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The management of constipation in palliative care: clinical practice recommendations.  


Constipation is one of the most common problems in patients receiving palliative care and can cause extreme suffering and discomfort. The aims of this study are to raise awareness of constipation in palliative care, provide clear, practical guidance on management and encourage further research in the area. A pan-European working group of physicians and nurses with significant experience in the management of constipation in palliative care met to evaluate the published evidence and produce these clinical practice recommendations. Four potentially relevant publications were identified, highlighting a lack of clear, practical guidance on the assessment, diagnosis and management of constipation in palliative care patients. Given the limited data available, our recommendations are based on expert clinical opinion, relevant research findings from other settings and best practice from the countries represented. Palliative care patients are at a high risk of constipation, and while general principles of prevention should be followed, pharmacological treatment is often necessary. The combination of a softener and stimulant laxative is generally recommended, and the choice of laxatives should be made on an individual basis. The current evidence base is poor and further research is required on many aspects of the assessment, diagnosis and management of constipation in palliative care. PMID:18838491

Larkin, P J; Sykes, N P; Centeno, C; Ellershaw, J E; Elsner, F; Eugene, B; Gootjes, J R G; Nabal, M; Noguera, A; Ripamonti, C; Zucco, F; Zuurmond, W W A



Clinical breast examination: practical recommendations for optimizing performance and reporting.  


Clinical breast examination (CBE) seeks to detect breast abnormalities or evaluate patient reports of symptoms to find palpable breast cancers at an earlier stage of progression. Treatment options for earlier-stage cancers are generally more numerous, include less toxic alternatives, and are usually more effective than treatments for later-stage cancers. For average-risk women aged 40 and younger, earlier detection of palpable tumors identified by CBE can lead to earlier therapy. After age 40, when mammography is recommended, CBE is regarded as an adjunct to mammography. Recent debate, however, has questioned the contributions of CBE to the detection of breast cancer in asymptomatic women and particularly to improved survival and reduced mortality rates. Clinicians remain widely divided about the level of evidence supporting CBE and their confidence in the examination. Yet, CBE is practiced extensively in the United States and continues to be recommended by many leading health organizations. It is in this context that this report provides a brief review of evidence for CBE's role in the earlier detection of breast cancer, highlights current practice issues, and presents recommendations that, when implemented, could contribute to greater standardization of the practice and reporting of CBE. These recommendations may also lead to improved evidence of the nature and extent of CBE's contribution to the earlier detection of breast cancer. PMID:15537576

Saslow, Debbie; Hannan, Judy; Osuch, Janet; Alciati, Marianne H; Baines, Cornelia; Barton, Mary; Bobo, Janet Kay; Coleman, Cathy; Dolan, Mary; Gaumer, Ginny; Kopans, Daniel; Kutner, Susan; Lane, Dorothy S; Lawson, Herschel; Meissner, Helen; Moorman, Candace; Pennypacker, Henry; Pierce, Peggy; Sciandra, Eva; Smith, Robert; Coates, Ralph


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



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

PubMed Central

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

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



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.



Management of primary ciliary dyskinesia in European children: recommendations and clinical practice.  


The European Respiratory Society Task Force on primary ciliary dyskinesia (PCD) in children recently published recommendations for diagnosis and management. This paper compares these recommendations with current clinical practice in Europe. Questionnaires were returned by 194 paediatric respiratory centres caring for PCD patients in 26 countries. In most countries, PCD care was not centralised, with a median (interquartile range) of 4 (2-9) patients treated per centre. Overall, 90% of centres had access to nasal or bronchial mucosal biopsy. Samples were analysed by electron microscopy (77%) and ciliary function tests (57%). Nasal nitric oxide was used for screening in 46% of centres and saccharine tests in 36%. Treatment approaches varied widely, both within and between countries. European region, size of centre and the country's general government expenditure on health partly defined availability of advanced diagnostic tests and choice of treatments. In conclusion, we found substantial heterogeneity in management of PCD within and between countries, and poor concordance with current recommendations. This demonstrates how essential it is to standardise management and decrease inequality between countries. Our results also demonstrate the urgent need for research: to simplify PCD diagnosis, to understand the natural history and to test the effectiveness of interventions. PMID:22282549

Strippoli, Marie-Pierre F; Frischer, Thomas; Barbato, Angelo; Snijders, Deborah; Maurer, Elisabeth; Lucas, Jane S A; Eber, Ernst; Karadag, Bulent; Pohunek, Petr; Zivkovic, Zorica; Escribano, Amparo; O'Callaghan, Chris; Bush, Andrew; Kuehni, Claudia E



Teaching the psychosocial aspects of care in the clinical setting: practical recommendations.  


Communication skills and the psychosocial dimensions of patient care are increasingly taught in medical schools and generalist residency programs. Evidence suggests they are not reinforced or optimally implemented in clinical training. The authors present the product of an iterative process that was part of a national faculty development program and involved both experts and generalist teachers concerning teaching psychosocial medicine while precepting medical students and residents in clinical settings. Using scientific evidence, educational theory, and experience, the authors developed recommendations, presented them in workshops, and revised them based on input from other experts and teachers, who gave feedback and added suggestions. The results are practical, expert consensus recommendations for clinical preceptors on how to teach and reinforce learning in this area. General skills to use in preparing the trainee for improved psychosocial care are organized into the mnemonic "CAARE MORE": Connect personally with the trainee; Ask psychosocial questions and Assess the trainee's knowledge/attitudes/skills/behaviors; Role model desired attitudes/skills/behaviors; create a safe, supportive, enjoyable learning Environment; formulate specific Management strategies regarding psychosocial issues; Observe the trainee's affect and behavior; Reflect and provide feedback on doctor-patient and preceptor-trainee interactions; and provide Educational resources and best Evidence. The preceptor-trainee teaching skills that are recommended parallel good doctor-patient interaction skills. They can be used during both preceptor-trainee and preceptor-trainee-patient encounters. Important common psychosocial situations that need to be managed in patients include substance abuse, depression, anxiety, somatoform disorder, physical and sexual abuse, and posttraumatic stress disorder. For these problems, where high-level evidence exists, specific psychosocial questions for screening and case finding are provided. PMID:15618086

Kern, David E; Branch, William T; Jackson, Jeffrey L; Brady, Donald W; Feldman, Mitchell D; Levinson, Wendy; Lipkin, Mack



Implementing Evidence-Based Practice in Undergraduate Teaching Clinics: A Systematic Review and Recommendations  

Microsoft Academic Search

The objective of this project was to identify an effective methodology of approaching and implementing evidence- based principles in undergraduate teaching clinics to promote evidence-based dentistry in future clinical practice. A systematic review was undertaken to examine evidence-based clinical teaching and faculty continuing education. Research published from 1996 to 2002 was retrieved by searching several databases and the Internet, along

Sara B. Werb; David W. Matear



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



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

PubMed Central

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



European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies  

Microsoft Academic Search

ObjectivesTo develop recommendations for monitoring patients with systemic lupus erythematosus (SLE) in clinical practice and observational studies and to develop a standardised core set of variables to monitor SLE.MethodsWe followed the European League Against Rheumatism (EULAR) standardised procedures for guideline development. The following techniques were applied: nominal groups, Delphi surveys for prioritisation, small group discussion, systematic literature review and two

M. Mosca; C. Tani; M. Aringer; S. Bombardieri; D. Boumpas; R. Brey; R. Cervera; A. Doria; D. Jayne; M. A. Khamashta; A. Kuhn; C. Gordon; M. Petri; O. P. Rekvig; M. Schneider; Y. Sherer; Y. Shoenfeld; J. S. Smolen; R. Talarico; A. Tincani; R. F. van Vollenhoven; M. M. Ward; V. P. Werth; L. Carmona



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



Recommendations on the use of belimumab in systemic lupus erythematosus. GEAS-SEMI Clinical Practice Guide.  


Biological therapies are based on the administration of various types of synthetic molecules related to the immune response. Their use has spread in recent years to the field of systemic autoimmune diseases, particularly to systemic lupus erythematosus (SLE). Until 2011, these diseases were not included in the therapeutic indications approved by international regulatory agencies. Therefore, the use of biological therapies was restricted to clinical trials and to compassionate use for cases refractory to standard treatments (off-label use), which require the approval of the Health Ministry. In 2011, belimumab, a human monoclonal antibody that specifically binds to the soluble form of the protein human B lymphocyte stimulator BlyS, was approved for use in patients with SLE. Because the clinical information on the use of this new drug in patients with SLE has only been obtained from the results of randomized trials, the Study Group of Autoimmune Diseases (GEAS) of the Spanish Society of Internal Medicine (SEMI) has developed therapeutic guidelines. These guidelines are based on the current scientific evidence on the use of belimumab in SLE patients in the clinical practice. PMID:23266125

Ramos-Casals, M; Ruiz-Irastorza, G; Jiménez-Alonso, J; Khamashta, M A



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 Central

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.

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



Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations  

PubMed Central

Clinical practice guidelines are one of the foundations of efforts to improve healthcare. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearinghouses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this second paper, we discuss issues of identifying and synthesizing evidence: deciding what type of evidence and outcomes to include in guidelines; integrating values into a guideline; incorporating economic considerations; synthesis, grading, and presentation of evidence; and moving from evidence to recommendations.



Mania and Insanity: An Analysis of Legal Standards and Recommendations for Clinical Practice  

Microsoft Academic Search

Significant attention has been allotted to the relationship between psychotic disorders and insanity; however, the study of manic symptoms on criminal responsibility evaluations has been virtually ignored. Given that criminal responsibility evaluations with manic defendants pose unique challenges to forensic examiners, recommendations are needed providing guidelines to insure accurate evaluation. Based on the lack of literature in this area, this

Michael J. Vitacco; Ira K. Packer



Treatment for Neuropathic Pain in Patients with Cancer: Comparative Analysis of Recommendations in National Clinical Practice Guidelines from European Countries.  


INTRODUCTION: Neuropathic pain is a common symptom, present in 39% of the patients with cancer pain. Treating this type of pain is challenging, as this patient group is often frail and has comorbidities which increase the risk of side events and hence influences their quality of life. Clinical practice guidelines (CPGs) can be helpful for clinicians, especially when scientific evidence is uncertain or weak. In this study, we focused on the quality of the review of the literature used in treatment recommendations in the selected European CPGs. METHODS: In a previous study, 9 CPGs from European countries that contained at least one paragraph on treatment for neuropathic pain in cancer were included. Recommendations with their grade (according SIGN 55 classification) and supporting literature (first author, patients' population, year and type of publication) were compared between CPGs. RESULTS: In all CPGs, amitriptylin was mentioned as the drug of first choice. Six guidelines proposed also gabapentinoids. Only 30 of the 163 citations (18%) were based on studies in patients with cancer. Seven CPGs did not argue the indirect evidence due to extrapolation of study results from non-cancer to patients with cancer. CONCLUSION: The majority of guideline development groups extrapolated their results from non-cancer publications to formulate recommendations. Consequently, these guidelines fail to address important issues such as altered kinetics and side effect profiles in these patients. We recommend creating specific recommendations by an international expert group for the treatment for neuropathic pain in patients with cancer supported by targeted research in patients with cancer. PMID:23360414

Piano, Virginie; Verhagen, Stans; Schalkwijk, Annelies; Hekster, Yechiel; Kress, Hans; Lanteri-Minet, Michel; Burgers, Jako; Treede, Rolf-Detlef; Engels, Yvonne; Vissers, Kris



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.



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

Microsoft Academic Search

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

P. Kenemans; L. Speroff



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



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

Microsoft Academic Search

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

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


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.



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.



Ethnic specific recommendations in clinical practice guidelines: a first exploratory comparison between guidelines from the USA, Canada, the UK, and the Netherlands  

PubMed Central

Objectives: To investigate whether clinical practice guidelines in different countries take ethnic differences between patients into consideration and to assess the scientific foundation of such ethnic specific recommendations. Design: Analysis of the primary care sections of clinical practice guidelines. Setting: Primary care practice guidelines for type 2 diabetes mellitus, hypertension, and asthma developed in the USA, Canada, the UK, and the Netherlands. Main outcome measures: Enumeration of the ethnic specific information and recommendations in the guidelines, and the scientific basis and strength of this evidence. Results: Different guidelines do address ethnic differences between patients, but to a varying extent. The USA guidelines contained the most ethnic specific statements and the Dutch guidelines the least. Most ethnic specific statements were backed by scientific evidence, usually arising from descriptive studies or narrative reviews. Conclusion: The attention given to ethnic differences between patients in clinical guidelines varies between countries. Guideline developers should be aware of the potential problems of ignoring differences in ethnicity.

Manna, D; Bruijnzeels, M; Mokkink, H; Berg, M



Delivery patterns of recommended chronic kidney disease care in clinical practice: administrative claims-based analysis and systematic literature review  

Microsoft Academic Search

Background  Clinical practice guidelines for management of chronic kidney disease (CKD) have been developed within the Kidney Disease\\u000a Outcomes Quality Initiative (K\\/DOQI). Adherence patterns may identify focus areas for quality improvement.\\u000a \\u000a \\u000a \\u000a Methods  We retrospectively studied contemporary CKD care patterns within a private health system in the United States, and systematically\\u000a reviewed literature of reported practices internationally. Five hundred and nineteen patients with

Marie D. Philipneri; Lisa A. Rocca Rey; Mark A. Schnitzler; Kevin C. Abbott; Daniel C. Brennan; Steven K. Takemoto; Paula M. Buchanan; Thomas E. Burroughs; Lisa M. Willoughby; Krista L. Lentine



Food and dietary pattern-based recommendations: an emerging approach to clinical practice guidelines for nutrition therapy in diabetes.  


Clinical practice guidelines (CPGs) for the nutritional management of diabetes mellitus have evolved considerably over the last 25 years. As major diabetes associations have focussed on the individualization of nutrition therapy, there has been a move toward a broader more flexible macronutrient distribution that emphasizes macronutrient quality over quantity. There is now a call for the integration of food- and dietary pattern-based approaches into diabetes association CPGs. The main argument has been that an approach that focuses on nutrients alone misses important nutrient interactions oversimplifying the complexity of foods and dietary patterns, both of which have been shown to have a stronger influence on disease risk than nutrients alone. Although cancer and heart associations have begun to integrate this approach into their dietary guidelines, diabetes associations have not yet adopted this approach. We provide a rationale for the adoption of this approach for The Canadian Diabetes Association (CDA) 2013 CPGs for nutrition therapy. The systematic review for the development of these guidelines revealed emerging evidence to support the use of vegetarian, Mediterranean, and Dietary Approaches to Stop Hypertension (DASH) dietary patterns as well as specific foods such as dietary pulses and nuts in people with diabetes. Popular and conventional weight loss diets were also found to have similar advantages in people with diabetes, although poor dietary adherence remains an issue with these diets. The CDA 2013 CPGs will support an even greater individualization of nutrition therapy for people with diabetes and appeal to a broader range of practice styles of health professionals. PMID:24070749

Sievenpiper, John L; Dworatzek, Paula D N



Impact of National Clinical Guideline Recommendations for Revascularization of Persistently Occluded Infarct-Related Arteries on Clinical Practice in the United States  

PubMed Central

Background The Occluded Artery Trial (OAT) was a large, randomized controlled trial published in 2006 that demonstrated no benefit to routine percutaneous coronary intervention (PCI) of persistently totally occluded infarct-related arteries (IRA) identified a minimum of 24 hours (on calendar days 3–28) after myocardial infarction (MI). The purpose of this study was to determine the impact of OAT results and consequent change in guideline recommendations for PCI for treatment of persistently occluded IRAs. Methods We identified all patients enrolled in the CathPCI Registry, from 2005 to 2008, undergoing catheterization more than 24 hours after MI with a totally occluded native coronary artery and no major OAT exclusion criteria. We examined trends in monthly rates of PCI for occlusions after OAT publication and after guideline revisions. Because reporting of diagnostic catheterizations was not mandatory, we examined trends among hospitals in the highest quartile for reporting of diagnostic procedures. Results A total of 28 780 patient visits from 896 hospitals were included. Overall, we found no significant decline in the adjusted monthly rate of PCI of occlusions after publication of OAT (odds ratio [OR], 0.997; 95% confidence interval [CI], 0.989–1.006) or after guideline revisions (OR, 1.007; 95% CI, 0.992–1.022). Among hospitals consistently reporting diagnostic catheterizations, there was no significant decline after OAT publication (OR, 1.018; 95% CI, 0.995–1.042), and there was a trend toward decline after guideline revisions (OR, 0.963; 95% CI, 0.920–1.000). Conclusion These findings suggest that the results of OAT and consequent guideline revisions have not, to date, been fully incorporated into clinical practice in a large cross-section of hospitals in the United States.

Deyell, Marc W.; Buller, Christopher E.; Miller, Louis H.; Wang, Tracy Y.; Dai, David; Lamas, Gervasio A.; Srinivas, Vankeepuram S.; Hochman, Judith S.



Toward standard classification schemes for nursing language: recommendations of the American Nurses Association Steering Committee on Databases to Support Clinical Nursing Practice.  

PubMed Central

The American Nurses Association (ANA) Cabinet on Nursing Practice mandated the formation of the Steering Committee on Databases to Support Clinical Nursing Practice. The Committee has established the process and the criteria by which to review and recommend nursing classification schemes based on the ANA Nursing Process Standards and elements contained in the Nursing Minimum Data Set (NMDS) for inclusion of nursing data elements in national databases. Four classification schemes have been recognized by the Committee for use in national databases. These classification schemes have been forwarded to the National Library of Medicine (NLM) for inclusion in the Unified Medical Language System (UMLS) and to the International Council of Nurses for the development of a proposed International Classification of Nursing Practice.

McCormick, K A; Lang, N; Zielstorff, R; Milholland, D K; Saba, V; Jacox, A



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.



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.



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.  


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. PMID:23258972

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



Clinical practice  

PubMed Central

Protein-losing enteropathy (PLE) is a rare complication of a variety of intestinal disorders characterized by an excessive loss of proteins into the gastrointestinal tract due to impaired integrity of the mucosa. The clinical presentation of patients with PLE is highly variable, depending upon the underlying cause, but mainly consists of edema due to hypoproteinemia. While considering PLE, other causes of hypoproteinemia such as malnutrition, impaired synthesis, or protein loss through other organs like the kidney, liver, or skin, have to be excluded. The disorders causing PLE can be divided into those due to protein loss from intestinal lymphatics, like primary intestinal lymphangiectasia or congenital heart disease and those with protein loss due to an inflamed or abnormal mucosal surface. The diagnosis is confirmed by increased fecal concentrations of alpha-1-antitrypsin. After PLE is diagnosed, the underlying cause should be identified by stool cultures, serologic evaluation, cardiac screening, or radiographic imaging. Treatment of PLE consists of nutrition state maintenance by using a high protein diet with supplement of fat-soluble vitamins. In patients with lymphangiectasia, a low fat with medium chain triglycerides (MCT) diet should be prescribed. Besides dietary adjustments, appropriate treatment for the underlying etiology is necessary and supportive care to avoid complications of edema. PLE is a rare complication of various diseases, mostly gastrointestinal or cardiac conditions that result into loss of proteins in the gastrointestinal tract. Prognosis depends upon the severity and treatment options of the underlying disease.

Braamskamp, Marjet J. A. M.; Dolman, Koert M.



International society of geriatric oncology (SIOG) clinical practice recommendations for the use of bisphosphonates in elderly patients  

Microsoft Academic Search

A society of geriatric oncology (SIOG) task force reviewed information from the literature (in PubMed) on bisphosphonates in elderly patients with bone metastases until December 2005. Additional pertinent data were obtained from the manufacturers.Bisphosphonates are recommended in the elderly with bone metastases to prevent skeletal-related events. Intravenous formulations are preferred for the treatment of hypercalcaemia. It has been recognised that

Jean-Jacques Body; Rob Coleman; Philippe Clezardin; Carla Ripamonti; Rene Rizzoli; Matti Aapro



Achievement of recommended glucose and blood pressure targets in patients with type 2 diabetes and hypertension in clinical practice - study rationale and protocol of DIALOGUE  

PubMed Central

Background Patients with type 2 diabetes have 2–4 times greater risk for cardiovascular morbidity and mortality than those without, and this is even further aggravated if they also suffer from hypertension. Unfortunately, less than one third of hypertensive diabetic patients meet blood pressure targets, and more than half fail to achieve target HbA1c values. Thus, appropriate blood pressure and glucose control are of utmost importance. Since treatment sometimes fails in clinical practice while clinical trials generally suggest good efficacy, data from daily clinical practice, especially with regard to the use of newly developed anti-diabetic and anti-hypertensive compounds in unselected patient populations, are essential. The DIALOGUE registry aims to close this important gap by evaluating different treatment approaches in hypertensive type 2 diabetic patients with respect to their effectiveness and tolerability and their impact on outcomes. In addition, DIALOGUE is the first registry to determine treatment success based on the new individualized treatment targets recommended by the ADA and the EASD. Methods DIALOGUE is a prospective observational German multicentre registry and will enrol 10,000 patients with both diabetes and hypertension in up to 700 sites. After a baseline visit, further documentations are scheduled at 6, 12 and 24 months. There are two co-primary objectives referring to the most recent guidelines for the treatment of diabetes and hypertension: 1) individual HbA1c goal achievement with respect to anti-diabetic pharmacotherapy and 2) individual blood pressure goal achievement with different antihypertensive treatments. Among the secondary objectives the rate of major cardio-vascular and cerebro-vascular events (MACCE) and the rate of hospitalizations are the most important. Conclusion The registry will be able to gain insights into the reasons for the obvious gap between the demonstrated efficacy and safety of anti-diabetic and anti-hypertensive drugs in clinical trials and their real world balance of effectiveness and safety.



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.



Clinical Outcome Assessment (COA): Recommended ...  

Center for Drug Evaluation (CDER)

... Exit Disclaimer; Recommendations on Evidence Needed to Support Measurement Equivalence between Electronic and Paper-Based Patient ... More results from


Implementing AORN Recommended Practices for Laser Safety.  


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



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



Implementing AORN recommended practices for electrosurgery.  


Technology is constantly changing, and it is important for perioperative nurses to stay current on new products and technologies in the perioperative setting. AORN's "Recommended practices for electrosurgery" addresses safety standards that all perioperative personnel should follow to minimize risks to both patients and staff members during the use of electrosurgical devices. Recommendations include how to select electrosurgical units and accessories for purchase, how to minimize the potential for patient and staff member injuries, what precautions to take during minimally invasive surgery, and how to avoid surgical smoke hazards. The recommendations also address education/competency, documentation, policies and procedures, and quality assurance/performance improvement. Perioperative nurses should consider the use of checklists and safety posters to remind staff members of the dangers of electrosurgery and the steps to take to minimize the risks for injury. PMID:22381556

Spruce, Lisa; Braswell, Melanie L



Implementing AORN recommended practices for hand hygiene.  


This article focuses on implementing the revised AORN "Recommended practices for hand hygiene in the perioperative setting." The content of the document has been expanded and reorganized from the previous iteration and now includes specific activity statements about water temperature, water and soap dispensing controls, the type of dispensers to use, paper towel dispenser requirements, placement of soap and rub dispensers, and regulatory requirements for products and recommendations for hand hygiene practices. A successful hand hygiene program allows end users to have input into the selection and evaluation of products and should include educating personnel about proper hand hygiene, product composition and safety, and how and when to use specific products. Measures for competency evaluation and compliance monitoring include observations, quizzes, skills labs, electronic monitoring systems, handheld device applications, and data collection forms. PMID:22464622

Patrick, Marcia; Van Wicklin, Sharon A



Practical recommendations for exercise training in patients with COPD.  


The aim of this article was to provide practical recommendations to healthcare professionals interested in offering a pulmonary rehabilitation programme for patients with chronic obstructive pulmonary disease (COPD). The latest research findings were brought together and translated into clinical practice. These recommendations focus on the description of useful assessment tests and of the most common exercise modalities for patients with COPD. We provide specific details on the rationale of why and especially how to implement exercise training in patients with COPD, including the prescription of training mode, intensity and duration, as well as suggestions of guidelines for training progression. PMID:23728873

Gloeckl, Rainer; Marinov, Blagoi; Pitta, Fabio



Sibutramine in clinical practice  

Microsoft Academic Search

The role of sibutramine as an effective adjunct to diet and exercise in weight management programmes has been proven in clinical trials. Although the reality of managing obesity in clinical practice is very different from that of a controlled clinical trial, there is good evidence that sibutramine is an easy-to-use and highly effective additional therapy when used in everyday practice

N Finer



Formalization of clinical practice guidelines.  


Clinical practice guidelines are textual recommendations based on the consensus of medical experts with the aim to solve diagnostic and therapeutic problems. For more advanced use in real medical applications it is necessary to find out mathematical models of physicians' decision-making processes. The acquisition of a formal model from text-based guidelines is a crucial point for development of decision support systems. We introduce a system for formalization and presentation of medical knowledge contained in clinical practice guidelines where knowledge formalization is based on the GLIF model. PMID:18487723

Buchtela, David; Peleska, Jan; Veselý, Arnost; Zvárová, Jana; Zvolský, Miroslav



Using recommendation to support adaptive clinical pathways.  


Clinical pathways are among the main tools used to manage the quality in health-care concerning the standardization of care processes. This paper deals with a recommendation service to support adaptive clinical pathways. The proposed approach can guide physicians in clinical pathways by providing recommendations on possible next steps based on the measurement of the target patient status and medical knowledge from completed clinical cases. The efficiency and usability of the proposed method is validated by experiments referring to a real data set extracted from Electronic Patient Records. The experimental results indicate that the recommendation service can provide its users with advice rationales that remain consistent even when patient status has changed. This makes adaptive clinical pathways possible. PMID:21207121

Huang, Zhengxing; Lu, Xudong; Duan, Huilong



Developing practice recommendations for endovascular revascularization for acute ischemic stroke.  


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

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



[Hydration in clinical practice].  


Water is an essential foundation for life, having both a regulatory and structural function. The former results from active and passive participation in all metabolic reactions, and its role in conserving and maintaining body temperature. Structurally speaking it is the major contributer to tissue mass, accounting for 60% of the basis of blood plasma, intracellular and intersticial fluid. Water is also part of the primary structures of life such as genetic material or proteins. Therefore, it is necessary that the nurse makes an early assessment of patients water needs to detect if there are signs of electrolyte imbalance. Dehydration can be a very serious problem, especially in children and the elderly. Dehydrations treatment with oral rehydration solution decreases the risk of developing hydration disorders, but even so, it is recommended to follow preventive measures to reduce the incidence and severity of dehydration. The key to having a proper hydration is prevention. Artificial nutrition encompasses the need for precise calculation of water needs in enteral nutrition as parenteral, so the nurse should be part of this process and use the tools for calculating the patient's requirements. All this helps to ensure an optimal nutritional status in patients at risk. Ethical dilemmas are becoming increasingly common in clinical practice. On the subject of artificial nutrition and hydration, there isn't yet any unanimous agreement regarding hydration as a basic care. It is necessary to take decisions in consensus with the health team, always thinking of the best interests of the patient. PMID:21428011

Maristany, Cleofé Pérez-Portabella; Segurola Gurruchaga, Hegoi



Grief in the context of HIV: recommendations for practice.  


Grief is a universal human response to loss. While the symptoms of grief are distressing and uncomfortable, they usually diminish over time without therapy. For persons grieving an HIV-related death, however, a variety of unique factors may interfere with the healthy resolution of symptoms. When the grief process becomes complicated, a person may experience serious alterations in physical health and/or disruptions in daily functioning. To assess grief, nurses need to apply interpersonal skills and therapeutic communication techniques in a compassionate manner; currently, no one screening instrument is optimal for evaluating grief in the clinical setting. The person experiencing grief or complicated grief may be referred for support services or counseling, pharmacologic interventions, or cognitive behavioral therapy. This report summarizes evidence from the literature and clinical practice to support recommendations for the practice of nurses caring for persons with HIV-associated grief; recommended strategies are illustrated through an exemplar case study. PMID:23290378

Mallinson, R Kevin


Clinical practice guideline: otitis media with effusion  

Microsoft Academic Search

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

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



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



Journey from clinical practice to clinical research  

PubMed Central

We have experienced a significant change into ‘the way we practice’ since we stepped into the area of clinical research. The training in good clinical practice (GCP) made us capable of imparting the excellence. We describe the experience of our journey from clinical practice to clinical research.

Fulwani, Mahesh; Pardeshi, Raviraj



Ultrasound guided fine-needle aspiration biopsy of thyroid nodules: Guidelines and recommendations vs clinical practice; a 12-month study of 89 patients  

PubMed Central

Introduction Given the high prevalence of thyroid nodules in the general population it is essential to develop a method for identifying those nodules which require fine-needle aspiration biopsy (FNAB) due to suspicion for malignancy in order to avoid over- or under treatment of this disease. The ultrasound (US) criteria identified by Kim et al. and the American Association of Clinical Endocrinologists appear to be the most sensitive and most specific. The purpose of this study was to analyze a sample of patients who underwent FNAB of the thyroid and to compare the obtained data with the international guidelines and the recommendations for management of thyroid nodules. Materials and methods This study analyzed the clinical, anamnestic and US reasons for which 97 nodules located in 89 patients underwent FNAB, and the data were compared with the criteria set by the guidelines and with the cytological results. Results Echogenicity was indication for FNAB in 99% of cases, appearance of the margins in 75.3%, presence of calcifications in 93.8% and presence of vascularity in 73.2%. In a total of 4.1% of cases, cytological outcome was positive for malignancy, 21.6% necessitated monitoring, 4.1% were referred to surgery and histological examination of the surgical specimen and 63.9% resulted negative for malignancy. Discussion The finding of hypoechoic nodules often leads to continued investigation; the presence of intranodular vascularization detected at Doppler US is perceived as suspicious and the presence of microcalcifications always leads to further investigation. On the request of the endocrinologist the dominant nodule in a goiter is in most cases subjected to FNAB even if the volume has not increased. Adequate US criteria can help identify potentially malignant nodules and guide implementation of FNAB. However, identification of malignant nodules using instrumental investigation cannot disregard medical records and clinical laboratory tests. According to the authors’ experience, a close collaboration between endocrinologists, radiologists and pathologists is essential for a correct evaluation of patients with thyroid nodules in order to avoid over or under estimation of the risk of malignancy of a nodule and therefore of the necessity to perform further examinations.

