. The results demonstrate a higher sensitivity to both high- and low-resistivity anomalies by the electric field in axial direction and confirm its great potentials for robust anomaly detection in the subsurface.

  13. Unmet needs for analyzing biological big data: A survey of 704 NSF principal investigators.

    Directory of Open Access Journals (Sweden)

    Lindsay Barone

    2017-10-01

    Full Text Available In a 2016 survey of 704 National Science Foundation (NSF Biological Sciences Directorate principal investigators (BIO PIs, nearly 90% indicated they are currently or will soon be analyzing large data sets. BIO PIs considered a range of computational needs important to their work, including high performance computing (HPC, bioinformatics support, multistep workflows, updated analysis software, and the ability to store, share, and publish data. Previous studies in the United States and Canada emphasized infrastructure needs. However, BIO PIs said the most pressing unmet needs are training in data integration, data management, and scaling analyses for HPC-acknowledging that data science skills will be required to build a deeper understanding of life. This portends a growing data knowledge gap in biology and challenges institutions and funding agencies to redouble their support for computational training in biology.

  14. Towards the development of a comprehensive framework: Qualitative systematic survey of definitions of clinical research quality.

    Directory of Open Access Journals (Sweden)

    Belinda von Niederhäusern

    Full Text Available To systematically survey existing definitions, concepts, and criteria of clinical research quality, both developed by stakeholder groups as well as in the medical literature. This study serves as a first step in the development of a comprehensive framework for the quality of clinical research.We systematically and in duplicate searched definitions, concepts and criteria of clinical research quality on websites of stakeholders in clinical research until no further insights emerged and in MEDLINE up to February 2015. Stakeholders included governmental bodies, regulatory agencies, the pharmaceutical industry, academic and commercial contract research organizations, initiatives, research ethics committees, patient organizations and funding agencies from 13 countries. Data synthesis involved descriptive and qualitative analyses following the Framework Method on definitions, concepts, and criteria of clinical research quality. Descriptive codes were applied and grouped into clusters to identify common and stakeholder-specific quality themes.Stakeholder concepts on how to assure quality throughout study conduct or articles on quality assessment tools were common, generally with no a priori definition of the term quality itself. We identified a total of 20 explicit definitions of clinical research quality including varying quality dimensions and focusing on different stages in the clinical research process. Encountered quality dimensions include ethical conduct, patient safety/rights/priorities, internal validity, precision of results, generalizability or external validity, scientific and societal relevance, transparency and accessibility of information, research infrastructure and sustainability. None of the definitions appeared to be comprehensive either in terms of quality dimensions, research stages, or stakeholder perspectives.Clinical research quality is often discussed but rarely defined. A framework defining clinical research quality across

  15. Towards the development of a comprehensive framework: Qualitative systematic survey of definitions of clinical research quality

    Science.gov (United States)

    von Niederhäusern, Belinda; Schandelmaier, Stefan; Mi Bonde, Marie; Brunner, Nicole; Hemkens, Lars G.; Rutquist, Marielle; Bhatnagar, Neera; Guyatt, Gordon H.; Pauli-Magnus, Christiane; Briel, Matthias

    2017-01-01

    Objective To systematically survey existing definitions, concepts, and criteria of clinical research quality, both developed by stakeholder groups as well as in the medical literature. This study serves as a first step in the development of a comprehensive framework for the quality of clinical research. Study design and setting We systematically and in duplicate searched definitions, concepts and criteria of clinical research quality on websites of stakeholders in clinical research until no further insights emerged and in MEDLINE up to February 2015. Stakeholders included governmental bodies, regulatory agencies, the pharmaceutical industry, academic and commercial contract research organizations, initiatives, research ethics committees, patient organizations and funding agencies from 13 countries. Data synthesis involved descriptive and qualitative analyses following the Framework Method on definitions, concepts, and criteria of clinical research quality. Descriptive codes were applied and grouped into clusters to identify common and stakeholder-specific quality themes. Results Stakeholder concepts on how to assure quality throughout study conduct or articles on quality assessment tools were common, generally with no a priori definition of the term quality itself. We identified a total of 20 explicit definitions of clinical research quality including varying quality dimensions and focusing on different stages in the clinical research process. Encountered quality dimensions include ethical conduct, patient safety/rights/priorities, internal validity, precision of results, generalizability or external validity, scientific and societal relevance, transparency and accessibility of information, research infrastructure and sustainability. None of the definitions appeared to be comprehensive either in terms of quality dimensions, research stages, or stakeholder perspectives. Conclusion Clinical research quality is often discussed but rarely defined. A framework defining

  16. Applicable or non-applicable: investigations of clinical heterogeneity in systematic reviews

    Directory of Open Access Journals (Sweden)

    Laura E. Chess

    2016-02-01

    Full Text Available Abstract Background Clinical heterogeneity can be defined as differences in participant characteristics, types or timing of outcome measurements and intervention characteristics. Clinical heterogeneity in systematic reviews has the possibility to significantly affect statistical heterogeneity leading to inaccurate conclusions and misled decision making. The aim of this study is to identify to what extent investigators are assessing clinical heterogeneity in both Cochrane and non-Cochrane systematic reviews. Methods The most recent 100 systematic reviews from the top five journals in medicine—JAMA, Archives of Internal Medicine, British Medical Journal, The Lancet, and PLOS Medicine—and the 100 most recently published and/or updated systematic reviews from Cochrane were collected. Various defined items of clinical heterogeneity were extracted from the included reviews. Investigators used chi-squared tests, logarithmic modeling and linear regressions to determine if the presence of such items served as a predictor for clinical heterogeneity when comparing Cochrane to non-Cochrane reviews. Extracted variables include number of studies, number of participants, presence of quantitative synthesis, exploration of clinical heterogeneity, heterogeneous characteristics explored, basis and methods used for investigating clinical heterogeneity, plotting/visual aids, author contact, inferences from clinical heterogeneity investigation, reporting assessment, and the presence of a priori or post-hoc analysis. Results A total of 317 systematic reviews were considered, of which 199 were in the final analysis. A total of 81 % of Cochrane reviews and 90 % of non-Cochrane reviews explored characteristics that are considered aspects of clinical heterogeneity and also described the methods they planned to use to investigate the influence of those characteristics. Only 1 % of non-Cochrane reviews and 8 % of Cochrane reviews explored the clinical

  17. Applicable or non-applicable: investigations of clinical heterogeneity in systematic reviews.

    Science.gov (United States)

    Chess, Laura E; Gagnier, Joel J

    2016-02-17

    Clinical heterogeneity can be defined as differences in participant characteristics, types or timing of outcome measurements and intervention characteristics. Clinical heterogeneity in systematic reviews has the possibility to significantly affect statistical heterogeneity leading to inaccurate conclusions and misled decision making. The aim of this study is to identify to what extent investigators are assessing clinical heterogeneity in both Cochrane and non-Cochrane systematic reviews. The most recent 100 systematic reviews from the top five journals in medicine-JAMA, Archives of Internal Medicine, British Medical Journal, The Lancet, and PLOS Medicine-and the 100 most recently published and/or updated systematic reviews from Cochrane were collected. Various defined items of clinical heterogeneity were extracted from the included reviews. Investigators used chi-squared tests, logarithmic modeling and linear regressions to determine if the presence of such items served as a predictor for clinical heterogeneity when comparing Cochrane to non-Cochrane reviews. Extracted variables include number of studies, number of participants, presence of quantitative synthesis, exploration of clinical heterogeneity, heterogeneous characteristics explored, basis and methods used for investigating clinical heterogeneity, plotting/visual aids, author contact, inferences from clinical heterogeneity investigation, reporting assessment, and the presence of a priori or post-hoc analysis. A total of 317 systematic reviews were considered, of which 199 were in the final analysis. A total of 81% of Cochrane reviews and 90% of non-Cochrane reviews explored characteristics that are considered aspects of clinical heterogeneity and also described the methods they planned to use to investigate the influence of those characteristics. Only 1% of non-Cochrane reviews and 8% of Cochrane reviews explored the clinical characteristics they initially chose as potential for clinical heterogeneity. Very

  18. Investigators' viewpoint of clinical trials in India: Past, present and future

    Directory of Open Access Journals (Sweden)

    Mohandas K Mallath

    2017-01-01

    Full Text Available India's success in producing food and milk for its population (Green Revolution and White Revolution happened because of scientific research and field trials. Likewise improving the health of Indians needs clinical research and clinical trials. A Large proportion of the sick Indians are poor, illiterate with no access to good health care. They are highly vulnerable to inducement and exploitation in clinical trials. The past two decades saw the rise and fall of clinical trials in India. The rise happened when our regulators created a favorable environment, and Indian investigators were invited to participate in global clinical trials. The gap between the demand and supply resulted in inadequate protection of the trial participants. Reports of abuses of the vulnerable trial participants followed by public interest litigations led to strengthening of regulations by the regulators. The stringent new regulations made the conduct of clinical trials more laborious and increased the cost of clinical trials in India. There was a loss of interest in sponsored clinical trials resulting in the fall in global clinical trials in India. Following repeated appeals by the investigators, the Indian regulators have recently relaxed some of the stringent regulations, while continuing to ensure the adequate patient protection. Clinical trials that are relevant to our population and conducted by well-trained investigators and monitored by trained and registered Ethics Committees will increase in the future. We must remain vigilant, avoid previous mistakes, and strive hard to protect the trial participants in the future trials.

  19. Investigating Climate Science Misconceptions Using a Teacher Professional Development Workshop Registration Survey

    Science.gov (United States)

    Lynds, S. E.; Gold, A. U.; McNeal, K.; Libarkin, J. C.; Buhr Sullivan, S. M.; Ledley, T. S.; Haddad, N.; Ellins, K. K.

    2013-12-01

    The EarthLabs Climate project, an NSF-Discovery Research K12 program, has developed a suite of three online classroom-ready modules: Climate and the Cryosphere; Climate and the Carbon Cycle; and Climate and the Biosphere. The EarthLabs Climate project included week-long professional development workshops during June of 2012 and 2013 in Texas and Mississippi. Evaluation of the 2012 and 2013 workshops included participant self-reported learning levels in many areas of climate science. Teachers' answers indicated they had increased their understanding of the topics addressed in the workshops. However, the project team was interested in refining the evaluation process to determine exactly those areas of climate science in which participants increased content knowledge and ameliorated misconceptions. Therefore, to enhance the investigation into what teachers got out of the workshop, a pre-test/post-test design was implemented for 2013. In particular, the evaluation team was interested in discovering the degree to which participants held misconceptions and whether those beliefs were modified by attendance at the workshops. For the 2013 workshops, a registration survey was implemented that included the Climate Concept Inventory (a climate content knowledge quiz developed by the education research team for the project). The multiple-choice questions are also part of the pre/post student quiz used in classrooms in which the EarthLabs Climate curriculum was implemented. Many of the questions in this instrument assess common misconceptions by using them as distractors in the multiple choice options. The registration survey also asked respondents to indicate their confidence in their answer to each question, because, in addition to knowledge limitations, lack of confidence also can be a barrier to effective teaching. Data from the registration survey informed workshop managers of the topic content knowledge of participants, allowing fine-tuning of the professional development

  20. Management of optic neuritis and impact of clinical trials: an international survey

    DEFF Research Database (Denmark)

    Biousse, Valérie; Calvetti, Olivier; Drews-Botsch, Carolyn D

    2009-01-01

    ,443 neurologists and 6,099 ophthalmologists in the southeast-USA, Canada, Australia/New Zealand, Denmark, France, and Thailand. USA data were compared to those of other countries. RESULTS: We collected 3,142 surveys (1,449 neurologists/1,693 ophthalmologists) (29.8% response rate). In all countries, ON patients......-80% of ON patients; lumbar punctures were obtained mostly in Europe and Thailand. Although most patients received acute treatment with intravenous steroids, between 14% and 65% of neurologists and ophthalmologists still recommended oral prednisone (1 mg/kg/day) for the treatment of acute isolated ON. In all...... ON patients according to the best evidence from clinical research. This confirms that evaluation of the impact of major clinical trials ("translational T2 clinical research") is essential when assessing the effects of interventions designed to improve quality of care....

  1. Survey of symptomatic dermatologic disease in homeless patients at a shelter-based clinic

    Directory of Open Access Journals (Sweden)

    Caitlin Contag

    2017-04-01

    Full Text Available This study aimed to survey the range of skin disorders diagnosed at a San Francisco clinic based in a temporary homeless shelter. We retrospectively reviewed 254 charts documenting encounters from 2011-2015 and collected demographic and historical data, along with skin disease morphology and location, clinical diagnosis, and recommended therapies. Of 254 charts reviewed, 136 (53.3% recorded a dermatologic complaint. Diagnostic categories from most to least prevalent were inflammatory dermatoses, superficial fungal infections, wounds and trauma, infestations, bacterial infections, neoplasms, and viral infections. The most prevalent body location of the skin complaint was the lower extremity. The high prevalence of dermatologic disease underscores the importance of expanding dermatologic care for unhoused individuals. Many of the cutaneous diseases were preventable or treatable with low-cost interventions. The frequency of skin conditions affecting the lower extremity suggests that a foot and leg exam should be routine in clinical encounters with homeless patients.

  2. A survey of ATRIPLA use in clinical practice as first-line therapy in HIV-positive persons in Europe

    DEFF Research Database (Denmark)

    Mocroft, A; Reiss, P; Rakhmanova, A

    2014-01-01

    ATRIPLA is licensed for use only in HIV-positive persons whose viral loads therapy (ART) in EuroSIDA using a web-based survey performed in Autumn 2012. 96/112 clinics (85.7 %) completed the survey. Recommendations...... when initiating first-line ART was TRUVADA plus efavirenz in 36 (37.5 %), ATRIPLA in 35 (36.5 %), a different first-line regimen in 12 clinics (12.5 %), and no recommendation in 7 clinics (7.3 %). ATRIPLA was commonest in Northern (15/21 clinics; 71.4 %), and least common in Eastern Europe (2....../31 clinics; 6.5 %; p therapy, despite EMA recommendations....

  3. National survey of clinical communication assessment in medical education in the United Kingdom (UK).

    Science.gov (United States)

    Laidlaw, Anita; Salisbury, Helen; Doherty, Eva M; Wiskin, Connie

    2014-01-13

    All medical schools in the UK are required to be able to provide evidence of competence in clinical communication in their graduates. This is usually provided by summative assessment of clinical communication, but there is considerable variation in how this is carried out. This study aimed to gain insight into the current assessment of clinical communication in UK medical schools. The survey was sent via e-mail to communication leads who then were asked to consult with all staff within their medical school involved in the assessment of communication. Results were obtained from 27 out of 33 schools (response rate 82%) and a total of 34 courses. The average number of assessments per year was 2.4 (minimum 0, maximum 10). The Objective Structured Clinical Exam (OSCE) was the most commonly used method of assessment (53%). Other assessments included MCQ and workplace based assessments. Only nine courses used a single method of assessment. Issues raised included, logistics and costs of assessing mainly by OSCE, the robustness and reliability of such exams and integration with other clinical skills. It is encouraging that a variety of assessment methods are being used within UK medical schools and that these methods target different components of clinical communication skills acquisition.

  4. Post-market clinical research conducted by medical device manufacturers: a cross-sectional survey.

    Science.gov (United States)

    Ross, Joseph S; Blount, Katrina L; Ritchie, Jessica D; Hodshon, Beth; Krumholz, Harlan M

    2015-01-01

    In the US, once a medical device is made available for use, several requirements have been established by the US Food and Drug Administration (FDA) to ensure ongoing post-market surveillance of device safety and effectiveness. Our objective was to determine how commonly medical device manufacturers initiate post-market clinical studies or augment FDA post-market surveillance requirements for higher-risk devices that are most often approved via the FDA's pre-market approval (PMA) pathway. We conducted a cross-sectional survey of 47 manufacturers with operations in California, Minnesota, and Massachusetts who market devices approved via the PMA pathway. Among 22 respondents (response rate =47%), nearly all self-reported conducting post-market clinical research studies, commonly between 1 and 5; only 1 respondent reported never conducting post-market clinical research studies. While manufacturers most often engaged in these studies to satisfy FDA requirements, other reasons were reported, including performance monitoring and surveillance and market acceptance initiatives. Risks of conducting and not conducting post-market clinical research studies were described through open-ended response to questions. Medical device manufacturers commonly initiate post-market clinical studies at the request of the FDA. Clinical data from these studies should be integrated into national post-market surveillance initiatives.

  5. Risk groups for clinical complications of norovirus infections: an outbreak investigation.

    NARCIS (Netherlands)

    Mattner, F; Sohr, D; Heim, A; Gastmeier, P; Vennema, H; Koopmans, M

    2006-01-01

    Norovirus infections have been described as self-limiting diseases of short duration. An investigation of a norovirus outbreak in a university hospital provided evidence for severe clinical features in patients with several underlying diseases. Clinical outcomes of norovirus infection were defined.

  6. Clinical Reasoning: Survey of Teaching Methods, Integration, and Assessment in Entry-Level Physical Therapist Academic Education.

    Science.gov (United States)

    Christensen, Nicole; Black, Lisa; Furze, Jennifer; Huhn, Karen; Vendrely, Ann; Wainwright, Susan

    2017-02-01

    Although clinical reasoning abilities are important learning outcomes of physical therapist entry-level education, best practice standards have not been established to guide clinical reasoning curricular design and learning assessment. This research explored how clinical reasoning is currently defined, taught, and assessed in physical therapist entry-level education programs. A descriptive, cross-sectional survey was administered to physical therapist program representatives. An electronic 24-question survey was distributed to the directors of 207 programs accredited by the Commission on Accreditation in Physical Therapy Education. Descriptive statistical analysis and qualitative content analysis were performed. Post hoc demographic and wave analyses revealed no evidence of nonresponse bias. A response rate of 46.4% (n=96) was achieved. All respondents reported that their programs incorporated clinical reasoning into their curricula. Only 25% of respondents reported a common definition of clinical reasoning in their programs. Most respondents (90.6%) reported that clinical reasoning was explicit in their curricula, and 94.8% indicated that multiple methods of curricular integration were used. Instructor-designed materials were most commonly used to teach clinical reasoning (83.3%). Assessment of clinical reasoning included practical examinations (99%), clinical coursework (94.8%), written examinations (87.5%), and written assignments (83.3%). Curricular integration of clinical reasoning-related self-reflection skills was reported by 91%. A large number of incomplete surveys affected the response rate, and the program directors to whom the survey was sent may not have consulted the faculty members who were most knowledgeable about clinical reasoning in their curricula. The survey construction limited some responses and application of the results. Although clinical reasoning was explicitly integrated into program curricula, it was not consistently defined, taught, or

  7. Healthcare professional surveys to investigate the implementation of the isotretinoin Pregnancy Prevention Programme : a descriptive study

    NARCIS (Netherlands)

    Crijns, Ineke; Mantel-Teeuwisse, Aukje; Bloemberg, Rudi; Pinas, Eldridge; Straus, Sabine; de Jong-van den Berg, Lolkje

    Objective: Three online surveys explored compliance with the PPP by pharmacists and dermatologists, in the Netherlands. In 2007 and 2011, two pharmacist surveys were conducted to assess improvement over time. Methods: In 2007, survey was sent to members of the Utrecht Pharmacy Panel for Education &

  8. [Survey of cachexia in digestive system cancer patients and its impact on clinical outcomes].

    Science.gov (United States)

    Sun, Yandong; Zhang, Bo; Han, Yusong; Jiang, Yi; Zhuang, Qiulin; Gong, Yuda; Wu, Guohao

    2014-10-01

    To investigate cachexia in hospitalized patients with digestive system cancer and evaluate its impact on clinical outcomes. By analyzing the clinical data of 5118 hospitalized patients with digestive system cancer in Zhongshan Hospital of Fudan University from January 2012 to December 2013, cachexia was investigated and clinical outcomes between cachexia patients and non-cachexia patients was compared. The total cachexia rate of hospitalized patients with digestive system cancer was 15.7%(803/5118). The highest rate of cachexia was 34.0%(89/262) in patients with pancreatic cancer followed by gastric cancer 22.4%(261/1164), colon cancer 21.7%(146/672), and rectal cancer 20.1%(117/581). In cachexia group and non-cachexia group, the overall completion rate of radical resection was 67.1%(539/803) and 74.5%(3214/4315) respectively(Pdigestive system cancer. Cachexia has significant adverse effects on clinical outcomes in hospitalized patients with digestive system cancer.

  9. PARTAKE survey of public knowledge and perceptions of clinical research in India.

    Directory of Open Access Journals (Sweden)

    Tal Burt

    Full Text Available BACKGROUND: A public that is an informed partner in clinical research is important for ethical, methodological, and operational reasons. There are indications that the public is unaware or misinformed, and not sufficiently engaged in clinical research but studies on the topic are lacking. PARTAKE - Public Awareness of Research for Therapeutic Advancements through Knowledge and Empowerment is a program aimed at increasing public awareness and partnership in clinical research. The PARTAKE Survey is a component of the program. OBJECTIVE: To study public knowledge and perceptions of clinical research. METHODS: A 40-item questionnaire combining multiple-choice and open-ended questions was administered to 175 English- or Hindi-speaking individuals in 8 public locations representing various socioeconomic strata in New Delhi, India. RESULTS: Interviewees were 18-84 old (mean: 39.6, SD ± 16.6, 23.6% female, 68.6% employed, 7.3% illiterate, 26.3% had heard of research, 2.9% had participated and 58.9% expressed willingness to participate in clinical research. The following perceptions were reported (% true/% false/% not aware: 'research benefits society' (94.1%/3.5%/2.3%, 'the government protects against unethical clinical research' (56.7%/26.3%/16.9%, 'research hospitals provide better care' (67.2%/8.7%/23.9%, 'confidentiality is adequately protected' (54.1%/12.3%/33.5%, 'participation in research is voluntary' (85.3%/5.8%/8.7%; 'participants treated like 'guinea pigs'' (20.7%/53.2%/26.0%, and 'compensation for participation is adequate' (24.7%/12.9%/62.3%. CONCLUSIONS: Results suggest the Indian public is aware of some key features of clinical research (e.g., purpose, value, voluntary nature of participation, and supports clinical research in general but is unaware of other key features (e.g., compensation, confidentiality, protection of human participants and exhibits some distrust in the conduct and reporting of clinical trials. Larger, cross

  10. Non-participation modestly increased with distance to the examination clinic among adults in Finnish health examination surveys.

    Science.gov (United States)

    Reinikainen, Jaakko; Saarsalmi, Perttu; Härkänen, Tommi; Jousilahti, Pekka; Karvanen, Juha; Männistö, Satu; Tolonen, Hanna

    2017-11-01

    Health examination surveys (HES) provide important information about population health and health-related factors, but declining participation rates threaten the representativeness of collected data. It is hard to conduct national HESs at examination clinics near to every sampled individual. Thus, it is interesting to look into the possible association between the distance from home to the examination clinic and non-participation, and whether there is a certain distance after which the participation activity decreases considerably. Data from two national HESs conducted in Finland in 2011 and 2012 were used and a logistic regression model was fitted to investigate how distance was related to non-participation. We found out that non-participation modestly increased with distance to the examination clinic. An additional analysis indicated that the option of having an examination at home may decrease the effect of distance to participation. Long distances from home to the examination clinic are one reason for low participation activity. Possible bias caused by these differences in participation could be decreased by providing the option of a home examination.

  11. Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014.

    Science.gov (United States)

    Adam, Jessica K; Abeyta, Roman; Smith, Brian; Gaul, Linda; Thomas, Dana L; Han, George; Sharp, Tyler M; Waterman, Stephen H; Tomashek, Kay M

    2017-03-01

    AbstractDengue, a mosquito-borne viral disease, is increasingly being identified as a cause of outbreaks in the United States. During July-December 2013, a total of three south Texas counties reported 53 laboratory-confirmed dengue cases; 26 were locally acquired, constituting the largest outbreak in Texas since 2005. Because dengue outbreaks are expected to continue in south Texas and early case identification and timely treatment can reduce mortality, we sought to determine clinicians' knowledge of dengue and its clinical management. A survey was sent to 2,375 south Texas clinicians; 217 (9%) completed the survey. Approximately half of participants demonstrated knowledge needed to identify dengue cases, including symptoms (56%), early indicators of shock (54%), or timing of thrombocytopenia (48%). Fewer than 20% correctly identified all prevention messages, severe dengue warning signs, or circumstances in which a dengue patient should return for care. Knowledge of clinical management was limited; few participants correctly identified scenarios when plasma leakage occurred (10%) or a crystalloid solution was indicated (7%); however, 45% correctly identified when a blood transfusion was indicated. Because of the ongoing threat of dengue, we recommend clinicians in south Texas receive dengue clinical management training.

  12. How clinical practitioners assess frailty in their daily practice: an international survey.

    Science.gov (United States)

    Bruyère, Olivier; Buckinx, Fanny; Beaudart, Charlotte; Reginster, Jean-Yves; Bauer, Juergen; Cederholm, Tommy; Cherubini, Antonio; Cooper, Cyrus; Cruz-Jentoft, Alfonso Jose; Landi, Francesco; Maggi, Stefania; Rizzoli, René; Sayer, Avan Aihie; Sieber, Cornel; Vellas, Bruno; Cesari, Matteo

    2017-08-02

    Various operational definitions have been proposed to assess the frailty condition among older individuals. Our objective was to assess how practitioners measure the geriatric syndrome of frailty in their daily routine. An online survey was sent to national geriatric societies affiliated to the European Union Geriatric Medicine Society (EUGMS) and to members of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). A total of 388 clinicians from 44 countries answered to the survey. Most of them were medical doctors (93%), and their primary field of practice was geriatrics (83%). Two hundred and five clinicians (52.8%) always assessed frailty in their daily practice, 38.1% reported to "sometimes" measure it, and 9.1% never assess it. A substantial proportion of clinicians (64.9%) diagnose frailty using more than one instrument. The most widely used tool was the gait speed test, adopted by 43.8% of the clinicians, followed by clinical frailty scale (34.3%), the SPPB test (30.2%), the frailty phenotype (26.8%) and the frailty index (16.8%). A variety of tools is used to assess frailty of older patients in clinical practice highlighting the need for standardisation and guidelines.

  13. [Asbestos clinics and asbestos health examinations--findings from a questionnaire survey of implementing organizations].

    Science.gov (United States)

    Nagao, Norihisa; Nishikawa, Kunihito; Kiyomoto, Yoshihumi; Todoroki, Miwako; Hoshuyama, Tsutomu; Takahashi, Ken

    2008-09-01

    In June 2005 the press reported that many former employees of a company which used asbestos, and individuals who lived near the company's factory, had been diagnosed with mesothelioma. This finding triggered concern and alarm in Japan. In response, many "asbestos clinics" were formed, and recognized medical institutions began to implement asbestos-related health examinations. We conducted a nationwide questionnaire survey to evaluate the activities in, and the challenges for, these medical institutions. We received 137 valid responses, more than half of which were from clinics and hospital-based "asbestos clinics" instigated after the "Kubota shock." Among the asbestos exposure history interviewing practices, job histories of the interviewee were prioritized, over place of residence, and possible exposure of family members. Standard questionnaires were utilized by over 70% of respondents. The practitioners reported problems with lack of manpower and evaluation of asbestos exposure. Examinees consulted attending physicians on a wide range of matters including asbestos-related diseases, asbestos exposure, and financial compensation. It is predicted that asbestos-related diseases in general, and mesothelioma in particular, will increase in the future. Accordingly, early detection and treatment should be accorded high priority. The organizations we surveyed have important roles to play. Although resources are limited, effective diagnosis and treatment are essential, and a system assisting organizations to make accurate and efficient identification of asbestos exposure hazards is imperative.

  14. Atrial Fibrillation Management Strategies in Routine Clinical Practice: Insights from the International RealiseAF Survey

    Science.gov (United States)

    Chiang, Chern-En; Naditch-Brûlé, Lisa; Brette, Sandrine; Silva-Cardoso, José; Gamra, Habib; Murin, Jan; Zharinov, Oleg J.; Steg, Philippe Gabriel

    2016-01-01

    Background Atrial fibrillation (AF) can be managed with rhythm- or rate-control strategies. There are few data from routine clinical practice on the frequency with which each strategy is used and their correlates in terms of patients’ clinical characteristics, AF control, and symptom burden. Methods RealiseAF was an international, cross-sectional, observational survey of 11,198 patients with AF. The aim of this analysis was to describe patient profiles and symptoms according to the AF management strategy used. A multivariate logistic regression identified factors associated with AF management strategy at the end of the visit. Results Among 10,497 eligible patients, 53.7% used a rate-control strategy, compared with 34.5% who used a rhythm-control strategy. In 11.8% of patients, no clear strategy was stated. The proportion of patients with AF-related symptoms (EHRA Class > = II) was 78.1% (n = 4396/5630) for those using a rate-control strategy vs. 67.8% for those using a rhythm-control strategy (pstrategy. A change in strategy was infrequent, even in patients with European Heart Rhythm Association (EHRA) Class > = II. Conclusions In the RealiseAF routine clinical practice survey, rate control was more commonly used than rhythm control, and a change in strategy was uncommon, even in symptomatic patients. In almost 12% of patients, no clear strategy was stated. Physician awareness regarding optimal management strategies for AF may be improved. PMID:26800084

  15. Investigations of Short-Timescale Outflow Variability in Quasars of the Sloan Digital Sky Survey

    Science.gov (United States)

    Hemler, Zachary; Grier, Catherine; Brandt, William; Hall, Patrick; Schneider, Donald; Shen, Yue; Fernandez-Trincado, Jose; SDSS-RM Collaboration

    2018-01-01

    Quasar outflows are hypothesized to regulate the growth of a quasar's host galaxy and the supermassive black hole (SMBH) itself. Thus, understanding the physics of these outflows is imperative to understanding galactic evolution. The physical properties of these outflows, such as density, radial distance from the SMBH, and kinetic energy can be investigated by measuring both the strength and shape variability of broad absorption lines (BALs) in quasar spectra. However, the accuracy of physical properties calculated using BAL variability methods is limited by the time resolution of the observations. Recent spectral data from the Sloan Digital Sky Survey Reverberation Mapping program (SDSS-RM) provides a novel opportunity to investigate the short-term BAL variability of many quasars at many epochs. The SDSS-RM program took many epochs of spectra for a large sample of quasars over a period of several years, many of which exhibit BALs. The median rest-frame time resolution of these observations is roughly 2 days, in contrast to previous large-sample studies, which typically have time spacing on the order of hundred of days. We are using the SDSS-RM dataset to conduct a BAL variability study that will further constrain outflow properties and provide significant insights into the variability mechanisms of quasar outflows. We are searching for variability in BALs on timescales of less than 2 days among our sample of 22 quasars and determining whether this behavior is common among quasars. We are also investigating the general short-term (less than 10 days) variability characteristics of the entire sample. We will present preliminary results from this study and the possible implications to our understanding of quasar outflows.

  16. A 2011 survey of clinical practice patterns in the management of Graves' disease.

    Science.gov (United States)

    Burch, Henry B; Burman, Kenneth D; Cooper, David S

    2012-12-01

    More than two decades have passed since members from the American Thyroid Association (ATA), European Thyroid Association, and Japan Thyroid Association were surveyed on management practices for patients with hyperthyroidism due to Graves' disease (GD). We sought to document current practices in the management of GD and compare these results both to those documented in earlier surveys and to practice recommendations made in the 2011 ATA/American Association of Clinical Endocrinologists (AACE) hyperthyroidism practice guidelines. Lastly, we sought to examine differences in GD management among international members of U.S.-based endocrine societies. Members of The Endocrine Society (TES), ATA, and AACE were invited to participate in a web-based survey dealing with testing, treatment preference, and modulating factors in patients with GD. A total of 730 respondents participated in the survey, 696 of whom completed all sections. Respondents included 641 TES members, 330 AACE members, and 157 ATA members. The preferred mode of therapy in uncomplicated GD was antithyroid drugs (ATDs) by 53.9% of respondents, radioactive iodine (RAI) therapy by 45.0%, and thyroid surgery in 0.7%. Compared with 1991, fewer U.S. (59.7 vs. 69%) and European (13.3% vs. 25%) respondents would use RAI therapy. Methimazole and carbimazole were the preferred ATDs, with only 2.7% of respondents selecting propylthiouracil. Patients with Graves' ophthalmopathy were treated with ATDs (62.9%) or surgery (18.5%) and less frequently with RAI plus corticosteroids (16.9%) or RAI alone (1.9%). Striking changes have occurred in the management of GD over the past two decades, with a shift away from RAI and toward ATDs in patients with uncomplicated GD. Apparent international differences persist but should be interpreted with caution. Current practices diverge in some areas from recently published guidelines; these differences should be assessed serially to determine the impact of the guidelines on future

  17. Canadian survey of critical care pharmacists' views and involvement in clinical research.

    Science.gov (United States)

    Perreault, Marc M; Thiboutot, Zoé; Burry, Lisa D; Rose, Louise; Kanji, Salmaan; LeBlanc, Jaclyn M; Carr, Roxane R; Williamson, David R

    2012-09-01

    The involvement of Canadian critical care pharmacists in clinical research is not well documented. To describe the clinical research experience of Canadian critical care pharmacists, describe their views about clinical research, and identify factors that facilitate their involvement in clinical research. A cross-sectional electronic survey of Canadian critical care pharmacists was developed through an iterative process and conducted from July to October 2010. We invited 325 pharmacists from 129 hospitals across Canada to participate. Surveys with more than 30% of questions unanswered were discarded. Analyzable response rate was 66.2%. Overall, 33 pharmacists (15.7%) were highly involved in research, 54 (25.7%) were moderately involved, and 123 (58.6%) were minimally involved. Most respondents (97.2%) believed that critical care pharmacist involvement in research was desirable, and many (80.4%) expressed interest to be more involved in research. Nearly all respondents (99.5%) agreed that more support should be provided to pharmacists interested in conducting research. Pharmacists currently involved in research have obtained higher academic degrees (adjusted OR 11.23; p care unit where involvement in research is valued (adjusted OR 5.61; p pharmacy departments is not related to involvement in research (adjusted OR 1.22; p = 0.633). Canadian critical care pharmacists are involved to varying degrees in clinical research and are very interested in initiating and supporting research activities. Opportunities are present but significant barriers exist. The value of pharmacist-initiated research needs recognition as a priority within hospital pharmacy administration.

  18. An Australian survey of clinical practices in management of neutropenic fever in adult cancer patients 2009.

    Science.gov (United States)

    Lingaratnam, S; Slavin, M A; Mileshkin, L; Solomon, B; Burbury, K; Seymour, J F; Sharma, R; Koczwara, B; Kirsa, S W; Davis, I D; Prince, M; Szer, J; Underhill, C; Morrissey, O; Thursky, K A

    2011-01-01

    An abundance of new evidence regarding treatment strategies for neutropenic fever is likely to contribute to variability in practice across institutions and clinicians alike. To describe current clinical practices in Australia, by surveying haematologists, oncologists and infectious diseases physicians involved in cancer care. Clinician members from Australian professional associations, accounting for the vast majority of Australian cancer specialists, were invited to participate in an electronic survey, comprising of a clinical case-based questionnaire. Clinical practice areas explored were: use of risk-assessment and empiric antibiotic strategies across various treatment settings; use of anti-bacterial prophylaxis; and use of granulocyte-colony stimulating factors for established neutropenic fever and for secondary prophylaxis. A total of 252 clinicians returned responses (approximately 30% response rate). The majority (>70%) were representative of practices in public, major city, tertiary referral hospitals. Less than half of clinicians were aware of risk-assessment tools and less than quarter currently used ambulatory care strategies. If adequate resources were made available, more than 80% were willing to use risk-assessment tools and 60% more clinicians were likely to use ambulatory care strategies. Most clinicians prescribed dual therapy parenteral antibiotics, even for clinically stable patients (53% haematologists, 56% oncologists). Granulocyte-colony stimulating factor was used frequently as secondary prophylaxis in the breast cancer case (91%), follicular lymphoma case (59%) and non-small cell lung cancer case (31%). Fluoroquinolone prophylaxis was infrequently prescribed (19% oncologists, 30% haematologists). Evidence-practice gaps were identified around the use of risk-assessment-based empiric therapy, and help to inform better clinical guidance. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

  19. A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa.

    Directory of Open Access Journals (Sweden)

    Yasmeen Hanifa

    Full Text Available The World Health Organization (WHO recommendation for regular tuberculosis (TB screening of HIV-positive individuals with Xpert MTB/RIF as the first diagnostic test has major resource implications.To develop a diagnostic prediction model for TB, for symptomatic adults attending for routine HIV care, to prioritise TB investigation.Cohort study exploring a TB testing algorithm.HIV clinics, South Africa.Representative sample of adult HIV clinic attendees; data from participants reporting ≥1 symptom on the WHO screening tool were split 50:50 to derive, then internally validate, a prediction model.TB, defined as "confirmed" if Xpert MTB/RIF, line probe assay or M. tuberculosis culture were positive; and "clinical" if TB treatment started without microbiological confirmation, within six months of enrolment.Overall, 79/2602 (3.0% participants on ART fulfilled TB case definitions, compared to 65/906 (7.2% pre-ART. Among 1133/3508 (32.3% participants screening positive on the WHO tool, 1048 met inclusion criteria for this analysis: 52/515 (10.1% in the derivation and 58/533 (10.9% in the validation dataset had TB. Our final model comprised ART status (on ART > 3 months vs. pre-ART or ART 1 symptom. We converted this to a clinical score, using clinically-relevant CD4 and BMI categories. A cut-off score of ≥3 identified those with TB with sensitivity and specificity of 91.8% and 34.3% respectively. If investigation was prioritised for individuals with score of ≥3, 68% (717/1048 symptomatic individuals would be tested, among whom the prevalence of TB would be 14.1% (101/717; 32% (331/1048 of tests would be avoided, but 3% (9/331 with TB would be missed amongst those not tested.Our clinical score may help prioritise TB investigation among symptomatic individuals.

