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Sample records for active clinical practice

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

    ERIC Educational Resources Information Center

    Lammert, Marilyn; Dolan, Mary M.

    1983-01-01

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

  2. Ankylosing spondylitis functional and activity indices in clinical practice

    PubMed Central

    Popescu, C; Trandafir, M; Bădică, AM; Morar, F; Predeţeanu, D

    2014-01-01

    Background: Clinicians have at hand several indices to evaluate disease activity and functionality in ankylosing spondylitis (AS), in order to evaluate the prognostic and the treatment of AS patients. Objectives: to examine the relationship between functional and activity scores in AS; to note whether disease activity is associated with any clinical or laboratory variables. Methods: the study included AS patients, classified according to the revised New York criteria; data recorded: demographics, disease duration, type of articular involvement, HLA B27 presence, history of uveitis, calculation of BASFI, BASDAI and ASDASCRP, quantification of inflammation markers. Results: 50 AS patients; ASDASCRP correlated significantly (p < 0.001) with BASFI (r = 811), BASDAI (r = 0.810) and with erythrocyte sedimentation rate (ESR; r = 0.505); HLA B27 positive patients had a median BASDAI 5 times higher than HLA B27 negative patients (p = 0.033); compared with patients with strictly axial disease form, patients with axial and peripheral disease had a median ESR 3 times higher (p = 0.042) and a median BASDAI 2 times higher (p = 0.050). Conclusions: functional and activity AS indices are strongly correlated in assessing disease severity; inflammation and HLA B27 can predict the high value of these indices; axial and peripheral disease pattern is associated with higher disease activity. PMID:24653763

  3. Strategies for promoting physical activity in clinical practice.

    PubMed

    Sallis, Robert; Franklin, Barry; Joy, Liz; Ross, Robert; Sabgir, David; Stone, James

    2015-01-01

    The time has come for healthcare systems to take an active role in the promotion of physical activity (PA). The connection between PA and health has been clearly established and exercise should be viewed as a cost effective medication that is universally prescribed as a first line treatment for virtually every chronic disease. While there are potential risks associated with exercise, these can be minimized with a proper approach and are far outweighed by the benefits. Key to promoting PA in the clinical setting is the use of a PA Vital Sign in which every patient's exercise habits are assessed and recorded in their medical record. Those not meeting the recommended 150min per week of moderate intensity PA should be encouraged to increase their PA levels with a proper exercise prescription. We can improve compliance by assessing our patient's barriers to being more active and employing new and evolving technology like accelerometers and smart phones applications, along with various websites and programs that have proven efficacy. PMID:25459975

  4. Clinical practice

    PubMed Central

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

    2010-01-01

    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. PMID:20179966

  5. Multispecialty Clinic Practice

    PubMed Central

    Margolin, David A.; Beck, David E.

    2011-01-01

    A multispecialty clinic practice is a common practice arrangement for colorectal surgeons. This type of practice has a variety of features, both positive and negative. The authors explore location, practice patterns, lifestyles, compensation, and academic opportunities associated with a multispecialty clinic practice. This information can assist younger surgeons in choosing a practice opportunity and guide experienced surgeons through their career progression. PMID:22654568

  6. Hypothyroidism in Clinical Practice

    PubMed Central

    Qari, Faiza

    2014-01-01

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

  7. New Brunswick nurses' views on nursing research, and factors influencing their research activities in clinical practice.

    PubMed

    Robichaud-Ekstrand, Sylvie

    2016-06-01

    New Brunswick became the first province in Canada to require a baccalaureate degree in nursing as the entry to practice, yet nursing research in hospital settings remains quite low. This study examined clinical nurses' views on nursing research, and identified some contributing factors to the research-practice gap. This descriptive, cross-sectional multicenter study involved 1081 nurses working in the Francophone Regional Health Authority in New Brunswick, Canada. Nurses were eager to identify nursing-care problems to improve patient care (92.9%), and to be involved in collecting data for nursing research studies (95.2%). However, without research supervision, few had engaged in basic research activities, such as formulating or refining research questions (24.5%), presenting at research conferences (6.9%), or changing their practice based on research findings (27.2%). Younger, more educated nurses, nurse managers, and educators participated more readily in research. Sharing research and clinical expertise, as well as infrastructures between academic and clinical institutions is the key to enduring successful patient-centered nursing research in clinical settings. Concrete actions are proposed to build clinical nursing research. PMID:26822438

  8. Feasibility and Validity of the Pediatric Ulcerative Colitis Activity Index in Routine Clinical Practice

    PubMed Central

    Dotson, Jennifer L.; Crandall, Wallace V.; Zhang, Peixin; Forrest, Christopher B; Bailey, L. Charles; Colletti, Richard B.; Kappelman, Michael D.

    2014-01-01

    Objectives The Pediatric Ulcerative Colitis Activity Index (PUCAI) is a non-invasive disease activity index developed as a clinical trial endpoint. More recently, practice guidelines have recommended the use of PUCAI in routine clinical care. We therefore sought to evaluate the feasibility, validity and responsiveness of PUCAI in a large, diverse collection of pediatric gastroenterology practices. Methods We extracted data from the two most recent encounters for patients with ulcerative colitis in the ImproveCareNow registry. Feasibility was determined by the percent of patients for whom all PUCAI components were recorded, validity by correlation of PUCAI scores across Physician Global Assessment (PGA) categories, and responsiveness to change by the correlation between the change in PUCAI and PGA scores between visits. Results 2503 patients were included (49.5% male, age 15.2±4.1 years, disease duration 3.7±3.2 years). All items in the PUCAI were completed for 96% of visits. PUCAI demonstrated excellent discriminatory ability between remission, mild and moderate disease; discrimination between moderate and severe disease was less robust. There was good correlation with PGA [r=0.76 (p<0.001), weighted kappa k=0.73 (p<0.001)]. The PUCAI change scores correlated well with PGA change scores (p<0.001). Test-retest reliability of the PUCAI was good (intra-class correlation coefficient=0.72 [95% CI 0.70–0.75], p<0.001). Guyatt’s responsiveness statistic was 1.18 and the correlation of ΔPUCAI with ΔPGA was 0.69 (p<0.001). Conclusions The PUCAI is feasible to use in routine clinical settings. Evidence of its validity and responsiveness support its use as a clinical tool for monitoring disease activity for patients with ulcerative colitis. PMID:25221935

  9. Thiamin in Clinical Practice.

    PubMed

    Frank, Laura L

    2015-07-01

    Thiamin is a water-soluble vitamin also known as vitamin B1. Its biologically active form, thiamin pyrophosphate (TPP), is a cofactor in macronutrient metabolism. In addition to its coenzyme roles, TPP plays a role in nerve structure and function as well as brain metabolism. Signs and symptoms of thiamin deficiency (TD) include lactic acidosis, peripheral neuropathy, ataxia, and ocular changes (eg, nystagmus). More advanced symptoms include confabulation and memory loss and/or psychosis, resulting in Wernicke's encephalopathy and/or Wernicke's Korsakoff syndrome, respectively. The nutrition support clinician should be aware of patients who may be at risk for TD. Risk factors include those patients with malnutrition due to 1 or more nutrition-related etiologies: decreased nutrient intake, increased nutrient losses, or impaired nutrient absorption. Clinical scenarios such as unexplained heart failure or lactic acidosis, renal failure with dialysis, alcoholism, starvation, hyperemesis gravidarum, or bariatric surgery may increase the risk for TD. Patients who are critically ill and require nutrition support may also be at risk for TD, especially those who are given intravenous dextrose void of thiamin repletion. Furthermore, understanding thiamin's role as a potential therapeutic agent for diabetes, some inborn errors of metabolism, and neurodegenerative diseases warrants further research. This tutorial describes the absorption, digestion, and metabolism of thiamin. Issues pertaining to thiamin in clinical practice will be described, and evidence-based practice suggestions for the prevention and treatment of TD will be discussed. PMID:25564426

  10. [Bioethics in clinical practice].

    PubMed

    Sánchez-Gonzaléz, Miguel; Herreros, Benjamín

    2015-01-01

    Bioethics has grown exponentially in recent decades. Its most important schools include principlism, casuistry, virtue ethics and the ethics of care. These schools are not exclusive. Within bioethics, clinical ethics addresses the inherent clinical practice ethical problems, problems which are many and very varied. Bioethics training is essential for clinicians to address these bioethics' problems. But even the professionals are trained, there are problems that cannot be solved individually and require advisory groups in clinical ethics: clinical ethics committees. These committees are also responsible for education in bioethics in health institutions. Clinical bioethics is a practical discipline, oriented to address specific problems, so its development is necessary to improve the decision making in such complex problems, inevitable problems in healthcare. PMID:25680645

  11. Good Clinical Practice Training

    PubMed Central

    Arango, Jaime; Chuck, Tina; Ellenberg, Susan S.; Foltz, Bridget; Gorman, Colleen; Hinrichs, Heidi; McHale, Susan; Merchant, Kunal; Shapley, Stephanie; Wild, Gretchen

    2016-01-01

    Good Clinical Practice (GCP) is an international standard for the design, conduct, performance, monitoring, auditing, recording, analyses, and reporting of clinical trials. The goal of GCP is to ensure the protection of the rights, integrity, and confidentiality of clinical trial participants and to ensure the credibility and accuracy of data and reported results. In the United States, trial sponsors generally require investigators to complete GCP training prior to participating in each clinical trial to foster GCP and as a method to meet regulatory expectations (ie, sponsor’s responsibility to select qualified investigators per 21 CFR 312.50 and 312.53(a) for drugs and biologics and 21 CFR 812.40 and 812.43(a) for medical devices). This training requirement is often extended to investigative site staff, as deemed relevant by the sponsor, institution, or investigator. Those who participate in multiple clinical trials are often required by sponsors to complete repeated GCP training, which is unnecessarily burdensome. The Clinical Trials Transformation Initiative convened a multidisciplinary project team involving partners from academia, industry, other researchers and research staff, and government to develop recommendations for streamlining current GCP training practices. Recommendations drafted by the project team, including the minimum key training elements, frequency, format, and evidence of training completion, were presented to a broad group of experts to foster discussion of the current issues and to seek consensus on proposed solutions. PMID:27390628

  12. Cost-effectiveness of activated protein C in real-life clinical practice

    PubMed Central

    Dhainaut, Jean-François; Payet, Stéphanie; Vallet, Benoit; França, Lionel Riou; Annane, Djillali; Bollaert, Pierre-Edouard; Tulzo, Yves Le; Runge, Isabelle; Malledant, Yannick; Guidet, Bertrand; Le Lay, Katell; Launois, Robert

    2007-01-01

    Background Recombinant human activated protein C (rhAPC) has been reported to be cost-effective in severely ill septic patients in studies using data from a pivotal randomized trial. We evaluated the cost-effectiveness of rhAPC in patients with severe sepsis and multiple organ failure in real-life intensive care practice. Methods We conducted a prospective observational study involving adult patients recruited before and after licensure of rhAPC in France. Inclusion criteria were applied according to the label approved in Europe. The expected recruitment bias was controlled by building a sample of patients matched for propensity score. Complete hospitalization costs were quantified using a regression equation involving intensive care units variables. rhAPC acquisition costs were added, assuming that all costs associated with rhAPC were already included in the equation. Cost comparisons were conducted using the nonparametric bootstrap method. Cost-effectiveness quadrants and acceptability curves were used to assess uncertainty of the cost-effectiveness ratio. Results In the initial cohort (n = 1096), post-license patients were younger, had less co-morbid conditions and had failure of more organs than did pre-license patients (for all: P < 0.0001). In the matched sample (n = 840) the mean age was 62.4 ± 14.9 years, Simplified Acute Physiology Score II was 56.7 ± 18.5, and the number of organ failures was 3.20 ± 0.83. When rhAPC was used, 28-day mortality tended to be reduced (34.1% post-license versus 37.4% pre-license, P = 0.34), bleeding events were more frequent (21.7% versus 13.6%, P = 0.002) and hospital costs were higher (€47,870 versus €36,717, P < 0.05). The incremental cost-effectiveness ratios gained were as follows: €20,278 per life-year gained and €33,797 per quality-adjusted life-year gained. There was a 74.5% probability that rhAPC would be cost-effective if there were willingness to pay €50,000 per life-year gained. The probability was 64

  13. Myocarditis in Clinical Practice.

    PubMed

    Sinagra, Gianfranco; Anzini, Marco; Pereira, Naveen L; Bussani, Rossana; Finocchiaro, Gherardo; Bartunek, Jozef; Merlo, Marco

    2016-09-01

    Myocarditis is a polymorphic disease characterized by great variability in clinical presentation and evolution. Patients presenting with severe left ventricular dysfunction and life-threatening arrhythmias represent a demanding challenge for the clinician. Modern techniques of cardiovascular imaging and the exhaustive molecular evaluation of the myocardium with endomyocardial biopsy have provided valuable insight into the pathophysiology of this disease, and several clinical registries have unraveled the disease's long-term evolution and prognosis. However, uncertainties persist in crucial practical issues in the management of patients. This article critically reviews current information for evidence-based management, offering a rational and practical approach to patients with myocarditis. For this review, we searched the PubMed and MEDLINE databases for articles published from January 1, 1980, through December 31, 2015, using the following terms: myocarditis, inflammatory cardiomyopathy, and endomyocardial biopsy. Articles were selected for inclusion if they represented primary data or were review articles published in high-impact journals. In particular, a risk-oriented approach is proposed. The different patterns of presentation of myocarditis are classified as low-, intermediate-, and high-risk syndromes according to the most recent evidence on prognosis, clinical findings, and both invasive and noninvasive testing, and appropriate management strategies are proposed for each risk class. PMID:27489051

  14. Voriconazole in clinical practice.

    PubMed

    Mikulska, Małgorzata; Novelli, Andrea; Aversa, Franco; Cesaro, Simone; de Rosa, Francesco Giuseppe; Girmenia, Corrado; Micozzi, Alessandra; Sanguinetti, Maurizio; Viscoli, Claudio

    2012-12-01

    Invasive fungal diseases are associated with significant morbidity and mortality in immunocompromized patients. Voriconazole is the first line treatment of invasive aspergillosis, and has been successfully used in other invasive fungal infections, such as candidiasis, fusariosis or scedosporidiosis. Voriconazole has non-linear pharmacokinetics and undergoes extensive hepatic metabolism by the cytochrome P450 system that depends on age, genetic factors, and interactions with other drugs. Thus, significant interpatient variability is observed after administration of the same dose. Additionally, the therapeutic window is narrow, with high risk of side effects at serum levels 3-5 times higher than the minimal threshold for efficacy. Therefore, the knowledge of pharmacological properties, metabolism, interactions, dosage indications in various populations and side effects is crucial. Therapeutic drug monitoring can help maximize the efficacy and minimize the risk of toxicity. Pharmacological, mycological and clinical aspects of the treatment with voriconazole are summarized in order to optimize its use in daily clinical practice. PMID:23174096

  15. Exercise Dose in Clinical Practice.

    PubMed

    Wasfy, Meagan M; Baggish, Aaron L

    2016-06-01

    There is wide variability in the physical activity patterns of the patients in contemporary clinical cardiovascular practice. This review is designed to address the impact of exercise dose on key cardiovascular risk factors and on mortality. We begin by examining the body of literature that supports a dose-response relationship between exercise and cardiovascular disease risk factors, including plasma lipids, hypertension, diabetes mellitus, and obesity. We next explore the relationship between exercise dose and mortality by reviewing the relevant epidemiological literature underlying current physical activity guideline recommendations. We then expand this discussion to critically examine recent data pertaining to the impact of exercise dose at the lowest and highest ends of the spectrum. Finally, we provide a framework for how the key concepts of exercise dose can be integrated into clinical practice. PMID:27267537

  16. Handbook of clinical nursing practice

    SciTech Connect

    Asheervath, J.; Blevins, D.R.

    1986-01-01

    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.

  17. Cannabinoids in clinical practice.

    PubMed

    Williamson, E M; Evans, F J

    2000-12-01

    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

  18. Improving clinical practice guidelines for practicing cardiologists.

    PubMed

    Benhorin, Jesaia; Bodenheimer, Monty; Brown, Mary; Case, Robert; Dwyer, Edward M; Eberly, Shirley; Francis, Charles; Gillespie, John A; Goldstein, Robert E; Greenberg, Henry; Haigney, Mark; Krone, Ronald J; Klein, Helmut; Lichstein, Edgar; Locati, Emanuela; Marcus, Frank I; Moss, Arthur J; Oakes, David; Ryan, Daniel H; Bloch Thomsen, Poul E; Zareba, Wojciech

    2015-06-15

    Cardiac-related clinical practice guidelines have become an integral part of the practice of cardiology. Unfortunately, these guidelines are often long, complex, and difficult for practicing cardiologists to use. Guidelines should be condensed and their format upgraded, so that the key messages are easier to comprehend and can be applied more readily by those involved in patient care. After presenting the historical background and describing the guideline structure, we make several recommendations to make clinical practice guidelines more user-friendly for clinical cardiologists. Our most important recommendations are that the clinical cardiology guidelines should focus exclusively on (1) class I recommendations with established benefits that are supported by randomized clinical trials and (2) class III recommendations for diagnostic or therapeutic approaches in which quality studies show no benefit or possible harm. Class II recommendations are not evidence based but reflect expert opinions related to published clinical studies, with potential for personal bias by members of the guideline committee. Class II recommendations should be published separately as "Expert Consensus Statements" or "Task Force Committee Opinions," so that both majority and minority expert opinions can be presented in a less dogmatic form than the way these recommendations currently appear in clinical practice guidelines. PMID:25918027

  19. Can research influence clinical practice?

    PubMed

    Jiménez, Juan Pablo

    2007-06-01

    After briefly reviewing the unfavourable reception accorded empirical research by parts of the psychoanalytic community, as well as some of the benefits to clinical practice of analysts being involved in research activities, the author examines whether the findings of process and outcome research in psychotherapy and psychoanalysis can help identify the most appropriate forms of intervention for producing therapeutic change, given the specific condition of the patient and the relationship that the individual establishes with the analyst. He argues that research findings can influence clinical practice on various levels and in different areas, and goes on to examine a number of related issues: the specificity of therapeutic interventions versus the relevance of common curative factors; the dyadic conception of technique and ways of understanding the therapeutic action of the treatment alliance; and the strategic or heuristic conception in psychoanalytic therapy. Finally, the author presents clinical material with the aim of illustrating how the knowledge acquired through research can be applied to psychoanalytic treatment. PMID:17537698

  20. The BE-ACTIV Project: How Research, Professional Training, Education, and Practice Were Integrated in a Single Clinical Trial

    PubMed Central

    Meeks, Suzanne; Getz, Brittney R.; Hess, Lauren S.; Kostiwa, Irene M.; Ludwin, Brian M.; Rodgers, James R.; Shah, Shruti N.

    2015-01-01

    This paper describes how research, practice, and education were integrated in an NIMH-funded clinical trial for treating depression in nursing homes. Involving undergraduate and doctoral students in our clinical trial supported the development of key competencies, expanded the professional pipeline, and provided an avenue for disseminating the treatment to other settings. The clinical trial served as a teaching laboratory for sixteen undergraduate and six doctoral students to: (1) observe the culture of older adults in nursing homes, (2) develop and adapt clinical skills to a challenging patient population, (3) refine skills for collaborating in multidisciplinary teams, and (4) appreciate the relationship between science and practice. Dissemination of the intervention to non-research settings was served when the students took their skills to the settings where they launched their careers. Involvement of trainees in clinical trial research expands and enriches the capacity of the healthcare workforce in both evidence-based practice and practice-informed research. PMID:25941982

  1. The BE-ACTIV Project: How Research, Professional Training, Education, and Practice Were Integrated in a Single Clinical Trial.

    PubMed

    Meeks, Suzanne; Getz, Brittney R; Hess, Lauren S; Kostiwa, Irene M; Ludwin, Brian M; Rodgers, James R; Shah, Shruti N

    2015-01-01

    This article describes how research, practice, and education were integrated in a National Institutes of Mental Health-funded clinical trial for treating depression in nursing homes. Involving undergraduate and doctoral students in this clinical trial supported the development of key competencies, expanded the professional pipeline, and provided an avenue for disseminating the treatment to other settings. The clinical trial served as a teaching laboratory for sixteen undergraduate and six doctoral students to (1) observe the culture of older adults in nursing homes, (2) develop and adapt clinical skills to a challenging patient population, (3) refine skills for collaborating in multidisciplinary teams, and (4) appreciate the relationship between science and practice. Dissemination of the intervention to nonresearch settings was served when the students took their skills to the settings where they launched their careers. Involvement of trainees in clinical trial research expands and enriches the capacity of the health care workforce in evidence-based practice and practice-informed research. PMID:25941982

  2. CMA Infobase: clinical practice guidelines.

    PubMed

    Fitzpatrick, Roberta Bronson

    2008-01-01

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

  3. Frailty in Clinical Practice.

    PubMed

    Cesari, Matteo; Vellas, Bruno

    2015-01-01

    Frailty is a geriatric syndrome characterized by reduced homeostatic reserves, exposing the organism to extreme vulnerability to endogenous and exogenous stressors. Since disability is considered as an almost irreversible condition at advanced age, frailty has been indicated as a promising target for specific interventions in order to prevent disability. From a theoretical viewpoint, the concept of frailty has been well established, but its operationalization is still subject to controversy. This impediment leads to the postponement of the integration of frailty in the clinical setting. In the present article, we discuss the main issues regarding the frailty syndrome in the clinical setting, describe possible solutions (especially on the basis of our experience derived from the frailty clinic we have set up in Toulouse, France), and present the most relevant research perspectives in the field. PMID:26485035

  4. Method of magnetobiological indication in clinical laboratory practice. [considering immunobiological activation

    NASA Technical Reports Server (NTRS)

    Sosunov, A. V.; Dubova, V. M.; Parfenov, Y. S.; Piksina, L. D.; Borisov, F. O.; Semenov, L. N.

    1974-01-01

    Data are presented on the use of the method of magnetobiological indication for defining the immunobiological state of patients with very serious diseases. It has been found that the enzymes of a patient react more sensitively to the energy from a magnetic field. It is important that the magnetoreactivity of the enzymes, like the cell forms of the blood in the patients, have a certain relationship to the clinical-nosological forms and the dynamics of the illness of the subject.

  5. Aphasia in Clinical Practice

    PubMed Central

    Kertesz, Andrew

    1983-01-01

    Aphasia is a central language impairment with word finding and comprehension deficit and paraphasias. The highlights of the essential language tests and the classification based on a scorable assessment are presented. The clinical syndromes of Broca's, global, Wernicke, conduction, anomic and transcortical aphasias are detailed with definition, localization, and prognosis. Modality specific disorders associated with aphasic syndromes are discussed. The management of the aphasic patient, consisting of informed support and coordination of available services, is often the responsibility of the family physician. ImagesFig. 1Fig. 2 PMID:21286589

  6. Mindfulness Meditation in Clinical Practice

    ERIC Educational Resources Information Center

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

    2004-01-01

    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…

  7. Clinical Practice. Postmenopausal Osteoporosis.

    PubMed

    Black, Dennis M; Rosen, Clifford J

    2016-01-21

    Key Clinical Points Postmenopausal Osteoporosis Fractures and osteoporosis are common, particularly among older women, and hip fractures can be devastating. Treatment is generally recommended in postmenopausal women who have a bone mineral density T score of -2.5 or less, a history of spine or hip fracture, or a Fracture Risk Assessment Tool (FRAX) score indicating increased fracture risk. Bisphosphonates (generic) and denosumab reduce the risk of hip, nonvertebral, and vertebral fractures; bisphosphonates are commonly used as first-line treatment in women who do not have contraindications. Teriparatide reduces the risk of nonvertebral and vertebral fractures. Osteonecrosis of the jaw and atypical femur fractures have been reported with treatment but are rare. The benefit-to-risk ratio for osteoporosis treatment is strongly positive for most women with osteoporosis. Because benefits are retained after discontinuation of alendronate or zoledronic acid, drug holidays after 5 years of alendronate therapy or 3 years of zoledronic acid therapy may be considered for patients at lower risk for fracture. PMID:26789873

  8. Cherubism: best clinical practice

    PubMed Central

    2012-01-01

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

  9. [Randomized clinical trials and real clinical practice].

    PubMed

    Heerlein, Andrés

    2009-01-01

    One of the emerging problems in modern medicine is that part of its highly efficacious treatments do not show significant effectiveness in real world systems of care. Efficacy studies address the appropriate dosages, short term response and feasibility of treatments in carefully selected populations, but they do not necessarily provide information for decisions in clinical practice. This review aims to present strengths and limitations of different methodological types of trials and to offer an overview of how knowledge from clinical trials can be used for clinical practice. The important effect of funding source on the outcome of randomized controlled trials is discussed. Some key questions in the treatment assessment of depression, schizophrenia and different medical conditions are discussed, with a focus on the possibilities and restrictions of translating clinical trial results into real-world settings. Empirical evidence shows that although randomized controlled trials are the gold standard for proving efficacy of a therapeutic procedure they often suffer from funding source bias and from lack of generalizability. Effectiveness studies evaluate effects of treatments under conditions approximating usual care. Another key area that can be addressed by effectiveness studies is the impact on important health policy measures such as disability days, days of work or medical costs, etc. Conclusions show that the future assessment of treatment regimes for clinical utility requires less biased efficacy studies and more effectiveness studies addressing major issues from all relevant perspectives. PMID:19543562

  10. Facilitating Critical Thinking in Clinical Practice.

    ERIC Educational Resources Information Center

    Persaud, Deanna; And Others

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

  11. Development and Delivery of a Physical Activity Intervention for People With Huntington Disease: Facilitating Translation to Clinical Practice

    PubMed Central

    Quinn, Lori; Trubey, Rob; Gobat, Nina; Dawes, Helen; Edwards, Rhiannon Tudor; Jones, Carys; Townson, Julia; Drew, Cheney; Kelson, Mark; Poile, Vincent; Rosser, Anne; Hood, Kerenza

    2016-01-01

    Background and Purpose: We studied the development and delivery of a 14-week complex physical activity intervention for people with Huntington disease, where detailed information about the intervention was fully embedded in the trial design process. Methods: Intervention Development: The intervention was developed through a series of focus groups. The findings from the focus groups informed the development of a logic model for the physical activity intervention that was broadly consistent with the framework of self-determination theory. Intervention Delivery: Key components underpinning the delivery of the intervention were implemented including a defined coach training program and intervention fidelity assessment methods. Training of coaches (physical therapists, occupational therapists, research nurses, and exercise trainers) was delivered via group and 1:1 training sessions using a detailed coach's manual, and with ongoing support via video calls, and e-mail communication as needed. Detailed documentation was provided to determine costs of intervention development and coach training. Results: Intervention delivery coaches at 8 sites across the United Kingdom participated in the face-to-face training. Self-report checklists completed by each of the coaches indicated that all components of the intervention were delivered in accordance with the protocol. Mean (standard deviation) intervention fidelity scores (n = 15), as measured using a purpose-developed rating scale, was 11 (2.4) (out of 16 possible points). Coaches' perceptions of intervention fidelity were similarly high. The total cost of developing the intervention and providing training was £30,773 ($47,042 USD). Discussion and Conclusions: An important consideration in promoting translation of clinical research into practice is the ability to convey the detailed components of how the intervention was delivered to facilitate replication if the results are favorable. This report presents an illustrative

  12. Clinical Supervision: History, Practice, Perspective.

    ERIC Educational Resources Information Center

    Miller, Robert; Miller, Kathleen

    1987-01-01

    There is a natural link between clinical supervision and its current interest in effective teaching. Describes how the process affects practice in schools today. Lists Morris Cogan's eight phases of supervision and Madeline Hunter's seven steps in the development of an effective teaching lesson. Includes five references. (Author/MD)

  13. Evaluation of economic efficiencies in clinical retina practice: activity-based cost analysis and modeling to determine impacts of changes in patient management

    PubMed Central

    Murray, Timothy G; Tornambe, Paul; Dugel, Pravin; Tong, Kuo Bianchini

    2011-01-01

    Background The purpose of this study is to report the use of activity-based cost analysis to identify areas of practice efficiencies and inefficiencies within a large academic retinal center and a small single-specialty group. This analysis establishes a framework for evaluating rapidly shifting clinical practices (anti-vascular endothelial growth factor therapy, microincisional vitrectomy surgery) and incorporating changing reimbursements for care delivery (intravitreal injections, optical coherence tomography [OCT]) to determine the impact on practice profitability. Pro forma modeling targeted the impact of declining reimbursement for OCT imaging and intravitreal injection using a strategy that incorporates activity-based cost analysis into a direct evaluation schema for clinical operations management. Methods Activity-based costing analyses were performed at two different types of retinal practices in the US, ie, a small single-specialty group practice and an academic hospital-based practice (Bascom Palmer Eye Institute). Retrospective claims data were utilized to identify all procedures performed and billed, submitted charges, allowed charges, and net collections from each of these two practices for the calendar years 2005–2006 and 2007–2008. A pro forma analysis utilizing current reimbursement profiles was performed to determine the impact of altered reimbursement on practice profitability. All analyses were performed by a third party consulting firm. Results The small single-specialty group practice outperformed the academic hospital-based practice on almost all markers of efficiency. In the academic hospital-based practice, only four service lines were profitable, ie, nonlaser surgery, laser surgery, non-OCT diagnostics, and injections. Profit margin varied from 62% for nonlaser surgery to 1% for intravitreal injections. Largest negative profit contributions were associated with office visits and OCT imaging. Conclusion Activity-based cost analysis is a

  14. Recombinant erythropoietin in clinical practice

    PubMed Central

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

    2003-01-01

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

  15. Fluorescence photodiagnosis in clinical practice.

    PubMed

    Moghissi, K; Stringer, M R; Dixon, Kate

    2008-12-01

    Fluorescence diagnosis has become an important method of investigation in clinical practice particularly in identification and localisation of pre and early cancerous lesions as well as image guided therapy. The method relies on the principle of differential fluorescence emission between abnormal and normal tissues in response to excitation by a specific wavelength of light within the visible spectrum range. In clinical practice two types of fluorescence diagnostic methods are used, namely autofluorescence and drug-induced fluorescence. The former relies on the differential fluorescence of "native" fluorophores whereas the latter requires a photosensitiser which enhances the differential fluorescence emission of the normal versus the abnormal tissues. Development and advances in fibreoptic, endoscopic instrumentation currently permit fluorescence endoscopy to be carried out in a number of situations. PMID:19356662

  16. Clinical practice guideline series update.

    PubMed

    Blissitt, Patricia A

    2013-10-01

    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

  17. A clinical academic practice partnership: a clinical education redesign.

    PubMed

    Jeffries, Pamela R; Rose, Linda; Belcher, Anne E; Dang, Deborah; Hochuli, Jo Fava; Fleischmann, Debbie; Gerson, Linda; Greene, Mary Ann; Jordan, Elizabeth Betty T; Krohn, Vicki L; Sartorius-Merganthaler, Susan; Walrath, Jo M

    2013-01-01

    The clinical academic practice partnership (CAPP), a clinical redesign based on the dedicated education unit concept, was developed and implemented by large, private school of nursing in collaboration with 4 clinical partners to provide quality clinical education, to explore new clinical models for the future, and to test an innovative clinical education design. An executive steering committee consisting of nursing leaders and educators from the school of nursing and the clinical institutions was established as the decision-making and planning components, with several collaborative task forces initiated to conduct the work and to accomplish the goals. This article will describe methods to initiate and to organize the key elements of this dedicated education unit-type clinical model, providing examples and an overview of the steps and elements needed as the development proceeded. After 18 months of implementation in 4 different nursing programs in 4 different clinical institutions, the clinical redesign has shown to be a positive initiative, with students actively requesting CAPP units for their clinical experiences. Preliminary findings and outcomes will be discussed, along with nursing education implications for this new clinical redesign. PMID:23706965

  18. Proton therapy in clinical practice

    PubMed Central

    Liu, Hui; Chang, Joe Y.

    2011-01-01

    Radiation dose escalation and acceleration improves local control but also increases toxicity. Proton radiation is an emerging therapy for localized cancers that is being sought with increasing frequency by patients. Compared with photon therapy, proton therapy spares more critical structures due to its unique physics. The physical properties of a proton beam make it ideal for clinical applications. By modulating the Bragg peak of protons in energy and time, a conformal radiation dose with or without intensity modulation can be delivered to the target while sparing the surrounding normal tissues. Thus, proton therapy is ideal when organ preservation is a priority. However, protons are more sensitive to organ motion and anatomy changes compared with photons. In this article, we review practical issues of proton therapy, describe its image-guided treatment planning and delivery, discuss clinical outcome for cancer patients, and suggest challenges and the future development of proton therapy. PMID:21527064

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

    PubMed Central

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

    2014-01-01

    Objective To describe the activities performed by people involved in clinical decision support (CDS) at leading sites. Materials and methods We conducted ethnographic observations at seven diverse sites with a history of excellence in CDS using the Rapid Assessment Process and analyzed the data using a series of card sorts, informed by Linstone's Multiple Perspectives Model. Results We identified 18 activities and grouped them into four areas. Area 1: Fostering relationships across the organization, with activities (a) training and support, (b) visibility/presence on the floor, (c) liaising between people, (d) administration and leadership, (e) project management, (f) cheerleading/buy-in/sponsorship, (g) preparing for CDS implementation. Area 2: Assembling the system with activities (a) providing technical support, (b) CDS content development, (c) purchasing products from vendors (d) knowledge management, (e) system integration. Area 3: Using CDS to achieve the organization's goals with activities (a) reporting, (b) requirements-gathering/specifications, (c) monitoring CDS, (d) linking CDS to goals, (e) managing data. Area 4: Participation in external policy and standards activities (this area consists of only a single activity). We also identified a set of recommendations associated with these 18 activities. Discussion All 18 activities we identified were performed at all sites, although the way they were organized into roles differed substantially. We consider these activities critical to the success of a CDS program. Conclusions A series of activities are performed by sites strong in CDS, and sites adopting CDS should ensure they incorporate these activities into their efforts. PMID:23999670

  20. Minimum qualifications for clinical pharmacy practice faculty.

    PubMed

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

    2014-05-01

    The American College of Clinical Pharmacy 2013 Educational Affairs Committee was charged with developing recommendations for the minimum qualifications required for clinical pharmacy practice faculty in United States colleges and schools of pharmacy with respect to education, postgraduate training, board certification, and other experiences. From a review of the literature, the committee recommends that clinical pharmacy practice faculty possess the following minimum qualifications, noting that, for some positions, additional qualifications may be necessary. Clinical pharmacy practice faculty should possess the Doctor of Pharmacy degree from an Accreditation Council for Pharmacy Education–accredited institution. In addition, faculty should have completed a postgraduate year one (PGY1) residency or possess at least 3 years of direct patient care experience. Faculty who practice in identified areas of pharmacotherapy specialization, as identified by American Society of Health-System Pharmacists postgraduate year two (PGY2) residency guidelines, should have completed a PGY2 residency in that area of specialty practice. Alternatively, faculty should have completed a minimum of a PGY1 residency and 1 additional year of practice, with at least 50% of time spent in their area of specialization, which is documented in a portfolio, or 4 years of direct patient care in their area of specialization, which is documented in a portfolio. Fellowship training or a graduate degree (e.g., Ph.D.) should be required for research-intensive clinical faculty positions. All faculty should obtain structured teaching experience during or after postgraduate training, preferably through a formal teaching certificate program or through activities documented in a teaching portfolio. A baseline record of scholarship should be obtained before hire as clinical pharmacy practice faculty through exposure in postgraduate programs or previous employment. Faculty should be board certified before hire

  1. Body composition in clinical practice.

    PubMed

    Andreoli, Angela; Garaci, Francesco; Cafarelli, Francesco Pio; Guglielmi, Giuseppe

    2016-08-01

    Nutritional status is the results of nutrients intake, absorption and utilization, able to influence physiological and pathological conditions. Nutritional status can be measured for individuals with different techniques, such as CT Body Composition, quantitative Magnetic Resonance Imaging, Ultrasound, Dual-Energy X-Ray Absorptiometry and Bioimpendance. Because obesity is becoming a worldwide epidemic, there is an increasing interest in the study of body composition to monitor conditions and delay in development of obesity-related diseases. The emergence of these evidence demonstrates the need of standard assessment of nutritional status based on body weight changes, playing an important role in several clinical setting, such as in quantitative measurement of tissues and their fluctuations in body composition, in survival rate, in pathologic condition and illnesses. Since body mass index has been shown to be an imprecise measurement of fat-free and fat mass, body cell mass and fluids, providing no information if weight changes, consequently there is the need to find a better way to evaluate body composition, in order to assess fat-free and fat mass with weight gain and loss, and during ageing. Monitoring body composition can be very useful for nutritional and medical interventional. This review is focused on the use of Body Composition in Clinical Practice. PMID:26971404

  2. [ECG mapping in clinical practice].

    PubMed

    Boudík, F; Aschermann, M; Anger, Z

    2002-12-01

    First the authors present a review of important cornerstones in the history of the electrocardiogram (ECG) and ECG mapping. The first to describe the electric cardiac field based on twenty ECGs was A.D. Waller in 1889. The decisive cornerstone for practical use was the introduction of a string galvanometer in 1901 by W. Einthoven and his triaxial lead system. Another very important cornerstone in the development of ECG were the findings of F.N. Wilson. Merits as regards the development and application of ECG mapping are due to B. Taccardi. Workers of the Second Medical Clinic in Prague enhanced after 15 years of studies and comparison of ECG maps with coronarographic findings in subjects with ischaemic heart disease (IHD) and microvascular coronary dysfunction (syndrome X--SyX) substantially the specificity of this method in impaired myocardial vascularization. Better diagnosis was achieved by introduction of diagnostic tests which influence coronary vascularization such as e.g. hyperventilation, as well as other tests. After their application progression of chronic myocardial ischaemia occurs, e.g. by the mechanism of the "steal phenomenon" or restriction of the microcirculation after hyperventilation in patients with SyX. Furthermore the authors present examples of ECG maps after PTCA, after application of diagnostic tests in IHD and SyX and also regression of myocardial ischaemia after marked reduction of total cholesterol. PMID:12744039

  3. Cognitive Processes in Clinical Practice.

    ERIC Educational Resources Information Center

    Witkin, Stanley L.

    1982-01-01

    Explores the cognitive processes that can lead social workers to make erroneous judgements about clients, and inappropriate practice decisions. Similarities between the assessment and practice methods advocated underscore the notion of practice as a process of systematic exploration and problem solving. (Author/JAC)

  4. Procedures for Using Clinical Practice Guidelines

    ERIC Educational Resources Information Center

    Hargrove, Patricia; Griffer, Mona; Lund, Bonnie

    2008-01-01

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

  5. Learning Clinical Skills during Bedside Teaching Encounters in General Practice: A Video-Observational Study with Insights from Activity Theory

    ERIC Educational Resources Information Center

    Ajjawi, Rola; Rees, Charlotte; Monrouxe, Lynn V.

    2015-01-01

    Purpose: This paper aims to explore how opportunities for learning clinical skills are negotiated within bedside teaching encounters (BTEs). Bedside teaching, within the medical workplace, is considered essential for helping students develop their clinical skills. Design/methodology/approach: An audio and/or video observational study examining…

  6. Whiteboards: mediating professional tensions in clinical practice.

    PubMed

    Riley, Robin; Forsyth, Rowena; Manias, Elizabeth; Iedema, Rick

    2007-01-01

    In this paper we argue that whiteboards in clinical settings play a hybrid role: communicating inter- and intraprofessional directives, mediating professional tensions, and mitigating potentially face-threatening acts. The data upon which this paper is based emanate from two independently conducted ethnographic studies: the first explored a range of nurse-nurse and nurse-doctor communication practices in operating rooms, while the second explored work routines and communication methods in oncology wards. Data collection included fieldwork using observations, interviews assisted by photographic methods, and in the first study, a personal diary. A deconstructive analysis was independently undertaken. As a communication method, the use of whiteboards in clinical settings provided a focal point for the coordination of clinical work activities and for the dissemination of information to large groups of people. Whiteboards were a conduit for potentially face-threatening information in that they facilitated the policing and disciplining of staff, while distancing communicators from one another. We conclude that whiteboards are 'pseudo-synchronous' in nature, enabling 'communication at a distance'. In doing so, whiteboards may facilitate and economize clinical communication but they also perpetuate the invisibility of nurses' contribution to ensuring safe care, and they mask the symbolic violence that is committed within and between health professionals. PMID:18052816

  7. Utilization of incontinence clinical practice guidelines.

    PubMed

    Roe, B; Moore, K N

    2001-11-01

    Clinical practice guidelines (CPGs) are evidence-based recommendations for best practice and have been developed with the assumption they will be embraced by practitioners; a further assumption is that clinical practice guidelines will improve the delivery of care. In this article, we provide a working definition of evidence-based practice, discuss the strengths and limitations of CPGs, describe the implementation of CPGs in the context of urinary incontinence, and consider the steps that the WOCN has taken to initiate evidence-based practice. Current issues are presented along with initiatives that have resulted in clinical practice guidelines on incontinence from the United States, United Kingdom, and Canada. On the basis of the current literature, it is concluded that clinical practice guidelines can play an important role in WOCN practice and that the implementation of guidelines may improve clinical practice. However, guidelines are only as valid as the evidence on which they are based and may not take into account gender or cultural differences or the effect that comorbid conditions can have on treatment outcomes. Finally, guidelines must follow a comprehensive approach that involves management and staff and includes education, facilitation, evaluation, feedback, and an understanding of change strategies. PMID:11707762

  8. Advanced practice: the clinical nurse specialist.

    PubMed

    Sparacino, P

    1992-01-01

    Historically, the clinically expert nurse who wanted to continue in direct patient care had few career options. That dilemma is changing in response to the recognised need for greater knowledge and clinical expertise in the domain of patient care. The clinical nurse specialist role is an answer to this concern. The clinical nurse specialist practices within a framework of theoretically-based knowledge and combines that knowledge with clinical expertise. The role is also pivotal in the promotion of patient care focused scientific inquiry and in the generation and refinement of nursing theories. Career options are more versatile than for the educator, researcher, or administrator. While the clinical nurse specialist is an essential person in influencing quality care in the traditional practice settings, there are now opportunities with clientele and practice settings which have expanded beyond the conventional boundaries. PMID:1528295

  9. Clinical and administrative review in general practice

    PubMed Central

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

    1975-01-01

    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. PMID:1223278

  10. Positive interventions in clinical practice.

    PubMed

    Rashid, Tayyab

    2009-05-01

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

  11. Genetics of Epilepsy in Clinical Practice

    PubMed Central

    2015-01-01

    Genetics should now be part of everyday clinical epilepsy practice. Good data exist to provide empiric risks based on epilepsy syndrome diagnosis. Investigation of the molecular basis of some epilepsies is now a practical clinical task and is of clear value to the patient and family. In some cases, specific therapeutic decisions can now be made based on genetic findings, and this scenario of precision therapy is likely to increase in the coming years. PMID:26316866

  12. Collaborative Clinical Practice: An Alternate Field Experience

    ERIC Educational Resources Information Center

    Dee, Amy Lynn

    2012-01-01

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

  13. Reshaping Clinical Practice for the New Millennium.

    ERIC Educational Resources Information Center

    Dietz, Christine A.

    2000-01-01

    Discusses the need to train clinical practitioners in social work to address ongoing issues of oppression. Describes a second-year Master's in Social Work clinical practice sequence taught from feminist, poststructuralist, postmodern, and social constructionist perspectives, where students learn to assess the impacts of oppression, discover…

  14. Thymomas: Review of Current Clinical Practice

    PubMed Central

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

    2010-01-01

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

  15. Entrustable Professional Activities for Pharmacy Practice

    PubMed Central

    Chapman, Scott A.; Frail, Caitlin K.; Moon, Jean Y.; Undeberg, Megan R.; Orzoff, Jordan H.

    2016-01-01

    The profession of pharmacy is facing a shifting health system context that holds both opportunity and risk. If the profession of pharmacy is to advance, pharmacists must be recognized as a consistent member of the health care team in all clinical settings, contributing at the fullest extent of licensure and education. One part of achieving this broad goal is to implement a new way of defining and assessing pharmacy practice skills, such as entrustable professional activities (EPA). Assessment of professional tasks and practice activities with EPAs has been successfully implemented in medical education for assessing trainee preparation for practice. This EPA model is being applied to pharmacy education to develop an assessment framework across the advanced pharmacy practice experience (APPE) curriculum. The APPE course directors, practice faculty members, and the Office of Experiential Education collaboratively defined a set of universal EPAs critical for pharmacists in any practice setting and would be assessed in all practice experience types. PMID:27293224

  16. [Malnutrition screening in clinical practice].

    PubMed

    Hankard, R; Colomb, V; Piloquet, H; Bocquet, A; Bresson, J-L; Briend, A; Chouraqui, J-P; Darmaun, D; Dupont, C; Frelut, M-L; Girardet, J-P; Goulet, O; Rieu, D; Simeoni, U; Turck, D; Vidailhet, M

    2012-10-01

    Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. It has a functional and structural impact and increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Pediatric Society recommends weighing and measuring any child when hospitalized or seen in consultation. The body mass index (BMI) must be calculated and analyzed according to references any time growth kinetics cannot be analyzed. Any child with a BMI below the third centile or -2 standard deviations for age and sex needs to be examined looking for clinical signs of malnutrition and signs orienting toward an etiology and requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing up a nutritional strategy along with the overall care plan. A target weight needs to be determined as well as the quantitative and qualitative nutritional care including its implementation. This plan must be evaluated afterwards in order to adapt the nutritional therapy. PMID:22959889

  17. Who Wrote This Clinical Practice Guideline?

    PubMed

    Tunkel, David E; Jones, Stephanie L

    2015-12-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines address a variety of otolaryngologic diseases and/or procedures. It may seem reasonable to create these guidelines by assembling a team of expert clinicians familiar with the pertinent clinical issues and the available evidence, with debate and eventual agreement leading to recommendations. However, trustworthy clinical practice guidelines are in fact created via a defined process to assemble a guideline development group composed of diverse stakeholders: clinician generalists and specialists, content experts, methodologists, physicians and nonphysicians, patients, and advocates. Such a guideline development group can create a valuable and trusted guideline for clinicians and affected patients. PMID:26443479

  18. Thrombophilia: clinical-practical aspects.

    PubMed

    Moll, Stephan

    2015-04-01

    No consensus exists as to who should be tested for thrombophilia, mainly due to the lack of good quality clinical outcome data in relationship to presence or absence of a given thrombophilia. Testing may be considered if (a) finding a thrombophilia predicts recurrent thrombosis and, thus, influences length of anticoagulation treatment decisions; (b) identifying a thrombophilia has implications on management of asymptomatic family members who are carriers of the detected thrombophilia; (c) a patient wishes to better understand why a thrombotic event occurred. Testing may be helpful in patients with venous thromboembolism at intermediate risk of recurrence in whom the finding of a strong thrombophilia can be one of the arguments for long-term anticoagulation--the "risk-of-recurrence-triangle" may be a useful aid in this decision process. Patients whose venous thromboembolism was provoked by a major transient risk factor should not be tested for thrombophilia. Thrombophilia tests should only be ordered by health care professionals who can provide the "4P": (a) appropriately select which patient to test, (b) provide pre-test counseling, (c) properly interpret the test results, and (d) provide education and advice to the patient. If testing is embarked on in patients with venous thromboembolism, it is advisable to be done at the time of decision making whether to stop or continue anticoagulation, i.e. typically after 3 months of anticoagulant therapy. Thrombophilia testing is best not done at the time of an acute thrombotic event and while a patient is on an anticoagulant. PMID:25724822

  19. Good clinical practice and phytotherapy.

    PubMed

    Kusche, J

    1993-05-01

    The GCP Guideline of the European Community on the performance of clinical trials became obligatory in June 1991. As the GCP standards have mainly been set for innovative drugs, there is a certain danger that these criteria could not be fulfilled by medicines used in phytotherapy. As regards, the chances and risks of the European guideline, especially for herbal medicines, the differences between chemically-defined and herbal drugs, as well as the extent, to which herbal medicines might be concerned by the guideline, have to be taken into account. Herbal medicines are different from chemically defined medicines in their character as well as in their medicinal use. They always contain a mixture of numerous substances. Data on preclinical investigations are often incomplete, whereas, on the other hand, physicians and patients have a long-term experience in applying these medicines. They are, in general, well-tolerated and therefore suitable for the treatment of chronic diseases. Due to a characteristic taste and smell, the production of placebos is often impossible. The GCP directive also contains basic elements concerning chemically defined drugs as well as herbal medicines in a similar way. PMID:8361262

  20. Clinical Practice Update: Pediculosis Capitis.

    PubMed

    Bohl, Brittany; Evetts, Jessica; McClain, Kymberli; Rosenauer, Amanda; Stellitano, Emily

    2015-01-01

    A review of the current evidence on primary treatment modalities of head lice demonstrates increasing resistance to current regimens. New and alternative therapies are now available. A treatment algorithm was created to address safety and efficacy of treatments, as well as to guide clinicians through navigation of the regimens. Through an online journal search, 59 articles were selected for the review. Literature searches were performed through PubMed, Medline, Ebsco Host, and CINAHL, with key search words of "Pediculosis capitis" and "head lice" in the title, abstract, and index. Meta-analyses and controlled clinical trials were viewed with greater weight if they had a large sample size, were statistically significant, and did not allude to bias. When resistant infestations are well-documented in a locality, changes to the treatment regimen are indicated, and alternative treatments should be considered. Recent studies and U.S. Food and Drug Administration (FDA) approvals have changed the available treatment options for Pediculosis capitis, including benzyl alcohol, topical ivermectin, spinosad, and the LouseBuster. Further, environmental management and prevention measures should be taken to avoid reinfestation and to prevent the spread of head lice. Continued study is recommended to establish long-term safety of new and alternative agents. PMID:26665422

  1. [Drug flow. Good manufacturing practices, good clinical practices].

    PubMed

    Dupin-Spriet, T; Spriet, A

    1991-01-01

    On a worldwide basis, the drug development circuit in clinical trials undergoes a general movement towards improvement which is sensitive to the degree of quality. The methods used to achieve this are found at the interface of Good Manufacturing Practices (GMP) and Good Clinical Practices (GCP). They consist primarily of two types, for which examples are given here: strengthening of controls (verification of the resemblance of test drugs in double-blind comparison by a "jury" and computerized systems of drug accountability), improvement in "compliance with therapy at the site of investigation" (use of more "intelligent" drug packages and labels). PMID:2020929

  2. [Lanthanum carbonate in clinical practice].

    PubMed

    Torregrosa Prats, V

    2008-01-01

    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

  3. Hemodialysis safety: Evaluation of clinical practice.

    PubMed

    Fadili, Wafaa; Adnouni, Adil; Laouad, Inass

    2016-05-01

    Hemodialysis (HD) safety has become a clinical priority; therefore, the use of checklists for making the dialysis session safe is now widely adopted. The aim of our study was to assess different shortcomings in the clinical practice of nurses working in different Moroccan dialysis centers and to discuss the interest of using such checklists. This cross-sectional study was performed in 13 chronic HD centers. Clinical practice of nurses was evaluated through checklists used in European outpatient dialysis units. We noted several deficiencies mainly related to the clinical evaluation of dialysis patients and to aspects related to hygiene and protection measures against contamination. Optimal safety of dialysis sessions requires the use of simple and reproducible means that improve clinical skills of the health staff. PMID:27215249

  4. [Clinical practice guideline: a complete geriatric evaluation].