Peli, M.; Capalbo, E.; Lovisatti, M.; Cosentino, M.; Berti, E.; Mattai Dal Moro, R.; Cariati, M.



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.



Recommendations for biomarker identification and qualification in clinical proteomics.  


Clinical proteomics has yielded some early positive results-the identification of potential disease biomarkers-indicating the promise for this analytical approach to improve the current state of the art in clinical practice. However, the inability to verify some candidate molecules in subsequent studies has led to skepticism among many clinicians and regulatory bodies, and it has become evident that commonly encountered shortcomings in fundamental aspects of experimental design mainly during biomarker discovery must be addressed in order to provide robust data. In this Perspective, we assert that successful studies generally use suitable statistical approaches for biomarker definition and confirm results in independent test sets; in addition, we describe a brief set of practical and feasible recommendations that we have developed for investigators to properly identify and qualify proteomic biomarkers, which could also be used as reporting requirements. Such recommendations should help put proteomic biomarker discovery on the solid ground needed for turning the old promise into a new reality. PMID:20739680

Mischak, Harald; Allmaier, Günter; Apweiler, Rolf; Attwood, Teresa; Baumann, Marc; Benigni, Ariela; Bennett, Samuel E; Bischoff, Rainer; Bongcam-Rudloff, Erik; Capasso, Giovambattista; Coon, Joshua J; D'Haese, Patrick; Dominiczak, Anna F; Dakna, Mohammed; Dihazi, Hassan; Ehrich, Jochen H; Fernandez-Llama, Patricia; Fliser, Danilo; Frokiaer, Jorgen; Garin, Jerome; Girolami, Mark; Hancock, William S; Haubitz, Marion; Hochstrasser, Denis; Holman, Rury R; Ioannidis, John P A; Jankowski, Joachim; Julian, Bruce A; Klein, Jon B; Kolch, Walter; Luider, Theo; Massy, Ziad; Mattes, William B; Molina, Franck; Monsarrat, Bernard; Novak, Jan; Peter, Karlheinz; Rossing, Peter; Sánchez-Carbayo, Marta; Schanstra, Joost P; Semmes, O John; Spasovski, Goce; Theodorescu, Dan; Thongboonkerd, Visith; Vanholder, Raymond; Veenstra, Timothy D; Weissinger, Eva; Yamamoto, Tadashi; Vlahou, Antonia



Clinical practice guideline series update.  


Approximately 20 per 100,000 people in the United States are currently living with myasthenia gravis (MG). MG is a chronic condition that occurs in all genders, ethnicities, and ages. The result of a defect at the neuromuscular junction, MG is characterized by fluctuating muscle weakness and fatigue. The purpose of the first edition of this American Association of Neuroscience Nurses' Clinical Practice Guideline is to summarize what is currently known about MG and to provide the reader with nursing-specific recommendations based on supporting evidence from nursing and other disciplines. Nursing Management of the Patient with Myasthenia Gravis includes information on epidemiology; types and classification of MG; pathophysiology; clinical features; clinical course; diagnostic tests; assessment; pharmacological, immunological, and surgical management; and the nurses' pivotal role in the care of the patient with MG. PMID:24025471

Blissitt, Patricia A



Stigma in clinical practice.  


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

Strkalj-Ivezi?, Sla?ana



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


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.Modern Pathology advance online publication, 14 June 2013; doi:10.1038/modpathol.2013.113. PMID:23765245

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



[Practical problems by implementation of vaccination recommendations].  


Patients with inflammatory rheumatic diseases are known to have an increased risk of infections due to the rheumatic disease itself and due to therapy with immunosuppressive agents. The most important procedure to prevent infections is vaccinations, which are usually well-tolerated. The German National Commission for Immunization (?STIKO) has published recommendations for patients with an immunodeficiency. The German Society of Rheumatology (DGRh) has generally implemented these recommendations for patients with chronic inflammatory rheumatic diseases. The immunization status of patients with rheumatic diseases is of increasing importance in routine patient care because some of the recently approved drugs may influence the strength of the immune response to vaccination. However, there is almost no information about the current immunization status and the willingness of patients with rheumatic diseases to undergo vaccination procedures in Germany. There are also no epidemiologic data on the implementation of recommendations for immunization at the level of general practitioners. Here we present the results of a prospective study on the efficacy of standardized recommendations for immunization given to different patient groups with rheumatic diseases treated in a hospital specialized in rheumatology. PMID:22370806

Fendler, C; Saracbasi, E; Dybowski, F; Heldmann, F; Braun, J



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


How to develop guidelines for clinical practice.  


Recent decades have seen an explosion of clinical practice guidelines documents developed to inform clinicians about the best options for managing treatment, with the explicit intent to influence behaviour. As our exposure to guidelines has increased it has become clear that the process of guideline development should follow specific rules in order to avoid disagreement, misunderstanding, misleading recommendations, and confusion. In this article, we review the approach to developing clinical practice guidelines suggested by an international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) workgroup. This approach suggests several steps for guideline development: 1. determine the purpose, scope, and intended audience; 2. select the panel of guideline authors; 3. specify the main focused clinical questions that the recommendations will address; 4. decide on the relative importance of outcomes; 5. find and summarize the evidence supporting each recommendation; 6. determine the quality of the available evidence; 7. evaluate the balance of desirable and undesirable consequences for a particular course of action; 8. formulate recommendations, including their strenght; and 9. consider a system for subsequent guideline implementation and evaluation. We aim to help the readers of practice guidelines asses those guidelines' quality and validity, as well as to assist the authors of future guidelines in systematically generating clinical recommendations. PMID:19002086

Jaeschke, R; Jankowski, M; Brozek, J; Antonelli, M



Adolescent Nutrition: Needs and Recommendations for Practice.  

ERIC Educational Resources Information Center

Discusses the importance of healthy dietary behaviors in youth. Lists many ways in which diet can significantly affect the health of adolescents including: nutrition and learning, chronic disease risk, overweight and obesity, unhealthy weight management practices and eating disorders, barriers to healthy eating habits, and overcoming barriers in…

Massey-Stokes, Marilyn



Adolescent Nutrition: Needs and Recommendations for Practice.  

ERIC Educational Resources Information Center

|Discusses the importance of healthy dietary behaviors in youth. Lists many ways in which diet can significantly affect the health of adolescents including: nutrition and learning, chronic disease risk, overweight and obesity, unhealthy weight management practices and eating disorders, barriers to healthy eating habits, and overcoming barriers in…

Massey-Stokes, Marilyn



Ethnic-Sensitive Practice: Contradictions and Recommendations  

ERIC Educational Resources Information Center

This article identifies some of the contradictions at the theoretical, attitudinal, and behavioral levels that are inherent in current approaches to ethnic-sensitive practice, including: (1) diversity and the history of the profession; (2) ethnicity as a credential; (3) the differential status of minority groups; and (4) the reliance on…

Iglehart, Alfreda P.; Becerra, Rosina M.



the role of clinical practice guidelines in professional power  

Microsoft Academic Search

Evidence-based medicine (EBM) aims to address the persistent prob- lem of clinical practice variation with the help of various tools, including standardized practice guidelines. Based on a systematic evaluation of the available scientific evidence, these guidelines offer recommendations for clinicians about details of patient care and clinical decision making. Because clinical practice guidelines specify how health care should be performed,

Stefan Timmermans



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



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


American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: Executive Summary of recommendations.  


American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules are systematically developed statements to assist health care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. PMID:20479572

Gharib, H; Papini, E; Paschke, R; Duick, D S; Valcavi, R; Hegedüs, L; Vitti, P



American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations.  


American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules are systematically developed statements to assist health care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. PMID:20543551

Gharib, H; Papini, E; Paschke, R; Duick, D S; Valcavi, R; Hegedüs, L; Vitti, P



American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations.  


American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules are systematically developed statements to assist health care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied.These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. PMID:20551008

Gharib, Hossein; Papini, Enrico; Paschke, Ralf; Duick, Daniel S; Valcavi, Roberto; Hegedüs, Laszlo; Vitti, Paolo


Assessing equity in clinical practice guidelines  

Microsoft Academic Search

Recognition of the need for systematically developed clinical practice guidelines (CPGs) has increased dramatically over the past 20 years. CPGs have focused primarily on the effectiveness of interventions, explicitly or implicitly addressing the following question: Will adherence to a recommendation do more good than harm? At times they have also focused on the cost-effectiveness of interventions: Are the net benefits

Antonio Miguel Dans; Leonila Dans; Andrew David Oxman; Vivian Robinson; Joselito Acuin; Peter Tugwell; Rodolfo Dennis; Deying Kang



Cannabinoids in clinical practice.  


Cannabis has a potential for clinical use often obscured by unreliable and purely anecdotal reports. The most important natural cannabinoid is the psychoactive tetrahydrocannabinol (delta9-THC); others include cannabidiol (CBD) and cannabigerol (CBG). Not all the observed effects can be ascribed to THC, and the other constituents may also modulate its action; for example CBD reduces anxiety induced by THC. A standardised extract of the herb may be therefore be more beneficial in practice and clinical trial protocols have been drawn up to assess this. The mechanism of action is still not fully understood, although cannabinoid receptors have been cloned and natural ligands identified. Cannabis is frequently used by patients with multiple sclerosis (MS) for muscle spasm and pain, and in an experimental model of MS low doses of cannabinoids alleviated tremor. Most of the controlled studies have been carried out with THC rather than cannabis herb and so do not mimic the usual clincal situation. Small clinical studies have confirmed the usefulness of THC as an analgesic; CBD and CBG also have analgesic and antiinflammatory effects, indicating that there is scope for developing drugs which do not have the psychoactive properties of THC. Patients taking the synthetic derivative nabilone for neurogenic pain actually preferred cannabis herb and reported that it relieved not only pain but the associated depression and anxiety. Cannabinoids are effective in chemotherapy-induced emesis and nabilone has been licensed for this use for several years. Currently, the synthetic cannabinoid HU211 is undergoing trials as a protective agent after brain trauma. Anecdotal reports of cannabis use include case studies in migraine and Tourette's syndrome, and as a treatment for asthma and glaucoma. Apart from the smoking aspect, the safety profile of cannabis is fairly good. However, adverse reactions include panic or anxiety attacks, which are worse in the elderly and in women, and less likely in children. Although psychosis has been cited as a consequence of cannabis use, an examination of psychiatric hospital admissions found no evidence of this, however, it may exacerbate existing symptoms. The relatively slow elimination from the body of the cannabinoids has safety implications for cognitive tasks, especially driving and operating machinery; although driving impairment with cannabis is only moderate, there is a significant interaction with alcohol. Natural materials are highly variable and multiple components need to be standardised to ensure reproducible effects. Pure natural and synthetic compounds do not have these disadvantages but may not have the overall therapeutic effect of the herb. PMID:11152013

Williamson, E M; Evans, F J



Service chief recommendations in performance-based clinical privileging.  


A medical facility is responsible for the standards of practice of its medical staff and can be found liable if it was negligent in appointing or reappointing a member of the staff who is incompetent. Joint Commission standards require that recommendations for consideration of initial, renewal, or revision of clinical privileges be made based upon peer evaluations of professional performance, judgment, and clinical and technical skills. Valid recommendations involve two discrete steps: collecting data and evaluating that data. The most pertinent data are those of current competence. The responsibility of interpreting the data rests with the Department or Service Chief. It is his clinical experience that enables him to evaluate a providers' care, in light of accepted standards of practice, for a specialty and for a specific region. Subsequently, in order for the Credentials Committee to make a meaningful performance-based privileging recommendation to the military treatment facility Commander, a summary must be written by the Department/Service Chief, incorporating all of the relevant data and the evaluation of those data. Based on the objective data with the accompanying evaluation, the summary must conclude that the provider is physically and mentally capable of performing the procedures requested, including having the social skills necessary to relate with others in the total care of the patient, and that his training, experience, and recent past performance is consistent with the prudent delivery of care. Continuous performance improvement strategies must support this process by organizing hospital committee structures, ancillary staffing, and information management processes to support a decision-making process based on facts. PMID:8855059

Carr, V F



Veteran teachers' use of recommended practices in deaf education.  


Deaf education teacher preparation programs face the likelihood that their graduates may not implement evidenced-based practices they were taught once they have graduated. The literature suggests that new teachers follow the school culture where they work rather than methods and strategies taught in their preparation programs. To investigate whether teachers of students who are deaf or hard of hearing (DHH) implement recommended practices, 23 teachers from three schools for the deaf were interviewed about their implementation and use of two recommended practices: independent reading and problem solving. The guiding questions were: Do teachers of students who are DHH use independent reading and problem solving after the enculturation process? If so, to what level? If not, can a review improve their level of use? Results demonstrated, at least regarding these two practices, that teachers of students who are DHH do implement evidence-based practices in their classrooms. PMID:19350954

Easterbrooks, Susan R; Stephenson, Brenda H; Gale, Elaine



Policy and Practice: Observations and Recommendations To Promote Inclusive Practices.  

ERIC Educational Resources Information Center

Examines the intersection of policy and practice in the areas of systemic reform and special education. Provides examples of statewide system reform efforts in Kentucky, Massachusetts, Oregon, and Vermont, as well as examples of how children with disabilities are included in the total reform efforts. (Author/CR)

Roach, Virginia; Caruso, Michael G.



Diving after stapedectomy: Clinical experience and recommendations  

Microsoft Academic Search

Objectives: Much controversy exists concerning the risk of inner ear barotrauma after stapes surgery in scuba and sky divers. Uniform consensus has not been established regarding poststapedectomy barorestrictions. The purpose of this study was (1) to determine the prevalence of adverse auditory and\\/or vestibular sequelae in patients after stapedectomy related to scuba and sky diving, and (2) to offer recommendations

John W. House; Elizabeth H. Toh; Alejandro Perez



Clinical practice guidelines to inform evidence-based clinical practice  

Microsoft Academic Search

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

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



Groundwater Control in Tunneling. Volume 3: Recommended Practice.  

National Technical Information Service (NTIS)

This volume summarizes Volumes 1 and 2 and presents guidelines for recommended best practice in a concise format. Design and construction details not included in the more general descriptive nature of Volumes 1 and 2 are included herein. The final chapter...

J. D. Guertin W. H. McTigue



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


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

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



Recommended practices for the calibration and use of leaks  

SciTech Connect

This document is the consensus view of the Calibrated Leak Subcommittee of the Recommended Practices Committee of the American Vacuum Society. It is divided into four main sections: Description, Calibration, Proper Usage, and Recommended Documentation of Leaks. Included in Sec. II are discussions of types of leaks, temperature effects, depletion rates, and units of leakage rate measurement. Section III addresses primary and secondary techniques for leak calibration, including uncertainties. Section IV addresses the proper handling and usage of leaks to achieve optimum results, recommendations of standardization of connections, and safety. The documentation to accompany and to be attached to each calibrated leak, recommended in Sec. V, is intended to provide the user with sufficient information about the leak for accurate and safe use. The appendices contain a glossary and a discussion of the use of throughput and flow rate units and conversions.

Ehrlich, C.D. (National Institute of Standards and Technology, Gaithersburg, Maryland 20899 (United States)); Basford, J.A. (Martin Marietta Energy Systems, Oak Ridge, Tennessee 37831 (United States))



Obesity management in adolescence: Clinical recommendations  

PubMed Central

Obesity is recognized by the World Health Organization as an emerging epidemic with significant health risks. This paper outlines the issues for overweight and obese adolescents in Canada, and provides guidelines for providing practical, office-based management in the community. The focus is upon promoting healthy approaches to weight, eating and activity.

Tonkin, Roger S; Sacks, Diane



Influenza Vaccination of HealthCare Personnel Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP)  

Microsoft Academic Search

Summary This report summarizes recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) concerning influenza vaccination of health-care personnel (HCP) in the United States. These recommendations apply to HCP in acute care hospitals, nursing homes, skilled nursing facilities, physician's offices, urgent care centers, and outpatient clinics, and to persons who provide

Michele L. Pearson; Carolyn B. Bridges; Scott A. Harper


Mindfulness Meditation in Clinical Practice  

ERIC Educational Resources Information Center

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

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



Recommendations for clinical electron beam dosimetry: Supplement to the recommendations of Task Group 25  

SciTech Connect

The goal of Task Group 25 (TG-25) of the Radiation Therapy Committee of the American Association of Physicists in Medicine (AAPM) was to provide a methodology and set of procedures for a medical physicist performing clinical electron beam dosimetry in the nominal energy range of 5-25 MeV. Specifically, the task group recommended procedures for acquiring basic information required for acceptance testing and treatment planning of new accelerators with therapeutic electron beams. Since the publication of the TG-25 report, significant advances have taken place in the field of electron beam dosimetry, the most significant being that primary standards laboratories around the world have shifted from calibration standards based on exposure or air kerma to standards based on absorbed dose to water. The AAPM has published a new calibration protocol, TG-51, for the calibration of high-energy photon and electron beams. The formalism and dosimetry procedures recommended in this protocol are based on the absorbed dose to water calibration coefficient of an ionization chamber at {sup 60}Co energy, N{sub D,w}{sup 60{sub C}{sub o}}, together with the theoretical beam quality conversion coefficient k{sub Q} for the determination of absorbed dose to water in high-energy photon and electron beams. Task Group 70 was charged to reassess and update the recommendations in TG-25 to bring them into alignment with report TG-51 and to recommend new methodologies and procedures that would allow the practicing medical physicist to initiate and continue a high quality program in clinical electron beam dosimetry. This TG-70 report is a supplement to the TG-25 report and enhances the TG-25 report by including new topics and topics that were not covered in depth in the TG-25 report. These topics include procedures for obtaining data to commission a treatment planning computer, determining dose in irregularly shaped electron fields, and commissioning of sophisticated special procedures using high-energy electron beams. The use of radiochromic film for electrons is addressed, and radiographic film that is no longer available has been replaced by film that is available. Realistic stopping-power data are incorporated when appropriate along with enhanced tables of electron fluence data. A larger list of clinical applications of electron beams is included in the full TG-70 report available at Descriptions of the techniques in the clinical sections are not exhaustive but do describe key elements of the procedures and how to initiate these programs in the clinic. There have been no major changes since the TG-25 report relating to flatness and symmetry, surface dose, use of thermoluminescent dosimeters or diodes, virtual source position designation, air gap corrections, oblique incidence, or corrections for inhomogeneities. Thus these topics are not addressed in the TG-70 report.

Gerbi, Bruce J.; Antolak, John A.; Deibel, F. Christopher [University of Minnesota, Minneapolis, Minnesota 55455 (United States); and others



Recommendations for clinical electron beam dosimetry: supplement to the recommendations of Task Group 25.  


The goal of Task Group 25 (TG-25) of the Radiation Therapy Committee of the American Association of.Physicists in Medicine (AAPM) was to provide a methodology and set of procedures for a medical physicist performing clinical electron beam dosimetry in the nominal energy range of 5-25 MeV. Specifically, the task group recommended procedures for acquiring basic information required for acceptance testing and treatment planning of new accelerators with therapeutic electron beams. Since the publication of the TG-25 report, significant advances have taken place in the field of electron beam dosimetry, the most significant being that primary standards laboratories around the world have shifted from calibration standards based on exposure or air kerma to standards based on absorbed dose to water. The AAPM has published a new calibration protocol, TG-51, for the calibration of high-energy photon and electron beams. The formalism and dosimetry procedures recommended in this protocol are based on the absorbed dose to water calibration coefficient of an ionization chamber at 60Co energy, N60Co(D,w), together with the theoretical beam quality conversion coefficient k(Q) for the determination of absorbed dose to water in high-energy photon and electron beams. Task Group 70 was charged to reassess and update the recommendations in TG-25 to bring them into alignment with report TG-51 and to recommend new methodologies and procedures that would allow the practicing medical physicist to initiate and continue a high quality program in clinical electron beam dosimetry. This TG-70 report is a supplement to the TG-25 report and enhances the TG-25 report by including new topics and topics that were not covered in depth in the TG-25 report. These topics include procedures for obtaining data to commission a treatment planning computer, determining dose in irregularly shaped electron fields, and commissioning of sophisticated special procedures using high-energy electron beams. The use of radiochromic film for electrons is addressed, and radiographic film that is no longer available has been replaced by film that is available. Realistic stopping-power data are incorporated when appropriate along with enhanced tables of electron fluence data. A larger list of clinical applications of electron beams is included in the full TG-70 report available at Descriptions of the techniques in the clinical sections are not exhaustive but do describe key elements of the procedures and how to initiate these programs in the clinic. There have been no major changes since the TG-25 report relating to flatness and symmetry, surface dose, use of thermoluminescent dosimeters or diodes, virtual source position designation, air gap corrections, oblique incidence, or corrections for inhomogeneities. Thus these topics are not addressed in the TG-70 report. PMID:19673223

Gerbi, Bruce J; Antolak, John A; Deibel, F Christopher; Followill, David S; Herman, Michael G; Higgins, Patrick D; Huq, M Saiful; Mihailidis, Dimitris N; Yorke, Ellen D; Hogstrom, Kenneth R; Khan, Faiz M



[Clinical practice guidelines for severe renal hyperparathyroidism].  


Clinical practice guidelines for bone metabolism and disease in chronic kidney disease (CKD) proposed parathyroidectomy (PTX) in patients with CKD. As surgical indications, the guideline recommended that PTX should be performed in patients with severe hyperparathyroidism (persistent serum i-PTH > 800 pg/mL), associated with hypercalcemia and/or hyperphosphatemia that are refractory to medical treatment. However, the indications are not well defined and there are no studies to define absolute biomedical criteria. The clinical studies is needed to define appropriate indications for surgical treatment. It was confirmed that effective surgical therapy of severe secondary hyperparathyroidism can be accomplished by subtotal PTX or total PTX with autograft. PMID:15577043

Tominaga, Yoshihiro



Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP).  


This report updates the previously published summary of recommendations for vaccinating health-care personnel (HCP) in the United States (CDC. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices [ACIP] and the Hospital Infection Control Practices Advisory Committee [HICPAC]. MMWR 1997;46[No. RR-18]). This report was reviewed by and includes input from the Healthcare (formerly Hospital) Infection Control Practices Advisory Committee. These updated recommendations can assist hospital administrators, infection-control practitioners, employee health clinicians, and HCP in optimizing infection prevention and control programs. The recommendations for vaccinating HCP are presented by disease in two categories: 1) those diseases for which vaccination or documentation of immunity is recommended because of risks to HCP in their work settings for acquiring disease or transmitting to patients and 2) those for which vaccination might be indicated in certain circumstances. Background information for each vaccine-preventable disease and specific recommendations for use of each vaccine are presented. Certain infection-control measures that relate to vaccination also are included in this report. In addition, ACIP recommendations for the remaining vaccines that are recommended for certain or all adults are summarized, as are considerations for catch-up and travel vaccinations and for work restrictions. This report summarizes all current ACIP recommendations for vaccination of HCP and does not contain any new recommendations or policies. The recommendations provided in this report apply, but are not limited, to HCP in acute-care hospitals; long-term-care facilities (e.g., nursing homes and skilled nursing facilities); physician's offices; rehabilitation centers; urgent care centers, and outpatient clinics as well as to persons who provide home health care and emergency medical services. PMID:22108587



Assessing equity in clinical practice guidelines.  


Recognition of the need for systematically developed clinical practice guidelines (CPGs) has increased dramatically over the past 20 years. CPGs have focused primarily on the effectiveness of interventions, explicitly or implicitly addressing the following question: Will adherence to a recommendation do more good than harm? At times they have also focused on the cost-effectiveness of interventions: Are the net benefits worth the costs? They rarely have focused on equity: Are the recommendations fair? The Knowledge Plus Project of the International Clinical Epidemiology Network attempts to improve the process of CPG development by formulating strategies to consider not just technical issues (effectiveness, and efficiency) but sociopolitical dimensions as well (equity and local appropriateness). This article discusses a proposed lens for users to evaluate how well CPGs address issues of equity. PMID:17493507

Dans, Antonio Miguel; Dans, Leonila; Oxman, Andrew David; Robinson, Vivian; Acuin, Joselito; Tugwell, Peter; Dennis, Rodolfo; Kang, Deying



[Tasks' assignments in radiotherapy units: Regulations and practice recommendations].  


Radiation therapy prescription and delivery are the result of a teamwork requiring the specific skills from various professionals. Regulation in force for some of them (medical physicists, or health professionals such as radiation oncologists and radiotherapists) has not followed the evolution of the organization of radiotherapy units, which had to adapt to miscellaneous constraints. This paper analyzes the tasks' assignments among professionals according to current regulations and practices and suggests some regulation change. Recognizing medical physicists and dosimetrists as health professionals is a natural evolution in the practice of radiation therapy. Arguments in favor of such are being discussed here. A larger autonomy of radiotherapists appears necessary and feasible. Whatever the tasks' assignments in radiotherapy units, it should be formally consigned in the management system documentation. Regulations and practice recommendations have deeply evolved over time and justify regulation adjustments. Propositions from the French societies of radiation oncologists, medical physicists and radiotherapists are submitted to French authorities. Decisions are expected. PMID:23993882

Chauvet, B; Lisbona, A; Le Tallec, P



Abuse and smoking cessation in clinical practice.  


Aims and objectives.? This discursive paper explores issues of abuse during smoking cessation counselling. Background.? During a training session for a smoking cessation intervention pilot study, nurses expressed concerns about issues of abuse that had previously surfaced during cessation counselling in their practice. Abused women are more likely to smoke. As guidelines recommend integrating cessation interventions into practice, issues of abuse are likely to surface. Methods.? A literature review and synthesis of abuse and smoking cessation was undertaken to arrive at recommendations for practice. Results.? There are a few suggestions about how to manage abuse within cessation counselling, but none have been studied: (1) integrate stress-management strategies, (2) assess for abuse, (3) provide separate interventions for partners to create a safe environment, and (4) develop interventions that consider the relationship couples have with tobacco. However, coping strategies alone do not address abuse, screening without treatment is not helpful, and partner interventions assume both partners are open to quitting/counselling. In contrast, as with all clinical practice, abuse and cessation would be considered separate but intertwined problems, and following best practice guidelines for abuse would provide the guidance on how to proceed. After care has been taken to address abuse, it is the patient's decision whether to continue with cessation counselling. Conclusion.? Guidelines addresses both care planning and the ethical/legal issues associated with the disclosure of abuse and provide a practical tool for addressing abuse that obviates the need to tailor cessation interventions to abuse. Relevance to clinical practice.? This paper clarifies a relationship between smoking and abuse and the subsequent implications for smoking cessation interventions and highlights the importance of addressing abuse and smoking cessation separately, even though they are interrelated problems. It provides nurses with appropriate initial responses when abuse is disclosed during an unexpected encounter such as during a smoking cessation intervention. PMID:22882871

Smith, Patricia M; Spadoni, Michelle M; Proper, Veronica M



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



Periodontal regeneration in clinical practice  

Microsoft Academic Search

The regeneration or restitution of lost supporting tissue has always been considered the ideal objective of periodontal therapy. However, attempts to convert this intention into solid clinical practice can become tremendously complex, the results of which are very different from the original intention. The aim of this article is to offer an up-to-date, general perspective on periodontal regeneration, orienting the

Francisco Manuel Alpiste Illueca; Pedro Buitrago Vera; Pablo de Grado Cabanilles; Vicente Fuenmayor Fernandez; Francisco José Gil Loscos


Clinical Practice Applications: Facility Based  

Microsoft Academic Search

New applications for facility-based clinical practice continue to be the fastest growing area of interest in nursing informatics (Fig. 7.1). Although there are many technological advances discussed here, the areas of greatest interest are conceptual. Source data capture, the development and use of decision support and expert systems, and the development of a nursing minimum data set as they relate

Kathryn Hannah; Marion Ball; Margaret Edwards


Virtual clinic for medical practice  

US Patent & Trademark Office Database

A method is provided for a virtual clinic to establish communications and working relationships among itself, patients, physicians, and insurance companies patient to facilitate the remote diagnosis and treatment of patients. In one embodiment, a patient may contact its insurance carrier via a web page on the Internet. The insurance company then matches the patient to one of its plans and then forwards information to the virtual clinic which then responds to the patient's web request. The patient is then put in operative communication with a physician who is known by the virtual clinic to be licensed to practice medicine in the patient's current location and to have expertise in the patient's condition.

Haq; Mohamed M. (Galveston County, Friendswood, TX)



Myelodysplastic syndromes: clinical practice guidelines in oncology.  


The myelodysplastic syndromes (MDS) represent a heterogeneous group of clonal hematopoietic disorders characterized by cytopenias, dysplasia in one or more myeloid lineages, and the potential for development of acute myeloid leukemia. These disorders primarily affect older adults. The NCCN Clinical Practice Guidelines in Oncology for MDS provide recommendations on the diagnostic evaluation and classification of MDS, risk evaluation according to established prognostic assessment tools (including the new revised International Prognostic Scoring System), treatment options according to risk categories, and management of related anemia. PMID:23847220

Greenberg, Peter L; Attar, Eyal; Bennett, John M; Bloomfield, Clara D; Borate, Uma; De Castro, Carlos M; Deeg, H Joachim; Frankfurt, Olga; Gaensler, Karin; Garcia-Manero, Guillermo; Gore, Steven D; Head, David; Komrokji, Rami; Maness, Lori J; Millenson, Michael; O'Donnell, Margaret R; Shami, Paul J; Stein, Brady L; Stone, Richard M; Thompson, James E; Westervelt, Peter; Wheeler, Benton; Shead, Dorothy A; Naganuma, Maoko



Clinical writing: additional ethical and practical issues.  