  20. A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa.

    Science.gov (United States)

    Hanifa, Yasmeen; Fielding, Katherine L; Chihota, Violet N; Adonis, Lungiswa; Charalambous, Salome; Foster, Nicola; Karstaedt, Alan; McCarthy, Kerrigan; Nicol, Mark P; Ndlovu, Nontobeko T; Sinanovic, Edina; Sahid, Faieza; Stevens, Wendy; Vassall, Anna; Churchyard, Gavin J; Grant, Alison D

    2017-01-01

    The World Health Organization (WHO) recommendation for regular tuberculosis (TB) screening of HIV-positive individuals with Xpert MTB/RIF as the first diagnostic test has major resource implications. To develop a diagnostic prediction model for TB, for symptomatic adults attending for routine HIV care, to prioritise TB investigation. Cohort study exploring a TB testing algorithm. HIV clinics, South Africa. Representative sample of adult HIV clinic attendees; data from participants reporting ≥1 symptom on the WHO screening tool were split 50:50 to derive, then internally validate, a prediction model. TB, defined as "confirmed" if Xpert MTB/RIF, line probe assay or M. tuberculosis culture were positive; and "clinical" if TB treatment started without microbiological confirmation, within six months of enrolment. Overall, 79/2602 (3.0%) participants on ART fulfilled TB case definitions, compared to 65/906 (7.2%) pre-ART. Among 1133/3508 (32.3%) participants screening positive on the WHO tool, 1048 met inclusion criteria for this analysis: 52/515 (10.1%) in the derivation and 58/533 (10.9%) in the validation dataset had TB. Our final model comprised ART status (on ART > 3 months vs. pre-ART or ART 1 symptom). We converted this to a clinical score, using clinically-relevant CD4 and BMI categories. A cut-off score of ≥3 identified those with TB with sensitivity and specificity of 91.8% and 34.3% respectively. If investigation was prioritised for individuals with score of ≥3, 68% (717/1048) symptomatic individuals would be tested, among whom the prevalence of TB would be 14.1% (101/717); 32% (331/1048) of tests would be avoided, but 3% (9/331) with TB would be missed amongst those not tested. Our clinical score may help prioritise TB investigation among symptomatic individuals.

  1. A National Radiation Oncology Medical Student Clerkship Survey: Didactic Curricular Components Increase Confidence in Clinical Competency

    Energy Technology Data Exchange (ETDEWEB)

    Jagadeesan, Vikrant S. [Department of Radiation and Cellular Oncology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois (United States); Raleigh, David R. [Department of Radiation Oncology, School of Medicine, University of California–San Francisco, San Francisco, California (United States); Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J. [Department of Radiation and Cellular Oncology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois (United States); Golden, Daniel W., E-mail: dgolden@radonc.uchicago.edu [Department of Radiation and Cellular Oncology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois (United States)

    2014-01-01

    Purpose: Students applying to radiation oncology residency programs complete 1 or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first-year radiation oncology resident are evaluated. Methods and Materials: An anonymous, Internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012-2013 academic year. The survey was composed of 3 main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results: The survey response rate was 37% (70 of 188). Respondents reported 191 unique clerkship experiences. Of the respondents, 27% (19 of 70) completed at least 1 clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent's confidence to function as a first-year radiation oncology resident (Wilcoxon rank–sum P=.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman ρ P=.48) or confidence to function as a first year resident (Spearman ρ P=.43). Conclusions: Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation oncology resident. These

  2. A national radiation oncology medical student clerkship survey: Didactic curricular components increase confidence in clinical competency

    Science.gov (United States)

    Jagadeesan, Vikrant S.; Raleigh, David R.; Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J.; Golden, Daniel W.

    2014-01-01

    Purpose/Objectives Students applying to radiation oncology residency programs complete one or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first year radiation oncology resident are evaluated. Methods and Materials An anonymous, internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012–2013 academic year. The survey was composed of three main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results The survey response rate was 37% (70/188). Respondents reported 191 unique clerkship experiences. 27% of respondents (19/70) completed at least one clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent’s confidence to function as a first- year radiation oncology resident (Wilcoxon rank-sum p = 0.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman’s rho p = 0.48) or confidence to function as a first year resident (Spearman’s rho p = 0.43). Conclusions Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation

  3. Demographic characteristics of doctors who intend to follow clinical academic careers: UK national questionnaire surveys.

    Science.gov (United States)

    Smith, Fay; Lambert, Trevor W; Goldacre, Michael J

    2014-10-01

    It is well recognised that women are underrepresented in clinical academic posts. Our aim was to determine which of a number of characteristics-notably gender, but also ethnicity, possession of an intercalated degree, medical school attended, choice of specialty-were predictive of doctors' intentions to follow clinical academic careers. Questionnaires to all UK-trained medical graduates of 2005 sent in 2006 and again in 2010, graduates of 2009 in 2010 and graduates of 2012 in 2013. At the end of their first year of medical work, 13.5% (368/2732) of men and 7.3% (358/4891) of women specified that they intended to apply for a clinical academic training post; and 6.0% (172/2873) of men and 2.2% (111/5044) of women specified that they intended to pursue clinical academic medicine as their eventual career. A higher percentage of Asian (4.8%) than White doctors (3.3%) wanted a long-term career as a clinical academic, as did a higher percentage of doctors who did an intercalated degree (5.6%) than others (2.2%) and a higher percentage of Oxbridge graduates (8.1%) than others (2.8%). Of the graduates of 2005, only 30% of those who in 2006 intended a clinical medicine career also did so when re-surveyed in 2010 (men 44%, women 12%). There are noteworthy differences by gender and other demographic factors in doctors' intentions to pursue academic training and careers. The gap between men and women in aspirations for a clinical academic career is present as early as the first year after qualification. 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.

  4. An electronic survey of physicians using online clinical discussion groups: a brief report.

    Science.gov (United States)

    Angelo, S J; Citkowitz, E

    2001-03-01

    Online discussion groups are a relatively new form of informal communication among physicians. Physicians' Online, an Internet-based medical information and communication network with a current membership base that includes more than 200,000, United States physicians, contains extensive bulletin-board discussion areas with more than 47,000 topics posted to date. There are no published data available regarding the characteristics and behaviors of the individuals who participate in these discussions. To better characterize the users of these groups, in March 1998, we posted an eight-question, multiple-choice electronic survey on Physicians' Online's home page inviting users of the clinical discussion groups to participate. We analyzed responses from 586 participants. The most common characteristics were: urban and Northeastern United States location, age less than 55 years, clinical practice of internal medicine or one of its subspecialties, private solo or single/multispecialty group practice, and reported weekly consultation with three or less colleagues. Most physicians were interested in specific clinical cases. Forty-one percent of the respondents chose to read discussion groups only but rarely or never initiated or responded. Younger age, urban setting, private practice, and infrequent consultation with colleagues were the most common characteristics found among users of Physicians' Online's online clinical discussion groups. That specific clinical cases were the most common interest speaks to the notion that discussion groups may represent an attractive resource for helping to manage clinical cases. Future research should explore in greater depth the demographics of users, specific motivations for physician use, ways to improve active participation, and the impact on clinical practice.

  5. An empirical survey to investigate quality of men's clothing market using QFD method

    Directory of Open Access Journals (Sweden)

    Samira Golshan

    2012-08-01

    Full Text Available One of the most important techniques on improving customer satisfaction in clothing and textile industry is to increase the quality of goods and services. There are literally different methods for detecting important items influencing clothing products and the proposed model of this paper uses quality function deployment (QFD. The proposed model of this paper designs and distributes a questionnaire among some experts to detect necessary factors and using house of quality we determine the most important factors impacting the customer's clothing selection. The proposed study of this paper focuses men who are 15 to 45 years old living in Yazd/Iran. The brand we do the investigation sells the products in three shopping centers located in this city. We have distributed 100 questionnaires and collected 65 properly filled ones. Based on the results of our survey, suitable design, printing and packaging specifications, necessary requirements, optimization of production planning and appropriate sewing machine setting are considered as the most important characteristics influencing the purchase of a clothing products.

  6. Factors Associated With Burnout Among US Hospital Clinical Pharmacy Practitioners: Results of a Nationwide Pilot Survey.

    Science.gov (United States)

    Jones, G Morgan; Roe, Neil A; Louden, Les; Tubbs, Crystal R

    2017-12-01

    Background: In health care, burnout has been defined as a psychological process whereby human service professionals attempting to positively impact the lives of others become overwhelmed and frustrated by unforeseen job stressors. Burnout among various physician groups who primarily practice in the hospital setting has been extensively studied; however, no evidence exists regarding burnout among hospital clinical pharmacists. Objective: The aim of this study was to characterize the level of and identify factors independently associated with burnout among clinical pharmacists practicing in an inpatient hospital setting within the United States. Methods: We conducted a prospective, cross-sectional pilot study utilizing an online, Qualtrics survey. Univariate analysis related to burnout was conducted, with multivariable logistic regression analysis used to identify factors independently associated with the burnout. Results: A total of 974 responses were analyzed (11.4% response rate). The majority were females who had practiced pharmacy for a median of 8 years. The burnout rate was high (61.2%) and largely driven by high emotional exhaustion. On multivariable analysis, we identified several subjective factors as being predictors of burnout, including inadequate administrative and teaching time, uncertainty of health care reform, too many nonclinical duties, difficult pharmacist colleagues, and feeling that contributions are underappreciated. Conclusions: The burnout rate of hospital clinical pharmacy providers was very high in this pilot survey. However, the overall response rate was low at 11.4%. The negative effects of burnout require further study and intervention to determine the influence of burnout on the lives of clinical pharmacists and on other health care-related outcomes.

  7. Telephone survey to investigate relationships between onychectomy or onychectomy technique and house soiling in cats.

    Science.gov (United States)

    Gerard, Amanda F; Larson, Mandy; Baldwin, Claudia J; Petersen, Christine

    2016-09-15

    OBJECTIVE To determine whether associations existed between onychectomy or onychectomy technique and house soiling in cats. DESIGN Cross-sectional study. SAMPLE 281 owners of 455 cats in Polk County, Iowa, identified via a list of randomly selected residential phone numbers of cat owners in that region. PROCEDURES A telephone survey was conducted to collect information from cat owners on factors hypothesized a priori to be associated with house soiling, including cat sex, reproductive status, medical history, and onychectomy history. When cats that had undergone onychectomy were identified, data were collected regarding the cat's age at the time of the procedure and whether a carbon dioxide laser (CDL) had been used. Information on history of house soiling behavior (urinating or defecating outside the litter box) was also collected. RESULTS Onychectomy technique was identified as a risk factor for house soiling. Cats for which a non-CDL technique was used had a higher risk of house soiling than cats for which the CDL technique was used. Cats that had undergone onychectomy and that lived in a multicat (3 to 5 cats) household were more than 3 times as likely to have house soiled as were single-housed cats with intact claws. CONCLUSIONS AND CLINICAL RELEVANCE Results of this cross-sectional study suggested that use of the CDL technique for onychectomy could decrease the risk of house soiling by cats relative to the risk associated with other techniques. This and other findings can be used to inform the decisions of owners and veterinarians when considering elective onychectomy for cats.

  8. Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification.

    Science.gov (United States)

    Moreau, William J; Nabhan, Dustin C; Walden, Taylor

    2015-09-01

    The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic. A 21-item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors. Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool-3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%). This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the Sideline Concussion Assessment Tool-3 as a sideline assessment tool.

  9. Perspectives on research evidence and clinical practice: a survey of Australian physiotherapists.

    Science.gov (United States)

    Grimmer-Somers, Karen; Lekkas, Peter; Nyland, Leah; Young, Alexandra; Kumar, Saravana

    2007-09-01

    Physiotherapists' use of research evidence with clinical decision-making has interested researchers world-wide since 1980; however, little is known about such practices in Australia. The present survey sought information on Australian physiotherapists' perceptions of the importance of research, and barriers to uptake of evidence in clinical practice, when compared with an international cohort from 2001. An Australian-relevant version of an English (UK) National Health Service (NHS) survey instrument was used to canvass 453 physiotherapists, randomly selected from the South Australian Physiotherapy Registration Board 2004-2005 records. The first survey was mailed in August 2005, a reminder was sent two weeks later to non-responders and a follow-up survey was sent in April 2006 to non-responders whose addresses had changed since 2005. There was a 51% response rate. Of the non-responders, 12% were not contactable at their listed address, highlighting the mobility of Australian physiotherapists. Most respondents had undertaken research as students (59.5%) or as students and clinicians (11.5%). Of these, 37.1% were encouraged to embark on more research, and 20.5% were discouraged. The significant predictors of positive perceived importance of research were: previous research experience; being positive about undertaking further research; working in hospitals and holding a postgraduate degree. Clinicians working privately were significantly less likely than managers to be positive about research importance. The only significant predictor for not perceiving barriers to uptake of evidence was being positive about undertaking future research. The study identified constraints on uptake of evidence into practice that were related to accessing, reading and interpreting published research, and implementing findings. Found consistently across employment categories were barriers relating to lack of time, uncertainty about what the research reported, scepticism about the value of

  10. Survey of clinical practice for irritable bowel syndrome in East asian countries.

    Science.gov (United States)

    Fukudo, Shin; Hahm, Ki-Baik; Zhu, Qi; Sollano, Jose D; Rani, Abdul A; Syam, Ari F; Kachintorn, Udom; Suzuki, Hidekazu; Kamiya, Takeshi; Joh, Takashi; Uchiyama, Kazuhiko; Naito, Yuji; Takahashi, Shin'ichi; Kinoshita, Yoshikazu; Ueno, Fumiaki; Yamagami, Hirokazu; Chan, Francis K L; Fock, Kwong M; Arakawa, Tetsuo

    2015-01-01

    Sociocultural factors are important because their different effects on the features of irritable bowel syndrome (IBS) between countries will provide clues towards solving this problem. The aims of this study were to depict the clinical realities of IBS in East Asian countries and test the hypothesis that the diagnosis and treatment of IBS differ between countries. Study participants were 251 physicians involved in the clinical practice of IBS at major institutions in Japan, South Korea, China, the Philippines, Indonesia and Singapore. The questionnaire contained 45 questions focused on the clinical practice of IBS. Subjects in Japan, South Korea, China, Indonesia, the Philippines and Singapore accounted for 55.4, 17.9, 8.8, 8.0, 6.4 and 3.6% of the study cohort, respectively. Amongst East Asian physicians, the most important symptom was considered to be abdominal pain by 33.4%, whilst 24.3% regarded alternating diarrhea and constipation to be the most important symptoms. Total colonoscopy and histopathology use showed no difference among countries. Prescriptions given for mild (p differed between the countries. Except for several minor points, IBS specialists showed no significant difference in their diagnosis and treatment of IBS when compared to nonspecialists. This survey provided data on the clinical treatment of IBS among East Asian countries. The results supported the hypothesis that the diagnosis and treatment of IBS differs between countries. © 2015 S. Karger AG, Basel.

  11. Single-centre survey of the application of cardiovascular magnetic resonance in clinical routine.

    Science.gov (United States)

    von Knobelsdorff-Brenkenhoff, Florian; Bublak, Angelika; El-Mahmoud, Sana; Wassmuth, Ralf; Opitz, Christian; Schulz-Menger, Jeanette

    2013-01-01

    Awareness of cardiovascular magnetic resonance (CMR) is growing due to increasing evidence for providing relevant functional and morphologic information. This single-centre survey aimed at providing descriptive data about the clinical application and potential impact of CMR. All 2598 clinically indicated CMR exams were prospectively registered during 1 year in one single centre. Detailed data of the individual patient and procedural information of each exam were collected. In a simulation of CMR-based clinical decision-making in a subgroup of 250 cases, the influence of CMR on further diagnostic testing and answering the clinical question was estimated. Inflammatory (31%) and coronary (28%) heart disease were the most frequent indications. The exams were fast (98% overcome claustrophobia in 3.8%. Two per cent of all exams were terminated prematurely. No severe adverse events occurred. All moderate adverse events (0.5%) were associated with stress medication (1.7% of all stress tests) or contrast media (0.15% of all contrast enhanced studies). In the simulation, CMR influenced the individual selection of diagnostic testing and provided valuable information to establish or exclude a diagnosis. This single-centre experience demonstrated a versatile application of CMR at reasonable time expense, safety, and robustness. The simulation of CMR-based decision-making indicated that CMR may influence patient management.

  12. Elastomeric liners for people with transtibial amputation: Survey of prosthetists' clinical practices.

    Science.gov (United States)

    Hafner, Brian J; Cagle, John C; Allyn, Katheryn J; Sanders, Joan E

    2017-04-01

    A diverse range of elastomeric liner products are available to people with transtibial amputation. However, little information is available about how prosthetists select the product best suited to each patient. To determine how prosthetists obtain information about liners, which features are most relevant to the selection process, and which products are used most for patients with transtibial amputation. Cross-sectional survey. A custom online survey was developed to solicit information about prosthetists' liner selection practices. Prosthetists with experience managing transtibial patients were recruited via advertisements posted in magazines, at conferences, and on a listserv. Responses were analyzed to characterize prosthetists' liner selection practices. Data from 106 experienced prosthetists (mean age: 44.4 years, mean experience: 15.7 years) were included. Most prosthetists (94%) obtained liner information from manufacturer representatives, websites, or literature. On average, respondents factored nine different liner characteristics into their selection processes. Prosthetists reported experience with 16 unique liner products with their transtibial patients, but routinely used fewer than 3. Although many different prosthetic liners are available, prosthetists regularly use only a few select liner products. Tools or strategies to objectively compare prosthetic liners across manufacturers are likely needed to facilitate more diverse prescription practices. Clinical relevance Knowledge of prosthetists' prosthetic liner selection practices may guide development of evidence-based resources or tools to facilitate matching patients with appropriate liners. Results of this study may also inform researchers and manufacturers about desirable liner characteristics and direct development of novel liner products to address prosthetists' clinical needs.

  13. Encountering aged care: a mixed methods investigation of medical students' clinical placement experiences.

    Science.gov (United States)

    Annear, Michael J; Lea, Emma; Lo, Amanda; Tierney, Laura; Robinson, Andrew

    2016-02-04

    Residential aged care is an increasingly important health setting due to population ageing and the increase in age-related conditions, such as dementia. However, medical education has limited engagement with this fast-growing sector and undergraduate training remains primarily focussed on acute presentations in hospital settings. Additionally, concerns have been raised about the adequacy of dementia-related content in undergraduate medical curricula, while research has found mixed attitudes among students towards the care of older people. This study explores how medical students engage with the learning experiences accessible in clinical placements in residential aged care facilities (RACFs), particularly exposure to multiple comorbidity, cognitive impairment, and palliative care. Fifth-year medical students (N = 61) completed five-day clinical placements at two Australian aged care facilities in 2013 and 2014. The placements were supported by an iterative yet structured program and academic teaching staff to ensure appropriate educational experiences and oversight. Mixed methods data were collected before and after the clinical placement. Quantitative data included surveys of dementia knowledge and questions about attitudes to the aged care sector and working with older adults. Qualitative data were collected from focus group discussions concerning medical student expectations, learning opportunities, and challenges to engagement. Pre-placement surveys identified good dementia knowledge, but poor attitudes towards aged care and older adults. Negative placement experiences were associated with a struggle to discern case complexity and a perception of an aged care placement as an opportunity cost associated with reduced hospital training time. Irrespective of negative sentiment, post-placement survey data showed significant improvements in attitudes to working with older people and dementia knowledge. Positive student experiences were explained by in

  14. Post-market clinical research conducted by medical device manufacturers: a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Ross JS

    2015-05-01

    Full Text Available Joseph S Ross, Katrina L Blount, Jessica D Ritchie, Beth Hodshon, Harlan M Krumholz Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA Background: In the US, once a medical device is made available for use, several requirements have been established by the US Food and Drug Administration (FDA to ensure ongoing post-market surveillance of device safety and effectiveness. Our objective was to determine how commonly medical device manufacturers initiate post-market clinical studies or augment FDA post-market surveillance requirements for higher-risk devices that are most often approved via the FDA's pre-market approval (PMA pathway. Methods and results: We conducted a cross-sectional survey of 47 manufacturers with operations in California, Minnesota, and Massachusetts who market devices approved via the PMA pathway. Among 22 respondents (response rate =47%, nearly all self-reported conducting post-market clinical research studies, commonly between 1 and 5; only 1 respondent reported never conducting post-market clinical research studies. While manufacturers most often engaged in these studies to satisfy FDA requirements, other reasons were reported, including performance monitoring and surveillance and market acceptance initiatives. Risks of conducting and not conducting post-market clinical research studies were described through open-ended response to questions. Conclusion: Medical device manufacturers commonly initiate post-market clinical studies at the request of the FDA. Clinical data from these studies should be integrated into national post-market surveillance initiatives. Keywords: FDA, PMA pathway, post-market surveillance

  15. A survey on relationships between thyroid hormone levels and clinical findings in dairy calf diarrhea

    Directory of Open Access Journals (Sweden)

    Ali Hajimohammadi

    2015-03-01

    Full Text Available Calf diarrhea is an important disease that occurs in association with the interaction of various infectious agents and calf susceptibility. The economic losses is associated with death loss and treatment costs, reduction of live weight gain, and reduction of productive life span, which may be considerable. Thyroid hormones previously thought mainly in thermoregulation and energy metabolism. Recently, several studies have challenged on their roles in the metabolic response of animals to certain conditions such as nutritional, environmental, or disease state. The aim of the present study was to survey relationships between thyroid hormones in calves with diarrhea in the different clinical features. Holstein calves (50 within 1 day to 2 months old with signs of diarrhea and healthy calves (40 with similar age and sex were selected. Standard clinical examinations and also dehydration degree assessment were carried out on each calf and recorded accordingly. Calves with clinical signs of diarrhea were divided in different groups based on the severity of the clinical findings, fever and degree of dehydration. Blood samples were taken from the jugular vein from all calves into vacutainer tubes for serum collection.T4, fT4, T3 and fT3 concentrations were measured by validated methods. A significant increase in T4, T3 and fT3 in diarrheic calves was observed (P<0.05. Thyroid hormones in calves with severe clinical signs decreased significantly (P<0.001 compared to calves with moderate or mild systemic clinical signs. Thyroid hormones between febrile diarrheic calves compared to afebrile diarrheic calves had no significant changes. Diarrheic calves with severe dehydration compared to diarrheic calves with mild and moderate dehydration had significant decreases in their thyroid hormones (P<0.001.

  16. The economic impact of poor sample quality in clinical chemistry laboratories: results from a global survey.

    Science.gov (United States)

    Erdal, Erik P; Mitra, Debanjali; Khangulov, Victor S; Church, Stephen; Plokhoy, Elizabeth

    2017-03-01

    Background Despite advances in clinical chemistry testing, poor blood sample quality continues to impact laboratory operations and the quality of results. While previous studies have identified the preanalytical causes of lower sample quality, few studies have examined the economic impact of poor sample quality on the laboratory. Specifically, the costs associated with workarounds related to fibrin and gel contaminants remain largely unexplored. Methods A quantitative survey of clinical chemistry laboratory stakeholders across 10 international regions, including countries in North America, Europe and Oceania, was conducted to examine current blood sample testing practices, sample quality issues and practices to remediate poor sample quality. Survey data were used to estimate costs incurred by laboratories to mitigate sample quality issues. Results Responses from 164 participants were included in the analysis, which was focused on three specific issues: fibrin strands, fibrin masses and gel globules. Fibrin strands were the most commonly reported issue, with an overall incidence rate of ∼3%. Further, 65% of respondents indicated that these issues contribute to analyzer probe clogging, and the majority of laboratories had visual inspection and manual remediation practices in place to address fibrin- and gel-related quality problems (55% and 70%, respectively). Probe maintenance/replacement, visual inspection and manual remediation were estimated to carry significant costs for the laboratories surveyed. Annual cost associated with lower sample quality and remediation related to fibrin and/or gel globules for an average US laboratory was estimated to be $100,247. Conclusions Measures to improve blood sample quality present an important step towards improved laboratory operations.

  17. Survey of self-assessed preparedness for clinical practice in one Croatian medical school

    Directory of Open Access Journals (Sweden)

    Jenkins Sarah M

    2009-07-01

    Full Text Available Abstract Background The Croatian higher education system is in the process of reforming its medical curricula to comply with European Union standards. We conducted a survey of students enrolled at the University of Zagreb (Croatia asking them to rate their perception of preparedness for clinical practice prior to initiation of the reform process. The purpose of the survey was to identify self-perceived deficiencies in education and to establish a reference point for the later assessment of ongoing educational reform. Findings One-hundred and forty seven (N = 147 graduates reported the levels of perceived preparedness on 30 items grouped into 8 educational domains. Main domains were: understanding science, practical skills/patient management, holistic care, prevention, interpersonal skills, confidence/coping skills, collaboration, and self-directed learning. For each item, graduates self assessed their preparedness on a scale ranging from 1 to 4, with 1 = "Very inadequate", 2 = "Somewhat inadequate", 3 = "Somewhat adequate", and 4 = "Very adequate". In 7 out of 8 domains the achieved median score was ≥ 3. Students expressed low confidence (defined when ≥ 25% of respondents supplied a rating for the survey question as: "very inadequate" or "somewhat inadequate" with interpersonal skills (discussing terminal disease, counseling distraught patients, balancing professional and personal life, and in performing certain basic semi-invasive or invasive procedures. Conclusion Zagreb medical graduates identified several deficiencies within educational domains required for standard clinical practice. Ongoing educational efforts need to be directed towards the correction of these deficiencies in order to achieve standards required by the European Union.

  18. Inequalities in access to genitourinary medicine clinics in the UK: results from a mystery shopper survey.

    Science.gov (United States)

    Foley, Elizabeth; Furegato, Martina; Hughes, Gwenda; Board, Christopher; Hayden, Vanessa; Prescott, Timothy; Shone, Eleanor; Patel, Rajul

    2017-11-01

    This study investigated whether access to genitourinary medicine (GUM) clinics meets UK-recommended standards. In January 2014 and 2015, postal questionnaires about appointment and service characteristics were sent to lead clinicians of UK GUM clinics. In February 2014 and 2015, researchers posing as symptomatic and asymptomatic 'patients' contacted clinics by telephone, requesting to be seen. Clinic and patient characteristics associated with the offer of an appointment within 48 hours were examined using unadjusted and UK country and patient gender adjusted multivariable logistic regression analyses. In March 2015, a convenience sample (one in four) of clinics was visited by researchers with the same clinical symptoms. Ability to achieve a same-day consultation and waiting time were assessed. In 2015, 90.8% of clinics offered symptomatic 'patients' an appointment within 48 hours when contacted by telephone, compared with 95.5% in 2014 (aOR=0.46 (0.26 to 0.83); pclinics in England (96.2% to 90.7%; pclinics were able to see symptomatic patients attending in person. Access to GUM services has worsened for those with symptoms suggestive of an acute STI and is significantly poorer for asymptomatic women. This evidence may support the reintroduction of process targets. 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/.

  19. Preparing investigation of methods for surveying tree seed demands among farmers in Tanzania

    DEFF Research Database (Denmark)

    Aabæk, Anders

    demand pattern in Tanzania, Uganda and Nicaragua are discussed and a choice of strategy for an extensive survey of seed demand and supply in Tanzania is made. Different data collection methods and tools, e.g. quantitative and qualitative surveys and rapid rural appraisals, are described in detail...

  20. Current approaches to managing fear of cancer recurrence; a descriptive survey of psychosocial and clinical health professionals.

    Science.gov (United States)

    Thewes, B; Brebach, R; Dzidowska, M; Rhodes, P; Sharpe, L; Butow, P

    2014-04-01

    Fear of cancer recurrence (FCR) is common amongst cancer survivors and help with this problem is the most frequently reported unmet need in this population. This study investigated how FCR is perceived and managed by clinical health professionals (medical and nursing staff) and psychosocial professionals in oncology settings. Clinical health professionals and psychosocial professionals in oncology settings received emailed invitations from their professional organisation to participate in an online survey. Data from 77 clinical health professionals and 64 psychosocial professionals indicate that FCR is perceived as common and challenging to manage. Thirty-one percent of psychosocial professionals estimated FCR is present in >50% of cancer survivors seen in their practise. Only a minority (21%) of clinical staff reported always referring patients with high levels of FCR to psychosocial support. Strategies for managing FCR differed considerably amongst psychosocial professionals, and most reported that aspects of acceptance and commitment therapy and/or cognitive behaviour therapy were helpful. Greater than 99% of participants were interested in training to help patients manage FCR. Fear of cancer recurrence is commonly identified in oncology settings and a common focus of discussion in follow-up care. However, patients with high levels of FCR are not routinely referred to psychosocial staff, and barriers to referral to psychosocial care should be investigated. The diversity of approaches reported by psychosocial professionals suggests lack of consensus regarding management of FCR, indicating that the development effective, theoretical-based intervention and evidence-based intervention for FCR is a matter of priority. Copyright © 2013 John Wiley & Sons, Ltd.

  1. Common definition for categories of clinical research: a prerequisite for a survey on regulatory requirements by the European Clinical Research Infrastructures Network (ECRIN

    Directory of Open Access Journals (Sweden)

    Sanz Nuria

    2009-10-01

    Full Text Available Abstract Background Thorough knowledge of the regulatory requirements is a challenging prerequisite for conducting multinational clinical studies in Europe given their complexity and heterogeneity in regulation and perception across the EU member states. Methods In order to summarise the current situation in relation to the wide spectrum of clinical research, the European Clinical Research Infrastructures Network (ECRIN developed a multinational survey in ten European countries. However a lack of common classification framework for major categories of clinical research was identified, and therefore reaching an agreement on a common classification was the initial step in the development of the survey. Results The ECRIN transnational working group on regulation, composed of experts in the field of clinical research from ten European countries, defined seven major categories of clinical research that seem relevant from both the regulatory and the scientific points of view, and correspond to congruent definitions in all countries: clinical trials on medicinal products; clinical trials on medical devices; other therapeutic trials (including surgery trials, transplantation trials, transfusion trials, trials with cell therapy, etc.; diagnostic studies; clinical research on nutrition; other interventional clinical research (including trials in complementary and alternative medicine, trials with collection of blood or tissue samples, physiology studies, etc.; and epidemiology studies. Our classification was essential to develop a survey focused on protocol submission to ethics committees and competent authorities, procedures for amendments, requirements for sponsor and insurance, and adverse event reporting following five main phases: drafting, consensus, data collection, validation, and finalising. Conclusion The list of clinical research categories as used for the survey could serve as a contribution to the, much needed, task of harmonisation and

  2. Common definition for categories of clinical research: a prerequisite for a survey on regulatory requirements by the European Clinical Research Infrastructures Network (ECRIN).

    Science.gov (United States)

    Kubiak, Christine; de Andres-Trelles, Fernando; Kuchinke, Wolfgang; Huemer, Karl-Heinz; Thirstrup, Steffen; Whitfield, Kate; Libersa, Christian; Barraud, Béatrice; Grählert, Xina; Dreier, Gabriele; Grychtol, Ruth; Temesvari, Zsuzsa; Blasko, Gyorgy; Kardos, Gabriella; O'Brien, Timothy; Cooney, Margaret; Gaynor, Siobhan; Schieppati, Arrigo; Sanz, Nuria; Hernandez, Raquel; Asker-Hagelberg, Charlotte; Johansson, Hanna; Bourne, Sue; Byrne, Jane; Asghar, Adeeba; Husson, Jean-Marc; Gluud, Christian; Demotes-Mainard, Jacques

    2009-10-16

    Thorough knowledge of the regulatory requirements is a challenging prerequisite for conducting multinational clinical studies in Europe given their complexity and heterogeneity in regulation and perception across the EU member states. In order to summarise the current situation in relation to the wide spectrum of clinical research, the European Clinical Research Infrastructures Network (ECRIN) developed a multinational survey in ten European countries. However a lack of common classification framework for major categories of clinical research was identified, and therefore reaching an agreement on a common classification was the initial step in the development of the survey. The ECRIN transnational working group on regulation, composed of experts in the field of clinical research from ten European countries, defined seven major categories of clinical research that seem relevant from both the regulatory and the scientific points of view, and correspond to congruent definitions in all countries: clinical trials on medicinal products; clinical trials on medical devices; other therapeutic trials (including surgery trials, transplantation trials, transfusion trials, trials with cell therapy, etc.); diagnostic studies; clinical research on nutrition; other interventional clinical research (including trials in complementary and alternative medicine, trials with collection of blood or tissue samples, physiology studies, etc.); and epidemiology studies. Our classification was essential to develop a survey focused on protocol submission to ethics committees and competent authorities, procedures for amendments, requirements for sponsor and insurance, and adverse event reporting following five main phases: drafting, consensus, data collection, validation, and finalising. The list of clinical research categories as used for the survey could serve as a contribution to the, much needed, task of harmonisation and simplification of the regulatory requirements for clinical research

  3. Common definition for categories of clinical research: a prerequisite for a survey on regulatory requirements by the European Clinical Research Infrastructures Network (ECRIN)

    LENUS (Irish Health Repository)

    Kubiak, Christine

    2009-10-16

    Abstract Background Thorough knowledge of the regulatory requirements is a challenging prerequisite for conducting multinational clinical studies in Europe given their complexity and heterogeneity in regulation and perception across the EU member states. Methods In order to summarise the current situation in relation to the wide spectrum of clinical research, the European Clinical Research Infrastructures Network (ECRIN) developed a multinational survey in ten European countries. However a lack of common classification framework for major categories of clinical research was identified, and therefore reaching an agreement on a common classification was the initial step in the development of the survey. Results The ECRIN transnational working group on regulation, composed of experts in the field of clinical research from ten European countries, defined seven major categories of clinical research that seem relevant from both the regulatory and the scientific points of view, and correspond to congruent definitions in all countries: clinical trials on medicinal products; clinical trials on medical devices; other therapeutic trials (including surgery trials, transplantation trials, transfusion trials, trials with cell therapy, etc.); diagnostic studies; clinical research on nutrition; other interventional clinical research (including trials in complementary and alternative medicine, trials with collection of blood or tissue samples, physiology studies, etc.); and epidemiology studies. Our classification was essential to develop a survey focused on protocol submission to ethics committees and competent authorities, procedures for amendments, requirements for sponsor and insurance, and adverse event reporting following five main phases: drafting, consensus, data collection, validation, and finalising. Conclusion The list of clinical research categories as used for the survey could serve as a contribution to the, much needed, task of harmonisation and simplification of the

  4. A meta-study investigating the sources of protest behaviour in stated preference surveys

    DEFF Research Database (Denmark)

    Mørkbak, Morten Raun; Olsen, Søren Bøye; Meyerhoff, Jürgen

      It is well known that some percentage of respondents participating in Stated Preference surveys will not give responses which reflect their true preferences. One reason is protest behaviour. If the distribution of protest responses is not independent of respondent demographics, the elicitation...... method, the question format, etc., then simply expelling protesters from surveys will lead to sample selection issues. Furthermore, WTP estimates will not be comparable across surveys. This paper seeks to explore potential causes of protest behaviour through a meta-study based on data from 10 different...... surveys. The objective of the study is to examine the effect of respondent specific variables as well as survey specific variables on protest behaviour. Our results suggest that some of the differences in WTP typically observed between different demographic groups, different elicitation formats...

  5. [Possibilities and problems in the development of forensic nursing in Japan: a questionnaire survey of clinical nurses].

    Science.gov (United States)

    Kodama, Hiromi; Tsuntematsu, Kayoko; Yanai, Keiko

    2012-09-01

    Forensic nursing scientifically obtains and preserves the criminal damage from victims of domestic violence, child abuse, elder abuse, sexual violence and other related forms of violence. This was developed in North America in the 1980s, and has carried out appropriate nursing care while protecting the human rights of victims. Serious crime in Japan has been increasing, and it would seem that forensic nursing opportunities should expand as well. However, in Japan, there hasn't been much discussion about forensic nursing. Theorizing that support for clinical forensic nursing should be recognized and relevant, we carried out a survey of 581 clinical nurses to investigate the development of forensic nursing in Japan. 93 clinical nurses (16.0%) had a low level of familiarity with forensic nursing; however, 324 nurses (56.3%) had encountered patients who had suffered violence. 264 nurses (45.4%) had a feeling of wanting to be involved in forensic nursing, but were not confident with the knowledge and technology, while 144 nurses (24.8%) were concerned about the larger responsibility they would have. 400 nurses (68.8%) hoped to receive specialized knowledge and technical education. It is necessary to establish an education system for forensic nursing in accordance with the educational status-quo while considering the present state of forensic nursing education.

