Note: This page contains sample records for the topic clinical practice recommendations from Science.gov.
While these samples are representative of the content of Science.gov,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of Science.gov
to obtain the most current and comprehensive results.
Last update: August 15, 2014.
1

Evidence-based cognitive rehabilitation: Recommendations for clinical practice  

Microsoft Academic Search

Cicerone KD, Dahlberg C, Kalmar K, Langenbahn DM, Malec JF, Bergquist TF, Felicetti T, Giacino JT, Harley JP, Harrington DE, Herzog J, Kneipp S, Laatsch L, Morse PA. Evidence-based cognitive rehabilitation: recommendations for clinical practice. Arch Phys Med Rehabil 2000;81:1596-615. Objective: To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific

Keith D. Cicerone; Cynthia Dahlberg; Kathleen Kalmar; Donna M. Langenbahn; James F. Malec; Thomas F. Bergquist; Thomas Felicetti; Joseph T. Giacino; J. Preston Harley; Douglas E. Harrington; Jean Herzog; Sally Kneipp; Linda Laatsch; Philip A. Morse

2000-01-01

2

Pharmacogenetics-based therapeutic recommendations — ready for clinical practice?  

Microsoft Academic Search

Although considerable progress has been made in basic pharmacogenetic research, less has been demonstrated in the application of pharmacogenetics (PGx)-based diagnostics to drug development and in clinical practice. There are drugs that are currently used in the clinic for which individualized therapy could be beneficial based on PGx data. However, specific, actionable recommendations on how to implement individualized therapy —

Uwe Fuhr; Jürgen Brockmöller; Julia Kirchheiner

2005-01-01

3

Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations.  

PubMed

Postmenopausal uterine bleeding is defined as uterine bleeding after permanent cessation of menstruation resulting from loss of ovarian follicular activity. Bleeding can be spontaneous or related to ovarian hormone replacement therapy or to use of selective estrogen receptor modulators (eg, tamoxifen adjuvant therapy for breast carcinoma). Because anovulatory "cycles" with episodes of multimonth amenorrhea frequently precede menopause, no consensus exists regarding the appropriate interval of amenorrhea before an episode of bleeding that allows for the definition of postmenopausal bleeding. The clinician faces the possibility that an underlying malignancy exists, knowing that most often the bleeding comes from a benign source. Formerly, the gold-standard clinical investigation of postmenopausal uterine bleeding was institution-based dilation and curettage, but there now exist office-based methods for the evaluation of women with this complaint. Strategies designed to implement these diagnostic methods must be applied in a balanced way considering the resource utilization issues of overinvestigation and the risk of missing a malignancy with underinvestigation. Consequently, guidelines and recommendations were developed to consider these issues and the diverse spectrum of practitioners who evaluate women with postmenopausal bleeding. The guideline development group determined that, for initial management of spontaneous postmenopausal bleeding, primary assessment may be with either endometrial sampling or transvaginal ultrasonography, allowing patients with an endometrial echo complex thickness of 4 mm or less to be managed expectantly. Guidelines are also provided for patients receiving selective estrogen receptor modulators or hormone replacement therapy, and for an endometrial echo complex with findings consistent with fluid in the endometrial cavity.? PMID:24377427

Munro, Malcolm G

2014-01-01

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

Implications of the Mmory Controversy for Clinical Practice: An Overview of Treatment Recommendations and Guidelines.  

ERIC Educational Resources Information Center

Provides an overview of the positions taken by both sides in the dispute of "false memory." Then presents major findings of several professional task forces charged with reviewing the controversy and arriving at recommendations for research, clinical practice, and forensic practice regarding delayed recall of memories for sexual abuse. (Contains…

Courtois, Christine A.

2001-01-01

6

Grading recommendations in clinical practice guidelines: randomised experimental evaluation of four different systems  

Microsoft Academic Search

ObjectiveTo evaluate the effect of presenting a recommendation in a clinical practice guideline using different grading systems to determine to what extent the system used changes the clinician's eventual response to a particular clinical question.DesignRandomised experimental study.SettingClinician offices and academic settings.ParticipantsPaediatricians and paediatric residents in private and public practice in Mexico.InterventionCase notes of a child with diarrhoea and a question

Carlos A Cuello García; Karla P Pacheco Alvarado; Giordano Pérez Gaxiola

2011-01-01

7

Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice  

Microsoft Academic Search

BackgroundThere is increasing evidence that, in addition to the well-known effects on musculoskeletal health, vitamin D status may be related to a number of non-skeletal diseases. An international expert panel formulated recommendations on vitamin D for clinical practice, taking into consideration the best evidence available based on published literature today. In addition, where data were limited to smaller clinical trials

Jean-Claude Souberbielle; Jean-Jacques Body; Joan M. Lappe; Mario Plebani; Yehuda Shoenfeld; Thomas J. Wang; Heike A. Bischoff-Ferrari; Etienne Cavalier; Peter R. Ebeling; Patrice Fardellone; Sara Gandini; Damien Gruson; Alain P. Guérin; Lene Heickendorff; Bruce W. Hollis; Sofia Ish-Shalom; Guillaume Jean; Philipp von Landenberg; Alvaro Largura; Tomas Olsson; Charles Pierrot-Deseilligny; Stefan Pilz; Angela Tincani; Andre Valcour; Armin Zittermann

2010-01-01

8

Application of GRADE: Making evidence-based recommendations about diagnostic tests in clinical practice guidelines  

PubMed Central

Background Accurate diagnosis is a fundamental aspect of appropriate healthcare. However, clinicians need guidance when implementing diagnostic tests given the number of tests available and resource constraints in healthcare. Practitioners of health often feel compelled to implement recommendations in guidelines, including recommendations about the use of diagnostic tests. However, the understanding about diagnostic tests by guideline panels and the methodology for developing recommendations is far from completely explored. Therefore, we evaluated the factors that guideline developers and users need to consider for the development of implementable recommendations about diagnostic tests. Methods Using a critical analysis of the process, we present the results of a case study using the Grading of Recommendations Applicability, Development and Evaluation (GRADE) approach to develop a clinical practice guideline for the diagnosis of Cow Milk Allergy with the World Allergy Organization. Results To ensure that guideline panels can develop informed recommendations about diagnostic tests, it appears that more emphasis needs to be placed on group processes, including question formulation, defining patient-important outcomes for diagnostic tests, and summarizing evidence. Explicit consideration of concepts of diagnosis from evidence-based medicine, such as pre-test probability and treatment threshold, is required to facilitate the work of a guideline panel and to formulate implementable recommendations. Discussion This case study provides useful guidance for guideline developers and clinicians about what they ought to demand from clinical practice guidelines to facilitate implementation and strengthen confidence in recommendations about diagnostic tests. Applying a structured framework like the GRADE approach with its requirement for transparency in the description of the evidence and factors that influence recommendations facilitates laying out the process and decision factors that are required for the development, interpretation, and implementation of recommendations about diagnostic tests.

2011-01-01

9

Rheumatoid Arthritis Disease Activity Measures: American College of Rheumatology Recommendations for Use in Clinical Practice  

PubMed Central

Objective Although the systematic measurement of disease activity facilitates clinical decision making in rheumatoid arthritis (RA), no recommendations currently exist on which measures should be applied in clinical practice in the US. The American College of Rheumatology (ACR) convened a Working Group (WG) to comprehensively evaluate the validity, feasibility, and acceptability of available RA disease activity measures and derive recommendations for their use in clinical practice. Methods The Rheumatoid Arthritis Clinical Disease Activity Measures Working Group conducted a systematic review of the literature to identify RA disease activity measures. Using exclusion criteria, input from an Expert Advisory Panel (EAP), and psychometric analysis, a list of potential measures was created. A survey was administered to rheumatologists soliciting input. The WG used these survey results in conjunction with the psychometric analyses to derive final recommendations. Results Systematic review of the literature resulted in identification of 63 RA disease activity measures. Application of exclusion criteria and ratings by the EAP narrowed the list to 14 measures for further evaluation. Practicing rheumatologists rated 9 of these 14 measures as most useful and feasible. From these 9 measures, the WG selected 6 with the best psychometric properties for inclusion in the final set of ACR-recommended RA disease activity measures. Conclusion We recommend the Clinical Disease Activity Index, Disease Activity Score with 28-joint counts (erythrocyte sedimentation rate or C-reactive protein), Patient Activity Scale (PAS), PAS-II, Routine Assessment of Patient Index Data with 3 measures, and Simplified Disease Activity Index because they are accurate reflections of disease activity; are sensitive to change; discriminate well between low, moderate, and high disease activity states; have remission criteria; and are feasible to perform in clinical settings.

ANDERSON, JACLYN; CAPLAN, LIRON; YAZDANY, JINOOS; ROBBINS, MARK L.; NEOGI, TUHINA; MICHAUD, KALEB; SAAG, KENNETH G.; O'DELL, JAMES R.; KAZI, SALAHUDDIN

2013-01-01

10

Update on current monitoring recommendations in chronic myeloid leukemia: practical points for clinical practice.  

PubMed

Excellent therapeutic options exist for the treatment of chronic-phase chronic myeloid leukemia (CML) patients. Therefore, managing CML patients has become a more common practice for many physicians. Most chronic-phase CML patients achieve durable cytogenetic and molecular responses on first-line tyrosine kinase inhibitor therapy. However, careful monitoring and assessment of adherence are essential for successful outcomes and to identify patients at risk for failing therapy. The European LeukemiaNet and National Comprehensive Cancer Network provide guidance and strategies for monitoring and managing patients treated with TKIs. These recommendations continue to evolve as approved treatment options expand to include second- and third-generation tyrosine kinase inhibitors. How measurements of response are defined and data supporting recent recommended changes to monitoring are reviewed here. These changes include increasing recognition of the importance of early response. The relevance of achieving deep molecular responses will also be addressed. PMID:24319179

Oehler, Vivian G

2013-01-01

11

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.

2012-01-01

12

Clarifying delirium management: practical, evidenced-based, expert recommendations for clinical practice.  

PubMed

Delirium is highly prevalent in those with serious or advanced medical illnesses. It is associated with many adverse consequences, including significant patient, family, and health care provider distress. This article suggests a novel approach to delirium assessment and management and provides useful, practical guidance for clinicians based on a complete review of the existing literature and the expert clinical opinion of the authors and their colleagues, derived from over a decade of collective bedside experience. Comprehensive assessment includes careful description of observed symptoms, signs, and behaviors; and an understanding of the patient's situation, including primary diagnosis, associated comorbidities, functional status, and prognosis. The importance of incorporating goals of care for the patient and family is discussed. The concepts of potential reversibility versus irreversible delirium and delirium subtype are proffered, with a description of how diagnostic and management strategies follow from these concepts. Pharmacological interventions that provide rapid, effective, and safe relief are presented. Employing both pharmacological and nonpharmacological interventions, including patient and family education, improves symptoms and relieves patient and family distress, whether the delirium is reversible or irreversible, hyperactive or hypoactive. All interventions can be provided in any setting of care, including patients' homes. PMID:23480299

Irwin, Scott A; Pirrello, Rosene D; Hirst, Jeremy M; Buckholz, Gary T; Ferris, Frank D

2013-04-01

13

Fractional flow reserve application in everyday practice: adherence to clinical recommendations  

PubMed Central

Fractional flow reserve (FFR) is considered the gold standard for invasive assessment of functional, significant coronary stenosis. Nevertheless, its application and outcome in daily practice is rarely reported. We investigated whether decisions in clinical practice adhered to FFR-generated recommendations and whether FFR influenced cardiovascular outcomes. This retrospective, observational, cohort study included 189 patients that underwent FFR measurements during coronary angiography at our institution The median follow up was 27 months (range, 7-112 months). Clinical outcomes (up to 2 years) included all-cause mortality, cardiac-mortality, and major adverse cardiac events (MACE) which comprised cardiac mortality, non-fatal MI, target vessel revascularization, and coronary artery bypass graft (CABG). Patients most frequently presented with unstable angina (74.6%). Only 55 patients (29.1%) exhibited significant functional stenosis (FFR ?0.8). Nevertheless, 68 patients (36%) underwent immediate coronary interventions; 64% were deferred from revascularization procedures and managed conservatively with optimal medical treatment. Thirty-five patients (18.5%) were treated in discordance with FFR results, but the overall MACE rate was similar to that of patients treated in concordance with FFR results (8.3% vs. 8.6%, P=0.41). In conclusion, in our everyday practice, the operator’s decision was in discordance to the FFR measurements and indications in nearly 20% of cases. In these selected cases, the operator’s subjective judgment may continue to play an important role.

Bental, Tamir; Eisen, Alon; Vaknin-Assa, Hana; Assali, Abid; Lev, Eli I.; Brosh, David; Kornowski, Ran

2013-01-01

14

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

15

A critical appraisal of the quality of critical care pharmacotherapy clinical practice guidelines and their strength of recommendations  

Microsoft Academic Search

Objective  Clinical practice guideline (CPG) quality assessment is important before applying their recommendations. Determining whether\\u000a recommendation strength is consistent with supporting quality of evidence is also essential. We aimed to determine quality\\u000a of critical care pharmacotherapy CPGs and to assess whether high quality evidence supports strong pharmacotherapy recommendations.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  MEDLINE (1966–February 2008), EMBASE (1980–February 2008), National Guideline Clearinghouse (February 2008) and personal

Sean K. Gorman; Michelle Ho Chung; Richard S. Slavik; Peter J. Zed; Kerry Wilbur; Vinay K. Dhingra

2010-01-01

16

[Current recommendations for the diagnosis of chronic pancreatitis in general clinical practice].  

PubMed

The paper gives practical recommendations based on the provisions of a number of foreign national guidelines for the diagnosis of chronic pancreatitis (CP). There is virtually no evidence for Class I database for its diagnosis. Despite an inadequate scientific rationale, the review of these international guidelines has brought together the basic available data in the context of the current global standards for the diagnosis of CP. PMID:23808299

Maev, I V; Kucheriavy?, Iu A; Kaziulin, A N; Samsonov, A A

2013-01-01

17

Safe Handling of Oral Chemotherapeutic Agents in Clinical Practice: Recommendations From an International Pharmacy Panel  

PubMed Central

Although there has been a significant increase in the availability and use of oral chemotherapeutic agents, the guidelines around their safe handling are still evolving. Although oral chemotherapy is associated with ease of administration, it has the same exposure risks to health care practitioners, patients, and their caregivers as intravenous formulations, and because it is administered in the home, to the families of patients. However, the general misconception appears to be that exposure risk is low and therefore oral chemotherapeutic agents present little risk and are safer to handle. In a series of three roundtable meetings, a team of international pharmacists from North America and Europe reviewed existing guidelines and identified gaps in recommendations that we believe are important for safe handling. The present article is a compilation of these gaps, especially applicable to manufacturers and distributors, storage and handling, and patient education regarding safe handling. These recommendations, on the basis of our experience and of best practices, provide an international perspective and can be adapted by institutions and practices for development of standardized procedures specific to their needs for the safe handling of oral chemotherapeutic agents.

Goodin, Susan; Griffith, Niesha; Chen, Beth; Chuk, Karen; Daouphars, Mikael; Doreau, Christian; Patel, Rinku A.; Schwartz, Rowena; Tames, Maria Jose; Terkola, Robert; Vadnais, Barbara; Wright, Debbie; Meier, Klaus

2011-01-01

18

Monitoring adverse events of low-dose glucocorticoid therapy: EULAR recommendations for clinical trials and daily practice  

Microsoft Academic Search

ObjectiveTo develop recommendations on monitoring for adverse events (AEs) of low-dose glucocorticoid (GC) therapy (?7.5 mg prednisone or equivalent daily) in clinical trials and daily practice.MethodsLiterature was searched for articles containing information on incidence and monitoring of GC-related AEs using PubMed, EMBASE and Cochrane databases. Second, the authors searched for broad accepted guidelines on the monitoring of certain AEs (eg,

M. C. van der Goes; J. W. G. Jacobs; M. Boers; T. Andrews; M. A. M. Blom-Bakkers; F. Buttgereit; N. Caeyers; M. Cutolo; J. A. P. Da Silva; L. Guillevin; J. R. Kirwan; J. Rovensky; G. Severijns; S. Webber; R. Westhovens; J. W. J. Bijlsma

2010-01-01

19

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

20

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.

Rosenthal, Stephanie; Evans, Cathy

2012-01-01

21

Support of personalized medicine through risk-stratified treatment recommendations - an environmental scan of clinical practice guidelines  

PubMed Central

Background Risk-stratified treatment recommendations facilitate treatment decision-making that balances patient-specific risks and preferences. It is unclear if and how such recommendations are developed in clinical practice guidelines (CPGs). Our aim was to assess if and how CPGs develop risk-stratified treatment recommendations for the prevention or treatment of common chronic diseases. Methods We searched the United States National Guideline Clearinghouse for US, Canadian and National Institute for Health and Clinical Excellence (United Kingdom) CPGs for heart disease, stroke, cancer, chronic obstructive pulmonary disease and diabetes that make risk-stratified treatment recommendations. We included only those CPGs that made risk-stratified treatment recommendations based on risk assessment tools. Two reviewers independently identified CPGs and extracted information on recommended risk assessment tools; type of evidence about treatment benefits and harms; methods for linking risk estimates to treatment evidence and for developing treatment thresholds; and consideration of patient preferences. Results We identified 20 CPGs that made risk-stratified treatment recommendations out of 133 CPGs that made any type of treatment recommendations for the chronic diseases considered in this study. Of the included 20 CPGs, 16 (80%) used evidence about treatment benefits from randomized controlled trials, meta-analyses or other guidelines, and the source of evidence was unclear in the remaining four (20%) CPGs. Nine CPGs (45%) used evidence on harms from randomized controlled trials or observational studies, while 11 CPGs (55%) did not clearly refer to harms. Nine CPGs (45%) explained how risk prediction and evidence about treatments effects were linked (for example, applying estimates of relative risk reductions to absolute risks), but only one CPG (5%) assessed benefit and harm quantitatively and three CPGs (15%) explicitly reported consideration of patient preferences. Conclusions Only a small proportion of CPGs for chronic diseases make risk-stratified treatment recommendations with a focus on heart disease and stroke prevention, diabetes and breast cancer. For most CPGs it is unclear how risk-stratified treatment recommendations were developed. As a consequence, it is uncertain if CPGs support patients and physicians in finding an acceptable benefit- harm balance that reflects both profile-specific outcome risks and preferences.

2013-01-01

22

The Role of Spirituality in the Treatment of Trauma and Eating Disorders: Recommendations for Clinical Practice  

Microsoft Academic Search

The relationships among trauma, eating disorders, and spirituality are complex. Both trauma and eating disorders can distance women from their own spirituality, which undermines a potentially important treatment resource. In this article, we offer suggestions based on our clinical experience for helping eating disorder patients who have suffered trauma to rediscover their faith and spirituality. We describe how spirituality can

Michael E. Berrett; Randy K. Hardman; Kari A. OGrady; P. Scott Richards

2007-01-01

23

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

24

Impact of Crop Management Diagnostic Clinics on Advisors' Recommendations and Producer Practices  

ERIC Educational Resources Information Center

Adoption resulting from University of Nebraska-Lincoln Crop Management Diagnostic Clinic (CMDC) field days was evaluated using an on-line survey. Respondents reported significant gains in skills because of CMDC, but the gains were similar across skill areas. Adoption was affected by compatibility with the cropping system, relative advantage,…

Wortmann, Charles S.; Glewen, Keith L.; Williams, Susan N.

2011-01-01

25

Tibolone: clinical recommendations and practical guidelines. A report of the International Tibolone Consensus Group.  

PubMed

An international multidisciplinary panel of experts in the management of the menopause met at the 4th Amsterdam Menopause Symposium in October 2004 to determine the specific place of tibolone, a synthetic steroid with a unique clinical profile, within the wide range of currently available postmenopausal therapy options. The consensus was that tibolone is a valuable treatment option for women with climacteric complaints. As well as relieving vasomotor symptoms, tibolone has positive effects on sexual well-being and mood, and improves vaginal atrophy and urogenital symptoms. Prevention of bone loss with tibolone is comparable to that seen with estrogen therapy (ET) and estrogen/progestogen therapy (EPT). As tibolone rarely causes endometrial proliferation, no additional progestogen is required. It also has good tolerability, being associated with a low incidence of vaginal bleeding and of breast pain. Tibolone does not increase mammographic density. Absolute numbers of women at increased risk for breast cancer are estimated to be low or absent with both tibolone and ET, and the risk with tibolone should be significantly lower than that with EPT. Tibolone might therefore be preferable to EPT in certain women who have not been hysterectomised. Based on the evidence available, the panel proposed a number of subgroups of postmenopausal women with vasomotor symptoms in whom tibolone might have added value; these included women with sexual dysfunction, mood disorders, fibroids and urogenital complaints, as well as those with breast tenderness or high mammographic breast density with EPT use. PMID:15883105

Kenemans, P; Speroff, L

2005-05-16

26

Periodontal and general health: clinical recommendations.  

PubMed

The purpose of Linking Research to Clinical Practice is to present evidence based information to clinical dental hygienists so that they can make informed decisions regarding patient treatment and recommendations. Each issue will feature a different topic area of importance to clinical dental hygienists with A BOTTOM LINE to translate the research findings into clinical application. PMID:24771770

Bowen, Denise M

2014-04-01

27

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.

2010-01-01

28

Prophylactic feeding tubes for patients with locally advanced head-and-neck cancer undergoing combined chemotherapy and radiotherapy--systematic review and recommendations for clinical practice  

PubMed Central

Goals This work aimed to determine the benefits and risks of prophylactic feeding tubes for adult patients with squamous cell carcinoma of the head and neck who receive combined chemotherapy and radiotherapy with curative intent and to make recommendations on the use of prophylactic feeding tubes and the provision of adequate nutrition to this patient population. Methods A national multidisciplinary panel conducted a systematic review of the evidence and formulated recommendations to guide clinical decision-making. The draft evidence summary and recommendations were distributed to clinicians across Canada for their input. Main Results No randomized controlled trials have directly addressed this question. Evidence from studies in the target population was limited to seven descriptive studies: two with control groups (one prospective, one retrospective) and five without control groups. Results from ten controlled studies in patients treated with radiotherapy alone were also reviewed. Conclusions The available evidence was insufficient to draw definitive conclusions about the effectiveness of prophylactic feeding tubes in the target patient population or to support an evidence-based practice guideline. After review of the evidence, of guidelines from other groups, and of current clinical practice in Canada, the multidisciplinary panel made consensus-based recommendations regarding comprehensive interdisciplinary clinical care before, during, and after cancer treatment. The recommendations are based on the expert opinion of the panel members and on their understanding of best clinical practice.

Orphanidou, C.; Biggs, K.; Johnston, M.E.; Wright, J.R.; Bowman, A.; Hotte, S.J.; Esau, A.; Myers, C.; Blunt, V.; Lafleur, M.; Sheehan, B.; Griffin, M.A.

2011-01-01

29

Peritoneal function in clinical practice: the importance of follow-up and its measurement in patients. Recommendations for patient information and measurement of peritoneal function.  

PubMed

A review is given on peritoneal function, especially ultrafiltration and ultrafiltration failure followed by recommendations on how to translate pathophysiology into clinical practice. The subsequent consequences for management of peritoneal membrane function and for patient information are also included. PMID:19461865

Coester, Annemieke M; Smit, Watske; Struijk, Dirk G; Krediet, Raymond T

2009-04-01

30

clinical practice  

PubMed Central

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. A 62-year-old healthy woman presents for routine care. She has no history of fracture, but she is worried about osteoporosis because her mother had a hip fracture at 72 years of age. She exercises regularly and has taken over-the-counter calcium carbonate at a dose of 1000 mg three times a day since her menopause at 54 years of age. This regimen provides 1200 mg of elemental calcium per day. She eats a healthy diet with multiple servings of fruits and vegetables and consumes one 8-oz serving of low-fat yogurt and one glass of low-fat milk almost every day. She recently heard that calcium supplements could increase her risk of cardiovascular disease and wants your opinion about whether or not she should receive them. What would you advise?

Bauer, Douglas C.

2014-01-01

31

Professional practices and recommendations What is the interest of rehabilitation in physical medicine and functional rehabilitation ward after total knee arthroplasty? Elaboration of French clinical practice guidelines  

Microsoft Academic Search

Objectives. - To develop clinical practice guidelines concerning the interest of post-operative rehabilitation in physical medicine and func- tional rehabilitation (PMR) ward after total knee arthroplasty (TKA). Method. - The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used. Main outcomes

B. Barrois; P. Ribinika; M. Revelc Rannou

32

Evidence-based risk recommendations for best practices in the training of qualified exercise professionals working with clinical populations.  

PubMed

This systematic review examines critically "best practices" in the training of qualified exercise professionals. Particular attention is given to the core competencies and educational requirements needed for working with clinical populations. Relevant information was obtained by a systematic search of 6 electronic databases, cross-referencing, and through the authors' knowledge of the area. The level and grade of the available evidence was established. A total of 52 articles relating to best practices and (or) core competencies in clinical exercise physiology met our eligibility criteria. Overall, current literature supports the need for qualified exercise professionals to possess advanced certification and education in the exercise sciences, particularly when dealing with "at-risk" populations. Current literature also substantiates the safety and effectiveness of exercise physiologist supervised stress testing and training in clinical populations. PMID:21800944

Warburton, Darren E R; Bredin, Shannon S D; Charlesworth, Sarah A; Foulds, Heather J A; McKenzie, Don C; Shephard, Roy J

2011-07-01

33

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.

Chaturvedi, Santosh K.

2014-01-01

34

Clinical practice guidelines in psychiatry: more confusion than clarity? A critical review and recommendation of a unified guideline.  

PubMed

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

Saddichha, Sahoo; Chaturvedi, Santosh K

2014-01-01

35

Conflicts of interest and clinical recommendations: comparison of two concurrent clinical practice guidelines for primary immune thrombocytopenia developed by different methods.  

PubMed

The growing influence of practice guidelines has increased concern for potential sources of bias. Two recent guidelines for primary immune thrombocytopenia (ITP) provided a unique opportunity for a systematic comparison of different methods of practice guideline development. One guideline (International Consensus Report [ICR]) was supported by pharmaceutical companies that produce products for ITP. The ICR panel members were selected for expertise in ITP; 16 (73%) reported associations with pharmaceutical companies. The other guideline was sponsored by the American Society of Hematology (ASH); panel members were selected for lack of conflicts and for expertise in guideline development as well as for ITP. Discrepancies were conspicuous when the guidelines addressed treatment. In contrast to the ASH guideline, the ICR gave stronger recommendations for agents manufactured by companies from which the ICR or its panel members received support. These data provide direct evidence that differences in financial support and methods of evidence evaluation can influence recommendations. PMID:23550214

George, James N; Vesely, Sara K; Woolf, Steven H

2014-01-01

36

A qualitative study of the activities performed by people involved in clinical decision support: recommended practices for success  

PubMed Central

Objective To describe the activities performed by people involved in clinical decision support (CDS) at leading sites. Materials and methods We conducted ethnographic observations at seven diverse sites with a history of excellence in CDS using the Rapid Assessment Process and analyzed the data using a series of card sorts, informed by Linstone's Multiple Perspectives Model. Results We identified 18 activities and grouped them into four areas. Area 1: Fostering relationships across the organization, with activities (a) training and support, (b) visibility/presence on the floor, (c) liaising between people, (d) administration and leadership, (e) project management, (f) cheerleading/buy-in/sponsorship, (g) preparing for CDS implementation. Area 2: Assembling the system with activities (a) providing technical support, (b) CDS content development, (c) purchasing products from vendors (d) knowledge management, (e) system integration. Area 3: Using CDS to achieve the organization's goals with activities (a) reporting, (b) requirements-gathering/specifications, (c) monitoring CDS, (d) linking CDS to goals, (e) managing data. Area 4: Participation in external policy and standards activities (this area consists of only a single activity). We also identified a set of recommendations associated with these 18 activities. Discussion All 18 activities we identified were performed at all sites, although the way they were organized into roles differed substantially. We consider these activities critical to the success of a CDS program. Conclusions A series of activities are performed by sites strong in CDS, and sites adopting CDS should ensure they incorporate these activities into their efforts.

Wright, Adam; Ash, Joan S; Erickson, Jessica L; Wasserman, Joe; Bunce, Arwen; Stanescu, Ana; St Hilaire, Daniel; Panzenhagen, Morgan; Gebhardt, Eric; McMullen, Carmit; Middleton, Blackford; Sittig, Dean F

2014-01-01

37

Clinical practice  

PubMed Central

The most important goal of introducing noninvasive ventilation (NIV) has been to decrease the need for intubation and, therefore, mechanical ventilation in newborns. As a result, this technique may reduce the incidence of bronchopulmonary dysplasia (BPD). In addition to nasal CPAP, improvements in sensors and flow delivery systems have resulted in the introduction of a variety of other types of NIV. For the optimal application of these novelties, a thorough physiological knowledge of mechanics of the respiratory system is necessary. In this overview, the modern insights of noninvasive respiratory therapy in newborns are discussed. These aspects include respiratory support in the delivery room; conventional and modern nCPAP; humidified, heated, and high-flow nasal cannula ventilation; and nasal intermittent positive pressure ventilation. Finally, an algorithm is presented describing common practice in taking care of respiratory distress in prematurely born infants.

de Vries, Machteld A. G.; Zimmermann, Luc J. I.

2010-01-01

38

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

Microsoft Academic Search

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

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

2006-01-01

39

Recommendations for Meeting the Pediatric Patient's Need for a Clinical Pharmacist: A Joint Opinion of the Pediatrics Practice and Research Network of the American College of Clinical Pharmacy and the Pediatric Pharmacy Advocacy Group  

PubMed Central

Children warrant access to care from clinical pharmacists trained in pediatrics. The American College of Clinical Pharmacy Pediatrics Practice and Research Network (ACCP Pediatrics PRN) released an opinion paper in 2005 with recommendations for improving the quality and quantity of pediatric pharmacy education in colleges of pharmacy, residency programs, and fellowships. While progress has been made in increasing the availability of pediatric residencies, there is still much to be done to meet the direct care needs of pediatric patients. The purpose of this Joint Opinion paper is to outline strategies and recommendations for expanding the quality and capacity of pediatric clinical pharmacy practitioners by 1) elevating the minimum expectations for pharmacists entering practice to provide pediatric care; 2) standardizing pediatric pharmacy education; 3) expanding the current number of pediatric clinical pharmacists; and 4) creating an infrastructure for development of pediatric clinical pharmacists and clinical scientists. These recommendations may be used to provide both a conceptual framework and action items for schools of pharmacy, health care systems, and policymakers to work together to increase the quality and quantity of pediatric training, practice, or research initiatives.

Bhatt-Mehta, Varsha; Buck, Marcia L.; Chung, Allison M.; Farrington, Elizabeth Anne; Hagemann, Tracy M.; Hoff, David S.; LaRochelle, Joseph M.; Pettit, Rebecca S.; Phan, Hanna; Potts, Amy L.; Smith, Katherine P.; Parrish, Richard H.

2012-01-01

40

[Sex- and gender-aspects in regard to clinical practice recommendations for pre-diabetes and diabetes].  

PubMed

Metabolic diseases dramatically affect life of men and women from infancy up to old age and are a major challenge for clinicians. Health professionals are confronted with different needs of women and men. This article aims at an increase of gender awareness and the implementation of current knowledge of gender medicine in daily clinical practice with regard to pre-diabetes and diabetes. Sex and gender affect screening and diagnosis of metabolic diseases as well as treatment strategies and outcome. Impaired glucose and lipid metabolism, regulation of energy balance and body fat distribution are related to steroid hormones and therefore impose their influence on cardiovascular health in both men and women. Furthermore, education, income and psychosocial factors relate to development of obesity and diabetes differently in men and women. Males appear to be at greater risk of diabetes at younger age and at lower BMI compared to women, but women feature a dramatic increase of their cardiometabolic risk after menopause. The estimated future years of life lost owing to diabetes is somewhat higher in women than men, with higher increase of vascular death in women, but higher increase of cancer death in men. In women pre-diabetes or diabetes are more distinctly associated with a higher number of vascular risk factors, such as inflammatory parameters, unfavourable changes of coagulation and blood pressure. Pre-diabetic and diabetic women are at much higher risk for vascular disease (3-6 times compared to non-diabetic women) than diabetic men (2-3 times compared to healthy males). Women are more often obese and less physically active, but may even have greater benefit from increased physical activity than males. Whereas men predominantly feature impaired fasting glucose, women often show impaired glucose tolerance. A history of gestational diabetes or the presence of a PCOS or increased androgen levels in women, on the other hand the presence of erectile dysfunction (ED) or decreased testosterone levels in men are sex specific risk factors for diabetes development. ED is a common feature of obese men with the Metabolic Syndrome and an important predictor of cardiovascular disease. Several studies showed that diabetic women reach their targets of metabolic control (HbA1c), blood pressure and LDL-cholesterol less often than their male counterparts, although the reasons for worse treatment outcome in diabetic females are not clear. Furthermore, sex differences in action, pharmacokinetics, and side effects of pharmacological therapy have to be taken into account. PMID:23250467

Kautzky-Willer, Alexandra; Weitgasser, Raimund; Fasching, Peter; Hoppichler, Fritz; Lechleitner, Monika

2012-12-01

41

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

42

Training Research: Practical Recommendations for Maximum Impact  

PubMed Central

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.

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

2011-01-01

43

Nutrition for tennis: practical recommendations.  