The recommendations by Sieck (2011, Obtaining clinical writing informed consent versus using client disguise and recommendations for practice, Psychotherapy, 49, pp. 3-11.) are a helpful starting point for considering the ethical issues involved in the decision to seek or not to seek informed consent from clients before writing about them. Sieck makes a compelling case for the idea that there are circumstances in which the most ethical choice would be to engage in clinical writing about a client without seeking informed consent, but instead disguising the client's identity. The present response raises a number of questions not considered in the article by Sieck. First, how should one disguise a case? Moreover, how should one assess whether the disguise is sufficient to preserve confidentiality while not distorting the clinical material to the point that the material is no longer useful to the field? Second, how can we estimate the likelihood of clients reading clinical writing, particularly in the age of the Internet? Given that psychologist-authored blogs that include reference to clinical material are beginning to emerge, it is crucial that we engage in a much deeper dialogue about the ethics of clinical writing. Third, how does the presentation of clinical material influence public perceptions of psychotherapy and confidentiality? If these public perceptions, in turn, could influence the likelihood of seeking psychotherapy, might these attitudes be important to consider in ethical thinking about clinical writing? Finally, where do we draw the line between clinical writing and single case study research (which requires informed consent)? PMID:22369079

Woodhouse, Susan S



Clinical effectiveness of biologics in clinical practice  

PubMed Central

TNF inhibitors are currently considered both effective and cost-effective in patients with active rheumatoid arthritis (RA), particularly in patients who have not responded fully to methotrexate. There is substantial doubt about the cost-effectiveness of TNF inhibitors as initial treatment for active RA. New data from the National Data Bank for Rheumatic Diseases now question the current consensus in methotrexate failures. The data suggest that in routine clinical practice TNF inhibitors provide only modest incremental benefits over best conventional therapy. If confirmed, these observational studies suggest that the economic argument underpinning the widespread use of TNF inhibitors in established RA is unsustainable.



Translating biomarkers to clinical practice  

PubMed Central

Biomarkers are the measurable characteristics of an individual that may represent risk factors for a disease or outcome, or that may be indicators of disease progression or of treatment-associated changes. In general, the process by which biomarkers, once identified, might be translated into clinical practice has received scant attention in recent psychiatric literature. A body of work in diagnostic development suggests a framework for evaluating and validating novel biomarkers, but this work may be unfamiliar to clinical and translational researchers in psychiatry. Therefore, this review focuses on the steps that might follow the identification of putative biomarkers. It first addresses standard approaches to characterizing biomarker performance, followed by demonstrations of how a putative biomarker might be shown to have clinical relevance. Finally, it addresses ways in which a biomarker-based test might be validated for clinical application in terms of efficacy and cost-effectiveness.

Perlis, RH



Recommendations for the Clinical Evaluation of Men and Women with Sexual Dysfunction  

Microsoft Academic Search

Introduction. The challenge in the field of sexual medicine is to develop evidence-based principles for clinical evaluation and create a uniform, widely accepted diagnostic and treatment approach for all sexual problems and dysfunctions, for both genders. Aim. To provide recommendations for the broad approach for assessing sexual problems in a medical practice setting; to develop an evidence-based diagnostic and treatment

Dimitrios Hatzichristou; Raymond C. Rosen; Leonard R. Derogatis; Wah Yun Low; Eric J. H. Meuleman; Richard Sadovsky; Tara Symonds



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.



[Seborrheic dermatitis in clinical practice].  


Seborrheic dermatitis is a chronic relapsing inflammatory skin condition characterized by scaling and poorly defined erythematous patches in areas rich in sebaceous glands. It is one of the most frequent skin disorders and may be socially embarrassing. Fungi of the genus Malassezia, lipid-dependent, ubiquitous skin residents, play a pathogenic role. Topical antifungal agents (e.g., ketoconazole) are the mainstay of treatment, and if used intermittently they can maintain remission. The vehicle itself may also play a relevant role. Improvements in diagnostic criteria, severity measures and outcome variables are needed to better design clinical trials and inform clinical practice. PMID:21572485

Rovelli, Francesca; Mercuri, Santo Raffaele; Naldi, Luigi



Bayesian classification of clinical practice guidelines.  


Clinical practice guidelines are generally constructed from an admixture of expert consensus opinion, case-control studies, and randomized controlled trials (RCTs) and are categorized according to the methodological quality of the underlying data (level of evidence) and the trade-off between the benefits and risks of treatment (class of recommendation). The process is driven principally by conventional statistical significance and does not specifically consider the clinical importance of the alternative treatment effects. We herein propose a more formal quantitative algorithm for the construction of guidelines using Bayes's theorem to integrate the clinical trial evidence with a range of prior belief representing the skeptical point of view embodied in the null hypothesis (to the effect that treatment can be expected to produce no reduction in risk), and the enthusiastic point of view embodied in the alternative hypothesis (to the effect that treatment can be expected to produce a specified clinically important reduction in risk). The operative practical utility of this algorithm is illustrated by application to a representative meta-analysis of RCTs. We conclude that this quantitative schema has the potential to improve the quality and cost of evidence-based clinical management. PMID:19667308

Diamond, George A; Kaul, Sanjay



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


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



Implementing AORN recommended practices for MIS: Part II.  


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

Morton, Paula J



Recommended Practice for Patch Management of Control Systems  

SciTech Connect

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

Steven Tom; Dale Christiansen; Dan Berrett



Randomized Play-the-Winner Clinical Trials: Review and Recommendations  

Microsoft Academic Search

The randomized play-the-winner rule is an adaptive randomized design, based on an urn model, that is used occasionally in clinical trials. This paper discusses practical and theoretical issues arising from its use, including stratification, delayed response, operating characteristics, selection of urn parameters, and inference. The paper also discusses recent experience with adaptive clinical trials within the pharmaceutical indus- try. The

William F. Rosenberger



ASCO classification in clinical practice.  


ASCO (Atherosclerosis, Small vessel disease, Cardiac source, Other cause) is a new of classification of ischemic cerebrovascular diseases. This classification categorizes the data of the patients according to all underlying diseases and allows the clinician to grade the severity of cause (Each of the four phenotypes can be graded 1, 2, or 3). It is suggested to use ASCO classification in large epidemiologic studies but this classification may be used in daily practice. In this study we aimed to analyze the clinical features of patients with ischemic stroke and to investigate results of ASCO classification of these patients and data of 35 patients with ischemic stroke is analyzed. Use of ASCO classification is discussed with the special example cases. Patients' etiology of stroke was classified according to ASCO as known, unknown, completely unknown and unclassifiable group. Percentile of the patients classified as "known" was 71.4% (n = 25), "unknown" was 17.1% (n = 6), "completely unknown" was 5.7% (n = 2) and "unclassifiable group" was 5.7% (n = 2). We think that the ASCO classification which is thought to be more useful in large epidemiologic studies may be used in clinical follow-up period of the stroke patients. Further studies, from different neurology centers and stroke units, are needed to expand our experiences about use of ASCO classification in clinical practice. PMID:23607231

Degirmenci, Eylem; Erdogan, Cagdas; Oguzhanoglu, Attila; Bir, Levent Sinan



Evaluation of clinical practice guidelines.  

PubMed Central

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

Basinski, A S



Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS.  


Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some non-liver applications. Time has moved on, and the need for international guidelines on the use of CEUS in the liver has become apparent. The present document describes the third iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS) using contrast specific imaging techniques. This joint WFUMB-EFSUMB initiative has implicated experts from major leading ultrasound societies worldwide. These liver CEUS guidelines are simultaneously published in the official journals of both organizing federations (i.e., Ultrasound in Medicine and Biology for WFUMB and Ultraschall in der Medizin/European Journal of Ultrasound for EFSUMB). These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). They are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide. PMID:23129518

Claudon, M; Dietrich, C F; Choi, B I; Cosgrove, D O; Kudo, M; Nolsøe, C P; Piscaglia, F; Wilson, S R; Barr, R G; Chammas, M C; Chaubal, N G; Chen, M-H; Clevert, D A; Correas, J M; Ding, H; Forsberg, F; Fowlkes, J B; Gibson, R N; Goldberg, B B; Lassau, N; Leen, E L S; Mattrey, R F; Moriyasu, F; Solbiati, L; Weskott, H-P; Xu, H-X



Improving Nutrition in Pregnant Adolescents: Recommendations for Clinical Practitioners  

PubMed Central

Pregnancy represents an ideal time for health promotion activities. Many women, including adolescents, are interested and willing to change health behaviors to improve the chance that they will deliver a healthy infant. This paper focuses on improving nutrition in pregnant adolescents. Seven recommendations are presented to help achieve this goal: 1) Focus on foods, not nutrients; 2) individualize and work within the pregnant adolescent's current eating habits; 3) consider the context of family and peer groups; 4) reward efforts; 5) make it easy; 6) focus on weight gain patterns for optimal birth outcomes; and 7) refer to a dietician, as needed. Use of these recommendations comprehensively addresses adolescent developmental needs to improve nutrition during pregnancy. These recommendations are not meant to be all-inclusive; rather, they are meant to serve as a guide for clinical management of nutrition for pregnant adolescents.

Montgomery, Kristen S.



Recommendations for conducting controlled clinical studies of dental restorative materials  

Microsoft Academic Search

About 35 years ago, Ryge provided a practical approach to evaluation of clinical performance of restorative materials. This\\u000a systematic approach was soon universally accepted. While that methodology has served us well, a large number of scientific\\u000a methodologies and more detailed questions have arisen that require more rigor. Current restorative materials have vastly improved\\u000a clinical performance and any changes over time are

R. Hickel; J.-F. Roulet; S. Bayne; S. D. Heintze; I. A. Mjör; M. Peters; V. Rousson; R. Randall; G. Schmalz; M. Tyas; G. Vanherle



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



Clinical practice guideline: Otitis media with effusion.  


The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline "Otitis Media With Effusion in Young Children," which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children aged 1 to 3 years with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the OME guideline. The subcommittee made a strong recommendation that clinicians use pneumatic otoscopy as the primary diagnostic method and distinguish OME from acute otitis media (AOM). The subcommittee made recommendations that clinicians should (1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME; (2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk; and (3) manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known), or from the date of diagnosis (if onset is unknown). The subcommittee also made recommendations that (4) hearing testing be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME; (5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; and (6) when a child becomes a surgical candidate, tympanostomy tube insertion is the preferred initial procedure. Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy, with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that (1) population-based screening programs for OME not be performed in healthy, asymptomatic children and (2) antihistamines and decongestants are ineffective for OME and should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management. The subcommittee gave as options that (1) tympanometry can be used to confirm the diagnosis of OME and (2) when children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech-language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery), and provide additional relevant information such as history of AOM and developmental status of the child. The subcommittee made no recommendations for (1) complementary and alternative medicine as a treatment for OME based on a lack of scientific evidence documenting efficacy and (2) allergy management as a treatment for OME based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence reviewed. The purpose of this guideline is to inform clinicians of evidence-based method

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



Interpreting the Clinical Importance of Treatment Outcomes in Chronic Pain Clinical Trials: IMMPACT Recommendations  

Microsoft Academic Search

A consensus meeting was convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to provide recommendations for interpreting clinical importance of treatment outcomes in clinical trials of the efficacy and effectiveness of chronic pain treatments. A group of 40 participants from universities, governmental agencies, a patient self-help organization, and the pharmaceutical industry considered methodologic issues

Robert H. Dworkin; Dennis C. Turk; Kathleen W. Wyrwich; Dorcas Beaton; Charles S. Cleeland; John T. Farrar; Jennifer A. Haythornthwaite; Mark P. Jensen; Robert D. Kerns; Deborah N. Ader; Nancy Brandenburg; Laurie B. Burke; David Cella; Julie Chandler; Penny Cowan; Rozalina Dimitrova; Raymond Dionne; Sharon Hertz; Alejandro R. Jadad; Nathaniel P. Katz; Henrik Kehlet; Lynn D. Kramer; Donald C. Manning; Cynthia McCormick; Michael P. McDermott; Henry J. McQuay; Sanjay Patel; Linda Porter; Steve Quessy; Bob A. Rappaport; Christine Rauschkolb; Dennis A. Revicki; Margaret Rothman; Kenneth E. Schmader; Brett R. Stacey; Joseph W. Stauffer; Thorsten von Stein; Richard E. White; James Witter; Stojan Zavisic



EASL clinical practice guidelines for HFE hemochromatosis.  


Iron overload in humans is associated with a variety of genetic and acquired conditions. Of these, HFE hemochromatosis (HFE-HC) is by far the most frequent and most well-defined inherited cause when considering epidemiological aspects and risks for iron-related morbidity and mortality. The majority of patients with HFE-HC are homozygotes for the C282Y polymorphism [1]. Without therapeutic intervention, there is a risk that iron overload will occur, with the potential for tissue damage and disease. While a specific genetic test now allows for the diagnosis of HFE-HC, the uncertainty in defining cases and disease burden, as well as the low phenotypic penetrance of C282Y homozygosity poses a number of clinical problems in the management of patients with HC. This Clinical Practice Guideline will therefore, focus on HFE-HC, while rarer forms of genetic iron overload recently attributed to pathogenic mutations of transferrin receptor 2, (TFR2), hepcidin (HAMP), hemojuvelin (HJV), or to a sub-type of ferroportin (FPN) mutations, on which limited and sparse clinical and epidemiologic data are available, will not be discussed. We have developed recommendations for the screening, diagnosis, and management of HFE-HC. PMID:20471131



WAIS practice effects in clinical neuropsychology  

Microsoft Academic Search

A recent review (Matarazzo, Carmody, & Jacobs, 1980) has focused attention on the issue of WAIS practice effects in clinical practice. Available literature suggests that WAIS practice effects in many samples of patients with neuropsychological dysfunction are minimal. Data relevant to this hypothesis are reviewed. Practical guidelines for the interpretation of test-retest changes on the WAIS in neuropsychological assessment are

Mark W. Shatz



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.



[Lanthanum carbonate in clinical practice].  


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



[Urgent ultrasound in clinical practice].  


Ultrasound (US) has been recognized as a powerful tool for use in the diagnosis and evaluation of many diseases in clinical practice. The possibility of immediate bedside US examinations in the evaluation of specific emergent complaints makes it an ideal tool for the emergency specialist. Correct diagnosis of potential life-threatening emergencies such as hematoperitoneum following blunt trauma, abdominal emergencies, ectopic pregnancy, pericardial tamponade, and aortic aneurysms with US evaluation can be easily made. Emergency physicians now view screening ultrasonography as highly focused and limited to answer on select set of questions. These questions include: Is there a pericardial effusion present? Are there gallstones present? Is there hydronephrosis evident? Is there free peritoneal fluid? Is there intrauterine pregnancy? Is there an abdominal aortic aneurysm (AAA) present? Is there a foreign body? It is clear that emergency screening ultrasound is now accepted tool for the rapid evaluation of the emergency patient. Using this effective diagnostic and therapeutic tool in emergency units our patients will have efficient, safe, and accurate health care. PMID:18822947

Salihefendi?, Nizama; Zildzi?, Muharem



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


ABSTRACT: 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. PMID:23363732

Bookman, Ebony B; Din-Lovinescu, Corina; Worrall, Bradford B; Manolio, Teri A; Bennett, Siiri N; Laurie, Cathy; Mirel, Daniel B; Doheny, Kimberly F; Anderson, Garnet L; Wehr, Kate; Weinshilboum, Richard; Chen, Donna T



Morbidity and Mortality Weekly Report, Volume 54, Number RR-13, November 11, 2005. Good Laboratory Practices for Waived Testing Sites: Survey Findings from Testing Sites Holding a Certificate of Waiver Under the Clinical Laboratory Improvement Amendments of 1988 and Recommendations for Promoting Quality Testing.  

National Technical Information Service (NTIS)

This report summarizes study findings and provides recommendations developed by the Clinical Laboratory Improvement Advisory Committee for conducting quality waived testing. These recommendations include considerations before introducing waived testing, s...

D. Howerton N. Anderson D. Bosse S. Granade G. Westbrook



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



DEC Personnel Preparation in Early Childhood Special Education: Implementing the DEC Recommended Practices.  

ERIC Educational Resources Information Center

The Division for Early Childhood (DEC) of the Council for Exceptional Children (CEC) has developed recommended practices for the ECSE field in the area of personnel preparation. This book provides guidance to higher education faculty and professional development specialists on how these recommended practices can be implemented in preservice and…

Stayton, Vicki D., Ed.; Miller, Patricia S., Ed.; Dinnebeil, Laurie A., Ed.


Ethical Dilemmas in Sport Psychology: Discussion and Recommendations for Practice  

Microsoft Academic Search

The practice demands required of sport psychologists often complicate the direct and specific fulfillment of several ethical regulations. Many practitioners face specific issues of confidentiality and the appropriate use of informed consent, challenges to practicing within areas of competence, issues regarding termination, and challenges that arise from multiorganizational demands and the formation of multiple relationships. Although ethical guidelines established by

Zella E. Moore



Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP).  


This report summarizes recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) concerning influenza vaccination of health-care personnel (HCP) in the United States. These recommendations apply to HCP in acute care hospitals, nursing homes, skilled nursing facilities, physician's offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services. The recommendations are targeted at health-care facility administrators, infection-control professionals, and occupational health professionals responsible for influenza vaccination programs and influenza infection-control programs in their institutions. HICPAC and ACIP recommend that all HCP be vaccinated annually against influenza. Facilities that employ HCP are strongly encouraged to provide vaccine to their staff by using evidence-based approaches that maximize vaccination rates. PMID:16498385

Pearson, Michele L; Bridges, Carolyn B; Harper, Scott A



Family practice clinics. Survey of family practice residents' attitudes.  

PubMed Central

All residents of McGill University's Department of Family Medicine were surveyed by mail about their family practice clinic experience. Residents were generally satisfied with their training site and their supervision, but noted problems with volume and diversity of patients, learning certain procedures, and knowledge of community resources. They did not want more family medicine clinic time.

Rubenstein, H.; Levitt, C.



[Clinical practice guideline on bipolar disorder: Drug and psychosocial therapy].  


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



Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures. Recommendations of the Immunization Practices Advisory committee (ACIP).  


This revision of the Immunization Practices Advisory Committee (ACIP) statement on diphtheria, tetanus, and pertussis updates the statement issued in 1985, and incorporates the 1987 supplementary statement, which addressed two issues: a) the risks and benefits of pertussis vaccine for infants and children with family histories of convulsions; and b) antipyretic use in conjunction with diphtheria and tetanus toxoids and pertussis vaccine absorbed (DTP) vaccination among children with personal or family histories of convulsions (1,2). This document presents new recommendations for epidemiologic investigation and management of contacts of diphtheria patients. The updated recommendations include a review of the epidemiology of the three diseases and descriptions of the available immunobiologic preparations with appropriate vaccination schedules. Also included are a) new information on and reassessment of the possible relation between receipt of DTP and the occurrence of serious acute neurologic illness and permanent brain damage, b) revisions in the recommendations on precautions for and contraindications to pertussis vaccine use, and c) revisions on recommendations for chemoprophylaxis for household and other close contacts of pertussis patients. The Committee has reviewed and taken into consideration the recent report by the Institute of Medicine entitled, "Adverse Effects of Pertussis and Rubella Vaccines" in making these recommendations. PMID:1865873



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



Best Practice Recommendations for Surgical Care in Weight Loss Surgery  

Microsoft Academic Search

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

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



Southern California Water Management: Practical Adoptions and Policy Recommendations  

Microsoft Academic Search

Contrary to popular belief, the L.A. region is more of a desert than a tropical oasis. Little rainfall during the winter months and practically no rainfall during the summer months is characteristic of Southern California’s desert-like weather patterns. Due to these low precipitation levels, water is considered the most important commodity in the Los Angeles region. Prior to 1900, the

Blake Kos



Puzzling practice: a strategy for working with clinical practice issues.  


In this paper we aim to share the evolution of innovative ways to explore, 'unpack' and reframe clinical issues that exist in everyday practice. The elements of these processes, which we call 'puzzling practice', and the techniques associated with them, were delineated over a two year period by the four authors using action theory based processes. The authors have evolved several different frameworks for 'puzzling practice' which we draw on and use in our practice development work and in our research practice. This paper pays attention to a particular form of puzzling practice that we have found to be useful in assisting individual clinicians and teams to explore and find workable solutions to practice issues. The paper uses a semi-fictitious example of 'Puzzling Practice' gleaned from our experience as practice development facilitators. In this example 'puzzling practice' uses seven different elements; naming the issue; puzzling the issue; testing the puzzle exploring the heart of out practice; formulating the puzzle question; visualizing the future; and generating new strategies for action. Each of the elements is illustrated by the story and the key foundations and ideas behind each element is explored. PMID:18315821

Walsh, Kenneth; Moss, Cheryle; Lawless, Jane; McKelvie, Rhonda; Duncan, Lindsay



Clinical and administrative review in general practice  

PubMed Central

Clinical and administrative review in primary medical care can be an enjoyable and creative part of group-practice life. A series of such reviews are described which improve internal or external communication for the primary care team.

Stott, N. C. H.; Davis, R. H.



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

PubMed Central

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



Assessing the practicality of research findings for clinical practice.  


Reading research articles can be challenging, but it also can be stimulating. Once you get a system for reviewing articles and interpreting their worth and value to your practice, you will find much usable information. Reviewing articles with the focus of assessing their importance to clinical practice could be done with a research committee of your local AORN chapter. It also would be an interesting and informational chapter program to have a panel discuss the relevance of two or three studies to perioperative practice. This process and type of information also can be used if your institution is developing research teams. Assessing the practicality of research to your practice is essential. Research is not a mystery; it is the answer to a mystery. It is necessary to the future of perioperative nursing. Change practice with empirical evidence! PMID:10476200

Girard, N



Treating Pressure Ulcers. Volume 2. Guideline Technical Report Number 15. Clinical Practice Guideline.  

National Technical Information Service (NTIS)

This Guideline Technical Report contains comprehensive documentation of the research base for recommendations in the Clinical Practice Guideline on treating pressure ulcers. The guideline offers a comprehensive program for treating adults with pressure ul...

J. Cuddigan N. Bergstrom



Treating Pressure Ulcers. Volume 1. Guideline Technical Report Number 15. Clinical Practice Guideline.  

National Technical Information Service (NTIS)

This Guideline Technical Report contains comprehensive documentation of the research base for recommendations in the Clinical Practice Guideline on treating pressure ulcers. The guideline offers a comprehensive program for treating adults with pressure ul...

J. Cuddigan N. Bergstrom



Change fatigue in clinical practice.  


The University of North Carolina is switching electronic health records (EHRs) next year, and the University of Michigan did so last year. Many others already have or will be adopting them for the first time. What is behind these recent efforts? In two words: meaningful use (see Figure 1). The Centers for Medicare and Medicaid Services (CMS) has issued a set of standards that governs the use of EHRs to improve the quality, safety, and efficiency of health care. Attainment of these meaningful use goals is tied to financial incentives, hence the movement by so many health systems and practices to select and implement these systems. PMID:24080043

Mayer, Deborah K; Hammelef, Karen



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)



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...



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

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.


Exercise therapy is evidence-based treatment of shoulder impingement syndrome. Current practice or recommendation only.  


Background: Subacromial impingement syndrome is the most common indication for shoulder operation. However, exercise therapy for the conservative treatment is recommended in the first instance. Aim: To evaluate the implementation of exercise therapy in impingement syndrome. Design: Retrospective study using structured postal questionnaire and data collected from hospital archive. Methods: A total of 104 consecutive patients who had undergone shoulder surgery due to impingement syndrome. Patients were asked about therapy modalities that they had received before and after the operation as well as pain (VAS) and functional impairment (ASES) at one-year follow-up. Results: Before surgery 49% of patients had not received advice for shoulder muscle exercises. After operation all patients had received mobility exercises, but one quarter of patients still reported that they had not received instructions about shoulder strength exercises. At the follow-up the means of the ASES index was 85 and use of NSAID had decreased by 75%. However, 15% of patients had moderate functional impairment (ASES under 60). Conclusion: About half of patients reported that they had not received advice for rotator cuff exercise therapy before surgery even though with it surgery would probably have been avoided in many cases. Although symptoms in most patients had decreased after operation, several patients still suffered from pain and decreased function. Still several patients had not received advice for shoulder strengthening exercises that are important to recovery. Clinical Rehabilitation Impact: The adherence to the current recommendations about exercise therapy is insufficient in clinical practice. Thus we recommend that it should be monitored in all institutions in which shoulder pain is treated. PMID:23480979

Ylinen, J; Vuorenmaa, M; Paloneva, J; Kiviranta, I; Kautiainen, H; Oikari, M; Häkkinen, A



[Recommendations for secondary prevention of the clinical coronary cardiopathy].  


These recommendations for secondary prevention of clinical coronary cardiopathy are the result of a symposium attended by 46 experts belonging to the councils on arteriosclerosis, clinical cardiology, epidemiology, and prevention and rehabilitation of the International Society and Federation of Cardiology. Secondary prevention of coronary cardiopathy refers to measures designed to prevent deterioration or death in patients with clinical manifestations of coronary cardiopathy. Such measures in addition to drugs include health actions that may improve the status of various coronary risk factors: the patient's life style should stress maintenance of proper weight, regular physical exercise, reduction of saturated fats and cholesterol in the diet, and elimination of smoking and excessive alcohol consumption. It is considered reasonable to control hypertension through the most innocuous means possible, but findings of the few existing controlled studies of effects of treatment of hypertension in coronary cardiopathy are complex. Drug treatment may be necessary for most patients, but nondrug measures should be added when possible. Various proofs including results of some controlled studies justify the recommendations for reducing elevated levels of serum cholesterol and low density lipoprotein cholesterol through dietary measures. Optimum plasma cholesterol levels are 5.2 mmol/1 or less, and the upper limit is 5.7 mmol/1. The rules for secondary prevention are the same for diabetics as for nondiabetics, but some special precautions are necessary in diabetics. Habitual and vigorous physical activity has been associated with a decline in the incidence of coronary cardiopathy in different population studies, although there has been no demonstration that exercise can alter the progression of atherosclerosis or improve collateral circulation. Stress should be recognized as a risk factor and included in secondary prevention, but the concept that stress is the key risk factor in coronary events is in conflict with a large body of scientific evidence. Oral contraceptives (OCs) tend to increase boood pressure and weight as well as serum triglyceride levels, and to reduce glucose tolerance and high density lipoprotein cholesterol in some formulations. OCs also affect the integrity of the vascular endothelium and alter blood coagulation, fibrinolysis, and platelet function. These thrombogenic changes are intensified with age, especially after 35, and with smoking. OCs are innocuous in women under 35 with no history of venous or arterial disease or pulmonary embolism and who have normal blood pressure and serum cholesterol levels. Patients using OCs should control their blood pressure and weight and be alert to any symptoms of thrombotic episodes. The risk/benefit ratio of longterm estrogen treatment in meno- and postmenopausal women with coronary cardiopathy has not yet been established. Apart from 1 study in primates, there is no evidence that vasectomy should be considered either indicated or contraindicated for coronary patients. Beta blockers, platelet function inhibitors, anticoagulants, and other drugs are under active study for secondary prevention of coronary cardiopathy. PMID:2858911


Botulinum toxin in clinical practice  

PubMed Central

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

Jankovic, J



[Platelet inhibitors in clinical practice].  


Despite improvements in the treatment of acute coronary syndromes, cardiovascular disease remains the leading cause of death in Europe and the United States. Antiplatelet agents, such as aspirin and clopidogrel, play an important role in the treatment of those patients. Several new alternatives have been tested in clinical trails and some of them have been approved for routine treatment of patients with ACS in Switzerland and the European Union. The latter include Prasugrel (Efient®) and Ticagrelor (Brilique®). Those substances provide more rapid and consistent platelet inhibition but increase the risk of bleeding in some patient subgroups. Thus, the main challenge is to tailor treatment for each patient by taking into consideration patient characteristics, comorbidities, underlying short- and long-term risk factors, ischemic and bleeding risks, and expected individual responses to different medications. This ambitious new approach will be a challenge for in daily clinical work and may ultimately require prioritization among several treatment alternatives. In this article, we review the new antiplatelet agents being developed as well as their pharmacological characteristics, key interactions and side effects and potential clinical indications in subpopulations. PMID:23117664

Gebhard, C; Beer, J



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

Microsoft Academic Search

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

Tari J Turner



Clinical practice: Contraception in adolescents.  


In affluent societies, median age at menarche has dropped to below 13 years. Younger age at menarche is associated with earlier sexual activity. To avoid unintended teenage pregnancies, barriers to contraception provision must be kept low, i.e. availability without prescription or through a low-threshold prescription system, low-cost options and long-term prescriptions or easy refills. Since many adolescents are (over)concerned about side effects, these should be addressed. A gynaecological examination prior to prescription is no longer recommended. All effective reversible contraceptive methods are available to adolescents: user-based hormonal contraceptives, trimonthly depot medroxyprogesterone acetate (DMPA), and long-acting reversible contraception (LARC). User-based hormonal contraceptives carry a small absolute risk of venous thromboembolism (~4 per 10,000 patient-years), but the risk is more than tenfold higher among young women with an inherited clotting defect. DMPA reduces bone mineral accumulation, but this is a reversible effect; the metabolic risks, including weight gain and insulin resistance, appear to be greater. LARC, including intrauterine contraceptive devices and the progestogen-containing implant, is gaining popularity among teenagers; abnormal bleeding is the main side effect. Any effective contraceptive should preferably be combined with consistent condom use to prevent sexually transmitted infections ("the double Dutch"). PMID:22318432

Verhaeghe, Johan



Management of T2 gallbladder cancer: are practice patterns consistent with national recommendations?  