    PubMed

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

    2011-01-01

    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

  5. Developing a Critical Practice of Clinical Supervision.

    ERIC Educational Resources Information Center

    Smyth, W. John

    1985-01-01

    The etymology of the term "clinical supervision" is discussed. How clinical supervision can be used with teachers as an active force toward reform and change is then examined. Through clinical supervision teachers can assist each other to gain control over their own professional lives and destinies. (RM)

  6. Clinical Understanding of Spasticity: Implications for Practice

    PubMed Central

    2014-01-01

    Spasticity is a poorly understood phenomenon. The aim of this paper is to understand the effect of spasticity on daily life and identify bedside strategies that enhance patient's function and improve comfort. Spasticity and clonus result from an upper motor neuron lesion that disinhibits the tendon stretch reflex; however, they are differentiated in the fact that spasticity results in a velocity dependent tightness of muscle whereas clonus results in uncontrollable jerks of the muscle. Clinical strategies that address function and comfort are paramount. This is a secondary content analysis using a qualitative research design. Adults experiencing spasticity associated with neuromuscular disorder were asked to participate during inpatient acute rehabilitation. They were asked to complete a semistructured interview to explain and describe the nature of their experienced spasticity on daily basis. Spasticity affects activities of daily living, function, and mobility. Undertreated spasticity can lead to pain, immobility, and risk of falls. There were missed opportunities to adequately care for patients with spasticity. Bedside care strategies identified by patients with spasticity are outlined. Uses of alternative therapies in conjunction with medications are needed to better manage spasticity. Patient reports on spasticity are important and should be part of clinical evaluation and practice. PMID:25276432

  7. Therapeutic equivalents in clinical practice.

    PubMed

    Benson, M D

    2001-01-01

    With increasing debate over the rising expenses of health care, a variety of cost-saving measures has been attempted over the years. Use of primary care physicians as "gate keepers," reduction in the length of hospital stays, and pushing women toward vaginal birth after Cesarean section have all been utilized despite on going issues with patient satisfaction and even safety. One remarkable success in stretching health-care dollars that has often been overlooked is the prescription of therapeutic equivalents, or generic drugs. Although available on a limited basis for decades, off-brand manufacture of pharmaceuticals with identical active ingredients as those of the branded drug received a large boost through Congressional legislation in 1984 with the Hatch-Waxman Act. "Fast-track" FDA approval was initiated by Congress to introduce competition into the marketplace for drugs whose patients had expired. While giving close scrutiny to the manufacturing process and requiring the same level of regulatory supervision for factors such as bioavailability and shelf life, the Hatch-Waxman Act removed the burden and expense from generic manufacturers of proving the safety and efficacy all over again of a previously FDA-approved drug. With less than a 20% market share of all prescribed drugs in 1984, the generic drug industry has captured roughly 44% of the market in recent years while accounting for only 8% of expenditures on prescription medication. The prescription of therapeutic equivalents is one method of keeping health care costs down without compromising patient satisfaction or safety. PMID:11374660

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

    PubMed Central

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

    1996-01-01

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

  9. Implementing human factors in clinical practice

    PubMed Central

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

    2015-01-01

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

  10. SMARTWheel: From Concept to Clinical Practice

    PubMed Central

    Cooper, Rory A.

    2009-01-01

    Background Wheelchair prescription is complex with thousands of choices and options. Theoretically, a higher quality or innovative wheelchair that is appropriately matched to the user and their unique needs will increase participation. It is well accepted that there is an alarmingly high incidence of carpal tunnel syndrome, and rotator cuff injuries among manual wheelchair users. Development Since the initial conceptualization, the SMARTWheel was intended to better understand the physiological and physical effects of wheelchair propulsion on the body. Initially, little was known about wheelchair propulsion and the SMARTWheel transformed the nascent field of wheelchair propulsion biomechanics. Impact Although still an important area of clinical research, the SMARTWheel has been critical to the study of the relationship between the type of wheelchair, set-up, activity, technique, anatomy, and physiology and repetitive strain injury. There has been growing evidence that the wheelchair-user interaction explains a substantial portion of the risk of developing a degenerative injury and on community participation. A noteworthy contribution of this work was the release of the clinical practice guideline, entitled, Preservation of Upper Limb Function Following Spinal Cord Injury in 2005. Discussion The SMARTWheel has been used by other scientists in areas that were not originally envisioned to be applications. It has been used to support the design of tools for developing a trail mapping rating and description system. It has also supported the design of accessible pedestrian walkways standards, accessible playground surfaces, and to evaluate carpets for wheelchair accessibility. It is likely that there are more new areas of exploration to emerge. This article describes the evolution of the SMARTWheel as new technologies became available and its applications in the field of wheelchair biomechanics and clinical service delivery. PMID:19658010

  11. The Effectiveness of Visual Short-Time Neurofeedback on Brain Activity and Clinical Characteristics in Alcohol Use Disorders: Practical Issues and Results.

    PubMed

    Lackner, Nina; Unterrainer, Human F; Skliris, Dimitris; Wood, Guilherme; Wallner-Liebmann, Sandra J; Neuper, Christa; Gruzelier, John H

    2016-07-01

    The present study was carried out to examine the efficacy of alpha/theta neurofeedback (NF) with a new visual paradigm in a cohort of alcohol use disordered (AUD) patients (n = 25) treated in an Austrian therapeutic community center. The experimental study design focused on changes in absolute and relative resting EEG band power as well as in clinical variables, including depression (Beck Depresion Inventory [BDI-V]), psychiatric symptoms (Brief Symptom Inventory [BSI], coping (Freiburg Questionnaire on Coping with Illness [FKV-lis]), psychotherapy motivation (Therapy Motivation Questionnaire [FPTM-23]), sense of coherence (Sense of Coherence Scale [SOC-13]), posttraumatic growth (Posttraumatic Growth Inventory [PPR]), and alcohol cravings (Alcohol Craving Questionnaire [ACQ]). For measuring training effects, participants were randomly allocated to 2 groups: an experimental group (EG, n = 13) and a control group (CG, n = 12). Patients in EG received 12 sessions of visual NF training over a period of 6 weeks to enhance alpha (8-12 Hz) and theta (4-7 Hz) frequency band power in addition to the standard treatment program of the rehabilitation center. Participants in CG received no additional NF intervention. The multivariate analysis of covariance (MANCOVA) showed a change by trend in absolute alpha and theta power in the EG. Even though no MANCOVA effects were found in the clinical scales, AUD patients reported increasing control of their brain activity during the course of NF. However, changes in several clinical scales (BDI-V, BSI, FKV-lis, PPR) from pre- to posttest were observed only in the EG contrary to the CG. The findings of this pilot study provide first evidence for the practicality and effectiveness of visual short-term NF as an additive intervention in the therapeutic community. PMID:26415612

  12. How Physicians Integrate Advances into Clinical Practices.

    ERIC Educational Resources Information Center

    Lockyer, Jocelyn M.; And Others

    1985-01-01

    Family physicians and specialists were asked to identify the sources of information they used in the process of making changes in their clinical practices. An average of 3.08 sources of information were utilized for each change and over 50 percent of the changes were complete in less than one year. (CT)

  13. Building a Vita for the Clinical Practice.

    ERIC Educational Resources Information Center

    Tentoni, Stuart C.

    Vita review is used by most prospective employers to determine which applicants will be interviewed for a particular position opening in clinical practice. Most graduate students have little knowledge and no training in this topic, which is vital for professional development. Specific examples of vitae construction are provided for one of the…

  14. Balancing Certainty and Uncertainty in Clinical Practice

    ERIC Educational Resources Information Center

    Kamhi, Alan G.

    2011-01-01

    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…

  15. Scaffolding Student Learning in Clinical Practice.

    ERIC Educational Resources Information Center

    Spouse, Jenny

    1998-01-01

    A longitudinal study of nursing students showed that without sponsorship by clinical staff students found it difficult to participate and learn. The strategy of scaffolding, building on Vygotsky's Zone of Proximal Development, enables recognition of learning needs and the relationship between theory and practice. (SK)

  16. Balancing Certainty and Uncertainty in Clinical Practice

    ERIC Educational Resources Information Center

    Kamhi, Alan G.

    2011-01-01

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

  17. Physicians Reentering Clinical Practice: Characteristics and Clinical Abilities

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  18. Binge eating disorder: from clinical research to clinical practice.

    PubMed

    Goracci, Arianna; Casamassima, Francesco; Iovieno, Nadia; di Volo, Silvia; Benbow, Jim; Bolognesi, Simone; Fagiolini, Andrea

    2015-01-01

    This case report describes the clinical course of a young woman suffering from binge eating disorder (BED) associated with obesity. It illustrates the efficacy of different medications in the treatment of BED and related conditions and is followed by the comments and clinical observations of 2 practicing psychiatrists. The issues described in this paper have important clinical implications and are topical, given that BED is now recognized as a specific disorder in the new Diagnostic and Statistical Manual of Mental Disorders, fifth edition classification system, but neither the US Food and Drug Administration nor any other regulatory agency has yet approved a drug for treatment of this disease, despite its very prevalent and disabling nature. Growing evidence from the fields of psychopathology and neurobiology, including preclinical and clinical studies, converges to support the idea that "overeating" has much in common with other behavioral addictions, and substance abuse treatment agents may show promise for the treatment of BED. PMID:25629882

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

    PubMed Central

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

    2013-01-01

    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. PMID:22642520

  20. High-Resolution Manometry in Clinical Practice

    PubMed Central

    Pandolfino, John E.

    2015-01-01

    High-resolution manometry (HRM) is the primary method used to evaluate esophageal motor function. Displayed and interpreted by esophageal pressure topography (EPT), HRM/ EPT provides a detailed assessment of esophageal function that is useful in the evaluation of patients with nonobstructive dysphagia and before foregut surgery. Esophageal motility diagnoses are determined systematically by applying objective metrics of esophageal sphincter and peristaltic function to the Chicago Classification of esophageal motility disorders. This article discusses HRM study, EPT interpretation, and the translation of EPT findings into clinical practice. Examples are provided to illustrate several clinical challenges. PMID:27118931

  1. Short QT Syndrome in Current Clinical Practice.

    PubMed

    Khera, Sahil; Jacobson, Jason T

    2016-01-01

    Short QT syndrome is a rare inherited autosomal dominant cardiac channelopathy associated with malignant ventricular and atrial arrhythmias. A shortened corrected QT interval is a marker for risk of malignant arrhythmias, which are secondary to increased transmural dispersion of repolarization. The underlying gain of function mutations in the potassium channels are most common but genetic testing remains low yield. This review discusses the cellular mechanisms, genetic involvement, clinical presentation, and current recommended management of patients with short QT syndrome relevant to current clinical practice. PMID:26440650

  2. Clinical practice guidelines for dementia in Australia.

    PubMed

    Laver, Kate; Cumming, Robert G; Dyer, Suzanne M; Agar, Meera R; Anstey, Kaarin J; Beattie, Elizabeth; Brodaty, Henry; Broe, Tony; Clemson, Lindy; Crotty, Maria; Dietz, Margaret; Draper, Brian M; Flicker, Leon; Friel, Margeret; Heuzenroeder, Louise Mary; Koch, Susan; Kurrle, Susan; Nay, Rhonda; Pond, C Dimity; Thompson, Jane; Santalucia, Yvonne; Whitehead, Craig; Yates, Mark W

    2016-03-21

    About 9% of Australians aged 65 years and over have a diagnosis of dementia. Clinical practice guidelines aim to enhance research translation by synthesising recent evidence for health and aged care professionals. New clinical practice guidelines and principles of care for people with dementia detail the optimal diagnosis and management in community, residential and hospital settings. The guidelines have been approved by the National Health and Medical Research Council. The guidelines emphasise timely diagnosis; living well with dementia and delaying functional decline; managing symptoms through training staff in how to provide person-centred care and using non-pharmacological approaches in the first instance; and training and supporting families and carers to provide care. PMID:26985848

  3. Review of clinical medicine and religious practice.

    PubMed

    Stewart, William C; Adams, Michelle P; Stewart, Jeanette A; Nelson, Lindsay A

    2013-03-01

    The purpose was to evaluate faith-based studies within the medical literature to determine whether there are ways to help physicians understand how religion affects patients’ lives and diseases. We reviewed articles that assessed the influence of religious practices on medicine as a primary or secondary variable in clinical practice. This review evaluated 49 articles and found that religious faith is important to many patients, particularly those with serious disease, and patients depend on it as a positive coping mechanism. The findings of this review can suggest that patients frequently practice religion and interact with God about their disease state. This spiritual interaction may benefit the patient by providing comfort, increasing knowledge about their disease, greater treatment adherence, and quality of life. The results of prayer on specific disease states appear inconsistent with cardiovascular disease but stronger in other disease states. PMID:23484213

  4. Clinical practice: between Aristotle and Cochrane.

    PubMed

    Fugelli, P

    1998-02-01

    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

  5. Mismatch repair deficiency testing in clinical practice.

    PubMed

    Buza, Natalia; Ziai, James; Hui, Pei

    2016-05-01

    Lynch syndrome, an autosomal dominant inherited disorder, is caused by inactivating mutations involving DNA mismatch repair (MMR) genes. This leads to profound genetic instability, including microsatellite instability (MSI) and increased risk for cancer development, particularly colon and endometrial malignancies. Clinical testing of tumor tissues for the presence of MMR gene deficiency is standard practice in clinical oncology, with immunohistochemistry and PCR-based microsatellite instability analysis used as screening tests to identify potential Lynch syndrome families. The ultimate diagnosis of Lynch syndrome requires documentation of mutation within one of the four MMR genes (MLH1, PMS2, MSH2 and MSH6) or EPCAM, currently achieved by comprehensive sequencing analysis of germline DNA. In this review, the genetic basis of Lynch syndrome, methodologies of MMR deficiency testing, and current diagnostic algorithms in the clinical management of Lynch syndrome, are discussed. PMID:26895074

  6. Tocilizumab in patients with active rheumatoid arthritis and inadequate responses to DMARDs and/or TNF inhibitors: a large, open-label study close to clinical practice

    PubMed Central

    Bykerk, Vivian P; Östör, Andrew J K; Alvaro-Gracia, José; Pavelka, Karel; Ivorra, José Andrés Román; Graninger, Winfried; Bensen, William; Nurmohamed, Michael T; Krause, Andreas; Bernasconi, Corrado; Stancati, Andrea; Sibilia, Jean

    2012-01-01

    Objective To evaluate the safety and efficacy of tocilizumab in clinical practice in patients with rheumatoid arthritis (RA) with inadequate responses (IR) to disease-modifying antirheumatic drugs (DMARDs) or both DMARDs and tumour necrosis factor α inhibitors (TNFis). Methods Patients—categorised as TNFi-naive, TNFi-previous (washout) or TNFi-recent (no washout) —received open-label tocilizumab (8 mg/kg) every 4 weeks ± DMARDs for 24 weeks. Adverse events (AEs) and treatment discontinuations were monitored. Efficacy end points included American College of Rheumatology (ACR) responses, 28-joint disease activity score (DAS28) and European League Against Rheumatism responses. Results Overall, 1681 (976 TNF-naive, 298 TNFi-previous and 407 TNFi-recent) patients were treated; 5.1% discontinued treatment because of AEs. The AE rate was numerically higher in TNFi-recent (652.6/100 patient-years (PY)) and TNFi-previous (653.6/100PY) than in TNFi-naive (551.1/100PY) patients. Serious AE rates were 18.0/100PY, 28.0/100PY and 18.6/100PY; serious infection rates were 6.0/100PY, 6.8/100PY and 4.2/100PY, respectively. At week 4, 36.5% of patients achieved ACR20 response and 14.9% DAS28 remission (<2.6); at week 24, 66.9%, 46.6%, 26.4% and 56.8% achieved ACR20/ACR50/ACR70 responses and DAS28 remission, respectively. Overall, 61.6% (TNFi-naive), 48.5% (TNFi-previous) and 50.4% (TNFi-recent) patients achieved DAS28 remission. Conclusions In patients with RA who were DMARD-IR/TNFi-IR, tocilizumab ± DMARDs provided rapid and sustained efficacy without unexpected safety concerns. PMID:22615456

  7. Physical activity: practice this idea

    PubMed Central

    Guimarães, Guilherme Veiga; Ciolac, Emmanuel Gomes

    2014-01-01

    Sedentary habits or insufficient activities to promote health benefits can influence the occurrence of chronic diseases. The cardiovascular risk factors arise, at least partially, from the individual-environment interaction during life, and worsen with aging and lack of physical exercise. Health promotion and prevention are among the greatest challenges of public health policies. However, physical activity turns out to be rarely recommended and, thus have a very poor adhesion. In spite of consensus about the benefits of physical activity in both primary and secondary prevention, only 32% of adults and 66% of children and adolescents, according to Healthy People 2010 guideline, practice leisure-time physical activity. Thus, the regular practice of physical activity and healthy habits require changes in basic concepts in government and social policies. The higher involvement of public and private sectors related to health and education, the more expressive would be the reduction in socioeconomic costs and the improvement in quality of life. PMID:24551484

  8. Effectiveness and efficiency in clinical orthodontic practice.

    PubMed

    Rinchuse, Daniel J; Cozzani, Mauro

    2015-12-01

    Proffitt et al. have described "effectiveness and efficiency" (E&E) as achieving desired results without wasting the orthodontist's and patients' time. In 1972, Archibald Cochrane published a monograph entitled "Effectiveness and Efficiency," which challenged the medical community to use medical protocols that were evidence-based. As a possible starting point for E&E, the orthodontist could consider an "Evidence-based clinical practice" (EBCP) model, which integrates the best research evidence with clinical expertise and patient values. This model considers scientific or evidence-based orthodontics (EBO) together with patient preferences and patient autonomy, clinical or patient circumstances, and clinical experience and judgment. In this paper, therefore, E&E will be discussed from an EBCP perspective which, for our purposes, includes relevant evidence but also our clinical experience and rationale. We will discuss: wire sequence; NiTi Wire types; space closure by sliding; canine retraction versus en masse retraction, 18" slot versus 22" slot, the Bidimensional System; self-ligating brackets (SL); vertical slot; economic aspects. PMID:26527490

  9. Role modeling excellence in clinical nursing practice.

    PubMed

    Perry, R N Beth

    2009-01-01

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

  10. Narrative medicine in clinical genetics practice.

    PubMed

    Nowaczyk, Małgorzata J M

    2012-08-01

    Over the last 30 years medicine has undergone a significant paradigm shift. Due to the tremendous advances of modern medicine more and more people are living longer with their illnesses. These people have stories to tell, and they want these stories to be heard: They are reclaiming their voices. As clinical geneticists we need to hear what these voices are telling us, especially so in our area of clinical care where cures are rare, and disease states can be permanent. Narrative medicine is an important new skill set that hones abilities to do just that.This article highlights how integral narrative medicine is to clinical genetics practice, how geneticists already employ many of its tools and how they practice it diligently every day. I will show how geneticists can further improve their abilities to hear and honor patients' stories by writing and sharing stories with patients and with each other as doctors, counselors, and nurses, social workers and chaplains. The review presents the skills of close reading and how they improve patient care and illustrates how geneticists can, by using reflective writing, reshape their emotions in order to understand them, to let them go, and to make room for more. It presents the major types of illness narratives whose recognition allows us to hear and understand patients' stories. When used, the tools of narrative medicine can result in better patient care. PMID:22753050

  11. Litigations and the Obstetrician in Clinical Practice.

    PubMed

    Adinma, Jib

    2016-01-01

    The expectation of obstetrics is a perfect outcome. Obstetrics malpractice can cause morbidity and mortality that may engender litigation. Globally, increasing trend to litigation in obstetrics practice has resulted in high indemnity cost to the obstetrician with consequent frustration and overall danger to the future of obstetrics practice. The objective was to review litigations and the Obstetrician in Clinical Practice, highlighting medical ethics, federation of gynecology and obstetrics (FIGO's) ethical responsibility guideline on women's sexual and reproductive health and right; examine the relationship between medical ethics and medical laws; X-ray medical negligence and litigable obstetrics malpractices; and make recommendation towards the improvement of obstetrics practices to avert misconduct that would lead to litigation. Review involves a literature search on the internet in relevant journals, textbooks, and monographs. Knowledge and application of medical ethics are important to the obstetricians to avert medical negligence that will lead to litigation. A medical negligence can occur in any of the three triads of medicare viz: Diagnosis, advice/counseling, and treatment. Lawsuits in obstetrics generally center on errors of omission or commission especially in relation to the failure to perform caesarean section or to perform the operation early enough. Fear of litigation, high indemnity cost, and long working hours are among the main reasons given by obstetricians for ceasing obstetrics practice. Increasing global trend in litigation with high indemnity cost to the obstetrician is likely to jeopardize the future of obstetrics care especially in countries without medical insurance coverage for health practitioners. Litigation in obstetrics can be prevented through the Obstetrician's mindfulness of its possibility; acquainting themselves of the medical laws and guidelines related to their practice; ensuring adequate communication with, and consent of

  12. Litigations and the Obstetrician in Clinical Practice

    PubMed Central

    Adinma, JIB

    2016-01-01

    The expectation of obstetrics is a perfect outcome. Obstetrics malpractice can cause morbidity and mortality that may engender litigation. Globally, increasing trend to litigation in obstetrics practice has resulted in high indemnity cost to the obstetrician with consequent frustration and overall danger to the future of obstetrics practice. The objective was to review litigations and the Obstetrician in Clinical Practice, highlighting medical ethics, federation of gynecology and obstetrics (FIGO’s) ethical responsibility guideline on women's sexual and reproductive health and right; examine the relationship between medical ethics and medical laws; X-ray medical negligence and litigable obstetrics malpractices; and make recommendation towards the improvement of obstetrics practices to avert misconduct that would lead to litigation. Review involves a literature search on the internet in relevant journals, textbooks, and monographs. Knowledge and application of medical ethics are important to the obstetricians to avert medical negligence that will lead to litigation. A medical negligence can occur in any of the three triads of medicare viz: Diagnosis, advice/counseling, and treatment. Lawsuits in obstetrics generally center on errors of omission or commission especially in relation to the failure to perform caesarean section or to perform the operation early enough. Fear of litigation, high indemnity cost, and long working hours are among the main reasons given by obstetricians for ceasing obstetrics practice. Increasing global trend in litigation with high indemnity cost to the obstetrician is likely to jeopardize the future of obstetrics care especially in countries without medical insurance coverage for health practitioners. Litigation in obstetrics can be prevented through the Obstetrician's mindfulness of its possibility; acquainting themselves of the medical laws and guidelines related to their practice; ensuring adequate communication with, and consent of

  13. The Sherlock Holmes method in clinical practice.

    PubMed

    Sopeña, B

    2014-04-01

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

  14. GLUT1 deficiency syndrome in clinical practice.

    PubMed

    Klepper, Joerg

    2012-07-01

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

  15. Biosensors in Clinical Practice: Focus on Oncohematology

    PubMed Central

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

    2013-01-01

    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. PMID:23673681

  16. [Breaking bad news in clinical practice].

    PubMed

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

    2014-10-01

    Breaking bad news is a complex task that requires multiple communication skills from health professionals. Clinical practice demands to communicate all type of bad news, from a diagnosis of cancer to adverse effects of a treatment. On the other hand, since the beginning of the health reform in 2003, the need to improve the quality of services was proposed, among which the concern about the rights and duties of patients stands out. Therefore, the health care provider-patient relationship becomes again the subject of discussion and study, and a topic of great importance for clinical work. We revise the consequences of breaking bad news for the patient and for the health care provider, as well as the current protocols available for this purpose. The importance of developing communication skills both for future health professionals as for those who currently work in the area is emphasized. PMID:25601116

  17. Advanced clinical insights & practice: ischemic heart disease.

    PubMed

    Benner, Randall W; Zavarella, Matthew S

    2008-03-01

    This issue sees the debut of a new series of continuing education articles. The series, Advanced Clinical Insights & Practice, is designed to provide continuing education to an ever-expanding realm of paramedicine that needs more of it: the critical care transport paramedic. Secondly, and equally important, are the benefits that can be reaped by other certification levels reading this feature. For EMT-Basics and Intermediates, it will provide a great enhancement to your core knowledge, although most of the interventions discussed will be beyond your traditional scope. For paramedics, it will augment both your pathophysiological understanding and clinical assessment/management skills of diseases and injuries discussed. Ultimately though, it is hoped that anyone who reads these articles will become a better clinician. The next article will appear in the July issue. PMID:18814637

  18. Integrating Pain Management in Clinical Practice

    PubMed Central

    Jamison, Robert N.; Edwards, Robert R.

    2014-01-01

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

  19. Breath analysis: translation into clinical practice.

    PubMed

    Brodrick, Emma; Davies, Antony; Neill, Paul; Hanna, Louise; Williams, E Mark

    2015-06-01

    Breath analysis in respiratory disease is a non-invasive technique which has the potential to complement or replace current screening and diagnostic techniques without inconvenience or harm to the patient. Recent advances in ion mobility spectrometry (IMS) have allowed exhaled breath to be analysed rapidly, reliably and robustly thereby facilitating larger studies of exhaled breath profiles in clinical environments. Preliminary studies have demonstrated that volatile organic compound (VOC) breath profiles of people with respiratory disease can be distinguished from healthy control groups but there is a need to validate, standardise and ensure comparability between laboratories before real-time breath analysis becomes a clinical reality. It is also important that breath sampling procedures and methodologies are developed in conjunction with clinicians and the practicalities of working within the clinical setting are considered to allow the full diagnostic potential of these techniques to be realised. A protocol is presented, which has been developed over three years and successfully deployed for quickly and accurately collecting breath samples from 323 respiratory patients recruited from 10 different secondary health care clinics. PMID:25971863

  20. Imperfection, practice and humility in clinical ethics.

    PubMed

    Garchar, Kim

    2012-10-01

    In this essay, I provide a description of the discipline of ethics using the philosophies of Aristotle and the American pragmatist John Dewey. Specifically, I argue that ethics is an active undertaking that is ambiguous and pluralistic. I then normatively prescribe the way in which clinical ethicists ought to approach their work in medicine. Rather than endeavouring to become, or behaving as if they are, experts, clinical ethicists must be humble. They must practise ethics. That is, they must admit ethics is the study and pursuit of the good life but that this study and pursuit occurs imperfectly in the face of problematic situations. PMID:22995007

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

    PubMed

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

    2016-05-01

    This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed. PMID:27118546

  2. [Implementation of therapeutic hypothermia into clinical practice].

    PubMed

    Himmel, Friederike; Desch, Steffen; Wolfrum, Sebastian

    2015-08-01

    Implementation of mild therapeutic hypothermia after cardiac arrest into clinical practice is a continuing process. Although ILCOR recommendation was given in 2003, only 24% of the German hospitals reported the use of hypothermia in this setting in 2005. Growing evidence and most importantly the implementation of hypothermia into the guidelines led to a significant increase of acceptance of this therapeutic option leading to a user rate of 69% in 2009. Encouraged by the new guidelines from 2010 86% of German hospitals finally reported to use hypothermia after cardiac arrest routinely in 2012, a decade after publication of the mile stone studies. The phenomenon of a delayed implementation of hypothermia into clinical practice can be seen throughout the world as many surveys from different countries at different time points have shown. When hypothermia is used, hospitals go with the guidelines quite strictly with respect to indication, duration of treatment and target temperature. This strengthens the importance of guidelines in the process to implement new therapeutic options. However, although a recent study still promotes a strict target temperature management it questions the need for a markedly reduced target temperature of 33°C. It remains to be elucidated how this study will affect the daily routine in the hospitals and most interestingly how this study will change the coming guidelines in 2015. PMID:26261928

  3. Taking PDT into mainstream clinical practice

    NASA Astrophysics Data System (ADS)

    Bown, Stephen G.

    2009-06-01

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

  4. 42 CFR 21.44 - Clinical or other practical demonstration.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Clinical or other practical demonstration. 21.44... COMMISSIONED OFFICERS Appointment § 21.44 Clinical or other practical demonstration. In the discretion of the... the Regular Corps may be required to perform successfully a clinical or other practical...

  5. 42 CFR 21.44 - Clinical or other practical demonstration.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Clinical or other practical demonstration. 21.44... COMMISSIONED OFFICERS Appointment § 21.44 Clinical or other practical demonstration. In the discretion of the... the Regular Corps may be required to perform successfully a clinical or other practical...

  6. Why are clinical practice guidelines not followed?

    PubMed

    Barth, Julian H; Misra, Shivani; Aakre, Kristin Moberg; Langlois, Michel R; Watine, Joseph; Twomey, Patrick J; Oosterhuis, Wytze P

    2016-07-01

    Clinical practice guidelines (CPG) are written with the aim of collating the most up to date information into a single document that will aid clinicians in providing the best practice for their patients. There is evidence to suggest that those clinicians who adhere to CPG deliver better outcomes for their patients. Why, therefore, are clinicians so poor at adhering to CPG? The main barriers include awareness, familiarity and agreement with the contents. Secondly, clinicians must feel that they have the skills and are therefore able to deliver on the CPG. Clinicians also need to be able to overcome the inertia of "normal practice" and understand the need for change. Thirdly, the goals of clinicians and patients are not always the same as each other (or the guidelines). Finally, there are a multitude of external barriers including equipment, space, educational materials, time, staff, and financial resource. In view of the considerable energy that has been placed on guidelines, there has been extensive research into their uptake. Laboratory medicine specialists are not immune from these barriers. Most CPG that include laboratory tests do not have sufficient detail for laboratories to provide any added value. However, where appropriate recommendations are made, then it appears that laboratory specialist express the same difficulties in compliance as front-line clinicians. PMID:26650076

  7. Putting Research Findings into Clinical Practice

    PubMed Central

    Bhargava, Deepa; Al-Lawatia, Zainab; Al-Abri, Rashid; Bhargava, Kamlesh

    2012-01-01

    Objectives: A perception exists that clinicians in Oman are reluctant to adopt evidence-based practice (EBP). This pilot study was undertaken to study the feasibility of using EBP pathways at the point of care in otorhinolaryngology head and neck surgery. The ultimate aim was to facilitate EBP with the probability of developing a new system for implementing research findings/translational research at the clinical point of care. Methods: A cross-sectional prospective questionnaire pilot survey of clinicians at Sultan Qaboos University Hospital (SQUH), Oman, a tertiary care medical centre, was undertaken. Respondents included 135 physicians and surgeons with between 3 months and 25 years of clinical experience and included personnel ranging from interns to senior consultants, in areas ranging from primary care to specialist care. Results: Of those polled, 90% (95% confidence interval (CI) 85–95%) either strongly agreed or agreed that evidence-based practice protocols (EBPP) could help in decision making. A total of 87.4% of participants (95% CI 81.8–93%) either strongly agreed or agreed that EBPPs can improve clinical outcomes; 91.8% of participants (95% CI 87.2–96.4%) would use and apply EBPP in day-to-day care if they were available at the point of care and embedded in the hospital information system. Conclusions: The perception that clinicians at SQUH are reluctant to adopt EBP is incorrect. The introduction of EBP pathways is very feasible at the primary care level. Institutional support for embedding EBP in hospital information systems is needed as well as further outcome research to assess the improvement in quality of care. PMID:22548137

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

    PubMed Central

    Bugaj, T. J.; Nikendei, C.

    2016-01-01

    Today, skills laboratories or “skills labs”, i.e. specific practical skill training facilities, are a firmly established part of medical education offering the possibility of training clinical procedures in a safe and fault-forging environment prior to real life application at bedside or in the operating room. Skills lab training follows a structured teaching concept, takes place under supervision and in consideration of methodological-didactic concepts, ideally creating an atmosphere that allows the repeated, anxiety- and risk-free practice of targeted skills. In this selective literature review, the first section is devoted to (I) the development and dissemination of the skills lab concept. There follows (II) an outline of the underlying idea and (III) an analysis of key efficacy factors. Thereafter, (IV) the training method’s effectiveness and transference are illuminated, before (V) the use of student tutors, in the sense of peer-assisted-learning, in skills labs is discussed separately. Finally, (VI) the efficiency of the skills lab concept is analyzed, followed by an outlook on future developments and trends in the field of skills lab training. PMID:27579363

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

    PubMed

    Bugaj, T J; Nikendei, C

    2016-01-01

    Today, skills laboratories or "skills labs", i.e. specific practical skill training facilities, are a firmly established part of medical education offering the possibility of training clinical procedures in a safe and fault-forging environment prior to real life application at bedside or in the operating room. Skills lab training follows a structured teaching concept, takes place under supervision and in consideration of methodological-didactic concepts, ideally creating an atmosphere that allows the repeated, anxiety- and risk-free practice of targeted skills. In this selective literature review, the first section is devoted to (I) the development and dissemination of the skills lab concept. There follows (II) an outline of the underlying idea and (III) an analysis of key efficacy factors. Thereafter, (IV) the training method's effectiveness and transference are illuminated, before (V) the use of student tutors, in the sense of peer-assisted-learning, in skills labs is discussed separately. Finally, (VI) the efficiency of the skills lab concept is analyzed, followed by an outlook on future developments and trends in the field of skills lab training. PMID:27579363

  10. [Clinical guide practice. Patent ductus arteriosus].

    PubMed

    San Luis-Miranda, Raúl; Arias-Monroy, Laura G; Peralta-Pedrero, María Luisa; Lázaro-Castillo, José Luis; León-Ávila, José L; Benítez-Aréchiga, Zaria Margarita; Jáuregui-Ruiz, Oddir; Yáñez-Gutiérrez, Lucelli; Manrique-Valle, Mónica

    2012-01-01

    Patent ductus arteriosus (PDA) is the most common congenital heart disease in Mexico. The clinical manifestations of the PCA are from asymptomatic patients to the presence of heart failure. Its management should be individualized based on clinical, hemodynamic data and presence of pulmonary hypertension. Our objective was to provide current medical recommendations based on the best, available scientific evidence for the diagnosis, study and therapeutic decisions of the PCA. Established a standardized sequence to search for Practice Guidelines, based on the clinical questions about PCA diagnosis and treatment. Most of the recommendations were taken from selected guidelines and supplemented with the remaining material. The information is expressed in levels of evidence (E) and grade of recommendation (R) according to the characteristics of the study design and type of publications. Currently produces large amounts of medical information in a relatively short period of time which is necessary to have evidence-based CPG to facilitate and standardize the diagnostic decision-treatment to provide better care for children and adults with PCA. PMID:23234752

  11. Hand kinematics: Application in clinical practice.

    PubMed

    Rath, Santosh

    2011-05-01

    Pathological conditions of the hand consequent to injuries, paralysis, disease, arthritis and congenital difference results in loss or limitation of function, deformities, stiffness, inadequate power and poor position for pinch. The pathogenesis of deformities is influenced by bio-mechanical principles of joints and muscle function. The crippling impact of secondary changes due to edema, soft tissue contractures, muscle shortening and functional adaptations also have a mechanical basis. For clinicians and hand therapists, it is necessary to understand these fundamental principles of biomechanics to plan treatment modalities. Interpretation of mechanics of hand deformities in rheumatoid arthritis and paralysis will enable the treating team to identify the appropriate interventions of splinting, therapy and surgical procedures. Basic knowledge of the principles of hand clinical bio-mechanics will help the beginner to sail through the multitude of tendon transfers described in the text books of hand surgery and find the best solution for a particular clinical presentation. Similarly, knowledge of bio-mechanics will provide solutions to an experienced surgeon to plan treatment protocols for complex situations. The article presents a concise summary of the basic principles of hand bio-mechanics for common hand conditions seen in clinical practice. Understanding and applying these principles will help clinicians in planning and devising treatment options for common and complex hand conditions. PMID:22022027

  12. PRACTICAL CHRONIC PAIN ASSESSMENT TOOLS IN CLINICAL PRACTICE.

    PubMed

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

    2016-03-01

    The aim of the study was to show the role of tools in the evaluation of chronic pain (CP) in general practitioner (GP) everyday clinical practice. The study was done by analyzing electronic database of the first visits of 1090 CP patients referred to the Pain Clinic of the Karlovac General Hospital, Karlovac, Croatia, by their GPs. All patient records were analyzed according to the cause of CP, strongest pain a week before the examination, quality of sleep, and the Patients' Global Impression of Change scale. All statistical analyses were done using the IBM SPSS Statistics version 19.0.0.1 (www.spss.com). CP predominantly occurs in older age group. Patients with musculoskeletal pain accounted for the highest percentage (n = 316; 29%), followed by those with neuropathic pain (n = 253; 23.20%) and those with low back pain (n = 225; 20.60%). The mean pain intensity rating scale score was 8.3 ± 1.8 a week before the examination and the mean quality of sleep score was 6.8 ± 1.9. Moderate and severe sleep quality disorder was significantly present in patients over 65 years of age (p = 0.007), patients with musculoskeletal and neuropathic pain, back pain, and those having rated Patients' Global Impression of Change scale as worsening (p = 0.001). The severity of pain and poor quality of sleep are the leading causes of deterioration of the Patients' Global Impression of Change scale in patients suffering from musculoskeletal and neuropathic pain. In order to treat CP comprehensively, it is important for GPs to evaluate the outcomes of clinical treatment using tools for CP assessment. PMID:27276768

  13. The Virtual Practice: Using the Residents' Continuity Clinic to Teach Practice Management and Systems-Based Practice

    PubMed Central

    Perez, Jose A.; Faust, Cheryl; Kenyon, Angie

    2009-01-01

    Background Education in systems-based practice is a required component of all postgraduate medical education programs in the United States. Competency in this area requires that trainees have an understanding of the health care system sufficient to provide optimal care to patients. Most trainees in residency programs have little understanding of the complexities and challenges of present-day practice in the current system of care and consider themselves unprepared to undertake this activity following completion of training. Training in practice management in residency programs has not been emphasized as an important component of systems-based practice. Historically, practice management training in residency programs has been done using a fully didactic model, and residents have expressed a desire to learn this skill by becoming more directly involved in the operations and management of a practice. The patient visit touches many aspects of the health care system, including clinic operations, insurance, quality, and finances. Approach At our institution, we used the residents' continuity clinic practices as a vehicle to provide education in practice management and systems-based practice by creating a curriculum that included the residents' perceived gaps in knowledge regarding going into practice. This is known as the virtual practice. This curriculum is taught using data obtained from residents' practice to illustrate concepts in many areas, including primary practice operations, malpractice insurance, financial benchmarks, and career planning. Results Resident self-assessed knowledge of these areas increased after participating in the curriculum, and resident testimonials indicate satisfaction with the project. In addition, residents have become engaged and interested in how their effort translates into performance and how they participate in the health care system. PMID:21975715

  14. [Definition of sarcopenia and diagnostic evaluation in clinical practice].

    PubMed

    Trombetti, A

    2015-03-18

    Aging is associated with progressive increase in body fat and a corresponding decline in lean muscle mass. When the decrease in muscle mass reaches a critical threshold, this may affect muscle strength and consequently limit the ability to cope with the activities of daily living, reducing the independence of elders. It is widely accepted to define sarcopenia as the loss of skeletal muscle mass and strength that occurs with advancing age. It is more difficult to establish cut-off points which are clinically relevant. The purpose of this paper is to summarize the definitions of sarcopenia and the assessment tools that can be used in clinical practice. PMID:25962226

  15. Nurses' intention to apply clinical practice guidelines.

    PubMed

    Kogan, Ella; Tabak, Nili

    2012-12-01

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

  16. The Emergence of Clinical Practice Guidelines

    PubMed Central

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

    2007-01-01

    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. PMID:18070334

  17. Clinical practice guideline: tinnitus executive summary.

    PubMed

    Tunkel, David E; Bauer, Carol A; Sun, Gordon H; Rosenfeld, Richard M; Chandrasekhar, Sujana S; Cunningham, Eugene R; Archer, Sanford M; Blakley, Brian W; Carter, John M; Granieri, Evelyn C; Henry, James A; Hollingsworth, Deena; Khan, Fawad A; Mitchell, Scott; Monfared, Ashkan; Newman, Craig W; Omole, Folashade S; Phillips, C Douglas; Robinson, Shannon K; Taw, Malcolm B; Tyler, Richard S; Waguespack, Richard; Whamond, Elizabeth J

    2014-10-01

    The American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Tinnitus. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 13 recommendations developed address the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the impact of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers. PMID:25274374

  18. Self-compassion in clinical practice.

    PubMed

    Germer, Christopher K; Neff, Kristin D

    2013-08-01

    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

  19. Integrating wound care research into clinical practice.

    PubMed

    Ho, Chester H; Bogie, Kath M

    2007-10-01

    The process of integrating wound care research into clinical practice incorporates research methodology--i.e., the standardized practices, procedures, and rules by which research is performed--and an evidence-based approach. Using examples from the literature and clinician experience treating pressure ulcers in a 32-bed regional spinal cord injury unit in a tertiary referral center in Cleveland, Ohio, the authors describe this process and review the challenges faced by an interdisciplinary skin care team tasked with implementing evidence-based care. Additional considerations include determining the amount of current wound care that is evidence-based and whether wound prevention and care outcomes are improved through the use of evidence-based medicine. Five years after establishing the skin care team and implementing evidence-based care, improvements in care processes and short-term outcomes--specifically, pressure ulcer prevention and treatment protocols including documentation--have been realized. Studies to ascertain the effects of these changes on long-term outcomes are planned. PMID:17978411

  20. Clinical Practice Patterns of Canadian Couple/Marital/Family Therapists

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  1. Knowing within: practice wisdom of clinical nurse educators.

    PubMed

    Paton, Brenda I

    2007-11-01

    The challenges nurse educators encounter and respond to while teaching undergraduate students in the clinical area require a unique set of skills and teaching expertise, different from those acquired through classroom teaching. As these educators encounter, make sense of, and move beyond these interruptions, a unique set of understandings and wisdom is acquired. In explicating this wisdom, philosophical literature on practical wisdom, tacit knowledge, smooth activity, and Unready to Hand immersions was accessed. Two layers of interviews were conducted with 9 educators (32 total interviews). An interpretive analysis of these stories elucidated the metaphor of Unready to Hand as Adventure, revealing three domains of practice: Preserving the Ideal, Salvaging Learning, and Sustaining Self. These domains clarify the professional teaching knowledge these educators acquired and offer insight into how one may respond within the everyday encounters that characterize this area of teaching practice. PMID:18019106

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

    PubMed

    Bartel, J C; Buturusis, B

    2000-12-01

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

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

    PubMed Central

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

    2012-01-01

    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). PMID:21811122

  4. Indices of serum tonicity in clinical practice.

    PubMed

    Rohrscheib, Mark; Rondon-Berrios, Helbert; Argyropoulos, Christos; Glew, Robert H; Murata, Glen H; Tzamaloukas, Antonios H

    2015-06-01

    Although disturbances of serum tonicity (effective osmolality) may have dire consequences, only surrogate indices of tonicity are available in practice. This report identifies the appropriate index for expressing clinical states of dystonicity. Serum sodium concentration ([Na]S) and osmolality ([Osm]S) may be incongruent. When the tonicity state shown by [Osm]S is higher than [Na]S and the difference between the 2 indices is caused by an excess of solute that distributes in total body water, tonicity is described by [Na]S. When this difference results from a gain of solute with extracellular distribution like mannitol or a decrease in serum water content, causing a falsely low measurement of [Na]S, [Osm]S accurately reflects tonicity. Two indices of tonicity are applicable during hyperglycemia: the tonicity formula (2 ·[Na]S + [Glucose]S/18) and the corrected [Na]S ([Na]S corrected to a normal [Glucose]S using an empirically derived coefficient). Clinicians should understand the uses and limitations of the tonicity indices. PMID:26002851

  5. Management of sarcoidosis in clinical practice.

    PubMed

    Jeny, Florence; Bouvry, Diane; Freynet, Olivia; Soussan, Michael; Brauner, Michel; Planes, Carole; Nunes, Hilario; Valeyre, Dominique

    2016-06-01

    Sarcoidosis is a systemic disease of unknown cause with very diverse presentation, outcome, severity and need for treatments. While some presentations may be very typical, for many patients, the presentation is nonspecific, with shared associations with other diseases at times being by far more frequent or misleading, which can be a cause of significant delay and often several consultations before a diagnosis of sarcoidosis can be confirmed. This is particularly the case when pulmonary manifestations are in the forefront. The diagnosis relies on three well-known criteria. In clinical practice, these criteria are not easily implemented, particularly by physicians without expertise in sarcoidosis, which can lead to a risk of either under- or over-diagnosis. Qualifying the presentation according to sarcoidosis diagnosis is essential. However, it is often not easy to classify the presentation as typical versus compatible or compatible versus inconsistent. Further investigations are needed before any other hypothesis is to be considered. It is important to detect events and to determine whether or not they are indicative of a flare of sarcoidosis. Eventually, treatment needs to be related to the correct indications. The evaluation of the efficacy and safety of treatments is crucial. To address such issues, we present five emblematic cases that illustrate this. PMID:27246591

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

    PubMed

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

    2013-11-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. There are myriad treatment options for Bell's palsy; some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, there are numerous diagnostic tests available that are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have an unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy. PMID:24190889

  7. Potential uses of probiotics in clinical practice.

    PubMed

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

    2003-10-01

    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. PMID:14557292

  8. Potential Uses of Probiotics in Clinical Practice

    PubMed Central

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

    2003-01-01

    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. PMID:14557292

  9. The practice-unit centered clinical database--the implementation.

    PubMed Central

    Bryner, U. M.

    1991-01-01

    A clinical database system under the name ClinTrac has been developed for the purpose of acquiring, processing, storing, analyzing, and communicating clinical information. The core of this system consists of a practice-unit centered database. PMID:1807752

  10. Sustaining excellence: clinical nurse specialist practice and magnet designation.

    PubMed

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

    2010-01-01

    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

  11. Myeloperoxidase and coronary arterial disease: from research to clinical practice.

    PubMed

    Roman, Raquel Melchior; Wendland, Andrea Elisabet; Polanczyk, Carisi Anne

    2008-07-01

    Myeloperoxidase (MPO) is an enzyme derived of leukocytes that catalyze formation of numerous reactive oxidant species. Besides members of the innate host defense, evidences have been proving the contribution of these oxidants to tissue injury during inflammation. MPO participates in proatherogenic biological activities related to the evolution of cardiovascular disease, including initiation, propagation and acute complications of atherosclerotic process. Thereby, MPO and its inflammatory cascade represents an attractive target for prognostical investigation and therapeutics in atherosclerotic cardiovascular disease. In this review, we present the state of the art in the understanding of biological actions to clinical evidences of the relationship between MPO and coronary arterial disease. Several studies point to the independent effect of MPO levels in the evolution of disease and incidence of events in patients with acute coronary syndrome. However, the additional predictive value of MPO levels in the cardiovascular risk assessment, to incorporate it to the clinical practice as marker of plaque vulnerability, is still not consistent. Additional studies are necessary to confirm its role in the different forms of presentation of ischemic disease, besides the standardization of the assay, fundamental point for transition of this marker from research atmosphere to use in clinical routine: : from laboratory to clinical practice. PMID:18660935

  12. Clinical practice guideline: management of acute pancreatitis

    PubMed Central

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

    2016-01-01

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

  13. Pareto Fronts in Clinical Practice for Pinnacle

    SciTech Connect

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

    2013-03-01

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

  14. Case studies in clinical practice development.

    PubMed

    Chopra, Romi; Lipman, John; Murphy, Timothy P

    2005-03-01

    By asking identical questions of several successful practitioners of clinical interventional radiology, a snapshot of the current and future status of interventional radiology as a clinical discipline is presented. PMID:21326672

  15. Application of Clinical Practice Guidelines for Pain, Agitation, and Delirium.

    PubMed

    Krupp, Anna; Balas, Michele C

    2016-06-01

    Critically ill patients experience several severe, distressing, and often life-altering symptoms during their intensive care unit stay. A clinical practice guideline released by the American College of Critical Care Medicine provides a template for improving the care and outcomes of the critically ill through evidence-based pain, agitation, and delirium assessment, prevention, and management. Key strategies include the use of valid and reliable assessment tools, setting a desired sedation level target, a focus on light sedation, choosing appropriate sedative medications, the use of nonpharmacologic symptom management strategies, and engaging and empowering patients and their family to play an active role in their intensive care unit care. PMID:27215361

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

    ERIC Educational Resources Information Center

    Hunter, Jerry L.; Snyder, Frank

    1980-01-01

    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)

  17. Learning Styles of Radiography Students during Clinical Practice

    ERIC Educational Resources Information Center

    Ward, L. Patrice

    2009-01-01

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

  18. Defining Clinical Excellence in Adult Infectious Disease Practice

    PubMed Central

    Chida, Natasha M.; Ghanem, Khalil G.; Auwaerter, Paul G.; Wright, Scott M.; Melia, Michael T.

    2016-01-01

    Clinical excellence should be recognized, particularly in the current climate that appropriately prioritizes relationship-centered care. In order to develop a recognition model, a definition of clinical excellence must be created and agreed upon. A paradigm recently suggested by C. Christmas describes clinical excellence through the following domains: diagnostic acumen, professionalism and humanism, communication and interpersonal skills, skillful negotiation of the healthcare system, knowledge, taking a scholarly approach to clinical practice, and having passion for clinical medicine. This work references examples of infectious disease (ID) clinical excellence across Christmas' domains and, in doing so, both examines how the definition of clinical excellence applies to ID practice and highlights the importance of ID physicians. Emphasizing such aspirational standards may not only inspire trainees and practicing physicians to pursue their own fulfilling clinical ID careers, it may also encourage health systems to fully value outstanding ID physicians who labor tirelessly to provide patients with exceptional care. PMID:27419186

  19. Defining Clinical Excellence in Adult Infectious Disease Practice.

    PubMed

    Chida, Natasha M; Ghanem, Khalil G; Auwaerter, Paul G; Wright, Scott M; Melia, Michael T

    2016-09-01

    Clinical excellence should be recognized, particularly in the current climate that appropriately prioritizes relationship-centered care. In order to develop a recognition model, a definition of clinical excellence must be created and agreed upon. A paradigm recently suggested by C. Christmas describes clinical excellence through the following domains: diagnostic acumen, professionalism and humanism, communication and interpersonal skills, skillful negotiation of the healthcare system, knowledge, taking a scholarly approach to clinical practice, and having passion for clinical medicine. This work references examples of infectious disease (ID) clinical excellence across Christmas' domains and, in doing so, both examines how the definition of clinical excellence applies to ID practice and highlights the importance of ID physicians. Emphasizing such aspirational standards may not only inspire trainees and practicing physicians to pursue their own fulfilling clinical ID careers, it may also encourage health systems to fully value outstanding ID physicians who labor tirelessly to provide patients with exceptional care. PMID:27419186

  20. Ichthyosis: clinical manifestations and practical treatment options.

    PubMed

    Oji, Vinzenz; Traupe, Heiko

    2009-01-01

    Ichthyoses constitute a large group of cornification disorders that affect the entire integument. The skin is characterized by visible scaling and in many cases by inflammation, for example, in bullous/keratinopathic ichthyosis or Netherton syndrome. From the viewpoint of classification it is useful to distinguish non-syndromic from syndromic types of ichthyosis. Ichthyosis vulgaris and recessive X-linked ichthyosis are common disorders - often of delayed onset, in contrast to congenital ichthyoses, which belong to the group of rare diseases and present at birth with either the features of collodion membrane or congenital ichthyosiform erythroderma. The diagnostic steps are based on clinical data, analyses such as the steroid sulfatase activity test, skin biopsies, and genetic results. However, the dramatic increase in knowledge about the pathophysiology of these conditions has not led to a curative therapy so far. The therapeutic management is multidisciplinary and involves ichthyosis patient organizations in many countries. The mainstay of treatment remains with moisturizing creams containing, for example, urea, lactic acid and other humectants and keratolytics, regular bathing, and mechanical scale removal. Patients with lamellar ichthyosis or ichthyosiform erythroderma in particular profit from oral therapy with retinoids or retinoic acid metabolism-blocking agents. PMID:19824737

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

    PubMed

    Osorio, Lyda

    2015-06-01

    An increasing number of countries are adopting good clinical practices guidelines as part of the regulation of clinical studies to register pharmaceutical products and other health-related products. Consequently, all parties involved in the research and development of these products should know them, implement them and ensure their compliance. However, good clinical practices guidelines are just one of the initiatives seeking to achieve the highest ethical and scientific standards in health research and in other areas where humans are research subjects. This review defines such practices and their objectives presenting in a practical manner their legal framework in Colombia, and clarifying their application in studies where interventions use no medications or those that are not clinical trials. Finally, the work discusses the challenges to ensure that good clinical practices contribute to the protection of research participants, the education of trustworthy health professionals, and a culture of respect for human beings. PMID:26535550

  2. The clinical practice developmental model: the transition process.

    PubMed

    Nuccio, S A; Lingen, D; Burke, L J; Kramer, A; Ladewig, N; Raaum, J; Shearer, B

    1996-12-01

    The authors report their hospital's experience in replicating Benner's novice-to-expert clinical nursing practice model, called the Clinical Practice Developmental Model. The authors describe the outcomes of an exploratory, qualitative study conducted to understand staff nurses' perceptions of their transition experience from a traditional clinical ladder for advancement and recognition to the theoretically based clinical practice developmental model. The findings of this study identify critical factors that influenced nurses' perceptions and describe positive and negative outcomes of transition. Specific recommendations to facilitate organizational changes for the nurse executive and the individual nurse are discussed. PMID:8968322

  3. Schools as Clinics: Learning about Practice in Practice

    ERIC Educational Resources Information Center

    Hands, Robin; Rong, Yuhang

    2014-01-01

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

  4. inPractice: A Practical Nursing Package for Clinical Decisions

    ERIC Educational Resources Information Center

    Ip, Barry; Cavanna, Annlouise; Corbett, Beverley

    2005-01-01

    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…

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

    PubMed

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

    2007-11-01

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

  6. Current clinical practices in stroke rehabilitation: regional pilot survey.

    PubMed

    Natarajan, Pradeep; Oelschlager, Ashley; Agah, Arvin; Pohl, Patricia S; Ahmad, S Omar; Liu, Wen

    2008-01-01

    This study was aimed at understanding the current physical and occupational therapy practices in stroke rehabilitation in the Midwest. The insights gained from this pilot study will be used in a future study aimed at understanding stroke rehabilitation practices across the nation. Researchers and clinicians in the field of stroke rehabilitation were interviewed, and past studies in the literature were analyzed. Through these activities, we developed a 37-item questionnaire that was sent to occupational and physical therapists practicing in Kansas and Missouri who focus on the care of people who have had a stroke (n = 320). A total of 107 respondents returned a com pleted questionnaire, which gives a response rate of about 36%. The majority of respondents had more than 12 years of experience treating patients with stroke. Consensus of 70% or more was found for 80% of the items. The preferred approaches for the rehabilitation of people who have had a stroke are the Bobath and Brunnstrom methods, which are being used by 93% and 85% of the physical and occupational therapists, respectively. Even though some variability existed in certain parts of the survey, in general clinicians agreed on different treatment approaches in issues dealing with muscle tone, weakness, and limited range of motion in stroke rehabilitation. Some newer treatment approaches that have been proven to be effective are practiced only by a minority of clinicians. The uncertainty among clinicians in some sections of the survey reveals that more evidence on clinical approaches is needed to ensure efficacious treatments. PMID:19009470

  7. Good documentation practice in clinical research

    PubMed Central

    Bargaje, Chitra

    2011-01-01

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

  8. Implications of Look AHEAD for Clinical Trials and Clinical Practice

    PubMed Central

    Wing, Rena R.