PubMed

Tennis is a pan-global sport that is played year-round in both hemispheres. This places notable demands on the physical and psychological preparation of players and included in these demands are nutritional and fluid requirements both of training and match- play. Thus, the purpose of this article is to review nutritional recommendations for tennis. Notably, tennis players do not excel in any particular physiological or anthropometric characteristic but are well adapted in all areas which is probably a result of the varied nature of the training demands of tennis match play. Energy expenditures of 30.9 ± 5.5 and 45.3 ± 7.3 kJ·min(-1) have been reported in women and men players respectively regardless of court surface. Tennis players should follow a habitually high carbohydrate diet of between 6-10 g·kg(-1)·d(-1) to ensure adequate glycogen stores, with women generally requiring slightly less than men. Protein intake guidelines for tennis players training at a high intensity and duration on a daily basis should be ~1.6 g·kg(-1)·d(-1) and dietary fat intake should not exceed 2 g·kg(-1)·d(-1). Caffeine in doses of 3 mg·kg(-1) provides ergogenic benefit when taken before and/or during tennis match play. Depending on environmental conditions, sweat rates of 0.5 to and over 5 L·hr(-1) and sodium losses of 0.5 - 1.8 g have been recorded in men and women players. 200 mL of fluid containing electrolytes should be consumed every change-over in mild to moderate temperatures of < 27°C but in temperatures greater than 27°C players should aim for ? 400 mL. 30-60 g·hr(-1) of carbohydrate should be ingested when match play exceeds 2 hours. Key PointsTennis players should follow a habitually high carbohydrate diet of between 6-10 g·kg(-1) to ensure adequate glycogen stores, with women generally requiring slightly less than men. Protein intake guidelines for tennis players training at a high intensity and duration on a daily basis should be ~1.6 g·kg(-1)·d(-1). Dietary fat intake should not exceed 2 g·kg(-1)·d(-1).Caffeine in doses of 3 mg·kg(-1) can provide ergogenic benefit when taken before and/or during tennis match play.200 mL of fluid containing electrolytes should be consumed every change-over in mild to moderate temperatures of < 27°C but in temperatures greater than 27°C players should aim for ? 400 mL.30-60 g·hr(-1) of carbohydrate should be ingested when match play exceeds 2 hours.During periods of travel, specific dietary requirements can be communicated with agencies and hotels prior to arrival and in the event that suitably nutritious foods are not available in the host country, players can bring or send non-perishable foods and goods where customs and quarantine laws allow. PMID:24149799

Ranchordas, Mayur K; Rogersion, David; Ruddock, Alan; Killer, Sophie C; Winter, Edward M

2013-01-01

44

Nutrition for Tennis: Practical Recommendations  

PubMed Central

Tennis is a pan-global sport that is played year-round in both hemispheres. This places notable demands on the physical and psychological preparation of players and included in these demands are nutritional and fluid requirements both of training and match- play. Thus, the purpose of this article is to review nutritional recommendations for tennis. Notably, tennis players do not excel in any particular physiological or anthropometric characteristic but are well adapted in all areas which is probably a result of the varied nature of the training demands of tennis match play. Energy expenditures of 30.9 ± 5.5 and 45.3 ± 7.3 kJ·min-1 have been reported in women and men players respectively regardless of court surface. Tennis players should follow a habitually high carbohydrate diet of between 6-10 g·kg-1·d-1 to ensure adequate glycogen stores, with women generally requiring slightly less than men. Protein intake guidelines for tennis players training at a high intensity and duration on a daily basis should be ~1.6 g·kg-1·d-1 and dietary fat intake should not exceed 2 g·kg-1·d-1. Caffeine in doses of 3 mg·kg-1 provides ergogenic benefit when taken before and/or during tennis match play. Depending on environmental conditions, sweat rates of 0.5 to and over 5 L·hr-1 and sodium losses of 0.5 - 1.8 g have been recorded in men and women players. 200 mL of fluid containing electrolytes should be consumed every change-over in mild to moderate temperatures of < 27°C but in temperatures greater than 27°C players should aim for ? 400 mL. 30-60 g·hr-1 of carbohydrate should be ingested when match play exceeds 2 hours. Key Points Tennis players should follow a habitually high carbohydrate diet of between 6-10 g·kg-1 to ensure adequate glycogen stores, with women generally requiring slightly less than men. Protein intake guidelines for tennis players training at a high intensity and duration on a daily basis should be ~1.6 g·kg-1·d-1. Dietary fat intake should not exceed 2 g·kg-1·d-1. Caffeine in doses of 3 mg·kg-1 can provide ergogenic benefit when taken before and/or during tennis match play. 200 mL of fluid containing electrolytes should be consumed every change-over in mild to moderate temperatures of < 27°C but in temperatures greater than 27°C players should aim for ? 400 mL. 30-60 g·hr-1 of carbohydrate should be ingested when match play exceeds 2 hours. During periods of travel, specific dietary requirements can be communicated with agencies and hotels prior to arrival and in the event that suitably nutritious foods are not available in the host country, players can bring or send non-perishable foods and goods where customs and quarantine laws allow.

Ranchordas, Mayur K.; Rogersion, David; Ruddock, Alan; Killer, Sophie C.; Winter, Edward M.

2013-01-01

45

Implementing AORN Recommended Practices for Laser Safety.  

PubMed

Lasers used in the OR pose many risks to both patients and personnel. AORN's "Recommended practices for laser safety in perioperative practice settings" identifies the potential hazards associated with laser use, such as eye damage and fire- and smoke-related injuries. The practice recommendations are intended to be used as a guide for establishing best practices in the workplace and to give perioperative nurses strategies for implementing the recommended safety measures. A laser safety program should include measures to control access to laser use areas; protect staff members and patients from exposure to the laser beam; provide staff members and patients with the appropriate safety eyewear for use in the laser use area; and protect staff members and patients from surgical smoke, electrical, and fire hazards. Measures such as using a safety checklist or creating a laser cart can help perioperative nurses successfully incorporate the practice recommendations. Patient scenarios are included as examples of how to use the document in real-life situations. PMID:22541772

Castelluccio, Donna

2012-05-01

46

Role and modalities of information and education in the management of patients with rheumatoid arthritis: development of recommendations for clinical practice based on published evidence and expert opinion  

Microsoft Academic Search

Objectives. – To develop recommendations for the information and education of patients with rheumatoid arthritis (RA) seen in everyday practice, using evidence from the literature, supplemented with expert opinion when needed.Methods. – A scientific committee developed eight questions using the Delphi consensus procedure. A task force reviewed the literature for answers to these questions, using the PubMed Medline database (1980–2004)

Bruno Fautrel; Thao Pham; Laure Gossec; Bernard Combe; René-Marc Flipo; Philippe Goupille; Xavier Le Loët; Xavier Mariette; Xavier Puéchal; Daniel Wendling; Thierry Schaeverbeke; Jean Sibilia; Jacques Sany; Maxime Dougados

2005-01-01

47

Implementing AORN recommended practices for sharps safety.  

PubMed

Prevention of percutaneous sharps injuries in perioperative settings remains a challenge. Occupational transmission of bloodborne pathogens, not only from patients to health care providers but also from health care providers to patients, is a significant concern. Legislation and position statements geared toward ensuring the safety of patients and health care workers have not resulted in significantly reduced sharps injuries in perioperative settings. Awareness and understanding of the types of percutaneous injuries that occur in perioperative settings is fundamental to developing an effective sharps injury prevention program. The AORN "Recommended practices for sharps safety" clearly delineates evidence-based recommendations for sharps injury prevention. Perioperative RNs can lead efforts to change practice for the safety of patients and perioperative team members by promoting the elimination of sharps hazards; the use of engineering, work practice, and administrative controls; and the proper use of personal protective equipment, including double gloving. PMID:24369976

Ford, Donna A

2014-01-01

48

Procedures for Using Clinical Practice Guidelines  

ERIC Educational Resources Information Center

Purpose: This article provides information about clinical practice guidelines (CPGs) to facilitate their application to the practice of speech-language pathology. CPGs are sets of recommendations based on evidence, including expert clinical opinion, that have been developed by a panel of reviewers. In this article, CPGs are defined and their…

Hargrove, Patricia; Griffer, Mona; Lund, Bonnie

2008-01-01

49

Zonisamide in clinical practice.  

PubMed

Zonisamide is currently licensed in Europe and the USA for the adjunctive treatment of partial seizures (with or without secondary generalization) in adults, based on the results of four pivotal, randomized, double-blind, placebo-controlled trials. It is also licensed in Europe as monotherapy for adults with newly diagnosed partial epilepsy, based on the results of a randomized, double-blind, non-inferiority trial. Because clinical trials are conducted under tightly controlled conditions, using rigid dosing schedules and employing strict exclusion/exclusion criteria, there is a need for 'real-world' evidence of an antiepileptic drug's effectiveness and tolerability in clinical practice, where patients are much more diverse in terms of clinical characteristics and treatment is tailored to the individual's specific needs. Several studies have demonstrated that adjunctive treatment with zonisamide is effective when administered under everyday clinical practice conditions, with a favourable safety/tolerability profile similar to that observed in clinical trials. In the Zonisamid im Alltag Der Epilepsiepatienten (ZADE) study, almost 80% of patients showed a reduction in seizure frequency of ?50% over a median follow-up of 18 weeks, and over one-third of patients became seizure free. Data from these clinical practice studies also indicate that zonisamide is effective and generally well tolerated when administered as a first-line adjunctive treatment and is associated with high retention rates and improvements in quality of life. Evidence from these clinical practice studies therefore complements data from zonisamide's clinical trial programme, providing pragmatic information on the likely benefits and risks of treatment under real-life conditions. PMID:23106523

Dupont, S; Stefan, H

2012-01-01

50

Clinical Guidelines and Practice  

PubMed Central

Subjective tinnitus is an enigmatic and chronic condition that is predominantly managed as symptomatic. Little high-level evidence exists for the efficacy and specificity of the various tinnitus management strategies currently used, and this is reflected in documents that aim to guide clinicians. As a consequence, there are clear gaps in evidence-based practice linking diagnosis to the most effective management strategies as well as a general lack of consensus about which are appropriate strategies for assessment and management. Several guidelines have been produced from research efforts and from expert opinion. All recommend standardization of assessment and a range of management options but do not yet provide a means to link the two. The authors call for clinicians, scientists, and policy makers to work together to address this barrier to good practice.

Hoare, Derek J.; Hall, Deborah A.

2011-01-01

51

Recommendations for Training and Certification for Pharmacists Practicing, Mentoring, and Educating in Infectious Diseases Pharmacotherapy Joint Opinion of the Society of Infectious Diseases Pharmacists and the Infectious Diseases Practice and Research Network of the American College of Clinical Pharmacy  

Microsoft Academic Search

Recently created guidelines for the development of institutional antimicrobial stewardship programs recommend that a pharmacist with infectious diseases training be included as a core member of the antimicrobial stewardship team. However, training and certification requirements for infectious diseases - trained clinical pharmacists have not been established. Although pharmacists have nurtured their interest in infectious diseases by self-directed learning or on-the-job

Erika J. Ernst; Michael E. Klepser; John A. Bosso; Michael J. Rybak; Elizabeth D. Hermsen; Marisel Segarra-Newnham; Richard H. Drew

2009-01-01

52

Stigma in clinical practice.  

PubMed

Much more is known about attitudes toward mental illness and social stigma, the viscious cycle of its consequences and how to fight the social stigma in public, but much less is known about how to combat the stigma and self stigma in clinical practice. Stigma theories have not been enough to understand the feelings and experience of people with mental illness. Conceptual framework that understands stigma as consisting of difficulties of knowledge (ignorance or misinformation), problems of attitudes (prejudice), and problems of behaviour (discrimination) have not o been enough to understand stigma dynamics in the patient therapist interaction. Understanding the psychodynamic aspects of internalized stereotype of mental illness in the patient- therapist relationship may improve our competency to deal with stigma and self stigma in clinical practice. PMID:23995176

Štrkalj-Ivezi?, Sla?ana

2013-09-01

53

Quality in clinical practice.  

PubMed

This paper reports the proceedings of the discussion panel assigned to look at clinical aspects of quality in emergency medicine. One of the seven stated objectives of the Academic Emergency Medicine consensus conference on quality in emergency medicine was to educate emergency physicians regarding quality measures and quality improvement as essential aspects of the practice of emergency medicine. Another topic of interest was a discussion of the value of information technology in facilitating quality care in the clinical practice of emergency medicine. It is important to note that this is not intended to be a comprehensive review of this extensive topic, but instead is designed to report the discussion that occurred at this session of the consensus conference. PMID:12414456

Cone, David C; Nedza, Susan M; Augustine, James J; Davidson, Steven J

2002-11-01

54

Implementing AORN recommended practices for prevention of transmissible infections.  

PubMed

Preventing infection in the perioperative setting is a critical element of patient and health care worker safety. This article reviews the recommendations in the AORN "Recommended practices for prevention of transmissible infections in the perioperative practice setting." The recommended practices are intended to help perioperative nurses implement standard and transmission-based precautions (ie, contact, droplet, airborne), including use of personal protective equipment as well as interventions to prevent surgical site infections and exposure to bloodborne pathogens. Additional recommendations cover vaccination programs and how to manage personnel who require work restrictions. Hospital and ambulatory patient scenarios are included to help perioperative nurses apply the recommendations in daily practice. PMID:24266933

Patrick, Marcia R; Hicks, Rodney W

2013-12-01

55

Evidence-based analysis of physical therapy in Parkinson's disease with recommendations for practice and research  

Microsoft Academic Search

Physical therapy is often prescribed in Parkinson's disease. To facilitate the uniformity and efficacy of this intervention, we analyzed current evidence and developed practice recommendations. We carried out an evidence-based literature review. The results were supplemented with clinical expertise and patient values and translated into practice recommendations, developed according to international standards for guideline development. A systematic literature search yielded

Samyra H. J. Keus; Bastiaan R. Bloem; Erik J. M. Hendriks; Alexandra B. Bredero-Cohen; Marten Munneke

2007-01-01

56

Toward standard HER2 testing of endometrial serous carcinoma: 4-year experience at a large academic center and recommendations for clinical practice.  

PubMed

HER2 overexpression and/or amplification have been reported in endometrial serous carcinoma, suggesting that HER2 may be a promising therapeutic target. However, there is considerable variation in the reported rates of HER2 overexpression and amplification, likely--at least in part--resulting from variability in the testing methods, interpretation, and scoring criteria used. Unlike in breast and gastric cancer, currently there are no established guidelines for HER2 testing in endometrial carcinoma. A total of 108 endometrial carcinoma cases--85 pure serous carcinomas and 23 mixed endometrial carcinomas with serous component--were identified over a 4-year period. All H&E and HER2 immunohistochemical slides were reviewed and HER2 FISH results (available on 52 cases) were retrieved from pathology reports. HER2 immunohistochemical scores were assigned according to the FDA criteria and the current breast ASCO/CAP scoring criteria. Clinical information was retrieved from the patients' medical records. Thirty-eight cases (35%) showed HER2 overexpression and/or gene amplification, 20 of which (53%) had significant heterogeneity of protein expression by immunohistochemistry. Lack of apical membrane staining resulting in a lateral/basolateral staining pattern was observed in the majority of HER2-positive tumors. Five of the HER2-positive cases (13%) demonstrated discrepant immunohistochemical scores when using the FDA versus ASCO/CAP scoring system. The overall concordance rate between HER2 immunohistochemistry and FISH was 75% (39/52) when using the FDA criteria, compared with 81% (42/52) by the ASCO/CAP scoring system. In conclusion, in this largest comprehensive study, 35% of endometrial serous carcinoma harbors HER2 protein overexpression and/or gene amplification, over half of which demonstrate significant heterogeneity of protein expression. The current breast ASCO/CAP scoring criteria provide the highest concordance between immunohistochemistry and FISH. Assessment of HER2 immunohistochemistry on multiple tumor sections or sections with large tumor areas is recommended, due to the significant heterogeneity of HER2 protein expression. PMID:23765245

Buza, Natalia; English, Diana P; Santin, Alessandro D; Hui, Pei

2013-12-01

57

Recommendations for Responsible Monitoring and Regulation of Clinical Software Systems  

PubMed Central

Abstract In mid-1996, the FDA called for discussions on regulation of clinical software programs as medical devices. In response, a consortium of organizations dedicated to improving health care through information technology has developed recommendations for the responsible regulation and monitoring of clinical software systems by users, vendors, and regulatory agencies. Organizations assisting in development of recommendations, or endorsing the consortium position include the American Medical Informatics Association, the Computer-based Patient Record Institute, the Medical Library Association, the Association of Academic Health Sciences Libraries, the American Health Information Management Association, the American Nurses Association, the Center for Healthcare Information Management, and the American College of Physicians. The consortium proposes four categories of clinical system risks and four classes of measured monitoring and regulatory actions that can be applied strategically based on the level of risk in a given setting. The consortium recommends local oversight of clinical software systems, and adoption by healthcare information system developers of a code of good business practices. Budgetary and other constraints limit the type and number of systems that the FDA can regulate effectively. FDA regulation should exempt most clinical software systems and focus on those systems posing highest clinical risk, with limited opportunities for competent human intervention.

Miller, Randolph A.; Gardner, Reed M.

1997-01-01

58

[Treatment recommendations do not automatically translate into treatment practices].  

PubMed

Treatment recommendations provide clinicians with evaluated and compiled information about effective treatment practices. The recommendations do not, however, automatically translate into treatment practices. Individual methods of application of treatment recommendations have at the most a moderate effect on the methods of operation of professionals. The effect may be stronger, if the obstacles to the realization of a treatment recommendation are recognized and the methods selected accordingly, observing the local conditions. The application of treatment recommendations should be bundled with the long-term development of the organization, whereby structures supporting the development work are formed within the organization. PMID:24822334

Sipilä, Raija; Lommi, Marja-Liisa

2014-01-01

59

Implementing AORN recommended practices for a safe environment of care.  

PubMed

Providing a safe environment for every patient undergoing a surgical or other invasive procedure is imperative. AORN's "Recommended practices for a safe environment of care" provides guidance on a wide range of topics related to the safety of perioperative patients and health care personnel. The recommendations are intended to provide guidance for establishing best practices and implementing safety measures in all perioperative practice settings. Perioperative nurses should be aware of risks related to musculoskeletal injuries, fire, equipment, latex, and chemicals, among others, and understand strategies for reducing the risks. Evidence-based recommendations can give practitioners the tools to guide safe practice. PMID:23890564

Hughes, Antonia B

2013-08-01

60

[Psychiatric clinical practice and medical clinical practice].  

PubMed

The field of Psychiatry encompasses the study of both nomothetic (i.e. submitted to a lawfulness) and idiographic (i.e. unpredictable, submitted to the free will or decisions of the individuals) phenomena. Clinical-diagnostic investigations function at three different speeds: -Adagio: slow gathering of diversified data, pertaining to: .history of malady (or psychological maladjustment); .personal history of the patient; .opinion of members of the family; .opinion of the referring practitioner; .last but not least: opinion of the nursing staff. -Allegro: selective grouping of the most significant symptoms; the putative syndrome is then compared with classical well-recognized diagnostic entities (inferential diagnosis). -Presto: the immediate primal impression; this type of perception deals mainly with a tentative and almost reflex appraisal of the personality; it is based on disputable data. This type of unconscious guess is actually more emotional than rational. Psychiatry cannot rely upon "hard symptoms" (such as a cardiac murmur), nor on images (if the latter are convincing they actually contribute to a diagnosis of organic brain impairment), or on chemical evidence of an underlying metabolic disorder. Dexamethazone suppression test did not hold its promises. Only the shortening of the latency time of the paradoxical (R.E.M.) sleep might be useful. All this contributes to the use of psychotropic drugs as a diagnostic tool. It is legitimate because what is known of the action of these drugs on various neuro-transmitters has given us some insight. Nevertheless simplistic ideas which flourished some twenty of thirty years ago, have not been entirely validated. PMID:7598358

Koupernik, C

1995-05-01

61

Recommended practices in global sensitivity analysis  

Microsoft Academic Search

Practices for global sensitivity analysis of model output are described in a recent textbook (Saltelli et al., 2007). These include (i) variance based techniques for general use in modelling, (ii) the elementary effect method for\\u000a factor screening for factors-rich models and (iii) Monte Carlo filtering. In the present work we try to put the practices\\u000a into the context of their

Andrea Saltelli; Daniele Vidoni; Massimiliano Mascherini

62

Recommended Standard Practices for Structural Testing of Steel Models.  

National Technical Information Service (NTIS)

A Panel for Standard Practice for Testing was set up in 1973 by the DOE-TRRL Working Group on Long Term Research into Steel Box Girder Bridges. The Report discusses practical problems of testing and gives recommendations for good practice under the follow...

1977-01-01

63

BOOK REPORTS--PRACTICES AND RECOMMENDATIONS.  

ERIC Educational Resources Information Center

A PROJECT WHOSE AIM WAS TO DEVELOP BOOK-REPORTING PROCEDURES WHICH WOULD EFFECTIVELY STIMULATE AND ENCOURAGE WIDE INDEPENDENT READING AND THE MASTERY OF APPROPRIATE BOOK-REPORTING SKILLS IS SUMMARIZED AND EVALUATED. A SUMMARY OF THE FINDINGS AND CONCLUSIONS OF A SURVEY OF CURRENT BOOK-REPORTING PRACTICES IN GRADES 2-7, CONDUCTED THROUGH PERSONAL…

MARTIN, KATHRYN J.; AND OTHERS

64

Bullous pemphigoid: clinical practice guidelines.  

PubMed

Bullous pemphigoid (BP) is an autoimmune subepidermal bullous disease in which autoantibodies are directed against components of the basement membrane. Most of these antibodies belong to the immunoglobulin G class and bind principally to 2 hemidesmosomal proteins: the 180-kD antigen (BP180) and the 230-kD antigen (BP230). It is the most common blistering disease in the adult population in developed countries, with an estimated incidence in Spain of 0.2 to 3 cases per 100,000 inhabitants per year. The disease primarily affects older people, although it can also occur in young people and even in children. In recent years, advances in clinical practice have led to a better understanding and improved management of this disorder. These advances include new diagnostic techniques, such as enzyme-linked immunosorbent assay for BP180 and new drugs for the treatment of BP, with diverse therapeutic targets. There is, however, still no international consensus on guidelines for the management of BP. This article is an updated review of the scientific literature on the treatment of BP. It focuses primarily on evidence-based recommendations and is written from a practical standpoint based on experience in the routine management of this disease. PMID:23540594

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

2014-05-01

65

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

66

Growing pains: contemporary knowledge and recommended practice  

Microsoft Academic Search

BACKGROUND: Leg pain in children, described as growing pains, is a frequent clinical presentation seen by an array of health care professionals. Described since 1823, growing pains continues to puzzle practitioners, yet diagnostic criteria and evidence based treatment is available. METHODS: The medical literature has been searched exhaustively to access all articles (English language) pertaining to leg pains in children

Angela M Evans

2008-01-01

67

[Practical recommendations for breathing-adapted radiotherapy].  

PubMed

Respiration-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast and liver tumors. An increased conformality of irradiation fields leading to decreased complications rates of organs at risk (lung, heart...) is expected. Respiratory gating is in line with the need for improved precision required by radiotherapy techniques such as 3D conformal radiotherapy or intensity modulated radiotherapy. Reduction of respiratory motion can be achieved by using either breath-hold techniques or respiration synchronized gating techniques. Breath-hold techniques can be achieved with active techniques, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily holds his/her breath. Synchronized gating techniques use external devices to predict the phase of the respiration cycle while the patient breaths freely. This work summarizes the different experiences of the centers of the STIC 2003 project. It describes the different techniques, gives an overview of the literature and proposes a practice based on our experience. PMID:17604206

Simon, L; Giraud, P; Dumas, J-L; Marre, D; Dupont, S; Varmenot, N; Ginestet, C; Caron, J; Marchesi, V; Ferreira, I; Lorchel, F; Garcia, R; Rosenwald, J-C

2007-06-01

68

Growing pains: contemporary knowledge and recommended practice  

PubMed Central

Background Leg pain in children, described as growing pains, is a frequent clinical presentation seen by an array of health care professionals. Described since 1823, growing pains continues to puzzle practitioners, yet diagnostic criteria and evidence based treatment is available. Methods The medical literature has been searched exhaustively to access all articles (English language) pertaining to leg pains in children which are ascribed to being 'growing pains'. Results The literature, whilst plentiful in quantity and spanning two centuries, is generally replete with reiterated opinion and anecdote and lacking in scientific rigour. The author searched 45 articles for relevance, determined according to title, abstract and full text, resulting in a yield of 22 original studies and 23 review articles. From the original studies, one small (non-blinded) randomised controlled trial that focused on GP treatment with leg muscle stretching was found. Nine prevalence studies were found revealing disparate estimates. Ten cohort (some case-controlled) studies, which investigated pain attribute differences in affected versus unaffected groups, were found. One series of single case experiment designs and one animal model study were found. Conclusion Growing pains is prevalent in young children, presents frequently in the health care setting where it is poorly managed and is continuing to be researched. A common childhood complaint, growing pains needs to be acknowledged and better managed in the contemporary medical setting.

Evans, Angela M

2008-01-01

69

Ministry of Health clinical practice guidelines: depression.  

PubMed

The Ministry of Health (MOH) have updated the clinical practice guidelines on Depression to provide doctors and patients in Singapore with evidence-based treatment for depression. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Depression, for the information of readers of the Singapore Medical Journal. Chapters and page 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/content/moh_web/home/Publications/guidelines/cpg/2012/depression.html. 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:22337190

Chua, H C; Chan, L L; Chee, K S; Chen, Y H; Chin, S A; Chua, P L W; Fones, S L C; Fung, D; Khoo, C L; Kwek, S K D; Lim, E C L; Ling, J; Poh, P; Sim, K; Tan, B L; Tan, C H; Tan, L L; Tan, Y H C; Tay, W K; Yeo, C; Su, H C A

2012-02-01

70

Can de facto dosing practices bridge the knowledge gap in pediatric medication recommendations?  

PubMed

A knowledge gap exists in pediatric medication dosing recommendations due in part to the complexity of researching medication efficacy and safety in children. One possible resource resides in the electronic prescribing practices of pediatric clinicians. In this study, de facto pediatric weight-based levothyroxine dosing practices were studied as a potential source for pediatric medication clinical decision support. This was accomplished by extracting physical exam and prescription details from a well-used clinical data warehouse to calculate weight-based dosing practices, and comparing the results with established medication recommendations. Of the 854 prescriptions, 85.2% were under the recommended range, 9.37% were within the range and 5.39% were over the range. Thus, real world prescribing practices may differ from recommendations. Such information may be a valuable resource in pediatric clinical decision support, particularly where practice differs from recommendations, and can help close the knowledge gap where pediatric medication dosing information is sparse or unavailable. PMID:20351920

Scheufele, Elisabeth L; Dubey, Anil

2009-01-01

71

Minimum qualifications for clinical pharmacy practice faculty.  

PubMed

The American College of Clinical Pharmacy 2013 Educational Affairs Committee was charged with developing recommendations for the minimum qualifications required for clinical pharmacy practice faculty in United States colleges and schools of pharmacy with respect to education, postgraduate training, board certification, and other experiences. From a review of the literature, the committee recommends that clinical pharmacy practice faculty possess the following minimum qualifications, noting that, for some positions, additional qualifications may be necessary. Clinical pharmacy practice faculty should possess the Doctor of Pharmacy degree from an Accreditation Council for Pharmacy Education–accredited institution. In addition, faculty should have completed a postgraduate year one (PGY1) residency or possess at least 3 years of direct patient care experience. Faculty who practice in identified areas of pharmacotherapy specialization, as identified by American Society of Health-System Pharmacists postgraduate year two (PGY2) residency guidelines, should have completed a PGY2 residency in that area of specialty practice. Alternatively, faculty should have completed a minimum of a PGY1 residency and 1 additional year of practice, with at least 50% of time spent in their area of specialization, which is documented in a portfolio, or 4 years of direct patient care in their area of specialization, which is documented in a portfolio. Fellowship training or a graduate degree (e.g., Ph.D.) should be required for research-intensive clinical faculty positions. All faculty should obtain structured teaching experience during or after postgraduate training, preferably through a formal teaching certificate program or through activities documented in a teaching portfolio. A baseline record of scholarship should be obtained before hire as clinical pharmacy practice faculty through exposure in postgraduate programs or previous employment. Faculty should be board certified before hire or attain board certification within 2 years of hire through the Board of Pharmacy Specialties (BPS) or, if appropriate for the practice area, through a nonBPS-certifying agency. If no certification exists in the area of specialty, the faculty member should develop a portfolio with evidence of excellence in clinical practice, teaching, and scholarship. PMID:24877188

Engle, Janet P; Erstad, Brian L; Anderson, Douglas C; Bucklin, Mason H; Chan, Alexandre; Donaldson, Amy R; Hagemann, Tracy M; O'Connell, Mary Beth; Rodgers, Philip T; Tennant, Sarah; Thomas, Zachariah

2014-05-01

72

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

73

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.

2012-01-01

74

Practice theory for clinical social work  

Microsoft Academic Search

It is suggested that practice theory for clinical social work practice is in a state of disarray. Six new books on clinical social work practice are reviewed, with an identification of their contributions to the development of clinical practice theory. The expanded societal functions of clinical social work have resulted in major changes in method and in practice activities, without

Max Siporin; David Brandon; Kegan Paul; Joel Fischer; Naomi Golan; William J. Reid; Laura Epstein; Herbert S. Strean

1979-01-01

75

Renewable Energy Training: Best Practices and Recommended Guidelines  

NSDL National Science Digital Library

The Advanced Technology Environmental and Energy Center (ATEEC) has provided this document highlighting best practices for renewable energy training. The document includes training guidelines, types of educational programs, essential steps of designing a training course and recommended resources and textbooks. Users must download this resource for viewing, which requires a free log-in. There is no cost to download the item.

2011-02-24

76

Recommendations for Post-Polypectomy Surveillance in Community Practice  

PubMed Central

Background After colon cancer screening, large numbers of persons discovered with colon polyps may receive post-polypectomy surveillance with multiple colonoscopy examinations over time. Decisions about surveillance interval are based in part on polyp size, histology, and number. Aims To learn physicians’ recommendations for post-polypectomy surveillance from physicians’ office charts. Methods Among 322 physicians performing colonoscopy in 126 practices in N. Carolina, offices of 152 physicians in 55 practices were visited to extract chart data, for each physician, on 125 consecutive persons having colonoscopy in 2003. Subjects included persons with first-time colonoscopy and no positive family history or other indication beyond colonoscopy findings that might affect postpolypectomy surveillance recommendations. Data were extracted about demographics, reason for colonoscopy, family history, symptoms, bowel prep, extent of examination, and features of each polyp including location, size, histology. Recommendations for post-polypectomy surveillance were noted. Results Among 10,089 first-time colonoscopy examinations, hyperplastic polyps were found in 4.5% of subjects, in whom follow-up by 4–6 years was recommended in 24%, sooner than recommended in guidelines. Of the 6.6% of persons with only small adenomas, 35% were recommended to return in 1–3 years (sooner than recommended in some guidelines) and 77% by 6 years. Surveillance interval tended to be shorter if colon prep was less than “excellent.” Prep quality was not reported for 32% of examinations. Conclusions Surveillance intervals after polypectomy of low-risk polyps may be more aggressive than guidelines recommend. The quality of post-polypectomy surveillance might be improved by increased attention to guidelines, bowel prep, and reporting.

Yankaskas, Bonnie; Gizlice, Ziya; Gangarosa, Lisa

2011-01-01

77

Randomization in clinical trials: conclusions and recommendations.  

PubMed

The statistical properties of simple (complete) randomization, permuted-block (or simply blocked) randomization, and the urn adaptive biased-coin randomization are summarized. These procedures are contrasted to covariate adaptive procedures such as minimization and to response adaptive procedures such as the play-the-winner rule. General recommendations are offered regarding the use of complete, permuted-block, or urn randomization. In a large double-masked trial, any of these procedures may be acceptable. For a given trial, the relative merits of each procedure should be carefully weighed in relation to the characteristics of the trial. Important considerations are the size of the trial, overall as well as within the smallest subgroup to be employed in a subgroup-specific analysis, whether or not the trial is to be masked, and the resources needed to perform the proper randomization-based permutational analysis. PMID:3203526

Lachin, J M; Matts, J P; Wei, L J

1988-12-01

78

A comparison of clinical practice guidelines for proximal femoral fracture.  

PubMed

Clinical practice guidelines are designed to assist clinical decision-making by summarising evidence and forming recommendations. The number of available guidelines is vast and they vary in relevance and quality. We reviewed guidelines relevant to the management of a patient with a fractured neck of femur and explored similarities and conflicts between recommendations. As guidelines are often produced in response to an area of clinical uncertainty, recommendations differ. This can result in a situation where the management of a particular clinical problem will depend upon which guideline is followed. We explore the reasons for such differences. PMID:23121498

Kearns, R J; Moss, L; Kinsella, J

2013-02-01

79

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

Microsoft Academic Search

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

Jodie A Trafton; Susana B Martins; Martha C Michel; Dan Wang; Samson W Tu; David J Clark; Jan Elliott; Brigit Vucic; Steve Balt; Michael E Clark; Charles D Sintek; Jack Rosenberg; Denise Daniels; Mary K Goldstein

2010-01-01

80

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.

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

2003-01-01

81

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

82

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.

2014-01-01

83

Clinicians' practice environment is associated with a higher likelihood of recommending cesarean deliveries.  

PubMed

Abstract Objective: Little data exist regarding clinicians' role in the rising annual incidence rate of cesarean delivery in the US. We aimed to examine if clinicians' practice environment is associated with recommending cesarean deliveries. Study design: This is a survey study of clinicians who practice obstetrics in the US. This survey included eight clinical vignettes and 27 questions regarding clinicians' practice environment. Chi-square test and multivariable logistic regression were used for statistical comparison. Results: Of 27?675 survey links sent, 3646 clinicians received and opened the survey electronically, and 1555 (43%) participated and 1486 (94%) completed the survey. Clinicians were categorized into three groups based on eight common obstetric vignettes as: more likely (n?=?215), average likelihood (n?=?1099), and less likely (n?=?168) to recommend cesarean. Clinician environment factors associated with a higher likelihood of recommending cesarean included Laborists/Hospitalists practice model (p?practice setting (p?recommending cesarean delivery. The decision to recommend cesarean delivery is a complicated one and is likely not solely based on patient factors. PMID:24224916

Cheng, Yvonne W; Snowden, Jonathan M; Handler, Stephanie; Tager, Ira B; Hubbard, Alan; Caughey, Aaron B

2014-08-01

84

Management of Graves' disease: an overview and comparison of clinical practice guidelines with actual practice trends.  

PubMed

Over the last century, much has been learned about the pathogenesis, manifestations, and management of Graves' disease leading to the establishment of evidence-based clinical practice guidelines. The joint clinical practice guidelines from the American Thyroid Association and the American Association of Clinical Endocrinologists give recommendations on both the diagnosis and treatment of hyperthyroidism. A survey of clinicians performed that same year, however, revealed that current practices diverge from these recently published guidelines in multiple areas. These differences will need to be assessed serially to determine the impact of the guidelines on future clinical practice and perhaps vice versa. PMID:24891174

Muldoon, Becky T; Mai, Vinh Q; Burch, Henry B

2014-06-01

85

[From clinical practice guidelines towards quality assurance].  

PubMed

Clinical practice guidelines have been introduced to assist decision making at the bedside of individual patients. Guidelines are also increasingly regarded as being an indispensable part of professional quality systems. Guidelines are important tools to improve knowledge-management, processes and outcomes in healthcare. They aim to assist professional and patient decisions especially in those areas of healthcare where considerable variation or potential for improvement exist and they can provide a foundation for assessing and evaluating the quality and effectiveness of healthcare in terms of measuring processes and outcomes. Quality indicators or performance measures based on guideline recommendations are necessary to evaluate the usefulness of guidelines and the appropriateness of healthcare delivery. Guideline recommendations are the tools for healthcare professionals to develop strategies for quality improvement in case deviations from desired processes or outcomes are identified by the measurement of quality indicators. PMID:21290269

Kopp, I B

2011-02-01

86

Handbook of clinical nursing practice  

SciTech Connect

Written in outline format, this reference will help nurses further their understanding of advanced nursing procedures. Information is provided on the physiological, psychological, environmental, and safety considerations of nursing activities associated with diagnostic and therapeutic procedures. Special consideration is given to the areas of pediatric nursing, nursing assessment, and selected radiologic and nuclear medicine procedures for each system. Contents: Clinical Introduction. Clinical Nursing Practice: Focus on Basics. Focus on Cardiovascular Function. Focus on Respiratory Function. Focus on Gastrointestinal Function. Focus on Renal and Genito-Urological Function. Focus on Neuro-Skeletal and Muscular Function. Appendices.

Asheervath, J.; Blevins, D.R.

1986-01-01

87

Bone scanning in clinical practice  

SciTech Connect

The technetium-99m(/sup 99m/Tc)-labelled diphosophonate bone scan remains the most frequently requested investigation in any nuclear medicine department because of its exquisite sensitivity for lesion detection. It has a wide, and apparently ever-increasing, range of applications in clinical practice and the purpose of this book is to provide a comprehensive review of the use of bone scanning. In addition, important topics of current interest, such as single photon emission computed tomography, quantitation of bone uptake of diphosphonate and bone mineral measurements by photon absorptiometry, are included. The emphasis is on the clinical use of bone scanning.

Fogelman, I.

1987-01-01

88

Reflections in the clinical practice.  

