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1

Clinical practice guidelines. USPSTF recommendations.  

PubMed

The set of USPSTF recommendations provides a valuable resource for clinicians in varied practice settings. Although the 2nd edition of recommendations addressed over 200 topics, only six statements have been released as part of the 3rd edition thus far. Others, not reviewed in this article include: screening for newborn hearing, screening for bacterial vaginosis during pregnancy, and screening for lipid disorders. The recommendations are conservative and, like all clinical practice guidelines, should be considered in light of one's philosophy of practice. The recommendations meet many of the criteria addressed in the initial column of this series. The factors considered by the panel members are identified, including accuracy of available screening methodologies, cost factors, and benefit/risk determinations. The evidence on which recommendations are based is rated. Exceptions to the recommendations are identified. For instance, the authors of the paper on skin cancer screenings indicate that they did not consider studies based on persons with familial skin cancers. Although no recommendation is made for or against skin cancer screenings, ways in which the skin can be assessed during physical examinations performed for other reasons are identified. The importance of individual patient preference is included. The USPSTF panel is multi-disciplinary and includes [table: see text] (http://www.guideline.gov). The statement on aspirin therapy was published in the Annals of Internal Medicine and is available, along with a second article discussing the evidence in more depth (Hayden, Pignone, Phillips, & Mulrow, 2002), at: http://www.annals.org. Print versions are available through the Agency for Healthcare Research and Quality (AHRQ) Publications Clearinghouse (1-800-358-9295). Readers are encouraged to obtain full copies of the recommendations that are applicable to their practice as they become available and to assess their potential application in practice. PMID:11924331

Goolsby, Mary Jo

2002-03-01

2

[Acute bronchiolitis clinical practice guideline: recommendations for clinical practice].  

PubMed

There are scientific controversies about the management of acute bronchiolitis that generate a great variability in the approach to this entity. A clinical practice guideline (CPG) is a set of systematically developed recommendations to assist practitioners and patients to make decisions based on evidence. A working group (WG) of experts has been selected and they have developed the clinical questions. A systematic search for evidence on the acute bronchiolitis has been done and the evidence has been assessed. The information obtained has been summarized in evidence tables and recommendations have been done from them. The WG has produced a total of 46 clinical questions grouped into sections (diagnosis, complementary tests, treatment, monitoring, prevention and evolution), resulting in 133 recommendations. The CPG on acute bronchiolitis provides an opportunity to unify clinical practice based on scientific evidence, which could rationalize the use of health resources, improving health care quality and equity of access to services. PMID:20634158

Nebot, M Simó; Teruel, G Claret; Cubells, C Luaces; Sabadell, M D Estrada; Fernández, J Pou

2010-10-01

3

Recommendations Pharmacotherapy (excluding biotherapies) for ankylosing spondylitis: Development of recommendations for clinical practice based on published evidence and expert opinion  

Microsoft Academic Search

Objectives: To develop recommendations about pharmacotherapy (excluding biotherapeutic agents) in patients with axial forms of ankylosing spondylitis (AS) seen in everyday clinical practice. Methods: The recommendations were based on evidence from the literature. First, a scientific committee used a Delphi procedure to select five focal points about which recommendations were needed. Then, a literature task force looked for relevant publications

Frederic Lavie; Stephan Pavy; Emmanuelle Dernis; Philippe Goupille; Alain Cantagrel; Jacques Tebib; Pascal Claudepierre; ReneMarc Flipo; Jean-Francis Maillefert; Xavier Mariette; Alain Saraux; Thierry Schaeverbeke; Daniel Wendling; Bernard Combe

2007-01-01

4

Pain Assessment in the Nonverbal Patient: Position Statement with Clinical Practice Recommendations  

Microsoft Academic Search

The article presents the position statement and clinical practice recommendations for pain assessment in the nonverbal patient developed by an appointed Task Force and approved by the ASPMN Board of Directors.

Keela Herr; Patrick J. Coyne; Tonya Key; Renee Manworren; Margo McCaffery; Sandra Merkel; Jane Pelosi-Kelly; Lori Wild

2006-01-01

5

Recommendations Usefulness of taping in lower limb osteoarthritis. French clinical practice guidelines  

Microsoft Academic Search

Objectives: To develop clinical practice guidelines about the use of taping in the management of lower limb osteoarthritis. Method: We used the methodology advocated by the SOFMER (French Society for Physical and Rehabilitation Medicine), which combines a literature review, collection of data on current practice patterns, and validation of the recommendations by a multidisciplinary panel of experts. Our evaluation focused

Pascal Richette; Patrick Sautreuil; Emmanuel Coudeyre; Xavier Chevalier; Michel Revel; Francois Rannou

6

Governance for clinical decision support: case studies and recommended practices from leading institutions  

PubMed Central

Objective Clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technical governance structures. The authors sought to determine the range and variety of these governance structures and identify a set of recommended practices through observational study. Design Three site visits were conducted at institutions across the USA to learn about CDS capabilities and processes from clinical, technical, and organizational perspectives. Based on the results of these visits, written questionnaires were sent to the three institutions visited and two additional sites. Together, these five organizations encompass a variety of academic and community hospitals as well as small and large ambulatory practices. These organizations use both commercially available and internally developed clinical information systems. Measurements Characteristics of clinical information systems and CDS systems used at each site as well as governance structures and content management approaches were identified through extensive field interviews and follow-up surveys. Results Six recommended practices were identified in the area of governance, and four were identified in the area of content management. Key similarities and differences between the organizations studied were also highlighted. Conclusion Each of the five sites studied contributed to the recommended practices presented in this paper for CDS governance. Since these strategies appear to be useful at a diverse range of institutions, they should be considered by any future implementers of decision support. PMID:21252052

Sittig, Dean F; Ash, Joan S; Bates, David W; Feblowitz, Joshua; Fraser, Greg; Maviglia, Saverio M; McMullen, Carmit; Nichol, W Paul; Pang, Justine E; Starmer, Jack; Middleton, Blackford

2011-01-01

7

Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study  

PubMed Central

Background The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. Methods Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. Results The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. Conclusions These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors. PMID:22333210

2012-01-01

8

[What is the contribution of clinical practice recommendations concerning the prevention of depressive recurrences?].  

PubMed

Depression has to be managed using a combination of data-driven evidence and clinical experience. Recommendations for clinical practice are various and heterogeneous, depending on their objectives. The identification of their differences can provide informations on the difficulties that we can have in treating depressed patients. Treatment guidelines for depression support both early vigorous treatment, and continued therapy after the acute phase. In recurrent depression, maintenance antidepressant therapy and regular monitoring is advised, but pharmacological strategies should be tailored to the individual for treatment that matches the phase of illness. Psychological strategies and more specifically Cognitive Behavioral Therapy should be developed to prevent relapse specifically. Relapse prevention involves putting supports in place to help the patient stay well and to reduce the likelihood of future illness. It includes developing a plan for managing early relapse symptoms and to identify potential high-risk situations. But, a large proportion of people with a depressive disorder do not receive minimally adequate treatment. Improving the concordance of everyday practice with clinical recommendations should be an important goal for clinicians. PMID:21211637

Llorca, P-M

2010-12-01

9

Authorized and Unauthorized (“PCA by Proxy”) Dosing of Analgesic Infusion Pumps: Position Statement with Clinical Practice Recommendations  

Microsoft Academic Search

The American Society for Pain Management Nursing (ASPMN), in order to address sentinel alerts issued by JCAHO in 2004 and ISMP in 2005 concerning “PCA by Proxy”, has developed a position statement and clinical practice recommendations on Authorized and Unauthorized (PCA by Proxy) Dosing of Analgesic Infusion Pumps, approved by the Board of Directors in June of 2006. In short,

Elsa Wuhrman; Maureen F. Cooney; Colleen J. Dunwoody; Nancy Eksterowicz; Sandra Merkel; Linda L. Oakes

2007-01-01

10

Clinical review: practical recommendations on the management of perioperative heart failure in cardiac surgery.  

PubMed

Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, significant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency and high-risk surgery. EuroSCORE reliably predicts perioperative cardiovascular alteration in patients aged less than 80 years. Preoperative B-type natriuretic peptide level is an additional risk stratification factor. Aggressively preserving heart function during cardiosurgery is a major goal. Volatile anaesthetics and levosimendan seem to be promising cardioprotective agents, but large trials are still needed to assess the best cardioprotective agent(s) and optimal protocol(s). The aim of monitoring is early detection and assessment of mechanisms of perioperative cardiovascular dysfunction. Ideally, volume status should be assessed by 'dynamic' measurement of haemodynamic parameters. Assess heart function first by echocardiography, then using a pulmonary artery catheter (especially in right heart dysfunction). If volaemia and heart function are in the normal range, cardiovascular dysfunction is very likely related to vascular dysfunction. In treating myocardial dysfunction, consider the following options, either alone or in combination: low-to-moderate doses of dobutamine and epinephrine, milrinone or levosimendan. In vasoplegia-induced hypotension, use norepinephrine to maintain adequate perfusion pressure. Exclude hypovolaemia in patients under vasopressors, through repeated volume assessments. Optimal perioperative use of inotropes/vasopressors in cardiosurgery remains controversial, and further large multinational studies are needed. Cardiosurgical perioperative classification of cardiac impairment should be based on time of occurrence (precardiotomy, failure to wean, postcardiotomy) and haemodynamic severity of the patient's condition (crash and burn, deteriorating fast, stable but inotrope dependent). In heart dysfunction with suspected coronary hypoperfusion, an intra-aortic balloon pump is highly recommended. A ventricular assist device should be considered before end organ dysfunction becomes evident. Extra-corporeal membrane oxygenation is an elegant solution as a bridge to recovery and/or decision making. This paper offers practical recommendations for management of perioperative HF in cardiosurgery based on European experts' opinion. It also emphasizes the need for large surveys and studies to assess the optimal way to manage perioperative HF in cardiac surgery. PMID:20497611

Mebazaa, Alexandre; Pitsis, Antonis A; Rudiger, Alain; Toller, Wolfgang; Longrois, Dan; Ricksten, Sven-Erik; Bobek, Ilona; De Hert, Stefan; Wieselthaler, Georg; Schirmer, Uwe; von Segesser, Ludwig K; Sander, Michael; Poldermans, Don; Ranucci, Marco; Karpati, Peter C J; Wouters, Patrick; Seeberger, Manfred; Schmid, Edith R; Weder, Walter; Follath, Ferenc

2010-01-01

11

Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery  

PubMed Central

Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, significant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency and high-risk surgery. EuroSCORE reliably predicts perioperative cardiovascular alteration in patients aged less than 80 years. Preoperative B-type natriuretic peptide level is an additional risk stratification factor. Aggressively preserving heart function during cardiosurgery is a major goal. Volatile anaesthetics and levosimendan seem to be promising cardioprotective agents, but large trials are still needed to assess the best cardioprotective agent(s) and optimal protocol(s). The aim of monitoring is early detection and assessment of mechanisms of perioperative cardiovascular dysfunction. Ideally, volume status should be assessed by 'dynamic' measurement of haemodynamic parameters. Assess heart function first by echocardiography, then using a pulmonary artery catheter (especially in right heart dysfunction). If volaemia and heart function are in the normal range, cardiovascular dysfunction is very likely related to vascular dysfunction. In treating myocardial dysfunction, consider the following options, either alone or in combination: low-to-moderate doses of dobutamine and epinephrine, milrinone or levosimendan. In vasoplegia-induced hypotension, use norepinephrine to maintain adequate perfusion pressure. Exclude hypovolaemia in patients under vasopressors, through repeated volume assessments. Optimal perioperative use of inotropes/vasopressors in cardiosurgery remains controversial, and further large multinational studies are needed. Cardiosurgical perioperative classification of cardiac impairment should be based on time of occurrence (precardiotomy, failure to wean, postcardiotomy) and haemodynamic severity of the patient's condition (crash and burn, deteriorating fast, stable but inotrope dependent). In heart dysfunction with suspected coronary hypoperfusion, an intra-aortic balloon pump is highly recommended. A ventricular assist device should be considered before end organ dysfunction becomes evident. Extra-corporeal membrane oxygenation is an elegant solution as a bridge to recovery and/or decision making. This paper offers practical recommendations for management of perioperative HF in cardiosurgery based on European experts' opinion. It also emphasizes the need for large surveys and studies to assess the optimal way to manage perioperative HF in cardiac surgery. PMID:20497611

2010-01-01

12

Patient-tailored Workflow Patterns from Clinical Practice Guidelines Recommendations Lucia Sacchia  

E-print Network

derive guideline- based patient-centered care pathways for long-term care. Dif- ferently from of a patient-centered healthcare pro- cess modeling strategy, based on careflows and different knowledge types: Clinical practice guidelines, patient-centric care, decision sup- port system. Introduction and Background

Peleg, Mor

13

Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson's disease.  

PubMed

Falls in Parkinson's disease (PD) are common and frequently devastating. Falls prevention is an urgent priority, but there is no accepted program that specifically addresses the risk profile in PD. Therefore, we aimed to provide consensus-based clinical practice recommendations that systematically address potential fall risk factors in PD. We developed an overview of both generic (age-related) and PD-specific factors. For each factor, we specified: best method of ascertainment; disciplines that should be involved in assessment and treatment; and which interventions could be engaged. Using a web-based tool, we asked 27 clinically active professionals from multiple relevant disciplines to evaluate this overview. The revised version was subsequently reviewed by 12 experts. Risk factors and their associated interventions were included in the final set of recommendations when at least 66% of reviewing experts agreed. These recommendations included 31 risk factors. Nearly all required a multidisciplinary team approach, usually involving a neurologist and PD-nurse specialist. Finally, the expert panel proposed to first identify the specific fall type and to tailor screening and treatment accordingly. A routine evaluation of all risk factors remains reserved for high-risk patients without prior falls, or for patients with seemingly unexplained falls. In conclusion, this project produced a set of consensus-based clinical practice recommendations for the examination and management of falls in PD. These may be used in two ways: for pragmatic use in current clinical practice, pending further evidence; and as the active intervention in clinical trials, aiming to evaluate the effectiveness and cost-effectiveness of large scale implementation. PMID:24484618

van der Marck, Marjolein A; Klok, Margit Ph C; Okun, Michael S; Giladi, Nir; Munneke, Marten; Bloem, Bastiaan R

2014-04-01

14

Achieving Consensus on Recommendations for the Clinical Management of Overweight and Obese Adults for Canadian Physiotherapy Practice  

PubMed Central

ABSTRACT Purpose: The purpose of this study was to reach consensus on the importance and feasibility of clinical practice guideline (CPG) recommendations for physiotherapy practice for the prevention and management of overweight and obesity in Canadian adults. Methods: We used a modified Delphi method to achieve consensus. Participants rated the importance and feasibility of recommendations using a nine-point scale in two rounds of electronic surveys and a conference call. The mean and distribution of ratings were analyzed to determine consensus. Results: Twenty-one physiotherapists experienced in the management of patients with obesity and representing diverse regions of Canada and areas of practice participated. Seventeen (81.0%) completed survey 1. Ten (47.6%) participated in the conference call and survey 2. Eight of 34 strategies received mean ratings of 7.00 or more for both importance and feasibility from at least two-thirds of participants. These strategies were related to physical activity prescription and assessment. Conclusions: A sample of physiotherapists in Canada agreed that obesity-related CPGs contain recommendations that are important to physiotherapy practice. These findings, along with the Canadian Physiotherapy Association's position statement on obesity, provide support for the argument that physiotherapists, as direct-access practitioners or members of multidisciplinary teams, should play a role in the health care of people with obesity and overweight. PMID:23277684

Rosenthal, Stephanie; Evans, Cathy

2012-01-01

15

How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines  

Microsoft Academic Search

BACKGROUND: Clinical practice guidelines give recommendations about what to do in various medical situations, including therapeutical recommendations for drug prescription. An effective way to computerize these recommendations is to design critiquing decision support systems, i.e. systems that criticize the physician's prescription when it does not conform to the guidelines. These systems are commonly based on a list of \\

Jean-Baptiste Lamy; Vahid Ebrahiminia; Christine Riou; Brigitte Seroussi; Jacques Bouaud; Christian Simon; Stéphane Dubois; Antoine Butti; Gérard Simon; Madeleine Favre; Hector Falcoff; Alain Venot

2010-01-01

16

Evidence-Based Assessment of Child Obsessive Compulsive Disorder: Recommendations for Clinical Practice and Treatment Research  

Microsoft Academic Search

Obsessive-compulsive disorder (OCD) presents heterogeneously and can be difficult to assess in youth. This review focuses\\u000a on research-supported assessment approaches for OCD in childhood. Content areas include pre-visit screening, diagnostic establishment,\\u000a differential diagnosis, assessment of comorbid psychiatric conditions, tracking symptom severity, determining psychosocial\\u000a functioning, and evaluating clinical improvement. Throughout this review, similarities and differences between assessment\\u000a approaches geared towards clinical

Adam B. Lewin; John Piacentini

2010-01-01

17

Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery  

Microsoft Academic Search

ABSTRACT: Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, significant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency

Alexandre Mebazaa; Antonis A Pitsis; Alain Rudiger; Wolfgang Toller; Dan Longrois; Sven-Erik Ricksten; Ilona Bobek; Stefan De Hert; Georg Wieselthaler; Uwe Schirmer; Ludwig K von Segesser; Michael Sander; Don Poldermans; Marco Ranucci; Peter CJ Karpati; Patrick Wouters; Manfred Seeberger; Edith R Schmid; Walter Weder; Ferenc Follath

2010-01-01

18

Quality Assessment of Physical Activity Recommendations Within Clinical Practice Guidelines for the Prevention and Treatment of Cardio-metabolic Risk Factors in People With Schizophrenia  

Microsoft Academic Search

The aim of this review was to assess the quality of physical activity recommendations within clinical practice guidelines\\u000a for the prevention and treatment of the cardio-metabolic risk factors in schizophrenia. Several databases were searched from\\u000a their inception through July 2010. The Appraisal of Guidelines for Research and Evaluation instrument was used for the quality\\u000a assessment. Twelve recommendations met all the

Davy Vancampfort; Kim Sweers; Michel Probst; Alex J. Mitchell; Jan Knapen; Marc De Hert

19

How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines  

PubMed Central

Background Clinical practice guidelines give recommendations about what to do in various medical situations, including therapeutical recommendations for drug prescription. An effective way to computerize these recommendations is to design critiquing decision support systems, i.e. systems that criticize the physician's prescription when it does not conform to the guidelines. These systems are commonly based on a list of "if conditions then criticism" rules. However, writing these rules from the guidelines is not a trivial task. The objective of this article is to propose methods that (1) simplify the implementation of guidelines' therapeutical recommendations in critiquing systems by automatically translating structured therapeutical recommendations into a list of "if conditions then criticize" rules, and (2) can generate an appropriate textual label to explain to the physician why his/her prescription is not recommended. Methods We worked on the therapeutic recommendations in five clinical practice guidelines concerning chronic diseases related to the management of cardiovascular risk. We evaluated the system using a test base of more than 2000 cases. Results Algorithms for automatically translating therapeutical recommendations into "if conditions then criticize" rules are presented. Eight generic recommendations are also proposed; they are guideline-independent, and can be used as default behaviour for handling various situations that are usually implicit in the guidelines, such as decreasing the dose of a poorly tolerated drug. Finally, we provide models and methods for generating a human-readable textual critique. The system was successfully evaluated on the test base. Conclusion We show that it is possible to criticize physicians' prescriptions starting from a structured clinical guideline, and to provide clear explanations. We are now planning a randomized clinical trial to evaluate the impact of the system on practices. PMID:20509903

2010-01-01

20

NACB: Practice Guidelines And Recommendations For Use Of Tumor Markers In The Clinic Cervical Cancer (Section 3J) 1 National Academy of Clinical Biochemistry Guidelines for the Use of Tumor Markers in Cervical Cancer  

E-print Network

evidence; MRI, magnetic resonance imaging; SCC, squamous cell carcinoma antigen; TPA, tissue polypeptide antigen; TPS, tissue polypeptide specific antigen. NACB: Practice Guidelines And Recommendations For Use Of Tumor Markers In The Clinic Cervical Cancer (Section 3J) 2

Katja N. Gaarenstroom; Johannes M. G. Bonfrer

21

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

PubMed Central

Background The importance of incorporating quality-of-life (QoL) assessments into medical practice is growing as health care practice shifts from a “disease-based” to a “patient-centered” model. The prevalence of age-related macular degeneration (AMD) is increasing in today’s aging population. The purpose of this paper is: (1) to discuss, by reviewing the current literature, the impact of AMD on patients’ QoL and the utility of QoL assessments in evaluating the impact of AMD and its treatment; and (2) to make a recommendation for incorporating QoL into clinical practice. Methods We conducted a PubMed and an open Internet search to identify publications on the measurement of QoL in AMD, as well as the impact of AMD and the effect of treatment on QoL. A total of 28 articles were selected. Results AMD has been found to cause a severity-dependent decrement in QoL that is comparable to systemic diseases such as cancer, ischemic heart disease, and stroke. QoL impairment manifests as greater social dependence, difficulty with daily living, higher rates of clinical depression, increased risk of falls, premature admission to nursing homes, and suicide. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) is the most widely used eye disease-specific QoL instrument in AMD. It has been shown to correlate significantly with visual acuity (VA). QoL reflects aspects of AMD including psychological well-being, functional capacity, and the ability to perform patients’ valued activities, which are not captured by a single, numerical VA score. Conclusion The literature shows that the adverse impact of AMD on QoL is comparable to serious systemic disease. Eye disease-specific instruments for measuring QoL, such as the NEI VFQ-25, have shown a significant correlation of QoL decrement with measures of disease severity, as well as significant QoL improvement with treatment. The NEI VFQ-25 and other validated instruments provide a wide-ranging assessment of vision-related functioning that is important to patients and complementary to VA measurement. We strongly recommend the incorporation of QoL assessment into routine clinical practice. PMID:23836961

Yuzawa, Mitsuko; Fujita, Kyoko; Tanaka, Erika; Wang, Edward C Y

2013-01-01

22

Initial practice recommendations for teleneuropsychology.  

PubMed

Telemedicine refers to the use of electronic communications to deliver health-related services from a distance, and is particularly useful in bringing specialty services to remote and/or underserved areas. Despite the increasing use of videoconference technology in psychology, there are very few guidelines to direct practitioners as to the ethical practice and utilization of telemedicine, and even fewer resources for practitioners of telecognitive assessment or teleneuropsychology. This paper seeks to outline several practical and ethical considerations that are relevant to the practice of telecognitive assessment and to assist practitioners in providing safe, ethical, and competent care to their patients by proposing some initial practice recommendations. PMID:21951075

Grosch, Maria C; Gottlieb, Michael C; Cullum, C Munro

2011-10-01

23

[New recommendations for evaluating the effectiveness of treatment of solid tumors and principles of the Guidelines for Clinical Practice (GCP)].  

PubMed

A new WHO protocol for measuring tumor during clinical studies using upgraded methods of tumor diagnosis was released in 1994. The recommendations based on the examination of over 4,000 patients included measuring greatest diameter of tumor and evaluation of treatment effect by changes of a sum total of largest diameters. Therapeutic effect is established by a decrease in the sum by at least 30%, while tumor progression--by an increase by at least 20%. The GCP provide standards for planning, implementing, monitoring, auditing and documentation of clinical trials and submitting their findings. These standards guarantee the accuracy and reliability of data, patients' rights of health protection and anonymity of those taking part in trials. Today, these rules are binding for the European Community, Japan and the USA. All Russian medical establishments running clinical tests are to observe the rules. PMID:11826496

Gorbunova, V A; Orel, N F; Zaruk, V A

2001-01-01

24

Turner syndrome and pregnancy: clinical practice. Recommendations for the management of patients with Turner syndrome before and during pregnancy.  

PubMed

Following the death in France by acute aortic dissection of two women with Turner syndrome who were pregnant following oocyte donation, the Director of the French Biomedicine Agency (Agence de la biomédecine) sent a letter to the President of the French College of Obstetricians and Gynaecologists (FCOG). He requested the College's expertise in reviewing point-by-point the cases and risk factors and in determining whether there are grounds to propose additional measures complementary to the recommendations made by the Haute autorité de santé or French National Authority for Health (HAS) in 2008 in terms of indication and monitoring of patients. A joint practice committee of the FCOG, the French Cardiologic Society, the French Chest and Cardiovascular Surgery Society, the French Society of Anaesthesia and Intensive Care, the French Endocrine Society, the French study group for oocyte donation, and the Biomedicine Agency defined the exact questions to be put to the experts, chose these experts, followed them up and drafted the synthesis of recommendations resulting from their work. The questions concerned the check-up before pregnancy of Turner patients, contraindication and acceptance of pregnancy, information for the patients, and recommendations for antenatal care, delivery and postnatal follow-up. PMID:20594638

Cabanes, Laure; Chalas, Celine; Christin-Maitre, Sophie; Donadille, Brun; Felten, Marie Louise; Gaxotte, Valerie; Jondeau, Guillaume; Lansac, Emmanuel; Lansac, Jacques; Letur, Hélène; N'Diaye, Tatia; Ohl, Jeanine; Pariente-Khayat, Anne; Roulot, Dominique; Thepot, François; Zénaty, Delphine

2010-09-01

25

Clinical practice  

Microsoft Academic Search

Allergen-specific immunotherapy (SIT) in its various application forms represents the main treatment approach of IgE-mediated\\u000a allergic diseases in adults and children. Despite this clear recommendation, many particularities of products, patient characteristics,\\u000a and product availability in different countries hamper the use of allergen-specific immunotherapy in particular in children.\\u000a The frequently asked questions by parents, patients, and physicians are the backbone of

Zsolt Szépfalusi; Saskia Gruber; Thomas Eiwegger; Eleonora Dehlink

2011-01-01

26

Clinical Practice Guidelines in Psychiatry: More Confusion Than Clarity? A Critical Review and Recommendation of a Unified Guideline  

PubMed Central

The discipline of psychiatry has a plethora of guidelines, designed to serve the needs of the clinician. Yet, even a cursory glance is enough to discern the differences between the various guidelines. This paper reviews the current standard guidelines being followed across the world and proposes a unified guideline on the backbone of current evidence and practice being followed. The algorithm for pharmacological and psychosocial treatment for bipolar disorder, major depressive disorder, and schizophrenia is formulated after cross-comparison across four different guidelines and recent meta-analytical evidence. For every disorder, guidelines have different suggestions. Hence, based on the current status of evidence, algorithms have been combined to form a unified guideline for management. Clinical practice guidelines form the basis of standard clinical practice for all disciplines of medicine, including psychiatry. Yet, they are often not read or followed because of poor quality or because of barriers to implementation due to either lack of agreement or ambiguity. A unified guideline can go a long way in helping clear some of the confusion that has crept in due to the use of different guidelines across the world. PMID:25006523

Chaturvedi, Santosh K.

2014-01-01

27

Clinical practice  

Microsoft Academic Search

Protein-losing enteropathy (PLE) is a rare complication of a variety of intestinal disorders characterized by an excessive\\u000a loss of proteins into the gastrointestinal tract due to impaired integrity of the mucosa. The clinical presentation of patients\\u000a with PLE is highly variable, depending upon the underlying cause, but mainly consists of edema due to hypoproteinemia. While\\u000a considering PLE, other causes of

Marjet J. A. M. Braamskamp; Koert M. Dolman; Merit M. Tabbers

2010-01-01

28

Clinical review 171: The rationale, efficacy and safety of androgen therapy in older men: future research and current practice recommendations.  

PubMed

Epidemiological studies indicate that normal male aging is associated with a gradual and variable decline in blood testosterone concentrations and unfavorable changes in muscle, bone, and fat that mimic those of androgen deficiency in young men. These age-related reductions in muscle and bone mass and increased fat mass may be responsible for other age-related changes, including decreased muscle strength and physical function, changes in metabolic function, and increased falls, fractures, and disability. Whether age-related relative androgen deficiency truly causes any of these features requires interventional studies specifically in older men, because aged tissues may not remain androgen sensitive nor is such treatment necessarily safe. A Medline search (years 1966 through January 2004, using search terms random and androgen), supplemented by subsequent reference searches of retrieved articles, identified randomized placebo-controlled studies of androgen therapy. These studies show that androgen replacement in older men increases muscle and reduces fat mass to a small degree, but to date has not improved muscle strength, physical function, or insulin sensitivity, nor does it convincingly improve bone density, although the latter effect is particularly dose responsive. However, idiosyncratic adverse effects, such as disordered sleep and breathing as well as polycythemia, are also dose responsive, suggesting that dose escalation to increase efficacy may create or aggravate undesirable side effects. Furthermore, the clinical safety of androgen therapy for cardiovascular and prostatic disease is uncertain. Under these circumstances, androgen supplementation is not recommended in healthy older men. However, interim recommendations are available to help guide appropriate and curb unnecessary androgen prescription for symptomatic older men with low serum testosterone levels. PMID:15472164

Liu, Peter Y; Swerdloff, Ronald S; Veldhuis, Johannes D

2004-10-01

29

[International clinical recommendations on scar management].  

PubMed

Many techniques for management of hypertrophic scars and keloids have been proven through extensive use, but few have been supported by prospective studies with adequate control groups. Several new therapies showed good results in small-scale trials, but these have not been repeated in larger trials with long-term follow-up. This article reports a qualitative overview of the available clinical literature by an international panel of experts using standard methods of appraisal. The article provides evidence- based recommendations on prevention and treatment of abnormal scarring and, where studies are insufficient, consensus on best practice. The recommendations focus on the management of hypertrophic scars and keloids, and are internationally applicable in a range of clinical situations. These recommendations support a move to a more evidence-based approach in scar management. This approach highlights a primary role for silicon gel sheeting and intralesional corticosteroids in the management of a wide variety of abnormal scars. The authors concluded that these are the only treatments for which sufficient evidence exists to make evidence-based recommendations. A number of other therapies that are in common use have achieved acceptance by the authors as standard practice. However, it is highly desirable that many standard practice and new emerging therapies undergo large-scale studies with long-term follow-up before being recommended conclusively as alternative therapies for scar management. PMID:15354252

Ziegler, U E

2004-08-01

30

Grading evidence and recommendations for clinical practice guidelines in nephrology. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO).  

PubMed

Considerable variation in grading systems used to rate the strength of guideline recommendations and the quality of the supporting evidence in Nephrology highlights the need for a uniform, internationally accepted, rigorous system. In 2004, Kidney Disease: Improving Global Outcomes (KDIGO) commissioned a methods expert group to recommend an approach for grading in future nephrology guidelines. This position statement by KDIGO recommends adopting the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach for the grading of evidence and guidelines on interventions. The GRADE approach appraises systematic reviews of the benefits and harms of an intervention to determine its net health benefit. The system considers the design, quality, and quantity of studies as well as the consistency and directness of findings when grading the quality of evidence. The strength of the recommendation builds on the quality of the evidence and additional considerations including costs. Adaptations of the GRADE approach are presented to address some issues pertinent to the field of nephrology, including (1) the need to extrapolate from studies performed predominantly in patients without kidney disease, and (2) the need to use qualitative summaries of effects when it is not feasible to quantitatively summarize them. Further refinement of the system will be required for grading of evidence on questions other than those related to intervention effects, such as diagnostic accuracy and prognosis. PMID:17003817

Uhlig, K; Macleod, A; Craig, J; Lau, J; Levey, A S; Levin, A; Moist, L; Steinberg, E; Walker, R; Wanner, C; Lameire, N; Eknoyan, G

2006-12-01

31

Hypothyroidism in Clinical Practice  

PubMed Central

Background: Hypothyroidism is the most common endocrine disease that was seen in the clinical practice especially for family physicians. Methods: This review article covered the important practical clinical issues for managing overt hypothyroidism, subclinical hypothyroidism and hypothyroidism during pregnancy. Conclusions: The clinical issues were addressed by clinical scenario followed by questions and stressed on the important clinical points. PMID:25161963

Qari, Faiza

2014-01-01

32

X-STOP surgical implant for the treatment of lumbar spinal stenosis: clinical practice recommendations for neurosurgical nurse practitioners.  

PubMed

Lumbar spinal stenosis is a common condition that affects the aging population because of the natural degenerative changes the spine undergoes during the aging process. The symptoms cause decreased functionality and quality of life. Traditional surgical treatment has been a decompressive laminectomy with or without a fusion. However, a newer less-invasive surgical technique called X-STOP interspinous process device is available for the treatment of neurogenic intermittent claudication because of lumbar spinal stenosis. The main goal of this procedure is to allow the patient to restore functional ability and improve quality of life, which bears significant importance in the aging population. Knowledge of the X-STOP interspinous process device can assist neurosurgical advanced practice nurses in providing optimum care for patients with lumbar spinal stenosis when nonsurgical therapies have failed. PMID:23291871

Nielsen, Magan

2013-02-01

33

Recommendations Adherence to, and results of, physical therapy programs in patients with hip or knee osteoarthritis. Development of French clinical practice guidelines  

Microsoft Academic Search

Objective: To develop recommendations regarding adherence to physical therapy programs by patients with hip or knee osteoarthritis. Methods: We used the method recommended by the French Society for Physical and Rehabilitation Therapy (SOFMER), which combines a systematic literature review, a practice survey, and validation by a multidisciplinary panel of experts. Results: When setting up exercise programs for patients with lower

Bernard Mazieres; Emmanuel Coudeyre; Xavier Chevalier; Michel Revel; Francois Rannou

34

Professional practices and recommendations Establishing recommendations for physical medicine and rehabilitation: the SOFMER methodology  

Microsoft Academic Search

Objective. - The development of a rigorous methodology based on published results of clinical trials, evaluation of daily practice in France and multidisciplinary expert opinion to elaborate recommendations for rehabilitation interventions. Methods and results. - The following describes the methodology of SOFMER (Société Française de Médecine Physique et de Réadaptation (French Society of Physical Medicine and Rehabilitation)) for developing recommendations

F. Rannoua; E. Coudeyre; Y. Macé; S. Poiraudeau; M. Revel

35

Training research: practical recommendations for maximum impact.  

PubMed

This review offers practical recommendations regarding research on training in evidence-based practices for mental health and substance abuse treatment. When designing training research, we recommend: (a) aligning with the larger dissemination and implementation literature to consider contextual variables and clearly defining terminology, (b) critically examining the implicit assumptions underlying the stage model of psychotherapy development, (c) incorporating research methods from other disciplines that embrace the principles of formative evaluation and iterative review, and (d) thinking about how technology can be used to take training to scale throughout all stages of a training research project. An example demonstrates the implementation of these recommendations. PMID:21380792

Beidas, Rinad S; Koerner, Kelly; Weingardt, Kenneth R; Kendall, Philip C

2011-07-01

36

Medication recommendations vs. peer practice in pediatric levothyroxine dosing : a study of collective intelligence from a clinical data warehouse as a potential model for clinical decision support  

E-print Network

Clinical decision support systems (CDSS) are developed primarily from knowledge gleaned from evidence-based research, guidelines, trusted resources and domain experts. While these resources generally represent information ...

Scheufele, Elisabeth Lee

2009-01-01

37

Recommendations for Practice: Justifying Claims of Generalizability  

ERIC Educational Resources Information Center

Recommendations for practice are routinely included in articles that report educational research. Robinson et al. suggest that reports of primary research should not routinely do so. They argue that single primary research studies seldom have sufficient external validity to support claims about practice policy. In this article, I draw on recent…

Hedges, Larry V.

2013-01-01

38

Clinical Psychology Center Center Review Recommendation  

E-print Network

Clinical Psychology Center Center Review Recommendation B. Review and Approval Process 2 to address issues of common interest. The purpose of the Clinical Psychology Center (CPC) is to serve and the Missoula community. Clinical psychology research endeavors focus on a broad range of `therapy outcomes

Vonessen, Nikolaus

39

Clinical practice guideline: otitis media with effusion  

Microsoft Academic Search

The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline “Otitis Media With Effusion in Young Children,” which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the

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

2004-01-01

40

Implementing AORN recommended practices for environmental cleaning.  

PubMed

In recent years, researchers have developed an increasing awareness of the role of the environment in the development of health care-associated infections. AORN's "Recommended practices for environmental cleaning" is an evidence-based document that provides specific guidance for cleaning processes, for the selection of appropriate cleaning equipment and supplies, and for ongoing education and quality improvement. This updated recommended practices document has an expanded focus on the need for health care personnel to work collaboratively to accomplish adequately thorough cleanliness in a culture of safety and mutual support. Perioperative nurses, as the primary advocates for patients while they are being cared for in the perioperative setting, should help ensure that a safe, clean environment is reestablished after each surgical procedure. PMID:24766919

Allen, George

2014-05-01

41

Management of fingolimod in clinical practice.  

PubMed

The efficacy of the innovative oral drug fingolimod has been proven in the largest study program in multiple sclerosis (MS) demonstrating reduced relapse and reduced disability progression in relapsing-remitting MS patients. Based on the extensive safety data of all clinical trials and the natural distribution pattern of fingolimod interacting receptors in organism, careful clinical monitoring is recommend and reviewed in this paper. Safety and tolerability data from clinical studies as well as current post-marketing experience present with high tolerability and easy-to-perform management of fingolimod. Here we present the recommended management of fingolimod in clinical practice starting with preparatory steps, first-dose application and long-term treatment period with fingolimod. This management of fingolimod in clinical practice ensure a safe treatment algorithm using fingolimod. We recommend documentation of fingolimod patients in clinical registries to generate postmarketing data on efficacy and safety of fingoilimod. PMID:24321158

Thomas, Katja; Ziemssen, Tjalf

2013-12-01

42

Developing practice recommendations for endovascular revascularization for acute ischemic stroke  

PubMed Central

Guidelines have been established for the management of acute ischemic stroke; however, specific recommendations for endovascular revascularization therapy are lacking. Burgeoning investigation of endovascular revascularization therapies for acute ischemic stroke, rapid device development, and a diverse training background of the providers performing the procedures underscore the need for practice recommendations. This review provides a concise summary of the Society of Vascular and Interventional Neurology endovascular acute ischemic stroke roundtable meeting. This document was developed to review current clinical efficacy of pharmacologic and mechanical revascularization therapy, selection criteria, periprocedure management, and endovascular time metrics and to highlight current practice patterns. It therefore provides an outline for the future development of multisociety guidelines and recommendations to improve patient selection, procedural management, and organizational strategies for revascularization therapies in acute ischemic stroke. PMID:23008406

Lazzaro, Marc A.; Alexandrov, Andrei V.; Darkhabani, Ziad; Edgell, Randall C.; English, Joey; Frei, Donald; Jamieson, Dara G.; Janardhan, Vallabh; Janjua, Nazli; Janjua, Rashid M.; Katzan, Irene; Khatri, Pooja; Kirmani, Jawad F.; Liebeskind, David S.; Linfante, Italo; Nguyen, Thanh N.; Saver, Jeffrey L.; Shutter, Lori; Xavier, Andrew; Yavagal, Dileep; Zaidat, Osama O.

2012-01-01

43

Grading quality of evidence and strength of recommendations in clinical practice guidelines: part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies  

Microsoft Academic Search

The GRADE approach to grading the quality of evidence and strength of recommendations provides a comprehensive and transparent approach for developing clinical recommendations about using diagnostic tests or diagnostic strategies. Although grading the quality of evidence and strength of recommendations about using tests shares the logic of grading recommendations for treatment, it presents unique challenges. Guideline panels and clinicians should

J. L. Brozek; E. A. Akl; R. Jaeschke; D. M. Lang; P. Bossuyt; P. Glasziou; M. Helfand; E. Ueffing; P. Alonso-Coello; J. Meerpohl; B. Phillips; A. R. Horvath; J. Bousquet; G. H. Guyatt; H. J. Schünemann

2009-01-01

44

Practice recommendations for preventing heel pressure ulcers.  

PubMed

Heels are the second most common anatomical location for pressure ulcers. A combination of risk factors, including pressure, may cause ulceration. Heel pressure ulcers are a particular concern for surgical patients. A review of the literature, including poster presentations, shows that controlled clinical studies to assess the effectiveness and cost-effectiveness of available interventions are not available. Case series (with or without historical controls) as well as pressure ulcer guideline recommendations suggest the most important aspect of heel ulcer prevention is pressure relief (offloading). It also has been documented that the incidence of heel ulcers can be reduced using a total-patient care approach and heel offloading devices. Guidelines, observational studies, and expert opinion intimate that reducing heel ulceration rates can be expected to improve patient outcomes, decrease costs associated with their care, and avoid costs related to hospital-acquired pressure ulcers. The heel pressure ulcer prevention strategies reviewed should be implemented until the results of prospective, randomized controlled studies to compare the effectiveness and cost-effectiveness of these strategies are available. PMID:18927483

Fowler, Evonne; Scott-Williams, Suzy; McGuire, James B

2008-10-01

45

Neonatal circumcision: new recommendations & implications for practice.  

PubMed

Neonatal male circumcision is the most common surgical procedure performed on pediatric patients. While the rate of neonatal circumcision in the United States has been dropping, circumcision continues to be frequent, ranging from 42% to 80% among various populations. While the cultural debate over circumcision continues, recent evidence of medical benefits led to a revision of the American Academy of Pediatrics (AAP) circumcision policy statement. In contrast to the 1999 AAP policy statement, the 2012 policy asserts that the preventive benefits of neonatal circumcision outweigh the risk of the procedure, which is well tolerated when performed by trained professionals, under sterile conditions, and with appropriate pain management. This Circumcision Policy Statement has also been endorsed by the American College of Obstetricians and Gynecologists and a similar policy statement is in place from the American Urologic Association. Despite the new recognized health benefits found by the 2012 Task Force of Circumcision (TFOC), circumcision remains controversial even among medical professionals. Other well recognized medical organizations including The American Academy of Family Practice and some international pediatric societies have not adopted such a strong endorsement of circumcision. The policy statements from these organizations continue to more closely resemble the 1999 AAP policy statement that stated, "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision." In this review we will summarize historical, cultural and ethical factors in neonatal circumcision and briefly compare common surgical techniques including anesthesia. In addition, we will discuss recent information regarding the benefits and risks of neonatal circumcision. Finally, we will discuss the financial reimbursement of practitioners and the benefits of standardized circumcision curriculum for trainees. PMID:25011345

Simpson, Elizabeth; Carstensen, Jean; Murphy, Patrick

2014-01-01

46

Recommendations for appropriate sublingual immunotherapy clinical trials.  

PubMed

Sublingual immunotherapy is currently considered a viable alternative to the subcutaneous route. The body of evidence of its efficacy is based on the results of 77 clinical trials and 7 meta-analyses, that have been published so far. Nonetheless, the experimental evidence is partially weak due to the large heterogeneity of studies, namely: doses, regimens, patient selection, duration of treatment, outcomes and reporting. In addition, it is virtually impossible to compare the potency of extracts produced by different manufacturers. Also, there is large variability in reporting and in the classification of adverse events, either systemic or local, so that only a rough estimate can be provided. Considering all these aspects, efforts are needed to harmonize the methodology, outcome measures and reporting of SLIT clinical trials, to achieve the ability of comparing the results of various studies. International societies and the World Allergy Organization have recently provided general recommendations on how to design and conduct trials which can provide more interpretable and homogeneous data. PMID:25309678

Passalacqua, Giovanni

2014-01-01

47

Recommended Practice for Accepting New Concrete Pavement  

E-print Network

2493, Standard Specification for P225/60R16 97S Radial Standard Reference Test Tire 2.3. ISO Standards.2. If any part of this practice is in conflict with references made, such as ASTM or AASHTO Standards and are to be regarded as the standard. 1.4. This practice should only be adopted after an evaluation of existing texture

48

Clinical practice guidelines to inform evidence-based clinical practice  

Microsoft Academic Search

Background  With the volume of medical research currently published, any one practitioner cannot independently review the literature to\\u000a determine best evidence-based medical care. Additionally, non-specialists usually do not have the experience to know best\\u000a practice for all of the frequent clinical circumstances for which there is no good evidence. Clinical practice guidelines\\u000a (CPGs) help clinicians to address these problems because they

J. Stuart Wolf; Heddy Hubbard; Martha M. Faraday; John B. Forrest

2011-01-01

49

CMA Infobase: clinical practice guidelines.  

PubMed

The CMA Infobase is a free Web-based resource that contains evidence-based clinical practice guidelines. The database is maintained by the Canadian Medical Association (CMA) and is available on its Web site. The CMA Infobase currently contains 1,200-plus clinical practice guidelines either developed or endorsed by an authoritative health care organization located in Canada. It is an alternative source of free clinical practice guidelines to the National Guideline Clearinghouse. This column will cover the basics of CMA Infobase, including searching, special features, and available resources which complement the database. PMID:19042721

Fitzpatrick, Roberta Bronson

2008-01-01

50

Practice Recommendations for Preventing Heel Pressure Ulcers  

Microsoft Academic Search

Heels are the second most common anatomical location for pressure ulcers. A combination of risk factors, including pressure, may cause ulceration. Heel pressure ulcers are a particular concern for surgical patients. A review of the literature, including poster presentations, shows that controlled clinical studies to assess the effectiveness and cost-effectiveness of available interventions are not available. Case series (with or

Evonne Fowler; Suzy Scott-Williams; James B. McGuire

51

Mindfulness Meditation in Clinical Practice  

ERIC Educational Resources Information Center

The practice of mindfulness is increasingly being integrated into contemporary clinical psychology. Based in Buddhist philosophy and subsequently integrated into Western health care in the contexts of psychotherapy and stress management, mindfulness meditation is evolving as a systematic clinical intervention. This article describes…

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

2004-01-01

52

Distress management. Clinical practice guidelines.  

PubMed

The evaluation and treatment model expressed in the NCCN Distress Management Guidelines recommends that each new patient be rapidly assessed in the office or clinic waiting room for evidence of distress using a brief screening tool (the Distress Thermometer and Problem List) presented in Figure 1 (see page 369). A score of 5 or greater on the thermometer should trigger further evaluation and referral to a psychosocial service. The choice of which service should be determined by the problem areas specified on the Problem List. Patients with practical and psychosocial problems are referred to social work, emotional or psychological (excessive sadness, worry, nervousness) problems to mental health, and spiritual concerns to pastoral counselors. The primary oncology team members--doctor, nurse, and social worker--are central to making this model work. Team members collect information from the brief screening and problem list and expand it with the clinical evaluation. It is critical for at least one team member to be familiar with the mental health, psychosocial, and pastoral counseling resources available in the institution and the community. A list of the names and phone numbers for these resources should be kept in all oncology clinics and updated frequently. The first step in implementing this model is to establish a multidisciplinary committee in each institution or office responsible for 1) revising and modifying the standards of care to fit the particular clinical care setting and 2) implementing and monitoring the use of these standards. Because each institution has its own culture, standards must be implemented in ways that are compatible with each institution. The second step is to institute professional educational programs to ensure that staff is 1) aware that distress is under-recognized, 2) knowledgeable about the management of distress, and 3) aware of the resources available to treat it. It is important to have access to mental health professionals and clergy who are trained to deal with cancer-related distress. The benefits of treating distress in cancer accrue to the patients and their families, to the treating staff, and to improved efficiencies in clinic operations. Health care contracts often allow these services to "fall through the cracks" by failing to reimburse for them through either behavioral health or medical insurance. Reimbursement for services to treat psychosocial distress must be included in medical health care contracts to prevent fragmentation of services for the medically ill. For patients with cancer, integration, not separation, of mental health services and medical services is critically important. Also outcomes research studies that include quality-of-life assessment and analysis of cost-effectiveness are needed. Patients and families should be informed that management of distress is part of their total medical care. Finally, the multidisciplinary committee, office practice, or institution must be responsible for evaluating the quality of the distress management (see guidelines algorithm [page 368]), with CQI studies making an important contribution. Presently, the quality of the psychological care patients receive is not routinely monitored. Accrediting bodies have not directly examined the quality of psychosocial care, nor have they established minimal performance standards for its delivery. The panel believes that psychosocial care should and will eventually be on our institution's report cards. PMID:19761069

2003-07-01

53

Practical nutritional recommendations for the athlete.  