  6. Measuring Disability in Population Based Surveys: The Interrelationship between Clinical Impairments and Reported Functional Limitations in Cameroon and India.

    Directory of Open Access Journals (Sweden)

    Islay Mactaggart

    Full Text Available To investigate the relationship between two distinct measures of disability: self-reported functional limitations and objectively-screened clinical impairments.We undertook an all age population-based survey of disability in two areas: North-West Cameroon (August/October 2013 and Telangana State, India (Feb/April 2014. Participants were selected for inclusion via two-stage cluster randomised sampling (probability proportionate to size cluster selection and compact segment sampling within clusters. Disability was defined as the presence of self-reported functional limitations across eight domains, or presence of moderate or greater clinical impairments. Clinical impairment screening comprised of visual acuity testing for vision impairment, pure tone audiometry for hearing impairment, musculoskeletal functioning assessment for musculoskeletal impairment, reported seizure history for epilepsy and reported symptoms of clinical depression (depression adults only. Information was collected using structured questionnaires, observations and examinations.Self-reported disability prevalence was 5.9% (95% CI 4.7-7.4 and 7.5% (5.9-9.4 in Cameroon and India respectively. The prevalence of moderate or greater clinical impairments in the same populations were 8.4% (7.5-9.4 in Cameroon and 10.5% (9.4-11.7 in India. Overall disability prevalence (self-report and/or screened positive to a moderate or greater clinical impairment was 10.5% in Cameroon and 12.2% in India, with limited overlap between the sub-populations identified using the two types of tools. 33% of participants in Cameroon identified to have a disability, and 45% in India, both reported functional limitations and screened positive to objectively-screened impairments, whilst the remainder were identified via one or other tool only. A large proportion of people with moderate or severe clinical impairments did not self-report functional difficulties despite reporting participation restrictions

  7. Measuring Disability in Population Based Surveys: The Interrelationship between Clinical Impairments and Reported Functional Limitations in Cameroon and India.

    Science.gov (United States)

    Mactaggart, Islay; Kuper, Hannah; Murthy, G V S; Oye, Joseph; Polack, Sarah

    2016-01-01

    To investigate the relationship between two distinct measures of disability: self-reported functional limitations and objectively-screened clinical impairments. We undertook an all age population-based survey of disability in two areas: North-West Cameroon (August/October 2013) and Telangana State, India (Feb/April 2014). Participants were selected for inclusion via two-stage cluster randomised sampling (probability proportionate to size cluster selection and compact segment sampling within clusters). Disability was defined as the presence of self-reported functional limitations across eight domains, or presence of moderate or greater clinical impairments. Clinical impairment screening comprised of visual acuity testing for vision impairment, pure tone audiometry for hearing impairment, musculoskeletal functioning assessment for musculoskeletal impairment, reported seizure history for epilepsy and reported symptoms of clinical depression (depression adults only). Information was collected using structured questionnaires, observations and examinations. Self-reported disability prevalence was 5.9% (95% CI 4.7-7.4) and 7.5% (5.9-9.4) in Cameroon and India respectively. The prevalence of moderate or greater clinical impairments in the same populations were 8.4% (7.5-9.4) in Cameroon and 10.5% (9.4-11.7) in India. Overall disability prevalence (self-report and/or screened positive to a moderate or greater clinical impairment) was 10.5% in Cameroon and 12.2% in India, with limited overlap between the sub-populations identified using the two types of tools. 33% of participants in Cameroon identified to have a disability, and 45% in India, both reported functional limitations and screened positive to objectively-screened impairments, whilst the remainder were identified via one or other tool only. A large proportion of people with moderate or severe clinical impairments did not self-report functional difficulties despite reporting participation restrictions. Tools to

  8. Guidelines in primary care: an investigation of general practitioners’ attitudes and behaviour towards clinical guidelines

    OpenAIRE

    Siriwardena, Niro

    1995-01-01

    Background. Little is known about the attitudes and behaviour of British general practitioners towards clinical guidelines. Aim. To investigate the beliefs, attitudes and behaviour of general practitioners towards clinical guidelines. Method. A postal questionnaire sent to all 326 general practitioner principals on the list of Lincolnshire Family Health Services Authority in 1994. Results. Of the 326 general practitioners sent questionnaires 213 (65.3%) replied. Most respondents (78....

  9. Clinical practice of acute respiratory distress syndrome in Japan: A nationwide survey and scientific evidences.

    Science.gov (United States)

    Tasaka, Sadatomo; Tatsumi, Koichiro

    2017-07-01

    There has been limited information about epidemiology and clinical practice of acute respiratory distress syndrome (ARDS) in Japan. An invitation letter to the web-based survey was mailed to all 871 board certified hospitals of the Japanese Respiratory Society. The questionnaires were designed to collect data on epidemiology and clinical practice of ARDS, including diagnostic measures and therapeutics. Within 4 months of the survey period, valid responses were obtained from 296 (34%) hospitals. The incidence of ARDS was estimated to be 3.13 cases/100 hospital beds or 1.91 cases/ICU bed per year. The most frequent underlying disease was pneumonia (34%), followed by sepsis (29%). In hospitals with fewer ICU beds, pulmonologists tended to be in charge of management of ARDS patients. Routine diagnostic measures included computed tomography of the chest (69.6% of the hospitals) and Swan-Ganz catheterization was rarely performed for diagnosis. In 87.4% of the hospitals, non-invasive ventilation was applied to management of ARDS patients, especially those with mild disease. Prone positioning and extracorporeal membrane oxygenation (ECMO) for ARDS patients was more widely adopted in hospitals with larger numbers of ICU beds and intensivists. In 58.2% of the responding hospitals, corticosteroid was considered as a treatment option for ARDS, among which pulse therapy was routinely introduced to ARDS patients in 35.4%. The incidence of ARDS in Japan was estimated to be lower than that in the recent international study. The scale and equipment of hospitals and the number of intensivists might influence clinical practice of ARDS. Copyright © 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  10. A 2013 survey of clinical practice patterns in the management of primary hypothyroidism.

    Science.gov (United States)

    Burch, Henry B; Burman, Kenneth D; Cooper, David S; Hennessey, James V

    2014-06-01

    In 2012, comprehensive clinical practice guidelines (CPGs) were published regarding the management of hypothyroidism. We sought to document current practices in the management of primary hypothyroidism and compare these results with recommendations made in the 2012 American Thyroid Association (ATA)/American Association of Clinical Endocrinologists (AACE) hypothyroidism CPGs. In addition, we sought to examine differences in management among international members of U.S.-based endocrine societies and to compare survey results with those obtained from a survey of ATA members performed 12 years earlier. Clinical members of The Endocrine Society (TES), the ATA, and the AACE were asked to take a web-based survey consisting of 30 questions dealing with testing, treatment, and modulating factors in the management of primary hypothyroidism. In total, 880 respondents completed the survey, including 618 members of TES, 582 AACE members, and 208 ATA members. North American respondents accounted for 67.6%, Latin American 9.7%, European 9.2%, Asia and Oceania 8.1%, and Africa and Middle East 5.5%. Overt hypothyroidism would be treated using l-T4 alone by 99.2% of respondents; 0.8% would use combination l-T4 and liothyronine (l-T3) therapy. Generic l-T4 would be used by 49.3% and a brand name by 49.9%. The rate of replacement would be gradual (38.5%); an empiric dose, adjusted to achieve target (33.6%); or a calculated full replacement dose (27.8%). A target TSH of 1.0 to 1.9 mU/L was favored in the index case, but 3.0 to 3.9 mU/L was the most commonly selected TSH target for an octogenarian. Persistent hypothyroid symptoms despite achieving a target TSH would prompt testing for other causes by 84.3% of respondents, a referral to primary care by 11.3%, and a change to l-T4 plus l-T3 therapy by 3.6%. Evaluation of persistent symptoms would include measurement of T3 levels by 21.9% of respondents. Subclinical disease with a TSH 5.0 to 10.0 mU/L would be treated without further

  11. SURVEY

    DEFF Research Database (Denmark)

    SURVEY er en udbredt metode og benyttes inden for bl.a. samfundsvidenskab, humaniora, psykologi og sundhedsforskning. Også uden for forskningsverdenen er der mange organisationer som f.eks. konsulentfirmaer og offentlige institutioner samt marketingsafdelinger i private virksomheder, der arbejder...

  12. The survey of clinical human experimentation research in ethical review of postgraduates students.

    Science.gov (United States)

    Xu, Yifan; Zhu, Zheng; Wang, Liyu

    2012-06-01

    An anonymous questionnaire was used to investigate the status quo of ethics review of human subject experiments among postgraduate students in clinical practice with the main conclusions as follows: Human subject experiments make up a large ratio of clinical research; the construction of an ethics review has been initially formulated, but there exists a gap in ethics awareness between advisors and the postgraduates with the desperate need to receive ethics review. It is necessary to realize the importance of informed consent and to strengthen the strict supervision of placebo application.

  13. The Etiology and Clinical Features of Anaphylaxis in a developing country: A nationwide survey in Turkey.

    Science.gov (United States)

    Civelek, Ersoy; Erkoçoğlu, Mustafa; Akan, Ayşegül; Özcan, Celal; Kaya, Ayşenur; Vezir, Emine; Giniş, Tayfur; Azkur, Dilek; Toyran, Müge; Tokaç, Mahmut; Kocabaş, Can Naci

    2017-12-01

    Despite the increasing frequency of anaphylaxis, there is inadequate information on the etiology and clinical features in various countries, regions and age groups, especially in developing countries. Our aim is to assess the etiology and clinical findings of anaphylaxis in Turkey. Gathering reliable data about the etiology and clinical findings of anaphylaxis in the general population will decrease the related morbidity and mortality. We obtained the names and phone numbers of individuals who had been prescribed an epinephrine auto-injector with a diagnosis of anaphylaxis from ministry of health. Demographic data, clinical history of the first episode of anaphylaxis including the triggering agent, clinical findings, course of hospitalization, and the management of anaphylaxis were obtained by phone survey. A total of 843 patients with a mean age of 21.4±17.3 years were evaluated. There was a significant male predominance among children younger than 10 years of age but a female predominance in older subjects. The most common causes of anaphylaxis were foods(40.1%) in children and bee venom(60.8%) in adults. The biphasic reaction rate was 4.3% and the median length of stay at an emergency department was 4.0 hours. Almost 60% of the patients had recurrent anaphylaxis episodes. Only 10.7% of the cases were prescribed an epinephrine auto-injector at their first anaphylaxis episode and only 59.2% of the patients were referred to an allergist during discharge from the emergency department. In Turkey, bee venom was the most common cause of anaphylaxis, followed by food and drug. While more than a half of patients reported recurrent attacks; only 10% had been prescribed epinephrine auto-injector kit after their first episode. Strategies to improve the anaphyalxis management are therefore urgently required.

  14. The clinical practice of CPCR in small animals: an internet-based survey.

    Science.gov (United States)

    Boller, Manuel; Kellett-Gregory, Lindsay; Shofer, Frances S; Rishniw, Mark

    2010-12-01

    To characterize the provision of CPCR by small animal veterinarians in clinical practice and to assess how this practice varies among different levels of expertise. Internet-based survey. Academia, referral practice, and general practice. Six hundred and two small animal veterinarians in clinical practice. Respondents were grouped a priori according to level of expertise: board-certified (ACVECC, ACVA, ECVAA) specialists; general practitioners in emergency clinics; general practitioners in general practice (GPG). Email invitations to the online questionnaire were disseminated via a veterinary internet platform and mailing list server discussion groups. Questions explored respondent characteristics, CPCR preparedness, infrastructural and personnel resources, and techniques of basic and advanced life support. In this group of practitioners, the majority (65%) were in general practice. GPG were more likely to perform CPCR small animal veterinary medicine; differences exist, both among and within different types of veterinarians with varying levels of expertise, in respect to available infrastructure, personnel and CPCR techniques used. © Veterinary Emergency and Critical Care Society 2010.

  15. THE FLORENCE BAPTISTERY: 3-D SURVEY AS A KNOWLEDGE TOOL FOR HISTORICAL AND STRUCTURAL INVESTIGATIONS

    Directory of Open Access Journals (Sweden)

    G. Tucci

    2016-06-01

    Then, it describes the new survey campaign, illustrating the approach followed in the planning, data acquisition and data elaboration phases; finally, it gives examples of some interpretations of the structure stemming from the new acquisitions.

  16. Inability of positive phase II clinical trials of investigational treatments to subsequently predict positive phase III clinical trials in glioblastoma.

    Science.gov (United States)

    Mandel, Jacob J; Yust-Katz, Shlomit; Patel, Akash J; Cachia, David; Liu, Diane; Park, Minjeong; Yuan, Ying; Kent, Thomas A; de Groot, John F

    2018-01-10

    Glioblastoma is the most common primary malignant brain tumor in adults, but effective therapies are lacking. With the scarcity of positive phase III trials, which are increasing in cost, we examined the ability of positive phase II trials to predict statistically significant improvement in clinical outcomes of phase III trials. A PubMed search was conducted to identify phase III clinical trials performed in the past 25 years for patients with newly diagnosed or recurrent glioblastoma. Trials were excluded if they did not examine an investigational chemotherapy or agent, if they were stopped early owing to toxicity, if they lacked prior phase II studies, or if a prior phase II study was negative. Seven phase III clinical trials in newly diagnosed glioblastoma and 4 phase III clinical trials in recurrent glioblastoma met the inclusion criteria. Only 1 (9%) phase III study documented an improvement in overall survival and changed the standard of care. The high failure rate of phase III trials demonstrates the urgent need to increase the reliability of phase II trials of treatments for glioblastoma. Strategies such as the use of adaptive trial designs, Bayesian statistics, biomarkers, volumetric imaging, and mathematical modeling warrant testing. Additionally, it is critical to increase our expectations of phase II trials so that positive findings increase the probability that a phase III trial will be successful.

  17. An investigation of the roles and functions of nurse preceptors in the clinical areas

    Directory of Open Access Journals (Sweden)

    S.C. Cele

    2002-09-01

    Full Text Available This article explores the confusion that exists in the clinical areas concerning proper accompaniment of student nurses. There is a feeling that professional nurses in clinical areas are not always actively involved in clinical teaching. The clinical instructors and nurse educators are unable to accompany student nurses properly because of staff shortages. Some hospitals have identified one professional nurse per unit to work as a nurse preceptor for accompaniment of student nurses. This has resulted in the need to find out if the professional nurse preceptor is solving the problem of lack of student accompaniment in clinical areas. The aim of this study therefore is to investigate the roles and functions of nurse preceptors in improving student accompaniment as compared to other professional nurses in clinical areas namely, clinical instructors, nurse educators and professional nurses working in clinical areas as viewed by student nurses themselves. A comparative descriptive study was done in one of the hospitals in KwaZulu-Natal (Region D on a purposely selected sample of (80 4 years comprehensive diploma student nurses, (16 nurse preceptors and (40 randomly-selected professional nurses. Open and closed-ended questions were used for collection of data. The study revealed that the most student nurses 87,5% (70 identified nurse preceptors as playing an important role in their accompaniment as compared to other professional nurses.

  18. What are the main inefficiencies in trial conduct: a survey of UKCRC registered clinical trials units in the UK.

    Science.gov (United States)

    Duley, Lelia; Gillman, Alexa; Duggan, Marian; Belson, Stephanie; Knox, Jill; McDonald, Alison; Rawcliffe, Charlotte; Simon, Joanne; Sprosen, Tim; Watson, Jude; Wood, Wendy

    2018-01-08

    The UK Clinical Research Collaboration (UKCRC) registered Clinical Trials Units (CTUs) Network aims to support high-quality, efficient and sustainable clinical trials research in the UK. To better understand the challenges in efficient trial conduct, and to help prioritise tackling these challenges, we surveyed CTU staff. The aim was to identify important inefficiencies during two key stages of the trial conduct life cycle: (i) from grant award to first participant, (ii) from first participant to reporting of final results. Respondents were asked to list their top three inefficiencies from grant award to recruitment of the first participant, and from recruitment of the first participant to publication of results. Free text space allowed respondents to explain why they thought these were important. The survey was constructed using SurveyMonkey and circulated to the 45 registered CTUs in May 2013. Respondents were asked to name their unit and job title, but were otherwise anonymous. Free-text responses were coded into broad categories. There were 43 respondents from 25 CTUs. The top inefficiency between grant award and recruitment of first participant was reported as obtaining research and development (R&D) approvals by 23 respondents (53%), contracts by 22 (51%), and other approvals by 13 (30%). The top inefficiency from recruitment of first participant to publication of results was failure to meet recruitment targets, reported by 19 (44%) respondents. A common comment was that this reflected overoptimistic or inaccurate estimates of recruitment at site. Data management, including case report form design and delays in resolving data queries with sites, was reported as an important inefficiency by 11 (26%) respondents, and preparation and submission for publication by 9 (21%). Recommendations for improving the efficiency of trial conduct within the CTUs network include: further reducing unnecessary bureaucracy in approvals and contracting; improving training for site

  19. Naa Technique for Clinical Investigation of Mice Immunized with BOTHROP Venom

    Science.gov (United States)

    Zamboni, C. B.; Aguiar, R. O.; Kovacs, L.; Suzuki, M.; Sant'Anna, O. A.

    2009-06-01

    In the present study Neutron Activation Analysis (NAA) technique was used to determine sodium concentration in whole blood of mice immunized with Bothrops venom. With this value it was possible to perform clinical investigation in this animal model using whole blood.

  20. Template protocol for clinical trials investigating vaccines—Focus on safety elements☆

    Science.gov (United States)

    Bonhoeffer, Jan; Imoukhuede, Egeruan B.; Aldrovandi, Grace; Bachtiar, Novilia S.; Chan, Eng-Soon; Chang, Soju; Chen, Robert T.; Fernandopulle, Rohini; Goldenthal, Karen L.; Heffelfinger, James D.; Hossain, Shah; Jevaji, Indira; Khamesipour, Ali; Kochhar, Sonali; Makhene, Mamodikoe; Malkin, Elissa; Nalin, David; Prevots, Rebecca; Ramasamy, Ranjan; Sellers, Sarah; Vekemans, Johan; Walker, Kenneth B.; Wilson, Pam; Wong, Virginia; Zaman, Khalequz; Heininger, Ulrich

    2015-01-01

    This document is intended as a guide to the protocol development for trials of prophylactic vaccines. The template may serve phases I–IV clinical trials protocol development to include safety relevant information as required by the regulatory authorities and as deemed useful by the investigators. This document may also be helpful for future site strengthening efforts. PMID:23499603

  1. Template protocol for clinical trials investigating vaccines Focus on safety elements

    OpenAIRE

    Bonhoeffer, Jan; Imoukhuede, Egeruan B; Aldrovandi, Grace; Bachtiar, Novilia S.; Chan, Eng-Soon; Chang, Soju; Chen, Robert T.; Fernandopulle, Rohini; Goldenthal, Karen L.; Heffelfinger, James D.; Hossain, Shah; Jevaji, Indira; Khamesipour, Ali; Kochhar, Sonali; Makhene, Mamodikoe

    2013-01-01

    This document is intended as a guide to the protocol development for trials of prophylactic vaccines. The template may serve phases I–IV clinical trials protocol development to include safety relevant information as required by the regulatory authorities and as deemed useful by the investigators. This document may also be helpful for future site strengthening efforts.

  2. Investigator and site selection and performing GCP clinical studies in India.

    Science.gov (United States)

    Maggon, Krishan

    2004-08-01

    The optimum site and investigator selection process remains a closely guarded confidential matter and an essential part of development expertise of big pharmaceutical companies and CROs. The right and careful selection and evaluation of investigators and site is critical for successful completion of the trial within budget, timelines and generation of high quality data. The criteria for site and investigator selection in India for Good Clinical Practices (GCP) clinical trials are described for a start up company/CRO and can be applied to any country in Asia and Africa. Foreign sponsors doing clinical studies in India should pay close attention to site and investigator selection. The first GCP study in India was done only in 1995. At the dawn of 21st century, India is at the take off stage in clinical trials now. GCP studies can be done in India, as the quality of data is good, costs are lower and patient enrolment is much faster resulting in early completion of studies.

  3. An academic writing needs assessment of English-as-a-second-language clinical investigators.

    Science.gov (United States)

    Wang, Min-Fen; Bakken, Lori L

    2004-01-01

    Academic writing for publication is competitive and demanding for researchers. For the novice English-as-a-second-language (ESL) researcher, the pressure to publish compounds the difficulties of mastering the English language. Very few studies have used ESL graduate and post-graduate students as academic writing research subjects. The purpose of this project was to assess the learning needs of ESL clinical investigators regarding academic writing for English scholarly publication. A qualitative evaluation approach was used to examine the gap between the current and desired proficiency level for the academic writing of ESL clinical investigators. We considered the perspectives of seven ESL clinical investigators plus three mentors and three writing instructors. Semi-structured questions were asked. Field notes were organized using a field-work recording system. They were analyzed using the constant comparative method. ESL clinical investigators do not accurately perceive their writing deficiencies. They have little knowledge of criteria for academic writing and they are influenced by their prior English learning experiences in their home culture, which engender passive attitudes toward seeking appropriate writing resources. Adequate time is especially needed to develop successful writing skills. Four basic steps are recommended to guide program planners in developing ESL writing activities for professional learning: (1) recognize discrepancies, (2) establish clear standards and performance criteria for scholarly writing, (3) develop individual plans, and (4) organize long-term writing assistance.

  4. 78 FR 57395 - Guidance for Industry on Electronic Source Data in Clinical Investigations; Availability

    Science.gov (United States)

    2013-09-18

    ... HUMAN SERVICES Food and Drug Administration Guidance for Industry on Electronic Source Data in Clinical Investigations; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing the availability of a guidance for industry entitled...

  5. 77 FR 76049 - Draft Guidance for Industry on Electronic Source Data in Clinical Investigations; Correction

    Science.gov (United States)

    2012-12-26

    ... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry on Electronic Source Data in Clinical Investigations; Correction AGENCY: Food and Drug Administration, HHS. ACTION: Notice; correction. ] SUMMARY: The Food and Drug Administration (FDA) is correcting a notice that appeared in the Federal...

  6. The Mallory body: morphological, clinical and experimental studies (Part 1 of a literature survey)

    DEFF Research Database (Denmark)

    Jensen, K; Gluud, C

    1994-01-01

    suggest a hit-and-run effect of alcohol, whereas other chronic liver diseases show evidence of gradual increase in prevalence of Mallory bodies with severity of hepatic pathology. Mallory bodies in cirrhosis do not imply alcoholic pathogenesis. Obesity, however, is associated with alcoholism and diabetes......, and Mallory bodies are only present in diabetic patients if alcoholism or obesity complicates the condition. In addition, case studies on diseases in which Mallory bodies have been identified, along with pharmacological side effects and experimental induction of Mallory bodies by various antimitotic......To aid understanding of markers of disease and predictors of outcome in alcohol-exposed systems, we undertook a literature survey of more than 700 articles to view the morphological characteristics and the clinical and experimental epidemiology of the Mallory body. Mallory bodies are filaments...

  7. A new gelatine-based hemostat for sinonasal surgery: a clinical survey.

    Science.gov (United States)

    Hildenbrand, Tanja

    2013-01-01

    To ensure more effective hemostasis in surgical procedures, a novel sponge of pharmaceutical-grade chemically cross-linked gelatine, characterized by a high pore density, reduced ligaments and a high nanoscale roughness of the surface has been developed. A questionnaire-based survey was carried out at seven ENT centers in Germany to collect clinical data. A total of 62 patients undergoing nasal and sinus surgery were treated with the new product to test its efficacy as a hemostat, its absorptive capacity, its handling in general, and its subsequent biodegradation. In summary, performance regarding the above parameters was very good. No adverse events were observed. The major advantages of this sponge in comparison with other available products were fast hemostasis and that there was no need for removal of the dressing because of its biodegradation.

  8. Help-seeking behavior for erectile dysfunction: a clinic-based survey in China

    Directory of Open Access Journals (Sweden)

    Kai Zhang

    2014-02-01

    Full Text Available The behavior of Chinese patients seeking help for erectile dysfunction (ED has not been described in detail. This was an observational study conducted using an outpatient clinic-based questionnaire survey of ED patients. From 2008 to 2009, physicians in 10 medical centers in China enrolled 2693 men (aged 25-70 years diagnosed with ED. The diagnosis was based on the International Index of Erectile Function 5 (IIEF-5 Questionnaire. The men completed a survey that asked questions about demographics, marital status, education level and household income as well as help-seeking behavior and awareness of medical therapy. The mean age of the 2693 men was 43.4 ± 5.3 years; 73% were <50-years-old and 49% had a high household income. The mean time between noticing ED and taking the first treatment was 4.3 ± 2.1 months. Of the 2577 respondents, physicians (54% and the internet (52% were most frequently consulted sources for information about ED. Young ED patients preferred using the internet and older patients preferred consulting with physicians. Western medicine (19% and traditional Chinese medicine (16% were most frequently used for treatment. Young ED patients preferred to first search the internet for information, whereas older patients first asked physicians for help. Side effects of treatment were the greatest concern, especially for older patients. Physicians and the internet are frequently consulted for ED information and therapy. On the basis of these survey results, we believe that physicians in China should enhance health education about ED, especially via the internet.

  9. National survey of China's oncologists' knowledge, attitudes, and clinical practice patterns on complementary and alternative medicine.

    Science.gov (United States)

    Yang, Geliang; Lee, Richard; Zhang, Huiqing; Gu, Wei; Yang, Peiying; Ling, Changquan

    2017-02-21

    It is common for cancer patients to use complementary and alternative medicine (CAM). This study was designed to explore China's oncologists' knowledge, attitudes and clinical practices regarding CAM use by their patients. An online survey was conducted of China's oncologists. Among 11,270 participants who completed the online survey, 6,007 (53.3%) were identified as oncologists. Most were men (75.2%), with a mean age of 33.4 (standard deviation: 6.5) years. The 6,007 oncologists discussed with 36.5% of their patients about CAM. Most of them (75.6%) did not want to initiate discussions due to lack of knowledge on CAM. Oncologists estimated that 40.0% of their patients used CAM treatments. Oncologists reported that 28.7% of their patients underwent anticancer therapy with the concurrent use of CAM. Four out of five of the responding oncologists self-reported inadequate knowledge and only 22.0% reported receiving professional education on CAM. Nearly half (44.9%) of the oncologists believed CAM treatment was effective for symptoms and treatment of cancer. Physician factors associated with initiating discussions with patients about CAM use included sex, age (≥ 33 years), medical license for traditional Chinese medicine, enough knowledge and professional education experience. China's oncologists infrequently discussed with their patients about CAM due to lack of knowledge. Most of the oncologists did not encourage CAM use.

  10. Chikungunya fever: a clinical and virological investigation of outpatients on Reunion Island, South-West Indian Ocean.

    Science.gov (United States)

    Thiberville, Simon-Djamel; Boisson, Veronique; Gaudart, Jean; Simon, Fabrice; Flahault, Antoine; de Lamballerie, Xavier

    2013-01-01

    Chikungunya virus (CHIKV) is responsible for acute febrile polyarthralgia and, in a proportion of cases, severe complications including chronic arthritis. CHIKV has spread recently in East Africa, South-West Indian Ocean, South-Asia and autochthonous cases have been reported in Europe. Although almost all patients are outpatients, medical investigations mainly focused on hospitalised patients. Here, we detail clinico-biological characteristics of Chikungunya (CHIK) outpatients in Reunion Island (2006). 76 outpatients with febrile arthralgia diagnosed within less than 48 hours were included by general practitioners during the CuraChik clinical trial. CHIK was confirmed in 54 patients and excluded in 22. A detailed clinical and biological follow-up was organised, that included analysis of viral intrahost diversity and telephone survey until day 300. The evolution of acute CHIK included 2 stages: the 'viral stage' (day 1-day 4) was associated with rapid decrease of viraemia and improvement of clinical presentation; the 'convalescent stage' (day 5-day 14) was associated with no detectable viraemia but a slower clinical improvement. Women and elderly had a significantly higher number of arthralgia at inclusion and at day 300. Based on the study clinico-biological dataset, scores for CHIK diagnosis in patients with recent febrile acute polyarthralgia were elaborated using arthralgia on hands and wrists, a minor or absent myalgia and the presence of lymphopenia (<1G/L) as major orientation criteria. Finally, we observed that CHIKV intra-host genetic diversity increased over time and that a higher viral amino-acid complexity at the acute stage was associated with increased number of arthralgia and intensity of sequelae at day 300. This study provided a detailed picture of clinico-biological CHIK evolution at the acute phase of the disease, allowed the elaboration of scores to assist CHIK diagnosis and investigated for the first time the impact of viral intra-host genetic

  11. The statistical investigation of the First and Second Byurakan survey galaxies and their neighbors

    Science.gov (United States)

    Nazaryan, Tigran A.

    2014-05-01

    In the thesis we study close pairs of galaxies with the aim of understanding the influence of gravitational interaction on nuclear activity and star formation of paired galaxies. For this purpose we investigate dependences of integral parameters of galaxies, their star formation and properties of nuclei on kinematic parameters of systems and their large-scale environment. The thesis has an introduction, three main chapters, a summary, lists of abbreviations and references, and three appendices. In the first chapter, the methods of selection of sample of pairs of galaxies and measurements of physical parameters of the First Byurakan Survey (Markarian) galaxies and their neighbors are presented, and the databases in appendices A and B are described, which contain parameters of neighbors of Markarian galaxies measured by us, and the parameters of pairs having Markarian galaxies, based on the Sloan Digital Sky Survey (SDSS) data. The selection effects of sample of pairs are discussed, and the statistical comparison of Markarian galaxies and their neighbors is done. The results of statistical study of star formation and activity of nuclei in pairs having Markarian galaxies are presented, as well as the correlations between properties of galaxies in pairs and the physical mechanisms behind them. In the second chapter, the results of statistical study of the Second Byurakan Survey (SBS) galaxies and their neighbors, and star formation and activity of nuclei in those pairs are presented and discussed. In the third chapter, possibilities of using supernovae as indicators of star formation are discussed, the sample of supernovae in pairs of galaxies is presented, and study of star formation in pairs of interacting galaxies by means of that sample of supernovae is done. Also а conclusion about the nature of progenitors of different types of supernovae is made. The short summary of main results of the study concludes the thesis. The thesis has 158 pages. The main results

  12. Investigation Clinical Competence and Its Relationship with Professional Ethics and Spiritual Health in Nurses

    Directory of Open Access Journals (Sweden)

    Elahe Ramezanzade Tabriz

    2017-03-01

    Full Text Available Abstract Background and Objectives: Study of clinical competence in nursing helps determine the quality of health care delivered to patients. Given the priority of observance of principles over caretaking and necessity of spirituality existence at the core of health care provision, this study was conducted to investigate clinical competence and its relationship with professional ethics and spiritual health in nurses. Methods: In this cross-sectional, descriptive, and correlational study, 281 nurses were enrolled by consensus sampling. Sampling was conducted from February, 2016 till June, 2016. The data were gathered by a demographics questionnaire, a self-assessment scale of clinical competence, a nursing ethics questionnaire, and a spiritual health questionnaire, and analyzed by descriptive statistics and t-test, Pearson's correlation coefficient, ANOVA, and linear regression analysis in SPSS 21. Results: The total scores for self-assessment scale of nurses' clinical competence, professional ethics, and spiritual health were moderate. In the light of the results of Spearman's correlation coefficient, there was a significant and positive correlation between clinical competence and spiritual health. Moreover, a significant positive correlation was observed between professional ethics and spiritual health but there was no correlation between professional ethics and clinical competence. Conclusion: Managers' and personnel's Knowledge about the level of nurses clinical competence, professional ethics, and spiritual health in teaching health care centers provides valuable information to develop in-service and efficacious education programs and ultimately to improve the quality of nursing services.

  13. Canonical Word Order of Japanese Ditransitive Sentences: A Preliminary Investigation through a Grammaticality Judgment Survey

    Directory of Open Access Journals (Sweden)

    Yasumasa Shigenaga

    2014-04-01

    Full Text Available There have been three competing analyses regarding the canonical word order of Japanese ditransitive sentences: a “S-ga IO-ni DO-o V” is the canonical word order rather than “S-ga DO-o IO-ni V”, b both word orders are canonical, and c the canonical word order depends on the type of the verb. The present study attempted to examine which of the three analyses might be most plausible through a grammaticality judgment survey. Twenty-seven native speakers of Japanese responded to a survey which consisted of three sections. While the data from one of the sections conformed to analysis a above, the results of the two other sections remained inconclusive. A future study with a larger number of items and more refined survey methods, along with more studies from structural and psycholinguistic perspectives, would be necessary to clarify the point.

  14. Factors Associated with Clinical Research Recruitment in a Pediatric Academic Medical Center--A Web-Based Survey

    National Research Council Canada - National Science Library

    Denhoff, Erica Rose; Milliren, Carly E; de Ferranti, Sarah D; Steltz, Sarah K; Osganian, Stavroula K

    2015-01-01

    .... Yet, this has been less well studied. We conducted a survey of investigators performing human subjects research in a single large academic pediatric hospital to better understand characteristics of studies with successful recruitment...

  15. Factors Associated with Clinical Research Recruitment in a Pediatric Academic Medical Center--A Web-Based Survey: e0140768

    National Research Council Canada - National Science Library

    Erica Rose Denhoff; Carly E Milliren; Sarah D de Ferranti; Sarah K Steltz; Stavroula K Osganian

    2015-01-01

    .... Yet, this has been less well studied. We conducted a survey of investigators performing human subjects research in a single large academic pediatric hospital to better understand characteristics of studies with successful recruitment...

  16. A survey on clinical and radiographic changes of pulpotomy using ferosulfate and formocresol in primary molars

    Directory of Open Access Journals (Sweden)

    Baradaran Nakhjavani Y.

    2004-07-01

    Full Text Available Statement of Problem: Pulpotomoy is considered as one of the most common treatments among primary teeth. Therefore, search for an appropriate and safe material seems necessary. Studies have proved ferosulfate as a therapeutic material in pulpotomy. Purpose: The goal of the present study was to compare clinical and radiographic changes of pulpotomy using ferosulfate and formocresol in primary molars among 3-8 year old children. Materials and Methods: In this clinical trial study, fifteen 3-8 years old children, referred to the pedodontics department, faculty of Dentistry, Tehran University of Medical Sciences were selected. All subjects did not show any systemic disease, with at least two clinically and radiographically accepted posterior teeth for pulpotomy technique. Totally, forty- three teeth were studied. For each patient both materials were used. Following treatment, patients were investigated, clinically and radiographically in 3, 6, 9 and 12 month follow-ups. During follow-up periods, teeth with failures were not excluded and investigated. For data analysis, Chi-square and Fisher’s-exact tests were used and treatment success was evaluated, based on clinical as well as radiographic findings. Results: In all follow-up periods (3, 6, 9 and 12 months after treatment, pulpotomies with formocresol showed more success rate (73.7% comparing to those with ferosulfate (70.8%, although the difference was not statistically significant (P>0.05. Statistical tests revealed no significant difference between two different treatment techniques regarding pain, external and internal resorption, calcified metamorphosis, abcess, apical root resorption, apical and interradicular radiolucency. Conclusion: Although ferosulfate, due to its less toxicity, may be considered as a proper substitute for formocresol in primary molars pulpotomies, more studies with longer-term follow up and larger sample size are required to determine its long-term effects.

  17. Using magnetic resonance imaging in diagnosing dementia: a Dutch outpatient memory clinics survey.

    Science.gov (United States)

    Boelaarts, Leo; Scheltens, Philip; de Jonghe, Jos

    2014-01-01

    In the Netherlands, dementia syndromes are diagnosed in specialized memory outpatient clinics (MC). Many radiologists are not trained to assess magnetic resonance imaging (MRI) scans with respect to possible radiological changes that may indicate neurodegenerative disease. This is a cross-sectional descriptive study. A survey was sent to all Dutch MC and included questions as to how MRI scans are assessed by radiologists and how these assessments are used in the diagnostic process. In most MC, radiologists report on typical Alzheimer pathology and large vessel disease. Small vessel disease and other anatomical changes signifying neurodegenerative disease frequently are not assessed. In the majority of MC, the radiological assessment is not standardized, and physicians assess MRI for themselves to use this information to discuss the consensus diagnosis subsequently. MRI assessment by radiologists in Dutch MC probably underestimates the presence of cerebrovascular and neurodegenerative disease. The validity of standardized assessment protocols in routine clinical practice deserves further study, as the implementation of standardization outside research settings could improve diagnostic accuracy.