PubMed

The purpose of this article is to analyze some models of expert decision and their impact on the clinical practice. We have analyzed decision-making considering the cognitive aspects (explanatory models, perceptual skills, analysis of the variability of a phenomenon, creating habits and inertia of reasoning and declarative models based on criteria). We have added the importance of emotions in decision making within highly complex situations, such as those occurring within the clinical practice. The quality of the reflective act depends, among other factors, on the ability of metacognition (thinking about what we think). Finally, we propose an educational strategy based on having a task supervisor and rectification scenarios to improve the quality of medical decision making. PMID:24468001

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

2014-03-01

89

Practical guide to understanding clinical research compliance.  

PubMed

Noncompliance with federal regulations, as monitored through institutional review boards for the ethical conduct of clinical research, can occur, even to seasoned investigators. The cause of this noncompliance can be that an investigator is overloaded, does not know the regulations, or does not take the time to pay attention to the details. Sometimes it happens just because of inevitable human error that can befall us all at any time. The authors begin by citing the inherent differences between clinical practice and clinical research. This is followed by an illustration of common noncompliance errors, with examples, followed by general and specific concepts and methods to minimize noncompliance events. The objective of this article is to condense the myriad details involved in conducting clinical research into a set of manageable recommendations that can be recalled easily before and during the research. The material supporting these recommendations comes from years of institutional review board work at several institutions and consultation with experienced principal investigators and their research coordinators. PMID:24598406

Neely, J Gail; Paniello, Randal C; Graboyes, Evan M; Sharon, Jeffrey D; Grindler, David J; Nussenbaum, Brian

2014-05-01

90

Dropout Prevention: Do Districts Pursue Best Practice Recommendations? A Center Policy & Practice Report  

ERIC Educational Resources Information Center

This report focuses on the reality that the dropout situation is unlikely to improve as long as policy and practice fail to ensure students have a comprehensive system of student and learning supports. To highlight the intervention problem, the emphasis is on first comparing federal practice guidance recommendations for addressing the dropout…

Center for Mental Health in Schools at UCLA, 2011

2011-01-01

91

On research in clinical practice.  

PubMed

Clinical research implies advancing current knowledge about health care by continually developing and testing new ideas about diseases, products, procedures, and strategies. Although this trait is inherent in human nature, it needs to be encouraged, nurtured, groomed, and channelized by creating a suitable atmosphere for it, providing the necessary resources, inculcating the necessary conceptual and manual skills, and rewarding the efforts and achievements suitably. Language, logic, statistics, and psychology play an important role in acquiring and developing research capability. To be socially relevant and economically viable, clinical research will need to partner with patients and their doctors in identifying what their goals of health care are, what they value, and what they are willing to "buy" in terms of goods and services. Besides, clinical research will need to bring on one platform the sponsors, the researchers, the patients, the payers, and the regulators to ensure that they do not work at cross purposes, that the cost of developing health care measures is scaled down through innovative approaches such as large simple trials, sequential trials, early marketing conditional on post-marketing surveillance, and so on. All these will be possible if day-to-day practice is slowly and systemically transformed into the largest laboratory of clinical research, which it ought to be, by forming networks of research-oriented practices, and popularizing the use of data collection and analysis tools such as Epi Info which are in the public domain. PMID:21829777

Nanivadekar, Arun

2010-01-01

92

78 FR 53773 - Select Updates for Non-Clinical Engineering Tests and Recommended Labeling for Intravascular...  

Federal Register 2010, 2011, 2012, 2013

...Select Updates for Non-Clinical Engineering Tests and Recommended Labeling for Intravascular...Select Updates for Non- Clinical Engineering Tests and Recommended Labeling for Intravascular...substantial updates to the ``Non-Clinical Engineering Tests and Recommended Labeling for...

2013-08-30

93

Proton therapy in clinical practice  

PubMed Central

Radiation dose escalation and acceleration improves local control but also increases toxicity. Proton radiation is an emerging therapy for localized cancers that is being sought with increasing frequency by patients. Compared with photon therapy, proton therapy spares more critical structures due to its unique physics. The physical properties of a proton beam make it ideal for clinical applications. By modulating the Bragg peak of protons in energy and time, a conformal radiation dose with or without intensity modulation can be delivered to the target while sparing the surrounding normal tissues. Thus, proton therapy is ideal when organ preservation is a priority. However, protons are more sensitive to organ motion and anatomy changes compared with photons. In this article, we review practical issues of proton therapy, describe its image-guided treatment planning and delivery, discuss clinical outcome for cancer patients, and suggest challenges and the future development of proton therapy.

Liu, Hui; Chang, Joe Y.

2011-01-01

94

Fire Safety in Housing. A Manual of Recommended Design and Construction Practice.  

National Technical Information Service (NTIS)

Recommended design and construction practices to eliminate fire hazards in housing are described. The applicability of the recommended practices is limited to single - family and multifamily residences; housing for the elderly, motels and hotels, and dorm...

1975-01-01

95

The procurement of cells for the derivation of human embryonic stem cell lines for therapeutic use: recommendations for good practice.  

PubMed

The donation of human embryos for the derivation of embryonic stem cell lines that may be used in the development of therapeutic products raises more complex ethical, practical and regulatory problems than the donation of embryos for non-clinical research. This review considers these issues and offers recommendations for good practice. PMID:21671059

Murdoch, Alison; Braude, Peter; Courtney, Aidan; Brison, Daniel; Hunt, Charles; Lawford-Davies, James; Moore, Harry; Stacey, Glyn; Sethe, Sebastian

2012-03-01

96

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

97

[Lanthanum carbonate in clinical practice].  

PubMed

Lanthanum is an element belonging to the group called rare earths. Due to its low solubility, lanthanum carbonate has been widely studied as an intestinal phosphate binder. The results of different clinical trials show that it is an effective and well-tolerated phosphate binder used in monotherapy. Serum phosphate levels are controlled in approximately 70% of patients at 5 years without causing hypercalcemia. The only significant adverse effects observed are a low percentage of gastrointestinal disturbances (6%). Lanthanum carbonate does not alter serum values of liposoluble vitamins or affect the pharmacokinetics of digoxin, warfarin, furosemide, phenytoin, ACE inhibitors or beta-blockers. However, it does alter the pharmacokinetics of ciprofloxacin (quinolones in general), tetracyclines and doxycycline. Lanthanum carbonate (Fosrenol) is available in Spain as 500 mg, 750 mg, and 1,000 mg chewable tablets, which should not be swallowed without chewing to avoid loss of efficacy. The initial dose recommended by the WHO is 2,250 mg/day, which is equivalent to one 750 mg at each meal. Lanthanum carbonate or lanthanum phosphate can be clearly visualized on a plain x-ray of the abdomen in patients who have recently ingested it. In summary, lanthanum carbonate is a widely studied potent phosphate binder, which offers the possibility of improving control of serum phosphate in patients with chronic kidney disease, without significant side effects. The fact that it is available as chewable tablets and that the number of daily tablets required has been significantly reduced will probably facilitate better patient compliance. PMID:18847414

Torregrosa Prats, V

2008-01-01

98

AARC Clinical Practice Guidelines. Providing patient and caregiver training 2010.  

PubMed

An electronic literature search for articles published between January 1990 and October 2009 was conducted by using the MEDLINE, CINAHL, and Cochrane Library databases. The update of this clinical practice guideline is the result of reviewing a total of 7 clinical trials and systematic reviews, and 33 articles investigating patient, family, and caregiver training. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria: (1) It is suggested that RTs take an active role in educating patient, family, and caregivers in the management of their cardiopulmonary disease state. PMID:20507661

2010-06-01

99

Clinical practice guideline: acute otitis externa executive summary.  

PubMed

The American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the updated Clinical Practice Guideline: Acute Otitis Externa, as a supplement to Otolaryngology-Head and Neck Surgery. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 8 recommendations developed address appropriate diagnosis of acute otitis externa (AOE) and the use of oral and topical antimicrobials and highlight the need for adequate pain relief. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. PMID:24492208

Rosenfeld, Richard M; Schwartz, Seth R; Cannon, C Ron; Roland, Peter S; Simon, Geoffrey R; Kumar, Kaparaboyna Ashok; Huang, William W; Haskell, Helen W; Robertson, Peter J

2014-02-01

100

Cold tolerance of bed bugs and practical recommendations for control.  

PubMed

Bed bugs were exposed to freezing temperatures for various exposure times to determine cold tolerance and mortality estimates for multiple life stages. The mean supercooling point for all bed bug life stages ranged from -21.3 degrees C to -30.3 degrees C, with the egg stage reporting the lowest value. A probit analysis provided a lower lethal temperature (LLT99) of -31.2 degrees C when estimates from all life stages were combined, demonstrating that all stages of bed bugs are not capable of surviving temperatures below body freezing and are therefore freeze intolerant. At conditions above the LLT99, bed bug mortality depended on temperature and exposure time at temperatures above LLT99. Based on our model estimates, survival was estimated for temperatures above -12 degrees C even after 1 wk of continuous exposure. However, exposure to temperatures below -13 degrees C will result in 100% mortality in d to ensure mortality of all life stages. Unfortunately, sublethal exposure to lower temperatures did not prevent subsequent feeding behavior in surviving stages. Practical recommendations for management of potentially infested items are discussed. PMID:24498745

Olson, Joelle F; Eaton, Marc; Kells, Stephen A; Morin, Victor; Wang, Changlu

2013-12-01

101

Clinical practice development in Central Coast Health.  

PubMed

Engagement in clinical practice development may be achieved in a range of ways. In this paper we describe the formation of a strategic plan for clinical practice development for Central Coast Health. The plan specifically builds on the work that has already been achieved by clinicians and is inclusive of the multi-disciplinary team. In order to clarify the strategic direction, three levels of clinical practice development are offered as examples of increasingly intensive clinical practice development. In the strategic plan senior personnel are recruited to support area-wide developments. At the same time clinicians are supported to work on specific local projects creating a simultaneous top-down and bottom-up approach. Preparation of clinicians for the challenges of team building and change in practice ensures that people choosing to engage in clinical practice have realistic expectations of the commitment and rewards that may be expected. PMID:14582944

FitzGerald, Mary; Solman, Annette

2003-07-01

102

Caring Practices of Clinical CRNA Instructors in Clinical Student Instruction.  

National Technical Information Service (NTIS)

Caring Practices of Clinical CRNA Instructors Caring and the ability to demonstrate caring behavior within a teacher-student relationship is deemed necessary in nursing education today. The purpose of this study was to assess the degree to which clinical ...

C. Clark

1993-01-01

103

Integrating clinical practice guidelines into the routine of everyday practice.  

PubMed

For years, the American College of Cardiology and the American Heart Association, along with other professional organizations, have produced clinical practice guidelines to improve the quality of cardiovascular care. Producing these comprehensive documents has required extraordinary effort, primarily from volunteer professionals. Quality improvement efforts based on these guidelines, however, have not fully engaged practicing physicians, as evidenced by studies of guideline adherence. The translation of the guidelines into routine practice remains a persistent challenge.Practitioners work in a complex and fast paced environment. In the routine of everyday practice, physicians, like all decision-makers, use cognitive shortcuts to help make rapid decisions under conditions of uncertainty. How practicing physicians package information in their working memory and use shortcuts called "heuristics" has implications for how clinical practice guidelines can most directly influence practice. Current guidelines are written as comprehensive review documents, but are not formatted to allow easy incorporation into the heuristics of everyday practice. Improving the interface between guidelines and routine practice may result in more rapid and appropriate translation of scientific evidence into practice.We describe the routine of everyday practice as a repetitive cycle where new scientific evidence is incorporated into the heuristics that drive daily medical decisions. Examining this cycle suggests ways to communicate guideline information more effectively and to improve practice routines. Recognizing the intuitive approaches that practicing physicians use to make rapid decisions may yield opportunities for responsive professional organizations and reflective practicing physicians to improve the quality of care. PMID:18340202

Brush, John E; Radford, Martha J; Krumholz, Harlan M

2005-09-01

104

Recommended Technical Provisions for Construction Practice in Shoring and Sloping of Trenches and Excavations.  

National Technical Information Service (NTIS)

On the basis of studies conducted by the National Bureau of Standards, technical provisions for the sloping and shoring of the banks of trenches and excavations are recommended. Included are a recommended standard practice for trenching which can be used ...

F. Y. Yokel

1980-01-01

105

Legislating Clinical Practice: Counselor Responses to an Evidence-Based Practice Mandate  

PubMed Central

The demand to connect research findings with clinical practice for patients with substance use disorders has accelerated state and federal efforts focused on implementation of evidence-based practices (EBPs). One unique state driven strategy is Oregon’s Evidence-Based Practice mandate, which ties state funds to specific treatment practices. Clinicians play an essential role in implementation of shifts in practice patterns and use of EBPs, but little is understood about how legislative efforts impact clinicians’ sentiments and decision-making. This study presents longitudinal data from focus groups and interviews completed during the planning phase (n = 66) and early implementation of the mandate (n = 73) to investigate provider attitudes toward this policy change. Results reflect three emergent themes: (1) concern about retaining individualized treatment and clinical latitude, (2) distrust of government involvement in clinical care, and (3) the need for accountability and credibility for the field. We conclude with recommendations for state agencies considering EBP mandates.

Rieckmann, Traci; Bergmann, Luke; Rasplica, Caitlin

2013-01-01

106

Incidental genetic findings in randomized clinical trials: recommendations from the Genomics and Randomized Trials Network (GARNET)  

PubMed Central

Recommendations and guidance on how to handle the return of genetic results to patients have offered limited insight into how to approach incidental genetic findings in the context of clinical trials. This paper provides the Genomics and Randomized Trials Network (GARNET) recommendations on incidental genetic findings in the context of clinical trials, and discusses the ethical and practical issues considered in formulating our recommendations. There are arguments in support of as well as against returning incidental genetic findings in clinical trials. For instance, reporting incidental findings in clinical trials may improve the investigator-participant relationship and the satisfaction of participation, but it may also blur the line between clinical care and research. The issues of whether and how to return incidental genetic findings, including the costs of doing so, should be considered when developing clinical trial protocols. Once decided, plans related to sharing individual results from the aim(s) of the trial, as well as incidental findings, should be discussed explicitly in the consent form. Institutional Review Boards (IRBs) and other study-specific governing bodies should be part of the decision as to if, when, and how to return incidental findings, including when plans in this regard are being reconsidered.

2013-01-01

107

Practical recommendations for pharmacogenomics-based prescription: 2010 ESF-UB Conference on Pharmacogenetics and Pharmacogenomics.  

PubMed

The present article summarizes the discussions of the 3rd European Science Foundation-University of Barcelona (ESF-UB) Conference in Biomedicine on Pharmacogenetics and Pharmacogenomics, which was held in June 2010 in Spain. It was focused on practical applications in routine medical practice. We provide practical recommendations for ten different clinical situations, that have either been approved or not approved by regulatory agencies. We propose some comments that might accompany the results of these tests, indicating the best drug and doses to be prescribed. The discussed examples include KRAS, cetuximab, panitumumab, EGFR-gefitinib, CYP2D6-tamoxifen, TPMT-azathioprine-6-mercaptopurine, VKORC1/CYP2C9-warfarin, CYP2C19-clopidogrel, HLA-B*5701-abacavir, HLA-B*5701-flucloxacillin, SLCO1B1-statins and CYP3A5-tacrolimus. We hope that these practical recommendations will help physicians, biologists, scientists and other healthcare professionals to prescribe, perform and interpret these genetic tests. PMID:21174626

Becquemont, Laurent; Alfirevic, Ana; Amstutz, Ursula; Brauch, Hiltrud; Jacqz-Aigrain, Evelyne; Laurent-Puig, Pierre; Molina, Miguel A; Niemi, Mikko; Schwab, Matthias; Somogyi, Andrew A; Thervet, Eric; Maitland-van der Zee, Anke-Hilse; van Kuilenburg, André Bp; van Schaik, Ron Hn; Verstuyft, Céline; Wadelius, Mia; Daly, Ann K

2011-01-01

108

Including Identity in Clinical Practices  

ERIC Educational Resources Information Center

This article adds qualitative analyses to established practices in speech-language pathology to demonstrate how clinicians can work with identity. Interview material is used to illustrate established analytical practices. This same material is again analyzed from the perspective of identity using the Functional Individual Systems (FIS) framework,…

Hagstrom, Fran

2004-01-01

109

List of Voluntary Product Standards, Commercial Standards, and Simplified Practice Recommendations.  

National Technical Information Service (NTIS)

The publication lists, by subject and in numerical order, existing Voluntary Product Standards (PS), Commercial Standards (CS), and Simplified Practice Recommendations (R). It contains instructions for ordering them.

1973-01-01

110

Clinical practice guideline use by oncology advanced practice nurses  

Microsoft Academic Search

Understanding how clinical practice guidelines (CPGs) are utilized and the effects of their implementation on outcomes is an important goal. The purpose of this investigation was to determine if oncology advanced practice nurse (APN) interventions provided to men with prostate cancer were consistent with Agency for Healthcare Policy and Research CPGs regarding pain [U.S. Department of Health and Human Services.

Regina S. Cunningham

2006-01-01

111

Recommendations for planning pilot studies in clinical and translational research.  

PubMed

Advances in clinical and translation science are facilitated by building on prior knowledge gained through experimentation and observation. In the context of drug development, preclinical studies are followed by a progression of phase I through phase IV clinical trials. At each step, the study design and statistical strategies are framed around research questions that are prerequisites for the next phase. In other types of biomedical research, pilot studies are used for gathering preliminary support for the next research step. However, the phrase "pilot study" is liberally applied to projects with little or no funding, characteristic of studies with poorly developed research proposals, and usually conducted with no detailed thought of the subsequent study. In this article, we present a rigorous definition of a pilot study, offer recommendations for the design, analysis and sample size justification of pilot studies in clinical and translational research, and emphasize the important role that well-designed pilot studies play in the advancement of science and scientific careers. PMID:22029804

Moore, Charity G; Carter, Rickey E; Nietert, Paul J; Stewart, Paul W

2011-10-01

112

Ministry of health clinical practice guidelines: diabetes mellitus.  

PubMed

The Ministry of Health (MOH) have updated the clinical practice guidelines on Diabetes Mellitus to provide doctors and patients in Singapore with evidence-based treatment for diabetes mellitus. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Diabetes Mellitus, for the information of SMJ readers. Chapters and page 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/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. 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:25017409

Goh, S Y; Ang, S B; Bee, Y M; Chen, Y T; Gardner, D S; Ho, E T; Adaikan, K; Lee, Y C; Lee, C H; Lim, F S; Lim, H B; Lim, S C; Seow, J; Soh, A W; Sum, C F; Tai, E S; Thai, A C; Wong, T Y; Yap, F

2014-06-01

113

ADA clinical recommendations on topical fluoride for caries prevention.  

PubMed

Scope and purposeThis guideline is intended to assist practitioners with decision making about the use of topical fluoride caries-preventive agents. It presents evidence-based clinical recommendations on professionally applied and prescription strength, home-use topical fluoride agents for caries prevention. Three clinical questions on the use of topical fluoride caries-preventive agents are addressed: In primary and permanent teeth, does the use of a topical fluoride compared to no topical fluoride reduce the incidence of new lesions, or arrest or reverse existing coronal and/or root caries?For primary and permanent teeth, is one topical fluoride agent more effective than another in reducing the incidence of, or arresting or reversing coronal and/or root caries?Does the use of prophylaxis before application of topical fluoride reduce the incidence of caries to a greater extent than topical fluoride application without prophylaxis?Sodium, stannous and acidulated phosphate fluoride for professional and prescription home use, including varnishes, gels, foams, rinses and prophylaxis pastes were evaluated.MethodologyThe previous version of this review (2006 ADA policy) was based on assimilation of evidence from systematic reviews. However, this update synthesises primary evidence collected through systematic review and appraisal of the literature.The Cochrane Library and Medline (via PubMed) were searched. Relevant systematic reviews and other selected articles were hand-searched.Two reviewers independently screened titles and abstracts, with one reviewer assessing all manuscripts in full for meeting the inclusion criteria. Two different members of the expert panel then approved the exclusion list. Discrepancies were resolved through discussion with the Chair of the workgroup. The USPSTF grading system was used.Review and updatingFive-year interval update in line with the ADA policy.Recommendations For individuals at risk of dental caries: 2.26% fluoride varnish or 1.23% fluoride (APF) gel, or prescription strength, home-use 0.5% fluoride gel or paste, or 0.09% fluoride mouth rinse for children who are aged six or over.The panel judged that the benefits outweighed the potential for harm for all professionally applied and prescription strength, home-use topical fluoride agents and age groups except for children aged under six years. Only 2.26% fluoride varnish was recommended for children less than six years old, as the panel considered the risk of adverse events (particularly nausea and vomiting) associated with swallowing all other professionally applied topical fluoride agents outweighed the potential benefits.There was insufficient data to answer the question on arresting and reversing coronal and/or root caries, so these outcomes were not addressed in the clinical recommendations.Research recommendationsThese focused on development of standard methodologies for well-designed trials with standardised reporting and trial registration. Specific areas for research included: investigation of mechanisms of fluoride action and effects against a background fluoride exposure; investigation of specific sub-groups such as high-risk elderly; research on specific products; measure and outcome development for arrested caries; economics and dissemination/implementation to realise guideline use. PMID:24971851

Maguire, Anne

2014-06-01

114

Clinical practice guidelines and medical malpractice.  

PubMed

As clinical practice guidelines become more and more prevalent, they will define the requisite "standard of care" for medical treatment and impact medical malpractice litigation. They may even replace expert testimony. PMID:11957408

Tzeel, Albert

2002-01-01

115

Collaborative Clinical Practice: An Alternate Field Experience  

ERIC Educational Resources Information Center

Teacher education in the 21st century is encountering increased scrutiny, added pressure, and escalating external regulations but does not have practical and immediate solutions for improving programs. While reforms in teacher education call for additional and improved clinical practice for candidates, through strengthened partnerships with local…

Dee, Amy Lynn

2012-01-01

116

Positive interventions in clinical practice.  

PubMed

Mainstream psychotherapy has made huge strides in treating symptoms and disorders, but it has largely overlooked happiness as a therapeutic goal despite frequently hearing from clients, "Doctor, I want to be happy." This issue of Journal of Clinical Psychology: In Session describes a number of positive interventions for specific clinical problems, such as depression, anxiety, schizophrenia, loss, grief, and relationship distress. Although the name may suggest it, positive interventions do not imply that rest of psychotherapies are negative. Neither are negatives denied nor minimized. Distinct from self-help recipes proffering instant changes, positive psychology interventions refer to systematic approaches to overcome challenges by using clients' strengths and assets. A hybrid psychotherapy-coaching model and strength-based assessment can ask a client "What is right with you?" All articles are supplemented with rich case illustrations. PMID:19294745

Rashid, Tayyab

2009-05-01

117

Preadolescent adjudicative competence: methodological considerations and recommendations for practice standards.  

PubMed

This article examines developmental and legal issues directed toward a downward age extension of forensic evaluation practice standards for preadolescent defendants whose competence is questioned. Existing research and practice standards were developed for cases involving adolescents and adults, but they lack sufficient application to evaluations of young children because of the ways in which legal parameters affect young children. We review practice implications of the legal role of "immaturity" for adjudicative competence, alterations of Dusky in some juvenile courts, and the role of parens patriae in competence hearings held in juvenile court. We examine competence abilities in a developmental framework. Examining practice standards is timely because adjudicative competence in preadolescent defendants has taken on recent significance. The last decade saw changes in the stringency of delinquency statutes, increased emphasis on adversarial approaches to juvenile proceedings, and a de-emphasis on rehabilitation and parens patriae protections. Statutory changes and increased referrals have heightened inquiry into the meaning of preadolescent adjudicative competence. PMID:11568960

Oberlander, L B; Goldstein, N E; Ho, C N

2001-01-01

118

Peer review practicalities in clinical medicine  

PubMed Central

Peer review processes in teaching requires a reviewer to observe a teacher’s practice in a planned manner. Conversation between the two enables the teacher to reflect on their own teaching, promoting self-improvement. Although a central part of the teaching process, and despite its crucial role in continuing professional development, peer review is not widely practiced in hospital settings. This article explains the process and its benefits. Practical implementations of the process in busy clinical settings are suggested. Its evaluation and incorporation into undergraduate learning and postgraduate clinical practice are described. With enthusiastic support for colleagues and allowances for its implementation, it should become part of the regular teaching practice, improving the quality of teaching delivered.

Metcalfe, Matthew J; Farrant, MAL; Farrant, JM

2010-01-01

119

Survey of advanced practice student clinical preceptors.  

PubMed

Most nursing schools use preceptors to provide critical elements of practice, instruction, and supervision. It is important to understand the factors influencing preceptors to volunteer their time and expertise. The purpose of this survey of advanced practice student clinical preceptors was twofold: to determine the barriers to and motivators for providing clinical mentoring and evaluation, and to determine the need for educational preparation to facilitate their roles as clinical preceptors. An online survey was distributed to a convenience sample of active clinical preceptors from multiple graduate-level programs. Responses to items in the categories of organizational support; rewards, disincentives, and barriers; relationship with school of nursing faculty members; and preparation for the preceptor role offered insights into the challenges and rewards that preceptors experience in their practice settings. This study's findings will be useful in understanding some of the issues that contribute to the shortages. PMID:23495701

Wiseman, Rebecca F

2013-05-01

120

Lipoprotein (A) in clinical practice.  

PubMed

Lipoprotein (a) is a strong and independent risk factor for atherosclerosis severity and a predictor of the risk of ischaemic heart disease and stroke. Many questions are still unanswered in relation to the clinical relevance of the scientific observations on Lp(a) and its application in the realms of cardiovascular prevention. Lp(a), a lipoprotein subtype, is linked to the Apo(a) gene located on chromosome 6q26-27 independently associated with increased risk of coronary artery disease (CAD). For this review, data sources from Cochrane, Pubmed, MEDLINE from 1960 till 2012 were analysed systematically. At least one-off measurement of plasma Lp(a) was found to be indicated in those with premature coronary disease when no real causative factor was identified. Management seemed promising with PCSK9 I, apheresis, CETPI, dietary choices and ACEi. There was clear evidence that Lp(a) is a definite risk marker for atherosclerotic cardiovascular disease (CVD). PMID:24864642

Jayasinghe, Rohan; Craig, Ian Hamilton; Mohan, Raj Kamal Alfred

2014-04-01

121

Reconsidering sore throats. Part I: Problems with current clinical practice.  

PubMed Central

OBJECTIVE: To provide evidence-based answers to clinical questions posed by family physicians about Group A streptococcus pharyngitis and to further understanding of why management is controversial. QUALITY OF EVIDENCE: Evidence from randomized trials was not found for most questions. The most critical information came from high-quality community prevalence studies and criterion standard studies of physician clinical judgement. MAIN FINDINGS: Expert recommendations for physician management are not likely to help prevent rheumatic fever, as most people with sore throats do not seek medical care. Current clinical practices result in overuse of antibiotics because accuracy of clinical judgment is limited. CONCLUSIONS: Costs associated with visits for upper respiratory infections as well as increasing antibiotic resistance necessitate reconsidering the current clinical approach. An alternative management strategy is presented in part 2.

McIsaac, W. J.; Goel, V.; Slaughter, P. M.; Parsons, G. W.; Woolnough, K. V.; Weir, P. T.; Ennet, J. R.

1997-01-01

122

Using data mining techniques to explore physicians' therapeutic decisions when clinical guidelines do not provide recommendations: methods and example for type 2 diabetes  

Microsoft Academic Search

BACKGROUND: Clinical guidelines carry medical evidence to the point of practice. As evidence is not always available, many guidelines do not provide recommendations for all clinical situations encountered in practice. We propose an approach for identifying knowledge gaps in guidelines and for exploring physicians' therapeutic decisions with data mining techniques to fill these knowledge gaps. We demonstrate our method by

Massoud Toussi; Jean-Baptiste Lamy; Philippe Le Toumelin; Alain Venot

2009-01-01

123

Melatonergic drugs in clinical practice.  

PubMed

Melatonin (CAS 73-31-4) has both hypnotic and sleep/wake rhythm regulating properties. These sleep promoting actions, which are already demonstrable in healthy humans, have been found useful in subjects suffering from circadian rhythm sleep disorders (CRSD) like delayed sleep phase syndrome (DSPS), jet lag and shift-work sleep disorder. Low nocturnal melatonin production and secretion have been documented in elderly insomniacs, and exogenous melatonin has been shown to be beneficial in treating sleep disturbances of these patients. In comparison to a number of sleep-promoting compounds that are usually prescribed, such as benzodiazepines and z-drugs (zolpidem and zopiclon belonging to the latter ones), melatonin has several advantages of clinical value: it does not cause hangover nor withdrawal effects and is devoid of any addictive potential. However, recent meta-analyses revealed that melatonin is not sufficiently effective in treating most primary sleep disorders. Some of the reasons for a limited efficacy of this natural hormone are related to its extremely short half-life in the circulation, and to the fact that sleep maintenance is also regulated by mechanisms downstream of primary melatonergic actions. Hence, there is an urgent need for the development of melatonin receptor agonists with a longer half-life, which could be suitable for a successful treatment of insomnia. Such requirements are fulfilled by ramelteon (CAS 196597-26-9), which possesses a high affinity for the melatonin receptors MT1 and MT2 present in the circadian pacemaker, the suprachiasmatic nucleus (SCN). Ramelteon also has a substantially longer half-life than melatonin. This new drug has been successfully used in treating elderly insomniacs without any adverse effects reported, and is promising for treating patients with primary insomnia and also those suffering from CRSD. Since sleep disturbances constitute the most prevalent symptoms of various forms of depression, the need for the development of an ideal antidepressant was felt, which would both improve sleep and mitigate depressive symptoms. Since most of the currently used antidepressants, including the selective serotonin re-uptake inhibitors worsen the sleep disturbances of depressive patients, another novel melatonergic drug, agomelatine (CAS 138112-76-2), holds some promise because of its particular combination of actions: it has a high affinity for MT1 and MT2 receptors in the SCN, but it acts additionally as a 5-HT(2C) antagonist [5-hydroxytryptamine (serotonin) receptor 2C antagonist]. The latter property, which is decisive for the antidepressive action, would not favor but potentially antagonize sleep, but this is overcome during night by the melatonergic, sleep-promoting effect. This drug has been found beneficial in treating patients with major depressive and seasonal affective disorders. Unlike the other antidepressants, agomelatine improves both sleep and clinical symptoms of depressive illness and does not have any of the side effects on sleep seen with other compounds in use. This property seems to be of particular value because of the aggravating effects of disturbed sleep in the development of depressive symptoms. Based on these facts, agomelatine seems to be a drug of superior efficacy with a promising future in the treatment of depressive disorders. However, long-term safety studies are required for both ramelteon and agomelatine, with a consideration of the pharmacology of their metabolites, their effects on redox metabolism, and of eventual undesired melatonergic effects, e. g., on reproductive functions. According to current data, both compounds seem to be safe during short-term treatment PMID:18368944

Hardeland, Rüdiger; Poeggeler, Burkhard; Srinivasan, Venkataramanujan; Trakht, Ilya; Pandi-Perumal, Seithikurippu R; Cardinali, Daniel P

2008-01-01

124

Recommended Practices Guide Securing WLANs using 802.11i  

SciTech Connect

This paper addresses design principles and best practices regarding the implementation and operation of Wireless LAN (WLAN) communication networks based on the 802.11i security standard. First, a general overview of WLAN technology and standards is provided in order to ground the discussion in the evolution of WLAN standards and security approaches. This is followed by a detailed explanation of the 802.11i standard for securing WLAN networks. Principles for designing secure WLAN networks are then presented, followed by a list of specific best practices that can be used as a guideline for organizations considering the deployment of WLAN networks for non-critical control and monitoring applications. Finally, a section on technical issues and considerations for deploying WLAN networks in critical environments is presented.

Masica, K

2006-10-16

125

Practice of embryo transfer: recommendations during and after.  

PubMed

Many patient and embryo factors influence the outcome of assisted reproductive technology (ART) treatment. The predictors for a successful ART cycle include female age, ovarian reserve, embryo quality, endometrial receptivity, and embryo transfer (ET) technique. ET, the final step of ART, has recently been noted as a crucial step affecting ART success. Variables affecting pregnancy rates following ET include ultrasound guidance, ease of ET transfer, catheter type, transfer and catheter-loading technique, blood or mucus effects, retained embryos, trial transfer, the physician's experience, and catheter tip placement. Despite the lack of consensus regarding the optimal ET technique, it is generally recommended that during ET, the disruption of the endometrium and the induction of uterine contractions should be avoided. The exposure of embryos to the ambient conditions should be minimized, and the embryo(s) should be placed at an optimal position within the fundal region of the uterine cavity. PMID:24919028

T?ras, Bulent; Cenksoy, Pinar Ozcan

2014-07-01

126

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.

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

127

Reading Instruction for Southwest Indian Children: Sociolinguistic Considerations and Recommended Practices.  

ERIC Educational Resources Information Center

Reports on the writer's experiences at the public schools in Magdalena, New Mexico. Attempts to identify several linguistic and social traits of Southwest Indian children and to recommend appropriate instructional practices for addressing these students' reading needs. (MG)

Kempter, Albert

1984-01-01

128

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.

129

List of Voluntary Product Standards, Commercial Standards, and Simplified Practice Recommendations.  

National Technical Information Service (NTIS)

The publication is intended to assist producers, distributors, consumers, students, and others desiring to obtain copies of Voluntary Product Standards, Commercial Standards, Simplified Practice Recommendations, and Tentative Standards. It contains a clas...

1971-01-01

130

List of Voluntary Product Standards, Commercial Standards, and Simplified Practice Recommendations.  

National Technical Information Service (NTIS)

The publication lists, by subject and in numerical order, existing Voluntary Product Standards (PS), Commercial Standards (CS), and Simplified Practice Recommendations (R). It contains instructions for ordering them. (Author)

1972-01-01

131

Designing Practice: A Review of Prescriptions and Recommendations from Instructional Design Theories.  

ERIC Educational Resources Information Center

Summarizes strategies and recommendations included in various prominent instructional theories (behaviorism, Gagne and Briggs' events of instruction, component display theory, cognitive research, and Keller's motivational-design) to provide guidelines for designing the practice component of instruction. (MBR)

Salisbury, David F.; And Others

1985-01-01

132

Echocardiography in hypertension: practical recommendations from the Italian Society of Hypertension (SIIA).  

PubMed

In this document some indications on practical management of patients with arterial hypertension are discussed and recommendations for how, when and to whom perform an echocardiogram are given. PMID:24043468

Cuspidi, Cesare; De Luca, Nicola; Muiesan, Maria Lorenza

2013-12-01

133

Is there a gap between recommended and 'real world' practice in the management of depression in young people? A medical file audit of practice  

PubMed Central

Background Literature has shown that dissemination of guidelines alone is insufficient to ensure that guideline recommendations are incorporated into every day clinical practice. Methods We aimed to investigate the gaps between guideline recommendations and clinical practice in the management of young people with depression by undertaking an audit of medical files in a catchment area public mental health service for 15 to 25 year olds in Melbourne, Australia. Results The results showed that the assessment and recording of depression severity to ensure appropriate treatment planning was not systematic nor consistent; that the majority of young people (74.5%) were prescribed an antidepressant before an adequate trial of psychotherapy was undertaken and that less than 50% were monitored for depression symptom improvement and antidepressant treatment emergent suicide related behaviours (35% and 30% respectively). Encouragingly 92% of first line prescriptions for those aged 18 years or under who were previously antidepressant-naïve was for fluoxetine as recommended. Conclusions This research has highlighted the need for targeted strategies to ensure effective implementation. These strategies might include practice system tools that allow for systematic monitoring of depression symptoms and adverse side effects, particularly suicide related behaviours. Additionally, youth specific psychotherapy that incorporates the most effective components for this age group, delivered in a youth friendly way would likely aid effective implementation of guideline recommendations for engagement in an adequate trial of psychotherapy before medication is initiated.