    2014-01-01

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

  9. ‘Indirect’ challenges from science to clinical practice

    PubMed Central

    Anderson, Sandra D.

    2016-01-01

    Indirect challenges act to provoke bronchoconstriction by causing the release of endogenous mediators and are used to identify airway hyper-responsiveness. This paper reviews the historical development of challenges, with exercise, eucapnic voluntary hyperpnoea (EVH) of dry air, wet hypertonic saline, and with dry powder mannitol, that preceded their use in clinical practice. The first challenge developed for clinical use was exercise. Physicians were keen for a standardized test to identify exercise-induced asthma (EIA) and to assess the effect of drugs such as disodium cromoglycate. EVH with dry air became a surrogate for exercise to increase ventilation to very high levels. A simple test was developed with EVH and used to identify EIA in defence force recruits and later in elite athletes. The research findings with different conditions of inspired air led to the conclusion that loss of water by evaporation from the airway surface was the stimulus to EIA. The proposal that water loss caused a transient increase in osmolarity led to the development of the hypertonic saline challenge. The wet aerosol challenge with 4.5% saline, provided a known osmotic stimulus, to which most asthmatics were sensitive. To simplify the osmotic challenge, a dry powder of mannitol was specially prepared and encapsulated. The test pack with different doses and an inhaler provided a common operating procedure that could be used at the point of care. All these challenge tests have a high specificity to identify currently active asthma. All have been used to assess the benefit of treatment with inhaled corticosteroids. Over the 50 years, the methods for testing became safer, less complex, and less expensive and all used forced expiratory volume in 1 sec to measure the response. Thus, they became practical to use routinely and were recommended in guidelines for use in clinical practice. PMID:26908255

  10. Electronic patient-reported outcome systems in oncology clinical practice.

    PubMed

    Bennett, Antonia V; Jensen, Roxanne E; Basch, Ethan

    2012-01-01

    Patient-reported outcome (PRO) questionnaires assess topics a patient can report about his or her own health. This includes symptoms (eg, nausea, fatigue, diarrhea, pain, or frequent urination), physical functioning (eg, difficulty climbing stairs or difficulty fastening buttons), and mental health (eg, anxiety, fear, or worry). Electronic PRO (ePRO) systems are used in oncology clinical care because of 1) their ability to enhance clinical care by flagging important symptoms and saving clinicians time; 2) the availability of standardized methods for creating and implementing PROs in clinics; and 3) the existence of user-friendly platforms for patient self-reporting like tablet computers and automated telephone surveys. Many ePRO systems can provide actionable links to clinical care such as summary reports in a patient's electronic medical record and real-time e-mail alerts to providers when patients report acute needs. This review presents 5 examples of ePRO systems currently in use in oncology practice. These systems support multiple clinical activities, including assessment of symptoms and toxicities related to chemotherapy and radiation, postoperative surveillance, and symptom management during palliative care and hospice. Patient self-reporting is possible both at clinical visits and between visits over the Internet or by telephone. The implementation of an ePRO system requires significant resources and expertise, as well as user training. ePRO systems enable regular monitoring of patient symptoms, function, and needs, and can enhance the efficiency and quality of care as well as communication with patients. PMID:22811342

  11. Assisting students to prepare for a clinical practice placement.

    PubMed

    Miller, Sam Louise

    2014-12-15

    All students undertaking a nursing programme are required to complete clinical practice placements. These placement hours are an essential component of the training necessary to join the Nursing and Midwifery Council register and to practise as a nurse. Clinical practice placements can be stressful for students, and this can compromise their learning. Thorough preparation by the student and an understanding of the change in learning environment that accompanies a placement can reduce anxiety and improve the learning experience. This article describes the preparations a student can make to ensure a successful and educational clinical practice placement. PMID:25492792

  12. Clinical teaching and support for learners in the practice environment.

    PubMed

    McBrien, Barry

    The purpose of planned clinical experience for students of nursing is primarily to provide students with the opportunity to develop their clinical skills, integrate theory and practice, and assist with their socialization into nursing. Nursing, in the main, is a practice-based profession. To this extent, it is essential that nurse education continues to have a strong practical element despite its full integration into higher education institutions (Department of Health, 1999). However, providing adequate support and supervision for learners is challenging. Undoubtedly, exacerbated by increasing numbers of learners, staff shortages and mentors training deficits. This article aims to critically analyse several strategies, which can be used to promote clinical learning. PMID:16835544

  13. [Nonconvulsive status epilepticus: clinical practice and pathophysiology].

    PubMed

    Nagayama, Masao

    2013-05-01

    The clinical spectrum of nonconvulsive status epilepticus (NCSE) is rapidly expanding from classical manifestations, such as staring, repetitive blinking, chewing, swallowing, and automatism to novel manifestations, such as acute and protracted coma, apnea, cognitive impairment, higher brain dysfunction, and cardiac arrest. It is only in the last decade that these novel NCSE manifestations have been revealed, which is certainly reflective of modern advances in critical care neurology, such as the introduction and spread of continuous electroencephalography (cEEG) monitoring. Although NCSE is a relatively frequent, treatable condition but with a high mortality rate, physicians are still unfamiliar with its clinical manifestations, thus leading to underdiagnosis. In this review, the clinical manifestations, epidemiology, diagnosis, and management of NCSE are critically described using the best available evidence and perspectives, including my hypothesis on epileptic organ dysfunction; in particular, the possible causal relationship between NCSE and cardiac arrhythmia, such as atrial fibrillation is also discussed. PMID:23667121

  14. Clinical profile and practice experience of almotriptan.

    PubMed

    Gendolla, A

    2004-01-01

    Patients expect their acute migraine treatment to have a rapid onset of action, achieve complete pain relief that is sustained for 24 h, and to have a good tolerability profile. Almotriptan has a favourable pharmacokinetic profile that translates clinically to a rapid onset of action and consistent absorption regardless of age, sex, food intake and status of the acute migraine attack. In addition, almotriptan is not associated with any clinically relevant drug-drug interactions. Pain-free status at 2 h postdose is achieved by approximately 39% of patients receiving almotriptan in clinical trials. Recurrence of headaches within 24 h is low with almotriptan (<22%). Almotriptan has a sustained pain-free rate of 25-27%, which in a meta-analysis of triptans was superior to sumatriptan 100 mg. Almotriptan therapy is associated with a low incidence of adverse events, including those affecting the central nervous system and chest. PMID:15595990

  15. Neurobiology of Addictions: Implications for Clinical Practice.

    ERIC Educational Resources Information Center

    Spence, Richard T., Ed.; DiNitto, Diana M., Ed.; Straussner, Shulamith Lala Ashenberg, Ed.

    This book offers helping professionals an introduction to the neurobiological aspects of substance abuse. It presents the basic information on the subject, including the various neurobiological theories of addiction, and places them in a psychosocial context. In addition to connecting the theoretical information with practical applications, the…

  16. Pharmacy Administration and Clinical Practice Research Agenda.

    ERIC Educational Resources Information Center

    Hepler, Charles D.

    1987-01-01

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

  17. Recognizing Primary Immune Deficiency in Clinical Practice

    PubMed Central

    Yarmohammadi, Hale; Estrella, Lissette; Doucette, John; Cunningham-Rundles, Charlotte

    2006-01-01

    Primary immunodeficiency results in recurrent infections, organ dysfunction, and autoimmunity. We studied 237 patients referred for suspicion of immunodeficiency, using a scoring system based on clinical information. The 113 patients with immunodeficiency had higher scores and more episodes of chronic illnesses and were more likely to have neutropenia, lymphopenia, or splenomegaly. PMID:16522773

  18. Triptan nonresponder studies: implications for clinical practice.

    PubMed

    Dodick, David W

    2005-02-01

    The maximum absolute response rate with oral triptans, as measured in clinical trials by the incidence of relief from migraine pain at 2 hours after taking medication, is approximately 70%. Therefore around 30% of patients fail to respond to a particular triptan. Nonresponse is likely to be due to a variety of factors, including low and inconsistent absorption, use of the medication late in an attack, inadequate dosing, and variability in individual response. Evidence from recent clinical trials, however, confirms the common clinical observation that patients with a poor response to one triptan can benefit from subsequent treatment with a different triptan. Two-hour pain-relief rates of 25% to 81% using alternative triptans (naratriptan, almotriptan, eletriptan, zolmitriptan, and rizatriptan) have been reported in patients who were described as poor responders to sumatriptan. Physicians should remain vigilant in assessing the response to acute therapy and take advantage of simple clinical questionnaires that have been developed to facilitate the recognition of those patients who require and may benefit from a change in acute therapy. PMID:15705122

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

    ERIC Educational Resources Information Center

    Apel, Kenn

    2014-01-01

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

  20. Practicing nurses perspectives of clinical scholarship: a qualitative study

    PubMed Central

    2013-01-01

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

  1. Using evidence-based practice for managing clinical outcomes in advanced practice nursing.

    PubMed

    Glanville, I; Schirm, V; Wineman, N M

    2000-10-01

    Preparation of advanced practice nurses to assume leadership positions for clinical decision making requires that traditional ways of solving clinical problems be augmented with information from relevant, research-derived evidence. In this article, the authors describe how one graduate program prepares advanced practice nurses to use the best scientific evidence with clinical expertise to influence patient outcomes. The assignments that students complete in their program provide examples of evidence-based practice that apply quality improvement principles and science-based nursing interventions to create best practices. PMID:11008434

  2. Novel ethical dilemmas arising in geriatric clinical practice.

    PubMed

    Calleja-Sordo, Elisa Constanza; de Hoyos, Adalberto; Méndez-Jiménez, Jorge; Altamirano-Bustamante, Nelly F; Islas-Andrade, Sergio; Valderrama, Alejandro; García-Peña, Carmen; Altamirano-Bustamante, Myriam M

    2015-05-01

    The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel-patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients' life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population. PMID:25185872

  3. Orienting Nursing Students to Cost Effective Clinical Practice.

    ERIC Educational Resources Information Center

    Lessner, Muriel W.; And Others

    1994-01-01

    Describes five principles for cost-effective clinical practice: efficient use of self, efficient use of equipment and supplies, delegation of work, critical path method, and organization of the environment. (SK)

  4. Clinical practice beyond science: debunking the scientific myth.

    PubMed

    Halasz, G

    1994-03-01

    The theme of the RANZCP 28th Conference questioned the science of clinical practice. This question is explored in the light of prevailing paradigms of 20th century psychiatry and recent claims by scientism, especially biologism, that assumes an organic causation for all abnormal behaviour. It is argued that a paradigm of objective science is necessary to understanding many aspects of mental illness, but not sufficient to explain certain essential phenomena, such as altered states of consciousness and empathy, encounted daily in clinical practice. Discarding these phenomena in the name of "science" runs the risk of clinical practice becoming "mindless". The "reconquest of the subjective" is offered as a way to extend clinical practice beyond objective science. PMID:8067971

  5. A Postdoctoral Fellowship in Industrial Clinical Pharmacy Practice.

    ERIC Educational Resources Information Center

    Barone, Joseph; And Others

    1985-01-01

    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

  6. Evaluating clinical dermatology practice in medical undergraduates.

    PubMed

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

    2014-06-01

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

  7. [Hypnotic communication and hypnosis in clinical practice].

    PubMed

    Wehrli, Hans

    2014-07-01

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

  8. Psychodermatology in Clinical Practice: Main Principles.

    PubMed

    Marshall, Claire; Taylor, Ruth; Bewley, Anthony

    2016-08-23

    Psychodermatology is a newer and emerging subspecialty of dermatology, which bridges psychiatry, psychology, paediatrics and dermatology. It has become increasingly recognised that the best outcomes for patients with psychodermatological disease is via a multidisciplinary psychodermatology team. The exact configuration of the multidisciplinary team is, to some extent, determined by local expertise. In addition there is a growing body of evidence that it is much more cost effective to manage patients with psychodermatological disease in dedicated psychodermatology clinics. Even so, despite this evidence, and the demand from patients (and patient advocacy groups), the delivery and establishment of psychodermatology services is very sporadic globally. Clinical and academic expertise in psychodermatology is emerging in dermatology and other (often peer-reviewed) literature. Organisations such as the European Society for Dermatology and Psychiatry champion clinical and academic advances in psychodermatology, whist also enabling training of health care professionals in psychodermatology. Emiliano Panconesi, to whom this supplement is dedicated, was at the forefront of psychodermatology research and was a founding member of ESDaP. PMID:27283859

  9. Rethinking the Role of Clinical Practice Guidelines in Pharmacy Education

    PubMed Central

    2015-01-01

    Clinical practice guidelines (CPGs) play a major role in pharmacy education. Students learn to locate, retrieve, and apply CPGs in didactic coursework and practice experiences. However, they often memorize and quote recommendations without critical analysis, which tends to undermine their clinical growth. Students should become genuine drug experts, based on strong critical-thinking skills and the ability to assimilate extensive clinical and scientific knowledge. Clinical practice guidelines improve health care, and students should be familiar with them, but there are legitimate criticisms of CPGs, stemming largely from potential conflicts of interest and limitations in the quality and scope of available evidence. Despite such flaws, CPGs can be used to facilitate the clinical growth of students if the emphasis is placed on critically analyzing and evaluating CPG recommendations, as opposed to blindly accepting them. From that perspective, the role that CPGs have come to play in education may need to be reconsidered. PMID:26889060

  10. Rethinking the Role of Clinical Practice Guidelines in Pharmacy Education.

    PubMed

    Brown, Daniel L

    2015-12-25

    Clinical practice guidelines (CPGs) play a major role in pharmacy education. Students learn to locate, retrieve, and apply CPGs in didactic coursework and practice experiences. However, they often memorize and quote recommendations without critical analysis, which tends to undermine their clinical growth. Students should become genuine drug experts, based on strong critical-thinking skills and the ability to assimilate extensive clinical and scientific knowledge. Clinical practice guidelines improve health care, and students should be familiar with them, but there are legitimate criticisms of CPGs, stemming largely from potential conflicts of interest and limitations in the quality and scope of available evidence. Despite such flaws, CPGs can be used to facilitate the clinical growth of students if the emphasis is placed on critically analyzing and evaluating CPG recommendations, as opposed to blindly accepting them. From that perspective, the role that CPGs have come to play in education may need to be reconsidered. PMID:26889060

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

    PubMed

    Zhang, Y; Liu, X J

    2016-04-01

    Digital medical technologies or computer aided medical procedures, refer to imaging, 3D reconstruction, virtual design, 3D printing, navigation guided surgery and robotic assisted surgery techniques. These techniques are integrated into conventional surgical procedures to create new clinical protocols that are known as "digital surgical techniques". Conventional health care is characterized by subjective experiences, while digital medical technologies bring quantifiable information, transferable data, repeatable methods and predictable outcomes into clinical practices. Being integrated into clinical practice, digital techniques facilitate surgical care by improving outcomes and reducing risks. Digital techniques are becoming increasingly popular in trauma surgery, orthopedics, neurosurgery, plastic and reconstructive surgery, imaging and anatomic sciences. Robotic assisted surgery is also evolving and being applied in general surgery, cardiovascular surgery and orthopedic surgery. Rapid development of digital medical technologies is changing healthcare and clinical practices. It is therefore important for all clinicians to purposefully adapt to these technologies and improve their clinical outcomes. PMID:27117211

  12. Critical appraisal in clinical practice: sometimes irrelevant, occasionally invalid.

    PubMed

    Coomarasamy, A; Latthe, P; Papaioannou, S; Publicover, M; Gee, H; Khan, K S

    2001-11-01

    A core activity of evidence-based practice is the search for and appraisal of evidence on specific clinical issues. Clinicians vary in their competence in this process; we therefore developed a 16-item checklist for quality of content (relevance and validity) and presentation (useability, attribution, currency and contact details). This was applied to a set of 55 consecutive appraisals conducted by clinicians and posted at a web-based medical journal club site. Questions were well formulated in 51/55 (92%) of the appraisals. However, 22% of appraisals missed the most relevant articles to answer the clinical question. Validity of articles was well appraised, with methodological information and data accurately extracted in 84% and accurate conversion to clinically meaningful summary statistics in 87%. The appraisals were presented in a useable way with appropriate and clear bottom-lines stated in 95%. The weakest link in production of good-quality critical appraisals was identification of relevant articles. This should be a focus for evidence-based medicine and critical appraisal skills. PMID:11691894

  13. Critical appraisal in clinical practice: sometimes irrelevant, occasionally invalid

    PubMed Central

    Coomarasamy, Aravinthan; Latthe, Pallavi; Papaioannou, Spyros; Publicover, Mary; Gee, Harry; Khan, Khalid S

    2001-01-01

    A core activity of evidence-based practice is the search for and appraisal of evidence on specific clinical issues. Clinicians vary in their competence in this process; we therefore developed a 16-item checklist for quality of content (relevance and validity) and presentation (useability, attribution, currency and contact details). This was applied to a set of 55 consecutive appraisals conducted by clinicians and posted at a web-based medical journal club site. Questions were well formulated in 51/55 (92%) of the appraisals. However, 22% of appraisals missed the most relevant articles to answer the clinical question. Validity of articles was well appraised, with methodological information and data accurately extracted in 84% and accurate conversion to clinically meaningful summary statistics in 87%. The appraisals were presented in a useable way with appropriate and clear bottom-lines stated in 95%. The weakest link in production of good-quality critical appraisals was identification of relevant articles. This should be a focus for evidence-based medicine and critical appraisal skills. PMID:11691894

  14. Multidisciplinary Management of Hepatocellular Carcinoma in Clinical Practice

    PubMed Central

    Cannita, Katia; Giordano, Aldo Victor; Manetta, Rosa; Vicentini, Roberto; Carducci, Sergio; Saltarelli, Patrizia; Iapadre, Nerio; Coletti, Gino; Ficorella, Corrado; Ricevuto, Enrico

    2014-01-01

    Background. Hepatocellular carcinoma (HCC) patients require different treatment strategies according to disease extension, liver function, and patient's fitness. We evaluated HCC multidisciplinary management in clinical practice. Methods. Consecutive patients were followed and treated with tailored medical, locoregional, and surgical treatments, according to disease stage and patient's fitness (age, Cumulative Illness Rating Scale (CIRS)). Activity, efficacy, and safety were evaluated. Results. Thirty-eight patients were evaluated: median age, 74; elderly 92%; CIRS secondary 28 (74%); Child-Pugh A 20 (53%), B 11 (29%); and Barcelona Clinic Liver Cancer (BCLC) 0 2 (5%), A 9 (24%), B 10 (26%), C 13 (34%), and D 4 (11%). Overall survival (OS) was 30 months. At 9 months median follow-up, among 25 unresectable HCC, OS was 10 months; BCLC B–D unfit for sorafenib showed OS 3 months. Ten patients (40%) received sorafenib: Child-Pugh A 5 (50%) and B 5 (50%) and disease control rate 89%, progression-free survival 7 months, and OS 9 months. G3-4 toxicities: anorexia, hypertransaminaemia, hyperbilirubinemia, and hypercreatininemia. Limiting toxicity syndromes were 40%, all multiple sites. Conclusion. HCC patients require multidisciplinary clinical management to properly select tailored treatments according to disease stage, fitness, and liver function. Patients suitable for sorafenib should be carefully selected, monitored for individual safety, and prevalently characterized by limiting toxicity syndromes multiple sites. PMID:24900987

  15. An Internet Portal for the Development of Clinical Practice Guidelines

    PubMed Central

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

    2010-01-01

    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. PMID:23616852

  16. Children with Phonological Problems: A Survey of Clinical Practice

    ERIC Educational Resources Information Center

    Joffe, Victoria; Pring, T.

    2008-01-01

    Background: Children with phonological problems are a significant proportion of many therapists' caseloads. However, little is known about current clinical practice with these children or whether research on the effects of therapy have influenced this practice. Aims: To investigate the methods of assessment and remediation used by therapists…

  17. Characteristics and Clinical Practices of Rural Marriage and Family Therapists

    ERIC Educational Resources Information Center

    Morris, James

    2007-01-01

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

  18. Clinical practice guideline: tonsillitis II. Surgical management.

    PubMed

    Windfuhr, Jochen P; Toepfner, Nicole; Steffen, Gregor; Waldfahrer, Frank; Berner, Reinhard

    2016-04-01

    In 2013, a total of 84,332 patients had undergone extracapsular tonsillectomies (TE) and 11,493 a tonsillotomy (TT) procedure in Germany. While the latter is increasingly performed, the number of the former is continually decreasing. However, a constant number of approximately 12,000 surgical procedures in terms of abscess-tonsillectomies or incision and drainage are annually performed in Germany to treat patients with a peritonsillar abscess. The purpose of this part of the clinical guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through the surgical treatment options to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical treatment options encompass intracapsular as well as extracapsular tonsil surgery and are related to three distinct entities: recurrent episodes of (1) acute tonsillitis, (2) peritonsillar abscess and (3) infectious mononucleosis. Conservative management of these entities is subject of part I of this guideline. (1) The quality of evidence for TE to resolve recurrent episodes of tonsillitis is moderate for children and low for adults. Conclusions concerning the efficacy of TE on the number of sore throat episodes per year are limited to 12 postoperative months in children and 5-6 months in adults. The impact of TE on the number of sore throat episodes per year in children is modest. Due to the heterogeneity of data, no firm conclusions on the effectiveness of TE in adults can be drawn. There is still an urgent need for further research to reliably estimate the value of TE compared to non-surgical therapy of tonsillitis/tonsillo-pharyngitis. The impact of TE on quality of life is considered as being positive, but further research is mandatory to establish appropriate inventories and standardized evaluation procedures, especially in children. In contrast to TE, TT or comparable procedures are characterized by a substantially lower postoperative

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

    PubMed

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

    2013-05-01

    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

  20. Clinical review: Checklists - translating evidence into practice

    PubMed Central

    2009-01-01

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

  1. Literature and medicine: contributions to clinical practice.

    PubMed

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

    1995-04-15

    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

  2. Sports Neurology in Clinical Practice: Case Studies.

    PubMed

    Seifert, Tad

    2016-08-01

    With regard to persistent posttraumatic headache, there is legitimate concern that duration of symptoms may have an impact on the efficacy of future treatment attempts. Without neuropathologic confirmation, a clinical diagnosis of chronic traumatic encephalopathy cannot be made with a high degree of confidence. Sport-related headaches are challenging in a return-to-play context, because it is often unclear whether an athlete has an exacerbation of a primary headache disorder, has new-onset headache unrelated to trauma, or is in the recovery phase after concussion. Regular physical exercise may prove beneficial to multiple neurologic disease states. PMID:27445251

  3. The practice of humanitarianism: a village birthing clinic in Palestine.

    PubMed

    Wick, Livia

    2011-01-01

    Discourses and practices surrounding humanitarian organisations have changed over time. This is certainly the case for Palestinian non-governmental organisations, which have followed the structural and ideological transformations observed in local, regional and international contexts. There have been three successive but interlocking generations of groups active in health in Palestine: charitable societies, popular committees, and donor-based entities. Against this background, a village clinic in the West Bank is seen to have gone through various incarnations in the context of an emerging neo-liberal economic, administrative and political environment. Despite the critiques justifiably addressed towards them, non-governmental organisations may in some cases be functionally fluid. Communities and people continue to use them strategically in their relations with states, political groups, individuals and receivers of aid, making them potential networking sites in the context of an ongoing occupation. PMID:24735467

  4. A manifesto for clinical pharmacology from principles to practice

    PubMed Central

    Aronson, Jeffrey K

    2010-01-01

    1 This is a manifesto for UK clinical pharmacology. 2 A clinical pharmacologist is a medically qualified practitioner who teaches, does research, frames policy, and gives information and advice about the actions and proper uses of medicines in humans and implements that knowledge in clinical practice. Those without medical qualifications who practise some aspect of clinical pharmacology could be described as, say, ‘applied pharmacologists’. 3 Clinical pharmacology is operationally defined as a translational discipline in terms of the basic tools of human pharmacology (e.g. receptor pharmacology) and applied pharmacology (e.g. pharmacokinetics) and how they are used in drug discovery and development and in solving practical therapeutic problems in individuals and populations. 4 Clinical pharmacologists are employed by universities, health-care services, private organizations (such as drug companies), and regulatory agencies. They are • mentors and teachers, teaching laboratory science, clinical science, and all aspects of practical drug therapy as underpinned by the science of pharmacology; they write and edit didactic and reference texts; • researchers, covering research described by the operational definition; • clinicians, practising general medicine, clinical toxicology, other medical specialties, and general practice; • policy makers, framing local, national, and international medicines policy, including formularies, licensing of medicines and prescribing policies. 5 The future of clinical pharmacology depends on the expansion and maintenance of a central core of practitioners (employed by universities or health-care services), training clinical pharmacologists to practise in universities, health-care services, private organizations, and regulatory agencies, and training other clinicians in the principles and practice of clinical pharmacology. PMID:20642541

  5. Improving Clinical Practices for Children with Language and Learning Disorders

    ERIC Educational Resources Information Center

    Kamhi, Alan G.

    2014-01-01

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

  6. Nutritional aspects of detoxification in clinical practice.

    PubMed

    Cline, John C

    2015-01-01

    Detoxification is a vital cellular task that, if lacking, can lead to early morbidity and mortality. The process of detoxification involves the mobilization, biotransformation, and elimination of toxicants of exogenous and endogenous origin. This article discusses the phase I and phase II detoxification and biotransformation pathways and promotes using food to support these highly complex processes. The author identifies the comprehensive elimination diet as a useful therapeutic tool for clinicians and patients to use to achieve detoxification. Using this diet, the patient removes the most common allergenic foods and beverages from the diet and replaces them with nonallergenic choices for a period of 4 wk, gradually adding back the eliminated foods and observing their effects. Another effective clinical tool that the author discusses is the detox-focused core food plan, which identifies the variety of foods required to supply key nutrients that can maximize the effectiveness of detoxification. Finally, the author provides a case study in which these tools were used to help a patient suffering from major, debilitating illnesses that resulted from exposure to malathion, including severe vomiting and diarrhea, headaches, night sweats, severe arthralgias and myalgias, episcleritis, and shortness of breath. The article details the interventions used and the clinical results (ie, successful resolution of most issues after 3 mo). PMID:26026145

  7. [Hand-held echocardiography in clinical practice].

    PubMed

    Mondillo, Sergio; Galderisi, Maurizio

    2005-05-01

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

  8. Optical coherence tomography: potentialities in clinical practice

    NASA Astrophysics Data System (ADS)

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

    2004-08-01

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

  9. Clinical practice: Helicobacter pylori infection in childhood.

    PubMed

    Ertem, Deniz

    2013-11-01

    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

  10. Clinical Practice Guideline for Vitamin D

    NASA Technical Reports Server (NTRS)

    Tarver, William J.

    2013-01-01

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

  11. Biosimilar safety considerations in clinical practice.

    PubMed

    Choy, Edwin; Jacobs, Ira Allen

    2014-02-01

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

  12. Machine learning on Parkinson's disease? Let's translate into clinical practice.

    PubMed

    Cerasa, Antonio

    2016-06-15

    Machine learning techniques represent the third-generation of clinical neuroimaging studies where the principal interest is not related to describe anatomical changes of a neurological disorder, but to evaluate if a multivariate approach may use these abnormalities to predict the correct classification of previously unseen clinical cohort. In the next few years, Machine learning will revolutionize clinical practice of Parkinson's disease, but enthusiasm should be turned down before removing some important barriers. PMID:26743974

  13. Digital clinical records and practice administration in primary dental care.

    PubMed

    Wagner, I-V; Ireland, R S; Eaton, K A

    2008-04-12

    Usually, a 'computerised dental practice' has included a series of diagnostic instruments, intra-oral cameras, digital radiographic systems, treatment planning systems, CAD-CAM systems, management systems etc. However, these 'island solutions' have not been integrated into one system. Nevertheless, it is possible to produce fully integrated systems for digital clinical records, based on established physiologic and cognitive-ergonomic concepts. The first part of this paper outlines the philosophy behind the development of such a totally integrated system for digital clinical records. The second--digital practice administration--considers how the 'digital revolution' has impacted upon practice administration. PMID:18408689

  14. The philosophy of clinical practice guidelines: purposes, problems, practicality and implementation.

    PubMed

    Hutchinson, A

    1998-03-01

    There are a number of technical and professional challenges to the use of clinical practice guidelines in the United Kingdom. Until recently, many guidelines have been consensus-based rather than being explicitly linked to evidence of effectiveness and have also been of variable quality. Moreover, clarity of purpose has been lacking with some guidelines being developed as a means of limiting access to secondary care rather than as a means of assisting clinical decision-making. Implementation of new research into practice and of clinical practice guideline recommendations shares many of the same barriers to changing clinician behaviour. Without local support systems to assist with implementation, including clinical audit programmes and methods of feeding back information on current practice, it is unlikely that guidelines will change practice in the majority of clinicians. Progress on the implementation of guidelines in the British National Health Service is discussed. PMID:9563563

  15. Ketamine use in current clinical practice.

    PubMed

    Gao, Mei; Rejaei, Damoon; Liu, Hong

    2016-07-01

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

  16. Ketamine use in current clinical practice

    PubMed Central

    Gao, Mei; Rejaei, Damoon; Liu, Hong

    2016-01-01

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

  17. Canadian Clinical Practice Guidelines for Rosacea.

    PubMed

    Asai, Yuka; Tan, Jerry; Baibergenova, Akerke; Barankin, Benjamin; Cochrane, Chris L; Humphrey, Shannon; Lynde, Charles W; Marcoux, Danielle; Poulin, Yves; Rivers, Jason K; Sapijaszko, Mariusz; Sibbald, R Gary; Toole, John; Ulmer, Marcie; Zip, Catherine

    2016-09-01

    Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review "Interventions in Rosacea" was used as a source of clinical trial evidence on which to base the recommendations. PMID:27207355

  18. Cars, CONSORT 2010, and clinical practice.

    PubMed

    Williams, Hywel C

    2010-01-01

    Just like you would not buy a car without key information such as service history, you would not "buy" a clinical trial report without key information such as concealment of allocation. Implementation of the updated CONSORT 2010 statement enables the reader to see exactly what was done in a trial, to whom and when. A fully "CONSORTed" trial report does not necessarily mean the trial is a good one, but at least the reader can make a judgement. Clear reporting is a pre-requisite for judgement of study quality. The CONSORT statement evolves as empirical research moves on. CONSORT 2010 is even clearer than before and includes some new items with a particular emphasis on selective reporting of outcomes. The challenge is for everyone to use it. PMID:20334635

  19. In search of the good: narrative reasoning in clinical practice.

    PubMed

    Mattingly, C

    1998-09-01

    Based on ethnographic work among North American occupational therapists, I compare two forms of everyday clinical talk. One, "chart talk," conforms to normative conceptions of clinical rationality. The second, storytelling, permeates clinical discussions but has no formal status as a vehicle for clinical reasoning. I argue that both modes of discourse provide avenues for reasoning about clinical problems. However, these discourses construct very different clinical objects and different phenomena to reason about. Further, the clinical problems created through storytelling point toward a more radically distinct conception of rationality than the one underlying biomedicine as it is formally conceived. Clinical storytelling is more usefully understood as a mode of Aristotle's "practical rationality" than the technical rationality of modern (enlightenment) conceptions of reasoning. PMID:9746895

  20. The role of MRI in musculoskeletal practice: a clinical perspective

    PubMed Central

    Dean Deyle, Gail

    2011-01-01

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

  1. Examining Activism in Practice: A Qualitative Study of Archival Activism

    ERIC Educational Resources Information Center

    Novak, Joy Rainbow

    2013-01-01

    While archival literature has increasingly discussed activism in the context of archives, there has been little examination of the extent to which archivists in the field have accepted or incorporated archival activism into practice. Scholarship that has explored the practical application of archival activism has predominately focused on case…

  2. [Clinical practice guidelines and primary care. SESPAS report 2012].

    PubMed

    Atienza, Gerardo; Bañeres, Joaquim; Gracia, Francisco Javier

    2012-03-01

    Clinical practice guidelines are intended to serve as a bridge between the decision levels and the sources of knowledge, giving decision makers the best synthesis of scientific evidence and an analysis of context, to provide elements of judgement and to transfer scientific knowledge into clinical practice. However, the actual impact on health care is variable and effectiveness in changing medical practice, moderate. Qualitative and quantitative studies show that most primary care physicians consider that the guides are a valuable source of advice and training and a kind of improving the quality of healthcare. However, they underline its rigidity, the difficulty to apply to individual patients and that their main goal is to reduce healthcare costs. In Spain, there are several experiences as GuíaSalud in developing clinical practice guidelines aimed specifically at primary care. However, the proper implementation of a clinical practice guideline includes not only the quality and thoroughness of the evidence, but the credibility of professionals and organizations and other contextual factors such as characteristics of patients, providers and organizations or systems. An important step in future research is to develop a better theoretical understanding of organizational change that is required for management and professionals to give appropriate guidance to the implementation of the clinical practice guidelines. PMID:21993072

  3. A model for reflection for good clinical practice.

    PubMed

    Balla, John I; Heneghan, Carl; Glasziou, Paul; Thompson, Matthew; Balla, Margaret E

    2009-12-01

    Rationale and aim The rapidly changing knowledge base of clinical practice highlights the need to keep abreast of knowledge changes that are most relevant for the practitioner. We aimed to develop a model for reflection on clinical practice that identified the key elements of medical knowledge needed for good medical practice. Method The dual theory of cognition, an integration of intuitive and analytic processes, provided the framework for the study. The design looked at the congruence between the clinical thinking process and the dual theory. A one-year study was conducted in general practice clinics in Oxfordshire, UK. Thirty-five general practitioners participated in 20-minute interviews to discuss how they worked through recently seen clinical cases. Over a one-year period 72 cases were recorded from 35 interviews. These were categorized according to emerging themes, which were manually coded and substantiated with verbatim quotations. Results There was a close fit between the dual theory and participants' clinical thinking processes. This included instant problem framing, consistent with automatic intuitive thinking, focusing on the risk and urgency of the case. Salient features accounting for these choices were recognizable. There was a second reflective phase, leading to the review of initial judgements. Conclusions The proposed model highlights the critical steps in decision making. This allows regular recalibration of knowledge that is most critical at each of these steps. In line with good practice, the model also links the crucial knowledge used in decision making, to value judgments made in relation to the patient. PMID:20367693

  4. From evidence to clinical practice in blood and marrow transplantation.

    PubMed

    Khera, Nandita

    2015-11-01

    Clinical practice in the field of blood and marrow transplantation (BMT) has evolved over time, as a result of thousands of basic and clinical research studies. While it appears that scientific discovery and adaptive clinical research may be well integrated in case of BMT, there is lack of sufficient literature to definitively understand the process of translation of evidence to practice and if it may be selective . In this review, examples from BMT and other areas of medicine are used to highlight the state of and potential barriers to evidence uptake. Strategies to help improve knowledge transfer are discussed and the role of existing framework provided by the Center for International Blood and Marrow Transplant Registry (CIBMTR) to monitor uptake and BMT Clinical Trials Network (BMT CTN) to enhance translation of evidence into practice is highlighted. PMID:25934009

  5. Evidence-based clinical practice guidelines for liver cirrhosis 2015.

    PubMed

    Fukui, Hiroshi; Saito, Hidetsugu; Ueno, Yoshiyuki; Uto, Hirofumi; Obara, Katsutoshi; Sakaida, Isao; Shibuya, Akitaka; Seike, Masataka; Nagoshi, Sumiko; Segawa, Makoto; Tsubouchi, Hirohito; Moriwaki, Hisataka; Kato, Akinobu; Hashimoto, Etsuko; Michitaka, Kojiro; Murawaki, Toshikazu; Sugano, Kentaro; Watanabe, Mamoru; Shimosegawa, Tooru

    2016-07-01

    The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for

  6. Non-linearity in clinical practice.

    PubMed

    Petros, Peter

    2003-05-01

    The whole spectrum of medicine consists of complex non-linear systems that are balanced and interact with each other. How non-linearity confers stability on a system and explains variation and uncertainty in clinical medicine is discussed. A major theme is that a small alteration in initial conditions may have a major effect on the end result. In the context of non-linearity, it is argued that 'evidence-based medicine' (EBM) as it exists today can only ever be relevant to a small fraction of the domain of medicine, that the 'art of medicine' consists of an intuitive 'tuning in' to these complex systems and as such is not so much an art as an expression of non-linear science. The main cause of iatrogenic disease is interpreted as a failure to understand the complexity of the systems being treated. Case study examples are given and analysed in non-linear terms. It is concluded that good medicine concerns individualized treatment of an individual patient whose body functions are governed by non-linear processes. EBM as it exists today paints with a broad and limited brush, but it does promise a fresh new direction. In this context, we need to expand the spectrum of scientific medicine to include non-linearity, and to look upon the 'art of medicine' as a historical (but unstated) legacy in this domain. PMID:12787180

  7. Clinical Implications of Numeracy: Theory and Practice

    PubMed Central

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

    2013-01-01

    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. PMID:18677452

  8. Chronic Myelomonocytic Leukemia: Focus on Clinical Practice.

    PubMed

    Patnaik, Mrinal M; Tefferi, Ayalew

    2016-02-01

    Chronic myelomonocytic leukemia (CMML) is a clonal stem cell disorder with features that overlap those of myelodysplastic syndromes (MDSs) and myeloproliferative neoplasms (MPNs). Chronic myelomonocytic leukemia often results in peripheral blood monocytosis and has an inherent tendency to transform to acute myeloid leukemia. Clonal cytogenetic changes are seen in approximately 30% of patients, and molecular abnormalities are seen in more than 90%. Gene mutations involving TET2 (∼60%), SRSF2 (∼50%), ASXL1 (∼40%), and RAS (∼30%) are frequent, with nonsense and frameshift ASXL1 mutations being the only mutations identified thus far to have an independent negative prognostic effect on overall survival. Contemporary molecularly integrated prognostic models (inclusive of ASXL1 mutations) include the Molecular Mayo Model and the Groupe Français des Myélodysplasies model. Given the lack of formal treatment and response criteria, management of CMML is often extrapolated from MDS and MPN, with allogeneic stem cell transplant being the only curative option. Hydroxyurea and other cytoreductive agents have been used to control MPN-like features, while epigenetic modifiers such as hypomethylating agents have been used for MDS-like features. Given the relatively poor response to these agents and the inherent risks associated with hematopoietic stem cell transplant, newer drugs exploiting molecular and epigenetic abnormalities in CMML are being developed. The creation of CMML-specific response criteria is a much needed step in order to improve clinical outcomes. PMID:26848006

  9. Clinical Practice Strategies outside the Realm of Managed Care.

    ERIC Educational Resources Information Center

    Walfish, Steven

    While more and more psychologists criticize managed care companies, most must depend upon them in order to maintain their practices. In this study, psychologists were surveyed and asked to identify activities in their own independent practice that fall outside of the purview of managed care. A total of 180 specific activities were identified that…

  10. Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update

    PubMed Central

    Basch, Ethan; Prestrud, Ann Alexis; Hesketh, Paul J.; Kris, Mark G.; Feyer, Petra C.; Somerfield, Mark R.; Chesney, Maurice; Clark-Snow, Rebecca Anne; Flaherty, Anne Marie; Freundlich, Barbara; Morrow, Gary; Rao, Kamakshi V.; Schwartz,, Rowena N.; Lyman, Gary H.

    2011-01-01

    Purpose To update the American Society of Clinical Oncology (ASCO) guideline for antiemetics in oncology. Methods A systematic review of the medical literature was completed to inform this update. MEDLINE, the Cochrane Collaboration Library, and meeting materials from ASCO and the Multinational Association for Supportive Care in Cancer were all searched. Primary outcomes of interest were complete response and rates of any vomiting or nausea. Results Thirty-seven trials met prespecified inclusion and exclusion criteria for this systematic review. Two systematic reviews from the Cochrane Collaboration were identified; one surveyed the pediatric literature. The other compared the relative efficacy of the 5-hydroxytryptamine-3 (5-HT3) receptor antagonists. Recommendations Combined anthracycline and cyclophosphamide regimens were reclassified as highly emetic. Patients who receive this combination or any highly emetic agents should receive a 5-HT3 receptor antagonist, dexamethasone, and a neurokinin 1 (NK1) receptor antagonist. A large trial validated the equivalency of fosaprepitant, a single-day intravenous formulation, with aprepitant; either therapy is appropriate. Preferential use of palonosetron is recommended for moderate emetic risk regimens, combined with dexamethasone. For low-risk agents, patients can be offered dexamethasone before the first dose of chemotherapy. Patients undergoing high emetic risk radiation therapy should receive a 5-HT3 receptor antagonist before each fraction and for 24 hours after treatment and may receive a 5-day course of dexamethasone during fractions 1 to 5. The Update Committee noted the importance of continued symptom monitoring throughout therapy. Clinicians underestimate the incidence of nausea, which is not as well controlled as emesis. PMID:21947834

  11. Data Resource Profile: Clinical Practice Research Datalink (CPRD)

    PubMed Central

    Herrett, Emily; Gallagher, Arlene M; Bhaskaran, Krishnan; Forbes, Harriet; Mathur, Rohini; van Staa, Tjeerd; Smeeth, Liam

    2015-01-01

    The Clinical Practice Research Datalink (CPRD) is an ongoing primary care database of anonymised medical records from general practitioners, with coverage of over 11.3 million patients from 674 practices in the UK. With 4.4 million active (alive, currently registered) patients meeting quality criteria, approximately 6.9% of the UK population are included and patients are broadly representative of the UK general population in terms of age, sex and ethnicity. General practitioners are the gatekeepers of primary care and specialist referrals in the UK. The CPRD primary care database is therefore a rich source of health data for research, including data on demographics, symptoms, tests, diagnoses, therapies, health-related behaviours and referrals to secondary care. For over half of patients, linkage with datasets from secondary care, disease-specific cohorts and mortality records enhance the range of data available for research. The CPRD is very widely used internationally for epidemiological research and has been used to produce over 1000 research studies, published in peer-reviewed journals across a broad range of health outcomes. However, researchers must be aware of the complexity of routinely collected electronic health records, including ways to manage variable completeness, misclassification and development of disease definitions for research. PMID:26050254

  12. RadioActive101 Practices

    ERIC Educational Resources Information Center

    Brites, Maria José; Ravenscroft, Andrew; Dellow, James; Rainey, Colin; Jorge, Ana; Santos, Sílvio Correia; Rees, Angela; Auwärter, Andreas; Catalão, Daniel; Balica, Magda; Camilleri, Anthony F.

    2014-01-01

    In keeping with the overarching RadioActive101 (RA101) spirit and ethos, this report is the product of collaborative and joined-up thinking from within the European consortium spread across five countries. As such, it is not simply a single voice reporting on the experiences and knowledge gained during the project. Rather it is a range of…

  13. Novices in clinical practice settings: student nurses stories of learning the practice of nursing.

    PubMed

    Orland-Barak, Lily; Wilhelem, Dalit

    2005-08-01

    Drawing on 24 stories of clinical practice in an apprenticeship context of training in Israel, this qualitative study examined student nurses' perspectives towards learning to become a nurse, as revealed through the language and content of their written stories of clinical practice. As our findings suggest, student nurses' stories of learning to become a nurse in practice settings, are characterized by procedural language, by medical rather than nursing terminology, and by a focus on actions rather than on interactions. We have learned that, despite the rich content that characterizes clinical practice settings, the apprenticeship orientation of the training program, combined with student nurses' state of being a novice, yielded representations of the experience of learning to nurse which were characterized by an instrumental perspective towards the practice. We interpret these findings through four interrelated insights that emerge from the study: (1) an 'instrumental practice' orientation in the setting of caring, (2) knowledge of clinical facts-not knowledge of clinical principles, (3) the fragmented character of novices' learning to nurse in practice, and (4) rich content of practice alone does not yield rich content of learning. PMID:16005116

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

    PubMed

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

    2014-05-01

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

  15. Effects of feedback of information on clinical practice: a review.

    PubMed Central

    Mugford, M; Banfield, P; O'Hanlon, M

    1991-01-01

    OBJECTIVE--To establish what is known about the role of feedback of statistical information in changing clinical practice. DESIGN--Review of 36 studies of interventions entailing the use of statistical information for audit or practice review, which used a formal research design. SUBJECTS--Papers identified from computer searches of medical and health service management publications, of which 36 describing studies of interventions designed to influence clinical care and including information feedback from clinical or administrative data systems were reviewed. MAIN OUTCOME MEASURES--Evidence for effect of information feedback on change in clinical practice. RESULTS--Information feedback was most likely to influence clinical practice if it was part of strategy to target decision makers who had already agreed to review their practice. A more direct effect was discernable if the information was presented close to the time of decision making. The questions of the optimum layout and quantity of information were not addressed; the 36 papers were insufficient for defining good formats for information to be used for audit or quality assurance. CONCLUSIONS--Given the cost of information processing and the current emphasis on closing the audit loop in the health services, it is important that the use of information in the audit process should be critically evaluated. PMID:1912809

  16. Obesity Related Coronary Microvascular Dysfunction: From Basic to Clinical Practice

    PubMed Central

    Selthofer-Relatić, K.; Bošnjak, I.; Kibel, A.

    2016-01-01

    Obesity related coronary microvascular disease is a medical entity which is not yet fully elucidated. The pathophysiological basis of coronary microcirculatory dysfunction consists of a heterogeneous group of disorders with individual morphologic/functional/clinical presentation and prognosis. Coronary microcirculatory changes include mechanisms connected with vascular dysfunction, as well as extravascular and vasostructural changes in responses to neural, mechanical, and metabolic factors. Cardiometabolic changes that include obesity, dyslipidemia, diabetes mellitus type II, and hypertension are associated with atherosclerosis of epicardial coronary arteries and/or microvascular coronary dysfunction, with incompletely understood underlying mechanisms. In obesity, microvascular disease is mediated via adipokines/cytokines causing chronic, subclinical inflammation with (a) reduced NO-mediated dilatation, (b) changed endothelial- and smooth muscle-dependent vasoregulating mechanisms, (c) altered vasomotor control with increased sympathetic activity, and (d) obesity related hypertension with cardiomyocytes hypertrophy and impaired cardiac vascular adaptation to metabolic needs. From a clinical point of view it can present itself in acute or chronic form with different prognosis, as a practice problem for real-life diagnosis and treatment. PMID:27092288

  17. Clinical biopsychosocial practice and primary health care in Eastern Nigeria.

    PubMed

    Day, S B

    1985-01-01

    An account with case reports of the organization of medical education in the direction of a synthesis between divergent biological paradigms within sociological parameters (the biopsychosocial way), towards problem solving and solution finding in rural health in Cross River State, in the Rain Forest Belt of Tropical West Africa (Nigeria) is described. The objective of the biopsychosocial programme is to strengthen rural health through primary health care based on health education and health communications transfer strategies, implemented by medical students absolving their Community Health Clinical Clerkship. Informational messages and health education is transmitted in such a way as to be accepted by village communities, and to lead to community action within their own resources (Self-Health and Self-Help). Individual and Community Health is integrated with general practice medicine in the clinical biopsychosocial approach, which fulfils the WHO position of health as physical (BIO), mental (PSYCHO) and SOCIAL well being. Rural support activities are a part of biosocial development. It is believed that the biopsychosocial way has contributed to health improvement in this part of Nigeria. PMID:4095596

  18. DYNAMICALLY EVOLVING CLINICAL PRACTICES AND IMPLICATIONS FOR PREDICTING MEDICAL DECISIONS.

    PubMed

    Chen, Jonathan H; Goldstein, Mary K; Asch, Steven M; Altman, Russ B

    2016-01-01

    Automatically data-mining clinical practice patterns from electronic health records (EHR) can enable prediction of future practices as a form of clinical decision support (CDS). Our objective is to determine the stability of learned clinical practice patterns over time and what implication this has when using varying longitudinal historical data sources towards predicting future decisions. We trained an association rule engine for clinical orders (e.g., labs, imaging, medications) using structured inpatient data from a tertiary academic hospital. Comparing top order associations per admission diagnosis from training data in 2009 vs. 2012, we find practice variability from unstable diagnoses with rank biased overlap (RBO)<0.35 (e.g., pneumonia) to stable admissions for planned procedures (e.g., chemotherapy, surgery) with comparatively high RBO>0.6. Predicting admission orders for future (2013) patients with associations trained on recent (2012) vs. older (2009) data improved accuracy evaluated by area under the receiver operating characteristic curve (ROC-AUC) 0.89 to 0.92, precision at ten (positive predictive value of the top ten predictions against actual orders) 30% to 37%, and weighted recall (sensitivity) at ten 2.4% to 13%, (P<10(-10)). Training with more longitudinal data (2009-2012) was no better than only using recent (2012) data. Secular trends in practice patterns likely explain why smaller but more recent training data is more accurate at predicting future practices. PMID:26776186

  19. DYNAMICALLY EVOLVING CLINICAL PRACTICES AND IMPLICATIONS FOR PREDICTING MEDICAL DECISIONS

    PubMed Central

    CHEN, JONATHAN H; GOLDSTEIN, MARY K; ASCH, STEVEN M; ALTMAN, RUSS B

    2015-01-01

    Automatically data-mining clinical practice patterns from electronic health records (EHR) can enable prediction of future practices as a form of clinical decision support (CDS). Our objective is to determine the stability of learned clinical practice patterns over time and what implication this has when using varying longitudinal historical data sources towards predicting future decisions. We trained an association rule engine for clinical orders (e.g., labs, imaging, medications) using structured inpatient data from a tertiary academic hospital. Comparing top order associations per admission diagnosis from training data in 2009 vs. 2012, we find practice variability from unstable diagnoses with rank biased overlap (RBO)<0.35 (e.g., pneumonia) to stable admissions for planned procedures (e.g., chemotherapy, surgery) with comparatively high RBO>0.6. Predicting admission orders for future (2013) patients with associations trained on recent (2012) vs. older (2009) data improved accuracy evaluated by area under the receiver operating characteristic curve (ROC-AUC) 0.89 to 0.92, precision at ten (positive predictive value of the top ten predictions against actual orders) 30% to 37%, and weighted recall (sensitivity) at ten 2.4% to 13%, (P<10−10). Training with more longitudinal data (2009-2012) was no better than only using recent (2012) data. Secular trends in practice patterns likely explain why smaller but more recent training data is more accurate at predicting future practices. PMID:26776186

  20. [Assessment of clinical practice guidelines evaluation. Scales and criteria].