PubMed

The aim of training is to achieve optimum performance on the day of competition via three processes or paradigms; training hard to create the required training stimulus, training smart to maximize adaptations to the training stimulus, and training specifically to fine- turn the behaviors or physiology needed for competition strategies. Dietary strategies for competition must target the factors that would otherwise cause fatigue during the event, promoting an enhancement of performance by reducing or delaying the onset of these factors. In some cases, the nutritional strategies needed to achieve these various paradigms are different, and even opposite to each other, so athletes need to periodize their nutrition, just as they periodize their training program. The evolution of new knowledge from sports nutrition research, such as presented in this book, usually starts with a stark concept that must be further refined; to move from individual nutrients to food, from 'one size fits all' to the individual needs and practices of different athletes, and from single issues to an integrated picture of sports nutrition. The translation from science to practice usually requires a large body of follow-up studies as well as experimentation in the field. PMID:22301840

Maughan, Ronald J; Burke, Louise M

2011-01-01

54

[Filariasis in clinical practice].  

PubMed

Filariases are infections caused by distinct species of nematodes. These infections are transmitted through insect bites and primarily affect lymph nodes and skin. Filariases are classified as neglected diseases and affect millions, producing severe disability and social stigma. This type of infection is rarely diagnosed in travellers, as prolonged stays in endemic areas are usually required acquire infection. Infections may be asymptomatic, and clinical manifestations depend on the host immune response to the infection and the parasite burden. Diagnosis is based on the demonstration of microfilariae in blood or skin, but there are other methods that support the diagnosis. Individual treatment is effective, but community interventions, mostly mass drug administration, have helped to diminish the incidence of filariases. PMID:22305667

Díaz-Menéndez, Marta; Norman, Francesca; Monge-Maillo, Begoña; Pérez-Molina, José Antonio; López-Vélez, Rogelio

2011-12-01

55

Education for clinical practice: an alternative approach.  

PubMed

Although there have been many advances in technology, nursing science, and the professional role, there has been little planned, substantive change in the approach to clinical education. Documented problems include faculty workload, clinical placements, student anxiety, and concurrent teaching and evaluation. This article reviews the current status of clinical education and offers an alternative approach. The recommendation involves teaching a course on clinical practice, which includes patient care and adaptive competencies, evaluation in the college laboratory, and placing students with preceptors in the clinical laboratory. Ideas for implementation are offered, which include curricular changes and student-centered teaching strategies that encourage activities such as reflection and decision making. Advantages include opportunities for professional development for faculty and preceptors, improved student learning, and elimination of reality shock. The need for faculty development and educational research is emphasized. PMID:7853058

Packer, J L

1994-11-01

56

Suicidality in clinical practice: anxieties and answers.  

PubMed

This issue of the Journal of Clinical Psychology: In Session is devoted to suicidality in clinical practice, with coverage of a broad range of topics. After summarizing some of the problems and recent advances in clinical suicidology, I provide a brief overview of the articles. Included are the more broadly defined issues of risk management and psychotherapy with suicidal individuals, along with more specific topics such as risk assessment, no-suicide contracts, and the risk of suicide with the use of selective serotonin reuptake inhibitors (SSRIs) by children and adolescents. Most of the articles feature case vignettes and provide practitioners with clinical recommendations, and all of the articles have clear and important clinical implications. PMID:16342286

Rudd, M David

2006-02-01

57

Cherubism: best clinical practice.  

PubMed

Cherubism is a skeletal dysplasia characterized by bilateral and symmetric fibro-osseous lesions limited to the mandible and maxilla. In most patients, cherubism is due to dominant mutations in the SH3BP2 gene on chromosome 4p16.3. Affected children appear normal at birth. Swelling of the jaws usually appears between 2 and 7 years of age, after which, lesions proliferate and increase in size until puberty. The lesions subsequently begin to regress, fill with bone and remodel until age 30, when they are frequently not detectable.Fibro-osseous lesions, including those in cherubism have been classified as quiescent, non-aggressive and aggressive on the basis of clinical behavior and radiographic findings. Quiescent cherubic lesions are usually seen in older patients and do not demonstrate progressive growth. Non-aggressive lesions are most frequently present in teenagers. Lesions in the aggressive form of cherubism occur in young children and are large, rapidly growing and may cause tooth displacement, root resorption, thinning and perforation of cortical bone.Because cherubism is usually self-limiting, operative treatment may not be necessary. Longitudinal observation and follow-up is the initial management in most cases. Surgical intervention with curettage, contouring or resection may be indicated for functional or aesthetic reasons. Surgical procedures are usually performed when the disease becomes quiescent. Aggressive lesions that cause severe functional problems such as airway obstruction justify early surgical intervention. PMID:22640403

Papadaki, Maria E; Lietman, Steven A; Levine, Michael A; Olsen, Bjorn R; Kaban, Leonard B; Reichenberger, Ernst J

2012-05-24

58

Cherubism: best clinical practice  

PubMed Central

Cherubism is a skeletal dysplasia characterized by bilateral and symmetric fibro-osseous lesions limited to the mandible and maxilla. In most patients, cherubism is due to dominant mutations in the SH3BP2 gene on chromosome 4p16.3. Affected children appear normal at birth. Swelling of the jaws usually appears between 2 and 7 years of age, after which, lesions proliferate and increase in size until puberty. The lesions subsequently begin to regress, fill with bone and remodel until age 30, when they are frequently not detectable. Fibro-osseous lesions, including those in cherubism have been classified as quiescent, non-aggressive and aggressive on the basis of clinical behavior and radiographic findings. Quiescent cherubic lesions are usually seen in older patients and do not demonstrate progressive growth. Non-aggressive lesions are most frequently present in teenagers. Lesions in the aggressive form of cherubism occur in young children and are large, rapidly growing and may cause tooth displacement, root resorption, thinning and perforation of cortical bone. Because cherubism is usually self-limiting, operative treatment may not be necessary. Longitudinal observation and follow-up is the initial management in most cases. Surgical intervention with curettage, contouring or resection may be indicated for functional or aesthetic reasons. Surgical procedures are usually performed when the disease becomes quiescent. Aggressive lesions that cause severe functional problems such as airway obstruction justify early surgical intervention. PMID:22640403

2012-01-01

59

EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications.  

PubMed

The clinical part of these Guidelines and Recommendations produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology EFSUMB assesses the clinically used applications of all forms of elastography, stressing the evidence from meta-analyses and giving practical advice for their uses and interpretation. Diffuse liver disease forms the largest section, reflecting the wide experience with transient and shear wave elastography . Then follow the breast, thyroid, gastro-intestinal tract, endoscopic elastography, the prostate and the musculo-skeletal system using strain and shear wave elastography as appropriate. The document is intended to form a reference and to guide clinical users in a practical way. PMID:23605169

Cosgrove, D; Piscaglia, F; Bamber, J; Bojunga, J; Correas, J-M; Gilja, O H; Klauser, A S; Sporea, I; Calliada, F; Cantisani, V; D'Onofrio, M; Drakonaki, E E; Fink, M; Friedrich-Rust, M; Fromageau, J; Havre, R F; Jenssen, C; Ohlinger, R; S?ftoiu, A; Schaefer, F; Dietrich, C F

2013-06-01

60

General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP).  

PubMed

This report is a revision of the General Recommendations on Immunization and updates the 2006 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55[No. RR-15]). The report also includes revised content from previous ACIP recommendations on the following topics: adult vaccination (CDC. Update on adult immunization recommendations of the immunization practices Advisory Committee [ACIP]. MMWR 1991;40[No. RR-12]); the assessment and feedback strategy to increase vaccination rates (CDC. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination rates-assessment and feedback of provider-based vaccination coverage information. MMWR 1996;45:219-20); linkage of vaccination services and those of the Supplemental Nutrition Program for Women, Infants, and Children (WIC program) (CDC. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination coverage by age 2 years-linkage of vaccination and WIC services. MMWR 1996;45:217-8); adolescent immunization (CDC. Immunization of adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association. MMWR 1996;45[No. RR-13]); and combination vaccines (CDC. Combination vaccines for childhood immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP], the American Academy of Pediatrics [AAP], and the American Academy of Family Physicians [AAFP]. MMWR 1999;48[No. RR-5]). Notable revisions to the 2006 recommendations include 1) revisions to the tables of contraindications and precautions to vaccination, as well as a separate table of conditions that are commonly misperceived as contraindications and precautions; 2) reordering of the report content, with vaccine risk-benefit screening, managing adverse reactions, reporting of adverse events, and the vaccine injury compensation program presented immediately after the discussion of contraindications and precautions; 3) stricter criteria for selecting an appropriate storage unit for vaccines; 4) additional guidance for maintaining the cold chain in the event of unavoidable temperature deviations; and 5) updated revisions for vaccination of patients who have received a hematopoietic cell transplant. The most recent ACIP recommendations for each specific vaccine should be consulted for comprehensive details. This report, ACIP recommendations for each vaccine, and additional information about vaccinations are available from CDC at http://www.cdc.gov/vaccines. PMID:21293327

2011-01-28

61

The validity of recommendations from clinical guidelines: a survival analysis  

PubMed Central

Background: Clinical guidelines should be updated to maintain their validity. Our aim was to estimate the length of time before recommendations become outdated. Methods: We used a retrospective cohort design and included recommendations from clinical guidelines developed in the Spanish National Health System clinical guideline program since 2008. We performed a descriptive analysis of references, recommendations and resources used, and a survival analysis of recommendations using the Kaplan–Meier method. Results: We included 113 recommendations from 4 clinical guidelines with a median of 4 years since the most recent search (range 3.9–4.4 yr). We retrieved 39 136 references (range 3343–14 787) using an exhaustive literature search, 668 of which were related to the recommendations in our sample. We identified 69 (10.3%) key references, corresponding to 25 (22.1%) recommendations that required updating. Ninety-two percent (95% confidence interval 86.9–97.0) of the recommendations were valid 1 year after their development. This probability decreased at 2 (85.7%), 3 (81.3%) and 4 years (77.8%). Interpretation: Recommendations quickly become outdated, with 1 out of 5 recommendations being out of date after 3 years. Waiting more than 3 years to review a guideline is potentially too long. PMID:25200758

Garcia, Laura Martinez; Sanabria, Andrea Juliana; Alvarez, Elvira Garcia; Trujillo-Martin, Maria Mar; Etxeandia-Ikobaltzeta, Itziar; Kotzeva, Anna; Rigau, David; Louro-Gonzalez, Arturo; Barajas-Nava, Leticia; del Campo, Petra Diaz; Estrada, Maria-Dolors; Sola, Ivan; Gracia, Javier; Salcedo-Fernandez, Flavia; Lawson, Jennifer; Haynes, R. Brian; Alonso-Coello, Pablo

2014-01-01

62

Introduction: NAON Surgical Site Infection Prevention Clinical Practice Guideline.  

PubMed

According to the , "Clinical practice guidelines are statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." Nursing clinical practice guidelines provide defined best practice modalities that assist nurses in the diagnosis, management, or prevention of specific healthcare conditions, while including recommendations that are derived from the highest levels of evidence. These levels of evidence include high-quality systematic reviews of current literature, meta-analyses, or well-designed clinical trials. PMID:24022414

Smith, Mary Atkinson; Dahlen, Nancy

2013-01-01

63

Validation of electronic systems to collect patient-reported outcome (PRO) data-recommendations for clinical trial teams: report of the ISPOR ePRO systems validation good research practices task force.  

PubMed

Outcomes research literature has many examples of high-quality, reliable patient-reported outcome (PRO) data entered directly by electronic means, ePRO, compared to data entered from original results on paper. Clinical trial managers are increasingly using ePRO data collection for PRO-based end points. Regulatory review dictates the rules to follow with ePRO data collection for medical label claims. A critical component for regulatory compliance is evidence of the validation of these electronic data collection systems. Validation of electronic systems is a process versus a focused activity that finishes at a single point in time. Eight steps need to be described and undertaken to qualify the validation of the data collection software in its target environment: requirements definition, design, coding, testing, tracing, user acceptance testing, installation and configuration, and decommissioning. These elements are consistent with recent regulatory guidance for systems validation. This report was written to explain how the validation process works for sponsors, trial teams, and other users of electronic data collection devices responsible for verifying the quality of the data entered into relational databases from such devices. It is a guide on the requirements and documentation needed from a data collection systems provider to demonstrate systems validation. It is a practical source of information for study teams to ensure that ePRO providers are using system validation and implementation processes that will ensure the systems and services: operate reliably when in practical use; produce accurate and complete data and data files; support management control and comply with any existing regulations. Furthermore, this short report will increase user understanding of the requirements for a technology review leading to more informed and balanced recommendations or decisions on electronic data collection methods. PMID:23796281

Zbrozek, Arthur; Hebert, Joy; Gogates, Gregory; Thorell, Rod; Dell, Christopher; Molsen, Elizabeth; Craig, Gretchen; Grice, Kenneth; Kern, Scottie; Hines, Sheldon

2013-06-01

64

Bone scanning in clinical practice  

SciTech Connect

The topics covered in this book include the history of bone scanning, mechanisms of uptake of diphosphonate in bone, the normal bone scan, and the role of bone scanning in clinical practice. The aim of this book is to provide a source of reference relating to bone scan imaging for all those who are interested in the skeleton.

Fogelman, I. (Guys Hospital, London (GB))

1987-01-01

65

College of Education Clinical Practice  

E-print Network

College of Education Clinical Practice 10-Day Improvement Plan Revised 5/2009 1 Prior Facilitator, and either the Department Chair or the Chair of the Student Progress Committee. Start Date. The cooperating teacher will maintain a daily feedback log on the teacher candidate's progress with each

Rusu, Adrian

66

[Recommendations for physical exercise practice during pregnancy: a critical review].  

PubMed

Physical exercise is recommended for all healthy pregnant women. Regular practice of exercises during pregnancy can provide many physical and psychological benefits, with no evidence of adverse outcomes for the fetus or the newborn when exercise is performed at mild to moderate intensity. However, few pregnant women engage in this practice and many still have fears and doubts about the safety of exercise. The objective of the present study was to inform the professionals who provide care for Brazilian pregnant women about the current recommendations regarding physical exercise during pregnancy based on the best scientific evidence available. In view of the perception that few systematic models are available about this topic and after performing several studies in this specific area, we assembled practical information of interest to both the professionals and the pregnant women. We also provide recommendations about the indications, contraindications, modalities (aerobics, resistance training, stretching and pelvic floor training), frequency, intensity and duration indicated for each gestational trimester. The review addresses physical exercise recommendation both for low risk pregnant women and for special populations, such as athletes and obese, hypertensive and diabetic subjects. The advantages of an active and healthy lifestyle should be always reinforced during and after gestation since pregnancy is an appropriate period to introduce new habits because pregnant women are usually more motivated to adhere to recommendations. Thus, routine exams, frequent returns and supervision are recommended in order to provide new guidelines that will have long-term beneficial effects for both mother and child. PMID:25230282

Nascimento, Simony Lira do; Godoy, Ana Carolina; Surita, Fernanda Garanhani; Pinto E Silva, João Luiz

2014-09-01

67

Updated recommendations: an assessment of NICE clinical guidelines  

PubMed Central

Background Updating is important to ensure clinical guideline (CG) recommendations remain valid. However, little research has been undertaken in this field. We assessed CGs produced by the National Institute for Health and Care Excellence (NICE) to identify and describe updated recommendations and to investigate potential factors associated with updating. Also, we evaluated the reporting and presentation of recommendation changes. Methods We performed a descriptive analysis of original and updated CGs and recommendations, and an assessment of presentation formats and methods for recording information. We conducted a case-control study, defining cases as original recommendations that were updated (‘new-replaced’ recommendations), and controls as original recommendations that were considered to remain valid (‘not changed’ recommendations). We performed a comparison of main characteristics between cases and controls, and we planned a multiple regression analysis to identify potential predictive factors for updating. Results We included nine updated CGs (1,306 recommendations) and their corresponding original versions (1,106 recommendations). Updated CGs included 812 (62%) recommendations ‘not reviewed’, 368 (28.1%) ‘new’ recommendations, 104 (7.9%) ‘amended’ recommendations, and 25 (1.9%) recommendations reviewed but unchanged. The presentation formats used to indicate the changes in recommendations varied widely across CGs. Changes in ‘amended’, ‘deleted’, and ‘new-replaced’ recommendations (n?=?296) were reported infrequently, mostly in appendices. These changes were recorded in 167 (56.4%) recommendations; and were explained in 81 (27.4%) recommendations. We retrieved a total of 7.1% (n?=?78) case recommendations (‘new-replaced’) and 2.4% (n?=?27) control recommendations (‘not changed’) in original CGs. The updates were mainly from ‘Fertility CG’, about ‘gynaecology, pregnancy and birth’ topic, and ‘treatment’ or ‘prevention’ purposes. We did not perform the multiple regression analysis as originally planned due to the small sample of recommendations retrieved. Conclusion Our study is the first to describe and assess updated CGs and recommendations from a national guideline program. Our results highlight the pressing need to standardise the reporting and presentation of updated recommendations and the research gap about the optimal way to present updates to guideline users. Furthermore, there is a need to investigate updating predictive factors. PMID:24919856

2014-01-01

68

Expanding the Grading of Recommendations Assessment, Development, and Evaluation (Ex-GRADE) for Evidence-Based Clinical Recommendations: Validation Study  

PubMed Central

Clinicians use general practice guidelines as a source of support for their intervention, but how much confidence should they place on these recommendations? How much confidence should patients place on these recommendations? Various instruments are available to assess the quality of evidence of research, such as the revised Wong scale (R-Wong) which examines the quality of research design, methodology and data analysis, and the revision of the assessment of multiple systematic reviews (R-AMSTAR), which examines the quality of systematic reviews. The Grading of Recommendation Assessment, Development, and Evaluation (GRADE) Working Group developed an instrument called the GRADE system in order to grade the quality of the evidence in studies and to evaluate the strength of recommendation of the intervention that is proposed in the published article. The GRADE looks at four factors to determine the quality of the evidence: study design, study quality, consistency, and directness. After combining the four components and assessing the grade of the evidence, the strength of recommendation of the intervention is established. The GRADE, however, only makes a qualitative assessment of the evidence and does not generate quantifiable data. In this study, we have quantified both the grading of the quality of evidence and also the strength of recommendation of the original GRADE, hence expanding the GRADE. This expansion of the GRADE (Ex-GRADE) permits the creation of a new instrument that can produce tangible data and possibly bridge the gap between evidence-based research and evidence-based clinical practice. PMID:22303416

Phi, Linda; Ajaj, Reem; Ramchandani, Manisha H; Brant, Xenia MC; Oluwadara, Oluwadayo; Polinovsky, Olga; Moradi, David; Barkhordarian, Andre; Sriphanlop, Pathu; Ong, Margaret; Giroux, Amy; Lee, Justin; Siddiqui, Muniza; Ghodousi, Nora; Chiappelli, Francesco

2012-01-01

69

Implementing AORN recommended practices for minimally invasive surgery: part I.  

PubMed

This article focuses on the patient safety aspects of the revised AORN "Recommended practices for minimally invasive surgery" (MIS). Key considerations include ensuring proper fluid management practices, assessing patients for risk factors related to MIS, implementing precautions for electrosurgery, planning for risks related to MIS, and assessing patients postoperatively for potential complications related to MIS. Collaboration and collegiality among members of the surgical team are essential for ensuring all pertinent aspects of care are recognized and considered. PMID:22935258

Morton, Paula J

2012-09-01

70

Recombinant erythropoietin in clinical practice  

PubMed Central

The introduction of recombinant human erythropoietin (RHuEPO) has revolutionised the treatment of patients with anaemia of chronic renal disease. Clinical studies have demonstrated that RHuEPO is also useful in various non-uraemic conditions including haematological and oncological disorders, prematurity, HIV infection, and perioperative therapies. Besides highlighting both the historical and functional aspects of RHuEPO, this review discusses the applications of RHuEPO in clinical practice and the potential problems of RHuEPO treatment. PMID:12897214

Ng, T; Marx, G; Littlewood, T; Macdougall, I

2003-01-01

71

American Brachytherapy Society recommendations for clinical implementation of NIST1999 standards for 103palladium brachytherapy  

Microsoft Academic Search

Purpose: Recent important developments in palladium-103 (103Pd) dosimetry mandate a reevaluation of 103Pd brachytherapy prescribing practices.Methods and Materials: The clinical research committee of the American Brachytherapy Society (ABS) convened a consensus session of brachytherapists and physicists to develop recommendations regarding future dose prescribing guidelines for National Institute of Standards and Technology (NIST-1999) calibrated 103Pd sources.Results: The ABS recommends that clinicians

David Beyer; Ravinder Nath; Wayne Butler; Gregory Merrick; John Blasko; Subir Nag; Colin Orton

2000-01-01

72

Evaluation of clinical practice guidelines.  

PubMed Central

Compared with the current focus on the development of clinical practice guidelines the effort devoted to their evaluation is meagre. Yet the ultimate success of guidelines depends on routine evaluation. Three types of evaluation are identified: evaluation of guidelines under development and before dissemination and implementation, evaluation of health care programs in which guidelines play a central role, and scientific evaluation, through studies that provide the scientific knowledge base for further evolution of guidelines. Identification of evaluation and program goals, evaluation design and a framework for evaluation planning are discussed. PMID:7489550

Basinski, A S

1995-01-01

73

FORM: An Australian method for formulating and grading recommendations in evidence-based clinical guidelines  

Microsoft Academic Search

Background  Clinical practice guidelines are an important element of evidence-based practice. Considering an often complicated body of\\u000a evidence can be problematic for guideline developers, who in the past may have resorted to using levels of evidence of individual\\u000a studies as a quasi-indicator for the strength of a recommendation. This paper reports on the production and trial of a methodology\\u000a and associated

Susan Hillier; Karen Grimmer-Somers; Tracy Merlin; Philippa Middleton; Janet Salisbury; Rebecca Tooher; Adele Weston

2011-01-01

74

Attributes of clinical guidelines that influence use of guidelines in general practice: observational study  

PubMed Central

Objective: To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice. Design: Observational study relating the use of 47 different recommendations from 10 national clinical guidelines to 12 different attributes of clinical guidelines—for example, evidence based, controversial, concrete. Setting: General practice in the Netherlands. Subjects: 61 general practitioners who made 12?880 decisions in their contacts with patients. Main outcome measures: Compliance of decisions with clinical guidelines according to the attribute of the guideline. Results: Recommendations were followed in, on average, 61% (7915/12?880) of the decisions. Controversial recommendations were followed in 35% (886/2497) of decisions and non-controversial recommendations in 68% (7029/10?383) of decisions. Vague and non-specific recommendations were followed in 36% (826/2280) of decisions and clear recommendations in 67% (7089/10?600) of decisions. Recommendations that demanded a change in existing practice routines were followed in 44% (1278/2912) of decisions and those that did not in 67% (6637/9968) of decisions. Evidence based recommendations were used more than recommendations for practice that were not based on research evidence (71% (2745/3841) v 57% (5170/9039)). Conclusions: People and organisations setting evidence based clinical practice guidelines should take into account some of the other important attributes of effective recommendations for clinical practice. Key messages Specific attributes of clinical practice guidelines determine whether they are used in practice Evidence based recommendations are better followed in practice than recommendations not based on scientific evidence Precise definitions of recommended performance improve the use of guidelines Testing the feasibility and acceptance of clinical guidelines among the target group is important for effective implementation People setting evidence based guidelines need to understand the attributes of effective guidelines PMID:9748183

Grol, Richard; Dalhuijsen, Johannes; Thomas, Siep; Veld, Cees in 't; Rutten, Guy; Mokkink, Henk

1998-01-01

75

Characteristics of effective clinical guidelines for general practice.  

PubMed Central

BACKGROUND: The use of clinical guidelines in general practice is often limited. Research on barriers to guideline adherence usually focuses on attitudinal factors. Factors linked to the guideline itself are much less studied. AIM: To identify characteristics of effective clinical guidelines for general practice, and to explore whether these differ between therapeutic and diagnostic recommendations. DESIGN OF STUDY: Analysis of performance data from an audit study of 200 general practitioners (GPs) in The Netherlands conducted in 1997. SETTING: Panel of 12 GPs in The Netherlands who were familiar with guideline methodology. METHOD: A set of 12 attributes, including six potential facilitators and six potential barriers to guideline use, was formulated. The panel assessed the presence of these attributes in 96 guideline recommendations formulated by the Dutch College of General Practitioners. The attributes of recommendations with high compliance rates (70% to 100%) were compared with those with low compliance rates (0% to 60%). RESULTS: Recommendations with high compliance rates were to a lesser extent those requiring new skills (7% compared with 22% in recommendations with low compliance rates), were less often part of a complex decision tree (12% versus 25%), were more compatible with existing norms and values in practice (87% versus 76%), and more often supported with evidence (47% versus 31%). For diagnostic recommendations, the ease of applying them and the potential (negative) reactions of patients were more relevant than for therapeutic recommendations. CONCLUSION: To bridge the gap between research and practice, the evidence as well as the applicability should be considered when formulating recommendations. If the recommendations are not compatible with existing norms and values, not easy to follow or require new knowledge and skills, appropriate implementation strategies should be designed to ensure change in daily practice. PMID:12569898

Burgers, Jako S; Grol, Richard P T M; Zaat, Joost O M; Spies, Teun H; van der Bij, Akke K; Mokkink, Henk G A

2003-01-01

76

Assessing Diabetes Practices in Clinical Settings: Precursor to Building Community Partnerships Around Disease Management  

Microsoft Academic Search

Many recommended best practices exist for clinical and community diabetes management and prevention. However, in many cases,\\u000a these recommendations are not being fully utilized. It is useful to gain a sense of currently utilized and needed practices\\u000a when beginning a partnership building effort to ameliorate such practice problems. The purpose of this study was to assess\\u000a current practices in clinical

John D. Prochaska; Nelda Mier; Jane N. Bolin; Kerrie L. Hora; Heather R. Clark; Marcia G. Ory

2009-01-01

77

[New KDIGO guidelines on acute kidney injury. Practical recommendations].  

PubMed

The incidence of acute kidney injury (AKI) in critically ill patients is very high and is associated with an increased morbidity and mortality. In 2012 the Kidney Disease: Improving Global Outcome (KDIGO) guidelines were published in which evidence-based practical recommendations are given for the evaluation and management of patients with AKI. The first section of the KDIGO guidelines deals with the unification of earlier consensus definitions and staging criteria for AKI. The subsequent sections of the guidelines cover the prevention and treatment of AKI as well as the management of renal replacement therapy (RRT) in patients with AKI. In each section the existing evidence is discussed and a specific treatment recommendation is given. The guidelines appreciates that there is insufficient evidence for many of the recommendations. As a specific pharmacological therapy is missing, an early diagnosis, aggressive hemodynamic optimization, tight volume control, and avoidance of nephrotoxic drugs are the only interventions to prevent AKI. If renal replacement therapy is required different modalities are available to provide an effective therapy with a low rate of adverse effects. PMID:24981152

Zarbock, A; John, S; Jörres, A; Kindgen-Milles, D

2014-07-01

78

Sphygmomanometers in hospital and family practice: problems and recommendations.  

PubMed

The accuracy and working condition of 210 sphygmomanometers were tested: 100 (50 and mercury and 50 aneroid) models were used in family practices and 100 mercury models in hospitals. Faults in the inflation-deflation system were common and caused mainly by dirt or wear in the control valves. Leakage occurred in 48% of the hospital and 33% of the family practice sphygmomanometers. In the mercury models the mercury or air vents were often in an unsatisfactory condition or the calibrated glass tube dirty. The accuracy of the gauges was examined at 90 and 150 mm Hg: fewer than 2% of the mercury sphygmomanometers but 30% of the aneroid models had errors greater than +/- 4 mm Hg at either pressure. Over half of the cuffs examined had bladders widths less than the recommended size, and 94% had bladders shorter than the length recommended for use on normal adults. Mercury sphygmomanometers should be bought in preference to aneroid models as they are more accurate, less expensive in the long term, and can be maintained by the owner; they should be checked every six to 12 months depending on usage. Replacement parts should be kept readily available. PMID:6809128

Burke, M J; Towers, H M; O'Malley, K; Fitzgerald, D J; O'Brien, E T

1982-08-14

79

A manual of recommended practices for hydrogen energy systems  

SciTech Connect

Technologies for the production, distribution, and use of hydrogen are rapidly maturing and the number and size of demonstration programs designed to showcase emerging hydrogen energy systems is expanding. The success of these programs is key to hydrogen commercialization. Currently there is no comprehensive set of widely-accepted codes or standards covering the installation and operation of hydrogen energy systems. This lack of codes or standards is a major obstacle to future hydrogen demonstrations in obtaining the requisite licenses, permits, insurance, and public acceptance. In a project begun in late 1996 to address this problem, W. Hoagland and Associates has been developing a Manual of Recommended Practices for Hydrogen Systems intended to serve as an interim document for the design and operation of hydrogen demonstration projects. It will also serve as a starting point for some of the needed standard-setting processes. The Manual will include design guidelines for hydrogen procedures, case studies of experience at existing hydrogen demonstration projects, a bibliography of information sources, and a compilation of suppliers of hydrogen equipment and hardware. Following extensive professional review, final publication will occur later in 1997. The primary goal is to develop a draft document in the shortest possible time frame. To accomplish this, the input and guidance of technology developers, industrial organizations, government R and D and regulatory organizations and others will be sought to define the organization and content of the draft Manual, gather and evaluate available information, develop a draft document, coordinate reviews and revisions, and develop recommendations for publication, distribution, and update of the final document. The workshop, Development of a Manual of Recommended Practices for Hydrogen Energy Systems, conducted on March 11, 1997 in Alexandria, Virginia, was a first step.

Hoagland, W.; Leach, S. [W. Hoagland and Associates, Boulder, CO (United States)

1997-12-31

80

Recommended Practice for Patch Management of Control Systems  

SciTech Connect

A key component in protecting a nation’s critical infrastructure and key resources is the security of control systems. The term industrial control system refers to supervisory control and data acquisition, process control, distributed control, and any other systems that control, monitor, and manage the nation’s critical infrastructure. Critical Infrastructure and Key Resources (CIKR) consists of electric power generators, transmission systems, transportation systems, dam and water systems, communication systems, chemical and petroleum systems, and other critical systems that cannot tolerate sudden interruptions in service. Simply stated, a control system gathers information and then performs a function based on its established parameters and the information it receives. The patch management of industrial control systems software used in CIKR is inconsistent at best and nonexistent at worst. Patches are important to resolve security vulnerabilities and functional issues. This report recommends patch management practices for consideration and deployment by industrial control systems owners.

Steven Tom; Dale Christiansen; Dan Berrett

2008-12-01

81

Implementing AORN recommended practices for MIS: Part II.  

PubMed

This article focuses on the equipment and workplace safety aspects of the revised AORN "Recommended practices for minimally invasive surgery." A multidisciplinary team that includes the perioperative nurse should be established to discuss aspects of the development and design of new construction or renovation (eg, room access, ergonomics, low-lighting, OR integration, hybrid OR considerations, design development). Equipment safety considerations during minimally invasive surgical procedures include using active electrode monitoring; verifying the properties of distention media; using smoke evacuation systems; reducing equipment, electrical, thermal, and fire hazards; performing routine safety checks on insufflation accessories; and minimizing the risk of ergonomic injuries to staff members. Additional considerations include using video recording devices, nonmagnetic equipment during magnetic resonance imaging, and fluid containment methods for fluid management. PMID:23017476

Morton, Paula J

2012-10-01

82

Romanian national guidelines and practical recommendations on liver elastography.  

PubMed

The use of liver elastography has substantially developed in the past few years; the introduction of novel elastographic methods (Transient Elastography, point Shear Wave Elastography, Real Time Shear Wave Elastography, Strain Elastography) has changed the perspective in the evaluation of liver disease. The ongoing research in this area is mainly focused on diffuse liver diseases and for predicting liver cirrhosis complication. This guideline created under the auspice of Romanian Society of Ultrasound in Medicine and Biology is intended to accustomize the clinician with the current practical use of liver elastography and has been issued to help in maximizing the clinical benefit for the patients with chronic liver diseases. PMID:24791844

Sporea, Ioan; Bota, Simona; S?ftoiu, Adrian; ?irli, Roxana; Gradin?ru-Ta?c?u, Oana; Popescu, Alina; Lup?or Platon, Monica; Fierbinteanu-Braticevici, Carmen; Gheonea, Dan Ionu?; S?ndulescu, Larisa; Badea, Radu

2014-06-01

83

Diagnosis and treatment of mast cell disorders: practical recommendations.  

PubMed

CONTEXT AND OBJECTIVE The term mastocytosis covers a group of rare disorders characterized by neoplastic proliferation and accumulation of clonal mast cells in one or more organs. The aim of this study was to assess the principal elements for diagnosing and treating these disorders. DESIGN AND SETTING Narrative review of the literature conducted at Grupo Fleury, São Paulo, Brazil. METHODS This study reviewed the scientific papers published in the PubMed, Embase (Excerpta Medica Database), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) and Cochrane Library databases that were identified using the search term "mastocytosis." RESULTS The clinical presentation of mastocytosis is remarkably heterogeneous and ranges from skin lesions that may regress spontaneously to aggressive forms associated with organ failure and short survival. Currently, seven subtypes of mastocytosis are recognized through the World Health Organization classification system for hematopoietic tumors. These disorders are diagnosed based on clinical manifestations and on identification of neoplastic mast cells using morphological, immunophenotypic, genetic and molecular methods. Abnormal mast cells display atypical and frequently spindle-shaped morphology, and aberrant expression of the CD25 and CD2 antigens. Elevation of serum tryptase is a common finding in some subtypes, and more than 90% of the patients present the D816V KIT mutation in mast cells. CONCLUSION Here, we described the most common signs and symptoms among patients with mastocytosis and suggested a practical approach for the diagnosis, classification and initial clinical treatment of mastocytosis. PMID:24141298

Sandes, Alex Freire; Medeiros, Raphael Salles Scortegagna; Rizzatti, Edgar Gil

2013-01-01

84

Invasive candidiasis in critical care setting, updated recommendations from "Invasive Fungal Infections-Clinical Forum", Iran.  

PubMed

Invasive candidiasis (IC) bears a high risk of morbidity and mortality in the intensive care units (ICU). With the current advances in critical care and the use of wide-spectrum antibiotics, invasive fungal infections (IFIs) and IC in particular, have turned into a growing concern in the ICU. Further to blood cultures, some auxiliary laboratory tests and biomarkers are developed to enable an earlier detection of infection, however these test are neither consistently available nor validated in our setting. On the other hand, patients' clinical status and local epidemiology data may justify the empiric antifungal approach using the proper antifungal option. The clinical approach to the management of IC in febrile, non-neutropenic critically ill patients has been defined in available international guidelines; nevertheless such recommendations need to be customized when applied to our local practice. Over the past three years, Iranian experts from intensive care and infectious diseases disciplines have tried to draw a consensus on the management of IFI with a particular focus on IC in the ICU. The established IFI-clinical forum (IFI-CF), comprising the scientific leaders in the field, has recently come up with and updated recommendation on the same (June 2014). The purpose of this review is to put together literature insights and Iranian experts' opinion at the IFI-CF, to propose an updated practical overview on recommended approaches for the management of IC in the ICU. PMID:25374806

Elhoufi, Ashraf; Ahmadi, Arezoo; Asnaashari, Amir Mohammad Hashem; Davarpanah, Mohammad Ali; Bidgoli, Behrooz Farzanegan; Moghaddam, Omid Moradi; Torabi-Nami, Mohammad; Abbasi, Saeed; El-Sobky, Malak; Ghaziani, Ali; Jarrahzadeh, Mohammad Hossein; Shahrami, Reza; Shirazian, Farzad; Soltani, Farhad; Yazdinejad, Homeira; Zand, Farid

2014-11-01

85

Invasive candidiasis in critical care setting, updated recommendations from "Invasive Fungal Infections-Clinical Forum", Iran  

PubMed Central

Invasive candidiasis (IC) bears a high risk of morbidity and mortality in the intensive care units (ICU). With the current advances in critical care and the use of wide-spectrum antibiotics, invasive fungal infections (IFIs) and IC in particular, have turned into a growing concern in the ICU. Further to blood cultures, some auxiliary laboratory tests and biomarkers are developed to enable an earlier detection of infection, however these test are neither consistently available nor validated in our setting. On the other hand, patients’ clinical status and local epidemiology data may justify the empiric antifungal approach using the proper antifungal option. The clinical approach to the management of IC in febrile, non-neutropenic critically ill patients has been defined in available international guidelines; nevertheless such recommendations need to be customized when applied to our local practice. Over the past three years, Iranian experts from intensive care and infectious diseases disciplines have tried to draw a consensus on the management of IFI with a particular focus on IC in the ICU. The established IFI-clinical forum (IFI-CF), comprising the scientific leaders in the field, has recently come up with and updated recommendation on the same (June 2014). The purpose of this review is to put together literature insights and Iranian experts’ opinion at the IFI-CF, to propose an updated practical overview on recommended approaches for the management of IC in the ICU. PMID:25374806

Elhoufi, Ashraf; Ahmadi, Arezoo; Asnaashari, Amir Mohammad Hashem; Davarpanah, Mohammad Ali; Bidgoli, Behrooz Farzanegan; Moghaddam, Omid Moradi; Torabi-Nami, Mohammad; Abbasi, Saeed; El-Sobky, Malak; Ghaziani, Ali; Jarrahzadeh, Mohammad Hossein; Shahrami, Reza; Shirazian, Farzad; Soltani, Farhad; Yazdinejad, Homeira; Zand, Farid

2014-01-01

86

The cycle of change: implementing best-evidence clinical practice.  

PubMed

To improve health outcomes, effective and systematic mechanisms to foster the adoption of evidence-based guideline recommendations into routine practice need to be identified. A cyclical process for achieving this objective involving three key phases is suggested. Phase 1. Writing actionable best-evidence guidelines that prioritize key recommendations while indicating the levels of adoption needed for population health benefits to be accomplished. Phase 2. Developing implementation plans for the priority guideline recommendations. These should systematically consider skills training and accreditation; social influences including opinion leaders and patient influences; environmental factors; monitoring and feedback; and incentives for clinical change. Phase 3. Pilot testing the effectiveness of proposed approaches in producing the desired clinical changes. If implementation requires system changes and evaluation at an organizational level, the use of alternative research designs to the randomized controlled trial could be considered. The purpose evaluation would be to enable refinement of the implementation plans before widespread dissemination. PMID:18988656

Carey, Mariko; Buchan, Heather; Sanson-Fisher, Rob

2009-02-01

87

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

PubMed Central

Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of other DSSs that translate written guidelines into actionable, real-time clinical recommendations. PMID:20385018

2010-01-01

88

Specialist outreach clinics in general practice.  

PubMed Central

OBJECTIVES--To establish the extent and nature of specialist outreach clinics in primary care and to describe specialists' and general practitioners' views on outreach clinics. DESIGN--Telephone interviews with hospital managers. Postal questionnaire surveys of specialists and general practitioners. SETTING--50 hospitals in England and Wales. SUBJECTS--50 hospital managers, all of whom responded. 96 specialists and 88 general practitioners involved in outreach clinics in general practice, of whom 69 (72%) and 46 (52%) respectively completed questionnaires. 122 additional general practitioner fundholders, of whom 72 (59%) completed questionnaires. MAIN OUTCOME MEASURES--Number of specialist outreach clinics; organisation and referral mechanism; waiting times; perceived benefits and problems. RESULTS--28 of the hospitals had a total of 96 outreach clinics, and 32 fundholders identified a further 61 clinics. These clinics covered psychiatry (43), medical specialties (38), and surgical specialties (76). Patients were seen by the consultant in 96% (107) of clinics and general practitioners attended at only six clinics. 61 outreach clinics had shorter waiting times for first outpatient appointment than hospital clinics. The most commonly reported benefits for patients were ease of access and shorter waiting times. CONCLUSIONS--Specialist outreach clinics cover a wide range of specialties and are popular, especially in fundholding practices. These clinics do not seem to have increased the interaction between general practitioners and specialists. PMID:8173432

Bailey, J. J.; Black, M. E.; Wilkin, D.

1994-01-01

89

Botulinum toxin in clinical practice  

PubMed Central

Botulinum toxin, the most potent biological toxin, has become a powerful therapeutic tool for a growing number of clinical applications. This review draws attention to new findings about the mechanism of action of botulinum toxin and briefly reviews some of its most frequent uses, focusing on evidence based data. Double blind, placebo controlled studies, as well as open label clinical trials, provide evidence that, when appropriate targets and doses are selected, botulinum toxin temporarily ameliorates disorders associated with excessive muscle contraction or autonomic dysfunction. When injected not more often than every three months, the risk of blocking antibodies is slight. Long term experience with this agent suggests that it is an effective and safe treatment not only for approved indications but also for an increasing number of off-label indications. PMID:15201348

Jankovic, J

2004-01-01

90

Positive Psychology in Clinical Practice  

Microsoft Academic Search

Ke yW ords well being, strength(s), meaning, flow, happiness ? Abstract Positive psychology is the scientific study of positive experiences and positive individual traits, and the institutions that facilitate their development. A field concerned with well-being and optimal functioning, positive psychology aims to broaden the focus of clinical psychology beyond suffering and its direct alleviation. Our proposed conceptual framework parses

Angela Lee Duckworth; Tracy A. Steen; Martin E. P. Seligman

2005-01-01

91

CT in your clinical practice.  

PubMed

This report presents the results of a survey of 500 U.S.-based radiologists on critical issues associated with the use of CT. The survey represents a collaboration between the American Roentgen Ray Society (ARRS) and Philips Medical Systems. An outside firm, ICR/International Communications Research, conducted the survey. Survey questions were designed to elicit opinions about the past, present and future of CT, especially MDCT imaging, in various practice environments. Most radiologists (69%) indicated that CT has had a major influence on their specialty, more than any other medical advance, and that they expected this influence to increase. The idea that MDCT radically improves diagnostic quality was not universal, and opinions were mixed about the expansion of CT into new applications such as cardiac imaging. A number of concerns were attributed to the advent of MDCT and expansion in the number of slices-a phenomenon commonly referred to as a "slice war." These concerns revolved around managing the data explosion, excessive patient irradiation, bottlenecks in patient throughput, the ability of CT staffs to keep up with the rapidly evolving technology and the costs of keeping up with these changes. Nevertheless, most radiologists (78%) who were surveyed indicated that they used MDCT and that MDCT has had a positive effect on their practices in the past five years (90%); most (77%) expected that the number of slices would increase by two to 10 times the current level. Fifty-six percent said that they would be adding one to two scanners to their practices in the next five years. PMID:15461297

Kohs, Gregory J; Legunn, Joel

2004-09-01

92

Thymomas: Review of Current Clinical Practice  

PubMed Central

Thymomas are the most common tumors of the mediastinum. The introduction of multimodality treatment strategies, as well as novel approaches to the diagnosis of these tumors, has led to changes in the clinical management of thymomas. Here we review the literature for current clinical practice in the diagnosis, management, and treatment of thymomas. PMID:19463649

Tomaszek, Sandra; Wigle, Dennis A.; Keshavjee, Shaf; Fischer, Stefan

2010-01-01

93

Quality assessment of clinical practice guidelines for the prevention and treatment of childhood overweight and obesity  

Microsoft Academic Search

Background  The prevalence of childhood overweight and obesity is increasing at dramatic rates in children and adolescents worldwide.\\u000a Clinical practice guidelines (CPGs) are “systematically developed statements to assist practitioner and patient decisions\\u000a about appropriate health care for specific clinical circumstances.” Their objective is to provide explicit recommendations\\u000a for clinical practice based on current evidence for best practice in the management of

Mario Delgado-Noguera; Sera Tort; Xavier Bonfill; Ignasi Gich; Pablo Alonso-Coello

2009-01-01

94

General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, Vol. 60, No. 2, January 28, 2011.  

National Technical Information Service (NTIS)

This report is a revision of the General Recommendations on Immunization and updates the 2006 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on ...

A. T. Kroger, C. V. Sumaya, L. K. Pickering, W. L. Atkinson

2010-01-01

95

Developing evidence-based clinical practice guidelines in hospitals in Australia, Indonesia, Malaysia, the Philippines and Thailand: values, requirements and barriers  

Microsoft Academic Search

BACKGROUND: Evidence-based clinical practice guidelines support clinical decision-making by making recommendations to guide clinical practice. These recommendations are developed by integrating the expertise of a multidisciplinary group of clinicians with the perspectives of consumers and the best available research evidence. However studies have raised concerns about the quality of guideline development, and particularly the link between research and recommendations. The

Tari J Turner

2009-01-01

96

Factors affecting the adoption of recommended agricultural practices by three different types of farmers in Mexico  

E-print Network

of the Sample Age Narital Status 27 27 28 Number of Children Formal Education . ~ Social Participation Sources of Income 28 28 31 31 Tenure 32 Farmers' Knowledge and Use of Recommended Practices from 1961 through 1966 34 Knowledge and Use... on Present Farm as Reported by Three Different Types of Farmers in Nexico 37 Knowledge and Use of Practices Recommended from 1961 through 1966 by Respondents of the Study 39 Ejidatarios Classified According to their Knowledge and Use of Recommended Practices...