  18. The perennial struggle to find clinical placement opportunities: a Canadian national survey.

    Science.gov (United States)

    Smith, Patricia M; Corso, Linda N; Cobb, Nancy

    2010-11-01

    Pre-licensure clinical placements are becoming increasingly difficult to obtain due to healthcare restructuring, workforce shortages, and increased student enrollment. This cross-sectional study was designed to nationally quantify the issues related to finding placements in this changing environment. A survey was developed based on the literature and key informant interviews, and a mailing list was developed to include clinical coordinators at all Canadian schools of nursing, licensed practical nursing, registered psychiatric nursing, midwifery, occupational therapy, physiotherapy, and medicine. The response rate was 70% (113/162). Results showed that although 87% (SD=13%) of placements were based on the previous year, 58% of the respondents reported difficulty finding a sufficient number of appropriate placements. The most frequent reasons for finding new placements were also the main reasons for the difficulty in finding sufficient appropriate placements-student requests, increased enrollment, and agency changes. Traditional methods for finding placements (historical use and faculty) remained the most common. Interagency/interschool collaborations, web-based registries, and innovations (such as schools developing their "own" placements) were evident but were still not the norm and used more by nursing than others. Given these results, it is suggested that consideration be given to expanding the repertoire of emerging and innovative methods for finding placements. Copyright © 2010 Elsevier Ltd. All rights reserved.

  19. National Ambulatory Medical Care Survey: tobacco intervention practices in outpatient clinics.

    Science.gov (United States)

    Payne, Thomas J; Chen, Chieh-I; Baker, Christine L; Shah, Sonali N; Pashos, Chris L; Boulanger, Luke

    2012-09-01

    Tobacco use remains the leading cause of preventable death. The outpatient medical clinic represents an important venue for delivering evidence-based interventions to large numbers of tobacco users. Extensive evidence supports the effectiveness of brief interventions. In a retrospective database analysis of 11,827 adult patients captured in the 2005 National Ambulatory Medical Care Survey (of which 2,420 were tobacco users), we examined the degree to which a variety of patient demographic, clinical and physician-related variables predict the delivery of tobacco counseling during a routine outpatient visit in primary care settings. In 2005, 21.7% of identified tobacco users received a tobacco intervention during their visit. The probability of receiving an intervention differed by gender, geographic region and source of payment. Individuals presenting with tobacco-related health conditions were more likely to receive an intervention. Most physicians classified as specialists were less likely to intervene. The provision of tobacco intervention services appears to be increasing at a modest rate, but remains well below desirable levels. It is a priority that brief interventions be routinely implemented to reduce the societal burden of tobacco use. PsycINFO Database Record (c) 2012 APA, all rights reserved.

  20. Investigation into the phenomenon of reduced household travel survey derived trip generation rates in Gauteng Province

    CSIR Research Space (South Africa)

    Nkosi, M

    2016-07-01

    Full Text Available such as reduced household size, increased unemployment and peak spreading are found to be present, it is the design of the survey instrument resulting in respondent fatigue that is found to be the main cause. In response, the paper provides some recommendations...

  1. Investigating Faculty Familiarity with Assessment Terminology by Applying Cluster Analysis to Interpret Survey Data

    Science.gov (United States)

    Raker, Jeffrey R.; Holme, Thomas A.

    2014-01-01

    A cluster analysis was conducted with a set of survey data on chemistry faculty familiarity with 13 assessment terms. Cluster groupings suggest a high, middle, and low overall familiarity with the terminology and an independent high and low familiarity with terms related to fundamental statistics. The six resultant clusters were found to be…

  2. A field survey to investigate why nightjars frequent roads at night ...

    African Journals Online (AJOL)

    All nightjar encounters were documented in relation to variations in road surface, road width, adjacent habitat, arc of sky visible and other variables, such as the time of night, moon phase and weather conditions. None of these factors provided a complete explanation for the presence of nightjars on the roads surveyed.

  3. The porphyrias: clinic, diagnostics, novel investigative tools and evolving molecular therapeutic strategies.

    Science.gov (United States)

    van Serooskerken, A-M van Tuyll; Poblete-Gutiérrez, P; Frank, J

    2010-01-01

    The porphyrias are clinically and genetically heterogeneous metabolic disorders resulting from a predominantly hereditary dysfunction of specific enzymes involved in heme biosynthesis. Today, the clinical, biochemical, and genetic characteristics of this fascinating group of diseases are well established. Recently, different in vitro and animal models have facilitated the investigation of etiopathologic mechanisms in the different types of porphyria and the development of causal treatment strategies such as pathway interference, enzyme replacement, and gene therapy. The continuous progress in basic science has made an invaluable contribution to the rapid translation of discoveries made in the laboratory into new diagnostics and therapeutics in the near future. 2010 S. Karger AG, Basel.

  4. Acute kidney injury burden in different clinical units: Data from nationwide survey in China

    Science.gov (United States)

    Yu, Shengqiang; Yang, Li; Mei, Changlin

    2017-01-01

    Background The inpatient morbidity and mortality of acute kidney injury (AKI) vary considerably in different clinical units, yet studies to compare the difference remain limited. Methods We compared the clinical characteristics of AKI in Intensive Care Unit (ICU), medical and surgical departments by using the data derived from the 2013 nationwide cross-sectional survey of AKI in China to capture variations among different clinical departments in recognition, management, and outcomes of AKI. Suspected AKI patients were identified based on changes in serum creatinine during hospitalization, and confirmed by reviewing medical records. Results The detection rate of AKI was the highest in ICU (22.46%), followed by the rates in medical (1.96%) and surgical departments (0.96%). However, the absolute number of cases was the largest in medical departments, which contributed to 50% of the cases. In medical departments, 78% of AKI cases were extensively distributed in cardiac, nephrology, oncology, gastroenterology, pneumology and neurology departments. In contrast, 87% of AKI cases in surgical departments were mainly from urology, general surgery and cardiothoracic departments. The in-time recognition rates were extremely low in all departments except nephrology. Only 10.5~15.0% AKI patients from non-nephrology departments received renal referral. Among all the death cases, 50% and 39% came from ICU and medical departments while only 11% from surgical departments. Older age, higher AKI stage and renal replacement therapy indication were identified as risk factors for high mortality in all departments. Delayed recognition and no renal referral were significantly associated with increased mortality in medical and ICU patients. Conclusions These findings suggest that ICU and medical departments are major affected departments in China with a large number of AKI cases and subsequent high mortality. The reality is more alarming considering the low awareness of AKI and the paucity

  5. Wide variation in organisation and clinical practice of paediatric intestinal failure teams: an international survey.

    Science.gov (United States)

    Neelis, Esther; de Koning, Barbara; van Winckel, Myriam; Tabbers, Merit; Hill, Susan; Hulst, Jessie

    2017-11-22

    We aimed to assess the current organisation and clinical practice of teams treating children with intestinal failure (IF) across Europe and compare the results with the current guideline. A two-part online survey was sent to all the major European specialist IF services. The first part concerned general information about the team and patients monitored. The second part concerned important care topics such as vascular access and monitoring of complications. No patient identifiers were collected. Seventy-three respondents completed the first part, representing 61 teams in 20 countries. The median number of children on parenteral nutrition (PN) at home per team was 15 (range 1-125). Teams consisted of the following members: paediatric gastroenterologist (present in 100% of the teams), dietitian (95%), specialist nurse (92%), paediatric surgeon (89%), pharmacist (82%), psychologist (66%), social worker (62%), speech therapist (48%), physiotherapist (38%), general paediatrician (33%). The second part was completed by 67/73 respondents (59/61 teams). Vascular access care was comparable with the guideline. Somatostatin analogues were prescribed by 14% of the IF teams and probiotics by 44% of the teams. Prophylactic anticoagulation was used by 46% of the teams. In 81% of the teams a multicomponent lipid emulsion containing fish oil was routinely used. Bone densitometry was regularly performed in 75% of teams, but never performed in 19%. In conclusion, there is a wide diversity of composition of IF teams and their number of patients treated. Overall, there is good compliance to the current guideline. Clinical practice that varied most was the standard use of medication such as probiotics and somatostatin analogues, and standard monitoring of long-term complications. Experience regarding specific treatment options should be shared. Moreover, international agreement on standards of care with focus on implementation of the guideline is needed to optimise care and improve

  6. [Investigation on the short-term clinical application of two types of glass fiber posts].

    Science.gov (United States)

    Song, Hui; Wang, Jingwen; Deng, Xuliang; Wei, Yan

    2014-08-01

    The clinical results of restoring defective teeth with two types of glass fiber prothetic systems is investigated to acquire clinical experience for further application of glass fiber posts with independent intellectual property rights. A total of 120 out-patients with restored defective teeth were selected from the Department of Stomatology, Beijing Xuanwu Hospital of Traditional Chinese Medicine and Peking University School and Hospital of Stomatology and randomly divided into two groups. OUYA FIBER posts and Tenax Fiber White posts were used to restore defective teeth in the experimental group and the control group, respectively. Clinical evaluation was conducted one week and three months post-restoration. Both clinical satisfactory rates of OUYA FIBER posts and Tenax Fiber White posts were higher than 98% one week post-restoration and higher than 96% three months post-restoration. No significant differences were observed between the clinical results of restoring defective teeth with the two types of fiber posts. Throughout the healing process, no root canal fracture or marginal staining were observed. OUYA FIBER post and Tenax Fiber White post showed similar clinical outcomes during the period of observation in this study. However, the long-term effects should be observed in future studies.

  7. [Clinical features and epidemiological survey of perianal warts in 72 males].

    Science.gov (United States)

    Lu, Yan; Wang, Xiu-Lai; Wu, Di; Dong, Zhen-Bang

    2006-10-01

    To investigate the clinical features and epidemiological data of 72 cases of male perianal warts. Seventy-two cases of perianal warts in our clinic dated from June, 2004 to April, 2006 were enrolled in the study, whose clinical information and epidemiological data were collected and analyzed. Perianal warts were most commonly seen in young and middle-aged men aged from 18 to 45, only 12.5% of whom had homosexual behaviors. Sauna was another predisposing factor of perianal warts in males in China (chi2 = 5.03, P condyloma acuminate was found in 61 (84.72%) of patients, who were susceptive to the infections of HPV 6/11, and were flat condylomas related to HPV16/18. Cryotherapy was believed to be one of the most efficient therapeutic choices for flat perianal warts. Suppression of cellular immune response was identified in the patients by comparison between the subgroups of peripheral T cells and the normal control. Sauna is an essential predisposing factor of perianal warts in males, while anus sexual intercourse is not the main route of HPV infection. Classical condylomata acuminate constitute the majority of the eruptions, and flat condylomata come next. The study also provides some useful data for understanding the clinical and epidemiological features of perianal warts in Chinese males for the sake of prevention and treatment of the disease.

  8. Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey.

    Science.gov (United States)

    Fujimoto, Shuhei; Kon, Noriko; Takasugi, Jun; Nakayama, Takeo

    2017-02-01

    [Purpose] This study aimed to investigate Japanese physical therapists' attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions.

  9. Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background.

    Science.gov (United States)

    Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E; Rogers, Ann E

    2014-05-15

    To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through "on the job" training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap.

  10. Common definition for categories of clinical research: a prerequisite for a survey on regulatory requirements by the European Clinical Research Infrastructures Network (ECRIN)

    DEFF Research Database (Denmark)

    Kubiak, Christine; de Andres-Trelles, Fernando; Kuchinke, Wolfgang

    2009-01-01

    with cell therapy, etc.); diagnostic studies; clinical research on nutrition; other interventional clinical research (including trials in complementary and alternative medicine, trials with collection of blood or tissue samples, physiology studies, etc.); and epidemiology studies. Our classification......BACKGROUND: Thorough knowledge of the regulatory requirements is a challenging prerequisite for conducting multinational clinical studies in Europe given their complexity and heterogeneity in regulation and perception across the EU member states. METHODS: In order to summarise the current situation...... in relation to the wide spectrum of clinical research, the European Clinical Research Infrastructures Network (ECRIN) developed a multinational survey in ten European countries. However a lack of common classification framework for major categories of clinical research was identified, and therefore reaching...

  11. 76 FR 53683 - Draft Guidance for Industry on Oversight of Clinical Investigations: A Risk-Based Approach to...

    Science.gov (United States)

    2011-08-29

    ... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry on Oversight of Clinical... guidance for industry entitled ``Oversight of Clinical Investigations: A Risk-Based Approach to Monitoring... for clinical investigations of human drugs, biologics, medical devices, and combinations thereof. The...

  12. Seismic site survey investigations in urban environments: The case of the underground metro project in Copenhagen, Denmark.

    Science.gov (United States)

    Martínez, K.; Mendoza, J. A.; Colberg-Larsen, J.; Ploug, C.

    2009-05-01

    Near surface geophysics applications are gaining more widespread use in geotechnical and engineering projects. The development of data acquisition, processing tools and interpretation methods have optimized survey time, reduced logistics costs and increase results reliability of seismic surveys during the last decades. However, the use of wide-scale geophysical methods under urban environments continues to face great challenges due to multiple noise sources and obstacles inherent to cities. A seismic pre-investigation was conducted to investigate the feasibility of using seismic methods to obtain information about the subsurface layer locations and media properties in Copenhagen. Such information is needed for hydrological, geotechnical and groundwater modeling related to the Cityringen underground metro project. The pre-investigation objectives were to validate methods in an urban environment and optimize field survey procedures, processing and interpretation methods in urban settings in the event of further seismic investigations. The geological setting at the survey site is characterized by several interlaced layers of clay, till and sand. These layers are found unevenly distributed throughout the city and present varying thickness, overlaying several different unit types of limestone at shallow depths. Specific results objectives were to map the bedrock surface, ascertain a structural geological framework and investigate bedrock media properties relevant to the construction design. The seismic test consisted of a combined seismic reflection and refraction analyses of a profile line conducted along an approximately 1400 m section in the northern part of Copenhagen, along the projected metro city line. The data acquisition was carried out using a 192 channels array, receiver groups with 5 m spacing and a Vibroseis as a source at 10 m spacing. Complementarily, six vertical seismic profiles (VSP) were performed at boreholes located along the line. The reflection

  13. Multi-agency radiation survey and site investigation manual (MARSIM). Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-12-01

    The MARSSIM provides information on planning, conducting, evaluating, and documenting building surface and surface soil final status radiological surveys for demonstrating compliance with dose or risk-based regulations or standards. The MARSSIM is a multi-agency consensus document that was developed collaboratively by four Federal agencies having authority and control over radioactive materials: Department of Defense (DOD), Department of Energy (DOE), Environmental Protection Agency (EPA), and Nuclear Regulatory Commission (NRC). The MARSSIM`s objective is to describe a consistent approach for planning, performing, and assessing building surface and surface soil final status surveys to meet established dose or risk-based release criteria, while at the same time encouraging an effective use of resources.

  14. General practitioners' views of clinically led commissioning: cross-sectional survey in England.

    Science.gov (United States)

    Moran, Valerie; Checkland, Kath; Coleman, Anna; Spooner, Sharon; Gibson, Jonathan; Sutton, Matt

    2017-06-08

    Involving general practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years. The Health and Social Care Act 2012 handed responsibility for commissioning of the majority of care for local populations to GP-led Clinical Commissioning Groups (CCGs). In this paper, we explore GP attitudes to involvement in commissioning and future intentions for engagement. Survey of a random sample of GPs across England in 2015. The Eighth National GP Worklife Survey was distributed to GPs in spring 2015. Responses were received from 2611 respondents (response rate = 46%). We compared responses across different GP characteristics and conducted two sample tests of proportions to identify statistically significant differences in responses across groups. We also used multivariate logistic regression to identify the characteristics associated with wanting a formal CCG role in the future. While GPs generally agree that they can add value to aspects of commissioning, only a minority feel that this is an important part of their role. Many current leaders intend to quit in the next 5 years, and there is limited appetite among those not currently in a formal role to take up such a role in the future. CCGs were set up as 'membership organisations' but only a minority of respondents reported feeling that they had 'ownership' of their local CCG and these were often GPs with formal CCG roles. However, respondents generally agree that the CCG has a legitimate role in influencing the work that they do. CCGs need to engage in active succession planning to find the next generation of GP leaders. GPs believe that CCGs have a legitimate role in influencing their work, suggesting that there may be scope for CCGs to involve GPs more fully in roles short of formal leadership. © 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

  15. General practitioners’ views of clinically led commissioning: cross-sectional survey in England

    Science.gov (United States)

    Moran, Valerie; Checkland, Kath; Coleman, Anna; Spooner, Sharon; Gibson, Jonathan; Sutton, Matt

    2017-01-01

    Objectives Involving general practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years. The Health and Social Care Act 2012 handed responsibility for commissioning of the majority of care for local populations to GP-led Clinical Commissioning Groups (CCGs). In this paper, we explore GP attitudes to involvement in commissioning and future intentions for engagement. Design and setting Survey of a random sample of GPs across England in 2015. Method The Eighth National GP Worklife Survey was distributed to GPs in spring 2015. Responses were received from 2611 respondents (response rate = 46%). We compared responses across different GP characteristics and conducted two sample tests of proportions to identify statistically significant differences in responses across groups. We also used multivariate logistic regression to identify the characteristics associated with wanting a formal CCG role in the future. Results While GPs generally agree that they can add value to aspects of commissioning, only a minority feel that this is an important part of their role. Many current leaders intend to quit in the next 5 years, and there is limited appetite among those not currently in a formal role to take up such a role in the future. CCGs were set up as ‘membership organisations’ but only a minority of respondents reported feeling that they had ‘ownership’ of their local CCG and these were often GPs with formal CCG roles. However, respondents generally agree that the CCG has a legitimate role in influencing the work that they do. Conclusion CCGs need to engage in active succession planning to find the next generation of GP leaders. GPs believe that CCGs have a legitimate role in influencing their work, suggesting that there may be scope for CCGs to involve GPs more fully in roles short of formal leadership. PMID:28596217

  16. National survey on turnaround time of clinical biochemistry tests in 738 laboratories in China.

    Science.gov (United States)

    Zhang, Xiaoyan; Fei, Yang; Wang, Wei; Zhao, Haijian; Wang, Minqi; Chen, Bingquan; Zhou, Jie; Wang, Zhiguo

    2017-05-11

    This survey was initiated to estimate the current status of turnaround time (TAT) monitoring of clinical biochemistry in China, provide baseline data for establishment of quality specifications and analyze the impact factors of TAT. 738 laboratories were included. Questionnaires involved general information and data of related indicators of TAT during 1 week were provided to participating laboratories. Nine quality indicators were covered, which were medians, 90th and outlier rates of pre-examination, examination, and post-examination TAT. The 25th percentile, median, and 75th percentile of TATs were calculated as optimum, desirable, and minimum quality specifications. Percentages and sigma values were used to describe the outlier rates. Mann-Whitney and Kruskal-Wallis tests were used to identify the potential impacts of TAT. Response rate of this survey was 46.44%. More than 50% of the laboratories indicated they had set up target TATs in three time intervals and monitored TATs generally. The post-examination TAT of most laboratories was 0min, while the pre-examination and examination TAT varied. Sigma values of outlier rates for 45%~60% of laboratories were above 4, while 15%~20% of labs whose sigma values were below 3. Group comparisons suggested nurse or mechanical pipeline transportation, link laboratory information system with hospital information system, and using computer reporting instead of printing report were related to shorter TATs. Despite of the remarkable progresses of TATs in China, there was also room to improve. Laboratories should strengthen the construction of information systems, identify reasons for TAT delay to improve the service quality continuously. © 2017 Wiley Periodicals, Inc.

  17. Archeological Investigations in Cochiti Reservoir, New Mexico. Volume 1. A Survey of Regional Variability.

    Science.gov (United States)

    1977-06-01

    include the invertebrates; reptiles tic populations. The source material for the following and amphibians are disregarded because they do not oc...herbivorous rodents and reptiles . PREVIOUS RESEARCH Al animals in this area avoid high daily temperaturesPand become active in the early evening, early morning...1972 Settlement Pattern Changes at Weatherill and Subsistence Along the Lower Chaco: The Mesa, Colorado: A Test Case for Computer CGP Survey. Ed. by C

  18. Patterns of technology use in patients attending a cardiopulmonary outpatient clinic: a self-report survey.

    Science.gov (United States)

    Disler, Rebecca T; Inglis, Sally C; Newton, Phillip J; Currow, David C; Macdonald, Peter S; Glanville, Allan R; Donesky, DorAnne; Carrieri-Kohlman, Virginia; Davidson, Patricia M

    2015-03-06

    Self-management education for cardiopulmonary diseases is primarily provided through time-limited, face-to-face programs, with access limited to a small percentage of patients. Telecommunication tools will increasingly be an important component of future health care delivery. The purpose of this study was to describe the patterns of technology use in patients attending a cardiopulmonary clinic in an academic medical center. A prevalence survey was developed to collect data on participant demographics (age in years, sex, and socioeconomic status); access to computers, Internet, and mobile phones; and use of current online health support sites or programs. Surveys were offered by reception staff to all patients attending the outpatient clinic. A total of 123 surveys were collected between March and April 2014. Technological devices were a pervasive part of everyday life with respondents engaged in regular computer (102/123, 82.9%), mobile telephone (115/117, 98.3%), and Internet (104/121, 86.0%) use. Emailing (101/121, 83.4%), researching and reading news articles (93/121, 76.9%), social media (71/121, 58.7%), and day-to-day activities (65/121, 53.7%) were the most common telecommunication activities. The majority of respondents reported that access to health support programs and assistance through the Internet (82/111, 73.9%) would be of use, with benefits reported as better understanding of health information (16/111, 22.5%), avoidance of difficult travel requirements and time-consuming face-to-face appointments (13/111, 18.3%), convenient and easily accessible help and information (12/111, 16.9%), and access to peer support and sharing (9/111, 12.7%). The majority of patients did not have concerns over participating in the online environment (87/111, 78.4%); the few concerns noted related to privacy and security (10/15), information accuracy (2/15), and computer literacy and access (2/15). Chronic disease burden and long-term self-management tasks provide a

  19. Ear Aesthetics: Investigation by the Use of an Online Viral Survey.

    Science.gov (United States)

    Steele, Jessica; Farmer, Eleanor; O'Hara, Justine; Bulstrode, Neil

    2017-03-01

    The ear is a key facial feature and yet few studies have previously assessed ear aesthetics. This study aimed to assess the anatomical components of the ear that have the greatest impact on the perception of ear aesthetics. Three photographs of a male adult ear (close-up, lateral, posterior) were digitally manipulated such that in each, 1 anatomical element of the ear was either enlarged or reduced. A complete set of 16 photographs including a repeat of the original ear as a control were randomized and entered into an online survey that required respondents to rate the attractiveness of each ear on a scale of 1 (least attractive) to 10 (most attractive). The survey was disseminated using email and social media. A total of 248 responses were received, 155 women and 92 men. Respondents were grouped by demographics of age and occupation. Reducing (R) or enlarging (E) the helix (R, P = 0.0256; E, P = 0.003), concha (R, P = 0.0002; E, P = aesthetics. Furthermore, this study has proven the usefulness of conducting research using viral online surveys.

  20. Clinical investigation of CT-guided ozone-blowing and fumigation ...

    African Journals Online (AJOL)

    STORAGESEVER

    2010-05-31

    May 31, 2010 ... Clinical investigation of CT-guided ozone-blowing and fumigation therapy for the chronic refractory cutaneous sinus and ulcer. Meng-Qi Wei1, Jian-Shou Zhou1, Hai-Tao Liu2, Yuan Yuan1, Jun-Qing Xu1, Yong Yang1, Jin-. Song Zhang1, Yong Peng1* and Yi Huan1*. 1Department of Radiology, Xijing ...

  1. Template protocol for clinical trials investigating vaccines--focus on safety elements.

    Science.gov (United States)

    Bonhoeffer, Jan; Imoukhuede, Egeruan B; Aldrovandi, Grace; Bachtiar, Novilia S; Chan, Eng-Soon; Chang, Soju; Chen, Robert T; Fernandopulle, Rohini; Goldenthal, Karen L; Heffelfinger, James D; Hossain, Shah; Jevaji, Indira; Khamesipour, Ali; Kochhar, Sonali; Makhene, Mamodikoe; Malkin, Elissa; Nalin, David; Prevots, Rebecca; Ramasamy, Ranjan; Sellers, Sarah; Vekemans, Johan; Walker, Kenneth B; Wilson, Pam; Wong, Virginia; Zaman, Khalequz; Heininger, Ulrich

    2013-11-12

    This document is intended as a guide to the protocol development for trials of prophylactic vaccines. The template may serve phases I-IV clinical trials protocol development to include safety relevant information as required by the regulatory authorities and as deemed useful by the investigators. This document may also be helpful for future site strengthening efforts. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Clinical and Pharmacological Investigation of Myotoxicity in Sri Lankan Russell's Viper (Daboia russelii) Envenoming.

    OpenAIRE

    Anjana Silva; Christopher Johnston; Sanjaya Kuruppu; Daniela Kneisz; Kalana Maduwage; Oded Kleifeld; A Ian Smith; Sisira Siribaddana; Nicholas A Buckley; Wayne C Hodgson; Geoffrey K Isbister

    2016-01-01

    Background Sri Lankan Russell?s viper (Daboia russelii) envenoming is reported to cause myotoxicity and neurotoxicity, which are different to the effects of envenoming by most other populations of Russell?s vipers. This study aimed to investigate evidence of myotoxicity in Russell?s viper envenoming, response to antivenom and the toxins responsible for myotoxicity. Methodology and Findings Clinical features of myotoxicity were assessed in authenticated Russell?s viper bite patients admitted t...

  3. Failure of Investigational Drugs in Late-Stage Clinical Development and Publication of Trial Results.

    Science.gov (United States)

    Hwang, Thomas J; Carpenter, Daniel; Lauffenburger, Julie C; Wang, Bo; Franklin, Jessica M; Kesselheim, Aaron S

    2016-12-01

    Many investigational drugs fail in late-stage clinical development. A better understanding of why investigational drugs fail can inform clinical practice, regulatory decisions, and future research. To assess factors associated with regulatory approval or reasons for failure of investigational therapeutics in phase 3 or pivotal trials and rates of publication of trial results. Using public sources and commercial databases, we identified investigational therapeutics that entered pivotal trials between 1998 and 2008, with follow-up through 2015. Agents were classified by therapeutic area, orphan designation status, fast track designation, novelty of biological pathway, company size, and as a pharmacologic or biologic product. For each product, we identified reasons for failure (efficacy, safety, commercial) and assessed the rates of publication of trial results. We used multivariable logistic regression models to evaluate factors associated with regulatory approval. Among 640 novel therapeutics, 344 (54%) failed in clinical development, 230 (36%) were approved by the US Food and Drug Administration (FDA), and 66 (10%) were approved in other countries but not by the FDA. Most products failed due to inadequate efficacy (n = 195; 57%), while 59 (17%) failed because of safety concerns and 74 (22%) failed due to commercial reasons. The pivotal trial results were published in peer-reviewed journals for 138 of the 344 (40%) failed agents. Of 74 trials for agents that failed for commercial reasons, only 6 (8.1%) were published. In analyses adjusted for therapeutic area, agent type, firm size, orphan designation, fast-track status, trial year, and novelty of biological pathway, orphan-designated drugs were significantly more likely than nonorphan drugs to be approved (46% vs 34%; adjusted odds ratio [aOR], 2.3; 95% CI, 1.4-3.7). Cancer drugs (27% vs 39%; aOR, 0.5; 95% CI, 0.3-0.9) and agents sponsored by small and medium-size companies (28% vs 42%; aOR, 0.4; 95% CI, 0

  4. [Trial provision in clinical routine. Definition of terms and investigation of normal practice].

    Science.gov (United States)

    Gonser, P; Matern, U

    2014-01-01

    It has become common for hospitals to borrow medical devices from manufacturers to test and try them during the daily routine before purchasing which today is known as trial provision. This study aims at offering a precise definition of trial provisions and a description of the way of proceeding. A total of 60 medical practitioners in 5 German hospitals were surveyed (surgeons n = 40, 66.7 %, radiologists n = 12, 20 % and anesthesiologists n = 8, 13.3 %). Manufacturers and distributors of medical devices (n = 10) and hospital administration executives (n = 8) were also interviewed. Trial provisions are a promotional marketing tool for manufacturers of medical devices. By lending the device over a specific period for testing before purchasing, hospitals can gain experience in the usage and handling of devices on which a purchase decision can be made. The survey revealed that there are basically three procedural methods which can, however, differ even within one hospital. Trial provisions influence purchasing decisions in clinics. If implemented incorrectly trial provisions may compromise physical integrity, safety and health of patients and can thus lead to judicial and legal consequences for hospitals and medical staff.

  5. Investigating the Local and High Redshift Universe With Deep Survey Data and Ground-Based Spectroscopy

    Science.gov (United States)

    Masters, Daniel Charles

    Large multiwavelength surveys are now driving the frontiers of astronomical research. I describe results from my work using data from two large astronomical surveys: the Cosmic Evolution Survey (COSMOS), which has obtained deep photometric and spectroscopic data on two square degrees of the sky using many of the most powerful telescopes in the world, and the WFC3 Infrared Spectroscopic Parallels (WISP) Survey, which uses the highly sensitive slitless spectroscopic capability of the Hubble Space Telescope Wide Field Camera 3 to detect star-forming galaxies over most of the universe's history. First I describe my work on the evolution of the high-redshift quasar luminosity function, an important observational quantity constraining the growth of the supermassive black holes in the early universe. I show that the number density of faint quasars declines rapidly above z ˜ 3. This result is discussed in the context of cosmic reionization and the coevolution of galaxies and their central black holes. Next I present results of a multi-year campaign of near-infrared spectroscopy with FIRE, a world-class near-infrared spectrometer on the Magellan Baade 6.5 meter telescope in Chile, targeting emission-line galaxies at z ˜ 2 discovered with the Hubble Space Telescope. Our results showed that the typical emission-line galaxy at this redshift has low-metallicity, low dust obscuration, high ionization parameter, and little evidence for significant active galactic nucleus (AGN) contribution to the emission lines. We also find evidence that high redshift star-forming galaxies have enhanced nitrogen abundances. This result has interesting implications for the nature of the star formation in such galaxies -- in particular, it could mean that a large fraction of such galaxies harbor substantial populations of Wolf-Rayet stars, which are massive, evolved stars ejecting large amounts of enriched matter into the interstellar medium. Finally, I will discuss the discovery of three

  6. Applied biomechanics in articular injuries: perspectives in the basic investigation of articular injuries and clinical application.

    Science.gov (United States)

    Olson, Steven A; Brown, Thomas D; Athanasiou, Kyriacos A; Natoli, Roman M; Dirschl, Douglas R

    2011-01-01

    Joint injury is an important cause of arthritis. Although the treatment of injury, in general, has been widely studied, the contribution of injury to the development of posttraumatic arthritis is still a relatively understudied area. One of the most perplexing aspects of investigating articular injuries is the complex nature of the injury itself and the multiple facets of the injury mechanism that can potentially lead to the development of arthritis. A symposium by the Orthopaedic Research Society and the American Academy of Orthopaedic Surgeons was designed to examine the spectrum of basic science to clinical investigation in the role of biomechanics in the study of joint injury and subsequent posttraumatic arthritis. Four perspectives in the clinical aspects of managing articular injuries were investigated, including the clinical applications of basic science findings, the challenges and advancements in measuring and modeling articular fractures, the relationship of articular cartilage mechanical injuries and osteoarthritis, and the controlled creation of an intra-articular fracture to permit observations of the natural history of posttraumatic arthritis.

  7. Understanding Career Success and Its Contributing Factors for Clinical and Translational Investigators.

    Science.gov (United States)

    Robinson, Georgeanna F W B; Schwartz, Lisa S; DiMeglio, Linda A; Ahluwalia, Jasjit S; Gabrilove, Janice L

    2016-04-01

    To understand the factors that facilitate career success for career development awardees in clinical and translational science and reconceptualize understand ing of career success for this population. In 2013-2014, the authors conducted semistructured interviews with former NIH KL2 or K12 scholars from nine Clinical and Translational Science Award-funded institutions. Participants either had or had not secured independent funding at least two years after the end of their last K award. Questions covered the factors that facilitate or hinder junior investigators' transition to independent funding. Interviews were recorded and transcribed, and the transcripts were analyzed thematically. Forty individuals participated, with equal representation by men and women and by independently and not independently funded investigators. Personal factors that facilitated success included networks, persistence and resilience, initiative, autonomy, and personal and professional balance. Organizational factors included appropriate mentorship, protected research time, and institutional resources and support.Even independently funded participants described challenges regarding career direction. Five participants without independent funding modeled a broad spectrum of successful career paths, having assumed leadership positions not reliant on grant funding. Alternative definitions of career success included improving public health, enjoying work, seeing mentees succeed, and receiving external acknowledgment of successes. Awareness of the factors that facilitate or hinder career success can help junior faculty, mentors, and institutional leaders support career development in clinical and translational science. New definitions of career success are needed, as are career paths for faculty who want to engage in research in roles other than principal investigator.

  8. Assessment of Patient Knowledge of Longitudinal Melanonychia: A Survey Study of Patients in Outpatient Clinics

    Science.gov (United States)

    Halteh, Pierre; Scher, Richard; Artis, Amanda; Lipner, Shari

    2017-01-01

    Importance Subungual melanoma (SM) is a rare subtype of cutaneous melanoma but carries a worse prognosis than similarly staged cutaneous melanomas. Assessing patient knowledge of melanonychia is integral to early diagnosis of SM. Objectives The aim of this paper is to determine patient knowledge of longitudinal melanonychia (LM) and warning signs for SM, frequency of nail self-examinations, and satisfaction of patients with their physician's nail examinations. Design, Setting, and Participants We conducted a survey-based study of 363 random patients at Weill Cornell Medicine in New York, USA, performed at 3 different clinics: a general dermatology clinic (n = 167), a nail specialty clinic (n = 44), and a primary care clinic (n = 152). Main Outcomes and Measures Knowledge of the ABCDEF mnemonic for SM was compared to the ABCD mnemonic for cutaneous melanoma. Analyses were performed for patient behavior regarding suspicious nail changes as well as satisfaction with nail counseling and examination. Results Only 5% (18/363) of the patients in our study had heard of the ABCDEF mnemonic. In contrast, 9.9% (36/363) of the patients had heard of the ABCD mnemonic for cutaneous melanoma. In total, 37/363 (10.2%) patients reported having LM, 32.4% (12/37) of the patients noted changes in color or width of the band, and 10.8% (4/37) presented with pain or bleeding of the nail, with only 45.9% (17/37) seeking medical attention. Only 11.8% (43/363) of the patients stated that their physician asked them about nail changes, and 1.4% (5/363) of the patients stated that they were counseled about the ABCDEF mnemonic. In comparison, 13.8% (50/363) of the patients were advised on the ABCD mnemonic for the cutaneous melanoma mnemonic. While 70.2% (255/363) of the patients stated that they used sunscreen or wore sun-protective clothing, only 31.4% (114/363) assessed their nails for color changes, with 54.9% (128/233) of the patients categorizing themselves as “very unsatisfied” with

  9. Experimental Investigation on Minimum Frame Rate Requirements of High-Speed Videoendoscopy for Clinical Voice Assessment.

    Science.gov (United States)

    Deliyski, Dimitar D; Powell, Maria Eg; Zacharias, Stephanie Rc; Gerlach, Terri Treman; de Alarcon, Alessandro

    2015-03-01

    This study investigated the impact of high-speed videoendoscopy (HSV) frame rates on the assessment of nine clinically-relevant vocal-fold vibratory features. Fourteen adult patients with voice disorder and 14 adult normal controls were recorded using monochromatic rigid HSV at a rate of 16000 frames per second (fps) and spatial resolution of 639×639 pixels. The 16000-fps data were downsampled to 16 other rate denominations. Using paired comparisons design, nine common clinical vibratory features were visually compared between the downsampled and the original images. Three raters reported the thresholds at which: (1) a detectable difference between the two videos was first noticed, and (2) differences between the two videos would result in a change of clinical rating. Results indicated that glottal edge, mucosal wave magnitude and extent, aperiodicity, contact and loss of contact of the vocal folds were the vibratory features most sensitive to frame rate. Of these vibratory features, the glottal edge was selected for further analysis, due to its higher rating reliability, universal prevalence and consistent definition. Rates of 8000 fps were found to be free from visually-perceivable feature degradation, and for rates of 5333 fps, degradation was minimal. For rates of 4000 fps and higher, clinical assessments of glottal edge were not affected. Rates of 2000 fps changed the clinical ratings in over 16% of the samples, which could lead to inaccurate functional assessment.