Microsoft Academic Search

BackgroundThe national recommendation for the management of localized T2 gallbladder cancer (GBCA) is radical cholecystectomy. Although reported survival for localized T2 disease has been poor, groups have documented improvement with radical resection. We hypothesized that a discrepancy exists between national recommendations and current practice patterns.

Byron E. Wright; Chris C. Lee; Douglas M. Iddings; Maihgan Kavanagh; Anton J. Bilchik



Recommended NDT Practice and its Model-based Investigation for Eddy Current Inspection of Aerospace Structures  

Microsoft Academic Search

This paper describes a model-based investigation of inspection standards being developed as a recommended practice for eddy current (EC) NDT of aerospace structures for surface cracks. Compared to experimental investigations that can be laborious and expensive, model-based approach provides cost-effective and quantitative verifications of the recommended practice that covers wide ranges of materials, probes, instruments, frequencies, and test conditions. Probe

B. P. C. Rao; N. Nakagawa



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

ERIC Educational Resources Information Center

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

Downs, Robyn Conley; Downs, Andrew



Recommendations for collection and handling of specimens from group breast cancer clinical trials.  


Recommendations for specimen collection and handling have been developed for adoption across breast cancer clinical trials conducted by the Breast International Group (BIG)-sponsored Groups and the National Cancer Institute (NCI)-sponsored North American Cooperative Groups. These recommendations are meant to promote identifiable standards for specimen collection and handling within and across breast cancer trials, such that the variability in collection/handling practices that currently exists is minimized and specimen condition and quality are enhanced, thereby maximizing results from specimen-based diagnostic testing and research. Three working groups were formed from the Cooperative Group Banking Committee, BIG groups, and North American breast cancer cooperative groups to identify standards for collection and handling of (1) formalin-fixed, paraffin-embedded (FFPE) tissue; (2) blood and its components; and (3) fresh/frozen tissue from breast cancer trials. The working groups collected standard operating procedures from multiple group specimen banks, administered a survey on banking practices to those banks, and engaged in a series of discussions from 2005 to 2007. Their contributions were synthesized into this document, which focuses primarily on collection and handling of specimens to the point of shipment to the central bank, although also offers some guidance to central banks. Major recommendations include submission of an FFPE block, whole blood, and serial serum or plasma from breast cancer clinical trials, and use of one fixative and buffer type (10% neutral phosphate-buffered formalin, pH 7) for FFPE tissue across trials. Recommendations for proper handling and shipping were developed for blood, serum, plasma, FFPE, and fresh/frozen tissue. PMID:18955459

Leyland-Jones, Brian R; Ambrosone, Christine B; Bartlett, John; Ellis, Matthew J C; Enos, Rebecca A; Raji, Adekunle; Pins, Michael R; Zujewski, Jo Anne; Hewitt, Stephen M; Forbes, John F; Abramovitz, Mark; Braga, Sofia; Cardoso, Fatima; Harbeck, Nadia; Denkert, Carsten; Jewell, Scott D



Recommendations for Collection and Handling of Specimens From Group Breast Cancer Clinical Trials  

PubMed Central

Recommendations for specimen collection and handling have been developed for adoption across breast cancer clinical trials conducted by the Breast International Group (BIG)-sponsored Groups and the National Cancer Institute (NCI)-sponsored North American Cooperative Groups. These recommendations are meant to promote identifiable standards for specimen collection and handling within and across breast cancer trials, such that the variability in collection/handling practices that currently exists is minimized and specimen condition and quality are enhanced, thereby maximizing results from specimen-based diagnostic testing and research. Three working groups were formed from the Cooperative Group Banking Committee, BIG groups, and North American breast cancer cooperative groups to identify standards for collection and handling of (1) formalin-fixed, paraffin-embedded (FFPE) tissue; (2) blood and its components; and (3) fresh/frozen tissue from breast cancer trials. The working groups collected standard operating procedures from multiple group specimen banks, administered a survey on banking practices to those banks, and engaged in a series of discussions from 2005 to 2007. Their contributions were synthesized into this document, which focuses primarily on collection and handling of specimens to the point of shipment to the central bank, although also offers some guidance to central banks. Major recommendations include submission of an FFPE block, whole blood, and serial serum or plasma from breast cancer clinical trials, and use of one fixative and buffer type (10% neutral phosphate-buffered formalin, pH 7) for FFPE tissue across trials. Recommendations for proper handling and shipping were developed for blood, serum, plasma, FFPE, and fresh/frozen tissue.

Leyland-Jones, Brian R.; Ambrosone, Christine B.; Bartlett, John; Ellis, Matthew J.C.; Enos, Rebecca A.; Raji, Adekunle; Pins, Michael R.; Zujewski, Jo Anne; Hewitt, Stephen M.; Forbes, John F.; Abramovitz, Mark; Braga, Sofia; Cardoso, Fatima; Harbeck, Nadia; Denkert, Carsten; Jewell, Scott D.



Clinical Practice: Chronic fatigue syndrome.  


The diagnosis chronic fatigue syndrome (CFS) was conceptualized in the mid-1980s. It is a clinically defined condition characterized by severe and disabling new onset fatigue with at least four additional symptoms: impaired memory or concentration, sore throat, tender cervical or axillary lymph nodes, muscle pain, multi-joint pain, new headaches, unrefreshing sleep or post-exertion malaise. Chronic fatigue syndrome in adolescents is a rare condition compared to symptomatic fatigue. The estimated prevalence of adolescent CFS ranges between 0.11 and 1.29 % in Dutch, British, and US populations. Diagnosis of the chronic fatigue syndrome is established through exclusion of other medical and psychiatric causes of chronic fatiguing illness. Taking a full clinical history and a full physical examination are therefore vital. In adolescence, CFS is associated with considerable school absence with long-term detrimental effects on academic and social development. One of the most successful potential treatments for adolescents with CFS is cognitive behavioural therapy, which has been shown to be effective after 6 months in two thirds of the adolescents with CFS. This treatment effect sustains at 2-3-year follow-up. In conclusion, the diagnosis CFS should be considered in any adolescent patient with severe disabling long-lasting fatigue. Cognitive behavioural therapy is effective in 60-70 % of the patients. Prompt diagnosis favours the prognosis. PMID:23756916

Werker, Charlotte L; Nijhof, Sanne L; van de Putte, Elise M



Immunization of Health Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report Recommendations and Reports Vol. 60 No. 7.  

National Technical Information Service (NTIS)

This report updates the previously published summary of recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare (formerly Hospital) Infection Control Practices Advisory Committee (HICPAC) for vaccinating health-care p...



Survey of advanced practice student clinical preceptors.  


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



Placebo interventions, placebo effects and clinical practice  

PubMed Central

This article reviews the role of placebo interventions and placebo effects in clinical practice. We first describe the relevance of different perspectives among scientists, physicians and patients on what is considered a placebo intervention in clinical practice. We then summarize how placebo effects have been investigated in randomized controlled trials under the questionable premise that such effects are produced by placebo interventions. We further discuss why a shift of focus from the placebo intervention to the overall therapeutic context is necessary and what research methods can be used for the clinical investigation of the relevance of context effects. In the last part of the manuscript, we discuss why placebo or context effects are seen as positive in clinical practice when they are associated with active treatments, while placebo interventions pose major ethical and professional problems and have to be avoided.

Linde, Klaus; Fassler, Margrit; Meissner, Karin



Concordance with clinical practice guidelines for dementia in general practice  

Microsoft Academic Search

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

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



Evidence-based practice: justifying changes in clinical practice based upon the appraisal of evidence.  


Patients with diabetes are known to be at higher risk of foot ulceration that can often lead to limb amputation. Anecdotal evidence suggested that the provision of a multidisciplinary foot clinic for patients with diabetes could improve outcomes. Although this approach appears common sense the author required evidence to support a bid for a change in practice. This paper begins by describing some of the origins and principles of evidence based practice and how they can be applied in practice. The search for evidence and critical appraisal of two papers is explained. The tools used to assist implementation of the change in practice are included. The paper concludes with recommendation for changes in practice based upon the evidence found. PMID:12599986

Thompson, Deb



Informed consent in clinical research: policies and practices in Singapore.  


The policies and practices for obtaining informed consent from research subjects in clinical research play a vital role in determining a nation's success as a center for clinical research. The difficulty lies in the fact that while on the one hand, informed consent is a necessary pre-condition for ethical clinical research, a scrupulous observance of the guidelines for informed consent could, on the other hand, cripple medical research. Crippling of ethical medical research can be adverse to public interest, and consequently, unethical. Hence, a fine balance must be struck in the application of the guidelines for obtaining informed consent. This, in turn, would depend on the constitution and skill of research ethics committees who are appointed to consider and approve clinical research proposals. The discussion below addresses the above difficulty with recommendations that could further enhance Singapore's image as a regional clinical trial hub. PMID:15239181

Ramachandran, A J



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.


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



Enhancing reflective practice through online learning: impact on clinical practice  

PubMed Central

Purpose Traditionally, radiographers and radiation therapists function in a workplace environment that is protocol-driven with limited functional autonomy. The workplace promotes a culture of conformity and discourages practitioners from reflective and critical thinking, essential attributes for continuing learning and advancing workplace practices. As part of the first author’s doctoral study, a continuing professional development (CPD) educational framework was used to design and implement an online module for radiation therapists’ CPD activities. The study aimed to determine if it is possible to enhance healthcare practitioners’ reflective practice via online learning and to establish the impact of reflective learning on clinical practice. Materials and methods The objectives of the online module were to increase radiation therapists’ knowledge in planning for radiation therapy for the breast by assisting them engage in reflective practice. The cyclical process of action research was used to pilot the module twice with two groups of volunteer radiation therapists (twenty-six participants) from Australia, New Zealand and Canada. Results The online module was evaluated using Kirkpatrick’s four-level evaluation model. Evidence indicated that participants were empowered as a result of participation in the module. They began reflecting in the workplace while assuming a more proactive role and increased clinical responsibilities, engaged colleagues in collaborative reflections and adopted evidence-based approaches in advancing clinical practices. Conclusion The study shows that it is possible to assist practitioners engage in reflective practice using an online CPD educational framework. Participants were able to apply the reflective learning they had developed in their workplace. As a result of their learning, they felt empowered to continue to effect changes in their workplace beyond the cessation of the online module.

Sim, J; Radloff, A



Medical nutrition therapy in chronic kidney failure: Integrating clinical practice guidelines  

Microsoft Academic Search

This review updates earlier published recommendations and integrates current clinical practice guidelines for nutritional care in chronic kidney disease as recommended by the National Kidney Foundation Kidney Dialysis Outcome Quality Initiative (K\\/DOQI). The scope covers chronic kidney disease in adults prior to kidney failure (Stages 1–4), chronic kidney failure with hemodialysis or peritoneal dialysis replacement therapy (Stage 5), and management

Judith A. Beto; Vinod K. Bansal



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



Operationalization of clinical practice guidelines using fuzzy logic.  

PubMed Central

There are a number of obstacles to successful operationalization of clinical practice guidelines, including the difficulty in accurately representing a statement's decidability or an action's executability. Both require reasoning with incomplete and imprecise information, and we present one means of processing such information. We begin with a brief overview of fuzzy set theory, in which elements can have partial memberships in multiple sets. With fuzzy inferencing, these sets can be combined to create multiple conclusions, each with varying degrees of truth. We demonstrate a fuzzy model developed from a published clinical practice guideline on the management of first simple febrile seizures. Although the creation of fuzzy sets can be an arbitrary process, we believe that fuzzy inferencing is an effective tool for the expression of guideline recommendations, and that it can be useful for the management of imprecision and uncertainty.

Liu, J. C.; Shiffman, R. N.



Best practices for veterinary toxicologic clinical pathology, with emphasis on the pharmaceutical and biotechnology industries.  


The purpose of this paper by the Regulatory Affairs Committee (RAC) of the American Society for Veterinary Clinical Pathology (ASVCP) is to review the current regulatory guidances (eg, guidelines) and published recommendations for best practices in veterinary toxicologic clinical pathology, particularly in the pharmaceutical and biotechnology industries, and to utilize the combined experience of ASVCP RAC to provide updated recommendations. Discussion points include (1) instrumentation, validation, and sample collection, (2) routine laboratory variables, (3) cytologic laboratory variables, (4) data interpretation and reporting (including peer review, reference intervals and statistics), and (5) roles and responsibilities of clinical pathologists and laboratory personnel. Revision and improvement of current practices should be in alignment with evolving regulatory guidance documents, new technology, and expanding understanding and utility of clinical pathology. These recommendations provide a contemporary guide for the refinement of veterinary toxicologic clinical pathology best practices. PMID:23889060

Tomlinson, Lindsay; Boone, Laura I; Ramaiah, Lila; Penraat, Kelley A; von Beust, Barbara R; Ameri, Mehrdad; Poitout-Belissent, Florence M; Weingand, Kurt; Workman, Heather C; Aulbach, Adam D; Meyer, Dennis J; Brown, Diane E; Macneill, Amy L; Bolliger, Anne Provencher; Bounous, Denise I



Translating Patient Safety Research into Clinical Practice  

Microsoft Academic Search

There is a pressing need to make patient safety research more relevant to clinicians and decisionmakers. The RE-AIM framework of Reach, Effectiveness, Adoption, Implementation, and Maintenance is one approach investigators can use to assess a study's potential for translation from research to clinical practice. In this paper, we show how the RE-AIM approach is being used to evaluate a pharmacy

David J. Magid; Paul A. Estabrooks; David W. Brand; Marsha A. Raebel; Ted E. Palen; John F. Steiner; Eli J. Korner; David W. Bates; Richard Platt; Russell E. Glasgow


Balancing Certainty and Uncertainty in Clinical Practice  

ERIC Educational Resources Information Center

|Purpose: In this article, I question how practitioners can balance the certainty and confidence that they can help their patients with the uncertainty that makes them continually question their beliefs and assumptions. Method: I compare the mechanisms of science and models of clinical practice that may help practitioners achieve the right balance…

Kamhi, Alan G.



Clinical practice guidelines: a critical review  

Microsoft Academic Search

Purpose – Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG compliance among practitioners so far would aid the understanding of factors influencing CPG compliance. This study seeks to provide this. Design\\/methodology\\/approach – A general review and discussion of

Keng Boon Harold Tan



Clinical nutrition practice in Italian Gastroenterology Units  

Microsoft Academic Search

Background. Nutritional status affects the course, ensuing complications and prognosis of virtually all diseases.Aims. To define the role of nutrition in Gastroenterology Units by means of two investigations that analyse: a) availability of devices for assessing nutritional status; b) nutritional treatment in clinical practice: incidence and frequency of indications for its use, together with type of treatment adopted.Patients and Methods.

F. W. Guglielmi; C. Panella; A. Losco; G. Budillon; D. Conte; C. Del Vecchio Blanco; G. Gasbarrini; C. Loguercio; M. Merli; G. Mingrone; G. Nardone; O. Riggio; A. Francavilla



Vaccinia (smallpox) vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2001.  


These revised recommendations regarding vaccinia (smallpox) vaccine update the previous Advisory Committee on Immunization Practices (ACIP) recommendations (MMWR 1991;40; No. RR-14:1-10) and include current information regarding the nonemergency use of vaccinia vaccine among laboratory and health-care workers occupationally exposed to vaccinia virus, recombinant vaccinia viruses, and other Orthopoxviruses that can infect humans. In addition, this report contains ACIP's recommendations for the use of vaccinia vaccine if smallpox (variola) virus were used as an agent of biological terrorism or if a smallpox outbreak were to occur for another unforeseen reason. PMID:15580803

Rotz, L D; Dotson, D A; Damon, I K; Becher, J A



Development of an electronic nursing records system based on information models and clinical practice guidelines.  


The purpose of this study was to test the feasibility of an electronic nursing records system for perinatal care that is based on information models and clinical practice guidelines in perinatal care. We first generated 799 nursing statements describing nursing assessment, diagnoses, interventions, and outcomes using the entities, attributes, and value sets of detailed clinical models for perinatal care that we developed in a previous study. We then extracted 506 detailed recommendations from clinical practice guidelines. Finally, we created sets of nursing statements to be used for nursing documentation by grouping nursing statements based on these detailed recommendations. A prototype electronic nursing records system providing nurses with detailed recommendations for nursing practice and sets of nursing statements based on the detailed recommendations to guide nursing documentation was developed and evaluated. PMID:22874402

Park, Hyeoun-Ae; Min, Yul Ha; Jeon, Eunjoo; Kim, Younglan; Km, Hyun-Young



Updated clinical recommendations for the use of tibolone in Asian women  

PubMed Central

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

Huang, K-E.; Baber, R.



Lexical concept distribution reflects clinical practice.  


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

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



Clinical decision support in electronic prescribing: recommendations and an action plan: report of the joint clinical decision support workgroup.  


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

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



Recommendations Accepted to Revamp NCI Clinical Trials System

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.


Do We Practice What We Preach? A Review of Actual Clinical Practice with Regards to Preconception Care Guidelines  

PubMed Central

Objectives: To review what past studies have found with regard to existing clinical practices and approaches to providing preconception care. Methods: A literature review between 1966 and September 2005 was performed using Medline. Key words included preconception care, preconception counseling, preconception surveys, practice patterns, pregnancy outcomes, prepregnancy planning, and prepregnancy surveys. Results: There are no current national recommendations that fully address preconception care; as a result, there is wide variability in what is provided clinically under the rubric of preconception care. Conclusions: In 2005, the Centers for Disease Control and Prevention sponsored a national summit regarding preconception care and efforts are underway to develop a uniform set of national recommendations and guidelines for preconception care. Understanding how preconception care is presently incorporated and manifested in current medical practices should help in the development of these national guidelines. Knowing where, how, and why some specific preconception recommendations have been successfully adopted and translated into clinical practice, as well as barriers to implementation of other recommendations or guidelines, is vitally important in developing an overarching set of national guidelines. Ultimately, the success of these recommendations rests on their ability to influence and shape women's health policy.

Abelman, Steve; Schulkin, Jay; Williams, Jennifer L.; Fassett, Elizabeth M.



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.



American Clinical Magnetoencephalography Society Clinical Practice Guideline 2: Presurgical Functional Brain Mapping Using Magnetic Evoked Fields*  

PubMed Central

The following are “minimum standards” for the routine clinical recording of magnetic evoked fields (MEFs) in all age-groups. Practicing at minimum standards should not be the goal of a magnetoencephalography (MEG) center but rather a starting level for continued improvement. Minimum standards meet only the most basic responsibilities to the patient and the referring physician. These minimum standards have been put forth to improve standardization of procedures, to facilitate interchange of recordings and reports among laboratories in the United States, and to confirm the expectations of referring physicians. Recommendations regarding Laboratory (Center) Environment and Preparation for MEG Recordings are detailed in the American Clinical Magnetoencephalography Society Clinical Practice Guideline (CPG) 1 : Recording and Analysis of Spontaneous Cerebral Activity, except for its EEG aspect that is not considered necessary (although may be helpful in trained hands) for MEFs (presurgical functional brain mapping).

Burgess, Richard C.; Funke, Michael E.; Bowyer, Susan M.; Lewine, Jeffrey D.; Kirsch, Heidi E.; Bagic, Anto I.



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

Microsoft Academic Search

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

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



Measurement Issues in Single Wall Carbon Nanotubes (NIST Recommended Practice Guide).  

National Technical Information Service (NTIS)

The NIST Recommended Practice Guide on Measurement Issues in 'Single Wall Carbon Nanotubes' represents the output from the 2nd NASA-NIST workshop devoted to issues of nanotube purity, dispersion and measurement techniques held at NIST in 2005. In attendan...

K. Migler S. Arepalli S. Freiman S. Hooker



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.



Progress on the development of standards and recommended practices for CEM computer modeling and code validation  

Microsoft Academic Search

Progress towards the development of standards and recommended practices for computational electromagnetics (CEM) computer modeling and simulation and code validation is discussed in this paper. This has been a topic of recent interest within the electromagnetics community. The relevant areas addressed include printed circuit board radiated and conducted emissions\\/immunity, system-level EMC, radar cross section (RCS) of complex structures, and the

Andrew L. Drozd



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

ERIC Educational Resources Information Center

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

Fedler, Anthony J.; Matthews, Bruce E.



Engaged Supervision to Support Recommended Practices for Young Children with Challenging Behavior  

ERIC Educational Resources Information Center

Although in the last 20 years much progress has been made on understanding the challenging behaviors of young children and providing effective prevention and intervention, it is not at all certain that recommended practices have been widely adopted across early care and education programs. In this article, the authors argue that a major impediment…

Strain, P. S.; Joseph, G. E.



Cystic Fibrosis Prenatal Screening in Genetic Counseling Practice: Recommendations of the National Society of Genetic Counselors  

Microsoft Academic Search

For over a decade, prenatal screening for cystic fibrosis (CF) has been considered a model for the integration of genetic testing into routine medical practice. Data from pilot studies and public policy discourse have led to recommendations by some professional organizations that CF screening should be offered or made available to pregnant women and their partners, and to couples planning

Elinor Langfelder-Schwind; Edward Kloza; Elaine Sugarman; Barbara Pettersen; Trisha Brown; Kim Jensen; Seth Marcus; Joy Redman



Recommended practice for determining exhaust emissions from heavy-duty vehicles under transient conditions. Technical report  

Microsoft Academic Search

This recommended practice represents the completion of one phase of EPA's transient cycle development effort. The finalized chassis procedures detailed here parallel the engine test procedures recently published as subpart N of the Heavy-Duty Notice of Proposed Rulemaking (NPRM). The engine test will remain for EPA the primary means of determining transient heavy-duty emissions; however, the chassis test will be

C. J. France; W. Clemmens; T. Wysor



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

ERIC Educational Resources Information Center

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

Fedler, Anthony J.; Matthews, Bruce E.



Drug testing of adolescents in general medical clinics, in school and at home: physician attitudes and practices  

Microsoft Academic Search

PurposeTo determine (1) whether physicians agree with recommendations for home and school drug screening, (2) under what circumstances physicians recommend urine drug tests for adolescents, and (3) how physicians manage adolescent patients with positive results. Few clinical practice guidelines have been published on urine drug testing of adolescents, and it is not known when physicians recommend this procedure or how

Sharon Levy; Sion K. Harris; Lon Sherritt; Michelle Angulo; John R. Knight



Practical guide to understanding the need for clinical practice guidelines.  


With recent changes in the landscape of health care, clinical practice guidelines (CPGs) have proliferated. Attitudes about guidelines differ considerably, forming 2 competing viewpoints with considerable tension between them. Some feel CPGs are unneeded or are efforts to create automated "cookie cutter" medical practice; at best, they are perceived as suggestions that may be altered by experience. Others feel they are mandates that must be followed to the letter. This article attempts to explain how and why we have arrived at this point and to explain the origins of the differing viewpoints. We begin by describing the 2 viewpoints and proceed to define the origin of medicine as a profession and to chronicle the evolution of health insurance, medical education, and scientific methods for evaluating evidence. PMID:23625796

Neely, J Gail; Graboyes, Evan; Paniello, Randal C; Sequeira, Sunitha M; Grindler, David J



Recommendations for practices utilizing gestational carriers: an ASRM Practice Committee guideline.  


This document provides the latest recommendations for evaluation of gestational carriers and intended parents. It incorporates recent information from the US Centers for Disease Control and Prevention, the US Food and Drug Administration, and the American Association of Tissue Banks, with which all programs offering gestational carrier services must be thoroughly familiar. PMID:22503416



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


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



Initiation of Warfarin Therapy: Recommendations and Clinical Pearls  

Microsoft Academic Search

Warfarin is a commonly used medication with a narrow therapeutic index. The initiation of warfarin requires consideration of a variety of factors, which include reviewing the indications and contraindications for this agent, performing a thorough clinical assessment along with a risk-benefit analysis for anticoagulation, consideration of warfarin pharmacology, developing strategies to monitor the intensity of anticoagulation and for the detection

Stephen Erban



Clinical practice: between Aristotle and Cochrane.  


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



Changes in compliance with recommended infection control practices and affecting factors among dentists in Taiwan.  


Compliance with recommended infection control practices in East Asia has not been clearly documented. To investigate changes in compliance with recommended infection control practices over a eleven-year period and to identify affecting factors, two nationwide cross-sectional surveys of dentists in Taiwan were conducted in 1999 and 2010. An anonymous questionnaire that assessed characteristics of dentists and practices of recommended infection control guidelines was mailed. Results showed that all infection control practices surveyed had improved in 2010. Factors affecting compliance with wearing basic protective barriers in 2010 were being female (odds ratio [OR]=3.631, p<0.001), aged forty-one to fifty years (OR=3.991, p<0.05), treating twenty-one to thirty patients per day (OR=2.690, p<0.05), and having information sources from seminars and conferences (OR=2.659, p<0.05). Although infection control practices have improved over time, there is still much room to increase rates of wearing a head cap, protective eyewear, and a face mask and disinfecting impression materials. Providing correct information about disinfection and sterilization processes through the Internet might be effective in improving compliance. PMID:23225688

Cheng, Hsin-Chung; Su, Chen-Yi; Huang, Chiung-Fang; Chuang, Chi-Yu



Primary Care Physicians' Cancer Screening Recommendation Practices and Perceptions of Cancer Risk of Asian Americans  

PubMed Central

Asian Americans experience disproportionate incidence and mortality rates of certain cancers, compared to other racial/ethnic groups. Primary care physicians are a critical source for cancer screening recommendations and play a significant role in increasing cancer screening of their patients. This study assessed primary care physicians’ perceptions of cancer risk in Asians and screening recommendation practices. Primary care physicians practicing in New Jersey and New York City (n=100) completed a 30-question survey on medical practice characteristics, Asian patient communication, cancer screening guidelines, and Asian cancer risk. Liver cancer and stomach cancer were perceived as higher cancer risks among Asian Americans than among the general population, and breast and prostate cancer were perceived as lower risks. Physicians are integral public health liaisons who can be both influential and resourceful toward educating Asian Americans about specific cancer awareness and screening information.

Kwon, Harry T; Ma, Grace X; Gold, Robert S; Atkinson, Nancy L; Wang, Min Qi



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


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:22178693

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



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


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 posttransplant 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:22446607

Majhail, N S; Rizzo, J D; Lee, S J; Aljurf, M; Atsuta, Y; Bonfim, C; Burns, L J; Chaudhri, N; Davies, S; Okamoto, S; Seber, A; Socie, G; Szer, J; Van Lint, M T; Wingard, J R; Tichelli, A



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



An Opportunity to Bridge the Gap Between Clinical Research and Clinical Practice: Implications for Clinical Training  

PubMed Central

Clinical researchers and clinical practitioners share a goal of increasing the integration of research and clinical practice, which is reflected in an evidence-based practice (EBP) approach to psychology. The EBP framework involves the integration of research findings with clinical expertise and client characteristics, values, and preferences, and consequently provides an important foundation for conducting clinically relevant research, as well as empirically based and clinically sensitive practice. Given the critical role that early training can play in the integration of science and practice and in promoting the future of the field, the present article addresses predoctoral training programs as a context for adopting an EBP approach to clinical work. We address training in the three components of EBP and provide suggestions for curriculum development and practicum training that we hope will contribute to bridging the gap between research and practice.

Hershenberg, Rachel; Drabick, Deborah A. G.; Vivian, Dina



Do We Practice What We Preach? A Review of Actual Clinical Practice with Regards to Preconception Care Guidelines  

Microsoft Academic Search

Objectives: To review what past studies have found with regard to existing clinical practices and approaches to providing preconception\\u000a care. Methods: A literature review between 1966 and September 2005 was performed using Medline. Key words included preconception care, preconception\\u000a counseling, preconception surveys, practice patterns, pregnancy outcomes, prepregnancy planning, and prepregnancy surveys.\\u000a Results: There are no current national recommendations that fully

Michele Curtis; Steve Abelman; Jay Schulkin; Jennifer L. Williams; Elizabeth M. Fassett



A qualitative study of nursing student experiences of clinical practice  

Microsoft Academic Search

BACKGROUND: Nursing student's experiences of their clinical practice provide greater insight to develop an effective clinical teaching strategy in nursing education. The main objective of this study was to investigate student nurses' experience about their clinical practice. METHODS: Focus groups were used to obtain students' opinion and experiences about their clinical practice. 90 baccalaureate nursing students at Shiraz University of

Farkhondeh Sharif; Sara Masoumi



Scaffolding student learning in clinical practice.  


For many years the profession has acknowledged a schism between theories taught in the classroom and the practice of clinicians. This tends to arise from beliefs that knowledge which has been generalized (formalized) can be readily transferred to informal settings (practice). Whilst apprehension of formalized knowledge is crucial to professional development, a mediator is necessary to demonstrate its relevance to practice. A variety of solutions have been offered which all have value but without effective social support fail to resolve the problem. Findings from a longitudinal study investigating the professional development of pre-registration nursing students indicate the importance of sponsorship by a member of clinical staff and participation in legitimate peripheral activities. In the absence of effective sponsorship, students found it difficult to participate in clinical activities or to learn. As a result, their professional development during placements became stunted with subsequent implications for their professional future. Questions concerned with this phenomena were explored using documentary evidence supplied by research participants, observations of their practice and focused interviews throughout their programme. Sociocultural or activity theories of human learning offer some attractive explanations. One strategy is scaffolding which takes place within sponsored nursing activities and builds on the important concept of the Zone of Proximal Development (ZPD), where speech becomes a tool to mediate learning and development. As a diagnostic tool, scaffolding enables both supervisor and learner to recognize knowledge-in-waiting and knowledge-in-use and hence learning need, thus stimulating opportunities for further learning and professional development beneficial to both learner and supervisor. It provides a means for theory and practice to become integrated. PMID:9847710

Spouse, J



[Sugammadex--two years in clinical practice].  