Garza-Falcon, Gilberto Severino

2012-06-07

97

Mayo Clinic Jacksonville electronic radiology practice  

NASA Astrophysics Data System (ADS)

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

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

1996-05-01

98

Multiple Clinical Practice Guidelines for Breast and Cervical Cancer Screening  

PubMed Central

Background Multiple clinical practice guidelines exist for breast and cervical cancer screening, and differ in aggressiveness with respect to the recommended frequency and target populations for screening. Objectives To determine (1) US primary care physicians’ (PCPs) perceptions of the influence of different clinical practice guidelines; (2) the relationship between the number, aggressiveness, and agreement of influential guidelines and the aggressiveness of physicians’ screening recommendations; and (3) factors associated with guideline perceptions. Research Design and Methods A nationally representative sample of 1212 PCPs was surveyed in 2006–2007. Cross-sectional analyses examined physicians’ perceptions of the influence of different breast and cervical cancer screening guidelines, the relationship of guideline perceptions to screening recommendations in response to hypothetical vignettes, and the predictors of guideline perceptions. Results American Cancer Society and American College of Obstetricians and Gynecologists guidelines were perceived as more influential than other guidelines. Most physicians (62%) valued multiple guidelines, and conflicting and aggressive rather than conservative guideline combinations. The number, aggressiveness, and agreement of influential guidelines were associated with the aggressiveness of screening recommendations (P < 0.01)—which was highest for physicians valuing multiple-aggressive, lowest for physicians valuing multiple-conservative, and intermediate for physicians valuing multiple-conflicting, single, and no guidelines. Obstetrician/gynecologists specialty predicted valuation of aggressive guidelines (P < 0.001). Conclusions PCPs’ perceptions of cancer screening guidelines vary, relate to screening recommendations in logically-consistent ways, and are predicted by specialty and other factors. The number, aggressiveness, and agreement of valued guidelines are associated with screening recommendations, suggesting that guideline multiplicity is an important problem in clinical decision-making. PMID:21206294

Han, Paul K. J.; Klabunde, Carrie N.; Breen, Nancy; Yuan, Gigi; Grauman, Alyssa; Davis, William W.; Taplin, Stephen H.

2014-01-01

99

Can the Use of Recommended Procurement Practices Save Money?  

Microsoft Academic Search

Procurement is an essential business function of government. Despite the importance of effective procurement practices to government efficiency, very little is known about what local governments do in practice, and how procurement practices affect government spending. This paper reports the results of a survey on procurement practices used by New York State school districts. To examine the potential costs savings

WILLIAM DUNCOMBE; CYNTHIA SEARCY

2007-01-01

100

[Acute bronchiolitis clinical practice guidelines: Description of the metodological process].  

PubMed

A clinical practice guideline (CPG) is a set of systematically developed recommendations to assist practitioners and patient decisions about appropriate health care, and to select the most appropriate diagnostic or therapeutic options to address a health problem or a specific clinical condition. Acute bronchiolitis is the most common lower respiratory tract infection in infants. In spite of its high prevalence, there is still controversy regarding its management. Therefore bronchiolitis is selected for the development of a CPG. We describe the methodological process used to develop the CPG on acute bronchiolitis. PMID:20627746

Nebot, M Simó; Teruel, G Claret; Cubells, C Luaces; Sabadell, M D Estrada; Fernández, J Pou

2010-10-01

101

Concordance with clinical practice guidelines for dementia in general practice  

Microsoft Academic Search

Background: Dementia is said to be under-recognized and sub-optimally managed in primary care, but there is little information about actual processes of diagnosis and clinical care.Aim: To determine general practitioners’ concordance with clinical guidelines on the diagnosis and management of patients with dementia.Design: Unblinded, cluster randomized pre-test–post-test controlled trial involving 35 practices in the UK.Methods: Patients with a diagnosis of

Jane Wilcock; Steve Iliffe; Stephen Turner; Michelle Bryans; Ronan O’Carroll; John Keady; Enid Levin; Murna Downs

2009-01-01

102

Recommended Practice: Creating Cyber Forensics Plans for Control Systems  

SciTech Connect

Cyber forensics has been in the popular mainstream for some time, and has matured into an information-technology capability that is very common among modern information security programs. The goal of cyber forensics is to support the elements of troubleshooting, monitoring, recovery, and the protection of sensitive data. Moreover, in the event of a crime being committed, cyber forensics is also the approach to collecting, analyzing, and archiving data as evidence in a court of law. Although scalable to many information technology domains, especially modern corporate architectures, cyber forensics can be challenging when being applied to non-traditional environments, which are not comprised of current information technologies or are designed with technologies that do not provide adequate data storage or audit capabilities. In addition, further complexity is introduced if the environments are designed using proprietary solutions and protocols, thus limiting the ease of which modern forensic methods can be utilized. The legacy nature and somewhat diverse or disparate component aspects of control systems environments can often prohibit the smooth translation of modern forensics analysis into the control systems domain. Compounded by a wide variety of proprietary technologies and protocols, as well as critical system technologies with no capability to store significant amounts of event information, the task of creating a ubiquitous and unified strategy for technical cyber forensics on a control systems device or computing resource is far from trivial. To date, no direction regarding cyber forensics as it relates to control systems has been produced other than what might be privately available from commercial vendors. Current materials have been designed to support event recreation (event-based), and although important, these requirements do not always satisfy the needs associated with incident response or forensics that are driven by cyber incidents. To address these issues and to accommodate for the diversity in both system and architecture types, a framework based in recommended practices to address forensics in the control systems domain is required. This framework must be fully flexible to allow for deployment into any control systems environment regardless of technologies used. Moreover, the framework and practices must provide for direction on the integration of modern network security technologies with traditionally closed systems, the result being a true defense-in-depth strategy for control systems architectures. This document takes the traditional concepts of cyber forensics and forensics engineering and provides direction regarding augmentation for control systems operational environments. The goal is to provide guidance to the reader with specifics relating to the complexity of cyber forensics for control systems, guidance to allow organizations to create a self-sustaining cyber forensics program, and guidance to support the maintenance and evolution of such programs. As the current control systems cyber security community of interest is without any specific direction on how to proceed with forensics in control systems environments, this information product is intended to be a first step.

Eric Cornelius; Mark Fabro

2008-08-01

103

Clinical practice guidelines. New-to-practice family physicians' attitudes.  

PubMed Central

OBJECTIVE: To examine the attitudes toward clinical practice guidelines of a group of family physicians who had recently entered practice in Ontario, and to compare them with the attitudes of a group of internists from the United States. DESIGN: Mailed questionnaire survey of all members of a defined cohort. SETTING: Ontario family practices. PARTICIPANTS: Certificants of the College of Family Physicians of Canada who received certification in 1989, 1990, and 1991 and who were practising in Ontario. Of 564-cohort members, 395 (70%) responded. Men (184) and women (211) responded at the same rate. MAIN OUTCOME MEASURES: Levels of agreement with 10 descriptive statements about practice guidelines and analyses of variance of these responses for several physician characteristics. RESULTS: Of respondents in independent practice, 80% were in group practice. Women were more likely to have chosen group practice, in which they were more likely to use practice guidelines than men. Generally favourable attitudes toward guidelines were observed. Physician characteristics occasionally influenced agreement with the descriptors. The pattern of agreement was similar to that noted in the study of American internists, but, in general, Ontario physicians were more supportive. CONCLUSIONS: This group of relatively new-to-practice Ontario family physicians shows little resistance to guidelines and appears to read less threat of external control in them than does the US group. PMID:8616286

Ferrier, B. M.; Woodward, C. A.; Cohen, M.; Williams, A. P.

1996-01-01

104

LLNL Site Specific ASCI Software Quality Engineering Recommended Practices Overview Version 1.0  

SciTech Connect

''The LLNL Site-Specific Advanced Simulation and Computing (ASCI) Software Quality Engineering Recommended Practices VI.I'' document describes a set of recommended software quality engineering (SQE) practices for ASCI code projects at Lawrence Livermore National Laboratory (LLNL). In this context, SQE is defined as the process of building quality into software products by applying the appropriate guiding principles and management practices. Continual code improvement and ongoing process improvement are expected benefits. Certain practices are recommended, although projects may select the specific activities they wish to improve, and the appropriate time lines for such actions. Additionally, projects can rely on the guidance of this document when generating ASCI Verification and Validation (VSrV) deliverables. ASCI program managers will gather information about their software engineering practices and improvement. This information can be shared to leverage the best SQE practices among development organizations. It will further be used to ensure the currency and vitality of the recommended practices. This Overview is intended to provide basic information to the LLNL ASCI software management and development staff from the ''LLNL Site-Specific ASCI Software Quality Engineering Recommended Practices VI.I'' document. Additionally the Overview provides steps to using the ''LLNL Site-Specific ASCI Software Quality Engineering Recommended Practices VI.I'' document. For definitions of terminology and acronyms, refer to the Glossary and Acronyms sections in the ''LLNL Site-Specific ASCI Software Quality Engineering Recommended Practices VI.I''.

Peck, T; Sparkman, D; Storch, N

2002-02-01

105

Clinical practice guidelines: Opportunities and implications  

Microsoft Academic Search

Clinical practice guidelines have been defined as systematically developed statements to assist practitioner and patient decisions\\u000a about appropriate health care for specific clinical circumstances. They are intended to improve the quality, appropriateness,\\u000a and effectiveness of care. While particular guidelines may be challenged on the grounds that they are not inclusive of all\\u000a effective treatment strategies or are too difficult or

Margaret Edmunds

1996-01-01

106

Integrating Research into a Clinical Practice  

Microsoft Academic Search

\\u000a While exposure to research techniques is a standard component of the training of most physicians and laboratory directors,\\u000a the progressive migration of reproductive medicine clinics away from academic institutions and into private practice has decreased\\u000a the exposure and involvement of many clinicians and laboratory technicians away from clinical or basic science research studies.\\u000a This chapter explores the benefits of implementing

Douglas T. Carrell

107

Oncologists' recommendations of clinical trial participation to patients. | accrualnet.cancer.gov  

Cancer.gov

This study contributes empirical data to the discussions about whether clinicians should make explicit recommendations to patients about whether to participate in a clinical trial. Some suggest that clinician recommendations may unduly influence patients and inhibit autonomous decision making. This study documents the frequency, context and type of oncologist recommendations and found that a personalized recommendation by the clinician influenced the patient’s decision to accept clinical trial participation.

108

Sphygmomanometers in hospital and family practice: problems and recommendations  

Microsoft Academic Search

The accuracy and working condition of 210 sphygmomanometers were tested: 100 (50 and mercury and 50 aneroid) models were used in family practices and 100 mercury models in hospitals. Faults in the inflation-deflation system were common and caused mainly by dirt or wear in the control valves. Leakage occurred in 48% of the hospital and 33% of the family practice

M J Burke; H M Towers; K OMalley; D J Fitzgerald; E T OBrien

1982-01-01

109

Constructivism: An approach to clinical practice  

Microsoft Academic Search

Constructivism, a view that we cannot know reality apart from our constructions of it, along with social constructionism, a belief that knowledge is socially, historically, and culturally situated, form the basis of a new approach to clinical practice. In the explication of this perspective, assessment is defined as a collaborative inquiry. Multiple theoretical perspectives are used as viable alternative explanations,

Ruth Grossman Dean

1993-01-01

110

Current social work perspectives on clinical practice  

Microsoft Academic Search

Several forms of progress in the development of clinical practice theory and method are identified. There is a renewed positive valuation of psychodynamic approaches, a general acceptance of a systems framework, and a greater operationalization of procedures. The current controversy between the social work scientists and artists concerning research strategies is discussed. Three promising new perspectives—of morality, spirituality, and hermeneutics-are

Max Siporin

1985-01-01

111

Balancing Certainty and Uncertainty in Clinical Practice  

ERIC Educational Resources Information Center

Purpose: In this epilogue, I respond to each of the five commentaries, discussing in some depth a central issue raised in each commentary. In the final section, I discuss how my thinking about certainty and uncertainty in clinical practice has evolved since I wrote the initial article. Method: Topics addressed include the similarities/differences…

Kamhi, Alan G.

2011-01-01

112

Lexical Concept Distribution Reflects Clinical Practice  

PubMed Central

It is not known whether narrative medical text directly reflects clinical reality. We have tested the hypothesis that the pattern of distribution of lexical concept of medication intensification in narrative provider notes correlates with clinical practice as reflected in electronic medication records. Over 29,000 medication intensifications identified in narrative provider notes and 444,000 electronic medication records for 82 anti-hypertensive, anti-hyperlipidemic and anti-hyperglycemic medications were analyzed. Pearson correlation coefficient between the fraction of dose increases among all medication intensifications and therapeutic range calculated from EMR medication records was 0.39 (p = 0.0003). Correlations with therapeutic ranges obtained from two medication dictionaries, used as a negative control, were not significant. These findings provide evidence that narrative medical documents directly reflect clinical practice and constitute a valid source of medical data. PMID:23304273

Breydo, Eugene; Shubina, Maria; Shalaby, James W.; Einbinder, Jonathan S.; Turchin, Alexander

2012-01-01

113

Canadian Association of Gastroenterology policy on the application for, and implementation of, clinical practice guidelines.  

PubMed

An important mandate of the Canadian Association of Gastroenterology (CAG), as documented in the Association's governance policies, is to optimize the care of patients with digestive disorders. Clinical practice guidelines are one means of achieving this goal. The benefits of timely, high-quality and evidenced-based recommendations include: ?Enhancing the professional development of clinical members through education and dissemination of synthesized clinical research; ?Improving patient care provided by members by providing focus on quality and evidence; ?Creating legislative environments that favour effective clinical practice; ?Enhancing the clinical care provided to patients with digestive disease by nongastroenterologists; and ?Identifying areas that require further information or research to improve clinical care. The present document provides the foundation required to ensure that clinical practice guidelines produced by the CAG are necessary, appropriate, credible and applicable. These recommendations should be adhered to as closely as possible to obtain CAG endorsement. PMID:25314352

Singh, Harminder; Leontiadis, Grigorios I; Hookey, Lawrence; Enns, Robert; Bistritz, Lana; Rioux, Louis-Charles; Hope, Louise; Sinclair, Paul

2014-10-01

114

Using Principles of Evidence-Based Practice to Improve Prescriptive Recommendations  

ERIC Educational Resources Information Center

We draw on the evidence-based practice (EBP) literature to consider the relationship between empirical results reported in primary research journals and prescriptive recommendations for practice based on those results. We argue that the relationship between individual empirical findings and practice should be mediated by two additional steps in…

Schraw, Gregory; Patall, Erika A.

2013-01-01

115

Forum for Injection Techniques, India: The First Indian Recommendations for Best Practice in Insulin Injection Technique  

PubMed Central

Advances in the treatment of diabetes have led to an increase in the number of injectable therapies, such as human insulin, insulin analogues, and glucagon-like peptide-1 analogues. The efficacy of injection therapy in diabetes depends on correct injection technique, among many other factors. Good injection technique is vital in achieving glycemic control and thus preventing complications of diabetes. From the patients’ and health-care providers’ perspective, it is essential to have guidelines to understand injections and injection techniques. The abridged version of the First Indian Insulin Injection technique guidelines developed by the Forum for Injection Technique (FIT) India presented here acknowledge good insulin injection techniques and provide evidence-based recommendations to assist diabetes care providers in improving their clinical practice. PMID:23226630

Kalra, Sanjay; Balhara, Yatan Pal Singh; Baruah, Manash P.; Chadha, Manoj; Chandalia, Hemraj B.; Chowdhury, Subhankar; Kumar, K. M. Prasanna; Modi, Sonal; Pitale, Shailesh; Shukla, Rishi; Sahay, Rakesh; Sundaram, Annamalai; Unnikrishnan, Ambika G.; Wangnoo, Subhash K.

2012-01-01

116

Integrating multiparametric prostate MRI into clinical practice  

PubMed Central

Abstract Multifunctional magnetic resonance imaging (MRI) techniques are increasingly being used to address bottlenecks in prostate cancer patient management. These techniques yield qualitative, semi-quantitative and fully quantitative biomarkers that reflect on the underlying biological status of a tumour. If these techniques are to have a role in patient management, then standard methods of data acquisition, analysis and reporting have to be developed. Effective communication by the use of scoring systems, structured reporting and a graphical interface that matches prostate anatomy are key elements. Practical guidelines for integrating multiparametric MRI into clinical practice are presented. PMID:22187067

2011-01-01

117

Clinically oriented evaluation of family practice teleradiology  

NASA Astrophysics Data System (ADS)

This study was designed to provide a clinically oriented evaluation of a commercially available teleradiology system for remote diagnosis in the family practice setting. We sought a technique to determine if the diagnostic report from interpretation of transmitted digitized radiographs differed from the report rendered following interpretation of the original radiograph. Radiographs taken in our Family Medicine Clinic were digitized and transmitted to a display station. One of two ABR certified radiologists interpreted the digitized images and a report was printed. In keeping with our current practice, the radiographs were transmitted by courier for interpretation. Interpretation of the original radiographs was rendered and entered into the medical record. Reports were compared retrospectively and classified as: Class I -- The reports agree; Class II -- The reports disagree without clinical significance; Class III -- The reports disagree with clinical significance. A total of 197 exams were compared, of which approximately half had positive findings on the radiograph. Of the 197 exams considered, the interpretations of digitized and original radiographs agreed in 183 (93%) of the cases. The 14 clinically significant discordant cases were reviewed to ascertain the reason for disagreement. For all 14 cases, both the electronic image and radiographs were interpreted again independently by both radiologists. This analysis demonstrated only 1 case with a Class III disagreement. Thus the interpretations were in agreement for 99.5% of the cases upon review. We believe this methodology is a viable and robust technique for the clinical evaluation of teleradiology systems. The radiologist performs similar and familiar functions in both domains and the technique can be easily implemented in many practice settings. We are encouraged that our results indicate substantial agreement is possible with a relatively inexpensive, commercially available teleradiology system. An expansion of our current study is underway.

Morin, Richard L.; Berquist, Thomas H.; Pietan, Jerald H.

1995-05-01

118

Adoption of recommended practices and basic technologies in a low-income setting  

PubMed Central

Objective In global health considerable attention is focused on the search for innovations; however, reports tracking their adoption in routine hospital settings from low-income countries are absent. Design and setting We used data collected on a consistent panel of indicators during four separate cross-sectional, hospital surveys in Kenya to track changes over a period of 11?years (2002–2012). Main outcome measures Basic resource availability, use of diagnostics and uptake of recommended practices. Results There appeared little change in availability of a panel of 28 basic resources (median 71% in 2002 to 82% in 2012) although availability of specific feeds for severe malnutrition and vitamin K improved. Use of blood glucose and HIV testing increased but remained inappropriately low throughout. Commonly (malaria) and uncommonly (lumbar puncture) performed diagnostic tests frequently failed to inform practice while pulse oximetry, a simple and cheap technology, was rarely available even in 2012. However, increasing adherence to prescribing guidance occurred during a period from 2006 to 2012 in which efforts were made to disseminate guidelines. Conclusions Findings suggest changes in clinical practices possibly linked to dissemination of guidelines at reasonable scale. However, full availability of basic resources was not attained and major gaps likely exist between the potential and actual impacts of simple diagnostics and technologies representing problems with availability, adoption and successful utilisation. These findings are relevant to debates on scaling up in low-income settings and to those developing novel therapeutic or diagnostic interventions. PMID:24482351

English, Mike; Gathara, David; Mwinga, Stephen; Ayieko, Philip; Opondo, Charles; Aluvaala, Jalemba; Kihuba, Elesban; Mwaniki, Paul; Were, Fred; Irimu, Grace; Wasunna, Aggrey; Mogoa, Wycliffe; Nyamai, Rachel

2014-01-01

119

Best Practice Recommendations for Surgical Care in Weight Loss Surgery  

Microsoft Academic Search

Objective: To establish evidence-based guidelines for best practices for surgical care in weight loss surgery (WLS).Research Methods and Procedures: We carried out a systematic search of English-language literature on WLS in MEDLINE and the Cochrane Library. Key words were used to narrow the field for a selective review of abstracts. Data extraction was performed, and evidence categories were assigned according

John Kelly; Michael Tarnoff; Scott Shikora; Bruce Thayer; Daniel B. Jones; R. Amour Forse; Matthew M. Hutter; Robert Fanelli; David Lautz; Frederick Buckley; Imtiaz Munshi; Nicolas Coe

2005-01-01

120

News Note: Not all doctors comply with practice guidelines for recommending colorectal cancer screenings  

Cancer.gov

A study of nearly 1,300 primary care physicians in the United States found that only about 20 percent of those doctors recommend colorectal cancer (CRC) screenings tests to their patients in accordance with current practice guidelines.

121

Incorporation of Pharmacogenomics into Routine Clinical Practice: the Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline Development Process  

PubMed Central

The Clinical Pharmacogenetics Implementation Consortium (CPIC) publishes genotype-based drug guidelines to help clinicians understand how available genetic test results could be used to optimize drug therapy. CPIC has focused initially on well-known examples of pharmacogenomic associations that have been implemented in selected clinical settings, publishing nine to date. Each CPIC guideline adheres to a standardized format and includes a standard system for grading levels of evidence linking genotypes to phenotypes and assigning a level of strength to each prescribing recommendation. CPIC guidelines contain the necessary information to help clinicians translate patient-specific diplotypes for each gene into clinical phenotypes or drug dosing groups. This paper reviews the development process of the CPIC guidelines and compares this process to the Institute of Medicine’s Standards for Developing Trustworthy Clinical Practice Guidelines. PMID:24479687

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

2014-01-01

122

Practices in Early Intervention for Children with Autism: A Comparison with the National Research Council Recommended Practices  

ERIC Educational Resources Information Center

The National Research Council (2001) report was reviewed to identify and document recommended practices for programs serving young children with autism spectrum disorder. Twenty seven surveys inquiring about program practices were sent to educational service districts, school districts, and neurodevelopmental centers in Oregon and Washington that…

Downs, Robyn Conley; Downs, Andrew

2010-01-01

123

Incorporating prognostic imaging biomarkers into clinical practice  

PubMed Central

Abstract A prognostic imaging biomarker can be defined as an imaging characteristic that is objectively measurable and provides information on the likely outcome of the cancer disease in an untreated individual and should be distinguished from predictive imaging biomarkers and imaging markers of response. A range of tumour characteristics of potential prognostic value can be measured using a variety imaging modalities. However, none has currently been adopted into routine clinical practice. This article considers key examples of emerging prognostic imaging biomarkers and proposes an evaluation framework that aims to demonstrate clinical efficacy and so support their introduction into the clinical arena. With appropriate validation within an established evaluation framework, prognostic imaging biomarkers have the potential to contribute to individualized cancer care, in some cases reducing the financial burden of expensive cancer treatments by facilitating their more rational use. PMID:24060808

Miles, Kenneth A.

2013-01-01

124

Updated clinical recommendations for the use of tibolone in Asian women  

PubMed Central

Tibolone, which is indicated for the relief of climacteric symptoms and the prevention of osteoporosis in postmenopausal women, has a tissue-specific mode of action different to that of conventional hormone replacement therapy (HRT). A large proportion of Asian postmenopausal women experience symptoms that most frequently include musculoskeletal pain, insomnia, forgetfulness, hot flushes and sexual dysfunction, and there is a need to address their specific requirements. Recent studies show that, in comparison to HRT, tibolone is as effective in alleviating menopausal symptoms and preventing bone loss, has a greater positive effect on sexual dysfunction and is associated with less vaginal bleeding, but it is rarely mentioned in guidelines for menopausal treatment. Levels of awareness amongst women about treatments for menopausal symptoms vary between Asian countries but, even in countries where awareness is high, HRT usage is much lower than in the West. To provide a practical approach to the use of tibolone in Asian postmenopausal women, a panel of experts in the management of menopause from 11 Asia Pacific countries has developed recommendations for its use, based on the evidence from clinical studies published since 2005. However, as much of the clinical data reviewed are from international studies, the recommendations and the treatment algorithm presented here are widely applicable. PMID:20443720

Huang, K-E.; Baber, R.

2010-01-01

125

Does implementation of a paediatric asthma clinical practice guideline worksheet change clinical practice?  

Microsoft Academic Search

Background  Despite the development of evidence-based practice guidelines in many countries for asthma treatment in children, there is\\u000a limited evidence that using such guidelines improves patient care.\\u000a \\u000a \\u000a \\u000a Aims  Our aim was to evaluate whether the implementation of an evidence-based asthma clinical practice guideline (CPG) worksheet\\u000a changes clinical practice.\\u000a \\u000a \\u000a \\u000a Methods  The study was a before and after study of the implementation of a paediatric

Johann Gildenhuys; Mark Lee; Geoffrey K. Isbister

2009-01-01

126

Recommendations Accepted to Revamp NCI Clinical Trials System  

Cancer.gov

The National Cancer Advisory Board (NCAB) of the National Cancer Institute (NCI) today accepted 22 strategic proposals for revamping the NCI's cancer clinical trials system and a five-year implementation plan to accomplish the changes.

127

Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan  

PubMed Central

Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system capabilities, including basic and advanced sets of CDS interventions and knowledge, supporting database elements, operational features to improve usability and measure performance, and management and governance structures; (2) uniform standards, vocabularies, and centralized knowledge structures and services that could reduce rework by vendors and care providers, improve dissemination of well-constructed CDS interventions, promote generally applicable research in CDS methods, and accelerate the movement of new medical knowledge from research to practice; and (3) appropriate financial and legal incentives to promote adoption. PMID:15802474

Teich, Jonathan M.; Osheroff, Jerome A.; Pifer, Eric A.; Sittig, Dean F.; Jenders, Robert A.

2005-01-01

128

COPD management: role of symptom assessment in routine clinical practice  

PubMed Central

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

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

2013-01-01

129

Collaborative Practice Improvement for Childhood Obesity in Rural Clinics: The Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP).  

PubMed

This study assessed the impact of participation in a virtual quality improvement (QI) learning network on adherence to clinical guidelines for childhood obesity prevention in rural clinics. A total of 7 primary care clinics in rural California included in the Healthy Eating Active Living TeleHealth Community of Practice and 288 children seen in these clinics for well-child care participated in this prospective observational pre-post study. Clinics participated in a virtual QI learning network over 9 months to implement best practices and to exchange strategies for improvement. Following the intervention, documentation of weight assessment and counseling increased significantly. Children who received care from clinicians who led the implementation of the intervention at their clinic showed significant improvements in nutrition and physical activity. Virtual QI learning networks in geographically dispersed clinics can significantly increase clinicians' adherence to guidelines for childhood obesity and improve access to recommended care for rural and underserved children. PMID:24170936

Shaikh, Ulfat; Nettiksimmons, Jasmine; Joseph, Jill G; Tancredi, Daniel; Romano, Patrick S

2014-11-01

130

Are laboratory investigations recommended in current medical practice guidelines supported by available evidence?  

PubMed

It has been suggested that evidence-based laboratory medicine (EBLM) could help to improve the pertinence and accuracy of medical guidelines. In order to demonstrate this, we have used an EBLM approach (i.e. a systematic review) to examine three recently published guidelines that gave quite conflicting recommendations regarding the use of laboratory variables in the management of primary non-small cell lung cancer patients. In recommending the routine measurement of serum albumin, and, to a lesser extent, that of serum calcium in the pre-therapeutic prognostic evaluation of the advanced disease, the American Thoracic Society and the European Respiratory Society were probably correct with regard to calcium but perhaps mistaken regarding albumin. Some of the recommendations of the European Group on Tumour Markers regarding the usefulness of routine measurements of tumour markers (carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), tissue-polypeptide antigen (TPA)) in the pre- and/or post-therapeutic prognostic evaluation can also be criticised. In addition, the latter society as well as the Société de Pneumologie de Langue Française did not even try to list laboratory variables, others than tumour markers, that would be useful to stratify patients participating in clinical trials (i.e. lactate dehydrogenase (LDH), albumin, calcium, blood cell count, etc.), and the laboratory variables listed by the two former societies were probably not the right ones in this context: in particular LDH and tumour markers (fragments of cytokeratin 19 (Cyfra 21-1), tissue-polypeptide-specific antigen (TPS), neuron-specific enolase (NSE)) were not mentioned. Most, if not all of these discrepancies in the current medical practice guidelines might have been avoided had an EBLM approach been used by the authors. PMID:12005215

Watine, Joseph

2002-03-01

131

[Sugammadex--two years in clinical practice].  

PubMed

Sugammadex is a modified gamma cyclodextrin, specifically designed for the reversal of neuromuscular blockade (NMB) induced by the steroidal neuromuscular blocking agents, rocuronium and vecuronium. Sugammadex acts by encapsulating the unbound drug molecules and reducing their concentration at the neuromuscular junction, allowing rapid reversal of NMB at every stage. Unlike acetylcholinesterase inhibitors, sugammadex is also effective in the reversal of profound NMB and is well tolerated. The recommended doses are in the range of 2-16 mg kg(-1), depending on the intensity of the block. Perioperative neuromuscular transmission monitoring is mandatory in enabling the choice of the right doses of sugammadex. This review presents various aspects of the use of sugammadex in adult and paediatric patients, and provides guidelines for practical administration. PMID:21413422

Glinka, Lidia; Onichimowski, Dariusz; Sieniuta, Pawe?; Korecki, Artur

2010-01-01

132

Graylyn Conference Report. Recommendations for reform of clinical pathology residency training. Conjoint Task Force of Clinical Pathology Residency Training Writing Committee.  

PubMed

The Graylyn Conference Report of the conjoint ACLPS, ASCP, APC, and CAP task force is prompted by the growing realization that without reform of the clinical pathology residency curriculum the future of clinical pathology practice may be in jeopardy. The conclusions reached at the ASCP-sponsored Colorado Springs IV Conference on Clinical Pathology Residency Training laid the groundwork for this report on curriculum reform. The goal is the creation of scientifically oriented clinical pathology practitioners capable of serving as consultants to other physicians of managing laboratory resources, and of playing leadership roles in an increasingly complex health-care system. Recommendations are described under the headings of patient care roles, graduated responsibility, analytical and technical training, laboratory management and informatics, and basic and applied research. In terms of reforming the structure and content of the curriculum, it is recommended that basic laboratory rotations be preceded by either a single didactic general 4- to 6-week orientation, or a series of shorter orientations incorporated into each rotation. The introductory and rotation phase should be 9 to 12 months in duration. It is further recommended that the remaining 6 to 9 months of the 18-month core be an integrated experience in which the resident practices Clinical Pathology by assuming service responsibilities for several laboratory sections simultaneously. PMID:7856552

1995-02-01

133

ACMG Recommendations for Reporting of Incidental Findings in Clinical Exome and Genome Sequencing  

PubMed Central

In clinical exome and genome sequencing, there is potential for the recognition and reporting of incidental or secondary findings unrelated to the indication for ordering the sequencing but of medical value for patient care. The American College of Medical Genetics and Genomics (ACMG) recently published a policy statement on clinical sequencing, which emphasized the importance of disclosing the possibility of such results in pretest patient discussions, clinical testing, and reporting of results. The ACMG appointed a Working Group on Incidental Findings in Clinical Exome and Genome Sequencing to make recommendations about responsible management of incidental findings when patients undergo exome or genome sequencing. This Working Group conducted a year-long consensus process, including review by outside experts, and produced recommendations that have been approved by the ACMG Board. Specific and detailed recommendations, and the background and rationale for these recommendations, are described herein. We recommend that laboratories performing clinical sequencing seek and report mutations of the specified classes or types in the genes listed here. This evaluation and reporting should be performed for all clinical germline (constitutional) exome and genome sequencing, including the ‘normal’ of tumor-normal subtractive analyses in all subjects, irrespective of age, but excluding fetal samples. We recognize that there are insufficient data on clinical utility to fully support these recommendations and we encourage the creation of an ongoing process for updating these recommendations at least annually as further data are collected. PMID:23788249

Green, Robert C.; Berg, Jonathan S.; Grody, Wayne W.; Kalia, Sarah S.; Korf, Bruce R.; Martin, Christa L.; McGuire, Amy; Nussbaum, Robert L.; O'Daniel, Julianne M.; Ormond, Kelly E.; Rehm, Heidi L.; Watson, Michael S.; Williams, Marc S.; Biesecker, Leslie G.

2013-01-01

134

Clinical review: Consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults  

PubMed Central

The management reporting and assessment of glycemic control lacks standardization. The use of different methods to measure the blood glucose concentration and to report the performance of insulin treatment yields major disparities and complicates the interpretation and comparison of clinical trials. We convened a meeting of 16 experts plus invited observers from industry to discuss and where possible reach consensus on the most appropriate methods to measure and monitor blood glucose in critically ill patients and on how glycemic control should be assessed and reported. Where consensus could not be reached, recommendations on further research and data needed to reach consensus in the future were suggested. Recognizing their clear conflict of interest, industry observers played no role in developing the consensus or recommendations from the meeting. Consensus recommendations were agreed for the measurement and reporting of glycemic control in clinical trials and for the measurement of blood glucose in clinical practice. Recommendations covered the following areas: How should we measure and report glucose control when intermittent blood glucose measurements are used? What are the appropriate performance standards for intermittent blood glucose monitors in the ICU? Continuous or automated intermittent glucose monitoring - methods and technology: can we use the same measures for assessment of glucose control with continuous and intermittent monitoring? What is acceptable performance for continuous glucose monitoring systems? If implemented, these recommendations have the potential to minimize the discrepancies in the conduct and reporting of clinical trials and to improve glucose control in clinical practice. Furthermore, to be fit for use, glucose meters and continuous monitoring systems must match their performance to fit the needs of patients and clinicians in the intensive care setting. See related commentary by Soto-Rivera and Agus, http://ccforum.com/content/17/3/155 PMID:23767816

2013-01-01

135

Japanese Encephalitis Vaccines Recommendations of the Advisory Committee on Immunization Practices (ACIP)  

Microsoft Academic Search

Summary This report updates the 1993 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the prevention of Japanese encephalitis (JE) among travelers (CDC. Inactivated Japanese encephalitis virus vaccine: recommenda- tions of the Advisory Committee on Immunization Practices (ACIP). MMWR 1993;42(No. RR-1)). This report summarizes the epidemiology of JE, describes the two JE vaccines that are licensed in the

Marc Fischer; Nicole Lindsey; J. Erin Staples; Susan Hills

136

Recommended Feeding and Dietary Practices To Improve Infant and Maternal Nutrition.  

ERIC Educational Resources Information Center

The LINKAGES Project is intended to improve breastfeeding and related complementary feeding and maternal dietary practices. The project, in consultation with technical experts and program managers, identified a set of recommended feeding and dietary practices intended to break the cycle of poor health and nutrition that passes from generation to…

Academy for Educational Development, Washington, DC.

137

Evidence-Based Practices in Addiction Treatment: Review and Recommendations for Public Policy  

PubMed Central

The movement in recent years towards evidence-based practice (EBP) in health care systems and policy has permeated the substance abuse treatment system, leading to a growing number of federal and statewide initiatives to mandate EBP implementation. Nevertheless, due to a lack of consensus in the addiction field regarding procedures or criteria to identify EBPs, the optimal processes for disseminating empirically based interventions into real-world clinical settings have not been identified. Although working lists of interventions considered to be evidence-based have been developed by a number of constituencies advocating for EBP dissemination in addiction treatment settings, the use of EBP lists to form policy-driven mandates has been controversial. This article examines the concept of EBP, critically reviews criteria used to evaluate the evidence basis of interventions, and highlights the manner in which such criteria have been applied in the addictions field. Controversies regarding EBP implementation policies and practices in addiction treatment are described, and suggestions are made to shift the focus of dissemination efforts from manualized psychosocial interventions to specific skill sets that are broadly applicable and easily learned by clinicians. Organizational and workforce barriers to EBP implementation are delineated, with corresponding recommendations to facilitate successful dissemination of evidence-based skills. PMID:20557970

Glasner-Edwards, Suzette; Rawson, Richard

2010-01-01

138

The Sherlock Holmes method in clinical practice.  

PubMed

This article lists the integral elements of the Sherlock Holmes method, which is based on the intelligent collection of information through detailed observation, careful listening and thorough examination. The information thus obtained is analyzed to develop the main and alternative hypotheses, which are shaped during the deductive process until the key leading to the solution is revealed. The Holmes investigative method applied to clinical practice highlights the advisability of having physicians reason through and seek out the causes of the disease with the data obtained from acute observation, a detailed review of the medical history and careful physical examination. PMID:24457141

Sopeña, B

2014-04-01

139

The use of smartphones in clinical practice.  

PubMed

The use of smartphones and applications or 'apps' in clinical practice among nurses and doctors is on the increase. This article discusses the results of a survey undertaken as part of a service improvement project to develop an 'app' for use by junior doctors. The survey asked nurses and doctors to share information about how they used their smartphones at work, what they used them for and how and if they risk assessed the apps they use. Responses from 82 nurses and 334 doctors show a high level of users of text books, formularies, clinical decision tools and calculators, with less than one quarter of these users performed any risk assessment before use. PMID:24967805

Moore, Sally; Jayewardene, Dharshana

2014-07-01

140

Parkinson's Disease: From Genetics to Clinical Practice  

PubMed Central

Breakthroughs in genetics over the last decade have radically advanced our understanding of the etiological basis of Parkinson's disease (PD). Although much research remains to be done, the main genetic causes of this neurodegenerative disorder are now partially unraveled, allowing us to feel more confident that our knowledge about the genetic architecture of PD will continue to increase exponentially. How and when these discoveries will be introduced into general clinical practice, however, remains uncertain. In this review, we provide a general summary of the progress in the genetics of PD and discuss how this knowledge will contribute to the diagnosis and clinical management of patients with, or at risk of this disorder. PMID:24532987

Clarimon, Jordi; Kulisevsky, Jaime

2013-01-01

141

Integrating Pain Management in Clinical Practice  

PubMed Central

There is much evidence to suggest that psychological and social issues are predictive of pain severity, emotional distress, work disability, and response to medical treatments among persons with chronic pain. Psychologists can play an important role in the identification of psychological and social dysfunction and in matching personal characteristics to effective interventions as part of a multidisciplinary approach to pain management, leading to a greater likelihood of treatment success. The assessment of different domains using semi-structured clinical interviews and standardized self-report measures permits identification of somatosensory, emotional, cognitive, behavioral and social issues in order to facilitate treatment planning. We briefly describe measures to assess constructs related to pain and intervention strategies for the behavioral treatment of chronic pain and discuss related psychiatric and substance abuse issues. Finally, we offer a future look at the role of integrating pain management in clinical practice in the psychological assessment and treatment for persons with chronic pain. PMID:22383018

Jamison, Robert N.; Edwards, Robert R.

2014-01-01

142

Improving the dependability of research in personality and social psychology: recommendations for research and educational practice.  

PubMed

In this article, the Society for Personality and Social Psychology (SPSP) Task Force on Publication and Research Practices offers a brief statistical primer and recommendations for improving the dependability of research. Recommendations for research practice include (a) describing and addressing the choice of N (sample size) and consequent issues of statistical power, (b) reporting effect sizes and 95% confidence intervals (CIs), (c) avoiding "questionable research practices" that can inflate the probability of Type I error, (d) making available research materials necessary to replicate reported results, (e) adhering to SPSP's data sharing policy, (f) encouraging publication of high-quality replication studies, and (g) maintaining flexibility and openness to alternative standards and methods. Recommendations for educational practice include (a) encouraging a culture of "getting it right," (b) teaching and encouraging transparency of data reporting, (c) improving methodological instruction, and (d) modeling sound science and supporting junior researchers who seek to "get it right." PMID:24214149

Funder, David C; Levine, John M; Mackie, Diane M; Morf, Carolyn C; Sansone, Carol; Vazire, Simine; West, Stephen G

2014-02-01

143

UVA SOM Recommended Steps for Successful Institutional Recovery from Industry Sponsored Clinical Trials  

E-print Network

Trials 1) Contract/Budget Negotiations a. Whether you are new to the clinical trials process or a seasoned veteran, please check with the budget coordinator in the SOM Clinical Trials Office for guidanceUVA SOM Recommended Steps for Successful Institutional Recovery from Industry Sponsored Clinical

Acton, Scott

144

Evaluation of clinical pharmacist recommendations in the geriatric ward of a Belgian university hospital  

PubMed Central

Objective To evaluate the type, acceptance rate, and clinical relevance of clinical pharmacist recommendations at the geriatric ward of the Ghent university hospital. Methods The clinical pharmacist evaluated drug use during a weekly 2-hour visit for a period of 4 months and, if needed, made recommendations to the prescribing physician. The recommendations were classified according to type, acceptance by the physician, prescribed medication, and underlying drug-related problem. Appropriateness of prescribing was assessed using the Medication Appropriateness Index (MAI) before and after the recommendations were made. Two clinical pharmacologists and two clinical pharmacists independently and retrospectively evaluated the clinical relevance of the recommendations and rated their own acceptance of them. Results The clinical pharmacist recommended 304 drug therapy changes for 100 patients taking a total of 1137 drugs. The most common underlying drug-related problems concerned incorrect dose, drug–drug interaction, and adverse drug reaction, which appeared most frequently for cardiovascular drugs, drugs for the central nervous system, and drugs for the gastrointestinal tract. The most common type of recommendation concerned adapting the dose, and stopping or changing a drug. In total, 59.7% of the recommendations were accepted by the treating physician. The acceptance rate by the evaluators ranged between 92.4% and 97.0%. The mean clinical relevance of the recommendations was assessed as possibly important (53.4%), possibly low relevance (38.1%), and possibly very important (4.2%). A low interrater agreement concerning clinical relevance between the evaluators was found: kappa values ranged between 0.15 and 0.25. Summated MAI scores significantly improved after the pharmacist recommendations, with mean values decreasing from 9.3 to 6.2 (P < 0.001). Conclusion In this study, the clinical pharmacist identified a high number of potential drug-related problems in older patients; however, the acceptance of the pharmacotherapy recommendations by the treating physician was lower than by a panel of evaluators. This panel, however, rated most recommendations as possibly important and as possibly having low relevance, with low interrater reliability. As the appropriateness of prescribing seemed to improve with decreased MAI scores, clinical pharmacy services may contribute to the optimization of drug therapy in older inpatients. PMID:23807844

Somers, Annemie; Robays, Hugo; De Paepe, Peter; Van Maele, Georges; Perehudoff, Katrina; Petrovic, Mirko

2013-01-01

145

Clinical practice: Helicobacter pylori infection in childhood.  

PubMed

Helicobacter pylori infection is recognised as a cause of gastritis and peptic ulcer disease (PUD) and usually acquired during the first years of life. While there is a decline in the prevalence of H. pylori infection in northern and western European countries, the infection is still common in southern and eastern parts of Europe and Asia. Symptoms of H. pylori-related PUD are nonspecific in children and may include epigastric pain, nausea and/or vomiting, anorexia, iron deficiency anaemia and hematemesis. Besides, only a small proportion of children develop symptoms and clinically relevant gastrointestinal disease. H. pylori infection can be diagnosed either by invasive tests requiring endoscopy and biopsy or non-invasive tests including the (13)C-urea breath test, detection of H. pylori antigen in stool and detection of antibodies in serum, urine and saliva. The aim of treatment is at least 90 % eradication rate of the bacteria, and a combination of two antibiotics plus a proton pump inhibitor has been recommended as first-line treatment. However, frequent use of antibiotics during childhood is associated with a decline in eradication rates and the search for new treatment strategies as well. This is an overview of the latest knowledge and evidence-based guidelines regarding clinical presentation, diagnosis and treatment of H. pylori infection in childhood. PMID:23015042

Ertem, Deniz

2013-11-01

146

Single case experimental design and empirical clinical practice  

Microsoft Academic Search

Research in clinical psychology is done infrequently by the practicing clinician. A major reason for this seems to be inadequate or cumbersome research tools that are incompatible with clinical realities and assumptions. Time series experimentation is explored as a possible research tool available to clinical practice. Standards of good clinical decision making seem to parallel closely the logic of time

Steven C. Hayes

1981-01-01

147

How updating textual clinical practice guidelines impacts clinical decision support systems: a case study with bladder cancer management.  

PubMed

Guideline-based clinical decision support systems (CDSSs) can be effective in increasing physician compliance with recommendations. However, the ever growing pace at which medical knowledge is produced requires that clinical practice guidelines (CPGs) be updated regularly. It is therefore mandatory that CDSSs be revised accordingly. The French Association for Urology publishes CPGs on bladder cancer management every 2 years. We studied the impact of the 2004 revision of these guidelines, with respect to the 2002 version with a CDSS, UroDoc. We proposed a typology of knowledge base modifications resulting from the update of CPGs making the difference between practice, clinical conditions and recommendations refinement as opposed to new practice and new recommendations. The number of formalized recommendations increased from 577 in 2002 to 1,081 in 2004. We evaluated the two versions of UroDoc on a randomized sample of patient records. A single new practice that modifies a decision taken in 49% of all recorded decisions leads to a fall from 67% to 46% of the compliance rate of decisions. PMID:17911832

Bouaud, Jacques; Séroussi, Brigitte; Brizon, Ambre; Culty, Thibault; Mentré, France; Ravery, Vincent

2007-01-01

148

[FEES in the stroke unit: recommendations for implementation in the clinical routine].  

PubMed

Dysphagia occurs in about 50 % of patients with acute stroke, is strongly related to early complications, such as aspiration pneumonia and is a major cause of increased morbidity and mortality in acute stroke. Flexible endoscopic evaluation of swallowing (FEES) has proven to be an easy to use, non-invasive tool for assessment of dysphagia in acute stroke, significantly adding accuracy to the clinical evaluation of dysphagia. With respect to the growing use of FEES in German stroke units this article summarizes recommendations for implementation and execution.A 3-step process is recommended to acquire the relevant knowledge and skills for carrying out FEES. After a systematic training (first step), swallowing endoscopy should be done under close supervision (second step) which is then followed by independent practice coupled with indirect supervision (third step). In principle, FEES should adopt a team approach involving both neurologists and speech language pathologists (SLP) or alternatively speech therapists. The allocation of responsibilities between these two professions should be kept flexible and should be adjusted to the individual level of education. Reducing the role of the SLP to mere assistance work in particular should be avoided. To enhance interprofessional communication and to allow for a smooth and efficient workflow, endoscopic grading of stroke-related dysphagia should adopt a standardized score that also includes protective and rehabilitative measures as well as nutritional recommendations. A major task for the future is to develop an educational curriculum for FEES that takes the specific needs of stroke unit care into account and is applicable to both physicians and SLPs. PMID:23695003

Dziewas, R; Busse, O; Glahn, J; Grond, M; Hamann, G F; Ickenstein, G W; Nabavi, D G; Prosiegel, M; Schäbitz, W-R; Schellinger, P D; Stanschus, S

2013-06-01

149

EURRECA/WHO workshop report: 'Deriving Micronutrient Recommendations: Updating Best Practices'.  