  10. The INVEST project: investigating the use of evidence synthesis in the design and analysis of clinical trials.

    Science.gov (United States)

    Clayton, Gemma L; Smith, Isabelle L; Higgins, Julian P T; Mihaylova, Borislava; Thorpe, Benjamin; Cicero, Robert; Lokuge, Kusal; Forman, Julia R; Tierney, Jayne F; White, Ian R; Sharples, Linda D; Jones, Hayley E

    2017-05-15

    When designing and analysing clinical trials, using previous relevant information, perhaps in the form of evidence syntheses, can reduce research waste. We conducted the INVEST (INVestigating the use of Evidence Synthesis in the design and analysis of clinical Trials) survey to summarise the current use of evidence synthesis in trial design and analysis, to capture opinions of trialists and methodologists on such use, and to understand any barriers. Our sampling frame was all delegates attending the International Clinical Trials Methodology Conference in November 2015. Respondents were asked to indicate (1) their views on the use of evidence synthesis in trial design and analysis, (2) their own use during the past 10 years and (3) the three greatest barriers to use in practice. Of approximately 638 attendees of the conference, 106 (17%) completed the survey, half of whom were statisticians. Support was generally high for using a description of previous evidence, a systematic review or a meta-analysis in trial design. Generally, respondents did not seem to be using evidence syntheses as often as they felt they should. For example, only 50% (42/84 relevant respondents) had used a meta-analysis to inform whether a trial is needed compared with 74% (62/84) indicating that this is desirable. Only 6% (5/81 relevant respondents) had used a value of information analysis to inform sample size calculations versus 22% (18/81) indicating support for this. Surprisingly large numbers of participants indicated support for, and previous use of, evidence syntheses in trial analysis. For example, 79% (79/100) of respondents indicated that external information about the treatment effect should be used to inform aspects of the analysis. The greatest perceived barrier to using evidence synthesis methods in trial design or analysis was time constraints, followed by a belief that the new trial was the first in the area. Evidence syntheses can be resource-intensive, but their use in

  11. Nationwide survey of Cockayne syndrome in Japan: Incidence, clinical course and prognosis.

    Science.gov (United States)

    Kubota, Masaya; Ohta, Sayaka; Ando, Aki; Koyama, Akiko; Terashima, Hiroshi; Kashii, Hirofumi; Hoshino, Hideki; Sugita, Katsuo; Hayashi, Masaharu

    2015-06-01

    In the first nationwide survey of Cockayne syndrome (CS) in Japan, the incidence of CS was estimated to be 2.77 per million births (95%CI: 2.19-3.11) and the prevalence was approximately 1 in 2,500,000. A total of 47 CS patients (24 surviving and 23 deceased) were identified. Based on clinical course, these 47 patients were classified into CS type 1 (n = 41; 21 surviving, 20 deceased), CS type 2 (n = 2; all deceased), CS type 3 (n = 3; all surviving), and CS/xeroderma pigmentosum type D (n = 1, deceased). In the 41 CS type 1 patients, seven findings (i.e. failure to thrive; photosensitivity; deafness; characteristic facial appearance of CS [sunken eyes]; foot joint contracture; intellectual disability; and basal ganglia calcification on computed tomography [CT]) were observed in >90% of patients. Of these, failure to thrive, photosensitivity, and intellectual disability (language delays) developed before 2 or 3 years of age, whereas deafness, sunken eyes, and basal ganglia calcification on CT occurred later. Features such as bodyweight and height stagnation, language delay, abnormal nutritional pathways (tube feeding), and renal failure were more prominent in the 20 deceased CS type 1 patients than in the 21 surviving CS type 1 patients. Of the 20 deceased CS type 1 patients, nine developed severe renal failure during the terminal stages of their condition. The present findings suggest that the clinical course of CS includes a diverse range of symptoms, but each type has characteristic symptoms. In addition, the management of renal failure and nutrition are very important for ensuring good quality of life throughout the long-term course of CS. © 2015 Japan Pediatric Society.

  12. Sociodemographic and clinical correlates of psychotic symptoms in the general population: Findings from the MHGP survey.

    Science.gov (United States)

    Pignon, Baptiste; Schürhoff, Franck; Szöke, Andrei; Geoffroy, Pierre A; Jardri, Renaud; Roelandt, Jean-Luc; Rolland, Benjamin; Thomas, Pierre; Vaiva, Guillaume; Amad, Ali

    2017-07-06

    We aimed to explore the sociodemographic and psychiatric correlates of psychotic symptoms in a large general population sample. The French Mental Health in the General Population cross-sectional survey interviewed 38,694 individuals using the Mini International Neuropsychiatric Interview. We looked for associations between the presence of lifetime psychotic symptoms, sociodemographic characteristics (including migrant status over three generations) and clinical characteristics. We then looked for associations regarding only hallucinations, delusional symptoms, and the co-occurrence of both hallucinations and delusional symptoms. To test the psychosis continuum hypothesis, associations with sociodemographic characteristics were compared with the characterized psychotic disorders' associations. We found that 22.3% of the population declared psychotic symptoms without psychotic disorders, including 5.7% who declared hallucinations, 20.5% delusional symptoms, 4.0% both hallucinations and delusional symptoms, and 2.8% characterized psychotic disorders. The presence of psychotic symptoms was associated with young age, migrant status (over three generations), secondary education level, low-income level and never-married and separated marital status. Hallucinations, delusional symptoms and the co-occurrence of both hallucinations and delusional symptoms showed the same correlates, and hallucinations were also associated with elementary education level. Characterized psychotic disorders showed the same correlates. Concerning clinical outcomes, the presence of psychotic symptoms, hallucinations and delusional symptoms was associated with all non-psychotic disorders, i.e., bipolar, depressive, alcohol use, generalized anxiety, social phobia, panic and post-traumatic stress disorders and dysthymia (except dysthymia, which was not associated with hallucinations). Our results indicate that psychotic symptoms are associated with broad psychopathologies and support the continuum

  13. Recruitment challenges in clinical research: Survey of potential participants in a diagnostic study of ovarian cancer.

    Science.gov (United States)

    Sun, Zhuoyu; Gilbert, Lucy; Ciampi, Antonio; Basso, Olga

    2017-09-01

    Recruiting participants in clinical research is challenging. Certain groups, such as older adults, rural residents, and individuals with lower socio-economic status, are typically underrepresented. Here, we explore perceived motivators and barriers among potential participants in a diagnostic study of ovarian cancer. Women aged 50 and older who answered a mail survey in Montreal, Canada, were asked to assess their eligibility to participate in the ongoing Diagnosing Ovarian cancer Early (DOvE) Study. If 'eligible', they were asked whether they planned to participate in DOvE. Using modified Poisson regression, we examined responders' self-assessment of eligibility, intention to participate, and reasons for why or why not, as a function of socio-demographic and health indicators. Of 826 responders, 33.1% misclassified themselves with respect to eligibility. Among 532 self-assessed eligible women, 56.4% planned to participate in the study. The majority of women not planning to participate preferred to be assessed by their physicians (a reason more commonly reported by those with lower education or income) or believed they were not at risk of ovarian cancer (despite having no fewer risk factors). "Inconvenience" was also a commonly reported reason, especially among rural residents. Women who planned to participate often perceived a benefit (e.g. to rule out ovarian cancer, or to receive a quick check-up). Recruitment, particularly of underrepresented groups, in clinical studies may be enhanced by involving primary care providers, facilitating access to study sites, and providing clear information about the disease under study (including risk factors) and eligibility criteria. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. A Clinically Meaningful Interpretation of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) Scintigraphic Data.

    Science.gov (United States)

    Cronin, Paul; Dwamena, Ben A

    2017-05-01

    Pulmonary embolism (PE) is a common condition associated with significant morbidity and mortality. Diagnostic test characteristics reported in terms of sensitivity and specificity are difficult to translate at the clinical level. More relevant measures are likelihood ratios (LRs), which can convert a pretest into a posttest probability. The aim of our study was to calculate the LRs and posttest probabilities for multiple-level test result for ventilation/perfusion (V/Q) lung scintigraphy and for perfusion scintigraphy combined with chest radiography using modified Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II and the Prospective Investigative Study of Pulmonary Embolism Diagnosis (PISAPED) criteria for each clinical probability level for the most commonly used clinical prediction rules (CPR) using the PIOPED data. PE pretest probability was estimated for the most commonly used CPRs (Wells, Geneva, Miniati, and Charlotte) at each clinical probability level (two-, three-, and four-level). Multiple-level LRs (high, indeterminate, low, very low probability, and normal) and the positive, indeterminate, and negative results for V/Q scintigraphy, and the positive, indeterminate, and negative results for perfusion scintigraphy were generated and used to calculate posttest probabilities based on the sensitivity and specificity data from PIOPED for each clinical probability level (low, intermediate, and high) for each CPR. Nomograms were also created. The LRs for a positive V/Q and perfusion scintigraphy test using modified PIOPED II and PISAPED criteria were 20.6, 11, and 23.7, and for a negative test result were 0.15, 0.16, and 0.2, respectively. In the three-level Wells score, the posttest probability for an initial low clinical probability PE for a positive, indeterminate, and negative test result, respectively, for V/Q scintigraphy is 56, 5, and 0.9; for perfusion scintigraphy with modified PIOPED 40, 7, and 0.9, and with PISAPED 59, not

  15. Clinical features of dysthyroid optic neuropathy: a European Group on Graves' Orbitopathy (EUGOGO) survey

    Science.gov (United States)

    McKeag, David; Lane, Carol; Lazarus, John H; Baldeschi, Lelio; Boboridis, Kostas; Dickinson, A Jane; Hullo, A Iain; Kahaly, George; Krassas, Gerry; Marcocci, Claudio; Marinò, Michele; Mourits, Maarten P; Nardi, Marco; Neoh, Christopher; Orgiazzi, Jacques; Perros, Petros; Pinchera, Aldo; Pitz, Susanne; Prummel, Mark F; Sartini, Maria S; Wiersinga, Wilmar M

    2007-01-01

    Background This study was performed to determine clinical features of dysthyroid optic neuropathy (DON) across Europe. Methods Forty seven patients with DON presented to seven European centres during one year. Local protocols for thyroid status, ophthalmic examination and further investigation were used. Each eye was classified as having definite, equivocal, or no DON. Results Graves' hyperthyroidism occurred in the majority; 20% had received radioiodine. Of 94 eyes, 55 had definite and 17 equivocal DON. Median Clinical Activity Score was 4/7 but 25% scored 3 or less, indicating severe inflammation was not essential. Best corrected visual acuity was 6/9 (Snellen) or worse in 75% of DON eyes. Colour vision was reduced in 33 eyes, of which all but one had DON. Half of the DON eyes had normal optic disc appearance. In DON eyes proptosis was > 21 mm (significant) in 66% and visual fields abnormal in 71%. Orbital imaging showed apical muscle crowding in 88% of DON patients. Optic nerve stretch and fat prolapse were infrequently reported. Conclusion Patients with DON may not have severe proptosis and orbital inflammation. Optic disc swelling, impaired colour vision and radiological evidence of apical optic nerve compression are the most useful clinical features in this series. PMID:17035276

  16. Investigation of faint galactic carbon stars from the first Byurakan spectral survey. III. Infrared characteristics

    OpenAIRE

    Gigoyan, K. S.; A. Sarkissian; Rossi, C.; Russeil, D.,; Kostandyan, G.; Calabresi, M.; Zamkotsian, F.; Meftah, M.

    2017-01-01

    Infra-Red(IR) astronomical databases, namely, IRAS, 2MASS, WISE, and Spitzer, are used to analyze photometric data of 126 carbon stars whose spectra are visible in the First Byurakan Survey low-resolution spectral plates. Among these, six new objects, recently confirmed on the digitized FBS plates, are included. For three of them, moderate-resolution CCD optical spectra are also presented. In this work several IR color-color diagrams are studied. Early and late-type C stars are separated in t...

  17. Investigating Measures of Social Context on 2 Population-Based Health Surveys, Hawaii, 2010-2012.

    Science.gov (United States)

    Pobutsky, Ann M; Baker, Kathleen Kromer; Reyes-Salvail, Florentina

    2015-12-17

    Measures from the Social Context Module of the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System were used on 2 population-based health surveys in Hawaii to explicate the role of the nonmedical and social determinants of health; these measures were also compared with conventional socioeconomic status (SES) variables. Results showed that the self-reported SES vulnerabilities of food and housing insecurity are both linked to demographic factors and physical and mental health status and significant when controlling for the conventional measures of SES. The social context module indicators should be increasingly used so results can inform appropriate interventions for vulnerable populations.

  18. The Religiosity and Spiritual Beliefs and Practices of Clinical Social Workers: A National Survey.

    Science.gov (United States)

    Oxhandler, Holly K; Polson, Edward C; Achenbaum, W Andrew

    2017-11-09

    This article describes the religious and spiritual beliefs and practices among a national sample of 426 licensed clinical social workers (LCSWs). Given the significant role LCSWs' intrinsic religiosity plays in whether or not they consider clients' religion and spirituality (RS) as it relates to practice, it is critical that the profession best understands current LCSWs' religious and spiritual beliefs, and in what ways these mirror or contrast those of the clients whom they serve. Findings from this secondary analysis of a recent national survey suggest that compared with the general U.S. population, fewer LCSWs self-identify as Protestant or Catholic, fewer engage in frequent prayer, and fewer self-identify as religious. However, more LCSWs engage in meditation and consider themselves to be spiritual. Although it appears that RS is an important area in both LCSWs' and clients' lives, the beliefs, practices, and degree of importance with either differ. This article addresses implications for practice and education, as identifying such differing views calls on the profession to strengthen its training surrounding LCSWs' self-awareness of their RS beliefs and recognizing that their clients may not hold similar beliefs or engage in similar practices. © 2017 National Association of Social Workers.

  19. Adverse interactions between herbal and dietary substances and prescription medications: a clinical survey.

    Science.gov (United States)

    Bush, Thomas M; Rayburn, Keith S; Holloway, Sandra W; Sanchez-Yamamoto, Deanna S; Allen, Blaine L; Lam, Tiffany; So, Brian K; Tran, De H; Greyber, Elizabeth R; Kantor, Sophia; Roth, Larry W

    2007-01-01

    Patients often combine prescription medications with herbal and dietary substances (herein referred to as herbal medicines). A variety of potential adverse herb-drug interactions exist based on the pharmacological properties of herbal and prescription medications. To determine the incidence of potential and observed adverse herb-drug interactions in patients using herbal medicines with prescription medications. Consecutive patients were questioned about their use of herbal medicines in 6 outpatient clinics. Patients reporting use of these products provided a list of their prescription medications, which were reviewed for any potential adverse herb-drug interactions using a comprehensive natural medicine database. Any potential adverse herb-drug interactions prompted a review of the patient's chart for evidence of an observed adverse herb-drug interaction. The rate of potential and observed adverse herb-drug interactions. Eight hundred four patients were surveyed, and 122 (15%) used herbal medicines. Eighty-five potential adverse herb-drug interactions were found in 49 patients (40% of herbal medicine users). Twelve possible adverse herb-drug interactions in 8 patients (7% of herbal medicine users) were observed. In all 12 cases, the severity scores were rated as mild, including 8 cases of hypoglycemia in diabetics taking nopal (prickly pear cactus). A substantial number of potential adverse herb-drug interactions were detected and a small number of adverse herb-drug interactions observed, particularly in diabetics taking nopal. Screening for herbal medicine usage in 804 patients did not uncover any serious adverse interactions with prescription medications.

  20. A survey of exercise advice and recommendations in United Kingdom paediatric cardiac clinics.

    Science.gov (United States)

    Williams, Craig A; Gowing, Lucy; Horn, Richard; Stuart, Alan Graham

    2017-07-01

    Physical activity and exercise have important health benefits for children and adolescents with CHD. The objective of this study was to survey the provision of advice and recommendations in United Kingdom paediatric CHD clinics. A three-page questionnaire was sent out to paediatric cardiac consultants in the United Kingdom, paediatric consultants with expertise in cardiology, and nursing staff (Paediatricians with Expertise in Cardiology Special Interest Group), as well as all members of the British Congenital Cardiovascular Association. The aim of this questionnaire was to determine the extent and scope of current information provision and to assess the importance that clinicians place on this advice. There were 68 responses in total, and the data showed that, of these, 24 (36%) clinicians had never provided paediatric CHD patients with written advice about exercise. Only 27 (39%) clinicians provided physical activity advice at every appointment. Lack of time during consultation (n=39, 56.9%), lack of training (n=38, 55.2%), and uncertainty about appropriate recommendations (n=38, 55.2%) were identified as the main factors preventing clinicians from providing patients with advice about physical activity. Although healthcare providers consider physical activity to be very important, the provision of clear, specific advice and recommendations is underutilised; therefore, more education and provision of resources to support the promotion of exercise need to be provided to clinicians and their support teams.

  1. Which Obstacles Prevent Us from Recruiting into Clinical Trials: A Survey about the Environment for Clinical Studies at a German University Hospital in a Comprehensive Cancer Center

    Directory of Open Access Journals (Sweden)

    Christoph Straube

    2017-08-01

    Full Text Available BackgroundProspective clinical studies are the most important tool in modern medicine. The standard in good clinical practice in clinical trials has constantly improved leading to more sophisticated protocols. Moreover, translational questions are increasingly addressed in clinical trials. Such trials must follow elaborate rules and regulations. This is accompanied by a significant increase in documentation issues which require substantial manpower. Furthermore, university-based clinical centers are interested in increasing the amount of patients treated within clinical trials, and this number has evolved to be a key quality criterion. The present study was initiated to elucidate the obstacles that limit clinical scientists in screening and recruiting for clinical trials.MethodsA specific questionnaire with 28 questions was developed focusing on all aspects of clinical trial design as well as trial management. This included questions on organizational issues, medical topics as well as potential patients’ preferences and physician’s goals. The questionnaire was established to collect data anonymously on a web-based platform. The survey was conducted within the Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich; physicians of all levels (Department Chairs, attending physicians, residents, as well as study nurses, and other study-related staff were addressed. The answers were analyzed using the Survio analyzing tool (http://www.survio.com/de/.ResultsWe collected 42 complete sets of answers; in total 28 physicians, 11 study nurses, and 3 persons with positions in administration answered our survey. The study centers reported to participate in a range of 3–160 clinical trials with a recruitment rate of 1–80%. Main obstacles were determined: 31/42 (74% complained about limited human resources and 22/42 (52% reported to have a lack on technical resources, too. 30/42 (71% consented to the answer, that the documentation

  2. [Clinical research and data collection during the investigation: Influence of a dedicated staff].

    Science.gov (United States)

    Ghenim, Sabine; Féron, Thomas; Barbe, Coralie; Wolak-Thierry, Aurore; Jolly, Damien

    2017-11-11

    In clinical research, the recourse to a staff dedicated as CRA with the investigator is common practice to facilitate the work of collection and limiting the missing data (MD). We, therefore, looked for the interest of the recourse of such personnel to data collection. MD were classified according to five categories: clinical, para-clinical, treatment, adverse events (serious) and others. Studies were separated in two designs, one-off studies during a single visit (so-called "no follow") and studies on the duration and including several visits (say "with follow"). Similarly, studies were differentiated according to their type of collection "Without ARC" if the data were collected by an investigator, and studies "With ARC". The presence of a CRA can reduce the number of MD whatever their type (Student test: Pdata collection to a staff dedicated reduces significantly the percentage of missing data. Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  3. Investigational glucagon receptor antagonists in Phase I and II clinical trials for diabetes.

    Science.gov (United States)

    Scheen, André J; Paquot, Nicolas; Lefèbvre, Pierre J

    2017-12-01

    Despite type 2 diabetes (T2D) being recognized as a bihormonal pancreatic disease, current therapies are mainly focusing on insulin, while targeting glucagon has been long dismissed. However, glucagon receptor (GCGr) antagonists are currently investigated in clinical trials. Area covered: Following a brief description of the rationale for antagonizing GCGr in T2D, lessons from GCGr knock-out mice and pharmacological means to antagonize GCGr, a detailed description of the main results obtained with GCGr antagonists in Phase I-II clinical trials is provided. The development of several small molecules has been discontinued, while new ones are currently considered as well as innovative approaches such as monoclonal antibodies or antisense oligonucleotides inhibiting GCGr gene expression. Their potential benefits but also limitations are discussed. Expert opinion: The proof-of-concept that antagonizing GCGr improves glucose control in T2D has been confirmed in humans. Nevertheless, some adverse events led to stopping the development of some of these GCGr antagonists. New approaches seem to have a better benefit/risk balance, although none has progressed to Phase III clinical trials so far. Pharmacotherapy of T2D is becoming a highly competitive field so that GCGr antagonists should provide clear advantages over numerous existing glucose-lowering medications before eventually reaching clinical practice.

  4. Investigating clinical predictors of arteriovenous fistula functional patency in a European cohort.

    Science.gov (United States)

    Masengu, Agnes; Maxwell, Alexander P; Hanko, Jennifer B

    2016-02-01

    Arteriovenous fistula (AVF) failure to mature (FTM) rates contribute to excessive dependence on central venous catheters for haemodialysis. Choosing the most appropriate vascular access site for an individual patient is guided largely by their age, co-morbidities and clinical examination. We investigated the clinical predictors of AVF FTM in a European cohort of patients and applied an existing clinical risk prediction model for AVF FTM to this population. A prospective cohort study was designed that included all patients undergoing AVF creation between January 2009 and December 2014 in a single centre (Belfast City Hospital) who had a functional AVF outcome observed by March 2015. A total of 525 patients had a functional AVF outcome recorded and were included in the FTM analysis. In this cohort, 309 (59%) patients achieved functional AVF patency and 216 (41%) patients had FTM. Female gender [P functional patency and ultimately survival in dialysis patients. Clinical predictors of AVF FTM may not be sufficient on their own to improve vascular access functional patency rates.

  5. A family cluster of streptococcal toxic shock syndrome in children: clinical implication and epidemiological investigation.

    Science.gov (United States)

    Huang, Y C; Hsueh, P R; Lin, T Y; Yan, D C; Hsia, S H

    2001-05-01

    Most invasive group A streptococcal (GAS) disease occurs sporadically. Reports of family clusters of these infections are scanty, and most invasive disease occurs in adults. We describe a family cluster of streptococcal toxic shock syndrome (STSS) involving 3 children and present the results of an epidemiologic investigation. During a 16-day period, 3 children in a family developed STSS with an interval of 7 and 9 days, respectively, between the onset of disease. Cases 2 and 3 had GAS isolated from blood culture. Case 2 was fatal. Pharyngeal culture survey of the family members and schoolchildren was conducted. Antibiogram, serotyping, detection of exotoxin genes, and random amplified polymorphic DNA patterns of the disease strains and survey strains were examined. One of 15 family members sampled-the sister of the index case-and 7 (5.6%) of 125 schoolchildren sampled had GAS isolated from pharyngeal cultures. Of the 10 strains examined, 2 isolates from the patients, 1 from the sister of index case, and 2 from the classmates of case 2 (the fatal case) had an identical pattern of both genotype and phenotype. We describe a family cluster of STSS involving 3 children caused by a single clone and provide additional data regarding invasive GAS infection subsequent to household contact. Additional studies should be conducted in conjunction with surveillance to define better the magnitude of risk in household contacts and to identify settings in which subsequent infections may occur.

  6. Pharmacy Students' Knowledge and Attitude toward Registration Trials and Clinical Research: A Survey in a Japanese University Hospital.

    Science.gov (United States)

    Ise, Natsuko; Takechi, Kenshi; Miyamoto, Toshiko; Ishizawa, Keisuke; Yanagawa, Hiroaki

    2017-12-11

    Clinical research plays a fundamental role in establishing new treatments. Clinical research coordinators are considered essential in clinical research, and medical professionals such as pharmacists often take on this role. Pharmacy students can be considered future candidates for this task. We used questionnaires to survey the knowledge of and attitudes toward registration trials and clinical research of pharmacy students at Tokushima University Hospital. All pharmacy students (103) to whom questionnaires were sent responded. Almost all respondents were aware of registration trials and clinical research. More than 90% were aware of the existence of clinical research coordinators, and about half (48.6%) understood their role. In clinical research terminology, most respondents were aware of informed consent and related issues, but fewer than 20% were aware of more practical things. In total, 29.1% and 40.8% of the respondents were willing to carry out and coordinate research. These findings suggest that pharmacy students have basic knowledge of clinical research and that many students are willing to carry out and coordinate clinical research. More practical exposure to clinical research may help to strengthen their future contribution. Further studies may help to determine how to provide education on registration trials and clinical research to pharmacy students.

  7. The Housing Careers of Older Canadians: An Investigation Using Cycle 16 of the General Social Survey

    Directory of Open Access Journals (Sweden)

    Michael Haan

    2008-12-01

    Full Text Available In this paper we use the Aging and Social Support Survey (GSS16 and the theoretical conception of a ‘housing career’ to identify the correlates of housing tenure (rent vs. own among Canadians age 45 and over. We draw on primarily US literature to isolate three general explanatory clusters (social support, health, and economic characteristics. Based on analyses using logistic regression, the results indicate that the majority of variation in housing tenure exists due to standard demographic and household characteristics. In fact, of the three focal explanatory clusters, only social support characteristics significantly enhance model fit beyond the baseline model, suggesting that the housing tenure of older Canadians hinges heavily on fairly standard characteristics.

  8. The qualitative findings from an online survey investigating nurses' perceptions of spirituality and spiritual care.

    Science.gov (United States)

    McSherry, Wilfred; Jamieson, Steve

    2013-11-01

    To provide an opportunity for members to express their understandings of spirituality and spiritual care. The role and place of spirituality within nursing have been contested by academics and wider society. One argument posited is supporting patients with their spiritual needs is not the responsibility of nurses. This is despite a clear professional requirement for nurses to achieve competence in the delivery of spiritual care. The Royal College of Nursing (RCN) conducted an online survey of its membership to ascertain their perceptions of spirituality and spiritual care identifying current practice. This article presents the findings from the final part of the survey that asked respondents to use a free-text facility to add comments on the subjects of spirituality and spiritual care. Overall, 4054 RCN members responded, of these 2327 provided additional comments. These comments were analysed using keyword and content/thematic analysis. Five broad themes emerged: (1) theoretical and conceptual understanding of spirituality, (2) fundamental aspects of nursing, (3) notion of integration and integrated care, (4) education and professional development and (5) religious belief and professional practice. Findings suggest that nurses have diverse understandings of spirituality and the majority consider spirituality to be an integral and fundamental element of the nurses' role. Generally, nurses had a broad, inclusive understanding of spirituality considering this to be 'universal'. There was some uncertainty and fear surrounding the boundaries between personal belief and professional practice. Respondents advocated formal integration of spirituality within programmes of nurse education. The concept of spirituality and the provision of spiritual care are now recognised as fundamental aspects of the nurse's role. There is a need for greater clarity between personal and professional boundaries to enable nurses to feel more confident and competent in delivering spiritual

  9. Variations in the clinical practice of physicians managing Takayasu arteritis: a nationwide survey

    Directory of Open Access Journals (Sweden)

    Barra L

    2017-05-01

    Full Text Available Lillian Barra,1 Patrick Liang,2 Susanne M Benseler,3 David A Cabral,4 Aurore Fifi-Mah,5 Yueyang Li,1 Nataliya Milman,6 Marinka Twilt,3 Elaine Yacyshyn,7 Christian Pagnoux8 1Division of Rheumatology, The University of Western Ontario, St Joseph’s Health Care, London, Ontario, 2Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, 3Division of Rheumatology, Department of Paediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, 4Division of Rheumatology, BC Children’s Hospital, Vancouver, British Columbia, 5Division of Rheumatology, South Health Campus, University of Calgary, Calgary, Alberta, 6Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, 7Division of Rheumatology, University of Alberta, Edmonton, Alberta, 8Department of Rheumatology, Mount Sinai Hospital, Toronto, University of Toronto, Ontario, Canada Objective: Takayasu arteritis (TAK is a large vessel vasculitis that predominately affects young women and can cause severe ischemic complications. Given the rarity of TAK, the management of this condition is challenging. We aim to describe current rheumatologist practices for the management of TAK and identify discrepancies and gaps in knowledge. Methods: An online survey (developed by the Canadian Vasculitis Network and approved by the Canadian Rheumatology Association containing 48 questions with regard to the diagnosis, monitoring and treatment of TAK was distributed to 495 Canadian adult and pediatric rheumatologists by email. Results: Sixty-six rheumatologists completed the survey (13% response rate: the majority (73% were from academic centers and ≤25% reported managing more than ten patients in their career. For establishing the diagnosis of TAK, they relied on a combination of signs and symptoms of ischemia, elevations of inflammatory markers and vascular imaging (typically computed tomography and magnetic resonance angiography. The

  10. How Do Emergency Medicine Residency Programs Structure Their Clinical Competency Committees? A Survey.

    Science.gov (United States)

    Doty, Christopher I; Roppolo, Lynn P; Asher, Shellie; Seamon, Jason P; Bhat, Rahul; Taft, Stephanie; Graham, Autumn; Willis, James

    2015-11-01

    The Accreditation Council for Graduate Medical Education (ACGME) recently has mandated the formation of a clinical competency committee (CCC) to evaluate residents across the newly defined milestone continuum. The ACGME has been nonproscriptive of how these CCCs are to be structured in order to provide flexibility to the programs. No best practices for the formation of CCCs currently exist. We seek to determine common structures of CCCs recently formed in the Council of Emergency Medicine Residency Directors (CORD) member programs and identify unique structures that have been developed. In this descriptive study, an 18-question survey was distributed via the CORD listserv in the late fall of 2013. Each member program was asked questions about the structure of its CCC. These responses were analyzed with simple descriptive statistics. A total of 116 of the 160 programs responded, giving a 73% response rate. Of responders, most (71.6%) CCCs are chaired by the associate or assistant program director, while a small number (14.7%) are chaired by a core faculty member. Program directors (PDs) chair 12.1% of CCCs. Most CCCs are attended by the PD (85.3%) and selected core faculty members (78.5%), leaving the remaining committees attended by any core faculty. Voting members of the CCC consist of the residency leadership either with the PD (53.9%) or without the PD (36.5%) as a voting member. CCCs have an average attendance of 7.4 members with a range of three to 15 members. Of respondents, 53.1% of CCCs meet quarterly while 37% meet monthly. The majority of programs (76.4%) report a system to match residents with a faculty mentor or advisor. Of respondents, 36% include the resident's faculty mentor or advisor to discuss a particular resident. Milestone summaries (determination of level for each milestone) are the primary focus of discussion (93.8%), utilizing multiple sources of information. The substantial variability and diversity found in our CORD survey of CCC structure

  11. Investigating the connections between health lean management and clinical risk management.

    Science.gov (United States)

    Crema, Maria; Verbano, Chiara

    2015-01-01

    The purpose of this paper is to investigate connections and overlaps between health lean management (HLM) and clinical risk management (CRM) understanding whether and how these two approaches can be combined together to pursue efficiency and patient safety improvements simultaneously. A systematic literature review has been carried out. Searching in academic databases, papers that focus not only on HLM, but also on clinical errors and risk reduction, were included. The general characteristics of the selected papers were analysed and a content analysis was conducted. In most of the papers, pursing objectives of HLM and CRM and adopting tools and practices of both approaches, results of quality and, particularly, of safety improvements were obtained. A two-way arrow between HLM and CRM emerged but so far, none of the studies has been focused on the relationship between HLM and CRM. Results highlight an emerging research stream, with many useful theoretical and practical implications and opportunities for further research.

  12. Sustaining the Clinical and Translational Research Workforce: Training and Empowering the Next Generation of Investigators.

    Science.gov (United States)

    Yin, Helen L; Gabrilove, Janice; Jackson, Rebecca; Sweeney, Carol; Fair, Alecia M; Toto, Robert

    2015-07-01

    There is mounting concern that clinician-scientists are a vanishing species and that the pipeline for clinical and translational research (CTR) investigators is in jeopardy. For the majority of current junior CTR investigators, the career path involves first obtaining a National Institutes of Health (NIH)-funded K-type career development award, particularly K08 and K23, and subsequently an NIH R01. This transition, popularly referred to as K2R, is a major hurdle with a low success rate and gaps in funding. In this Perspective, the authors identify factors that facilitate K2R transition and important aspects of increasing and sustaining the pipeline of CTR investigators. They also highlight significant differences in success rates of women and those underrepresented in biomedical research. Early career exposure to research methodology, protected time, multidisciplinary mentoring, and institutional "culture shift" are important for fostering and rewarding team science. Mentoring is the single most important contributor to K2R success, and emerging evidence suggests that formal mentor training and team mentoring are effective. Leadership training can empower junior investigators to thrive as independent CTR investigators. Future research should focus on delineating the difference between essential and supplemental factors to achieve this transition, and mentoring methods that foster success, including those that promote K2R transition of women and those underrepresented in biomedical research. The Clinical and Translational Science Awards National Consortium is well positioned to test existing models aimed at shortening the time frame, increasing the rate of K2R transition, and identifying strategies that improve success.

  13. PERSPECTIVE: Is acuity enough? Other considerations in clinical investigations of visual prostheses

    Science.gov (United States)

    Lepri, Bernard P.

    2009-06-01

    Visual impairing eye diseases are the major frontier facing ophthalmic research today in light of our rapidly aging population. The visual skills necessary for improving the quality of daily function and life are inextricably linked to these impairing diseases. Both research and reimbursement programs are emphasizing outcome-based results. Is improvement in visual acuity alone enough to improve the function and quality of life of visually impaired persons? This perspective summarizes the types of effectiveness endpoints for clinical investigations of visual prostheses that go beyond visual acuity. The clinical investigation of visual prostheses should include visual function, functional vision and quality of life measures. Specifically, they encompass contrast sensitivity, orientation and mobility, activities of daily living and quality of life assessments. The perspective focuses on the design of clinical trials for visual prostheses and the methods of determining effectiveness above and beyond visual acuity that will yield outcomes that are measured by improved function in the visual world and quality of life. The visually impaired population is the primary consideration in this presentation with particular emphases on retinitis pigmentosa and age-related macular degeneration. Clinical trials for visual prostheses cannot be isolated from the need for medical rehabilitation in order to obtain measurements of effectiveness that produce outcomes/evidence-based success. This approach will facilitate improvement in daily function and quality of life of patients with diseases that cause chronic vision impairment. The views and opinions are those of the author and do not necessarily reflect those of the US Food and Drug Administration, the US Department of Health and Human Services or the Public Health Service.

  14. The clinical utility of fluorodeoxyglucose-positron emission tomography for investigation of fever in immunocompromised children.

    Science.gov (United States)

    Wang, Shiqi Stacie; Mechinaud, Francoise; Thursky, Karin; Cain, Timothy; Lau, Eddie; Haeusler, Gabrielle M

    2017-12-13

    Fever in immunocompromised children presents significant challenges. We aimed to determine the clinical impact of fluorodeoxyglucose-positron emission tomography (FDG-PET) in combination with computed tomography (CT) in children with malignancy or following haematopoietic stem cell transplantation with prolonged or recurrent fever. Immunocompromised children who underwent FDG-PET/CT for investigation of prolonged or recurrent fever were identified from hospital databases. The clinical impact of the FDG-PET/CT was considered 'high' if it contributed to any of the following: diagnosis of a new site infection/inflammation, change to antimicrobials or chemotherapy, or additional investigations or specialist consult contributing to final diagnosis. Fourteen patients underwent an FDG-PET/CT for prolonged or recurrent fever. Median age was 11 years and 46% had diagnosis of acute lymphoblastic leukaemia. The median absolute neutrophil count on the day of FDG-PET/CT was 0.47 cells/μL. The clinical impact of FDG-PET/CT was 'high' in 11 (79%) patients, contributing to rationalisation of antimicrobials in three, and cessation of antimicrobials in five. Compared to conventional imaging, FDG PET/CT identified seven additional sites of clinically significant infection/inflammation in seven patients. Of the 10 patients who had a cause of fever identified, FDG-PET/CT contributed to the final diagnosis in six (60%). This study has identified potential utility for FDG-PET/CT in immunocompromised children with prolonged or recurrent fever. Further prospective studies are needed to compare FDG-PET/CT versus conventional imaging, to identify the optimal timing of FDG-PET/CT and to study the role of subsequent scans to monitor response to therapy. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  15. Good clinical teachers likely to be specialist role models: results from a multicenter cross-sectional survey.

    Science.gov (United States)

    Lombarts, Kiki M J M H; Heineman, Maas Jan; Arah, Onyebuchi A

    2010-12-29

    Medical educational reform includes enhancing role modelling of clinical teachers. This requires faculty being aware of their role model status and performance. We developed the System for Evaluation of Teaching Qualities (SETQ) to generate individualized feedback on previously defined teaching qualities and role model status for faculty in (non) academic hospitals. (i) To examine whether teaching qualities of faculty were associated with their being seen as a specialist role model by residents, and (ii) to investigate whether those associations differed across residency years and specialties. Cross-sectional questionnaire survey amongst 549 Residents of 36 teaching programs in 15 hospitals in the Netherlands. The main outcome measure was faculty being seen as specialist role models by residents. Statistical analyses included (i) Pearson's correlation coefficients and (ii) multivariable logistic generalized estimating equations to assess the (adjusted) associations between each of five teaching qualities and 'being seen as a role model'. 407 residents completed a total of 4123 evaluations of 662 faculty. All teaching qualities were positively correlated with 'being seen as a role model' with correlation coefficients ranging from 0.49 for 'evaluation of residents' to 0.64 for 'learning climate' (Pprofessional attitude towards residents' (OR 2.70, 95% CI: 2.34-3.10) and 'creating a positive learning climate' (OR 2.45, 95% CI: 1.97-3.04). Results did not seem to vary much across residency years. The relative strength of associations between teaching qualities and being seen as a role model were more distinct when comparing specialties. Good clinical educators are more likely to be seen as specialist role models for most residents.