    PubMed

    Rico Iturrioz, Rosa; Gutiérrez-Ibarluzea, Iñaki; Asua Batarrita, José; Navarro Puerto, Maria Asunción; Reyes Domínguez, Antonio; Marín León, Ignacio; Briones Pérez de la Blanca, Eduardo

    2004-01-01

    Not only are there large number of guides, protocols and other support tools available for the clinical decision-making process in the Spanish National Health System, but there is also a major degree of variability among them, reflecting inconsistencies and low quality of those documents. This study is aimed at conducting all inventory of the Clinical Practice Guideline assessment scales and clinical analysis tools and to propose a scale or set of criteria for assessing the quality of the Clinical Practice Guidelines put out in Spain. A systematic search of critical evaluation scales was conducted. The inclusion criteria and the concordance analysis of the items by three evaluators were independently applied. The discordances were resolved by explicit consensus. Ten suggested critical assessment scales and sets of criteria from eleven institutions were identified, eight of which consist of scales and tools proposed for assessing the quality of the Clinical Practice Guidelines, the other two being proposals for assessing the implementation and inclusion of the Clinical Practice Guidelines in a register. In the comparative analysis, the criteria most often repeated on the scales analysed were related to the areas included in the AGREE Instrument. The areas considered in most of the critical assessment scales were the same as those of the AGREE Instrument. Although this tool does not take in criteria for guide implementation assessment purposes, it is considered suitable for use in the assessment prior to inclusion to the national CPG register. PMID:15384260

  1. Port protectors in clinical practice: an audit.

    PubMed

    Cameron-Watson, Corinne

    This article discusses the effect on compliance and incidence of vascular access device (VAD)-related bacteraemia following the introduction of a passive disinfection device (Curos®) for 6 months in four areas at one hospital trust. The hospital's infection prevention and control team replaced the 'active' disinfection using a disinfection wipe with 'scrub the hub'. Disinfection wipes used for needle-free devices were removed from all four trial areas and Curos was incorporated into the aseptic non-touch technique (ANTT(®)) protocols for the trial wards. Staff training was provided before and during the study, and audits of staff compliance with Curos placement were undertaken monthly. A benchmarking audit of 'scrub the hub' techniques was conducted 1 month before audit began. The results of the audit showed VAD-related bacteraemia rates reduced by 69% from 26 cases (confirmed through review of blood culture laboratory data and source identified by consultant microbiologists) before the study, to 8 when staff compliance with Curos placement onto VADs was 80% or more. PMID:27126760

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

    PubMed Central

    Rieckmann, Traci; Bergmann, Luke; Rasplica, Caitlin

    2013-01-01

    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. PMID:22185037

  3. Legislating clinical practice: counselor responses to an evidence-based practice mandate.

    PubMed

    Rieckmann, Traci; Bergmann, Luke; Rasplica, Caitlin

    2011-09-01

    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. PMID:22185037

  4. Using clinical audit in practice: a pilot peer review project.

    PubMed

    Holt, V P; Earp, D P

    1996-09-01

    A well-established study group undertook a pilot peer review project testing the use of clinical audit in members' practices. Two peer review groups were formed involving a total of 16 practices. Practice visits were undertaken and a series of meetings were held to prepare and discuss the various projects. The progress of the groups was monitored by questionnaires. All practitioners reported benefits from the project (specifically, from the practice visits) and made changes in areas of their practice other than those specifically chosen for their project. The benefits of carrying out audit projects in a peer review setting are stressed as are the benefits of reciprocal practice visits. The importance of prior establishment of mutual trust and confidence in the peer review group is emphasised. PMID:10332335

  5. Essentials of ethics in clinical practice: a communications perspective.

    PubMed

    Gartland, G

    1987-01-01

    A knowledge of ethics and communication skills is essential to professional practice, just as it is essential to treatment techniques in the clinical application of physical therapy. Ethics has personal, professional and legal implications which, if neglected, may result in adverse consequences for both the clinician and the patient. The purpose of this paper is to outline four practical ethical doctrines and their import on clinical practice. The emphasis is on communication. Improvement in technical, clinical and research expertise is a continuing objective in the development of Canadian physical therapy. The maintenance of a parallel focus on human needs and values, along with ethics and interpersonal communication skills, serves to enhance the image of physical therapy as an holistic and caring profession. PMID:10282425

  6. Current clinical practice guidelines in atrial fibrillation: a review.

    PubMed

    Galvez-Olortegui, José Kelvin; Álvarez-Vargas, Mayita Lizbeth; Galvez-Olortegui, Tomas Vladimir; Godoy-Palomino, Armando; Camacho-Saavedra, Luis

    2016-01-01

    The aim of this study is the methodological evaluation of Clinical Practice Guidelines (CPG) in atrial fibrillation. This is the second in a series of articles of review, analysis, assessment in methodology and content of clinical practice guidelines in Cardiology. Among all clinical practice guidelines, we selected the American, Canadian and NICE (National Institute for Health and Care Excellence) guidelines. We used the AGREE (Appraisal of Guidelines for Research and Evaluation) II instrument for the assessment. In general, the guidelines obtained the lowest score in the applicability domain (mean 36.1%); while the highest score was for clarity of presentation (mean 93.5%). The lowest percentage was found in the editorial independence domain (Canadian guideline) and the highest of all scores in the applicability domain (NICE guideline). Regarding global quality, the NICE guideline obtained the AGREE II instrument best scores, followed by the American guideline, both recommended for use without modifications. PMID:26939036

  7. Good Clinical Practice Guidance and Pragmatic Clinical Trials: Balancing the Best of Both Worlds.

    PubMed

    Mentz, Robert J; Hernandez, Adrian F; Berdan, Lisa G; Rorick, Tyrus; O'Brien, Emily C; Ibarra, Jenny C; Curtis, Lesley H; Peterson, Eric D

    2016-03-01

    Randomized, clinical trials are commonly regarded as the highest level of evidence to support clinical decisions. Good Clinical Practice guidelines have been constructed to provide an ethical and scientific quality standard for trials that involve human subjects in a manner aligned with the Declaration of Helsinki. Originally designed to provide a unified standard of trial data to support submission to regulatory authorities, the principles may also be applied to other studies of human subjects. Although the application of Good Clinical Practice principles generally led to improvements in the quality and consistency of trial operations, these principles have also contributed to increasing trial complexity and costs. Alternatively, the growing availability of electronic health record data has facilitated the possibility for streamlined pragmatic clinical trials. The central tenets of Good Clinical Practice and pragmatic clinical trials represent potential tensions in trial design (stringent quality and highly efficient operations). In the present article, we highlight potential areas of discordance between Good Clinical Practice guidelines and the principles of pragmatic clinical trials and suggest strategies to streamline study conduct in an ethical manner to optimally perform clinical trials in the electronic age. PMID:26927005

  8. Pregnancy loss: French clinical practice guidelines.

    PubMed

    Huchon, C; Deffieux, X; Beucher, G; Capmas, P; Carcopino, X; Costedoat-Chalumeau, N; Delabaere, A; Gallot, V; Iraola, E; Lavoue, V; Legendre, G; Lejeune-Saada, V; Leveque, J; Nedellec, S; Nizard, J; Quibel, T; Subtil, D; Vialard, F; Lemery, D

    2016-06-01

    In intrauterine pregnancies of uncertain viability with a gestational sac without a yolk sac (with a mean of three orthogonal transvaginal ultrasound measurements <25mm), the suspected pregnancy loss should only be confirmed after a follow-up scan at least 14 days later shows no embryo with cardiac activity (Grade C). In intrauterine pregnancies of uncertain viability with an embryo <7mm on transvaginal ultrasound, the suspected pregnancy loss should only be confirmed after a follow-up scan at least 7 days later (Grade C). In pregnancies of unknown location after transvaginal ultrasound (i.e. not visible in the uterus), a threshold of at least 3510IU/l for the serum human chorionic gonadotrophin assay is recommended; above that level, a viable intrauterine pregnancy can be ruled out (Grade C). Postponing conception after an early miscarriage in women who want a new pregnancy is not recommended (Grade A). A work-up for women with recurrent pregnancy loss should include the following: diabetes (Grade A), antiphospholipid syndrome (Grade A), hypothyroidism with anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies (Grade A), vitamin deficiencies (B9, B12) (Grade C), hyperhomocysteinaemia (Grade C), hyperprolactinaemia (Grade B), diminished ovarian reserve (Grade C), and a uterine malformation or an acquired uterine abnormality amenable to surgical treatment (Grade C). The treatment options recommended for women with a missed early miscarriage are vacuum aspiration (Grade A) or misoprostol (Grade B); and the treatment options recommended for women with an incomplete early miscarriage are vacuum aspiration (Grade A) or expectant management (Grade A). In the absence of both chorioamnionitis and rupture of the membranes, women with a threatened late miscarriage and an open cervix, with or without protrusion of the amniotic sac into the vagina, should receive McDonald cerclage, tocolysis with indomethacin, and antibiotics (Grade C). Among women

  9. Nursing students learning to utilize nursing research in clinical practice.

    PubMed

    Mattila, Lea-Riitta; Eriksson, Elina

    2007-08-01

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

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

    PubMed

    Williams, Angela; Taylor, Cathy

    2008-11-01

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

  11. [GRADE: Methodology for formulating and grading recommendations in clinical practice].

    PubMed

    Sanabria, Andrea Juliana; Rigau, David; Rotaeche, Rafael; Selva, Anna; Marzo-Castillejo, Mercè; Alonso-Coello, Pablo

    2015-01-01

    Clinical practice guidelines (CPG) provide recommendations on the benefits and harms of different healthcare interventions. Proper CPG development and implementation can potentially reduce variability in clinical practice while improving its quality and safety. The GRADE system is used to assess the quality of evidence and to grade the strength of recommendations in the context of the development of CPGs, systematic reviews or health technology assessments. The aim of this article is to describe the main characteristics of the GRADE system through relevant examples in the context of primary care. PMID:24684818

  12. Implications of pharmacogenomics for drug development and clinical practice.

    PubMed

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

    2005-11-14

    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

  13. [Use of antihistamines in a physician's clinical practice].

    PubMed

    Luss, L V

    2014-01-01

    Histamine that belongs to one of the most important mediators involved in the regulation of the body's vital functions plays a great role in the pathogenesis of different diseases. Histamine is released during inflammatory and allergic reactions, anaphylactic and anaphylactoid shock, pseudoallergic reactions, and others. Acting through histamine receptors, it leads to increased intracellular concentration of cyclic guanosine monophosphate, enhanced chemotaxis of eosinophils and neutrophils, production of prostaglandins and thromboxane B, suppressed synthesis of lymphokines, etc. and causes contraction of smooth muscles of particularly the bronchi and intestine, dilation of vessels and their increased permeability, mucus hypersecretion in the upper airways, lower blood pressure, angioedema and itch, etc. In this connection, antihistamines that block histamine-induced reactions in various ways: by inhibiting its biosynthesis, enhancing its neutralization, blocking the access to receptors, and suppressing the release from mast cells, occupy a prominent place in clinical practice. The review covers the classification, main mechanisms of pharmacological action, and indications for the use of antihistamines that not only have the well-known antihistamine properties, but have also a broad spectrum of anti-inflammatory activity. There are data on the benefits of a group of antihistamines, the quinuclidine derivatives (quifenadine, sequifenadine) that were designed by Academician M.D. Mashkovsky and are one of the first examples of designing new classes of multifunctional non-sedating antihistamines, which combines a high selective activity to block histamine type 1 receptors and an ability to block serotonin and to break down histamine directly in tissues. PMID:25306755

  14. Reflections by clinical nurse specialists on changing ward practice.

    PubMed

    Thomas, Catherine; Ramcharan, Angie

    In September 2010, palliative care clinical nurse specialists at North Middlesex University Hospital Trust introduced competencies for all nurses in setting up and using syringe drivers. This was done after the trust identified a high level of clinical incidents involving syringe drivers. This article discusses how the competencies were implemented and assessed, explores the importance of understanding change management to achieve change, and how different leadership styles affect changes to practice. PMID:21957520

  15. Dual Perspectives on Theory in Clinical Practice: Practice Makes Perfect: The Incompatibility of Practicing Speech and Meaningful Communication.

    ERIC Educational Resources Information Center

    Kamhi, Alan G.

    2000-01-01

    This article uses a case study to suggest that some children view speech-language therapy as a separate situation for learning practicing new sounds and language forms whereas the purpose of talking outside of therapy is meaningful communication. Clinical implications of this potential incompatibility between practicing speech and communicating…

  16. [Construction of terminology subsets: contributions to clinical nursing practice].

    PubMed

    Clares, Jorge Wilker Bezerra; de Freitas, Maria Célia; Guedes, Maria Vilaní Cavalcante; da Nóbrega, Maria Miriam Lima

    2013-08-01

    The International Classification for Nursing Practice (ICNP®) is a classification system that unifies the elements of nursing practice (diagnoses, interventions and outcomes), enabling elucidation of elements of a specific nursing language through the construction of terminology subsets. In this reflective essay, aspects relevant to the construction of ICNP® terminology subsets are highlighted, as well as their contributions to clinical nursing practice. The development of subsets as a tool that contributes to making nursing language universal, facilitates the communication process, as well as the scientific and technological advancement of the profession, is discussed. Therefore, its use by nurses worldwide is encouraged. PMID:24310697

  17. Medical Wikis Dedicated to Clinical Practice: A Systematic Review

    PubMed Central

    Llorca, Guy; Letrilliart, Laurent

    2015-01-01

    Background Wikis may give clinician communities the opportunity to build knowledge relevant to their practice. The only previous study reviewing a set of health-related wikis, without specification of purpose or audience, globally showed a poor reliability. Objective Our aim was to review medical wiki websites dedicated to clinical practices. Methods We used Google in ten languages, PubMed, Embase, Lilacs, and Web of Science to identify websites. The review included wiki sites, accessible and operating, having a topic relevant for clinical medicine, targeting physicians or medical students. Wikis were described according to their purposes, platform, management, information framework, contributions, content, and activity. Purposes were classified as “encyclopedic” or “non-encyclopedic”. The information framework quality was assessed based on the Health On the Net (HONcode) principles for collaborative websites, with additional criteria related to users’ transparency and editorial policy. From a sample of five articles per wikis, we assessed the readability using the Flesch test and compared articles according to the wikis’ main purpose. Annual editorial activities were estimated using the Google engine. Results Among 25 wikis included, 11 aimed at building an encyclopedia, five a textbook, three lessons, two oncology protocols, one a single article, and three at reporting clinical cases. Sixteen wikis were specialized with specific themes or disciplines. Fifteen wikis were using MediaWiki software as-is, three were hosted by online wiki farms, and seven were purpose-built. Except for one MediaWiki-based site, only purpose-built platforms managed detailed user disclosures. The owners were ten organizations, six individuals, four private companies, two universities, two scientific societies, and one unknown. Among 21 open communities, 10 required users’ credentials to give editing rights. The median information framework quality score was 6 out of 16

  18. [Genomic Tests: From Basic Research to Clinical Practice].

    PubMed

    Nakatani, Kaname; Mochiki, Ikuyo

    2015-03-01

    Advanced genomic analytical technologies are developing and challenging the current framework of clinical laboratory testing. However, most genomic tests have been devised as laboratory-developed tests (LDTs) without sufficient validation of their analytical validity. Quality assurance (QA) of tests is mandatory for routine clinical practice. External quality management systems such as ISO add QA. Other than QAs of pre-analysis, analytical procedures, reports, and laboratory personnel should be regularly assessed using appropriate best practices and guidelines for analytical validity. Moreover, ethical, legal, and social issues concerning genomic information should be resolved in genomic tests. Taken together, clinicians and health care policymakers must consider the accuracy with which a test identifies a patient's clinical status and the risks and benefits resulting from test use. Genomic tests in current use vary in terms of their accuracy and potential to improve health outcomes. Recently, high-throughput analysis using next-generation sequencing and microarrays is being developed and introduced into clinical practice. As analysis of these data sets is a huge challenge, it requires novel analytical processes that include data quality assessment, comprehensive analysis, interpretation of the results, and presenting the results to users. Especially, human resources are required to develop genome informatics to interpret large amounts of data. Another issue is to regulate Direct To Consumers (DTC) genetic tests by medical institutions as a salutary health service. Although advanced genomic analytical technologies present some issues, they are useful and powerful tools in clinical practice. Thus, they will be properly introduced into clinical practices in a step by step manner. PMID:26524861

  19. [Clinical practice as an arborescent and rhizomorphic practice in surgical nursing work].

    PubMed

    de Sousa, Lenice Dutra; Lunardi, Wilson Danilo Filho; Cezar-Vaz, Marta Regina; de Figueiredo, Paula Pereira

    2013-12-01

    A qualitative and exploratory case study was conducted in a surgery unit of a university hospital. The study aimed to analyze the nurses' work from the perspective of health care production and clinical practice. The subjects of the study were six nurses. Non-participant observations, documentary research and in-depth interviews were carried out, followed by discursive textual analysis. Nursing work is organized according to two interconnected and interdependent perspectives: a clinical model, which forms the central structure of its practice, and a structure formed by multiple and heterogeneous elements. in this way, the clinical model of health care is organized as a centered structure that enables the fulfillment of biological needs and acts as a basis for connecting disparate knowledge and practices that expand practice through interconnections with the work environment. PMID:24626366

  20. Prototypes for Content-Based Image Retrieval in Clinical Practice

    PubMed Central

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

    2011-01-01

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

  1. Normal Personality Assessment in Clinical Practice: The NEO Personality Inventory.

    ERIC Educational Resources Information Center

    Costa, Paul T.; McCrae, Robert R.

    1992-01-01

    The NEO Personality Inventory (NEO-PI) is described as a measure of five factors of personality and its use in clinical assessment and treatment practice is reviewed. Data from 17 adult men and women show links between NEO-PI scales and other measures of psychopathology. (SLD)

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  3. Clinical Vignettes Improve Performance in Anatomy Practical Assessment

    ERIC Educational Resources Information Center

    Ikah, December S. K.; Finn, Gabrielle M.; Swamy, Meenakshi; White, Pamela M.; McLachlan, John C.

    2015-01-01

    Although medical curricula now adopt an integrated teaching approach, this is not adequately reflected in assessment of anatomy knowledge and skills. In this study, we aimed to explore the impact of the addition of clinical vignette to item stems on students' performance in anatomy practical examinations. In this study, 129 undergraduate medical…

  4. Supporting Clinical Practice Candidates in Learning Community Development

    ERIC Educational Resources Information Center

    DeJarnette, Nancy K.; Sudeck, Maria

    2015-01-01

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

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

    PubMed Central

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

    1997-01-01

    OBJECTIVE: To provide evidence-based answers to clinical questions posed by family physicians about Group A streptococcus pharyngitis and to further understanding of why management is controversial. QUALITY OF EVIDENCE: Evidence from randomized trials was not found for most questions. The most critical information came from high-quality community prevalence studies and criterion standard studies of physician clinical judgement. MAIN FINDINGS: Expert recommendations for physician management are not likely to help prevent rheumatic fever, as most people with sore throats do not seek medical care. Current clinical practices result in overuse of antibiotics because accuracy of clinical judgment is limited. CONCLUSIONS: Costs associated with visits for upper respiratory infections as well as increasing antibiotic resistance necessitate reconsidering the current clinical approach. An alternative management strategy is presented in part 2. PMID:9116520

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

    ERIC Educational Resources Information Center

    Ferguson, Alison; Armstrong, Elizabeth

    2004-01-01

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

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

    PubMed

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

    2011-09-01

    Clinical audit is a systematic review of the procedures in order to improve the quality and the outcome of patient care, whereby the procedures are examined against agreed standards for good medical RADIOLOGICAL procedures. The criteria of good procedures (i.e. the good practice) are thus the cornerstones for development of clinical audits: these should be the basis of assessments regardless of the type of the audit--external, internal, comprehensive or partial. A lot of criteria for good practices are available through the recommendations and publications by international and national professional societies and other relevant organisations. For practical use in clinical audits, the criteria need to be compiled, sorted out and agreed on for the particular aims of an audit (comprehensive or partial, external or internal). The national professional and scientific societies can provide valuable contribution to this development. For examination--or treatment-specific criteria--preliminary consensus needs to be obtained with the help of clinical experts, while clinical audits can be useful as a benchmarking tool to improve the criteria. PMID:21979432

  8. A study of clinical opinion and practice regarding circumcision

    PubMed Central

    Farshi, Z; Atkinson, K; Squire, R

    2000-01-01

    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.

 PMID:11040144

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

    PubMed

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

    2013-01-01

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

  10. Queering know-how: clinical skill acquisition as ethical practice.

    PubMed

    Heyes, Cressida J; Thachuk, Angela

    2015-06-01

    Our study of queer women patients and their primary health care providers (HCPs) in Halifax, Nova Scotia, reveals a gap between providers' theoretical knowledge of "cultural competency" and patients' experience. Drawing on Patricia Benner's Dreyfusian model of skill acquisition in nursing, we suggest that the dissonance between the anti-heteronormative principles expressed in interviews and the relative absence of skilled anti-heteronormative clinical practice can be understood as a failure to grasp the field of practice as a whole. Moving from "knowing-that" to "knowing-how" in terms of anti-heteronormative clinical skills is not only a desirable epistemological trajectory, we argue, but also a way of understanding better and worse ethical practice. PMID:25037245

  11. Identifying components of advanced-level clinical nutrition practice: a Delphi study.

    PubMed

    Brody, Rebecca A; Byham-Gray, Laura; Touger-Decker, Riva; Passannante, Marian R; O'Sullivan Maillet, Julie

    2012-06-01

    The dietetics profession lacks a comprehensive definition of advanced-level practice. Using a three-round Delphi study with mailed surveys, expert consensus on four dimensions of advanced-level practice that define advanced practice registered dietitians (RDs) in clinical nutrition was explored. Purposive sampling identified 117 RDs who met advanced-level practice criteria. In round 1, experts rated the essentiality of statements on a 7-point ordinal scale and generated open-ended practice activity statements regarding the following four dimensions of advanced-level practice: professional knowledge, abilities and skills, approaches to practice, roles and relationships, and practice behaviors. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 was neutral, and 5.0 to 7.0 were nonessential. In rounds 2 and 3, experts re-rated statements not reaching consensus by evaluating their previous responses, group median rating, and comments. Consensus was reached when the interquartile range of responses to a statement was ≤2.0. Eighty-five experts enrolled (72.6%); 76 (89.4%) completed all rounds. In total, 233 statements were rated, with 100% achieving consensus; 211 (90.6%) were essential to advanced practice RD clinical practice. Having a master's degree; completing an advanced practice residency; research coursework; and advanced continuing education were essential, as were having 8 years of experience; clinical nutrition knowledge/expertise; specialization; participation in research activities; and skills in technology and communication. Highly essential approaches to practice were systematic yet adaptable and used critical thinking and intuition and highly essential values encompassed professional growth and service to patients. Roles emphasized patient care and leadership. Essential practice activities within the nutrition care process included provision of complex patient-centered nutrition care using application of advanced knowledge/expertise and

  12. Alzheimer’s Disease: A Clinical Practice-Oriented Review

    PubMed Central

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

    2012-01-01

    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 Aβ analysis, as well as available data on their diagnostic accuracy, are also discussed. Factors predicting rate of disease progression are briefly mentioned. Finally, non-pharmacological and pharmacological treatments, including established and emerging drugs, are addressed. PMID:22529838

  13. Guide to clinical practice guidelines: the current state of play

    PubMed Central

    Kredo, Tamara; Bernhardsson, Susanne; Machingaidze, Shingai; Young, Taryn; Louw, Quinette; Ochodo, Eleanor; Grimmer, Karen

    2016-01-01

    Introduction Extensive research has been undertaken over the last 30 years on the methods underpinning clinical practice guidelines (CPGs), including their development, updating, reporting, tailoring for specific purposes, implementation and evaluation. This has resulted in an increasing number of terms, tools and acronyms. Over time, CPGs have shifted from opinion-based to evidence-informed, including increasingly sophisticated methodologies and implementation strategies, and thus keeping abreast of evolution in this field of research can be challenging. Methods This article collates findings from an extensive document search, to provide a guide describing standards, methods and systems reported in the current CPG methodology and implementation literature. This guide is targeted at those working in health care quality and safety and responsible for either commissioning, researching or delivering health care. It is presented in a way that can be updated as the field expands. Conclusion CPG development and implementation have attracted the most international interest and activity, whilst CPG updating, adopting (with or without contextualization), adapting and impact evaluation are less well addressed. PMID:26796486

  14. The legal status of clinical practice parameters: an annotated bibliography.

    PubMed

    Kapp, M B

    1993-01-01

    An important recent development in American medicine has been the strong push in the last few years toward the formal creation, dissemination, and enforcement of explicit clinical practice guidelines or parameters relating to the quality and efficacy of various medical interventions, parameters that would guide the decisions and actions of physicians and other health care providers (1-3). Medical societies (4), governmental agencies such as the federal Agency for Health Care Policy and Research, and insurers are utilizing a variety of approaches to the development of practice parameters for medical diagnosis and intervention, including informal consensus development, formal consensus development, evidence-based guideline development, and explicit guideline development (5). The number and variety of practice parameters has burgeoned in response to the wide national variations in medical practice patterns, without corresponding differences in clinical outcomes, that have been documented by health services researchers. Several commentators have expressed serious skepticism about the probable impact of practice parameters, surmising that they will be used extensively in a negative manner in medical malpractice litigation (6, 7). Many physicians in particular have asked "how they [practice parameters] can be implemented without courting the ruin of the individual practitioner" (8). In response to these anxieties, a new medicolegal literature has arisen to address the relationship between the development of clinical practice parameters and the physician's exposure to malpractice litigation and adverse judgments, as well as the implications for malpractice insurance premiums. This growing literature has now achieved a critical mass. The major contributions to this corpus at present are listed and annotated below. PMID:8334377

  15. Cancer-related fatigue. Clinical practice guidelines in oncology.

    PubMed

    2003-07-01

    These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue using a brief screening instrument, and are treated as indicated by their fatigue level. The algorithm's goal is to identify and treat all patients with fatigue that causes distress or interferes with their daily activities or functioning. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point the patient is assessed for current disease and treatment status, a review of body systems, and an in-depth fatigue evaluation. In addition, the patient is assessed for the presence of seven treatable factors known to contribute to fatigue: pain, emotional distress, sleep disturbance, anemia, alterations in nutrition, deconditioning, and comorbidities. If any of these conditions are present, they should be treated according to practice guidelines, with referral to other care professionals as appropriate, and the patient's fatigue should be reevaluated regularly. If none of the seven factors are present or the fatigue is unresolved, selection of appropriate fatigue management and treatment strategies is considered within the context of the patient's clinical status: receiving active cancer treatment, receiving disease-free long-term follow-up, or receiving care at the end of life. Management of fatigue is cause-specific when conditions known to cause fatigue can be identified and treated. When specific causes, such as infection, fluid and electrolyte imbalances, or cardiac dysfunction, cannot be identified and corrected, nonpharmacologic and pharmacologic treatment of the fatigue should be considered. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, psychosocial programs to manage stress and

  16. Justification for conducting neurological clinical trials as part of patient care within private practice.

    PubMed

    Beran, R G; Stepanova, D; Beran, M E

    2016-05-01

    The aim of this review was to assess the benefits and drawbacks of conducting neurological clinical trials and research in private practice for the patients, clinician, Practice Manager, sponsors/Clinical Research Organisations (CROs) and Clinical Trial Coordinator (CTC) to determine if this is justified for all involved. A combination of literature reviews, original research articles and books were selected from 2005 to 2015. Provided that the practice has sufficient number of active trials to prevent financial loss, support staff, adequate facilities and equipment and time, the benefits outweigh the drawbacks. Clinical trials provide patients with more thorough monitoring, re-imbursement of trial-related expenses and the opportunity to try an innovative treatment at no charge when other options have failed. For the clinician, clinical trials provide more information to ensure better care for their patients and improved treatment methods, technical experience and global recognition. Trials collect detailed and up-to-date information on the benefits and risks of drugs, improving society's confidence in clinical research and pharmaceuticals, allow trial sponsors to explore new scientific questions and accelerate innovation. For the CTC, industry-sponsored clinical trials allow potential entry for a career in clinical research giving CTCs the opportunity to become Clinical Research Associates (CRAs), Study Start-Up Managers or Drug Safety Associates. PMID:27040457

  17. Clinical nurse specialists driving research and practice through Research Roundtables.

    PubMed

    Harne-Britner, Sarah; Schafer, Deborah J

    2009-01-01

    Providing patient care based on the best evidence is a priority for healthcare institutions across the country to improve practice and patient outcomes. Creating a culture of evidence-based practice (EBP) within an organization can be a challenging task. Literature has identified numerous barriers to EBP including negative attitudes and perceptions among nurses and lack of organizational support, time, resources, and confidence with these skills. Creating programs that help nurses appreciate the value and importance of nursing research for practice can be an effective approach in changing the culture. Research Roundtable is a collaborative partnership between a healthcare system and a baccalaureate nursing program to promote EBP and research skills in nurses and nursing students. Initial goals of the program focused on increasing the nurses' knowledge base of the research process and applying research to actual clinical problems. Over the course of 3 years, Roundtable evolved from development and implementation of research projects to concentrating on the identification of clinical problems that could be analyzed and solved through the use of EBP processes. The program has resulted in the completion of research studies, implementation of practice changes based on evidence uncovered in group work, and the approval of research projects in data collection phases. The positive impacts of Roundtable have been identified at the level of the staff nurse and the organization as a whole. This article describes the role of the clinical nurse specialist in the development and implementation of the Research Roundtable. PMID:19858901

  18. The use of cough cardiopulmonary resuscitation in clinical practice.

    PubMed

    Schultz, D D; Olivas, G S

    1986-05-01

    In summary, the cough CPR technique uses physiologic principles similar to those that maintain circulation during chest compression with a number of significant advantages over the latter. At the onset of lethal arrhythmias such as asystole, profound bradycardia, VT, and VF, coughing may assist in maintaining consciousness and an optimum systolic blood pressure. It may also generate the mechanism required to convert the arrhythmia. The simplicity and effectiveness of this technique warrants its consideration for greater clinical use by hospital staff in all monitored settings. It has been noted, however, that clinical research is indicated to more closely examine the proposed cause and effect relationship between cough and arrhythmia conversion and to compare the clinical efficacy between the cough CPR technique and chest blow or other clinical practice measures. PMID:3516934

  19. Unsafe clinical practices as perceived by final year baccalaureate nursing students: Q methodology

    PubMed Central

    2012-01-01

    Background Nursing education necessitates vigilance for clinical safety, a daunting challenge given the complex interchanges between students, patients and educators. As active learners, students offer a subjective understanding concerning safety in the practice milieu that merits further study. This study describes the viewpoints of senior undergraduate nursing students about compromised safety in the clinical learning environment. Methods Q methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning from the perspective of senior students enrolled in a baccalaureate nursing program offered at multiple sites in Ontario, Canada. Across two program sites, 59 fourth year students sorted 43 theoretical statement cards, descriptive of unsafe clinical practice. Q-analysis identified similarities and differences among participant viewpoints yielding discrete and consensus perspectives. Results A total of six discrete viewpoints and two consensus perspectives were identified. The discrete viewpoints at one site were Endorsement of Uncritical Knowledge Transfer, Non-student Centered Program and Overt Patterns of Unsatisfactory Clinical Performance. In addition, a consensus perspective, labelled Contravening Practices was identified as responsible for compromised clinical safety at this site. At the other site, the discrete viewpoints were Premature and Inappropriate Clinical Progression, Non-patient Centered Practice and Negating Purposeful Interactions for Experiential Learning. There was consensus that Eroding Conventions compromised clinical safety from the perspective of students at this second site. Conclusions Senior nursing students perceive that deficits in knowledge, patient-centered practice, professional morality and authenticity threaten safety in the clinical learning environment. In an effort to eradicate compromised safety associated with learning in the clinical milieu, students and educators must embody the ontological

  20. Changing clinical practice: views about the management of adult asthma

    PubMed Central

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

    1999-01-01

    A case study of clinical practice in adult asthma is presented. The case is part of a larger project, funded by the North Thames NHS Executive Research and Development Programme, that sought to explore the part played by clinicians in the implementation of research and development into practice in two areas: adult asthma and glue ear in children. The first case of glue ear in children was reported in a previous issue of this journal (Quality in Health Care 1999;8:99-107). Background information from secondary sources on the condition, treatment, and organisation and location of care is followed by an account of the results of semistructured interviews with 159 clinicians. The findings are reported in two sections: clinical management and the organisation of care, and clinicians' accounts of what, why, and how they introduce changes into their practice. The way clinicians talk about their learning, their expressed views on acceptable practice, and their willingness to change were shown to be informed by construction of legitimate and sufficient evidence, respected colleagues, and accumulated individual experience. There was little open acknowledgment of the influence of organisational factors in influencing practice. To investigate whether relationships between task performance and organisational arrangements found in other sectors apply to UK health, more robust measures by which performance can be evaluated are needed. PMID:10847888

  1. Prognostic Factors Toward Clinically Relevant Radiographic Progression in Patients With Rheumatoid Arthritis in Clinical Practice

    PubMed Central

    Koga, Tomohiro; Okada, Akitomo; Fukuda, Takaaki; Hidaka, Toshihiko; Ishii, Tomonori; Ueki, Yukitaka; Kodera, Takao; Nakashima, Munetoshi; Takahashi, Yuichi; Honda, Seiyo; Horai, Yoshiro; Watanabe, Ryu; Okuno, Hiroshi; Aramaki, Toshiyuki; Izumiyama, Tomomasa; Takai, Osamu; Miyashita, Taiichiro; Sato, Shuntaro; Kawashiri, Shin-ya; Iwamoto, Naoki; Ichinose, Kunihiro; Tamai, Mami; Origuchi, Tomoki; Nakamura, Hideki; Aoyagi, Kiyoshi; Eguchi, Katsumi; Kawakami, Atsushi

    2016-01-01

    Abstract To determine prognostic factors of clinically relevant radiographic progression (CRRP) in patients with rheumatoid arthritis (RA) in clinical practice. We performed a multicenter prospective study in Japan of biological disease-modifying antirheumatic drug (bDMARD)-naive RA patients with moderate to high disease activity treated with conventional synthetic DMARDs (csDMARDs) at study entry. We longitudinally observed 408 patients for 1 year and assessed disease activity every 3 months. CRRP was defined as yearly progression of modified total Sharp score (mTSS) > 3.0 U. We also divided the cohort into 2 groups based on disease duration (<3 vs ≥3 years) and performed a subgroup analysis. CRRP was found in 10.3% of the patients. A multiple logistic regression analysis revealed that the independent variables to predict the development of CRRP were: CRP at baseline (0.30 mg/dL increase, 95% confidence interval [CI] 1.01–1.11), time-integrated Disease Activity Score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) during the 1 year postbaseline (12.4-unit increase, 95%CI 1.17–2.59), RA typical erosion at baseline (95%CI 1.56–21.1), and the introduction of bDMARDs (95%CI 0.06–0.38). The subgroup analysis revealed that time-integrated DAS28-ESR is not a predictor whereas the introduction of bDMARDs is a significant protective factor for CRRP in RA patients with disease duration <3 years. We identified factors that could be used to predict the development of CRRP in RA patients treated with DMARDs. These variables appear to be different based on the RA patients’ disease durations. PMID:27124044

  2. Ten tips for receiving feedback effectively in clinical practice

    PubMed Central

    Algiraigri, Ali H.

    2014-01-01

    Background Despite being recognized as a fundamental part of the educational process and emphasized for several decades in medical education, the influence of the feedback process is still suboptimal. This may not be surprising, because the focus is primarily centered on only one half of the process – the teachers. The learners are the targets of the feedback process and improvement needs to be shifted. Learners need to be empowered with the skills needed to receive and utilize feedback and compensate for less than ideal feedback delivery due to the busy clinical environment. Methods Based on the available feedback literature and clinical experience regarding feedback, the author developed 10 tips to empower learners with the necessary skills to seek, receive, and handle feedback effectively, regardless of how it is delivered. Although, most of the tips are directed at the individual clinical trainee, this model can be utilized by clinical educators involved in learner development and serve as a framework for educational workshops or curriculum. Results Ten practical tips are identified that specifically address the learner's role in the feedback process. These tips not only help the learner to ask, receive, and handle the feedback, but will also ease the process for the teachers. Collectively, these tips help to overcome most, if not all, of the barriers to feedback and bridge the gaps in busy clinical practices. Conclusions Feedback is a crucial element in the educational process and it is shown that we are still behind in the optimal use of it; thus, learners need to be taught how to better receive and utilize feedback. The focus in medical education needs to balance the two sides of the feedback process. It is time now to invest on the learner's development of skills that can be utilized in a busy day-to-day clinical practice. PMID:25079664

  3. Clinical practice of traditional Chinese medicines for chronic heart failure

    PubMed Central

    Fu, Shufei; Zhang, Junhua; Gao, Xiumei; Xia, Ye; Ferrelli, Rita; Fauci, Alice; Guerra, Ranieri; Hu, Limin

    2010-01-01

    Background Chinese medicines have been used for chronic heart failure (CHF) for thousands of years; however, the status of traditional Chinese medicines (TCMs) used for CHF has not been reported. This review was carried out in the framework of a joint Sino-Italian Laboratory. Objective To investigate the baseline of clinical practice of TCMs for CHF, and to provide valuable information for research and clinical practice. Methods The authors included articles about the use of TCMs for the treatment of CHF by searching the Chinese Journal Full-text Database (1994 to November 2007). Results In all, 1029 papers were included, with 239 herbs retrieved from these. The most commonly used herbs included Huangqi (Radix Astragali), Fuling (Poria), Danshen (Radix Salviae Miltiorrhiae), Fuzi (Radix Aconiti Lateralis Preparata) and Tinglizi (Semen Lepidii). Modern Chinese patent medicines (produced by pharmaceutical companies) and traditional prescriptions (comprising several herbs) are the application forms of these drugs. Shenmai, Shengmai and Astragalus injections were the most commonly used Chinese patent medicines. Some classic prescriptions (including Zhenwu decoction, Shengmai powder and Lingguizhugan decoction) were also frequently used. The effectiveness and safety of the TCMs were both satisfactory, and the traditional Chinese medicine and western medicine therapy could significantly improve the clinical effectiveness and reduce some of the adverse reactions from western medicines used alone. Conclusion The authors have acquired overall information about the clinical application of TCMs for CHF. Modern pharmacology has provided limited evidence for the rationality of this clinical use. Further research is needed to provide more evidence. PMID:27325938

  4. The clinical nurse specialist's role as coach in a clinical practice development model.

    PubMed

    Lewis, C K

    1996-06-01

    Over the past 5 years, nursing leadership at St. Luke's Medical Center in Milwaukee has been considering various mechanisms in response to recurrent comments from nursing staff regarding our career ladder. A lack of satisfaction with our career ladder led to the adoption of a new model for nursing. This shift from a career ladder to a clinical ladder has taken place over many years. In April 1994 all staff nurses were staged and transitioned to a clinical practice development model (CPDM). The CPDM is based solely on nursing practice. Our new model was developed from more than 100 narratives of clinical practice submitted by nurses at St. Luke's. Narratives are first-person accounts of an actual clinical experience. The model is based on research conducted by Patricia Benner, PhD, RN, which focused on how nurses acquired their clinical skills and what characteristics are embedded in nurses' practice. This article describes the clinical nurse specialist (CNS) role as a "coach" in facilitating nursing staff transition from a career ladder to a CPDM. The CNS is in a unique position to contribute directly to quality patient care, and also indirectly by fostering professional growth and development of staff nurses. CPDM supports staff development along a continuum. The challenge for the CNS role is to further develop the coaching role to move staff along the continuum. PMID:8900771

  5. Combining Body Mass and Shape Indices in Clinical Practice

    PubMed Central

    Krakauer, Jesse C.

    2016-01-01

    We present preliminary clinical experience with combined consideration of the commonly used BMI (body mass index) and the newly developed ABSI (a body shape index) using a point of care anthropometric calculator for comparisons of index values and associated relative risks to population normals. In a series of 282 patients, BMI and ABSI were close to being independently distributed, supporting the value of considering both indices. Three selected cases illustrate scenarios where assessment of ABSI together with BMI could inform patient care and counseling. These data suggest that combined assessment of BMI and ABSI may prove useful in clinical practice. PMID:27034680

  6. Concept maps: linking nursing theory to clinical nursing practice.

    PubMed

    Daley, B J

    1996-01-01

    The purpose of this article is to offer a different methodology for teaching and learning in continuing nursing education and staff development. This article describes a qualitative research study that analyzed how linkages are made between theoretical material and clinical nursing practice. Findings indicate that nursing students did not link the elements of nursing process together, that clinical preparation was not linked to theoretical material, that the meaning students made of the information was different than the instructors' and that concepts from the basic sciences were not incorporated into student meaning structures. Implications for the use of concept maps as an educational strategy in continuing nursing education are drawn. PMID:8576492

  7. Bringing New PET drugs to clinical practice - a regulatory perspective.

    PubMed

    Hung, Joseph C

    2013-01-01

    The regulatory framework for radioactive drugs, in particular those used in positron emission tomography (PET) scans, has been gradually established since the release of the Food and Drug Administration Modernization Act in 1997. Various guidances specially tailored to accommodate special properties of PET drugs have been issued by the Food and Drug Administration (FDA) in order to ensure this valuable technology (i.e., PET molecular imaging) will continue to be available to patients and yet the safety and efficacy of PET drugs are well regulated so that public health will be protected. This article presents several key elements of this regulatory framework for PET drugs. New regulatory avenues proposed by the FDA to facilitate the research and development process to bring more new PET drugs to clinical practice, as well as to foster the opportunity of using "orphan" PET drugs in clinical practice are also discussed in this paper. PMID:24312157

  8. Operationalization of clinical practice guidelines using fuzzy logic.

    PubMed Central

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

    1997-01-01

    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. PMID:9357633

  9. Bisphosphonates: mechanism of action and role in clinical practice.

    PubMed

    Drake, Matthew T; Clarke, Bart L; Khosla, Suneep

    2008-09-01

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

  10. Ministry of Health Clinical Practice Guidelines: Diabetes Mellitus

    PubMed Central

    Goh, Su Yen; Ang, Seng Bin; Bee, Yong Mong; Chen, Richard YT; Gardner, Daphne; Ho, Emily; Adaikan, Kala; Lee, Alvin; Lee, Chung Horn; Lim, Fong Seng; Lim, Hwee Boon; Lim, Su Chi; Seow, Julie; Soh, Abel Wah Ek; Sum, Chee Fang; Tai, E Shyong; Thai, Ah Chuan; Wong, Tien Yin; Yap, Fabian

    2014-01-01

    The Ministry of Health (MOH) have updated the clinical practice guidelines on Diabetes Mellitus to provide doctors and patients in Singapore with evidence-based treatment for diabetes mellitus. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Diabetes Mellitus, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:25017409

  11. Clinician Perspectives on Using Pharmacogenomics in Clinical Practice

    PubMed Central

    Unertl, Kim M.; Field, Julie R.; Price, Lisa; Peterson, Josh F.

    2015-01-01

    Aim To describe the knowledge and attitudes of clinicians participating in a large pharmacogenomics implementation program. Materials & methods Semi-structured interviews with 15 physicians and nurse practitioners were conducted. Results Three categories of themes were identified: preparation and knowledge, pharmacogenomics usage in practice, and future management of genomic variants. Providers expressed an inability to keep up with the rapid pace of evidence generation and indicated strong support for clinical decision support to assist with genotype-tailored therapies. Concerns raised by clinicians included effectively communicating results, long-term responsibility for actionable results and hand-offs with providers outside the implementation program. Conclusions Clinicians identified their own knowledge deficits, workflow integration, and longitudinal responsibility as challenges to successful usage of pharmacogenomics in clinical practice. PMID:26635887

  12. [Legal responsibility in the exercising of the neurology clinical practice].

    PubMed

    Siso Martín, J

    2004-12-01

    The importance of responsibility in the clinical practice is derived from the transcendency of what they affect (life and health) and the risk implicit to it. The clinical performance does not require curing. The obligations that are derived from them are means and not results. It is also not correct to associate error and responsibility. Responsibility of the professional may be claimed by civil, patrimony, corporative, disciplinary and penal routes based on the reasons and according to who is making the claim. These claims may be presented individually or jointly based on whether the modality of the professional practice is free or carried out by others, whether in public health or private health care. The professional has different alternatives to respond to the possible lawsuits that are presented, both penal and civil action or protection have the common problem of the difficulty of proof. PMID:15719285

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

    PubMed

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

    2016-01-01

    The Office of Nursing Services of the Department of Veterans Affairs (VA) piloted implementation of the clinical nurse leader (CNL) into the care delivery model and established a strategic goal in 2011 to implement the CNL role across the VA health care system. The VA Office of Nursing Services CNL Implementation and Evaluation (CNL I&E) Service was created as one mechanism to facilitate that goal in response to a need identified by facility nurse executives for consultative support for CNL practice integration. This article discusses strategies employed by the CNL I&E consultative team to help facility-level nursing leadership integrate CNLs into practice. Measures of success include steady growth in CNL practice capacity as well as positive feedback from nurse executives about the value of consultative engagement. Future steps to better integrate CNL practice into the VA include consolidation of lessons learned, collaboration to strengthen the evidence base for CNL practice, and further exploration of the transformational potential of CNL practice across the care continuum. PMID:26636231

  14. Clinical Decision Support for Vascular Disease in Community Family Practice

    PubMed Central

    Keshavjee, K; Holbrook, AM; Lau, E; Esporlas-Jewer, I; Troyan, S

    2006-01-01

    The COMPETE III Vascular Disease Tracker (C3VT) is a personalized, Web-based, clinical decision support tool that provides patients and physicians access to a patient’s 16 individual vascular risk markers, specific advice for each marker and links to best practices in vascular disease management. It utilizes the chronic care model1 so that physicians can better manage patients with chronic diseases. Over 1100 patients have been enrolled into the COMPETE III study to date.

  15. Boundary issues in clinical practice as reported by Army social workers.

    PubMed

    Pehrson, Kyle Lynn; Hamlin, Elwood R

    2002-01-01

    Clinical practice in military settings requires the clinician to be acutely aware of boundary issues that may arise. Given the legal significance associated with therapeutic relationships in which one stands in a special relationship of trust, confidence, or responsibility, setting appropriate boundaries in practice is critical. This article specifically addresses various questions faced by mental health practitioners in making boundary-related choices. The code of ethics of the National Association of Social Work as well as those of other disciplines now place increasing emphasis on the obligation to protect the public from known or perceived risks emanating from boundary crossings. This article presents the findings of a study involving active duty and reserve Army clinical social work officers regarding boundary issues. The study addresses the social work officers' perceptions of boundary issues and behavior related to boundary choices in clinical practice. The results provide insight regarding boundary crossings, boundary violations, and dual relationships. PMID:11799807

  16. Ethical Behaviours in Clinical Practice Among Mexican Health Care Workers

    PubMed Central

    Valdez-Martínez, Edith; Lavielle, Pilar; Bedolla, Miguel; Squires, Allison

    2009-01-01

    The objective of this study was to describe the cultural domain of ethical behaviours in clinical practice as defined by health care providers in Mexico. Structured interviews were carried out with 500 health professionals employed at the Mexican Institute of Social Security in Mexico City. The Smith Salience Index was used to evaluate the relevance of concepts gathered from the free listings of the interviewees. Cluster analysis and factor analysis facilitated construction of the conceptual categories, which the authors refer to as ‘dimensions of ethical practice’. Six dimensions emerged from the analysis to define the qualities that comprise ethical clinical practice for Mexican health care providers: overall quality of clinical performance; working conditions that favour quality of care; use of ethical considerations as prerequisites for any health care intervention; values favouring teamwork in the health professional–patient relationship; patient satisfaction scores; and communication between health care providers and patients. The findings suggest that improved working conditions and management practices that promote the values identified by the study’s participants would help to improve quality of care. PMID:18849364

  17. General practitioners and clinical practice guidelines: a reexamination.

    PubMed

    Clerc, Isabelle; Ventelou, Bruno; Guerville, Marc-André; Paraponaris, Alain; Verger, Pierre

    2011-08-01

    General practitioners' (GPs') use of clinical practice guidelines (CPGs) may be influenced by various contextual and attitudinal factors. This study examines general attitudes toward CPGs to establish profiles according to these attitudes and to determine if these profiles are associated with awareness and with use of CPGs in daily practice. The authors conducted a cross-sectional telephone survey of 1,759 French GPs and measured (a) their general attitudes toward CPGs and (b) their awareness and use in daily practice of CPGs for six specific health problems. A bivariate probit model was used with sample selection to analyze the links between GPs' general attitudes and CPG awareness/use. The authors found three GP profiles according to their opinions toward CPGs and a positive association between these profiles and CPG awareness but not use. It is important to build awareness of CPGs before GPs develop negative attitudes toward them. PMID:21536601

  18. Conflict of interest reporting in otolaryngology clinical practice guidelines.

    PubMed

    Sun, Gordon H

    2013-08-01

    Clinical practice guidelines (CPGs) have become increasingly important in recent years due to an increasing emphasis on evidence-based practice, as well as serious discussions in academic, medical, and legal circles about their possible role in measuring physician performance, setting provider reimbursement strategy, and establishing protection from litigation in the future. At the same time, CPGs are costly to develop. Thus, as CPGs gain influence in medical practice, it will become essential that CPGs are developed using trustworthy standards and that the authors of CPGs are not being unduly influenced by financial pressures from external stakeholders. Since 2004, the 9 CPGs sponsored by the American Academy of Otolaryngology-Head and Neck Surgery Foundation have been developed with full disclosure and appropriate management of potential financial conflicts of interest. This commentary discusses the potential for conflict of interest in otolaryngology CPGs and how the otolaryngology guideline development process can serve as a model for other professional medical organizations. PMID:23702973

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

    PubMed Central

    Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

    2015-01-01

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

  20. Good clinical practice: a nuisance, a help or a necessity for clinical pharmacology?

    PubMed Central

    Sweatman, John

    2003-01-01

    This article reviews the impact of good clinical practice (GCP) on clinical pharmacology with particular reference to the new European Union Clinical Trial Directive. The Directive will be applied to both commercial and noncommercial studies on medicinal products for human use. The Directive requires that GCP should be used in all clinical trials except noninterventional studies. GCP is likely to follow the International Conference on Harmonization GCP guidelines in many aspects. GCP will enforce tighter guidelines on ethical aspects of a clinical study. Higher standards will be required in terms of comprehensive documentation for the clinical protocol, record keeping, training, and facilities including computers. Quality assurance and inspections will ensure that these standards are achieved. The additional requirements of GCP are discussed and any advantage to the study subject. The impact of the new Directive within the Research Governance Framework of the UK Department of Health is reviewed. PMID:12534634

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

    ERIC Educational Resources Information Center

    Baker, Elise; McLeod, Sharynne

    2011-01-01

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

  2. Autonomy and Privacy in Clinical Laboratory Science Policy and Practice.

    PubMed

    Leibach, Elizabeth Kenimer

    2014-01-01

    Rapid advancements in diagnostic technologies coupled with growth in testing options and choices mandate the development of evidence-based testing algorithms linked to the care paths of the major chronic diseases and health challenges encountered most frequently. As care paths are evaluated, patient/consumers become partners in healthcare delivery. Clinical laboratory scientists find themselves firmly embedded in both quality improvement and clinical research with an urgent need to translate clinical laboratory information into knowledge required by practitioners and patient/consumers alike. To implement this patient-centered care approach in clinical laboratory science, practitioners must understand their roles in (1) protecting patient/consumer autonomy in the healthcare informed consent process and (2) assuring patient/consumer privacy and confidentiality while blending quality improvement study findings with protected health information. A literature review, describing the current ethical environment, supports a consultative role for clinical laboratory scientists in the clinical decision-making process and suggests guidance for policy and practice regarding the principle of autonomy and its associated operational characteristics: informed consent and privacy. PMID:26084151

  3. Evidence-based clinical practice guidelines for chronic pancreatitis 2015.

    PubMed

    Ito, Tetsuhide; Ishiguro, Hiroshi; Ohara, Hirotaka; Kamisawa, Terumi; Sakagami, Junichi; Sata, Naohiro; Takeyama, Yoshifumi; Hirota, Morihisa; Miyakawa, Hiroyuki; Igarashi, Hisato; Lee, Lingaku; Fujiyama, Takashi; Hijioka, Masayuki; Ueda, Keijiro; Tachibana, Yuichi; Sogame, Yoshio; Yasuda, Hiroaki; Kato, Ryusuke; Kataoka, Keisho; Shiratori, Keiko; Sugiyama, Masanori; Okazaki, Kazuichi; Kawa, Shigeyuki; Tando, Yusuke; Kinoshita, Yoshikazu; Watanabe, Mamoru; Shimosegawa, Tooru

    2016-02-01

    Chronic pancreatitis is considered to be an irreversible progressive chronic inflammatory disease. The etiology and pathology of chronic pancreatitis are complex; therefore, it is important to correctly understand the stage and pathology and provide appropriate treatment accordingly. The newly revised Clinical Practice Guidelines of Chronic Pancreatitis 2015 consist of four chapters, i.e., diagnosis, staging, treatment, and prognosis, and includes a total of 65 clinical questions. These guidelines have aimed at providing certain directions and clinically practical contents for the management of chronic pancreatitis, preferentially adopting clinically useful articles. These revised guidelines also refer to early chronic pancreatitis based on the Criteria for the Diagnosis of Chronic Pancreatitis 2009. They include such items as health insurance coverage of high-titer lipase preparations and extracorporeal shock wave lithotripsy, new antidiabetic drugs, and the definition of and treatment approach to pancreatic pseudocyst. The accuracy of these guidelines has been improved by examining and adopting new evidence obtained after the publication of the first edition. PMID:26725837

  4. Vitamin D in North-East Asian clinical nutrition practice.

    PubMed

    Wahlqvist, Mark L

    2013-01-01

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

  5. Re-engineering Opportunities in Clinical Research using Workflow Analysis in Community Practice Settings

    PubMed Central

    Khan, Sharib A.; Kukafka, Rita; Bigger, J. Thomas; Johnson, Stephen B.