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

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


Improving clinical effectiveness: a practical approach.  


The publication of the government white paper 'Working for Patients' (1989, HMSO) and implementation of subsequent NHS reforms has led to the development of a great number of initiatives designed to improve the quality of patient care and to make the provision of care more clinically and cost effective. Many of these initiatives, whilst laudable, have been developed in isolation and often without proper consideration of how they relate to one another or might practically be implemented throughout the NHS. It has commonly been the case that attempts to transfer the initiative from an environment of high enthusiasm and, often, high resource to the NHS in general has either failed or led to poor application. Strategies to improve clinical effectiveness have not become a feature of the everyday practice of many, let alone most or all, clinicians in the NHS. The result has been their failure significantly to raise standards of care across the NHS as a whole. It is suggested that many of the initiatives are closely related, and more effective implementation in the NHS as a whole may follow attempts to integrate them in a more practical approach to care management within an organization-wide clinical effectiveness strategy. It is further suggested that this is best achieved by a continuous quality improvement approach focusing on the care process as the centrepiece of the initiative, and that this method will lead to significant improvements not only in clinical effectiveness but also in cost effectiveness. This paper describes a proposed method of achieving these goals. PMID:9456425

Waters, E



Psychosocial care for cancer: a framework to guide practice, and actionable recommendations for Ontario  

PubMed Central

Objectives We set out to create a psychosocial oncology care framework and a set of relevant recommendations that can be used to improve the quality of comprehensive cancer care for Ontario patients and their the psychosocial health care needs of cancer patients and their families at both the provider and system levels. Data Sources and Methods The adapte process and the practice guideline development cycle were used to adapt the 10 recommendations from the 2008 U.S. Institute of Medicine standard Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs into the psychosocial oncology care framework. In addition, the evidence contained in the original document was used, in combination with the expertise of the working group, to create a set of actionable recommendations. Refinement after formal external review was conducted. Data Extraction and Synthesis The new framework consists of 8 defining domains. Of those 8 domains, 7 were adapted from recommendations in the source document; 1 new domain, to raise awareness about the need for psychosocial support of cancer patients and their families, was added. To ensure high-quality psychosocial care and services, 31 actionable recommendations were created. The document was submitted to an external review process. More than 70% of practitioners rated the quality of the advice document as high and reported that they would recommend its use. Conclusions This advice document advocates for a multidisciplinary approach to cancer care in response to the distress experienced by cancer patients and their families. The recommendations will be useful in future to measure performance, quality of practice, and access to psychosocial services.

Turnbull Macdonald, G.C.; Baldassarre, F.; Brown, P.; Hatton-Bauer, J.; Li, M.; Green, E.; Lebel, S.



American Association of Clinical Endocrinologists Protocol for Standardized Production of Clinical Practice Guidelines--2010 update.  


In 2004, the American Association of Clinical Endocrinologists (AACE) published the "Protocol for Standardized Production of Clinical Practice Guidelines," which was to be implemented in forthcoming clinical practice guidelines (CPG). This protocol formally incorporated subjective factors and evidence-based medicine (EBM) methods that tightly mapped evidence levels to recommendation grades. A uniform publication template and multilevel review process were also outlined. Seven CPG have been subsequently published with use of this 2004 AACE protocol. Recently, growing concerns about the usefulness of CPG have been raised. The purposes of this report are to address shortcomings of the 2004 AACE protocol and to present an updated 2010 AACE protocol for CPG development. AACE CPG are developed without any industry involvement. Multiplicities of interests among writers and reviewers that might compromise the usefulness of CPG are avoided. Three major goals are to (1) balance transparently the effect of rigid quantitative EBM methods with subjective factors, (2) create a less onerous, less time-consuming, and less costly CPG production process, and (3) introduce an electronic implementation component. The updated 2010 AACE protocol emphasizes "informed judgment" and hybridizes EBM descriptors (study design type), qualifiers (study flaws), and subjective factors (such as risk, cost, and relevance). In addition, by focusing on more specific topics and clinical questions, the expert evaluation and multilevel review process is more transparent and expeditious. Lastly, the final recommendations are linked to a new electronic implementation feature. PMID:20350905

Mechanick, Jeffrey I; Camacho, Pauline M; Cobin, Rhoda H; Garber, Alan J; Garber, Jeffrey R; Gharib, Hossein; Petak, Steven M; Rodbard, Helena W; Trence, Dace L


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



Japanese clinical practice guidelines for pancreaticobiliary maljunction.  


There have been no clinical guidelines for the management of pancreaticobiliary maljunction (PBM). The Japanese Study Group on Pancreaticobiliary Maljunction (JSPBM) has proposed to establish clinical practice guidelines on how to deal with PBM, with the support of the Japan Biliary Association (JBA). Because the body of evidence-based literature is relatively small, we decided to create guidelines based on the consensus of experts, using the medical literature for reference. A total of 46 clinical questions (CQs) were considered by the members of the editorial committee responsible for the guidelines. The CQs covered distinct aspects of PBM: (1) Concepts and Pathophysiology (10 CQs); (2) Diagnosis (10 CQs); (3) Pancreatobiliary complications (9 CQs); and (4) Treatments and prognosis (17 CQs). Statements and comments for each CQ were prepared by the guidelines committee members and collaborating partners. The CQs were completed after review by members of the editorial committee, meetings of this committee, public comments on the homepages of the JSPBM and the JBA, public hearings, and assessment and approval by the guidelines evaluation board. PBM includes cases where the bile duct is dilated (PBM with biliary dilatation) and those in which it is not (PBM without biliary dilatation). In these guidelines, PBM with biliary dilatation is defined as being identical to congenital biliary dilatation of Todani type I (except for type Ib) and type IV-A, both of which are accompanied by PBM in almost all cases. These guidelines are created to provide assistance in the clinical practice of PBM management; their contents focus on clinical utility, and they include general information on PBM to make this disease more widely recognized. PMID:22722902

Kamisawa, Terumi; Ando, Hisami; Suyama, Masafumi; Shimada, Mitsuo; Morine, Yuji; Shimada, Hiroshi



Blinding in clinical trials: a practical approach.  


Blinding is important in the conduct of clinical trials, yet it generally receives less attention and effort than other trial components (e.g., randomization, compliance) that are rigorously treated in the design and/or analysis stages. Furthermore, although the word "blind" commonly appears in the titles of publications, its use is not always well justified. We are human beings, and our behavior or decisions can change depending on whether our eyes are open or closed. That is why virtually everyone in the clinical trial community, including subjects, investigators, treating practitioners, and outcome assessors, would agree that some form of blinding is needed to reach a fair and objective conclusion uninfluenced by knowledge of intervention assignment. Despite our best efforts, however, blinding may not always be successful. There is a considerable body of literature about blinding and the need to assess whether it has been properly implemented and maintained. By discussing how the trialist and the team may handle blinding-related issues in different stages of a clinical trial, this brief article intends to offer reasonable suggestions that could improve current practice, helping researchers deal confidently with blinding-related issues and research in a manner that meets rigorous standards, but is practical and flexible. PMID:23140113

Bang, Heejung; Park, Jongbae J



Patient satisfaction with clinical nurse specialists' practice.  


A co-ordinated approach was adopted to monitor practice standards among clinical nurse specialists (CNSs) in West Midlands breast screening assessment nursing teams. A regional working party was assembled and a patient satisfaction survey was produced. Results of the survey show that for women attending for breast screening assessment, interaction with a CNS is perceived to be highly beneficial. Contact points vary with local practice, but the majority of women had contact with a CNS at some point during the assessment process for support and information. The results of the survey are used as an integral part of the quality assurance process in relation to CNS provision in the West Midlands. Services should aim to ensure that sufficient CNSs are available for women attending breast screening assessment centres. PMID:23914694

Baker, Joanne; Kearins, Olive; O'Sullivan, Emma; Casey, Margaret


[Qualitative translational science in clinical practice].  


Qualitative translational research refers to the "bench-to-bedside" enterprise of harnessing knowledge from the basic sciences to produce new treatment options or nursing interventions for patients. Three evidence-based translational problems related to qualitative translational research discussed this year address the interfaces among the nursing paradigm, the basic sciences, and clinical nursing work. This article illustrates the definition of translational science and translational blocks of evidence-based practice; discusses the qualitative research perspective in evidence synthesis, evidence translation and evidence utilization; and discusses the research questions that must be answered to solve the problems of the three translational gaps from the qualitative research perspective. Qualitative inquiry has an essential role to play in efforts to improve current healthcare-provider nursing interventions, experiences, and contexts. Thus, it is vital to introduce qualitative perspectives into evidence-based practice from the knowledge discovery through to the knowledge implementation process. PMID:24096461

Mu, Pei-Fan



Biosensors in Clinical Practice: Focus on Oncohematology  

PubMed Central

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

Fracchiolla, Nicola S.; Artuso, Silvia; Cortelezzi, Agostino



Low Impact Development Practices: A Review of Current Research and Recommendations for Future Directions  

Microsoft Academic Search

The low impact development (LID) approach has been recommended as an alternative to traditional stormwater design. Research\\u000a on individual LID practices such as bioretention, pervious pavements, and grassed swales has increased in recent years. Bioretention\\u000a cells have been effective in retaining large volumes of runoff and pollutants on site, and consistently reduced concentrations\\u000a of certain pollutants such as metals. However,

Michael E. Dietz



[Oral anticoagulant drugs in clinical practice].  


In current clinical practice, oral anticoagulant therapy is one of the most widely employed treatments in order to prevent embolic events in cardiovascular diseases. This therapy is bound to become more and more employed because of increasing mean age of general population and related increase of clinical settings which may require anticoagulation. Nowadays, available drugs for oral anticoagulation are vitamin K antagonists which inhibit the coagulation factors depending upon this vitamin for their synthesis. In this review we will examine: --their mechanism of action and its clinical implications related with the initial phase of therapy and the likelihood of side effects as cutaneous necrosis; --their pharmacokinetics which explain most of drug interactions; --affecting therapy factors: age of patients, impaired absorption, genetic polymorphisms of cytochrome P450, drug resistance, coagulation factors defects, particular clinical situations, vitamin K dietary intake; --different properties of various anticoagulant drugs; --toxicity; --problems related to monitoring anticoagulation intensity. At last, we will present the new pharmacological perspectives offered by direct inhibitors of the coagulation factors. PMID:15061605

Calisi, Pasqualina; Griffo, Raffaele



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.



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


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



Clinical practice on the horizon: personalized medicine.  


With the advent of the human genome project, we have never known so much about the uniqueness of individuals. Personalized medicine is poised to use this genetic and genomic information along with the impact of environment and clinical presentation to provide healthcare from an individual perspective. This offers the opportunity to improve our ability to diagnose and predict disease, provide earlier intervention, identify new treatment regimens, and address the safety and efficacy of drug use. The impact of personalized medicine to our current model of healthcare delivery is tremendous, and although strides have been made, there are still challenges and barriers to overcome before personalized medicine can be fully implemented. Advanced practice nurses may not be fully aware of the personalized medicine initiative or may not be well versed on genetic and genomic content, which is a key concept of personalized medicine. The role of advanced practice nurses is an integral part of the healthcare system, and as such, they are poised to be key providers and contributors to personalized medicine. The personalized medicine initiative is discussed along with examples of genetic and genomic information that lend to our understanding, diagnosis, and treatment of disease, as well as the role and responsibilities of advanced practice nurses. Resources for personalized medicine and genetic and genomic content are provided. PMID:23222027

Chadwell, Katherine


Diagnostic evaluation of paediatric pulmonary hypertension in current clinical practice.  


Current paediatric pulmonary hypertension (PH) diagnostic algorithms include some testing specifically for paediatrics, but it is unclear if this is used in clinical practice. We describe the current diagnostic workup of the TOPP (Tracking Outcomes and Practice in Paediatric Pulmonary hypertension) registry for suspected PH. We investigated 456 patients enrolled until February 2010. The majority had ECGs (94%), echocardiograms (96%) and/or chest radiographs (89%) performed and these were the noninvasive tests most frequently used for evaluation of suspected PH. No patient had all three tests considered normal, suggesting the potential for the combined use to rule out PH. For evaluation of complications associated with heart catheterisation (HC) we analysed a total of 908 HCs reported until February 2012. Of these, 554 were at diagnosis and 354 in follow-up. Complications were reported in 5.9% with five deaths considered related to HC, suggesting a higher rate of HC complications compared to adult studies. However, current recommendations support HC in paediatric PH. A proper application of the risk/benefit ratio for HC requires further data. Most children did not undergo the diagnostic workup currently recommended for adults, which highlights either incomplete awareness of current guidelines and/or challenges their appropriateness for children. PMID:23563261

Beghetti, Maurice; Berger, Rolf M F; Schulze-Neick, Ingram; Day, Ronald W; Pulido, Tomás; Feinstein, Jeffrey; Barst, Robyn J; Humpl, Tilman



Committee opinion no. 577: understanding and using the u.s. Selected practice recommendations for contraceptive use, 2013.  


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



Clinical Practice: Helicobacter pylori infection in childhood.  


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

Ertem, Deniz



GDSI: A Web-Based Decision Support System to Facilitate the Efficient and Effective Use of Clinical Practice Guideline  

Microsoft Academic Search

Clinical practice guidelines (CPGs) are systematically developed healthcare recommendations designed to improve quality and control costs by reducing errors, minimizing practice variability, and promoting best practices. Although considerable effort and resources have been applied to CPG design, development, and deployment, the impact of CPGs on clinician behavior is inconsistent at best. The biomedical literature suggests that CPG efficacy could be

Douglas C. Stahl; Layla Rouse; Dave Ko; Joyce C. Niland



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

Microsoft Academic Search

Purpose: To develop guidelines for the conduct of Phase III clinical trials of larynx preservation in patients with locally advanced laryngeal and hypopharyngeal cancer. Methods and Materials: A multidisciplinary international consensus panel developed recommendations after reviewing results from completed Phase III randomized trials, meta-analyses, and published clinical reports with updates available through November, 2007. The guidelines were reviewed and approved

Jean-Louis Lefebvre; K. Kian Ang



Single case experimental design and empirical clinical practice  

Microsoft Academic Search

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

Steven C. Hayes



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

PubMed Central

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

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



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


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

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



Impact of anthropometric measurements in clinical practice.  


Anthropometry helps to assess nutritional status which is an important determinant of clinical outcome in many patients, including the number of those suffering from chronic kidney disease (CKD). Weight gain after successful kidney transplantation is a well-known phenomenon, therefore we hypothesized that intensive counseling, based of menu analysis by a dietitian of CKD patients with a kidney transplant, can prevent the significant body weight (BW) gain after the transplant operation. The aim of the investigation was to study long-term anthropometrical, biochemical and dual-energy densitometry changes in the kidney transplant patients, to study correlations between the studied parameters and to compare those with the follow-up data. The prospective long-term study was carried out in 28 clinically stable renal transplant patients. Control groups consisted both transplant patients (47 patients), receiving ordinary nutritional counseling, and of healthy population subjects (342). Anthropometry and biochemistry were studied in patients twice: the first follow-up (FU1) data were collected 1.3 +/- 0.2 years, and the second follow-up (FU2) data were collected 2.7 +/- 0.3 years after the transplant. Significant BW gain was found only in renal transplant male patients (FU1 vs. FU2, p < 0.001) but not in females. The mean weight gain in control group patients was significant both in the male and female groups. In males, the mean C-reactive protein was significantly correlated with different body circumferences. But, in females, no clear associations were found. In females, significant correlation was found between mean body weight, body mass index and triglycerides. We conclude that the use of anthropometry in clinical practice, together with intensive and individual counseling by a dietitian, should be regular in the kidney transplant patients' population to prevent overweight. Monitoring of the dynamics of anthropometrical and biochemical parameters are clinically relevant in the post-transplant period together with densitometry. PMID:23390829

Kiisk, Liidia; Kaarma, Helje; Ots-Rosenberg, Mai



Reboxetine in clinical practice: a review.  


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

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



Self-compassion in clinical practice.  


Self-compassion is conceptualized as containing 3 core components: self-kindness versus self-judgment, common humanity versus isolation, and mindfulness versus overidentification, when relating to painful experiences. Research evidence demonstrates that self-compassion is related to psychological flourishing and reduced psychopathology. Mindful Self-Compassion (MSC) is an 8-week training program, meeting 2.5 hours each week, designed to help participants cultivate self-compassion. MSC contains a variety of meditations (e.g., loving-kindness, affectionate breathing) as well as informal practices for use in daily life (e.g., soothing touch, self-compassionate letter writing). A detailed clinical case illustrates the journey of a client through the 8 weeks of MSC training, describing the key features of each session and the client's response. PMID:23775511

Germer, Christopher K; Neff, Kristin D



The Emergence of Clinical Practice Guidelines  

PubMed Central

Clinical practice guidelines are now ubiquitous. This article describes the emergence of such guidelines in a way that differs from the two dominant explanations, one focusing on administrative cost-cutting and the other on the need to protect collective professional autonomy. Instead, this article argues that the spread of guidelines represents a new regulation of medical care resulting from a confluence of circumstances that mobilized many different groups. Although the regulation of quality has traditionally been based on the standardization of professional credentials, since the 1960s it has intensified and been supplemented by efforts to standardize the use of medical procedures. This shift is related to the spread of standardization within medicine and especially in research, public health, and large bureaucratic health care organizations.

Weisz, George; Cambrosio, Alberto; Keating, Peter; Knaapen, Loes; Schlich, Thomas; Tournay, Virginie J



The new oral anticoagulants in clinical practice.  


Vitamin K antagonists were the only class of oral anticoagulants available to clinicians for decades. However, with the US Food and Drug Administration approval of new oral anticoagulants, such as dabigatran, rivaroxaban, and apixaban, clinicians now have a broader choice. Given the recent approval and availability of these medications, several questions arise while deciding which of them would be best suited for a particular patient. This article provides a concise review for clinicians entailing the main studies that evaluated the efficacy and safety of these drugs, their pharmacokinetic and pharmacodynamic properties, and a practical approach to their clinical use. For this review, we conducted searches of PubMed and MEDLINE for articles published between January 1, 2000, and January 30, 2013, using the following search terms: oral anticoagulants, dabigatran, apixaban, rivaroxaban, novel anticoagulants, bleeding complications, management of bleeding complications, pharmacodynamics, and pharmacokinetics. Studies published in English were selected for inclusion in this review, as were additional articles identified from bibliographies. PMID:23639500

Gonsalves, Wilson I; Pruthi, Rajiv K; Patnaik, Mrinal M



Re-overcoming barriers in translating biomarkers to clinical practice.  


Importance of the field: Recently, there has been growing evidence for the concept of personalized medicine as the implementation of genomic and molecular information in the delivery of healthcare. In parallel, the identification of biomarkers has become of enormous significance as a prerequisite for individualized intervention regimens. Areas covered in this review: Biomarkers are developed to improve prevention, diagnosis or therapeutic outcome of a given disease. Although each application reveals distinct developmental strategies, evidence-based approval of new biomarkers is important for the success of new drugs, diagnostic tests or recommendations in preventive medicine. Current hurdles to bringing biomarkers into clinical practice are reviewed, thereby focusing on adequate approaches to overcome these limitations in the future. What the reader will gain: The reader will get an introduction to strategies resolving actual barriers in clinical biomarker development. Take home message: The identification of evidence-based biomarkers is crucial for the success of individualized therapeutic approaches. Developmental strategies have to be adapted to clinical need, thereby focusing on biomarker validation in clinical settings as well as on the establishment of standardized biomarker test systems for routine application. Consortia have been established bringing together representatives of government, academia and industry to improve future biomarker development. PMID:23484444

Staratschek-Jox, Andrea; Schultze, Joachim L



Addressing Low Literacy and Health Literacy in Clinical Oncology Practice  

PubMed Central

Low functional literacy and low health literacy continue to be under-recognized and are associated with poorer patient health outcomes. Health literacy is a dynamic state influenced by how well a healthcare system delivers information and services that match patients’ abilities, needs and preferences. Oncology care poses considerable health literacy demands on patients who are expected to process high stakes information about complex multidisciplinary treatment over lengths of time. Much of the information provided to patients in clinical care and research is beyond their literacy levels. In this paper, we provide an overview of currently available guidelines and resources to improve how the needs of patients with diverse literacy skills are met by cancer care providers and clinics. We present recommendations for health literacy assessment in clinical practice and ways to enhance the usability of health information and services by improving written materials and verbal communication, incorporating multimedia and culturally appropriate approaches, and promoting health literacy in cancer care settings. The paper also includes a list of additional resources that can be used to develop and implement health literacy initiatives in cancer care clinics.

Garcia, Sofia F.; Hahn, Elizabeth A.; Jacobs, Elizabeth A.



Mobile teledermatology: a promising future in clinical practice.  


Background:As a product of electronic health, teledermatology is a cost-effective means of improving access to care, facilitating specialist consultations, and supporting patient self-management. Even so, use of traditional teledermatology services is limited by infrastructure and costs in the form of digital cameras, computers, and Internet access.Methods:Considering the significant improvement in smartphone camera resolution and the rapidly increasing number of physicians using smartphones, we explored the use of smartphones as reliable, effective clinical tools in store-and-forward teledermatology. We describe the technical specifications of modern smartphone cameras, the widespread use of smartphones by physicians, and the advantages of smartphones over traditional camera and Internet teledermatology, and we propose recommendations as to how mobile teledermatology may be more effectively used in modern dermatologic practice. PMID:24138974

Zuo, Kevin J; Guo, Danny; Rao, Jaggi


Glucose Biosensors: An Overview of Use in Clinical Practice  

PubMed Central

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

Yoo, Eun-Hyung; Lee, Soo-Youn



[Clinical practice guideline: a complete geriatric evaluation].  


The care of elderly patients requires an evaluation that deserves a host of special considerations, such as biological aspects of aging, those related to activities of daily living and functionality, neuro-psychological conceptions, family dynamics and economic conditions. The growth of the aging population in our country is accompanied by an increase in chronic diseases and more individuals have greater vulnerability, requiring a more consumption of resources because of the high demand for services. This requires the incorporation of specialized care in the institutional system, which has caused serious consequences in the current health system, benefiting specialization and technology, but with a loss of an integrated and horizontal view of the patient. Therefore it is necessary to develop a practical tool that allows the family physician to identify and differentiate the geriatric population that requires specialized care from who does not, identifying problems that may improve and allow the design of strategies to improve health status and maintain functional autonomy of the elderly. Comprehensive Geriatric Assessment (CGA) is a fundamental tool for clinical practice of any medical care to the elderly. PMID:22176832

Medina-Chávez, Juan Humberto; Torres-Arreola, Laura Del Pilar; Cortés-González, Rosa María; Durán-Gómez, Verónica; Martínez-Hernández, Fernando; Esquivel-Romero, Gustavo


A consensus-based approach to patient safety in epilepsy monitoring units: recommendations for preferred practices.  


Patients in an epilepsy monitoring unit (EMU) with video-EEG telemetry have a risk for seizure emergencies, injuries and adverse events, which emphasizes the need for strategies to prevent avoidable harm. An expert consensus process was used to establish recommendations for patient safety in EMUs. Workgroups analyzed literature and expert opinion regarding seizure observation, seizure provocation, acute seizures, and activity/environment. A Delphi methodology was used to establish consensus for items submitted by these workgroups. Fifty-three items reached consensus and were organized into 30 recommendations. High levels of agreement were noted for items pertaining to orientation, training, communication, seizure precautions, individualized plans, and patient/family education. It was agreed that seizure observation should include direct observation or use of closed-circuit camera. The use of continuous observation was strongest in patients with invasive electrodes, at high risk for injury, or undergoing AED withdrawal. This process provides a first step in establishing EMU safety practices. PMID:22999858

Shafer, Patricia O; Buelow, Janice M; Noe, Katherine; Shinnar, Ruth; Dewar, Sandra; Levisohn, Paul M; Dean, Patricia; Ficker, David; Pugh, Mary Jo; Barkley, Gregory L



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


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

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



Practice guidelines for perioperative transesophageal echocardiography: Recommendations of the Indian association of cardiovascular thoracic anesthesiologists.  


Transoesophageal Echocardiography (TEE) is now an integral part of practice of cardiac anaesthesiology. Advances in instrumentation and the information that can be obtained from the TEE examination has proceeded at a breath-taking pace since the introduction of this technology in the early 1980s. Recognizing the importance of TEE in the management of surgical patients, the American Societies of Anesthesiologists (ASA) and the Society of Cardiac Anesthesiologists, USA (SCA) published practice guidelines for the clinical application of perioperative TEE in 1996. On a similar pattern, Indian Association of Cardiac Anaesthesiologists (IACTA) has taken the task of putting forth guidelines for transesophageal echocardiography (TEE) to standardize practice across the country. This review assesses the risks and benefits of TEE for several indications or clinical scenarios. The indications for this review were drawn from common applications or anticipated uses as well as current clinical practice guidelines published by various society practicing Cardiac Anaesthesia and cardiology . Based on the input received, it was determined that the most important parts of the TEE examination could be displayed in a set of 20 cross sectional imaging planes. These 20 cross sections would provide also the format for digital acquisition and storage of a comprehensive TEE examination. Because variability exists in the precise anatomic orientation between the heart and the esophagus in individual patients, an attempt was made to provide specific criteria based on identifiable anatomic landmarks to improve the reproducibility and consistency of image acquisition for each of the standard cross sections. PMID:24107693

Muralidhar, Kanchi; Tempe, Deepak; Chakravarthy, Murali; Shastry, Naman; Kapoor, Poonam Malhotra; Tewari, Prabhat; Gadhinglajkar, Shrinivas V; Mehta, Yatin


Recommendations for best practices in the treatment of Alzheimer's disease in managed care  

Microsoft Academic Search

Background:Alzheimer's disease and related dementias (ADRDs) are increasingly recognized as important causes of impaired cognition, function, and quality of life, as well as excess medical care utilization and costs in the elderly Medicare managed care population. Evidence-based clinical practice guidelines for ADRDs were published in 2001. More recent studies have resulted in the approval of new agents and demonstrated an

Howard M. Fillit; Rachelle Smith Doody; Kimberly Binaso; Glenna M. Crooks; Steven H. Ferris; Martin R. Farlow; Bennett Leifer; Charles Mills; Neil Minkoff; Burton Orland; William E. Reichman; Stephen Salloway



Clinical implementation of AAPM Task Group 32 recommendations on brachytherapy source strength specification  

SciTech Connect

Historically the strength of sealed brachytherapy sources has been described by many physical quantities, including true activity, apparent activity, and equivalent mass of radium. Recently, the AAPM Task Group 32 recommended that these quantities be replaced by a single quantity, air-kerma strength, with units of {mu}Gy m{sup 2} h{sup {minus}1}. A set of equations has been developed for unambiguously converting source strength estimates and renormalizing published dose-rate tables, which assume traditional quantities and units, into forms consistent with air-kerma strength. For commonly used brachytherapy sources, multiplicative conversion factors for each source-strength formalism and set of units are given. To convert equivalent mass of radium to air-kerma strength requires a single multiplicative factor, 7.23 {mu}Gy m{sup 2} h{sup {minus}1}/mgRaEq, applicable to all sources. Based upon a review of vendor source specification practices, the factors for converting source strength of {sup 198}Au, {sup 103}Pd, and {sup 125}I seeds from apparent mCi to air-kerma strength are 2.06, 1.29, and 1.27 {mu}Gy m{sup 2} h{sup {minus}1}/mCi(apparent), respectively. These factors are independent of source geometry but depend on the nominal exposure rate constant value selected by the vendor. Conversion factors applicable to mass of radium or true activity depend upon both source geometry and radionuclide identity. Because many of these conversion factors depend upon vendor choices of physical constants and exposure rate constants, readers are cautioned to carefully review vendor source strength specification practices before adopting these values clinically. Finally, the relationships between the various source strength quantities and absorbed dose rate in the medium surrounding the source are elucidated.

Williamson, J.F. (Department of Radiation Oncology, University of Arizona Health Science Center, Tucson, Arizona 85724 (USA)); Nath, R. (Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06510 (USA))



Clinical implementation of AAPM Task Group 32 recommendations on brachytherapy source strength specification.  


Historically the strength of sealed brachytherapy sources has been described by many physical quantities, including true activity, apparent activity, and equivalent mass of radium. Recently, the AAPM Task Group 32 recommended that these quantities be replaced by a single quantity, air-kerma strength, with units of muGy m2h-1. A set of equations has been developed for unambiguously converting source strength estimates and renormalizing published dose-rate tables, which assume traditional quantities and units, into forms consistent with air-kerma strength. For commonly used brachytherapy sources, multiplicative conversion factors for each source-strength formalism and set of units are given. To convert equivalent mass of radium to air-kerma strength requires a single multiplicative factor, 7.23 muGy m2h-1/mgRaEq, applicable to all sources. Based upon a review of vendor source specification practices, the factors for converting source strength of 198Au, 103Pd, and 125I seeds from apparent mCi to air-kerma strength are 2.06, 1.29, and 1.27 muGy m2h-1/mCi(apparent), respectively. These factors are independent of source geometry but depend on the nominal exposure rate constant value selected by the vendor. Conversion factors applicable to mass of radium or true activity depend upon both source geometry and radionuclide identity. Because many of these conversion factors depend upon vendor choices of physical constants and exposure rate constants, readers are cautioned to carefully review vendor source strength specification practices before adopting these values clinically. Finally, the relationships between the various source strength quantities and absorbed dose rate in the medium surrounding the source are elucidated. PMID:1870487

Williamson, J F; Nath, R


Individual and Practice Characteristics Associated With Physician Provision of Recommended Care for Children With Special Health Care Needs  

Microsoft Academic Search

Objective. To examine physician and practice characteristics associated with recommended care practices for children with special health care needs (CSHCN). Methods. A survey of primary care physicians (PCPs) in Arkansas with a Medicaid caseload of ?100 children was conducted. Predictor variables included physician specialty field, demographics, practice type, and percentage of patients with public insurance. Multivariate regression analyses described predictors

Dennis Z. Kuo; James M. Robbins; Katherine H. Burns; Patrick H. Casey



Evidence-based clinical practice guidelines for bladder cancer (summary - JUA 2009 Edition).  