  16. [France, an attractive country for international clinical research: 2008 survey assessed by Leem (French association of pharmaceutical companies)].

    Science.gov (United States)

    Lassale, Catherine; Sibenaler, Claire; Béhier, Jehan-Michel; Plétan, Yannick; Courcier, Soizic

    2008-01-01

    In order to evaluate the attractiveness of France for conducting international clinical trials, a survey is performed every two years among pharmaceutical companies that are based in France or have affiliates in France. Nineteen companies (61.9 % of the French market) have participated in the current survey which included 385 international phase II and III clinical studies, 77 countries, 29,708 centres and 312,835 patients (included in 2006/2007). France (400 patients/million inhabitants) ranked among the best European recruiters in second position behind Scandinavia. Since 2006, France has improved administrative processes and reduced deadlines for hospital contracts. Protocols are now to be given the go-ahead by French Authorities (Afssaps and CPP) within 60 days, in accordance with European directive. Its performance in early phases, oncology/hematology and vaccines/anti-infectious contribute to the attractiveness of France in international clinical research.

  17. Competence of clinical teachers: A survey on perception of masters of nursing specialist postgraduates, their clinical teachers, and head nurses

    Directory of Open Access Journals (Sweden)

    Xiao-fen Wang

    2017-04-01

    Conclusion: The evaluation from MNS postgraduates is obviously lower than the self-evaluation of clinical teachers, and all participants are aware of the deficiency in research ability of the teachers. Thus, the admittance and examination of clinical teachers should be controlled strictly. Training should be carried out immediately to strengthen their comprehensive abilities, especially their research ability.

  18. Clinical Reasoning Education at US Medical Schools: Results from a National Survey of Internal Medicine Clerkship Directors.

    Science.gov (United States)

    Rencic, Joseph; Trowbridge, Robert L; Fagan, Mark; Szauter, Karen; Durning, Steven

    2017-11-01

    Recent reports, including the Institute of Medicine's Improving Diagnosis in Health Care, highlight the pervasiveness and underappreciated harm of diagnostic error, and recommend enhancing health care professional education in diagnostic reasoning. However, little is known about clinical reasoning curricula at US medical schools. To describe clinical reasoning curricula at US medical schools and to determine the attitudes of internal medicine clerkship directors toward teaching of clinical reasoning. Cross-sectional multicenter study. US institutional members of the Clerkship Directors in Internal Medicine (CDIM). Examined responses to a survey that was emailed in May 2015 to CDIM institutional representatives, who reported on their medical school's clinical reasoning curriculum. The response rate was 74% (91/123). Most respondents reported that a structured curriculum in clinical reasoning should be taught in all phases of medical education, including the preclinical years (64/85; 75%), clinical clerkships (76/87; 87%), and the fourth year (75/88; 85%), and that more curricular time should be devoted to the topic. Respondents indicated that most students enter the clerkship with only poor (25/85; 29%) to fair (47/85; 55%) knowledge of key clinical reasoning concepts. Most institutions (52/91; 57%) surveyed lacked sessions dedicated to these topics. Lack of curricular time (59/67, 88%) and faculty expertise in teaching these concepts (53/76, 69%) were identified as barriers. Internal medicine clerkship directors believe that clinical reasoning should be taught throughout the 4 years of medical school, with the greatest emphasis in the clinical years. However, only a minority reported having teaching sessions devoted to clinical reasoning, citing a lack of curricular time and faculty expertise as the largest barriers. Our findings suggest that additional institutional and national resources should be dedicated to developing clinical reasoning curricula to improve

  19. Clinical investigations of the therapeutic potential of ayahuasca: rationale and regulatory challenges.

    Science.gov (United States)

    McKenna, Dennis J

    2004-05-01

    Ayahuasca is a hallucinogenic beverage that is prominent in the ethnomedicine and shamanism of indigenous Amazonian tribes. Its unique pharmacology depends on the oral activity of the hallucinogen, N,N-dimethyltryptamine (DMT), which results from inhibition of monoamine oxidase (MAO) by beta-carboline alkaloids. MAO is the enzyme that normally degrades DMT in the liver and gut. Ayahuasca has long been integrated into mestizo folk medicine in the northwest Amazon. In Brazil, it is used as a sacrament by several syncretic churches. Some of these organizations have incorporated in the United States. The recreational and religious use of ayahuasca in the United States, as well as "ayahuasca tourism" in the Amazon, is increasing. The current legal status of ayahuasca or its source plants in the United States is unclear, although DMT is a Schedule I controlled substance. One ayahuasca church has received favorable rulings in 2 federal courts in response to its petition to the Department of Justice for the right to use ayahuasca under the Religious Freedom Restoration Act. A biomedical study of one of the churches, the Uñiao do Vegetal (UDV), indicated that ayahuasca may have therapeutic applications for the treatment of alcoholism, substance abuse, and possibly other disorders. Clinical studies conducted in Spain have demonstrated that ayahuasca can be used safely in normal healthy adults, but have done little to clarify its potential therapeutic uses. Because of ayahuasca's ill-defined legal status and variable botanical and chemical composition, clinical investigations in the United States, ideally under an approved Investigational New Drug (IND) protocol, are complicated by both regulatory and methodological issues. This article provides an overview of ayahuasca and discusses some of the challenges that must be overcome before it can be clinically investigated in the United States.

  20. Perception survey on the introduction of clinical performance examination as part of the national nursing licensing examination in Korea

    Directory of Open Access Journals (Sweden)

    Su Jin Shin

    2017-10-01

    Full Text Available Purpose The purpose of this study was to analyze opinions about the action plan for implementation of clinical performance exam as part of the national nursing licensing examination and presents the expected effects of the performance exam and aspects to consider regarding its implementation. Methods This study used a mixed-methods design. Quantitative data were collected by a questionnaire survey, while qualitative data were collected by focus group interviews with experts. The survey targeted 200 nursing professors and clinical nurses with more than 5 years of work experience, and the focus group interviews were conducted with 28 of professors, clinical instructors, and nurses at hospitals. Results First, nursing professors and clinical specialists agreed that the current written tests have limitations in evaluating examinees’ ability, and that the introduction of a clinical performance exam will yield positive results. Clinical performance exam is necessary to evaluate and improve nurses’ work ability, which means that the implementation of a performance exam is advisable if its credibility and validity can be verified. Second, most respondents chose direct performance exams using simulators or standardized patients as the most suitable format of the test. Conclusion In conclusion, the current national nursing licensing exam is somewhat limited in its ability to identify competent nurses. Thus, the time has come for us to seriously consider the introduction of a performance exam. The prerequisites for successfully implementing clinical performance exam as part of the national nursing licensing exam are a professional training process and forming a consortium to standardize practical training.

  1. Barriers to implementing evidence-based clinical guidelines: A survey of early adopters

    Science.gov (United States)

    Spallek, Heiko; Song, Mei; Polk, Deborah E; Bekhuis, Tanja; Frantsve-Hawley, Julie; Aravamudhan, Krishna

    2010-01-01

    Objective The purpose of this study is to identify barriers that early-adopting dentists perceive as common and challenging when implementing recommendations from evidence-based (EB) clinical guidelines. Method This is a cross-sectional study. Dentists who attended the 2008 Evidence-based Dentistry Champion Conference were eligible for inclusion. Forty-three dentists (34%) responded to a 22-item questionnaire administered online. Two investigators independently coded and categorized responses to open-ended items. Descriptive statistics were computed to assess the frequency of barriers and perceived challenges. Results The most common barriers to implementation are difficulty in changing current practice model, resistance and criticism from colleagues, and lack of trust in evidence or research. Barriers perceived as serious problems have to do with lack of up-to-date evidence, lack of clear answers to clinical questions, and contradictory information in the scientific literature. Conclusions Knowledge of barriers will help improve translation of biomedical research for dentists. Information in guidelines needs to be current, clear, and simplified for use at chairside; dentists’ fears need to be addressed. PMID:21093800

  2. Comparing administrative and survey data for ascertaining cases of irritable bowel syndrome: a population-based investigation

    Directory of Open Access Journals (Sweden)

    Targownick Laura E

    2010-02-01

    Full Text Available Abstract Background Administrative and survey data are two key data sources for population-based research about chronic disease. The objectives of this methodological paper are to: (1 estimate agreement between the two data sources for irritable bowel syndrome (IBS and compare the results to those for inflammatory bowel disease (IBD; (2 compare the frequency of IBS-related diagnoses in administrative data for survey respondents with and without self-reported IBS, and (3 estimate IBS prevalence from both sources. Methods This retrospective cohort study used linked administrative and health survey data for 5,134 adults from the province of Manitoba, Canada. Diagnoses in hospital and physician administrative data were investigated for respondents with self-reported IBS, IBD, and no bowel disorder. Agreement between survey and administrative data was estimated using the κ statistic. The χ2 statistic tested the association between the frequency of IBS-related diagnoses and self-reported IBS. Crude, sex-specific, and age-specific IBS prevalence estimates were calculated from both sources. Results Overall, 3.0% of the cohort had self-reported IBS, 0.8% had self-reported IBD, and 95.3% reported no bowel disorder. Agreement was poor to fair for IBS and substantially higher for IBD. The most frequent IBS-related diagnoses among the cohort were anxiety disorders (34.4%, symptoms of the abdomen and pelvis (26.9%, and diverticulitis of the intestine (10.6%. Crude IBS prevalence estimates from both sources were lower than those reported previously. Conclusions Poor agreement between administrative and survey data for IBS may account for differences in the results of health services and outcomes research using these sources. Further research is needed to identify the optimal method(s to ascertain IBS cases in both data sources.

  3. Emotional labour, job satisfaction and organizational commitment amongst clinical nurses: a questionnaire survey.

    Science.gov (United States)

    Yang, Feng-Hua; Chang, Chen-Chieh

    2008-06-01

    According to Hochschild's (1983. The Managed Heart. Berkeley: University of California Press) classification of emotional labour, nursing staff express high emotional labour. This paper investigates how nursing staff influence job satisfaction and organizational commitment when they perform emotional labour. This paper examines the relationship between emotional labour, job satisfaction, and organizational commitment from the perspective of nursing staff. A questionnaire survey was carried out to explore these interrelationships. Teaching hospital in Taiwan. Questionnaires were distributed to 500 nursing staff; 295 valid questionnaires were collected and analysed-a 59% response rate. The questionnaires contained items on emotional labour, job satisfaction, and organizational commitment as well as some basic socio-demographics. In addition, descriptive statistics, correlation and linear structure relation (LISREL) were computed. Emotional display rule (EDR) was significantly and negatively related to job satisfaction. Surface acting (SA) was not significantly related to job satisfaction but demonstrated a significantly negative relationship with organizational commitment. Deep acting (DA) significantly and positively correlated with job satisfaction but demonstrated no significance with organizational commitment. The variety of emotions required (VER) was not significantly related to job satisfaction; frequency and duration of interaction (FDI) and negatively related to job satisfaction; and job satisfaction significantly and positively correlated with organizational commitment. We found that some dimensions of emotional labour significantly relate to job satisfaction. Job satisfaction positively affects organizational commitment and has an intervening effect on DA and organizational commitment.

  4. Does the use of a university lecturer as a visiting tutor support learning and assessment during physiotherapy students' clinical placements? A survey of higher education institution providers.

    Science.gov (United States)

    Dean, M; Levis, A

    2016-12-01

    To establish the rationale for using a lecturer as a visiting tutor, and to identify the activities undertaken during clinical placements to support student learning and assessment in practice. A secure electronic survey was used to incorporate qualitative and quantitative data collection procedures. Thirty-three higher education institution (HEI) providers of physiotherapy education in the UK, registered with the Chartered Society of Physiotherapy. UK HEI physiotherapy placement coordinators. A questionnaire was used to examine HEI perceptions. A pilot focus group consultation informed the questionnaire content. Surveys were analysed based on the proportion of responses to closed questions on an adapted Likert scale, with further thematic analysis of open questions. All 25 respondents (25/33, 76%) indicated their provision of support for students and clinical educators throughout their clinical placements. 'Face-to-face' engagement during the placement visit was viewed as essential to guide the clinical educator to provide a consistent approach to learning and assessment strategies; ensuring cohesion between theoretical and clinical components of the curriculum was viewed as a core objective by visiting academic tutors. However, the emergent themes highlighted key differences between HEIs' perspectives of what this support for clinical placement learning should entail. The majority of HEIs endorse the use of a lecturer as a visiting tutor to inform and maintain the standard of learning and assessment within the clinical placement. However, the value of this interaction requires confirmation via other stakeholders, and exploration of other forms of non-face-to-face support processes warrant further investigation. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  5. Self-care and adherence to medication: a survey in the hypertension outpatient clinic

    Directory of Open Access Journals (Sweden)

    Lip Gregory YH

    2008-02-01

    Full Text Available Abstract Background Self-care practices for patients with hypertension include adherence to medication, use of blood pressure self-monitoring and use of complementary and alternative therapies (CAM The prevalence of CAM use and blood pressure self-monitoring have not been described in a UK secondary care population of patients with hypertension and their impact on adherence to medication has not been described. Adherence to medication is important for blood pressure control, but poor adherence is common. The study aimed to determine the prevalence of self-care behaviours in patients attending a secondary care hypertension clinic. Methods Cross-sectional questionnaire survey. 196 patients attending a secondary care hypertension clinic in a teaching hospital serving a multiethnic population, Birmingham, UK. Main outcome measures: Prevalence of use of CAM, home monitors, adherence to anti-hypertensive medication. Results CAM use in previous 12 months was reported by 66 (43.1% respondents. CAM users did not differ statistically from non-CAM users by age, gender, marital status or education. Vitamins, prayer a dietary supplements were the most commonly used CAM. Nine (12.7% women reported using herbal CAM compared to one man (1.2%, (p = 0.006. Ten (6.7% respondents reported ever being asked by a doctor about CAM use. Perfect adherence to anti-hypertensive medication was reported by 26 (44.8% CAM-users and 46 (60.5% non-CAM users (p = 0.07. Being female and a CAM user was significantly associated with imperfect adherence to anti-hypertensive medication. Older and white British respondents were significantly more likely to report perfect adherence. Blood pressure monitors were used by 67 (43.8% respondents, which was not associated with gender, CAM use or adherence to medication. Conclusion Hypertensive patients use a variety of self-care methods, including CAM, home blood pressure monitors, and adherence to prescribed medication. This study found the

  6. Graduates' perceptions of their clinical competencies in allergy and immunology: results of a survey.

    Science.gov (United States)

    Li, James T-C; Stoll, Doris A; Smith, June E; Lin, John J; Swing, Susan R

    2003-09-01

    The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) have identified six areas of general competency. This study surveyed graduates of allergy and immunology training programs about their perceived clinical competency and the adequacy of their subspecialty training. In August 2000 and May 2001, a questionnaire was mailed to 373 physicians who had completed a fellowship in allergy and immunology in the United States between 1995 and 2001. Physicians were asked to rate the perceived importance and adequacy of their training in, and their level of competency for, 57 general competencies and subspecialty-specific competencies and procedures. A total of 253 physicians responded (68%). All items in the six ACGME/ABMS general competencies had high ratings (>/= 90%) for perceived importance. One item in the practice-based learning area had low ratings for adequacy of training (57%) and intermediate for competency (75%). Two items in the system-based practice area had low ratings for training (65% and 67%) and intermediate for competency (86% and 88%). Generally, core specialty-specific items (allergic rhinitis, asthma, and urticaria) had high ratings (>/= 90%) for importance, training, and competency. Without exception, items with ratings of less than 70% for adequacy of training also had ratings of less than 90% for competency. The general competencies were considered important, but training in system-based practice and practice-based learning may be deficient. Although self-perceived competency in core areas of allergy and immunology was high, weaknesses in training and self-perceived competency in selected areas were identified.

  7. Clinical preventive services in Guatemala: a cross-sectional survey of internal medicine physicians.

    Directory of Open Access Journals (Sweden)

    Juan E Corral

    Full Text Available Guatemala is currently undergoing an epidemiologic transition. Preventive services are key to reducing the burden of non-communicable diseases, and smoking counseling and cessation are among the most cost-effective and wide-reaching strategies. Internal medicine physicians are fundamental to providing such services, and their knowledge is a cornerstone of non-communicable disease control.A national cross-sectional survey was conducted in 2011 to evaluate knowledge of clinical preventive services for non-communicable diseases. Interns, residents, and attending physicians of the internal medicine departments of all teaching hospitals in Guatemala completed a self-administered questionnaire. Participants' responses were contrasted with the Guatemalan Ministry of Health (MoH prevention guidelines and the US Preventive Services Task Force (USPSTF recommendations. Analysis compared knowledge of recommendations within and between hospitals.In response to simulated patient scenarios, all services were recommended by more than half of physicians regardless of MoH or USPSTF recommendations. Prioritization was adequate according to the MoH guidelines but not including other potentially effective services (e.g. colorectal cancer and lipid disorder screenings. With the exception of colorectal and prostate cancer screening, less frequently recommended by interns, there was no difference in recommendation rates by level.Guatemalan internal medicine physicians' knowledge on preventive services recommendations for non-communicable diseases is limited, and prioritization did not reflect cost-effectiveness. Based on these data we recommend that preventive medicine training be strengthened and development of evidence-based guidelines for low-middle income countries be a priority.

  8. Investigation of the teaching cognition and capabilities of clinical advisers for masters degree level nursing specialty graduate students

    Directory of Open Access Journals (Sweden)

    Xiao-Lei Zhao

    2014-03-01

    Conclusion: Clinical advisers for nursing specialty graduate students in our survey were generally inexperienced with regarding to training and culturing nursing graduate students. These advisers were prepared for core teaching competency, but were not qualified to conduct scientific research. Based on these results, it would be beneficial to provide the clinical advisers more training on teaching cognition for graduate students and improve their competency to perform scientific research.

  9. Further Investigating Method Effects Associated with Negatively Worded Items on Self-Report Surveys

    Science.gov (United States)

    DiStefano, Christine; Motl, Robert W.

    2006-01-01

    This article used multitrait-multimethod methodology and covariance modeling for an investigation of the presence and correlates of method effects associated with negatively worded items on the Rosenberg Self-Esteem (RSE) scale (Rosenberg, 1989) using a sample of 757 adults. Results showed that method effects associated with negative item phrasing…

  10. Comparative investigations of Klebsiella species of clinical origin: plasmid patterns, biochemical reactions, antibiotic resistances and serotypes.

    Science.gov (United States)

    Podschun, R; Heineken, P; Ullmann, U; Sonntag, H G

    1986-09-01

    A total of 124 K. pneumoniae and 52 K. oxytoca isolates obtained from clinical specimens was investigated for plasmid patterns, biochemical reactions, antibiotic resistances and serotypes regarding to the distribution and relationships of these characters. A great diversity of plasmid patterns, bio/serotypes and resistance patterns was revealed. About 90% of strains contained plasmid DNA and up to seven plasmid bands per isolate could be shown. For K. pneumoniae, serotype 7 and for K. oxytoca, type 55 were most common. In general, little difference between both species was found and characters were similarly distributed. With respect to the site of isolation, serotype 7 was predominating in K. pneumoniae strains from the respiratory tract. Highly multiple-resistant organism were found in the largest number in specimens from the urogenital tract, in the lowest in specimens from wounds. Extensive statistical analyses did not detect any relationship among the characters investigated.

  11. Investigation of open clusters based on IPHAS and APASS survey data

    Science.gov (United States)

    Dambis, A. K.; Glushkova, E. V.; Berdnikov, L. N.; Joshi, Y. C.; Pandey, A. K.

    2017-02-01

    We adapt the classical Q-method based on a reddening-free parameter constructed from three passband magnitudes to the filter set of Isaac Newton Telescope Photometric Hα Survey and combine it with the maximum-likelihood-based cluster parameter estimator by Naylor & Jeffries (2006) to determine the extinction, heliocentric distances, and ages of young open clusters using Hαri data. The method is also adapted for the case of significant variations of extinction across the cluster field. Our technique is validated by comparing the colour excesses, distances, and ages determined in this study with the most bona fide values reported for the 18 well-studied young open clusters in the past and a fairly good agreement is found between our extinction and distance estimates and earlier published results, although our age estimates are not very consistent with those published by other authors. We also show that individual extinction values can be determined rather accurately for stars with (r - i) > 0.1. Our results open up a prospect for determining a uniform set of parameters for northern clusters based on homogeneous photometric data, and for searching for new, hitherto undiscovered open clusters.

  12. An international survey of physicians regarding clinical trials: a comparison between Kyoto University Hospital and Seoul National University Hospital

    Science.gov (United States)

    2013-01-01

    Background International clinical trials are now rapidly expanding into Asia. However, the proportion of global trials is higher in South Korea compared to Japan despite implementation of similar governmental support in both countries. The difference in clinical trial environment might influence the respective physicians’ attitudes and experience towards clinical trials. Therefore, we designed a questionnaire to explore how physicians conceive the issues surrounding clinical trials in both countries. Methods A questionnaire survey was conducted at Kyoto University Hospital (KUHP) and Seoul National University Hospital (SNUH) in 2008. The questionnaire consisted of 15 questions and 2 open-ended questions on broad key issues relating to clinical trials. Results The number of responders was 301 at KUHP and 398 at SNUH. Doctors with trial experience were 196 at KUHP and 150 at SNUH. Among them, 12% (24/196) at KUHP and 41% (61/150) at SUNH had global trial experience. Most respondents at both institutions viewed clinical trials favorably and thought that conducting clinical trials contributed to medical advances, which would ultimately lead to new and better treatments. The main reason raised as a hindrance to conducting clinical trials was the lack of personnel support and time. Doctors at both university hospitals thought that more clinical research coordinators were required to conduct clinical trials more efficiently. KUHP doctors were driven mainly by pure academic interest or for their desire to find new treatments, while obtaining credits for board certification and co-authorship on manuscripts also served as motivation factors for doctors at SNUH. Conclusions Our results revealed that there might be two different approaches to increase clinical trial activity. One is a social level approach to establish clinical trial infrastructure providing sufficient clinical research professionals. The other is an individual level approach that would provide incentives to

  13. 78 FR 48173 - Guidance for Industry on Oversight of Clinical Investigations-A Risk-Based Approach to Monitoring...

    Science.gov (United States)

    2013-08-07

    ... No. FDA-2011-D-0597] Guidance for Industry on Oversight of Clinical Investigations--A Risk-Based... entitled ``Oversight of Clinical Investigations--A Risk-Based Approach to Monitoring.'' This guidance... human drugs, biologics, medical devices, and combinations thereof. The overarching goal of this guidance...

  14. Effect modification, interaction and mediation: an overview of theoretical insights for clinical investigators

    Directory of Open Access Journals (Sweden)

    Corraini P

    2017-06-01

    Full Text Available Priscila Corraini,1 Morten Olsen,1 Lars Pedersen,1 Olaf M Dekkers,1,2 Jan P Vandenbroucke1–3 1Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; 2Leiden University Medical Center, Leiden, the Netherlands; 3Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK Abstract: We revisited the three interrelated epidemiological concepts of effect modification, interaction and mediation for clinical investigators and examined their applicability when using research databases. The standard methods that are available to assess interaction, effect modification and mediation are explained and exemplified. For each concept, we first give a simple “best-case” example from a randomized controlled trial, followed by a structurally similar example from an observational study using research databases. Our explanation of the examples is based on recent theoretical developments and insights in the context of large health care databases. Terminology is sometimes ambiguous for what constitutes effect modification and interaction. The strong assumptions underlying the assessment of interaction, and particularly mediation, require clinicians and epidemiologists to take extra care when conducting observational studies in the context of health care databases. These strong assumptions may limit the applicability of interaction and mediation assessments, at least until the biases and limitations of these assessments when using large research databases are clarified. Keywords: methods, epidemiology, effect modifiers, stratified analyses, health care administrative claims

  15. MX Siting Investigation. Mineral Resources Survey, Seven Additional Valleys, Nevada/Utah Siting Area. Volume I.

    Science.gov (United States)

    1981-06-23

    DIVIDE DISTRICT WITH MONTEZUMA VAL LEY IN THE CENTER BACKGROUND. B - VIEW W - OLD CHERRY CREEK MILL WITH NEW HEAP LEACH PADS UNDER CONSTRUCTION MX...LEFT), AND OLD GOLD PITS (LOWER-CENTER). B - VIEWW CYPRUS VINE’S LEACH PADS AND MILL FACILITIES IN BIG SMOKY VALLEY. ! MX SITING INVESTIGATION ! ErUC...potential is also assigned to most of the Pinto District where Diamond Silverado, Inc. is mining silver and has a heap leach mill operating (Photograph 11B

  16. Clinical FDG PET CT in the Investigation of Suspected Inflammatory and Infective Conditions

    DEFF Research Database (Denmark)

    Lorenz, Eleanor; Wig, Surabhi; Prakash, Vineet

    performed in a tertiary referal centre is presented illustrating its applications and clinical value in the evaluation of suspected or known inflammatory conditions.                   METHOD AND MATERIALS          a retrospective case review of 59 patients was carried out. all patients underwent PET CT......PURPOSE          F18 FDG PET CT is an established molecular imaging technique most commonly used in the diagnosis and staging of oncological conditions. A rapidly growing clinical application of PET CT is in the investigation of inflammatory and infectious diseases. A review of PET CT scans...... scanning after multiple diagnostic investigations failed to determine a diagnosis.                   RESULTS          PET CT was useful in all 59 cases; revealing malignancy in 11 (2 of whom had associated myositis), systemic vasculitis in 9, inflammatory arthropathy in 5, infectious/other inflammatory...

  17. Methods to reduce medication errors in a clinical trial of an investigational parenteral medication

    Directory of Open Access Journals (Sweden)

    Gillian L. Fell

    2016-12-01

    Full Text Available There are few evidence-based guidelines to inform optimal design of complex clinical trials, such as those assessing the safety and efficacy of intravenous drugs administered daily with infusion times over many hours per day and treatment durations that may span years. This study is a retrospective review of inpatient administration deviation reports for an investigational drug that is administered daily with infusion times of 8–24 h, and variable treatment durations for each patient. We report study design modifications made in 2007–2008 aimed at minimizing deviations from an investigational drug infusion protocol approved by an institutional review board and the United States Food and Drug Administration. Modifications were specifically aimed at minimizing errors of infusion rate, incorrect dose, incorrect patient, or wrong drug administered. We found that the rate of these types of administration errors of the study drug was significantly decreased following adoption of the specific study design changes. This report provides guidance in the design of clinical trials testing the safety and efficacy of study drugs administered via intravenous infusion in an inpatient setting so as to minimize drug administration protocol deviations and optimize patient safety.

  18. Promising investigational drug candidates in phase I and phase II clinical trials for mesothelioma.

    Science.gov (United States)

    Guazzelli, Alice; Bakker, Emyr; Tian, Kun; Demonacos, Constantinos; Krstic-Demonacos, Marija; Mutti, Luciano

    2017-08-01

    Malignant mesothelioma is a rare and lethal malignancy primarily affecting the pleura and peritoneum. Mesothelioma incidence is expected to increase worldwide and current treatments remain ineffective, leading to poor prognosis. Within this article potential targets to improve the quality of life of the patients and assessment of further avenues for research are discussed. Areas covered: This review highlights emerging therapies currently under investigation for malignant mesothelioma with a specific focus on phase I and phase II clinical trials. Three main areas are discussed: immunotherapy (immune checkpoint blockade and cancer vaccines, among others), multitargeted therapy (such as targeting pro-angiogenic genes) and gene therapy (such as suicide gene therapy). For each, clinical trials are described to detail the current or past investigations at phase I and II. Expert opinion: The approach of applying existing treatments from other cancers does not show significant benefit, with the most promising outcome being an increase in survival of 2.7 months following combination of chemotherapy with bevacizumab. It is our opinion that the hypoxic microenvironment, the role of the stroma, and the metabolic status of mesothelioma should all be assessed and characterised to aid in the development of new treatments to improve patient outcomes.

  19. SU-F-P-13: NRG Oncology Medical Physics Manpower Survey Quantifying Support Demands for Multi Institutional Clinical Trials

    Energy Technology Data Exchange (ETDEWEB)

    Monroe, J [St. Anthony’s Cancer Center, St. Louis, MO (United States); Case Western Reserve University (United States); Boparai, K [ACR, Reston, VA (United States); Xiao, Y [University of Pennsylvania, Philadelphia, PA (United States); Followill, D [UT MD Anderson Cancer Center, Houston, TX (United States); Galvin, J [Thomas Jefferson University Hospital, Newtown, PA (United States); Sohn, J [Case Western University, Cleveland, OH (United States)

    2016-06-15

    Purpose: A survey was taken by NRG Oncology to assess Full Time Equivalent (FTE) contributions to multi institutional clinical trials by medical physicists.No current quantification of physicists’ efforts in FTE units associated with clinical trials is available. The complexity of multi-institutional trials increases with new technologies and techniques. Proper staffing may directly impact the quality of trial data and outcomes. The demands on physics time supporting clinical trials needs to be assessed. Methods: The NRG Oncology Medical Physicist Subcommittee created a sixteen question survey to obtain this FTE data. IROC Houston distributed the survey to their list of 1802 contact physicists. Results: After three weeks, 363 responded (20.1% response). 187 (51.5%) institutions reporting external beam participation were processed. There was a wide range in number of protocols active and supported at each institution. Of the 187 clinics, 134 (71.7%) participate in 0 to 10 trials, 28 (15%) in 11 to 20 trials, 10 (5.3%) in 21 to 30 trials, 9 (4.8%) had 40 to 75 trials. On average, physicist spent 2.7 hours (SD: 6.0) per week supervising or interacting with clinical trial staff. 1.25 hours (SD: 3.37), 1.83 hours (SD: 4.13), and 0.64 hours(SD: 1.13) per week were spent on patient simulation, reviewing treatment plans, and maintaining a DICOM server, respectively. For all protocol credentialing activities, physicist spent an average of 37.05 hours (SD: 96.94) yearly. To support dosimetrists, clinicians, and therapists, physicist spend on average 2.07 hours (SD: 3.52) per week just reading protocols. Physicist attended clinical trial meetings for on average 1.13 hours (SD: 1.85) per month. Conclusion: Responding physicists spend a nontrivial amount of time: 8.8 hours per week (0.22 FTE) supporting, on average, 9 active multi-institutional clinical trials.

  20. A cross-sectional survey to investigate community understanding of medical research ethics committees.

    Science.gov (United States)

    Fritschi, Lin; Kelsall, Helen L; Loff, Bebe; Slegers, Claudia; Zion, Deborah; Glass, Deborah C

    2015-07-01

    Study explanatory forms often state that an ethics committee has approved a research project. To determine whether the lay community understand the roles of ethics committees in research, we took a cross-sectional national sample from three sampling frames: the general population (n=1532); cohort study participants (n=397); and case-control study participants (n=151). About half (51.3%) of the participants had heard of ethics committees. Those who had were more likely to be those who had participated in previous surveys, older participants, those born in Australia and those with higher education. Almost all participants agreed that the roles of an ethics committee were to protect participants' privacy and ensure no harm came to study participants and most agreed that the committee's role was to ensure that the research was capable of providing answers. Case-control and cohort participants were more likely than the general population to consider that the role of an ethics committee was to design the research and obtain research funding. Overall, we found that about half of the population are aware of ethics committees and that most could correctly identify that ethics committees are there to protect the welfare and rights of research participants, although a substantial minority had some incorrect beliefs about the committees' roles. Increased education, particularly for migrants and older people, might improve understanding of the role of ethics committees in research. 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.

  1. Geochemical investigations by the U.S. Geological Survey on uranium mining, milling, and environmental restoration

    Science.gov (United States)

    Landa, Edward R.; Cravotta, Charles A.; Naftz, David L.; Verplanck, Philip L.; Nordstrom, D. Kirk; Zielinski, Robert A.

    2000-01-01

    Recent research by the U.S. Geological Survey has characterized contaminant sources and identified important geochemical processes that influence transport of radionuclides from uranium mining and milling wastes. 1) Selective extraction studies indicated that alkaline earth sulfates and hydrous ferric oxides are important hosts of 226Ra in uranium mill tailings. The action of sulfate-reducing and ironreducing bacteria on these phases was shown to enhance release of radium, and this adverse result may temper decisions to dispose of uranium mill tailings in anaerobic environments. 2) Field studies have shown that although surface-applied sewage sludge/wood chip amendments aid in revegetating pyritic spoil, the nitrogen in sludge leachate can enhance pyrite oxidation, acidification of groundwater, and the consequent mobilization of metals and radionuclides. 3) In a U.S. Environmental Protection Agencyfunded study, three permeable reactive barriers consisting of phosphate-rich material, zero-valent iron, or amorphous ferric oxyhydroxide have been installed at an abandoned uranium upgrader facility near Fry Canyon, UT. Preliminary results indicate that each of the permeable reactive barriers is removing the majority of the uranium from the groundwater. 4) Studies on the geochemistry of rare earth elements as analogues for actinides such as uranium and thorium in acid mine drainage environments indicate high mobility under acid-weathering conditions but measurable attenuation associated with iron and aluminum colloid formation. Mass balances from field and laboratory studies are being used to quantify the amount of attenuation. 5) A field study in Colorado demonstrated the use of 234U/238U isotopic ratio measurements to evaluate contamination of shallow groundwater with uranium mill effluent.

  2. Eating disorders in musicians: a survey investigating self-reported eating disorders of musicians.

    Science.gov (United States)

    Kapsetaki, Marianna Evangelia; Easmon, Charlie

    2017-07-14

    This study aimed to estimate the prevalence of eating disorders (EDs) in musicians, and to evaluate their relation to perfectionism, stress, anxiety and depression. It examined: (1) the prevalence of EDs using the Eating Disorder Examination Questionnaire (EDE-Q), body mass index (BMI) and self-reports, (2) psychological risk factors using the Depression Anxiety Stress Scale (DASS-21) and perfectionism inventory and (3) demographic details, information about musical and career development, lifestyle, eating habits and health. A survey was distributed worldwide and a total of 301 English-speaking musicians aged 18 years and older participated. Our screening tools for EDs showed a high prevalence of EDs in musicians: the EDE-Q Global Score (EDE-QGS) showed pathological values in 18.66% of the musicians and when questioned about lifetime prevalence, 32.3% of the musicians answered positively. The median BMI was within the normal range. Regarding general mental health, the DASS-21 showed that depression and stress were severe, anxiety was extremely severe and the perfectionism inventory composite score was 26.53. There was no significant difference on the EDE-QGS between musicians who perform different types of music, but music students, professionals, soloists and musicians travelling overseas had a higher percentage of pathological EDE-QGS. Perfectionism was higher in classical musicians and there was a low positive correlation between EDE-QGS and the risk factors: perfectionism, depression, anxiety, stress, peer pressure and social isolation. EDs are prevalent in musicians and possible risk factors are their increased perfectionism, depression, anxiety and stress due to the demands of their job.

  3. Paperwork Versus Patient Care: A Nationwide Survey of Residents' Perceptions of Clinical Documentation Requirements and Patient Care

    Science.gov (United States)

    Christino, Melissa A.; Matson, Andrew P.; Fischer, Staci A.; Reinert, Steven E.; DiGiovanni, Christopher W.; Fadale, Paul D.

    2013-01-01

    Background The current health care system requires a substantial amount of documentation by physicians, potentially limiting time spent on patient care. Objective We sought to explore trainees' perceptions of their clinical documentation requirements and the relationship between time spent on clinical documentation versus time available for patient care. Methods An anonymous, online survey was sent to trainees in all postgraduate years of training and specialties in Accreditation Council for Graduate Medical Education–accredited programs. Results Over a 2-month time frame, 1515 trainees in 24 specialties completed the survey. Most (92%) reported that documentation obligations are excessive, that time spent with patients has been compromised by this (90%), and that the amount of clinical documentation has had a negative effect on patient care (73%). Most residents and fellows reported feeling rushed and frustrated because of these documentation demands. They also reported that time spent on these tasks decreased their time available for teaching others and reduced the quality of their education. Respondents reported spending more time on clinical documentation than on direct patient care (P < .001). Conclusions Trainees' current clinical documentation workload may be a barrier to optimal patient care and to resident and fellow education. Residents and fellows report that clinical documentation duties are onerous, and there is a perceived negative effect on time spent with patients, overall quality of patient care, physician well-being, time available for teaching, and quality of resident education. PMID:24455008

  4. Towards Horizon 2020: challenges and advances for clinical mental health research – outcome of an expert survey

    Science.gov (United States)

    van der Feltz-Cornelis, Christina M; van Os, Jim; Knappe, Susanne; Schumann, Gunter; Vieta, Eduard; Wittchen, Hans-Ulrich; Lewis, Shôn W; Elfeddali, Iman; Wahlbeck, Kristian; Linszen, Donald; Obradors-Tarragó, Carla; Haro, Josep Maria

    2014-01-01

    Background The size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders. Methods The research was conducted as an expert survey and expert panel discussion during a scientific workshop. Results Eighty-nine experts in clinical research and representing most European countries participated in this survey. Identified top priorities were the need for new intervention studies, understanding the diagnostic and therapeutic implications of mechanisms of disease, and research in the field of somatic-psychiatric comorbidity. The “subjectivity gap” between basic neuroscience research and clinical reality for patients with mental disorders is considered the main challenge in psychiatric research, suggesting that a shift in research paradigms is required. Conclusion Innovations in clinical mental health research should bridge the gap between mechanisms underlying novel therapeutic interventions and the patient experience of mental disorder and, if present, somatic comorbidity. Clinical mental health research is relatively underfunded and should receive specific attention in Horizon 2020 funding programs. PMID:25061300

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-12-07

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

  7. Trial Steering Committees in randomised controlled trials: A survey of registered clinical trials units to establish current practice and experiences.