    2008-01-01

    In this paper we examine frequently performed clinical research activities with the objective of identifying aspects of workflow that could be amenable to informatics-based re-engineering. This paper is part of a series of studies under the NIH Roadmap initiative, which examines workflow of clinical research in community practices. We describe three common work activities, detailing the main actors involved, the tools used and the challenges faced. These activities illustrate inefficiencies in the clinical research workflow which include: a) lack of supporting tools to perform routine work activities, b) redundancy, low reuse of data and poor interoperability between systems and c) the fragmented and distributed nature of the workflow. We identify opportunities for re-engineering at both a micro (activity) and macro level (organization). PMID:18999299

  6. Practical clinical considerations of luting cements: A review

    PubMed Central

    Lad, Pritam P; Kamath, Maya; Tarale, Kavita; Kusugal, Preethi B

    2014-01-01

    The longevity of fixed partial denture depends on the type of luting cement used with tooth preparation. The clinician’s understating of various cements, their advantages and disadvantages is of utmost importance. In recent years, many luting agents cements have been introduced claiming clinically better performance than existing materials due to improved characteristics. Both conventional and contemporary dental luting cements are discussed here. The various agents discussed are: Zinc phosphate, Zinc polycarboxylate, Zinc oxide-eugenol, Glass-ionomer, Resin modified GIC, Compomers and Resin cement. The purpose of this article is to provide a discussion that provides a clinical perspective of luting cements currently available to help the general practitioner make smarter and appropriate choices. How to cite the article: Lad PP, Kamath M, Tarale K, Kusugal PB. Practical clinical considerations of luting cements: A review. J Int Oral Health 2014;6(1):116-20. PMID:24653615

  7. Practical clinical considerations of luting cements: A review.

    PubMed

    Lad, Pritam P; Kamath, Maya; Tarale, Kavita; Kusugal, Preethi B

    2014-02-01

    The longevity of fixed partial denture depends on the type of luting cement used with tooth preparation. The clinician's understating of various cements, their advantages and disadvantages is of utmost importance. In recent years, many luting agents cements have been introduced claiming clinically better performance than existing materials due to improved characteristics. Both conventional and contemporary dental luting cements are discussed here. The various agents discussed are: Zinc phosphate, Zinc polycarboxylate, Zinc oxide-eugenol, Glass-ionomer, Resin modified GIC, Compomers and Resin cement. The purpose of this article is to provide a discussion that provides a clinical perspective of luting cements currently available to help the general practitioner make smarter and appropriate choices. How to cite the article: Lad PP, Kamath M, Tarale K, Kusugal PB. Practical clinical considerations of luting cements: A review. J Int Oral Health 2014;6(1):116-20. PMID:24653615

  8. Clinical application of plasma thermograms. Utility, practical approaches and considerations

    PubMed Central

    Garbett, Nichola C.; Mekmaysy, Chongkham S.; DeLeeuw, Lynn; Chaires, Jonathan B.

    2014-01-01

    Differential scanning calorimetry (DSC) studies of blood plasma are part of an emerging area of the clinical application of DSC to biofluid analysis. DSC analysis of plasma from healthy individuals and patients with various diseases has revealed changes in the thermal profiles of the major plasma proteins associated with the clinical status of the patient. The sensitivity of DSC to the concentration of proteins, their interactions with other proteins or ligands, or their covalent modifications underlies the potential utility of DSC analysis. A growing body of literature has demonstrated the versatility and performance of clinical DSC analysis across a range of biofluids and in a number of disease settings. The principles, practice and challenges of DSC analysis of plasma are described in this article. PMID:25448297

  9. [Embryo vitrification: French clinical practice analysis for BLEFCO].

    PubMed

    Hesters, L; Achour-Frydman, N; Mandelbaum, J; Levy, R

    2013-09-01

    Frozen thawed embryo transfer is currently an important part of present-day assisted reproductive technology (ART) aiming at increasing the clinical pregnancy rate per oocyte retrieval. Although slow freezing method has been the reference during 2 decades, the recent years witnessed an expansion of ultrarapid cryopreservation method named vitrification. Recently in France, vitrification has been authorized for cryopreserving human embryos. Therefore BLEFCO consortium decides to perform a descriptive study through questionnaires to evaluate the state of vitrification in the French clinical practice. Questionnaires were addressed to the 105 French centres of reproductive biology and 60 were fully completed. Data analysis revealed that embryo survival rate as well as, clinical pregnancy rate were increased after vitrification technology when compared to slow freezing procedure. Overall, these preliminary data suggest that vitrification may improve ART outcomes through an increasing of the cumulative pregnancy rate per oocyte retrieval. PMID:23962680

  10. Parenteral trace element provision: recent clinical research and practical conclusions.

    PubMed

    Stehle, P; Stoffel-Wagner, B; Kuhn, K S

    2016-08-01

    The aim of this systematic review (PubMed, www.ncbi.nlm.nih.gov/pubmed and Cochrane, www.cochrane.org; last entry 31 December 2014) was to present data from recent clinical studies investigating parenteral trace element provision in adult patients and to draw conclusions for clinical practice. Important physiological functions in human metabolism are known for nine trace elements: selenium, zinc, copper, manganese, chromium, iron, molybdenum, iodine and fluoride. Lack of, or an insufficient supply of, these trace elements in nutrition therapy over a prolonged period is associated with trace element deprivation, which may lead to a deterioration of existing clinical symptoms and/or the development of characteristic malnutrition syndromes. Therefore, all parenteral nutrition prescriptions should include a daily dose of trace elements. To avoid trace element deprivation or imbalances, physiological doses are recommended. PMID:27049031

  11. JCL roundtable: PCSK9 inhibitors in clinical practice.

    PubMed

    Brown, W Virgil; Moriarty, Patrick M; McKenney, James M

    2016-01-01

    The roundtable this month will involve a discussion of two new drugs that have been approved by the Food and Drug Administration for the reduction of low-density lipoprotein cholesterol (LDL-C). The Food and Drug Administration approved the first of these, alirocumab as an "adjunct to diet and maximally tolerated statin therapy for the treatment of adults with heterozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease, who require additional lowering of LDL [low-density lipoprotein]-cholesterol." Evolucumab has similar indications plus an indication specifically for treatment of homozygous familial hypercholesterolemia. This sets the stage for their clinical use and in this roundtable, we will discuss with two experts, the implications of these indications for the practicing physician. Dr McKenney and Dr Moriarty have had extensive experience in the conduct of clinical trials that provided the evidence of safety and efficacy of these so called PCSK9 inhibitors. PMID:26892118

  12. A retrospective of personal craniofaciodental research and clinical practice.

    PubMed

    Sarnat, B G

    1997-07-01

    Recent reports have emphasized the need for further knowledge about the growth of bone(s). This is particularly true because an understanding of the normal and abnormal growth of bone(s) forms the basis of early recognition and appropriate treatment of many deformities. It is less well appreciated, however, that the findings in the abnormal may be employed to test and extend our knowledge of the normal. Genetic makeup, as well as various types of diseases and injuries such as trauma, inflammation, radiation, and chemicals, may affect skeletal growth sites and centers, thereby causing faulty growth of bone(s). The degree of the subsequent deformity will depend not only on the type, intensity, extent, and chronology of the noxious agent but also on the site and its particular susceptibility and growth activity. The problem of treatment of craniofaciodental deformities is a difficult one. Over the years, I conceived, designed, initiated, and carried out a series of experiments in regard to bone(s), teeth, and cartilage in both young and adult animals (turtles, rats, gophers, lagomorphs, pigs, dogs, and monkeys). Eventually, I directed my efforts principally toward local surgical experimentation as it related to both normal and abnormal gross postnatal craniofaciodental growth. Because of the wide variety of different structures, their interrelated individualities, and the challenges presented in both its richness of sites of growth and complexity, the skull proved to be a most unusual source of study. The purpose of this selective, organized, and limited review, analysis, and summary of personally conducted experiments is to relate certain aspects of differential growth and change and nonchange to age, sites, rates, factors, and mechanisms. In many instances, correlations are made between research findings and clinical practice. No such similar report as this was found in the literature. This retrospective study brings it all together. PMID:9207672

  13. 7 CFR 1469.8 - Conservation practices and activities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... General Provisions § 1469.8 Conservation practices and activities. (a) Conservation practice and activity selection. (1) The Chief will provide a list of structural and land management practices and activities... practices and activities and their associated rates, the Chief will consider: (i) The cost and...

  14. Clinical Nurse Leader Integration Into Practice: Developing Theory To Guide Best Practice.

    PubMed

    Bender, Miriam

    2016-01-01

    Numerous policy bodies have identified the clinical nurse leader (CNL) as an innovative new role for meeting higher health care quality standards. Although there is growing evidence of improved care environment and patient safety and quality outcomes after redesigning care delivery microsystems to integrate CNL practice, significant variation in CNL implementation has been noted across reports, making it difficult to causally link CNL practice to reported outcomes. This variability reflects the overall absence in the literature of a well-defined CNL theoretical framework to help guide standardized application in practice. To address this knowledge gap, an interpretive synthesis with a grounded theory analysis of CNL narratives was conducted to develop a theoretical model for CNL practice. The model clarifies CNL practice domains and proposes mechanisms by which CNL-integrated care delivery microsystems improve health care quality. The model highlights the need for a systematic approach to CNL implementation including a well-thought out strategy for care delivery redesign; a consistent, competency-based CNL workflow; and sustained macro-to-micro system leadership support. CNL practice can be considered an effective approach to organizing nursing care that maximizes the scope of nursing to influence the ways care is delivered by all professions within a clinical microsystem. PMID:26802589

  15. \\How Can Clinical Ethics Committees Take on Organizational Ethics? Some Practical Suggestions.

    PubMed

    Sabin, James E

    2016-01-01

    Although leaders in the field of ethics have for many years pointed to the crucial role that organizations play in shaping healthcare ethics, organizational ethics remains a relatively undeveloped area of ethics activity. Clinical ethics committees are an important source of potential expertise, but new skills will be required. Clinical ethics committees seeking to extend their purview to organizational issues will have to respond to three challenges-how to gain sanction and support for addressing controversial and sensitive issues, how to develop an acceptable process, and how to make a difference on the ground. The article presents practical suggestions for how clinical ethics committees meet these challenges. PMID:27333061

  16. Some Practical Aspects of Electromagnetic Activation

    NASA Astrophysics Data System (ADS)

    MacLeod, C.; Gow, K. S.; Capanni, N.

    Electromagnetic Activation (EMA) is an alternative to combustion in Scramjet-like hypersonic engines. The basis of the system was outlined in previous publications. This paper builds on these results and explores some further practical and theoretical aspects of its operation. These include the beam paths and thermodynamics of the duct, the efficiency of the system, a review of the available radiation generation devices and a discussion of power supply options.

  17. Practical Clinical Trials in Psychopharmacology: a Systematic Review

    PubMed Central

    Vitiello, Benedetto

    2015-01-01

    Practical clinical trials (PCT) are randomized experiments under typical practice conditions with the aim of testing the “real life” benefits and risks of therapeutic interventions. Influential PCTs have been conducted in cardiology, oncology, and internal medicine. Psychotropic medications are widely and increasingly used in medical practice. This review examines recent progress in conducting PCTs in psychopharmacology. The January 2000 – October 2014 MEDLINE, Scopus, and ClinicalTrials.gov databases were searched for peer-reviewed publications of PCTs with at least 100 subjects per treatment arm. Most PCTs in psychiatry evaluated mental health services or psychosocial interventions rather than specific pharmacotherapies. Of 157 PCTs in psychiatry, 30 (19%) were in psychopharmacology, with a median of 2 publications per year and no increase over the period of observation. Sample size ranged from 200 to 18,154; only 11 studies randomized 500 patients or more. Psychopharmacology PCTs were equally likely to be funded by industry as by public agencies. There were 10 PCTs of antidepressants, for a total of 4,206 patients (in comparison with at least 46 PCT of antihypertensive medications, for a total of 208,014 patients). Some psychopharmacology PCTs used suicidal behavior, treatment discontinuation, or mortality as primary outcome, and produced effectiveness and safety data that have influenced both practice guidelines and regulatory decisions. PCTs can constitute an important source of information for clinicians, patients, regulators, and policy makers, but have been relatively underutilized in psychopharmacology. Electronic medical records and integrated practice research networks offer promising platforms for a more efficient conduct of PCTs. PMID:25679131

  18. [Eslicarbazepine acetate in clinical practice. Efficacy and safety results].

    PubMed

    Serrano-Castro, Pedro J; Payán-Ortiz, Manuel; Cimadevilla, José M; Quiroga-Subirana, Pablo; Fernández-Pérez, Javier

    2013-03-16

    INTRODUCTION. Eslicarbazepine acetate (ESL) is a new antiepileptic drug (AED) licensed in Spain in February 2011 as an adjunctive therapy in adults with partial seizures with or without secondary generalization. Clinical trials with ESL have demonstrated acceptable efficacy and safety. AIM. To evaluate the results of ESL in our epilepsy unit during its first year of clinical experience with this AED. PATIENTS AND METHODS. We included all patients who started treatment with ESL at our epilepsy unit from March 2011 to May 2012. We collected the following variables: gender, aetiology of epilepsy, epileptogenic area, reason for switch to ESL, clinical response after initiation of ESL, adverse effects of ESL, refractoriness criteria and treatment discontinuation. A bivariate factor-to-factor correlation study was carried out to establish associations between the independent variables and the clinical response. RESULTS. We recruited 105 patients (51.4% male). 20,7% of patients remained seizure-free and 58.4% showed > 50% improvement after introduction of ESL. At 6 months, 18.1% had experienced some type of side effect, with cognitive disorders being the most common, and 11.5% had discontinued treatment. Combination with lacosamide proved to be significantly less effective in the control of seizures. Combination of ESL with the rest of sodium channel inhibitors was similar in efficacy to others combinations. CONCLUSIONS. ESL is a well-tolerated and effective AED when is used as adjunctive treatment with most of other AED in clinical practice. PMID:23483464

  19. On the Relation of Clinical Research to Clinical Practice: Current Issues, New Directions.

    ERIC Educational Resources Information Center

    Barlow, David H.

    1981-01-01

    In seven articles methods of enhancing clinical practice through empirical approaches and realistic approaches and realistic research are discussed including: (1) Cronbach's method of intensive observation; (2) intensive monitoring of treatment strength, integrity, and effectiveness; (3) the use of dependent measures; (4) drawing valid conclusions…

  20. Good clinical practice is now obligatory in academic clinical drug research in the European Union.

    PubMed

    Jørgensen, Annette; Bach, Karin Friis; Friis, Karen

    2004-02-01

    By May 2004, all clinical trials in the European Union (EU) on medicinal products have to be initiated and conducted in compliance with the principles in the new directive on Good Clinical Practice (GCP). This requirement will also apply to non-commercial trials involving registered drugs and may therefore restrain the academic clinical drug research. In Denmark, three public GCP units connected in a national network and associated with the university hospitals in Copenhagen, Odense and Aarhus have been established. The GCP units offer academic researchers the necessary quality assurance and quality control systems to ensure that clinical drug research can be performed according to GCP. The Danish initiative is presented here as a contribution to the future work with implementation of the principles of GCP in academic clinical drug research in the European Union. PMID:14748847

  1. Treating sarcopenia in clinical practice: where are we now?

    PubMed

    De Spiegeleer, Anton; Petrovic, Mirko; Boeckxstaens, Pauline; Van Den Noortgate, Nele

    2016-08-01

    Sarcopenia - or the loss of muscle mass, strength and function with ageing - represents an important health issue of the twenty-first century because of its devastating effects in addition to an increased prevalence of aged people. The devastating health effects of sarcopenia are multiple: an increased falls risk, a decreased physical ability and quality of life and an independent increase of all-cause mortality. Although the ultimate remedy for sarcopenia yet has to be found, some interventions have proven their merit and might be of practical use in clinical practice, especially for geriatricians, who deal most with sarcopenia. This review intends to summarize the current therapeutic interventions, their proposed mechanism of action as well as their clinical value. The results of our review highlight the importance of exercise (50% resistance training, 50% endurance training), nutrition (25-30 g proteins with essential amino acids every meal and long-chain ω-3 fatty acids) and limitation of alcohol and smoking. In addition, studies also suggest a place for vitamin D (aim serum levels >30 ng/L), testosterone (aim serum levels >300 ng/dL) and creatine (15-20 g/d for five days, thereafter 3-5 g/d). In conclusion, although more studies are needed to elucidate the exact effectiveness and safety of many sarcopenia interventions, the current evidence already provides clinically useful information, which might benefit the patient with (pre-)sarcopenia. PMID:27112427

  2. Pathogenesis of Acute Kidney Injury: Foundation for Clinical Practice

    PubMed Central

    Kinsey, Gilbert R.; Okusa, Mark D.

    2011-01-01

    The pathogenesis of acute kidney injury (AKI) is complex, involving factors such as vasoconstriction, leukostasis, vascular congestion, cell death, and abnormal immune modulators and growth factors. Many targeted clinical therapies have failed, are inconclusive, or have yet to be tested. Given the complexity of the pathogenesis of AKI, it may be naïve to expect one therapeutic intervention would have success. Some examples of detrimental processes that can be blocked in pre-clinical models to improve kidney function and survival are apoptotic cell death in tubular epithelial cells, complement-mediated immune system activation, and impairment of cellular homeostasis and metabolism. Modalities with potential to reduce morbidity and mortality in AKI include vasodilators, growth factors, anti-inflammatory agents, and cell-based therapies. Pharmacological agents that target these diverse pathways are being used clinically for other indications. Using combinatorial approaches in future clinical trials may improve our ability to prevent and treat AKI. PMID:21530035

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

    PubMed

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

    2011-05-01

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

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

    PubMed

    Anderson, Joel G; Taylor, Ann Gill

    2011-09-01

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

  5. Effectiveness and safety of natalizumab in real-world clinical practice: Review of observational studies.

    PubMed

    van Pesch, Vincent; Sindic, Christian J; Fernández, Oscar

    2016-10-01

    Clinical trials have shown that natalizumab is highly effective for treating relapsing forms of multiple sclerosis (MS). The purpose of this analysis was to conduct a targeted review of data from country-specific observational studies and registries of natalizumab-treated patients with relapsing MS in order to more fully investigate the longer-term effectiveness and safety of this disease-modifying therapy in real-world clinical practice settings. A PubMed search was conducted on March 13, 2014, using the terms (natalizumab AND multiple sclerosis) AND (observational OR registry OR post-marketing OR clinical practice). Only English-language papers that reported effectiveness (in terms of effects on relapses, disability progression, and magnetic resonance imaging findings) and/or safety results from studies were included. Data from 22 studies/registries were included. Annualized relapse rates decreased by 73%-94% from baseline across the studies, with improvement maintained for up to 5 years during natalizumab treatment. Natalizumab effectiveness was also demonstrated via assessment of disability progression (Expanded Disability Status Scale), radiological measures, and no-evidence-of-disease-activity measures (clinical, radiological, and overall). Results were similar among patient groups stratified by level of disease activity. Safety outcomes were consistent with natalizumab's known safety profile. Data from country-specific observational studies and registries varying in size and scope support the effectiveness and safety of natalizumab in a broad range of patients in clinical practice. PMID:27475049

  6. An Appraisal of Clinical Practice Guidelines for Diabetic Retinopathy.

    PubMed

    Wu, Connie M; Wu, Annie M; Young, Benjamin K; Wu, Dominic J; Margo, Curtis E; Greenberg, Paul B

    2016-07-01

    The objective is to evaluate the methodological quality of clinical practice guidelines (CPGs) published by the American Academy of Ophthalmology (AAO), Canadian Ophthalmological Society (COS), and Royal College of Ophthalmologists (RCO) for diabetic retinopathy. Four evaluators independently appraised the CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which covers 6 domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence). Scores ranged from 35% to 78% (AAO), 60% to 92% (COS), and 35% to 82% (RCO). Intraclass correlation coefficients for the reliability of mean scores were 0.78, 0.78, and 0.79, respectively. The strongest domains were Scope and Purpose, and Clarity of Presentation (COS). The weakest were Stakeholder Involvement (AAO), Rigor of Development (AAO, RCO), Applicability, and Editorial Independence (RCO). Diabetic retinopathy practice guidelines can be improved by targeting Stakeholder Involvement, Rigor of Development, Applicability, and Editorial Independence. PMID:25742906

  7. Some business and tax aspects of clinical practice plans.

    PubMed

    Mancino, D

    1978-10-01

    Medical schools throughout the country have developed diverse organizational forms through which their faculty members provide clinical services. In this article the author reviews several of the reasons frequently offered to support involvement of a medical school in a faculty practice plan and suggests many business and tax considerations which should be taken into account by a medical school in developing a plan to meet its objectives. He also reviews many of the considerations involved in establishing and operating specific types of group practice plans. The author concludes that, with conscientious planning and implementation, faculty members can receive professional satisfaction, medical schools can obtain many benefits, and the public will benefit from improved health care. PMID:712767

  8. Comments on gestational diabetes mellitus: from pathophysiology to clinical practice.

    PubMed

    Poulakos, Pavlos; Mintziori, Gesthimani; Tsirou, Efrosini; Taousani, Eleftheria; Savvaki, Dimitra; Harizopoulou, Vikentia; Goulis, Dimitrios G

    2015-01-01

    Gestational diabetes mellitus (GDM) is a topic of major interest, as it affects up to 16% of pregnant women and may lead to adverse pregnancy outcomes, which, however, are preventable by appropriate treatment. The aim of the present study was to discuss basic concepts and to critically appraise recent updates on practical issues in the field of GDM. GDM pathophysiology, long-term complications including "fetal programming" and GDM diagnosis are discussed, while clinical practice guidelines on follow-up, medical nutrition therapy, oral hypoglycemic agents and insulin treatment are also reviewed. GDM comprises a serious yet preventable public health problem and prevention by lifestyle changes, early detection and adequate treatment can lead to better health outcomes for both mothers with GDM and their offspring. PMID:26188220

  9. [General Strategies for Implementation of Clinical Practice Guidelines].

    PubMed

    Valenzuela-Flores, Adriana Abigail; Viniegra-Osorio, Arturo; Torres-Arreola, Laura Laura

    2015-01-01

    The need to use clinical practice guidelines (CPG) arises from the health conditions and problems that public health institutions in the country face. CPG are informative documents that help improve the quality of care processes and patient safety; having among its objectives, to reduce the variability of medical practice. The Instituto Mexicano del Seguro Social designed a strategic plan for the dissemination, implementation, monitoring and control of CPG to establish an applicable model in the medical units in the three levels of care at the Instituto. This paper summarizes some of the strategies of the plan that were made with the knowledge and experience of clinicians and managers, with which they intend to promote the adoption of the key recommendations of the guidelines, to promote a sense of belonging for health personnel, and to encourage changes in organizational culture. PMID:26506498

  10. A Person-Centered Approach to Clinical Practice

    PubMed Central

    Wong, Kathleen M.; Cloninger, C. Robert

    2015-01-01

    Effective clinical practice depends on tools that facilitate nonstigmatizing personality assessment, rapid development of a therapeutic alliance, and the guided development of self-awareness so that people learn how to live well. As an expert in psychological medicine, the psychiatrist is uniquely qualified to develop a holistic treatment approach addressing the needs of the person's body, thoughts, and psyche for the promotion of health and well-being. Personality assessment can be integrated into psychiatric practice in a way that is practical and that has many benefits for the psychiatrist and his or her patients. Personal reflection on one's temperament and character profile promotes understanding without judging or blaming. The dialogue between psychiatrist and patient about personality promotes the rapid development of a therapeutic alliance based on mutual respect, positive regard, and shared goals. The expertise and empathy of the psychiatrist in knowing more about the person's strengths and vulnerabilities beyond even the person's own awareness builds respect, trust, and hope. In this way, the assessment of personality promotes recovery of well-being and reduces disease and stigma. Likewise, the psychiatrist is more effective and satisfied with practice, standing ready with expertise, patience, and compassion to assist patients to work and develop at their own chosen pace. PMID:26029006

  11. Experience of isolated sleep paralysis in clinical practice in Nigeria.

    PubMed Central

    Ohaeri, J. U.

    1992-01-01

    The supernatural fears associated with the experience of isolated sleep paralysis in the culture of developing countries is sometimes associated with the evolution of somatic symptoms of psychological origin in patients predisposed to neurotic illness. Patients rarely spontaneously volunteer these fears and doctors pay them scant attention. Illustrative case histories that demonstrate the dynamics of the clinical presentation, as well as the treatment approach, are highlighted. It is hoped that doctors in general medical practice and in psychological medicine in developing countries where belief in supernatural causation of illness is rife will consider these factors in order to provide more effective treatment. PMID:1608064

  12. Supporting patients in shared decision making in clinical practice.

    PubMed

    Madsen, Claire; Fraser, Aileen

    2015-04-01

    This article defines shared decision making in patient care and describes the background to this philosophy. The shared decision making approach is part of a wider initiative to promote patient-centred care and increase patient involvement in clinical decisions. Shared decision making recognises patients' rights to make decisions about their care and is used to assist them to make informed and individualised decisions about care and treatment. As well as reviewing the principles of shared decision making, the article offers practical guidance on how nurses can implement this initiative, including information on sharing expertise, agenda setting, assessing risks and benefits, setting goals, and support and follow up. PMID:25828022

  13. Current Clinical Practice Scenario of Osteoporosis Management in India

    PubMed Central

    Jhaveri, Shailesh; Upashani, Tejas; Bhadauria, Jitendra; Patel, Kamlesh

    2015-01-01

    Background Various osteoporosis guidelines are available for practice. Aim To understand the current clinical practice scenario from the perspective of Indian orthopaedicians, especially about the epidemiology, clinical manifestations, approach to diagnosis and management and patient compliance patterns to long term treatment. Materials and Methods A pre-validated structured questionnaire containing questions (mostly objective, some open-ended) catering to various objectives of the study was circulated amongst orthopaedic surgeons across India by means of post/courier, after giving a brief overview of the study telephonically. Data was extracted from the completed questionnaires, and analysed using Microsoft Excel software. Results The questionnaire was filled by a total of 84 orthopaedicians throughout India. The prevalence of osteoporosis in India according to the orthopaedic surgeons was 38.4% and there was a female preponderance. Most of the respondents felt out of every 100 osteoporosis patients in India, less than 20 patients are actually diagnosed and treated for osteoporosis. The most common initial presenting feature of established osteoporosis cases was general symptoms. Most respondents preferred Dual-energy X-ray absorptiometry (DEXA) as the initial investigation for the diagnosis of osteoporosis in a patient presenting with typical features. While most respondents preferred once-a-month oral over intravenous (IV) bisphosphonates, they agreed that IV administration had advantages such as lower gastrointestinal side effects and improved compliance. The average duration of therapy of oral bisphosphonates was the longest (27.04 months) among the other anti- osteoporosis therapies that they used. On an average, the patient compliance rate in osteoporosis management was around 64%. IV Zoledronic acid (ZA) and intranasal calcitonin were infrequently used than other anti- osteoporosis therapies. While concerns about cost and availability deterred more frequent

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

    PubMed

    Calderón Montero, A

    2014-07-01

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

  15. Experience of isolated sleep paralysis in clinical practice in Nigeria.

    PubMed

    Ohaeri, J U

    1992-06-01

    The supernatural fears associated with the experience of isolated sleep paralysis in the culture of developing countries is sometimes associated with the evolution of somatic symptoms of psychological origin in patients predisposed to neurotic illness. Patients rarely spontaneously volunteer these fears and doctors pay them scant attention. Illustrative case histories that demonstrate the dynamics of the clinical presentation, as well as the treatment approach, are highlighted. It is hoped that doctors in general medical practice and in psychological medicine in developing countries where belief in supernatural causation of illness is rife will consider these factors in order to provide more effective treatment. PMID:1608064

  16. Unhealthy Weight Control Practices: Culprits and Clinical Recommendations

    PubMed Central

    Ferraro, Zachary Michael; Patterson, Sean; Chaput, Jean-Philippe

    2015-01-01

    Preoccupation with weight status and a desire to lose weight appears common. Many individuals seek “magic bullet” approaches to weight loss and waive the risks of using these products. In this paper, we review the challenges of weight maintenance, highlight some unhealthy weight control practices, and discuss the futility and potential danger of unregulated weight control agents. Novel clinical strategies are discussed that health care providers may use to triage patients with obesity in an attempt to make ethical and personalized treatment decisions. PMID:25733947

  17. Pros and cons of using apps in clinical practice.

    PubMed

    Moore, Sally; Anderson, John; Cox, Susanne

    2012-10-01

    There is a lack of research on the use of smartphone apps among nurses in the UK, but the number of healthcare-related apps is increasing and it is likely that nurses will want to include them in practice. It will, therefore, be necessary to assess their effectiveness, appropriateness and efficacy to ensure they enhance patient care. This article looks at the literature on the subject and suggests some issues managers should consider before allowing the use of apps in their clinical areas. It also invites readers to take part in a survey on the use of apps in nursing. PMID:23252086

  18. Cystic lesions of the pancreas: challenging issues in clinical practice.

    PubMed

    Oh, Hyoung-Chul; Kim, Myung-Hwan; Hwang, Chang Yun; Lee, Tae Yoon; Lee, Sang Soo; Seo, Dong-Wan; Lee, Sung Koo

    2008-01-01

    Cystic lesions of the pancreas are being recognized with increasing frequency and have become a common finding in clinical practice. Cystic lesions of the pancreas display a wide spectrum of histopathology and biologic behavior. Differentiating among lesions and choosing an optimal therapy is challenging, and evidence-based guidelines for diagnosis, management, and follow-up for cystic lesions of the pancreas are needed. This review describes the epidemiology and typical features of cystic lesions of the pancreas, including a summary of commonly used descriptive terms, as well as the primary issues in the differential diagnosis and management of these lesions. PMID:18076739

  19. Evidence-based clinical practice for the neurointerventionalist.

    PubMed

    Hirsch, Joshua A; Turk, Aquilla S; Mocco, J; Fiorella, David J; Jayaraman, Mahesh V; Meyers, Phillip M; Yoo, Albert J; Manchikanti, Laxmaiah

    2015-03-01

    The field of neurointerventional (NI) surgery has developed in the context of technologic innovation. Many treatments readily provided in 2014 would have been hard to imagine as recently as 10 years ago. The reality of present day NI care is that, while providers, payors, policy makers and patients rely on evidence to guide NI decision-making, the available data are often less robust than participants might desire. In this paper we will explore the fundamentals of evidence-based clinical practice. PMID:24578482

  20. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update.

    PubMed

    2015-11-01

    The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for all stages of chronic kidney disease (CKD) and related complications since 1997. The 2015 update of the KDOQI Clinical Practice Guideline for Hemodialysis Adequacy is intended to assist practitioners caring for patients in preparation for and during hemodialysis. The literature reviewed for this update includes clinical trials and observational studies published between 2000 and March 2014. New topics include high-frequency hemodialysis and risks; prescription flexibility in initiation timing, frequency, duration, and ultrafiltration rate; and more emphasis on volume and blood pressure control. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Limitations of the evidence are discussed and specific suggestions are provided for future research. PMID:26498416

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

    PubMed Central

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

    2013-01-01

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

  2. The development of precision medicine in clinical practice.

    PubMed

    He, Mingyan; Xia, Jinglin; Shehab, Mohamed; Wang, Xiangdong

    2015-12-01

    Precision medicine allows a dramatic expansion of biological data, while there is still an urgent need to understand and insight the exact meaning of those data to human health and disease. This has led to an increasing wealth of data unanalyzed. The concept of precision medicine is about the customization of healthcare, with decisions and practices tailored to an individual patient based on their intrinsic biology in addition to clinical "signs and symptoms". Construction of a standardized model for the integration of data from various platforms is the central mission of the 'New Disease Management Model'. The model is helpful for the development of new taxonomy of diseases and subtypes, to personalize therapy based on patient genetic profiles. A rapid progression of precision therapy has been made recently. Clinical trials have shown the therapeutic efficacy of discovered and developed therapeutic agents has improved. However, next-generation drugs would be designed for disease subtypes with more specificity, efficacy and lower toxicity. PMID:26302883

  3. Health-related quality of life assessment in clinical practice.

    PubMed

    Meers, C; Singer, M A

    1996-01-01

    Assessment of biochemical responses to therapy is routine in the management of patients with end stage renal disease (ESRD). Assessment of health-related quality of life (HRQOL), however, is less common. Previous research indicates that HRQOL is a meaningful indicator that should be integrated into clinical practice. HRQOL is longitudinally evaluated in in-centre hemodialysis patients using the RAND 36-item Health Survey 1.0. Caregivers incorporate scores from this instrument into their assessment of patient functioning and well-being. HRQOL scores can be utilized to evaluate responses to changes in therapy, and to direct clinical decision-making, adding an important dimension to holistic, quality care for ESRD patients. PMID:8900807

  4. Clinical Practice Guideline: Otitis Media with Effusion Executive Summary (Update).

    PubMed

    Rosenfeld, Richard M; Shin, Jennifer J; Schwartz, Seth R; Coggins, Robyn; Gagnon, Lisa; Hackell, Jesse M; Hoelting, David; Hunter, Lisa L; Kummer, Ann W; Payne, Spencer C; Poe, Dennis S; Veling, Maria; Vila, Peter M; Walsh, Sandra A; Corrigan, Maureen D

    2016-02-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the updated "Clinical Practice Guideline: Otitis Media with Effusion." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 18 recommendations developed emphasize diagnostic accuracy, identification of children who are most susceptible to developmental sequelae from otitis media with effusion, and education of clinicians and patients regarding the favorable natural history of most otitis media with effusion and the lack of efficacy for medical therapy (eg, steroids, antihistamines, decongestants). An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. PMID:26833645

  5. Clinical practice guideline (update): Adult Sinusitis Executive Summary.

    PubMed

    Rosenfeld, Richard M; Piccirillo, Jay F; Chandrasekhar, Sujana S; Brook, Itzhak; Kumar, Kaparaboyna Ashok; Kramper, Maggie; Orlandi, Richard R; Palmer, James N; Patel, Zara M; Peters, Anju; Walsh, Sandra A; Corrigan, Maureen D

    2015-04-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue featuring the updated "Clinical Practice Guideline: Adult Sinusitis" as a supplement to Otolaryngology-Head and Neck Surgery. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 developed recommendations address diagnostic accuracy for adult rhinosinusitis, the appropriate use of ancillary tests to confirm diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function), and the judicious use of systemic and topical therapy. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. An updated guideline is needed as a result of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. PMID:25833927

  6. Bridges between health care research evidence and clinical practice.

    PubMed Central

    Haynes, R B; Hayward, R S; Lomas, J

    1995-01-01

    Research is producing increasing amounts of important new evidence for health care, but there is a large gap between what this evidence shows can be done and the care that most patients actually receive. An important reason for this gap is the extensive processing that evidence requires before application. This article discusses a three-step model for bridging research evidence to management of clinical problems: getting the evidence straight, formulating evidence-based clinical policies, and applying evidence-based clinical policies at the right place and time. This model is purposely broad in scope and provides a framework for coordinating efforts to support evidence-based medical care. The authors' purpose is to represent the roles of health informatics in the context of the roles of all the key players, including health care researchers and practitioners, health care organizations, and the public. Health informatics has already made important contributions to bridging evidence to practice, including improving evidence retrieval, evaluation, and synthesis; new evidence-based information products; and computerized aids for facilitating the use of these products during clinical decision making. However, much more innovation and coordination are needed. The authors call for health informaticians to pay balanced attention to 1) the quality of evidence embodied in information innovations, 2) the performance of technologies and systems that retrieve, prepare, disseminate, and apply evidence, and 3) the fit of information tools to the specific clinical circumstances in which evidence is to be applied. Effective interdisciplinary teams that include health services researchers and other evidence experts, clinical practitioners, informaticians, and health care managers are needed to achieve success. Informaticians can make increasingly important contributions to the transfer of health care research by joining such teams. PMID:8581550

  7. Study of Clinical Practical Model of Urinary System Injury

    PubMed Central

    Li, Gang; Wu, Yuan-Yi; Fu, Wei-Jun; Jia, Ying-Xin; Zhang, Bing-Hong; Xu, Yong-De; Wang, Zhong-Xin; Shi, Jian-Guo; Tan, Hai-Song; Qian, Ye-Yong; Shi, Bin-Yi; Zhang, Chao-Hua; Wang, Xiao-Xiong

    2015-01-01

    Background: In order to improve the clinical treatment level of urinary system injury, it is necessary to build up an animal model of urinary system wound, which is not only analogous to real clinical practice, but also simple and practical. Methods: We have developed the third generation of firearm fragment wound generator based on the first and the second producer. The best explosive charge of the blank cartridge was selected by gradient powder loading experiments. The firearm fragment injuries were made to the bulbous urethra of 10 New Zealand male rabbits. One week preoperatively and 2, 4 and 8 weeks postoperatively, all the animals underwent urethroscopy and urethrography. At 2, 4 and 8 weeks postoperatively, two animals were randomly selected and killed, and the urethra was cut off for pathological examination. Results: The shooting distance of the third generation of firearm fragment wound generator is 2 cm. The best explosive charge of the blank cartridge is 1 g of nitrocotton. All rabbits survived the procedures and stayed alive until they were killed. Injuries were limited to bulbous urethra and distal urethra. Round damaged areas, 1–1.5 cm in length, on the ventral wall were observed. Ureteroscopy results showed that canal diameter gradually shrank by over 50% in 9 rabbits. The rate of success was 90%. Urethrography result noted that a 1–1.3 cm stricture was formed at the bulbous urethra. Histology results of injured stricture urethra showed that fibrous connective tissue hyperplasia and hyaline degeneration caused further stricture in the canal. Conclusions: The third generation of firearm fragment wound generator imitates the bullet firing process and is more accurate and repeatable. The corresponding rabbit model of traumatic complex urethral stricture simulates the real complex clinical conditions. This animal model provides a standardized platform for clinical researches on treating traumatic injuries to the urinary system. PMID:25836614

  8. Defining ‘elderly’ in clinical practice guidelines for pharmacotherapy

    PubMed Central

    Singh, Shamsher; Bajorek., Beata

    2014-01-01

    Objective: To identify how ‘elderly’ patients are defined and considered within Australian clinical guidelines for the use of pharmacotherapy. Method: Guidelines pertaining to the use of pharmacotherapy, focusing on conditions described in National Health Priority Areas, were identified using databases (Medline, Google Scholar) and organisation websites (Department of Health and Ageing, National Heart Foundation, National Health and Medical Research Council). Guidelines were reviewed and qualitatively analysed to identify any references or definitions of ‘elderly’ persons. Results: Among the 20 guidelines reviewed, 3 defined ‘elderly’ by chronological age (i.e., years since birth) while the remaining 17 guidelines did not define ‘elderly’ in any way. All 20 guidelines used the term ‘elderly’, whilst some guidelines provided age (chronological)-based dosage recommendations suggesting an ageist or generalist approach in their representation of ‘elderly’, for which rationale was seldom provided. Thematic analysis of the statements revealed five key themes regarding how ‘elderly’ was considered within the guidelines, broadly describing ‘elderly’ persons as being frail and with altered pharmacology. Some guidelines also highlighted the limited evidence base to direct clinical decision-making. A continuum of perceptions of ageing also emerged out of the identified themes. Conclusion: Clinical practice guidelines currently do not adequately define ‘elderly’ persons and provide limited guidance on how to apply treatment recommendations to older persons. The representation of ‘elderly’ in guidelines needs to be less based on chronological age or generic definitions focusing more on establishing a direct link between an individual patient’s characteristics and the pharmacology of their prescribed medication. Clinical guidelines that do not offer any practical descriptions of the features of ageing that are specifically related to the

  9. Addressing Low Literacy and Health Literacy in Clinical Oncology Practice

    PubMed Central

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

    2011-01-01

    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. PMID:20464884

  10. Clinical significance in COPD patients followed in a real practice

    PubMed Central

    2013-01-01

    Background Chronic obstructive pulmonary disease (COPD) is an important public health issue in many countries which is estimated to become the fifth cause of disability and the third cause of mortality in the world within 2020. The objective of this study was to identify the clinical characteristics in the real clinical practice of a sample of patients with COPD followed in a pulmonology clinic. Methods The initial sample contained 207 subjects with respiratory claims that searched for specialized treatment and initiated regular monitoring between 2004 and 2009 in a private clinic localized in Cascavel, in the state of Parana, Brazil. Demographic data (weight, height, body mass index - BMI), history of comorbidities, use of respiratory and non respiratory drugs were also registered. Results The main cause related to the development of COPD was current or prior smoking (92.0%); the most frequently reported symptom was dyspnea (95.0%), followed by cough (86.1%), wheezing (69.4%) and sputum production (40.0%). During the follow up, 51 patients developed the need for oxygen therapy (28.3%). In 96 patients, there were periods of acute exacerbation, resulting in 37 hospitalizations. In addition to COPD, a significant number of comorbidities were identified, being cardiovascular disease and neurological disorders the most prevalent ones. Conclusions Based on the data collected, we could outline the profile of patients with COPD, showing characteristics of an elderly population, with multiple comorbidities, suggesting a health related quality of life lower than expected. PMID:23806051

  11. Clinical applications of vibration therapy in orthopaedic practice

    PubMed Central

    Cerciello, Simone; Rossi, Silvio; Visonà, Enrico; Corona, Katia; Oliva, Francesco

    2016-01-01

    Summary Background Vibration therapy (VT) has been proposed as an option to improve physical performance and reduce the negative effects of ageing on bone, muscles and tendons. Several discrepancies exist on the type of applications, frequency and magnitude. These differences reflex on the contradictory clinical results in literature. Aim of the present study is to carry on an exhaustive review to focus on technical options on the market, clinical applications in orthopaedic practice and expected outcomes. Methods a literature review using the key words “vibration therapy” and “whole-body vibration” and “orthopaedics” was performed. After checking the available abstracts 71 full text articles were evaluated. Results fifty-one articles focused on the effects of VT on muscles and tendons reporting ways of action and clinical outcomes. In a similar way 20 studies focused on the influence of VT on bone tissue with regard on ways of action and clinical trials. Conclusions VT provides anabolic mechanical signals to bone and musculo-tendinous system. The best effects seem to be achieved with devices that deliver low-intensity stimuli at high frequencies providing linear horizontal displacement. PMID:27331044

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

    MedlinePlus

    Annals of Internal Medicine Summaries for Patients Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice ... of Physicians The full report is titled “Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice ...

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

    MedlinePlus

    ... of Internal Medicine Summaries for Patients Treatment of Anemia in Patients With Heart Disease: A Clinical Practice ... Physicians The full report is titled “Treatment of Anemia in Patients With Heart Disease: A Clinical Practice ...

  14. Utilization of the American Telemedicine Association's Clinical Practice Guidelines

    PubMed Central

    Antoniotti, Nina; Bernard, Jordana

    2013-01-01

    Abstract Background: The American Telemedicine Association (ATA) Standards and Guidelines Committee develops practice standards and guidelines. Key to the Committee's mission is dissemination so the standards can be used in the practice of telemedicine. Over a 2-year period, when a standards document was accessed from the ATA Web site, a short survey was completed, but it did not assess how the documents were used once downloaded. A more formal survey was conducted to determine the impact ATA standards and guidelines are having on healthcare delivery via telemedicine. Materials and Methods: A survey was developed and distributed via SurveyMonkey to 13,177 ATA members and nonmembers in November 2011. Results were compiled and analyzed after a 90-day open period for responses to be submitted. Results: The majority of respondents (96%) believe the practice of telemedicine/telehealth should have standards and guidelines and that the ATA and other professional societies/associations should be responsible for developing them. The top uses of guidelines include guidance for clinical practice, training, gaining reimbursement, and research. Respondents indicating a need for standards and guidelines said the ATA (78.7%) and other professional societies/associations (74.5%) should be responsible for development. When asked to list specific practice guidelines or standards they are using for telehealth, the majority (21.5%) are using in-house (e.g., hospital, company)-developed guidelines, followed by those from professional associations/societies (20.4%) and those developed by the ATA (18.2%). Conclusions: Overall, the survey results indicate guidelines documents developed by the ATA and other professional societies and those developed in-house are being regularly accessed and used in both public and private sectors. Practitioners of telemedicine believe that standards and guidelines are needed for guidance for clinical practice, training, gaining reimbursement, and research

  15. Contribution of biomechanics to clinical practice in orthopaedics.

    PubMed

    Woo, Savio L-Y

    2004-01-01

    Biomechanics is a field that has a very long history. It was described in ancient Chinese and Greek literature as early as 400-500 BC. The foundation of biomechanics, however, was laid during a period between the 1500's to 1700's by renowned personalities, da Vinci, Galileo, Borelli, Hooke, Newton, and so (Fung, Y.C., Biomechanics: Mechanical Properties of Living Tissues, 2nd Ed. Springer Verlag, Chapter 1, 1993). Beginning in the 1950's, Muybridge, Steindler, Inman, Lissner, and Hirsch performed the pioneering work on musculoskeletal biomechanics and the foundation of orthopaedic biomechanics was formed. For the following two decades, the field has blossomed and significant contributions in the biomechanics of bone, articular cartilage, soft tissues, upper and lower extremities, spine and so on has been made. More sophisticated equipment, coupled with mathematical modeling and better engineering design, has enabled us to make great strides. Bioengineers, in collaboration with orthopaedic surgeons, have translated many laboratory discoveries into clinical practice, leading to improved patient treatment and outcome. In the past 30 years, my colleagues and I have focused our research on the biomechanics of musculoskeletal soft tissues, ligaments and tendons, in particular. Therefore, in this lecture, the function of knee ligaments, the associated homeostatic responses secondary to immobilization and exercise, and healing of the ligaments will be reviewed. Examples of scientific findings that help to guide the surgical management of injury to ligaments will be given. New ideas on functional tissue engineering to improve the healing of knee ligaments and tendons will be presented. We have learned that tendons and ligaments are indeed complex biological tissues. To fully understand their behavior, healing and remodelling processes, this author advocates major efforts be made to bring molecular biologists, morphologists, biochemists, bioengineers, physical therapists and

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

    PubMed

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

    2016-09-01

    Nurses today work in practice settings where the expectation is to "draw upon the best evidence to provide the care most appropriate to each patient" (Olsen, Goolsby, & McGinnis, 2009, p. 10) while caring for patients with high acuity in highly specialized settings. Within the nursing profession, the Magnet Recognition Program® advocates for exemplary professional practice and the generation of new knowledge through research and clinical innovation. Nurses working in a clinical setting are often the best resource to identify important clinical questions and gaps in practice, but a lack of resources presents challenges to nurses in fully developing their questions and identifying the most appropriate methods to answer them. These challenges often fall into three broad categories: individual nurse characteristics, organizational characteristics, and environmental characteristics (Dobbins, Ciliska, Cockerill, Barnsley, & DiCenso, 2002). Creating a dedicated partnership between nurses and library staff is one method that can overcome these challenges to use existing resources and support nurses who are asking and answering important clinical questions (DePalma, 2005; Vrabel, 2005). 
. PMID:27541547

  17. Development of an interprofessional and interdisciplinary collaborative research practice for clinical faculty

    PubMed Central

    Hager, Keri; St Hill, Catherine; Prunuske, Jacob; Swanoski, Michael; Anderson, Grant; Lutfiyya, May Nawal

    2016-01-01

    ABSTRACT This article describes an interprofessional collaborative research practice fellowship designed to foster the research skills of clinical faculty. The year-long fellowship was grounded in big data analysis and the triangle of informatics—knowledge, information, and data. Fellows were selected to include diverse perspectives, training, and knowledge but had limited experience in team science or being a member of an interprofessional research team. The underlying philosophy of the fellowship was experiential learning. Protected time and formal mentorship were necessary factors for developing the interprofessional research practice and the skills to participate in an interprofessional research team. We believe that this innovative interprofessional faculty research fellowship is a viable option for supporting scholarly activity and research collaboration. The findings could inform interprofessional clinical practice and be implemented for patient care. Engagement in interprofessional collaborative research and incorporation of the perspectives, knowledge and expertise of multiple professions, is a model to de silo knowledge creation. PMID:26934068

  18. Development of an interprofessional and interdisciplinary collaborative research practice for clinical faculty.

    PubMed

    Hager, Keri; St Hill, Catherine; Prunuske, Jacob; Swanoski, Michael; Anderson, Grant; Lutfiyya, May Nawal

    2016-03-01

    This article describes an interprofessional collaborative research practice fellowship designed to foster the research skills of clinical faculty. The year-long fellowship was grounded in big data analysis and the triangle of informatics-knowledge, information, and data. Fellows were selected to include diverse perspectives, training, and knowledge but had limited experience in team science or being a member of an interprofessional research team. The underlying philosophy of the fellowship was experiential learning. Protected time and formal mentorship were necessary factors for developing the interprofessional research practice and the skills to participate in an interprofessional research team. We believe that this innovative interprofessional faculty research fellowship is a viable option for supporting scholarly activity and research collaboration. The findings could inform interprofessional clinical practice and be implemented for patient care. Engagement in interprofessional collaborative research and incorporation of the perspectives, knowledge and expertise of multiple professions, is a model to de silo knowledge creation. PMID:26934068

  19. Incorporation of pharmacogenomics into routine clinical practice: the Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline development process.