2012-01-01

134

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

135

A study of clinical opinion and practice regarding circumcision  

PubMed Central

AIM—To establish clinical opinion regarding appropriate indications for circumcision and to examine actual clinical practice.?METHODS—A questionnaire was sent to all NHS hospital consultants in the Yorkshire region of the UK identified as having a role to play in the management of boys (under 16 years of age) requiring circumcision. Retrospective data on actual clinical practice during a three month study period were also collected via a simple proforma.?RESULTS—Of 153 questionnaires sent, 64 were returned. Responses revealed varying opinions regarding appropriate indications for circumcision within each consultant group, and between paediatricians and surgeons. Surgeons were generally more inclined to recommend circumcision for each of the indications listed in the questionnaire. Analysis of clinical practice revealed that almost two thirds of procedures were carried out for phimosis, and nearly half of these children were under the age of 5years.?CONCLUSION—There are differences in the clinical opinions of surgeons and paediatricians on what constitutes an appropriate indication for circumcision. Paediatricians' opinions are generally more in line with current evidence than those of surgeons, possibly resulting in many unnecessary circumcisions.??

Farshi, Z; Atkinson, K; Squire, R

2000-01-01

136

From Clinical Trials to Clinical Practice Why the Gap?  

Microsoft Academic Search

evidence for the cardiovascular and renal benefits of hyper- tension control, during that same decade, hypertension con- trol rates increased from 24.6% to only 31.0%. At a time when he was director of the National Heart, Lung, and Blood Institute, Claude Lenfant expressed the concern that the potential benefits of clinical research are lost in the translation into clinical practice.2Others

Theodore A. Kotchen

137

Clinical practice guidelines and the law.  

PubMed Central

With physicians in Canada under increasing threat of malpractice litigation, it has been suggested that adopting clinical practice guidelines (CPGs) as standards of care would free doctors from the fear of litigation initiated by dissatisfied patients. However, ethicist Eike-Henner Kluge argues that CPGs can only be considered general indicators of standards of care.

Kluge, E H

1996-01-01

138

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

139

Facilitating Critical Thinking in Clinical Practice.  

ERIC Educational Resources Information Center

Activities to promote the transfer of theoretical knowledge into clinical practice have been developed to facilitate learning by individuals with various learning styles, reduce student stress, and improve teaching methods in a baccalaureate nursing program at the California State University, Chico. Specific activities included innovative…

Persaud, Deanna; And Others

140

[Clinical practice guideline. Drug prescription in elderly].  

PubMed

The process of prescribing a medication is complex and includes: deciding whether it is indicated, choosing the best option, determining the dose and the appropriate management scheme to the physiological condition of the patient, and monitoring effectiveness and toxicity. We have to inform patients about the expected side effects and indications for requesting a consultation. Specific clinical questions were designed based on the acronym PICOST. The search was made in the specific websites of clinical practice guidelines, was limited to the population of older adults, in English or Spanish. We used 10 related clinical practice guidelines, eight systematic reviews and five meta-analyses. Finally, we made a search of original articles or clinical reviews for specific topics. The development and validation of clinical practice guidelines for "rational drug prescriptions in the elderly" is intended to promote an improvement in the quality of prescription through the prevention and detection of inappropriate prescribing in the elderly and, as a result of this, a decrease in the adverse events by drugs, deterioration of health of patients and expenditure of resources. PMID:23693115

Peralta-Pedrero, María Luisa; Valdivia-Ibarra, Francisco Javier; Hernández-Manzano, Mario; Medina-Beltrán, Gustavo Rodrigo; Cordero-Guillén, Miguel Angel; Baca-Zúñiga, José; Cruz-Avelar, Agles; Aguilar-Salas, Ismael; Avalos-Mejía, Annia Marisol

2013-01-01

141

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.

142

Parents' Evaluation of the Usability of a Web Site on Recommended Practices.  

ERIC Educational Resources Information Center

This article describes 21 parents' evaluation of a Web site intended to provide practical information about recommended practices such as activity-based or embedded instruction to families whose young children have disabilities or are at developmental risk. The parent group found the Web site, SPIES for Parents, to be helpful, useful, and…

Cook, Robert S.; Rule, Sarah; Mariger, Heather

2003-01-01

143

Physicians Reentering Clinical Practice: Characteristics and Clinical Abilities  

ERIC Educational Resources Information Center

Introduction: Limited information exists to describe physicians who return to practice after absences from patient care. The Center for Personalized Education for Physicians (CPEP) is an independent, not-for-profit organization that provides clinical competency assessment and educational programs for physicians, including those reentering…

Grace, Elizabeth S.; Korinek, Elizabeth J.; Weitzel, Lindsay B.; Wentz, Dennis K.

2011-01-01

144

Physicians Reentering Clinical Practice: Characteristics and Clinical Abilities  

ERIC Educational Resources Information Center

Introduction: Limited information exists to describe physicians who return to practice after absences from patient care. The Center for Personalized Education for Physicians (CPEP) is an independent, not-for-profit organization that provides clinical competency assessment and educational programs for physicians, including those reentering…

Grace, Elizabeth S.; Korinek, Elizabeth J.; Weitzel, Lindsay B.; Wentz, Dennis K.

2010-01-01

145

[Practical genetic counseling conducted by clinical neurologist].  

PubMed

With the increasing knowledge of the molecular bases for neurological disorders, neurologists are now often required to administer genetic testing and to present the resulting information effectively in clinical practice. In the neurologic clinical setting, genetic testing of affected individuals is usually taken into consideration for a correct diagnosis, but is rarely undertaken in healthy individuals to determine genetic risks for their life planning. Genetic counseling is indispensable for genetic testing because test results may cause serious distress for patients and their family members (referred to as "clients" in the counseling session). Genetic counseling is the medical process of communication that helps clients understand the nature of the genetic disorder and the options open to them in management and family planning. Through the counseling process, clients are given both the medical information and psychosocial support necessary for their own decision-making. Thus, the aim of genetic counseling is to support the client's decision-making process regarding genetic testing, and to avoid unfavorable actions after disclosure of test results. In the broad sense, genetic counseling is a part of ordinary clinical practice for patients with hereditary neurological disorders because neurologic clinical practice includes education and psychosocial support for patients. But clients seeking predictive genetic testing, which includes complicated ethical and psychosocial issues, should be referred to more specialized genetic counseling clinics that take a multi-disciplinary approach. The counseling process is not a one-way transmission of medical information by neurologists, but consists of two-way communication between patients and neurologists. It is therefore crucial for neurologists to master communication skills, particularly those involving active listening and empathic understanding, in order to conduct effective genetic counseling in clinical practice. PMID:22277396

Yoshida, Kunihiro

2011-11-01

146

Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline.  

PubMed

Objective: The aim was to formulate clinical practice guidelines for pheochromocytoma and paraganglioma (PPGL). Participants: The Task Force included a chair selected by the Endocrine Society Clinical Guidelines Subcommittee (CGS), seven experts in the field, and a methodologist. The authors received no corporate funding or remuneration. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. The Task Force reviewed primary evidence and commissioned two additional systematic reviews. Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, European Society of Endocrinology, and Americal Association for Clinical Chemistry reviewed drafts of the guidelines. Conclusions: The Task Force recommends that initial biochemical testing for PPGLs should include measurements of plasma free or urinary fractionated metanephrines. Consideration should be given to preanalytical factors leading to false-positive or false-negative results. All positive results require follow-up. Computed tomography is suggested for initial imaging, but magnetic resonance is a better option in patients with metastatic disease or when radiation exposure must be limited. (123)I-metaiodobenzylguanidine scintigraphy is a useful imaging modality for metastatic PPGLs. We recommend consideration of genetic testing in all patients, with testing by accredited laboratories. Patients with paraganglioma should be tested for SDHx mutations, and those with metastatic disease for SDHB mutations. All patients with functional PPGLs should undergo preoperative blockade to prevent perioperative complications. Preparation should include a high-sodium diet and fluid intake to prevent postoperative hypotension. We recommend minimally invasive adrenalectomy for most pheochromocytomas with open resection for most paragangliomas. Partial adrenalectomy is an option for selected patients. Lifelong follow-up is suggested to detect recurrent or metastatic disease. We suggest personalized management with evaluation and treatment by multidisciplinary teams with appropriate expertise to ensure favorable outcomes. PMID:24893135

Lenders, Jacques W M; Duh, Quan-Yang; Eisenhofer, Graeme; Gimenez-Roqueplo, Anne-Paule; Grebe, Stefan K G; Murad, Mohammad Hassan; Naruse, Mitsuhide; Pacak, Karel; Young, William F

2014-06-01

147

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.

Glasner-Edwards, Suzette; Rawson, Richard

2010-01-01

148

Strength-based assessment in clinical practice.  

PubMed

Strength-based assessment can enhance clinical clarity, improve the range of information, and provide a more complete picture of clients and their circumstances. Deficit-oriented assessment has improved the assessment and treatment of a number of disorders but, at the same time, has created a negative bias, considered strengths as clinical peripheries or by-products, tended to reduce clients to diagnostic categories, and created a power differential, which could be counterproductive to clinical efficacy. Strength-based assessment explores weaknesses as well as strengths to effectively deal with problems. We present a number of strength-based strategies for use in clinical practice. These strategies, we hope, will help clinicians to operationalize how strengths and weaknesses reverberate and contribute to a client's psychological status, which is comprehensive and guards against negative bias. PMID:19294732

Rashid, Tayyab; Ostermann, Robert F

2009-05-01

149

Guidelines on Good Clinical Laboratory Practice  

PubMed Central

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

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

2008-01-01

150

Ultrasound transducer selection in clinical imaging practice.  

PubMed

Many types of medical ultrasound transducers are used in clinical practice. They operate at different center frequencies, have different physical dimensions, footprints, and shapes, and provide different image formats. However, little information is available about which transducers are most appropriate for a given application, and the purpose of this article is to address this deficiency. Specifically, the relationship between the transducer, imaging format, and clinical applications is discussed, and systematic selection criteria that allow matching of transducers to specific clinical needs are presented. These criteria include access to and coverage of the region of interest, maximum scan depth, and coverage of essential diagnostic modes required to optimize a patient's diagnosis. Three comprehensive figures organize and summarize the imaging planes, scanning modes, and types of diagnostic transducers to facilitate their selection in clinical diagnosis. PMID:23525382

Szabo, Thomas L; Lewin, Peter A

2013-04-01

151

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

152

Integrating pharmacogenomics into oncology clinical practice.  

PubMed

Oncology pharmacogenomics has seen a great deal of progress in the past 10 years. The release of the Human Genome Project data and the availability of fast, affordable genotyping platforms has allowed the field to expand and has provided invaluable data for pharmacogenomics research. The introduction of US FDA-approved targeted therapy (trastuzumab), package insert changes (irinotecan and tamoxifen) and the initiation of a genotype-guided clinical trial for cancer therapy (TYMS TSER in rectal cancer), along with panels of DNA and expression markers (Roche AmpliChip(®) and Oncotype Dx™ panel) are paving the way towards the integration of pharmacogenomics into clinical practice. PMID:24410511

Marsh, Sharon; Phillips, Michael S

2008-01-01

153

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.

Clarimon, Jordi; Kulisevsky, Jaime

2013-01-01

154

Clinical Governance: Learning and changing practice  

Microsoft Academic Search

ContextThis paper describes a very simple, non-threatening method for improving communication and sharing learning points.ObjectiveTo test whether sharing anonymised reporting of problems and helpful hints is acceptable and useful to staff.DesignA pink slip (pinkie) was designed and made available in every clinic venue. All staff were asked to write about any episodes where practice was less than optimum or to

Sue Ingram; Sarah Randall

2001-01-01

155

Clinical practice: between Aristotle and Cochrane.  

PubMed

Health and disease consist of amino acids and self image, cell membranes and human ideals, muscles and politics. Only to a limited extent can clinical practice be based on science. It can never be carried on in isolation from political, and cultural forces that influence patients' health behaviour. Evidence-based medicine is essential but not sufficient. A continuous relationship with patients is a conditio sine qua non for general practice. The general practitioner must be a master of pragmatic medicine. Rationality, the dominant modern trend, may be dangerous for patients and doctors: (1) advances in technology can give patients and doctors the illusion of mastering the universe; (2) patients complain of being treated like biomachines, without human touch. Another symptom of modernity is the decline of religion. But patients and doctors are by no means rational beings. God, destiny and hope are replaced by modern medico-scientific megalomania. Modern medicine is also strongly influenced by commercialization and invasion by bureaucrats. Instead of becoming a biomedical robot, the general practitioner must learn to value the Aristotelian concept of phronesis. It means practical wisdom and can only be gained by personal experience; a form of learning by doing. Good clinical practice cannot come from science alone, or from personal experience alone. It is an amalgam of scientia and phronesis. PMID:9540138

Fugelli, P

1998-02-01

156

Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a clinical practice guideline  

Microsoft Academic Search

BACKGROUND: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. A clinical practice guideline was developed based on a systematic review investigating neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer. METHODS: A systematic review with meta-analysis was developed and clinical recommendations

Richard A Malthaner; Rebecca KS Wong; R Bryan Rumble; Lisa Zuraw

2004-01-01

157

Clinical Practice: Diagnosis and Evaluation of Dyspepsia  

PubMed Central

The main issue regarding the approach to the patient with uninvestigated dyspepsia are whether the symptoms are the result of important clinical illness which then determines the appropriate management strategy for treatment of the symptoms. A initial trial of empiric anti-secretory drugs is recommended for those without H. pylori infection and no alarm symptoms whereas H. pylori eradication is recommended for those with an active H. pylori infection. Treatment expectations for H. pylori infections should theoretically be similar to other common infectious diseases. In most regions clarithromycin resistance has undermined traditional triple therapy such that it is no longer a suitable choice as an empiric therapy. Four drug therapies such as sequential, concomitant, and bismuth-quadruple therapy are generally still acceptable choices as empiric therapies. Post eradication testing is highly recommended to provides early identification of otherwise unrecognized increasing antimicrobial resistance. However, despite the ability to successfully cure H. pylori infections, a symptomatic response can be expected in only a minority of those with dyspepsia not associated with ulcers (so called non-ulcer dyspepsia). Overall, from the patients stand point, symptomatic relief is often difficult to achieve and physicians must relay on reassurance along with empiric and individualized care.

Graham, David Y.; Rugge, Massimo

2010-01-01

158

Pharmacogenomics: from bedside to clinical practice.  

PubMed

The field of pharmacogenomics has seen some exciting advances in the recent past. The Human Genome Project and International HapMap projects have uncovered a wealth of information for researchers. The discovery of clinically predictive genotypes (e.g. UGT1A1*28, TYMS TSER), haplotypes (e.g. VKORC1 Haplotype A) and somatic mutations (e.g. epidermal growth factor receptor), along with the introduction of FDA approved pharmacogenetic tests (UGT1A1*28) and the initiation of a genotype-guided clinical trial for cancer therapy (TYMS TSER in rectal cancer) have provided the first steps towards the integration of pharmacogenomics into clinical practice. This review describes some of the recent advances in pharmacogenomics research. PMID:16651374

Marsh, Sharon; McLeod, Howard L

2006-04-15

159

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.

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

160

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.

161

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

2013-01-01

162

Assessment of Eating Disorders: Review and Recommendations for Clinical Use  

ERIC Educational Resources Information Center

Practitioners have come under increasing pressure to provide objective data on assessment and treatment outcome of clients. This article provides a brief summary of assessment of eating disorders for the practicing clinician, with an emphasis on well-validated assessment instruments. The critical domains that should be covered in a thorough…

Anderson, Drew A.; Lundgren, Jennifer D.; Shapiro, Jennifer R.; Paulosky, Carrie A.

2004-01-01

163

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.

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

2013-01-01

164

Incorporating socio-political health promotion activities in clinical practice.  

PubMed

A criticism laid at the door of many nurses in relation to their health promotion activity is that they almost exclusively adopt a biomedical/preventative health education approach. When it comes to adopting socio-political health promotion approaches, there is scant evidence that nurses implement these activities in clinical practice. This article is designed to raise awareness and signpost the types of activities that nurses could be involved with if they wish to influence the broader social and political health promotion agenda. In doing so, it has developed an 'effect' programme model for socio-political health promotion practice as a framework for those practitioners who wish to review their current health-related activities and/or who are seeking to extend their range of health promotional practice. This article draws upon a critical review of the literature in order to develop an evolving theoretical perspective for health promotion practice. The proposed model was developed from this new perspective as were recommendations for practice. PMID:12919213

Whitehead, Dean

2003-09-01

165

ACMG recommendations for reporting of incidental findings in clinical exome and genome sequencing.  

PubMed

In clinical exome and genome sequencing, there is a 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 that emphasized the importance of alerting the patient to 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 an open forum at the 2012 Annual Meeting and 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. The ACMG recommends 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 penetrance and 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 L; Nussbaum, Robert L; O'Daniel, Julianne M; Ormond, Kelly E; Rehm, Heidi L; Watson, Michael S; Williams, Marc S; Biesecker, Leslie G

2013-07-01

166

Role modeling excellence in clinical nursing practice.  

PubMed

Role modeling excellence in clinical nursing practice is the focus of this paper. The phenomenological research study reported involved a group of 8 nurses identified by their colleagues as exemplary. The major theme revealed in this study was that these exemplary nurses were also excellent role models in the clinical setting. This paper details approaches used by these nurses that made them excellent role models. Specifically, the themes of attending to the little things, making connections, maintaining a light-hearted attitude, modeling, and affirming others are presented. These themes are discussed within the framework of Watson [Watson, J., 1989. Human caring and suffering: a subjective model for health services. In: Watson, J., Taylor, R. (Eds.), They Shall Not Hurt: Human Suffering and Human Caring. Colorado University, Boulder, CO] "transpersonal caring" and [Bandura, A., 1997. Social Learning Theory. Prentice Hall, Englewood Cliffs, NJ] "Social Learning Theory." Particular emphasis in the discussion is on how positive role modeling by exemplary practitioners can contribute to the education of clinical nurses in the practice setting. PMID:18590978

Perry, R N Beth

2009-01-01

167

Electronic pain assessment in clinical practice.  

PubMed

SUMMARY The assessment and treatment of chronic pain remains an international challenge for healthcare providers among aging patients and rising healthcare costs. This article provides a brief overview of studies on the use of electronic pain diaries and innovative software programs for pain assessment and monitoring among providers and persons with chronic pain. The advent of software pain monitoring programs on smart phones, personal digital assistants and internet-based tracking allow for the collection of large datasets of momentary data to better assist in the management of chronic pain. Electronic tracking in the home and clinic can improve data quality and reduce the biases of recalled information compared with paper diaries and questionnaires. Furthermore, 3D pain mapping programs can enable patients to represent the location and intensity of their pain with greater accuracy. However, despite the benefits, there are a number of barriers to incorporating electronic pain assessment into daily clinical practice. Additional control trials and clinical investigations are needed to demonstrate the efficacy and benefit of electronic pain assessment over and above standard practices. PMID:24645659

Marceau, Lisa D; Smith, Lauren D; Jamison, Robert N

2011-07-01

168

Attitudes and practices related to clinical alarms.  

PubMed

Background The number of devices with alarms has multiplied in recent years, causing alarm fatigue in bedside clinicians. Alarm fatigue is now recognized as a critical safety issue. Objective To determine if attitudes and practices related to clinical alarms have changed since 2005. Methods The Healthcare Technology Foundation's Clinical Alarms Committee developed an online survey for hospital personnel that addressed attitudes and practices related to clinical alarms. They administered it in 2005-2006 and in 2011 and compared the results. Results Respondents were asked about their level of agreement with 19 statements about alarms. Many of the statements revealed no significant differences between the 2 survey years, although some differences were apparent. Respondents to the 2011 survey were significantly more likely to agree with statements about alarm sounds differentiating the priority of alarm and the helpfulness of central alarm management. Respondents in 2011 were significantly less likely to feel that nuisance alarms occur frequently and disrupt patient care. Respondents also ranked the importance of 9 different alarm issues. In both years, they ranked frequent false alarms as the most important. In response to a new question in the 2011 survey, 18% of respondents reported patients' experiencing adverse events related to alarms at their institutions. Conclusions Since 2005-2006 when the first survey was conducted, not much has changed. False alarms continue to contribute to a noisy hospital environment, and sentinel events related to alarm fatigue persist. Alarm hazards are a significant patient safety issue. PMID:24786820

Funk, Marjorie; Clark, J Tobey; Bauld, Thomas J; Ott, Jennifer C; Coss, Paul

2014-05-01

169

Practical recommendations for statistical analysis and data presentation in Biochemia Medica journal  

PubMed Central

The aim of this article is to highlight practical recommendations based on our experience as reviewers and journal editors and refer to some most common mistakes in manuscripts submitted to Biochemia Medica. One of the most important parts of the article is the Abstract. Authors quite often forget that Abstract is sometimes the first (and only) part of the article read by the readers. The article Abstract must therefore be comprehensive and provide key results of your work. Problematic part of the article, also often neglected by authors is the subheading Statistical analysis, within Materials and methods, where authors must explain which statistical tests were used in their data analysis and the rationale for using those tests. They also need to make sure that all tests used are listed under Statistical analysis section, as well as that all tests listed are indeed used in the study. When writing Results section there are several key points to keep in mind, such as: are results presented with adequate precision and accurately; is descriptive analysis appropriate; is the measure of confidence provided for all estimates; if necessary and applicable, are correct statistical tests used for analysis; is P value provided for all tests, etc. Especially important is not to make any conclusions on the causal relationship unless the study is an experiment or clinical trial. We believe that the use of the proposed checklist might increase the quality of the submitted work and speed up the peer-review and publication process for published articles.

Simundic, Ana-Maria

2012-01-01

170

Ethical Issues of Air Force Nurses Practitioners in Clinical Practice.  

National Technical Information Service (NTIS)

What are the ethical issues or situations Air Force Nurse Practitioners (AFNPs) experience in clinical practice. Which moral or ethical principles are reflected. Little has been written about the ethical issues faced by AFNPs in clinical practice. The des...

C. L. Gilchrist

2000-01-01

171

GLUT1 deficiency syndrome in clinical practice.  

PubMed

GLUT1 deficiency syndrome (GLUT1DS) is caused by impaired glucose transport into brain and is effectively treated by means of a ketogenic diet. In clinical practice the diagnosis of GLUT1DS often is challenging due to the increasing complexity of symptoms, diagnostic cut-offs for hypoglycorrhachia and genetic heterogeneity. In terms of treatment alternative ketogenic diets and their long-term side effects as well as novel compounds such as alpha-lipoic acid and triheptanoin have raised a variety of issues. The current diagnostic and therapeutic approach to GLUT1DS is discussed in this review in view of these recent developments. PMID:21382692

Klepper, Joerg

2012-07-01

172

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

173

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

174

Recommended Practices and Parent Perspectives regarding AT Use in Early Intervention  

ERIC Educational Resources Information Center

It frequently is suggested that parents underutilize assistive technology (AT) for their young children with disabilities despite wide spread recommended practices for providing optimal AT interventions (i.e., devices and services). However, neither parent perspectives of AT underutilization or families' experiences with AT have been reported in…

Wilcox, M. Jeanne; Dugan, Lauren M.; Campbell, Philippa H.; Guimond, Amy

2006-01-01

175

Recommended Practices for Promoting Physical Activity in Early Childhood Education Settings  

ERIC Educational Resources Information Center

Although the importance of physical development as an integrated part of early childhood education is well understood, many early childhood teachers lack the specific background and training in this area. To fill this gap, this article presents a framework of recommended practices and a corresponding assessment tool. The Head Start Body Start…

Wright, Paul M.; Stork, Steve

2013-01-01

176

SFPO and ESOP recommendations for the practical stability of anticancer drugs: an update.  

PubMed

The recommendations for the practical stability of anticancer drugs published in 2010 by the French Society of Hospital Pharmacists (SFPO) and the European Society of Oncology Pharmacists (ESOP) have been updated. Ten new molecules have been included (asparaginase, azacitidine, bevacizumab, clofarabine, eribuline mesylate, folinate sodium, levofolinate calcium, nelarabine, rituximab, temsirolimus). PMID:24206590

Vigneron, J; Astier, A; Trittler, R; Hecq, J D; Daouphars, M; Larsson, I; Pourroy, B; Pinguet, F

2013-11-01

177

The State of School-Based Bilingual Assessment: Actual Practice versus Recommended Guidelines  

ERIC Educational Resources Information Center

Purpose: This study was designed to investigate the frequency with which school-based speech-language pathologists (SLPs) used recommended practices when assessing the language skills of bilingual students. The study also investigated the frequency with which SLPs used formal, standardized tests versus informal, alternative procedures with this…

Caesar, Lena G.; Kohler, Paula D.

2007-01-01

178

National Survey of Primary Care Physicians' Recommendations & Practice for Breast, Cervical, Colorectal, & Lung Cancer Screening  

Cancer.gov

This NCI-led survey (the Agency for Healthcare Research and Quality and Centers for Disease Control and Prevention are co-sponsors) was fielded between September 2006 and May 2007. It obtained current, national data on primary care physicians' (PCPs') knowledge, attitudes, recommendations, and practices related to screening for breast, cervical, colorectal, and lung cancer.

179

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

2014-06-26

180

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.

Jamison, Robert N.; Edwards, Robert R.

2014-01-01

181

Applying HIV testing guidelines in clinical practice.  

PubMed

An estimated one fourth of persons with human immunodeficiency virus (HIV) are not aware they are infected. Early diagnosis of HIV has the potential to ensure optimal outcomes for infected persons and to limit the spread of the virus. Important barriers to testing among physicians include insufficient time, reimbursement issues, and lack of patient acceptance. Current HIV testing guidelines address many of these barriers by making the testing process more streamlined and less stigmatizing. The opt-out consent process has been shown to improve test acceptance. Formal pretest counseling and written consent are no longer recommended by the Centers for Disease Control and Prevention. Nevertheless, pretest discussions provide an opportunity to give information about HIV, address fears of discrimination, and identify ongoing high-risk activities. With increased HIV screening in the primary care setting, more persons with HIV could be identified earlier, receive timely and appropriate care, and get treatment to prevent clinical progression and transmission. PMID:20000306

Mahoney, Megan R; Fogler, Jess; Weber, Shannon; Goldschmidt, Ronald H

2009-12-15

182

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

183

2011 Clinical Practice Guidelines for Type 2 Diabetes in Korea  

PubMed Central

As in other countries, type 2 diabetes is major health concern in Korea. A dramatic increase in the prevalence of type 2 diabetes and its chronic complications has led to an increase in health costs and economic burdens. Early detection of high risk individuals, hidden diabetic patients, and improvement in the quality of care for the disease are the first steps to mitigate the increase in prevalence. The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the '3rd Clinical Practice Guidelines' at the end of 2010. In the guidelines, the committee recommended active screening of high risk individuals for early detection and added the hemoglobin A1c level to the diagnostic criteria for type 2 diabetes based on clinical studies performed in Korea. Furthermore, the committee members emphasized that integrating patient education and self-management is an essential part of care. The drug treatment algorithm based on the degree of hyperglycemia and patient characteristics were also updated.

Ko, Seung-Hyun; Kim, Sung-Rea; Kim, Dong-Joon; Oh, Seung-Joon; Lee, Hye-Jin; Shim, Kang-Hee; Woo, Mi-Hye; Kim, Jun-Young; Kim, Nan-Hee; Kim, Jae-Taik; Kim, Chong Hwa; Kim, Hae Jin; Jeong, In-Kyung; Hong, Eun-Kyung; Cho, Jae-Hyoung; Mok, Ji-Oh

2011-01-01

184

High-sensitivity cardiac troponins in everyday clinical practice  

PubMed Central

High-sensitivity cardiac troponin (hs-cTn) assays are increasingly being used in many countries worldwide, however, a generally accepted definition of high-sensitivity is still pending. These assays enable cTn measurement with a high degree of analytical sensitivity with a low analytical imprecision at the low measuring range of cTn assays (coefficient of variation of < 10% at the 99th percentile upper reference limit). One of the most important advantages of these new assays is that they allow novel, more rapid approaches to rule in or rule out acute coronary syndromes (ACSs) than with previous cTn assay generations which are still more commonly used in practice worldwide. hs-cTn is also more sensitive for the detection of myocardial damage unrelated to acute myocardial ischemia. Therefore, the increase in early diagnostic sensitivity of hs-cTn assays for ACS comes at the cost of a reduced ACS specificity, because more patients with other causes of acute or chronic myocardial injury without overt myocardial ischemia are detected than with previous cTn assays. As hs-cTn assays are increasingly being adopted in clinical practice and more hs-cTn assays are being developed, this review attempts to synthesize the available clinical data to make recommendations for their everyday clinical routine use.

Mair, Johannes

2014-01-01

185

Taking PDT into mainstream clinical practice  

NASA Astrophysics Data System (ADS)

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

Bown, Stephen G.

2009-06-01

186

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.

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

187

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.

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

2012-01-01

188

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.

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

189

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

PubMed

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 (eg, 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 posttransplantation exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation 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:24975331

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; VAN Lint, Maria Teresa; Wingard, John R; Tichelli, Andre

2014-06-01

190

Recommendations for a Clinical Decision Support for the Management of Individuals with Chronic Kidney Disease  

PubMed Central

Background and objectives: Care for advanced CKD patients is suboptimal. CKD practice guidelines aim to close gaps in care, but making providers aware of guidelines is an ineffective implementation strategy. The Institute of Medicine has endorsed the use of clinical decision support (CDS) for implementing guidelines. The authors’ objective was to identify the requirements of an optimal CDS system for CKD management. Design, setting, participants, and measurements: The aims of this study expanded on those of previous work that used the facilitated process improvement (FPI) methodology. In FPI, an expert workgroup develops a set of quality improvement tools that can subsequently be utilized by practicing physicians. The authors conducted a discussion with a group of multidisciplinary experts to identify requirements for an optimal CDS system. Results: The panel considered the process of patient identification and management, associated barriers, and elements by which CDS could address these barriers. The panel also discussed specific knowledge needs in the context of a typical scenario in which CDS would be used. Finally, the group developed a set of core requirements that will likely facilitate the implementation of a CDS system aimed at improving the management of any chronic medical condition. Conclusions: Considering the growing burden of CKD and the potential healthcare and resource impact of guideline implementation through CDS, the relevance of this systematic process, consistent with Institute of Medicine recommendations, cannot be understated. The requirements described in this report could serve as a basis for the design of a CKD-specific CDS.

Patwardhan, Meenal B.; Kawamoto, Kensaku; Lobach, David; Patel, Uptal D.; Matchar, David B.

2009-01-01

191

Guidelines for the nonpharmacologic management of migraine in clinical practice  

PubMed Central

OBJECTIVE: To provide physicians and allied health care professionals with guidelines for the nonpharmacologic management of migraine in clinical practice. OPTIONS: The full range and quality of nonpharmacologic therapies available for the management of migraine. OUTCOMES: Improvement in the nonpharmacologic management of migraine. EVIDENCE AND VALUES: The creation of the guidelines followed a needs assessment by members of the Canadian Headache Society and included a statement of objectives; development of guidelines by multidisciplinary working groups using information from literature reviews and other resources; comparison of alternative clinical pathways and description of how published data were analysed; definition of the level of evidence for data in each case; evaluation and revision of the guidelines at a consensus conference held in Ottawa on Oct. 27-29, 1995; redrafting and insertion of tables showing key variables and data from various studies and tables of data with recommendations; and reassessment by all conference participants. BENEFITS, HARMS AND COSTS: Augmentation of the use of nonpharmacologic therapies for the acute and prophylactic management of migraine is likely to lead to substantial benefits in both human and economic terms. RECOMMENDATIONS: Both the avoidance of migraine trigger factors and the use of nonpharmacologic therapies have a part to play in overall migraine management. VALIDATION: The guidelines are based on consensus of Canadian experts in neurology, emergency medicine, psychiatry, psychology and family medicine, and consumers. Previous guidelines did not exist. Field testing of the guidelines is in progress.

Pryse-Phillips, W E; Dodick, D W; Edmeads, J G; Gawel, M J; Nelson, R F; Purdy, R A; Robinson, G; Stirling, D; Worthington, I

1998-01-01

192

Pharmacogenomics in clinical practice and drug development  

PubMed Central

Genome-wide association studies (GWAS) of responses to drugs, including clopidogrel, pegylated-interferon and carbamazepine, have led to the identification of specific patient subgroups that benefit from therapy. However, the identification and replication of common sequence variants that are associated with either efficacy or safety for most prescription medications at odds ratios (ORs) >3.0 (equivalent to >300% increased efficacy or safety) has yet to be translated to clinical practice. Although some of the studies have been completed, the results have not been incorporated into therapy, and a large number of commonly used medications have not been subject to proper pharmacogenomic analysis. Adoption of GWAS, exome or whole genome sequencing by drug development and treatment programs is the most striking near-term opportunity for improving the drug candidate pipeline and boosting the efficacy of medications already in use.

Harper, Andrew R; Topol, Eric J

2013-01-01

193

Dermatoscopy: alternative uses in daily clinical practice.  

PubMed

Dermatoscopy, also known as dermoscopy, epiluminescence microscopy, or surface microscopy, is a noninvasive technique allowing rapid and magnified (× 10) in vivo observation of the skin with the visualization of morphologic features often imperceptible to the naked eye. Videodermatoscopy (VD) represents the evolution of dermatoscopy and is performed with a video camera equipped with lenses providing higher magnification (× 10 to × 1000). Over the past few years, both dermatoscopy and VD have been demonstrated to be useful in a wide variety of cutaneous disorders, including ectoparasitic infestations, cutaneous/mucosal infections, hair and nail abnormalities, psoriasis, and other dermatologic as well as cosmetologic conditions. Depending on the skin disorder, both dermatoscopy and VD may be useful for differential diagnosis, prognostic evaluation, and monitoring response to treatment. Nowadays, it represents an important and relatively simple aid in daily clinical practice. PMID:21292346

Micali, Giuseppe; Lacarrubba, Francesco; Massimino, Doriana; Schwartz, Robert A

2011-06-01

194

[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

195

Irritable bowel syndrome: diagnostic approaches in clinical practice  

PubMed Central

Background: Irritable bowel syndrome (IBS), a functional gastrointestinal disorder long considered a diagnosis of exclusion, has chronic symptoms that vary over time and overlap with those of non-IBS disorders. Traditional symptom-based criteria effectively identify IBS patients but are not easily applied in clinical practice, leaving >40% of patients to experience symptoms up to 5 years before diagnosis. Objective: To review the diagnostic evaluation of patients with suspected IBS, strengths and weaknesses of current methodologies, and newer diagnostic tools that can augment current symptom-based criteria. Methods: The peer-reviewed literature (PubMed) was searched for primary reports and reviews using the limiters of date (1999–2009) and English language and the search terms irritable bowel syndrome, diagnosis, gastrointestinal disease, symptom-based criteria, outcome, serology, and fecal markers. Abstracts from Digestive Disease Week 2008–2009 and reference lists of identified articles were reviewed. Results: A disconnect is apparent between practice guidelines and clinical practice. The American Gastroenterological Association and American College of Gastroenterology recommend diagnosing IBS in patients without alarm features of organic disease using symptom-based criteria (eg, Rome). However, physicians report confidence in a symptom-based diagnosis without further testing only up to 42% of the time; many order laboratory tests and perform sigmoidoscopies or colonoscopies despite good evidence showing no utility for this work-up in uncomplicated cases. In the absence of diagnostic criteria easily usable in a busy practice, newer diagnostic methods, such as stool-form examination, fecal inflammatory markers, and serum biomarkers, have been proposed as adjunctive tools to aid in an IBS diagnosis by increasing physicians’ confidence and changing the diagnostic paradigm to one of inclusion rather than exclusion. Conclusion: New adjunctive testing for IBS can augment traditional symptom-based criteria, improving the speed and safety with which a patient is diagnosed and avoiding unnecessary, sometimes invasive, testing that adds little to the diagnostic process in suspected IBS.