    Science.gov (United States)

    Conroy, Elizabeth J; Harman, Nicola L; Lane, J Athene; Lewis, Steff C; Murray, Gordon; Norrie, John; Sydes, Matt R; Gamble, Carrol

    2015-12-01

    The Medical Research Council Guidelines for Good Clinical Practice outlines a three-committee trial oversight structure--the day-to-day Trial Management Group, the Data Monitoring Committee and the Trial Steering Committee. In this model, the Trial Steering Committee is the executive committee that oversees the trial and considers the recommendations from the Data Monitoring Committee. There is yet to be in-depth consideration establishing the Trial Steering Committee's role and functionality. A survey to establish Trial Steering Committee's current practices, role and the use and opinion on the Medical Research Council guidelines was undertaken within UK Clinical Research Collaborative registered Clinical Trials Units. Completed surveys were obtained from 38 of 47 fully and partially registered Units. Individual items in the survey were analysed and reported spanning current Trial Steering Committee practices including its role, requirement and experience required for membership; methods to identify members; and meeting frequency. Terms (a document describing the committee's remit, objectives and functionality) were obtained and analysed from 21 of 33 Units with documents in place at their Unit. A total of 20 responders suggested aspects of the current Medical Research Council Guidelines that need improvement. We present the first survey reporting on practices within UK Clinical Research Collaborative registered Clinical Trials Units on the experience and remits of Trial Steering Committees. We have identified a widespread adoption of Medical Research Council Guidelines for Trial Steering Committees in the United Kingdom, but limitations in this existing provision have been identified that need to be addressed. © The Author(s) 2015.

  8. Suicide within 12 months of contact with mental health services: national clinical survey

    Science.gov (United States)

    Appleby, Louis; Shaw, Jenny; Amos, Tim; McDonnell, Ros; Harris, Catherine; McCann, Kerry; Kiernan, Katy; Davies, Sue; Bickley, Harriet; Parsons, Rebecca

    1999-01-01

    Objective To describe the clinical circumstances in which psychiatric patients commit suicide. Design National clinical survey. Setting England and Wales. Subjects A two year sample of people who had committed suicide, in particular those who had been in contact with mental health services in the 12 months before death. Main outcome measures Proportion of suicides in people who had had recent contact with mental health services; proportion of suicides in inpatients; proportion of people committing suicide and timing of suicide within three months of hospital discharge; proportion receiving high priority under the care programme approach; proportion who were recently non-compliant and not attending. Results 10 040 suicides were notified to the study between April 1996 and March 1998, of whom 2370 (24%; 95% confidence interval 23% to 24%) had had contact with mental health services in the year before death. Data were obtained on 2177, a response rate of 92%. In general these subjects had broad social and clinical needs. Alcohol and drug misuse were common. 358 (16%; 15% to 18%) were psychiatric inpatients at the time of death, 21% (17% to 25%) of whom were under special observation. Difficulties in observing patients because of ward design and nursing shortages were both reported in around a quarter of inpatient suicides. 519 (24%; 22% to 26%) suicides occurred within three months of hospital discharge, the highest number occurring in the first week after discharge. 914 (43%; 40% to 44%) were in the highest priority category for community care. 488 (26% excluding people whose compliance was unknown; 24% to 28%) were non-compliant with drug treatment while 486 (28%; 26% to 30%) community patients had lost contact with services. Most people who committed suicide were thought to have been at no or low immediate risk at the final service contact. Mental health teams believed suicide could have been prevented in 423 (22%; 20% to 24%) cases. Conclusions Several suicide

  9. The management of clinical laboratories in Europe: a FESCC survey. Forum of the European Societies of Clinical Chemistry and Laboratory Medicine.

    Science.gov (United States)

    de Kieviet, Wim; Blaton, Victor; Kovacs, Gabor L; Palicka, Vladimir; Pulkki, Kari

    2002-03-01

    The professional duties of the specialists in clinical chemistry differ from country to country in Europe. One of the main goals of the Strategic Plan of the Forum of the European Societies of Clinical Chemistry and Laboratory Medicine (FESCC; IFCC-Europe) is to promote a high scientific and professional standard in the field of clinical chemistry and laboratory medicine in Europe. This can be stimulated by the knowledge of the local conditions in each country and by striving towards a strong and harmonised position in all the European countries. In order to enhance the knowledge of the managerial situation of the specialists in clinical chemistry in Europe, FESCC launched a survey in September 2000. This survey provides information about the position of the specialists in clinical chemistry in the various disciplines in the medical laboratories and in hospitals, and about the advisory tasks and the managerial education during the post-graduate training in clinical chemistry. Of the 35 FESCC member countries 33 have participated in the survey (94%). The results show a rather heterogeneous situation in Europe caused by the local historical developments, the differences in academic background and the relative numbers of private and physicians' office laboratories. Large differences exist between the European countries in the disciplines of laboratory medicine that are headed by a specialist in clinical chemistry. In the different countries the clinical chemistry laboratories are headed by specialists in clinical chemistry in between 20% and 100% of the laboratories. The haematology, immunology, microbiology, therapeutic drug monitoring, molecular biology and haemostasis laboratories and departments of blood banking are headed by specialists in clinical chemistry in between 0% and 100% of the laboratories. The responsibilities for the various managerial tasks of the specialists in clinical chemistry show no uniformity in Europe. In the majority of the countries the

  10. Computational and clinical investigation on the role of mechanical vibration on orthodontic tooth movement.

    Science.gov (United States)

    Liao, Zhipeng; Elekdag-Turk, Selma; Turk, Tamer; Grove, Johnathan; Dalci, Oyku; Chen, Junning; Zheng, Keke; Ali Darendeliler, M; Swain, Michael; Li, Qing

    2017-07-26

    The aim of this study is to investigate the biomechanics for orthodontic tooth movement (OTM) subjected to concurrent single-tooth vibration (50Hz) with conventional orthodontic force application, via a clinical study and computational simulation. Thirteen patients were recruited in the clinical study, which involved distal retraction of maxillary canines with 1.5N (150g) force for 12weeks. In a split mouth study, vibration and non-vibration sides were randomly assigned to each subject. Vibration of 50Hz, of approximately 0.2N (20g) of magnitude, was applied on the buccal surface of maxillary canine for the vibration group. A mode-based steady-state dynamic finite element analysis (FEA) was conducted based on an anatomically detailed model, complying with the clinical protocol. Both the amounts of space closure and canine distalization of the vibration group were significantly higher than those of the control group, as measured intra-orally or on models (pvibration can accelerate maxillary canine retraction. The volume-average hydrostatic stress (VHS) in the periodontal ligament (PDL) was computationally calculated to be higher with vibration compared with the control group for maxillary teeth and for both linguo-buccal and mesial-distal directions. An increase in vibratory frequency further amplified the PDL response before reaching a local natural frequency. An amplification of PDL response was also shown to be induced by vibration based on computational simulation. The vibration-enhanced OTM can be described by mild, vigorous and diminishing zones among which the mild zone is considered to be clinically beneficial. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. An Investigation of Community Attitudes Toward Blast Noise. General Community Survey, Study Site 1

    Science.gov (United States)

    2012-04-01

    acknowledge Larry Pater, Bob Baumgart- ner, and George Luz for their input, guidance, and support during the planning phase of this project. The team...catalog.php?record_id=9135#toc ERDC/CERL TR-12-9 41 Nykaza E. T., K. Hodgdon, T. Gaugler, P. Krecker, and G. Luz . 2010a. An Investigation of...127664/file/WP-1546-IR.pdf Nykaza E.T., K. Hodgdon, T. Gaugler, P. Krecker, and G. Luz , 2012. On the relationship between blast noise complaints and

  12. The Housing Careers of Older Canadians: An Investigation Using Cycle 16 of the General Social Survey

    Directory of Open Access Journals (Sweden)

    Perks, Thomas

    2008-01-01

    Full Text Available EnglishIn this paper we use the Aging and Social Support Survey (GSS16 and the theoretical conception of a ‘housing career’ to identify the correlates of housing tenure (rent vs.own among Canadians age 45 and over. We draw on primarily US literature to isolate three general explanatory clusters (social support, health, and economic characteristics.Based on analyses using logistic regression, the results indicate that the majority of variation in housing tenure exists due to standard demographic and household characteristics. In fact, of the three focal explanatory clusters, only social support characteristics significantly enhance model fit beyond the baseline model, suggesting that the housing tenure of older Canadians hinges heavily on fairly standard characteristics.FrenchDans cet article, nous nous sommes servis de l’enquête « Vieillissement et soutien social» (ESG16 et de la théorie du cycle de vie du logement pour identifier les corrélatsdes modes d’occupation (location vs. propriétariat chez les canadiens âgés de 45 ans etplus. Nous avons principalement puisé la littérature des États-Unis pour isoler trois groupesexplicatifs généraux (caractéristiques: de support social, de santé, et économiques.Les résultats, basés sur des analyses de régression logistique, indiquent que la majoritédes variations dans les modes d’occupation peuvent être attribuées à des caractéristiquesdémographiques et économiques de base. En effet, des trois groupes explicatifs focaux, cesont seulement les caractéristiques de support social qui ont fait monter l’ajustement dumodèle en delà du modèle de base, ce qui suggère que les modes d’occupation des logementspour les canadiens d’un certain âge dépend beaucoup des caractéristiques de base.Mots clés: Cycle de vie du logement, modes d’occupation de logements, adultes âgés

  13. Investigations in the Spectral Properties of Operators with Distant Perturbations (survey

    Directory of Open Access Journals (Sweden)

    A. M. Golovina

    2015-01-01

    Full Text Available We propose a chronological overview of researches on operators with distant perturbations. Let us explain what "distant perturbations" mean. An elementary example of the operator with distant perturbations is a differential operator of the second order with two finite potentials. Supports of these operators are at a great distance from each other, i.e. they are \\distant".The study of such operators has been performed since the middle of the last century, mostly by foreign researchers see eg. R. Ahlrichs, T. Aktosun, M. Klaus, P. Aventini, P. Exner, E.B. Davies, V. Graffi, E.V. Harrell II, H.J. Silverstone, M. Mebkhout, R. Hoegh-Krohn, W. Hun ziker, V. Kostrykin, R. Schrader, J.D. Morgan (III, Y. Pinchover, O.K. Reity, H. Tamura, X. Wang, Y. Wang, S. Kondej, B. Simon, I. Veselic, D.I. Borisov, A.M. Golovina. The main objects of their investigation were the asymptotic behaviors of eigenvalues and corresponding eigenfunctions of perturbed operators. In several papers the research was focused on resolvents and eigenvalues of perturbed operator arising from the edge of the essential spectrum. The main results of the past century are the first members of the asymptotics of perturbed eigenvalues and the corresponding eigenfunctions and the first members of the asymptotics of resolvents of the perturbed operators. The main results of the last fifteen years are full asymptotic expansions for the eigenvalues and their corresponding functions and an explicit formula for the resolvent of the perturbed operator.In this paper, we also note that up to 2004 only different kind of potentials were considered as perturbing operators, and Laplace and Dirac operators were considered as unperturbed operators. Only since 2004, nonpotential perturbing operators appeared in the literature. Since 2012, an arbitrary elliptic differential operator is considered as an unperturbed operator.We propose a classification of investigations on distant perturbations, based on the

  14. A Survey on Turkish nursing students' perception of clinical learning environment and its association with academic motivation and clinical decision making.

    Science.gov (United States)

    Aktaş, Yeşim Yaman; Karabulut, Neziha

    2016-01-01

    Nursing education is a process that includes theoretical and practical learning and requires the acquisition of theoretical knowledge and skill. Nursing students need a good clinical practice environment in order to apply their knowledge and skills due to the fact that the clinical practice settings play an important role in the nursing profession. This study was carried out in an effort to explore nursing students' perception of the clinical learning environment and its association with academic motivation and clinical decision making. A descriptive survey design was used. This study was conducted in Giresun University in Turkey. Participants were second-, third- and fourth-year undergraduate students (n=222) in the Bachelor of Nursing Science Degree in the academic spring term of 2014-2015. The data was collected using the 'Clinical Learning Environment Scale', the 'Academic Motivation, and the 'The Clinical Decision Making in Nursing Scale'. Of the respondents in this study, 45% of the students were second class, 30.6% of the students were third class and 24.3% of the students were fourth class. There was a statistically significant positive correlation found between the clinical learning environment and the nursing students' academic motivation (r=0.182, plearning environment and clinical decision making (r=0.082, p>.05). One of the prerequisites for the training of qualified students is to provide nursing students with a qualified clinical environment. It was found that nursing students' academic motivation increased as the quality of their clinical learning environment improved. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Engendered Responses to, and Interventions for, Shame in Dissociative Disorders: A Survey and Experimental Investigation.

    Science.gov (United States)

    Dorahy, Martin J; Gorgas, Julia; Seager, Lenaire; Middleton, Warwick

    2017-11-01

    This study examined shame and responses to it in adult dissociative disorder (DD; n = 24) and comparison psychiatric (n = 14) samples. To investigate how helpful different therapeutic responses are after shame disclosures in therapy, participants heard two vignettes from "mock" patients disclosing a) shame and b) surprise. Participants rated the helpfulness of five potential responses. Interventions covered withdrawing from the affect (withdrawal focused) to feeling it (feeling focused), with other interventions on cognitions (cognitive focused), management strategies (management focused), and previous experiences (history focused). The DD sample reported higher characterological and bodily shame, and more shame avoidance and withdrawal. There was no difference across groups for intervention ratings. For shame, interventions focused on feelings, cognitions, or previous shame experiences were deemed most helpful, but this was qualified by experiencing dissociation while hearing the script, where the history intervention was reported less helpful. Exposure to shame while monitoring dissociation should accompany therapy for DDs.

  16. DNA typing in forensic medicine and in criminal investigations: a current survey

    Science.gov (United States)

    Benecke, Mark

    Since 1985 DNA typing of biological material has become one of the most powerful tools for personal identification in forensic medicine and in criminal investigations [1-6]. Classical DNA "fingerprinting" is increasingly being replaced by polymerase chain reaction (PCR) based technology which detects very short polymorphic stretches of DNA [7-15]. DNA loci which forensic scientists study do not code for proteins, and they are spread over the whole genome [16, 17]. These loci are neutral, and few provide any information about individuals except for their identity. Minute amounts of biological material are sufficient for DNA typing. Many European countries are beginning to establish databases to store DNA profiles of crime scenes and known offenders. A brief overview is given of past and present DNA typing and the establishment of forensic DNA databases in Europe.

  17. Clinical characteristics of bipolar vs. unipolar depression in preschool children: an empirical investigation.

    Science.gov (United States)

    Luby, Joan L; Belden, Andy C

    2008-12-01

    Despite retrospective reports of the onset of childhood bipolar disorder during the preschool period, few studies have investigated whether mania symptoms can be identified in preschoolers. A group of children with a cluster of mania symptoms that showed discriminant validity from other disruptive disorders was identified in a large preschool sample. These empirical data add to descriptive studies of mania in clinical preschool populations. An investigation of the characteristics of depression among putative bipolar preschoolers may inform the controversial nosologic questions that surround the diagnosis in this young age group. This study, conducted from 2002 to 2007, investigated major depressive disorder (MDD) symptoms and severity in preschoolers with a bipolar syndrome in comparison to those with unipolar MDD, identified by an age-appropriate structured psychiatric interview, the Preschool Age Psychiatric Assessment (based on DSM-IV). Twenty-one preschoolers were identified who met DSM-IV symptom criteria for bipolar I disorder and MDD and were compared to 54 preschoolers with unipolar MDD. The bipolar depressed preschoolers had significantly higher depression severity (p nosology of this early-onset disorder. Copyright 2008 Physicians Postgraduate Press, Inc.

  18. A survey of the clinical acceptability of screening for postnatal depression in depressed and non-depressed women

    Directory of Open Access Journals (Sweden)

    Ericksen Jennifer

    2006-08-01

    Full Text Available Abstract Background Information on clinical acceptability is needed when making cost-utility decisions about health screening implementation. Despite being in use for two decades, most data on the clinical acceptability of the Edinburgh Postnatal Depression Scale (EPDS come from qualitative reports, or include relatively small samples of depressed women. This study aimed to measure acceptability in a survey of a relatively large, community sample with a high representation of clinically depressed women. Methods Using mail, telephone and face-to-face interview, 920 postnatal women were approached to take part in a survey on the acceptability of the EPDS, including 601 women who had screened positive for depression and 245 who had received DSM-IV diagnoses of depression. Acceptability was measured on a 5-point Likert scale of comfort ranging from "Not Comfortable", through "Comfortable" to "Very Comfortable". Results The response rate was just over half for postal surveys (52% and was 100% for telephone and face-to-face surveys (432, 21 and 26 respondents for postal, telephone and face-to-face surveys respectively making 479 respondents in total. Of these, 81.2% indicated that screening with the EPDS had been in the range of "Comfortable" to "Very Comfortable". The other 18.8 % rated screening below the "Comfortable" point, including a small fraction (4.3% who rated answering questions on the EPDS as "Not Comfortable" at the extreme end of the scale. Comfort was inversely related to EPDS score, but the absolute size of this effect was small. Almost all respondents (97% felt that screening was desirable. Conclusion The EPDS had good acceptability in this study for depressed and non-depressed women. Women's views on the desirability of postnatal depression screening appear to be largely independent of personal level of comfort with screening. These results should be useful to policy-makers and are broadly supportive of the Edinburgh Postnatal

  19. Clinical trials from the patient perspective: survey in an online patient community.

    Science.gov (United States)

    DasMahapatra, Pronabesh; Raja, Priya; Gilbert, Jeremy; Wicks, Paul

    2017-02-27

    Developing new medicines relies on the successful conduct of clinical trials. As trial protocols become more arduous, it becomes harder to recruit and retain patient volunteers, although recent efforts such as OMERACT and I-SPY2 show that partnering with patients can be beneficial. We sought to describe drivers and barriers to trial participation, as well as condition-specific trial preferences. An online survey was fielded via the patient-powered research network PatientsLikeMe to 1,621 members living with nine selected chronic health conditions. Questions included demographics, trial experience, reasons for non-participation, questions relating to aspects of trial design, and an adaptation of the Net Promoter Score (NPS) for trial satisfaction. Mean age of respondents was 55 years; most patients were white (93%), female (67%), and living in the United States (72%). Primary conditions were MS (21%), Parkinson's (20%), fibromyalgia (15%), ALS (10%), type 2 diabetes (10%), rheumatoid arthritis (RA, 8%), epilepsy (8%), major depressive disorder (MDD, 5%) and systemic lupus erythematosus (SLE, 3%). Most patients had not discussed a trial with their physician and only 21% had ever enrolled, with rates highest in ALS (36%), Parkinson's disease (36%) and MS (20%) and lowest among SLE (9%), MDD (11%) and Fibromyalgia (11%). Common reasons for non-participation were eligibility criteria, inconvenience of travel and concerns about side effects. NPS suggested that many patients were unsatisfied; patients with lupus, epilepsy, RA, and fibromyalgia reported negative scores, i.e. they would dissuade other patients like them from taking part in trials. The most important considerations in trial participation were the opportunity to improve one's own health and that of others, the reputation of the institution, and having medical bills covered in case of injury. Least important were remuneration and possibility of receiving a placebo. ALS patients were more willing to tolerate

  20. A within-sample investigation of test–retest reliability in choice experiment surveys with real economic incentives

    DEFF Research Database (Denmark)

    Mørkbak, Morten Raun; Olsen, Søren Bøye

    2015-01-01

    comparing choices, we also test for differences in preferences and error variance when a sample of respondents is given the exact same questionnaire twice, with a time lag of 2 weeks in between. Finally, we examine potential reasons and covariates explaining the level of agreement in choices across the 2......In this paper, we investigate the level of agreement between respondents' choices in identical choice sets in a test-retest choice experiment for a market good with real economic incentives, thus investigating whether the incentivised CE method can be reliable and stable over time. Besides...... weeks. Across four different tests, we find very good agreement between the two choice experiments - both with respect to overall choices and with respect to preferences. Furthermore, error variances do not differ significantly between the two surveys. The results also show that the larger the utility...

  1. THE ATTITUDE TOWARDS TREATMENT OF CARDIOVASCULAR DISEASES: A SURVEY OF PATIENTS OF STATE OUTPATIENT CLINICS AND PRIVATE MEDICAL CENTERS

    Directory of Open Access Journals (Sweden)

    O. N. Semenova

    2015-01-01

    Full Text Available Aim. To study the differences in views on treatment among patients with cardiovascular diseases in state and private outpatient clinics, as well as the motivation for choosing one of these outpatient clinics.Material and methods. Anonymous and voluntary survey of cardiology patients (n=90 in 2 state (57.7% and 3 private outpatient clinics (42.2% was conducted in Saratov.Results. 33.3% of respondents were men; the median age was 65 years. Patients of state outpatient clinics were more likely to have retirement age (p=0.0008, low income (p=0.0006, history of hypertensive crises (p=0.0129 and chronic heart failure (p=0.0001. Patients of private outpatient clinics were more likely to have mental work (p=0.0001, higher education (p=0.0001, moderate income (p=0.0006. The difference in views on the disease and the attitude towards a doctor among patients of state and private clinics was shown.Conclusion. Patients of private outpatient clinics were more active, young, aimed at continuation of life. They are more likely to have higher education, mental work and moderate income. Patients of state outpatient clinics are "infatuated with their illness"; it is their “lifestyle”. Paternalistic model of communication with doctors is expressed in all the patients.

  2. Are activity limitations associated with lower urinary tract symptoms in stroke patients? A cross-sectional, clinical survey

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Gard, Gunvor; Klarskov, Peter

    2009-01-01

    Objective. To assess self-reported activity limitations in a clinical sample of stroke patients and to identify their association with prevalence, severity and impact on daily life of lower urinary tract symptoms (LUTS). Material and methods. A cross-sectional, clinical survey was initiated whereby....... The response rate was 84%. The activity limitations were reported by 17-34% depending on the measurement. Mobility velocity was highly significantly associated (p=0.01) with severity of LUTS. In the LUTS incontinence symptom group, Barthel Index and mobility velocity were significantly associated...

  3. Compassionate use of interventions: results of a European Clinical Research Infrastructures Network (ECRIN) survey of ten European countries

    LENUS (Irish Health Repository)

    Whitfield, Kate

    2010-11-12

    Abstract Background \\'Compassionate use\\' programmes allow medicinal products that are not authorised, but are in the development process, to be made available to patients with a severe disease who have no other satisfactory treatment available to them. We sought to understand how such programmes are regulated in ten European Union countries. Methods The European Clinical Research Infrastructures Network (ECRIN) conducted a comprehensive survey on clinical research regulatory requirements, including questions on regulations of \\'compassionate use\\' programmes. Ten European countries, covering approximately 70% of the EU population, were included in the survey (Austria, Denmark, France, Germany, Hungary, Ireland, Italy, Spain, Sweden, and the UK). Results European Regulation 726\\/2004\\/EC is clear on the intentions of \\'compassionate use\\' programmes and aimed to harmonise them in the European Union. The survey reveals that different countries have adopted different requirements and that \\'compassionate use\\' is not interpreted in the same way across Europe. Four of the ten countries surveyed have no formal regulatory system for the programmes. We discuss the need for \\'compassionate use\\' programmes and their regulation where protection of patients is paramount. Conclusions \\'Compassionate use\\' is a misleading term and should be replaced with \\'expanded access\\'. There is a need for expanded access programmes in order to serve the interests of seriously ill patients who have no other treatment options. To protect these patients, European legislation needs to be more explicit and informative with regard to the regulatory requirements, restrictions, and responsibilities in expanded access programmes.

  4. Temporal availability of obstetrics and gynecology clinics in Taiwan: A nationwide survey

    Directory of Open Access Journals (Sweden)

    Wei-Ting Chang

    2017-10-01

    Conclusion: Obstetrics–gynecology clinics in Taiwan offered great temporal availability. In addition to the remarkable urban–rural disparity in the distribution of obstetrics–gynecology clinics, the availability of services on Sundays in rural areas demands special attention.

  5. A 2012 survey of the Australasian clinical medical physics and biomedical engineering workforce.

    Science.gov (United States)

    Round, W H

    2013-06-01

    A survey of the medical physics and biomedical engineering workforce in Australia and New Zealand was carried out in 2012 following on from similar surveys in 2009 and 2006. 761 positions (equivalent to 736 equivalent full time (EFT) positions) were captured by the survey. Of these, 428 EFT were in radiation oncology physics, 63 EFT were in radiology physics, 49 EFT were in nuclear medicine physics, 150 EFT were in biomedical engineering and 46 EFT were attributed to other activities. The survey reviewed the experience profile, the salary levels and the number of vacant positions in the workforce for the different disciplines in each Australian state and in New Zealand. Analysis of the data shows the changes to the workforce over the preceding 6 years and identifies shortfalls in the workforce.

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

    Science.gov (United States)

    Smith, Sophia K; Selig, Wendy; Harker, Matthew; Roberts, Jamie N; Hesterlee, Sharon; Leventhal, David; Klein, Richard; Patrick-Lake, Bray; Abernethy, Amy P

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Sophia K Smith

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

  8. Survey of medico-legal investigation of homicide in the region of Epirus (Northwest Greece).

    Science.gov (United States)

    Fragkouli, Kleio; Boumba, Vassiliki; Vougiouklakis, Theodore

    2016-01-01

    This study analyzed the forensic features of homicides in North-West Greece (Epirus) from 1998 to 2013, a borderland area between Greece and Albania. Although Greece is critically influenced by both the increasing flow of refugees and the current socioeconomic crisis, very little information has been published regarding the patterns of homicide in the country. Fifty-eight autopsied victims (36 males; 22 females) were investigated. The median age was 37 years old. The average annual homicide rate was 0.85 per 100,000 inhabitants and showed remarkable fluctuation, with largest increase during Greek financial downturn. Sixteen victims were not Greek citizens. The most common method of commitment was the use of firearm (40%). The main motives were economical causes (26%) and passion (14%). Four cases were categorized as matricide (7%), 3 as homicide-suicide (5%), 2 as patricide (3%) and 1 as infanticide (2%). Toxicological analysis proved negative for ethanol and other psychotropic substances in the majority of the victims (50%). There is an urgent need for public actions both in Epirus and in Greece, with the application of effective strategies against criminality. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  9. Clinical experience, infection control practices and diagnostic algorithms for poxvirus infections - an Emerging Infections Network survey

    Directory of Open Access Journals (Sweden)

    Lash R Ryan

    2010-02-01

    Full Text Available Abstract Background In order to determine how best to tailor outreach messages about poxvirus diagnosis and infection control for health practitioners, we surveyed infectious disease physicians in the Infectious Diseases Society of America's Emerging Infections Network. Findings Surveys consisting of two unknown case scenarios designed to raise suspicion for monkeypox and orf were distributed to the 1,080 members of the EIN. The surveys contained questions pertaining to which diagnostic tests, points of contact, and transmission precautions they would likely utilize during patient evaluation. Basic response rates and frequencies of responses were calculated. Comparisons of the survey responses were made using the chi-square test. Of the 212 members who responded (20% response rate, significantly more respondents indicated that they would request diagnostic testing in the context of the monkeypox case scenario as compared to the orf case scenario. A significantly higher number of respondents indicated they would institute droplet or airborne precautions for the monkeypox case as opposed to the orf case scenario. Conclusions This survey provided an opportunity for public health practitioners to gain insight into physician approaches to evaluation, diagnosis and reporting of suspected poxvirus-associated infections. This survey identified key areas in which public health practitioners can better serve physicians by focusing on education. As a result we were able to identify potential knowledge gaps and deficits in the availability of useful resources to facilitate accurate case identification and management.

  10. 2015 American Academy of Clinical Neuropsychology (AACN) student affairs committee survey of neuropsychology trainees.

    Science.gov (United States)

    Whiteside, Douglas M; Guidotti Breting, Leslie M; Butts, Alissa M; Hahn-Ketter, Amanda E; Osborn, Katie; Towns, Stephanie J; Barisa, Mark; Santos, Octavio A; Smith, Daniel

    2016-07-01

    Surveys of practicing neuropsychologists have been conducted for years; however, there have been no comprehensive surveys of neuropsychology trainees, which may result in important issues being overlooked by the profession. This survey assessed trainees' experiences in areas such as student debt, professional development, and training satisfaction. Survey items were written by a task force of the AACN Student Affairs Committee (SAC), and neuropsychology trainees were recruited via neuropsychology-focused listservs. In total, 344 trainees completed the survey (75% female) and included participants from every region of the US and Canada. Based on the survey questions, nearly half of all trainees (47%) indicated financial factors were the greatest limitation in their training. Student debt had a bimodal distribution; 32.7% had minimal debt, but 45% had debt >$100,000. In contrast, expected starting salaries were modest, but consistent with findings ($80-100,000). While almost all trainees intended to pursue board certification (97% through ABPP), many were 'not at all' or only 'somewhat' familiar with the process. Results indicated additional critical concerns beyond those related to debt and lack of familiarity with board certification procedures. The results will inform SAC conference programming and the profession on the current 'state of the trainees' in neuropsychology.

  11. Epidemiological and Clinical Investigation of the ST Elevated Myocardial Infarction in an Emergency Department in Turkey

    Directory of Open Access Journals (Sweden)

    Senay Akpinar

    2013-12-01

    Full Text Available INTRODUCTION: In this study, epidemiologic investigation of clinical features and risk factors of the patients diagnosed as acute ST elevation myocardial infarction (STEMI. METHODS: The study designed as retrospective, descriptive, cross-sectional. 229 patients admitted to the training and research hospital emergency department with a yearly admission of 252677 in 2010, were included the study. RESULTS: A total of 77.7% of the patients was male. Patient admission was the most in February (11.8%, and the least in August (5.2%. The most effected part of the heart was anterior (48.5%. 55.4% of the patients had smoking and 2.8% had alcohol usage history; 23.3% had hypertension, 20.0% hyperlipidemia, 18.3% diabetes mellitus, 11.7% family history of coronary artery disease. DISCUSSION AND CONCLUSION: By the prevention from the modifiable risk factors for acute coronary diseases can reduce the frequency of coronary artery diseases.

  12. The contribution of clinical phonetics to the investigation of oracy problems in the classroom.

    Science.gov (United States)

    Rahilly, Joan

    2003-01-01

    This paper explains how insights from clinical linguistics can be applied to the investigation of oracy problems in the classroom. While the importance of oracy skills at school and beyond is undisputed, there is often a lack of conveniently manageable frameworks for assessing these skills. It is suggested here that methods from phonetics and phonology can be easily and profitably adopted into routine language profiling in schools and that they offer one means of uncovering potential speech difficulties in children. Two main areas are addressed: speech acquisition and speech production skills. The main focus is on the assessment of oracy in the UK, although the role of assessment in US Curriculum Framework is also considered.

  13. Optimal clinical assessment strategies for chemotherapy-induced peripheral neuropathy (CIPN): a systematic review and Delphi survey.

    Science.gov (United States)

    McCrary, J Matt; Goldstein, David; Boyle, Frances; Cox, Keith; Grimison, Peter; Kiernan, Matthew C; Krishnan, Arun V; Lewis, Craig R; Webber, Kate; Baron-Hay, Sally; Horvath, Lisa; Park, Susanna B

    2017-11-01

    Chemotherapy-induced peripheral neuropathy (CIPN) is a prominent side effect of the treatment of cancer. Despite this frequent complication, there has been no comprehensive review and quality appraisal of CIPN assessments. The purpose of this study is to provide a definitive quality appraisal of CIPN assessment strategies for clinical use. Relevant studies were identified through database searches of Medline, Embase, CINAHL, and Cochrane. CIPN assessment strategies from included articles were extracted and initially rated by an oncologist and neurophysiologist according to criteria related to assessment depth, comprehensiveness, appropriateness, and reliability. The six highest scoring assessment strategies were the focus of a two-round Delphi survey of a working party of 32 physicians, nurses, and consumers to achieve consensus on the highest rated assessments for each criterion. The database search yielded 117 distinct CIPN assessments that were extracted from 2373 articles. Three patient-reported outcome surveys and three clinician-based assessments were included in the Delphi survey. No consensus was generated regarding the best overall CIPN assessment, although good (≥70%) consensus was achieved regarding the best assessment within each criterion. The Participant Neurotoxicity Questionnaire (PNQ) was rated the highest overall and patient-reported outcome (PRO) assessment, while the Total Neuropathy Score clinical version (TNSc) was the highest rated clinician-based assessment. A diverse range of CIPN assessments currently exists. While several assessments assess CIPN symptoms with adequate comprehensiveness, depth, language, and feasibility, the consensus 'gold standard' clinical assessment remains to be established.

  14. Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy.

    Science.gov (United States)

    Lacey, Susan R; Goodyear-Bruch, Caryl; Olney, Adrienne; Hanson, Dave; Altman, Marian S; Varn-Davis, Natasha S; Brinker, Debbie; Lavandero, Ramón; Cox, Karen S

    2017-08-01

    Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes. To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes. The curriculum of the Academy included leadership topics, communication, change concepts, quality improvement methods, project management, and data management and analysis. Each team of participants collected project data to show improvements in patient care. The program evaluation used many data sources to assess the program effectiveness, relating to the professional growth of the participant nurses. The participants assessed project patient outcomes, sustainability, and spread. The first cohort of CSI participants included 164 direct care nurses from 42 hospitals in 6 cities. They rated the Academy highly in the program evaluation, and they reported that the Academy contributed to their professional development. The individual hospital quality improvement projects resulted in positive patient and estimated fiscal outcomes that were generally sustained 1 year after the program. With the skills, tools, and support obtained from participation in the CSI Academy, staff nurses can make substantial contributions to their organizations in clinical and possibly fiscal outcomes. ©2017 American Association of Critical-Care Nurses.

  15. Phase II drugs under clinical investigation for the treatment of chronic constipation.

    Science.gov (United States)

    Mozaffari, Shilan; Didari, Tina; Nikfar, Shekoufeh; Abdollahi, Mohammad

    2014-11-01

    Chronic constipation (CC) is a common gastrointestinal (GI) motility disorder that significantly impairs the quality of life in affected subjects. As almost half of the patients suffering from CC are not satisfied with currently available medicines, there is a need to develop new molecules with better effectiveness and tolerability. The authors include all experimental and clinical trials (up to Phase II) about new investigational drugs for the treatment of CC. The article identifies nine new agents: mitemcinal, TD-8954, YKP10811, itopride, RM-131, KWA-0711, elobixibat, velusetrag, and naronapride. All nine agents have shown prokinetic effects in different stages of the development. The mechanisms of new developing drugs include: the activation of 5-hydroxytryptamine type-4 (5-HT4), ghrelin and motilin receptors, antagonizing dopamine type-2 (D2) receptors, inhibition of ileal bile acid reabsorption and acetylcholine esterase, as well as water absorption from the GI tract. At this current point in time, new generations of 5-HT4 receptor agonists (velusetrag, noranopride and YKP10811) are hoped to progress, further in the future, due to better efficiency and safety. However, it is not possible to make a concise conclusion at this current time due to a lack of evidence. Further clinical trials with a longer duration and a larger sample size are warranted.

  16. Market applications of Resistivity, Induced Polarisation, Magnetic Resonance and Electromagnetic methods for Groundwater Investigations, Mining Exploration, Environmental and Engineering Surveys

    Science.gov (United States)

    Bernard, J.