    PubMed

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

    2014-02-01

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

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

    PubMed Central

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

    2014-01-01

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

  1. Application of The APA Practice Guidelines on Suicide to Clinical Practice.

    PubMed

    Jacobs, Douglas G; Brewer, Margaret L

    2006-06-01

    This article presents charts from The American Psychiatric Association Practice Guideline for the Assessment and Treatment of Patients with Suicidal Behaviors, part of the Practice Guidelines for the Treatment of Psychiatric Disorders Compendium, and a summary of the assessment information in a format that can be used in routine clinical practice. Four steps in the assessment process are presented: the use of a thorough psychiatric examination to obtain information about the patient's current presentation, history, diagnosis, and to recognize suicide risk factors therein; the necessity of asking very specific questions about suicidal ideation, intent, plans, and attempts; the process of making an estimation of the patient's level of suicide risk is explained; and the use of modifiable risk and protective factors as the basis for treatment planning is demonstrated. Case reports are used to clarify use of each step in this process. PMID:16816784

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

    PubMed Central

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

    2013-01-01

    Practice-based research should be performed in all practice settings if the results are to be applied to all settings. However, some practice settings, such as community clinics, have unique features that may make the conduct of such research more challenging. The purpose of this article is to describe and compare the similarities and unique challenges related to conducting research in community clinics compared to private practices within the Northwest Practice-Based REsearch Collaborative in Evidence-Based DENTistry (PRECEDENT) network. Information was obtained from meetings with general dentists, a survey of general dentists (N = 253), and a clinical examination and record review of a systemic random sample of patients visiting community clinics and private practices. (N = 1903)—all part of a dental practice-based research network. The processes of conducting research, the dentist and patient sociodemographic characteristics, the prevalence of oral diseases, and the dental treatments received in community clinics and private practices were compared. Both community clinics and private practices have the clinical treatment of the patients as their priority and have time constraints on research. The processes of research training, obtaining informed consent, and collecting, transmitting, and securely maintaining research data are also similar. The patient populations and treatment needs differ substantially between community clinics and private practices, with a higher prevalence of dental caries and higher restorative treatment needs in the community clinic patients. The process of study participant selection and follow-up for research and the dentist and staff work arrangements also vary between the two practice settings. Although community clinic patients and their dental healthcare providers have different research needs and challenges than their counterparts in private practice, practice-based research can be successfully PMID:25429251

  3. Korean clinical practice guideline for benign prostatic hyperplasia.

    PubMed

    Yeo, Jeong Kyun; Choi, Hun; Bae, Jae Hyun; Kim, Jae Heon; Yang, Seong Ok; Oh, Chul Young; Cho, Young Sam; Kim, Kyoung Woo; Kim, Hyung Ji

    2016-01-01

    In 2014, the Korean Urological Association organized the Benign Prostatic Hyperplasia Guideline Developing Committee composed of experts in the field of benign prostatic hyperplasia (BPH) with the participation of the Korean Academy of Family Medicine and the Korean Continence Society to develop a Korean clinical practice guideline for BPH. The purpose of this clinical practice guideline is to provide current and comprehensive recommendations for the evaluation and treatment of BPH. The committee developed the guideline mainly by adapting existing guidelines and partially by using the de novo method. A comprehensive literature review was carried out primarily from 2009 to 2013 by using medical search engines including data from Korea. Based on the published evidence, recommendations were synthesized, and the level of evidence of the recommendations was determined by using methods adapted from the 2011 Oxford Centre for Evidence-Based Medicine. Meta-analysis was done for one key question and four recommendations. A draft guideline was reviewed by expert peer reviewers and discussed at an expert consensus meeting until final agreement was achieved. This evidence-based guideline for BPH provides recommendations to primary practitioners and urologists for the diagnosis and treatment of BPH in men older than 40 years. PMID:26966724

  4. [Still the social factor: crisis in the clinical practice].

    PubMed

    Marzano, Fernando J

    2014-01-01

    Consultations in our hospital center are problematic, mainly due to the poor living situation which patients come from (the suburbs of Buenos Aires). The housing situation, the environment and the economic or political conditions of these patients frame "the social" emergency that sets the context and the impact in the different psychopathological symptoms that they present. These conditions should also be reviewed from our theoretical assessment together with the clinical approach that our assistance practice studies. From a perception viewpoint we observe that "self-perception is far from any ideals. The perception of their environment is threatening and has no future". We constantly note the loss of the value of words and speech, when we hear our patients, wo have turned language into just an abject joy, as in the word of the addict. These issues must be studied from a theoretical point of view to be applied clinically. Such analysis reveals that our practice takes place in a context of failure. However, we cannot move backwards in "potential treatment" as Lacan states in the ethics as regards psychosis. PMID:24887363

  5. Korean clinical practice guideline for benign prostatic hyperplasia

    PubMed Central

    Yeo, Jeong Kyun; Choi, Hun; Bae, Jae Hyun; Kim, Jae Heon; Yang, Seong Ok; Oh, Chul Young; Cho, Young Sam; Kim, Kyoung Woo

    2016-01-01

    In 2014, the Korean Urological Association organized the Benign Prostatic Hyperplasia Guideline Developing Committee composed of experts in the field of benign prostatic hyperplasia (BPH) with the participation of the Korean Academy of Family Medicine and the Korean Continence Society to develop a Korean clinical practice guideline for BPH. The purpose of this clinical practice guideline is to provide current and comprehensive recommendations for the evaluation and treatment of BPH. The committee developed the guideline mainly by adapting existing guidelines and partially by using the de novo method. A comprehensive literature review was carried out primarily from 2009 to 2013 by using medical search engines including data from Korea. Based on the published evidence, recommendations were synthesized, and the level of evidence of the recommendations was determined by using methods adapted from the 2011 Oxford Centre for Evidence-Based Medicine. Meta-analysis was done for one key question and four recommendations. A draft guideline was reviewed by expert peer reviewers and discussed at an expert consensus meeting until final agreement was achieved. This evidence-based guideline for BPH provides recommendations to primary practitioners and urologists for the diagnosis and treatment of BPH in men older than 40 years. PMID:26966724

  6. Integrating the principles of evidence-based practice into clinical practice.

    PubMed

    Klardie, Kathleen A; Johnson, Judith; McNaughton, Molly Ann; Meyers, Wendy

    2004-03-01

    This series of articles illustrates many considerations relevant to the application of clinical practice guidelines (CPGs). This particular column describes the actions of a nurse practitioner (NP) striving to understand the foundations of recommendations that are based largely on expert opinion. Although application of CPGs does not generally require this degree of investigation, it is essential that providers understand the processes used to interpret the basis of recommendations, including the application of the basic statistical concepts, when making decisions about how recommendations apply to individual patient scenarios. Utilizing evidence-based practice when providing patient care requires a range of skills that allows the NP to locate appropriate research evidence, to develop an understanding of the statistics used in interpreting and reporting research, and to evaluate the effects of interventions on patient outcomes. The application of the key concepts of evidenced-based practice within the primary care setting is explored through a hypothetical patient scenario, which was created as the focal point for three articles that illustrate principles of evidence-based practice. The goal of this series of articles is to provide a basic understanding of evidence-based practice and its application in clinical practice. This article explores the use of interventions selected from CPGs and investigates the potential effects of recommended interventions on patient outcomes. Commonly encountered statistical concepts are reviewed, and examples of their application in interpreting and reporting research are demonstrated. The principles of relative risk, relative risk reduction, absolute risk reduction, and numbers needed to treat are described. This review provides the NP with some basic skills to determine both the quality and usefulness of research. PMID:15130064

  7. Clinical audit: shining a light on good practice.

    PubMed

    Grainger, Angela

    2010-07-01

    Healthcare organisations undertake quality assurance to produce safe and effective patient care systems. Statutory quality assurance requirements are met through external reviews, monitoring and inspection processes, and each NHS trust must produce a corporate annual quality account. However, this can result in approaching audits as if they are 'tick-box activities'. This article discusses how organisations can avoid this trap by applying audit results to practice. PMID:20681403

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

    ERIC Educational Resources Information Center

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

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

  9. [Clinical practice guidelines for systemic lupus erythematosus: Recommendations for general clinical management].

    PubMed

    Trujillo-Martín, María M; Rúa-Figueroa Fernández de Larrinoa, Iñigo; Ruíz-Irastorza, Guillermo; Pego-Reigosa, José María; Sabio Sánchez, José Mario; Serrano-Aguilar, Pedro

    2016-05-01

    Systemic lupus erythematosus (SLE) is a complex rheumatic multisystemic disease of autoimmune origin with significant potential morbidity and mortality. It is one of the most common autoimmune diseases with an estimated prevalence of 20-150 cases per 100,000 inhabitants. The clinical spectrum of SLE is wide and variable both in clinical manifestations and severity. This prompted the Spanish Ministry of Health, Social Services and Equality to promote and fund the development of a clinical practice guideline (CPG) for the clinical care of SLE patients within the Programme of CPG in the National Health System which coordinates GuiaSalud. This CPG is is intended as the reference tool in the Spanish National Health System in order to support the comprehensive clinical management of people with SLE by all health professionals involved, regardless of specialty and level of care, helping to standardize and improve the quality of clinical decisions in our context in order to improve the health outcomes of the people affected. The purpose of this document is to present and discuss the rationale of the recommendations on the general management of SLE, specifically, clinical follow-up, general therapeutic approach, healthy lifestyles, photoprotection, and training programmes for patients. These recommendations are based on the best available scientific evidence, on discussion and the consensus of expert groups. PMID:26975887

  10. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy.

    PubMed

    Tunis, Sean R; Stryer, Daniel B; Clancy, Carolyn M

    2003-09-24

    Decision makers in health care are increasingly interested in using high-quality scientific evidence to support clinical and health policy choices; however, the quality of available scientific evidence is often found to be inadequate. Reliable evidence is essential to improve health care quality and to support efficient use of limited resources. The widespread gaps in evidence-based knowledge suggest that systematic flaws exist in the production of scientific evidence, in part because there is no consistent effort to conduct clinical trials designed to meet the needs of decision makers. Clinical trials for which the hypothesis and study design are developed specifically to answer the questions faced by decision makers are called pragmatic or practical clinical trials (PCTs). The characteristic features of PCTs are that they (1) select clinically relevant alternative interventions to compare, (2) include a diverse population of study participants, (3) recruit participants from heterogeneous practice settings, and (4) collect data on a broad range of health outcomes. The supply of PCTs is limited primarily because the major funders of clinical research, the National Institutes of Health and the medical products industry, do not focus on supporting such trials. Increasing the supply of PCTs will depend on the development of a mechanism to establish priorities for these studies, significant expansion of an infrastructure to conduct clinical research within the health care delivery system, more reliance on high-quality evidence by health care decision makers, and a substantial increase in public and private funding for these studies. For these changes to occur, clinical and health policy decision makers will need to become more involved in all aspects of clinical research, including priority setting, infrastructure development, and funding. PMID:14506122

  11. Imaging of neurodegenerative cognitive and behavioral disorders: practical considerations for dementia clinical practice.

    PubMed

    Atri, Alireza

    2016-01-01

    This chapter reviews clinical applications and imaging findings useful in medical practice relating to neurodegenerative cognitive/dementing disorders. The preponderance of evidence and consensus guidelines support an essential role of multitiered neuroimaging in the evaluation and management of neurodegenerative cognitive/dementia syndrome that range in severity from mild impairments to frank dementia. Additionally, imaging features are incorporated in updated clinical and research diagnostic criteria for most dementias, including Alzheimer's disease (AD), Dementia with Lewy bodies (DLB), Frontotemporal Lobar Degenerations/Frontotemporal Dementia (FTD), and Vascular Cognitive Impairment (VCI). Best clinical practices dictate that structural imaging, preferably with magnetic resonance imaging (MRI) when possible and computed tomography when not, be obtained as a first-tier approach during the course of a thorough clinical evaluation to improve diagnostic confidence and assess for nonneurodegenerative treatable conditions that may cause or substantially contribute to cognitive/behavioral symptoms or which may dictate a substantial change in management. These conditions include less common structural (e.g., mass lesions such as tumors and hematomas; normal-pressure hydrocephalus), inflammatory, autoimmune and infectious conditions, and more common comorbid contributing conditions (e.g., vascular cerebral injury causing leukoaraiosis, infarcts, or microhemorrhages) that can produce a mixed dementia syndrome. When, after appropriate clinical, cognitive/neuropsychologic, and structural neuroimaging assessment, a dementia specialist remains in doubt regarding etiology and appropriate management, second-tier imaging with molecular methods, preferably with fluorodexoyglucose positron emission tomography (PET) (or single-photon emission computed tomography if PET is unavailable) can provide more diagnostic specificity (e.g., help differentiate between atypical AD and FTD as

  12. Clinical trials and the new good clinical practice guideline in Japan. An economic perspective.

    PubMed

    Ono, S; Kodama, Y

    2000-08-01

    Japanese clinical trials have been drastically changing in response to the implementation of the International Conference on Harmonisation-Good Clinical Practice (ICH-GCP) guideline in 1997. The most important aim of the new guideline is to standardise the quality of clinical trials in the US, European Union and Japan, but it inevitably imposes substantial costs on investigators, sponsors and even patients in Japan. The study environment in Japan differs from that in the US in several ways: (i) historical lack of a formal requirement for informed consent; (ii) patients' attitudes to clinical trials in terms of expectation of positive outcomes; (iii) the implications of universal health insurance for trial participation; (iv) the historical absence of on-site monitoring by the sponsor, with the attendant effects on study quality; and (v) the lack of adequate financial and personnel support for the conduct of trials. Implementation of the new GCP guideline will improve the ethical and scientific quality of trials conducted in Japan. It may also lead to an improved relationship between medical professionals and patients if the requirement for explicit informed consent in clinical trials leads to the provision of a similar level of patient information in routine care and changes the traditional paternalistic attitude of physicians to patients. The initial response of the Japanese 'market' for clinical trials to the implementation of the ICH-GCP guideline has been clinical trial price increases and a decrease in the number of study contracts. These changes can be explained by applying a simple demand-supply scheme. Whether clinical trials undertaken in Japan become more or less attractive to the industry in the long term will depend on other factors such as international regulations on the acceptability of foreign clinical trials and the reform of domestic healthcare policies. PMID:11067647

  13. Fit for Practice: Project 2000 Student Nurses' Views on How Well the Curriculum Prepares Them for Clinical Practice.

    ERIC Educational Resources Information Center

    Fulbrook, Paul; Rolfe, Gary; Albarran, John; Boxall, Frances

    2000-01-01

    Comparison of the perceptions of 55 student nurses whose curriculum emphasized academics over clinical practice with those of 39 in a revised curriculum emphasizing theory-practice links found only modest evidence that the newer curriculum improved student perceptions of their preparation for clinical placement. (SK)

  14. Patient and Family Engagement Summit: Needed Changes in Clinical Practice.

    PubMed

    Swartwout, Ellen; Drenkard, Karen; McGuinn, Kathy; Grant, Susan; El-Zein, Ashley

    2016-03-01

    Patient and family engagement is a strategy to enhance healthcare outcomes through strong clinician-patient partnerships. A new care delivery process, in which the patient is the driver of the healthcare team, is required to achieve optimal health. A summit partially funded by a seed grant from the Robert Wood Johnson Executive Nurse Fellow Alumni Foundation was held with interprofessional colleagues and patient representatives to identify needed clinical competencies and future practice changes. Recommended shifts in the care delivery process included a focus on patient strengths, including the patient as a valued team member, doing care "with me" and not "to me," and considering all entities or providers including the patient, as equal partners. PMID:26906687

  15. Mechanical Lumbar Traction: What Is Its Place in Clinical Practice?

    PubMed

    2016-03-01

    Summary evidence concludes that mechanical lumbar traction is not effective for treating acute or chronic nonspecific low back pain (LBP). However, many physical therapists continue to use it, primarily as an additional modality. Indeed, expert clinical opinion, theoretical models, and some research evidence suggest that certain patients with LBP respond positively to traction. A study published in the March 2016 issue of JOSPT investigates the effectiveness of traction in prone as an adjunct to an extension-oriented exercise program in patients with LBP and leg pain and explores whether a previously identified set of patient characteristics is associated with better outcomes from traction. In this Perspectives for Practice, the authors explain the impact of their findings for clinicians treating these patients. PMID:26928736

  16. Ethical decision-making challenges in clinical practice.

    PubMed

    Horowitz, Beverly P

    2003-01-01

    Today's health care environment requires professionals to pay increasing attention to efficiencies and functional outcomes. Today's patients are hospitalized for short stays, and those needing rehabilitation often have multiple diagnoses and goals. Cost effective strategies support fast paced occupational therapy programs and professionals who are adept multi-task specialists and problem solvers. Practitioners have multiple resources and strategies for clinical reasoning and decision-making; however, ethical decision-making requires use of additional resources and strategies. This paper provides strategies to examine everyday ethical problems and dilemmas, including application of The American Occupational Therapy's Code of Ethics, to support ethical decision-making in practice settings (American Occupational Therapy Association, 2000a). PMID:23930704

  17. The impact of genetic information on policy and clinical practice.

    PubMed

    Abel, Elizabeth; Horner, Sharon D; Tyler, Diane; Innerarity, Sheryl A

    2005-02-01

    This article discusses genetics-related policy issues that have an impact on health care systems, health care providers, and their patients: privacy, mass screening, family screening, and knowledge dissemination. Access, cost, and ethical implications are important discussant points for each of these genetic-related policy issues. Embedded in the issue of privacy are concerns of insurability, confidentiality, and discrimination. The public health policy implications related to mass screening programs include efficacy of the screening tests, availability of primary and secondary interventions, access, costs, and program evaluation. Policy issues for family screening are similar to mass screening, with added concerns about privacy and availability of adequate resources, including health care providers and counselors trained in genetics. Knowledge dissemination is critical to maintaining currency of clinical information and applications of genetic technologies and treatments. As genetic information expands, the need for knowledge dissemination will increase. The importance of advanced practice nurses' involvement in these policy issues is discussed. PMID:16443953

  18. Glucose Biosensors: An Overview of Use in Clinical Practice

    PubMed Central

    Yoo, Eun-Hyung; Lee, Soo-Youn

    2010-01-01

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

  19. Using cooperative inquiry and clinical supervision to improve practice.

    PubMed

    Jenkins, Emrys

    2007-02-01

    District nurses and a nurse lecturer used the process of co-operative inquiry (Heron, 1996; Reason and Heron, 2001) to research the value of regular, critical reflection in developing their practice. Stories and metaphor were shared and appraised through (i) supportive challenge and (ii) talking that critically informed learning (rather than reinforcing opinions or moaning). These methods were informed by clinical supervision and action research literature. The co-inquiry process made overt our tendencies to hide and the merit in sharing and in being ourselves, authentic (Hartrick 1997; McCormack 2003). In place of professional attitudes that present a 'we know best' stance, we are improving our nursing and education work through engaging more personally with others. Our relationships and humour help us to seek more holistic appreciation of experience than solitary self-reflection can provide, and we need dedicated time for this social, more critical appreciation. PMID:17363869

  20. Developing clinical practice guidelines for spinal cord medicine. Lessons learned.

    PubMed

    Biddle, A K; Fraher, E P

    2000-02-01

    This article describes the process used by the Consortium for Spinal Cord Medicine to develop evidence-based clinical practice guidelines for managing and treating individuals with spinal cord injury and provides important information on lessons learned and the potential problems to avoid. Issues to consider during the guideline development process include topic selection and explication, methods for selecting the panel chair and panel members, the writing of recommendations and supporting scientific rationales, peer-reviewing guidelines, and the process for disseminating, implementing, and evaluating guidelines. The applicability, advantages, and disadvantages of available evidence and guideline recommendation grading systems and issues arising from the lack of scientific evidence supporting particular recommendations are also discussed. PMID:10680167

  1. [Molecular characterization of breast cancer in clinical practice].

    PubMed

    Zemmouri, Y; De Croze, D; Vincent Salomon, A; Rouzier, R; Bonneau, C

    2016-05-01

    Breast cancer involves various types of tumors. The objective of this review was to provide a summary of the main methods currently available in clinical practice to characterize breast cancers at a molecular level and to discuss their prognostic and predictive values. Hormonal receptors expression and the HER2 status are prognostic markers and can also predict the response to targeted therapies. Their analysis through immunohistochemistry is systematical. Ki67 is an effective prognostic marker, but its reliability is debated because of its low reproducibility between laboratories and between pathologists. Commercial genomic signatures are all considered valid prognostic tools and may guide physicians to make therapeutic choices. These signatures are costly and should therefore be restricted to situations in which the use of chemotherapy remains equivocal. PMID:27150068

  2. Neuroplasticity and Clinical Practice: Building Brain Power for Health.

    PubMed

    Shaffer, Joyce

    2016-01-01

    The focus of this review is on driving neuroplasticity in a positive direction using evidence-based interventions that also have the potential to improve general health. One goal is to provide an overview of the many ways new neuroscience can inform treatment protocols to empower and motivate clients to make the lifestyle choices that could help build brain power and could increase adherence to healthy lifestyle changes that have also been associated with simultaneously enhancing vigorous longevity, health, happiness, and wellness. Another goal is to explore the use of a focus in clinical practice on helping clients appreciate this new evidence and use evolving neuroscience in establishing individualized goals, designing strategies for achieving them and increasing treatment compliance. The timing is urgent for such interventions with goals of enhancing brain health across the lifespan and improving statistics on dementia worldwide. PMID:27507957

  3. [Analysis of an intercultural clinical practice in a judicial setting].

    PubMed

    Govindama, Yolande

    2007-01-01

    This article analyses an intercultural clinical practice in a legal setting from an anthropological and psychoanalytical perspective, demonstrating necessary reorganizations inherent to the framework. The culture of the new country and its founding myth being implicit to the judicial framework, the professional intervening introduces psychoanalytical references particularly totemic principles and the symbolic father by making genealogy, a universal object of transmission as guarantee of fundamental taboos of humanity. The metacultural perspective in this approach integrates ethnopsychoanalytical principles put forth by Devereux as well as the method although this latter has been adapted to the framework. This approach allows to re-question Devereux's ethnopsychoanalytical principles by opening the debate on the perspective of a psychoanalytical as well as psychiatric. PMID:18253668

  4. Clinical practice guidelines: their use, misuse, and future directions.

    PubMed

    Sanders, James O; Bozic, Kevin J; Glassman, Steven D; Jevsevar, David S; Weber, Kristy L

    2014-03-01

    Evidence-based clinical practice guidelines (CPGs) have the potential to bring the best-quality evidence to orthopaedic surgeons and their patients. CPGs can improve quality by decreasing the variability in orthopaedic care, but they can also be misused through inappropriate development or application. The quality of a CPG is dependent on the strength of its evidence base, which is often deficient in orthopaedic publications. In addition, many surgeons express concern about legal liability associated with CPGs. Specific processes in CPG development and implementation can counter these potential problems. Other evidence tools, such as appropriate use criteria, also can help in the application of the proper treatment of patients by identifying those who are appropriate for specific procedures. Because payers, patients, and surgeons need access to the best evidence, CPGs will continue to be developed, and orthopaedic surgeons have the opportunity to ensure their proper development and implementation by understanding and participating in the process. PMID:24603823

  5. Neuroplasticity and Clinical Practice: Building Brain Power for Health

    PubMed Central

    Shaffer, Joyce

    2016-01-01

    The focus of this review is on driving neuroplasticity in a positive direction using evidence-based interventions that also have the potential to improve general health. One goal is to provide an overview of the many ways new neuroscience can inform treatment protocols to empower and motivate clients to make the lifestyle choices that could help build brain power and could increase adherence to healthy lifestyle changes that have also been associated with simultaneously enhancing vigorous longevity, health, happiness, and wellness. Another goal is to explore the use of a focus in clinical practice on helping clients appreciate this new evidence and use evolving neuroscience in establishing individualized goals, designing strategies for achieving them and increasing treatment compliance. The timing is urgent for such interventions with goals of enhancing brain health across the lifespan and improving statistics on dementia worldwide. PMID:27507957

  6. Swiss clinical practice guidelines on field cancerization of the skin.

    PubMed

    Hofbauer, Günther; Anliker, Mark; Boehncke, Wolf-Henning; Brand, Christoph; Braun, Ralph; Gaide, Olivier; Hafner, Jürg; Hunger, Robert; Itin, Peter; Kaeuper, Gina; Lautenschlager, Stephan; Mainetti, Carlo; Streit, Markus

    2014-01-01

    Actinic keratosis (AK) affects millions of people worldwide, and its prevalence continues to increase. AK lesions are caused by chronic ultraviolet radiation exposure, and the presence of two or more AK lesions along with photodamage should raise the consideration of a diagnosis of field cancerization. Effective treatment of individual lesions as well as field cancerization is essential for good long-term outcomes. The Swiss Registry of Actinic Keratosis Treatment (REAKT) Working Group has developed clinical practice guidelines for the treatment of field cancerization in patients who present with AK. These guidelines are intended to serve as a resource for physicians as to the most appropriate treatment and management of AK and field cancerization based on current evidence and the combined practical experience of the authors. Treatment of AK and field cancerization should be driven by consideration of relevant patient, disease, and treatment factors, and appropriate treatment decisions will differ from patient to patient. Prevention measures and screening recommendations are discussed, and special considerations related to management of immunocompromised patients are provided. PMID:25539459

  7. New strategies in lung cancer: translating immunotherapy into clinical practice.

    PubMed

    Forde, Patrick M; Kelly, Ronan J; Brahmer, Julie R

    2014-03-01

    Recent breakthroughs in translating the early development of immunomodulatory antibodies into the clinic, notably with the anti-cytotoxic T-lymphocyte antigen-4 antibody, ipilimumab, have led to durable benefits and prolonged survival for a subgroup of patients with advanced melanoma. Subsequent studies have shown that related immune checkpoint antibodies, specifically those targeting the programmed death-1 pathway, have activity in non-small cell lung cancer. Non-small cell lung cancer is the commonest cause of cancer death worldwide and this exciting avenue of clinical investigation carries with it great promise and new challenges. In this article, we discuss recent developments in lung cancer immunotherapy, reviewing recent findings from therapeutic vaccine studies and in particular we focus on the refinement of immunomodulation as a therapeutic strategy in this challenging disease. PMID:24470514

  8. Importance of population-based studies in clinical practice

    PubMed Central

    Ronnie, George; Ve, Ramesh Sathyamangalam; Velumuri, Lokapavani; Asokan, Rashima; Vijaya, Lingam

    2011-01-01

    In the last decade, there have been reports on the prevalence of glaucoma from the Vellore Eye Survey, Andhra Pradesh Eye Diseases Survey, Aravind Comprehensive Eye Survey, Chennai Glaucoma Study and West Bengal Glaucoma Study. Population-based studies provide important information regarding the prevalence and risk factors for glaucoma. They also highlight regional differences in the prevalence of various types of glaucoma. It is possible to gather important insights regarding the number of persons affected with glaucoma and the proportion with undiagnosed disease. We reviewed the different population-based studies from India and compare their findings. The lacunae in ophthalmic care that can be inferred from these studies are identified and possible reasons and solutions are discussed. We also discuss the clinical relevance of the various findings, and how it reflects on clinical practice in the country. Since India has a significantly high disease burden, we examine the possibility of population-based screening for disease in the Indian context. PMID:21150021

  9. Fingolimod Real World Experience: Efficacy and Safety in Clinical Practice

    PubMed Central

    Fonseca, Joaquim

    2015-01-01

    Fingolimod is a multiple sclerosis treatment licensed in Europe since 2011. Its efficacy has been demonstrated in three large phase III trials, used in the regulatory submissions throughout the world. As usual, in these trials the inclusion and exclusion criteria were designed to obtain a homogeneous population, with interchangeable characteristics in the different treatment arms. Although this is the best strategy to achieve a robust answer to the investigation question, it does not guaranty the treatment efficacy in the clinical practice, since in the real world there are concomitant treatments, comorbidities, adherence, and persistence challenges. But, to make informed treatment decision for a real life patient, we need to have evidence of the treatment efficacy, what has been called treatment effectiveness. This work aims to review fingolimod effectiveness, using, as source of information, abstracts, posters, and manuscripts. This unorthodox strategy was developed because more than half of the published experience with fingolimod is still on abstracts and posters. Only a small part of the studies reviewed are already published in peer reviewed journals. Fingolimod seems to be, at least, as effective and safe as it was on clinical trials, and with its long-term experience no new safety signals were observed. PMID:26693475

  10. Understanding gastrointestinal distress: a framework for clinical practice.

    PubMed

    Spiegel, Brennan M R; Khanna, Dinesh; Bolus, Roger; Agarwal, Nikhil; Khanna, Puja; Chang, Lin

    2011-03-01

    We describe a framework to help clinicians think about health-related quality of life in their gastrointestinal (GI) patients. We introduce "GI distress" as a clinically relevant concept and explain how it may result from physical symptoms, cognitions, and emotions. The GI distress framework suggests that providers should divide GI physical symptoms into four categories: pain, gas/bloat, altered defecation, and foregut symptoms. We describe how these physical symptoms can be amplified by maladaptive cognitions, including external locus of control, catastrophizing, and anticipation anxiety. We suggest determining the level of embarrassment from GI symptoms and asking about stigmatization. GI patients may also harbor emotional distress from their illness and may exhibit visceral anxiety marked by hypervigilance, fear, and avoidance of GI sensations. Look for signs of devitalization, indicated by inappropriate fatigue. When appropriate, screen for suicidal ideations. Finally, we provide a list of high-yield questions to screen for these maladaptive cognitions and emotions, and explain how the GI distress framework can be used in clinical practice. PMID:21378758

  11. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice

    PubMed Central

    Castro-Torres, Yaniel; Carmona-Puerta, Raimundo; Katholi, Richard E

    2015-01-01

    Malignant cardiac arrhythmias which result in sudden cardiac death may be present in individuals apparently healthy or be associated with other medical conditions. The way to predict their appearance represents a challenge for the medical community due to the tragic outcomes in most cases. In the last two decades some ventricular repolarization (VR) markers have been found to be useful to predict malignant cardiac arrhythmias in several clinical conditions. The corrected QT, QT dispersion, Tpeak-Tend, Tpeak-Tend dispersion and Tp-e/QT have been studied and implemented in clinical practice for this purpose. These markers are obtained from 12 lead surface electrocardiogram. In this review we discuss how these markers have demonstrated to be effective to predict malignant arrhythmias in medical conditions such as long and short QT syndromes, Brugada syndrome, early repolarization syndrome, acute myocardial ischemia, heart failure, hypertension, diabetes mellitus, obesity and highly trained athletes. Also the main pathophysiological mechanisms that explain the arrhythmogenic predisposition in these diseases and the basis for the VR markers are discussed. However, the same results have not been found in all conditions. Further studies are needed to reach a global consensus in order to incorporate these VR parameters in risk stratification of these patients. PMID:26301231

  12. [Diagnosing Alzheimer's disease: from research to clinical practice and ethics].

    PubMed

    Tarquini, Daniela; Pucci, Eugenio; Gasparini, Maddalena; Zullo, Silvia; Tiraboschi, Pietro; Bonito, Virginio; Defanti, Carlo Alberto

    2014-01-01

    In 2011, the so-called Dubois criteria introduced the use of biomarkers in research (in particular, brain amyloid positron emission tomography imaging and the cerebrospinal fluid levels of tau/fosfo-tau and beta-amyloid 1-42) for the early or preclinical diagnosis of Alzheimer's disease. Even so, we are looking at an increased use of these markers in clinical practice. In the 1960s, Alzheimer's disease was considered a rare form of presenile dementia, but gradually it has been recognized as the prevalent form of old-age dementia. As a consequence, what was once regarded as an inevitable outcome of old age is now recognized as a true disease. Several factors contributed to this paradigm shift, in particular a longer lifespan, new techniques of in vivo study of the central nervous system, and the pressure exerted by the pharmaceutical industry and patient groups. The current lack of disease-modifying therapies and the high incidence of mild cognitive impairment, which is a risk factor for dementia, raise a series of clinical ethical problems ranging from how diagnosis is communicated to how resources are used. This article offers a conceptual scheme through which these issues can be addressed. PMID:25072545

  13. Frailty measurement in research and clinical practice: A review.

    PubMed

    Dent, Elsa; Kowal, Paul; Hoogendijk, Emiel O

    2016-06-01

    One of the leading causes of morbidity and premature mortality in older people is frailty. Frailty occurs when multiple physiological systems decline, to the extent that an individual's cellular repair mechanisms cannot maintain system homeostasis. This review gives an overview of the definitions and measurement of frailty in research and clinical practice, including: Fried's frailty phenotype; Rockwood and Mitnitski's Frailty Index (FI); the Study of Osteoporotic Fractures (SOF) Index; Edmonton Frailty Scale (EFS); the Fatigue, Resistance, Ambulation, Illness and Loss of weight (FRAIL) Index; Clinical Frailty Scale (CFS); the Multidimensional Prognostic Index (MPI); Tilburg Frailty Indicator (TFI); PRISMA-7; Groningen Frailty Indicator (GFI), Sherbrooke Postal Questionnaire (SPQ); the Gérontopôle Frailty Screening Tool (GFST) and the Kihon Checklist (KCL), among others. We summarise the main strengths and limitations of existing frailty measurements, and examine how well these measurements operationalise frailty according to Clegg's guidelines for frailty classification - that is: their accuracy in identifying frailty; their basis on biological causative theory; and their ability to reliably predict patient outcomes and response to potential therapies. PMID:27039014

  14. Implementation of Multi-parametric Prostate MRI in Clinical Practice.

    PubMed

    Kierans, Andrea S; Taneja, Samir S; Rosenkrantz, Andrew B

    2015-08-01

    While initial implementations of prostate MRI suffered from suboptimal performance in tumor detection, technological advances over the past decade have allowed modern multi-parametric prostate MRI (mpMRI) to achieve high diagnostic accuracy for detection, localization, and staging and thereby impact patient management. A particular emerging application of mpMRI is in the pre-biopsy setting to allow for MRI-targeted biopsy, for instance, through real-time MRI/ultrasound fusion, which may help reduce the over-detection of low-risk disease and selectively detect clinically significant cancers, in comparison with use of standard systematic biopsy alone. mpMRI and MRI-targeted biopsy are spreading beyond the large academic centers to increasingly be adopted within small and community practices. Aims of this review article are to summarize the hardware and sequences used for performing mpMRI, explore patient specific technical considerations, delineate approaches for study interpretation and reporting [including the recent American College of Radiology Prostate Imaging Reporting and Data System (PI-RADS) version 2], and describe challenges and implications relating to the widespread clinical implementation of mpMRI. PMID:26077358

  15. Optical coherence tomography: clinical applications in medical practice.

    PubMed

    Al-Mujaini, Abdullah; Wali, Upender K; Azeem, Sitara

    2013-03-01

    Optical Coherence Tomography (OCT) is a success story of scientific and technological co-operation between a physicist and a clinician. The concept of cross-sectional imaging revolutionalized the applicability of OCT in the medical profession. OCT is a non-contact, topographic, biomicroscopic device that provides high resolution, cross-sectional digital images of live biological tissues in vivo and in real time. OCT is based on the property of tissues to reflect and backscatter light involving low-coherence interferometry. The spatial resolution of as little as 3 microns or even less has allowed us to study tissues almost at a cellular level. Overall, OCT is an invaluable adjunct in the diagnosis and follow up of many diseases of both anterior and posterior segments of the eye, primarily or secondary to systemic diseases. The digitalization and advanced software has made it possible to store and retrieve huge patient data for patient services, clinical applications and academic research. OCT has revolutionized the sensitivity and specificity of diagnosis, follow up and response to treatment in almost all fields of clinical practice involving primary ocular pathologies and secondary ocular manifestations in systemic diseases like diabetes mellitus, hypertension, vascular and neurological diseases, thus benefitting non-ophthalmologists as well. Systemically, OCT is proving to be a helpful tool in substantiating early diagnosis in diseases like multiple sclerosis and drug induced retinopathies by detecting early changes in morphology of the retinal nerve fiber layer. PMID:23599874

  16. Guidelines for the nonpharmacologic management of migraine in clinical practice

    PubMed Central

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

    1998-01-01

    OBJECTIVE: To provide physicians and allied health care professionals with guidelines for the nonpharmacologic management of migraine in clinical practice. OPTIONS: The full range and quality of nonpharmacologic therapies available for the management of migraine. OUTCOMES: Improvement in the nonpharmacologic management of migraine. EVIDENCE AND VALUES: The creation of the guidelines followed a needs assessment by members of the Canadian Headache Society and included a statement of objectives; development of guidelines by multidisciplinary working groups using information from literature reviews and other resources; comparison of alternative clinical pathways and description of how published data were analysed; definition of the level of evidence for data in each case; evaluation and revision of the guidelines at a consensus conference held in Ottawa on Oct. 27-29, 1995; redrafting and insertion of tables showing key variables and data from various studies and tables of data with recommendations; and reassessment by all conference participants. BENEFITS, HARMS AND COSTS: Augmentation of the use of nonpharmacologic therapies for the acute and prophylactic management of migraine is likely to lead to substantial benefits in both human and economic terms. RECOMMENDATIONS: Both the avoidance of migraine trigger factors and the use of nonpharmacologic therapies have a part to play in overall migraine management. VALIDATION: The guidelines are based on consensus of Canadian experts in neurology, emergency medicine, psychiatry, psychology and family medicine, and consumers. Previous guidelines did not exist. Field testing of the guidelines is in progress. PMID:9679487

  17. Practices, patients and (im)perfect data - feasibility of a randomised controlled clinical drug trial in German general practices

    PubMed Central

    2011-01-01

    Background Randomised controlled clinical (drug) trials supply high quality evidence for therapeutic strategies in primary care. Until now, experience with drug trials in German general practice has been sparse. In 2007/2008, the authors conducted an investigator-initiated, non-commercial, double-blind, randomised controlled pilot trial (HWI-01) to assess the clinical equivalence of ibuprofen and ciprofloxacin in the treatment of uncomplicated urinary tract infection (UTI). Here, we report the feasibility of this trial in German general practices and the implementation of Good Clinical Practice (GCP) standards as defined by the International Conference on Harmonisation (ICH) in mainly inexperienced general practices. Methods This report is based on the experience of the HWI-01 study conducted in 29 German general practices. Feasibility was defined by 1) successful practice recruitment, 2) sufficient patient recruitment, 3) complete and accurate data collection and 4) appropriate protection of patient safety. Results The final practice recruitment rate was 18%. In these practices, 79 of 195 screened UTI patients were enrolled. Recruitment differed strongly between practices (range 0-12, mean 2.8 patients per practice) and was below the recruitment goal of approximately 100 patients. As anticipated, practice nurses became the key figures in the screening und recruitment of patients. Clinical trial demands, in particular for completing symptom questionnaires, documentation of source data and reporting of adverse events, did not agree well with GPs' documentation habits and required support from study nurses. In many cases, GPs and practice staff seemed to be overwhelmed by the amount of information and regulations. No sudden unexpected serious adverse reactions (SUSARs) were observed during the trial. Conclusions To enable drug trials in general practice, it is necessary to adapt the setup of clinical research infrastructure to the needs of GPs and their practice

  18. Diagnostic Methods for Bile Acid Malabsorption in Clinical Practice

    PubMed Central

    Vijayvargiya, Priya; Camilleri, Michael; Shin, Andrea; Saenger, Amy

    2013-01-01

    Altered bile acid (BA) concentrations in the colon may cause diarrhea or constipation. BA malabsorption (BAM) accounts for >25% of patients with irritable bowel syndrome (IBS) with diarrhea and chronic diarrhea in Western countries. As BAM is increasingly recognized, proper diagnostic methods are desired in clinical practice to help direct the most effective treatment course for the chronic bowel dysfunction. This review appraises the methodology, advantages and disadvantages of 4 tools that directly measure BAM: 14C-glycocholate breath and stool test, 75Selenium HomotauroCholic Acid Test (SeHCAT), 7 α-hydroxy-4-cholesten-3-one (C4) and fecal BAs. 14C-glycocholate is a laborious test no longer widely utilized. 75SeHCAT is validated, but not available in the United States. Serum C4 is a simple, accurate method that is applicable to a majority of patients, but requires further clinical validation. Fecal measurements to quantify total and individual fecal BAs are technically cumbersome and not widely available. Regrettably, none of these tests are routinely available in the U.S., and a therapeutic trial with a BA binder is used as a surrogate for diagnosis of BAM. Recent data suggest there is an advantage to studying fecal excretion of the individual BAs and their role in BAM; this may constitute a significant advantage of the fecal BA method over the other tests. Fecal BA test could become a routine addition to fecal fat measurement in patients with unexplained diarrhea. In summary, availability determines the choice of test among C4, SeHCAT and fecal BA; more widespread availability of such tests would enhance clinical management of these patients. PMID:23644387

  19. Natural orifice translumenal endoscopic surgery applications in clinical practice

    PubMed Central

    Coomber, Ross S; Sodergren, Mikael H; Clark, James; Teare, Julian; Yang, Guang-Zhong; Darzi, Ara

    2012-01-01

    To review natural orifice translumenal endoscopic surgery (NOTES) applications in clinical practice and assess the evidence base for each application as reported in the literature. An electronic literature search was performed. Inclusion criteria were publications relating to NOTES applications in humans. For each type of operation the highest level of evidence available for clinical NOTES publications was evaluated. Morbidity and short-term operative outcomes were compared with gold standard published evidence where available. Finally, registered trials recruiting patients for NOTES applications were identified. Human NOTES publications with the highest level of evidence in each application are identified. There were no RCTs in the literature to date. The strongest evidence came in the form of large, multi-centre trials with 300-500 patients. The results are encouraging, comparable with gold standard techniques on morbidity and mortality. While short-term operative outcomes were also similar when compared to the gold standard techniques, other than improved cosmesis little else can definitely be concluded as a clear benefit of a NOTES procedure. The most common procedures are cholecystectomy, appendicectomy and peritoneoscopy mainly performed via transvaginal access. It is evident that morbidity appears to be higher when the transgastric route is used. The safety profile of hybrid NOTES transvaginal procedures is beginning to be confirmed as is evident from the large number of procedures presented in this review. A number of authors have presented work on pure NOTES procedures but the results are inconsistent and thus the vast majority of NOTES procedures worldwide are performed in a hybrid fashion with a variable amount of laparoscopy. This review of the clinical applications of NOTES summarises the growing evidence behind this surgical discipline and highlights NOTES procedures with an acceptable safety profile. PMID:22442743

  20. Breast ultrasound tomography: bridging the gap to clinical practice

    NASA Astrophysics Data System (ADS)

    Duric, Neb; Littrup, Peter; Li, Cuiping; Roy, Olivier; Schmidt, Steven; Janer, Roman; Cheng, Xiaoyang; Goll, Jeffrey; Rama, Olsi; Bey-Knight, Lisa; Greenway, William

    2012-03-01

    Conventional sonography, which performs well in dense breast tissue and is comfortable and radiation-free, is not practical for screening because of its operator dependence and the time needed to scan the whole breast. While magnetic resonance imaging (MRI) can significantly improve on these limitations, it is also not practical because it has long been prohibitively expensive for routine use. There is therefore a need for an alternative breast imaging method that obviates the constraints of these standard imaging modalities. The lack of such an alternative is a barrier to dramatically impacting mortality (about 45,000 women in the US per year) and morbidity from breast cancer because, currently, there is a trade-off between the cost effectiveness of mammography and sonography on the one hand and the imaging accuracy of MRI on the other. This paper presents a progress report on our long term goal to eliminate this trade-off and thereby improve breast cancer survival rates and decrease unnecessary biopsies through the introduction of safe, cost-effective, operatorindependent sonography that can rival MRI in accuracy. The objective of the study described in this paper was to design and build an improved ultrasound tomography (UST) scanner in support of our goals. To that end, we report on a design that builds on our current research prototype. The design of the new scanner is based on a comparison of the capabilities of our existing prototype and the performance needed for clinical efficacy. The performance gap was quantified by using clinical studies to establish the baseline performance of the research prototype, and using known MRI capabilities to establish the required performance. Simulation software was used to determine the basic operating characteristics of an improved scanner that would provide the necessary performance. Design elements focused on transducer geometry, which in turn drove the data acquisition system and the image reconstruction engine

  1. Evaluation of Clinical Innovation: A Gray Zone in the Ethics of Modern Clinical Practice?

    PubMed Central

    Grant, Andrew M.; Xhignesse, Marianne; Leblanc, Frédéric; Courteau, Josiane

    2007-01-01

    BACKGROUND Various stakeholders can have differing opinions regarding ethical review when introducing new procedures with patients. OBJECTIVE This pilot study examines the way in which Research Ethics Boards (REBs; Institutional Review Boards) and clinical biochemists (CBs; laboratory medicine specialists) differ in their interpretation of what is research and what should be considered common practice versus innovation versus experimentation when introducing new procedures with patients. It also explores whether these groups agree on who is responsible for the ethical review of new procedures. METHODS A validated case scenario for the introduction of a new diagnostic test into clinical practice was sent to CBs and REBs across Canada. Participants were asked to determine whether the scenario constituted research; whether the test procedure should be considered as experimental, innovative, or commonly accepted care; and whether the project required approval by a REB and, if not, who should be responsible for ethical review. RESULTS Results showed 81% of 37 CBs and 52% of 27 REBs identified the scenario as research. Responsibility for ethical review was assigned to REBs by 44% of REBs and 54% of CBs. Of all participants, 53% classified the test procedure as ‘innovative’, 8% as ‘experimental’, whereas 17% classified it as ‘commonly accepted’. CONCLUSIONS This pilot study indicates a substantial variation in the ethical assessment of innovation in clinical care. This suggests the need to further elaborate on the types of innovation in health care and categorize the nature of the risks associated with each. PMID:18095040

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

    PubMed

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

    2013-05-01

    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

  3. Rural nurse specialists: clinical practice and the politics of care.

    PubMed

    Fitzgerald, Ruth P

    2008-01-01

    Doctor flight from rural areas is an international phenomenon that places great pressure on primary health care delivery. In New Zealand, the response to these empty doctors' surgeries has been the introduction of nurse-led rural health clinics that have attracted controversy both in the media and from urban-based doctors over whether such nurse-led care is a direct substitution of medical care. This article analyzes the reflections of nurses working in some of these clinics who suggest that their situation is more complex than a direct substitution of labor. Although the nurses indicate some significant pressures moving them closer to the work of doctoring, they actively police this cross-boundary work and labor simultaneously to shore up their nursing identities. My own conclusions support their assertions. I argue that it is the maintenance of a holistic professional habitus that best secures their professional identity as nurses while they undertake the cross-boundary tasks of primary rural health care. There are clear professional benefits and disadvantages for the nurses in these situations, which make the positions highly politicized. These recurring divisions of labor within medical care giving and the elaboration of new types of care worker form an appropriate although neglected topic of study for anthropologists. The study of the social organization of clinical medicine is much enriched by paying closer attention to its interaction with allied health professions and their associated understandings of "good" care. PMID:18663640

  4. A framework for effective management of change in clinical practice: dissemination and implementation of clinical practice guidelines.

    PubMed

    Moulding, N T; Silagy, C A; Weller, D P

    1999-09-01

    Theories from social and behavioural science can make an important contribution to the process of developing a conceptual framework for improving use of clinical practice guidelines and clinician performance. A conceptual framework for guideline dissemination and implementation is presented which draws on relevant concepts from diffusion of innovation theory, the transtheoretical model of behaviour change, health education theory, social influence theory, and social ecology, as well as evidence from systematic literature reviews on the effectiveness of various behaviour change strategies. The framework emphasises the need for preimplementation assessment of (a) readiness of clinicians to adopt guidelines into practice, (b) barriers to change as experienced by clinicians, and (c) the level at which interventions should be targeted. It also incorporates the need for multifaceted interventions, identifies the type of barriers which will be addressed by each strategy, and develops the concept of progression through stages of guideline adoption by clinicians, with the use of appropriately targeted support strategies. The potential value of the model is that it may enable those involved in the process of guideline dissemination and implementation to direct strategies to target groups more effectively. Clearly, the effectiveness and utility of the model in facilitating guideline dissemination and implementation requires validation by further empirical research. Until such research is available, it provides a theoretical framework that may assist in the selection of appropriate guideline dissemination and implementation strategies. PMID:10847875

  5. [Behavioral Activation for Depression: Theory and Practice].

    PubMed

    Nakao, Tomohiro

    2015-01-01

    Behavioral activation (BA) has recently attracted marked attention. While cognitive therapy focuses on the cognitive distortion of patients with depression and asks them to change their behaviors as the process of altering the cognitive distortion, BA pays attention to behavior to avoid an unpleasant situation or social situation as a key symptom that leads to persistence of the depression. Avoidance behaviors are often seen during every process of depression, from onset to recurrence. Avoidance behaviors, a decrease in pleasant phenomena, or increase in unpleasant phenomena, result in reinforcing a depressive mood. If patients can set appropriate behavioral targets and achieve them, the beneficial behaviors will be further promoted with positive feed-back. The behavioral change, as-a consequence, will result in improvement of the mood, cognition, and depression itself. In this manuscript, the author presents two clinical cases, in which BA assisted the patients in recovering from their depression. The first case was a male in his thirties who repeatedly took sick leave from his work because of maladjustment, which resulted in persistent depression. The second case was a female in her thirties who suffered from OCD and then became maladjusted to her place of work, depressive, and emotionally unstable. In both cases, avoidant behaviors caused their conditions to persist. Appropriate activities formed by BA improved their moods, and their self-efficacies were gradually regained. It was suggested that BA is markedly effective, especially in patients whose avoidant behaviors mainly cause the persistence of their depressive symptoms. PMID:26514042

  6. Magnetic resonance enterography in Crohn's disease: optimal use in clinical practice and clinical trials.

    PubMed

    Rimola, Jordi; Panés, Julián; Ordás, Ingrid

    2015-01-01

    The purpose of this review is to provide a practical appraisal of the usefulness of magnetic resonance enterography in the management of Crohn's disease and the potential utilities that this imaging modality may have in clinical research. Also, we review some basic technical considerations that clinicians should know to understand the value and limitations of the technique. Lastly, we outline the future trends and potential contributions of new technological advances in the field of magnetic resonance imaging that can improve the classic magnetic resonance enterography technique. PMID:25523557

  7. Psychologists' Clinical Practices in Assessing Dementia in Individuals with Down Syndrome

    ERIC Educational Resources Information Center

    Auty, Ellen; Scior, Katrina

    2008-01-01

    There are now ample guidelines for the assessment and diagnosis of possible dementia in individuals with intellectual disabilities (ID) and Down syndrome. However, little is known about their implementation in clinical practice. This study set out to examine the clinical practice of one key professional group, namely clinical psychologists. A…

  8. Integrating Single-System Design Research into the Clinical Practice Class

    ERIC Educational Resources Information Center

    Cooper, Marlene G.

    2006-01-01

    Clinical practice and research are generally taught separately in Master of Social Work programs by faculty with distinct areas of expertise. This paper discusses the teaching of single-subject design research methodology by clinical faculty, in the clinical practice class. Examples from student papers demonstrate the effectiveness of integrating…

  9. Examining the evidence for the use of probiotics in clinical practice.

    PubMed

    Hickson, Mary

    This article reviews the use of probiotics in clinical practice, including explanations of what they are and how they work. Evidence for the health benefits of consuming probiotic bacteria and yeast are examined in several clinical conditions. The problems associated with making recommendations for the use of probiotics in clinical practice are also discussed. PMID:23634499

  10. 7 CFR 1469.8 - Conservation practices and activities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Conservation practices and activities. 1469.8 Section... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM General Provisions § 1469.8 Conservation practices and activities. (a) Conservation practice and...

  11. 7 CFR 1469.8 - Conservation practices and activities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Conservation practices and activities. 1469.8 Section... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM General Provisions § 1469.8 Conservation practices and activities. (a) Conservation practice and...

  12. 7 CFR 1469.8 - Conservation practices and activities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Conservation practices and activities. 1469.8 Section... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM General Provisions § 1469.8 Conservation practices and activities. (a) Conservation practice and...

  13. 7 CFR 1469.8 - Conservation practices and activities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Conservation practices and activities. 1469.8 Section... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM General Provisions § 1469.8 Conservation practices and activities. (a) Conservation practice and...

  14. How to Develop an Electronic Clinical Endometriosis Research File Integrated in Clinical Practice

    PubMed Central

    Vanhie, A.; Fassbender, A.; O, D.; Tomassetti, C.; Meuleman, C.; Peeraer, K.; Debrock, S.; D'Hooghe, Th.