Burbige, Eugene J

2010-01-01

196

Can surveying practitioners about their practices help identify priority clinical practice guideline topics?  

Microsoft Academic Search

BACKGROUND: Clinical practice guidelines are systematically developed statements designed to assist in patient and physician clinical decision making for specific clinical circumstances. In order to establish which guideline topics are priorities, practitioners were surveyed regarding their current practice. METHODS: One hundred ninety-seven practitioners in Ontario, Canada were mailed a survey exploring their current practice or opinion regarding the prophylactic use

Melissa C Brouwers; Alexandra Chambers; James Perry

2003-01-01

197

Knowledge of Evidence-Based Urinary Catheter Care Practice Recommendations Among Healthcare Workers in Nursing Homes  

PubMed Central

Objectives This study assessed the knowledge of recommended urinary catheter care practices among nursing home (NH) healthcare workers (HCWs) in Southeast Michigan. Design A self-administered survey. Setting Seven nursing homes in Southeast Michigan. Participants Three hundred and fifty-six healthcare workers. Methods An anonymous, self-administered survey of HCWs (nurses & nurse aides) in seven NHs in 2006. The survey included questions about respondent characteristics and knowledge about indications, care, and personal hygiene pertaining to urinary catheters. The association of knowledge measures with occupation (nurses vs. aides) was assessed using generalized estimating equations. Results A total of 356 of 440 HCWs (81%) responded. Over 90% of HCWs were aware of measures such as cleaning around the catheter daily, glove use, and hand hygiene with catheter manipulation. They were less aware of research-proven recommendations of not disconnecting the catheter from its bag (59% nurses vs. 30% aides, P < .001), not routinely irrigating the catheter (48% nurses vs. 8% aides, P < .001), and hand hygiene even after casual contact (60% nurses vs. 69% aides, P = .07). HCWs were also unaware of recommendations regarding alcohol-based handrub (27% nurses & 32% aides with correct responses, P = .38). HCWs reported sources, both informal (such as nurse supervisors) and formal (in-services), of knowledge about catheter care. Conclusion Wide discrepancies remain between research-proven recommendations pertaining to urinary catheter care and HCWs' knowledge. Nurses and aides differ in their knowledge of recommendations against harmful practices, such as disconnecting the catheter from the bag and routinely irrigating catheters. Further research should focus on strategies to enhance dissemination of proven infection control practices in NHs.

Mody, Lona; Saint, Sanjay; Galecki, Andrzej; Chen, Shu; Krein, Sarah L.

2010-01-01

198

Large-Eddy Simulation: Current Capabilities, Recommended Practices, and Future Research  

NASA Technical Reports Server (NTRS)

This paper presents the results of an activity by the Large Eddy Simulation (LES) Working Group of the AIAA Fluid Dynamics Technical Committee to (1) address the current capabilities of LES, (2) outline recommended practices and key considerations for using LES, and (3) identify future research needs to advance the capabilities and reliability of LES for analysis of turbulent flows. To address the current capabilities and future needs, a survey comprised of eleven questions was posed to LES Working Group members to assemble a broad range of perspectives on important topics related to LES. The responses to these survey questions are summarized with the intent not to be a comprehensive dictate on LES, but rather the perspective of one group on some important issues. A list of recommended practices is also provided, which does not treat all aspects of a LES, but provides guidance on some of the key areas that should be considered.

Georgiadis, Nicholas J.; Rizzetta, Donald P.; Fureby, Christer

2009-01-01

199

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

200

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.

2013-01-01

201

Mobile service distribution from the end-user perspective: the survey study on recommendation practices  

Microsoft Academic Search

Vast amounts of mobile services and applications are being offered to end users via app stores and service providers' web sites. In addition, users take part in the distribution of services by recommending services to each other, i.e. through various word-of-mouth practices. To understand the current patterns of user-initiated service distribution, we conducted an exploratory survey study (N=203) to investigate

Zeynep Ahmet; Kaisa Väänänen-Vainio Mattila

2012-01-01

202

SMARTWheel: From Concept to Clinical Practice  

PubMed Central

Background Wheelchair prescription is complex with thousands of choices and options. Theoretically, a higher quality or innovative wheelchair that is appropriately matched to the user and their unique needs will increase participation. It is well accepted that there is an alarmingly high incidence of carpal tunnel syndrome, and rotator cuff injuries among manual wheelchair users. Development Since the initial conceptualization, the SMARTWheel was intended to better understand the physiological and physical effects of wheelchair propulsion on the body. Initially, little was known about wheelchair propulsion and the SMARTWheel transformed the nascent field of wheelchair propulsion biomechanics. Impact Although still an important area of clinical research, the SMARTWheel has been critical to the study of the relationship between the type of wheelchair, set-up, activity, technique, anatomy, and physiology and repetitive strain injury. There has been growing evidence that the wheelchair-user interaction explains a substantial portion of the risk of developing a degenerative injury and on community participation. A noteworthy contribution of this work was the release of the clinical practice guideline, entitled, Preservation of Upper Limb Function Following Spinal Cord Injury in 2005. Discussion The SMARTWheel has been used by other scientists in areas that were not originally envisioned to be applications. It has been used to support the design of tools for developing a trail mapping rating and description system. It has also supported the design of accessible pedestrian walkways standards, accessible playground surfaces, and to evaluate carpets for wheelchair accessibility. It is likely that there are more new areas of exploration to emerge. This article describes the evolution of the SMARTWheel as new technologies became available and its applications in the field of wheelchair biomechanics and clinical service delivery.

Cooper, Rory A.

2009-01-01

203

ACOG Committee Opinion No. 577: Understanding and using the U.S. Selected Practice Recommendations for Contraceptive Use, 2013.  

PubMed

The U.S. Selected Practice Recommendations for Contraceptive Use, 2013 (U.S. SPR), issued by the Centers for Disease Control and Prevention is a companion piece to the Centers for Disease Control and Prevention's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. The U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, provides guidance for which contraceptive methods are safe for women with selected characteristics and medical conditions, whereas the U.S. SPR offers guidance on how to use these methods most effectively. The American College of Obstetricians and Gynecologists endorses the U.S. SPR and encourages its use by Fellows; providers should always consider the specific clinical situation when applying these guidelines to individual clinical care. PMID:24150028

2013-11-01

204

The Internet and clinical practice of child neurology.  

PubMed

The Internet has great potential for aiding patient care. Concerns regarding patient confidentiality, provider liability, and efficient and fair use of these new resources have triggered specific recommendations for integration of the Internet into our practices. PMID:10987571

Leber, S; Mack, K

2000-04-01

205

Troubling Practices and the Academy: Dialoguing Educational and Clinical Supervision  

Microsoft Academic Search

This paper contrasts the practices of educational and clinical supervision, which have different histories and clientele. Educational supervision -- of new teachers or of thesis researchers-- has some surprising resonances with clinical supervision practices involving support for professionals in mental health fields. Both involve complex practices of economic accountability within organisations. Both are widely perceived to be beneficial to educational

SUE CORNFORTH; LISE BIRD CLAIBORNE

2007-01-01

206

Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study.  

PubMed

Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P < 0·001). Audits between 2003 and 2011 of 4368 patient medical records identified compliance with pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital. PMID:22515476

Barker, Anna Lucia; Kamar, Jeannette; Tyndall, Tamara Jane; White, Lyn; Hutchinson, Anastasia; Klopfer, Nicole; Weller, Carolina

2013-06-01

207

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

208

Analyzing multiple endpoints in clinical trials of pain treatments: IMMPACT recommendations  

Microsoft Academic Search

The increasing complexity of randomized clinical trials and the practice of obtaining a wide variety of measurements from study participants have made the consideration of multiple endpoints a critically important issue in the design, analysis, and interpretation of clinical trials. Failure to consider important outcomes can limit the validity and utility of clinical trials; specifying multiple endpoints for the evaluation

Dennis C. Turk; Robert H. Dworkin; Michael P. McDermott; Nicholas Bellamy; Laurie B. Burke; Julie M. Chandler; Charles S. Cleeland; Penney Cowan; Rozalina Dimitrova; John T. Farrar; Sharon Hertz; Joseph F. Heyse; Smriti Iyengar; Alejandro R. Jadad; Gary W. Jay; John A. Jermano; Nathaniel P. Katz; Donald C. Manning; Susan Martin; Mitchell B. Max; Patrick McGrath; Henry J. McQuay; Steve Quessy; Bob A. Rappaport; Dennis A. Revicki; Margaret Rothman; Joseph W. Stauffer; Ola Svensson; Richard E. White; James Witter

2008-01-01

209

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.

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

2014-01-01

210

Clinical expertise in advanced practice nursing: a Canadian perspective  

Microsoft Academic Search

The need to articulate clearly the definition and description of advanced nursing practice is critical if the nursing profession is to move forward in the development of nursing practice. Concern arises when the core of advanced practice nursing is overshadowed with medical functions. Consensus on the educational preparation of advanced practice nurses, explication of the nature of clinical expertise in

Glenn Donnelly

2003-01-01

211

Clustering of Unhealthy Lifestyle Behaviors is Associated with a Low Adherence to Recommended Preventive Practices Among COPD Patients in Spain.  

PubMed

Abstract Aims: To analyze clustering of unhealthy lifestyle behavior and its relationship with non-adherence to recommended clinical preventive care services among Spanish COPD patients. Methods: Cross-sectional study including 2,575 COPD subjects from the 2006 Spanish National Health Survey (NHS) and 2009 European Health Survey for Spain (EHISS). Subjects were asked about the following recommended preventive practices: uptake of blood pressure (BP) measurement, lipid profile, influenza vaccination and dental examination. Lifestyle behaviors included: smoking status, physical activity, alcohol consumption and obesity. Logistic regression models were built to assess the association between clustering of unhealthy lifestyle and the uptake of preventive activities. Results: Blood pressure measurement in the previous 6 months and a blood lipid test in the last year had not been taken by 11.74% and 23.26% of the subjects, respectively, in 2006 NHS and by 11.16% and 16.33% of the subjects, respectively, in EHISS 2009. Then, 36.36% percent had not been vaccinated and 70.61% had not received dental examination in 2006 NHS and these percentages decreased to 27.33% and 66.22%, respectively, in 2009 EHISS. A higher number of unhealthy lifestyle behaviors increased the probability of not being vaccinated and not having a dental examination. Clustering of unhealthy lifestyle behaviors is linearly associated with a greater number of preventive measures unfulfilled. Conclusions: Compliance with healthy lifestyles and adherence to recommended clinical preventive services is under desirable levels among Spanish COPD patients. Patients with lifestyles considered as "worse" are those who also have lower uptake of recommended preventive activities. PMID:24568374

de Miguel-Díez, Javier; Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; Maestu, Luis Puente; Aparicio, Irene Jarana; Ramos, Alicia Oliva; López de Andrés, Ana; Carrasco-Garrido, Pilar

2014-08-01

212

Phase 0 clinical trials: recommendations from the Task Force on Methodology for the Development of Innovative Cancer Therapies.  

PubMed

The Methodology for the Development of Innovative Cancer Therapies (MDICT) task force has been established as an expert forum to develop practical guidance on the development of innovative anticancer agents, in particular targeted agents. The task force recently addressed the utility, design and application of Phase 0 clinical trials in anticancer drug development. It was concluded that the role of non-therapeutic Phase 0 trials is controversial for several reasons, including the lack of clinical benefit for participating patients. However, it was recognised that Phase 0 trials provide an opportunity to generate essential human pharmacokinetic and pharmacodynamic data earlier in the drug development process, which could be a major advantage in the design and decision making concerning further clinical development of an agent. Construction of a 'decision chart' was highly recommended to assist investigators and sponsors in determining whether an agent is suitable for evaluation in a Phase 0 trial. PMID:19091546

Kummar, Shivaani; Doroshow, James H; Tomaszewski, Joseph E; Calvert, A Hilary; Lobbezoo, Marinus; Giaccone, Giuseppe

2009-03-01

213

Phase 0 Clinical Trials: Recommendations from the Task Force on Methodology for the Development of Innovative Cancer Therapies  

PubMed Central

The Methodology for the Development of Innovative Cancer Therapies (MDICT) task force has been established as an expert forum to develop practical guidance on the development of innovative anticancer agents, in particular targeted agents. The task force recently addressed the utility, design, and application of Phase 0 clinical trials in anticancer drug development. It was concluded that the role of nontherapeutic Phase 0 trials is controversial for several reasons, including the lack of clinical benefit for participating patients. However, it was recognized that Phase 0 trials provide an opportunity to generate essential human pharmacokinetic and pharmacodynamic data earlier in the drug development process, which could be a major advantage in the design and decision making concerning further clinical development of an agent. Construction of a “decision chart” was highly recommended to assist investigators and sponsors in determining whether an agent is suitable for evaluation in a Phase 0 trial.

Kummar, Shivaani; Doroshow, James H.; Tomaszewski, Joseph E.; Calvert, A. Hilary; Lobbezoo, Marinus; Giaccone, Giuseppe

2010-01-01

214

Translating trial-based molecular monitoring into clinical practice: importance of international standards and practical considerations for community practitioners.  

PubMed

The success of tyrosine kinase inhibition of the BCR-ABL fusion gene with imatinib in the treatment of chronic myeloid leukemia (CML) has resulted in the use of molecular detection techniques for routine clinical management. Current clinical guidelines recommend the use of molecular testing of BCR-ABL transcript levels by quantitative real-time transcriptase polymerase chain reaction (qRT-PCR) every 3 to 6 months. However, qRT-PCR methods have not yet been standardized, particularly in the United States, where most patients are initially treated outside of academic practices. The lack of standard methods for molecular monitoring has resulted in the failure to follow National Comprehensive Cancer Network and European LeukemiaNet guideline recommendations and in the misinterpretation of test results. Standardization of molecular monitoring methods and adherence to guideline recommendations are important for optimal patient management. In this article, we provide an update on the current clinical trial results by using the molecular technique to monitor patient response. Current problems and efforts in standardizing the qRT-PCR technique and reporting are reviewed. We provide examples of potential problems of various reference laboratory reports and present recommendations for assessing molecular test results. These recommendations seem particularly important because nilotinib and dasatinib appear to have improved the molecular response in the initial treatment of CML. PMID:21723805

Akard, Luke P; Wang, Y Lynn

2011-10-01

215

Standardized Clinical Assessment And Management Plans (SCAMPs) Provide A Better Alternative To Clinical Practice Guidelines  

PubMed Central

Variability in medical practice in the United States leads to higher costs without achieving better patient outcomes. Clinical practice guidelines, which are intended to reduce variation and improve care, have several drawbacks that limit the extent of buy-in by clinicians. In contrast, standardized clinical assessment and management plans (SCAMPs) offer a clinician-designed approach to promoting care standardization that accommodates patients’ individual differences, respects providers’ clinical acumen, and keeps pace with the rapid growth of medical knowledge. Since early 2009 more than 12,000 patients have been enrolled in forty-nine SCAMPs in nine states and Washington, D.C. In one example, a SCAMP was credited with increasing clinicians’ rate of compliance with a recommended specialist referral for children from 19.6 percent to 75 percent. In another example, SCAMPs were associated with an 11–51 percent decrease in total medical expenses for six conditions when compared with a historical cohort. Innovative tools such as SCAMPs should be carefully examined by policy makers searching for methods to promote the delivery of high-quality, cost-effective care.

Farias, Michael; Jenkins, Kathy; Lock, James; Rathod, Rahul; Newburger, Jane; Bates, David W.; Safran, Dana G.; Friedman, Kevin; Greenberg, Josh

2014-01-01

216

[Autologous blood donation--good clinical practice and good recuperation practice].  

PubMed

Since October 1987, autologous blood donations have been performed in Bern and in 1994 reached a total of 946, representing 3% of all blood donations. This value is lower than the 4.9% for Switzerland as a whole. We report on the motivation and reasons of patients in favour of autologous blood donations and compare the results of 1989 with 1995. In the 6 years' period, the median patient's age increased from 54 to 63 years. The motivation for autologous blood donations changed from "routine surgical office" to "doctors". More than 50% of the patients mentioned the risk of acquiring an infectious disease, especially HIV, as the main reason for autologous blood donations. Labeling, testing or storage of autologous blood products of 37 out of 100 patients was incorrect, and in a another 20% an enquiry at the donation centres was needed to confirm the required quality of the autologous blood products. In 7 cases only one out of several blood bags was screened for viral diseases, and in 5 cases, unfortunately, none of the autologous blood products were tested for HIV or hepatitis B and C. Considering the negative cost-effectiveness of autologous blood transfusion, it is strongly recommended that the intrinsically low clinical benefit of autologous blood product should not be compromised by lack of good clinical practice and good manufacturing practice. PMID:8984605

Hauser, S P; Otth, C; Franscini, L; Nydegger, U E

1996-11-16

217

Social Work Clinical Practice in Family Medicine Centers: The Need for a Practice Model  

Microsoft Academic Search

This paper reports the findings of a recently conducted study of the clinical practice of social work in family medicine residency training centers in eight southeastern states. Findings indicate that the practice of social work is firmly entrenched and expanding in this primary health care setting. Analysis of the clinical practice of these workers shows that workers tend to select

Howard Hess

1985-01-01

218

Evidence-based practice, clinical simulations workshop, and intravenous medications: moving toward safer practice.  

PubMed

In an era of increased emphasis on medication safety practice, a gap exists in the translation of research to clinical practice for administering intravenous continuous infusion medications. An educational initiative was designed for medical-surgical nurses in a tertiary care center to standardize operational procedures in a clinical model focusing on evidence-based practice. PMID:19591361

Crimlisk, Janet T; Johnstone, Donald J; Sanchez, Gail M

2009-01-01

219

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

220

Pareto Fronts in Clinical Practice for Pinnacle  

SciTech Connect

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

Janssen, Tomas; Kesteren, Zdenko van; Franssen, Gijs; Damen, Eugène [Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands)] [Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Vliet, Corine van, E-mail: c.v.vliet@nki.nl [Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands)

2013-03-01

221

American Society of Clinical Oncology Recommendations on Adjuvant Chemotherapy for Stage II Colon Cancer  

Microsoft Academic Search

Purpose To address whether all medically fit patients with curatively resected stage II colon cancer should be offered adjuvant chemotherapy as part of routine clinical practice, to identify patients with poor prognosis characteristics, and to describe strategies for oncologists to use to discuss adjuvant chemotherapy in practice.

Al B. Benson; Deborah Schrag; Mark R. Somerfield; Alfred M. Cohen; Alvaro T. Figueredo; Patrick J. Flynn; Monika K. Krzyzanowska; Jean Maroun; Pamela McAllister; Eric Van Cutsem; Melissa Brouwers; Manya Charette; Daniel G. Haller

2004-01-01

222

Family meetings in palliative care: Multidisciplinary clinical practice guidelines  

PubMed Central

Background Support for family carers is a core function of palliative care. Family meetings are commonly recommended as a useful way for health care professionals to convey information, discuss goals of care and plan care strategies with patients and family carers. Yet it seems there is insufficient research to demonstrate the utlility of family meetings or the best way to conduct them. This study sought to develop multidisciplinary clinical practice guidelines for conducting family meetings in the specialist palliative care setting based on available evidence and consensus based expert opinion. Methods The guidelines were developed via the following methods: (1) A literature review; (2) Conceptual framework; (3) Refinement of the guidelines based on feedback from an expert panel and focus groups with multidisciplinary specialists from three palliative care units and three major teaching hospitals in Melbourne, Australia. Results The literature review revealed that no comprehensive exploration of the conduct and utility of family meetings in the specialist palliative care setting has occurred. Preliminary clinical guidelines were developed by the research team, based on relevant literature and a conceptual framework informed by: single session therapy, principles of therapeutic communication and models of coping and family consultation. A multidisciplinary expert panel refined the content of the guidelines and the applicability of the guidelines was then assessed via two focus groups of multidisciplinary palliative care specialists. The complete version of the guidelines is presented. Conclusion Family meetings provide an opportunity to enhance the quality of care provided to palliative care patients and their family carers. The clinical guidelines developed from this study offer a framework for preparing, conducting and evaluating family meetings. Future research and clinical implications are outlined.

Hudson, Peter; Quinn, Karen; O'Hanlon, Brendan; Aranda, Sanchia

2008-01-01

223

Comparison of appropriateness of cholesterol testing in general practice with the recommendations of national guidelines: an audit of patient records in 20 general practices  

Microsoft Academic Search

OBJECTIVE: To compare the profiles of those patients selected by general practitioners for measurement of serum cholesterol with the recommended profiles for opportunistic cholesterol testing described in the national practice guidelines published by the Dutch College of General Practitioners. DESIGN: Retrospective audit of general practitioners' records. MATERIALS: Practice records of 3577 adult patients systematically sampled from 20 general practices. MAIN

T van der Weijden; A Dansen; B J Schouten; J A Knottnerus; R P Grol

1996-01-01

224

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.

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

2013-01-01

225

[Nutrition in pregnancy - Practice recommendations of the Network "Healthy Start - Young Family Network"].  

PubMed

Nutrition, physical activity and lifestyle in pregnancy influence maternal and child health. The "Healthy start - Young Family Network" supported by the German Government with the national action plan IN FORM developed recommendations on nutrition in pregnancy. Folic acid supplements (400 µg/day) should be started before pregnancy and continue for at least the first trimester. Iodine rich foods and salt and an iodine supplement (100-150 µg/day) are recommended. Long-chain omega-3 fatty acids should be provided with ? 1 weekly portion of oily sea fish, or a DHA-supplement if regular fish consumption is avoided. Vitamin D supplementation is advisable unless there is regular exposure to sunlight. Iron supplements should be used based on medical history and blood testing. Vegetarian diets with nutritional supplements can provide adequate nutrition, but counselling is recommended. In contrast, a vegan diet is inadequate and requires additional micronutrient supplementation. For risk reduction of listeriosis and toxoplasmosis, raw animal foods, soft cheeses and packed fresh salads should be avoided; fresh fruit, vegetables and salad should be washed well and consumed promptly. Pregnant women should remain physically active and perform sports with moderate intensity. They should avoid alcohol, active and passive smoking. Up to 3 daily cups of coffee are considered harmless, but energy drinks should be avoided. Childhood allergy is not reduced by avoiding certain foods in pregnancy whereas oily sea fish is recommended. Health care professions should lead parents to health-promoting lifestyles. Subjects of part 1 of the article are practice recommendations on nutrition, on energy needs, micronutrient needs and body weight/weight gain in pregnancy. PMID:22692838

Koletzko, B; Bauer, C-P; Bung, P; Cremer, M; Flothkötter, M; Hellmers, C; Kersting, M; Krawinkel, M; Przyrembel, H; Rasenack, R; Schäfer, T; Vetter, K; Wahn, U; Weißenborn, A; Wöckel, A

2012-06-01

226

Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan Report of the Joint Clinical Decision Support Workgroup  

Microsoft Academic Search

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

JONATHAN M. TEICH; JEROME A. OSHEROFF; ERIC A. PIFER; DEAN F. SITTIG; ROBERT A. JENDERS

2005-01-01

227

Ingredients for Success: A Familial Cancer Clinic in an Oncology Practice Setting  

PubMed Central

Purpose: Genetic cancer risk assessment (GCRA) has become increasingly important in clinical cancer care. Almost all published information on genetic risk assessment has come from academic institutions. However, a majority of patients with cancer are seen in the community practice setting. Methods: We describe the evolution of a community oncology practice GCRA clinic. Results: Over a 10-year period, 445 patients were seen for a possible genetic cancer syndrome. This included 325 patients with family history of breast or ovarian cancer, 92 patients with family history of colorectal cancer or polyposis, and 28 families with another familial cancer predisposition. Fifty-three unique families with a genetic mutation were identified. Conclusion: A GCRA clinic can be incorporated into an oncology practice setting and can enhance the standard of care for the entire community. We present data reflecting a 10-year experience with such a clinic and provide recommendations for establishing a successful one.

Duncan, Paul R.; Lin, James T.

2011-01-01

228

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

229

Experience with a Family-Practice-Resident-Directed Obstetrical Clinic.  

ERIC Educational Resources Information Center

At Toledo Hospital, family practice residents have assumed responsibility for the normal obstetrics clinic. Specialty consultations are provided by the hospital's obstetrics residency program. A medical audit of the clinic indicates that the family practice residents obtained consultations and made referrals at the appropriate times. (JMD)

Hunter, Jerry L.; Snyder, Frank

1980-01-01

230

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

231

Children and Youth with Fetal Alcohol Spectrum Disorders: Summary of Intervention Recommendations after Clinical Diagnosis  

ERIC Educational Resources Information Center

Children with fetal alcohol spectrum disorders (FASDs) present with a wide range of developmental disabilities; however, clinical standards of care after a diagnosis are not well established. This retrospective review summarizes the types of intervention recommendations generated by an interdisciplinary FASD diagnostic team for 120 children ages…

Jirikowic, Tracy; Gelo, Julie; Astley, Susan

2010-01-01

232

Clinical Lactation Practice: 20 Years of Evidence  

Microsoft Academic Search

Lactation consultants depend on a vast multidisciplinary knowledge base to support their practices. To coincide with the 20-year anniversary of the International Lactation Consultant Association, the authors sought to highlight the knowledge base to demonstrate how practice has been affected. Using standard databases, they extracted English-language scientific literature related to breastfeeding and maternal and infant health outcomes; factors associated with

Karen Wambach; Suzanne Hetzel Campbell; Sara L. Gill; Joan E. Dodgson; Titilayo C. Abiona; M. Jane Heinig

2005-01-01

233

Burn disaster response planning in New York City: updated recommendations for best practices.  

PubMed

Since its inception in 2006, the New York City (NYC) Task Force for Patients with Burns has continued to develop a city-wide and regional response plan that addressed the triage, treatment, transportation of 50/million (400) adult and pediatric victims for 3 to 5 days after a large-scale burn disaster within NYC until such time that a burn center bed and transportation could be secured. The following presents updated recommendations on these planning efforts. Previously published literature, project deliverables, and meeting documents for the period of 2009-2010 were reviewed. A numerical simulation was designed to evaluate the triage algorithm developed for this plan. A new, secondary triage scoring algorithm, based on co-morbidities and predicted outcomes, was created to prioritize multiple patients within a given acuity and predicted survivability cohort. Recommendations for a centralized patient and resource tracking database, plan operations, activation thresholds, mass triage, communications, data flow, staffing, resource utilization, provider indemnification, and stakeholder roles and responsibilities were specified. Educational modules for prehospital providers and nonburn center nurses and physicians who would provide interim care to burn injured disaster victims were created and pilot tested. These updated best practice recommendations provide a strong foundation for further planning efforts, and as of February 2011, serve as the frame work for the NYC Burn Surge Response Plan that has been incorporated into the New York State Burn Plan. PMID:22964548

Leahy, Nicole E; Yurt, Roger W; Lazar, Eliot J; Villacara, Alfred A; Rabbitts, Angela C; Berger, Laurence; Chan, Carri; Chertoff, Laurence; Conlon, Kathe M; Cooper, Arthur; Green, Linda V; Greenstein, Bruce; Lu, Yina; Miller, Susan; Mineo, Frank P; Pruitt, Darrin; Ribaudo, Daniel S; Ruhren, Chris; Silber, Steven H; Soloff, Lewis

2012-01-01

234

Specialist outreach clinics in general practice: what do they offer?  

PubMed Central

BACKGROUND: Specialist outreach clinics in general practice, in which hospital-based specialists hold outpatient clinics in general practitioners' (GPs) surgeries, are one example of a shift in services from secondary to primary care. AIM: To describe specialist outreach clinics held in fundholding general practices in two specialties from the perspective of patients, GPs, and consultants, and to estimate the comparative costs of these outreach clinics and equivalent hospital outpatient clinics. METHOD: Data were collected from single outreach sessions in fundholding practices and single outpatient clinics held by three dermatologists and three orthopaedic surgeons. Patients attending the outreach and outpatient clinics, GPs from practices in which the outreach clinics were held, and the consultants all completed questionnaires. Managers in general practice and hospital finance departments supplied data for the estimation of costs. RESULTS: Initial patient questionnaires were completed by 83 (86%) outreach patients and 81 (75%) outpatients. The specialist outreach clinics sampled provided few opportunities for increased interaction between specialists and GPs. Specialists were concerned about the travelling time resulting from their involvement in outreach clinics. Waiting times for first appointments were shorter in some outreach clinics than in outpatient clinics. However, patients were less concerned about the location of their consultation with the specialist than they were about the interpersonal aspects of the consultation. There was some evidence of a difference in casemix between the dermatology patients seen at outreach and those seen at outpatient clinics, which confounded the comparison of total costs associated with the two types of clinic. However, when treatment and overhead costs were excluded, the marginal cost per patient was greater in outreach clinics than in hospital clinics for both specialties studied. CONCLUSION: The study suggests that a cautious approach should be taken to further development of outreach clinics in the two specialties studied because the benefits of outreach clinics to patients, GPs and consultants may be modest, and their higher cost means that they are unlikely to be cost-effective.

Black, M; Leese, B; Gosden, T; Mead, N

1997-01-01

235

Recommended Radiation Protection Practices for Low-Level Waste Disposal Sites  

SciTech Connect

The United States Nuclear Regulatory Commission contracted with Pacific Northwest Laboratory (PNL) to provide technical assistance in estsblishing operational guidelines, with respect to radiation control programs and methods of minimizing occupational radiation exposure, at Low-Level Waste (LLW) dis- posal sites. The PNL, through site visits, evaluated operations at LLW dis- posal sites to determine the adequacy of current practices in maintaining occupational exposures as low as is reasonably achievable (ALARA). The data sought included the specifics of: ALARA programs, training programs, external exposure control , internal exposure control , respiratory protection, survei 1 - lance, radioactive waste management, facilities and equipment, and external dose analysis. The results of the study indicated the following: The Radiation Protection and ALARA programs at the three commercial LLW disposal sites were observed to be adequate in scope and content compared to similar programs at other types of nuclear facilities. However, it should be noted that there were many areas that could be improved upon to help ensure the health and safety of the occupa- tionally exposed individuals. As a result, radiation protection practices were recommended with related rationales in order to reduce occupational exposures as far below specified radiation limits as is reasonably achievable. In addition, recommendations were developed for achieving occupational exposure ALARA under the Regulatory Requirements issued in 10 CFR Part 61.

D. E. Hadlock, C. D. Hooker, W. N. Herrington, R. L. Gilchrist

1983-12-01

236

78 FR 15931 - Sunshine Act Meeting; Request for Comments on Draft Evaluation of Recommended Practice on Fatigue...  

Federal Register 2010, 2011, 2012, 2013

...Recommended Practice on Fatigue Risk Management Systems for Personnel...follows: [D]evelop fatigue prevention guidelines...in voting members (management vs. union and other...that ``workplace fatigue is a risk to safe...

2013-03-13

237

Recommended childhood immunization schedule United States--1995. American Academy of Pediatrics and the Advisory Committee on Immunization Practices.  

PubMed Central

The need for a single childhood immunization schedule prompted the unification of previous vaccine recommendations made by the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP). In addition to presenting the newly recommended schedule for the administration of childhood vaccines, this article addresses the previous differences between the AAP and ACIP schedules, and provides the rationale for changing previous recommendations.

Gindler, J.

1995-01-01

238

Human Rabies Prevention, United States, 2008. Recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report, Vol. 57, No. RR-3, May 23, 2008.  

National Technical Information Service (NTIS)

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 Pr...

B. A. Slade J. K. Iskander K. Kretsinger K. R. Broder M. P. Joyce T. Tiwari T. V. Murphy

2008-01-01

239

Domestic refrigeration practices with emphasis on hygiene: analysis of a survey and consumer recommendations.  

PubMed

A Web-enabled survey was conducted to improve knowledge of home refrigeration practices of French consumers (n = 809), with an emphasis on hygiene, and this information was used to establish recommendations. The survey targeted a convenience sample of working people. Analysis of the survey responses revealed that efforts should be directed toward improvement of microbiological control measures. Only 37% of respondents made sure the temperature in their refrigerator was 4 degrees C or below. Only 37% of respondents reported that they systematically wrapped food. Sponges, known to be frequently highly contaminated, were used by 89% of the respondents to clean their refrigerator, which indicates the need to recommend disinfection of sponges before they are used for cleaning. Twenty-seven percent of respondents used sodium hypochlorite (bleach), but it was applied without previous cleaning (21% of the users) or in the commercial concentrated form (7% of the users). The permanent presence of water condensation on the shelves was noted by 2% of respondents, suggesting imperfect closure of the door, with a consequence of higher energy consumption and water available for microbial circulation and growth. Thus, an important recommendation is to check the door gaskets and to ensure the tight closure of the door. Seventy percent of the respondents declared that they never put warm or hot food in the refrigerator. However, many people, when orally questioned, acknowledged that they leave dishes at ambient temperature overnight before putting them in the refrigerator. It therefore is essential to recommend that perishable food not be left for more than 2 h at ambient temperature. PMID:18810875

Lagendijk, Emmanuelle; Asséré, Adrien; Derens, Evelyne; Carpentier, Brigitte

2008-09-01

240

Recommendations Regarding Exercise During Pregnancy Made by Private/Small Group Practice Obstetricians in the USA  

PubMed Central

For pregnant women, exercise offers numerous benefits with little risk. The American College of Obstetricians and Gynecologists (ACOG) endorses aerobic exercise for all pregnant women without medical or obstetric complications. Nonetheless, only a small percentage of pregnant women meet exercise guidelines. We investigated the extent to which obstetricians (Obs) in private or small group practice in the USA actively recommend exercise to their pregnant patients. Surveys were sent to 300 Obs in 33 American cities, of which 83 were returned. 52% of respondents reported discussing exercise with 81-100% of their patients. Using a 7- point Likert scale (1 = never, 7 = always), Obs reported recommending aerobic exercise more often than resistance exercise (5.6 ± 1.5 versus 3.8 ± 1.6, p < 0.001). Obs do not routinely advise sedentary women to initiate exercise during pregnancy (mean 4.4 ± 1.8). Of the 67% of Obs who specify a target exercise duration, 95% recommend ? 16 min, consistent with ACOG guidelines. However, 62% of Obs reported that they regularly specify a maximum heart rate, even though ACOG guidelines do not. Half of respondents indicated that they advise a reduction in exercise load during the third trimester, even for uncomplicated pregnancies. Respondents’ opinions were mixed regarding the extent to which exercise reduces gestational diabetes or preeclampsia risk and they believe more research on exercise during pregnancy is needed. Half of Obs do not routinely discuss exercise. The majority is hesitant to advise sedentary gravidae to start exercise and is conservative with respect to exercise intensity. Action may be needed to convince more Obs to routinely recommend exercise to all healthy patients. Key Points 52% of surveyed obstetricians discuss exercise with 81-100% of pregnant patients. 68% of surveyed obstetricians do not regularly advise sedentary pregnant women to initiate an exercise program. 62% of surveyed obstetricians recommend pregnant patients not exceed a maximum heart rate during exercise, even though ACOG guidelines do not specify a maximum heart rate. Approximately half of surveyed obstetricians recommend a reduction in exercise load during the third trimester, even though ACOG guidelines do not. Regular exercise was thought by surveyed obstetricians to have some potential for reducing the risk of gestational diabetes, but little effect on risk of preeclampsia.