PubMed

This paper describes the outcome of the workshop 'Deriving Micronutrient Recommendations: Updating Best Practices' which took place in Brussels in April 2012. The workshop was organised jointly by the European Micronutrient Recommendations Aligned (EURRECA) Network of Excellence and the World Health Organization (WHO) Regional Office for Europe. The delegates included, among others, representatives from nutrient recommendation setting bodies (NRSBs) across Europe. The current paper focuses on the gaps and needs of NRSBs as identified by the workshop participants: (i) practical tools and best practices to adapt dietary reference values, (ii) comparable nationally representative food consumption data (including updated and complete food composition databases), (iii) adequate financial resources and technical capacity, (iv) independence and transparency in expert selection, research conduct and communication of research results and (v) clear correspondence of terminology used at national levels. PMID:23234881

van't Veer, Pieter; Heseker, Helmut; Grammatikaki, Evangelia; Benetou, Vassiliki; Gregori?, Matej; Margaritis, Irene; Raats, Monique M; Wijnhoven, Trudy

2013-01-01

150

The National Cancer Institute-American Society of Clinical Oncology Cancer Trial Accrual Symposium: Summary and Recommendations  

PubMed Central

Introduction: Many challenges to clinical trial accrual exist, resulting in studies with inadequate enrollment and potentially delaying answers to important scientific and clinical questions. Methods: The National Cancer Institute (NCI) and the American Society of Clinical Oncology (ASCO) cosponsored the Cancer Trial Accrual Symposium: Science and Solutions on April 29-30, 2010 to examine the state of accrual science related to patient/community, physician/provider, and site/organizational influences, and identify new interventions to facilitate clinical trial enrollment. The symposium featured breakout sessions, plenary sessions, and a poster session including 100 abstracts. Among the 358 attendees were clinical investigators, researchers of accrual strategies, research administrators, nurses, research coordinators, patient advocates, and educators. A bibliography of the accrual literature in these three major areas was provided to participants in advance of the meeting. After the symposium, the literature in these areas was revisited to determine if the symposium recommendations remained relevant within the context of the current literature. Results: Few rigorously conducted studies have tested interventions to address challenges to clinical trials accrual. Attendees developed recommendations for improving accrual and identified priority areas for future accrual research at the patient/community, physician/provider, and site/organizational levels. Current literature continues to support the symposium recommendations. Conclusions: A combination of approaches addressing both the multifactorial nature of accrual challenges and the characteristics of the target population may be needed to improve accrual to cancer clinical trials. Recommendations for best practices and for future research developed from the symposium are provided. PMID:24130252

Denicoff, Andrea M.; McCaskill-Stevens, Worta; Grubbs, Stephen S.; Bruinooge, Suanna S.; Comis, Robert L.; Devine, Peggy; Dilts, David M.; Duff, Michelle E.; Ford, Jean G.; Joffe, Steven; Schapira, Lidia; Weinfurt, Kevin P.; Michaels, Margo; Raghavan, Derek; Richmond, Ellen S.; Zon, Robin; Albrecht, Terrance L.; Bookman, Michael A.; Dowlati, Afshin; Enos, Rebecca A.; Fouad, Mona N.; Good, Marjorie; Hicks, William J.; Loehrer, Patrick J.; Lyss, Alan P.; Wolff, Steven N.; Wujcik, Debra M.; Meropol, Neal J.

2013-01-01

151

Nurses' intention to apply clinical practice guidelines.  

PubMed

Using Ajzen and Madden's Theory of Planned Behavior, this study investigates factors which influence nurses' intention to apply clinical practice guidelines in their daily ward work. A convenience sample of 91 nurses in internal medicine wards in three Israeli hospitals answered four questionnaires. Data were processed by Pearson correlation coefficients and multivariate regression. The main findings were that burnout was negatively correlated with the intention to work according to guidelines and that professionalism (in the sense of a tendency to follow taught procedure rather than personal judgment) was positively correlated with it. Furthermore, nurses who perceive their behavioral control and subjective norms to be positive will be the most determined to work according to guidelines, provided they personally command the necessary resources to do so. PMID:23447906

Kogan, Ella; Tabak, Nili

2012-12-01

152

Reboxetine in clinical practice: a review.  

PubMed

Reboxetine is a selective noradrenaline reuptake inhibitor (NaRI), the first drug of a new antidepressant class. Reboxetine has been approved for the treatment of Major Depression in many European countries, but the application for approval was rejected in the United States. It has been found useful in Narcolepsy, ADHD, Panic Attack Disorder, treatment of depression in patients with Parkinson' s Disease. Moreover reboxetine has been proposed as an effective and safe therapeutic option for Cocaine Dependence Disorder. Despite a large number of studies have documented that reboxetine was equally effective in treating major depressive illness compared to other antidepressants, recent reports argue reboxetine to be ineffective and potentially harmful for the treatment of acute depression. Aim of the present review is to summarize and discuss the last literature findings, comparing risks and benefits of reboxetine usage in everyday clinical practice. PMID:23007832

Sepede, G; Corbo, M; Fiori, F; Martinotti, G

2012-07-01

153

Professional Practice Plans: Recommendations from the 2005 Council of Faculties-Council of Deans Task Force  

PubMed Central

Objectives Determine the degree to which AACP member schools have established professional practice plans, characterize the nature of existing practice plans, and provide recommendations on the implementation of practice plans at AACP member schools. Design Survey of CEO Deans of AACP member institutions administered via online survey instrument. Results Sixty-five schools responded, with 29 (45%) indicating that they had an active practice plan in place. Fifty-two percent of those who do no have practice plans in place anticipate having plans established within three years. A variety of revenue sources are addressed by existing practice plans including sponsored research, patient care, educational activities and consulting. Conclusions Academic pharmacy lacks sophistication in regards to developing comprehensive professional practice plans. Colleges of pharmacy should consider differentiating plans that address monies collected from sponsored research vs. professional services. AACP should continue to monitor this topic as increasing participation by member schools is expected. PMID:17136167

Sorensen, Todd D.; Anderson, Wayne; Delafuente, Jeffrey C.; Diamond, Louis; Nappi, Jean; Pieper, John

2006-01-01

154

Glucose Biosensors: An Overview of Use in Clinical Practice  

PubMed Central

Blood glucose monitoring has been established as a valuable tool in the management of diabetes. Since maintaining normal blood glucose levels is recommended, a series of suitable glucose biosensors have been developed. During the last 50 years, glucose biosensor technology including point-of-care devices, continuous glucose monitoring systems and noninvasive glucose monitoring systems has been significantly improved. However, there continues to be several challenges related to the achievement of accurate and reliable glucose monitoring. Further technical improvements in glucose biosensors, standardization of the analytical goals for their performance, and continuously assessing and training lay users are required. This article reviews the brief history, basic principles, analytical performance, and the present status of glucose biosensors in the clinical practice. PMID:22399892

Yoo, Eun-Hyung; Lee, Soo-Youn

2010-01-01

155

[Clinical practice guidelines and knowledge management in healthcare].  

PubMed

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

Ollenschläger, Günter

2013-10-01

156

Clinical Understanding of Spasticity: Implications for Practice  

PubMed Central

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

2014-01-01

157

Clinical Procedure Page 1 of 2 Clinical Manual Nursing Practice Manual  

E-print Network

. Initiate transfusion. APPROVAL: Nursing Standards Committee Transfusion Committee Director of Transfusion Medicine #12;Clinical Procedure Page 2 of 2 Clinical Manual ­ Nursing Practice Manual John Dempsey Hospital

Oliver, Douglas L.

158

What is the quality of drug therapy clinical practice guidelines in Canada?  

Microsoft Academic Search

Background: The Canadian Medical Association maintains a national online data- base of clinical practice guidelines developed, endorsed or reviewed by Can- adian organizations within 5 years of the current date. This study was designed to identify and describe guidelines in the database that make recommendations related to the use of drug therapy, and to assess their quality using a standard-

Ian D. Graham; Susan Beardall; Anne O. Carter; Judith Glennie; Paul C. Hébert; Jacqueline M. Tetroe; Finlay A. McAlister; Silvia Visentin; Geoffrey M. Anderson

159

Clinical Practice Patterns of Canadian Couple/Marital/Family Therapists  

ERIC Educational Resources Information Center

This clinical practice pattern survey had two unique aspects. It was a national survey of American Association for Marriage and Family Therapy (AAMFT) members in Canada that included all AAMFT membership categories, including student, affiliate, associate, clinical, and supervisor. It compared practice pattern data for clinical members from Canada…

Beaton, John; Dienhart, Anna; Schmidt, Jonathan; Turner, Jean

2009-01-01

160

Kidney function and clinical recommendations of drug dose adjustment in geriatric patients  

PubMed Central

Background In elderly patients chronic kidney disease often limits drug prescription. As several equations for quick assessment of kidney function by estimating glomerular filtration rate (eGFR) and several different clinical recommendations for drug dose adjustment in renal failure are published, choosing the correct approach for drug dosage is difficult for the practitioner. The aims of our study were to quantify the agreement between eGFR-equations grouped by creatinine-based or cystatin C-based and within the groups of creatinine and cystatin C-based equations and to investigate whether use of various literature and online references results in different recommendations for drug dose adjustment in renal disease in very elderly primary care patients. Methods We included 108 primary care patients aged 80 years and older from 11 family practices into a cross-sectional study. GFR was estimated using two serum creatinine-based equations (Cockroft-Gault, MDRD) and three serum cystatin C-based equations (Grubb, Hoek, Perkins). Concordance between different equations was quantified using intraclass correlation coefficients (ICCs). Essential changes in drug doses or discontinuation of medication were documented and compared in terms of estimated renal function as a consequence of the different eGFR-equations using five references commonly used in the US, Great Britain and Germany. Results In general, creatinine-based equations resulted in lower eGFR-estimation and in higher necessity of drug dose adjustment than cystatin C-based equations. Concordance was high between creatinine-based equations alone (ICCs 0.87) and between cystatin C-based equations alone (ICCs 0.90 to 0.96), and moderate between creatinine-based equations and cystatin C-based equations (ICCs 0.54 to 0.76). When comparing the five different references consulted to identify necessary drug dose adjustments we found that the numbers of drugs that necessitate dose adjustment in the case of renal impairment differed considerably. The mean number of recommended changes in drug dosage ranged between 1.9 and 2.5 per patient depending on the chosen literature reference. Conclusions Our data suggest that the choice of the literature source might have even greater impact on drug management than the choice of the equation used to estimate GFR alone. Efforts should be deployed to standardize methods for estimating kidney function in geriatric patients and literature recommendations on drug dose adjustment in renal failure. PMID:24020893

2013-01-01

161

Prevention and Treatment of Postoperative Infections after Sinus Elevation Surgery: Clinical Consensus and Recommendations  

PubMed Central

Introduction. Maxillary sinus surgery is a reliable and predictable treatment option for the prosthetic rehabilitation of the atrophic maxilla. Nevertheless, these interventions are not riskless of postoperative complications with respect to implant positioning in pristine bone. Aim. The aim of this paper is to report the results of a clinical consensus of experts (periodontists, implantologists, maxillofacial surgeons, ENT, and microbiology specialists) on several clinical questions and to give clinical recommendations on how to prevent, diagnose, and treat postoperative infections. Materials and Methods. A panel of experts in different fields of dentistry and medicine, after having reviewed the available literature on the topic and taking into account their long-standing clinical experience, gave their response to a series of clinical questions and reached a consensus. Results and Conclusion. The incidence of postop infections is relatively low (2%–5.6%). A multidisciplinary approach is advisable. A list of clinical recommendation are given. PMID:22927851

Testori, Tiziano; Drago, Lorenzo; Wallace, Steven S.; Capelli, Matteo; Galli, Fabio; Zuffetti, Francesco; Parenti, Andrea; Deflorian, Matteo; Fumagalli, Luca; Weinstein, Roberto L.; Maiorana, Carlo; Di Stefano, Danilo; Valentini, Pascal; Giannì, Aldo B.; Chiapasco, Matteo; Vinci, Raffaele; Pignataro, Lorenzo; Mantovani, Mario; Torretta, Sara; Pipolo, Carlotta; Felisati, Giovanni; Padoan, Giovanni; Castelnuovo, Paolo; Mattina, Roberto; Del Fabbro, Massimo

2012-01-01

162

Access to Information and Instructional Technologies in Higher Education II: Practical Recommendations for Disability Service Providers  

ERIC Educational Resources Information Center

This is an applied companion to our empirical article elsewhere in this issue (Fichten et al., in press) on technological needs and concerns of Canadian junior/community college- and university-based disability service providers. Here, we provide highlights of our findings as well as timely, practical recommendations to disability service…

Asuncion, Jennison V.; Fichten, Catherine S.; Barile, Maria; Fossey, Myrtis E.; Robillard, Chantal

2004-01-01

163

SOLAR MAGNETIC TRACKING. I. SOFTWARE COMPARISON AND RECOMMENDED PRACTICES C. E. DeForest  

E-print Network

SOLAR MAGNETIC TRACKING. I. SOFTWARE COMPARISON AND RECOMMENDED PRACTICES C. E. DeForest Southwest Research Institute, 1050 Walnut Street, Suite 400, Boulder, CO 80302; deforest@boulder.swri.edu H. J & Deforest 2003) is intended to drive semi- empirical MHD models of the quiet Sun, and YAFTA (Welsch

DeForest, Craig

164

Appraisal of recommended respiratory infection control practices in primary care and emergency department  

Microsoft Academic Search

Background: The severe acute respiratory syndrome (SARS) epidemic and concern about pandemic influenza prompted the Cen- ters for Disease Control and Prevention (CDC) to develop guidelines to prevent the transmission of all respiratory infections in health care settings during first contact with a potentially infected person. The extent to which health care workers and institutions use these CDC recommended practices

Wayne Turnberg; William Daniell; Noah Seixas; Terri Simpson; Jude Van Buren; Edward Lipkin; Jeffery Duchin

165

Recommendations for Best Professional Practices in Fishing, Boating and Stewardship Education.  

ERIC Educational Resources Information Center

To implement its mission of increasing participation in fishing and boating and the stewardship of related resources, the Recreational Boating and Fishing Foundation solicited input from 11 experts in related fields. They identified 10 principles for education programs and recommended best practices in four educational areas: program planning,…

Fedler, Anthony J.; Matthews, Bruce E.

2001-01-01

166

Evidence-Based Practice Recommendations for Nutrition-Related Management of Children and Adults with Cystic Fibrosis and Pancreatic Insufficiency: Results of a Systematic Review  

Microsoft Academic Search

The Cystic Fibrosis Foundation established a process of systematic review of evidence to inform the development of clinical care guidelines and encourage evidence-based practice. The Subcommittee on Growth and Nutrition reviewed the evidence in two areas: energy intake and dosing for pancreatic enzyme replacement therapy. Evidence-based recommendations are presented here. Also, an ad hoc working group conducted a review of

Virginia A. Stallings; Lori J. Stark; Karen A. Robinson; Andrew P. Feranchak; Hebe Quinton

2008-01-01

167

Application of Recommended Design Practices for Conceptual Nuclear Fusion Space Propulsion Systems  

NASA Technical Reports Server (NTRS)

An AIAA Special Project Report was recently produced by AIAA's Nuclear and Future Flight Propulsion Technical Committee and is currently in peer review. The Report provides recommended design practices for conceptual engineering studies of nuclear fusion space propulsion systems. Discussion and recommendations are made on key topics including design reference missions, degree of technological extrapolation and concomitant risk, thoroughness in calculating mass properties (nominal mass properties, weight-growth contingency and propellant margins, and specific impulse), and thoroughness in calculating power generation and usage (power-flow, power contingencies, specific power). The report represents a general consensus of the nuclear fusion space propulsion system conceptual design community and proposes 15 recommendations. This paper expands on the Report by providing specific examples illustrating how to apply each of the recommendations.

Williams, Craig H.

2004-01-01

168

Recommended infection-control practices for dentistry, 1993. Centers for Disease Control and Prevention.  

PubMed

This document updates previously published CDC recommendations for infection-control practices in dentistry to reflect new data, materials, technology, and equipment. When implemented, these recommendations should reduce the risk of disease transmission in the dental environment, from patient to dental health-care worker (DHCW), from DHCW to patient, and from patient to patient. Based on principles of infection control, the document delineates specific recommendations related to vaccination of DHCWs; protective attire and barrier techniques; handwashing and care of hands; the use and care of sharp instruments and needles; sterilization or disinfection of instruments; cleaning and disinfection of the dental unit and environmental surfaces; disinfection and the dental laboratory; use and care of handpieces, antiretraction valves, and other intraoral dental devices attached to air and water lines of dental units; single-use disposable instruments; the handling of biopsy specimens; use of extracted teeth in dental educational settings; disposal of waste materials; and implementation of recommendations. PMID:8502212

1993-05-28

169

Have professional recommendations and consumer demand altered pediatric practice regarding child development?  

Microsoft Academic Search

Objective  Amid growing consumer demand and professional society recommendations for more information on early childhood development,\\u000a current practices of pediatricians in regard to children's development remain largely unknown. We investigate whether there\\u000a are differences in provider practices and satisfaction with regard to children's development (based on length of time in practice).\\u000a \\u000a \\u000a \\u000a Design  A self-reported survey was conducted of physicians at 30 pediatric

Cynthia Minkovitz; M. Bijoy Mathew; Donna Strobino

1998-01-01

170

Clinical practice: new challenges for the advanced practice nurse.  

PubMed

This report describes the challenges for advanced practice nurses (APNs) relative to supply and demand issues. The article also includes opportunities with the Balanced Budget Act, physician acceptance of Advanced Practice Nurses, and expanding practice opportunities. The challenges include the nursing shortage (both in nursing students and faculty), the aging of the nursing workforce, and a lag in nursing salaries; increased demand for nursing based on aging baby boomers, increasing patient acuity and technology, and new arenas for practice. The Balanced Budget Act of 1997 provided new opportunities for advanced practice nurses, including enhanced autonomy to provide services and bill independently of physicians. With these changes come new opportunities for advanced practice nurse entrepreneurs in the areas of independent practice, including opportunities to positively impact the health of families and communities in alignment with the Federal government's vision for "Healthy People 2010." As physician acceptance of advanced practice nurses continues to grow and in light of the changes in medical practice and education (residency reduction), opportunities to expand collaborative practice arrangements also exist. APNs are best suited to make the most of these changes. One example of an opportunity for independent practice, a Community Wellness Center, is developed as an entrepreneurial venture benefiting both the APN and the health of a community. Who better than registered nurses (RNs), especially those practicing at the advanced level, can ensure that these opportunities and challenges are addressed in an ethical manner and focused on the needs and health of the community? PMID:12029667

Bartel, J C; Buturusis, B

2000-12-01

171

Clinical Decision Support Systems for the Practice of Evidence-based Medicine  

Microsoft Academic Search

BackgroundThe use of clinical decision support systems to facilitate the practice of evidence-based medicine promises to substantially improve health care quality.ObjectiveTo describe, on the basis of the proceedings of the Evidence and Decision Support track at the 2000 AMIA Spring Symposium, the research and policy challenges for capturing research and practice-based evidence in machine-interpretable repositories, and to present recommendations for

Ida Sim; Paul Gorman; Robert A Greenes; R Brian Haynes; Bonnie Kaplan; Harold Lehmann; Paul C Tang

2001-01-01

172

Recommended Screening and Preventive Practices for Long-term Survivors after Hematopoietic Cell Transplantation  

PubMed Central

Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (e.g. umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri- and post-transplant exposures and risk-factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplant experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT. PMID:22446607

Majhail, Navneet S; Rizzo, J Douglas; Lee, Stephanie J; Aljurf, Mahmoud; Atsuta, Yoshiko; Bonfim, Carmem; Burns, Linda J; Chaudhri, Naeem; Davies, Stella; Okamoto, Shinichiro; Seber, Adriana; Socie, Gerard; Szer, Jeff; Lint, Maria Teresa Van; Wingard, John R; Tichelli, Andre

2011-01-01

173

Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation  

PubMed Central

Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (e.g. umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, periand post-transplant exposures and risk-factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplant experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT. PMID:23049402

Majhail, Navneet Singh; Rizzo, James Douglas; Lee, Stephanie Joi; Aljurf, Mahmoud; Atsuta, Yoshiko; Bonfim, Carmem; Burns, Linda Jean; Chaudhri, Naeem; Davies, Stella; Okamoto, Shinichiro; Seber, Adriana; Socie, Gerard; Szer, Jeff; Lint, Maria Teresa Van; Wingard, John Reid; Tichelli, Andre

2012-01-01

174

Recommended Screening and Preventive Practices for Long-term Survivors after Hematopoietic Cell Transplantation  

PubMed Central

Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (e.g. umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri- and post-transplant exposures and risk-factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplant experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT. PMID:22178693

Majhail, Navneet S; Rizzo, J Douglas; Lee, Stephanie J; Aljurf, Mahmoud; Atsuta, Yoshiko; Bonfim, Carmem; Burns, Linda J; Chaudhri, Naeem; Davies, Stella; Okamoto, Shinichiro; Seber, Adriana; Socie, Gerard; Szer, Jeff; Lint, Maria Teresa Van; Wingard, John R; Tichelli, Andre

2011-01-01

175

Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations  

PubMed Central

Background Although antineoplastic agents are critical in the treatment of cancer, they can potentially cause hypersensitivity reactions that can have serious consequences. When such a reaction occurs, clinicians can either continue the treatment, at the risk of causing a severe or a potentially fatal anaphylactic reaction, or stop the treatment, although it might be the only one available. The objective of the present work was to evaluate the effectiveness of methods used to prevent and treat hypersensitivity reactions to platinum- or taxane-based chemotherapy and to develop evidence-based recommendations. Methods The scientific literature published to December 2013, inclusive, was reviewed. Results Premedication with antihistamines, H2 blockers, and corticosteroids is not effective in preventing hypersensitivity reactions to platinum salts. However, premedication significantly reduces the incidence of hypersensitivity to taxanes. A skin test can generally be performed to screen for patients at risk of developing a severe reaction to platinum salts in the presence of grade 1 or 2 reactions, but skin testing does not appear to be useful for taxanes. A desensitization protocol allows for re-administration of either platinum- or taxane-based chemotherapy to some patients without causing severe hypersensitivity reactions. Conclusions Several strategies such as premedication, skin testing, and desensitization protocols are available to potentially allow for administration of platinum- or taxane-based chemotherapy to patients who have had a hypersensitivity reaction and for whom no other treatment options are available. Considering the available evidence, the Comité de l’évolution des pratiques en oncologie made recommendations for clinical practice in Quebec. PMID:25089112

Boulanger, J.; Boursiquot, J.N.; Cournoyer, G.; Lemieux, J.; Masse, M.S.; Almanric, K.; Guay, M.P.

2014-01-01

176

An Electronic Protocol for Translation of Research Results to Clinical Practice: A Preliminary Report  

PubMed Central

Introduction We evaluated the feasibility of using an electronic protocol developed for research use (Research-eProtocol-insulin) for blood glucose management in usual intensive care unit clinical practice. Methods We implemented the rules of Research-eProtocol-insulin in the electronic medical record of the Intermountain Healthcare hospital system (Clinical-eProtocol-insulin) for use in usual clinical practice. We evaluated the performance of Clinical-eProtocol-insulin rules in the intensive care units of seven Intermountain Healthcare hospitals and compared this performance with the performance of Research-eProtocol-insulin at the LDS Hospital Shock/Trauma/Respiratory Intensive Care Unit. Results Clinician (nurse or physician) compliance with computerized protocol recommendations was 95% (of 21,325 recommendations) with Research-eProtocol-insulin and 92% (of 109,458 recommendations) with Clinical-eProtocol-insulin. The blood glucose distribution in clinical practice (Clinical-eProtocol-insulin) was similar to the research use distribution (Research-eProtocol-insulin); however, the mean values (119 mg/dl vs 113 mg/dl) were statistically different (P = 0.0001). Hypoglycemia rates in the research and practice settings did not differ: the percentage of measurements ?40 mg/dl (0.11% vs 0.1%, P = 0.65) and the percentage of patients with at least one blood glucose ?40 mg/dl (4.2% vs 3%, P = 0.23) were not statistically significantly different. Conclusion Our electronic blood glucose protocol enabled translation of a research decision-support tool (Research-eProtocol-insulin) to usual clinical practice (Clinical-eProtocol-insulin). PMID:19885263

Morris, Alan H.; Orme, James; Rocha, Beatriz H.; Holmen, John; Clemmer, Terry; Nelson, Nancy; Allen, Jode; Jephson, Al; Sorenson, Dean; Sward, Kathy; Warner, Homer

2008-01-01

177

Korean clinical practice guidelines: otitis media in children.  

PubMed

Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media. PMID:22876048

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

2012-08-01

178

Korean Clinical Practice Guidelines: Otitis Media in Children  

PubMed Central

Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media. PMID:22876048

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

2012-01-01

179

Clinical practice guidelines in the nursing home.  

PubMed

Clinical practice guidelines are an important tool for improving quality of care. This study determined whether and how guidelines are being used in nursing homes. We surveyed staff at 36 Department of Veterans Affairs (VA) nursing homes. Employees were asked whether they were familiar with guidelines as well as whether 5 specific guidelines had been read, were available, and had been adopted. Among 1065 respondents (60% of those surveyed), 79% reported familiarity with guidelines. The proportion of staff at a facility reporting adoption was generally less than 50%. Those nursing homes in which a high percentage of the staff reported adoption of one guideline were more likely to have adopted other guidelines. However, staff were not more likely to report adoption of a specific guideline when the nurse manager stated that it was adopted. We conclude that staff at VA nursing homes are familiar with guidelines. Guideline adoption at individual nursing homes, however, is not a systematic process involving the entire staff. PMID:11816849

Berlowitz, D R; Young, G J; Hickey, E C; Joseph, J; Anderson, J J; Ash, A S; Moskowitz, M A

2001-01-01

180

Using Evidence-Based Principles in Clinical Practice  

E-print Network

To help students better understand how to use evidence-based principles in clinical practice, Prof. Storkel is revising her SPLH 880 course so that students can access evidence from clinical research and apply it to specific ...

Storkel, Holly Lynn

2004-01-01

181

Including Clinical Trials in Your Practice | accrualnet.cancer.gov  

Cancer.gov

This resource is a Web-based course for healthcare providers who are interested in becoming clinical trials investigators and incorporating cancer clinical trials into their practices. A certificate of completion is offered at the end of the course.

182

Clinical Procedure Page 1 of 5 Clinical Manual Nursing Practice Manual  

E-print Network

Clinical Procedure Page 1 of 5 Clinical Manual ­ Nursing Practice Manual John Dempsey Hospital according to this standard. #12;Clinical Procedure Page 2 of 5 Clinical Manual ­ Nursing Practice Manual ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: Blood Components

Oliver, Douglas L.

183

Clinical Procedure Page 1 of 2 Clinical Manual -Nursing Practice Manual  

E-print Network

Clinical Procedure Page 1 of 2 Clinical Manual - Nursing Practice Manual John Dempsey Hospital receipt. The receipt must be signed by a nurse or other licensed practitioner and a Proof of Use sheet;Clinical Procedure Page 2 of 2 Clinical Manual - Nursing Practice Manual John Dempsey Hospital ­ Department

Oliver, Douglas L.

184

Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations  

PubMed Central

OBJECTIVES: Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. METHODS: We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. RESULTS: Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p?=?0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p?=?0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p?=?0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p?=?0.002; OR: 0.98; 95% CI: 0.96-0.99). CONCLUSIONS: Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.

Marques, Andre C; Calderaro, Daniela; Yu, Pai C; Gualandro, Danielle M; Carmo, Gabriel A L; Azevedo, Fernanda R; Pastana, Adriana F; Lima, Eneas M O; Monachini, Maristela; Caramelli, Bruno

2014-01-01

185

Photodynamic Therapy: Occupational Hazards and Preventative Recommendations for Clinical Administration by Healthcare Providers  

PubMed Central

Abstract Objective: Photodynamic therapy (PDT) as a medical treatment for cancers is an increasing practice in clinical settings, as new photosensitizing chemicals and light source technologies are developed and applied. PDT involves dosing patients with photosensitizing drugs, and then exposing them to light using a directed energy device in order to manifest a therapeutic effect. Healthcare professionals providing PDT should be aware of potential occupational health and safety hazards posed by these treatment devices and photosensitizing agents administered to patients. Materials and methods: Here we outline and identify pertinent health and safety considerations to be taken by healthcare staff during PDT procedures. Results: Physical hazards (for example, non-ionizing radiation generated by the light-emitting device, with potential for skin and eye exposure) and chemical hazards (including the photosensitizing agents administered to patients that have the potential for exposure via skin, subcutaneous, ingestion, or inhalation routes) must be considered for safe use of PDT by the healthcare professional. Conclusions: Engineering, administrative, and personal protective equipment controls are recommendations for the safe use and handling of PDT agents and light-emitting technologies. PMID:23859750

Lacey, Steven E.; Vesper, Benjamin J.; Paradise, William A.; Radosevich, James A.; Colvard, Michael D.

2013-01-01

186

Clinician-patient communication: evidence-based recommendations to guide practice in cancer  

PubMed Central

Goals of Work To develop recommendations for effective communication between cancer health care providers and patients based on a systematic review of methods of clinician–patient communication that may affect patient outcomes associated with distress at critical points in the course of cancer care. Materials and Methods A systematic review of the literature was conducted, and evidence-based recommendations were formulated to guide clinician–patient communication in cancer care. A formal external review was conducted to validate the relevance of these recommendations. Main Results Recommendations for communication in cancer care are presented, based on guidelines from the Australian National Breast Cancer Centre and the Australian National Cancer Control Initiative,an updated systematic review of the research evidence, anda consensus by the Clinician–Patient Communications Working Panel of the Program in Evidence-Based Care of Cancer Care Ontario. The recommendations were sent to 110 Ontario practitioners for external review: 33 responded (30% response rate). Most of these respondents (87%) agreed with the draft recommendations and approved of their use as a practice guideline (90%). A condensed version of the recommendations, including 10 key points, was also created. Conclusions There is evidence to support general clinician–patient communication approaches, although the preferences of cancer patients regarding such communication exhibit individual and cultural variability. Recommendations are provided, based on evidence, the consensus of an expert panel, and feedback from a survey of external practitioners. Evidence evaluating the role of decision aids and strategies to facilitate better communication is inconsistent, although such tools may be of value for some patients. PMID:20016745

Rodin, G.; Zimmermann, C.; Mayer, C.; Howell, D.; Katz, M.; Sussman, J.; Mackay, J.A.; Brouwers, M.

2009-01-01

187

Family building using donated gametes and embryos in the UK: recommendations for policy and practice on behalf of the British Infertility Counselling Association and the British Fertility Society in collaboration with the Association of Clinical Embryologists and the Royal College of Nurses Fertility Nurses Forum.  

PubMed

The UK Department of Health's consultation on the future of the Human Fertilisation and Embryology Authority (HFEA) presented an opportunity to review current practice in relation to donor conception (DC) and make recommendations for improving services to those seeking fertility treatment, to families with donor conceived children and those of donors, and to those seeking later information. The year 2023 marks the start of post-2005 donor conceived adults having statutory access to identifying information about their donor(s); some adults with pre-2005 donors will have access sooner if the donor(s) re-registers as 'willing to be identified'. This paper examines current practice in UK licensed treatment centres in collecting and disseminating donor information and in supporting donors and prospective parents. Further, it considers current HFEA functions concerning DC including its responsibilities for the Register of Information and Donor Sibling Link and its approach to policy making, regulation and the release of information from these Registers to applicants. Proposals for how these functions could be carried out in the future are set out together with recommendations for national support and intermediary services. The key evidence available to support these recommendations is outlined. PMID:24329028

Wilde, Ruth; McTavish, Alison; Crawshaw, Marilyn

2014-03-01

188

Learning Styles of Radiography Students during Clinical Practice  

ERIC Educational Resources Information Center

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

Ward, L. Patrice

2009-01-01

189

Characteristics and Clinical Practices of Rural Marriage and Family Therapists  

ERIC Educational Resources Information Center

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

Morris, James

2007-01-01

190

Recommended Practice for Pressure Measurements and Calculation of Effective Pumping Speeds During Electric Propulsion Testing  

NASA Technical Reports Server (NTRS)

The electric propulsion community has been implored to establish and implement a set of universally applicable test standards during the research, development, and qualification of electric propulsion systems. Variability between facility-to-facility and more importantly ground-to-flight performance can result in large margins in application or aversion to mission infusion. Performance measurements and life testing under appropriate conditions can be costly and lengthy. Measurement practices must be consistent, accurate, and repeatable. Additionally, the measurements must be universally transportable across facilities throughout the development, qualification, spacecraft integration, and on-orbit performance. A recommended practice for making pressure measurements, pressure diagnostics, and calculating effective pumping speeds with justification is presented.

Dankanich, John W.; Walker, Mitchell; Swiatek, Michael W.; Yim, John T.

2013-01-01

191

Systematic Review of Clinical Practice Guidelines Related to Multiple Sclerosis  

PubMed Central

Background High quality clinical practice guidelines (CPGs) can provide clinicians with explicit recommendations on how to manage health conditions and bridge the gap between research and clinical practice. Unfortunately, the quality of CPGs for multiple sclerosis (MS) has not been evaluated. Objective To evaluate the methodological quality of CPGs on MS using the AGREE II instrument. Methods According to the inclusion and exclusion criteria, we searched four databases and two websites related to CPGs, including the Cochrane library, PubMed, EMBASE, DynaMed, the National Guideline Clearinghouse (NGC), and Chinese Biomedical Literature database (CBM). The searches were performed on September 20th 2013. All CPGs on MS were evaluated by the AGREE II instrument. The software used for analysis was SPSS 17.0. Results A total of 27 CPGs on MS met inclusion criteria. The overall agreement among reviews was good or substantial (ICC was above 0.70). The mean scores for each of all six domains were presented as follows: scope and purpose (mean ± SD: 59.05±16.13), stakeholder involvement (mean ± SD: 29.53±17.67), rigor of development (mean ± SD: 31.52±21.50), clarity of presentation (mean ± SD: 60.39±13.73), applicability (mean ± SD: 27.08±17.66), editorial independence (mean ± SD: 28.70±22.03). Conclusions The methodological quality of CPGs for MS was acceptable for scope, purpose and clarity of presentation. The developers of CPGs need to pay more attention to editorial independence, applicability, rigor of development and stakeholder involvement during the development process. The AGREE II instrument should be adopted by guideline developers. PMID:25302678

Guo, Jia; Cheng, Chuang; Yan, Weiping; Xu, Guanghui; Feng, Jinzhou; Wang, Tianzhu; Chen, Cindy Si; Qin, Xinyue

2014-01-01

192

International adaptations of NCCN Clinical Practice Guidelines in Oncology.  

PubMed

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) are evidence- and consensus-based clinical practice guidelines addressing malignancies that affect more than 97% of all patients with cancer in the United States. The NCCN Guidelines are used extensively in the United States and globally. Use of the guidelines outside the United States has driven the need to adapt the guidelines based on local, regional, or national resources. The NCCN Guidelines Panels created, vetted, and continually update the NCCN Guidelines based on published scientific data on cancer detection, diagnosis, and treatment efficacy. The guidelines are developed within the context of commonly available resources, methods of payment, societal and cultural expectations, and governmental regulations as they exist in the United States. Although many of the cancer management recommendations contained in the NCCN Guidelines apply broadly from a global perspective, not all do. Disparities in availability and access to health care exist among countries, within countries, and among different social groups in the same country, especially regarding resources for cancer prevention, early detection, and treatment. In addition, different drug approval and payment processes result in regional variation in availability of and access to cancer treatment, especially highly expensive agents and radiation therapy. Differences in cancer risk, predictive biomarker expression, and pharmacogenetics exist across ethnic and racial groups, and therefore across geographic locations. Cultural and societal expectations and requirements may also require modification of NCCN Guidelines for use outside the United States. This article describes the adaptation process, using the recent Latin American adaptation of the 2013 NCCN Guidelines for Colorectal Cancer as an example. PMID:24812133

Carlson, Robert W; Larsen, Jonathan K; McClure, Joan; Fitzgerald, C Lyn; Venook, Alan P; Benson, Al B; Anderson, Benjamin O

2014-05-01

193

Respecting Patient Autonomy in Clinical Genomics: New Recommendations on Incidental Findings Go Astray  

PubMed Central

In spite of the centrality of informed consent in clinical genetics and genomics, new recommendations from the American College of Medical Genetics and Genomics (ACMG) call for laboratories and clinicians to test for and report specific genetic incidental findings, even when the patient does not consent to the testing or disclosure and even when the patient is a child. PMID:23686341

Wolf, Susan M.; Annas, George J.; Elias, Sherman

2013-01-01

194

[Congress of European society of cardiology (amsterdam, 2013): new recommendations and most important clinical studies].  

PubMed

In this review we present short report on European Congress of Cardiology which took place in Amsterdam from August 3 to September 4, 2013. Four new European recommendations on the treatment of cardiovascular diseases are briefly characterized and reports of Hot Line and Clinical Trial Update scientific sessions are presented. PMID:25177890

Kanorski?, S G; Mamedov, M N

2014-01-01

195

District nurse clinics: accountability and practice.  

PubMed

The numbers of district nurse clinics are continuing to grow in primary care and they provide timely and more cost effective intervention for patients. The clinics provide exciting opportunities for district nurses but also carry an increased risk of exposure to liability. This article discusses some of the key areas of accountability underpinning the duty of care of district nurses working in nurse-led clinics. PMID:23370845

Griffith, Richard; Tengnah, Cassam

2013-02-01

196

Nursing students’opinions regarding the clinical practice guide  

Microsoft Academic Search

Clinic field experience provides the opportunities to nursing students to combine cognitive, psychomotor and affective skills, and problem-solving abilities.This study was definitively conducted to determine the opinions of nursing students regarding clinical practice guide.The universe and sampling of the study were made up of 79 students who were taking the Surgical Nursing Course.At the end of clinical practice,the students’opinions regarding

Nalan Özhan Elba?; Hülya Bulut; Sevil Güler Demir; Sevilay Yüceer

2010-01-01

197

INTERNATIONAL REPORT: Practical realization of the definition of the metre, including recommended radiations of other optical frequency standards (2003)  

NASA Astrophysics Data System (ADS)

In 2003, the International Committee for Weights and Measures (CIPM) recommended updated values of the frequency for certain optical frequency standards recommended for the practical realization of the definition of the metre. The text of this CIPM Recommendation and details of the updated radiations are given here. The complete updated set of recommended radiations, including frequencies, wavelengths, uncertainties and operating conditions where appropriate, is available on the BIPM website.

Felder, R.

2005-08-01

198

Child Diagnostic Assessment: Current Training Practices in Clinical Psychology Internships  

Microsoft Academic Search

We surveyed clinical psychology internships with particular regard to current practices in training child diagnostic assessment: proportion of interns’ time spent in child versus adult experiences, child assessment versus other types of child experiences, and didactic versus direct clinical experience. Information concerned the frequency of assessment experience with various age levels, types of clinical problems, and specific test instruments. We

Jean C. Elbert; E. Wayne Holden

1987-01-01

199

Clinical Practice and Epidemiology in Mental Health  

Microsoft Academic Search

Background: Adjustment Disorder is a condition strongly tied to acute and chronic stress. Despite clinical suggestion of a large prevalence in the general population and the high frequency of its diagnosis in the clinical settings, there has been relatively little research reported and, consequently, very few hints about its treatments. Methods: the authors gathered old and current information on the

Mauro Giovanni Carta; Matteo Balestrieri; Andrea Murru; Maria Carolina Hardoy

200

An official American Thoracic Society workshop report: developing performance measures from clinical practice guidelines.  

PubMed

Many health care performance measures are either not based on high-quality clinical evidence or not tightly linked to patient-centered outcomes, limiting their usefulness in quality improvement. In this report we summarize the proceedings of an American Thoracic Society workshop convened to address this problem by reviewing current approaches to performance measure development and creating a framework for developing high-quality performance measures by basing them directly on recommendations from well-constructed clinical practice guidelines. Workshop participants concluded that ideally performance measures addressing care processes should be linked to clinical practice guidelines that explicitly rate the quality of evidence and the strength of recommendations, such as the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. Under this framework, process-based performance measures would only be developed from strong recommendations based on high- or moderate-quality evidence. This approach would help ensure that clinical processes specified in performance measures are both of clear benefit to patients and supported by strong evidence. Although this approach may result in fewer performance measures, it would substantially increase the likelihood that quality-improvement programs based on these measures actually improve patient care. PMID:24828810

Kahn, Jeremy M; Gould, Michael K; Krishnan, Jerry A; Wilson, Kevin C; Au, David H; Cooke, Colin R; Douglas, Ivor S; Feemster, Laura C; Mularski, Richard A; Slatore, Christopher G; Wiener, Renda Soylemez

2014-05-01

201

inPractice: A Practical Nursing Package for Clinical Decisions  

ERIC Educational Resources Information Center

This paper examines the recent development of a computer-assisted learning program--in Practice--at the School of Health Science, in the University of Wales Swansea. The project, which began in 2001, was developed in close collaboration with The Meningitis Trust, the aim being to produce a software package to increase nursing students' knowledge…

Ip, Barry; Cavanna, Annlouise; Corbett, Beverley

2005-01-01

202

Schools as Clinics: Learning about Practice in Practice  

ERIC Educational Resources Information Center

The Neag School of Education at the University of Connecticut is committed to the intentionality of interweaving course work and practice in its 5-year teacher preparation program, the Integrated Bachelor's and Master's program. It offers a wide range of field experiences to teacher candidates. Teacher candidates enter the program at the…

Hands, Robin; Rong, Yuhang

2014-01-01

203

Enhancing reflective practice through online learning: impact on clinical practice  

Microsoft Academic Search

Purpose : Traditionally, radiographers and radiation therapists function in a workplace environment that is protocol- driven with limited functional autonomy. The workplace promotes a culture of conformity and discourages practitioners from reflective and critical thinking, essential attributes for continuing learning and advancing workplace practices. As part of the first author's doctoral study, a continuing professional development (CPD) educational framework was

J Sim; A Radloff

204

Good documentation practice in clinical research  

PubMed Central

One of the most common inspection findings in investigator site inspections is lack of reliable, accurate and adequate source documentation. This also happens to be the most common pitfall identified during sponsor audits. The importance of good documentation practice needs to be emphasized to investigator sites to ensure that the study results are built on the foundation of credible and valid data. This article focuses on the key principles of good documentation practice and offers suggestions for improvement. PMID:21731856

Bargaje, Chitra

2011-01-01

205

[Proposed recommendations for the practical use of internal quality controls (IQC) in a medical biology laboratory].  

PubMed

We propose a set of recommendations and practices to optimize the use of quality control of medical biology examinations. The fundamentals are reviewed: definition of a series of analysis, IQC at one or more level, Westgard alert rules and rejection, practical remedial actions to take for the technician, corrective and preventive actions to be implemented by the biologist. We have also formalized three flowcharts to guide the technician in their daily practice to ensure analytical quality of investigations carried out. These decision trees are the result of the experience submitted by an accredited and professional laboratory attentive to the ongoing improvement of IQC. This article can provide useful assistance to biologists for accreditation but also aims to foster collaboration reliable medical biology laboratory at the appropriate management of patients. PMID:21896419

Giannoli, Jean-Marc; Szymanowicz, Anton

2011-01-01

206

Conducting Record Review Studies in Clinical Practice  

PubMed Central

Clinical record review or chart review is a previously recorded data to answer clinical queries. Such a study can be used to answer specific clinical questions in a relatively easy and less resource intensive manner. But these studies may be constrained by the limited information retrievable and inadequacy of records. Various types of data sources may be available for conducting such reviews (like case charts, computerized registries, etc), each with specific strengths and weaknesses. The procedure usually consists of drawing up the research question, identifying the appropriate data source, devising a data extraction plan, extracting the data, checking for errors, data analysis, and appropriate archiving and dissemination of the findings. The ethical aspects in such studies primarily pertain to issues of informed consent and confidentiality. This paper provides a broad overview of how to go about a clinical record review, and serves as a ready reference for those who would like to undertake such record reviews. PMID:25386466

Seshadri, Divya

2014-01-01

207

Conducting record review studies in clinical practice.  

PubMed

Clinical record review or chart review is a previously recorded data to answer clinical queries. Such a study can be used to answer specific clinical questions in a relatively easy and less resource intensive manner. But these studies may be constrained by the limited information retrievable and inadequacy of records. Various types of data sources may be available for conducting such reviews (like case charts, computerized registries, etc), each with specific strengths and weaknesses. The procedure usually consists of drawing up the research question, identifying the appropriate data source, devising a data extraction plan, extracting the data, checking for errors, data analysis, and appropriate archiving and dissemination of the findings. The ethical aspects in such studies primarily pertain to issues of informed consent and confidentiality. This paper provides a broad overview of how to go about a clinical record review, and serves as a ready reference for those who would like to undertake such record reviews. PMID:25386466

Sarkar, Siddharth; Seshadri, Divya

2014-09-01

208

Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP).  

PubMed

Meningococcal disease describes the spectrum of infections caused by Neisseria meningiditis, including meningitdis, bacteremia, and bacteremic pneumonia. Two quadrivalent meningococcal polysaccharide-protein conjugate vaccines that provide protection against meningococcal serogroups A, C, W, and Y (MenACWY-D [Menactra, manufactured by Sanofi Pasteur, Inc., Swiftwater, Pennsylvania] and MenACWY-CRM [Menveo, manufactured by Novartis Vaccines, Cambridge, Massachusetts]) are licensed in the United States for use among persons aged 2 through 55 years. MenACWY-D also is licensed for use among infants and toddlers aged 9 through 23 months. Quadrivalent meningococcal polysaccharide vaccine (MPSV4 [Menommune, manufactured by sanofi pasteur, Inc., Swiftwater, Pennsylvania]) is the only vaccine licensed for use among persons aged ?56 years. A bivalent meningococcal polysaccharide protein conjugate vaccine that provides protection against meningococcal serogroups C and Y along with Haemophilus influenzae type b (Hib) (Hib-MenCY-TT [MenHibrix, manufactured by GlaxoSmithKline Biologicals, Rixensart, Belgium]) is licensed for use in children aged 6 weeks through 18 months. This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of meningococcal disease in the United States, specifically the changes in the recommendations published since 2005 (CDC. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2005;54 [No. RR-7]). As a comprehensive summary of previously published recommendations, this report does not contain any new recommendations; it is intended for use by clinicians as a resource. ACIP recommends routine vaccination with a quadrivalent meningococcal conjugate vaccine (MenACWY) for adolescents aged 11 or 12 years, with a booster dose at age 16 years. ACIP also recommends routine vaccination for persons at increased risk for meningococcal disease (i.e., persons who have persistent complement component deficiencies, persons who have anatomic or functional asplenia, microbiologists who routinely are exposed to isolates of N. meningitidis, military recruits, and persons who travel to or reside in areas in which meningococcal disease is hyperendemic or epidemic). Guidelines for antimicrobial chemoprophylaxis and for evaluation and management of suspected outbreaks of meningococcal disease also are provided. PMID:23515099

Cohn, Amanda C; MacNeil, Jessica R; Clark, Thomas A; Ortega-Sanchez, Ismael R; Briere, Elizabeth Z; Meissner, H Cody; Baker, Carol J; Messonnier, Nancy E

2013-03-22

209

Breast tomosynthesis in clinical practice: initial results  

Microsoft Academic Search

The purpose of this study was to assess the potential value of tomosynthesis in women with an abnormal screening mammogram\\u000a or with clinical symptoms. Mammography and tomosynthesis investigations of 513 woman with an abnormal screening mammogram\\u000a or with clinical symptoms were prospectively classified according to the ACR BI-RADS criteria. Sensitivity and specificity\\u000a of both techniques for the detection of cancer

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

2010-01-01

210

Update on Cystatin C: Incorporation Into Clinical Practice  

PubMed Central

Kidney function monitoring using creatinine-based GFR estimation is a routine part of clinical practice. Emerging evidence has shown that cystatin C may improve classification of GFR for defining chronic kidney disease (CKD) in certain clinical populations, and assist in understanding the complications of CKD. In this review and update, we summarize the overall literature on cystatin C, critically evaluate recent high-impact studies, highlight the role of cystatin C in recent kidney disease guidelines, and suggest a practical approach for clinicians to incorporate cystatin C into practice. We conclude by addressing frequently asked questions related to implementing cystatin C use in a clinical setting. PMID:23701892

Shlipak, Michael G.; Mattes, Monica D.; Peralta, Carmen A.