    2015-01-01

    Endometriosis is associated with a range of pelvic-abdominal pain symptoms and infertility. It is a chronic disease that can have a significant impact on various aspects of women's lives, including their social and sexual relationships, work, and study. Despite several international guidelines on the management of endometriosis, there is a wide variety of clinical practice in the management of endometriosis, resulting in many women receiving delayed or suboptimal care. In this paper we discuss the possibilities and benefits of using electronic health records for clinical research in the field of endometriosis. The development of a wide range of clinical software for electronic patient records has made the registration of large datasets feasible and the integration of research files and clinical files possible. Integration of global standards on registration of endometriosis care in electronic health records could improve reporting of research data and facilitate the execution of large, multicentre randomized trials on the management of endometriosis. These highly needed trials could bring us the evidence needed for the optimisation of management of women with endometriosis. PMID:26240823

  15. How to Develop an Electronic Clinical Endometriosis Research File Integrated in Clinical Practice.

    PubMed

    Vanhie, A; Fassbender, A; O, D; Tomassetti, C; Meuleman, C; Peeraer, K; Debrock, S; D'Hooghe, Th

    2015-01-01

    Endometriosis is associated with a range of pelvic-abdominal pain symptoms and infertility. It is a chronic disease that can have a significant impact on various aspects of women's lives, including their social and sexual relationships, work, and study. Despite several international guidelines on the management of endometriosis, there is a wide variety of clinical practice in the management of endometriosis, resulting in many women receiving delayed or suboptimal care. In this paper we discuss the possibilities and benefits of using electronic health records for clinical research in the field of endometriosis. The development of a wide range of clinical software for electronic patient records has made the registration of large datasets feasible and the integration of research files and clinical files possible. Integration of global standards on registration of endometriosis care in electronic health records could improve reporting of research data and facilitate the execution of large, multicentre randomized trials on the management of endometriosis. These highly needed trials could bring us the evidence needed for the optimisation of management of women with endometriosis. PMID:26240823

  16. Harmonia axyridis ladybug hypersensitivity in clinical allergy practice.

    PubMed

    Goetz, David W

    2007-01-01

    The imported Harmonia axyridis ladybug infests homes in northern West Virginia from fall through spring, causing allergic disease. Retrospective single-practice chart reviews were performed: (1) all skin prick tests (1400 included ladybug) in a community allergy practice over 4 years and (2) clinical analysis of 400 randomly chosen patients. The usual adult aeroallergen skin test panel included ladybug and 57 other allergens. Statistics used were contingency table analyses and the kappa-statistic for concordance. Home infestation with ladybugs was most common in rural areas but did not predict ladybug sensitization (kappa = -0.02). Ladybug sensitization and allergy occurred at all ages. Ladybug sensitization occurred with 21% frequency compared with cat at 24% frequency, cockroach at 27% frequency, and dust mites at 40% frequency. Only ladybug showed a significant (p < 0.0001) skin test sensitization decreasing from rural (30%), mixed (21%), to urban (16%) home demographics. Isolated single-positive skin tests constituted 10% of dust mites, 6% of cockroach, 6% of ladybug, and 4% of cat-positive skin tests. Skin test concordance was strongest between the pairs: ladybug-cockroach (kappa = 0.36), cockroach-dust mite (kappa = 0.29), and dust mite-cat (kappa = 0.25). Ladybug is a major allergen in endemic areas, causing rhinoconjunctivitis (8% prevalence), asthma (2% prevalence), and urticaria (1% prevalence). Ladybug skin test sensitization is more common in rural areas and is comparable in frequency and age distribution with cat and cockroach. Cockroach and ladybug have a high degree of skin test concordance. A quality commercial ladybug allergen extract and increased ladybug allergen research are needed. PMID:17390758

  17. Automating Identification of Multiple Chronic Conditions in Clinical Practice Guidelines

    PubMed Central

    Leung, Tiffany I.; Jalal, Hawre; Zulman, Donna M.; Dumontier, Michel; Owens, Douglas K.; Musen, Mark A.; Goldstein, Mary K.

    2015-01-01

    Many clinical practice guidelines (CPGs) are intended to provide evidence-based guidance to clinicians on a single disease, and are frequently considered inadequate when caring for patients with multiple chronic conditions (MCC), or two or more chronic conditions. It is unclear to what degree disease-specific CPGs provide guidance about MCC. In this study, we develop a method for extracting knowledge from single-disease chronic condition CPGs to determine how frequently they mention commonly co-occurring chronic diseases. We focus on 15 highly prevalent chronic conditions. We use publicly available resources, including a repository of guideline summaries from the National Guideline Clearinghouse to build a text corpus, a data dictionary of ICD-9 codes from the Medicare Chronic Conditions Data Warehouse (CCW) to construct an initial list of disease terms, and disease synonyms from the National Center for Biomedical Ontology to enhance the list of disease terms. First, for each disease guideline, we determined the frequency of comorbid condition mentions (a disease-comorbidity pair) by exactly matching disease synonyms in the text corpus. Then, we developed an annotated reference standard using a sample subset of guidelines. We used this reference standard to evaluate our approach. Then, we compared the co-prevalence of common pairs of chronic conditions from Medicare CCW data to the frequency of disease-comorbidity pairs in CPGs. Our results show that some disease-comorbidity pairs occur more frequently in CPGs than others. Sixty-one (29.0%) of 210 possible disease-comorbidity pairs occurred zero times; for example, no guideline on chronic kidney disease mentioned depression, while heart failure guidelines mentioned ischemic heart disease the most frequently. Our method adequately identifies comorbid chronic conditions in CPG recommendations with precision 0.82, recall 0.75, and F-measure 0.78. Our work identifies knowledge currently embedded in the free text of

  18. Automating Identification of Multiple Chronic Conditions in Clinical Practice Guidelines.

    PubMed

    Leung, Tiffany I; Jalal, Hawre; Zulman, Donna M; Dumontier, Michel; Owens, Douglas K; Musen, Mark A; Goldstein, Mary K

    2015-01-01

    Many clinical practice guidelines (CPGs) are intended to provide evidence-based guidance to clinicians on a single disease, and are frequently considered inadequate when caring for patients with multiple chronic conditions (MCC), or two or more chronic conditions. It is unclear to what degree disease-specific CPGs provide guidance about MCC. In this study, we develop a method for extracting knowledge from single-disease chronic condition CPGs to determine how frequently they mention commonly co-occurring chronic diseases. We focus on 15 highly prevalent chronic conditions. We use publicly available resources, including a repository of guideline summaries from the National Guideline Clearinghouse to build a text corpus, a data dictionary of ICD-9 codes from the Medicare Chronic Conditions Data Warehouse (CCW) to construct an initial list of disease terms, and disease synonyms from the National Center for Biomedical Ontology to enhance the list of disease terms. First, for each disease guideline, we determined the frequency of comorbid condition mentions (a disease-comorbidity pair) by exactly matching disease synonyms in the text corpus. Then, we developed an annotated reference standard using a sample subset of guidelines. We used this reference standard to evaluate our approach. Then, we compared the co-prevalence of common pairs of chronic conditions from Medicare CCW data to the frequency of disease-comorbidity pairs in CPGs. Our results show that some disease-comorbidity pairs occur more frequently in CPGs than others. Sixty-one (29.0%) of 210 possible disease-comorbidity pairs occurred zero times; for example, no guideline on chronic kidney disease mentioned depression, while heart failure guidelines mentioned ischemic heart disease the most frequently. Our method adequately identifies comorbid chronic conditions in CPG recommendations with precision 0.82, recall 0.75, and F-measure 0.78. Our work identifies knowledge currently embedded in the free text of

  19. Quality Appraisal of Clinical Practice Guidelines on Pancreatic Cancer

    PubMed Central

    He, Zhiyun; Tian, Hongliang; Song, Ailin; Jin, Lan; Zhou, Xiaona; Liu, Xiaoye; Guo, Wei; Zhang, Zhongtao

    2015-01-01

    Abstract Clinical practice guidelines (CPGs) play an important role in health care. The guideline development process should be precise and rigorous to ensure that the results are reproducible and not vague. To determine the quality of guidelines, the Appraisal of Guidelines and Research and Evaluation (AGREE) instrument was developed and introduced. The objective of this study is to assess the methodological quality of CPGs on pancreatic cancer. Five databases (included MEDLINE and EMBASE) and guideline websites were searched till April, 2014. The methodological quality of the guidelines was assessed by 4 authors independently using the AGREE II instrument. From 2526 citations, 21 relevant guidelines were included. The overall agreement among reviewers was moderate (intraclass correlation coefficient = 0.86, 95% confidence interval 0.64–0.96). The mean scores were moderate for the domains “scope and purpose” and “clarity of presentation”; however, they were low for the domains “stakeholder involvement” (31.22), “rigor of development”, “applicability”, and “editorial independence”. These domain scores were lower when compared with international levels. There are 5 (23.81%) guidelines that described the systematic methods for searching. Moreover, only 5 (23.81%) guidelines reported that methodological expertise were included in the guideline developing teams. The quality and transparency of the development process and the consistency in the reporting of pancreatic cancer guidelines need to be improved. Many other methodological disadvantages were identified. In the future, pancreatic cancer CPGs should base on the best available evidence rigorously developed and reported. Greater efforts are needed to provide high-quality guidelines that serve as a useful and reliable tool for clinical decision making in this field. PMID:25816030

  20. Online hemodiafiltration. Technical options and best clinical practices.

    PubMed

    Canaud, B

    2007-01-01

    Online production of substitution fluid by 'cold sterilization' (ultrafiltration) of dialysis fluid gives access to virtually unlimited amounts of sterile and nonpyrogenic solution. The incorporation of the online hemodiafiltration (ol-HDF) module into the dialysis proportioning machine hardware simplifies the handling procedure, secures the process by keeping the safety regulation of the monitor and offers virtually unlimited amounts of sterile and nonpyrogenic substitutive solution. The safety of the ol-HDF relies upon use of ultrapure water and strict and permanent highly hygienic rules of use. The use of a specifically designed certified HDF machine is also mandatory. Several forms of ol-HDF have been developed and used to cover specific clinical needs of chronic kidney disease patients. Conventional ol-HDF are classified according to the mode of substitution as post-, pre- and mixed dilution. Alternative-based ol-HDF incorporate push/pull HDF, double high-flux HDF, paired HDF and middilution HDF. A very simple description of these methods is provided in this section. Best clinical practices are summarized in this section to optimize performances of ol-HDF and maximize the safety of the method. It is noteworthy to stress the important role of blood flow, fluid volume exchange, hemodiafilter performances and duration of sessions in the overall treatment efficacy. It is also crucial to insist on the importance of strict hygienic handling, microbiology monitoring and the quality assurance process to ensure the safety of the method. In addition, ol-HDF offers the best technical platform to develop new therapeutic strategies such as daily treatment, total automation of priming and cleansing procedures and biofeedback volume control. PMID:17684349

  1. Sitagliptin: Is It Effective in Routine Clinical Practice?

    PubMed Central

    Mohan Dallumal, Rita; Chua, Siew Siang; Wu, David Bin-Chia; Vethakkan, Shireene Ratna

    2015-01-01

    Aim. The present study was conducted to determine the glycaemic effects of sitagliptin in type 2 diabetes patients. Methods. Data was collected from patient medical records of a major teaching hospital in Malaysia, from 2009 to 2012. Glycated hemoglobin (HbA1c) values prior to and up to 12 months after the initiation of sitagliptin were analysed. The change in HbA1c values was accounted for based on a generalized linear model generated using the Generalized Estimating Equations (GEE) method. Results and Discussion. Of the 457 patients, 53.6% were elderly and 81.4% were overweight. The mean HbA1c (standard deviation) before initiation of sitagliptin was 8.5 (1.4)%. This dropped to 7.7 (1.4)%, 3 to 6 months after initiation of sitagliptin, with a mean difference of 0.8% (95% confidence interval (CI): 0.7–1.0; P < 0.001). However, this value increased to 8.0 (1.7)% after 7 to 12 months on sitagliptin (P = 0.002) with a mean difference from baseline of 0.6% (95% CI: 0.4–0.7; P < 0.001). Conclusion. In routine clinical practice, sitagliptin produces a significant reduction in mean HbA1c (0.8%) within the first 6 months of use which corresponds to efficacy data obtained in controlled clinical trials. However, this reduction was lesser, 7 to 12 month later. PMID:26089904

  2. Relevance of federal antitrust statutes to clinical practice.

    PubMed

    Satiani, Bhagwan

    2003-06-01

    With the advent of Medicare prospective payment systems, health care entities and physicians were forced to decrease expenses by sharing services and to increase revenue by attempting to jointly negotiate better reimbursement from third- party payers. Both activities have raised the specter of prosecution under antitrust laws that have been with us for more than a century but are poorly understood by practicing physicians. Recent monopolistic activities in the health care arena have prompted the Federal Trade Commission to file actions under specific acts of Congress, eg, the Sherman Anti-Trust Act, Clayton Act, Federal Trade Commission Act, Robinson-Patman Act, and Celler-Kefauver Act. Inasmuch as it is likely that specialties such as vascular surgery as a business will undergo substantial transformation, physicians need to be aware of the severe civil and criminal sanctions imposed if they are found guilty; fines that are several times actual damages; activities that raise antitrust issues including utilization review, medical staff privileges for competing specialties, participating provider agreements, and predatory pricing; and affirmative defenses and relief available in terms of specific exemptions. As health care providers react, innovate, and adjust to stay solvent, their business strategies will surely continue to be scrutinized for antitrust behavior by federal and state officials. The physician must have a basic understanding of the groundrules that govern any contemplated business strategy so that common pitfalls may be averted. PMID:12764288

  3. Intramuscular preparations of antipsychotics: uses and relevance in clinical practice.

    PubMed

    Altamura, A Cario; Sassella, Francesca; Santini, Annalisa; Montresor, Clauno; Fumagalli, Sara; Mundo, Emanuela

    2003-01-01

    Intramuscular formulations of antipsychotics can be sub-divided into two groups on the basis of their pharmacokinetic features: short-acting preparations and long-acting or depot preparations. Short-acting intramuscular formulations are used to manage acute psychotic episodes. On the other hand, long-acting compounds, also called "depot", are administered as antipsychotic maintenance treatment to ensure compliance and to eliminate bioavailability problems related to absorption and first pass metabolism. Adverse effects of antipsychotics have been studied with particular respect to oral versus short- and long-acting intramuscular formulations of the different compounds. For short-term intramuscular preparations the main risk with classical compounds are hypotension and extrapyramidal side effects (EPS). Data on the incidence of EPS with depot formulations are controversial: some studies point out that the incidence of EPS is significantly higher in patients receiving depot preparations, whereas others show no difference between oral and depot antipsychotics. Studies on the strategies for switching patients from oral to depot treatment suggest that this procedure is reasonably well tolerated, so that in clinical practice depot antipsychotic therapy is usually begun while the oral treatment is still being administered, with gradual tapering of the oral dose. Efficacy, pharmacodynamics and clinical pharmacokinetics of haloperidol decanoate, fluphenazine enanthate and decanoate, clopenthixol decanoate, zuclopenthixol decanoate and acutard, flupenthixol decanoate, perphenazine enanthate, pipothiazine palmitate and undecylenate, and fluspirilene are reviewed. In addition, the intramuscular preparations of atypical antipsychotics and clinical uses are reviewed. Olanzapine and ziprasidone are available only as short-acting preparations, while risperidone is to date the only novel antipsychotic available as depot formulation. To date, acutely ill, agitated psychotic patients

  4. Ethical clinical practice and sport psychology: when two worlds collide.

    PubMed

    Brown, Jeffrey L; Cogan, Karen D

    2006-01-01

    From their own practices, the authors offer insight into potential ethical dilemmas that may frequently develop in an applied psychology setting in which sport psychology is also being practiced. Specific ethical situations offered for the reader's consideration include confidentiality with coaches, administration, parents, and athlete-clients; accountability in ethical billing practices and accurate diagnosing; identification of ethical boundaries in nontraditional practice settings (locker room, field, rink, etc.); and establishment of professional competence as it relates to professional practice and marketing. PMID:17036422

  5. Concordance between Clinical Practice and Published Evidence: Findings from The National Dental Practice-Based Research Network

    PubMed Central

    Norton, Wynne E.; Funkhouser, Ellen; Makhija, Sonia K.; Gordan, Valeria V.; Bader, James D.; Rindal, D. Brad; Pihlstrom, Daniel J.; Hilton, Thomas J.; Frantsve-Hawley, Julie; Gilbert, Gregg H.

    2013-01-01

    Background. Documenting the gap between what is occurring in clinical practice and what published research suggests is an important step toward improving care. This study quantified concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in the National Dental Practice-Based Research Network. Methods. Network dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors. Responses to each clinical practice were coded as consistent (i.e., ‘1’) or inconsistent (i.e., ‘0’) with published evidence, summed, and divided by the number of all non-missing to create an overall ‘concordance’ score, calculated as the mean percent of responses that were consistent with published evidence. Results. Analyses were limited to participants in the United States (N = 591). Mean concordance at the practitioner level was 62% (SD = 18); procedure-specific concordance ranged from 8-100%. Affiliation with a large group practice, being a female practitioner, and receiving a dental degree before 1990 were independently associated with high concordance (≥75%). Conclusions. Dentists reported a medium-range concordance between practice and evidence. Clinical Implications. Efforts to bring research findings into routine practice are needed. PMID:24379327

  6. Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline

    PubMed Central

    Nieman, Lynnette K.; Biller, Beverly M. K.; Findling, James W.; Murad, M. Hassan; Newell-Price, John; Savage, Martin O.; Tabarin, Antoine

    2015-01-01

    Objective: The objective is to formulate clinical practice guidelines for treating Cushing's syndrome. Participants: Participants include an Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer. The European Society for Endocrinology co-sponsored the guideline. Evidence: The Task Force used the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus Process: The Task Force achieved consensus through one group meeting, several conference calls, and numerous e-mail communications. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Conclusions: Treatment of Cushing's syndrome is essential to reduce mortality and associated comorbidities. Effective treatment includes the normalization of cortisol levels or action. It also includes the normalization of comorbidities via directly treating the cause of Cushing's syndrome and by adjunctive treatments (eg, antihypertensives). Surgical resection of the causal lesion(s) is generally the first-line approach. The choice of second-line treatments, including medication, bilateral adrenalectomy, and radiation therapy (for corticotrope tumors), must be individualized to each patient. PMID:26222757

  7. Aspergillus fumigatus-Related Species in Clinical Practice

    PubMed Central

    Lamoth, Frédéric

    2016-01-01

    Aspergillus fumigatus is the main etiologic agent of invasive aspergillosis (IA). Other Aspergillus species belonging to the section Fumigati (A. fumigatus complex) may occasionally be the cause of IA. These strains are often misidentified, as they cannot be distinguished from A. fumigatus by conventional morphological analysis and sequencing methods. This lack of recognition may have important consequences as these A. fumigatus-related species often display some level of intrinsic resistance to azoles and other antifungal drugs. A. lentulus, A. udagawae, A. viridinutans, and A. thermomutatus (Neosartorya pseudofischeri) have been associated with refractory cases of IA. Microbiologists should be able to suspect the presence of these cryptic species behind a putative A. fumigatus isolate on the basis of some simple characteristics, such as defect in sporulation and/or unusual antifungal susceptibility profile. However, definitive species identification requires specific sequencing analyses of the beta-tubulin or calmodulin genes, which are not available in most laboratories. Multiplex PCR assays or matrix-assisted laser desorption ionization – time-of-flight mass spectrometry (MALDI-TOF MS) gave promising results for rapid and accurate distinction between A. fumigatus and other Aspergillus spp. of the section Fumigati in clinical practice. Improved diagnostic procedures and antifungal susceptibility testing may be helpful for the early detection and management of these particular IA cases. PMID:27242710

  8. Why use automated office blood pressure measurements in clinical practice?

    PubMed

    Andreadis, Emmanuel A; Angelopoulos, Epameinondas T; Agaliotis, Gerasimos D; Tsakanikas, Athanasios P; Mousoulis, George P

    2011-09-01

    Automated office blood pressure (AOBP) measurement with the patient resting alone in a quiet examining room can eliminate the white-coat effect associated with conventional readings taken by manual sphygmomanometer. The key to reducing the white-coat response appears to be multiple blood pressure (BP) readings taken in a non-observer office setting, thus eliminating any interaction that could provoke an office-induced increase in BP. Furthermore, AOBP readings have shown a higher correlation with the mean awake ambulatory BP compared with BP readings recorded in routine clinical practice. Although there is a paucity of studies connecting AOBP with organ damage, AOBP values were recently found to be equally associated with left ventricular mass index as those of ambulatory BP. This concludes that in contrast to routine manual office BP, AOBP readings compare favourably with 24-hour ambulatory BP measurements in the appraisal of cardiac remodelling and, as such, could be complementary to ambulatory readings in a way similar to home BP measurements. PMID:21950780

  9. Advances, practice, and clinical perspectives in high-throughput sequencing.

    PubMed

    Park, S-J; Saito-Adachi, M; Komiyama, Y; Nakai, K

    2016-07-01

    Remarkable advances in high-throughput sequencing technologies have fundamentally changed our understanding of the genetic and epigenetic molecular bases underlying human health and diseases. As these technologies continue to revolutionize molecular biology leading to fresh perspectives, it is imperative to thoroughly consider the enormous excitement surrounding the technologies by highlighting the characteristics of platforms and their global trends as well as potential benefits and limitations. To date, with a variety of platforms, the technologies provide an impressive range of applications, including sequencing of whole genomes and transcriptomes, identifying of genome modifications, and profiling of protein interactions. Because these applications produce a flood of data, simultaneous development of bioinformatics tools is required to efficiently deal with the big data and to comprehensively analyze them. This review covers the major achievements and performances of the high-throughput sequencing and further summarizes the characteristics of their applications along with introducing applicable bioinformatics tools. Moreover, a step-by-step procedure for a practical transcriptome analysis is described employing an analytical pipeline. Clinical perspectives with special consideration to human oral health and diseases are also covered. PMID:26602181

  10. Korean Clinical Practice Guidelines: Otitis Media in Children

    PubMed Central

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

    2012-01-01

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

  11. Clinical applications of laser therapy on the dental practice

    NASA Astrophysics Data System (ADS)

    Pinheiro, Antonio L. B.

    2004-09-01

    Dental practice consists of a series of laboring procedures which demands the use of several types of equipment and materials. Usually patient"s fears brings additional burden to the Dentists. The use of Lasers for treating and diagnosis in Dentistry is quite new comparing to other medical areas. Initially Laser technology was used as an alternative method for treating dental caries in order to substitute the use of the drill. Lately surgical Lasers have shown themselves very useful for treating several pathologies and began to be used as a powerful tool on the treatment of several conditions affecting the maxillofacial complex and later on, the era of the use of Laser therapy began. The advent of the diode Lasers made possible the introduction of small units at the dental office and Laser therapy was used to improve healing and later included also caries diagnosis. This paper discuss the use of Laser therapy on Restorative Dentistry, Periodondology, Oral and Maxillofacial Surgery, Oral implantology and other. Clinical and laboratorial experience has demonstrated that Laser therapy does improve the healing of both mineralized and soft tissues, reduces pain and inflammation, and also reduces both cost and length of the dental treatment.

  12. [Neural prostheses and neuromodulation : Research and clinical practice in therapy and rehabilitation].

    PubMed

    Stieglitz, T

    2010-08-01

    Stimulation of the nervous system with the aid of electrical active implants has changed the therapy of neurological diseases and rehabilitation of lost functions and has expanded clinical practice within the last few years. Alleviation of effects of neurodegenerative diseases, therapy of psychiatric diseases, the functional restoration of hearing as well as other applications have been transferred successfully into clinical practice. Other approaches are still under development in preclinical and clinical trials. The restoration of sight by implantable electronic systems that interface with the retina in the eye is an example how technological progress promotes novel medical devices. The idea of using the electrical signal of the brain to control technical devices and (neural) prostheses is driving current research in the field of brain-computer interfaces. The benefit for the patient always has to be balanced with the risks and side effects of those implants in comparison to medicinal and surgical treatments. How these and other developments become established in practice depends finally on their acceptance by the patients and the reimbursement of their costs. PMID:20700777

  13. Clinical and arthroscopic findings in recreationally active patients

    PubMed Central

    2010-01-01

    Objective To examine the diagnostic accuracy of standard clinical tests for the shoulder in recreational athletes with activity related pain. Design Cohort study with index test of clinical examination and reference standard of arthroscopy. Setting Sports Medicine clinic in Sheffield, U.K. Participants 101 recreational athletes (82 male, 19 female; mean age 40.8 ± 14.6 years) over a six year period. Interventions Bilateral evaluation of movements of the shoulder followed by standardized shoulder tests, formulation of clinical diagnosis and shoulder arthroscopy conducted by the same surgeon. Main Outcome Measurements Sensitivity, specificity, likelihood ratio for a positive test and over-all accuracy of clinical examination was examined retrospectively and compared with arthroscopy. Results Isolated pathology was rare, most patients (72%) having more than one injury recorded. O'Brien's clinical test had a mediocre sensitivity (64%) and over-all accuracy (54%) for diagnosing SLAP lesions. Hawkins test and Jobe's test had the highest but still not impressive over-all accuracy (67%) and sensitivity (67%) for rotator cuff pathology respectively. External and internal impingement tests showed similar levels of accuracy. When a positive test was observed in one of a combination of shoulder tests used for diagnosing SLAP lesions or rotator cuff disease, sensitivity increased substantially whilst specificity decreased. Conclusions The diagnostic accuracy of isolated standard shoulder tests in recreational athletes was over-all very poor, potentially due to the majority of athletes (71%) having concomitant shoulder injuries. Most likely, this means that many of these injuries are missed in general practice and treatment is therefore delayed. Clinical examination of the shoulder should involve a combination of clinical tests in order to identify likely intra articular pathology which may warrant referral to specialist for surgery. PMID:20157421

  14. Exercise and Fall Prevention: Narrowing the Research-to-Practice Gap and Enhancing Integration of Clinical and Community Practice.

    PubMed

    Li, Fuzhong; Eckstrom, Elizabeth; Harmer, Peter; Fitzgerald, Kathleen; Voit, Jan; Cameron, Kathleen A

    2016-02-01

    Falls in older adults are a global public health crisis, but mounting evidence from randomized controlled trials shows that falls can be reduced through exercise. Public health authorities and healthcare professionals endorse the use of evidence-based, exercise-focused fall interventions, but there are major obstacles to translating and disseminating research findings into healthcare practice, including lack of evidence of the transferability of efficacy trial results to clinical and community settings, insufficient local expertise to roll out community exercise programs, and inadequate infrastructure to integrate evidence-based programs into clinical and community practice. The practical solutions highlighted in this article can be used to address these evidence-to-practice challenges. Falls and their associated healthcare costs can be reduced by better integrating research on exercise intervention into clinical practice and community programs. PMID:26825429

  15. Knowledge systems, health care teams, and clinical practice: a study of successful change.

    PubMed

    Olson, Curtis A; Tooman, Tricia R; Alvarado, Carla J

    2010-10-01

    Clinical teams are of growing importance to healthcare delivery, but little is known about how teams learn and change their clinical practice. We examined how teams in three US hospitals succeeded in making significant practice improvements in the area of antimicrobial resistance. This was a qualitative cross-case study employing Soft Knowledge Systems as a conceptual framework. The purpose was to describe how teams produced, obtained, and used knowledge and information to bring about successful change. A purposeful sampling strategy was used to maximize variation between cases. Data were collected through interviews, archival document review, and direct observation. Individual case data were analyzed through a two-phase coding process followed by the cross-case analysis. Project teams varied in size and were multidisciplinary. Each project had more than one champion, only some of whom were physicians. Team members obtained relevant knowledge and information from multiple sources including the scientific literature, experts, external organizations, and their own experience. The success of these projects hinged on the teams' ability to blend scientific evidence, practical knowledge, and clinical data. Practice change was a longitudinal, iterative learning process during which teams continued to acquire, produce, and synthesize relevant knowledge and information and test different strategies until they found a workable solution to their problem. This study adds to our understanding of how teams learn and change, showing that innovation can take the form of an iterative, ongoing process in which bits of K&I are assembled from multiple sources into potential solutions that are then tested. It suggests that existing approaches to assessing the impact of continuing education activities may overlook significant contributions and more attention should be given to the role that practical knowledge plays in the change process in addition to scientific knowledge. PMID

  16. BIOMARKERS: HOPES AND CHALLENGES IN THE PATH FROM DISCOVERY TO CLINICAL PRACTICE

    PubMed Central

    Frangogiannis, Nikolaos G

    2015-01-01

    Biomarkers are objectively measured indicators of normal or pathological processes that may be helpful in diagnosis, staging, monitoring treatment, or prognostic evaluation of a disease. Although development of genomic, metabolomic and proteomic technologies has contributed to an explosion in identification of candidate analytes, validation remains expensive and challenging, and successful introduction of new biomarkers to clinical practice occurs at a very slow pace. The goal of this introductory overview is to provide the context for a series of review manuscripts published in the special issue on biomarkers. The promises and challenges of biomarker discovery are highlighted. Discovery and implementation of transformative new biomarkers in clinical practice requires close collaborations between scientists, clinicians and industry. High throughput technologies can identify a myriad of promising candidates but cannot predict their clinical value. In addition to rapid effective and systematic approaches for clinical validation, there is a need to study and establish links between the purported biomarker and the pathophysiologic basis of the disease of interest. Biomarkers are most informative when they provide insights into activation of specific pathways, thus serving as windows into the molecular basis of the disease. PMID:22424424

  17. Usability of a virtual community of practice for workforce development of clinical supervisors.

    PubMed

    Mather, Carey; Cummings, Elizabeth

    2014-01-01

    Workplaces are being transformed by technological change. There is great potential for innovation at educational institutions and in the workplace. Creative and effective use of information communication technology in learning and teaching and for continuing professional development of health professionals is imperative. To determine the usability of a virtual community of practice for clinical supervisors, an online survey was administered prior to attendance at professional development workshops. Clinical supervisors were targeted because they were senior nurse leaders and could promote and model the use of the virtual network within their organisations. Survey findings indicated that a community of practice would be useful for communication about clinical supervision and obtaining information from the University. However, respondents were less certain they would share information by actively contributing to the public mobile learning resources. This study indicates there is considerable potential to build capacity of healthcare professionals through workforce development. Support for clinical supervisors to understand and use mobile learning strategies for continuing professional development and promote life-long learning can assist with realising the vision of the National Workforce Development Strategy. PMID:25087535

  18. [Implementation of clinical practice guidelines: how can we close the evidence-practice gap?].

    PubMed

    Muche-Borowski, Cathleen; Nothacker, M; Kopp, I

    2015-01-01

    Guidelines are intended as instruments of knowledge transfer to support decision-making by physicians, other health professionals and patients in clinical practice and thereby contribute to quality improvements in healthcare. To date they are an indispensable tool for healthcare. Their benefit for patients can only be seen in application, i.e. the implementation of guideline recommendations. For successful implementation, implementability and practicability play a crucial role and these characteristics can be influenced and should be promoted by the guideline development group. In addition, a force field analysis to identify barriers against and facilitators for the implementation of specific guideline recommendations from the perspective of physicians and patients is recommended to guide the development of an individual implementation strategy and the selection of appropriate interventions. However, implementation cannot be achieved by the guideline development group alone and a universal implementation strategy does not exist. Therefore, a process using theory, analysis, experience and shared responsibility of stakeholders in healthcare is recommended, with the aim to achieve sustainable behavioral change and improve the quality of care by guideline-oriented behavior. PMID:25412582

  19. Teaching to the three apprenticeships: designing learning activities for professional practice in an undergraduate curriculum.

    PubMed

    Noone, Joanne

    2009-08-01

    The Carnegie Foundation for the Advancement of Teaching recently completed a series of comparative studies that examined components and best practices in professional education and practice across five professions (clergy, law, medicine, nursing, and engineering). Across these disciplines, three apprenticeships were identified as necessary components of education for professional practice: an intellectual or cognitive apprenticeship, a skill-based apprenticeship related to clinical judgment and practice, and an apprenticeship to the ethical comportment or behavior of the profession. Although nursing education has a strong theory and clinical practice base historically, the comparative study of nursing education by the Carnegie Foundation found limited integration of the apprenticeships. Using an exemplar, this article discusses intentional design of learning objectives and activities to integrate learning across the three apprenticeships with an emphasis on key elements for professional practice in nursing. PMID:19681538

  20. Effects of an advanced surgical nursing module on clinical practice.

    PubMed

    Frost, J

    1994-04-01

    1. Innovation and changes in practice can be developed through continuing education. 2. By adapting appropriate change strategies, theories learned in class can be applied in practice. 3. Excellence in quality can be achieved by all qualified nurses by applying theory to practice. PMID:7513891

  1. Protein Biomarker Research in UK Hospital Clinical Biochemistry Laboratories: A Survey of Current Practice and Views

    PubMed Central

    Hepburn, Sophie; Banks, Rosamonde E; Thompson, Douglas

    2014-01-01

    Background: With the increasing drive for more and better disease biomarkers to underpin the stratified or personalised medicine agenda, clinical biochemistry laboratories should be ideally placed to play a major role in their translation into clinical practice. However, little is known about the current extent of biomarker-related research activity in UK National Health Service clinical biochemistry departments. Methods: In December 2010, an online questionnaire was sent to active UK members of the Association for Clinical Biochemistry (ACB) to determine the extent of their current research activity and involvement in protein biomarker discovery and translation, including an assessment of the awareness of proteomics. Results: A total of 198 eligible responses (19% response rate) was received from across the UK. Of a further 50 eligible people who responded to a follow-up for initial non-responders, most cited insufficient knowledge about the topic as the reason for non-response (24% total response rate). The results illustrate the highly skilled nature of the workforce with many having experience in a research environment (75%) with postgraduate qualifications. However, more than half spend <10% of their time undertaking research in their current role, and many (61%) would like to be more research active. Encouragingly, approximately a third were involved in biomarker discovery activities, even though for <10% of their time, with slightly more reporting involvement in biomarker translation. Conclusions: Although there are people with the necessary skills and desire to be involved in biomarker research in clinical biochemistry departments, their involvement is small, predominantly due to issues with capacity and resources. It is likely that the majority of biomarker programmes will therefore continue to be carried out by a small number of academic groups, hopefully with collaborative input from hospital laboratories. PMID:25210209

  2. The cardiac troponins: uses in routine clinical practice. Experiences from GUSTO and other clinical trials.

    PubMed

    Stubbs, P

    1998-11-01

    Recent advances in pharmacological and mechanical approaches to acute coronary syndromes have led to rapid changes in the management of patients admitted with acute coronary syndromes. These changes have been mirrored by the appearance of newer highly specific biochemical markers of myocardial damage particularly the cardiac troponins. When new biochemical markers become available it is the responsibility of the clinical chemist to evaluate them critically in terms of sensitivity, specificity, efficiency and analyzer precision, in the rigid setting of quality control that laboratories practise, and to compare them with other markers. When the data are shown to Clinical Cardiologists with supporting statements such as 'useful management tool' and 'can be used for early diagnosis of Myocardial Infarction', a different set of questions may need to be answered. The 'So what?' response is most frequent and is the most important hurdle that these newer biochemical markers have to overcome to convince physicians to change their current practice. This presentation will review the results of studies that have examined the potential clinical usefulness of the cardiac troponins with respect to diagnosis and risk stratification of patients admitted with suspected acute coronary syndromes. Any troponin variable that survives the 'so what' question has one further major hurdle to overcome. This is the requirement to inform physicians what different therapeutic strategies they should follow if the variable is present. Available clinical trial evidence about differing management options for patients according to their troponin status will be reviewed and outline management algorithms will be presented. Many questions remain unanswered and these will be included at the time points where they may be relevant. PMID:9857942

  3. Systematic literature review for clinical practice guideline development.

    PubMed

    O'Day, D M; Steinberg, E P; Dickersin, K

    1993-01-01

    The purpose of this paper was to evaluate the quality and scope of the published literature on functional impairment due to cataract in adults as reviewed for the Agency for Health Care Policy and Research Clinical Practice Guideline. We examined the method of literature retrieved and analysis performed in the course of development of literature-based recommendations for the guideline panel. To collect data, we reviewed the process of literature acquisition and identification and the quality assessments made by reviewers of 14 individual topics composed of 77 issues related to the guideline. We collated this information to provide an assessment of the quality and scope of the relevant literature. Less than 4% (310) of the approximately 8,000 articles initially identified as potentially relevant to the guideline were ultimately used. The majority covered three topics (surgery and complication, 100; Nd:YAG capsulotomy, 77; and potential vision testing, 40). Three other topics--indications for surgery, preoperative medical evaluation, and rehabilitation--were devoid of articles meeting inclusion criteria. For 43 issues, there was no identifiable relevant literature. With few exceptions, the quality of the literature was rated fair to poor owing to major flaws in experimental design. Case series (256 reports) of one type or another accounted for the majority of the included literature. There were 17 random controlled trials. This review revealed a sparse and generally low-quality literature relevant to the management of functional impairment due to cataract, despite a relatively large data base in reputable peer-reviewed journals. PMID:8140702

  4. Understanding developmental pharmacodynamics: importance for drug development and clinical practice.

    PubMed

    Mulla, Hussain

    2010-08-01

    Developmental pharmacodynamics is the study of age-related maturation of the structure and function of biologic systems and how this affects response to pharmacotherapy. This may manifest as a change in the potency, efficacy, or therapeutic range of a drug. The paucity of studies exploring developmental pharmacodynamics reflects the lack of suitable juvenile animal models and the ethical and practical constraints of conducting studies in children. However, where data from animal models are available, valuable insight has been gained into how response to therapy can change through the course of development. For example, animal neurodevelopmental models have revealed that temporal differences in the maturation of norepinephrine and serotonin neurotransmitter systems may explain the lack of efficacy of some antidepressants in children. GABA(A) receptors that switch from an excitatory to inhibitory mode during early development help to explain paradoxical seizures experienced by infants after exposure to benzodiazepines. The increased sensitivity of neonates to morphine may be due to increased postnatal expression of the mu opioid receptor. An age dependency to the pharmacokinetic-pharmacodynamic relationship has also been found in some clinical studies. For example, immunosuppressive effects of ciclosporin (cyclosporine) revealed markedly enhanced sensitivity in infants compared with older children and adults. A study of sotalol in the treatment of children with supraventricular tachycardia showed that neonates exhibited a higher sensitivity towards QTc interval prolongation compared with older children. However, the data are limited and efforts to increase and establish data on developmental pharmacodynamics are necessary to achieve optimal drug therapy in children and to ensure long-term success of pediatric drug development. This requires a dual 'bottom up' (ontogeny knowledge driven) and 'top down' (pediatric pharmacokinetic-pharmacodynamic studies) approach. PMID

  5. [Clinical application of skin sympathetic nerve activity].

    PubMed

    Iwase, Satoshi

    2009-03-01

    Skin sympathetic nerve activity (SSNA) is microneurographically recorded from the skin nerve fascicle in the peripheral nerves. It is characterized by the following features: 1) irregular, pulse asynchronous, burst activity with respiratory variation, 2) burst activity followed by vasoconstriction and/or sweating, 3) elicited by mental stress and arousal stimuli, e.g., sound, pain, electric stimulation, 4) burst with longer duration as compared with sympathetic outflow to muscles, and 5) burst activity following sudden inspiratory action. It comprises vasoconstrictor (VC) and sudomotor(SM) activity, as well as vasodilator (VD) activity. VC and SM discharge independently, whereas VD is the same activity with different neurotransmission. The VC and SM are differentiated by effector response, e.g., laser Doppler flowmetry and skin potential changes. SSNA function in thermoregulation in the human body; however it is also elicited by mental stress. SSNA is the lowest at thermoneutral ambient temperature (approximately 27 degrees C), and is enhanced in the pressence of ambient warm and cool air. The burst amplitude is well-correlated to both skin blood flow reduction rate or sweat rate change. The clinical application of SSNA comprises the following: 1) clarification of sweating phenomenon, 2) clarification and diagnosis of anhidrosis, 3) clarification and diagnosis of hyperhidrosis, 4) clarification of thermoregulatory function and diagnosis of thermoregulatory disorder, 5) clarification of pathophysiology and diagnosis of vascular diseases, e.g., Raynaud and Buerger diseases. 6) clarification of the relation between cognitive function and SSNA and 7) determination of pharmacological effect attributable to change in neuroeffector responses. PMID:19301594

  6. Teaching Reflective Practice in Practice Settings: Students' Perceptions of Their Clinical Educators

    ERIC Educational Resources Information Center

    Trede, Franziska; Smith, Megan

    2012-01-01

    Reflective practice in practice settings can enhance practice knowledge, self-assessment and lifelong learning, develop future practice capability and professional identity, and critically appraise practice traditions rather than reproduce them. The inherent power imbalance between student and educator runs the risk for the reflective practice…

  7. Gamete activation: basic knowledge and clinical applications

    PubMed Central

    Tosti, Elisabetta; Ménézo, Yves

    2016-01-01

    changes in gamete morphology and behavior, the regulatory molecules triggering gamete activation and the intracellular ions and second messengers involved in active metabolic pathways in different species. Recent scientific advances suggest that artificial gamete activation may represent a novel technique to improve human IVF outcomes, but this approach requires caution. Wider implications Although controversial, manipulation of gamete activation represents a promising tool for ameliorating the fertilization rate in assisted reproductive technologies. A better knowledge of mechanisms that transform the quiescent oocyte into a pluripotent cell may also provide new insights for the clinical use of stem cells. PMID:27278231

  8. Music therapy services in pediatric oncology: a national clinical practice review.

    PubMed

    Tucquet, Belinda; Leung, Maggie

    2014-01-01

    This article presents the results of a national clinical practice review conducted in Australia of music therapy services in pediatric oncology hospitals. Literature specifically related to music therapy and symptom management in pediatric oncology is reviewed. The results from a national benchmarking survey distributed to all music therapists working with children with cancer in Australian pediatric hospitals are discussed. Patient and family feedback provided from a quality improvement activity conducted at a major pediatric tertiary hospital is summarized, and considerations for future growth as a profession and further research is proposed. PMID:25027188

  9. Steroid injections in the upper extremity: experienced clinical opinion versus evidence-based practices.

    PubMed

    Kegel, Gary; Marshall, Astrid; Barron, O Alton; Catalano, Louis W; Glickel, Steven Z; Kuhn, Margaret

    2013-09-01

    A survey regarding upper-extremity steroid injection practices was distributed to all active members of the American Society for Surgery of the Hand (ASSH) and American Shoulder and Elbow Surgeons (ASES) using SurveyMonkey. Response rates for the ASSH and ASES were 26% and 24%, respectively. The potency-adjusted dose of steroid injected for common hand and wrist injections ranged from 0.375 to 133.33 mg and for shoulder injections ranged from 0.375 to 250 mg. These ranges span 356-fold and 667-fold differences, respectively. Potency-adjusted doses differed significantly between steroid types for all injections evaluated in this study. American Society for Surgery of the Hand members gave significantly smaller doses of steroid for the glenohumeral and acromioclavicular joints than ASES members. Only 9% of respondents based injection practice on a scientific reference. Sixteen percent of ASSH and 31% of ASES respondents reported no specific rationale for their steroid injection practice; 78% of ASSH and 52% of ASES respondents attributed their rationale to some kind of instruction from their mentors or colleagues. Upper-extremity surgeons demonstrate substantial variability in their practice of steroid injections, with up to a 667-fold range in steroid dose. Experienced clinical opinion is the principal rationale for these injection practices; little rationale is based on formal scientific evidence. PMID:24025004

  10. Heart support systems: from idea to clinical practice.

    PubMed

    del Cañizo Juan, F

    2008-12-01

    This paper describes the development of a pneumatic ventricular assist device by our group from the first steps to the clinical assay. The device, called BCM, has an input compliant cannula that improves the filling of the device. Results of the clinical assay showed that the BCM device was suitable for clinical use. New developments of our group are also mentioned. PMID:19259039

  11. Is medical perspective on clinical governance practices associated with clinical units’ performance and mortality? A cross-sectional study through a record-linkage procedure

    PubMed Central

    Sarchielli, Guido; De Plato, Giovanni; Cavalli, Mario; Albertini, Stefano; Nonni, Ilaria; Bencivenni, Lucia; Montali, Arianna; Ventura, Antonio; Montali, Francesca

    2016-01-01

    Objective: Assessment of the knowledge and application as well as perceived utility by doctors of clinical governance tools in order to explore their impact on clinical units’ performance measured through mortality rates and efficiency indicators. Methods: This research is a cross-sectional study with a deterministic record-linkage procedure. The sample includes n = 1250 doctors (n = 249 chiefs of clinical units; n = 1001 physicians) working in six public hospitals located in the Emilia-Romagna Region in Italy. Survey instruments include a checklist and a research-made questionnaire which were used for data collection about doctors’ knowledge and application as well as perceived utility of clinical governance tools. The analysis was based on clinical units’ performance indicators which include patients’ mortality, extra-region active mobility rate, average hospital stay, bed occupancy, rotation and turnover rates, and the comparative performance index as efficiency indicators. Results: The clinical governance tools are known and applied differently in all the considered clinical units. Significant differences emerged between roles and organizational levels at which the medical leadership is carried out. The levels of knowledge and application of clinical governance practices are correlated with the clinical units’ efficiency indicators (bed occupancy rate, bed turnover interval, and extra-region mobility). These multiple linear regression analyses highlighted that the clinical governance knowledge and application is correlated with clinical units’ mortality rates (odds ratio, −8.677; 95% confidence interval, −16.654, −0.700). Conclusion: The knowledge and application, as well as perceived utility by medical professionals of clinical governance tools, are associated with the mortality rates of their units and with some efficiency indicators. However, the medical frontline staff seems to not consider homogeneously useful the clinical

  12. Oral Immunotherapy for Treatment of Immunoglobulin E-Mediated Food Allergy: The Transition to Clinical Practice

    PubMed Central

    Cox, Linda; Caminiti, Lucia; Ramistella, Vincenzo; Crisafulli, Giuseppe

    2014-01-01

    Today, there is neither an effective nor an active treatment for food allergy. Allergy immunotherapy has been proposed as an attractive strategy to actively treat food allergy. Oral immunotherapy (OIT), also known as oral desensitization, is a method of inducing the body's immune system to tolerate a food that causes an allergic overreaction. It has been studied for the use in treatment of immunoglobulin E-mediated food allergy to the most common foods, including milk, egg, and peanut. OIT has been able to desensitize subjects to varying degrees. However, many questions remain unanswered, including efficient formulation, optimal dosing, and induction protocol to achieve full tolerance, transition of OIT to clinical practice, and maximal safety profile. This review focuses on the use of OIT as a new and active treatment for food allergy. The possibility of transition of OIT to clinical practice represents, in this field, the next pivotal step with the goal of improving the quality of life of patients with food allergy and their families. PMID:24963452

  13. [Practice of Behavioral Activation in Cognitive-behavioral Therapy].

    PubMed

    Kitagawa, Nobuki

    2015-01-01

    An approach focusing on behavioral activation (BA) was adopted in the cognitive therapy of A. T. Beck, and it came to be considered that BA can play an important role in cognitive-behavioral therapy (CBT) for depression. Therefore, in recent years, BA based on clinical behavior analysis has been developed as a new treatment (Martell, et al.). The core characteristics are as follows: 1) focusing attention on context in daily life to promote the behavior control of patients and avoidance of a hatred experience ; 2) breaking the vicious circle; 3) promoting the behavior according to the purpose that the patients originally expect; 4) recognizing a relationship between behavior and the situation (contingency), thereby recovering self-efficacy tied to the long-term results that one originally expects. This does not increase pleasant activity at random when the patient is inactive, or give a sense of accomplishment. We know that depression is maintained by conducting functional analysis of detailed life behavior, and encourage the patients to have healthy behavior according to individual values. We help them to complete schedules regardless of mood and reflect on the results patiently. It is considered that those processes are important. BA may be easy to apply in clinical practice and effective for the chronic cases, or the patients in a convalescent stage. Also, in principle in the CBT for major depression, it may be effective that behavioral activation is provided in an early stage, and cognitive reconstruction in a latter stage. However, an approach to carry out functional analysis by small steps with careful activity monitoring is essential when the symptoms are severe. Furthermore, it should be considered that the way of psychoeducation requires caution because we encourage rest in the treatment of depression in our country. In particular, we must be careful not to take an attitude that an inactive behavior pattern is unproductive only based model cases. PMID

  14. Compliance with infection control practices in an university hospital dental clinic

    PubMed Central

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

    2014-01-01

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

  15. Electroencephalographic neurofeedback: Level of evidence in mental and brain disorders and suggestions for good clinical practice.

    PubMed

    Micoulaud-Franchi, J-A; McGonigal, A; Lopez, R; Daudet, C; Kotwas, I; Bartolomei, F

    2015-12-01

    The technique of electroencephalographic neurofeedback (EEG NF) emerged in the 1970s and is a technique that measures a subject's EEG signal, processes it in real time, extracts a parameter of interest and presents this information in visual or auditory form. The goal is to effectuate a behavioural modification by modulating brain activity. The EEG NF opens new therapeutic possibilities in the fields of psychiatry and neurology. However, the development of EEG NF in clinical practice requires (i) a good level of evidence of therapeutic efficacy of this technique, (ii) a good practice guide for this technique. Firstly, this article investigates selected trials with the following criteria: study design with controlled, randomized, and open or blind protocol, primary endpoint related to the mental and brain disorders treated and assessed with standardized measurement tools, identifiable EEG neurophysiological targets, underpinned by pathophysiological relevance. Trials were found for: epilepsies, migraine, stroke, chronic insomnia, attentional-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, major depressive disorder, anxiety disorders, addictive disorders, psychotic disorders. Secondly, this article investigates the principles of neurofeedback therapy in line with learning theory. Different underlying therapeutic models are presented didactically between two continua: a continuum between implicit and explicit learning and a continuum between the biomedical model (centred on "the disease") and integrative biopsychosocial model of health (centred on "the illness"). The main relevant learning model is to link neurofeedback therapy with the field of cognitive remediation techniques. The methodological specificity of neurofeedback is to be guided by biologically relevant neurophysiological parameters. Guidelines for good clinical practice of EEG NF concerning technical issues of electrophysiology and of learning are suggested. These require validation by

  16. Knowledge Systems, Health Care Teams, and Clinical Practice: A Study of Successful Change

    ERIC Educational Resources Information Center

    Olson, Curtis A.; Tooman, Tricia R.; Alvarado, Carla J.