Entin, Pauline L.; Munhall, Kelly M.

2006-01-01

241

Sexually Transmitted Diseases. Clinical Practice Guidelines.  

National Technical Information Service (NTIS)

Table of Contents: Preface; Acknowledgements; Routine Evaluation of STD Clinic Patients; Gonorrhea; Chlamydial infection; Nongonococcal Urethritis; Acute Epididymitis; Vaginal infections; Mucopurulent cervicitis; Pelvic Inflammatory Disease; Genital herpe...

2003-01-01

242

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; Renda Soylemez, Wiener

2014-05-01

243

Statistics for clinical nursing practice: an introduction.  

PubMed

Difficulty in understanding statistics is one of the most frequently reported barriers to nurses applying research results in their practice. Yet the amount of nursing research published each year continues to grow, as does the expectation that nurses will undertake practice based on this evidence. Critical care nurses do not need to be statisticians, but they do need to develop a working knowledge of statistics so they can be informed consumers of research and so practice can evolve and improve. For those undertaking a research project, statistical literacy is required to interact with other researchers and statisticians, so as to best design and undertake the project. This article is the first in a series that guides critical care nurses through statistical terms and concepts relevant to their practice. PMID:18926715

Rickard, Claire M

2008-11-01

244

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

245

Assessment of Clinical Skills in Medical Practice  

ERIC Educational Resources Information Center

The introduction of a clinical skills examination (CSE) to Step 2 of the U.S. Medical Licensing Examination (USMLE) has focused attention on the design and delivery of large-scale standardized tests of clinical skills and raised the question of the appropriateness of evaluation of these competencies across the span of a physician's career. This…

Scoles, Peter V.; Hawkins, Richard E.; LaDuca, Anthony

2003-01-01

246

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

247

An investigation of nurse educator's perceptions and experiences of undertaking clinical practice.  

PubMed

Educational policy (DOH, 1999. Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare. Department of Health, London; UKCC, 1999. Fitness for Practice. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London; Nursing and Midwifery Council, 2006. Standards to support learning and assessment in practice. Nursing and Midwifery Council, London) and current nursing literature (Griscti, O., Jacono, B., Jacono, J., 2005. The nurse educator's clinical role. Journal of Advanced Nursing 50 (1), 84-92; Owen, S., Ferguson, K., Baguley, I., 2005. The clinical activity of mental health nurse lecturers. Journal of Psychiatric and Mental Health Nursing 12, 310-316), place increasing emphasis on nurse educators undertaking clinical practice to facilitate their clinical confidence and competence. This study investigated nurse educators' perceptions and experiences of undertaking clinical practice. A qualitative design and descriptive, exploratory approach were used. A purposive sample of 11 nurse educators in one nursing department, took part in two focus group interviews, one with 5 and the other with 6 respondents, to identify and discuss their perceptions and experiences of undertaking clinical practice. A process of thematic content analysis revealed three broad themes relating to the meaning and importance of clinical practice, perceived benefits and barriers which are examined and discussed. The paper concludes that despite policy recommendations, barriers highlighted in this study such as insufficient time, heavy workload and a lack of valuing of the clinical role have been raised over the past few decades. The effect of undertaking clinical practice, particularly on the quality of teaching is argued to be valuable armoury in the battle to secure sufficient resources to support engagement in clinical practice. Financial and organisational commitment; valuing of clinical practice and research evidence are crucial to realising clinical practice for nurse educators. Alternative interpretations of what may constitute the clinical role such as joint research projects and supporting and supervising students are offered, which need to be assessed against clear, specific and realistic aims for the clinical role of the nurse educator. PMID:18586358

Williams, Angela; Taylor, Cathy

2008-11-01

248

Formoterol in clinical practice—safety issues  

Microsoft Academic Search

While short-acting ?2-agonists are seen as the cornerstone of treatment as relief medication for asthma, current guidelines recommend long-acting ?2-agonists as maintenance therapy in combination with inhaled corticosteroids in patients with moderate to severe asthma, poorly controlled on present treatment. Although evidence has shown that formoterol, with its fast- and long-acting profile, is effective when used both as regular and

K. F. Rabe

2001-01-01

249

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

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

2014-08-01

250

Accelerating translation of physical activity and cancer survivorship research into practice: recommendations for a more integrated and collaborative approach.  

PubMed

Physical activity has been deemed safe and effective in reducing many negative side effects of treatment for cancer survivors and promoting better overall health. However, most of this research has focused on highly controlled randomized trials and little of this research has been translated into care or policy for survivors. The purpose of the present article is to present a research agenda for the field to accelerate the dissemination and implementation of empirically supported physical activity interventions into care. We provide rationale for the role of basic, behavioral, clinical implementation, and population scientists in moving this science forward and call for a more coordinated effort across different phases of research. In addition, we provide key strategies and examples for ongoing and future studies using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework and pose recommendations for collaborations between researchers and stakeholders to enhance the integration of this research into policy and practice. Overall, we recommend that physical activity and cancer survivorship research use additional study designs, include relevant stakeholders, and be more collaborative, integrated, contextual, and representative in terms of both setting and participants. Cancer Epidemiol Biomarkers Prev; 23(5); 687-99. ©2014 AACR. PMID:24599577

Phillips, Siobhan M; Alfano, Catherine M; Perna, Frank M; Glasgow, Russell E

2014-05-01

251

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.

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

2012-01-01

252

Clinical Practice Guideline for Vitamin D.  

National Technical Information Service (NTIS)

Vitamin D and its metabolites have clinical significance because they play a critical function in calcium homeostasis and bone metabolism. Although not all of the pathologic mechanisms have been adequately described, vitamin D insufficiency and deficiency...

W. J. Tarver

2013-01-01

253

Sjögren-Larsson syndrome in clinical practice.  

PubMed

This review article gives a state-of-the-art synopsis of current pathophysiological concepts in Sjögren-Larsson syndrome (SLS) mainly based upon original research data of the authors in one of the world's largest clinical SLS study cohorts. Clinical features are discussed in order of appearance, and diagnostic tests are set out to guide the clinician toward the diagnosis SLS. Furthermore, current and future treatment strategies are discussed to render a comprehensive review of the topic. PMID:22833178

Fuijkschot, Joris; Theelen, Thomas; Seyger, Marieke M B; van der Graaf, Marinette; de Groot, Imelda J M; Wevers, Ron A; Wanders, Ronald J A; Waterham, Hans R; Willemsen, Michèl A A P

2012-11-01

254

[Clinical practice guideline on bipolar disorder: drug and psychosocial therapy. Asociación Española de Neuropsiquiatría].  

PubMed

Bipolar disorder is a chronic and recurrent mood disorder, which may severely impact on the patient's global functioning. It has been estimated that approximately 1.6% of the population is affected. A long delay in diagnosis and an excessive disparity in the treatment of these patients have been detected. Within the Quality Plan of the Spanish National Health System, one of the key strategies is to improve clinical practice through the development and use of clinical practice guidelines (CPGs). In this context, the CPG on bipolar disorder arises from an agreement between the Ministry of Health and the University of Alcalá, involving the Spanish Association of Neuropsychiatry as developer and project manager. Its main objective is to develop recommendations on the diagnostic, therapeutic and rehabilitative care for patients with bipolar disorder, primarily applicable in the public mental health services. In this paper we present the main recommendations on pharmacological and psychosocial interventions in bipolar disorder. PMID:23891130

Bravo, Maria Fe; Lahera, Guillermo; Lalucat, Lluis; Fernández-Liria, Alberto

2013-10-01

255

Assay formats: Recommendation for best practices and harmonization from the global bioanalysis consortium harmonization team.  

PubMed

As part of the GBC (Global Bioanalysis Consortium), the L3 assay format team has focused on reviewing common platforms used to support ligand binding assays in the detection of biotherapeutics. The following review is an overview of discussions and presentations from around the globe with a group of experts from different companies to allow an international harmonization of common practices and suggestions for different platforms. Some of the major platforms include Gyrolab, Erenna, RIA, AlphaLISA, Delfia, Immuno-PCR, Luminex, BIAcore, and ELISAs. The review is meant to support bioanalysts in taking decisions between different platforms depending on the needs of the analyte with a number of recommendations to help integration of platforms into a GLP environment. PMID:24343771

Dudal, Sherri; Baltrukonis, Daniel; Crisino, Rebecca; Goyal, M Jaya; Joyce, Alison; Osterlund, Karolina; Smeraglia, John; Taniguchi, Yoshitaka; Yang, Jihong

2014-03-01

256

IT Governance Practices in Small and Medium-Sized Enterprises: Recommendations from an Empirical Study  

NASA Astrophysics Data System (ADS)

Much has been learned through IT governance research about the nature of IT-related decisions, the location of decision rights for these decisions, and governance mechanisms applied to facilitate associated decision processes in large organisations. Our knowledge about IT governance structures in small and medium-sized enterprises (SME), on the other hand, is quite limited. Adopting a qualitative and inductive approach, this study examines the nature and influence of IT governance in SMEs through interviews with executives from three SMEs. Our results demonstrate that IT decision authority was centralized in all three SMEs but that senior management involvement in governance procedures and communication practices about governance policies were observed to explain differences in these organisations’ IT use. We propose recommendations based on the findings of this study.

Huang, Rui; Zmud, Robert W.; Price, R. Leon

257

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

258

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.

2013-01-01

259

Hip protectors: recommendations for conducting clinical trials—an international consensus statement (part II)  

Microsoft Academic Search

Introduction  While hip protectors are effective in some clinical trials, many, including all in community settings, have been unable to\\u000a demonstrate effectiveness. This is due partly to differences in the design and analysis. The aim of this report is to develop\\u000a recommendations for subsequent clinical research.\\u000a \\u000a \\u000a \\u000a Methods  In November of 2007, the International Hip Protector Research Group met to address barriers to

I. D. Cameron; S. Robinovitch; S. Birge; P. Kannus; K. Khan; J. Lauritzen; J. Howland; S. Evans; J. Minns; A. Laing; P. Cripton; S. Derler; D. Plant; D. P. Kiel

2010-01-01

260

A Postdoctoral Fellowship in Industrial Clinical Pharmacy Practice.  

ERIC Educational Resources Information Center

A postdoctoral pharmacy fellowship is described that provides training in industrial clinical pharmacy practice and related tasks associated with the development of new pharmaceuticals, through experience in industrial and hospital settings and in research projects. (MSE) PUBTYPE[141

Barone, Joseph; And Others

1985-01-01

261

Determination of vancomycin pharmacokinetics in neonates to develop practical initial dosing recommendations.  

PubMed

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; Walker, Sandra A N; Iaboni, Dolores C; Walker, Scott E; Elligsen, Marion; Dunn, Michael S; Allen, Vanessa G; Simor, Andrew

2014-05-01

262

Developing Cultural Proficiency in Clinical Practice.  

ERIC Educational Resources Information Center

This paper suggests that in an increasingly multicultural world, cultural competence requires that racism, power, oppression, and privilege be fully acknowledged and addressed to maximize the effectiveness of clinical interventions. Psychotherapists must learn to appropriately address racial or cultural differences in the therapy room. In order to…

Mock, Matthew R.

263

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

264

Aberrometry in clinical practice: Case series  

Microsoft Academic Search

The application of aberrometry in the field of refractive surgery has led to the availability of several methods of measuring ocular aberrations in a clinical setting. A case series from four patients diagnosed with corneal thinning disorders is described in this paper (keratectasia following refractive surgery, pellucid marginal degeneration, forme fruste keratoconus or keratoconus). These cases demonstrate how aberrometry can

Hema Radhakrishnan; Clare O’Donnell

2008-01-01

265

Hemochromatosis: genetic testing and clinical practice.  

PubMed

The availability of a facile treatment for hemochromatosis renders early diagnosis of iron overload syndromes mandatory, and in many instances genetic testing allows identification of individuals at risk of developing clinical disease before pathologic iron storage occurs. Numerous proteins implicated in iron homeostasis have recently come to light, and defects in the cognate genes are associated with iron storage. Although most adult patients with hereditary iron overload are homozygous for the C282Y mutation of the HFE gene, an increasing number with hereditary iron storage have an HFE genotype not characteristic of the disease. Heterozygosity for mutations in the gene encoding ferroportin 1 (FPN1) is probably the second most common genetic cause of hereditary iron storage in adults; here the primarily affected cell is the macrophage. Rare defects, including mutations in the transferrin receptor 2 (TFR2) gene, have also been identified in pedigrees affected with "non-HFE hemochromatosis." Homozygous mutations in the newly identified genes encoding hemojuvelin (HFE2) and hepcidin (HAMP) cause juvenile hemochromatosis. At the same time, heterozygosity for mutations in these genes can modify the clinical expression of iron storage in patients predisposed to iron storage in adult life. Hemochromatosis might thus be considered as a polygenic disease with strong environmental influences on its clinical expression. As our mechanistic understanding of iron pathophysiology improves, our desire to integrate clinical decision making with the results of laboratory tests and molecular analysis of human genes poses increasing challenges. PMID:16234038

Zoller, Heinz; Cox, Timothy M

2005-10-01

266

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

267

[Evaluation of infant feeding practices after implementation of recommendations for coeliac disease prophylaxis - pilot study].  

PubMed

Recent research data concerning the risk of coeliac disease confirm that introduction of food containing gluten during breast-feeding not later than 6 months of life is justified. According to ESPGHAN and EFSA introduction of solid foods in the diet of infants between 4-6 months of age is safe. Aim of study: Evaluation of feeding practices in healthy full-term infants after implementation of the recommendations of coeliac disease prevention. Material and methods: Conducted analysis concerned 54 healthy full-term infants, living in Warsaw, aged 6 to 12 months. Of these, 27 children were exclusively breastfed for the first 6 months of life and 27 children were non-breastfed. The differences between selected parameters of nutritional status and diets of breastfed and nonbreastfed infants were evaluated by using t-Student test. Relations between quantitative variables were assessed by chi2 test. Results: Products containing gluten were introduced into the breastfed children's diet in the 5th month of life in 22% of studied subgroup, in the 6th month - in 15%, in the 7th or 8th month - in 30%, between 9th and 11th month - in 22% and 11% of these children have not received food containing gluten in the first year of life. In the group of non-breastfed infants 15% received products with gluten before 5th month of life, 15% in 5th month, 11% at age of 6 months, 22% between 7th and 8th month, 15% in 11th month and 22% of children have not received food containing gluten in the first 12 months of life. An average daily intake of foods with varying content of gluten amounted to 55 g in breastfed infants and 70.5 g in non-breastfed infants (p <0.05). Conclusions: In the pilot study it was found out that nutritional recommendations concerning prophylaxis of coeliac disease were not implemented correctly by the majority of mothers of studied infants. Products containing gluten were introduced to the infant's diet too early or too late and mostly in larger quantities than it was recommended. Due to the small number of studied children it is important to carry out the investigation on a larger sample. At the same time it is necessary to introduce more effective methods of implementing nutritional recommendations concerning prophylaxis of celiac disease. PMID:22516707

Kosi?ska, Hanna; Rowicka, Gra?yna; Weker, Halina

2011-01-01

268

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

269

Quality control and the practice of clinical psychology  

Microsoft Academic Search

Because of current health care reforms, quality control, accountability, and cost-effectiveness have become important issues in the practice of clinical psychology. It is imperative that practicing clinicians begin to evaluate their services to assess whether they demonstrate high quality and cost-effectiveness, as well as a continued commitment to qualify improvement. Deming's (1986) approach to quality control is discussed as a

Elizabeth A. Yeater; P GRACZYK

1998-01-01

270

Bridging the Gap between Ethics and Clinical Practice.  

ERIC Educational Resources Information Center

Describes attitude sets characterized as ethics as intuition, ethics as foreign language, and ethics as irrelevant to practice among nurses and physicians and the consequences they engender. Addresses strategies to bridge the gap between ethics knowledge and clinical practice, including interdisciplinary ethics education. (JOW)

Hamric, Ann B.

2002-01-01

271

Evidence-Based Diagnosis: Incorporating Diagnostic Instruments into Clinical Practice  

ERIC Educational Resources Information Center

This article is intended to serve as a practical guide for practitioners interested in incorporating evidence-based diagnosis (EBD) instruments into their clinical practices to refine the diagnostic process. Three measures are used to illustrate this process, the DISC-IV (Shaffer et al., 2000), the Schedule for Affective Disorders and…

Doss, Amanda Jensen

2005-01-01

272

Patient Safety Culture: A Review of the Nursing Home Literature and Recommendations for Practice  

PubMed Central

Patient safety culture (PSC) is a critical factor in creating high-reliability health-care organizations. Most PSC research studies to date have been conducted in acute care settings; however, nursing home studies have recently begun to appear in the literature. Nursing homes differ from hospitals in a number of ways, including the population they serve, the medical model of care, and having the vast majority of direct care provided by non-licensed certified nursing assistants. Research has shown that nursing home PSC differs in important ways from PSC in acute care institutions. Recent PSC studies conducted in nursing homes and related quality and safety research can guide recommendations for nursing homes wishing to evaluate their own PSC. Relationships between PSC measurement, quality improvement, and workforce issues are potentially important and may influence clinical outcomes.

Bonner, Alice F.; Castle, Nicholas G.; Perera, Subashan; Handler, Steven M.

2010-01-01

273

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.

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

2013-01-01

274

What does consent mean in clinical practice?  

PubMed

Nurses need to be aware of the importance of patient consent in relation to issues such as confidentiality or research participation. They also need to understand the importance of consent to care. This article, the second in a two-part series, focuses on consent to treatment and other therapeutic interventions, such as assistance with personal care. It considers what valid consent means in practice, and explores the conditions that must be satisfied for consent to both uphold a patient's right to autonomy and provide a sound legal defence.lthoug PMID:24371881

Taylor, Helen

275

Dabigatran: will it change clinical practice?  

PubMed

Dabigatran (Pradaxa) is a new oral anticoagulant approved in the United States for the primary prevention of stroke and systemic embolization in patients with nonvalvular atrial fibrillation. It offers clinicians an alternative to warfarin (Coumadin), and it has received considerable interest because of its convenience of use, clinical efficacy, and safety profile. However, it is more expensive, and this may limit its widespread use. PMID:21968472

Wartak, Siddharth A; Bartholomew, John R

2011-10-01

276

Getting ready for patient-reported outcomes measures (PROMs) in clinical practice.  

PubMed

Patient-reported outcome measures (PROMs) include reports and ratings provided by patients or their proxies about their health, functioning, health behaviours and quality of care. PROMs reflect the patient perspective and increase the comprehensiveness of outcome measurement in clinical research. There is growing interest in using PROMs in clinical practice: for screening, monitoring and improving communication at the individual level; and to aid in decision-making, monitor populations and assess quality in the aggregate. For use in clinical practice, the authors draw an analogy to getting to the prom (a North American graduation dance). Whom to go with? They recommend seeking a group of partners and developing methods and standards with national and international groups. The authors advocate for incentives to encourage broad participation. What to wear? They suggest selecting existing, well-tested PROMs and highlight the ability of dynamic questionnaires to provide tailored assessments. How to get there? The authors recommend web-based formatting of measures and results, using their system, PatientViewpoint, as an example. How to get the most out of the experience? They discuss the variety of applications of PROMs data and recommend providing clinicians with actions that they can take to mitigate problems in non-clinical domains. PMID:22543293

Wu, Albert W; Snyder, Claire

2011-01-01

277

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.

2009-01-01

278

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.

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

2010-01-01

279

An overview of candesartan in clinical practice  

PubMed Central

Hypertension is a major risk factor for coronary heart disease, stroke, heart failure and renal disease. The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure 7 defined hypertension as a blood pressure of more than 140/90 mmHg and recommended to initiate treatment with a two-drug combination for stage 2 hypertension (blood pressure of 160-179/100-109 mmHg). The need for drug combinations is clear from a patient and physician perspective as they provide more effective blood pressure lowering, reduce pill burden, improve compliance and decrease hypertension-related morbidity and mortality. Angiotensin II receptor blocker therapy has been proven to be well tolerated and effective in the management of hypertension, chronic heart failure with left ventricular dysfunction and the prevention and progression of diabetic renal disease. Blockers of the renin-angiotensin system are an important component of antihypertensive combination therapy. Thiazide-type diuretics are usually added to increase the blood pressure lowering efficacy. Fixed drug-drug combinations of both principles, such as candesartan/hydrochlorothiazide, are highly effective in lowering blood pressure while providing improved compliance, a good tolerability and largely neutral metabolic profile. In this article, we review the literature for the role of candesartan-based therapy for hypertension, stroke, diabetes mellitus and heart failure.

Khawaja, Zeeshan; Wilcox, Christopher S

2011-01-01

280

PET/CT Standardized Uptake Values (SUVs) in Clinical Practice and Assessing Response to Therapy  

PubMed Central

The use of standardized uptake values (SUVs) is now common place in clinical FDG-PET/CT oncology imaging, and has a specific role in assessing patient response to cancer therapy. Ideally, the use of SUVs removes variability introduced by differences in patient size and the amount of injected FDG. However, in practice there are several sources of bias and variance that are introduced in the measurement of FDG uptake in tumors and also in the conversion of the image count data to SUVs. The overall imaging process is reviewed and estimates of the magnitude of errors, where known, are given. Recommendations are provided for best practices in improving SUV accuracy.

Kinahan, Paul E.; Fletcher, James W.

2010-01-01

281

Utility of Structured Care Approaches in Education and Clinical Practice.  

ERIC Educational Resources Information Center

Describes structured care approaches, such as protocols, clinical pathways, and algorithms, which are being used increasingly to organize clinical knowledge and guide patient care. Reviews the types of structured care approaches available to the clinician and explores the value of structured care approaches in practice and education. (Contains 32…

O'Neill, Eileen S.; Dluhy, Nancy M.

2000-01-01

282

The Development of Psychotherapists' Theoretical Orientation and Clinical Practice.  

ERIC Educational Resources Information Center

Outlines a model of the development of therapists' theoretical orientation and clinical practice, based on the integration of data from 161 Portuguese therapists with the extant literature. Indicates that therapists from different persuasions appear to emphasize different variables. Indicates clinical experience plays a central role, and…

Vasco, Antonio Branco; Dryden, Windy

1994-01-01

283

Clinical Implications of Numeracy: Theory and Practice  

Microsoft Academic Search

Background  Low numeracy is pervasive and constrains informed patient choice, reduces medication compliance, limits access to treatments,\\u000a impairs risk communication, and affects medical outcomes; therefore, it is incumbent upon providers to minimize its adverse\\u000a effects.\\u000a \\u000a \\u000a \\u000a Purpose  We provide an overview of research on health numeracy and discuss its implications in clinical contexts.\\u000a \\u000a \\u000a \\u000a Conclusions  Low numeracy cannot be reliably inferred on the basis of

Wendy Nelson; Valerie F. Reyna; Angela Fagerlin; Isaac Lipkus; Ellen Peters

2008-01-01

284

SEOM clinical guidelines for using molecular markers in clinical practice  

Microsoft Academic Search

Nowadays, treatment selection for most types of cancers is based on anatomical, histological and clinical criteria, which\\u000a are defined by the selection criteria used in registration phase III trials. However, different cancers present distinct molecular\\u000a features, so the current approach results in a lack of specificity of cancer therapy, which is associated with decreased efficacy\\u000a and unnecessary toxicities and costs.

Virginia Arrazubi; Roberto Pazo; Dolores Isla; José Luis Pérez Gracia

2011-01-01

285

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.

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

2012-01-01

286

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.

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

2013-01-01

287

Potential Uses of Probiotics in Clinical Practice  

PubMed Central

Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. There is now mounting evidence that selected probiotic strains can provide health benefits to their human hosts. Numerous clinical trials show that certain strains can improve the outcome of intestinal infections by reducing the duration of diarrhea. Further investigations have shown benefits in reducing the recurrence of urogenital infections in women, while promising studies in cancer and allergies require research into the mechanisms of activity for particular strains and better-designed trials. At present, only a small percentage of physicians either know of probiotics or understand their potential applicability to patient care. Thus, probiotics are not yet part of the clinical arsenal for prevention and treatment of disease or maintenance of health. The establishment of accepted standards and guidelines, proposed by the Food and Agriculture Organization of the United Nations and the World Health Organization, represents a key step in ensuring that reliable products with suitable, informative health claims become available. Based upon the evidence to date, future advances with single- and multiple-strain therapies are on the horizon for the management of a number of debilitating and even fatal conditions.

Reid, Gregor; Jass, Jana; Sebulsky, M. Tom; McCormick, John K.

2003-01-01

288

Biosimilar safety considerations in clinical practice.  

PubMed

Biologics are important treatments for a number of cancers. Patents for several biologics will expire over the next decade, removing a barrier to the development and commercialization of biosimilars. As biologics differ from small-molecule drugs due to their size and complexity, multifaceted manufacturing process, and their potential for immunogenicity, biosimilars cannot be considered "generic versions" of currently approved biologics. In highly regulated markets, biosimilars can be authorized only if they are demonstrated to be highly similar to the original drug from an analytical and clinical perspective. Any differences must be justified and shown to have no clinically meaningful effect on the safety and efficacy of the biosimilar. The European Medicines Agency has approved a number of biosimilars and the recent approval of the biosimilar infliximab monoclonal antibody is another regulatory milestone. This article will provide context regarding key safety issues addressed in biosimilar development, approval, and delivery, as well as inform oncologists on matters of safety to consider when prescribing biosimilars. Pertinent issues about safety from countries or regions where biosimilars are currently in use also will be reviewed. PMID:24560025

Choy, Edwin; Jacobs, Ira Allen

2014-02-01

289

The illusion of futility in clinical practice.  

PubMed

The claim that a treatment is futile is often used to justify a shift in the physician's ethical obligations to patients. In clinical situations in which non-futile treatments are available, the physician has an obligation to discuss therapeutic alternatives with the patient. By contrast, a physician is under no obligation to offer, or even to discuss, futile therapies. This shift is supported by moral reasoning in ancient and modern medical ethics, by public policy, and by case law. Given this shift in ethical obligations, one might expect that physicians would have unambiguous criteria for determining when a therapy is futile. This is not the case. Rather than being a discrete and definable entity, futile therapy is merely the end of the spectrum of therapies with very low efficacy. Ambiguity in determining futility, arising from linguistic errors, from statistical misinterpretations, and from disagreements about the goals of therapy, undermines the force of futility claims. Decisions to withhold therapy that is deemed futile, like all treatment choices, must follow both clinical judgments about the chance of success of a therapy and an explicit consideration of the patient's goals for therapy. Futility claims rarely should be used to justify a radical shift in ethical obligations. PMID:2741985

Lantos, J D; Singer, P A; Walker, R M; Gramelspacher, G P; Shapiro, G R; Sanchez-Gonzalez, M A; Stocking, C B; Miles, S H; Siegler, M

1989-07-01

290

[Hand-held echocardiography in clinical practice].  

PubMed

In the last years the industry has created echocardiographic portable machines of reduced size, available for a growing number of operators. After the first experiences of the '70s, hand-held echocardiography (HHE) is earned interesting commercial positions. The transportability of these machines allows to perform examinations outside the echo-lab and provides diagnostic information in heterogeneous locations such as intensive care unit, emergency room and outpatient structures, at the bedside and even in ambulance. HHE can be useful for detection of several pathologies including aortic aneurysms and left ventricular hypertrophy, regional wall motion abnormalities, pericardial and pleural effusion. To date, four main kinds of HHE can be distinguished: a first, high-cost variety, including miniaturized machines, equipped with instrumentations of standard echocardiography and even new softwares for tissue Doppler and myocardial contrast echocardiography; a second kind of machines of high level but not miniaturized; a third (intermediate level and low cost), and a fourth one (basic level and very low cost), including "cardioscopes" corresponding to the ultrasound stethoscope, able to complete efficaciously the clinical examination. The introduction of HHE opens controversy about its diagnostic accuracy, the opportunity to establish the clinical scenario where it should be utilized and the identification of the potential users and the needed competence level. Preliminary experiences show the possibility of improving and anticipating the diagnosis of several cardiac diseases but also the need to plan specific ultrasound training to avoid inappropriate use of HHE. PMID:15934422

Mondillo, Sergio; Galderisi, Maurizio

2005-05-01

291

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

292

Management of subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex (TSC): Clinical recommendations.  

PubMed

Subependymal giant cell astrocytoma (SEGA) is a type of brain tumour that develops in 10-15% of individuals with tuberous sclerosis complex (TSC). SEGAs can be unilateral or bilateral, developing from benign subependymal nodules (hamartomas) located near the foramen of Monro. These are usually slow-growing, glialneuronal tumours that develop within the first 2 decades of life. Traditionally, the management of SEGA involved monitoring using periodic neuroimaging, and surgical resection of tumours that exhibited growth and/or caused clinical signs of intracranial hypertension. Recent clinical research has demonstrated that mammalian target of rapamycin (mTOR) inhibitors can induce partial regression of SEGA associated with TSC and so might provide an acceptable alternative to neurosurgery for these tumours. This report summarizes the clinical recommendations for the management of SEGA made by a panel of European experts in March 2012. Current treatment options and outstanding questions are outlined. PMID:23391693

Jó?wiak, Sergiusz; Nabbout, Rima; Curatolo, Paolo

2013-07-01

293

Aberrometry in clinical practice: case series.  

PubMed

The application of aberrometry in the field of refractive surgery has led to the availability of several methods of measuring ocular aberrations in a clinical setting. A case series from four patients diagnosed with corneal thinning disorders is described in this paper (keratectasia following refractive surgery, pellucid marginal degeneration, forme fruste keratoconus or keratoconus). These cases demonstrate how aberrometry can be used to help in the differential diagnosis of patients with corneal thinning disorders, although the standard polynomial fitting for aberrometry data may fail in some patients. Measurement of ocular aberrations can provide an improved description of the optical quality of the eye and hence can be useful to the clinician in evaluating eyes with optical abnormalities. PMID:18602858

Radhakrishnan, Hema; O'Donnell, Clare

2008-08-01

294

Setting practice standards for palliative care in Lebanon--recommendations of the Subcommittee on Practice --National Committee for Pain Control and Palliative Care.  

PubMed

Palliative care is in the early stages of development in Lebanon. The National Committee for Pain Control and Palliative Care (NCPCPC) was established under the Ministry of Public Health to work towards the development of palliative care. This paper summarizes the recommendations of the Subcommittee on Practice of the NCPCPC regarding hospital standards and provider competencies in palliative care. The authors propose actions that should be taken to implement these recommendations to help move palliative care forward in the country. PMID:24428073

Osman, Hibah; Abboud, Miguel; El Zein, Lama; Ghusn, Husam; Hanna, Janane; Kanazi, Ghassan

2013-01-01

295

Best practices for extractables and leachables in orally inhaled and nasal drug products: an overview of the PQRI recommendations.  

PubMed

The Product Quality Research Institute Leachables and Extractables Working Group includes pharmaceutical development scientists representing industry, government, and academia. The Working Group was created and constituted to address scientific and regulatory questions concerning the pharmaceutical development process for Orally Inhaled and Nasal Drug Products (OINDP) related to organic extractables and leachables. This effort has resulted in the creation of a detailed "Recommendation Document", which was submitted to the U.S. FDA for consideration in September 2006. The recommendations include proposed safety and analytical thresholds for leachables and extractables, as well as detailed "best practice" recommendations for various aspects of the OINDP pharmaceutical development process, including: materials selection for OINDP container closure system components, Controlled Extraction Studies, Leachables Studies, and Routine Extractables Testing. The Working Group's processes and the detailed and comprehensive recommendations that resulted from those processes, demonstrate that the Product Quality Research Institute collaborative process can result in consensus science-based and data driven recommendations that could have a positive effect on patient care. It is anticipated that the Working Group's recommendations will also contribute to the new "Quality by Design" pharmaceutical development paradigm. This commentary summarizes the best practice recommendations within the context of an overall pharmaceutical development process. PMID:18183477

Norwood, Daniel L; Paskiet, Diane; Ruberto, Michael; Feinberg, Thomas; Schroeder, Alan; Poochikian, Guirag; Wang, Qingxi; Deng, Tian Jing; DeGrazio, Fran; Munos, Melinda K; Nagao, Lee M

2008-04-01

296

Chromogranin A assay in clinical practice.  

PubMed

Chromogranins belong to the family of secretory chromogranin and secretogranin proteins. They are found in secretory vesicles throughout the neuroendocrine system. Chromogranin A (CgA) is the main component. CgA acts as a prohormone submitted to processes of degradation through which active peptides are generated. CgA has auto, para and endocrine functions. It is widely used as an immunohistochemical marker. Despite the lack of international standardization, and the lack of an accurate definition of the diagnostic cut-off levels, some CgA assays are reliable. Numerous studies have suggested that CgA determination may be of interest for the diagnosis and the follow-up of various endocrine tumors. Plasma levels of this general marker are proportional to tumor mass. The localization of the primitive tumor, the presence of associated hormonal secretions and possible renal failure and/or hypergastrinemia must be taken into consideration for proper interpretation of CgA levels. New clinical indications are emerging for the evaluation of stress in intensive care units and the assessment of cardiovascular risk. New assays estimating the concentration of active peptides are under development. PMID:20538257

d'Herbomez, M; Do Cao, C; Vezzosi, D; Borzon-Chasot, F; Baudin, E

2010-09-01

297

Clinical Implications of Numeracy: Theory and Practice  

PubMed Central

Background Low numeracy is pervasive and constrains informed patient choice, reduces medication compliance, limits access to treatments, impairs risk communication, and affects medical outcomes; therefore, it is incumbent upon providers to minimize its adverse effects. Purpose We provide an overview of research on health numeracy and discuss its implications in clinical contexts. Conclusions Low numeracy cannot be reliably inferred on the basis of patients’ education, intelligence, or other observable characteristics. Objective and subjective assessments of numeracy are available in short forms and could be used to tailor health communication. Low scorers on these assessments are subject to cognitive biases, irrelevant cues (e.g., mood), and sharper temporal discounting. Because prevention of the leading causes of death (e.g., cancer and cardiovascular disease) depends on taking action now to prevent serious consequences later, those low in numeracy are likely to require more explanation of risk to engage in prevention behaviors. Visual displays can be used to make numerical relations more transparent, and different types of displays have different effects (e.g., greater risk avoidance). Ironically, superior quantitative processing seems to be achieved by focusing on qualitative gist and affective meaning, which has important implications for empowering patients to take advantage of the evidence in evidence-based medicine.

Reyna, Valerie F.; Fagerlin, Angela; Lipkus, Isaac; Peters, Ellen

2013-01-01

298

Placebos in clinical practice and research.  

PubMed Central

The main current application of placebo is in clinical research. The term placebo effect refers to diverse non-specific, desired or non-desired effects of substances or procedures and interactions between patient and therapist. Unpredictability of the placebo effect necessitates placebo-controlled designs for most trials. Therapeutic and diagnostic use of placebo is ethically acceptable only in few well-defined cases. While "therapeutic" application of placebo almost invariably implies deception, this is not the case for its use in research. Conflicts may exist between the therapist's Hippocratic and scientific obligations. The authors provide examples in neuropsychiatry, illustrating that objective scientific data and well-considered guidelines may solve the ethical dilemma. Placebo control might even be considered an ethical obligation but some provisos should be kept in mind: (a) no adequate therapy for the disease should exist and/or (presumed) active therapy should have serious side-effects; (b) placebo treatment should not last too long; (c) placebo treatment should not inflict unacceptable risks, and (d) the experimental subject should be adequately informed and informed consent given.