2013-01-01

211

Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009.  

PubMed

These recommendations from the Advisory Committee on Immunization Practices (ACIP) update the previous recommendations for anthrax vaccine adsorbed (AVA) (CDC. Use of anthrax vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2000;49:1-20; CDC. Use of anthrax vaccine in response to terrorism: supplemental recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2002;51:1024-6) and reflect the status of anthrax vaccine supplies in the United States. This statement 1) provides updated information on anthrax epidemiology; 2) summarizes the evidence regarding the effectiveness and efficacy, immunogenicity, and safety of AVA; 3) provides recommendations for pre-event and preexposure use of AVA; and 4) provides recommendations for postexposure use of AVA. In certain instances, recommendations that did not change were clarified. No new licensed anthrax vaccines are presented. Substantial changes to these recommendations include the following: 1) reducing the number of doses required to complete the pre-event and preexposure primary series from 6 doses to 5 doses, 2) recommending intramuscular rather than subcutaneous AVA administration for preexposure use, 3) recommending AVA as a component of postexposure prophylaxis in pregnant women exposed to aerosolized Bacillus anthracis spores, 4) providing guidance regarding preexposure vaccination of emergency and other responder organizations under the direction of an occupational health program, and 5) recommending 60 days of antimicrobial prophylaxis in conjunction with 3 doses of AVA for optimal protection of previously unvaccinated persons after exposure to aerosolized B. anthracis spores. PMID:20651644

Wright, Jennifer Gordon; Quinn, Conrad P; Shadomy, Sean; Messonnier, Nancy

2010-07-23

212

Alzheimer's Disease: A Clinical Practice-Oriented Review  

PubMed Central

Investigation in the field of Alzheimer’s disease (AD), the commonest cause of dementia, has been very active in recent years and it may be difficult for the clinician to keep up with all the innovations and to be aware of the implications they have in clinical practice. The authors, thus, reviewed recent literature on the theme in order to provide the clinician with an updated overview, intended to support decision-making on aspects of diagnosis and management. This article begins to focus on the concept of AD and on its pathogenesis. Afterward, epidemiology and non-genetic risk factors are approached. Genetics, including genetic risk factors and guidelines for genetic testing, are mentioned next. Recommendations for diagnosis of AD, including recently proposed criteria, are then reviewed. Data on the variants of AD is presented. First approach to the patient is dealt with next, followed by neuropsychological evaluation. Biomarkers, namely magnetic resonance imaging, single photon emission tomography, FDG PET, PiB PET, CSF tau, and A? analysis, as well as available data on their diagnostic accuracy, are also discussed. Factors predicting rate of disease progression are briefly mentioned. Finally, non-pharmacological and pharmacological treatments, including established and emerging drugs, are addressed. PMID:22529838

Alves, Luisa; Correia, Ana Sofia A.; Miguel, Rita; Alegria, Paulo; Bugalho, Paulo

2012-01-01

213

Hit Identification and Optimization in Virtual Screening: Practical Recommendations Based Upon a Critical Literature Analysis  

PubMed Central

A critical analysis of virtual screening results published between 2007 and 2011 was performed. The activity of reported hit compounds from over 400 studies was compared to their hit identification criteria. Hit rates and ligand efficiencies were calculated to assist in these analyses and the results were compared with factors such as the size of the virtual library and the number of compounds tested. A series of promiscuity, drug-like, and ADMET filters were applied to the reported hits to assess the quality of compounds reported and a careful analysis of a subset of the studies which presented hit optimization was performed. This data allowed us to make several practical recommendations with respect to selection of compounds for experimental testing, defining hit identification criteria, and general virtual screening hit criteria to allow for realistic hit optimization. A key recommendation is the use of size-targeted ligand efficiency values as hit identification criteria. PMID:23688234

Zhu, Tian; Cao, Shuyi; Su, Pin-Chih; Patel, Ram; Shah, Darshan; Chokshi, Heta B.; Szukala, Richard; Johnson, Michael E.; Hevener, Kirk E.

2013-01-01

214

Prophylaxis and treatment of GVHD: EBMT-ELN working group recommendations for a standardized practice.  

PubMed

GVHD remains the major impediment to broader application of allogeneic haematopoietic SCT. It can be prevented completely, but at the expense of other complications, rejection, relapse or delayed immune reconstitution. No optimal prevention or treatment method has been defined. This is reflected by enormous heterogeneity in approaches in Europe. Retrospective comparisons between different policies, although warranted, do not give definite answers. In order to improve the present situation, an European Group for Blood and Marrow Transplantation and the European LeukemiaNet working group has developed in a Delphi-like approach recommendations for prophylaxis and treatment of GVHD in the most common allogeneic transplant setting, transplantation from an HLA-identical sibling or unrelated donor for standard risk malignant disease. The working group proposes these guidelines to be adopted as routine standard in transplantation centres and to be used as comparator in systematic studies evaluating the advantages and disadvantages of practices differing from these recommendations. PMID:23892326

Ruutu, T; Gratwohl, A; de Witte, T; Afanasyev, B; Apperley, J; Bacigalupo, A; Dazzi, F; Dreger, P; Duarte, R; Finke, J; Garderet, L; Greinix, H; Holler, E; Kröger, N; Lawitschka, A; Mohty, M; Nagler, A; Passweg, J; Ringdén, O; Socié, G; Sierra, J; Sureda, A; Wiktor-Jedrzejczak, W; Madrigal, A; Niederwieser, D

2014-02-01

215

Topical anesthesia in neonates: clinical practices and practical considerations.  

PubMed

During the past two decades there has been a substantial increase in the number and types of topical anesthetics available. Options for the prevention of neonatal pain associated with skin-breaking procedures were previously limited to injections of lidocaine hydrochloride. Topical anesthetics are now available as creams, gels, and a heat-activated patch system. Although lidocaine injection continues to be widely used for pain associated with circumcision, lumbar puncture, or placement of central venous lines, practical information regarding the use of newer agents in the neonate is needed. This review seeks to expand the options for topical anesthesia in neonates. PMID:17905188

Lehr, Victoria Tutag; Taddio, Anna

2007-10-01

216

Critical care outreach: the need for effective decision-making in clinical practice (part 2).  

PubMed

As the extension of nursing into roles previously within the domain of medicine and the demand for evidence based practice continue to increase, the quality of decision making becomes imperative. Making accurate decisions is essential, both for the practitioner and for the patient, especially in the provision of critical care outreach (CCOR), to improve outcomes of care. With changes in health care delivery and increased accountability for practitioners' decisions, it is important to understand more about how clinical decisions are made and what factors influence them in order to inform practice. The previous paper outlined the theoretical background of clinical decision making and the knowledge that underpins practice in CCOR. In this paper, the authors, a Nurse Consultant in CCOR and a research fellow, examine the process of a practitioner's decision making in the practice of CCOR, through a collaborative reflective account of a case study. From this, recommendations are made about the future development of CCOR practitioners and services. PMID:16949288

Hancock, Helen C; Durham, Lesley

2007-04-01

217

Repeat analysis and incurred sample reanalysis: recommendation for best practices and harmonization from the global bioanalysis consortium harmonization team.  

PubMed

The A7 harmonization team (A7 HT), a part of the Global Bioanalysis Consortium (GBC), focused on reviewing best practices for repeat analysis and incurred sample reanalysis (ISR) as applied during regulated bioanalysis. With international representation from Europe, Latin America, North America, and the Asia Pacific region, the team first collated common practices and guidance recommendations and assessed their suitability from both a scientific and logistical perspective. Subsequently, team members developed best practice recommendations and refined them through discussions and presentations with industry experts at scientific meetings. This review summarizes the team findings and best practice recommendations. The few topics where no consensus could be reached are also discussed. The A7 HT recommendations, together with those from the other GBC teams, provide the basis for future international harmonization of regulated bioanalytical practices. PMID:25135836

Fluhler, Eric; Vazvaei, Faye; Singhal, Puran; Vinck, Petra; Li, Wenkui; Bhatt, Jignesh; de Boer, Theo; Chaudhary, Ajai; Tangiuchi, Masahiro; Rezende, Vinicius; Zhong, Dafang

2014-11-01

218

Implications of Look AHEAD for clinical trials and clinical practice.  

PubMed

Look AHEAD (Action for Health in Diabetes) was a randomized clinical trial designed to examine the long-term health effects of weight loss in overweight and obese individuals with type 2 diabetes. The primary result was that the incidence of cardiovascular events over a median follow-up of 9.6 years was not reduced in the Intensive Lifestyle Group relative to the control group. This finding is discussed, with emphasis on its implications for design of trials and clinical treatment of obese persons with type 2 diabetes. PMID:24853636

Wing, R R

2014-12-01

219

Ministry of Health clinical practice guidelines: Management of Rhinosinusitis and Allergic Rhinitis.  

PubMed

The Ministry of Health publishes national clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the Ministry of Health clinical practice guidelines on Management of Rhinosinusitis and Allergic Rhinitis, for the information of readers of the Singapore Medical Journal. Chapters, page and figure numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=24046). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:20428739

Siow, J K; Alshaikh, N A; Balakrishnan, A; Chan, K O; Chao, S S; Goh, L G; Hwang, S Y; Lee, C Y; Leong, J L; Lim, L; Menon, A; Sethi, D S; Tan, H; Wang, D Y

2010-03-01

220

Practicing nurses perspectives of clinical scholarship: a qualitative study  

PubMed Central

Background There is a scarcity of research published on clinical scholarship. Much of the conceptualisation has been conducted in the academy. Nurse academics espouse that the practice of nursing must be built within a framework of clinical scholarship. A key concept of clinical scholarship emerging from discussions in the literature is that it is an essential component of enabling evidence–based nursing and the development of best practice standards to provide for the needs of patients/clients. However, there is no comprehensive definition of clinical scholarship from the practicing nurses. The aim of this study was to contribute to this definitional discussion on the nature of clinical scholarship in nursing. Methods Naturalistic inquiry informed the method. Using an interpretative approach 18 practicing nurses from Australia, Canada and England were interviewed using a semi-structured format. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories and the components of clinical scholarship described by the participants compared to the scholarship framework of Boyer [JHEOE 7:5-18, 2010]. Results Clinical scholarship is difficult to conceptualise. Two of the essential elements of clinical scholarship are vision and passion. The other components of clinical scholarship were building and disseminating nursing knowledge, sharing knowledge, linking academic research to practice and doing practice-based research. Conclusion Academic scholarship dominated the discourse in nursing. However, in order for nursing to develop and to impact on health care, clinical scholarship needs to be explored and theorised. Nurse educators, hospital-based researchers and health organisations need to work together with academics to achieve this goal. Frameworks of scholarship conceptualised by nurse academics are reflected in the findings of this study with their emphasis on reading and doing research and translating it into nursing practice. This needs to be done in a nonthreatening environment. PMID:24066801

2013-01-01

221

Clinical Scientists Improving Clinical Practices: In Thoughts and Actions  

ERIC Educational Resources Information Center

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

Apel, Kenn

2014-01-01

222

Pharmacy Administration and Clinical Practice Research Agenda.  

ERIC Educational Resources Information Center

Research needs for pharmacy administration and clinical pharmacy include study of the relationship of pharmacists and society, management methods for providing health care services, pharmacist training and socialization, competence evaluation, formative and summative research on drug use control, and organizational decision making. (MSE)

Hepler, Charles D.

1987-01-01

223

Mental Training with Youth Sport Teams: Developmental Considerations & Best Practice Recommendations  

PubMed Central

Working with youth athletes requires knowledge of the inherent variability in child and adolescent development that will impact the implementation of a mental training program. The purpose of this paper is to provide an overview of developmental considerations that should be noted when doing mental training, particularly for athletes participating in sport at mid-childhood, early adolescence, and mid-adolescence. Gender differences at these stages of development are also highlighted. Additionally, we forward best practice recommendations and learning-activities that have been tailored for each developmental stage that can be used in the provision of a mental training program in a team setting. PMID:24273682

Visek, Amanda J.; Harris, Brandonn; Blom, Lindsey C.

2013-01-01

224

An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide.  

PubMed

We provide comprehensive, practical guidance for physicians on when to offer, recommend, perform, and refer patients for induced abortion and feticide. We precisely define terminology and articulate an ethical framework based on respecting the autonomy of the pregnant woman, the fetus as a patient, and the individual conscience of the physician. We elucidate autonomy-based and beneficence-based obligations and distinguish professional conscience from individual conscience. The obstetrician's role should be based primarily on professional conscience, which is shaped by autonomy-based and beneficence-based obligations of the obstetrician to the pregnant and fetal patients, with important but limited constraints originating in individual conscience. PMID:19762005

Chervenak, Frank A; McCullough, Laurence B

2009-12-01

225

Hernia Surgery: From Guidelines to Clinical Practice  

PubMed Central

INTRODUCTION Over the last 30 years, hernia surgery has developed into an evidence-based practice assisted by the development of guidelines. MATERIALS AND METHODS Prior to 1993, best practice in the UK was a nylon darn repair under general anaesthesia as an in-patient with prolonged recovery. The publication of The Royal College of Surgeons of England (RCSE) Guidelines on Groin Hernia Repair stimulated debate and coincided with the introduction of mesh hernioplasty and laparoscopic techniques. Further evolution of hernia management has occurred to enable the production of the European Hernia Society (EHS) guidelines in 2008. RESULTS The EHS guidelines cover all aspects of abdominal wall surgery including: indications for operation; investigations; organising surgical care; techniques; local anaesthesia; after-care, complications and outcome; and information for patients. CONCLUSIONS Surgeons have many choices when selecting an appropriate hernia operation for an individual patient. The EHS guidelines provide a basis for this decision-making. PMID:19416585

Kingsnorth, Andrew N

2009-01-01

226

Issues in Clinical Practice With Sex Offenders  

Microsoft Academic Search

Various issues are considered in terms of their empirical support and practical utility. DSM-III-R diagnostic criteria seem inappropriate and are largely ignored by researchers; revisions are clearly needed. Assessments of sex offenders characteristically cover cognitions, social difficulties, life-style problems, and sexual deviances. The first three of these areas have generated limited research to date and there is need to expand

W. L. MARSHALL; A. ECCLES

1991-01-01

227

Human rabies prevention--United States, 2008: recommendations of the Advisory Committee on Immunization Practices.  

PubMed

These recommendations of the Advisory Committee on Immunization Practices (ACIP) update the previous recommendations on human rabies prevention (CDC. Human rabies prevention--United States, 1999: recommendations of the Advisory Committee on Immunization Practices. MMWR 1999;48 [No. RR-1]) and reflect the status of rabies and antirabies biologics in the United States. This statement 1) provides updated information on human and animal rabies epidemiology; 2) summarizes the evidence regarding the effectiveness/efficacy, immunogenicity, and safety of rabies biologics; 3) presents new information on the cost-effectiveness of rabies postexposure prophylaxis; 4) presents recommendations for rabies postexposure and pre-exposure prophylaxis; and 5) presents information regarding treatment considerations for human rabies patients. These recommendations involve no substantial changes to the recommended approach for rabies postexposure or pre-exposure prophylaxis. ACIP recommends that prophylaxis for the prevention of rabies in humans exposed to rabies virus should include prompt and thorough wound cleansing followed by passive rabies immunization with human rabies immune globulin (HRIG) and vaccination with a cell culture rabies vaccine. For persons who have never been vaccinated against rabies, postexposure antirabies vaccination should always include administration of both passive antibody (HRIG) and vaccine (human diploid cell vaccine [HDCV] or purified chick embryo cell vaccine [PCECV]). Persons who have ever previously received complete vaccination regimens (pre-exposure or postexposure) with a cell culture vaccine or persons who have been vaccinated with other types of vaccines and have previously had a documented rabies virus neutralizing antibody titer should receive only 2 doses of vaccine: one on day 0 (as soon as the exposure is recognized and administration of vaccine can be arranged) and the second on day 3. HRIG is administered only once (i.e., at the beginning of antirabies prophylaxis) to previously unvaccinated persons to provide immediate, passive, rabies virus neutralizing antibody coverage until the patient responds to HDCV or PCECV by actively producing antibodies. A regimen of 5 1-mL doses of HDCV or PCECV should be administered intramuscularly to previously unvaccinated persons. The first dose of the 5-dose course should be administered as soon as possible after exposure (day 0). Additional doses should then be administered on days 3, 7, 14, and 28 after the first vaccination. Rabies pre-exposure vaccination should include three 1.0-mL injections of HDCV or PCECV administered intramuscularly (one injection per day on days 0, 7, and 21 or 28). Modifications were made to the language of the guidelines to clarify the recommendations and better specify the situations in which rabies post- and pre-exposure prophylaxis should be administered. No new rabies biologics are presented, and no changes were made to the vaccination schedules. However, rabies vaccine adsorbed (RVA, Bioport Corporation) is no longer available for rabies postexposure or pre-exposure prophylaxis, and intradermal pre-exposure prophylaxis is no longer recommended because it is not available in the United States. PMID:18496505

Manning, Susan E; Rupprecht, Charles E; Fishbein, Daniel; Hanlon, Cathleen A; Lumlertdacha, Boonlert; Guerra, Marta; Meltzer, Martin I; Dhankhar, Praveen; Vaidya, Sagar A; Jenkins, Suzanne R; Sun, Benjamin; Hull, Harry F

2008-05-23

228

Keratoprostheses in clinical practice - a review.  

PubMed

The search for a substitute for the natural cornea dates back more than 200 years. Although several devices have been developed and trialled, very few have had successful long-term results and continue in regular clinical use. Keratoprosthesis (KPro) surgery is complex and should be performed in centres with an experienced multidisciplinary team. Currently available KPro devices range from the totally synthetic, such as the Boston KPro, to the totally biological tissue-engineered artificial cornea. The osteo-odonto keratoprothesis combines a synthetic optic with a biological haptic. All keratoprostheses have significant limitations, although visual improvement is possible with each of the devices in clinical use today. This review discusses these devices with emphasis on their indications, surgical techniques and results, before briefly exploring emerging devices and innovative approaches for the future. PMID:20398109

Gomaa, Ahmed; Comyn, Oliver; Liu, Christopher

2010-03-01

229

Evaluating clinical dermatology practice in medical undergraduates.  

PubMed

The acquisition of competences (the set of knowledge, skills and attitudes required to perform a job to a professional level) is considered a fundamental part of medical training. Dermatology competences should include, in addition to effective clinical interviewing and detailed descriptions of skin lesions, appropriate management (diagnosis, differentiation, and treatment) of common skin disorders and tumors. Such competences can only be acquired during hospital clerkships. As a way of certifying these competences, we propose evaluating the different components as follows: knowledge, via clinical examinations or critical incident discussions; communication and certain instrumental skills, via structured workplace observation and scoring using a set of indicators; and attitudes, via joint evaluation by staff familiar with the student. PMID:23664251

Casanova, J M; Sanmartín, V; Martí, R M; Morales, J L; Soler, J; Purroy, F; Pujol, R

2014-06-01

230

[Hypnotic communication and hypnosis in clinical practice].  

PubMed

In addition to usual medical care it is often critical to consider the patient's inner world in order to sensitively differentiate between harmful and helpful suggestive elements. The respective abilities in terms of hypnotic communication can be easily learned. Confident, empathic attention and a calm, understanding and figurative language narrowing the focus on positive emotions and positive change, which have been shown to improve the patient's chances of healing, are of particular importance. Proper clinical hypnosis goes one step further: it makes explicit use of suggestions, trance, and trance phenomena. The major clinical indications for hypnosis include psychosomatic disorders, anxiety disorders, obsessive-compulsive disorders, depression, and pain syndromes. Hypnosis can also be employed as an adjunct for surgical therapy. PMID:24985229

Wehrli, Hans

2014-07-01

231

Investigators' Perspectives on Translating Human Microbiome Research into Clinical Practice  

PubMed Central

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

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

2013-01-01

232

Integration of Evidence-Based Practice into the University Clinic  

ERIC Educational Resources Information Center

The author explains different principles, which can be used for the integration of evidence-based practice into the university clinic. Research literature, systematic reviews and practice guidelines are shown to work as the evidence for the teachers, as well as the students.

Goldstein, Brian A.

2008-01-01

233

Clinical governance: implementing a change in workplace practice.  

PubMed

The development of a draft guideline on confirming placement of nasogastric tubes laid the basis for a senior nurse to use the principles of clinical governance to lead an improvement in practice. Key factors included risk management, dissemination of draft guidelines reflecting current evidence and changing practice. Good communication was vital to the project. PMID:12229049

Reid, Wendy

2002-08-01

234

The clinical nurse leader: a response from practice  

Microsoft Academic Search

In October 2003, over 200 nurse leaders from education and practice met at the invitation of the American Association of Colleges of Nursing. A newly released white paper, describing the role of the clinical nurse leader, was discussed at the conference. This article outlines a response to that white paper from one practice setting. The article shares information about another

Karen Neil Drenkard

2004-01-01

235

The Use of Research Measures in Adult Clinical Practice  

PubMed Central

Many psychopathology research assessment tools can be used easily and productively in clinical practice. We conducted a workshop in 2009 and 2010 at the American Psychiatric Association annual meeting designed to bring clinicians some commonly used adult research measures with broad applicability to a variety of conditions. This article reviews what was most helpful to the practicing clinicians at the workshop. PMID:21637630

Kaplan, Stuart L.; Greco, Nicholas; Sheehan, David V.

2011-01-01

236

Clinical placements in general practice: relationships between practice nurses and tertiary institutions.  

PubMed

As a practice-based discipline a key component of undergraduate nurse education is clinical practice experience. The quality of clinical experiences has a significant impact on the students' ability to function competently post graduation. The relationship between higher education institutions (HEIs) and health service placement providers impacts upon the quality of clinical placements. In Australia, the growth of primary care nursing and the shortage of acute clinical places has prompted HEIs to explore the placement of students in general practice. Given the increasing attention being paid to non-traditional clinical placements, it is timely to explore how universities are establishing relationships and models of clinical placement. This paper uses qualitative research methods to explore the perspectives of 12 Australian general practice nurses who have experience in facilitating undergraduate clinical placements about the relationships between HEIs and nurses. Findings are presented in the following three themes: (1) Appropriate preparation for placement: They don't know what primary health really means, (2) Seeking greater consultation in the organisation of clinical placements: they've got to do it one way for everyone, and (3) Uncertainty and lack of support: I had no contact with the university. Clinical placements in general practice can be an innovative strategy providing non-traditional, yet high quality, teaching and learning experiences for undergraduate nursing students. To optimise the quality of these placements, however, it is essential that HEIs provide appropriate support to the practice nurses mentoring these students. PMID:23069694

Peters, Kathleen; Halcomb, Elizabeth J; McInnes, Susan

2013-05-01

237

Reporting practices in confirmatory factor analysis: an overview and some recommendations.  

PubMed

Reporting practices in 194 confirmatory factor analysis studies (1,409 factor models) published in American Psychological Association journals from 1998 to 2006 were reviewed and compared with established reporting guidelines. Three research questions were addressed: (a) how do actual reporting practices compare with published guidelines? (b) how do researchers report model fit in light of divergent perspectives on the use of ancillary fit indices (e.g., L.-T. Hu & P. M. Bentler, 1999; H. W. Marsh, K.-T., Hau, & Z. Wen, 2004)? and (c) are fit measures that support hypothesized models reported more often than fit measures that are less favorable? Results indicate some positive findings with respect to reporting practices including proposing multiple models a priori and near universal reporting of the chi-square significance test. However, many deficiencies were found such as lack of information regarding missing data and assessment of normality. Additionally, the authors found increases in reported values of some incremental fit statistics and no statistically significant evidence that researchers selectively report measures of fit that support their preferred model. Recommendations for reporting are summarized and a checklist is provided to help editors, reviewers, and authors improve reporting practices. PMID:19271845

Jackson, Dennis L; Gillaspy, J Arthur; Purc-Stephenson, Rebecca

2009-03-01

238

Improving Clinical Practices for Children with Language and Learning Disorders  

ERIC Educational Resources Information Center

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

Kamhi, Alan G.

2014-01-01

239

The challenge of treatment in bipolar depression: evidence from clinical guidelines, treatment recommendations and complex treatment situations.  

PubMed

Bipolar depression and its clinical presentation is a frequent but complex psychiatric disease. Despite the high prevalence and the clinical and economic relevance of bipolar depression, few treatments are proven to be highly and consistently effective. In practice, the treatment of bipolar depression typically includes complex treatment decision-making. The best evidence for a pharmacological treatment exists for quetiapine. Alternatives with limitations are lamotrigine (also in the combination with lithium), carbamazepine and olanzapine. The effectiveness and recommendation of antidepressants in the treatment of bipolar depression remains controversial. Initially, depressive episodes should been treated with one of the named substances with antidepressant properties. In non-responders, a combination of lithium and lamotrigine, or antidepressants in combination with either lithium, an antiepileptic drug or atypical antipsychotics, may be necessary. If a depressive episode occurs under ongoing mood-stabilizing treatment, combination treatments of different substances, even with antidepressants, can be necessary. In the case of treatment-resistant depressive episodes, complex treatment strategies (combination therapies, MAO inhibitors) should be considered. This review describes the treatment recommendations of different guidelines for bipolar depression and emphasizes their differences. Furthermore, alternative pharmacological treatment strategies and complex treatment situations are discussed. PMID:24549861

Köhler, S; Gaus, S; Bschor, T

2014-03-01

240

Interferon alpha for the adjuvant treatment of melanoma: review of international literature and practical recommendations from an expert panel on the use of interferon  

PubMed Central

The degree to which interferon (IFN) alpha-2b offers real clinical benefits in the adjuvant therapy of melanoma at high risk of recurrence is a subject of debate. This, together with questions over optimal treatment scheme and concerns over toxicity, has limited its clinical use. On the basis of a review of the literature, an Italian Expert Panel has made practical recommendations for a consistent approach in the use of IFN. Although it is clear that more research into predictive factors to identify patients most likely to benefit from adjuvant IFN therapy is required, IFN remains the only currently available adjuvant option for melanoma. Based on meta-analyses of clinical trials, there is clear evidence that treatment with IFN is beneficial with regard to overall and recurrence-free survival (RFS). As such, IFN should be offered to patients who are at high risk of recurrence. Specific recommendations with regard to disease stage are provided. PMID:24621162

Ascierto, Paolo A; Chiarion-Sileni, Vanna; Muggiano, Antonio; Mandalà, Mario; Pimpinelli, Nicola; Vecchio, Michele Del; Rinaldi, Gaetana; Simeone, Ester; Queirolo, Paola

2014-01-01

241

Impact of Pathology Practice on Outcome in Published Studies of DCIS. Recommendations for a Uniform Pathology Protocol  

Cancer.gov

Impact of Pathology Practice on Outcome in Published Studies of DCIS. Recommendations for a Uniform Pathology Protocol Michael D. Lagios The Breast Cancer Consultation Service Tiburon, CA Prognostic Factors for Local Recurrence • Grade • Size (extent

242

Clinical review: Checklists - translating evidence into practice  

PubMed Central

Checklists are common tools used in many industries. Unfortunately, their adoption in the field of medicine has been limited to equipment operations or part of specific algorithms. Yet they have tremendous potential to improve patient outcomes by democratizing knowledge and helping ensure that all patients receive evidence-based best practices and safe high-quality care. Checklist adoption has been slowed by a variety of factors, including provider resistance, delays in knowledge dissemination and integration, limited methodology to guide development and maintenance, and lack of effective technical strategies to make them available and easy to use. In this article, we explore some of the principles and possible strategies to further develop and encourage the implementation of checklists into medical practice. We describe different types of checklists using examples and explore the benefits they offer to improve care. We suggest methods to create checklists and offer suggestions for how we might apply them, using some examples from our own experience, and finally, offer some possible directions for future research. PMID:20064195

2009-01-01

243

Erring and learning in clinical practice.  

PubMed Central

This paper discusses error type their possible consequences and the doctors who make them. There is no single, all-encompassing typology of medical errors. They are frequently multifactorial in origin and use from the mental processes of individuals; from defects in perception, thinking reasoning planning and interpretation and from failures of team-working omissions and poorly executed actions. They also arise from inadequately designed and operated healthcare systems or procedures. The paper considers error-truth relatedness, the approach of UK courts to medical errors, the learning opportunities which flow from error recognition and the need for personal and professional self awareness of clinical fallibilities. PMID:12389767

Hurwitz, Brian

2002-01-01

244

Adoption in Clinical Psychology: A Review of the Absence, Ramifications, and Recommendations for Change  

Microsoft Academic Search

Practicing clinical psychologists reported that 5 to 10% of their patients are adoption triad members (Sass & Henderson, 1999) and yet recent studies concluded that the majority of psychologists are not being taught about adoption-related issues in their preservice raining (Post, 1999; Sass & Henderson, 1999). This article discusses the need for training on adoption in the context of the

Diana E. Post

2000-01-01

245

Testicular biopsy: clinical practice and interpretation  

PubMed Central

Testicular biopsy was considered the cornerstone of male infertility diagnosis for many years in men with unexplained infertility and azoospermia. Recent guidelines for male infertility have limited the indications for a diagnostic testicular biopsy to the confirmation of obstructive azoospermia in men with normal size testes and normal reproductive hormones. Nowadays, testicular biopsies are mainly performed for sperm harvesting in men with non-obstructive azoospermia, to be used for intracytoplasmic sperm injection. Testicular biopsy is also performed in men with risk factors for testicular malignancy. In a subgroup of infertile men, there is an increased risk for carcinoma in situ of the testis, especially in men with a history of cryptorchidism and testicular malignancy and in men with testicular atrophy. Ultrasonographic abnormalities, such as testicular microlithiasis, inhomogeneous parenchyma and lesions of the testes, further increase the risk of carcinoma in situ (CIS) in these men. For an accurate histological classification, proper tissue handling, fixation, preparation of the specimen and evaluation are needed. A standardized approach to testicular biopsy is recommended. In addition, approaches to the detection of CIS of the testis testicular immunohistochemistry are mandatory. In this mini-review, we describe the current indications for testicular biopsies in the diagnosis and management of male infertility. PMID:22157985

Dohle, Gert R; Elzanaty, Saad; van Casteren, Niels J

2012-01-01

246

Measuring Outcome in Traumatic Brain Injury Treatment Trials: Recommendations From the Traumatic Brain Injury Clinical Trials Network  

PubMed Central

Background Traumatic brain injury (TBI) involves several aspects of a patient’s condition, including physical, mental, emotional, cognitive, social, and functional changes. Therefore, a clinical trial with individuals with TBI should consider outcome measures that reflect their global status. Methods We present the work of the National Institute of Child Health and Development–sponsored Traumatic Brain Injury Clinical Trials Network Outcome Measures subcommittee and its choice of outcome measures for a phase III clinical trial of patients with complicated mild to severe TBI. Results On the basis of theoretical and practical considerations, the subcommittee recommended the adoption of a core of 9 measures that cover 2 different areas of recovery: functional and cognitive. These measures are the Extended Glasgow Outcome Scale; the Controlled Oral Word Association Test; the Trail Making Test, Parts A and B; the California Verbal Learning Test–II; the Wechsler Adult Intelligence Scale–III Digit Span subtest; the Wechsler Adult Intelligence Scale–III Processing Speed Index; and the Stroop Color-Word Matching Test, Parts 1 and 2. Conclusions The statistical methods proposed to analyze these measures using a global test procedure, along with research and methodological and regulatory issues involved with the use of multiple outcomes in a clinical trial, are discussed. PMID:20216459

Bagiella, Emilia; Novack, Thomas A.; Ansel, Beth; Diaz-Arrastia, Ramon; Dikmen, Sureyya; Hart, Tessa; Temkin, Nancy

2010-01-01

247

Why Practice Recommendations Are Important in Use-Inspired Basic Research and Why Too Much Caution Is Dysfunctional  

ERIC Educational Resources Information Center

Robinson et al. ("Educ Psychol Rev" 25:291-302, 2013) have suggested refraining from practice and policy recommendations in primary educational research articles, in particular because primary research journals are not the appropriate outlet for such recommendations, the evidence provided by one research article is usually not…

Renkl, Alexander

2013-01-01

248

A National Cancer Clinical Trials Network: Recommendations from the Institute of Medicine  

PubMed Central

Oncology has become one of the most active areas of drug discovery, with more than 800 cancer therapeutics in development. This presents an unprecedented opportunity to improve the outcome for patients with cancer, but also requires an effective and efficient clinical trials network to generate the evidence necessary for regulatory approval and optimal integration of new treatments into clinical care. The Clinical Trials Cooperative Group Program supported by the National Cancer Institute has been instrumental in establishing standards of care in oncology over the last 50 years, but it currently faces numerous challenges that threaten its ability to undertake the large-scale, multi-institutional trials that advance patient care. The Institute of Medicine recently appointed a consensus study committee to assess the organization and operation of the Cooperative Group Program and recommend ways to improve the quality of cancer clinical trials conducted by the Groups and others. The committee developed a set of recommendations, summarized here, that aim to improve the speed and efficiency of trials; incorporate innovative science and trial design; improve prioritization, selection, and support of trials; and increase participation by patients and physicians. PMID:21326081

Nass, Sharyl J.; Balogh, Erin; Mendelsohn, John

2010-01-01

249

A Recommended Scale for Cognitive Screening in Clinical Trials of Parkinson's Disease  

PubMed Central

Background Cognitive impairment is common in Parkinson’s disease (PD). There is a critical need for a brief, standard cognitive screening measure for use in PD trials whose primary focus is not on cognition. Methods The Parkinson Study Group (PSG) Cognitive/Psychiatric Working Group formed a Task Force to make recommendations for a cognitive scale that could screen for dementia and mild cognitive impairment in clinical trials of PD where cognition is not the primary outcome. This Task Force conducted a systematic literature search for cognitive assessments previously used in a PD population. Scales were then evaluated for their appropriateness to screen for cognitive deficits in clinical trials, including brief administration time (<15 minutes), assessment of the major cognitive domains, and potential to detect subtle cognitive impairment in PD. Results Five scales of global cognition met the predetermined screening criteria and were considered for review. Based on the Task Force’s evaluation criteria the Montreal Cognitive Assessment (MoCA), appeared to be the most suitable measure. Conclusions This Task Force recommends consideration of the MoCA as a minimum cognitive screening measure in clinical trials of PD where cognitive performance is not the primary outcome measure. The MoCA still requires further study of its diagnostic utility in PD populations but appears to be the most appropriate measure among the currently available brief cognitive assessments. Widespread adoption of a single instrument such as the MoCA in clinical trials can improve comparability between research studies on PD. PMID:20878991

Chou, Kelvin L.; Amick, Melissa M.; Brandt, Jason; Camicioli, Richard; Frei, Karen; Gitelman, Darren; Goldman, Jennifer; Growdon, John; Hurtig, Howard I.; Levin, Bonnie; Litvan, Irene; Marsh, Laura; Simuni, Tanya; Troster, Alexander I.; Uc, Ergun Y.

2010-01-01

250

Optical coherence tomography: potentialities in clinical practice  

NASA Astrophysics Data System (ADS)

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

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

2004-08-01

251

Incorporating novel virologic tests into clinical practice.  

PubMed

Virologic assays continue to evolve in order to meet the needs of HIV-infected patients and their health care providers. Genotypic and phenotypic assays for resistance to reverse transcriptase inhibitors, protease inhibitors, and fusion inhibitors have clear roles in disease management, with both types of assay having advantages and disadvantages. The failure of current assays to identify or measure the presence of minority resistant variants has clinical implications, since presence of such variants is associated with increased risk of virologic failure. Viral fitness may be relevant to disease management, but clinical role of available assays has not been determined. HIV coreceptor tropism assays will also be a crucial tool in the use of coreceptor antagonists, and data are emerging that will define pathways to treatment failure when using these new agents and the new integrase inhibitors. One clear finding for all antiretroviral drugs is that they select for resistance and must be used with good optimized background therapy to avoid virologic failure. This article summarizes a presentation on viral assays made by Eric S. Daar, MD, at an International AIDS Society-USA Continuing Medical Education course in Chicago in May 2007. The original presentation is available as a Webcast at www.iasusa.org. PMID:17720997

Daar, Eric S

2007-01-01

252

The role of MRI in musculoskeletal practice: a clinical perspective  

PubMed Central

This clinical perspective presents an overview of current and potential uses for magnetic resonance imaging (MRI) in musculoskeletal practice. Clinical practice guidelines and current evidence for improved outcomes will help providers determine the situations when an MRI is indicated. The advanced competency standard of examination used by physical therapists will be helpful to prevent overuse of musculoskeletal imaging, reduce diagnostic errors, and provide the appropriate clinical context to pathology revealed on MRI. Physical therapists are diagnostically accurate and appropriately conservative in their use of MRI consistent with evidence-based principles of diagnosis and screening. PMID:22851878

Dean Deyle, Gail

2011-01-01

253

Recommendations for clinical laboratory science reports regarding properties, units, and symbols: the NPU format.  

PubMed

The document describes the Nomenclature for Properties and Units (NPU) format developed by the joint committee on Nomenclature for Properties and Units of the IFCC and IUPAC. Basic concepts, in particular system, component, kind-of-property, and unit are defined. Generalities concerning quantities and units, and terminological rules are recalled. A constant format is structured for reporting clinical laboratory information. It is adapted for examinations, including measurements, performed in the clinical laboratories. The NPU format follows international recommendations. Using this format, more than 16,000 properties examined in the clinical laboratories have been described. A regularly updated version of the descriptions is available from the IFCC. Examples from different disciplines are given to promote the dissemination of the format. The object of the NPU format is the transfer of examination data without loss of accuracy between the laboratory personnel and the clinicians. The format is well-adapted for comparative and epidemiological studies. PMID:23314546

Férard, Georges; Dybkaer, René

2013-05-01

254

Clinical practice guidelines for mild traumatic brain injury and persistent symptoms  

PubMed Central

Abstract Objective To outline new guidelines for the management of mild traumatic brain injury (MTBI) and persistent postconcussive symptoms (PPCS) in order to provide information and direction to physicians managing patients’ recovery from MTBI. Quality of evidence A search for existing clinical practice guidelines addressing MTBI and a systematic review of the literature evaluating treatment of PPCS were conducted. Because little guidance on the management of PPCS was found within the traumatic brain injury field, a second search was completed for clinical practice guidelines and systematic reviews that addressed management of these common symptoms in the general population. Health care professionals representing a range of disciplines from across Canada and abroad were brought together at an expert consensus conference to review the existing guidelines and evidence and to attempt to develop a comprehensive guideline for the management of MTBI and PPCS. Main message A modified Delphi process was used to create 71 recommendations that address the diagnosis and management of MTBI and PPCS. In addition, numerous resources and tools were included in the guideline to aid in the implementation of the recommendations. Conclusion A clinical practice guideline was developed to aid health care professionals in implementing evidence-based, best-practice care for the challenging population of individuals who experience PPCS following MTBI. PMID:22518895

Marshall, Shawn; Bayley, Mark; McCullagh, Scott; Velikonja, Diana; Berrigan, Lindsay

2012-01-01

255

Classification and clinical diagnosis of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines.  

PubMed

Objectives. Fibromyalgia syndrome (FMS), characterized by subjective complaints without physical or biomarker abnormality, courts controversy. Recommendations in recent guidelines addressing classification and diagnosis were examined for consistencies or differences. Methods. Systematic searches from January 2008 to February 2013 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, Guidelines International Network, and Medline for evidence-based guidelines for the management of FMS were conducted. Results. Three evidence-based interdisciplinary guidelines, independently developed in Canada, Germany, and Israel, recommended that FMS can be clinically diagnosed by a typical cluster of symptoms following a defined evaluation including history, physical examination, and selected laboratory tests, to exclude another somatic disease. Specialist referral is only recommended when some other physical or mental illness is reasonably suspected. The diagnosis can be based on the (modified) preliminary American College of Rheumatology (ACR) 2010 diagnostic criteria. Discussion. Guidelines from three continents showed remarkable consistency regarding the clinical concept of FMS, acknowledging that FMS is neither a distinct rheumatic nor mental disorder, but rather a cluster of symptoms, not explained by another somatic disease. While FMS remains an integral part of rheumatology, it is not an exclusive rheumatic condition and spans a broad range of medical disciplines. PMID:24379886

Fitzcharles, Mary-Ann; Shir, Yoram; Ablin, Jacob N; Buskila, Dan; Amital, Howard; Henningsen, Peter; Häuser, Winfried

2013-01-01

256

Classification and Clinical Diagnosis of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines  

PubMed Central

Objectives. Fibromyalgia syndrome (FMS), characterized by subjective complaints without physical or biomarker abnormality, courts controversy. Recommendations in recent guidelines addressing classification and diagnosis were examined for consistencies or differences. Methods. Systematic searches from January 2008 to February 2013 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, Guidelines International Network, and Medline for evidence-based guidelines for the management of FMS were conducted. Results. Three evidence-based interdisciplinary guidelines, independently developed in Canada, Germany, and Israel, recommended that FMS can be clinically diagnosed by a typical cluster of symptoms following a defined evaluation including history, physical examination, and selected laboratory tests, to exclude another somatic disease. Specialist referral is only recommended when some other physical or mental illness is reasonably suspected. The diagnosis can be based on the (modified) preliminary American College of Rheumatology (ACR) 2010 diagnostic criteria. Discussion. Guidelines from three continents showed remarkable consistency regarding the clinical concept of FMS, acknowledging that FMS is neither a distinct rheumatic nor mental disorder, but rather a cluster of symptoms, not explained by another somatic disease. While FMS remains an integral part of rheumatology, it is not an exclusive rheumatic condition and spans a broad range of medical disciplines. PMID:24379886

Fitzcharles, Mary-Ann; Shir, Yoram; Ablin, Jacob N.; Buskila, Dan; Henningsen, Peter

2013-01-01

257

Clinical Procedure Page 1 of 2 Clinical Manual -Nursing Practice Manual  

E-print Network

Clinical Procedure Page 1 of 2 Clinical Manual - Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: Allergies: Identification of Patient Allergies POLICY: CLINICAL ASSESSMENT AND CARE/SAFETY: DOCUMENTATION CPOE UNITS: NON-CPOE UNITS: 1

Oliver, Douglas L.

258

Clinical Procedure Page 1 of 3 Clinical Manual -Nursing Practice Manual  

E-print Network

Clinical Procedure Page 1 of 3 Clinical Manual - Nursing Practice Manual John Dempsey Hospital specific populations, therapies, or procedures may indicate alternative placement. Site selection should with lymphedema or DVTs f. areas of planned procedures or with post-procedure swelling #12;Clinical Procedure Page

Oliver, Douglas L.

259

NHMRC guidelines for clinical practice for ASD and PTSD.  

PubMed

Dear Editor, Recently I described the case of a scuba instructor suffering from acute stress disorder (ASD), a type of post-traumatic stress disorder (PTSD), following the death of one of her students. The treatment described was a combination of eye movement desensitization and reprocessing (EMDR) and cognitive-behavioural therapy (CBT) exposure based exercises. As it happens, in August the Australian Centre for Post Traumatic Mental Health published Australian clinical practice guidelines for ASD and PTSD. These have been endorsed by the National Health and Medical Research Council (NHMRC). The treatment described in the diver injury case is consistent with these guidelines. The NHMRC guidelines suggest that immediately following a traumatic episode (e.g., diver death or serious injury) the most helpful response is to offer psychological first aid. This includes providing information on traumatic stress reactions, encouraging self care and using available social support. It is recommended that the medical practitioner monitor the patient, watching for improvement, plateau or deterioration, and be ready to offer assistance or appropriate referral if needed. The guidelines recommend the use of trauma-focused psychological therapy as the first-line intervention for ASD and PTSD. EMDR, with in vivo exposure included, and CBT are considered the most effective treatments. If medication is required, selective serotonin re-uptake inhibitor antidepressants are considered the best choice. For the benefit and convenience of patients and practitioners, the NHMRC guidelines and a comprehensive set of information guides on ASD and PTSD are available online as pdf file downloads at http://www.acpmh.unimelb.edu.au. An update in Medical Journal of Australia provides traumatic stress information for medical practitioners including screening questions that can be used to identify patients suffering with ASD and PTSD. This article is available online at: http://www.mja.com.au/public/issues/187_02_160707/for10467_fm.html. Brief articles and summary sheets specifically for divers on the subjects of traumatic stress reactions, death and panic are available at http://psychodiver.com. PMID:22692662

Ladd, Gary

2008-03-01

260

Antiplatelet drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).  

PubMed

This article about currently available antiplatelet drugs is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). It describes the mechanism of action, pharmacokinetics, and pharmacodynamics of aspirin, reversible cyclooxygenase inhibitors, thienopyridines, and integrin alphaIIbbeta3 receptor antagonists. The relationships among dose, efficacy, and safety are thoroughly discussed, with a mechanistic overview of randomized clinical trials. The article does not provide specific management recommendations; however, it does highlight important practical aspects related to antiplatelet therapy, including the optimal dose of aspirin, the variable balance of benefits and hazards in different clinical settings, and the issue of interindividual variability in response to antiplatelet drugs. PMID:18574266

Patrono, Carlo; Baigent, Colin; Hirsh, Jack; Roth, Gerald

2008-06-01

261

Fluid resuscitation in neonatal and pediatric hypovolemic shock: a Dutch Pediatric Society evidence-based clinical practice guideline  

Microsoft Academic Search

Objective  To develop a clinical practice guideline that provides recommendations for the fluid, i.e. colloid or crystalloid, used for resuscitation in critically ill neonates and children up to the age of 18 years with hypovolemia.Methods  The guideline was developed through a comprehensive search and analysis of the pediatric literature. Recommendations were formulated by a national multidisciplinary committee involving all stakeholders in neonatal and pediatric intensive

Nicole Boluyt; Casper W. Bollen; Albert P. Bos; Joke H. Kok; Martin Offringa

2006-01-01

262

Reexamination of the ethics of placebo use in clinical practice.  