In Japan, until now, the treatment of bladder cancer has been based on guidelines from overseas. The problem with this practice is that the options recommended in overseas guidelines are not necessarily suitable for Japanese clinical practice. A relatively large number of clinical trials have been conducted in Japan in the field of bladder cancer, and the Japanese Urological Association (JUA) considered it appropriate to formulate their own guidelines. These Guidelines present an overview of bladder cancer at each clinical stage, followed by clinical questions that address problems frequently faced in everyday clinical practice. In this English translation of a shortened version of the original Guidelines, we have abridged each overview, summarized each clinical question and its answer, and only included the references we considered of particular importance. PMID:20377834



Assessing physical activity in general practice: a disconnect between clinical practice and public health?  

PubMed Central

Background GPs comply poorly to public health recommendations to routinely assess their patients' physical activity. The reasons for this disconnect between recommended practice and GPs' actual practice are unclear. Aim To investigate GPs' perceptions of assessing physical activity, and to explore how GPs assess their patients' physical activity. Design of the study Qualitative study. Setting General practice. Method Semi-structured interviews were performed with 15 randomly selected southern Tasmanian GPs, with stratification to include GPs with a range of demographic characteristics. Each interview was recorded, transcribed in full, and analysed using an iterative thematic approach to identify major themes. Results GPs recognised the importance of assessing physical activity, but rather than assessing every patient, they target at-risk patients and those with conditions likely to benefit from increased physical activity. Depth of assessment and GPs' definition of sufficient physical activity varied according to the clinical and social context of each patient. Major barriers were the time needed to perform an adequate assessment and lack of time to deal with physical inactivity in patients once it was identified. Conclusion GPs' assessment of physical activity is a complex and highly individualised process that cannot be divorced from the issue of managing physical inactivity once it is identified. Expectations that GPs will assess physical activity levels in all their patients are unlikely to be met. This must be taken into account when developing strategies to improve physical activity assessment in general practice, and should be considered in policy decisions about approaches to take to improve physical activity levels at a population level.

Winzenberg, Tania; Reid, Pam; Shaw, Kelly



The Legitimacy of Placebo Treatments in Clinical Practice: Evidence and Ethics  

Microsoft Academic Search

Physicians commonly recommend ‘placebo treatments’, which are not believed to have specific efficacy for the patient's condition. Motivations for placebo treatments include complying with patient expectations and promoting a placebo effect. In this article, we focus on two key empirical questions that must be addressed in order to assess the ethical legitimacy of placebo treatments in clinical practice: 1) do

Franklin G. Miller; Luana Colloca



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

Microsoft Academic Search

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

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


Cognitive-Behavioral Therapy with Chinese Americans: Research, Theory, and Clinical Practice  

ERIC Educational Resources Information Center

|In this article, we discuss how to conduct cognitive-behavioral therapy with Chinese Americans. We present an integration of theory, research, and clinical practice to help mental health practitioners understand how Chinese culture may potentially influence the CBT treatment process for Chinese immigrants. Several recommendations are provided as…

Hwang, Wei-Chin; Wood, Jeffrey J.; Lin, Keh-Ming; Cheung, Freda



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


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



An innovative clinical practicum to teach evidence-based practice.  


A clinical practicum was successfully implemented for RN to BSN students to apply evidence-based practice to actual clinical problems affecting nursing practice. The author describes how this practicum was implemented and the requisite resources and support systems. This senior-level capstone course enabled students to understand and value a lifelong learning approach to evidence-based practice. PMID:16980821

Brancato, Vera C


Rotavirus vaccine for the prevention of rotavirus gastroenteritis among children. Recommendations of the Advisory Committee on Immunization Practices (ACIP).  


These recommendations represent the first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of an oral, live rotavirus vaccine licensed by the Food and Drug Administration on August 31, 1998, for use among infants. This report reviews the epidemiology of rotavirus, describes the licensed rotavirus vaccine, and makes recommendations regarding its use for the routine immunization of infants in the United States. These recommendations are based on estimates of the disease burden of rotavirus gastroenteritis among children in the United States and on the results of clinical trials of the vaccine. Rotavirus affects virtually all children during the first 5 years of life in both developed and developing countries, and rotavirus infection is the most common cause of severe gastroenteritis in the United States and worldwide. In the United States, rotavirus is a common cause of hospitalizations, emergency room visits, and outpatient clinic visits, and it is responsible for considerable health-care costs. Because of this large burden of disease, several rotavirus vaccines have been developed. One of these vaccines - an oral, live, tetravalent, rhesus-based rotavirus vaccine (RRV-TV) -- was found to be safe and efficacious in clinical trials among children in North America, South America, and Europe and on the basis of these studies is now licensed for use among infants in the United States. The vaccine is an oral, live preparation that should be administered to infants between the ages of 6 weeks and 1 year. The recommended schedule is a three-dose series, with doses to be administered at ages 2, 4, and 6 months. The first dose may be administered from the ages of 6 weeks to 6 months; subsequent doses should be administered with a minimum interval of 3 weeks between any two doses. The first dose should not be administered to children aged > or =7 months because of an increased rate of febrile reactions after the first dose among older infants. Second and third doses should be administered before the first birthday. Implementation of these recommendations in the United States should prevent most physician visits for rotavirus gastroenteritis and at least two-thirds of hospitalizations and deaths related to rotavirus. PMID:10219046



Fabry disease practice guidelines: recommendations of the national society of genetic counselors.  


Identification and comprehensive care of individuals who have Fabry disease (FD) requires a multidisciplinary approach inclusive of genetic testing, test interpretation, genetic counseling, long term disease symptom monitoring, treatment recommendations, and coordination of therapy. The purpose of this document is to provide health care professionals with guidelines for testing, care coordination, identification of psychosocial issues, and to facilitate a better understanding of disease treatment expert recommendations for patients with Fabry disease. These recommendations are the opinions of a multicenter working group of genetic counselors, medical geneticists, and other health professionals with expertise in Fabry disease counseling, as well as representatives/founders of the two United States based Fabry disease patient advocacy groups who are themselves affected by Fabry disease. The recommendations are U.S. Preventive Task Force Class III, and they are based on clinical experience, a review of pertinent English-language articles, and reports of expert committees. This document reviews the genetics of Fabry disease, the indications for genetic testing, interpretation of results, psychosocial considerations, and references to professional and patient resources. PMID:23860966

Laney, Dawn A; Bennett, Robin L; Clarke, Virginia; Fox, Angela; Hopkin, Robert J; Johnson, Jack; O'Rourke, Erin; Sims, Katherine; Walter, Gerald



Implementing AORN Recommended Practices for Care of Patients Undergoing Pneumatic Tourniquet-Assisted Procedures.  


Perioperative nurses are likely to encounter the use of pneumatic tourniquets in a variety of operative and invasive extremity procedures. Use of a pneumatic tourniquet offers an opportunity to obtain a near-bloodless surgical field; however, the use of tourniquets is not without risk. Unfavorable outcomes include pain, thrombotic events, nerve compression injuries, and disruption of skin integrity. Perioperative nurses should be familiar with the indications, contraindications, and changes in physiology associated with pneumatic tourniquet use. The revised AORN "Recommended practices for care of patients undergoing pneumatic tourniquet-assisted procedures" is focused on the perioperative nurse's role in patient care and provides guidance for developing, implementing, and evaluating practices that promote patient safety and improve the likelihood of positive outcomes. PMID:24075334

Hicks, Rodney W; Denholm, Bonnie



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



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

Microsoft Academic Search

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

Traci Rieckmann; Luke Bergmann; Caitlin Rasplica



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



Korean Clinical Practice Guidelines: Otitis Media in Children  

PubMed Central

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

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



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


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


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



Nursing informatics in clinical practice in China.  


Nursing informatics has become a useful tool for worldwide patient care and management; however, its implementation greatly varies according to specialty, healthcare setting, and nation. The purpose of this study was to determine nursing informatics implementation in Qiqihar, China. Questionnaires evaluating the advantages and disadvantages of nursing informatics implementation and hospital information system knowledge were distributed among three hospitals in Qiqihar. A convenient sample of 50 nurses from each hospital (total N = 150) was selected to participate in this study. Responses indicated that despite a relatively brief training period, nursing informatics was adequately implemented, and nurses were knowledgeable about hospital information systems. Respondents identified several key advantages of nursing informatics implementation, particularly its usefulness in aiding patient care for data management. Finally, respondents identified hospital information system instability as a major obstacle to nursing informatics implementation. Our study results may help clinical nursing practitioners improve their technology skills and help nursing administrators improve information programs. These findings provide an important reference for both nursing informatics practice and further studies. PMID:23549042

Xu, Wei-Lan; Yang, Li-Qun; Zhang, Hong-Yu



The CDC Revised Recommendations for HIV Testing: Reactions of Women Attending Community Health Clinics  

PubMed Central

Purpose To examine reactions to the CDC revised recommendations for HIV testing by women attending community health clinics. Methods Thirty women attending three community clinics completed semi-structured individual interviews containing three questions about the recommendations. Thematic content analysis of responses was conducted. Findings All agreed with the recommendation for universal testing. Most viewed opt-out screening as an acceptable approach to HIV testing. Many emphasized the importance of provision of explicit verbal informed consent. The majority strongly opposed the elimination of the requirement for pre-test prevention counseling and spontaneously talked about the ongoing importance of post-test counseling. Conclusions There was strong support for universal testing of all persons 13-64 years old, but scant support for the elimination of pre-test prevention counseling. In general, respondents believed that verbal informed consent for testing as well as provision of HIV-related information before and after testing were crucial.

Burrage, Joe W.; Zimet, Gregory D.; Cox, Dena S.; Cox, Anthony D.; Mays, Rose M.; Fife, Rose S.; Fife, Kenneth H.



Clinical Uroselectivity: A 3Year Follow-Up in General Practice  

Microsoft Academic Search

The objectives of this open-labeled study were to assess the clinical uroselectivity of alfuzosin in a long-term follow-up study in general practice. A total of 3,228 patients with clinical benign prostatic hyperplasia (BPH) from 812 centers were included in a prospective 3-year open-labeled study and treated with alfuzosin (immediate-release formulation) at the recommended dosage. Symptom score (Boyarsky, modified) and a

B. Lukacs; J. C. Grange; C. McCarthy; D. Comet



The Limited Incorporation of Economic Analyses in Clinical Practice Guidelines  

PubMed Central

BACKGROUND Because there is increasing concern that economic data are not used in the clinical guideline development process, our objective was to evaluate the extent to which economic analyses are incorporated in guideline development. METHODS We searched medline and HealthSTAR databases to identify English-language clinical practice guidelines (1996–1999) and economic analyses (1990–1998). Additional guidelines were obtained from The National Guidelines Clearinghouse Internet site available at . Eligible guidelines met the Institute of Medicine definition and addressed a topic included in an economic analysis. Eligible economic analyses assessed interventions addressed in a guideline and predated the guideline by 1 or more years. Economic analyses were defined as incorporated in guideline development if 1) the economic analysis or the results were mentioned in the text or 2) listed as a reference. The quality of economic analyses was assessed using a structured scoring system. RESULTS Using guidelines as the unit of analysis, 9 of 35 (26%) incorporated at least 1 economic analysis of above-average quality in the text and 11 of 35 (31%) incorporated at least 1 in the references. Using economic analyses as the unit of analysis, 63 economic analyses of above-average quality had opportunities for incorporation in 198 instances across the 35 guidelines. Economic analyses were incorporated in the text in 13 of 198 instances (7%) and in the references in 18 of 198 instances (9%). CONCLUSIONS Rigorous economic analyses may be infrequently incorporated in the development of clinical practice guidelines. A systematic approach to guideline development should be used to ensure the consideration of economic analyses so that recommendations from guidelines may impact both the quality of care and the efficient allocation of resources.

Wallace, Joel F; Weingarten, Scott R; Chiou, Chiun-Fang; Henning, James M; Hohlbauch, Andriana A; Richards, Margaret S; Herzog, Nicole S; Lewensztain, Lior S; Ofman, Joshua J



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



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



Electronic prescribing increases uptake of clinical pharmacologists' recommendations in the hospital setting  

PubMed Central

AIMS To determine whether electronic prescribing facilitates the uptake of clinical pharmacologists' recommendations for improving drug safety in medical inpatients. METHODS Electronic case records and prescription charts (either electronic or paper) of 502 patients hospitalized on medical wards in a large Swiss teaching hospital between January 2009 and January 2010 were studied by four junior and four senior clinical pharmacologists. Drug-related problems were identified and interventions proposed. The implementation and time delays of these proposed interventions were compared between the patients for whom paper drug charts were used and the patients for whom electronic drug charts were used. RESULTS One hundred and fifty-eight drug-related problems in 109 hospital admissions were identified and 145 recommendations were made, of which 51% were implemented. Admissions with an electronic prescription chart (n = 90) were found to have 2.74 times higher odds for implementation of the change than those with a paper prescription chart (n = 53) (95% confidence interval 1.2, 6.3, P = 0.018, adjusted for any dependency introduced by patient, ward or clinical team; follow-up for two cases missing). The time delay between recommendations being made and their implementation (if any) was minimal (median 1 day) and did not differ between the two groups. CONCLUSIONS Electronic prescribing in this hospital setting was associated with increased implementation of clinical pharmacologists' recommendations for improving drug safety when compared with handwritten prescribing on paper.

Taegtmeyer, Anne B; Curkovic, Ivanka; Rufibach, Kaspar; Corti, Natascia; Battegay, Edouard; Kullak-Ublick, Gerd A



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



Standardized Clinical Assessment And Management Plans (SCAMPs) provide a better alternative to clinical practice guidelines.  


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. PMID:23650325

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



Sustaining excellence: clinical nurse specialist practice and magnet designation.  


Clinical nurse specialist practice is essential in providing the clinical expertise, leadership, and organizational influence necessary for attaining the excellence in care reflected by the American Nurses Credentialing Center's Magnet designation. Clinical nurse specialists, prepared as advanced practice nurses, bring clinical expertise, knowledge of advanced physiology, and pathology and a system-wide vision for process improvements. This unique curriculum specifically prepares clinical nurse specialists (CNSs) to immediately practice as leaders of interdisciplinary groups to improve outcomes. Clinical nurse specialist graduates possess an understanding of complex adaptive systems theory, advanced physical assessment, and pathophysiology and knowledge of optimal learning modalities, all applicable to improving the health care environment. Their practice specifically links complex clinical data with multidisciplinary partnering and understanding of organizational systems. The basis for optimal clinical practice change and sustained process improvement, foundational to Magnet designation, is grounded in the combined educational preparation and systems impact of CNS practice. This article describes the role of the CNS in achieving and sustaining Magnet designation in an urban, academic quaternary care center. Using the National Association of Clinical Nurse Specialists model of spheres of influence, focus is on the CNS's contribution to improving clinical outcomes, nurse satisfaction, and patient satisfaction. Exemplars demonstrating use of a champion model to implement practice improvement and rapid adoption of optimal practice guidelines are provided. These exemplars reflect improved and sustained patient care outcomes, and implementation strategies used to achieve these improvements are discussed. PMID:20716978

Muller, Anne C; Hujcs, Marianne; Dubendorf, Phyllis; Harrington, Paul T


Microbiological assessment in strawberry production and recommendations to establish a good agricultural practice system.  


This study conducted microbiological assessment in tunnel style strawberry greenhouses and packaging centers and suggested recommendations to establish a good agricultural practice for strawberry production. The samples from irrigation water, workers' gloves, harvest bins, soil, strawberry leaves and strawberries in greenhouses, packers' gloves, conveyor belts, packaging tables, and door knobs of entrances in packaging centers were collected. Bacterial cell counts of aerobic plate counts, coliforms, Escherichia coli, E. coli O157:H7, Salmonella, Staphylococcus aureus, and Bacillus cereus were then enumerated on appropriate selective media. In general, bacterial populations were similar (p ? 0.05) among strawberry greenhouses but not among packaging houses. E. coli and E. coli O157:H7 were negative in all samples, and low levels of Salmonella and B. cereus were detected. However, high bacterial cell counts of aerobic plate counts, coliforms, and S. aureus were found in most samples. These results suggest that food safety practice in strawberry greenhouses and packaging centers should be improved, and the results may be useful in the establishment of a good agricultural practice system for strawberry production. PMID:21121865

Yoon, Yohan; Kim, Kyeongyeol; Nam, Minji; Shim, Won-Bo; Ryu, Jae-Gee; Kim, Doo-Ho; You, Oh-Jong; Chung, Duck-Hwa



Adherence to screening mammography recommendations in a university general medicine clinic  

Microsoft Academic Search

OBJECTIVE: To determine factors predicting adherence to a health care provider’s screening mammography recommendation in a general internal\\u000a medicine practice.\\u000a \\u000a \\u000a DESIGN: Prospective observational study.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: An urban academic general internal medicine practice.\\u000a \\u000a \\u000a \\u000a \\u000a PATIENTS: Three hundred forty-nine asymptomatic women, aged 50 years and older, without prior history of breast cancer, who received\\u000a a health care provider’s recommendation for screening mammography.\\u000a \\u000a \\u000a \\u000a \\u000a MEASUREMENT:

Nancy C. Dolan; Douglas R. Reifler; Mary McGrae McDermott; William C. McGaghie



ASCPRO Recommendations for the Assessment of Fatigue as an Outcome in Clinical Trials  

PubMed Central

Context Development of pharmacologic and behavioral interventions for cancer-related fatigue (CRF) requires adequate measures of this symptom. A guidance document from the Food and Drug Administration offers criteria for the formulation and evaluation of patient-reported outcome measures used in clinical trials to support drug or device labeling claims. Methods An independent working group, ASCPRO (Assessing Symptoms of Cancer Using Patient-Reported Outcomes), has begun developing recommendations for the measurement of symptoms in oncology clinical trials. The recommendations of the Fatigue Task Force for measurement of CRF are presented here. Results There was consensus that CRF could be measured effectively in clinical trials as the sensation of fatigue or tiredness, impact of fatigue/tiredness on usual functioning or as both sensation and impact. The ASCPRO Fatigue Task Force constructed a definition and conceptual model to guide measurement of CRF. ASCPRO recommendations do not endorse a specific fatigue measure but clarify how to evaluate and implement fatigue assessments in clinical studies. The selection of a CRF measure should be tailored to the goals of the research. Measurement issues related to various research environments were also discussed. Conclusion There exist in the literature good measures of CRF for clinical trials with strong evidence of clarity and comprehensibility to patients, content and construct validity, reliability, sensitivity to change in conditions in which one would expect them to change (assay sensitivity), and sufficient evidence to establish guides for interpreting changes in scores. Direction for future research is discussed.

Barsevick, Andrea M.; Cleeland, Charles S.; Manning, Donald C.; O'Mara, Ann M.; Reeve, Bryce B.; Scott, Jane A.; Sloan, Jeff A.



Grading student clinical practice performance: the Australian perspective  

Microsoft Academic Search

Educators have long considered assigning a grade in the assessment of student clinical practice performance as too variable, too subjective, or educationally inappropriate. Consequently, most undergraduate nurse education programs have maintained non-graded pass\\/fail criteria assessment for evaluating and reporting student clinical performance. This paper argues that, while the varied clinical environments do make assessing students’ clinical performance difficult, the reliability

Kate Andre



Aspirin Resistance and Its Implications in Clinical Practice  

PubMed Central

Abstract and Introduction Abstract Recent studies have suggested that some patients may not obtain the full benefits of aspirin's antiplatelet effects. An international roundtable of experts was held November 6, 2004, in New Orleans, Louisiana, to address the concept of aspirin resistance and its clinical implications. Panelists discussed various definitions and possible mechanisms of aspirin resistance, along with several tests currently available to measure platelet function. They recommended that until the clinical importance of these tests is known, physicians should continue to prescribe low-dose aspirin therapy for individuals at high risk for cardiovascular events and patients currently taking aspirin should continue to comply with their prescribed therapy. Introduction Aspirin therapy has long been known to be an effective method of preventing heart attacks and strokes. This benefit stems from the ability of aspirin to irreversibly inhibit platelet aggregation, which in turn reduces the risk of vascular occlusion. However, several recent studies have suggested that some patients may not get the full benefits of aspirin's antiplatelet effects. These findings have raised many questions for clinicians: Are some patients resistant to aspirin's antiplatelet effects? If so, how should aspirin resistance be defined? What causes it? Should patients be tested for it? Should aspirin therapy be altered on the basis of these tests? On November 6, 2004, an international panel convened for a roundtable meeting in New Orleans prior to the American Heart Association Scientific Sessions to address these critical issues. Panel members representing a range of disciplines including cardiology, clinical pharmacology, hematology, and gastroenterology examined the current literature along with a number of case studies and provided insight into the concept of aspirin resistance and its implications in clinical practice.

Eikelboom, John; Feldman, Mark; Mehta, Shamir R.; Michelson, Alan D.; Oates, John A.; Topol, Eric; Reisman, Miriam; Lande, Stephen D.



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



Jail Health Assessment Practices: An Analysis of National Trends as Compared to National Commission on Correctional Health Care Recommendations  

Microsoft Academic Search

This article examines current trends in jail health assessment practices and their financial implications. A brief historical perspective of the evolution of jail health standards is presented as a preface to analyzing current practices nationally. A survey of 509 jails across the United States suggests that health assessments are conducted aggressively in spite of national guideline recommendations, resulting in a

Sally K. Miller



Health hazard evaluation and recommended industrial hygiene practices for aboveground oil shale processing  

SciTech Connect

Specific process unit operations of aboveground oil shale processing are evaluated to identify and characterize potential health hazards that may be associated with those operations. Process operations evaluated include oil shale mining (both surface and underground), shale preparation and handling, retorting, spent shale disposal, retort offgas handling and cleaning, product oil separation and handling, on-site product upgrading and storage, retort water handling and treatment, by-product recovery, and general plant facilities. Situations common to many process units or operations, such as maintenance and confined space/limited egress, are discussed. Recommended industrial hygiene practices are discussed, including engineering controls, industrial hygiene monitoring, worker health training, personal protective equipment, decontamination, employee health surveillance, and recordkeeping. 220 refs., 33 figs., 18 tabs.

Brandt, M.T.; Hargis, K.M.; Schulte, H.F.



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


Recommended practices for spline usage in CAD/CAM systems: CADCAM-007  

SciTech Connect

Sandia National Laboratories has been assigned Lead Lab responsibility for integrating CAD/CAM activities throughout the DOE Nuclear Weapons Complex (NWC) and automating exchange of product definition. Transfer of splines between CAD/CAM systems presents a special problem due to the use of different spline interpolation schemes in these systems. Automated exchange via IGES (Initial Graphics Exchange Specification, ANSI Y14.26M-1981) shows promise but does not yet provide a usable data path for NWC spline needs. Data exchange today is primarily via hard copy drawings with manual data reentry and spline recomputation. In this environment, spline problems can be minimized by following the recommended practices set forth in this report.

Fletcher, S.K.



Ecotoxicity test methods for engineered nanomaterials: practical experiences and recommendations from the bench.  


Ecotoxicology research is using many methods for engineered nanomaterials (ENMs), but the collective experience from researchers has not been documented. This paper reports the practical issues for working with ENMs and suggests nano-specific modifications to protocols. The review considers generic practical issues, as well as specific issues for aquatic tests, marine grazers, soil organisms, and bioaccumulation studies. Current procedures for cleaning glassware are adequate, but electrodes are problematic. The maintenance of exposure concentration is challenging, but can be achieved with some ENMs. The need to characterize the media during experiments is identified, but rapid analytical methods are not available to do this. The use of sonication and natural/synthetic dispersants are discussed. Nano-specific biological endpoints may be developed for a tiered monitoring scheme to diagnose ENM exposure or effect. A case study of the algal growth test highlights many small deviations in current regulatory test protocols that are allowed (shaking, lighting, mixing methods), but these should be standardized for ENMs. Invertebrate (Daphnia) tests should account for mechanical toxicity of ENMs. Fish tests should consider semistatic exposure to minimize wastewater and animal husbandry. The inclusion of a benthic test is recommended for the base set of ecotoxicity tests with ENMs. The sensitivity of soil tests needs to be increased for ENMs and shortened for logistics reasons; improvements include using Caenorhabditis elegans, aquatic media, and metabolism endpoints in the plant growth tests. The existing bioaccumulation tests are conceptually flawed and require considerable modification, or a new test, to work for ENMs. Overall, most methodologies need some amendments, and recommendations are made to assist researchers. PMID:22002667

Handy, Richard D; Cornelis, Geert; Fernandes, Teresa; Tsyusko, Olga; Decho, Alan; Sabo-Attwood, Tara; Metcalfe, Chris; Steevens, Jeffery A; Klaine, Stephen J; Koelmans, Albert A; Horne, Nina



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



Enhancing reflective practice through online learning: impact on clinical practice  

Microsoft Academic Search

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

J Sim; A Radloff


inPractice: A Practical Nursing Package for Clinical Decisions  

ERIC Educational Resources Information Center

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

Ip, Barry; Cavanna, Annlouise; Corbett, Beverley



inPractice: A Practical Nursing Package for Clinical Decisions  

ERIC Educational Resources Information Center

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

Ip, Barry; Cavanna, Annlouise; Corbett, Beverley



What is Correctional about Clinical Practice in Corrections?  

Microsoft Academic Search

It is clear that adequate academic and continuing education\\/training for correctional mental health professionals is imperative if their practice is to be effective. To help shape such training, the clinical and correctional knowledge ranked most meaningful and relevant by psychologists practicing in federal prisons is determined. Overall, results suggest nine core bodies of knowledge representing a mix of clinical (e.g.,

Philip R. Magaletta; Marc W. Patry; Erik F. Dietz; Robert K. Ax



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



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


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. PMID:21701601

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



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.



Evidence-Based Research and Practice in Clinical Neuropsychology  

Microsoft Academic Search

While a definition for evidence-based clinical neuropsychological practice (EBCNP) has yet to emerge, it is likely to integrate the same core features as evidence-based medicine; namely, best research evidence, clinical expertise, and individual patient needs. Given the nascent stage of EBCNP, suggestions are made to advance evidence-based approaches in both research and practice. The common elements are: recognition that clinical

Gordon J. Chelune



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...



[Immunoglobulin A nephropaty: clinical practice guidelines].  


Immunoglobulin A nephropathy (N.IgA) is the world most common glomerular disease; 15-50% of patients develop loss of renal function in 10-20 years, and the rest remission or mild proteinuria/ hematuria. The optimal treatment is uncertain. Our aim was to develop evidence-based recommendations through research in Medline, Embasse, Lilacs and Cochrane Central Register of Controlled Trials. The study-quality was independently assessed by the reviewers following the Cochrane Renal Group checklist: randomization, blinding, intention-to-treat analysis and follow-up period. Levels of evidence and grades of recommendation were assigned according to Center for Evidence-Based Medicine, Oxford. Two approaches were considered: Immunosuppressive therapy (corticosteroids, cytostatics, cyclosporine A, mycophenolate-mofetil): Level I a, grade A. -Combined suppressive therapy in adults. Corticosteroids plus cytotoxics drugs (cyclophosphamide/azathioprine): Level II b, grade B. In children with severe IgA nephropathy: Level II b, grade D. Cyclosporine and mycophenolate- mophetil: Level II b, grade C. Cyclosporine and mycophenolate-mophetil: Level ll b, grade C. -Non immunosuppressive therapy: reninangiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers (ARB), fish oil, statins, antiplatelets and tonsillectomy. ACEI and/or ARB, in patients with proteinuria ? 1 g: Level I a, grade A. In children with moderate proteinuria: ACEI and/or ARB with close monitoring of renal function and serum potassium level: Level II b, grade B. Antiplatelet as supportive treatment: Level I a, grade C. Fish oil in addition to ACEI or ARB in patients with mild histological lesions: Level II b, grade B (Not in children). Statins: no evidence to recommend these drugs in children. In patients > 5 years with nephrotic syndrome and hyper-cholesterolemia, use statins with close monitoring of serum creatine-kinase. There is no evidence to recommend tonsillectomy. PMID:21903506

Fayad, Alicia; Robaina Sindin, Javier; Calvo Abeucci, Mónica; Trimarchi, Hernán; Vázquez, Vanina



Seborrheic dermatitis: a clinical practice snapshot.  


Seborrheic dermatitis is a chronic, recurring skin disorder that has no cure.Current clinical research has implicated Malassezia yeast in the etiology. Using a clear, concise clinical picture and a thorough patient history, even the novice NP can formulate an effective treatment plan. PMID:21768832

Schmidt, Jennifer A



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


NHS Lanarkshire's leadership development programme's impact on clinical practice  

Microsoft Academic Search

Purpose – The purpose of this paper is to explore the effect of a clinical leadership programme on senior clinicians within National Health Service Lanarkshire, in terms of key constituents for fostering leadership development, specific skills developed and impact this has had on clinical practice. Design\\/methodology\\/approach – A qualitative research design was employed over several stages, involving 44 senior clinical

Angela M. Sutherland; Frances Dodd



Stress Management Training in Health Psychology Practice: Critical Clinical Issues  

Microsoft Academic Search

Stress management training interventions have become one of the most popular treatment programs in health psychology practice. Although numerous clinical approaches are available, limited attention is given to the matching of intervention with the clinical needs of individuals. As a result, stress management programs are more frequently marketed in clinical and community settings as palliative techniques without sufficient exploration of

J. Bruce Hillenberg; Thomas M. DiLorenzo



[HIV/AIDS in the workplace. Practical recommendations of the International Labor Organization].  