    2012-12-01

    The Manufacturers of geophysical instruments have been facing these past decades the fast evolution of the electronics and of the computer sciences. More automatisms have been introduced into the equipment and into the processing and interpretation software which may let believe that conducting geophysical surveys requires less understanding of the method and less experience than in the past. Hence some misunderstandings in the skills that are needed to make the geophysical results well integrated among the global information which the applied geologist needs to acquire to be successful in his applications. Globally, the demand in geophysical investigation goes towards more penetration depth, requiring more powerful transmitters, and towards a better resolution, requiring more data such as in 3D analysis. Budgets aspects strongly suggest a high efficiency in the field associated to high speed data processing. The innovation is required in all aspects of geophysics to fit with the market needs, including new technological (instruments, software) and methodological (methods, procedures, arrays) developments. The structures in charge of the geophysical work can be public organisations (institutes, ministries, geological surveys,…) or can come from the private sector (large companies, sub-contractors, consultants, …), each one of them getting their own constraints in the field work and in the processing and interpretation phases. In the applications concerning Groundwater investigations, Mining Exploration, Environmental and Engineering surveys, examples of data and their interpretation presently carried out all around the world will be presented for DC Resistivity (Vertical Electrical Sounding, 2D, 3D Resistivity Imaging, Resistivity Monitoring), Induced Polarisation (Time Domain 2D, 3D arrays for mining and environmental), Magnetic Resonance Sounding (direct detection and characterisation of groundwater) and Electromagnetic (multi-component and multi

  17. Clinical practice in perioperative monitoring in adult cardiac surgery: is there a standard of care? Results from an national survey.

    Science.gov (United States)

    Bignami, Elena; Belletti, Alessandro; Moliterni, Paola; Frati, Elena; Guarnieri, Marcello; Tritapepe, Luigi

    2016-06-01

    This study was to investigate and define what is considered as a current clinical practice in hemodynamic monitoring and vasoactive medication use after cardiac surgery in Italy. A 33-item questionnaire was sent to all intensive care units (ICUs) admitting patients after cardiac surgery. 71 out of 92 identified centers (77.2 %) returned a completed questionnaire. Electrocardiogram, invasive blood pressure, central venous pressure, pulse oximetry, diuresis, body temperature and blood gas analysis were identified as routinely used hemodynamic monitoring, whereas advanced monitoring was performed with pulmonary artery catheter or echocardiography. Crystalloids were the fluids of choice for volume replacement (86.8 % of Centers). To guide volume management, central venous pressure (26.7 %) and invasive blood pressure (19.7 %) were the most frequently used parameters. Dobutamine was the first choice for treatment of left heart dysfunction (40 %) and epinephrine was the first choice for right heart dysfunction (26.8 %). Half of the Centers had an internal protocol for vasoactive drugs administration. Intra-aortic balloon pump and extra-corporeal membrane oxygenation were widely available among Cardiothoracic ICUs. Angiotensin-converting enzyme inhibitors were suspended in 28 % of the Centers. The survey shows what is considered as standard monitoring in Italian Cardiac ICUs. Standard, routinely used monitoring consists of ECG, SpO2, etCO2, invasive BP, CVP, diuresis, body temperature, and BGA. It also shows that there is large variability among the various Centers regarding hemodynamic monitoring of fluid therapy and inotropes administration. Further research is required to better standardize and define the indicators to improve the standards of intensive care after cardiac surgery among Italian cardiac ICUs.

  18. Nurses and challenges faced as clinical educators: a survey of a group of nurses in Cameroon

    Directory of Open Access Journals (Sweden)

    Vivian E A Eta

    2011-03-01

    Full Text Available BACKGROUND: Clinical teaching is an important component of clinical education. In nursing, clinical teaching is ensured by clinical nurse educators (CNEs. This study aimed at describing the major challenges faced by CNEs in Cameroon. METHODS: In a qualitative study, supplemented with quantitative methods, CNEs were enrolled from three health districts to represent their frequency in Cameroon’s health delivery system. RESULTS: A total of 56 CNEs participated in the study, of whom, as many as 58.9% acknowledged always facing challenges in clinical teaching and supervision. The major challenges identified were the lack of opportunities to update knowledge and skills, students’ lack of preparedness and the CNEs not being prepared for clinical teaching. CNEs attributed these challenges in major part to the lack of incentives and poor health policies. CONCLUSION: CNEs in Cameroon do indeed face major challenges which are of diverse origins and could adversely affect teaching in clinical settings

  19. About DNA databasing and investigative genetic analysis of externally visible characteristics: A public survey.

    Science.gov (United States)

    Zieger, Martin; Utz, Silvia

    2015-07-01

    During the last decade, DNA profiling and the use of DNA databases have become two of the most employed instruments of police investigations. This very rapid establishment of forensic genetics is yet far from being complete. In the last few years novel types of analyses have been presented to describe phenotypically a possible perpetrator. We conducted the present study among German speaking Swiss residents for two main reasons: firstly, we aimed at getting an impression of the public awareness and acceptance of the Swiss DNA database and the perception of a hypothetical DNA database containing all Swiss residents. Secondly, we wanted to get a broader picture of how people that are not working in the field of forensic genetics think about legal permission to establish phenotypic descriptions of alleged criminals by genetic means. Even though a significant number of study participants did not even know about the existence of the Swiss DNA database, its acceptance appears to be very high. Generally our results suggest that the current forensic use of DNA profiling is considered highly trustworthy. However, the acceptance of a hypothetical universal database would be only as low as about 30% among the 284 respondents to our study, mostly because people are concerned about the security of their genetic data, their privacy or a possible risk of abuse of such a database. Concerning the genetic analysis of externally visible characteristics and biogeographical ancestry, we discover a high degree of acceptance. The acceptance decreases slightly when precise characteristics are presented to the participants in detail. About half of the respondents would be in favor of the moderate use of physical traits analyses only for serious crimes threatening life, health or sexual integrity. The possible risk of discrimination and reinforcement of racism, as discussed by scholars from anthropology, bioethics, law, philosophy and sociology, is mentioned less frequently by the study

  20. Components of the model of the clinical practice of emergency medicine: a survey of American Board of Emergency Medicine diplomates.

    Science.gov (United States)

    Beeson, Michael S; Marco, Catherine A; Nelson, Richard N; Korte, Robert C

    2013-06-01

    The Model of the Clinical Practice of Emergency Medicine is the basis for the content specifications of all American Board of Emergency Medicine (ABEM) examinations. This study describes the frequency with which ABEM diplomates diagnose and manage the conditions and components listed in the Model of the Clinical Practice of Emergency Medicine. The objectives of this study were to determine the frequency with which ABEM diplomates diagnose and manage the conditions and components described in the Model of the Clinical Practice of Emergency Medicine. The listing of conditions and components of the Model of the Clinical Practice of Emergency Medicine were sent to 16,230 randomly selected ABEM diplomates. One of five surveys was sent to each diplomate. Each condition and component was assessed by participants for the frequency that emergency physicians diagnose (D) and manage (M) that condition, as seen in their practice of Emergency Medicine. Of the 16,230 surveys sent, 5006 were returned (30.8% response rate). The genders of the respondents were 75% male and 24% female. The ages of the respondents were primarily in the age 40-49 years, and 30-39 years age groups. All categories of the listing of conditions and components of the Model of the Clinical Practice of Emergency Medicine were encountered frequently in the practice of Emergency Medicine, as indicated by study participants. A survey of practicing ABEM diplomates was useful in defining the frequency with which specific conditions and components are diagnosed and managed in the practice of Emergency Medicine. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Investigations by the U.S. Geological Survey of soil and moisture conservation on public domain lands, 1941-1964

    Science.gov (United States)

    Peterson, H.V.; Melin, K.R.

    1979-01-01

    The passage of the Taylor Grazing Act in 1934 marked the end of an era in the land policies in the United States in that disposal of the public lands by homesteading was terminated except under rigidly prescribed procedures, and the remaining public lands covering about 175 million acres in the western conterminous states were brought under regulatory authority for grazing use. In 1934 the lands were mostly in a severe state of deterioration as a result of overgrazing and drought. In addition to reducing numbers of livestock using the lands, successive programs of conservation practices were established of which the Soil and Moisture Conservation Program of the Department of the Interior is of particular interest here. The services of the Geological Survey, in an investigational and advisory capacity were enlisted in this program. The work of the Geological Survey has consisted of the collection of hydrologic data, investigations of range-water supplies to facilitate management and provide information for design of structures and land-treatment measures. Appraisal of the effects of treatment practices has also been an important activity. Conservation on the public domain involves mainly growing vegetation for forage and reducing erosion. The two elements are intimately related--accomplishment in one is usually reflected by an improvement in the other. Erosion is a serious problem on most of the public domain, but particularly in the Colorado River and Rio Grande basins where, despite low annual water yields, the public domain and similar lands on the Indian reservations contribute the major part of the sediment measured at the downstream gaging stations. In parts of the Missouri River basin also, erosion is obviously very active but the sediment yield contributed by the public domain cannot be as readily isolated. The reasons for the erosion are generally evident--the erodibility of the rock and soils and the sparsity of vegetation as a result of low precipitation

  2. Heterogeneity prevails: the state of clinical trial data management in Europe - results of a survey of ECRIN centres

    DEFF Research Database (Denmark)

    Kuchinke, Wolfgang; Ohmann, Christian; Yang, Qin

    2010-01-01

    The use of Clinical Data Management Systems (CDMS) has become essential in clinical trials to handle the increasing amount of data that must be collected and analyzed. With a CDMS trial data are captured at investigator sites with "electronic Case Report Forms". Although more and more of these el......The use of Clinical Data Management Systems (CDMS) has become essential in clinical trials to handle the increasing amount of data that must be collected and analyzed. With a CDMS trial data are captured at investigator sites with "electronic Case Report Forms". Although more and more...... of these electronic data management systems are used in academic research centres an overview of CDMS products and of available data management and quality management resources for academic clinical trials in Europe is missing....

  3. Investigating Clinically and Scientifically Useful Cut Points on the Compulsive Sexual Behavior Inventory.

    Science.gov (United States)

    Miner, Michael H; Raymond, Nancy; Coleman, Eli; Swinburne Romine, Rebecca

    2017-05-01

    clinical screening tool and the other, more conservative measurement that is useful for etiologic and epidemiologic research. Miner MH, Raymond N, Coleman E, Swinburne Romine R. Investigating Clinically and Scientifically Useful Cut Points on the Compulsive Sexual Behavior Inventory. J Sex Med 2017;14:715-720. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  4. A survey of adult referrals to specialist attention-deficit/hyperactivity disorder clinics in Canada

    Directory of Open Access Journals (Sweden)

    Klassen LJ

    2017-12-01

    Full Text Available Larry J Klassen,1 C Matthew Blackwood,2 Christopher J Reaume,3 Samuel Schaffer,3 James G Burns3 1Eden Mental Health Centre, Winkler, MB, 2Cedar Care Clinic, Mission, BC, 3International Medical Affairs, Shire Pharma Canada ULC, Toronto, ON, Canada Background: Canadian guidelines encourage family physicians to diagnose/manage adults with uncomplicated attention-deficit/hyperactivity disorder (ADHD; specialist referral is recommended only for complex cases. This retrospective case review investigated adults referred to Canadian ADHD clinics. Methods: Adult ADHD specialists reviewed referral letters/charts of patients (aged ≥18 years and no family history/known/expressed childhood ADHD from family physicians/psychiatrists over 2 years. Results: Data on 515 referrals (mean age 33 years, 60% males were collected (December 2014 to September 2015; 472/515 (92% were made by family physicians. No psychiatric comorbid symptoms were noted in 344/515 (67% referrals. ADHD was confirmed by a specialist in 483/515 (94% cases, whether comorbid symptoms were noted at referral (155/171 [91%] or not (328/344 [95%]. ADHD was reported to impact “work” (251/317 [79%], “school” (121/166 [73%], “social/friends” (260/483 [54%], and “spouse/family” (231/483 [48%]. Overall, 335/483 (69% patients had more than or equal to one comorbid symptom (diagnosed by referring physician or specialist. Stimulant monotherapy was recommended for 383/483 (79% patients, non-stimulant monotherapy for 41/483 (8% patients, and stimulant plus non-stimulant monotherapy for 39/483 (8% patients. Almost half of patients were returned for referring physician’s follow-up, either before treatment initiation (102/483 [21%] or after treatment stabilization (99/483 [20%]. Follow-up was by a specialist for 282/483 (58% patients. Conclusion: ADHD diagnosis was specialist confirmed in most cases. Although most referrals (67% noted no psychiatric comorbid symptoms, 69% of patients had

  5. Forsmark site investigation. Detailed ground magnetic survey and lineament interpretation in the Forsmark area, 2006-2007

    Energy Technology Data Exchange (ETDEWEB)

    Isaksson, Hans; Thunehed, Hans; Pitkaenen, Timo; Keisu, Mikael (GeoVista AB, Luleaa (SE))

    2007-12-15

    The report presents detailed ground magnetic measurements carried out on an 11.1 km2 area in the Forsmark site investigation area. The main objective of this activity is to determine a detailed ground magnetic representation of the bedrock. The results from previous surveys were encouraging and have led to a broad geophysical programme for investigation of lineaments at Forsmark. This report comprises the results from the second and final phase of the extended survey programme and a compilation and summary of all phases in the programme. On ground and on lake ice, a grid with parallel lines was staked. Measurements of the magnetic total field were carried out along profiles, perpendicular to the staked lines, with a profile spacing of 10 m and a station spacing of 5 m. Measurements on the ice-covered sea bays were carried out by a two man crew. One crew member walked along the survey lines, carrying a RTK-GPS guiding the other crew member who measured the magnetic total field. No seaborne survey was carried out in the final phase. Previously, using a high accuracy RTK-GPS unit for boat navigation gave a seaborne survey grid of on average 10 m line spacing and 2-3 m station spacing. In total 427,238 magnetic survey stations have been measured and an area of 4.7 km2 has been surveyed from boat. The magnetic pattern in the survey area can be divided into six main areas with different magnetic character. Along the southwest margin of the survey area the magnetic pattern is intensely banded with rapidly changing low and highly magnetic bands striking southeast-northwest, which to the northeast changes to a gentler, banded pattern of low to moderate magnetic intensity. To the northeast, at the SFR office and along the coastline to the southeast, the pattern is again intensely banded with, southeast-northwest trending, rapidly changing low and highly magnetic bands. These two banded structures probably forms fold limbs of a common fold with a northwest oriented fold axis

  6. Clinical management practices adopted by physiotherapists in India for chronic obstructive pulmonary disease: A national survey

    Directory of Open Access Journals (Sweden)

    Aripta Jingar

    2013-01-01

    Full Text Available Background and Objective: Evidence supports the use of pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease (COPD patients both during acute exacerbation and at later stages. It is used in India; but, to date, there has been no study that has investigated the structure of pulmonary rehabilitation programs for COPD patients in India. The recent study aims to determine the current practice patterns of Indian Physiotherapists for COPD patients admitted in Intensive Care Units (ICUs and wards in terms of assessment and treatment. Materials and Methods: A questionnaire-based survey was conducted across India. Questionnaires were distributed to around 800 physiotherapists via E-mail. Physiotherapists with a Master Degree and a specialization in cardiopulmonary science or a minimum of 1 year of experience in treating cardiopulmonary patients were included. The questionnaires addressed assessment measures and treatment techniques given to COPD patients. Results: A total of 342 completed questionnaires were received, yielding a response rate of 43.8%, with a majority of responses from Karnataka, Maharashtra and Gujarat. The assessment and treatment techniques used were almost similar between ICUs and wards. More than 80% of the responders carried out the assessment of certain respiratory impairments in both ICUs and wards. An objective measure of dyspnea was taken by less than 40% of the responders, with little attention given to functional exercise capacity and health-related quality of life. Eighty-five percent of the responders used Dyspnea-relieving strategies and traditional airway clearance techniques in both ICUs and wards. Eighty-three percent of the responders were giving patients in the wards training for upper and lower extremity. Fifty percent were giving strength training in the wards. Conclusion: Whether patients are admitted in ICUs or Wards, the practice pattern adopted by Physiotherapists to treat them vary

  7. Investigations with FDG-PET Scanning in Prostate Cancer Show Limited Value for Clinical Practice

    Energy Technology Data Exchange (ETDEWEB)

    Salminen, Eeva [Univ. of Turku (Finland). Department of Oncology and Radiotherapy; Hogg, Annette; Binns, David; Hicks, Rodney [The Peter MacCallum Cancer Institute, East Melbourne, Vic (Australia). Dept. of Diagnostic Imaging; Frydenberg, Mark [Monash Medical Centre, Clayton, Vic (Australia)

    2002-09-01

    The aim of this study was to investigate FDG-PET (fluorodeoxyglucose positron emission tomography) imaging in the management of prostate cancer. Twenty-two patients were studied during different disease phases of prostate cancer, for staging or restaging to clarify specific clinical questions. FDG-PET was performed encompassing the thorax, abdomen and pelvis using the Penn PET 300H scanner. Scanning was begun 60 min after {sup 18}F fluorodeoxyglucose marker. Patients were catheterized and administered diuretics to minimize urinary activity. Information obtained with FDG-PET was concordant with findings from other investigations in 7/22 (32%) patients, discordant in 15/22 (68%) patients and equivalent in one patient (4%). PET indicated progressive disease in five patients with prostate-specific antigen (PSA) <4 ng/L. The impact on management of the patients was high in 46% of cases, low in 41% and for 14% there was no impact on management. The accuracy of FDG-PET was 72% (95% CI 50-89) as confirmed by invasive diagnostics/follow-up. FDG-PET can provide useful information and improve the clinician's decision on further management procedures in selected patients with low PSA and bone or lymph node changes. A negative PET scan in prostate cancer should be interpreted with caution.

  8. Investigation of the antifungal potential of linalool against clinical isolates of fluconazole resistant Trichophyton rubrum.

    Science.gov (United States)

    de Oliveira Lima, M I; Araújo de Medeiros, A C; Souza Silva, K V; Cardoso, G N; de Oliveira Lima, E; de Oliveira Pereira, F

    2017-06-01

    The aim of this study was to investigate the activity of the monoterpene linalool against clinical isolates of Trichophyton rubrum. Initially, a sensitivity assay for commercial antifungals with solid disks in diffusion medium was performed. Minimum inhibitory concentration (MIC) of linalool and ketoconazole (positive control) were determined by microdilution in RPMI 1640 medium (CLSI M38-A2). We then evaluated the action of linalool and ketoconazole at different concentrations (1/2MIC, MIC and 2×MIC) on mycelial growth (radial mycelial growth), conidia production and conidia germination using a hemacytometer. The effects on cell membrane (release of intracellular material) were also investigated. Finally, changes in fungal morphology as induced by the test drugs were analyzed. Based on the sensitivity tests, the fungal strains showed resistance to 5-fluorocytosine and fluconazole. The linalool MIC values ranged from 256μg/mL to 512μg/mL, whereas ketoconazole showed values of 4μg/mL to 8μg/mL. For the LM 305 strain, the test drugs showed the following MIC values: linalool 256μg/mL and ketoconazole 8μg/mL. The mycelial growth of T. rubrum LM 305 was inhibited by linalool (2×MIC) and ketoconazole (1/2MIC, MIC, 2×MIC), in 7 days of treatment (PTrichophyton rubrum potential, an important dermatophytosis agent. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  9. Clinical investigation of TROP-2 as an independent biomarker and potential therapeutic target in colon cancer.

    Science.gov (United States)

    Zhao, Peng; Yu, Hai-Zheng; Cai, Jian-Hui

    2015-09-01

    Colon cancer is associated with a severe demographic and economic burden worldwide. The pathogenesis of colon cancer is highly complex and involves sequential genetic and epigenetic mechanisms. Despite extensive investigation, the pathogenesis of colon cancer remains to be elucidated. As the third most common type of cancer worldwide, the treatment options for colon cancer are currently limited. Human trophoblast cell‑surface marker (TROP‑2), is a cell‑surface transmembrane glycoprotein overexpressed by several types of epithelial carcinoma. In addition, TROP‑2 has been demonstrated to be associated with tumorigenesis and invasiveness in solid types of tumor. The aim of the present study was to investigate the protein expression of TROP‑2 in colon cancer tissues, and further explore the association between the expression of TROP‑2 and clinicopathological features of patients with colon cancer. The expression and localization of the TROP‑2 protein was examined using western blot analysis and immunofluorescence staining. Finally, the expression of TROP‑2 expression was correlated to conventional clinicopathological features of colon cancer using a χ2 test. The results revealed that TROP‑2 protein was expressed at high levels in the colon cancer tissues, which was associated with the development and pathological process of colon cancer. Therefore, TROP‑2 may be used as a biomarker to determine the clinical prognosis, and as a potential therapeutic target in colon cancer.

  10. Survey of Implementation of Antiemetic Prescription Standards in Indian Oncology Practices and Its Adherence to the American Society of Clinical Oncology Antiemetic Clinical Guideline

    Science.gov (United States)

    Patil, Vijay; Noronha, Vanita; Joshi, Amit; Parikh, Purvish; Bhattacharjee, Atanu; Chakraborty, Santam; Jandyal, Sunny; Muddu, Vamshi; Ramaswamy, Anant; Babu, K. Govinda; Lokeshwar, Nilesh; Hingmire, Sachin; Ghadyalpatil, Nikhil; Banavali, Shripad

    2017-01-01

    Purpose Adherence to international antiemetic prophylaxis guidelines like those of ASCO can result in better control of chemotherapy-induced nausea and vomiting; however, the extent of implementation of such guidelines in India is unknown. Therefore, this survey was planned. Methods This study was an anonymized cross-sectional survey approved by the ethics committee. Survey items were generated from the clinical questions given in the ASCO guidelines. The survey was disseminated through personal contacts at an oncology conference and via e-mail to various community oncology centers across India. The B1, B2, and B3 domains included questions regarding the optimal antiemetic prophylaxis for high, moderate, and low-minimal emetogenic regimens. Results Sixty-six (62.9%) of 105 responded and 65 centers (98.5%) were aware of the published guidelines. The partial, full, and no implementation scores were 92.5%, 4.5%, and 3.0%, respectively. Full implementation was better for the low-minimal emetogenic regimens (34.8%) than the highly emetogenic regimens (6.1%). The three most frequent reasons for hampered implementation of ASCO guidelines in routine chemotherapy practice cited by centers were a lack of sensitization (26 centers; 39.4%), lack of national guidelines (12 centers; 18.2%), and lack of administrative support (10 centers; 15.2%). Conclusion Awareness regarding ASCO antiemetic guidelines is satisfactory in Indian oncology practices; however, there is a need for sensitization of oncologists toward complete implementation of these guidelines in their clinical practice. PMID:28831443

  11. Survey of Implementation of Antiemetic Prescription Standards in Indian Oncology Practices and Its Adherence to the American Society of Clinical Oncology Antiemetic Clinical Guideline

    Directory of Open Access Journals (Sweden)

    Vijay Patil

    2017-08-01

    Full Text Available Purpose: Adherence to international antiemetic prophylaxis guidelines like those of ASCO can result in better control of chemotherapy-induced nausea and vomiting; however, the extent of implementation of such guidelines in India is unknown. Therefore, this survey was planned. Methods: This study was an anonymized cross-sectional survey approved by the ethics committee. Survey items were generated from the clinical questions given in the ASCO guidelines. The survey was disseminated through personal contacts at an oncology conference and via e-mail to various community oncology centers across India. The B1, B2, and B3 domains included questions regarding the optimal antiemetic prophylaxis for high, moderate, and low-minimal emetogenic regimens. Results: Sixty-six (62.9% of 105 responded and 65 centers (98.5% were aware of the published guidelines. The partial, full, and no implementation scores were 92.5%, 4.5%, and 3.0%, respectively. Full implementation was better for the low-minimal emetogenic regimens (34.8% than the highly emetogenic regimens (6.1%. The three most frequent reasons for hampered implementation of ASCO guidelines in routine chemotherapy practice cited by centers were a lack of sensitization (26 centers; 39.4%, lack of national guidelines (12 centers; 18.2%, and lack of administrative support (10 centers; 15.2%. Conclusion: Awareness regarding ASCO antiemetic guidelines is satisfactory in Indian oncology practices; however, there is a need for sensitization of oncologists toward complete implementation of these guidelines in their clinical practice.

  12. Clinical studies involving probiotics: when FDA's investigational new drug rubric applies-and when it may not.

    Science.gov (United States)

    Degnan, Fred H

    2012-01-01

    Researchers from a diverse array of scientific disciplines have focused and continue to focus on opportunities and areas for responsible clinical research involving the possible beneficial health effects of "probiotics." Investigators and researchers should be aware that not all clinical research involving probiotics reasonably falls within the requirements of the "investigational new drug" (IND) rubric administered and enforced by the US Food and Drug Administration. In determining whether an IND application is required before a clinical study may lawfully commence, investigators and researchers as well as institutional review boards should consider the regulatory classification, e.g., "drug," "new drug," "food," "food additive," "dietary supplement," etc. that applies to the substance under investigation. A potential probiotic product can fall along a continuum of regulatory classifications, each having implications on the nature and degree of regulatory requirements for clinical research and, ultimately, for claim substantiation and market access.

  13. Genomic investigation of Danish Staphylococcus aureus isolates from bulk tank milk and dairy cows with clinical mastitis

    DEFF Research Database (Denmark)

    Ronco, Troels; Klaas, Ilka C.; Stegger, Marc

    2018-01-01

    wholegenome sequenced and further analyzed. Thus, the main objective was to investigate the population structure and genomic content of isolates from bulk tank milk and clinical mastitis, using whole-genome sequencing. This may reveal the origin of strains that cause clinical mastitis. S. aureus isolates from...

  14. Clinical investigation of large perfusion defect cases with {sup 201}Tl exercise myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Morota, Motoi; Kobayashi, Yasuhiko [Tokyo Medical Coll. (Japan)

    1999-02-01

    We investigated retrospectively the clinical significance of large perfusion defect on {sup 201}Thallium myocardial scintigraphy from the records of 833 patients during the past 3 years from 1991 to 1994. The patients were divided into 3 groups according to the extent of perfusion defect; cases with normal perfusion (n=561), with small perfusion defect (n=211) and with large perfusion defect (n=61). We found that the proportions of cases with large perfusion defect was significantly larger than that of cases with small perfusion defect in myocardial disease (MD; hypertrophic cardiomyopathy, dilated cardiomyopathy, and post myocarditis combined) (P<0.001). Analyzing patients with ischemic heart disease (IHD; angina pectoris and myocardial infarction) according to the severity of coronary artery lesion, the proportion of cases with large perfusion defect was significantly larger than that of cases with small perfusion defect in 3 vessel disease (P<0.001). Incidence of diabetes mellitus was significantly higher in patients with IHD than in those with MD in large perfusion defect group (P<0.01). As for symptoms in large perfusion defect group, the incidences of chest pain, chest oppression, and chest discomfort were significantly higher in patients with IHD than in those with MD (P<0.001), whereas the incidences of palpitation and shortness of breath were significantly higher in patients with MD (P<0.001). These results suggest that IHD with multiple artery lesions and MD underlie large perfusion defect on {sup 201}Thallium myocardial scintigraphy and that complication of diabetes mellitus and clinical symptoms may be useful in differentiating IHD from MD. (author)

  15. Investigation of the clinical potential of scattering foil free electron beams.

    Science.gov (United States)

    Eldib, Ahmed; Jin, Lihui; Li, Jinsheng; Ma, C-M Charlie

    2014-02-21

    Electron beam therapy has been an important radiation therapy modality for many decades. Studies have been conducted recently for more efficient and advanced delivery of electron beam radiation therapy. X-ray contamination is a common problem that exists with all of the advanced electron beam therapy techniques such as Bolus Electron conformal therapy, segmented electron conformal therapy, and modulated electron arc therapy. X-ray contamination could add some limitations to the advancement and clinical utility of those electron modalities. It was previously shown in the literature that the scattering foil is one of the major accelerator parts contributing to the generation of bremsstrahlung photons. Thus, in this work we investigate the dosimetric characteristics of scattering foil free (SFF) electron beams and the feasibility of using those beams for breast cancer boosts. The SFF electron beams were modeled and simulated using the Monte Carlo method. CT scans of six previously treated breast patients were used for the treatment plan generation utilizing our in-house Monte Carlo-based treatment planning system. Electron boost plans with conventional beams and the SFF beams were generated, respectively, for all patients. A significant reduction of the photon component was observed with the removal of the primary scattering foil for beam energies higher than 12 MeV. Flatness was greatly affected but the difference in flatness between conventional and SFF beams was much reduced for small cone sizes, which were often used clinically for breast boosts. It was found that the SFF electron beams could deliver high-quality dose distributions as conventional electron beams for boost treatments of the breast with an added advantage of a further reduced dose to the lung and the heart.

  16. Nebulized anticoagulants for acute lung injury - a systematic review of preclinical and clinical investigations.

    Science.gov (United States)

    Tuinman, Pieter R; Dixon, Barry; Levi, Marcel; Juffermans, Nicole P; Schultz, Marcus J

    2012-12-12

    Data from interventional trials of systemic anticoagulation for sepsis inconsistently suggest beneficial effects in case of acute lung injury (ALI). Severe systemic bleeding due to anticoagulation may have offset the possible positive effects. Nebulization of anticoagulants may allow for improved local biological availability and as such may improve efficacy in the lungs and lower the risk of systemic bleeding complications. We performed a systematic review of preclinical studies and clinical trials investigating the efficacy and safety of nebulized anticoagulants in the setting of lung injury in animals and ALI in humans. The efficacy of nebulized activated protein C, antithrombin, heparin and danaparoid has been tested in diverse animal models of direct (for example, pneumonia-, intra-pulmonary lipopolysaccharide (LPS)-, and smoke inhalation-induced lung injury) and indirect lung injury (for example, intravenous LPS- and trauma-induced lung injury). Nebulized anticoagulants were found to have the potential to attenuate pulmonary coagulopathy and frequently also inflammation. Notably, nebulized danaparoid and heparin but not activated protein C and antithrombin, were found to have an effect on systemic coagulation. Clinical trials of nebulized anticoagulants are very limited. Nebulized heparin was found to improve survival of patients with smoke inhalation-induced ALI. In a trial of critically ill patients who needed mechanical ventilation for longer than two days, nebulized heparin was associated with a higher number of ventilator-free days. In line with results from preclinical studies, nebulization of heparin was found to have an effect on systemic coagulation, but without causing systemic bleedings. Local anticoagulant therapy through nebulization of anticoagulants attenuates pulmonary coagulopathy and frequently also inflammation in preclinical studies of lung injury. Recent human trials suggest nebulized heparin for ALI to be beneficial and safe, but data

  17. Anatomic investigation of lumbar transforaminal fenestration approach and its clinical application in far lateral disc herniation.

    Science.gov (United States)

    Xu, Baoshan; Xu, Haiwei; Destandau, Jean; Ma, Xinlong; He, Jian; Xia, Qun; Ji, Ning; Yang, Qiang; Liu, Yue; Jiang, Hongfeng

    2017-07-01

    Treating lumbar disease at the intervertebal foramina is controversial because we lack an approach providing sufficient exposure and preserving spinal stability. The primary objective of this study was to investigate the feasibility of the transforaminal fenestration (TFF) approach for treating lumbar disease involving the intervertebal foramina.In the anatomic study of 30 adult cadaveric lumbar spine specimens, the TFF approach was used from L1 to S1. The scope of resection was measured manually and on 3D CT images. 3D CT images of the lumbar spine of 31 adult patients were collected, and the scope of resection needed during the TFF approach was defined and measured from L1 to S1. In total, 30 patients (14 men) with lumbar FLDH underwent microendoscopic discectomy (MED) via the TFF approach. The results were evaluated with visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 survey (SF-36), and the MacNab scale.In cadavers, the TFF approach provided sufficient exposure to the posterolateral aspect of the disc and the exiting nerve root at all segments. At L1 to L4, a relatively small part of the isthmus and facet joint was resected; at L4 to S1, a relatively large part of the isthmus and facet joint was resected, so luniform fenestration was needed to preserve a more inferior articular process and continuity of the isthmus. Treatment with MED via the TFF approach was successful in the 30 patients with significantly relieved of symptom after operation. In total, 24 patients were followed for a mean of 24 months. The VAS, ODI, SF-36 physical component, and mental component summary scores at the final follow-up improved significantly compared with preoperative data (P approach can provide sufficient exposure to the lumbar intervertebal foramina with preservation of stability and can be used effectively with MED to treat lumbar FLDH.

  18. Typical investigational medicinal products follow relatively uniform regulations in 10 European Clinical Research Infrastructures Network (ECRIN) countries

    DEFF Research Database (Denmark)

    Gluud, Christian; Kubiak, Christine; Whitfield, Kate

    2012-01-01

    In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe.......In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe....

  19. Clinical Data Systems to Support Public Health Practice: A National Survey of Software and Storage Systems Among Local Health Departments.

    Science.gov (United States)

    McCullough, J Mac; Goodin, Kate

    2016-01-01

    Numerous software and data storage systems are employed by local health departments (LHDs) to manage clinical and nonclinical data needs. Leveraging electronic systems may yield improvements in public health practice. However, information is lacking regarding current usage patterns among LHDs. To analyze clinical and nonclinical data storage and software types by LHDs. Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County and City Health Officials. A total of 324 LHDs from all 50 states completed the survey (response rate: 50%). Outcome measures included LHD's primary clinical service data system, nonclinical data system(s) used, and plans to adopt electronic clinical data system (if not already in use). Predictors of interest included jurisdiction size and governance type, and other informatics capacities within the LHD. Bivariate analyses were performed using χ and t tests. Up to 38.4% of LHDs reported using an electronic health record (EHR). Usage was common especially among LHDs that provide primary care and/or dental services. LHDs serving smaller populations and those with state-level governance were both less likely to use an EHR. Paper records were a common data storage approach for both clinical data (28.9%) and nonclinical data (59.4%). Among LHDs without an EHR, 84.7% reported implementation plans. Our findings suggest that LHDs are increasingly using EHRs as a clinical data storage solution and that more LHDs are likely to adopt EHRs in the foreseeable future. Yet use of paper records remains common. Correlates of electronic system usage emerged across a range of factors. Program- or system-specific needs may be barriers or facilitators to EHR adoption. Policy makers can tailor resources to address barriers specific to LHD size, governance, service portfolio, existing informatics capabilities, and other pertinent characteristics.

  20. Proposed program for and present status of the Geological Survey's investigation of domestic resources of radioactive raw materials

    Science.gov (United States)

    Bulter, A.P.; Killeen, P.L.; Page, G.B.; Rubey, W.W.

    1983-01-01

    This interim report is designed to show the present status of the Geological Survey's information and the parts of a comprehensive program necessary to improve our information about the raw material resources of uranium and thorium. Rarely in geologic work has it been necessary. to determine so completely a nation's resources of useful minerals in so brief a span of time. Ordinarily, information on mineral resources Is accumulated during a long period of years. However, uranium and thorium were suddenly thrust from a position of subsidiary economic interest into one of great strategic importance. Information concerning their occurrence must, therefore, be obtained as rapidly as reliable methods of investigation will permit. Accordingly the program must be at once comprehensive and carried out over an area more extensive than is usual in the search for and appraisal of most other mineral resources.

  1. Risk of tuberculosis among air passengers estimated by interferon gamma release assay: survey of contact investigations, Japan, 2012 to 2015.

    Science.gov (United States)

    Ota, Masaki; Kato, Seiya

    2017-03-23

    Although the World Health Organization recommends contact investigations around air travel-associated sputum smear-positive tuberculosis (TB) patients, evidence suggests that the information thus obtained may have overestimated the risk of TB infection because it involved some contacts born in countries with high TB burden who were likely to have been infected with TB in the past, or because tuberculin skin tests were used, which are less specific than the interferon gamma release assay (IGRA) particularly in areas where Bacillus Calmette-Guérin (BCG) vaccination coverage is high. We conducted a questionnaire survey on air travel-associated TB contact investigations in local health offices of Japan from 2012 to 2015, focusing on IGRA positivity. Among 651 air travel-associated TB contacts, average positivity was 3.8% (95% confidence interval (CI): 2.5-5.6) with a statistically significant increasing trend with older age (p < 0.0094). Positivity among 0-34 year-old contacts was 1.0% (95% CI: 0.12-3.5%), suggesting their risk of TB infection is as small as among Japanese young adults with low risk of TB infection (positivity: 0.85-0.90%). Limiting the contact investigation to fewer passengers (within two seats surrounding the index case, rather than two rows) seems reasonable in the case of aircraft with many seats per row. This article is copyright of The Authors, 2017.

  2. Obstetric anal sphincter injuries: a survey of clinical practice among Canadian obstetricians.

    Science.gov (United States)

    Best, Carolyn; Drutz, Harold P; Alarab, May

    2012-08-01

    To describe the current practice, experience, and confidence of Canadian obstetricians in the management of obstetric anal sphincter injuries (OASIS) and to explore the need for national practice guidelines on this topic. We conducted a cross-sectional, Internet-based survey between December 2010 and March 2011. The survey was initially tested among a sample population and then distributed electronically to 665 Canadian obstetricians. Data were analyzed descriptively. The main outcome measures were the self-reported confidence and experience of Canadian obstetricians in OASIS management and the frequency of performing specific OASIS management steps. The survey response rate was 28.7%. The majority of the respondents (95%) reported confidence in performing OASIS repairs. In the event of a perineal laceration, 47.9% of respondents routinely performed a rectal examination. Most OASIS repairs were performed in the delivery room (89.4%) under local anaesthesia (60.6%) when regional ana