PubMed

A placebo is a substance or intervention believed to be inactive, but is administered by the healthcare professional as if it was an active medication. Unlike standard treatments, clinical use of placebo usually involves deception and is therefore ethically problematic. Our attitudes toward the clinical use of placebo, which inevitably includes deception or withholding information, have a tremendous effect on our practice regarding truth-telling and informed consent. A casual attitude towards it weakens the current practice based on shared decision-making and mutual trust between patients and healthcare professionals. Issues concerning the clinical use of placebo are thus intimately related to patient-provider relationships, the public's trust in medicine, and medical education. A review of recent survey studies suggests that the clinical use of placebo appears to be fairly well accepted among healthcare professionals and is common in clinical settings in various countries. However, we think that an ethical discussion is urgently needed because of its controversial nature. If judged to be ethically wrong, the practice should end. In the present paper, we discuss the ethicality of the clinical use of placebo with deception and argue against it, concluding that it is unethical and should be banned. We will show that most arguments in favor of the clinical use of placebo can be refuted and are therefore incorrect or weak. These arguments will be presented and examined individually. Finally, we will briefly consider issues relevant to the clinical use of placebo without deception. PMID:22296589

Asai, Atsushi; Kadooka, Yasuhiro

2013-05-01

263

Dronedarone for atrial fibrillation: the limited reliability of clinical practice guidelines.  

PubMed

Concerns have been expressed about the reliability of clinical practice guidelines. We analyzed 3 guidelines from medical specialty societies about dronedarone hydrochloride, an antiarrhythmic drug related to amiodarone hydrochloride, for treatment of patients with atrial fibrillation. We compared the recommendations in these guidelines with the conclusions about dronedarone that we reached by applying the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Method to the same evidence base. In our analysis, as a rate control drug, dronedarone was better than placebo only for a surrogate outcome (heart rate). As a rhythm control drug, dronedarone was associated with 13 (95% CI, -15 to 61) excess deaths per 1000 patients treated as compared with placebo. Compared with amiodarone, dronedarone was less effective (214 [95% CI, 130 to 294] more recurrences of atrial fibrillation per 1000 patients treated) and similarly tolerated (-28 [95% CI, -69 to 33] more serious adverse events requiring drug suspension per 1000 patients treated). Despite the limits of the evidence, all 3 guidelines recommended dronedarone for prevention of recurrences of atrial fibrillation; 2 of the guidelines recommended it as a rate control agent. Our findings raise questions about the reliability of these clinical practice guidelines, as well as the financial associations between many of the panel members and the manufacturer of dronedarone. PMID:24535046

Iannone, Primiano; Haupt, Enrico; Flego, Gaddo; Truglio, Paola; Minardi, Monica; Clarke, Simon; Magrini, Nicola

2014-04-01

264

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

PubMed

Clinical pharmacy has a rich history of advancing practice through innovation. These innovations helped to mold clinical pharmacy into a patient-centered discipline recognized for its contributions to improving medication therapy outcomes. However, innovations in clinical pharmacy practice have now waned. In our view, the growth of academic–practice partnerships could reverse this trend and stimulate innovation among the next generation of pioneering clinical pharmacists. Although collaboration facilitates innovation,academic institutions and health care systems/organizations are not taking full advantage of this opportunity. The academic–practice partnership can be optimized by making both partners accountable for the desired outcomes of their collaboration, fostering symbiotic relationships that promote value-added clinical pharmacy services and emphasizing continuous quality improvement in the delivery of these services. Optimizing academic–practice collaboration on a broader scale requires both partners to adopt a culture that provides for dedicated time to pursue innovation, establishes mechanisms to incubate ideas, recognizes where motivation and vision align, and supports the purpose of the partnership. With appropriate leadership and support, a shift in current professional education and training practices, and a commitment to cultivate future innovators, the academic–practice partnership can develop new and innovative practice advancements that will improve patient outcomes. PMID:24877189

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

2014-05-01

265

Use of competencies in training fertility nurses in clinical practice.  

PubMed

In this article, the value of clinical competencies in the role development of fertility nurses is discussed using the example of the Oxford Fertility Programme. Clinical competencies are incorporated into the training programme within the Oxford Fertility Unit to enable new staff to demonstrate their clinical ability and undergo assessment while learning new and expanded skills. New staff are required to explore both the theoretical and practical foundations that underpin clinical practice. Competencies are used in a structured programme in which staff have to provide evidence of the appropriate knowledge to perform new and expanded procedures. New staff work with a senior nurse, who is their lecturer and who assesses both their clinical and theoretical development. The new staff are also assigned a preceptor with whom they work on a daily basis to consolidate the practice explored with the lecturer. The Scope of Professional Practice produced by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC, 1992) places the emphasis on professional development for individual practitioners. Within the Oxford Fertility Unit, the nurses work collectively and as autonomous practitioners, which enables them to provide a specialized and personal service to their patients. Professional profiles are an integral element of an individual's professional development and are used in the training programme. They provide an accurate record of a nurse's abilities and knowledge and how he or she relates them to practice. PMID:11844318

Barber, Debbie

1999-01-01

266

Individual treatment effects: implications for research, clinical practice, and policy.  

PubMed

Funding for comparative effectiveness research (CER) has focused attention on what treatments work best under what specific clinical circumstances, and for whom. Because not all patients respond in the same way, treatment decisions, clinical guidelines, and coverage policies applied in a "one-size-fits-all" fashion based upon the population "average" response may lead to suboptimal outcomes. Existing frameworks focus on why patients respond differently to treatments. We propose a framework that identifies when these differences are likely to be clinically important. Scenarios are presented in which it may be most critical for clinical decisions and policies to distinguish between the average and the individual patient so that treatment recommendations provide the greatest benefits for the largest number of patients. We provide recommendations for researchers to help identify issues to study, for providers to help assist them in recommending optimal treatment for individual patients, and for payers or public health bodies to help balance societal needs with those of the individual. PMID:25295400

Graff, Jennifer S; Grasela, Thaddeus; Meltzer, David O; Dubois, Robert W

2014-07-01

267

Larynx Preservation Clinical Trial Design: Key Issues and Recommendations-A Consensus Panel Summary  

SciTech Connect

Purpose: To develop guidelines for the conduct of Phase III clinical trials of larynx preservation in patients with locally advanced laryngeal and hypopharyngeal cancer. Methods and Materials: A multidisciplinary international consensus panel developed recommendations after reviewing results from completed Phase III randomized trials, meta-analyses, and published clinical reports with updates available through November, 2007. The guidelines were reviewed and approved by the panel. Results: According to the recommendations, the trial population should include patients with T2 or T3 laryngeal or hypopharyngeal squamous cell carcinoma not considered for partial laryngectomy and exclude those with laryngeal dysfunction or age greater than 70 years. Functional assessments should include speech and swallowing. Voice should be routinely assessed with a simple, validated instrument. The primary endpoint should capture survival and function. The panel created a new endpoint: laryngo-esophageal dysfunction-free survival. Events are death, local relapse, total or partial laryngectomy, tracheotomy at 2 years or later, or feeding tube at 2 years or later. Recommended secondary endpoints are overall survival, progression-free survival, locoregional control, time to tracheotomy, time to laryngectomy, time to discontinuation of feeding tube, and quality of life/patient-reported outcomes. Correlative biomarker studies for near-term trials should include estimated glomerular filtration rate, excision repair cross-complementary-1 gene, E-cadherin and {beta}-catenin, epiregulin and amphiregulin, and TP53 mutation. Conclusions: Revised trial designs in several key areas are needed to advance the study of larynx preservation. With consistent methodologies, clinical trials can more effectively evaluate and quantify the therapeutic benefit of novel treatment options for patients with locally advanced laryngeal and hypopharyngeal cancer.

Lefebvre, Jean-Louis [Departement de Cancerologie Cervico-Faciale, Centre Oscar Lambret, Lille (France)], E-mail: jl-lefebvre@o-lambret.fr; Ang, K. Kian [University of Texas MD Anderson Cancer Center, Houston, TX (United States)

2009-04-01

268

Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease  

PubMed Central

Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions – the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1–13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols. PMID:25077519

Cameron, Daniel J; Johnson, Lorraine B; Maloney, Elizabeth L

2014-01-01

269

Clinical practice guidelines for the medical and surgical management of primary intracerebral hemorrhage in Korea.  

PubMed

The purpose of this clinical practice guideline (CPG) is to provide current and comprehensive recommendations for the medical and surgical management of primary intracerebral hemorrhage (ICH). Since the release of the first Korean CPGs for stroke, evidence has been accumulated in the management of ICH, such as intracranial pressure control and minimally invasive surgery, and it needs to be reflected in the updated version. The Quality Control Committee at the Korean Society of cerebrovascular Surgeons and the Writing Group at the Clinical Research Center for Stroke (CRCS) systematically reviewed relevant literature and major published guidelines between June 2007 and June 2013. Based on the published evidence, recommendations were synthesized, and the level of evidence and the grade of the recommendation were determined using the methods adapted from CRCS. A draft guideline was scrutinized by expert peer reviewers and also discussed at an expert consensus meeting until final agreement was achieved. CPGs based on scientific evidence are presented for the medical and surgical management of patients presenting with primary ICH. This CPG describes the current pertinent recommendations and suggests Korean recommendations for the medical and surgical management of a patient with primary ICH. PMID:25368758

Kim, Jeong Eun; Ko, Sang-Bae; Kang, Hyun-Seung; Seo, Dae-Hee; Park, Sukh-Que; Sheen, Seung Hun; Park, Hyun Sun; Kang, Sung Don; Kim, Jae Min; Oh, Chang Wan; Hong, Keun-Sik; Yu, Kyung-Ho; Heo, Ji Hoe; Kwon, Sun-Uck; Bae, Hee-Joon; Lee, Byung-Chul; Yoon, Byung-Woo; Park, In Sung; Rha, Joung-Ho

2014-09-01

270

Clinical Practice Guidelines for the Medical and Surgical Management of Primary Intracerebral Hemorrhage in Korea  

PubMed Central

The purpose of this clinical practice guideline (CPG) is to provide current and comprehensive recommendations for the medical and surgical management of primary intracerebral hemorrhage (ICH). Since the release of the first Korean CPGs for stroke, evidence has been accumulated in the management of ICH, such as intracranial pressure control and minimally invasive surgery, and it needs to be reflected in the updated version. The Quality Control Committee at the Korean Society of cerebrovascular Surgeons and the Writing Group at the Clinical Research Center for Stroke (CRCS) systematically reviewed relevant literature and major published guidelines between June 2007 and June 2013. Based on the published evidence, recommendations were synthesized, and the level of evidence and the grade of the recommendation were determined using the methods adapted from CRCS. A draft guideline was scrutinized by expert peer reviewers and also discussed at an expert consensus meeting until final agreement was achieved. CPGs based on scientific evidence are presented for the medical and surgical management of patients presenting with primary ICH. This CPG describes the current pertinent recommendations and suggests Korean recommendations for the medical and surgical management of a patient with primary ICH. PMID:25368758

Kim, Jeong Eun; Kang, Hyun-Seung; Seo, Dae-Hee; Park, Sukh-Que; Sheen, Seung Hun; Park, Hyun Sun; Kang, Sung Don; Kim, Jae Min; Oh, Chang Wan; Hong, Keun-Sik; Yu, Kyung-Ho; Heo, Ji Hoe; Kwon, Sun-Uck; Bae, Hee-Joon; Lee, Byung-Chul; Yoon, Byung-Woo; Park, In Sung; Rha, Joung-Ho

2014-01-01

271

Assessing dental students' competence: best practice recommendations in the performance assessment literature and investigation of current practices in predoctoral dental education.  

PubMed

In this article, the Task Force on Student Outcomes Assessment of the American Dental Education Association's Commission on Change and Innovation in Dental Education describes the current status of student outcomes assessment in U.S. dental education. This review is divided into six sections. The first summarizes the literature on assessment of dental students' performance. Section two discusses catalysts, with a focus on problem-based learning, for development of new assessment methods, while the third section presents several resources and guides that can be used to inform selection of assessment techniques for various domains of competence. The fourth section describes the methodology and results of a 2008 survey of current assessment practices in U.S. dental schools. In the fifth section, findings from this survey are discussed within the context of competency-based education, the educational model for the predoctoral curriculum endorsed by the American Dental Education Association and prescribed by the Commission on Dental Accreditation. The article concludes with a summary of assessments recommended as optimal strategies to measure three components of professional competence based on the triangulation model. The survey of assessment practices in predoctoral education was completed by 931 course directors, representing 45 percent of course directors nationwide, from fifty-three of the fifty-six U.S. dental schools. Survey findings indicate that five traditional mainstays of student performance evaluation-multiple-choice testing, lab practicals, daily grades, clinical competency exams, and procedural requirements-still comprise the primary assessment tools in dental education. The survey revealed that a group of newer assessment techniques, although frequently identified as best practices in the literature and commonly used in other areas of health professions education, are rarely employed in predoctoral dental education. PMID:19056620

Albino, Judith E N; Young, Stephen K; Neumann, Laura M; Kramer, Gene A; Andrieu, Sandra C; Henson, Lindsey; Horn, Bruce; Hendricson, William D

2008-12-01

272

Abuse liability measures for use in analgesic clinical trials in patients with pain: IMMPACT recommendations.  

PubMed

Assessing and mitigating the abuse liability (AL) of analgesics is an urgent clinical and societal problem. Analgesics have traditionally been assessed in randomized clinical trials (RCTs) designed to demonstrate analgesic efficacy relative to placebo or an active comparator. In these trials, rigorous, prospectively designed assessment for AL is generally not performed. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) convened a consensus meeting to review the available evidence and discuss methods for improving the assessment of the AL of analgesics in clinical trials in patients with pain. Recommendations for improved assessment include: (1) performing trials that include individuals with diverse risks of abuse; (2) improving the assessment of AL in clinical trials (eg, training study personnel in the principles of abuse and addiction behaviors, designing the trial to assess AL outcomes as primary or secondary outcome measures depending on the trial objectives); (3) performing standardized assessment of outcomes, including targeted observations by study personnel and using structured adverse events query forms that ask all subjects specifically for certain symptoms (such as euphoria and craving); and (4) collecting detailed information about events of potential concern (eg, unexpected urine drug testing results, loss of study medication, and dropping out of the trial). The authors also propose a research agenda for improving the assessment of AL in future trials. PMID:24148704

O'Connor, Alec B; Turk, Dennis C; Dworkin, Robert H; Katz, Nathaniel P; Colucci, Robert; Haythornthwaite, Jennifer A; Klein, Michael; O'Brien, Charles; Posner, Kelly; Rappaport, Bob A; Reisfield, Gary; Adams, Edgar H; Balster, Robert L; Bigelow, George E; Burke, Laurie B; Comer, Sandra D; Cone, Edward; Cowan, Penney; Denisco, Richard A; Farrar, John T; Foltin, Richard W; Haddox, J David; Hertz, Sharon; Jay, Gary W; Junor, Roderick; Kopecky, Ernest A; Leiderman, Deborah B; McDermott, Michael P; Palmer, Pamela P; Raja, Srinivasa N; Rauschkolb, Christine; Rowbotham, Michael C; Sampaio, Cristina; Setnik, Beatrice; Smith, Shannon M; Sokolowska, Marta; Stauffer, Joseph W; Walsh, Sharon L; Zacny, James P

2013-11-01

273

A Study of Business Incubators: Models, Best Practices, and Recommendations for NASA and Florida  

NASA Technical Reports Server (NTRS)

This study was conducted to provide NASA-Kennedy Space Center with information and recommendations to support establishing one or more technology-based business incubators In Florida. The study involved assembling information about incubators: why they succeed, why they fail, how they are organized, and what services they provide. Consequently, this study focuses on widely-recognized "best practices," needed to establish successful technology- based business incubators. The findings are used to optimize the design and implementation of one or more technology-based business incubators to be established in Florida. Recommendations reflect both the essential characteristics of successful incubators and the optimal business demographics in Florida. Appendix A provides a fuller description of the objectives of the study. Technology-based business incubators are an increasing catalyst of new business development across the USi Incubators focus on providing entrepreneurs and small start-up firms with a wide array of support services necessary to bring forth new products and processes based on technologies developed in the nation's federal and private laboratories and universities. Appendix B provides extensive discussion of findings relative to technology- based business incubators.

1997-01-01

274

Acquisition of clinical skills in postgraduate training for general practice.  

PubMed Central

BACKGROUND: Postgraduate training in general practice aims to develop clinical competence. However, little is known about its effect on trainees' development of clinical skills. AIM: To assess the acquisition of clinical skills during a 3-year training programme and to evaluate whether a satisfactory level is achieved towards the end of training. DESIGN OF STUDY: Cross-sectional design. SETTING: Dutch postgraduate training in general practice from 1995 to 1998. METHOD: Clinical skills were assessed using a written knowledge test of skills and by an Objective Structured Clinical Examination (OSCE). The written test was administered to trainees in all 3 years. Trainees at completion of their training took the OSCE. The results of both tests were compared with a standard of adequacy and to a reference group of general practitioner (GP) trainers. RESULTS: An increase in the level of clinical skills and pass rate was found throughout the training, being most prominent during the first 6 months. At completion of their training, trainees scored higher than the GPs on the written test (48% versus 39%) and on the OSCE (69% versus 63%). Eighty-eight per cent of the trainees would have passed the written test against 70% of the GPs and 94% would have passed the OSCE against 80% of the GPs. CONCLUSION: A 3-year postgraduate training period in general practice contributes to a satisfactory acquisition of clinical skills. Further research into when and where acquisition takes place, and the role of the GP trainer, is needed. PMID:15103874

Kramer, Anneke W; Jansen, Koos J; Dusman, Herman; Tan, Lisa H; van der Vleuten, Cees P; Grol, Richard P

2003-01-01

275

Developing an advanced practice nurse-led liver clinic.  

PubMed

End-stage liver disease (ESLD) is a leading cause of digestive disease deaths in the United States and continues to increase exponentially every year. Best practice does not currently recognize or utilize a clinic practice model for ESLD management. Advanced practice registered nurses (APRNs) can impact ESLD disease management by implementing an outpatient clinic care model to focus on treatment compliance, patient education, improvement of patient outcomes, and reduction in hospital admission rates for ESLD patients. A review of 15 research articles was completed to determine the impact APRNs can make on chronic care of ESLD patients. Results from the review support APRN analysis, assessment, diagnosis, treatment, intervention, and evaluation of ESLD patients. The literature reviewed also demonstrates that ESLD patients have improved symptom management when maintained in an outpatient setting, allowing for decreased hospital and insurance expenditures. Following evaluation of the evidence, it was concluded that an APRN-led ESLD clinic merits further study. PMID:22647802

McAfee, Jean L

2012-01-01

276

Influences on clinical practice: the case of glue ear  

PubMed Central

A case study of clinical practice in children with glue ear is presented. The case is part of a larger project, funded by the North Thames Research and Development Programme, that sought to explore the part played by clinicians in the implementation of research and development into practice in two areas: adult asthma and glue ear in children. What is striking about this case is the differences found in every area of the analysis. That is, diversity was found in views about diagnosis and treatment of glue ear; the organisation of related services; and in the reported practice of our interviewees, both between particular groupings of clinical staff and within these groupings. The challenge inherent in the case is to go beyond describing the complexity and differences that were found, and look for patterns in the accounts of practice and tease out why such patterns may occur. PMID:10557674

Dopson, S.; Miller, R.; Dawson, S.; Sutherland, K.

1999-01-01

277

Nursing students learning to utilize nursing research in clinical practice.  

PubMed

The purpose of the study was to examine the significance of a learning assignment in relation to research skills and learning of nursing students in clinical practice. The learning assignment included an oral presentation of a nursing research article, which the students gave to their fellow students and ward nurses. The students also chaired the discussion after the presentation. The target group for the study was nursing students of a Finnish polytechnic who had been studying for 2-2 1/2 years and had accomplished a minimum of 120 ECTS credits of the total of 210 ECTS credits. When participating in the study, the students were completing a six-week clinical practice of optional studies. The data were collected with a questionnaire designed for the study. It consisted of six open-ended questions. Three of the questions were related to learning of research skills. Two questions were concerned with learning during the ongoing clinical practice. The final question inquired the students' views on the development of the learning assignment. The students received the questionnaire before the commencement of their clinical practice, and they returned it to the other researcher after their clinical practice. The questionnaire was given to 80 students, of which 50 returned it; the response rate was 63%. The data were analysed by content analysis question by question. According to the results, the learning assignment advanced the understanding of research concepts for the majority of the students. In particular, the students reported that the oral presentation clarified the research concepts, and the structure of a scientific article was also elucidated. The students stated that the assignment generated ideas concerning the development of nursing care. In relation to the ongoing clinical practice, the assignment advanced patient encounters and interaction, and bearing responsibility the most. Proposals for the further development of the learning assignment were expressed by more than half of the nursing students. Half of them suggested ensuring the interest in the topic from the ward. PMID:17064819

Mattila, Lea-Riitta; Eriksson, Elina

2007-08-01

278

Evidence based practice: the practicalities of keeping abreast of clinical evidence while in training  

Microsoft Academic Search

This paper gives a practical account of why and how to learn to practise evidence based medicine while still in clinical training. It highlights practical benefits to learning the skills (such as passing exams, coping with information overload and helping patients), and explains how to manage each of the four essential steps (asking questions, acquiring information, appraising evidence, and applying

R Phillips; P Glasziou

2008-01-01

279

Determination of Vancomycin Pharmacokinetics in Neonates To Develop Practical Initial Dosing Recommendations  

PubMed Central

Variability in neonatal vancomycin pharmacokinetics and the lack of consensus for optimal trough concentrations in neonatal intensive care units pose challenges to dosing vancomycin in neonates. Our objective was to determine vancomycin pharmacokinetics in neonates and evaluate dosing regimens to identify whether practical initial recommendations that targeted trough concentrations most commonly used in neonatal intensive care units could be determined. Fifty neonates who received vancomycin with at least one set of steady-state levels were evaluated retrospectively. Mean pharmacokinetic values were determined using first-order pharmacokinetic equations, and Monte Carlo simulation was used to evaluate initial dosing recommendations for target trough concentrations of 15 to 20 mg/liter, 5 to 20 mg/liter, and ?20 mg/liter. Monte Carlo simulation revealed that dosing by mg/kg of body weight was optimal where intermittent dosing of 9 to 12 mg/kg intravenously (i.v.) every 8 h (q8h) had the highest probability of attaining a target trough concentration of 15 to 20 mg/liter. However, continuous infusion with a loading dose of 10 mg/kg followed by 25 to 30 mg/kg per day infused over 24 h had the best overall probability of target attainment. Initial intermittent dosing of 9 to 15 mg/kg i.v. q12h was optimal for target trough concentrations of 5 to 20 mg/liter and ?20 mg/liter. In conclusion, we determined that the practical initial vancomycin dose of 10 mg/kg vancomycin i.v. q12h was optimal for vancomycin trough concentrations of either 5 to 20 mg/liter or ?20 mg/liter and that the same initial dose q8h was optimal for target trough concentrations of 15 to 20 mg/liter. However, due to large interpatient vancomycin pharmacokinetic variability in neonates, monitoring of serum concentrations is recommended when trough concentrations between 15 and 20 mg/liter or 5 and 20 mg/liter are desired. PMID:24614381

Kim, Julianne; Iaboni, Dolores C.; Walker, Scott E.; Elligsen, Marion; Dunn, Michael S.; Allen, Vanessa G.; Simor, Andrew

2014-01-01

280

The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines  

Microsoft Academic Search

Flawed clinical practice guidelines may compromise patient care. Commercial conflicts of interest on panels that write treatment guidelines are particularly problematic, because panelists may have conflicting agendas that influence guideline recommendations. Historically, there has been no legal remedy for conflicts of interest on guidelines panels. However, in May 2008, the Attorney General of Connecticut concluded a ground-breaking antitrust investigation into

Lorraine Johnson; Raphael B Stricker

2010-01-01

281

Shared-Learning Experience During a Clinical Pharmacy Practice Experience  

PubMed Central

Objective To implement a shared learning approach through fourth-year students’ mentorship of third-year students and to assess the perceptions of the mentored students on the value of their shared learning experience. Design We introduced the shared learning experience in clinical pharmacy and pharmacotherapeutic practice experiences involving 87 third-year and 51 fourth-year students. Both student groups undertook the practice experiences together, with third-year students working in smaller groups mentored by fourth-year students. Assessment A majority of the students (> 75%) believed that they learned to work as a team during their practice experiences and that the shared learning approach provided an opportunity to practice their communication skills. Similarly, most respondents (> 70%) agreed that the new approach would help them become effective members of the healthcare team and would facilitate their professional relationships in future practice. Almost two-thirds of the students believed that the shared learning enhanced their ability to understand clinical problems. However, about 31% of the pharmacy students felt that they could have learned clinical problem-solving skills equally well working only with peers from their own student group. Conclusions The pharmacy students in the current study generally believed that the shared-learning approach enhanced their ability to understand clinical problems and improved their communication and teamwork skills. Both groups of students were positive that they had acquired some skills through the shared-learning approach. PMID:21769151

Awaisu, Ahmed

2011-01-01

282

Implications of pharmacogenomics for drug development and clinical practice.  

PubMed

Pharmacogenomics is likely to be among the first clinical applications of the Human Genome Project and is certain to have an enormous impact on the clinical practice of medicine. Herein, we discuss the potential implications of pharmacogenomics on the drug development process, including drug safety, productivity, market segmentation, market expansion, differentiation, and personalized health care. We also review 3 challenges facing the translation of pharmacogenomics into clinical practice: dependence on information technology, limited health care financing, and the scientific uncertainty surrounding validation of specific applications of the technology. To our knowledge, there is currently no formal agenda to promote and cultivate innovation, to develop progressive information technology, or to obtain the financing that would be required to advance the use of pharmacogenomic technologies in patient care. Although the potential of these technologies is driving change in the development of clinical sciences, it remains to be seen which health care systems level needs will be addressed. PMID:16287761

Ginsburg, Geoffrey S; Konstance, Richard P; Allsbrook, Jennifer S; Schulman, Kevin A

2005-11-14

283

The clinical nurse leader: a response from practice.  

PubMed

In October 2003, over 200 nurse leaders from education and practice met at the invitation of the American Association of Colleges of Nursing. A newly released white paper, describing the role of the clinical nurse leader, was discussed at the conference. This article outlines a response to that white paper from one practice setting. The article shares information about another role, that of team coordinator, that is similar to clinical nurse leader and has been implemented at an integrated not-for-profit health care system in 5 hospitals. The comparison of the team coordinator role to the clinical nurse leader role might assist in visualizing such a role in practice. Although the roles are not identical, many of the driving forces for change were similar; these included the need to meet the changing demands for improved patient outcomes and nurse retention. The team coordinator role has 4 domains of practice that are crosswalked against the clinical nurse leader 15 core competencies. An evaluation of the team coordinator role showed changes that need to be made, such as placing more emphasis on clinical progression of patients. Lessons learned are shared, including keeping the scope of the role manageable, providing documentation standards for new roles, and the leadership required of the nursing executive to implement change. PMID:15176010

Drenkard, Karen Neil

2004-01-01

284

Heterogeneity in head and neck IMRT target design and clinical practice  

PubMed Central

Purpose To assess patterns of H&N IMRT practice with particular emphasis on elective target delineation. Materials and methods Twenty institutions with established H&N IMRT expertise were solicited to design clinical target volumes for the identical H&N cancer case. To limit contouring variability, a primary tonsil GTV and ipsilateral level II node were pre-contoured. Participants were asked to accept this GTV, and contour their recommended CTV and PTV. Dose prescriptions, contouring time, and recommendations regarding chemotherapy were solicited. Results All 20 institutions responded. Remarkable heterogeneity in H&N IMRT design and practice was identified. Seventeen of 20 centers recommended treatment of bilateral necks whereas 3/20 recommended treatment of the ipsilateral neck only. The average CTV volume was 250 cm3 (range 37–676 cm3). Although there was high concordance in coverage of ipsilateral neck levels II and III, substantial variation was identified for levels I, V, and the contralateral neck. Average CTV expansion was 4.1 mm (range 0–15 mm). Eight of 20 centers recommended chemotherapy (cisplatin), whereas 12/20 recommended radiation alone. Responders prescribed on average 69 and 68 Gy to the tumor and metastatic node GTV, respectively. Average H&N target volume contouring time was 102.5 min (range 60–210 min). Conclusion This study identifies substantial heterogeneity in H&N IMRT target definition, prescription, neck treatment, and use of chemotherapy among practitioners with established H&N IMRT expertise. These data suggest that continued efforts to standardize and simplify the H&N IMRT process are desirable for the safe and effective global advancement of H&N IMRT practice. PMID:22405806

Hong, Theodore S.; Tome, Wolfgang A.; Harari, Paul M.

2013-01-01

285

Immmunotherapy of cancer: from vision to standard clinical practice  

Microsoft Academic Search

Until the end of the 19th century the possibility that a tumor could be rejected merely by the body’s immune defense was no more than a vision. After more than 100 years of preclinical and clinical research in the field, the vision of cancer immunotherapy became real and has, with multiple tools, successfully entered clinical standard practice. Non-specific mediators of immune

Christoph H. Huber; Thomas Wölfel

2004-01-01

286

Maternal Assessment of Physician Qualification to Give Advice on AAP-Recommended Infant Sleep Practices Related to SIDS  

PubMed Central

Objective The American Academy of Pediatrics (AAP) strongly recommends the supine-only sleep position for infants and issued 2 more sudden infant death syndrome (SIDS) reduction recommendations: avoid bed sharing and use pacifiers during sleep. In this study, we investigated the following: 1) if mothers from at risk populations rate physicians as qualified to give advice about sleep practices and 2) if these ratings were associated with reports of recommended practice. Methods A cross-sectional survey of mothers (N = 2355) of infants aged <8 months was conducted at Women, Infants, and Children (WIC) Program centers in 6 cities from 2006 to 2008. The predictor measures were maternal rating of physician qualification to give advice about 3 recommended sleep practices and reported nature of physician advice. The dependent measures were maternal report of usage of recommended behavior: 1) “infant usually placed supine for sleep,” 2) “infant usually does not share a bed with an adult during sleep,” and 3) “infant usually uses a pacifier during sleep.” Results Physician qualification ratings varied by topic: sleep position (80%), bed sharing (69%), and pacifier use (60%). High ratings of physician qualification were associated with maternal reports of recommended behavior: supine sleep (adjusted odds ratio [AOR] 2.1, 95% confidence interval [CI], 1.6–2.6); usually no bed sharing (AOR 1.5, 95% CI, 1.2–1.9), and usually use a pacifier during sleep (AOR 1.2, 95% CI, 1.0–1.5). Conclusions High maternal ratings of physician qualification to give advice on 2 of the 3 recommended sleep practices targeted to reduce the risk of SIDS were significantly associated with maternal report of using these behaviors. Lower ratings of physician qualification to give advice about these sleep practices may undermine physician effectiveness in promoting the recommended behavior. PMID:21075318

Smith, Lauren A.; Colson, Eve R.; Rybin, Denis; Margolis, Amy; Colton, Theodore; Lister, George; Corwin, Michael J.

2011-01-01

287

Research design considerations for clinical studies of abuse-deterrent opioid analgesics: IMMPACT recommendations  

PubMed Central

Opioids are essential to the management of pain in many patients, but they also are associated with potential risks for abuse, overdose, and diversion. A number of efforts have been devoted to the development of abuse-deterrent formulations of opioids to reduce these risks. This article summarizes a consensus meeting that was organized to propose recommendations for the types of clinical studies that can be used to assess the abuse deterrence of different opioid formulations. Due to the many types of individuals who may be exposed to opioids, an opioid formulation will need to be studied in several populations using various study designs in order to determine its abuse-deterrent capabilities. It is recommended that the research conducted to evaluate abuse deterrence should include studies assessing: (1) abuse liability; (2) the likelihood that opioid abusers will find methods to circumvent the deterrent properties of the formulation; (3) measures of misuse and abuse in randomized clinical trials involving pain patients with both low risk and high risk of abuse; and (4) post-marketing epidemiological studies. PMID:22770841

Turk, Dennis C.; O'Connor, Alec B.; Dworkin, Robert H.; Chaudhry, Amina; Katz, Nathaniel P.; Adams, Edgar H.; Brownstein, John S.; Comer, Sandra D.; Dart, Richard; Dasgupta, Nabarun; Denisco, Richard A.; Klein, Michael; Leiderman, Deborah B.; Lubran, Robert; Rappaport, Bob A.; Zacny, James P.; Ahdieh, Harry; Burke, Laurie B.; Cowan, Penney; Jacobs, Petra; Malamut, Richard; Markman, John; Michna, Edward; Palmer, Pamela; Peirce-Sandner, Sarah; Potter, Jennifer S.; Raja, Srinivasa N.; Rauschkolb, Christine; Roland, Carl L.; Webster, Lynn R.; Weiss, Roger D.; Wolf, Kerry

2013-01-01

288

Do our current clinical trial designs help to guide clinical practice?  

PubMed

There is a markedly increasing contrast between the current refinement of nosologic classification of sarcoma integrating molecular typing with a growing number of subtypes and the usually standardized approach proposed in clinical practice guidelines for both local and systemic treatment. Although gastrointestinal stromal tumor (GIST), dermatofibrosarcoma protuberans, and a few other subtypes now have specific therapeutic strategies, the majority of sarcomas are still lumped together in clinical trials investigating novel therapeutic options. These trials may not provide sufficient information to guide routine clinical practice. Proof-of-concept trials exploring a targeted agent in a selected molecular subtype, randomized phase II trials, and trials focusing on histologic subtypes-all integrating translational research and aiming to identify the mechanisms of sensitivity and resistance to the treatment-are needed. This paper discusses the limitations of previous clinical trial designs to guide clinical practice in this complex context. PMID:23714554

Blay, Jean-Yves; Derbel, Olfa; Ray-Coquard, Isabelle

2013-01-01

289

Consensus Recommendations for Current Treatments and Accelerating Clinical Trials for Patients with Neurofibromatosis Type 2  

PubMed Central

Neurofibromatosis type 2 (NF2) is a tumor suppressor syndrome characterized by bilateral vestibular schwannomas (VS) which often result in deafness despite aggressive management. Meningiomas, ependymomas and other cranial nerve and peripheral schwannomas are also commonly found in NF2 and collectively lead to major neurologic morbidity and mortality. Traditionally, the overall survival rate in patients with NF2 is estimated to be 38% at 20 years from diagnosis. Hence, there is a desperate need for new, effective therapies. Recent progress in understanding the molecular basis of NF2 related tumors has aided in the identification of potential therapeutic targets and emerging clinical therapies. In June 2010, representatives of the international NF2 research and clinical community convened under the leadership of Drs. D. Gareth Evans (University of Manchester) and Marco Giovannini (House Research Institute) to review the state of NF2 treatment and clinical trials. This manuscript summarizes the expert opinions about current treatments for NF2 associated tumors and recommendations for advancing therapies emerging from that meeting. The development of effective therapies for NF2 associated tumors has the potential for significant clinical advancement not only for patients with NF2 but for thousands of neuro-oncology patients afflicted with these tumors. PMID:22140088

Blakeley, Jaishri O; Evans, D. Gareth; Adler, John; Brackmann, Derald; Chen, Ruihong; Ferner, Rosalie E.; Hanemann, C. Oliver; Harris, Gordon; Huson, Susan M.; Jacob, Abraham; Kalamarides, Michel; Karajannis, Matthias A.; Korf, Bruce R.; Mautner, Victor-Felix; McClatchey, Andrea I.; Miao, Harry; Plotkin, Scott R.; Slattery, William; Stemmer-Rachamimov, Anat O.; Welling, D. Bradley; Wen, Patrick Y.; Widemann, Brigitte; Hunter-Schaedle, Kim; Giovannini, Marco

2011-01-01

290

Consensus recommendations for current treatments and accelerating clinical trials for patients with neurofibromatosis type 2.  

PubMed

Neurofibromatosis type 2 (NF2) is a tumor suppressor syndrome characterized by bilateral vestibular schwannomas (VS) which often result in deafness despite aggressive management. Meningiomas, ependymomas, and other cranial nerve and peripheral schwannomas are also commonly found in NF2 and collectively lead to major neurologic morbidity and mortality. Traditionally, the overall survival rate in patients with NF2 is estimated to be 38% at 20 years from diagnosis. Hence, there is a desperate need for new, effective therapies. Recent progress in understanding the molecular basis of NF2 related tumors has aided in the identification of potential therapeutic targets and emerging clinical therapies. In June 2010, representatives of the international NF2 research and clinical community convened under the leadership of Drs. D. Gareth Evans (University of Manchester) and Marco Giovannini (House Research Institute) to review the state of NF2 treatment and clinical trials. This manuscript summarizes the expert opinions about current treatments for NF2 associated tumors and recommendations for advancing therapies emerging from that meeting. The development of effective therapies for NF2 associated tumors has the potential for significant clinical advancement not only for patients with NF2 but for thousands of neuro-oncology patients afflicted with these tumors. PMID:22140088

Blakeley, Jaishri O; Evans, D Gareth; Adler, John; Brackmann, Derald; Chen, Ruihong; Ferner, Rosalie E; Hanemann, C Oliver; Harris, Gordon; Huson, Susan M; Jacob, Abraham; Kalamarides, Michel; Karajannis, Matthias A; Korf, Bruce R; Mautner, Victor-Felix; McClatchey, Andrea I; Miao, Harry; Plotkin, Scott R; Slattery, William; Stemmer-Rachamimov, Anat O; Welling, D Bradley; Wen, Patrick Y; Widemann, Brigitte; Hunter-Schaedle, Kim; Giovannini, Marco

2012-01-01

291

Diabetic Clinics Today and Tomorrow: Mini-clinics in General Practice  

Microsoft Academic Search

In the belief that there was need for diabetic clinics in general practice, 14 of them have been started in the Wolverhampton area. Provided that patients with diabetes that is difficult to control, or who need extra care, remain the responsibility of the hospital diabetic department, this system is an advantage for the hospital department, general practice, and the patient.

P. A. Thorn; R. G. Russell

1973-01-01

292

Geographic Practice Plans: Their Impact on Podiatric Clinical Education.  

ERIC Educational Resources Information Center

A program that combines certain attractive features of private practice (closer doctor-patient relationship and financial remuneration) and academic medicine is outlined and its feasibility demonstrated. The program is intended to improve the skills of faculty clinicians and provide additional clinical opportunities for podiatry students. (MSE)

Block, Philip

1980-01-01

293

Chronic Pain: Treatment Barriers and Strategies for Clinical Practice  

Microsoft Academic Search

Background: Chronic pain is a clinical challenge for the practicing physician. Lack of knowledge about opioids, negative attitudes toward prescribing opioids, and inadequate pain-assessment skills combine to create major barriers to pain relief. Patient-related barriers, such as lack of communication and un- warranted fears of addiction, further complicate pain assessment and treatment. The health care system itself can hinder pain

Myra Glajchen

294

Formal Methods for Verification of Clinical Practice Guidelines  

E-print Network

. In Section 4, we briefly discuss formal meth- ods in relation to protocol development and compliance checking, as described above. Finally, in Section 5, we discuss the role of formal methods in its relation to medicalFormal Methods for Verification of Clinical Practice Guidelines Arjen HOMMERSOM a,1 , Perry GROOT

Groot, Perry

295

Clinical Protocol Page 1 of 4 Nursing Practice Manual  

E-print Network

Clinical Protocol Page 1 of 4 Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing with POLICY: 1. All patients admitted with a primary diagnosis of Congestive Heart Failure (CHF) should have the CHF order set initiated. 2. All patients admitted with a primary diagnosis of CHF will have

Oliver, Douglas L.

296

Clinical Procedure Page 1 of 5 Nursing Practice Manual  

E-print Network

the nurse should be aware of the patient's diagnosis, baseline hemoglobin, hematocrit, ferritinClinical Procedure Page 1 of 5 Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: PROCEDURE FOR: Therapeutic Phlebotomy

Oliver, Douglas L.

297

A General Model for Preventive Intervention in Clinical Practice.  

ERIC Educational Resources Information Center

A project to develop curriculum and instructional materials in preventive medicine has been initiated by the Association of Teachers of Preventive Medicine in cooperation with the Center for Educational Development in Health at Boston University. A model delineating physician responsibilities in the preventive dimension of clinical practice was…

Segall, Ascher; And Others

1981-01-01

298

Clinical Protocol Page 1 of 1 Nursing Practice Manual  

E-print Network

Clinical Protocol Page 1 of 1 Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing evaluated by psychiatry and a level of safe observation is determined. 2. Nursing should verify that a psychiatric consult has been ordered. 3. Staff will maintain awareness of patient's safety, especially during

Oliver, Douglas L.

299

Clinical Procedure Page 1 of 2 Nursing Practice Manual  

E-print Network

being removed intraoperatively to maintain patient safety. APPROVAL: Nursing Standards CommitteeClinical Procedure Page 1 of 2 Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROTOCOL FOR: Jewelry: Wearing of Jewelry and Body

Oliver, Douglas L.

300

Prototypes for content-based image retrieval in clinical practice.  

PubMed

Content-based image retrieval (CBIR) has been proposed as key technology for computer-aided diagnostics (CAD). This paper reviews the state of the art and future challenges in CBIR for CAD applied to clinical practice.We define applicability to clinical practice by having recently demonstrated the CBIR system on one of the CAD demonstration workshops held at international conferences, such as SPIE Medical Imaging, CARS, SIIM, RSNA, and IEEE ISBI. From 2009 to 2011, the programs of CADdemo@CARS and the CAD Demonstration Workshop at SPIE Medical Imaging were sought for the key word "retrieval" in the title. The systems identified were analyzed and compared according to the hierarchy of gaps for CBIR systems.In total, 70 software demonstrations were analyzed. 5 systems were identified meeting the criterions. The fields of application are (i) bone age assessment, (ii) bone fractures, (iii) interstitial lung diseases, and (iv) mammography. Bridging the particular gaps of semantics, feature extraction, feature structure, and evaluation have been addressed most frequently.In specific application domains, CBIR technology is available for clinical practice. While system development has mainly focused on bridging content and feature gaps, performance and usability have become increasingly important. The evaluation must be based on a larger set of reference data, and workflow integration must be achieved before CBIR-CAD is really established in clinical practice. PMID:21892374

Depeursinge, Adrien; Fischer, Benedikt; Müller, Henning; Deserno, Thomas M

2011-01-01

301

The Use of Bone Age in Clinical Practice – Part 1  

Microsoft Academic Search

This review examines the role of skeletal maturity (‘bone age’, BA) assessment in clinical practice. BA is mainly used in children with the following conditions: short stature (addressed in part 1 of this review), tall stature, early or late puberty, and congenital adrenal hyperplasia (all addressed in part 2). Various manual and automatic methods of BA assessment have been developed.

David D. Martin; Jan M. Wit; Ze’ev Hochberg; Lars Sävendahl; Rick R. van Rijn; Oliver Fricke; Noël Cameron; Janina Caliebe; Thomas Hertel; Daniela Kiepe; Kerstin Albertsson-Wikland; Hans Henrik Thodberg; Gerhard Binder; Michael B. Ranke

2011-01-01

302

Semi-Spontaneous Oral Text Production: Measurements in Clinical Practice  

ERIC Educational Resources Information Center

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

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

2009-01-01

303

Procedure Page 1 of 2 Clinical Manual / Nursing Practice Manual  

E-print Network

Procedure Page 1 of 2 Clinical Manual / Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: Blood Components: Type and Screen / ABO specimens will be rejected by the Blood Bank. This includes any discrepancies between the patient

Oliver, Douglas L.

304

Clinical Procedure Page 1 of 2 Clinical Manual / Nursing Practice Manual  

E-print Network

. The progress/care plan note may be labeled using a nursing diagnosis, an event or symptom, or a variance. 5Clinical Procedure Page 1 of 2 Clinical Manual / Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: Documentation: Progress

Oliver, Douglas L.

305

Clinical Procedure Page 1 of 2 Clinical Manual-Nursing Practice Manual  

E-print Network

Clinical Procedure Page 1 of 2 Clinical Manual-Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: Ambulatory Patient Summary and will minimally include: a. Known Medical Diagnoses/Conditions and date of diagnosis/occurrence b. Known Surgeries

Oliver, Douglas L.

306

Clinical Protocol Page 1 of 1 Clinical Manual Nursing Practice Manual  

E-print Network

Clinical Protocol Page 1 of 1 Clinical Manual ­ Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROTOCOL FOR: Hypertension: Care of the Patient with POLICY: 1. Any patient admitted to the hospital with an admission diagnosis of hypertension

Oliver, Douglas L.

307

Clinical Protocol/Procedure Page 1 of 2 Clinical Manual -Nursing Practice Manual  

E-print Network

Clinical Protocol/Procedure Page 1 of 2 Clinical Manual - Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROTOCOL/ PROCEDURE FOR orthopedic procedure, surgery or trauma, then every 4 hours for 24 hours, then every shift, or per specific

Oliver, Douglas L.

308

Clinical Protocol Page 1 of 6 Clinical Manual -Nursing Practice Manual  

E-print Network

of restraint. Nursing: The comprehensive assessment should address patient safety, limitations in mobilityClinical Protocol Page 1 of 6 Clinical Manual - Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROTOCOL: Restraint Use for Non

Oliver, Douglas L.

309

Clinical Procedure Page 1 of 1 Clinical Manual -Nursing Practice Manual  

E-print Network

Clinical Procedure Page 1 of 1 Clinical Manual - Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: Insulin, Regular U500: Use of PURPOSE: The purpose of this policy is to standardize prescribing and ensure safety measures

Oliver, Douglas L.

310

Coordination of Scheduling Clinical Externship or Clinical Practice Experiences for Students in Physical Therapy Educational Programs.  

ERIC Educational Resources Information Center

A project to coordinate the scheduling of allied health occupations students for clinical practice or externship experiences in Southeast Florida is described. A model clinical facility utilization and time schedule matrix was developed for four programs: the physical therapy programs at Florida International University (FIU) and the University of…

Patterson, Robert K.; Kass, Susan H.

311

Clinical Policy Page 1 of 1 Clinical Manual -Nursing Practice Manual  

E-print Network

Clinical Policy Page 1 of 1 Clinical Manual - Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: Oxygen Therapy: Oxygen by a licensed person. A written order must be obtained by the responsible MD/LIP once the patient has been

Oliver, Douglas L.

312

Clinical Procedure Page 1 of 3 Clinical Manual / Nursing Practice Manual  

E-print Network

. Temperature, heart rate, blood pressure, respiratory rate (Vital Signs, including Admission and Post-op vitalClinical Procedure Page 1 of 3 Clinical Manual / Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: Assessment: Scope of Nursing

Oliver, Douglas L.