De Deyn, P P; D'Hooge, R

1996-01-01

299

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

300

Clinically Relevant Transmitted Drug Resistance to First Line Antiretroviral Drugs and Implications for Recommendations  

PubMed Central

Background The aim was to analyse trends in clinically relevant resistance to first-line antiretroviral drugs in Spain, applying the Stanford algorithm, and to compare these results with reported Transmitted Drug Resistance (TDR) defined by the 2009 update of the WHO SDRM list. Methods We analysed 2781 sequences from ARV naive patients of the CoRIS cohort (Spain) between 2007–2011. Using the Stanford algorithm “Low-level resistance”, “Intermediate resistance” and “High-level resistance” categories were considered as “Resistant”. Results 70% of the TDR found using the WHO list were relevant for first-line treatment according to the Stanford algorithm. A total of 188 patients showed clinically relevant resistance to first-line ARVs [6.8% (95%Confidence Interval: 5.8–7.7)], and 221 harbored TDR using the WHO list [7.9% (6.9–9.0)]. Differences were due to a lower prevalence in clinically relevant resistance for NRTIs [2.3% (1.8–2.9) vs. 3.6% (2.9–4.3) by the WHO list] and PIs [0.8% (0.4–1.1) vs. 1.7% (1.2–2.2)], while it was higher for NNRTIs [4.6% (3.8–5.3) vs. 3.7% (3.0–4.7)]. While TDR remained stable throughout the study period, clinically relevant resistance to first line drugs showed a significant trend to a decline (p?=?0.02). Conclusions Prevalence of clinically relevant resistance to first line ARVs in Spain is decreasing, and lower than the one expected looking at TDR using the WHO list. Resistance to first-line PIs falls below 1%, so the recommendation of screening for TDR in the protease gene should be questioned in our setting. Cost-effectiveness studies need to be carried out to inform evidence-based recommendations.

Monge, Susana; Guillot, Vicente; Alvarez, Marta; Chueca, Natalia; Stella, Natalia; Pena, Alejandro; Delgado, Rafael; Cordoba, Juan; Aguilera, Antonio; Vidal, Carmen; Garcia, Federico; CoRIS

2014-01-01

301

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

302

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

303

Review of refugee mental health interventions following resettlement: best practices and recommendations.  

PubMed

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 psychoeducational 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

2010-10-01

304

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.

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

2013-01-01

305

KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury.  

PubMed

In response to the recently released 2012 KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guideline for acute kidney injury (AKI), the National Kidney Foundation organized a group of US experts in adult and pediatric AKI and critical care nephrology to review the recommendations and comment on their relevancy in the context of current US clinical practice and concerns. The first portion of the KDIGO guideline attempts to harmonize earlier consensus definitions and staging criteria for AKI. While the expert panel thought that the KDIGO definition and staging criteria are appropriate for defining the epidemiology of AKI and in the design of clinical trials, the panel concluded that there is insufficient evidence to support their widespread application to clinical care in the United States. The panel generally concurred with the remainder of the KDIGO guidelines that are focused on the prevention and pharmacologic and dialytic management of AKI, although noting the dearth of clinical trial evidence to provide strong evidence-based recommendations and the continued absence of effective therapies beyond hemodynamic optimization and avoidance of nephrotoxins for the prevention and treatment of AKI. PMID:23499048

Palevsky, Paul M; Liu, Kathleen D; Brophy, Patrick D; Chawla, Lakhmir S; Parikh, Chirag R; Thakar, Charuhas V; Tolwani, Ashita J; Waikar, Sushrut S; Weisbord, Steven D

2013-05-01

306

Management of epilepsy associated with tuberous sclerosis complex (TSC): clinical recommendations.  

PubMed

Tuberous sclerosis complex (TSC) is a leading genetic cause of epilepsy. TSC-associated epilepsy generally begins during the first year of life, and is associated with neurodevelopmental and cognitive problems. Management is challenging and seizures tend to persist in a large proportion of patients despite pharmacological and surgical treatment. This report summarizes the clinical recommendations for the management of TSC-associated epilepsy made by a panel of European experts in March 2012. Current treatment options and outstanding questions are outlined. PMID:22695035

Curatolo, Paolo; Jó?wiak, Sergiusz; Nabbout, Rima

2012-11-01

307

Evidence-Based Practice, Person-in-Environment, and Clinical Social Work: Issues of Practical Concern  

Microsoft Academic Search

Evidence-based practice (EBP) is a movement that has gained recent momentum in social work following the tradition of evidence-based medicine (EBM). Use of EBP as a guiding philosophy of clinical social work practice has been debated among academics, researchers, and clinicians for more than a decade. An area of complexity within EBP involves selecting the best available evidence while accounting

Beverly M. Simmons

2012-01-01

308

Practice nurse involvement in general practice clinical care: policy and funding issues need resolution.  

PubMed

In Australia, primary care-based funding initiatives have been implemented to encourage general practices to employ practice nurses. The aim of this paper is to discuss limitations of the current funding and policy arrangements in enhancing the clinical role of practice nurses in the management of chronic conditions. This paper draws on the results of a real-world economic evaluation, the Primary Care Services Improvement Project (PCSIP). The PCSIP linked routinely collected clinical and resource use data to undertake a risk-adjusted cost-effectiveness analysis of increased practice nurse involvement in clinical-based activities for the management of diabetes and obesity. The findings of the PCSIP suggested that the active involvement of practice nurses in collaborative clinical-based activities is cost-effective, as well as addressing general practice workforce issues. Although primary healthcare organisations (e.g. Medicare Locals) can play a key role in supporting enhanced practice nurse roles, improvements to practice nurse funding models could further encourage more efficient use of an important resource. PMID:24870661

Afzali, Hossein Haji Ali; Karnon, Jonathan; Beilby, Justin; Gray, Jodi; Holton, Christine; Banham, David

2014-06-01

309

Digital breast tomosynthesis and the challenges of implementing an emerging breast cancer screening technology into clinical practice.  

PubMed

Emerging imaging technologies, including digital breast tomosynthesis, have the potential to transform breast cancer screening. However, the rapid adoption of these new technologies outpaces the evidence of their clinical and cost-effectiveness. The authors describe the forces driving the rapid diffusion of tomosynthesis into clinical practice, comparing it with the rapid diffusion of digital mammography shortly after its introduction. They outline the potential positive and negative effects that adoption can have on imaging workflow and describe the practice management challenges when incorporating tomosynthesis. The authors also provide recommendations for collecting evidence supporting the development of policies and best practices. PMID:24295940

Lee, Christoph I; Lehman, Constance D

2013-12-01

310

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

311

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

312

Influences on clinical practice: the case of glue ear.  

PubMed

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

1999-06-01

313

Hepatocellular Carcinoma: Consensus Recommendations of the National Cancer Institute Clinical Trials Planning Meeting  

PubMed Central

Hepatocelluar carcinoma (HCC) is the most common primary malignancy of the liver in adults and the third most common cause of cancer death worldwide. The incidence of HCC in the United States is rising steadily because of the prevalence of hepatitis C viral infection and other causes of hepatic cirrhosis. The majority of patients have underlying hepatic dysfunction, which complicates patient management and the search for safe and effective therapies. The Clinical Trials Planning Meeting (CTPM) in HCC was convened by the National Cancer Institute's Gastrointestinal Cancer Steering Committee to identify the key knowledge gaps in HCC and define clinical research priorities. The CTPM structured its review according to current evidence-based treatment modalities in HCC and prioritized the recommendations on the basis of the patient populations representing the greatest unmet medical need.

Thomas, Melanie B.; Jaffe, Deborah; Choti, Michael M.; Belghiti, Jacques; Curley, Steven; Fong, Yuman; Gores, Gregory; Kerlan, Robert; Merle, Phillipe; O'Neil, Bert; Poon, Ronnie; Schwartz, Lawrence; Tepper, Joel; Yao, Francis; Haller, Daniel; Mooney, Margaret; Venook, Alan

2010-01-01

314

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.

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

2003-01-01

315

[Acute coronary syndromes without ST elevation. State-of-the-art, recommendations, and best practices].  

PubMed

In the last decade, acute coronary syndromes without ST elevation (ACS ST-) have become a clinical entity encompassing previous technologies such as acute coronary insufficiency and non-Q wave myocardial infarction. The recognition of its risks and, above all, the development and adaptation of medical and interventional strategies have transformed the prognosis. Patients presenting with ACS ST- are not all identical and do not all have the same prognosis; based on this observation, a number of prognostic scores have been proposed which help decide whether to use drugs such as GP IIb/IIIa inhibitors or coronary angioplasty. Conservative and aggressive strategies are opposing choices but risk stratification allows the treating physician to take a safe decision in the majority of cases. Besides angioplasty and GP IIb/IIIa inhibitors, the basic treatment (aspirin, low molecular weight heparin, clopidogrel, betablockers) should of course be prescribed and its efficacy has contributed to a better outcome in these patients. The recommendations of the scientific societies have evolved with time and increased understanding, allowing an evidence-based approach to the management of ACS ST- patients. PMID:16379102

Blanchard, D; Chevalier, B; Eltchaninoff, H

2005-11-01

316

CONNECTING PRE-MARKETING CLINICAL RESEARCH AND MEDICAL PRACTICE  

Microsoft Academic Search

Abstract Objectives: To identify core issues that contribute to the gap between,pre-marketing clinical research and practice as seen from the perspective of medical practice, as well as possible changes and potential barriers for closing this gap. Methods: Interviews with 47 physicians and pharmacists,who were liaised to drug regulation through their role in the pre- and post-marketing shaping of new cardiovascular

Nicolien F. Wieringa; Jules L. Peschar; Petra Denig; Pieter A. de Graeff; Rein Vos

2003-01-01

317

Evaluation of Clinical Outcome after Laparoscopic Antireflux Surgery in Clinical Practice: Still a Controversial Issue  

PubMed Central

Background. Laparoscopic antireflux surgery has shown to be effective in controlling gastroesophageal reflux (GERD). Yet, a universally accepted definition and evaluation for treatment success/failure in GERD is still controversial. The purpose of this paper is to assess if and how the outcome variables used in the different studies could possibly lead to an homogeneous appraisal of the limits and indications of LARS. Methods. We analyzed papers focusing on the efficacy and outcome of LARS and published in English literature over the last 10 years. Results. Symptoms scores and outcome variables reported are dissimilar and not uniform. The most consistent parameter was patient's satisfaction (mean satisfaction rate: 88.9%). Antireflux medications are not a trustworthy outcome index. Endoscopy and esophageal manometry do not appear very helpful. Twenty-four hours pH metry is recommended in patients difficult to manage for recurrent typical symptoms. Conclusions. More uniform symptoms scales and quality of life tools are needed for assessing the clinical outcome after laparoscopic antireflux surgery. In an era of cost containment, objective evaluation tests should be more specifically addressed. Relying on patient's satisfaction may be ambiguous, yet from this study it can be considered a practical and simple tool.

Contini, Sandro; Scarpignato, Carmelo

2011-01-01

318

Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP).  

PubMed

This report is a compendium of all current recommendations for the prevention of measles, rubella, congenital rubella syndrome (CRS), and mumps. The report presents the recent revisions adopted by the Advisory Committee on Immunization Practices (ACIP) on October 24, 2012, and also summarizes all existing ACIP recommendations that have been published previously during 1998-2011 (CDC. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1998;47[No. RR-8]; CDC. Revised ACIP recommendation for avoiding pregnancy after receiving a rubellacontaining vaccine. MMWR 2001;50:1117; CDC. Updated recommendations of the Advisory Committee on Immunization Practices [ACIP] for the control and elimination of mumps. MMWR 2006;55:629-30; and, CDC. Immunization of healthcare personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60[No. RR-7]). Currently, ACIP recommends 2 doses of MMR vaccine routinely for children with the first dose administered at age 12 through 15 months and the second dose administered at age 4 through 6 years before school entry. Two doses are recommended for adults at high risk for exposure and transmission (e.g., students attending colleges or other post-high school educational institutions, healthcare personnel, and international travelers) and 1 dose for other adults aged ?18 years. For prevention of rubella, 1 dose of MMR vaccine is recommended for persons aged ?12 months. At the October 24, 2012 meeting, ACIP adopted the following revisions, which are published here for the first time. These included: • For acceptable evidence of immunity, removing documentation of physician diagnosed disease as an acceptable criterion for evidence of immunity for measles and mumps, and including laboratory confirmation of disease as a criterion for acceptable evidence of immunity for measles, rubella, and mumps. • For persons with human immunodeficiency virus (HIV) infection, expanding recommendations for vaccination to all persons aged ?12 months with HIV infection who do not have evidence of current severe immunosuppression; recommending revaccination of persons with perinatal HIV infection who were vaccinated before establishment of effective antiretroviral therapy (ART) with 2 appropriately spaced doses of MMR vaccine once effective ART has been established; and changing the recommended timing of the 2 doses of MMR vaccine for HIV-infected persons to age 12 through 15 months and 4 through 6 years. • For measles postexposure prophylaxis, expanding recommendations for use of immune globulin administered intramuscularly (IGIM) to include infants aged birth to 6 months exposed to measles; increasing the recommended dose of IGIM for immunocompetent persons; and recommending use of immune globulin administered intravenously (IGIV) for severely immunocompromised persons and pregnant women without evidence of measles immunity who are exposed to measles. As a compendium of all current recommendations for the prevention of measles, rubella, congenital rubella syndrome (CRS), and mumps, the information in this report is intended for use by clinicians as baseline guidance for scheduling of vaccinations for these conditions and considerations regarding vaccination of special populations. ACIP recommendations are reviewed periodically and are revised as indicated when new information becomes available. PMID:23760231

McLean, Huong Q; Fiebelkorn, Amy Parker; Temte, Jonathan L; Wallace, Gregory S

2013-06-14

319

Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, Vol. 55, No. RR-10, July 28, 2006.  

National Technical Information Service (NTIS)

This report updates the 2005 recommendations by the Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Imm...

D. K. Shay J. S. Bresee N. J. Cox N. M. Smith T. M. Uyeki

2006-01-01

320

Prevention of Varicella: Update Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, Vol. 48, No. RR-6, May 28, 1999.  

National Technical Information Service (NTIS)

In February 1999, the Advisory Committee on Immunization Practices (ACIP) expanded recommendations for varicella (chickenpox) vaccine to promote wider use of the vaccine for susceptible children and adults. The updated recom-mendations include establishin...

K. Galil G. P. Mootrey J. Seward M. Wharton

1999-01-01

321

Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. Morbidity and Mortality Weekly Report, Vol. 56, No. RR-6, July 13, 2007.  

National Technical Information Service (NTIS)

This report updates the 2006 recommendations by CDCs Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Im...

2007-01-01

322

On Going (Way) beyond One's Data: A Proposal to Restrict Recommendations for Practice in Primary Educational Research Journals  

ERIC Educational Resources Information Center

To counteract what we see as a growing research-reporting concern, we propose the following editorial-policy change regarding the content of primary research articles in educational research journals: Contributors should restrict their discussion and conclusions to their data and not offer recommendations for educational practice nor speculate…

Robinson, Daniel H.; Levin, Joel R.; Schraw, Gregory; Patall, Erika A.; Hunt, Earl B.

2013-01-01

323

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

324

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.

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

325

Benchmarks of Recommended Practice: Needs Assessment for Successful Inclusion of Infants and Toddlers with Disabilities in Natural Settings.  

ERIC Educational Resources Information Center

This needs assessment instrument contains indicators of recommended practice for serving infants and toddlers with disabilities in inclusive natural settings. It is designed to be used by early intervention personnel, child care providers, early childhood teachers, early Head Start providers, and others who wish to identify their needs for…

Frank, Adrienne, Ed.

326

47,XXY Klinefelter syndrome: clinical characteristics and age-specific recommendations for medical management.  

PubMed

47,XXY (Klinefelter syndrome) is the most frequent sex chromosomal disorder and affects approximately one in 660 newborn boys. The syndrome is characterized by varying degrees of cognitive, social, behavioral, and learning difficulties and in adulthood additionally primary testicular failure with small testes, hypergonadotropic hypogonadism, tall stature, and eunuchoid body proportions. The phenotype is variable ranging from "near-normal" to a significantly affected individual. In addition, newborns with Klinefelter syndrome generally present with a normal male phenotype and the only consistent clinical finding in KS is small testes, that are most often not identified until after puberty. Decreased awareness of this syndrome among health professionals and a general perception that all patients with 47,XXY exhibit the classic textbook phenotype results in a highly under-diagnosed condition with up to 75% of the patients left undetected. Typically, diagnosis is delayed with the majority of patients identified during fertility workup in adulthood, and only 10% of patients diagnosed prior to puberty. Early detection of this syndrome is recommended in order to offer treatment and intervention at the appropriate ages and stages of development for the purpose of preventing osteopenia/osteoporosis, metabolic syndrome, and other medical conditions related to hypogonadism and to the XXY as well as minimizing potential learning and psychosocial problems. The aim of this review is to present the clinical aspects of XXY and the age-specific recommendations for medical management. © 2013 Wiley Periodicals, Inc. PMID:23345262

Aksglaede, Lise; Link, Katarina; Giwercman, Aleksander; Jørgensen, Niels; Skakkebaek, Niels E; Juul, Anders

2013-02-15

327

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.

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

328

Strategies for learning evidence-based practice: critically appraising clinical practice guidelines.  

PubMed

Nurse educators have a mandate to educate our students about using an evidence-based practice approach to clinical decision making. At the Lienhard School of Nursing, Pace University, faculty have successfully integrated evidence-based practice into the family nurse practitioner curriculum. This article describes one teaching-learning strategy to help students learn how to critically appraise clinical practice guidelines using the AGREE instrument. There are several steps to the learning exercise: completing preparatory reading, obtaining the guideline that forms the focus of the assignment, working as teams, using the AGREE tool to assess the guideline's validity, and reporting team findings to the entire class. Students have found this learning activity helpful in preparing them for clinical practice. PMID:18751653

Singleton, Joanne; Levin, Rona

2008-08-01

329

[Allergy to drugs and contrast media--recommendations of the Israeli Allergy and Clinical Immunology Association].  

PubMed

Drug hypersensitivity is an adverse reaction that was brought about by a specific immunologic response, not related to the pharmacological components of the drug. Additionally, drug related pseudoallergic and anaphylactoid reactions have been encompassed under the umbrella of hypersensitivity. Some of these reactions are linked with significant morbidity and mortality. Nowadays, the hypersensitivity reactions of most drugs can be well defined and recurrence risk following exposure to the culprit drug and/or related drugs can be assessed. Medical history skin, blood and challenge tests, conducted in an allergy clinic, enable prediction and prevention of repeated events as well as unnecessary avoidance of certain compounds. For instance, most patients who report a prior reaction to penicillin are not allergic to beta-lactams upon allergic evaluation, while avoidance of penicillin based on self-reporting alone often leads to the use of an alternate antibiotic with greater cost or side effect profile. On the other hand, for patients who previously exhibited hypersensitivity to a compound which is currently required, premedication or a desensitization protocol can be recommended to allow the use of this compound. Drug hypersensitivity is most commonly attributed to beta-lactams antibiotics, contrast media reagents and non-steroidal anti-inflammatory drugs (NSAID). Hence, in the current review the recommendations of the Israeli Association for Allergy and Clinical Immunology for the evaluation and treatment of patients suspected to have hypersensitivity to beta-lactams and contrast media reagents are detailed. Recommendations regarding the evaluation of NSAID hypersensitivity will be published on the IMA website, together with those explicated herein. PMID:24364087

Agmon-Levin, Nancy; Tal, Yuval; Broides, Arnon; Asher, Ilan; Hersheko, Alon; Staubers, Tali; Confino-Cohen, Ronit

2013-09-01

330

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

331

The Promise of Mindfulness for Clinical Practice Education  

Microsoft Academic Search

This article reviews the recent trend in mindfulness-based psychotherapies and explores the utility of mindfulness training for clinical practice education. It presents the current literature and evidence suggesting that mindfulness training may provide a vehicle to foster essential clinical skills and attitudes, increase self-care and reduce the impact of occupational stress, and prepare students to understand and use mindfulness-based interventions

Annemarie Gockel

2010-01-01

332

Pain measurement tools for clinical practice and research.  

PubMed

An important component of effective postoperative pain management is a measure of the patient's pain intensity. This article examines three unidimensional pain measurement instruments and one multidimensional pain measurement instrument used in daily practice and clinical research. The strengths and weaknesses of the numerical rating scale, verbal descriptor scale, visual analogue scale, and the McGill Pain Questionnaire are discussed. Issues of validity and reliability, important in clinical research, are also presented. PMID:9095685

Flaherty, S A

1996-04-01

333

[Measurement of renal function in clinical practice: principles and limitations].  

PubMed

Methods for measurement of glomerular filtration rate (GFR) (clearance in plasma, urine or both of an « exogenous » tracer, usually radio labeled) often are considered impractical from a clinical standpoint. Alternate methods proposed to estimate the GFR are based on plasma levels of « endogenous » tracers (creatinine, cystatin C). These methods are so imprecise that they provide little if any true reassurance with regards to warnings and recommended GFR values for the use of iodinated and gadolinium based contrast agents. PMID:21549883

Prigent, A

2011-04-01

334

Practices and recommendations in infant feeding and HIV prevention: the child's perspective.  

PubMed

Although the attainment of Millennium Development Goal 4 (MDG 4), reducing under-five mortality by two-thirds by the year 2015, depends on optimizing breast-feeding practices in resource-limited settings, there are some conditions in which breast-feeding is impossible, contraindicated, or not recommended. The overall impact of involuntary nonbreast-feeding on the attainment of MDG 4 has not been documented. In industrialized and many middle-income countries replacement feeding is affordable, feasible, acceptable, sustainable, and safe and complete avoidance of breast-feeding is the norm to prevent postnatal transmission of HIV. The situation is very different in many low-income countries affected by the HIV epidemic where infants are exposed to HIV and antiretroviral (ARV) mediation through breast milk for long periods with risk of acquiring HIV infection, development of multidrug resistant HIV and short and long term toxicity associated to ARV medications. Despite the obvious needs, there is no specific research on how to make replacement feeding safer for infants with no access to breast-feeding and for whom replacement feeding is justified. Orphans, abandoned and infants of severely ill mothers unable to breast-feed, won't benefit from the research done on making breast-feeding safer for HIV exposed infants. A child rights perspective illuminates societal obligations to provide replacement feeding with infant formula milk to such infants, and to support research to make it safer at the same time that breast-feeding is promoted and protected for the general population. PMID:24735258

Torres, Victorio; Bedell, Richard Albert; Wachira, Mary Njoki; Dalmau, David

2014-10-01

335

Pharmacological treatment of chorea in Huntington's disease-good clinical practice versus evidence-based guideline  

PubMed Central

Recently, the American Academy of Neurology published an evidence-based guideline for the pharmacological treatment of chorea in Huntington’s disease. Although the progress in medical care because of the implementation of criteria of evidence-based medicine is undisputed, the guideline classifies the level of evidence for drugs to reduce chorea based on anchors in the Unified Huntington’s Disease Rating Scale-Total Motor Score chorea sum score, which were chosen arbitrarily and do not reflect validated or generally accepted levels of clinical relevance. Thus, the guideline faces several serious limitations and delivers clinical recommendations that do not represent current clinical practice; these are reviewed in detail, and arguments are presented why these recommendations should not be followed. To remedy the lack of evidence-based recommendations and provide guidance to a pragmatic symptomatic therapy of chorea in HD, a flow-chart pathway that follows currently established clinical standards based on expert opinion is presented. © 2013 Movement Disorder Society

Reilmann, Ralf

2013-01-01

336

Correlation of Performance on Clinical Laboratory Proficiency Examinations with Performance in Clinical Laboratory Practice.  

National Technical Information Service (NTIS)

The purpose of the present research was to investigate the extent to which performance on a criterion-referenced, written proficiency examination in clinical laboratory technology (CLT) correlates with measures of laboratory practice. The following assess...

C. G. Schoon M. Kaley I. Stern

1979-01-01

337

The Clinical Practice of Interventional Radiology: A European Perspective  

SciTech Connect

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

Keeling, Aoife N. [Beaumont Hospital, Department of Academic Radiology (Ireland); Reekers, Jim A. [Academic Medical Centre, University of Amsterdam, Department of Radiology (Netherlands); Lee, Michael J., E-mail: mlee@rcsi.i [Beaumont Hospital, Department of Academic Radiology (Ireland)

2009-05-15

338

The clinical practice of interventional radiology: a European perspective.  

PubMed

The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management's refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently. PMID:19184195

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

2009-05-01

339

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.

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

2013-01-01

340

Vector-Borne Diseases - constant challenge for practicing veterinarians: recommendations from the CVBD World Forum  

PubMed Central

The human-animal bond has been a fundamental feature of mankind's history for millennia. The first, and strongest of these, man's relationship with the dog, is believed to pre-date even agriculture, going back as far as 30,000 years. It remains at least as powerful today. Fed by the changing nature of the interactions between people and their dogs worldwide and the increasing tendency towards close domesticity, the health of dogs has never played a more important role in family life. Thanks to developments in scientific understanding and diagnostic techniques, as well as changing priorities of pet owners, veterinarians are now able, and indeed expected, to play a fundamental role in the prevention and treatment of canine disease, including canine vector-borne diseases (CVBDs). The CVBDs represent a varied and complex group of diseases, including anaplasmosis, babesiosis, bartonellosis, borreliosis, dirofilariosis, ehrlichiosis, leishmaniosis, rickettsiosis and thelaziosis, with new syndromes being uncovered every year. Many of these diseases can cause serious, even life-threatening clinical conditions in dogs, with a number having zoonotic potential, affecting the human population. Today, CVBDs pose a growing global threat as they continue their spread far from their traditional geographical and temporal restraints as a result of changes in both climatic conditions and pet dog travel patterns, exposing new populations to previously unknown infectious agents and posing unprecedented challenges to veterinarians. In response to this growing threat, the CVBD World Forum, a multidisciplinary group of experts in CVBDs from around the world which meets on an annual basis, gathered in Nice (France) in 2011 to share the latest research on CVBDs and discuss the best approaches to managing these diseases around the world. As a result of these discussions, we, the members of the CVBD Forum have developed the following recommendations to veterinarians for the management of CVBDs.

2012-01-01

341

The Life Cycle of Clinical Decision Support (CDS): CDS Theory and Practice from Request to Maintenance  

PubMed Central

The promise of Clinical Decision Support (CDS) has always been to transform patient care and improve patient safety with delivery of timely and appropriate recommendations that are both patient-specific and more often than not appropriately actionable. However, the users of CDS, providers, are frequently bombarded with inappropriate and inapplicable CDS that is frequently neither informational, integrated into the workflow, patient-specific, and may present out of date and irrelevant recommendations. The life cycle of Clinical Decision Support begins with a request for CDS, continues with design and implementation, and concludes with ongoing knowledge maintenance. This State of the Practice will look at how using the best science and latest knowledge regarding CDS can create request and maintenance processes that work in the real world. Dr. David Bates will present the best science and knowledge behind CDS that works. Dr.’s Joseph Kannry and Thomas Yackel will present case studies of CDS requests and design processes that use this science to generate useful, useable, and timely patient-specific recommendations. Dr. Tonya Hongsermeier will present best practices in knowledge maintenance. Finally, Dr. Michael Krall will present a case study of knowledge maintenance from Kaiser Permanente that results in appropriate and up-to-date CDS.

Kannry, Joseph; Bates, David; Hongsermeier, Tonya; Krall, Michael; Yackel, Thomas

2012-01-01

342

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

343

Evaluating Juveniles' Adjudicative Competence: A Guide for Clinical Practice  

Microsoft Academic Search

Citation: Grisso, T. (2005). Evaluating juveniles’ adjudicative competence: A guide for clinical practice. Sarasota, FL: Professional Resource Press. ISBN 1568870957.\\u000aDeveloped by the John D. and Catherine T. MacArthur Foundation Research Network on Adolescent Development and Juvenile Justice.

Thomas Grisso

2005-01-01

344

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

345

Knowledge taxonomy for Clinical Practice Guidelines - Implications for Computerization  

Microsoft Academic Search

Much effort has been put into developing clinical practice guidelines (CPG's), but yet the effect of CPG's is limited. A path for better practitioner adherence to CPG's could be to offer IT-based process support, based on CPG's To accomplish this it is necessary to transform existing narrative CPG's into a computer-readable format. Based on an analysis of a corpus of

Karen Marie Lyng

346

Attachment theory: Application to clinical practice with adults  

Microsoft Academic Search

An application of attachment theory to clinical practice with adults is based on psychoanalytic-object relations theory, expanding and emphasizing the influence of affectional bonds with others. The role of the therapist is to provide the conditions in which to explore current and past experiences, especially those related to attachment, separation and loss, helping patients reappraise and reconstruct their inner representations

Pat Sable

1992-01-01

347

Guidelines for the nonpharmacologic management of migraine in clinical practice  

Microsoft Academic Search

Objective: To provide physicians and allied health care professionals with guide- lines for the nonpharmacologic management of migraine in clinical practice. Options: The full range and quality of nonpharmacologic therapies available for the management of migraine. Outcomes: Improvement in the nonpharmacologic management of migraine. Evidence and values: The creation of the guidelines followed a needs assessment by members of the

William E. M. Pryse-Phillips; David W. Dodick; John G. Edmeads; Marek J. Gawel; Robert F. Nelson; R. Allan Purdy; Gordon Robinson; Denise Stirling; Irene Worthington

1998-01-01

348

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

349

Podiatry Manpower: Characteristics of Clinical Practice, United States-1970.  

National Technical Information Service (NTIS)

The report presents data on the clinical practice of podiatry, United States, 1970. Patient-care activity is described in terms of its volume and its nature. Indications of volume are number of hours per week spent in patient care, number of patient visit...

H. Kock H. Phillips

1974-01-01

350

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

351

[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

352

European Society of Gastrointestinal Endoscopy (ESGE): recommendations (2009) on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases.  

PubMed

These recommendations on video capsule endoscopy, an emerging technology with an impact on the practice of endoscopy, were developed by the European Society of Gastrointestinal Endoscopy (ESGE) Guidelines Committee. The first draft of each section was prepared by one or two members of the writing team, who were selected as experts on the content of that section on the basis of their published work. They used evidence-based methodology, performing MEDLINE and PubMed literature searches to identify relevant clinical studies. Abstracts from scientific meetings were included only if there was no published full paper on a particular topic. If there was disagreement, the first author of the Guideline made the final decision. Recommendations were graded according to the strength of the supporting evidence. The draft guideline was critically reviewed by all authors and submitted to the ESGE councillors for their critical review before approval of the final document. The ESGE Guidelines Committee acknowledges that this document is based on a critical review of the data available at the time of preparation and that further studies may be needed to clarify some aspects. Moreover, this Guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. This document should be regarded as supplying recommendations only to gastroenterologists in providing care to their patients. It is not a set of rules and should not be construed as establishing a legal standard of care, or as encouraging, advocating, requiring, or discouraging any particular treatment. These recommendations must be interpreted according to the clinician's knowledge, expertise, and clinical judgment in the management of individual patients and, if necessary, a course of action that varies from recommendations must be undertaken. PMID:20195992

Ladas, S D; Triantafyllou, K; Spada, C; Riccioni, M E; Rey, J-F; Niv, Y; Delvaux, M; de Franchis, R; Costamagna, G

2010-03-01

353

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

354

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

355

Withdrawal symptoms and rebound syndromes associated with switching and discontinuing atypical antipsychotics: theoretical background and practical recommendations.  

PubMed

With the widespread use of atypical or second-generation antipsychotics, switching treatment has become current practice and more complicated, as the pharmacological profiles of these agents differ substantially despite their similarity in being 'atypical'. All share the ability to block dopamine D? receptors, and most of them also block serotonin 5-HT2A receptors. Apart from these common features, some atypical antipsychotics are also able to block or stimulate other dopamine or serotonin receptors, as well as histaminergic, muscarinergic or adrenergic receptors. As a result of the varying receptor affinities, in switching or discontinuing compounds several possible pitfalls have to be considered, including the occurrence of withdrawal and rebound syndromes. This article reviews the pharmacological background of functional blockade or stimulation of receptors of interest in regard to atypical antipsychotics and the implicated potential withdrawal and rebound phenomena. A MEDLINE search was carried out to identify information on withdrawal or rebound syndromes occurring after discontinuation of atypical antipsychotics. Using the resulting literature, we first discuss the theoretical background to the functional consequences of atypical antipsychotic-induced blockade or stimulation of neurotransmitter receptors and, secondly, we highlight the clinical consequences of this. We then review the available clinical literature on switching between atypical antipsychotics, with respect to the occurrence of withdrawal or rebound symptoms. Finally, we offer practical recommendations based on the reviewed findings. The systematic evaluation of withdrawal or rebound phenomena using randomized controlled trials is still understudied. Knowledge of pharmacological receptor-binding profiles may help clinicians in choosing adequate switching or discontinuation strategies for each agent. Results from large switching trials indicate that switching atypical antipsychotics can be performed in a safe manner. Treatment-emergent adverse events during or after switching are not always considered to be, at least in part, associated with the pre-switch antipsychotic. Further studies are needed to substantiate the evidence gained so far on different switching strategies. The use of concomitant medication, e.g., benzodiazepines or anticholinergic drugs, may help to minimize symptoms arising from the discontinuation or switching of antipsychotic treatment. PMID:23821039

Cerovecki, Anja; Musil, Richard; Klimke, Ansgar; Seemüller, Florian; Haen, Ekkehard; Schennach, Rebecca; Kühn, Kai-Uwe; Volz, Hans-Peter; Riedel, Michael

2013-07-01

356

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

357

Evaluation of evidence-based literature and formulation of recommendations for the clinical preventive guidelines for immigrants and refugees in Canada  

PubMed Central

Background: This article describes the evidence review and guideline development method developed for the Clinical Preventive Guidelines for Immigrants and Refugees in Canada by the Canadian Collaboration for Immigrant and Refugee Health Guideline Committee. Methods: The Appraisal of Guidelines for Research and Evaluation (AGREE) best-practice framework was combined with the recently developed Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to produce evidence-based clinical guidelines for immigrants and refugees in Canada. Results: A systematic approach was designed to produce the evidence reviews and apply the GRADE approach, including building on evidence from previous systematic reviews, searching for and comparing evidence between general and specific immigrant populations, and applying the GRADE criteria for making recommendations. This method was used for priority health conditions that had been selected by practitioners caring for immigrants and refugees in Canada. Interpretation: This article outlines the 14-step method that was defined to standardize the guideline development process for each priority health condition.

Tugwell, Peter; Pottie, Kevin; Welch, Vivian; Ueffing, Erin; Chambers, Andrea; Feightner, John

2011-01-01

358

Evidence-based therapy relationships: research conclusions and clinical practices.  