There are now some 36 million people in the world infected with HIV/AIDS. It is estimated that more than 23 million of them are economically active, including 642,000 persons in Latin America and the Caribbean. In the workplace, HIV/AIDS reduces incomes, imposes added costs on companies, and undermines fundamental labor laws due to the discrimination and rejection that infected individuals suffer. In response, the International Labor Organization (ILO) has produced a document entitled An ILO code of practice on HIV/AIDS and the world of work, which is summarized in this piece. The ILO document aims to help those in the workplace to cope with the HIV/AIDS epidemic through a set of guidelines related to: (a) preventing infection, (b) managing and reducing the impact that HIV/AIDS has on the workplace, (c) delivering care and support for infected workers and, in general, to all the people affected by this epidemic, and (d) eliminating discrimination against persons who are infected or are suspected of being infected. The ILO Code is intended to help in preparing and adopting specific measures in the workplace, thus promoting dialogue and other forms of cooperation among the government, employers, workers and their representatives, workplace health and safety officers, HIV/AIDS specialists, and other interested parties. The intention is also for the Code recommendations to be implemented and integrated with national laws, policies, and programs; company or business agreements; and workplace policies and action plans. This ILO Code is an important step in the struggle against HIV/AIDS. Aimed at governments, employers, and workers throughout the world, the Code recommendations constitute a useful tool in addressing the problem of HIV/AIDS in the workplace, in a just manner. As a "motor" of society, work cannot remain separated from issues of such great social impact. PMID:11998187



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

Microsoft Academic Search

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

Diana E. Post



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



[From theory to clinical practice: recombinant FSH in daily practice].  


The purpose of the present study is to determine the efficacy of induction ovulation with recombinant FSH in patients treated with in vitro fertilization and embryo transfer (IVF-ET) and basic assisted reproductive techniques (ART). One hundred seven cycles were analyzed. The patients were divided in two groups: Group 1, treated with IVF (n = 12) and group 2, treated with basic ART (n = 95). Only recombinant FSH was utilized for ovulation induction; human corionic gonadotropin (hCG), 10,000 IU, were administered when one or more dominant follicles with diameter > or = 18 mm were presents; oocyte retrieval was performed 34 hour, while intrauterine insemination was practiced at 36 hours after the hCG injection. The pregnancy rate per IVF cycle was 25.0%, and 16.4% for basic ART. It is concluded that ovulation induction with recombinant FSH is a good and efficient alternative for both variations of ART. PMID:10504796

Kably Ambe, A; Barrón Vallejo, J; Góngora Rodríguez, A; Carballo Mondragón, E; Anta Jaén, E



Principles, methods, and technique of laser application in clinical practice  

NASA Astrophysics Data System (ADS)

Laser, being intensely bright, highly directional, monochromatic, and coherent, has a wide application in the future of bio-medical science. As a new therapy, laser in clinical practice is mainly used for certain curing effects through its heat and photochemical effects, respectively, obtained from its four properties acting on human organisms to produce certain desired changes. Laser therapy, according to its bio-chemical effects, can be roughly divided into three categories: laser vaporization, laser solidification, and laser stimulation. Clinical practice has proven that each category has its appropriate symptom in all kinds of diseases. Laser therapy is playing a unique part in clinical practice.

Tian, Zhaobing



Sjögren-Larsson syndrome in clinical practice.  


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



[Managing of the patient with dyspepsia. Clinical Practice Guideline. Update 2012].  


The "Preparation of Clinical Practice Guidelines in Digestive Diseases, from Primary Care to Specialist Care" Program, is a joint project by the Spanish Gastroenterology Association (AEG), the Spanish Society of Family and Community Medicine (SEMFyC), and the IberoAmerican Cochrane Center (CCI). We present the update of the Guidelines on the Management of Dyspepsia, which was published in 2003. The essential criteria provided in the AGREE (Appraisal of Guidelines, Research and Evaluation for Europe) Instrument were taken into account in the preparation of this document. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to classify the scientific evidence and strengthen the recommendations. PMID:23089244

Gisbert, Javier P; Calvet Calvo, Xavier; Ferrándiz Santos, Juan; Mascort Roca, Juan José; Alonso-Coello, Pablo; Marzo Castillejo, Mercè



Probiotics in clinical practice: an overview.  


The observation that intestinal bacterial microflora might be able to influence immune system surveillance through changed nutritional habits has raised awareness of the role of probiotics. These are live microorganisms that are able to reach the gastrointestinal tract and alter its microfloral composition, producing beneficial health effects when consumed in adequate amounts. Recent clinical trials have evaluated the clinical effectiveness of probiotics in the treatment and prevention of a wide range of acute and chronic gastrointestinal diseases, and also non-gastrointestinal diseases, such as atopy, respiratory infections, vaginitis and hypercholesterolaemia. Probiotic supplements are generally regarded as safe because the microorganisms they contain are identical to those found in human gastrointestinal and vaginal microflora. Guidelines on the use of probiotics in the clinical setting require periodical updates for the latest data to be included in clinical applications. The purpose of this clinical report is to review current evidence on the use of probiotics in a variety of gastrointestinal and non-gastrointestinal conditions. PMID:18230282

Zuccotti, G V; Meneghin, F; Raimondi, C; Dilillo, D; Agostoni, C; Riva, E; Giovannini, M



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



Bioinformatics and the allergy assessment of agricultural biotechnology products: industry practices and recommendations.  


Bioinformatic tools are being increasingly utilized to evaluate the degree of similarity between a novel protein and known allergens within the context of a larger allergy safety assessment process. Importantly, bioinformatics is not a predictive analysis that can determine if a novel protein will ''become" an allergen, but rather a tool to assess whether the protein is a known allergen or is potentially cross-reactive with an existing allergen. Bioinformatic tools are key components of the 2009 CodexAlimentarius Commission's weight-of-evidence approach, which encompasses a variety of experimental approaches for an overall assessment of the allergenic potential of a novel protein. Bioinformatic search comparisons between novel protein sequences, as well as potential novel fusion sequences derived from the genome and transgene, and known allergens are required by all regulatory agencies that assess the safety of genetically modified (GM) products. The objective of this paper is to identify opportunities for consensus in the methods of applying bioinformatics and to outline differences that impact a consistent and reliable allergy safety assessment. The bioinformatic comparison process has some critical features, which are outlined in this paper. One of them is a curated, publicly available and well-managed database with known allergenic sequences. In this paper, the best practices, scientific value, and food safety implications of bioinformatic analyses, as they are applied to GM food crops are discussed. Recommendations for conducting bioinformatic analysis on novel food proteins for potential cross-reactivity to known allergens are also put forth. PMID:21320564

Ladics, Gregory S; Cressman, Robert F; Herouet-Guicheney, Corinne; Herman, Rod A; Privalle, Laura; Song, Ping; Ward, Jason M; McClain, Scott



High-altitude exposure in patients with cardiovascular disease: risk assessment and practical recommendations.  


Because of the development of modern transportation facilities, an ever rising number of individuals including many patients with preexisting diseases visit high-altitude locations (>2500 m). High-altitude exposure triggers a series of physiologic responses intended to maintain an adequate tissue oxygenation. Even in normal subjects, there is enormous interindividual variability in these responses that may be further amplified by environmental factors such as cold temperature, low humidity, exercise, and stress. These adaptive mechanisms, although generally tolerated by most healthy subjects, may induce major problems in patients with preexisting cardiovascular diseases in which the functional reserves are already limited. Preexposure assessment of patients helps to minimize risk and detect contraindications to high-altitude exposure. Moreover, the great variability and nonpredictability of the adaptive response should encourage physicians counseling such patients to adapt a cautionary approach. Here, we will briefly review how high-altitude adjustments may interfere with and aggravate/decompensate preexisting cardiovascular diseases. Moreover, we will provide practical recommendations on how to investigate and counsel patients with cardiovascular disease desiring to travel to high-altitude locations. PMID:20417345

Rimoldi, Stefano F; Sartori, Claudio; Seiler, Christian; Delacrétaz, Etienne; Mattle, Heinrich P; Scherrer, Urs; Allemann, Yves


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


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

Férard, Georges; Dybkaer, René



Integrating Clinical Practice Guidelines into Daily Practice: Impact of an Interactive Workshop on Drafting of a Written Action Plan for Asthma Patients  

ERIC Educational Resources Information Center

|Introduction: Written action plans (WAPs) are instructions that enable asthmatics to manage their condition appropriately and are recommended by current asthma clinical practice guidelines (CPGs). However, general practitioners (GPs) rarely draft WAPs for their patients. An interactive, case-based workshop for asthma, combined with an objective…

Labelle, Martin; Beaulieu, Michele; Renzi, Paolo; Rahme, Elham; Thivierge, Robert L.



Developmental theory and the practice of clinical child psychology.  


Examined developmental theory and its relevance for the practice of clinical child psychology. Following a brief review of basic principles of developmental psychology and developmental psychopathology, implications of a developmental perspective are explored for the diagnosis, assessment, and treatment of childhood disorders. Although it is obvious that many developmental issues confront the clinical child psychologist and that we have learned much about translating developmental theory into clinical practice, we conclude we have a long way to go before we can assert that a true developmental-clinical child interface has been realized. PMID:10587895

Ollendick, T H; Vasey, M W



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



42 CFR 21.44 - Clinical or other practical demonstration.  

Code of Federal Regulations, 2012 CFR

... COMMISSIONED OFFICERS Appointment § 21.44 Clinical or other practical demonstration. In the discretion of the Surgeon General a candidate for appointment to any grade up to and including the senior assistant grade in the Regular Corps may be...



42 CFR 21.44 - Clinical or other practical demonstration.  

Code of Federal Regulations, 2011 CFR

... COMMISSIONED OFFICERS Appointment § 21.44 Clinical or other practical demonstration. In the discretion of the Surgeon General a candidate for appointment to any grade up to and including the senior assistant grade in the Regular Corps may be...



Nonpharmacological smoking cessation interventions in clinical practice  

Microsoft Academic Search

Doctors and other healthcare professionals are in a unique position to advise smokers to quit by their ability to integrate the various aspects of an effective counselling. The present review provides an overview of nonpharmacological interventions for smokers presenting in a clinical setting. Strategies used for smoking cessation counselling differ according to the patient's readiness to quit. For smokers who

J. Cornuz; C. Willi



Nuclear diagnostic imaging: Practical clinical applications  

SciTech Connect

This book consists of three parts, containing 14 chapters. The part headings are: Introductory Principles, Clinical Applications, and Additional Procedures. Some of the chapter titles are: Radiopharmaceuticals, Quality Assurance and Quality Control, Endocrine Imaging, Musculoskeletal Imaging, Central Nervous System Imaging, and Other Useful Procedures and New Technology.

Not Available



The ezetimibe controversy: implications for clinical practice.  


Low-density lipoprotein cholesterol (LDL-C) remains the primary target of lipid-lowering therapy. Achieving LDL-C goals as outlined by the National Cholesterol Education Program Adult Treatment Panel III can be difficult with statins alone; therefore, adjunctive therapy is often indicated to reduce cardiovascular risk. Ezetimibe, a potent inhibitor of intestinal cholesterol absorption, has been shown to be safe, tolerable and effective at lowering LDL-C, non-high-density lipoprotein cholesterol and apolipoprotein B, each of which has been correlated with improved clinical outcomes, alone or in combination with a statin. However, because of randomized trials that demonstrated mixed results about atherosclerotic plaque regression via carotid intima-media thickness and a concern about cancer risk, ezetimibe's role in lipid therapy has been questioned. Currently, a large randomized controlled trial is in progress to answer if ezetimibe improves clinical outcomes in patients with high-risk acute coronary syndrome. A smaller trial in patients with chronic kidney disease demonstrated reduced clinical events, including myocardial infarction, stroke and revascularization for patients taking the combination of ezetimibe and simvastatin versus those taking statin or placebo alone. In this paper, we review the trials that have led to the ezetimibe controversy and then discuss the possible role of ezetimibe in specific patient populations until the results of ongoing clinical trials are known. PMID:21636623

Khanderia, Ujjaini; Regal, Randolph E; Rubenfire, Melvyn; Boyden, Thomas



The Control of Breathing in Clinical Practice  

Microsoft Academic Search

The control of breathing results from a complex interaction involving the respiratory centers, which feed signals to a central control mechanism that, in turn, provides output to the effector muscles. In this review, we describe the individual elements of this system, and what is known about their function in man. We outline clinically relevant aspects of the integration of human

Brendan Caruana-Montaldo; Kevin Gleeson; Clifford W. Zwillich



A Working Model of Cross-Cultural Clinical Practice (CCCP)  

Microsoft Academic Search

A long-standing gap between clinical and cultural practice can lead clinicians to feel overwhelmed by the task of integrating\\u000a clinical practice with a culturally sensitive approach, while working toward changes in clients’ lives. This article attempts\\u000a to assist clinicians in their efforts to achieve this task. Using a Task-Analysis approach in the alliance research (Safran\\u000a et al. 1994), this article

Eunjung Lee


Development and implementation of Clinical Practice Guidelines in physical therapy  

Microsoft Academic Search

Summary Quality assurance and cost-effectiveness are important issues in modern-day healthcare. They are of great concern to the Royal Dutch Society for Physical Therapy (KNGF). One strategy for improving the quality of physical therapy (physiotherapy) is to minimize undesirable variability in clinical practice by developing and implementing evidence-based clinical practice guidelines. However, even well- established guidelines will not contribute to

J. Van der Wees


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


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



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

PubMed Central

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

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



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.



Influences on clinical practice: the case of glue ear  

Microsoft Academic Search

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

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



Integration of Evidence-Based Practice into the University Clinic  

ERIC Educational Resources Information Center

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

Goldstein, Brian A.



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.



Mandatory Clinical Practice for Dental and Dental Hygiene Faculty.  

ERIC Educational Resources Information Center

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

Cameron, Cheryl A.; And Others



The Use of Research Measures in Adult Clinical Practice  

PubMed Central

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

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



An Internet Portal for the Development of Clinical Practice Guidelines  

PubMed Central

Background The complexity and quality requirements for the development of clinical practice guidelines steadily increase. Internet technologies support this process by optimizing the development process. Objective The aim of this internet based solution was to facilitate the development of clinical practice guidelines. Methods An internet portal was developed allowing for a shared workplace to support clinical practice guideline authoring. It is based on a Content Management System and combines different tools for document handling and editing, communication as well as process and team steering. Results Until now, the internet portal has been successfully implicated in the development of six evidence- and consensus-based clinical practice guidelines. Additional German and European clinical practice guidelines are currently generated with support of the internet portal. The available tools allow for a flexible design of the scheduled workflow, depending on the requirements of the respective group. An additional strength of the platform is the advantage to transfer all data from a previous version of a guideline into the next ‘life-cycle’. Conclusion The application of the portal results in a considerable reduction of costs and development time of the resulting clinical practice guidelines.

Hohne, W.J.; Karge, T.; Siegmund, B.; Preiss, J.; Hoffmann, J.C.; Zeitz, M.; Folsch, U.R.



The Importance of Trichoscopy in Clinical Practice  

PubMed Central

Trichoscopy corresponds to scalp and hair dermoscopy and has been increasingly used as an aid in the diagnosis, follow-up, and prognosis of hair disorders. Herein, we report selected cases harbouring scalp or hair diseases, in whom trichoscopy proved to be a valuable tool in their management. A review of the recent literature on this hot topic was performed comparing the described patterns with our findings in clinically common conditions, as well as in rare hair shaft abnormalities, where trichoscopy may display pathognomonic features. In our view, trichoscopy represents a valuable link between clinical and histological diagnosis. We detailed some trichoscopic patterns, complemented with our original photographs and our insights into nondescribed patterns.

Pedrosa, Ana Filipa; Lisboa, Carmen; Azevedo, Filomena



Literature and medicine: contributions to clinical practice.  


Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine. PMID:7887555

Charon, R; Banks, J T; Connelly, J E; Hawkins, A H; Hunter, K M; Jones, A H; Montello, M; Poirer, S



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.



Methodological considerations and practical recommendations for the application of peripheral arterial tonometry in children and adolescents.  


Endothelial dysfunction is recognized as the primum movens in the development of atherosclerosis. Its crucial role in both cardiovascular morbidity and mortality has been confirmed. In the past, research was hampered by the invasive character of endothelial function assessment. The development of non-invasive and feasible techniques to measure endothelial function has facilitated and promoted research in various adult and paediatric subpopulations. To avoid user dependence of flow-mediated dilation (FMD), which evaluates nitric oxide dependent vasodilation in large vessels, a semi-automated, method to assess peripheral microvascular function, called peripheral arterial tonometry (Endo-PAT(®)), was recently introduced. The number of studies using this technique in children and adolescents is rapidly increasing, yet there is no consensus with regard to either measuring protocol or data analysis of peripheral arterial tonometry in children and adolescents. Most paediatric studies simply applied measuring and analysing methodology established in adults, a simplification that may not be appropriate. This paper provides a detailed description of endothelial function assessment using the Endo-PAT for researchers and clinicians. We discuss clinical and methodological considerations and point out the differences between children, adolescents and adults. Finally, the main aim of this paper is to provide recommendations for a standardised application of Endo-PAT in children and adolescents, as well as for population-specific data analysis methodology. PMID:23972967

Bruyndonckx, Luc; Radtke, Thomas; Eser, Prisca; Vrints, Christiaan J; Ramet, José; Wilhelm, Matthias; Conraads, Viviane M



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


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



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



Compliance With the North American Guidelines for Children's Agricultural Tasks (NAGCAT) Work Practice Recommendations for Youth Working With Large Animals  

Microsoft Academic Search

The North American Guidelines for Children's Agricultural Tasks (NAGCAT) were developed to reduce the risk of childhood agricultural injury. The purpose of this study was to evaluate compliance with NAGCAT-recommended work practices (WPs) when youth work with large animals. On a daily basis, over a period of 10 weeks, youth self-reported the number of minutes they worked with a large

L. Asti; B. D. Canan; C. Heaney; S. Ashida; K. Renick; H. Xiang; L. Stallones; S. D. Jepsen; J. M. Crawford; J. R. Wilkins III



New API fired heater standard and air preheat systems recommended practice reflects refiners' needs to maximize flexibility and reliability  

Microsoft Academic Search

The American Petroleum Institute will soon be providing refiners with two new publications that address the need to maximize flexibility and reliability of fired heaters and attendant combustion air preheat systems. These new publications are API Standard 560 Fired Heaters for General Refinery Service, and API RP533, Recommended Practice for Design of Air Preheat Systems. The objective of these publications

F. W. Elfers; M. O. Fankhanel



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


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

Wallcraft, Jan; Amering, Michaela; Freidin, Julian; Davar, Bhargavi; Froggatt, Diane; Jafri, Hussain; Javed, Afzal; Katontoka, Sylvester; Raja, Shoba; Rataemane, Solomon; Steffen, Sigrid; Tyano, Sam; Underhill, Christopher; Wahlberg, Henrik; Warner, Richard; Herrman, Helen



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

ERIC Educational Resources Information Center

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

National Governors' Association, Washington, DC.


From guidelines to clinical practice: cardiovascular risk management in inflammatory arthritis patients.  


There exists significant evidence of increased risk of cardiovascular (CV) disease in rheumatoid arthritis (RA) patients in comparison with the general population. This finding has been supported by a number of guidelines recommending screening for CV disease risk in patients with the disease. However, the opportunity to identify and manage those patients at risk has been missed in both primary and secondary care. The success of CV risk management in diabetes patients provides a clear incentive to identify and actively manage CV risk in all RA patients as part of routine practice. This article provides an approach that shows how to assess for CV risk in standard clinical practice. PMID:24005485

Palmer, Deborah; El Miedany, Yasser



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



Recommendations for Clinical Decision Support Deployment: Synthesis of a Roundtable of Medical Directors of Information Systems  

PubMed Central

Background: Ample evidence exists that clinical decision support (CDS) can improve clinician performance. Nevertheless, additional evidence demonstrates that clinicians still do not perform adequately in many instances. This suggests an ongoing need for implementation of CDS, in turn prompting development of a roadmap for national action regarding CDS. Objective: Develop practical advice to aid CDS implementation in order to improve clinician performance. Method: Structured group interview during a roundtable discussion by medical directors of information systems (N = 30), with subsequent review by participants and synthesis. Results: Participant consensus was that CDS should be comprehensive and should involve techniques such as order sets and facilitated documentation as well as alerts; should be subject to ongoing feedback; and should flow from and be governed by an organization’s clinical goals. Conclusion: A structured roundtable discussion of clinicians experienced in health information technology can yield practical, consensus advice for implementation of CDS.

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



Practical recommendations for the use of ACE inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers in heart failure: Putting guidelines into practice  

Microsoft Academic Search

Surveys of prescribing patterns in both hospitals and primary care have usually shown delays in translating the evidence from clinical trials of pharmacological agents into clinical practice, thereby denying patients with heart failure (HF) the benefits of drug treatments proven to improve well-being and prolong life. This may be due to unfamiliarity with the evidence-base for these therapies, the clinical

John McMurray; Alain Cohen-Solal; Rainer Dietz; Eric Eichhorn; Leif Erhardt; F. D. Richard Hobbs; Henry Krum; Aldo Maggioni; Robert S. McKelvie; Ileana L. Pinaj; Jordi Soler-Soler; Karl Swedberg


Erring and learning in clinical practice.  

PubMed Central

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

Hurwitz, Brian



Peritoneal dialysis membrane evaluation in clinical practice.  


A review is given on the various methods to assess the quality of the peritoneum as a dialysis membrane. The quality of the peritoneum in patients who are treated with chronic peritoneal dialysis (PD) has mainly focused on solute transport. Only recently have biomarkers in effluent been considered as useful, but are not generally applied. Peritoneal function tests should not be performed only when clinical problems are present, but rather on a regular basis, for instance every 6-12 months. Only in this way can the natural cause become apparent. PMID:22652743

Krediet, Raymond T; Struijk, Dirk G



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


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

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



REFEREE: An Open Framework for Practical Testing of Recommender Systems using ResearchIndex  

Microsoft Academic Search

Automated recommendation (e.g., personalized product recommendation on an ecommerce web site) is an increasingly valuable service associ- ated with many databases—typically online re- tail catalogs and web logs. Currently, a ma- jor obstacle for evaluating recommendation al- gorithms is the lack of any standard, public, real-world testbed appropriate for the task. In an attempt to fill this gap, we have

Dan Cosley; Steve Lawrence; David M. Pennock



Clinical practice guidelines: The dangerous pitfalls of avoiding methodological rigor  

Microsoft Academic Search

In the past two decades, clinical guidelines have become practical tools that assist clinicians, policy makers and insurers make informed decisions about the clinical and administrative management of patients. The popularity of these tools has increased so rapidly that clinicians now face the dilemma of having to choose from a plethora of documents of varying quality that were developed by

Pierre Côté; Jill Hayden



Use of lactate in small animal clinical practice.  


Lactate is a product of anaerobic metabolism. Lactate concentration in blood is used clinically as an indicator of tissue hypoperfusion and hypoxia to determine disease severity, assess response to therapy, and predict outcome. This article reviews lactate physiology, sample collection and processing, and interpretation of lactate concentration in clinical practice. PMID:24144091

Sharkey, Leslie C; Wellman, Maxey L



Prioritization strategies in clinical practice guidelines development: a pilot study  

Microsoft Academic Search

OBJECTIVE: Few methodological studies address the prioritization of clinical topics for the development of Clinical Practice Guidelines (CPGs). The aim of this study was to validate a methodology for Priority Determination of Topics (PDT) of CPGs. METHODS AND RESULTS: Firstly, we developed an instrument for PDT with 41 criteria that were grouped under 10 domains, based on a comprehensive systematic

Ludovic Reveiz; Diana R Tellez; Juan S Castillo; Paola A Mosquera; Marcela Torres; Luis G Cuervo; Andres F Cardona; Rodrigo Pardo



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



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



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.



Implementation of a clinical workstation for general practice.  


It is now well recognized that achieving international best practice in the primary health sector will require the development of methods based on a fundamental integration of communications and information technologies with clinical practice. This will have far reaching effects, both on the pattern of medical practice and domiciliary care and on patient outcomes. In the past, information and communications technology has been presented as a tool for management, rather than as a tool for supporting, improving, and making more efficient the professional practice of medicine and the delivery of health care to the patient and the community. In this paper, we propose that an essential element for the achievement of international best practice in the health sector is the development and widespread use of information, measurement, and communications technology targeted towards the clinical practice of medicine, the provision of health services and domiciliary care in the community, and the analysis of morbidity patterns and health care outcomes. A key element of this strategy is the development of an integrated Clinical Workstation specifically designed for the general practitioner, practice nurses, and domiciliary care nurses in their professional tasks of measurement, diagnosis, management, and delivery of health care to the community. We will present our work on the design of an integrated Clinical Workstation for Primary Health Care. The Workstation is Windows based, has a sophisticated user interface, and supports a wide range of computing platforms, from desktop to laptop to hand-held notebook computers. The Workstation will be modular and expandable, both in its software and hardware components, so that users may select only those modules appropriate to their own roles, clinical practice, and levels of expertise. The design will focus on the provision of clinical services and will integrate the following key components: Patient records and basic practice management; Clinical records. Based on ICD10, ICPC, or Read Code classifications; Clinical measurements. Blood pressure, spirometry, ECG, and basic hematology and biochemistry; Clinical decision support. Based on epidemiologic data, protocols, and medical expert systems; Domiciliary care and evaluation of the functional health status of the elderly; Communications and networks. Wireless LAN, modem, and fax; Clinical reporting. Morbidity profiles prescribing profiles, and laboratory services and procedures. Implementation of these requirements will ultimately take the form of an untethered, portable notepad computer supporting a communications link via modem, LAN, or wireless LAN, and removable instrumentation and clinical measurement modules. PMID:8591325

Lovell, N H; Celler, B G



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



The role of MRI in musculoskeletal practice: a clinical perspective  

PubMed Central

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

Dean Deyle, Gail



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



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


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



NHMRC guidelines for clinical practice for ASD and PTSD.  


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

Ladd, Gary



Automated application of clinical practice guidelines for asthma management.  

PubMed Central

Clinical practice guidelines will be more beneficial when they are integrated with the electronic medical record. We applied natural language processing (NLP) techniques to extract clinical findings from outpatient progress notes in an attempt to: 1) select outpatient chart notes appropriate for evaluation against the National Heart, Lung, and Blood/National Asthma Education Program clinical practice guidelines for the diagnosis and management of asthma, 2) determine patient need for inhaled anti-inflammatory agents, and 3) quantify the severity of asthma. Our results were compared to judgements by an expert panel of practitioners. We were able to correctly identify the need for inhaled anti-inflammatory agents 76% of the time. The success of this pilot project could have broad implications for the application of clinical practice guidelines.

Ertle, A. R.; Campbell, E. M.; Hersh, W. R.



Achieving remission in clinical practice: lessons from clinical trial data.  


This review examines the literature on the frequency of remission associated with different treatment approaches in early rheumatoid arthritis (ERA). Trials reporting remission outcomes were identified through searches of the CINAHL, EMBASE, and Medline (PubMed) databases from 2000 through August 2012. Additional literature was identified through hand searching. The proportion of patients achieving remission and/or radiographic non-progression was extracted from each study. Evidence was examined in the context of unified remission criteria and practical considerations for achieving and maintaining remission are discussed. The literature highlights the benefits of early treatment with disease-modifying anti-rheumatic drug (DMARD) combination therapy, combination therapy with a biologic, and tight control with a pre-specified treatment target in achieving remission in ERA. The added stringency of the 2011 remission criteria may increase the proportion of patients achieving true remission, while identifying predictors of sustained remission may also help patients achieve better radiographic and functional outcomes. PMID:23622099

Bykerk, Vivian P; Keystone, Edward C; Kuriya, Bindee; Larché, Maggie; Thorne, J Carter; Haraoui, Boulos



2006-2007 American Diabetes Association Nutrition Recommendations: Issue for Practice Translation  

Technology Transfer Automated Retrieval System (TEKTRAN)

The American Diabetes Association 2006 Nutrition Recommendations update the previous 2002 statement which was accompanied by technical review and was modified slightly in 2004. The complete 2006 recommendations are available at add link information). The role of nutrition in dia...


Performance of US hospitals on recommended screening and immunization practices for pregnant and postpartum women  

Microsoft Academic Search

Objective: Recommendations by most national advisory committees on immunization include evaluating all pregnant women for chronic hepatitis B virus infection and immunity to rubella. It is recommended that all pregnant women be screened for hepatitis B surface antigen during an early prenatal visit and that rubella vaccine be administered in the postpartum period to women not known to be immune.

Sue K. Bath; James A. Singleton; Raymond A. Strikas; John M. Stevenson; Linda L. McDonald; Walter W. Williams



Fabry Disease in Genetic Counseling Practice: Recommendations of the National Society of Genetic Counselors  

Microsoft Academic Search

The objective of this document is to provide health care professionals with recommendations for genetic counseling and testing of individuals with a suspected or confirmed diagnosis of Fabry disease, with a family history of Fabry disease, and those identified as female carriers of Fabry disease. These recommendations are the opinions of a multicenter working group of genetic counselors, medical geneticists,

Robin L. Bennett; Kimberly A. Hart; Erin O'Rourke; John A. Barranger; Jack Johnson; Kay D. MacDermot; Gregory M. Pastores; Robert D. Steiner; Ravi Thadhani



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.