313

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

ERIC Educational Resources Information Center

Background: Research into the practices of speech-language therapists in clinical sessions is beginning to identify the way communication in clinical interactions both facilitates and potentially impedes the achievement of therapy goals. Aims: This target article aims to raise the issues that arise from critical reflections on the communication of…

Ferguson, Alison; Armstrong, Elizabeth

2004-01-01

314

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

PubMed

Patricia Benner applied the Dreyfus Model of Skill Acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice. Operational definitions for the 5 levels of her original Novice to Expert Theory were used by the study participants in a large Midwestern pediatric hospital to self-identify their level of practice. The frontline clinical managers of these direct care registered nurses (RNs) used the same tool to rate their direct reports. The aim of this portion of a larger study was to determine if the clinical manager's perception of their direct reports was the same as that of the RNs. The results of this study are being used by one study unit's clinical managers as the basis for implementing the Hersey and Blanchard Situational Leadership Model. The clinical managers work with their direct reports depending on the level of practice and the details of the task to be performed. One example is creating therapeutic relationships with each other and with families to ensure a safe environment for all. PMID:23934257

Longo, M Anne; Roussel, Linda; Pennington, Sandra L; Hoying, Cheryl

2013-01-01

315

Clinical practice guideline on diagnosis and treatment of hyponatraemia.  

PubMed

Hyponatraemia, defined as a serum sodium concentration <135 mmol/L, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. Hyponatraemia is present in 15-20% of emergency admissions to hospital and occurs in up to 20% of critically ill patients. Symptomatology may vary from subtle to severe or even life threatening. Despite this, the management of patients remains problematic. Against this background, the European Society of Intensive Care Medicine, the European Society of Endocrinology and the European Renal Association-European Dialysis and Transplant Association, represented by European Renal Best Practice have developed a Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. PMID:24562549

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

2014-03-01

316

On the relation of clinical research to clinical practice: Current issues, new directions  

Microsoft Academic Search

Recent trends in clinical psychology training have institutionalized the scientist–practitioner split after observations that clinicians are unlikely to engage in research of any kind. But a more serious development is the realization that many clinicians are not even influenced by clinical research findings, resorting instead to a trial-and-error eclecticism in their clinical practice. This is due more to limitations in

David H. Barlow

1981-01-01

317

[Functional neuroimaging in the diagnosis of patients with Parkinsonism: Update and recommendations for clinical use].  

PubMed

Functional Neuroimaging has been traditionally used in research for patients with different Parkinsonian syndromes. However, the emergence of commercial radiotracers together with the availability of single photon emission computed tomography (SPECT) and, more recently, positron emission tomography (PET) have made them available for clinical practice. Particularly, the development of clinical evidence achieved by functional neuroimaging techniques over the past two decades have motivated a progressive inclusion of several biomarkers in the clinical diagnostic criteria for neurodegenerative diseases that occur with Parkinsonism. However, the wide range of radiotracers designed to assess the involvement of different pathways in the neurodegenerative process underlying Parkinsonian syndromes (dopaminergic nigrostriatal pathway integrity, basal ganglia and cortical neuronal activity, myocardial sympathetic innervation), and the different neuroimaging techniques currently available (scintigraphy, SPECT and PET), have generated some controversy concerning the best neuroimaging test that should be indicated for the differential diagnosis of Parkinsonism. In this article, a panel of nuclear medicine and neurology experts has evaluated the functional neuroimaging techniques emphazising practical considerations related to the diagnosis of patients with uncertain origin parkinsonism and the assessment Parkinson's disease progression. PMID:24731551

Arbizu, J; Luquin, M R; Abella, J; de la Fuente-Fernández, R; Fernandez-Torrón, R; García-Solís, D; Garrastachu, P; Jiménez-Hoyuela, J M; Llaneza, M; Lomeña, F; Lorenzo-Bosquet, C; Martí, M J; Martinez-Castrillo, J C; Mir, P; Mitjavila, M; Ruiz-Martínez, J; Vela, L

2014-01-01

318

Good Clinical Practice in Resource-Limited Settings: Translating Theory into Practice  

PubMed Central

A Good Clinical Practices (GCPs) course, based on the combination of theoretical modules with a practical training in real-life conditions, was held in 2010 in Burkina Faso. It was attended by 15 trainees from nine African, Asian, and Latin American countries. There were some discrepancies between the average good results at the end of the theoretical phase and the GCP application during the first days of the practical phase, underlying the difficulties of translating theoretical knowledge into good practices. Most of the findings were not unexpected and reflected the challenges commonly faced by clinical investigators in resource-poor contexts (i.e., the high workload at peripheral health facilities, the need to conciliate routine clinical activities with clinical research, and the risk of creating a double standard among patients attending the same health facility [free care for recruited patients versus user fees for non-recruited patients with the same medical condition]). Even if limited in number and time, these observations suggest that a theoretical training alone may not be sufficient to prepare trainees for the challenges of medical research in real-life settings. Conversely, when a practical phase immediately follows a theoretical one, trainees can immediately experience what the research methodology implicates in terms of work organization and relationship with recruited and non-recruited patients. This initial experience shows the complexity of translating GCP into practice and suggests the need to rethink the current conception of GCP training. PMID:23553224

Tinto, Halidou; Noor, Ramadhani A.; Wanga, Charles L.; Valea, Innocent; Mbaye, Maimouna Ndour; D'Alessandro, Umberto; Ravinetto, Raffaella M.

2013-01-01

319

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

PubMed Central

This study aimed to estimate the proportion of patients at the University Hospital of the West Indies (UHWI) Diabetes Clinic who engage in recommended foot care and footwear practices. Seventy-two participants from the UHWI Diabetes Clinic completed an interviewer-administered questionnaire on foot care practices and types of footwear worn. Participants were a subset of a sex-stratified random sample of clinic attendees and were interviewed in 2010. Data analysis included frequency estimates of the various foot care practices and types of footwear worn. Participants had a mean age of 57.0±14.3 years and mean duration of diabetes of 17.0±10.3 years. Fifty-three percent of participants reported being taught how to care for their feet, while daily foot inspection was performed by approximately 60% of participants. Most participants (90%) reported daily use of moisturizing lotion on the feet but almost 50% used lotion between the toes. Approximately 85% of participants reported wearing shoes or slippers both indoors and outdoors but over 40% reported walking barefoot at some time. Thirteen percent wore special shoes for diabetes while over 80% wore shoes without socks at some time. Although much larger proportions reported wearing broad round toe shoes (82%) or leather shoes (64%), fairly high proportions reported wearing pointed toe shoes (39%), and 43% of women wore high heel shoes. In conclusion, approximately 60% of patients at the UHWI diabetic clinic engage in daily foot inspection and other recommended practices, but fairly high proportions reported foot care or footwear choices that should be avoided. PMID:24765484

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

2012-01-01

320

Leveraging Epidemiology and Clinical Studies of Cancer Outcomes: Recommendations and Opportunities for Translational Research  

PubMed Central

As the number of cancer survivors continues to grow, research investigating the factors that affect cancer outcomes, such as disease recurrence, risk of second malignant neoplasms, and the late effects of cancer treatments, becomes ever more important. Numerous epidemiologic studies have investigated factors that affect cancer risk, but far fewer have addressed the extent to which demographic, lifestyle, genomic, clinical, and psychosocial factors influence cancer outcomes. To identify research priorities as well as resources and infrastructure needed to advance the field of cancer outcomes and survivorship research, the National Cancer Institute sponsored a workshop titled “Utilizing Data from Cancer Survivor Cohorts: Understanding the Current State of Knowledge and Developing Future Research Priorities” on November 3, 2011, in Washington, DC. This commentary highlights recent findings presented at the workshop, opportunities to leverage existing data, and recommendations for future research, data, and infrastructure needed to address high priority clinical and research questions. Multidisciplinary teams that include epidemiologists, clinicians, biostatisticians, and bioinformaticists will be essential to facilitate future cancer outcome studies focused on improving clinical care of cancer patients, identifying those at high risk of poor outcomes, and implementing effective interventions to ultimately improve the quality and duration of survival. PMID:23197494

2013-01-01

321

RUNNING HEAD: From the Classroom to Clinical Practice From the Classroom to Clinical Practice: A Music Therapy Students' Perspective  

Microsoft Academic Search

This paper provides the opportunity to learn about three music therapy students' experiences of applying classroom learning in clinical practice in community- based agencies in Ontario. Varying outcomes and insights as result of placements including an Alzheimer's day program, a continuing care facility, and an intervention centre for children with Autism are discussed.

Robyn Braybrook; Ruth Watkiss; Nefeli Kaderli; Petra Kern

322

Electronic risk assessment for venous thromboembolism: investigating physicians' rationale for bypassing clinical decision support recommendations  

PubMed Central

Objective The underutilisation of venous thromboembolism (VTE) prophylaxis is still a problem in the UK despite the emergence of national guidelines and incentives to increase the number of patients undergoing VTE risk assessments. Our objective was to examine the reasons doctors gave for not prescribing enoxaparin when recommended by an electronic VTE risk assessment alert. Design We used a qualitative research design to conduct a thematic analysis of free text entered into an electronic prescribing system. Setting The study took place in a large University teaching hospital, which has a locally developed electronic prescribing system known as PICS (Prescribing, Information and Communication System). Participants We extracted prescription data from all inpatient admissions over a 7-month period in 2012 using the audit database of PICS. Intervention The completion of the VTE risk assessment form introduced into the hospital-wide electronic prescribing and health records system is mandatory. Where doctors do not prescribe VTE prophylaxis when recommended, they are asked to provide a reason for this decision. The free-text field was introduced in May 2012. Primary and secondary outcome measures Free-text reasons for not prescribing enoxaparin when recommended were thematically coded. Results A total of 1136 free-text responses from 259 doctors were collected in the time period and 1206 separate reasons were analysed and coded. 389 reasons (32.3%) for not prescribing enoxaparin were coded as being due to ‘clinical judgment’; in 288 (23.9%) of the responses, doctors were going to reassess the patient or prescribe enoxaparin; and in 245 responses (20.3%), the system was seen to have produced an inappropriate alert. Conclusions In order to increase specificity of warnings and avoid users developing alert fatigue, it is essential that an evaluation of user responses and/or end user feedback as to the appropriateness and timing of alerts is obtained. PMID:25260369

Nwulu, Ugochi; Brooks, Hannah; Richardson, Suzanna; McFarland, Lorraine; Coleman, Jamie J

2014-01-01

323

Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices.  

PubMed

This report summarizes new recommendation and updates previous recommendations of the Advisory Committee on Immunization Practices (ACIP) for postexposure prophylaxis (PEP) to prevent human rabies (CDC. Human rabies prevention---United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR 2008;57[No. RR-3]). Previously, ACIP recommended a 5-dose rabies vaccination regimen with human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV). These new recommendations reduce the number of vaccine doses to four. The reduction in doses recommended for PEP was based in part on evidence from rabies virus pathogenesis data, experimental animal work, clinical studies, and epidemiologic surveillance. These studies indicated that 4 vaccine doses in combination with rabies immune globulin (RIG) elicited adequate immune responses and that a fifth dose of vaccine did not contribute to more favorable outcomes. For persons previously unvaccinated with rabies vaccine, the reduced regimen of 4 1-mL doses of HDCV or PCECV should be administered intramuscularly. The first dose of the 4-dose course should be administered as soon as possible after exposure (day 0). Additional doses then should be administered on days 3, 7, and 14 after the first vaccination. ACIP recommendations for the use of RIG remain unchanged. For persons who previously received a complete vaccination series (pre- or postexposure prophylaxis) with a cell-culture vaccine or who previously had a documented adequate rabies virus-neutralizing antibody titer following vaccination with noncell-culture vaccine, the recommendation for a 2-dose PEP vaccination series has not changed. Similarly, the number of doses recommended for persons with altered immunocompetence has not changed; for such persons, PEP should continue to comprise a 5-dose vaccination regimen with 1 dose of RIG. Recommendations for pre-exposure prophylaxis also remain unchanged, with 3 doses of vaccine administered on days 0, 7, and 21 or 28. Prompt rabies PEP combining wound care, infiltration of RIG into and around the wound, and multiple doses of rabies cell-culture vaccine continue to be highly effective in preventing human rabies. PMID:20300058

Rupprecht, Charles E; Briggs, Deborah; Brown, Catherine M; Franka, Richard; Katz, Samuel L; Kerr, Harry D; Lett, Susan M; Levis, Robin; Meltzer, Martin I; Schaffner, William; Cieslak, Paul R

2010-03-19

324

Technology transfer through a network of standard methods and recommended practices - The case of petrochemicals  

NASA Astrophysics Data System (ADS)

Technology transfer may take place in parallel with cooperative action between companies participating in the same organizational scheme or using one another as subcontractor (outsourcing). In this case, cooperation should be realized by means of Standard Methods and Recommended Practices (SRPs) to achieve (i) quality of intermediate/final products according to specifications and (ii) industrial process control as required to guarantee such quality with minimum deviation (corresponding to maximum reliability) from preset mean values of representative quality parameters. This work deals with the design of the network of SRPs needed in each case for successful cooperation, implying also the corresponding technology transfer, effectuated through a methodological framework developed in the form of an algorithmic procedure with 20 activity stages and 8 decision nodes. The functionality of this methodology is proved by presenting the path leading from (and relating) a standard test method for toluene, as petrochemical feedstock in the toluene diisocyanate production, to the (6 generations distance upstream) performance evaluation of industrial process control systems (ie., from ASTM D5606 to BS EN 61003-1:2004 in the SRPs network).

Batzias, Dimitris F.; Karvounis, Sotirios

2012-12-01

325

Recommended management practices for operation and closure of shallow injection wells at DOE facilities  

SciTech Connect

The Safe Drinking Water Act established the Underground Injection Control (UIC) program to ensure that underground injection of wastes does not endanger an underground source of drinking water. Under UIC regulations, an injection well is a hole in the ground, deeper than it is wide, that receives wastes or other fluid substances. Types of injection wells range from deep cased wells to shallow sumps, drywells, and drainfields. The report describes the five classes of UIC wells and summarizes relevant regulations for each class of wells and for the UIC program. The main focus of the report is Class IV and V shallow injection wells. Class IV wells are prohibited and should be closed when they are identified. Class V wells are generally authorized by rule, but EPA or a delegated state may require a permit for a Class V well. This report provides recommendations on sound operating and closure practices for shallow injection wells. In addition the report contains copies of several relevant EPA documents that provide additional information on well operation and closure. Another appendix contains information on the UIC programs in 21 states in which there are DOE facilities discharging to injection wells. The appendix includes the name of the responsible regulatory agency and contact person, a summary of differences between the state`s regulations and Federal regulations, and any closure guidelines for Class IV and V wells.

Not Available

1993-07-01

326

Review of Refugee Mental Health Interventions Following Resettlement: Best Practices and Recommendations  

PubMed Central

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psycho-educational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement. PMID:20950298

Murray, Kate E; Davidson, Graham R; Schweitzer, Robert D

2013-01-01

327

Advancing Clinical Practice and Policy through Guidelines. The Role of the American Thoracic Society  

PubMed Central

In the face of an overwhelmingly large and growing medical literature, providers often turn to clinical practice guidelines to inform the decisions they make with patients. By systematically appraising the evidence and providing transparent recommendations for practice, guidelines have the potential to improve both bedside decision-making and health policy. This potential has not been fully realized because most guidelines lack transparency, are tainted by conflicts of interest, or fail to employ rigorous methods to appraise the evidence. To address the shortcomings of past guidelines, the Institute of Medicine (IOM) published recommendations for trustworthy guidelines, effectively setting the “gold standard” for what constitutes a high-quality guideline. Along with many other groups that develop guidelines, the American Thoracic Society (ATS) is rapidly evolving processes for development and implementation to meet many of the IOM standards. This Pulmonary Perspective describes the rapidly changing landscape of clinical practice guidelines, the role of the ATS in this landscape, and the activities the ATS is engaged in to ensure that the guidelines it produces are of the highest quality with the broadest impact. PMID:23392437

Gould, Michael K.

2013-01-01

328

Recommendations for clinical trials of off-label drugs used to treat advanced-stage cancer. | accrualnet.cancer.gov  

Cancer.gov

Between one half and three quarters of cancer drugs are being used off label, and only 27 percent of off-label uses are supported by strong clinical evidence. More clinical trials on off-label usage of cancer drugs are needed. This study provides recommendations that may be helpful in planning recruitment strategies for such trials.

329

Clinical practice guideline on diagnosis and treatment of hyponatraemia.  

PubMed

Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice. PMID:24569496

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

2014-04-01

330

Clinical practice guideline on diagnosis and treatment of hyponatraemia.  

PubMed

Hyponatraemia, defined as a serum sodium concentration <135?mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice. PMID:24569125

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

2014-03-01

331

Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review  

PubMed Central

Objectives Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP. Design Systematic review. Two investigators independently performed the systematic reviewing process. Information sources MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011. Eligibility criteria for included studies Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings. Results We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside. Conclusions More than 20?years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP. PMID:23355664

Ubbink, Dirk T; Guyatt, Gordon H; Vermeulen, Hester

2013-01-01

332

The practice of clinical handover: a respite perspective.  

PubMed

This article aims to reflect on handovers that take place in respite settings-a healthcare setting with little mention in the literature. The author presents a reflective account of the practice of handover in one respite unit in south-east England. As these are the author's own observations and experience, no reflective model has been used as a guide. The article also reports on the findings of a small web-based survey conducted by Facebook and email contacts that aimed to understand the attitudes of health professionals, mainly from the respite-care setting, towards the practice of clinical handover. The findings showed that handover is an important part of safer care practice and is highly valued by the respondents as being a planning and organising mechanism for better management of shifts. This paper concludes by raising awareness of the lack of information available about the practice of clinical handover in respite settings. It also suggests the need for an in-depth study on handover practice in respite care. PMID:25072335

Croos, Solomon

333

Cardiovascular implantable electronic device leads in CKD and ESRD patients: review and recommendations for practice.  

PubMed

Cardiovascular implantable electronic devices (CIEDs) are frequently utilized for management of cardiac dysrhythmias in patients with chronic kidney disease or end-stage renal disease receiving hemodialysis. The survival benefit from use of implantable cardioverter defibrillators in patients with CKD or ESRD is not as clear as in the general population, particularly when used for primary prevention of sudden cardiac death. Transvenous CIED leads are associated with central vein stenosis resulting in significant adverse consequences for existing or future arteriovenous access. Venous hypertension from CIED lead-related central vein stenosis is a challenging clinical problem and may require repeated percutaneous interventions, replacement of the CIED, or creation of alternative arteriovenous access. Infections associated with transvenous CIED leads are more frequent and associated with worse outcomes in patients with renal disease. Epicardial CIED leads or other nontransvenous devices may reduce complications of both central venous stenosis and endovascular infection in these vulnerable patients. Consensus recommendations are offered for avoidance and management of complications arising from the use of CIEDs and arteriovenous hemodialysis access. PMID:22891983

Saad, Theodore F; Hentschel, Dirk M; Koplan, Bruce; Wasse, Haimanot; Asif, Arif; Patel, Daniel V; Salman, Loay; Carrillo, Roger; Hoggard, Jeff

2013-01-01

334

A review of clinical practice guidelines for lung cancer  

PubMed Central

Clinical practice guidelines are important evidence-based resources to guide complex clinical decision making. However, it is challenging for health professionals to keep abreast available guidelines and to know how and where to access relevant guidelines. This review examines currently available guidelines for lung cancer published in the English language. Important key features are listed for each identified guideline. The methodology, approaches to dissemination and implementation, and associated resources are summarised. General challenges in the area of guideline development are highlighted. The potential to collaborate more widely across lung cancer guideline developers by sharing literature searches and assessments is discussed. PMID:24163752

Ball, David; Silvestri, Gerard A.

2013-01-01

335

Clinical management of atopic dermatitis: practical highlights and updates from the atopic dermatitis practice parameter 2012.  

PubMed

Atopic dermatitis is a challenging condition for clinicians and patients. Recent advances were documented in the Atopic Dermatitis Practice Parameter 2012, and we want to provide clinicians with key points from the Atopic Dermatitis Practice Parameter 2012. In this article, we highlight the evidence-based therapy of atopic dermatitis as well as provide practical tips for clinicians and families. An updated review of immunopathology provides a firm basis for patient education and therapy. We also review clinical diagnosis and ways to improve quality of life for patients with atopic dermatitis. PMID:25017522

Lio, Peter A; Lee, Margaret; LeBovidge, Jennifer; Timmons, Karol G; Schneider, Lynda

2014-01-01

336

Notifying Parents Following a College Student Suicide Attempt: A Review of Case Law and FERPA, and Recommendations for Practice  

ERIC Educational Resources Information Center

Decisions by university officials not to notify a student's parents following a suicide attempt on campus have been severely criticized by some observers. Although courts have not imposed a parental notice requirement, the practice is advantageous to students in many situations. The author recommends a system of notification that relies primarily…

Baker, Thomas R.

2005-01-01

337

Investing in Youth: A Compilation of Recommended Policies and Practices. National Conference (New Orleans, Louisiana, December 9-11, 1992).  

ERIC Educational Resources Information Center

These proceedings include 13 "perspectives from the field" and 9 selected papers (with abstracts) from a national conference on recommended policies and practices for investing in youth. The 13 perspectives papers are as follows: "Saving the Next Generation" (Berlin); "Effective Strategies for Investing in Youth" (El-Amin); "Policies and Issues…

National Governors' Association, Washington, DC.

338

Partnerships for better mental health worldwide: WPA recommendations on best practices in working with service users and family carers  

PubMed Central

WPA President M. Maj established the Task Force on Best Practice in Working with Service Users and Carers in 2008, chaired by H. Herrman. The Task Force had the remit to create recommendations for the international mental health community on how to develop successful partnership working. The work began with a review of literature on service user and carer involvement and partnership. This set out a range of considerations for good practice, including choice of appropriate terminology, clarifying the partnership process and identifying and reducing barriers to partnership working. Based on the literature review and on the shared knowledge in the Task Force, a set of ten recommendations for good practice was developed. These recommendations were the basis for a worldwide consultation of stakeholders with expertise as service users, families and carers, and the WPA Board and Council. The results showed a strong consensus across the international mental health community on the ten recommendations, with the strongest agreement coming from service users and carers. This general consensus gives a basis for Task Force plans to seek support for activities to promote shared work worldwide to identify best practice examples and create a resource to assist others to begin successful collaboration. PMID:21991284

WALLCRAFT, JAN; AMERING, MICHAELA; FREIDIN, JULIAN; DAVAR, BHARGAVI; FROGGATT, DIANE; JAFRI, HUSSAIN; JAVED, AFZAL; KATONTOKA, SYLVESTER; RAJA, SHOBA; RATAEMANE, SOLOMON; STEFFEN, SIGRID; TYANO, SAM; UNDERHILL, CHRISTPHER; WAHLBERG, HENRIK; WARNER, RICHARD; HERRMAN, HELEN

2011-01-01

339

Recommendations for Modernization of Solid Waste Management Practices in Class -I Cities -Suggestions on Choice of Technology in Indian Context  

E-print Network

filled in a scientific manner. Integrated Plant Nutrient Management or IPNM, where composted urban wasteRecommendations for Modernization of Solid Waste Management Practices in Class - I Cities. 61') Preamble The Supreme Court Committee for Solid Waste Management in Class-1 Cities in India

Columbia University

340

Method transfer, partial validation, and cross validation: recommendations for best practices and harmonization from the global bioanalysis consortium harmonization team.  

PubMed

This paper presents the recommendations of the Global Bioanalytical Consortium Harmonization Team on method transfer, partial validation, and cross validation. These aspects of bioanalytical method validation, while important, have received little detailed attention in recent years. The team has attempted to define, separate, and describe these related activities, and present practical guidance in how to apply these techniques. PMID:25190270

Briggs, R J; Nicholson, R; Vazvaei, F; Busch, J; Mabuchi, M; Mahesh, K S; Brudny-Kloeppel, M; Weng, N; Galvinas, P A R; Duchene, P; Hu, Pei; Abbott, R W

2014-11-01

341

Bisphosphonates: Mechanism of Action and Role in Clinical Practice  

PubMed Central

Bisphosphonates are primary agents in the current pharmacological arsenal against osteoclast-mediated bone loss due to osteoporosis, Paget disease of bone, malignancies metastatic to bone, multiple myeloma, and hypercalcemia of malignancy. In addition to currently approved uses, bisphosphonates are commonly prescribed for prevention and treatment of a variety of other skeletal conditions, such as low bone density and osteogenesis imperfecta. However, the recent recognition that bisphosphonate use is associated with pathologic conditions including osteonecrosis of the jaw has sharpened the level of scrutiny of the current widespread use of bisphosphonate therapy. Using the key words bisphosphonate and clinical practice in a PubMed literature search from January 1, 1998, to May 1, 2008, we review current understanding of the mechanisms by which bisphosphonates exert their effects on osteoclasts, discuss the role of bisphosphonates in clinical practice, and highlight some areas of concern associated with bisphosphonate use. PMID:18775204

Drake, Matthew T.; Clarke, Bart L.; Khosla, Sundeep

2009-01-01

342

Diagnostic Value of Urinary Dysmorphic Erythrocytes in Clinical Practice  

Microsoft Academic Search

Background: In clinical practice, discriminating between glomerular and nonglomerular causes of hematuria is often difficult. Dysmorphic red blood cells (dRBC) in the urinary sediment are claimed to be effective, but the cutoff points in the literature vary. This follow-up study aimed to determine the diagnostic value of dRBC. Methods: We investigated 134 hematuria patients in the departments of nephrology and

Meindert J. Crop; Yolanda B. de Rijke; Paul C. M. S. Verhagen; Karlien Cransberg; Robert Zietse

2010-01-01

343

Biosimilars in oncology: from development to clinical practice.  

PubMed

Biologics play an integral role in the treatment of cancer not only for their therapeutic effects and ability to improve outcomes, but also as supportive care agents. Biologics are more complex to manufacture and take longer to bring to market. Because biologics are considerably more costly than small-molecule drugs, their use has placed an increasing economic demand on healthcare systems worldwide. Biosimilars are designed to be highly similar to existing branded biologics, but because biologics cannot be exactly copied, biosimilars should not be referred to as generic, exact versions of the innovator biologic. Biosimilars have the potential to increase access and provide lower cost options for cancer care as patent protection for some of the most widely used biologics begins to expire. Regulatory requirements for biosimilars are evolving, as are global harmonization and/or standardization strategies that can facilitate their robust clinical development. This review highlights critical factors involved with the integration of biosimilars into oncology treatment paradigms and practices. Clinicians will likely seek out practice guidelines and position statements from established scientific societies to help evaluate key information regarding biosimilars, such as efficacy, safety, comparability, and interchangeability with the reference biologic. Automatic substitution, nomenclature, extrapolation of clinical data from one indication to another, as well as parameters for ongoing pharmacovigilance are evolving considerations. Education of physicians and other healthcare providers, payers, and patients about biosimilars may facilitate informed decision making, promote acceptance of biosimilars into clinical practice, increase accessibility, and expedite associated health and economic benefits. PMID:24767633

Rak Tkaczuk, Katherine H; Jacobs, Ira Allen

2014-04-01

344

Evidence-Based Practice for Children with Speech Sound Disorders: Part 2 Application to Clinical Practice  

ERIC Educational Resources Information Center

Purpose: This article provides both a tutorial and a clinical example of how speech-language pathologists (SLPs) can conduct evidence-based practice (EBP) when working with children with speech sound disorders (SSDs). It is a companion paper to the narrative review of 134 intervention studies for children who have an SSD (Baker & McLeod, 2011).…

Baker, Elise; McLeod, Sharynne

2011-01-01

345

An interprofessional collaborative practice model: Primary-care clinical associates at the family practice setting  

Microsoft Academic Search

A persistent physician shortage challenges the ability of our healthcare system to meet the growing health needs of our aging population. Health system redesign must maximize the efficient use of available human resources. The Alberta Westview Primary Care Network (WPCN) introduced the Primary Care Clinical Associate (CA) program in 2005. This interprofessional collaborative practice model recruits nonphysician health professionals from

Jessica S. E. Moe; Allan L. Bailey; Stanley Kroeker; Grace Moe

2010-01-01

346

Common data elements for pediatric traumatic brain injury: recommendations from the working group on demographics and clinical assessment.  

PubMed

The Common Data Elements (CDEs) initiative is a National Institutes of Health (NIH) interagency effort to standardize naming, definitions, and data structure for clinical research variables. Comparisons of the results of clinical studies of neurological disorders have been hampered by variability in data coding, definitions, and procedures for sample collection. The CDE project objective is to enable comparison of future clinical trials results in major neurological disorders, including traumatic brain injury (TBI), stroke, multiple sclerosis, and epilepsy. As part of this effort, recommendations for CDEs for research on TBI were developed through a 2009 multi-agency initiative. Following the initial recommendations of the Working Group on Demographics and Clinical Assessment, a separate workgroup developed recommendations on the coding of clinical and demographic variables specific to pediatric TBI studies for subjects younger than 18 years. This article summarizes the selection of measures by the Pediatric TBI Demographics and Clinical Assessment Working Group. The variables are grouped into modules which are grouped into categories. For consistency with other CDE working groups, each variable was classified by priority (core, supplemental, and emerging). Templates were produced to summarize coding formats, guide selection of data points, and provide procedural recommendations. This proposed standardization, together with the products of the other pediatric TBI working groups in imaging, biomarkers, and outcome assessment, will facilitate multi-center studies, comparison of results across studies, and high-quality meta-analyses of individual patient data. PMID:21939389

Adelson, P David; Pineda, Jose; Bell, Michael J; Abend, Nicholas S; Berger, Rachel P; Giza, Christopher C; Hotz, Gillian; Wainwright, Mark S

2012-03-01

347

Use of dexamethasone in patients with high-grade glioma: a clinical practice guideline  

PubMed Central

Background Dexamethasone is the corticosteroid most commonly used for the management of vasogenic edema and increased intracranial pressure in patients with brain tumours. It is also used after surgery (before embarking on radiotherapy), particularly in patients whose tumours exert significant mass effect. Few prospective clinical trials have set out to determine the optimal dose and schedule for dexamethasone in patients with primary brain tumours, and subsequently, fewer clinical practice guideline recommendations have been formulated. Methods A review of the scientific literature published to November 2012 considered all publications that addressed dexamethasone use in adult patients with brain tumours. Evidence was selected and reviewed by a working group comprising 3 clinicians and 1 methodologist. The resulting draft guideline underwent internal review by members of the Alberta Provincial cns Tumour Team, and feedback was incorporated into the final version of the guideline. Recommendations Based on the evidence available to date, the Alberta Provincial cns Tumour Team makes these recommendations: Treatment with dexamethasone is recommended for symptom relief in adult patients with primary high-grade glioma and cerebral edema.After surgery, a maximum dose of 16 mg daily, administered in 4 equal doses, is recommended for symptomatic patients. This protocol should ideally be started by the neurosurgeon.A rapid dexamethasone tapering schedule should be considered where appropriate.Patients who have high-grade tumours, are symptomatic, or have poor life expectancy, can be maintained on a 0.5–1.0 mg dose of dexamethasone daily.Side effects with dexamethasone are common, and they increase in frequency and severity with increased dose and duration of therapy. Patients should be carefully monitored for endocrine, muscular, skeletal, gastrointestinal, psychiatric, and hematologic complications, and for infections and other general side effects. PMID:24940109

Kostaras, X.; Cusano, F.; Kline, G.A.; Roa, W.; Easaw, J.

2014-01-01

348

Skin care practices for newborns and infants: review of the clinical evidence for best practices.  

PubMed

In recent years, there have been continuing efforts to understand the effects of baby skin care routines and products on the healthy development of baby skin. Such efforts aim ultimately to determine the best infant skin care practices. The pediatric and dermatologic communities have not reached consensus on what constitutes an appropriate cleansing practice. In the United States, guidelines for neonatal skin care have been developed, propagated, and implemented. The accumulated knowledge has promoted evidence-based clinical practices and, therefore, may help to improve clinical outcomes, although these guidelines primarily cover the care of preterm newborns and the treatment of those with other health problems. High-level, long-term clinical evidence of the effective and safe cleansing of healthy, full-term newborns and infants is scarce. This review presents a comprehensive analysis of the scientific literature on baby skin development, cleansing practices, and related products (for healthy newborns and babies) since 1970. The evidence drawn from the reviewed literature can be summarized as follows: Bathing immersed in water seems generally superior to washing alone. Bathing or washing with synthetic detergents (syndets) or mild liquid baby cleansers seems comparable with or even superior to water alone. Nevertheless, larger randomized clinical trials with age-defined cohorts of babies as well as more-defined parameters are required to identify optimal practices and products for skin cleansing of healthy infants. These parameters may include standardized skin function parameters such as transepidermal water loss, stratum corneum hydration, skin surface pH, and sebum production. Clinical skin scores such as the Neonatal Skin Condition Score may be employed as outcome measures. PMID:22011065

Blume-Peytavi, Ulrike; Hauser, Matthias; Stamatas, Georgios N; Pathirana, Delano; Garcia Bartels, Natalie

2012-01-01

349

Translating Research Into Practice: The Schizophrenia Patient Outcomes Research Team (PORT) Treatment Recommendations  

Microsoft Academic Search

Beginning in 1992, the Agency for Health Care Policy and Research and the National Institute of Mental Health funded the Schizophrenia Patient Outcomes Research Team (PORT) to develop and disseminate recommendations for the treatment of schizophrenia based on existing scientific evidence. These Treatment Recommendations, presented here in final form for the first time, are based on exhaustive reviews of the

Anthony F. Lehman; Donald M. Steinwachs

1998-01-01

350

Recommendations from the Clinical Trials Task Force as regards Phase II trials  

Cancer.gov

The CTD-TF has attempted to provide guidance by developing these general recommendations. These recommendations primarily focus on trial designs to demonstrate activity but may include secondary objectives exploring toxicity, scheduling or biomarkers.

351

A survey of clinical practices and readiness to adopt evidence-based practices: Dissemination research in an addiction treatment system  

Microsoft Academic Search

Addiction research is challenged to disseminate evidence-based practices into routine clinical settings. The successful adoption of innovation must consider issues of fit, such as the characteristics, readiness, and attitudes of clinicians in the community. We constructed a survey to assess clinical practices and readiness to adopt certain evidence-based practices in addiction treatment programs. The instrument was administered to directors (n

Mark P. McGovern; Thomas S. Fox; Haiyi Xie; Robert E. Drake

2004-01-01

352

Evaluation in clinical practice: problems, precedents and principles.  

PubMed

'Audit' is now in widespread use in our National Health Service, but there is little documentation of improvement resulting from audit. If it is to be used to identify mistakes in clinical practice, we must be prepared to admit them, or to have our work evaluated by others; such openness is uncommon. Understandably, doctors are concerned about possible litigation, undermining of their authority, and/or interference with their methods of practice. Furthermore, few are willing to comment adversely on the work of others. There is confusion about the best method(s) of audit. Outcome and process audit serve different purposes. Outcome audit measures the effect of care on patients' health, but in individual cases a poor outcome may result after impeccable medical care and a good outcome after poor care. Outcome audit requires a large patient group, is costly, and is of value for a limited number of conditions. Appropriate standards are needed to judge the results; it may be fallacious to compare outcomes in different settings, and with different patient groups. Furthermore, outcome audit is of little value for auditing the care given by individual doctors, and this limits its value in clinical education. Process audit deals with the appropriateness of clinical actions, on the assumption that they affect outcome. It can detect poor performance when outcome audit would be unlikely to identify poor outcome. For common or well-defined problems, process audit can make use of clear criteria, for example agreed protocols, and this may have immediate benefit for individual patients. When there is no agreed protocol the overall quality of care can still be audited against relatively explicit criteria, if there is agreement on the relevant 'principles of clinical practice', i.e. the rules which should guide the clinical management of individual patients. Clearly these should cover the collection, recording and analysis of patient data; planning for diagnosis, monitoring, treatment and patient education, and steps to be taken when there is uncertainty about the best course of action. Performance in these areas can be assessed by reviewing the patients' notes, but most clinical records are inadequate for this purpose. Process audit can be applied to all clinical problems, and is the method of choice for assessing the actions of individuals. Its educational value is self-evident. It allows the identification of deficiencies, and the provision of feedback to correct them. Furthermore, it provides for a continuum of audit through the undergraduate and postgraduate years of a doctor's training. PMID:9238553

McIntyre, N

1995-09-01

353

Research designs for proof-of-concept chronic pain clinical trials: IMMPACT recommendations.  

PubMed

Proof-of-concept (POC) clinical trials play an important role in developing novel treatments and determining whether existing treatments may be efficacious in broader populations of patients. The goal of most POC trials is to determine whether a treatment is likely to be efficacious for a given indication and thus whether it is worth investing the financial resources and participant exposure necessary for a confirmatory trial of that intervention. A challenge in designing POC trials is obtaining sufficient information to make this important go/no-go decision in a cost-effective manner. An IMMPACT consensus meeting was convened to discuss design considerations for POC trials in analgesia, with a focus on maximizing power with limited resources and participants. We present general design aspects to consider including patient population, active comparators and placebos, study power, pharmacokinetic-pharmacodynamic relationships, and minimization of missing data. Efficiency of single-dose studies for treatments with rapid onset is discussed. The trade-off between parallel-group and crossover designs with respect to overall sample sizes, trial duration, and applicability is summarized. The advantages and disadvantages of more recent trial designs, including N-of-1 designs, enriched designs, adaptive designs, and sequential parallel comparison designs, are summarized, and recommendations for consideration are provided. More attention to identifying efficient yet powerful designs for POC clinical trials of chronic pain treatments may increase the percentage of truly efficacious pain treatments that are advanced to confirmatory trials while decreasing the percentage of ineffective treatments that continue to be evaluated rather than abandoned. PMID:24865794

Gewandter, Jennifer S; Dworkin, Robert H; Turk, Dennis C; McDermott, Michael P; Baron, Ralf; Gastonguay, Marc R; Gilron, Ian; Katz, Nathaniel P; Mehta, Cyrus; Raja, Srinivasa N; Senn, Stephen; Taylor, Charles; Cowan, Penney; Desjardins, Paul; Dimitrova, Rozalina; Dionne, Raymond; Farrar, John T; Hewitt, David J; Iyengar, Smriti; Jay, Gary W; Kalso, Eija; Kerns, Robert D; Leff, Richard; Leong, Michael; Petersen, Karin L; Ravina, Bernard M; Rauschkolb, Christine; Rice, Andrew S C; Rowbotham, Michael C; Sampaio, Cristina; Sindrup, Søren H; Stauffer, Joseph W; Steigerwald, Ilona; Stewart, Jonathan; Tobias, Jeffrey; Treede, Rolf-Detlef; Wallace, Mark; White, Richard E

2014-09-01

354

Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension: A clinical practice guideline  

PubMed Central

BACKGROUND Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembolic pulmonary hypertension (CTEPH). Many care gaps exist in the diagnosis and management of CTEPH patients including lack of awareness, incomplete diagnostic assessment, and inconsistent use of surgical and medical therapies. METHODS A representative interdisciplinary panel of medical experts undertook a formal clinical practice guideline development process. A total of 20 key clinical issues were defined according to the patient population, intervention, comparator, outcome (PICO) approach. The panel performed an evidence-based, systematic, literature review, assessed and graded the relevant evidence, and made 26 recommendations. RESULTS Asymptomatic patients postpulmonary embolism should not be screened for CTEPH. In patients with pulmonary hypertension, the possibility of CTEPH should be routinely evaluated with initial ventilation/ perfusion lung scanning, not computed tomography angiography. Pulmonary endarterectomy surgery is the treatment of choice in patients with surgically accessible CTEPH, and may also be effective in CTEPH patients with disease in more ‘distal’ pulmonary arteries. The anatomical extent of CTEPH for surgical pulmonary endarterectomy is best assessed by contrast pulmonary angiography, although positive computed tomography angiography may be acceptable. Novel medications indicated for the treatment of pulmonary hypertension may be effective for selected CTEPH patients. CONCLUSIONS The present guideline requires formal dissemination to relevant target user groups, the development of tools for implementation into routine clinical practice and formal evaluation of the impact of the guideline on the quality of care of CTEPH patients. Moreover, the guideline will be updated periodically to reflect new evidence or clinical approaches. PMID:21165353

Mehta, Sanjay; Helmersen, Doug; Provencher, Steeve; Hirani, Naushad; Rubens, Fraser D; De Perrot, Marc; Blostein, Mark; Boutet, Kim; Chandy, George; Dennie, Carole; Granton, John; Hernandez, Paul; Hirsch, Andrew M; Laframboise, Karen; Levy, Robert D; Lien, Dale; Martel, Simon; Shoemaker, Gerard; Swiston, John; Weinkauf, Justin

2010-01-01

355

The Problematic Label of Suicide Gesture: Alternatives for Clinical Research and Practice  

PubMed Central

Historically, certain terms used to describe psychopathology have evolved over time due to changing social and political contexts. This paper explores the importance of a clear and consistent language for characterizing suicide-related behaviors with a particular focus on the commonly used label “suicide gesture.” The historical and contemporary uses of the term are explored, and clinical, research, and training implications are discussed. Clinicians and researchers are strongly encouraged to consider discontinuing the use of the term suicide gesture in light of its associated dismissive connotations and inconsistent application in clinical practice and research. In lieu of the term suicide gesture, recommendations are made regarding an increased emphasis by clinicians and researchers on more precise descriptions of suicidal behaviors and the functional assessment of suicide-related behaviors. PMID:20640243

Heilbron, Nicole; Compton, Jill S.; Daniel, Stephanie S.; Goldston, David B.

2010-01-01

356

Rufinamide from clinical trials to clinical practice in the United States and Europe.  

PubMed

Rufinamide is a triazole derivative structurally unrelated to other antiepileptic drugs that is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients aged ?4 years. Originally granted orphan drug status, marketing authorisation was obtained on the basis of a randomised, double-blind, placebo-controlled trial conducted in 138 LGS patients. An open-label extension study subsequently demonstrated that rufinamide's efficacy and tolerability were maintained over the longer term (median duration of treatment, 432 days). Recently published reports from Europe and the United States have described the use of adjunctive rufinamide to treat LGS in clinical practice. These data complement the clinical trial results, by providing information on the efficacy and tolerability of rufinamide when used on an individualised basis in real-world practice, under less tightly restricted conditions in terms of patient population and dosing strategies. A comparison of the data reveals that a "lower and slower" dosing strategy tends to be adopted in clinical practice, in comparison with the clinical trial, which does not appear to compromise efficacy, but may provide improvements in tolerability. Individual case reports provide additional valuable information on how rufinamide is being used to treat different seizure types associated with LGS. Since clinical experience with rufinamide is currently at an early stage, there are still unanswered questions relating to its use, and it is likely that its place in the adjunctive treatment of LGS will evolve as further data emerge. PMID:21669560

Resnick, Trevor; Arzimanoglou, Alexis; Brown, Lawrence W; Flamini, Robert; Kerr, Michael; Kluger, Gerhard; Kothare, Sanjeev; Philip, Sunny; Harrison, Miranda; Narurkar, Milind

2011-05-01

357

Water immersion recovery for athletes: effect on exercise performance and practical recommendations.  

PubMed

Water immersion is increasingly being used by elite athletes seeking to minimize fatigue and accelerate post-exercise recovery. Accelerated short-term (hours to days) recovery may improve competition performance, allow greater training loads or enhance the effect of a given training load. However, the optimal water immersion protocols to assist short-term recovery of performance still remain unclear. This article will review the water immersion recovery protocols investigated in the literature, their effects on performance recovery, briefly outline the potential mechanisms involved and provide practical recommendations for their use by athletes. For the purposes of this review, water immersion has been divided into four techniques according to water temperature: cold water immersion (CWI; ?20 °C), hot water immersion (HWI; ?36 °C), contrast water therapy (CWT; alternating CWI and HWI) and thermoneutral water immersion (TWI; >20 to <36 °C). Numerous articles have reported that CWI can enhance recovery of performance in a variety of sports, with immersion in 10-15 °C water for 5-15 min duration appearing to be most effective at accelerating performance recovery. However, the optimal CWI duration may depend on the water temperature, and the time between CWI and the subsequent exercise bout appears to influence the effect on performance. The few studies examining the effect of post-exercise HWI on subsequent performance have reported conflicting findings; therefore the effect of HWI on performance recovery is unclear. CWT is most likely to enhance performance recovery when equal time is spent in hot and cold water, individual immersion durations are short (~1 min) and the total immersion duration is up to approximately 15 min. A dose-response relationship between CWT duration and recovery of exercise performance is unlikely to exist. Some articles that have reported CWT to not enhance performance recovery have had methodological issues, such as failing to detect a decrease in performance in control trials, not performing full-body immersion, or using hot showers instead of pools. TWI has been investigated as both a control to determine the effect of water temperature on performance recovery, and as an intervention itself. However, due to conflicting findings it is uncertain whether TWI improves recovery of subsequent exercise performance. Both CWI and CWT appear likely to assist recovery of exercise performance more than HWI and TWI; however, it is unclear which technique is most effective. While the literature on the use of water immersion for recovery of exercise performance is increasing, further research is required to obtain a more complete understanding of the effects on performance. PMID:23743793

Versey, Nathan G; Halson, Shona L; Dawson, Brian T

2013-11-01

358

Teaching and learning care--exploring nursing students' clinical practice.  

PubMed

Care has always been a key element of nursing. This paper presents findings from research on the following issue: What opportunities and limitations do nursing students encounter when learning nursing care? The study has a qualitative design with field methodology and the study of documents. Six nursing students have been closely monitored during their clinical studies in hospitals, nursing homes and home-based nursing. The study shows that nursing students are likely to possess the potential to provide care for sick and unknown people. The motivation for their commitment to patients may contain an egoistical orientation and runs contrary to former ideals of the nurse's self-sacrificing altruism. Moreover the study shows that there is a potential in the clinical field and in the university college to reflective considerations on experience of care. While clinical practice often has focus on practical problem-solving and procedures, the college tends to focus on abstract theory. Both of these promote the privatisation and neglect of the students' experience of care. The paper concludes with a call for teaching and learning strategies targeting the use of nursing students' personal experience of care. PMID:19581026

Solvoll, Betty-Ann; Heggen, Kristin M

2010-01-01

359

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

PubMed

Hands-on healing and energy-based interventions have been found in cultures throughout history around the world. These complementary therapies, rooted in ancient Eastern healing practices, are becoming mainstream. Healing Touch, a biofield therapy that arose in the nursing field in the late 1980s, is used in a variety of settings (i.e., pain centers, surgical settings, and private practices) with reported benefits (i.e., decreased anxiety, pain, and depressive behaviors; increased relaxation and a sense of well-being). However, clinical trial data concerning the effectiveness of Healing Touch have not been evaluated using a systematic, evidence-based approach. Thus, this systematic review is aimed at critically evaluating the data from randomized clinical trials examining the clinical efficacy of Healing Touch as a supportive care modality for any medical condition. PMID:21228402

Anderson, Joel G; Taylor, Ann Gill

2011-09-01

360

Preschool English Language Learners with Disabilities: A Comparison of Recommended and Actual Language of Instruction Practices  

E-print Network

This study investigated, through survey methodology, the instructional practices of teachers of English Language Learners (ELLs) with disabilities in Preschool Programs for Children with Disabilities (PPCD). These practices were compared to best...