    2010-01-01

    Clinical teams are of growing importance to healthcare delivery, but little is known about how teams learn and change their clinical practice. We examined how teams in three US hospitals succeeded in making significant practice improvements in the area of antimicrobial resistance. This was a qualitative cross-case study employing Soft Knowledge…

  17. Implementing a Gerontological Clinical Nursing Practice with an Interdisciplinary Focus: Lessons Learned

    ERIC Educational Resources Information Center

    Dahlke, Sherry; Fehr, Cindy

    2010-01-01

    A gerontological clinical nursing practice with an interdisciplinary focus was developed to provide opportunities for student nurses to expand their knowledge about aging, hone assessment skills, and critically examine beliefs about older adults. The practice included theory about older adults and a rotation through a variety of clinical settings…

  18. General practice, clinical intention and the Sexual Offences Act 2003

    PubMed Central

    2009-01-01

    General practitioners must be capable of regularly taking ‘ultimate’ responsibility for difficult decisions in situations of clinical complexity and uncertainty. The Sexual Offences Act 2003 criminalises all sexual activity with a child under the age of 16. However, those who act with the purpose of protecting a child from a sexually transmitted infection, protecting the physical safety of a child, preventing the child from becoming pregnant or promoting the child's emotional well-being by the giving of advice will not commit an offence. Medicolegal academic writers have compared the legal separation of intention and foreseeability with the special defence of double-effect used in the palliative care context. This paper seeks to draw upon legal principles in constructing an ethical framework for analysis of this issue. It is hoped that this case study will stimulate further discussion, clarify the moral reasoning underpinning the existing guidelines for GPs and how the doctrine or principle of double effect can be used outside the palliative medicine context. PMID:25949594

  19. Beyond positivism: a metaphysical basis for clinical practice?

    PubMed

    Herman, J

    1992-09-01

    Medicine does not have its own unified body of scientific knowledge. Instead, physicians who are oriented to research make sporadic incursions into the basic sciences such as genetics, biochemistry, immunology, epidemiology, physiology, pharmacology and so on. These latter, taken together, comprise biomedicine which is said to have adopted the positivist epistemology or the Cartesian/Newtonian one that regards the scientist as an uninvolved observer of nature. In effect, medical science has come to rest on a theory of knowledge which links meaning to probability and considers prediction as the scientist's chief task. Like its predecessor, the probability theory of meaning rejects metaphysical speculation and remains connected to observations made, directly or indirectly, by means of the five senses. Despite some brilliant successes touching on relatively uncommon disorders, biomedicine cannot explain most day-to-day clinical activity. An understanding of what transpires between patient and doctor, of its diagnostic potential and therapeutic weight requires hermeneutic, or phenomenological, inquiry which brings about changes in both parties to it. Such a science, as ontological speculation has been called, cannot be deciphered by an epistemology couched in the imagery of physics and chemistry. PMID:1435396

  20. Criteria Used in Clinical Practice to Guide Immunosuppressive Treatment in Patients with Primary Sclerosing Cholangitis

    PubMed Central

    Schulze, Kornelius; Weismüller, Tobias J.; Bubenheim, Michael; Huebener, Peter; Zenouzi, Roman; Lenzen, Henrike; Rupp, Christian; Gotthardt, Daniel; de Leuw, Philipp; Teufel, Andreas; Zimmer, Vincent; Reiter, Florian P.; Rust, Christian; Tharun, Lars; Quaas, Alexander; Weidemann, Sören A.; Lammert, Frank; Sarrazin, Christoph; Manns, Michael P.; Lohse, Ansgar W.; Schramm, Christoph

    2015-01-01

    Background & Aims Current guidelines recommend immunosuppressive treatment (IT) in patients with primary sclerosing cholangitis (PSC) and elevated aminotransferase levels more than five times the upper limit of normal and elevated serum IgG-levels above twice the upper limit of normal. Since there is no evidence to support this recommendation, we aimed to assess the criteria that guided clinicians in clinical practice to initiate IT in patients with previously diagnosed PSC. Methods This is a retrospective analysis of 196 PSC patients from seven German hepatology centers, of whom 36 patients had received IT solely for their liver disease during the course of PSC. Analyses were carried out using methods for competing risks. Results A simplified autoimmune hepatitis (AIH) score >5 (HR of 36, p<0.0001) and a modified histological activity index (mHAI) greater than 3/18 points (HR 3.6, p = 0.0274) were associated with the initiation of IT during the course of PSC. Of note, PSC patients who subsequently received IT differed already at the time of PSC diagnosis from those patients, who did not receive IT during follow-up: they presented with increased levels of IgG (p = 0.004) and more frequently had clinical signs of cirrhosis (p = 0.0002). Conclusions This is the first study which investigates the parameters associated with IT in patients with PSC in clinical practice. A simplified AIH score >5 and a mHAI score >3, suggesting concomitant features of AIH, influenced the decision to introduce IT during the course of PSC. In German clinical practice, the cutoffs used to guide IT may be lower than recommended by current guidelines. PMID:26489083

  1. The Characteristics of Heterosexual STD Clinic Attendees Who Practice Oral Sex in Zhejiang Province, China

    PubMed Central

    Ma, Qiaoqin; Pan, Xiaohong; Cai, Gaofeng; Yan, Jiezhe; Xu, Yun; Ono-Kihara, Masako; Kihara, Masahiro

    2013-01-01

    Background The characteristics of heterosexual attendees who visit sexually transmitted disease (STD) clinics and practice oral sex have not been revealed in China. This information is important for the development of targeted STD prevention programmes for this population. Study Design A self-administered questionnaire survey with a cross-sectional design was administered to consecutive attendees at four STD clinics in Zhejiang Province, China, between October and December in 2007. Demographic, psychosocial, and behavioural factors associated with oral sex over a lifetime were identified using univariate and multivariate analyses. Results Of the 872 attendees, 6.9% engaged in oral sex over their lifetimes. Of the oral-sex group, 96.6% also engaged in vaginal sex. The correlates for oral sex over a lifetime as determined by the multivariate analysis were high income (odds ratio [OR] = 2.53, 95% confidence interval [CI] 1.39–4.59), high human immunodeficiency virus (HIV)-related knowledge (OR = 2.71, 95% CI 1.26–5.81), early sex initiation (OR = 2.42, 95% CI 1.37–4.27), multiple sexual partners (OR = 3.09, 95% CI 1.58–6.06), and sexually active in the previous 6 months (OR = 7.73, 95% CI 1.04–57.39). Conclusions Though the prevalence of oral sex is low, the heterosexual STD clinic attendees practicing oral sex was found to have higher risks associated with STD/HIV transmission than those not. Behavioural and medical interventions conducted by clinicians in Chinese STD clinics should take into account the characteristics and related risks of those who practice oral sex. PMID:23825627

  2. Calculating Clinically Significant Change: Applications of the Clinical Global Impressions (CGI) Scale to Evaluate Client Outcomes in Private Practice

    ERIC Educational Resources Information Center

    Kelly, Peter James

    2010-01-01

    The Clinical Global Impressions (CGI) scale is a therapist-rated measure of client outcome that has been widely used within the research literature. The current study aimed to develop reliable and clinically significant change indices for the CGI, and to demonstrate its application in private psychological practice. Following the guidelines…

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

    PubMed Central

    Gould, Michael K.

    2013-01-01

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

  4. Using activity-based costing to track resource use in group practices.

    PubMed

    Zeller, T L; Siegel, G; Kaciuba, G; Lau, A H

    1999-09-01

    Research shows that understanding how resources are consumed can help group practices control costs. An American Academy of Orthopaedic Surgeons study used an activity-based costing (ABC) system to measure how resources are consumed in providing medical services. Teams of accounting professors observed 18 diverse orthopedic surgery practices. The researchers identified 17 resource-consuming business processes performed by nonphysician office staff. They measured resource consumption by assigning costs to each process according to how much time is spent on related work activities. When group practices understand how their resources are being consumed, they can reduce costs and optimize revenues by making adjustments in how administrative and clinical staff work. PMID:11066706

  5. Clinical pharmacy service practice in a Chinese tertiary hospital.

    PubMed

    Chen, Bing; Huang, Jing-Jing; Chen, He-feng; Xu, Bei-ming

    2015-12-01

    Clinical pharmacy service is focused on the rationality and safety of medication therapy. Clinical pharmacists play an important role in designing therapeutic regimen, preventing medication errors, reducing the incidence of adverse drug reaction, and saving medical costs. Although clinical pharmacy service in China is in its early stage, its development is rapid. In this manuscript, the working model of clinical pharmacists in a Chinese tertiary hospital is introduced, including ward rounds, consultation, stewardship of antimicrobial therapy, drug adverse reaction monitoring, therapeutic drug monitoring, clinical pharmacokinetics and pharmacogenetics, and training system. With the efforts of clinical pharmacists, there will be a significant increase in the optimization of medication therapy and a notable reduction in preventable adverse drug events as well as health-care cost in China. PMID:26457791

  6. Reconciling pairs of concurrently used clinical practice guidelines using Constraint Logic Programming.

    PubMed

    Wilk, Szymon; Michalowski, Martin; Michalowski, Wojtek; Hing, Marisela Mainegra; Farion, Ken

    2011-01-01

    This paper describes a new methodological approach to reconciling adverse and contradictory activities (called points of contention) occurring when a patient is managed according to two or more concurrently used clinical practice guidelines (CPGs). The need to address these inconsistencies occurs when a patient with more than one disease, each of which is a comorbid condition, has to be managed according to different treatment regimens. We propose an automatic procedure that constructs a mathematical guideline model using the Constraint Logic Programming (CLP) methodology, uses this model to identify and mitigate encountered points of contention, and revises the considered CPGs accordingly. The proposed procedure is used as an alerting mechanism and coupled with a guideline execution engine warns the physician about potential problems with the concurrent application of two or more guidelines. We illustrate the operation of our procedure in a clinical scenario describing simultaneous use of CPGs for duodenal ulcer and transient ischemic attack. PMID:22195153

  7. Sustainability of professionals’ adherence to clinical practice guidelines in medical care: a systematic review

    PubMed Central

    Ament, Stephanie M C; de Groot, Jeanny J A; Maessen, José M C; Dirksen, Carmen D; van der Weijden, Trudy; Kleijnen, Jos

    2015-01-01

    Objectives To evaluate (1) the state of the art in sustainability research and (2) the outcomes of professionals’ adherence to guideline recommendations in medical practice. Design Systematic review. Data sources Searches were conducted until August 2015 in MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and the Guidelines International Network (GIN) library. A snowball strategy, in which reference sections of other reviews and of included papers were searched, was used to identify additional papers. Eligibility criteria Studies needed to be focused on sustainability and on professionals’ adherence to clinical practice guidelines in medical care. Studies had to include at least 2 measurements: 1 before (PRE) or immediately after implementation (EARLY POST) and 1 measurement longer than 1 year after active implementation (LATE POST). Results The search retrieved 4219 items, of which 14 studies met the inclusion criteria, involving 18 sustainability evaluations. The mean timeframe between the end of active implementation and the sustainability evaluation was 2.6 years (minimum 1.5–maximum 7.0). The studies were heterogeneous with respect to their methodology. Sustainability was considered to be successful if performance in terms of professionals’ adherence was fully maintained in the late postimplementation phase. Long-term sustainability of professionals’ adherence was reported in 7 out of 18 evaluations, adherence was not sustained in 6 evaluations, 4 evaluations showed mixed sustainability results and in 1 evaluation it was unclear whether the professional adherence was sustained. Conclusions (2) Professionals’ adherence to a clinical practice guideline in medical care decreased after more than 1 year after implementation in about half of the cases. (1) Owing to the limited number of studies, the absence of a uniform definition, the high risk of bias, and the mixed results of studies, no firm conclusion about the

  8. Feasibility of streamlining an interactive Bayesian-based diagnostic support tool designed for clinical practice

    NASA Astrophysics Data System (ADS)

    Chen, Po-Hao; Botzolakis, Emmanuel; Mohan, Suyash; Bryan, R. N.; Cook, Tessa

    2016-03-01

    In radiology, diagnostic errors occur either through the failure of detection or incorrect interpretation. Errors are estimated to occur in 30-35% of all exams and contribute to 40-54% of medical malpractice litigations. In this work, we focus on reducing incorrect interpretation of known imaging features. Existing literature categorizes cognitive bias leading a radiologist to an incorrect diagnosis despite having correctly recognized the abnormal imaging features: anchoring bias, framing effect, availability bias, and premature closure. Computational methods make a unique contribution, as they do not exhibit the same cognitive biases as a human. Bayesian networks formalize the diagnostic process. They modify pre-test diagnostic probabilities using clinical and imaging features, arriving at a post-test probability for each possible diagnosis. To translate Bayesian networks to clinical practice, we implemented an entirely web-based open-source software tool. In this tool, the radiologist first selects a network of choice (e.g. basal ganglia). Then, large, clearly labeled buttons displaying salient imaging features are displayed on the screen serving both as a checklist and for input. As the radiologist inputs the value of an extracted imaging feature, the conditional probabilities of each possible diagnosis are updated. The software presents its level of diagnostic discrimination using a Pareto distribution chart, updated with each additional imaging feature. Active collaboration with the clinical radiologist is a feasible approach to software design and leads to design decisions closely coupling the complex mathematics of conditional probability in Bayesian networks with practice.

  9. Untangling Uncertainty: A Study of the Discourses Shaping Clinical Ethics Consultation as a Professional Practice.

    PubMed

    Saxén, Salla

    2016-01-01

    This qualitative social scientific interview study delves into the ways in which professional vision is constructed in clinical ethics consultation (CEC). The data consist of 11 semi-structured interviews that were conducted with clinical ethics consultants currently working in hospitals in one major urban area in the U.S. The interviews were analyzed with the qualitative research method of critical discourse analysis, with a focus on identifying the cultural structures of knowledge that shape CEC as a professional practice. The discourses were first identified as belonging to two higher discourse categories, order and agency. Order was divided into three lower categories, emotional, managerial, and rational order, and discourses of agency into the lower categories of exploration, technique, deliberation, and distancing. An additional discourse of neutral interaction was identified as a bridging discourse, activated to level tensions emerging out of conflicting goals and agencies embedded in CEC practice. This analysis brings out as its main observation that clinical ethics consultants draw on and shift between potentially ideologically conflicting social positions that can create built-in tensions within the professional domain. The study calls attention to these tensions and suggests for the professional group to discuss the possibility of defining priorities between different kinds of order, identified in this study, that shape the CEC domain. PMID:27333060

  10. The challenges of using epidemiology to inform clinical practice

    PubMed Central

    Kessler, Ronald C.

    2007-01-01

    This paper discusses challenges and prospects for increasing the clinical relevance of psychiatric epidemiological research. The discussion begins with a review of the structural determinants of the fact that current psychiatric epidemiological research has less clinical relevance that epidemiological research in other areas of medicine. The discussion then turns to ways in which the focus of psychiatric epidemiological research might be changed to increase its clinical relevance. A review is then presented of recent innovations in community psychiatric epidemiological research that were designed to increase clinical relevance. An argument is then made that the full clinical value of psychiatric epidemiology will only be realized when community epidemiology becomes better integrated with clinical epidemiology and the latter takes on a more prominent role than it currently has in psychiatric research. Existing initiatives to realize an integration of community psychiatric epidemiology with clinical epidemiology are then reviewed. Finally, an agenda is proposed for an expansion of clinical psychiatric epidemiology to include a focus on both naturalistic and quasi-experimental studies of illness course and treatment response in diverse clinical samples. PMID:17896231

  11. Closing the Gap between Research Evidence and Clinical Practice: Jordanian Nurses' Perceived Barriers to Research Utilisation

    ERIC Educational Resources Information Center

    Al Khalaileh, Murad; Al Qadire, Mohammad; Musa, Ahmad S.; Al-Khawaldeh, Omar A.; Al Qudah, Hani; Alhabahbeh, Atalla

    2016-01-01

    Background: The nursing profession is a combination of theory and practical skill, and nurses are required to generate and develop knowledge through implementing research into clinical practice. Considerable number of barriers could hind implementing research findings into practice. Barriers to research utilisation are not identified in the…

  12. The Working Practices and Clinical Experiences of Paediatric Speech and Language Therapists: A National UK Survey

    ERIC Educational Resources Information Center

    Pring, Tim; Flood, Emma; Dodd, Barbara; Joffe, Victoria

    2012-01-01

    Background: The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice. Aims: To investigate the working practices and…

  13. Australian Nurse Practitioner Practice: Value Adding through Clinical Reflexivity

    PubMed Central

    Woods, Michelle; Murfet, Giuliana

    2015-01-01

    The role of the Australian Nurse Practitioner (NP) is in its infancy and at a crossroads where extensive research demonstrates effective quality care and yet the role remains underrecognised and underutilised. The translation of practice into “value” is critical for the sustainability of NP roles and requires the practitioner to adopt a systematic method of inquiry. Kim's (1999) “Critical Reflective Inquiry” (CRI) method was adapted by two Australian NPs who specialise in diabetes and chronic disease management. Kim highlights the intent of CRI as understanding the meaning of practice, delivering improvements to practice through self-reflection, and the critique of practice that can lead to practice changes and development of new models of care translated to “products” of value. Based on the thematically analysis of 3 years of CRI application, the authors formed 5 headings that represented the NP's practice as Specialised Care Access, Complications and Diagnostics Interventions, Pharmaceutical Treatment, Vulnerable Populations, and Leadership. The utility of CRI demonstrates how NP practice is integral to a continuous cycle of addressing health care services gaps, and the conversion of “products” into “value” and positions the NP to assimilate the role of the practitioner-researcher. PMID:25705517

  14. A Model for Ethical Practices in Clinical Phonetics and Linguistics

    ERIC Educational Resources Information Center

    Powell, Thomas W.

    2007-01-01

    The emergence of clinical phonetics and linguistics as an area of scientific inquiry gives rise to the need for guidelines that define ethical and responsible conduct. The diverse membership of the International Clinical Phonetics and Linguistics Association (ICPLA) and the readership of this journal are uniquely suited to consider ethical issues…

  15. Ambulatory Blood Pressure Monitoring in Spinal Cord Injury: Clinical Practicability

    PubMed Central

    Hubli, Michèle

    2014-01-01

    Abstract Trauma to the spinal cord often results not only in sensorimotor but also autonomic impairments. The loss of autonomic control over the cardiovascular system can cause profound blood pressure (BP) derangements in subjects with spinal cord injury (SCI) and may therefore lead to increased cardiovascular disease (CVD) risk in this population. The use of ambulatory blood pressure monitoring (ABPM) allows insights into circadian BP profiles, which have been shown to be of good prognostic value for cardiovascular morbidity and mortality in able-bodied subjects. Past studies in SCI subjects using ABPM have shown that alterations in circadian BP patterns are dependent on the spinal lesion level. Tetraplegic subjects with sensorimotor complete lesions have a decreased daytime arterial BP, loss of the physiological nocturnal BP dip, and higher circadian BP variability, including potentially life-threatening hypertensive episodes known as autonomic dysreflexia (AD), compared with paraplegic and able-bodied subjects. The proposed underlying mechanisms of these adverse BP alterations mainly are attributed to a lost or decreased central drive to sympathetic spinal preganglionic neurons controlling the heart and blood vessels. In addition, several maladaptive anatomical changes within the spinal cord and the periphery, as well as the general decrease of physical daily activity in SCI subjects, account for adverse BP changes. ABPM enables the identification of adverse BP profiles and the associated increased risk for CVD in SCI subjects. Concurrently, it also might provide a useful clinical tool to monitor improvements of AD and lost nocturnal dip after appropriate treatments in the SCI population. PMID:24175653

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

    PubMed

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

    2012-04-01

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

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

    PubMed

    Munro, Malcolm G

    2014-01-01

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

  18. Investigation of Women with Postmenopausal Uterine Bleeding: Clinical Practice Recommendations

    PubMed Central

    Munro, Malcolm G

    2014-01-01

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

  19. Treatment of chronic hepatitis B in clinical practice with entecavir or tenofovir.

    PubMed

    Ridruejo, Ezequiel

    2014-06-21

    Results from phase III clinical trials clearly demonstrate the efficacy and safety of entecavir and tenofovir in the controlled environment of randomized clinical studies. There are several studies with both drugs performed in clinical practice (also called "real life studies"). Despite the pros and cons, studies performed in real life conditions represent everyday practice and add important information about long term treatment effectiveness and safety in this clinical setting. This review shows that patients treated with first line nucleos(t)ide analogs at referral centres, with good clinical follow-up and adherence to international guidelines, can achieve high treatment response rates with a very low rate of adverse events. PMID:24966587

  20. Clinical and financial aspects of shared/part-time practice.

    PubMed

    Hofferber, J; Fitzpatrick, B

    1991-01-01

    Shared and part-time medical practices are popular with both the medical group and the clinicians who fill these positions at Group Health Cooperative. The medical group benefits from the flexibility provided by part-time practitioners. Part-time clinicians have the opportunity to devote time to their families or second careers. There are, however, additional costs and administrative problems associated with shared and part-time practices. PMID:10114295

  1. Mind-Body Practices and the Adolescent Brain: Clinical Neuroimaging Studies

    PubMed Central

    Sharma, Anup; Newberg, Andrew B

    2016-01-01

    Background Mind-Body practices constitute a large and diverse group of practices that can substantially affect neurophysiology in both healthy individuals and those with various psychiatric disorders. In spite of the growing literature on the clinical and physiological effects of mind-body practices, very little is known about their impact on central nervous system (CNS) structure and function in adolescents with psychiatric disorders. Method This overview highlights findings in a select group of mind-body practices including yoga postures, yoga breathing techniques and meditation practices. Results Mind-body practices offer novel therapeutic approaches for adolescents with psychiatric disorders. Findings from these studies provide insights into the design and implementation of neuroimaging studies for adolescents with psychiatric disorders. Conclusions Clinical neuroimaging studies will be critical in understanding how different practices affect disease pathogenesis and symptomatology in adolescents. Neuroimaging of mind-body practices on adolescents with psychiatric disorders will certainly be an open and exciting area of investigation. PMID:27347478

  2. Use of handheld computers in clinical practice: a systematic review

    PubMed Central

    2014-01-01

    Background Many healthcare professionals use smartphones and tablets to inform patient care. Contemporary research suggests that handheld computers may support aspects of clinical diagnosis and management. This systematic review was designed to synthesise high quality evidence to answer the question; Does healthcare professionals’ use of handheld computers improve their access to information and support clinical decision making at the point of care? Methods A detailed search was conducted using Cochrane, MEDLINE, EMBASE, PsycINFO, Science and Social Science Citation Indices since 2001. Interventions promoting healthcare professionals seeking information or making clinical decisions using handheld computers were included. Classroom learning and the use of laptop computers were excluded. Two authors independently selected studies, assessed quality using the Cochrane Risk of Bias tool and extracted data. High levels of data heterogeneity negated statistical synthesis. Instead, evidence for effectiveness was summarised narratively, according to each study’s aim for assessing the impact of handheld computer use. Results We included seven randomised trials investigating medical or nursing staffs’ use of Personal Digital Assistants. Effectiveness was demonstrated across three distinct functions that emerged from the data: accessing information for clinical knowledge, adherence to guidelines and diagnostic decision making. When healthcare professionals used handheld computers to access clinical information, their knowledge improved significantly more than peers who used paper resources. When clinical guideline recommendations were presented on handheld computers, clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper resources. Finally, healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on handheld computers compared to colleagues

  3. Transforming Staff Practice through Active Support

    ERIC Educational Resources Information Center

    Riches, Vivienne C.; Harman, Anthony D.; Keen, Deb; Pennell, Donna; Harley, Jane H.; Walker, Michelle

    2011-01-01

    Background: Active support is being introduced in many residential and respite homes in an effort to improve engagement in meaningful activity of people with intellectual disability. Method: A train-the-trainer approach was used in a large government organisation that supports people with intellectual disability in Australia. Five apprentice…

  4. Practical Activities in Astronomy for Nonscience Students.

    ERIC Educational Resources Information Center

    Bisard, Walter J.

    1985-01-01

    Describes science activities which have been successful with nonscience majors. Each activity requires students to make observations, record the data gathered, interpret data, and prepare a written report. Subject areas include motion of stars, sunspots, lunar orbits, sunset points, meteor showers, and sun shadows. (JN)

  5. Interdisciplinary Best Practices for Adapted Physical Activity

    ERIC Educational Resources Information Center

    Szostak, Rick

    2016-01-01

    This article provides an introduction to the literature on interdisciplinary research. It then draws lessons from that literature for the field of adapted physical activity. It is argued that adapted physical activity should be a self-consciously interdisciplinary field. It should insist that research be performed according to recognized…

  6. Social Work Practice with LGBT Elders at End of Life: Developing Practice Evaluation and Clinical Skills Through a Cultural Perspective.

    PubMed

    Arthur, Darren P

    2015-01-01

    This article focuses on culturally sensitive clinical issues related to best practices with lesbian, gay, bisexual, transgender (LGBT) elder patients at end-of-life (EOL) at key points in the therapeutic relationship. Vital concepts, including practice evaluation and clinical skills, are presented through a cultural and oncology lens. There is a paucity of LGBT research and literature as well as a shortfall of MSW graduate school education specific to social work palliative and end-of-life care (PELC) practice with LGBT elders. The content of this article is designed to be adapted and used as an educational tool for institutions, agencies, graduate programs, medical professions, social work, and students. Learning the unique elements of LGBT cultural history and their implications on EOL care can improve social work practice. This article provides an examination from assessment and engagement basics to advance care planning incorporating specific LGBT EOL issues. PMID:26380926

  7. A Clinical Pharmacy Certificate Program for Practicing Pharmacists.

    ERIC Educational Resources Information Center

    Burelle, Timothy N.

    1985-01-01

    A clinical pharmacy certificate program, the most popular among Alabama pharmacists, is described, including statistics concerning enrollment, participant characteristics, factors important in pharmacists' entering and leaving the program, and pharmacists' views of the program's strengths and weaknesses. (MSE)

  8. Translating shared decision-making into health care clinical practices: Proof of concepts

    PubMed Central

    Légaré, France; Elwyn, Glyn; Fishbein, Martin; Frémont, Pierre; Frosch, Dominick; Gagnon, Marie-Pierre; Kenny, David A; Labrecque, Michel; Stacey, Dawn; St-Jacques, Sylvie; van der Weijden, Trudy

    2008-01-01

    Background There is considerable interest today in shared decision-making (SDM), defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal is to bring together the resources and the expertise needed to develop an interdisciplinary and international research team on the implementation of SDM in clinical practice using a theory-based dyadic perspective. Methods Participants include researchers from Canada, US, UK, and Netherlands, representing medicine, nursing, psychology, community health and epidemiology. In order to develop a collaborative research network that takes advantage of the expertise of the team members, the following research activities are planned: 1) establish networking and on-going communication through internet-based forum, conference calls, and a bi-weekly e-bulletin; 2) hold a two-day workshop with two key experts (one in theoretical underpinnings of behavioral change, and a second in dyadic data analysis), and invite all investigators to present their views on the challenges related to the implementation of SDM in clinical practices; 3) conduct a secondary analyses of existing dyadic datasets to ensure that discussion among team members is grounded in empirical data; 4) build capacity with involvement of graduate students in the workshop and online forum; and 5) elaborate a position paper and an international multi-site study protocol. Discussion This study protocol aims to inform researchers, educators, and clinicians interested in improving their understanding of effective strategies to implement shared decision-making in clinical practice using a theory-based dyadic perspective. PMID:18194521

  9. Concise Review of Optical Coherence Tomography in Clinical Practice

    PubMed Central

    Su, Min-I; Chen, Chun-Yen; Yeh, Hung-I; Wang, Kuang-Te

    2016-01-01

    Optical coherence tomography (OCT) is a novel image modality with higher resolution in the catheterization laboratory. It can differentiate tissue characteristics and provide detailed information, including dissection, tissue prolapse, thrombi, and stent apposition. In this study, we comprehensively reviewed the current pros and cons of OCT clinical applications and presented our clinical experiences associated with the advantages and limitations of this new imaging modality. PMID:27471350

  10. Implications of the concept of minimal risk in research on informed choice in clinical practice.

    PubMed

    Wada, Kyoko; Nisker, Jeff

    2015-10-01

    The concept of a minimal risk threshold in research, beneath which exception to informed consent and ethics review processes may occur, has been codified for over 30 years in many national research regulations and by the Council for International Organizations of Medical Sciences. Although minimal risk in research constitutes one of the criteria for allowing waiver of informed consent or modification to the consent process and a large body of literature exists, discussion of a minimal risk threshold in clinical practice has not occurred. One reason for lack of discussion may be that implicit consent is accepted for a wide range of routine clinical practices. Extending the role of minimal risk in research to clinical practice might assist clinicians in identifying circumstances for which implicit consent is indeed sufficient and circumstances in which it is not. Further, concepts from minimal risk in research might assist clinicians regarding when information provision in health promotion is required. We begin by reviewing concepts in both minimal risk in research and informed choice in clinical practice. We then explore how a clinical minimal risk concept may clarify recommendations for information provision in clinical practice and support the patient's informed choice regarding therapeutic and diagnostic procedures and also health promotion. Given that clinical practice involves a broad scope of health information, professional practice guidelines on information provision based on the application of the minimal risk threshold in research could be developed to guide clinicians in what information must be provided to their patients. PMID:26108215

  11. Implications of the concept of minimal risk in research on informed choice in clinical practice

    PubMed Central

    Wada, Kyoko; Nisker, Jeff

    2015-01-01

    The concept of a minimal risk threshold in research, beneath which exception to informed consent and ethics review processes may occur, has been codified for over 30 years in many national research regulations and by the Council for International Organizations of Medical Sciences. Although minimal risk in research constitutes one of the criteria for allowing waiver of informed consent or modification to the consent process and a large body of literature exists, discussion of a minimal risk threshold in clinical practice has not occurred. One reason for lack of discussion may be that implicit consent is accepted for a wide range of routine clinical practices. Extending the role of minimal risk in research to clinical practice might assist clinicians in identifying circumstances for which implicit consent is indeed sufficient and circumstances in which it is not. Further, concepts from minimal risk in research might assist clinicians regarding when information provision in health promotion is required. We begin by reviewing concepts in both minimal risk in research and informed choice in clinical practice. We then explore how a clinical minimal risk concept may clarify recommendations for information provision in clinical practice and support the patient's informed choice regarding therapeutic and diagnostic procedures and also health promotion. Given that clinical practice involves a broad scope of health information, professional practice guidelines on information provision based on the application of the minimal risk threshold in research could be developed to guide clinicians in what information must be provided to their patients. PMID:26108215

  12. Advances in website information resources to aid in clinical practice.

    PubMed

    Rioth, Matthew J; Osterman, Travis J; Warner, Jeremy L

    2015-01-01

    The World Wide Web, which has been widely implemented for roughly two decades, is humankind's most impressive effort to aggregate and organize knowledge to date. The medical community was slower to embrace the Internet than others, but the majority of clinicians now use it as part of their everyday practice. For the practicing oncologist, there is a daunting quantity of information to master. For example, a new article relating to cancer is added to the MEDLINE database approximately every 3 minutes. Fortunately, Internet resources can help organize the deluge of information into useful knowledge. This manuscript provides an overview of resources related to general medicine, oncology, and social media that will be of practical use to the practicing oncologist. It is clear from the vast size of the Internet that we are all life-long learners, and the challenge is to acquire "just-in-time" information so that we can provide the best possible care to our patients. The resources that we have presented in this article should help the practicing oncologist continue along the path of transforming information to knowledge to wisdom. PMID:25993230

  13. [Antimicrobial activity of cefodizime against clinical isolates].

    PubMed

    Suzuki, Y; Ishihara, R; Ishii, Y; Nakazawa, A; Deguchi, K; Matsumoto, Y; Nishinari, C; Nakane, Y; Fukumoto, T

    1996-10-01

    In order to evaluate antimicrobial activity of cefodizime (CDZM), minimum inhibitory concentrations (MICs) of CDZM and control drugs were determined against clinical isolates collected from nation-wide medical institutions and in our laboratory from September to December of 1992 and from September to December of 1995. The results are summarized as follows: 1. Bacterial species with no or few strains resistant to CDZM included Streptococcus pyogenes, Haemophilus influenzae, Citrobacter koseri, Proteus mirabilis and Neisseria gonorrhoeae. The range of MIC values of CDZM against Klebsiella pneumoniae was spread. Other strains, Streptococcus pneumoniae, Moraxella subgenus Branhamella catarrhalis, Escherichia coli, Citrobacter freundii, Enterobacter spp., Serratia marcescens, Proteus vulgaris, Morganella morganii, Providencia spp., Peptostreptococcus spp. and Bacteroides fragilis group were resistant to cephems including CDZM. 2. The MIC90's of CDZM were 0.05 approximately 3.13 micrograms/ml against Streptococcus spp., H. influenzae, M. (B.) catarrhalis, E. coli, Klebsiella spp., P. mirabilis, N. gonorrhoeae and Peptostreptococcus spp. obtained in 1995 that were frequently found in daily treatment of infections. It appears that the effectiveness of CDZM was still relatively high against community-acquired infections. 3. Among H. influenzae isolates included imipenem (IPM)-resistant and norfloxacin (NFLX)-resistant strains. The MIC-range of CDZM against strains collected in 1995 including IPM-resistant and NFLX-resistant strains was < or = 0.025 approximately 0.1 microgram/ml, and MIC90 against these strains was 0.05 microgram/ml. CDZM showed strong antimicrobial activities against H. influenzae strains resistant to carbapenems and new-quinolones. PMID:8986558

  14. Inertia based functional scoring of the shoulder in clinical practice.

    PubMed

    Körver, R J P; Heyligers, I C; Samijo, S K; Grimm, B

    2014-02-01

    Shoulder-related dysfunction is the second most common musculoskeletal disorder and is responsible for an increasing burden on health-care systems. Commonly used clinical outcome scores suffer from subjectivity, pain dominance and a ceiling effect. Objective functional measurement has been identified as a relevant issue in clinical rehabilitation. In recognition of this goal simple techniques for routine clinical application have been investigated with some success. Inertia based motion analysis (IMA) is a new generation of objective outcome assessment tool; it can produce objective movement parameters while being fast, cheap and easy to operate. This study investigates if a simple IMA shoulder test is suitable as a functional outcome measure for routine clinical follow-up. We measured 100 healthy subjects and 50 patients with confirmed unilateral shoulder pathology. Two motion tasks were performed on both shoulders and two simple motion parameters based on angular rate and acceleration were calculated. Patients were also assessed by the disability of arm, shoulder and hand (DASH) and the simple shoulder test. IMA produced high intra- (ICC = 0.94) and inter-assessor reliability (ICC = 0.90). Asymmetry was >3 times higher in patients than in healthy controls (p < 0.01). Healthy and pathological subjects could be distinguished with high diagnostic sensitivity (>84.0%) and specificity (>81.0%). There was a weak correlation between the IMA shoulder score and the clinical questionnaires (Pearson R < 0.25), as it may add an objective functional dimension to outcome assessment. The fast assessment (t < 5 min) of a simple motion task makes it workable for routine clinical follow-up. The IMA shoulder test adds objective information on functional capacity to the clinical scores and may help the physician in his decision-making, follow-up of treatment, effect of training and possibly lead to the development of new therapeutic interventions. PMID:24398361

  15. 77 FR 49448 - Food and Drug Administration Clinical Trial Requirements, Compliance, and Good Clinical Practice...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-16

    ... HUMAN SERVICES Food and Drug Administration Food and Drug Administration Clinical Trial Requirements... public workshop on FDA's clinical trial requirements is designed to aid the clinical research... interaction with FDA representatives. The program will focus on the relationships among FDA and clinical...

  16. "Clinical" Significance: "Clinical" Significance and "Practical" Significance are NOT the Same Things

    ERIC Educational Resources Information Center

    Peterson, Lisa S.

    2008-01-01

    Clinical significance is an important concept in research, particularly in education and the social sciences. The present article first compares clinical significance to other measures of "significance" in statistics. The major methods used to determine clinical significance are explained and the strengths and weaknesses of clinical significance…

  17. Reconciling Multiple Hypertension Guidelines to Promote Effective Clinical Practice.

    PubMed

    Salvo, Marissa; White, C Michael

    2014-06-20

    The new Joint National Committee 8 (JNC-8) blood pressure guidelines were recently published, and there are some major changes from JNC-7. There are also differences between JNC-8 and hypertension guidelines created by major organizations in North America and around the world published from 2013 to the present. In the face of conflicting evidence, it is difficult for practicing clinicians to reconcile these differences and to incorporate new guidance into their practice. This commentary will identify similarities and differences between guidelines, provide some literature context in the areas of differing recommendations, and then provide advice to enhance patient care. PMID:24951309

  18. Reiki as a clinical intervention in oncology nursing practice.

    PubMed

    Bossi, Larraine M; Ott, Mary Jane; DeCristofaro, Susan

    2008-06-01

    Oncology nurses and their patients are frequently on the cutting edge of new therapies and interventions that support coping, health, and healing. Reiki is a practice that is requested with increasing frequency, is easy to learn, does not require expensive equipment, and in preliminary research, elicits a relaxation response and helps patients to feel more peaceful and experience less pain. Those who practice Reiki report that it supports them in self-care and a healthy lifestyle. This article will describe the process of Reiki, review current literature, present vignettes of patient responses to the intervention, and make recommendations for future study. PMID:18515247

  19. The discovery of rivaroxaban: translating preclinical assessments into clinical practice

    PubMed Central

    Kubitza, Dagmar; Perzborn, Elisabeth; Berkowitz, Scott D.

    2013-01-01

    Direct oral anticoagulants that target a single coagulation factor (such as factor Xa or thrombin) have been developed in recent years in an attempt to address some of the limitations of traditional anticoagulants. Rivaroxaban is an oral, direct factor Xa inhibitor that inhibits free and clot-bound factor Xa and factor Xa in the prothrombinase complex. Preclinical studies demonstrated a potent anticoagulant effect of rivaroxaban in plasma as well as the ability of this agent to prevent and treat venous and arterial thrombosis in animal models. These studies led to an extensive phase I clinical development program that investigated the pharmacological properties of rivaroxaban in humans. In these studies, rivaroxaban was shown to exhibit predictable pharmacokinetics and pharmacodynamics and to have no clinically relevant interactions with many commonly prescribed co-medications. The pharmacodynamic effects of rivaroxaban (for example, inhibition of factor Xa and prolongation of prothrombin time) were closely correlated with rivaroxaban concentrations in plasma. The encouraging findings from preclinical and early clinical studies were expanded upon in large, randomized phase III studies, which demonstrated the clinical efficacy and safety of rivaroxaban in a broad spectrum of patients. This article provides an overview of the discovery and development of rivaroxaban, describing the pharmacodynamic profile established in preclinical studies and the optimal translation to clinical studies in healthy subjects and patient populations. PMID:24324436

  20. Clinical Practice Guidelines and Consensus Statements in Oncology – An Assessment of Their Methodological Quality

    PubMed Central

    Jacobs, Carmel; Graham, Ian D.; Makarski, Julie; Chassé, Michaël; Fergusson, Dean; Hutton, Brian; Clemons, Mark

    2014-01-01

    Background Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine’s standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. Findings Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice guidelines. One journal

  1. Nutrition Informatics Applications in Clinical Practice: a Systematic Review

    PubMed Central

    North, Jennifer C.; Jordan, Kristine C.; Metos, Julie; Hurdle, John F.

    2015-01-01

    Nutrition care and metabolic control contribute to clinical patient outcomes. Biomedical informatics applications represent a way to potentially improve quality and efficiency of nutrition management. We performed a systematic literature review to identify clinical decision support and computerized provider order entry systems used to manage nutrition care. Online research databases were searched using a specific set of keywords. Additionally, bibliographies were referenced for supplemental citations. Four independent reviewers selected sixteen studies out of 364 for review. These papers described adult and neonatal nutrition support applications, blood glucose management applications, and other nutrition applications. Overall, results indicated that computerized interventions could contribute to improved patient outcomes and provider performance. Specifically, computer systems in the clinical setting improved nutrient delivery, rates of malnutrition, weight loss, blood glucose values, clinician efficiency, and error rates. In conclusion, further investigation of informatics applications on nutritional and performance outcomes utilizing rigorous study designs is recommended. PMID:26958233

  2. Promoting Good Clinical Laboratory Practices and Laboratory Accreditation to Support Clinical Trials in Sub-Saharan Africa

    PubMed Central

    Shott, Joseph P.; Saye, Renion; Diakité, Moussa L.; Sanogo, Sintry; Dembele, Moussa B.; Keita, Sekouba; Nagel, Mary C.; Ellis, Ruth D.; Aebig, Joan A.; Diallo, Dapa A.; Doumbo, Ogobara K.

    2012-01-01

    Laboratory capacity in the developing world frequently lacks quality management systems (QMS) such as good clinical laboratory practices, proper safety precautions, and adequate facilities; impacting the ability to conduct biomedical research where it is needed most. As the regulatory climate changes globally, higher quality laboratory support is needed to protect study volunteers and to accurately assess biological parameters. The University of Bamako and its partners have undertaken a comprehensive QMS plan to improve quality and productivity using the Clinical and Laboratory Standards Institute standards and guidelines. The clinical laboratory passed the College of American Pathologists inspection in April 2010, and received full accreditation in June 2010. Our efforts to implement high-quality standards have been valuable for evaluating safety and immunogenicity of malaria vaccine candidates in Mali. Other disease-specific research groups in resource-limited settings may benefit by incorporating similar training initiatives, QMS methods, and continual improvement practices to ensure best practices. PMID:22492138

  3. Evidence-Based Practice for Outpatient Clinical Teams

    ERIC Educational Resources Information Center

    Hamilton, John D.

    2006-01-01

    This column focuses on evidence-based practice (EBP) within multidisciplinary outpatient settings, but first provides some definitions. Besides EBP (Burns and Hoagwood, 2005; Guyatt and Rennie, 2002), there are also evidence-based medicine (EBM; March et al., 2005), evidence-based service (EBS; Chorpita et al., 2002), and evidence-based treatment…

  4. Best Practices in Assessment for School and Clinical Settings.

    ERIC Educational Resources Information Center

    Vance, H. Booney, Ed.

    This book is designed to provide insight into the ways in which psychologists conduct psychoeducational assessments in a variety of settings. Each contributed chapter gives a detailed and practical discussion of a particular assessment instrument or strategy along with a detailed case study. Chapters have the following titles and authors:…

  5. Questions about Certainty and Uncertainty in Clinical Practice

    ERIC Educational Resources Information Center

    Nelson, Nickola Wolf

    2011-01-01

    Purpose: This article offers a critical response to Kamhi's (2011) essay regarding the need to balance certainty and uncertainty in evidence-based practice (EBP). Method: Points of concordance and discordance (counterpoints) between Kamhi's essay and the author's frames of reference were considered. Results: In agreement with Kamhi, a major role…

  6. Benchmarking clinical practice in surgery: looking beyond traditional mortality rates.

    PubMed

    Castro, Ricardo A S; Oliveira, Pedro N; Silva Portela, Conceição; Camanho, Ana S; Queiroz e Melo, João

    2015-12-01

    This paper proposes two new measures to assess performance of surgical practice based on observed mortality: reliability, measured as the area under the ROC curve and a living score, the sum of individual risk among surviving patients, divided by the total number of patients. A Monte Carlo simulation of surgeons' practice was used for conceptual validation and an analysis of a real-world hospital department was used for managerial validation. We modelled surgical practice as a bivariate distribution function of risk and final state. We sampled 250 distributions, varying the maximum risk each surgeon faced, the distribution of risk among dead patients, the mortality rate and the number of surgeries performed yearly. We applied the measures developed to a Portuguese cardiothoracic department. We found that the joint use of the reliability and living score measures overcomes the limitations of risk adjusted mortality rates, as it enables a different valuation of deaths, according to their risk levels. Reliability favours surgeons with casualties, predominantly, in high values of risk and penalizes surgeons with deaths in relatively low levels of risk. The living score is positively influenced by the maximum risk for which a surgeon yields surviving patients. These measures enable a deeper understanding of surgical practice and, as risk adjusted mortality rates, they rely only on mortality and risk scores data. The case study revealed that the performance of the department analysed could be improved with enhanced policies of risk management, involving the assignment of surgeries based on surgeon's reliability and living score. PMID:24633958

  7. Typologies of Cohabitation: Implications for Clinical Practice and Research

    ERIC Educational Resources Information Center

    Gold, Joshua M.

    2012-01-01

    This article will explore the current evolution in the practice of cohabitation. The intent of this literature- and web-based article is to acquaint counselors with three typologies of cohabitation. These categories can be utilized in the development of psychoeducational and remedial interventions and in the identification of areas of future…

  8. Reconciling Paternalism and Empowerment in Clinical Practice: An Intersubjective Perspective

    ERIC Educational Resources Information Center

    Bransford, Cassandra L.

    2011-01-01

    The focus of this article is on illustrating how the differences between the paternalistic and empowerment approaches embedded within social work have unnecessarily evolved into competing approaches to practice. Tracing the historical evolution of both paternalistic and empowerment approaches, the article posits that social work is more amenable…

  9. Curing Student Underachievement: Clinical Practice for School Leaders

    ERIC Educational Resources Information Center

    Esbrandt, Philip; Hayes, Bruce

    2011-01-01

    "Cure Student Underachievement" is the culmination of the authors' research, practice, and experience as principals, superintendents, graduate professors, and consultants in efforts to improve school performance and increase student achievement. Searching for the real causes of underperformance, the authors explored problem-solving strategies in…

  10. Incorporating Computer-Aided Language Sample Analysis into Clinical Practice

    ERIC Educational Resources Information Center

    Price, Lisa Hammett; Hendricks, Sean; Cook, Colleen

    2010-01-01

    Purpose: During the evaluation of language abilities, the needs of the child are best served when multiple types and sources of data are included in the evaluation process. Current educational policies and practice guidelines further dictate the use of authentic assessment data to inform diagnosis and treatment planning. Language sampling and…

  11. School based oral health promotional intervention: Effect on knowledge, practices and clinical oral health related parameters

    PubMed Central

    Gauba, Arjun; Bal, Ikreet Singh; Jain, Ashish; Mittal, Hitesh Chander

    2013-01-01

    Background: No organized school oral health program is existent in India. Aim: The aim of this study is to test the feasibility and efficacy of an economical school oral health promotional intervention with educational and preventive components. Settings and Design: School oral health promotional intervention carried out in one of the randomly selected school and evaluated through short duration prospective model. Materials and Methods: A total of 100 children with an age range of 10-12 years with no previous history of dental intervention were enrolled. Interventions comprised of oral health education (delivered through lecture and demonstrations by an undergraduate dental student) and topical antibacterial therapy (fluoride varnish and povidone iodine). Outcomes consisted of Knowledge and practices (KAP) regarding oral health, clinical oral health related parameters such as plaque index (PI), gingival index (GI) and caries activity as per Modified Snyder's test. These were reported at baseline, 3 weeks and 6 months follow-up examination by a calibrated examiner. Statistical Analysis: McNemar Bowker's test, Student's t-test, Pearson Chi-square tests were used. Results: Highly significant (P < 0.001) improvements in KAP scores, PI scores, GI scores and caries activity were reported at 3 weeks and 6 months follow-up examination. Conclusion: This small economical school oral health program positively influenced oral health related practices and parameters of oral health such as oral cleanliness, gingival health and caries activity. PMID:24403795

  12. Use of Polypodium leucotomas Extract in Clinical Practice

    PubMed Central

    2016-01-01

    Polypodium leucotomas extract is a natural product derived from a tropical fern that is available as an over-the-counter product in the United States and several other countries. A designated brand of oral Polypodium leucotomas extract has been shown in several research studies to exhibit a variety of antioxidant and photoprotective properties. Clinical research with this same formulation of Polypodium leucotomas extract has demonstrated multiple potential therapeutic applications. This article provides a thorough overview of research completed with Polypodium leucotomas extract and outlines suggested approaches for clinical use. PMID:27386044

  13. Immediate implant therapy in clinical practice: single-tooth replacement.

    PubMed

    Fugazzotto, Paul A; Baker, Richard; Lightfoot, Scott

    2007-01-01

    Once viewed as an esoteric treatment option, implant therapy has demonstrated long-term predictability at least equal to that of more "conventional" treatment modalities. The continued evolution of implant surface technology and restorative options has made implant therapy the treatment modality of choice in many if not most, clinical situations. It is, therefore, only natural that the role of immediate implant therapy continues to expand. Proponents of immediate implant therapy advocate its use at the time of tooth removal or, in a partially or fully edentulous arch, to meet a variety of clinical challenges. PMID:18069591

  14. Low-power coherent and noncoherent light in clinical practice

    NASA Astrophysics Data System (ADS)

    Antipa, Ciprian; Pascu, Mihail-Lucian; Stanciulescu, Viorica; Mayerzedt, Claudia; Vlaiculescu, Mihaela

    1996-11-01

    In order to find out the comparative clinical effects of coherent and noncoherent low power light, we divided 74 patients with sciatics in three groups, treated with the same energy dose, as follows: A group: with IR continuous diode laser; B group: with noncoherent IR diode; C group: with placebo laser. The positive results were 66.66 percent for A group, 52.00 percent for B group and 36.36 percent for C group. We conclude, after these preliminary results, that coherent low power light has superior clinical efficacy versus noncoherent light and placebo laser, when used the same energy dose.

  15. Geographic Variations in Elementary School-Based Physical Activity Practices

    ERIC Educational Resources Information Center

    Turner, Lindsey; Chaloupka, Frank J.; Slater, Sandy J.

    2012-01-01

    Background: Physical activity (PA) is associated with health and academic benefits among children, but many schools do not meet national recommendations. This study examined school-based PA practices in nationally representative samples of public elementary schools, and geographic variations in those practices. Methods: Mail-back surveys were used…

  16. Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

    PubMed Central

    Koh, Serena SL; Manias, Elizabeth; Hutchinson, Alison M; Donath, Susan; Johnston, Linda

    2008-01-01

    Background Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore. Methods Nurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, 'Barriers and facilitators assessment instrument', was administered to nurses (n = 1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore. Results An 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and, education of staff and patients. Conclusion Numerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings. PMID:18485235

  17. Best practices in nursing homes. Clinical supervision, management, and human resource practices.

    PubMed

    Dellefield, Mary Ellen

    2008-07-01

    Human resource practices including supervision and management are associated with organizational performance. Evidence supportive of such an association in nursing homes is found in the results of numerous research studies conducted during the past 17 years. In this article, best practices related to this topic have been culled from descriptive, explanatory, and intervention studies in a range of interdisciplinary research journals published between 1990 and 2007. Identified best practices include implementation of training programs on supervision and management for licensed nurses, certified nursing assistant job enrichment programs, implementation of consistent nursing assignments, and the use of electronic documentation. Organizational barriers and facilitators of these best practices are described. PMID:20077964

  18. Smartphone Applications for the Clinical Oncologist in UK Practice.

    PubMed

    Rozati, Hamoun; Shah, Sonya Pratik; Shah, Neha

    2015-06-01

    A number of medical smartphone applications have been developed to assist clinical oncology specialists. Concerns have arisen that the information provided may not be under sufficient scrutiny. This study aims to analyse the current applications available for clinical oncologists in the UK. Applications aimed specifically at physician clinical oncologists were searched for on the major smartphone operating systems: Apple iOS; Google Android; Microsoft Windows OS; and Blackberry OS. All applications were installed and analysed. The applications were scrutinised to assess the following information: cost; whether the information included was referenced; when the information was last updated; and whether they made any reference to UK guidelines. A novel rating score based on these criteria was applied to each application. Fifty applications were identified: 24 for Apple's iOS; 23 for Google's Android; 2 for Blackberry OS; and 1 for Windows OS. The categories of applications available were: drug reference; journal reference; learning; clinical calculators; decision support; guidelines; and dictionaries. Journal reference and guideline applications scored highly on our rating system. Drug reference application costs were prohibitive. Learning tools were poorly referenced and not up-to-date. Smartphones provide easy access to information. There are numerous applications devoted to oncology physicians, many of which are free and contain referenced, up-to-date data. The cost and quality of drug reference and learning applications have significant scope for improvement. A regulatory body is needed to ensure the presence of peer-reviewed, validated applications to ensure their reliability. PMID:24903139

  19. Coherent and noncoherent low-power diodes in clinical practice

    NASA Astrophysics Data System (ADS)

    Antipa, Ciprian; Pascu, Mihail-Lucian; Stanciulescu, Viorica; Vlaiculescu, Mihaela; Ionescu, Elena; Bordea, Daniel

    1997-05-01

    Clinical efficacy of the low power laser (LPL) in medical treatments is still not well established. In a double blind, placebo controlled study, we tried to find out first which type of LPL is more efficient, and second if coherence is an important character for clinical efficacy. We treated 1228 patients having different rheumatic diseases, with low power diode, used as follows: A group: IR coherent diode, continuous emission, 3 mW power; B group: IR coherent diode, pulsed emission, output power about 3 mW; C group: IR noncoherent diode continuous emission 9 mW power; D group: both IR diode lasers (continuous or pulsed) and HeNe laser, continuous emission, 2 mW power; E group: placebo laser as control group. The energy dose used for every group was the same, as well as the clinical protocols. The positive results were: 66.16% for A group; 64.06% for B group; 48.87% for C group; 76.66% for D group, and 39.07% for E group. Finally, we showed that LPL is really efficient in the treatment of some rheumatic diseases, especially when red and IR diode laser were used in combination. The type of emission (continuous or pulsed) is not important, but coherence is obviously necessary for clinical efficacy.

  20. Family Empowerment Intervention: Conceptual Foundations and Clinical Practices.

    ERIC Educational Resources Information Center

    Dembo, Richard; Dudell, Gary; Livingston, Stephen; Schmeidler, James

    2001-01-01

    Presents a detailed overview of the Family Empowerment Intervention (FEI), a system-oriented intervention delivered in-home by well-trained nontherapists. A clinical trial of FEI targeted arrested youths and their families. Topics covered included: theoretical foundations and goals of FEI, structural intervention strategies, and phases of the…