PubMed

In this closing article of the special issue, we present the conclusions and recommendations of the interdivisional task force on evidence-based therapy relationships. The work was based on a series of meta-analyses conducted on the effectiveness of various relationship elements and methods of treatment adaptation. A panel of experts concluded that several relationship elements were demonstrably effective (alliance in individual psychotherapy, alliance in youth psychotherapy, alliance in family therapy, cohesion in group therapy, empathy, collecting client feedback) while others were probably effective (goal consensus, collaboration, positive regard). Three other relationship elements (congruence/genuineness, repairing alliance ruptures, and managing countertransference) were deemed promising but had insufficient evidence to conclude that they were effective. Multiple recommendations for practice, training, research, and policy are advanced. PMID:21401280

Norcross, John C; Wampold, Bruce E

2011-03-01

359

Use of handheld computers in clinical practice: a systematic review  

PubMed Central

Background Many healthcare professionals use smartphones and tablets to inform patient care. Contemporary research suggests that handheld computers may support aspects of clinical diagnosis and management. This systematic review was designed to synthesise high quality evidence to answer the question; Does healthcare professionals’ use of handheld computers improve their access to information and support clinical decision making at the point of care? Methods A detailed search was conducted using Cochrane, MEDLINE, EMBASE, PsycINFO, Science and Social Science Citation Indices since 2001. Interventions promoting healthcare professionals seeking information or making clinical decisions using handheld computers were included. Classroom learning and the use of laptop computers were excluded. Two authors independently selected studies, assessed quality using the Cochrane Risk of Bias tool and extracted data. High levels of data heterogeneity negated statistical synthesis. Instead, evidence for effectiveness was summarised narratively, according to each study’s aim for assessing the impact of handheld computer use. Results We included seven randomised trials investigating medical or nursing staffs’ use of Personal Digital Assistants. Effectiveness was demonstrated across three distinct functions that emerged from the data: accessing information for clinical knowledge, adherence to guidelines and diagnostic decision making. When healthcare professionals used handheld computers to access clinical information, their knowledge improved significantly more than peers who used paper resources. When clinical guideline recommendations were presented on handheld computers, clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper resources. Finally, healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on handheld computers compared to colleagues who did not have access to these tools. For these clinical decisions, the numbers need to test/screen were all less than 11. Conclusion Healthcare professionals’ use of handheld computers may improve their information seeking, adherence to guidelines and clinical decision making. Handheld computers can provide real time access to and analysis of clinical information. The integration of clinical decision support systems within handheld computers offers clinicians the highest level of synthesised evidence at the point of care. Future research is needed to replicate these early results and to identify beneficial clinical outcomes.

2014-01-01

360

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

361

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.

2013-01-01

362

What are the clinical questions of practicing veterinarians?  

PubMed

Clinical questions are central to learning among veterinarians and drive informal learning during clinical practice. We set out to classify the clinical questions of practicing veterinarians using a taxonomy previously validated in human medicine. This prospective observational study used a convenience sample of 12 veterinarians in private, small-animal practices. We used three methods to gather clinical questions from the veterinarians: direct observation (asking veterinarians after each encounter), self-report via e-mail, and self-report via data-collection pocket cards. We then classified these questions using a validated taxonomy of question types, as well as by clinical category. A total of 157 clinical questions were collected; 99 were about dogs, 33 were about cats, and 25 were about multiple species or did not specify a species. Nearly half of the questions were rated as high priority, and only 11.5% as low priority. Over half of the questions (53%) were about treatment and 20% were about diagnosis. The two most common question types were "Is drug X indicated in situation Y or for condition Y?" and "How should I treat finding/condition Y (given situation Z)?" Overall, 5 of 57 question-type categories accounted for over half of the questions. The most common clinical categories were pharmacology, endocrine, musculoskeletal, and general surgery. This is the first study to systematically identify and classify the clinical questions of veterinarians. A better understanding of these questions can be used to inform the development of continuing-education (CE) activities that are directly responsive to the information needs of participants. PMID:23975074

Ebell, Mark H; Budsberg, Steven; Cervero, Ronald; Shinholser, Joanna; Call, Marlene

2013-01-01

363

Pharmacogenetics of antidepressant drugs: current clinical practice and future directions.  

PubMed

While antidepressants are widely used to treat mood and anxiety disorders, only half of the patients will respond to antidepressant treatment and only one-third of patients experience a full remission of symptoms. The identification of genetic biomarkers that predict antidepressant-treatment response can improve current clinical practice. This is an emerging field known as pharmacogenetics, which comprises of genetic studies on both the pharmacokinetics and pharmacodynamics of treatment response. Recent studies on antidepressant-treatment response have focused on both aspects of pharmacogenetics research, identifying new candidate genes that may predict better treatment response for patients. This paper reviews recent findings on the pharmacogenetics of antidepressant drugs and future clinical applications. Ultimately, these studies should lead to the use of genetic testing to guide the use of antidepressants in clinical practice. PMID:22380000

Narasimhan, Sneha; Lohoff, Falk W

2012-03-01

364

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

PubMed

Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice. PMID:24809607

Weise, Kathryn L; Daly, Barbara J

2014-06-01

365

Ethnography's role in assisting mental health research and clinical practice.  

PubMed

In this article, the author discusses the utility of qualitative approaches in mental health research and clinical practice. He highlights the value of conceptualizing research designs and procedures that include relevant cultural information about study participants. Emphasis is placed on African American women participants, consumers, and others who are understudied, underrepresented, and underserved in large-scale studies and treatment. Limitations and strengths are noted. Contributions of qualitative methodology are described, particularly the functions of ethnography and grounded theory in conceptualization, hypotheses building, and hypotheses testing of outcome data on African American women and culturally diverse groups. Clinical researchers are encouraged to utilize qualitative and mixed methods approaches to bolster outcomes and better inform their clinical practice. PMID:16703604

Quimby, Ernest

2006-07-01

366

How Current Clinical Practice Guidelines for Low Back Pain Reflect Traditional Medicine in East Asian Countries: A Systematic Review of Clinical Practice Guidelines and Systematic Reviews  

PubMed Central

Objectives The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM) interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs) and evidence from current systematic reviews and meta-analyses (SR-MAs) and to analyze the impact of this gap on present CPGs. Methods We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs. Results Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54%) mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure). However, the CPGs did not recommend acupuncture (or acupressure). Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (sub)acute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (sub)acute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence. Conclusions The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system.

Cho, Hyun-Woo; Hwang, Eui-Hyoung; Lim, Byungmook; Heo, Kwang-Ho; Liu, Jian-Ping; Tsutani, Kiichiro; Lee, Myeong Soo; Shin, Byung-Cheul

2014-01-01

367

The importance of Good Clinical Practice guidelines and its role in clinical trials  

Microsoft Academic Search

Good Clinical Practice (GCP) is an international ethical and scientific quality standard for the design, conduct, performance, monitoring, auditing, recording, analyses and reporting of clinical trials. It also serves to protect the rights, integrity and confidentiality of trial subjects. It is very important to understand the background of the formation of the ICH-GCP guidelines as this, in itself, explains the

O Nawawi

368

Informed consent in psychiatry clinical research: A conceptual review of issues, challenges, and recommendations  

PubMed Central

Obtaining informed consent in psychiatry clinical research involving subjects with diminished mental abilities and impaired consent capacity has been a challenge for researchers, posing many ethical concerns and procedural hurdles due to participants’ cognitive deficits and impaired ability to judge reality. Regulations seem inadequate and provide limited guidance, not sufficient to address all the ethical issues inherent in different situations related to obtaining consent from decisionally impaired persons. Researchers are struggling to find a balance between risk-benefit ratio, research advancement, and autonomy of study subjects. Inspired to improve the consent process in psychiatry clinical research, many studies have been conducted focusing on various informed consent-related ethical concerns, with the aim of developing appropriate strategies and optimizing the informed consent procedure in psychiatry clinical research, overcoming the ethical concerns. This article critically reviews the various ethical issues and consent challenges, their underlying reasons, and investigates the appropriate strategies and practices needed to be adopted while obtaining informed consent from subjects with impaired consent capacity, participating in psychiatry clinical research.

Gupta, Umesh Chandra; Kharawala, Saifuddin

2012-01-01

369

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

370

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.

371

Reconciling the clinical practice guidelines on Bell's palsy from the AAO-HNSF and the AAN.  

PubMed

Bell's palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mononeuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. In the past 2 years, both the American Academy of Neurology (AAN) and the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) have published clinical practice guidelines aimed to improve the quality of care and outcomes for patients diagnosed with Bell's palsy. This commentary aims to address the similarities and differences in the scope and final recommendations made by each guideline development group. PMID:24789656

Schwartz, Seth R; Jones, Stephanie L; Getchius, Thomas S D; Gronseth, Gary S

2014-05-01

372

Reconciling the clinical practice guidelines on Bell palsy from the AAO-HNSF and the AAN.  

PubMed

Bell palsy, named after the Scottish anatomist Sir Charles Bell, is the most common acute mononeuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. In the past 2 years, both the American Academy of Neurology and the Academy of Otolaryngology-Head and Neck Surgery Foundation have published clinical practice guidelines aimed at improving the quality of care and outcomes for patients diagnosed with Bell palsy. This commentary aims to address the similarities and differences in the scope and final recommendations made by each guideline development group. PMID:24793182

Schwartz, Seth R; Jones, Stephanie L; Getchius, Thomas S D; Gronseth, Gary S

2014-05-27

373

Status of quantitative EEG (QEEG) in clinical practice, 1994.  

PubMed

Clinical quantitative EEG (qEEG) is a complex specialty that may include not only standard EEG but also digital ("paperless") EEG, topographic mapping, spectral analysis, spectral coherence, long latency and event related potentials (EP), significance probability mapping (SPM), dipole source localization methodology (DLM), and discriminant function analysis. There are three basic clinical uses: non-specific detection of organicity/encephalopathy, specific categorization of disease or clinical condition, and epileptic source localization. Extreme variations exist in the competency of laboratories practicing clinical qEEG; universally agreed upon standards of practice have not been established but there are a number of efforts to do so. As expected, the clinical value of qEEG to patients varies similarly. Criticisms of qEEG have now been answered: Color displays need not be deceptive. Statistical "capitalization upon chance" can be easily avoided. By training and with newer analytic procedures, artifacts can be recognized and often removed. Data based upon spectral analysis and EP can reliably classify clinical conditions thereby demonstrating a greater sensitivity to EEG/EP data than possible by conventional visual inspection. QEEG is clearly of clinical value when performed in concert with standard EEG and analyzed by clinicians with demonstrated competency in standard EEG followed by specialized training and demonstrated competency in qEEG. QEEG is not a simple substitute for conventional EEG and cannot be seen as a substitute for clinical competence. Although continuing to develop, qEEG technology has matured sufficiently and is now well established. Concerns regarding its clinical use have primarily resulted from its misapplication and misinterpretation stemming, largely, from inadequate personnel training and expertise. PMID:7813090

Duffy, F H; Hughes, J R; Miranda, F; Bernad, P; Cook, P

1994-10-01

374

Quality Control Procedures for Achived Operations Traffic Data: Synthesis of Practice and Recommendations.  

National Technical Information Service (NTIS)

This report summarizes and provides recommendations for quality control procedures to be used for archived data that have been collected and saved by traffic operations systems. This report summarizes quality control procedures used in numerous archived d...

S. Turner

2007-01-01

375

Changing clinical practice: views about the management of adult asthma  

PubMed Central

A case study of clinical practice in adult asthma is presented. The case is part of a larger project, funded by the North Thames NHS Executive 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. The first case of glue ear in children was reported in a previous issue of this journal (Quality in Health Care 1999;8:99-107). Background information from secondary sources on the condition, treatment, and organisation and location of care is followed by an account of the results of semistructured interviews with 159 clinicians. The findings are reported in two sections: clinical management and the organisation of care, and clinicians' accounts of what, why, and how they introduce changes into their practice. The way clinicians talk about their learning, their expressed views on acceptable practice, and their willingness to change were shown to be informed by construction of legitimate and sufficient evidence, respected colleagues, and accumulated individual experience. There was little open acknowledgment of the influence of organisational factors in influencing practice. To investigate whether relationships between task performance and organisational arrangements found in other sectors apply to UK health, more robust measures by which performance can be evaluated are needed.

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

1999-01-01

376

Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice.  

PubMed

Sleep disturbance is prevalent in cancer with detrimental effects on health outcomes. Sleep problems are seldom identified or addressed in cancer practice. The purpose of this review was to identify the evidence base for the assessment and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) for oncology practice. The search of the health literature included grey literature data sources and empirical databases from June 2004 to June 2012. The evidence was reviewed by a Canadian Sleep Expert Panel, comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers and guideline methodologists to develop clinical practice recommendations for pan-Canadian use reported in a separate paper. Three clinical practice guidelines and 12 randomized, controlled trials were identified as the main source of evidence. Additional guidelines and systematic reviews were also reviewed for evidence-based recommendations on the assessment and management of insomnia not necessarily in cancer. A need to routinely screen for sleep disturbances was identified and the randomized, controlled trial (RCT) evidence suggests benefits for cognitive behavioural therapy for improving sleep quality in cancer. Sleep disturbance is a prevalent problem in cancer that needs greater recognition in clinical practice and in future research. PMID:24287882

Howell, D; Oliver, T K; Keller-Olaman, S; Davidson, J R; Garland, S; Samuels, C; Savard, J; Harris, C; Aubin, M; Olson, K; Sussman, J; Macfarlane, J; Taylor, C

2014-04-01

377

Using data mining techniques to explore physicians' therapeutic decisions when clinical guidelines do not provide recommendations: methods and example for type 2 diabetes  

PubMed Central

Background Clinical guidelines carry medical evidence to the point of practice. As evidence is not always available, many guidelines do not provide recommendations for all clinical situations encountered in practice. We propose an approach for identifying knowledge gaps in guidelines and for exploring physicians' therapeutic decisions with data mining techniques to fill these knowledge gaps. We demonstrate our method by an example in the domain of type 2 diabetes. Methods We analyzed the French national guidelines for the management of type 2 diabetes to identify clinical conditions that are not covered or those for which the guidelines do not provide recommendations. We extracted patient records corresponding to each clinical condition from a database of type 2 diabetic patients treated at Avicenne University Hospital of Bobigny, France. We explored physicians' prescriptions for each of these profiles using C5.0 decision-tree learning algorithm. We developed decision-trees for different levels of detail of the therapeutic decision, namely the type of treatment, the pharmaco-therapeutic class, the international non proprietary name, and the dose of each medication. We compared the rules generated with those added to the guidelines in a newer version, to examine their similarity. Results We extracted 27 rules from the analysis of a database of 463 patient records. Eleven rules were about the choice of the type of treatment and thirteen rules about the choice of the pharmaco-therapeutic class of each drug. For the choice of the international non proprietary name and the dose, we could extract only a few rules because the number of patient records was too low for these factors. The extracted rules showed similarities with those added to the newer version of the guidelines. Conclusion Our method showed its usefulness for completing guidelines recommendations with rules learnt automatically from physicians' prescriptions. It could be used during the development of guidelines as a complementary source from practice-based knowledge. It can also be used as an evaluation tool for comparing a physician's therapeutic decisions with those recommended by a given set of clinical guidelines. The example we described showed that physician practice was in some ways ahead of the guideline.

2009-01-01

378

Biomarkers of sarcopenia in clinical trials-recommendations from the International Working Group on Sarcopenia.  

PubMed

Sarcopenia, the age-related skeletal muscle decline, is associated with relevant clinical and socioeconomic negative outcomes in older persons. The study of this phenomenon and the development of preventive/therapeutic strategies represent public health priorities. The present document reports the results of a recent meeting of the International Working Group on Sarcopenia (a task force consisting of geriatricians and scientists from academia and industry) held on June 7-8, 2011 in Toulouse (France). The meeting was specifically focused at gaining knowledge on the currently available biomarkers (functional, biological, or imaging-related) that could be utilized in clinical trials of sarcopenia and considered the most reliable and promising to evaluate age-related modifications of skeletal muscle. Specific recommendations about the assessment of aging skeletal muscle in older people and the optimal methodological design of studies on sarcopenia were also discussed and finalized. Although the study of skeletal muscle decline is still in a very preliminary phase, the potential great benefits derived from a better understanding and treatment of this condition should encourage research on sarcopenia. However, the reasonable uncertainties (derived from exploring a novel field and the exponential acceleration of scientific progress) require the adoption of a cautious and comprehensive approach to the subject. PMID:22865205

Cesari, Matteo; Fielding, Roger A; Pahor, Marco; Goodpaster, Bret; Hellerstein, Marc; van Kan, Gabor A; Anker, Stefan D; Rutkove, Seward; Vrijbloed, J Willem; Isaac, Maria; Rolland, Yves; M'rini, Christine; Aubertin-Leheudre, Mylène; Cedarbaum, Jesse M; Zamboni, Mauro; Sieber, Cornell C; Laurent, Didier; Evans, William J; Roubenoff, Ronenn; Morley, John E; Vellas, Bruno

2012-09-01

379

Best practices recommendations in the application of immunohistochemistry in the bladder lesions: report from the international society of urologic pathology consensus conference.  

PubMed

The bladder working group of the 2013 International Society of Urologic Pathology (ISUP) Conference on Best Practices Recommendation in the Application of Immunohistochemistry (IHC) in Urologic Pathology discussed 5 settings in which IHC is commonly used in clinical practice. With regard to markers for urothelial differentiation, the committee found that there is no ideal marker or established panel to confirm urothelial differentiation. On the basis of the differential diagnostic consideration, positivity for GATA3, CK20, p63, and either high-molecular weight cytokeratin (HMWCK) or cytokeratin (CK)5/6 is of value in proving urothelial differentiation in the appropriate morphologic and clinical context. With regard to the role of IHC in the distinction of reactive atypia from urothelial carcinoma in situ, the committee recommended that morphology remains the gold standard in this differential diagnosis and that, at best, the IHC panel of CK20/p53/CD44(s) has potential utility but is variably used and has limitations. The immunostaining pattern must be interpreted with strict morphologic correlation, because overreliance on IHC may be misleading, particularly in the posttreatment setting. IHC has no role in the distinction of dysplasia versus carcinoma in situ and in the grading of papillary urothelial carcinoma. IHC may have a limited but distinct role in staging of bladder cancer. In a subset of cases, depending on the clinical and histologic context, broad-spectrum cytokeratins (to identify early or obscured invasion) and desmin (distinction of muscle from desmoplasia and to highlight muscle contours for subclassification) may be helpful. Limited experience and conflicting data preclude smoothelin or vimentin to be recommended routinely for subclassifying muscle type at this time. In the workup of a spindled cell proliferation of the bladder and in limited specimens, we recommend an immunohistochemical panel of 6 markers including ALK1, SMA, desmin, cytokeratin (AE1/AE3), and p63 with either of HMWCK or CK5/6. Currently, there are no prognostic immunohistochemical or molecular studies that are recommended to be routinely performed on biopsy or resection specimens. PMID:25029121

Amin, Mahul B; Trpkov, Kiril; Lopez-Beltran, Antonio; Grignon, David

2014-08-01

380

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.

Ball, David; Silvestri, Gerard A.

2013-01-01

381

Expediting the transfer of evidence into practice: building clinical partnerships.  

PubMed

A librarian/clinician partnership was fostered in one hospital through the formation of the Evidence-based Practice Committee, with an ulterior goal of facilitating the transfer of evidence into practice. The paper will describe barriers to evidence-based practice and outline the committee's strategies for overcoming these barriers, including the development and promotion of a Web-based guide to evidence-based practice specifically designed for clinicians (health professionals). Educational strategies for use of the Web-based guide will also be addressed. Advantages of this partnership are that the skills of librarians in meeting the needs of clinicians are maximized. The evidence-based practice skills of clinicians are honed and librarians make a valuable contribution to the knowledge-base of the clinical staff. The knowledge acquired through the partnership by both clinicians and librarians will increase the sophistication of the dialogue between the two groups and in turn will expedite the transfer of evidence into practice. PMID:10928710

Rader, T; Gagnon, A J

2000-07-01

382

Analyzing how radiologists recommend follow-up: toward development of an automated tracking and feedback system for clinical, laboratory, and radiologic studies  

NASA Astrophysics Data System (ADS)

Radiologists often recommend further imaging, laboratory or clinical follow-up as part of a study interpretation, but rarely receive feedback as to the results of these additional tests. In most cases, the radiologist has to actively pursue this information by searching through the multiple electronic medical records at our institution. In this work, we seek to determine if it would be possible to automate the feedback process by analyzing how radiologists phrase recommendations for clinical, laboratory or radiologic follow-up. We surveyed a dozen attending radiologists to create a set of phrases conventionally used to indicate the need for follow-up. Next, we mined dictated reports over a 1-year period to quantify the appearance of each of these phrases. We are able to isolate 5 phrases that appear in over 21,000 studies performed during the 1-year period, and classify them by modality. We also validated the query by evaluating one day's worth of reports for follow-up recommendations and assessing the comparative performance of the follow-up query. By automatically mining imaging reports for these key phrases and tracking these patients' electronic medical records for additional imaging or pathology, we can begin to provide radiologists with automated feedback regarding studies they have interpreted. Furthermore, we can analyze how often these recommendations lead to a definitive diagnosis and enable radiologists to adjust their practice and decision-making accordingly and ultimately improve patient care.

Cook, T. S.; Itri, J. N.; Boonn, W. W.; Kim, W.

2010-03-01

383

A simple instrument for assessing stress in clinical practice.  

PubMed Central

Methods to assess the role of stress factors in patients with medical conditions are often rather complex, require specific training, and are difficult to use in clinical practice. We attempted to develop a short index tailored to a busy clinical setting, which would be easy to use while providing adequate individual information. This index (Psychosocial Index) was largely derived from well-established instruments, such as Kellner's Screening List for Psychosocial Problems. In addition, on the basis of the patient's self-report of items, the clinician is asked to rate four dimensions of the patient's life: stress, wellbeing, psychological distress, and illness behaviour. The questionnaires of 34 female patients with functional medical disorders were first rated by an internist and afterwards, blindly, by a psychiatrist. Agreement between the two raters was excellent, as measured by the intraclass correlation coefficient. It is hoped that this Psychosocial Index may provide a new tool for psychosomatic research and practice.

Sonino, N.; Fava, G. A.

1998-01-01

384

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

385

Diagnostic value of faecal calprotectin in paediatric gastroenterology clinical practice  

Microsoft Academic Search

Background. Faecal calprotectin (FC) is a new marker of intestinal inflammation. Data on FC in paediatric gastroenterology clinical practice are still scarce.Aims. To assess FC values in different paediatric gastrointestinal diseases comparing them with those obtained in healthy children.Patients. Two hundred and eighty-one children (age range 13–216 months) consecutively referred for gastrointestinal symptoms. Seventy-six healthy controls (age range 13–209 months).

R. Berni Canani; L. Rapacciuolo; M. T. Romano; L. Tanturri de Horatio; G. Terrin; F. Manguso; P. Cirillo; F. Paparo; R. Troncone

2004-01-01

386

The 2013 Model of the Clinical Practice of Emergency Medicine.  

PubMed

In 2001, "The Model of the Clinical Practice of Emergency Medicine" was first published. This document, the first of its kind, was the result of an extensive practice analysis of emergency department (ED) visits and several expert panels, overseen by representatives from six collaborating professional organizations (the American Board of Emergency Medicine, the American College of Emergency Physicians, the Society for Academic Emergency Medicine, the Residency Review Committee for Emergency Medicine, the Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents' Association). Every 2 years, the document is reviewed by these organizations to identify practice changes, incorporate new evidence, and identify perceived deficiencies. For this revision, a seventh organization was included, the American Academy of Emergency Medicine. PMID:24842511

Counselman, Francis L; Borenstein, Marc A; Chisholm, Carey D; Epter, Michael L; Khandelwal, Sorabh; Kraus, Chadd K; Luber, Samuel D; Marco, Catherine A; Promes, Susan B; Schmitz, Gillian; Keehbauch, Julia N

2014-05-01

387

Clinical application of topical fluoride products--risks, benefits, and recommendations.  

PubMed

This portion of the symposium discusses the various methods of professionally applying high-concentration topical fluoride products and their risks and benefits. Numerous recent investigations in this area of research are reviewed and discussed. Data from these research investigations point to the need for care when high-potency F products are used, especially in young children. Oral-retained F doses following four-minute topical application procedures ranged from 10 to 31 mg when no suction devices or patient expectoration was utilized. Following the use of suctioning devices, oral-retained F doses ranged from 6 to 12 mg, a clinically unacceptable level. Following the use of suctioning devices plus patient expectoration, the oral-retained F doses were reduced to from 2 to 7.5 mg, depending on type of F product and application system. The following recommendation for topical application of high-potency F products are made: (1) No more than 2 g of gel per tray or approximately 40% of tray capacity should be dispensed. Even more conservative amounts should be considered for small children. (2) Because patients may have the need to swallow during a four-minute topical application procedure, the use of a saliva ejector during the procedure is recommended. (3) Following the four-minute application procedure, the patient should be instructed to expectorate thoroughly for from 30 sec to one min, regardless of whether high-speed suction is utilized. Expectoration is probably the single most effective way of reducing orally retained fluoride. (4) When utilizing custom individually fitted trays for patients requiring daily or weekly application of a high-F-concentration product, utilize only 5 to 10 drops of product per tray. PMID:3475324

Lecompte, E J

1987-05-01

388

Ethical and practical similarities between pedagogical and clinical research.  

PubMed

Clinical research and educational research face similar practical and ethical constraints that impact the rigor of both kinds of studies. Practical constraints facing undergraduate science education research include small sample sizes (largely a result of disproportionate incentives to conduct educational research at small colleges versus large universities), and the impossibility of randomizing individual students to separate arms of a study. Ethical constraints include gaining the informed consent and assuring the confidentiality of study participants, and the requirement of equipoise (i.e., that it is unethical to subject some study participants to an experimental treatment that researchers have good reason to believe to be inferior to another treatment). While these constraints have long been recognized for clinical research, their implications for educational research have not been fully recognized. Criticism that educational research lacks rigor should be tempered by the recognition that educational research is not parallel to laboratory research, but is parallel to clinical research. These parallels suggest solutions to some of the practical and ethical difficulties faced by educational researchers, as well. PMID:23653778

Robson, Rachel L; Huckfeldt, Vaughn E

2012-01-01

389

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

390

Clinical practice guidelines for anemia in chronic kidney disease: problems and solutions. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO)  

Microsoft Academic Search

The development of clinical practice guidelines for the treatment of anemia in chronic kidney disease has been instrumental in identifying and reducing variations in the use of erythropoiesis-stimulating agents and iron replacement. Challenges to the effectiveness and safety of recommendations made in these guidelines were magnified when recent clinical trials showed no benefit or harm with respect to cardiovascular outcomes

Francesco Locatelli; Allen R. Nissenson; Brendan J. Barrett; Rowan G. Walker; David C. Wheeler; Kai U. Eckardt; Norbert H. Lameire; Garabed Eknoyan; Tom Manley

2008-01-01

391

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.

392

[Cranberry preparations in urological practice: view of a clinical pharmacologist].  

PubMed

Cranberry has been used in various urological problems from ancient times but only now cranberry preparations were studied clinically and pharmacologically in terms of prophylaxis of urinary tract infections. The active component of cranberry are protoantocianides which have no antibacterial activity but inhibit adhesion of uropathogenic E.coli due to block of P-fimbria and thus inhibit development of biofilms. When cranberry preparations are taken per os, proantocianides accumulate in high doses in urine. Efficacy of cranberry in prophylaxis of recurrent urinary infection was demonstrated in randomized clinical trials. Administration of standard cranberry preparations containing not less than 36 mg of proantocianides such as monurel is recommended by European Urological Association (EUA). Cranberry preparations are well tolerated, especially in capsules. However, they can contribute to nephrolithiasis progression and enhance anticoagulation action of indirect anticoagulant drugs. PMID:22448492

Sychev, D A

2011-01-01

393

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

394

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

395

National Kidney Foundation K\\/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure  

Microsoft Academic Search

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in Chronic Renal Failure was recently published in the American Journal of Kidney Diseases. This publication provides 27 clinical practice guidelines for adults and 10 clinical practice guidelines for children. The adult guidelines focus primarily on patients undergoing maintenance dialysis therapy, although there are several clinical

Joel D. Kopple

2001-01-01

396

Understanding the Mental Health Needs of American Muslims: Recommendations and Considerations for Practice  

ERIC Educational Resources Information Center

American Muslims represent a heterogeneous population that is underserved by the mental health community, despite increased psychological distress reported since 9/11. This article offers professionals an understanding of the mental health needs of American Muslims. Recommendations for conducting culturally responsive assessments and treatment are…

Ahmed, Sameera; Reddy, Linda A.

2007-01-01

397

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

398

Translating Research into Practice: Trans Youth Recommendations for Improving School Systems  

ERIC Educational Resources Information Center

Trans youth are considered one of the most marginalized and oppressed populations. Many experience transphobia and violence based on their gender identity and expression. This qualitative study describes the school experiences of 24 trans youth in Philadelphia and presents their recommendations for school administrators and educators. To…

Sausa, Lydia A.

2005-01-01

399

Theory and practical recommendations for autocorrelation-based image correlation spectroscopy  

NASA Astrophysics Data System (ADS)

Image correlation spectroscopy (ICS) is a powerful technique for detecting arrangement of fluorophores in images. This tutorial gives background into the mathematical underpinnings of ICS, specifically image autocorrelation. The effects of various artifacts and image processing steps, including background subtraction, noise, and image morphology were examined analytically and their effects on ICS analysis modeled. A series of recommendations was built based on this analysis.

Robertson, Claire; George, Steven C.

2012-08-01

400

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.

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

2014-01-01

401

Vitamin D in North-East Asian clinical nutrition practice.  

PubMed

Sound clinical nutrition practice is grounded in evidence and stimulated by research. Yet, there are unanswered questions about food-health relationships. Clinical nutrition involves the identification of nutritional disorders and the motivation to rectify them with all required care. Vitamin D health exemplifies the biomedical, societal and environmental dimensions of clinical nutrition, its science and practice. It depends most of all on access to sunshine and food and probably represents a paradigm in human health which is still at its beginning. Nevertheless, the problem of its deficiency is much more widespread and common than has been thought since it was first identified as a cause of rickets and osteomalacia. It is now known to spare no body organ or system. The problem in North-East Asia is comparable to much of the rest of the world, but the risk profile for it is exaggerated by atmospheric pollution, cultures with sun-avoidance on account of skin colour and potentially mitigated by foodstuffs like fish, eggs, organ meats and mushrooms which can partially offset sunshine-deficiency. Diagnosis requires a high index of suspicion and confirmation by biochemistry which may not be affordable. Therefore a close working relationship between public health and clinical nutritionist is essential. PMID:23353625

Wahlqvist, Mark L

2013-01-01

402

Ergonomic best practices in masonry: regional differences, benefits, barriers, and recommendations for dissemination.  

PubMed

Within construction the masonry trade has particularly high rates of musculoskeletal disorders (MSDs). A NIOSH-sponsored meeting of masonry stakeholders explored current and potential "Best Practices" for reducing MSDs in masonry and identified potential regional differences in use of practices. To verify and better understand the regional effects and other factors associated with differences in practice use, a national telephone survey of masonry contractors was conducted. The United States was divided into four regions for evaluation: Northeast, Southeast, Midwest, and West Coast. Nine practices with the potential to reduce MSDs in masonry workers were evaluated. Masonry contractors, owners, and foremen completed 183 surveys. The results verify regional differences in use of best practices in masonry. Half-weight cement bags and autoclave aerated concrete were rarely used anywhere, while lightweight block and mortar silos appear to be diffusing across the country. The Northeast uses significantly fewer best practices than other regions. This article examines reasons for regional differences in masonry best practice, and findings provide insight into use and barriers to adoption that can be used by safety managers, researchers, and other safety advocates to more effectively disseminate ergonomic solutions across the masonry industry. PMID:20521196

Hess, Jennifer; Weinstein, Marc; Welch, Laura

2010-08-01

403

Guidelines International Network: toward international standards for clinical practice guidelines.  

PubMed

Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. Standards for guideline development can help organizations ensure that recommendations are evidence-based and can help users identify high-quality guidelines. Such organizations as the U.S. Institute of Medicine and the United Kingdom's National Institute for Health and Clinical Excellence have developed recommendations to define trustworthy guidelines within their locales. Many groups charged with guideline development find the lengthy list of standards developed by such organizations to be aspirational but infeasible to follow in entirety. Founded in 2002, the Guidelines International Network (G-I-N) is a network of guideline developers that includes 93 organizations and 89 individual members representing 46 countries. The G-I-N board of trustees recognized the importance of guideline development processes that are both rigorous and feasible even for modestly funded groups to implement and initiated an effort toward consensus about minimum standards for high-quality guidelines. In contrast to other existing standards for guideline development at national or local levels, the key components proposed by G-I-N will represent the consensus of an international, multidisciplinary group of active guideline developers. This article presents G-I-N's proposed set of key components for guideline development. These key components address panel composition, decision-making process, conflicts of interest, guideline objective, development methods, evidence review, basis of recommendations, ratings of evidence and recommendations, guideline review, updating processes, and funding. It is hoped that this article promotes discussion and eventual agreement on a set of international standards for guideline development. PMID:22473437

Qaseem, Amir; Forland, Frode; Macbeth, Fergus; Ollenschläger, Günter; Phillips, Sue; van der Wees, Philip

2012-04-01

404

Awareness and use of intertrochanteric osteotomies in current clinical practice. An international survey.  

PubMed

Current literature shows that intertrochanteric osteotomies can produce excellent results in selected hip disorders in specific groups of patients. However, it appears that this surgical option is considered an historical one that has no role to play in modern practice. In order to examine current awareness of and views on intertrochanteric osteotomies among international hip surgeons, an online survey was carried out. The survey consisted of a set of questions regarding current clinical practice and awareness of osteotomies. The second part of the survey consisted of five clinical cases and sought to elicit views on preoperative radiological investigations and preferred (surgical) treatments. The results of our survey showed that most of these experts believe that intertrochanteric osteotomies should still be performed in selected cases. Only 56% perform intertrochanteric osteotomies themselves and of those, only 11% perform more than five per year. The responses to the cases show that about 30-40% recommend intertrochanteric osteotomies in young symptomatic patients. This survey shows that the role of intertrochanteric osteotomies is declining in clinical practice. PMID:17431624

Haverkamp, D; Eijer, H; Besselaar, P P; Marti, R K

2008-02-01

405

[The usefulness of platelet function evaluation in clinical practice].  

PubMed

Platelets play a pivotal role in the regulation of both thrombosis and haemostasis. Functional testing of platelet response has been exclusively used in the diagnosis and management of bleeding disorders. Recent advances of light transmission aggregometry and development of more useful devices have demonstrated the clinical utility to enlarge platelet function testing in patients with cardiovascular disease. The ex vivo measurement of residual platelet response seems, with some assays, predictive of adverse clinical events. Still a debate, it represents an emerging area of interest for both the clinician and the basic scientist. Heparin-induced thrombocytopenia diagnosis is also difficult and a functional assay is now available for an easier and rapid method to rule out such a life-threatening situation. This review article will describe the available methods of measuring platelet response and will discuss both the limitations and emerging data supporting the role of platelet function studies in clinical practice. PMID:24235328

Elalamy, Ismail; Gkalea, Vasiliki; Gerotziafas, Grigorios; Ketatni, Hela; Hatmi, Mohamed

2013-11-01

406

Practical considerations of melanoma/skin cancer screening clinics.  

PubMed

In 1989 a voluntary melanoma/skin cancer screening clinic was held in Oss, the Netherlands. The campaign was carried out according to the free clinics conducted since 1985 in the USA. Our experiences with the first clinic urged us to improve on the organization of the screen. This produced a better yield of the second screen, conducted in 1990 in Arnhem. In this paper we present the practical and organizational implications of melanoma/skin cancer screening based on both screening exercises. It is emphasized that only dermatologists should screen. Concomitant public education will enhance self-selection of people at risk for melanoma/skin cancer. There should be ample provider time, sufficient auxiliary personnel and abundant examination rooms. Total-body skin examination is optional. Follow-up of positive screenees is mandatory. It is concluded that melanoma/skin cancer screening is feasible, particularly in countries with a high dermatologist-to-patient ratio. PMID:1392110

Rampen, F H; van Huystee, B E; Kiemeney, L A

1992-01-01

407

Practical clinical considerations of luting cements: A review  

PubMed Central

The longevity of fixed partial denture depends on the type of luting cement used with tooth preparation. The clinician’s