Cole, Corinna V.

2010-07-14

361

Clinical Practice Guideline for the Management of Intracranial Aneurysms  

PubMed Central

Purpose An intracranial aneurysm, with or without subarachnoid hemorrhage (SAH), is a relevant health problem. The rupture of an intracranial aneurysm is a critical concern for individual health; even an unruptured intracranial aneurysm is an anxious condition for the individual. The aim of this guideline is to present current and comprehensive recommendations for the management of intracranial aneurysms, with or without rupture. Materials and Methods We performed an extensive literature search, using Medline. We met in person to discuss recommendations. This document is reviewed by the Task Force Team of the Korean Society of Interventional Neuroradiology (KSIN). Results We divided the current guideline for ruptured intracranial aneurysms (RIAs) and unruptured intracranial aneurysms (UIAs). The guideline for RIAs focuses on diagnosis and treatment. And the guideline for UIAs focuses on the definition of a high-risk patient, screening, principle for treatment and selection of treatment method. Conclusion This guideline provides practical, evidence-based advice for the management of patients with an intracranial aneurysm, with or without rupture.

Seo, Jung Hwa; Kim, Sung Tae; Jung, Cheol Kyu; Suh, Sang-il

2014-01-01

362

A review of blood pressure measurement protocols among hypertension trials: implications for "evidence-based" clinical practice.  

PubMed

Hypertension guidelines recommend following published standardized protocols to obtain accurate blood pressure (BP) readings in clinical practice. However, the various measurement techniques among clinical trials that provide the basis for evidence-based management have not been evaluated or compared with guideline recommendations. We reviewed published information regarding BP measurement in clinical trials (n = 64) from 1990-2014 by searching PubMed and Google Scholar databases. Every trial failed to provide published information regarding at least one of the 10 methodological aspects we evaluated. Details regarding the health-care provider(s) performing measurement(s), temporal-relation to last medication dosage, number of readings, resting time before (and between recordings), and the device(s) used varied among the trials and often differed from clinical recommendations. Most studies did evaluate ?2 BP readings in a seated position, presumably from the upper arm (although explicit acknowledgment of this latter detail was rare). When indicated, "trough" BP levels were most commonly obtained (15 of 16 trials), whereas the usage of automated devices increased over time. Numerous aspects of BP measurement varied considerably across trials and often from most recent guideline recommendations. The lack of uniform methodologies in outcome studies that form the foundation of evidence-based guidelines may have significant clinical implications. PMID:25224868

Giorgini, Paolo; Weder, Alan B; Jackson, Elizabeth A; Brook, Robert D

2014-09-01

363

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

MedlinePLUS

Treatment of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians The full report is titled “Treatment of Anemia in Patients With Heart Disease: A Clinical Practice ...

364

Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guideline  

MedlinePLUS

Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guideline From the American College of Physicians The full report is titled “Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice ...

365

Informed consent in clinical practice and literature overview.  

PubMed

Informed consent is a legal requirement to be fulfilled before any procedure is carried out in clinical practice. It has wide ramification and different interpretations in the present healthcare system. Free and informed consent is required for medical treatments and procedures, except in an emergency situation when informed consent cannot be obtained and there is no indication that a reasonable patient would refuse consent to treatment. Increasing litigations and other ethical considerations have prompted us to review this subject with a review of literature on subject and inferences by different experts in this field. PMID:22773162

Dhar, Hansa; Dhar, Dinesh

2012-09-01

366

[Agreements and disagreements among the main clinical practice guidelines].  

PubMed

Diabetes mellitus has an enormous health and social impact and its incidence is rising exponentially in the industrialized world as a result of unhealthy lifestyles. In the last few years, research in this field has increased, leading to the development of new drugs and new indications. Consequently, numerous updates of clinical practice guidelines for diabetes have been published in the last 12 months, which provide health professionals with an up-to-date view of therapeutic possibilities. The present article reviews the guidelines with the greatest scientific impact and discusses areas of agreement and disagreement among these documents. PMID:25311716

Calderón Montero, A

2014-07-01

367

Determinants of adherence to osteoporosis treatment in clinical practice  

Microsoft Academic Search

Introduction\\u000a   Poor adherence to prescribed treatments is widespread in clinical practice and this can lead to potentially life-threatening\\u000a events. This problem is apparently very common for osteoporosis treatment but the causes of discontinuation and low compliance\\u000a are complex and poorly defined.\\u000a \\u000a \\u000a \\u000a \\u000a Methods\\u000a   Global adherence to osteoporosis treatment was specifically addressed in a nation-wide survey carried out in 9851 postmenopausal\\u000a women

M. Rossini; G. Bianchi; O. Di Munno; S. Giannini; S. Minisola; L. Sinigaglia; S. Adami

2006-01-01

368

Genetic Testing for Dilated Cardiomyopathy in Clinical Practice  

PubMed Central

Background Familial involvement is common in dilated cardiomyopathy (DCM) and >40 genes have been implicated in causing disease. However, the role of genetic testing in clinical practice is not well defined. We examined the experience of clinical genetic testing in a diverse DCM population to characterize the prevalence and predictors of gene mutations. Methods and Results We studied 264 unrelated adult and pediatric DCM index patients referred to 1 reference lab for clinical genetic testing. Up to 10 genes were analyzed (MYH7, TNNT2, TNNI3, TPM1, MYBPC3, ACTC, LMNA, PLN, TAZ, and LDB3), and 70% of patients were tested for all genes. The mean age was 26.6 ± 21.3 years, and 52% had a family history of DCM. Rigorous criteria were used to classify DNA variants as clinically relevant (mutations), variants of unknown clinical significance (VUS), or presumed benign. Mutations were found in 17.4% of patients, commonly involving MYH7, LMNA, or TNNT2 (78%). An additional 10.6% of patients had VUS. Genetic testing was rarely positive in older patients without a family history of DCM. Conversely in pediatric patients, family history did not increase the sensitivity of genetic testing. Conclusions Using rigorous criteria for classifying DNA variants, mutations were identified in 17% of a diverse group of DCM index patients referred for clinical genetic testing. The low sensitivity of genetic testing in DCM reflects limitations in both current methodology and knowledge of DCM-associated genes. However, if mutations are identified, genetic testing can help guide family management. PMID:22464770

Lakdawala, Neal K.; Funke, Birgit H.; Baxter, Samantha; Cirino, Allison L.; Roberts, Amy E.; Judge, Daniel P.; Johnson, Nicole; Mendelsohn, Nancy J.; Morel, Chantal; Care, Melanie; Chung, Wendy K.; Jones, Carolyn; Psychogios, Apostolos; Duffy, Elizabeth; Rehm, Heidi L.; White, Emily; Seidman, J.G.; Seidman, Christine E.; Ho, Carolyn Y.

2013-01-01

369

The current status of targeted radiotherapy in clinical practice.  

PubMed

Biologically targeted radiotherapy in clinical practice requires a molecule which has a relative specificity for tumour tissue--the missile--coupled to a radionuclide with appropriate physical characteristics--the warhead. When administered to a patient this combination should result in selective irradiation of the target tumour cells with relative sparing of normal tissues. Simple ions and small molecules which follow physiological pathways as either the natural substrates or analogues form the best examples of biological targeting. Clinically valuable results are seen with, for instance, iodine uptake by normal and malignant thyroid cells, incorporation of the calci-mimetic element strontium in areas of increased bone metabolism and accumulation of the catecholamine analogue meta-iodobenzylguanidine in neuroblastoma. The use of monoclonal antibodies as targeting vehicles has not proved to be a panacea, yet some patients with lymphoma, hepatoma and ovarian carcinoma have obtained benefit. Current clinical studies in targeted radiotherapy focus on the integration of radionuclide treatment with conventional treatments, and the optimization of such combined approaches. The development of modifications to offset the limitations inherent in the use of crude antibodies also offers an opportunity for improved clinical outcomes. PMID:8912369

Gaze, M N

1996-10-01

370

Routine Depression Screening in an MS Clinic and Its Association with Provider Treatment Recommendations and Related Treatment Outcome.  

PubMed

Depression, a frequent concomitant disorder in multiple sclerosis (MS), can impact MS treatment adherence and quality of life. Depression screening in MS care settings may facilitate needed intervention when providers are responsive to screening findings. This study sought to examine the relationship between depression screening results and provider depression treatment recommendations documented in the medical records of 283 patients receiving care in an integrated MS clinic. Forty-six percent of patients screening positive for depression received a treatment recommendation; females, those with past mental health diagnoses, on psychotropic medications, and those with higher symptom severity were more likely to receive a treatment recommendation. On subsequent screenings, patients reported fewer depressive symptoms regardless of whether a formal treatment recommendation was documented. These findings suggest that while depression screening does lead to depression related intervention in many cases, more research is necessary to determine who is most likely to benefit and under what conditions. PMID:25194308

Stepleman, L M; Penwell-Waines, L M; Rollock, M; Casillas, R S; Brands, T; Campbell, J; Ange, B; Waller, J L

2014-12-01

371

Are VA Primary Care Providers Aware of HIV Testing Recommendations for Veterans? Findings at an Urban VA Primary Care Clinic  

PubMed Central

Given the prevalence of human immunodeficiency virus (HIV) in veterans and that nearly 90% of veterans have not been HIV tested, the Veterans Affairs (VA) has recommended routine HIV testing of all veterans. The objective of this study carried out at an urban VA primary care clinic was to assess provider knowledge of recent U.S. Centers for Disease Control and Prevention (CDC) and VA HIV testing recommendations and policies. Fifty-six primary care providers completed a survey. Nearly 40% of providers were unaware of the CDC recommendation to test all persons ages 13 to 64 in health care settings or the VA policy to test veterans of all ages. Over 75% of providers were unaware of the latest requirements for pre- and posttest counseling, and many were unaware of the latest consent process requirements. Educating VA providers about recent HIV testing recommendations and policies may improve the low HIV testing prevalence in the VA. PMID:23707836

Arya, Monisha; Bush, Amber L.; Kallen, Michael A.; Rodriguez-Barradas, Maria C.; Giordano, Thomas P.

2014-01-01

372

Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash  

PubMed Central

OBJECTIVE To provide an evidence-based clinical practice guideline for the chiropractic cervical treatment of adults with acute or chronic neck pain not due to whiplash. This is a considerable health concern considered to be a priority by stakeholders, and about which the scientific information was poorly organized. OPTIONS Cervical treatments: manipulation, mobilization, ischemic pressure, clinic- and home-based exercise, traction, education, low-power laser, massage, transcutaneous electrical nerve stimulation, pillows, pulsed electromagnetic therapy, and ultrasound. OUTCOMES The primary outcomes considered were improved (reduced and less intrusive) pain and improved (increased and easier) ranges of motion (ROM) of the adult cervical spine. EVIDENCE An “extraction” team recorded evidence from articles found by literature search teams using 4 separate literature searches, and rated it using a Table adapted from the Oxford Centre for Evidence-based Medicine. The searches were 1) Treatment; August, 2003, using MEDLINE, CINAHL, AMED, MANTIS, ICL, The Cochrane Library (includes CENTRAL), and EBSCO, identified 182 articles. 2) Risk management (adverse events); October, 2004, identified 230 articles and 2 texts. 3) Risk management (dissection); September, 2003, identified 79 articles. 4) Treatment update; a repeat of the treatment search for articles published between September, 2003 and November, 2004 inclusive identified 121 articles. VALUES To enable the search of the literature, the authors (Guidelines Development Committee [GDC]) regarded chiropractic treatment as including elements of “conservative” care in the search strategies, but not in the consideration of the range of chiropractic practice. Also, knowledge based only on clinical experience was considered less valid and reliable than good-caliber evidence, but where the caliber of the relevant evidence was low or it was non-existent, unpublished clinical experience was considered to be equivalent to, or better than the published evidence. REPORTED BENEFITS, HARMS AND COSTS The expected benefits from the recommendations include more rapid recovery from pain, impairment and disability (improved pain and ROM). The GDC identified evidence-based pain benefits from 10 unimodal treatments and more than 7 multimodal treatments. There were no pain benefits from magnets in necklaces, education or relaxation alone, occipital release alone, or head retraction-extension exercise combinations alone. The specificity of the studied treatments meant few studies could be generalized to more than a minority of patients. Adverse events were not addressed in most studies, but where they were, there were none or they were minor. The theoretic harm of vertebral artery dissection (VAD) was not reported, but an analysis suggested that 1 VAD may occur subsequent to 1 million cervical manipulations. Costs were not analyzed in this guideline, but it is the understanding of the GDC that recommendations limiting ineffective care and promoting a more rapid return of patients to full functional capacity will reduce patient costs, as well as increase patient safety and satisfaction. For simplicity, this version of the guideline includes primarily data synthesized across studies (evidence syntheses), whereas the technical and the interactive versions of this guideline (http://ccachiro.org/cpg) also include relevant data from individual studies (evidence extractions). RECOMMENDATIONS The GDC developed treatment, risk-management and research recommendations using the available evidence. Treatment recommendations addressing 13 treatment modalities revolved around a decision algorithm comprising diagnosis (or assessment leading to diagnosis), treatment and reassessment. Several specific variations of modalities of treatment were not recommended. For adverse events not associated with a treatment modality, but that occur in the clinical setting, there was evidence to recommend reconsideration of treatment options or referral to the appropriate health services. For adverse eve

Anderson-Peacock, Elizabeth; Blouin, Jean-Sebastien; Bryans, Roland; Danis, Normand; Furlan, Andrea; Marcoux, Henri; Potter, Brock; Ruegg, Rick; Gross Stein, Janice; White, Eleanor

2005-01-01

373

The conduct of practice-based research in community clinics compared to private practices: similarities, differences, and challenges  

PubMed Central

Practice-based research should be performed in all practice settings if the results are to be applied to all settings. However, some practice settings, such as community clinics, have unique features that may make the conduct of such research more challenging. The purpose of this article is to describe and compare the similarities and unique challenges related to conducting research in community clinics compared to private practices within the Northwest Practice-Based REsearch Collaborative in Evidence-Based DENTistry (PRECEDENT) network. Information was obtained from meetings with general dentists, a survey of general dentists (N = 253), and a clinical examination and record review of a systemic random sample of patients visiting community clinics and private practices. (N = 1903)—all part of a dental practice-based research network. The processes of conducting research, the dentist and patient sociodemographic characteristics, the prevalence of oral diseases, and the dental treatments received in community clinics and private practices were compared. Both community clinics and private practices have the clinical treatment of the patients as their priority and have time constraints on research. The processes of research training, obtaining informed consent, and collecting, transmitting, and securely maintaining research data are also similar. The patient populations and treatment needs differ substantially between community clinics and private practices, with a higher prevalence of dental caries and higher restorative treatment needs in the community clinic patients. The process of study participant selection and follow-up for research and the dentist and staff work arrangements also vary between the two practice settings. Although community clinic patients and their dental healthcare providers have different research needs and challenges than their counterparts in private practice, practice-based research can be successfully

Gillette, Jane; Cunha-Cruz, Joana; Gilbert, Ann; Speed-McIntyre, Pollene; Zhou, Lingmei; DeRouen, Timothy

2013-01-01

374

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

ERIC Educational Resources Information Center

This package includes a clinical practice guideline, quick reference guide for clinicians, and patient's guide to predicting and preventing pressure ulcers in adults. The clinical practice guideline includes the following: overview of the incidence and prevalence of pressure ulcers; clinical practice guideline (introduction, risk assessment tools…

Agency for Health Care Policy and Research (DHHS/PHS), Rockville, MD.

375

Patient Follow-up in an Urban Resident Continuity Clinic: An Initiative to Improve Scheduling Practices  

PubMed Central

Introduction Failure to schedule timely follow-up appointments may impair continuity and quality of care, especially for patients with low health literacy and unstable living situations. Resident continuity clinics face particular challenges in scheduling patient follow-up because of residents' complex schedules and limited time in clinic. Methods As part of a structured quality-improvement curriculum, residents initiated discussions with clinical supervisors and clerical staff to evaluate and improve scheduling practices in an urban continuity clinic. The problem-solving process emphasized feasibility (rapid implementation/evaluation cycle, low time/resource burden) and measurable outcomes. These discussions led to design of a new scheduling form. We evaluated the short-term impact of awareness raising by comparing scheduling rates before (month 1) versus after (months 2–3) implementation, and of the form itself by randomly selecting 2 afternoon clinics to implement the new form, with a third serving as control. Results We analyzed all patient encounters over a 3-month period (n ?=? 910), excluding patients with a recommended follow-up interval of greater than 4 months. The proportion of appointments “never scheduled” (at 1 month after provider-requested follow-up date) declined from 18.8% (95% confidence interval [CI], 14.5%–23.9%) in month 1 to 11.4% (CI, 8.1%–15.5%) in month 3. This proportion was significantly higher before than after implementation of the form (multivariable relative risk, 1.49; 95% CI, 1.08–2.03; P ?=? .02), both in clinics that used and did not use the form (P ?=? .93 for difference). Conclusions We describe a model resident-led, team-based intervention that addressed core competencies in graduate medical education while improving outpatient scheduling practices. PMID:22655154

Dowdy, David W.; Horton, Claire K.; Lau, Ben; Ferrer, Rosaly; Chen, Alice H.

2011-01-01

376

Prevention and control of haemophilus influenzae type b disease: recommendations of the advisory committee on immunization practices (ACIP).  

PubMed

This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of Haemophilus influenzae type b (Hib) disease in the United States. As a comprehensive summary of previously published recommendations, this report does not contain any new recommendations; it is intended for use by clinicians, public health officials, vaccination providers, and immunization program personnel as a resource. ACIP recommends routine vaccination with a licensed conjugate Hib vaccine for infants aged 2 through 6 months (2 or 3 doses, depending on vaccine product) with a booster dose at age 12 through 15 months. ACIP also recommends vaccination for certain persons at increased risk for Hib disease (i.e., persons who have early component complement deficiencies, immunoglobulin deficiency, anatomic or functional asplenia, or HIV infection; recipients of hematopoietic stem cell transplant; and recipients of chemotherapy or radiation therapy for malignant neoplasms). This report summarizes current information on Hib epidemiology in the United States and describes Hib vaccines licensed for use in the United States. Guidelines for antimicrobial chemoprophylaxis of contacts of persons with Hib disease also are provided. PMID:24572654

Briere, Elizabeth C; Rubin, Lorry; Moro, Pedro L; Cohn, Amanda; Clark, Thomas; Messonnier, Nancy

2014-02-28

377

Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP).  

PubMed

This report presents new recommendations adopted in June 2009 by CDC's Advisory Committee on Immunization Practices (ACIP) regarding use of the combination measles, mumps, rubella, and varicella vaccine (MMRV, ProQuad, Merck & Co., Inc.). MMRV vaccine was licensed in the United States in September 2005 and may be used instead of measles, mumps, rubella vaccine (MMR, M-M-RII, Merck & Co., Inc.) and varicella vaccine (VARIVAX, Merck & Co., Inc.) to implement the recommended 2-dose vaccine schedule for prevention of measles, mumps, rubella, and varicella among children aged 12 months-12 years. At the time of its licensure, use of MMRV vaccine was preferred for both the first and second doses over separate injections of equivalent component vaccines (MMR vaccine and varicella vaccine), which was consistent with ACIP's 2006 general recommendations on use of combination vaccines (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55;[No. RR-15]). Since July 2007, supplies of MMRV vaccine have been temporarily unavailable as a result of manufacturing constraints unrelated to efficacy or safety. MMRV vaccine is expected to be available again in the United States in May 2010. In February 2008, on the basis of preliminary data from two studies conducted postlicensure that suggested an increased risk for febrile seizures 5-12 days after vaccination among children aged 12-23 months who had received the first dose of MMRV vaccine compared with children the same age who had received the first dose of MMR vaccine and varicella vaccine administered as separate injections at the same visit, ACIP issued updated recommendations regarding MMRV vaccine use (CDC. Update: recommendations from the Advisory Committee on Immunization Practices [ACIP] regarding administration of combination MMRV vaccine. MMWR 2008;57:258-60). These updated recommendations expressed no preference for use of MMRV vaccine over separate injections of equivalent component vaccines for both the first and second doses. The final results of the two postlicensure studies indicated that among children aged 12--23 months, one additional febrile seizure occurred 5-12 days after vaccination per 2,300-2,600 children who had received the first dose of MMRV vaccine compared with children who had received the first dose of MMR vaccine and varicella vaccine administered as separate injections at the same visit. Data from postlicensure studies do not suggest that children aged 4--6 years who received the second dose of MMRV vaccine had an increased risk for febrile seizures after vaccination compared with children the same age who received MMR vaccine and varicella vaccine administered as separate injections at the same visit. In June 2009, after consideration of the postlicensure data and other evidence, ACIP adopted new recommendations regarding use of MMRV vaccine for the first and second doses and identified a personal or family (i.e., sibling or parent) history of seizure as a precaution for use of MMRV vaccine. For the first dose of measles, mumps, rubella, and varicella vaccines at age 12--47 months, either MMR vaccine and varicella vaccine or MMRV vaccine may be used. Providers who are considering administering MMRV vaccine should discuss the benefits and risks of both vaccination options with the parents or caregivers. Unless the parent or caregiver expresses a preference for MMRV vaccine, CDC recommends that MMR vaccine and varicella vaccine should be administered for the first dose in this age group. For the second dose of measles, mumps, rubella, and varicella vaccines at any age (15 months-12 years) and for the first dose at age >or=48 months, use of MMRV vaccine generally is preferred over separate injections of its equivalent component vaccines (i.e., MMR vaccine and varicella vaccine). This recommendation is consistent with ACIP's 2009 provisional general recommendations regarding use of combination vaccines (available at http://www.cdc.gov/vaccines/recs/provisional/downloads/combo-va

Marin, Mona; Broder, Karen R; Temte, Jonathan L; Snider, Dixie E; Seward, Jane F

2010-05-01

378

Conflicts of Interest among Authors of Clinical Practice Guidelines for Glycemic Control in Type 2 Diabetes Mellitus  

PubMed Central

Background Conflict of interest (COI) is an important potential source of bias in the development of clinical practice guidelines (CPGs). Objectives To examine rates of disclosure of COI, including financial interests in companies that manufacture drugs that are recommended in CPGs on glycemic control in type 2 diabetes mellitus, and to explore the relationship between recommendations for specific drugs in a guideline and author COI. Methods We identified a cohort of relevant guidelines from the National Guideline Clearinghouse (NGC) and abstracted COI disclosures from all guideline authors for this observational, cross-sectional study. We determined which hypoglycemic drugs were recommended in each guideline, and explored the relationship between specific disclosures and whether a drug was recommended. Results Among 13 included guidelines, the percentage of authors with one or more financial disclosures varied from 0 to 94% (mean 44.2%), and was particularly high for two US-based guidelines (91% and 94%). Three guidelines disclosed no author financial COI. The percentage of authors with disclosures of financial interests in manufacturers of recommended drugs was also high (mean 30%). On average, 56% of manufacturers of patented drugs recommended in each guideline had one or more authors with a financial interest in their company. We did not find a significant relationship between financial interests and whether a drug was recommended in our sample; US-based guidelines were more likely to make recommendations for a specific drug compared to non-US based guidelines. Discussion Authors of this cohort of guidelines have financial interests directly related to the drugs that they are recommending. Although we did not find an association between author COI and drugs recommended in these guidelines and we cannot draw conclusions about the validity of the recommendations, the credibility of many of these guidelines is in doubt. PMID:24155870

Norris, Susan L.; Holmer, Haley K.; Ogden, Lauren A.; Burda, Brittany U.; Fu, Rongwei

2013-01-01

379

Clinical practice and costs of treating catheter-related infections with teicoplanin or vancomycin  

PubMed Central

Objectives To elicit actual clinical practice of treating intensive care unit patients with catheter-related infections with teicoplanin or vancomycin from a hospital perspective. As clinical trials have demonstrated similar efficacy of these glycopeptides, a cost-minimisation analysis was also carried out. Methods The Delphi survey technique was used to gather the opinion of nine physicians regarding resource utilization associated with teicoplanin and vancomycin. Treatment costs considered were costs of drug acquisition, costs of material and nursing time required for drug preparation and administration, and costs of laboratory tests. Results Physicians tend to administer higher loading doses of teicoplanin than recommended in the drug information leaflet. Even though evidence of the effectiveness of vancomycin is mainly derived from trials using multiple-daily administration schedules, five physicians administered it on a once-daily basis. Mean treatment costs amounted to 1,272€ with teicoplanin and 1,041€ with vancomycin. Higher treatment costs with teicoplanin arose from more elevated drug acquisition costs (1,076€ versus 795€). Treatment with vancomycin was associated with higher costs of laboratory tests as a result of more frequent monitoring of serum concentrations (217€ versus 150€). Conclusions This analysis of clinical practice and costs indicated that the resource utilisation advantages from fewer laboratory tests with teicoplanin partially offset higher drug acquisition costs. In addition to efficacy and costs, other factors such as route of administration, patient profile and adverse effects need to inform the choice between teicoplanin and vancomycin.

Simoens, Steven; De Corte, Nik; Laekeman, Gert

380

Exploring nurses' perceptions of collecting and using HOBIC measures to guide clinical practice and improve care.  

PubMed

Ontario's Health Outcomes for Better Information and Care (HOBIC) is designed to help organizations and nurses plan and evaluate care by comparing patient outcomes with historical data on similar cases. Yet, fewer than 15% of patients in a 2010 study were found to have complete admission and discharge data sets. This low utilization rate of HOBIC measures prompted the current qualitative study, in which nurses from three clinical settings in an academic teaching hospital were interviewed to gain their perceptions related to collecting and using HOBIC measures in practice. The objective was to identify factors that promote or impede the collection and use of HOBIC data in clinical practice to improve patient care and outcomes. Analysis of interview results produced four key themes related to (a) use of HOBIC measures to inform patient care, (b) collecting and documenting HOBIC measures, (c) HOBIC as an afterthought and "black hole" and (d) impediments to assessing and documenting HOBIC measures because of language barriers, patients' cognitive status and lack of time. Recommendations to improve uptake include developing, implementing and evaluating a communication and learning plan that promotes HOBIC's values and benefits, and determining how managers and administrators perceive utilization of HOBIC at the clinical unit and organizational levels. PMID:22469758

Jeffs, Lianne; Wilson, Gail; Ferris, Ella; Cardiff, Brenda; Ng, San; Lanceta, Mary; White, Peggy; Pringle, Dorothy

2012-03-01

381

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

PubMed

The aim of this study was to develop a model for clinical supervision to promote the clinical practice of nursing students. The study was implemented in Finland and it was carried out in three phases. Firstly, data were collected by means of a literature review and focus group interviews. Secondly, the data were analysed and described in expert groups, and finally the model itself was evaluated by 23 nursing experts. The data of literature review and focus group interviews consisted of 27 studies and four groups from three organisations: nurses (n=7), managers (n=6), teachers (n=8) and students (n=6). The data were analysed by qualitative content analysis. The model devolved from the study includes the concepts describing prerequisites, content and influence of clinical supervision. The prerequisites are nursing skills, a holistic view of the nursing curriculum, pedagogical, organisational, development, cooperation and interaction competence and decision-making skills. The content of clinical supervision includes support of professional development, pedagogical competence, research and development activities and collaborative working. Clinical supervision has influence on students' professional and personal development and conception of the future of nursing profession, students' preparedness for career planning and the teacher's and preceptor's professional development. The model could unify the notions of all parties concerned of the prerequisites, content and influence of clinical supervision. Furthermore, the entire supervision process and its control could be clarified. The model may be utilised in selecting and educating preceptors and evaluating the quality of clinical supervision. PMID:17936544

Häggman-Laitila, Arja; Elina, Eriksson; Riitta, Meretoja; Kirsi, Sillanpää; Leena, Rekola

2007-11-01

382

Microperimetry and clinical practice: an evidence-based review.  

PubMed

Microperimeters embody technological abilities required to assess components of residual visual functions and functional vision. Residual visual functions and functional vision after macular vision loss are mostly defined by 3 major components: scotoma characteristics, preferred retinal loci (PRLs) and oculomotor control. Microperimetry may be proven superior as a method to standard automated perimetry (SAP) for residual visual function assessment. During microperimetry stimuli are projected directly on the retina with accurate test-retest of the same retinal point monitored by eye tracking technology. Microperimeters offer also abilities to determine accurately the location of a PRL. Recent research reveals also that fixation stability estimates in low vision cases are reliable predictors of visual acuity estimates. Fixation stability estimates provided automatically by the microperimeters are based on proprietary algorithms and provide reasonable estimates very close to BCEA values calculated from raw data. More and more microperimeters are used in clinical retina practice to assess more accurately the impact of diseases or of interventions on the retina. Microperimeters are also in use more often in glaucoma practices and it seems evident that the main usage for microperimeters is destined to monitor glaucoma damaged residual visual functions and functional vision. In addition identification of eccentric location of PRLs and fixation stability estimates at the PRL in low vision patients offers the LVR practitioner the option to use the best residual visual function available for rehabilitation. For mainstream ophthalmology many indicators point to the fact that microperimeters may take the lead role played by SAP in the last decades. For vision rehabilitation practitioners the advent of multiple choices for microperimetry portends the introduction of modern rehabilitation concepts in most clinical practices. Both developments seem to happen sooner, rather than later as expected by most. PMID:24093179

Markowitz, Samuel N; Reyes, Sophia V

2013-10-01

383

Incorporating new materials and techniques into clinical practice.  

PubMed

This article outlines the subjects presented and discussed at the December 2012 IADR Dental Materials Innovation Workshop held at King's College London. Incorporating new materials and techniques into clinical practice was considered from 4 perspectives: (1) Accelerating the "research to regulatory approval" process was presented with current developments in the United States, with the National Institutes of Health/Food and Drug Administration process as a working example; (2) intellectual property and regulatory requirements were discussed across the well-established US and EU frameworks, as well as the more recently developed procedures across Brazil, Russia, India, and China; (3) the challenges and opportunities of incorporating innovations into dental education were considered with reference to the future needs of both students and faculty; and (4) the key but difficult and unpredictable step of translating such innovations into routine dental practice was then explored. Constructive and far-ranging discussion among the broadly based Workshop participants (from dental research, education, practice, and industry, as well as environmental organizations and the World Health Organization) mapped out key issues for the future. The focus was on facilitating the more timely adoption of improvements in both materials and techniques to improve patient health and health systems, while minimizing environmental impact. PMID:24129815

Pitts, N B; Drummond, J; Guggenberger, R; Ferrillo, P; Johnston, S

2013-11-01

384

Compliance with infection control practices in an university hospital dental clinic  

PubMed Central

Aim: Compliance with infection control practices is the key to quality care and excellence in dentistry. Infection control remains one of the most cost-beneficial interventions available. However, implementing control procedures requires full compliance of the whole dental team. The aim of our study was to measure the compliance in daily clinical practice. Methods: The compliance with infection control practices in dentistry by dental health care personnel (DHCP) in a German university dental clinic was observed during clinical work. In addition, a survey was conducted to assess the individual knowledge about infection control procedures. Contamination of the workplace during invasive dental procedures was tested, as well. Results: A total of 58 invasive dental treatments implying close contacts between HCWs and patients were scrutinized. All HCWs (100%) wore gloves during dental work, but in some cases (female dentists: 14.3%; dental assistants: 28.6%) gloves were neither changed nor hands were disinfected between different activities or patient contacts (female dentists: 68.6%; male dentists: 60.9%; dental assistants: 93%). Only 31.4% of female and 39.1% of male dentists carried out adequate hygienic hand disinfection after removing gloves. Male dentists wore significantly more often (100%) protective eyewear compared to 77.1% of female dentists (p<0.05). In addition, most of female dentists (62.9%) and dental assistants (80.7%) wore jewelry during dental procedures. Conclusion: Despite the knowledge of distinct hygiene procedures only a small percentage of dental staff performs hygiene practices according to recommended guidelines. Strict audit is clearly needed in the dental setting to ensure compliance with infection control guidelines to prevent transmission of pathogens. Our results provide insights for the development of a targeted education and training strategy to enhance compliance of dental staff especially of dental assistants with infection control procedures.

Mutters, Nico T.; Hagele, Ulrike; Hagenfeld, Daniel; Hellwig, Elmar; Frank, Uwe

2014-01-01

385

Impact of Rheumatoid Arthritis Disease Activity Test on Clinical Practice  

PubMed Central

Background Variability exists in the assessment of disease activity in rheumatoid arthritis (RA) patients that may affect quality of care. Objectives To measure the impact on quality of care of a Multi-Biomarker Disease Activity (MBDA) test that quantitatively assesses RA disease activity. Methods Board-certified rheumatologists without prior experience with the MBDA test (N?=?81) were randomized into an intervention or control group as part of a longitudinal randomized-control study. All physicians were asked to care for three simulated RA patients, using Clinical Performance and Value (CPV™) vignettes, in a before and after design. CPV™ vignettes have been validated to assess the quality of clinical practice and identify variation in care. The vignettes covered all domains of a regular patient visit; scores were determined as a percentage of explicit predefined criteria completed. Three vignettes, representing typical RA cases, were administered each round. In the first round, no physician received information about the MBDA test. In the second round, only physicians in the intervention group were given educational materials about the test and hypothetical test results for each of the simulated patients. The outcome measures were the overall quality of care, disease assessment and treatment. Results The overall quality scores in the intervention group improved by 3 percent (p?=?0.02) post-intervention compared with baseline, versus no change in the control group. The greatest benefit in the intervention group was to the quality of disease activity assessment and treatment decisions, which improved by 12 percent (p<0.01) compared with no significant change in the control group. The intervention was associated with more appropriate use of biologic and/or combination DMARDs in the co-morbidity case type (p<0.01). Conclusions Based on these results, use of the MBDA test improved the assessment and treatment decisions for simulated cases of RA and may prove useful for rheumatologists in clinical practice. PMID:23667587

Peabody, John W.; Strand, Vibeke; Shimkhada, Riti; Lee, Rachel; Chernoff, David

2013-01-01

386

Pain management knowledge, attitudes and clinical practice: The impact of nurses' characteristics and education  

Microsoft Academic Search

This study examined the knowattitudes, and clinical practice of registered nurses (N = 120) regarding paint management Data were collected from nine varied clinical units in a large, univasity-effiliaated teaching hospital to an urban area of the Northeast. Demogrohic information was also collected to explore the relationship between nurses' characteristics, including previous pain education, clinical experience, area of clinical practice,

Ellen B. Clarke; Brian French; Mary Liz Bilodeau; Virginia C. Capasso; Annabel Edwards; Joanne Empoliti

1996-01-01

387

Recommended Policies and Practices for Advancing Indiana's System of Adult Education and Workforce Training  

ERIC Educational Resources Information Center

With generous support from the Lilly Endowment, the Indiana Chamber has contracted with National Center for Higher Education Management Systems (NCHEMS) to provide a policy framework and specific recommendations for improving the system of adult education and workforce training in Indiana--building on the important initiatives that have already…

National Center for Higher Education Management Systems (NJ1), 2009

2009-01-01

388

Evaluation in New Jersey Education: A Survey of Present Practices and Recommendations for Future Action.  

ERIC Educational Resources Information Center

Current evaluation activities in the New Jersey school system are surveyed, and recommendations for future evaluation efforts are made. The current activities and future developments of school (or school district), statewide, and project (or program) evaluation are discussed individually. The following program objectives are suggested: to raise…

Pinkowski, Francis; And Others

389

Preschool Integration: Recommendations for School Administrators. Policy and Practice in Early Childhood Special Education Series.  

ERIC Educational Resources Information Center

This paper offers recommendations for establishing meaningful integration opportunities for preschool children with disabilities, derived from the work of the Research Institute on Preschool Mainstreaming, a 5-year federally funded project of St. Peter's Child Development Centers, Inc., in Pittsburgh, Pennsylvania. The knowledge base on preschool…

Smith, Barbara J.; Rose, Deborah F.

390

The clinical significance of cardiac troponins in medical practice  

PubMed Central

Troponins are regulatory proteins that form the cornerstone of muscle contraction. The amino acid sequences of cardiac troponins differentiate them from that of skeletal muscles, allowing for the development of monoclonal antibody-based assay of troponin I (TnI) and troponin T (TnT). Along with the patient history, physical examination and electrocardiography, the measurement of highly sensitive and specific cardiac troponin has supplanted the former gold standard biomarker (creatine kinase-MB) to detect myocardial damage and estimate the prognosis of patients with ischemic heart disease. The current guidelines for the diagnosis of non-ST segment elevation myocardial infarction are largely based on an elevated troponin level. The implementation of these new guidelines in clinical practice has led to a substantial increase in the frequency of myocardial infarction diagnosis. Automated assays using cardiac-specific monoclonal antibodies to cardiac TnI and TnT are commercially available. They play a major role in the evaluation of myocardial injury and prediction of cardiovascular outcome in cardiac and non-cardiac causes. In this review we discuss the clinical applications of cardiac troponins and the interpretation of elevated levels in the context of various clinical settings. PMID:23960628

Al-Otaiby, Mohammed A.; Al-Amri, Hussein S.; Al-Moghairi, Abdulrahman M.

2010-01-01

391

The Assessment of Endothelial Function - From Research into Clinical Practice  

PubMed Central

The discovery of the endothelium as a crucial organ for the regulation of the vasculature to physiological needs and the recognition of endothelial dysfunction as a key pathological condition - which is associated with most if not all cardiovascular risk factors - led to a tremendous boost of endothelial research in the past 3 decades. Despite the possibility to measure endothelial function in the individual and its widespread use in research, its use as a clinical tool in daily medicine is not established yet. We review the most common methods to assess vascular function in humans and discuss their advantages and disadvantages. Furthermore we give an overview about clinical settings were endothelial function measurements may be valuable in individual patients. Specifically, we provide information why endothelial function is not only a risk marker for cardiovascular risk but may also provides prognostic information beyond commonly used risk scores in primary prevention, and in patients with already established coronary disease. We conclude, that non-invasive endothelial function measurements provide valuable additional information, however, to ascertain its use for daily clinical practice, future research should determine whether endothelial function can be used to guide treatment in the individual and if this translates into better outcomes. PMID:22869857

Flammer, Andreas J.; Anderson, Todd; Celermajer, David S.; Creager, Mark A.; Deanfield, John; Ganz, Peter; Hamburg, Naomi; Luscher, Thomas F.; Shechter, Michael; Taddei, Stefano; Vita, Joseph A; Lerman, Amir

2012-01-01

392

Use of Incisional Negative Pressure Wound Therapy on Closed Median Sternal Incisions after Cardiothoracic Surgery: Clinical Evidence and Consensus Recommendations  

PubMed Central

Negative pressure wound therapy is a concept introduced initially to assist in the treatment of chronic open wounds. Recently, there has been growing interest in using the technique on closed incisions after surgery to prevent potentially severe surgical site infections and other wound complications in high-risk patients. Negative pressure wound therapy uses a negative pressure unit and specific dressings that help to hold the incision edges together, redistribute lateral tension, reduce edema, stimulate perfusion, and protect the surgical site from external infectious sources. Randomized, controlled studies of negative pressure wound therapy for closed incisions in orthopedic settings (which also is a clean surgical procedure in absence of an open fracture) have shown the technology can reduce the risk of wound infection, wound dehiscence, and seroma, and there is accumulating evidence that it also improves wound outcomes after cardiothoracic surgery. Identifying at-risk individuals for whom prophylactic use of negative pressure wound therapy would be most cost-effective remains a challenge; however, several risk-stratification systems have been proposed and should be evaluated more fully. The recent availability of a single-use, closed incision management system offers surgeons a convenient and practical means of delivering negative pressure wound therapy to their high-risk patients, with excellent wound outcomes reported to date. Although larger, randomized, controlled studies will help to clarify the precise role and benefits of such a system in cardiothoracic surgery, limited initial evidence from clinical studies and from the authors’ own experiences appears promising. In light of the growing interest in this technology among cardiothoracic surgeons, a consensus meeting, which was attended by a group of international experts, was held to review existing evidence for negative pressure wound therapy in the prevention of wound complications after surgery and to provide recommendations on the optimal use of negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery. PMID:25280449

Dohmen, Pascal M.; Markou, Thanasie; Ingemansson, Richard; Rotering, Heinrich; Hartman, Jean M.; van Valen, Richard; Brunott, Maaike; Segers, Patrique

2014-01-01

393

Use of incisional negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery: clinical evidence and consensus recommendations.  

PubMed

Abstract Negative pressure wound therapy is a concept introduced initially to assist in the treatment of chronic open wounds. Recently, there has been growing interest in using the technique on closed incisions after surgery to prevent potentially severe surgical site infections and other wound complications in high-risk patients. Negative pressure wound therapy uses a negative pressure unit and specific dressings that help to hold the incision edges together, redistribute lateral tension, reduce edema, stimulate perfusion, and protect the surgical site from external infectious sources. Randomized, controlled studies of negative pressure wound therapy for closed incisions in orthopedic settings (which also is a clean surgical procedure in absence of an open fracture) have shown the technology can reduce the risk of wound infection, wound dehiscence, and seroma, and there is accumulating evidence that it also improves wound outcomes after cardiothoracic surgery. Identifying at-risk individuals for whom prophylactic use of negative pressure wound therapy would be most cost-effective remains a challenge; however, several risk-stratification systems have been proposed and should be evaluated more fully. The recent availability of a single-use, closed incision management system offers surgeons a convenient and practical means of delivering negative pressure wound therapy to their high-risk patients, with excellent wound outcomes reported to date. Although larger, randomized, controlled studies will help to clarify the precise role and benefits of such a system in cardiothoracic surgery, limited initial evidence from clinical studies and from the authors' own experiences appears promising. In light of the growing interest in this technology among cardiothoracic surgeons, a consensus meeting, which was attended by a group of international experts, was held to review existing evidence for negative pressure wound therapy in the prevention of wound complications after surgery and to provide recommendations on the optimal use of negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery. PMID:25280449

Dohmen, Pascal M; Markou, Thanasie; Ingemansson, Richard; Rotering, Heinrich; Hartman, Jean M; van Valen, Richard; Brunott, Maaike; Segers, Patrique

2014-01-01

394

Emergency Response Training Practices for People With DisabilitiesAnalysis of Some Current Practices and Recommendations for Future Training Programs  

Microsoft Academic Search

Each year thousands of people are potentially affected by the types of emergency preparedness and response training plans practiced in their communities. Between 1998 and 2002, 3,000 counties in the United States declared disasters that have included floods, tornadoes, hurricanes, winter storms, thunderstorms, fires, ice storms, and earthquakes. Emergency preparedness for all people, including people with disabilities, may involve natural

Jennifer L. Rowland; Glen W. White; Michael H. Fox; Catherine Rooney

2007-01-01

395

Canadian clinical practice guidelines for acute and chronic rhinosinusitis  

PubMed Central

This document provides healthcare practitioners with information regarding the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS) and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in guidelines development, and do not address the particulars of the Canadian healthcare environment. Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation), which have led to changes in therapeutic approaches (eg, increased use of corticosteroids). The role of bacteria in the persistence of chronic infections, and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused. Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on readability rather than completeness, yet covers relevant information, offers summaries of areas where considerable evidence exists, and provides recommendations with an assessment of strength of the evidence base and degree of endorsement by the multidisciplinary expert group preparing the document. These guidelines have been copublished in both Allergy, Asthma & Clinical Immunology and the Journal of Otolaryngology-Head and Neck Surgery. PMID:21310056

2011-01-01

396

KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis.  

PubMed

Glomerulonephritis (GN) is an important cause of morbidity and mortality in patients of all ages throughout the world. Because these disorders are relatively rare, it is difficult to perform randomized clinical trials to define optimal treatment for many of the specific glomerulopathies. In the absence of high-grade evidence to guide the care of glomerular diseases, in June 2012, KDIGO (Kidney Disease: Improving Global Outcomes) published an international clinical guideline for GN. The Work Group report represents an important review of the literature in this area and offers valid and useful guidelines for the most common situations that arise in the management of patients with glomerular disease. This commentary, developed by a panel of clinical experts convened by the National Kidney Foundation, attempts to put the GN guideline into the context of the US health care system. Overall, we support the vast majority of the recommendations and highlight select areas in which epidemiological factors and medical practice patterns in this country justify modifications and adjustments in order to achieve favorable outcomes. There remain large gaps in our knowledge of the best approaches to treat glomerular disease and we strongly endorse an expanded clinical research effort to improve the health and long-term outcomes of children and adults with GN. PMID:23871408

Beck, Laurence; Bomback, Andrew S; Choi, Michael J; Holzman, Larry B; Langford, Carol; Mariani, Laura H; Somers, Michael J; Trachtman, Howard; Waldman, Meryl

2013-09-01

397

Best Practice Recommendations for Anesthetic Perioperative Care and Pain Management in Weight Loss Surgery  

Microsoft Academic Search

Objective: To develop evidence-based recommendations that optimize the safety and efficacy of perioperative anesthetic care and pain management in weight loss surgery (WLS) patients.Research Methods and Procedures: This Task Group examined the scientific literature on anesthetic perioperative care and pain management published in MEDLINE from January 1994 to March 2004. We also reviewed additional data from other sources (e.g., book

Roman Schumann; Stephanie B. Jones; Vilma E. Ortiz; Kathleen Connor; Istvan Pulai; Edwin T. Ozawa; Alan M. Harvey; Daniel B. Carr

2005-01-01

398

Clinical practice guidelines: their use, misuse, and future directions.  

PubMed

Evidence-based clinical practice guidelines (CPGs) have the potential to bring the best-quality evidence to orthopaedic surgeons and their patients. CPGs can improve quality by decreasing the variability in orthopaedic care, but they can also be misused through inappropriate development or application. The quality of a CPG is dependent on the strength of its evidence base, which is often deficient in orthopaedic publications. In addition, many surgeons express concern about legal liability associated with CPGs. Specific processes in CPG development and implementation can counter these potential problems. Other evidence tools, such as appropriate use criteria, also can help in the application of the proper treatment of patients by identifying those who are appropriate for specific procedures. Because payers, patients, and surgeons need access to the best evidence, CPGs will continue to be developed, and orthopaedic surgeons have the opportunity to ensure their proper development and implementation by understanding and participating in the process. PMID:24603823

Sanders, James O; Bozic, Kevin J; Glassman, Steven D; Jevsevar, David S; Weber, Kristy L

2014-03-01