TNF-alpha blockers in inflammatory bowel diseases: practical consensus recommendations and a user's guide.  


More than seventy years after their initial characterisation, the aetiology of inflammatory bowel diseases remains elusive. A recent review evaluating the incidence trends of the last 25 years concluded that an increasing incidence has been observed almost worldwide. A north-south gradient is still found in Europe. Genetic associations are variably reproduced worldwide and indicate a strong impact of environmental factors. Tumour necrosis factor alpha (TNF-alpha) has been shown to play a critical role in the pathogenesis of inflammatory bowel disease (IBD). TNF-alpha blockers are biological agents that specifically target this key cytokine in the inflammatory process and have become a mainstay in the therapy of inflammatory bowel diseases. This paper reviews the necessary investigations before using such agents, the use of such agents in pregnancy and lactation, the role of co-immunosuppression, how to monitor efficacy and safety, dose-adaptation, and the decision as to when to switch to another TNF-alpha blocker. Finally it gives recommendations for special situations. Currently there are three TNF-alpha blockers available for clinical use in IBD in Switzerland: infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). Infliximab is a chimeric monoclonal antibody composed of a human IgG1 constant region and a murine variable region and is administered intravenously. Adalimumab is a humanised monoclonal antibody, with both human IgG1 constant and variable regions. Certolizumab pegol is a pegylated, humanised monoclonal anti-TNF fragment antigen binding fragment. Both adalimumab and certolizumab pegol are administered by subcutaneous injection. The efficacy and safety of TNF-alpha blockers in Crohn's disease has been reviewed. The authors conclude that the three above-mentioned agents are effective in luminal Crohn's disease. In fistulizing Crohn's disease, TNF-alpha blockers other than infliximab require additional investigation. PMID:19452290

Pache, Isabelle; Rogler, Gerhard; Felley, Christian



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

PubMed Central

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

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



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



CAPD prescription in current clinical practice.  


A total of 132 patients from 15 dialysis centers were studied. Analyses were made of each drained dialysate exchange over 24 hours to determine total peritoneal urea clearance (KpT, liters/day), and a 24-hour urine was collected to determine total renal urea clearance (KrT, liters/day) and the sum of KpT+KrT or KprT, liters/day. Body water volume (V, L) was estimated from gender and surface area, and daily fractional urea clearance (KprT/V) was calculated. Normalized protein catabolic rate (PCRN, grams/kilogram/day) was also calculated from the urea data. Major results were the following: KrT comprised 25% of KprT; the mean KprT/V was 0.28, but ranged from 0.10-0.50; an equivalent thrice-weekly hemodialysis KT/V was calculated from the KprT/V values and showed mean KT/V = 1.07, but 67% of values were less than 1.0. In contrast, the Health Care Finance Administration (HCFA) consensus criteria indicated 91% of prescriptions were adequate. These data indicate the need for clinical outcome studies with KprT/V randomized over the range 0.20-0.30 to better define the domain of adequate CAPD. PMID:8105966

Gotch, F; Gentile, D E; Schoenfeld, P Y



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



Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline  

PubMed Central

Objective: We developed clinical practice guidelines for congenital adrenal hyperplasia (CAH). Participants: The Task Force included a chair, selected by The Endocrine Society Clinical Guidelines Subcommittee (CGS), ten additional clinicians experienced in treating CAH, a methodologist, and a medical writer. Additional experts were also consulted. The authors received no corporate funding or remuneration. Consensus Process: Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society’s CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage, the Task Force incorporated changes in response to written comments. Conclusions: We recommend universal newborn screening for severe steroid 21-hydroxylase deficiency followed by confirmatory tests. We recommend that prenatal treatment of CAH continue to be regarded as experimental. The diagnosis rests on clinical and hormonal data; genotyping is reserved for equivocal cases and genetic counseling. Glucocorticoid dosage should be minimized to avoid iatrogenic Cushing’s syndrome. Mineralocorticoids and, in infants, supplemental sodium are recommended in classic CAH patients. We recommend against the routine use of experimental therapies to promote growth and delay puberty; we suggest patients avoid adrenalectomy. Surgical guidelines emphasize early single-stage genital repair for severely virilized girls, performed by experienced surgeons. Clinicians should consider patients’ quality of life, consulting mental health professionals as appropriate. At the transition to adulthood, we recommend monitoring for potential complications of CAH. Finally, we recommend judicious use of medication during pregnancy and in symptomatic patients with nonclassic CAH.

Speiser, Phyllis W.; Azziz, Ricardo; Baskin, Laurence S.; Ghizzoni, Lucia; Hensle, Terry W.; Merke, Deborah P.; Meyer-Bahlburg, Heino F. L.; Miller, Walter L.; Montori, Victor M.; Oberfield, Sharon E.; Ritzen, Martin; White, Perrin C.



A Randomized Clinical Trial of a Care Recommendation Letter Intervention for Somatization in Primary Care  

PubMed Central

PURPOSE This paper describes the impact of a care recommendation (CR) letter intervention on patients with multisomatoform disorder (MSD) and analysis of patient factors that affect the response to the intervention. METHODS One hundred eighty-eight patients from 3 family practices, identified through screening of 2,902 consecutive patients, were classified using somatization diagnoses based on the number of unexplained physical symptoms from a standardized mental health interview. In a controlled, single-crossover trial, patients were randomized to have their primary care physician receive the CR letter either immediately following enrollment or 12 months after enrollment. The CR letter notified the physician of the patient’s somatization status and provided recommendations for the patient’s care. Patients were followed for 24 months with assessments of functional status at baseline, 12, and 24 months. RESULTS Longitudinal analysis revealed a 12-month intervention effect for patients with multisomatoform disorder (MSD) of 5.5 points (P < .001) on the physical functioning (PCS) scale of the SF-36. Analysis of scores on the MCS scale of the SF-36 found no significant effect on mental functioning. The intervention was more effective for patients with 1 or more comorbid chronic physical diseases (P = .01). CONCLUSIONS The CR letter has a favorable impact on physical impairment of primary care patients with MSD, especially for patients with comorbid chronic physical disease. Multisomatoform disorder appears to be a useful diagnostic classification for managing and studying somatization in primary care patients.

Dickinson, W. Perry; Dickinson, L. Miriam; deGruy, Frank V.; Main, Deborah S.; Candib, Lucy M.; Rost, Kathryn



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

Microsoft Academic Search

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

R Phillips; P Glasziou



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



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


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

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



Heterogeneity in head and neck IMRT target design and clinical practice  

PubMed Central

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

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



KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD.  


The 2012 KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for Anemia in Chronic Kidney Disease provides clinicians with comprehensive evidence-based recommendations to improve patient care. In this commentary, we review these recommendations and the underlying evidence. Most recommendations are well reasoned. For some, the evidence is unclear and recommendations require some qualification. While the KDIGO guideline stresses the potential risks of intravenous iron therapy, withholding iron might have its own risks. The recommendation to avoid hemoglobin levels falling below 9 g/dL sets a lower bound of "acceptability" that may increase blood transfusion. Given the lack of research supporting the optimal transfusion strategy for end-stage renal disease patients, it is difficult to weigh the risks and benefits of red blood cell transfusion. We find a paucity of evidence that hemoglobin concentration targeted between 11 and 11.5 g/dL is associated with a safety risk. Although the evidence that erythropoiesis-stimulating agent use improves patient quality of life is poor, it is possible that the instruments used to measure quality of life may not be well attuned to the needs of chronic kidney disease or dialysis patients. Our last section focuses specifically on the recommendations to treat anemia in children. PMID:23891356

Kliger, Alan S; Foley, Robert N; Goldfarb, David S; Goldstein, Stuart L; Johansen, Kirsten; Singh, Ajay; Szczech, Lynda



Developing search strategies for clinical practice guidelines in SUMSearch and Google Scholar and assessing their retrieval performance  

Microsoft Academic Search

BACKGROUND: Information overload, increasing time constraints, and inappropriate search strategies complicate the detection of clinical practice guidelines (CPGs). The aim of this study was to provide clinicians with recommendations for search strategies to efficiently identify relevant CPGs in SUMSearch and Google Scholar. METHODS: We compared the retrieval efficiency (retrieval performance) of search strategies to identify CPGs in SUMSearch and Google

Andrea Haase; Markus Follmann; Guido Skipka; Hanna Kirchner



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



Clinical Practice as Natural Laboratory for Psychotherapy Research  

Microsoft Academic Search

Both researchers and practitioners need to know more about how laboratory treatment protocols translate to real- world practice settings and how clinical innovations can be systematically tested and communicated to a skeptical sci- entific community. The single-case time-series study is well suited to opening a productive discourse between practice and laboratory. The appeal of case-based time-series stud- ies, with multiple

Jeffrey J. Borckardt; Michael R. Nash; Martin D. Murphy; Darlene Shaw; Patrick O'Neil


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



Poor asthma control in children: evidence from epidemiological surveys and implications for clinical practice.  


The objectives of this study is to compile current knowledge about asthma control in children in relation to goals proposed in international guidelines, to elucidate the factors associated with insufficient asthma control and to address the implications for clinical practice. Review of recent worldwide large population epidemiological surveys and clinical asthma studies of more than 20,000 children are the methods used in this study. The studies report high frequencies of sleep disturbances, emergency visits, school absence and limitations of physical activity due to asthma. Only a small percentage of children with asthma reach the goals of good asthma control set out by Global Initiative for Asthma (GINA). There is evidence of underuse of inhaled corticosteroids even in children with moderate or severe persistent asthma and over-reliance on short-acting beta(2)-agonist rescue medication. Both parents and physicians generally overestimate asthma control and have low expectations about the level of achievable control. Many children with asthma are not being managed in accordance with guideline recommendations, and asthma management practices vary widely between countries. Asthma control falls short of guideline recommendations in large proportions of children with asthma worldwide. Simple methods for assessing asthma control in clinical practice are needed. Treatment goals based on raised expectations should be established in partnership with the asthmatic child and the parents. Effective anti-inflammatory treatment should be used more frequently, and patients should be reviewed regularly. PMID:16494648

Gustafsson, P M; Watson, L; Davis, K J; Rabe, K F



Prescribing Practices in a US cohort of Rheumatoid Arthritis Patients Before and After Publication of the ACR Treatment Recommendations  

PubMed Central

Purpose To examine prescribing of biologic and nonbiologic disease-modifying anti-rheumatic drugs (nbDMARDs) in Rheumatoid Arthritis (RA) before and after publication of the American College of Rheumatology (ACR) treatment recommendations. Methods We identified biologic naïve RA patients cared for by US rheumatologists participating in the CORRONA registry with visits prior to and/or at least 6 months after publication of the ACR recommendations (time periods: 2/02 - 6/08 vs. 12/08 - 12/09). The population was divided into two mutually exclusive cohorts: 1) methotrexate (MTX) monotherapy users; and 2) multiple nbDMARD users. Initiation or dose escalation of biologic and nbDMARDs in response to active disease was assessed cross-sectionally and longitudinally in comparison to the ACR recommendations. The impact of the publication of the ACR recommendations on treatment practices was compared using logistic regression stratified by disease activity adjusting for clustering of physicians and geographic region. Results After one visit, 24 to 37% of MTX monotherapy users with moderate disease activity and poor prognosis or high disease activity received care consistent with the recommendations; it was 34 to 56% after 2 visits. In the multiple nbDMARD users, 30 to 47% of those with moderate or high disease activity received care consistent with the recommendation after one visit and 43 to 51% after 2 visits. Publication of the recommendations did not significantly change treatment patterns for active disease. Conclusions Substantial numbers of RA patients with active disease did not receive care consistent with the current ACR treatment recommendations. Innovative approaches to improve care are necessary.

Harrold, Leslie R.; Harrington, J. Timothy; Curtis, Jeffrey R.; Furst, Daniel E.; Bentley, Mary jane; Shan, Ying; Reed, George; Kremer, Joel; Greenberg, Jeffrey D.



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



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


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



Otitis Media with Effusion in Young Children. Clinical Practice Guideline Number 12; Managing Otitis Media with Effusion in Young Children. Quick Reference Guide for Clinicians Number 12; Middle Ear Fluid in Young Children: Consumer Version. Clinical Practice Guideline Number 12; A Parent Guide.  

National Technical Information Service (NTIS)

This guide includes a Clinical Practice Guideline, Quick Reference Guide for Clinicians, and a Consumer Version. The publications provide in various formats the findings and recommendations of a multidisciplinary panel of experts on the diagnosis and mana...



Pain After Spinal Cord Injury: An Evidence-based Review for Clinical Practice and Research  

PubMed Central

Background/Objectives: To examine the reliability, validity, sensitivity, and practicality of various outcome measures for pain after spinal cord injury (SCI), and to provide recommendations for specific measures for use in clinical trials. Data Sources: Relevant articles were obtained through a search of MEDLINE, EMBASE, CINAHL, and PubMed databases from inception through 2006. Study Selection: The authors performed literature searches to find articles containing data relevant to the reliability and validity of each pain outcome measure in SCI and selected non-SCI populations. Data Extraction: After reviewing the articles, an investigator extracted information utilizing a standard template. A second investigator reviewed the chosen articles and the extracted pertinent information to confirm the findings of the first investigator. Data Synthesis: Taking into consideration both the quantity and quality of the studies analyzed, judgments on reliability and validity of the measures were made by the two investigators. Based upon these judgments, recommendations were formulated for use of specific measures in future clinical trials. In addition, for a subset of measures a voting process by a larger group of SCI experts allowed formulation of recommendations including determining which measures should be incorporated into a minimal dataset of measures for clinical trials and which ones need revision and further validity and reliability testing before use. Conclusions: A 0–10 Point Numerical Rating Scale (NRS) is recommended as the outcome measure for pain intensity after SCI, while the 7-Point Guy/Farrar Patient Global Impression of Change (PGIC) scale is recommended as the outcome measure for global improvement in pain. The SF-36 single pain interference question and the Multidimensional Pain Inventory (MPI) or Brief Pain Inventory (BPI) pain interference items are recommended as the outcome measures for pain interference after SCI. Brush or cotton wool and at least one high-threshold von Frey filament are recommended to test mechanical allodynia/hyperalgesia while a Peltier-type thermotester is recommended to test thermal allodynia/hyperalgesia. The International Association for the Study of Pain (IASP) or Bryce-Ragnarsson pain taxonomies are recommended for classification of pain after SCI, while the Neuropathic Pain Scale (NPS) is recommended for measuring change in neuropathic pain and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) for quantitating neuropathic and nociceptive pain discrimination.

Bryce, Thomas N; Budh, Cecilia Norrbrink; Cardenas, Diana D; Dijkers, Marcel; Felix, Elizabeth R; Finnerup, Nanna B; Kennedy, Paul; Lundeberg, Thomas; Richards, J. Scott; Rintala, Diana H; Siddall, Philip; Widerstrom-Noga, Eva



Paramedic intubation of patients with severe head injury: a review of current Australian practice and recommendations for change.  


Secondary brain injury may occur early after severe traumatic brain injury due to hypoxia and/or hypotension. Prehospital care by ambulance paramedics has the goal of preventing and treating these complications and, thus, improving outcomes. In Australia, most ambulance services recommend paramedics attempt endotracheal intubation in patients with severe head injury. Even though most patients with severe head injury retain airway reflexes, most states do not allow the use of appropriate drugs to facilitate intubation. In contrast, recent evidence from trauma registries suggests that this approach may be associated with significantly worse outcomes compared with no intubation. Two states allow intubation facilitated by sedative (but not relaxant) drugs, but this has a low success rate and could worsen brain injury because of a decrease in cerebral perfusion pressure. For road-based paramedics, the role of rapid sequence intubation is uncertain. Given the risks of this procedure and the lack of proven benefit, this procedure should not be introduced without supportive evidence from randomised, controlled trials. In contrast, for safety reasons, comatose patients transported by helicopter should undergo rapid sequence intubation prior to flight. However, this is not authorised in most states, despite good supportive evidence that this can be safely and effectively undertaken by paramedics. Finally, there is evidence that inadvertent hyperventilation is associated with adverse outcome, yet only two ambulance services use waveform capnography in head injury patients who are intubated. Overall, current paramedic airway practice in most states of Australia is not supported by the evidence and is probably associated with worse patient outcomes after severe head injury. For road-based paramedics, rapid transport to hospital without intubation should be regarded as the current standard of care. Rapid sequence intubation should be limited to use within appropriate clinical trials, or patients transported by helicopter. For patients who are intubated, waveform capnography is essential to confirm tracheal placement and to prevent inadvertent hyperventilation. PMID:16712531

Bernard, Stephen A



Implications of pharmacogenomics for drug development and clinical practice.  


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



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


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



Compliance of Middle School–Aged Babysitters in Central Pennsylvania With National Recommendations for Emergency Preparedness and Safety Practices  

Microsoft Academic Search

Objective. To determine the compliance of middle school–aged babysitters with national recommendations for emergency preparedness and safety practices. Patients and methods. A prospective, self-administered questionnaire-based study was conducted at 3 middle schools in central Pennsylvania. Results. A total of 1364 questionnaires were available for analysis. Responding babysitters (n = 890) reported previous training that included babysitter (21%), first aid (64%),

Nicole M. Hackman; Katie Cass; Robert P. Olympia



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



Immmunotherapy of cancer: from vision to standard clinical practice  

Microsoft Academic Search

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

Christoph H. Huber; Thomas Wölfel



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



[Efficiancy Angiotensin -converting enzyme inhibitors for the clinical practice].  


These clinical trials show the efficiency of therapy with angiotensin-converting enzyme (ACE) inhibitors in essential hypertension (EH), chronic heart failure and coronary heart disease (CHD). The SMILE studies have indicated positive results of the early administration (<24 hours) of zofenopril in patients with acute myocardial infarction (AMI). These results have been confirmed in high-risk patients, including those with hypertension and diabetes mellitus, which enables zofenopril to be recommended for clinical use in patients with EH and CHD. Zofenopril has a better safety profile than other agents. PMID:21778538

Abuladze, G V; Nebieridze, M I; Narsiia, E V; Erkomaishvili, I G; Pipiia, N G



Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP).  


Hepatitis B virus (HBV) causes acute and chronic infection of the liver leading to substantial morbidity and mortality. In the United States, since 1996, a total of 29 outbreaks of HBV infection in one or multiple long-term-care (LTC) facilities, including nursing homes and assisted-living facilities, were reported to CDC; of these, 25 involved adults with diabetes receiving assisted blood glucose monitoring. These outbreaks prompted the Hepatitis Vaccines Work Group of the Advisory Committee on Immunization Practices (ACIP) to evaluate the risk for HBV infection among all adults with diagnosed diabetes. The Work Group reviewed HBV infection-related morbidity and mortality and the effectiveness of implementing infection prevention and control measures. The strength of scientific evidence regarding protection was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology,* and safety, values, and cost-effectiveness were incorporated into a recommendation using the GRADE system. Based on the Work Group findings, on October 25, 2011, ACIP recommended that all previously unvaccinated adults aged 19 through 59 years with diabetes mellitus (type 1 and type 2) be vaccinated against hepatitis B as soon as possible after a diagnosis of diabetes is made (recommendation category A). Data on the risk for hepatitis B among adults aged ?60 years are less robust. Therefore, ACIP recommended that unvaccinated adults aged ?60 years with diabetes may be vaccinated at the discretion of the treating clinician after assessing their risk and the likelihood of an adequate immune response to vaccination (recommendation category B). This report summarizes these recommendations and provides the rationale used by ACIP to inform their decision making. PMID:22189894



Reporting Practices in Confirmatory Factor Analysis: An Overview and Some Recommendations  

ERIC Educational Resources Information Center

|Reporting practices in 194 confirmatory factor analysis studies (1,409 factor models) published in American Psychological Association journals from 1998 to 2006 were reviewed and compared with established reporting guidelines. Three research questions were addressed: (a) how do actual reporting practices compare with published guidelines? (b) how…

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



Teaching Evidence-Based Practice: Strategic and Pedagogical Recommendations for Schools of Social Work  

ERIC Educational Resources Information Center

|Widespread adoption of pedagogical methods promoting evidence-based practice (EBP) could enhance the effectiveness of social work practice education. Schools of social work should ensure that faculty are trained in the methods of EBP; establish a committee responsible for tracking and implementing demonstrably effective instructional innovations…

Howard, Matthew Owen; Allen-Meares, Paula; Ruffolo, Mary C.



Toward a more effective approach to stroke: Canadian Best Practice Recommendations for Stroke Care  

Microsoft Academic Search

Each year more than 50 000 Canadians experience a stroke and more than 300 000 currently live with its effects. Despite the evidence supporting best practices in stroke care, signifi- cant gaps in translating this knowledge into action remains in Canada. An interdisciplinary working group of the Canad- ian Stroke Strategy was formed to develop best-practice rec- ommendations relevant to

Patrice Lindsay RN; Mark Bayley; Alison McDonald; Ian D. Graham; Grace Warner; Stephen Phillips MBBS



Clinical Expert Panel on Monitoring Potential Lung Toxicity of Inhaled Oligonucleotides: Consensus Points and Recommendations  

PubMed Central

Oligonucleotides (ONs) are an emerging class of drugs being developed for the treatment of a wide variety of diseases including the treatment of respiratory diseases by the inhalation route. As a class, their toxicity on human lungs has not been fully characterized, and predictive toxicity biomarkers have not been identified. To that end, identification of sensitive methods and biomarkers that can detect toxicity in humans before any long term and/or irreversible side effects occur would be helpful. In light of the public's greater interests, the Inhalation Subcommittee of the Oligonucleotide Safety Working Group (OSWG) held expert panel discussions focusing on the potential toxicity of inhaled ONs and assessing the strengths and weaknesses of different monitoring techniques for use during the clinical evaluation of inhaled ON candidates. This white paper summarizes the key discussions and captures the panelists' perspectives and recommendations which, we propose, could be used as a framework to guide both industry and regulatory scientists in future clinical research to characterize and monitor the short and long term lung response to inhaled ONs.

Alton, Eric W.; Boushey, Homer A.; Garn, Holger; Green, Francis H.; Hodges, Michael; Martin, Richard J.; Murdoch, Robert D.; Renz, Harald; Shrewsbury, Stephen B.; Seguin, Rosanne; Johnson, Graham; Parry, Joel D.; Tepper, Jeff; Renzi, Paolo; Cavagnaro, Joy



Structural MRI in Huntington's disease and recommendations for its potential use in clinical trials.  


Huntington's disease (HD) results in progressive impairment of motor and cognitive function and neuropsychiatric disturbance. There are no disease-modifying treatments available, but HD research is entering a critical phase where promising disease-specific therapies are on the horizon. Thus, a pressing need exists for biomarkers capable of monitoring progression and ultimately determining drug efficacy. Neuroimaging provides a powerful tool for assessing disease progression. However, in order to be accepted as biomarkers for clinical trials, imaging measures must be reproducible, robust to scanner differences, sensitive to disease-related change and demonstrate a relationship to clinically meaningful measures. We provide a review of the current structural imaging literature in HD and highlight inconsistencies between studies. We make recommendations for the standardisation of reporting for future studies, such as appropriate cohort characterisation and documentation of methodologies to facilitate comparisons and inform trial design. We also argue for an intensified effort to consider issues highlighted here so that we have the best chance of assessing the efficacy of the therapeutic benefit in forestalling this devastating disease. PMID:23376047

Georgiou-Karistianis, Nellie; Scahill, Rachael; Tabrizi, Sarah J; Squitieri, Ferdinando; Aylward, Elizabeth



The Use of Bone Age in Clinical Practice – Part 1  

Microsoft Academic Search

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

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



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



Conceptual models for implementing biopsychosocial theory in clinical practice  

Microsoft Academic Search

The integration of the biopsychosocial model into manual therapy practice is challenging for clinicians, especially for those who have not received formal training in biopsychosocial theory or its application. In this masterclass two contemporary models of health and disability are presented along with a model for organizing clinical knowledge, and a model of reasoning strategies that will assist clinicians in

M. Jones; I. Edwards; L. Gifford



Becoming a Principal: Role Transformation through Clinical Practice.  

ERIC Educational Resources Information Center

This paper discusses two important elements in the preparation of K-12 school leaders: (1) role transformation through clinical practice during administrator preparation programs; and (2) reconceptualization of traditional internship experiences to enhance role transformation. Data analyzed for this study originally were collected in doctoral…

Browne-Ferrigno, Tricia; Muth, Rodney


Representation of Clinical Practice Guidelines For Computer-Based Implementations  

Microsoft Academic Search

Representation of clinical practice guidelines is a critical issue for computer-based guideline development, implementation and evaluation. We studied eight types of computer-based guideline models. Typical primitives for these models include decisions, actions, patient states and execution states. We also find temporal constraints and nesting to be important aspects of guideline structure representation. Integration of guidelines with electronic medical records is

Dongwen Wang; Mor Peleg; Samson W. Tu; Edward H. Shortliffe; Robert A. Greenes



Towards a Clinical Practice Guideline Implementation for Asthma Treatment  

Microsoft Academic Search

There is a tremendous amount of effort involved in the definition of Clinical Practice Guidelines (CPG) by physicians. Because the quality of medical assistance is highly impacted by the use of CPG, and establishing their use is difficult, we consider necessary to develop an ef fective solution that implements CPG through Decision Support Systems (DSS). Among the many existing representation

Francisco Javier Sobrado; Juan Manuel Pikatza; Iker Unai Larburu; Diego López De Ipiña



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


Rate of occult specimen provenance complications in routine clinical practice.  


Occult specimen provenance complications (SPCs), which occur when there is an absence of any direct or indirect indication that a specimen switch or contamination may have occurred, constitute a significant patient safety and medical-legal problem because they can lead to misdiagnosis. However, the rate at which occult SPCs occur is unknown because, by definition, this category of errors is not identified by standard laboratory practices. In this study, we evaluated a data set comprising almost 13,000 prostate biopsies that were prospectively tested for specimen provenance errors as part of routine clinical practice. The frequency of occult type 1 errors (a complete transposition between patients) and type 2 errors (contamination of the patient's tissue with 1 or more unrelated patients) was 0.26% and 0.67%, respectively; every urology practice setting and surgical pathology laboratory type with a representative sample size experienced at least 1 type 1 and 1 type 2 error during the study period. Overall, the mean frequency of SPCs across practice settings was 0.22% for type 1 errors and 1.69% for type 2 errors. The type 1 rate showed no correlation with a surgical pathology laboratory setting or urologic practice group setting; the type 2 rate correlated solely with a surgical pathology laboratory setting. The occult SPC rate in this limited data set provides an estimate of the scope of the problem of potential misdiagnosis as a result of occult specimen provenance errors in routine clinical practice. PMID:23270904

Pfeifer, John D; Liu, Jingxia



The Consequences of Experimentalism in Formulating Recommendations for Policy and Practice in Mathematics Education  

Microsoft Academic Search

In this response to Foundations for Success: The Final Report of the National Mathematics Advisory Panel (2008), the authors argue that the Panel's assumption that only experimental research studies can produce scientific evidence limits the power of the Panel's recommendations to improve mathematics teaching and learning. The authors first discuss the theoretical underpinnings, potential contributions, and limitations of experimental studies.

Paul Cobb; Kara Jackson



Evaluation in New Jersey Education: A Survey of Present Practices and Recommendations for Future Action.  

ERIC Educational Resources Information Center

|Current evaluation activities in the New Jersey school system are surveyed, and recommendations for future evaluation efforts are made. The current activities and future developments of school (or school district), statewide, and project (or program) evaluation are discussed individually. The following program objectives are suggested: to raise…

Pinkowski, Francis; And Others


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…

Ahmed, Sameera; Reddy, Linda A.



Mentoring advanced practice nurses in research: recommendations from a pilot program.  


Advanced Practice Nurses (APNs) need research skills to develop and advance their practice and, yet, many have limited access to research training and support following completion of their advanced degree. In this paper we report on the development, delivery, and evaluation of an innovative pilot program that combined research training and one-to-one mentorship for nine APNs in conducting research relevant to their practice. The program was organized within an academic institution and its affiliated hospitals in Toronto, Canada. Our experience with this program may assist those in other organizations to plan and deliver a similar program for APN research mentorship. PMID:22443046

Leung, Doris; Widger, Kimberley; Howell, Doris; Nelson, Sioban; Molassiotis, Alex



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


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



The influence of clinical evidence on surgical practice.  


Given the considerable interest in the use of evidence-based medicine to guide clinical practice, it is surprising that the results of a recent randomized controlled trial have been met with such a limited response. The DECompressive CRAniectomy study investigators have recently published the results of a landmark trial in neurosurgery, comparing early decompressive craniectomy with standard medical therapy in patients who developed intracranial hypertension after diffuse closed traumatic brain injury (TBI). This is the first ever randomized controlled trial investigating the surgical management of adult patients with severe TBI. The trial clearly demonstrated that early decompression did not provide clinical benefit; however, rather than having a significant impact on clinical practice, it has been almost uniformly criticized. While there were some problems with randomization and crossover, we feel that the trial has been somewhat misinterpreted and in this article we address some of the key issues. PMID:22568805

Honeybul, S; Ho, K M



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


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



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.



Moving from Principles to Practice: Recommended Policy Changes to Promote Family-Centered Care  

Microsoft Academic Search

This paper emphasizes the value of family-centered care. Discussion highlights family-centered philosophies (e.g., Systems\\u000a of Care [SOCs]) and practice models (i.e., wraparound) and identifies discrepancies between conceptualizations and actual\\u000a practice. Data from multiple sources detail issues in fidelity to family-centered values and needs and risks experienced by\\u000a siblings of children with severe emotional disturbance and their caregivers. This discussion provides

Ryan P. KilmerJames; James R. Cook; Eylin Palamaro